Case 1

Case 1

Mr. Zhang, a 56-year-old man, visited the clinic in January 1996 due to “pain in the liver area accompanied by abdominal discomfort and poor appetite.” Physical examination revealed a gaunt physique, slight jaundice of the skin and sclera, normal cardiac and pulmonary function, a slightly distended abdomen, a liver size of 4 cm below the xiphoid process, firm texture, uneven surface, ascites (+), a spleen not palpable below the rib cage, a pale red tongue with a yellowish, greasy coating, and a tense, wiry pulse. Ultrasound imaging showed a 5.0 cm × 4.2 cm mass in the left lobe of the liver, likely indicative of liver cancer. Liver function tests revealed total bilirubin levels of 18 μmol/L, a turbid reaction to cresol of 6 u, alanine aminotransferase levels of 45 u, total protein levels of 59 g/L, and a white-to-globulin ratio of 1.2:1. Alpha-fetoprotein levels were 400 ng/L. Western medical diagnosis: primary liver cancer; TCM syndrome differentiation: liver qi stagnation, liver wood overcoming earth. Treatment was prescribed to soothe the liver and strengthen the spleen, using Chaihu Shu Gan San with modifications: 10g of chaihu, 10g of white peony, 10g of citrus aurantium, 6g of licorice, 6g of chuanxiong, 6g of fragrant ligusticum, 6g of green tangerine peel, 30g of salvia miltiorrhiza, 10g of astragalus, 10g of honghu, 15g of sea lettuce, 10g of kelp, 10g of turtle shell, 3g of wood fragrance, 3g of grass cardamom—all brewed in water and taken daily, divided into doses. After 14 doses, his appetite and abdominal discomfort eased. However, he still felt pain in the liver area, so the original formula was adjusted by removing wood fragrance, grass cardamom, turtle shell, and turtle shell, adding 10g of sanleng, 10g of oshiro, 10g of turmeric, and 3g of prepared milk vetch. After 20 doses, the liver pain subsided, though he still experienced discomfort in the liver area and abdomen. His overall condition remained mildly jaundiced, his tongue was pale red, coated with yellow grease, and his pulse was tense. The formula was further modified by removing turmeric and prepared milk vetch, adding 30g of processed coptis root, 10g of chicken gallbladder, and after 20 doses, ultrasound imaging showed a 3.0 cm × 2.4 cm mass in the left lobe of the liver—larger than before, but smaller than before. Liver function tests also returned to normal.