Precautions When Treating Ascites with TCM in Advanced Cancer Patients
Although for most cancer patients who develop ascites the end of life is near, a small number can, if appropriate measures are taken, survive for a time with a relatively good quality of life; some can even turn danger to safety. Among the ascites patients I have treated, several survived more than one year after treatment.
When a cancer patient develops ascites, one must absolutely not use formulas such as Shizao Tang (Ten Jujube Decoction) or Guzheng Wan, which contain strongly toxic herbs such as Daji (Euphorbiae Pekinensis Radix) and Gansui (Kansui Radix); this is especially true of advanced cancer patients. Among the advanced cancer patients I have seen, every single one who used Shizao Tang or Guzheng Wan died soon afterward. Shizao Tang may produce temporary effect, but usually the effect can hardly be maintained for more than half a month, after which there is a violent rebound. The patient’s constitution rapidly deteriorates and is beyond rescue. Shizao Tang is generally suitable only for ascites in non-cancer patients or in early-stage cancer.
Some doctors grind the ingredients of Shizao Tang into powder or fill capsules for patients to take. I particularly warn cancer patients and their families not to abuse doctors’ self-made preparations of unknown composition. In the cases I have seen, most doctors grind highly toxic herbs such as Daji, Gansui, Yuanhua (Genkwa Flos), Badou (Crotonis Fructus), and Qianniuzi (Pharbitidis Semen) into powder for patients. The patient may feel good at first, but an advanced cancer patient is like a candle in the wind; once such strong purging and downbearing herbs are used, the constitution deteriorates rapidly and is beyond rescue. Patients treated at home, without the constant observation of hospital physicians, should be especially cautious.
Dietary therapy should be considered first for ascites. Dishes such as white radish stewed with crucian carp, stir-fried huju (bottle gourd), and winter melon are no less effective for ascites than most diuretic Chinese and Western drugs. The gourd-family huju in particular has a very good diuretic effect. Laifuzi (Raphani Semen, i.e., radish seeds) also diuretics well; it can be started at 30 g, and in large doses may be used up to 150–250 g at a time; Laifuzi is very safe.
For ascites due to liver cancer (primary or secondary), diuresis should be combined with decoctions based on Xiao Chaihu Tang (Minor Bupleurum Decoction) and the kidney-eight series of patent medicines (Jinkui Shenqi Wan, Jisheng Shenqi Wan, Liuwei Dihuang Wan, etc.), to regulate the patient’s digestive and urinary function.
Ascites treatment must never be rushed; those who rapidly drive off the fluid hardly ever survive. I usually follow the treatment approach of the late famous physician Zhao Shaoqin for ascites; Master Zhao treated steadily, effectively, and safely. The basic approach is to harmonize and resolve the shaoyang, soothe and regulate the qi dynamic, and moderately leach out fluid. If the patient has not already been tormented by other doctors’ tiger-wolf medicines, in about half a month to two months the ascites can be brought under control.
Patients with primary or secondary liver cancer should, when taking Chinese medicines on a regular basis, use Chaihu and Huangqin long-term; in each formula, Chaihu and Huangqin should each be used at 6–12 g. This is very helpful in preventing cancer fever and ascites. This is the clinical experience of an old Beijing TCM physician; several of his cancer patients survived for more than ten years.
Through patients of mine who had previously been treated by this old physician, I have seen the formulas he prescribed over the years; in almost every one, Chaihu and Huangqin were mandatory. I have been borrowing this approach in treating cancer patients over the last few years, and the results have been good. Unfortunately, this old physician retired many years ago due to age, and I do not know whether he is still living.
In addition, if an ascites patient’s condition is severe, part of the ascitic fluid should be drained early and without hesitation to gain treatment time; ascites in a liver cancer patient is like facing a major enemy. TCM treatment should generally be started early. Current Western diuretics such as spironolactone have very little effect on liver-cancer ascites; many patients get no benefit, and even when there is an effect it generally wears off after one to two weeks. But with Chinese decoctions combined with dietary therapy, some patients can gain a slim chance of survival.