Traditional Chinese medicine (TCM) has been used within China for thousands of years. Comprising practices such as herbal pharmacology, acupuncture and massage, it is grounded in the belief that the body is a system of balance, with a vital energy (chi) circulating around it in channels. When there are imbalances in the body, disease ensues.
Within the Western world, TCM has predominantly been viewed as a complementary or alternative branch of medicine. Despite its many adherents – the World Health Organisation estimates that 100 million Europeans use traditional medicines – the scientific community has tended to view it somewhat dismissively.
A 2007 Nature editorial, asking why the qualitative study of TCM had yielded so few cures, suggested: “the most obvious answer is that it actually has little to offer: it is largely just pseudoscience, with no rational mechanism of action for most of its therapies.”
However, as interest continues to surge, many researchers are seeking ways to bridge the gap between TCM and Western medicine. Currently valued at $121bn, the TCM market is growing fast, driven in part by pharma companies looking to investigate its benefits.
Growing interest thanks to globalisation
According to Elsevier Information Systems, the volume of published resources on TCM is growing at around 6% a year, with more than 10,000 scholarly articles published in 2017 alone.
The race is on to find the next artemisinin, an anti-malaria drug derived from the Chinese herb Qing Hao (sweet wormwood). It was first developed in 1972 by the Chinese scientist Tu Youyou, who was awarded half of the 2015 Nobel Prize in Medicine for her discovery.
“With globalisation comes the spread of new ideas and practices across cultures, and the potential of traditional Chinese medicine (TCM) is becoming more widely known,” says Ivan Krstic, senior product development manager of Embase at Elsevier. “With successes like artemisinin helping to highlight the potential of different forms of medication, it is no surprise that interest in TCM is growing.”
He adds that China plays host to over 7,000 pharmaceutical companies, the majority of which produce herbal medicines. With more than 300 herbal drugs already listed in the national essential drug list, Western curiosity is understandable: surely some of these therapies are translatable to evidence-based medicine?
The Embase collaboration: creating a new taxonomy
In February, Elsevier announced a collaboration with the Beijing University of Chinese Medicine (BUCM) to help deepen research into this field. They are looking to create a new taxonomy for TCM, which will be hosted in Embase, Elsevier’s biomedical literature database.
“We are now in the era of knowledge sharing and data sharing,” says Krstic. “Elsevier and BUCM are hoping that by working together they will help to disseminate TCM-related scientific research as widely as possible, helping to avoid duplicated effort and wasted resources.”
BUCM is part of the Cochrane organisation, a global independent network of researchers, industry professionals and patients dedicated to evidence-based practices. The university was already using the Embase database, and considered it a valuable resource. However, it had encountered a few problems with the way TCM was taxonomised.
“When using Embase, the BUCM team identified ways in which the existing TCM descriptions could be improved and organised,” says Krstic. “As specialists in TCM, BUCM approached Elsevier to suggest a collaborative project to improve the TCM taxonomy for all users, and make information widely shareable.”
Despite their work in this field, neither BUCM nor Elsevier are promoting the use of TCM. Rather, they are collaborating to help share information, which further down the line will assist researchers exploring the potential of Chinese medicines.
“A search in the Elsevier Embase and the PubMed tools show that, as of 6 March 2018, there are a total of 100,169 examples of research around TCM published in international peer review journals,” points out Krstic. “Research into TCM is already happening – and we hope our project will help open this up to even more researchers and companies.”
Research challenges and systems biology
So why the need for such a database? As Krstic explains, it isn’t always easy to place traditional treatments within a modern scientific framework.
“The biggest challenge would be the complexity of the herbal formula,” he says. “Typically, this is composed of many different herbs and can be used across multiple different target populations. As with any new drug development, it’s not simple and there is a long way to go before clarifying the active ingredients and mechanism.”
Indeed, many TCM advocates would argue that Western researchers, to date, have been overly focused on isolating specific compounds within the herbs. This approach ignores the various chemical interactions between the ingredients, and could be seen as unhelpfully reductive, given that TCM is above all a holistic discipline.
Over the last decade or so, however, researchers have found a possible solution to this problem in the form of systems biology. This approach aims to understand biological functions at the system level, and has been described as ‘a pivotal research methodology for understanding the mechanisms of traditional medicine’.
The difficulty here is that systems biology requires reams of data, which, in the case of TCM, is not always readily available. In fact, poor access to information is often the central obstacle to research projects getting off the ground.
“A lot of the data around these medicines is hundreds of years old, and the Chinese terms have changed a lot in this time,” says Krstic. “There is also a lack of consistency in formatting, with multiple terms used for the same compounds and these can vary across their translations between Chinese and English.”
Hopes for the future
The BUCM/Elsevier project aims to address these data access issues. Once it is completed in early 2019, Embase will contain all the necessary terms and the structure – the up branch, narrow branch and children branch – to classify TCM data in complete taxonomies.
“Additionally, it will contain the English and Chinese name for different compounds alongside the traditional terms so that researchers can be assured they have access to all the information they require from Embase,” says Krstic.
He feels that access to this information will be of interest to university researchers, along with pharma companies that are looking to validate the benefits of TCM. In the long run, this might lead to new therapies based on ancient Chinese practices, while forming links between two forms of medicine that may once have seemed unbridgeable.
“Some of the largest pharmaceuticals companies are already interested in exploring how TCM can aid drug discovery and the development of new therapies, and we are excited to support this,” says Krstic. “The goal of the collaboration between Elsevier and BUCM is to make existing research around TCM more discoverable, allowing drug researchers to seek knowledge from traditional clinical practices for modern biomedical sciences.”