Old Physician Zhang Mengnong's Experience in Treating Ascites Due to Cirrhosis (Gur distension)
Zhang Mengnong (1896–1977), originally named Bingcheng, courtesy name Hongbiao, was a native of Hanchuan, Hubei. He was born into a fishing family; at 15 he left school, went fishing with his elder brother and studied medical books on his own, often forgetting to cast his net while grasping the meaning of a text. In 1922 he studied medicine under the local famous physician An Shilin. In 1947 he became a lecturer at the Shancu Chinese National Medicine School in Shaanxi and compiled the book Outline of Diagnostics (Zhenduan Xue Gangyao).
In autumn 1928, Zhang Mengnong was engaged to practice at the Lu Shouxuan pharmacy in Hanchuan. On one house call he met a dying patient whose family was preparing the funeral rites. On examination, Zhang Mengnong found the patient "merely had food stagnation complicated by phlegm, spleen-stomach transportation failing, ascending and descending deranged, yin and yang blocked, which had dragged on into the critical condition of guan-ge. It can still be saved." He promptly applied the burnt-salt emetic method; the patient drank three times and vomited three times, bringing up a bowlful of sticky phlegm, whereupon he immediately regained consciousness, opened his eyes, stopped moaning and could speak; he was then given regulating treatment and recovered.
In 1932 he went to Zhengzhou and changed his name to Zhang Mengnong. Because he cured many severe cases such as cholera, his reputation grew; he was appointed TCM consultant to the public advisory page of the Zhengzhou Popular Daily, elected a director of the Zhengzhou National Medicine Guild, and served as a voluntary physician at the Zhengzhou shelter of the flood-relief committee. After the July 7 Incident he went to Xi'an to practice, and was successively elected supervisor, director and then chairman of the Xi'an National Medicine Guild.
In 1954, Zhang Mengnong returned to Hubei to practice and was elected chairman of the Hanchuan County Medical Workers' Association. The next year he was transferred to the Hubei Schistosomiasis Prevention Institute as a TCM attending physician and became a member of the provincial schistosomiasis committee and research society; soon after he was transferred to teach at the Hubei TCM refresher school. After the founding of Hubei TCM College, he headed the Neijing teaching and research group. He was once a member of the third Hubei Provincial Committee of the Chinese People's Political Consultative Conference.
Zhang Mengnong esteemed the Neijing view that "human beings correspond to heaven and earth," and emphasized the relationship between the internal and external environment. He held that treatment must take account of the seasons, day-night alternation, yin-yang changes, water intake and surroundings in order to hit the mark. He had rich experience treating difficult and complicated diseases, and carried out particularly deep research on chronic persistent hepatitis, cirrhosis, chronic glomerulonephritis, and phlegm-rheum; in his later years he also explored many approaches to treating tumors.
Zhang Mengnong was skilled at using single-substance and proven folk formulas and absorbing their essence—for example, using raw goose blood to treat esophageal cancer, white hyacinth-bean powder for chronic glomerulonephritis, crucian carp blood for hemoptysis from bronchiectasis, cogongrass root for pulmonary tuberculosis, and alum-processed (vinegar) millet for cirrhosis—all with good results. He read widely and could recite many classics from memory. He wrote more than forty volumes of collected clinical experience.
The following is his experience, recorded in his book Linzheng Huiyao, in treating cirrhosis with ascites:
Symptoms of cirrhosis with ascites: the epigastrium and abdomen are hard and distended like a drum; the liver region is intermittently painful; abdominal wall veins are engorged; the limbs show obvious spider nevi and palmar erythema; the hands and feet are emaciated; appetite is poor, urine short, spirit weary and the body heavy; on exertion there is shortness of breath and wheezing; some patients develop jaundice. If untreated over time, the righteous qi collapses, hepatic coma sets in, and death follows.
Cause of cirrhosis with ascites: liver qi stagnation and blood stasis cause dysfunction of spleen-stomach transportation; dampness is constrained and heat bound, so the sanjiao's drainage loses its duty and the waterways become unobstructed, thereby forming ascites.
Treatment method for cirrhosis with ascites: soothe the liver, regulate the spleen, activate blood, resolve stasis, clear heat, drain dampness, soften hardness and dissipate nodules; use pills for gradual, long-term effect.
Formula for cirrhosis with ascites: Atractylodes (white and black) each 60 g, Magnolia Bark (Chuan Houpo) 60 g, fried Immature Bitter Orange (Zhi Shi) 60 g, charred Inula (Xuanfuhua Tan) 60 g, roasted Curcuma (Sanleng) 60 g, roasted Curcuma Ezhu (Ezhu) 60 g, vinegar-fried Tortoise Shell (Biejia) 90 g, Capillary Wormwood (Mao Yinchen) 120 g, fried Sophora Pod (Huaijiao) 60 g, Tangerine Peel (Guang Chenpi) 60 g, Patrinia (Baijiangcao) 90 g, Red and White Peony each 60 g, Red Rice Bean (Hongfandou) 120 g, Eclonia (Kunbu) 60 g, Sargassum (Haizao) 60 g, Betel Nut (Binglang) 60 g, Ground Beetle (Dibie Chong) 30, dried Mole Cricket (Gulou) 30 g, Dandelion (Pugongying) 120 g, Violet (Diding) 120 g.
How to take the cirrhosis ascites formula: Stir-fry all together until scorched and grind extremely fine. Separately: take 120 g of alum (Zaofan), put into half a jin of vinegar, heat to dissolve, then add 1000 g of millet (Sumi), mix well, sun-dry, and stir-fry slowly in a pot into charcoal. When the smoke has ended and it has cooled, spread the millet charcoal on the ground over paper for about two hours to remove the fiery qi, then grind extremely fine. Mix it into the above herb powder and blend evenly. Then take 750 g of white flour, add equal parts vinegar and water, and beat into a paste; combine everything to form pills the size of a small bean, and sun-dry. Take 30 pills each time, taken with sugar dissolved in warm water before meals, three times a day. If after taking it there is a gnawing discomfort in the stomach, take only 20 or 10 pills; once the reaction has gone, add 5 pills per day, gradually increasing to 30 pills each time, never exceeding 40 pills at a time. After one course (one batch) is taken, if the disease has receded, prepare more by the same formula and continue taking until cured.
Formula rationale for cirrhosis ascites: the treatment of this disease is fundamentally different from that of edema. The Tang physician Sun Simiao noted that some treat gur (drum/gur) with water-drugs, treat water-swelling with gur-drugs, or whenever they see distension simply use water-drugs; of such people, Zhongjing said "foolish physicians kill them." But he did not point out that the root of the disease lies in the liver.
The author (Zhang Mengnong) once cured several cases of this disease, basing the formulas entirely on earlier treatments for jaundice and liver disease. Over the following twenty-plus years, on this foundation, by visiting patients, exploring the formulas, checking gains and losses and summarizing results, he made repeated improvements, until they became the formula introduced here.
This formula is guided by the argument in the Jingui Yaolue (Essentials of the Golden Cabinet): "When you see liver disease, know that the liver will transmit to the spleen; you must first fortify the spleen." Because the liver stores blood and governs free flow, liver disease causes blood stasis and qi stagnation so that it cannot free-flow the spleen earth; spleen disease then cannot move the stomach's fluids and cannot control kidney water, so water floods into the space between the intestines and stomach, producing the ascites/gur disease with taut abdominal skin and engorged veins. The treatment should fortify the spleen and benefit the stomach to support the mechanism of transportation, and moreover break blood and scatter stasis to disperse the hard nodules and restore free flow. The mechanism is: once stasis is dispersed, new blood of itself generates; once the spleen and stomach are strong, transportation returns to normal and the waterways of themselves become unobstructed.
(The composition of the above cirrhosis ascites formula follows Zhou Yigong's Yinzhi Wan, using damp-draining and stasis-dispersing, spleen-fortifying and stomach-benefiting Pingwei San; vinegar-calcined alum to disperse stasis and activate blood; and vinegar-soaked, charred millet, which benefits the spleen-stomach and promotes urination, as the chief. It is assisted by Inula, which treats liver binding; and by Capillary Wormwood and Sophora Pod, which treat jaundice. It is佐 by Curcuma (Sanleng), Zedoary (Ezhu), Tortoise Shell, Immature Bitter Orange and Red Peony, which disperse stasis, move qi, break accumulation and attack stagnation; Violet and Dandelion, which remove toxin and dissipate swelling; Eclonia and Sargassum, which soften hardness and promote diuresis; and it is使 by Ground Beetle and Mole Cricket, which expel water and unblock the collaterals. The whole is stir-fried, ground, and made into pills with a vinegar paste.)
For any severe case of cirrhosis ascites gur distension, so long as the original qi is not defeated, if the patient can persist in taking this medicine and observe the above prohibitions, there is hope of turning danger to safety and even complete cure.
Cases of old Dr. Zhang Mengnong's treating cirrhosis with ascites:
1. Patient Jiang (a case of icteric hepatitis and cirrhosis with ascites), male, 25. He had suffered icteric hepatitis for over two years; the liver was enlarged by three fingerbreadths, hard as a board; flat nodules the size of bean kernels appeared all over the limbs, more numerous over thick-muscled areas. He stated they were caused by long-term use of a certain chemical drug; the nodules and jaundice had not cleared for two years. In December 1938 he came to Xi'an for treatment; he was given the Yinzhi Wan formula and took two batches continuously. By March 1939 the jaundice had completely cleared, the nodules all gone, the liver soft and smaller, and spirit, appetite and strength fully restored. The author (Zhang Mengnong) personally saw this man again in the summer of 1964; he was healthy and the disease had not recurred.
2. Patient Yu (a case of hepatitis and cirrhosis with ascites), male, 36. He had hepatitis for 8 years; the liver was enlarged by three fingerbreadths, hard as stone, often painful, and liver function was extremely poor. He came in April 1965 and took the flavored Yinzhi Wan formula (i.e., this formula) for several months; symptoms completely disappeared, his health was restored, and there has been no recurrence in the nine years since.
3. Patient Liu, male, 36. He had long-unhealed icteric hepatitis; the liver was enlarged and hard, and gur distension had formed; repeated treatment failed. He came in January 1968; after taking this formula for over three months, the jaundice completely cleared and the gur distension subsided; the hardened liver softened and shrank. He was told to take one more batch; he has been well for seven years.
4. Patient Zhao (a case of icteric hepatitis and cirrhosis with ascites), male, 32. He had icteric hepatitis for 7 years; the liver had hardened and shrunk, the liver region was often painful and he could not lie on his side; ascites was obvious, the belly drum-like, and his whole body and face were yellow. He came in November 1968. He first took the cirrhosis decoction formula for two months; symptoms receded; he then took this pill formula for several months and was cured.
5. Patient Zhang (a case of icteric hepatitis and cirrhosis with ascites), male, 38. Long-standing icteric hepatitis had turned to cirrhosis, long unhealed; the liver was enlarged and hard, reaching from below the xiphoid to the navel, with secondary jaundice and gradually rising ascites, the belly still distended. He came in August 1965; after taking this formula for half a year he was cured. For nine years since, his spirit and strength have remained very good.
6. Patient Chen (a case of icteric hepatitis and cirrhosis with ascites), male, 38. He had cirrhosis with ascites; the belly was large as a drum, the skin taut and shiny; liver and spleen could not be felt; the legs were swollen like pillars, the scrotum swollen like a gourd; he could sit but not lie, panted on exertion, and ate very little. He came in September 1969. I first gave the severe nephritis decoction formula; after 7 doses, the swelling of the legs and scrotum completely subsided and the abdominal distension much reduced; the liver could now be felt but was hard as stone. I then gave cirrhosis formula No. 1, which he continued for 3 months; the gur distension completely disappeared, the liver softened and shrank, and he was told to take one more batch of this formula to consolidate. He has had no recurrence in five years.
7. Patient Li (a case of icteric hepatitis and cirrhosis with ascites), male, 40. He had cirrhosis with jaundice, complicated by ascites gur distension; the liver was enlarged and painful, liver function extremely poor, with reversed albumin/globulin ratio. He came in March 1971. I first gave cirrhosis formula No. 1; after several doses the jaundice receded, the swelling diminished and the liver pain stopped. He then continued this formula for several months; the liver softened and shrank and the gur distension completely disappeared. By early 1972, because he had broken the prohibitions, the condition showed a tendency to recur; he then took this formula again and was cured. He has since been able to keep working.
Note by Zhiyuan: the "cirrhosis formula No. 1" noted by old Dr. Zhang Mengnong refers to a prescription he commonly used clinically for cirrhosis: Capillary Wormwood (Mao Yinchen) 30 g, Eclonia (Kunbu) 15 g, fried Sophora Pod (Huaijiao) 10 g, Zedoary (Ezhu) 10 g, Sargassum (Haizao) 15 g, Curcuma (Sanleng) 10 g, processed Tortoise Shell (Biejia) 15 g, Red Peony (Chishao) 10 g, Inula (Xuanfuhua) 10 g, Trogopterus (Wulingzhi) 10 g, Cattail Pollen (Puhuang) 10 g, Selfheal Spike (Xiakucao) 30 g, Dandelion (Pugongying) 30 g. Decoct in water; one dose a day, divided into four warm doses. The severe nephritis decoction formula: Ephedra (Mahuang), Atractylodes (Baizhu), White Peony (Baishao), Tangerine Peel (Chenpi), Akebia (Mutong), Prepared Aconite (Shufupian), each 10 g; Anemarrhena (Zhimu), Alisma (Zexie), fried Kochia (Difuzi), Plantain Herb (Cheqiancao), Red Rice Bean (Hongfandou), Poria (Fuling), fried Barley Malt (Maiya), each 15 g; Asarum (Xixin) 2.5 g; Cinnamon Twig (Guizhi) 5 g; fresh Ginger (Shengjiang) 2 slices.