Professor Zhu Chenyu's Experience Using "Niu She San" to Treat Severe Cirrhotic Ascites with Hepatic Coma

In 1975, Professor Zhu Chenyu participated in a consultation to rescue a late-stage patient with cirrhotic ascites. The patient had already developed hepatic encephalopathy (hepatic coma): confusion, incoherent speech, agitation and violence. Western medicine measured a very high blood ammonia, and the condition was already very serious. Western medicine administered intravenous drip of sodium glutamate and other drugs for a month, with symptoms fluctuating. By January 30, 1975, the patient was completely unconscious, and Western medicine urgently invited Professor Zhu Chenyu for consultation.

The patient's family had obtained elsewhere an empirical formula for treating hepatic coma, whose main ingredients were bezoar and musk, totaling over ten herbs. After reviewing it, Professor Zhu Chenyu felt the formula was rationally constructed, and based on the patient's condition he streamlined it to six herbs: Shexiang (musk), Niuhuang (bezoar), Lingyangjiao (antelope horn), Changpu (Acorus gramineus), Dingxiang (clove), and Zanghonghua (Crocus sativus/saffron), ground into powder and administered by water drenching. Two days later the patient regained consciousness. Professor Zhu Chenyu later named this formula "Niu She San" (Bezoar-Musk Powder). Using this formula in combination with Western medicine, he rescued multiple patients with hepatic encephalopathy and high-fever coma, all with effect.

However, the patient's ascites and jaundice had not been resolved; there remained abdominal distension and fatigue, poor appetite, scanty urine, loose stools, an enlarged tongue, and very high bilirubin. Professor Zhu Chenyu, applying TCM pattern differentiation, considered the patient to have the pattern of damp-heat and blood stasis mutually binding, with water-dampness internally retained. He decided to treat by clearing and disinhibiting damp-heat, warming yang and transforming qi, and fortifying the spleen and percolating dampness.

So, while taking Niu She San, a decoction was also prescribed: Yinchen (Artemisia capillaris) 30g, Huangqin (Scutellaria baicalensis) 10g, Zhizi (Gardenia jasminoides) 10g, Fuling (Poria cocos) 24g, Zhuling (Polyporus umbellatus) 15g, Zexie (Alisma orientalis) 15g, Baizhu (Atractylodes macrocephala) 12g, Guizhi (Cinnamomum cassia twig) 10g, Pao Fuzi (processed Aconitum) 6g. One dose daily, together with half a bottle of Niu She San twice daily, mixed with water and given by nasal feeding.

After 12 doses, the patient's condition had greatly improved. Professor Zhu Chenyu considered the cost of Niu She San too high, so he discontinued it, added Danshen (Salvia miltiorrhiza) 30g to the decoction, and after a further 15 doses the patient's strength and appetite had improved greatly, jaundice had receded substantially, but the sclera was still yellow, and urine was still scanty and stools loose.

Professor Zhu Chenyu adjusted the prescription: Yinchen (Artemisia capillaris) 30g, Longdancao (Gentiana scabra) 6g, Guizhi (Cinnamon twig) 10g, Baizhu (Atractylodes) 10g, Zhuling (Polyporus) 24g, Fuling (Poria) 24g, Zexie (Alisma) 15g, Cheqiancao (Plantago asiatica) 30g, Hanliancao (Eclipta prostrata) 30g, Jixueteng (Spatholobus suberectus) 30g.

Here, Cheqiancao (Plantago asiatica) and Hanliancao (Eclipta prostrata) are an herb pair commonly used by Mr. Shi Jinmo. This pair comes from "Chishui Xuanzhu" (Mysterious Records of the Red Water); this small formula has a name, "Er Cao Dan" (Two-Herb Elixir), and was the herb pair Mr. Shi Jinmo most commonly used for treating patients with edema. As for the efficacy of this pair, it is explained in "Shi Jinmo's Paired Herbs" (4th ed., p. 331), compiled by Mr. Shi Jinmo's disciple, Professor Lv Jingshan; interested readers may look it up themselves.

This patient improved step by step under Professor Zhu Chenyu's treatment. Thereafter, Professor Zhu basically used Yinchen Wuling San (Artemisia Five-Ingredient Powder) as the main formula, modifying the herbs according to the patient's symptoms, and treated for about a year. The patient fully recovered, with ALT and bilirubin both returning to normal.

Cirrhotic ascites is a severe condition; patients who survive after developing hepatic coma are not common, and even with today's medical conditions it is difficult to cure such patients. But Professor Zhu Chenyu, on the basis of an empirical formula combined with TCM pattern differentiation, achieved such outstanding results, which is truly rare.

The author explains this case in detail to provide reference for other liver cancer and cirrhosis patients, their families, and TCM physicians. It is a pity that the original formula of over ten herbs, before Professor Zhu streamlined it, is not recorded. Many folk empirical formulas are effective; Professor Zhu, in clinical practice, had no sectarian prejudices and was skilled at adopting empirical formulas from all sources, which embodies his open-minded spirit.

The author has recently also learned that some patients, when taking a water-percolating and swelling-reducing Chinese patent medicine composed of twenty herbs including Biejia (Carapax trionycis), Huangqi (Astragalus), Zequi (Euphorbia helioscopia), Chan tan (charred toad), Xiyangshen (American ginseng), Rengong Niuhuang (artificial bezoar), Guiban (Carapax testudinis), Gugou (Gryllotalpa), Xishuai (cricket), and Tinglizi (Descurainia sophia seeds), can achieve the effect of eliminating pleural, ascitic, and pelvic effusions.

Unfortunately, those who use this formula are relatively conservative and unwilling to reveal the full prescription, only telling the author that this formula does not use any of the herbs in the TCM "eighteen incompatibilities" or "nineteen mutual antagonisms"; thus herbs like Yuanhua (Daphne genkwa) and Daji (Cirsium) from the Shizao Tang (Ten-Jujube Decoction) do not appear in this formula. This formula was also popularized after curing a cirrhotic ascites patient; one imagines that its approach has points in common with the approach Professor Zhu Chenyu used. Readers may refer to these two approaches in considering the medication strategy for liver cancer, cirrhosis, and hepatic ascites patients.

It should be noted here that natural musk, bezoar, antelope horn, and saffron are all now very expensive—especially musk and bezoar, which cost far more than gold, beyond the means of ordinary families. But artificial musk and artificial bezoar can be used as substitutes; when this formula has to be used out of necessity, artificial products may replace natural musk and bezoar.

The author has reviewed Professor Zhu Chenyu's various writings but has not found the dosages of the individual herbs in the "Niu She San" he used. Generally speaking, however, the dosages of natural bezoar and musk are both very small; a single dose equivalent to 0.01-0.05 grams is basically sufficient. When specifically composing the formula, the prescriber should weigh the dosage according to the patient's specific condition.

Hepatic ascites and hepatic coma are both critical emergencies, with a low rescue success rate. Professor Zhu Chenyu's precious medical experience is well worth consulting and learning from.