**1. Introduction**

Primary liver cancer is a serious disease threatening human health. It was the sixth most frequent cancer, and the second leading cause of cancer death worldwide according to the reports from the International Liver Cancer Association in 2014 [1]. The most common type of liver cancer is hepatocellular carcinoma (HCC), which is originated from hepatocyte. Other types of liver cancer, such as hepatoblastoma and intrahepatic cholangiocarcinoma, are relatively uncommon. Recognized risk factors for liver cancer include viral hepatitis B or C infection, obesity and alcohol abuse. In developing countries such as African countries and China, Hepatitis B or C is the major cause of liver cancer, whereas in developed countries such

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

as the European Union and United States, the predominant cause of liver cancer is cirrhosis caused by alcohol abuse or obesity [2]. In addition, inherited factor may also increase the risk of liver cancer. Recent studies have found that some patients developed liver cancer with inherited susceptible genes from their parents [3]. Usually, liver cancer has no symptoms at the early stages; with the tumor progression, symptoms such as yellow skin, abdominal pain, abdominal mass, nausea or liver dysfunction appear and rapidly deteriorate. Generally, the prognosis of liver cancer is poor, because only 10–20% patients with early detection can receive curative resection surgery. In addition, surgical resection is unavailable for cirrhotic patients as increased risk of fatal complications may occur during resection on cirrhotic livers [4]. Other conventional cancer treatment options such as radiation and chemotherapy are not routinely used for liver cancer as the liver is chemotherapy‐refractory and not tolerant to radiation [5, 6]. In recent decades, several novel targeted therapies have been developed for liver cancer treatment. The National Comprehensive Cancer Network (NCCN) guidelines recommend sorafenib as the standard frontline therapy for patients with unresectable HCC but with well‐ preserved liver function [7, 8]. Other locoregional or adjuvant therapies such as the percuta‐ neous ablation (ethanol injection and radiofrequency ablation), intra‐arterial radiolabeled lipiodol, intra‐arterial chemotherapy, transarterial chemoembolization (TACE), interferon, adoptive immunotherapy and complementary and alternative medicine are recommended for providing opportunity for liver transplantation or extending disease‐free survival and improving survival quality. For patients who are diagnosed with early stage liver cancer, the 5‐year survival rate is about 31%. If the tumor has invaded to the surrounding organs or lymph nodes, the 5‐year survival rate will decrease to 11%. If the cancer has metastasized to distant organs, the 5‐year survival rate is only 3% [9].

Traditional Chinese medicine (TCM) is one of the most popular complementary and alternative medicine in cancer patients worldwide. In China, TCM is based on the foundation of about 2500 years of folk medical practice, which have been covered by the National Health Insurance Program and supported by the government in both Mainland of China and Taiwan. Different from the western medicines that are based on modern human anatomy and pathology, TCM is mainly focused on the identification of functional entities. In the view of TCM, health is based on the harmonious interaction of the internal functional entities and the external environment. The primary functional entities used by TCM include gas (Qi), blood (Xie), internal organs (Zang‐fu) and the meridians (Jing‐luo) that are main channels of communica‐ tion of Qi and Xie in the body and link Zang‐Fu with the superficial areas of the body [10, 11]. There are various forms of TCM, which have been used for cancer patients, such as the herbal remedies, acupuncture, moxibustion, breathing exercise and dietary therapy. These therapies may have potential in improving the overall survival in cancer patients and the survival quality.

#### **2. The understanding of liver cancer in traditional Chinese medicine**

In TCM, liver cancer is associated with the presence of an "abdominal mass" called "zheng jia" . "Zheng" means fixed mass in the abdomen with fixed pain, while "Jia"

refers to abdominal mass occurs intermittently with no fixed pain. According to TCM litera‐ ture, the symptoms of liver cancer include abdominal distention, jaundice, abdominal fullness and oppression. Those symptoms can be concluded as "Jiju" ( ), which means syndromes caused by abdominal lump with pain or swelling. In TCM, the causes of liver cancer can be divided into internal factors and external factors. The internal factors include individual congenital constitution and emotional conditions. The emotions are considered as the major internal causes of liver cancer in TCM. Emotions are regarded as internal, normal, physiolog‐ ical response to stimulus from the external factors. The negative emotions with high intensity and prolonged duration may cause serious damage to the internal organs and influence the healthy condition of the whole body. External factors include unhealthy dietary habits and lifestyle such as alcohol beverage and contaminated food or over exhaustion. These factors can lead to spleen and body disharmony. Other external factors such as the environment also play an important role in the process of tumorigenesis. For example, the wet climate is considered as an induction factor for liver cancer in TCM. Both internal and external factors may cause stagnation of qi, spleen deficiency and the accumulation of dampness, which can eventually lead to liver cancer.

as the European Union and United States, the predominant cause of liver cancer is cirrhosis caused by alcohol abuse or obesity [2]. In addition, inherited factor may also increase the risk of liver cancer. Recent studies have found that some patients developed liver cancer with inherited susceptible genes from their parents [3]. Usually, liver cancer has no symptoms at the early stages; with the tumor progression, symptoms such as yellow skin, abdominal pain, abdominal mass, nausea or liver dysfunction appear and rapidly deteriorate. Generally, the prognosis of liver cancer is poor, because only 10–20% patients with early detection can receive curative resection surgery. In addition, surgical resection is unavailable for cirrhotic patients as increased risk of fatal complications may occur during resection on cirrhotic livers [4]. Other conventional cancer treatment options such as radiation and chemotherapy are not routinely used for liver cancer as the liver is chemotherapy‐refractory and not tolerant to radiation [5, 6]. In recent decades, several novel targeted therapies have been developed for liver cancer treatment. The National Comprehensive Cancer Network (NCCN) guidelines recommend sorafenib as the standard frontline therapy for patients with unresectable HCC but with well‐ preserved liver function [7, 8]. Other locoregional or adjuvant therapies such as the percuta‐ neous ablation (ethanol injection and radiofrequency ablation), intra‐arterial radiolabeled lipiodol, intra‐arterial chemotherapy, transarterial chemoembolization (TACE), interferon, adoptive immunotherapy and complementary and alternative medicine are recommended for providing opportunity for liver transplantation or extending disease‐free survival and improving survival quality. For patients who are diagnosed with early stage liver cancer, the 5‐year survival rate is about 31%. If the tumor has invaded to the surrounding organs or lymph nodes, the 5‐year survival rate will decrease to 11%. If the cancer has metastasized to distant

Traditional Chinese medicine (TCM) is one of the most popular complementary and alternative medicine in cancer patients worldwide. In China, TCM is based on the foundation of about 2500 years of folk medical practice, which have been covered by the National Health Insurance Program and supported by the government in both Mainland of China and Taiwan. Different from the western medicines that are based on modern human anatomy and pathology, TCM is mainly focused on the identification of functional entities. In the view of TCM, health is based on the harmonious interaction of the internal functional entities and the external environment. The primary functional entities used by TCM include gas (Qi), blood (Xie), internal organs (Zang‐fu) and the meridians (Jing‐luo) that are main channels of communica‐ tion of Qi and Xie in the body and link Zang‐Fu with the superficial areas of the body [10, 11]. There are various forms of TCM, which have been used for cancer patients, such as the herbal remedies, acupuncture, moxibustion, breathing exercise and dietary therapy. These therapies may have potential in improving the overall survival in cancer patients and the survival quality.

**2. The understanding of liver cancer in traditional Chinese medicine**

In TCM, liver cancer is associated with the presence of an "abdominal mass" called "zheng jia" . "Zheng" means fixed mass in the abdomen with fixed pain, while "Jia"

organs, the 5‐year survival rate is only 3% [9].

50 Anti-cancer Drugs - Nature, Synthesis and Cell
