Zhao Bingnan's "Black Gangrene Sore Plaster" and Diabetic Foot

Professor Zhao Bingnan was a great contemporary master of TCM external medicine in China. In the Zhao Bingnan Linchuang Jingyan Ji (Collected Clinical Experiences of Zhao Bingnan), there is a formula called Black Gangrene Sore Plaster (Hei Ju Chuang Gao); its composition and preparation are as follows:

Group herbs: Baizhi (Angelica dahurica) 3 qian, Danggui (Angelica sinensis) 5 qian, Xuanshen (Scrophularia) 5 qian, Huangqi (Astragalus) 5 qian, Fangfeng (Saposhnikovia) 5 qian, Gancao (Licorice) 3 qian, Shengdi (Rehmannia) 5 qian, Shetui (snake slough) 2 qian, Xueyu (hair) 3 qian, Fengfang (wasp nest) 5 qian, Paoshanjia (processed pangolin scale) 3 qian, Xingren (Apricot seed) 5 qian.

Powdered herbs: Zhangdan (lead oxide) 3 qian, Ruxiang (Olibanum) 5 qian, Qingfen (calomel) 3 qian, Hongfen (mercury bichloride / red powder) 2 qian, Bingpian (Borneol) 2 qian, Mizhu (rice pearl) 1 qian, Shexiang (Musk) 1 qian, Moyao (Myrrh) 5 qian, Xuejie (dragon's blood) 2 qian, Ercha (catechu) 5 qian, Longgu (Dragon bone) 3 qian.

Other reserve adjuvants: Songxiang (rosin) 3 liang 5 qian, Huangla (beeswax) 2 liang, Xiangyou (sesame oil) 1 jin.

Preparation: Soak the group herbs in sesame oil for about 1 week, then decoct over a gentle flame until the herbs turn a scorched yellow, filter out the dregs, add rosin and beeswax; once melted and uniform, remove from heat, cool slightly, add the powdered herbs, stir evenly, and allow to congeal.

This formula's function is to restore yang and generate flesh, and to transform necrosis and draw out toxin; it mainly treats chronic ulcers and tuberculous ulcers. When using, apply the plaster directly to the affected area. It should be noted that this formula is not suitable for the yang-type sores of TCM, and it should be forbidden in those allergic to mercury.

The author has mentioned this formula in a previous article. The first person to introduce it to me was Dr. Li Zhonghui, a retired Western-medicine specialist at Beijing Chaoyang Hospital; she graduated early from Peking University Medical School and was once an expert in detoxification. Before retiring, she used the Black Gangrene Sore Plaster to treat diabetic foot with very good results and no serious adverse reactions.

Professor Zhao Bingnan worked in the surgery department of Beijing Hospital of TCM during his lifetime. After hearing Dr. Li's account more than ten years ago, I specifically went to Beijing Hospital of TCM to ask about it; a physician there who specialized in TCM surgery told me at the time that their hospital no longer used this prescription, because they felt it contained highly toxic drugs such as calomel and red powder and were worried about medication safety.

Today, in my Western Pathology class, we happened to reach the section on "gangrene," and I could not help thinking once more of this formula and of Dr. Li's very firm recommendation of the Black Gangrene Sore Plaster.

According to the classification of Western pathology, diabetic foot belongs to "dry gangrene" within gangrene. This kind of gangrene is common in the extremities where the artery is obstructed but venous return remains patent; because much moisture is lost, the tissue is dry and shrunken, with a clear boundary from normal tissue, and the lesion progresses relatively slowly. Even so, the lower limbs of diabetic-foot patients still have a large area of tissue necrosis, secondarily infected to varying degrees by putrefying bacteria, turning the necrotic tissue black. This black color arises because putrefying bacteria decompose the necrotic tissue to produce hydrogen sulfide, which combines with ferrous ions in hemoglobin to form black iron sulfide. Because of the putrefying bacteria, the gangrenous limb also gives off a foul odor.

The main action of Professor Zhao Bingnan's Black Gangrene Sore Plaster is to remove necrotic flesh, activate blood and generate muscle; it is not surprising that this formula treats gangrene such as diabetic foot. Besides diabetic foot, it can also treat other forms of dry gangrene. Unfortunately, this plaster now survives only as a formula, with no place that can produce it. After a few more years, such genuinely effective formulas will probably never attract anyone's attention again.

In fact, there are many diseases like diabetic foot, and traditional TCM has no shortage of similar formulas for such refractory diseases. For example, both the Waike Zhengzong (Orthodox External Medicine) by the Ming-dynasty Chen Shigong and the Qing-dynasty external-medicine classic Waike Dacheng (Compendium of External Medicine) contain such external formulas with highly toxic drugs like arsenic, red powder and calomel. Chen Shigong's "Sanpin Yitiao Qiang" (Three-Grade Single-Thread Spear) was once used in some maternal and child health hospitals in China last century to treat cervical cancer, with very good results; but now no one dares to use it again.

I know that, for reasons of the times, the elimination of these formulas may be unavoidable, but I still hope to leave this written record so that future readers know these formulas once played a very good role in clinical practice. I look forward to the day when the TCM community or pharmaceutical companies, within the scope permitted by current law, value the practical worth of such formulas and carry out lawful clinical practice to benefit patients.