Collation And Study Of Clinical Experience On Hepatic Carcinoma Treatment By Professor Li Peiwen

Primary hepatic carcinoma is one of the malignant tumors happened in liver cell or intrahepatic duct. In our country, the majority of patients are with hepatitis B and liver cirrhosis. Liver cancer onset domently, highly malignant, progress fast, high recurrence rate after surgery. The treatment of radiotherapy and chemotherapy is not sensitive. The effect is bad. The survival time of patients in late stage is only three to six months. Liver cancer has a high mortality rate, the rate of5years survival is only4-7%. So primary hepatic carcinoma is one of the main diseases which serious harm human’s health.My tutor professor Li Peiwen, who has worked on combining traditional Chinese and western medicine in treatment of cancer for more than forty years, has accumulated rich experience of the treatment in liver cancer. He thinks that the principle of treatment in liver cancer should be comprehensive treatment. Patients need to accept many therapy including surgery, the hepatic arterial infusion chemotherapy, radio frequency treatment, local ablation, absolute alcohol injection, even systemic chemotherapy and radiation therapy. He also thinks that TCM play a important effect in the whole process of liver cancer. In the early stag Chinese medicine intervention can prevent chronic hepatitis and cirrhosis developing to liver cancer; Postoperative liver cancer with Chinese traditional medicine can prevent cancer relapsing and metastasis; Patients with treatment of embolism, radiation and chemotherapy use traditional Chinese medicine can reduce the side effects; Advanced liver cancer patients use herbal treatment can alleviate clinical symptoms, ease complications liver cancer, improve the quality of life and prolong survival time.Years of clinical practice, professor Li accumulated a plenty of experience in the cause of primary liver cancer, clinical characteristic, determination of treatment based on differentiation of syndromes. He has his own unique opinion to the disease and good effect. Tn the disease cause and pathogenesis, professor Li emphasizes liver depression, spleen deficiency and blood stasis. He thinks it is disease in stomach, liver and spleen which lead to liver cancer. Wet, heat, qi, blood and poison form the masses.Professor Li thinks synthesis of the four diagnoses:observation, listening and smelling, asking, palpationand pulse-taking are both important. Mr Li has paid more attention to tongue. We can judge the exuberance of pathogenic factors leading to weakness of vital qi, physical state and the drug use from tongue coating.In the treatment of liver cancer teacher will divide patients into four types:1. Liver depression and spleen deficiency type:the treatment will be smoothing liver and strengthening spleen. The prescription is XiaoYaoSan, ChaiHuShuGanSan, ZhiShiXiaoPi decoction.2. Damp-heat in liver and gallbladder type:the treatment is clearing heat and normalizing gallbladder function, eliminating dampness. The prescription is YinChenHaoTang, WuLingSan and LongDanXieGan decoction.3. Obstruction of collaterals by blood stasis:the treatment is promoting qi and blood circulation, removing amass. The prescription is HuaGanJian, GeXiaZhu Yu decoction.4. Liver-Kidney Yin deficiency pattern:the treatment is nourishing liver kidney, cool blood and soft firm. The prescription is ZhiBaiDiHuangWan, YiGuanJian decoction.In the determination of treatment based on differentiation of syndromes. Professor Li thinks:1. Type of syndrome is not unchangeable:in the whole course of liver cancer, the type of syndrome will change with the progress of the cancer course.2. Treatment based on not only differentiation of symptoms and signs but also of disease:liver cancer is malignant tumor. Cancer diagnosis and treatment are different from other disease. It is hard to cure. Professor Li attach important to differentiation of symptoms and signs. But at the same time he also does not forget disease differentiation.Characteristic of the medicine used by my teacher involves:1. The first heavy raise blood:liver for just dirty, storing blood zang Lord, Yin and Yang body with; Look from the pathological changes. YiKang liver Yang, GanFeng easy to move. So Mr Li emphasized repeatedly to fully realize liver body should be soft, liver disease must pay attention to keep blood.2. Emphasizing the use of herbs for soothing the liver:liver govers dispersion, which likes regulating qi activity but hates dumps. Illness in liver is always companying with disorder of qi activity. Drugs for promoting qi circulation are often added in the therapy.3. The use of the drug for activating blood circulation and eliminating stasis: in the liver cancer patients the most common type of clinical evidence is qi stagnancy and blood stasis. Therapy for activating blood circulation and eliminating stasis in the treatment of liver cancer is very important. But we must pay attention to the liver cancer patients at the same time there is abnormal blood coagulation mechanism which leads to merge bleeding. We should also use the blood activating herbs carefully, in case the massive haemorrhage can endanger the patient lives.4. The use of toxic traditional Chinese medicine:the mass of traditional Chinese medicine think that tumor happened with poison and related implication. So it emphasized that the therapy of "fight fire with fire" should be used in treatment. Drugs of poisonous insect, such as BanMao QueXie, ShuiZhi, WuGong, BiHu, MaQianZi, ChanChu, etc are often used. Prefessor Li stresses that the poisonous insect can be used, but it should be used with consideration of individual’s physique, climatic and season condition. We shouldn’t blindly, large and long time use the toxic quality.5. Removing the pathogen factor and don’t forgetting to support vital qi: tumor belongs to chronic diseases, especially advanced liver cancer. It is difficult to get the opportunity to cure. So it should be done with the long-term coexistence of preparation, more emphasis on the protection of vital qi.6. Disease and syndrome together being cured:In liver cancer TCM treatment, Professor Li emphasizes that treatment should be based on differentiation of disease together with syndrome differentiation. Teacher often add in the prescription of herbs to clearing away heat and toxic material, remove blood stasis. soft hard lumps and dispel nodes. These methods can remove the tumor directly.7. Ingredients for the accompanying syndromes:besides syndrome differentiation, Professor Li also pays attention to use the drug to accompanying syndromes. Chinese medicine to the symptomatic treatment has very good effect which can obviously improve the patient’s quality of life and increase the confidence of the patients.8. Paying attention to the guiding medicinal herb:in liver cancer treatment, Professor Li attaches great importance to the use of ShuiHongHuaZi, BaYueZha, LingXiaoHua, BieJia. These herbs can be chosen to use in every prescription almost all used in one prescription. They are called by Professor Li of the liver channel medicine.9. Prevent of cancer pain:in patients of late liver cancer the pain happened in a significant proportion of80-90%. Professor Li found that patients with long-term use of traditional Chinese medicine would have the lower occurrence of pain proportion. Chinese traditional medicine has a certain degree to prevent the happening of the pain and reduce moderate or severe pain in the advanced liver cancer patients.For advanced liver cancer patients, Professor Li thinks the focus of therapy is not to pursue the narrowing of the tumors, but to improve the patient’s clinical symptoms, improve the quality of life, the maximum extended survival. For advanced liver cancer the treatment of complications, such as jaundice. ascites, cancerous pain, also has its unique effect. Especially Chinese medicine for external use, the therapy is simple, inexpensive and valid.To traditional Chinese medicine Jaundice is due to toxic damp-heat which lead to wet muddy block and liver function disorder. The secretion of bile is abnormal. The bile overflows to the skin which leads to the yellow of skin, eyes and urine.Professor Li thinks that the outbreak of jaundice is connected with damp pathogen mostly. The key to pathogenesis is the damp. The main causes of jaundice are damp and hot accumulate knot, liver and gallbladder heat stagnation, deficiency in spleen and stomach with cold manifestations and abdominal masses. The main exogenous evil is damp-heat and the internal cause to damage of spleen and stomach, emotional depression. Jaundice is divided into two categories:Yang jaundice and Yin jaundice. Yang jaundice is due to damp and heat. Yin jaundice is due to invasion interior by cold-dampness, spleen Yang deficiency and bile overflow to the spill. Pathogenesis of Jaundice is connected with wet, poison and stasis closely. Professor Li emphasizes the basic principle of the treatment is clearing heat and toxic materials, removing dampness and jaundice, cool blood and promoting blood circulation.The key of differentiation to jaundice is Yin and Yang. Yang jaundice is due to damp and hot. Yin jaundice is due to cold dampness. The main treatment is removing dampness by urinate. Yang jaundice:1. Heat overweight than wet:the treatment is clearing heat and damp adjuvant with purgation. The prescription is YinChenHao Decoction.2. Wet overweight than hot:the treatment is removing dampness and dissolving turbidity adjuvant with clearing heat. The prescription is YinChenWuLing and GanLuXioaDu decoction. Yin jaundice:1. Spleen besieged by cold-dampness:the treatment is strong spleen and stomach. The prescription is YinChenShuFu decoction.2. Deficiency of both Qi and blood:the treatment is invigorating Qi and blood companying with removing dampness and clearing yellow. Prescription is BaZhen decoction.3. Health energy deficiency and blood stasis:the treatment is reinforcing Qi and blood, promoting blood circulation by removing blood stasis. Prescription is:BaZhen and HuaJi decoction.Professor Li thinks patients with liver cancer, who appears Yin yellow, are not completely caused by cold dampness, but due to blood stasis, poison stasis too. The yellow is tarnish not bright. At this time the treatment can reduce heat drugs and add herbs to warm yang, such as GuiZhi, FuZi, GanJiang etc. Especially the drug for invigorating blood circulating and eliminating stasis should be used such as DanShen, ChiShao, EShu, SanQi, WuGong etc.Ascites is common complication in patients with liver cancer and is one of the important signs into the late stag of liver cancer. Ascites belongs to GuZhang range in traditional Chinese medicine. Professor Li holds that the happen of ascites basing on health energy deficiency, especially deficiency of lung, spleen and kidney.The principle of treatment for ascites is expelling together with reinforce. Removing the evil and taking care of health energy at the same time. Professor Li divides ascites into several type while in treatment:1. Phlegm-dampness retention: treatment is invigorating spleen to reduce phlegm, invigorate blood circulation and anti-cancer. Prescription is SiJunZi, WuLingSan and WuPiYin decoction.2. Blood stasis causing water retention:the treatment is promoting blood circulation by removing stasis and promoting qi circulation for diuresis. Prescription is DangGuiShaoYaoSan and ShaoFuZhuYu decoction.3. Spleen-kidney Yang failure: the treatment should be warming Yang and invigorating spleen. ShiPiYin, ZhenWuTang, LingGuiZhuGan decoction are used.4. Liver-kidney Yin deficiency: treatment is nourishing liver and kidney, increasing secretion of urine. Prescription is Liu WeiDiHuang and YiGuanJian decoction.For ascites, such late complications, the teacher also stressed the external use of traditional Chinese medicine. The herbs will be absorbed through the skin and work. The patients will avoid the suffering of the infusion and oral of the medicine. Professor Li developed an effective drug called ShiPiXiaoShui Extract which can be used in patients with hydrorax and ascites.Pain is one of the common symptoms in advanced liver cancer patients. It is one of important factors which influence the quality of survival.Professor Li divided the cause of pain into the actual two kinds: demonstration and deficiency. The pain of demonstration is due to stagnation of qi and blood. The pain of deficiency is due to the insufficient of qi, blood, Yin and Yang. He made the principle of treatment such as promoting flow of qi and blood circulation, removing obstruct in channels, clearing heat, expelling cold. In addition to the internal medicine. Professor Li committed to the external use of research and developed some effective drugs. In the pain treatment, he developed two kind of medicine:one is TongKuaiLing externally used paste, the other is called TongKuaiXiao cataplasm.In the clinical study, there were56primary liver cancer patients selected. They were treated by the TCM of invigorating the spleen and removing blood stasis. By comparing the tumor size, the reduce of clinical symptoms and AFP, improving of quality life etc, the validity of the therapy of invigorating the spleen and removing blood stasis was proven.