It is generally believed that "the front is called the neck, and the back is called the nape." This section only discusses sore and ulcer of the neck. Goiter, tumor, and scrofula are not within the scope of this section; for details, see the relevant section.

bubble_chart Pattern Analysis

1. Liver-Stomach Heat Accumulation︰Initially, a hard lump resembling a chicken egg appears beside the neck, white or slightly red in color, diffusely swollen and firm, with burning heat and pain, alternating chills and fever, headache, neck stiffness, yellow and greasy tongue coating, and slippery, rapid pulse. If treated promptly, the heat may subside and the swelling may dissipate. However, if the fever persists for seven to ten days, the skin gradually turns red, swelling and pain intensify, and the pain feels like being pecked by a chicken, indicating the formation of pus. After rupture, thick yellow-white pus is discharged, the swelling subsides, and the pus diminishes, eventually leading to healing. This condition is often caused by external contraction of wind-warmth pathogens combined with phlegm-turbidity obstructing the Shaoyang collaterals. Symptoms include egg-sized lumps on both sides of the neck, slightly red, diffusely swollen and firm, with burning heat and pain, alternating chills and fever, yellow and greasy tongue coating, and slippery, rapid pulse.
2. Lung-Stomach Fire Toxin︰Initially, there is redness and swelling around the throat, with a diffuse base, hardness, burning pain, high fever, thirst, headache, neck stiffness, yellow and greasy tongue coating, red tongue body, and wiry, slippery, rapid pulse. The swelling may extend to both sides of the neck, even reaching the cheeks above and the chest below, potentially involving the throat and complicating into throat wind or carcinoma of the tongue, making it difficult to swallow liquids. There may also be excessive phlegm, shortness of breath, convulsions, or syncope. With treatment, if the base gradually contracts, the swelling subsides, and pus forms easily, or if after pus discharge, the pus is thick and yellow, the fever subsides, and the swelling diminishes, these are considered mild cases. However, if the base remains diffuse, the swelling becomes flat and dark red, pus formation is difficult, or after pus discharge, the pus is thin, the wound has hollow spaces, or the infection penetrates inward toward the throat, these are severe cases with slow healing. This condition is often caused by warm pathogens transforming into fire toxin, which ascends along the meridians and accumulates in the throat, leading to a rapid and dangerous progression. **Key diagnostic points**: Redness and swelling around the throat, diffuse base, hardness, burning pain, high fever, thirst, yellow and greasy tongue coating, red tongue body, wiry, slippery, rapid pulse. - For liver and stomach heat accumulation, treatment should focus on dispersing wind, clearing heat, reducing swelling, and removing toxin. Lonicera and Forsythia Powder or Burdock Muscle-Relieving Decoction may be used. - For lung and stomach fire toxin, treatment should focus on dispersing wind, clearing heat, and removing toxin. Universal Relief Decoction for Eliminating Toxin with Rhubarb Rhizoma may be used. If there is panting, phlegm congestion, or syncope, fresh bamboo juice or radish juice can be added to clear phlegm and resolve fire. For both patterns, when pus forms, the above methods can be supplemented with pus-promoting herbs such as pangolin scales or Gleditsia spine, or combined with Pus-Draining Powder. After ulceration, medication is generally unnecessary. **External treatment**: - Before ulceration: Apply Jinhuang ointment. - When pus forms: Incise to drain pus. - After ulceration with abundant pus: Use Wuwu Dan. - When pus is drained: Apply Granulation-Promoting Jade and Red Paste.
3. Liver Depression and Blood Stasis︰On both sides of the neck (left or right), lumps form like peaches or plums, or like chicken eggs, gradually enlarging and hardening like stone, with unchanged skin color, causing tendon pain but no inflammation. They are difficult to resolve or ulcerate, and even if ulcerated, they are hard to heal. This is mostly caused by liver qi depression, leading to stagnation of qi and blood in the meridians. The onset is relatively rapid, with dull pain from the beginning. Treatment should differentiate between deficiency and excess: for those with strong constitutions, it is advisable to soothe the liver and relieve depression, promote blood circulation, and dissipate nodules, using the Liver-Soothing Promoting Suppuration Decoction; for those with weak constitutions, it is advisable to warm and tonify qi and blood, using the Ten Major Tonics Decoction. For unulcerated cases, apply Yang-Harmonizing and Stasis-Resolving Plaster externally; for ulcerated cases, use Granulation-Promoting Jade and Red Paste externally.
4. Liver Depression with Phlegm Coagulation︰It initially appears as a swollen lump on the neck or around the ears, resembling a chestnut in shape, with a protruding top and deep roots. It feels neither hard nor soft to the touch, immovable, with unchanged skin color, no heat, and no pain. Over half a year or a year, the lump gradually enlarges, accompanied by vague pain, and local purplish spots appear, soon leading to ulceration. Upon ulceration, it only discharges foul-smelling bloody fluid, and despite decay and ulceration, the hardness persists, with the swelling and firmness increasing. The ulcerated area gradually enlarges, becoming uneven like rock, or bleeding in a jet-like manner. At this stage, the pain becomes excruciating, radiating to the head, causing sleepless nights, chest tightness, dysphoria, and a dull complexion, leading to emaciation. In severe cases, it may gradually result in exhaustion of qi and blood. This condition is mostly caused by excessive worry, anger, qi depression, blood counterflow, and the congealment of phlegm-fire in the Shaoyang and Yangming meridians. Key points of differentiation: the onset is slow, initially painless, with pain developing over time. In the initial stage [first stage], treatment should focus on clearing liver heat, relieving depression, resolving phlegm, and dispersing hardness. Xiaoyao Powder with additions such as moutan bark, gardenia, seaweed, and kelp can be used. If the lump persists without resolution, leading to damage of both qi and blood, treatment should aim at tonifying qi, nourishing the nutrient system, tranquilizing the mind, calming the spirit, and relieving depression to disperse stagnation. Internally, Heying Sanjian Pill can be taken, and externally, Taiyi Plaster can be applied. If purpura appears, switch to Hongling Dan Ointment. After ulceration, with continuous discharge of bloody fluid and exhaustion of qi and blood, treatment should primarily focus on tonifying and nourishing qi and blood. Internally, Returning to Spleen Decoction or Xiangbei Yangying Decoction can be taken, and externally, Haifu Powder mixed with Granulation-Promoting Jade and Red Paste can be applied. Additionally, whether ulcerated or not, Minor Golden Pill and Wake-Up Subsiding Pill can be taken in combination.

bubble_chart Documentation

1. Waike Dacheng．Neck and nape: "Throat-locking toxin, sudden swelling and pain in the neck and nape, like the condition of a stiff neck, which over time becomes red and spreads around the shoulders and back, hard and difficult to dissipate. Caused by external invasion of wind-heat due to excessive drinking in obese individuals. Treatment should focus on clearing summerheat and dispersing wind. Throat abscess, occurring in the center outside the throat, also known as ominous abscess of throat, pertains to the Ren meridian and the three meridians of the hand taiyang and shaoyin, caused by grief and anger. Suitable treatments include Coptis Rhizome detoxification drink and health-preserving powder. Lingshujing says, 'If pus is not drained, it will block the throat, leading to death within half a day,' thus it is advisable to needle to release the toxin and take tonifying and supporting agents. Even if it ulcerates and discharges fluid, it can still heal. Moxibustion at the Shaohai point seven times is also effective."