Swelling of the Lymph Nodes

JOURNAL OF CHINESE MEDICINE NUMBER 31 SEPTEMBER 1989

THE TREATMENT OF LUOLI BY CHINESE MEDICINE MAZIN AL-KHAFAJI INTRODUCTION ‘Luo Li’ is the name given to the syndrome characterized  by swelling of the lymph lymph nodes of the neck and around the ear. In more severe cases the glands of ‘que pen’ (the supraclavicular fossa) and the armpit may also be swollen.The smaller swellings are known as Luo, the larger as Li. They are either unilateral or bilateral. The name Luo Li was first used in the chapter on heat and cold in the Ling Shu  (Spiritual Axis) where the Yellow Emperor asks “What is the energy that gives rise to the hot and cold Luo Li (swellings) that occur in the neck and the armpit?” Qi Bo replies “they are brought about by the toxins of the hot and cold energies that remain in the channels and do not depart.” He goes on to explain the method of needling as well as the likely outcome of  treatment. In later times different names were given to glandular swellings in different parts of the body, so that for example swellings in the anterior aspect of the neck  along the Yang Ming channel were called ‘Tan Li’ (Phlegm Li), swellings of the sides of the neck along the path of the Shao Yang channel were called ‘Qi Li’, swellings along the posterior aspect of the neck, traversed by the Tai Yang channel were known as ‘Shi Li’ (Damp Li), and so on. Another classification classification was according to the origin of the disease, for example Qi toxin, Wind toxin, Heat toxin etc. Yet other classifications were made according to the size and number of swellings and the texture and shape of  the nodules. Generally speaking, most doctors nowadays prefer to classify Luo Li according to two methods: i. differentiation of syndrome (Stagnant Liver-Qi, Lung and Kidney Yin-Xu etc.), and ii. the length of time that the nodules have persisted, i.e. initial, middle and late stage. In the later stages, if the nodule ruptures but fails to heal, it is known as ‘Shu Lou’ or ‘Lao Chuang’. Luo Li is a disease that mostly afflicts children and young adults. It generally corresponds to tuberculosis of  the lymph nodes as well as acute or chronic lymphadenitis in Western Medicine, and is often translated as scrofula.

ORIGIN AND MECHANISM OF DISEASE 1. STAGNATION OF QI AND PHLEGM

The main components in the initial stages of the formation of the nodules are stagnant Qi and phlegm. Any

emotional disturbance (most notably anger, frustration, resentment, depression etc.) which is of sufficient strength and duration to disrupt the smooth flow of the Liver-Qi, can give rise to this disorder in susceptible individuals. The phlegm is created in two ways: i. Stagnation of Liver-Qi often disrupts the Spleen’s function of transporting the Gu-Qi. Over time the stagnant Gu-Qi will form phlegm. ii. If Stagnant Qi persists for any length of time, fire is generated. Fire is considered the non-material aspect of  phlegm, and phlegm the material aspect of fire (in fact the Chinese character for phlegm consists of the disease radical and the character for fire repeated twice) . Fire and phlegm easily give rise to one another. Another name for Luo Li is ‘Tan He’ (‘Phlegm pit’ or ‘Phlegm stone’). This underlines the importance of  phlegm in the formation of these nodules (in fact phlegm is almost always involved in the formation and growth of a wide variety of nodules anywhere in the body). In the chapter on Luo Li in the Yi Men Bu Yao  of the Qing dynasty, Zhao Lian states: “For the most part there is stagnation of Liver-Qi, stagnant blood and phlegm in the Stomach, and unsmooth circulation of the channels and collaterals; as a result the phlegm will follow the Qi upwards to the neck. Together the Qi and phlegm will accumulate and form heat. The Qi will meet the phlegm so there is coagulation; when the phlegm has heat there is swelling. If time elapses and it is not dispersed then Luo Li is formed”. To summarise: stagnant Qi and phlegm (and quite often fire ) will stagnate, rising upwards to the neck to coagulate there and form small nodules, which if not treated promptly will grow in size and number. In the latter stages the fire generated by the long term stagnation of  Qi is apt to scorch and thus deplete the Yin of the Kidney. Thus the condition which to begin with is predominantly Shi, will over time lead to Xu. The phlegm present will also be thickened by the action of the fire, and together with the heat from the fire give rise to the pus that is discharged at the final stages of the disorder. 2. EXTERNAL INVASION OF WIND HEAT

Invasion of wind-heat is a rare origin for this disorder and is only seen in the initial stage of Luo Li. Phlegm is often already present as a latent pathogen in the body, so that when there is an acute attack of wind-heat, the wind will carry the heat deep into the channels to mix with the phlegm. The presence of wind means that the pathological changes take place in the upper part of the body, in this case usually the neck. The phlegm and heat mix and

JOURNAL OF CHINESE MEDICINE NUMBER 31 SEPTEMBER 1989

coagulate causing the glands to swell. After the initial attack, stagnation of phlegm and heat generate further heat which in time will consume the Yin, and lead to the middle and final stages of Luo Li.

DIFFERENTIATION AND TREATMENT

3. DEFICIENCY OF LUNG AND KIDNEY YIN

1. STAGNATION OF QI AND PHLEGM

A constitutional weakness of the Yin aspect of the Lung and Kidney can also predispose an individual to the formation of Luo Li. The uncontrolled fire that blazes as a result of Yin-Xu will injure not only the body fluids but the Lung’s function of distributing the fluids. As a result the fluids stagnate, and are thickened by the action of the fire, thus laying the foundation for the formation of Luo Li.

In the great majority of cases the initial stage of the development of the nodules can be differentiated as stagnation of Qi and phlegm. In addition to the symptoms already mentioned under the initial stage, other symptoms of stagnation of Liver-Qi and coagulation of  phlegm may or may not be present. In either case, unless wind-heat is present, the treatment for stagnation of Qi and phlegm is applied.The treatment principle consists of dredging the Liver, moving stagnation and transforming phlegm. Heat is easily formed when Qi and phlegm stagnate; if this is the case than the treatment principle and prescription should be adjusted accordingly. If signs of deficiency of Blood or Yin are evident, steps must be taken to strengthen them, thus preventing the progress of the disease.

4. BCG1 INOCULATION

In some cases Luo Li may occur in infants of one year or less after such an inoculation.

CLINICAL MANIFESTATIONS In the formation and eventual breakdown of Luo Li three main stages are recognized: 1. Initial stage: The swollen gland, usually on the neck or

 behind the ear, is often painless and usually found by accident. The consistency of the swollen gland is hard and it can be easily moved. There is no sensation of heat or cold and the colour and texture of the skin is normal. Generally there is no major alteration in health at this stage. In a minority of cases the onset is marked by more striking signs. An attack of wind-heat will give rise to fever, headache, aches and pains of the bones, redness and pain of the eyes, a thin yellow coating on the tongue and a floating rapid pulse. 2. Middle stage: The gland enlarges slowly over a period

of some weeks, adjacent glands become involved, and quite often several glands join together to form one mass. At this stage the nodules begin to feel painful and on palpation it is found that they are hard and not easily moved. This stage may be accompanied by a mild fever and a slightly reduced appetite. 3. Final stage: This is the stage where abscess formation

and eventually the discharge of pus takes place. There are two main possibilities: i. The purulent fluid discharged from the nodule is thick, the surrounding area is red and after a while the wound closes up and heals. ii. There is a slow discharge of purulent fluid, and the surrounding area turns a characteristic dark purple. The wound remains open and an empty shell is left. Generally this stage is accompanied either by symptoms of  Lung and Kidney Yin-Xu such as tidal fever, steaming  bones, cough, night sweats etc, or more commonly symptoms of exhaustion and deficiency of Qi and blood, such as dizziness, tired spirit, insomnia, amenorrhoea etc. If  the Spleen-Qi is deficient, symptoms such as loose stools, poor appetite, distention of the abdomen etc. will also be seen. In cases of a constitutional weakness of Yin of Lung and Kidney, Yin-Xu symptoms may be discerned at any of  the three stages.

i. Acupuncture Treatment Prescription:

Zhangmen LIV-13 Zulinqi GB-41 Zusanli ST-36 Tianjing SJ-10 Binao L.I.-14 Fenglong ST-40 Explanation:

•Zhangmen LIV-13 is the Front-Mu point of the Spleen as well as a meeting point of the Shao Yang channel. It has the function of dredging and regulating the Qi of the Liver and Gallbladder as well as strengthening the Spleen and transforming Damp and expelling phlegm. •Zulinqi GB-41 is the Shu-Stream point of the Gallbladder channel. It has a very strong action of regulating the flow of Qi and thus strengthening the action of Zhangmen LIV-13. •Zusanli ST-36 is used to nourish Qi and Blood, thus strengthening the ability of the body to overcome the illness. •Tianjing SJ-10 is the He-Sea point and Earth point of the Sanjiao channel. It is a particularly effective point for treating Luo Li along the pathway of the channel. It also has a strong action of draining fire in any of the three  Jiaos. •Binao L.I.-14 is an effective empirical point for treating Luo Li. •Fenglong ST-40, the Luo point of the Stomach channel, is effective for transforming and expelling phlegm. In any of the three stages, the following points may be added to treat Luo Li of specific areas: •Posterior aspect of the neck and ear: Yifeng SJ-17, Fengchi GB-20, Zulinqi GB-41, Tianjing SJ-10. •Anterior aspect of the neck: Shouwuli L.I.-13, Binao L.I.-14, Jianyu L.I.-15, Tianding L.I.-17, Futu L.I.-18 •Armpit: Jianjing GB-21, Shaohai HE-3, Yangfu GB-38, Diwuhui GB-42. Bailao (Extra: 2 cun above Dazhui DU-14 and 1 cun lateral to the midline), and Zhoujian (Extra: on the tip of  the ulnar olecranon when the elbow is flexed) can be

JOURNAL OF CHINESE MEDICINE NUMBER 31 SEPTEMBER 1989

treated by moxibustion for any type of Luo Li. •In cases of distention of the chest and flanks add: Neiguan P-6, Zhigou SJ-6, Yanglingquan GB-34. •In cases of poor appetite and pain of the epigastrium add: Zhongwan REN-12, Gongsun SP-4. •In cases of Yin-Xu add : Taixi KID-3, Zhaohai KID-6.

ii. Herbal Treatment According to the individual case, choose from amongst the following prescriptions, making adjustments to suit the presenting signs:

XIAO YAO WAN

Functions: to dredge the Liver and dissipate stagnation,

strengthen the Spleen and nourish the blood. Ingredients: Chai Hu (Radix Bupleuri), Bai Shao (Radix Paeoniae Lactiflorae), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Dang Gui (Radix Angelicae Sinensis), Fu Ling (Sclerotium Poriae Cocos), Gan Cao (Radix Glycyrrhizae Uralensis), Sheng Jiang (Rhizoma Zingiberis Officinalis Recens), Bo He (Herba Menthae). If Liver-Fire is formed and begins to damage the Yin, use Xia Ku Cao Gao or Qing Gan Hua Tan Wan:

SHU GAN KUI JIAN TANG

Functions: to dredge Liver-Qi, transform phlegm and

 break up nodules. Ingredients: Chai Hu (Radix Bupleuri), Shi Jue Ming (Concha Haliotidis), Dang Gui (Radix Angelicae Sinensis), Hong Hua (Flos Carthami Tinctorii), Jiang Can (Bombyx Batryticatus), Chen Pi (Pericarpium Citri Reticulatae), Xia Ku Cao (Spica Prunellae Vulgaris), Xiang Fu (Rhizoma Cyperi Rotundi), Chuan Xiong (Radix Ligustici Wallichii), Chi Shao (Radix Paeoniae Rubrae), Gan Cao (Radix Glycyrrhizae Uralensis), Shan Jia (Squama Manitis Pentadactylae), Jiang Huang (Rhizoma Curcumae). NEI XIAO LUO LI WAN

Functions: to clear heat, transform phlegm and dissipate

nodules; used for phlegm-heat Luo Li - swollen, painful and not yet suppurating. Ingredients: Xia Ku Cao (Spica Prunellae Vulgaris), Xuan Shen (Radix Scrophulariae Ningpoensis), Qing Yan (Halite), Hai Zao (Herba Sargassii), Bo He (Herba Menthae), Chuan Bei Mu (Bulbus Fritillariae Cirrhosae), Tian Hua Fen (Radix Trichosanthis), Hai Fen (Notarchus Leachii Freeri), Kun Bu (Thallus Algae), Lian Qiao (Fructus Forsythiae Suspensae), Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae), Gan Cao (Radix Glycyrrhizae Uralensis), Sheng Di Huang (Radix Rehmanniae Glutinosae), Jie Geng (Radix Platycodi Grandiflori), Zhi Ke (Fructus Citri seu Ponciri), Dang Gui (Radix Angelicae Sinensis), Xiao Shi (Saltpetre). XIAO LUO WAN

Functions: to clear heat and transform phlegm, soften

hardness and dissipate nodules. Ingredients: Xuan Shen (Radix Scrophulariae Ningpoensis), Mu Li (Concha Ostreae), Bei Mu (Bulbus Fritillariae). XIAO JIN DAN

Functions: to transform phlegm and expel damp, expel

stagnant blood and move the Luo. Use in the beginning stages of Luo Li with no colour change and hard painful swellings. Ingredients: Bai Jiao Xiang (Liquidambaris Taiwanianae) Wu Ling Zhi (Excrementum Trogopterori seu Pteromi) Cao Wu (Radix Aconitum Kuznezoffii Praeparatae), Di Long (Lumbricus), Mu Bie Zi (Semen Momordicae Cochinchinensis), Ru Xiang (Gummi Olibanum), Mo Yao (Myrrha), Dang Gui (Radix Angelicae Sinensis), She Xiang (Secretio Moschus moschiferi), Han Lian Cao (Herba Ecliptae Prostratae).

XIA KU CAO GAO

Actions: to move Qi and invigorate blood, transform

phlegm and dissipate nodules. Used for Luo Li with hyperactive Liver and dry blood. Ingredients: Xia Ku Cao (Spica Prunellae Vulgaris), Dang Gui (Radix Angelicae Sinensis), Bai Shao (Radix Paeoniae Lactiflorae), Xuan Shen (Radix Scrophulariae Ningpoensis), Wu Yao (Radix Linderae Strychnifoliae), Zhe Bei Mu (Bulbus Fritillariae Thunbergii), Jiang Can (Bombyx Batryticatus), Kun Bu (Thallus Algae), Jie Geng (Radix Platycodi Grandiflori), Chen Pi (Pericarpium Citri Reticulatae), Chuan Xiong (Radix Ligustici Wallichii), Gan Cao (Radix Glycyrrhizae Uralensis), Xiang Fu (Rhizoma Cyperi Rotundi), Hong Hua (Flos Carthami Tinctorii). QING GAN HUA TAN WAN

Actions: to clear heat, transform phlegm and dissipate

nodules. Ingredients: Sheng Di Huang (Radix Rehmanniae Gluti-

nosae), Mu Dan Pi (Cortex Moutan Radicis), Hai Zao (Herba Sargassii), Bei Mu Bulbus Fritillariae), Kun Bu (Thallus Algae), Chai Hu (Radix Bupleuri), Hai Bu, Xia Ku Cao (Spica Prunellae Vulgaris), Jiang Can (Bombyx Batryticatus), Dang Gui (Radix Angelicae Sinensis), Lian Qiao (Fructus Forsythiae Suspensae), Zhi Zi (Fructus Gardeniae Jasminoidis). 2. EXTERNAL INVASION OF WIND HEAT

As already mentioned, the onset of Luo Li tends to be slow, and the nodules may be discovered for the first time almost by accident. However in a minority of cases (about one in six) the onset and subsequent development of the nodules is more abrupt, pointing clearly to an external invasion. Wind-heat will be the most common diagnosis (if the attack begins with an invasion of windcold it will rapidly develop into wind-heat). In treatment, care should be exercised in identifying and making allowance for any other pathogen combining with the wind-heat (most commonly external dampness, and to a lesser extent external dryness). Typical symptoms and signs of wind-heat will include fever, headache, aches and pains of the bones, redness and pain of the eyes, sore and dry throat, a thin yellow coating on the tongue and a floating rapid pulse. The glands tend to enlarge more rapidly and attain a greater size when the onset is heralded by an attack of windheat. However as in the more common initial stage of  stagnation of Qi and phlegm, pain of the swollen gland is surprisingly slight.

JOURNAL OF CHINESE MEDICINE NUMBER 31 SEPTEMBER 1989

The treatment principle is to release the exterior and expel wind-heat.

i. Acupuncture Treatment Prescription:

Dazhui DU-14 Quchi L.I.-11 Hegu L.I.-4 Fengchi GB-20 Yifeng SJ-17 Add Taodao DU-13 if heat signs are pronounced. Local and distal points are also added depending on the site of the swollen glands. Explanation:

•Dazhui DU-14, Quchi L.I.-11 and Hegu L.I.-4 form the hub of the prescription to clear the exterior of wind-heat. •Yifeng SJ-17 disperses wind and clears the channels of  obstruction (an important local point). It also has a useful action of clearing the eyes (redness and pain of the eyes is a common symptom in Luo Li of wind-heat origin) especially when combined with Fengchi GB-20 and Hegu L.I.-4. •Fengchi GB-20 is an important point to disperse windheat from the head and eyes.

ii. Herbal Treatment In Yin-Xu in any of the three stages base the prescription around the following: ZHI BO DI HUANG WAN

Functions: to tonify Yin and lower fire. Ingredients: Huang Bo (Cortex Phellodendri), Zhi Mu

(Radix Anemarrhenae Asphodeloidis), Sheng Di Huang (Radix Rehmanniae Glutinosae), Shan Zhu Yu (Fructus Corni Officinalis), Shan Yao (Radix Dioscoreae Oppositae), Ze Xie (Rhizoma Alismatis Plantago-aquaticae), Mu Dan Pi (Cortex Moutan Radicis), Fu Ling (Sclerotium Poriae Cocos). DA BU YIN WAN

YIN QIAO SAN

Functions: to nourish Yin and lower fire. Ingredients: Huang Bo (Cortex Phellodendri), Zhi Mu

clear heat and detoxify. Ingredients: Jin Yin Hua (Flos Lonicerae Japonicae), Lian Qiao (Fructus Forsythiae Suspensae), Niu Bang Zi (Fructus Arctii Lappae), Lu Gen (Rhizoma Phragmitis Communis), Jing Jie (Herba seu Flos Schizonepetae Tenuifoliae), Jie Geng (Radix Platycodi Grandiflori), Dan Dou Chi (Semen Sojae Praeparatum), Zhu Ye (Herba Lophatheri Gracilis), Bo He (Herba Menthae), Gan Cao (Radix Glycyrrhizae Uralensis), •Add herbs to dissipate the nodule such as Xia Ku Cao (Spica Prunellae Vulgaris), Bei Mu Bulbus Fritillariae), Xuan Shen (Radix Scrophulariae Ningpoensis). •If there is pain and redness of the eyes add: Ju Hua (Flos Chrysanthemi Morifolii), Sang Ye (Folium Mori Albae). •If the pain of the throat is severe add: She Gan (Rhizoma Belamcandae Chinensis). 3. YIN-XU WITH INTERNAL HEAT

This syndrome may be seen in any of the three stages, from the development to the breakdown of the nodules, however it is most commonly seen in the middle and final stages of Luo Li.Typical Yin-Xu symptoms will include tidal fever, night sweats, malar flush, five palms hot, dry mouth etc. The treatment principle is to nourish Yin and lower fire.

i. Acupuncture Treatment Shenshu BL-23 Feishu BL-13 Pishu BL-20 Shaohai HE-3 Tianjing SJ-10

•Shenshu BL-23 and Feishu BL-13 have the action of  nourishing the Yin of the Kidney and Lung. •Pishu BL-20 tonifies the middle jiao, thus nourishing the post-natal Qi and ‘firming the Root’. •Shaohai HE-3 lowers Fire and transforms turbid phlegm. •Tianjing SJ-10 has a good action on draining Fire, and is especially effective for the treatment of Luo Li when combined with Shaohai HE-3. •In case of night sweats add Yinxi HE-6 and Houxi SI-3.

ii. Herbal Treatment Functions: to release the exterior (pungent and cool),

Prescription:

Explanation:

(Radix Anemarrhenae Asphodeloidis), Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae), Gui Ban (Plastrum Testudinis). If the Internal Heat is particularly severe add: QING GU SAN

Functions: to clear empty heat and dispel steaming bone

syndrome. Ingredients: Yin Chai Hu (Radix Stellariae Dichotomae), Huang Lian (Rhizoma Coptidis), Qin Jiao (Radix Gentianae Macrophyllae), Bie Jia (Carapax Amydae Sinensis), Di Gu Pi (Cortex Lycii Chinensis Radicis), Qing Hao (Herba Artemisiae Apiaceae), Zhi Mu (Radix Anemarrhenae Asphodeloidis), Gan Cao (Radix Glycyrrhizae Uralensis). In the initial and middle stages, where the nodule has not yet broken down, add prescriptions to dissipate and scatter the nodules such as: NEI XIAO LUI LI WAN  (see above) XIAO LUO WAN (see above)

In the final stage where the nodules are discharging pus add: TOU NONG SAN

Functions: to tonify Qi, nourish blood and expel pus; use

only when the pus is formed but not yet discharged. Ingredients: Huang Qi (Radix Astragali), Dang Gui (Radix Angelicae Sinensis), Chuan Shan Jia (Squama Manitis Pentadactylae), Zao Jiao Ci (Spina Gleditsiae Sinensis), Chuan Xiong (Radix Ligustici Wallichii).

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4. QI AND BLOOD XU

In cases where the Qi and blood of the body is exhausted, when the final stage of the development of the nodule is reached (i.e. its breakdown), instead of thick pus discharging, thin liquid drips out, the nodule ulcerates turning a dark purple colour and an empty shell is left which does not close up.There is a low grade fever, day and night sweats, pale ashen complexion, emaciation, lack of appetite listlessness and thin and weak pulse. This stage is known as ‘Shu Lou’ or ‘Lao Chuang’. If  allowed to reach this stage, the condition may persist for a long time with periodic and sometimes continuous discharge for years. When eventually the shell closes up and the discharge ceases, unsightly red scars remain. Prolonged treatment may be required.

i. Acupuncture Treatment Generally speaking herbs are used to treat this late stage of the disease. However if herbs are used, regular acupuncture of points to strengthen the Qi and blood (such as Zusanli ST-36, Qihai REN-6 etc.) can only be of benefit. ii. Herbal Treatment Strongly tonify and strengthen the Qi and Blood. At the same time transform phlegm and dissipate stagnation. Base the prescription around: XIANG BEI YANG ZONG TANG

Functions: to tonify Qi and nourish blood, transform

phlegm and expel stagnation. Ingredients: Bai Zhu (Rhizoma Atractylodis Macrocephalae), Ren Shen (Radix Ginseng), Fu Ling (Sclerotium Poriae Cocos), Chen Pi (Pericarpium Citri Reticulatae), Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae), Chuan Xiong (Radix Ligustici Wallichii), Dang Gui (Radix Angelicae Sinensis), Bei Mu Bulbus Fritillariae), Xiang Fu (Rhizoma Cyperi Rotundi), Bai Shao (Radix Paeoniae Lactiflorae), Jie Geng (Radix Platycodi Grandiflori), Gan Cao (Radix Glycyrrhizae Uralensis), Sheng  Jiang (Rhizoma Zingiberis Officinalis Recens), Da Zao (Fructus Zizyphi Jujubae). It should be noted that even in cases where the nodules are swollen and hard, herbs that harshly dissipate the stagnation should not be used for fear of damaging the Zheng-Qi of the body. EXTERNAL TREATMENT Initial stage: use TAN HE GAO: Ma Huang (Herba

Ephedrae), Gan Sui (Radix Euphorbiae Kansui), Da Ji (Herba Cirsii Japonici), Bai Jie Zi (Semen Sinapis Albae),  Jiang Can (Bombyx Batryticatus), Ma You (Sesame Oil), Sheng Nan Xing (Rhizoma Arisaematis),Sheng Ban Xia (Rhizoma Pinelliae Ternatae), Ze Qi (Herba Euphorbiae Helioscopiae). Middle stage (the pus is forming but is not yet ripe enough to be discharged): use QIAN CHUI GAO: Huo Ma Ren (Semen Cannabis Sativae), Song Xiang (Pinus Massonionae), Qing Fen (Calomelas), Qian Dan (Red Lead), Yin Zhu (Vermilion), Cha You (Camellia Oleifera; Tea seed oil) Final Stage:

i. When the abscess is discharging normally use: WU

WU DAN: Calcinated Shi Gao (Gypsum), Sheng Dan. ii. When the abscess continues to discharge thin pus for a long time and the wound shows no signs of closing use: MAO YAN CAO GAO: Mao Yan Cao (Herba Euphorbiae Helioscopiae) - also known as Ze Qi.

Notes 1. BCG vaccine: an active immunising agent prepared from from bacillus Calmette-Guerin and most commonly prescribed for immunisation against tuberculosis.