TCM Case: Mr. Du with Gallbladder Cancer and Hepatic and Pancreatic Metastases

Mr. Du, 60 years old, male, a resident of Datong, Shanxi Province. In early 2015 he was admitted for abdominal distension and weight loss, and gallbladder cancer was found. On June 3 he underwent surgery in the general surgery ward of Beijing Tongren Hospital. The discharge diagnosis was gallbladder adenocarcinoma (T4N1M0) with metastatic liver cancer, intrahepatic bile duct stones, common bile duct stones, hepatic insufficiency, hypoproteinemia, and anemia. After surgery he took Xiloda (capecitabine), but recently the cancer recurred. He had previously received TCM treatment at Beijing Hospital of TCM and elsewhere, with poor results. He first sought consultation on December 5, 2015.

Both left and right pulses were wiry, rapid, and forceful; the tongue was red with little coating. He was irritable, restless, thin and fatigued, with abdominal distension and frequent belching. Combining pulse and tongue, the pattern was differentiated as liver-gallbladder depressive heat. Treatment was planned by combining Danzhi Xiaoyao San, Jiangi San, and Xiaoluo Wan with additions. The prescription was as follows:

Chaihu (Bupleuri Radix) 9 g, Zhizi (Gardeniae Fructus) 6 g, Zhigancao (Glycyrrhizae Radix Praeparata) 6 g, Zhi Biejia (Testudinis Carapax et Plastrum Praeparatum) 12 g (decocted first), Danggui (Angelicae Sinensis Radix) 12 g, Chao Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried) 12 g, Baishao (Paeoniae Radix Alba) 12 g, Mudanpi (Moutan Cortex) 12 g, Bohe (Menthae Herba) 3 g (added later), Fuling (Poria) 12 g, Pianjianghuang (Curcumae Longae Rhizoma) 6 g, Jiangcan (Bombyx Batryticatus) 12 g, Chanyi (Cicadae Periostracum) 6 g, Xuanfuhua (Inulae Flos) 10 g (wrapped), Xiangfu (Cyperi Rhizoma) 10 g, Baihuasheshecao (Oldenlandiae Herba) 30 g, Banbianlian (Lobeliae Chinensis Herba) 20 g, Xuanshen (Scrophulariae Radix) 12 g, Zhebeimu (Fritillariae Thunbergii Bulbus) 12 g, Sheng Muli (Ostreae Concha) 30 g (decocted first)

One dose daily, taken all at once or divided into two meals.

Additionally, Jiawei Xiaoyao Wan twice daily; Xihuang Wan once daily at bedtime with plain water: 3 g on day 1, 6 g on day 2, 9 g on day 3, and 12 g from day 4 to day 7.

Take medicine for seven days, then rest seven days.

The family was additionally instructed to prepare Yinyang Gongji Wan for standby.