Four Tigers Powder

Four poisons, which is what the name counts: large arisaema, wild aconite, raw pinellia and raw Fischer euphorbia root, in equal parts, made into a vinegar-and-honey paste and spread over the swelling. 如牛領皮 — hard as the hide across an ox's neck — is the 疽 presentation of the 靈樞 line quoted earlier in this chapter, and 按之方痛, pain only on pressure, is the sign that the collection is deep. 留頭, leaving the head open, is the single most important instruction in the leaf and it is the 圍藥 principle: the paste rings the swelling and is deliberately not closed over the centre, so that the sore still has a way to discharge. The reasoning is sound and survives — an occlusive dressing over an undrained collection makes things worse — but the ring here is made of four of the most toxic drugs in the pharmacy, chosen for their numbing and dispersing action on a hard, painful mass. This is the chapter's 外用 counterpart to the wine it gives internally for the same yin abscess. **Contains wild aconite, raw arisaema, raw pinellia and Fischer euphorbia root, all severely toxic; aconitine and the euphorbia diterpenes are absorbed through broken skin. This must not be prepared or applied.** A deep, hard, tender swelling needs imaging and drainage, which is what the 留頭 instruction was reaching for. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.