Integrative medicine is not only an innovative China model in clinical practice, but also the bridge for TCM toward the world. In the past thirty years, great achievements have been made in integrative medicine researches, especially in clinical practice. The clinical achievements mainly include the following three: innovating methodology of disease-syndrome combination, excavating the classical theory in traditional Chinese medicine (TCM), preventing and curing refractory diseases. The development ideas and strategies of integrative medicine for future mainly include (a) standing on frontier field of international medicine and improving the capability of preventing and curing refractory diseases; (b) moving prevention and control strategy forward and improving the curative effect of common and frequent disease; (c) excavating the classical theory of TCM and broadening the treatment system of modern medicine; (d) improving the innovation level of new high effective drugs on the basis of classical prescriptions and herbs in TCM; (e) rerecognizing the theory of formula corresponding to syndrome in TCM and enhancing the level of clinical research evidence based on evidence-based medicine. Integrative medicine will do obtain greater achievements in creating new medicine and pharmacology and make more tremendous contributions for the great rejuvenation of the Chinese nation and human health care.
The coexistence of western medicine (WM) and traditional Chinese medicine (TCM) began to appear when WM was introduced to China from the middle of 16th century. The tendency of “confluence of Chinese and western medicine” appeared as the two medical systems contacting and influencing with each other since then. With the development of modern medical technology, intercourse, and cooperation between TCM and WM, integrative medicine was established in the 1980s. Under the guidance of “system learning, comprehensively mastering, sorting, and improving,” predecessors of integrative medicine have been exploiting the complementary advantages of macro and micro, global and local, structure and function, traditional and modern, disease differentiation, and syndrome differentiation in WM and TCM, in order to create new medicine and pharmacology theory. Through unremitting efforts of integrative medicine staffs at home and abroad, remarkable achievements have been made in health care, teaching, researching, academic development, discipline construction, talent training, and so forth. So we can say that integrative medicine is not only an innovative China model in clinical practice, but also the bridge for TCM toward the world [
The relationship between disease and syndrome is thought to be one of the most significant problems in TCM clinical and basic practice. As a new mode for syndrome research, disease-syndrome combination mainly refers to absorbing the idea and theory of disease differentiation in western medicine (WM) as well as syndrome differentiation in TCM. The mode, which originates from the medical practice since more than half a century ago, has realized mutual compensation of advantages of TCM and WM [
Academician Chen Keji pointed out that modern view of disease-syndrome combination includes six aspects: (a) mode of disease differentiation by WM combined with syndrome differentiation by TCM; (b) mode of syndrome differentiation and treatment combined with specific prescription for certain illness; (c) mode of treating according to disease staging; (d) mode of differentiation of the basic pathogenesis combined with syndrome differentiation and treatment in TCM; (e) mode of treating according to syndrome differentiation rather than disease differentiation when there’s no disease can be diagnosed in WM; (f) mode of treating according to disease differentiation rather than syndrome differentiation when there’s no syndrome can be diagnosed in TCM [
Syndrome is not only the core of TCM basic theory and syndrome differentiation, but also the bridge to associate disease and formula. Different from diagnosis based on pathological mechanism, syndrome is a classification according to subjective symptom and objective sign collected by physical examination [
Through mathematical statistics method and computational intelligence approach, it was found out that the major syndrome factors of coronary heart disease are blood stasis, qi deficiency, turbid phlegm, qi stagnation, heat deposition, yang deficiency, yin deficiency, and cold coagulation based on calculation analysis of 5099 cases patients reported on literatures and 1069 cases patients with coronary heart disease validated by coronary angiographic. We also constructed the diagnosis scales of blood stasis syndrome and its accompanied syndromes in coronary heart disease, such as qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome [
It is meaningful to promote the original innovation in integrative medicine researches through further understanding the connotation of syndrome diagnosis, therapeutic principle, and classical prescription by modern science and technology. Among these studies, three researches below are honored.
The first one is blood stasis syndrome theory and the clinical application of the method of promoting blood circulation and removing blood stasis. Blood stasis syndrome theory is first recorded in
The second study is the theory of dispelling interior pathogenic factors and purgation and its application in the treatment of acute abdomen. According to the theoretical basis of “the six fu-viscera function well when unobstructed,” academician Wu Xianzhong began to explore integrative medicine therapy on acute abdomen in early years. Through unifying standard for syndrome differentiation and defining operative indication, his team accumulated a large number of valid acute abdomen cases with the therapeutic method of expelling pathogens by purgation. Under the leadership of Professor Wu, the multidisciplinary and prospective researches included the effects of dispelling interior pathogenic factors and purgation on the splanchnic blood flow and caecal single smooth muscle cell, the clinical characteristics of multiple organ dysfunction syndrome (MODS) caused by several different kinds of elements, the changes of nerve-endocrine-immunological network in MODS and the effects of purgative herbs on information transmission mechanism of immune cells through four times of different scale joint research in the seventh to tenth five-year plan period. After years of efforts, significant progress had been made and the operation rate had been reduced in the treatment of acute abdomen, such as severe acute cholangitis, acute severe pancreatitis, and complicated biliary stones, which was awarded the second award of national science and technology progress in 2003 [
The third one is the theory of “treating the toxifying disease with poisonous agents” and researches for arsenic trioxide (AS2O3) treating acute promyelocytic leukemia (APL). The theory is a traditional simple understanding of hypertoxic drug treating difficult and complicated diseases. It was recorded in
As the frontier field and hot issue of cardiovascular diseases, restenosis after percutaneous coronary intervention and myocardial ischemia reperfusion injury (MIRI) during open heart surgery of cardiopulmonary bypass has become the best innovative points of clinical studies in integrative medicine. Researches showed that restenosis after percutaneous coronary intervention was closely related to blood stasis syndrome. Predominantly evaluated by restenosis (RS) rate estimated by coronary angiography (CAG), a prospective randomized controlled study was carried out on RS after PCI to observe the intervention effect of
As the establishing the cardiopulmonary bypass of open heart surgery is key point of successful operation, myocardial ischemia reperfusion injury (MIRI), which is very obvious during the recovery of circulation, has become the hot issue needed to be resolved. Some scholars found that the pathogenesis of MIRI during open heart surgery of cardiopulmonary bypass is deficiency of heart qi in the origin and excess of heart blood stasis and internal turbid toxin in the superficiality and the therapeutic principles are boosting qi and nourishing heart, activating blood circulation and resolving toxin simultaneously. It was proposed that of astragalus injection and tetramethylpyrazine injection for boosting qi and activating blood circulation should be given by vein injection during operation and
Multiple organ dysfunction syndrome (MODS) is one of the difficult problems in the field of the critical care medicine, which is characterized by acute onset, rapid progress, and extremely high mortality. Since the 1970s of 20th century, some scholars began to take vigorous action to explore a new way of preventing and treating MODS by integrative medicine and a new theory of “bacteria and bacterial toxin treated simultaneously” was presented ultimately. They also perfected schemes for the diagnosis procedure and treatment standard of MODS by both TCM and integrative medicine. And four therapeutic principles for the main types of syndromes were put forward, such as activating blood circulation to dissipate blood stasis therapy on blood stasis syndrome, clearing heat and toxin therapy on heat toxin syndrome, reinforcing the vital energy and consolidating the constitution therapy on acute deficient syndrome, and dispelling interior pathogenic factors and purgation therapy on Yangming fu-organ syndrome. Integrative medicine therapy can effectively improve the clinical efficacy and shorten the course of the disease thus reducing mortality. A famous injection of Chinese medicine, “
Chronic hepatitis B is the common disease in China, as well as in the world, causing great affliction to patients. It has become the major issue in the treatment of chronic liver disease. The progression of chronic hepatitis B may lead to liver cirrhosis and hepatocellular carcinoma. Hepatic fibrosis is the common pathological end stage of various chronic liver diseases regardless of the etiology, and blocking the occurrence and development of fibrosis of liver is very important in chronic hepatic diseases’ treatment and prognosis. TCM has become the important therapy in treating chronic hepatitis, liver fibrosis, and liver cirrhosis. Some scholars put forward the hypothesis that liver fibrosis and early liver cirrhosis can be reversed. They found out that the basic pathogenesis of liver fibrosis is weakened body resistance and blood stasis, so therapeutic method of strengthening body resistance and dispelling stasis was established, and “
Combining the macroscopic view with microscopic view, syndrome differentiation with disease differentiation, regional with global, taking stopgap measures with taking radical measures, supporting healthy aspects with eliminating pathogens, tumor treatment model by integrative medicine emphasizes contriving individual treatment plan and evaluation standard on the basis of biological characteristics and the course of disease. Malignant tumors could be treated by TCM therapies such as reinforcing the vital energy and consolidating the constitution, supplementing qi and nourishing yin, and clearing away heat and toxic materials, combined with conventional therapies such as radiotherapy, chemotherapy, and surgery. TCM treatment has significances in decreasing toxicity and increasing efficacy on radiotherapy and chemotherapy. Integrative medicine theory has a remarkable effect in alleviating symptoms such as dry mouth in hyperpyrexic consumption of yin syndrome and deficiency of both qi and yin syndrome caused by head and neck cancer after radiotherapy, relieving symptoms such as cough caused by acute radiation pneumonitis, improving immune function, and survival quality of postoperative patients, preventing the tumor from recurrence or metastasis and prolonging survival time. The new model of combining TCM and modern cancer treatment has attracted widespread attention in the world, which is known as “China Model for Cancer Treatment” [
APL is a special type of acute leukemic (AL). TCM suggests that the pathogenesis of APL is weakened body resistance and excessiveness of pathogen, so therapeutic method of eliminating pathogenic factors and strengthening body resistance was established. Some scholars developed the Compound Realgar Natural Indigo Tablets (Realgar, Indigo Naturals, Salvia and Radix pseudostell) on the basis of clearing away heat and toxic materials and supplementing qi with activating blood circulation and promoting hemogenesis method. 155 cases of APL patients were treated by the Compound Realgar Natural Indigo Tablets and the remission rate was 97.42% after treating for 6 months. No side effect, serious infection, bleeding, and DIC were found during the treatment course. It was also characterized by higher negative conversion rate of PML—RAR
Since the 1970s of 20th century, the basic syndrome of type 2 diabetes included yin deficiency with internal excessive heat, deficiency of both qi and yin, and deficiency of both yin and yang, therefore, III-type differentiation of type 2 diabetes was established and developed. It had already been adopted by national guidelines for new drug in the late 1980s. As deficiency of both qi and yin was the important basic syndrome of the disease, “
Severe pancreatitis, namely, acute hemorrhagic necrotizing pancreatitis, is characterized by acute onset, rapid progress, high mortality, and poor prognosis. 65% of the death cases are due to complicating with acute respiratory distress syndrome (ARDS). According to the theoretical basis that “the six fu-viscera function well when unobstructed” and “the lung and the large intestine are interior-exteriorly related,” acute pancreatitis is treated by expelling pathogens by purgation, and the average cure rate reached to 97%, while the average cure rate of severe pancreatitis was 80%. Compared with our country and abroad, the mortality has reached the lowest level.
A certain progress was also made on dermatosis and burn medicine by integrative medicine therapy. Vitiligo was effectly treated by taking modified
Severe acute respiratory syndrome (SARS) has aroused international attention for strong infectiousness, rapid progression, poor prognosis, and high mortality, which has no special effective therapy yet. 524 patients of SARS in China were divided into integrative medicine treatment group (
Previous achievements in clinical researches of integrative medicine showed that it is absolutely necessary to keep a foothold at frontier field of international medicine and life science and derive the wisdom and new theories from these subjects in order to find the innovation and breakthrough from subject cross and osmosis. Aiming at the hot issues and knotty problems confronted in clinical medicine, we could put forward scientific hypotheses in exploring the etiology and pathogenesis of the disease and seek for the effective therapeutic principles and classical prescriptions. Basing on the research mentioned above, the clinical efficacy should be objectively evaluated by randomized controlled trials (RCT), and the potential mechanism should be illustrated ultimately. By summarizing the clinical regularity in time, it will contribute to the innovation of the medical theory and guide clinical practice.
Taking coronary heart disease as example, despite great advancements in the fields of basic and clinical researches made by modern medicine, there are still some issues to be resolved, such as acute coronary syndrome complicated by microvascular thrombosis, myocardial ischemia-reperfusion injury, no-reflow phenomenon, stent thrombosis, obvious subjective symptoms such as hypodynamia and shortness of breath remained after percutaneous coronary intervention (PCI), and ventricular remodeling following myocardial infarction [
In addition, as viral infectious disease belonged to the category of epidemic febrile disease in TCM thousands years ago, Chinese ancients had accumulated rich experience and formed a systematic and complete theory in treatment. Currently, better therapeutic efficacy of viral infectious diseases could be achieved by combining two medical systems, especially in SARS, N1H1, and bird flu. Also, more similar breakthrough points of integrative medicine can be found, for instance, improving the low success rate of assisted reproductive technology (ART) by combining ART with TCM therapeutic method of reinforcing kidney and activating blood, and so forth.
“Moving prevention and control strategy forward” is a national macrohealth policy, which well adapted to the new medical model, “physiological-psychological-social-environmental” model. It means that the focal point of medicine will be transferred from treating disease to health care, and disease prevention will be paid more attention to. Therefore, the policy of “prevention first” will be carried out instead of traditional ideological concept “treatment is more major than prevention.” It is similar to the TCM theory of “preventive treatment of disease,” including principles of “preventing measure taken before the occurrence of disease” and “preventing measure taken after the occurrence of disease” in
Taking cardiovascular disease, for example, there are about 30% of the population in the world died from cardiovascular and cerebrovascular events, among which 62% of stroke and 49% of cardiovascular events were directly caused by hypertension [
JAMA, an international authoritative journal, have commented that traditional medicine should joint tracks with modern medicine. It suggested that not only should we inherit traditional academic thoughts but also keep an eye on modernization of TCM and study it in a scientific and systematic way [
Viscera, meridians, prescriptions, and syndromes, the precious wealth in TCM left by our ancients, are worth deeply researching into. However, as the theory is profound, classical, and concise, combining with clinical practice is the unique way to understand the connotation. For example, the lung and the large intestine are interior-exteriorly related, that is to say, the lung was associated with the large intestine by meridians. In the clinical practice, dysfunction of the large intestine conduction could cause no descending of the lung qi, conversely, no descending of the lung qi also can result in obstruction of fu-qi. It is reported that introducing fu-unblocking and purgation therapy into adults’ acute pneumonia is a rapid and effective treatment. In the 70th of the last century, Professor Wang had applied
Compared with TCM theory, Chinese herbs are much easier to be modernized and recognized. Therefore, it is of great significance in promoting modernization, industrialization, and industrialization of the Chinese herbs, by ways of combining modern technology with fully understanding of classical prescriptions and herbs.
China is a great power with rich herb resources. According to the records in Formula Dictionary of Traditional Chinese Medicine, there are approximately 100 thousand prescriptions, including special prescriptions and herbs for certain diseases. The classical prescriptions and herbs provided with definite clinical indications are of more meaning to be developed. That will provide an effective shortcut to improve the capability of developing new drugs, which is characterized by definite chemical structure, explicit action mechanism, obviously curative effect, advanced formulations, convenience for taking, and low price.
At present, the effective fractions and monomers extracted from Chinese herbs had obtained reliable clinical benefits. For instance, artemisinin extracted from Sweet Wormwood (
In addition, indirubin extracted from indigo naturals in
Evidence-based medicine (EBM) is a new subject quickly developed in the clinical medicine field in the 1990s. The core thinking is to combine evidence, personal experiences, and patients’ actual situation to formulate scientific measures for preventing diseases, promoting the recovery and improving life quality. Among them, clinical evidence originates mainly from randomized controlled trial (RCT), systematic review, and meta-analysis. With medical science transforming from traditional experience medicine into evidence-based medicine, fundamental changes have taken place in clinical medicine. Therefore, following the principle of respecting science and evidence, it is of the utmost importance to enhance the level of clinical research evidence in TCM and integrative medicine [
It is noteworthy that the treatment concept, formula corresponding to syndrome, lied in classical works of TCM, is similar to the ideas of EBM. However, it had been ignored for a long time. The theory of syndrome differentiation and formula corresponding to syndrome are two characteristic inheritance veins in TCM. Generally speaking, the former is always the mainstream ideology in TCM, while the latter has been paid little attention. Clinical medication based on pathogenesis is the core idea of syndrome differentiation, while clinical medication based on formula syndrome is not exactly the same as it. The most significant difference between them is whether giving attention to the objective evidences of formula utilization. The theory of formula corresponding to syndrome attaches great importance to the objective indications of herbs, which mainly comes from long-term, large-scale and repeated clinical trials by Chinese ancients.
As the indications of herbs are objective and concrete, clinical effect could be repeated at anytime, anywhere, and for anybody. So it is suggested that, facing with one patient, 10 TCM physicians may prescribe the identical prescription and get rapid treatment effect simultaneously according to the indications of formulae and herbs. This is just the reason why the significant curative effect can be by classical prescriptions get in treating severe and lingering illness. The extractive process of indications is similar to the evidence-based research, and indications of herbs have probably exceeded the category of expert experience in EBM. Therefore, carrying out clinical studies under guidance of EBM and formula corresponding to syndrome is helpful to summarize the indications of formulae and herbs, and enhance the level of clinical research evidence in TCM [
The history of man’s science development showed that the crossing and blending of two kinds of knowledge systems will be able to set up a new knowledge system. Integrative medicine, an unprecedented task in present world, is a new pattern of medicine, which is formed by the integration of TCM and WM. The current situation of integrative medicine career was highly evaluated by academician Han Qide. He pointed out that integrative medicine is an inevitable choice for the development of Chinese medicine and the breakthrough point of development for modern medicine, which have unique advantages and will play an important role in China. With changing of the disease chart, increasing of metabolic disease, malignant tumor, iatrogenic disease and drug-induced disease, and the coming of senile society as well as the change of people’s views on health and medical mode, both opportunities and challenges have been brought to the development of integrative medicine. Thus we believed that under the guidance of “pay equal attention to both WM and TCM” and “implementing the integrative medicine and developing TCM,” integrative medicine will obtain great achievements in creating new medicine and pharmacology, which builds on the combination of both WM and TCM, and make tremendous contributions for the great rejuvenation of the Chinese nation and human health care [
All authors manifest that there is no conflict of interests.
The current work was partially supported by the National Basic Research Program of China (973 Program no. 2003CB517103) and the National Natural Science Foundation Project of China (no. 90209011). The first author and the corresponding author contributed equally in this paper.