Biejia Jian Wan (Soft-Shelled Turtle Shell Decoction Pill): A Patent Medicine for Liver Cancer and Cirrhosis
Biejia Jian Wan is a classic famous formula from the Han-dynasty Zhang Zhongjing's "Jingui Yaolue" (Essential Prescriptions from the Golden Cabinet). Modern pharmaceutical versions are sometimes called Renshen Biejia Jian Wan (Ginseng Soft-Shelled Turtle Shell Decoction Pill). Its ingredients include soft-shelled turtle shell glue (Biejiajiao), donkey-hide glue (Ejiao), honeycomb, stir-fried (Chaofengfang), rat female (Shufuchong), stir-fried ground beetle (Tubiechong), dung beetle (Qianglang), refined nitre (Xiaoshi), bupleurum (Chaihu), scutellaria (Huangqin), processed Pinellia (Banxia), Codonopsis (Dangshen), dried ginger (Ganjiang), ginger-processed magnolia (Houpo), cassia twig (Guizhi), stir-fried white peony (Baishao), blackberry lily (Shegan), peach kernel (Taoren), moutan bark (Danpi), rhubarb (Dahuang), Chinese trumpet creeper (Lingxiaohua), Descurainia seed (Tinglizi), Pyrrosia (Shiwei), and Dianthus (Qumai), among others. The original formula was used to treat "zheng-jia" (abdominal masses) and "nue-mu" (malarial splenomegaly).
Biejia Jian Wan's actions are to expel stasis and resolve phlegm, soften hardness and disperse abdominal masses. It is indicated for abdominal masses below the rib side that feel hard and painful on palpation and do not move when pushed, abdominal pain, emaciation, reduced appetite, alternating chills and fever; it also treats amenorrhea in women, a dark, lusterless tongue, and a wiry fine pulse. Modern clinical use includes liver cancer, stomach cancer, uterine tumors, ovarian tumors, cirrhosis, hepatosplenomegaly, liver fibrosis, and peptic ulcers.
Modern pharmacological research shows that among Biejia Jian Wan's components, soft-shelled turtle shell, white peony, rhubarb, peach kernel, and bupleurum all lower alanine transaminase (ALT), correct the reversed albumin/globulin ratio, and inhibit fibrous tissue proliferation; scutellaria has an anti-hepatitis-B-virus effect; rhubarb, Pinellia, honeycomb, ground beetle, soft-shelled turtle, Dianthus, and dung beetle have anti-cancer actions; and Dianthus also reduces liver lesion severity.
Animal experiments further prove Biejia Jian Wan inhibits tumor growth and tumor angiogenesis and can prolong the life of tumor-bearing mice. Clinically, modified Biejia Jian Wan may be used for liver cancer, cirrhosis, and liver-area distending pain.
Biejia Jian Wan has a complex composition — it is the formula with the most ingredients among Zhang Zhongjing's classical prescriptions. In it, cold and heat are used together, and supplementation and drainage are integrated, but it leans toward attacking and is weak in supplementation. This is also a basic feature of formulas for hepatobiliary system disease, so this formula should not be used long-term. When using it, one should follow the principle of stopping once the disease is addressed (zhongbing ji zhi): once the patient's symptoms ease, whether or not the disease is cured, pause for a period and wait until the patient's upright qi recovers before considering further use. As a rule, the longest continuous course should not exceed one month.