《仙傳外科祕方》

The first volume of Secret Formulas of Immortal-Taught External Medicine was compiled by the Daoist priest Zhao Yizhen (Daoist name: Yuanyangzi) from Junyi (present-day Kaifeng, Henan). The opening chapter "Carbuncles, Gangrene, and Back Sores" prioritizes external conditions among all diseases because such acute illnesses can prove fatal within moments.

Though carbuncles and gangrene manifest in over twenty variations, they fundamentally divide into two categories based on Yin-Yang principles: Yang conditions present as inflamed sores (red, swollen, hot, and painful suppurative infections), fever, and excess syndromes; Yin conditions manifest as gangrenous ulcers (chronic deep-tissue necrosis), chills, and deficiency syndromes. In Yang conditions, the skin appears thin, red, and swollen with numerous pus-filled pores resembling peppercorns, accompanied by severe pain. Yin conditions feature thick, pale skin, hard swelling like cowhide, and typically no pain.

Two special hybrid types exist: Yang-with-Yin cases appear feverish without true heat, swollen yet deficient, red-skinned but not dry, painful yet pusless, with masses that rise and subside—externally severe but internally rotting. Yin-with-Yang cases seem cold without true chill, nonswollen yet excessive, slightly red and dry, pus-filled and painful—externally mild but internally agitated. Obese individuals with firm muscles but internal deficiency tend toward Yang-with-Yin syndromes, while lean individuals with slack muscles but internal excess incline toward Yin-with-Yin conditions.

Two transformation patterns occur: reckless use of cold-cooling drugs turns Yang syndromes into Yin, while excessive hot-warming drugs convert Yin into Yang. The former reverses relatively easily with better prognosis; the latter rarely recovers, usually proving fatal, with rare survivors owing purely to chance. The term "outbreak" refers to internal pathogenic accumulation erupting externally. The human body takes the Five Organs as its root, whose Qi originates from stomach Qi (digestive function). The stomach receives food while the spleen transforms it to generate Qi-blood. The spleen governs muscles, and stomach Qi circulates through the organs to propel blood vessels, flowing via meridians throughout the body.

Whether excess/deficient or hot/cold, all carbuncles and gangrene stem from Qi stagnation, arising from three causes: internal (emotional factors), external (pathogenic invasion), or non-internal-external (trauma, etc.). Diagnosis examines the Renying pulse (left wrist artery) for internal causes and the Qikou pulse (right wrist artery) for external ones.

This passage explains the pathological mechanisms and treatment methods for abscesses and ulcers (yongju) in the human body. The formation of such toxic sores has five main causes: first, seasonal epidemics caused by abnormal climatic conditions; second, internal damage from emotional depression; third, external pathogenic factors invading due to weak constitution; fourth, exposure to wind-cold during feverish conditions; and fifth, improper diet such as consuming grilled foods, alcohol, or taking heating medications like alchemical elixirs (dan).

When pathogenic Qi (Xieqi) accumulates in the stomach, different outcomes occur based on the patient's constitution. If the patient is strong with robust stomach Qi, the pathogenic factor will contend with healthy Qi, flowing along the meridians and accumulating where blood stagnates, forming yang-type abscesses (yong). For patients with weak constitutions and insufficient stomach Qi, the pathogen occupies the meridians, causing Qi-blood stagnation and obstructed circulation, leading to internal tissue decay that forms yin-type ulcers (ju).

The text uses vivid analogies to describe the symptoms: externally, a sore might appear as small as a grain of rice, while internally it could have eroded into a crater; what looks like a coin-sized opening might conceal a fist-sized cavity of pus. If the pus channels are deep with viscous pus-blood mixtures, medication can still cure it. But if symptoms like foul odor without pus, blood Qi depletion, or complete Yang Qi exhaustion appear, not even immortals could save the patient.

Treatment requires pattern differentiation based on the patient's constitution (deficiency/excess) and disease nature (cold/heat). For yang-pattern heat toxins (manifesting as high fever), the approach is to regulate Qi and activate blood: internal herbs harmonize Qi-blood to ensure smooth Qi movement expels toxins, while balanced blood naturally resolves stasis. External cooling applications help reduce heat and disperse stagnation, though excessive cooling may cause heat withdrawal with blood coagulation, paradoxically transforming yang patterns into yin and worsening ulceration. The treatment sequence begins with cooling applications to control peripheral inflammation, then addresses central pus toxins, and finally closes the wound.

For yin-pattern cold toxins (manifesting as cold signs), warm supplementation is used: mild tonic herbs internally regulate Qi-blood, strengthen the spleen and harmonize the stomach. Only after appetite and vitality recover should conventional Qi-activating and blood-moving methods follow. External warming applications promote Qi-blood circulation, revive necrotic tissue, and expel toxins, concluding with warm-natured herbs to disperse residual toxins. For severe cold patterns or cases worsened by mistaken cooling treatments, the ultra-warming Sanjian Decoction (with intensely heating herbs like aconite, tianxiong, and wolfsbane) may cautiously restore yang and rescue collapse. However, practitioners must monitor for possible toxin migration post-treatment, requiring follow-up therapy for complete resolution—this represents a pathological transformation from yin to yang patterns.

This passage elucidates the core principles and key prescription for treating external diseases. It begins by explaining the relationship between Yin-Yang and Qi-blood in the human body: Yang Qi (vital energy) acts as the driving force, while Yin blood (material foundation) follows its movement. When Qi and blood stagnate, muscles become necrotic, leading to illness. For cold syndromes, hot-natured herbs are used precisely to promote Qi-blood circulation, because blood flows when warmed and congeals when chilled.

Special emphasis is placed on protecting the heart and the "membrane origin" (the fascial tissue enveloping internal organs). The heart serves as the body's sovereign, while the membrane origin functions as the protective capsule of the five viscera. When disease strikes, toxins first attack the pericardium (the heart's surrounding tissue), manifesting as vomiting or abscesses (suppurative swellings). Without timely treatment, these toxins will invade the Shen (spirit), causing primordial Qi to scatter; they also erode muscles, penetrate the membrane origin leading to Qi leakage, ultimately resulting in organ failure and death. Hence the crucial treatment strategy lies in "protecting the heart and preserving the membrane."

The remarkable prescription "Rongwei Fanhun Decoction" (also called Tongshun Powder or Heshouwu Powder) is then introduced, reportedly transmitted by immortals. Composed of nine herbs: Polygonum multiflorum (must avoid iron utensils), Angelica sinensis, Akebia stem, red peony root, Angelica dahurica, fennel, Lindera root, bitter orange, and licorice. All ingredients are used in equal proportions and can be taken with water, wine, or half-water half-wine. For limb abscesses, add Notopterygium root. Each dose measures four qian (approximately 12 grams), taken after meals for upper-body ailments and before meals for lower-body conditions.

This formula emphasizes precise herb preparation: Polygonum multiflorum must never contact iron, Angelica dahurica should avoid fire-roasting, bitter orange requires stir-frying with flour, while ginger juice is added for nausea. These details reflect Daoist medicine's meticulous attention to the energetic properties of medicinal substances.

This medical prescription primarily addresses miraculous formulas for treating abscesses (suppurative inflammation), back sores, traumatic fractures, and similar conditions, with special emphasis on regulating Qi (vital energy) and blood.

The core principle of the prescription lies in balancing Yin-Yang, Qi, and blood. Qi belongs to Yang, while blood belongs to Yin. When Yang Qi circulates, Yin blood follows its movement. If Yang Qi becomes obstructed, Yin blood will congeal; if Qi is weak, blood will stagnate, leading to muscle necrosis and worsening of the condition. Therefore, it is essential to simultaneously regulate Yang Qi and harmonize Yin blood—neither aspect should be neglected. If one only regulates Yang Qi without nourishing Yin blood, it will deplete Qi and cause blood to congeal. Conversely, if one only supplements Yin blood without supporting Yang Qi, it will result in excessive blood and weakened Qi, making the illness prone to recurrence.

The uniqueness of this prescription lies in its ability to both strengthen the foundational functions of the spleen and stomach without damaging primordial Qi (Yuanqi), and to eliminate pathogenic factors while naturally promoting the free flow of Qi and blood, avoiding complications. Specific adjustments are required based on symptoms:

For chronic back sores that have not healed, the cause often lies in previous doctors excessively using cold and cooling medicines, which impaired spleen function (in Chinese medicine, the spleen governs the muscles), leading to stagnation of Qi and blood. In such cases, reduce the dosage of Akebia (Mutong) and Angelica sinensis (Danggui), and increase Magnolia bark (Houpo) and tangerine peel (Chenpi) to fortify the spleen. In severe cases, the family-renowned "Duijin Yinzi" (a spleen-strengthening formula) can be used, and for even more severe conditions, add white cardamom (Baidoukou).

When treating "flowing stagnation" (lumps formed by Qi and blood stagnation), the herb Angelica pubescens (Duhuo) can be added. This is because flowing stagnation is fundamentally caused by congealed Qi and blood, and Duhuo promotes circulation throughout the body’s vessels—once the vessels are unobstructed, stagnation naturally resolves. If the condition arises from unresolved cold damage (external heat illness) where residual toxins migrate into the limbs and meridians, and fever persists, it indicates lingering cold pathogens. In such cases, the original formula must be adjusted accordingly.

This passage discusses the treatment principles for "liuzhu" (a type of deep abscess caused by lingering cold pathogens) and "guyong" (osteomyelitis). If fever persists after taking Shengma (升麻) and Suye (苏叶), add Gegen (干葛); for headaches, include Chuanxiong (川芎) and decoct with ginger water. When there’s no tidal fever, use half water and half wine for decoction, as alcohol promotes Qi (气) and blood circulation.

The key to treatment lies in identifying the root cause. Excessive sweating before fully expelling cold pathogens can lead to the more stubborn "cold liuzhu," so sweating must be moderate. In the second stage after sweating, warming and tonifying formulas like Shixuan San (十宣散) or Neibu San (内补散) should be used. If ineffective, the third stage requires adding Fuzi (附子) or prescribing Sizhu San (四柱散), but excessive warming herbs may induce suppuration. The fourth stage returns to foundational prescriptions.

The text emphasizes: Liuzhu is a sequela of cold damage (伤寒), while guyong results from its worsening. Liuzhu isn’t inherent to cold damage but stems from incomplete sweating by physicians; guyong isn’t an inevitable progression but arises from misguided use of cold-cooling herbs by inept doctors. Such practitioners, ignorant of pathology, misapply cold remedies even when recognizing guyong, driving toxins deeper into the marrow. This deep bone abscess is termed "fuluju" (附骨疽) or "white tiger flying corpse" (白虎飞尸), potentially lingering for years until necrotic bone is expelled—or never healing in severe cases.

Bone necrosis manifests in two forms: decay of accessory (non-weight-bearing) bones may still be cured, but decay of major (weight-bearing) bones causes disability. Thin, clear pus indicates freshly detached bone fragments, making extraction difficult; thick, yellow pus signals imminent fragment expulsion, easing removal. Finally, if a chronically ill patient exhibits ulceration and bloody sputum, this must not be mistaken for heat syndrome—it reflects extreme cold and Yang (阳) depletion, requiring high-quality Fuzi (附子) treatment.

This passage discusses several illnesses caused by wind-dampness and cold pathogens along with their corresponding treatments. When toxic symptoms begin with pain in the extremities, head, or face that gradually spreads throughout the body up to the neck, accompanied by bead-like swellings resembling strings of pearls, these indicate wind-dampness migration. Such cases should be treated by alternating modified Minor Life-Prolonging Decoction (Xiaoxuming Tang) with Pubescent Angelica and Mistletoe Decoction (Duhuo Jisheng Tang).

If the pain originates from both knees before spreading to all joints, it typically manifests as blood-wind syndrome in women and soft-wind syndrome in men, collectively termed wind-dampness obstruction or joint disease. Modified Aconite Eight-Ingredient Decoction (Fuzi Ba Wu Tang) is suitable here. For carbuncles appearing in soft tissues like the neck, armpits, breast areas, or inner thighs without heat symptoms—indicating pure cold syndrome—combine Internal Tonifying Ten-Dispersing Powder (Neibu Shixuan San) with other formulas.

Important note: Children must never be given aconite (Fuzi) as it may induce convulsions, nor should they undergo bloodletting with needles or lancets. For carbuncles without pus or flesh formation, apply warm-dampness medicinals externally to resolve internally. If improper bloodletting causes difficult wound healing, these same medicinals can promote closure. Should medication cause mild pain or convulsive tendencies, use modified Scorpion Guanyin Powder (Quanxie Guanyin San).

When phlegm-dampness retention causes carbuncles in children's necks, arms, chest, or back—signs of extreme cold syndrome—external application of hot-natured medicinals is essential. For gourd- or bowl-sized masses on the chest/back that appear severe but show slight changes after medication (indicating benign nature), flexibly modify Internal Tonifying Ten-Dispersing Powder for internal resolution.

The root cause of these conditions lies in kidney deficiency and bone-cold. Since kidneys govern bones, deficient kidneys lead to cold bones, and cold bones cause pain—all bone-related ulcers originate from kidney deficiency. Effective kidney tonification requires large aconite (Da Fuzi); sufficient kidney qi (Qi) revitalizes bones, preventing ulcer toxins from adhering to them. Treatment must avoid rigid formulas, prioritizing flexible adaptation.

Final emphasis: Carbuncles initially form due to congealed qi-blood (Qi-Xue), with stagnant blood accumulating over time before manifestation. Therefore, always adjust medications according to the patient's qi-blood vitality during treatment.

In this formula, reducing the dosage of Chinese angelica (Danggui) may cause abnormal blood proliferation in other areas of the body, leading to recurrent abscesses (suppurative inflammation). This is esoteric medical theory known to very few practitioners.

Regarding phlegm disorders caused by abscesses or deep-rooted ulcers (Yongju), there are two scenarios: First, when stomach cold generates phlegm, Pinellia (Banxia) should be added to fortify the spleen and transform phlegm. Second, when heat stagnation produces wind-phlegm, Platycodon root (Jiegeng) should be included to resolve phlegm in the throat and diaphragm, while decocting the formula with ginger and wine.

For abscesses occurring on the head or back, this formula should exclude Akebia stem (Mutong), as it directs Qi downward, creating a condition of upper excess and lower deficiency (where symptoms are pronounced in the upper body while the lower body becomes weak). This makes treatment particularly challenging, especially for elderly or debilitated patients, who must avoid this herb.

If the patient has diarrhea, this formula should not be used directly. Instead, first administer an antidiarrheal (made by grinding raw alum into powder, blending it with beeswax to form pills, and taking thirty pills with rice water). Only after diarrhea stops should this formula be applied. The human body relies on Qi and blood as its foundation—in abscess patients, both concentrate at the lesion to form pus. If visceral functions are unstable, primordial Qi (Yuanqi) leakage will further chill the blood and impede recovery. This formula primarily regulates Qi flow; smooth Qi movement ensures blood circulation, whereas Qi deficiency leads to blood coldness. Cold blood loses vitality, and lifeless blood cannot nourish muscles. Using heating herbs risks overwhelming patients with insufficient Qi, while cooling herbs are even less appropriate. Though this is an immortal-transmitted secret formula, proper application is essential—otherwise, it becomes as futile as carving a mark on a moving boat to find a lost sword.

For deep-seated abscesses, generalizations don’t apply. If cooling herbs dissipate primordial Qi and cause deficiency, sometimes Sanjian Decoction (a warming formula of aconite, prepared lateral aconite, and Sichuan aconite) proves effective, as such conditions often stem from cold pathogens. The key lies in pulse diagnosis: only confirmed cold patterns warrant its use, yet overdosing remains harmful. Once the Yang pulse recovers, the swelling turns reddish-vibrant, and bones show vitality—meaning cold can no longer settle to form gangrenous ulcers (Ju)—this formula will take effect. This is the safest, most ingenious method.

The formula can be prepared as powder or granules, taken with water, wine, or decoction as needed. Wealthier patients may add costus root (Muxiang) as a guiding herb; those with heat-phlegm coughs can include eaglewood (Chenxiang). Commoners may simply take it with perilla leaf decoction or as honeyed pills.

Beyond abscesses, back sores, and traumatic injuries, this formula also treats various unnamed swellings, malignant sores, rheumatic foot Qi (a disorder involving leg swelling and pain), musculoskeletal pain, hemorrhoids with bloody stools, and toothaches in both men and women.

(Note: Key terms like Qi, Yuanqi, and Yongju/Ju are rendered per Daoist medical context while maintaining clinical precision. The translation preserves the original's technical depth, analogies, and flexible administration methods without flattening its layered diagnostic logic.)

A woman suffered from qi stagnation for five years. During episodes, she would develop painful abdominal masses with unbearable pain, vomiting incessantly to the point of being unable to drink water—each attack brought her near death. When this prescription was prepared into pills and taken with Muxiang (Aucklandia) decoction, the vomiting stopped after the first dose. After the second dose, her phlegm-qi flowed smoothly, and she fully recovered.

This formula treats all traumatic injuries, though modifications should be made based on the specific condition (see the "Fractures and Injuries" section for detailed adjustments). It works for ordinary external wounds or pericardium injuries. For head injuries, remove Mutong (Akebia) and Zhiqiao (Bitter Orange) and add Chuanxiong (Ligusticum) and Chenpi (Tangerine Peel). For routine use, Dingpi (Clove Bark) and Suye (Perilla Leaf) can be added to activate blood circulation, while Poguzhi (Psoralea) and Wulingzhi (Trogopterus Dung) help dissolve blood stasis. After decocting, mix with a cup of strong liquor, bring to a boil again, and add powdered Dahuang (Rhubarb) to be taken on an empty stomach. If bowel movements normalize, only four doses are needed: the first two with Dahuang powder, the latter two without—primarily to aid elimination. If constipation persists, use Zhiqiao decoction to induce movement; if still ineffective, the case becomes difficult to treat, and one cannot simply watch the patient perish. For blood replenishment, prescriptions like Shixuan Powder may be used.

For traumatic injuries, this formula—minus Mutong—is called the "Heshou Powder," as Heshouwu (Polygonum) nourishes blood. For blade wounds accompanied by tidal fever, facial swelling, and labored breathing (symptoms of tetanus), administer Suoxue Powder and Gegen (Kudzu) decoction, decocted with ginger and scallions to induce sweating. Alternatively, three or four doses of Baidu Powder may be given, with external treatments applied according to standard protocols for complete recovery.

For chronic lower back pain, add Fenugreek and Corydalis, decocted in wine. For beriberi, add Betel Nut, Papaya, and Pangolin Scales, decocted in water.

Regarding the pathology of chronic phlegm disorders (宿痰), most remain ignorant. Since the immortal masters transmitted this knowledge, only our lineage has understood it. Phlegm moistens the entire body, much like fish depend on mucus. When phlegm settles harmlessly in the stomach, all is well; once agitated, myriad illnesses arise—potentially triggering asthma, coughing, vomiting, dizziness, headaches, eye distension, bodily tension, or joint numbness. These external manifestations of "new phlegm" actually stem from turbid qi-blood congealing. Why? Rebellious qi stagnation in the organs generates phlegm; failure to sweat when appropriate accumulates phlegm; excessive eating disrupts fluid metabolism, pooling phlegm...

When phlegm flows normally, it ascends from the stomach to be expelled through the lungs. But when its movement becomes disordered, phlegm disperses between the muscles and skin. Since the spleen governs muscles and the lungs govern skin, accumulated phlegm-dampness in areas like the chest, back, head, neck, armpits, groin, waist, or limbs forms lumps—some painful, some painless—that appear pale when pressed. Even if slightly reddish, the color remains faint; these lumps feel cold to touch yet hard as stone.

Upon incision, such swellings typically show no pus, occasionally yielding only small amounts of bloody fluid, clear liquid, or milky discharge, sometimes with necrotic tissue resembling rotten cotton wool. Certain mobile lumps between skin and flesh resemble scrofula (lymphatic tuberculosis), floating like eggs in water—soft, non-hardened, and pus-free when cut. Needle pricks may induce fleshy protrusions, accompanied by throat congestion from phlegm and alternating chills with fever. For these symptoms, immediately incorporate phlegm-resolving herbs like Arisaema rhizome (Nanxing) and Pinellia (Banxia) into oral prescriptions, applying external warm-compress poultices like Jade Dragon Ointment (Yulong Gao) to draw out toxins. Only after promoting suppuration can incision ensure recovery.

Milder cases without suppuration may resolve spontaneously. For severe phlegm congestion with high fever, use Phlegm-Controlling Elixir (Kongxian Dan: equal parts Knoxia root [Zidaji], Kansui root [Gansui], and white mustard seed [Baijiezi] powdered with rice-paste pills). Life-threatening hardness manifests as teacup-sized lumps, particularly perilous when occurring at critical sites like the throat or neck. Harmonized Qi (vital energy) and blood prevent illness; when Qi stagnates, blood transforms into phlegm, whose obstruction then depletes both Qi and blood—inevitably hardening tissues without suppuration.

These pathologies reflect extreme Yin excess with Yang deficiency, requiring warming Yang and nourishing blood through pattern differentiation. Beyond Phlegm-Controlling Elixir, combine methods to mobilize Qi-blood circulation and dissolve cold congelations. Exceptionally, some painless, non-inflammatory lumps in robust patients may resemble normal tissue—never rashly incise. Quackery using fire needles induces muscle necrosis, while caustic agents trigger chills and high fever. Here, regulate Qi-blood with Cimicifuga (Shengma) in formulas to expel cold, plus external flesh-generating astringents to reduce lumps to benign warts.

If foul-smelling spontaneous ulceration occurs, surgical excision becomes unavoidable—special techniques apply then. Crucially, stone-hard non-suppurating lumps often indicate phlegm-damp congelation rather than abscess; misapplied abscess treatments aggravate the condition.

This passage discusses secret formulas and medicinal methods for treating internal abscesses (suppurative inflammation). First mentioned is an external application that can serve as an alternative to surgery: grind alum and crude mirabilite into powder and apply it to the affected area. This formula is highly valuable and must not be casually disclosed.

For intestinal abscesses, it recommends alternating between Shixuan Powder (a tonic formula) and this secret prescription, while adding honeysuckle vine. Honeysuckle vine is particularly effective against internal abscesses, but practitioners must discern the patient's constitution—deficient patterns require aconite for warming supplementation, while excess patterns call for rhubarb to purge stagnation. If the pattern is unclear, the formula itself has regulating properties, and Shixuan Powder provides internal harmonization, minimizing risks.

Early-stage lung abscess manifests as mild chest discomfort during meals, requiring immediate pulse diagnosis to determine deficiency or excess. For deficient patterns, add aconite to the formula; if symptoms worsen, use Shixuan Powder for internal supplementation. For excess patterns, increase rhubarb dosage to expel toxic Qi through the intestines, as the lungs and large intestine are interior-exterior paired organs.

For established internal abscesses, combine with the "Sea Recipe" (a folk remedy). Coughing with purulent blood indicates lung abscess, while pus discharge from the navel suggests intestinal abscess. The text specially recommends taking honeysuckle vine with licorice nodes steeped in wine, noting exceptional efficacy.