Shuzhuo Yinzi, a Famous TCM Formula for Treating Pleural and Ascitic Fluid and Edema

Shuzhuo Yinzi comes from Jisheng Fang (Prescriptions for Succoring the Sick). It is composed of Fulingpi (Poria peel), Zexie (Alisma), Mutong (Akebia), Chixiaodou (red Phaseolus bean), Dafupi (Areca peel), Qianghuo (Notopterygium), Jiaomu (Prickly ash seed), Qinjiao (Gentiana macrophylla), Binglang (areca nut), Shanglu (Phytolacca) and Shengjiang (fresh ginger). The common modern adult dosage is: Zexie 12 g, Chixiaodou (stir-fried) 15 g, Shanglu 6 g, Qianghuo (rootlets removed) 9 g, Dafupi 15 g, Jiaomu 9 g, Mutong 12 g, Qinjiao (rootlets removed) 9 g, Binglang 9 g, Fulingpi 30 g. The dosage for children is reduced as appropriate: infants aged 0–3 use one-third of the adult dose, children aged 4–9 use half the adult dose, and children aged 10 and above may use the adult dose. For excessively thin children, reduce according to their actual body weight.

This formula has the actions of purging and expelling water, and dispersing wind and releasing the exterior. It is used for the syndrome of exuberant water-dampness, presenting with generalized edema, tight and glossy skin, chest and abdominal glomus and fullness, vexing heat and thirst, panting, dry stools, scanty dark urine, a red tongue with yellow greasy coating, and a deep-rapid or wiry-slippery pulse. Today this formula is mostly used to treat various edematous diseases presenting with the above symptoms, such as cirrhotic ascites, malignant pleural and ascitic fluid, primary nephrotic syndrome, ascites from peritonitis, pleural effusion from pleurisy, idiopathic edema, and cardiac edema.

Every herb in this formula has a strong diuretic effect. Among them, Shanglu belongs to the harsh purgative water-expelling herbs and promotes both bowel movement and urination; Qinjiao drains dampness and dispels bi, and Shennong Bencao Jing records that Qinjiao "mainly treats cold and heat evil, cold-damp wind bi, pain of the limbs and joints, moves water, and promotes urination". Zexie, Chixiaodou, Jiaomu, Mutong and Fulingpi all promote diuresis, drain dampness and dispel edema; Binglang and Dafupi move qi and guide stagnation, enabling qi to flow and water to move; Qianghuo and Shengjiang disperse wind and release the exterior, opening and venting the interstices so that water-dampness exits through the skin. When these herbs are combined, the water-damp evil is discharged simultaneously through both the interior and the exterior.

When pleural effusion compresses the patient so that they pant and cannot lie flat, Tinglizi (Descurainia seed), Sangbaipi (white mulberry bark), Xuanfuhua (Inula flower), Pipaye (loquat leaf) and Xingren (apricot kernel) may be added to drain the lung and promote diuresis. For damp-heat jaundice with edema, Yinchen (Artemisia capillaris), Jinqiancao (Lysimachia), Huzhang (Reynoutria) and Bianlian (Lobelia chinensis) may be added to promote diuresis and resolve jaundice. When heat-toxin is exuberant, Zihuadiding (Viola), Baihuasheshecao (Oldenlandia), Banzhilian (Scutellaria barbata), Pugongying (Dandelion), Lianqiao (Forsythia) and Jinyinhua (Honeysuckle) may be appropriately added to clear heat and resolve toxin. For dry throat and mouth, Baimaogen (Imperata rhizome), Lugen (Phragmites rhizome), Xuanshen (Scrophularia) and Tianhuafen (Trichosanthes root) may be added to nourish yin and moisten dryness. For ascites due to cirrhosis or liver cancer, Biejia (soft-shelled turtle shell) and Shuihonghuazi (Polygonum orientale fruit) may be added to soften hardness and dissipate nodules, plus Yinchen, Zhuling (Polyporus), Yezhuzhu (Phyllanthus urinaria), Hulu (Lagenaria) and Yiyiren (Coix seed) for anti-cancer and diuretic effect. When water and qi bind together with abdominal distension that feels soft on pressure, Muxiang (Aucklandia), Xiangfu (Cyperus) and Laifuzi (radish seed) may be appropriately added to move qi and eliminate fullness. When water and stasis bind together with distending pain of the hypochondria, dark complexion, purple-dark tongue with obvious sublingual stasis spots, blood-activating and stasis-resolving herbs may be added, such as Yimucao (Leonurus), Zelang (Lycopus), Yujin (Curcuma aromatica), Sanleng (Sparganium), Ezhu (Curcuma zedoaria), Chishao (red Paeonia), Sanqi (Panax notoginseng), Danshen (Salvia), Taoren (peach kernel) and Shuizhi (leech).

This formula is not suitable for patients who are excessively weak, because the purging and water-expelling force of the herbs in the formula is strong and easily damages the patient’s original qi. If weak patients use this formula, large doses of Huangqi (Astragalus) and Dangshen (Codonopsis) should be added to support the healthy. Pregnant women should also not use this formula to treat various edematous diseases.