The West Learns from China, Creating Chinese New Medicine-Academician of Western Medicine TANG Zhao-you's View on the Integration of Traditional Chinese and Western Medicine

SHI Xue (石 雪), SUN Yi-nuo (孫一諾), ZHANG Wei-han (張巍翰), LIU Zi-ning (劉子寧), ZOU Jian-hua (鄒建華)

1. Beijing University of Chinese Medicine, Beijing 100029, China

2. Center for Translation, World Federation of Chinese Medicine Societies, Beijing 100101, China

THE REASON OF CREATING NEW MEDICINE IN CHINA

Over the past few hundred years of self-seclusion, China has lagged behind the world in natural science. Therefore, in the next one hundred years or even longer time, "making foreign things serve China" will become the mainstream and the norm. But Chinese medicine could not be an extension of western medicine for a long time. Whether it can surpass western medicine and how to surpass western medicine is a question we must consider.

In fact, President MAO Ze-dong said in 1950s,"Chinese medicine is a great treasure house. We should strive to explore and improve it. Western medicine should learn from traditional Chinese medicine (TCM) to have two sets of skills, so as to integrate TCM with western medicine, and to form unified Chinese new medicine and new pharmacy. He also stressed that western medicine and TCM cannot be separated. Chinese scientist QIAN Xue-sen also had a good discussion on the integration of traditional Chinese and western medicine. He said, "traditional medicine is treasure, because it is a summary on thousands of years of practical experience, and it is of great importance." "TCM is characterized by a holistic and systematic view on problems. Future medicine must be a new one that integrates TCM, western medicine and medicine of all nationalities." "The treasure house of TCM can release an unprecedented brightness only after it is explained with modern science and technology, and this work must be based on correct understanding of TCM theory." General secretary XI Jin-ping also stressed repeatedly that TCM is a gem of ancient Chinese science and a key to the treasure house of Chinese civilization.

The development of science and technology is quite rapid, and it is more necessary to use Chinese thinking to solve problems. We need to learn advanced technology, but we also need to deal with the relationship between "learning" and"questioning". If we do not study but only question,it will lead to falling behind, like the self-seclusion in the past few hundred years. If we only study but not question, we will be westernized and stagnant.Therefore, in order to achieve transcendence and development, we should adhere to the attitude of both learning and questioning when "making foreign things serve China".

"INTEGRATION OF TRADITIONAL CHINESE AND WESTERN MEDICINE" IS THE CORE OF NEW MEDICINE

After 65 years in medicine, TANG Zhao-you feels that although modern medicine is not perfect,it is really outstanding. According to statistics in the United States, the 5-year survival rate of cancer was 35% in 1953 and 68% in 2005. Despite the obvious progress, he doesn't think we've won all the games.In another article, it is said that 1/3 of anti-cancer drugs (mainly molecular targeted drugs) can not obtain total survival data after several years on the market, which indicates that their efficacy in treating cancer has not been fully confirmed.

With the development of science and technology, western medicine has gradually focused on the "disease" part, but it is difficult to take into account the "patient" as a whole. Without being separated from the whole and the practice for thousands of years, TCM is therefore better than western medicine in macro aspect. But it is far inferior to western medicine in micro aspect.Therefore, the relationship of TCM and western medicine is not mutual substitution, but partners to learn from each other's strengths and weaknesses.So, can "western medicine technology + TCM concepts" be a direction of new medicine?

As a surgeon, TANG Zhao-you had operated on many patients. Unexpectedly, several of his family members suffered from diseases requiring operation,but finally they were cured without operation. In 1987, TANG Zhao-you's 91-year-old mother was suffering from acute appendicitis perforation and diffuse peritonitis when he was travelling abroad.His teacher came to see his mother and suggested an immediate operation. The family did not agree to do the operation. By the time he got home, there was a lot of fluid flowing in her abdominal cavity, but she still refused to be hospitalized. So he could only give his mother an intravenous drip per day, which should have been 4 bottles, but she only agreed to have 1 bottle, with only 1/4 of the normal dose of antibiotics in the bottle. At the end of the 1950s,TANG Zhao-you began to study the integration of traditional Chinese and western medicine. He once participated to publish "116 cases of acute appendicitis treated by acupuncture" in Chinese Medical Journal. So he used acupuncture twice a day to stimulate his mother's Zusanli (ST 36). In this way, his mother's disease was cured in only 9 days by the method of integrating traditional Chinese and western medicine. TANG Zhao-you also used acupuncture to cure appendicitis of his son and his wife successively, without recurrence.

Practice is the only criterion for testing truth,and there must be scientific reasons for achieving curative effect. The Art of War says, "subdue the enemy without fighting", which is reflected in the above cases, verifying the rationality of reducing invasive treatment, and this may be a major direction of medical development. The core of new medicine is the integration of traditional Chinese and western medicine, the integration of local and whole, and the complementation of micro and macro.

TANG ZHAO-YOU'S EXPERIENCE AND PRACTICE OF INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE

The treatment principle of western medicine for acute appendicitis is to operate immediately after making a definite diagnosis. However, the result of the paper in 1960, "116 cases of acute appendicitis treated by acupuncture" published in the Chinese Medical Journal showed that clinical indicators after acupuncture treatment were mostly returned to normal, which was obviously a challenge to the principle of western medicine treatment. According to national conditions, it is the mainstream for acupuncture and other therapies, which are "more,faster, better and cheaper", to supplement "highgrade, precision and advanced" therapy, and it is similar to minimally invasive laparotomy, relieving appendix obstruction and retaining appendix.

In the 1960s and 1970s, patients with liver cancer "walked in, and were carried out", but they still died after active treatment. Preliminary attempts were made to combine attacking method in western medicine, chemoradiotherapy, with attacking method in TCM. As a result, patients quickly vomited blood with liver ruptured. After summing up the experience and lessons, the combination of chemoradiotherapy in western medicine and supplementing method in TCM finally reduced complications of the patients and prolonged their survival time.

By studying the relationship between syndrome differentiation in TCM and disease types and disease stages in western medicine in primary liver cancer, it was found that in terms of liver cancer,four diagnostic methods in TCM can reflect clinical reality on the whole, and the syndrome differentiation based on the four diagnostic methods is generally reliable. Therefore, the syndrome differentiation and treatment based on the four diagnostic methods is actually an individualized treatment.

Another randomized controlled study on primary liver cancer showed that "experienced TCM syndrome differentiation and treatment" was superior to "chemotherapy + TCM symptomatic treatment". The goal of TCM treatment is to continuously consider the "imbalance" state of patients to give targeted therapy, so as to restore"relative equilibrium of yin and yang", which is a dynamic and individualized treatment; while western medicine attaches importance to etiology and molecular targets. So, there are possibilities and basis for complementation of TCM and western medicine, which is also an important way to improve the curative effect.

By the experimental study of "Songyou Decoction" (including Radix Astragali seu Hedysari,Radix Salviae Miltiorrhizae, Fructus Lycii, Carapax Trionycis and Fructus Crataegi, prescribed by TANG Zhao-you's wife, LI Qi-song), it was found that it had functions of down-regulating stem cell markers in liver cancer, anti-inflammation, improving microenvironment, improving oxygen supply and improving immunity, thereby reducing metastasis and prolonging survival time in tumor-bearing animals.

Generally speaking, the integration of traditional Chinese and western medicine is worthy of in-depth study in aspects of whole and local complementation, macro and micro complementation, complementation of strengthening the body resistance and attacking cancer, and so on. It is important to find new anti-cancer drugs from Chinese materia medica, but the concept of anti-cancer in TCM reflects philosophical thinking in ancient China, and it is worth exploring and improving.

FORMING THE "TWO STEPS" OF CHINESE NEW MEDICINE

Creating Chinese new medicine requires two steps. The first is "making foreign things serve China +Chinese thinking", and the second is "integration of traditional Chinese and western medicine".

Step 1: "Make Foreign Things Serve China"and Strive to Surpass Them

As China's modern technology is generally lagging behind the west, it is a mainstream trend to "make foreign things serve China" in the next hundred years or even longer, and "transcendence"needs "Chinese thinking".

Learning and Questioning the West

Rational questioning is an important part of scientific spirit. It helps to promote innovation and make China's science and technology surpass the advanced level over the world. It needs to deal with the dialectical relationship between learning and questioning in "making foreign things serve China".TANG Zhao-you's team questioned some western medicine's judgments on liver cancer. Through more than 10 years' practice, they initiated early diagnosis and treatment for liver cancer, established a unique metastasis model, overcame side effects of "cancer killing" therapy, and greatly improved the curative effect.

Combining TCM concepts

People like LI Qi-song who have left their jobs to study TCM are mostly old or dead. Modern TCM education attaches importance to western medicine, but TCM hospitals are only a minority, not the mainstream. Although it is difficult to create new medicine with Chinese characteristics in a short time and it is also unrealistic to ask doctors of western medicine to prescribe Chinese materia medica,western medicine can refer to "holistic view" and other TCM concepts. It may be a way out to realize TCM concepts through western medicine methods.

Combining The Art of War

Medical science has the same purpose as war, so we can draw on some tactical ideas of The Art of War. Such as "subduing the enemy without fighting" is compared to prevention and noninvasive diagnosis and treatment. "A good warrior is better than winning with ease" is compared to early diagnosis and treatment. "Attacking the enemy with ten times the force" is compared to concentrating forces and comprehensive treatment, indicating that even if the enemy is strong and I am weak, as long as we can create a situation of attacking an inferior force with a superior one in each part and combine with multiple therapies, local success may be achieved. "Blocking the enemy with frontal assault and winning with marvelous strategies" implies that it is necessary to pay attention to norms and more necessary to innovate. We need to strictly abide by diagnostic and therapeutic norms in clinic. However,only the innovation on this basis, can improve medical level.

Combining modern experience

Most cancer patients are in the situation of"the enemy is strong and I am weak". They can learn from MAO Ze-dong's military thinking, such as protracted war, the enemy advancing while we retreating, and national war. Do not be impatient,expect to solve the problem once for all, and only pay attention to operation and drugs.

Step 2: New Medicine on Integration of Traditional Chinese and Western Medicine

The realization of the Chinese dream is inseparable from medical science that guarantees people's health. However, "wholesale westernization" is not able to solve the problem of "difficult to see a doctor, expensive medical treatment, and curing illness". Therefore, "creating Chinese new medicine" is conducive to the realization of the Chinese dream. The integration of traditional Chinese and western medicine has made it possible for TCM to contribute to the whole world.TCM is likely to supplement "more, faster, better and cheaper" therapies. For example, TU You-you won the Nobel prize for artemisinin in 2015. The formation of Chinese new medicine that combines TCM and western medicine helps to improve national self-confidence. Overseas men of insight also notice integrated medicine that combines TCM and western medicine.

The integration of traditional Chinese and western medicine should attach importance to the essence of TCM theory, which needs to be condensed by TCM doctors with deep foundation and studied by western medicine doctors with deep foundation of TCM. Although TU You-you's success suggests that TCM is a treasure house, however,this is not the whole of the integration of traditional Chinese and western medicine. It is necessary to get away from the wrong path of "abolishing TCM and reserving Chinese materia medica." It is necessary to study TCM with the latest science and technology, not only from a chemical point of view, but also in combination with clinical practice.It is necessary to dialectically treat evidence-based medicine, because questioning is a prerequisite for transcendence. To develop medical science with Chinese characteristics, it is also necessary to establish a research platform and evaluation criteria for the integration of traditional Chinese and western medicine.

It is worth emphasizing that "the integration of traditional Chinese and western medicine" is different from "simultaneous use of TCM and western medicine". The two must not be confused.The former is to consider a patient's situation and according to advantages and disadvantages of TCM and western medicine, to choose appropriate western medicine and TCM therapies from the whole to achieve complementation. The latter is to choose a treatment plan from the perspective of TCM and western medicine, respectively. Such as for tumors,an attacking method in TCM and an attacking method in western medicine are not complementary,but repetitive, and this repetition may bring worse results.

The focus of the new medicine of "the integration of traditional Chinese and western medicine" is to learn TCM concepts and the essence of Chinese civilization, such as referring to The Book of Changes, Tao Te Ching and The Inner Canon of Huangdi. TANG Zhao-you's wife, Professor LI Qisong, is his classmate in western medical university.In 1959, she responded to the call to leave her post to study TCM. In 1965, she was also selected to treat a senior officer in a three-person expert group headed by Professor ZHANG Xiao-qian, a wellknown internal medicine specialist in China. She has cured many diseases which can not be cured by western medicine with the method of combining TCM and western medicine.

The integration of traditional Chinese and western medicine also needs appropriate policy support: to increase TCM content in teaching western medicine, such as a course of The Inner Canon of Huangdi; to implement a system of western medicine doctor off-job learning TCM, and to adjust the policy on promotion of academic titles in "the west learning from China"; to implement point-plane integration in research institutions, because most researchers in the so-called research institutions of integrated traditional Chinese and western medicine have not learned TCM; to increase research fund of integrated traditional Chinese and western medicine;to pay attention to the harmony between TCM and western medicine, respect each other, learn from each other's strengths and weaknesses, and pay attention to the guidance of public opinion.

EXPECTING A PROTRACTED WAR OF"ELIMINATION + TRANSFORMATION" FOR CANCER PREVENTION AND CONTROL STARTED BY THE INTEGRATION OF TRADITIONAL CHINESE AND WESTERN MEDICINE

No matter what kind of cancer elimination therapy, it is difficult to eliminate cancer 100%,because there are circulating cancer cells. After radical treatment, results of keeping using cancer elimination therapy to prevent metastasis and recurrence are not satisfactory. It is like using hand grenades to hunt down a very small number of mice in a porcelain shop, which is costly and inefficient.For this reason, we need to supplement measures other than "elimination". Foreign countries acknowledge that the 40-year anti-cancer war has not succeeded. Recurrence and metastasis are still bottlenecks after radical treatment. However,contributions of "anti-cancer war" based on cancer elimination cannot go unnoticed and it is still the mainstream, especially for early cancer.Tempering justice with mercy has existed since ancient times. In the same way, cancer control also needs dual tactics: elimination and transformation.Transform residual cancer, microenvironment and human body, as well as perform comprehensive transformation.

Why is "cancer control war" a protracted war?Cancer is a chronic and systemic disease. Clinical cancer is in a situation of strong enemy and weak self. But protracted war does not require patients to keep alert all day, but to despise strategically and attach importance to tactics, such as paying attention to life style. As the enemy is strong while we are weak, tactically, there should be advance and retreat, that is, "we retreat while the enemy advances, we attack when the enemy is tired, we disturb the enemy when they are stationed, and we chase the enemy when they retreat". We should attach importance to base construction: in the past,we often neglected to mobilize subjective initiative of patients. In fact, human body has tremendous capacity for repair. Transforming the human body is a fundamental way to the control cancer war. We should not only apply external intervention, but also attach importance to mobilizing patients' enthusiasm to work along both lines. This is "strengthening the body resistance to eliminate pathogenic factors"emphasized in TCM concepts.

In the protracted war of cancer control, the integration of traditional Chinese and western medicine is worth looking forward to. TCM belongs to comprehensive transformation. Among them,concepts like holistic view, treatment based on syndrome differentiation, strengthening the body resistance to eliminate pathogenic factors, restoring imbalance (relative equilibrium of yin and yang)and dredging are complementary to ideas in western medicine (local treatment, one disease with one prescription, killing all, blocking and killing,etc.). Western medicine is far superior to TCM in"eliminating" tumors, while TCM has its advantages in "transforming".

ACADEMICIAN TANG ZHAO-YOU'S EVALUATION ON THE ANTI-CANCER PRESCRIPTION

Union for International Cancer Control(UICC) published a report which said that there were 12 million new cases of cancer occurrence worldwide every year, and up to 40% could have been prevented in life. So is the "cheapest anticancer prescription" circulating in society effective?Professor TANG Zhao-you said, "compared with high cost of treatment after cancer, the following can be called the cheapest prescription for cancer prevention in the world. Although it has not been carefully studied, I generally agree."

1. Open the window for at least half an hour.2. Wipe your back with a dry towel. 3. Eat with garlic and scallions. 4. Drink soymilk to prevent"female cancer". 5. Walk for 1 hour a day. 6. Drink 6 glasses of water a day. 7. Bask in the sunshine for 15 minutes every day. 8. Drink 4 cups of green tea everyday. 9. Chew the food for 30 times. 10. Sleep for 7 hours. 11. Eat less sugar. 12. Drink a glass of red wine when eating meat.

MEDICAL PROSPECTS IN THE AGE OF GREAT SCIENCE

Human beings are in the era of rapid development of science and technology. Artificial intelligence, big data, quantum science and so on will affect human beings in an all-round way, and their views on medicine will also be diversified. The development of medicine is not only related to the life and death of individuals, but also to the rise and fall of the nation. By "letting a hundred flowers bloom and a hundred schools of thought contend", we can comb out the Chinese new medicine which is in line with China's national conditions and with Chinese thinking.This is also an important historical mission to realize the great rejuvenation of the Chinese nation.