Zhang Xichun's Xiaoluo Wan and Xiaoluo Gao for Scrofula

Zhang Xichun, a famous physician of the integration-of-Chinese-and-Western-medicine school in the late Qing and early Republican periods, had two empirical formulas for treating scrofula: one was the orally taken "Xiaoluo Wan" (Nodule-Resolving Pill), and the other was the externally applied "Xiaoluo Gao" (Nodule-Resolving Paste).

The Xiaoluo Wan formula is as follows: Duan Muli (calcined Ostreae Concha) 10 liang, Sheng Huangqi (raw Astragali Radix) 4 liang, Sanleng (Sparganii Rhizoma) 2 liang, Ezhu (Curcumae Rhizoma) 2 liang, Xuejie (Draconis Sanguis) 1 liang, Sheng Ruxiang (raw Olibanum) 1 liang, Sheng Moyao (raw Myrrha) 1 liang, Longdancao (Gentianae Radix) 2 liang, Xuanshen (Scrophulariae Radix) 3 liang, Zhe Beimu (Fritillariae Thunbergii Bulbus) 2 liang.

This formula is actually an enhancement of the original formula by Cheng Guopeng of the Qing dynasty. Cheng Guopeng's Xiaoluo Wan in the Yixue Xinwu (Medical Insights) consisted of only three herbs: Xuanshen, Zhe Beimu, and Muli. Zhang Xichun further developed this formula into the more effective "Xiaoluo Wan."

TCM scrofula includes both tuberculous lymphadenitis and lymphoma in modern medicine, so Xiaoluo Wan is an empirical formula for treating such serious diseases. The empirical formulas of many contemporary TCM physicians who treat cancer are actually enhancements based on this empirical formula of Cheng Guopeng and Zhang Xichun. Xuanshen cools blood and reduces swelling; Duan Muli softens hardness and dissipates nodules; Zhe Beimu resolves phlegm and dissipates nodules; Sanleng, Ezhu, Xuejie, Ruxiang, and Moyao invigorate blood and reduce swelling; Longdancao drains fire and reduces swelling; Sheng Huangqi supports the healthy root. Its approach of supporting the healthy and eliminating the pathogen gradually became complete. Contemporary TCM practitioners have further added herbs such as Shijianchuan, Daqingye, Banlangen, Qingdai, Banzhilian, Baihua Shelingshe, and Xianhecao, which clear heat, resolve toxin, and anti-cancer and reduce swelling, composing anti-cancer formulas.

This compositional approach still occupies the mainstream among TCM anti-cancer formulas today. But contemporary TCM practitioners rarely use externally applied plasters to assist oral formulas. In fact, Zhang Xichun also had an external formula, "Xiaoluo Gao," consisting of: Sheng Banxia (raw Pinelliae Rhizoma) 1 liang, Chuanshanjia (Manis squamae; now banned under wildlife protection regulations, may be replaced by 3 times the amount of Shuihonghuazi) 3 qian, Sheng Gansui (raw Kansui Radix) 1 qian, Sheng Maqianzi (raw Strychni Semen) 4 qian, Zaojiaoci (Gleditsiae Spina) 3 qian, Xuejie (Draconis Sanguis) 2 qian. Except for Xuejie, fry the above herbs in sesame oil until withered, remove the dregs, add Huangdan to form the plaster; when the right consistency is reached, mix in the finely ground Xuejie. Apply externally according to the size of the scrofula, adding a little Shexiang (Moschus) when applying.

Both Zhang Xichun's treatment formulas and methods are worth learning from. Combining external medication with internal medicine to treat scrofula-type diseases gives a more ideal effect. The basic framework of Zhang Xichun's formulas is still not outdated today, but it should be noted that his external formula is highly toxic and must never be taken internally.