Marked Effect of Topical Application of Chinese Medicine Combined with Moxibustion in a Case of Refractory Malignant Ascites in Diffuse Liver Cancer

Abstract

Background: Although diffuse hepatocellular carcinoma (HCC) is rarely enc ountered in clinical practice, it frequently leads to the refractory complication o f malignant ascites. Conventional treatments such as diuretics, therapeutic parac entesis, and intraperitoneal chemotherapy often yield suboptimal outcomes. Case Presentation: We report a detailed case of a 55-year-old female patien t with diffuse HCC (CNLC stage IV, Child-Pugh C), portal vein tumor thromb us, and malignant ascites refractory to diuretics. Following confirmation of the diagnosis,she was treated with a novel approach: topical application of a spe cific herbal paste (containing Asarum sieboldii, Cinnamomum cassia, Zanthoxyl um bungeanum, Astragalus membranaceus, and Solanum nigrum) at the Shenqu e acupoint (CV8) combined with daily one-hour moxibustion. After one month of treatment, her abdominal circumference decreased markedly from 86 cm to 71 cm, and her ECOG performance status improved from 3 to 2. The treatmen t was well-tolerated with no observed adverse effects. Clinical Context: To provide broader clinical context, we briefly note the o utcomes of three additional patients with advanced HCC and malignant ascites managed during the same period: two who received the same herbal paste with TDP irradiation (without moxibustion) showed stabilization of ascites, while o ne untreated patient progressed rapidly. Conclusion: This detailed case report demonstrates that topical traditional C hinese medicine (TCM) therapy combined with moxibustion at the Shenque acu point (CV8) was associated with a marked reduction in refractory malignant as cites in one patient with advanced diffuse hepatocellular carcinoma. The treatm ent was well-tolerated, with no observed adverse effects, and the patient report ed subjective symptom relief and voluntarily continued therapy at home, sugges ting good acceptability. This unique, non-invasive, acupoint-specific combinatori al strategy introduces a novel approach worthy of further investigation. While t hese preliminary findings are hypothesis-generating and supported by contextual observations from three additional patients, they require validation through larg er, controlled studies to establish efficacy, safety, and underlying mechanisms.