Professor Jiang Chunhua's Experience Treating Hepatic Ascites with Xiayuxue Decoction as the Base

Professor Jiang Chunhua was a renowned contemporary TCM master. For treating hepatic ascites, Professor Jiang had a general formula based on Xiayuxue Tang (Stasis-Expelling Decoction). Xiayuxue Tang comes from Zhang Zhongjing's Jingui Yaolue; its original composition is: Dahuang (Rhei Radix et Rhizoma) 2 liang, Taoren (Persicae Semen) and Zhechong (Eupolyphaga) 20 pieces each. A modern preparation may be: Dahuang 6 g, Taoren 9 g, Zhechong 15 g. Xiayuxue Tang was originally a gynecological formula, indicated for postpartum abdominal pain due to static blood, and for static blood obstructing menstruation, difficult menses, and abdominal zheng masses. Professor Jiang used it as the base for ascites because, in TCM terms, hepatic ascites is a condition of intermingled stasis and dampness.

1. General formula for mild-to-moderate ascites: Xiayuxue Tang plus Danggui (Angelicae Sinensis Radix) 9 g, Danshen (Salviae Miltiorrhizae Radix) 9 g, Shengdi (raw Rehmannia) 9 g, Shudi (prepared Rehmannia) 9 g, Chishao (Paeoniae Radix Rubra) 9 g, Baishao (Paeoniae Radix Alba) 9 g, Dangshen (Codonopsis) 9 g (or Renshen powder 3 g), Huangqi (Astragalus) 9 g, Baizhu (Atractylodis Macrocephalae Rhizoma) 15 g, Fuling (Poria) 15 g, Sharen (Amomi Fructus) 3 g, Heidadou (black soybean) 30 g, Biejia (Trionydis Carapax) 15 g, Muli (Ostreae Concha) 30 g. Professor Jiang said this formula works for the first episode of hepatic ascites of any pattern; after three or four recurrences it becomes hard to be effective.

This formula combines Xiayuxue Tang with Bazhen Tang and modifies it: it removes the warm-drying Chuanxiong from Bazhen Tang, adds Danshen (which has the same effect as Siwu Tang), uses both raw and prepared Rehmannia and both red and white Paeonia, adds Sharen to move qi, black soybean to nourish kidney yin, clear heat and drain fire, and promote urination and reduce swelling, and Biejia and Muli to soften hard masses and dissipate nodules. This composition both supports zheng qi and attacks pathogen, treating both root and branch, and so is effective.

2. For patients with more ascites, relatively weak constitution, and difficult urination, use the following: Xiayuxue Tang plus Dangshen 9 g, Huangqi 15 g, Baizhu 12 g, Heidadou 30 g, Zexie (Alismatis Rhizoma) 15 g, Fuling 15 g, Xiguapi (watermelon peel) 30 g, Chen Hulu (aged bottle gourd) 30 g, Yumixu (corn silk) 30 g, Duizuo Cao (Lysimachiae Herba) 30 g, Mutong (Akebiae Caulis) 9 g, Jiangjun Gan (dry cricket) 9 g (or Lougu (Gryllotalpa) 9 g).

This formula was built by combining Sijunzi Tang with Xiayuxue Tang and modifying. Dangshen, Huangqi, and Baizhu supplement qi and fortify the spleen; Zexie and Fuling drain dampness and reduce swelling; watermelon peel, aged bottle gourd, and corn silk are all food-grade, strongly diuretic Chinese herbs, used in relatively large doses here; Duizuo Cao is Jinqian Cao, whose main action is to drain dampness and resolve jaundice, and is a branch-treating herb specifically for ascites; Mutong promotes urination and relieves strangury, and clears the heart and eliminates irritability; Jiangjun Gan is the cricket, which, like the mole cricket, is an insect drug with diuretic action.

From this composition, Professor Jiang's formula emphasizes supplementing qi and resolving stasis, promoting urination and reducing swelling. Although the diuretic and swelling-reducing herbs are used in large doses, they are all very safe and unlikely to cause medical accidents.

3. For patients with a relatively robust constitution, massive ascites, unbearable distension, and very scant urine, use Xiayuxue Tang plus the following purgative herbs: Shanglu (Phytolaccae Radix) 9 g, Daji (Euphorbiae Pekinensis Radix) 15 g, Yuanhua (Genkwa Flos) 1.5 g, Cheqianzi (Plantaginis Semen) 15 g, Chifuling (red Poria) 15 g, Chen Hulu 30 g, Duizuo Cao 30 g, Qumai (Dianthi Herba) 15 g, Dafupi (areca peel) 9 g, Dafupizi (areca nut) 9 g, Hei Chou and Bai Chou each 30 g (i.e., black Pharbitidis Semen 30 g plus white Pharbitidis Semen 30 g), ground to powder and stirred into the decoction.

Professor Jiang's formula here already emphasizes strong attack over supplementation, and is therefore explicitly noted as suitable only for patients with a relatively robust constitution, large ascitic volume, unbearable distension, and very scant urine. Shanglu, Daji, Yuanhua, and Hei-Bai Chou in this formula are all toxic; Daji and Yuanhua are highly toxic. Patients of even slightly weaker constitution who use this formula are at great risk, so it must not be abused.

Most of the herbs used here are strong purgative diuretics in TCM. Although they could all be obtained in Professor Jiang's day, ordinary TCM pharmacies cannot now dispense such a combination because of the risk of medical accidents. But the Chinese patent medicine Zhangzheng Wan contains these highly toxic components and may be used together.

There is almost no good treatment for severe ascites, and formulas like this are unavoidable "tiger-wolf" medicines. If the patient responds, do not prolong the fight; once symptoms ease, switch to formula 2 or formula 1.

In addition, Professor Jiang Chunhua had another empirical formula for ascites, "Baqi Wan," based on Croton feces (Bardou crud medicinalis) and dry lacquer. I have written about it before; interested readers may consult my earlier article, "Professor Jiang Chunhua's Empirical Formula 'Baqi Wan' for Cirrhotic Ascites."