Turning point for traditional Chinese medicine

Turning point for traditional Chinese medicine
Dr Tu Youyou has maintained she drew her inspiration from the medical text of a fourth-century Chinese physician and alchemist named Ge Hong.

I am sure I am not the only one surprised by the announcement that half of the 2015 Nobel Prize in Physiology or Medicine has gone to a researcher who spent her entire career researching traditional Chinese medicine (TCM).

Based at the Chinese Academy of Traditional Chinese Medicine in Beijing (now the China Academy of Chinese Medical Sciences) since 1965, scientist Tu Youyou, her colleagues, and home institution may well be just as stunned as I am. Being granted the Lasker Award is often a good predictor of Nobel Prize prospects. Dr Tu received one in 2011 for her discovery of artemisinin as an alternative malaria cure to the standard chloroquine, which was quickly losing ground in the 1960s due to increasingly drug-resistant parasites.

Scientific research on the pharmaceutically active properties of traditional Chinese medicinals, however, has never been a predictor for such widespread international recognition.

Traditional medical knowledge anywhere in the world has not even been on the radar for Nobel Prize prospects. Until now, that is. So how should we interpret this arguably seismic shift in international attention on TCM?

In the question-and-answer session after the announcement at the Karolinska Institute, which awards the Nobels, one of the panellists emphasised not just the quality of Dr Tu's scientific research, but also the value of recorded empirical experience in the past.

The antifebrile effect of the Chinese herb Artemisia annua, or sweet wormwood, was known 1,700 years ago, he noted. Dr Tu was the first to extract the biologically active component of the herb - called artemisinin - and clarify how it worked. The result was a paradigm shift in the medical field that allowed for artemisinin to be both clinically studied and produced on a large scale.

Dr Tu has always maintained she drew her inspiration from the medical text of fourth-century Chinese physician Ge Hong (circa 283-343).

His Emergency Formulas To Keep At Hand can best be understood as a handbook of drug formulas for emergencies. It was a book light enough to keep in one's sleeve, where Chinese men sometimes carried their belongings. We can discern from Ge's astute description of his patients' symptoms that people then suffered not only from malaria but also from other deadly diseases, including smallpox, typhoid and dysentery.

Beyond recording the fever-fighting qualities of Artemisia annua, Ge also wrote about how Ephedra sinica (red Realgar) effectively treated respiratory problems and how arsenic sulphide helped control some dermatological problems.

Just because a compound has natural roots and has long been used in traditional medicine is no reason to take it lightly.

In 2004, the US Food and Drug Administration actually banned ephedra-containing dietary and performance-enhancing supplements. They had been the cause not only of serious side effects but also several deaths. The ban remains in effect in the US. Related drug ephedrine, however, is used to treat low blood pressure and is a common ingredient in overthe-counter asthma medicines.

As for Realgar, its toxicity was well-known in both ancient Greece and Chinese antiquity. In Chinese medical thought, though, skilfully administered toxins may also be powerful antidotes for other toxins. Realgar thus continues to be used in Chinese medicine as a drug that relieves toxicity and kills parasites. Applied topically, it treats scabies, ringworm and rashes on the skin's surface; taken internally, it expels intestinal parasites.

Although biomedicine does not currently use Realgar or its related mineral arsenicals in treatments, Chinese researchers have been studying their anti-cancer properties for some time now. In 2011, a Johns Hopkins University researcher, Dr Jun Liu (with other colleagues), also discovered Chinese medicinal plant Tripterygium wilfordii Hook F is effective against cancer, arthritis and skin-graft rejection.

Dr Tu's groundbreaking work on artemisinin, in fact, can be seen as the tip of the iceberg of the extensive and global scientific study of pharmacologically active Chinese medicinals, including another successful anti-malarial Dichroa febrifuga that has roots in the new scientific research on Chinese medicinals in 1940s mainland China.

It was validation of this traditional drug as an anti-malarial in the 1940s, in fact, that set the foundation for Chinese leader Mao Zedong's directive two decades later in the late 1960s to find a cure for malaria. Indeed, Dr Tu's research is best understood within the complex politics and history of top-down support from the Chinese government of Chinese medicine in mainland China during the long period of the 20th century, and not just in the Maoist period.

Even outside mainland China, though, such research has yielded results. In the 1970s, for example, US and Japanese researchers developed the statin drugs used to lower cholesterol from studying the mould Monascus purpureus that makes red yeast rice, well, "red".

Empirical evidence of the medical efficacy in the rich Chinese medical archive from centuries earlier similarly influenced the initial direction of this research.

So is this Nobel Prize for Dr Tu's discovery a signal that Western science has changed how it perceives alternative systems of medicine? Perhaps, but only slightly.

One of the Karolinska Institute panellists acknowledged there are many sources from which scientists draw inspiration to develop drugs. Among them, we should not ignore the long history of experiences from the past. As he clarified, such sources may be inspirational, but the old herbs found there cannot be used just as they are. Do not underestimate the sophisticated methods Dr Tu used to extract the active artemisinin compound from Artemesia annua, another one of the panellists concluded.

So the Nobel Prize is not only acknowledging this complete transformation of a Chinese herb through modern biomedical science into something powerfully efficacious, but also the millions of lives saved because of its successful application worldwide.

But there is something else that marks Dr Tu as extraordinary vis-a-vis both her two fellow Nobel laureates for medicine, Dr William Campbell and Dr Satoshi Omura, and her more Western medically oriented colleagues in pharmacology. She embodies, in both her history and her research, what I call medical bilingualism - the ability not only to read in two different medical languages but also to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.

This medical bilingualism is a quality that current researchers mining the same fine line between the empirical knowledge of traditional medical traditions and the highest level of modern biomedical science would be lucky to share with Nobel laureate Tu Youyou.

The writer is Associate Professor of the History of Medicine at Johns Hopkins University

This article first appeared on The Conversation US, a website of analysis from academics and researchers.

This article was first published on Oct 11, 2015.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

This website is best viewed using the latest versions of web browsers.