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ӢȻ2007.7.12

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News Feature

Nature 448, 126-128 (12 July 2007) | doi:10.1038/448126a; Published 
online 11 July 2007

Traditional medicine: A culture in the balance

Jane Qiu1

   1. Jane Qiu writes for Nature from Beijing.

Traditional Chinese medicine and Western science face almost 
irreconcilable differences. Can systems biology bring them together? 
Jane Qiu reports.

Liu Wen-long's modest Beijing practice looks no different from most 
clinics. But he is no ordinary doctor. Liu never orders lab tests, nor 
does he prescribe high-tech imaging diagnostics. He relies on simple 
observations, checking a patient's pulse, complexion and odour, and 
asking about habits and medical history. At 69 years old, he has been 
practising traditional Chinese medicine for 43 years and he is 
resolute about its benefits. "People keep coming back because it cures 
them and improves their well-being," he says.

Indeed, patients trickle in to see Liu all morning for conditions 
ranging from allergies to lung cancer. Some are nervous first-timers, 
others are regulars, confident in what traditional Chinese medicine 
has to offer. Ms Huang, an accountant from the outskirts of Beijing, 
is delighted that her migraines, which haunted her for years, 
disappeared after three herbal regimens. "I used to live on 
painkillers and felt tired all the time," she says. "I am now a 
totally different person."

In a country that is fiercely embracing modernity, clinics such as 
Liu's, which have been operating the same way for thousands of years, 
seem vulnerable and out of place. Indeed, attitudes on traditional 
Chinese medicine have divided the country. Last year, Zhang Gong-yao, 
from the Central South University in Changsha, Hunan, published an 
article in a Chinese journal calling traditional Chinese medicine a 
pseudoscience that should be banished from public healthcare and 
research1. The article caused uproar in the country, and earlier this 
year the government announced an ambitious plan to modernize the 
millennia-old practice2.

But should such a formidable gap be bridged? Modern Western medicine 
generally prescribes treatments for specific diseases, often on the 
basis of their physiological cause. Traditional Chinese medicine, 
however, focuses on symptoms, and uses plant and animal products, 
minerals, acupuncture and moxibustion  the burning of the mugwort 
herb (Artemisia vulgaris) on or near the skin. But whether these 
methods are effective and, if they are, how they work remain a source 
of some derision. The greatest divide is in the testing. In the West, 
researchers test a drug's safety and efficacy in randomized, 
controlled trials. Traditional Chinese treatments are mixtures of 
ingredients, concocted on the spot on the basis of a patient's 
symptoms and characteristics and using theories passed down through 
generations.

The mainstream medical community, in China and abroad, has been highly 
critical of the underlying theories. Traditional Chinese medicine is 
based on ideas such as qi (meridian), in which illness is caused by 
blocked energy channels; yin and yang, which emphasizes the balance of 
energy; and wuxing (five elements), in which people's organs and 
health status are categorized according to their 'elemental 
characteristics': fire, wood, water, earth and metal.

Pharmaceutical companies have become more interested in traditional 
Chinese medicines over the past decade. But their approach has been 
characteristically Western: isolate the active ingredients and test 
them one at a time. This reductionist approach has led to the approval 
of drugs such as artemisinin for malaria, which is used to treat fever 
in traditional Chinese medicine, and arsenic trioxide, which has been 
carried over from Chinese medicine for treatment of acute 
promyelocytic leukaemia.

But identifying the active ingredients isn't easy. Most remedies in 
traditional Chinese medicine, as it turns out, are compound formulae 
 or fufang  that contain as many as 50 species of herbs, and 
thousands of chemicals therein (see 'Knowledge mining'). To tap into 
the deeper well of traditional Chinese treatments, researchers think 
they may need to look at how the mixtures of ingredients act in concert.
Relaxed regulation

The criteria for approval of herbal mixtures as medicines are now 
starting to relax, at least in the United States. In June 2004, the US 
Food and Drug Administration (FDA) issued new guidelines that permit 
the approval of herbal mixtures if they can be shown to be safe and 
effective, even if the active constituents are not known. Last October, 
the FDA approved the first such botanical drug under the new rules, a 
proprietary mixture of green-tea extracts called Veregen developed by 
the German company MediGene for treating genital warts.

These new regulations have helped to renew industry's interest in the 
complex formulae. And a buzzing new Western field could be poised to 
capitalize on the deeper secrets of traditional Chinese medicine. 
Systems biology attempts to understand the function and behaviour of 
an organism by studying the interactions between its components. It 
has been called a more holistic approach to biology and is seen by 
some as a perfect match for traditional Chinese medicine.

By measuring many genes, proteins and metabolites at the same time, 
systems biology may provide a measure of the entire body's response to 
a complex mixture of herbs. "If there is any technology that could 
lead to a breakthrough in traditional Chinese medicine, it will be 
systems biology," says Robert Verpoorte, head of the pharmacognosy 
department at the University of Leiden in the Netherlands. But not 
everyone agrees that the new technology is equipped to test old ideas.

Jia Wei, a pharmacologist at the Shanghai Centre for Systems 
Biomedicine at Jiao Tong University, and Tang Hui-ru at the Wuhan 
Institute of Physics and Mathematics, part of the Chinese Academy of 
Sciences, want to understand more fully how herbal extracts affect the 
whole body. They are collaborating with Jeremy Nicholson, head of the 
department of biomolecular medicine at Imperial College London, and 
using technologies such as nuclear magnetic resonance spectroscopy and 
mass spectrometry to profile the metabolites in a person's urine or 
blood  a discipline they call metabonomics.

Jia and his colleagues found that rats given the compound 
1,2-dimethylhydrazine to induce tumours in their colons had different 
metabolic profiles in their urine from those in the control group. And 
by feeding the rats a combination of two herbal extracts  Coptidis 
rhizoma and Evodia rutaecarpa, which are widely used in traditional 
Chinese medicine to treat gastric conditions  the researchers were 
able to reverse these changes in metabolism. Their results have not 
yet been published, but the researchers say that by looking at the 
changes in metabolites in detail, they have pinpointed the metabolic 
pathways that the herbs affect.
Culture shift

Jan van der Greef from SU Biomedicine in Zeist, the Netherlands, and 
his colleague Wang Mei are using a similar approach. In a mouse model 
of metabolic syndrome  a cluster of conditions such as insulin 
resistance and high blood pressure that often occur together  they 
and their team looked at the effect of an undisclosed formula used in 
traditional Chinese medicine on lipid profiles. When these mice are 
fed a high-fat diet, they become more resistant to insulin. The lipid 
profiles of these mice were clearly distinguishable from those of mice 
fed a normal diet, and they shifted towards the healthy state when the 
mice were given traditional Chinese medicine3.

The researchers noticed that the profile shift resembled that caused 
by the Western obesity drug Rimonabant, which acts on proteins called 
CB-1 endocannabinoid receptors. And their unpublished work with cell 
culture suggests that herbal extracts can affect lipid metabolism 
through the same receptor, says van der Greef. The team is now testing 
the formula in clinical trials.

Although one active ingredient may act as the Western drug, the 
uncertain role of additional ingredients and the variability of active 
ingredients confounds Western sensibilities. "Variations worry 
people," Nicholson says. The same plant species grown in different 
regions and harvested in different seasons could have distinct 
chemical compositions. This has always been a vexing issue for 
herbal-medicine researchers.

While at Nicholson's lab, Tang and his colleagues analysed the 
molecular components in chamomile plants from Egypt, Slovakia, and 
Hungary, and could classify them easily4. Using similar approaches, 
the team from the Wuhan Institute of Physics and Mathematics found 
significant variations in the same herbal medicines produced by 
different companies and even between different batches produced by the 
same company. "This is an issue China must tackle for its herbal 
medicines to raise their game in the world market," says Tang.

To many self-purported systems biologists, several approaches are 
needed to build a complete picture of a living organism and to 
understand the effect of traditional Chinese medicine. Nevertheless, 
systems biology has been a conspicuously hard field to define. Many 
have used the term loosely, and pioneers in the field contend that the 
technologies haven't been honed to the point that they could be used 
for these approaches.

"It's conceivable that systems biology could find applications in 
trying to sort out components in Chinese herbal medicine, but it's 
very early days," says Leroy Hood, president of the Institute for 
Systems Biology in Seattle, Washington, and regarded as the field's 
founding father. "It would be an enormous challenge at this point and 
time."

Systems biology has been successful in model organisms, according to 
Hood, but is much less so in human studies. Many hurdles need to be 
overcome before researchers could even begin to contemplate how to 
deal with subjects as complex as traditional Chinese medicine. For 
example, better detection systems are needed to measure metabolites, 
especially proteins, accurately in the blood, and more powerful 
computational and statistical tools are crucial for dealing with large 
and complex data sets. "Those technologies are at early stages of 
maturation," Hood says.

There are also broader concerns about the modernization of traditional 
Chinese medicine, from both advocates and sceptics of the practice. 
Some are uncomfortable with separating the study and development of 
Chinese herbal medicines from the theories that underlie its normal 
practice. "Traditional Chinese medicine is not just a medical system, 
but a branch of philosophy and healing art that is an important part 
of Chinese culture," says Fu Jing-hua, a retired researcher at the 
Chinese Academy of Chinese Medicine Sciences in Beijing and president 
of the Chinese Ancient Books Publishing House in Beijing. "Devoid of 
that cultural context, it would become a tree without roots."
Lofty ideals

But Zhang and Fang Shi-min, a US-trained biochemist who now runs a 
society called New Threads that is known for fighting pseudoscience 
and research misconduct in China say that it is exactly those 
traditional Chinese medicine theories that should be abolished. 
Conceits such as yin and yang, wuxing and qi "are inaccurate 
descriptions of the human body that verge on imagination", he says.

Inevitably, cultural factors may be the biggest obstacle in bridging 
the EastCWest gap. "The field of traditional Chinese medicine is 
notorious for being averse to criticism," says Yuan Zhong, a 
philosopher of medicine at the Chinese Academy of Medical Sciences. 
"If people are not allowed to disagree or voice their opinions, there 
would be no hope of progress for any discipline."

But although heated exchanges are boiling over in debates on the 
future of traditional Chinese medicine, it's business as usual in 
Liu's practice. He is sanguine about the convergence between 
traditional Chinese medicine and Western medicine, but has a pragmatic 
attitude towards it. "Whether from the East or the West, we share the 
same goal of improving human health. As long as it works, anything 
goes," he remarks. But Liu says that he is yet to see any real 
progress in the merging of the two philosophies and, until then, his 
intuition and experience  as well as traditional Chinese medicine's 
seemingly arcane theory and practice  will serve him and his 
patients just fine.

See Editorial, page 106.

References

   1. Zhang, G.-Y. Med. Phil. 27, 14C17 (2006).
   2. Qiu, J. Nature 446, 590C591 (2007). | Article |
   3. Wang, M. et al. Phytother. Res. 19, 173C182 (2005). | Article | 
PubMed | ChemPort |
   4. Wang, Y. et al. Planta Med. 70, 250C255 (2004).

Editorial

Nature 448, 105-106 (12 July 2007) | doi:10.1038/448106a; Published 
online 11 July 2007

Hard to swallow
Is it possible to gauge the true potential of traditional Chinese 
medicine?

Researchers, practitioners and drug companies around the world are 
engaged in a complex, tentative dance over the best way to tap into 
the unknown potential of traditional Chinese medicine. The scientific 
community and the drug industry both tend to be sniffy about 
'traditional' cures; yet there is a strong sense that millennia of 
practice in China  much of it barely documented  is likely to have 
yielded at least some treatments that work.

Pharmaceutical companies are understandably eager to enter a Chinese 
domestic market that was estimated by the Boston Consulting Group to 
be worth US$13 billion last year, and growing fast. But they are 
tantalized by one opportunity above all: the prospect that the 
nation's traditional medicine might contain a number of potentially 
profitable compounds hidden somewhere in its arcane array of potions 
and herbal mixtures.

The task of finding these elusive gems has been approached in a 
typically reductionist manner, with researchers seeking single 
compounds that might have a role in treating specific diseases. 
Sometimes this has been successful: artemisinin, for example, which is 
currently the most effective treatment for malaria, was fished out of 
a herbal treatment for fevers. But such success stories have been few 
and far between.

So if traditional Chinese medicine is so great, why hasn't the 
qualitative study of its outcomes opened the door to a flood of cures? 
The most obvious answer is that it actually has little to offer: it is 
largely just pseudoscience, with no rational mechanism of action for 
most of its therapies. Advocates respond by claiming that researchers 
are missing aspects of the art, notably the interactions between 
different ingredients in traditional therapies.

Nevertheless, the drug industry is not exactly awash with promising 
new medicines at the moment. Perhaps as a result, the global 
regulatory process has become increasingly receptive to traditional 
approaches. In 2004, for example, the US Food and Drug Administration 
issued new guidelines on botanical drugs that made it much easier to 
get extracts into clinical trials if there was some history of prior 
use, and that obviated the need to characterize all compounds in an 
extract.

Some researchers in China and elsewhere, meanwhile, are advocating 
systems biology  the study of the interactions between proteins, 
genes, metabolites and components of cells or organisms  as a way to 
assess the usefulness of traditional medicines (see page 126). 
Constructive approaches to divining the potential usefulness of 
traditional therapies are to be welcomed. But it seems problematic to 
apply a brand new technique, largely untested in the clinic, to test 
the veracity of traditional Chinese medicine, when the field is so 
fraught with pseudoscience. In the meantime, claims made on behalf of 
an uncharted body of knowledge should be treated with the customary 
scepticism that is the bedrock of both science and medicine.

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ţյĺ޷ҵҳ


ţܷαʿ  籨 2007-7-19 00:00

http://www.dnzb.com.cn/gb/content/2007-07/19/content_2528198.htm

޷ҵҳ
ҳѾɾʱá


۸һ:ţţܷ
 - 2007718

http://finance.dayoo.com/gb/content/2007-07/18/content_2877481.htm

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5Զվͼ


ţɵϵͳʵ鲢δʵ
ɹ - 2007711

http://news.nmgnews.com.cn/pdeb/article/20070711/17744_1.html

ţɵ ϵͳʵ鲢δʵ
www.nmgnews.com.cn 2007-07-11 18:35 ӡҳ 壺СС󡿡

ѱɾ

رմҳ Դгѱ ߣ褾  ༭ƾ


ţɵϵͳʵ鲢δʵ
ڽ - 2007711

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ɴ۳а취뱻ʦ໥ᣨ类ڱԺйϵ潫
ļ¸ٵȣһ˾šⳡ־Ľ
ڣʦưǷзʵʤ۱磬˾ļ˵
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ϡǣϴ˲İϲӰ참
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ҪʱðԱ߷ԺԱӦڳ
  ϴϹҪİйزϵģӦǰ
ԱԱϵѾսİйزϵģӦ
ԺйزŹԱϵ
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  ϴвİڰоִо
顢顢ͥ¼֤ݲϵȡ
  ϴ˲İйزϺӦʱĵȫ
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ʮ  ⵥλĵӦءżϣءģӦ硢
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вӰİòġʦĵӦͨԭа˰
ڲϳо顢ö顢ȽԲ⣬ԭϲ׼ժ
͸ơ

עҳ¹֤ڷ2007/6/30

(XYS20070721)

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һ衰ֽڰӡԻ﹥ӵ

/g27946

ϵ빥ӵ ġƼ¡
ֽڰӡ---̣й̣
http://www.xinwenren.com/xfuedu/12224.htm

ʵ˿תһѿ˱̨ıдһۺж
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˭뵽̨ĽĿԱȻ٣

йʳƷȫǳĴ󱳾£˱̨ı
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鱻֮˿תˣ

07.07.20, ձֽڰӡٱԱദ
07.07.19, iwicomֽӵţ滹Ǽ٣
07.07.19, ǧֽӱʵΪ
ȶƪԳ塣

ˡѺȸýҲڵһʱھתˡֽڰӡı
ƺͳʶйʳƷ״ìܵģȨı
̨ĵӱתѵۡƾ˵κһ
˶ΪxysԼˡѺʲôġ

д˵ʲôأ

⡰ֽڰӡ---̣й̣
ɫģ
רŷּ֧ŵķ﷢Ļ,
񼤷ߵı.Ѿĵزϵĵز.
ֱǲӬֻʺĵز.TMDҪ.!

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רŷּ֧ŵķӣ
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˵ЩԻˣʵκһֻҪרҳϵ
bu3bu4 ֱˡ [ͼ]ӵҹ¿С [Ͻ]Ѫծ
ǱӾLóĸмǺ [07-16] ׳ڻԾ
ǸרϵĶЩʲô͵ЩдֵˮƽϣͿ֪
Ʒˮƽ

żãһǽȫˣɵزϲӣ˶
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(XYS20070721)

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人мԺԭԺ ͥϿ߶Բ𵳺

20070720ճ춼б

Ѷ 9ʱмԺǱԺ㻪ͥ
ͥ人мԺԭǡԺܻ߽Ԫһ

ʡԺԺָأ199620066¼䣬䵣人
˴ίḱ鳤鳤人мԺǡԺְ֮㣬
ȺԭбƲչ˾人ֹ˾人޹˾³ĳĳ
人ڻ޹˾³ĳȵλ˻¸93.69Ԫ
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(XYS20070721)

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ߣCrucify

,

տ̨3׿Ƽ۲죺Ԥ֮ա˵

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(XYS20070721)

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A)	ֽڰӡģҪϰ죻Ӱ쵳󣬻
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B)	Ǽٵģʵǡʵкõýְ
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ѡʲôأ

ʾһ⣬ʲôǡϰ족Ϊʲôɳ죬
ϰ족ϰ족ʵ̫ĸˣ֡ǹ֡ꡢʮ
ɱͷĸϰ죿ϰǲйⷨɣ쵼
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ֽڰӡŻǼſν˷룬ҲҪ
죬ڵôݹĳҲǼţҪйǻ
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ʱ٣ʱ档

ע͢ Դ 2007720 ձ

(XYS20070721)

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йձ ˷ֽڰ޺óԣ

¼£ձ   (2007-07-20)

ۺϵ磩й'ֽƤڡȻǼţȻձ
˷ֽڰӣ޺óԡ

ýǰ౨й'ֽڰӡţձѸ
Ŀе䷽ʵ'ֽڰӡҴ'óԡշ
ۡйѶԴԳ'ձ
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ƷݳȻӲ࣬һЩά
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ŨȲйѳƣ'ձ˵ѧϰɼΣְǵ¹ѧ
ˣ

ǰй̨һ򣬺̷ֽڵ
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עĿǰٵĵ̨ԱѾ̨ҲǸ

й̨Ǹ'ʹٱԲӰ죬
̨Ϊˣ̵Ǹ

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http://www.tanteifile.com/diary/2007/07/14_01/index2.html

(XYS20070721)

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20070720Ϸձ 

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գѡiamhelan̳һƪΪɥӴ
Աµ֭˭ҳԳӣ
ߵıϸɽһ׺´ӹڳһѵ㡣ݸ
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ѵġשͷɡϸһʱý壬
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ᵽͷִܲϵŹ
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(XYS20070721)

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