Appreciation of a Medical Case: Li Congfu Treating Cirrhotic Ascites

Li Congfu (1905-1990), a native of Huangmei County, Hubei Province, began studying TCM through apprenticeship at age 13 and opened his own practice in 1925. Old Doctor Li was engaged in medicine for more than 60 years and served as president of Hunan Provincial TCM Hospital, director of Hunan Provincial Research Institute of TCM, and other positions. He published monographs including A Special Treatise on Measles, A Study of TCM Physiology, Medical Discussions of Li Congfu, Medical Cases of Li Congfu, and A Study of the Academic Thought of the Four Great Masters of the Jin-Yuan Dynasties.

Old Doctor Li once treated a patient with cirrhotic ascites; the patient was 45 years old at the time. Before the visit, the patient had suffered from jaundice hepatitis; after treatment, the jaundice index normalized, but there was dull distending pain in the right hypochondrium, pain below the xiphoid that refused pressure, weakness of the limbs, mental fatigue, fluctuating between better and worse. At the visit, jaundice reappeared in the sclera and skin; the complexion was dark and dull; the muscles were emaciated; there was nausea and aversion to greasy food, poor appetite, dizziness and palpitations, loose stools, and dark urine; the abdominal wall was tense and painful with distension; spider angiomas were visible on the shoulders and neck; liver function was impaired; there was mild ascites. Western medicine diagnosed early-stage cirrhosis; after Western treatment failed, the patient was referred to TCM. Old Doctor Li found the pulse deep, wiry, and rapid, the tongue bluish, and the coating yellow and greasy.

Old Doctor Li's syndrome differentiation determined that the patient had liver blood stasis obstruction with spleen qi damage. Treatment should soothe the liver and regulate the spleen, move qi and invigorate blood. He treated the patient with his self-formulated Shugan Yin (Liver-Soothing Drink).

Initial prescription: Zhi Biejia (dry-fried Trionycis Carapax) 16 g; Danshen (Salviae Miltiorrhizae Radix) 13 g; Fuling (Poria) 13 g; Baizhu (Atractylodis Macrocephalae Rhizoma) 10 g; Danggui Shen (Angelicae Sinensis Radix body) 10 g; Baishao (Paeoniae Alba Radix) 10 g; Yujin (Curcumae Radix) 9 g; Qingpi (Citri Reticulatae Viride Pericarpium) 6 g; Zexie (Alismatis Rhizoma) 10 g; Zhiqiao (Aurantii Fructus) 7 g; Guangmuxiang (Aucklandiae Radix) 5 g; Zhi Gancao (honey-fried Glycyrrhizae Radix) 3 g. One dose daily, decocted in water and taken in two divided doses.

After taking 40 doses, the patient's complexion improved and was no longer dark; the bluish marks on the tongue faded with a thin coating; the patient felt the abdominal distension much reduced; appetite improved; spirit and energy all improved; urination increased; the pulse tended toward moderate. The condition had improved, so Old Doctor Li decided to keep the treatment principle unchanged and make slight adjustments.

Second-visit prescription: Zhi Biejia 13 g; Danshen 13 g; Baizhu 10 g; Fuling 13 g; Danggui Shen 10 g; Baishao 10 g; Yujin 6 g; Baishao 10 g; Qingpi 5 g; Chenpi (Citri Reticulatae Pericarpium) 5 g; Chao Maiya (stir-fried Hordei Fructus Germinatus) 10 g; Chao Shenqu (stir-fried Massa Fermentata) 10 g; Zhishi (Aurantii Fructus Immaturus) 6 g; Zhi Gancao 3 g.

After continuing another 40 doses, the face became lustrous and ruddy, the pulse was even and moderate, appetite increased day by day, and the body gradually strengthened; then the treatment was changed to a liver-spleen harmonizing regimen.

Third-visit prescription: Dangshen (Codonopsis Radix) 13 g; Baizhu 10 g; Fuling 10 g; Danggui Shen 10 g; Baishao 10 g; Guyaomai (Setariae/Hordei Fructus Germinatus), 10 g each; Chenpi 6 g; Chao Jineijin (stir-fried Gigeriae Galli Endothelium Corneum) 5 g; Zhi Gancao 3 g.

TCM treatment of cirrhosis mostly uses Biejia to soften the liver, because Biejia indeed has a certain effect on cirrhosis and liver cancer. Starting from Zhang Zhongjing's "Biejia Jian Wan" in the Han Dynasty, there have been many formulas through the dynasties using Biejia to treat "nüe mu" (i.e., cirrhosis or liver cancer in modern medicine). Li Congfu's medical case also uses Biejia to soften the liver, assisted by blood-invigorating and qi-regulating herbs and spleen-fortifying, dampness-leaching herbs, treating both root and manifestation.