《仙傳外科祕方》Vol. 3

This passage discusses a warming external poultice called "Huiyang Yulong Gao" (Jade Dragon Yang-Returning Ointment) in Daoist medicine, compiled and recorded by the Yuan dynasty Daoist Zhao Yizhen (Daoist name: Yuanyangzi). This formula is primarily used to treat various cold syndromes.

The prescription consists of: three liang of processed Aconitum (stir-fried), one liang of processed Arisaema rhizome (roasted), two liang of dried ginger (roasted), one liang of Angelica dahurica (unprocessed by fire), one liang of red peony root (stir-fried), and half liang of cinnamon bark (unprocessed by fire). All these herbs possess warming properties.

This formula treats conditions including: yin-type dorsal carbuncles, cold abscesses, rheumatic joint pain, chronic strain pain, wind-cold-damp obstruction, cold-type beriberi with swelling and pain (without redness or heat symptoms), pure cold pain without swelling, stubborn foot numbness, and various yin syndromes (cold disorders) in women caused by blood-cold. The author emphasizes this as the premier remedy for such cold syndromes, with detailed usage instructions to follow. For application, it should be mixed with heated wine before external application.

The author further explains: although these conditions manifest on the skin and limbs, their root lies in the internal organs. Because the qi and blood of the organs circulate continuously through the meridians day and night, when an organ becomes diseased, it will inevitably manifest along its corresponding meridian pathways—this reflects the medical principle of "yin-yang distribution according to hand and foot meridians."

Compared to heat syndromes, cold syndromes are more challenging to treat. Cold syndromes necessarily arise from yang qi deficiency in the organs, allowing pathogenic wind to invade, disrupting qi-blood circulation from the meridians to the skin surface, obstructing the flow. As cold accumulates and incompetent physicians mistakenly attack it with cooling medicines both internally and externally, the condition often becomes critical.

Physicians should diagnose internal causes through external symptoms, achieving correspondence between surface and root for accurate diagnosis. This formula contains warming blood-activating herbs like dried ginger and cinnamon bark, but generating heat without dispersing cold would be harmful—hence the addition of Aconitum and Arisaema to break malign qi, expel wind toxins, revive necrotic tissue, eliminate bone pain and masses, and awaken yang qi. Combined with red peony and Angelica dahurica to disperse stagnant blood, relieve pain, and regenerate flesh—all taken with heated wine to enhance efficacy and promote qi-blood circulation. Even severe cold syndromes can be cured with this formula, like rekindling cold ashes or reviving dead wood. Generally speaking, cold syndromes lead to tissue necrosis.

This passage from Secret Formulas of Immortals' Teachings on External Medicine primarily discusses treatment methods for several types of external ailments, all involving topical herbal applications.

The first condition involves blackened, necrotic lesions on the back. If the darkening and decay result from excessive use of cold-natured medicines, apply Hongbao Dan (洪宝丹) directly to the affected area—the blackened tissue will turn red overnight. Should the periphery redden while a central black necrotic core remains, this indicates localized blood necrosis. Prepare a poultice with crude saltpore (朴消) and alum (明矾), applying it to draw out the dead tissue by the following day.

The second condition addresses cold-type abscesses (流注冷证), characterized by hardened muscles near bones, chilling bone pain, and contracted tendons. These lesions cannot be treated with lancing as they produce no pus or blood. Instead, warm-natured herbs like galangal (军姜) and angelica root (白芷) should be mixed with heated wine for topical application. This alleviates bone chill and pain while relaxing constricted tendons. Notably, Chinese wax (木腊) proves essential here—it dissolves stagnation and reduces swelling, though excessive use diminishes efficacy.

The third condition, Drumstick Wind (鼓椎风), arises from dampness, post-febrile complications, or wind-damp deficiency. Two manifestations occur: Type One shows knocking knees, unsteady gait, and slight shinbone swelling; Type Two presents drumstick-like swelling at the knee-shin junction with atrophied thigh muscles.

This passage describes several lower limb conditions caused by wind-cold-damp pathogens and their treatments. When the knee area is invaded by wind-cold-damp from the Liver Channel, it obstructs blood circulation, causing symptoms of swelling and heat in the upper leg with coldness and atrophy in the lower leg. This occurs because blood vessels in the lower leg only drain without replenishment, leading to muscle wasting, while stagnant blood accumulates in the upper leg causing swelling.

If the condition results from "wandering infusion" (a TCM concept describing pathogenic migration), muscles first ulcerate before cold toxins erode the bones. Once bone decay occurs, the condition becomes difficult to treat. Before ulceration develops, immediately apply heated medicinal wine compresses to painful knee and upper leg areas to relieve pain and restore Yang Qi. Simultaneously apply Chonghe Ointment (a warming formula for dispersing cold) to cold lower legs to promote blood-Qi circulation, and place medicinal dressings at tibial junctions to reconnect blood flow and expel cold. Internally take Zhuifeng Pills (a wind-dispelling formula) with doubled frankincense dosage to relax tendons and activate collaterals.

For chronic wind-cold-bi pain with limb numbness or restricted movement, wrap medicinal cotton pouches around affected areas. A crawling ant-like skin sensation indicates the medicine is taking effect. Severe cases may require additional herbs like clove bark and evodia fruit combined with Zhuifeng Pills for dual internal-external treatment.

For acute unbearable foot pain, take Zhuifeng Pills internally while applying fresh ginger juice and flour poultices externally. For rapid pain relief, apply frankincense and myrrh mixed with wine.

Old bone injuries often stem from unresolved blood stasis after trauma. While robust youth may mask symptoms, aging with declining Qi-blood allows wind-cold-damp to trigger recurrence. Treatment similarly requires combined internal and external medication.

The passage discusses treatment methods for several types of external conditions. For sudden traumatic injuries, it's best to apply medicinal formulas mixed with heated wine, combining both internal and external treatments for optimal results. However, for patients with deficient Qi and blood, if the condition occurs between the chest, ribs, waist, or back and isn't treated promptly, it can develop into stubborn blood stagnation and consumptive disorders. The treatment principle remains the same regardless of age, whether the injury is new or old, or whether the condition is severe or mild. Such deeply rooted illnesses cannot be cured with a single dose of medicine but require long-term regulation. Cases not yet developed into consumptive disorders are easier to treat, while established consumptive conditions prove more difficult.

One prescription uses only Arisaema rhizome (Tiannanxing) and Aconite (Cao Wu) with a small amount of Cinnamon bark (Rougui) to treat black, rotten, and suppurative wounds—this is called the "Small Jade Dragon" formula. For stony abscesses (hard, rock-like swellings), apply the medicine mixed with heated wine externally, then surround the area with Hongbao ointment. Once suppuration occurs, lance it to drain the pus.

Female breast abscesses (mastitis) often result from milk stagnation after weaning, excessive milk production beyond what the infant can consume, irregular menstruation causing reversed Qi and blood flow, or pathogenic factors accumulating internally. At the initial stage, cold and cooling medicines must absolutely not be used, as breast milk is transformed from blood and will congeal into hard masses when exposed to cold. The intrinsic nature of milk is cool; if cold medicines are applied, the congealing worsens. Over time, this leads to fever, swelling, pain, and suppuration, causing extreme suffering—often the entire breast must ulcerate before healing occurs. Thus, women who have had mastitis usually lose their ability to breastfeed. However, cooling medicines aren't entirely forbidden; they become appropriate once suppuration and ulceration have set in.

At the early stage, use Arisaema rhizome mixed evenly with ginger juice and wine in equal parts, applying it warm to reduce swelling. To hasten recovery, add Aconite—this herb has potent properties to break up masses, expel cold and heat, reduce swelling when cold, and promote ulceration when warm. If an abscess has already formed, follow conventional methods using Chonghe ointment or add Aconite and Arisaema rhizome. After ulceration, identify the cause: use Chonghe ointment to close the wound if due to cold, or Hongbao ointment to regenerate flesh if due to heat. Additionally, apply Frankincense (Ruxiang) and Myrrh (Moyao) to relieve pain. For internal medication, simply use herbs like Trichosanthes fruit (Gualou).

This passage describes the symptoms and treatments for several breast-related ailments. When a breast lump appears at the nipple, it's called "blowing breast" (chuiru); when located in the pendulous lower breast area, it's termed "breast leakage" (rulou), which proves most challenging to treat due to blood stagnation. Elderly patients over fifty suffering from suppurative breast abscesses face poor prognosis, though those occurring in pendulous breast tissue still hold some hope, whereas abscesses near the sternum indicate grave danger.

For non-suppurative pain caused by phlegm-damp obstruction, targeted topical medications can be applied. Optimal treatment results in lateral pus drainage—failure to achieve this depletes primordial qi (yuanqi). Critically ill patients with deficient primordial qi require immediate external application of Jade Dragon Ointment (yulong gao) to draw out pus, combined with internal consumption of Tongshun Powder enhanced by platycodon root, pinellia tuber, Chinese angelica, and cinnamon bark. When the affected area shows redness and heat, Chinese Angelica Harmonizing Decoction (danggui chonghe tang) proves most effective—cold-natured medicines must be strictly avoided. These formulas solely serve to expel toxins and promote suppuration; discontinue upon improvement and combine with pulse diagnosis for optimal results.

A critical warning: abdominal abscesses (internal suppuration) prove extremely perilous, with ninety percent mortality. The stomach's yin nature creates external cold but internal heat, causing qi and blood to congregate at heated areas, often resulting in concealed internal abscesses. Sometimes incipient abscesses get suppressed by cold medications—such cases become virtually incurable. During initial abdominal pain, manual pressure revealing shifting pain indicates qi masses, whereas fixed pain with slight swelling confirms internal abscess, requiring immediate toxin-expelling medication before suppuration treatment. Internally administer Chonghe Decoction with honeysuckle stem, following previous methods. Naturally surfacing abscesses don't require toxin-drawing formulas—use only Chonghe Decoction and absolutely avoid premature surgical intervention. If improper metal instrument use causes non-healing wounds, apply Jade Dragon Ointment around the abscess head while externally using Chonghe Decoction. For obstructed pus drainage, mix three parts Hongbao Powder with seven parts ginger juice and tea for topical application.

In treating this condition, internally one should apply balanced tonification at the Shixuan points (acupoints at the ten fingertips) to regenerate tissues, while externally continuing to use Chonghe Ointment (a topical medicinal paste) to aid wound healing. This ailment exhibits excessive Yin-Qi and deficient Yang-Qi, causing severe bodily damage. During the critical convalescent period when recovery is imminent yet incomplete, double the dosage of internal tonics to generate Qi and blood—only then can healing occur smoothly. Otherwise, the wound may repeatedly swell and resist closure.

After stabilization, prolonged use of internal tonics with added Aconite (a Yang-warming herb) becomes essential, lest Qi deficiency persists unresolved. For patients with cold constitutions, administer Aconite formulas even before ulceration occurs. However, once ulceration develops, absolutely avoid overly astringent medications to prevent toxic Qi stagnation. With proper medicinal efficacy, wounds will heal naturally.

For internal abscesses that have fully formed and cannot be extracted, apply only Chonghe Ointment externally to induce gentle suppuration through the skin, allowing expulsion via the viscera rather than internal putrefaction. Life or death hinges entirely on appropriate medication, as detailed in previous sections. Strictly avoid consuming "trigger foods" (dietary items that exacerbate conditions)—their ingestion causes relapse and complicates treatment.

Pregnant patients require special consideration: use Perilla Decoction (a fetus-calming formula) to protect the pregnancy, never administering other medicines indiscriminately. Near delivery, pus and blood will discharge together with the fetus; if term remains distant, evacuation occurs through the large intestine. For incipient symptoms, proper medication induces dispersion. When abscesses manifest externally with inevitable fever, treat exclusively with Chonghe Ointment—yet always adjust application cautiously according to severity to avoid therapeutic errors.