A Case Commentary: Professor Wang Peng Treating Ascites
Professor Wang Peng was a professor of internal medicine at Hubei University of Chinese Medicine. From 1985 to 1998 he served successively as deputy director and then director of the general internal medicine department of the Affiliated Hospital of Hubei College of Traditional Chinese Medicine (now Hubei University of Chinese Medicine). He has more than 30 years of clinical experience in TCM internal medicine and another 30 years of teaching experience, making him an outstanding dual-qualified clinician-educator.
In May 1984, Professor Wang Peng saw a patient with ascites surnamed Peng. The patient was already 64 years old. His abdomen was swollen like a drum, painfully distended and unbearable; he was emaciated, withered muscles, disheveled hair, a pained expression, dull eyes, and a sallow, lustreless complexion. He moaned and gasped continuously, his voice faint, with shortness of breath. His lower limbs were edematous, leaving deep pitting on pressure; the pulse was fine and wiry, and the tongue was dim and pale.
Before consulting Professor Wang, the patient had tried various internal and external Chinese and Western methods, including oral Chinese and Western diuretics and external diuretic applications. Urine occasionally increased, but the effect never lasted. Ascites progressed rapidly; at the visit his abdominal circumference reached 103 cm.
Professor Wang differentiated the pattern as qi deficiency with retained water, with healthy qi deficient and evil excess. He planned treatment by supporting the righteous and expelling the evil.
Prescription: 4-8 capsules of Gansui (Kansui Radix) powder (each containing 0.5 g of Gansui powder) daily, together with an oral formula that greatly supplements qi and blood. The oral formula was: Sheng Huangqi (raw Astragali Radix) 300 g, Dangshen (Codonopsis Radix) 15 g, Danggui (Angelicae Sinensis Radix) 12 g, Baishao (Paeoniae Alba Radix) 12 g, Chenpi (Citri Reticulatae Pericarpium) 10 g.
After ten days of this combined treatment, the patient urinated and defecated more than ten times daily, his abdominal circumference shrank to 80 cm, the swelling of both lower limbs disappeared, his appetite improved, and his spirits rose. He was then discharged and never relapsed thereafter.
Professor Wang Peng's method of treating ascites was distinctive: he applied great force both to support the righteous and to expel evil. Gansui powder was used at 2-4 g. Gansui is a drastic purgative and diuretic that TCM considers highly toxic; even Zhang Zhongjing dared not use it in large doses. Used this way, if mishandled, the patient could develop acute gastroenteritis or, in severe cases, organ failure.
But Professor Wang paired Gansui powder with a large dose of Sheng Huangqi, making the combination much safer. In his oral formula, Sheng Huangqi reached as much as 300 g, a rarely seen dosage. Modern research shows that raw Huangqi raises hemoglobin, and many ascites patients have low blood hemoglobin. In TCM terms, such a large dose of Sheng Huangqi strengthens the spleen and supplements qi; when the spleen is deficient it cannot transform dampness, and once the spleen is strengthened it transforms dampness and promotes urination. In modern medical terms, this is replenishing protein. This use therefore rapidly eliminates ascites in a way consistent both with traditional TCM pharmacology and with modern medicine.
Dangshen, Danggui, and Baishao also supplement qi and blood, but in this formula they were used in smaller, conventional doses. Although these herbs support the righteous, they lack the spleen-strengthening and water-promoting action of Sheng Huangqi, so they should not be dosed as heavily. Chenpi moves qi; a small amount both moves qi and dissipates nodules and prevents Sheng Huangqi from causing bloating, reducing its side effects—achieving two aims at once.
Treating ascites has always been difficult, and every physician develops his own unique experience. Professor Wang Peng's approach is original and well worth learning from.