Systems Biology-Based Diagnostic Principles as Pillars of the Bridge between Chinese and Western Medicine

Jan van der Greef; Herman van Wietmarschen; Jan Schroën; Mei Wang; Thomas Hankemeier; Guowang Xu

doi:10.1055/s-0030-1250450

Planta Medica, Table of Contents

Planta Med 2010; 76(17): 2036-2047
DOI: 10.1055/s-0030-1250450

Traditional Chinese Medicine

Reviews
© Georg Thieme Verlag KG Stuttgart · New York

Systems Biology-Based Diagnostic Principles as Pillars of the Bridge between Chinese and Western Medicine

Jan van der Greef¹ ^, ² ^, ³ ^, ⁵ [*] , Herman van Wietmarschen¹ ^, ³ [*] , Jan Schroën¹ [*] , Mei Wang¹ ^, ⁵ , Thomas Hankemeier¹ ^, ³ , Guowang Xu¹ ^, ⁴

¹Sino-Dutch Centre for Preventive and Personalized Medicine, Zeist, The Netherlands
²TNO Quality of Life, Zeist, The Netherlands
³Leiden University, Netherlands Metabolomics Center, Division of Analytical Biosciences, Leiden, The Netherlands
⁴CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, People's Republic of China
⁵SU BioMedicine, Zeist, The Netherlands

Abstract

Innovative systems approaches to develop medicine and health care are emerging from the integration of Chinese and Western medicine strategies, philosophies and practices. The two medical systems are highly complementary as the reductionist aspects of Western medicine are favourable in acute disease situations and the holistic aspects of Chinese medicine offer more opportunities in chronic conditions and for prevention. In this article we argue that diagnosis plays a key role in building the bridge between Chinese and Western medicine. Recent advances in the study of health, healing, placebo effects and patient-physician interactions will be discussed pointing out the development of a system-based diagnosis. Especially, a system biology-based diagnosis can be used to capture phenotype information, leading towards a scientific basis for a more refined patient characterization, new diagnostic tools and personalized heath strategies. Subtyping of rheumatoid arthritis patients based on Chinese diagnostic principles is discussed as an example. New insights from this process of integrating Western and Chinese medicine will pave the way for a patient-centred health care ecosystem.

Key words

personalized medicine - Chinese medicine - diagnosis - systems biology - rheumatoid arthritis - metabolomics - phenotyping - targeted care

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References

1 Marshall E. Science and the stimulus. Medicine under the microscope. Science. 2009; 326 1183-1185
2 Vries G D. De ontwikkeling van wetenschap: Een inleiding in de wetenschapsfilosofie. Groningen; Wolters-Noordhoff 1984
3 Pearcy L T. Diagnosis as narrative in ancient literature. Am J Philol. 1992; 113 595-616
4 Pagel W. Prognosis and diagnosis: a comparison of ancient and modern medicine. J Warburg Inst. 1939; 2 382-398
5 Hua-Ching N. The book of changes and the unchanging truth, 2nd edition. Los Angeles; SevenStar Communications 1999
6 Schroën J. Non-linear dynamics and Chinese medicine: an essay on research models, TCM and recent changes in modern scientific philosophy. Clin Acupunct Orient Med. 2002; 3 92-98
7 Ni M. The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1st edition. Boston; Shambhala 1995: 316
8 Wilber K. The marriage of sense and soul: integrating science and religion. Reprint. New York; Random House 1999
9 Hahn R A, Gaines A D. Physicians of Western medicine. Berlin; Springer 1985
10 Capra F. The hidden connections: integrating the biological, cognitive, and social dimensions of life into a science of sustainability. New York; Doubleday 2002
11 Antonovsky A. Unraveling the mystery of health. How people manage stress and stay well. San Francisco; Jossey-Bass 1987
12 Lindström B, Eriksson M. Salutogenesis. J Epidemiol Community Health. 2005; 59 440-442
13 Wang M, Lamers R J A N, Korthout H A A J, van Nesselrooij J H J, Witkamp R F, van der Heijden R, Voshol P J, Havekes L M, Verpoorte R, van der Greef J. Metabolomics in the context of systems biology: bridging traditional Chinese medicine and molecular pharmacology. Phytother Res. 2005; 19 173-182
14 Van der Greef J, Martin S, Juhasz P, Adourian A, Plasterer T, Verheij E R, McBurney R N. The art and practice of systems biology in medicine: mapping patterns of relationships. J Proteome Res. 2007; 6 1540-1559
15 Clish C B, Davidov E, Oresic M, Plasterer T N, Lavine G, Londo T, Meys M, Snell P, Stochaj W, Adourian A, Zhang X, Morel N, Neumann E, Verheij E, Vogels J T W E, Havekes L M, Afeyan N, Regnier F, van der Greef J, Naylor S. Integrative biological analysis of the APOE*3-leiden transgenic mouse. OMICS. 2004; 8 3-13
16 Wang J, van der Heijden R, Spruit S, Hankemeier T, Chan K, van der Greef J, Xu G, Wang M. Quality and safety of Chinese herbal medicines guided by a systems biology perspective. J Ethnopharmacol. 2009; 126 31-41
17 Chang W T, Thissen U, Ehlert K A, Koek M M, Jellema R H, Hankemeier T, van der Greef J, Wang M. Effects of growth conditions and processing on Ehmannia glutinosa using fingerprint strategy. Planta Med. 2006; 72 458-467
18 Callard R, George A J, Stark J. Cytokines, chaos, and complexity. Immunity. 1999; 11 507-513
19 Higgins J P. Nonlinear systems in medicine. Yale J Biol Med. 2002; 75 247-260
20 Van der Greef J, Stroobant P, van der Heijden R. The role of analytical sciences in medical systems biology. Curr Opin Chem Biol. 2004; 8 559-565
21 Kwee S H, Tan H H, Marsman A, Wauters C. The effect of Chinese herbal medicines (CHM) on menopausal symptoms compared to hormone replacement therapy (HRT) and placebo. Maturitas. 2007; 58 83-90
22 Van der Greef J. Systems biology, connectivity and the future of medicine. Syst Biol. 2005; 152 174-178
23 Van der Greef J, Hankemeier T, McBurney R N. Metabolomics-based systems biology and personalized medicine: moving towards n = 1 clinical trials?. Pharmacogenomics. 2006; 7 1087-1094
24 Tolle E. The power of now. Novato; New World Library 2004
25 Wilber K. Integral medicine: a noetic reader. Available at. http://wilber.shambhala.com/html/misc/intergal-med.pdf Accessed January 21, 2010
26 Lovelock J E, Margulis L. Atmospheric homeostasis by and for the biosphere – the Gaia hypothesis. Tellus. 1974; 26 2-10
27 Kirsch I, Sapirstein G. Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prev Treat. 1998; 1 0002
28 Kirsch I, Deacon B J, Huedo-Medina T B, Scoboria A, Moore T J, Johnson B T. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med. 2002; 5 260-268
29 Walach H, Sadaghiani C, Dehm C, Bierman D J. The therapeutic effect of clinical trials: understanding placebo response rates in clinical trials – a secondary analysis. BMC Med Res Methodol. 2005; 5 26
30 Walach H, Falkenberg T, Fonnebo V, Lewith G, Jonas W B. Circular instead of hierarchical: methodological principles for the evaluation of complex interventions. BMC Med Res Methodol. 2006; 6 29
31 Moerman D E, Jonas W B. Deconstructing the placebo effect and finding the meaning response. Ann Intern Med. 2002; 136 471-476
32 Giordano J. Spirituality, suffering, and the self. Mind and Matter. 2008; 6 179-191
33 Kohls N, Walach H, Lewith G. The impact of positive and negative spiritual experiences on distress and the moderating role of mindfulness. Arch Psychol Relig. 2009; 31 357-374
34 Kohls N, Sauer S, Walach H. Facets of mindfulness – results of an online study investigating the Frieburg mindfulness inventory. Pers Individ Dif. 2009; 46 224-230
35 Benedetti F. Mechanisms of placebo and placebo-related effects across diseases and treatments. Annu Rev Pharmacol Toxicol. 2008; 48 33-60
36 Benedetti F, Lanotte M, Colloca L, Drucati A, Zibetti M, Lopiano L. Electrophysiological properties of thalamic, subthalamic and nigral neurons during the anti-parkinsonian placebo response. J Physiol. 2009; 587 3869-3883
37 Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses. Neuron Rev. 2008; 59 195-206
38 Walach H, Jonas W B. Placebo research: the evidence base for harnessing self-healing capacities. J Altern Complement Med. 2004; 10 (S1) s103-s112
39 Scharmer C O. Theory U: leading from the future as it emerges. Cambridge, MA; The Society for Organizational Learning 2007
40 Van der Greef J, McBurney R N. Innovation: Rescuing drug discovery: in vivo systems pathology and systems pharmacology. Nat Rev Drug Discov. 2005; 4 961-967
41 Symmons D P M. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol. 2002; 16 707-722
42 Hochberg M C, Silman A J, Smolen J S, Weinblatt M E, Weisman M H. Rheumatology. Mosby; Elsevier Limited 2008
43 Welsing P M J, Fransen J, van Riel P L C M. Is the disease course of rheumatoid arthritis becoming milder? Time trends since 1985 in an inception cohort of early rheumatoid arthritis. Arthritis Rheum. 2005; 52 2616-2624
44 Bridges S L. Personalized medicine in rheumatoid arthritis: hopes and challenges. Bull NYU Hosp Jt Dis. 2007; 65 174-177
45 Anderson J J, Wells G, Verhoeven A C, Felson D T. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum. 2000; 43 22-29
46 Smolen J S, Aletaha D. Challenges of predicting treatment response in patients with rheumatoid arthritis. Nat Clin Pract Rheumatol. 2005; 1 62-63
47 Gaston J S H. Cytokines in arthritis – the 'big numbers' move centre stage. Rheumatology (Oxford). 2008; 47 8-12
48 Lundy S K, Sarkar S, Tesmer L A, Fox D A. Cells of the synovium in rheumatoid arthritis. T lymphocytes. Arthritis Res Ther. 2007; 9 202
49 Van der Helm-van Mil A H M, Huizinga T W J, de Vries R R P, Toes R E M. Emerging patterns of risk factor make-up enable subclassification of rheumatoid arthritis. Arthritis Rheum. 2007; 56 1728-1735
50 Van der Helm-van Mil A H M, Verpoort K N, Breedveld F C, Toes R E M, Huizinga T W J. Antibodies to citrullinated proteins and differences in clinical progression of rheumatoid arthritis. Arthritis Res Ther. 2005; 7 R949-R958
51 Van der Pouw Kraan T C T M, Wijbrandts C A, van Baarsen L G M, Voskuyl A E, Rustenburg F, Baggen J M, Ibrahim S M, Fero M, Dijkmans B A C, Tak P P, Verweij C L. Rheumatoid arthritis subtypes identified by genomic profiling of peripheral blood cells: assignment of a type I interferon signature in a subpopulation of patients. Ann Rheum Dis. 2007; 66 1008-1014
52 Glocker M O, Guthke R, Kekow J, Thiesen H J. Rheumatoid arthritis, a complex multifactorial disease: on the way toward individualized medicine. Med Res Rev. 2006; 26 63-87
53 Arnett F C, Edworthy S M, Bloch D A, McShane D J, Fries J F, Cooper N S, Healey L A, Kaplan S R, Liang M H, Luthra H S, Medsger T A, Mitchell D M, Neustadt D H, Pinals R S, Schaller J G, Sharp J T, Wilder R L, Hunder G G. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31 315-324
54 Vangermeersch L. Bi-syndromes. Brussels; Satas 1994
55 Maciocia G. The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists, 2nd edition. Kidlington; Churchill Livingstone 2005
56 Tao X, Younger J, Fan F Z, Wang B, Lipsky P E. Benefit of an extract of Tripterygium wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study. Arthritis Rheum. 2002; 46 1735-1743
57 Gu W Z, Brandwein S R, Banerjee S. Inhibition of type II collagen induced arthritis in mice by an immunosuppressive extract of Tripterygium wilfordii Hook f. J Rheumatol. 1992; 19 682-688
58 Li E K, Tam L, Wong C K, Li W C, Lam C W K, Wachtel-Galor S, Benzie I F F, Bao Y X, Leung P C, Tomlinson B. Safety and efficacy of Ganoderma lucidum (lingzhi) and San Miao San supplementation in patients with rheumatoid arthritis: a double-blind, randomized, placebo-controlled pilot trial. Arthritis Rheum. 2007; 57 1143-1150
59 Tong L, Moudgil K. Celastrus aculeatus Merr. suppresses the induction and progression of autoimmune arthritis by modulating immune response to heat-shock protein 65. Arthritis Res Ther. 2007; 9 R70
60 Chen X, Oppenheim J J, Howard O M Z. Chemokines and chemokine receptors as novel therapeutic targets in rheumatoid arthritis (RA): inhibitory effects of traditional Chinese medicinal components. Cell Mol Immunol. 2004; 1 336-342
61 He Y, Lu A, Zha Y, Yan X, Song Y, Zeng S, Liu W, Zhu W, Su L, Feng X, Qian X, Lu C. Correlations between symptoms as assessed in traditional Chinese medicine (TCM) and ACR20 efficacy response: a comparison study in 396 patients with rheumatoid arthritis treated with TCM or Western medicine. J Clin Rheumatol. 2007; 13 317-321
62 Kamada T, Kawai S. An algorithm for drawing general undirected graphs. Inf Process Lett. 1989; 31 7-15
63 Viswanathan G A, Seto J, Patil S, Nudelman G, Sealfon S C. Getting started in biological pathway construction and analysis. PLoS Comput Biol. 2008; 4 e16
64 Beers M H. The Merck manual, 18th edition. Whitehouse Station; Merck 2006
65 Van Wietmarschen H A, Yuan K, Lu C, Gao P, Wang J, Xiao C, Yan X, Wang M, Schroen J, Lu A, Xu G, van der Greef J. Systems biology guided by Chinese medicine reveals new markers for subtyping rheumatoid arthritis patients. J Clin Rheumatol. 2009; 15 330-337
66 Zhang G G, Lee W, Bausell B, Lao L, Handwerger B, Berman B. Variability in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis. J Altern Complement Med. 2005; 11 415-421
67 Jiang W. Therapeutic wisdom in traditional Chinese medicine: a perspective from modern science. Trends Pharmacol Sci. 2005; 26 558-563
68 Li S, Zhang Z Q, Wu L J, Wang Y Y. Understanding ZHENG in traditional Chinese medicine in the context of neuro-endocrine-immune network. IET Syst Biol. 2007; 1 51-60
69 Capellino S, Straub R H. Neuroendocrine immune pathways in chronic arthritis. Best Pract Res Clin Rheumatol. 2008; 22 285-297
70 Czura J, Tracey K J. Autonomic neural regulation of immunity. J Intern Med. 2005; 257 156-166
71 Jackson D B. Clinical and economic impact of the nonresponder phenomenon – implications for systems based discovery. Drug Discov Today. 2009; 14 380-385

1 Each of these authors has equally contributed to this paper.

Jan van der Greef

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