Zhugan Pills from Yixue Rumen for Abdominal Masses with Stabbing Pain

In Yixue Rumen (Introduction to Medicine) there is a folk prescription called "Zhugan Wan" (Pig-Liver Pills), specifically for abdominal masses (zhengjia) with stabbing pain. The pills are prepared as follows: take one whole pig liver (i.e., one entire lobe) and 50 Ba Dou (croton) seeds; pierce the croton seeds into the pig liver, add 1 sheng of vinegar, and simmer slowly until thoroughly cooked; remove the croton, mash the liver, and add Sanleng powder (i.e., Sparganii Rhizoma ground into powder; the original text does not specify the amount, but by reference to the croton dosage, the author suggests using no less than 200 g of Sanleng) to form pills the size of phoenix-tree seeds (about 7–8 mm in diameter). Take 5 pills each time with hot wine, three times daily. Zhugan Pills break qi and resolve phlegm, disperse accumulation and stop pain. They treat all zhengjia abdominal masses with stabbing pain that have lasted for years without healing. The zhengjia stabbing pain referred to here corresponds in modern medicine to diseases such as liver cirrhosis, liver cancer, gastric cancer, and cholangiocarcinoma that present with abdominal distension, abdominal pain, and hard, lumpy masses palpable in the abdomen. The Ba Dou used in this formula is the most drastic purgative, belonging to the strongly purgative class in TCM. TCM holds that croton opens the orifices and strongly flushes out cold accumulation. Li Shizhen's Bencao Gangmu (Compendium of Materia Medica) records that croton can "disperse stagnation and check dysentery" (TCM uses this purgative to treat dysentery mainly by following the therapeutic principle of "treating obstruction with opening"). Although croton is not commonly used, it is also employed in treating major diseases. Croton has severe side effects; an extremely small amount of croton oil can cause a burning sensation on the skin and mucous membranes, the oral mucosa, and the gastric mucosa. Excessive use causes vomiting and diarrhea, and long-term use has mutagenic and carcinogenic side effects. Clinically, therefore, croton must be used with careful assessment of the patient's constitution, with strict control of dosage and duration, taking its benefit while avoiding its harm. In using croton, this formula employs a special processing method: the croton seeds are pierced into the pig liver, the liver is then simmered in vinegar until thoroughly cooked, the croton is removed, and the liver is mashed. This processing allows the active constituent, croton oil, to infuse into the pig liver; removing the croton afterward reduces the side effects. Note that when preparing Zhugan Pills, one must not use degreased croton; raw, unprocessed croton is required, because the croton-oil content of degreased croton has been greatly reduced, and degreased croton will not achieve the therapeutic effect. The Sanleng (Sparganii Rhizoma) in this formula is a blood-activating, stasis-resolving Chinese herb that breaks blood and moves qi, disperses accumulation and stops pain; it is one of the most commonly used herbs in TCM cancer treatment. Sanleng can soften hardness and dissipate nodules and activate blood and resolve stasis, but it can also cause bleeding as a side effect. It should be used cautiously in patients with liver cirrhosis, liver cancer, or metastatic liver cancer who already show signs of bleeding from portal hypertension. Using pig liver in this formula achieves the effect of "supplementing the liver with liver." Modern medicine is likewise attempting to use live pig liver cells to create artificial livers to treat patients who have lost normal liver function. In addition to pig liver, the author suggests simultaneously taking one to two whole turtle shells (Biejia), boiling them together with the pig liver and croton, removing the croton, and mashing the pig liver and turtle shell together into the medicine. TCM holds that Biejia softens hardness and dissipates nodules, nourishes yin and subdues yang, and clears deficiency heat; modern medicine has confirmed that Biejia inhibits the progression of liver tumors. Adding Biejia to this formula makes the effect more pronounced.