Library

[General Remarks (Part 1)]

Among external treatment methods, acupuncture and moxibustion are the most ancient. Since Zhang Zhongjing of the Han Dynasty changed from acupuncture to decoctions, subsequent generations for a hundred dynasties have revered this approach. The *I Ching* (Book of Changes) states: "When things reach an extreme, they change; when they change, they can penetrate through." Although decoctions can be varied, acupuncture and moxibustion also cannot fail to penetrate. To think of how to relieve this predicament without violating ancient methods but benefiting the present, there is nothing better than plasters. I lived in my hometown for eight years, having verified their efficacy, and dared not keep them secret. Thus, I selected collected prescriptions, connected them in parallel prose, and elucidated the principle that internal and external treatments, though different in path, lead to the same goal. I consulted old friends, who all said this indeed forms its own school, but regretted that it used parallel prose style and mixed content from various schools of thought and history, which is not suitable for popularization. It is advisable to summarize the main points and use plain language to highlight the essentials, so that everyone can understand upon opening the book. I agreed with this view, and thus added these General Remarks at the beginning.

Most diseases enter from the outside, so doctors have external treatment methods. Medical classics list internal and external treatments side by side, never teaching people to rely solely on internal treatment. If one claims that external treatment relies on some specific means, then the words of the sages would be untrustworthy. Moreover, for upper body conditions, use sneezing therapy (sneezing induces vomiting; suitable for pathogens entering via mouth and nose); for middle body conditions, use filling therapy (such as navel-filling powders, or applying pastes to the navel); for lower body conditions, use sitting suppositories (suppositories act as purgatives, e.g., using crushed scallions for edema to induce downward flow of water). These three sentences encompass the methods of inducing vomiting, sweating, and purging, covering the entirety of external treatment, and are even more rapid than internal administration. Those who inoculate smallpox introduce the vaccine into the nasal cavity to transmit through the twelve meridians; to treat sudden stroke or collapse, blowing medicine into the ears opens the seven orifices. The mutual influence of qi is truly miraculous.

The *Neijing* (Inner Canon) records using cinnamon heart soaked in wine to warm-moxa cold-bi, and mixing cassia twig with white wine to apply to wind-stroke affecting blood vessels. This marks the beginning of using plasters. Zhang Zhongjing's Guizhi Tang (Cinnamon Twig Decoction) treats wind-cold and harmonizes Ying and Wei (nutritive and defensive qi), essentially originating from this. Now, transforming decoction formulas back into plasters is, in principle, returning to the origin, and those who claim this is a reckless alteration of ancient methods are incorrect.

The principle of external treatment is the same as internal treatment; the medicines for external treatment are the same as those for internal treatment. The only difference lies in the method. Medical principles and drug properties are identical, yet they manifest magically. At the highest level, they can reveal the profound mysteries of creation and the Five Elements; at the lowest level, they can rescue crises repeatedly and endlessly. Furthermore, treating externally has no prohibitions, no obstructions, no constraints, and no stagnation. A physician who is widely learned should demonstrate their talent here.

External treatment must, like internal treatment, first seek the root. What is the root? It is understanding Yin and Yang, and recognizing the Zang-Fu organs. From the *Lingshu* and *Suwen* downwards, works by masters such as those on *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) must be read. Even the elaborations by Yu Jiayan, Ke Yunbo, and Wang Jinshan contain profound thoughts and must be carefully studied. Today, lacking a master teacher, these books serve as teachers. Once thoroughly understood, all books become formless yet useful, allowing manipulation and variation by oneself. Although treating externally, it is no different from treating internally. This is why external treatment is indestructible, and why it can run parallel to internal treatment, compensating for its deficiencies. If one does not investigate its origins but relies merely on one or two effective prescriptions passed down, boasting of quick secrets without inner insight, what happens when encountering difficult cases with no ancient prescription? How many would not be trapped? Knowing one part but not the other may cause no immediate error, but the patient may suffer hidden damage. As the proverb says, "Curing the headache blinds the eyes"; a skilled artisan would not do this.

Plasters and medicines are divided into two categories; clinical flexibility lies here. There are cases using only plasters without medicine, cases using only medicine without plasters, cases combining both, cases where plaster and medicine function oppositely yet complementarily, and cases where plaster is medicine and medicine is plaster, assisting and enhancing each other. Ancients called boiled preparations "plasters" and powdered preparations "medicines." Combining them achieves completeness. Modern people confuse them as just "plasters," whereas separating them reveals their unique excellences.

The plaster is the outline; the medicine is the detail. Plasters categorize the Upper, Middle, and Lower Jiao (burners), Zang-Fu organs, exterior-interior, cold-heat, and deficiency-excess to set the outline. Medicines follow the plaster for detailed analysis. There are plasters for the Heart and Lung (Upper Jiao), Spleen and Stomach (Middle Jiao), Liver and Kidney (Lower Jiao), and plasters specifically targeting one Zang organ. Zang organs have clearing and warming tonifications. There are plasters specifically targeting one Fu organ. Fu organs have draining and astringent functions. There are also plasters treating all three Jiaos, all five Zang organs, or all six Fu organs. There are plasters for specific exterior-interior, cold-heat, or deficiency-excess patterns, mutually used plasters, and combined plasters. Medicines can be sprinkled inside the plaster, applied on top, used for washing/rubbing before the plaster, or for fumigation/warming after the plaster. The plaster commands the medicine; the medicine assists the plaster. Jing Songya said, "Observing the waxing and waning of Yin and Yang in the *Yijing* reveals the principles of internal treatment." I believe observing the division of duties among the Six Officials in the *Zhouli* (Rites of Zhou), with precise arrangement like water-tight defenses, provides a method for using plasters and medicines. Scholars should grasp this meaning. (Medicine sprinkled in plaster can use single-herb effective formulas ground into powder; topical medicines should be made into pills; other medicines are prepared fresh.)

The formulation of plasters follows the methods of decoctions and pills. Any effective decoction or pill can be boiled into a plaster, not just common formulas like Xiangsu Shenzhu Tang, Huanglian Jiedu Tang, Muxiang Daoshi Tang, Lizhua Tan Tang, Lizhong Tang, Jianzhong Tang, Tiaowei Chengqi Tang, Pingwei San, Liujunzi Tang, Liuwei Dihuang Wan, Yangxin Tang, Guipi Tang, or Buzhong Yiqi Tang. Some ask: Why boil decoctions/pills into plasters instead of taking them internally? The reason is precisely because I dare not recommend internal administration, hence the use of plasters. Historically, it is warned that causing harm does not necessarily require toxic drugs. If understanding is not clear, Guizhi Tang swallowed or Chengqi Tang ingested can also cause death. Even a single herb like Ephedrae Herba (Mahuang), Coptidis Rhizoma (Huanglian), Atractodis Rhizoma (Baizhu), or Rehmanniae Radix Praeparata (Shudi), if misused, causes endless harm. The foolish insist they are right without knowing their wrong; bystanders laugh secretly. The wise know but dare not speak, feeling ashamed and regretful. Yet, how can they spit it out? Others say: Skilled physicians need not worry about this. But consider how few skilled physicians exist in antiquity and modern times. Moreover, skilled physicians do not abandon external treatment. Previously, Ye Tianshi used Pingwei San fried and warmed to treat dysentery, and Changshan Yin fried and sniffed to treat malaria, transforming decoctions into external treatments, truly opening infinite methods for later generations. My use of plasters is based on this. If one insists on internal administration, whether wrongly administering drugs or drugs aggravating the illness, what method exists for patients who refuse to take medicine or cannot take it, whose condition we pity and cannot ignore?

Plasters can govern a hundred diseases, yet people ridicule this. They cite famous scholars' arguments against Zijin Ding (Purple Gold Pill) governing all diseases as proof. This is also a biased view. Treating one meridian or one symptom separately, when compiled, naturally governs broadly. For example, Chonghe Tang is a formula for releasing the Taiyang exterior, but can treat Warmth in spring, Heat in summer, and Dampness in autumn, and is also effective for miscellaneous diseases. Tongsheng San is a formula for resolving both exterior and interior, treating Wind, Heat, and Dryness simultaneously. Wuji San is a formula for internal injury and external contraction, applicable to internal Zang-Fu, external skin/hair/collaterals, upper head/neck, lower waist/legs, and women's menstruation regulation. Another formula, Mahuang Baizhu San, treats diseases caused by郁 (stagnation) of Wind, Fire, Damp, and Heat, containing herbs for exterior/interior, cold/heat, tonification/draining. Yueju Wan treats Qi, Phlegm, Blood, Food, Damp, and Heat stagnation; transformed into Xue Yi's Bawei Xiaoyao San, or expanded into Yangsheng Liuyu Jiedu Fang. Gao Gufeng treated Blood disorders using one formula to cover Seven Emotions, hunger/fullness, and labor fatigue, deeply admired by Hu Nianzhai and praised by Chen Xiuyuan. Others include Sanhe Tang, Sanyi Chengqi Tang, Sanyi Shenqi Tang, Liuyi Shunqi Tang, etc. Such examples in antiquity are countless. Plasters adopt these meanings and expand them; treating a hundred diseases is no difficulty. Essentially, human diseases are limited to Qi stagnation and Blood coagulation, or Yin having Cold-Damp, or Yin having Dry-Heat. Observing the Nineteen Pathogenesis Patterns, the text says "all belong to," where "all" implies governance. If diseases can be governed, why not medicines? One who grasps the key summarizes it in one word. Making plasters also depends on grasping the key. Scattered coins in a room can be strung together by one thread; hundreds, thousands, or ten thousand coins can be strung. This is grasping the key. A domino set involves simple odd-even combinations, yet generates infinite variations. This is also grasping the key. The way to grasp the key is summarized by "penetration" (Tong). When principles are penetrated, treatment follows. However, penetration requires humble reading.

External treatment medicines often contain miraculous formulas. Without sufficient knowledge, one cannot comprehend them. Or, being unfamiliar with rare things, one might criticize ancients incorrectly, which is greatly inadvisable. I believe the doctor's problem is lack of method. Once the method exists, one is not bound to rigid application. If ancient texts mention washing or fumigating, I can wash or fumigate with medicine; if rubbing or warming, I can rub or warm with medicine. Use the original formula if applicable; otherwise, select another or create a new one. Zhang Yuansu said, "Ancient formulas do not fit modern diseases." Xu Yishi said, "Use the method, not the formula." This is not only because times and situations differ and symptoms change, making formulas inflexible, but also to prevent later generations from misunderstanding predecessors and criticizing them blindly, thereby teaching flexible application. This is what it means to be good at learning from antiquity.

Herbs in plasters must include those that penetrate meridians and collaterals, open orifices, penetrate bone, and draw disease outward, such as Ginger, Scallion, Garlic, White Mustard Seed, Sichuan Pepper, and branches of Locust, Willow, Mulberry, Peach, Castor Bean, Fairy Flower, Calomel, Pangolin Scales, etc. These are indispensable, not just Ice Borneol and Musk. Tonifying medicines must use substances of flesh and blood (animal products) to benefit humans, such as Lamb Soup, Pig Kidney Pills, Black-Bone Chicken Mixed Pills, Turtle Shell Decoction, Crucian Carp Plaster, etc., which can be imitated. Ziheche (Human Placenta) must absolutely not be used; instead, Cow Placenta can substitute it with greater potency, being the premier tonic. Note that in external treatment, free flow of Qi and Blood constitutes tonification; herbal tonics are not strictly necessary.

Herbs in plasters must have strong aroma and flavor to be effective. Even drying herbs like Atractodis Rhizoma (Cangzhu) and Pinelliae Rhizoma (Banxia) become moistening when entered into oil; even toxic herbs like Kansui Radix (Gansui), Pharbitis Semen (Qianniu), Crotonis Fructus (Badou), Arisaematis Rhizoma (Nanxing), and Momordica Cochinchinensis Seed (Miebiao) become neutralized when entered into oil, causing no hindrance. Stir-fried or steamed use is inferior to raw use; forcing substitutions is worse than changing entirely (e.g., replacing Honeysuckle Flower with Honeysuckle Vine, Poria with Plantago Seed). Leading troops, breaking gates, capturing chiefs—this is how military strategy wins victory. Plasters are similar. If measured against the mild and light prescriptions of modern doctors, observers would flee in shock.

Hot plasters work faster than cool ones, because heat is rapid and cool is slow. Attacking plasters work faster than tonifying ones, because attack force is fierce and tonification force is weak. However, for severe Heat syndromes, cooling brings immediate relief; for extreme Deficiency syndromes, tonification brings immediate peace. It depends on matching the syndrome. Sometimes Heat syndromes can be treated with Heat herbs: either to promote movement with heat, or to attract heat outwards (treating Heat with Heat, a reverse treatment). Sometimes Deficiency syndromes can be treated with attacking herbs: disease must be removed first, not nourished to prolong illness. Also, due to mutual influence of Qi, deficient persons can withstand non-deficient treatments. This danger of deficiency requires clinical discretion. (Cold accumulation and ice-like stasis worsen with tonification.)

Ancient decoctions for one syndrome often combined Cold and Heat herbs, or Draining and Tonifying herbs. Why should plasters be different? A key principle is applying warm plasters with cool medicines, or tonifying plasters with draining medicines. This embodies the meaning of supporting Righteous Qi to expel Evil. If treating two syndromes simultaneously, Cold/Heat and Draining/Tonifying can be used together, provided upper does not invade lower, lower does not invade upper, and middle does not interfere, leaving no worries.

In *Shanghan Lun*, Zhang Zhongjing used fire fumigation to induce sweat, cold water splashing, red bean insertion into nose, and pig bile/honey suppositories—all external treatments, belonging to sweating and purging methods. Improper use is not the fault of the method. Later experts used warming/moxa methods for Pi Qi (abdominal masses) and Jie Xiong (chest binding), applicable to errors in treating Yin-originating or Yang-originating diseases. For those without Yang, steaming is suitable; for Zang Jie (organ knotting), moxa is suitable. New methods were introduced where none existed, becoming thorough and detailed. However, due to high talent and insight, they did not specialize in external treatment, so external formulas are less complete than internal ones. Yet, collecting various books reveals a basic framework. Some say Warm Disease cannot be treated externally. I argue Warm Disease treatment derives from Shanghan; experts distinguish sources clearly. Wu Jutong's *Wenbing Tiaobian* focuses on Hand-Taiyin and Foot-Taiyang, distinguishing Yin/Yang injury. Methods like Xiexin Tang or Baihu Tang are not outside Shanghan principles. For Heat evil transmitting inward in Shanghan, there are黄连 Water Chest Wash, Niter Water Chest Application, Genkwa Water Chest Patting, Gypsum Paste Chest Application, Earthworm/Salt Chest Paste, Smallpox Rash Blue Green Powder/Lycopus Water Sweep, Well Water Splashing for Hematemesis/Epistaxis, Ye's Soup Rubbing for Blood Pooling, and Cornu Bubali/Rehmanniae Paste for general heat. Miscellaneous Shanghan complications all have external treatments. All drugs for Heat diseases exist in Shanghan; even if not, they can be deduced by analogy. Thus, treating Warm Disease externally can be deduced from Shanghan external methods. Some say Warm Disease spreads too fast for plasters. But decoctions cannot be taken multiple times a day, while plasters can be changed multiple times. It depends on the user's agility. Methods are created by us, not for those who blindly pick formulas. Breaking conventions and overcoming rigidity is hoped for in intelligent minds. (In Cold/Warm transmission, symptoms change before decoction finishes; waiting for plasters is slower, but pre-emptive use of Kudzu Root to block Yangming or Atractylodes to stabilize Taiyin is steadier.)

Ancient plasters, besides Taiyi Plaster and Guanyin Feiyun Plaster, included Wanling Plaster for four-season Cold Damage, Jinsiy Wanying Plaster for Spleen/Stomach, and five types for Consumption. Also Nuanqi Plaster and Yongquan Plaster show internal conditions were treated with plasters historically. Their ingredients were complex, treating external symptoms too, differing from pure decoctions. Physicians criticized them; ear-eaters dismissed them. When internal meds failed and crisis hit, plasters were used too late, explaining their decline. Wang Jinshan commented on *Bencao* Four Spirit Pill: removing erroneous herbs and adding synergistic ones yields miracles. He is a true merit-maker of antiquity. We need another Wang Jinshan today to revitalize ancient plasters and create dozens of new formulas for guidance. (Ye Tianshi's *Linzheng Zhinan* would benefit from a specialized external treatment guide.)

Plaster application does not focus on a single acupoint. Like the fifty-nine needle points for Heat diseases in classics: five rows of five on the head to vent Yang Heat. Midline (Du Meridian): Shangxing, Xinhui, Qiangding, Baihui, Houding. Lateral (Bladder Meridian): Chengguang, Tongtian, Naogai, Yuzhen, Tianzhu. Lateral (Gallbladder Meridian): Linqi, Muchuang, Zhengying, Chengling, Naokong. Eight points (Tianzhu, Yingshu/Zhongfu, Quepen, Beishu/Fengmen) drain Chest Heat. Qichong, Zusanli, Shangjuxu, Xiajuxu drain Stomach Heat. Yunmen, Jianyu, Weizhong, Suikong drain Limb Heat. Fifty points beside Five Zang Shu points drain Zang Heat. Total fifty-nine points divide and reduce pathogenic force. Even severe cases improve. For Taiyang External Contraction, apply plaster to Taiyang (headache point), Fengchi, Fengmen (clear pathway), Danzhong (induce sweat from Heart). Apply medicine to Tianting, fumigate head/face/calves, rub chest/back/palms/soles (induce sweat), dividing the force. This derives from needling; other meridians follow. (Malaria and Blood disorders have interception methods.) For Zang-Fu, apply to location: upper chest, middle navel, lower Dantian. Or pair Xinshu with chest, Mingmen with navel, Yongquan with Dantian. For external lesions, apply to site plus one on chest to protect Heart, or use Stomach-opening paste to aid appetite/strength, replacing internal support. (External treatment uses diet as tonification.)

Internal treatment with decoctions is like being in a dark room; external treatment with plasters is like being in a public square. In the dark room, no one sees; in public, everyone sees. Thus, internal treatment can be concealed/deceived, but external cannot. However, this makes correcting errors easier and avoiding grave blame easier. Poor people relying on medicine for livelihood, with little study or experience, find plasters safer for themselves and others, bearing no risk. This preserves reputation, wealth, health, and offspring. Some became wealthy through plasters. Plasters are often tested on the poor, who trust them due to lack of funds for doctors and habit of not taking internal meds. Rich families with minor ailments consult many experts; comparing remedies is common. How can they quickly accept plasters? But when all drugs fail and doctors give up, plasters proving effective spread easily. Doctors should do their best. Plaster preparation is unseen; do not mix good and bad drugs, losing authenticity. Do not exploit emergencies or hoard goods. Practicing virtue secretly among the poor, regardless of profit, is true blessing.

My formulated plasters, Qingyang Plaster, Sanyin Plaster, Jinian Plaster, ... Plaster, Cuisheng Plaster, are most effective, published after the main text. Childbirth is not a disease, nor is induction necessary, but plasters are prepared for postpartum illness. Often, 2-3 days postpartum, mothers cannot sleep, feel restless, Fire rises, baby stays down. After applying this plaster, abdomen feels warm, eyes close, sleep comes, and birth occurs upon waking. How can pure Yin plaster warm? Because Yang Qi leaks outward, Yin plaster returns Yang inward, warming the abdomen. This is the method of anchoring Yang with Yin. Sleep restores Yin Qi and closes the birth canal. Rest allows the baby to turn. Nature's way returns to nature. Without plaster, sleep is impossible due to stagnant Qi. Not to calm the mother, but to enable sleep for medicine to work. This contains medical intent, proven by trials. (Imitate for chronic consumption with no specific cure.) I saw difficult births treated with Cathartics or Castor Oil with no effect; some died exposing their bellies due to exhausted Yang Qi. Medical principles are subtle and require quiet contemplation. I offer this formula for consideration, showing plasters can be self-made, not needing ancient precedent. Others include Lingfei Plaster, Taishan Stone Carving Plaster, Qibao Yuxian Plaster, Lingsha Plaster, Yanling Plaster, Qingbu Plaster, Wenbu Plaster, Shangfeng Fasan Plaster, Shanghan Fasan Plaster, Sanshi Ganmao Shuangjie Plaster, Dongdan Wenzheng...