Method for Washing a Fistulous Sore

The wash that goes with the fumigation, and the plainest leaf in the section: a decoction of two drugs, or two others instead, used to steam and wash out a tract, followed by drying and a dusting of pomegranate root bark. Hornet's nest and angelica are the chapter's habitual pair; sophora root and areca husk are the substitutes, both bitter and both used against itch and worms. What makes this leaf worth reading is the two instructions around the drugs. 常須避風洗淨 — always wash it clean, and do it out of the draught — and the 得效 line attached at the end: 凡諸瘡切忌生水洗, no sore of any kind may ever be washed with raw water. That is the one piece of genuine wound hygiene in the chapter. Unboiled water carries Pseudomonas, Aeromonas and environmental mycobacteria, and irrigating an open tract with it is how a clean sinus becomes an infected one. The prohibition is correct and was arrived at by observation. Pomegranate root bark contains pelletierine alkaloids and was a real anthelmintic by mouth, which is why it is here for 淫虫, the worms thought to breed in a tract; dusted into a fistula it does nothing, and the alkaloids are toxic enough that it was abandoned as a vermifuge. Irrigation itself, with sterile saline, remains part of managing a chronic sinus — the rest of the treatment is finding and removing what is feeding it. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.