Integrative thinking facilitates traditional medical research

Zhi-ping Yang

1. Shanghai Mingpin Institute of Holistic Integrative Medicine, Shanghai, China

2. Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China Email: 13991253213@126.com

Traditional medicine, especially traditional Chinese medicine, has made indelible contributions to the reproduction and development of the Chinese nation. In the current era dominated by western medicine, the development of traditional medicine has encountered great challenges and difficulties. People with lofty ideals put forward that traditional medicine should take the road of modernization, especially advocating the modernization of traditional Chinese medicine. It is true that the research and practice of traditional medicine must advance with the times and keep up with the times, but we must also guard against the trap of modernization, that is, the plight of traditional Chinese medicine. This is because reductionist western medicine cannot effectively explain the profound Oriental wisdom and culture. At present, some problems in traditional medical research have caused us to worry.

In basic research, it is difficult for traditional medicine to find a way out according to the target theory of Western medicine. Man is an organic whole with dynamic changes, and he has a strong ability of self-regulation or compensation. The so-called holding the gourd took the scoop, holding the scoop and picking up the gourd. In addition to the well-diagnosed single-gene rare disease, single-target or multitarget interventions do not play a fundamental role in most diseases, especially chronic disease diagnosis and health maintenance. If the human body is compared to a tree, the targets in the body are like roots. Every scientist works on a familiar tree root and has published a number of papers with high impact factors, but few have had any real impact on clinical practice. Why is that? The science is to look at what happens to a tree when all the other roots are removed or not working. The human body is a complicated system. Which tree roots will not work? The use of a single target is likely to bring more side effects or systemic harm.For example,the British Medical Journal recently reported that angiotensin-converting enzyme inhibitors significantly increase the risk of lung cancer [1].Therefore, the overall concept of regulation in traditional medical research should be worthy of our inheritance and development.For example,many traditional Chinese medicines actually act on the whole body by changing the intestinal flora or its metabolites. Drug developers must not, as chemists do, separate a drug into monomers to find its active ingredient.A single substance often has no effect on the human body,or it is prone to excessive toxicity.The compatibility theory of Traditional Chinese Medicine Prescriptions and Monarch, minister, assistant and guide should be an important direction of traditional medical research.

In clinical research, traditional medicine does not have to operate according to an evidencebased system based on randomized controlled trials (RCT). RCT, through random, blind and strict matching of the control group, makes the internal validity of the study very high, but the external validity is poor.Because RCT is aimed at a very limited population, it is a special research group selected after inclusion and exclusion criteria.Drugs or interventions that are proven to be very effective by RCT often encounter a large number of accidents and exceptions in real clinical practice.Therefore,real-world research, which has been widely advocated in recent years, will become an important means in the field of clinical research of traditional medicine. It is more in line with the characteristic parameters of traditional medical research and more close to the real clinical practice.Of course,there is no need to set these two kinds of research designs in opposition. RCT obtains efficacy, which is whether it is useful under ideal conditions. What the realworld studies have shown is that effectiveness, that is,is actually effective.If it is not possible to prove whether a drug or intervention is useful under ideal conditions, how do you know that the drug or the measure works in a real-world situation? The real world research is the result of multi-factor, multi-stage, multi-dimensional and multi-logic comprehensive contest. With the rapid development of artificial intelligence and wearable devices, traditional medicine should also seize the great opportunity to carry out real world research under big data.

How should we deal with the relationship between traditional medicine and mainstream western medicine? We don't want confrontation or moderation, but integrative thinking. Roger Martin, a famous Canadian management scientist, once elaborated on the concept of integrative thinking, that is, holding two contradictory views in the mind at the same time, and from which he came up with a solution combining the advantages of two parties. It aims to deal with opposing views in a constructive way,not at the expense of choosing the other, but in an innovative way to eliminate the confrontation between the two views. The new views contain some elements of the opposing points and are superior to the two opposing points [2].Professor Martin illustrates his argument with examples of designing a trip or several carriages. Using integrative thinking needs to grasp several principles: first,expand the scope of key factors in decisionmaking; Second, consider multi-faceted and indirect causality; Third, in the decision-making process, the problem is not divided into several independent individuals to solve one by one, but to deal with each part while maintaining the integrity of the problem. The fourth is to struggle to find innovative solutions, each idea and process is more efficient and accurate than the previous one.

In view of this, Chinese scholar Daiming Fan is the first in the world to propose a new concept of holistic integrative medicine [3].To construct a new medical system more suitable for human health and disease treatment, Holistic Integrative Medicine regards the human body as a holistic entity; organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties; and develops corresponding revisions and adjustments according to social, environmental, and psychological conditions.Proceeding from a holistic, integrated, and medical viewpoint, it looks at the human being as a whole and situates patients in a larger context,involving natural,social,psychological,and other factors. By converting the data and evidence obtained from medical research back into their original facts, transforming knowledge and consensus gained from clinical practice into experience,and consolidating techniques and arts discerned from clinical explorations into medical approaches, HIM takes shape through these repeated practices at the level of facts,experience,and medical approaches [4].Integrative thinking will contribute to the innovative development of traditional medical research and avoid falling into the trap of modernization. In other words, traditional medicine is bound to become an important part in the era of holistic integrative medicine.