Primary liver cancer is a common malignant tumor of the digestive system. According to the World Health Organization, the mortality rate of liver cancer ranks fifth worldwide, while the mortality rate of primary liver cancer in China fluctuates between 20~24/100,000, which has become the first cause of death in rural areas and the second cause of death in urban areas. More than 40% of the annual new cases worldwide occur in China, mainly in the southeast coastal region. The disease starts insidiously and is mostly advanced when first diagnosed, with a natural course of about 24 months and a median survival of only about 6 months for patients in the middle and late stages. Primary liver cancer can be classified as “liver accumulation”, “obstruction”, “accumulation”, “dropsy” and “dropsy” in Chinese medicine. “The combination of Chinese and Western medicine plays an important role in the prevention and treatment of hepatocellular carcinoma. In the past, Chinese medicine mostly used drugs for clearing heat and detoxification, activating blood circulation and eliminating blood stasis to treat liver cancer, but the efficacy was not obvious; while recognizing the pathogenesis of liver cancer according to the theory of spleen and stomach, and using the method of strengthening spleen and regulating qi to treat liver cancer, certain efficacy was achieved. The common symptoms of liver cancer and their frequency are pain in the liver area, epigastric mass, epigastric distension, weakness, poor appetite, nausea and vomiting, fever and diarrhea, etc. All these symptoms are closely related to the spleen and stomach. According to “the spleen has moving qi, press the firm as if it were painful, its disease abdominal distension and fullness, food does not disappear, body weight joint pain, laziness and sleepiness, limbs do not collect” and “spleen disease, when the umbilicus has moving qi, press the firm as if it were painful, moving qi building and building, firm as if it were accumulation and hard, if it were painful, even then also great pain, there is a spleen deficiency disease also “, indicating that spleen disease can have manifestations of epigastric pain and masses. As for fever, the Treatise on the Spleen and Stomach also says: “Stomach disease is short of breath, less spirit and great fever”. It is also related to the spleen and stomach. The above shows that from the perspective of Chinese medicine theory, the Chinese pathogenesis of liver cancer is closely related to the pathological changes of the spleen and stomach. Since the common symptoms of liver cancer are related to the spleen and stomach, the basic treatment should be based on the principle of strengthening the spleen and regulating qi. In the treatment of primary hepatocellular carcinoma, the following aspects are mainly covered: 1. Combination of Chinese medicine and surgical treatment Pre-operative treatment is based on adjusting yin and yang, qi and blood, and the function of internal organs, and the basic treatment is to strengthen the spleen and benefit qi, nourish qi and blood, and nourish liver and kidney, with drugs such as Bajian Tang, Bao Yuan Tang, Liu Wei Di Huang Wan, etc. Such drugs can enhance the immune function of the body. After radical surgery, we often choose Bazhen Tang and Liu Wei Di Huang Wan according to the specific symptoms such as low fever, night sweats and loss of appetite to promote the recovery of the body; after palliative surgery, we often show that the positive energy is depleted and the evil energy is still incandescent, so we should pay attention to supporting the positive energy and eliminating the evil energy on the basis of protecting the positive energy, and choose anti-cancer herbs as appropriate. 2. Combination of Chinese medicine and radiotherapy Liver cancer is moderately sensitive to radiation, if radical radiotherapy is performed early, long-term survival can be achieved. Postoperative adjuvant radiotherapy can reduce local recurrence and improve long-term survival rate. Palliative radiotherapy for advanced hepatocellular carcinoma can alleviate local symptoms and is more effective when combined with Chinese medicine. The benefits of combining TCM with radiotherapy include local sensitization, improving radiotherapy effect, preventing and linking radiotherapy-related adverse effects, and preventing sequelae. More importantly, it consolidates the efficacy of radiotherapy, reduces recurrence and metastasis, and improves the long-term survival rate of patients. For example, for those who suffer from dizziness, weakness and leukopenia due to radiotherapy, it is most appropriate to benefit Qi and nourish blood, nourish liver and kidney, and benefit essence and fill marrow. In the identification of prescriptions, try to use drugs that are consistent with the type of evidence and also have anti-tumor therapeutic effects. 3. Combination of Chinese medicine and hepatic artery local chemotherapy Hepatocellular carcinoma is not sensitive to most chemotherapeutic drugs, so systemic chemotherapy is seldom used, and interventional embolization chemotherapy (TACE) is mostly used now. Almost all patients have different degrees of adverse reactions after chemotherapy, especially the “post-embolization syndrome” after interventional embolization, and Chinese medicine has good effect on the prevention and treatment of adverse reactions after chemotherapy. Bone marrow suppression caused by chemotherapy is quite common, and TCM advocates the legislation of “kidney is the master of bone and marrow”, and actively uses liver and kidney tonics to regulate, such as Zuo Gui Wan, Liu Wei Di Huang Wan, etc. For thrombocytopenia and spontaneous bleeding, the treatment is based on the treatment of qi not taking blood, which is given to Gui Shen Tang to benefit the qi and strengthen the spleen to take blood; for heavy gastrointestinal reactions, it is often given to strengthen the spleen and stomach, and to lower rebellion and stop vomiting. For more severe gastrointestinal reactions, treatment is often given to strengthen the spleen and stomach, subdue rebellion and stop vomiting. The combination of spleen-strengthening and qi-regulating herbs with TACE for hepatocellular carcinoma is effective and well tolerated by most patients, and the adverse effects can be substantially reduced after intervention. Combination of Chinese medicine and biological therapy Biological and immunological therapy for liver cancer is also repeatedly applied in clinical practice. In this sense, “supporting the righteous” means adjusting the body’s immune function, while “eliminating the evil” means killing cancer cells as much as possible. The combination of spleen-strengthening and qi-regulating herbs with biological or immunotherapy can increase the number of spleen cells, cell proliferation and killing function, and the expression of interleukin 2 receptor, and increase the TH ratio significantly, thus improving the immune function of the whole body. In conclusion, spleen-strengthening and qi-regulating herbal medicines have a wide range of applications in the comprehensive treatment of primary hepatocellular carcinoma, either alone or in combination with various modern medical treatments, which are significantly better than single treatment. The efficacy of the combination of spleen-strengthening and qi-regulating herbs with targeted therapy for liver cancer is to be tested in subsequent clinical practice. Combined Chinese and Western medicine treatment for middle and late stage pancreatic cancer Pancreatic cancer is a common and lethal cancer of the digestive system. In the United States, the mortality rate of pancreatic cancer was the 4th highest among all malignant tumors in 2007. In the past 20 years, the incidence of pancreatic cancer in large and medium-sized cities in China has increased substantially, and the annual incidence rate has increased 4 times in 20 years in high incidence areas such as Shanghai and Tianjin, with an annual incidence rate of about 9/100,000, and pancreatic cancer in Shanghai ranks 8th in the incidence rate of tumors in men and 10th in women. Because of the insidious onset of pancreatic cancer, the clinical manifestations are non-specific and the disease progresses rapidly, most patients are already in advanced stage or have distant metastasis when diagnosed. Non-surgical treatment is the most important treatment for pancreatic cancer. Pancreatic cancer belongs to the categories of “Fuliang”, “accumulation” and “jaundice” in Chinese medicine. Early symptoms are not obvious, most of them are anorexia and weight loss, abdominal pain is the earliest symptom of pancreatic tail cancer, jaundice appears earlier in pancreatic head cancer. In the late stage, abdominal mass, fever and emaciation may appear. According to Chinese medicine, the occurrence of this disease is mainly due to the poor qi flow, dampness and turbidity, and the accumulation of damp heat and evil toxins. The pathogenesis of the disease includes: 1. liver qi stagnation, poor qi flow, qi stagnation and heat, heat and toxicity accumulation, forming lumps over time. 2. 2. Spleen deficiency generates dampness, dampness and toxicity accumulate inside, and after prolonged period of time, dampness becomes heat, and dampness and heat and toxicity become tumors. Dampness, heat toxicity and the interconnection of dampness and heat toxicity are the key to the pathology of pancreatic cancer in Chinese medicine. The treatment of pancreatic cancer in Chinese medicine should be based on the principles of “clearing heat”, “resolving dampness” and “detoxifying toxins”. The Chinese herbal remedies based on this principle can stabilize the tumor foci, prolong the survival period and improve the long-term survival rate. Patients with intermediate and advanced pancreatic cancer (including locally advanced and metastatic pancreatic cancer) lose the chance of surgery and are mainly treated with palliative care. 1. Combination of Chinese medicine and radiotherapy Pancreatic cancer is moderately sensitive to radiation, adjuvant radiotherapy after radical surgery can reduce postoperative recurrence, and radiotherapy for middle and advanced pancreatic cancer can control local lesions and improve long-term survival benefit. It can be combined with chemotherapy. The target area for radiation is based on CT or intraoperative markers, including the primary tumor and local lymph nodes. Preference is given to 3D conformal radiotherapy at a dose of 40-50 Gy (1.8-2 Gy/d). During radiotherapy, Chinese herbal medicines to clear heat and dampness and detoxify and reduce swelling can be taken together to improve the efficacy and reduce the local tissue edema and radioactive inflammatory reaction caused by radiotherapy. 2. Combination of Chinese medicine and systemic chemotherapy Systemic chemotherapy is the main treatment for middle and advanced pancreatic cancer. The purpose of treatment must be explained to patients before chemotherapy, and patients receiving chemotherapy must be closely followed up, including physical examination, abdominal and chest imaging examinations and regular testing of serum CA19-9. Indications: Adjuvant chemotherapy after radical surgical resection; pancreatic cancer with metastasis; locally advanced unresectable pancreatic cancer, recurrent metastasis after surgery or other treatments. The role of neoadjuvant chemotherapy has not been conclusively established. Locally advanced pancreatic cancer: concurrent radiotherapy (5-FU + radiotherapy/gemcitabine + radiotherapy) and/or focused ultrasound knife therapy is the standard regimen; after concurrent radiotherapy and chemotherapy, if the disease has not progressed, gemcitabine chemotherapy can be used as a continuation regimen, and for those who cannot be treated with radiotherapy and/or focused ultrasound knife therapy, gemcitabine chemotherapy can be used as an alternative regimen for a total of 4-6 cycles of chemotherapy. Standard first-line chemotherapy for metastatic pancreatic cancer: gemcitabine 1000 mg/m2, 30-minute drip, once a week for 3 weeks, 28 days for 1 cycle, 4-6 cycles; with hepatic metastases may include hepatic artery chemotherapy; for those with primary pancreatic lesions, palliative local treatment of the pancreas (ultrasound focused knife and/or radiotherapy) may be given at the same time as chemotherapy if the general condition is good. Gemcitabine can be administered at a fixed dose rate (1000 mg/m2/min) instead of a 30-minute drip method. Chinese medicine and chemotherapy can be administered simultaneously, and the treatment needs to be typed: 1. Damp and toxic type Treatment: Drying dampness and strengthening the spleen. The formula is Er Chen Tang. 2. Heat toxicity type Treatment: Clearing heat and detoxifying. Prescription Clear the pancreas and resolve stagnation. 3. Damp-Heat-Toxin type Treatment: Clearing heat and relieving dampness to detoxify. The formula is Yin Chen Artemisia Tang. Chinese medicine treatment can also be adjusted according to the condition of the body after chemotherapy. If there is deficiency of qi and blood after chemotherapy, give benefit to qi and nourish blood as appropriate; if there is heavy reaction in digestive tract, give benefit to spleen and stomach; if there is obvious decrease of platelet, give benefit to qi and blood intake and symptomatic treatment. 3. Combination of Chinese medicine and interventional treatment Interventional treatment indications: pancreatic cancer with liver metastasis at the time of discovery; liver metastasis after surgery or other treatment for pancreatic cancer; failure of systemic chemotherapy for unresectable pancreatic cancer. For those with primary pancreatic lesions, if the general condition is good, palliative local treatment of the pancreas (radiotherapy and/or ultrasound focused knife, etc.) should be given after arterial chemotherapy. If the liver metastases are rich in blood supply, the hepatic artery (or the artery supplying blood to the liver metastases) should be embolized with super-liquidated iodine oil, the dosage of which depends on the size of the tumor, the diameter of the blood vessels and the patient’s tolerance. The efficacy of systemic chemotherapy combined with interventional therapy is significantly better than that of single interventional or single systemic chemotherapy, so the combined therapy should be promoted. Combined application of Chinese medicine and interventional therapy is mainly used for prevention and treatment of “post-embolization syndrome”, before and after intervention can be taken to clear heat and dampness and detoxify the main Chinese medicine formula (qing pancreatic and defuse accumulation formula), and add or subtract as appropriate with the disease. 4. Combination of Chinese medicine and focused ultrasound thermal therapy High-intensity focused ultrasound knife can treat liver metastases by destroying the abdominal plexus branches behind the pancreas, so it can be used to control the pain of pancreatic cancer, improve the quality of survival and prolong the survival period. The combination of Chinese medicine and focused ultrasound thermotherapy can minimize the thermal damage caused by physical cauterization of the body by focused ultrasound, and Chinese medicine can be used both internally and externally, mainly to clear heat and detoxify the body, supplemented by nourishing Yin and benefiting Qi, with flexible addition and reduction. Middle and late stage pancreatic cancer is a highly refractory malignant tumor and patients cannot receive surgical treatment, therefore, the survival period is short and the prognosis is extremely poor. Chinese medicine combined with radiotherapy, interventional, focused ultrasound thermal therapy and systemic chemotherapy can fully compensate for the shortcomings of each treatment, minimize their adverse effects and achieve better synergistic effects, which has positive efficacy in improving patients’ survival quality and prolonging survival.