MAINTAINING
CHINESE MEDICINE'S UNIQUE CHARACTERISTICS DURING MODERNIZATION
AbstractThis 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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