A Case: Professor Yin Huihe Treating Cirrhotic Ascites
Professor Yin Huihe once treated a cirrhotic ascites patient surnamed Li, who first visited him on March 17, 1988. At the visit the patient's chief complaints were right hypochondriac pain and fatigue for more than ten years, abdominal distension for two years, worsened over the past half year. Liver function was abnormal, and an outside hospital had diagnosed cirrhosis with esophageal varices. Over the past half year the abdominal distension had worsened, with large-volume ascites, edema of both lower limbs, five-center heat, dry mouth with desire to drink, poor appetite, scanty urine, and loose stools.
Examination: yellow skin and sclera, abdomen distended like a drum with ascites signs. The tongue was red-crimson with little coating and scant moisture; the pulse was wiry and fine.
Professor Yin differentiated the pattern as prolonged stasis accumulating into a mass, with yin damaged and water gathered. He planned treatment by nourishing yin, softening hard masses, and eliminating water.
Initial prescription: Sheng Muli (raw Ostrae Concha) 30 g (decocted first), Duan Muli (calcined Ostrae Concha) 30 g (decocted first), Biejia (Amydae Carapax) 30 g (decocted first), Guiban (Testudinis Plastrum) 30 g (decocted first), Mudanpi (Moutan Cortex) 12 g, Chishao 30 g, Gancao 10 g, Tiandong (Asparagi Radix) 10 g, Maidong (Ophiopogonis Radix) 10 g, Ejiaozhu (processed Asini Corii Colla) 10 g, Shudihuang 10 g, Chenpi 10 g, Danshen 30 g, Jiegeng (Platycodi Radix) 10 g, Ziyuan (Asteris Radix) 10 g, Jiaomu (Zanthoxyli Fructus) 10 g, Tinglizi (Descurainiae/Lepidii Semen) 10 g, Zelan (Lycopi Herba) 15 g.
The patient took this until the return visit on May 12, 1988, reporting that abdominal distension, vexing thirst, and dry mouth had lessened, ascites was moderate, and stools were formed. The tongue was red with scant coating and moisture; the pulse was wiry. Professor Yin considered that the patient's stomach qi had not yet recovered, so treatment should focus on soothing the liver and opening the lung to facilitate the triple burner.
Second-visit prescription: Chaihu 10 g, Chishao 30 g, Danshen 30 g, Sheng Muli 60 g (decocted first), Danggui 15 g, Yujin 12 g, Chuanlianzi (Toosendan Fructus) 12 g, Taoren 10 g, Zhechong 10 g, Shuizhi (Hirudo) 10 g, Huaruishi (Talcum/Ochroite) 15 g (decocted first), Jiegeng 10 g, Ziyuan 10 g, Jiaomu 10 g, Tinglizi 10 g, Zelan 15 g, Honghua 10 g, Sangshenzi (Mori Fructus) 30 g.
By June 16, 1988, abdominal distension had clearly lessened with only a little ascites left; appetite improved, stools were regular, and urine was moderate. The tongue was red with yellow coating and the pulse fine. Professor Yin then added Pao Jiapian (processed Manis Squama) 30 g and Dongguapi (Benincasae Exocarpium) 30 g to the third-visit prescription to consolidate the effect.
These four visits and prescriptions by Professor Yin Huihe were basically tailored to the patient's symptoms. Professor Yin once described his experience: in clinic he had found that using drastic purgatives such as Shizao Tang and Zhouche Wan, or warming-tonifying herbs such as Renshen, Huangqi, Baizhu, and Gancao, had little effect on cirrhotic ascites; only by soothing the liver and regulating blood as the root, assisted by opening lung qi and facilitating the triple burner, could there be a ray of hope.