医学新闻阅读 | Traditional Chinese medicine faces uncertain future
The collision between Eastern and Western cultures is no more evident than in the practice of traditional Chinese medicine (TCM) – a medical approach passed down through generations that focuses on holistic healing by changing imbalances in the body. But what chance does it have of helping to resolve China’s growing medical crisis?
As China has modernised, its health services have struggled to keep pace. Where once many Chinese would have accepted the services of a ‘barefoot doctor’, today they demand efficient diagnosis and treatment with the most effective drugs or surgical procedures.
Added to which is a growing demographic problem. In 2013 China had more than 200m senior citizens above the age of 60, presenting huge challenges to the country’s health sector. And things will get worse before they get better, with the proportion of elderly in the population set to increase significantly in the coming decades.
TCM originated in China and has evolved over the course of several thousand years. Its practitioners use both herbal medicines and mind and body practices to treat and prevent a large range of health problems.Although there has been growing interest in Western medicine, TCM is still an integral part of the Chinese health system,with its own dedicated hospitals where the doctors are trained in and practice both conventional Western medicine and TCM.
Speaking at the first TCM Science Conference held in Beijing in November, Wang Guoiang, head of the State Administration of TCM, told delegates that TCM and Western medicine complement each other, which is an important trait of China’s health system. “As TCM has an advantage in prevention and healthcare and is cheaper than Western medicine, it will help resolve people’s difficulties in getting medical treatment,” he added. He urged practitioners to innovate by developing new medicines and equipment and promoting TCM techniques.
The Ministry of Science and Technology has also made the modernisation of TCM one of the 12 focal points in the current five-year plan, allocating $3.6m to screening both conventional chemical compounds and herbs for possible medicines.
Despite problems, the TCM sector has experienced rapid growth in recent years, with revenues increasing at an annual average of 21.6%. It now encompasses more than 1,100 enterprises and employs more than 135,000 workers. According to Xinhua, in 2013 the total value of TCM output exceeded 560bn yuan (US$91.4bn) – one-third of the total value of China’s medicine industry.
However, the wide availability of Western drugs in China is changing the way people think about illness and medicine. With the public becoming more educated and informed about health and medicine, people are more likely to ask questions and seek alternative therapies.
Besides, although it is commonly used in China and is growing increasingly popular in the West, scientific evidence of TCM’s effectiveness is limited. TCM is notoriously difficult for researchers to study due to the complexity and specificity of its treatments and the fact that its theory is based on ideas very different from those that underpin modern Western medicine. Most studies of TCM have looked at only a limited number of techniques, particularly acupuncture and Chinese herbal remedies.
The inability of TCM practitioners to provide safety assurances as required by modern medicine has also created problems for China. The TCM market – now worth an estimated $30bn annually – is increasingly dominated by Japanese and South Korean companies, who currently own 70% of the market compared to just 5% by China, mainly comprising raw materials. They are more diligent in satisfying their clients’ concerns about safety.
Shen Zhixiang, president of the Chinese Folk Medicine Research Association, enumerated the reason for this: “Chinese TCM companies have given neither enough effort nor funding to safety and effectiveness”, he said, adding that it was up to the industry to do the required research. Unfortunately, many Chinese TCM producers prefer to invest in new product research that can help improve their stock prices, rather than spending funds on time-consuming clinical or safety trials.
Ironically, as TCM has come under pressure in the land of its creation, in the West it has gradually gained traction among a small but dedicated group of scientists. For example, the US Food and Drug Administration in the United States has recently approved a phase II trial of Kanglaite, a preparation made from a staple food grain in south-east China that said to be an effective anti-cancer treatment.
The US government established the National Center for Complementary and Alternative Medicine as long ago as 1998. The organization has a budget of around $120m to fund research on the efficacy and safety of alternative medicines, especially those related to TCM. Clinics are becoming increasingly common; the Cleveland Clinic in Ohio, for example, recently opened a herbal therapy centre, based on the Materia Medica, a TCM text covering thousands of herbs, minerals and extracts. That success in turn has spurred scientists in China, Hong Kong and Taiwan to screen around 10,000 plants described in the Chinese herbal medicine literature to see if they can find any other powerful drugs.
And Hong Kong has agreed a 10-year plan to make the city an international centre for Chinese medicine. A new Institute of Chinese Medicine has been set up and dozens of new research projects are underway. In Taiwan, there are proposals to spend hundreds of millions of dollars over the next five years to develop the country’s medicinal herb industry.
Yet while many researchers remain positive that both TCM and Western medicine can benefit from an open exchange of knowledge and ideas, there are problems. Last year, for example, Britain’s Medicines and Healthcare Products Regulatory Agency warned that extreme caution should be used with a number of TCM drugs because they could contain dangerously high levels of toxins, including lead, mercury and arsenic. These drugs, not authorized for sale in Britain, can be bought on the Internet. “People are warned to exercise extreme caution when buying unlicensed medicines as they have not been assessed for safety and quality, and standards can vary widely,” the release said.
They pointed to one product, Bak Foong Pills, used for the treatment of menstrual pain, that had been recalled in Hong Kong after it was found to contain up to twice the level of lead permitted under local regulations. In Sweden, the National Food Agency also found high levels of arsenic in such preparations as Niu-Huang Chieh-tu-pein, Divya Kaishore Guggul and Chandraprabha Vati, mostly used for the treatment of mumps, sore throat, tonsillitis, toothache, skin infections, anorexia and fever in young children.
None of these products were licensed or authorised for sale in the UK, although they can be obtained through internet suppliers. Only products carrying the Traditional Herbal Registration symbol should be used.
Some Chinese doctors argue that the working and methods of TCM are unreliable and fake. Perhaps the most high profile sceptic is Ning Fanggang, a doctor at Beijing’s Jishuitan Hospital, who has pledged to give 100,000 yuan ($16,250) to any registered Chinese medicine doctor who is able to demonstrate at least 80% accuracy in diagnosing pregnancy within 12 weeks of conception by using the traditional method of taking a pulse.
The rules for the challenge have now been set; there will be 32 test subjects, randomly selected from a group of 40 women, half of whom will be pregnant and half not pregnant. As of late November, no challengers had registered for the challenge.
Despite its deep roots in China, the future for TCM is uncertain. Undoubtedly some herbs contains extremely powerful active ingredients and these will continue in use whatever happens. But other treatments are much more difficult to adjudicate. The very nature of TCM, with its holistic treatments and individualised prescriptions, means it is impossible to produce an objective guide to what works and what is mere quackery. In the end, money is likely to be the deciding factor. Those who can afford to pay thousands of dollars for expensive, but potentially effective, western drugs will do so; those that can’t will do what they have always done and call in on the herbalist in the market.
December 12, 2014，by Denis Green
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