Two Medical Cases of Integrated Chinese-Western Treatment: One Bile Duct Cancer and One Gallbladder Cancer

Gallbladder cancer and cholangiocarcinoma are common malignant tumors of the biliary system. Chronic cholecystitis, gallstones, gallbladder polyps, and cholecystoenteric fistula are risk factors for gallbladder cancer; gallbladder adenoma and gallbladder adenomyomatosis are precancerous lesions of gallbladder cancer. Benign bile duct tumors, primary sclerosing cholangitis, congenital choledochal cysts, and chronic cholangitis are precancerous lesions of cholangiocarcinoma.

Gallbladder cancer and cholangiocarcinoma have similar clinical symptoms. When the disease reaches the middle-to-late stage, symptoms such as upper abdominal pain, anorexia and fatigue, nausea and vomiting, jaundice, and hypochondriac pain appear. TCM mostly considers this disease as patterns of liver qi stagnation, liver-gallbladder damp-heat, and phlegm-qi binding, with treatment approaches mainly of soothing the liver and relieving depression, clearing heat and transforming dampness, and regulating qi and dispersing nodules. Commonly used formulas and medicines include Chaihu Shugan San, Yinchenhao Tang, Xiaoluo Wan, Xihuang Wan, Dahuang Zhechong Wan, Biejia Jian Wan, Compound Mylabris Capsules, and Shugan Hewei Wan.

Biliary system tumors are highly malignant with a poor prognosis, and patient survival is often short, but with proper treatment there are long-term survivors. This article introduces the integrated Chinese-Western treatment process for one gallbladder cancer patient and one cholangiocarcinoma patient treated by the author.

Case 1: Yu, female, born in 1967, a nurse at a hospital in Dalian, Liaoning. She first consulted me on April 27, 2018, having already been diagnosed by Western medicine with gallbladder cancer stage T3N0M0, having undergone two surgeries and completed chemotherapy. Tongue coating yellow and greasy; bitter mouth, dry mouth; discomfort in the ribs and back. Her body was weak with spontaneous sweating and shortness of breath, and occasional transient dizziness.

Decoction: Bupleurum (Chaihu) 10g, Scutellaria (Huangqin) 10g, Schisandra (Wuweizi) 10g, Cinnamon Twig (Guizhi) 10g, White Peony (Baishao) 10g, prepared Licorice (Zhi Gancao) 6g, raw Astragalus (Sheng Huangqi) 30g, Angelica (Danggui) 10g, Atractylodes (Baizhu) 20g, Saposhnikovia (Fangfeng) 10g, processed Pinellia (Fabanxia) 10g, Curcuma (Pianjianghuang) 6g, Stiff Silkworm (Jiangcan) 10g, Cicada Slough (Chanyi) 6g, Artemisia Capillaris (Yinchen) 15g, Gardenia (Zhizi) 15g, Codonopsis (Dangshen) 15g, Sophora Flavescens (Kushen) 10g, Scutellaria Barbata (Banzhilian) 20g, Oldenlandia (Baihua She Zhecao) 20g, Agrimonia (Xianhecao) 30g, Sparganium (Sanleng) 10g, Curcuma Ezhu (Ezhu) 10g, each of the three Jiao Shenqu (Jiao Sanxian) 10g, roasted Chicken Gizzard Lining (Chao Jineijin) 30g.

Chinese patent medicines: Xihuang Wan (Beijing Tongrentang); demethylcantharidin tablets; Shugan Hewei Wan; and pills made from Toad Venom (Chansu), Moschus (Shexiang), Julus (Malu Chong), and Turtle Shell (Biejia) for oral use.

Follow-up on July 27, 2018 (during menstruation): for the past half month she had felt discomfort around the surgical incision, occasional colicky pain below the epigastrium, acceptable appetite, poor sleep quality, and easy waking. A rash had broken out on her left arm and itched in the sun, with no hair loss. Stools were formed, no mucus or black stools, urination normal. Tongue coating yellow and greasy; when sleeping poorly her tongue felt dry and her mouth bitter, with abundant eye discharge; breast distending pain before menstruation. Recent CA125 and neuron-specific enolase were elevated. Blood lipids high, somewhat obese; pulse gentle and moderate, tongue coating slightly yellow and greasy.

Decoction: Bupleurum (Chaihu) 10g, Angelica (Danggui) 10g, White Peony (Baishao) 10g, Atractylodes (Baizhu) 10g, Poria (Fuling) 10g, Trichosanthes (Gualou) 18g, Fritillaria (Beimu) 10g, processed Pinellia (Fabanxia) 10g, Arisaema cum Bile (Dannanxing) 6g, raw Oyster Shell (Sheng Muli) 15g (decocted first), Cremastra (Shancigu) 10g, Dandelion (Pugongying) 20g, Scutellaria Barbata (Banzhilian) 15g, Oldenlandia (Baihua She Zhecao) 15g, Sophora Flavescens (Kushen) 10g, Curcuma Ezhu (Ezhu) 10g, Agrimonia (Xianhecao) 50g, Eclipta (Mohanlian) 15g, Ligustrum (Nüzhenzi) 15g, Astragali Complanati Seed (Shayuanzi) 10g, Cuscuta (Tusizi) 10g, Moutan (Mudanpi) 10g, Cardamom (Doukouren) 10g, Coix Seed (Yiyiren) 30g, roasted Malt (Chao Maiya) 30g, roasted Sprout (Chao Guya) 30g, Dioscorea (Huai Shanyao) 30g, prepared Licorice (Zhi Gancao) 6g, each of the three Jiao Shenqu (Jiao Sanxian) 10g, roasted Chicken Gizzard Lining (Chao Jineijin) 30g.

Chinese patent medicines: Jiawei Xiaoyao Wan (stopped once the dry tongue and bitter mouth were gone); Neixiao Sanjie Wan; demethylcantharidin tablets. Xihuang Wan was discontinued because it was too expensive and a heavy financial burden.

Follow-up on November 5, 2018: due to endometriosis and adenomyosis she had excessive bleeding and dysmenorrhea, with no abnormal vaginal discharge. Western medicine recommended injecting leuprorelin acetate microspheres to stop menstruation.

Pulse wiry and moderate; blood pressure 138/80; mouth slightly bitter, more bitter at two or three in the morning and on waking. Faint epigastric discomfort. Slight discomfort under the right rib. Tongue coating white and greasy, tongue slightly bluish-purple. Averse to wind and cold; scapular discomfort. She sweats a little, not much, and occasionally sweats at night. Stools normal, once a day, occasionally twice, basically formed, occasionally loose. Urination normal.

Decoction 1: Guizhi Jia Gegen Tang.

Cinnamon Twig (Guizhi) 10g, White Peony (Baishao) 10g, prepared Licorice (Zhi Gancao) 6g, Ginger (Shengjiang) 3 slices, Jujube (Dazao) 5 pieces, Pueraria (Gegen) 20g.

Decoction 2: Huangtu Tang (Yellow Earth Decoction).

Hearth Flue Earth (Zaoxintu) 30g, roasted Atractylodes (Chao Baizhu) 10g, blast Aconite (Pao Fuzi) 10g, Donkey-Hide Glue (Ejiao) 10g, Scutellaria (Huangqin) 10g, prepared Licorice (Zhi Gancao) 10g.

Decoction 3: Modified Guipi Tang (Return-to-Spleen Decoction).

raw Astragalus (Sheng Huangqi) 30g, roasted Atractylodes (Chao Baizhu) 10g, Poria (Fuling) 10g, Codonopsis (Dangshen) 15g, Auklandia (Muxiang) 10g, Longan Aril (Longyanrou) 6g, Angelica (Danggui) 6g, Polygala (Yuanzhi) 10g, Dioscorea (Huai Shanyao) 20g, Polygonatum (Huangjing) 10g, Eclipta (Mohanlian) 10g, Ligustrum (Nüzhenzi) 10g, Astragali Complanati Seed (Shayuanzi) 10g, Cuscuta (Tusizi) 10g, Actinidia Root (Tengligen) 20g, Pyrrosia (Shiwei) 20g, Oldenlandia (Baihua She Zhecao) 15g, Scutellaria Barbata (Banzhilian) 15g.

The above three decoctions were taken alternately.

Chinese patent medicines basically as before.

After this, long-term use of decoctions affected her appetite, so she switched to taking only pills. The treatment approach was basically as before, but with minor adjustments every 1–3 months according to changes in her condition. For over three years after taking the medicine, her condition was consistently good. But on February 27, 2021, due to sudden abnormal liver function, MRI re-examination at the Second Affiliated Hospital of Dalian Medical University (outpatient no. 17081100093, order no. 290326722) showed an abnormal signal shadow in the hepatic hilum area with intrahepatic bile duct dilation, considered tumor recurrence.

She then underwent interventional therapy, after which she continued TCM maintenance. Treatment basically followed the approach of soothing the liver and relieving depression, promoting diuresis andrelieving jaundice, regulating qi and resolving stasis, and softening and dispersing hard masses, with modifications based on Chaihu Shugan San and Xiaoyao San. Treated up to now, her condition is stable and she lives a normal life. During this period, due to adenomyosis with uncontrolled bleeding, various methods were tried with poor results; later I advised sitz baths with cooked Mugwort (Aiye) water, which basically controlled it. Currently the patient lives normally and practices Guo Lin Qigong, re-examining regularly with no abnormalities.

Case 2: Cai, male, born in 1972, from Zhengding, Hebei. Low-differentiated adenocarcinoma of the common bile duct, partly undifferentiated adenocarcinoma, infiltrating the full thickness of the duct wall and invading the pancreas, with obstructive jaundice, acute liver injury, abnormal liver function, and hypoproteinemia. Surgery at a local Hebei hospital resected the bile duct, pancreas, duodenum, hepatoduodenal ligament lymph nodes, and peripancreatic common hepatic artery lymph nodes; postoperatively the pancreaticojejunostomy had continuous high drainage, considered a pancreatic fistula.

First consultation on May 13, 2019: right pulse fine, rapid, weak, and forceless; left pulse weak and forceless; tongue bluish-purple, watery-slippery with teeth marks, no coating, and no obvious stasis-purple beneath the tongue. Urination and defecation normal; urine occasionally yellow; jaundice. Face dark and turbid (post-chemotherapy reaction), skin darkened in many places. The patient reported that two years earlier he had begun to have pain in the right lower abdomen at the liver region, but hospital exams found no obvious lesion. He had recently lost twenty jin, which drew attention.

The patient's father died of liver cancer at 68; the patient had a history of hepatitis 30 years earlier, already cured. Around New Year's 2019, after drinking he developed heartburn and vomiting, vomitus being gastric contents, with black stools; he sought outpatient treatment at a clinic and took oral medication, and the stool color returned to normal. Two days later, while bathing, he found his whole body yellow and his stools clay-colored; at the Second Hospital of Hebei Medical University (medical record no. 2119559) he was found to have cholangiocarcinoma. There was pleural, abdominal, and pelvic effusion, and the right middle lung lobe streaks had shrunk from before. Main symptoms now were bloating and chest oppression, lower abdominal pain, chest tightness, fullness, and fatigue. No bitter mouth.

Decoction: raw Astragalus (Sheng Huangqi) 30g, Stephania Tetrandra (Han Fangji) 30g, roasted Atractylodes (Chao Baizhu) 30g, Poria (Fuling) 30g, Polyporus (Zhuling) 20g, Magnolia Bark (Houpo) 30g, processed Pinellia (Fabanxia) 10g, Codonopsis (Dangshen) 30g, Angelica (Danggui) 10g, Artemisia Capillaris (Yinchen) 20g, Lysimachia (Jinqiancao) 30g, Spora Lygodii (Haijinsha) 30g, Motherwort (Yimucao) 30g, Eclipta (Mohanlian) 20g, Ligustrum (Nüzhenzi) 20g, Astragali Complanati Seed (Shayuanzi) 10g, Cuscuta (Tusizi) 10g, each of the three Jiao Shenqu (Jiao Sanxian) 20g, Chicken Gizzard Lining (Jineijin) 30g, Oldenlandia (Baihua She Zhecao) 30g, Scutellaria Barbata (Banzhilian) 30g, Agrimonia (Xianhecao) 30g, Achyranthes (Huainiuxi) 10g, Plantago Seed (Cheqianzi) 15g, Plantago Herb (Cheqiancao) 15g, Bupleurum (Chaihu) 10g, Scutellaria (Huangqin) 10g, Curcuma (Pianjianghuang) 6g, Cicada Slough (Chanyi) 6g, roasted Stiff Silkworm (Chao Jiangcan) 10g, prepared Turtle Shell (Zhi Biejia) 24g (decocted first), Polygonatum (Huangjing) 30g, Coix Seed (Yiyiren) 60g, Ginger (Shengjiang) 7 slices, Jujube (Dazao) 7 pieces (crushed).

One dose is decocted twice and divided into six equal portions, drunk within two days.

Patent medicines: Compound Mylabris Capsules; bicyclol or silybin capsules; and pills made from Moschus (Shexiang), Cow Bezoar (Niuhuang), Toad Venom (Chansu), Leech (Shuizhi), Gecko (Bihu), Centipede (Wugong), and Scorpion (Quanxie) for oral use.

The patient's family was torn over whether to undergo chemotherapy and did not know how to choose. Considering the patient was young with decent strength, I advised him to go back and do two chemotherapy courses while I provided TCM adjuvant treatment to relieve the side effects. If he could not tolerate it, he could abandon chemotherapy at any time and switch to pure TCM; if he tolerated it, he should complete chemotherapy and then do TCM to prevent tumor recurrence.

Follow-up on October 15, 2019: after the initial visit, the family followed my advice and went home for six chemotherapy courses. His weight had recently recovered by over ten jin, his dark face had slightly improved, and he occasionally had oppressive chest pain, which improved greatly after chemotherapy. Blood hemoglobin was high; right pulse wiry, slippery, rapid, and forceful; left pulse gentle and even; bitter and dry mouth. When eating greasy food, stools were unformed, 2–4 times a day. Urine not yellow; sleep acceptable.

Given the patient's acceptable condition, I advised long-term pill taking; the pill prescription was slightly modified from the initial prescription, changing a few herbs every month or two, so that he could persist long-term at low cost. The patient and his family accepted this advice, so he has been treated on the basis of the above formula, modifying with the symptoms over time up to the present, re-examining regularly with no recurrence.

Gallbladder cancer and cholangiocarcinoma are highly malignant, prone to early recurrence after treatment, with a short recurrence interval and short patient survival. Integrated Chinese-Western treatment—Western surgery and chemotherapy to fight cancer, and TCM liver-protecting and gallbladder-benefiting, liver-soothing and qi-regulating, stasis-resolving and nodule-dispersing, diuresis-promoting and jaundice-relieving drugs for consolidation—can significantly prolong patient survival and improve quality of life.