《仙传外科集验方》

The Collected Tested Prescriptions for External Conditions from the Immortals’ Traditions is a medical text gathering surgical disorders and their treatments. It is included in the Scriptures on Nourishing and Preserving Life from the Great Clarity, part of the Chinese Daoist Canon.

The book is divided into eleven volumes. The first discusses abscesses and carbuncles, including sores on the back, and introduces ways to adapt medication during treatment. Volumes two through four cover warming, hot, and cooling medicines for external application. The fifth compiles practical treatments for abscesses and carbuncles. The sixth describes treatments for various furuncles. The seventh addresses scrofula, throat disorders, and bites from rabid dogs. The eighth presents prescriptions and theories concerning various abscesses and sores. The ninth explains the symptoms of sores on the back. The tenth discusses treatments for assorted illnesses and includes material attributed to Hua Tuo on detoxification, cold damage, and emergency treatment for miscellaneous disorders. The eleventh is an appendix on treatments for miscellaneous illnesses.

The preface begins by saying that when the author was young and studying, he once heard a worthy from an earlier generation say: “A child must not…”

When I was young and studying, I once heard the wise men of earlier generations say, “Children ought to know medicine.” So whenever I came across a good medical book or prescription, I liked to copy it down, and over time I accumulated dozens of volumes. When I saw someone ill, I always felt as if I were ill myself, and I often prepared medicines to give to the sick.

One day my father instructed me: “Rather than give someone medicine, give them the prescription. That way you can help more people.” From then on, whenever I came across a prescription that truly worked, I made a point of sharing it with people who were generous and eager to do good.

Later, I withdrew into the Daoist tradition and set aside what I had learned in earlier years. I also lived through many upheavals, and most of my old collection of books was destroyed. Only one volume remained: Collected Proven Prescriptions for External Medicine, compiled by Yang Qingsou of Hechuan. He passed the book to Wu Ningji; Ningji’s son Youzhang then passed it to Master Li Shanguan of Xiping, who in turn passed it to me, Zhao Yizhen. The prescriptions in this book are concise and practical. Sadly, it had never been printed, and so it survived in my hands alone.

Some time ago, I traveled to the blessed site of Jinjing and passed through Yudu. My disciple Xiao Tianni, whose Daoist name is Fenggang, came from a prominent family in Xichang. He had studied the Dao at Ziyang Abbey from childhood for twenty years, and earlier had traveled with me as a student. He was also able to pray for wind and rain and bring relief from drought and flooding. This was probably because his ties to the Dao ran deep and his practice was upright and disciplined. His junior fellow disciple, Liu Zhirou, whose Daoist name is Shunchuan, had been covered in boils for several years. Medicines such as Jinghuang Decoction and Toxin-Dispelling Powder had done him no good. I gave them the book of external medicine prescriptions, and Liu Zhirou recovered before he had even finished one dose of the Soul-Restoring Decoction. Xiao Tianni was so pleased that he paid to have the book carved and printed, then distributed it widely. Given how earnestly he helps others, it is no surprise that his prayers for wind and rain are answered.

Yet an old friend of mine once suffered from “drum-and-spindle wind,” with alternating chills and fever that kept him bedridden for months. Many doctors failed to cure him. At last, one doctor diagnosed him: “Though this has become a chronic illness, an external pathogenic factor remains unresolved in the Shaoyang channel. If he has taken Five Accumulations Powder, that was the wrong medicine.” When asked, my friend confirmed that he had. The doctor gave him several doses of Minor Bupleurum Decoction, and the chills and fever soon subsided. He then used prescriptions from this book, including Wind-Chasing Pills, to treat the wind disorder, and my friend eventually recovered.

There are prescriptions for the various miscellaneous illnesses, while cold damage illnesses have their own methods of treatment. Only someone who understands both can be called a good physician. If a doctor specializes in just one area, whether general internal medicine or external medicine, they may treat an unfamiliar illness incorrectly without realizing it. How could such a doctor be considered fully competent? This book on external medicine explains how to distinguish illnesses and lists prescriptions in great depth, surpassing other collections of prescriptions in particular. Even so, a doctor must judge each case flexibly and be especially careful when examining a patient.

Written on the first day of the ninth month in the Wuwu year of the Hongwu era by Zhao Yizhen of Junyi, Daoist name Yuanyangzi.

The art of medicine has a long history. Since the time when Shennong, the legendary ruler of high antiquity, personally tasted every kind of herb and distinguished medicines by their warm, cool, cold, and hot properties, using them to treat the people and keep them from dying young of illness, medicine has performed a great service. Later, Bian Que and Hua Tuo became the most accomplished physicians. Their methods were astonishingly effective, but regrettably, their skills were not passed down in full. The external medicine practiced today is only a part of what ancient medicine left behind.

Among external ailments, yongju—suppurating swellings between the skin and muscles—are the most serious. Ju can further be classified as Yin or Yang, and as deficient or replete. The slightest mistake in choosing a medicine may immediately endanger a patient’s life. Next in severity are conditions such as ding sores and throat diseases, which can also readily prove fatal. Many people practice external medicine, but few truly master it.

Zhao Lianshi of Yuanyi in Junyi, known for his command of Confucian learning, inherited his family tradition from Laozi and his Daoist teachings. His Daoist cultivation was pure and lofty, far surpassing that of his peers, and he had always kept the relief of others at heart. He gathered unusual medical recipes he had collected over the years and compiled them into a book. The manuscript was later lost amid the upheavals of war; only the recipes for external medicine survived.

In the autumn of the Wuwu year, he traveled through Jinjing with this book and lodged at Ziyang Abbey in Yudu. Twenty years earlier, he had taught Daoist methods there to the abbey’s accomplished adept, Xiao Fenggang. On this return visit, he also cured a longstanding sore that had afflicted Xiao Fenggang’s disciple, Liu Shunchuan. Xiao Fenggang then resolved to fund the printing of the book, so that Zhao Yuanyi’s wish to aid people in distress and save them from danger might be widely carried forward.

Yudu was remote, and it was difficult to find skilled block carvers, so the project was delayed. In the fifth month of the summer of the Renxu year, Zhao Yuanyi passed away. On his deathbed, he charged his disciple to fulfill his wish to publish the book and to compile the secret remedies he had taught into a single volume. Zhao Yuanyi wrote the account, and Xiao Fenggang donated the funds for printing; both acted with great generosity.

Once published, this book can treat patients in critical condition and help people respond to sudden illness. If children obtain it, they may be able to treat their parents in time and avoid the regret of having failed in their filial duty. If physicians obtain it, they may avoid letting down their humane wish to save lives through a lack of effective remedies. The intentions of benevolent people and filial children are both entrusted to this book. I have therefore written this preface in the hope of honoring the labor of its compilers.

Preface written by Youlan Fu Hao Ren of Luling in the Yangfu month of the Hongwu era, the eleventh lunar month in which the winter solstice falls.

Note: In the manuscript, the character rendered here as “kuang” is written as “chen.”

External medicine places abscesses and carbuncles—suppurating swellings in the skin and muscles—at the head of all illnesses because their condition may change sharply in a short time, putting life at risk in an instant. Though abscesses and carbuncles have more than twenty names, the key is to distinguish Yin patterns from Yang patterns. Those that arise as Yang are called abscesses and generally show heat and excess; those that arise as Yin are called carbuncles and generally show cold and deficiency.

In a Yang pattern, the skin is usually thin and red, the swelling raised, and the surface often dotted with many small pits like peppercorn holes. The pain is pronounced. In a Yin pattern, the skin is thick and pale, and the swelling is hard, like the hide on an ox’s neck, but not very painful. There are also cases between the two. Some seem hot but are actually weak: though red and swollen, they are not dry; they seem about to hurt but produce no pus; the swelling rises and then subsides. They look severe on the surface, yet the tissue within has already decayed. Other cases seem cold but in fact have excess heat within: the swelling is not obvious, and is slightly red and dry, yet there is pus and pain. They look mild on the outside, while within there is distress and discomfort. The first type, “Yin within Yang,” is commonly found in people who are overweight, with firm muscles but internal weakness. The second, “Yang within Yin,” is commonly found in people who are thin, with slack muscles but internal excess pathogens.

The ancients held that Yang patterns turning into Yin patterns were often caused by physicians’ indiscriminate use of cold medicines. Yin patterns turning into Yang patterns might result from suddenly using warming, hot medicines. Yang turning into Yin is more common and may still turn back into a Yang pattern, so more patients survive. Yin turning into Yang is rare and often difficult to reverse, so deaths are more frequent. When a patient does survive, it is sometimes because the physician happened to choose the right medicine.

What is called “eruption” occurs when pathogenic influences accumulate inside the body and then manifest on its surface. The five Zang organs are the body’s foundation, and the Qi of all five depends on stomach Qi. The stomach receives food, and the Spleen transforms it into Qi. The Spleen governs the muscles; stomach Qi then carries nourishment to the five Zang organs and drives the blood through the body’s channels. Though abscesses and carbuncles may involve deficiency or excess, cold or heat, their underlying cause is always related to stagnation in the movement of Qi.

Causes are broadly divided into internal, external, and those that are neither internal nor external. The ancients distinguished them by the pulse: a point one fen before the barrier position on the left wrist, called “Renying,” was used to observe internal causes; a point one fen before the barrier position on the right wrist, called the “Qi mouth,” was used to observe external causes. If the pulses at both points were even and calm, the cause was considered neither internal nor external. There are also five kinds of root causes: seasonal epidemic Qi; emotional constraint caused by the seven emotions; bodily weakness combined with exposure to external pathogens; exposure to wind and cold while feverish; and consuming roasted foods, strong liquor, or hot, toxic substances such as alchemical minerals.

These factors cause pathogenic Qi to stagnate in the stomach. In people with abundant stomach Qi and a strong constitution, pathogens clash with the body’s healthy Qi, flow into the channels, obstruct the blood vessels, and gather to form an abscess. In people with weak stomach Qi and a deficient constitution, pathogens readily remain in the channels, causing the blood vessels to congeal and become sluggish. The muscles then decay from within, forming a carbuncle. Ancient texts describe this process vividly: something that looks no larger than a millet grain on the outside may hold a grain of rice within; something only the size of a coin on the surface may be large enough inside to fill a fist. If a malignant sinus extends several inches deep, and pus and blood have dried and congealed, it may still be treated with medicine. But if there is a foul stench and no trace of blood, this means the blood has decayed and Qi has weakened; the bowels and viscera have lost their function, and Yin pathogens are at their extreme, making treatment very difficult.

Treatment must be based on the person’s deficiency or excess and the illness’s cold or heat, with careful investigation of its cause and root. It cannot be applied indiscriminately. When heat in a Yang pattern is intense, the movement of Qi should be regulated and the flow of blood harmonized. When Qi flows smoothly, pathogenic toxins can disperse; when blood circulates, stagnation can be resolved. Qi belongs to Yang and blood to Yin; the condition can settle only when Yin and Yang are in harmony. Cold medicines may be used externally, but once the heat has subsided, the blood may congeal because of the cold treatment. This can gradually turn a Yang pattern into a Yin pattern, becoming the root cause of tissue death and ulceration. The method of treatment must then be adjusted promptly: open the blood pathways around the affected area, drain the pus and toxins that have formed, and then treat the wound according to the appropriate method.

When a Yin pattern is severely cold, internal medicines should mainly provide gentle nourishment, helping Qi flow freely, nourishing blood, supporting healthy Qi, and warming the original Yang. The Spleen and stomach must also be protected. Once appetite returns and the spirit improves, Qi and blood can be regulated as usual. External treatment should use warming methods to move Qi and blood throughout the body, restore vitality to tissues that have lost it, and drive out pathogenic toxins. Warming medicines can then be used to disperse the pathogens. If the cold pattern is extremely severe, or has been mistakenly treated with cold medicines, the “Three Jian”—a class of hot medicines used in antiquity to restore Yang and rescue the patient—may be needed to support Yang. If the illness then reappears in a nearby area, the ancients considered this a possible sign that Yin was turning into Yang and that life was returning. If the Yang within has not recovered and there is no outward improvement, however, this was taken as a sign of severe Yin-Yang imbalance and a poor chance of recovery.

Yang represents Qi and Yin represents blood; blood moves only when Yang Qi is active. If Qi does not move, blood stagnates. When blood stagnates, the muscles are deprived of nourishment and die, and the illness worsens. Hot medicines are used for cold patterns mainly to set Qi and blood in motion: the ancients held that warmth makes Qi and blood flow, while cold makes them stop.

The text also stresses that, whether cold or hot medicines are used, prescriptions such as frankincense and bean flour should first be given to protect the heart and the membrane. “Membrane” here refers to the tissues that enclose and protect the organs. When an abscess or carbuncle first arises, pathogenic toxins may attack the pericardial network from above. Vomiting may therefore occur first, followed by the eruption, or the eruption may appear first, followed by vomiting. Without prompt treatment, the toxins may attack the domain governed by the heart, leaving the spirit without support and the original Qi clouded and depleted. If the toxins then penetrate the protective membrane, original Qi leaks away, the organs are deprived of nourishment, the spirit withers, and the pulse weakens. Thus, some patients survive despite very severe illness because their organs have not been damaged and the protective membrane remains intact. Others die despite an illness that seems mild because the muscles have not yet ulcerated, but the membrane has already been damaged. Protecting the heart and safeguarding the organs first is the foremost principle of treatment.

The text calls these prescriptions secret formulas transmitted by immortals, and regards their methods as subtle and unlike the ordinary practice of herbal healers, who treat illness only with single herbs, acupuncture, or knives. It cautions those who learn the essential principles to treasure and preserve them.

Rongwei Rejuvenating the Soul Decoction, also called Tongshun Powder or He Shouwu Powder, consists of nine ingredients in equal amounts: He Shouwu, Angelica, Akebia stem, red peony root, Angelica dahurica, fennel, earth-grown lindera root, aged bitter orange, and licorice. He Shouwu must not come into contact with iron. Remove the outer bark and nodes from the Akebia stem. Stir-fry the red peony root, fennel, and earth-grown lindera root. Do not stir-fry the Angelica dahurica. Coat the aged bitter orange in flour and stir-fry it. If nausea occurs after taking the decoction, stir-fry the licorice in ginger juice.

When preparing and taking it, use water, wine, or another decoction as appropriate to the condition; water and wine may also be mixed in equal parts. To treat “wandering stagnation”—an illness in which pathogenic factors move through and lodge in places such as the muscles or joints—add Japanese angelica root. Take four qian per dose. For illness in the upper body, take it after meals; for illness in the lower body, take it before meals.

This medicine treats migrating sores, carbuncles and deep abscesses, sores on the back, and injuries from falls or blows; without it, these conditions are difficult to cure. It can rescue patients whose illnesses have worsened and restore vitality to necrotic flesh. It can also eliminate trouble before it arises and remove the root of an illness after recovery. The formula’s chief, assistant, supporting, and guiding herbs—the roles assigned to different medicines in a prescription—work in turn like the four seasons and the Five Phases. Herbs can be added or removed according to the condition, and the formula’s effects are too numerous to describe fully. This is because the medicine is especially effective at regulating the movement of Qi and harmonizing the blood.

Qi belongs to Yang, and blood belongs to Yin. When Yang Qi moves, Yin blood follows; when Qi circulates, blood flows as well. When Yang Qi is obstructed, Yin blood congeals; when Qi is weak, blood loses its vitality. When blood loses its vitality, the flesh becomes necrotic; once the flesh is necrotic, the condition is difficult to save. Yang Qi must therefore be regulated and Yin blood harmonized so that Qi and blood remain balanced; neither can be neglected.

Regulating Yang alone without harmonizing Yin depletes Qi and causes blood to stagnate, making it difficult for the flesh to regain its vitality. Formulas such as Wuxiang Lianqiao are of this kind. Harmonizing Yin alone without regulating Yang may leave the blood abundant but Qi weak, making the illness prone to return. Formulas such as Neibu Shixuan are of this kind. These two types of formula can, however, be used together; one should not cling rigidly to a single method. This medicine supports the foundation of the Spleen and Stomach without damaging the original Qi. It also clears away pathogenic impurities, allowing Qi and blood to flow freely without causing other changes. It is indeed a remarkable formula. Detailed instructions for its use follow.

An abscess on the back (fa bei) that has persisted for a long time without healing may have been caused by the previous physician’s excessive use of cold medicines. Cold medicines can damage the Spleen and Stomach and obstruct the circulation of blood at the body’s surface. The Spleen governs the muscles. When it is weakened, appetite declines, the complexion becomes haggard, and the muscles struggle to grow back. Blood circulates through the channels and collaterals. When cold congeals the blood, Qi becomes weak and the muscles may ulcerate. Treatment should therefore begin by regulating the Spleen and Stomach: when Spleen Qi is strong, the muscles can recover more readily. For this prescription, one may omit Mutong, use less Danggui, and double the Houpo and Chenpi. If the condition is more severe, one may use the family recipe “Dui Jin Yin Zi”; for an even more serious case, add herbs such as Baidoukou.

When treating a spreading abscess (liuzhu), a condition involving stagnant Qi and blood with localized swelling, pain, or lumps, Duhuo may be added. Liuzhu arises when Qi and blood do not circulate smoothly: Qi flows but meets an obstruction, and blood then gathers and stagnates. Adding Duhuo is intended to promote the circulation of Qi and blood through the channels throughout the body. Once the blood vessels are moving freely, liuzhu is less likely to continue forming.

Duhuo may be added when treating liuzhu. Liuzhu is a manifestation of stagnant Qi and blood: Qi’s movement is obstructed, and blood then gathers and congeals. Duhuo is added to promote the circulation of blood throughout the body; when the blood vessels flow freely, liuzhu is less likely to form again.

A liuzhu (liúzhù, a deep swelling and pain from residual cold-evil and toxins lodged in the channels) arises from shanghan (shānghán, cold damage). When the external evil of shanghan has not been fully resolved, the leftover pathogen flows into the channels of the limbs, stagnates, and fails to disperse, and in time forms a liuzhu. If the patient still has intermittent fever, cold-evil has not fully left the body, and shengma (shēngmá, cimicifuga) and suye (sūyè, perilla leaf) may be added to the original formula. If the fever persists after taking the medicine, gegen (gégēn, pueraria root) may be added. If there is headache, chuanxiong (chuānxiōng, ligusticum) may be added, and the decoction is taken with ginger soup. If there is no intermittent fever, the medicine may be decocted in equal parts water and wine, because wine helps move the blood and promote qi. When qi moves smoothly and blood circulates freely, recovery can be expected.

Why should liuzhu still be treated by dispersing the external evil? The purpose is to trace the cause, clarify the source of the illness, and never lose sight of the root. Once cold-evil has been fully dispelled, excessive dispersion will instead produce a "cold liuzhu," which is harder to treat, so dispersion should be moderate. After dispersion, the second stage calls for mild tonifying medicines, such as those of the shixuan neibu (shíxuān nèibǔ, Ten Diffusions Internal Tonic) type. If the effect is poor, fuzi (fùzǐ, aconite) may be added in the third stage, or several doses of sizhu san (sìzhù sǎn, Four Pillars Powder) may be given, and the medicine should be stopped once the effect appears. Warming medicines should also not be used in excess, or they will aggravate the suffering and make it hard for pus and blood to drain cleanly. The fourth stage returns to the original formula.

If the external evil is not completely resolved, the leftover pathogen may attach to the bone and form guyong (gǔyōng, bone carbuncle). Liuzhu is the residual toxin after shanghan; guyong is the condition that results when liuzhu worsens. Liuzhu is not caused by shanghan itself but by the physician's failure to handle the external evil properly. Guyong is also not the inevitable result of liuzhu. It may instead be caused by an unskilled physician who prescribes cold, cooling medicines. A practitioner of poor skill who does not clearly distinguish the pattern, even when recognizing guyong, does not know how to treat it correctly. Instead, they continue cooling medicines or use sharp blades, which causes the pathogen to remain lodged. Cooling medicines and metal instruments can both drive the pathogen more deeply into the bone, making recovery difficult.

How can bone develop a carbuncle? Once bone suppurates, medicines can hardly cure it, so it is called fuguju (fùgǔjū, "bone-attached ulcer"), also called baihu feishi (báihǔ fēishī, "white tiger flying corpse"). The illness may drag on for a year or stretch over several years. Some patients recover only after the cold toxin subsides and the necrotic bone is fully expelled, while others never recover for life. These cases are mostly caused by improper treatment in the early stage. If the necrotic bone is a secondary bone, recovery is still possible. If a main bone is necrotic, lifelong disability often remains. When the pus is clear, thin, and white, and the fragments have just come loose, they lie deep and are hard to remove. When the pus is yellow and thick, and the bone fragments are about to be expelled, they lie shallower and can be removed with a sharp knife, with specific methods described later. These are only the general principles for treating guyong.

There is another illness, which has dragged on for several months in a patient who has suffered a knife wound. The patient has a thin body, contracted hands and feet, and symptoms of cough, coughing up blood, and rotting, dark flesh. This belongs to extreme cold-evil, weakened yang qi, and a predominance of yin cold. One must not regard blood in the sputum as a heat pattern. Instead, high-quality fuzi should be used, with the dosage adjusted according to the condition.

If the toxin begins in the hands, feet, head, or face and pain spreads through the whole body, distributing along the channels to the neck and other areas, it belongs to the category of wind-damp and flowing-qi conditions. The jiajian xiaoming tang (jiājiǎn xiǎomìng tāng, Modified Minor Life-Extending Decoction) and duhuo jisheng tang (dúhuó jìshēng tāng, Duhuo Jisheng Decoction) may be combined with the present formula. If pain begins in both knees and later all the bone joints ache, the condition resembles "xue feng" (xuè fēng, "blood wind") in women and "ruan feng" (ruǎn fēng, "soft wind") in men. This is called wind-damp bi (bì, painful obstruction), also known as fuzhi (fùzhì), and the jiajian fuzi bawu tang (fùzǐ bāwù tāng, Aconite Eight-Ingredient Decoction) may be used with modifications.

If the swelling appears on soft areas such as the neck, armpits, beside the breasts, or the hips, it is called "zhengjing yong" (zhēngjìng yōng). This belongs to a cold pattern without heat signs, and the neibu shixuan san (nèibǔ shíxuān sǎn, Ten Diffusions Internal Tonic Powder) may be combined with the present formula. Children should not be given fuzi lightly, lest it trigger convulsions and fright-seizures, and needles and blades must never be used again. If blood is scant and no pus forms, and the protruding flesh cannot close, warm medicines may be applied externally, together with internal medicine to disperse the swelling. If protruding granulation tissue has grown after the use of blades or needles, these same medicines may also be used to astringe it. If slight pain or signs of convulsions appear after medication, quanxie guanyin san (quánxiē guānyīn sǎn, Scorpion and Guanyin Powder) may be used with modifications. Once convulsions settle, return to the original formula.

Children may also develop swellings on the neck, arms, chest, or back due to abnormal movement of old phlegm. This belongs to extreme cold-evil, and the key to treatment lies in applying warm medicines externally. The lesion needs an opening left for continued treatment, and specific methods are described later.

There is also a condition called “flowing lumps,” in which toxic pathogens spread and gather to form a swelling as large as a gourd or an overturned bowl, appearing on the chest or back. Its symptoms resemble an abscess, but the condition is dangerous. After taking medicine, even a slight change in the swelling’s shape or force indicates that the illness is no longer an ordinary abscess. The “Internal Supplementation, Ten Provisions” formula should be used alongside this prescription, adjusting it flexibly according to the symptoms to help the swelling disperse from within the body.

In general, these disorders arise from cold, so the pain is bone pain. Bone is regarded as the surplus Qi of the kidneys. When the kidneys are deficient, the bones are easily affected by cold, causing pain. “Bone abscesses,” sores that penetrate deep into the bones, also commonly originate in the kidneys because their root lies there. For this reason, replenishing the kidneys with a large dose of aconite is more likely to be effective. When kidney Qi is full, the bones can thrive, and abscess toxins are less likely to lodge in them. Treatment must not be confined to a single method; it should be adapted to the circumstances.

At the onset, abscesses are usually caused by Qi and blood stagnation. If they persist for a long time, blood accumulates where circulation is obstructed, and the condition worsens. Therefore, when this formula is used for patients with abundant Qi and blood, the amount of angelica should be reduced. Too much angelica promotes the generation of blood and may cause the swelling toxin to emerge elsewhere, forming new abscesses and leading to repeated outbreaks. This is a secret therapeutic insight known to few physicians.

Phlegm accompanying an abscess occurs in two forms. In one, cold in the stomach produces phlegm; pinellia may be added to strengthen the Spleen and transform phlegm. In the other, heat pathogens become constrained and form wind-phlegm; platycodon root may be added to resolve phlegm in the throat and chest, together with fresh ginger, and the ingredients should be decocted in water and wine.

When an abscess occurs on the head or back, where the affected area is in the upper part of the body, the akebia stem may be removed from this prescription. This prevents the medicine from promoting downward drainage and damaging the lower foundation, which could leave the pathogen strong above and the body weak below, making treatment more difficult. Removing the akebia stem is especially appropriate for the elderly and the frail.

When a patient is still suffering from diarrhea, this formula should not be given immediately. First use an antidiarrheal: grind raw alum into a fine powder, melt yellow wax, and form the powder into pills. Take thirty pills with rice water. Once the diarrhea has stopped, use this formula.

Qi and blood are the foundation of the human body. In someone with a carbuncle—a suppurating sore on the body’s surface—Qi and blood gather in one place and turn into pus. If the organs and viscera do not function securely, primordial Qi will dissipate with the diarrhea, while the blood will become even colder and more stagnant, making the sore harder to heal. This formula is chiefly able to regulate the movement of Qi. In general, when Qi moves freely, blood circulates; when Qi is depleted, blood becomes cold and stagnant; when Qi is cold, blood congeals; and when blood congeals, flesh cannot grow.

If hot medicines are prescribed, the patient may be too weak to tolerate them, and the flesh may still fail to grow; they will only add to the suffering. Cool medicines, too, are inconsistent with the nature of this illness. Although this formula is said to have been transmitted by an immortal, it must still be used appropriately. Otherwise, one is like a person who carves a mark on a boat to find a dropped sword: clinging to an old method without adapting to circumstances. As for flowing abscesses—conditions in which pus or pathogenic influences travel through the body and collect—they cannot all be treated alike. If cool medicines have dissipated primordial Qi and caused it to become depleted, the Sanjian (a class of Daoist medical formulas based mainly on acrid, hot medicines) may sometimes be effective, since these conditions often arise from cold patterns. But the pulse must be examined carefully and the pattern clearly identified. Use Sanjian only when the condition is confirmed to be a cold pattern, and do not use too much, or it will also cause harm. If the Yang pulse recovers, the swollen area becomes red and fresh, the bone shows signs of life, and cold no longer congeals into a deep abscess, then the formula may be considered effective. This is a safe and effective method of treatment.

This medicine can be made into pills, granules, or powder. Depending on the circumstances, take it with water, wine, or a decoction. In wealthy households, the pills may be coated with Mu Xiang (Aucklandia root). If the patient has hot phlegm and a cough, the wealthy may take it with a Chen Xiang (agarwood) decoction, while those with fewer means may take it with a Su Ye (perilla leaf) decoction. Make the pills with honey.

This formula can treat not only carbuncles, sores on the back, and injuries from falls or blows, but also hernias and disorders of Qi and blood in men and women. It has repeatedly proved effective. A woman had suffered from a Qi disorder for five years. When it flared up, she would feel a painful lump in her abdomen and vomit, unable even to drink water; each attack seemed likely to kill her. She took pills made from this medicine with a decoction of costus root. After one dose, the vomiting stopped. After a second, the phlegm and Qi flowed freely, and she recovered.

This formula can be used for fractures caused by falls or blows, with additions or reductions according to the circumstances; see “Injuries and Fractures” for details. It can also treat ordinary injuries from falls or blows, including injuries to the pericardium. For a head injury, remove akebia stem and immature bitter orange, and add Sichuan lovage root and dried tangerine peel. Costus bark and perilla leaf may be added to invigorate the blood; psoralea fruit and flying squirrel feces may be added to disperse clotted blood. After simmering the herbs in water, add a cup of strong wine. When it comes to a boil again, add powdered rhubarb and take it on an empty stomach. If the bowels move freely, four doses are usually taken: add powdered rhubarb to the first two, but not the last two, which are used only to bring on the medicine’s effect and expel accumulated stagnation. If the bowels still do not move, keep urging them with a decoction of immature bitter orange. If they still fail to move, the patient cannot be saved. One must not watch someone die without knowing how to treat them. Formulas such as Ten-Ingredient Blood-Tonifying Powder may also be used.

This formula is often used for injuries from falls or blows. Akebia stem may be omitted, and the formula is then called “Polygonum Multiflorum Powder,” since polygonum multiflorum nourishes the blood. If, after a wound from a blade, the patient develops tidal fever, facial swelling, and shortness of breath, this indicates a tetanus pattern. The patient may take several doses of Blood-Searching Powder and kudzu root decoction, then sweat out the illness with a decoction of ginger and scallion, or take three or four doses of Toxin-Expelling Powder. Apply an external medicinal dressing and follow the prescribed treatment; recovery is then certain.

For lower back pain lasting a year, add Chinese foxglove root and corydalis, and simmer the formula in wine.

To treat beriberi, add betel nut, Chinese quince, and pangolin scales, and simmer the formula in water.

If phlegm suddenly goes astray in its movement overnight, ordinary people do not know about this condition. Since it was first taught by the immortals, only our lineage has understood it. The human body contains phlegm, which moistens the whole body, just as fish have mucus. While phlegm remains in the stomach, it causes no illness if it stays still. But when it moves abnormally, it can bring on many ailments, such as asthma, coughing, vomiting, dizziness, headache, eye pain, stiffness throughout the body, and numbness and pain in the joints. This is newly formed phlegm, produced when Qi and blood deteriorate and turbid stagnation congeals.

Why does this happen? When the Qi of the organs and bowels moves in reverse or becomes stagnant, phlegm forms. If sweating does not occur when it should, phlegm accumulates. Excessive eating harms the body, impedes the movement of fluids, and can also cause phlegm to gather. Phlegm normally travels from the upper stomach to the lungs, then leaves the body. If its movement goes astray, it spreads from the upper stomach into the muscles, skin, and hair. The spleen governs the muscles, and the lungs govern the skin and hair. As a result, lumps may gather in the chest and back, head and neck, armpits, groin, waist and legs, or hands and feet. They may be hard or painful, or painless. Pressing them does not bring blood to the surface; even if they redden slightly, the color is faint and there is no heat. They feel hard as stone. When cut open, they contain no pus; there may be only pale blood, clear fluid, or a milky liquid, and sometimes damaged flesh like torn cotton. Some lumps resemble scrofula, or look like quail eggs floating in water: they can move and are soft rather than hard. When cut open, they likewise contain no pus or blood, yet flesh bulges out through the puncture. Patients may also feel that phlegm is abundant and obstructing the throat, and may alternate between chills and fever.

For this condition, urgently use the prescribed internal remedies, such as Nanxing and Banxia, while applying Yulong warming medicine externally to draw out the pathogenic influence. If the lump can be made to suppurate and rupture, the treatment is considered effective. In milder cases, where there is no pus, the lump will disperse on its own. If phlegm-heat is severe and phlegm is congested, use Kongxian Dan, a formula for expelling phlegm and mucus: grind equal parts of purple Daji, Gansui, and Baijiezi into powder, then form pills with rice paste. If the whole body is swollen and hard, with lumps as large as a cup or basin, especially in critical areas such as the throat or neck, treatment is more difficult.

When Qi and blood are harmonized and flow freely, the body naturally suffers less illness. When Qi does not move smoothly, blood can turn into phlegm. If phlegm then moves abnormally, Qi and blood will weaken; they cannot form pus, and only hard swelling results. This is a natural consequence of the pathology. In such cases, Yin and cold predominate while Yang is deficient. Choose medicines according to the symptoms: support Yang and restore vitality, nourish the blood, and expel phlegm and mucus. At the same time, apply the method described below to the body’s surface to stir the Qi and blood throughout the body and disperse the cold, congealed lumps.

If a lump persists without shrinking, pain, or heat, and the patient is robust, has no other symptoms, and the lump resembles normal muscle, the condition is different. Do not rashly injure yourself with a needle or knife. If a village doctor has used acupuncture or moxibustion and caused deep muscle tissue to ulcerate, or used corrosive poison to eat away and peel the tissue, leaving the patient with chills and fever, then find a way to regulate the flow of Qi and blood. Add Shengma to the prescription to dispel cold, then use medicines that close the wound and form a scab to soothe it, leaving only a growth resembling a wart. If the affected area happens to become foul-smelling and rotten on its own, and a knife must be used, there are also medicines that can take its place. This method should not be disclosed lightly: grind alum and calcined Puxiaoxiao into powder and apply it.

For intestinal carbuncles (suppurative conditions within the abdominal cavity), it is suitable to take Ten-Proclamation Powder, alternating it with this formula and adding honeysuckle vine. Honeysuckle vine is especially effective for internal carbuncles. First determine whether the condition is one of deficiency or excess, then decide whether to tonify or unblock: for tonification, use aconite; to unblock, use rhubarb. If deficiency and excess cannot be distinguished, this formula alone can help clear and harmonize. Ten-Proclamation Powder, meanwhile, tonifies from within and generally does not cause other changes.

At the onset of a lung carbuncle (a suppurative condition of the lungs), a feeling that food is obstructed, together with slight pain in the chest and diaphragm, may indicate this illness. Examine the pulse promptly to distinguish deficiency from excess. For deficiency, add aconite to this formula as appropriate. If the symptoms worsen slightly, use Ten-Proclamation Powder to tonify from within, and the illness will then disperse on its own. For excess, add a small amount of rhubarb to this formula to drain the pathogenic influence downward. The lungs and large intestine are interiorly and exteriorly related—that is, Chinese medicine regards their physiological functions as interconnected—so this method can be used.

If an internal carbuncle has already formed, combine the formula known as the Sea formula with this one, adjusting the medicines according to the condition. Wheezing, coughing, and coughing up pus and blood indicate a lung carbuncle. Pus in the stool, or pus flowing from the navel, indicates an abdominal carbuncle. Honeysuckle vine and licorice stem nodes, boiled in wine and taken, work well.

End of Volume One of Secret Formulas of the Immortals’ Tradition of External Medicine.

Volume Two: Warm Medicines for External Application

Harmonizing Immortal Paste, also called Yellow Cloud Paste or Immortal Paste, is used for conditions whose cold or hot nature is difficult to determine. It may be taken mixed with tea or wine, according to the condition.

Five liang of Sichuan red-bark root, stir-fried; also called red flesh or “internal dispersal.” Two liang of red peony root, stir-fried. Three …

Take five liang of Sichuan redbud bark and stir-fry it; two liang of red peony root, stir-fried; three liang of duhuo, stir-fried, using neither the roots nor the joints; one liang of bai zhi, not heated; and an appropriate amount of wood wax, stir-fried. Wood wax is also called “vanishing at a glance” and “spring snow”; it is calamus. Grind all five ingredients together into a fine powder. Instructions for use appear below.

In the author’s view, abscesses, deep-seated sores, and similar conditions form when Qi and blood stagnate and congeal. When exposed to warmth, the illness grows; when exposed to cold, it congeals. “Growing” means that the illness spreads; “dying” means that it congeals and does not disperse. This formula is mild in nature. Sichuan redbud bark is called the essence of Wood: it can break up Qi, move blood, and reduce swelling. Duhuo is called the essence of Earth: it can dispel wind, invigorate blood, move Qi, draw out toxins from the bones, relieve painful obstruction and dampness, and, together with wood wax, dissolve lumps as hard as stone. Red peony root is called the essence of Fire: it can gently generate blood, relieve pain, and dispel wind. Wood wax is called the essence of Water: it can generate blood, relieve pain, reduce swelling, and break up wind and disperse blood. Bai zhi is called the essence of Metal: it can dispel wind, promote tissue growth, and relieve pain. The author holds that when blood can grow, the affected area will not become necrotic; when blood can flow, Qi and blood will circulate freely; when flesh can grow, the affected area will not decay; when pain stops, the swelling will not continue to develop; when pathogenic wind is expelled, congealed blood will disperse; and when stagnant Qi is broken up, hard lumps can subside and toxins disperse. Working together, the five ingredients offer hope of a cure.

There are three patterns of illness and three methods of treatment. If the illness is extremely hot, double the amounts of Sichuan redbud bark and wood wax in the formula. Even if only small amounts of these three ingredients are used, the swollen masses can disperse, though the effect will be slower. If the illness is extremely cold, add a little more red peony root and duhuo. These can also invigorate blood and disperse the masses, though the effect will be somewhat slower; they will not harm the patient’s constitution.

If the fever is very high, do not mix the medicine with wine under any circumstances. Use only the broth made by boiling scallions to prepare it, then apply it to the affected area while hot. Scallions also help disperse the movement of Qi. Heat makes the blood flow, so apply the medicine warm. Once the illness has eased somewhat, switch to preparing the medicine with wine: wine promotes the formation of blood, and warmth makes it easier for blood to form; wine also promotes blood circulation, and warmth makes the blood flow more freely.

If blood blisters appear on the wound and small sores form, do not use wood wax, as its medicinal nature may be too drying and harsh, and removing it could injure the affected area. First apply the four medicines to the area, then cover them with wood wax, spreading it around the edges of the sore to stop and direct the flow of blood. Always apply the medicine while hot. If it dries, moisten it again with the liquid originally used to prepare it, so that the medicine’s properties can penetrate through the moist heat; the illness will then naturally subside.

If, after applying the standard prescription, the dark discoloration around the sore has not faded and the wound has no color at all, this indicates that the patient previously used too many cold-natured medicines. Do not immediately apply Jade Dragon Plaster, an external medicine, because the skin has not yet become necrotic; if the medicine is too strong, it may worsen the pain. Add cinnamon bark, a warming herb that promotes circulation, and Chinese angelica, which nourishes and invigorates the blood, to the original prescription. This will set the stagnant blood flowing again, and the dark discoloration will naturally fade as the medicine takes effect. Once the blood’s color has returned, remove these two added herbs and continue treatment with the standard prescription alone.

If the pain continues after using the standard prescription, dissolve frankincense and myrrh, commonly used herbs for invigorating the blood and relieving pain, in wine. Heat the mixture over a fire until melted, then use the wine to prepare the medicine. Apply it while hot, and the pain will stop.

If a flowing abscess—a condition in which pus or pathogenic influences travel between the sinews and vessels—prevents the sinews from extending, add frankincense to the prescription for external application, since it helps relax and extend the sinews.

If red granulation tissue protrudes from the sore, this may be due to one of three causes: the affected area came into contact with water, it was exposed to wind, or, after an incision, the wound edges turned outward and would not lie flat. In such cases, add frankincense to the prescription for external application, since it helps relax and extend the sinews.

If red flesh protrudes from the opening of a sore, there are three possible causes: the affected area has been exposed to water, it has been exposed to wind, or, after an incision, the flesh at the cut has turned outward. For treatment, add a small amount of tiannanxing (a medicinal herb commonly used to dispel wind and transform phlegm) to this prescription, and take it mixed with ginger juice and wine. If the protruding flesh still does not recede, it is most likely because an incompetent physician pressed too hard with his hand, enlarging the pus core, and then used cooling medicines that chilled the skin. Using warming medicines afterward will make the wound ulcerate even more severely. There is also a formula for this: grind alum and calcined, dried sodium nitrate (a nitrate medicine processed by calcination) into a fine powder and apply it, then sprinkle on powdered sulfur. For internal use, take Rongwei Jia Dui Jin Drink; apply Chonghe Paste externally.

If the condition is very hot, do not immediately use cooling medicines. When heat is intense, Qi and blood become congested and tend to accumulate in large quantities. If very cold medicines are used suddenly, the blood may not fully disperse and may instead congeal in the cooled area. It is therefore advisable to use warming and cooling medicines together: warmth makes the blood flow, while the cooling quality helps disperse it. Add Duiting Hongbao Pill to this prescription, mix it with scallion broth, and apply it.

This prescription is used to treat back abscesses and migrating abscesses, including toxic sores and pus-filled swellings. Warmth makes the blood flow, while the cooling quality helps disperse it. Add Duiting Hongbao Pill to this prescription, mix it with scallion broth, and apply it.

This formula is considered the treatment of choice for back carbuncles—swollen, suppurating sores on the back—and for “flowing stagnation,” painful swellings caused when pathogenic toxins lodge in the channels and collaterals and impede the movement of Qi and blood. Practitioners should learn to apply it flexibly, matching the medicines to both exterior and interior conditions; then the course of the illness is easier to manage. Severe back carbuncles can be a matter of life and death. The author considers this formula mild and reliable, something one can depend on throughout the course of treatment without fear that the condition will worsen. Ordinary physicians may be able to cure mild cases, but changes in the illness or errors in treatment can bring complications. If the illness affects the Yin aspect—lying deeper in the body and tending toward cold—it is beyond the skill of ordinary herbal practitioners. The author therefore praises this formula for addressing both Yin and Yang and treating conditions of different natures at the same time.

Flowing stagnation does not necessarily cause death directly, but it often leaves patients disabled; prolonged disability may in turn become life-threatening. Even when a physician can cure it, improvement usually takes six months or a year, and such success is said to be rare—only one case in a hundred. Patients often remain physically weak afterward. The author says that the formulas of this tradition work quickly and produce striking results, describing their effect as “bringing the dead back to life.”

According to this passage, flowing stagnation is a pathogenic toxin left behind after a Cold Damage illness. If the pathogen has not been fully dispersed from the body’s exterior, residual toxin can lodge in the channels and collaterals, disrupting the movement of Qi and blood and producing hot flowing stagnation. If treatment disperses too aggressively and depletes Qi and blood, the residual toxin may flow into the flesh and lodge in the interstices—the spaces and grooves between skin and muscle—producing cold flowing stagnation. The author considers cold flowing stagnation more common and harder to treat. Cold obstructs the movement of Qi and blood more severely, causing blood to accumulate; a lump forms, but it is difficult for pus to develop.

The author holds that if a physician then uses cold-natured medicines, the cold condition becomes even more deeply congealed, causing tissue to die and decay as the toxin invades the bones and forms a bone abscess—an abscess that affects the bone—ultimately leading to disability. The passage therefore presents bone abscess as a condition that develops when flowing stagnation worsens. It also argues that bone abscess is not caused by flowing stagnation itself, but by a physician’s mistaken use of cold-natured medicines.

“Flowing” means moving or circulating, while “stagnation” means remaining in place. When the movement of Qi is obstructed, blood stops and congeals. Qi belongs to Yang and blood to Yin: when Yang Qi moves, Yin blood follows. The author explains that flowing stagnation can be guided to another location and then dispersed because Qi and blood can be set in motion. Once they move, Yin and Yang can come into balance, making it less likely that the affected area will suppurate; instead, the condition can disperse as it shifts. The passage says that Du Huo, a Chinese medicinal herb often used to dispel wind-dampness and open the channels and collaterals, is used to guide the pathogen to move precisely because it can promote the circulation of Qi and blood.

If a liuzhu sore (an abscess-like lesion) appears in an important area such as the back, shoulder, waist, or leg, apply a thick layer of this medicine to the affected area. Then take powdered duhuo, mix it with wine, and apply it while warm along a single path. As the medicine takes effect, the lesion will shift along that path. This method is called “shifting”: it redirects the blood and Qi elsewhere, drawing the abscess to a less critical area so it can then be dispersed.

If an abscess has suppurated but cannot be drained, promptly use this medicine to draw out the toxins and prevent the condition from developing into bone gangrene, a sore that invades the bone. If an incompetent physician mistakenly uses cold medicines and then cuts with a needle or knife, the condition may become a bone abscess. Medicine alone is unlikely to cure it; recovery requires waiting until all the bone fragments have been expelled. If one fears using a needle or knife, one may use Yulong (here referring to a topical medicine such as Yulong Plaster; the related treatment is described later). If a major bone is exposed, there is no remedy; if only an accessory bone is exposed, recovery is still possible.

One prescription combines baizhi and zijingpi with wine to disperse a swelling abscess from within at its onset. It is called “One Victory Plaster.” Another prescription uses only chishao, mulaxi, and zijingpi to make a binding medicine—a topical preparation applied around the affected area to contain the swelling. It is called “Three Victories Plaster.”

Another prescription treats cases in which an adult or child happens to hold a knife in their mouth and accidentally cuts the tongue, nearly severing it but not cutting it completely through. First wrap the tongue in the soft membrane from inside an eggshell, then mix Poxue Dan with honey and apply it to the root of the tongue to stop the bleeding. Once the bleeding has stopped, mix honey and wax to a suitable consistency, stir in the powdered medicine, and apply the mixture to the eggshell membrane. This soft membrane is chosen because it is thin enough to let the medicine pass through. If it dissolves in the mouth, keep applying fresh membrane. After three days, when the tongue has rejoined, remove the membrane and continue applying the medicine mixed with honey and wax; the wound should heal in seven days. The author uses this example to show that treatment must be adaptable, and that its subtleties are not confined to what a teacher passes on. If progress is slow, a medicine for metal wounds—such as cuts and other injuries—may also be used.

When treating a swelling before it has fully formed, the method should be adapted to the circumstances. What matters is using the right treatment; there is no need to cling to a fixed method passed down by one’s teacher. If it does not work quickly, it can be combined with a wound medicine—a topical remedy for cuts and other injuries—with especially good results.

When a swelling has not yet come to a head, do not apply Hongbao Powder immediately to its center. Its cold nature might cause the blood to stagnate, prevent the lump from subsiding, or even damage the flesh. First apply only this formula. If the lump still does not go down and you want to encourage it to form pus, apply Yulong, a topical preparation for swellings, to the head of the lesion, then apply this formula beneath the Yulong and surround it with Hongbao Powder to keep new blood swelling from spreading. If the condition is mild and has not been suppressed by cold medicines, there is no need to apply this formula beneath the Yulong; simply apply Hongbao Powder around the affected area.

If the condition has already worsened and is difficult to manage, and Yulong is still unsuitable, using this formula alone is safer and can spare the patient further pain.

When a carbuncle or ulcer first appears on the back and has not yet fully formed, apply only powdered redbud bark around the affected area, mixed with wine. This can draw in the swelling and keep it from spreading. Take Oakwood Decoction internally; it is an inexpensive and useful prescription.

Add suitable amounts of Nanxing and Caowu to this formula, mix with hot wine, and apply. This can bring various swellings to a head without causing much pain. Applying Yulong alone and surrounding it with Hongbao Powder is less effective than this method.

For a bite from a rabid dog, apply only Ziyang, a medicinal substance, mixed with brown sugar, leaving the wound uncovered. Use Jindan, another medicinal substance, to reduce the swelling, and chew almonds and hold them in the mouth; this is said to draw out the poison.

Mix equal parts of this formula, Nanxing, and Caowu with hot wine and apply to injuries that have not healed for a long time. The results are very good.

For soft-joint conditions in children—swelling or other problems around the joints—add Junjiang, a medicinal substance, to this formula and mix it with wine before applying. If the condition has just begun, apply this formula mixed with wine; that is sufficient once it comes to a head. If applying redbud bark and Mulaxi, another medicinal substance, mixed with wine at the outset makes the swelling subside, do not use Hongbao Powder.

This formula is used to treat yin-type sores and ulcers on the back caused by cold pathogens congealing and obstructing, cold-pattern wandering pain caused by cold pathogens, drum-spine wind, pain from old injuries, cold impediment and wind-dampness, and cold swelling caused by various forms of beriberi, where there is no redness or heat. It also treats cold pain without swelling, numbness or loss of sensation in the feet, and women’s cold-blood wind, a gynecological condition attributed to cold pathogens.

The ingredients are one liang of red peony root, unprocessed by heat, and half a liang of cinnamon bark, dry-fried. The scripture calls this the foremost formula for treating various yin patterns. For detailed instructions, see below: mix with hot wine and apply to the affected area.

Although various disorders appear on the skin or in the hands and feet, their causes often lie in the internal organs. The blood vessels and meridians of the organs extend throughout the body, circulating day and night without pause. When an organ is diseased, symptoms often appear along the course of its meridians—that is, in the parts of the hands and feet associated with the Yin and Yang meridians.

These disorders may be cold or hot. Hot conditions are generally easier to treat, while cold conditions are harder to cure. Cold conditions usually arise when the organs’ original Yang, the body’s fundamental warming energy, is weak. Wind pathogen then takes advantage of this weakness and invades, disrupting the movement of Qi and blood. Wind and other pathogens lodge between the meridians and the skin. When Qi and blood cannot circulate freely, they stagnate; the more severe the cold, the deeper the stagnation and the harder it is to disperse. If a practitioner with poor judgment then uses cold-natured medicines, the internal and external cold pathogens may intensify one another, and the condition can become dangerous.

The practitioner should observe the outward symptoms, determine which internal organ is affected, and compare the exterior with the interior. This makes errors in diagnosis and treatment less likely. This formula uses dried ginger and cinnamon bark to warm and unblock the blood vessels and support the generation of blood. But if Qi and blood still fail to disperse after warming and tonifying, they may instead become congested. The formula therefore also includes Aconitum kusnezoffii and Arisaema, to break up accumulated pathogens, dispel wind toxins, improve necrotic flesh, ease bone pain, disperse lumps, and help restore Yang. Red peony root and angelica dahurica are added to disperse stagnant blood, relieve pain, and promote the growth of flesh. Wine is used to guide the medicines, helping their effects circulate and Qi and blood disperse. According to this passage, even severe cold conditions may be cured, as though cold ashes were made to flame again and spring returned to withered wood.

In general, cold conditions leave the flesh cold and putrid, and patients may even lose the ability to feel pain or itching. When pain does occur, it often reaches deep into the bones. If the condition is not promptly resolved, cold pathogens may penetrate the bone marrow, where ordinary medicines are unlikely to work. This formula is said to drive out Yin cold pathogens, restore Yang, ease pain within the bones, and treat disorders of the flesh and skin. The dosage should be carefully measured and never excessive. The specific methods of treatment and adjustments to the ingredients are given below.

Some back carbuncles—suppurating sores on the back—begin as cold-pattern disorders and are mistakenly treated with cooling medicines. Others are originally heat-pattern disorders, but mistaken use of cooling medicines turns them cold, leaving the whole back black and decayed. Apply Hongbao Powder, an external medicine that protects the edges of the sore, to the healthy skin and flesh around the decayed area, and apply this medicine to the center. After one night, if Yang Qi has recovered, the black area will turn red. Once its color looks healthy and vibrant, stop the cooling medicine that was mistakenly used and switch to Chonghe Ointment, an external medicine that harmonizes sores and draws their edges together. If there is still no improvement and pus is about to form, add Nanxing and Caowu to the Chonghe Ointment. If Yang Qi has recovered and the black area has turned red, but a small black, decayed spot remains in the center, the blood and flesh there have died. Use sodium sulfate and alum, or white clove, borax, and frankincense, mixed evenly with saliva. Apply the mixture in a ring along the boundary between the black and red flesh, then cover it with Chonghe Ointment. The next morning, remove the medicine; the black flesh will have come away. Then wash the wound and apply a flesh-regenerating medicine to encourage new tissue to grow and the sore to heal.

When a deep-seated abscess migrates or spreads through the muscles and is a cold-pattern disorder, it often lies close to the bone. The muscles remain hard and swollen, the bone feels cold and painful, and the sinews contract and cannot straighten. If a knife or needle is used rashly to cut or puncture it, there is usually no pus or blood; sometimes only thin fluid or stagnant blood comes out. In this case, apply this medicine. Once the swelling and pain have eased somewhat, mix equal amounts of Jiangjun, Baizhi, Rougui, and Caowu, combine them with hot wine, and apply the mixture. When the chill in the bone is gone and the pain has stopped, Qi and blood will warm and harmonize, the sinews will relax on their own, and the hard mass will disperse. Treatment of these abscesses should also include Mula, which is effective at breaking up stagnant Qi and dispersing hard swellings. Do not use too much, or it will weaken the medicine’s effect. Warm medicines are the main treatment for this condition.

Yiguzhui wind usually arises from invasion by damp pathogens; it may also be caused by unresolved residual toxins from cold damage, by worsening of liuzhu (a condition in which toxic pathogens migrate among the muscles and joints), or by wind-damp leading to weakness and numbness of the limbs.

This disease has three presentations: First, the knees knock against each other and walking is unsteady and swaying, with slight swelling of the bone beside the knee. Second, the joint at the bone beside the knee swells to the size of a mallet, the thigh muscles waste away, and the skin clings tightly to the bone. Third, the upper thigh is swollen, while the lower leg is cold and thin.

This is because the foot and knee correspond to the Liver. When the Liver channel is invaded by wind, cold, and damp pathogens, the blood vessels do not flow smoothly, and these symptoms appear. Cold blocks the knee and the blood congeals so that it does not flow: in the lower leg the blood vessels only drain and do not return, so the leg becomes increasingly thin and cold, and the sinews and vessels become more and more contracted; in the thigh, by contrast, blood accumulates and does not disperse, so the area becomes increasingly swollen and hot, while the muscles gradually waste away.

If the root of the disease comes from liuzhu, the muscles will necrose and rot; after rotting, cold toxin will erode the bone. Once the dead bone has sloughed out, even an immortal cannot help. If it has not yet ulcerated, this shows that the muscles have not necrosed; one should promptly mix this formula with hot wine and apply it to the bone beside the knee and to the thigh to relieve bone pain and restore yang qi. Then apply Chonghe (the name of an external medicine) to the cold area of the lower leg to guide blood and qi downward and open the blood vessels; also apply this formula at the junction of the bone beside the knee to receive the blood vessels drawn downward and to disperse accumulated yin-cold qi.

When taking Zhuifeng Pill internally, double the amount of frankincense to relax the sinews and vessels, and take it according to the formula; in most cases this will bring recovery. If one needs to go out, one may take Wuji Powder (a formula that warms and disperses cold-damp), adding ginger, cinnamon, baizhi, and danggui (fresh ginger, cinnamon, Angelica dahurica, and Angelica sinensis), then further add large Chuanwu, Achyranthes, areca, and mugua, and take it mixed with tea or wine.

For those who have long suffered from cold impediment or “blood wind”—an ancient term for painful impediment caused by wind, cold, and damp, along with related symptoms—with numb, stiff hands and feet that may even be unable to move, place the medicine in a cotton pouch over the affected area. Wind a long strip of cloth tightly around it, then secure it with a silk pouch. This medicine can ease bone pain. If, when applied to the skin, it feels as though ants are crawling over it, that is a sign the medicine is taking effect. For impediment pain, add equal amounts of clove bark, Evodia, myrrh, and Sichuan aconite, and use these together with Wind-Chasing Pills, a pill for dispelling wind and relieving pain. The text says that treating the condition both internally and externally in this way is highly effective.

If rheumatic pain in the feet is unbearable, take Wind-Chasing Pills internally and apply this formula externally: add raw flour, mix it with ginger juice, and apply while hot. To relieve the pain more quickly, add frankincense and myrrh, dissolve them in wine, and apply.

If an old injury has damaged the bone, it is often because bruising from a fall, crushing injury, or other accident has not dispersed and has remained at the site for a long time. The text compares a severe accumulation to “a chicken’s lung attached to the ribs,” and a milder one to “moss clinging to a stone.” In youth, when Qi and blood are strong, people often feel no symptoms. In old age, when Qi and blood have weakened, exposure to wind and cold or to rain and dampness can bring on pain. Apply this formula mixed with hot wine, and take the Damage-Seeking Pain-Finding Pill, a prescription for pain from old injuries, internally. Treating both internally and externally addresses the condition on both fronts.

The text also says that when a person with weak Qi and blood has a condition between the chest and ribs or in the lower back, and the stagnation persists without resolving, it may develop into “blood-stasis consumptive disease,” a chronic illness caused by accumulated blood stasis. Regardless of age or how long the illness has lasted, the affected area may extend throughout the body or be limited to an area the size of a fist or half an arm; the treatment is the same. The root of this kind of illness lies deep, so it requires prolonged treatment and cannot be cured with a single dose. It is easier to recover before it develops into consumptive disease; once it has done so, recovery is more difficult.

Another simple method uses only Nanshing and grass aconite, with a small amount of cinnamon. It is said to be suitable for affected areas that are black, necrotic, ulcerated, and discharging persistent pus. This preparation is called “Little Jade Dragon.”

To treat a stone carbuncle, a swelling hard as stone, mix this formula with hot wine and apply it, then bind the surrounding area with Hongbao, a medicine used to encircle and secure the affected site after application.

To treat a stone carbuncle, mix this remedy with hot wine until smooth and apply it to the affected area. Then surround the lump with Hongbao, a medicine for external application. Once pus has formed, cut the swelling open and drain it.

Breast abscesses in women commonly arise in several situations: after an infant is weaned, when the milk does not recede; when there is an abundant supply of milk but the child drinks little, causing the milk to stagnate and coagulate; when menstruation is irregular and the blood flows in disorder; or when pathogenic Qi becomes lodged in the body and later forms a lump. At the onset, never apply cold medicines or cold compresses. Milk is transformed from blood, and when it cannot be discharged, it coagulates into a hard swelling. The breasts are naturally cold in nature; applying cold medicine or a cold compress makes the coagulation even harder to disperse. After the stagnation has persisted for some time, the milk can no longer transform, and heat and pain appear, followed by the formation of pus. The pain can be severe, and recovery often comes only after the abscess ruptures and drains completely. As a result, a woman who has recovered from a breast abscess often has lasting damage to the breast and loses the ability to nurse.

Cold medicines are not entirely unsuitable, however; they are more appropriate after the abscess has ruptured. At the onset, one may add Nanxing, a medicinal herb, to this remedy, mix it with equal parts ginger juice and wine, and apply it while hot. The text says this can make the lump disperse on its own. To hasten the effect, one may also add Caowu, a potent medicinal herb. The text says it can disperse stubborn lumps and drive away cold and heat: when applied cold, it disperses the lump; when applied hot, it promotes rupture. If a carbuncle has already formed, use the Chonghe formula, an external application, as usual, or add Caowu and Nanxing. After the abscess ruptures, choose the remedy according to its cause: for a condition caused by cold, use the Chonghe formula to promote healing; for one caused by heat, use Hongbao to promote the growth of new flesh, and add frankincense and myrrh to relieve pain.

For internal treatment, use Gualou San, alternating it with Tongshun San or Shixuan, formulas that regulate Qi and blood and support the interior to expel pus, according to whether the patient is weak or robust.

The text also distinguishes breast disorders by their location and appearance. A condition with multiple openings is called “breast eruption”; a hard breast is called “stone breast”; a swelling at the nipple is called “blown breast”; and a disorder in the pouch beneath the breast that forms a fistula is called “breast fistula.” The breast tissue hangs down, and blood can readily accumulate there, making these conditions difficult to treat. A single cyst with a single opening is called a “breast abscess.” The text says that there is no treatment for a breast abscess in someone over fifty, though an elderly person with a breast nodule can still be treated. A lump on the fleshy part of the hanging breast is called a carbuncle; one near the chest is called a nodule.

If Phlegm-Dampness has stagnated for a night, obstructing the flow of Qi and blood, and the carbuncle has not yet formed pus, apply this medicine to the center of the affected area to encourage pus to drain outward from the lesion. It is better to apply it once more afterward. If this treatment cannot be used, the cause may be weakness and depletion of the original Yang—the root of the body’s Yang Qi. This is a critical pattern of collapse. In such cases, promptly apply the “Full-Body Jade Dragon Poultice” to draw out toxins and promote suppuration. For internal use, add platycodon root, pinellia, angelica, cinnamon, and similar ingredients to “Tongshun Powder” to improve the flow of Qi and blood.

If the affected area is vividly red and the heat suddenly intensifies, use the “Danggui Chonghe” formula; do not mistakenly use cold-natured medicines. This formula is only for drawing out toxins and promoting suppuration. Stop using it as soon as the condition improves, and do not use it in excess. Its effects are better when combined with “Taomai Shenzhi,” a formula found in Essentials of External Medicine.

Nine out of ten cases of abdominal carbuncle, in which a carbuncle forms inside the abdomen, are fatal. The original text states that the stomach belongs to Yin: cold surrounds it from the outside, while heat pathogens lie within. When Qi and blood gather, they move toward heat and away from cold, so the lesion usually forms inside the body and is difficult to detect from the surface. Its effects are better when combined with “Taomai Shenzhi,” a formula found in Essentials of External Medicine.

Abdominal abscesses, which form within the abdomen, are fatal in about nine cases out of ten. The stomach belongs to Yin, and external cold encloses internal heat. Qi and blood gather where there is heat and avoid where there is cold, so abscesses tend to form inside the body rather than appear on its surface. Now and then, a faint reddish mark may begin to emerge, but it may be exposed to cold medicines. If cold medicines are then taken again, even a physician with the skill of an immortal may be unable to save the patient. How, then, could treatment be undertaken without great care?

When this condition occurs, as soon as abdominal pain is first felt, press the area with the hand to distinguish its nature. If the pain shifts and moves unpredictably, it may be a mass of Qi. If the base of the lump is fixed and does not move, with slight redness and swelling on the surface, it may be an internal abscess. Immediately use this formula to draw out the toxic Qi, turning the internal abscess into an abscess on the body’s surface. Then treat it with Chonghe, a topical medicine for sores and abscesses. Take Tongshun Powder internally with honeysuckle vine; the specific method is the same as described above. If the abscess has already appeared on the surface by itself, there is no need to use a formula to draw it out. Treat it with Chonghe alone, and do not casually use needles or knives.

If the abscess has been punctured with an iron instrument and the wound will not close, apply only Yulong Plaster to the head of the abscess and surround it with Chonghe. Follow the method described above and allow it to break open on its own. If the pus does not drain freely, prepare three parts Hongbao and seven parts ginger juice, mix them with tea, and apply the mixture as directed to drain the pus completely. Take Shixuan Pingbu Shengji internally to replenish the body and promote tissue growth; externally, continue to treat the wound with Chonghe as described above. Here, “parts” refers to the proportions of the ingredients.

This condition is more often of a Yin nature than a Yang nature, and it greatly harms the body. When the illness is beginning to settle, increase the use of internal tonics to nourish Qi and blood, which makes recovery more likely. Otherwise, the swelling may return after subsiding, and the wound may be difficult to close. Even once the condition has stabilized, continue taking internal tonics, with aconite added; without it, the body’s source Qi may weaken and the illness may not settle. If the condition is cold in nature, take an aconite formula before the abscess breaks open. After it has opened, never use medicines that close the wound too quickly, lest the toxic evil inside the body be prevented from dispersing. Once the medicine has taken effect, the wound will close naturally.

If an internal abscess has formed but cannot be drawn out of the body, apply Chonghe externally alone. This gently brings the affected area to suppuration at the surface, allowing pus to drain outward from the internal organs and preventing decay inside the body. Whether the patient lives or dies depends entirely on whether the medicines are taken appropriately; for the specific method, see above. Foods that are harmful or toxic must be avoided. If the illness is triggered by improper eating, it will recur and be difficult to treat.

Treatment differs for pregnant women with this condition. Take Zisu Drink internally to protect the pregnancy, and do not casually use other medicines. If delivery is near, the child and the pus may be expelled together. If delivery is still far off, the pus will be discharged in the stool. At the very beginning of the condition, taking medicine may sometimes make it recede. If the abscess has already appeared on the surface, the illness is necessarily hot in nature; treat it only with Chonghe, using care according to the severity so that the treatment does not cause harm.

This concludes Volume Three. Volume Four is titled Secret External Surgery Prescriptions of the Immortals, compiled by Zhao Yizhen, the Master of Yuanyang from Junyi.

Using the wrong medicine for an application can also affect its efficacy.

Cooling Medicines for Topical Application

Hongbao Powder, also known as Golden Elixir, Cun Jin, Four Yellows Powder, One Yellow Powder, Blood-Breaking Elixir, or Yellow Medicine. Its ingredients are three liang of Tianhua Powder, one liang of turmeric, one liang of white angelica, and two liang of red peony root. Grind the ingredients into a fine powder and mix with tea, wine, or a decoction. Apply warm according to the condition. It is suitable for abscesses and swellings caused by various heat conditions, as well as metal-inflicted wounds, such as injuries caused by knives or swords.

This medicine is cooling in nature. It can turn blood into fluid, but it may also cause blood stasis to congeal and accumulate. It can cool the skin and promote the growth of new flesh, but it can also remove dead and rotting tissue. It can break up blood stasis and reduce swelling, but it may also impede the flow of Qi and cause edema. It can relieve pain, but it may also bring on pain. It can close a wound through which pus is draining, but it can also promote the discharge of pus. Its effects can shift in opposite directions depending on the condition and how it is used.

The medicine has no other particular qualities: it is less effective when the pattern is cold and more effective when the pattern is hot. Therefore, do not use it casually unless the condition is clearly a Yang pattern, one characterized by heat, lest Cold Evil become congealed and make treatment more difficult. For bleeding from metal-inflicted wounds, such as cuts made by swords or knives, however, this medicine is essential and is the first choice. In other cases, it generally serves only as an adjunct to the two medicines mentioned earlier. Diagnose the pattern carefully and use it with caution.

In general, these three medicines may be combined to achieve the same effect or used individually; they may be assigned complementary roles or used together to attack the illness; they may support one another or each take responsibility on its own. Treatment may proceed by direct means first and prevail through an unconventional method, or begin with an unconventional method and then prevail through direct means. The ways of arranging the medicines are as varied as the art of war. Yet an army follows the commands conveyed by its seal, and its generals act according to orders; whether it achieves victory depends on the person directing the troops. Without a thorough grasp of medicine and the ability to adapt skillfully, one cannot truly master these methods. The specific methods are as follows.

If the condition is intensely hot, mix the medicine with hot tea and apply it. If the heat is mild, mix it with wine. To draw out pus—to gather it and promote its discharge—mix three parts ginger juice with seven parts tea. This medicine is very cooling and can cause blood to recede; ginger juice is hot in nature and can set blood in motion. After the blood recedes, ginger juice stirs it into movement, while the medicine’s force restrains that movement. These two forces counterbalance one another, eventually promoting the formation and rupture of pus so that as much of it as possible is discharged.

When a wound has already opened, but the flesh around it remains hard and slow to subside, this indicates that the wound has been invaded by pathogenic Wind. When using this formula, add duhuo (a herb that dispels Wind) and mix it with hot wine to make an external application. If the condition still does not improve, the Wind toxin has penetrated deeply and the flesh has become firm. Add zǐjīng pí, the bark of the Chinese redbud, to help disperse it.

This formula is best suited to sword and knife wounds and other injuries, as well as various conditions marked by heat, redness, and swelling. It can stop the bleeding and prevent the redness and swelling from spreading further. It should not be used casually for yongju (deep, pus-forming sores and swellings). The concern is that the pathogenic toxin at the site of application may fail to disperse and instead penetrate inward: if it reaches the bone, it may cause a bone abscess; in the throat or neck, it may gather in the throat; in the chest or back, it may erode the internal organs; and in the abdomen, it may form an internal abscess and endanger life. Great care is essential. Assess the condition and choose between the Chonghe and Yulong external applications according to the prescribed method.

In young, strong people with abundant Qi and Blood, as well as in the elderly and frail whose Qi and Blood are depleted, severe bleeding that is left untreated may lead to death from excessive blood loss. For an injury to a hand or foot, mix the medicine with tea and apply it to the wound, covering an area extending more than a foot above and below it. For an injury to the chest, back, waist, or abdomen, apply it over the whole body to control the channels through which blood is flowing and stop the bleeding. Then switch to a blood-stanching medicine, such as powdered wǔbèi (gallnut), mentioned later, or the army’s miraculous formula. Only after changing the medicine can the wound gradually heal.

For severe metal weapon wounds, when the tendons and vessels are injured and the bleeding will not stop, potentially endangering life, first tie the arm tightly with a cord or a silk cloth band. Mix this formula with tea and apply it above the injury, near the bleeding site, to restrict the blood flow; then sprinkle the hemostatic powder over the wound. Do not take internal tonics or blood-nourishing medicines such as Siwu Decoction at this time, as they may cause vomiting and, in severe cases, deviation of the mouth and eyes. Agitation and fever may soon follow, developing into tetanus. Take only Dui Jin Drink, adding Chuanxiong and Baizhi, and decocting them with ginger and jujubes. This can stabilize the condition; blood can then be replenished gradually. If symptoms of tetanus appear, tetanus medicines must also be used, such as formulas like Gegen Decoction listed later. When applying the military formula to the wound, nine-ribbed turtle shell, with its nine ridges, may be added. Roast it in butter and grind it into a fine powder.

For metal weapon wounds to the head or face, if the bleeding will not stop, immediately mix this formula with tea and apply it around the neck to restrict the blood flow. Apply medicine along the wound’s edges as well, and sprinkle the powdered military formula over the wound. Severe injuries respond within ten days; mild ones within three.

If a metal weapon wound gets wet and the flesh at the wound turns outward and swells, mix this formula with Chinese chive juice and apply it on both sides of the wound, then warm it over a low flame. The wound may also be fumigated with smoke from early-ripening rice straw. If fluid seeps from the wound, it will heal. If no fluid seeps out, this indicates an invasion by pathogenic wind. Mix Arisaema, a Chinese medicinal herb, with tea and apply it to the wound; then sprinkle the powdered military formula over it.

For women whose menstrual blood surges upward after childbirth or after menstruation has ceased, causing distress of the spirit, as well as for vomiting blood, nosebleeds, or bleeding from the tongue, mix this formula with well-flower water—water drawn from a well at dawn—and apply it to the neck. Then sprinkle the medicine powder over the wound.

After childbirth, or after menstruation has stopped, menstrual blood may flow upward and disturb the mind and spirit, or cause vomiting blood, nosebleeds, or bleeding from the tongue. This prescription may be used for all these conditions. Mix the medicine with the first-drawn well water of the morning and apply it to the neck. Mixing it with fresh mugwort juice is also effective and can stop the bleeding quickly. The medicine should then also be taken internally to stop the bleeding at its source.

When the tongue is bleeding, a blood blister usually forms. If it is punctured, it swells again. A thread may be tied around the base of the tongue and the neck and left in place temporarily. This presses on the blood vessels in the neck and reduces the bleeding. At the same time, take medicines such as Scutellaria root and Schizonepeta to clear Heart Fire and control the source of the bleeding. Apply honey mixed with medicines that help close the wound to the surface of the tongue. Once the blister breaks, remove the thread; the blister will not swell again. One may also take a prescription to clear the Heart and cool the blood: Four-Substance Decoction with Schizonepeta, mint, and cinnabar.

When this prescription is mixed into a paste and applied to painful swelling caused by heat toxins, egg white can be used instead if there is concern that the paste will dry and cause pain while the redness and swelling persist. Egg white keeps the paste from drying out easily and may be used for all kinds of painful swelling caused by heat toxins. The same method can be used for burns.

If there is an injury or rupture above the chest and diaphragm, and blood does not pass downward after taking medicine to move the blood, mix this powdered medicine with mung bean water and take it. The person will vomit up stagnant blood, and the condition will then ease. In another case, someone fell from a height and took medicine to move the blood, but the blood still did not pass downward. After several days of illness, the person was close to death. This was probably because the weather was cold and the person had taken cold medicines such as rhubarb, causing clotted blood to become immobile. Mix dried ginger powder with hot wine and take it; after a while, the blood will begin to flow and the person will recover from the crisis. The warming nature of the hot medicine helps stagnant blood move again, allowing the blood-moving medicine mentioned earlier to take effect.

Sixth: Combining Prescriptions

Yellow Alum Pill, also called Membrane-Protecting Powder.

One liang of raw alum, ground into a fine powder, and some yellow beeswax.

Melt the beeswax over a fire, remove it from the heat, and let it cool until it is about nine-tenths cooled. Add the alum powder and mix thoroughly, then form pills the size of Chinese parasol tree seeds. Take ten pills at a time, gradually increasing to twenty, with rice water. An unruptured lesion will break open; one that has already ruptured will close. This prescription is said to protect the membranes and connective tissues inside the body, safeguard the Heart, and prevent toxic influences from entering the body.

Oakleaf Decoction is used to treat sores on the back, carbuncles, and deep abscesses. It is suitable whether a sore has formed or not, and is a good remedy for families with limited means.

Grind four liang of dried oak leaves, together with one liang each of the leaf centers and stems of dried lotus leaves, daylily root, sections of licorice root, and garden burnet root into a coarse powder. For each dose, take half a liang, add two bowls of water, and simmer until reduced to one bowl. Divide the liquid into two portions, taking one in the morning and one in the evening. Then add water to the herbs left after simmering and decoct them again for another dose. Sores containing pus may dry up, and those that have already formed pus may gradually disperse. While taking the medicine, avoid all poisonous or unclean foods.

Three-Mineral Powder is used to treat thirst and frequent urination that arise after sores develop.

Take one qian each of ginseng, white atractylodes, Chinese angelica, white peony, platycodon root, anemarrhena, and gardenia; two qian each of poria, forsythia, trichosanthes root, and dried kudzu root; half a qian each of cinnamon bark, patchouli, and costus root; six qian of licorice; one liang and six qian of mirabilite; eight qian each of calcite and gypsum; and one liang each of talc and rhubarb. Grind all the ingredients into a fine powder. For each dose, take five qian, add one cup of water and three slices of fresh ginger, and simmer until reduced by half. Strain the liquid through cloth or silk, add a little honey, and drink. The dose may gradually be increased to one liang. Take it three times a day, keeping urination regular. If diarrhea occurs, omit the mirabilite and rhubarb. The Eight-Ingredient Pill recorded in the Essentials of External Medicine can also treat this condition.

Trichosanthes Powder is used to treat carbuncles and deep abscesses.

Take fresh or stored trichosanthes fruit and stir-fry it with Sichuan pepper, then crush it. Separately, take twenty Sichuan peppercorns, three to five inches of licorice root cut into pieces, and five grains of frankincense, each about the size of a Chinese honey-locust seed.

Decoct it with three bowls of unclarified wine—wine without lime or other impurities—until it is reduced to one bowl. Strain out the dregs, then drink it warm. The toxin will soon dissipate. If the lesion has not yet formed pus, it will subside; if pus has already formed, it will drain on its own. Do not squeeze it by hand.

The Haishang Formula records a treatment for internal abscesses—abscesses that form inside the body. When the pus has turned foul and is very fetid and unclean, even causing coldness and pain in the abdomen around the navel, this is due to putrefying pus. This formula can be used to promote its discharge.

One liang of Baizhi, half a liang of Baishao, half a liang of calcined Baifan, and two liang of single-leaf red hollyhock root.

Grind the ingredients into a fine powder.

One liang of Baizhi, half a liang of Baishao, half a liang of calcined Baifan, and two liang of single-leaf red hollyhock root. Grind the ingredients into powder, then melt them together with wax and form pills about the size of parasol tree seeds. Take thirty pills on an empty stomach before meals, with rice water, until all the pus has drained. Then take Shixuan Powder, a formula used to strengthen and restore the body.

Another formula uses fish paste to fry crucian carp, treating intestinal abscesses—abscesses inside the intestines.

Another formula: burn turtle shell until its medicinal properties remain, then take it.

Zhenjun’s Miraculous Plaster Powder

Three liang of purified sulfur and two liang of buckwheat flour.

Grind the ingredients into a fine powder. Mix with well water drawn at dawn until it reaches a suitably fluid consistency, then shape it into cakes. Dry them in the sun or by gentle heating and store. When a severe ulcer appears, grind a cake into powder again, mix it with dawn-drawn well water, and apply it to the affected area. The text says that if the area hurts after application, the pain will stop; if it did not hurt before, pain will arise, after which the illness will be cured.

Wind-Chasing Pills

Treat numbness in the hands and feet, wandering pain in the channels caused by cold, obstruction, and impaired circulation of Qi and blood, as well as a condition called “Drum-Hammer Wind,” in both men and women.

Five qian of Chenxiang; three liang of Niuxi, soaked in wine and then stir-fried; three liang of Danggui, baked; two liang of Yiyiren; two liang of Baizhi; two liang of Chuanxiong; five qian of Qianghuo; five qian of Fangfeng, stir-fried; one Chuanwu, prepared; five qian of Chishao, stir-fried; five qian of Tianma, stir-fried; five qian of Caowu, stir-fried; five qian of yellow Rougui; one liang of dried ginger, stir-fried; five qian of clove bark; five qian of Ruxiang; five qian of Moyao; five qian of Muxiang; and three liang of Mugua, stir-fried.

Grind the ingredients into a fine powder. The text repeats some of the ingredients at the end, but the passage is incomplete.

Grind the medicines into a fine powder and mix with honey to make pills. Take thirty pills at a time with wine. For treating beriberi, use wine paste to make the pills and swallow them with warm wine. If taking the powder directly, mix it with wine before swallowing. Avoid hot foods.

Bone-Setting and Pain-Searching Pills: These may be used to set bones and to treat pain throughout the body, old injuries that have damaged the bones, and similar conditions. For wounds caused by metal weapons such as swords, use them in the circumstances described below.

The ingredients are two qian of frankincense, two qian of myrrh, one liang of Chinese angelica, five liang of roasted dried ginger, three qian of cinnamon bark, one liang of Sichuan lovage, one liang of roasted coix seed (increase this ingredient if the sinews and vessels are severed), five qian of clove bark, five qian of roasted pubescent angelica root, two qian of roasted fennel, five qian of aconite root roasted until yellow, two liang of roasted Drynaria rhizome, five qian of roasted red peony root, five qian of roasted angelica dahurica root, and five qian of roasted shi ku teng (another version gives two liang).

Grind the ingredients into a fine powder and use honey to make pills. Before taking them, chew fresh ginger thoroughly, then swallow the pills with warm wine. Alternatively, mix the powder with ginger wine, or soak it in wine and take it.

For fractures, use the ingredients in this prescription. It may be taken when there is numbness throughout the body. To set a bone, add one spoonful of aconite root and mix with a generous amount of hot wine; adjust the dose according to whether the patient is old or young and whether their constitution is weak or strong. If the numbness does not go away, make a strong decoction of large black beans and drink the liquid to counteract it. If large black beans are unavailable, a strong decoction of fermented black soybeans may also be used. If vomiting occurs, add ginger juice.

Repeated-Decoction Powder: Used to treat carbuncles and sores on the back, especially swollen, ulcerated lesions there.

Take one qian each of phellodendron bark, scutellaria root, coptis root, anemarrhena rhizome, and fresh rehmannia root; half a qian each of saposhnikovia root washed in wine, gardenia fruit, notopterygium root, astragalus root, ophiopogon root, and honey-fried licorice root; half a qian each of honey-fried pubescent angelica root and ginseng; two qian of the tip of Chinese angelica root; and suitable amounts of aged tangerine peel, the tip of saposhnikovia root, the tip of licorice root, raw sappanwood, the body of Chinese angelica root, schisandra fruit, poria, ligusticum root, forsythia fruit, and platycodon root. Grind the ingredients into a coarse powder. For each dose, take four qian, add two bowls of water, and simmer until about seven-tenths of the liquid remains. Strain out the dregs. Depending on whether the condition affects the upper or lower part of the body, take it before or after meals.

Shenfeng Powder, also called Substitute-Needle Paste.

Take bing medicinal powder, needle water, seven white lilac seeds, and one zi of sal ammoniac (an ancient measure for a very small amount). Mix with needle water and apply as a dressing.

Wujin Powder is used to remove dead flesh from a wound and drain accumulated, stagnant pus.

Take half a qian of croton seeds and two liang of cold-food flour. Mix the flour with water and shape it into a cake, wrapping the croton seeds inside. Burn until black, then grind to a fine powder, adjusting the amount to the size of the wound. Apply dry to the affected area.

Suo Xue Powder: When a person has been cut by a blade and develops tidal fever, facial swelling, shortness of breath, or similar symptoms, ancient practitioners considered this to be tetanus and treated it with this formula. For frail elderly people who have lost a great deal of blood, omit kudzu root and add three qian of Sichuan lovage root. Also add three qian each of red peony root, asarum, notopterygium root, platycodon root, stir-fried licorice root, cinnamon bark, and angelica root.

Grind the ingredients into a powder. Take it with a decoction of ginger and scallion.

Kudzu Root Decoction: Used when alternating chills and fever occur after a blade injury, and also when wandering lesions (ailments or painful swellings that move or spread) appear on the body of a man or woman. If fever begins and is accompanied by redness, swelling, heat, and pain, this formula can be used to disperse the condition. Take the powdered herbs with a decoction of ginger and scallion.

One liang of shengma, two liang of gegen, two and a half qian of licorice, and five qian each of pinellia, perilla leaf, baizhi, clove bark, Sichuan lovage, xiangfu, and aged tangerine peel.

Grind the ingredients into a powder. Take two qian per dose with a decoction of ginger and scallion, on an empty stomach.

“Blood-Dispersing Powder” is used to support recovery after cuts from blades and severe blood loss.

Five qian each of ginseng, danggui, baizhi, white poria, and astragalus; two qian each of sharen, aged tangerine peel, and clove; three qian each of bitter orange and stir-fried achyranthes; one liang of Sichuan lovage soaked in wine; one qian of atractylodes; and one qian each of stir-fried fennel, stir-fried licorice, and cinnamon. When blood loss is severe, use more cinnamon.

Chop the ingredients. Take three qian per dose, decocted with ginger and jujubes. It may be taken at any time. This medicine should be taken whenever a wound or an injury from a beating needs to grow new flesh. “Tenfold Proclamation Powder” may also be taken; it is a formula used after sores have ulcerated to promote tissue growth.

“Blood-Mobilizing Powder” is used when the flesh has been injured but there is no bleeding, when the whole body is red and swollen after a fall or blow, or when urination and bowel movements are blocked. It is intended to free the flow of Qi and blood.

Three qian of rhubarb, wrapped in flour and baked until cooked; two qian of danggui, dried by roasting.

Decoct sappanwood and bitter orange, then stir in the powdered herbs and take warm. If taking it with wine, add the urine of a young boy. Do not use wine when there is tidal fever. If the blockage persists, take the medicine with a decoction of stir-fried bitter orange to strengthen its effect.

“Cockcrow Powder” is also used to free the flow of blood.

Use raw rhubarb, ground into powder; peel and remove the tips from the almonds, then stir-fry them.

Grind the ingredients into powder and take as a drink.

A formula from Chancellor Bayan’s army: used for wounds caused by swords, arrows, and other weapons; it is said to have no cases it cannot cure.

Grind equal amounts of frankincense, myrrh, notopterygium, perilla, asarum, lindera (some say this is aconite), half a zi of musk, calcined snake-containing stone, thick cinnamon bark, baizhi (unprocessed by fire), dalbergia, danggui, sappanwood, sandalwood, dragon bone, arisaema, sulfur, parasitic plant tail, and flower-core stone (quenched more than ten times in the urine of a young boy). Apply the powder dry to the wound to stop bleeding and pain, dispel wind, and promote tissue growth. Apply Hongbao Powder around the wound.

Use equal amounts of each of the above ingredients. Grind them into a fine powder and apply it dry to the wound to stop bleeding and pain, dispel Wind, and promote tissue growth. Applying Hongbao Dan around the edges of the sore works very well.

Fumigation and Washing Formula: This formula treats various abscesses, sores on the back, and skin ulcers. It may also be used for open wounds, fractures where the skin remains unbroken, and injuries in which the bone is intact but the area is swollen and painful.

Morus bark is the principal ingredient for treating injuries. Use one and a half liang of Angelica dahurica and two liang of red peony root. Lindera root is chiefly used for swelling and bone pain. Left-twining vine, schizonepeta, tangerine leaves, and patchouli are suitable when the injured area smells foul or is decaying; Chinese tallow tree root may also be added.

Grind the ingredients into a powder and adjust the amounts according to the condition. For each liang of powder, add two bowls of water and decoct. When washing metal-inflicted wounds, such as cuts from knives or swords, add schizonepeta and Morus bark. If the injury smells foul, add patchouli; for a toxic sore, add Chinese tallow tree root bark. When the decoction is warm, pour it from a bottle over the affected area to wash it.

If the injury covers much of the body or is severe, heat several large bricks in a small, windless room. First use the hot medicinal decoction to fumigate and wash the affected areas. When the heat subsides, plunge the red-hot bricks one by one into the decoction to warm its medicinal vapors again. The aim is to bring on a slight sweat.

Musk and Calomel Powder, also called Fourfold Peach-Red Powder: This formula promotes tissue growth and helps wounds close. It also relieves pain and dispels Wind. For various sores and abscesses, or wounds that have failed to close after a fall or fracture, first wash the area with a medicinal decoction, then apply the powder dry to the wound.

Frankincense, myrrh, and stir-fried Chinese gall are the principal ingredients. Unprocessed Angelica dahurica dispels Wind and promotes tissue growth; red peony root disperses stagnant Blood and relieves pain. Calomel and national cinnabar are purified by levigation. Calcined red ochre acts quickly. Musk and dragon’s blood stop bleeding and promote tissue growth. Betel nut stops bleeding and helps the other ingredients circulate. Also include Angelica sinensis, washed with wine and then dried by roasting, and cuttlebone.

Grind all the ingredients into a fine powder and use it when changing the dressing.

Divine and Wondrous Four-Seven Plaster: This formula treats various chronic sores that do not heal, as well as malignant and toxic sores.

The ingredients include frankincense, myrrh, saposhnikovia, notopterygium, Angelica dahurica, red peony root, Angelica sinensis, Coptis, cinnamon bark, Chinese honey locust, Chinese gall, shelled croton seeds, Chinese soapberry seeds, national cinnabar, castor seeds, “nameless mineral,” betel nut, water powder, calomel, Chinese sweetgum resin, and long pepper. Another version adds Lindera root, pine resin, and yellow beeswax in equal amounts. Peach, willow, and locust branches, wax ointment, and clear oil are also used in making the plaster.

Apart from frankincense, myrrh, musk, light powder, and the medicinal pills, which should each be ground finely, first fry the remaining ingredients in clear oil until they are scorched and dry. Then add Liquidambar resin, pine resin, yellow wax, and wax paste, and continue heating until they melt. Strain the mixture through silk to remove the dregs, then add national elixir and water powder. Keep heating until it turns purple. Next add the frankincense, myrrh, musk, and finely ground light powder. Stir constantly with a peach, willow, or scholar tree branch until a drop of the mixture holds together when placed in water. Store it in an earthenware vessel, and use it only after the medicine’s “fire toxin”—its drying, hot nature when freshly made—has dissipated.

Another formula is used to stop bleeding, promote tissue growth, and close wounds. Its ingredients may be adjusted as needed: talc, which is mild in nature; calcined cold water stone; calcined gypsum, which is mild in nature; foreign fragrant resin; burnt realgar, used to stop odor and remove decayed tissue; calcined dragon bone, which acts quickly; stir-fried Sichuan pangolin scale, used to reduce swelling; plant ash; stir-fried Liu Jinu herb, used to stop bleeding; stir-fried Wangbuliuxing seed, used to stop bleeding; Cherokee rose fruit; Jiuliguang herb, used to stop bleeding; ramie root burnt until its form remains; and old pine bark burnt until its form remains. Grind each ingredient into powder, then adjust the amounts as appropriate when using the formula.

“Pain-Stilling Black Powder” can also stop bleeding. Combine plant ash, ramie root burnt until its form remains, and burnt, finely ground foreign frankincense; use the mixture to close wounds.

Burn old pine bark until its form remains, then grind it into powder. It can stop bleeding from knife and staff wounds, and can also be used for various kinds of unrelenting pain.

The Miraculously Effective Restorative Qi-Penetrating Powder treats various severe sores. Take it three times in succession as soon as the illness is first noticed. It can also be used for carbuncles, abscesses, sores, swelling, and pain. If pain is intense and persistent, this powder may also be taken.

Formula: three liang of angelica, one liang of licorice, half a liang of raw rehmannia, one liang of astragalus, one liang of white peony, one liang of trichosanthes root, half a liang of prepared rehmannia, and two liang of honeysuckle. For each dose, take five qian of the ingredients and decoct them in one and a half bowls of water until one bowl remains. Drink warm. Depending on whether the condition is in the upper or lower part of the body, take it before or after meals. Other names for the ingredients in this formula are explained in the notes.

This mnemonic uses figurative alternative names to explain the common or corresponding names of medicinal ingredients, making them easier to identify and combine in prescriptions: He Shou Wu is called “Horse Liver Stone”; Mu Tong, “Jade Lotus”; red peony root, “Red Peony”; Shi Chang Pu, “Spring Yang Wood”; fennel, “Stomach-Soothing Fragrance”; Du Huo, “Longevity Herb”; Cao Wu, “Golden Crow Powder Herb”; Nan Xing, “Tiger-Bone Paste”; Zhi Ke, “Huai River Orange”; Jun Jiang, “Dragon-Spring Fragrance”; Dang Gui, “Blood-Nourishing Resin”; Jiang Huang, “Precious Cauldron Fragrance”; aromatic Bai Zhi, “Jade Arrow”; Tu Mu Xiang, “Earth Wu Medicine”; cinnamon bark, “Golden-Dust Fragrance”; Zi Jing Pi, “Purple-Cloud Glue”; frankincense and myrrh, “Jade Marrow and Fine Nectar”; Tian Hua Fen, “Auspicious Snow”; and Gan Cao, “Elder of the State.” The mnemonic’s final line says to find the corresponding herbs by their names and categories, then use them together.

In preparing the medicines, Bai Zhi and cinnamon bark are not treated with fire. He Shou Wu must not come into contact with iron tools during processing. Tu Wu Medicine, red peony root, fennel, Zi Jing Pi, Wang Jian Xiao, and Jun Jiang are stir-fried together. Du Huo is fried after its joints are removed. Dang Gui is washed with wine, then dried by roasting. Use aged Zhi Ke and simmer it wrapped in material. Gan Cao is roasted. Remove the skin and joints from Mu Tong. Simmer Nan Xing and Huai Cao Wu wrapped in material. Jiang Huang and Tian Hua Fen are used raw.

The closing words, “The Secret Prescriptions of the Immortals for External Medicine, Volume Four, End,” mark the end of the fourth volume. Versional collation notes follow, and then the title of the fifth volume begins.

Compiled by Zhao Yizhen, Master Yuanyang of Junyi.

An Empirical Remedy for Treating Carbuncles and Abscesses

People with wasting-thirst disease, commonly marked by thirst and excessive drinking, are prone to developing carbuncles and abscesses—suppurating sores between the skin and flesh. This water is said to bring rapid relief.

Take water from the twelfth lunar month and use the method indicated by “□” to collect the silk and retain the liquid. Let it stand until the water clears and cools, then warm it and drink it twenty-three times. After taking it, the condition should ease and the thirst disappear. A character is missing from the original here, so the precise method for “collecting the silk and retaining the liquid” cannot be determined.

Internal-Tonifying Astragalus Powder

For patients with carbuncles and abscesses who are internally weak, have pus that continues to drain, weak limbs, and no appetite, and whose illness lingers without healing. The original says this condition may develop into “internal leakage,” in which the sore breaks inward and forms a lesion that communicates with the interior.

Ingredients: aconite, astragalus, cistanche, polygala, ophiopogon, prepared rehmannia, and morinda, one liang each; white poria, white peony, ginseng, dendrobium, and licorice, three qian each; northern schisandra, cornus fruit, dodder seed, Chinese angelica, ligusticum, dimai, and wu wei, five qian each.

Grind all the ingredients together into a fine powder. Take two qian per dose with an infusion of schizonepeta.

Internal-Tonifying Powder

For carbuncles and abscesses on the back. The list of ingredients in this entry is incomplete: only cornus fruit, dodder seed, Chinese angelica, ligusticum, dimai, and wu wei are listed, five qian each; some text appears to be missing from the beginning.

Grind the ingredients into a fine powder. Take two qian per dose with an infusion of schizonepeta.

Internal-Tonifying Powder

For carbuncles and abscesses on the back where the sores have broken open and discharge large amounts of pus, accompanied by bodily weakness, lack of strength, and loss of appetite.

Ingredients: ginseng, white poria, Chinese angelica, astragalus, cassia bark, and polygala, half a qian each; ligusticum, two liang; ophiopogon, one liang; licorice, half a liang; white peony, aged tangerine peel, prepared rehmannia, and northern schisandra, one liang each.

Cut the ingredients into pieces. For each dose, take one portion and add one and a half cups of water, three slices of ginger, and three red dates. Boil until about seven tenths remains, then drink warm.

Internal-Tonifying Powder

For carbuncles and abscesses on the back accompanied by an Yin pattern and a severe course of illness. “Yin pattern” is a traditional medical term for a group of cold and deficiency symptoms.

Ingredients: aconite, cassia bark, dried ginger, amur corktree bark, ginseng, and Sichuan pepper, two qian each; ligusticum, two liang; red adzuki beans, one and a half he; skullcap, saposhnikovia, and licorice, one and a half liang each.

Cut the ingredients into pieces. Take four qian per dose, decoct in wine until about seven tenths remains, and drink warm.

Agarwood Powder is used to treat various sores and swellings when toxic pathogens drive inward into the abdomen, causing agitation in the chest, abdominal distension and fullness, and loss of appetite.

Take one liang each of agarwood, costus root, frankincense, clove, and rhubarb, with a small amount of musk.

Roughly chop the ingredients and decoct them in water. Drink while warm.

Frankincense Powder is used to treat conditions in which a carbuncle on the back has ulcerated internally. The ingredients are one liang each of frankincense, clove, and rhubarb, with a small amount of musk. Roughly chop the ingredients, decoct them in water, and drink warm.

Frankincense Powder is used to treat carbuncles on the back that have ulcerated internally, as well as severe conditions in which toxic Qi drives inward, causing vomiting and nausea. For malignant carbuncles, furuncles, boils, and similar sores, it may be taken once or twice daily to help expel toxic pathogens outward and prevent them from attacking the internal organs.

Take frankincense (the resin of Boswellia, ground separately before use) and genuine mung bean powder (or peeled mung beans).

Grind the ingredients into a fine powder. For each dose, take one qian, mix it with a little freshly drawn well water, and swallow slowly. One person had a large carbuncle on the back along the meridians. The swelling extended from below the shoulder to the waist and ribs; it was as hard as stone and purple-black in color. After a physician applied an old medicine externally, the patient vomited violently in the middle of the night. This powder was then given three or four times in succession, and the vomiting soon stopped. The sore later ruptured, discharging a large quantity of red fluid, and the patient recovered after forty days. Another person had scrofulous sores and would vomit whenever they became painful; after taking the medicine, the retching stopped immediately. The powder may also be mixed with a decoction of grass nodes.

Internal Dissolving Powder is used to treat abscesses, carbuncles on the back, and various hard lumps and painful boils that do not cease hurting.

Take one liang each of ginseng, Chinese angelica, astragalus root, Sichuan snakeroot, agarwood, scutellaria root, fangji, fangfeng, dianthus, ampelopsis root, and licorice; add one he (a measure) of red adzuki beans, dry-fried.

Grind all the ingredients together into a fine powder. Take two qian per dose, at any time, mixed with warm wine.

Ophiopogon Powder is used to treat carbuncles on the back and breast abscesses, with redness, swelling, and pain, accompanied by fever, agitation, and unrelenting thirst.

One and a half liang of astragalus root, one and a half liang of baical skullcap root, one and a half liang of Ophiopogon root (a medicinal herb that nourishes Yin and moistens the lungs), one liang of Sichuan red-rooted salvia, one liang of red poria, one liang of red peony root, one liang of Scrophularia root, one liang of Chinese angelica root, one liang of licorice root, one liang of anemarrhena rhizome, one liang of trichosanthes root, and four qian of fresh rehmannia root.

Chop the ingredients. For each dose, take four qian and decoct in water. Drink warm well after a meal. If the fever is severe, add lophatherum leaves and rush pith.

Akebia Powder is used to treat outbreaks of carbuncles and sores (suppurating lesions between the skin and flesh), stagnation of Qi, and inability to urinate or pass stool.

Two qian each of akebia stem, baical skullcap root, rhubarb, Chinese trichosanthes root, Chanlu, licorice root, and mirabilite; and three qian of gardenia seeds.

Chop the ingredients and decoct them in water. Drink warm before a meal, taking enough to promote elimination.

Dianthus Powder is used to treat carbuncles and sores, including sores on the back. It helps drain pus, relieve pain, and promote urination.

Equal portions of cassia bark, red peony root, Chinese angelica root, astragalus root, Sichuan lovage rhizome, dianthus, white hyacinth bean, and Ophiopogon root; one ge of red adzuki beans, soaked in wine and then stir-fried dry.

If a carbuncle or sore has burst or has not yet burst, and the wound continues to discharge pus and blood with unbearable pain, add asarum, angelica dahurica root, white hyacinth bean, and coix seeds to the formula.

Chop the ingredients. For each dose, take four qian, add wine, and decoct. Drink warm.

Qilin-Stopping Powder is used to treat carbuncles, sores, and malignant ulcers that recur after flesh has regenerated, following sexual activity or strenuous labor, causing persistent bleeding.

Half a liang each of dragon’s blood resin, betel nut, alum, coptis root, phellodendron bark, and terminalia fruit.

Grind all the ingredients together into a fine powder. Mix it with egg white and apply it to the affected area, then cover it with paper. Replace the dressing once the medicine dries. Do not mix the medicine with water.

Immortal Formula Phlegm-Transforming Elixir:

Two liang each of alum, green vitriol, and large pinellia (soaked seven times in hot water), and large arisaema. Treat half with seven washes in hot water, and prepare the other half by boiling it with honey locust pods.

Internal prescription for the right side: Take half an ounce of tuber of Arisaema and cut it into slices. Cut an unworm-eaten Chinese honey locust pod into seven sections, each one inch long. Boil the slices and pod sections together in water until the water has completely evaporated. Remove the pod and keep only the Arisaema; dry it over a low heat. Grind all the medicinal ingredients used above into a fine powder. Mix the powder with water to make a fairly stiff paste. When it has cooled, add concentrated fresh ginger juice and stir well. Combine the powder and paste to form pills the size of parasol tree seeds. Take thirty to fifty pills at a time on an empty stomach, washed down with mild ginger tea. It is said to work quickly.

Astragalus Powder for Lung Abscess, also called Platycodon Decoction, is used to treat a lung abscess (a suppurating swelling in the lungs). Symptoms include obstructed Qi in the chest, coughing up pus and blood, discomfort in the shoulders and back, reddish-yellow urine, frequent difficulty passing stool, and poor appetite.

The ingredients are one ounce each of astragalus root, asparagus tuber, Chinese rhubarb, perilla leaf, red poria, mulberry root bark, and prepared rehmannia root; three mace each of apricot kernel, tribulus fruit, and bitter orange; and half an ounce each of Chinese angelica root and licorice root. Add fritillaria bulb and coix seed. Chop the ingredients. For each dose, add three slices of fresh ginger and boil; take warm.

Platycodon Pills are used for lung abscess, with symptoms including fullness and discomfort in the chest, chills and shaking, a rapid, hurried pulse, a dry throat without thirst, and frequent expectoration of foul-smelling phlegm. In prolonged illness, the patient may cough up pus resembling thick porridge.

Another prescription calls for half an ounce of platycodon root and three slices of fresh ginger, boiled together and taken warm.

Platycodon Pill prescription: Take half an ounce each of platycodon root and fritillaria bulb, and one mace of croton seed with its oil removed. Grind the ingredients together into a fine powder and use refined honey to make pills the size of parasol tree seeds. Those of strong constitution should take five pills with rice-water; those of weak constitution should take three. If the illness is above the diaphragm, the medicine will cause vomiting and expulsion; if below the diaphragm, it will be expelled through the bowels. If excessive diarrhea continues without stopping, eat three or four spoonfuls of cold rice to restore balance; this will stop it.

For treating intestinal carbuncle (a carbuncle that develops inside the intestines): This prescription may be used when the patient has a high fever, sweats profusely, and is short of breath; the lower abdomen is swollen and painful; urination is difficult, as in strangury, or bowel movements are difficult; the pain feels like stabbing knives, and the back also hurts. It may be used when pus has formed in the intestines or is discharged in the stool.

One liang of angelica, lightly dry-fried; one ge of sweet melon seeds; one chi-long piece of snake slough.

Chop the ingredients. For each dose, take four qian and decoct in one and a half bowls of water. Drink before meals. If foul matter is discharged afterward, the medicine has taken effect.

Peony Powder: For cases in which pus has not yet formed in the intestines and the abdominal pain is unbearable.

Three liang each of costus root, peony, patrinia, sweet melon seeds, red peony root, peach kernels, mirabilite, and Sichuan rhubarb (lightly dry-fried).

An incomplete passage above also reads, “Three liang of costus root … take four qian per dose and decoct before drinking.” The full list of ingredients may be missing. The later text says that Peony Powder is for intestinal carbuncle before pus has formed, when the abdominal pain is unbearable, and appears to connect it with this prescription.

Xialing Decoction: For patients with intestinal carbuncle whose lower abdomen feels tight and drawn, is painful to the touch, and whose urination is impaired; they may also sweat from time to time, feel cold, and have a slow pulse. It is for cases in which pus has not yet formed.

The ingredients are red poria, peach kernels, sweet melon seeds, Sichuan rhubarb (lightly dry-fried), Sichuan mirabilite, and peony. Chop the ingredients, add water, and decoct. It should take effect within three or four days.

Bezoar Powder: For cases in which pus has already formed in the intestines.

One qian of bezoar; half a qian of dragon’s blood; sodium nitrate, rhubarb, morning glory seed, burdock seed, and psoralea fruit.

Grind the ingredients together into a fine powder. Take it mixed with cool, warmed wine, continuing until pus and blood are discharged.

The Qianjin Fang says: Intestinal carbuncle may be accompanied by coarse, irregular ridges in the folds of the ear. At first, there is abdominal pain, sometimes circling around the navel. A sore the size of a chestnut may appear on the abdomen, and the skin feels hot. Pus and blood may be discharged with the stool, as in red-and-white dysentery. Without treatment, the patient will surely die.

Lulou Decoction

The text lists “three liang of lulou,” then repeats the symptoms and prescription name for intestinal carbuncle given above. No other ingredients or directions for use are provided.

Louro, scutellaria root, bletilla rhizome, ephedra (with the joints removed), and rhubarb, three liang each; cimicifuga, white peony root, citrus fruit (with the white pith removed and dry-fried with bran), and peony root, two liang each; powdered licorice (honey-roasted licorice root), two liang.

Coarsely chop the ingredients. For each dose, take four qian and decoct in one cup of water until reduced to seven-tenths of its volume. Take hot on an empty stomach. Omit mirabilite and scutellaria root from this formula. If heat symptoms occur and the condition is pronounced, add five liang of rhubarb; mirabilite may also be added.

Cimicifuga Harmonizing Qi Drink: Treats sores and scabies on the limbs, with pain and itching that wax and wane, sometimes accompanied by chills and fever, swelling, oozing, and damp, itchy skin.

Cimicifuga, dried kudzu root, platycodon root, atractylodes rhizome, aged citrus peel, angelica dahurica root, and licorice root, one liang each; prepared citrus fruit, prepared pinellia, prepared dried ginger, poria, and angelica sinensis root, half a liang each; steamed peony root, seven and a half qian; steamed rhubarb, half a liang.

Coarsely chop the ingredients. For each dose, take four qian and decoct in one cup of water with fresh ginger and rush pith. Take warm before meals.

Restore the Source and Open Qi Powder: Treats various conditions caused by obstructed Qi, including deafness, abdominal abscesses, perianal or perineal abscesses, and sores or ulcers without a distinct head of pus. It also relieves distending pain and reduces swelling.

Green citrus peel and aged citrus peel, four liang each; Chinese pangolin scales (soaked in water), three liang; licorice root, three liang (half used raw and half roasted); kuwei root, three liang; honeysuckle, one liang; forsythia fruit, rhubarb, and angelica sinensis root, half a liang each; gleditsia thorn, one liang.

Grind the ingredients into a fine powder and mix with hot wine to take. They may also be decocted with wine and taken.

Astragalus and Poria Decoction: Treats cases in which the pus has drained from various abscesses and ulcers and the body is generally left with deficiency heat.

Red poria, cimicifuga, rhubarb, astragalus root, scutellaria root, and polygala root, one liang each; red peony root, licorice root, ginseng, angelica sinensis root, and raw rehmannia root, two liang each; ophiopogon root, one and a half liang.

Coarsely chop the ingredients. Take four qian per dose and decoct.

End of Volume Five of Secret Formulas from the Immortals for External Medicine.

Dietary remedy: From this point onward, the Ming edition reads: “Two liang each of licorice root, ginseng, Chinese angelica root, and fresh rehmannia root, and one and a half liang of ophiopogon root.”

Coarsely chop the ingredients above. Take four qian at a time, decoct, and drink.

Secret Formulas from the Immortals for External Medicine, Volume Six

Compiled by Zhao Yizhen, Master Yangyuan of Junyi.

Proven remedies for treating various types of ding sores.

When a ding sore first appears, if its color has not changed and it has not spread…

When a ding sore first appears, if its color has not changed, pressing it causes no pain, it stays fixed in place when pressed, and its head is sunken, while the body alternates between chills and fever, it is a ding sore. Qi ding, Water-Fire ding, Snake Eye, Stone ding, Male and Female ding, Rotten ding, Blood ding, Knife-and-Axe ding, Red Thread, Fish Eye, Purple Inkstone, and Sesame Seed are all different names for ding sores.

Immediately apply “Yellow-Ring Medicine” around the sore. Take the gallbladder of a male pig slaughtered in the twelfth lunar month, add powdered realgar, inkstick, and ginger juice, and put the mixture inside the gallbladder. Then apply the medicine to the sore, circling its opening to prevent the toxic influence from spreading. As soon as the sore’s head emerges, prick it with a needle, stopping when the needle reaches the painful spot; bleeding is acceptable. Next, use the “Immortal Toad Toxin-Drawing” method: put toxin-drawing medicine into the opening, then cover it with “Water-Sinking Plaster” or “Spirit-Response Plaster.” Once the yellow toxin has been drawn out and the sore becomes red and swollen, needle around the swollen area to release blood, yellow toxin, and yellow fluid.

If the yellow toxin spreads, observe how far the red streak extends and cut it off with a fire needle; this is said to stop the toxin from spreading further. Then find where the yellow toxin first flowed and formed a hard lump. Needle there to release blood and toxic matter. Another method is to make thirty to fifty successive punctures at the site of the yellow toxin, allowing blood and toxic Qi to flow out, then apply “Yellow-Absorbing Medicine” to draw out the toxin. If the yellow toxin spreads from the left side to the right, or from the right side to the left, the condition is difficult to treat and may even be fatal. If needling the sore produces no blood, or the blood that comes out is purplish-black, the condition is also considered difficult to treat and potentially fatal. To remove the yellow toxin, use only gold, silver, or copper needles, never iron ones.

When a ding sore first develops, immediately take “Pain-Chasing, Life-Saving Decoction.” It is said to disperse the sore’s toxin within the body and act quickly. “Flying-Dragon Life-Saving Pill” may also be taken. Afterward, take “Toxin-Transforming, Swelling-Reducing, Supportive Powder.” With all these medicines, the dose should be sufficient to bring on profuse sweating.

How to Obtain Toad Secretion

Using the above method to collect chansu (toad venom, the toxic secretion of the toad): squeeze the chansu from the brow ridge of a live toad by hand onto oiled paper or a yellow mulberry leaf, then scrape it off with a bamboo splint, collect it on the bamboo splint, and leave it in a shaded place overnight. The toad venom will dry naturally; afterward store it for later use.

Zhui Du Dan (Toxin-Pursuing Elixir): used to draw out the head of a ding sore and promote the discharge of pus and toxin; it is said to take effect quickly.

Take one qian of chansu, dried before use; seven croton seeds, shelled but not de-oiled, softened in aged wine; and separately one qian of bai dingxiang. If bai dingxiang is unavailable, substitute a wine-soaked centipede, and add dry naosha (sal ammoniac) one qian, realgar two qian, calomel one qian, and cinnabar two qian. Coat with yellow lead oxide; cinnabar may also be used.

Grind the ingredients together into a fine powder, mix with white flour, and add water to make pills. If the pills are difficult to form, use wine and flour paste, then roll them into pills the size of wheat grains with both ends pointed. Insert the pill into the sore opening after pricking it open with a needle, then apply Shui Chen Gao. Afterwards use plasters and tissue-generating medicines to promote the discharge of pus, blood, and toxins.

If the sore opening is black and sunken, the surrounding necrotic flesh has not been removed, and new flesh cannot grow, then according to the original text it is difficult to cure. This medicine can also be used to draw out toxin, remove necrotic tissue, and promote the growth of new flesh. For small sores use one pill; for large sores increase the amount as appropriate. When the condition is mild, there is no need to use a needle; simply scrape lightly at the top of the sore with a fingernail, then place the pill and apply Shui Chen Gao. Redness and swelling at the sore site indicate that the stated effect has been achieved; after the necrotic tissue is removed, the original text claims that the therapeutic effect is remarkable and quick.

Shui Chen Gao (Water-Sinking Ointment): place baiji (Bletilla striata) powder in a cup, add water so that the powder settles, then apply it with paper. The original text also says that when using the plaster one should not remove necrotic tissue, and it notes that the use of tissue-generating medicine is described above.

Apply a mixture of huangyao, cicada slough (the shed shell of a cicada), stiff silkworm (a processed silkworm), and similar ingredients.

Another formula: loofah leaves, the white part of a scallion with its roots, and Chinese chives.

Another formula: burn the roots and shoots of cocklebur to ash, then add white salt, ash from smoked plums, and indigo. This is said to work better.

Grind all the ingredients above into a fine powder and mix evenly with sour vinegar. Apply it around the edges of the sore, leaving the opening uncovered so the toxin can drain out. When the medicine dries, keep moistening it with vinegar. If the sore does not subside, add Huadu Powder or Xueba Dusan from the earlier formulas; these are said to work quickly.

For a furuncle (an acute, pus-forming sore) that is sunken rather than raised, or whose discharge does not dry up, there is a separate formula said to treat furuncles, sores on the back, and various malignant sores and boils. Grind an appropriate amount of rusted iron into a fine powder, mix it with vinegar, and apply it to the furuncle. It is said that within moments the toxin will rise to the surface and the discharge will dry up, bringing immediate relief.

Zhui Ding Duo Ming Decoction is a secret formula reputed to act quickly and make swellings dissipate from within the body. Its ingredients are qianghuo, duhuo, green tangerine peel, fangfeng (in a larger amount), huanglian, red peony root, xixin, licorice nodes, cicada slough, stiff silkworm, jiaolian, and other ingredients, in equal amounts.

Add placenta, zelan, and honeysuckle. If there is pus, add he shou wu, baizhi (to promote drainage), green akebia, rhubarb, gardenia, and morning glory seed. If the sore is on the foot, add Chinese quince.

Coarsely chop the ingredients above and take five qian per dose. For the first dose, add a small amount of zelan leaves, jinyinlan, and honeysuckle. If there is pus, also add he shou wu, baizhi (to promote drainage), and green akebia.