A Case Commentary: Prof. Wang Peng of Hubei University of Chinese Medicine Treating Ascites
Prof. Wang Peng is an internal medicine professor, chief physician, and doctoral supervisor at Hubei University of Chinese Medicine. In May 1984 he admitted a patient with abdominal tympanites (ascites); the outcome was excellent and the approach distinctive.
The case is reproduced below:
Patient Peng, male, 64 years old, first visit in early May 1984. The abdomen was enlarged like a drum, unbearably distended; the body was emaciated, with wasting of the large muscles, disheveled hair, a pained expression, dull eyes, a sallow lustrousless complexion, constant groaning and gasping in a faint voice, shortness of breath, and marked pitting edema of the lower limbs (deep pitting on pressure). The pulse was wiry and fine; the tongue body was dark and pale.
Before admission the patient had tried various Chinese and Western diuretics without effect, and the abdominal distension had only increased. After admission he was treated with Chinese herbs warming and tonifying the spleen and kidney, transforming qi and promoting urination, and activating blood and moving qi; external application to the umbilicus of shexiang (Moschus), Heichou and Baichou (Pharbitidis Semen), and congbai (Allii Fistulosi Bulbus) was also used, all to no avail. Adding Western diuretics such as furosemide also failed; the abdominal girth reached 103 cm.
The case does not specify the cause of the ascites, so the underlying etiology is unknown. But the causes of ascites always include cancer, liver cirrhosis, and schistosomiasis; ascites this severe should be classed as refractory ascites. Seeing that every gentle measure had failed, Prof. Wang decided to apply the principle of hepatology expert Guan Youbo: “simultaneously supplement qi and aggressively expel fluid.”
Prescription: fill Gansui (Kansui Radix) powder into capsules (0.5 g each); take 4–8 capsules daily. Simultaneously use a decoction to strongly supplement qi and blood: Huangqi (Astragali Radix) 300 g, Dangshen (Codonopsis Radix) 15 g, Danggui (Angelicae Sinensis Radix) 12 g, Baishao (Paeoniae Alba Radix) 12 g, Chenpi (Citri Reticulatae Pericarpium) 10 g.
After ten days of this combined therapy, the patient had more than ten bowel and urinary movements daily; abdominal girth gradually shrank to 80 cm, lower-limb edema disappeared, appetite returned, and spirits improved; he was then discharged. Follow-up after discharge showed no recurrence.
Wang Peng’s regimen is distinctive. First, he used Gansui powder, and not sparingly—2–4 g daily. Gansui is violently toxic; improper dosing can kill, but it belongs to TCM’s aggressively purgative, water-expelling herbs. This patient had already failed repeated Chinese and Western treatments; rather than sit and await death, it was reasonable to take a calculated risk. Prof. Wang’s willingness to take that risk on the patient’s behalf shows a physician’s benevolence.
But note: this patient was in hospital, not at home. With staff monitoring safety, the risk was manageable; if toxicity appeared, resuscitation could be immediate. If treated at home, using Gansui this way would be unsafe; toxicity could cause sudden death. It is not recommended that home-care patients use it this way.
Second, Prof. Wang used Huangqi at a striking 300 g—a dose few physicians have ever used. Even Qing-dynasty masters like Chen Shiduo and Wang Qingren, who were famous for high-dose Huangqi, rarely reached this dose.
Traditional TCM theory holds that Huangqi supplements qi and fortifies the spleen and promotes urination to reduce swelling. Modern pharmacology shows Huangqi raises hemoglobin and albumin; using raw Huangqi at this dose is not unlike infusing albumin.
The Dangshen, Danggui, Baishao, and Chenpi in the formula were all at normal doses: Dangshen supplements qi, fortifies the spleen, and nourishes blood; Danggui and Baishao are blood-nourishing; Chenpi moves qi and reduces distension. The decoction therefore focuses on supplementing qi and blood and moving qi to reduce distension. Pairing it with Gansui was an unconventional winning move.
Gansui is now a controlled substance under State Council regulation and is not sold in most pharmacies. Another veteran TCM physician in Hubei, treating thoracic and abdominal fluid, habitually uses high-dose Laifuzi (Raphani Semen, radish seeds), up to 150–500 g, with good results.
Laifuzi is a medicinal-food dual-use substance, safe and non-toxic, and might substitute for Gansui. Combining high-dose Laifuzi with high-dose raw Huangqi might achieve similar results. This is my pharmacological conjecture, not yet clinically tested; interested practitioners may try it.