Sanju Tang: TCM Treatment of Abdominal Masses (Hyperplasia or Nodular Diseases)

Sanju Tang (Mass-Dispersing Decoction), as the name suggests, is a formula aimed at dispersing accumulations and gatherings. Historically, many medical works contain a formula named Sanju Tang. For instance, Chen Yan's Sanyin Jiyi Zhengzheng Fanglun of the Song dynasty contains "Sanju Tang"; the Ming-dynasty physician Wu Kun's Yifang Kao contains Sanju Tang; and the Qing-dynasty physician Xu Lingtai's Yilue Liushu also contains Sanju Tang. Yifang Kao explains the name Sanju Tang as follows: "This formula is named Sanju because it disperses the gathering qi of the six fu organs."

The composition of Sanju Tang in successive medical works is not entirely identical, but its prescribing logic is basically the same. Sanju Tang is mainly used to regulate disordered qi movement and phlegm-damp accumulation. Its prescribing strategy is chiefly to move qi and eliminate distension, resolve phlegm and drain dampness, and dissipate nodules and scrofula. Common ingredients include Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Fuling (Poria), Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Xiangfu (Cyperi Rhizoma), Xingren (Armeniacae Semen), Binglang (Arecae Semen), Fuzi (Aconiti Lateralis Radix Praeparata), Chuanxiong (Chuanxiong Rhizoma), Wuzhuyu (Evodiae Fructus), Danggui (Angelicae Sinensis Radix), Huanglian (Coptidis Rhizoma), Rougui (Cinnamomi Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Muxiang (Aucklandiae Radix), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma). It is indicated for chest and hypochondrial fullness, phlegm-nodule accumulations, and epigastric-abdominal glomus and oppression. Modernly, Sanju Tang is used for chronic diseases such as chronic gastritis, cholecystitis, gastric cancer, liver cancer, pancreatic cancer, gallbladder cancer, lipoma, and thyroid nodules.

When studying this prescription, we should not study it rigidly but draw from its prescribing logic the ancients' experience in treating such diseases. Chenpi and Banxia dry dampness and resolve phlegm, relieving nausea and vomiting caused by phlegm-damp obstruction; if necessary, Dannannan (Arisaema cum Bile), Zhuru (Bambusae Caulis in Taeniam), Tianzhuhuang (Bambusae Concretio Silicea), Xuanfuhua (Inulae Flos), Daizheshi (Hematitum), and Pipaye (Eriobotryae Folium) may be added to strengthen dampness-drying, phlegm-resolving, and anti-emetic power. Zhiqiao, Houpo, and Muxiang move qi and loosen the center, improving epigastric-abdominal fullness; if necessary, Sharen (Amomi Fructus), Cangzhu (Atractylodis Rhizoma), and Zhishi (Aurantii Fructus Immaturus) may be added to strengthen this. Xiangfu, Xingren, Chuanxiong, and Danggui soothe the liver, regulate qi, and invigorate blood, improving hypochondrial pain or emotional constraint due to qi stagnation and blood stasis; if necessary, Yujin (Curcumae Radix), Bayuezha (Akebiae Fructus), Meiguihua (Rosae Rugosae Flos), and Dai daihua (Citri Aurantii Flos) may be added to strengthen liver-soothing and qi-regulating power. Huanglian, Rougui, Wuzhuyu, and Fuzi are used together, cold and hot combined, to treat epigastric emptiness, acid regurgitation, and heartburn; if the patient's gastric burning and pain are strong, Baishao (Paeoniae Radix Alba), Baiji (Bletillae Rhizoma), and Wuzeigu (Sepiae Endoconcha) may be added to suppress acid and stop pain. Sanleng and Ezhu break qi and disperse gatherings, and are excellent herbs for treating concrete glomus masses; Ruxiang (Olibanum), Moyao (Myrrha), Xuejie (Draconis Sanguis), and Ercha (Catechu) may also be added to strengthen mass-dispersing power.

Beyond this, we may also modify the formula according to the patient's symptoms. If the patient has exuberant heat-toxin, add Pugongying (Taraxaci Herba), Lianqiao (Forsythiae Fructus), Jinyinhua (Lonicerae Flos), Zihuadiding (Violæ Herba), Yejuhua (Chrysanthemi Indici Flos), Huangqin (Scutellariae Radix), Banlangen (Isatidis Radix), and Daqingye (Isatidis Folium) to clear heat and resolve toxin. If the patient has edema or ascites, appropriately add Zhizi (Gardeniae Fructus), Yinchen (Artemisiae Scopariae Herba), Zhuling (Polyporus), Hanfangji (Stephaniae Tetrandrae Radix), Cheqiancao (Plantaginis Herba), Huainiuxi (Achyranthis Bidentatae Radix), Yimucao (Leonuri Herba), and Zelan (Lycopi Herba). If the patient has concrete phlegm nodules that have long failed to disperse, appropriately add Haizao (Sargassum), Kunbu (Eckloniae Thallus), Xuanshen (Scrophulariae Radix), Zhebeimu (Fritillariae Thunbergii Bulbus), Muli (Ostrea Concha), and Huangyaozi (Dioscoreae Bulbiferae Rhizoma) to resolve phlegm and scatter nodules.

Accumulations and gatherings (ji ju) are major diseases in TCM; severe cases are even among the four terminal diseases of TCM internal medicine. Treatment is extremely difficult; the physician must use comprehensive medication according to the patient's condition and continuously adjust the therapeutic strategy based on feedback after dosing, achieving results slowly. Once the effect is stable, the patient may be told to make the most suitable formula into pills for long-term use.

Accumulations and gatherings are also related to the patient's unhealthy lifestyle; such diseases mostly occur in people who love smoking and alcohol, eat rich, greasy food, and dislike exercise. During medication, patients should also adjust their habits: quit smoking and alcohol, do not overeat meat and pickled foods, do not stay up late, and exercise moderately. Only by integrating medical treatment with self-care can better results be achieved.