Shenxiao Tingli San: A Formula for Various Body Effusions
In Taiping Shenghui Fang (Imperial Grace Formulas of the Taiping Era) there is a formula called “Shenxiao Tingli San” (Miraculous Descurainia Powder), indicated for “the ten types of water diseases uncured by a hundred formulas, with face, eyes, and limbs all swollen, breath rushing and panting, unable to lie down or sleep, urine gradually scant, swelling and qi oppression, water not entering the mouth, life hanging by a thread.” These symptoms are common in patients with pleural effusion, ascites, and pericardial effusion, especially cirrhotic and late-stage cancer patients with pleural and abdominal fluid.Shenxiao Tingli Powder consists of: sweet Tinglizi (Descurainia seed, stir-fried with paper until purple) 3 liang (now 90 g), Qianniuzi (pharbitis seed, slightly stir-fried) 2.5 liang (now 75 g), Zhuling (Polyporus, black skin removed) 2 liang (now 60 g), Zexie (Alisma) 2 liang (now 60 g), Jiaomu (Sichuan pepper seed, slightly stir-fried) 1.5 liang (now 45 g). Grind all herbs together into powder. Each time take three qian (now 9 g), with 3 scallion whites and one large cup of jiangshui (i.e., plain water, about 100–150 ml today), boil to half a cup, then add half a cup of clear wine (about 50–75 ml), stir well, and take on an empty stomach. The clear wine of the Song dynasty was very low in alcohol, similar to today’s sweet rice wine. But for cancer and cirrhosis patients, no wine should be added.After taking it, “either three to five sheng of urine passes, or the bowels move, panting immediately settles, swelling reduces by seven-tenths; take again the next day; for a hundred days, nourish carefully.” This means after the dose the patient may urinate more or have more bowel movements; after purgation, panting improves greatly and edema decreases by seven or eight-tenths. But this is not a disease cured in one dose; take it every other day for about a hundred days. Moreover, salt and all wheat foods are forbidden; this dietary restriction is hard to enforce, so a light diet suffices.All the herbs in Shenxiao Tingli Powder are purgative diuretics. Sweet Tinglizi is Descurainia seed; Jiaomu is Sichuan pepper seed. In Zhang Zhongjing’s Jingui Yaolue (Essential Prescriptions from the Golden Cabinet) there is also a formula combining Tinglizi and Jiaomu for edema—Jijiao Lihuang Wan, consisting of Fangji (Stephania), Jiaomu, Tinglizi, and Dahuang. Because it contains Dahuang, Jijiao Lihuang Pills are actually unsuitable for long-term use.Relatively speaking, Shenxiao Tingli Powder’s composition is more suited to treating edema and more suitable for prolonged use. Even so, such purgatives raise safety concerns; patients must remember to use it every other day, not daily.Although this formula is a strong diuretic, for end-stage patients who have long used diuretics (whether Chinese or Western), it may no longer induce diuresis. Also, for weak patients with pleural or abdominal effusion, this formula is too drastic and should be combined with qi-supporting, root-securing herbs. Very weak patients may decoct 30–60 g Huangqi (Astragalus), 30–60 g Yiyiren (Coix), 15–30 g Dangshen (Codonopsis), and 15–30 g Huangjing (Polygonatum) into a broth, then use this broth to decoct 9 g of Shenxiao Tingli Powder.Once late-stage cancer patients develop pleural or ascites, prognosis is mostly poor. This formula may relieve symptoms but can hardly control tumor progression on its own; it must be combined with other anti-tumor regimens.This formula can also be used for pleural effusion caused by bronchial asthma, pleurisy, emphysema, and similar diseases. Elderly patients should follow the method of Tinglizi Dazao Xiefei Decoction—decocting with 10 Dazao (jujubes) to protect the body’s zheng qi.