Traditional and Complementary Medicine Practice Guidelines on

Traditional and
Complementary
Medicine
Practice
Guidelines on
Herbal Therapy
as Adjunct
Treatment for
Cancer.
First Edition, July 2009
Issued by:
Traditional and Complementary Medicine Division
Ministry of Health Malaysia
First Edition, July 2009
1.
INTRODUCTION...........................................................................................................................5
2.
HERBAL THERAPY ........................................................................................................................5
2.1
The aim of this therapy are...................................................................................................5
2.2
Types of cancer for herbal therapy........................................................................................6
2.3
Category of patients for herbal therapy.................................................................................6
3.
Standard of Practice ....................................................................................................................6
4.
Consultation Sessions ..................................................................................................................7
5.
Treatment Proper........................................................................................................................8
5.1
Herb – Drug interaction5.......................................................................................................9
5.2
Herb-Herb Interactions ......................................................................................................10
6.
Procurement and Storage of Formulated Herbal Products ...........................................................10
7.
Dispensing of Herbs...................................................................................................................11
8.
Others ......................................................................................................................................11
Appendix 1: List of herbs that shown to have different effects on immune effector cells and
cytokine levels in laboratory, animal and human studies9 ............................................................12
Appendix 2 : Herbal treatment Card (Kad rawatan herba)...........................................................13
Appendix 3 : Consent form for Herbal therapy ............................................................................17
Appendix 4: Work process in patients’ management for herbal therapy as adjunct treatment for
cancer ......................................................................................................................................18
Appendix 5: List of Used formulated herbs in Traditional and Complementary unit. ....................19
Appendix 6 : List of Approved Single Herbs Extracts as adjunct treatment for cancer11,12,13,14,15,16...20
Appendix 7: Prescription card ....................................................................................................28
Appendix 8 : Guide in Regime of treatment in Herbal medicine ..................................................29
References .......................................................................................................................................31
Acknowledgements
Special thanks to every individual and organization who have in one way or another
contributed comments and advices during the preparation of this Guideline on Herbal
Therapy as complementary cancer treatment for Traditional and Complementary Medicine
(T&CM) Unit in integrated hospital setting.
1.
INTRODUCTION
The Cabinet of Malaysia on the 11th January 2006 had approved the establishment of
Traditional and Complementary medicine unit in three hospitals, namely Hospital Kepala Batas
in Pulau Pinang, Hospital Putrajaya in Federal Territory of Putrajaya and Hospital Sultan Ismail
in Johor. The implementation of the pioneer project is towards integrating traditional and
complementary medicine into the existing public healthcare delivery system.
The unit will initially provide three modalities of treatment comprising of Malay traditional
massage, acupuncture and herbal therapy as adjunct therapy for cancer treatment. Within each
modality, Malay traditional massage and Acupuncture provide services for the management of
post stroke and chronic pain, while herbal therapy is provided for the purpose of improving
quality of life, boosting body immunity, reducing side effects of chemotherapy and radiotherapy
and for synergistic effect of anti cancer drugs
In Malaysia, malignant neoplasm persisted as one of the five principal causes of national
mortality . In 2005, cancer contributed an approximate 10% of all death in government hospitals
compared to 7.4% in 1975 1. The cancer incidence is estimated to be about 150 for every
100,000 population. The estimated number of new cases per year is approximately 40,000 2.
2.
HERBAL THERAPY
The main objective of this guideline is to promote the rational usage of herbal therapy as an
adjunct treatment for cancer. Adjunct here is defined as a supporting treatment for
chemotherapy and radiotherapy. The aim of herbal treatment is usually to produce persisting
improvements in well being.
2.1
The aim of this therapy are :-
1. Reduce side effect of cancer treatment3
Cancer patients experience multiple symptoms related either to the cancer itself or to
late onset of side effects. These side effects have an adverse effect on quality of life.
Herbal medicine plays a useful role in relieving symptoms cancer related side effects for
example Fa ban xia is used to reduce the symptoms of nausea and vomiting.
2. Improve body immune system 4,5.
Patients with cancer often demonstrate suppression of immune function that usually
worsens as the disease progresses. This is manifested as impaired humoral and cellmediated responsiveness as well as decreased nonspecific defense mechanisms. Several
herbs have been shown to have different effects on immune effector cells and cytokine
levels in laboratory, animal and human studies as shown in the Appendix 1.
3. Synergistic effect.
Some herbs which are used in combination with modern drugs can exert synergistic
effects that helps patient to recover .
2.2
Types of cancer for herbal therapy
For the introduction phase, herbal therapy used for adjunct cancer treatment will focus on six
types of the most prevalence cancers in Malaysia 6,7 which are the breast , lung , cervix,
nasopharynx, colorectal and liver. This may be extended to other types of cancer when
required.
2.3
Category of patients for herbal therapy
The category of patients that will be referred for this therapy are:i. Newly diagnosed cancer patients on radiotherapy or chemotherapy or
surgery
ii. Patients completed chemotherapy with recurrence
iii. Advanced stage cancer on palliative treatment
iv. Cancer patients who refused medical treatment.
3.
Standard of Practice
a) All
cancer patients seeking for adjunct treatment at Traditional and
Complementary Medicine (T&CM) Unit should be referred by medical oncologist,
properly investigated and a precise diagnosis had been made.
b) T&CM Oncologist shall attend to patient in the T&CM unit , however he/she will
attend patients in ward upon request by the attending clinical specialists.
c) T&CM Oncologist shall made an assessment on patients’ current mode of
treatment and prescribe the necessary herbal products.
d) T&CM Oncologist shall document all the relevant diagnostic indicators such as Xray & laboratory profiles in monitoring treatment’s response.
T&CM oncologist may in the course of starting the treatment or during follow up
visits, request the relevant diagnostic indicators such as X-ray & laboratory
profiles to assist them in starting or monitoring treatment’s response.
e) For a referral of new cases, the Medical oncologist or related specialist shall
provide the following information :
1.
2.
3.
4.
5.
Complete diagnosis with stages
Laboratory profiles,
Radio-imaging reports,
Chemotherapy and radiotherapy regimes
Other relevant information.
f) The standard treatment card and the prescription sheet of herbal therapy for
complementary cancer treatment shall be used (Please refer to Appendix 2) .
4.
Consultation Sessions
a) Consultation hours shall be from 8.00am to 5.00pm on working days.
b) Complete history taking and initial assessment shall be done to ascertain suitability for
herbal therapy.
c) T&CM Oncologist are required to sent a patient to emergency department for medical
evaluation if the patient presented with an acute illness or new medical complaints that
need an emergency medical / surgical interventions.
d) It is the responsibility of the T&CM Oncologist to maintain surveillance on the
management of patients on long term follow-up according to needs.
e) Patients’ records must be maintained for future references. Consent form to be used by
the T&CM oncologist for patient’s treatment as in Appendix 3.
5.
Treatment Proper
a) Management of patient is at T&CM Unit (Please refer to Appendix 4)
b) Practitioners must maintain the cleanliness of the treatment room and adhere
to the infection control protocol.
c) The lists of finished herbal formulations and single herbs extract powder for
adjunct treatment for cancer according to the types of cancer shall be
standardized. ( Appendix 5 & 6 )
d) Practitioners must ensure that the original prescription is attached in the
treatment card and copy will be given to the pharmacist (Appendix 7).
e) If the intended appropriate prescription is unavailable from the formulation
lists or out of stock, T&CM Practitioners may then prescribe appropriately to
enable ones to buy the medicinal herbs from identified outlets of Chinese
medical halls.
f) Practitioners are advised to refer patient if there is sign of worsening condition
or symptoms to emergency department during their initial or follow-up visits.
g) The frequency and total duration of follow-ups are tailor-made to the
individual’s necessity. However , appendix 8 can be used as a guide.
Below are guidance on herb- drug and herb – herb interactions.
5.1
Herb – Drug interaction5
The following examples of pharmacological categories are recommended to be used with
caution.
Anticoagulants
Bai Zhu (Rhizoma
Atractylodis
Macro cephalae)
Dan Shen (Radix Salviae
Miltiorrhizae)
Chuan Xiong (Radix
Ligustici Wallichii)
E zhu
CNS stimulating effect
Jin Yin Hua (Flos
Lonicerae Japonicae)
Ma Huang (Herba
Ephedrae)
Ren Shen (Radix
Ginseng)
Coronary vasodilating and flow
increasing
Bai Guo Ye (Folium
Ginkgo Bilobae)
Bai Shao (Radix
Paeoniae Lactiflorae)
Bu Gu Zhi (Fructus
Psoraleae Corylifoliae)
Ji Xue Teng (Radix et
Antithrombics
Dang Gui (Radix
Angelicae Sinensis)
Hong Hua (Flos
Carthami Tinctorii)
Jiang Huang (Rhizoma
Curcuma e)
Yi Mu Cao (Herba
Leonuri Heterophylli)
Caulis Jixueteng)
Platelet aggregation inhibitors
Ge Gen (Radix
Puerariae)
Shan Zhu Yu (Fru ctus
Corni Officinalis)
Yan Hu Suo (Rhizoma
Corydalis Yanhusuo)
Yin Yang Huo (Herba
Epimedii)
Hypertensives
Sheng Jiang (Rhizoma
Zingiberis Officinalis
Recens)
Chen Pi (Perica rpium
Citri Reticulatae)
Wu Yao (Radix Linderae
Strychnifoliae)
The examples given above is extracted from 86 single herbs used in the Pilot Project.
5.2
Herb-Herb Interactions
Incompatible combinations 8: This includes herbs such as Gan cao
(aconite, licorice, and veratrum) with 6 other herbs. Their combinations
would lead to herb-to-herb interactions and/or toxicity. To include more
information since this is very important for TCM practitioners
R. Glycerrhiza (Gan Cao)*
Incompatible
combinations
R. Euphorbiae Kansui (Gan sui), R.
Euphorbiae seu Knoxiae (Da ji), Fos
Geukwa (Yuan Hua), and Herba
sargassum (Hat zao)
Rhizoma Aconite (Wu tou)
Bulbus fritillariae cirrhosac (Chuan bei
mu), bulbus fritillariae thundergii (Zhe
bei mu), Fructus trichosanthis (Gua
luo), Rhizoma pinelliac (Ban xia), R.
Ampelopsis (Bai lian), and Rhizoma
bletillae (Bai ji).
Rhizoma et Radix veratri (Li lu)
R. ginseng (Ren shen), R. Glehniae (Bet
sha shen), R. adenophorae (Nan shi
shen), R. scrophulariae (Xuan shen), R.
paeoniae alba (Bat shao), R. paeoniac
Rubra (Chi shao), and Herba asari (Xi
xin).
* currently used in the Pilot project
Note : Herbs such as Huang Qi (Astragalus) , Shen yi capsules (combination herbs),
Wei Mai Ning Jiao Nang (combination) and Yi Fei Qing Hua Ke Li (combination) has undergone
clinical trials The combination formulation can be used individually or in combination, with other
single herbs.
6.
Procurement and Storage of Formulated Herbal Products
a) The herbal products shall be confined to the listed finished products of single
or formulated herbs in the form of capsules, tablets, granules or fluid
concoctions. Every batch of herbs products must be accompanied with their
own Certificate of Analysis (COA) and passed all relevant test.
b) All the herbal product shall must not contain any animal parts and must
contain ‘halal’ ingredients.
c) All the finished products of traditional Chinese herbs must be stored in a
proper storage area, shall be locked and with updated inventories.
d) Random sampling of herbs
must be done and sent to National
Pharmaceutical Control Bureau for analysis.
7.
Dispensing of Herbs
a) Dispensing of formulated herbs shall be carried out by the trained
Pharmacist under close supervision of T&CM Oncologist.
b) Proper labeling, instructions of usage and name of ingredients must be
clearly stated on the container and also at the packaging of the herbs.
8.
Others
The fee charges will be according to the existing fee act or other relevant regulations.
Appendix 1: List of herbs that shown to have different effects on immune effector cells and
cytokine levels in laboratory, animal and human studies 9
Herbal agent
Other name
Immune modulatory effects reported
Radix Astragali
Huang Qi
Increased CD4/CD8 ratio and phagocytic activity in
patients
with
gastric
cancer
undergoing
chemotherapy. Stimulation of lymphocyte IL-2, IL-3,
IL-6, TNFa and IFN-g
Radix
Salviae Dan Shen
Miltiorrhizae
Increased T lymphocyte production and function
Rhizoma
Atractylodis
Macrocephalae
Increased phagocytosis, lymphocyte transformation,
rosette formation, and serum IgG post chemotherapy
Bai Zhu
Fructus Ligustri Nu Zhen Zi
Lucidi
Lessened leukopenia due
radiation
Radix Salix
Improved regenerative capacity of bone marrow after
chemotherapy
Liu Zhi
to chemotherapy or
Fructus
Lycii Gou Qi Zi
Chinensis
Fructus Ligustri Nu Zhen Zi
Lucidi
Radix Ginseng
bone marrow stimulatory (hematopoietic) effects
Ren Shen
Radix et Caulis Ji Xue Teng
Jixueteng
Radix Angelicae Dang Gui
Sinensis
Helps in treating anaemia by increasing red blood
cells
Appendix 2 : Herbal treatment Card (Kad rawatan herba)
KAD RAWATAN HERBA
( HERBA L TREATMENT CARD)
MAKLUMAT PESAKIT
(PATIENTS PARTICULARS)
Nama:
Name
Alamat :
Address
No KP:
I/C No
Tarikh Lahir:
Date of birth
Umur :
Age
No Daftar :
Registration No
Jantina:
Bangsa:
Gender
Race
No.Tel:
Phone No
Waris Terdekat
Next of Kin
Diagnosis ( mengikut Kod ICD 10):
Diagnoses
LATAR BELAKANG RAWATAN PESAKIT
PATIENT’S TREATMENT HISTORY
PEMBEDAHAN
SURGERY
TARIKH:
Date
Tarikh:
Date
RADIOTERAPI
RADIOTHERAPY
Tarikh mula:
Date started
KEMOTERAPI
CHEMO THERAPY
Tarikh mula :
Date Started
JENIS:
Type
Rejim :
Regimen
Rejim:
Regimen
KOMPLIKASI:
Complications
LAPURAN SI ASATAN
INVESTIGATION REPORT
Radiologi:
Radiology
X-ray
Makmal :
Laboratory
FBC
BUSE /RP
Patologi :
Pathology
Biopsi :
Biopsy
CT scan
LVT
MRI
Jenis Biopsi
Type of biopsy
ESR
PT /APPT/INR
Tarikh diambil :
Date taken
PENILAIAN PESAKIT
PATIENT’S ASSESSMENT
Tanda vital :
Vital signs:
Tekanan darah (BP):
Blood Pressu re
Kadar Nadi (HR):
Heat Ra te
Paras Gula:
Dextrostix (Dxt)
Ketepuan oxygen:
Oxygen saturation
Suhu Badan ( °C):
Temp era ture
Berat (kg)
Weight
Lain-lain:
Others
JENIS SIMPTOM
Types of symptoms
Nama Pengamal :
Practitioner’ s Name
Tarikh:
Date
PELAN RAW ATAN
TREATMENT PLAN
JENIS PRESKRIPSI HERBA
DOS
Types of Herbal
Dosage
Prescrip tions
TEMPOH
Duration
Tandatangan :
Signature
ULASAN
Rema rks
RAWATAN HERBA ( TEMU JANJI ULANGAN)
Nama:
Name
Diagnosis ( mengikut Kod ICD 10):
Diagnoses
HERBA L TREATMENT CARD ( FOLLOW UP APPOINTMENT)
MAKLUMAT PESAKIT
(PATIENTS PARTICULARS)
No KP:
No Daftar :
I/C No
Registration No
PENILAIAN PESAKIT
PATIENT ASSESSMENT
Tanda vital :
Vital signs:
Tekanan darah (BP):
Blood Pressu re
Kadar Nadi (HR):
Heat Ra te
Paras Gula:
Dextrostix (Dxt)
Ketepuan oxygen:
Oxygen saturation
Suhu Badan ( °C):
Temp era ture
Berat Badan (kg)
Weight
LAPORAN SIASATAN MAKMAL
LABORATORY INVESTIGATIO N REPORTS
PELAN RAW ATAN
TREATMENT PLAN
JENIS SIMPTOM
Types of symptoms
JENIS PRESKRIPSI HERBA
Types of Herbal
Prescrip tions
DOS
Dosage
TEMPOH
Duration
PELAN RAW ATAN ULANGAN
FOLLOW UP TREA TMENT PLAN
Nama Pengamal :
Practitioner’ Name
Tarikh
Date
Tandatangan :
Signature
ULASAN
Rema rks
CONSENT FOR HERBAL TREATMENT AS A N ADJUNCT THERAPY FOR CA NCER
………………………………………………………………………………………………………………… Hospital .
I, ………………………………………………………… of ……………………………………………………………. herby consent to
undergo herbal treatment as an adjunct therapy for cancer …………………………………… * the submission of my child / ward
…………………………………………………………………… to undergo herbal treatment as an adjunct therapy for
cancer……………………….. the nature and purpose of which have been explained to me by Traditional & Complementary
Practitioner ……………………………………………………………………….
I also consent to such fur ther or other measures as may be found necessary during the course of above mention treatment.
I understand that I can ask any questions per taining to my treatment before signing this form. I have the right to refuse or
discontinue any treatment at any time .
Date : …………………………………
Signed : …………………………………………
(Patient / Parent / Guardian)
Relationship : …………………………………..
I/C No : ………………………………………….
* Note : If any other person gives his/hers consent as a guardian, his/her relationship with the patient should be given below
his/her signature.
______________________________________________________________________________________________________
Traditional & Complementary Practitioner
I confir m that I have explained the nature and purpose of herbal treatment as an adjunct therapy for cancer ………… …..to the
patient /parent / guardian *.
Date : ……………………………………..
Signed : …………………………………………
( Traditional & Complementary practitioner )
Appendix 3 : Consent form for Herbal therapy
Start
Start
Patient/Client
Referral
Appointment
Registration
History Taking and
Assessment
YES
NO
Suitable for
Herbal
Therapy?
Herbal Therapy and
Counseling
Treatment?
?
Ad vise
appropriately
and Discharge
Follow-Up
Discharge
Appendix 4: Work process in patients’ management for herbal therapy as adjunct treatment
for cancer
Cancer Type
10
1) Capsule Shen Qi Pian (参芪片
31)
2) Capsule Yi Fei Qing Hua Ke Li
益肺清化颗粒
3.) Capsule Wei Mai Ning Jiao Nang
威麦宁胶囊
Ingredients
Radix Ginseng
Radix Astragali seu Hedysari
Radix Astragali seu Hedysari
Radix Codonopsis Pilosulae
Herba Hedyotis Diffu sae
Radix Glehniae
Radix Ophiopogonis
Herba Patriniae
Herba Agrimoniae
Bulbus Fritillariae Cirrhosa e
Semen Armenia cae Ama rum
Rhizoma Fagopyri Cymosi
Indication
Improve quality of life and better cope with cancer therapy.
Relieve pain and improve quality of life.
Improve quality of life.
Appendix 5: List of Used formulated herbs in Traditional and Complementary unit.
Appendix 6 : List of Approved Single Herbs Extracts as adjunct treatment for
cancer11,12,13,14,15, 16
Indication*
Pinyin Name
No.
Extracts
Scientific name
1
Bulbus Allii
Macrostemonis
Allium macrostemon
Bge
Xie Bai
2
Bulbus Fritillariae
Fritillaria sp.
Bei Mu
3
Bulbus Fritillariae
Cirrhosae
Fritillaria cirrhos a D.
Don
4
Caulis Spatholobi
5
Cort ex Eucommiae
6
Cort ex Lycii
7
Cort ex Paeonia
Suffruticosa
8
Flos Cart hami
Cart hamus tinctorius
L.
9
Flos Chrysanthemi
Chrysanthemum
indicum L.
Ju Hua
10
Flos Lonicerae
Lonicera japonica
Thunb.
Jin Yin Hua
11
Folium Eriobottrya
Japonica
12
Fructus Amomi
13
Fructus Aurantii
Citrus aurantium L
Zhi Qiao, Zhi
Ke
14
Fructus Corni
Cornus officinalis
Sieb. Et Zucc
Shan Zhu Yu
15
16
17
Fructus Hordei
Germinatus
Fructus Ligustri
Lucidi
Fructus Lycii
Spatholobus
suberectus Dunn
Eucommia ulmoides
Oliv.
Lycium chinense Mill.
Paeonia suffruticosa
Andr
Eriobottrya japonica
(Thunb.) Lindl.
Amomum willosum
Lour.
Chuan Bei Mu
Ji Xue Teng
Du Zhong
Di Gu Pi
Mu Dan Pi
Hong Hua
Pi Pa Ye
Sha Ren
Hordeum vulgare L
Mai Ya
Ligustrum lucidum
Ait.
Nü Zhen Zi
Lycium barbarum L
Gou Qi Zi
Strengthen Heart Functions
Resolving phlegm, antitussive,
clearing heat and coagulation
Cough with thick green sputum,
dryness of the mout h and nasal
cavity
Enrichment of the blood, sedative,
hypnotic, anti inflammat ory
Tonic for liver and kidney to reduce
headache and dizziness
Antipyretic, antibacterial,
hypotensive, reduce blood sugar,
inhibit lipids, adjusts immunological
function
anti-inflammatory, preventions of
thrombosis and atherosclerosis,
arrest of arrhythmia, hypotensive
actions
Relieve pain, facilitate blood flow,
reduction of blood lipids, prevention
of thrombosis
Antibacterial, improve
cardiovascular function, antipyretic
Inhibition of pathogenic microbes,
ehance of immunological functions,
anti-inflammatory, antipyretic
Antitussive, antiasthamatic,
antibacterial, antihelminthic
Dispelling Dampness
diuretic, immunological stimulant,
antitumour, inhibit pathogenic
bacteria, protect liver
Improving any symptoms of
prostate
Acute and chronic hepatitis,
promote digestion
Detoxyfying agent, Tonic for liver
and kidney, reduce palpitation
Nourish the liver, tone up kidney,
nourish blood –overcome dizziness
,constipation due to dryness in the
intestines.
*according to Traditional Chinese Medicine diagnosis
No.
Extracts
Scientific name
18
Fructus Mori
Morus alba L
19
Fructus Schisandrae
Chinensis
Schisandra chinesis
(Turcz.) Barll.
Fructus Setariae
Germinatus
Fructus
Trichosanthes
Kirilowi
Setaria italica (L.)
Beauv.
20
21
22
Trichosanthes
k irilowii Maxim
Pinyin Name
Sang Shen Zi
Wu Wei Zi
Gu Ya
Gynostemma
pentaphyllum
Agrimoniae pilosa
Ledeb.
Artemisia capillaris
Thunb.
Pei Lan
improves the circulation, stimulates
liver function, strengthens the
immune and nervous systems, and
reduces blood sugar and
cholesterol levels.
regulate blood, constrict and arrest
bleeding
remove dampness, prot ect liver,
reduce jaundice
Relieve stress and fatigue,
eliminate phlegm and relieve
cough, strengthen tendons and
bones.
Reduce phlegm and fatigue
Bai Hua She
She Cao
Hemolytic hypotensive sedative,
hypnotic
Xian He Cao
23
Herba Agrimoniae
24
Herba Art emisiae
Capillaris
25
Herba Epimedii
Epimedium
brevicornum Maxim
26
Herba Eupatorii
Eupatorium fort unei
Turcz.
27
Herba Hedyotis
Diffus ae
28
Herba Leonuri
29
Herba Pat riniae
30
Herba Salviae
Chinensis
31
Herba Scutellariae
Barbatae
Scutellaria barbata D.
Don
Ban Zhi Lian
32
Herba Tarax aci
Taraxacum
mongolicum Hand.
Mazz
Pu Gong Ying
Hedyotis diffusa
(Willd.) Roxb
Leonurus japonicus
Houtt.
Deficient yin and blood manifested
as dizziness, vertigo, blurred
vision, tinnitus, deafness, insomnia
and early graying of hair
Thirst and dry mouth due to
deficient body fluids or diabetes
manifested as thirst with desire to
drink, profuse urine and lassitude
Constipation due to dryness in the
intestines.
antitussive, expectorant,
antipyretic, prot ection of the liver
,antibacterial, antitumour,
Tonify the spleen and stomach,
digestion of starchy food
Reduce phelgm
Gua Lou
Jiao Gu Lan
Gynostemma
Indication*
Yin Chen Hao
Xian Lin Pi or
Yin Yang Huo
Yi Mu Cao
Bai Jiang Cao
/ Improving cardiovascular system,
renal function and stimulate
respiratory center in the brain
reduce toxicity, Clear heat,
Patrinia villosa Juss
Salvia chinensis
Benth
Shi Jian Chuan
For promoting circulation and
arrest pain. Being used in achy
bones, carbuncle, and canc er
To disperse fluid and toxin,
bacteriostatic effect on abnormal
lymphosytes
Anticancer
33
Herba Violae
No.
34
35
Extracts
Pericarpium Arecae
Catechu
Pericarpium Citri
Reticulatae
Viola yedoensis
Makino
Scientific name
Zi Hua Di Ding
Pinyin Name
Areca catechu L.
Da Fu Pi
Citrus reticulata
Blanco
Chen Pi
Anticancer Properties
Indication*
Abdominal distension, superficial
edema and food stagnation
Vomiting, expectorant, anti
asthmatic
diuretic, immunological stimulant,
antitumour, inhibit pathogenic
bacteria, protect liver
Diuretic, enhancement of immunity,
antitumour, sedative, prevent
formation of peptic ulcer, reduc e
secretions of gastric juice, prot ect
liver, relax smooth muscle
36
Polyporus
Polyporus umbellatus
(Pers.) Fires
Zhu Ling
37
Poria
Poria covos (Schw. )
Wolf
Fu Ling
38
Radix Actinidia*
Actinidia cbinensis
Planch.
Teng Li Gen
39
Radix Adenophorae
Adenophora
tetraphylla (Thunb.)
Fisch.
40
Radix Angelicae
Sinensis
Angelica sinensis
(Oliv. ) Diels
Dang Gui
Regulate menstruation, increasing
metabolism rate, stimulating and
relaxing of uterine muscles, diuretic
effect, relaxes smooth muscles
41
Radix Astragali
Astragalus
membranaceus
(Fisch.) Bge
Huang Qi
Cardiotonic and tonifying effect,
diuretic effect, aids in T cell
production
Radioprotective activities
treat coughs caused by yin
Nan Sha Shen
deficiency
42
Radix Bupleuri
Bupleurum chinese
DC.
Chai Hu
Antipyretic, sedative, analgesic,
antitussive, antibacterial, antiviral,
anti-inflammatory, protection of the
liver, enhance immunological
actions, peptic ulcer
43
Radix Codonopsis
Pilosulae
Codonopsis pilosula
(Franch.) Nannf.
Dang Shen
Stimulates the nervous system,
increase body resistance,
promotes digestion
Radix Curcumae
Curc uma wenyujin
Y.H.Chen
44
Yu Jin
Prevent and treat coronary heart
disease, improving the blood
rheological properties, inhibit skin
disease, promote secretion of bile
Appendix 6 : List of Approved Single Herbs Extracts as adjunct treatment for cancer 12,13
Indication*
Pinyin Name
No.
45
Extracts
Radix Dipsaci
Scientific name
Dipsacus asperoides
C.Y. Chen
Xu Duan
Lumbar pain
46
Radix et Rhizoma Rhei
Rheum palma tum L
Da Huang
Appetite stimulant,counteract toxic
effect remove coagulation,
astringent, antibacterial effect
47
Radix Ginseng
Panax ginseng C. A.
May
Ren Shen
Stimulates the nervous system and
the adrenal gland
Radix Glycyrrhizae
Glycyrrhiza uralensis
Fisch.
Gan Cao
Antiinflammatory, antispasmodic,
detoxifying effect, increase blood
pressure
Morinda officinalis How
Ba Ji Tian
Strengthening muscles and bones,
eliminating dampness
48
49
50
51
52
53
54
Radix Morindae
Officinalis
Radix Notoginseng
Radix Paeonia Alba
Radix Paeonia Rubra
Radix Panacis
Quinquefolii
Radix Platycodonis
San Qi
To control bleeding and blood
circulations, anti-inflammatory
analgesic and improve
cardiovascular functions, protect
liver, antibacterial
Bai Shao
Sedative, anticonvulsive,
antipyretic, enhance delayed
hypersensitivity to adjust the
immunity of the human body,
improving cardiovascular system
and blood system, antiinflammatory
Paeonia veitchii Lynch
Chi Shao
improve cardiovascular function,
sedative analgesic anticonvulsive,
improve digestive system
Panax quinquefolium L
Xi Yang Shen
Panax notoginseng
(Burk.) F.H.Chen
Paeonia lactiflora Pall
Platycodon
grandiflorum (Jacq.) A.
DC
Jie Geng
nourish stomach, clear up heat
Expectorant and antitussive, antiinflammatory, inhibit gastric
secretion, prevent formation of
peptic ulcer, reduction of blood
sugar and blood lipid
No.
55
56
57
58
59
60
Extracts
Scientific name
Radix Polygoni
Polygonum multifloru m
Multiflori
Thunb.
Radix Pseudostellariae
Pseudostella ria
heterophylla (Miq.) Pax
Radix Rehmanniae
Rehmannia glutinosa
Preparata
Libosch
Radix Salviae
Miltiorrhizae
Salvia miltiorrhiza Bge
Radix Scrophulariae
Scrophularia
ningpoensis Hemsl
Radix Scutellariae
Scutella ria baicalensis
George
Pinyin Name
He Shou Wu
Tai Zi Shen
Indication*
Tone up liver and kidney
Poor appetite and lassitude,
Deficient yin of the lungs
manifested as dry cough or cough
with scanty sputum
Shu Di Huang
tone up blood,protect liver, to
overcome dizziness and vertigo
Dan Shen
Stimulates the nervous system,
increase body resistance,
promotes digestion
Xuan Shen
Clearing heat to cool blood,
purging fire, detoxicating,
dissolving lumps
Huang Qin
Cardiotonic and tonifying effect,
diuretic effect, aids in T cell
production
Inhibitions of pat hogenic microbes,
anti-inflammatory,
immunos uppressive, anti
neoplastic, anti arryhtmic,
resistance to myocardial
inschemis, sedative, hypnotic,
antipyretic
61
Radix Sophorae
Flavescentis
Sophora Flavescens Ait
Ku Shen
62
Radix Sophorae
Tonkinensis
Sophora tonk inensis
Gagnep
Shan Dou Gen
63
Rhizoma Acori
Talarinowii
Acorus tatarinowii
Schott.
Shi Chang Pu
64
Rhizoma Alismatis
Alisma orient alis
(Sam.) Juzep
Ze Xie
For painful and swollen throat.
delirium,
epilepsy,
coronary
diseases, angina, arrhythmia,
stroke, vertigo, ringing in the ears,
atrophic gastritis, external injury of
the brain, mentally handicapped/
disabled
diuretic, reductions of blood lipids,
protection of the liver, anti
inflammatory
Pinyin Name
Indication*
No.
Extracts
Scientific name
65
Rhizoma
Anemarrhenae
Anemarrhena
asphodeloides Bge.
66
Rhizoma
Atractylodis
Macrocephalae
Atractylodes
macroceohala Koidz.
Bai Zhu
67
Rhizoma Coptidis
Coptis chinensis
Franc h.
Huang Lian
Inhibitions of pat hogenic microbes,
improve cardiovascular function,
anti inflammatory, sedative
68
Rhizoma Curcumae
Curc uma phaeocaulis
Valeton
E Zhu
Antitumour, improving blood
rheological properties, dilatation of
blood vessel, bactericidal effect
69
Rhizoma Cyperi
Cyperus rotundus L.
Xiang Fu
produce estrogenic effect,
analgesic ,sedative ,anti pyretic
70
Rhizoma Dioscoreae
Dioscorea opposita
Thunb.
Shan Yao
strengthen spleen stomach, relive
diarrhea
71
Rhizoma Imperatae
Imperata cylindrica
Beauv. var. major
(Ness)
Bai Mao Gen
Clearing heat from blood to stop
bleeding, induce diuresis, promote
generation of body fluid
72
Rhizoma Pinelliae
Preparat um
Pinellia tetnat a
(Thunb.) Breit.
Fa Ban Xia
73
Rhizoma Polygonati
Polygonatum
k ingianum Coll. et
Hemsl.
74
Rhizoma Polygonati
Odorati
Polygonatum
odoratum (Mill.)
Druc e
Yu Zhu
75
Rhizoma Polygoni
Bistortae
Polygonum bistorta L.
Quan Shen
Zhi Mu
Huang Jing
Antibacterial, antipyretic, inhibition
sympathetic adrenal function,
reduction blood sugar
Diuretic, sedative, antiemetic,
promote digestion
Reduce phlegm, stop vomiting
Protect liver, spleen tonic, lubricate
lung, good for dry cough
Impairment of yin of the lung and
stomach with dry cough, dryness of
the throat and thirst, wasting thirst
due to internal heat
Fatigue
No.
Extracts
Scientific name
Pinyin Name
Indication*
Taeniasis, ascariasis,
fasciolopsiasis; abdominal pain due
to intestinal parasitosis; diarrhea
and tenesmus due to accumulation
of undigested food; edema and
weak ness of the legs
76
Semen Areaca
Catechu
Areca catechu L.
Jiao Bin Lang
77
Semen Armeniacae
Amarum
Prunus armeniaca
L. var., ansu Maxim
Ku Xing Ren
78
Semen Coicis
Coix lacrymajobi L.
var ma-yuen (Roman)
Stapf.
Yi Yi Ren
Inducing diuresis, strengthening
spleen, excreting dampness,
arresting diarrhoea, clearing heat
and pus
79
Semen Cuscutae
Cuscuta chinensis
Lam.
Tu Si Zi
Lumbar Pain
Descurainia sophia
(L) Schur
Ting Li Zi
Drains lung heat, reduces phlegm,
calms wheezing, reduces edema
Chi Xiao Dou
Edema due to deficiency in spleen
or kidneys ; Boils and carbuncles
due to toxic heat and damp-heat
jaundice.
Tao Ren
Improving blood rheological
properties, improving
cardiovascular system,
caccagogue action, antiinflammatory, antitussive
80
81
82
Semen Descurainiae
Semen Phaseoli
Semen Prunus
Persica
Phaseolus calcaratus
Roxb.
Prunus persica
Batsch
Suppress cough, reduce sputum
83
Semen Ziziphi
Spinosae
Ziziphus jujuba Mill.
var spinosa (B unge)
Suan Zao Ren
Anticonvulsive, analgesic,
antipyretic, improving
cardiovascular system, protect
against radiation injury
84
Spica Prunellae
Prunella vulgaris L
Xia Ku Cao
Clearing liver heat, subduing
swelling, resolving hard lump
85
Stamen Nelumbinis
Nelumbo nucifera
Gaertn.
Lian Xu
Seminal emission, spermat orrhea,
excessive leukorrhea, frequent
urination.
86
Tuber Ophiopogonis
Japonici
Ophiopogon
japonicus (Thunb.)
Mai Dong, Mai
Men Dong
improve immune system, improves
recoveries of cells of the pancrea
and lowering blood sugar, anti
bacteria
Herbal Prescriptions - Kepala Batas Hospital
No.
Item code
Name (Chinese)
Name (Pinyin)
SYJN
参一胶囊
Shen Yi Jiao Nang
YFQHKL
益肺请化颗粒
Yi Fei Qing Hua Ke Li
3
WMNJN
威麦宁胶囊
Wei Mai Ning Jiao Nang
No.
Item code
Name (Chinese)
Name (Pinyin)
1
2
A001
C227
巴戟天
白花蛇舌草
3
C225
4
5
1
2
Qty
Serial Number :(printed 4 digit)
Re marks
No.
Item
code
No.
Item
code
Name
(Chinese)
Ba Ji Tian
Bai Hua She She Cao
30
31
Name (Pinyin)
Huang Lian
Huang Qi
59
60
B213
A100
五味子
西洋参
Wu wei Zi
Xi Yang Shen
败酱草
Bai Jiang Cao
黄芩
Huang Qin
61
C263
夏枯草
A003
A005
白茅根
白芍
Xia Ku Cao
G340
A054
鸡血藤
桔梗
Ji Xue Teng
Jie Geng
62
63
C260
A434
仙鹤草
香附
Xian He Cao
Xiang Fu
6
A006
35
D289
金银花
Jin Yin Hua
64
A102
薤白
7
Xie Bai
36
D290
菊花
Ju Hua
65
A104
续断
Xu Duan
37
38
A055
B174
苦参
苦杏仁
Ku Shen
Ku Xing Ren
66
67
A105
C265
玄参
益母草
Xuan Shen
Yi Mu Cao
39
D409
莲须
Lian Xu
68
B219
薏苡仁
Yi Yi Ren
40
41
B182
F328
麦芽
牡丹皮
Mai Ya
Mu Dan Pi
69
70
C266
A108
茵陈蒿
玉竹
Yin Chen Hao
Yu Zhu
42
B443
女贞子
Nu Zhen Zi
71
A109
郁金
Yu Jin
43
44
C249
E310
佩兰
枇杷叶
Pei Lan
Pi Pa Ye
72
73
A110
A112
泽泻
知母
Ze Xie
Zhi Mu
Dang Gui
Dang Shen
45
46
C248
A483
蒲公英
人参
Pu Gong Ying
Ren Shen
74
75
B444
I365
枳壳
猪苓
Zhi Qiao
Zhu Ling
地骨皮
杜仲
Di Gu Pi
Du Zhong
47
48
A078
A080
拳参(草河车)
三七
Quan Shen
San Qi
76
77
C270
紫花地丁
Zi Hua Di Ding
A032
A033
I360
莪术
法半夏
茯苓
E Zhu
Fa Ban Xia
Fu Ling
49
50
51
B196
B198
A081
桑椹子
砂仁
山豆根
Sang Shen Zi
Sha Ren
Shan Dou Gen
78
79
80
A037
B156
B449
甘草
枸杞子
谷芽
Gan Cao
Gou Qi Zi
Gu Ya
52
53
54
A082
B200
A089
山药
山茱萸
熟地黄
Shan Yao
Shan Zhu Yu
Shu Di Huang
81
82
83
Qty
Name (Pinyin)
A048
A049
Name (Chinese)
黄连
黄芪
32
A050
Bai Mao Gen
Bai Shao
33
34
白术
Bai Zhu
C228
半枝莲
Ban Zhi Lian
8
9
A111
A017
贝母
柴胡
Bei Mu
Chai Hu
10
B142
陈皮
Chen Pi
11
12
A020
B143
赤芍
赤小豆
Chi Shao
Chi Xiao Dou
13
A021
川贝母
Chuan Bei Mu
14
15
A085
A024
大黄
丹参
Da Huang
Dan Shen
16
17
A027
A028
当归
党参
18
19
F320
F322
20
21
22
23
24
25
Qty
Qty
26
B194
瓜蒌
Gua Lou
55
B206
酸枣仁
Suan Zao Ren
84
27
A438
何首乌
He Shou Wu
56
A091
太子参
Tai Zi Shen
85
28
D285
红花
Hong Hua
57
B207
桃仁
Tao Ren
86
29
A436
黄精
Huang Jing
TOTAL ITEM
58
B209
菟丝子
Tu Si Zi
TOTAL ITEM
87
Name
I/C
Age
:
:
:
Appendix 7: Prescription card
Diagnosis
Doctor's Signature,
Name, and Cop
:
:
TOTAL ITEM
TOTAL SUM
Date
Dispense by
TCA Date
:
:
:
Appendix 8 : Guide in Regime of treatment in Herbal medicine
Frequency
prescriptions
Herbal medicine
1 st week -Once daily
2nd week -Twice daily ( depend on patient suitability)
Duration of
treatment
Note : once the patients experience any unwanted effects relate to
the herbal intake (e.g. palpitation), the patients are advised to report
the event to the herbal oncologists
After one course of treatment (2 months)
Stop treatment for 1 week (herbal free interval).
Then continue / start another course of treatment
Note : During each visit, the herbal oncologist may modify the
formula according to the patients’ current condition.
Treatment course
assessment
After 2 month of treatment
SURVEILLANCE/MONITORING
 Identify and record adverse reactions
- patients are advised to report any adverse reactions to the herbal oncologists or pharmacists.
- identified by the herbal oncologists
- adverse reactions is to be filled in the MADRAC’s Adverse Reaction Form and to be sent to
National Pharmaceutical Control Bureau.
- measures to be taken :
a) re-challenge the same regime
b) change to other regime OR
c) adjust the dosage of the regime
 Effectiveness of treatment

Both medical oncologists and herbal oncologists evaluate the chief complaints or the
main concerns of the patients (e.g. improve in appetite).

full blood count, liver functions, renal functions tests may be requested by the herbal
oncologists monthly or every 2 month, but ordered by the medical oncologists

tumour marker measurement (e.g. CEA) every ½ year

record in the patient’s tickets
feedback on patients’ current condition and effectiveness of herbal treatment is to be
sent to medical oncologists.
 Evaluation of treatment
- revise management by herbal oncologists
- after every course (2 months) or every visit
- according to signs and symptoms
- patients are advised to try other modalities (e.g. acupuncture) concurrent with herbal
treatment whenever applicable (e.g. for cancer related pain, numbness, insomnia).
- revise management by pharmacists
- assess patients’ compliance
 Stop treatment
- there is no maximum courses for herbal treatment
- stop treatment after re-challenged if suspected or possible serious adverse reactions
occurs
- patient is no longer willing to continue herbal treatment (defaulted patients)
 Change modalities
- patients’ desire to change to other modalities.
References
1. Annual Report, Ministry of Health Malaysia, 2005.
2. National Cancer Blueprint, 10-year Master Plan : 2006-2015.
3. Integrating Conventional and Chinese Medicine in Cancer Care : A Clinical
Guide, Tai Lahans, Churchill Livingstone 2007.
4. Cancer and TraditionalChinese Medicine Treating the Side Effects
Chemotherapy and Radiation with Traditional Chinese Herbs,Amy Hanks (2000)
Eastland Press
5. (Part Two) Traditional Chinese Medicine in the Treatment of Breast Cancer
Isaac Cohen, LAc, OMD, Mary Tagliaferri, MD, LAc & Debu Tripathy, MD; view at
http://www.cancersupportivecare.com/chinesemedicine2.html (access on
September 2007)
6. National Cancer Blueprint, 10-year Master Plan : 2006-2015 - The Goals of
Traditional and Complementary Medicine.
7. National Cancer Registry, 2003.
8. H. Chan Thai, ND; Herb-Drug Interactions,Harborview Medical Center
http://ethnomed.org/clin_topics/herbal_medicine/herb-drug_rev.pdf
9. (Part Three) Traditional Chinese Medicine in the Treatment of Breast Cancer
Isaac Cohen, LAc, OMD, Mary Tagliaferri, MD, LAc & Debu Tripathy, MD; view at
http://www.cancersupportivecare.com/chinesemedicine2.html (access on
September 2007)
10. Sun yan et al, A randomised prospective, multicentre clinical trial of NP regiman
(vinovelbine + cisplatinum) plus Ginseng Rg 3 in the treatment of advanced non
small lung cancer patients, Clin .J. Lung Cancer, June 2006 Vol 9 No: 3, 254
11. Pharmacopoeia of the People’s Republic of China, English ed,2001 : vol 1
12. Medicinal plants i n China – A selection of 150 commonly used species . WHO
Regional Publications, Western Pacific Series No 2 (1989)
13. The Chinese Materia Medica edited by Beijing University of Traditional Chinese
Medicine, Academy Press, 1 st Edition 1998.
14. An Illustrated Chinese Materia Medica by Jiang- Nuan Wu,, Oxford University
Press, 2006
15. Mc CullochM,et al : astralagus – based Chinese herbs and plantinum based
chemotherapy for advanced NSCL and meta analysis of randomised trials. J.
Clin.Oncol 2006,24 :419-430
16. Wang Bin J: the research on radioprotective agents in Chinese Materia Medica,
Mem. Inst. Oswaldo Cruz, Rio de Janeiro, Vol 86. Suppl II, 1991: 165 -167.