Appreciation of a Medical Case: Henan TCM Master Li Zhenhua Treating Cirrhosis with "Tympanites (Gu Zhang)"

Professor Li Zhenhua once served as director of the Internal Medicine Teaching and Research Office of Henan College of Traditional Chinese Medicine (now Henan University of Chinese Medicine) and vice president of the Affiliated Hospital of Henan College of TCM. He had rich clinical and teaching experience.

On April 8, 1974, Professor Li Zhenhua treated a 30-year-old female patient, Li, with hepatosplenomegaly accompanied by ascites. The patient had suffered from hepatitis four years earlier and was cured at a county hospital. But since then, she felt dull pain in the right hypochondrium upon slight exertion, and her appetite was poor. In the summer of 1973, overeating raw and cold food led to abdominal pain and diarrhea, with more than ten watery stools a day, accompanied by nausea and vomiting. After treatment by a local barefoot doctor, the diarrhea stopped, but abdominal distension appeared from then on, with two bowel movements daily containing undigested food residues.

In February 1974, the patient was admitted to hospital because of worsening abdominal distension and right hypochondriac pain, scant and pale-colored urine, and lower limb edema. A local hospital examination revealed cirrhosis, hepatosplenomegaly, and ascites. After more than a month of treatment with both Chinese and Western medicine, the ascites disappeared, but the hepatosplenomegaly reached 14 cm; the patient was listless, spoke in a low voice, had a haggard face and dark yellow complexion. The local hospital recommended surgical removal of the spleen. The patient feared surgery and sought treatment everywhere; during this process, the ascites recurred, and she finally came to Professor Li Zhenhua for treatment.

Professor Li Zhenhua's syndrome differentiation determined that this patient had liver-spleen disharmony with damp obstruction and blood stasis, belonging to TCM tympanites (gu zhang; in Western medicine, cirrhosis with hypersplenism). He planned treatment with the method of regulating the liver and spleen, leaching out dampness, and resolving stasis.

Initial prescription: Danggui (Angelicae Sinensis Radix) 12 g; Baishao (Paeoniae Alba Radix) 15 g; Baizhu (Atractylodis Macrocephalae Rhizoma) 10 g; Fuling (Poria) 20 g; Chaihu (Bupleuri Radix) 6 g; Xiangfu (Cyperi Rhizoma) 9 g; Yujin (Curcumae Radix) 9 g; Qingpi (Citri Reticulatae Viride Pericarpium) 9 g; Dafupi (Arecae Pericarpium) 12 g; Mudanpi (Moutan Cortex) 9 g; Yuanhu (Corydalis Rhizoma) 9 g; Chuanshanjia (Manis Squama) 9 g; Biejia (Trionycis Carapax) 15 g; Danshen (Salviae Miltiorrhizae Radix) 15 g; Muli (Ostreae Concha) 15 g; Gancao (Glycyrrhizae Radix) 3 g. 6 doses, one dose daily, decocted in water, taken twice daily (morning and evening).

After taking the above 6 doses, the patient's abdominal distension was reduced, but urination was still not smooth. Therefore, Zhuling (Polyporus) 15 g and Cheqianzi (Plantaginis Semen) 12 g were added to the previous formula. After continuing another 6 doses, the abdominal distension was significantly reduced, appetite improved, and urination became smooth. But the splenomegaly had not yet shrunk, so Yuanhu 9 g and Taoren (Persicae Semen) 9 g were further added to the decoction, together with the patent medicine Biejia Jian Wan (Carapace Clearing Pill), 60 small water pills each time, three times daily.

The patient thereafter followed the above treatment method for more than one year, taking more than 300 doses. At the re-examination on August 4, 1975, the spleen was no longer enlarged. Follow-up until 1981 showed no recurrence.

Modern liver and spleen lesions in TCM mostly belong to shaoyang syndrome, and are often treated with Chaihu-series formulas. In this medical case of Professor Li Zhenhua, the patient presented a typical shaoyang symptom complex: abdominal distension, nausea and vomiting, listlessness, and depression. Professor Li treated this patient with a modified Xiaoyao Wan, which is exactly a good symptomatic treatment approach.

The formula also added soft-hardness and mass-dispersing herbs such as Chuanshanjia, Biejia, and Muli; added Yuanhu, Danshen, Mudanpi, and Yujin to invigorate blood and stop pain; added Qingpi and Dafupi to move qi and promote diuresis. This took into account both syndrome differentiation and disease differentiation, so the entire treatment process combined disease-based treatment with syndrome-based treatment, addressing both root and manifestation. Such a prescribing approach is worth learning from.