"Bixia Dingzi" for Treating Malignant Superficial Sores

Some of the "malignant superficial sores" of ancient TCM texts correspond to superficial tumors in modern medicine, while others are related to infectious diseases. Ancient TCM treated such sores mostly by external methods.

One of the Four Great Masters of the Jin-Yuan period, Li Dongyuan, included a formula called Bixia Dingzi (Jade Mist Pastille) for malignant superficial sores in his Huofa Jiyao. It is composed as follows: Tonglü (verdigris, copper acetate) 1 liang; Shanaosha (sal ammoniac) 2 qian; Chansu (toad venom) 1 qian. Grind all into a fine powder, mix with cooked rice into wheat-grain-sized pastilles. For malignant sores that feel no pain when pricked, first prick until bleeding, then place the medicine inside, and cover with plaster.

I have used both Shanaosha and Chansu in this formula to treat cancerous masses, and both have some effect. Though mildly toxic, they are rarely dangerous when used externally. Verdigris is mainly basic copper carbonate; it is toxic and must not be taken internally, but is relatively safe externally. It removes putrid flesh and engenders sores; Shanaosha is corrosive; Chansu clears heat, resolves toxin, fights cancer, and reduces swelling. Used together, the three have some inhibitory effect on malignant superficial sores. But this external method is only local treatment and cannot replace systemic therapy.

In the Huofa Jiyao, Li Dongyuan also noted the matching internal medicine. "For back boils and nail-head sores, before or after pus formation: if deficient with headache, add Wuweizi (Schisandra) to the interior-supporting herbs; if restless and uneasy, add Renshen (ginseng) and Fulin (Poria); if deficient with fever, add Dihuang (rehmannia) and Gualouren (trichosanthes root); if tidal fever, add Dihuang and Digupi (lycium bark); if unquenchable thirst, add Zhimu (anemarrhena) and Chixiaodou (red bean); if deficiency irritability, add Gouqi (lycium) and Tiandong (asparagus root); if spontaneous diarrhea, add Houpo (magnolia bark); if profuse pus, add Danggui (angelica) and Chuanxiong (Sichuan lovage); if severe pain, add Shaoyao (peony) and Ruxiang (frankincense); if muscle grows slowly, add Bailian (ampelopsis) and Rougui (cinnamon); if wind evil, add Duhuo (angelica pubescens) and Fangfeng (saposhnikovia); if palpitations and fright, add Dansha (cinnabar); if vomiting and retching, add Dingxiang (clove) and Huoxiang (agastache leaf); if much phlegm, add Banxia (pinellia) and Chenpi (tangerine peel)."

Li Dongyuan does not specify what these "interior-supporting herbs" are, but his commonly used interior-supporting decoction for sores is the Shengma Tuoli Tang, composed of: Shengma (Cimicifuga), Gegen (pueraria), and Lianqiao (forsythia), each 1.5 qian (about 5 g); Huangqi (astragalus), Danggui (angelica root), and Zhi Gancao (honey-fried licorice), each 1 qian (about 3 g); Niuzi (arctium fruit) 5 fen (about 1.5 g); Rougui (cinnamon) 3 fen (about 0.9 g); Huangbai (phellodendron) 2 fen (about 0.6 g). This combined internal-and-external method has some efficacy and may be used for reference.