Chinese medicine for liver syndromes research
Treatment of chronic liver diseases with traditional Chinese medicine.
Wang BE.
Beijing Friendship Hospital, Capital University of Medical Sciences, PR China.
Traditional Chinese medicine is still being extensively used for treatment of liver disease in China. The anti-viral herbs, Phyllanthus amarus, P. niruri and P urninaria, and Oxymatrine extracted from Sophora flavecientis and S. subprostratae, have been shown to have a remarkable HBV suppressing effect with a serum conversion rate for HBeAg and HBV DNA around 45%, similar to that of IFN-alpha. The anti-inflammatory compound, Stronger NeoMinophagen C (SNMC), is a Japanese preparation of glycerrhizin, extracted from Glyceriza glabra, which has shown an effective rate of ALT and AST normalization and reduction to < 60 U/L in 65.6%, and 73.5% of patients. Compound 861, made of 10 herbs with Salvia miltiorrhiza as its chief component, has been shown experimentally to be effective in suppressing fibrogenesis, enhancing collagen degradation, and inhibiting TIMP expression. Clinically, an open trial of 2,000 patients showed improvement of symptoms in 83% and normalization of serum ALT in 82%. In a controlled study of 107 patients with HBV-related diseases, double liver biopsies showed that the fibrosis reversal rate after 6 months treatment with Cpd 861 was 78% in S2, 82% in S3 (precirrhotic stage) and 75% in S4 (early cirrhosis), as assessed by Scheuer's and Chevallier's criterion. In conclusion, traditional Chinese medicine has great potential in the treatment of chronic hepatitis B.

A survey of Chinese herbal ingredients with liver protection activities.
Wang R, Kong J, Wang D, Lien LL, Lien EJ.
Department of Pharmaceutical Sciences, School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089-9121, USA.
A literature survey was conducted on herbs, their preparations and ingredients with reported liver protection activities, in which a total of 274 different species and hundreds of active ingredients have been examined. These ingredients can be roughly classified into two categories according to their activities: (1) the main ingredients, such as silybin, osthole, coumarin, glycyrrhizin, saikosaponin A, schisandrin A, flavonoids; and (2) supporting substances, such as sugars, amino acids, resins, tannins and volatile oil. Among them, some active ingredients have hepatoprotective activities (e.g. anti-inflammatory, anticancer, antioxidant, immunomodulating and liver cirrhosis-regulating effects). Calculation of physicochemical parameters indicates that the main ingredients with negative and positive E(lumo) values possibly display their hepatoprotective effects through different mechanisms, such as antioxidative, anti-inflammatory and immunomodulating effects. As the combination of herbs may achieve some treatment effects synergistically and/or additively, it is common in Chinese medicine to use mixtures of various medicinal herbs with pharmacologically active compounds to have synergistic and/or additive effects, or to reduce harmful effects of some pharmacologically active compounds. In particular, the active compounds with Clog P around 2 are suitable for passive transport across membranes and accessible to the target sites. Thus, E(lumo) and Clog P values are good indicators among the calculated parameters.Seven different physicochemical parameters (MW, Clog P, CMR, mu, E(lumo), E(lumo) and H(f)) and four major biological activities (antioxidant, anti-inflammatory, antiviral/antitumor and immunomodulating) are discussed in this review. It is hoped that the discussion may provide some leads in the development of new hepatoprotective drugs.

Effect of traditional Chinese herbs for nourishing the liver on intracellular free calcium level in gallbladder cells of guinea pigs with gallstones
Shen P, Fang BJ, Zhu PT, Zhang JZ, Pei XJ.
Department of Hepatobiliary Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032.
OBJECTIVE: To observe the changes of intracellular free calcium level ([Ca(2+)]i) in gallbladder cells of guinea pigs with gallstones so as to study the mechanisms of gallstone formation and the prevention and treatment function of traditional Chinese herbs for nourishing the liver. METHODS: Eighty guinea pigs were randomly divided into four groups, which were normal control group, untreated group, nourishing-liver Chinese drug (NLCD) group and ursodeoxycholic acid (UDCA) group, with 20 guinea pigs in each group. Gallstones were induced in the guinea pigs of the latter 3 groups by the feed of diet inducing cholelithiasis with high cholesterol, while the corresponding medicines were used in NLCD group and UDCA group for prevention and treatment for 7 weeks. Then the state of the guinea pigs, the formation of gallstones, and the changes of [Ca(2+)]i in gallbladder cells were observed. RESULTS: The [Ca(2+)]i in gallbladder cells of guinea pigs in the untreated group was decreased significantly. NLCD improved the behavioral signs of the guinea pigs, significantly decreased the formative rate of gallstones and increased the [Ca(2+)]i in gallbladder cells. CONCLUSIONS: The [Ca(2+)]i in gallbladder cells is the important factor for contractile function of gallbladder and the information of gallstones. Traditional Chinese herbs for nourishing the liver may significantly increase the [Ca(2+)]i in gallbladder cells to facilitate contraction of the smooth muscle cells of gallbladder and relieve the cholestatis. It may be one of the mechanisms of traditional Chinese herbs for nourishing the liver in preventing and treating cholelithiasis.

Herbal medicine in the treatment of liver diseases.
Stickel F, Schuppan D.
Institute of Clinical Pharmacology, University of Berne, Murtenstrasse 35, CH-3010 Berne, Switzerland.
Herbal drugs have become increasingly popular and their use is widespread. Licensing regulations and pharmacovigilance regarding herbal products are still incomplete and clearcut proof of their efficacy in liver diseases is sparse. Nevertheless, a number of herbals show promising activity including silymarin for antifibrotic treatment, phyllantus amarus in chronic hepatitis B, glycyrrhizin to treat chronic viral hepatitis, and a number of herbal combinations from China and Japan that deserve testing in appropriate studies. Apart from therapeutic properties, reports are accumulating about liver injury after the intake of herbals, including those advertised for liver diseases. Acute and/or chronic liver damage occurred after ingestion of some Chinese herbs, herbals that contain pyrrolizidine alkaloids, germander, greater celandine, kava, atractylis gummifera, callilepsis laureola, senna alkaloids, chaparral and many others. Since the evidence supporting the use of botanicals to treat chronic liver diseases is insufficient and only few of them are well standardised and free of potential serious side effects, most of these medications are not recommended outside clinical trials. Particularly with regard to the latter, adequately powered randomised-controlled clinical trials with well-selected end points are needed to assess the role of herbal therapy for liver diseases.

Chinese herbal medicine and chemotherapy in the treatment of hepatocellular carcinoma: a meta-analysis of randomized controlled trials.
Shu X, McCulloch M, Xiao H, Broffman M, Gao J.
Pine Street Foundation, San Anselmo, CA 94960, USA.
BACKGROUND: Hepatocellular carcinoma (HCC), one of the most common malignancies worldwide, is highly resistant to standard therapy. It is unclear whether chemotherapy, arterial embolization, or arterial chemoembolization improve survival advantage enough to justify their high toxicity. Treatment with Chinese herbal medicine has been explored, combining herbs that stimulate host immune response with those that have cytotoxic activity against HCC cells. The authors sought to evaluate the effectiveness of Chinese herbal medicine combined with chemotherapy. The hypothesis was that Chinese herbal medicine added to chemotherapy for the treatment of HCC would improve survival and tumor response, when compared to treatment with chemotherapy alone. METHODS: The authors searched the databases TCMLARS, PubMed, and EMBASE as well as the bibliographies of studies identified in the systematic search for potentially relevant titles or abstracts of studies in any language. They retained those that (1) treated only HCC patients, (2) were described as randomized or reported that there was no statistical difference between treatment groups, (3) gave patients either Chinese herbal medicine therapy combined with chemotherapy in the treatment group or chemotherapy alone in the control group, and (4) provided data on the number of enrolled subjects and responders and nonresponders for tumor response and survival. The authors used random effects meta-analysis to combine data. RESULTS: Twenty-six studies representing 2079 patients met the inclusion criteria. Chinese herbal medicine combined with chemotherapy, compared to chemotherapy alone, improved survival at 12 months (relative risk [RR], 1.55; 95% confidence interval [CI], 1.39-1.72; P < .000), 24 months (RR, 2.15; 95% CI, 1.75-2.64; P < .000), and 36 months (RR, 2.76; 95% CI, 1.95-3.91; P < .000). Tumor response increased (RR, 1.39; 95% CI, 1.24-1.56; P < .000). CONCLUSIONS: These findings provide promising evidence that combining Chinese herbal medicine with chemotherapy may benefit patients with HCC. Because of the low quality of these studies, these findings should be confirmed through conducting high-quality, rigorously controlled trials.

Analysis of literature on therapeutic methods and medicines of traditional Chinese medicine for primary liver cancer
Liu Q, Zhang YB, Ma CH, Yue XQ, Ling CQ.
Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
OBJECTIVE: To find out the rules of therapeutic methods, formulas and medicines of traditional Chinese medicine (TCM) for primary liver cancer (PLC). METHODS: The frequencies of treatments and medicines of TCM in 978 pieces of documents concerning PLC were analyzed. RESULTS: Among the 165 therapeutic methods, 277 formulas and 459 kinds of herbs, the methods for activating blood circulation, the formulas for regulating qi-flowing and the herbs for invigorating qi are the most commonly used. CONCLUSION: Therapeutic methods such as invigorating qi, regulating qi-flowing and activating blood circulation are the main choices for PLC, and the methods such as clearing heat, removing dampness and nourishing yin are used as supplements.

Anti-proliferative and pro-apoptotic effects of herbal medicine on hepatic stellate cell.
Chor SY, Hui AY, To KF, Chan KK, Go YY, Chan HL, Leung WK, Sung JJ.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Hepatic stellate cells (HSC) play a central role in hepatic fibrosis and compounds that promote apoptosis in HSC may have anti-fibrotic potentials. Herbal medicine has long been used in chronic liver disease but there is little scientific evidence for their actions. The present study investigated the effects of 14 commonly used herbs on cellular proliferation and apoptosis of a rat hepatic stellate cell line, HSC-T6 and the underlying mechanism of herb-induced apoptosis. HSC-T6 cell were incubated with herbal extracts and their proliferation was assessed by colorimetric assay. Apoptosis was measured and confirmed by flow cytometry, terminal transferase uridyl nick end labeling (TUNEL) assay and morphological features in hematoxylin and eosin staining. Apoptotic pathways involving Fas receptor and Bcl-2 family were investigated by Western blot. Five herbs, namely Angelica sinensis (AS), Carthamus tinctorius (CT), Ligusticum chuanxiong (LC), Salvia miltiorrhiza (SM) and Stephania tetrandra (ST) demonstrated both anti-proliferative and pro-apoptotic activities in HSC-T6. The highest potency was detected in SM and ST with 51.63 and 44.52% of HSC-T6 showing apoptotic changes, respectively. This was associated with upregulation of Fas and Bax and down-regulation of Bcl-xL in HSC. Fas ligand and Bcl2 expressions remained unchanged. The potential anti-fibrotic effect of herbal medicine warrants further evaluation.

Clinical study on comprehensive treatment of primary liver cancer mainly with chinese medicinal perfusion/embolization
Xu K, Luo HY, Li LN.
Second Clinical Medical College, Guangzhou University of TCM, Guangzhou
OBJECTIVE: To study the clinical efficacy and adverse reaction of comprehensive therapy mainly with Chinese anti-cancer medicinal perfusion/embolization and assisted with Chinese drug-therapy based on TCM Syndrome Differentiation in treating primary liver cancer. METHODS: Forty-one patients with liver cancer were divided into the treated group and the control group. To the treated group turmeric oil microballoon, cinobufotalin, Aidi injection and iodized oil were given via hepatic artery perfusion/embolization, and to the control group chemotherapeutic agents and iodized oil were given for instead. Besides, both groups were given Chinese herbs according to TCM Syndrome Differentiation additionally. RESULTS: The tumor inhibitory rate in the treated group and the control group was 77.78% and 69.57% respectively, with insignificant difference between them. The improvement of fatigue and anorexia in the treated group was better than that in the control group (P < 0. 05). The 6-month, 12-month and 24-month survival rate in the treated group and control group was 61.11% vs 56.62%, 27.78% vs 30.43% and 22.22% vs 26.09%, respectively, the difference between the two groups was insignificant. The occurrence of adverse reactions such as decreasing of white blood cells, platelet and hemoglobin, nausea and vomiting were obviously lower in the treated group than those in the control group (P < 0.05). CONCLUSION: Chinese anti-cancer medicinal perfusion/embolization has affirmative short-term clinical effect in treating primary liver cancer with few adverse reactions, which was tolerable to patients, but its long-term clinical efficacy needs further observation.

Investigation on the molecular mechanisms of anti-hepatocarcinoma herbs of traditional Chinese medicine by cell cycle microarray
Wang GL, Chen CB, Gao JM, Ni H, Wang TS, Chen L.
Molecular Cytogenetics Lab, Nankai University, Tianjin 300071, China.
OBJECTIVE: To design DNA microarray and investigate the molecular anti-tumor mechanism of herbs of traditional Chinese medicine. METHOD: cDNA microarrays consisting of 56 probes representing 24 human cell cycle genes were constructed, Four anti-hepatocarcinoma herbs including Radix Linderae, Hebra Artemisiae Annuae, Radix Amebiae, Radix Astragli, were chosen. Effects of herbs on SMMC-7721 cell cycle were observed by flow cytometry assay. Effects of herbs on cell cycle gene expression in SMMC-7721 cells were analyzed by comparing hybridization of Dig-Labeled cDNAs from herb-treated cells and cDNAs from untreated cells. RESULT: Expressions of cell cycle geneswere changed in different degrees after herbs treated. Some genes were down-regulated and some genes were up-regulated. The changes in gene expression agreed with the results of flow cytometry assay. CONCLUSION: The results suggest that these herbs may have effects on cell cycle and DNA damage checkpoint genes which may be the mechanism of the herbs, and DNA microarray can be used to investigate the biological function of extracts of traditional Chinese medicine.

Studies on treatment of fatty liver with traditional Chinese medicine
Xu LM, Hu YY.
Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
Great progress has been made in the study of fatty liver with integrated traditional Chinese and western medicine in aspects of diagnosis, treatment and experimental study, etc. Most researches were designed to utilize diagnostic or model replicating method of western medicine to observe the effects or investigate the action mechanism of compound recipe, single Chinese herb or effective ingredients of Chinese herbs on fatty liver. According to the pathological mechanism of traditional Chinese medicine (TCM), fatty liver is characterized by deficiency in nature and repletion in appearance, which involves three Zang viscera such as liver, spleen and kidney and manifests as spleen Qi deficiency, liver and kidney deficiency, phlegm and dampness heaping internally, and Qi stagnation and blood stasis. This facilitates us to use specific recipe or modified recipe to treat fatty liver from the points of integrated traditional Chinese and western medicine and combining syndrome differentiation with disease differentiation. With gratifying achievement, this kind of approach has been the mainstream of the research on fatty liver and many researchers have reached an agreement on this point domestically. Spleen Fortifying and Blood Invigorating Recipe (SFBVER in brief, invented by our institute) can significantly improve the B ultrasound outcome of the liver in patients with fatty liver, with significant difference in B ultrasound scoring between pre-and post-treatment. It can alleviate the patients' symptoms, improve or regain liver function, decrease waist/buttocks ratio and the content of triglyceride and cholesterol in blood. SFBVER is superior to Dongbao Gantai Recipe in general effective rate. Experimental study also reveals that SFBVER can alleviate CCl(4) induced liver cell fatty degeneration and the inflammatory cell infiltration in rats, decrease the activities of ALT and AST, lower the content of triglyceride in liver, recover SOD activity in liver to normal level. The overall efficacy of SFBVER is superior to that of Dongbao Gantai Recipe. Further correlated study should be focused on inventing new preparation of traditional Chinese medicine and investigating its action mechanism with the guiding of the theory of TCM and referring to the latest discovery in fatty liver research in modern medicine.

Experimental study on effects of herbs for nourishing and smoothing the liver in reversing bile lithogenicity of guinea pig
Zhang JZ, Yuan ZB, Gao J, Zhang XL, Shen P, Jiao YZ, Zhu PT.
Department of Biliary Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
OBJECTIVE: To further probe the mechanisms of herbs for nourishing and smoothing the liver in reversing bile lithogenicity of guinea pig. METHODS: Sixty guinea pigs were divided randomly into control group (fed with normal diet, n=20), model group (fed with lithogenic diet, n=20) and treatment group (fed with lithogenic diet plus herbal medicine, n=20). After four-week feeding, the animals were sacrificed and sampled, the rates of gallstone formation in each group were estimated, and the total bile acid (TBA), total bilirubin (TBIL), conjugated bilirubin (CB), unconjugated bilirubin (UCB), and calcium ion in the bile were determined, and the different bilirubins were analyzed by HPLC. RESULTS: (1) The rate of gallstone formation was 5% in normal group, 81.25% in model group and 31.25% in treatment group (P<0.05). (2) The bile TBIL, CB, UCB and Ca(2+) were higher and the bile TBA was lower significantly in model group than that in the other two groups (P<0.05). (3) HPLC analysis revealed that MCB was higher and DCB was lower significantly in model group (P<0.01), and there were no significant differences of UCB and IPA among the three groups. (4) The percentages of MCB and UCB were much higher and the percentage of DCB was remarkably lower in model group (P<0.05). CONCLUSION: Herbs for nourishing and smoothing the liver can significantly reduce the rate of gallstone formation and has effect of reversing lithogenicity of bile in guinea pigs fed with lithogenic diet.

Pathological study of the therapeutic effect of wen-yang herbs on experimental liver cirrhosis
Wang LC, Lei BJ, Li L, Zhao JB.
Department of Infectious Disease, West China Hospital, Sichuan University, Chengdu 610041, China.
OBJECTIVE: To observe the pathological effect of wen-yang herbs on experimental hepatic fibrosis. METHODS: Thirty-two male Wistar rats were used in this study comprising four groups. To start with, 24 rats of three groups were given subcutaneous injection of CCl4 and drinking 10% alcohol so as to make the model of hepatic fibrosis. After the establishment of the pathologic model, the rats were divided into the model group, the pathological control group and the therapeutic group by randomization. The rats of the therapeutic group were given the herbal remedies via gastrogavage, q.d. x 30. The rats of the pathological control group were given normal saline via gastrogavage, q.d. x 30. Then liver tissue Hydroxyproline (Hyp) content was examined in these 3 groups and the normal group. Quantitative marks were done according to a modified semiquantitative scoring system (SSS). The results of SSS marks and Hyp contents were analysed using Pearson's coefficient of correlation. RESULTS: The Hyp content and SSS marks of the therapeutic group decreased remarkably as compared with those of the control group (P<0.01), and the SSS marks had a strong positive correlation with Hyp content (r=0.804). CONCLUSION: Wen-yang herbs can mitigate the rats' hepatic fibrosis and promote a recovery of their experimental illness.

Traditional Chinese medicine prevents inflammation in CCl4-related liver injury in mice.
Li MY, Ryan P, Batey RG.
Cathay Herbal Laboratories.
Alternative medicines are being increasingly used and investigated in the management of a variety of disorders. Hepatitis is a common indication for the use of alternative therapies but evidence for the efficacy of many compounds is lacking. We have utilized a well-defined model of liver injury to study the efficacy of three herbal products designed to assist in the management of liver disease. Mice were exposed to carbon tetrachloride (CCL4) given intragastrically after they had been pretreated for five days with either saline or one of four doses of silymarin extract or CH100 (a Chinese herbal medicine comprising of 19 herbs) or one of two doses of CH101 (a Chinese herbal preparation designed to reduce fibrosis). Animals were sacrificed 24 hours after receiving CCL4. Liver enzymes and hepatic histology formed the basis for evaluating efficacy of the treatments. Each of the alternative medicines reduced the alanine amino transferase (ALT) elevation demonstrated after CCL4 injection. The high dose CH100 regimen was most effective in protecting against injury and this was confirmed with hepatic histology. Other doses of CH100, CH101 and silymarin were not shown to provide protection against the histological damage. In conclusion, Silymarin, CH100 and CH101 are able to reduce ALT elevation in animals exposed to CCL4. High dose CH100 provides protection from hepatocyte necrosis in this model. The data add to our understanding of the capacity some herbal medicines have to modify the reaction of the liver to a variety of insults and suggest the value of studying these agents further in human liver diseases.

Liver-protective activities of aucubin derived from traditional oriental medicine.
Chang IM.
Natural Products Research Institute and Graduate Studies in Natural Products Science, Seoul National University, Korea.
The iridoid glycosides including aucubin (AU), catalpol (CA), swertimarin (SW), and gardenoside (GA) are frequently found as natural constituents of many traditional oriental medicinal plants including Chinese herbs. Among these iridoid glycosides, AU was systematically studied for its potent liver-protective activities using experimental systems of hepatic damage. AU showed high liver-protective activity against carbon tetrachloride-induced hepatic damage in mice. Also AU showed significant protective activity against alpha-amanitin-induced hepatic damage in mice, and it prevented a depression of liver RNA biosynthesis caused by alpha-amanitin administration. Potent antidotal effects on mushroom poisoning in beagle dogs ingested with aqueous extract of Amanita virosa was observed; beagle dogs completely survived, even when AU administration was withheld for half an hour after mushroom poisoning. In addition, AU was found to suppress hepatitis B viral DNA replication in vitro. Conversion of AU to its aglycone form appeared to be a prerequisite step for an exhibition of such antiviral activity.

Experimental study of preventing liver cirrhosis by using four kinds of Chinese herbs
Wang ZL.
Dept. of Gastroenterology, Shanxi Institute of TCM, Taiyuan.
55 rats were divided into six groups; (1) normal control, (2) cirrhosis control, (3-6) Chinese herbs groups, 2-6 groups were liver cirrhosis model caused by combined factor dominated by CCl4, and 3-6 groups were given Chinese herbs simultaneously until the end of sixth week. Radix Salviae miltlorrhizae (RSM) were used in group 3, Flos Carthami (FC) in group 4, Radix Angelicae sinensis (RAS) in group 5, Semen persicae (SP) in group 6. The results: in group 2, 7 out of 9 rats developed into cirrhosis, the degree of fibrosis was 2.55+ and collagen protein content was 35.3 mg/g.liver, SGPT 387u. In group 3(RSM), no cirrhosis was found, the degree of the fibrosis was 0.43+ (compared with group 2, P < 0.01, collagen protein content was 16.7 mg/g.liver (P < 0.01), SGPT 132u (P < 0.01). In group 4(FC), 8 out of 9 rats did not develop into cirrhosis, collagen content 21.1 mg/g.liver, compared with group 2, P < 0.05. In the group of 5 and 6, some rats were developed into cirrhosis. The result showed that RSM and FC possessed an inhibitory effect on fibrogenesis. The effect of RSM was remarkable. It could prevent experimental cirrhosis. The effect of RAS and SP were uncertain. This experiment predicted that RAM would become the promising drug to restrain chronic hepatic disease from developing into cirrhosis clinically.

Treatment of chronic liver injury in mice by oral administration of xiao-chai-hu-tang.
Amagaya S, Hayakawa M, Ogihara Y, Ohta Y, Fujiwara K, Oka H, Oshio H, Kishi T.
Faculty of Pharmaceutical Science, Nagoya City University, Japan.
Oral administration of Xiao-Chai-Hu-Tang, the extract of a mixture of seven herbs, attenuated the hepatic fibrosis developed in mice after repeated doses of carbon tetrachloride. Its pre-administration reduced the derangement of liver function tests seen after a single dose of carbon tetrachloride as well as that seen after d-galactosamine intoxication. Xiao-Chai-Hu-Tang may be effective in the treatment of chronic liver injury through hepatocytoprotection.

Analysis of 70 cases of primary liver carcinoma treated by pu tuo ointment and herbs
Wang DL.
Shundong, Provincial Hospital Jinan.
This paper deals with 70 cases of primary liver cancer treated by externally applying Pu Tuo plaster and internally taking oral Chinese herbal medicine. In term of the statistic, of all the cases applied the plaster, 96.7% has proved to be effective in alleviating the pain, 83.5% was remarkable. It has significantly improved the quality of the patients' later lifes. Applying Pu Tuo plaster with taking oral Chinese herbal medicine, the patients could survive longer. On average, after the treatment, the patient could live ten and half months, 44.8% of the II-stage liver cancer patients applied the plaster could live as long as one year, the longest one has been living more than 2 years and 8 months, he looks still well now. He has been working since 1987. In recent B-ultrasonic examination, the patient's primary focus disappeared, and alpha-fetoprotein test turned to be negative.

Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer.
Li QS, Cao SH, Xie GM, Gan YH, Ma HJ, Lu JZ, Zhang ZH.
Research Center on Pain, Zhong Shan Hospital, Shanghai Medical University.
In the evaluation of Chinese herbs (A), ear-acupuncture (B) and epidural morphine (C) to relieve postoperative pain and abdominal distension, sixteen male patients with primary liver cancer were observed. This study was conducted by means of orthogonal experiment and double blind, randomized design. The patients received various treatments according to the display of the orthogonal table L16(2)15 which corresponds to 2(3) factorial experiment design. C+ (morphine 2 mg) was given before the peritoneum was sutured. A+ (orally administered) and B+ were given 24 hours after operation. 50-100 mg of pethidine was given when the pain intensity VAS (0-100) exceeded 50-70. The observation parameters included plasma leucine enkephalin (LEK), postoperative total dosage of narcotics administered for 5 days, VAS for pain and pain reliever, abdominal distension, urinary retention, constipation, etc. The results were as follows: a. Patients who had received A (A+B+C+, A+B+C-, A+B-C-, A+B-C+); C (C+A+B+, C+A+B-, C+A-B+, C+A-B-), or B (B+A+C+, B+A+C-, B+A-C+, B+A-C-) produced better analgesic effects than those who had received placebo. The A, B, and C reduced narcotics 650, 450 and 550 mg respectively when compared with placebo. The effects of A and C were of statistical significance (P < 0.05), while AB, BC, and AC interactions were not found; b. A and B minimized abdominal distension and urinary retention, while C prolonged them. As compared with the placebo, A and B accelerated restoration of bowel peristalsis (P < 0.05, ANOVA). Both A and B decreased it for 165 hours, while epidural morphine prolonged it for 49 hours.

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