Master Zhu Liangchun’s Inherited Small Formula - Zao Zhi San, Two Herbs for Nodules and Masses
13. Master Zhu Liangchun’s Inherited Small Formula - Zao Zhi San, Two Herbs for Nodules and Masses
Zhu Liangchun, first-ever National Master of TCM, Zao Zhi San is one of his nine cancer-treatment formulas, originally for esophageal cancer with phlegm-stasis mutual binding, later extended to thyroid nodules, breast hyperplasia, uterine fibroids, lymph node enlargement, and various other nodules and masses.
Pathomechanism
| Pathomechanism Level | Pathological Evolution | Pattern Manifestations |
|---|---|---|
| Phlegm turbidity condensation | Spleen transport fails, water-dampness internally retained, accumulating into phlegm, phlegm turbidity flows with qi, condensing locally | Mass palpable on body surface or internally, medium or slightly soft texture, white or yellow greasy tongue coating, slippery pulse |
| Blood stasis obstructing collaterals | Qi mechanism stagnant or prolonged disease entering collaterals, blood flow impeded, stasis accumulating and intersecting with phlegm turbidity | Mass texture slightly hard, fixed and immovable, dark purple tongue or with stasis spots, thin choppy pulse |
| Phlegm-stasis mutual binding | Phlegm turbidity and stasis blood mutually adhesive, over time forming masses, mass gradually enlarging or hardening | Nodule masses not dissipating over time, purple tongue with greasy coating, stasis spots at edges, thin slippery or thin choppy pulse |
Formula Composition
Composition: Seaweed 30g, Fresh Water Leech 6g
Efficacy: Softening hardness and scattering nodules, breaking blood and dissipating masses, clearing phlegm and transforming stasis
Indications: Nodules and masses from phlegm-stasis mutual binding (thyroid nodules, breast hyperplasia, uterine fibroids, lymph node enlargement, esophageal cancer, etc.)
Preparation: Both herbs dried at low temperature, ground into extremely fine powder, stored sealed and protected from light
Usage: 6g per dose, once each morning and evening, taken with yellow wine mixed with warm water. Those who cannot tolerate alcohol may use warm water alone. Because fresh water leech has a strong fishy smell, those who are sensitive to it may encapsulate it in empty capsules
This formula has only two herbs, simple in drugs but focused in power. Seaweed dosage is five times that of water leech, primarily softening hardness and clearing phlegm, water leech breaking stasis as auxiliary, treating phlegm and stasis together. Seaweed is salty and cold in nature, salty softens hardness, cold clears heat; the Shennong Bencao Jing records it governs goiter masses and nodules below the neck, it is the key herb for treating goiter and nodules. Water leech is salty-bitter and neutral in nature, its blood-breaking stasis-removing power is vigorous; the Shennong Bencao Jing records it removes evil blood and stasis, it can search out and remove deep collateral stasis. The two herbs combined, Seaweed clears phlegm and softens hardness to scatter the condensation, Water Leech breaks blood and removes stasis to unblock the collaterals; when phlegm and stasis are both removed, nodules and masses gradually dissipate.
Choosing powder rather than decoction has two considerations. First, water leech in decoction has reduced efficacy, its active compounds cannot withstand high-temperature prolonged decoction; grinding to powder and taking preserves full drug power. Second, nodules and masses are mostly chronic disease processes; powder taken slowly, accumulating day by day, drug power continuously acting on the disease site, conforming to the principle of treating masses should attack slowly. Taking with yellow wine uses its warming-unblocking quality, helping drug power reach the collaterals; those who cannot tolerate alcohol may use warm water.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Softening hardness and clearing phlegm | Seaweed 30g | Salty flavor softens hardness, clears phlegm and scatters nodules, dissipates goiter and nodular swelling, uniquely heavy dosage as sovereign |
| Breaking blood and removing stasis | Fresh Water Leech 6g | Breaks blood and removes stasis, searches out and removes old collateral stasis, lighter dosage than Seaweed as minister, ground to powder to preserve full drug effect |
Modifications
Zao Zhi San original formula has only two herbs; clinically often combined with other herbs based on the pattern or used with decoctions:
| Concomitant Pattern | Modified Herbs | Treatment Intent |
|---|---|---|
| Marked qi stagnation | Add Bupleurum 10g, Turmeric 12g, Cypress Fruit 10g | Soothing the liver and regulating qi, when qi moves phlegm-stasis dissipates easily |
| Predominant phlegm turbidity | Add Fritillaria 12g, Prunella 15g, Raw Oyster Shell 30g | Clearing phlegm and softening hardness, strengthening nodule-scattering power |
| Severe stasis blood | Add Sparganium 10g, Curcuma Zedoary 10g, Processed Pangolin Scale 6g | Breaking blood, moving stasis, dissipating masses, strengthening stasis transformation and nodule scattering |
| Spleen deficiency weak qi | Add Astragalus 30g, Codonopsis 15g, White Atractylodes 12g | Fortifying the spleen and supplementing qi, supporting healthy qi to aid mass dissipation, preventing attack from damaging healthy qi |
| Combined with ulcer bleeding | Add Panax Notoginseng Powder 3g (taken with water) | Transforming stasis and stopping bleeding, water leech’s blood-breaking power is vigorous, those with bleeding tendency must combine with Panax Notoginseng |
Clinically Zao Zhi San is often taken with decoctions for adjustment. For thyroid nodules combined with Sihai Shuyu Wan or Haizao Yuhu Tang modifications, for breast hyperplasia combined with Xiaoyao San modifications, for uterine fibroids combined with Cinnamon Twig and Poria Pill modifications. Powder follows the formula for gradual attack, decoction adjusts flexibly based on the pattern, the two proceed in parallel.
Summary
Zao Zhi San uses Seaweed 30g to soften hardness and clear phlegm, Fresh Water Leech 6g to break blood and remove stasis, two herbs forming the formula, treating phlegm and stasis together. Powder taken preserves full water leech drug effect, yellow wine guides the drugs into the collaterals, gradual attack with long-term use suitable for thyroid nodules, breast hyperplasia, uterine fibroids, and various other phlegm-stasis mutual binding nodules and masses. Although the formula is simple, the method is clear, emphasizing softening hardness while lightly breaking stasis, attacking with moderation. Clinically often combined with decoctions, powder follows the formula for gradual approach, decoction adjusts flexibly based on the pattern, the two proceed in parallel for effect.
References:
[1] Zhu Liangchun. Application of Insect Herbs [M]. Beijing: People’s Medical Publishing House, 2011.
[2] Zhu Liangchun. National Master Zhu Liangchun’s Nine Cancer Formulas [N]. China TCM Report.
[3] Zhu Liangchun Academic Experience Inheritance Research Office. Zao Zhi San for Treating Esophageal Cancer Proven Formula [J]. Toutiao, 2017.
[4] Chen Shigong. Zhengzong of Surgery [M]. Beijing: People’s Medical Publishing House, 2007.
13. 朱良春傳世小方——藻蛭散 兩味藥治結節腫塊
朱良春首屆國醫大師，藻蛭散為其治癌九方之一，原治食管癌痰瘀互結證，後推廣用於甲狀腺結節、乳腺增生、子宮肌瘤、淋巴結腫大等各類結節腫塊。
病機
| 病機層次 | 病理演變 | 證候表現 |
|---|---|---|
| 痰濁凝滯 | 脾運失司，水溼內停，聚而成痰，痰濁隨氣流行，凝於局部 | 體表或體內觸及腫塊，質中或偏軟，舌苔白膩或黃膩，脈滑 |
| 血瘀阻絡 | 氣機鬱滯或久病入絡，血行不暢，瘀血停積與痰濁交結 | 腫塊質地偏硬，固定不移，舌質暗紫或有瘀斑，脈細澀 |
| 痰瘀互結 | 痰濁與瘀血相互膠結，日久成癥，腫塊漸增大或變硬 | 結節腫塊日久不消，舌紫苔膩，邊有瘀斑，脈細滑或細澀 |
方藥組成
組成：海藻 30g，生水蛭 6g
功效：軟堅散結，破血消癥，消痰化瘀
主治：痰瘀互結所致結節、腫塊（甲狀腺結節、乳腺增生、子宮肌瘤、淋巴結腫大、食管癌等）
製法：兩藥低溫烘乾，研磨成極細藥粉，密封避光保存
用法：每次6g，早晚各1次，黃酒加溫水對半沖服。不耐酒者單用溫水送服。因生水蛭腥味較重，怕腥者可裝入空心膠囊服用
本方僅兩味藥，藥簡而力專。海藻用量五倍於水蛭，以軟堅化痰為主，水蛭破瘀為輔，痰瘀同治。海藻味鹹性寒，鹹能軟堅，寒能清熱，《神農本草經》載其”主癭瘤氣，頸下核”，是治療癭瘤結節的要藥。水蛭味鹹苦性平，破血逐瘀之力峻猛，《神農本草經》載其”逐惡血、瘀血”，能搜剔絡脈深處之瘀血。兩藥配合，海藻化痰軟堅以散其凝結，水蛭破血逐瘀以通其絡脈，痰瘀併除則結節腫塊漸消。
選用散劑而非湯劑，有兩層考量。其一，水蛭入湯劑效減，其有效成分不耐高溫久煎，研末沖服可保全藥力。其二，結節腫塊多為慢性病程，散劑緩服，日積月累，藥力持續作用於病所，符合”治癥瘕當緩攻”的原則。黃酒沖服取其溫通之性，助藥力通達絡脈，不耐酒者溫水亦可。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 軟堅消痰 | 海藻 30g | 味鹹軟堅，化痰散結，消癭瘤核腫，用量獨重為君 |
| 破血逐瘀 | 生水蛭 6g | 破血逐瘀，搜剔絡脈久瘀，劑量輕於海藻為臣，研末沖服保全藥效 |
隨證加減
藻蛭散原方僅兩味，臨床多在此基礎上隨證配伍或與湯劑合用：
| 兼證 | 加減藥物 | 立法用意 |
|---|---|---|
| 氣滯明顯 | 加柴胡 10g、鬱金 12g、香附 10g | 疏肝理氣，氣行則痰瘀易消 |
| 痰濁偏盛 | 加浙貝母 12g、夏枯草 15g、生牡蠣 30g | 化痰軟堅，增強散結之力 |
| 瘀血重證 | 加三稜 10g、莪術 10g、炮山甲 6g | 破血行瘀消癥，加強化瘀散結 |
| 脾虛氣弱 | 加黃芪 30g、黨參 15g、白朮 12g | 健脾益氣，扶正以助消癥，防攻伐傷正 |
| 合併潰瘍出血 | 加參三七粉 3g（沖服） | 化瘀止血，水蛭破血力峻，有出血傾向者須配三七 |
臨床常以藻蛭散吞服配合湯劑調治。如甲狀腺結節合四海舒鬱丸或海藻玉壺湯加減，乳腺增生合逍遙散加減，子宮肌瘤合桂枝茯苓丸加減。散劑守方緩攻，湯劑隨證變通，兩者並行。
小結
藻蛭散以海藻30g軟堅消痰、生水蛭6g破血逐瘀，兩味成方，痰瘀同治。散劑沖服保全水蛭藥效，黃酒引藥入絡，緩攻久服適用於甲狀腺結節、乳腺增生、子宮肌瘤等各類痰瘀互結之結節腫塊。方雖簡而法度明確，重軟堅而輕破瘀，攻中有節。臨床常與湯劑合用，散劑守方緩圖，湯劑隨證調治，二者並行取效。
參考文獻：
[1] 朱良春.蟲類藥的應用[M].北京:人民衛生出版社,2011.
[2] 朱良春.國醫大師朱良春治癌九方[N].中國中醫藥報.
[3] 朱良春學術經驗傳承研究室.藻蛭散治食管癌驗方[J].今日頭條,2017.
[4] 陳實功.外科正宗[M].北京:人民衛生出版社,2007.