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Pu Mingzi stated: Luoli (scrofula, cervical lymph node tuberculosis) is a disease of the Liver. The Liver governs the sinews. If there is blood dryness and internal fire in the Liver meridian, it leads to sinew tension and the formation of Luoli. Luoli often occurs around the ears because this area belongs to the Gallbladder region, and the Gallbladder and Liver are exterior-interiorly related. In the initial stage, Xiaoluo Wan should be used to dissipate the nodules; one must not use knives or needles, nor apply medications that cause ulceration. If the disease has been prolonged and already ulcerated, one should apply Puji Wanquan Gao externally and take Xiaoluo Wan and Xiaoyao San internally, which will invariably lead to recovery. Furthermore, one must abstain from anger and avoid fried foods and items that obstruct Qi flow, to prevent continuous discharge of pus and gradual progression into deficiency consumptive disease. How can those suffering from this illness fail to take heed?

(Newly collected) Xiaoluo Wan.
This formula yields miraculous results, with countless cures. I have also had it printed and distributed widely.
Shenxuan (Prepared Scrophulariae Radix), Muli (Calcined Oyster Shell), Beimu (Prepared Fritillariae Bulbus), each four liang.
Grind into fine powder, form pills with refined honey. Take three qian per dose, washed down with boiled water, once daily.

My commentary: Pu Mingzi authored "Yixue Xinwu" (Heart Mirror of Medicine), but did not include this formula's base version, and other prescriptions rarely yield efficacy. Only this formula, though seemingly plain, is miraculously effective and should be cherished by all. However, the area around the ears and back of the head is actually governed by the Shaoyang meridian. (Pu Mingzi claimed it was the Liver's domain, which is incorrect; thus, I correct it here.)

The *Neijing* states: "Deficiency in the upper part causes vertigo." It also says: "Kidney deficiency leads to swaying of the head; insufficiency of the Marrow Sea causes dizziness and tinnitus." All these refer to deficiency. Zhang Zhongjing discusses vertigo primarily in terms of Phlegm-Fluid retention. Zhu Danxi followed Liu Hejian's theory, stating that without Phlegm there is no vertigo, and without Fire there is no dizziness; these refer to excess conditions. Why are the views of ancient sages and later worthies so contradictory? One must understand that this condition is inseparable from the Liver. As the *Jing* says: "All wind-induced tremors and vertigo belong to the Liver." This "wind" does not refer to external pathogenic wind, but rather to Jueyin Wind-Wood qi. Jueyin Wind-Wood resides together with Shaoyang Ministerial Fire. When Jueyin Qi rebels upward, wind generates and fire erupts; hence, Liu Hejian established his theory on Wind-Fire. When wind generates, it inevitably carries Wood energy to overcome Earth (Spleen/Stomach). Spleen pathology leads to fluid accumulation forming Phlegm; thus, Zhang Zhongjing established his theory on Phlegm-Fluid, and Zhu Danxi on Phlegm-Fire. However, where pathogens gather in the body, that is precisely where deficiency exists. The head is the meeting point of all Yang meridians; for Ministerial Fire to reverse and ascend, it must be due to Upper Jiao deficiency. The Kidney is the Mother of the Liver; the Kidney stores Essence. Insufficient Essence leads to an empty Marrow Sea and heavy head. Thus, the *Neijing* establishes its theory on Upper Deficiency, Kidney Deficiency, and Marrow Sea insufficiency. Speaking of "deficiency" refers to the root cause of the disease.

Rapid pulse indicates heat excess; choppy pulse indicates blood deficiency. Wiry pulse indicates Liver Wind; slippery and solid pulse indicates Phlegm-Turbidity. Deficient and small pulse indicates Qi deficiency; large pulse indicates disease progression.

For vertigo with wiry pulse, fever, or alternating chills and fever, Xiaoyao San is appropriate, added with Banxia, Tianma, and Gouteng as the main treatment. (48)

For vertigo with rapid or slippery-solid pulse, constipation, chest and hypochondriac pain, deafness, tinnitus, and irritability, indicating Liver Meridian Excess Fire, Danggui Lurve Wan is appropriate. This method was derived from Yu Jiayan's case study in *Yuyi Cao* regarding the mother of Wu Tiangong.

For vertigo with choppy pulse, indicating insufficiency of Essence and Qi, aiming to nourish the upper part and irrigate the ear roots, Liujun Dihuang Tang is appropriate. Double the dosage of Dihuang, remove Danpi and Zexie, add Xixin and Zhigancao (each 1 qian), Chuanxiong (2 qian), Gouqizi (3 qian), and Roushouling.

For deficient, thin, small, and weak pulse, indicating Qi deficiency, Buzhong Yiqi Tang is appropriate, added with Tianma, Banxia, and Gouteng. (5)

For wiry and slippery pulse with vertigo and vomiting, indicating Phlegm-Fluid, Zexie (4 qian) and Baizhu (2 qian) decocted in water is appropriate. Or use Erchen Tang, added with Tianma and Banxia.

For unbearable severe excess Fire vertigo, Dahuang stir-fried three times in wine and ground into powder, taken with tea (2-3 qian), is appropriate.

For deficiency-type vertigo unresponsive to other medicines, Lurong (Deer Antler) 5 qian, decocted in wine, filtered, with a small amount of Shexiang (Musk) added, is appropriate. This is based on the principle of similarity, as Deer Antler grows on the head.

For severe deficiency vertigo unresponsive to various medicines, and for post-illness conditioning in deficient individuals, Zhengyuan Dan is appropriate. (20)

Guifu Bawei Wan. (15)