An Empirical Formula Relieving Intestinal Adhesion, Obstruction, and Ascites Complications in Cancer Patients
Patients with mid- to late-stage cancer often develop various cancer complications. Ascites and intestinal adhesions occurring together are extremely common, and in severe cases there may even be intestinal obstruction.
This is especially common in gynecological patients with ovarian cancer and cervical cancer. Some colorectal-cancer patients, or patients with other tumors that have metastasized to the liver and intestine, are also prone to this.
In my clinical work, through constant trial and exploration, I have worked out an empirical formula of fairly good effect that can relieve the abdominal distension and other problems these patients suffer from ascites, intestinal adhesions, and obstruction. I offer it here for readers' reference.
The formula is as follows:
Houpo (Magnolia bark) 24 g, Shengjiang (fresh ginger, chopped) 24 g, Fabanxia (processed Pinellia) 10 g, Zhi Gancao (honey-fried licorice) 6 g, Renshen (Ginseng, or Xiyangshen/American ginseng) 3–10 g (decocted separately and mixed into the broth), Fulin (Poria) 30 g, Zhuling (Polyporus) 10 g, Han Fangji (Stephania) 30 g, Sheng Huangqi (raw Astragalus) 30 g, Chao Baizhu (stir-fried Atractylodes) 15 g, Huainiuxi (Achyranthes) 10 g, Dazao (jujube, broken up) 10 pieces, Cheqiancao (Plantago herb) 15 g, Cheqianzi (Plantago seed) 15 g, Jiao Sanxian (charred three immortals) 10 g each, Ezhu (Curcuma) 15 g.
This formula is in fact a combination of two classic famous formulas of Chinese medicine, plus a few targeted herbs.
The first formula is "Houpo Shengjiang Banxia Gancao Renshen Tang" (Magnolia-Fresh-Ginger-Pinellia-Licorice-Ginseng Decoction), and the second is "Fangji Huangqi Tang" (Stephania-Astragalus Decoction); the two are combined into one. On this basis are added Huainiuxi, Cheqiancao, Cheqianzi, Zhuling, and other diuretic, swelling-reducing herbs, plus Jiao Sanxian and other digestive, distension-relieving herbs, and Ezhu to break qi and disperse accumulation; together these achieve the effects of promoting urination and reducing swelling, removing fullness and distension, and dissolving glomus and binding.
If the patient's urine is yellow and scalding with difficult, dripping urination, one may on this basis add Yinchen (Artemisia capillaris), Zhizi (gardenia), Mutong (Akebia), Baitongcao (Tetrapanax pith), and Huashi (talc). If the stool is bound and constipated, one may add Roucongrong (Cistanche), Huomaren (Cannabis seed), Yuliren (Prunus seed), Fanxieye (senna leaf), and Dahuang (rhubarb) to open the bowels.
"Houpo Shengjiang Banxia Gancao Renshen Tang" comes from the Shanghan Lun (Treatise on Cold Damage). It is a classic formula that combines supplementation with dissipation; in Chinese medicine its action is often described as "three parts supplementation, seven parts dissipation." That is, it is three parts tonifying and seven parts reducing: it uses Renshen and Zhi Gancao to fortify the spleen and boost qi, and Fabanxia and Houpo to dissipate phlegm and scatter binding, removing distension and fullness. Fresh ginger is warm in nature: it both helps Banxia and Houpo eliminate distension and fullness and reduces the toxicity of Banxia.
Patients with concurrent ascites, intestinal adhesions, and obstruction (adhesions and obstruction often cause intestinal gas accumulation) typically present with abdominal fullness and discomfort that is especially severe after midday. For such patients, a purging attack cannot solve the problem once and for all, and easily injures the patient's righteous qi; this is precisely when the "three parts supplementation, seven parts dissipation" approach is needed—removing distension and fullness while fortifying the spleen and supporting righteous qi.
This formula alone cannot solve the problem of ascites. So it must be combined with "Fangji Huangqi Tang."
"Fangji Huangqi Tang" comes from the Jingui Yaolüe (Golden Cabinet). It was originally for "wind-damp with a floating pulse, heavy body, sweating, and aversion to wind," and contains only four herbs: Han Fangji, Sheng Huangqi, Zhi Gancao, and Chao Baizhu. In my clinical use, this formula for pleural and peritoneal effusion and pelvic fluid accumulation is often effective. But these four herbs alone are not strong enough at promoting urination and reducing swelling, so some diuretic, swelling-reducing herbs must be added on top to raise its efficacy.
Of course, the above combination may only be used to relieve the clinical symptoms caused by cancer cachexia (ascites, pleural effusion, pelvic fluid, etc.) and intestinal adhesions (or obstruction), to ease the patient's suffering and prolong life (many patients die of cancer complications, so reducing complications will certainly prolong survival). If one hopes for further efficacy and to control the progress of the tumor, some targeted antitumor drugs must also be added according to the patient's specific condition.
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