Guzheng Shenxiao San for Pleural Effusion and Ascites
Guzheng Shenxiao San (Magical Tympanites Powder) comes from Zhang Zhaozhen's Chuimo Youde Ji (Personal Reflections) of the Qing dynasty. The formula consists of fried malt (Chao Maiya), areca nut (Binglang), and Euphorbia kansui (Gansui), each 1 qian (3 g). Powder the above medicines finely; each time take 5 fen (1.5 g), washed down with yellow rice wine, twice daily. Guzheng Shenxiao San has the action of dispersing accumulation and expelling water, and is indicated for tympanites, that is, what we today call ascites.
This formula uses few medicinals and has a simple composition.
The fried malt in the formula has the actions of moving qi and dispersing accumulation, and fortifying the spleen and stimulating the appetite; it can treat food accumulation with abdominal distension and epigastric and abdominal pain, and can also soothe the liver and resolve depression. It is a medicinal commonly used in TCM to aid digestion.
Areca nut has the action of expelling water and reducing swelling. The Mingyi Bielu (Miscellaneous Records of Famous Physicians) records that areca nut "mainly digests grain and expels water"; the Yaoxing Bencao records that areca nut "disinhibits the congestion of the five zang and six fu organs, breaks hardened fullness-qi, and drives down water edema"; the Jiaoqi Lun records that areca nut "treats beriberi congestion-toxin and water-qi edema." From these records we can see that in ancient times areca nut was used as a diuretic and detumescent medicinal for treating edematous disorders.
Gansui belongs to the drastic water-expelling medicinals of Chinese materia medica; it has the actions of expelling water and flushing out retained fluid, and reducing swelling and dispersing nodules. It is mainly used for edema and fullness, water accumulation in the chest and abdomen, phlegm-fluid accumulations, counterflow qi with cough and wheezing, and constipation and dysuria. Modern pharmacological research has found that Gansui has antiviral, antitumor, and diuretic effects, but Gansui is a toxic medicinal; in clinical use the dose must not be too large, and it is best used after processing. Vinegar-processed Gansui (Cu Gansui) is relatively safer.
The above three medicines combined into a formula can both move qi and disperse accumulation and expel water and reduce swelling, and also have a certain antitumor effect. But because Gansui is quite toxic, the dose must not be too large when used. This formula is used as a powder, only 1.5 g each time, of which Gansui accounts for 0.5 g; its toxicity is still controllable and the side effects when taken are not too great. Using vinegar-processed Gansui makes the side effects even smaller.
If the patient develops diarrhea, or vomiting and diarrhea, after taking this formula, that is mainly caused by Gansui; at that point one should not continue the formula, but promptly take berberine tablets (Huangliansu Pian) or Sishen Wan to stop the diarrhea. Patients who are especially weak and emaciated should also use this formula with caution.
Ascites in patients is mostly caused by liver disease or tumors; such patients are best not given the medicine mixed with yellow rice wine, because all alcoholic drinks are disadvantageous for tumor and liver-disease patients. It may instead be mixed with ginger-scallion water, which is made by boiling an appropriate amount of fresh ginger and scallion in water. Mixing with yellow rice wine is meant to help the medicine act faster; ginger-scallion water achieves the same adjuvant effect as yellow rice wine, but without its side effects.