Wuzhuyu Wan (Evodia Pill) for Vomiting and Edema

The Yifang Leiju (A Compendium of Medical Prescriptions) collects a formula called Wuzhuyu Wan (Evodia Pill), originally recorded in the Jingyan Liangfang (Effective Proven Prescriptions). Its composition is: Wuzhuyu (Evodia Fruit) 4 liang (120 g), Tian Tinglizi (sweet Descurainia Lepidium Seed, stir-fried) 2 liang (60 g), Gansui (Euphorbia Kansui, boiled in water) 1 liang (30 g). Preparation: dry the herbs, powder them, and form pills with refined honey the size of wutong seeds. Take 10 pills each morning, noon, and before bed, washed down with rice soup.

This formula warms the middle and supplements deficiency, descends counterflow and stops vomiting, and promotes urination to resolve edema. It is indicated for "bloating syndrome" (peng zheng) with edema, abdominal distension, and vomiting. This is what we today call ascites, most often seen in cirrhosis or late-stage cancer. The abdomen is distended and hard on pressure; urination is difficult, or both urination and defecation are difficult; the mouth is dry but the patient does not wish to drink. When liver function is abnormal, there may also be a bitter taste, scleral icterus, jaundiced skin, and grayish stools. Such patients should additionally take Yinzhihuang granules.

This formula uses a large dose of Wuzhuyu because it disperses cold, stops pain, descends counterflow, and stops vomiting. Ascites sometimes coexists with obstruction or partial obstruction, so the patient has not only abdominal distension but incessant vomiting. Wuzhuyu is a strongly antiemetic herb; using it to descend counterflow and stop vomiting relieves obstructive symptoms.

Tinglizi and Gansui are both drastic water-expelling herbs, and both are toxic; hence Tinglizi is stir-fried to remove its oil, and Gansui is boiled in water—processing intended to reduce toxicity and avoid poisoning the patient. Even after processing, their toxicity is reduced but not eliminated, so safety must be observed. Stop as soon as the disease responds: once the patient's abdominal distension and edema lessen, switch to gentle formulas such as Zhuling Tang (Polyporus Decoction), Wuling San (Five-Ingredient Powder with Poria), Huangqi Fangji Tang (Astragalus and Stephania Decoction), or Fangji Fuling Tang (Stephania and Poria Decoction) to continue treatment gradually and avoid medical mishaps.