Inner Support and Middle Harmonizing Decoction

This is Six Gentlemen — ginseng, atractylodes, poria, licorice, tangerine peel and pinellia — with astragalus, roasted dried ginger and costus root added. The base is chosen for the symptom list and not for the abscess: vomiting, diarrhoea and no appetite after a suppuration has drained is a failing middle, and the formula treats the middle. Astragalus is the one drug in it aimed at the sore, and 托裏 in the title is what the astragalus and ginseng together are claimed to do. It sits in the chapter's 排膿生肌 section, the one headed by the line 托裏之法不可一日缺也 — the method of supporting from within must not be left off for a single day. The reasoning there is explicit and it is good reasoning: flesh will not grow where the stomach has failed, dead tissue will not clear where flesh is not growing, and so the gut has to be made to work before the wound can close. Read against the draining formulas in the first half of the chapter, this is the other half of the same argument. That argument holds up. A patient who is catabolic after severe infection, not eating and losing weight, does not heal wounds, and nutritional support measurably changes wound outcomes. **Raw pinellia is toxic and must be properly processed before use.** A wound that is still not closing needs to be looked at for an undrained collection, dead tissue or a foreign body as well as fed. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.