Integration of traditional, complementary, and alternative medicine with modern biomedicine: the scientization, evidence, and challenges for integration of traditional Chinese medicine

Abstract

Traditional medicine has garnered significant global recognition, with an estimated 80% of the global population using it. Therefore, it is essential to fully understand the integration of traditional medicines into current healthcare systems. This review aims to provide a comprehensive overview of the standard process to modernize traditional medicine scientifically in the context of modern biomedicine, further termed here as “scientization”. Specifically, we aim to summarize the advancements made in understanding the efficacy, effectiveness, and underlying mechanisms of herbal medicine. We also examined the transition from experience- to evidence-based medicine during acupuncture. Furthermore, we explore the development of universal safety and quality control standards. Finally, we discuss international trade and export markets for Chinese medical products. The development and integration of traditional medicine have allowed it to further improve human health, resulting in a more comprehensive health solution for the global population.

Keywords

Acupuncture / Conventional medicine / Herbal medicine / Modernization / Scientization / Traditional Chinese medicine

References

[[1]] Moshi MJ, Mhame PP.Legislation on medicinal plants in Africa. Medicinal Plant Research in Africa. Elsevier; Muhimbili, Tanzania; 2013:843-858.

[[2]] Che C-T. Pharmacognosy. Traditional Medicine.Academic Press; University of the West Indies, Kingston, Jamaica; 2017:15-30.

[[3]] Keji C, Hao XU.The integration of traditional Chinese medicine and Western medicine. Eur Rev 2003;11(2):225-235.

[[4]] Tang JL, Liu BY, Ma KW.Traditional Chinese medicine. Lancet 2008;372(9654):1938-1940.

[[5]] Newman DJ, Cragg GM.Natural products as sources of new drugs over the 30 years from 1981 to 2010. J Nat Prod 2012;75(3):311-335.

[[6]] Cragg GM, Newman DJ.Natural products: a continuing source of novel drug leads. Biochim Biophys Acta Gen Subj 2013;1830(6):3670-3695.

[[7]] Corson TW, Crews CM.Molecular understanding and modern application of traditional medicines: triumphs and trials. Cell 2007;130(5):769-774.

[[8]] Li WH, Vederas JC.Drug discovery and natural products: end of an era or an endless frontier? Science 2009;325(5937):161-165.

[[9]] Tu Y.Artemisinin-a gift from traditional Chinese medicine to the world (Nobel Lecture). Angew Chem 2016;55(41):10210-10226.

[[10]] Chan K.Progress in traditional Chinese medicine. Trends Pharmacol Sci 1995;16(6):182-187.

[[11]] Wang J, Wong YK, Liao F.What has traditional Chinese medicine delivered for modern medicine? Expert Rev Mol Med 2018;20:e4.

[[12]] Xu Q, Bauer R, Hendry BM, et al.The quest for modernisation of traditional Chinese medicine. BMC Complement Altern Med 2013;13(1):1-11.

[[13]] Balkrishna A, Singh N, Pathak S, et al.Research on traditional medicine: what has been done, the difficulties, and possible solutions. Evid Based Complement Alternat Med 2014;2014:495635.

[[14]] Kendall DE.Dao of Chinese medicine: understanding an ancient healing art. Acupuncture in Medicine. Oxford University Press; Oxford, UK; 2002.

[[15]] Facchinetti F, Dante G, Neri I.Herbal supplements in pregnancy: effects on conceptions and delivery. Handbook of Fertility. Academic Press; Cambridge, Massachusetts, USA; 2015:253-260.

[[16]] Kong YC, Liang S.The Cultural Fabric of Chinese Medicine. Commercial Press; 2005.

[[17]] Nyman U, George V.Glimpses of Indian Ethnopharmacology. Tropical Botanic Garden and Research Institute; 1995.

[[18]] Gemechu FG.Embracing nutritional qualities, biological activities and technological properties of coffee byproducts in functional food formulation. Trends Food Sci Technol 2020;104(2):235-261.

[[19]] David G.The quinine connection. J Antimicrob Chemother 1992;30(4):417-427.

[[20]] Mahdi JG, Mahdi AJ, Bowen ID.The historical analysis of aspirin discovery, its relation to the willow tree and antiproliferative and anticancer potential. Cell Prolif 2006;39(2):147-155.

[[21]] Schmidt BM, Ribnicky DM, Lipsky PE, et al.Revisiting the ancient concept of botanical therapeutics. Nat Chem Biol 2007;3(7):360-366.

[[22]] Vennerstrom J, Arbe-Barnes S, Brun R, et al.Identification of an antimalarial synthetic trioxolane drug development candidate. Nature 2004;430(7002):900-904.

[[23]] Li FS, Weng JK.Demystifying traditional herbal medicine with modern approach. Nat plants 2017;3(8):1-7.

[[24]] Hershman DL, Unger JM, Greenlee H, et al. Abstract GS4-04: randomized blinded sham- and waitlist-controlled trial of acupuncture for joint symptoms related to aromatase inhibitors in women with early stage breast cancer (S1200). Cancer Res2018;78(4 Supplement):GS4-G04.

[[25]] Gang W, Jing X.[Comments on “Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial” published in Journal of the American Medical Association]. Chinese Acupuncture Moxibustion 2017;37(11):1238.

[[26]] Maeda Y, Kim H, Kettner N, et al.Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Deutsche Zeitschrift Für Akupunktur 2017;60:914-927.

[[27]] Linde K, Streng A, Jürgens S, et al.Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005;293(17):2118-2125.

[[28]] Xu S, Yu L, Luo X, et al.Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. BMJ 2020;368:m697.

[[29]] Witt C, Brinkhaus B, Jena S, et al.Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005;366(9480):136-143.

[[30]] Molassiotis A, Bardy J, Finnegan-John J, et al.A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture. Ann Oncol 2013;24(6):1645-1652.

[[31]] Assefi NP, Sherman KJ, Jacobsen C, et al.A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med 2005;143(1):I24.

[[32]] Melchart D, Streng A, Hoppe A, et al.Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 2005;331(7513):376-382.

[[33]] Zeng F, Qin W, Ma T, et al.Influence of acupuncture treatment on cerebral activity in functional dyspepsia patients and its relationship with efficacy. Am J Gastroenterol 2012;107(8):1236-1247.

[[34]] Scharf H-P, Mansmann U, Streitberger K, et al.Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med 2006;145(1):12-42.

[[35]] Sunay D, Sunay M, Aydomu Y, et al.Acupuncture versus paroxetine for the treatment of premature ejaculation: a randomized, placebo-controlled clinical trial. Eur Urol 2011;59(5):765-771.

[[36]] Deng G, Vickers AJ, Yeung S, et al.Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. J Clin Oncol 2008;25(35):5584-5590.

[[37]] Fung KP, Chow OKW, So SY.Attenuation of exercise-induced asthma by acupuncture. Lancet 1986;328(8521-8522):1419-1422.

[[38]] Lux G, Hagel J, Backer P, et al.Acupuncture inhibits vagal gastric acid secretion stimulated by sham feeding in healthy subjects. Gut 1994;35(8):1026-1029.

[[39]] Ee C, Xue C, Chondros P, et al.Acupuncture for menopausal hot flashes: a randomized trial. Ann Intern Med 2016;164(3):146-154.

[[40]] Zhao L, Chen J, Li Y, et al.The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial. JAMA Intern Med 2017;177:508-515.

[[41]] Foster NE, Thomas E, Barlas P, et al.Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ 2007;335(7617):436-440.

[[42]] Lembo AJ, Conboy L, Kelley JM, et al.A treatment trial of acupuncture in IBS patients. Am J Gastroenterol 2009;104(6):1489-1497.

[[43]] Jobst K, Mcpherson K, Brown V, et al.Controlled trial of acupuncture for disabling breathlessness—ScienceDirect. Lancet 1986;328(8521-8522):1416-1419.

[[44]] Streitberger K, Friedrichrust M, Bardenheuer H, et al.Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Clin Cancer Res 2003;9(7):2538-2544.

[[45]] Pfister DG, Cassileth BR, Deng GE, et al.Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol 2010;28(15):2565-2570.

[[46]] Smith CA, de Lacey S, Chapman M, et al. Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization a randomized clinical trial. JAMA 2018;319(19):1990-1998.

[[47]] Brjeson S.Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea—a randomized controlled study. Ann Oncol 2012;23(5):1353.

[[48]] Brinkhaus B, Ortiz M, Witt CM, et al.Acupuncture in patients with seasonal allergic rhinitis: a randomized trial. Ann Intern Med 2013;158(4):225-234.

[[49]] Walker EM, Rodriguez AI, Kohn B, et al.Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 2010;28(4):634-640.

[[50]] Vickers AJ, Rees RW, Zollman CE, et al.Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ 2004;328(7442):744.

[[51]] White P, Lewith G, Prescott P, et al.Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med 2004;141(12):911-919.

[[52]] Molassiotis A, Bardy J, Finnegan-John J, et al.Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 2012;30(36):4470-4476.

[[53]] Diener HC, Kronfeld K, Boewing G, et al.Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol 2006;5(4):310-316.

[[54]] Richter A, Herlitz J, Hjalmarson A.Effect of acupuncture in patients with angina pectoris. Eur Heart J 1991;12(2):175-178.

[[55]] Berman B, Lao L, Langenberg P, et al.Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. A randomized, controlled trial. Br J Sports Med 2004;141(12):901-910.

[[56]] Irnich D, Behrens N, Molzen H, et al.Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain. BMJ 2001;322(7302):1574-1578.

[[57]] Lesi G, Razzini G, Musti MA, et al.Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: a prospective multicenter randomized controlled trial (AcCliMaT). J Clin Oncol 2016;34:1795-1802.

[[58]] Garland SN, Xie SX, Kate DH, et al.Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: a randomized clinical trial. J Natl Cancer Inst 2019;111(12):1323-1331.

[[59]] Alimi D, Rubino C, Pichard LE, et al.Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol 2003;21(22):4120-4126.

[[60]] Elden H, Ladfors L, Olsen MF, et al.Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ 2005;330:761.

[[61]] Flachskampf FA, Gallasch J, Gefeller O, et al.Randomized trial of acupuncture to lower blood pressure. Circulation 2007;115(24):3121-3129.

[[62]] Macpherson H, Richmond SJ, Bland M, et al.Acupuncture and counselling for depression in primary care: a randomised controlled trial. PLoS Med 2013;10(9):e1001518.

[[63]] Margolin A, Kleber HD, Avants SK, et al.Acupuncture for the treatment of cocaine addiction: a randomized controlled trial. JAMA 2002;287(1):55-63.

[[64]] Vas J, Méndez C, Perea-Milla E, et al.Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 2004;329(7476):1216.

[[65]] MacPherson H, Tilbrook H, Richmond S, et al. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain: a randomized trial. Ann Intern Med 2015;163(9):653-662.

[[66]] Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA 2014;312(13):1313-1322.

[[67]] Radmayr C, Schlager A, Studen M, et al.Prospective randomized trial using laser acupuncture versus desmopressin in the treatment of nocturnal enuresis. Eur Urol 2001;40(2):201-205.

[[68]] Crew KD, Capodice JL, Greenlee H, et al.Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol 2010;28(7):1154-1160.

[[69]] Ng SS, Leung WW, Mak TW, et al. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterology2013;144(2):307-313.e1.

[[70]] Simcock R, Fallowfield L, Monson K, et al.ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 2013;24(3):776-783.

[[71]] Gaw AC, Chang LW, Shaw L-C.Efficacy of acupuncture on osteoarthritic pain. A controlled, double-blind study. N Engl J Med 1975;293(8):375-378.

[[72]] Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006;333(7569):623.

[[73]] Schneider A, Enck P, Streitberger K, et al.Acupuncture treatment in irritable bowel syndrome. Gut 2006;55(5):649-654.

[[74]] Shlay JC, Chaloner K, Max MB, et al.Acupuncture and amitriptyline for pain due to HIV-related peripheral neuropathy: a randomized controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. JAMA 1998;280(18):1590-1595.

[[75]] Mao JJ, Bowman MA, Xie SX, et al.Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial. J Clin Oncol 2015;33(31):3615-3620.

[[76]] Liu Z, Yan S, Wu J, et al.Acupuncture for chronic severe functional constipation: a randomized trial. Ann Intern Med 2016;165(11):761-769.

[[77]] Frisk J, Spetz AC, Hjertberg H, et al.Two modes of acupuncture as a treatment for hot flushes in men with prostate cancer—a prospective multicenter study with long-term follow-up. Eur Urol 2009;55(1):156-163.

[[78]] Shen J, Wenger N, Glaspy J, et al.Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled trial. JAMA 2000;284(21):2755-2761.

[[79]] Cardini F, Weixin H.Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA 1998;280(18):1580-1584.

[[80]] Liu S, Wang Z, Su Y, et al.A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature 2021;598(7882):641-645.

[[81]] Yin LM, Xu YD, Peng LL, et al. Transgelin-2 as a therapeutic target for asthmatic pulmonary resistance. Sci Found China2018;10(427):eaam8604.

[[82]] He Y, Guo X, May BH, et al.Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncol 2020;6(2):271-278.

[[83]] Chang S, Kim DH, Jang EY, et al. Acupuncture attenuates alcohol dependence through activation of endorphinergic input to the nucleus accumbens from the arcuate nucleus. Sci Adv2019;5(9):eaax1342.

[[84]] Zhao L, Li D, Zheng H, et al.Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial. JAMA Intern Med 2019;179:1388-1397.

[[85]] Li Y, Zheng H, Witt CM, et al.Acupuncture for migraine prophylaxis: a randomized controlled trial. CMAJ 2012;184(4):401-410.

[[86]] Lezotre PL. International Cooperation, Convergence and Harmonization of Pharmaceutical Regulations. State of Play and Review of Major Cooperation Initiatives; 2014:7-170.

[[87]] Iriondo-Dehond M, Miguel E, del Castillo MD. Food byproducts as sustainable ingredients for innovative and healthy dairy foods. Nutrients 2018;10(10):1358.

[[88]] Yang Y, Liu J, Luo L.[Current development of acupuncturemoxibustion in India: a case study of West Bengal]. Zhongguo Zhen Jiu 2017;37(3):313-316.

[[89]] Dzoyem JP.Medicinal plant research in Africa. Medicinal Plants Market and Industry in Africa. Elsevier; Amsterdam, Netherlands; 2013:859-890.

[[90]] Huang YF, He F, Xie Y, et al.ISO/TC 249 platform promotes the development of international standardization and trade for the Chinese medicines industry. Pharmacol Res 2020;160:105066.

[[91]] Lam WC, Lyu A, Bian Z.ICD-11: impact on traditional Chinese medicine and world healthcare systems. Pharmaceut Med 2019;33(5):373-377.

[[92]] Haiyan L, Zhen G, York P, et al.Research of traditional Chinese medicine in terms of herbalomics. World Sci Technol 2010;12(2):160-164.

[[93]] Ikram RRR, Ghani MKA.An overview of traditional Malay medicine in the Malaysian healthcare system. J Appl Sci 2015;15(5):723-727.

[[94]] Ma Y, Zhou K, Fan J, et al.Traditional Chinese medicine: potential approaches from modern dynamical complexity theories. Front Med 2016;10:28-32.

[[95]] Hu H, Shen X, Liao B, et al.Herbgenomics: a stepping stone for research into herbal medicine. Sci China Life Sci 2019;62:913-920.

[[96]] Ziegler S, Pries V, Hedberg C, et al.Target identification for small bioactive molecules: finding the needle in the haystack. Angew Chem Int Ed Engl 2013;52(10):2744-2792.

[[97]] Wang J, Gao L, Lee YM, et al.Target identification of natural and traditional medicines with quantitative chemical proteomics approaches. Pharmacol Ther 2016;162(2):3.

[[98]] Li WF, Jiang JG, Chen J.Chinese medicine and its modernization demands. Arch Med Res 2008;39(2):246-251.

[[99]] Chan E, Tan M, Xin J, et al.Interactions between traditional Chinese medicines and Western. Curr Opin Drug Discov Devel 2010;13(1):50-65.

[[100]] Ahmed S, Ullah B.A review article on pharmaceutical analysis of pharmaceutical industry according to pharmacopoeias. Orient J Chem 2020;36:1-10.

[[101]] Song ZQ, Li XF.Recent advances in molecular marker-assisted breeding for quality improvement of traditional Chinese medicine. Curr Pharm Biotechnol 2021;22(6):857-865.

[[102]] Franz G, Wang M.The role of the European Pharmacopoeia (Ph Eur) in quality control of traditional Chinese herbal medicine in European member states. World J Tradit Chin Med 2015;1(1):5-15.

RIGHTS & PERMISSIONS

2024 Acupuncture and Herbal Medicine