Tou Nong San

What Tou Nong San is for

This is the formula for the abscess that has matured but will not open: a firm, painful, indurated swelling with pus inside that will not come to a head or discharge, on skin overlying a depleted person. It tonifies the Qi and Blood that give the body force to expel, and adds herbs that open the lesion so the pus can escape.

The lesion is a firm, painful swelling with pus inside that will not point or discharge. The skin over it is indurated, sometimes dusky, and it stays closed while the swelling persists, so there is no free drainage. The course is slow rather than the acute flare of a hot abscess, and the surrounding skin is pale because the person is depleted. This is the stuck, mature lesion rather than the early red sore that needs clearing.

Huang Qi tonifies Qi and provides the force to expel the pus, Dang Gui nourishes and moves the Blood so the tissue and the discharge are supported, and Chuan Xiong moves Qi and Blood to help the lesion open. Chuan Shan Jia penetrates and unblocks, reaching pus that will not surface, and Zao Jiao Ci promotes suppuration and discharge so the abscess can come to a head. Two tonics and three opening herbs: the body is given strength and the pus is given a route.

It is used at the mature stage in a depleted person, as a short course alongside medical care. It is not for early lesions without pus, nor for hot spreading infection in a robust patient, where clearing is needed instead. A large or febrile abscess needs medical drainage, and this formula supports that process rather than replacing it. Once the abscess has drained, a healing formula is used instead.

Actions

• Expels pus and promotes discharge
• Tonifies Qi and nourishes Blood
• Opens the lesion and relieves swelling
• Supports healing after drainage

Properties

• Taste and temperature: Predominantly sweet and pungent. Sweet tonifies Qi and Blood, pungent penetrates and opens.
• Organs: Spleen, Liver, Lungs
• Channels: Spleen, Liver

The pattern behind it

The pattern is an abscess that cannot discharge on a base of Qi and Blood deficiency. The deficiency means the body lacks the force to push the pus out, and the lesion stays indurated. The formula tonifies that force and opens the lesion, which is why it is used for the depleted patient rather than for a robust one.

Composition

The herbs in Tou Nong San, with their role and dose.

Patterns it treats

How the formula is built

Two tonics and three opening herbs. The tonics give the body the strength to expel, and the opening herbs give the pus a route, which is why the formula is used at the stage when an abscess has matured but not drained.

Skin conditions it is used for

Where this formula appears in the skin conditions of the library.

Preparation and use

Taken as a powder in warm water, or decocted, in two divided doses.

Modifications

• If the pus is deep and hard to reach, the penetrating herbs are increased.
• If the person is very depleted, the tonics are increased.
• If Heat is present, cooling herbs are added.
• Once the abscess has drained, a healing formula is used instead.

Timing

Taken in two divided doses.

Duration

Short course: three to seven days until the abscess drains, then reassessed.

Diet while taking it

Nourishing warm food to support the tonics; avoid greasy and cold food.

Safety

Interactions

Huang Qi may affect blood sugar and immune function, and the Blood-moving herbs may add to anticoagulants.

Pregnancy

Contraindicated in pregnancy because Chuan Shan Jia and Chuan Xiong move Blood and penetrate.

Breastfeeding

Use only under professional guidance.

Children

Used only with professional supervision.

Before you use it

Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription, and a large, spreading or febrile abscess needs urgent medical assessment and drainage.

General safety references

General references for herbal hepatotoxicity and herb-drug interactions; they are not specific to this formula.

• Review article: Herbal hepatotoxicity - an update on traditional Chinese medicine preparations. Alimentary Pharmacology & Therapeutics, 2014. PMID: 24844799.
• Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs, 2009. PMID: 19719333.
• Warfarin and food, herbal or dietary supplement interactions: a systematic review. British Journal of Clinical Pharmacology, 2021. PMID: 32478963.

Selected PubMed records

Real PubMed records for the modern, non-TCM discussion of this formula. They are references, not a claim that the formula is proven for any skin condition.

• Tou Nong San Attenuates Inflammation in TNBS-IBD Model by Inhibiting NF-κB Signaling Pathway.. Evidence-based complementary and alternative medicine : eCAM, 2018. PMID: 30046345.
• The effect of tou nong san on transplanted tumor growth in nude mice.. Evidence-based complementary and alternative medicine : eCAM, 2015. PMID: 25788964.

Origin and history

Wai Ke Zheng Zong (外科正宗, Orthodox Manual of External Medicine) by Chen Shigong, Ming dynasty, 1617.

The formula comes from Chen Shigong's surgical manual of 1617, where it treats the abscess that has matured but will not open in a depleted patient. Its principle, that tonifying the body helps it expel what should not remain, is a distinctive surgical idea in the tradition.

Classical record

Related formulas

Evidence note

No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.