Method for Fumigating a Fistulous Sore

A sitz fumigation, and the simplest of the four method-leaves: four drugs in equal parts, cut up, burnt like incense in a tall bucket, and the patient sat over the smoke. The site is the reason for the form — the section says sinuses favour 項腋及陰僻肛門之間, the neck, the armpit, the groin and the anus, and the last of those can be reached by smoke from below when it cannot easily be dressed. Mugwort is there because burning mugwort is what this tradition burns; Chinese gall is strongly astringent and tannin-rich, sweetgum resin is a balsam, and chinaberry root bark is the chapter's usual antiparasitic. Carried as smoke, none of them arrives in any quantity. What the patient gets is warmth and the drying of a macerated perineum, which is not nothing for a weeping sinus between the buttocks. Chinaberry root bark is not harmless — it contains toosendanin and is hepatotoxic and neurotoxic when taken in quantity — though burnt in a bucket it is unlikely to reach a dose that matters. A perianal fistula is a tract between the anal canal and the skin, usually from an infected anal gland, and it is cured surgically; smoke cannot reach the internal opening, and a fistula in a young patient with bowel symptoms should raise the question of Crohn's disease. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.