There are many treatments for liver cancer
I. Basic treatment plan
The goals of liver cancer treatment are, firstly, to cure it radically; secondly, to prolong the survival period; and thirdly, to alleviate the pain. From the therapeutic point of view and in the light of national conditions, there are several factors that are closely related to the treatment: (1) compensation of liver function; (2) whether the tumor involves half of the liver or the whole liver; (3) whether the tumor is larger or smaller than 5cm; (4) whether there is cancer thrombus in the main trunk of the portal vein. For small hepatocellular carcinoma, treatment should be used when the tumor is small, and for large hepatocellular carcinoma, diagnosis and treatment should be made when cancerous thrombus occurs in the main trunk of portal vein.
For small hepatocellular carcinoma less than 5cm, if liver function is compensated, resection should be strived for; for left lobe, local resection, hepatic segment or subhepatic segment resection can be done as appropriate; for right lobe or porta hepatis, local resection is preferred in case of cirrhosis, and local resection or hepatic lobe resection can be done as appropriate in case of no cirrhosis; for small hepatocellular carcinoma that can not be resected, intraoperative ligation of hepatic artery on the affected side (HAL), hepatic artery cannulae instillation of drugs (HAI), combined with or without local resection as appropriate, should be done. For unresectable small hepatocellular carcinoma, intraoperative hepatic artery ligation (HAL), hepatic artery cannulation and drug infusion (HAI) can be performed, combined with or without local treatments as appropriate, such as cryotherapy, laser, microwave, intra-tumoral injection of anhydrous ethanol (which will continue to be carried out under the guidance of ultrasound after the operation), and percutaneous hepatic artery embolization (TAE) can also be performed after the operation in those who have not had HAL. For small hepatocellular carcinoma with decompensated liver function, ultrasound-guided anhydrous ethanol injection is appropriate, and TAE can be cautiously tried in a few cases.
For large hepatocellular carcinoma with decompensated liver function, unilateral radical resection should be pursued, and those who are unable to undergo radical resection can opt for the post-reduction resection program, with intra-operative or HAL+HAI, or cryo, laser, microwave, anhydrous ethanol, or a combination of both as appropriate, and TAE (reverse multiple) can also be carried out if there is no possibility of resection as estimated preoperatively. TAE (counter get multiple times). After palliative surgery and TAE, local radiation therapy, radioimmunotherapy, biological response modifiers (BRM), and TCM modification can be combined later as appropriate. If the hepatoma shrinks to the point where resection is possible, second-stage resection is sought. For large hepatocellular carcinoma involving bilateral liver, palliative surgery (mainly HAL+HAI) or TAE can also be performed, and later combined with radioimmunotherapy, BRM or TCM. A very small number of patients with large hepatocellular carcinoma and cirrhosis who are functionally insolvent and dry can still try TAE cautiously, and most of them are only suitable to use BRM, traditional Chinese medicine, or try a small amount of oral chemotherapeutic drugs.
With portal vein trunk thrombosis, small hepatocellular carcinoma can try ultrasound-guided anhydrous ethanol injection, and large hepatocellular carcinoma can try TAE, and then combined with BRM and traditional Chinese medicine treatment.
For subclinical recurrence or single lung metastasis after radical resection, it is advisable to actively perform re-resection; if resection is not possible or not suitable, all kinds of local treatments can be performed.
Combination of traditional Chinese and western medicines is the most commonly used method to treat liver cancer, which is the original creation of our country.
Chinese Cancer invited relevant experts to formulate the standardized plan of combining Chinese and western medicine for liver cancer as follows:
T1N0M0, surgical resection, or radiation therapy, or local injection of drugs and long-term Chinese medicine.
T2N0M0, surgical resection, or radiation or local injection treatment, combined with long-term traditional Chinese medicine or immunotherapy.
T3N0M0 can be treated with surgery, radiotherapy or interventional therapy and long-term TCM, depending on the situation; among them, if it is a single tumor with diameter >8cm, interventional therapy can be performed, followed by radiotherapy or surgical resection and long-term TCM; if it is a single tumor with diameter ≥10cm, interventional therapy should be performed first, followed by radiotherapy and long-term TCM.
T4N0M0 is mainly treated with traditional Chinese medicine, or radiotherapy or intervention.
T1 if the lymphatic swelling of the liver gate, can be given radiation.
M1 patients, can also be given surgery, radiotherapy, interventional therapy or systemic chemotherapy, and traditional Chinese medicine, or only given traditional Chinese medicine.
Regardless of T, N and M, if liver function is abnormal or cirrhosis is serious, traditional Chinese medicine is the main treatment for hepatocellular carcinoma. If there are jaundice and ascites, Chinese medicine is also given as the main treatment, and other treatments will be decided after jaundice and ascites are controlled.
At present, there is no other effective treatment except radical resection which may cure liver cancer. In recent years, researches have shown that while searching for new methods, if the old methods can be applied properly, unexpected effect can be received, i.e., 1+1＞2, and if integrated, 1+1＜2 or even 1+1=0. In principle, integrated treatment and sequential treatment should make all kinds of therapies to take advantage of their strengths and complement their weaknesses, or each of them is aimed at different aspects, or make up for the side effects of another method, etc., and be flexibly mastered in order to maximize the killing of liver cancer and to achieve the best possible results. In order to achieve maximum tumor killing and maximum preservation of the body (especially liver function, immune function and hematopoietic function), the overall design should also pay attention to the attacking and complementing functions. In the overall design, attention should also be paid to the balance between attack and complement, focusing on the methods of tumor elimination (e.g., surgery, radiotherapy, chemotherapy, orientation therapy, etc.) and the methods of supporting and mobilizing the body's ability to resist disease (e.g., BRM, traditional Chinese medicine to support the corrective approach, etc.).
II. Chinese medicine treatment
At present, more than 80% of clinically diagnosed tumors are in the middle and late stages, and only a few patients are suitable for surgical resection. As tumors are local manifestations of systemic diseases, not only patients after surgical resection need to be treated with traditional Chinese medicine, but also those who cannot be surgically resected need to be treated with traditional Chinese medicine or combination of traditional Chinese medicine and western medicine. Chinese medicine has become the most basic and widely used treatment method for liver cancer. Prof. Tang pointed out that the efficacy of Chinese medicine in treating liver cancer is not inferior to chemotherapy.
(1) Identification and typing treatment
The Third National TCM Tumor Symposium (November 1988) introduced that "the basic point of liver cancer treatment is to get rid of the evil without hurting the positive and to support the positive in order to reach the evil, and the selection of prescriptions and medicines should be considered in a comprehensive way to identify the disease. Specifically applying the treatment rules of sparing the liver and strengthening the spleen, nourishing yin and benefiting qi, clearing heat and removing toxins, resolving phlegm and softening hardness, and regulating qi and activating blood circulation, etc., the treatment can make some patients with hepatocellular carcinoma basically disappear, their conditions stabilize, and the foci shrink, and at the same time prolong the survival period, so that the survival rate of more than half of them for one year reaches 28.98%, and that for more than two years reaches 13.51%, and a few of the patients' survival period reaches more than three to six years.
Sun Simiao of the Tang Dynasty pointed out, "The accumulation of all diseases starts from emptiness, and emptiness gives birth to all diseases." Launching the Decoction Pill of Softening Accumulation and Turtle Armor with ginseng, astragalus, gum, cinnamon, ginger, and chaihu, scutellaria, to strengthen the root of the body and calm the cold and heat; turtle armour, beehive, ground louse, dung beetle, to attack and break up the accumulation in order to get rid of the heat of the deficiency; rhubarb, peach kernel, dandelion, red nitrate, peony, and lingxiao to invigorate blood circulation and remove blood stasis; and shotgan, Drabanemerosa hebecarpa, Houpao, hemicranium, stoneweed, and quemel in order to regulate qi and remove dampness. According to the principle of this formula, tonifying the deficiency in order to support the correctness, softening the hardness in order to attack the accumulation. Based on the author's knowledge that the deficiency of cancer patients is dominated by yang deficiency, it is appropriate to add yang-warming medicines, such as Pseudostellariae, Deer Antler, Cynomolgus and other medicines, to form the basic formula for hepatocellular carcinoma on the basis of Hepatocellular carcinoma Softening and Warming turtle armor decoction. The basic formula should be supplemented with the addition and subtraction of the basic formula according to the specific condition of the patient.
Chen Yiwen and other experts of the old generation have derived the basic formula of Inner Cancer Pill from Huanjie Tiejia Decoction Pill, which is applied in the clinical practice of cancer and added and subtracted according to the evidence. We only emphasized warming yang and supporting correctness compared with this.
1. Liver depression and spleen deficiency type (simple or non-sclerotic liver cancer)
The symptoms include fullness and distension in chest and abdomen, which is even worse after eating, poor appetite, nausea and fatigue, with yellowish and greasy tongue coating, and fine stringy pulse. Use Basic Formula for Liver Cancer supplemented with Chai Hu Liver-Sparing Drink combined with Ginseng Ling Bai Zhu San or Liver-Sparing and Folding Soup to relieve the liver, warm the yang, strengthen the spleen and dissolve dampness.
2. Liver-heat and blood stasis type (i.e. inflammatory liver cancer)
Signs of fever, irritable thirst, tingling under the dermatome, deepening jaundice, increased aminotransferase, bleeding from gums, or even blood in stools, with yellowish, greasy and dry tongue coating, and number of strings in the pulse. First use gentian diarrhea liver soup, liver rescue and detoxification powder, Huanglian detoxification soup to clear the heat and detoxify the toxin. After the heat subsided, then apply Basic Formula for Liver Cancer with additions and subtractions.
3. Yin deficiency of liver and kidney (sclerosing hepatocellular carcinoma)
Signs of Yin deficiency with internal heat, low fever that does not subside, mental fatigue, weakness of limbs, sweating when moving, poor appetite, dry mouth and little fluid, little tongue coating, and thin and weak pulse. This is the period of liver and kidney yang deficiency of liver cancer, which develops to the period of yin deficiency. Treatment should be supplemented with Liuwei Di Huang Pill, Da Zhenyin Pill or Artemisia turtle turtle turtle soup. The drugs or dosage of warming yang and dryness can be reduced, and the drugs of nourishing yin and clearing deficiency heat can be added to achieve warming yang and benefiting qi, nourishing yin and clearing heat.
Pain in the liver area plus neem, yanhuisuo, yellow tulip; nausea and vomiting plus chenpi, bamboo mushrooms, half-summer; jaundice deepens plus chen, mast, tulip; abdominal distension plus thick park, rhubarb, abdominal skin; blood in the stools or black stools plus blood Yu charcoal, cimicifugal grass, cynoglossus, panax quinquefolium, and so on.
We treat primary liver cancer with the basic formula for liver cancer according to the above typology, and have achieved better curative effect, if supplemented with intravenous Huazhongin injection, Senmai injection or Ginseng injection, the curative effect is even more obvious.
(2) Modern research on the identification of liver cancer
The symptoms of liver cancer, especially after the middle stage, change a lot. In traditional diagnosis, if the cancer is in the liver, it is recognized as stagnation of liver qi; if it is a tangible lump, it is recognized as blood stasis; and if there is heat in the cancer, it is recognized as either symptomatic or internal heat. The treatment includes clearing heat and removing toxins, activating blood circulation and removing blood stasis, and softening and dispersing hard lumps, which are different from each other, and the efficacy is also poor.
The expert group led by Prof. Yu Ersin, based on the clinical analysis of more than 1,000 cases of primary liver cancer, found that the symptoms of liver cancer were, in order, epigastric pain, palpable mass in the epigastric region, epigastric distension, fatigue, loss of appetite, nausea and vomiting, fever and diarrhea. According to Chinese medicine analysis, abdominal distension, fatigue, loss of appetite, nausea and vomiting, diarrhea all belong to "spleen and stomach" symptoms. Among them, pain in the liver area, epigastric mass, fever, the general identification of the difference is large, but they are not for the "spleen and stomach" identification. The author examined the Chinese medical literature and found that the latter three symptoms should also be regarded as "spleen and stomach" symptoms. Such as Li Dongyuan said: "Spleen disease, when the umbilical cord has to move the gas, according to the firm if the pain, move the gas to build, firm as if the accumulation of hard, if it seems to be painful, even if it is also a big pain, there is is a deficiency of the spleen disease also." Pointed out that pain, abdominal masses can indeed be caused by spleen disease. Li Dongyuan also said: "stomach disease, then shortness of breath, less spirit to generate great heat", and "some fatigue, the shape of the gas is less, the grain gas is not abundant, the upper Jiao can not, the lower epigastric not pass, and the stomach gas is hot, hot gas smoked in the chest, so the internal heat". Visible fever can also be caused by "spleen and stomach" disease. Therefore, the author believes that, although the cancer originates in the liver from the point of view of western medical diagnosis, from the point of view of traditional Chinese medicine, it belongs to the disease of "spleen and stomach", which is neither a liver disease nor a "blood stasis" disease.
Chronic hepatitis B, cirrhosis, is considered to be a pre-cancerous liver lesions, the author found that in this stage can already have the manifestation of spleen deficiency. 1970s, there was a large-scale screening of alpha-fetoprotein to detect liver cancer. At that time, there was a part of the test subjects, the alpha-fetoprotein had been elevated, but the imaging diagnosis at that time failed to find the hepatic area occupation. In this part of the subjects, in the follow-up, it could be found that the rate of liver cancer appearing in two years was more than 10%. We treated a part of the subjects with spleen strengthening method, and the rate of liver cancer emergence in that part later could be significantly reduced, at about 2.7%.
In this way, it can be inferred that before the formation of hepatocellular carcinoma, there is a long period of "spleen and stomach" disease. Due to "spleen deficiency", it can cause stagnation of qi, which can further cause blood stasis. And due to spleen deficiency, it can cause dampness obstruction, which can turn into heat and become dampness-heat. The spleen and stomach are both sick, and stomach heat can be formed. On such a basis, it gradually becomes cancerous. Therefore, from the diagnosis of liver cancer in western medicine, but from the identification of Chinese medicine, although the disease is in the liver, its root is in the "spleen".
The treatment by grasping the core of "spleen and stomach" disease may be the "essence" of liver cancer treatment. The overall treatment of liver cancer can be carried out according to this idea. After adjusting the spleen and stomach, the whole body will be adjusted, which will not only improve the symptoms, but also enhance the therapeutic effect.
According to the above ideas and methods, the author treated 228 cases of large liver cancer, and 157 cases in the group of total amount of radiation >20Gy were analyzed according to different TCM identification. That is, 92 cases were treated by strengthening the spleen and regulating qi, and the 1-year survival rate was 86.67%±3.58%, the 3-year survival rate was 55.25%±6.96%, and the 5-year survival rate was 42.97%±11.98%, with a median of 53.4 months. In contrast, 65 cases treated according to activating blood circulation and removing blood stasis, clearing heat and removing toxins had a 1-year survival rate of 46.77% ± 6.34%, a 3-year survival rate of 26.06% ± 6.85%, a 5-year survival rate of 14.48% ± 7.19%, and a median survival period of 11.1 months. The difference between the two groups was very obvious. The cancer patients can be analyzed according to the Chinese medicine point of view, and their respective disease "essence" can be clearly identified and treated as a holistic treatment.
The spleen should be strengthened if it is deficient, and the spleen should be strengthened by warming the yang and strengthening the spleen. Therefore, we think that Prof. Yu Erxin's identification of the fundamental pathogenesis of liver cancer as "deficiency of spleen" is not contradictory to the fundamental pathogenesis of cancer as "deficiency of yang and qi", and that the method of strengthening the spleen and regulating the qi and then focusing on warming the yang and using warming agents has better curative effects.
Shanghai Second Medical University summarized the experimental observation on rats with spleen deficiency as follows: Cancer of digestive tract is a common cancer in China. The most common "evidence" of digestive tract cancer is spleen deficiency.
We followed the method reported by Zeng of Beijing Normal University and used rhubarb and mannite to form a model of spleen deficiency. After the tumor was loaded, it was treated with the method of strengthening the spleen. Then certain healing mechanisms were explored.
(1) After tumor loading in spleen-deficient mice, the development of tumors has these characteristics: short "latency period" from transplantation to the appearance of lumps, rapid development of tumors, poor systemic condition of the hosts, and short survival period of the hosts. This is true for mice, rats, and nude mice, as well as for transplanted HAC, BERH-2, and human hepatocellular carcinoma.
(2) After treatment with spleen-enhancing drugs, the "latent period" is long, the tumor development is slow, the host's systemic condition is good, and the host's survival period is long. This is similar to what is seen in the clinic. Compared with the untreated patients, the difference is very obvious.
(3) Spleen-enhancing drugs have effects on cancer cell cycle. It makes the proportion of S-phase decrease and cell proliferation index decrease. There are also some changes in the pathology.
(4) Effects on immunomodulation. It restores and improves the function of T cells that have been decreased, decreases the function of T suppressor cells that have been activated, increases the activity of NK cells, and increases the activity of LAK by decreasing the dosage of rIL-2 when inducing LAK cells.
(5) It has a restorative effect on the altered albumin/globulin, hepatic glycogen, blood viscosity, etc. in spleen-deficient hosts with loaded tumors, and has an overall regulatory effect.
(6) Combined with radiotherapy and chemotherapy, it can bring about the best control of cancerous tumors, restoration of immune function, the longest survival period of the host, and recovery of the host's general condition.
(7) When cancer is induced by diethylnitrosamine, the spleen-healthy drug has a blocking effect on the cancer-inducing process. It was also found that the overexpression of the oncogene N-RAS in the induced cancer could be made close to normal.
(8) It was also found that mice with spleen deficiency could be normalized only with spleen-healthy drugs, and the above results were obtained. Clearing and detoxifying drugs, on the other hand, caused more damage to the host and suppression of immune function.
Clinical practice has shown that favoring the use of heat-clearing and detoxifying, qi-breaking and blood-breaking and laxative products is prone to induce hemorrhage and hepatic coma.
All in all, spleen-healthy and qi regulating traditional Chinese medicines can improve the immune level, protect liver function, and improve the metabolic level of the body in the spleen-deficient mice model of hepatocellular carcinoma, and also have some effects on hepatocellular carcinoma cells; and the use of the same medicine with radiotherapy and chemotherapy enhances the effect and helps to block the process of cancerous transformation. These experimental results are similar to the clinical results. From the experimental point of view, it confirms that the fundamental pathogenesis of liver cancer is spleen deficiency, or spleen yang deficiency. And it is appropriate to use spleen-healthy drugs, and cannot apply heat-clearing and detoxifying drugs for treatment.
(3) Discussion on tongue diagnosis and pathogenesis of patients with hepatocellular carcinoma
In 1960s, Tong Guoquan et al. found the tongue diagnostic feature of primary hepatocellular carcinoma-hepatic gall line, and the research reports about tongue diagnosis gradually increased later. When Tang Chenlong et al. analyzed the connection between tongue and clinic in 100 cases of hepatocellular carcinoma, they found that those with normal tongue were mostly seen in the early stage of hepatocellular carcinoma, with relatively stable liver function, smaller extent of tumors, milder degree of combined cirrhosis, longer survival period and better prognosis; and the red and stagnant tongue was just the opposite. Li Naimin studied the relationship between tongue image and condition of liver cancer patients, and found that greenish-purple and reddish-purple tongues on both sides of tongue were mostly found, and combined with the number and severity of petechial spots, streak line elevations and vein twisting coloration of tongue, the degree of lesions of liver cancer could be reflected to a certain extent. For those with blue-purple tongue or reddish-purple tongue, most of the liver tumors are larger than 5cm, and easy to spread in the liver, with low rate of surgical resection and AFP conversion rate after resection, and easy to recur in a short period of time, which often leads to death; for those with light red tongue or only red tongue, most of the liver tumors are smaller than 5cm, generally without intrahepatic spread, with high rate of surgical resection and AFP conversion rate, and long time of postoperative reoccurrence, with many chances of second or third operation, and the prognosis is also better. The prognosis is also better. Liu Haojiang et al. observed the tongues of 103 cases of primary hepatocellular carcinoma, which showed that the tongue texture was more reddish-reddish, followed by light white, light red, and less dark red, and the tongue coating was more white and greasy, followed by yellowish greasy, thin white, and less thin yellow. Some scholars have pointed out that the pathologic factors of cyanotic tongue may be related to portal vein stasis, increased plasma viscosity or microcirculatory stasis. From the perspective of Chinese medicine, it is a manifestation of cold and blood stasis. In early stage of liver cancer, the tongue is pale white or reddish, and the tongue coating is thin white or white greasy. Cold and blood stasis are not obvious, but with the development of the disease, cold and blood stasis are gradually manifested on the tongue.
The tongue is greenish-purple or purple-red, and the tongue coating is yellowish-greasy or thinly yellow. The development of the disease is positively related to the degree of manifestation of the blue and purple tongue. The same way that the condition improves with our treatment, the blue and purple tongue phenomenon is also reduced. For the manifestation of blue and purple tongue, Chinese medicine believes that it is cold and blood stasis, cold is the root, cold is the deficiency of yang qi, yang deficiency is cold, yang deficiency is the inability of qi, and qi inability is the blood stasis, therefore, we are correct in applying the Basic Formula for Liver Cancer and adding yang-warming medicines in treating liver cancer, and we have achieved good curative effect in the clinic. In our application, we observed that patients applying Basic Formula for Liver Cancer plus warm-yang drugs have less green and purple tongue phenomenon and their condition is reduced; if we stop using warm-yang drugs or applying heat-removing and detoxicating drugs, patients' green and purple tongue phenomenon will be aggravated and their condition will be worsened; on the contrary, it will be improved. Observation of changes in the tongue has become an important indicator of clinical guidance for the use of medication (e.g., according to changes in the tongue, we can adjust the type and dosage of warm-yang and blood-activating drugs), which is of great significance to clinical treatment.
(4) Specialized and tested prescriptions
1. Hepatocellular carcinoma is treated according to the theory of "obstruction and accumulation in the abdomen". The main prescription of liver-expelling and blood-activating drugs is mainly applicable to those who have stagnation of qi and blood stasis and have obvious lumps. Zhejiang Hospital of Traditional Chinese Medicine treated 19 cases of hepatocellular carcinoma with the formula of Chai Hu, Poria, Paeonia lactiflora, Paeonia lactiflora, Cimicifuga, Angelica sinensis, Yujin, Xiangsui, Fleabane, Scutellaria baicalensis, Curcuma longa, Psidium guajava, Phellodendron amurense, Cortex Erythropoieticus, Cortex Erythropoieticus, Yunnan Baiyao, and other drugs with the survival time of 12 years for five cases, two cases of two years, one case of four years, and six cases of more than five years, and the average survival time was 17.4 months.
2. 12g of Radix Bupleurum Chinense, 10g of Pericarpium Citri Reticulatae, 9g of Chrysanthemum, 9g of Radix Angelicae Sinensis, 10g of Salviae Miltiorrhizae, 20g of Augustus Zizae, 6g of Safflower, 12g of Poria, 25g of Semen Aesculi, 20g of Sanguisorba Lateralis, 30g of Rhizoma Cervi Pinnatifida, 10g of Salviae Miltiorrhizae, 20g of Taraxacum officinale, 20g of Herba Euphrasiae, 20g of Inulae Vulgaris, 20g of Qi deficiency. Neem, frankincense, myrrh; jaundice plus gardenia; abdominal distension plus Mucuna pruriens, Houpu; lumps plus Baiying; ascites plus petunia seeds, zedoary, poria, hemicranium, shanglu.
3. Curcuma longa 20g, nine fragrant worm 20g, Chai Hu 10g, Shan Ci Mushroom 20g, Soapwort 10g, Flea 15g, Citrus aurantium 12g, Liu Shun Nu 15g, raw oyster 20g, turtle shell 15g, wood shampoo 10g, Chen Pi 10g, Salviae Miltiorrhizae 15g, Dangshen 15g, Dangshen 15g, jaundice of the skin, reuse Artemisiae argyi, Panax notoginseng; hepatic pain in the region of the intense addition of Boswellia serrata, Myrrh, Yuan Hu, Yu Jin, White flexuose, neem, sumac, Xu Changqing; organism failure add white peony, raw land, angelica, turtle shell, danpi, yam, raw astragalus, dry lotus herb, chasteberry.
4. 30g of Xia Gu Cao, 15g of Shi Jian Jian, 30g of Curcuma longa, 30g of Salvia miltiorrhiza, 15g of Codonopsis pilosula, 15g of Verbascum officinale, 30g of Fleabane, 15g of Sanguisorba angustifolia, 15g of Codonopsis tigrinus, 15g of Cnidium sativum, 15g of Pseudostemonium tigrinum.
Adding and subtracting: for ascites, add Zedoaria japonica, Poria, Plantago aspera; for pain in hepatic region, add Huanyu, Descendantia, Neem Zizi; for low fever, add Bone Skin of the Ground, Yin Chaihu, Artemisia, and for high fever add Cold water stone, slippery stone, water horn, gypsum.
(5) Proprietary Chinese medicines
1. Abdominal Fule, developed by Pan Minqiu, director of Hunan Institute of Traditional Chinese Medicine, is mainly composed of many kinds of Chinese medicines such as Codonopsis pilosulae, turtle shells, fleabane, sedum and so on, which has the functions of eliminating blood stasis and dispersing knots, regulating qi and strengthening the spleen, and clearing heat and removing toxins. It has good efficacy in controlling liver cancer mass and improving clinical symptoms, with an effective rate of 74.55%.
2.Toad and Dragon Powder: 10g of toad biscuit, 50g of centipede and catechu, 500g each of Baiying, Longquan, Yam bean root, Danshen and Panax notoginseng.****To be finely powdered, 1g orally each time, 3 times a day, used for those who have heat knot in liver cancer.
3. Compound Wooden Chicken Punch Composed of Yunzhi extract and broad bean root, it has the effect of turning negative on those who are persistently low-positive for alpha-fetoprotein, thus suggesting that it has a certain preventive effect on hepatocellular carcinoma and is used for chronic hepatitis B and early and middle-phase primary hepatocellular carcinoma. The composition of the drug contains walnut bark, which has a significant effect on improving cellular immune function.
4. Zebra fiber preparation There are many researches on the therapeutic effect of zebra fiber on liver cancer, and there are many dosage forms of zebra fiber, such as zebra fiber tablets, hydroxy zebra fiber amine tablets, compounded zebra fiber tablets, compounded zebra fiber capsules, zebra fiber injections, hydroxy zebra fiber amine injection, etc. Some of these dosage forms are westernized Chinese medicines and are used in chronic liver B and early and middle stage primary liver cancer. Some dosage forms belong to the western system of traditional Chinese medicine, and the active ingredients have been purified and widely used in clinical practice.
5. Jinlong Capsule A specialized anti-cancer preparation developed from fresh animal herbs to make fresh medicine work in anti-cancer. This is one of the major features of Prof. Li Jiansheng in the application of traditional Chinese medicine. Fresh use of traditional Chinese medicine is unique in processing, concocting, preserving, and preparation, and has shown good effects in therapeutic efficacy.
6. Lotus Flower Tablet The main ingredients are fleabane, hemiptera, shan ci mushrooms, curcuma, panax ginseng and so on. Each tablet 0.5g, each time 6~8 tablets, can be taken for several months to a year. This drug has been used for a long time in various places and is suitable for liver cancer patients with liver heat and blood stasis but not yet weakened in positive qi.
7. Wake Up Brain Jing Injection is composed of tulip gold, ice tablet, mast and other ingredients. Its main effects are clearing away heat and removing toxins, waking up the mind and relieving fever, cooling blood and activating blood circulation, moving qi and relieving pain. It is useful for fever, central nervous system disorders, hepatic coma, hepatic encephalopathy and toxic encephalopathy. The drug has more chances to be applied in the treatment of liver cancer patients, such as cancer fever, hepatic coma, bleeding caused by coagulation mechanism disorder, liver function abnormality, etc. This product can be tried, and it can often play a role in tumor emergency rescue. There are 3 kinds of specifications, such as 2/ml, 5ml, 10ml, etc., which can be used for intramuscular and intravenous administration. Generally, 20ml of this product is added to 5% dextrose injection 500ml for intravenous drip, 1~2 times a day. No obvious toxic side effects have been found.
8. Toadstool injection 6ml each time, once a day, intravenous injection. Used for 5 days rest 2 days as a cycle, 4 cycles as a course of treatment. It is suitable for liver cancer mass type with accumulation under diaphragm.
9. Crow's gall injection: 4ml each time, once a day, intramuscular injection, 30 days as a course of treatment. It is suitable for those with jaundice of liver cancer.
(6) Acupuncture and acupoint injection
Principal acupoints: Lily of the valley, bilateral gastric area (skin needle on the head), Neiguan, Sanyinjiao. Supporting points: Liver Yu, Kidney Yu, Life Gate, Ah Yes point. The needle is inserted into the skin, and then the needle is twisted 3 times in turn and then withdrawn from the needle. Acupuncture point injection: take the foot three li, big vertebrae, a yes point, 20% ~ 50% placenta injection 2 ~ 4 ml into the total amount of 10 ~ 16 ml each time can be injected once a day or every other day, 15 times for a course of treatment, rest for 3 ~ 5 days, and then start the next course of treatment, and with the traditional Chinese medicine diagnosis and treatment.
Take the acupoints Quchi and Xiajuhu, alternating between the two sides. Vitamin K34ml was injected into each point each time, the needle was punctured about 2~3cm deep, slightly lifted and inserted, and the drug was injected with qi, and the critically ill people were injected 2~3 times a day, and acupoint injections were made at the time of opening of yang-yin meridian at 6~9 o'clock in the morning every day, and other treatments were also used for the upper gastrointestinal hemorrhage complicated by hepatocellular carcinoma.
(7) External medication
1. Cancer pain dispersal 20g each of crabapple, frankincense, myrrh, rhubarb, gardenia, Angelica dahurica, scutellaria baicalensis, 15g each of fennel, male clove, red peony, magnolia, cypress, 20 castor beans. *** Research fine powder, add egg white, and even into a paste, apply it on Sanmen acupoint, change the medicine once in 6~12 hours, and take Chinese medicine soup together with internal medicine. It is suitable for people with liver cancer pain.
2. Paste of gentian herb, lead dan, ice tablet, male clove, andrographis, fine Xin 15g each, raw southern star 20g, systematic milk nocturne, dried toad skin, mitochondria 30g each, rhubarb, turmeric 50g each, calcined cold-water stone 60g. each is finely powdered, and well mixed. When using discretionary powder into the petroleum jelly, spread on the gauze, paste the liver block parts, every other day a change. If localized pimples or blisters appear, stop using it and use it again after the skin is normal. Suitable for those with painful lumps.
3. rhubarb, turmeric, cypress, pi nitro, hibiscus leaves 50g, smallpox pollen 100g, andrographis 30g, raw star, frankincense, myrrh, ice chips 20g. *** research finely ground, and even water into a thick paste, spread on oil paper, external compresses in the liver pain, every other day.
There are many other external remedies, you can refer to the relevant books.
Three, surgical treatment
(1) Role of surgery in liver cancer treatment
Surgery is the best treatment method for early liver cancer at present. After surgical resection of early-stage liver cancer, 1-year survival rate reaches more than 80% and 5-year survival rate reaches more than 50%. If supplemented with traditional Chinese medicine, chemotherapy or immunotherapy after surgery, better therapeutic effect can be obtained. In addition, various local treatments for hepatocellular carcinoma can be carried out through surgery (e.g. ligation of hepatic artery, intraoperative hepatic artery embolization, intraoperative intra-tumoral injection of anhydrous ethanol or other cytotoxic drugs, liquid nitrogen cryotherapy, high-power laser vaporization, microwave therapy, etc.), and conditions can also be created through surgery for postoperative comprehensive treatment (e.g. cannulation of hepatic artery for postoperative chemotherapy infusion, intra-hepatic artery-directed therapy or embolization therapy, intraoperative silver clip localization for postoperative For subclinical recurrence and metastasis, resection can be performed. Hepatocellular carcinoma that shrinks after comprehensive treatment is resected at second stage. Hepatocellular carcinoma complications include the management of emergency and sometimes require surgical cooperation.
(2) Update of some concepts of liver cancer surgery
1. The traditional concept is that the resection of hepatocellular carcinoma should be regular, but the practice of small hepatocellular carcinoma treatment has shown that local resection not only improves the rate of resection significantly in cases with cirrhosis, but also reduces the mortality rate significantly, and achieves the similar or even better long-term efficacy than lobectomy.
2. In the past, it was thought that after radical resection, once the intrahepatic recurrence should not be reopened, but the practice in recent years suggests that the subclinical recurrence is a good target for reopening, and it is advisable to actively reopen.
3. The traditional concept is that lung metastases are advanced after resection, but now it is believed that a single lung metastasis is a good candidate for reoperation.
4. The traditional practice of unresectable hepatocellular carcinoma is regarded as "incurable", and even if the tumor shrinks, no further resection is required, but now it is considered that as long as the liver function is still good, and technically there is the possibility of resection, it is advisable to actively carry out the second-stage surgical resection, whose therapeutic efficacy is close to that of small hepatocellular carcinomas, i.e., there is still the hope of obtaining a radical cure.
5. In the past, jaundice was considered to be a contraindication for surgery once liver cancer was diagnosed, but in recent years, it was found that for those who had obstructive jaundice caused by compression of hepatocellular carcinoma in hepatoportal area, if the remaining liver was better, active treatment (such as ligation of hepatic artery, insertion of chemotherapy, local radiation, etc.) should be taken, which could often make jaundice subside or even get resection because of the obvious shrinkage of the tumor.
(3) Indications for surgery
1. The general condition and cardiac, pulmonary and renal functions are good, and those who can tolerate the surgery;
2. There is no obvious jaundice, ascites or distant metastasis;
3. Liver function is well compensated (A/G is not inverted, bilirubin is in the normal range, plasminogen time is more than 50% of the normal value, and there is no significant abnormality in SGPT);
4. The tumor has the possibility of resection or still has the possibility of palliative surgical treatment other than resection.
(4) Contraindications to surgery
1. Poor general condition, poor cardiac, pulmonary, renal function, and inability to tolerate surgery.
2. Obvious jaundice, ascites or distant metastasis;
3. Poor hepatic function compensation;
4. Unlikely resection of the tumor, with the tumor invading the hepatic hilar region and inferior vena cava.
(5) Choice of surgical approach
Surgical resection usually includes left outer hepatic lobe, left hemihepatic, right hemihepatic, right trilobar, and middle hepatic lobe resection. The choice of surgical method should depend on the size, location, number of tumors, the presence and severity of hepatic cirrhosis, hepatic function compensation and systemic conditions. Surgical resection should strive for smaller surgical scope, minimize the risk of surgery and obtain better long-term effect. Left lobe hepatocellular carcinoma can be resected in the left outer lobe, square lobe or even left hemihepatic resection; whereas right hepatocellular carcinoma is difficult to tolerate lobe resection, therefore, those in the periphery can be wedge resected, those in the central surface can be shuttle resected, and those in the deep right lobe can be cut through the liver parenchyma and then locally resected; those located in the hepatic hilar area can only be gouged out along the pericardium of the tumor. Most of the hepatocellular carcinomas located in the hilar region can only be excised along the tumor peritoneum. In the early years, blood flow blocking cryoperfusion bloodless hepatectomy was sometimes used, but this method is complicated, so it has been rarely used, and room temperature bloodless hepatectomy is also used. The inferior vena cava above and below the liver should be controlled and hepatic portal blockage should be performed. In addition, with the development of science, liver transplantation has become an important surgical procedure.
(6) Surgical treatment of non-surgical resection
Among the cases with surgical indication and exploration, about 60%~70% were confirmed to be unresectable, and 30%~40% of the earlier liver cancer cases detected by census were unresectable. Surgical treatment with non-surgical resection, which has been adopted in recent years, helps to improve the prognosis of this group of patients. In surgical exploration, the following treatments can be used intraoperatively for this group of patients:
1. Hepatic artery intubation and perfusion (HAI) This method can make the liver localized with high drug concentration. Usually, if intravenous application is ineffective, arterial infusion has certain effect. Shanghai Medical University Hepatocellular Carcinoma Research Institute has improved this method:
(1) By dissecting the hepatic hilar and inserting the catheter into the branch of hepatic artery on the affected side under the clear vision, and verifying the catheter placement in the correct position with methylene blue;
(2) Paying attention to the maintenance of the smoothness of the catheter, which can be maintained for 3-6 months, and individually up to years;
(3) Improving the drug of perfusion, and the clinical observation suggests DDP as the preferred drug, usually 10mg per day, and the drug of choice. The preferred drug, usually 10mg per day, 10 days for a course of treatment, can be repeated every 3 weeks, to a total of 500mg.
(4) Other also used MMC, ADM, MTX, etc., and in recent years, also via the hepatic artery catheterization perfusion-directed therapeutic drugs, such as 131I-ferritin antibodies.
2. Hepatic artery ligation (HAL) 90% of the blood supply of hepatocellular carcinoma comes from the hepatic artery, therefore, ligation or embolization of the hepatic artery can lead to a large number of necrosis of hepatocellular carcinoma cells, which can be tolerated by the normal liver tissues, and the collateral circulation can be opened after 6 weeks. Its main complication is renal failure caused by massive tumor necrosis, with a mortality rate of 10%. In recent years, this type of complication can be avoided by using interstitial blockade or by using embolic agents that can be reopened. This treatment is contraindicated in cases where the tumor exceeds 70% of the total liver and cirrhosis is severe.
3. Chemoembolization At the time of dissection, if the tumor cannot be resected, a slow-release drug similar to mitomycin can be injected into the hepatic artery, and the hepatic artery can be embolized with a gelatin sponge. This method can play the role of slow release of chemotherapeutic drugs in the local area to achieve the anti-cancer effect of chemotherapy, but also can play the purpose of blocking the blood supply of the hepatic artery embolization, which is beneficial to improving the prognosis.
4. Injection of anhydrous alcohol into liver cancer foci After CT or ultrasound examination of liver and dissection of liver, it is considered that the cancer cannot be resected, especially the multiple cancers less than 3cm, injection of anhydrous ethanol into the cancer foci is a very good palliative treatment.
After the above treatments, some of the patients can see the tumor shrinking, and if resection is possible, the tumor should still be resected without loss of time.
(VII) Surgery and traditional Chinese medicine
1. Preoperative Angelica sinensis and Dihuang Tang should be given to nourish yin and replenish blood, such as those with abnormal liver function (significant increase in SGPT and GGT) can prolong the preoperative preparation time as appropriate, and application of including traditional Chinese medicines with hepatoprotective therapy. Preoperative use of traditional Chinese medicine that clears heat and removes toxins, activates blood circulation and removes blood stasis, and breaks qi and blood should not be used, and high-dose chemotherapy should be avoided to avoid hemorrhage or inducing hepatic coma.
2. When surgery is the main treatment, traditional Chinese medicine should be used to warm yang and benefit qi, strengthen the spleen and stop bleeding. Commonly used angelica dihuang tang and gui fu dihuang tang plus reduction: angelica 12g, 15g, yam 12g, cornelian cherry 12g, zedoary 6g, gui zhi 9g, cannabis 10g, goji berry 15g, danpi 9g, xi cao 6g, xianhe cao 9g, baked licorice 6g, boiled in water, 1 dose per day.
Early postoperative period was given Shengwei San combined with regulating stomach and Chengqi Tang with addition and subtraction (ginseng, angelica sinensis, maitake, schizandra, making rhubarb, citrus aurantium dulcis, coix lacryma, and xianhecao, etc.). Wu Mengchao injected Stomach Regulating and Cheng Qi Tang through gastric tube on the first day of surgery, and defecation occurred 50 hours after surgery. If postoperative pulse number, moss yellow, dry mouth and thirst, can be used to sheng pulse san. For those with low fever, Artemisia sinensis turtle turtle turtle soup and diaphragm under the blood stasis soup were used, and antibiotics were used, and after recovery, the flavor of six gentleman's soup was added, which could make the condition of those who had the right lobe of liver resected smoother.
Yu Erxin and Yu Rencun wrote a paper that preoperative and postoperative treatment with traditional Chinese medicine is expected to increase the rate of surgical resection, promote postoperative recovery, and improve the 5-year survival rate; generally, preoperative medicine such as tonic Zhong Yi Qi Tang can be used to strengthen the spleen and qi, in order to enhance the body's ability to cope with stress, and postoperative medicine such as Xiao Chaihu Tang can be used to promote the recovery of the body and liver function, and a wide range of methods can be used according to the patient's different conditions. Methods