In the Qing Dynasty medical text “Si He Ting Ji Fang”, there is a formula called Du Tian Zao Hua Wan (Pill to Seize Heaven’s Creation), which consists of 26 ingredients. It is designed to regulate qi and blood, treat the five labors and seven injuries, nine types of heart pain, various forms of bloating, chest and abdominal pain, and conditions of deficiency and edema.The primary ingredient in this formula is the rare herb Zhen Sha (Needle Sand), which is the fine residue produced when making steel needles. Do not confuse it with ordinary iron powder, as only the specific type used in this context is medicinal.
Although rare, Zhen Sha is pungent, sour, and salty, with a slightly cold nature. It has the effects of calming the heart, soothing the liver, strengthening the spleen, reducing stagnation, nourishing blood, and promoting diuresis to alleviate swelling. It is an excellent remedy for abdominal accumulation, liver diseases, and jaundice. Particularly for liver cirrhosis, it can transform phlegm, suppress liver qi, and its hardness allows it to treat stubborn conditions.The famous medical text by Zhu Danxi from the Jin-Yuan period, Dan Xi Xin Fa (Danxi’s Heart Method), also utilizes Zhen Sha in the Xiao Wen Zhong Wan (Minor Warm Middle Pill), primarily for treating ascites due to liver cirrhosis.The liver prefers gentle treatment; when hardened, it resembles a heart turned to stone after being hurt. Liver hardening can also result from stagnant liver qi. When liver qi is not flowing smoothly, it disrupts the spleen and stomach’s ability to regulate, leading to spleen deficiency and damp-heat accumulation, resulting in abdominal distension and ascites. Accompanying symptoms include loose stools, edema in the lower limbs due to dampness, a thick and greasy tongue coating, and a slippery pulse.Composition of Xiao Wen Zhong Wan:30g Qing Pi (Green Peel), 120g Tong Pian (Child’s Urine) soaked Xiang Fu (Cyperus), 60g Cang Zhu (Atractylodes), 60g Ban Xia (Pinellia), 15g Bai Zhu (White Atractylodes), 30g Chen Pi (Dried Tangerine Peel), 15g Ku Shen (Bitter Root), 30g Jiang Zhi Chao Huang Lian (Ginger Juice Fried Coptis), and 60g Cu Chao Zhen Sha (Vinegar Fried Needle Sand).In addition to Zhen Sha, the other ingredients also have notable benefits.For instance, Qing Pi paired with Chen Pi. Qing Pi, being green, enters the liver and is adept at unblocking liver qi and breaking up stagnant liver energy. Chen Pi, being yellow, belongs to the earth element and is effective in strengthening the spleen and regulating the qi of the spleen and stomach, even affecting the lungs. The combination acts like a blower for the chest and abdomen, first dispersing stagnation.Xiang Fu is the commander of qi disorders, its fragrance helps liver qi to flow freely throughout the body, and when soaked in child’s urine, it enhances its ability to nourish and replenish.Cang Zhu paired with Bai Zhu provides high-quality treatment for the spleen. It loosens and fertilizes the earth, creating fertile ground, while also digging channels to prevent soil from becoming compacted or overly damp, thus maximizing land utilization.Ban Xia works on the stomach. The spleen and stomach are the body’s transit departments; if stomach qi does not descend or if damp-heat accumulates in the stomach, it can lead to stagnant water in the chest and abdomen, such as in liver ascites.Ban Xia is warm and pungent, like a central air conditioning system, capable of removing dampness and turbidity from the stomach, restoring the smooth flow of qi, thus preventing phlegm, distension, and stagnation from taking root, thereby preventing the formation of liver ascites.
Ku Shen and Huang Lian are both bitter herbs. Huang Lian is already quite bitter, but Ku Shen is even more so. In TCM, bitterness can dry dampness and promote downward movement, akin to using a blower’s cold air to dry out moisture and a washing machine’s spin cycle to remove excess water. This dehydration function in the body acts like a diuretic, providing an outlet for excess fluids.Huang Lian can drain all excess damp-heat, resembling the cold air from a blower. Ku Shen has a particularly notable diuretic effect, akin to the washing machine’s dehydration function. Together, they work from multiple angles to resolve ascites.Both herbs are cold in nature, complementing the warmth of Cang Zhu, Ban Xia, and Bai Zhu, thus harmonizing the medicinal properties.However, the formula is named Xiao Wen Zhong Tang (Minor Warm Middle Decoction), so the overall flavor is primarily warm, as the spleen and stomach prefer warmth over cold. The warmth from Cang Zhu and Bai Zhu helps the spleen and stomach to function effectively, while the bitterness and coldness of Ku Shen and Huang Lian remove the damp-heat accumulation in the abdomen, and the warmth from Ban Xia and Chen Pi protects the spleen and stomach for optimal function.As for Qing Pi and Xiang Fu, they are both masters of qi movement. When qi flows smoothly, the abdomen does not bloat, and with the blood-nourishing and diuretic effects of Zhen Sha, the liver is strengthened, and the spleen is invigorated, effectively resolving damp-heat accumulation and abdominal distension, leading to more formed stools. Additionally, the dampness that causes lower limb edema is also eliminated.(Public Account: Ben Cao Fang)If Du Tian Zao Hua Wan places Zhen Sha in the first position, in this formula, Zhen Sha plays a crucial supporting role. Thus, the saying goes: “Unusual diseases require unusual remedies.” Liver cirrhosis with ascites is indeed a challenging condition.
In practical application, adjustments to the formula can be made based on individual circumstances, achieving good therapeutic effects.According to “Jiangsu Traditional Chinese Medicine”, this formula was adjusted to treat 45 patients with liver cirrhosis and ascites, achieving a total effective rate of 86.6%.The so-called adjustments include supplementing qi for qi deficiency, nourishing blood for blood deficiency, and even increasing the dosage of Huang Lian if there is significant heat. However, Ku Shen has slight toxicity, so the dosage should not be excessive.Preparation and Dosage of Xiao Wen Zhong Wan:Grind into a fine powder, mix with Shen Qu (a type of fermented wheat) paste to form pills. Take 6 grams each time, twice daily.Reminder: Each person’s body condition is different; the formulas provided in this article should be adjusted according to individual diagnosis. It is recommended to seek guidance from a professional doctor. (Images sourced from the internet; please contact for removal if there are any copyright issues.)
