Program: Dermatological Clinic
Research Method: HanScope Multi-Literature Cross-Research

Key Summary

The debate surrounding wart (疣子) treatment in Traditional East Asian Medicine (TEAM) was not merely a difference in techniques but a fundamental clash of paradigms regarding the human body. The internal treatment-centric school, represented by Xue Lizhai (薛立齋) and Xiao Jing (肖京) of the Ming Dynasty, condemned physical external treatments such as corrosion, excision, and moxibustion as "reckless actions that deplete essence and blood, damage the Liver-tendons, and lead to pathological failure." They advocated for long-term administration of internal remedies like Liuwei Dihuang Wan (六味地黃丸) and Qinggan Yiying Tang (清肝益榮湯) to address the internal pathogenic mechanisms of Liver-Fire and Blood-Dryness (肝火血燥) and Kidney-Water Deficiency (腎水不足). In contrast, the surgical tradition of texts like Waike Xinfa Yaojue (外科心法要訣) and Waike Fangwai Qifang (外科方外奇方) actively championed external treatment methods that directly removed lesions through potent chemical corrosion and expulsion of toxins using Baigangdan (白降丹) and Hongseungdan (紅升丹), prepared with mercury, alum, and niter. At the core of this conflict was the judgment of whether the patient's Original Qi (元氣) and Essence and Blood (精血) were sufficiently robust to withstand surgical attack and reduction (攻伐). This served as a clear selection criterion even in texts by the same author from the same era.

Context of the Question

Warts are chronic, recurrent conditions that are difficult to cure even in modern medicine. The traditional East Asian medical term "Cheonilchang" (千日瘡, "thousand-day sore") originated from observations of their natural resolution process. However, regarding how this disease should be "treated," a stark methodological division existed even within the intricate field of Traditional East Asian Medicine. This was not merely a matter of preferred medical techniques but a fundamental question concerning the core philosophical concept of "Biao-Ben" (標本) in TEAM: which should take precedence—the externally manifested symptoms (Biao) or the internal pathogenic mechanism (Ben) that underlies them?

Historically, the Ming Dynasty was both a golden age for Traditional East Asian Medicine surgery and a period when internal medicine schools focused on nourishing Earth (補土) and Yin (補陰) flourished. Xue Lizhai, a leading figure of the warm tonification (溫補) school, based his approach on the Neijing's (內經) principle, "If Zheng Qi (Upright Qi) is stored internally, pathogenic factors cannot interfere" (正氣存內, 邪不可干). He asserted that surgical conditions must also be traced to the excess or deficiency of the Zang-fu organs. Conversely, surgical traditions extending from the Song and Yuan dynasties, particularly schools inheriting Hua Tuo's (華佗) surgical techniques, believed that courage to directly excise lesions was necessary to become a "Divine Physician" (神醫) like Bian Que (扁鵲). Within this tension, warts, a relatively benign yet externally sensitive condition, serve as an excellent lens through which to view the clash of these two paradigms.

What a clinician can gain from this research is not simply "which method is more effective." It provides specific criteria for choosing and combining surgical and internal methods based on the patient's age, constitution, location and size of the lesion, and history of recurrence. Furthermore, it illuminates the mechanisms of pathological failure (敗證) that occur when an incorrect choice is made, along with strategies for recovery. Especially in the contemporary context where the use of external medications is diminished in Traditional East Asian Medicine, understanding the principles and limitations of potent chemical corrosive agents from traditional surgery serves as a crucial historical asset for developing new treatment strategies.

What the Original Texts Say

1. Disease Name and Etiology: Warts are an expression of Liver-Fire and Blood-Dryness, and Kidney-Water Deficiency

Understanding the Traditional East Asian medical names and causes of warts is the starting point for selecting treatment methods. Waike Xinfa Yaojue defines warts as follows:

疣音休, 俗乎雞眼子是也... 又名千日瘡, 又名晦氣瘡.

(Warts (疣) are pronounced 'you,' commonly known as jianzi (雞眼子, "chicken's eye")... Also called qianrichuang (千日瘡, "thousand-day sore"), and huichiqian (晦氣瘡, "ill-omened sore").)

— Waike Xinfa Yaojue (外科心法要訣)

The name "Cheonilchang" (Qianrichuang) reflects the observation that warts tend to resolve naturally after a course of approximately three years. However, medical interest lay not in "waiting" for this natural resolution, but in understanding why they occur and how to "early" treat them.

Etiologically, the most important interpretation comes from Xue Lizhai, who describes "Liver-Fire and Blood-Dryness" (肝火血燥) and "Kidney-Water Deficiency" (腎水不足):

此證由肝膽風熱, 血燥, 或怒動肝火, 或肝客淫氣所致.

(This condition is caused by Wind-Heat in the Liver and Gallbladder, Blood-Dryness, or Liver-Fire stirred by anger, or invasion of pathogenic Qi into the Liver.)

— Waike Xinfa Yaojue (外科心法要訣)

The core of this passage is that warts are not merely localized skin lesions (局所病變) but superficial manifestations of a systemic pathology involving Liver-Fire (火氣), dryness of blood, and deficiency of Kidney-Water (水液). Therefore, simply removing the external wart will not resolve the fundamental pathogenic mechanism, leading inevitably to recurrence, with the added warning that surgical irritation might even aggravate Liver-Fire.

2. Scholarly Debate on External Treatment Methods: Contraindication vs. Utilization

Xue Lizhai strongly contraindicates specific external treatments for warts:

若用艾灸, 螳螂蝕, 芫花綫, 著艾灸, 腐蝕等法, 誤用致變.

(If one uses moxibustion, mantis erosion, Yuanhua thread ligation, mugwort moxibustion, or corrosive medicines, misuse will lead to pathological changes.)

— Waike Xinfa Yaojue (外科心法要訣)

The external treatment methods mentioned here have all been traditionally used for wart treatment. "Binding with spider web," "using mantis (螳螂)," "Yuanhua thread (芫花綫)," "mugwort moxibustion," and "corrosive medicines" are widely known techniques ranging from folk remedies to specialized surgery. Xue Lizhai's classification of all these as "misuse" (誤用) demonstrates how internal treatment-centric his therapeutic philosophy was.

Conversely, Shin Du-won's (申斗垣) Gyehyon (啟玄) affirms moxibustion:

初起者, 用蘄艾灸之, 餘者皆落.

(For those that have just appeared, use Qiai (蘄艾) moxibustion, and the rest will all fall off.)

— Quoted in Waike Xinfa Yaojue (外科心法要訣)

The essence of this debate is not the efficacy of moxibustion itself, but the difference in interpreting its effects on the patient's constitution and pathogenic mechanism. Xue Lizhai believed that the heat of moxibustion would further burn the Yin-Blood of a patient already suffering from Liver-Fire and Blood-Dryness, damaging essence and blood. Shin Du-won, on the other hand, believed that moxibustion's warming and unblocking action harmonized the Qi and Blood in the meridians, thereby dispersing the energy of the warts.

3. Chemical Principles of Corrosive Agents: Baigangdan and Hongseungdan

At the core of the surgical tradition was the preparation and use of elixir (丹藥) based on mercury. Waike Fangwai Qifang and Waike Xinfa Yaojue record detailed methods for preparing Baigangdan (白降丹) and Hongseungdan (紅升丹).

Preparation and Action of Baigangdan (White Precipitate Elixir):

水銀一兩, 火硝四兩, 白礬二兩, 皂礬六錢, 雄黃朱砂各五錢... 取陽城罐一個... 放炭火上, 先文後武, 降三炷香火, 則藥降矣.

(Mercury 1 liang, niter 4 liang, alum 2 liang, soapstone/talc 6 qian, orpiment and cinnabar 5 qian each... Take a Yangcheng pot... Place it on charcoal fire, first with a gentle heat then a strong heat, allow it to descend for the time it takes three incense sticks to burn, then the medicine will have precipitated.)

— Waike Fangwai Qifang (外科方外奇方)

The "descending method" (降法) is a pharmaceutical technique where drugs are heated and condensed below. Baigangdan possesses a powerful corrosive action. Waike Xinfa Yaojue describes its efficacy as follows:

點痣亦落.

(Even moles (痣) will fall off when treated.)

— Waike Xinfa Yaojue (外科心法要訣)

"Moles" (痣) are skin growths similar to warts. This implies that Baigangdan's potent chemical corrosive action destroys tissue, causing it to slough off. However, the repeated warnings from Xue Lizhai in the same text suggest that this powerful medicine, if misused, could lead to "pathological failure where the wound opens up and inverts."

Complementary Role of Hongseungdan (Red Precipitate Elixir):

一切瘡瘍潰後, 拔毒去腐, 生新長肉, 瘡口堅硬, 肉暗紫黑, 用丹少許, 雞翎掃上, 立刻紅活. 外科若無升降二丹, 焉能立刻奏效.

(After all sores and ulcers have ruptured, to expel toxins and remove putrefaction, generate new flesh and promote growth—if the wound is hard and the flesh dark purple-black—apply a small amount of the elixir with a chicken feather, and it will immediately become red and vibrant. If surgery lacks the two elixirs of ascending and descending (升降二丹), how can it achieve immediate results?)

— Waike Xinfa Yaojue (外科心法要訣)

Hongseungdan is prepared using the "ascending method" (升法), producing a sublimate. It aids tissue regeneration after Baigangdan's corrosion. The combined use of these "two elixirs of ascending and descending" (升降二丹) illustrates the core paradigm of the surgical tradition: powerfully removing the lesion (descending/降) and then regenerating the tissue (ascending/升).

Elixir Name	Preparation Method	Main Ingredients	Primary Action	Wart Application
Baigangdan (白降丹)	Descending method (降法)	Mercury, niter, alum, soapstone/talc, orpiment, cinnabar	Potent corrosion (腐蝕), expulsion of toxins (拔毒)	Direct application to remove warts/moles
Hongseungdan (紅升丹)	Ascending method (升法)	Mercury, alum, niter, cinnabar, orpiment	Expel toxins and remove putrefaction (拔毒去腐), generate new flesh and promote growth (生肌長肉)	Wound healing after corrosion
Xiaoshengdan (小升丹/三仙丹)	Ascending method (升法)	Mercury, alum, niter	Mild expulsion of toxins, tissue regeneration	Healing mild wounds

4. Specific Prescriptions for Internal Treatment and the Effects of Long-Term Administration

Xue Lizhai's internal treatment-centric approach is supported by specific prescriptions and clinical cases. The most crucial prescription is Liuwei Dihuang Wan (六味地黃丸):

一人項下結一核, 用散堅行氣等藥, 不應. 彼謂無藥可消, 彼亦畏而不治. 予診之, 肝脈弦數, 以加味逍遙散加黃連, 治之而愈. 後又生一子, 因怒頓腫, 先以小柴胡湯加青皮, 山梔, 當歸, 治之, 腫少退, 乃以加味歸脾湯, 間服加味逍遙散, 加減八味丸, 服之而消.

(A person had a nodule below their neck. Medicines for dispersing stagnation and promoting Qi circulation were used but without effect. He claimed there was no medicine that could resolve it and was afraid to treat it. I diagnosed a wiry and rapid pulse in the Liver position and treated it with Jiawei Xiaoyao San (Modified Rambling Powder) plus Coptis chinensis, and it healed. Later, another one appeared, which suddenly swelled due to anger. I first treated it with Xiao Chaihu Tang (Minor Bupleurum Decoction) plus tangerine peel, gardenia fruit, and Angelica sinensis; the swelling subsided slightly. Then, I alternated between Jiawei Guipi Tang (Modified Restore the Spleen Decoction), Jiawei Xiaoyao San, and Jiajian Bami Wan (Modified Eight-Ingredient Pill), and it resolved.)

— Lizhai Waike Fahui (立齋外科發揮)

Notable in this case is that aggressive agents (攻劑) for "dispersing stagnation and promoting Qi circulation" were ineffective. Instead, long-term administration of Xiaoyao San to harmonize Liver Qi, Guipi Tang to tonify the Spleen and Stomach, and Bami Wan to tonify Kidney Yin, prevented recurrence. The following case, in particular, is the clearest record regarding the prevention of wart recurrence:

一人素膏粱醇酒, 先便血, 便結, 驚恐失寢, 患疣如大豆許, 間生如聚, 延頸上, 發熱, 形瘦, 食少, 口乾, 日晡益甚, 脈益數, 左尺洪數, 右關弦數. 余曰: 腎水不能生肝木, 火旺而益燥, 故發熱口乾, 肝木剋脾土, 故食少形瘦也. 與加味歸脾湯, 加減八味丸, 間服, 年餘, 諸疣亦復生, 仍用前藥, 加黃栢, 知母, 地黃, 當歸, 煎膏常服, 年餘, 諸疣亦不生矣.

(A person habitually consumed rich foods and strong alcohol. Initially, there was blood in the stool and constipation. Due to fright and anxiety, they suffered from insomnia. Warts, the size of soybeans, appeared intermittently like clusters, spreading up the neck. They had fever, emaciation, poor appetite, dry mouth, worsening in the late afternoon. The pulse was increasingly rapid, the left cubit position was surging and rapid, and the right Guan position was wiry and rapid. I said: "Kidney-Water cannot generate Liver-Wood, so Fire flourishes and causes further dryness, hence the fever and dry mouth. Liver-Wood restrains Spleen-Earth, hence the poor appetite and emaciation." I prescribed Jiawei Guipi Tang and Jiajian Bami Wan to be taken alternately. After more than a year, the warts reappeared. I still used the previous medicines, adding Phellodendron amurense, Anemarrhena asphodeloides, Rehmannia glutinosa, and Angelica sinensis, decocted into a paste for regular consumption. After more than another year, the warts did not reappear.)

— Lizhai Waike Fahui (立齋外科發揮)

This case illustrates the core principle of internal treatment: initially, symptoms improved, but because the fundamental cure was not complete, recurrence occurred. Long-term (over two years) continuous medication, combined with lifestyle improvements (moderation of rich foods and alcohol), ultimately prevented recurrence. It clearly establishes that restoring the principle of "Kidney-Water generating Liver-Wood" (腎水生肝木) is the fundamental mechanism for wart resolution.

5. Specific Criteria for Choosing External vs. Internal Treatment: Original Qi and the Excess/Deficiency of the Disease Location

Xiao Jing's Xuanqi Jiuzhen Lun (軒岐救正論) clearly presents criteria for selecting external or internal treatment for surgical conditions:

若其人年力壯盛, 脾胃素強, 飲食如常, 六脈洪實, 此雖有外證, 猶可暫用苦寒攻伐之劑.

(If a person is in the prime of life, with strong Spleen and Stomach constitution, normal appetite, and all six pulses are surging and full, then even though there is an external manifestation, bitter-cold attacking/purging agents can be temporarily used.)

— Xuanqi Jiuzhen Lun (軒岐救正論)

However, he emphasizes that if these conditions are not met—i.e., "Liver and Kidney are deficient due to excessive sexual activity, and Middle Qi is injured by overwork"—then "warm and gentle internal tonifying agents must be used." This implies that when deciding on surgical corrosion or excision for warts, the patient's overall systemic condition must first be assessed.

Xiao Jing also asserts the nature of surgical conditions as follows:

皮毛肌肉, 皆五臟六腑十二經脈所聯屬灌輸, 而瘡瘍之發, 由內應於外.

(The skin, hair, and muscles are all connected and nourished by the Five Zang-organs, Six Fu-organs, and Twelve Meridians; thus, the eruption of sores and ulcers corresponds from the inside to the outside.)

— Xuanqi Jiuzhen Lun (軒岐救正論)

This "internal and external unity" (內外合一) perspective interprets warts not merely as a skin problem but as a manifestation of Zang-fu organ pathology on the surface. Therefore, surgical removal alone does not cure the "root" (本), and internal medical intervention must always be combined.

Cross-Reading

Citation Chain: Original Text → Commentary → Reinterpretation

Understanding original texts on wart treatment involves multiple layers of interpretation. The originating record in the Neijing, "Warts are produced when the collateral of the Hand Taiyang, Zizheng point, is deficient" (手太陽之別絡支正穴虛者生疣), goes beyond a simple symptomatic description, presenting a pathological model where meridian deficiency manifests as a skin lesion. This original text was interpreted in various ways by later physicians.

Xue Lizhai reinterpreted this meridian deficiency syndrome as "Liver-Fire and Blood-Dryness" and "Kidney-Water Deficiency," developing internal treatment methods that went beyond simple meridian replenishment to restore the Yin-Yang harmony of the Zang-fu organs. Conversely, the surgical tradition developed external treatments such as moxibustion, acupuncture, and corrosive agents to directly alleviate Qi stagnation (氣鬱) caused by meridian deficiency.

This division in interpretation can be understood within the specific context of Ming Dynasty medicine. This was a period when Taoist alchemy (煉丹術) deeply permeated medicine, leading to the widespread use of inorganic mineral drugs such as mercury, lead, and arsenic. The surgical elixir tradition was influenced by this alchemy, pursuing "immediate effects" based on potent chemical efficacy. In contrast, orthodox Confucian medicine was wary of such "fierce" drug use, favoring a warm tonifying (溫補) approach that respected the body's natural healing abilities.

Pattern Analysis of Scholarly Debate

Category	Internal Treatment-Centric School (Xue Lizhai · Xiao Jing)	External Treatment-Centric School (Surgical Tradition)
Core Pathogenic Mechanism	Liver-Fire and Blood-Dryness, Kidney-Water Deficiency	Wind-Heat stagnation, Toxic Qi stagnation
Treatment Principle	Treat the Root (治本), nourish and transform the source (滋養化源)	Treat the Manifestation (治標), attack toxins and remove putrefaction (攻毒去腐)
Attitude Towards External Treatment	Strongly contraindicated (risk of pathological failure)	Actively utilized (Baigangdan and Hongseungdan)
Key Prescriptions	Liuwei Dihuang Wan, Qinggan Yiying Tang, Jiawei Xiaoyao San	Baigangdan, Hongseungdan, moxibustion, acupuncture
Prognostic View	Emphasizes recurrence prevention, long-term treatment	Emphasizes immediate removal, subsequent management
Patient Selection	Yin-Blood Deficiency syndrome, frailty, chronic recurrence	Robust Original Qi, acute, sporadic

This table suggests not just a simple opposition, but also possibilities for mutual complementarity. For instance, for a young patient with robust Original Qi and a sporadic wart, immediate removal with Baigangdan followed by Liuwei Dihuang Wan to prevent recurrence combines the strengths of both schools. However, the original texts tend to emphasize their respective methods rather than explicit combination therapies.

Shared Warning of Pathological Failure (敗證)

Interestingly, a commonality between the two schools is their warning about the risk of "pathological failure" (敗證). Xue Lizhai believed that the misuse of external treatments could damage essence and blood, leading to pathological failure. The surgical tradition also acknowledged that potent corrosive agents like Baigangdan could cause "extremely severe pain," requiring mitigation with Pinellia ternata or borneol, and if misused, could damage normal tissues. This shows that wart treatment was not merely a technique but a high-risk medical act requiring precise calculation of drug toxicity and patient tolerance.

Unknown Aspects

Gaps in the Historical Axis

The currently collected data primarily focuses on the Ming Dynasty (1368-1644) and early Qing Dynasty (1644-1912). While there are mentions of warts in Xiao'er Yaofa Zhi Jue (小兒藥證直訣) from the Song Dynasty (960-1279) and Waike Zhengyi (外科正義) from the Yuan Dynasty (1271-1368), these are generally limited to etiological overviews rather than specific treatment methods. Especially, the origins of wart treatment connected to the surgical techniques of Hua Tuo, preceding the Tang Dynasty (618-907), are difficult to confirm from current data.

Bias in the Scholarly Axis

The collected data is predominantly biased towards the medical traditions of the Jiangnan region, particularly the Wujiang school centered around Xue Lizhai and Xiao Jing's tradition. Northern medicine, especially the wart treatment theories of Li Dongyuan's (李東垣) Spleen-Tonifying school from the Jin-Yuan dynasties (1115-1234), or the approach of the Warm Disease school, are relatively lacking. Furthermore, wart treatment methods from folk medicine (走方醫), especially the use of drugs like Brucea javanica (鴉膽子), are rarely covered in orthodox surgical texts.

Connection to Modern Clinical Practice

Data on how the internal treatment methods (Liuwei Dihuang Wan, Xiaoyao San, etc.) from the original texts are applied in modern Traditional East Asian Medicine clinical practice for warts, and on modern reinterpretations of external elixirs (e.g., chemical component analysis, toxicity evaluation), has not been collected. Especially in the modern era where the link to HPV infection has been elucidated, discussion is needed on how the Traditional East Asian medical concept of "Du" (毒, toxicity/pathogenic factor) can correspond to viral infections.

Additional Research Questions

When, where, and in what context was the application of Brucea javanica (鴉膽子) for wart treatment introduced into Traditional East Asian Medicine?
How were wart treatments adopted and modified in Joseon Dynasty Korean Medicine? What relevant records exist in Donguibogam or Uibangyuchwi?
What are the specific chemical components of the "two elixirs of ascending and descending" and their modern toxicological evaluation?
What are the practical clinical applicability and patient compliance of long-term treatments like "two years of administration" for internal methods?

Original Text Citation Cards

Source 1

Source: Waike Xinfa Yaojue (外科心法要訣)
Author/Era: Compiled by Wu Qian (吳謙) et al., Qing Dynasty (compiled in Yizong Jinjian in 1742)
Reliability: high
Key point: Defines the pathogenic mechanism of warts as Liver-Fire and Blood-Dryness (肝火血燥) and Kidney-Water Deficiency (腎水不足), contrasts Xue Lizhai's internal treatment methods with Shin Du-won's moxibustion, and details the surgical application of the two elixirs of ascending and descending (升降二丹).

Source 2

Source: Lizhai Waike Fahui (立齋外科發揮) / Waike Shuyao (外科樞要)
Author/Era: Xue Ji (薛己, Xue Lizhai), Ming Dynasty (1487-1559)
Reliability: high
Key point: Strongly contraindicates external treatment methods for warts and advocates for the prevention of recurrence through long-term administration of Liuwei Dihuang Wan, Qinggan Yiying Tang, and Jiawei Xiaoyao San.

Source 3

Source: Waike Fangwai Qifang (外科方外奇方)
Author/Era: Wu Shichang (吳世昌), Qing Dynasty (19th century)
Reliability: medium
Key point: Records detailed preparation methods and clinical applications of mercury-based elixirs (Baigangdan, Hongseungdan, Xiaoshengdan). Practically organizes the chemical principles of the ascending and descending methods (升降法).

Source 4

Source: Xuanqi Jiuzhen Lun (軒岐救正論)
Author/Era: Xiao Jing (肖京), Ming Dynasty (early 17th century)
Reliability: high
Key point: Emphasizes the "internal and external unity" (內外合一) principle for surgical conditions and provides criteria for selecting between surgical and internal methods based on the patient's Original Qi (元氣) and the strength of the Spleen and Stomach.

Source 5

Source: Xiao'er Yaofa Zhi Jue (小兒藥證直訣) / Ying'er Lun (嬰兒論)
Author/Era: Qian Yi (錢乙) / Author unknown, Song Dynasty
Reliability: medium
Key point: Indirect records of eye warts (眼疣) and skin tags/exophytic lesions (贅瘡) in children. Presents dietary guidelines and external treatment methods related to Spleen stagnation (脾鬱).

Related Document: Summary of Traditional East Asian Medical Treatment for Warts/Papillomas: Moxibustion and Corrosive Agents vs. Remaining Fundamental Treatment
Research Information: HanScope Traditional East Asian Medicine Research System | 5 sub-questions | 11 NotebookLM queries | 2026-03-20

This document is an academic research material based on literary evidence from Traditional East Asian medical classics. For clinical application, please consult a qualified Traditional East Asian medical practitioner.

A Study of Classical Traditional Korean Medicine Texts on Wart Treatment: The Textual Debate Between the Surgical and Internal Medicine Schools

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