Zhao Bingnan's Experience Formula Huiyang Ruanjian Tang for Treating Yin Ju (Yin Carbuncle)

The veteran TCM physician Zhao Bingnan was a famous contemporary master of TCM surgery. In his work *Collected Clinical Experiences of Zhao Bingnan* (Zhao Bingnan Linchuang Jingyan Ji), there is a formula named "Huiyang Ruanjian Tang" (Yang-Restoring, Hardness-Softening Decoction). Its composition is: 3–9g of cinnamon bark (Shang Rougui, 1–3 qian), 9–15g of white mustard seed (Baijiezi, 3–5 qian), 6–12g of blast-fried ginger (Pao Jiang, 2–4 qian), 15–30g of processed rehmannia (Shudi, 5 qian–1 liang), 6–12g of white stiff silkworm (Bai Jiangcan, 2–4 qian), 9–15g of tangerine red (Juhong, 3–5 qian), 9–15g of curcuma sanleng (Sanleng, 3–5 qian), 3–6g of ephedra (Mahuang, 1–2 qian), 9–15g of zedoary (Ezhu, 3–5 qian), and 6–15g of whole loofah (Quan Sigua, 2–5 qian).

This formula has the effects of restoring yang and softening hardness, warming and transforming phlegm-dampness, and softening hardness and dispersing nodules. It is mainly indicated for chest-wall ju, axillary ju, and all yin-ju syndromes in which the overlying skin color is unchanged but there is a hard, swollen, cohesive mass.

Professor Zhao's formula is a modification of Yanghe Tang by the famous Qing-dynasty surgeon Wang Hongxu (composed of rehmannia, ephedra, deerhorn glue, white mustard seed, blast-fried ginger, cinnamon bark, and licorice), hence the similar name. Huiyang Ruanjian Tang removes deerhorn glue (which warms yang and nourishes blood) and licorice (which clears heat and resolves toxin), and adds white stiff silkworm (which softens hardness and disperses nodules), plus Sanleng and Ezhu (which break blood and attack hardness, reducing swelling and dispersing nodules), whole loofah (which unblocks collaterals and resolves phlegm), and tangerine red (which moves qi and resolves phlegm). Its nodule-dispersing effect is therefore even more pronounced. Moreover, the cost of the herbs drops sharply; deerhorn glue is a rare, expensive medicine that ordinary families cannot afford, showing that Professor Zhao also considered economic cost when prescribing.

What TCM calls yin ju refers to various masses visible from the skin surface. Yin ju are usually neither red nor painful, but hard, swollen, cohesive, and immobile; they resemble lipomas, lymphomas, and lymph node tuberculosis in modern medicine. TCM holds that such yin ju are mostly formed by long-standing yang deficiency, qi and blood insufficiency, and congealed cold-phlegm; treatment should warm yang, nourish blood, and dissipate phlegm nodules. Cinnamon bark, rehmannia, and blast-fried ginger warm yang and nourish blood; ephedra disperses cold and reduces swelling; white mustard seed warms and transforms cold-phlegm. Together they achieve the effect of dispelling cold and reducing swelling—which is precisely the rationale behind Yanghe Tang.

Professor Zhao retained these key herbs of Yanghe Tang and added white stiff silkworm, tangerine red, and whole loofah to resolve phlegm and dissipate nodules, plus Sanleng and Ezhu to attack hardness. This composition makes its hardness-attacking and nodule-dispersing force stronger than Yanghe Tang. Every herb in this formula has some anti-tumor effect, so the formula has some inhibitory effect on tumors presenting as yin ju.

But TCM surgery has a saying that Yanghe Tang is an excellent formula for yin ju, yet patients with yang patterns should "not let it touch their lips," because such warming herbs worsen yang-pattern symptoms. Yang-pattern masses usually present with redness, swelling, heat, and pain and are mostly benign masses caused by infection; if a surface mass shows redness, swelling, heat, or pain, do not lightly use Yanghe Tang. Huiyang Ruanjian Tang evolved from Yanghe Tang, and its contraindications are the same, so yang-pattern patients should use this formula cautiously.

Using this formula alone to treat cancer is somewhat insufficient in force; patients should combine it with other anti-tumor medicines, such as Compound Cantharides Capsules (Fufang Banmao Jiaonang), Xihuang Pills, or Pingxiao Capsules, or seek comprehensive diagnosis and treatment from an experienced TCM physician. Here, one qian is converted to the modern 3g; Professor Zhao's dosage is the adult daily dose. Decoct twice in water and take in 2–3 divided doses after meals. For chronic conditions that respond to this formula, it may also be made into pills in the same proportion, taken 2–3 times daily, 6–10g each time.