Fulong San and Its Derivative Formulas: Powder for Inflammation, Swelling, and Pain

Fulong Gan is the name of a Chinese medicinal—namely, furnace earth (zaoxin tu), the red soil taken from the center of a rural wood-fired stove. This red clay has been calcined many times at the furnace chamber, giving it special properties. Its main components are silicic acid, aluminum oxide, and ferric oxide, along with sodium oxide, potassium oxide, magnesium oxide, calcium oxide, and calcium phosphate. Traditional TCM holds that fulong gan (furnace earth) is acrid and warm in nature, and warms the middle to stop bleeding, vomiting, and diarrhea. In practice, furnace earth may also be applied externally to the affected area, where it exerts anti-inflammatory, swelling-reducing, and pain-relieving effects.

Historically there have been powders using fulong gan as the main ingredient for relieving inflammation, swelling, and pain; several formulas are named Fulong San, two of which are as follows.

The first is "Fulong San" from Xian Nian Ju. Its composition is: fulong gan alone, ground to a fine powder. When using, mix the powder with breast milk expressed from a nursing woman and apply as a poultice, changing once daily. This formula reduces swelling and astringes sores; it is indicated for scalds and burns. Scald-burn sores are ulcers that form after burns, presenting with redness, swelling, heat, pain, and exudate.

The second is "Fulong San" from Waike Zhenquan (True Explanations of External Medicine). Its composition is: fulong gan 3 qian (9 g), stir-fried phellodendron (Huangbo) 3 qian (9 g), and borneol (Bingpian) 2 fen (0.6 g). Grind the herbs to a fine powder; when using, mix with egg white and apply to the affected area, changing once daily. This formula clears heat and resolves toxicity, reduces swelling and relieves pain. It is indicated for external wind-heat attack causing redness and swelling of the face, gradually descending from the head and spreading to other parts of the body where redness and swelling also appear. Such symptoms usually follow infection by some pathogen and resemble the TCM condition of datou wen ("big-head plague").

This Fulong San from Waike Zhenquan may be regarded as an improved version of the one from Xian Nian Ju. Mixing with breast milk and with egg white work on the same principle: both use the proteins they contain to help the medicine penetrate cell membranes and take effect.

These two Fulong San formulas may be compared with an empirical "swelling-reducing plaster" (Xiaozhong Gao) of the late renowned contemporary TCM physician Ling Yunpeng. Ling Yunpeng's Xiaozhong Gao is composed of: white kaolin (or talcum powder) 5 jin, magnesium sulfate 1 jin, boric acid 0.5 jin, glycerin 2 jin, eucalyptus oil 10 ml, and an appropriate amount of 0.1% rivanol solution, mixed well. When using, apply a thick layer to the affected area; it is indicated for redness, swelling, heat, and pain caused by various infections and traumatic injuries.

Ling Yunpeng's formula already has a Chinese-Western integrative flavor, and its preparation also borrows from modern pharmaceutical technology—it is a way of learning from the ancients without being bound by them. In Ling's formula, the composition of kaolin is essentially the same as that of fulong gan; in fact, rural wood-fired stoves are built using just this kind of clay.

Ling Yunpeng added magnesium sulfate, one of whose major actions is to reduce swelling and pain. Boric acid is also a common external agent for reducing swelling and pain, and rivanol solution is a common anti-inflammatory, antiseptic. Ling then mixed the herbs with glycerin and eucalyptus oil, making it easier for the medicine to cross cell membranes—whose main structure is a phospholipid bilayer—and penetrate into cells to act. In preparing his formula this way, Ling made full use of modern biological and chemical knowledge, greatly improving the clinical efficacy of traditional Chinese medicinals.

I venture to suggest that Ling Yunpeng's formula could still benefit from borrowing ideas from Fulong San: adding phellodendron and borneol to its composition should further improve its anti-inflammatory and analgesic effects. When we study TCM formulas, we should thoroughly understand their principles of composition; only then can we flexibly improve them as needed and as science advances.

At the same time, this tells us that it is highly beneficial for TCM physicians to study biology and chemistry. The broader our knowledge, the more flexible and developed our clinical thinking. Thus, in contemporary TCM clinical work, we must not only master traditional Chinese medicine well, but also actively broaden our knowledge, comprehensively improve our competence, think more, and actively use improved therapies to better serve our patients.