TCM: Made in China

Traditional medicine — a system of ancient medical practice that differs in substance, methodology and philosophy to modern medicine — plays an important role in health maintenance for the peoples of Asia, and is becoming more frequently used in countries in the West. Despite their growing popularity, there are misunderstandings about what these traditional medicines comprise and the standards they conform to. Here we aim to clear up some of the common misconceptions.

Within Asia, traditional Chinese medicine (TCM) is the system with the longest history. TCM was developed through thousands of years of empirical testing and refinement. It was the only medical practice in China before the early nineteenth century, when English missionaries arrived, bringing with them the drugs, devices and practices of modern medicine.

Figure 1 
 
Next Outside China, in other Asian countries including Japan, South Korea, Malaysia and Vietnam, traditional medicine has formed its own distinct culture. In Japan, the traditional medicine is commonly called Kampo. In these countries, different traditional medicines might use different prescriptions or methods of diagnosis, but the underlying philosophy and principles are similar because they all originate in China.

Figure 2 
 
PreviousFigures index “Investigating whether these therapies have underlying mechanisms of action is now a central task in TCM research.”
TCM encompasses a wide range of practices, including some that are familiar to the West, such as herbal medicine and acupuncture, plus others that remain peculiar to most Westerners, such as cupping (heated cup therapy), tuina (massage), qigong (movement and breathing exercises) and moxibustion (burnt mugwort therapy). Investigating whether these therapies have underlying mechanisms of action is now a central task in TCM research. This Nature Outlook will focus mainly on herbal medicines, which are the most comparable to modern pharmaceuticals.

TCM treatment

A visit to a TCM practitioner involves four examinations. First, the patient's skin complexion, physique and tongue condition are inspected. The TCM doctor then listens to the patient's voice to see if there are any breathing problems, cough or phlegm, and sniffs to detect any body odours that might indicate ill health.

Next, the practitioner questions how the patient feels overall: if they are hot or cold; whether they are sweating; how their stools look; if the patient is thirsty, and so forth. Finally, the TCM practitioner palpates the patient's wrist to feel the quality of the pulse and so assess overall health.

It is the pattern of all these signs and symptoms that determines the diagnosis, and the practitioner would then prescribe a treatment regimen consisting of any or all of the above-mentioned therapies to resolve the problem. Within TCM, the healthy human body is viewed as an entity in equilibrium — the ultimate goal of treatment is to restore the qi (energy) and yin-yang (balance) of this complex system. Although the concept might seem strange to Western perceptions, many TCM practitioners draw a parallel with the well-understood scientific concepts of metabolism (roughly equivalent to energy), and immunity and homeostasis (balance) (see 'All systems go', page S87').

Most people who visit a TCM practitioner do so because they are feeling unwell. However, others visit a TCM practitioner while perfectly healthy. The reason is that TCM stresses the importance of preventive treatment — that is, its practitioners claim to determine a patient's state of qi and, if it is thought to be weak, attempt to strengthen it before a problem surfaces.

TCM prevalence

Millions of patients around the world use TCM or a related practice. In Hong Kong and mainland China, approximately 60% of the population has consulted traditional medicine practitioners at least once. According to the latest national survey data, anywhere from 60% to 75% of the populations of Taiwan, Japan, South Korea and Singapore use traditional medicine at least once a year.

Elsewhere around the world, the use of TCM is also common. The United States is the biggest importer of TCM products from China, having spent US$7.6 billion in 2010. According to the Centers for Disease Control and Prevention in Atlanta, Georgia, four out of ten US adults use complementary and alternative medicine (CAM) in a given year. The CAM category includes TCM and other herbal medicines, as well as non-traditional medicines such as homeopathy — so using CAM as a proxy for TCM might overestimate its use, but it does indicate a general willingness to seek alternative forms of therapy.

Europe, too, is experiencing a growth in the use of TCM. In 2010, exports of TCM products from China to European countries amounted to nearly US$2 billion, and that figure is rising at 10% per year. National surveys have found that, in the United Kingdom, approximately one in ten people had used CAM in the past year, whereas in Switzerland and the Scandinavian countries, the equivalent figures were between three and five out of ten.

Australia has even higher figures: a national survey found that two-thirds of the population had used CAM in the past year and, at 69 million, the number of visits by Australian adults to CAM practitioners was almost identical to the number of visits made to medical doctors.

Prospects of TCM research

Modern medicine often clashes with traditional medicine such as TCM because of the inherent difficulties both sides have of appreciating the others' principles and concepts. In an effort to promote integration of traditional medicine with modern medicine, the World Health Organization (WHO) endorsed an international agreement drawn up in Beijing in November 2008 to support the safe and effective use of traditional medicine within the modern healthcare systems of member states.

Countries are pursuing this type of integration in various ways. For instance, between 2006 and 2010, Malaysia opened 12 hospitals that practice both modern and traditional medicine. In addition, the WHO has established 25 collaborating centres for traditional medicine: 7 in China, 5 in Africa, 3 in Europe, 2 in each of Japan, South Korea, India and the United States, and 1 in both North Korea and Vietnam. These centres aim to encourage research into traditional medicine, provide professional advice to support the development of WHO guidelines and, if necessary, provide training.

Pharmaceutical companies are also taking an active interest in TCM research. For instance, London-based GlaxoSmithKline has established a research and development base in Shanghai, China, and is actively seeking to expand its operations in traditional medicine. Most of these companies are hoping to find the next 'miracle' drug like artemisinin, an antimalarial drug extracted from the medicinal plant sweet wormwood, which has saved millions of lives.

Ensuring the safety, efficacy and quality of TCM requires a great deal of research and development. Investment from the central Chinese government is substantial. The total funding allocated to TCM research was 4.9 billion yuan (US$770.5 million) in 2010 — more than quadruple its 2001 level. In 2010, according to the State Administration of Traditional Chinese Medicine, 6,093 Chinese scientists were employed in TCM research — a 53% increase since 2001.

As of May 2011, China has signed 91 TCM partnership agreements with more than 70 countries, which aim to promote greater recognition of TCM around the world.

http://www.nature.com/nature/journal/v480/n7378_supp/full/480S81a.html

TCM: Made in China
Felix Cheung
Nature Volume: 480, Pages: S82–S83 Date published: (22 December 2011) doi:10.1038/480S82a Published online 21 December 2011


中医——中国制造

中国传统医学包含许多方面，其中一部分和西方的相似，例如草药和针刺疗法，另外还包括一些对西方人来说很独特的治疗方法，比如拔火罐、推拿、气功（动作和呼吸练习）和艾灸。研究这些治疗方法起作用的潜在机理是目前中医研究的核心工作。这次Nature Outlook栏目将主要关注中药方面，对现代药物来说这是最有可比性的。

中医治疗

一名中医师的诊病包括四个方面。一是“望”，病人的面色、肤色、体型和舌苔情况都需要检查。二是“闻”，通过倾听病人的声音来考察是否有呼吸道问题、咳嗽或痰液，还有闻人体的气味，这也可能帮助找出潜在的疾病。三是“问”，询问病人所有的感受：是觉得”寒“还是”热“，是否出汗，二便如何，是否口渴等等。最后是”切“，中医师对病人手腕脉搏进行触诊并评价整体的健康情况。

这些病症都决定着最后的诊断结果，然后医师会开出一个治疗方案——上面提到的任一一种或者全部的治疗方法——来解决问题。在中医学上，健康的人体是一个均衡的存在——治疗的最终目的是为了恢复这个复杂系统的”气“（能量）和”阴阳“（平衡）。虽然对于西方的观念来说这似乎很奇怪，但是许多中医师能够把这些观念与新陈代谢（略等同于能量）、免疫力和内稳态（平衡）这些易理解的科学概念进行对比。

许多人不舒服时去看中医。但是，也有很健康的人去看中医的。因为中医学强调预防的重要性，换句话说，中医师会考察病人的气血状态，如果觉得可能会”气衰“时，会尝试去加强它，防止演变成大问题。

中医的盛行

全球数百万计的病人使用中医或者相关的治疗方法。在香港和中国大陆，约60%的人口至少咨询过一次中医师。根据最新的国家调查数据显示，无论是在台湾、日本，还是南韩、新加坡，有60%-75%的人口在过去一年里至少使用过一次传统医药。

在世界的其他地区，中医的应用也很普遍。美国是中国中医药制品的最大进口国，2010年的进口额达76亿美元。根据亚特兰大、乔治亚州的疾病防控中心调查显示，每10个美国成年人就有4个曾使用过替代疗法（CAM）。替代疗法当中包括中医药和其他草药，同时还有其他非传统医学，例如顺势疗法。当然用CAM作为中医药的替代来评估也许高估了中医药的使用人群，但它显示了普通人寻求替代疗法的意愿。

在欧洲，中医的使用人数也在增加。2010年，从中国出口到欧洲的中医药制品总量接近20亿美元，并且以每年10%的势头在增加。全国性调查发现，在英国，过去一年里大约每10人就有1人使用过替代疗法。然而在瑞士和斯堪的纳维亚半岛诸国的数据为每10人中有3-5人。

澳大利亚的数据甚至更高：一个全国性调查发现2/3的澳大利亚成年人在过去一年里曾寻求过替代疗法，而且6900万的澳大利亚成年人寻求替代疗法这个数字几乎就相当于现代医学从业者的门诊量。

中医研究的前景

由于双方在原则和观念上的固有差异，现代医学和传统医学，比如中医，经常发生冲突。为了促使传统医学和现代医学的整合，2008年11月世界卫生组织在北京起草了一份国际性协议，支持在成员国的现代医疗保健系统中安全有效地使用传统医药。

国家之间通过不同的方式来实现这种整合。例如，2006至2010年间，马拉西亚开放了12个能够同时提供现代医疗和传统医疗的医院。另外，世界卫生组织已经成立了25个传统医学合作中心：7个在中国，5个在非洲，3个在欧洲，2个分别在日本、南韩、印度和美国，1个在朝鲜和越南。这些中心成立的目的在于鼓励传统医学的研究，提供专业的建议去支持WHO方针的发展落实，同时如果有必要的话，提供培训。

制药公司对中医的研究也十分感兴趣。例如，伦敦的葛兰素史克（英国制药公司）已经在上海成立了一个研发基地而且正积极地力图扩张其在传统药物上的业务。这些公司的绝大部分是为了找到第二个类似青蒿素的“奇迹之药”，一种从药用植物青蒿中提取出来的抗疟疾药品，其使用已经拯救了几百万个生命。

确保中药的安全、有效和质量需要大量的研究和开发。中国中央政府对这方面的投资也是巨大的。2010年分配给中医药研究的全部经费达49亿人民币（7亿7千零50万美元），比2001年的四倍还要多。据国家中医药管理局介绍，2010年有6093名中国科学家投身到中医药的研究上，比2001年增加了53%。

直至2011年5月，中国已经和多达70个国家签署了91份合作协议，目的在于提高全球范围内中医药的认可度。

翻译出自:http://kan.weibo.com/con/3517033225233251