Professor Jiang Chunhua's Proven Formula Baqi Wan for Cirrhotic Ascites

Professor Jiang Chunhua was a renowned late TCM physician of Shanghai and a master of the Yun Tieqiao school of integrated Chinese-Western medicine. His created empirical formula Baqi Wan has a certain efficacy in treating cirrhotic ascites. According to Academician Shen Ziyi, Jiang Chunhua's student, when he followed Jiang Chunhua to copy prescriptions, he saw Professor Jiang use Baqi Wan to treat many cases of cirrhotic ascites, with remarkable results.

While Academician Shen Ziyi was organizing Professor Jiang Chunhua's proven cases of Baqi Wan, when he reached the 96th case, Jiefang Daily learned from patients' letters that Professor Jiang's Baqi Wan was remarkably effective for cirrhotic ascites, and went to interview him and the hospital's director, Qian De.

Director Qian De was a famous Chinese infectious-disease specialist. Director Qian was a Western doctor and was half-convinced, half-skeptical of the efficacy of Baqi Wan, so he himself earnestly went to the TCM ward every day and measured patients' abdominal circumference with a tape measure; within a week he saw the patients' ascites gradually disappear. To compare this with the effect of Western purgatives, Director Qian also specifically admitted a patient with cirrhotic ascites and treated him with the Western drug magnesium sulfate, with poor results.

This practice impressed Director Qian, who wrote an article on TCM treatment of cirrhosis and published it in the newspaper. Academician Shen Ziyi also organized the clinical efficacy of Professor Jiang Chunhua's Baqi Wan into an article, published at the same time as Director Qian's.

The formula thus became widely known in medical circles.

Here I reprint the complete text on Baqi Wan recorded by Academician Shen Ziyi:

Composition: croton cream (badou shuang) 1.5 g, dried lacquer (ganqi) 10 g (lightly roasted to remove smoke), tangerine peel (chenpi) 10 g, raw atractylodes (sheng cangzhu) 10 g.

Function: aggressively purge and expel water.

Indications: cirrhotic ascites due to various causes.

Formula explanation: This formula uses croton. The Shennong Bencao Jing says it mainly breaks zheng-jia masses, accumulations and bindings, hard concretions, retained fluids and phlegm, and water distention; it washes and drains the five zang and six fu, opens blockages, and promotes the water and grain pathways. The Yaoxing says it treats ten types of edema. According to modern pharmacological research, croton oil, upon reaching the intestine and reacting with alkaline intestinal fluid, releases crotonoleic acid, which exerts a drastic purgative effect and strongly intensifies intestinal peristalsis. Following traditional usage, this formula de-oils the croton into croton cream, so the toxicity is weaker and abdominal pain rarely occurs after taking it. The Mingyi Bielu says dried lacquer disperses blood stasis and glomus accumulations and benefits the small intestine. Zhang Yuansu said it can shave off deep, long-bound accumulations and break old, congealed blood stasis. The Master used it to eliminate stasis and break concretions. Tangerine peel is the peel of sweet orange produced in Guangdong; aged, it is called chenpi. The Bencao Jing says it mainly treats glomus heat and counterflow qi in the intestine and promotes water and grain. The Bielu says it treats descending qi, stops hiccup and cough, treats qi surging into the chest, removes retained heat and retained water in the bladder, and promotes urination. In this formula it is used as a spleen-fortifying and qi-moving herb. Atractylodes: the Bielu says it dissolves phlegm-water, expels wind-water between the skin, binding and swelling, and removes binding fullness below the heart. Zhen Quan said it mainly treats abdominal glomus pain and edema with distention. Combined with tangerine peel, magnolia bark, and licorice, it forms Pingwei San, used to strengthen the stomach and aid digestion; modern pharmacology considers it to contain large amounts of vitamins A and B. In the whole formula, croton drastically purges and expels water, and dried lacquer eliminates stasis and breaks concretions, as the chief herbs; they are paired with atractylodes and tangerine peel to fortify the spleen and harmonize the stomach, move qi and promote water. This both assists the chief herbs in expelling water and breaking bindings, and protects the spleen and stomach, avoiding damage to the stomach and intestines by the harsh herbs—so as to achieve drastic purging of water without excessively damaging the upright qi.

Preparation, method of administration, and precautions: Grind the above herbs finely, mix with honey water evenly, and roll into pills the size of mung beans. Prepare and take them fresh; they must not be too dry, for if too dry they will not dissolve after taking and will be passed out whole. Nor should they be ground up for taking, as that would irritate the stomach and cause nausea and vomiting, and in those with dilated esophageal veins it could cause bleeding. Thus the consistency should be neither dry nor wet—soft and easy to dissolve. Take 1.5 g each time.

If purgation does not occur, the dose may be gradually increased to 2.1 g, 3 g, with a maximum of 4.5 g. The criterion is the discharge of a large amount of fluid. Take once or twice daily, or every other day, or once every few days; in short, depending on the condition and the patient's constitution. Those taking once daily may take it on an empty stomach in the early morning, followed by a bowl of hot congee to aid the action of the medicine. Those taking twice daily may take the second dose at three in the afternoon; to avoid nighttime bowel movements for patients, it is best not to take it after 3 p.m.

Because this formula is very strong in attacking and expelling water-rheum, it does a certain damage to the patient's physical strength. Therefore, it must not be used in any of the following conditions: signs of hepatic coma; very marked esophageal varices or repeated massive hematemesis and melena; or concurrent complications such as high fever or portal vein thrombosis.

After treatment, the following issues must still be noted:

1. In those whose condition is extremely severe, whose strength is utterly depleted, or who have taken Baqi Wan up to 3 g for several consecutive days without purgation, treatment is difficult to render effective; other methods should be adopted early.

2. After ascites has fully receded, a decoction should still be taken for a period to consolidate. A supplement-and-drainage formula may be used, removing the three herbs: shanglu (Phytolacca), dried bottle-gourd, and qumai (Dianthus).

3. During treatment, according to TCM tradition and combined with Western therapeutic principles, a salt-free, low-oil or low-salt, low-oil diet may be given; after ascites recedes, salt in the diet may be gradually increased. In addition, vitamins, glucose, and the like may be given as appropriate.

4. Those with esophageal varices must still be careful during the course of illness about fish bones and coarse, hard food, so as not to cause bleeding. After treatment, once strength is restored, surgical intervention is still preferable.

5. If diarrhea with severe abdominal pain occurs after taking the medicine, one aspirin tablet (0.3 g) may be taken to stop it; it is best not to use atropine. If the patient has continuous diarrhea without stopping, the medicine may be stopped for a day or two.

Modified according to pattern: When using Baqi Wan, several decoctions may be chosen as adjuncts according to the patient's constitution and condition. Begin with a purgative formula; as ascites gradually recedes, switch to a purge-and-tonify formula. Those too weak to withstand purgation use a supplement-and-drainage formula.

1. Purgative formula: suitable for those of strong physique, no signs of deficiency, scanty and dark urination, able to eat but afraid to eat because of abdominal distention. Do not use in those with existing diarrhea, extreme debility, or inability to take food.

Binglang (Areca) 20 g, shanglu (Phytolacca) 12 g, gansui (Euphorbia kansui) 4.5 g (roasted), yuliren (Prunus japonica seed) 10 g (pounded), xuisuizi (Euphorbia lathyris seed) 10 g (pounded), qianniuzi (pharbitis seed) 12 g (pounded), biejia (turtle shell) 30 g, cangzhu (atractylodes) 15 g, chenpi (tangerine peel) 6 g.

2. Purge-and-tonify formula: biejia (turtle shell) 30 g, danggui (angelica) 10 g, huangqi (astragalus) 10 g, shanglu 12 g, gansui 4.5 g (roasted), zhuling (polyporus) 15 g, chifuling (red poria) 15 g, dried bottle-gourd 12 g, binglang 15 g, raw cangzhu 10 g, raw gancao (licorice) 6 g.

If the patient is relatively deficient, dangshen (Codonopsis) 15 g may be added.

3. Supplement-and-drainage formula: designed for those unsuitable for Baqi Wan and the purgative formula.

Dangshen 10 g, huangqi 10 g, chenpi 10 g, shanyao (Dioscorea) 10 g, danggui 10 g, zhuling 10 g, chiling (red poria) 10 g, cangzhu 10 g, dried bottle-gourd 15 g, biejia 30 g, qumai (Dianthus) 10 g, shanglu 15 g.

Zhiyuan's note: Several of the herbs Professor Jiang Chunhua used are relatively harsh purgatives—croton cream, gansui, shanglu, and the like. These are now hard to buy at ordinary pharmacies; you may have to go to a nearby medicinal-herb wholesale market to find them.

Croton oil is highly toxic, so croton must be processed into croton cream before use. Most people do not have the skill to process croton cream, so it is best not to buy raw croton but to buy the already-processed croton cream. If only croton is available and croton cream cannot be bought, one must learn to make the cream oneself. One can wrap the croton in absorbent printing paper or toilet paper to draw out the croton oil before use; this is much safer.

Using this formula carries a certain risk, but as long as each herb is properly processed and the precautions for using Baqi Wan recorded by Academician Shen Ziyi (as observed by his teacher) are strictly followed, it is still quite safe to use.

This formula is reprinted for the reference only of patients with cirrhotic ascites for whom the conventional Chinese and Western methods have already failed. Ordinary patients: if a safer medication plan is available, please do not misuse this one, so as to avoid serious consequences through inexperience. Most earnest warning! Most earnest warning!