MBBS Enrichment Year 2018-19

The Green Planet •Modern plant biology Principles of Ecology Empires =============================C HOW H EI C HING 3035378858============================ S UPERVISOR : D R S O T SZ H IM Abstract T RADITIONAL C HINESE M EDICINE (TCM) HERBS ARE COMMONLY REGARDED TO BE SAFE WITH MINIMAL TOXICITIES IN C HINESE COMMUNITIES . C ANCER PATIENTS WHO ARE RECEIVING W ESTERN ONCOLOGY THERAPY OFTEN CONCURRENTLY TAKE TCM HERBS FOR ANTI - CANCER AND SYMPTOM RELIEF PURPOSES . W E PERFORMED A LITERATURE REVIEW FOR CURRENT EVIDENCE ON TCM HERB INDUCED LIVER INJURY FROM AN ONCOLOGICAL PERSPECTIVE . A LITERATURE SEARCH ON P UB M ED WAS PERFORMED TO IDENTIFY PUBLICATIONS REGARDING TCM HERBS AND CONCOCTIONS WITH HEPATOPROTECTIVE OR HEPATOTOXIC PROPERTIES . L ISTS OF COMMONLY USED HERBS AND THEIR CAUSALITY LEVELS AND WERE COMPILED . TCM WITH ANTI - CANCER OR SYMPTOM RELIEF USES WERE DISCUSSED IN DETAIL IN RESPECT OF THEIR HEPATOTOXIC OR HEPATOPROTECTIVE PROPERTIES . Hepatotoxic TCM •He Shou Wu ( 何首烏 Polygoni multiflori )Chuan Lian Zi ( 川楝子 Melia toosendan ) •Ren Shen ( 人參 Panax ginseng ) •Tu San Qi ( 土三七 Radix Gynurae Segeti ) •Chai Hu ( 柴胡 Bupleurum falcatum ) •Yin Chen Hao ( 茵陳蒿 Artemisia capillaris ) Hepatoprotective TCM •Yin Chen Hao Tang ( 茵陳蒿湯 ) •Wu Wei Zi ( 五味子 Schisandra chinensis ) •Bai Shao ( 白芍 Radix Paeoniae Alba ) •San Qi( 三七 Panax notoginseng ) Hepatotoxic TCM •Bai Xian Pi ( 白鮮皮 Dictamus dasycarpus ) • Camellia sinensis ( 綠茶 ), green tea •Huang Yao Zi ( 黃 藥子 Dioscorea bulbifera L. ) •Huang Qin ( 黃芩 Scutellaria baicalnsis ) • Camptotheca acuminata (Xishu 喜樹 ) A Pilot Prospective Cross-sectional Comparison Study on Incidence of Liver Toxicity in Cancer Patients on Western Anti-cancer Drug Therapy with or without Concurrent Chinese Herbal Medicine Literature Review of Traditional Chinese Medicine Herbs- Induced Liver Injury from an Oncological Perspective Sem 2- Research Attachment at QMH Sem 1- Exchange •Physiological ecology of plants & animals, life history strategies, ecological significance of genetic variability •Classic themes and concepts in colonial studies, post-colonial studies, cultural studies and political economy For symptom relief Anti-cancer ABSTRACT Objective This pilot study addressed the problem of hepatotoxicity of concurrent CHM use, which is the major hurdle of integrated Chinese-Western medicine practice in cancer medicine. We evaluated the difference in incidence of liver toxicity of cancer patients receiving systemic therapy with or without concurrent Chinese Herbal Medicine (CHM ), and aimed to establish whether the current general oncologists’ suggestion to avoid CHM while on systemic therapy is justified . Methods 187 patients were recruited in the Department of Clinical Oncology of Queen Mary Hospital. Through questionnaires and CMS, they were followed up for 3 months, their current Western systemic therapy, CHM taken, and liver function tests results (bilirubin, ALT, AST, ALP) were retrieved. Patients were divided into the CHM and non-CHM group, depending on whether CHM was taken concurrently with systemic therapy. Liver function derangement was graded by CTCAE v4.0. The differences between the CHM and non-CHM groups were analysed by Pearson's chi-squared test. Multivariable analysis was performed by Cox proportional hazard models to identify the prognostic factors for CHM coverage. Results There was no significant difference of liver toxicity incidence between the CHM and non-CHM group(P=0.577). No prognostic factors (age and sex) were identified for CHM coverage. Conclusion The results of our pilot study suggest CHM usage by cancer patients may not lead to liver toxicity, which contradicts with the suggestion by oncologists to avoid CHM during systemic therapy. Our results warrant further investigations to confirm this finding. Chow Hei Ching 55