A TCM Case: Ascites from Hepatosplenomegaly due to Schistosomiasis with Lung Cancer—Patient Zhou

Zhou, female, 73, mother of Dr. Liu, a chief physician at a Grade-A tertiary hospital in Yueyang, Hunan. On December 18, 2020, Dr. Liu for the first time invited me to a video consultation for his mother.

The patient had advanced schistosomiasis, liver cirrhosis with ascites, splenomegaly, type 2 diabetes, and hypertension; platelets very low, RBC and WBC both on the low side.

At video consult: dry but not bitter mouth, no abdominal distension or pain, shortness of breath on walking fast. Constitution declined; hands ice-cold, feet slightly better, legs slightly edematous. Had used spironolactone, now mainly on Western liver-protecting drugs. After local herbs her spirit improved, but appetite poor and she was losing weight progressively. She also had cholesterol gallstones and many skin spots. Stools dark and formed. Frequent nighttime urination, slightly pale yellow urine; daytime frequency not obvious. No back pain; dull pain under left rib margin. Snored; slept seven-eight hours, could fall back after each void. Frequency predated spironolactone and worsened on diuretics. No back referred pain; tinnitus and deafness.

I gave Dr. Liu the following suggestions to judge himself:

1. Take ursodeoxycholic acid tablets for gallstones and gallbladder cholesterol deposition;
2. Take Jinkui Shenqi Wan (Golden Chamber Kidney-Qi Pill) for leg edema, nocturia, cold hands, and ascites;
3. Take Biejia Ruangan Pian (Turtle Shell Liver-Softening Tablet) for cirrhosis and splenomegaly;
4. Daily, wrap 30 g raw Huangqi (Astragalus) and 6 g Danggui (Angelica) in cloth and cook with 30-60 g Coix seed into porridge, eaten at breakfast or lunch (not evening) to improve the blood picture;
5. Is there occult blood in stool? If so, also take Yunnan Baiyao capsules twice daily, 0.5 g each.

On April 11, 2021, Dr. Liu again consulted me: his mother had followed my advice and was stable, with good diet, routine, and spirit. But over the prior two weeks her calves and ankles became slightly edematous, worse each afternoon, basically gone by next morning. A few days earlier she had distension and poor appetite; hospital tests showed considerable new ascites and liver changes. Contrast CT showed space-occupying lung lesions. Given his clinical experience, Dr. Liu chose conservative TCM treatment for his mother.

At consult the patient reported tasteless mouth, no dryness, abdominal distension, shortness of breath on exertion. Spirit fair. Yellow stools; frequent nocturia. Little gas; slight early-morning diarrhea. Bowels usually regular; after wontons that morning loose once, then fine. Urine frequent by day, less at night, about 3000 ml/day. Both flanks distended. Foot edema slightly better after IV fluids. Recent fatigue easing; she could be outdoors. Dr. Liu wanted insurance-covered Western diuretics combined with TCM.

I combined Xiao Chaihu Tang (Minor Bupleurum Decoction), Huangqi Fangji Tang (Astragalus-Stephania Decoction), and Jiangjiang San, with modifications:

Chaihu (Bupleurum) 6 g, Huangqin (Scutellaria) 6 g, Dangshen 15 g, Huangjing 15 g, raw Huangqi 30 g, Hanfangji 15 g, Baizhu 15 g, Fuling 15 g, Xiangfu 10 g, Xuanfuhua 10 g (wrapped), Pipaye 6 g, Pianjianghuang 6 g, Chantui 6 g, Jiangcan 10 g, Muxiang 6 g, Danshen 10 g, Jiao Sanxian 10 g each, Banzhilian 10 g, Baihuasheshecao 10 g, Shayuanzi 6 g, Tusizi 6 g, Nüzhenzi 6 g, Mohanlian 6 g.

Patent medicines: continue Biejia Ruangan Pian; in addition, pills were compounded per my multi-target herbal anticancer approach; the regimen is in my article 'My Practical Experience in Using Broad-Spectrum, Multi-Target Chinese Herbal Compounds against Cancer'.

On April 17, Dr. Liu said Western diuretics were weakening and asked to strengthen the herbal diuresis. I changed the formula to:

Yinchen (Artemisia capillaris) 20 g, fried Zhizi (Gardenia) 15 g, Jinqiancao 30 g, Fuling 10 g, Zhuling 10 g, Zexie 10 g, raw Baizhu 20 g, Yimucao 30 g, Baimaogen 30 g, Cheqianzi 20 g, Huainiuxi 15 g, Cangzhu 15 g, Houpo 10 g, Fabanxia 10 g, Zelan 20 g, Zhi Gancao 6 g, Dangshen 30 g, Huangjing 30 g, Hanliancao 30 g, Nüzhenzi 10 g, fresh ginger 7 slices, jujube 10 pieces.

Video visit, April 20.

After diuretics, urine slightly more; stools difficult. For years, due to external hemorrhoids, she had to digitally assist or wash to pass stool; stools dark. Recent two days dry mouth, not bitter. Teeth-marked tongue; poor appetite. Distension; shortness of breath. Fatigue about the same; foot pain better. Gas returned the prior two days, less yesterday. I decided on Guipi Tang (Spleen-Returning Decoction) combined with Jiangjiang San and Xiaoluo Tang, with additions.

Decoction: raw Huangqi 30 g, Dangshen 30 g, Huangjing 30 g, Yuzhu 15 g, fried Baizhu 30 g, Fuling 30 g, Zhuling 10 g, Shihu 15 g, Cheqianzi 15 g, Danggui 10 g, Danshen 30 g, Muxiang 10 g, Longyanrou 10 g, Suanzaoren 10 g, Yuanzhi 10 g, Zhi Gancao 10 g, Xuanshen 12 g, Zhebeimu 12 g, raw Muli 30 g (first half hour), Zhi Biejia 30 g (first half hour), Guiban 30 g (first half hour), Yimucao 30 g, Yinchen 20 g, fried Zhizi 15 g, Pianjianghuang 10 g, Ezhu 10 g, fried Jiangcan 10 g, Yujin 10 g, Chantui 6 g, Shudahuang 10 g, Maidong 15 g, Tiandong 15 g, raw Rehmannia 30 g, fried malt 30 g, burnt Shanzha 10 g, burnt Shenqu 10 g, Dafupi 30 g, jujube 10 pieces, ginger 7 slices.

Video follow-up, May 1.

Bitter mouth improved; occasional dryness. Distension lessened; abdominal circumference about the same. Foot edema slightly better. Yellow greasy tongue coating. Hands and feet cool. Cold aversion, still using an electric blanket; housing chilly. Stools formed, dark, not black. Appetite fair; small frequent meals. Urine still yellowish.

raw Huangqi 30 g, Dangshen 30 g, Huangjing 30 g, Yuzhu 15 g, fried Baizhu 30 g, Guizhi 30 g, Fuling 30 g, Zhuling 10 g, Cheqianzi 15 g, Danggui 10 g, Danshen 30 g, Muxiang 6 g, Houpo 10 g, Fabanxia 10 g, Suanzaoren 10 g, Yuanzhi 10 g, Zhi Gancao 10 g, Xuanshen 12 g, Zhebeimu 12 g, raw Muli 30 g (first), Zhi Biejia 30 g (first), Guiban 30 g (first), Yimucao 30 g, Zelan 30 g, Yiyiren 30 g, Yinchen 30 g, Jinqiancao 30 g, fried Zhizi 15 g, Pianjianghuang 10 g, Ezhu 15 g, fried Jiangcan 10 g, Yujin 10 g, Chantui 6 g, Dafupi 30 g, Shiwei 30 g, Tengligen 30 g, Mohanlian 30 g, Nüzhenzi 15 g, Xuduan 10 g, Duzhong 10 g, fried malt 30 g, burnt Shanzha 10 g, burnt Shenqu 10 g, Dafupi 30 g, jujube 10 pieces, ginger 7 slices.

After the above, abdominal circumference gradually shrank, appetite returned, and spirit improved daily; she has now normalized. Per the principle of not changing an effective formula, she continued it with regular feedback.

Here the family were experienced clinicians who knew the consequences of aggressive therapy in such a complex elderly patient, so they chose conservative TCM to improve quality of life and prolong survival. With mutual trust and a deep grasp of medicine's limits, treatment met expectations. I was relaxed and dared to use the herbs, yielding a result satisfying to both sides.