"Neituo Shengji San" for Non-healing Ulcers

"Neituo Shengji San" (Interior-Supporting Granulation-Promoting Powder) comes from Yi Xue Zhong Zhong Can Xi Lu (Records of Integrating Chinese and Western Medicine) by the famous late-Qing/early-Republic physician Zhang Xichun. It is composed of 120 g (4 liang) of raw Huangqi (Astragalus Root), 60 g (2 liang) of Gancao (Licorice), 45 g (1.5 qian) of raw Ruxiang (Myrrh), 45 g (1.5 qian) of raw Moyao (Frankincense), 60 g (2 liang) of raw Baishao (White Peony Root), 90 g (3 liang) of Tianhuafen (Trichosanthes Root), and 45 g (1.5 qian) of Danshen (Salvia Root).

Grind all the herbs together into a fine powder. Take 9 g (3 qian) each time, mixed with boiling water, three times a day. If taking powder is difficult, the herbs may be made into pills; take an equivalent amount of pills each time. They may also be prepared as a decoction. The adult daily decoction dosage is as follows: raw Huangqi 24 g, raw Gancao 12 g, raw Ruxiang 9 g, raw Moyao 9 g, raw Baishao 12 g, Tianhuafen 18 g, Danshen 9 g.

This formula supplements qi and supports the interior, activates blood and promotes tissue regeneration. It chiefly treats scrofula and sores that, after rupturing, leave qi and blood deficient and unable to generate pus and granulation tissue; or ulcers that have not healed for years, where the external opening is small but the internal ulceration is large, with extensions to other sites where medicine cannot be applied.

Neituo Shengji San is composed according to the TCM principle of combining the supporting method (tuo fa) commonly used in external medicine with the method of activating blood and resolving stasis. The dosage of raw Huangqi in this formula is especially large. Raw Huangqi supplements qi and secures the exterior, supports sores and promotes granulation, and promotes urination; it is the most commonly used herb in the supporting method of TCM external medicine. If the patient's ulcer is severe, the dosage of raw Huangqi in the decoction may even be increased to 60-120 g for a faster effect.

Ruxiang, Moyao, and Danshen are all herbs that activate blood and reduce swelling. After a sore or ulcer ruptures, there is inevitably static blood, so Ruxiang, Moyao, and Danshen are used to activate blood and resolve stasis, eliminating old blood and generating new. One herb Danshen is as effective as the Siwu (Four Substances); it not only activates blood but also nourishes blood. Baishao nourishes yin and blood; Tianhuafen clears heat and purges fire, generates fluids and stops thirst, and reduces swelling and expels pus. When ulcers persist over time, yin and blood become deficient; these two herbs both nourish yin and clear heat, and reduce swelling and expel pus, which is exactly appropriate. Gancao both harmonizes the other herbs and has a detoxifying action. Hence this formula is well composed.

Neituo Shengji San can treat various ulcers, such as diabetic foot ulcers, ulcers caused by chemotherapy, and pressure ulcers in patients bedridden for long periods. When treating pressure ulcers, it may be used together with an external pressure-ulcer ointment for even better results. This formula may also be tried for ruptured cancers such as lymphoma and breast cancer, but should be used together with other antitumor drugs.