By Henry Ehrlich
The bio-marker study described in detail by three of our contributors, Drs. Xiu-Min Li, Purvi Parikh, and my cousin and collaborator Paul M. Ehrlich is a new chapter in the long, mostly distant relationship between Chinese medicine and Western medicine.
The first instance of what we now call “integrative medicine” was a treatment for high fever concocted by a Qing Dynasty physician. He was introduced to a new medicine called aspirin by British invaders during the Opium Wars of the 19th century, and after combining it with an ancient asthma remedy called ma huang* (ephedra), created “white tiger formula.”
The next hundred years or so were summed up from the American point of view in the New England Journal of Medicine in a 1934 review of a book called Chinese Medicine by William R. Morse:
“The author makes a serious attempt to understand Chinese medicine, which, he says, is vitalistic, while ours is materialistic. It began about 3000 B.C. and up to about 1000 A.D., it evolved a high standard of practice relative to that age. Since then, it has remained static. Being a philosophy, it is untouched by modern science. Chinese medical procedures are only of academic interest to the medical historian; they are of no actual value unless as suggestive and psychological therapeutics. The outstanding exception of ephedrine is not mentioned by the author.” (NEJM May 17, 1934)
I found this passage fascinating for several reasons. One, that it used a word you don’t see every day—vitalistic, from vitalism, defined by Oxford as, “The theory that that the origin and phenomena of life are dependent on a force or principle distinct from purely chemical or physical forces.” Two, the sweeping claim that Chinese medicine is “untouched by modern science.” And finally, the pronouncement that there is no actual value except for the above-mentioned ephedrine.
Never mind. Cut to the present. We have arrived at sweet spot for collaboration. “Western” diseases have stubbornly resisted treatment using “materialistic” medicine. Meanwhile, progress is on the march around the world, bringing with it epidemics of immune and inflammatory diseases. In my ever-humble opinion, East needs West needs East. I spent two years writing my book about Dr. Li’s work and am convinced that TCM has now been “touched by modern science” and proven very promising. Evidence? For one thing, the anti-asthma herbal intervention called ASHMI™ was created without using ma huang, which has fallen into disrepute because it has been used to deadly effect in diet drugs and is a precursor for crystal meth.
Last spring Dr. Li told a graduating class at the New York College of Traditional Chinese Medicine:
“As TCM practitioners we know that our herbs work. But the regulatory system under which the Western medical system functions must show a number of things.
“1–That our treatments are safe. First do no harm.
“2–That they work. And
“3–If we’re good, WHY they work.
“At that point, doctors will begin to use them, without ever knowing whether a disease is rising from the spleen or descending from the liver.”
The bio-marker study is notable for a number of reasons. First of all, it will be funded out of donations, based on the mutual interests of donors and investigators, not government or institutional grants.
Second, the proposed study is also not aimed primarily at a cure or even treatment, as is the case with most big grants. Dr. Li calls it “a bridge between the science and TCM practice.” The results will help the researchers understand how TCM therapy may improve immune system-poly-sensitization and optimize methodology of clinical studies. Among other factors, it will help assess the effectiveness of refined versions of the formulas, which is a big factor in patient compliance. Too many pills spoil the treatment. The study will shed light on the trade-offs between dosages and simplified protocols on the one hand and clinical efficacy on the other. Other issues are the timing and dosing of protocol, mono-therapy vs. a comprehensive regimen, and the influence of individual immune status on clinical outcomes. Food allergy has unique clinical features. For example, most individuals who have them are generally healthy; active disease is invisible if they are rigorously avoiding exposure. Skin tests and IgE levels don’t do the trick of assessing reactive status, and food challenge is an unpleasant or even dangerous prospect for severe food allergic individuals.
Third, it is a “real world” study. The NIH/NCCAM has become increasingly open to this idea because they recognize that studying a new idea or drug among a narrow set of subjects doesn’t reflect patient realities. Almost every new drug enters the market with a very good safety record based on small, homogeneous clinical trials, and then black box warnings start to appear on the label as problems arise with a wider patient population. Instead of being conducted on patients with a narrow illness profile, the bio-marker study will look at patients more typical of what doctors see routinely, with a variety of atopic conditions in addition to food allergies, diseases that are manageable, not curable, by conventional medicine. These variations may point in new directions for study.
Fourth, the study is practice based, with one foot in TCM and the other in mainstream allergy. Both disciplines will contribute what they do best. The doctors will communicate. And, we can hope that out of their collaboration will come a new synthesis, a new vocabulary for treating conditions that have eluded conventional medicine for a hundred years.
*Ma huang turned up in the New England Journal of Medicine (199:1024-1062) in 1928 as a sidebar to an article about asthma. It was the third year of famine, and residents of hungry regions were encouraged to harvest the plant from roadsides in exchange for food. “This year 200 tons of the herb were brought in, and that amount practically exhausted the supply within a radius of twenty miles, which is about the limit of the distance which it pays men to transport the herb….” American, Canadian, and German drug makers were a big market.
Graphic by http://www.bio.davidson.edu/