San Fu Tie by Nicola Court - Published in the RCHM Journal Winter 2022 Vol19 no2
As practitioners we know that we need to treat conditions before they become symptomatic – like treating allergies before the allergy season arrives. We treat using the system of Dong Xia Bing Zhi - treat winter diseases in the summer – which for respiratory issues is vital.
Asthma is included in one of the conditions we need to treat ahead of it making an appearance. Many of us treat asthma with internal herbs and acupuncture, but external herb application is not well utilised in this country as far as I can tell. I was most excited then when I found out that there is a system for treating such conditions with external herbs, and it is called San Fu Tie. I came across this treatment modality when I attended a lecture on the application of external herbs with Suzanne Rubidoux .
After attending the workshop and learning all that San Fu Tie can offer, I was extremely keen to put into practice what I had learned. I decided to offer this in my clinic and have now held two 'San Fu Tie' drop-in clinics.
What Exactly is San Fu Tie?
San Fu Tie is the application of external medicinal plasters onto specific points on the back to address Lung Inflammation, to strengthen the immune system and to dry out lung wetness from COPD, chronic cold asthma, and chronic cough. This system of healing belongs to transdermal drug delivery.
Absorption occurs via the circulatory system from the local capillaries in the skin. (Margetts, 2010)
An advantage in treating this way is that it is very gentle for people with weak digestive systems (no need to take internal herbs – or for needle shy patients!). Although we are taught to avoid over heating patients in the summer, keeping moxa and similar treatments to a minimum, the San Fu Tie treatment is one of the exceptions. We use warming herbs to help treat the root cause of the disease.
San means three. Fu contains the idea of being hidden or concealed, as in lying in ambush or laying low (隐伏 yin fu). In this case, the three fu days means that yang qi is pressed into and hidden or stored in the earth below. (Wilcox, 2009)
When to Administer San Fu Tie Treatments
San Fu treatment is traditionally carried out on the ‘Dog days of summer’ – the three ten-day periods of the hottest season. This is most Yang time of the year and therefore the perfect time to strengthen the yang of the body and the Wei Qi, in readiness for winter. The hottest days do not however, necessarily coincide with the solstice.
The Fu days are worked out to being on the most auspicious days of the year: and relate to yang metal. Metal as we know is linked with the Lungs. (Wen, 2009)
The first Fu day is the 3rd male metal day after summer solstice
The 2nd Fu day is the 4th male metal day of summer solstice
And the 3rd is the first male metal day after start of autumn
San Fu Tie Clinic Offering
The first clinic I held was in December of 2021. I chose this date as it was near the winter solstice. This is also a good time to practice San Fu Tie – the lowest part of the year when the Yin energy is lowest and Wei Qi having to work flat out!
This year, I held all three of the Fu days. I did the following dates, but keep in mind, these days will change every year. Most clients attended all three days offered. Although, I have found that even a single session can have excellent effects.
July 16, 2022
July 26, 2022
August 15, 2022
I advertised the treatment to people with the following type of conditions: 'cold' type asthma (symptoms get worse in cold weather, shortness of breath accompanied by clicking, bubbling, or rattling sounds); people with cough with foamy phlegm, cold hands and feet; people who have had recurrent lung issues - bronchitis or pneumonia; or recurrent colds. The aim apart from strengthening the immune system is to expel dampness from the lungs and to warm and open the interior.
Treatment generally lasts around two to three hours. This time can vary, as there are different times suggested from various Practitioners. There is some literature that suggests the plasters can be left for up to six hours. Whilst you need to allow time for the herbs to transdermally absorb (Sawyer, 2007), keep in mind that the longer you leave the plasters, the more you increase the risk of blisters and burns.
This risk is due to the energetic nature of the herbs. Therefore, a patch test is advised prior to full treatment. The blisters are not necessarily a negative occurrence as it can show that the dampness and cold is being expelled. However, as with all treatments, patients need to be warned that this may happen. In the event a burn does occur, it is recommended that they seek medical advice if they are concerned.
Although you will come across Practitioners that are aiming for blisters and burns, and see this as good medicine, I personally don’t agree with that style. While most of my clients stayed for the better part of two to three hours, I did have one client whose patches were removed after one hour as his skin started to get very red. I felt that he was better off having the shorter session. It is good to keep in mind as well that children would need less time than adults. Due to these different aspects of the treatment and the warming nature of the herbs, I would never send people home with the herbs on or allow them to administer the treatment without being present.
The application process involves placing the herbal plasters on specific back shu points. The points used during my clinic treatments were BL13, BL15, BL20, and BL23. Once the plasters are secure on the back, the patient can then sit comfortably in a chair or on a treatment table and relax. I chose the chairs so that I could include a higher number of clients at one time. I kept my number of participants to a maximum of six per session. I did this so that I could monitor everyone safely throughout the treatment.
Herbal Plaster Preparation
The herbs used in a San Fu Tie treatment are warming and moving, expel cold damp and warm the upper to promote healing. In traditional treatments, xi xin (Asarum heterotropoides) is used. However, due to regulations and not being able to use xi xin, it is recommended to replace it with rou gui (Cinnamomum cassia). Different herbs can be used depending on the type of ailment being treated. The herbs I used are specific for the treatment of cold asthma. They can be used for general improvements to lung function - but the herbs chosen are for cold wet lung issues. There are other herbs that would address hot type asthma- including tao ren (Prunus persica), xing ren (Prunus Armeniaca) and hu jiao (Piperaceae) - these clients would have yellow phlegm, fever, asthma attacks worse in hot weather etc.
Herbal Plaster Ingredients:
Yan Hu Suo (Corydalis yanhusuo)
Xi Xin (Asarum heterotropoides)
Gan Sui (Euphorbia kansui)
Sheng Jiang (Zingiber officinale)
Preparing the Herbs:
To begin, grind up all of the raw herbs. You will need to grind the ginger until you can extract the juice. Then you mix a portion of the juice with the ground herbs to make a paste – this can then be rolled into balls and placed onto a plaster.
Each plaster contained 7g of the herbal paste. We kept these fairly sloppy in texture as they can dry out and will become rather crumbly.
Preparing the herbs for the San Fu Tie clinic. Photos courtesy of Nicola Court
Success of the Clinics
All the participants had a nice relaxing time, and many reported a change in their breathing in the days and weeks after. Many reported a reduction in their inhaler usage as well. With the problems many of our long covid patients are experiencing, San Fu treatments could be key to aiding recovery.
Margetts, L., Sawyer, R. (2007). Transdermal drug delivery: principles and opioid therapy. Continuing Education in Anaesthesia Critical Care & Pain [online], Vol. 7, Issue 5, pp. 171 – 176. Available at https://doi.org/10.1093/bjaceaccp/mkm033
Wen, C., Liu, Y., et al. (2015). A Systematic and Narrative Review of Acupuncture Point Application Therapies in the Treatment of Allergic Rhinitis and Asthma during Dog Days. Evidence Based Alternative Complementary Alternative Medicine. [online]. Available at DOI: 10.1155/2015/846851
Wlicox, L. (2009). San Fu Moxibustion and Lung-Related Disorders. The Journal of Chinese Medicine, [online]. Available from https://www.jcm.co.uk/san-fu-moxibustion-and-lungrelated-disorders.html