Wuzhuyu Wan for Edema and Abdominal Distension

In "Yifang Juyi" (A Comprehensive Compendium of Medical Formulas) there is a prescription called "Wuzhuyu Wan" (Evodia Pill), quoted from "Jingyan Liangfang" (Effective Proven Formulas). Its composition: Wuzhuyu (evodia fruit) 4 liang (120 g), Tian Tinglizi (sweet Descurainia seed) 2 liang (60 g, stir-fried), Gansui (Euphorbia kansui root) 1 liang (30 g, boiled in water). Preparation: stir-fry the sweet Tinglizi until scorched, boil the Gansui in water, then dry both together, grind into a fine powder, and use refined honey as excipient and binder to form Wu-tse-sized pills. Dosage: take 10 pills each time, three times daily, washed down with rice gruel in the morning, at noon, and before bed.

This formula directs counterflow downward and stops vomiting, and promotes urination to reduce edema. It is indicated for edema and abdominal distension, often caused by pleural effusion (thoracic fluid) or ascites (abdominal fluid), with obstruction in severe cases.

This formula uses a heavy dose of Wuzhuyu because evodia strongly suppresses acid and stops vomiting. TCM holds that Wuzhuyu is pungent and bitter, hot in nature, and disperses cold and stops pain, soothes the liver and directs qi downward, and warms the middle and dries dampness. It is indicated for epigastric and abdominal cold pain, jueyin headache, hernia pain, dysmenorrhea, beriberi swelling and pain, vomiting with acid regurgitation, and cold-damp diarrhea. Wuzhuyu is used in the largest dose here because patients with edema and abdominal distension often have obstruction and vomiting is a common symptom. Moreover, Wuzhuyu can reduce the purgative effect of Gansui and Tinglizi, lowering the formula's side effects.

Tinglizi and Gansui are both TCM purgatives. Tinglizi mainly promotes urination but also has a mild purgative side effect. Gansui is a drastic purgative of great toxicity that causes diarrhea and has a low lethal dose, so it must first be boiled in water to reduce its toxicity. Tinglizi is also somewhat toxic, though less than Gansui; to reduce its toxicity and side effects, it too must be stir-fried until scorched before use.

Even with this combination, the formula still has some purgative effect; patients with weak stomach and intestines will inevitably develop loose stools or diarrhea. But its water-expelling, edema-reducing effect is good, and it provides symptomatic treatment for patients with pleural or ascitic fluid who have difficulty urinating and defecating. Such patients are usually those with severe infectious disease or with cirrhosis or late-stage cancer; in treating them, besides symptomatic measures, other treatments such as anti-infection and anti-tumor therapy are needed.