Marked effect of topical application of Chinese medicine combined with moxibustion in a case of refractory malignant ascites in diffuse liver cancer

Background Although diffuse hepatocellular carcinoma (HCC) is rarely encountered in clinical practice, it frequently leads to the refractory complication of malignant ascites. Conventional treatments such as diuretics, therapeutic paracentesis, and intraperitoneal chemotherapy often yield suboptimal outcomes. Case presentation We report a detailed case of a 55-year-old female patient with diffuse HCC (CNLC stage IV, Child-Pugh C), portal vein tumor thrombus, and malignant ascites refractory to diuretics. Following confirmation of the diagnosis, she was treated with a novel approach: topical application of a specific herbal paste (containing Asarum sieboldii, Cinnamomum cassia , Zanthoxylum bungeanum, Astragalus membranaceus, and Solanum nigrum ) at the Shenque acupoint (CV8) combined with daily one-hour moxibustion. After 1 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 treatment was well-tolerated with no observed adverse effects. Clinical context To provide broader clinical context, we briefly note the outcomes 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 one untreated patient progressed rapidly. Conclusion This detailed case report demonstrates that topical traditional Chinese medicine (TCM) therapy combined with moxibustion at the Shenque acupoint (CV8) was associated with a marked reduction in refractory malignant ascites in one patient with advanced diffuse hepatocellular carcinoma. The treatment was well-tolerated, with no observed adverse effects, and the patient reported subjective symptom relief and voluntarily continued therapy at home, suggesting good acceptability. This unique, non-invasive, acupoint-specific combinatorial strategy introduces a novel approach worthy of further investigation. While these preliminary findings are hypothesis-generating and supported by contextual observations from three additional patients, they require validation through larger, controlled studies to establish efficacy, safety, and underlying mechanisms.