Symposium 3

Symposium 3: Evidence-based Chinese Medicine in Other Disorders

Date: 6 July 2025, Sunday | Time: 1530 - 1730 | Venue: The NAK Auditorium, Academia

Co-Chairs: Co-Chairs: Mr Koh Boon Khai (SCHMI), Assoc Prof Bernard Thong (TTSH) & Assoc Prof Loo Chian Min (SGH)

TOPIC 1:

Acupuncture for Cancer-related Conditions: An Overview of Systematic Reviews

Acupuncture is commonly used for cancer-related conditions worldwide, and we evaluated systematic reviews (SRs) on acupuncture for cancer-related conditions. A comprehensive search was conducted on eight databases till October, 2021. SRs of randomized controlled trials (RCTs) on acupuncture for cancer-related conditions were to be included. The methodological quality of all included reviews was evaluated by AMSTAR 2 and ROBIS. Fifty-one SRs of RCTs on acupuncture for cancer-related conditions were included. The methodological quality of SRs included 1 “high”, 5 “low” and 45 “very low” by AMSTAR 2. Sixteen SRs assessed as low risk of bias (31.37%), and 35 SRs had high risk of bias (68.63%) by ROBIS. Acupuncture showed effective on cancer pain, fatigue, insomnia, quality of life; chemotherapy-induced nausea and vomiting and bone marrow suppression; and breast cancer-related menopause, hot flashes, arthralgia, and nasopharyngeal cancer-related dysphagia. Acupuncture appeared to have benefit for patients with lymphoedema, gastrointestinal symptom, and xerostomia. The use of acupuncture was safe in cancer patients. Evidence from SRs showed that acupuncture is beneficial to cancer survivors with cancer-related pain, fatigue, insomnia, improved quality of life, nausea and vomiting, bone marrow suppression, menopausal symptoms.

TOPIC 2:

Role of Integrative Oncology in Improving Treatment Outcome for Patients with Cancer

Speaker: Asst Prof Rose Fok Wai Yee (NCCS)

Integrative oncology is an emerging, patient-centred approach that combines conventional cancer treatments with evidence-informed complementary therapies to address the physical, emotional, and spiritual needs of patients. By integrating modalities such as nutrition counselling, acupuncture, mindfulness, physical activity, and psychosocial support alongside standard chemotherapy, radiation, and surgery, integrative oncology aims to enhance quality of life, reduce treatment-related side effects, and improve overall clinical outcomes. This multidisciplinary approach fosters greater patient engagement, adherence to treatment plans, and resilience during the cancer journey. Furthermore, integrative oncology contributes to personalized care, aligning treatment strategies with individual patient preferences, values, and lifestyles.

Recent guidelines developed by the Society of Integrative Oncology on managing pain, anxiety, depression and fatigue have been endorsed by ASCO. As the field evolves, continued research and more standardised guidelines are essential to optimize its implementation and validate its long-term impact on survival and recovery. Use of complementary therapy is prevalent in our cancer population and NCCS plans to introduce Integrative Oncology as a new service to address unmet needs in our patients. Integrative oncology has the potential to transform cancer care by improving not only the efficacy of treatment but also provide holistic well-being of patients.

TOPIC 3:

Acupuncture and Chinese Herbal Medicine for Functional Digestive Disorders

Speaker: Dr (TCM) Linda Zhong (NTU)

Traditional, Complementary, and Integrative Medicine (TCIM) is increasingly recognized for managing functional digestive disorders (FDD), especially in Asia. In March 2024, the 2nd Asian Functional Dyspepsia Consensus emphasized integrating TCIM into international guidelines, highlighting evidence-based approaches like the Zhizhu Kuanzhong Capsule (ZZKZ) for functional dyspepsia (FD). Meanwhile, international guidelines such the Japanese Society of Gastroenterology (JSGE) and the Canadian Association of Gastroenterology, reviewed the application of acupuncture in managing irritable bowel syndrome (IBS). Recently, we have focused on both clinical and mechanistic studies of ZZKZ for FD and acupuncture for IBS with constipation (IBS-C). These studies aim to reveal how herbal medicine and acupuncture interact with functional gastrointestinal disorder (FGID) pathophysiology, particularly the gut-brain axis. Potential mechanisms include modulation of gut microbiota, regulation of the gut-brain axis, anti-inflammatory effects, alleviation of symptoms, regulation of gastrointestinal motility, and modulation of pain and visceral sensitivity.

TOPIC 4:

Acupuncture for Faecal Incontinence

Speaker: Dr Tan Koon Yaw (NTU)

Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy, including biofeedback therapy, improves mild symptoms with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity, resulting in low uptake and acceptability. This study is to determine the effectiveness of acupuncture, compared to biofeedback therapy, in the treatment of fecal incontinence and at the same time investigate the differences in quality of life after treatment.

TOPIC 5:

HarmoKNEE Study

Speaker: Dr Bryan Tan Yijia (WHC) and TCMP Ng Hui Ping (SCHMI)

Background - Acupuncture has increasingly gained popularity as alternative approach to conventional care for knee osteoarthritis (KOA) management. We conducted a pragmatic randomized controlled study to evaluate the clinical and cost-effectiveness of acupuncture and heat therapy in conjunction with standard care for KOA.

Methods - Community-ambulating KOA patients of 45 years or older were randomly assigned to the intervention or control (SC) group. The HARMOKnee group received 12 acupuncture and heat treatments in addition to standard care for six weeks. We evaluated the Knee Injury and Osteoarthritis and Outcome Score-12 (KOOS-12) at baseline, 6-, 12- and 24-week. Secondary outcomes including Pain, Enjoyment of Life and General Activity (PEG) scores, Patient Health Questionnaire-4 (PHQ-4), and TCM syndrome differentiation were evaluated. Comparative analysis was performed using mixed-effect models.

Results - Among 101 participants (HARMOKnee=50; SC=51), the mean age was 63.99±7.03 years, and KOA duration was 5.07±6.35 years. There was a significant intervention-time interaction, favouring HARMOKnee group, for the KOOS-12 total score [Coef=6.43, 95%CI:0.72, 12.14; p=0.027], KOOS-12 quality of life (QOL) domain-score [Coef=8.50, 95%CI:1.28, 15.73; p=0.021], and PEG overall score [Coef=-1.32, 95%CI:-2.14, -0.49; p=0.002] at 6-week. No between-group differences were identified at other time-points. The HARMOKnee group demonstrated considerable pain reduction and improved knee flexion and extension after 12 treatments (0.001<p<0.014). This treatment approach markedly enhanced knee flexion in patients with Kidney yang deficiency with phlegm and blood stasis syndrome.

Conclusions - HARMOKnee provides short-term pain-management benefits to KOA patients compared to standard care alone, particularly in patients with Kidney yang deficiency with phlegm and blood stasis syndrome.