Scorpions and cockroaches weren’t necessarily part of the picture when Dr. Eric Peterson imagined the benefits of developing relationships with his Chinese counterparts. The senior associate dean for clinical research at UT Southwestern Medical Center had been looking to expand the reach of large trials he was leading by recruiting patients and researchers in what was then the world’s most populous country.
He hadn’t considered that Chinese physicians might come to him hoping to flip the script. In 2019, a group of cardiologists contacted Peterson, wanting to test a traditional Chinese medication using Western methodology. Led by Dr. Yuejin Yang, they had long prescribed tongxinluo—the word’s meaning translates as “to open the network of the heart”—to cardiac patients who had suffered a stroke or were experiencing chest pain. The drug contains extracts from several herbs, as well as from animals including centipedes, cicadas, cockroaches, leeches, and scorpions.
And Peterson certainly didn’t expect the results of the double-blind trial that followed. The researchers tracked 3,777 Chinese patients who had recently suffered severe heart attacks and were given doses of tongxinluo or a placebo, in addition to conventional treatments. A year later, those who had taken tongxinluo were about 25 percent less likely to have died from a cardiac condition. More broadly, they were 30 percent less likely to have experienced any major adverse cardiac or cerebrovascular event, including another heart attack, stroke, or the need for emergency procedures to restore blood flow.
These findings were startling, in large part because existing post–heart attack treatments are considered effective. “To find something that would add, on top of that, a rather significant reduction in events? You don’t find that too often,” Peterson says.
The study, published in October in the prestigious Journal of the American Medical Association, has been met with a combination of excitement and disbelief. “In making a judgment about the validity of this research, the editors were faced with the task of walking a fine line between skepticism and plausibility,” wrote Dr. Gregory Curfman, JAMA’s executive editor. He also noted that Nobel Prize–winning scientist Tu Youyou had helped develop a lifesaving drug to treat malaria from a traditional Chinese medicine.
Peterson expected doubts from the medical community, and he harbored some of his own. To protect against potential criticisms of the data’s integrity, he took “a step that I would never do for a Western study,” he says. He and coauthor Dr. Ying Xian, a professor of neurology at UT Southwestern, traveled to participating clinics in China and randomly pulled medical records of study participants in order to compare those to the information in the study’s database. They found no irregularities.
Nevertheless, the research has its critics. “I can’t prove to you that it’s wrong, but I don’t know if it will stand the test of time,” one prominent cardiac researcher told the medical news site STAT. One of the primary concerns among Western experts is that researchers haven’t determined how tongxinluo works, or which of the many ingredients is responsible for the apparently beneficial outcomes. Both of these are concerns that the study’s authors readily acknowledge, and Peterson says answering these questions should be the goal of future research.
Another limitation some reviewers have noted is that results that appear promising in one population may not translate to another. For instance, in China there are much lower rates of obesity than in the U.S., but a higher percentage of patients are smokers. Such dynamics could spell different outcomes for American patients. Likewise, many study participants didn’t receive the same follow-up care to a heart attack that they might have gotten in the U.S. Only about 57 percent were put on beta-blockers to lower their blood pressure, for instance, compared to about 98 percent of heart attack patients in the U.S.
Dr. Scott Shurmur, a cardiologist and chairman of the department of internal medicine at Texas Tech University Health Sciences Center, in Lubbock, echoes others dubious of the findings. “Second heart attacks and urgent revascularization are vanishingly small in this trial, and that’s really difficult to achieve,” he says. “Maybe this is just sort of Western traditional ego talking, but I think it’s a little bit unlikely there’s something in here we hadn’t thought of before that would confer a really major advance.”
Traditional Chinese medicine is built on an understanding of the interplay between opposite and complementary forces known as yin and yang. Together, those are said to comprise the human body’s vital force of life, known as qi. It’s believed that imbalance in one’s qi can cause injury or illness, so the discipline’s practitioners use both acupuncture and herbal medicines, among many other treatments, to promote an equilibrium in their patients.
“Unlike ‘Western medicine,’ physicians have the flexibility to add or subtract certain ingredients” to traditional medications, explains Xian, who collaborated with Peterson and more than two dozen Chinese researchers on the study. While tongxinluo’s ingredients have been used in concoctions for centuries, the standardization of the exact combination tested in the study is relatively new.
Some widely accepted medications, such as aspirin (a synthetic version of a compound found in willow bark) and morphine (isolated from opium poppy), first arose from the study of natural ingredients such as those in tongxinluo. In recent years, there’s been an effort among many top medical centers to integrate treatments that traditionally haven’t been part of conventional Western medicine. MD Anderson Cancer Center, for instance, has an integrative medicine center that offers clinical services in acupuncture and meditation, among other disciplines.
Justin Phillips, the academic dean at Texas Health and Science University, a traditional Chinese medicine college with campuses in Austin and San Antonio, says he was excited to hear of the results of the tongxinluo study, “both because of what it demonstrated for a really good clinical effective medicine, as well as just seeing that continued progression of integration.”
While acupuncturists and herbalists in the U.S. are trained in the components of tongxinluo, the medicine isn’t widely used here, according to Phillips. “If someone’s having chronic significant chest pains, I’m usually not the guy they come see,” he explains. Practitioners of Chinese medicine in the U.S. do prescribe herbal remedies such as Atractylodes for gout and hawthorn leaf for nonalcoholic fatty liver disease, but these are considered supplements and thus don’t require FDA approval. Phillips notes that many traditional medications commonly used in China for more severe conditions, such as respiratory infections and cancer, have not been broadly accepted by Western medicine. He’s hopeful that the UT Southwestern study will encourage more collaboration between the disciplines.
Peterson, though steeped in a different tradition, agrees that there’s more research to be done on promising Chinese medicines. “I’ve spent my career on the side of believing in in the rigorous evaluation and tests in the randomized trial, so I’m very excited to see these results and to see that people will be willing to ultimately evaluate whether this therapy works or not,” he says.
Phillips imagines a future in which acupuncturists and physicians can work together to address their patients’ maladies. “At the end of the day, a patient’s got one body, and we’re all treating the same body,” he says. “If things go the way they ought, this is a glimpse of the future.”
