Poultice, specifically refers to the paste taken internally, and belongs to one of the eight dosage forms in Chinese medicine: pill, powder, paste, dan, wine, dew, soup and ingot. It is widely believed that winter is the best time to take poultices. However, according to the history of poultices, the characteristics of spring and summer seasons and diseases, and the characteristics of poultice formulations, it is practical to apply poultices in spring and summer seasons.
1.History of poultices
The history of poultice prescriptions was first recorded in the Yellow Emperor’s Classic of Internal Medicine and the Fifty-two Disease Formula, which were mainly applied externally. The first internal prescriptions were found in the “Great Wutou Decoction” and “Pig Paste Hair Decoction” in the “Jin Kui Yao”, which were mainly for treatment. The nourishing and nourishing poultices appeared in “Qianjin Fang” in the Sui and Tang dynasties, and the nourishing advantages of poultices were gradually recognized. The theory of the Jiangnan School of Kidney Life incorporates the concepts of the Yellow Emperor’s Classic of Internal Medicine, such as “nourishing yin in autumn and winter”, “the kidneys hide essence”, and “those who hide essence do not get warm in spring”, into the doctrine of life [1], and brings into play the concept of Winter tonic. In addition, medical practitioners have applied the internal dosage form of ointment, which is suitable for nourishment, to winter tonic, thus the rise of ointment formula. Since winter is characterized by the submergence of Yang energy, taking medicines that nourish the life of the kidney at this time will benefit the kidney’s function of hiding essence, strengthen the reserves of vital essence, and enhance the new round of hair growth in the coming spring (water produces wood).
However, it is biased to think of poultices as mere autumn and winter tonic. Take the famous poultice “Huanglian Poultice” as an example [2], it was developed from the external use for surgery in “Liu Juanzi’s Ghost Legacy Formula” in the North and South Dynasties to the oral dosage form in “The Living Method” in the Jin and Yuan Dynasties, and it has been widely used in dermatology, surgery, wound medicine, ophthalmology and internal medicine through the generations to modern application, with remarkable effects, not limited to the changes of the four seasons. The treatment-oriented poultices are centered around diseases and are not limited to seasons.
2. Characteristics of spring and summer season
The theory of “spring birth, summer growth, autumn harvest and winter storage” in the Yellow Emperor’s Classic of Internal Medicine is based on the law of the four seasons of human yang energy and the length of sunlight.
From the “autumn equinox”, the sunlight time starts to be shorter than the night, and the yang energy gradually closes and hides, and at the time of frostfall, the cold current starts to go south, the north wind blows more, and the position of the direct sunlight on the earth shifts south. Although the light is shortening, the ratio of yin and yang is still dominated by yang, so it is necessary to protect the yin energy. At the “winter solstice”, the light time is shortest and the yin energy reaches its peak.
From “spring” to “vernal equinox”, Yang Qi is not yet sufficient, and Yin Qi is still strong. This is reflected in the climate: the temperature is slow to rise, and the spring cold is still present, with the coldness of winter. In terms of treatment and health care, it is necessary to protect yang energy from being injured by yin and cold. On the day of the vernal equinox, yin and yang reach a balance, and yang energy grows to a level comparable to that of yin energy, after which yin energy gradually decreases and yang energy becomes more abundant. Since the vernal equinox equalizes the day and night, cold and heat, people should pay attention to maintaining the balance of yin and yang in the human body when taking care of their health. Another seasonal characteristic of spring reveals itself: more wind. “The spring equinox wind is not small, to prevent pain deep disturbance”.
From the “summer” to the “summer solstice”, Yang Qi is becoming more and more abundant, the sunlight time is extended, until after the “summer” into the “three volts “After the highest temperature and humidity of the year, the yin is forced by the yang qi and hide. By the time “autumn”, the humidity is gradually purged and the temperature is cooler.
Spring and summer yang is growing, due to its yin and yang changes for the impact of disease, health care is to nourish Yang.
3. Identification of physical constitution and characteristics of spring and summer diseases
3.1 Based on the classification of physical constitution, the Chinese people are divided into pinghe, special granularity, qi deficiency, qi stagnation, blood stasis, yin deficiency, yang deficiency, phlegm dampness and damp heat. However, Mr. Qin Bo Wei also believes that chronic deficiency diseases can be properly nourished for years. For the special granularity, blood stasis, phlegm dampness, and damp heat, it is more effective to take care of them at the turn of the seasons than to treat them continuously in autumn and winter. For the compound constitution, especially the deficiency-reality constitution, the effect of treatment in autumn and winter is not good, such as yin deficiency, yang hyperactivity, yin deficiency, wind movement, yin deficiency, phlegm-heat, yang deficiency, blood stasis, etc.
3.2 The etiology of spring diseases is mainly wind, including internal wind and external wind; the pathogenesis is centered on the liver. Common diseases in spring are wind-heat colds, pox rash, hepatitis, allergic diseases, hypertension, etc. The causes of summer diseases are mainly fire and dampness; the pathogenesis is centered on the heart and spleen; common diseases are summer-damp colds, pyrexia, epidemic type B encephalitis, cerebral hemorrhage, hyperthyroidism, insomnia, boils, etc. Treatment focuses on draining wind and clearing heat.
4.Characteristics of poultice formula
As Mr. Qin Bowei [4] said, “Paste formula is not a mere tonic, but contains the meaning of saving bias but disease”. When discussing the prevention and treatment of stroke, Wang S. and Zhao Y. [5] analyzed that the cream formula is characterized by a broad formula system, with the formulas changing, flexible combinations, and drug pairs as a unit; it allows cold and warmth in one furnace, incorporates the five organs with drugs in one, and the yin and yang are combined, and the herbs, wood, gold and stone animals are nourished together, and the prescription of drugs is based on static, and the combination of movement and static. The characteristics of spring and summer cream formula are based on the liver, spleen and heart, combining heat clearing and yin nourishment, wind draining and yang submergence, aromatic dampness and qi benefit, both through and tonic, up and down, in order to achieve the purpose of yin and yang, and harmonize yin and yang.
5, typical cases: the combination of physical conditioning and disease treatment, citing its treatment of sleep disorders cream two cases, in order to explore the application of spring and summer cream.
5.1 Case 1: Yue××, male, 48 years old, first diagnosed on April 13, 2011 (the 8th day after Qingming). Complains of sleep disorder for more than twenty years. The patient has been suffering from sleep disorder for 20 years, mainly difficulty in falling asleep, waking up early, snoring, still tired after waking up, easily dizziness, triggered by position change, feeling heavy and not relaxed, difficult to get out if there is phlegm in the throat, easily anxious, spontaneous sweating, lazy speech, skin scratches easily, appetite is OK, no abdominal distension, 1-2 lines of stool a day, urine is OK. He was previously diagnosed with “sleep breathing disorder syndrome” in 2008 at Peking University Hospital and was not continuously treated with a non-invasive ventilator. Hypertension was found for 5 years, with a maximum blood pressure of 170/100mmHg, and was treated with Betalac, Loxodren, and Yashida. Tongue: dark red tongue with thin yellow coating. Pulse: sunken string and slow. Physical self-measurement scale classification: Yin deficiency type, damp-heat type, blood stasis type. TCM diagnosis: hyperactivity of liver-yang, non-interaction between heart and kidney, and blood stasis. Ointment formula: Tianma 15g, Pueraria Mirifica 30g, Radix Angelicae Sinensis 15g, Rhizoma Lobatae (posteriorly) 15g, Rhizoma Dioscorea 20g, Rhizoma Chuanxian 15g, Fried Eucommia 15g, Rhizoma Huanglian 6g, Cinnamon 1g, Fried Jujube 20g, Zhi Mu 15g, Poria 15g, Yuan Zhi 12g, Radix et Rhizoma Longji (priorly) 30g, Salviae Miltiorrhizae 15g, Rhizoma Chuanxiong 15g, Rhizoma Dioscorea 12g, Panax Ginseng Powder (punch) 6g, Radix Fructus Panaxiae 9g, Sheng Di Huang 18g, Xuan Shen 15g, Xia Ku Cao 15g, Mai Dong 15g, Angelica Sinensis 15g. above a total of 28 doses, boiled and concentrated, mixed with honey 200g to close the paste, take four weeks, 30g each morning and evening. after one month, the patient complained of difficulty falling asleep significantly improved, other symptoms such as dizziness, fatigue, anxiety, spontaneous sweating improved, still have a sense of congestion in the throat. Keep the above continue to make cream for one month, all the symptoms are reduced.
According to: this patient deficiency mixed, phlegm and stasis mutual obstruction, liver and kidney deficiency, wind and fire incite. Treatment should take into account both the symptoms and the root cause. This formula is both clear and tonic, with Huang Lian, Sheng Di, Mai Dong, Xuan Shen to clear the heat of the heart and stomach, Tian Ma, Hooked Vine, Chuan Xiong, Di Long, Ge Ge Gen to evacuate the wind of the Turk’s Yin and Yang Ming, Han Xia, Xia Ku Cao to clear the phlegm and heat, nightshade vine, raw dragon tooth, fried jujube to calm the mind and help sleep, Du Zhong, Sheng Di to tonify the kidneys, Dan Shen, Chuan Xiong, Di Long, San Qi, Angelica Sinensis to invigorate the blood, Niu Kne, Du Zhong, Cinnamon, Sheng Di Huang to induce fire to return to the source. The patient’s complaints of sleep difficulty, snoring and high blood pressure were reduced by >70%.
5.2 Case 2: Ugly x x, female, 50 years old, first seen on March 23, 2011 (the third day after the spring equinox). Complains of sleep disorder for five years. The patient had recurrent sleep disorder after menopause five years ago, difficulty in falling asleep, early awakening, restless sleep, dreaminess, easy anxiety, easy fear, depressed mood, spontaneous sweating, easy sneezing and runny nose, fear of heat, lumbar acidity, self-consciousness of facial heat, dry mouth, forgetfulness, nocturnal urination 1-2 times, stool twice a day, thin texture. He has a history of lumbar fascial trauma, hyperlipidemia, thyroid nodules, and osteoporosis. Physical examination was low in female hormones and had uterine fibroids. Tongue: dark red tongue with thin yellow coating. Pulse: fine. TCM diagnosis: Yin deficiency and internal heat, liver and spleen disorder. Classification of physical self-measurement scale: Qi-deficiency type, Yin-deficiency type, Qi-depression type. Ointment formula: Zhi Mu 15g, Huang Bai 12g, Sheng Di 15g, Shan Yao 12g, Shan Yu Fructus 12g, Fructus Wheat 30g, Da Zao 10g, Sheng Gan Cao 10g, Fried Jujube 20g, Lian Zi Xin 9g, Sheng Long Dong 30g, Yu Jin 12g, Shi Calamus 10g, Huang Lian 6g, Quan Gua Zhu 15g, Fa Han Xia 9g, Fried Bai Zhu 15g, Fu Ling 15g, Xiang Shen 12g, Fried Gardenia 12g The above total 28 doses, boiled and concentrated, mixed with honey 200g to close the paste, take four weeks, 30g each morning and evening. the patient took the above sleep significantly improved, the interval of two months did not return to the clinic. On July 14 of that year, the second consultation, complaining of sleep significantly improved, sometimes disturbed, no obvious dry mouth and face heat, easy to runny sneeze, reduced spontaneous sweating, head sweat, 1-2 lines of stool a day, unshaped, 0-1 night urination. Tongue: dark red tongue with thin yellow coating. Pulse: Fine. Ointment: Zhi Mu 15g, Huang Bai 15g, Sheng Di 18g, Shan Yao 12g, Shan Yu Fructus 12g, Fructus Wheat 30g, Da Zao 10g, Glycyrrhiza Glabra 9g, Fried Gardenia 12g, Tempeh 10g, Lotus Heart 9g, Bamboo Leaves 12g, Lantern’s Heart 3g, Sheng Long Teeth (first) 30g, Shou Wu Vine 20g, Yuan Zhi 12g, Gui Zhi 9g, Bai Shao 15g, Cang Er Zi 9g, Xin Yi Hua After 28 doses, boiled and concentrated, mixed with 200g of honey to collect the paste, and taken for four weeks, 30g each in the morning and evening. 2 months after treatment, the patient returned by telephone, the main symptoms of sleep disorder were reduced by more than 70%, and secondary symptoms such as sweating, sneezing and fear were reduced by >90%.
Note: This patient has been postmenopausal for 5 years, her kidney yin is in great decline, her yin deficiency and fire is exuberant, her heart and mind are disturbed, and her heart and kidneys are not intertwined. The formula is based on Zhi Bai Di Huang Wan to nourish the liver, spleen and kidney, and to clear and lower the fire of the heart and liver. At the first consultation, she also treated the liver and Qi, cleared the heat and phlegm, and removed the disturbance and tranquilized the mind. At the second consultation, the heat and phlegm were reduced, but the residual heat in the heart and liver was not restrained, so the astringent and enlightening products were added to the basic formula, and lotus seed heart, bamboo leaf and lantern grass were used to make the residual heat go away from the stool, and Shou Wu Tang, Yuan Zhi, calamus and dragon tooth were used to tranquilize and calm the mind. Although the patient was suffering from qi deficiency, the patient’s tongue and pulse were considered to be mainly yin deficiency and phlegm-heat, and both consultations achieved better results without the use of qi-supplementing products, which was due to the consideration of the seasonal characteristics at that time. The first consultation was after the vernal equinox, when the patient was suffering from liver depression and phlegm-heat disturbance of the mind, because “Qi has a surplus is fire”, so he was given aromatic herbs and yujin to clear the liver, a small sunken chest formula to clear the hot phlegm, purple shellfish and raw dragon tooth to clear heat and calm the will, while white atractylodes, poria and barley to dispel dampness and the spleen will be restored. At the same time, Bai Zhu, Poria and Job dispel Dampness and the Spleen Qi returns. At the time of the second consultation, it was 7 days after “Xia Xia”, entering the stage of “San Fu”, Yang Qi was forced by Yin evil (Dampness) and was hidden, so Gui Zhi and Bai Shao were used to harmonize Ying and Wei, and Cang Er Zi and Xin Yi Hua were used to lightly clear the orifices so that the hidden Yang Qi could have access to the body.
6. Conclusion: In conclusion, as one of the herbal dosage forms, poultice has a tonic and a therapeutic effect. Because of its complex composition, it can take into account various aspects such as treatment of diseases, physical conditioning and changes of yin and yang in the four seasons, so it has its advantages in the treatment of chronic diseases and physical conditioning. In spring and summer, the use of poultices has practical application value, taking into account disease characteristics, physique classification and seasonal factors, and is worth further observation and research.