Professor Zhang Xuewen's Experience Using Tongqiao Huoxue Decoction for Hydrocephalus

Professor Zhang Xuewen once treated a six-month-old infant with congenital hydrocephalus present since birth. The patient, a child surnamed Yan, first consulted Professor Zhang on January 23, 1975. After birth the head had been large, the complexion pale, the fontanelle bulging; the head was clearly larger than that of normal infants, shaped larger above and smaller below, with engorged scalp veins, poor spirit, spitting up milk, and a bluish-purple finger vein.

After pattern differentiation, Professor Zhang considered the child to have inborn deficiency with mutual binding of water and stasis. He therefore treated with a modified Tongqiao Huoxue Tang (Orifice-Unblocking Blood-Activating Decoction) from the Qing-dynasty physician Wang Qingren, with the following prescription: Chishao (Paeoniae Radix Rubra) 3g, Chuanxiong (Chuanxiong Rhizoma) 3g, Taoren (Persicae Semen) 3g, Honghua (Carthami Flos) 3g, Fuling (Poria) 24g, Hongzao (Jujubae Fructus) 7 pieces, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Shexiang (Moschus) 1g (taken in 10 divided doses, infused), Zexie (Alismatis Rhizoma) 6g, Chuanniuxi (Cyathulae Radix) 6g, Congbai (Allii Fistulosi Bulbus) 6g, Danshen (Salviae Miltiorrhizae Radix) 6g, Huangjiu (yellow rice wine) 60g as a guide (added in 10 divided doses when decocting).

After taking ten doses, the infant's spirit improved, complexion became rosy, bowel movements were two or three times daily and somewhat loose, the child could not yet stand, and the finger vein remained bluish-purple. Since the initial prescription was effective, Professor Zhang modified it: Chishao 3g, Chuanxiong 6g, Taoren 4.5g, Honghua 3g, Fuling 24g, Zexie 6g, Chuanniuxi 6g, Hupo (Succinum) 3g, Shexiang 1g (in 10 divided infused doses), Shanzha (Crataegi Fructus) 6g, Shengjiang 3 slices, Dazao 7 pieces, Huangjiu 60g (in 10 divided doses).

After thirty doses of the second prescription, the shape of the infant's head had clearly shrunk; the child could sit and stand, lift the head on its own, and call "Baba" and "Yeye" (father and grandfather). The spirit was good, but the child still could not walk and slept poorly at night. Professor Zhang then removed Shengjiang and Dazao from the second prescription and added Cheqianzi (Plantaginis Semen) 9g and Danshen 9g. After another month, the child's condition improved greatly.

Hydrocephalus is an abnormal increase in cerebrospinal fluid caused by various diseases. It may result from intracranial space-occupying lesions, from intracranial infection, or it may be congenital in infants. Because of the blood-brain barrier, ordinary herbal medicines are generally hard to penetrate, making treatment very tricky; literature on the topic is also sparse. Professor Zhang's case record is a relatively valuable resource on treating hydrocephalus with TCM.

Tongqiao Huoxue Tang comes from Wang Qingren's Yilin Gaicuo (Correction of Errors in Medical Works). It is composed of Chishao 1 qian (3g), Chuanxiong 1 qian (3g), Taoren 3 qian (9g, ground into mash), Hongzao 7 pieces (pitted), Honghua 3 qian (9g), Laocong (old scallion) 3 stalks (chopped), Xianjiang (fresh ginger) 3 qian (9g, chopped), and Shexiang 5 li (0.15g, wrapped in silk gauze and decocted). When decocting, use 250 ml of yellow rice wine; decoct all herbs except Shexiang down to about 150 ml of liquid, remove the dregs, add Shexiang, and bring to two boils. Take before bedtime.

This formula activates blood and resolves stasis, and unblocks the orifices and collaterals. It is used for long-unhealed migraine, head and facial blood stasis, hair loss, eye pain with red sclera, rosacea, deafness, purple-white vitiligo, gingivitis (acute suppurative gingivitis), female consumptive blood depletion, and pediatric gan (infantile nutritional impairment). Because it contains Shexiang, it can cross the blood-brain barrier and treat brain diseases. Some modern doctors use it for brain tumors and traumatic brain injury, with some effect.

Professor Zhang added to this formula water-disinhibiting and swelling-dispersing herbs such as Fuling, Zexie, Niuxi, and Cheqianzi, so that while Tongqiao Huoxue Tang activates blood, resolves stasis, and arouses the spirit and opens the orifices, it is accompanied by water-disinhibiting, swelling-dispersing herbs—treating both root and manifestation.

The author has recently seen some post-COVID patients with hydrocephalus, and also some tumor patients (especially brain-tumor patients) with hydrocephalus; when such patients develop hydrocephalus it is often tricky and hard to treat. Professor Zhang's therapeutic approach may serve as a reference.