A 56-year-old man with a three-year history of primary liver cancer, experiencing severe fatigue, poor appetite, and right rib pain, was successfully managed using a Spleen-tonifying and toxicity-clearing herbal strategy.

Case ID: CHC-0077

Case Summary

This case describes a 56-year-old man who presented with a worsening three-year history of primary liver cancer. Characterized by right hypochondriac (rib) discomfort, severe fatigue, a dull yellow complexion, and loose stools, his presentation highlighted a deep systemic weakness. The original report documented a conventional diagnosis of primary liver cancer and a TCM assessment of Liver Accumulation (Gan Ji) driven by Righteous Qi Deficiency and Pathogenic Accumulation. He was managed by Professor Hu Shiping using a highly strategic approach based on the classical tenet “treating liver disease requires first treating the spleen,” utilizing a heavily modified Si Junzi Tang (Four-Gentleman Decoction) to rebuild his core immunity alongside targeted tumor-softening medicinals, resulting in a rapid recovery of his physical strength, appetite, and clinical symptoms.

Patient Presentation

• Patient: 56-year-old male (Surname: Liu).
• Main Complaint: Right hypochondriac (rib) discomfort accompanied by poor appetite and fatigue for over 3 years, worsening over the past week.
• History: The patient sought his initial consultation on October 23, 2020. Over three years prior, without any obvious trigger, he developed right rib discomfort, poor appetite, and fatigue. An abdominal CT scan revealed a space-occupying lesion in the right lobe of the liver, leading to a diagnosis of primary liver cancer. One week before the visit, his symptoms noticeably worsened, prompting him to seek specialized TCM treatment.
• Associated Symptoms: His complexion was dull and yellowish. He experienced a bland taste in his mouth, severe fatigue, yellow urine, and loose, unformed stools.

Examination and Diagnosis

• Conventional Diagnosis: Primary liver cancer.
• TCM Tongue and Pulse: The tongue body was pale with a thin, white coating. The pulse was stringy and fine (脉弦细).

TCM Assessment

The original practitioner interpreted the presentation as Liver Accumulation driven by Righteous Qi Deficiency and Pathogenic Accumulation (肝积 – 正虚邪结).

According to the holistic principles of Chinese Medicine, Professor Hu Shiping emphasizes that the core pathogenesis of liver cancer is “Righteous Qi Deficiency with Stasis and Toxicity” (正虚瘀毒). The root cause is a profound deficiency of the Liver and Spleen, while the “branch” (the tumor itself) is formed by congealed blood stasis and toxic heat.

In this patient, the chronic illness had severely weakened his Spleen (the digestive center), causing the loose stools, fatigue, bland taste in the mouth, and pale tongue. Because the Spleen could not produce enough Qi and Blood, the Liver became malnourished. The resulting stagnation of Liver Qi and blood formed the physical “accumulation” (tumor) in his right rib area. The stringy pulse indicated the Liver pathology, while the fine pulse confirmed the deep underlying blood and essence deficiency.

Treatment Approach

The primary treatment principle was to support Righteous Qi and dispel pathogenic factors, soften hardness and dissipate nodules (扶正祛邪，软坚散结). The strategy heavily prioritized “tonifying the earth (Spleen) to harmonize wood (Liver)”—focusing first on restoring the patient’s digestive system to rebuild his stamina and blood supply, while simultaneously applying targeted anti-cancer herbs that would not damage his already weak stomach.

Interventions and Herbal Formulas

• Initial Herbal Formula (October 23, 2020): A 13-herb decoction merging Si Junzi Tang (to tonify Spleen) and Dang Gui Buxue Tang (to nourish Blood), with added anti-cancer medicinals.
  • Tonifying Spleen and Boosting Qi: Tai Zi Shen (Pseudostellaria, 15g), Huang Qi (Astragalus, 20g), Bai Zhu (Atractylodes macrocephala, 15g), Fu Ling (Poria, 15g), and Shan Yao (Chinese Yam, 15g) form a powerful core to rebuild the Spleen’s transport function, stopping the diarrhea and severe fatigue.
  • Aiding Digestion: Chao Gu Ya (Fried Rice Sprout, 10g) and Chao Mai Ya (Fried Barley Sprout, 10g) gently awaken the appetite without causing stagnation.
  • Nourishing and Moving Blood: Dang Gui (Angelica Sinensis, 10g) and Dan Shen (Salvia, 15g) nourish the Liver blood and move localized stasis.
  • Softening Hardness and Clearing Toxicity: Zhi Bie Jia (Prepared Turtle Shell, 30g – decocted first) deeply nourishes Yin and physically softens tumor masses. Bai Hua She She Cao (Hedyotis, 15g), Ban Zhi Lian (Scutellaria barbata, 15g), and Ling Zhi (Ganoderma, 15g) clear deep heat-toxicity and combat the cancerous growth.
  • Administration: 14 doses, water decocted, taken warm after breakfast and dinner.
• Second Visit (November 6, 2020): After 14 doses, the right rib discomfort significantly improved. His appetite turned excellent, his spirit greatly increased, and crucially, his stools became formed. The pale tongue and stringy-fine pulse remained. To address the yellow urine and slight remaining damp-heat, Dang Gui was removed and Yin Chen (Artemisia capillaris, 24g) was added. (7 doses).
• Third Visit (November 13, 2020): The patient only had occasional right rib discomfort. His physical strength and energy had fully recovered to normal, urine turned a normal light color, and bowel movements remained normal. The practitioner added Yi Yi Ren (Coix Seed, 20g) to further drain Spleen dampness and Sheng Mu Li (Raw Oyster Shell, 20g) to synergize with the Turtle Shell in softening the tumor mass. (14 doses).

Follow-Up

• Subsequent follow-ups confirmed that the patient reported no further discomfort, maintaining a stable and symptom-free state with excellent quality of life.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is its strict adherence to a classical TCM paradigm in modern oncology: “When seeing liver disease, know that it transmits to the spleen; therefore, one must first strengthen the spleen” (见肝之病，知肝传脾，当先实脾).

When faced with a severe, life-threatening diagnosis like liver cancer, many practitioners are tempted to immediately prescribe heavy, aggressive, toxic herbs to “attack” and shrink the tumor. Professor Hu Shiping highlights that this is a fatal mistake if the patient’s Spleen is weak (indicated by his loose stools and extreme fatigue). Heavy anti-cancer herbs would destroy the patient’s remaining digestive fire, accelerating their decline. By prioritizing the Spleen—ensuring the patient could eat, digest, and produce their own energy (Qi and Blood) using Si Junzi Tang—the practitioner successfully rebuilt the patient’s innate immune defense (Righteous Qi). The anti-tumor herbs (Bai Hua She She Cao, Zhi Bie Jia) were then able to work harmoniously without damaging the body, successfully delaying the progression of the disease and restoring the patient’s vitality.

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Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：正虚瘀毒作肝癌，肝病治脾为良策 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 16, 2024 Original language: Chinese