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Traditional Chinese Medicine and New Concepts 41

to be associated with chronic psychosocial stress (Kupaev et al., 2016; Yan
et al., 2012, 2015) and poor lifestyle factors (Bi et al., 2014; Chen et al., 2014).
Since ancient times, TCM has identified a physical status between health and
disease (Wang and Yan, 2012; Wasser, 2002; Yan et al., 2008).
The existence of a reliable and valid instrument to assess SHS is essential. Wang
et al. (2014) developed a tool, the SHS questionnaire-25 (SHSQ-25), to assess
five components of health (Wang et al., 2014; Yan et al., 2009). The SHSQ-25
accounts for the multidimensionality of SHS by encompassing the following
domains: fatigue (Zhao, 1999), the cardiovascular system (Year Book, 2008a),
the digestive tract (Peng et al., 2006), the immune system (Year Book, 1991),
and mental status (Year Book, 2008b). The SHSQ-25 is short and easy to com-
prehend and, therefore, an instrument suitable for use in both large-scale stud-
ies of the general population and routine health surveys (Wang et al., 2014).
The validity and reliability of this approach were evaluated in a small pilot
study and then in a cross-sectional study of 3405 participants in China. A cor-
relation between SHS and systolic blood pressure, diastolic blood pressure,
plasma glucose, total cholesterol, and high-density lipoprotein (HDL) choles-
terol among men, and a correlation between SHS and systolic blood pressure,
diastolic blood pressure, total cholesterol, triglycerides, and HDL cholesterol
among women were detected. An ongoing longitudinal SHS cohort survey
(China Suboptimal Health Cohort Study, COACS) consisting of 50,000 par-
ticipants will provide a powerful health trial for the use of SHSQ-25 and its
application to PPPM through patient stratification and therapy monitoring by
using innovative technologies of predictive diagnostics and prognosis. To date
the SHSQ-25 as a self-reported survey tool has been validated in various popu-
lations, including European ethic groups (Kupaev et al., 2016; Yan et al., 2015;
Wang et al., 2017), and currently the SHSQ-25 has also been applied to a real-
life community-based health survey in Ghana, Africa (Adua et al., 2017). SHS
thus has been recognized internationally and is used as a novel tool for the
early detection of chronic disease (Kupaev et al., 2016; Yan et al., 2015).
The availability of reliable biomarkers for noncommunicable chronic diseases
(NCD) is essential for improving early detection and intervention. Specific
biomarkers, such as plasma glycome or serum peptidome, are believed to
represent an “intermediate phenotype” in the etiology of adult-onset dis-
eases (Lu et al., 2011; McLachlan et al., 2016; Wang et al., 2016a,b). Therefore
these profiles might hold the key to understanding the underlying biological
mechanisms that create SHS. SHSQ-25 affords a window of opportunity for
early detection and intervention, contributing to the reduction of chronic dis-
ease burdens. The inclusion of the “objective” biomarkers and the subjective
“SHS” assessment into population studies is therefore believed to be timely
in improving chronic disease control and in strengthening opportunities for
chronic disease prevention.