Chunze Tang: Supplementing Deficiency, Promoting Urination, and Relieving Edema

Chunze Tang comes from Shiyi Dexiao Fang (Effective Formulas to Benefit Physicians), and is an empirical formula for treating vexed thirst with a desire to drink together with difficult urination. The original text mainly uses it for summer-heat damage with vexed thirst and uncontrolled drinking, and also for cold damage and warm disease where the exterior and interior are not yet resolved, with vexed thirst and a desire for water, vomiting immediately after water enters, or difficult urination—dribbling, small volume and poor flow, or even no drop at all—along with fatigue and lack of strength, poor appetite, pale lusterless face, shortness of breath and rapid panting, pale tongue with white coating, and a weak, forceless pulse.

This formula is Wuling San (Poria, Cinnamon, Atractylodes, Alisma, Polyporus Powder) minus the cinnamon branch plus ginseng, using five herbs: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Zexie (Alismatis Rhizoma), and Zhuling (Polyporus), generally 10 g each in modern practice. It has the action of boosting qi and promoting urination, and ginseng also stops thirst. Today it is often used for micturition syncope, urinary retention, anuria, and neurogenic urinary obstruction. It may also be used for prostatitis, chronic colitis, pediatric urinary frequency, pediatric diarrhea, pulmonary heart disease, and heart failure.

I often use it for late-stage ascites presenting with dry mouth, thirst, and difficult urination. If abdominal distension is marked and there is constipation, this formula may be combined with Zengye Chengqi Tang, adding Houpo (Magnoliae Cortex) and Zhiqiao (Aurantii Fructus) in moderation. If difficult urination is severe, Cheqianzi (Plantaginis Semen), Huainiuixi (Achyranthis Bidentatae Radix), Yimucao (Leonuri Herba), Huashi (Talcum), Yiyiren (Coicis Semen), Mudanpi (Moutan Cortex), and Shuizhi (Hirudo) may be added, and the dose of diuretic and edema-relieving herbs increased.

But if the patient has already repeatedly used diuretics from both Chinese and Western medicine, such a formula is of little further use; such patients are mostly in the terminal stage, and medication has scant effect.

Thirst is a common symptom in ascites patients; some patients, while taking Chinese medicine, obtain relief of thirst by taking small oral rehydration salts or oral glucose. Because potassium loss is too severe, late-stage ascites patients also develop palpitations, anxiety, fatigue, and similar symptoms; Chunze Tang should be combined with Shengmai San, adding Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix) to Chunze Tang, in doses equal to the ginseng.