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Ai-Ping
Lu, Hong-Wei Jia, Cheng Xiao, Institute of Basic Theory, China
Academy of Traditional Chinese Medicine, Beijing 100700, China
Qing-Ping Lu, National Pharmaceutical Engineering Research
Center, Nanchang 330077, Jiangxi Province, China
Supported by the Key Grant Program in National Administration
of Traditional Chinese Medicine, No.2000-J-Z-02 and the Key Program
in National Natural Science Foundation of China, No. 90209002
Correspondence to: Dr. Ai-Ping Lu, Institute of Basic Theory,
China Academy of Traditional Chinese Medicine, Beijing 100700,
China. catcm@public.bta.net.cn
Telephone: +86-10-64067611
Fax: +86-10-64013896
Received: 2003-11-18
Accepted: 2004-02-01
Abstract
Traditional Chinese medicine, including herbal medicine and
acupuncture, as one of the most important parts in complementary and
alternative medicine (CAM), plays the key role in the formation of
integrative medicine. Why do not the modern drugs targeting the
specificity of diseases produce theoretical effects in clinical
observation? Why does not the traditional Chinese medicine targeting
the Zheng (syndrome) produce theoretical effects in clinic? There
should have some reasons to combine Western medicine with Chinese
herbal medicine so as to form the integrative medicine. During the
integration, how to clarify the impact of CAM theory on Western
medicine has become an emergent topic. This paper focuses on the
exploration of the impact of theory of traditional Chinese medicine
on the therapy of diseases in Western medicine.
Lu AP, Jia HW, Xiao C,
Lu QP. Theory of traditional Chinese medicine and therapeutic method
of diseases. World J Gastroenterol
2004; 10(13): 1854-1856
http://www.wjgnet.com/1007-9327/10/1854.asp
INTRODUCTION
More than one third of patients in the United States use
complementary and alternative medicine (CAM)[1], and more
and more scientists are interested in integrative medicine research
in USA. Recent research showed that integrative medicine (also
complementary and alternative medicine) could contribute to primary
health care[2,3]. Traditional Chinese medicine (TAM),
including herbal medicine and acupuncture, as one of the most
important parts in CAM, should play the key role in the formation of
integrative medicine. During the integration, how to clarify the
impact of CAM theory on Western medicine has become the emergent
topic.
TCM was formed two
thousand years ago, and developed in the following centuries. TCM
recognizes human body by system discrimination and cybernetic way.
TCM can be characterized as holistic with emphasis on the integrity
of the human body and the close relationship between human and its
social and natural environment. TCM focuses on health maintenance
and in the treatment of disease emphasizes on enhancing the body's
resistance to diseases. For improving health, TCM applies multiple
natural therapeutic methods.
Zheng (syndrome) is the
basic unit and key term in TCM theory. Zheng is an outcome after
analyzing all symptoms and signs. All therapeutic methods in TCM
come from the differentiation of Zheng. The methods have been used
for thousands of years, which proves that TCM therapeutic approach
is effective. From this point of view, Zheng should play an
important role in determining the effect. Combined with modern
medicine, Zheng should have an impact on disease pathogenesis that
directly influences the therapeutic effect.
HISTORICAL BACKGROUND
At the time when TCM formed, there was nothing modernized in
medical and biological fields, but there was something developed in
Chinese philosophy, astronomy and literature. Also at that time,
people got a great amount of experiences on how to deal with the
disorders by natural methods, such as puncture, Qigong (mind
controlling), taking plants. Some talents in China began to
summarize those phenomena and sublimated to theory based on their
philosophical and social knowledge at that time. The theory is the
original TCM. Thus TCM handles human physiology and pathology
following old Chinese philosophical thinking. In the following
centuries, accumulation of experiences and addition of relative
knowledge (such as clinical observation data and less anatomical
experience) made TCM developed. The terminology TCM is partially
originated from Chinese philosophy. Other terms in TCM, even same as
those in modern medicine, have completely different meanings. It is
believed that to understand the physiology of TCM, to some extent,
should have some knowledge about Chinese philosophy.
PHYSIOLOGY AND PATHOLOGY IN TCM
During the formation and development of TCM, there are two
ideological ideas that fully penetrate into the whole process. The
first is the homeostasis idea that focuses on the integrity of human
body, and emphasizes the close relationship between human body and
its social and natural environment (integrity between human and
cosmos). The second is the dynamic balance idea that takes emphasis
on the movement in the integrity. Physiologically TCM recognizes
human body by system discrimination and cybernetic way. In system
discrimination approach, the intrinsic activities of human body can
be clarified by analyzing the audio-visual information. The human
body, a complicated system, could be identified as different closely
related systems that form a network (integrity). The external
information should reflect something intrinsic because of the
integrity between human body and its social and natural environment.
For example, the heart as a center, together with blood, vessel,
mind, tongue, small intestine, consists of the heart system in TCM.
Any information from any parts in the system can demonstrate the
system's activity even the structure of the part is unclear. In
cybernetic approach, TCM takes human body as a self-controlled
system network. The network is connected by the meridian that exists
in whole body. Blood and vital energy flow also contributes to the
connection. The Five elements theory in TCM, named as wood, fire,
earth, metal and water, divides human body into five systems. Each
system has its own specific features that can be inferred by
analyzing those natural materials. The movement and interchange
among the five elements are used to explain human body's physiology.
Since
TCM has its unique physiology in understanding human body, it has
its special understanding on human body's disorders. Pathologically,
TCM focuses on the pathogeneicity of social and natural factors. The
factors have a close relationship with humans to consist of the
integrity. Mostly they are non-direct and non-specific factors if we
say bacteria or viruses are direct and specific ones. TCM is not
completely to seek the specific pathogen, and pathological changes
in a specific organ, while it is to seek the disturbances among the
self-controlled systems by analyzing all symptoms and signs. In the
heart system, any disturbance in any part of the system is useful to
clarify the pathology. At the same time, comparison of the
disturbance happened in different period is also important in
pathological analyses. TCM takes emphasis on the dynamic changes in
any parts and any connections in the self-controlled system.
THERAPEUTIC MECHANISM IN TCM
Physiology in TCM is featured with self-controlled system
discrimination and its pathology is featured with dynamic changes in
the system (whether direct or indirect, specific or non-specific).
The therapeutic mechanism in TCM focuses on enhancing human body's
resistance to diseases and prevention by improving the
inter-connections among self-controlled systems. To reach the
approach, TCM uses different therapeutic methods, such as
mind-spiritual methods (such as Qigong, Taiji boxing), natural
methods (acupuncture, moxibustion, herbal medicine). These
therapeutic methods are characterized by fewer side effects since
they are natural. TCM evaluates the therapeutic results by comparing
the symptoms before and after the treatment. The treatment is based
on the differentiation of symptoms to clarify what is wrong in the
self-controlled system. TCM seeks the therapeutic mechanism from the
integrity. The integrity includes the human itself as integrity, and
the integrity between human and its social and natural environment.
The therapeutic mechanism can be achieved by activating systems,
improving system connection and enhancing human resistance. The
mechanism in TCM is not like modern medicine that seeks the
mechanism from cellular or molecular level (such as killing bacteria
and virus, antagonistic method). If someone lives well (no
symptoms), she is healthy in TCM, whether she has some signs in
cellular and molecular level such as high blood pressure.
KEY TERM IN TCM THERAPEUTIC APPROACH: DIFFERENTIATION OF ZHENG
Zheng (syndrome), a basic unit in TCM, decides the therapeutic
methods. Zheng is the outcome after a careful analysis of all
symptoms and signs (tongue appearance and pulse feeling included).
Zheng outcome might change since the symptoms and signs might
change. There are many Zhengs in TCM, either simple Zheng or
combined ones.
Zheng, as the key term
and basic unit in TCM therapeutic theory, develops following the
progress in disease theory progress. Tens of years ago, Zheng did
not include any signs from modern diagnostic instruments, and
nowadays, Zheng is combined with or referred to disease diagnosis
during the therapeutic process to some content.
The process of how to get
the outcome is called differentiation of Zheng, which is based on
the physiology and pathology of TCM.
IMPACT OF ZHENG ON DISEASE
TREATMENT
Disease's key units usually contain etiology, pathology and
disease location. Modern medicine is trying to get the specificity
of the cause, pathology and location, and as a result, the
therapeutic approach is targeting on the specificity. New drugs in
modern medicine are developed from strictly designed scientific
pharmacological tests that are targeting on the specificity.
Pharmacological tests show better effect than the effect shown in
clinic.
In differentiation of
Zheng, clinical effect should be better if the theory of
differentiation of Zheng and physiology of TCM are followed.
Unfortunately the effect in practice, even completely following the
differentiation of Zheng, is not as good as the theoretical one.
There should have some reasons to explain the difference between
theoretical and clinical effects in TCM practice.
As summarized, there are
two questions about the therapeutic problem in medical science. One
is why is there difference between the pharmacological and clinical
effects in modern medicine? The other is why is there difference
between the theoretical and clinical effects in traditional Chinese
medicine?
The questions refer to
that there are some shortages of therapeutic approach both in modern
medicine and in traditional Chinese medicine.
Any disease (morbidity)
could contain two parts of appearance. One is the so-called
specificity to the realities of morbidity, such as the pathological
change. The other is the non-specificity that refers to the
reactions caused by interactions between personal physique and
environments, such as heterogeneous manifestations. Modern medicine
is aimed to explore the specificity of morbidity, while traditional
Chinese medicine is mainly aimed to explore the reality of the
morbidity by checking the external appearance (that is the
differentiation of Zheng). It is believed that the non-specificity
sometimes could influence or change the process of morbidity, and
only targeting the specificity is not enough to stop the progress of
morbidity[4].
Disease mainly refers to
the specificity of cause and pathology with less emphasis on the
non-specificity. Non-specificity includes all symptoms and signs not
directly induced by the specific cause and pathology. Usually the
specificity decides the process of diseases. Drugs in modern
medicine are targeting the specific cause and pathology, and it
usually gives good effect even though the effect is not as good as
the pharmacological effect. Since the specific cause and pathology
cannot be found in all diseases, the effect of modern drugs depends
on whether the cause and pathology are clear or not. In reality,
modern drugs are good at curing those diseases with clarified cause
and pathology, and not good at curing those diseases due to multiple
factors in the pathogenesis, which have become more common in
medical science.
However, whenever the
non-specificity influences on the specificity, drugs targeting the
specificity have no good effect. That is the main reason why modern
drugs sometimes are not effective in some cases in the treatment of
a disease with a clarified cause and pathology.
Zheng mainly refers to
the non-specificity and part of specificity that is only obtained
from symptoms and signs by asking, watching and feeling since there
are no modern diagnostic instruments. Chinese herbal medicine, based
on the Zheng which is taken as an outcome of differentiation of
symptoms and signs, targets to the non-specificity and part of the
specificity. The effect of herbal medicine is not so good in curing
a disease with specific signs, which can be only obtained by modern
diagnostic instruments since Zheng does not refer to those signs.
However, the effect of herbal medicine is better in treating some
cases when the non-specificity decides the process of a disease.
Thus, the reason why there is a difference between the theoretical
effect based on Zheng differentiation and the clinical effect is
that Zheng differentiation can not exactly differentiate the
specificity of a disease.
COMBINING ZHENG WITH DISEASE:
NEW STRATEGY IN THERAPEUTIC APPROACH
Following TCM Zheng theory, different diseases may be treated by
a same therapeutic approach if they show same Zhengs. One herbal
preparation can be used to treat different diseases, a common
phenomenon in TCM. Similarly, the same disease may be treated by
different therapeutic approaches if the disease shows different
Zhengs. It is common in TCM that one kind of disease is treated with
different therapies. As mentioned above, Zheng is the outcome of
differentiation of symptoms and primary signs obtained by getting
from watching (tongue watching) and feeling (pulse feeling), and
definitely Zheng is not so accurate. The following example can be
used to explain the shortage of Zheng information. Gastritis and
stomach cancer could show similar symptoms and primary signs,
suggesting that they could be differentiated as the same Zheng in
TCM, and could be treated by the same TCM approach. The effect,
there is no doubt, should be different since stomach cancer is
difficult to be cured by herbal medicine. Thus, the differentiation
of Zheng would not give any good effect when the specificity is not
clarified resulting from the decisive factor in the evaluation of
effects.
It was reported that the
effects of two herbal preparations that targeted on coronary heart
disease with different Zhengs were at least partially dependent on
the Zhengs. The results showed that for coronary heart disease cases
with Qi deficiency, Zheng could be alleviated by herbal medicine to
reinforce Qi deficiency at effective rate of 89%, while the cases
could be alleviated by herbal medicine targeting coronary heart
disease and nourishing Yin at effective rate of 60%. For the
coronary heart disease cases with Yin deficiency, Zheng could be
alleviated by herbal medicine to nourish Yin at the effective rate
of 87%, while the cases could be alleviated by herbal medicine to
reinforce Qi at effective rate of 65%. Thus, the differentiation of
Zheng plays an important role in the therapeutic process and affects
the therapeutic result of a specific disease.
Following the disease
theory there should have a specific therapy targeting the specific
cause, pathology and location. If the specificity is clarified, the
disease would be cured. Actually, there might not be so good effect
in alleviating some diseases or symptoms even the specificity is
clarified. The reason is that the non-specificity influences the
specificity. Thus, targeting the specificity of a disease may not
result in a good effect or give no effect at all when the
non-specificity is decisive in the effect evaluation. The example
about drugs in lowing blood pressure would be helpful to explain the
reason. In patients with hypertension, there are some good drugs in
decreasing blood pressure, and the real thing is that there always
have some cases showing any effect after taking drugs. The partial
reason is that, in some cases of hypertension, the non-specific
appearance could play a key role in influencing the effect of drugs.
At this point, new anti-hypertension drugs for the cases in which
the non-specificity is a decisive factor need to be developed.
Combining the
differentiation of Zheng with diagnosis of disease, which is
combining herbal medicine mainly targeting non-specificity with
modern drugs targeting the specificity, would achieve the best
therapeutic effect.
Many
clinical studies have shown that combining modern drugs with herbal
medicine would dominantly increase the effect. For example, the
effect rate in treating coronary heart disease with modern drugs
(routine therapy) was 45.5%, while combing with herbal medicine it
was up to 87.3%[5]. The importance is to explore how to
combine the two therapies.
More double-blinded
clinical trials need to be conducted, both for modern drugs and
herbal medicine. All specific and non-specific information needs to
be collected for further analysis.
Any new drug, even
targeting the exact specific pathology, does not act on all cases of
diseases since the effect of non-specificity may affect the process
of pathogenesis. Any herbal medicine originating from the exact
differentiation of Zheng does not act on all cases with Zheng since
lack of enough specificity may lose the decisive factor in the
treatment.
After the information
about new drug classification is obtained, the best effect could be
achieved by either combination of drugs targeting the specificity
with herbal medicine targeting the non-specificity, or by complex
new drug development focusing both on specificity and
non-specificity.
TCM focuses on the
integrity of human body and the close relationship with its social
and natural environments. It recognizes human physiology by
analyzing external information by system discrimination and
cybernetic approach, and regards that any disorders are caused by
the disturbance in any part of the self-controlled system in the
integrity. In therapeutics, TCM targets the non-specificity and part
of specificity by natural ways.
Why modern
drugs cannot achieve the effect as the pharmacological study and the
same effect in a same disease is that Zheng in TCM contributes to
the progress of a disease. It is important to clarify that in what
situation drugs targeting the disease specificity would be effective
and how to make the drug become more effective.
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