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Precision Medical Treatment in Traditional Chinese Medicine
Jian Chen1, Xue-Qing Hu1, Qi-Long Chen1, Yuanjia Hu2 and Shi-Bing Su1*
1Research Center for Traditional Chinese Medicine Complexity System, Shanghai University of Traditional Chinese Medicine, Shanghai, China
2State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Zhuhai, China

ABSTRACT
Precision medical treatment in Traditional Chinese Medicine (TCM) refers to personalized medical diagnosis and treatment as well as precise prediction and prevention under the guidance of TCM theory, using technologies and methods of precision medicine. Here, we briefly introduced the accurate diagnosis and treatment based on ZHENG in TCM.
KEYWORDS
Precision diagnosis ; Precision treatment; Traditional Chinese Medicine; ZHENG

Introduction
Precision medicine, based on personalized medicine, is to provide personalized and precise prediction, prevention, diagnosis and treatment by genomic, proteomic, metabolomic and other omics technologies and big data analysis techniques. Guided by the Traditional Chinese Medicine (TCM) theory, we may use the technologies and methods of precision medicine to analyze and mine the TCM “Four Diagnosis” information, to get better understanding of TCM ZHENG. Then we can make accurate ZHENG classification, diagnosis and carry out ZHENG based treatment. Precision medical treatment in TCM focuses on individual diagnosis and treatment in the views of system, like disease process and individual integrity with emphasis on main elements and primary contradictions in the system. The study of accurate diagnosis and treatment based on disease ZHENG is of great importance in TCM.
Accurate Diagnosis of ZHENG
ZHENG, also called TCM syndrome or TCM pattern, is an integral and essential part of TCM theory [1]. A TCM ZHENG, in essence, is a characteristic profile of all clinical manifestations collected by “Four Diagnosis” (observing, listening, asking and feeling), which can be identified by a TCM practitioner. Effective clinical treatments rely on the successful differentiation of a specific ZHENG [2]. Accurate diagnosis is the basis of proper medical treatment. Objective and accurate identification of ZHENG is the premise of effective TCM treatment. The objectification of ZHENG and its essence discovery has always been the focus of TCM research. Accurate diagnosis of disease ZHENG is to objectively collect and analyze the clinical symptoms and signs with the application of system biology, bioinformatics and big data mining technologies etc. Then we may discover the biological material basis and biomarkers of ZHENG and make molecular classification of the phenotypes to explain its development and evolution mechanisms objectively and accurately.

Recently, some new technologies and methods such as the System Omics Approach were introduced in ZHENG research, which significantly facilitate the accurate diagnosis of ZHENG [2]. Previous studies have investigated ZHENG classification and biomarkers in chronic hepatitis B and liver cirrhosis, and have found that IL-10-819-C/T loci associated with the deficiency syndrome in hepatitis B caused cirrhosis [3]. Both miR-583 and miR-662 were able to distinguish the Liver and gallbladder damp heat syndrome from liver and kidney yin deficiency syndrome in patients with hepatitis B [4]. Additionally, the expression levels of PNP, AQP7 and PSMD2 were important to distinguish the damp heat syndrome from liver depression and spleen deficiency syndrome in hepatitis B caused cirrhosis [5]. These studies have provided the evidences for further study of ZHENG objectification to make accurate diagnosis of TCM.
Accurate TCM Treatment
Accurate TCM treatment is the individualized treatment using herbal medicine or acupuncture and moxibustion based on the accurate identification of ZHENG types, which depends on the different disease ZHENG molecular classification. Accurate treatment is fundamental to achieve desirable effect. Making diagnosis of disease via western medicine and combining the characteristics of TCM ZHENG with its molecular classification are beneficial to evaluating the curative effect of TCM treatment for disease ZHENG objectively and correctly and are also good to carry out the precise individualized treatment underlying ZHENG classification. Moreover, it may help to clarify curative effect mechanisms. Therefore, how to associate the genotyping of disease ZHENG with the effects of TCM treatment? This needs further study on the relationships between genetic variation or mutation and efficacy and safety of TCM treatment. Based on genotyping technologies of pharmacological genomics, previous study has that CYP1A2-G2964A is related to the curative effect of Fuzheng-Huayu tablet, a formula, which is able to improve the clinical symptoms of patients with the deficiency syndrome in hepatitis B caused cirrhosis [6]. Studies on transcriptional profiling and miRNA target network analysis have evidenced the efficacy of Fuzheng-Huayu [7]. This offers a case in point.

At present, the clinical research of ZHENG and ZHENG based treatment in TCM still lack large scale, multicenter clinical trial studies. Objective criterion for ZHENG classification and material basis for its formation and developing are important topics of the research in the future. The mode of precision treatment based on genes and molecular classification of disease ZHENG, may provide the useful research approaches and methods for TCM individualized treatment as well as the precision of TCM health care.

Figures


Figure 1: (a) Chemical structures of PAMPS48-PEG227-PAMPS48 (AEA) and PEG47-PMAPTACm (EMm, m = 27,53, and 106).
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 2: Time-conversion (?) and the first-order kinetic plots (?) for the polymerization of AMPS in the presence of CPD-PEG-CPD in water at 70oC.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 3: GPC elution curves for a sample of HO-PEG-OH (Mn = 9.40 ? 103; Mw/Mn = 1.06) (----) and triblock copolymer of PAMPS48-PEG227-PAMPS48 (AEA, Mn = 2.32 × 104; Mw/Mn = 1.42) (--).
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 4: 1H NMR spectra for (a) EM53, (b) AEA, and (c) AEA/EM53 micelle in D2O containing 0.1 M NaCl at 20°C. Assignments are indicated for the resonance peaks.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 5: (a) Light scattering intensities and (b) Rh for PIC micelles of AEA/EM106 (?), AEA/EM53 (?), and AEA/M27 (?) as a function of fAMPS (= [AMPS]/([AMPS] + [MAPTAC])) in 0.1 M NaCl aqueous solutions. [AMPS] and [MAPTAC] represent the concentrations of the AMPS and MAPTAC units, respectively. The total polymer concentration was kept constant at 1 g/L.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 6: (a) Distributions of Rh for the PIC micelles of AEA/EM106 (?), AEA/EM53 (?), and AEA/EM27 (?) in 0.1 M NaCl aqueous solutions. (b) Relationship between relaxation rate (G) and square of the magnitude of the scattering vector (q2). (c) Plots of Rh as a function of Cp.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 7: A typical example of Zimm plots for AEA/EM106 micelle in 0.1 M NaCl aqueous solution.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.



Figure 8: TEM images for (a) AEA/EM27, (b) AEA/EM53, and (c) AEA/EM106 micelles.
[M]0 and [M] represent the concentrations of the monomer at polymerization time = 0 and the corresponding time, respectively.

Tables
SamplesMn(theo)a × 10-4Mn(NMR)b ×10-4Mn(GPC)c ×10-4Mw/MncRhd (nm)?-potential (mV)
EM270.780.830.821.034.518.2
EM531.361.411.111.024.324.2
EM1062.522.581.511.026.125.4
AEA3.213.262.321.426.1-14.4
Table 1: Number-average Molecular weight (Mn), Molecular weight distribution (Mw/Mn), hydrodynamic radius (Rh), and ?-potential for the polymers.
aCalculated from Equation (2), bEstimated from 1H NMR, cEstimated from GPC, dEstimated from DLS.

PIC micelles Mwa × 10-5 Rga Rhb Rg/Rh Naggc dPICd

?-potential

(mV)
(nm) (nm)
AEA/EM27 8.48 15.1 15.2 0.99 50 0.096 -0.88
AEA/EM53 189 36.6 41.0 0.89 735 0.109 -0.53
AEA/EM106 111 28.6 32.4 0.88 302 0.129 -0.20
Table 2: Dynamic and static light scattering data for PIC micelles in 0.1 M NaCl.
aEstimated by SLS in 0.1 M NaCl, bEstimated by DLS in 0.1 M NaCl, cAggregation number of PIC micelles calculated from Mw(SLS) of PIC micelles determined by SLS and Mw of the corresponding unimers determined by 1H NR and GPC, dDensity calculated from Equation (3).

Citation: Chen J, Hu X-Q, Chen Q-L, Hu Y, Su S-B (2017) Precision Medical Treatment in Traditional Chinese Medicine. J Altern Complement Integr Med 3: 024.