Cholangiocarcinoma develops to the advanced stage and is easy to metastasize. At this time, what the patient can't bear is pain. Some patients will also have bloody stools, edema, nonsense and tantrums, and the symptoms are obvious. In the late stage of cholangiocarcinoma, abdominal pain is severe, accompanied by obvious thrombocytopenia, and poorly differentiated adenocarcinoma has a high degree of malignancy and rapid development. It is suggested to treat with anti-cancer traditional Chinese medicine and take some drugs to prevent bleeding, such as VK, VC, Sanqi, Yunnan and so on. At present, traumatic and destructive treatment is not recommended for patients with cholangiocarcinoma spread in the abdomen. Although radiotherapy and chemotherapy have a certain short-term effect, the long-term effect is poor, which is easy to produce drug resistance and cannot be carried out for a long time. After stopping the drug, the tumor may rebound. In the treatment, we should choose drugs for inhibiting and treating cancer, which are safe and non-toxic, with quick short-term effect and definite long-term effect. Traditional Chinese medicine is more effective in advanced cancer, because most cancer cells have metastasized to many places, and the local treatment effect of western medicine is not good, so patients can not tolerate surgery, radiotherapy and chemotherapy. Taking traditional Chinese medicine can comprehensively regulate the internal environment of the body, invigorate qi and nourish blood, strengthen the body resistance and eliminate pathogens, effectively control the disease, relieve pain and prolong life. Surgery is not suitable for all patients, and surgery is not a panacea. Only when there is no local or distant metastasis, the tumor is small and suitable for surgery; If the focus has been removed, the metastatic focus is single and the body is in good condition, surgery can also be performed on the metastatic focus. If there are more than two metastatic lesions, in principle, no surgery will be performed. Liver protection treatment of hilar cholangiocarcinoma: It is very important to evaluate liver function and protect liver for patients with long-term severe jaundice, especially those who may undergo extensive hepatectomy. Some lesions can be resected locally, because the liver reserve state is not enough to bear, and the opportunity for surgery is lost. Some patients who are fully prepared before operation can successfully pass the perioperative period because of the complexity, long time and large scope of the operation. Preoperative preparation is the premise to ensure the safety of operation and reduce complications and mortality. The following conditions show that the liver function is poor and it is not suitable for liver surgery, especially for hepatectomy or pancreatectomy above half liver: a. Serum total bilirubin is 256? More than mole/liter; B. Human albumin is below 35g/L; C. The prothrombin activity is lower than 60%, and it is still difficult to correct after injection of vitamin K 1 week. ④ Indigo green test is abnormal. Preoperative CT measurement of total liver volume, liver volume to be resected and calculation of retained liver volume are helpful to evaluate the liver function of extended radical resection of hilar cholangiocarcinoma. In addition, glucose tolerance test and prealbumin determination are helpful to evaluate the liver function of patients. It is necessary to protect liver before operation, but if biliary obstruction cannot be relieved, it is ineffective to rely solely on drugs to protect liver. At present, the commonly used drugs are aimed at reducing transaminase, supplementing energy and increasing nutrition. Commonly used are hypertonic glucose, human serum albumin (albumin), liver amino acid infusion (branched-chain amino acid), glucuronic acid lactone (glucuronic acid lactone), ubidecarenone (coenzyme Q 10), vitamin K, high-dose vitamin C and so on. Preoperative liver protection treatment should also pay attention to avoid using drugs harmful to the liver. Cholangiocarcinoma is a kind of malignant tumor that is difficult to cure. Radical surgery is the only effective method for the treatment of cholangiocarcinoma. However, the early symptoms of cholangiocarcinoma are not obvious and difficult to find. Once most of them have entered the advanced stage, it is difficult to remove them by surgery. Therefore, it is necessary to find other non-surgical methods to treat cholangiocarcinoma. At present, the drugs used in clinic are insensitive to cholangiocarcinoma and have obvious toxic and side effects. Therefore, it is necessary to explore more sensitive and effective drugs to improve the curative effect of drug treatment for cholangiocarcinoma. In this paper, human cholangiocarcinoma QBC939 cells cultured in vitro were used as a drug screening model, and six kinds of medicinal plant extracts, such as Phyllanthus urinaria, sorghum rice, Catharanthus roseus and Cephalotaxus fortunei, freshwater shellfish Corbicula fluminea extract, natural product compounds, thiosemicarbazone compounds and commonly used chemotherapy drugs were screened from natural and chemically synthesized substances by MTT method. The results showed that the ethyl acetate and n-butanol extracts of Phyllanthus urinaria and Phyllanthus urinaria, the water extract of Solanum lyratum Thunb, the total alkaloids of Catharanthus roseus, the ethyl acetate extract of Corbicula fluminea, quercetin, tannic acid, 2- chlorobenzaldehyde thiosemicarbazone, 2,4-dichlorobenzaldehyde thiosemicarbazone and tamoxifen had anti-proliferation activities in vitro. Compared with 5- fluorouracil and cisplatin, tamoxifen has stronger inhibitory effect on cholangiocarcinoma cells. Therefore, tamoxifen (TAM) was chosen as the further research object in this study to explore its mechanism of anti-cholangiocarcinoma in vitro. The results of MTT assay, morphological observation, flow cytometry and DNA ladder showed that TAM inhibited the proliferation of cholangiocarcinoma QBC939 cells in a time-and dose-dependent manner, significantly changed the cell morphology, arrested the cell cycle at G0/G 1 phase, and significantly induced apoptosis. The results of WestERn blot and other methods showed that TAM had an effect on cyclin D 1, er? Inhibition of C-Myc protein expression, activation of caspase-3/caspase-9 signaling pathway and up-regulation of Bax and p53 protein expression are some mechanisms of TAM's anti-cholangiocarcinoma effect. In order to further explore the molecular mechanism and drug target of tamoxifen's anti-cholangiocarcinoma effect, we first studied the effect of tamoxifen on the global protein expression profile of human cholangiocarcinoma QBC939 cells by protein omics. Finally, the differentially expressed protein spots such as heat shock protein, cytoskeleton protein, annexin and metabolism-related enzymes were successfully identified. Combined with the functions of these proteins, the possible molecular mechanism of tamoxifen's anti-cholangiocarcinoma effect was comprehensively and systematically analyzed. It provides new clues for the drug treatment of cholangiocarcinoma, provides basic theoretical support for the clinical application of tamoxifen in the treatment of cholangiocarcinoma, and also provides new ideas and clues for clarifying the new target of tamoxifen's anti-cholangiocarcinoma effect.