Traditional Chinese medicine (TCM) is an integral part of the Chinese medical system and culture, with a long history of about 3,000 years starting from the Zhou Dynasty or earlier. TCM practices, ranging from herbal tea to cupping to acupuncture, are commonly used for the maintenance of health and the treatment and prevention of diseases. Globally, TCM has gained increasing recognition. Locally, resources from the Hong Kong government to support the national blueprints for Healthy China and five CM Highlands in the Greater Bay Area (GBA) will help institutionalise the TCM industry and elevate the discipline to a higher level.
To prepare for the opportunities ahead, PolyU established the Research Centre for Chinese Medicine Innovation (RCMI) in October 2021. The Centre represents PolyU’s unique interdisciplinary approach to CM research and applications for the improvement of people’s health and well-being. In this Issue, Prof. Wong Man-sau, Director of RCMI, will give us a deeper understanding of the Centre’s research and development.
Driving CM development in Hong Kong
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A number of international, regional, and local developments have driven the establishment of RCMI at PolyU. Currently, non-communicable diseases (NCDs) like heart disease, stroke, cancer, diabetes, and chronic lung disease account for almost 70% of deaths throughout the world. In Hong Kong, 56% of death cases recorded in 2019 were NCD-related. “Unlike the disease treatment approach in conventional medicine, TCM emphasises the maintenance and restoration of holistic health. It is now widely promoted and recognised. In 2019, the World Health Organization (WHO) incorporated TCM into its International Classification of Diseases, which categorises and assigns codes to medical conditions. In the same year, the agency started the development of benchmarking documents for TCM training and practice,” Prof. Wong explained.
In Hong Kong, recent national and local developments have added impetus for TCM development by injecting new technologies, innovations and models. The nation highlighted the role of modern technology for new TCM drug development in the “Healthy China 2030” policy agenda and pledged to construct five Chinese Medicine Highlands (Medical Highland, Innovative Highland, Talent Highland, Industrial Highland and International Highland) in the GBA between 2020 and 2025. “Scientists, clinical practitioners and industries in Hong Kong can gear up and seize the opportunities brought by these national policies,” said Prof. Wong. “The Hong Kong government is placing more emphasis on the role of ‘evidence-based’ CM and outpatient CM services in the public primary healthcare system. The Hospital Authority (HA) transformed its 18 Chinese Medicine Centres for Training and Research into Chinese Medicine Clinics cum Training and Research Centres from March 2020, and launched a pilot project to operate Integrative Chinese and Western Medicine which provides CM in-patient services. The city’s first Chinese Medicine Hospital will be completed by 2025. These milestones will help to raise the standards of CM healthcare services and offer more comprehensive prevention strategies and treatments to the general public.”
Building a distinctive and innovative CM research unit in higher education
“PolyU is determined to establish a CM unit which distinguishes itself from other centres in the local higher education system by leveraging the University’s strengths in allied health and primary care subjects, its solid partnerships with industry, government and academics, as well as experience in external collaboration and technology transfer.”
PolyU is determined to establish a CM unit which distinguishes itself from other centres in the local higher education system by leveraging the University’s strengths in allied health and primary care subjects, its solid partnerships with industry, government and academics, as well as experience in external collaboration and technology transfer. “The University has been proactively working with industries and businesses to bring practical CM applications. For example, we have worked with large companies like Nestle, Yili, Kanion Pharmaceuticals Limited, etc., on consultancy projects on the integration of CM for bone health; collaborated with Purapharm in the production of PolyU-developed puerarin phospholipids complex capsules; and received donations from private companies for the development and use of Qigong as an intervention for chronic depression,” Prof. Wong recounted. “We have also been working with tertiary institutions and CM hospitals in inland China. Our joint study with Jinan University on anti-osteoporotic CM has achieved remarkable success, with over ten research grants secured, an
award from the Ministry of Education (MOE) and five patents filed.”
CM has always been one of PolyU’s research foci. The Department of Applied Biology and Chemical Technology (ABCT) has been conducting CM research for more than two decades. “RCMI research is essentially different from the department’s research, in that RCMI researchers focus on translational clinical research which promotes preventive health and related treatments, the illustration of TCM theory and action mechanisms using modern tools, new drug development, and empirical evidence of TCM practices for its integration into primary care,” explained Prof. Wong.
Currently, RCMI focuses on five research areas. Women’s Health covers a wide range of common health conditions in women like osteoporosis, breastfeeding, depression and menopause-related problems. Metabolic Syndrome and Liver Diseases concerns the management of metabolic syndrome and obesity-related non-communicable diseases including non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus and cardiovascular diseases. Integrative Solutions for Physical Wellness focuses on translational and/ or clinical research for preventive health and targets age-related health conditions such as brain health, skin health, sleep control, weight control, acute or chronic pain, fall prevention and stress management. Chinese Ophthalmology investigates TCM-based drugs for eye disorders like myopia, dry eye, glaucoma and ocular hypertension. Finally, Integration of TCM and Intelligent Wearable Systems integrates cutting-edge technology, fabrics and manufacturing techniques to support TCM treatment and diagnosis as well as mobility enhancement for persons with Parkinson’s disease.
New elements and interdisciplinary approach to TCM research
“RCMI seeks to generate impactful, interdisciplinary and translational research on CM treatment, drugs, practices and applications which provides the scientific foundation for TCM theory, for better understanding by the research community, medical community and the general public.”
The establishment of RCMI under PAIR marks the University’s new innovative and interdisciplinary approach to CM research. With the vision to become a leading institute for the research and application of CM treatment and practices, RCMI seeks to generate impactful, interdisciplinary and translational research on CM treatment, drugs, practices and applications which provide the scientific foundation for TCM theory, for better understanding by the research community, medical community and the general public.
“One key example of RCMI’s interdisciplinary pursuits is our collaborative research on metabolic syndrome and liver diseases. We are working with the Research Institute for Smart Ageing (RISA) on the use of TCM for the prevention of diseases and health promotion for elders,” Prof. Wong highlighted. “In this collaborative project, we engage scholars from biomedical engineering, applied biology and chemical technology as well as rehabilitation science, whose expertise enables the various research activities in different stages—from the use of 3D ultrasound screening for NAFLD diagnosis, to the collection of data on elders’ nutrition and lifestyle status, to the analysis of elders’ serum and urine samples using mass spectrometry, to the integration of TCM exercises into everyday living as a lifelong management intervention for persons with metabolic syndrome.” The team will also use a mouse model which involves the administration of potential TCM into NAFLD mice, with the aims of identifying the molecular mechanisms of chronic diseases which very often associated with ageing and discovering active substances, if any, that are responsible for the health benefits of the TCM under studied.
Chinese medicine innovation is an interdisciplinary subject by nature, as it relies on a combination of research platforms so that a TCM-based drug or intervention can be developed, thoroughly understood, prescribed and applied in primary care. Prof. Wong explained, “the herbal standardisation and quality control platform establishes the standardised CM and quality control standards for studies. The preclinical platform, which is concerned with pharmacology and disease models, enables in vitro and in vivo models for efficacy and mechanistic studies. Finally, clinical studies provide input for the planning and implementation of TCM clinical applications.”
Proactive partnership strategy that drives TCM development
Since RCMI’s establishment in October 2021, the unit has expanded rapidly in terms of team composition and research development. Currently comprising 51 members, RCMI has generated significant research output in the first year of operation, with HK$9 million grants awarded, 17 internally-supported projects, ten external projects awarded and seven affiliated publications. The Centre has also signed a collaborative agreement with industry to establish a new joint laboratory. “With generous support of HK$10 million from Increasepharm (HK), the joint laboratory will focus on conditions including osteoporosis, sarcopenia, dementia and ocular diseases, and conduct research to develop a series of CM-based molecular compounds for treatments,” explained Prof. Wong. RCMI members are now working on small-molecule drug development. Their next step is to apply for external funds jointly with Increasepharm, which is responsible for development of the dosage form as well as synthesis and industrialisation of the new drugs.
A number of flagship projects have been planned. “In December 2022, RCMI has recently co-organised the Botanical Symposium 2022: Exploring Innovative Approaches in Chinese Medicine – From Bench to Bedside with other units, including the State Key Laboratory of Chinese Medicine and Molecular Pharmacology, the Institute of Chinese Medicine, and the State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants of the Chinese University of Hong Kong. This symposium was previously held as part of the department’s annual event for four years, but has been postponed for the past two years due to the pandemic. The event brings together eminent researchers and scientists from around the world for fruitful dialogue and promotes recent research endeavours in natural products and herbal medicine,” Prof. Wong said. “Another flagship event planned is the Clinical and Pre-clinical International Symposium which will be held in December 2023.”
Making TCM information and knowledge accessible
With the general public’s keen interest in health tips and myths about CM, RCMI has been dedicated to raising public awareness of CM and providing accurate information via social media, broadcast channels and other knowledge exchange activities. “Dr Jerry Yeung, Management Committee (MC) member of RCMI, and other Research Assistant Professors have been running and managing Facebook channels which share TCM-related information or COVID-related information,” shared Prof. Wong. “Dr Christina Poon, RCMI member and Research Assistant Professor in the Department of Applied Biology and Chemical Technology, and I were featured on the TVB programme 100 Health Tips to debunk health myths such as the effectiveness of soy milk in the prevention of osteoporosis and premenopausal breast cancer, as well as the impact of various cooking methods on the nutritional value of food. Another RCMI member, Prof. Hector Tsang, Chair Professor of Rehabilitation Sciences and Head of Department of Rehabilitation Sciences; and MC member Dr Jerry Yeung were featured on the RTHK programme Healthpedia. They shared tips for a healthy lifestyle during the pandemic and discussed the role of TCM in addressing long-haul COVID symptoms, respectively,” Prof. Wong further explained. The Centre has also been sharing TCM studies in a number of knowledge exchange events such as PolyU InnoTech Open Day, academic conferences and webinars.
RCMI members have been actively responding to the timely needs in society. In March 2022, when Hong Kong experienced the fifth wave of COVID-19, several RCMI key members received an internal funding of HK$3 million to conduct a project on long COVID symptoms, which aims to evaluate the effects of TCM-based treatments for COVID survivors. “Treatment of long-haul COVID symptoms requires a multidisciplinary approach. In our study, we evaluated the effects of physical interventions involving acupuncture and lifestyle management, and Chinese herbal medicine. We applied Chinese medicine knowledge and advanced diagnostic techniques including magnetic resonance imaging (MRI) and mass spectrometry to identify the causes of the condition and to provide target-oriented treatment, with a view to promoting the recovery from long-haul COVID symptoms,” Prof. Wong shared. The multidisciplinary approach calls for interdisciplinary efforts from the Institute. “To make this project possible, we have engaged members from three departments at PolyU, including the Department of Applied Biology and Chemical Technology, the Department of Rehabilitation Sciences, and the School of Nursing. They hold expertise ranging from basic sciences (e.g., metabonomic, pharmacology, microbiology, molecular biology), TCM clinical practice, to primary care (e.g., Qigong, acupressure, wellness management). This collaboration experience greatly enhances our research capacity in understanding more about long COVID.”
Prolific research in bone health
While the pandemic has slowed down global developments in various ways, this has not prevented Prof. Wong from pursuing rigorous research which profoundly impacts people’s health. In October 2022, according to the annual list released by Stanford University, Prof. Wong was named among the top 2% most-cited scientists in the world in the area of Medicinal & Biomolecular Chemistry. Between 2019 and 2022, she has published over 20 affiliated works, most of which are related to bone health. “The publications have resulted from the major research interests of my laboratory in understanding the protective effects of TCM on bone health. We are interested in seeing if TCM protects against bone loss by mimicking the effects of oestrogen in the body, especially for treatment of postmenopausal osteoporosis,” Prof. Wong explained. “Oestrogen deficiency is known to induce bone loss as well as changes in lipid profiles and gut microbiota composition. Our earlier reports demonstrated that Er-xian decoction, Herba Epimedii, Rhizoma Drynaria and Sambucus Williamsii Hance can exert oestrogen-like activities in bone and protect against oestrogen-deficiency induced bone loss. In addition, we have discovered that Fructus Ligustri Lucidi can exert vitamin D-like actions in the body and help to improve calcium balance and protect against age-related bone loss. Recent studies have indicated that TCM might exert its beneficial effects via gut microbiota, but it is unclear if such a mechanism is involved in mediating the actions of bone-protective Chinese medicine.”
To ascertain the protective effects of TCM on bone health, Prof. Wong has recently been carrying out a number of projects with funding support from the HKSAR Innovation and Technology Commission and the Ministry of Science and Technology as well as from the HKSAR Health Bureau. These projects concern the development of a safe and effective herbal drug for postmenopausal osteoporosis; the development of natural anti-osteoporotic lead compounds from microbial transformation; and the effects of soy exposure in early life on bone development and gut microbiota.
Trends in health and wellness
“Health consciousness among the general public has increased globally during the pandemic and post-pandemic period. Consumer demand for healthy food products, Chinese medicine, nutraceuticals and dietary supplements, especially those related to immune function improvement, are expected to increase.”
Prof. Wong is now serving as a key member of over ten councils and committees for the government, non-profit organisations, and professional associations. Drawing on her experience, Prof. Wong envisions a number of important changes in the public health and demand for CM. “Health consciousness among the general public has increased globally during the pandemic and post-pandemic period. Consumer demand for healthy food products, Chinese medicine, nutraceuticals and dietary supplements, especially those related to immune function improvement, are expected to increase,” Prof. Wong explained. With the prevalence of online food purchases and meal orders, particularly among the new generation of consumers, she also pointed out the need for public health measures on these online platforms to promote healthy food choices. “The HKSAR government puts strong emphasis on reducing salt and sugar consumption among the general public and reducing the content of salt and sugar in processed food. With the ageing population in Hong Kong, we will need a more targeted approach to enable older adults to control salt and sugar intake,” Prof. Wong further explained.
Practising CM and a healthy lifestyle in everyday living
Having grown up in Hong Kong, Prof. Wong and her family are accustomed to Chinese medicine and treatments. Her 25-year experience in CM research has given her great confidence in the use of CM for health maintenance and disease prevention. “We use Chinese herbs in making Chinese-style soup at home, regularly consume Chinese floral teas and use over-the-counter Chinese medicine formulae. My family also see CM doctors to maintain health and treat cold-related conditions,” Prof. Wong added.
Being well-versed in plant-based chemicals and nutrients, Prof. Wong stresses the quantity and variety of fruit and vegetables in diets: “The general rules of my family are (1) to make sure there will be two different kinds of vegetables in the dishes for dinner; and (2) one to two types of fruit are consumed on a daily basis.”
