Appreciating Jiang Yilan's TCM Case of Treating Giant Hepatocellular Carcinoma

This case report was published in the Journal of Traditional Chinese Medicine Guide (2022, 28(02): 180-183), under the original title "Jiang Yilan's Experience in Treating Massive Hepatocellular Carcinoma Based on the Theory that 'the Liver Takes Yin as its Substance and Yang as its Function'", authored by Lu Zhulin, Tang Yinggang, Yang Jie, et al.

The patient in this case was a 56-year-old man with liver cancer. He presented on April 9, 2016 after discovering a liver space-occupying lesion for more than one month. On February 25, 2016, an abdominal B-ultrasound at a local hospital had found a giant space-occupying lesion in the liver, suggestive of liver cancer. Further examination at a tertiary Grade-A hospital confirmed a space-occupying lesion in the inner lobe of the liver with intratumoral hemorrhage, measuring about 11.8 cm × 9.9 cm. Tumor markers were abnormal.

The patient had previously been a hepatitis B virus carrier. At presentation, his main complaints were nausea, vomiting, aversion to greasy food, fatigue and lack of strength, poor appetite, abdominal distension, acceptable sleep, loose stools, soreness and weakness of the waist and knees, dry mouth, bitter taste, and dry eyes. Examination found a red tongue with thin greasy coating; the pulse was fine, wiry, and rapid. Because the tumor was large, surgery was difficult and high-risk, the patient refused surgery, and repeatedly refused needle biopsy. He chose purely TCM anti-cancer treatment, and so came to Dr. Jiang Yilan. Among Western medical options he was only willing to take the oral anti-hepatitis-B antiviral drug entecavir.

Dr. Jiang considered that the patient presented with insufficiency of both liver, spleen, and kidney, along with internal binding of cancer-toxin. Treatment should follow the principle of tonifying and soothing the liver, detoxifying, and fighting cancer. She prescribed a modified combination of Yiguan Jian (One-Inch Decoction) and Xiangsha Liujun Tang (Cyperus and Amomum Six-Gentleman Decoction).

First-visit prescription: Dangshen (Codonopsis, 党参) 15 g, Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) 10 g, Fuling (Poria, 茯苓) 15 g, Chenpi (Citri Reticulatae Pericarpium, 陈皮) 9 g, Muxiang (Aucklandiae Radix, 木香) 8 g, Sharen (Amomi Fructus, 砂仁) 5 g, Maidong (Ophiopogonis Radix, 麦冬) 12 g, Danggui (Angelicae Sinensis Radix, 当归) 12 g, Shengdi (Rehmanniae Radix, 生地) 15 g, Gouqizi (Lycii Fructus, 枸杞子) 10 g, Choushijia (wine-processed Trionycis Carapax, 醋鳖甲) 15 g, Chuanlianzi (Toosendan Fructus, 川楝子) 6 g, Shijianchuan (Salviae Chinensis Herba, 石见穿) 30 g, Huainiuxi (Achyranthis Bidentatae Radix, 怀牛膝) 10 g, Beichaihu (Bupleurum, 北柴胡) 15 g, Baishao (Paeonia Alba, 白芍) 15 g, Houpo (Magnoliae Officinalis Cortex, 厚朴) 10 g, Huangqin (Scutellariae Radix, 黄芩) 9 g. 15 doses, one dose daily, decocted in water.

At the follow-up on May 23, the patient reported that his symptoms had markedly improved: appetite was acceptable, stools were normal, but he still had dull right hypochondriac pain, dry mouth and eyes, abdominal distension, and fatigue. The tongue was dark red with thin yellow coating; the pulse was wiry and fine. Dr. Jiang considered that the first prescription had basically taken effect and only needed slight adjustment. Thus, on the basis of the first prescription, she removed Chenpi, Sharen, and Baizhu, and added Quanxie (Scorpio, 全蝎) 6 g, Jixueteng (Spatholobi Caulis, 鸡血藤) 15 g, and Chonglou (Paridis Rhizoma, 重楼) 15 g.

Thereafter the patient returned regularly every 1-2 months, basically following this approach, with medication adjusted at any time according to his symptoms. The patient was treated until July 13, 2021, when a re-examination at a local hospital showed the liver tumor had enlarged to 12.6 × 12.1 cm; on September 4, 2021, a repeat scan showed the tumor at 13.5 × 8.5 cm. Over five years, although the tumor had enlarged slightly, the patient's quality of life remained acceptable, and up to the publication of this case report he was still surviving with the tumor, without ever developing ascites or other malignant symptoms.

This patient's stable condition was related both to Dr. Jiang's treatment and to his continued adherence to the hepatitis B antiviral drug entecavir. Precisely because the hepatitis B virus was controlled, the growth rate of the liver tumor slowed considerably. Dr. Jiang's formulas were steady and balanced, with medication taking into account both safety and efficacy. That this patient survived so long must have surprised both the patient himself and Dr. Jiang.

TCM holds that "when seeing liver disease, know that the liver will transmit to the spleen, and the spleen must be secured first." Dr. Jiang's treatment of this liver cancer patient followed exactly this principle. Her approach of combining Xiangsha Liujun Wan with Yiguan Jian simultaneously fortified spleen yang and nourished liver yin. Prescribing on this basis could basically relieve the patient's various clinical symptoms. At the same time, adding herbs such as Biejia (Trionyx), Shijianchuan, Quanxie (Scorpio), and Chonglou—which soften hardness, dissipate nodules, clear heat and detoxify, and fight cancer and reduce swelling—allowed a slow, gradual strategy that delayed disease progression and sustained the patient's life. Such a treatment approach is worth learning from.