2 English reference [Chinese Medicine Terminology Committee. Terminology of Traditional Chinese Medicine (2004)]
Cervical lymph node tuberculosis [Chinese medicine terminology examination Committee]. Terminology of traditional Chinese medicine (20 13)]
Lymphadenitis [Landau Chinese-English Dictionary]
Crulus [Landau Chinese-English Dictionary]
The Evil of the King [Landau Chinese-English Dictionary]
Lymphadenitis Landau Chinese-English Dictionary
Lapis [Landau Chinese-English Dictionary]
Landau Chinese-English dictionary
3. Summarize Jiuzichuang as the name of the disease, namely scrofula [1].
The name of the scrotum is [2][3]. Refers to the neck slowly appear a smooth lump the size of a bean, like a bead, not red and painless, and the pus is clear and thin after collapse, which is easy to form a sinus [4]. Because of its tuberculosis, it was named Pearl. The scrofula is commonly called scrofula and mouse sore [2]. Also known as rat fistula, rat sore, nine-child sore, rat carbuncle, rat carbuncle, mole, pearl gall, wild gall, string sore, etc. [1]. The small one is carbuncle, and the big one is carbuncle [1]. It has different names because it appears in different parts. If born in front of the neck, it belongs to Yangming meridian, which is called phlegm; Born on both sides of the neck, it belongs to shaoyang meridian, called qi stagnation; Born under the armpit and chest, he is called a knight with a sword [5]. The scrofula is caused by stagnation of liver-qi, qi stagnation becomes fire, and body fluid burns into phlegm, which is bound to the neck, showing tuberculosis clustering, pus after collapse, and long-lasting sores [5]. More common in frail children or young people, easy to occur in the neck and behind the ears, slow onset. At first, tuberculosis was like beans, with the same skin color and no pain. Later, it gradually increased and can be mass-produced. After the collapse, the pus is clear and thin, and there is a sheep intestine-like substance, which often collapses one after another to form a sinus.
Huangdi Neijing Lingshu Cold and Heat: "Cold and heat are in the neck."
Shi Xue's medical record of lymph node tuberculosis: "Its symptoms mainly occur between the front and back of the ear, and these two parts combine to nucleate. At first I felt cold and hot, and my throat was very strong. "
"Six Books on Hejian": "The husband is full of money. What is the so-called tuberculosis? Or before and after the ear; , even the neck and chin, even lack of washbasin, all is scrofula, "
Jiuzi sore is equivalent to cervical lymph node tuberculosis in western medicine [4].
4 Etiology and Pathogenesis of Jiuzi Ulcer Most of Jiuzi Ulcer is due to yin deficiency of lung and kidney, stagnation of liver qi for a long time, internal burning due to deficiency fire, phlegm in semen, or pathogenic wind and fire, which is confined to the neck, neck, fu organs and crotch [1].
Nine-child sores are mostly caused by physical weakness, qi stagnation, phlegm turbidity, evil toxin and accumulation of meridians [2].
Nine-child sores are mostly caused by emotional stagnation, liver qi stagnation and qi stagnation, which hurts the spleen, leading to spleen loss of health and endogenous phlegm and dampness, ending in the neck. Over time, phlegm-dampness turns into heat, or liver depression turns into fire, kidney yin goes down, and heat is better than meat rot and pus, or pus is dripping with water, which consumes qi and blood and gradually becomes deficiency. It can also be due to the deficiency of lung and kidney yin, which leads to the deficiency of yin fire, the lung and body fluid can not be transported, the burning body fluid is phlegm, and the phlegm fire condenses and nucleates.
Nine-child sores are mostly caused by stagnation of liver-qi, stagnation of qi and phlegm coagulation, or excessive fire due to yin deficiency, burning of body fluid as phlegm, and stagnation under the neck. After a long time, tuberculosis festers, both qi and blood are deficient, and evil love is deficient [5].
4. 1 qi stagnation and phlegm hinder spleen injury, spleen does not transport dampness, phlegm is endogenous, and it is blocked by the veins of shaoyang and Yangming, forming cervical axillary lymph node nucleus [5].
4.2 Fire due to yin deficiency will turn into fire due to liver depression, and kidney yin deficiency for a long time, or lung and kidney yin deficiency, all of which can lead to fire due to yin deficiency, and phlegm fire will increase day by day, and it will fight against the pulse of shaoyang and Yangming, and finally the neck and armpit [5].
4.3 Deficiency of both qi and blood, if not cured for a long time, will gradually lead to tuberculosis ulceration, purulent dripping, gas and blood consumption, and it is difficult to eliminate putrefaction and promote granulation, resulting in sinus tract unhealed for many years [5].
5 Symptoms of Jiuzi sores Jiuzi sores are mostly around the neck and ears, and the nucleus is as round as a bead [2]. Clinically, there are three or five round nuclei in series, which are located on one side of the neck, behind the ear and even connected with the chest and armpit [2].
As a bean, it is not red, painless and hot in quantity, but it grows as big as a plum and is hard but can be popularized [2].
In the later stage, I feel slight pain, caking and adhesion, which makes it difficult to push [2].
The skin will be purplish red when it collapses, and pus will flow out after it collapses. The pus will be very thin and contain a pustule-like substance, and it will close slowly, and it will often collapse one after another, making it difficult to close for a long time to form a fistula [2].
6 diagnosis of nine-child sores Nine-child sores often occur on one or both sides of the neck and ears, and can also extend to the submaxillary, clavicle and armpit.
6. 1 At first, there was a lump on one or both sides of the neck, swollen like a bean, hard and painless, and the skin seemed normal. Can be extended to a few days without collapse. Generally, there are no systemic symptoms.
6.2 In the middle stage, caking gradually increased and adhered to the skin and surrounding tissues. Cakes can also adhere to each other and fuse into blocks, forming nodular hard blocks that are not easy to push. If liquefied into pus, the skin is reddish, or purple and shiny, slightly hot and slightly fluctuating. Some patients have systemic symptoms such as low fever and loss of appetite.
6.3 After the caking liquefied into pus is cut or festered by itself in the later stage, the pus is thin or mixed with necrotic tissue. The wound is a latent cavity, the wound is gray and the skin of the wound is purple and dark, and sinus can be formed if it does not converge for a long time. At this time, some patients have low fever, fatigue, dizziness, loss of appetite, abdominal distension, loose stool and other symptoms. Or night sweats, cough, hot flashes and other symptoms: if the pus thickens and the granulation turns bright red, it means that it will heal.
6.4 The auxiliary examination of tuberculin test is positive, and the ESR can be accelerated. Mycobacterium tuberculosis can be found by pus smear examination, and biopsy can be done if necessary, which is helpful to the diagnosis of the disease.
The dishonor of diseases that need to be differentiated from Jiuzi sore: more common in middle-aged and elderly people; Malignant tumors of oral cavity and nasopharynx can metastasize to cervical lymph nodes; The lump is as hard as stone, uneven and immobile; After festering, like pomegranate, dripping with blood; Often accompanied by headaches and nosebleeds.
8. Treatment of Jiuzi Ulcer 8. 1 At the initial stage of syndrome differentiation treatment, it is advisable to soothe the liver and relieve depression, soften the hard mass and resolve phlegm, add and subtract Xiaoyao Powder combined with Erchen Decoction or take Xiaoyu Pill [1]. In the later stage, the lung and kidney were mainly nourished, and Liuwei Dihuang Pill, Gaza Ginseng and Ophiopogon japonicus were used [1]. In the case of wind-heat toxicity, we should take Fangfeng Du Qing Drink [1] mainly to dispel wind and clear heat, supplemented by softening and resolving hard mass.
8. 1. 1 Syndrome of qi stagnation and phlegm coagulation refers to the syndrome of qi stagnation and phlegm coagulation, which is characterized by solid mass, no obvious systemic symptoms, thin and greasy tongue coating and slippery pulse.
8. 1. 1. 1 The symptoms are caking and swelling like beans, one or more of which vary. The skin color is unchanged, press hard and push actively, which is not hot or painful; No obvious systemic symptoms; The fur is greasy and the pulse is slippery.
It is more common in the early stage of lymph node tuberculosis (nodular stage). The mass is solid, the general symptoms are not obvious, the coating is thin and greasy, and the pulse is slippery [5].
8. 1. 1.2 dialectical analysis of emotional internal injury, stagnation of liver-qi, spleen loss of healthy transport, endogenous phlegm heat, with the meridians reaching the neck, phlegm congeals and gas blocks; At the beginning of the disease, it has not turned hot, so the skin color remains unchanged, neither hot nor painful; The greasy fur and slippery pulse are manifestations of qi stagnation and phlegm coagulation.
Poor mood, liver depression and spleen deficiency, spleen loss of health, accumulation of dampness and phlegm, blocked by shaoyang and Yangming meridians, aggregated into blocks, so the lump is solid. At this time, the healthy qi is not empty, and the pathogenic potential is still light, so the systemic symptoms are not obvious. Thin and greasy fur and slippery pulse are signs of qi stagnation and phlegm coagulation. [5]
8. 1. 1.3 Prescription treatment: soothing the liver and nourishing blood, strengthening the spleen and resolving phlegm.
Xiaoyao powder combined with Erchen decoction.
8. 1. 1.4 Acupuncture treatment: soothing the liver and relieving depression, resolving phlegm and resolving stagnation [5].
Acupoint selection: the gallbladder meridian of foot shaoyang and the triple energizer meridian of hand shaoyang are the main points. Take Shoulder Well, Patio, Zhangmen, Fenglong, Elbow Tip and Ashi Point [5].
Match points according to the syndrome: If there is tuberculosis on both sides of the neck and under the armpit, add wind and cry. If tuberculosis occurs under the jaw and the neck is the former, arms and face should be added. If accompanied by chest pain, add Yanglingquan. Stay with me, I'll add Zhongwan and Zusanli. [5]
Acupuncture method: needle purging method, or moxibustion.
Prescription 1: Take the patio of the first Shaoyang meridian point to dredge the qi of the three meridians, relieve depression and dissipate stagnation, which is the experience point for treating scrofula. Jianjing point can dredge shaoyang meridian qi, thus achieving the functions of promoting qi circulation, dispersing stagnation and resolving phlegm. The head is the intersection of the meridian of foot shaoyang and the meridian of foot jueyin, and it is also the point of invigorating the spleen, which can not only relax the qi of the liver and gallbladder, but also resolve phlegm, dissipate stagnation and eliminate scrofula. Therefore, acupuncture A and B contain: "The head is mainly used to treat knife swelling and fistula". Red dragon can eliminate dampness, eliminate phlegm and disperse stagnation. The tip of the elbow is a very strange point, passing through the Shaoyang Meridian. Moxibustion can eliminate phlegm and dredge collaterals. There is an experience of "elbow tip failed to cure carbuncle, but it didn't collapse" in Experience Book of Ulcer. Ashi point dredges local qi and blood. [5]
8. 1.2 The syndrome of scrofula due to yin deficiency and excessive fire refers to the syndrome of yin deficiency and excessive fire, which is characterized by gradually enlarged nodules, adhesion to skin, dark skin color, hot flashes in the afternoon, night sweats, red tongue, less tongue coating and rapid pulse.
8. 1.2. 1 The symptoms of caking are getting worse, the skin is adhered and the skin color is dark red; See hot flashes, night sweats, coughing or bloody sputum all over the body, upset and insomnia; Red tongue, less fur and thready pulse.
It is more common in the metaphase of lymph node nucleus (abscess stage). The lump gradually increases, adheres to the skin, and the skin turns dark and red, accompanied by hot flashes and night sweats, and the tongue is red with little fur, with rapid pulse [5].
8. 1.2.2 dialectical analysis of lung and kidney yin deficiency, yin deficiency and excessive fire, body fluid burning as phlegm, phlegm combined with deficiency fire to form a mass; Yin deficiency and fire flourishing, then hot flashes; Deficiency heat forces body fluid to leak out, then night sweats; Deficiency fire hurts lung collaterals, so cough phlegm is bloodshot; Deficiency fire disturbs the mind, so it is upset and insomnia; Red tongue, less coating and rapid pulse are signs of yin deficiency and internal heat.
Liver depression turns into fire for a long time, which burns kidney yin if it is not treated in time; Or lung and kidney yin deficiency, can lead to yin deficiency and excessive fire, and the decoction of deficiency fire turns into phlegm, and the phlegm fire jumps in shaoyang and Yangming veins and binds to the neck and jaw, which leads to the aggravation of tuberculosis. Wet phlegm belongs to yin and is sticky. When it fights virtual fire, the skin of tuberculosis is dark red and adheres to the skin. Yin deficiency leads to excessive fire, internal steaming due to deficiency heat and forced fluid leakage, so hot flashes and night sweats are seen. Red tongue with little fur and rapid pulse are manifestations of yin deficiency and fire flourishing. [5]
8. 1.2.3 Recipe: Nourish yin and reduce fire.
Liuwei Dihuang Decoction and Qinggu Powder.
8. 1.2.4 Acupuncture treatment: nourishing yin and clearing away heat, resolving phlegm and resolving stagnation [5].
Acupoint selection: The acupoints of the Sanjiao Meridian of Shaoyang in the hand and the Kidney Meridian of Shaoyin in the foot are mainly selected, and Tianjing, Shaohai, Sanyinjiao, Taixi and Bailao are selected [5].
Acupoint matching according to syndrome: if accompanied by hot flashes and night sweats, add Yin ointment. For patients with cough, Legqog and Shu Fei should be added. [5]
Acupuncture and moxibustion: acupuncture combined with reinforcing and reducing method [5].
Fang Yi: Sanyinjiao and Taixi points use tonic method to nourish yin and reduce fire, which means "the master of strong water to control sunshine". Courtyard diarrhea can clear away heat, resolve phlegm, disperse knots and eliminate canthus. Bai Lao is a strange point outside the meridian, and Shao Hai is the meridian point with less yin in the hand. Both of them use the method of reinforcing and reducing diarrhea, which can tonify deficiency and reduce fire, stop night sweats, resolve phlegm and reduce turbidity, and are the experience points for treating scrofula. [5]
8. 1.3 scrofula of deficiency of both qi and blood refers to the common symptoms of deficiency of both qi and blood, such as sores, pus, blood stasis, thinness, listlessness, dull complexion, tender tongue, thin tongue coating and thready pulse.
8. 1.3. 1 After symptoms collapse or incision, pus is thin and drips endlessly, or the wound is gray, forming a sinus, which is not easy to close; Pale face, dizziness, mental fatigue, poor appetite; The tongue is red, the coating is thin, and the pulse is thin.
It is more common in the late stage of lymph node tuberculosis (ulceration stage). The purulent secretion of the wound is thin, cotton-wadded, emaciated, listless, dull, tender tongue, thin coating and thready pulse. [5]
8. 1.3.2 Dialectical analysis shows that the qi and blood are insufficient and cannot be fermented into pus, so the pus is thin and clear; Insufficient qi and blood, can not be proud of the face, then pale, dizzy; Spleen loses health, stomach is not fragrant, and mental fatigue; Red tongue, thin fur and weak pulse are signs of deficiency of both qi and blood.
For a long time, lymph node nuclei, local ulceration, pus, long-term unhealed. At this time, the evil toxin has declined, the healthy qi has been consumed, the qi has no owner, the blood is lifeless, and both yin and yang are deficient. Therefore, although the sore bursts out, the pus is clear and thin, and there is a failure. After a long illness, qi and blood are exhausted, the body is undernourished, and the spirit is not full, so it is thin and tired. Both qi and blood are deficient, and you can't be proud of your face, so your face will be dull. The tongue is tender, the coating is thin, and the pulse is thin, all of which are manifestations of deficiency of both qi and blood. [5]
8. 1.3.3 Prescription treatment: supplementing qi and nourishing blood.
Jiawei Xiangbei Angelababy Soup.
8. 1.3.4 Acupuncture treatment: supplementing qi and nourishing blood [5].
Acupoint selection: The stomach meridian of Foot Yangming and spleen meridian of Foot Taiyin are the main points, and Zusanli, Sanyinjiao, Gaojia, Bailao, Qihai and Shu Ge are selected [5].
Match points according to syndrome: Taohe and Taixi points are added for those with deficiency heat [5].
Acupuncture moxibustion: acupuncture tonic or moxibustion [5].
Formula 1: Zusanli and Sanyinjiao points strengthen the source of qi and blood biochemistry. Ointment and efforts can cure all diseases and various deficiencies. Shu Ge is a blood association, combined with Qi and the sea, which can tonify deficiency of both qi and blood. Sea moxibustion plus plaster can replenish vitality, strengthen the body resistance and eliminate pathogens, remove putrefaction and promote granulation. [5]
8. 1.4 lung and kidney yin deficiency refers to lung and kidney yin deficiency, which is characterized by nodules and poor mobility. After a long time, the skin turns dark red, pus festers, pus is thin, and sinus is formed, accompanied by thinness.
8.2 External treatment: Yang Xie Ning ointment is used for those who have not collapsed, and Dan medicine or Shengji powder is used for those who have collapsed [1].
At the initial stage, the local caking can be smeared with Chonghe ointment or Yanghe Ning Jie ointment mixed with black, and then it can disappear.
In the middle stage, use Chonghe ointment externally, and use Qianchong ointment when the pus is immature. If the pus is ripe, it should be cut and discharged, and the wound should be big.
In the later stage, Qi San Dan or Ba Er Dan mixed with cotton wool was wrapped in the ulcer, and red ointment or Chonghe ointment was used externally. If granulation is red and pus rot is exhausted, Shengjisan and White ointment can be used instead. If there is a cavity or sinus, the necrotic tissue can be removed by using the golden thread or surgical method.
Nucleation therapy: suitable for small swollen nuclei that cannot be internalized. Those who are in good health. Mix a little plumbum preparatium with Taiyi ointment, cover it and stick it on the caking place. Every 3 days 1 time, the nodules will fall off in about 7 days, and the lumps can be pulled out in about 10 days. After tuberculosis falls off, Shengjisan and White ointment can be used instead. Because the drugs used are very strong, we must strictly control the indications when using them. This method is not suitable for people with large and deep lumps, or people with adhesion to surrounding tissues, or elderly and weak people.
8.3 Acupuncture treatment acupuncture treatment of this disease has a certain effect, of which fire needle and moxibustion treatment are more satisfactory. However, the fire needle should not be too deep, and it is recorded in Acupuncture Dacheng that "it should not be too deep, for fear of hurting meridians", so it should be cautious [2].
For those who have suppurated, it is not appropriate to directly acupuncture locally; For those who have been broken, they should cooperate with external application drugs; For those who don't keep their mouths shut for a long time, local mild moxibustion is beneficial to wound convergence [2][2].
During the treatment, we should strengthen nutrition, pay attention to rest and avoid overwork [2].
8.3. 1 Body acupuncture mainly selects points such as patio, Bailao, elbow tip, etc., and garlic-separated moxibustion is used locally in lymph node nucleus [2]. For patients with cervical lymph node tuberculosis, the arm diaphragm should be inserted into Quchi and Shousanli; Hurricanes, branchial grooves and foot crying are added to the patients with ear and neck lymph node tuberculosis; For patients with axillary lymph node tuberculosis, Jianjing, Shaohai and Yangfu points are added [2].
Puncture the tumor directly, with Ganshu and Shu Ge, 1 time, daily, medium * * *. Not suitable for suppuration.
8.3.2 Fire needle prescription 1: After heating, the fire needle penetrates into the core from the center of tuberculosis, each core 1 needle, every 2-3 days 1 time [2].
Fang 2: Shoujing, Tianjing, Shousanli, Zusanli, and Nodules. According to the operation method of fire needle, 2 ~ 4 acupoints are selected at a time, and the method of quick needling and quick exit is adopted, 1 time per week, and 3 ~ 5 times are 1 course of treatment. [5]
Prescription 3: Take a local lesion. If the mass is nodular, puncture 1 needle at the upper, middle and lower parts of the earliest or largest nodule, so as to puncture the core or basal part quickly; If the lump has festered and not festered, you can use a thick-handled fire needle to directly stab the center of the lesion and drain the pus as soon as possible; For those that have been broken, use a fire needle to shallow stab at 0.5cm around the break; When the sinus cavity oozes to form a fistula, directly puncture the lumen with the corresponding long fire needle. Every week 1 time, 3 ~ 5 times is 1 course of treatment. [5]
8.3.3 Method 1: Look for the tender points of red spots or rice grains on both sides of the back below the scapular angle, which are slightly higher than the skin, and puncture the roots of subcutaneous fibrous objects with a thick needle to pick them out [2]. 65438 +0 times every 3 ~ 5 days [2].
Formula 2: first, look for tuberculosis points under the scapula and on both sides of the spine (slightly higher than the skin, red in color and indelible in finger pressure) for treatment; It can also be selected and treated in Jianjing, Shu Fei and its vicinity.
Recipe 3: Take a positive sitting posture and look for the positive reaction point from the interval of 6 ~ 9 sides of the chest 1.5 inches. Routine disinfection, local anesthesia, using a scalpel to cut the skin horizontally about 0.5cm, and then using a sterile triangular needle to pick out the white fibers at the incision one by one until they reach the fat. After operation, the incision was sutured, coated with iodine, covered with sterile gauze and fixed with adhesive tape. Weekly 1 time, 1 time is 1 course of treatment, and the interval is1week. This method is suitable for nodular stage, and it is forbidden for those with skin inflammation. [2]
8.3.4 Shu Ge and Ganshu are selected as cutting methods. After disinfection, the epidermis of acupoints was cut with a scalpel with a length of 1 ~ 2 cm under local anesthesia, and a little subcutaneous fat was taken out and sutured after operation [2]. Weekly 1 time, each time 1 log integral [2].
8.3.5 Scar moxibustion takes scrofula point (positioning: based on the length of the horizontal bar from the end of the patient's middle finger to the elbow, measure it from Changqiang point along the midline of the spine to the end of the standard length, and then draw a horizontal line perpendicular to this line, whose length is based on the patient's spat spacing, and the horizontal line is equidistant from left to right, and its end point is scrofula point), and operate according to the scar moxibustion procedure. The size of soybean grains used for moxibustion is 5 ~ 10 Zhuang, and boric acid ointment is applied externally after moxibustion to prevent infection. Every moxibustion 1 time needs an interval of 2 months. [5]
8.4 Anti-tuberculosis treatment The duration of regular anti-tuberculosis treatment is about 1 year. Isoniazid 65438 can be taken orally for 0 ~ 2 years, or combined with streptomycin 1 ~ 2 months by intramuscular injection.
Daily health care for patients with Jiuzichuang 1. Keep cheerful, strengthen exercise and enhance physical fitness.
2. Increase nutrition appropriately and avoid spicy food.
3. Actively treat tuberculosis lesions in other parts.
10 medical case 1. I am four years old, the king of Shangshu, Xi Weng Naiai, suffering from nuclear swelling and neck pain, and the medicine has not been cured. I was asked to ask him why. Neck disease has its own place at the intersection of the original collateral, well and Shu. Take the original point and stab it, and the consequences will heal with the needle. The stronger the moxibustion, the worse it will be. Generally speaking, the neck is the place where meridians meet. If there is nuclear swelling, it is not a good sign. If you don't get to the root of it, you will inevitably run away with moxibustion. Patients should be cautious. (Acupuncture Dacheng)
Example 2. Zhang XXX, male, 17 years old. The acute attack of left cervical lymph node nucleus caused high fever, the mass diameter was 1.5cm, the white blood cell count was 13.8× 109/L, and the white blood cell classification count was 0.85. The patient's mind is clear, her pulse is slippery, and her fur is thin and white. The combination of pulse condition and ginseng is formed by the combination of shaoyang wind-heat and fainting depression. Treatment: Take the wind shoulder well at Shaoyanghui point of hand and foot, and keep the needle for a long time by purging method to dispel wind and heat and disperse depressed fire; Then take the method of acupuncture at the experienced point to disperse the knot and unblock the collaterals. After 8 treatments, the tumor obviously softened and shrank. After two courses of treatment (acupuncture 12 times per course), the lump completely disappeared and recovered. (Collection of Ancient and Modern Acupuncture Medical Records)
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