Primary liver cancer refers to malignant tumors arising from hepatocytes or intrahepatic bile duct cells, and is one of the common malignant tumors in China. The number of new liver cancer cases in China accounts for more than half of the global population, which seriously affects people’s life and health. Chinese medicine has certain advantages in the treatment of primary liver cancer and plays an important role in the comprehensive treatment of liver cancer. The author’s unit is the head unit of Liver Cancer Collaboration Group of State Administration of Traditional Chinese Medicine Tumor Key Specialty, and has rich clinical experience in treating primary liver cancer. Now, I would like to summarize my personal experience in treating primary liver cancer as follows: 1. Detailed examination of etiology and pathogenesis Chinese medicine does not have the name of primary liver cancer, and according to its clinical manifestations and descriptions in medical books, it probably belongs to “accumulation of liver”, “jaundice”, “accumulation of qi”, “jaundice”, and “jaundice”, “accumulation of qi”, “obstruction in the abdomen”, “accumulation of masses”, “bulging”, “dystocia” and so on. dystocia” and other categories. For example, the Secret Essentials of Wai Tai said: “the accumulation of obstruction in the abdomen and heart, blocks as large as pots and bowls, jaundice, support full of gas, when abdominal distension”; “General Records of the Sheng Ji” said: “accumulation of gas in the abdomen, long time no difference, firm push of the unshakable, …… by pressing the Its shape is like a cup and plate firmly knotted for a long time, making people’s body thin and abdomen big, and not eliminated until death”. These descriptions are similar to the clinical manifestations of middle and late-stage liver cancer, and they have made more detailed observations on the rapid progression of liver cancer, advanced stage with malignant quality, and poorer prognosis. According to motherland medicine, liver is the organ of wind and wood, main in evacuating and storing blood, its gas rises and develops, likes to be organized and hates to be depressed, liver takes blood as its body and gas as its use, body yin and yang, sets yin and yang qi and blood in one body, and becomes the body of unity of yin and yang. Therefore, its pathology is complex and varied. If the mood is not smooth, tiredness and internal injuries, exogenous six epidemic, dietary disorders, visceral deficiency, gas and blood disharmony, will cause stagnation of blood stasis, phlegm cohesion, and the cost of the disease over a long period of time. As “the origin of all diseases? Jaundice wait” cloud: “the disease of jaundice, this is from the wine and food excess, viscera and internal organs are not and, water and grain, accumulated in the spleen and stomach, but also for the wind and dampness of the fight, stasis is not, heat and steam, such as food has been such as hunger, the whole body, face, eyes, and claws and armor urination yellow, and want to lie down peacefully. …… yellow face, yellow teeth, yellow, yellow claws and armor on the yellow, jaundice is. ” 2.Be careful with the identification of evidence-based treatment Identification of evidence-based treatment is the basic principle of TCM to recognize and treat diseases, and it is the process of applying reasoning, method, prescription and medicine to clinic. In the treatment process of primary liver cancer, the principle of identification and treatment must be strictly observed. After years of research and exploration, primary liver cancer is mainly classified into the following five types: 2.1 Liver depletion and spleen deficiency type: epigastric mass swelling and discomfort, lethargy, tiredness and shortness of breath, abdominal distension, less energy, bloating after eating, dry mouth and not liking to drink, loose stools, short and yellow urine, or even ascites, jaundice, swelling of the lower limbs, with a fat tongue, white fur on the tongue, and a thin stringy pulse. Treatment: Strengthening the spleen and vital energy, diarrhea and softening the liver. Main formula: add subtraction of Easy San. 2.2 Hepatobiliary Damp-Heat Type: yellow staining of the body and eyes, irritability, fever and thirst, dry and bitter mouth, distension and burning pain of the ribs and dorsal area, abdominal distension, short, yellowish and reddish urine, constipation, lumps under the dorsal area, red tongue, yellowish and greasy tongue coating, and number of strings in the pulse. Treatment: clearing away heat, inducing diuresis, detoxifying and eliminating yellow coloration. Main formula: adding subtractions to Yin Chen Artemisia Tang. 2.3 Liver-heat and blood stasis type: epigastric lumps with stone hardness, distension and pain refusing to be pressed, or chest and hypochondrium pain refusing to be pressed, or chest and hypochondrium pain and discomfort, vexation and heat, dry mouth and lips, dryness and knotting of stools, yellow or short red urine, or even skin nail mistake, red or dark red tongue, sometimes with teeth marks, white and thick tongue coating, and stringy or slippery and strong pulse. Treatment: clearing the liver and detoxifying the toxin, eliminating blood stasis and softening the hardness. Main prescription: gentian diarrhea and liver soup combined with Xia Yu Blood Stasis Soup with additions and subtractions. 2.4 Spleen Deficiency with Dampness Main Symptoms: Abdominal distension and fullness, fatigue, heaviness and dullness, heavy limbs and swollen feet, and scanty urination. Sticky mouth with no desire to drink, nausea, loose stools, pale tongue with teeth marks on the side, thick and greasy moss, and thin stringy or slippery or moistened pulse. Treatment: Strengthening the spleen and regulating qi, resolving blood stasis and softening hardness, inducing dampness and removing toxins. Main formula: Consistent Decoction plus subtractions. 2.5 Yin deficiency of the liver and kidney: dropsy and swelling of the limbs, frogs and abdominal veins, thin limbs, shortness of breath and shortness of breath, red lips and dry mouth, dullness and fear of food, restlessness and sleeplessness, shortness of drowning and number of stools, or even fainting and touching the bed, upper and lower blood spillage, red tongue with reddish-red color and glossy tongue with no moss, and a fine and feeble pulse, or a pulse like sparrow’s peck. Treatment: nourishing water and containing wood, benefiting Qi and nurturing Yin. Main formula: Consistent Decoction plus subtractions. Liver is a rigid organ, main evacuation, likes to be organized, and hates depression. During the development of liver diseases, it is common for liver qi to be depressed and spleen to be offended by liver excess, resulting in deficiency of spleen qi. In the precancerous lesions of liver cancer, spleen deficiency often exists, on the basis of which liver cancer gradually evolves. In the whole process of liver cancer development, spleen deficiency is also present throughout. In the pathogenesis of liver cancer, the prevalence of spleen and stomach determines the prevalence of positive qi, and as the saying goes, “when we see the disease of liver, we know that the liver spreads to the spleen, and it must be solidly applied to the out of the body first”, therefore, strengthening the spleen can be carried out throughout the treatment of liver cancer. As spleen deficiency lasts for a long time, it can be combined with qi stagnation, blood stasis, dampness-heat and even yin deficiency. In the early stage of pathological process, symptoms of dampness obstruction and qi stagnation and spleen deficiency are mostly manifested; in the middle stage, qi stagnation, blood stasis, dampness-heat and heat-toxicity appear; in the late stage, yin deficiency and fluid deficiency are common, and signs of damage to lungs, livers and kidneys may appear. However, spleen deficiency still plays a dominant role. The pathogenesis of spleen deficiency and qi stagnation can explain most of the clinical symptoms of hepatocellular carcinoma, so strengthening the spleen and regulating qi is an important therapeutic method for primary hepatocellular carcinoma. Therefore, strengthening the spleen and regulating qi is an important treatment method for primary liver cancer. The method of strengthening the spleen and regulating qi has been most frequently applied in the clinical treatment of liver cancer and proved to be the most effective. It is suggested in “The Heart of Medicine” that: “When treating accumulation, according to the three methods at the end of the middle and middle school, the person with deficiency suffering from accumulation must first replenish his deficiency, regulate his spleen, increase his diet, and then use medicine to attack his accumulation, which is a good treatment.” It clarified the discriminative relationship between attacking the evil and strengthening the spleen to support the correctness in liver cancer, which is still of practical guiding significance in the clinical treatment of liver cancer. Commonly used traditional Chinese medicines include Codonopsis, Atractylodes macrocephala, Poria, Astragalus, Huaishan, etc. Commonly used formulas include Si Jun Zi Tang, Liu Jun Zi Tang, and Zhen Zhong Yi Qi Tang. 4.1 Detoxification “Toxicity” is an important pathological factor of primary liver cancer, which plays an important role in the development of primary liver cancer. Clinically, detoxification has two main meanings: on the one hand, it is clearing heat and removing toxins. The method of clearing heat and removing toxins is a common treatment for liver cancer. Many clinical manifestations of hepatocellular carcinoma are related to the internalization of heat and toxicity, especially in the advanced stage of hepatocellular carcinoma when jaundice and fever appear, the signs of heat and toxicity are more obvious, and at this time, applying heat-clearing and detoxicating method is often a good treatment. Commonly used medicines for clearing heat and removing toxins include half lotus, fleabane, gardenia, dandelion, white-flower snakeweed, rhubarb, tiger’s stick, gentian herb, etc. On the other hand, it is to fight toxins with toxins. On the other hand, it is to fight poison with poison. Cancer toxicity is the root cause of primary liver cancer, which is different from the external six evils and also different from the general internal five evils, but is formed by the long-term stimulation of various pathogenic factors. Commonly used clinical drugs to fight poison with poison include whole scorpion, centipede, gecko, dewberry, white-flower snake and mountain bean root. When using detoxifying drugs, it should be noted that some of the drugs are bitter and cold, easily damaging the spleen and stomach, and those with cold spleen and stomach should be cautious in using them or use them together with drugs to strengthen the spleen and promote vital energy; some of the drugs have a certain degree of toxicity, and if they are used improperly, they will be easily poisoned, so attention should be paid to the dosage, time of use, concoctions, and methods of preparation when using them. 4.2 Dispel blood stasis The occurrence of primary liver cancer is closely related to stagnation of qi and blood and blockage of veins and channels. “Qi is the commander, and blood is the main mother of qi”. When liver qi is depressed and stagnant, blood stasis occurs, and the stasis becomes lumps and forms cancerous tumors in the long run. The Medical Forest Reform and Error says: “Lumps in the belly and abdomen must have tangible blood”. Patients with primary liver cancer commonly suffer from various clinical manifestations of blood stasis, such as hard and stabbing pain of lumps under hypochondrium, fixed pain, greenish color, wrong skin armor, reddish veins on chest and abdominal wall, liver gall line, blue and purple tongue, tortuous veins under the tongue, etc. Clinically used medicines to activate blood stasis and remove blood stasis are also common in primary liver cancer. Clinically used medicines for activating blood circulation and removing blood stasis include Sanleng, Curcuma longa, Boswellia serrata, peach kernel, safflower, Panax ginseng, Salvia divinorum, and so on. 4.3 Resolving dampness As a result of external dampness, or damage to spleen and stomach, essence and microorganisms are not distributed, phlegm-dampness is generated internally, which affects the normal operation of qi, blood and fluid of liver, and the veins and collaterals are blocked in the long run, which often leads to the occurrence of hepatocellular carcinoma in the organism. Phlegm-dampness is not only the cause of tumor development, but also the pathological product formed in the process of liver cancer development. The pathogenesis and clinical manifestation of primary hepatocellular carcinoma are very similar to the nature and characteristics of dampness, which is of great significance in the treatment of hepatocellular carcinoma. Clinically, the medicines of resolving phlegm and removing dampness, such as Mian Yin Chen, Poria, Poria, Psyllium, Fructus Semen, Semen Coix Seed, etc., are commonly used. In fact, since the basic lesions of hepatocellular carcinoma are stasis, toxicity, dampness and deficiency coexisting with each other, which are the cause and effect of each other in a vicious circle throughout the whole course of the disease, therefore, the methods are often used in combination in order to complement each other and give full play to the advantages of overall treatment. 5, external treatment external drug action on the body surface, can make the drug through the skin and hair coupling, internal organs, adjust the balance of yin and yang of the body, to achieve the dissipation of lumps, blood circulation and pain relief purposes. Just as the cloud of “Li Bo Fian Wen”: “The reason of external treatment is the reason of internal treatment, and the medicine of external treatment is also the medicine of internal treatment, which is different from the method.” External treatment for primary liver cancer patients has its unique advantages in relieving cancer pain and reducing ascites. Commonly used external medicines for relieving cancer pain include andrographis, blood exhaust, frankincense, myrrh, strychnine, ice tablet, cypress powder, toadstool ointment, amber pain-relieving ointment and so on. Commonly used in the treatment of ascites external drugs are manganese nitrate, glycyrrhiza glabra, Xu Changqing, seven leaves of one flower, petunia seeds, astragalus, psyllium and so on. The so-called disease diagnosis and treatment refers to the comprehensive analysis and identification of symptoms, causes, nature, location, patient’s physique and results of various examinations under the guidance of Chinese medicine theory, so as to make a diagnosis of the disease and decide the treatment measures on the basis of it. The treatment of primary liver cancer, just like other diseases, should be carried out under the principle of diagnosis and treatment. However, due to the special pathological and biological characteristics of primary liver cancer, the treatment of primary liver cancer should be based on the principle of diagnosis and treatment and combined with the treatment of disease identification to improve the clinical therapeutic effect. “Disease and evidence are both different and closely related. By identifying the disease and evidence, the evolution of the disease can be grasped and the individual differences of patients can be taken into full consideration. Therefore, the identification of disease and the identification of evidence can neither be separated from each other, nor can they replace each other. Combining the identification of evidence with the identification of disease, that is, identifying the disease while identifying the evidence, combining the traditional theories and experiences of traditional Chinese medicine for many years, and selecting some drugs with proven anti-cancer effects for treatment according to the nature, taste, efficacy and clinical application characteristics of drugs. A large number of clinical practices have proved that the combination of identification of evidence and identification of disease in the treatment of malignant tumors often achieves better results, which is based on scientific evidence. Only when the combination of disease identification and evidence identification treatment is proper, better therapeutic effect can be achieved in clinical practice. Commonly used Chinese medicines for primary liver cancer include centipede, scorpion, hemicranium, fleabane, trigonelline, curcuma, octopus, sanguinaria, lobelia, baiying, etc. Commonly used proprietary Chinese medicines for identification of disease include pingxiao capsule, hepatic fulele tablets, jinlong capsule, huachanin injection, oenothera oil milk injection, arsenic acid injection, elemolynum injection, aiDi injection, kangwaiyi injection and so on.