Tian Jiu Herbal Plaster Therapy

Tian Jiu is a traditional external treatment in Chinese medicine, also known as herbal blistering therapy. It includes summer San Fu Tian Jiu and winter San Jiu Tian Jiu. Herbal preparations are applied to acupuncture points on the skin. The stimulation may cause local redness, congestion, or even blistering and is traditionally intended to activate the meridians and regulate Qi and Blood.

This therapy is very popular in southern China. During the hottest periods of summer and the coldest periods of winter, many thousands of people attend hospitals and clinics for treatment.

More than ten years ago, I also benefited from this therapy when treating my own chronic rhinitis. After a childhood cold, my runny nose never fully resolved. I took many antibiotics and rhinitis medicines, with symptoms repeatedly improving and returning. My office drawer was always full of medicines until Tian Jiu treatment finally allowed me to put the bottles away.

Afterwards I became very interested in the method. I participated in Tian Jiu treatment days at the hospital, sometimes treating nearly one hundred patients in one day, and I studied a substantial amount of related literature.

Traditionally, Tian Jiu is used for the following conditions:

1. Chronic or allergic rhinitis, including reactions to pollen and dust
2. Chronic or allergic asthma
3. Rheumatic arthritis
4. Menstrual pain, cold-type stomach pain or diarrhoea, and kidney-related lower-back pain
5. Frequent colds and constitutional weakness
6. Cold hands and feet, sensitivity to cold, and a Yang-deficient constitution

1. Traditional treatment principle

In TCM, many of the conditions above are associated with insufficient Yang Qi. Tian Jiu is traditionally understood as stimulating the body’s defence system, increasing Yang Qi, and thereby strengthening resistance and self-healing capacity.

The San Fu period is the hottest part of the year, when Yang Qi is considered especially abundant. The pores are more open and the circulation of Qi and Blood through the meridians is thought to favour penetration and absorption of the herbal preparation.

The herbs used are strongly irritating and can cause the skin to blister. They may dilate local blood vessels, promote circulation, improve nourishment of surrounding tissues, support constitutional vitality, and strengthen resistance. The traditional aim is to prevent recurrence of winter illnesses or reduce their severity. This is known as “treating winter illness in summer.”

In traditional theory, allergy reflects not only an external trigger but also the body’s ability to respond and adapt. People with Qi deficiency or Yang deficiency are considered more susceptible to allergic rhinitis.

2. Treatment periods

Treatment is traditionally carried out around the hottest San Fu days and the coldest San Jiu days near the winter solstice. Exact dates vary each year.

For example, the 2015 summer dates were 13 July, 23 July, and 12 August. The winter dates were 22 December, 31 December, and 9 January 2016.

In summer the treatment is generally repeated every ten days, three to five times. In winter it is repeated every nine days, also three to five times. Traditionally this cycle may be continued for three to five years, with gradual improvement expected from year to year. If the exact date is missed, treatment may also be applied a few days before or afterwards.

In my opinion, treatment can be carried out on sufficiently warm summer days rather than being restricted to one exact date. Clinically, the period from the summer solstice to the end of summer provides enough time for patients to complete treatment.

3. How it is applied

The Chinese herbs are first ground into powder and mixed. Common ingredients include white mustard seed, kansui root, asarum, and corydalis. Formulas differ between hospitals and clinics and are usually not disclosed, although the main ingredients are similar.

On the day of treatment, the powder is mixed with ginger juice into small portions and fixed to selected acupuncture points with adhesive tape. Applications are repeated every nine to ten days. Adults usually keep the plaster on for two to three hours; children for approximately 30 to 60 minutes. The aim is visible redness. During a first treatment, the skin should be checked regularly. Marked redness, blistering, severe itching, or strong stinging means the treatment should be stopped early. It is preferable not to bathe on the same day.

4. Course of treatment

Tian Jiu is not a one-time treatment. A traditional course consists of three applications. One or two additional applications may be added to strengthen and consolidate the effect. Traditionally, treatment is continued for three consecutive years; interruptions may reduce the expected benefit.

5. Precautions

• On the treatment day, avoid raw, cold, chilled, and spicy foods and avoid very cold rooms. For three or four days afterwards, eat lightly and reduce high-fat foods.
• Women with heavy menstrual bleeding should not receive Tian Jiu during that time. It may be considered when bleeding is light or near the end of menstruation.
• Do not use during an acute flare or infectious illness such as acute pharyngitis or a cold, or when body temperature exceeds 38°C.
• Because infant skin is delicate and easily burned, Tian Jiu is not recommended for children under two years of age.
• Do not use in people who form severe scars or keloids.
• Contraindications include pregnancy, malignant tumours, active pulmonary tuberculosis, bronchiectasis, and severe allergic constitution.

6. Acupuncture points

Main points are commonly selected from the Bladder channel, Ren Mai, and Du Mai. Examples include Shanzhong, Dazhui, Feishu, Jueyinshu, Fengmen, Gaohuangshu, Shenshu, and Pishu.

Additional points vary according to the condition. Tiantu may be added for asthma; Zusanli for stomach pain; Guanyuan or the point below the seventeenth vertebra for menstrual pain; Jianyu for shoulder arthritis; inner and outer Xiyan for knee arthritis; and Bailao or related points for cervical problems.

7. Skin reactions

Local redness, warmth, mild stinging, or small blisters may occur. Large blisters are uncommon. Pigmentation may remain for a period and gradually fade; in some people it may last six months to one year.

Small blisters generally require no special treatment and may be allowed to absorb naturally. Burn ointment may be applied to reduce discomfort. Large blisters should be assessed and treated hygienically to reduce the risk of infection.

Keep the area dry. Do not rub or scratch it, and avoid bath products or other anti-itch preparations that might further irritate the skin.

The original traditional view held that blistering indicated a stronger effect. In modern practice, however, treatment time should be adjusted carefully and significant blistering should be avoided.

8. Reported effects

Every treatment is effective for only some people. Reports have described overall response rates of 60–80% after three consecutive years, counting complete recovery, symptom reduction, and fewer attacks as responses. Traditional theory particularly values Tian Jiu as a preventive method and holds that abundant Yang Qi strengthens resistance to illness.

In May 2015, at the large European TCM congress in Rothenburg, Germany, a practitioner from Taiwan formally introduced this therapy to the European TCM community.

I hope the method can become more widely available in Europe, although regulatory and organisational questions need to be resolved.

A Tian Jiu treatment scene in Guangdong:

Please note: no therapeutic result can be guaranteed, and suitability must be assessed individually.