A Failed TCM Case: Treating Ascites due to Liver Cancer
This medical case was published by a certain professor of Chinese medicine; to respect his privacy, he will not be named. The fact that the professor openly published this case honestly is commendable. Refractory ascites due to liver cancer carries a very poor prognosis, and treatment failure is inevitable. Successful treatment experience is naturally valuable, but the lessons from failed treatment are actually equally valuable.
The patient in this case was a woman with liver cancer. In May of a certain year, she was hospitalized for liver cancer with severe ascites. Western medicine tried various treatments without effect, and by June her lower limbs were already markedly edematous. The patient reported abdominal distension and hypochondriac pain, loose stools, scant urine, and poor appetite. Because the disease was already at an advanced stage, after chemotherapy, repeated abdominal paracentesis, and Western diuretics, the patient was exhausted, emaciated, with a deep yellow, sallow, and gloomy complexion. Her lower limbs were severely edematous, with swelling reaching the groin.
The professor's initial prescription was: Guizhi (Ramulus Cinnamomi) 10 g, Zhuling (Polyporus) 20 g, Fuling (Poria) 20 g, Zexie (Rhizoma Alismatis) 10 g, Baizhu (Rhizoma Atractylodis Macrocephalae) 20 g, Hongshen (Radix Ginseng Rubra) 5 g, Zisu (Folium Perillae) 5 g, and Xiaohuixiang (Fructus Foeniculi) 5 g. This formula was based on Wuling Powder with the addition of Hongshen, Zisu, and Xiaohuixiang. Wuling Powder promotes diuresis and reduces edema; Zisu and Xiaohuixiang soothe the liver and regulate qi, while also promoting diuresis; Hongshen additionally supports zheng qi and secures the root.
After taking the medicine, the patient's urine flowed like a flood, and the edema of both lower limbs rapidly resolved; more than half of the lower-limb edema subsided within a single day. When the Western doctors in the same hospital learned how quickly the patient's ascites was resolving, they grew alarmed and warned the professor that such rapid diuresis would lead to electrolyte disturbances and other, even more intractable problems. But the professor felt that, following this TCM approach of simultaneously supporting zheng and dispelling pathogen, there was no need for undue concern, and he instructed the patient to continue the original formula. After two more doses, the edema completely resolved. But the patient died shortly thereafter.
In an earlier article titled "Qualitative and Quantitative Issues in the Treatment of Ascites (Peritoneal Effusion)," I already discussed in detail the issues that should be noted when treating ascites; in fact, these principles apply equally to the treatment of pleural effusion and pelvic effusion. This professor probably never expected that Wuling Powder with additions would produce such a strong diuretic effect in this patient with refractory ascites; this should have been a very good thing. But the treatment may have been pressed too hard. Lacking some basic knowledge of modern medicine, he failed to control the rate at which the ascites was cleared, which ultimately led to the patient's rapid death. This is truly regrettable.
If, after the patient first responded so dramatically to Wuling Powder with additions, the physician—conversant with both Chinese and Western medicine and aware of some modern medical principles of ascites treatment—had reduced the dosage of subsequent doses, slowing the rate of ascites resolution, while concurrently adding other herbs that support zheng and fight cancer, this patient might have weathered the crisis and achieved a markedly prolonged survival.