TF Fok

This issue of the Journal is devoted to Neonatology, one of the most mature subspecialties in Paediatrics. Much to our delight the response from our contributors have been overwhelming, as shown by the large variety of articles that appear in this edition. Owing to space constraint, some of the articles that were rated highly publishable by our reviewers could not be published this time and will have to wait for their turn in later editions of the Journal. Among those appearing in this issue, of particular interest is the in-vitro study by Jiang et al on the potential therapeutic effect of Xiaochaihu Decoction on Coxackie myocarditis. Xiaochaihu is a popular traditional Chinese herbal remedy for a variety of illnesses in both adults and children. In Jiang's study, the decoction was added to cultured rat myocardial cells that had been previously infected with Coxackie virus. The results showed that treatment resulted in more rapid and better recovery of the cells when compared to the controls, suggesting a positive therapeutic effect of the herbal preparation. However, like most other TCM studies, there are a number of limitations in the methodology of this study. Similar to most traditional Chinese herbal medications, the Xiaochaihu Decoction is prepared by boiling a certain amount of herbal mixture, which might also contain minerals and animal ingredients, in water. Usually only the liquid portion of the resultant herbal tea is consumed. The concentrations of the ingredients in the decoction are very variable, being determined very crudely by the quantity of each ingredient of the herbal mixture, the amount of water added to the mixture, and the amount of water remaining at the end of the boiling process, as prescribed by the TCM practitioner. This, plus the fact that the active ingredients of the herbal mixture are unknown, makes it impossible for the investigators to provide any pharmacological information. The second limitation is also common to all in-vitro TCM studies. The Xiaochaihu Decoction was added directly to the myocardial cells in cell cultures. It is not known whether it could retain similar pharmacological properties after passage through the intestinal tract and liver where its active ingredients might undergo biotransformation or interact with each other to produce different pharmacological properties. With so many unknowns it would be difficult to interpret the observations made by Jiang et al in their study. In fact, the editorial board had debated on the desirability of publishing research papers of this nature in the Journal, and finally reached a consensus that allowance has to be made for studies on TCM which is a newcomer to the arena of scientific research. Albeit difficult to interpret, observations made in these studies may generate hypothesis that will eventually benefit mankind, after verification by better designed studies, probably on animals or even human subjects. It is hoped that TCM researches can eventually reach a degree of maturity where they can undergo the highest level of scrutiny currently employed for their western counterparts.