Sparking Thinking: Studying Modern Precision Medicine Will Accelerate the Progression of Traditional Chinese Medicine Patterns

Precision medicine closes the gap between genomic knowledge and personalized care. This novel concept has the potential to profoundly enhance current clinical practice. ¹ The rapid development of human genome sequencing and analytical methodologies has assisted clinical researchers in exploring diseases. Genetic testing has already been incorporated directly into the clinical decision-making process and has been successfully commercialized for Mendelian disease prediction and cancer treatments. ^2,3 Before May 2016, a total of 2437 genome-wide association studies (GWASs) had been performed, and 16,617 single nucleotide polymorphisms associated with diseases/traits had been identified. ⁴ One hundred of those GWASs were from China, and ∼200 loci suspected to be associated with 50 diseases have been discovered. ⁴ Although numerous positive loci associated with certain diseases or phenotypic traits have been identified, a gap between genetic testing and real clinical practice remains, which future research must address. ⁵

In Traditional Chinese Medicine (TCM), a pattern (“Zhenghou” as the Chinese term) is defined as the overall physiological and/or pathological status of the human body in response to the external environment and internal conditions. Four typical TCM diagnostic steps (inspection, smelling and listening, inquiry, and palpation) are applied to patients to classify their patterns. TCM clinicians prescribe patients Chinese-specific medical interventions (herbs with dosage, acupuncture, and cupping) based on their individual patterns. Pioneering scientists have already incorporated TCM pattern classification into modern medical research and clinical practice, and many amazing results have been documented. Prof Ai-ping Lu's team has applied pattern classification in clinical trials for rheumatoid arthritis (RA) and found that “cold pattern” RA patients have a better response rate to chemical interventions, whereas patients with the “deficiency pattern” benefited most from herbal interventions. ⁶ Prof. Anlong Xu's team systematically investigated the relationship between the human leukocyte antigen gene family and TCM constitution and suggested a genetic basis for the classification of physical constitution in TCM in 2007. ⁷ Our team has found that variants within the SCAP gene are associated with nonalcoholic fatty liver disease and “deficiency pattern” and “excess pattern” patients. ⁸ Prof. Keji Chen's team found that 107 different genetic biomarkers are associated with the “blood stasis” pattern of coronary heart disease. ⁹

A brief search of the medical literature was conducted using the search term “Zhenghou.” After searching the Chinese Biomedical Literature Database, 161,500 publications were found, with more than 14,000 papers being published per year in recent times (www.sinomed.ac.cn. Accessed February 2017). However, commonly accepted and objective criteria are necessary to qualify the different “pattern” subtypes. The lack of objective evidence and validation studies prevents the successful combination of TCM patterning and precision research.

With the question of how TCM knowledge can be integrated into precision medicine research and practice being raised, we believe that the essential elements of Chinese pattern knowledge and modern genetics studies will benefit both modern molecular biologists and TCM practitioners. The integration of pattern knowledge with modern genetics studies could even elevate precision medicine to a higher level. Therefore, we provide suggestions hereunder regarding how to optimally combine these two fields.