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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 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 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.
DIFFERENTIATION AND
TREATMENT
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
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.
i. Acupuncture Treatment
Prescription:
Shenshu BL-23
Feishu BL-13
Pishu BL-20
Shaohai HE-3
Tianjing SJ-10
Explanation:
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.
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.
Notes
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.