Fangji Huangqi Tang Has Good Efficacy in Treating Pleural Effusion and Ascites in Cancer Patients

Fangji Huangqi Tang (Stephania and Astragalus Decoction) is a famous formula from the Jin Gui Yao Lue (Essentials from the Golden Cabinet) by the Han-dynasty master physician Zhang Zhongjing. I often use this formula, with modifications, to treat pleural effusion and ascites in cancer patients; when properly applied, the results are very good. I now write to introduce its use.

In the Jin Gui Yao Lue, Fangji Huangqi Tang is mainly used to treat wind-damp with exterior deficiency, presenting as heavy painful body or edema, floating pulse, sweating, and aversion to wind. These are the clinical indications for its use.

So in practice, watch for these indications; if a patient shows them, one may boldly use the formula.

Fangji Huangqi Tang has four herbs: huangqi (Astragali Radix), hanfangji (Stephaniae Tetrandrae Radix), baizhu (Atractylodis Macrocephalae Rhizoma), and gancao (Glycyrrhizae Radix).

In treating cancer patients' pleural effusion and ascites, my usual clinical dose is: sheng huangqi (raw Astragalus) 30 g, hanfangji 30 g, chao baizhu (stir-fried Atractylodes) 30 g, zhi gancao (honey-fried Licorice) 10 g. I have treated several patients with pleural effusion, ascites, or pelvic effusion using only these four herbs; most achieved good results within one week to one month.

Of course, in actual treatment, one may add or subtract according to the patient's symptoms for a more targeted effect. Below are my usual modifications.

If ascites is severe and urination is a mere trickle, add niuxi (Achyranthis Bidentatae Radix) and cheqianzi (Plantaginis Semen), 10–15 g each. For loose soft stool with difficult urination, add fuling (Poria) and zhuling (Polyporus), 10–30 g each.

For deficient construction-defense (ying-wei) consolidation, add shengjiang (Zingiberis Rhizoma Recens) and dazao (Ziziphi Fructus) in appropriate amounts. For back pain as though cut, add xuduan (Dipsaci Radix) and duzhong (Eucommiae Cortex), 10–15 g each. For weak, soft knees, add bajitian (Morindae Radix), xianlingpi (Epimedii Herba), shayuanzi (Astragali Complanati Semen), and tusizi (Cuscutae Semen), 10–15 g each.

If constipation occurs, add sheng dahuang (raw Rheum) 6–30 g. For bitter mouth, hypochondriac pain, and jaundice, add chaihu (Bupleuri Radix) 10 g, huangqin (Scutellariae Radix) 10 g, chao zhizi (stir-fried Gardeniae Fructus) 10–15 g, and yinchen (Artemisiae Scopariae Herba) 10–30 g.

For spleen deficiency with excessive dampness, add yiyiren (Coicis Semen) as appropriate: those with a weak spleen-stomach take chao yiyiren (stir-fried Coix), while those with a strong spleen-stomach take sheng yiyiren (raw Coix). For poor appetite, add jiao sanxian (the three charred digestive herbs), 10–15 g each, and chao jineijin (stir-fried Endothelium Corneum Gigeriae Galli) 30 g.

For severe abdominal distension, add laifuzi (Raphani Semen) 30–60 g and binglang (Arecae Semen) 6–15 g. For bloody ascites, depending on the severity of bleeding, add daji (Cirsii Japonici Herba) and xiaoji (Cirsii Herba), 10–30 g each, and baiji (Bletillae Rhizoma) 6–30 g. Patients with chronic prostatitis or urethritis may also combine with the patent medicine San Jin Pian.

Besides treating pleural effusion and ascites, I used this approach to treat paralysis in a cancer patient, with satisfactory results.

A grassroots pediatrician once saw an ascites patient and, unsure how to treat, consulted me; I suggested Fangji Huangqi Tang. On my basic formula he added zhuling and fuling, 30 g each. After about a month, the patient's ascites was cured.

Later, the same doctor used this formula for a patient with lower-extremity vasculitis, with good results.

I myself often use Fangji Huangqi Tang for the ascites and pleural effusion patients who consult me, achieving good results about half the time, especially when there is limb edema and weakness.

In stubborn cancerous ascites where Ehrlich ascites carcinoma can be detected, related Chinese and Western anti-cancer regimens must be combined.

I once treated a late-stage cancer patient with spinal metastases, already paralyzed, who also had ascites and pelvic effusion. Treating mainly with modified Fangji Huangqi Tang, plus kidney-tonifying, bone-strengthening herbs, I unexpectedly cured not only the ascites and pelvic effusion but, in passing, the paralysis as well.

The day before writing this article, the patient returned for follow-up and could already walk freely, no longer needing the wheelchair. I believe this result relates to fangji's good effect in treating bi-syndrome.

But this formula should not be used for too long. In TCM theory, a spleen-strengthening formula, used long, damages the kidney.

The huangqi, fangji, baizhu and other herbs in this formula have a strong diuretic effect; overuse will cause frequent urination.

So stop when enough is enough. Generally, once limb edema resolves, adjust the strategy and switch to slow treatment with pills like Shenqi Wan (Kidney Qi Pill) and Guipi Wan (Spleen-Returning Pill) for recovery, telling the patient to gradually reduce even the pills. Once effusion-related symptoms resolve, switch, according to the patient's condition, to a more targeted anti-cancer formula.