Veteran TCM Physician Wang Guosan's Experienced Formula "Xiaoshui Decoction" for Cirrhotic Ascites
Veteran TCM physician Wang Guosan was born in 1930 and hailed from Hebei Province. He was the honorary director and chief physician of the Tangshan Traditional Chinese Medicine Hospital in Hebei. He was an early disciple of the late renowned veteran TCM physician Yue Meizhong. Dr. Wang excelled in treating cirrhotic ascites. Using his self-created experienced formula "Xiaoshui Decoction" (Water-Resolving Decoction) for hepatic ascites, he treated many cases with reliable outcomes. The author writes this article specifically to introduce his line of treatment.Dr. Wang's "Xiaoshui Decoction": American ginseng powder 6 g (taken in 3 divided doses infused in warm water), Cangzhu (Atractylodis Rhizoma) 30 g, Huainiuxi (Achyranthis Bidentatae Radix) 30 g, Chuanniuxi (Cyathulae Radix) 30 g, Dongguapi (Benincasae Exocarpium) 24 g, Hanliancao (Ecliptae Herba) 30 g, Cheqianzi (Plantaginis Semen) 30 g (wrapped for decoction), Jiao Sanxian (scorched malt, hawthorn, germinated barley) 9 g each, Jineijin (Galli Gasteris Endothelium Corneum) 18 g, Hanfangji (Stephaniae Tetrandrae Radix) 40–100 g, Tinglizi (Descurainiae Semen) 24 g.One dosage per day; decoct twice, combine the decoctions, and take in three divided doses after each meal.The greatest feature of Dr. Wang's "Xiaoshui Decoction" is its large dosage. In this formula, Cangzhu, Huainiuxi, Chuanniuxi, Dongguapi, Hanliancao, Cheqianzi, Hanfangji and Tinglizi all have strong water-disinhibiting effects. Dr. Wang used larger doses than those commonly used by others. In particular, with Hanfangji, his dosage was extraordinarily large: no less than 40 g, and on occasion 60–100 g.It should be explained here that Fangji comes in three kinds—Mufangji, Guangfangji and Hanfangji (Hanfangji is also called Fenfangji). Although all three are named Fangji, they are actually not the same medicinal. Mufangji and Hanfangji belong to the Menispermaceae family, whereas Guangfangji belongs to the Aristolochiaceae family. Guangfangji is nephrotoxic and must be used with caution in clinical practice. Hanfangji, however, is not an Aristolochiaceae plant, is not the toxic Chinese herb of rumor, and can be used in large doses.In this formula, American ginseng supplements the original qi and roots the constitution; Canghui disinhibits water and eliminates distension; Huainiuxi and Chuanniuxi both disinhibit water and conduct blood downward; Dongguapi is an excellent herb for promoting urination and reducing edema; Hanliancao combined with Cheqianzi forms the "Er Cao Dan" recorded in Chishui Xuanzhu, which disinhibits water and benefits stranguria while cooling blood and stopping bleeding; Hanfangji promotes diuresis, reduces edema, and resolves inflammation and pain; Tinglii descends qi, disinhibits water and reduces swelling; Jiao Sanxian and Jineijin aid digestion. When all these medicinals are combined, they jointly supplement the original qi, root the constitution, resolve water and eliminate distension.However, caution is required when using this formula. Cangzhu is quite irritating to the gastric mucosa, so patients with pre-existing gastric disease should use it cautiously. Cangzhu accelerates intestinal peristalsis and can easily trigger bloating in patients with intestinal obstruction or adhesions; such patients must also be cautious when using this formula.In addition, elderly, frail patients should be cautious when taking such large doses. Huainiuxi and Chuanniuxi have a blood-activating action, so patients with bleeding tendency should reduce the dose or combine them with other hemostatic and water-disinhibiting medicinals. The author personally suggests combining them with Xiaoji (Cirsii Herba) and Shiwei (Pyrrosiae Folium), also at 30 g or above.This formula may also offer a reference approach for resolving ascites, pleural effusion, pelvic effusion and pericardial effusion in cancer patients. However, cancer patients are unlikely to achieve satisfactory results with this formula alone; they must simultaneously use standard anti-cancer and anti-swelling medicinals. This formula treats hepatic ascites, but to treat cirrhosis itself, other liver-softening medicinals such as Biejiajian Pills (Trionyx Shell Pill) or Dahuang Zhechong Pills must also be used under a doctor's guidance.Ascites is a critical, acute condition. TCM has always emphasized: "In acute conditions, treat the branch; in chronic conditions, treat the root." Liver cirrhosis, liver cancer and other tumors often give rise to complications such as pleural and peritoneal effusions. These effusions are acute emergencies; if not treated promptly, the patient's life is at risk. When treating such deep-seated, severe disorders, small doses produce little effect. Dr. Wang's water-resolving formula follows the principle that deep-seated, serious illness calls for strong, potent agents.Ascites is a stage-specific symptom of conditions such as liver cirrhosis and cancer. Once ascites is resolved, the physician must re-apply pattern differentiation and treatment according to the new "pattern" that emerges in the patient's new stage; one should not rigidly adhere to a single formula to the very end.