Integrating modern toxicology with traditional Chinese medicine: Perspectives from Hong Kong

Chinese medicine (CM) has long been an integral part of the healthcare system in Hong Kong. In 2024, around 3% of Hong Kong residents (238,700 out of 7,534,200 population) were estimated to have consulted Chinese medicine practitioners within 30 days before being interviewed with the highest consultation rates among those aged 65 and above.1 The percentage translated to about 2.9 million CM consultations per year. Apparently, CM is a mainstream healthcare choice, especially for older adults in the territory. This sector of patients, often burdened by multimorbidity and polypharmacy, is also the most vulnerable to adverse events of CM. Most patient consulted Chinese medicine practitioner for chronic rather than acute condition, and most common presenting problem to Chinese medicine practitioner were respiratory, musculoskeletal complaints, cough, and low back pain.2 In line with pharmacovigilance practice, poisoning related to CM should be better described as adverse herb event (AHE) associated with CM scientifically. The incidence of such AHE was not well studied but the rate of significant AHE was considered to be low. The Hong Kong Poison Information Center (HKPIC) recorded 306 cases of suspected AHE in 2021.3 The figure roughly translated to 1 suspected AHE reported to HKPIC among 10,000 CM consultations in the territory.1, 3 A study analyzed decade-long medical records of 2 high-volume emergency departments in Hong Kong showed that the mean annual incidences of AHE related to PCM was 4.12 per 100,000 emergency department attendances, respectively.4 In this special edition, SK Law et al. published an insightful literature review covering publications both in English and Chinese with the key words: acute Chinese medicine poisoning and Hong Kong.5 The authors highlighted the need for continual quality assurance in CM practice with effective regulatory oversight in the prevention of CM poisoning. Another study by RPK Lam et al.6 reviewed the epidemiology of aconite poisoning, the commonest acute poisoning due to CM recorded by HKPIC from 2008 to 2021. The authors identified 179 laboratory-confirmed cases with a dropping annual incidence from around 25 down to 5 cases in 2021 which might have reflected improved safety in CM practice over the past decade. However, aconite poisoning was often severe with one third of victims requiring intensive care and cardiopulmonary resuscitation were necessitated in 5.6% of the patients of this cohort. A study by Wu et al.7 investigated CM use as a potential cause of hyponatraemia. They reviewed 72 local cases recorded in HKPIC and found strong causative association in about 20% of them. CM-induced syndrome of inappropriate secretion of antidiuretic hormones (SIADH) was suggested to be the commonest underlying pathophysiology. In the background of increasing CM use in Hong Kong and worldwide and the opening of the first and only Hong Kong CM hospital,8 we hope readers will find the articles both insightful and engaging and may inspire on future pharmacovigilance researches on Chinese medicine practice. Michael Chi Tak Pang: Conceptualization; data curation; writing—original draft. Man Li Tse: Conceptualization; writing—review and editing. The authors declare no conflicts of interest. No individual patient or participant data were included; informed consent was not required. The authors declare no AI used. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.