Tech Coloproctol (2008) 12:16

DOI 10.1007/s10151-008-0392-z

REVIEW

The role of traditional Chinese medicine in colorectal cancer

treatment
K.Y. Tan C.B. Liu A.H. Chen Y.J. Ding
H.Y. Jin F. Seow-Choen

Received: 9 October 2007 / Accepted: 28 December 2007

Abstract Surgery, chemotherapy and radiotherapy have

been the mainstay of colorectal cancer treatment. There is
however current intense research on traditional Chinese
medicine (TCM) as novel or additional treatment methods for colorectal cancer. This article reviews the current
use of TCM in colorectal cancer so as to increase the
awareness of colorectal surgeons. The pathogenesis of
colorectal cancer according to TCM is discussed. TCM
has been used successfully during the perioperative period to relieve intestinal obstruction, reduce postoperative
ileus and reduce urinary retention after rectal surgery.
Good results have been reported in the treatment of the
complications of chemotherapy and radiation enterocolitis. Favourable results have also been shown in the use of

TCM either alone or in combination with chemotherapy

to treat advanced colorectal cancer. Molecular studies
have shown some TCM compounds to reduce tumour cell
proliferation and induce apoptosis. Although the reported
results of TCM have been exciting thus far, problems of
lack of consensus on treatment regimes and questions on
the reliability, validity and applicability of published
studies prevent its widespread use. There is now an
urgent need for colorectal surgeons to work with TCM
physicians in the continuing research on this 6000-yearold art so as to realize its full potential for our patients.
Key words Traditional medicine Chinese medicine
Colorectal cancer

Introduction
K.Y. Tan
Department of Surgery
Colorectal Service
Alexandra Hospital, Singapore
C.B. Liu A.H. Chen
Department of Colorectal Surgery
Second Affiliated Hospital
Zhejiang Wenzhou Medical College
Wenzhou, PR China
Y.J. Ding H.Y. Jin
Nanjing Colorectal TCM Hospital
Nanjing, PR China
F. Seow-Choen ()
Seow-Choen Colorectal Centre
3 Mt Elizabeth Medical Centre 09-10
Singapore 228510
e-mail: seowchoen@colorectalcentre.com

Surgery, chemotherapy and radiotherapy had been the

mainstay of treatment of colorectal cancer in traditional
western medicine [1]. More recently, there had been
increased research into molecular medicine,
immunotherapy as well as various forms of gene therapy.
Traditional Chinese medicine (TCM), however, had been
used to treat colorectal cancer over the last 6000 years or
so with some degree of success. The time is therefore
right for us to revisit and explore the possibility of learning from TCM. TCM may offer novel or exciting additional treatment methods for colorectal cancer. It is now
an area of enthusiastic study in China and elsewhere in
the West. In this modern age of medical advancement we
cannot, as colorectal cancer surgeons, pass off TCM
treatments as myths without first acquiring a proper
understanding or study of them. An attempt should be
made to understand the basics of TCM and the principles

behind it. This article explores the current use of TCM in

colorectal cancer. Perhaps we can see better, then, the
advantages of combining western and eastern medicines
in this field.

Pathogenesis of colorectal cancer according to TCM

According to TCM, colorectal cancer belongs to a group
of diseases caused by an accumulation of toxins [2].
There is an imbalance in the body with inadequate qi
and excess toxic fluids and heat in the body. The combination of these effects is further aggravated by a weak
spleen and kidneys allowing the flow of toxins into the
intestines where they accumulate. A deficiency of qi is
thought to be the major driving force resulting in colorectal cancer. As such some herbs are making progress as
main remedies; these herbs are mainly used to promote
circulation, eliminate blood stasis, clear toxins and heat,
invigorate the spleen and kidneys and most importantly
replenish qi.

Concepts of Qi
Ancient Chinese philosophy holds that qi is the most
basic substance constituting the world [2]. Accordingly,
TCM also believes that qi is the most fundamental substance in the construction of the human body and in the
maintenance of its life activities. Qi of the human body
takes 2 forms. The first is coagulated qi which is manifested as various structural components of the body, such
as viscera, body figure, sense organs, blood and body fluids; the second is diffused qi which is manifested as the
energy and life force that flows in the body, but takes no
certain form. It flows within a fixed network of twelve
invisible pathways or meridians in the body. This is the
most important concept of Chinese medicine. Qi has the
function of promoting the growth and development of the
body and the distribution and discharge of blood and
body fluids. Qi also has the functions of warming,
defense and homeostasis in the human body.
Wellness is achieved when opposite and complementary forces, called Yin (feminine - cool, moist, nutritive,
quiet) and Yang (masculine - warm, dry, energetic,
active), are in balance and promote the unobstructed
flow of qi. An imbalance of qi, Yin and Yang are
believed to result in sickness. All treatments aim to balance a persons qi. Several methods are used to promote, maintain and restore qi, including herbal remedies for nourishment, acupuncture, moxibustion (heat
therapy), diet, massage, meditation and exercises such
as qigong and tai chi.

Tech Coloproctol (2008) 12:16

Treatment of intestinal obstruction

TCM distinguishes malignant bowel obstruction from
benign bowel obstruction. In malignant obstruction, not
only is there mechanical obstruction of the bowel, there
is impediment of the flow of qi, blood stasis and accumulation of toxins. It is thought that these issues have
severe impact on surgical outcome and need to be
resolved to achieve uncomplicated surgery.
Peng [3] treated 45 patients with acute bowel obstruction with a concoction comprising: Aurantii immaturus
fruit (immature bitter orange), Magnoliae officinalis bark
(officinal magnolia bark), fried Raphani seed (radish
seed), Codonopsis root (tangshen root), Rhei root and
rhizome (rhubarb), Paeoniae rubra root (red peony root),
mirabilitum (mirabilite) and Patriniae herb (whiteflower
patrinia herb). Of the 45 patients, 35 experienced relief
of the obstruction before surgery and subsequently
underwent surgery with no complications. The obstruction was not resolved in the remaining 10 who underwent
emergency surgery.
Zhou [4] treated 30 patients with acute colonic
obstruction using rhubarb root and rhizome, mirabilite,
immature bitter orange, officinal magnolia bark, Chinese
angelica root, red peony root and Aucklandiae root (costushoot). Obstruction was alleviated in 14 patients, who
underwent complication-free curative surgery with good
survival on follow-up. Of the remaining 16 who underwent emergency surgery, 6 underwent curative surgery
while the remaining 10 underwent non-curative surgery.
None had major surgical complications. These herbs
have been thought to be able to reduce inflammation and
improve circulation to the bowel wall, and thus to have a
protective effect on bowel anastomosis.

Reduction of post-surgical ileus

While post-surgical ileus after colorectal surgery is treated with nutrition and supportive treatment in western
centres, TCM offers an extra dimension with a combination of acupuncture and herbal enemas. Acupuncture was
used in combination with rhubarb root and rhizome and
mirabilite enemas [5]. Whether these enemas had any
side effects in these post-surgical patients, however, was
not reported.

Urinary retention after rectal cancer surgery

Urinary retention following rectal surgery had been
reduced with the widespread use of sharp total mesorectal excision compared to blunt rectal avulsion, but the

Tech Coloproctol (2008) 12:16

problem remains in some patients. In TCM, acupuncture

had been used to treat urinary retention effectively after
rectal surgery. The basis for this treatment is to improve
the flow of blood and qi, regulate water flow and invigorate the bladder. Acupuncture after recto-anal surgery
had been used with an efficacy reported as high as 94%
[6]. However at the moment there is still no standard protocol, inadequate data from different centres and minimal
basic research.

Treatment of complications of chemotherapy

Many patients with colorectal cancer require adjuvant
chemotherapy after surgery. With advances in the field of
oncology, toxicity and side effects have been significantly reduced but remain a problem. Gastrointestinal discomfort and bone marrow depression are among the main
complications during therapy. Patients with severe complications may have difficulty in completing the treatment cycle, leading to suboptimal results.
The use of TCM to invigorate the spleen, replenish
qi, improve immunological function and regulate the
flow of qi and blood has been found to improve patients
tolerance to chemotherapy. Mao and Huang [7] treated 46
patients during chemotherapy with Liujunzi soup, which
consists of tangshen root, membranous milkvetch root,
largehead atractylodes rhizome, Indian buead, pinellia
tuber, Chinese angelica, tangerine peel, platycodon root,
barbed skullcap herb and Paridis rhizome (Yunnan
manyleaf Paris rhizome). Compared with 33 patients who
underwent chemotherapy alone, the TCM group had a
significantly lower rate of nausea and vomiting, occurring
in 26% of patients compared with 45% in the control
group. Patients in the treatment group also had better
sleep and appetite compared to the control group.
Jing and Zhang [8] conducted a small randomized
study on 30 patients undergoing chemotherapy for middle and terminal stage colorectal cancer. The experimental group received Da An Wan, which consists of largehead atractylodes rhizome, Crataegi fruit (hawthorn
fruit), tangerine peel, radish seed, Forsythiae fruit (weeping forsythiae capsule) and other ingredients. Da An Wan
was found to significantly reduce gastrointestinal discomfort such as nausea and vomiting.
Zhang [9] described 47 patients undergoing
chemotherapy with a basic remedy (Fuzhengpeiben)
which improved immunologic function. Ingredients
included membranous milkvetch root, largehead atractylodes rhizome, Diosscoreae (common yam rhizome),
tangshen root, Chinese angelica, Paeoniae alba root
(white peony root), tangerine peel, tangshen root, Coicis
seed (coix seed), Bambusae shavings (bamboo shavings)

and costushoot root. All patients treated had normal

appetite without any complaints of fatigue; 30 of these
patients (63.8%) had normal white cell counts, hemoglobin and platelets and only 10 (21.5%) had mild symptoms. Total efficacy was 85.1%.
Zhang and Fei [10] tried herbs including tangshen
root, membranous milkvetch root, largehead atractylodes
rhizome, Cuscutae seed (south dodder seed), tangerine
peel, fried Ozyzae germinatus (rice grain sprout), fried
Hordei germinatus (malt), Psoraleae fruit (malaytea
scrufpea fruit), Corni fruit (common macrocarpium fruit),
red peony root and Glycyrrhizae root (liquoric root) in 24
patients. These herbs were prescribed preoperatively to
patients with colon cancer who were subsequently to
undergo chemotherapy. There were significant improvements in fatigue (76.9%), appetite (75%), nausea and
vomiting (55.6%) and defecation dysfunction (66.7%).
Wang and Guan [11] observed 56 patients undergoing
chemotherapy after surgery (10 colorectal cancer cases).
They prescribed Chinese angelica, largehead atractylodes
rhizome, tangshen root, tangerine peel, membranous
milkvetch root, pinellia tuber, Gypsym fibrosum (gypsym), Amomi fruit (villous amomum fruit), bamboo shavings, Hedyotidis diffusae herb (spreading hedyotis herb),
and Agrimoniae herb (hairyvein agrimonia herb). Only
17% experienced nausea.
Therefore, some clinical studies suggest that herbs
are useful for treating complications of chemotherapy.
However, the underlying pharmacology of these herbs is
still not clear and the prescriptions are variable. Thus, a
consensus is required regarding these aspects and there is
a real need for more organized research.

Treatment of radiation enterocolitis

Radiation enterocolitis may result in problematic symptoms in patients undergoing pelvic radiation. The use of
steroids in western medicine has only met with
mediocre results. TCM enemas have been reported to be
useful in treating this problem. Ding et al. [12] treated
patients with acute radiation colitis with membranous
milkvetch root, largehead atractylodes rhizome, tangshen root, and Coptidis rhizome (golden thread) and
other ingredients. A good response was found in 93.8%
of patients. The same authors had previously investigated the effects of these drugs on the mucosa of irradiated
rat bowels [13]. They found that there was a significant
increase in the number and height of villi in the mucosa
of the irradiated bowels after treatment with TCM, suggesting that it promotes regeneration. Also, TCM was
found to depress nitric oxide levels at the mucosa resulting in less inflammation.

Tech Coloproctol (2008) 12:16

Treatment of advanced colorectal cancer

Patients in this category currently continue to have a poor
prognosis, with a 5-year survival of less than 10%. This
is improving with the development of targeted
chemotherapeutic agents. However, the cost of these
agents limits their availability to many patients. The side
effects of standard palliative chemotherapy and radiotherapy also remain a problem.
There have been reports of combination chemotherapy and TCM achieving good results. Hu and Jie [14]
reported the use of TCM in combination with chemotherapy (FOLFOX: oxaliplatin, leucovorin, 5-fluorouracil)
and radiotherapy in 28 patients with advanced colorectal
cancer. They prescribed a soup consisting of tangshen
root, largehead atractylodes rhizome, Indian buead,
Chinese angelica, Chuanxiong rhizome (Szechuan lovage
rhizome), liquoric root, and fresh and processed
Rehmanniae root (rehmannia root). They further added
hawthorn fruit, fried rice-grain sprout and fried malt for
patients with nausea. This combination effectively
reduced symptoms in 39.3% of patients and enhanced the
quality of life in 42.9% of patients. Stabilization of disease was achieved in 78.6% of patients.
Zhang and Yang [15] combined chemotherapy of cisplatin and 5-fluorouracil with an enema consisting of
barbed skullcap herb, raw coix seed, spreading hedyotis
herb and Curcumae rhizome (zedoary). They found that
it was effective in 42.8% of 28 patients.
Wang [16] used Jianpixieshijiedu soup consisting of
ginseng root, largehead atractylodes rhizome, Indian
buead, coix seed, barbed skullcap herb, liquoric root and
Smilacis glabrae rhizome (glabrous greenbrier rhizome)
6 days before infusional chemotherapy. He found this
formula effective in providing short-term benefit in 83%
of the patients.
Cha [17] used Qingchangjiedu soup to treat 24
patients with advanced colorectal cancer. The prescription included Sophorae flavescentis root (lightyellow
sophora root), Pteridis multifidae herb (Chinese brake
herb), Euphobiae humufusae herb (humifuse euphorbia
herb), spreading hedyotis herb, Vitis adstrictae root
(romanet grape root), coix seed and common peony root.
The survival rates were: 62.5% at 1 year, 25.0% at 2
years and 12.4% at 3 years.
Chen [18] reported excellent survival results of 100%
at 1 year, 66.7% at 3 years and 38.9% at 5 years in 18
patients with advanced colorectal cancer. He prescribed
Pulsatillae root (Chinese pulsatilla root), Portulacae
herb (parslane herb), spreading hedyotis herb, Iphigeniae
indicae (Indian iphigenia bulb), Phellodendri bark (amur
corktree bark), Chinese angelica, common peony root,
and fried bitter orange. For patients with purulent and

blood-stained diarrhea, he added Cyrtomii rhizome (cyrtomium rhizome), Cacumen platycladi (Chinese arbovitae twig), and raw Sanguisorbae root (garden burnet
root). He also added Prunellae (common selfheal fruitspike), Sargassum (seaweed) and Thallus laminariae
(kelp) for patients with lymphatic metastasis. He treated
qi deficiency and anaemia with the standard tangshen
root and membranous milkvetch root. He also used an
enema consisting of spreading hedyotis herb, Bruceae
(java brucea fruit), whiteflower patrinia herb, glabrous
greenbrier rhizome, Draconis (dragons blood resin) and
Gleditsiae (Chinese honey locust spine).
There are therefore favourable results with TCM
alone or in combination with western chemotherapy in
the treatment of advanced colorectal cancer. However,
the treatment regimens vary widely.

Molecular basis of TCM

There is currently intense research in China with regards
to the use of various herbs and remedies for colorectal
cancer. Some of these studies investigated the molecular
basis of these herbs in colorectal cancer. There is emerging evidence that the modes of action include: inducing
cancer cell apoptosis, promoting immunologic response
to cancer cells and regulating or inhibiting oncogene
expression. Ye et al. [19] found tea polyphenol extracted
from tea leaf to inhibit colorectal cancer cell proliferation
and to decrease microsatellite instability. The action was,
however, not found to be through the regulation of the
hMLH1 and hMSH2 genes, suggesting another pathway
of action on microsatellite instability in these cells. Zuo et
al. [20] found that an extract of the herb Rabdosia
rubescens has an inhibiting effect on tumour cell proliferation. It was found that oridonin, purified from Rabdosia
rubescens, induces apoptosis in cancer cells. More than
one hundred herbs, including Andrographis (common
andrographis herb), Scutellariae root (baical skullcap
root), barbed skullcap herb, spreading hedyotis herb and
largehead atractylodes rhizome, have been found to have
effects on colorectal cancer. With further studies, some
medicine from TCM may become novel western medicine
for use in colorectal cancer therapeutics.

Discussion
This article aims to increase the awareness of the use of
TCM in colorectal cancer amongst western colorectal
specialists. The uses and variations in TCM treatments are
innumerable and an exhaustive description is not within
the scope of this article since TCM is an evolution of thou-

Tech Coloproctol (2008) 12:16

sands of years of practical experience. TCM use is unfortunately still currently not adequately documented or published in western medical literature. Many TCM physicians furthermore consider their management methods a
family secret and hence many do not publish their results.
It seems, then, that TCM, although initially an art
passed down from teacher to student behind closed
doors, is now slowly becoming a science with more scientific research. It is encouraging to see more and more
articles on TCM and its use in colorectal cancer in the literature. An understanding of this literature by practitioners of western medicine, however, remains a hurdle as it
requires one to have a good grasp of both the Chinese
and English languages. Even then, some published studies on TCM and its use in colorectal cancer are questionable regarding their reliability, validity and applicability.
The problem with the available information is that
while the basic premise for treatment of the various
aspects of colorectal cancer is similar, it is evident that
there is a wide variation in prescription even for the same
condition. Each prescription contains numerous herbs
and ingredients with indefinite permutations. It is not
known whether each ingredient plays a vital role or can
be omitted with no difference in result. Whether these
published concoctions represent what the majority of
TCM physicians use remains a question. The rationale
behind the use of the ingredients is sometimes abstract
and physicians may differ in their opinions on their
usage. In order to make these studies more reliable, there
is an urgent need for consensus meetings among TCM
physicians so that concepts and treatment regimes can be
more standardized. Secondly, there is a pressing need for
more western trained doctors to investigate these therapies more thoroughly so that truth will come out.
Most of the known reports of success are unfortunately based on case studies conducted on small numbers of
patients. Whilst there had been some attempts to make
comparative studies, these numbers are small. Reporting
of results also lack uniformity, casting doubts on the
validity of these results. It is however encouraging that
more and more of these studies are being performed.
Emphasis however should be on improving study design
to make these studies more credible. It is in this area that
it is particularly helpful for physicians trained in TCM to
work with physicians of western medicine whose practice had become more evidence-based especially over the
last few years.
The integration and application of TCM methods to
patients with colorectal cancer remain a challenge. More
efficacy studies on TCM are required before widespread
application is possible and TCM still has to gain its place
as an acceptable practice. It is vital that side effects and
complications do not go unreported. TCM however

remains an entity that a large number of people in the

world increasingly turn to. It therefore behooves us to
investigate this traditional phenomenon as practitioners
in colorectal surgery.
Perhaps the most exciting aspects of TCM are in the
areas where western medicine has continued to have
inadequate solutions. The use of TCM in the reduction of
side effects and improvement of the outcome of standard
treatment and surgery should be areas of further research.
TCM represents a ray of hope for patients who suffer
from advanced disease and many patients have already
taken to it with anecdotal good results. The emphasis of
the Chinese on molecular research is absolutely correct
as it is only through basic research that light can be cast
on how these agents work. It is only then that TCM can
truly be integrated into current treatment practices.
References
1. Tjandra JJ, Kilkenny JW, Buie WD et al (2005) The Standards
Practice Task Force; The American Society of Colon and Rectal
Surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 48:411423
2. Huang Di Nei Ching (The Canon of Internal Medicine)
3. Peng B (2003) Chinese medicine treatment as intervention for
acute cancerous colon obstruction. Beijing Zhongyi 22:25
4. Zhou YL (2004) Colon cancer and acute intestinal obstruction.
Treatment of 30 patients with Chinese medicine. Fujian Med J
26:158
5. Chuang QH (1998) Chinese medicine treatment of post-operative
ileus. J Practical Traditional Chinese Med 14:29
6. Dong WH, Zhan LY, Chen F (2003) The aetiology and management of acute urinary retention after rectal surgery. Xiandai
Zhong Xi Yi Jiehe Zhazhi 12:20822083
7. Mao XL, Huang M (2005) Clinical trial of the use of TCM to
reduce side-effects of post-operative chemotherapy in colon cancer patients. Shandong Zhongyixue Daxuexuebao 29:128129
8. Jing J, Zhang MZ (2005) Clinical trial on Da An Wan reducing
post colonic surgery chemotherapy nausea and vomiting.
Zhongguo Zhongyiyao Newsletter 9:823824
9. Zhang WY (2004) TCM (fuzhengpeiben method) aids chemotherapy in 47 patients. Zhongyiyao Lingchuang Zhazhi 16:117118
10. Zhang LH, Fei GD (2001) Clinical study on fuzhengpeiben used
preoperatively in 24 patients. Anhui Zhongyi Clin J 13:9596
11. Wang ZH, Guan WJ (2004) Clinical results of using TCM in treating chemotherapy related nausea. Shiyongquanke Yixue 2:254
12. Ding XF, Li DX, Zhao L (2004) Clinical study of TCM on the
treatment and prevention of radiation related bowel injury.
Zhonghua Fangse Yixueyifanghu Zhazhi 24:4951
13. Ding XF, Li DX, Zhao L (2003) Rat study on the mucosa and
nitric oxide levels of irradiated bowel after treatment with TCM.
Zhongguo Xiandai Yixue Zhazhi 13:4244
14. Hu AM, Jie FY (2006) Results of combining TCM with chemotherapy in advanced colorectal cancer. Shiyongaizhen Zhazhi 21:74
15. Zhang Y, Yang Y (2003) Combination of chemotherapy and TCM
enema in the treatment of advanced colorectal cancer. Hubei
Zhongyi Zhazhi 25:34
16. Wang ZX (2001) Results of using jianpixieshijiedu soup before the
commencement of infusional chemotherapy. Beijing Zhongyi 20:36
17. Cha XL (1997) The use of qingchangjiedu soup in the treatment of
24 patients with advanced colorectal cancer. Jiangsu Zhongyi 18:20

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6
18. Chen PF (1995) TCM in the management of 18 patients with
advanced colorectal cancer. Jiangxi Zhong Yi 16:12
19. Ye J, Jiang H, Zhou JW et al (2002) Tea polyphenol inhibits colorectal cancer and reduces microsatellite instability. Huaxueyi
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20. Zuo HJ, Li D, Zheng W et al (2005) The chemical composition of
Rabdosia rubescens and its effect on tumours. Shenyang
Yikedaxue Xuebao 22:258261

Invited comment
This is an interesting article since it begins to inform the
western reader of traditional Chinese medicine (TCM)
applied to colorectal cancer. It is important to keep an
open mind since TCM has been applied to patients for a
very long time and therefore must have been valued by
those receiving it. Professor Seow-Choen is an acknowledged world authority in colorectal surgery and has
achieved this through conventional western practice to
which he has made important contributions.
To deal with a system which has developed largely
without objective clinical testing is difficult. His article
gives the reader an overall view of the variety of treatments available. To the westerner it is obvious that there
is a cultural scientific gulf between the two systems. One
of the difficulties is that throughout history there has been
no easy means of communication. Western doctors have
no possibility to understand the Chinese literature. The
writing cannot be read and Chinese journals are therefore
inaccessible. We are therefore not in a position to understand the Chinese concept of the pathogenesis of colorectal cancer which is completely outside the mainstream of
western science. It is important here to realise that rational scientific progress in the West has been based on the
scientific method which originated in the seventeenth
century in Europe. This approach by experiment based on
hypothesis has resulted in the technology from which the
world today benefits. Western science has pursued the
understanding of natural phenomena largely included in
the discipline of physics. Physics is the basis of all scientific advances including medical discovery.
The western reader is therefore taken aback by a system which does not follow this line. To him or her qi is
akin to the four elements of ancient Greek philosophy.
The natural question from the westerner would be how is
qi defined. Can it be measured? How was the division
between coagulated qi and defuse qi ratified? The
overall sentiment is one of scepticism.
Professor Seow-Choen quotes studies of TCM applied
to conditions including obstruction, postoperative ileus and
urinary retention. While it is quite possible that the concoctions will contain active pharmacological substances, the
studies beg the question of their identity as well as proof of

their effectiveness by formal controlled clinical trial. The

same can be said for the treatment of complications of
chemotherapy and radiotherapy, the latter having so far
defeated western medical (as opposed to surgical) treatment. When it comes to the treatment of advanced colorectal cancer there is an even greater need for controlled clinical trials using adequate numbers of patients. The reader is
left in the difficult position of being sceptical without being
able to assess the various published articles. Again it may
be that herbs can cause apoptosis but we need greater detail
of the methodology of the quoted studies, particularly their
design and the status of controls.
Professor Seow-Choen is a realist and in the discussion he acknowledges the difficulty of access by westerners to Chinese articles and also the lack of uniformity of
the herbal regimes prescribed. In commenting on this
article, I very much agree with him that western practitioners should take TCM seriously but in reality this will
only be possible if the work by Chinese doctors is accessible, that is to say published in a language that can be
understood. Thus if there are positive effects as judged
by molecular research, these should be communicated so
that the results can be assessed using rational criteria
through the objective interpretation of appropriately constructed investigation.
R.J. Nicholls
London, UK
Authors reply
We thank Professor Nicholls for his very thoughtful and
meaningful comments. In truth, he is the one who has
brought English coloproctology into Europe and the rest
of the world by his very characteristic charismatic and
ecumenical thoughts with which he has influenced and
won over the western world. His world-renowned interest in cultures and languages beyond English had made
him a true ambassador to influence coloproctology in
the right direction. We had written this manuscript in the
hope that it will serve as a springboard for others to consider investigating the phenomenon of TCM coloproctology. We are honored therefore to have Professor
Nicholls look at this paper and accept his comments
which we hope will now serve to fuse western and eastern coloproctology and bring us into the next age of new
beginnings.
K.Y. Tan, C.B. Liu, A.H. Chen,
Y.J. Ding, H.Y. Jin, F. Seow-Choen
Alexandra Hospital
Singapore