Hepatocellular carcinoma is a malignant tumor originating from hepatocytes or (and) intrahepatic bile duct epithelial cells, also known as primary hepatocellular carcinoma. It belongs to the categories of “dropsy”, “jaundice”, “liver accumulation” and “obstruction” in Chinese medicine. Now the name of the disease in Chinese medicine is collectively called “liver cancer”.
I. Diagnosis
Diagnosis of symptoms
1. Liver depression and spleen deficiency: epigastric masses, distention and discomfort, emaciation and weakness, tiredness and shortage of breath, abdominal distension and lack of appetite, distension after eating, dry mouth and lack of desire to drink, loose stools, short yellow urine, or even ascites, jaundice, swelling of lower limbs, fat tongue, white tongue coating, thin pulse.
2.Damp-heat of liver and gallbladder: head heavy, body sleepy, body and eyes yellowish, irritable, feverish and thirsty, dry and bitter mouth, chest and epigastric stuffiness, burning pain in the hypochondrium, abdominal distention and fullness, hypochondriac mass, dullness and vomiting, short and yellowish red urine, constipated or unpleasant stool, red tongue, yellowish greasy tongue coating, string or smooth pulse.
3, liver heat and blood stasis: epigastric masses, stone hard, swollen top pain and refusal to press, or chest pain and refusal to press, or chest pain and discomfort, irritable heat, dry mouth and lips, dry stool, urine yellow or short red, or even skin nail wrong, tongue red or dark red, tongue coating white thick, pulse string or string smooth and strong.
4, spleen deficiency dampness trapped: abdominal bloating, fatigue, heavy body, heavy limbs and feet swelling, urine less. The mouth is sticky and does not want to drink, sometimes feeling nauseous, loose stools, light tongue, teeth marks on the edge of the tongue, thick and greasy moss, thin string or smooth or moist pulse.
5.Yin deficiency of liver and kidney: dropsy, swollen limbs, blue tendons in the frog’s abdomen, thin limbs, short breath and panting, red lips and dry mouth, dullness and fear of food, restlessness and sleeplessness, short drowning and number of stools, or even touching the bed with clothes, blood overflowing up and down, red and vivid tongue, light tongue without moss, thin and weak pulse, or pulse like bird peck.
II. Treatment plan
(A) Selecting oral Chinese herbal tonics according to the evidence
1. Liver depression and spleen deficiency
Treatment: Strengthening the spleen and benefiting the qi, draining the liver and softening the firmness.
Recommended formula: Prosperity San combined with Si Jun Zi Tang plus or minus.
2.Damp-heat in liver and gallbladder
Treatment: Clearing heat and dampness, cooling the blood and detoxifying the toxin.
Recommended remedy: Artemisia Inchi Tang with Addition.
Mian Yin Chen, Gardenia, Rhubarb, Money Grass, Poria, Chai Hu, Bai Shao, Yu Jin, Neem, Citrus aurantium, Half Branch Lotus, Seven-leaved One-branch Flower, Plantago ovata, Zeligia, etc.
3.Liver heat and blood stasis
Treatment: Clearing the liver and cooling the blood, detoxifying and removing blood stasis.
Recommended formula: Gentian and Liver Dissolving Soup combined with Xie Yu Blood Stasis Soup plus reduction.
Gentian Herb, Semen Nelumbo, Gardenia, Zedoary, Mouton, Plantago, Radix et Rhizoma, Radix Bupleurum, Peach kernel, Curcuma longa, Rhizoma Rheum, Radix Rehmanniae, Dampness, Radix Glycyrrhiza Uralensis, etc.
4, spleen deficiency dampness trapped
Treatment: Strengthening the spleen and benefiting the qi, relieving dampness and detoxification.
Formula: Si Jun Zi Tang combined with Wu Pi Drink plus or minus.
Radix Astragali, Radix Codonopsis, Atractylodes Macrocephala, Poria Bark, Radix Aromaticus, Citrus Aurantium, Chen Pi, Rhizoma Polygonati, Melon Peel, Zedoary, Coix Coix Seed, Rhizoma Longifolia, Rhizoma Peach, Curcuma longa, Radix et Rhizoma Glycyrrhizae.
5.Yin deficiency of liver and kidney
Treatment: Clearing heat and nourishing yin, softening hardness and dispersing nodules.
Remedy: Consistent decoction with added flavor.
Radix Rehmanniae Praeparata, Radix Salviae Miltiorrhiza, Radix Angelicae Sinensis, Fructus Lycii, Semen Mulberry, Neem, Radix Paeoniae Alba, Semen Turtle A (first decoction), Radix chasteberry, Radix et Rhizoma Drynariae, Dangpi, etc.
6.Discriminative use of medicine
On the basis of evidence-based treatment, 2-4 herbs with clear anti-cancer effects can be added, such as half-branch lotus, centipede, August zha, Andrographis paniculata, seven-leaved one branch flower, mountain cichlid mushroom, white flowered snake’s tongue herb, lobelia herb, swelling wind, winter ling grass, etc.
(2) Select oral Chinese medicine according to the evidence
According to the condition, choose to apply Xihuangwan, Jinke Huaier granules, Hepatofuole, Jinlong capsule, Ankangxin capsule, Xiaojinwan, Huanzhihuisheng tablets, Crow’s bile oil soft capsule, Pingxiao capsule, Jinshui Bao capsule, Bai Ling capsule, etc.
(3) Selecting intravenous injection of Chinese medicine according to the evidence
According to the condition, choose to apply Kanglaite injection, compound bitter ginseng injection, sodium zebranate injection, eleuthero milk injection, opium bilberry oil milk injection, Edi injection, anti-cancer flat injection, Kangai injection, huachansu injection, arsenious acid injection, etc.
(iv) External treatment method
According to the condition, use Chinese herbal medicines and proprietary Chinese medicines to activate blood circulation and remove blood stasis, clear heat and detoxification, etc. for external treatment, Chinese medicine soaking and washing, Chinese medicine fumigation, etc.
(E) Acupuncture treatment
According to the condition and clinical practice, body acupuncture, head acupuncture, electric acupuncture, ear acupuncture, wrist and ankle acupuncture, eye acupuncture, moxibustion, acupuncture point buried thread, acupuncture point compressing bean and cupping can be applied. For acupuncture treatment, the main acupuncture points are Liver Yu and Foot San Li, with Yanglingquan, Periodic Gate, Zhangmen and Sanyinjiao; for acupuncture point dressing, the main acupuncture points are Zhangmen, Periodic Gate, Liver Yu, Neiguan and Gongsun, with Waiguan, Foot San Li and Yanglingquan for pain; for ascites, Qihai, Sanyinjiao and Yinlingquan.
(F) Other treatments
According to the condition, appropriate treatment equipment is used to improve the efficacy, such as radiofrequency ablation therapy, Chinese medicine interventional therapy, deep heat therapy, immune system therapy, etc.
(vii) Internal medicine basic treatment
Mainly includes the prevention and treatment of pain, jaundice, bleeding, infection, fever and other complications.
(H) Nursing care
Including position selection, diet, oral care, respiratory care, Chinese medicine evidence-based care, prevention and care of complications, etc.