Two External-Application Prescriptions for Superficial Tumors from Chen Shiduo's Dongtian Aozhi
Dongtian Aozhi (Secret Lore of a Grotto Heaven), by the Qing-dynasty physician Chen Shiduo, is one of the great classics of TCM external medicine. In his early years Chen Shiduo traveled widely and exchanged ideas with physicians everywhere; he was especially close to Fu Qingzhu, a famous physician of the late Ming and early Qing. His book therefore draws on the strengths of many schools and contains many innovations, and numerous of his formulas still yield good clinical results today.
Here I excerpt two external-application formulas from Dongtian Aozhi for treating superficial tumors, for readers' reference.
Kuliu Fang (Wither-the-Tumor Formula):
Indicated for tumors that have just formed and not yet ulcerated, and for those with a small, non-diffuse base. Composition: white arsenic (bai pi) 1 qian, sal ammoniac (naosha) 1 qian, yellow lead (huangdan) 1 qian, calomel (qingfen) 1 qian, realgar (xionghuang) 1 qian, frankincense (ruxiang) 1 qian, myrrh (moyao) 1 qian, borax (pengsha) 1 qian, 20 Chinese blister beetles (banmao), 3 large river snails (tianluo, shelled, dried in the shade and sliced). Grind all together to an extremely fine powder, mix with glutinous rice gruel, press into small chess-piece-shaped cakes, and dry in the sun. First apply three moxa cones on the top of the tumor, then apply the medicinal cake; on top spread a paste of phellodendron (huangbai) powder mixed with water, covering the cake. After about ten days, the tumor will naturally wither and drop off; afterward use a wound-astringing medicine.
Michuan Liuliu Gao (Secretly Transmitted Tumor-Astringing Paste):
Dragon's blood (xuejie) 1 qian, calomel (qingfen) 1 qian, dragon bone (longgu) 1 qian, cuttlebone (haipiaoxiao) 1 qian, elephant hide (xiangpi) 1 qian, frankincense (ruxiang) 1 qian, 15 chicken eggs (boiled; use the yolks to decoct a small cup of oil). Grind each ingredient into a fine powder, then grind them together finely (today an electric grinder may be used), and mix into the egg-yolk oil, stirring evenly. Every morning and evening, first wash the affected area with licorice (gancao) decoction, then use a chicken feather to dab the medicine onto it, and cover with a medicinal plaster. Both of Chen's formulas use toxic drugs and are typical "using poison to attack poison" remedies.
In Kuliu Fang, white arsenic, calomel, realgar, and blister beetles are all highly toxic; the Secretly Transmitted Tumor-Astringing Paste also uses toxic calomel. These are now controlled substances; taken internally they carry great risk, but applied externally they are relatively safer.
White arsenic is arsenic trioxide. It is remarkably effective against acute promyelocytic leukemia and is now listed by the WHO as a first-line treatment for that leukemia type. Besides acute promyelocytic leukemia, arsenic trioxide can also treat other tumors; some Chinese medical institutions are now studying its use against lung and liver cancers.
Sal ammoniac (naosha) also has some tumor-inhibiting effect, but it is strongly caustic, so care is needed when applying it externally.
Calomel (qingfen) is a mixture of a mercury compound, alum, and salt; in ancient China it was often used to treat tumors and hyperplastic conditions, but almost always externally.
Blister beetles (banmao) have antitumor activity, but they are also very toxic; there are many reports of deaths from ingesting unprocessed banmao.
Elephant hide is now a banned substance; it may be replaced by bletilla (baiji) and floral stone (Huaruishi).
Both of Chen's formulas are difficult to prepare today, and no ready-made Chinese patent medicines are sold. Unless absolutely necessary, they should not be considered for clinical use.