2 retention, anal ﬁssures, and even bowel obstruction [11]. However, the “best” treatment for constipation on both eﬃcacy and safety remains an unresolved issue [12, 13]. According to the TCM theory, constipation can be broadly divided into excessive and deﬁcient patterns based on the underlying aetiology. The excessive pattern is characterized by excess heat or pathological accumulation of Qi (stag- nation), while the deﬁcient pattern is characterized by the dryness from insuﬃcient ﬂuid lubrication in the form of blood (Yin) or lack of propulsion power from the deﬁciency of Qi or Yang [4, 14, 15]. Five common TCM syndromes can be summarized from the TCM references of Internal Medicine of Chinese Medicine [4], Criteria of Diagnosis and Therapeutic Eﬀect of Diseases and Syndromes in Traditional Chinese Medicine [5], and Clinical Handbook of Internal Medicine [14, 15]. They are the intestine with excess heat, intestinal Qi stagnation, spleen deﬁciency with weakness of Qi, spleen-kidney Yang deﬁciency, and Yin deﬁciency with intestinal dryness. Each of them has its unique treatment principle and prescription. However, none of these references is speciﬁed on advanced cancer patients. The constitutions of these patients are diﬀerent from general patients only with constipation; therefore, an epidemiological study on syndrome distribution is important for the establishment of practice guidelines in palliative cancer care. In this present study, the TCM syndromes distribution and their common symptoms and signs among constipated advanced cancer patients are ﬁrst determined. Besides, the impacts of patient demographics and opioids prescribed on TCM syndromes are also investigated. The results are impor- tant for tailor-made Chinese herbal formulation for the management of constipation for advanced cancer patients, and launching large-scale clinical study in future. In parallel, the bowel habits and the use of relieving measures are examined and reported in a separated article [16]. 2. Materials and Methods This study was a cross-sectional survey carried out in the palliative care units of Caritas Medical Centre and Our Lady of Maryknoll Hospital, which ran a comprehensive range of specialist palliative care services including inpatient, outpa- tient, home care, and day care services. Participants were interviewed by a registered Chinese medicine practitioner who possessed a degree in Chinese Medicine and with at least three-year working experience on clinical practice and TCM-related scientiﬁc researches. The whole study was conducted in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Kowloon West Cluster Research Ethics Committee, Hong Kong Hospital Authority, and the study protocol was registered at ClinicalTrials.gov (NCT01399294). 2.1. Patients. All advanced cancer patients (aged 18 or above) under the care of palliative care unit of Caritas Medical Centre and Our Lady of Maryknoll Hospital who had constipation during the period from May 1, 2010 to July 31, 2010 were invited to participate in the study. Patients were recruited only from those who reported (1) on medications Evidence-Based Complementary and Alternative Medicine (laxatives, enemas, Chinese herbal medicine (CHM), and/or health supplements) for facilitating bowel movement; (2) constipation as two points or more by the constipation visual analogue scale (CVAS) (0: none to 7: most severe) [17]. Patients who were unable to communicate, cognitive impaired, put on colostomy bag, clinically diagnosed gas- trointestinal obstruction, or at end-of-life (EOL) were excluded. Written or verbal informed consents were obtained before starting the interview, and all subjects were free to withdraw at any time from the study. 2.2. Questionnaire. The questionnaire was designed by the research team with Traditional Chinese Medicine profession- als and Palliative Medicine specialists, comprising of three parts written in Chinese (See Appendix 1 available online at doi:10.1155/2012/739642). The ﬁrst part consisted of patient demographics. Patient’s age, gender, primary cancer, functional status as measured by Palliative Performance Scale (PPS), biochemical parameters from blood tests, and pre- scription of opioid were recorded by the Palliative Medicine specialists. The second part was about patients’ perception of bowel function. The bowel habit, such as frequency, stool type, rectal measure, and laxatives/enemas required, was enquired. Besides, the severity of constipation was evaluated by the constipation visual analogue scale (CVAS). It was an 8-point ordinal rating scale, where 0-1 indicated no constipation, 2–4 indicated constipation, and 5–7 indicated severe constipation [18]. Speciﬁc analysis and interpretations about the correlation between the patient demographics and their bowel habits were reported with details in a separate paper [16]. The third part consisted of the TCM syndrome patterns as diagnosed by a registered Chinese Medicine practitioner. Five syndromes, that is, excess heat, Qi stagnation, Qi deﬁ- ciency, Yang deﬁciency, and Yin deﬁciency, were simpliﬁed from the TCM references [4, 5, 14, 15]. The former two were in excessive pattern, while the latter three were in deﬁcient pattern. Typical symptoms and signs of each syndrome were listed in a designated table. The Chinese Medicine practition- er collected data with the four classic diagnostic methods, completed the table, and diagnosed the syndrome of patient instantaneously. 2.3. Statistical Analyses. The data were entered into the Sta- tistical Package for Social Sciences programme (SPSS 13.0), while the completed questionnaires were kept in a locked cabinet inside the clinic. Continuous variables were calcu- lated using analysis of variance (ANOVA), and the chi-square test was used for analysing categorical data. All statistical tests were two-sided, and a P value of <0.05 was considered signiﬁcant. 3. Results A total of 228 advanced cancer patients were recruited. Three patients were excluded: two refused to participate and one could not complete questionnaire during interview. Thirty- nine participants, who could not write, only gave their verbal informed consent. For the 225 cases further analyzed, 127