Appreciation of Dr. Wan Wenmo's Case Records of Treating Liver Cancer and Cirrhosis

Chief physician Wan Wenmo, born in 1923 and a native of Wuhan, Hubei Province, worked at the Wuhan Ninth Hospital. He specialized in treating liver cancer and cirrhosis, and had a characteristic formula for liver cancer called "toad oil": one live toad, eviscerated and washed, fried dry in 500 g of sesame oil, strained, and the remaining oil used for stir-frying dishes as a dietary supplement. When prescribing according to pattern differentiation, Dr. Wan often also advised patients to use toad oil as dietary therapy, with good results.

Dr. Wan Wenmo believed that the mechanism of liver cancer is mostly accumulation and binding of damp-heat toxin, congealed phlegm and blood stasis, and disordered spleen transportation; treatment should follow the principles of clearing heat and draining dampness, resolving toxin and masses, and fortifying the spleen and benefiting the stomach.

Dr. Wan once published three case records of treating liver cancer.

Case one: Hu, first seen by Dr. Wan on May 24, 1974, inpatient No. 53500. The patient was a 61-year-old worker admitted to the Wuhan Ninth Hospital on March 30, 1974 for right upper quadrant discomfort and emaciation. After admission, B-ultrasound showed a mass about 4 cm in diameter in the right liver, measuring 3.5 cm x 6 cm, with normal liver function. Three further imaging examinations all suggested a space-occupying lesion in the right hepatic lobe. Initially liver function and alpha-fetoprotein were normal, but from May 24 alpha-fetoprotein became abnormal, and primary liver cancer was diagnosed.

After one chemotherapy cycle the patient had a strong reaction and stopped. From May 4 he switched to Chinese medicine; the first doctor he saw did not achieve obvious results, so on May 24 he changed doctors and came to Dr. Wan. At the first visit he was emaciated and fatigued, with abdominal distension and poor appetite, bitter mouth and dark urine, occasional dull right hypochondriac pain, loose stools and yellow coating. Dr. Wan diagnosed accumulation and binding of damp-heat toxin, congealed phlegm and blood stasis, and disordered spleen transportation.

Initial prescription: Baihua sheshecao (Oldenlandia) 60 g, Chuipencao (Sedum sarmentosum) 60 g, Huzhang (Reynoutria) 30 g, Shengmuli (raw Oyster Shell) 30 g, Xiakucao (Prunella) 15 g, Tengligen (Actinidia root) 15 g, Danshen (Salvia) 15 g, Shexiang (Moschus) 9 g, Yujin (Curcuma) 9 g, Baizhu (Atractylodes) 9 g, Gancao (Licorice) 9 g.

After 15 doses, symptoms improved and the condition stabilized, but abdominal distension and fatigue remained. At the second visit on June 8, 1974: Huzhang 30 g, Tengligen 30 g, Baihuasheshecao 30 g, Banzhilian (Scutellaria barbata) 30 g, Tielingjiao 30 g, Sheng Biejia (raw Turtle Shell) 30 g, Nuzhenzi (Ligustrum) 30 g, Taizishen (Pseudostellaria) 30 g, Hongzao (Jujube) 30 g, Yujin 9 g, Huoxiang (Agastache) 9 g, Ganchanpi (dried toad skin) 6 g (gradually increased to 9 g). By September 11 the patient was discharged. After discharge he continued this formula and, following Dr. Wan's method, made his own toad oil for stir-frying.

Treatment continued until March 30, 1975, when re-examination showed the liver lesion had disappeared, alpha-fetoprotein was normal, symptoms were gone, and spirit and strength had returned to normal. Follow-up to May 1984 showed no recurrence; the patient had survived 10 years.

Case two: Yao, male, 50, a cadre. First visit November 27, 1983.

The patient had a history of chronic hepatitis, erysipelas and hypertension. On November 17, 1983 he suddenly had massive gingival bleeding and went to a dental hospital; the doctor used a paste to stop the bleeding. Bleeding reduced, but examination found the gingival bleeding was due to thrombocytopenia secondary to cirrhosis, which the dental department could not treat.

On November 27 he came to the Wuhan Ninth Hospital. Examination showed the liver was palpable 5 cm below the right costal margin, hard, with a fairly regular edge and nodular surface; the spleen was palpable 3 cm below the left costal margin, hard, with a rough edge. Liver function was abnormal and platelets were low. B-ultrasound on December 24 showed multiple solid space-occupying lesions in the right liver, the largest measuring 3.5 cm x 5.6 cm; liver cancer and cirrhosis were diagnosed. Dr. Wan considered the TCM pattern to be lingering toxin, yin deficiency with fire hyperactivity, phlegm obstruction and blood stasis, and blood heat causing reckless movement.

Initial prescription: Mohanlian (Eclipta) 30 g, Nuzhenzi 30 g, Baimaogen (Imperata) 30 g, Xiaoji 30 g, Shengmuli 30 g, Huzhang 15 g, Yinchen (Artemisia capillaris) 15 g, Xiakucao 15 g, Shengdihuang (raw Rehmannia) 15 g, Biejia 15 g, Ejiao (Asini Corii Colla) 10 g, Mudanpi (Moutan) 10 g, Chenpi (Citrus reticulata peel) 10 g, Fulin (Poria) 10 g, Sanqi powder 6 g (infused).

After 6 doses, gingival bleeding resolved, dry bitter and foul taste in the mouth resolved, bowels moved freely, and spirit improved. The patient continued 6 doses with Shengdihuang removed, after which the prescription was adjusted as follows:

Huzhang 30 g, Sheng Biejia 30 g, Yinchen 30 g, Baihuasheshecao 30 g, Banzhilian 30 g, Longkui (Solanum nigrum) 30 g, Nuzhenzi 30 g, Taizishen 30 g, Tengligen 15 g, Tianhuafen (Trichosanthes root) 15 g, Danshen 15 g, Ejiao 10 g, Baizhu 10 g, Ganchan (dried toad) 6 g, Sanqi powder 6 g. Xihuang Pills were also taken twice daily, 3 g each time. The patient was told to make his own toad oil for stir-frying.

After 45 doses, the prescription was adjusted: Taizishen 30 g, Baihuasheshecao 30 g, Banzhilian 30 g, Bai Shiying (Quartz album) 30 g, Longkui 30 g, Nuzhenzi 30 g, Hanliancao 30 g, Guiban (Turtle plastron) 30 g, Sheng Biejia 30 g, Shengmuli 30 g, Chenpi 10 g, Gancao 10 g, Fulin 10 g, Ejiao 10 g.

Treatment continued until August 12, 1986, when re-examination showed no obvious space-occupying liver lesion, and liver function and platelets were normal. Thereafter he drank a decoction as tea to prevent recurrence: Longkui 30 g, Baihuasheshecao 30 g, Xiakucao 15 g, Chenpi 10 g, Gancao 10 g.

Four years of follow-up showed no recurrence; the patient felt generally well, with occasional mild stomach pain relieved by Liujunzi Decoction combined with Zuojin Pill.

Case three: Xiao, male, 57, a worker. First seen by Dr. Wan on July 18, 1985. During a prior hospital stay, B-ultrasound and CT had both shown a liver space-occupying lesion, clinically diagnosed as primary hepatocellular carcinoma. Exploratory laparotomy confirmed a tumor in the left hepatic lobe without invasion of the porta hepatis; he was discharged after ligation of the left hepatic artery and chemotherapy, then sought TCM treatment.

The patient felt dull hypochondriac pain, mild abdominal distension, two or three bowel movements daily, dark urine, teeth-marked tongue, wiry fine pulse, and ascites. Dr. Wan diagnosed accumulation and binding of damp-heat toxin, dysfunction of liver and spleen, congealed phlegm and blood stasis forming masses, and internal retention of water-dampness. He decided to treat by clearing heat and draining dampness, fortifying the spleen and promoting diuresis, and resolving toxin and masses.

Initial prescription: Taizishen 15 g, Huzhang 15 g, Tengligen 15 g, Xiakucao 15 g, Bai Shiying 15 g, Longkui 15 g, Guiban 15 g, Sheng Biejia 15 g, Shengmuli 15 g, Baihuasheshecao 30 g, Banbianlian (Lobelia) 30 g, Chen Hulu (dried gourd) 30 g, Chishao 10 g, Baishao 10 g, Danggui 10 g, Baizhu 10 g, Dafupi (Pericarpium Arecae) 10 g. The patient was told to make toad oil according to Dr. Wan's method for stir-frying.

After 60 doses, re-examination showed no ascites and no lower-extremity edema. Dr. Wan removed water-draining herbs such as Chen Hulu and Yiyiren, and added Nuzhenzi and Sheng Huangqi (raw Astragalus) to nourish yin and boost qi. Another 60 doses were taken. The patient took medicine intermittently for 2 years and 10 months, and his strength returned to normal.

These patients treated by Dr. Wan all had typical clinical signs of liver cancer. He basically followed the same treatment approach, emphasizing clearing heat and draining dampness, resolving toxin and dispersing nodules, and fortifying the spleen and promoting diuresis, and he always urged patients to prepare toad oil for dietary therapy, with good results. His approach has much worth learning.