Appreciation of Two Cases of Dr. Gong Zhixian's Treatment of Cirrhotic Ascites

Old physician Gong Zhixian was born in 1907, began studying with a master at 13, and opened his practice at 16. Before he passed away, Dr. Gong treated cirrhotic patients and published two case records. From these cases we can learn his experience in treating cirrhosis.

Case one: Chai, male, 54.

First seen March 1969. At presentation the patient was emaciated, fatigued, with pain in both hypochondria, a tense distended abdomen with abdominal wall varices, ascites, slight shortness of breath, poor appetite that worsened after eating, scanty dark urine and loose stools. He had one spider nevus on the face and one on the neck, frequent gingival bleeding, and lower-extremity edema. Western diagnosis was cirrhosis with abnormal liver function.

Dr. Gong diagnosed damage to righteous qi, liver constraint with spleen deficiency, dual deficiency of qi and blood, and binding of qi, blood and water to form abdominal distension—a pattern of great excess and great deficiency.

Initial prescription: Yuxingcao (Houttuynia) 30 g, Yinchen 15 g, Guangmuxiang (Aucklandia) 10 g, Foshou pian (Citrus medica slices) 12 g, Tonghuagen 30 g, Shuidengxin (Juncus) 30 g, Shichangpu (Acorus) 20 g, Chao Huixiang (stir-fried fennel) 12 g, Fulin 20 g, Zhuling (Polyporus) 12 g, Zexie (Alisma) 25 g, Niaoliaopan (Malan/Kalimeris) 30 g. 30 doses.

After about 20 doses, urine output increased, abdominal distension and ascites lessened, and appetite improved to about 50 g per meal. But with continued use symptoms did not improve much and the limbs became weaker. Dr. Gong considered that the righteous qi was injured, qi and blood were deficient, and righteous could not overcome evil; it could not move water, and too many diuretics had weakened the body. He therefore decided to strengthen the support of righteous qi and root.

Second-visit prescription: Huangqi (Astragalus) 30 g, Dangshen (Codonopsis) 25 g, Danggui 10 g, Jiao Baizhu (charred Atractylodes) 12 g, Yuxingcao 30 g, Tonghuagen 30 g, Yinchen 15 g, Shuidengxin 30 g, Shichangpu 20 g, Guangmuxiang 10 g, Fulin 20 g, Zexie 25 g, Niaoliaopan 30 g.

Thereafter, with modifications according to symptoms on this base, the patient took medicine for about a year and all measures improved markedly. Re-examination returned to normal; he then used Buzhong Yiqi Pills and Xiangsha Liujun Pills for about three months to consolidate.

Case two: Qu, male, 47.

In June 1960, after a Beijing hospital diagnosed cirrhosis with esophageal varices and abnormal liver function, he came to Dr. Gong. The patient reported over ten years of acid regurgitation, belching, epigastric distending pain, dull liver-area pain, fatigue, red face and poor appetite, eating less than 50 g per meal, difficulty falling asleep with nightmares, melancholy, frequent nosebleeds and gingival bleeding. During hospitalization in Beijing he vomited blood twice, with loose stools and dark urine.

Dr. Gong differentiated liver heat constraint and dual deficiency of spleen and kidney, and decided to treat by soothing the liver and clearing heat, fortifying the spleen and warming the kidney.

Initial prescription: Wuzhuyu 1.5 g, Huanglian 3 g, Jing Banxia 10 g, Danshen 12 g, Nanshashen (Adenophora) 12 g, Jianqu (medicated leaven) 12 g, Jineijin (Endothelium corneum gigeriae galli) 12 g, Guanghuoxiang 10 g, Cangzhu (Atractylodes lancea) 6 g, Chao Chuanlianzi (stir-fried toosendan) 10 g, Chenpi 10 g.

After 5 doses, belching and acid regurgitation lessened and appetite improved, but sleep remained poor and fatigue persisted. Considering the esophageal varices and fearing rebleeding, Dr. Gong decided to boost qi and activate blood.

Second-visit prescription: Huangqi 12 g, Dangshen 10 g, Baizhu 10 g, Fulin 12 g, Chenpi 6 g, Chao Zaoren (stir-fried zizyphus) 15 g, Chuanxiong 6 g, Danggui 10 g, Baishao 10 g, Wuzeigu (Os Sepiellae) 12 g, Qiancaogen (Radix Rubiae) 10 g, Gancao 3 g.

After 10 consecutive doses, belching and acid regurgitation greatly improved, the stomach felt comfortable, and sleep also improved; the left-guan pulse was wiry and forceful and the tongue slightly red. Dr. Gong considered liver heat constraint remained, and planned to use a powder to soothe the liver and clear heat and a decoction to activate blood and nourish the liver, while cultivating spleen and kidney.

Powder prescription: Rengong Niuhuang (artificial bezoar) 0.15 g, Xiongdan (bear bile) 0.3 g, Ku Baifan (dried alum) 0.15 g; grind finely together and put in capsules; take one dose nightly with warm water.

Decoction prescription: Huangqi 12 g, Dangshen 10 g, Baizhu 10 g, Fulin 12 g, Danggui 10 g, Chuanxiong 6 g, Baishao 10 g, Chao Zaoren 15 g, Chenpi 10 g, Wuzeigu 15 g, Yizhiren (Fructus Alpiniae Oxyphyllae) 10 g.

After 10 days on these formulas, the constraint heat resolved, liver-area pain lessened, and spirit improved, but sleep was still poor. Dr. Gong decided to focus on supporting righteous qi, assisted by spirit-calming herbs, still using both powder and decoction.

Powder: Hupo powder (Amber) 0.6 g, Hehuanhua powder (Albizia flower) 0.9 g, infused before sleep.

Decoction: Dihuang (Rehmannia) 10 g, Rougui 3 g, Huangqi 20 g, Dangshen 12 g, Baizhu 10 g, Fulin 12 g, Jing Banxia 10 g, Shengmuli 15 g, Danggui 10 g, Baishao 10 g.

Continuing this for 14 days further improved the patient, but urine was still pale yellow. Dr. Gong decided to focus on softening the liver and boosting qi, fortifying the spleen and tonifying the kidney, assisted by soothing the liver and clearing heat.

Prescription: Huangqi 25 g, Dangshen 15 g, Danggui 10 g, Jiao Baizhu 10 g, Shengma 3 g, Chaihu 6 g, Chenpi 10 g, Shudi (processed Rehmannia) 12 g, Rougui 3 g, Maidong 12 g, Gouqizi (Lycium) 12 g, Tusizi 10 g, Fulin 12 g, Sharen 6 g, Gancao 6 g. One dose daily, decocted in water.

Separate pill formula: Wulingzhi 30 g, Puhuang (Typha pollen) 15 g, Huanglian 10 g, Mutong (Akebia) 10 g, Jiao Zhizi (charred gardenia) 15 g, Hezi (Chebula) 25 g, Qingpi (green tangerine peel) 15 g, Chenpi 15 g, Danggui 15 g, Baishao 15 g, Jianghuang (Curcuma longa) 15 g, Yujin 25 g, Guangmuxiang 15 g, Honghua 15 g. Powder the herbs and make water-paste pills the size of a mung bean. Take 1.5 g morning and evening with warm water. Before sleep still take Hupo powder 0.6 g and Hehuanhua powder 0.9 g to calm the spirit and aid sleep.

After three more months of medication, western re-examination showed esophageal varices were no longer prominent and liver function returned to normal. Dr. Gong then had the patient take Buzhong Yiqi Pills 6 g each morning and Maiwei Dihuang Pills 6 g each evening to consolidate. After four more months of pills, the patient's health basically returned to normal and he could work normally.

The two cirrhosis cases were treated differently by Dr. Gong, but the principle was the same: following TCM pattern differentiation, "if the pattern is present, use the corresponding drug," applying symptomatic supportive treatment, with good results in both. Cirrhosis is a serious disease with poor prognosis; that Dr. Gong achieved marked results with pure TCM is truly remarkable.