Torsadogenic Index: Its Chinese Medical Origin

doi:10.4236/pp.2013.47A1001

Paper Menu >>

Journal Menu >>

Pharmacology & Pharmacy, 2013, 4, 1-3

http://dx.doi.org/10.4236/pp.2013.47A1001 Published Online October 2013 (http://www.scirp.org/journal/pp) 1

Torsadogenic Index: Its Chinese Medical Origin

Adrián Ángel Inchauspe1,2,3,4,5*

1Scientific Department, Argentina Acupuncture Society, Buenos Aires, Argentina; 2Argentina Resuscitation Council, Buenos Aires,

Argentina; 3Investigation Department, HINEA y C. “Dr. Alejandro Korn”, Melchor Romero, La Plata, Argentina; 4Medical Sciences

Faculty of La Plata University, La Plata, Argentina; 5Chronic and Acute Care Neuropsychiatric Hospital Interzonal “Dr. Alejandro

Korn”, Melchor Romero, La Plata, Argentina.

Email: adrian.incha[email protected]

Received July 20th, 2013; revised August 21st, 2013; accepted September 8th, 2013

cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The foundational chronology of Torsadogenic Index is introduced to explain the relationship between impending death

situations and drug prescription, combination, self-indication, or abuse of torsadogenic pharmacological products. The

pathophysiological basis of Torsade de Pointes is presented with the most frequent causes of Long QT syndrome. Tradi-

tional Chinese Medical principles are exposed in order to help people to understand its par a-logical sequ ence, prov iding

another view of medical explanations upon scientific evidence. Development of Torsadogenic Risk Management

Project and Torsadogenic Traceability concepts derived from these Chinese Medical perpetual axioms are presented

in this paper.

Keywords: T. Index; TCM Principles; Scientific Evidence

1. Background

Invited by the Chinese Government to the 8th BIT’s In-

ternational Congress of Drug Development, Science and

Technology, I assisted to the Overture Ceremony in the

Beijing International Convention Center [1].

In Expert’s Presentation, I met Dr. Jufeng Wang, for

that times Chief of the Exploratory Office of Toxicology

in Harvard. During his interesting dissertation [2], he

announced several medications that derive into sudden

death for electrocardiographic QT interval prolongation.

Deeply impressed, I returned to Argentina wondering

how many impending death situations could be referred

to patients that had previously taken drug s.

Back at work, I asked Dr. Wang for a complete list in

order to prevent its dangerous consequences. With great

surprise, 80 pharmacological products of common use

appeared as potentially cardiac arrest threatening risk [3].

All of them lead to death for the same reason: the devel-

opment of a menacing arrhythmia called Torsade de

Pointes (TdP) [4,5].

2. Introduction

Torsade de Pointes is a potentially tachyarrhythmia ca-

pable to progress into ventricular fibrillation, a major

cause of heart arrest [4].

Long QT syndrome appears due to genetic mutation

(Congenital LQTS) or secondary causes (Acquired

LQTS) as [5]:

- Bradyarrhythmias: sinusal arrhythmia—sinus brady-

cardia—AV block;

- Metabolic abnormalities;

- Drugs;

- Central Nervous System’s injuries: thalamic hema-

toma—subarachnoid hemorrhage;

- Hidroelectrolitical disturbances;

- Malnutrition—anorexia nervosa—liquid protein ele-

mental diets.

3. Physiopathology

*National Delegate for the 5th International Conference on Drug Dis-

covery and Therapy 2013, Dubai, United Arab Emirates; National

Delegate from Argentina in Ninth International Brain Injury Associa-

tion Congress, Edinburgh, UK; Editorial Highlight Member of the

World Journal of Critical Care Medicine, Ed. Baishideng, Beijing,

China; Editorial Guest Member of Frontiers of Clinical Pharmacology

Research and Outcomes Journal, Basilea, Switzerland.

This TdP condition is caused by an ionic channel dys-

function in cardiac cells membranes [5].

It occurs due to blocking potassium efflux or excessive

sodium entry in cardiac cells, causing intracellular posi-

tive ion’s overload that delays ventricular repolarization,

Torsadogenic Index: Its Chinese Medical Origin

facilitating early depolarization [6].

4. Material

After obtaining the suspicious drug list, I began spread-

ing this knowledge in order to mitigate risks. First con-

ference took place in La Plata Children’s Hospital; and

its personnel kept in touch with me, consulting about

pharmacological indications over quoted drugs.

From this group of patients was extracted the case pre-

sented in Torsadogenic Index: a proposal to improve sur-

vival rates in cardiac arrest due to prescribed drugs [7].

From the beginning, this impending death situation

was analyzed under Traditiona l Chinese Medicine (TCM)

principles, founding its reasons in its ancient intricate

relationships [8,9].

Quoted case in Frontiers of Medical Pharmacology

Research and Outcomes was a one-year-old infant with

acute lymphocytic leukemia under oncological treatment

with vincristine, daunorubicin and pegylated asparagi-

nase—MARMA Interfant 05 IB protocol—prescribed in

a particular season and in a specific hour of the day [7].

These facts, almost irrelevant for Western medical

science, are crucial to understand the following conse-

quences that finished in the cardiac arrest of this child

[8].

5. Method

A chronological sequence shows quoted cases charac-

teristics that lead to conclusions according to TCM view.

First of all, TCM developed the Five Movements

Theory for explaining a Cosmological order; the har-

mony in human nature and—in our bodies—their organs

and viscus relationships. This Five Elements’ Principles

remind me the Euclidian Geometry’s Axioms. It’s not

by chance that Euclid explained Universe’s structure

based upon its Five Regular Polyhedrons, naming them

in the same way as Chinese masters did.

In particular, reference to Wood element, it’s com-

pound by Liver—as its organ; and Gallblader—as its

viscus. Unlike in Water, where patient condition “falls

down” as it gets worse—like in a cascade, Wood patho-

logies behave like flames: as condition get in progress,

the “burning state” is more serious over the patient; “and

the flames grow up”.

Oncological drugs—vincristine, pegylated asparagi-

nase and daunorubicin—even administrated in correct

prescription and doses—have notorious hepatotoxic ad-

verse effects.

This condition is called “Toxic Heat”; and over the

Liver—a Wood zhang—may provoke an “ignition” that

puts this organ in serious functional danger.

Furthermore, medication was administrated in Sum-

mer—a Fire season; another reason that make Liver—as

a Wood organ—vulnerable to flames [10].

Finally, treatment was accomplished at 12:30 a.m.:

very near the most Yang hour, and sun plenum clarity

and heat.

Synthetically, under Traditional Chinese Medicine’s

view, this child received its hepatotoxic medicines (“To-

xic Heat”); in Summer (“Fire station”); and at mid-day

(“Fire hour”).

Quoted deductions about this summary of conditions

that affected Heart—the next organ in TCM’s “Mother

and Son Rule”—is based upon Cheng Generation Cy-

cle that allows a creative sequence between the Five Ele-

ments in Chinese Medicine.

Heart is the “Son” of Wood; so that “Toxic Heat”

damaged it so seriously, that cardiac arrest was the cor-

ollary of this accursed ex ample.

6. Results

As quoted in Frontiers journal, oncological drug plan

was scheduled with a week-interval between drugs; and

this kid had a successful treatment and kept alive [7].

Downloaded by more than 500 subscriber experts;

Frontiers editorial considered Torsadogenic Index’s Im-

pact Factor as one of the most impressive of this prestig-

ious journal.

Invited as speaker to 5th Drug Discovery and Therapy

Dubai conference and last 5th World Drug Discovery

Congress in Boston, made me possible to introduce new

Drug Risk Management Project [11] and Torsadogenic

Traceability Concept [12] for reducing death rate due to

drug prescription, combination and self-indication [13-

15].

The most enthusiastic sponsor of this work was Dr.

Wang, cu rrent Presiden t of F.D.A. China and Dir ector of

the Chinese National Drug Evaluation Center. His sup-

port has been fundamental for this success.

7. Conclusions

Still in 21th century, Traditional Chinese Medicine con-

tributing to Western science can be useful for taking de-

cisions through its ancient and perpetual principles.

Originated from TCM parameters [16], Torsadogenic

Index Management Project and Torsadogenic Tracea-

bility [11,12] will be main subject for discussion into

next Washington F.D.A. Meeting agenda.

Turning results into evidence will convince Western

Medicine [17,18] to convoke these alternative ways for

improvin g pat i e nt s’ heal t h [19-22].

REFERENCES

[1] A. Inchauspe, “D-Phenylalanine Injection over K-1 Yong-

quan: A Theoretical Way of Upgrading Survival Rates in

Torsadogenic Index: Its Chinese Medical Origin

CPR,” BIT’s 8th Annual Congress of International Drug

Discovery Science and Technology (IDDST), Beijing,

23-26 October 2010.

[2] J. Wang, “Cardiovascular Safety: How to Develop Risk

Assessment,” BIT’s 8th Annual Congress of International

Drug Discovery Science and Technology (IDDST), Bei-

jing, 23-26 October 2010

[3] A. Inchauspe, “Fármaco-Vigilancia y Muerte Súbita,”

Jornadas Multidiscipinarias del HINEA y C “Dr. Ale-

jandro Korn”, Melchor Romero, La Plata, 2011.

[4] F. Desertenne, “La Tachicardie Ventriculaire a Deux Foy-

ers Repposes Veriables,” Archives des Maladies du Coeur

et des Vaisseaux, Vol. 59, 1966, pp. 263-272.

[5] M. Lanzotti and N. Citta, “Síndrome de QT Largo Ad-

quirido: Torsade de Pointes,” Univ. Buenos Aires, Uni-

versitá degli Studi de’ll Insubria, 2003.

http://www.fac.org.ar/tcvc/llave/c312/lazotti.PDF

[6] E. Whitsel and P. Rautaharju, “Electrocardiography QT

Interval Prolongation and Risk of Primary Cardiac Arrest

in Diabetic Patients,” American Diabetes Association,

2005.

[7] A. Inchauspe, “Torsadogenic Index: A Proposal to Im-

prove Survival Rates in Cardiac Arrests Due to Prescribed

Drugs,” Frontiers in Pharmacology, Vol. 3, 2012, p. 99.

http://dx.doi.org/10.3389/fphar.2012.00099

[8] A. Inchauspe, “Recent Advances in Theories and Practice

in Chinese Medicine,” In: Traditional Chinese Medical

Criteria about the Use of Yongquan as a Life Support

Maneuver, InTech, Croatia, 2011, pp. 362-366.

http://dx.doi.org/10.5772/29138

[9] A. Inchauspe, “Traditional Chinese Medicine and Brain

Protection: Can Its Principles Be Consistent with Western

Science?” 9th IBIA International Brain Injury Associa-

tion Congress, Edimburgh, 23-26 March 2012.

[10] Ling Shu, “Origin and Gathering (Gen Jie),” Chapter 5.

[11] A. Inchauspe, “Risk Management Project Applied to Tor-

sadogenic Index,” 5th International Conference on Drug

Discovery and Therapy, Dubai, 18-21 February 2013.

[12] A. Inchauspe, “Torsadogenic Index: A Vanguard Risk

Management Risk Measure into the Risk Statement Stra-

tegy,” Drug Discovery & Therapy World Congress, Bos-

ton, 3-6 June 2013.

[13] D. Iyer, “Optimum Patient Care through Appropiate Dru g-

Safety Monitoring,” IDDST, 2010.

[14] J. Kattwinkel and S. Niermeyer, “ILCOR Adv isory State -

ments: Resuscitation of the Newborn Infant. An Advisory

Statement from the Pediatric working Group of the Inter-

national Liaison Committee on Resuscitation,” Circula-

tion, Vol. 99, 1999, pp. 1927-1938.

http://dx.doi.org/10.1161/01.CIR.99.14.1927

[15] N. Swedborg, “Drug Abuse and Dependence Liability

Assessment in Safety Pharmacology,” BIT’s 8th Annual

Congress of International Drug Discovery Science and

Technology (IDDST), Beijing, 23-26 October 2010.

[16] Ling Shu, “Beginning and Ending (Zhong Zhui),” Chap-

ter 9.

[17] F. Dessertenne, A. Fabiato and P. Courmel, “Un Chapitre

Nouveau Délectrocardiographie: Les Variations Progres-

sives de Lámplitude de L’électrocardiogramme,” Actual

Cardio. Angeio. Int, Vol. 15, 1966, pp. 241-258.

[18] J. López-Valcárcel, “10 Preguntas Frecuentes Sobre el

Síndrome del Qt Largo.”

http://www.qtsyndrome.ch/faqsp.html

[19] B. J. Maron and N. A. Mark Estes III, “Conmotio Cor-

dis,” New England Journal of Medicine, Vol. 362, No. 10,

2010, pp. 917-927.

http://dx.doi.org/10.1056/NEJMra0910111

[20] A. Inchauspe, “Traditional Chinese Medicine K-1 Yong-

quan and Resuscitation: Another Kind of ‘Lazarus Phe-

nomnon’,” Resuscitation, Vol. 81, No. 4, 2009, pp. 505-

506. http://dx.doi.org/10.1016/j.resuscitation.2009.12.009

[21] A. Inchauspe, “Sudden, Predictable and Preventab le Dea th

in Pharmacological Cardio Safety,” 5th International Co n-

ference on Drug Discovery and Therapy, Dubai, 18-21

February 2013.

[22] M. Ugarte, “Detección precoz de Enfermedades Endó-

crino-Metabólicas en el Recién Nacido,” Comunidad de

Madrid. www.madrid.org