Experience in Treating Ascites in 3 Cancer Patients Using the Approach of Soothing and Regulating Qi Movement

Doctor zhou March 1, 2021

Patients with primary or secondary tumors of the hepatobiliary system often develop ascites in the late stage. Treating ascites in such cancer patients with only the approach of promoting urination and reducing swelling does not work well.

Among the medical cases of the late renowned TCM warm-disease master Professor Zhao Shaoqin, there is one of a gastric cancer patient with liver metastasis. On March 14, 1985, the patient's ultrasound showed: hypoechoic areas in the lateral segment and medial margin of the left liver, measuring 2.0×2.1 cm and 3.0×2.9 cm respectively, with fairly clear boundaries; the right liver echo was uniform with no obvious abnormal area. Suggestion: multiple space-occupying lesions (M) in the left liver. Elder Zhao treated the patient with the approach of resoothing and regulating qi movement; after more than a year of continued medication, the tumor actually disappeared. Elder Zhao mainly used the famous warm-disease formula Shengjiang San (Ascending-Descending Powder), emphasizing resoothing and regulating qi movement, continuously adjusting the prescription according to the patient's condition, and treating both the root and the manifestation. The herbs used included Xuan Fu Hua (Inulae Flos), Pian Jiang Huang (Curcumae Longae Rhizoma preparata), Chan Yi (Cicadae Periostracum), Jiang Can (Bombyx Batryticatus), Xiang Fu (Cyperi Rhizoma), Mu Xiang (Aucklandiae Radix), Dan Shen (Salviae Miltiorrhizae Radix), Jiao San Xian (three charred digestive herbs), Pi Pa Ye (Eriobotryae Folium), Zhu Ru (Bambusae Caulis in Taeniam), Ban Bian Lian (Lobeliae Chinensis Herba), Chi Shao (Paeoniae Rubra Radix), Qian Cao (Rubiae Radix), Chen Pi (Citri Reticulatae Pericarpium), and Fa Ban Xia (processed Pinelliae Rhizoma).

I have also followed Professor Zhao Shaoqin's approach and treated three hepatobiliary cancer patients who developed hepatic ascites, with quite good results. I now compile the medical cases of these three patients for everyone's reference.

First patient: Ding, male, 53 years old; first visit December 1, 2013.

The patient was hospitalized and examined at Beijing 302 Hospital on November 28, 2013. The CT report (image no. 100210226) showed: enlargement of the left hepatic lobe, widened hepatic fissure, irregular surface, shrinkage of the right hepatic lobe, uneven hepatic parenchymal density with multiple fiducial markers; enhanced scan showed uneven enhancement of the right hepatic lobe, with mixed-density shadows in the portal venous and delayed phases. Multiple small nodular high-density shadows were seen in the left hepatic lobe; enhanced scan showed several small patchy enhancements in the left lobe, and a 21×23 mm low-density shadow in the portal venous and delayed phases, with a filling defect in the portal vein. The gallbladder was not enlarged, with thickened wall; the spleen measured 5–6 rib units; the pancreas and kidneys appeared normal. Soft-tissue nodular shadows were seen around the abdominal aorta; water-density shadows were seen in the abdominal cavity and right thoracic cavity.

Diagnostic opinion: 1. Post-treatment state of liver cancer; MRI recommended for further examination; retroperitoneal lymph node enlargement. 2. Liver cirrhosis, correlate clinically; right pleural effusion and ascites. 3. Cholecystitis.

In addition, the patient's chest CT showed lesions in the lungs as well.

Before coming to me, this patient had already been treated for ascites at several Beijing hospitals by several renowned TCM professors. On November 28 he had this follow-up examination, and after finding that previous treatments were ineffective, he came to me for help.

The patient's right pulse was fine and slippery, the left deep and tight; there was mild distending pain and discomfort around both rib sides, more pronounced after walking and after meals. He usually coughed up sputum with black spots; the tongue was enlarged and moist, with a white greasy coating and no obvious teeth marks; the skin was itchy. Recently he had sought treatment from a renowned TCM liver specialist, who focused on strengthening the spleen with the following prescription:

Sheng Huang Qi (Astragali Radix) 30 g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 30 g, Zhu Ling (Polyporus) 30 g, Dong Gua Pi (Benincasae Exocarpium) 30 g, Ting Li Zi (Lepidii/Descurainiae Semen) 30 g, Che Qian Zi (Plantaginis Semen) 20 g, Xuan Fu Hua (Inulae Flos) 10 g, Dai Zhe Shi (Hematitum) 10 g, Hou Po (Magnoliae Officinalis Cortex) 10 g, Da Fu Pi (Arecae Pericarpium) 20 g, Chen Pi (Citri Reticulatae Pericarpium) 15 g, Dang Gui (Angelicae Sinensis Radix) 10 g, Cao He Che (Paris/Liriopes/Rhizoma Paridis) 30 g, Shan Ci Gu (Creidis/Pseudobulbus Cremastrae) 10 g, Feng Fang (Vespae Nidus) 5 g, Lou Lu (Rhapontici Radix) 30 g.

After taking 15 doses, there was no obvious improvement.

After my face-to-face consultation, I decided to borrow Professor Zhao Shaoqin's approach, focusing on resoothing and regulating qi movement while also nourishing yin and clearing and draining damp-heat. The prescription was:

Sha Shen (Glehniae/Lycii Radix) 10 g, Mai Dong (Ophiopogonis Radix) 10 g, Wu Wei Zi (Schisandrae Fructus) 10 g, Pian Jiang Huang (Curcumae Longae Rhizoma preparata) 6 g, Chan Tui (Cicadae Periostracum) 6 g, Chao Jiang Can (stir-fried Bombyx Batryticatus) 10 g, Yu Jin (Curcumae Radix) 6 g, Chai Hu (Bupleuri Radix) 6 g, Cu Xiang Fu (vinegar-processed Cyperi Rhizoma) 10 g, Xuan Fu Hua (Inulae Flos) 10 g, Xing Ren (Armeniacae Semen) 10 g, Pi Pa Ye (Eriobotryae Folium) 10 g, Mao Zhua Cao (Ranunculi Ternati Radix) 30 g, Xu Chang Qing (Cynanchi Paniculati Radix) 15 g, Yin Chen (Artemisiae Scopariae Herba) 10 g, Chao Zhi Zi (stir-fried Gardeniae Fructus) 6 g, Ban Zhi Lian (Scutellariae Barbatae Herba) 10 g, Bai Shao (Paeoniae Alba Radix) 10 g, Chi Shao (Paeoniae Rubra Radix) 10 g, Qian Cao (Rubiae Radix) 10 g, Sheng Huang Qi (Astragali Radix) 20 g, Qian Li Guang (Senecionis Scandentis Herba) 15 g, Qin Pi (Fraxini Cortex) 10 g.

7 doses; return for a follow-up visit after one week.

On December 8 the patient returned, reporting that after taking the above formula he had dull periumbilical pain, loose stools, and indigestion after meals. The above formula was bitter-cold and had damaged spleen yang, so I adjusted it as follows:

Dang Shen (Codonopsis Radix) 15 g, Fa Ban Xia (processed Pinelliae Rhizoma) 10 g, Chen Pi (Citri Reticulatae Pericarpium) 10 g, Zi Su (Perillae Folium) 10 g, Chai Hu (Bupleuri Radix) 10 g, Huang Qin (Scutellariae Radix) 10 g, Huang Lian (Coptidis Rhizoma) 6 g, Pian Jiang Huang (Curcumae Longae Rhizoma preparata) 6 g, Chan Tui (Cicadae Periostracum) 6 g, Chao Jiang Can (stir-fried Bombyx Batryticatus) 10 g, Mao Zhua Cao (Ranunculi Ternati Radix) 30 g, Bai Hua She She Cao (Oldenlandiae/Hedyotis Herba) 30 g, Chao Zhi Zi (stir-fried Gardeniae Fructus) 10 g, Chao Bai Zhu (stir-fried Atractylodis Macrocephalae Rhizoma) 10 g, Cang Zhu (Atractylodis Rhizoma) 10 g, Chao Zhi Qiao (stir-fried Aurantii Fructus) 10 g, Ji Nei Jin (Galli Gigerii Endothelium Corneum) 30 g, Shui Hong Hua Zi (Polygoni Orientalis Fructus) 10 g, Jiao Shan Zha (charred Crataegi Fructus) 15 g, E Zhu (Curcumae Rhizoma) 6 g, Zhi Gan Cao (honey-fried Glycyrrhizae Radix) 6 g, Mu Xiang (Aucklandiae Radix) 10 g, Fu Ling (Poria) 15 g, Zhu Ling (Polyporus) 8 g, Bai Shao (Paeoniae Alba Radix) 15 g.

On December 22 the patient returned again; his condition had improved markedly, so I decided to continue treating him mainly with Chai Hu, Huang Qin, and Shengjiang San:

Chai Hu (Bupleuri Radix) 12 g, Huang Qin (Scutellariae Radix) 12 g, Jiang Can (Bombyx Batryticatus) 10 g, Chan Yi (Cicadae Periostracum) 6 g, Pian Jiang Huang (Curcumae Longae Rhizoma preparata) 6 g, Fa Ban Xia (processed Pinelliae Rhizoma) 10 g, Dang Shen (Codonopsis Radix) 15 g, Bai Shao (Paeoniae Alba Radix) 12 g, Chi Shao (Paeoniae Rubra Radix) 12 g, Zhi Gan Cao (honey-fried Glycyrrhizae Radix) 6 g, Yin Chen (Artemisiae Scopariae Herba) 6 g, Mao Zhua Cao (Ranunculi Ternati Radix) 30 g, Shan Dou Gen (Sophorae Tonkinensis Radix) 6 g, Bai Hua She She Cao (Oldenlandiae/Hedyotis Herba) 30 g, Mao Zhua Cao 30 g, Xiang Fu (Cyperi Rhizoma) 10 g, Xing Ren (Armeniacae Semen) 10 g, fresh Sheng Jiang (Zingiberis Rhizoma) 5 slices, Da Zao (Jujubae Fructus) 5 pieces.

He also took Compound Cantharidin Capsules, Xi Huang Wan, and other anti-cancer medicines for the tumor, Gui Pi Wan to strengthen the spleen, and Compound Berberine for anti-inflammation. One more week later, the patient's pleural effusion and ascites disappeared; the previously elevated tumor markers returned to normal; his condition improved markedly, and he walked more than ten thousand brisk steps a day. The patient then continued treatment with me for nearly two years. When he first came to me, his Western doctor had held out no hope that he would live through that year's Spring Festival. But the patient not only passed that year's Spring Festival safely, he also passed the next year's Spring Festival without incident.

Later, after the patient learned his true condition, he began to panic, lost confidence in TCM treatment, and sought other treatments. As a result, after switching doctors his condition deteriorated rapidly; ascites recurred. After a TCM specialist's treatment failed, he switched again to an old TCM doctor who used harsh diuretics of the Shi Zao Tang (Ten-Jujube Decoction) type, and his condition grew worse. When he came back to me for help, his condition was already quite severe, and I could do nothing. He was sent to 302 Hospital; despite combined TCM-WM treatment, he died.

I have previously published Ding's medical case. Later, a gallbladder cancer patient Liu from Enshi, Hubei, also had ascites and was critically ill with severe abdominal distension, greatly affecting his quality of life. Before having a face-to-face consultation with me, he took the prescription from Ding's case that I had published on his own, namely:

After taking the medicine, the patient's condition was markedly relieved and he was able to go out. He had his first visit with me on May 30, 2019. On May 20, 2019, he underwent a CT examination at the Enshi Tujia and Miao Autonomous Prefecture Central Hospital (affiliated to Wuhan University Enshi Clinical College) (hospital no. 201942573, CT no. C293812), which showed: malignant gallbladder tumor with multiple liver metastatic tumors and greater omentum metastases, markedly progressed compared with before; thickened bowel wall of the transverse colon and duodenal bulb, possible tumor invasion; possible duodenal diverticulum; small retroperitoneal lymph node shadows; enlarged and increased abdominal lymph nodes; abdominal effusion. Bilateral renal cysts. CEA, CA125, CA19-9, CA72-4, ferritin, NSE, and CYFRA21-1 were all elevated. Weight had dropped sharply and he was emaciated.

The right pulse was wiry, slippery, soft, and weak; the left pulse was fine, wiry, slippery, soft, and weak; the tongue was red, watery-slippery, with no coating. Bitter mouth, low blood pressure, abdominal distension, difficult urination and defecation; frequent hiccups; back pain. The condition was already severe, and cure was unlikely. I spoke with the family, telling them the medicine could only relieve the patient's suffering.

Decoction: Dang Shen 15 g, Fa Ban Xia 10 g, Chen Pi 10 g, Zi Su 10 g, Chai Hu 10 g, Huang Qin 10 g, Huang Lian 6 g, Pian Jiang Huang 6 g, Chan Tui 6 g, Chao Jiang Can 10 g, Mao Zhua Cao 30 g, Bai Hua She She Cao 30 g, Chao Zhi Zi 10 g, Chao Bai Zhu 10 g, Cang Zhu 10 g, Chao Zhi Qiao 10 g, Ji Nei Jin 30 g, Shui Hong Hua Zi 10 g, Jiao Shan Zha 15 g, E Zhu 6 g, Zhi Gan Cao 6 g, Mu Xiang 10 g, Fu Ling 15 g, Zhu Ling 8 g, Bai Shao 15 g, Yin Chen (Artemisiae Scopariae Herba) 20 g, Jin Qian Cao (Lysimachiae Herba) 30 g, Hai Jin Sha (Lygodii Spora) 15 g, Yi Mu Cao (Leonuri Herba) 20 g, Mo Han Lian (Ecliptae Herba) 6 g, Nu Zhen Zi (Ligustri Lucidi Fructus) 6 g, Sha Yuan Zi (Astragali Complanati Semen) 6 g, Tu Si Zi (Cuscutae Semen) 6 g, Huai Niu Xi (Achyranthis Bidentatae Radix) 10 g, Che Qian Cao (Plantaginis Herba) 15 g, Che Qian Zi (Plantaginis Semen) 15 g.

After several more remote adjustments of the prescription, the suffering of the patient's final days was alleviated.

Recently I encountered another case, a cholangiocarcinoma patient from Xinjiang. The patient's daughter works and lives in Tianjin, and the patient also sought care in Tianjin. On February 17, 2021, the patient underwent color Doppler examination at Tianjin First Central Hospital (outpatient no. 210217979812), which showed: solid mass of the common bile duct, post-PTCD state, intrahepatic bile duct dilation (more marked in the right liver), gallbladder edema with biliary sludge, cystic duct dilation, portal vein thrombus, and ascites. This patient had previously been treated by a local TCM doctor in Tianjin, which resolved some problems, but the ascites was never resolved. Because of the pandemic, the patient could not come in person, so his daughter sought my help remotely. The patient's tongue coating was bruised-black, with bitter mouth, dry mouth, difficult defecation, and leg edema. I carefully reviewed the previous TCM prescriptions, which had used large amounts of spleen-strengthening and diuretic herbs without resolving the fluid; so I decided to treat the patient according to Professor Zhao Shaoqin's approach of resoothing and regulating qi movement. The prescription was:

Sha Shen 10 g, Mai Dong 10 g, Wu Wei Zi 10 g, Pian Jiang Huang 6 g, Chan Tui 6 g, Chao Jiang Can 10 g, Yu Jin 6 g, Chai Hu 6 g, Cu Xiang Fu 10 g, Xuan Fu Hua 10 g, Xing Ren 10 g, Pi Pa Ye 10 g, Mao Zhua Cao 30 g, Xu Chang Qing 15 g, Yin Chen 10 g, Chao Zhi Zi 6 g, Ban Zhi Lian 10 g, Bai Shao 10 g, Chi Shao 10 g, Qian Cao 10 g, Sheng Huang Qi 20 g, Yi Mu Cao (Leonuri Herba) 30 g, Che Qian Cao (Plantaginis Herba) 30 g, Mo Han Lian (Ecliptae Herba) 30 g, Shu Da Huang (prepared Rhei Radix) 10 g.

3 doses, decocted in water.

After taking 3 doses, the patient's leg edema subsided markedly, abdominal distension was much reduced, the bruised-black tongue coating resolved, dry mouth improved, and appetite improved.

Why is the approach of resoothing and regulating qi movement so much more effective than strengthening the spleen and promoting diuresis for ascites in hepatobiliary cancer patients? It is mainly because, in TCM view, the liver's body is yin while its function is yang; it prefers smooth spreading and dislikes constraint. Therefore, when treating tumor patients of the hepatobiliary system, one should soothe the liver and move qi as the main approach, while also addressing the manifestation. If one blindly uses diuretic and swelling-reducing herbs without spreading liver qi, there is no way to address the “root.”

The patient Professor Zhao Shaoqin treated had not progressed to a severe stage and had not yet developed ascites, so the timing of treatment was well chosen. Moreover, Elder Zhao was a towering figure in the medical community, a master of the warm-disease school, with superb skill; the patient trusted him and cooperated with the treatment, so after more than a year of treatment, he was actually cured.

When I read Elder Zhao's medical cases, I too found this efficacy unbelievable, but after personally treating several patients following his approach and obtaining results, I was deeply convinced by this medication strategy. Recently the famous Hong Kong comedian Uncle Tat (Ng Man-tat) also passed away from liver cancer. From the symptoms described in the news before his death, he too belonged to late-stage hepatobiliary tumor patients with constrained qi movement; if he could have been treated with Professor Zhao Shaoqin's approach, his life might have been prolonged.

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