Western Medicine

The liver is a large wedge shaped organ found in the upper right side of the abdominal cavity. It is essential for the digestion and metabolism of food, breakdown of toxins and drugs, production of blood clotting factors and storage of blood.

Liver cancer is one of the most common fatal cancers in many Asian and African countries. Less than 5% of patients survive five years after diagnosis. It is much less common (about 50 times less) in North America and Europe where it is still considered rare. However, rates are rising in some western countries such as Australia. This is thought to be due to a rise in Hepatitis B and Hepatitis C virus infection rates, both of which are major causes of liver cancer. It may be also attributed to a rise in emigration of people from countries where liver cancer is common.

When talking about liver cancer it is important to distinguish between primary liver cancer, known as hepatocellular carcinoma, and secondary liver cancer, because the type of cancer affects the selection of treatment. Primary liver cancer develops in the liver first and may spread to other parts of the body late in the disease process. Secondary liver cancers are tumors formed by cancer cells that have spread by either the blood or the lymphatics from tumors that originally developed in other parts of the body. Another cancer sometimes mistakenly called "liver cancer", because it affects the liver's functioning, is primary bile duct cancer-cancer that grows in the tubes carrying the enzyme rich digestive fluid, bile.

This article will focus on primary liver cancer (hepatocellular carcinoma).

Chinese Medicine

In Traditional Chinese Medicine (TCM), liver cancer is associated with the presence of an "abdominal mass" referred to as "zheng" and "jia". "Zheng" is a palpable and fixed mass in the abdomen with localized pain. "Jia," is an abdominal mass, which occurs intermittently and has pain that can move within the abdomen. Since TCM does not focus on anatomical pathological (disease) changes, the exact location of the abdominal mass is not as important as figuring out the disharmony pattern which causes the mass to occur.

Early TCM medical literature described symptoms similar to our modern day understanding of liver cancer. One example is the "xi fen" disorder, which is the ancient medical name for lumps found at the left flank region (below the chest). Other symptom categories that have close relationships with liver cancer include abdominal distention, jaundice and abdominal fullness and oppression. Both oppression and fullness are TCM symptoms mainly caused by stagnation of qi flow (vital energy) in the chest.

In western medicine, liver cancer may be classified as either being benign, meaning cancer that does not spread, or malignant, meaning cancer that can spread as primary and secondary liver tumors. Secondary liver cancer refers to a tumor, which has metastasized from other organs.

This article will mainly discuss primary hepatocellular carcinoma, a type of cancer that originates in the liver.

TCM Representation of the liver, spleen and gall bladder organs

Western Medicine

Diagram from
http://www.info.gov.hk

/hepatitis/whhepd.htm

Infection with the hepatitis B virus is the major cause of liver cancer. Worldwide, eighty percent of cases occur in people who carry the hepatitis B virus. People with chronic hepatitis-B virus infection, or who have a condition known as being a hepatitis B carrier, have a 12 to 300 times higher risk of developing primary liver cancer (according to different studies) than people who do not carry the hepatitis B virus.

Hepatitis B is a virus passed by the exchange of blood, blood products or bodily fluids between humans. It is usually passed through blood transfusions, sexual intercourse and from mother to child during pregnancy and birth.

In East Asia where hepatitis B infection rates are very high, the most common route of transmission is from mother to child. This means many people have hepatitis B from birth, an important factor in developing liver cancer. It is the slow damage caused by chronic hepatitis B infection that leads the liver cells to change into cancer cells.

In Western countries, where hepatitis B infection rates are much lower, most cases are due to hepatitis C infection, a virus also passed by exchange of blood, blood products or bodily fluids.

The other major cause of liver cancer in western countries is the liver damage caused by chronic alcohol abuse to liver cells known as alcoholic cirrhosis.

Chinese Medicine

In TCM, the causes of liver cancer can be divided into inherited factors and environmental factors.

1. Inherited factors:
Some individuals develop liver cancer because they have inherited susceptible genes from their parents.

2. Environmental factors:
These include:

• Diet: Over-consumption of alcohol and eating improperly cleaned food can upset the digestive health, which is known as spleen disharmony.
• Lifestyle: Over-exhaustion can lead to body disharmony.
• Living: Environment such as a wet climate

Both inherited and environmental factors may result in spleen deficiency, stagnation of qi and the accumulation of dampness, which can progress to liver cancer. These terms are further explained in the symptom sections.

Click here to see how liver cancer forms from a TCM perspecture

Western Medicine

One of the problems with detecting liver cancer is that it is often silent. It may not cause any symptoms likely to alert the sufferer that he or she may have cancer.

When there are symptoms, the most common ones are:

• Pain: usually more discomfort felt in the upper right side and middle of the belly. Sometimes pain caused by liver cancer can also be felt around the right shoulder blade.
• Abdominal fullness
• Fever
• Jaundice: yellow eyes and skin, pale stools and very dark (tea-colored) urine.

At a very late stage, there may be symptoms of blood and metabolism disorders caused by liver failure.

These include:

• Dizziness, headaches and fainting caused by low blood sugar.
• Bleeding and bruising for no reason.
• Mental confusion.
• Coma.

Chinese Medicine

Individuals who are suffering from liver cancer usually develop a spleen deficiency first. In TCM, the spleen is largely responsible for the body's digestive functions, which includes transforming water and nutrients into vital energy or qi, which in turn, is used by the body to carry out its daily functions. If liquids are unable to be transformed or digested properly by the spleen, dampness accumulates. When the dampness accumulates without being transformed into qi, it will turn into heat, which damages the body and makes a person sick. Sometimes when the dampness accumulates in the abdomen, abdominal distention will occur.

If the spleen deficiency remains uncontrolled, qi movement becomes stagnant. Qi commands the blood so when qi stagnation persists, blood stasis (lack of smooth blood flow) is the result. When this condition continues to be uncontrolled for a long time, individuals develop excessive heat, which typically occurs in the stomach. It is often referred to as the heat of yang ming; because, the stomach is closely associated with the stomach meridian. When the liver cancer progresses to the late stage, the heat will exhaust the physiological fluids in the body leading to a condition known as yin deficiency. (See below).

Depending on the stage of the liver cancer, individuals will show one or more of the disharmony patterns listed below. The disharmony patterns can progress to other patterns and deficiencies not listed here if the conditions cannot be reversed back to healthy body functions.

Click here to see Disharmony Pattern Symptoms

Types of Disharmony Patterns:
a) Spleen deficiency
As mentioned before, the spleen is important for transformation of nutrients and water. A deficiency can lead to an accumulation of unhealthy dampness, triggering weight loss, malaise, poor appetite and loose stools. Generally, the tongue does not appear red and the pulse feels soft or soggy, which are signs of dampness.

b) Stagnation of Qi
When qi becomes stagnant, the qi movement in the body will be disturbed, leading to a feeling of fullness in the upper abdomen. Individuals may have a poor appetite and flatulence (gas). With this condition, the pulse may be wiry or smooth. The tongue will have a thin and greasy coating and usually does not appear red.

c) Influence of dampness and heat
Under the influence of heat, which belongs to yang evils, individuals may have irregular fevers and dark urine. As a result of dampness and heat in the liver and gall bladder, the normal regulation of bile will be affected. Bile is made in the liver and stored in the gallbladder where it is then excreted into the intestines to digest food. In TCM, jaundice occurs when the bile is "spilt over" or backed up into the liver. Since heat causes these problems, the pulse feels rapid and smooth if dampness is present. The tongue usually appears red with a yellow and greasy coating, also indicating heat and dampness in the body.

d) Excessive heat
With excessive heat, individuals may develop a fever with varying temperatures. Before developing a fever, some individuals may experience an aversion to feeling cold. Those who have a greater aversion to cold usually develop a higher temperature. For individuals with liver problems, the fever comes on at regular and particular times, usually in the afternoon, and it goes away without treatment. However, there are some cases, where individuals have sustained fevers. Sweating occurs once the fever has broken. With excessive heat, the pulse usually feels rapid and smooth, and the tongue may appear dry. Sometimes individuals without a fever will be classified as having excessive heat because of a hot feeling in the liver region.

e) Blood stasis
Blood stasis occurs when there is not a smooth flow of blood in a particular area of the body. Individuals with liver cancer who have blood stasis experience sharp pain in the liver region. The pain will be aggravated when the affected area is pressed, and it is usually fixed in a certain position. The pulse feels thin and choppy, and the tongue will appear dark with purple spots.

f) Yin deficiency
In TCM, material and fluid-like substances belong to yin. If a person is yin deficient, he or she will have a dry mouth and thin pulse. Since yin and yang always aim to be in balance, a yin deficiency can lead to a relative excess of yang. It is relative; because, even though the symptoms look like an excess problem, they originate from a deficiency and therefore need to be treated as a yin deficiency and not a yang excess. Symptoms of a relative excessive yang include irritability, a rapid pulse and a red tongue. Another symptom of yin deficiency is a tongue that has a shiny or peeled appearance if the tongue does not have a coating present.

Symptoms Associated with Liver Cancer:
Early stage liver cancer can be difficult to detect because there are few obvious symptoms. When the disease progresses to the intermediate and late stages, symptoms will become more prominent and noticeable.

General symptoms:
1. Pain in the "liver" region (the flank and upper abdomen)
There are mainly two types of pain; dull and sharp. Sharp pain can be aggravated by pressure. It is usually caused by blood stasis (when blood is unable to flow smoothly), which is considered an excessive type disharmony. In TCM, an excessive type disharmony usually refers to a disharmony pattern caused by an excess of evils in the body. (These excesses are usually external forces outside the body that invade it and cause disease. This includes things such as heat, wind, dampness, cold and dryness.) In order to treat this disharmony, the evils need to be removed. If the disharmony were a deficiency type, the treatment would aim to replenish the deficient aspect instead of removing the evils. On the other hand, dull pain is caused by stagnant qi. Smooth flow of qi and blood are necessary for the body to function properly. If disharmony affects their flow, health problems will occur. Pain is a symptom of poor flow of qi and/or blood.

2. Mass in the upper abdomen
In TCM, this type of mass, known as "zheng" or an "accumulation," is described in the definition section. There are several theories about how "zheng" develops. One theory is that it is caused by stagnant qi or blood stasis. Another theory is that it results from a spleen deficiency.

3. Other common symptoms
As a result of a spleen deficiency, individuals with liver cancer can feel general sluggishness because the spleen is responsible for "ruling" the four limbs. The spleen is also responsible for transforming nutrients and water into qi or vital energy for the body. Without healthy transformation, dampness accumulates in the body and causes many types of health problems. For example, accumulated dampness in the large intestine will lead to symptoms of diarrhea and nausea.

Spleen deficiency is often associated with abdominal distention. Being an earth element, the spleen should be able to contain and control the direction of water flow in the body. When spleen disharmony occurs, water is not controlled properly and fills up the abdomen resulting in abdominal distention. In western medicine, the symptom is known as ascites.

Abdominal distention located in the upper abdomen is known as "pi man," which means feeling fullness and oppression. Both oppression and fullness are mainly caused by stagnation of qi flow in the chest. If distention of the whole abdomen occurs, the condition is known as "gu zhang." A spleen deficiency rather than improper qi flow mainly cause "gu zhang."

Western Medicine

History:

Liver cancer usually has few symptoms or signs. However a history of hepatitis, whether or not the cause is known, will alert your health care provider to the possibility that you could have or are developing liver cancer. Risk factors for developing liver cancer are:

• Being of Asian or African origin
• A family history of hepatitis or liver cancer
• Heavy use of alcohol
• Known intravenous drug use
• Known liver problems, including the advanced liver disease cirrhosis
• Known to be a Hepatitis B "carrier." This is a state where you may never have had any illness but carry the virus in your blood stream. Some people with this condition develop liver cancer later in life
• Proven hepatitis C or hepatitis B infection in the past

Physical Examination:

• When examining you, your health care provider will look for:
• Signs of liver failure: for example, tiny red blotches on the skin of your neck chest and hands called spider nevi and a hand tremor.
• Jaundice: a yellowing of the "whites of the eyes", a yellowish tinge to the skin, yellow palms.
• Signs of blood clotting problems: bruises on your arms, legs, and abdomen, or bleeding in your nose and/or around your teeth.
• Signs of cancer spread: weight loss, hardened lymph nodes in the neck, abdomen and groin.

Signs of cancer in the liver itself:

• if the cancer is widespread, the liver may feel hard, irregular (knobby) and shrunken. However, because the liver retreats under the rib cage when shrunken, it may be difficult or impossible to feel.
• Investigations
• Blood tests will be done to look at the liver enzyme levels and the level of bile in the blood stream. A protein called alphafetoprotein will also be measured because this can be raised in liver cancer.
• A plain x-ray of the abdomen may reveal calcification or irregularities in the liver region.
• An ultrasound will give more information about the nature of the liver tissue, and whether there are any suspicious masses or cysts suggestive of cancer.
• A liver scan, a CT (computed tomography) scan or an MRI (magnetic resonance imaging) picture of the abdomen, pelvis and chest may be used to further investigate suspicious masses, giving more information about their location, nature, number and possible origin.
• Exploratory surgery using a laparoscope to look inside the abdomen and to take a biopsy provides the definitive diagnosis. The biopsy may also be made with a needle through the skin rather than at surgery. After inspection of the tissue by a pathologist, it can be determined whether the tumors are cancerous and whether or not they come from a different part of the body or are primary tumors of the liver.
• Angiography, where dye is injected into the arteries leading to the liver, may be done to see more clearly what blood vessels supply nutrients to the tumor and what sections of the liver are involved.

Chinese Medicine

Diagnosis is based on four examination techniques. The first is "questioning." The TCM practitioner will want to know what the individual's current complaints are, and will need their medical history and family health history. The second technique is "observation." Physical features of the body such as the face, tongue, hair, nails, sputum (mucus that is coughed up) and examining the area of pain all offer clues as to what the problem may be. Observation of the tongue is particularly used as a gage to assess illness. The third technique is "hearing and smelling." Smelling the sputum and breath and listening to the sounds coming from the chest offer additional clues. The last technique used in examination is "touching." Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about the body's imbalance. If the TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat he or she may recommend that the individual see a western doctor for further follow up.

From a TCM point of view, liver cancer is generally classified according to the disharmony patterns each individual has. The symptoms section reviews the different disharmony patterns in detail.

Types of Disharmony Patterns:

• Spleen Deficiency
• Stagnation of qi
• Influence of Dampness and heat
• Excessive Heat
• Blood Stasis
• Yin Deficiency

When classifying the patterns there are several important points that need to be differentiated:
1. Classification of pain at the liver region
It is important to distinguish between pain due to stagnation of qi and pain due to blood stasis because it affects the choice of herbs and treatment strategies used. Pain due to qi stagnation usually feels dull while pain due to blood stasis feels sharp. In addition, it is also important to know whether a person with liver cancer has abdominal distention due to blood stasis because the patient may faint as a result of the disharmony.

2. Classification of abdominal distention Abdominal distention should be differentiated between qi stagnation and constrained liver qi because each is treated differently. Distention due to qi stagnation is known as "pi man" in TCM. It is characterized by the distention in the central upper abdomen, and it is usually aggravated after meals. On the other hand, constrained liver qi distention is characterized by distention at both flanks (below the chest) with dull pain and discomfort. Eating meals does not aggravate abdominal distension.

3. Classification of fever
In addition to fever, liver cancer patients usually have signs of exterior disharmony. Exterior disharmony is similar to having a cold or the flu. Symptoms include an aversion to cold, a high temperature, and a floating pulse. However, fevers associated with liver cancer usually come in the afternoon and is associated with profuse sweating and a hot feeling over the liver region.

Western Medicine

Surgery

Because liver cancer is a "silent" disease, it is usually too advanced at the time of diagnosis to be removed completely by surgery. However, if detected early enough, and found to be in just one part of the liver, surgeons may remove one of the liver's two lobes, or they may remove a small portion, known as a segment. If there are a number of small tumors in different parts of the liver, the surgeon may remove the segments in which those tumors are located. Because the liver is one of the few human tissues able to regenerate very quickly, quite a large amount of liver can be removed without destroying the organ or harming its function. However, if the tumors are near major blood vessels they cannot be removed because the blood vessels may be damaged.

Cyrosurgery

Cyrosurgery is a method of selectively destroying tissue by freezing it with liquid nitrogen and leaving it in place to be reabsorbed by the body, rather than cutting it out. It is useful when tumors are in places where cutting the tumor out would damage surrounding vital structures such as blood vessels. So far, surgeons are finding this method as effective as actually cutting out the tumor. Surgeons operating to remove liver tumors may cut out some and freeze others at the same time, ensuring as much tumor as possible is removed.

Chemothorapy

Chemothorapy, a form of treatment where drugs highly toxic to growing cells are given either via the bloodstream (intravenously) or as pills (orally), is used to treat liver cancer which cannot be surgically removed. It is often given after surgery to destroy any cancer cells that may remain in the liver. Because chemotherapy drugs are toxic to rapidly growing cells, other cells including normal liver cells, red blood cells and immune cells are destroyed, so doses have to be limited or given in ways able to minimize this problem. Sometimes chemotherapy drugs are put directly into the liver, through a tube inserted into a liver artery, during surgery. This is done to give the tumor the highest dose possible without exposing too much of the rest of the body to these very toxic chemicals.

Chemo-embolization:

Emboli are small clumps of cells, fat, tissue, blood platelets or foreign bodies that flow through arteries and veins and eventually block them. If you inject little emboli into the arteries and veins supplying blood to a tumor, the tumor will lose its food and oxygen supply and die. Chemo-embolization is a technique now being used to destroy multiple tumors where small pieces of material saturated with chemotherapy drugs are injected into the arteries known to supply tumors. This works two ways. The blood flow supply is stopped and the tumor is left in a bath of highly toxic drugs, so it dies rapidly. This is still being tested as a form of therapy, but early studies indicate this method can shrink tumors in people with primary liver cancer and prolong their survival times.

 

Alcohol Injection:

Pure alcohol (100 percent alcohol) is highly toxic to liver tumors. When alcohol, usually ethanol, is injected directly into liver tumors, it makes the cells dry out and causes their protein to disintegrate. This form of treatment may be given to people who are considered medically unfit for surgery but who have only a few tumors. It has been found to increase survival significantly. Some hospitals are now experimenting with injecting the tumors with a mixture of alcohol and chemotherapy drugs to see if this is even more effective.

Radiation therapy:

Radiation therapy is a common form of cancer treatment where a beam of radiation able to destroy cells is aimed at a tumor. It is not used very much in liver cancer because it is hard to protect the highly sensitive normal liver cells from the radiation. Sometimes a dose of radiation therapy may be given at the time of surgery to kill off any microscopic tumor cells the surgeon cannot see, in order to maximize clearance of the tumor.

Radio frequency ablation:

This is a new form of treatment, where tumor cells are literally "cooked" and therefore killed, by heating them to high temperatures, (80 - 100 oC). A thin needle is inserted through the skin and into the tumor using ultrasound to guide the operator. Once the needle is in the tumor, an electrical current is switched on, making the needle tip intensely hot, so it heats up and destroys the tumor. Small tumors less than four centimeters can be destroyed this way. Some advantages of this technique are that patients do not need general anesthetic, rarely have side effects and can usually go home soon after the procedure.

A similar technique using optical fibers instead of needles, known as interstitial laser photocoagulation, is also being tested now.

Liver Transplantation

This is only recommended for people with early stage primary liver cancer who have liver failure. The entire liver is removed and a healthy liver, usually donated by a car accident victim, is transplanted in its place. In the right cases, it can be an effective cure, as long as the cause of the liver failure i.e. alcohol abuse or hepatitis B infection has been treated effectively.

Immunotherapy:

Immunotherapy or biological therapy is a form of therapy that tries to enlist the body's immune system to fight cancer. It is currently experimental but involves taking materials taken from the patient's body, or making materials known as "biological response modifiers", and trying to use them to strengthen and direct the body's immune system to help it attack the cancer cells.

Chinese Medicine

In TCM, liver cancer is mainly treated according to the classification of the individuals' disharmony pattern.

1. Spleen Deficiency
The therapeutic aim is to strengthen the spleen. This decoction example includes the four herbs, which are a well-known combination for boosting spleen health and spleen qi in the body:

Si Junzi Decoction

Dang shen	Tangshen
Bai Zhu	Largehead Atractylodes Rhizome
Fu Ling	Indian Bread
Gan Cao	Liquorice Root

In this decoction, dang shen invigorates qi. Bai zhu strengthens the spleen. Fu ling promotes diuresis (urination) to eliminate dampness, and Gan Cao moderates the other herbs.

Modification may be made to the basic Si Junzi decoction in order to promote the regulation of qi. An example includes:

Xiangsha Liujun pills

Dang shen	Tangshen
Bai Zhu	Largehead Atractylodes Rhizome
Fu Ling	Indian Bread
Gan Cao	Liquorice Root
Ban xia	Pinellia Tuber
Chen pi	Dried Tangerine Peel
Mu xiang	Costusroot
Sha ren	Villous Amomum Fruit

In this decoction, the basic four herbs in Si Junzi Decoction help strengthen the spleen. In addition, Ban xia and Chen pi regulates qi circulation and eliminates dampness and phlegm. Mu xiang and Sha ren further promote the qi circulation. The decoction is especially good for patients with spleen deficiency and stagnation of qi.

2. Abdominal distention (ascites)
Xiangsha Liujun pills can further be modified to treat abdominal distention. Modification is as follows.

Dang shen	Tangshen
Bai Zhu	Largehead Atractylodes Rhizome
Fu ling (outer cortex)	Indian Bread Peel
Gan Cao	Liquorice Root
Ban xia	Pinellia Tuber
Chen pi	Dried Tangerine Peel
Mu xiang	Costusroot
Sha ren	Villous Amomum Fruit
Che qian zi	Plantain Seed
Da fu pi	Areca Peel

In addition to the benefits of treating spleen deficiency and qi stagnation, the decoction also contains Che qian zi and Da fu pi, which can further relieve stagnation, promote diuresis (urination) and relieve edema (swelling) and dampness.

3. Stagnation of qi
The therapeutic aim is to resume the circulation of qi in the middle burner including the stomach and spleen.

Zhishi Xiaopi Pills

Dang shen	Tangshen
Bai Zhu	Largehead Atractylodes Rhizome
Fu Ling	Indian Bread
Gan jiang	Dry Ginger
Ban xia qu (one type of Ban xia)	PinelliaTuber
Zhi shi	Immature Orange Fruit
Hou po	Officinal Magnolia Bark
Huang liang	Golden Thread
Mai ya	Germinated Barley (fried)

In this decoction, Zhi shi is the main herb for promoting qi circulation, dispersing the stagnation and helping to remove the abdominal mass. It is further supported by Hou po. Both Ban xia and Gan jiang are pungent in taste. In TCM, pungent tasting herbs can be used to help to remove a mass. Chinese terms describe this as "opening" the mass. Huang liang has bitter and cold properties that can clear away heat and remove dampness. Together with the bitter taste of Zhi shi and Hou po, they descend the qi, which also helps to disperse the mass. The whole decoction is supported by Dang shen, Bai zhu, Fu ling, which are all good herbs in invigorating spleen and removing dampness.

4. Influence of dampness and heat

Yinchenhao Decoction

Yin chen	Virgate Wormwood Herb
Zhi zi	Cape Jasmine Fruit
Da huang	Rhubarb

In the decoction, Yin chen is the main herb for clearing away heat and dampness and relieving jaundice. Zhi zi has cold and bitter properties, which eliminates heat and guides the dampness and heat to move downwards by penetrating the triple burner meridian. In TCM, the triple meridian is regarded as the distribution channels for body fluids. Da Huang is also cold and bitter. Not only can it remove heat, dampness and stasis, but is especially helpful in guiding the heat to leave the body through stools by penetrating the large intestine meridian.

5. Excessive heat

Baihu Decoction

Shi gao	Gypsum
Zhi mu	Common Anemarrhena Rhizome
Gan Cao	Liquorice Root

 

In this decoction, both Shi gao and Zhi wu are cold herbs. Shi gao is also pungent and sweet. The decoction is very useful for removing extreme heat in the body, and it is supported by the Zhi wu herb, which is also cold and bitter. Gan cao is essential for protecting the stomach and spleen, and preventing the cold herbs from hurting the spleen. The decoction also has the added benefit of nourishing the body's yin.

6. Blood stasis

Shixiao powder

Pu huang	Cattail pollen
Wu ling zhi	feces of Trogoterus xanthipes

In this decoction, both Pu huang and Wu ling zhi promote blood circulation, remove blood stasis and relieve pain.

7. Yin deficiency

Sancai decoction

Taizi shen	Heterophylly Falsestarwort Root
Tian dong	Cochinchinese Asparagus Root
Sheng di	Rehmannia Root

In this decoction, Taizi shen is good for invigorating qi and promoting the production of body fluids. All three herbs work together to replenish yin deficiency in the body. Tian dong nourishes yin, clears away heat, moisturizes the lungs and benefits the kidneys. Sheng di cools the blood and nourishes yin to promote the production of body fluids.:

Western Medicine

Prevention of infection with hepatitis B or hepatitis C is the most effective way to prevent liver cancer. A vaccine against hepatitis B is available and is now given to newborn babies in many countries. Adults and children who were not vaccinated at birth, and have not been infected by the hepatitis B virus should consider having a hepatitis B vaccination, especially if they are in countries or areas where infection rates are high or if they are exposed to the disease through work or lifestyle.

Several studies in Asian countries where hepatitis B immunization is being given to all children (Taiwan, Korea) have found that the rates of liver cancer dropped markedly (by 40 percent) in those groups receiving immunization.

The hepatitis B vaccine is given as three injections over a six month period. Once immunized, your hepatitis B antibody status should be checked every ten years. You may require a booster shot or need to repeat the immunization series if you have lost immunity.

Controlling hepatitis C will require effective vaccination, but no such vaccine has yet been developed. Until then, monitoring donated blood and blood products to ensure it is hepatitis C free, and encouraging intravenous drug users not to share needles and to use clean needles (needle exchange programs) are the most effective ways of preventing hepatitis C infections.

In countries where hepatitis B infection is not widespread, people also die from liver cancer brought on by alcohol abuse. Keeping alcohol consumption to a moderate level (no more than two standard alcohol drinks per day for men and no more than one standard alcohol drink per day for women) will also prevent liver cancer.

Don't over consume alcohol

Along with these specific recommendations, following an anti-cancer regime will help boost your immune system and help it remain vigilant against cancerous changes in your body's cells. Such a regime involves increasing the percentage of fresh green, yellow and red vegetables in the diet, exercising for one hour per day, getting eight hours sleep a day and reducing stress levels in work and home life.

Chinese Medicine

From a TCM point of view, it is important to pay attention to the following points in order to prevent the occurrence of liver cancer.

Healthy diet

Diet is important because it affects the spleen. In TCM, the spleen is responsible for extracting the nutrition from ingested foods and fluids and transforming them into qi and blood. It is also regarded as the source of these substances. It is such an important organ that it is sometimes referred to as the "foundation of afterbirth (postnatal) existence". As previously discussed, spleen deficiency is one of the main causes for liver cancer. Symptoms like abdominal distention, ascites (fluid in the abdomen) are all related to spleen function and health. The spleen has a close relationship with the liver. Being an earth element, the spleen can easily be inhibited and restricted by the liver, a wood element, if it becomes deficient. Therefore, in order to maintain good harmony between the spleen and liver, it is particularly important to pay attention to strengthening spleen health.

In order to maintain good spleen health, we should avoid eating too much spicy and "cold" food. "Cold" food includes those that are cold in temperature such as ice cream and refrigerated food, and those that have cold properties such as green beans. Avoid taking too much alcohol because alcohol is warm in property, and may aggravate the dampness and heat influences that usually occur in spleen deficient individuals.

This cycle shows how the five elements restrict one another

This cycle shows how the five organs restrict one another

In TCM and western medicine, moderate alcohol consumption is recommended. It is now known that alcohol is a common reason for causing cirrhosis (irreversible damage of the liver), which is linked to the development of liver cancer. It is a good idea to discuss with your health care provider as to how much alcohol consumption is considered moderate since this may vary from person to person.

Don't over consume alcohol

Healthy lifestyle and health maintenance

TCM stresses maintaining harmony between our internal body and external environment for achieving optimal health. Therefore, it is essential to keep the body fit and have enough rest. Over-exhaustion is one of the main causes for body disharmony, which may eventually lead to liver cancer. Early detection of unhealthy conditions and disharmony patterns can prevent the body from progressing to liver cancer. These include detecting signs and symptoms associated with spleen deficiency, the influence of dampness, stagnation of qi, excessive heat, blood stasis and yin deficiency.(See symptoms section for detailed symptoms of the disharmony patterns.)Efforts should be taken to resume the body's balance when disharmony occurs and not let it persist because liver cancer usually occurs from long-term imbalances. By maintaining a balanced and healthy lifestyle, liver cancer can be prevented.

maintaining a healthy balanced lifestyle overall will help prevent cancer

Western Medicine

Chinese Medicine