6 was actually in deﬁciency-excess complex (Table 4). It is not only because the speciﬁcity of symptom and sign for a particular syndrome pattern is relatively low, but also human body is an organic and complex whole, for which coexistence and transition of syndrome patterns are ordinary. Therefore, syndrome pattern should be diﬀerentiated comprehensively from a series of symptoms and signs. The dominant manifes- tations listed in Table 2 showed the norm of each symptom, which can be a reference for other TCM studies on advanced cancer. In the past decades, the essence of syndrome patterns is determined with modern medical examination in terms of system biology [19]. For example, Chu et al. used serum proteomes to distinguish the essential hypertension patients with abundant phlegm-dampness from the healthy persons and the essential hypertension patients with non-phlegm- dampness [20]. In this study, patients in deﬁcient pattern was signiﬁcantly in higher mean age, and lower functional status (PPS) and level of blood haemoglobin when comparing with that in excessive pattern, while their Complex was at inter- mediate (P < 0.05). These objective assessment measures in conventional Western medicine may be as an auxiliary for the diﬀerentiation of syndrome patterns, although further investigations are necessary to develop certain guidelines. Furthermore, the impact of prescribed opioids on syndrome patterns cannot be concluded in this study. The inﬂuence of confounding by the opioid dose, duration of opioids intake, polypharmacy and polytreatment may be probably present. Syndrome is the quintessence of TCM theory. However, consensus on its diagnosis is still limited; the diagnostic consistency among Chinese Medicine practitioners can be as low as 30% [21]. These not only make syndrome diﬃcult to interpret and repeat on researches, but also impede the generalization of TCM to the world. We believe that stan- dardizing the terminology, quantizing the description of syn- drome, and validating TCM with evidence-based approaches are urgently needed for the development of TCM in future. Moreover, TCM has its vantage on analyzing diseases from a macroscopic point of view and human-oriented mind. Subjective measures, such as inadequate pushing force, sense of incomplete defecation and diﬃculty in defecation used in this study, are important for making diagnosis and pre- scription in TCM. On the contrary, conventional medicine is more dependent on objective measures and scientiﬁc assessment tools. Up till recently, patient’s own perception of diﬃcult defecation in the clinical assessment of constipation in palliative care and in treatment evaluation is emphasized [22]. We foresee that there are many opportunities for the incorporation of traditional medicine to convention medicine on diagnosis and treatment in both clinical practice and scientiﬁc researches. Two aspects of this study should be reported as potential limitations in drawing broad conclusions. First, the whole study only involved 225 cases from two palliative care units, and there were 13 and seven patients in the groups of excess Heat and pure excessive pattern, respectively. When working with these small sample sizes, the results obtained from statistics may be underpowered to detect important eﬀects or associations [23]. The distribution of syndrome patterns may Evidence-Based Complementary and Alternative Medicine not be able to generalize for all palliative cancer patients in Hong Kong. Second, variations in diagnosis do exist among CM practitioners [24]. Therefore, the diagnosis of syndrome should be made from more than one CM practitioner, and disagreements are resolved by discussions. 5. Conclusion Advanced cancer patients were subject to be in deﬁcient pat- tern, and many of them were complicated by excessive pat- tern. Qi deﬁciency and its combination of Qi stagnation and blood (Yin) deﬁciency were the most common syndromes for patients with constipation. Furthermore, age, functional status, and level of blood haemoglobin were factors related to the type of TCM syndrome. A TCM prescription with the functions on replenishing the deﬁciency, redirecting the ﬂow of Qi stagnation and moistening the dryness caused by the blood (Yin) deﬁciency can be made for the treatment of advance cancer patients with constipation. Robust trials are urgently needed for further justifying its eﬃcacy and safety in evidence-based approaches. Conﬂict of Interests The authors declare that there are no competing ﬁnancial or other interests exist. Acknowledgments This study was fully supported by the Yan Chai Hospital- Hong Kong Baptist University Clinical Centre for Training and Research in Chinese Medicine (West Kowloon). The authors would also like to thank the Hong Kong Hospital Authority for providing administrative support. References [1] T. L. Lee, “Complementary and alternative medicine, and traditional Chinese medicine: time for critical engagement,” Annals of the Academy of Medicine Singapore, vol. 35, no. 11, pp. 749–752, 2006. [2] A. P. Lu, H. W. Jia, C. Xiao, and Q. P. Lu, “Theory of traditional chinese medicine and therapeutic method of diseases,” World Journal of Gastroenterology, vol. 10, no. 13, pp. 1854–1856, 2004. [3] World Health Organization Western Paciﬁc Region, “WHO International Standard Terminologies on Traditional Med- icine in the Western Paciﬁc Region,” 2007, http://www.wpro .who.int/publications/PUB 9789290612487/en/index.html. [4] B. Y. Zhang, J. H. Dong, and Z. Y. Zhou, Internal Medicine of Chinese Medicine, Shanghai Scientiﬁc and Technical Publish- ers, Shanghai, China, 1985. [5] The State Administration of traditional Chinese Medicine of the People’s Republic of China, Criteria of diagnosis and ther- apeutic eﬀect of diseases and syndromes in traditional Chinese medicine, Nanjing University Press, Beijing, China, 1994. [6] X. Y. Zheng, Guidelines for Clinical Research on New Drug of Chinese Medicine (trial implementation), China Medical Science and Technology Press, Beijing, China, 2002.