Disease Overview Hepatic hemangiomas are benign tumors of the liver. Hepatic cavernous hemangioma is the most common. Cavernous hemangiomas are usually solitary and occur in the right lobe of the liver; about 10% are multiple and may be distributed in one lobe of the liver or bilaterally. Hemangiomas appear as dark reddish, bluish-purple sac-like elevations in the liver. It is lobulated or nodular, soft, compressible, and most of them are clearly demarcated from neighboring tissues. Patients usually have no conscious symptoms. The cause of hemangioma formation is not known, some people think that it is caused by the abnormal development of intrahepatic vascular structure, and some people think that it is related to the level of estrogen. The disease is more common in middle-aged women, and the incidence of the disease is six times higher in women than in men. Since this disease has no obvious symptoms and only manifests as an intrahepatic space-occupying lesion, clinical attention should be paid to differentiating it from hepatocellular carcinoma. Disease classification (1) Cavernous hemangioma: its section is honeycomb, full of blood, microscopic examination shows different sizes of cystic sinusoids, full of erythrocytes, sometimes thrombosis, there is a fibrous tissue septum between the sinusoids, and small blood vessels and bile ducts are seen in the fibrous septum, and the compressed hepatocellular cords can be seen occasionally. The thrombus in the fibrous septum and the blood sinusoid can be seen as calcification or vein stone. (2) Sclerosing hemangioma, the lumen of the blood vessel is closed, and the fibrous septum is degenerative. (3) Vascular endothelial cell tumor, the proliferation of vascular endothelial cells is active, which may lead to malignant changes. (4) Hepatic capillary hemangioma, with narrow vascular lumen and many fibrous interstitial tissues. Clinical manifestations 1. Small hemangiomas are asymptomatic; larger hemangiomas may have distension and pain in the liver area. 2.Small hemangiomas have no physical signs, while larger hemangiomas may have palpable mass in the right upper abdomen and liver enlargement. 3.Liver enlargement, mass and compression symptoms appear after tumor enlargement, and there is no symptom in early stage. Diagnosis is mainly based on ultrasound, cT, nuclear scanning and hepatic arteriography. Smaller hemangiomas with no symptoms do not need to be treated and can be observed dynamically; those with compression symptoms can choose partial hepatectomy. Hemangiomas are mostly solitary and less than 4 cm in diameter. Hepatic hemangioma is often found incidentally during ultrasound examination, its size and shape and number are not certain, often congenital. If it is static and does not develop, without any conscious symptoms, it is usually not life-threatening. about 40% of those above 4 cm are accompanied by abdominal discomfort, hepatomegaly, poor appetite, dyspepsia and other symptoms. Hepatic hemangioma may have fibrous tissue, mechanized thrombus, which may cause tumor swelling due to repeated thrombosis, causing liver pericardium pulling and distension. In recent years, according to the tracking observation of many cases, it is found that the development of hepatic hemangioma in many patients is very slow, and there is no obvious development even after years of follow-up, and no malignant transformation has been found. Therefore, any small-sized intrahepatic hemangioma can be examined by ultrasound regularly under medical supervision for half a year or one year). If symptoms such as swelling and pain in the liver area, abdominal distension and discomfort, and poor appetite occur, traditional Chinese medicine can be taken to treat them. Only when the hemangioma is progressively enlarged can it be treated surgically to avoid the danger of rupture and bleeding of hemangioma. Diagnostic basis: 1. Swelling and pain in liver area, liver size or palpable mass. 2. Color ultrasound shows hemangioma-like changes in liver. 3.CT examination: there is a low-density area with uniform density in the liver, and a “C”-shaped enhancement band can appear in the edge area of the tumor after enhancement. 4, Hepatic arteriography: there is a “vascular lake” image around the lesion area, and the contrast agent stays for a long time. 5. Laparoscopy: it can observe the color and shape of the tumor on the surface of liver. 6.X-ray examination: the liver shadow is large, the diaphragm is elevated, and calcified shadow can be found. 7.ECT shows hepatic hemangioma changes. Treatment principle 1, tumor diameter <5cm, no need for surgical treatment, regular review, follow-up. 2.If the tumor diameter is 5-10cm, surgery can be considered. 3.Tumor diameter >10cm is usually treated by surgery. 4.Surgical methods are: (1) hepatic hemangioma resection or lobectomy; (2) hepatic artery ligation; (3) intraoperative cryotherapy. Non-surgical treatment: (1) radiation therapy; (2) hepatic arteriography and tumor artery embolization. Principle of medication Generally, no medication is needed. Surgical treatment in addition to the selection of basic drugs in antibiotic prevention of wound infection. Evaluation of therapeutic effect 1. Cure: CT, color ultrasound shows the disappearance of mass, disappearance of symptoms, healing of incision, no complications. 2.Improvement: CT, color ultrasound showed that the swelling became smaller and the symptoms were reduced. Uncured: no change, or further expansion of the mass. Expert’s tip: Hepatic hemangioma is a benign lesion, at present, there is still no therapeutic drug for hepatic hemangioma, so patients with hemangioma <5cm don't need to seek for medical treatment everywhere, and regular follow-up can be enough. If the tumor is >5cm, and there are self-conscious symptoms, the patient should go to the hospital to follow the medical treatment. Chinese medicine diagnosis and treatment Liver hemangioma (TCM name: hepatic obstruction) is a common benign tumor of the liver. Small tumors can be asymptomatic, while large tumors can cause symptoms such as loss of appetite, belching, and pain and distension. Western medicine advocates surgical resection, radiation therapy, and ligation of the hepatic artery as treatment methods for this disease. Many patients are afraid of surgery and seek treatment from TCM practitioners. This disease belongs to the category of obstruction in the abdomen in Chinese medicine. Ancient Chinese medical texts on obstructions in the abdomen mostly attribute it to internal injuries of the seven emotions, leading to stagnation of liver qi, stagnation of qi and stagnation of blood, and stagnation of blood for a long period of time, resulting in obstructions in the abdomen. The cause of this disease is stagnation of qi and blood stasis, or due to dietary disorders, spleen deficiency and lack of transportation, water-dampness is not transformed and becomes phlegm, phlegm stagnates in the veins and channels, and accumulates with blood and qi to form the obstruction in the abdomen. The treatment of this disease is based on promoting qi and dredging the liver, activating blood circulation and removing blood stasis, and softening hardness and dispersing knots, but in the specific treatment, one should distinguish between the predominance of qi stagnation and blood stasis. If blood stasis is the mainstay, the following drugs are used: antelope bone, buffalo horn, oxalis, red peony to clear heat and cool the blood to relieve pain; Chai Hu, Huang Pi Nuclear, Su Chime Needle, etc. to regulate qi and open up the depression; Salvia divinorum and safflower to activate blood circulation and remove blood stasis; fried goat’s nest, Soapberry, Chuan Fu, to soften and disperse knots, and to run away from the meridians. If the stagnation of qi is the main, the following drugs are used: Chaihu, tulip gold, Huangpi nuclear, vegetarian chime needle, etc. to promote qi and relieve depression; with danshen, safflower, trigonelline, curcuma, rhubarb to promote blood circulation and remove blood stasis; fried mountain armor, soap horn spur, Chuan foot to soften and disperse knots, and to relieve pain. Combined with the oral administration of “Bear Gall Pill” and “Dan Huo Tou Heat Therapy”, the treatment effect is even better. The obstruction in the abdomen is different from that of the general qi stagnation and blood stasis, as it is often stagnant for a long period of time and cannot be treated by simply promoting qi and blood circulation. Therefore, when choosing the herbs, the use of qi promoting and blood circulation medicines, together with the combination of sautéed sanshoujia, saponaria, and Chuanzhu, not only softens and disperses the hard lumps, but also opens up the collaterals and relieves pain, which is of unique efficacy. Note 1 “bear bile pills” formula bear bile, pearl, seven leaves of a flower, Tianqi, cowhuang, appropriate amount, roasted, research for fine powder mix well, each serving one gram. Functions: Clearing the orifices, relieving pain, activating blood circulation and removing blood stasis. Note 2 “Dan fire through the heat therapy” formula Dan medicine formula: 30 grams of sulfur, 12 grams of cinnabar, 12 grams of andrographis 12 grams [production method] will be the end of the sulfur in a copper ladle in the fire melting, add andrographis, cinnabar, mixing, poured in the aluminum basin cooled into a slice. Dan seat formula: France Xia, gall star 30 grams of wood, two pointed each 18 grams [production method] on the drug powder, honey into a paste, pinched into a chestnut-sized center of the concave Dan seat. How to use] Place the Dan seat in the required acupoints (this disease needs to take Zhangmen point and the period of the door point) inserted melon seeds in the depression in the Dan tablets, with a fire, to the extent that the skin burning sensation. Extinguish the fire, apply cotton pads externally to fix it, and remove the elixir after 3 hours. 1~2 times a day. [Function] Warming the meridians and collaterals, promoting circulation of Qi and dispersing knots.