A TCM Protocol for Treating Cirrhotic Ascites
Issue 5 (page 324) of the Anhui Journal of Clinical Traditional Chinese Medicine (1999) published an empirical formula for treating cirrhotic ascites. It has a certain efficacy: treating 52 patients, after 6–12 months of treatment, 14 were clinically cured, 37 improved, and 1 ineffective, for a total effective rate as high as 96.84%.
It is reproduced below:
First use modified Wei Ling Tang (Stomach Poria Decoction): Chao Cangzhu (stir-fried Atractylodes) and Chao Baizhu (stir-fried Atractylodes Macrocephala) each 12g, Yunfuling (Poria) 12g, Zhi Huangqi (honey-fried Astragalus) 30g, Qingpi (Citri Reticulatae Viride Pericarpium) and Chenpi (aged tangerine peel) each 9g, Zexie (Alisma) 9g, Zhuling (Polyporus) 9g, Huaishanyao (Dioscorea) 15g, Jiao Shanzha (charred hawthorn) 12g, Jiao Maiya (charred malt) 12g, Wuweizi (Schisandra) 5g, Danshen (Salvia) 12g, Honghua (Carthamus) 5g, Sanleng (Sparganii Rhizoma) 5g, Ezhu (Curcumae Rhizoma) 5g, Zhigancao (honey-fried Glycyrrhiza) 5g, Dingxiang (Caryophylli Flos) 2g, Dazao (Jujube) 10g. For yang deficiency, add Bajitian (Morinda) 10g, Tusizi (Cuscuta) 12g; for yin deficiency, remove Cangzhu, change Chao Baizhu to Sheng Baizhu (raw Atractylodes Macrocephala) 10g, and add Zhi Biejia (processed Carapax Trionycis, decoct first) 12g, Gouqizi (Lycii Fructus) 10g, Maimendong (Ophiopogon) 10g, Taizishen (Pseudostellariae Radix) 15g. Decoct the above herbs in water, one dose daily, morning and evening. After two weeks, switch to modified Shi Zao Tang (Ten Jujubes Decoction).
Modified Shi Zao Tang: Yuanhua (Genkwa Flos) 15g, Chao Cheqianzi (stir-fried Plantaginis Semen) 10g, Dazao (Jujube) 15g. Usable for both yang and yin deficiency. First grind Yuanhua and Cheqianzi into a fine powder, then stuff into pitted jujubes; simmer over low heat to extract a concentrated decoction to take. Accompany with a little rice broth to protect the stomach qi.
This protocol is used as follows: begin with the first formula for 2 weeks to bolster the upright qi, then use the second formula, protecting the stomach with rice broth, until the patient develops diarrhea; then switch back to the first formula for 1–2 weeks to bolster upright qi. Repeat the cycle until the ascites completely disappears.
Ascites is a common critical and severe clinical condition; if poorly managed, the patient easily dies. This protocol alternates two formulas, addressing both bolstering the upright and expelling pathogen. When upright qi is restored, boldly use stronger pathogen-expelling herbs; once pathogen-expelling produces diarrhea, switch back to mainly bolstering upright. This treatment differs from the common approach of using one formula to the end; it is a relatively novel therapeutic idea.
The first formula in this protocol, modified Wei Ling Tang, has a very reasonable composition. Cangzhu, Baizhu, Huangqi, and Huaishanyao fortify the spleen; Qingpi, Chenpi, and Dingxiang move qi; Zexie, Zhuling, and Yunfuling promote diuresis and reduce edema; Jiao Shanzha and Jiao Maiya strengthen the stomach and aid digestion; Danshen, Honghua, Sanleng, and Ezhu activate blood and resolve stasis, reduce swelling and disperse nodules; Wuweizi and Zhigancao bolster the root and secure yuan, nourish and astringe yin to prevent damaging the upright. Adding Zhi Biejia softens the liver and disperses nodules; adding Maimendong, Taizishen, and Gouqizi nourishes yin; adding Bajitian and Tusizi supports yang. This prescribing logic is comprehensive and reliable.
Modified Shi Zao Tang uses Yuanhua and Cheqianzi to promote diuresis and reduce edema, with Dazao protecting upright qi—precisely the important herbs for removing ascites. But Yuanhua is a very harsh purgative; used improperly it can kill the patient. So it must not be used long; stop once the patient develops diarrhea.
Alternating the two formulas takes into account that the patient's condition changes at any time during treatment, and the doctor adjusts at any time according to the patient's specific situation. Here there is flexibility: if the patient's condition is still good, the first formula need not be used for a full 2 weeks before the second is used. If the patient remains weak, the second formula need not be used in haste—it may even be omitted, proceeding gradually.
The course of treatment for cirrhosis is long. After a cirrhotic patient has taken this formula for a month and the condition has eased, subsequent treatment can switch from decoction to pills. Dispense herbs according to this formula, grind into powder, and make into pills, taking once morning and evening, or morning, noon, and evening, 10g each time, treating gradually.
Patients with cirrhotic ascites should avoid alcohol and anger, and avoid spicy, greasy, and pickled foods. During treatment, patients should observe dietary taboos and maintain a regular routine. Liver cancer patients or other cancer patients who develop hepatic ascites may also draw on the above approach, but they need to combine it with some anti-cancer drugs.