14. Doctor's Note：Functional Medicine Opens Another Window

Author: Ting ZHOU, MD, Endocrinologist, Peking Union Medical College Hospital, Beijing, China

Before I was introduced to the concept of functional medicine, I have been thinking about one single question for a long time: The development of modern medicine has been advancing very rapidly. Our understanding of diseases has become much clearer and deeper. And the treatments and therapies have also become very diversified and abundant. But why is the number of patients also increasing very rapidly? All the medical partitioners are struggling to cope with this situation. One possible explanation is that because of the changes in the current environment (including the global environment, the environment surrounding us, and the environment inside our body), in conjunction with the change in our lifestyles, chronic diseases often have complex causes and cannot be completely cured. That is why there are more and more patients. This explanation is definitely not the best answer. Is there any alternative method that can prevent and slow down the occurrence of chronic diseases by addressing some of the problems, if not all, directly at the upstream sources? Let’s think about it together.

Traditional Chinese medicine is a very extensive and profound system. Although I have learned some of it in college, I have not delved into it. In my understanding, the essence of traditional Chinese medicine, has to be the emphasis on "balance", no matter whether it is the balance of yin and yang, or the balance of the internal and external environment of human body. The holistic view of traditional Chinese medicine is patient-oriented, which is very valuable and worth to be learned by the Western medicine. Chinese medicine certainly has its own limitations. In my view, human beings are constantly evolving and developing in the process of continuous communication and adaptation between humans and nature, the environment, and other factors,. Through natural selection, human genes will also change, especially the expression of genes. So now, is it appropriate to use the past treatment methods to treat modern diseases, I am not so sure. On the other hand, I believe traditional Chinese medicine should also keep up with the changes I mentioned earlier. This is only my personal opinion. Those who study Chinese medicine, you are more than welcome to share your opinions and advice.

Western medicine primarily emphasizes on the treatment of diseases by itself, but it does not mean it does not emphasize on the whole body. We also often need multidisciplinary cooperation. However, it is mainly focused on the disease and symptom itself. This method is very suitable for treating acute diseases and infectious diseases with clear causes, and can achieve good results very quickly. But for chronic diseases, the root cause of many diseases is unclear and complex, so this method may not be as suitable. In fact, everyone knows about it, but there is no better way to replace it so far.

Can functional medicine open another window for us to treat chronic diseases? I will only talk about some of my superficial ideas. And I would also like to communicate with colleagues who are engaged in functional medicine research and practice.

Functional medicine may have been developed in the United States for more than 30 years, and has developed for more than 10 years in China. It has its own unique understanding and treatment of the pathogenesis of chronic diseases. I feel that it is more or less a combination of Western medicine and traditional medicine (including traditional Chinese medicine) . It emphasizes both genetics and the impact of genes on health, but it believes that genetic influences are not primary and unchanging. Functional medicine believes that changes in genes are related to the information they receive. And through healthy lifestyles, diet, nutrition, etc., gene expression can be altered to develop in a positive direction. Functional medicine emphasizes patient-centered approach, emphasizes communication with patients, including collecting medical history, searching for the interaction between diseases and genes, environment, and lifestyle, and emphasizing individualized treatment. It changes modern medicine's disease-centered treatment methods and emphasizes holism and individuality. It integrates the impact of genetic science, biology, environment and lifestyle on the occurrence and development of diseases. It also emphasizes the integration of doctors, dietitian, other health professionals and patients, and makes individualized treatment for different individuals. At the same time, it emphasizes the subjective initiative of patients, who are the masters of their own health, and encourages the development of positive and healthy lifestyles to achieve internal and external balance in body, mind, and spirit.

If considering health as a big tree, the roots and soil of the tree consist of a good lifestyle, such as good sleep, active exercise, balanced nutrition, appropriate stress levels, good relationships and genetic predisposition. In my opinion, the most important soil is the nutritional state of cells. All the other factors can affect the nutritional state of cells, that is to say, can affect the quality of soil. Whereas Western medicine focuses on symptoms, the state of branches and leaves, which are actually the result of disease, the real cause may be something wrong with the roots and/or the soil. This is similar to the theory of traditional Chinese medicine, but not exactly the same. Because it can be quantified, tracked and followed up by modern technological means.

Functional medicine should consider both diagnosis and seeking answers to questions. Why does this person get this disease? To answer this question, it is necessary to uncover the genetics, triggering factors, transmission mediators, and possible pathological processes which are underlying the symptoms, signs, and disease behavior. Then, medical genomics is used to clarify the relationship between disease related genotypes and product expression, providing another pair of eyes for examining diseases. If we protect the soil and roots of big trees well, would it be not so easy to get sick? The answer should be yes. However, this is an emerging science that needs to be fully tested and gradually improved in practice.

This is just my own understanding of functional medicine, and I believe we can do something in this area, at least it is a good supplement to modern Western medicine.