Appreciation of Professor Yin Huihe's Case in Treating Postoperative Jaundice following Liver Cancer Surgery

The patient, Mr. Meng, a 40-year-old male with liver cancer, first visited the clinic on June 8, 1992. That January, the patient had undergone a partial resection of the right lobe of the liver through a combined thoracoabdominal incision at a certain hospital; postoperative pathology revealed liver cancer. After surgery, right-sided pleural effusion persisted continuously, requiring 250 ml of pleural fluid to be drained each day; the fluid was dark yellow, accompanied by edema of both lower limbs, distending discomfort in the liver region, low-grade fever of 37.5–37.8°C, and four to five bowel movements daily. Western medicine diagnosed postoperative jaundice due to liver cancer. When he came to seek treatment from Elderly Yin, the tongue was red with a slightly yellowish coating, and the pulse was wiry and fine. Elderly Yin differentiated the pattern as stasis and accumulation in the Liver channel, and treated it with a protocol of coursing the liver and dispersing nodules, together with clearing heat and resolving toxicity.

Initial prescription: Chaihu (Bupleurum) 12g, Danggui (Angelica Sinensis Radix) 30g, Chishao (Red Peony) 30g, Sheng Muli (raw Oyster Shell) 60g [decoct first], Taoren (Peach Kernel) 12g, Yujin (Curcuma) 15g, Chuanlianzi (Toosendan Fruit) 15g, Chuan Beimu (Fritillary Bulb) 10g, Xuanshen (Scrophularia) 15g, Zelan (Lycopus) 15g, Yinchen (Capillary Wormwood) 30g, Zhizi (Gardenia) 12g, Digupi (Lycium Bark) 15g, Huangbai (Phellodendron) 15g, Qinghao (Sweet Wormwood) 15g, Sheng Shigao (raw Gypsum) 45g [decoct first], Tu Fuling (Glabrous Greenbrier) 30g, Tu Beimu (Bolbostemma) 15g, Baihua Shezhecao (Oldenlandia) 60g, Banzhilian (Scutellaria Barbata) 30g, Banbianlian (Lobelia) 15g, Jinqiancao (Coin Grass) 30g.

Second visit, June 18, 1992. The condition had improved, the jaundice had lessened, appetite was acceptable, and the edema was worse in the afternoon (the author's note: most patients with pleural or ascitic fluid are worse in the afternoon and better in the morning). An outside hospital's X-ray showed that the pleural effusion had been absorbed, with pleural adhesion. The tongue and pulse were as before; because the original formula was effective, the principle of "when effective, do not change the formula" was followed.

Third visit, August 17, 1992. The condition had improved; the jaundice had completely subsided. There was pain in the liver region, mild edema of the lower limbs, and three to four bowel movements daily. The patient requested that the herbs be made into pills for long-term use.

Prescription: Chaihu 100g, Chishao 300g, Danggui 300g, Sheng Muli 300g, Yujin 150g, Taoren 120g, Chuanlianzi 150g, Tubiechong (Eupolyphaga) 120g, Chuan Beimu 100g, Xuanshen 150g, Haizao (Sargassum) 150g, Kunbu (Ecklonia) 150g, Haifushi (Pumice) 180g, Tu Fuling 300g, Tu Beimu 150g, Baihua Shezhecao 300g, Banzhilian 300g, Banbianlian 300g. The above were ground together into powder and made into honey pills, each pill weighing 10g; taken twice daily, three pills each time.

Fourth visit, July 26, 1993. Apart from occasional pain in the right rib-side, the symptoms had basically disappeared, and liver function and serum bilirubin were normal. A repeat B-ultrasound on July 23, 1993 showed that the liver was not enlarged in shape, with coarse and uneven internal echoes, small echo nodules on the surface, and a relatively large left lobe, consistent with cirrhotic changes. The tongue was red with a slightly yellowish coating, and the pulse was wiry and fine. Elderly Yin decided to continue treatment with coursing the liver, resolving toxicity, and dispersing nodules to consolidate the effect.

Prescription: Chaihu 10g, Danggui 30g, Chishao 30g, Sheng Muli 60g [decoct first], Yujin 15g, Taoren 10g, Chuanlianzi 15g, Tubiechong 12g, Pugongying (Dandelion) 30g, Huzhang (Reynoutria) 30g, Baihua Shezhecao 60g, Banzhilian 30g, Banbianlian 15g, Tu Fuling 30g, Tu Beimu 15g, Xiakucao (Selfheal) 15g, Haizao 15g, Kunbu 15g, Haifushi 18g [decoct first].

In this case of Elderly Yin, the decoction was not marked with how long one dose was to be taken; according to Elderly Yin's prescribing habit, one package of herbs was generally taken over one day. If this was the daily dosage, the amounts of many of the herbs in this formula were quite large; many patients with a weak spleen and stomach could not tolerate such large doses. Therefore, patients must not misuse other people's prescriptions to treat their own diseases; they should consult an experienced physician and adjust the formula according to their own condition before taking Chinese medicine. The author is here only analyzing Elderly Yin's approach to treating disease, and does not advise patients to use the formula as written.

Elderly Yin's prescribing thinking never strayed from a modified Xiaoluo Wan (Scrofula-Dispersing Pill: Xuanshen, Beimu, Sheng Muli, Haizao, Kunbu). Xiaoluo Wan is a classic famous formula for softening hardness and dispersing nodules, created by the renowned Qing-dynasty physician Cheng Zhongling and recorded in his work *Medical Mind Awakening (Yixue Xinwu)*. Later generations of physicians, building on this formula, added herbs that clear heat, resolve toxicity, and fight cancer and disperse nodules; then, combining the approach of TCM pattern differentiation, they added corresponding herbs according to the patient's clinical symptoms to form anti-cancer TCM formulas.

At the first visit, based on the patient's jaundice, Elderly Yin heavily used Yinchen, Jinqiancao, Zhizi, and other TCM herbs that treat jaundice, and used Chaihu, Danggui, Chishao, Chuanlianzi, and others to treat the subcostal pain caused by liver stasis and qi stagnation. He then added anti-cancer herbs such as Banzhilian, Banbianlian, and Baihua Shezhecao, together with a modified Xiaoluo Wan. This constituted an anti-cancer formula that treated both the branch and the root. At the second visit, following the principle "when effective, do not change the formula," he did not adjust the prescription.

By the third visit, at the patient's request, the decoction was changed to pills for gentle, slow treatment, treating cancer as a chronic disease and slowly regulating the body. The prescribing thinking still followed the principle of combining disease differentiation with pattern differentiation: he selected Chaihu-series formulas to course the liver and resolve depression, used a modified Xiaoluo Wan to dissipate phlegm and disperse nodules, and again applied large quantities of commonly used anti-cancer Chinese medicines. In this way, with gentle pill treatment lasting over a year, the formula was never changed. By the fourth visit, the patient's condition was already very good, and treatment was switched back to a decoction.

The appearance of pleural effusion together with lower-limb edema after surgery in a liver-cancer patient indicates that the complications were already quite serious. If an effective treatment could not be adopted, the patient's quality of life would be very poor and life itself would be seriously threatened. With a prudent and steady prescribing approach and patient, careful adjustment and treatment, Elderly Yin achieved an unexpected therapeutic effect.

The solid tumor in this patient had already been surgically removed; such postoperative patients enjoy certain advantages when treated with Chinese medicine. Elderly Yin did not use too many "attack poison with poison" or anti-cancer, swelling-dispersing herbs, also because the solid tumor in the patient's body had already been surgically cleared. If a tumor still remained in the patient's body, Elderly Yin would have considered using tumor-dissolving Chinese medicines such as Sanleng (Sparganium), Ezhu (Curcuma Rhizome), or Banmao (Mylabris). Therefore, those who learn from this case should also make corresponding adjustments according to the specific patient's condition; do not rigidly copy the thinking of predecessors, otherwise you will not cure the disease.