Systems Biology and TCM

I was reading The End of Illness the other day by Dr. Agus (I know I'm a sucker for anything featured on the Daily Show). He gets into explaining the role that proteomics can have and will have in the future of medical diagnosis. Proteomics is a systems biology approach to lab analysis that takes a snapshot of the various peptides present in a tissue sample and thereby quantifies and qualifies the relative strength of inflammatory, homeostatic, and other processes in the body to arrive at a richer and more nuanced view of health. Sounds an awful lot like some good old bian zheng (or pattern differentiation) to me. Nobody tell them they can do it without all that expensive machinery, our economy needs those purchases.

Well, I dove a bit deeper and found that a lot of research has been done, looking at systems biology approaches such as proteomics, transcriptomics and metabolomics and how well it correlates across patients with the same TCM diagnosis, and the answer is, wait for it....pretty darn well. There is some really interesting stuff out there on this subject. We know that multiple Western Medical diagnosis can have the same TCM diagnosis. If they also have the same proteomic profile, then Western Medicine may finally have a tool that puts them at least in the same ballpark as TCM in terms of overall diagnostic ability. Granted their diagnostic accuracy with this technique is pretty crude still and it'll take a pretty long time before this sort of diagnostic approach really reaps gains for them. But, the value to me is in having anther peg to hang a hat on when I think of what exactly is happening in the body when I think of kidney yang deficiency, or spleen qi deficiency, or liver qi stagnation. Before I outrage my chinese medicine brethren, I am in no way suggesting that this sort of understanding is any more "real" or "true" than our own understanding of them or that any blood test can replace our unique diagnostic skills and approach. Truly complete understanding of the patient's health I think is like the Tao in that understanding it in abstractions is possible but when grasping for a concrete and objective finality inspection will always yield a deeper level of murkiness. So...so to the fun part! The studies!

In one study, in the American Journal of Chinese Medicine, they looked at "heat" type asthma in a group of patients and sought a systems biology style correlate of this TCM term. They found that those diagnosed with a "heat" pattern demonstrated an increase in eosinophil cationic protein, which according to wikipedia is released during degranulation of eosinophils...ie inflammatory process and in our medicine, a very simplistic, and potentially unreliable indicator of heat patterns. I know I would trust my 4 examinations long before the ECP count in my patients serum as an indicator of their pattern, but you gotta give it to them for trying.

Another article, in the Journal of Pharmaceutical and Biomedical Analysis (sorry no free full text). Looked at multiple studies on this subject and the authors wrote about various zheng and their relevant systems biology style biomarkers:

Investigations into the characters of the ‘Kidney-Yang Deficiency syndrome’ induced by high dose of hydrocortisone and the therapeutic effects of Rhizoma Drynariae, classic TCM in treating the syndrome, have been performed by robust metabolomics method based on UPLC/MS [44]. It was found that significant difference in metabolic profiling was observed from hydrocortisone-induced group compared with the pre-dose group by using PCA. The time-dependent regression tendency in Rhizoma Drynariae treatment group was obtained, and the major metabolic alterations responsible for group separation were linked to some significantly changed metabolites like phenylalanine, N(2)-succinyl-L-ornithine, phenylacetylglycine, creatinine, hippurate, L-proline, and citrate. Biochemical changes were related to the disturbance of amino acid metabolism, energy metabolism and gut microflora, which are helpful to further understand the ‘Kidney-Yang Deficiency syndrome’ and the therapeutic mechanism of Rhizoma Drynariae. Therefore, metabolomics not only opens out mechanism of classical TCM theory on syndrome but also enriches current research on complex diseases [45].

So in plain english that means they induced kidney yang deficiency in these rats by giving them hydrocortisone then compared the metabolites present in their blood with those in other rats with their kidney yang intact. They found changes consistent across the study group in terms of the amino acid building blocks present. They attributed the changes in the biochemical profiles of these rats to not only this difference in the metabolites, but also the energy metabolism that resulted from it as well as changes in gut flora. I really appreciate their recognition of the gut flora (other systems biology folks also ascribe huge importance to these bacteria). I think the gut flora should be considered its own discrete organ from the western sense and I consider it to occupy a pretty large part of what we recognize as the spleen zang in Chinese Medicine.

I try not to jump up and down too much when a new testing method comes out. I don't, for instance, see this new approach as a reliable diagnostic for autism. (check out this great blog post on this subject by Paul Whiteley.) What I do think, is that this is an exciting new way to look at the body. A way that allows for gray areas and very subtly nuanced differences. This type of investigational approach serves due respect to the organism whose true nature often defies clear distinction.