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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
Further Information

Publication History

received February 5, 2010 revised Sept. 20, 2010

accepted Sept. 21, 2010

Publication Date:
26 October 2010 (online)

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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

References

  • 1 Marshall E. Science and the stimulus. Medicine under the microscope.  Science. 2009;  326 1183-1185
    CrossrefPubMedGoogle Scholar
  • 2 Vries G D. De ontwikkeling van wetenschap: Een inleiding in de wetenschapsfilosofie. Groningen; Wolters-Noordhoff 1984
    Google Scholar
  • 3 Pearcy L T. Diagnosis as narrative in ancient literature.  Am J Philol. 1992;  113 595-616
    PubMedGoogle Scholar
  • 4 Pagel W. Prognosis and diagnosis: a comparison of ancient and modern medicine.  J Warburg Inst. 1939;  2 382-398
    PubMedGoogle Scholar
  • 5 Hua-Ching N. The book of changes and the unchanging truth, 2nd edition. Los Angeles; SevenStar Communications 1999
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 8 Wilber K. The marriage of sense and soul: integrating science and religion. Reprint. New York; Random House 1999
    Google Scholar
  • 9 Hahn R A, Gaines A D. Physicians of Western medicine. Berlin; Springer 1985
    Google Scholar
  • 10 Capra F. The hidden connections: integrating the biological, cognitive, and social dimensions of life into a science of sustainability. New York; Doubleday 2002
    Google Scholar
  • 11 Antonovsky A. Unraveling the mystery of health. How people manage stress and stay well. San Francisco; Jossey-Bass 1987
    Google Scholar
  • 12 Lindström B, Eriksson M. Salutogenesis.  J Epidemiol Community Health. 2005;  59 440-442
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Callard R, George A J, Stark J. Cytokines, chaos, and complexity.  Immunity. 1999;  11 507-513
    PubMedGoogle Scholar
  • 19 Higgins J P. Nonlinear systems in medicine.  Yale J Biol Med. 2002;  75 247-260
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 22 Van der Greef J. Systems biology, connectivity and the future of medicine.  Syst Biol. 2005;  152 174-178
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Tolle E. The power of now. Novato; New World Library 2004
    Google Scholar
  • 25 Wilber K. Integral medicine: a noetic reader. Available at. http://wilber.shambhala.com/html/misc/intergal-med.pdf Accessed January 21, 2010
    Google Scholar
  • 26 Lovelock J E, Margulis L. Atmospheric homeostasis by and for the biosphere – the Gaia hypothesis.  Tellus. 1974;  26 2-10
    CrossrefPubMedGoogle Scholar
  • 27 Kirsch I, Sapirstein G. Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication.  Prev Treat. 1998;  1 0002
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 31 Moerman D E, Jonas W B. Deconstructing the placebo effect and finding the meaning response.  Ann Intern Med. 2002;  136 471-476
    CrossrefPubMedGoogle Scholar
  • 32 Giordano J. Spirituality, suffering, and the self.  Mind and Matter. 2008;  6 179-191
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 35 Benedetti F. Mechanisms of placebo and placebo-related effects across diseases and treatments.  Annu Rev Pharmacol Toxicol. 2008;  48 33-60
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 37 Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses.  Neuron Rev. 2008;  59 195-206
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 39 Scharmer C O. Theory U: leading from the future as it emerges. Cambridge, MA; The Society for Organizational Learning 2007
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 41 Symmons D P M. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome.  Best Pract Res Clin Rheumatol. 2002;  16 707-722
    CrossrefPubMedGoogle Scholar
  • 42 Hochberg M C, Silman A J, Smolen J S, Weinblatt M E, Weisman M H. Rheumatology. Mosby; Elsevier Limited 2008
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 44 Bridges S L. Personalized medicine in rheumatoid arthritis: hopes and challenges.  Bull NYU Hosp Jt Dis. 2007;  65 174-177
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 46 Smolen J S, Aletaha D. Challenges of predicting treatment response in patients with rheumatoid arthritis.  Nat Clin Pract Rheumatol. 2005;  1 62-63
    CrossrefPubMedGoogle Scholar
  • 47 Gaston J S H. Cytokines in arthritis – the 'big numbers' move centre stage.  Rheumatology (Oxford). 2008;  47 8-12
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 54 Vangermeersch L. Bi-syndromes. Brussels; Satas 1994
    Google Scholar
  • 55 Maciocia G. The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists, 2nd edition. Kidlington; Churchill Livingstone 2005
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 62 Kamada T, Kawai S. An algorithm for drawing general undirected graphs.  Inf Process Lett. 1989;  31 7-15
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 64 Beers M H. The Merck manual, 18th edition. Whitehouse Station; Merck 2006
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 67 Jiang W. Therapeutic wisdom in traditional Chinese medicine: a perspective from modern science.  Trends Pharmacol Sci. 2005;  26 558-563
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 69 Capellino S, Straub R H. Neuroendocrine immune pathways in chronic arthritis.  Best Pract Res Clin Rheumatol. 2008;  22 285-297
    CrossrefPubMedGoogle Scholar
  • 70 Czura J, Tracey K J. Autonomic neural regulation of immunity.  J Intern Med. 2005;  257 156-166
    CrossrefPubMedGoogle Scholar
  • 71 Jackson D B. Clinical and economic impact of the nonresponder phenomenon – implications for systems based discovery.  Drug Discov Today. 2009;  14 380-385
    CrossrefPubMedGoogle Scholar

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

Jan van der Greef

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