A 68-year-old woman experiencing mild hepatic discomfort, sleep disturbances, and digestive issues five years after liver cancer surgeries was managed with a dynamic herbal approach targeting Liver stagnation and Spleen deficiency.

Case ID: CHC-0007

Case Summary

This case describes a 68-year-old woman presenting with residual symptoms five years after being diagnosed with and surgically treated for liver cancer. The original report documented a TCM assessment of Liver Qi stagnation combined with Spleen deficiency and blood stasis. The patient was managed through a staged herbal strategy designed to harmonize the Liver and Gallbladder, invigorate blood, and fortify the digestive system.

Patient Presentation

• Patient: 68-year-old female.
• Main Complaint: Post-surgical discomfort in the liver area, frequent dreaming, and hard stools.
• History: The patient was diagnosed with liver cancer five years prior and had undergone two surgical procedures. She sought consultation on October 21, 2020, reporting mild discomfort in the right hypochondriac (liver) region, frequent dreaming, menstrual blood with clots, and hard, difficult-to-pass stools. She did not experience nausea, acid reflux, dizziness, chest tightness, or abdominal pain. Her general appetite was fair, and urination was normal.

Examination and Diagnosis

• Conventional Diagnosis: Post-operative liver cancer status. Physical examination noted mild jaundice (yellowing of the skin and mucous membranes) and symmetrical pitting edema in the lower extremities. A systolic murmur was also noted during cardiac auscultation.
• TCM Tongue and Pulse: The tongue was pale with a white, greasy coating, and the sublingual veins showed distinct signs of stasis. The pulse was stringy and tight (弦紧).

TCM Assessment

The original practitioner interpreted the presentation as Liver Qi stagnation and Spleen deficiency with Blood stasis (肝郁脾虚，瘀血内阻).

According to the principles of Yin and Yang Chinese Medicine, major surgery and chronic illness can severely deplete the body’s foundational Qi (energy). In this patient, the underlying Qi deficiency weakened the Spleen’s ability to transport fluids and digest food properly, which led to the accumulation of dampness (evidenced by the greasy tongue coating) and intestinal dryness (hard stools). Simultaneously, the physical trauma of surgery and the emotional toll of a cancer diagnosis contributed to Liver Qi stagnation. Because Qi is the commander of Blood, when Qi stalls, blood stagnates, resulting in localized hepatic discomfort, menstrual clots, and sublingual vein stasis. The practitioner located the disease mechanism primarily at the Shaoyang (Lesser Yang) stage, which governs the physiological pivot between the body’s interior and exterior.

Treatment Approach

The primary treatment principle was to soothe the Liver, strengthen the Spleen, invigorate blood, and move Qi (疏肝健脾，活血行气). The practitioner employed a dynamic, two-step approach: first clearing the stagnation and breaking up the stasis, and then pivoting to rebuild the digestive function and moisten the intestines once the stasis began to resolve.

Herbal Formulas and Modifications

• Initial Formula (October 21, 2020): The practitioner utilized a modified version of the classic Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) combined with targeted blood-moving herbs.
  • Harmonizing the Pivot: Huang Qin and Gua Lou Pi were used to clear heat and generate fluids, while Gui Zhi and Gan Jiang were included to warm the interior and assist the transformation of Qi.
  • Breaking Stasis: Because the patient exhibited clear signs of blood stasis, strong blood-invigorating herbs including Hong Hua, Tao Ren, and Cu Shan Jia (Prepared Pangolin Scales – a historical TCM medicinal noted in the original text) were added to aggressively clear the blockages, alongside Xiang Fu to move Qi.
  • Tonifying Deficiency: Jiu Huang Jing was added to gently supplement her underlying weakness.
• Second Visit (October 28, 2020): After one week, the source reported that the patient’s symptoms had improved, particularly the signs of blood stasis. The primary remaining issues were hard stools and a suboptimal appetite. The practitioner adjusted the formula significantly. The heavy blood-breaking herbs (Tao Ren, Shan Jia) were removed. Instead, Rou Cong Rong was introduced to tonify the kidneys and moisten the intestines to relieve constipation, while Spleen-fortifying herbs such as Dang Shen, Bai Zhu, Fu Ling, and Chen Pi were emphasized to strengthen digestion and improve appetite.

Follow-Up

• October 28, 2020 (Second Visit): The original report noted an overall improvement in her condition following the first week of treatment, specifically a reduction in blood stasis symptoms. The treatment strategy was then successfully shifted from resolving stasis to nourishing the digestive tract and addressing the bowel irregularity. (Note: Further long-term follow-up outcomes were not detailed in the provided case excerpt).

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the sophisticated management of a fragile, post-surgical oncology patient. The original practitioner recognized that despite the serious history of liver cancer, the current presentation was a complex, intertwined mix of deficiency (weak Spleen, Qi depletion from surgery) and excess (stagnant Liver Qi, blood stasis).

Rather than solely focusing on heavy, anti-cancer botanicals, the treatment prioritized restoring the body’s internal physiological machinery. By using Chaihu Guizhi Ganjiang Tang, the practitioner addressed the Shaoyang pivot, carefully balancing cold and heat dynamics. Furthermore, the rapid adjustment in the second week—stepping back from aggressive blood-moving herbs once the stasis showed improvement, and pivoting to moistening the bowels and tonifying the Spleen—demonstrates the core TCM philosophy of continuously adapting the prescription to the patient’s shifting clinical picture, ensuring that the treatment clears pathology without further damaging the patient’s foundational energy.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Dongguan Hospital of Traditional Chinese Medicine (东莞市中医院) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】董明国：疏肝健脾，活血行气治疗肝癌案
• Practitioner: Professor Dong Mingguo (董明国)
• Publication date: November 5, 2024
• Original language: Chinese
• Source link: View original page
• ChineseHerb.org version: English translation and editorial adaptation