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External medicine formulas

外科方剂 〔外科方剂〕 wài kē fāng jì

Medicinal formulas that treat suppurative lesions, including welling-abscesses and flat-abscesses, clove sores, and boils, by actions that include resolving toxin, expelling pulse, closing sores, and engendering flesh.

External medicine formulas comprise external-use agents and medicinals from other categories.

Welling-abscesses, flat-abscesses, clove sores, boils, and other suppurative swellings are attributable to numerous causes. Damp-heat and fire-toxin are by far the most common causes. However, numerous factors may be at play: affect damage can cause depression and stagnation that transforms into fire; damp-heat arising from indulgence in hot, spicy, acrid food or fried or roasted food; externally contracted disease evils invading the skin and flesh, the channel and network vessels, the blood vessels, and sinew and bone; provisioning-defense disharmony arising from yang vacuity and congealing cold, vacuity and stagnation of provisioning and blood, and phlegm-turbidity congestion. In sum, the conditions arise from heat toxin, damp-heat, or yīn-cold congealing and stagnating causing disharmony of provisioning and defense, qì and blood stagnation, obstruction of the channels and network vessels, giving rise to vanquished blood (putrefying static blood) and putrefying flesh.

Suppurative lesions can be internal or external. They can form on the surface of the body, on the trunk or limbs in the form of welling-abscesses, flat-abscesses, clove sores, boils, and other suppurative swellings. They can form within the body as lung welling-abscesses or intestinal welling abscesses. Pattern identification requires identifying a yīn or yáng pattern. Yáng patterns are caused by damp-heat, fire toxin, with blood stasis, manifesting in the local redness, swelling, and heat; when fully formed, they have a clearly defined root (local area from which they form). Yīn patterns are caused by phlegm-damp and cold evils causing stagnation in the vessels and are marked by diffuse swelling without a root, no change in skin color, and pain without heat signs.

Suppurative lesions are treated differently according to the stage of development. In the initial stage, they are treated by dispersion; in the suppurative stage, by expression, and in the final stage after rupture, by supplementation.

Dispersion (消法 xiāo fǎ) is used when in the early stages, when the lesion has not yet assumed a definite form. Treatment involves clearing heat and resolving toxin, coursing and dispersing evils and outthrusting them through the exterior, warming the interior and dispersing cold, moving qì and quickening the blood.

Expression (托法 tuō fǎ) means drawing out the sore-toxin from within the body, an action also called internal expression. This method is used in the middle stages when evil qì is exuberant but right qì is not strong enough to force the toxin out. In such cases, the sore is flat and diffuse without a clearly defined root. Expression supplements qì and blood and pus-outthrusting agents to support right qì, force the toxin outward in the form of pus, while also preventing it from falling inward to cause generalized signs.

Supplementation (補法 bǔ fǎ) is used in the final stages after suppuration has forced the toxin out of the body, when the lesion exudes clear thin pus or fails to close, and when the patient has a pale tongue with scant fur, and a lusterless facial complexion. It is designed to close the lesions, engender flesh, and support right qì.

Cautions

Correct identification of yīn and yáng patterns as well as the stage of the lesion, to ensure effective use of dispersion, expression, and supplementation.

When pus has formed, dispersion treatment should be discontinued. Heat-clearing dispersing agents can be applied topically and the lesion can be lanced to prevent damage to qì and blood that might hamper rupture and closing.

In the middle stage, when right qì has not weakened, pus-expelling treatment can be given to draw the toxin out and prevent it from spreading. When the toxin is especially exuberant, heat-clearing toxin-resolving agents can be used heavily to ensure a powerful evil-dispelling action. If rupture is difficult, powerful outthrusting medicinals can be used.

In the final stages, even though the lesion may have ruptured but the toxin is not completely eliminated, supplementation should not be used too early since this might detain the evil. Patients with yáng sores should not be given warming supplementation since this can evacuate vacuity.

Subcategories

  1. Binds and welling-abscess dispersion formulas
  2. Internal expression pus-expelling formulas
  3. Vacuity-supplementing sores-closing formulas

1. Binds and Welling-Abscess Dispersion Formulas

Formulas that disperse binds are used before pus has formed and the evil qì is exuberant. Whether the evil comes from outside the body or from within, yīn, yáng, cold, and heat must be identified.

Yáng patterns are marked by localized redness, swelling, and pain, generalized heat effusion, thirst, possibly constipation, a red tongue with yellow fur, and a pulse that is rapid, slippery, and forceful.

Yīn patterns are marked by diffuse swelling without heat or redness, dull pain, fatigue, aversion to cold, a white tongue fur, and a moderate pulse.

In the initial stage patterns vary considerably from heat toxin to congealing cold evil, with exterior evils, interior repletion, phlegm turbidity, damp toxin, qì stagnation, and blood stasis. In general, formulas have agents that either clear heat and resolve toxin or warm the interior and disperse cold as their main components, which are complemented by others that resolve the exterior, attack the internal to eliminate toxin, dispel dampness and transform phlegm, move qì and free the network vessels, or quicken the blood and disperse stasis.

Representative formulas

2. Internal Expression Pus-Expelling Formulas

Internal expression pus-expelling formulas treat midstage patterns where the evil is exuberant and where there is also right qì vacuity, allowing the evil to fall inward, giving rise to a condition in which pus has already formed but is not rupturing and producing putridity so that the pus toxin cannot be discharged from the body. This is marked by swelling and distension, scorching heat, acute pain, with little sign of pus forming and after rupturing little sign of it being discharged. In such cases, treatment focuses on expelling the pulse and promoting rupture.

Main agents

Representative formulas

3. Vacuity-Supplementing Sores-Closing Formulas

Supplementing formulas that help to close sores treat suppurative lesions after rupture when although the toxic evil has gone, qì and blood are depleted, forestalling the natural healing process of engendering flesh and closing the sore. Signs include clear thin pus, failure to heal long after rupture, absence of new flesh growing, together with a lusterless facial complexion, lassitude of spirit, and a vacuous pulse. In yīn vacuity, the lesion is dry on the surface and fails to close with a haggard-looking facial complexion, and dry throat and mouth. In yáng vacuity with exuberant yīn, the swelling is soft and diffuse, appearing dark and dull after rupture, absence of regrowth of flesh, sloppy stool, clear urine, cold limbs, and spontaneous sweating.

Main agents

Representative formulas

See external medicine external medicine agents. See also sores.

External Medicine Formulas

Binds and Swelling Dispersion Formulas

Internal Expression Pus-Expelling Formulas

Vacuity-Supplementing Sore-Closing Formulas