Use Shizao Tang and Pengzheng Wan with Caution When Cancer Patients Develop Effusions

Cancer patients easily develop complications such as pleural and ascitic effusion, pericardial effusion, and pelvic effusion. Some patients, after teaching themselves a little TCM, learn that Shizao Tang in the Shanghan Lun and Jingui Yaolue treats 'suspended fluid' (xuan yin), and so take Shizao Tang or its derivatives—Kongxian Dan and Pengzheng Wan—with very serious consequences.

I have researched TCM anticancer therapy for about ten years now, and every late- or end-stage patient I have seen use Shizao Tang or Pengzheng Wan for severe pleural/ascitic, pericardial, or pelvic effusion—especially those already emaciated—died rapidly, without exception. I stress 'without exception' here.

Formulas using harsh purgatives like Gansui (Kansui), Yuanhua (Genkwa), and Daji (Euphorbia), such as Shizao Tang and Pengzheng Wan, can be used for pleurisy, costopleurisy, and the pleural/ascitic effusion of early cirrhosis, and may even be tried for ascites in some early-to-mid cancer patients. But they must absolutely not be used on late-stage cancer patients, especially emaciated ones, because Gansui, Yuanhua, and Daji are too toxic for such patients to bear.

One of the four great famous physicians of the Jin-Yuan period, Zhu Danxi, wrote in his Danxi Xinfa: 'One must not overuse the harsh formulas of Yuanhua, Daji, and Gansui; once unleashed they cannot be recalled. I fear that while the drastic effect comes easily, securing and holding it afterward is hard, and the water returns with nothing left to treat it.' Zhu Danxi's judgment is most fair; that he could hold this view shows he was a clinician of rich experience.

Using harsh, drastic water-expelling purgatives for pleural/ascitic, pericardial, or pelvic effusion does give temporary relief of abdominal distension after a bout of painful diarrhea, but it harms righteous qi even more. Moreover, after a few hours the distension usually returns as before; if one then continues with harsh medicines like Shizao Tang and Pengzheng Wan, the patient can easily die rapidly.

The fastest death I saw came within three days of taking Shizao Tang. Another patient, still strong enough to cut firewood on the hillside, died within half a month of taking Pengzheng Wan. Clinicians, cancer patients, and families should take warning.

There is a Western proverb: 'He is the best physician that knows the worthlessness of the most medicines.' In Chinese this means: only the doctor who understands that most medicines are ineffective is the best doctor.

'Safety and efficacy' are the core of medicine. I grieve to see so many exaggerating the effect of Shizao Tang and Pengzheng Wan on the pleural/ascitic, pericardial, and pelvic effusions of cancer patients. These medicines are poorly safe and low in efficacy; the effusions of cancer patients are especially stubborn and are by no means easily solved by such formulas.

Moreover, as long as the tumor cannot be controlled, the effusions will inevitably return within a short time; by then the patient's righteous qi is already damaged, and no other medicine can rescue them. And Shizao Tang and Pengzheng Wan cannot control tumor growth.

Treating the effusions of late-stage cancer requires patience and composure: prioritize supporting righteous qi, persist in fortifying the spleen and kidney, moderately add diuretic, digestive, and liver-soothing herbs, and slowly regulate, improving the patient's quality of life and prolonging survival as much as possible. Overly high expectations and an impatient, anxious mindset will only shorten survival and make the patient's final days more painful.

TCM has long held that those who bungle affairs are usually rash and shallow. Now there are indeed too many shallow people who, ignorant and therefore fearless, read a few books and dare to recklessly try such harsh medicines, gambling with patients' lives. Fortunately, the strongly toxic herbs Yuanhua, Daji, and Gansui are now controlled drugs in China and cannot be bought at ordinary pharmacies; otherwise who knows how many patients would have died in vain.