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A prescription for health


Chinese pharmacists make up prescriptions
Pharmacists at a hospital in Anhui province make up a prescription (Photo by Liu Qinli for China Daily)

By Xu Lin (China Daily, 2011-11-22)

China is promoting its traditional medicine overseas but is discovering many obstacles to entering the global market. Xu Lin reports.

Jiang Yuechun turned to traditional Chinese medicine (TCM) after Western treatments failed to remove dozens of flat warts coating the backs of her hands.

The 31-year-old university teacher in Beijing says the warts shriveled away without scarring after she imbibed a porridge of coix seeds (a tropical grain).

She is among many Chinese seeking TCM treatments in place of modern Western remedies at a time when her homeland is promoting the internationalization of its traditional medicine - already regularly used in about 140 countries but part of the healthcare systems of only a few.

China's 12th Five-Year Plan (2011-2015) earmarks financial support for TCM's globalization. It also outlines plans for TCM's development and industry regulation.

"Despite TCM's popularity overseas, only a handful of countries, such as Singapore, legally recognize it," the Beijing University of Chinese Medicine's former president Long Zhixian says.

"Few countries include TCM in their healthcare systems."

Artemisinin - a southernwood extract used to treat malaria - is the only TCM widely accepted abroad, mostly in Africa, Beijing University of Chinese Medicine professor Gao Xuemin says. The World Health Organization lists it in its essential medicines catalogue.

Several other traditional remedies, including those for cardiovascular diseases, are undergoing clinical testing overseas and may soon be approved for international use.

But Long believes there are many obstacles to TCM's expansion in the global market.

Perhaps the most challenging is that TCM is based on traditional Chinese culture and philosophy. These include such concepts as the balance of yin (the cool, calming side of the body) and yang (the hot, stimulating side of the body), and the relationship of the five elements that are said to constitute the universe - fire, earth, metal, water and wood.

"Western culture is totally different," Long says. "It's not easy for them to believe in TCM if they don't understand these theories."

He says another difficulty is difference in scientific views. "Westerners value experimental data in medicine, while TCM is based on experience accumulated over the past 4,000 years," he says.

"They always try to understand TCM according to the Western medical perspective. But that doesn't make any sense. In my opinion, as long as a medicine cures, it's a good one."

More than 9,000 TCM treatments were approved for sale in the market in 2008, according to the White Paper on Status Quo of Drug Supervision in China.

These TCM treatments have all passed clinical safety tests. Most have a history of several centuries, Long says.

"Current technology can't detect the active ingredients in some TCM compounds, which are very complicated," he says.

Long says it's difficult to determine the numbers and ratios of ingredients in most TCM compounds. Determining which are active ingredients is even more challenging. Artemisinin is an exception, which is why it has been successfully globalized.

TCM doctor Zhou Chaofan says another challenge to internationalization is medicine export standards vary around the world, and China's standards often can't meet foreign countries'.

"Some TCMs use heavy metals, such as cinnabar and realgar, which may not meet some foreign countries' criteria," Zhou says.

Long agrees. "Standards for heavy metals are different in countries," he says.

"It's hard to establish a global standard for TCM because of its complicated ingredients lists."

But Long remains optimistic. "It's just a matter of time for TCM to officially enter the global market," he says.

"We first and foremost must promote Chinese culture, so foreigners can understand TCM's philosophy."

The market will surely open up if TCM can cure diseases Western medicine can't, he believes. And more experiments will provide clinical evidence of TCM's usefulness and show how it works.

Dozens of Western pharmaceutical companies are currently undertaking such research in hopes of entering the Chinese market as foreign brands.

"This is a typical approach," Long says. "They first take notice of a TCM treatment and then research and finally produce it. But the impact on the Chinese market is limited."

But some don't view TCM's prospects for internationalization as so promising.

Among their ranks is Fang Zhouzi, an academic known for his opposition to "pseudoscience" and TCM.

"TCM theories are not scientific," Fang says.

"They're just an amalgam of superstition, metaphysics, philosophy and witchcraft. They should be replaced by better medical science. Some theories aren't logical at all, such as eating bones to strengthen one's bones."

But time, tests and international opinion will tell whether TCM will become a basement of parochial quackery or a lofty pillar of global healthcare's architecture.

China to launch massive survey on TCM resources

China will soon launch its fourth national survey on Traditional Chinese Medicine (TCM) resources to secure the industry's sustainable development, according to a senior health official, reported by Xinhua News in November.

The preparatory work has been completed and a pilot program for the survey will commence soon, covering six provinces and regions, including Anhui, Hunan, Hubei, Sichuan, Xinjiang and Yunnan, said Wang Guoqiang, vice minister of health.

Wang, also director of the State Administration of TCM, made the remarks Sunday at the annual gathering for the country's pharmaceutical professionals.

The last survey on this subject, conducted between 1983 and 1987, indicated that the country had over 12,000 types of TCM resources with the majority in the wild.

Experts predict that it is very likely that has changed after more than two decades.

"A new survey is crucial in drawing major plans for TCM resources' management, protection and utilization," said Prof. Huang Luqi, vice president of the China Academy of Chinese Medical Science.

It may also help to build a dynamic assessment system for those precious resources, Huang added.

TCM generally refers to the comprehensive Chinese medical system based upon the body's balance and harmony.

Among the components of TCM are traditional herbal drugs and inherent therapies, including acupuncture, physical exercise, and remedial massage.

Official figures showed that the TCM industry posted a strong performance in 2010, with the output value up 29.5 percent year-on-year to reach 317.2 billion yuan (50 billion U.S. dollars), which exceeded that of the country's entire pharmaceutical industry.

In addition, experts have forecasted that TCM's annual output value in China will exceed one trillion yuan by 2015.

Overseas markets, however, have only granted limited recognition to TCM, partly due to Chinese pharmaceutical enterprises' failure to obtain accreditations from markets such as the European Union, where TCM is generally categorized as a "food supplement."

Some producers complain that TCM's clinical efficacy and the chemical composition of the drugs can hardly be explained in scientific terms.

To curb these difficulties for market access, Chinese regulators have invested heavily in TCM's R&D projects and called for innovation in building clinical R&D systems, setting up key TCM labs, facilitating technology transfers into the industry and improving R&D management and quality control.

Promoting TCM is not only a solution to help China achieve universal health care at less expense, but also an indicator of the country's soft power and influence abroad, Wang said.

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