Case Record of Patient Yang YL from Guizhou with Liver Cancer and Cirrhosis
The patient, Yang YL, had suspected multiple postoperative recurrences of liver cancer along with cirrhosis and many years of hepatitis B. On November 3, 2015, she underwent a postoperative B-ultrasound at Lianyungang First People's Hospital. She came to Beijing for her first consultation on November 7.
Findings on examination:
Liver: Multiple slightly hyperechoic areas are seen within the liver. The larger one is located in the left lobe of the liver, measuring about 14*13 mm. The remaining contour is regular, with a smooth capsule. The hepatic echoes are coarse and uneven. The intrahepatic vessels run with clear visibility.
Gallbladder: Normal size, regular shape, rough wall.
Common bile duct: No obvious dilatation.
Pancreas: Regular shape, homogeneous internal echoes.
Spleen: Normal size, regular shape, intact capsule, homogeneous internal echoes.
Ultrasound impression:
Multiple slightly hyperechoic areas within the liver; coarse and uneven hepatic echoes.
Rough gallbladder wall.
No obvious abnormality of the pancreas or spleen.
Initial consultation impression: The pulse was wiry and large, and the patient sweated extremely easily. According to her own account, she had severe sweating on the head whenever she ate, ever since childhood, at times even emitting white vapour from her head. Her appetite was enormous. She worked in the toy industry. The original pulse case record has been lost; this case is reconstructed today from the initial prescription the patient sent back to me.
Initial prescription:
Zhi Biejia (Carbonized Turtle Shell) 15 g (decoct first), Xi Shengdi (Unprepared Rehmannia Root) 12 g, Mudanpi (Moutan Bark) 9 g, Baishao (White Peony Root) 9 g, Zhimu (Anemarrhena Rhizome) 6 g, Chishao (Red Peony Root) 9 g, Pian Jianghuang (Curcuma Longa) 6 g, Jiangcan (Stiff Silkworm) 9 g, Chanyi (Cicada Slough) 6 g, Chaihu (Bupleurum Root) 12 g, Baizhu (Atractylodes Rhizome) 6 g, Fuling (Poria) 9 g, Ezhu (Zedoaria Rhizome) 6 g, Taizishen (Pseudostellaria Root) 15 g, Huangqin (Scutellaria Root) 6 g, Maidong (Ophiopogon Root) 9 g, Xuanfuhua (Inula Flower) 9 g (wrapped), Wuweizi (Schisandra Fruit) 9 g, Gouqi (Lycium Fruit) 9 g, Baihuasheshecao (Spreading Hedyotis Herb) 15 g, Banzhilian (Barbated Scullcap Herb) 15 g, Shengjiang (Fresh Ginger) 15 g (sliced), Dazao (Jujube) 5 pieces (broken by hand), Qinghao (Sweet Wormwood) 6 g (added later)
One dose per day, divided into 2-3 portions, taken 0.5-1 hour after meals; take five days out of each week.
Chinese patent medicines: Compound Cantharidin Capsules, 3 capsules once daily after breakfast; Xihuang Wan (Yellow Emperor's Pill), 6 g once daily after dinner (3 g for the first two doses).
There was no obvious effect from the above formula. On December 24, 2015, the prescription was changed as follows:
Chaihu 10 g, Baizhu 20 g, Fuling 20 g, Danggui (Angelica Root) 20 g, Baishao 20 g, Huaishanyao (Chinese Yam) 20 g, Lianqiao (Forsythia Fruit) 20 g, Wuweizi 15 g, Yinchen (Virgate Wormwood) 20 g, Chao Zhizi (dry-fried Gardenia Fruit) 15 g, Sheng Gancao (Unprepared Licorice Root) 15 g, Danshen (Salvia Root) 40 g, Sheng Huangqi (Unprepared Astragalus Root) 15 g, Huangqin 10 g, Ezhu 15 g, Sanleng (Burreed Tuber) 15 g, Zhi Biejia (Processed Turtle Shell) 15 g, Dilong/Tubiechong (Eupolyphaga) 15 g, Chan Chu (Dried Toad) 6 g, Huzhang (Giant Knotweed Rhizome) 15 g, Tengligen (Yangtao Actinidia Root) 30 g, Baihuasheshecao 30 g, Banbianlian (Chinese Lobelia Herb) 30 g, Xianhecao (Hairy Vein Agrimony) 30 g
Xiaojin Wan (Little Golden Pill) 6 g in the morning; Xihuang Wan 6 g in the evening.