External plasters, also known as tie gao (贴膏) therapy, are one of the suitable techniques in Traditional Chinese Medicine (TCM). The efficacy of external plaster therapy is indeed effective, convenient to use, has a wide range of medicinal sources, and is inexpensive. Some plaster medicines are easily available in hospital pharmacies and drug stores (such as Shang Shi Zhi Tong Gao (伤湿止痛膏), Yunnan Baiyao Tie Gao (云南白药贴膏), Shirun Shaoshang Gao (湿润烧伤膏), Ma Ying Long Zhi Chuang Gao (马应龙痔疮膏), etc.), and can effectively protect the health of a wide range of patients.
Classification of Plasters
External plasters can be classified into soft plasters and adhesive plasters.
1. Soft Plaster:
Also known as yao gao (药膏), it refers to a semi-solid external preparation made by mixing extracts or fine powders of medicinal materials with suitable bases. Common bases are classified into oily, water-soluble, and emulsion bases, which are easy to apply to the skin or mucous membranes, such as San Huang Gao (三黄膏), Chuan Xin Lian Ruan Gao (穿心莲软膏), etc.
2. Hard Plaster:
This type involves dissolving or mixing medicinal substances in a suitable base, spreading it on a backing material for application, and is a solid-like external dosage form that has local or systemic therapeutic effects. Depending on the composition of the base, it can be classified into lead plasters, rosin plasters, rubber hard plasters, Ba Bu Gao (巴布膏), and transdermal patches.
3. Paste Plaster:
This is made by grinding medicinal substances into powder and mixing them with various media, such as egg whites, vinegar, alcohol, fresh medicinal juice, or gel, to form a paste or plaster that is applied to specific areas or acupuncture points on the body. This type is easy to prepare and has significant effects, making it the most widely used in clinical practice.
Steps for Preparing Clinical External Plasters
1. Soaking: Place the selected TCM herbs into a pot and soak them in a suitable amount of plant or animal oil, such as sesame oil, rapeseed oil, or lard, for more than 24 hours. It is best to use a copper pot or clay pot for decocting; currently, enamel or stainless steel pots are mostly used, while iron and new aluminum pots are not recommended.
2. Decoction: Use low heat to decoct the soaked herbs in oil until the residue is charred, then strain out the residue and reserve the medicinal liquid.
3. Concentration: Place the strained medicinal liquid in a pot and simmer on low heat to concentrate. Stir evenly during decoction to prevent burning, and continue until a concentrated liquid is obtained. At this point, add Huang Dan (黄丹), or Qian Dan (铅丹), rosin, etc., and continue heating until a thick paste is formed.
4. Collecting the Paste: Keep the thick paste boiling and slowly add finely ground medicinal materials, such as Ren Shen (人参), Lu Rong (鹿茸), Ru Xiang (乳香), Mo Yao (没药), etc., while stirring evenly. Control the heat to prevent overflow or burning. The concentrated liquid will gradually thicken, and when the paste is sticky enough that it clings to chopsticks without dripping, or forms beads when water is dripped, it indicates that the paste is ready.
5. Packaging: Allow the prepared paste to cool completely, remove any fire toxins, and store it in containers such as enamel pots or ceramic bottles. These containers should be cleaned, dried, and sterilized beforehand to prevent mold and spoilage. When using, the medicinal paste can be directly applied to the affected area, bandaged, or heated and spread for external use, which can be placed on hard paper, animal skin, or gauze, and applied to the navel, acupuncture points, or affected areas.
Precautions
Understand the Indications:
Each type of plaster has its unique pharmacological effects and should not be used interchangeably. For example, for chronic low back pain caused by wind-cold or traumatic injuries, Gou Pi Gao (狗皮膏) or Zhui Feng Gao (追风膏) can be used to disperse cold, expel wind, relax tendons, invigorate blood, and relieve pain; for abscesses caused by heat toxin, with hard lumps that do not dissipate, redness, swelling, and pain, or pus that does not rupture or does not heal for a long time, Bao Du Gao (拔毒膏) can be used to draw out toxins, reduce swelling, and promote tissue regeneration; rubber plasters have anti-inflammatory and analgesic effects and are effective for postpartum pain, rheumatic pain, low back pain, muscle pain, sprains, and bruises; Jiu Xin Gao (救心膏) is made from blood-invigorating and dampness-dispelling herbs such as She Xiang (麝香), Bing Pian (冰片), Hong Hua (红花), Ru Xiang (乳香), Mo Yao (没药), etc., combined with nitroglycerin, and can be applied immediately when symptoms of angina pectoris occur, usually relieving symptoms within 5-6 minutes.
Correct Method:
Before applying the plaster, the affected area or acupuncture point should be cleaned and dried with a hot towel or ginger slices. The plaster should be applied to areas with minimal hair or after shaving to avoid pain when removing it.
In cold winter weather, rubber plasters may not adhere well; in this case, after applying the plaster, use a hot water bag to ensure it sticks firmly and enhances the therapeutic effect.
There are also specific methods for heating, such as warming black plasters over a low flame from an alcohol lamp or candle, or floating them in boiling water to soften them before applying them to the affected area when they are not too hot for the skin.
The affected area must be washed with warm water and dried; otherwise, the plaster will not adhere well. Such plasters can be applied continuously for 1-2 weeks.
Correct Placement: Some plasters must be applied to specific areas, such as Warm Navel Plaster (暖脐膏) for treating cold accumulation abdominal pain in children, which must be applied to the navel; for infants under one month, it should be applied to the lower abdomen below the navel; Shi Xiang Warm Navel Plaster (十香暖脐膏) for treating cold pain in the abdomen can be applied to the navel or the painful area; for Yang He Jie Ning Gao (阳和解凝膏), it should be applied to the Da Zhui (大椎穴) on the back of the neck.
Contraindications:
(1) Do not apply plasters to areas with redness, swelling, or ulceration to avoid purulent infections; use Bao Du Gao (拔毒膏) according to the condition.
(2) Do not apply Shang Shi Zhi Tong Gao (伤湿止痛膏) or Zhui Feng Gao (麝香追风膏) immediately to areas with muscle bruises or joint/ligament strains caused by exercise or labor, as these plasters have blood-invigorating and stasis-dispelling effects, which will not achieve the desired swelling reduction and pain relief.
(3) Pregnant women should avoid plasters containing She Xiang (麝香), Ru Xiang (乳香), Hong Hua (红花), Mo Yao (没药), Tao Ren (桃仁), etc., as they may stimulate the abdomen and lead to miscarriage.
(4) If local skin reactions such as rashes, blisters, or severe itching occur after applying the plaster, discontinue use immediately and seek anti-allergic treatment.
(5) Any contraindications for internal use of TCM should also be considered for plaster therapy, such as the Shiba Fan (十八反), Shijiu Wei (十九畏), and pregnancy medication contraindications.
(6) While plasters are effective and convenient, they should be selected or prepared under the guidance of experienced local doctors or pharmacists.
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