Discussion on the thinking innovation of the“Treatment based on syndrome differentiation” according to “Precision medical”

Long Jia,Hua Zhang

1Gansu University of traditional Chinese Medicine,Lanzhou,Gansu,China.2Affiliated Hospital of Gansu University of Traditional Chinese Medicine,Gansu,China.

Abstract Based on the concept of"precision medicine",this paper is to probe into the thinking innovation thought and development direction of"dialectical theory"of TCM,and to compare the development prospects of"syndrome differentiation"and"genetic constitution".It points out that the dialectical concept of"syndrome differentiation and treatment"is combined with the concept of high and new technology of"precision medicine"to further clarify the scientific connotation of traditional Chinese medicine.

Key words:Precision medical,Treatment based on syndrome differentiation,Innovative thinking

Introduction

Treatment based on syndrome differentiation is one of the essencial theories of traditional Chinese medicine(TCM).Su wen told us how to check the pathogenesis.First,we must carefully examine the pathogenesis and the intrinsic link between symptoms.Second,identify the actual situation and find a clear attribute.Empirical evidence should be clear what is going on and what its trend is.In addition,we should grasp the inherent relationship between the five elements of the human body,so as to make it clear what is the cause of the disease,as well as their interrelationship.Once the pathogenesis is confirmed,the treatment method can be followed.As early in the Spring and Autumn Period people had already recognized the importance of the etiology and pathogenesis of disease,the ancient physicians are always seeking the best way to explore the etiology and pathogenesis and they emphasized that"treatment based on syndrome differentiation"is the premise.The accuracy of syndrome differentiation(the accuracy of understanding of the etiology and pathogenesis)determines the validity of the theory of treatment.The concept of precision medicine is a collection of much modern medical science,technology development of knowledge elements and technology system,which not only reflecting the trend of medical science,but also represents the direction of the development of clinical practice.Its concept is coordinate with "treatment based on syndrome differentiation"and will help to improve the syndrome differentiation theory system.

The connotation and development of precision medical

The connotation of precision medical

The term"precision medical"first appeared in the report of"Towards Precision Medicine:Building a Network of Biomedical Research and Knowledge and a New Disease Classification System"released by the National Academy of Sciences in 2011[1].It aims to achieve the maximum benefit of patients and the sufficient allocation of social medical investment.It tends to standardize personalized medicine based on molecularbiology features or indicators.It combines preventive medicine,clinical diagnosis and treatment, epidemiology, molecular medicine,medical information technology,medical sociology and health economics together.It is a medical model that combined the pre-hospital precautionary management, hospital disease diagnosis and treatment information integration and accurate hospital rehabilitation management together.Precision medicine relies on genomics,proteomics,metabonomics,molecular information and other medical frontier technology.By precisely looking for the etiopathogenisis and targets of the disease,accurate medicine formulates customized and accurate treatment plans based on the characteristics of the patients,from the prevention and screening of the disease, diagnosis and treatment, to the rehabilitation plan.The smallest resource gets the maximum health protection.

The development of precision medical

The essence of precision medicine is"personalized medicine".The concept of"personalized medicine"was first proposed in the 1970s until the"Human Genome Project"was completed in 2002[4].Recent decades,as high-throughput sequencing and high performance mass spectrometry was developed rapidly,a great deal of"big data of biology"including genomics,transcriptomics,proteomics and metabolomics have been collected.On the basis of this, all countries are beginning to conduct group-based studies to personalized treatment for the purpose of accurate medical plan[5].As early as 2015,the United States announced the launch of the"Precise Medical Plan"based on cost reduction and technology improvement of large-scale biological database construction and gene sequencing[6].At the same time,China has also actively followed up on accurate medical research to demonstrate the feasibility of starting an accurate medical plan and formulated the plan for accurate medical treatment in the national"13th Five-year Plan"for scientific and technological development.Given the current uneven distribution of medical resources in our country,the relevant legal mechanisms are not perfect enough,the medical occupancy ratio is small,as well as a large population base,serious aging and other lagging factors,there are still many difficulties in the implementation of precision medicine.

Accurate medical treatment and syndrome differentiation of TCM

Focus on disease prevention

The precise prevention system in the "precise pedical"aims to establish a huge medical database based on different characteristics,such as population,race,environment,time,occupation,climate and individual constitution of genetic polymorphism and molecular basis of individual differences in constitutional polymorphisms.Precision medicine aims to understand the individual susceptibility genes,analysis of individual genetic composition,draw the disease spectrum of specific populations and establish the development of disease prevention strategies.Precision medicine intends to achieve accurate prevention and control of disease and construct a regular screening system for patients with a high risk of disease.Meanwhile,the establishment of an early warning mechanism to prevent the occurrence of disease,or early detection and early treatment was the ultimate destination of precision medicine[7-8].Records on Huang Di Nei Jing and Sun Si-miao has emphasized the importance of preventing disease [9]. The idea of disease prevention fully embodies the concept of"integrity of human body"and"different symptoms have different treatments"in the theory of TCM.In the process of prevention,TCM emphasizes individual difference and identifies the causes,the nidus,the nature and the development of disease.At the same time,following the principle of individualization,integration and integration.

Individual diagnosis.

The accurate diagnosis of diseases under the system of"precision medicine"mainly depends on the purely technical factors such as diagnostic instruments and analytical techniques,as well as the research and development of diagnostic techniques such as evidence-based medical research methods and personalized medical concepts such as research methodologies.Based on the development of medical information,accurate disease information diagnosis management system will be established[11-12].On this basis,it also emphasizes individual differences.As genome,proteomics,metabonomics and other molecular information and other factors are different among individuals,it is important to develop individualized prevention programs,by which to reduce the risk of disease and make early diagnosis.Precise diagnosis of disease is the basis of treatment,so it is very important to implement accurate assessment methods.

Syndrome differentiation is the basic principle of TCM in understanding diseases and managing diseases.It is the process to establish the symptoms through analyzing diseases information.It also the process to give formula and apply the theory into practice.In the process,we not only emphasize syndrome differentiation and treatment,but also emphasize the combination of dialectics and disease differentiation.According to the cause of the disease,location,nature and the law of change and other factors,the ancient Chinese medical researchers established syndrome differentiation of eight principles, viscera syndrome differentiation,syndrome-differentiation of the six meridians,syndrome-differentiation of weifen.Thus,in TCM,the same disease may have different"syndromes"in different human bodies,and different diseases may have the same"syndromes"."Syndromes"are the basis of syndrome differentiation and individualized medical treatment[8].

Individual treatment

Precision medical treatment can make implementation of precise and safe personalized intervention relying on accurate medical equipment inspection and molecular information detection,by which it can directly observe the human body's intrinsic gene,protein,metabolism and other omics information.

On the other hand,syndrome differentiation of TCM was conducted from an overall perspective and individualized treatment was carried out according to the difference of pathogenesis,which reflects the highly individualized features with addition and subtraction of syndromes. The incidence,development and prognosis of diseases are affected by many factors such as seasonal climate,geographical environment,physical strength,age and other factors.Therefore,the treatment should be based on the relationship between the disease and climate, geography and patients to develop appropriate treatment methods in order to achieve the desired therapeutic effect.Furthermore,"treating different diseases with different diseases" and"treating different diseases with the same rule of law"are the essence of the theory of syndrome differentiation and treatment,and their meaning is also for the purpose of achieving accurate treatment[7-8].Precise medicine also emphasizes molecular information such as"same disease with different diseases"and"same disease with different diseases",such as different individuals with the same disease based on genomics and other molecular information,and different molecular disease information may also have similar molecular information based on different molecules group information to develop a precise personalized treatment program[8,13].

The similarities and dissimilarities between the precision medicine and syndrome differentiation

At the macro level

Syndrome differentiation is the core characteristic of the theoretical system of TCM and is the vitality of the development of TCM.Syndrome differentiation and treatment is based on"Syndrome",by which personalized medical care is based on the four diagnosis and the clinical experience.It has many advantages in improving symptoms,improving quality of life and improving the prognosis of the disease, as the local conditions and human circumstances are considered to formulate its appropriate principles of treatment and prescriptions.

However,syndrome differentiation system in TCM is not standardized and lacks of objectivity and uniform standards on disease name, clinical diagnosis and treatment.It is the great obstacles which has an impact on the inheritance and development of Chinese medicine.

On the microscopic level

Precision medical is based on the characteristics of molecular biology, with genetics, protein,metabolomics and other histological information.It has great advantage over traditional Chinese medicine on the precision diagnosis and treatment.Through it,we can accurately find the cause of the disease and treatment targets for disease prevention,diagnosis and treatment.By which,"tailored"for the patient to develop personalized and accurate treatment programs.However,precision medicine is an interdisciplinary combination of medical science,biological big data and information science.It is facing enormous economic cost problems.Genomics testing,such as gene sequencing,is expensive.

Application of precision medicine in innovation of syndrome differentiation.

Application in disease prevention

The idea of"preventive treatment of disease"is an important idea of disease prevention in TCM.that is,the concept of carrying out individualized prevention and treatment actively throughout the entire course of disease[15].Precision Medicine is based on the discovery of genomic programs and the"big data of biology"established under the new medical model.Understanding the"genetic constitution"of each individual,screening for high-risk major diseases,ultra-early diagnosis,and sub-health adjustments could achieve the goal of precautionary prevention[16].However,it is of great significance to recognize the habitus in TCM to cure the disease in advance.After the susceptibility gene is activated,the onset and cure of the disease depends largely on the constitutional characteristics[7]."Paying attention to disease treatment and neglecting prevention and rehabilitation"is still a common phenomenon in the medical system in our country nowadays.The current medical system is missing this most important part.Based on the precise physical identification,Wang Qi et al[17]proposed Nine Body Health Plan based on different physical constitution of the Chinese precision medical[18].Under the guidance of syndrome differentiation and treatment,combining macroscopical and microscopic methods,we can carry out all-round,multi-link and multi-path disease prevention,and construct an individual precise prevention system for TCM.

Application in disease diagnosis

With the rapid development of bio-big data,regenerative medicine,immunotherapy and mobile medical industries,and the rapid development of technologies such as molecular markers and big data analysis,accurate medical treatment could find the cause and treatment targets in individual diseases more accurately and diagnose the disease more precisely[19].The TCM syndrome differentiation based on"syndrome".The high dimension and high order complexity of"syndrome"have brought great difficulties to the standardization of syndromes,the study of connotation and the establishment of diagnostic criteria,thus greatly reducing the accuracy of syndrome differentiation [20].Therefore,the innovation and development of syndrome differentiation must rely on the development of precision medicine in gene regulation,cytochemistry,immunology and molecular biology.A clear rule the of development and spread of"syndrome"could deepen and expand the comprehensive analysis by the four examination methods [21-22].When sticking to syndrome differentiation and macro-classical dialectical differentiation,we must also affirm the important auxiliary role of microscopic syndrome differentiation on the diagnosis of syndromes under precision medicine[23].

Application in Disease Treatment

Syndrome differentiation and precise medicine have a high degree of consistency in clinical practice.Uphold the rule that symptomatic treatment in acute condition, radical treatment in chronic case,comprehensive treatment,we must recognize many bottlenecks in the development of the syndrome differentiation. Syndrome differentiation and treatment in clinical practice,relying on TCM diagnosis,treatment methods,conventional diagnosis and treatment experiences.So the blind medication is inevitable in the course of treatment,which not only resulted in waste of resources,but also injured patients.Forexample,the abuse of domestic antibiotics causes the appearance of"super bacteria",the pharmacodynamic components of traditional Chinese medicine and the metabolism of enzymes is still unclear[24].In recent years,the concept of"precise medical treatment"has been embodied in the theory of syndrome differentiation and treatment.The concept of"precise medical treatment"as a unitary treatmentis introduced into syndrome differentiation.According to different patients'drug effects,gene and genetics background data,doctors choose the most reasonable drugs with the most appropriate dose [24].Combining the classical dialectical concept of"treating syndrome based on syndrome differentiation"with the high-tech medical concept of"precise medical treatment",we further clarify the scientific connotation of accurate medical treatment in TCM.TCM is also facing more technical problems in the precision medicine.The lack of objective and quantitative diagnosis and treatment of traditional Chinese medicine has hindered the internationalization of Chinese medicine and has become a bottleneck restricting the standardization and objectivity of TCM syndromes differentiation. The only way to modernize traditional Chinese medicine is to transit the speculative and macro-level experience of TCM to the combination of high-level analysis and synthesis.In the era of precision medicine,we should combine TCM syndrome differentiation,habitus,genes and other"omics",combine physicalanalys is and syndrome differentiation as well.It is necessary to explore whether there is a certain inherent relationship between the complexity of"omics"such as genes and"syndrome"in the TCM system rule and to bring new ideas into the research of TCM syndromes.