Two Ancient Formulas Showing Forsythia's Role in Treating Enlarged Lymph Nodes

Lianzhao (Forsythiae Fructus) is known as the "divine herb for sores and swellings" and is the first choice of TCM external medicine for treating tumoral sores. Traditional TCM holds that lianzhao clears heat and resolves toxin, disperses swelling and dissipates nodules, and scatters wind-heat. Modern pharmacological research shows lianzhao has anti-pathogen, anti-infective, antipyretic, anti-inflammatory, antioxidant, anti-tumor, liver-protective and antiemetic effects.

Luoli (scrofula), popularly called "rat sore," is a TCM disease name referring to enlarged lymph nodes strung along the neck. The enlarged nodes are palpable, with or without pain; the larger ones are called luo and the smaller ones li, together luoli. It is generally caused by infection or tumor; in ancient times both modern lymph-node tuberculosis and primary or secondary lymph-node tumors were collectively called luoli. Luoli is often accompanied by prolonged low-grade fever, so using lianzhao for luoli is well matched to the pattern.

There are many formulas in the classical TCM literature for luoli, quite a few of which contain lianzhao; two examples follow. The first is "Muli San" from the Imperial Benevolent Prescriptions (Shengji Zonglu); the second is "Zaozi Wan" from the Prescriptions for Succoring the Sick (Jisheng Fang).

Muli San is composed of: muli (Ostreae Concha, calcined and ground) and lianzhao (stir-fried yellow on tiles), each 1 liang (30 g). The herbs are ground into a fine powder. Each time take 1 qian (3 g), mixed and taken with unfiltered wine before bedtime. This formula softens hard masses and dissipates nodules; it is indicated for luoli.

Zaozi Wan is composed of: zaojiazi (Gleditsiae Fructus) 5 liang (150 g), and xuanshen (Scrophulariae Radix) and lianzhao, each 1 liang. Steep the herbs in 1 sheng of water, then simmer over low heat until the water is gone. Pick out the hardened, cooked gleditsia seeds, pound them, and use refined honey as a binder to make pills the size of a hazelnut. Take 3 pills each time, after meals and before bed, 2–3 times daily. This formula clears heat and resolves phlegm, softens hardness and dissipates nodules; it is indicated for luoli covering the whole neck without rupturing, and for tubercular swelling and pain—here "luoli covering the whole neck" means enlarged lymph nodes all over the neck.

Both formulas use lianzhao, and lianzhao is among the principal acting herbs in each; their indications are basically the same, and such use is worth our reference. Note here the zaojiazi: this herb is rarely used today, mainly because gleditsia has side effects—it can cause acute gastrointestinal events, nerve paralysis and other adverse reactions, and can also produce hemolysis. In today's medical environment, such unsafe Chinese herbs are gradually being phased out.