3.3 Traditional Chinese Medicine's Understanding of Treatment Principles for Liver Cancer

3.3 Traditional Chinese Medicine's Understanding of Treatment Principles for Liver Cancer

The "Plain Questions" states: "For major accumulations and clusters... reduce them by half and stop," thus first proposing the treatment principle of combining attack and support. The "Secret Essentials of the Outer Court" also suggested using methods such as activating blood circulation and removing stasis, softening hard masses and dispersing nodules, and warming and dispersing with pungent flavors. Medications like Achyranthes bidentata, turtle plastron, Asarum sieboldii, and Ligusticum chuanxiong were found to be quite effective. During the Yuan dynasty, Zhu Zhenheng opposed the use of purgatives, advocating instead for removing stasis, strengthening the spleen, and resolving phlegm, while emphasizing that after removing the lump, "large tonics should be used to reinforce the body." These insights provided valuable experience for later generations of physicians. Li Zhongzi's "Essential Readings on Medical Classics" states: "In the early stages, when the disease just begins and the righteous qi is still strong while the pathogenic qi is still shallow, one can focus on attacking; in the middle stages, when the disease has persisted longer and the pathogenic qi is deeper while the righteous qi is weaker, one should both attack and support; in the final stages, when the disease has lasted a long time and the pathogenic qi has overwhelmed the righteous qi, one should focus on supporting." In other words, the method of attack and support should be adjusted according to the course of the disease. During the Qing dynasty, some physicians also pointed out that strengthening the spleen and stomach could help eliminate accumulation by bolstering qi and blood. The treatment principles of physicians throughout history have helped clear the fog surrounding the treatment of liver cancer, demonstrating good efficacy through syndrome differentiation and individualized treatment.

In recent years, various traditional Chinese medicines and herbal formulas have achieved good results in treating liver cancer, all employing methods such as activating blood circulation and removing stasis, softening hard masses and dispersing nodules, and clearing heat and detoxifying. Modern research has further revealed their specific mechanisms: inhibiting tumor angiogenesis, promoting apoptosis of cancer genes, reversing precancerous lesions, directly killing liver cancer cells, preventing metastasis and recurrence, and enhancing the body's immunity.

3.3.1 Traditional Chinese Medicines Can Enhance the Body's Immunity

Tumors often occur when the body's immune system is disrupted or deficient. The immune system—especially cellular immunity—is closely linked to the occurrence, development, metastasis, and recurrence of tumors. Therefore, enhancing the body's immunity has become a major advantage of traditional Chinese medicines in fighting tumors. Modern research shows that many traditional Chinese medicines activate the immune functions of B lymphocytes, T lymphocytes, NK cells, macrophages, and dendritic cells, and can also promote the production of numerous cytokines such as IFN, IL-1, IL-2, and TNF, collectively exerting anti-tumor effects. For example, studies on Astragalus, ginseng, and Aconitum carmichaelii have shown that astragalus polysaccharides increase TNF-α activity; ginsenosides enhance the cytotoxicity of NK cells, promote apoptosis, induce DNA fragmentation, stimulate the production of apoptotic protein Bax, and thus promote tumor cell apoptosis; Aconitum carmichaelii can also stimulate T-cell proliferation. Herbal formulas are even more effective: Li Qing and others discovered that the mechanism of Shenqi Heji involves significantly inducing apoptosis in H22 tumor-bearing mice, while simultaneously enhancing the cytotoxic activity of macrophages and NK cells, promoting the production of cytokines such as IL-12, and thus exerting anti-tumor effects. In essence, these measures all aim to enhance the body's immunity, prevent tumor formation, inhibit tumor growth, metastasis, and recurrence, reduce the side effects of radiotherapy and chemotherapy, and greatly improve quality of life.

3.3.2 Traditional Chinese Medicines Can Induce Apoptosis in Liver Cancer Cells or Directly Kill Cancer Cells

Apoptosis refers to the programmed death of cells, a process controlled by multiple genes. Many traditional Chinese medicines participate in inducing apoptosis. Modern research shows that Semen Sophorae Flavescentis, Sophora flavescens, and Sophora tonkinensis can regulate the expression of apoptosis-related proteins such as Bax, Bcl-2, Caspase, p53, and p21, thereby inducing cancer cell death. Si Weike observed that sophoridine induces apoptosis in cancer cells and found that cytokines P27, P53, and P16 are upregulated, while cyclin D1 is downregulated, illustrating sophoridine's mechanism in inducing liver cancer cell apoptosis. Zhang Xia discovered that traditional Chinese medicines cause cancer cells to shrink, chromatin to fragment, and cell cycles to be blocked, ultimately leading to apoptosis. Yan and others found that resveratrol causes tumor cells to exhibit nuclear shrinkage, nuclear condensation, and nuclear fragmentation—characteristic features of apoptosis. Huang Renmin and others experimented with 0.5 μg/mL of tanshinone IIA, which induced maturation of NB4 and HL-60 cells in vitro and subsequently triggered apoptosis. Bee venom can also upregulate Fas mRNA and Fas protein expression in liver cancer cells, as well as mitochondrial membrane protein expression. Additionally, pearl ginseng can block DNA synthesis during the S phase of cancer cells; curcumin induces subdiploid apoptosis peaks in cancer cells; and the higher the concentration of ginsenoside diol, the easier it is to inhibit cancer cells at the G1/S phase. Moreover, various herbal formulas studied in the literature, such as Zhao Xiaoqin's compound Solanum nigrum syrup, Li Xiurong's anti-tumor and metastasis-reducing formula, and Li Dongtao's qi-tonifying, blood-activating, hard-mass-softening, and detoxifying formula, each have different effects in inducing apoptosis in liver cancer cells. Traditional Chinese medicine also plays an important role in directly killing cancer cells. For example, medicinal herbs such as toad venom, American ginseng, Scutellaria barbata, Hedyotis diffusa, and Sophora flavescens have been shown through numerous experimental studies by scholars to directly inhibit the proliferation of cancer cells. Toad venom exhibits cytotoxic effects, upregulating the expression of the P21 gene while downregulating the expression of PCNA, or proliferating cell nuclear antigen, thereby exerting a killing effect on liver cancer cells. The mechanism by which American ginseng kills cancer cells lies in blocking tumor cell proliferation at the S phase and altering the properties of the extracellular matrix, leading to direct damage to the cell membrane. Hedyotis diffusa can downregulate the expression of Bcl-2 and mutant P53 protein, regulate the synthesis of Cyclin D1 cell cycle protein, thereby inhibiting cancer cell proliferation. Furthermore, Cheng Xiangdong et al. found that matrine, when applied to HepG2 cells, induces HepG2 cell apoptosis in a dose-dependent manner, downregulating Bcl-2 gene expression in a time-dependent manner, degrading caspase-9 and caspase-3, and increasing the expression of Bax gene. Thus, matrine promotes the hydrolytic cascade reaction of caspase-3 and caspase-9 by upregulating the expression of Bcl-2 and Bax proteins in cells, ultimately leading to HepG2 cell apoptosis. Scutellaria barbata also exerts a killing effect, promoting the differentiation of cancer cells toward maturity. Deng et al. discovered that brucine causes mitochondrial membrane depolarization in HepG2 cells, reduces Cox-2 (intracellular cyclooxygenase-2) levels, and increases caspase-3 levels, thereby inducing apoptosis in HepG2 cells.