II. Eczema

II. Eczema

1. Qiang Fang Compound: Qiang and Duohuo each 10g, Fangfeng 12g, Zhimu 20g, Nindong Teng 20g, Tao Ren 10g, Zelan 10g, Zhu Ru 6g, Xue Jie 3g, Jiangchan 6g, Quanxie 6g, Wugong 1 bar, Tu Fu Ling 12g, Chi Shao 10g, Sheng Di 12g, Danggui 10g, Yuan Shen 10g, Dan Pi 6g, Jingjie 10g, Fangfeng 12g, water decocted and taken once daily. This formula is suitable for pediatric eczema; one dose is decocted twice, yielding 300–400ml of liquid. For infants under one year old, administer 5–20ml per dose, 2–3 times daily after meals. For children over one year old, dosage increases according to age. Adults take one dose per day.

2. Fufang Er Miao San: Cang Zhu 6g, Huang Bai 6g, Duohuo 10g, Jujube 10g, Fuling 12g, Ze Xie 10g, Dan Shen 10g, Ku Shen 20g, Wushe 6g, Baixianpi 15g, Tu Fu Ling 12g, Chi Shao 10g, Sheng Di 12g, Danggui 10g, Yuan Shen 10g, Dan Pi 6g, Jingjie 10g, Fangfeng 12g, water decocted and taken once daily. This formula is suitable for localized eczema that repeatedly flares up and persists for a long time.

3. Fufang Chai Hu Tang: Chai Hu 10g, Huang Qin 10g, Ban Xia 6g, Dang Shen 10g, Sheng Shi Gao 30g, Zhimu 10g, Er Hua 15g, Lianqiao 15g, Mu Tong 6g, Chan Yi 6g, Hua Shi 15g, Dan Pi 10g, Shan Zhi 10g, Huang Lian 6g, Huang Bai 6g, Qiang and Duohuo each 15g, Fangfeng 15g, water decocted and taken once daily. This formula is suitable for widespread, generalized eczema, characterized by pustules, erosion, infection, and fever.

4. External Eczema Ointment: 300g of Shale Powder, 100g of Sheng Shi Gao Powder, 50g of Borax Powder, 50g of Magnesium Sulphate Powder, 20g of Carbonic Acid, add 1000ml of Black Bean Distillate Oil to create an ointment. Apply to affected areas, secure with gauze pads, and change the dressing once daily. Method for preparing Black Bean Distillate Oil: Use a set of distillation apparatus for chemical experiments. Place half of black soybeans inside the distillation flask, place it on a distillation rack, and heat it with an electric heating element. As the black soybeans are heated, steam rises to the bottom of the flask; when cooled, the steam flows back into liquid form and exits through the flask’s mouth, collected as Black Bean Distillate Oil.

III. Dermatitis

1. Jiawei Tao Hong Si Wu Tang: Danggui 10g, Chi Shao 10g, Chuan Xiong 6g, Sheng Di 12g, Tao Ren 10g, Honghua 6g, Dan Pi 10g, Shan Zhi 10g, Huang Lian 3g, Huang Qin 10g, Huang Bai 6g, Qiang and Duohuo 15g, Fangfeng 12g, Chai Hu 10g, Dou Chi 10g, Niu Bang Zi 10g, water decocted and taken once daily. This formula is suitable for neurodermatitis with lichenification, cracked skin, thickened, rough skin; it can be taken locally or systemically. It is also appropriate for exfoliative dermatitis and allergic dermatitis. Long-term adherence to this formula is recommended to gradually see results. If necessary, increase the dosage by a factor of ten, grind the herbs into powder, sift through a sieve, and take 5–10g three times daily, dissolved in warm water.

2. Huang Hua Tang: Huang Bai 6g, Chuan Jiao 6g, Gan Cao 6g, Difuzi 12g, Sheng Di 12g, Sheng Yiren 20g, Ku Shen 20g, Chan Yi 6g, Danggui 10g, Chi Shao 10g, Cang Zhu 6g, Gongying 15g, Baishang 20g, Jin Yin Hua 20g, Difuzi 10g, Baixianpi 10g, Bai Bu 6g, Tao Ren 10g, water decocted and taken once daily. This formula is suitable for contact dermatitis caused by substances like lacquer, dyes, plastics, crude oil, or furs; even belts and ties can sometimes trigger allergic dermatitis.

3. Dermatitis Ointment: Huang Lian 100g, She Chong Zi 200g, Zhu Sha 50g, Huang Bai 100g, ground into powder, mixed with a large amount of Vaseline (to achieve a paste-like consistency), applied externally as an ointment. This ointment is suitable for all dermatitis patients, providing significant relief from itching and moisturizing the skin.

IV. Prurigo

1. Xiao Feng San: Cang Zhu 6g, Hou Pu 6g, Chen Pi 6g, Gan Cao 6g, Dang Shen 10g, Fuling 12g, Chan Yi 6g, Jiang Chan 6g, Qiang and Duohuo each 15g, Fangfeng 12g, Chuan Xiong 6g, Huo Xiang 12g, Baixianpi 10g, Difuzi 10g, Niu Bang Zi 10g, water decocted and taken once daily. This formula is suitable for elderly patients with skin itching, especially during summer or during pregnancy-induced pruritus.

2. Yin Yang Li Xiao Tang: Tu Fu Ling 12g, Sheng Di 12g, Nindong Teng 20g, Che Qian Zi 10g, Ku Shen 20g, Gan Cao 6g, Danggui 10g, Chi Shao 10g, Ban Xia 6g, Chen Pi 6g, Bin Lang 10g, Wushe 6g, Chan Yi 6g, Baixianpi 12g, Difuzi 12g, water decocted and taken once daily. This formula is suitable for women experiencing vaginal itching (excluding trichomoniasis and fungal vaginitis), as well as nodular prurigo.

V. Ringworm and Scabies

1. Wan Xuan Jie Yi Fang: Tie Suo 50g, Tu Jin Pi 50g, ground into powder, sifted through a sieve, added to 100ml of rice vinegar, heated and boiled for 5 minutes before use. Apply externally to affected areas, changing the dressing once daily. This formula is suitable for tinea corporis, tinea pedis, and various skin diseases caused by fungi.

2. Scabies Ointment: Hu Ma 15g, Bai Bu 15g, Ku Shen 15g, Wu Bei Zi 10g, Ku Fan 10g, Qing Fen 10g, Zhang Mao 3g, Mei Pian 8g, ground into fine powder, sifted through a sieve, then mixed with rice vinegar to form a paste, applied to affected areas. This formula is suitable for various types of tinea corporis and tinea cruris.

3. Scabies Ointment: Sulfur 10g, Ming Fang 10g, Mang Xiao 10g, Borax 10g, ground into powder, sifted through a sieve, mixed with 200g of Vaseline, applied externally as an ointment, changed every day.

4. Scabies Wash: Chuan Jiao 20g, Chuan Lian Zi 20g, Ming Fang 3g, add 2000ml of water, boil for 10 minutes, extract the liquid and wash affected areas, then apply scabies ointment after washing.

My Views on the Treatment of Hyperthyroidism

Hyperthyroidism is short for hyperfunction of the thyroid gland—a pathological condition resulting from excessive thyroid hormone secretion due to various causes. In 1956, Japanese researcher Hashimoto discovered antibodies against thyroid antigens in the serum of patients with chronic thyroiditis complicated by hyperthyroidism. Later, six types of thyroid-related immunoglobulins were identified, confirming the close relationship between this condition and autoimmune mechanisms. While the exact cause of hyperthyroidism remains unclear, based on my long-term clinical experience, most patients with hyperthyroidism have a history of recurrent subacute thyroiditis, suggesting that subacute thyroiditis is at least one of the underlying causes of hyperthyroidism. Given that subacute thyroiditis itself is recognized as an autoimmune disease, the connection between hyperthyroidism and autoimmunity becomes natural. A majority of patients with subacute thyroiditis develop hyperthyroid symptoms; a small number experience hypothyroid symptoms; and a smaller group experiences alternating symptoms of both hyperthyroidism and hypothyroidism. I have observed that patients who develop hyperthyroid symptoms are most likely to progress to pure hyperthyroidism. Whether this type of hyperthyroidism is the same as that described by Bacedaw and Gravre is still not clearly established. My clinical observations of hyperthyroidism patients generally align with those found in textbooks. Palpitations, excessive sweating, fine tremors, goiter, slight swelling in the anterior tibial region, emotional agitation, and restlessness are the six major subjective symptoms of hyperthyroidism. Elevated levels of T₃ and T₄, along with low levels of TSH, are the most common laboratory indicators. Anemia, impotence, and amenorrhea may also serve as references. Western medicine commonly uses methimazole and propylthiouracil to manage symptoms, but these medications do not provide a cure. In recent years, iodine therapy has shown significant promise in treating this condition—but because medication must be administered under specific conditions and can easily lead to hypothyroidism, its effectiveness has not been particularly satisfactory. Total thyroidectomy remains one of the effective treatments for hyperthyroidism, though it is typically reserved for patients with large cold nodules or those with signs of thyroid cancer.

For these reasons, the use of traditional Chinese medicine and herbal remedies to treat hyperthyroidism represents a unique approach.

Over decades, I have achieved good therapeutic results using traditional Chinese medicine to treat hyperthyroidism, believing that the greatest advantage of this approach lies in its non-toxic side effects and long-term benefits.

I believe that the primary symptoms of hyperthyroidism include excessive sweating, rapid pulse, heart palpitations, and tremors—these symptoms correspond to the “fire” syndrome in Traditional Chinese Medicine, which originates from kidney yin deficiency, leading to water failing to nourish wood. Wood overcomes fire, and fire arises from liver excess, causing liver fire to manifest as wind. This “fire” is called “yang fire,” or “dragon and thunder fire!” It is neither real fire nor internal heat within the organs; therefore, prescriptions like White Tiger Decoction or Cheng Qi Decoction are ineffective. The root cause of the condition lies in kidney yin deficiency, so nourishing kidney yin and replenishing yin should be the primary treatment approach for hyperthyroidism. Over time, this “fire” consumes qi, leading to qi deficiency—and qi is the commander of blood, while blood is the mother of qi; when qi is deficient, blood also becomes deficient! Therefore, nourishing qi and nourishing blood is also a fundamental principle in treating this condition. Thyroid enlargement falls under the categories of “goiter” or “phlegm nodes,” which are also formed through the burning of “fire.” In addition to nourishing yin and clearing fire, it is also necessary to resolve phlegm, soften hard tissue, and dissolve masses. Thus, nourishing yin and clearing fire, tonifying qi and blood, and softening hard tissue and dissolving masses constitute the three core approaches to treating hyperthyroidism. Within the strategy of softening hard tissue and dissolving masses, there is also an emphasis on regulating qi and activating blood circulation. When treating hyperthyroidism, I often use the following four formulas, adjusting them based on clinical circumstances, and frequently achieve the desired results.

1. Guishan Compound: Turtle Placenta 15g, Yam 10g, Xiang Fu 6g, Xia Kucuo 20g, Bi Jia 15g, Bai Shao 15g, He Shou Wu 20g, Huang Qi 30g, Sheng Di 12g, Dan Shen 20g, Sheng Longmu 15g, Zi Shi Ying 20g, Huang Lian 3g, Huang Qin 10g, Huang Bai 6g, Danggui 15g, water decocted and taken once daily. This formula is suitable for patients with pronounced hyperthyroid symptoms, including rapid heart rate, palpitations, excessive sweating, tremors, and irritability. Patients often feel fatigued, lose weight, struggle to continue working, and exhibit elevated levels of T₃ and T₄.

2. San Shu Tang: San Ling 10g, E Zhi 10g, Qing Chen Pi each 6g, Xia Kucuo 20g, Sheng Di 12g, Yuan Shen 10g, Mai Dong 10g, Shan Yu 10g, Shan Yao 10g, Dan Pi 10g, Fuling 12g, Ze Xie 10g, Danggui 10g, Bai Shao 15g, Zhe Bei Mu 10g, Sheng Longmu 15g, Kaizheng Wa Leng 15g, water decocted and taken once daily. This formula is suitable for patients with significant thyroid enlargement, whose symptoms are not severe but persist for a long time, and who primarily experience fatigue, weight loss, and difficulty concentrating at work.

3. Fufang Xia Mu Tang: Xia Kucuo 12g, Sheng Longmu 20g, Chai Hu 10g, Bai Shao 15g, Huang Bai 10g, Ban Xia 6g, Dang Shen 10g, Mai Dong 10g, Wu Wei Zi 6g, Fu Shen 10g, Yuan Zhi 10g, Chao Zao Ren 15g, Bai Jie Zi 10g, Xiang Fu 6g, Su Zi 10g, water decocted and taken once daily. This formula is suitable for patients with prominent psychological symptoms, including frequent irritability, restlessness, insomnia, and significant discomfort when sitting or lying down.

4. Tu Yan Zheng Fang: San Ling 15g, E Zhi 15g, Hai Zao 15g, Kun Bu 15g, Chuan Shan Jia 10g, Zao Jiao Ci 10g, Zhi Lu Mo 6g, Zhe Bei Mu 10g, Yuan Shen 20g, Sheng Mu Li 20g, Xia Kucuo 15g, Huang Yao Zi 10g, Shan Ci Gu 10g, Danggui 10g, Huang Qi 20g, Dang Shen 10g, Bai Zhu 10g, Rou Gui 3g, water decocted and taken once daily. This formula is suitable for advanced stages of hyperthyroidism, particularly when eye bulging is prominent.

In addition to these four formulas, I have also used Chai Hu Jia Long Gu Mu Li Tang (Zhang Zhongjing), Sheng Tie Luo Yin (Cheng Zhongling), Bai Jin San (from “Surgical Complete Treatise”), and Gan Mai Da Zao Tang (Zhang Zhongjing) for patients with markedly abnormal psychological symptoms; I have also found some efficacy in using Tian Wang Bu Xin Dan (from “Secrets of Life”) and Bai Zi Yang Xin Wan (from “Comprehensive Collection of Health Preservation”).

The Wonderful Uses of Ganluo Xiaodong Dan

This formula is derived from “Wen Re Jing Wei,” consisting of Huang Qin 10g, Lian Qiao 4g, Bo He 4g, Shan Zhi 10g, Hua Shi 15g, Mu Tong 5g, Yin Chen 11g, Huo Xiang 4g, Shi Chang Pu 6g, Zhe Bei Mu 5g, Rou Dou Kou 4g, She Gan 4g, ground into powder, each dose being 10g, dissolved in warm water. Alternatively, use Shen Qu as a pill, about the size of a marble, dissolved in hot water. According to the original text, this formula was originally prescribed to treat early-stage damp-heat, with both dampness and heat present, and pathogenic factors residing in the qi layer.

I had never given much importance to this formula until the 1980s, when I encountered a patient with chronic hepatitis B. His liver function continued to deteriorate despite multiple treatments, and he was hospitalized at Beijing 302 Hospital for over two months, spending more than 40,000 yuan. His GPT and GOT levels remained high, and even mild jaundice did not improve. Desperate for a solution, he sought my help. Upon examination, his pulse was slippery, rapid, and tense, his tongue was red with a yellow, greasy coating—this was a sign of both damp-heat and a heavy presence of heat in the body. I prescribed Ganluo Xiaodong Dan, using the original formulation, decocting it into a soup and taking it once daily. After 10 doses, the patient felt a sudden sense of comfort throughout his body, his spirits improved significantly, and his GPT dropped from 172 μmol/L to normal levels; his total bilirubin also decreased from 32 μmol/L to normal. Because this formula produced unexpected results, I began to take it seriously and, over the following 20+ years of clinical practice, I often used this formula to treat various types of liver disease, discovering that it possessed unique efficacy in improving liver function.

In the 1990s, I treated a female patient with chronic urinary tract infections—40 years old—who had experienced recurrent urinary frequency, urgency, dysuria, accompanied by mild edema, lower back pain, and a feeling of fullness in the lower abdomen. Urinalysis frequently revealed casts and white blood cells, and during flare-ups, protein was often detected in the urine (10–20). She had tried various antibiotics, but only saw minor improvements, unable to achieve a complete cure. Through a friend’s recommendation, she came to me for treatment. She had previously used many different combinations of Western and traditional Chinese medicines, but her treatment costs had exceeded 10,000 yuan, yet no significant results were seen. I asked her about the previous prescriptions she had taken, and they included Longdan Xiegan, Ba Zheng San, Gui Fu Ba Wei, and Zhi Bai Di Huang. She said that over the years, she had spent tens of thousands of yuan on various treatments without seeing noticeable improvement, so she turned to me. I thought to myself, if the previous Chinese medicines had been appropriately tailored to her condition, why hadn’t they worked? I knew I needed to explore another approach to overcome this challenge. Her pulse was tense, slippery, and rapid, her tongue was red with a thick, greasy yellow coating—a clear sign of heavy damp-heat. I decided to adjust the formula, adding ingredients from Ganluo Xiaodong Dan, and after just 3 doses, she reported significant improvement. After 7 doses, she saw remarkable results. Through this treatment, I came to respect the remarkable efficacy of Ganluo Xiaodong Dan even more.

At the beginning of the 21st century, non-gonococcal urethritis became prevalent, and tests for Chlamydia and Mycoplasma were widely available in both provincial and county-level hospitals. This disease is contagious, and standard antibiotics often prove ineffective. The condition tends to linger, worsening over time and causing physical and mental suffering for patients, while also having negative impacts on society. Remembering the successful treatment of a previous urinary tract infection patient, I decided to treat non-gonococcal urethritis with Ganluo Xiaodong Dan, and the results were equally impressive. A 26-year-old man, unmarried, who had traveled to Inner Mongolia and other places for work, returned to Lanzhou for treatment due to urinary tract infections and prostatitis. Tests for Chlamydia and Mycoplasma were positive, and the Lanzhou Second People’s Hospital diagnosed him with non-gonococcal urethritis. He had tried Azithromycin, Ceftriaxone, and other antibiotics, but only saw minor improvements. Through a friend’s recommendation, he came to me for treatment. His pulse was slippery and rapid, his tongue was red with a thick, greasy yellow coating, accompanied by urinary pain, as well as pain in the lower abdomen, perineum, and groin. I diagnosed him as having damp-heat accumulating in the bladder and prescribed Ganluo Xiaodong Dan. After 10 doses, the patient reported significant improvement and said that he had never seen such remarkable results in his previous treatments. Today, Ganluo Xiaodong Dan is used as a first-line treatment for non-gonococcal urethritis in clinical practice, and it has proven effective for most patients with non-gonococcal urethritis.

A Brief Overview of Gastric Cancer Treatment Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: 20th century 1980s, I traveled to Guangzhou with Professor Xu Zicheng from Lanzhou Medical College for a conference. On our way through Wuhan, we stayed at the guesthouse of Hubei College of Traditional Chinese Medicine. Professor Hong Ziyun of that institution was a renowned veteran TCM practitioner nationwide; he had taught in the Central China Integrated Chinese and Western Medicine Training Program in the 1950s, where Xu Zicheng studied at the time, thus establishing a teacher-student relationship between them. That evening, Xu arranged an exclusive interview with Mr. Hong Ziyun. At that time, Mr. Hong was already advanced in age, yet his mind was remarkably sharp. When discussing his clinical experience, he spoke eloquently, and unexpectedly mentioned the case of a patient who was cured using traditional Chinese medicine for stomach cancer. Under repeated requests from me and Xu, he shared a prescription: 6 black plums, 6 grams of Sichuan pepper, 6 grams of Coptis chinensis, 6 grams of dried ginger, 3 grams of Asarum sieboldii, 6 grams of Pinellia ternata, 6 grams of Curcuma longa, 10 grams of Salvia miltiorrhiza, 15 grams of White Peony, 10 grams of Red Peony, 6 grams of Poria cocos, 20 grams of Coix Seed, 10 grams of Ligusticum chuanxiong, 20 grams of Citrus peel, 20 grams of Bupleurum root, and 10 grams of Herba Leonuri. The herbs were decocted in water and taken as one dose per day. I copied the formula and kept it carefully. After returning to Lanzhou from Guangzhou, several years passed. One day, while browsing through the bookshelf, I came across the prescription and quickly wrote it down in my notebook. In October 2000 (Gengchen year), a 58-year-old female patient named Wang, who had been diagnosed with moderately differentiated adenocarcinoma of the gastric body via gastroscopy biopsy, sought treatment from me because she firmly refused surgery and chemotherapy. The patient was emaciated, pale, and suffered from persistent, severe pain in the upper abdomen, which often worsened in episodes accompanied by intense burning sensations. Her pulse was wiry, large, and slippery, her tongue was red with a yellowish greasy coating. The pulse and symptoms matched the Hong formula—no modifications were made to the original formula, so I copied it for her. After taking 10 doses of the medicine, the patient came back with her son, who reported that the pain had significantly decreased, and the burning sensation had also eased noticeably compared to before. Her pulse had become more balanced, and the yellowish greasy coating on her tongue had begun to subside slightly. I immediately realized how truly valuable and precious Mr. Hong’s herbal formula was, and I was deeply impressed by his rigorous academic approach, his down-to-earth work ethic, and his sincere teaching style. Upon asking about her condition in detail, I learned that the patient occasionally experienced nausea and vomiting, along with constipation. To address these issues, I increased the dosage of Coptis chinensis to 6 grams and Ginger to 6 grams, decocting the herbs in water and taking one dose per day. After another 10 doses, the patient returned for a follow-up visit, saying that after taking the medicine, her pain had subsided considerably, and the burning sensation had also lessened significantly compared to before. Her pulse had become calmer, and the yellowish greasy coating on her tongue had begun to fade slightly. I felt that Mr. Hong’s herbal formula was truly invaluable, and I admired his meticulous approach to medical practice—his grounded, practical methods, and his genuine dedication to teaching others. After learning more about her condition, I discovered that the patient frequently experienced nausea and vomiting, as well as dry, hard stools. Therefore, I added 6 grams of Rheum palmatum and 6 grams of Fresh Ginger to the original formula, decocting the herbs in water and taking one dose per day. After another 10 doses, the patient returned for a follow-up visit, saying that she could now eat a bowl of noodles, and her symptoms had improved markedly compared to before, with her physical strength also recovering. I added 3 grams of Agastache rugosa and 3 grams of Amomum villosum to the original formula, recommending that she take them regularly. A year later, when the patient returned for a follow-up visit, she said that the medicine had gotten better with each dose, so she continued taking the medication for over 200 doses. Now, there were no longer any abnormal sensations in her stomach, her complexion was rosy, and her overall demeanor and spirit were just like those of a healthy person. A barium meal X-ray showed no masses, and a gastroscopy revealed no masses—only congestion of the gastric mucosa. The diagnosis was chronic superficial gastritis. The recovery of this patient was truly inspiring, and it was a testament to Mr. Hong Ziyun’s exceptional medical skills and his genuine commitment to teaching others. This formula has since been used frequently in clinical practice. Ultimately, the conclusion is that this formula is effective for most cases of stomach cancer, especially for patients suffering from pain-related symptoms associated with stomach cancer. The ingredients in this formula—black plum, Sichuan pepper, dried ginger, Coptis chinensis, Pinellia ternata, and Asarum sieboldii—are all components of the Wumei Pill. Wumei Pill was specially formulated by Zhang Zhongjing in the Shanghan Lun for treating cold-damp syndromes of the Jueyin channel, and it was also listed in the Jin Gui Yao Lü as a remedy for intestinal colic. Both texts clearly state that this formula can alleviate stomach pain. Dried ginger, Coix Seed, Citrus peel, and Poria are known for their properties of removing dampness, regulating qi, and descending rebellious qi; Salvia miltiorrhiza, Red Peony, and Curcuma longa promote blood circulation and resolve blood stasis, specifically treating chronic conditions that have lingered in the meridians. Bupleurum and Herba Leonuri clear heat and detoxify, helping to control inflammation in the stomach. It is precisely because of these properties that the formula has such remarkable effects. I created a mnemonic to help remember the formula: “Wumei Pill, then Jin Dan, Shao, Pinellia, Dried Ginger, Poria, Bupleurum, and Herba Leonuri—these ingredients combine perfectly to treat stomach pain in patients with stomach cancer.”

Electrolyte Imbalance in Decompensated Liver Cirrhosis

In patients with decompensated liver cirrhosis, massive ascites leads to systemic sodium-water retention. This condition naturally results in hypokalemia, as sodium and potassium are both monovalent cations that compete with each other. Moreover, the use of diuretics causes potassium loss, so electrolyte disturbances in patients with liver cirrhosis-induced ascites often begin with hypokalemia. Some argue that hypokalemia is a fundamental characteristic of liver cirrhosis-associated ascites, and that potassium supplementation is a basic therapeutic strategy for liver cirrhosis-induced ascites—this view has some merit. Since calcium and magnesium are also monovalent cations, they share a similar competitive relationship with potassium, so when hypokalemia occurs, calcium and magnesium levels also tend to be low. Although the body exhibits sodium-water retention due to ascites and edema, since sodium ions are abundant in the interstitial space, serum sodium levels remain below normal. Thus, in the early stages of liver cirrhosis-associated ascites, the overall serum electrolyte levels are generally described as “low.” However, as liver cirrhosis progresses and renal dysfunction develops, this “low” electrolyte profile quickly begins to shift. Liver cirrhosis can lead to secondary renal impairment, resulting in hepatorenal syndrome. At this stage, the kidneys’ clearance function is compromised, leading to elevated blood urea nitrogen, elevated creatinine levels, and decreased carbon dioxide binding capacity, which in turn causes acidosis. Initially, due to oliguria and reduced excretory function, serum potassium levels rise; as phosphate excretion is hindered, hyperphosphatemia develops. The antagonistic relationship between calcium and phosphorus causes calcium levels to drop, further lowering calcium levels. Acidosis leads to the uptake of sodium and calcium cations by acidic radicals, making hypokalemia and hypocalcemia even more pronounced. Only a small number of patients are exceptions—those with hyperparathyroidism, where calcium levels rise while phosphorus levels drop immediately.

In summary, once hepatorenal syndrome develops, as serum potassium and phosphorus levels rise and serum calcium levels decline, and as acidosis progresses, the adsorption of cations by acidic radicals intensifies, serum calcium and sodium levels continue to fall. Only in cases of liver cirrhosis complicated by hyperparathyroidism does serum calcium levels sometimes reverse their usual pattern, rising while serum phosphorus levels may drop. In fact, the changes in electrolytes in patients with liver cirrhosis and ascites may seem complex, but they are actually quite simple—if you grasp the key points outlined above, you only need to focus on three essential considerations:

1. In cases of liver cirrhosis-associated ascites, potassium, calcium, sodium, phosphorus, magnesium, and other major electrolytes are all low or deficient.
2. When renal failure—specifically hepatorenal syndrome—develops, as urine output decreases, serum potassium levels rise; as acidosis sets in, serum phosphorus levels begin to increase, and hypocalcemia becomes even more pronounced.
3. Only in cases of hyperparathyroidism do serum calcium levels rise, while serum phosphorus levels may drop.

The key characteristics of decompensated liver cirrhosis include the presence of ascites; the hallmark sign of hepatorenal syndrome is elevated blood urea nitrogen levels; and hyperparathyroidism leads to changes in calcium and phosphorus levels.

Case Studies: Four Clinical Cases

After the Spring Festival in 2000 (Gengchen year), I participated in four external consultations, each involving the diagnosis and treatment of four different cases. These cases are recorded here faithfully, and they may prove helpful for young medical professionals.

Case 1: Elderly Patient with Heart Failure Due to Excessive Fluid Administration

I was invited to consult at Lanzhou Railway Center Hospital. The patient was an 82-year-old woman, the mother of Wei Shiguang, Secretary of the Party Committee of Qilihe District in Lanzhou City. One week prior, she had experienced an acute episode of cholecystitis and underwent gallbladder removal surgery. Three days later, abdominal distension began, with a continuous trickle of fluid at the incision site, persisting throughout the day. The attending physician performed a fluid analysis, which revealed transudate—no fever, normal blood counts, and no signs of infection; liver function tests were normal, the spleen was not enlarged, and liver cirrhosis was ruled out. The attending physician informed the department head and hospital director, but it was still difficult to reach a definitive diagnosis. For this reason, I was specially invited to consult at the hospital. Upon examining her pulse, I found it deep, fine, and with a weak, irregular rhythm. Auscultation revealed a diminished first heart sound in the precordial area, along with multiple premature beats. When I asked about her condition, I learned that she had received approximately 2,500 ml of fluids daily post-surgery, with infusion rates never restricted—up to 80 drops per minute—and fine crackles were heard at the lung bases. The patient complained of palpitations, shortness of breath, chest tightness, and occasional coughing and wheezing. Her abdomen was markedly distended, with the liver located 8 cm below the xiphoid process and 3 cm below the costal margin. The ascitic sign was strongly positive, along with lower limb edema and jugular vein distension. I concluded that she had heart failure. I advised her to reduce her fluid intake and slow down the infusion rate, prescribing digoxin 0.25 mg twice daily, orally and intravenously. She was also prescribed traditional Chinese medicine: 10 g of Codonopsis, 10 g of Atractylodes macrocephala, 12 g of Poria, 6 g of Licorice, 10 g of Cinnamon Twig, 6 g of Rhizoma Atractylodis Macrocephalae, 10 g of White Peony, 6 g of Dried Ginger, 10 g of Ophiopogon japonicus, and 6 g of Schisandra chinensis—decocted in water and taken as one dose per day. For Western medicine, I administered 2 g of Bactrim in 250 ml of saline, slowly infused intravenously (less than 30 drops per minute). Three days later, the patient’s ascites and edema had completely disappeared, her spirits were good, and symptoms such as chest tightness, palpitations, and shortness of breath had vanished entirely. After the surgical sutures were removed, she was discharged from the hospital. Following the consultation, the patient’s diagnosis was confirmed, and she took appropriate measures—within just three days, her symptoms resolved. The elderly patient had undergone surgical trauma and had received large volumes of fluids for a week, with infusion rates reaching 80–90 drops per minute, placing excessive strain on her heart. Soon after, she developed heart failure, with crackles at the lung bases, chest tightness, shortness of breath, and palpitations—indicating left ventricular failure. Hepatomegaly, ascites, lower limb edema, and jugular vein distension suggested right ventricular failure. Arrhythmias were also a clinical manifestation of cardiac dysfunction.

Case 2: Misdiagnosis of Malignant Lymphoma

I was invited to consult at Gansu Provincial People’s Hospital. The patient was a 60-year-old man named Liu, who had been experiencing chest pain and shortness of breath for three months. He had been diagnosed with coronary heart disease. He had been hospitalized in the high-altitude ward of the provincial hospital for over a month, but his treatment had been ineffective. Recently, his condition had worsened, prompting him to seek consultation. Two to three months earlier, the patient began experiencing intermittent pain in the epigastric region, accompanied by palpitations and shortness of breath. His electrocardiogram showed ST-segment changes, and he was treated for coronary heart disease. Recently, the pain had shifted to the gastric region. A gastroscopy confirmed atrophic gastritis of the gastric antrum, and in addition to medications for coronary heart disease, he also took Loxonin and Guifan’an. Despite taking these medications, the chest and epigastric pain did not improve; instead, the pain became increasingly severe. I observed that the patient was emaciated and weakened, with significant tenderness in the upper abdomen. A mass could be felt in the upper part of the stomach, with an unclear border. I recommended a gastroscopy for biopsy and further evaluation, noting that the mass might be malignant. In addition to coronary heart disease and atrophic gastritis, the patient may also have malignant lymphoma. Three days later, I consulted again. A gastroscopy revealed a mass in the gastric body, which had been pushed inward from the outside. A biopsy confirmed malignant lymphoma (non-Hodgkin’s), and I recommended chemotherapy using the COPP regimen as supportive therapy. Two months later, the attending physician called to report that, after the aforementioned treatment, the patient’s chest and epigastric pain had disappeared, and the mass in the upper abdomen had also vanished. The patient’s spirits were good, his physical strength gradually recovered, and he was discharged to return home for further recovery. The primary symptom of this patient was chest and epigastric pain; his electrocardiogram abnormalities led to a misdiagnosis of coronary heart disease, while his gastroscopic findings led to a misdiagnosis of atrophic gastritis. Although coronary heart disease and atrophic gastritis were present, the main cause of chest and epigastric pain was malignant lymphoma infiltrating the gastric wall. Precisely because of this, the patient had been hospitalized in the high-altitude ward for over a month, but his treatment had been ineffective before the consultation.

Case 3: Persistent Hiccups

I was invited to consult at Lanzhou First Medical University Hospital. The patient was Jiang, a 81-year-old man who had developed a high fever, cough, and chest pain due to a cold one week ago. He was admitted to the hospital for treatment, and an X-ray confirmed pneumonia in the lobar form. After four days of broad-spectrum antibiotic therapy, his fever subsided, and his cough, chest pain, and shortness of breath also improved. Over the past two days, the patient had experienced frequent vomiting. Despite taking Domperidone and Guifan’an, and receiving injections of Diphenhydramine and Phenergan, the vomiting persisted—even after applying atropine to the Zusanli acupoint, the effect was minimal. The patient was elderly and frail, and his hiccups were severe, lasting day and night without stopping. Not only did they interfere with his rest and diet, but the risk of pulmonary infection also increased, with a tendency toward recurrence. His family brought him to me for consultation. Upon examination, I saw that his face was tired, his hiccups were frequent, and he described unbearable pain. His pulse was tense, smooth, and weak, with a particularly strong pulse in the Guan region. His tongue was thick and pale, with a yellowish, thick, greasy coating. When I inquired about his bowel movements, I learned that he had not had a bowel movement for a week! I diagnosed him with damp-heat in the middle burner, with stagnation of stomach qi and lack of upward movement of spleen qi—resulting in stomach qi rising upward, causing constipation and dry stools. The elderly patient was also frail, and his fever had just subsided, leaving both qi and yin depleted. Treatment should focus on descending rebellious qi, opening the intestines, clearing heat and drying dampness, while also tonifying qi and supporting righteous energy. The following formula was prescribed:

6 g of Coptis chinensis, 10 g of Astragalus membranaceus, 10 g of Rheum palmatum, 6 g of Dried Ginger, 6 g of Pinellia ternata, 10 g of Rotandus plantain, 20 g of Poria cocos, 10 g of Codonopsis, 6 g of Clove, 6 persimmon seeds, 6 g of Licorice, 6 g of Fresh Ginger, 4 jujubes, and 180 g of Kitchen Soil—first decocted in water, then boiled with water for 10 minutes, and the water was used to prepare the medicine, one dose per day.

After one dose, the symptoms improved slightly; after two doses, the hiccups stopped, and the patient never experienced another episode. The formula combined the Xiaoxin Decoction with the Xianfu Decoction, the Clove Persimmon Decoction, the Small Half-Season Decoction, the Sanhuang Xiaoxin Decoction, the Ginger Xiaoxin Decoction, and the Licorice Xiaoxin Decoction—all in one preparation, bringing together various formulas for descending rebellious qi and soothing the stomach, while also clearing heat and drying dampness. The Kitchen Soil, also known as Fulong Gan, was used in this formula—pure charcoal firewood, the central charred soil from the hearth. Today, people’s living standards have risen, and the use of firewood for cooking has largely disappeared in urban and rural areas. The Kitchen Soil used in this formula came from the Hui Cui Tang Pharmacy in Lanzhou City. Ms. Fan Junling, the owner of the pharmacy, traveled to impoverished mountain villages in Yuzhong County after the horse-horse mountain range to obtain pure charcoal firewood. She eventually found a particularly impoverished farmer’s household and purchased over 200 kilograms of Kitchen Soil, a story that became a local legend in the Chinese medicine community of Lanzhou.

Case 4: Urinary Calculi

I was invited to consult at the General Hospital of the PLA in Lanzhou. The patient was Qu, a 45-year-old man who served as a cadre in the Qinghai Provincial Party Committee. On his way back from a conference in Beijing, he suddenly experienced lower back pain and hematuria during a flight. After landing at Lanzhou Airport, he was urgently admitted to the high-altitude ward of the General Hospital. The next day, he underwent lithotripsy, but he continued to experience hematuria and severe lower back pain. Ultrasound and CT scans revealed a fragmented stone in the right kidney, lodged in the upper segment of the ureter. I examined his pulse, which was tense, rapid, and smooth, with a yellowish, thick, greasy coating. The formula was:

10 g of Sanling, 10 g of Ophiopogon japonicus, 6 g each of Radix Curcumae Longae and Radix Paeoniae Alba, 10 g of Pangolus, 10 g of Acacia Sinensis, 10 g of Kelp, 10 g of Laminaria, 10 g of Fructus Aurantii, 6 g of Poria cocos, 10 g of Carthamus tinctorius, 10 g of Paeoniae Rubrae, 30 g of Lysimachia, 20 g of Coix Seed, 10 g of Prunus armeniaca, 10 g of Achyranthes bidentata, decocted in water and taken as one dose per day.

After three doses, the lower back pain suddenly disappeared. During urination, the patient noticed two stones, about the size of poppy seeds, yellowish-brown and black in color. The patient said that he only felt mild lower back discomfort now, with a thin, delicate pulse in the Shou region; his tongue coating had become thinner, and its color had faded. He was prescribed Golden Key Kidney Qi Pills. The patient was soon discharged and went to Qinghai to continue his work.

All four cases involved consultations based on the sixteen-character principle of “Western diagnosis, Traditional Chinese Medicine differentiation, traditional Chinese medicine as the primary treatment, Western medicine as a supplementary approach.” Because this mindset guided clinical diagnosis and treatment in everyday practice, when consulting at external hospitals, we were able to correct misdiagnoses, compensate for shortcomings, and help patients who had been unable to receive a proper diagnosis or effective treatment to finally receive a confirmed diagnosis or effective care. This approach embodies the strengths of integrated traditional Chinese medicine and Western medicine, as well as their ongoing vitality. While traditional Chinese medicine and modern medicine often struggle to find common ground, consultations between TCM and Western medicine often remain superficial, either seeking mere formalities or merely going through the motions, or focusing on shifting responsibility—often without real impact. The four consultations mentioned above demonstrate that consultations between TCM and Western medicine physicians can leverage each other’s strengths while avoiding their weaknesses, ultimately improving treatment outcomes and helping patients achieve healing. Cases 1 and 2 corrected diagnoses and proposed integrated TCM-Western medicine treatment approaches; Cases 3 and 4 provided effective treatment for patients whose Western medical treatments had failed.

Discussing Treatment for Decompensated Liver Cirrhosis

Liver fibrosis caused by various factors eventually leads to portal hypertension, which is known as liver cirrhosis. Portal hypertension triggers a series of compensatory changes, including splenic enlargement, esophageal varices, and ascites. The persistent production of ascites indicates that these compensatory changes have reached a point of no return, hence the term “decompensated liver cirrhosis.” Liver cirrhosis typically develops on the basis of recurrent chronic active hepatitis. Clinically, early liver cirrhosis can be diagnosed when there is a long-term imbalance in albumin and globulin levels, fixed splenic enlargement, and a portal vein diameter exceeding 14 mm; mid-stage liver cirrhosis is indicated by esophageal varices, while late-stage liver cirrhosis is characterized by ascites. Thus, decompensated liver cirrhosis refers to the late stage of liver cirrhosis, with ascites being a key indicator. In addition to decompensated liver cirrhosis, most patients may also develop more severe complications, such as gastrointestinal bleeding, hepatic necrosis, hepatic encephalopathy, secondary aplastic anemia, and electrolyte imbalances. These complications can threaten a patient’s life at any time. Therefore, treating decompensated liver cirrhosis is an extremely challenging task—only through integrated TCM and Western medicine, with full dedication, can we turn the tide and extend patients’ lives. Having practiced medicine for over 40 years, I have personally witnessed countless rescue efforts and accumulated extensive experience.