Exploring Traditional Chinese Medicine for Pleural Effusion, Ascites, and Pericardial Effusion in Cancer Patients
Malignant fluid produced by tumors and accumulating in the thoracic cavity, abdominal cavity, and pericardium is what is commonly called pleural effusion, ascites, and pericardial effusion. These are common complications in cancer patients; if not handled well, many cancer patients die precisely from pleural, peritoneal, or pericardial effusion.
Western clinical treatment of pleural effusion, ascites, and pericardial effusion mostly uses oral diuretics and surgical drainage. But the results are not ideal; many patients die quickly after Western clinical management. I myself often receive help requests from cancer patients with pleural effusion, ascites, or pericardial effusion. I treat these patients with a comprehensive TCM approach, and the results are often far better than simple diuresis.
In the early stage of treating pleural, peritoneal, and pericardial effusion, I mostly relied on diuretics. This approach is easy to make the patient better quickly and to win the trust of patients and families, but it has a major flaw: most cancer patients die rapidly after rapid diuresis. The effusion, once quickly eliminated, rapidly recurs. Moreover, some harsh diuretics in TCM—such as Shizao Decoction (Ten-Jujube Decoction), Zilong Wan, Pengzheng Wan—contain highly toxic herbs such as Gansui (Kansui root), Daji (Euphorbia), and Yuanhua (Genkwa flower), and often cause sudden death.
In my own observation, some patients, after taking Shizao Decoction (usually ground into powder) or Pengzheng Wan prescribed by certain doctors, underwent a drastic decline in constitution; some who had been active a few days earlier were bedridden within three days of taking the medicine and eventually died unnaturally. Moreover, patients who take such harsh downward-draining medicines are extremely hard to reverse even when they later meet a good doctor.
So, in view of this, I later adopted a comprehensive treatment plan for these cancer complications rather than simple purgation (draining the urine and stool). But I have also seen other TCM doctors who, in handling effusion, used large doses of mild diuretic herbs and achieved good short-term results.
For instance, some practitioners, when using Wuling Powder, use Atractylodes (Baizhu) and Poria (Fuling) at over 100 g each; some, treating pleural and peritoneal effusion, use Coix seed (Yiyiren)—a food-medicine dual herb with both anticancer and diuretic effects—at about 500 g per day. The effect in resolving effusion is almost immediate, far more effective than Western medicine's draining today only to refill tomorrow. Some lucky patients even obtained good results through dietary therapy such as radish and crucian carp soup or winter melon soup. Such treatment experience that has achieved real results is also worth drawing on.
When I now treat pleural, peritoneal, and pericardial effusion, I generally advise patients and their families to be patient, not to be impatient, and not to take too many risks in pursuit of short-term results. The appearance of effusion generally reflects that the cancer has progressed to a certain stage, caused by persistent inflammation, histamine secretion, and other factors. Treatment should follow the principle of seeking the root of the disease, treating the cause of the effusion; by adjusting the patient's overall condition, we promote the body's automatic absorption and digestion of the effusion, and only moderately use some diuretics to assist drainage. This is both safe and removes the patient's root cause; it can greatly prolong survival, sometimes by one or two years, in many cases three to five years, and may even allow long-term cancer-bearing survival.
In treating effusion in cancer patients, I have been greatly influenced by the late veteran TCM physician Zhao Shaoqin. I have always emphasized spreading and regulating the patient's qi mechanism, rather than the "fortifying the spleen and promoting diuresis" approach favored by most clinicians. In treatment I seldom use spleen-fortifying and water-draining herbs; even when I do, I use them in small amounts, combined with dietary therapy. Alongside the herbs I tell patients to eat foods with strong diuretic action—coix porridge, winter melon, radish, and bottle gourd—and the effect is often outstanding.
So in treating pleural, peritoneal, and pericardial effusion, I personally place great emphasis on regulating the patient's triple burner (sanjiao), using the traditional TCM harmonizing method rather than purgation or spleen-fortification. Generally speaking, when the upper and lower fail to communicate and the triple burner is not free, that is an important cause of effusion. If we can unblock the qi mechanism of the triple burner, the patient's organ functions return to normal, the ascending and descending of the body's qi becomes free, and the water is eliminated without directly draining it.
Thus Professor Zhao Shaoqin himself, clinically treating cancerous effusion, often based treatment on the famous warm-disease formula Shengjiang Powder (Ascending-Descending Powder), adding herbs such as Xingren (Apricot kernel) and Xuanfuhua (Inula flower) to regulate the body's qi mechanism, and occasionally adding Chaihu (Bupleurum) and Chixiangfu (Cyperus) to soothe the liver and resolve stagnation. The clinical results were outstanding. There were even liver cancer patients whom Western medicine could not cure who, after taking Professor Zhao's prescriptions based on this approach, achieved clinical cure with tumor disappearance.
In my own practice, while drawing on this approach, I have also expanded it. From an elderly folk TCM doctor in Beijing I learned his characteristic use of Chaihu (Bupleurum) together with Huangqin (Scutellaria) when treating cancer. That old doctor has also passed away, but during his lifetime many Beijing patients survived for a very long time under his treatment; some treated purely with TCM achieved results far better than Western medicine. By chance I once met and treated a lymphoma patient whom this old doctor had treated, and was able to collect a large number of prescriptions he had given during his life. Remarkably, not a single formula lacked both Chaihu and Huangqin.
I have combined this old doctor's approach with Professor Zhao Shaoqin's, basing treatment on the harmonizing method using the Chaihu–Huangqin herb pair, with the main strategy of spreading the qi mechanism and unblocking the triple burner. Treating several patients with effusion in this way, with appropriate herbs, the results have been remarkably effective. There are now several cancer patients maintained for three to five years by TCM under this approach who are still alive. Others have achieved good short-term results. Moreover, using Chaihu together with Huangqin not only unblocks the qi mechanism but also effectively prevents complications such as cancer fever, clearly improving the quality of life of late-stage cancer patients.
Below, I illustrate the application of this approach with two case records of patients I have treated.
Patient Ding, male, 53 years old; first visit December 1, 2013.
The patient was hospitalized and examined at Beijing 302 Hospital on November 28, 2013. The CT report (image no. 100210226) showed: enlargement of the left hepatic lobe, wide hepatic fissure, uneven surface, shrinkage of the right hepatic lobe, uneven density of the liver parenchyma, multiple dense opacities visible; contrast-enhanced scan showed uneven enhancement of the right lobe, with mixed-density opacities on the portal-venous and delayed phases. Multiple small nodular high-density opacities were seen in the left lobe; enhancement showed several small patchy enhancements in the left lobe, and a 21x23 mm low-density opacity on the portal-venous and delayed phases, with filling defect in the portal vein. The gallbladder was not enlarged, with thickened wall; the spleen measured 5–6 rib units; the pancreas and kidneys appeared normal. Soft-tissue nodular opacities were seen around the abdominal aorta, and water-density opacities were seen in the abdominal cavity and right thoracic cavity.
Diagnostic opinion: 1. Status post-treatment for liver cancer; MRI recommended for further examination; retroperitoneal lymph node enlargement. 2. Liver cirrhosis—correlate clinically; right pleural effusion and ascites. 3. Cholecystitis.
The patient's chest CT also showed lesions in the lungs.
Before coming to me, this patient had already been treated for ascites by several renowned TCM professors at multiple Beijing hospitals. After the November 28 re-examination showed that the previous doctors' treatment had failed, he came to me for help.
The pulse was fine and slippery on the right, deep and tight on the left; there was slight distending pain and discomfort around both hypochondria, more pronounced after walking and eating; the sputum usually contained black spots; the tongue was enlarged and moist, with a white greasy coating and no obvious teeth marks; the skin was itchy.
Recently he had sought treatment from a renowned TCM liver specialist who treated mainly by fortifying the spleen, with the following formula:
Sheng Huangqi (raw Astragalus) 30 g, Baizhu (Atractylodes) 30 g, Zhuling (Polyporus) 30 g, Dongguapi (Winter melon peel) 30 g, Tinglizi (Descurainia) 30 g, Cheqianzi (Plantago seed) 20 g, Xuanfuhua (Inula) 10 g, Daizheshi (Hematite) 10 g, Houpo (Magnolia bark) 10 g, Dafupi (Areca peel) 20 g, Chenpi (Tangerine peel) 15 g, Danggui (Angelica) 10 g, Caoshanhe (Paris/Sumatranus) 30 g, Shancigu (Cremastra) 10 g, Fengfang (Wasp nest) 5 g, Lulu (Rhaponticum) 30 g.
After 15 doses, there was no significant improvement.
After my face-to-face examination, I decided to draw on Professor Zhao Shaoqin's approach, basing treatment on regulating and spreading the qi mechanism while clearing and draining damp-heat:
Shashen (Glehnia) 10 g, Maidong (Ophiopogon) 10 g, Wuweizi (Schisandra) 10 g, Pianjianghuang (Curcuma) 6 g, Chantui (Cicada slough) 6 g, Chao Jiangcan (fried Bombyx) 10 g, Yujin (Curcuma) 6 g, Chaihu (Bupleurum) 6 g, Cu Xiangfu (vinegar Cyperus) 10 g, Xuanfuhua (Inula) 10 g, Xingren (Apricot kernel) 10 g, Pipa Ye (Loquat leaf) 10 g, Maozhaocao (Radix Ranunculi) 30 g, Xuchangqing (Cynanchum) 15 g, Yinchen (Artemisia capillaris) 10 g, Chao Zhizi (fried Gardenia) 6 g, Banzhilian (Scutellaria barbata) 10 g, Baishao (White peony) 10 g, Chishao (Red peony) 10 g, Qiancao (Madder) 10 g, Sheng Huangqi (raw Astragalus) 20 g, Qianliguang (Senecio) 15 g, Qinpi (Fraxinus bark) 10 g.
7 doses; return for follow-up after one week.
On December 8 the patient returned, reporting dull pain around the navel, loose stools, and indigestion after meals. The above formula was bitter-cold and had damaged spleen yang, so I adjusted it as follows:
Dangshen (Codonopsis) 15 g, Fabanxia (processed Pinellia) 10 g, Chenpi (Tangerine peel) 10 g, Zisu (Perilla) 10 g, Chaihu (Bupleurum) 10 g, Huangqin (Scutellaria) 10 g, Huanglian (Coptis) 6 g, Pianjianghuang (Curcuma) 6 g, Chantui (Cicada slough) 6 g, Chao Jiangcan (fried Bombyx) 10 g, Maozhaocao 30 g, Baihuasheshecao (Oldenlandia) 30 g, Chao Zhizi (fried Gardenia) 10 g, Chao Baizhu (fried Atractylodes) 10 g, Cangzhu (Atractylodes lancea) 10 g, Chao Zhiqiao (fried Aurantium) 10 g, Jineijin (Chicken gizzard lining) 30 g, Shuihonghuazi (Polygonum orientale) 10 g, Jiaoshanzha (charred Crataegus) 15 g, Ezhu (Curcuma zedoaria) 6 g, Zhi Gancao (honey-fried Licorice) 6 g, Muxiang (Aucklandia) 10 g, Fulin (Poria) 15 g, Zhuling (Polyporus) 8 g, Baishao (White peony) 15 g.
On December 22 the patient returned again; the condition had clearly improved, so I decided to continue basing treatment on Chaihu, Huangqin, and Shengjiang Powder:
Chaihu (Bupleurum) 12 g, Huangqin (Scutellaria) 12 g, Jiangcan (Bombyx) 10 g, Chanyi (Cicada slough) 6 g, Pianjianghuang (Curcuma) 6 g, Fabanxia (processed Pinellia) 10 g, Dangshen (Codonopsis) 15 g, Baishao (White peony) 12 g, Chishao (Red peony) 12 g, Zhi Gancao (honey-fried Licorice) 6 g, Yinchen (Artemisia capillaris) 6 g, Maozhaocao 30 g, Shandougen (Sophora tonkinensis) 6 g, Baihuasheshecao (Oldenlandia) 30 g, Maozhaocao 30 g, Xiangfu (Cyperus) 10 g, Xingren (Apricot kernel) 10 g, Shengjiang (fresh ginger) 5 slices, Dazao (jujube) 5 pieces.
He also took anticancer medicines such as Compound Cantharides Capsules and Xihuang Wan (Yellow Pill), Guipi Wan (Spleen-Returning Pill) to fortify the spleen, and Compound Berberine for anti-inflammation.
Another week later, the patient's pleural and peritoneal effusion disappeared; the previously elevated cancer markers returned to normal, and his condition improved markedly, walking more than ten thousand steps a day. He continued treatment with me for nearly two years. When he began treatment with me, his Western doctor had not hoped he would survive that year's Spring Festival, but he not only lived through that Spring Festival but the next one as well, safely.
For a long time the patient did not know his true condition. Later, learning the truth, he panicked, lost confidence in TCM, and sought other treatment. After switching doctors, his condition deteriorated rapidly, effusion recurred, and after failing to respond to treatment by a renowned anticancer TCM expert at a Beijing Grade-A tertiary hospital, he switched to an old TCM doctor who used harsh water-draining medicines of the Shizao Decoction type, which made things worse. He came to me again for help, but by then I had already left Beijing to make a living in business. When I rushed back to Beijing, his condition was already quite severe; after treatment with integrated Chinese and Western medicine at 302 Hospital, he died.
In treating this patient's effusion, I had earnestly urged his family not to be impatient, not to over-drain water, and to seek the root of the disease; using the approach described above, the results were good, safe, and reliable, and they controlled the tumor's progression very well, at one point restoring the patient to normal health. This shows that Professor Zhao Shaoqin's approach of unblocking the triple burner and spreading the qi mechanism is steady and effective in treating effusion in cancer patients.
Another patient was from Weihai, Shandong; her ascites was caused by peritoneal mesothelioma. When she came to me, her abdomen was swollen as if pregnant. Unfortunately, the notebook in which I recorded this case has been lost. I recall that her pulse was relatively slow, indicating a yang-deficiency constitution; Western medicine diagnosed late-stage mesothelioma with an expected survival of only a few months.
I used Yanghe Decoction together with Chaihu and Huangqin, combined with Xihuang Wan taken orally. Over about three months of adjustment and treatment, the patient's ascites disappeared and her cancer markers returned to normal. Now, more than five years later, this patient lives and works as an ordinary person. All these years she has refused any further Western treatment, opting for pure TCM. This is because she had previously been treated by Western medicine and by several renowned Beijing TCM doctors, all without success, before coming to me for pure TCM.
I recall the basic formula used for her ascites was as follows:
Chaihu (Bupleurum) 12 g, Huangqin (Scutellaria) 12 g, Shudihuang (processed Rehmannia) 40 g, Lujiaojiao (deer antler glue) 12 g, Baijiezi (White mustard seed) 8 g, Rougui (Cinnamon bark) 4 g, Sheng Gancao (raw Licorice) 4 g, Paojiang (blast-fried ginger) 2 g, Mahuang (Ephedra) 2 g.
Alongside, she took the patent medicine Jinkui Shenqi Wan (Golden Chamber Kidney-Qi Pill; the Tongrentang product is actually the formula of Jisheng Shenqi Wan). I used almost no water-draining herbs, yet the patient's ascites was eliminated and her cancer was controlled. This shows that in treating effusion and other complications in cancer patients, one does not necessarily have to stubbornly rely on water-draining herbs. Treating water by treating the water alone commits the fault of treating the branch rather than the root.