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Tubercles (Lump-like swellings) are caused by the hyperactivity of Ministerial Fire (Xianghuo, the physiological fire residing in the Kidney and Liver) and are a manifestation of Phlegm-Fire. Those who suffer from this condition but fail to treat it preemptively rarely avoid critical danger. Why? This is generally because the Kidney Water (Kidney Yin) is first depleted, allowing Ministerial Fire to blaze forth. This heat steams and forces the Body Fluids to condense beneath the skin and above the muscle layers. The lumps resemble plums or dates; they are neither red nor swollen, nor do they cause severe pain, yet they eventually ulcerate over time. People often neglect them, which characterizes the syndrome. Initially, there may be alternating chills and fever resembling malaria, with gradual emaciation. In later stages, muscles waste away, coughing occurs accompanied by hemoptysis, and symptoms such as tidal fever, night sweats, spermatorrhea, and seminal emission arise concurrently. The treatment method must involve tonifying Water (Kidney Yin) and clearing Metal (Lung), nourishing Yin to suppress Yang, combined with herbs that resolve stagnation and regulate Qi. It is essential to ensure that Water ascends and Fire descends, Body Fluids circulate freely, and the nodules dissipate, thereby preventing future complications. If treatment is delayed or neglected, leading to complete wasting of muscles and extreme debility, with rotting masses and ulcerated tubercles, the situation becomes like the collapse of a capital city; can it still be saved? One must be extremely cautious.

It is said that the etiology of tubercles differs significantly from sores, ulcers, and carbuncles. Misdiagnosis and mistreatment can cause serious harm. Why? The Classics state: "All pain, itching, ulcers, and sores belong to Heart Fire," as they are formed by Heart Fire forcing blood dysregulation; this is an Excess syndrome. For unulcerated cases, cooling Blood and resolving toxicity, or using bitter-cold purgatives to drive out pathogens, is appropriate. For ulcerated cases, draining pus and supporting the interior to expel toxins is indicated; recovery follows when pus drains and toxins resolve. However, the etiology and treatment of tubercles differ. They originate from the initial exhaustion of True Yin (Kidney Yin), where blazing Ministerial Fire steams and forces fluids to become obstructed and condensed. Accumulating day after day, they form slowly and thus do not ulcerate easily; this is a Deficiency syndrome. Initially, without typical Phlegm-Fire symptoms and with normal body shape, only nodules are present. Treatment should focus on resolving stagnation, descending Fire, eliminating Phlegm, and regulating Qi. Once the nodules dissolve, the condition resolves, analogous to brine dissolving upon contact with water. If hesitation and delay allow all nodules to ulcerate and the body to emaciate, then tidal fever, night sweats, and bleeding will inevitably arise. This indicates extreme Yin deficiency with intensified Ministerial Fire, causing solitary Yang to become frantic while weak Yin struggles to sustain itself. Consequently, Qi scatters and Blood congeals, leading to widespread ulceration of nodules, sometimes leaving no intact skin. At this stage, treatment must address the root while managing the branch to achieve mastery. The method prioritizes clearing Lung Metal and tonifying Kidney Water as the principal strategy, supporting Yang and nourishing Yin as adjuncts, and resolving stagnation while descending Fire as guides. The goal is to ensure Water ascends and Fire descends, Body Fluids circulate, ulcers heal, and nodules disperse. This brings the excessive pathogenic factors under control, harmonizing the Qi of the Five Zang organs, similar to a warm breeze in a cold valley restoring harmony. If bitter-cold, harsh purgatives are used, or if treated according to protocols for sores and ulcers, it is akin to drinking poison when thirsty, surely accelerating death! Generally, scrofula (Luoli), phlegm nodules, and "horse knife" lymphadenopathy (Madao) result from rebellious Qi in the Shaoyang Gallbladder channel and intense burning of Ministerial Fire. Treatment must resolve stagnation and promote free flow, ensuring Gallbladder Qi flows smoothly so that nodules naturally resolve.