📘 Outline
Patterns and Pharmacologic Responses of Hepatocellular Carcinoma in Taeeumin and Soeumin Constitutions
Case 1: A Taeeumin Patient with a 400% Tumor Increase within 10 Days after Lenvatinib (Lenvima)
Case 2: A Soeumin Patient Successfully Treated with Atezolizumab (Tecentriq) + Bevacizumab (Avastin) Combined with Herbal Medicine
Case 3: A Taeeumin Patient Whose Tumor Initially Decreased after Radiation Therapy but Subsequently Disseminated after TACE with Adriamycin, Leading to Death
Case 4: A Soeumin Patient with Recurrent Liver Cancer and Pulmonary Metastasis after Hepatic Lobectomy and Radiofrequency Ablation, Treated with Capecitabine (Xeloda) and Herbal Medicine
📘 Introduction
Today, I would like to discuss both the conventional treatment protocols for hepatocellular carcinoma and the more recently developed, novel drug-centered therapeutic approaches that are increasingly being utilized.
In addition, I will present the clinical significance and therapeutic implications of classifying anticancer agents according to Sasang constitutional medicine, and how this constitution-based stratification may influence treatment outcomes.
1) Patterns of Hepatocellular Carcinoma in Taeeumin and Soeumin Constitutions and Their Pharmacologic Implications
In Western medicine, hepatocellular carcinoma (HCC) is commonly classified into morphological types such as the nodular type, multifocal type, and infiltrative type.
From the perspective of Sasang constitutional medicine, a distinctive pattern emerges:
- The nodular type is more frequently observed in Taeeumin patients.
- The infiltrative type tends to be more common in Soeumin patients.
- The multifocal type appears to occur in both constitutions without a clear predominance.
This correspondence suggests a potential relationship between constitutional type and tumor growth pattern, which may have important implications for therapeutic strategy and drug responsiveness.
| Classification Aspect | Western Medicine Classification | Taeeumin (Sasang Type) | Soeumin (Sasang Type) | Remarks |
|---|---|---|---|---|
| Tumor Morphology | Nodular Type | Predominant | Less common | Often presents as a single, large mass |
| Infiltrative Type | Less common | Predominant | Diffuse, spreading pattern | |
| Multifocal Type | Present | Present | Occurs in both constitutions without clear predominance | |
| Clinical Implication | Growth Pattern | Expansile, localized | Diffuse, invasive | May influence treatment strategy |
| Pharmacologic Implication | Drug Responsiveness | May differ by constitution | May differ by constitution | Suggests need for constitution-based therapeutic approach |
Standard treatment for hepatocellular carcinoma has traditionally been dominated by transarterial chemoembolization (TACE). However, in recent years, the emergence of novel agents has significantly changed the treatment landscape. Regimens such as atezolizumab combined with bevacizumab are now widely used as first-line therapies for HCC. In addition, targeted agents such as sorafenib and lenvatinib are also commonly utilized.
However, if these treatments are not matched to the patient’s constitutional type, they may lead to serious and potentially fatal adverse effects.
In patients whose constitution is well suited to a given therapy, these agents can produce excellent clinical outcomes. In conventional Western medicine, lack of efficacy is often interpreted simply as “no response.” However, I argue that in some cases, this is not merely a lack of response, but rather an active worsening of the disease.
In addition, there is a drug called Imfinzi (durvalumab), which has recently begun to receive insurance coverage for hepatocellular carcinoma. This agent was originally used in biliary and pancreatic cancers, and now appears to be expanding into the HCC treatment domain.
From the perspective of Sasang constitutional medicine, I consider this drug to be more suitable for Taeeumin patients. In contrast, I have observed multiple cases in which Soeumin patients experienced a dramatic worsening after its use.
For example, there was a patient who had been warned that receiving this treatment twice could be fatal. Despite this, the patient proceeded with Imfinzi treatment, incurring significant financial cost. Following administration, the tumor increased by several tens of times in volume within approximately three months.
Therefore, while the introduction of Imfinzi into the HCC treatment field with insurance coverage is certainly a positive development—particularly for Taeeumin patients—it may be potentially dangerous for Soeumin patients. This, however, remains my personal clinical observation and interpretation.
| Drug Name | Mechanism | Target | Brand Name | Constitution (Sasang Type) |
|---|---|---|---|---|
| Atezolizumab | Immune checkpoint inhibition (PD-L1 blockade → T-cell activation) | PD-L1 | Tecentriq | Soeumin |
| Bevacizumab | Anti-angiogenesis (VEGF inhibition → reduced tumor blood supply) | VEGF-A | Avastin | Soeumin |
| Sorafenib | Multi-kinase inhibition (RAF, VEGFR, PDGFR) → anti-proliferation + anti-angiogenesis | RAF / VEGFR / PDGFR | Nexavar | Taeeumin |
| Lenvatinib | VEGFR and FGFR inhibition → suppression of angiogenesis and tumor growth | VEGFR / FGFR | Lenvima | Soeumin |
| Regorafenib | VEGFR, TIE2, RAF inhibition → anti-angiogenic + anti-proliferative | VEGFR / TIE2 / RAF | Stivarga | Taeeumin |
| Cabozantinib | MET and VEGFR2 inhibition → anti-invasion/metastasis + anti-angiogenesis | MET / VEGFR2 | Cabometyx | Unclassified |
| Nivolumab | Immune checkpoint inhibition (PD-1 blockade → T-cell activation) | PD-1 | Opdivo | Taeeumin |
| Adriamycin | DNA intercalation + Topoisomerase II inhibition + free radical generation → induces apoptosis | DNA / Topoisomerase II | Adriamycin | Soeumin |
Therefore, for patients undergoing treatment for hepatocellular carcinoma, I would like to present a report on the constitutional classification of these drugs, along with previous clinical applications of Xeloda in liver cancer treatment.
To illustrate this, I will discuss two recent cases I observed involving Lenvima. In both cases, Taeeumin patients showed a remarkably rapid progression of tumor growth after administration of this drug.
Was this simply a failure to suppress tumor growth? Or did the mismatch with the patient’s constitutional type actually accelerate tumor progression?
My consistent view has been that anticancer agents that do not match the patient’s constitution are not merely ineffective, but may in fact be worse than not using them at all.
These issues certainly require rigorous scientific validation. However, in the current state of Western medicine—where pharmacogenomics has not yet been fully translated into routine clinical practice—the use of newly developed drugs without such stratification may, in some cases, lead to unexpectedly severe and detrimental outcomes.
2) Case 1: A Taeeumin Patient with a 400% Tumor Increase within 10 Days after Lenvatinib (Lenvima)
In a recent case I observed, a patient experienced a 400% (fourfold) increase in tumor volume within just 10 days after initiating Lenvima. Despite investing a significant amount of money with high expectations for this new therapy, the outcome was devastating.
The patient’s mother came to me for consultation with the available records. When I asked her to bring the previous medical data, she replied that the young couple felt such distress toward the treating hospital that they were unwilling to return even to obtain the official medical records.
From the perspective of a young patient with limited financial resources, it is understandable that they placed high hopes in a costly, non-reimbursed treatment. However, given that the condition deteriorated so rapidly, it is also understandable that they might feel resentment toward the treating physician.
Pharmaceutical companies may argue that this type of classification lacks sufficient evidence. However, this is not an issue that should be overlooked. It is natural for patients to place hope in newly developed therapies when facing serious illness. Yet, if a treatment leads to a situation in which a tumor that might have progressed slowly instead grows and spreads rapidly, the clinical concern becomes significant.
Rather than focusing solely on proving causality in each instance, a constitution-based framework such as Sasang medicine may offer a practical approach to minimizing such risks in clinical settings.
3) Case 2: A Soeumin Patient Successfully Treated with Atezolizumab (Tecentriq) + Bevacizumab (Avastin) Combined with Herbal Medicine
The current first-line treatment for hepatocellular carcinoma is Tecentriq (atezolizumab) combined with Avastin (bevacizumab). One patient who came to see me had been told at the hospital that without treatment the prognosis was poor, and that undergoing therapy might extend survival by only about three to four months. The patient questioned whether it was worth enduring the considerable burden of anticancer treatment for such a limited extension of life, and sought consultation.
As this patient was identified as a Soeumin type, I recommended this regimen. When combined with herbal medicine, the patient showed a remarkable response: the PIVKA-II level decreased from 23,483 to 19 within four months, and the tumor nearly disappeared.
However, due to underlying cirrhosis, the patient eventually developed esophageal variceal bleeding and underwent liver transplantation. The patient has since been doing well.
In this case, the therapy was well matched to the patient’s constitution. Despite the tumor having been diffusely disseminated throughout the liver, with a poor prognosis given at the hospital and even portal vein obstruction present, the portal vein reopened and the tumor nearly disappeared.
Therefore, even newly developed therapies can offer meaningful hope when they align well with a patient’s constitution. However, if a drug is mismatched to the individual, it may, in some cases, lead to a more rapid deterioration. This is my perspective from the standpoint of Sasang constitutional medicine.
From the viewpoint of Western medicine, efficacy is established through extensive experimentation and statistical validation. However, statistical outcomes do not always fully capture individual clinical realities. Even when a drug is considered highly effective on a population level, there are cases in which the disease progresses unexpectedly fast—sometimes even more rapidly than its natural course.
| 날짜 | 2022/9/2 | 2022/9/13 | 2022/9/19 | 2022/10/18 | 2022/11/10 | 2022/12/6 | 2022/12/29 | 2023/1/7 |
| PIVKA-II | 23483 | 20130 | 15150 | 6704 | 895 | 111 | 49 | 19 |
Abnormal Form of Prothrombin
Under normal conditions, prothrombin undergoes vitamin K–dependent γ-carboxylation.
👉 When this process does not occur, an abnormal form of the protein is produced.
👉 This is referred to as:
PIVKA = Protein Induced by Vitamin K Absence
⚠️ Clinical Significance in Liver Cancer
Commonly used together with AFP (alpha-fetoprotein)
A tumor marker for hepatocellular carcinoma (HCC)
In my clinical experience, many hepatocellular carcinoma patients undergoing TACE have been treated with Adriamycin. In Taeeumin patients, I have often observed very rapid tumor progression leading to death. From the patient’s perspective, they are usually unaware that a constitutionally mismatched drug may have been used, and instead accept the situation as the cancer itself being inherently aggressive, which I find deeply unfortunate. I plan to document and present these cases in the future.
In contrast, I encountered one case in which, although I do not know which physician was responsible, Taxol was used in TACE. The patient was a Taeeumin type, and after receiving Taxol-based treatment, the outcome was remarkably favorable.
4) Case 3: A Taeeumin Patient Whose Tumor Initially Decreased after Radiation Therapy but Subsequently Disseminated after TACE with Adriamycin, Leading to Death
This occurred last year. A colleague of mine presented with advanced-stage hepatocellular carcinoma. The tumor involved the entire right lobe of the liver, making TACE initially not feasible. As the patient was a Taeeumin type, I advised undergoing radiation therapy only, and if TACE were to be considered, to use lipiodol alone.
He strongly requested his physician to proceed with radiation therapy alone, and this approach was accepted. He did not use any herbal medicine. Since he only came to me for consultation, he relied entirely on conventional Western treatment.
After some time, I was informed that the tumor had decreased by nearly half.
Subsequently, as the tumor had markedly decreased, the attending physician suggested that performing TACE could eliminate the tumor more quickly. The patient proceeded with TACE, setting aside the prior cautions I had emphasized. Following this, the disease disseminated throughout the liver, and he remained hospitalized for three months before ultimately passing away.
These issues arise because conclusions derived from scientific research are translated into clinical practice through statistical validation and then adopted as standard therapies. However, this can also reflect a limitation of statistics. Selecting a drug based primarily on relatively higher probabilities may overlook important individual variations, and in that sense, it may not fully capture the complexity of clinical reality.
At present, in the absence of alternative frameworks, this approach is regarded as “scientific,” and Sasang constitutional medicine is often subject to criticism.
From my perspective, however, relying solely on probabilistic selection at the endpoint of science can resemble a form of oversimplification. It is not unlike a lottery in that individual variability is not fully accounted for. Anticancer agents are highly potent, and when mismatched to a patient’s constitution, they may, in my view, accelerate deterioration.
This view is supported by clinical observations in which patients who worsened under one anticancer agent—presumably due to a mismatch—showed improvement after switching to another agent more aligned with their constitution, particularly when sufficient physiological reserve remained. If the deterioration had been solely due to natural disease progression, such rapid reversal with a different agent would be difficult to explain.
All of these observations suggest that my Sasang-based classification system will ultimately require scientific and genetic validation in order to become widely accepted. However, at present, it provides a very important clinical clue for predicting prognosis in patients with cancer.
If integrated with Western pharmacogenomics, this approach could become a promising pathway for research and may offer new possibilities for improving outcomes in many cancer patients.
5) Case 4: A Soeumin Patient with Recurrent Hepatocellular Carcinoma after Hepatic Lobectomy and Radiofrequency Ablation, Treated with Xeloda (Capecitabine) and Herbal Medicine
xeloda 와 한약으로 치료한 말기 간암환자.
This patient underwent hepatic lobectomy in October 2002 for a tumor located in the right lobe of the liver. Eleven months later, the cancer recurred, and radiofrequency ablation (RFA) was performed.
Four months later, the tumor recurred at the surgical site. The disease had also spread into the abdomen, with two sites of lymph node metastasis identified adjacent to the liver.
Three months later, the tumor had grown further and began to involve the left lobe of the liver.
| 원문 (English) | 번역 (Korean) |
| CT 2004-05-04 | CT 2004년 5월 4일 |
| Two large peritoneal metastatic lesions in the right upper abdomen. | 우상복부에 복막 전이 병변 2개가 크게 관찰됨 |
| Two small pulmonary metastatics lesions. | 폐에 작은 전이 병변 2개가 관찰됨 |
| No evidence of newly – developed hepatocellular carcinoma in the left liver. | 좌엽 간에는 새롭게 발생한 간세포암의 증거는 없음 |
| Irregular small and medium–sized low – attenuating lesion in portal phase CT scans: consistent with eosinophilic infiltration. | 문맥기 CT에서 불규칙한 소형 및 중간 크기의 저음영 병변이 관찰되며, 호산구 침윤과 일치함 |
| 요망: Please check peripheral eosinophilia. | 요청: 말초혈액 호산구 증가 여부를 확인 요망 |
The patient presented in May 2004. Imaging at that time showed extensive hepatic involvement, with severe intrahepatic spread. Multiple abdominal lymph nodes were markedly enlarged, and the left lobe of the liver was significantly involved. In addition, there were multiple pulmonary metastases.
Metastatic nodules were also observed in the lungs.
The patient was informed at Samsung Medical Center that no further treatment options were available. Being the chairman of a large corporation with sufficient resources, he then visited MD Anderson Cancer Center. There, he was told that his expected survival was approximately two months, after which he came to my clinic through a personal referral.
I initiated a combination therapy of herbal medicine and Xeloda (capecitabine). At that time, a physician at Samsung Medical Center advised against taking herbal medicine, citing concerns about potential hepatic toxicity.
Given that one of the world’s leading hospitals had estimated a survival of approximately two months, I asked the patient to decide whether to proceed with treatment or not. The patient chose to begin my treatment.
Within one month of therapy, the tumors began to regress rapidly.
After two months of integrative therapy, the tumor had regressed significantly.
Seven months after initiating treatment, the pulmonary tumors had completely disappeared, and the abdominal lymph node metastases had regressed to only minimal residual lesions.
Chest & abdomal CT with CE: 2005-06-10
Compared with the last CT on Jan. 27, 2005, previously noted tracheal mass is disappeared,
and recurred mass in surgical bed of the right hepatic lobe is also not seen in this study.
No abnormal contrast enhancement. No other significant interval changes are seen.
Impression:
Hepatoma, right hepatectomy state.
Recurred mass. Surgical bed of the right hepatic lobe. Disappeared.
Tracheal mass. Disappeared.
RF ablation defect. Left hepatic lobe, no interval change.
Doctor S.H. LEE M.D / Ph.D
The patient followed my recommendations, and the outcome was remarkable. The foundation of this integrative treatment was based on the application of constitution-specific pharmacologic agents, as I have classified for Soeumin patients, combined with herbal medicine. My view is that anticancer therapies should not be selected solely based on tumor location, but rather according to the patient’s constitutional type.
The tumors regressed rapidly and eventually disappeared, including the pulmonary metastases. About one year later, a physician at Samsung Medical Center advised discontinuing the herbal medicine, noting that the cancer had resolved and expressing concern about potential hepatic effects from prolonged use.
The patient subsequently stopped the herbal treatment. As he had a prior tendency toward alcohol use, he resumed drinking. Approximately six months after discontinuing the herbal therapy, the cancer recurred, and he returned to me. By that time, his alcohol use had become severe, but it was still possible to extend his survival by approximately six more months.
Reflecting on this case, it is difficult for me to fully understand the patient’s decision to follow the recommendation to discontinue treatment.
It is like someone who has been drifting at sea finally climbing aboard a ship, beginning to recover, and then choosing to abandon the ship and fall back into the ocean. Failing to clearly recognize what had sustained and improved his condition, and instead relying on authoritative advice without deeper insight, ultimately led to the loss of his life.
In such cases, if continuous treatment had been maintained, it is reasonable to expect that the disease could have been controlled for at least 4 to 5 years. With dedicated effort in exercise and lifestyle modification, even complete remission might have been possible.
In fact, another patient mentioned previously—who presented with recurrent gallbladder cancer, pulmonary metastases, and abdominal lymph node metastases, and was given a two-month prognosis—remains alive to this day. This patient began treatment at the same time, and despite being told at four different hospitals that survival beyond two months was unlikely, he committed to intensive exercise and continued herbal therapy. As a result, he has now been living in complete remission for over 20 years.
One patient continued herbal treatment to the end and completed therapy after seven years.
This patient adhered very strictly to exercise and dietary management and achieved complete remission using herbal medicine alone, without the aid of conventional anticancer drugs. The case was included in a government-funded study led by Professor Jeon Mi-sun at Ajou University. It serves as evidence suggesting the anticancer potential of herbal medicine as a standalone therapy. Although it was briefly mentioned in a previous manuscript, I will present it in more detail at a later time.
As for the perspective on integrative therapy combining herbal medicine and anticancer treatment, I encourage you to reflect on the cases presented above. This was not a simple case of cancer, but one that had rapidly progressed to systemic metastasis, including the lungs.
A patient who was given a two-month prognosis at MD Anderson experienced rapid tumor regression during integrative treatment, and later showed recurrence after discontinuing therapy. By carefully examining this course, one can better appreciate the potential role and clinical value of herbal medicine.
Conclusion
As demonstrated in the cases above, the combination of constitutionally appropriate conventional medicine and herbal therapy can lead to dramatic clinical outcomes.
However, in today’s clinical reality, many patients believe that herbal medicine is inherently toxic, and instead seek out so-called “safe” health supplements. In doing so, they often spend large amounts of money on products that, in comparison to the therapeutic potential of herbal medicine, may offer only a fraction of the benefit.
Just as cosmetics can make the face appear radiant, they cannot restore or heal internal organs. True therapeutic value does not lie in persuasive marketing or appealing packaging, but in real clinical outcomes demonstrated through actual cases.
Therefore, understanding the classification of herbal medicine—particularly the concept of the three grades (삼품)—and recognizing the effectiveness of integrative treatment, as illustrated in the cases above, can provide a meaningful pathway toward prolonging life and even achieving complete remission.
