Applying science to TCM for natural pain relief

Yen Tse's inherited family formula has been developed from boiling herbs like these, to form a liniment, to a hydrogel patch and gel. — Photos: SAMUEL ONG/The Star

For centuries, Asian cultures have been using traditional herbal medicines to treat a variety of ailments.

Taken orally or applied topically, medicinal herbs are used both as a self-cure by patients and as a professional remedy by traditional and complementary medicine (TCM) practitioners.

The TCM system is based on empirical and accumulated knowledge, hence there is a dearth of research on it.

The research that has been done has focused on individual herbs, with most of the attention given to herbal medicines that are taken orally, while only a handful of those used topically have been looked at.

In a probable first in the country, two men have conducted a scientifically-verified study to show the efficacy of a topical, plant-based pain-relieving solution.

In 2016, Yap Yen Tse and Fan Jian Ping were introduced by a mutual friend and clicked.

Yen Tse, 43, was looking for a way to scale up his family’s traditional Chinese medicine business, while Fan, 35, was hunting for opportunities to open a business.

Both had studied and worked overseas for over a decade.

Yen Tse holds a masters degree in finance from Princeton University in the United States, while Fan has a PhD in biomechanical engineering from University College London in the United Kingdom, with a focus on the synthesis and characterisation of novel composite scaffolds in tissue engineering.

Sharing the family formula

“In the early 2000s, the TCM industry here was not regulated and my dad was making these liniments for pain relief and selling them without a label.

“He got all the formulas from my grandfather, bought the herbs from China, and laboriously processed them himself.

“When the Health Ministry (MOH) decided to regulate TCM, he stopped selling them because he didn’t have the know-how and the resources to do the documentation,” shares Yen Tse, who returned to Malaysia in 2011.

Grandpa Yap Shu Shen, a grandmaster in Northern Shaolin Kung Fu and a member of the Chin Woo Martial Arts Association in China, was among the members of the association who were sent to South-East Asia last century to share Chinese culture, including martial arts.

He landed in Malaysia.

Yen Tse continues: “He was also a healer who inherited knowledge of herbal formulas to treat injuries you would typically find in ardent kung fu practitioners – bruises, cuts, sprains and other types of physical trauma.

“My grandfather established a small healing practice at the sports stadium where his martial arts association was housed.

“He taught kung fu and tended to a variety of musculoskeletal injuries, treating conditions that conventional medicine found hard to resolve.”

Although grandpa had knowledge of basic human anatomy and body mechanics, it was the traditional Chinese formulas that helped him heal patients.

He passed on his knowledge to his son, Yap Chan Kor, who then opened a pain management centre for the public, focusing on relieving musculoskeletal pain.

“I knew it wasn’t any special skill but the herbs that were producing the healing result, and I was thinking of a business plan and what technology I had that could grow the business.

“I had already introduced (our products to) physiotherapists trained in tissue manipulation massage and they were using the liniments on patients.

“We also started collecting clinical data on patient recovery,” recalls Yen Tse, who didn’t pick up much kung fu from grandpa.

Fan offers: “Yen Tse had a vision on what to do with the herbs and we agreed that the current products in the market don’t really address the issue of inflammation.

"They tell you whether it gives a cool or hot sensation, but they don’t target the root cause of pain.

“So there was this big empty space to fill, which required a lot of innovation.”

At that point, they didn’t know which pain-relieving formulation they were going to make and whether it was going to be cream, lotion, gel, oil or patch, but they knew that scientific backing was necessary.

They brainstormed and set to work.

That meant Yen Tse had to reveal some of his grandfather’s secret formulas.

“Yes, there was a trust issue,” he admits.

“Internally, there were certain struggles.

“But I used the analogy from the Coca-Cola company – the drink can be formulated by anyone, but it won’t taste 100% like Coke.

“We needed Jian Ping’s expertise in science and research, and to approach MOH to submit scientific evidence to support the product.

“Also, we had to reveal the ingredients in the product.”

The family took a leap of faith and agreed to share the formula with an outsider.

Yen Tse adds: “If we didn’t, we’d be stuck making the product on a small scale.

“Besides, we have several different formulations here, but we were only working on one.”

Scientific proof

With a research grant, they collaborated with Monash University Malaysia to do a study.

Fan (left) and Yen Tse knew that scientific evidence was necessary for the next step to expand their business.

Fan says: “At first, I was sceptical because there were so many different herbs that went into making one liniment!”

They proceeded to conduct studies on the in-vitro anti-inflammatory characteristics of the herbs using Human Embryonic Kidney (HEK293) cells, since most life functions, including the inflammation response, happens at the cellular level.

To ensure the herbal extracts were not toxic to the cells, in-vitro toxicology was first conducted.

“I then induced inflammation on fertilised chicken eggs and when the little veins appeared on the shell, I applied the herbal extract to counter it in one group and none in the other.

“We treated the eggs for 24 hours and found there was a reduction in inflammation after two hours in the treatment group.

“The problem was getting enough eggs as we were working with 13-14 herbs and had to do it separately and synergistically,” he explains.

Nevertheless, it was an exciting milestone because they finally unlocked the secrets of a centuries-old folk medicine using modern scientific methods.

Yen Tse’s father had been boiling the herbs and spreading them on a dressing sheet before plastering it on the pain site.

It was too cumbersome, so Fan concocted a hydrogel formula to modernise the patch.

“No more old-fashioned boiling, although dad still does it for the patients who come to the centre,” says Yen Tse.

Encouraged by the positive results, the duo came up with their own pain-relieving patch.

It took almost two years to complete the research and register the patch as a medical device.

Next, it was time to test it on humans.

More to do

Alas, that was in 2020, just when Covid-19 struck and they couldn’t market it physically.

Yen Tse had a business partner in the US and sent him samples of the product, but selling it there online was too expensive.

“He tried to figure out the best way to market to the US audience and he thought maybe college football was the way to go, so he used the ‘backdoor’ route via retired NFL (National Football League) players.

“He approached them and they were open to listening and working with us.

“The plan was to do a survey, and if the results were good, we could market it to players in other sports,” Yen Tse explains.

Last year (2022), they sent five patches each to 50 members of the NFL alumni experiencing some kind of musculoskeletal pain.

The majority reported that the patches did indeed help them.

Yen Tse and Fan were thrilled.

In the meantime, they got the gel (in a tube) version registered locally before the patch was approved.

Yen Tse reveals: “We started selling the gel first (online) as it was easier to complete the documentation.

“Despite it being priced slightly higher, we were quite surprised at the good response.”

Chips in Fan: “It required educating the customers on the higher price as we put in a lot of time on the research – the formula was not just plucked from air.”

Two months ago (April 2023), the duo added a cream (warm sensation) to the range; it functions the same as the gel, but the formula has been tweaked.

They’ve also tied up with a local pharmacy to sell the products.

How soon one can get pain relief depends on the severity of the pain, and whether it is acute or chronic.

With chronic problems, the process takes longer.

Possible side effects include skin irritation from the herbs or plasters, although these occur in less than 1% of users.

The formulations cannot be used by pregnant or breastfeeding women, and those allergic to menthol or camphor.

“You can also use it for maintenance and prevention, e.g. if you are doing a high stress activity, apply it beforehand to reduce muscle soreness.

“The best results come from combining specific exercises with the formulation,” says Yen Tse.

There’s a lot more research to be done, but the duo are taking it one step at a time.