Using Zhufu Tang (Pig-Skin Decoction) for Refractory Diarrhea in Cancer Patients

Zhufu Tang (Pig-Skin Decoction) is a formula in the Shanghan Lun for treating shaoyin throat pain. The original text: "In shaoyin disease, with diarrhea, throat pain, chest fullness, and heart vexation, Zhufu Tang governs. Zhufu Tang: one jin of pig skin. Boil this one ingredient in one dou of water down to five sheng, strain, add one sheng of white honey and five ge of white powder, fry until fragrant, blend well, and take warm in six divided doses." The "white powder" here is powder ground from rice—rice stir-fried fragrant and then ground.

Zhufu Tang is very simple, yet few people use it; published case reports of Zhufu Tang treating diarrhea are extremely rare. But according to the original text of the Shanghan Lun, Zhufu Tang can treat "xiali" (i.e., diarrhea or loose stools). The diarrhea it treats belongs to the shaoyin yin-deficiency pattern and should be accompanied by the pulses and signs of shaoyin yin deficiency. The shaoyin yin-deficiency pulse is generally deep and minute or deep and fine; the signs include throat pain, chest fullness and heart vexation, as well as low fever or five-pronged heat.

This year I treated a liposarcoma patient who had a history of surgery and had long received TCM treatment from me. At the turn of spring and summer this year, after an external contraction, he developed diarrhea. Thereafter, despite repeated TCM and Western treatments, with poor results, the diarrhea persisted. I myself successively used Guizhi plus Gegen Tang, Sishen Wan, Shenling Baizhu granules, berberine, and Zhengchangsheng, with little effect.

Then it suddenly occurred to me that the patient's baseline body temperature had risen somewhat compared with before, which accorded with some features of shaoyin yin deficiency, so I decided to have him try Zhufu Tang. I instructed him: take one jin of pig skin, boil it in one sheng of water down to half a sheng, add one jin of huaihua honey, then fry one jin of rice until fragrant, grind it to powder, stir it all together, and eat it in six portions.

After seven days on this regimen, the diarrhea that had tormented him for months finally stopped, and the low fever also improved markedly; only a little white mucus-like material remained in the stool. A little more Zhengchangsheng and Changyanning then brought about a complete cure.

This experience taught me that Zhufu Tang, though all its ingredients look like ordinary food, has a strong antidiarrheal effect. Many cancer patients have persistent, unrelenting diarrhea after surgery, radiotherapy/chemotherapy, or after chemotherapy and targeted drugs; when every drug has failed, this dietary-therapy approach is worth a try.

It should be explained that zhufu is pig skin—the outermost thin layer that a butcher shaves off when skinning the meat one buys at the market. This layer has little fat; it is mostly collagen, which simmering turns into gelatin. Gelatin has a reticular spatial structure that binds a great deal of water and can enhance cellular physiological metabolism.

Why does this formula treat diarrhea? I am not entirely sure. But since Zhang Zhongjing recorded it as treating shaoyin xiali, the ancients must have observed in practice that Zhufu Tang stops diarrhea. Before we understand its antidiarrheal mechanism, remembering this formula-pattern can still guide our clinical practice.