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In the chapter "Cold and Heat" of the *Suwen* (Basic Questions), the Yellow Emperor asked: What qi causes cold-heat scrofula (scrofula characterized by alternating chills and fever) appearing in the neck and axilla? Qibo replied: These are all toxic vapors of mouse-scrofula cold-heat, lingering in the meridians without departing. The root of mouse-scrofula lies within the zang organs, while its branches manifest upward between the neck and axilla. If the pathogen floats within the vessels but has not yet penetrated into the muscles nor externally transformed into pus and blood, it is easy to treat. The Yellow Emperor asked: How should it be removed? Qibo said: Please address the root and guide the branch; this can cause the pathogenic factors to decline and cut off the cold-heat. Treat along the meridian pathways, inserting the needle slowly and withdrawing it slowly to expel the pathogen. If the nodule is small like a wheat grain, one acupuncture session brings improvement, and three sessions result in cure. The Yellow Emperor asked: How to determine life and death prognosis? Qibo said: Observe the eyes. If red vessels penetrate vertically through the pupil, seeing one red vessel indicates death in one year; one and a half vessels indicates death in one and a half years; two vessels indicate death in two years; two and a half vessels indicate death in two and a half years; three vessels indicate death in three years. If the red vessels do not extend downward to penetrate the pupil, the condition is treatable.

The *Waitai Miyao* states: Deficient heat in the Liver and Kidney generates scrofula.
The *Bingji* (Pathogenesis) states: Scrofula is not caused by changes from rich foods, cinnabar/stone drugs, or fire-heat toxins, but is generally due to deficiency labor (chronic depletion) and qi stagnation. It should only be treated with herbs that tonify qi and nourish the nutritive level (ying); the sores will subside naturally without needing sweating or purging methods.

Zhu Danxi stated: Scrofula invariably originates in the Foot-Shaoyang Gallbladder Meridian. If taboos are not observed, it spreads to the Foot-Yangming Stomach Meridian. Rich flavors and long-standing qi stagnation create toxicity, wind, and heat. These three factors interact and transform; one must distinguish excess from deficiency. Excess patterns are easier to treat, while deficiency patterns are concerning. This meridian governs decision-making and contains ministerial fire; it has abundant qi but scarce blood. In women, if menstruation is irregular and cold-heat variations arise, progressing over time to tidal fever, unless sexual abstinence and a bland diet are maintained, even divine physicians cannot cure it.
He also stated: For moxibustion treatment of scrofula, select one point at the junction of the acromion and olecranon fossae on each side (specifically Jianyu [LI15] and Quchi [LI11] of the Hand-Yangming Large Intestine Meridian). Moxa seven cones on each point. Treat the left side for left-sided lesions, the right for right-sided lesions, and both if bilateral. I have used this method frequently with great efficacy. (Xue Lizhai considered the selection of Quchi alone inaccurate.)
Xue Lizhai stated: For men and women whose scrofula fails to heal due to anger injuring the Liver and causing qi-blood stagnation, moxibustion at these points is suitable to unblock the meridians. To locate these points, press the four affected areas (both elbows and both shoulders) with fingernails until a sour-numb sensation is felt; this confirms the correct point. This is a secret method for treating scrofula.

Dai Fu'an stated: Scrofula involves qi-blood congestion and knotting, rooted in the zang organs, often clustering in the neck region. The nodules vary in size and number, accompanied by chills and fever during flare-ups, with pus and blood discharging from ulcers. As one subsides, another arises.

Wang Kentang stated: A single-nest scrofula refers to a solitary nodule. Those arising in the neck are difficult to treat; those arising at the fontanelle are also difficult. Treat with toxic herbs, preventing prolonged maceration. (*Zhunsheng*)
He further stated: Lotus-seed scrofula consists of a sac containing dozens of nodules, located on either side of the neck. If movable upon touch, it remains treatable with medicine. If hard and immovable, it is incurable. Accompanied by aversion to cold, fever, restlessness, and thirst, such cases are extremely difficult to treat; even divine physicians are helpless.
He also described Double-Terrace scrofula: Arising in the neck, unilateral or bilateral, starting as a single nest above or below, appearing in overlapping layers. This condition resists herbal and acupuncture treatment. If toxicity spreads causing swelling, pain, fever, thirst, and phlegm, mortality is high, and the disease progresses rapidly. Upon initial suspicion, immediately administer Xiaoxijiao Wan (Small Rhinoceros Horn Pill) or Fenjin San (Powdered Gold Powder).
He also mentioned Swallow-Nest scrofula: Shaped like a swallow's nest, it is untreatable.

Chen Yuangong stated: Phlegm nodules in the neck, hard as stone, may transform into scrofula over time, discharging pus and blood. As one mass resolves, another grows, eventually ulcerating. Locations include under the ear, supraclavicular fossa, or shoulder/rib area, exhibiting a wandering pattern, hence named Mouse-Cancer or Wandering-Sore, resembling rat burrows. Some attribute this to consuming food stolen by rats, but this is not entirely accurate. This condition largely stems from phlegm, which arises from stagnation. Without stagnation, there is no phlegm; without phlegm, there is no scrofula. Therefore, treatment must prioritize resolving stagnation. However, prolonged stagnation consumes qi and blood, and discharge of pus/blood further depletes them. Eliminating phlegm without resolving stagnation, or resolving stagnation without eliminating phlegm, both exacerbate deficiency. Xiao Chuan Dan (Eliminate Wandering Pill): Baishao (Radix Paeoniae Alba) 30g, Baizhu (Rhizoma Atractylodis Macrocephalae) 30g, Chaihu (Radix Bupleuri) 6g, Pugongying (Herba Taraxaci) 9g, Fuling (Sclerotium Poriae Cocos) 15g, Chenpi (Pericarpium Citri Reticulatae) 3g, Fuzi (Radix Aconiti Lateralis Preparata) 1 slice, Gancao (Radix Glycyrrhizae Uralensis) 3g, Tianhuafen (Radix Trichosanthis) 9g, Zi Bei Tian Kui (Tubera Typhonii Flagelliformis) 15g. Decoct in water. After eight doses, phlegm nodules gradually subside; after ten more doses, they dissolve completely; full recovery occurs after one month. Post-recovery, take Liujunzi Tang (Six Gentlemen Decoction) for consolidation to prevent recurrence. The efficacy of this formula lies in Pugongying and Tiankui as supreme agents for dissolving wandering knots, supported by Chaihu and Baishao to soothe the Liver, and Fuling and Baizhu to strengthen the Spleen/Stomach. With Fuzi guiding the herbs to the center, old phlegm is cleared rapidly. (*Shishi Milu*)
He also stated: Chronic scrofula involving extensive necrosis of the neck extending to the chest/diaphragm, accompanied by systemic fever/chills, emaciation, anorexia, spontaneous/night sweats, palpitations, and mental confusion, is inherently difficult but curable with proper method. Initial treatment should prioritize resolving stagnation and tonifying deficiency to dissipate toxicity. Adhering to standard phlegm-resolving and detoxifying methods accelerates death. Zhuanbai Dan (Transform Failure Pill): Ren Shen (Radix Ginseng) 60g, Chaihu 6g, Baishao 9g, Jinyinhua (Flos Lonicerae Japonicae) 90g, Danggui (Radix Angelicae Sinensis) 60g, Banxia (Rhizoma Pinelliae Preparata) 15g, Baizhu 30g, Sheng Gancao (Raw Radix Glycyrrhizae) 9g. Decoct in water. After four doses, chest phlegm clears; after four more, neck ulcers heal. Reduce dosage by half and continue for ten doses to flatten scars and prevent recurrence. This formula emphasizes tonification over elimination, embedding stagnation resolution within phlegm transformation. Unknowingly, many fail because they rely solely on aggressive detoxification. This divine prescription is often ridiculed but is truly a miracle drug. I sigh deeply upon closing the book.

Chen Shigong stated: Scrofula differs in Wind-Toxicity, Heat-Toxicity, and Qi-Toxicity; distinctions exist between Scrofula, Phlegm-Nodules, and Tendon-Ulcers. Wind-Toxicity results from external wind-cold binding meridians, presenting with initial chills then fever, tender swollen nodes; treat by dispersing wind and removing dampness. Heat-Toxicity arises from extreme summer heat affecting Yang meridians or internal accumulation from rich foods, presenting with red, slightly hot, hard nodes; treat by clearing the Spleen and draining heat. Qi-Toxicity results from seasonal epidemic pathogens affecting ears, neck, chest, axilla, causing sudden masses, chills/fever, dizziness, and stiff painful neck; treat by regulating blood and harmonizing qi. Scrofula presents as beads strung together, 3-5 connected, starting small and growing large without chills/fever, initially painless but becoming painful and hard like chess pieces or plums/peaches around the neck and axilla; caused by ingesting insect/rat remnants or contaminated water/tea, representing long-term food-toxin stagnation, hardest to resolve; treat by softening hardness and harmonizing blood. Phlegm-Nodules start plum-sized, spread over the body, turn slightly red, ulcerate easily, and heal readily; caused by dietary imbalance and emotional instability impairing Spleen transportation; treat by resolving phlegm and moving qi. Tendon-Ulcers arise between tendons on the neck side, hard like chess pieces, varying in size, sunken or protruding, leading to wasting and chills/fever, worsened by fatigue/anger; caused by worry/thoughts and anger injuring the Liver, causing tendon contraction and nodule formation; treat by clearing the Liver and resolving stagnation. (*Zhengzong*)
He also stated: Widows, nuns, widowers, and illegitimate children who suppress desires and frustrations accumulate thoughts and exhaust essence; this labor-damage is hardest to regulate. First nourish Heart blood, then open stagnation, benefit Kidney and calm spirit, soothe Liver and open diaphragm. Use Guipi Tang (Restore the Spleen Decoction) or Yiqi Yangrong Tang (Tonify Qi and Nourish Ying Decoction) plus Xiangfu (Rhizoma Cyperi Rotundi), Qingpi (Pericarpium Citri Reticulatae Viride), Zhizi (Fructus Gardeniae Jasminoidis), Beimu (Bulbus Fritillariae Cirrhosae), and Muxiang (Radix Aucklandiae).
He warned: Men should avoid symptoms like Sun-Meridian blue veins, tidal fever, cough, and sweating; women should avoid red filaments in eyes, amenorrhea, bone-steaming fever, and irritability, as these progress to consumption (tuberculosis). Avoid drastic purgatives like Badoushuang (Croton Seed Preparation), Qianniu (Seed Pharbitidis), Banmao (Mylabris), and Dahuang (Radix et Rhizoma Rhei) for erosion, as excessive attacking often leads to death. Be vigilant.
He defined Snake-Coiling Scrofula as nodules encircling the neck.
He described acute swelling in ears/neck/chest/axilla with redness, slight heat, chills/fever, and headache as an acute attack of wind-cold-summer-heat. This resolves easily; use Jingfang Baidu San (Aristolochia and Saposhnikovia Decoction to Overcome Toxicity) plus Beimu and Xiakucao (Herba Prunellae Spicatos). If ineffective, add softening and stagnation-resolving herbs.
He defined Vine-Like Scrofula as spreading from neck to chest/axilla.

Feng Luzhan stated: Persistent nodules in neck/cheeks indicate severe qi-blood deficiency; do not use attacking methods. (*Jinnang*)
He stated: Ancient names for scrofula include Nine-Leakages. Caused by yin deficiency with hyperactive fire striking gateways, combined with excessive roasted foods, wind-phlegm-heat-toxicity forming stubborn knots. Treatment should nourish yin, harmonize Liver, regulate Spleen, resolve stagnation, and clear phlegm. Avoid destructive methods that damage true yuan. Infantile cases due to fetal toxin stem from maternal Liver/Gallbladder fire/qi stagnation; treat by soothing Liver, nourishing Kidney, and transforming toxin. Although originating in Liver, the root is Kidney; Liver fire excess stems from Kidney yin insufficiency. Root is in zang, branch in neck/axilla. Floating in vessels without muscle involvement/pus is easy to treat. Red vessels piercing pupils indicate poor prognosis (death timelines as previously described). Starting as one nodule, multiplying to ten+ around neck, suppurating and failing to dry, named Leak-Neck. On chest/flanks, named Horse-Knife. Deep black ulcers eroding throat, inability to eat, bulging eyes/protruding tongue, yellow ear discharge are intractable. Sudden chills/fever with millet-like nodules on body/neck/chest/abdomen/back without pain is called Wind-Qi Swelling. Differentiate wind/fire, deficiency/excess.
He also stated: Scrofula results from heat-stagnation in Hand/Foot Shaoyang meridians. These meridians have abundant qi but scarce blood, leading to hard, non-ulcerating, spreading nodules. Yangming meridians have abundant qi/blood and ulcerate easily (commonly called Rotten Scrofula). Shaoyang-originated cases must be treated at the root; vulgar doctors wrongly use toxic herbs, worsening the condition like adding firewood to a fire, potentially causing consumption in those with weak yuan.
He noted: Xiakucao (Herba Prunellae Spicatos) dissipates stagnant qi and nourishes blood vessels, relieving chills/fever; safe for deficiency patterns. For excess patterns, combine with dispersing herbs and external moxibustion for gradual effect.
He stated: Nodules anywhere (neck, arm, body, behind ear, vertex) that are swollen but not red/painful/non-suppurating are phlegm deposits due to qi stagnation (phlegm, qi, heat). Long-standing unresolved cases become scrofula; treat early. Generally caused by emotional stagnation or anger during meals, most common in women. Treat by opening stagnation, smoothing qi, benefiting diaphragm, resolving phlegm, and clearing Lung. Underlying cause is often yin deficiency with fire-wang leading to consumption roots; thus, supplementing yin is essential.

Zhou Wencai stated: Nodules meeting at head/neck junction are Snake-Coiling Scrofula. Treat early. (*Qixuan*)
Li Dongyuan stated: Scrofula nodules with chills/fever/thirst persisting long, with sallow complexion and tidal fever steaming upward, indicate suppuration. (*Dongyuan Shishu*)
Shen Douyuan stated: Nine-Leakages include Wild Wolf Leakage (root Liver, from unfulfilled desires/anger), Mouse Leakage (root Stomach, from eating rat scraps/toxin spreading to Liver), Pus Leakage (root Gallbladder, from thwarted will), Mole Cricket Leakage (root Large Intestine, from eating mole crickets/scorpions), Bee Leakage (root Spleen, from honey/bees), Centipede Leakage (root Lung, from centipede contact), Caterpillar Leakage (root Heart, from excessive joy), Scrofula Leakage (root Kidney, from blood/hair/kidney ingestion), Pulse-Turning Leakage (root Small Intestine, from fright/sleeping on pillow improperly). Hence the term Nine-Leakages.

Dou Hanqing stated: Solitary nodules are termed Knots; connected chains are Scrofula. Not caused by rich food, but deficiency labor and qi stagnation. Use Qi-Yi Yang-Rong agents; avoid harsh mineral/drug therapies that damage qi-blood.
He added: After ulceration, use Shiquan Dabu Tang (Ten Great Tonifying Decoction) plus Beimu, Xiangfu, Yuanzhi.

Wang Shengzhi stated: For early scrofula, press with a four-cornered iron ring, puncture one hole, insert paper wick to cauterize/prevent closure, cutting off the source for rapid effect. (*Lili*)
Hu Gongbi stated: Scrofula are hard neck nodules in front/behind/below ears, related to Hand/Foot Shaoyang meridians (abundant qi, scarce blood). Initially bean-sized, painless; later grow to plum/peach size, painful, with dizziness, limb pain/swelling, alternating chills/fever like malaria. Text mentions Phlegm-Nodules, Qi-Scrofula, Wind, Tendon-Ulcers, Blood-Ulcers, Wandering Neck Rat-Tail. Before rupture, like bullet seeds, single or multiple, linked continuously, thin skin, bursting with pus, or oozing ulcers, or surgically opened, or chronic non-healing. Rooted in emotional injury internally and blood/qi excess externally, damaging Liver (governs tendons). Toxicity knots in upper jiao/chest, ears, chin, supraclavicular fossa, named Scrofula, a Hand-Shaoyang Sanjiao Meridian syndrome. Prognosis: Do not let pathology reach the Heart (fatal). Assess mobility: mobile is easy to treat, immobile is difficult. Differentiate Five Good and Seven Bad signs; do not treat uniformly. Major method: Fire needle to pierce node, insert medicinal thread 6-7 times, change frequency based on sore size. Penetrate deep to destroy root or sever blood vessels. If bleeding persists, apply Baicaoshuang (Soot from Burning Grass). If patient faints from blood loss, tonify blood; apply external dressing around nodule until it detaches, then use flesh-regenerating herbs. (*Qingnang*)

Liu Hejian stated: Knots result from intense fire-heat stagnation, hard like fruit pits. No need to induce suppuration; dissipating heat resolves them spontaneously.
Zhu Danxi stated: Knots in neck/arm/body, subcutaneous, non-red/non-swollen/non-hard/non-painful, are mostly phlegm deposits. Ask about dietary habits, use expectorant/purgative methods, then herbs to scatter nodules.
He added: Neck knots: equal parts Baijiangcan (Bombyx Batryticatus), fried Dahuang soaked in wine, Qingdai (Indigo Naturalis), Dantanxing (Arisaema cum Bile). Honey-pill, held in mouth. Chin knots: Erchen Tang plus wine-fried Dahuang, Chaihu, Jiegeng, Lianqiao. Arm knots: Erchen Tang plus Lianqiao, Fangfeng, Chuanxiong, wine-Huangqin, Cangzhu, Zaojiaoren, Baijiangcan, Shexiang. Moves accumulated phlegm in Taiyin/Jueyin, resolving knots quickly. Wind-heat knots: Dalianqiao Yin plus Baijiangcan, Niubangzi. Wind-knots: Changfu Qu Feng Xiaohe San (Wind-Dispersing Knot-Resolving Powder).
He also stated: Painful wind-knots: Apply warm paste of Da Qiaomagen (Polygonum Multiflorum Root) and Hulu Gen (Calabash Root) powder mixed with rice wash and vinegar.

Jiang Shiji stated: Scrofula with male bone-steaming or female amenorrhea represents advanced bad syndrome. Attacking the node directly accelerates death. Regulate Spleen/Stomach, tonify qi-blood to secure foundation, then treat sores for chance of survival. (*Shuoyue*)
He added: Scrofula arises from emotions/desires, phlegm-fluid stagnation-heat accumulating over time, not overnight. Prioritize Qi-Yi Yang-Rong, assisting with scrofula-specific herbs. Fear that if defensive/nutritive levels decline, complications arise, making treatment impossible.
He warned: In scrofula cases, assess deficiency/excess; do not overuse attacking herbs to damage yuan qi, causing bad outcomes in 80-90% of cases. This is physician error, not fate. Exercise caution.

*Shengji Zonglu* stated: Scrofula behind ears/jaw/neck/supraclavicular fossa is governed by Hand-Shaoyang Sanjiao Meridian.
*Neijing* stated: Depressed meridians form scrofula, lingering in muscle clefts; this is the disease.
*Bingji* warned: Treating scrofula without analyzing pulse/symptoms/meridian differences, using purgatives violates meridian/disease taboos. The disaster of treating deficiency as excess is obvious.

Liu Hejian stated: Scrofula behind ears/neck, also called Nine-Children Pack or Mouse-Cancer. Protruding ones are scrofula, often from Jueyin/Shaoyang meridians (abundant qi, scarce blood). Caused by excessive desires/alcohol/rich food/worry/unfulfilled wishes, external lust, internal emotions, internal desires, contagion, or mis-treatment. Types differ, harm is same. Men get sudden tidal fever; women get menstrual irregularity. Untreated, even gods cannot save.
Divine Formula: At onset (2-3 nodes), when pearl-like chain forms behind ear/neck, apply moxa cone directly on the largest initial node. Each