Hallmarks of health: A Chinese medicine perspective

Dear Editor,

The conventional biomedical model of health, rooted in 19th-century germ theory and modern pathology, has long employed a deficit-oriented framework that defines health primarily as the absence of disease. While effective in acute and specific disease contexts, this model proves increasingly inadequate for addressing complex challenges such as chronic conditions, preventive care, and the demand for holistic health management. Acknowledging these limitations, the World Health Organization (WHO) proposed in 1946 a broader definition of health as “a state of complete physical, mental, and social well-being”—a conceptual advance that has nonetheless remained largely abstract in practical application.

Traditional Chinese medicine (TCM) offers a distinct proactive paradigm, framing health as the dynamic manifestation of physiological robustness and adaptive capacity. Grounded in classical Chinese philosophy and refined through millennia of clinical observation, TCM emphasizes relational networks spanning environmental, somatic, and mental dimensions, prioritizing systemic harmony over reductionist approaches. This perspective converges remarkably with modern scientific developments, as biomedical research undergoes a parallel evolution toward function-oriented perspectives. The proposal by López-Otín et al. of eight hallmarks of health marks a pivotal shift toward systemic understanding of biological well-being. These pillars of modern health biology display striking conceptual similarities with TCM’s six foundational dimensions.

TCM's foundational dimensions

Human-environment harmony

This dimension conceptualizes health as emerging from dynamic synchronization between organisms and their environmental contexts, encompassing climatic, seasonal, and geographical adaptations. Representative mechanisms include microbial community shifts in response to seasonal variations. Environmental disruptions, such as artificial light exposure, can suppress nocturnal melatonin secretion, significantly delaying sleep onset and raising the risk of metabolic syndrome. Interventions such as time-restricted feeding windows and controlled light exposure exemplify practical applications that restore temporal harmony, thereby operationalizing this TCM principle in contemporary health practices.

While modern environmental medicine quantifies the disruption of circadian and seasonal rhythms by urbanization and artificial light, TCM's principle of human-environment harmony provides a proactive framework for designing lifestyle and clinical interventions (e.g., time-restricted eating and ecological exposure) aimed at resynchronizing human physiology with natural cycles.

Yin-yang dynamic equilibrium

This principle embodies the dynamic balance between complementary physiological forces operating across multiple organizational levels. Exemplary manifestations include redox homeostasis, maintaining equilibrium between reactive oxygen species (ROS) signaling and antioxidant defense systems. Pathological imbalances, such as disrupted mechanistic target of rapamycin (mTOR)-AMP-activated protein kinase (AMPK) signaling cascades, underlie various metabolic and inflammatory conditions. Therapeutic approaches, including metformin administration and chronotherapeutic interventions, demonstrate effective strategies for reestablishing homeostatic balance through multi-target mechanisms, reflecting the dialectical nature of this foundational concept.

While systems biology delineates the molecular feedback loops (e.g., AMPK/mTOR and PER/CRY) underlying physiological balance, TCM's yin-yang framework conceptualizes this equilibrium as a dynamic and dialectical process, guiding therapeutic strategies that restore balance through multi-target modulation rather than isolated correction.