Appreciation of He Yanshen's Medical Case of Liver Cirrhosis
He Yanshen, born 1922, was a native of Dongguan, Guangdong. A self-taught chief TCM physician, he served after liberation as president of the Dongguan Chinese Medicine Hospital in Guangdong and specialized in treating critical conditions such as stroke, Japanese encephalitis, and renal failure.
On May 5, 1971, Old Master He saw a 45-year-old female patient with liver cirrhosis. The patient, Xiao, was a staff officer at a military unit on Hainan Island; during the Cultural Revolution she was subjected to struggle and investigation, which tormented her mentally and physically. In 1970 she contracted hepatitis that dragged on without resolving; worn out in body and mind, she was diagnosed with cirrhosis on Hainan Island in April 1971. She was granted sick leave to return to her ancestral home in Dongguan, Guangdong, to recuperate and seek treatment from Old Master He.
At the visit the patient was puffy-looking, with a dull complexion and palpable masses below both flanks. The liver was enlarged by 4.5 cm, hard, with a thick blunt edge and mild tenderness. The spleen was enlarged 2-5 cm, of medium-hard consistency. Seven or eight spider angiomas were visible on the upper chest; the abdomen was distended with a girth of 84 cm and shifting dullness, and examination showed ascites. Liver function tests were abnormal.
The patient reported short-term fatigue, shortness of breath and weakness on slight exertion, palpitations, fullness in the flanks and epigastrium, counterflow qi with nausea, poor appetite, postprandial epigastric discomfort, stool that was first dry then loose, and scanty difficult urination—a picture of central deficiency with qi stagnation and fluid retention. She also had dizziness, blurred vision, tinnitus, dry throat, poor sleep, and night sweats. The pulse was deep, wiry, and rough; the tongue was dry and dark red with dusky purple edges, and the coating was white and dry, thick and turbid at the root.
Old Master He diagnosed spleen-kidney dual deficiency with liver qi stagnation and qi stagnation and blood stasis; the treatment principle was to fortify the spleen and supplement the kidney, transform qi and move water, and quicken blood and disperse accumulation. First-visit prescription: Huangqi (Astragali Radix) 60 g, Dangshen (Codonopsis Radix) 30 g, Baizhu (Atractylodis Macrocephalae Rhizoma) 15 g, Fuling (Poria) 30 g, Huaishanyao (Dioscoreae Rhizoma) 24 g, Shudihuang (Rehmanniae Radix Praeparata) 24 g, Gouqizi (Lycii Fructus) 12 g, Zexie (Alismatis Rhizoma) 12 g, Sharen (Amomi Fructus) 4.5 g, Danshen (Salviae Miltiorrhizae Radix) 15 g, Biejia (Trionycis Carapax) 24 g, Baibeiyegen (Malloti Apeltae Radix, whiteback leaf root) 30 g. Separately, Jilin Renshen (Jilin ginseng) 1 g, Sanqi (Notoginseng Radix) 0.5 g, Zhenzhuceng Fen (pearl-layer powder) 0.5 g were ground fine and taken with warm water, three times daily.
After taking this formula the symptoms eased. Old Master He thereafter kept it as the base formula, making small adjustments according to the patient's condition. Because the patient had loose stools, Gouqizi was removed; because she had abdominal distension and nausea, Banxia, Maiya (Hordei Fructus Germinatus), Biandou (Dolichoris Semen), and Mugua (Chaenomelis Fructus) were added to harmonize the middle and transform dampness; because ascites was severe, Dafupi (Arae Fructus Pericarpium), Cheqianzi (Plantaginis Semen), and Yiyiren (Coicis Semen) were added to drain water and reduce swelling; after the ascites resolved, Danggui and Baishao (Paeoniae Radix Alba) were added to nourish and supplement blood.
After about five months of such intermittent treatment, all ailments settled, symptoms disappeared, and her body basically returned to normal. The patient returned to Hainan in the winter of 1971 to resume work. Afterward she stayed in touch by letter, and Old Master He adjusted the medication in his replies; consolidation continued for about half a year before stopping. In 1981 she was transferred to a job in Shenzhen and visited Old Master He; he learned that she was in good health and the cirrhosis had not recurred.
Old Master He's formula looks unremarkable—it is essentially a modification of Sijunzi Tang (Four Gentlemen Decoction). The Biejia used is a specific herb for cirrhosis and is still used today (the Chinese patent medicine Biejia Ruangan Pian is a common treatment for cirrhosis). His additions and subtractions based on symptoms were also uncomplicated. That such a grave illness could be treated with such an ordinary formula and achieve such excellent results is truly remarkable.
The Baibeiyegen in this formula is an uncommon herb; it is the root of Mallotus apelta (family Euphorbiaceae), with heat-clearing, dampness-draining, astringing, and blood-quickening effects. It is used for hepatitis, enteritis, lin syndrome and leukorrhea, rectal prolapse, uterine prolapse, hepatosplenomegaly, bruises and sprains. It was probably a local herb commonly used in the Dongguan area in Old Master He's time; it is not found in most TCM pharmacies elsewhere.
In this case Old Master He combined pattern-based treatment with disease-based treatment. The modified Sijunzi Tang was symptomatic, pattern-based treatment; using Biejia to soften the liver and Baibeiyegen to treat hepatitis was disease-based treatment. This approach both relieved the patient's clinical symptoms and built her confidence in recovery, while also targeting her hepatitis and the cirrhosis caused by it. His method is well grounded from both the TCM and modern medical perspectives, so the good results are no surprise.
Cirrhosis is a serious liver disease that, if unchecked, can progress to liver cancer; cirrhotic ascites can itself be fatal. Treating such an illness requires a long course and the patient's patient cooperation. This patient's treatment lasted a year, and she was essentially on decoctions the whole time; her persistence for so long is itself remarkable.