National Medical Master Yan Dexin's External Formula 'Xiaopi Powder' for Splenomegaly in Chronic Leukemia

Xiaopi Powder ("Mass-Dissolving Powder") is an external formula created by National Medical Master Yan Dexin for treating splenomegaly in patients with chronic leukemia. It is composed of Shuihonghuazi (Prince-of-Feather cockscomb fruit) and Pixiao (Glauber's salt), 1 liang each; Zhangnao (camphor), Taoren (peach kernel), and Tubiechong (ground beetle), 4 qian each; raw Banxia (Pinellia), raw Tiannanxing (Arisaema), Shanjiapian (pangolin scale), Sanleng (burreed rhizome), Wangbuliuxing (cowherb seed), Baijiezi (white mustard seed), raw Chuanwu (Aconitum), and raw Caowu (wild Aconitum), 5 qian each; and raw Baifuzi (Typhonium) and Yanhusuo (Corydalis), 3 qian each.

All the above herbs are ground into fine powder and mixed with honey and vinegar into a paste. Finally, 4 fen of Shexiang (musk; artificial musk may be substituted) and 1 qian of Meipian (borneol) are added. The paste is applied externally over the enlarged spleen, covered with a single layer of soft tissue paper, secured with gauze, and then a hot-water bag is placed over it to promote penetration of the medicinal effect. The dressing is changed once daily. If the powder dries out and falls off midway, it may be re-moistened with honey and vinegar and reused; there is no need to add more musk or borneol.

Professor Yan Dexin repeatedly achieved results with Xiaopi Powder in clinical practice. He used it to treat splenomegaly in 7 patients with chronic myeloid leukemia: 4 had marked effect (the spleen shrank by more than 5 cm compared with before treatment), 1 had effect (the spleen shrank by 2-5 cm), and 2 had no effect. In the effective cases, most patients also showed a corresponding trend toward improvement in the peripheral blood picture, with no suppressive effect on red blood cells or platelets. Usually effects begin after 3-5 days of use, the spleen shrinks markedly within 2 weeks, and thereafter improvement slows. Relapse may occur after treatment, but re-using Xiaopi Powder after relapse is still effective, though the longer the disease course, the poorer the effect. However, this formula is less effective for hepatosplenomegaly caused by liver tumors or cirrhosis.

Shuihonghuazi, used in Xiaopi Powder, is the dried ripe seed of Polygonum orientale (knotweed; alias wild pepper). TCM holds that it disperses blood and dissolves abdominal masses, resolves food stagnation and relieves pain, and promotes diuresis and reduces swelling. It is indicated for abdominal masses and concretions, goiter and tumors, indigestion, epigastric distention and stagnation, ascites, and edema. It may be taken internally or applied externally. It is not a commonly used medicinal herb, but it is frequently employed in oncology.

Pixiao is the crystalline form obtained by processing Mangxiao (Glauber's salt), its main component being hydrated sodium sulfate. TCM holds that Mangxiao purges and frees the bowels, moistens dryness and softens hardness, and clears fire and reduces swelling. It is indicated for accumulation of excess-heat, abdominal fullness and distending pain, dry bound stool, and intestinal abscess with swelling and pain. Pixiao is also often used externally for breast abscess and swollen painful hemorrhoids.

Camphor is a crystalline substance extracted from the trunk, branches, and leaves of the camphor tree; its main component is the natural bicyclic terpenoid ketone. Camphor has a distinctive odor; it is acrid and warm in nature and toxic, but can repel insects and kill germs, awaken the brain and refresh the spirit, and reduce swelling and stop pain. It is also one of the common external herbs used in TCM for welling-abscess and cellulitis-type disorders.

Tao ren, Tubiechong, Sanleng, Wangbuliuxing, Shanjiapian, Yanhusuo, Shexiang, and Meipian all invigorate blood, reduce swelling, and stop pain. Raw Banxia, raw Tiannanxing, raw Baifuzi, and Baijiezi resolve phlegm and disperse nodules; however, raw Banxia, raw Tiannanxing, and raw Baifuzi are highly toxic, are drugs controlled by the state, and must not be taken internally—they are for external use only, and even externally they are prohibited on broken skin. Raw Chuanwu and raw Caowu both warm the channels and stop pain, and dispel wind and reduce swelling; these two herbs are also highly toxic, likewise state-controlled drugs, and must not be taken internally, being for external use only.

When these herbs are combined, they produce a relatively strong effect of reducing swelling and stopping pain, so this formula can dispel the abdominal mass caused by splenomegaly. This formula contains many toxic drugs, most with very low lethal doses, and it must never be taken internally during clinical use. If a patient develops skin allergy after application, such as blistering or red rash, the use must stop immediately and the area should be washed with plenty of clean water. Although transdermal delivery of toxic external herbs carries far fewer toxic side effects, it can occasionally impair liver or kidney function; if long-term use is required, liver and kidney function should be rechecked regularly.