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MAINTAINING CHINESE MEDICINE'S UNIQUE CHARACTERISTICS DURING MODERNIZATION

Abstract

This paper was delivered by Dr. Leung at the The First International Conference and Exhibition of the Modernization of Chinese Medicine, March 16, 2002 (Hong Kong), organized by MCMIA.  Dr. Paul Coates, Director of the US Office of Dietary Supplements was the key-note speaker at the Conference.

Traditional Chinese medicine has an extensively documented history that dates back at least three thousand years.  It is a multifaceted health-care system that includes various areas of traditional practice such as acupuncture, qigong, and Chinese materia medica (CM).  It is holistic and preventive.  It is also the most advanced non-allopathic health-care system in the world, developed over millennia through the trial-and-error process on literally billions of human subjects.  Hence, the accumulated information on disease prevention, disease treatment, and health maintenance is extensive, which must be preserved and modernized.  Modernization is not simply using CM as a source of raw materials for new drug development or using modern scientific methods to study CM without considering the relevance of such studies to CM’s traditional practice.  True modernization of CM must make use of modern science to make CM relevant to a modern society, yet at the same time not abandoning CM’s accumulated wisdom.

Introduction

 Chinese medicine, as it is traditionally practiced, has an extensively documented history that dates back at least three thousand years.  It is a multifaceted health-care system that includes various areas of traditional practice, such as Chinese materia medica, diet therapy, acupuncture, qigong, massage, and others.  It is holistic and preventive.  It is also the most advanced non-allopathic health-care system in the world, developed over millennia through the trial-and-error process on literally billions of human subjects.  Hence, the accumulated information on disease prevention, disease treatment, and health maintenance is extensive, and must be preserved.  Modernization is not simply using CM as a source of raw materials for new drug development or using modern scientific methods to study CM without considering the relevance of such studies to CM's traditional practice.  True modernization of CM must make use of modern science to make CM relevant to a modern society, yet at the same time not abandoning CM's accumulated wisdom.  For simplicity and for lack of expertise in the other traditional aspects, Chinese medicine (CM) discussed in this presentation will be limited to its materia medica aspect.


Chinese medicine paradigm: practical or obsolete

Although traditional Chinese medicine (TCM) is empirically based, it has an extremely well-developed theoretical foundation that unfortunately is also not easy for the casual student to comprehend. Due to its esoteric nature (especially its terminology), this part of TCM is probably the main cause of misunderstanding by modern science and medicine. Consequently, TCM is often considered as ‘nonscientific’ and ‘superstition-based.’ Because of this, its survival has been seriously threatened during the past century. Both the Nationalist and the Communist governments have tried to ‘modernize’ it or even replace it with modern, science-based medicine. However, there have been no coordinated efforts to assure that ‘modernization’ is indeed modernization and not merely simplifying TCM to fit into modern medicine’s framework. Consequently, despite failures to abolish TCM altogether, the TCM with over two thousand years of traditional wisdom has taken a serious toll. And concerns have been raised inside and outside of China as to whether TCM is in danger of losing its tenets and true value as a time-honored health-care system, as schools of TCM have been gradually eliminating the classics from their curricula and incorporating modern allopathic practices and diagnostic techniques as part of the ‘new’ or ‘modern’ TCM. The outcome is that many recently trained TCM physicians are deprived of a solid training and knowledge in the classics but, instead, given minimal training in modern allopathic medicine in the name of ‘modernization.’ If this trend continues, there will not be qualified practitioners and teachers in TCM who can carry on the mission of preserving and imparting the age-old wisdom of TCM to future generations of TCM physicians.1,2 In addition, with the increasing interest of Westerners in TCM, a new generation of TCM physicians is being trained in a translated and abridged version of TCM. This further adds to the problem. The reason is that only a very minor portion of the documented wisdom of TCM has been interpreted and translated into English, hence even the most popular and highest-quality English texts lack depth in scope and accuracy in the interpretation of TCM concepts. The end result is not only that the current practice of TCM is greatly handicapped and its quality suffers, but also that a new version of TCM has emerged which cannot be equated to the TCM steeped in traditional wisdom. The materia medica (CM) aspect, which used to be an integral and inseparable part of TCM, has been gradually heading towards the field of natural medicines as practiced in the West and is in danger of losing its identity as part of TCM.

Although Chinese materia medica is only a part of the total traditional Chinese medical system, it is nonetheless the most developed and the most extensively and continuously documented natural medicine system in the world. From 365 drugs described in the Shen Nong Ben Cao Jing 神 農 本 草 經 (the Shennong Herbal) 2,000 years ago, the number has grown to over 12,800 by the last decade.3-5 In addition, formulas or prescriptions used in the practice of CM are well documented. A recently published formulary describes 100,000 classic prescriptions in detail.6,7 Considering that the use of CM normally involves multi-drug formulas in accordance with traditional principles and practice, the actual number of formulas currently being used worldwide, which have not been published, should be many times more than 100,000. Although still viewed by most of the modern medical and scientific communities as ‘non-scientific,’ properly formulated CM is especially adept at preventing and treating common viral and immunologic diseases (influenza, cold, allergies, etc.) which modern allopathic medicine with all its modern resources and technology still cannot treat adequately. For example, in my opinion, there is still no Western parallel to traditional formulas like Yu Ping Feng San (Jade Screen Powder 玉 屏 風 散 ) and Yin Qiao San (Honeysuckle Forsythia Powder 銀 翹 散 ) for preventing and treating influenza and the common cold, even though these formulas are traditionally used, in TCM terms, to ward off or remove the ‘evil’ (xie邪) or ‘wind evil’ (feng xie風 邪 ) that causes these conditions. In addition, CM contains the richest source of nutritional supplements in the form of traditional tonics, developed over a period of thousands of years, with documentation dating back to around 1,000 BC. For the above reasons, not only can CM stand alone as a well-established health-care system, it can also serve as a source of pharmaceuticals and nutritional supplements for a modern society and modern medicine.

Currently, the practice of CM involves the following areas:

Combination of CM

Use of patent formulas

Automated preparation, e.g., decocting

Integration/combination of CM herbs with modern pharmaceuticals

Use of modern allopathic techniques (e.g., injections, X-ray diagnosis)

In addition, the following modern technologies are increasingly being employed:

Good agricultural practice (GAP)

Good manufacturing practice (GMP)

Quality assurance /quality control/good laboratory practice (QA/QC/GLP)

Isolation and use of active principles (e.g., berberine & andrographolide)

Scientific investigations of active principles and/or efficacy

The traditional practice of CM is focused on a preventive and holistic approach that is contrary to the allopathic nature of modern medicine. Hence, some of the above practices are not typical of the traditional CM practice (e.g., injections, X-ray diagnosis, isolated chemicals). However, these may not be totally undesirable or out of character for CM as long as the adopted techniques are complementary to TCM practice. The reason is that, over the centuries, the practice of TCM has adopted numerous drugs from Western sources, which eventually have become standard CM. Examples include drug aloe, myrrh, and senna. Hence, it is not too farfetched to envision some of the allopathic practices may someday become part of modernized CM. Only time will tell.


What is modernization of CM

The modernization of CM means different things to different people.  To the pharmaceutical chemist, it is the isolation of active principles from which to make new pharmaceuticals; to the pharmacologist and Western medical doctor, it’s proven clinical trials; to the quality-control chemist, it’s standardization of CM with marker compounds; and to the TCM physician, it may mean easing the one-on-one doctor-patient relationship to adapt to the trend of increased mass production and use of patent formulas and instrument/computer-assisted diagnosis. Hence, it is obvious there are many issues that need ongoing discussion and debate. And there are no easy answers or solutions. I hope this Conference will allow us to start the dialogue and debate among experts from China and elsewhere.

How to modernize CM without abandoning its traditional wisdom and values

'Modernization' of CM can be effected in two ways: (1) Use modern science to make CM relevant to our modern society, yet at the same time not abandoning CM’s accumulated wisdom; and (2) use modern scientific technologies to evaluate and adapt CM to our modern society without bothering to consider the relevance of such actions to its traditional rationale and wisdom.

During this session, I hope both methods of modernization will be discussed. The first method, in my opinion, is the ideal one, and definitely more desirable, but it is also much more difficult, if not impossible, to achieve. It will require a combination of expertise from classically trained, highly experienced TCM professionals (teachers, practitioners, etc.) and scientifically trained professionals in the biomedical or related fields. On the other hand, the second method needs no collaboration between the two groups of professionals. All one needs is to forge ahead and apply one’s expertise to CM in whatever manner one inclines, based on one’s training and experience. Because of this, my major concern is that this second method has already been started way ahead of the first and is being given too much attention and importance by scientists, which may overshadow the value and importance of the first. Unless we make serious efforts, with financial and intellectual commitment on an international level, to bring together scientists and traditionally trained TCM professionals to work together in this modernization effort, the law of inertia will lead to an arbitrary application of modern technologies to TCM, which may not result in true modernization. In my personal opinion, certain ongoing attempts or activities in modernization do NOT qualify as true modernization of CM. The following is a partial list of these activities:

New drug development using CM as raw materials – the end result is a modern pharmaceutical drug that has nothing to do with CM.

Using chemical markers as sole criteria to determine the quality of CM, which frequently don’t have the same properties and efficacy of the CM in question.

Arbitrarily equating a chemical or a group of chemicals to a CM, resulting in chemical compounds that often have no relevance to the original CM, e.g., ginsenoside Rb1 does not represent Asian or American ginseng, though both contain it.

Irrelevant pharmacological investigations and evaluations of CM, such as testing a single chemical in a CM containing dozens to hundreds of such compounds and projecting it to hold the pharmacologic activity of the CM involved.


To achieve true modernization, the following modern technologies need to be instituted and appropriately applied:

Good agricultural practice (GAP) – strict control of pesticide use; control of heavy metals contamination; improve harvesting and processing techniques (e.g, eliminate sulfur treatment whenever feasible; etc.)

Good manufacturing practices (GMP) – e.g., improve sanitation and control of reproducibility of CM products from batch to batch.

Quality assurance/quality control (QA/QC) – start with raw material identification and authentication using modern botanical, physicochemical, and biological (bioassay, gene expression, etc.) techniques to assure production of reproducible and consistently efficacious CM that resemble closest the traditional CM.

Computerization of CM research and health applications – establish database of CM theory/terminology correlated with modern medical terminology to help demystify CM so that it will be more easily understood, appreciated, and utilized by modern science; database to centralize information on R&D and applications of CM; etc.

And the following unique CM characteristics must be preserved:

Diagnostic principles

Preventive/holistic aspect

Harvesting and processing rationale – a highly developed rational system not matched elsewhere

Formulation theory/rationale – maximizing the therapeutic effects of CM and minimizing their potential adverse effects


To maximize the benefits of CM to the modern world, the following areas are worth exploring:

Relevance of modern scientific disciplines (e.g., chemistry, pharmacology) in CM research

CM as source of modern drugs

CM (tonics/foods) as source of dietary supplements

New opportunities offered by the US Dietary Supplements Health and Education Act (DSHEA) for CM products


Concluding remarks

Chinese medicine (including its materia medica) is a well-established and stand-alone health-care system. But it needs to be modernized and made relevant to a modern society. Our challenge in its modernization is to not simply take the easy path by the irrelevant application of modern science to CM but rather, using modern technologies appropriately, to upgrade its cultivation, collection, processing, identification, authentication, formulating, manufacturing, documentation, and other traditional practices, while at the same time preserving its traditional rationale.

References

(1) Fruehauf, H., “Science, politics, and the making of “TCM” - Chinese medicine in crisis,” J. Chin. Med., 61 (Oct.): 6-14 (1999).

(2) Liang Hua-long, “Three paradoxes in the development of traditional Chinese medicine,” Henan Zhongyi, 21(1): 5-12 (2001).

(3) Zhonghua Bencao Editorial Committee, Chinese State Administration of TCM, Eds. , Zhonghua Bencao 中華本草 (The Chinese Herbal), 10 Vols. Shanghai Scientific and Technical Press, Shanghai, 1999.

(4) Institute of Chinese Materia Medica, China Academy of TCM, Eds., Quanguo Zhongcaoyao Mingjian 全 國 中 草 葯 名 鑒, 3 Vols. People’s Health Press, Beijing, 1996.

(5) Leung, A.Y., “The Chinese Herbal (Zhonghua Bencao),” Leung’s (Chinese) Herb News, 30 (Janurary/February): 1-3 (2001).

(6) Leung, A.Y., “Encyclopedia of Traditional Chinese Prescriptions (Zhongyi Fangji Da Cidian),” Leung’s (Chinese) Herb News, 31 (March/April): 2-3 (2001).

(7) Peng Huai-ren et al., Eds., Zhong Yi Fang Ji Da Cidian 中医方劑大辞典 (Encyclopedia of Traditional Chinese Prescriptions), 11 Vols., People’s Health Press, Beijing, 1993-1997.
 

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