The concern and prospective between precision medicine and traditional Chinese medicine
Editorial

The concern and prospective between precision medicine and traditional Chinese medicine

Tsai-Ju Chien1,2

1Division of Hematology/Oncology, Department of Medicine, Taipei City Hospital Zhong-Xiao Branch, Taipei, Taiwan; 2Institute of Traditional Chinese, National Yang-Ming University, Taipei, Taiwan

Correspondence to: Tsai-Ju Chien. Division of Hematology/Oncology, Department of Medicine, Taipei City Hospital Zhong-Xiao Branch, Taipei, Taiwan. Email: chientsaiju@gmail.com.

Provenance: This is an editorial commissioned by the Editor-in-Chief, Zhen Xiao, MD, MPA (Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China).

Comment on: Genovese TJ, Mao JJ. Genetic Predictors of Response to Acupuncture for Aromatase Inhibitor-Associated Arthralgia Among Breast Cancer Survivors. Pain Med 2018. [Epub ahead of print].


Received: 05 August 2018; Accepted: 05 September 2018; Published: 17 September 2018.

doi: 10.21037/lcm.2018.09.01


Traditional Chinese medicine (TCM) has a historical based-theory which has been adopted in oriental countries. It is gradually being noted by the western world for the limitation of reductionism of mainstream medicine and TCM is often seen as more accessible and more acceptable to people.

It is clear that the unifying systems theory of TCM could complement the western medicine; thus; TCM has raised the public’s attention and more and more issues are worth discussion (1,2). As precision medicine is so hot thus some scholars now try bridge western medicine and TCM by precision medicine and there could be some concern and perspective towards this issue.


Concern and perspective

“Zheng” oriented and “Disease” oriented

TCM is based on Zheng, a kind of symptom complex while western medicine is based on disease orientation. From the view of TCM, a patient with a disease, for instance, hepatitis could present with different Zheng in a different stage and need to be treated accordingly. However, it is difficult to define Zheng by western medicine though some research has made effort in this issue (3,4). We notice that some research trying to approach qi from molecular view point (5,6). An inspiring example is that Jin et al. even define the qi-deficiency and blood deficiency related pathway and protein by applying biomedical methods in TCM formula (7). It is worth encouraging yet so far we don’t have globalized standard Zhang classification. Other methods include the using of a database of TCM or bio information to approach related molecular mechanism (8,9). We deem it a step to connect the TCM and western medicine and worth for further evaluation to connect the concept of Zheng and western medicine.

TCM herb vs. precision medicine

Many studies have tried to clarify pathways of some Chinese herbs which aim to find effective compounds or new drugs (10,11). Though developing a new drug from the decoction (mix herbs) is hard to define the active components, especially the diverse effects from combine myriad herbs (12,13) Actually, TCM works in an artistic way; several-herbs’ permutations and combinations will generate different effects in varied TCM syndromes. Though this part is difficult to approach through current study design in the field of mainstream medicine; we are still delighted to see more and more scholars try bridging TCM and western medicine via precision medicine and bioinformatics. Just as the former American president Obama has addressed: “Recognizing that there is no “one size fits all” approach is an un-ignorable step for it aims to tailor treatment and prevention strategies to people’s unique characteristics, including their genome sequence, microbiome composition, health history, lifestyle, and diet. This statement is just consistent with TCM’s individualized care. We can, therefore, imagine that there will be a spark when TCM meets precision medicine.

Additionally, biomarkers, which are stars in recent years, intrigue researcher interests from western medicine to Chinese medicine. An article published in 2018 Sci Rep tries to differentiate TCM syndromes of HIV/AIDS by using bioinformatics and biomarkers identification (14); Liu et al. also try to apply miRNA-target network analysis to identify potential biomarkers for TCM syndrome development evaluation in hepatitis B related liver cirrhosis (15); similar publish are growing rapidly in recent years (16,17). Though it is an inspiring and encouraging phenomenon in bridging precision medicine and TCM; yet the existing dilemma is there are no definite and standardized criteria for TCM syndrome definition between these researches. Though some TCM syndrome research has been investigated based on disease oriented (3,18,19); a worldwide convinced edition is still lacking. Two Chinese form constitution or TCM syndrome classification have been published yet not well applied in all related research (20,21). Aside from the standardization of TCM syndrome or “Zheng”, precision medicine might be a cue for bridging effect of herb and of which population or TCM syndrome is a response to certain herbs (22,23).

Acupuncture vs. precision medicine

Acupuncture is widely accepted and studied than herbs for many electrophysiology related study have focused in this field (24,25). Though neuromas study has proved the efficacy and safety of acupuncture; we observed that a certain population or people with the certain constitution are more sensitive to this treatment. Therefore, it intrigues scholars to further investigate it and some research start to find out if any bio information is linked to the effect of acupuncture (26). Some research has proved the efficacy of acupuncture in aromatase inhibitor-related arthralgia in breast cancer (27,28). A further study published recently demonstrates that specific genetic variations at loci rs4680 and rs2369049 are associated with response to acupuncture-type intervention for management of arthralgia (29). Albeit the study sample size is too small to draw a definite conclusion, the idea to locate the biomarkers of which population is responsive to acupuncture is novel. Another issue within acupuncture and precision medicine is whether the meridians are existing and corresponding to a certain biomarker? Should we focus on meridian stimulation or acupoints stimulation when applying for precision medicine in the acupuncture- related study?


Conclusions

To sum up, personalized medicine has been stressed in recent years albeit it is an old lesson. Mapping the molecular pathway for each Chinese herb or finding biomarkers for targeted population or specific TCM syndrome help to fill the gap between TCM and mainstream medicine and only with these evidence-based study can we integrate the holism and reductionism. Actually, taking a purely holistic approach will result in some bias and criticism, especially when quality control of medicinal products and the reproducibility of results comes into question. On the other side; pure precision medicine approach cannot totally cover the essence of TCM; especially hard to explain the concept such as excess and deficiency; Yin-Yang; TCM syndrome and multi-effect between mixing herbs. Consequently, a middle way might be considered in order to make the best of East and West and brings them together for the benefit of all.

What needs more attention is: from the viewpoint of health economics, finding the relationship between bio information and acupuncture or TCM treatment might promote the evidence-based study of TCM; yet the cost of gene study must be high and could not be widely available in the real world. Thus, how to conduct a practical and promising study to link the precision medicine and TCM will be a task worth deep deliberation.


Acknowledgements

None.


Footnote

Conflicts of Interest: The author has no conflicts of interest to declare.


References

  1. Chen HB, Cheng HB, Lu W, et al. Systems biology is a bridge of integrated traditional Chinese and Western medicine. Zhongguo Zhong Xi Yi Jie He Za Zhi 2013;33:119-24. [PubMed]
  2. Sun DZ, Li SD, Liu Y, et al. Differences in the origin of philosophy between Chinese medicine and Western medicine: Exploration of the holistic advantages of Chinese medicine. Chin J Integr Med 2013;19:706-11. [Crossref] [PubMed]
  3. Hsu CH, Lee CJ, Chien TJ, et al. The Relationship between Qi Deficiency, Cancer-related Fatigue and Quality of Life in Cancer Patients. J Tradit Complement Med 2012;2:129-35. [Crossref] [PubMed]
  4. Chien TJ, Song YL, Lin CP, et al. The correlation of traditional chinese medicine deficiency syndromes, cancer related fatigue, and quality of life in breast cancer patients. J Tradit Complement Med 2012;2:204-10. [Crossref] [PubMed]
  5. Zhu M, Liu Z, Gao M, et al. The effect of Bu Zhong Yi Qi decoction on simulated weightlessnessinduced muscle atrophy and its mechanisms. Mol Med Rep 2017;16:5165-74. [Crossref] [PubMed]
  6. Xiong Y, Shang B, Xu S, et al. Protective effect of Bu-zhong-yi-qi decoction, the water extract of Chinese traditional herbal medicine, on 5-fluorouracil-induced renal injury in mice. Ren Fail 2016;38:1240-8. [Crossref] [PubMed]
  7. Sun J, Zhang L, He Y, et al. To Unveil the Molecular Mechanisms of Qi and Blood through Systems Biology-Based Investigation into Si-Jun-Zi-Tang and Si-Wu-Tang formulae. Sci Rep 2016;6:34328. [Crossref] [PubMed]
  8. Liu Z, Guo F, Wang Y, et al. BATMAN-TCM: a Bioinformatics Analysis Tool for Molecular mechANism of Traditional Chinese Medicine. Sci Rep 2016;6:21146. [Crossref] [PubMed]
  9. Xue R, Fang Z, Zhang M, et al. TCMID: Traditional Chinese Medicine integrative database for herb molecular mechanism analysis. Nucleic Acids Res 2013;41:D1089-95. [Crossref] [PubMed]
  10. Tsao YT, Kuo CY, Kuan YD, et al. The Extracts of Astragalus membranaceus Inhibit Melanogenesis through the ERK Signaling Pathway. Int J Med Sci 2017;14:1049-53. [Crossref] [PubMed]
  11. Yu J, Ji HY, Liu AJ. Alcohol-soluble polysaccharide from Astragalus membranaceus: Preparation, characteristics and antitumor activity. Int J Biol Macromol 2018.2057-64. [PubMed]
  12. Chien TJ, Liu CY, Lu RH, et al. Therapeutic efficacy of Traditional Chinese medicine, "Kuan-Sin-Yin", in patients undergoing chemotherapy for advanced colon cancer - A controlled trial. Complement Ther Med 2016;29:204-12. [Crossref] [PubMed]
  13. Chien TJ, Liu CY, Ko PH, et al. A Chinese Decoction, Kuan-Sin-Yin, Improves Autonomic Function and Cancer-Related Symptoms of Metastatic Colon Cancer. Integr Cancer Ther 2016;15:113-23. [Crossref] [PubMed]
  14. Wen L, Liu YF, Jiang C, et al. Comparative Proteomic Profiling and Biomarker Identification of Traditional Chinese Medicine-Based HIV/AIDS Syndromes. Sci Rep 2018;8:4187. [Crossref] [PubMed]
  15. Liu Y, Wang M, Luo Y, et al. MiRNA-target network analysis identifies potential biomarkers for Traditional Chinese Medicine (TCM) syndrome development evaluation in hepatitis B caused liver cirrhosis. Sci Rep 2017;7:11054. [Crossref] [PubMed]
  16. Yang Z, Zeng B, Tang X, et al. MicroRNA-146a and miR-99a are potential biomarkers for disease activity and clinical efficacy assessment in psoriasis patients treated with traditional Chinese medicine. J Ethnopharmacol 2016;194:727-32. [Crossref] [PubMed]
  17. Zhang C, Jiang M, Zhang G, et al. Progress and perspectives of biomarker discovery in Chinese medicine research. Chin J Integr Med 2014. [Epub ahead of print]. [Crossref] [PubMed]
  18. Gu Z, Qi X, Zhai X, et al. Study on TCM Syndrome Differentiation of Primary Liver Cancer Based on the Analysis of Latent Structural Model. Evid Based Complement Alternat Med 2015;2015. [Crossref] [PubMed]
  19. Shi Q, Zhao H, Chen J, et al. Study on TCM Syndrome Identification Modes of Coronary Heart Disease Based on Data Mining. Evid Based Complement Alternat Med 2012;2012. [Crossref] [PubMed]
  20. Su Y. Ti Zhi Qiang Hua Zhi Zhong Yi Yao Dian Ji Yan Jiu. Taipei: Committee on Chinese Medicine and Pharmacy, 2006.
  21. Zhu YB, Wang Q, Origasa H. Evaluation on reliability and validity of the constitution in Chinese medicine questionnaire (CCMQ). Chin J Behavioral Med Sci 2007;16:651-4.
  22. Liu J, Li Y, Wei L, et al. Screening and identification of potential biomarkers and establishment of the diagnostic serum proteomic model for the Traditional Chinese Medicine Syndromes of tuberculosis. J Ethnopharmacol 2014;155:1322-31. [Crossref] [PubMed]
  23. Liu L, Gao Y, Ma B. Exploring molecular mechanism underlying Chinese medicine syndrome: a study on correlation between Chinese medicine syndrome and biomarkers for ischemic stroke. Chin J Integr Med 2014;20:11-8. [Crossref] [PubMed]
  24. Kao MJ, Hsieh YL, Kuo FJ, et al. Electrophysiological assessment of acupuncture points. Am J Phys Med Rehabil 2006;85:443-8. [Crossref] [PubMed]
  25. Zhou Q, Gai S, Lin N, et al. Power spectral differences of electrophysiological signals detected at acupuncture points and non-acupuncture points. Acupunct Electrother Res 2014;39:169-81. [Crossref] [PubMed]
  26. Ju Z, Cui H, Guo X, et al. Molecular mechanisms underlying the effects of acupuncture on neuropathic pain. Neural Regen Res 2013;8:2350-9. [PubMed]
  27. Chien TJ, Liu CY, Chang YF, et al. Acupuncture for treating aromatase inhibitor-related arthralgia in breast cancer: a systematic review and meta-analysis. J Altern Complement Med 2015;21:251-60. [Crossref] [PubMed]
  28. Mao JJ, Xie SX, Farrar JT, et al. A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. Eur J Cancer 2014;50:267-76. [Crossref] [PubMed]
  29. Reinbolt RE, Sonis S, Timmers CD, et al. Genomic risk prediction of aromatase inhibitor-related arthralgia in patients with breast cancer using a novel machine-learning algorithm. Cancer Med 2018;7:240-53. [Crossref] [PubMed]
doi: 10.21037/lcm.2018.09.01
Cite this article as: Chien TJ. The concern and prospective between precision medicine and traditional Chinese medicine. Longhua Chin Med 2018;1:12.