Search JIM Advanced Search

Journal of Integrative Medicine ›› 2022, Vol. 20 ›› Issue (6): 524-533.doi: 10.1016/j.joim.2022.08.002

• Original Clinical Research • Previous Articles     Next Articles

Appraisal of treatment outcomes in integrative medicine using metabonomics: Taking non-alcoholic fatty liver disease with spleen deficiency syndrome as an example

Liang Dai a,b, Jing-juan Xu b,c, Wen-jun Zhou b, Ai-ping Lü d,e, Guang Ji b   

  1. a Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen 518032, Guangdong Province, China
    b Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
    c Department of Integrated Traditional and Western Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
    d Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    e School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China
  • Received:2022-01-19 Accepted:2022-07-06 Online:2022-11-15 Published:2022-08-13
  • Contact: Ai-ping Lü, Guang Ji,

Appraisal of treatment outcomes in integrative medicine is a challenge due to a gap between the concepts of Western medicine (WM) disease and traditional Chinese medicine (TCM) syndrome. This study presents an approach for the appraisal of integrative medicine that is based on targeted metabolomics. We use non-alcoholic fatty liver disease with spleen deficiency syndrome as a test case.

A patient-reported outcome (PRO) scale was developed based on literature review, Delphi consensus survey, and reliability and validity test, to quantitatively evaluate spleen deficiency syndrome. Then, a metabonomic foundation for the treatment of non-alcoholic fatty liver disease with spleen deficiency syndrome was identified via a longitudinal interventional trial and targeted metabolomics. Finally, an integrated appraisal model was established by identifying metabolites that responded in the treatment of WM disease and TCM syndrome as positive outcomes and using other aspects of the metabonomic foundation as independent variables.

Ten symptoms and signs were included in the spleen deficiency PRO scale. The internal reliability, content validity, discriminative validity and structural validity of the scale were all qualified. Based on treatment responses to treatments for WM disease (homeostasis model assessment of insulin resistance) or TCM syndrome (spleen deficiency PRO scale score) from a previous randomized controlled trial, two cohorts comprised of 30 participants each were established for targeted metabolomics detection. Twenty-five metabolites were found to be involved in successful treatment outcomes to both WM and TCM, following quantitative comparison and multivariate analysis. Finally, the model of the integrated appraisal system was exploratively established using binary logistic regression; it included 9 core metabolites and had the prediction probability of 83.3%.

This study presented a new and comprehensive research route for integrative appraisal of treatment outcomes for WM disease and TCM syndrome. Critical research techniques used in this research included the development of a TCM syndrome assessment tool, a longitudinal interventional trial with verified TCM treatment, identification of homogeneous metabolites, and statistical modeling.

Key words: Complementary and alternative medicine, Integrative medicine, Patient-reported outcome measures, Metabolomics, Non-alcoholic fatty liver disease, Spleen deficiency syndrome

[1] Han-ting Wu, Cong-hua Ji, Rong-chen Dai, Pei-jie Hei, Juan Liang, Xia-qiu Wu, Qiu-shuang Li, Jun-chao Yang, Wei Maob, Qing Guo. Traditional Chinese medicine treatment for COVID-19: An overview of systematic reviews and meta-analyses. Journal of Integrative Medicine, 2022, 20(5): 416-426.
[2] Tara Rajendran. Addressing the need for personalizing music therapy in integrative oncology. Journal of Integrative Medicine, 2022, 20(4): 281-283.
[3] Shuai Chen, Jin Hu, Deng-cheng Lu, Hong-yi Liu, Shan-shan Wei. Metabolomic characteristics of spontaneously hypertensive rats under chronic stress and the treatment effect of Danzhi Xiaoyao Powder, a traditional Chinese medicine formula. Journal of Integrative Medicine, 2022, 20(1): 73-82.
[4] Jose Antonio Castilla-Jimena, Isabel Ruiz-Pérez, Jesús Henares-Montiel. Impact of socioeconomic and health-related factors on consumption of homeopathic and natural remedies in Spain in 2006, 2011 and 2017. Journal of Integrative Medicine, 2022, 20(1): 52-56.
[5] Rui-jin Qiu, Min Li, Jia-yuan Hu, Jing Chen, Hong-cai Shang. Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine. Journal of Integrative Medicine, 2021, 19(5): 389-394.
[6] Yunita Sari, Akhyarul Anam, Annas Sumeru, Eman Sutrisna. The knowledge, attitude, practice and predictors of complementary and alternative medicine use among type 2 diabetes mellitus patients in Indonesia. Journal of Integrative Medicine, 2021, 19(4): 347-353.
[7] Sibel Şentürk, Dilek Efe Arslan, Adil Çetinkaya. Association of complementary and integrative therapy use and symptoms among Turkish patients with familial Mediterranean fever. Journal of Integrative Medicine, 2021, 19(4): 340-346.
[8] Si-qi Tang, Yun-liang Wang, Zi-ye Xie, Yang Zhang, Yi Guo, Kang-li Gao, Tang-you Mao, Chun-e Xie, Jun-xiang Li, Xiao-yan Gao. Serum metabolic profiling of traditional Chinese medicine syndromes in patients with diarrhea-predominant irritable bowel syndrome. Journal of Integrative Medicine, 2021, 19(3): 274-281.
[9] Baoyi Shao, Saiying Hou, Yuenyan Chan, Changchun Shao, Lixing Lao. Remission of new-onset type 2 diabetes mellitus in an adolescent using an integrative medicine approach: A case report. Journal of Integrative Medicine, 2021, 19(1): 85-88.
[10] George Chengxi Bao. The idealist and pragmatist view of qi in tai chi and qigong: A narrative commentary and review. Journal of Integrative Medicine, 2020, 18(5): 363-368.
[11] Louisa Sylvia, Emerson West, Allyson M. Blackburn, Carina Gupta, Eric Bui, Tara Mahoney, Geraldine Duncan, Edward C. Wright, Simon Lejeune, Thomas J. Spencer. Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury. Journal of Integrative Medicine, 2020, 18(2): 169-173.
[12] Brody Slostad, Tejinder Khalsa, Kathleen Young, Hildalicia Guerra, Anjali Bhagra. A case-based approach to integrative medicine for cardiovascular disease prevention. Journal of Integrative Medicine, 2020, 18(2): 159-162.
[13] Mikhail Teppone. Medicine has always been “Modern” and “Scientific” from ancient times to the present day. Journal of Integrative Medicine, 2019, 17(4): 229-237.
[14] Mohammad Hossein Ayati, Ata Pourabbasi, Nazli Namazi, Arman Zargaran, Zahra Kheiry, Amir Hooman Kazemi, Bagher Larijani. The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran. Journal of Integrative Medicine, 2019, 17(4): 296-301.
[15] Tamer Aboushanab, Mohamed Khalil, YaserAl Ahmari. The present state of complementary medicine regulation in Saudi Arabia. Journal of Integrative Medicine, 2019, 17(3): 147-149.
Full text



[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Zhao-guo Li. Discussion on English translation of commonly used sentences in traditional Chinese medicine: part one. Journal of Chinese Integrative Medicine, 2008, 6(1): 107-110
[3] Jun Hu, Jian-ping Liu. Non-invasive physical treatments for chronic/recurrent headache. Journal of Chinese Integrative Medicine, 2008, 6(1): 31
[4] Xue-mei Liu, Qi-fu Huang, Yun-ling Zhang, Jin-li Lou, Hong-sheng Liu, Hong Zheng. Effects of Tribulus terrestris L. saponion on apoptosis of cortical neurons induced by hypoxia-reoxygenation in rats. Journal of Chinese Integrative Medicine, 2008, 6(1): 45-50
[5] . Uniform requirements for manuscripts submitted to biomedical journals: Writing and editing for biomedical publication (Chinese version, part two). Journal of Chinese Integrative Medicine, 2010, 8(11): 1001-1005
[6] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[7] Hong Liu , Guo-liang Zhang, Li Shen , Zhen Zeng, Bao-luo Zhou, Cheng-hai Liu, Guang Nie . Application and evaluation of a pseudotyped virus assay for screening herbs for anti-H5Nl avian influenza virus. Journal of Chinese Integrative Medicine, 2010, 8(11): 1036-1040
[8] Zhao-guo Li . A discussion of English translation of 1995 and 1997 Chinese National Standards of Traditional Chinese Medical Terminologies for Clinical Diagnosis and Treatment. Journal of Chinese Integrative Medicine, 2010, 8(11): 1090-1096
[9] Rui Jin, Bing Zhang. A complexity analysis of Chinese herbal property theory: the multiple formations of herbal property (Part 1). Journal of Chinese Integrative Medicine, 2012, 10(11): 1198-1205
[10] Hui-min Liu, Xian-bo Wang, Yu-juan Chang, Li-li Gu. Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis. Journal of Chinese Integrative Medicine, 2012, 10(11): 1211-1228