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Damage to liver function
All types of radiotherapy and chemotherapy can damage the liver function. The hepatic cells can become inflamed, although the mechanism is not the same as in viral hepatitis. Radiation can cause swelling and detachment of the vascular endothelial cells and deposi-tion of fibrin in the vascular lumen, resulting in stenosis, obstruction and portal hyperten-sion, especially in the venous system. Disturbance of blood circulation in the liver prevents normal nourishment of the tissue and has the secondary effect of causing liver atrophy, necrosis, and destruction of the hepatic lobules. Some anti-cancer drugs may induce hepatic cell necrosis and inflammation, and in the long run lead to fatty degeneration, granuloma formation, eosinophil infiltration, and fibrosis. Methotrexate, chlorambucil and 6-mercaptopurine can cause toxic hepatitis and cholestasis. Cytarabine and nitrosourea may induce a temporary increase in transaminase. In addition, long-term use of methotrexate can result in liver fibrosis and eventually cir-rhosis, particularly after long-term administration of small doses or intravenous or hepatic arterial injection of a relatively large dose, which may extend the half-life of the drug in the peripheral blood. All these pathological changes will damage the liver function. Etiology and pathology
Pathogenic Toxins, Heat and Dryness damage the Liver and impair its function of ensuring the smooth flow of Qi. Disharmony between the upward and downward movement of Qi leads to Liver Qi stagnation with symptoms such as distension in the hypochondrium and pain in the area of the liver. Enduring stagnation of Liver Qi will impair the Spleen’s transportation and transformation function and cause Spleen and Stomach Deficiency and internal generation of Damp-Heat with symptoms such as abdominal distension, diarrhea and fatigue. Liver Qi stagnation also may lead to the impairment of blood circulation, re-sulting in Blood stasis manifesting as a dark purple tongue body, sometimes with stasis marks, and a soot-black or somber facial complexion. Clinical manifestations
In most cases, onset is acute and the course of the condition relatively short. Recovery generally takes place soon after suspension of drug administration, although recovery from radiation hepatitis is slower. Jaundice may occur in some patients, accompanied by nausea, abdominal distension, diarrhea, fatigue, and pain in the liver area. The tongue body is purple with stasis marks or dark red; the pulse is wiry or wiry and thready. In a minority of cases, severe symptoms involving the digestive tract occur, including ascites and hemorrhage, which can progress to hepatic coma (hepatic encephalopathy) and finally death due to liver failure. Laboratory examinations show abnormality of liver functions, such as transitory elevation of serum transaminase and an increase in Pattern identification and
alkaline phosphatase (ALP) and gamma-glutamyl treatment principles
QI STAGNATION
General treatment methods
Main symptoms and signs
Since the Liver stores the Blood and governs the Pan in the area of the liver, and distension and dis- smooth flow of Qi, the treatment of liver diseases comfort in the hypochondrium. The tongue is should be aimed at treating the Blood, especially in normal and the pulse is wiry. If Qi stagnation cases of damage to the liver function caused by transforms into Heat, the tongue body is red with a radiotherapy or chemotherapy. The main treatment principles are emolliating the Liver, nourishing the Blood and regulating Qi, supported by clearing Treatment principle
Commonly used materia medica include
Soothe the Liver and relieve Depression, emolliate Dang Gui (Radix Angelicae Sinensis) Dan Shen (Radix Salviae Miltiorrhizae) Prescription
Bai Shao (Radix Paeoniae Lactiflorae) CHAI HU SHU GAN SAN HE SI WU TANG
Sheng Di Huang (Radix Rehmanniae Glutinosae) Huang Qi (Radix Astragali seu Hedysari) Bupleurum Powder for Dredging the Liver Com- bined With Four Agents Decoction, with modifica- Pu Gong Ying (Herba Taraxaci cum Radice) Huang Qin (Radix Scutellariae Baicalensis) Ji Nei Jin‡ (Endothelium Corneum Gigeriae Galli) Jiang Huang (Rhizoma Curcumae Longae) 10g Bai Hua She She Cao (Herba Hedyotidis Diffusae) Gan Cao (Radix Glycyrrhizae) 6g Huang Qin (Radix Scutellariae Baicalensis) 10g Commonly used acupuncture points include
Xiang Fu (Rhizoma Cyperi Rotundi) 10g Dang Gui (Radix Angelicae Sinensis) 10g Bai Shao (Radix Paeoniae Lactiflorae) 15g Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Chuan Xiong (Rhizoma Ligustici Chuanxiong) 6g Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 10g Chuan Lian Zi (Fructus Meliae Toosendan) 10g Explanation
functional activities of Qi in the Upper, Middle Chai Hu (Radix Bupleuri) dredges the Liver and and Lower Burners to invigorate the Blood and Huang Qin (Radix Scutellariae Baicalensis) clears Heat.
SPLEEN DEFICIENCY
Xiang Fu (Rhizoma Cyperi Rotundi), Yu Jin (Radix Curcumae) and Jiang Huang (Rhizoma Main symptoms and signs
Curcumae Longae) move Qi and invigorate the Lack of strength, abdominal distension, diarrhea, and poor appetite. The tongue body is dark or pale Dang Gui (Radix Angelicae Sinensis), Bai Shao red with a greasy coating; the pulse is wiry and (Radix Paeoniae Lactiflorae), Gan Cao (Radix Glycyrrhizae), and Sheng Di Huang (Radix Reh-manniae Glutinosae) emolliate the Liver and Chuan Xiong (Rhizoma Ligustici Chuanxiong), Treatment principle
Yan Hu Suo (Rhizoma Corydalis Yanhusuo) and Fortify the Spleen and augment Qi, harmonize the Chuan Lian Zi (Fructus Meliae Toosendan) in- Prescription
BU ZHONG YI QI TANG HE SI JUN ZI

Modification
TANG JIA JIAN
For Qi stagnation transforming into Heat, add Mu Decoction for Supplementing the Middle Burner Dan Pi (Cortex Moutan Radicis) 10g and Zhi Zi and Augmenting Qi Combined With Four Gentle- Huang Qi (Radix Astragali seu Hedysari) 30g Bai Zhu (Rhizoma Atractylodis Macrocephalae) 15g Treatment principle
Chen Pi (Pericarpium Citri Reticulatae) 6g Soothe the Liver and relieve Depression, emolliate the Liver and nourish the Blood, regulate Qi and Dang Shen (Radix Codonopsitis Pilosulae) 15g Gan Cao (Radix Glycyrrhizae) 6g Dang Gui (Radix Angelicae Sinensis) 10g Points: BL-18 Ganshu, LR-3 Taichong, PC-6
Fu Ling (Sclerotium Poriae Cocos) 15g Neiguan, LR-14 Qimen, CV-17 Danzhong, and Sha Ren (Fructus Amomi) 6g, added 10 minutes Technique: Use filiform needles and apply the
Chao Ji Nei Jin‡ (Endothelium Corneum Gigeriae even method. Retain the needles for 20-30 minutes. Galli, stir-fried) 10g Shen Qu (Massa Fermentata) 30g Explanation
Shan Yao (Rhizoma Dioscoreae Oppositae) 30g x Combining BL-18 Ganshu and LR-14 Qimen, the back-shu and front-mu points related to the Explanation
Liver, with LR-3 Taichong, the yuan (source) Si Jun Zi Tang (Four Gentlemen Decoction [Bai point of the Liver channel, soothes the Liver, Zhu (Rhizoma Atractylodis Macrocephalae), relieves Depression and nourishes the Blood. Gan Cao (Radix Glycyrrhizae), Fu Ling (Scle- x PC-6 Neiguan loosens the chest and regulates rotium Poriae Cocos), and Dang Shen (Radix Codonopsitis Pilosulae)]), Huang Qi (Radix As- x CV-17 Danzhong and CV-6 Qihai regulate the tragali seu Hedysari) and Shan Yao (Rhizoma Dioscoreae Oppositae) fortify the Spleen and BLOOD STASIS
Main symptoms and signs: stabbing pain in the liver Chai Hu (Radix Bupleuri) uplifts Yang Qi. area, a soot-black facial complexion, purple lips, Dang Gui (Radix Angelicae Sinensis), Sha Ren hepatomegaly, and dry and scaling skin. The tongue (Fructus Amomi), Chao Ji Nei Jin‡ (Endothelium body is dark red with stasis marks; the pulse is wiry Corneum Gigeriae Galli, stir-fried), and Shen Qu (Massa Fermentata) harmonize the Blood and nourish the Stomach. Treatment principle
Chen Pi (Pericarpium Citri Reticulatae) regulates Dredge the Liver and regulate Qi, invigorate the Modification
For severe diarrhea, add Wei Ge Gen (Radix Puer- Prescription
ariae, roasted in fresh cinders) 30g, Mu Xiang* XIAO YAO SAN HE GE XIA ZHU YU TANG
(Radix Aucklandiae Lappae) 6g and Huang Lian Free Wanderer Powder Combined With Decoction for Expelling from Blood Stasis from Below the Treatment principle
Fortify the Spleen, augment Qi, harmonize the Dang Gui (Radix Angelicae Sinensis) 10g Stomach, supplement the Middle Jiao, and nourish Chi Shao (Radix Paeoniae Rubra) 10g Bai Shao (Radix Paeoniae Lactiflorae) 10g Dan Shen (Radix Salviae Miltiorrhizae) 30g Points: BL-20 Pishu, BL-21 Weishu, ST-36 Zusanli,
CV-12 Zhongwan, ST-25 Tianshu, and LR-13 Chuan Xiong (Rhizoma Ligustici Chuanxiong) 6g Mu Dan Pi (Cortex Moutan Radicis) 10g Technique: Use filiform needles and apply the re-
Hong Hua (Flos Carthami Tinctorii) 6g, infused separately inforcing method. Retain the needles for 20-30 Xiang Fu (Rhizoma Cyperi Rotundi) 10g minutes. Select two or three points each time to Qing Pi (Pericarpium Citri Reticulatae Viride) 6g Chen Pi (Pericarpium Citri Reticulatae) 6g Yu Jin (Radix Curcumae) 10g Explanation
x Combining BL-20 Pishu, BL-21 Weishu, LR-13 San Qi Fen (Pulvis Radicis Notoginseng) 6g, infused Zhangmen and CV-12 Zhongwan, the back-shu and front-mu points related to the Spleen and Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 10g Stomach, fortifies the Spleen and boosts the Bie Jia* (Carapax Amydae Sinensis) 15g, decocted Stomach, supplements Qi and nourishes the for 30 minutes before adding the other ingredients x ST-25 Tianshu, the front-mu point of the Large Explanation
Intestine channel, regulates Qi, disperses disten- Xiao Yao San (Free Wanderer Powder) dredges the Liver and regulates Qi. Ge Xia Zhu Yu Tang x ST-36 Zusanli is a key point for strengthening (Decoction for Expelling Blood Stasis from the body; it supplements the Middle Jiao and Below the Diaphragm) invigorates the Blood and disperses Blood stasis. When Qi and Blood circulate smoothly and are in harmony, the x CV-17 Danzhong regulates Qi to assist the Chai Hu (Radix Bupleuri), Xiang Fu (Rhizoma Cyperi Rotundi), Qing Pi (Pericarpium Citri Re- DAMP-HEAT
ticulatae Viride), Chen Pi (Pericarpium Citri Re-ticulatae), and Yu Jin (Radix Curcumae) dredge Main symptoms and signs
Jaundice, accompanied by a bright yellow facial Chi Shao (Radix Paeoniae Rubra), Bai Shao complexion, abdominal distension and yellow urine. (Radix Paeoniae Lactiflorae), Dang Gui (Radix The tongue body is red with a yellow coating; the Angelicae Sinensis), Dan Shen (Radix Salviae Miltiorrhizae), Chuan Xiong (Rhizoma Ligustici Chuanxiong), Mu Dan Pi (Cortex Moutan Treatment principle
Radicis), Hong Hua (Flos Carthami Tinctorii), E Clear Heat, benefit the movement of Dampness Zhu (Rhizoma Curcumae), and San Qi Fen (Pulvis Radicis Notoginseng) invigorate the Blood and dissipate Blood stasis. Yan Hu Suo (Rhizoma Corydalis Yanhusuo) Prescription
YIN CHEN HAO TANG JIA JIAN
Bie Jia* (Carapax Amydae Sinensis) softens Oriental Wormwood Decoction, with modifications Gan Cao (Radix Glycyrrhizae) regulates and Yin Chen Hao (Herba Artemisiae Scopariae) 30g harmonizes the properties of the other ingre- Zhi Zi (Fructus Gardeniae Jasminoidis) 10g Note: Bie Jia* (Carapax Amydae Sinensis) may be
Jiang Huang (Rhizoma Curcumae Longae) 10g replaced by Jiang Can‡ (Bombyx Batryticatus) 10g or Jin Qian Cao (Herba Lysimachiae) 30g Gou Teng (Ramulus Uncariae cum Uncis) 15g. Chi Shao (Radix Paeoniae Rubra) 10g Da Huang (Radix et Rhizoma Rhei) 10g Gan Cao (Radix Glycyrrhizae) 6g Che Qian Zi (Semen Plantaginis) 10g, wrapped Treatment principle
Mu Dan Pi (Cortex Moutan Radicis) 10g Dredge the Liver and regulate Qi, invigorate the Da Fu Pi (Pericarpium Arecae Catechu) 10g Explanation
Points: BL-18 Ganshu, BL-17 Geshu, LR-14 Qimen,
SP-6 Sanyinjiao, LR-3 Taichong, and CV-17 Dan-
Yin Chen Hao (Herba Artemisiae Scopariae), Zhi Zi (Fructus Gardeniae Jasminoidis) and Jin Qian Cao (Herba Lysimachiae) clear Heat, benefit the Technique: Use filiform needles and apply the
movement of Dampness and abate jaundice. even method. Retain the needles for 20-30 minutes. Yu Jin (Radix Curcumae) and Jiang Huang (Rhi- Apply cupping therapy over needles at the back-shu zoma Curcumae Longae) invigorate the Blood Chi Shao (Radix Paeoniae Rubra) and Mu Dan Pi Explanation
(Cortex Moutan Radicis) clear Heat and cool Taichong soothe the Liver and regulate Qi. Che Qian Zi (Semen Plantaginis) and Da Fu Pi x BL-17 Geshu and SP-6 Sanyinjiao invigorate (Pericarpium Arecae Catechu) drain Heat and Da Huang (Radix et Rhizoma Rhei) clears Heat Prescription
DANG GUI LIU HUANG TANG JIA JIAN
Gan Cao (Radix Glycyrrhizae) regulates and Chinese Angelica Root Six Yellows Decoction, with harmonizes the properties of the other ingre- Dang Gui (Radix Angelicae Sinensis) 10g Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g Modification
Shu Di Huang (Radix Rehmanniae Glutinosae Con- For pain in the liver area, add Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 10g and Chuan Lian Zi (Fruc- Huang Qin (Radix Scutellariae Baicalensis) 10g Huang Bai (Cortex Phellodendri) 6g Huang Qi (Radix Astragali seu Hedysari) 15g Xiao Hui Xiang (Fructus Foeniculi Vulgaris) 6g Yu Jin (Radix Curcumae) 10g Treatment principle
Clear Heat, benefit the movement of Dampness Dan Shen (Radix Salviae Miltiorrhizae) 15g Points: BL-19 Danshu, BL-20 Pishu, SP-9
Pu Gong Ying (Herba Taraxaci cum Radice) 30g Yinlingquan, GB-34 Yanglingquan, CV-3 Zhongji, Wu Wei Zi (Fructus Schisandrae) 15g Bai Hua She She Cao (Herba Hedyotidis Diffusae) 30g Technique: Use filiform needles and apply the
reducing method. Retain the needles for 20-30 min-
Explanation
Dang Gui (Radix Angelicae Sinensis), Sheng Di Huang (Radix Rehmanniae Glutinosae) and Shu Explanation
Di Huang (Radix Rehmanniae Glutinosae Con- x BL-18 Ganshu, BL-19 Danshu, GB-34 Yang- quita) emolliate the Liver and nourish the lingquan, and GB-40 Qiuxu dredge the Liver and abate jaundice by promoting the flow of Yu Jin (Radix Curcumae) and Chai Hu (Radix Bupleuri) dredge the Liver and regulate Qi. x BL-20 Pishu, SP-9 Yinlingquan and CV-3 Huang Qin (Radix Scutellariae Baicalensis), Zhongji clear Heat and benefit the movement Huang Bai (Cortex Phellodendri), Pu Gong Ying (Herba Taraxaci cum Radice), and Bai Hua She She Cao (Herba Hedyotidis Diffusae) clear Heat and relieve Toxicity. ASYMPTOMATIC INCREASE IN
Dan Shen (Radix Salviae Miltiorrhizae) invigo- TRANSAMINASE LEVELS
Main symptoms and signs: none obvious.
Wu Wei Zi (Fructus Schisandrae) and Huang Qi(Radix Astragali seu Hedysari) augment Qi and constrain Yin. Xiao Hui Xiang (Fructus Foeniculi Vulgaris) Treatment principle
Emolliate the Liver and nourish the Blood, clear Gan Cao (Radix Glycyrrhizae) regulates and har- monizes the properties of the other ingredients. Experimental studies
A, B and C contained in Wu Wei Zi (Fructus Schisandrae) limited the increase in ALT in-duced by liver damage during in vitro trials.50 EFFECT ON LIVER FUNCTION
Modern pharmacological studies indicate that a EFFECT ON GALLBLADDER FUNCTION
number of Chinese materia medica are very effec- Certain Chinese materia medica are also effective in tive in protecting the liver function by inhibiting an normalizing the function of the Gallbladder. increase in transaminases and preventing a decrease San Ke Zhen (Radix Berberidis) reduces tension in the gallbladder, limits the number of contrac- Gan Cao (Radix Glycyrrhizae) inhibits alanine tions and increases the volume of bile flow51 transaminase (ALT) and aspartate transaminase Da Huang (Radix et Rhizoma Rhei) increases the volume of bile flow, strengthens contractility of Long Dan Cao (Radix Gentianae Scabrae) pre- the gallbladder and raises the amount of bile Bai Zhu (Rhizoma Atractylodis Macrocephalae) Long Dan Cao (Radix Gentianae Scabrae) in- prevents a decrease in hepatic glycogen and in- creases the volume of bile flow and improves hibits an increase in transaminases and lactic Jin Qian Cao (Herba Lysimachiae) increases the Sheng Di Huang (Radix Rehmanniae Glutinosae) volume of bile flow, enhances the secretion of prevents a decrease in hepatic glycogen37 Dang Gui (Radix Angelicae Sinensis) prevents a Ban Bian Lian (Herba Lobeliae Chinensis cum decrease in hepatic glycogen and protects Radice) increases the volume of bile flow54 x Hu Zhang (Radix et Rhizoma Polygoni Cuspidati) Lian Qiao (Fructus Forsythiae Suspensae) re- enhances the secretion of bile and reduces ten- duces ALT and enhances recovery of hepatic Jin Yin Hua (Flos Lonicerae) enhances the se- Ling Zhi (Ganoderma) reduces ALT40 Bai Jiang Cao (Herba Patriniae cum Radice) in- Huang Qin (Radix Scutellariae Baicalensis) en- Yin Chen Hao (Herba Artemisiae Scopariae) re-duces ALT, AST and serum bilirubin42 Fu Ling (Sclerotium Poriae Cocos) reduces Clinical observation reports
Hou Po (Cortex Magnoliae Officinalis) reduces SUPPORTING VITAL QI AND DISPELLING
BLOOD STASIS
Chai Hu (Radix Bupleuri) increases secretion of bile and reduces ALT45 Zhou et al. reported on application of the principle
Huang Qi (Radix Astragali seu Hedysari) reduces of supporting Vital Qi (Zheng Qi) and dispelling Blood stasis in treating liver damage due to chemo- Pu Gong Ying (Herba Taraxaci cum Radice) re- Group: 30 patients, 22 male and 8 female, aged
Bo He (Herba Menthae Haplocalycis) reduces from 29 to 70 (mean age: 48); there were 8 patients with cancer of the cardia, 6 with stomach cancer, 4 Nü Zhen Zi (Fructus Ligustri Lucidi) prevents a with lung cancer, 4 with breast cancer, 3 with Hodgkin’s lymphoma, 2 with esophageal cancer, and x In addition, the deoxyschizandrin and gomisin one each with cancer of the rectum, osteosarcoma, and seminoma. Liver damage was evident from the One bag per day was used to prepare a decoction, very high level of alanine transaminase (ALT) and the higher-than-normal levels of alkaline phos-phatase (ALP) and gamma-glutamyl transpeptidase x Pronounced improvement (symptoms disap- Main symptoms: low spirits, a lusterless facial
peared and ALT returned to normal after taking complexion, fatigued limbs, no pleasure in eating, a the decoction for 2-4 weeks) in 23 cases. pale tongue with purple margins or stasis marks and x Some improvement (symptoms disappeared a thin white coating, and a wiry and thready pulse. and ALT returned to normal after taking the decoction for 4-8 weeks) in 3 cases. Empirical prescription ingredients
x No improvement (little or no change in symp- toms and ALT after taking the decoction for 8 Zhi Huang Qi (Radix Astragali seu Hedysari, mix- The average value of ALT before treatment was Chao Dang Shen (Radix Codonopsitis Pilosulae, stir- 153.57 IU/L; this was reduced to 43.7 IU/L after treatment (t = 3.63, P<0.01).
Chao Bai Zhu (Rhizoma Atractylodis Macrocephalae, stir-fried) 9g Discussion
Fu Ling (Sclerotium Poriae Cocos) 9g The authors consider that malignant tumors repre- Shan Yao (Rhizoma Dioscoreae Oppositae) 12g sent a pattern of Vital Qi (Zheng Qi) Deficiency Chen Pi (Pericarpium Citri Reticulatae) 5g and invasion of pathogenic factors. Chemothera- Dang Gui (Radix Angelicae Sinensis) 9g peutic agents are considered as Toxins in TCM and Chi Shao (Radix Paeoniae Rubra) 9g long-term use causes pathogenic Toxins to accu- Chuan Xiong (Rhizoma Ligustici Chuanxiong) 5g mulate in the Liver resulting in the Liver failing to Dan Shen (Radix Salviae Miltiorrhizae) 30g ensure the smooth flow of Qi, the functional activi- ties of Qi being obstructed, and Blood not flowing Hong Hua (Flos Carthami Tinctorii) 6g freely in the vessels, eventually leading to Blood Tu Fu Ling (Rhizoma Smilacis Glabrae) 30g stasis and Toxins fighting and binding, and subse-quently to damage to the Liver. The treatment prin- Modifications
ciple should therefore focus on supporting Vital Qi 1. For stomach distension, Zhi Huang Qi (Radix Astragali seu Hedysari, mix-fried with honey) was removed and Mu Xiang* (Radix Aucklandiae Explanation of prescription
Lappae) 5g, Chao Zhi Ke (Fructus Citri Aurantii, Zhi Huang Qi (Radix Astragali seu Hedysari, stir-fried) 6g and Zhi Ji Nei Jin‡ (Endothelium mix-fried with honey), Chao Dang Shen (Radix Corneum Gigeriae Galli, mix-fried) 4g were Codonopsitis Pilosulae, stir-fried), Chao Bai Zhu (Rhizoma Atractylodis Macrocephalae, stir- 2. For loose stools, Wei Mu Xiang* (Radix Auck- fried), Fu Ling (Sclerotium Poriae Cocos), Shan landiae Lappae, roasted in fresh cinders) 9g and Yao (Rhizoma Dioscoreae Oppositae), and Chen Wei Rou Dou Kou (Semen Myristicae Fragrantis, Pi (Pericarpium Citri Reticulatae) augment Qi roasted in fresh cinders) 6g were added. and fortify the Spleen to support Vital Qi 3. For severe pain in the hypochondrium, Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 9g was added. Dang Gui (Radix Angelicae Sinensis), Chi Shao 4. For jaundice, Yin Chen Hao (Herba Artemisiae (Radix Paeoniae Rubra), Dan Shen (Radix Salviae Scopariae) 15g, Ze Xie (Rhizoma Alismatis Miltiorrhizae), Yu Jin (Radix Curcumae), Chuan Orientalis) 9g and Che Qian Zi (Semen Plan- Xiong (Rhizoma Ligustici Chuanxiong), and Hong Hua (Flos Carthami Tinctorii) invigorate the Blood and dispel Blood stasis; once Blood variously with fever due to extensive necrosis of stasis is removed, new Blood can be generated. cancerous liver tissue and absorption of the tumor, x Large doses of Tu Fu Ling (Rhizoma Smilacis pain in the area of the liver, vomiting, and gastro- Standard treatment of these symptoms with LIVER DAMAGE
Western drugs was adopted for patients in both groups as and when symptoms arose: Ye et al. reported on the clinical observation of
x For patients with a temperature higher than Xiao Chai Hu Tang Jia Jian (Minor Bupleurum De- 38.5°C, 25mg of indomethacin was adminis- coction, with modifications) in the treatment of tered orally one to three times a day, accompa- liver damage caused by the Lp-TAE (Lipiodol- nied by intravenous injection of 5-10mg of transcatheter arterial embolization) method of dexamethasone, once every two or three days, Background
x Patients with vomiting were given 10-20mg of From 1988 to 1998, the authors treated 300 patients metoclopramide orally three times a day until with liver damage after treatment for liver cancer by the Lp-TAE method. These patients were diag- x Patients with pain were given 30-90mg of Hy- nosed with primary liver cancer by B ultrasound, CT, drochloride Bucinnazine, once every 4-6 hours, MRI and AFP investigations, and indices of hepatic and intravenous injection of 50mg of mepe- ridine hydrochloride, with frequency depending : The authors divided the patients randomly
into two groups according to the order of admis- x To prevent hemorrhage in the digestive tract, all patients were given 10mg of aluminum hydrox- x 150 patients, 143 male and 7 female, aged from ide gel, three times a day, and intravenous injec- 28 to 73 (mean age: 55), were placed in the tion of 0.4g of cimetidine, twice a day. TCM treatment group; the diameter of the In addition, the TCM treatment group was given cancer ranged from 10 cm to 21 cm in this Xiao Chai Hu Tang Jia Jian (Minor Bupleurum De- x 150 patients, 145 male and 5 female, aged from 18 to 74 (mean age: 58), were placed in a com- Ingredients
parison group; the diameter of the cancer Dang Shen (Radix Codonopsitis Pilosulae) 12g ranged from 10 cm to 19 cm in this group. Treatment method for liver cancer (Lp-TAE
Huang Qin (Radix Scutellariae Baicalensis) 12g Fa Ban Xia (Rhizoma Pinelliae Ternatae Prae- The Seldinger technique was adopted, by percuta- neous femoral artery catheterization with infusion Xian He Cao (Herba Agrimoniae Pilosae) 12g into the bilateral liver arteries of 3-20ml of Yu Jin (Radix Curcumae) 20g ultra-liquid iodized oil, 50-70mg/m2 of doxorubicin, Bie Jia* (Carapax Amydae Sinensis) 30g 10-14mg/m2 of mitomycin and embolism of liver Bai Hua She She Cao (Herba Hedyotidis Diffusae) 30g arteries by small pieces of gelfoam (cut as 1/6 of a piece of gelating sponge). Patients were treated 3.5 San Qi Fen (Pulvis Radicis Notoginseng) 3g, infused times on average (range one to eight times) with one to six months’ interval between courses. Treatment of side-effects
Modifications
After the Lp-TAE treatment, patients manifested 1. For damage to Yin due to severe fever, Di Gu Pi (Cortex Lycii Radicis) and Wu Wei Zi (Fructus 7. For Damp-Heat accumulating and steaming, Huang Lian (Rhizoma Coptidis), Yin Chen Hao 2. For exuberant Heat, Zhi Zi (Fructus Gardeniae (Herba Artemisiae Scopariae), Yi Yi Ren (Semen Jasminoidis), Shi Gao‡ (Gypsum Fibrosum), Da Coicis Lachryma-jobi), and Jin Qian Cao (Herba Huang (Radix et Rhizoma Rhei), and Hu Zhang (Radix et Rhizoma Polygoni Cuspidati) were 8. For severe pain, Yan Hu Suo (Rhizoma Corydalis 3. For Blood stasis due to binding of Heat, Tao 9. For severe vomiting, Xuan Fu Hua (Flos Inulae), Ren (Semen Persicae) and Quan Xie‡ (Buthus Dai Zhe Shi‡ (Haematitum) and Zhu Ru (Caulis 4. For Blood depletion and Qi Deficiency, Huang Patients started taking the decoction on the third Qi (Radix Astragali seu Hedysari) and Ji Xue day after the start of the Lp-TAE treatment. One Teng (Caulis Spatholobi) were added. bag per day was used to prepare a decoction by 5. For Wind stirring due to exuberant Heat, Ling adding to 1000ml of water and boiling down to Yang Jiao‡ (Cornu Antelopis) and Gou Teng (Ra- 500ml of liquid, taken in equal portions twice a day. TCM treatment continued for two weeks. As with 6. For mental confusion and delirious speech, An the comparison group, treatment with the Western Gong Niu Huang Wan (Peaceful Palace Bovine drugs detailed above was given should any symp- Table 4-2 (1) Appearance of side-effects Table 4-2 (2) Pain in the liver area § Pain graded according to WHO criteria. Note: By day 7, there was a significant difference between the two groups, P<0.05 (t test used for statistical purposes). Conclusion
treated by Xiao Chai Hu Tang (Minor Bupleurum The authors observed that, after treatment of liver cancer patients with the Lp-TAE regime, symptoms The observation indicated that the TCM treat- such as fever, vomiting, poor appetite, and pain in ment group fared significantly better than the com- liver area appearing within the period of observa- parison group in terms of improvement in fever, tion generally correspond to the main symptoms vomiting, poor appetite, and pain in the liver area. The average recovery time in the TCM treatment enabling patients in that group to start the next group was less than in the comparison group, thus course earlier.

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