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Luo Li is the name given to the syndrome characterized
by swelling of the 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
Another 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.


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 Spleens
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.
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


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.




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 Lungs 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

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.

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

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
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

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

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
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
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


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:

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

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).

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).

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
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).


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:

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

Actions: to clear heat, transform phlegm and dissipate

Ingredients: Sheng Di Huang (Radix Rehmanniae Glutinosae), 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).
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.


The treatment principle is to release the exterior and

expel wind-heat.

i. Acupuncture Treatment
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.
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
Fengchi GB-20 is an important point to disperse windheat from the head and eyes.

ii. Herbal Treatment


Functions: to release the exterior (pungent and cool),

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).
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

In Yin-Xu in any of the three stages base the prescription
around the following:

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).

Functions: to nourish Yin and lower fire.

Ingredients: Huang Bo (Cortex Phellodendri), Zhi Mu
(Radix Anemarrhenae Asphodeloidis), Shu Di Huang
(Radix Rehmanniae Glutinosae Conquitae), Gui Ban
(Plastrum Testudinis).
If the Internal Heat is particularly severe add:

Functions: to clear empty heat and dispel steaming bone

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


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).


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.

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.

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

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:

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.
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
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