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External-use agents

外用药 〔外用药〕 wài yòng yào

Also medicinals for external use; topical agents. Medicinals applied topically to the affected areas in the treatment of external injury, flat-abscesses, welling-abscesses, clove sores, damp sores, and scab2 and lichen, and other types of sore.

External-use medicinals are used in external medicine formulas, which also include formulas that are taken orally.

Subcategories

  1. Toxin-attacking worm-killing itch-relieving medicinals: These attack or resolve toxin and disperse swelling, relieve itching, and kill worms (parasites) that give rise to sores.
  2. Toxin-drawing putridity-transforming and flesh-engendering agents: These draw out the toxin, transform putridity, promote the growth of new flesh, absorb dampness, and cause open sores to close.

Properties

The nature, flavor, and channel entry of medicinals for external use have no correspondences to the action they have when used externally (treating those conditions listed under pathology concepts below). They are related only to actions that the same medicinals have when taken orally.

The majority of medicinals for external use are toxic to some degree.

Subcategories

  1. Toxin-attacking, worm-killing, and itch-relieving agents
  2. Toxin-drawing, putridity-transforming, and flesh-engendering agents

Actions andIndications

The two categories of medicinals for external use each perform different functions.

1. Toxin-Attacking, Worm-Killing, and Itch-Relieving Agents

Attacking toxin and dispersing swelling: Medicinals that attack toxin and disperse swelling are mostly toxic. They are used in the treatment of toxin swelling (painful, red swellings) of sores and welling-abscesses or of snakebites or insect stings and bites.

Killing worms and relieving itch: Medicinals that kill worms and relieve itching treat itching conditions that were traditionally ascribed to worms (parasites), even though these were not visible.

2. Toxin-Drawing, Putridity-Transforming, and Flesh-Engendering Agents

1. Drawing toxin and transforming putridity: Medicinals that draw toxin and transform putridity treat sores and welling-abscesses. Drawing toxin is achieved by expelling (or drawing) pus. As the pus is discharged, the toxin is expelled from the body so that the sore can heal. Transforming putridity means helping putrefied tissue to separate from the healthy tissue, which is also necessary for the sore to heal.

Engendering flesh and closing sores: Medicinals that engender flesh and close sores help to promote the regeneration of tissue and the healing of the sore.

Note that toxic medicinals that are used to attack toxin were traditionally understood to produce their effects by attacking toxin with toxin. Lú gān shí (炉甘石 Calamina) and péng shā (硼砂 Borax) were traditionally considered not to be toxic, and consequently their action was described as resolving toxin instead. An exception is xióng huáng (雄黄 Realgar), which is said to be toxic, but its action is resolving toxin.

Combinations with Other Categories

Medicinals from other categories applied externally: Most sores are attributable to heat toxin, which causes local congestion of qì and blood, which in turn causes the flesh to putrefy. The external-use medicinals are often combined, in topical applications, with heat-clearing toxin-resolving medicinals to address the heat toxin, and with blood-quickening medicinals to address the provisioning-blood congestion.

In addition, open sores that fail to close tend to exude fluid, so that dampness-absorbing medicinals are also often used to encourage healing. Examples of dampness-absorbing agents in other categories are: huáng lián (黄连 Coptidis Rhizoma), huáng qín (黄芩 Scutellariae Radix), and huáng bǎi (黄柏 Phellodendri Cortex) among the heat-clearing agents.

Medicinals from other categories taken orally: The use of externally applied medicinals alone can suffice if the sores are mild and the patient is healthy. However, oral medication can be included in the treatment to enhance the effect of a topical application. This procedure should be observed whenever the sores are so severe that they affect the whole body or when there are generalized disorders of qì, blood, yīn, and yáng that affect the development and healing of sores.

In the initial stages where there is intense heat causing local redness, swelling, heat, and pain prior to suppuration, we normally give the patient decoctions of heat-clearing toxin-resolving medicinals and blood-quickening stasis-transforming medicinals. These are to be taken orally to disperse the sores before suppuration occurs. This method of treatment is called internal dispersion (内消 nèi xiāo).

Once sores have suppurated but have not ruptured, we use decoctions that clear heat and express toxin to promote rupture and expulsion of pus. This method of treatment is called internal expression (内拖 nèi tuō).

In the advanced stages, if weakness of right qì prevents sores from healing, it is general practice to provide oral medications that regulate and supplement qì, blood, yīn, and yáng. This method of treatment is called external medical supplementation (外科补法 wài kē bǔ fǎ).

Method of Use

Medicinals for external use are mostly applied in the form of powders, pastes, washes, and medicinal liquors.

Powders, dried and finely ground medicinals, are sprinkled on the affected area or blown into the throat, or applied to a medium such as paper for insertion into cavities.

Medicinal pastes are soft pastes for topical application. They are made by adding powdered medicinals to pork or sheep fat, pine resin, sesame oil, wax, or more recently petroleum jelly. They are used in the treatment of sores, scab (scabies), and lichen.

Ointments are modern commercially made preparations that are usually softer than medicinal pastes.

Plasters are topical preparations consisting of solidified pastes mounted on cloth. They are made by boiling medicinals in sesame or other oil and reducing them to a thick paste that is spread on a cloth for topical application. Plasters are used for joint pain, numbness of the skin, fractures, and damage to sinews. They are also applied for flat- and welling-abscesses, boils, and clove sores to disperse swelling and relieve pain or to eliminate putridity and close sores.

Medicinal liquors are preparations that are made by steeping medicinals in strong liquor such as sorghum liquor.

Washes or steam-washes are made by decocting medicinals in water; these are used to bathe and steam the affected area.

Warnings

Medicinals for external use are largely toxic and present the danger of poisoning.

When applied externally or taken orally, medicinals for external use must be used in strictly controlled dosages.

In topical applications, the area and density of application must be carefully considered, in order to ensure that dosages do not exceed safe limits.

In oral medication, toxic medicinals should be taken in pill form, since pills take longer to break down and be absorbed than decoctions or orally taken powders. When oral or topical medicinals cause any side effects, the treatment should be discontinued.

Medicinals that heal and close sores must not be used before suppuration and putrefaction have ceased because they can increase ulceration, slow down the healing process, and cause the toxin to fall inward, thus affecting the interior of the body.

The properties of medicinals for external are often unrelated to their external use.

Externa-Use Agents

Toxin-Attacking, Worm-Killing, and Itch-Relieving Agents

Toxin-Drawing, Putridity-Transforming, and Flesh-Engendering Agents

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