An Empirical Formula for Ascites in Late-Stage Schistosomiasis
Jiangxi Journal of Traditional Chinese Medicine (2004, 5, 49) once published an empirical formula for treating schistosomal ascites. Its base formula is as follows: Codonopsis Radix (dangshen) 10 g, Poria (fuling) 10 g, stir-fried Atractylodis Macrocephalae Rhizoma (chaobaizhu) 10 g, Coicis Semen (yiyiren) 10 g, Amomi Fructus (sharen) 6 g, Platycodi Radix (jiegeng) 6 g, Dioscoreae Rhizoma (huaishanyao) 6 g, stir-fried Dolichoris Semen (chaobiandou) 10 g, Citri Reticulatae Pericarpium (chenpi) 8 g, Glycyrrhizae Radix (gancao) 6 g, Arecae Pericarpium (dafupi) 10 g, Polyporus (zhuling) 10 g, Alismatis Rhizoma (zexie) 8 g.
Modifications are as follows: if the patient has scant urine and abdominal distension, add Akebiae Caulis (mutong), Lophatheri Herba (danzhuye) and Pheretima (dilong) to promote urination and percolate dampness; for upper abdominal fullness and poor appetite, add stir-fried Magnoliae Officinalis Cortex (chaohoupo) 10 g, Aurantii Fructus (zhike) 6 g and Amomi Rotundus Fructus (baidoukou) 6 g to move qi and reduce distension, fortify the spleen and drain dampness; for pain and distension in both flanks, add Curcumae Radix (yujin) and Bupleuri Radix (chaihu) to soothe the liver and resolve constraint; for postprandial bloating and undigested food in the stool, add Pinelliae Rhizoma (banxia), stir-fried Hordei Fructus (chaomaiya), Galli Gigerii Endothelium (neijinei) and Massa Medicata (shenqu) to digest food and fortify the stomach; for chest and epigastric stuffiness with a pale tongue and white greasy coating, add Amomi Rotundus (baidoukou), Alpiniae Katsumadai Semen (caodoukou), Agastache (huoxiang), Eupatorii Herba (peilan), Acori Rhizoma (shichangpu) and stir-fried Atractylodis Rhizoma (chaocangzhu) to dry dampness and awaken the spleen; for a pale enlarged tongue with teeth marks on the edges, add processed Aconiti Radix (fupian) and Zingiberis Rhizoma (ganjiang) to warm yang and promote diuresis.
Take one dose daily; one month constitutes one course, for a total of 1–3 courses. According to the report, this formula treated 256 patients with late-stage schistosomal ascites: 208 were clinically cured, 43 improved, 5 ineffective, for a total effective rate of 98.0%.
Although this is a formula for schistosomal ascites, its composition is well reasoned. Following the TCM principles of pattern differentiation and "treating different diseases with the same method," this formula may also be used for ascites of other causes, such as cirrhotic ascites, liver-cancer ascites, or ascites due to other tumors.
The base formula is derived with modifications from Wu Ling San (Five-Ingredient Powder, composed of Poria, Polyporus, Atractylodes, Alisma and Cinnamomi Ramus). On the basis of Wu Ling San, this formula removes the acrid, warm and drying Cinnamon Twig and adds Codonopsis, Dioscorea and stir-fried Dolichos to fortify the spleen, boost qi and support zheng qi; it adds tangerine peel, Platycodon and areca peel to regulate qi, and uses Licorice to harmonize the other herbs. The medication is balanced and moderate, dispelling pathogens without forgetting to support the root — a very reasonable approach. Adding Magnolia bark 10 g and Aucklandia 10 g would further improve its qi-moving and diuretic effect.
When using this formula for cirrhosis, one may also consider adding Amydae Plastrum (biejia) 24 g and Polygoni Orientalis Fructus (shuihonghuazi) 30 g to soften hardness and dissipate nodules. When using it for hepatic ascites due to liver cancer or liver metastases, anti-tumor patent medicines such as Fule Pian (Ganfule tablets/capsules), Composite Mylabris Capsules (Fufang Banmao Jiaonang), Xi Huang Capsules and Sanjie Ling Capsules may be taken concurrently, but liver function must be watched. If the patient has jaundice, add Artemisiae Scopariae Herba (yinchen) 30 g, Lysimachiae Herba (jinqiancao) 15 g and Polygoni Cuspidati Rhizoma (huzhang) 10 g to promote diuresis and reduce jaundice; if the patient has drug-induced liver injury, consider combining it with Western drugs for drug-induced liver injury such as glutathione tablets, and regularly recheck liver function and perform hepatobiliary ultrasound to monitor the condition.
Schistosomal ascites may be relatively easy to treat, but the course for malignant ascites is longer. Once the patient responds to this formula, they should not be impatient but continue for a while longer, combined with anti-tumor drugs. Once the condition is stable, the herbs may be made into pills for continued use.