A Combinatorial Interpretation of TCM's Emperor Court Hiearchy

Dr. Chen Zhu (陈竺) is not only an outstanding biologist and researcher in China, he is also the head of the Ministry of Health in the government. He is also well known as a strong believer and advocate of the traditional Chinese medicine (TCM). As a scientist and health official, he has frequently spoken out the importance of TCM as a cultural heritage as well as useful means for curing diseases and improving health. With his position, he is working on providing more and more fundings into the TCM.

He is also active in using the modern biological research tools, particularly the systems biology, to prove the philosophy and methodology in TCM. His latest result is causing a mini wave in the Chinese media.

In a paper just published in the Proceedings of the National Academy of Sciences (USA), Dr. Chen and his coworkers (including his wife Chen Saijuan), described their dissection of mechanisms of a TCM formula as an effective treatment for promyelocytic leukemia.

The TCM formula, or the medicine Compound Huangdai Tablets (复方黄黛片), has been available and in active medical use in China for many years. There are a few earlier researches testifying its effectiveness in treating leukemia, but none of them appear to meet the rigorous standard of drug testing. Chen's new paper provided more evidence of the drug's effect at cell level.

But Chen et al. also go further. They dissected the compound medicine into three major active ingredients and claimed that they acted in combinatorial synergy in treatment. That is, one ingredient could not do the job as effectively without the presence of the others.

Still, there is nothing terribly new here.

But when the news of this paper's publication is reported in China, it took an entirely different tone. China Daily, in its English report, was quite modest in claiming that "TCM applauded for leukemia treatment". Other media went much further. Based on a press release from Chen's institute itself, the news was widely reported as PNAS's recognition of TCM itself. Chen's research, the reports said, not only shown the effectiveness of one drug, but also proved the ancient TCM philosophy of how to construct a compound drug: 君臣佐使.

Simply put, this philosophy models four components or roles in a compound drug as a court of an emperor. The emperor (君) serves as the principle in attacking the disease; the minister (臣) acts as assisting and augmenting the principle; the assistant (佐) also assists the principle and counter-reacts any possible side-effects of the principle; the servants (使) acts to deliver the medicine where it should go.

Such terms did not exist in Chen's paper itself, although the paper emphasizes on the combinatorial synergy of the components it identified. However, a diagram in the press release displays their belief that their research indeed is based on and provides evidence of this ancient philosophy:

Interestingly enough though, they only had three components so the two cohorts, the ministers and the assistants, have to double-duty as delivering servants as well.

The press release and news report also contains many descriptions of the "Yin" and "Yang" of the components, which did not exist in the research paper itself, just as the above diagram.

Fang Zhouzi criticizes these news report as another example of distortion to fit its own agenda of advocating TCM. Also, due to Dr. Chen is a member of PNAS' editorial board and PNAS' archaic policy, Fang questions whether this paper has been properly peer-reviewed.