Shipu San (Real-The-Decorum Powder) for Spleen-Kidney Yang-Deficiency Edema

Shipu San comes from Yan's Jisheng Fang (Formulas to Aid the Living, Yan's Family). It mainly treats "yang-deficiency edema, with more severe swelling below the middle of the body, chest and abdominal fullness, or a large abdomen with heavy body, fatigue and poor appetite, cold hands and feet, absence of thirst, thin loose stools, scanty urine, a greasy coating, and a deep slow or deep fine pulse." Today it is often used for intractable edema of cor pulmonale, senile chronic bronchitis, chronic heart failure, refractory ascites, cancerous ascites, pelvic effusion, and infusion-related edema.

The formula consists of: prepared Aconite (pao fuzi) two qian (6 g), Atractylodes macrocephala (baizhu) two qian (6 g), white Poria (bailing) two qian (6 g), dried ginger (ganjiang) two qian (6 g), Magnolia bark (houpo) two qian (6 g), Chaenomeles (mugua) two qian (6 g), Aucklandia (muxiang) two qian (6 g), Tsaoko (caoguo) two qian (6 g), Areca fruit (dafupi) two qian (6 g), licorice (gancao) one qian (6 g), three slices of fresh ginger, and three jujubes. The original formula chops all herbs except ginger and jujube into a powder and decocts with ginger and jujube in water. Modern practice mostly decocts the crude pieces directly; considering the quality of today's herbs, when I use this formula myself I generally use 2-3 times the original dose.

The medication indications for this formula are: aversion to cold with cold limbs, scanty urine, loose or diarrhea stools, abdominal distention, absence of thirst, lower-limb edema, and a heavy body.

In this formula, Aconite and Atractylodes warm the kidney and fortify the spleen; dried ginger, greatly acrid and hot, helps Aconite warm yang; Magnolia bark, Tsaoko, and Aucklandia move qi and eliminate distention, also drying dampness and stopping diarrhea; Poria and Areca fruit percolate water and subside swelling; ginger and jujube boost stomach qi; licorice harmonizes the various herbs; Chaenomeles both dries dampness and stops diarrhea. Because this is an edema condition, a large dose of licorice would retain dampness and obstruct the diaphragm, so the dose of licorice in this formula is small.

Any edema, ascites, or pleural-effusion case accompanied by the above symptoms may use this formula. Shipu San has a wide range of applications and a wealth of clinical research, too much to enumerate. As long as the indications are met, no matter what kind of edema the patient has, one may try this formula. Ascites patients with constipation should use it cautiously.