Zhu Ling Tang (Ginseng and Poria Combination) as Adjuvant Therapy for Ascites and Diabetes

In Shi Yi De Xiao Fang (Effective Formulas from Generations of Physicians) there is a formula called Zhu Ling Tang (Stomach Poria Decoction). It is made by taking 2–3 qian (6–9 g) each of Wu Ling San (Five-Ingredient Powder with Poria) and Ping Wei San (Calm the Stomach Powder); when decocting, take an appropriate amount of Su Zi (Perilla fruit) and Wu Mei (smoked plum) and decoct together in water to wash the medicine down. If the desired effect is not achieved, add Mu Xiang (Aucklandia), Sha Ren (Amomum), Bai Zhu (Atractylodes), and Ding Xiang (Clove) and decoct together.

This formula dispels dampness and harmonizes the stomach, moves qi and promotes water metabolism. It is indicated for damage to the spleen and stomach by cold between summer and autumn, undigested water and grain, watery diarrhea, edema, abdominal distension, and difficult urination. Zhu Ling Tang is now mostly used for ascites due to cirrhosis or cancer, hyperlipoproteinemia, viral enteritis, and diabetes.

Wu Ling San comes from Shang Han Lun (Treatise on Cold Damage). It consists of: Zhu Ling (Polyporus) 18 zhu (9 g), Ze Xie (Alismatis Rhizoma) 1 liang 6 zhu (15 g), Bai Zhu (Atractylodis Macrocephalae Rhizoma) 18 zhu (9 g), Fu Ling (Poria) 18 zhu (9 g), Gui Zhi (Cinnamomi Ramulus) half liang (6 g). To use, grind the above into a powder and take a fang-chi spoon (about 2–3 g) with white drink (plain water), three times daily; after taking, drink plenty of warm water to promote sweating; once sweating occurs, it is cured.

Wu Ling San is the representative TCM formula for Taiyang bladder-water retention syndrome. This disease is mainly caused by unresolved exterior evil in the Taiyang channel; the evil transmits along the channel into the fu-organ, causing dysfunction of bladder qi transformation, and finally simultaneous disease of the Taiyang channel and fu, with difficult urination. So after taking Wu Ling San, one must, as with taking Gui Zhi Tang, drink some hot water or hot congee to assist yang and qi transformation, so that urination becomes free. The patent medicine Wu Ling Capsule is made according to the Wu Ling San prescription.

Ping Wei San comes from Jian Yao Ji Zhong Fang (Brief Formulas for Saving the State). It is a TCM dampness-drying formula with the actions of drying dampness and activating the spleen, moving qi and harmonizing the stomach. It is indicated for dampness obstructing the spleen and stomach, presenting with epigastric and abdominal fullness, no desire to eat, bland taste in the mouth, nausea and vomiting, belching and acid regurgitation, heavy limbs, lassitude and somnolence, loose stools, a thick, greasy white tongue coating, and a moderate pulse. It is now mostly used for chronic gastritis, digestive-tract dysfunction, and gastric and duodenal ulcers belonging to dampness obstructing the spleen and stomach. The patent medicines Ping Wei Wan or Xiang Sha Ping Wei Wan are made according to the Ping Wei San prescription.

If we do not want to decoct herbs and prefer patent medicines, we can take Wu Ling Capsules and Xiang Sha Ping Wei Wan together according to the package inserts; this is effectively taking Zhu Ling Tang. Many doctors now sometimes prescribe Wu Ling Capsules to ascites patients; actually, combining Wu Ling Capsules with Xiang Sha Ping Wei Wan, adding Bie Jia Ruan Gan Pian for cirrhosis patients, and adding appropriate anti-cancer patent medicines (such as Xi Huang Wan, Compound Banmao Capsule, Huachansu, Compound Yew Capsule, Weimai Ning Capsule, etc.) for cancer patients, is also a good medication combination. This approach both relieves the patient's clinical symptoms and reduces the hardship of taking medicine, and the cost is lower than taking decoctions.

Modern research has found that Zhu Ling Tang can assist in treating cirrhotic ascites, and can also assist in treating hepatic ascites in patients with liver cancer or other advanced cancers.

At the same time it can treat diabetes. Xinjiang Journal of Traditional Chinese Medicine once reported a clinical trial involving 42 patients; the trial showed that diabetic patients taking modified Zhu Ling Tang with Dong Gua Pi (waxgourd peel), Sang Bai Pi (white mulberry bark), and Yi Mu Cao (Motherwort) could effectively lower blood sugar, with an effective rate as high as 95.3%.

As a common formula for diarrhea, Zhu Ling Tang also has a good therapeutic effect on enteritis caused by rotavirus and other viruses, and on autumn diarrhea in children. Chinese Journal of Practical Formulas reported in 2000 a clinical trial of 82 patients, showing that Zhu Ling Tang treated rotaviral infantile diarrhea with an effective rate as high as 96.34%. Hebei Journal of TCM reported in 2001 a clinical trial of 116 children, showing that modified Zhu Ling Tang treated infantile autumn diarrhea with an effective rate as high as 96.55%.

In addition, clinical reports show that modified Zhu Ling Tang with fresh ginger and jujube treated patients with hyperlipoproteinemia, with a total effective rate as high as 88%.