Professor Yin Huihe's Empirical Formula "Huayu Tongqi Paishui Fang" for Ascites due to Liver Disease

Professor Yin Huihe had an empirical formula called "Huayu Tongqi Paishui Fang" (Stasis-Transforming, Qi-Moving, Water-Draining Formula) for treating ascites due to liver disease. It may be used for ascites caused by liver cirrhosis or hepatitis, and as adjuvant treatment for ascites caused by liver cancer or liver metastases. Its base formula is: Chai Hu (Bupleuri Radix) 9 g, Chi Shao (Paeoniae Radix Rubra) 15 g, Dan Shen (Salviae Miltiorrhizae Radix) 15 g, Dang Gui (Angelicae Sinensis Radix) 15 g, Guang Yu Jin (Curcumae Radix) 9 g, Chuan Lian Zi (Toosendan Fructus) 12 g, Tao Ren (Persicae Semen) 9 g, Hong Hua (Carthami Flos) 9 g, Jie Geng (Platycodi Radix) 9 g, Zi Wan (Asteris Radix) 9 g, Tu Bie Chong (Eupolyphaga) 9 g, Sheng Mu Li (Ostreae Concha, raw, decocted first) 30 g, Chuan Jiao Mu (Zanthoxyli Pericarpium) 9 g, Ting Li Zi (Lepidii Descurainiae Semen) 9 g.

When treating liver cirrhosis, add Duan Mu Li (calcined oyster shell) 30 g, Bie Jia (Trionycis Carapax) 30 g, and Gui Ban (Testudinis Carapax) 30 g to soften the liver. When treating liver cancer, add San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Bai Hua She She Cao (Hedyotidis Herba), and Ban Zhi Lian (Scutellariae Barbatae Herba) to fight cancer. For long-standing, more severe ascites, add Ze Lan (Lycopi Herba) 15 g. For fluid-fluid insufficiency with red tongue, no coating, and little moisture, add Tian Dong (Asparagi Radix) 10 g and Mai Dong (Ophiopogonis Radix) 10 g.

This formula soothes the liver and moves qi, activates blood and resolves stasis, and promotes diuresis to reduce swelling. Although this is Old Master Yin's base formula, he himself usually made modifications according to each patient's condition. Therefore, when ordinary patients use this formula, it is best to consult a professional TCM physician for appropriate additions and subtractions based on the patient's situation.

Old Master Yin once treated a patient with liver cirrhosis. Using this formula as the base, he prescribed, based on the patient's yin-deficiency internal heat signs of five-center heat, dry mouth with desire to drink, poor appetite, loose stool, and scanty dark urine: Sheng Mu Li 30 g (decocted first), Duan Mu Li 30 g (decocted first), Bie Jia 30 g (decocted first), Gui Ban 30 g (decocted first), Dan Pi (Moutan Cortex) 12 g, Chi Shao 30 g, Gan Cao (Glycyrrhizae Radix) 10 g, Tian Dong 10 g, Mai Dong 10 g, E Jiao Zhu (processed Ass-hide glue pearls) 10 g, Zi Wan 10 g, Shu Di Huang (Rehmanniae Radix Praeparata) 10 g, Chen Pi (Citri Reticulatae Pericarpium) 10 g, Dan Shen 30 g, Jie Geng 10 g, Chuan Jiao Mu 10 g, Ting Li Zi 10 g, Ze Lan 15 g.

After taking this formula for over a month, the patient's ascites decreased, but the tongue still remained red with little coating, although moisture had returned. Old Master Yin then modified the formula to: Chai Hu 10 g, Chi Shao 30 g, Dang Gui 15 g, Dan Shen 30 g, Sheng Mu Li 60 g (decocted first), Guang Yu Jin 12 g, Chuan Lian Zi 12 g, Tao Ren 10 g, Jie Geng 10 g, Zi Wan 10 g, Tu Bie Chong 10 g, Shui Zhi (Hirudo) 10 g, Hua Rui Shi (Ouidiae, decocted first) 15 g, Chuan Jiao Mu 10 g, Ting Li Zi 10 g, Ze Lan 15 g, Hong Hua 10 g, Sang Shen Zi (Mori Fructus) 30 g. After taking this second formula for another month, the patient still had a small amount of ascites, so Old Master Yin added Pao Shan Jia (processed Manis squama) 30 g and Dong Gua Pi (Benincasae Exocarpium) 30 g to the second formula, continuing to take it to consolidate the effect.

From this case we can see that when applying his own empirical formula, Old Master Yin also made appropriate modifications based on the patient's condition. We should also see that a serious illness like ascites cannot be resolved in a day or two even by an expert of Professor Yin Huihe's caliber. Cirrhotic ascites is easier to treat than cancerous ascites, yet Old Master Yin still needed over two months. Some patients and families are extremely impatient, hoping the physician can cure cancerous ascites in a week or two; such unreasonable expectations make physicians hesitate to take them on.

In my many years of experience, to Old Master Yin's formula one may also add Che Qian Zi (Plantaginis Semen), Che Qian Cao (Plantaginis Herba), Huai Niu Xi (Achyranthis Bidentatae Radix), Cang Zhu (Atractylodis Rhizoma), Yi Yi Ren (Coicis Semen), Lou Gu (Gryllus), Yi Mu Cao (Leonuri Herba), and Han Lian Cao (Ecliptae Herba) to enhance diuresis and nourish yin. Why use yin-nourishing herbs among diuretics? Because modern ascites patients have usually taken diuretics for a long time, and diuretics damage yin and consume fluids; the patient Old Master Yin treated is a typical example. That is why Old Master Yin himself added yin-nourishing herbs such as E Jiao Zhu, Shu Di Huang, Sang Shen Zi, Tian Dong, and Mai Dong to his diuretic formulas.

Ascites in liver cirrhosis and liver cancer occurs because portal hypertension causes water and nutrients in the blood to leak from the venous wall into the abdominal cavity; venous return obstruction also causes lower-extremity edema. This problem is hard to solve with ordinary treatment approaches. Old Master Yin started from four directions: activating blood and resolving stasis, moving qi and dispersing accumulation, soothing the liver and resolving stagnation, and promoting diuresis to reduce swelling. In this formula, Chai Hu, Dang Gui, Dan Shen, Chi Shao, Guang Yu Jin, Chuan Lian Zi, Tao Ren, and Hong Hua soothe the liver and regulate blood; Sheng Mu Li and Tu Bie Chong activate blood, resolve stasis, soften hardness, and dissipate nodules; Jie Geng and Zi Wan diffuse lung qi and promote diuresis; Chuan Jiao Mu and Ting Li Zi open the waterways and unblock the sanjiao. For weak patients, E Jiao nourishes yin and supports zheng qi; patients with firm stool may add Da Huang (Rhei Radix et Rhizoma) to unblock the bowels. Used together, these herbs can eliminate hepatic ascites.

This formula is also effective for ascites caused by liver cancer and liver metastases. I once saw a patient with cirrhosis who, after finding Old Master Yin's empirical formula effective for himself, made the formula into capsules and sold them among cancer and cirrhotic ascites patients; some benefited. But because this patient was not medically trained and lacked professional grounding, many other patients suffered serious side effects after taking it—appetite and weight dropped sharply, accelerating death. This is not because the formula's logic was wrong, but because those who mechanically apply empirical formulas do not know how to adjust the prescription to the patient's condition.

Although TCM empirical formulas have general value, the physician must still adjust the herbs according to the patient's condition. Ascites in cancer patients mostly indicates advanced disease, when the body is extremely weak. Therefore, when using such a diuretic formula, one must also support zheng qi; if one blindly drains water without supporting the patient, although urine output increases, such a qi-consuming, blood-moving formula will inevitably weaken the patient further. This is the TCM error of "making the deficient more deficient."

The choice of qi-supporting herbs must be weighed according to the patient's actual condition. Weak patients with normal bowel movements may use Shen (Ginseng) and Qi (Astragali Radix); those with yin deficiency and internal heat should use E Jiao, Shu Di Huang, Huang Jing (Polygonati Rhizoma), and Yu Zhu (Polygonati Odorati Rhizoma); those with very poor appetite need digestive herbs such as Jiao Mai Ya (dry-fried malt), Chao Gu Ya (rice-grain sprout), Shen Qu (Massa Fermentata), and Ji Nei Jin (Gigeriae Endothelium); some patients have a bleeding tendency, and with such a formula extra caution is required: reduce or omit blood-activating herbs like Chi Shao, Dan Shen, Tao Ren, and Hong Hua, and add hemostatic herbs such as San Qi (Notoginseng Radix), Bai Ji (Bletillae Rhizoma), Xian He Cao (Agrimoniae Herba), Qian Cao (Rubiae Radix), Pu Huang (Typhae Pollen), and Di Yu (Sanguisorbae Radix). Otherwise the patient is very likely to die of massive hemorrhage. Patients should not mechanically apply empirical formulas on their own, to avoid accidents.