I thought long and hard before writing this column – I am going to give my views about Traditional Chinese Medicine, and there are surely minefields that I would be prudent to avoid.
On the one hand, one of my recent collaborators in treating a patient, a senior consultant gastroenterologist with special interest in liver diseases, Dr Yap, thought that I ought to highlight problems with the use of TCM because “only through education can we change this cultural mind set”. He was referring to the faith that many continue to hold that TCM is as effective but less toxic compared to Western medicine.
On the other hand, my wife was very concerned with the possible backlash. Both of us recall an incident that occurred when we were medical students. A well-respected senior professor in pediatrics commented that taking traditional chinese medicine (TCM) was like eating grass.
He was well-intentioned in warning the public of the dangers of children consuming TCM. But the advice did not go down well, eliciting strong reaction. The rumour was that he received a bullet in his mailbox and had to go into hiding for a brief period.
That was many years ago, but even today, there are strong sentiments about TCM.
I have never been an opponent for the use of TCM. I am reasonably confident that there must be some medicinal value in TCM, otherwise its use could not have continued through the centuries.
But like all medicines, TCM carries potential risks.
Mei Ling, aged 54, has been under my care since she was diagnosed to have stage four lung cancer.
Her history dated back to December 2009, when she saw several general practitioners for her persistent cough.
It would get better with medication but always recurred.
A chest x-ray was finally done in June 2010, when the cause of her cough was found to be due to a cancer in the lung.
By that time, the cancer had already spread to the lymph nodes in the neck as well as to various bones in her body.
Mei Ling has been through many courses of chemotherapy.
The good news was that each time, Mei Ling never failed to respond to the treatment.
The bad news – the repeated treatments have taken a toll on her body.
When she completed her last course which consisted of six cycles of chemotherapy in May 2013, we agreed that the chemotherapy should be discontinued to allow the body to rest.
On the July 4, she came to see me on an unscheduled visit because she was experiencing some pain. To my surprise, I noticed that the whites of her eyes (called the sclera) had turned bright yellow. On direct questioning, she admitted that the colour of her urine had turned dark, the colour of Chinese tea. She also admitted that she started taking TCM five days ago, to try to strengthen her ravaged body. I immediately admitted her and the blood test indicated that her liver had been severely damaged and there was evidence of early liver failure. This acute injury of the liver cells is broadly termed acute hepatitis.
There are many causes of acute hepatitis including viral infections, alcohol, drugs and auto-immune conditions.
Dr Yap was consulted on this patient and after extensive tests; he concluded that the most likely cause for Mei Ling’s hepatitis was the TCM she had consumed.
However, he cautioned that diagnosis was one of exclusion, meaning that it was made from the patient’s history and after systematically excluding all the known causes of hepatitis – there are no tests that could actually prove that the TCM caused her liver injury.
Coincidentally, exactly one week later, Madam Sia, aged 52, was seen as a new patient in my clinic.
She had been diagnosed with a tumour in her chest. She was deemed unfit for surgery or chemotherapy because her liver enzymes were more than 1000 (the normal being less than 40 units).
For months, Madam Sia had been taking TCM for her persistent cough, which she said helped to relieve her symptoms.
Unknown to her, the TCM had also caused severe injury to the liver.
She was unaware that she was jaundiced but admitted on direct questioning that she had tea coloured urine.
There is no actual treatment for drug-induced liver injury.
What we do is stop the consumption of the offending drug, ensure good nutrition for the patient, treat any underlying infection, and reduce the toxic load through sterilisation of the gut.
All this is merely supportive – we count on the liver to regenerate and heal itself.
Despite these measures, some patients will succumb from irreversible liver failure.
Thankfully, both Mei Ling and Madam Sia are recovering from their ordeal.
Mei Ling was discharged after a 16-day stay in hospital and Madam Sia has recovered well enough for surgery to be planned for the removal of the tumour in her chest.
TCM is a strong medicine, and we are not quite sure how it works yet, or how it fits into current prevailing medical practices.
Doctors must work with patients to ensure the best outcomes, while respecting individual choices.
In all this, data is vital. So it is timely for the Ministry of Health to consider making all cases of drug-induced liver injury a notifiable condition.
It is through the registry of these incidents and the offending agents that we may be able to learn and avoid future harm to our patients.