Transition
to modern ... argy wormwood, a leaf extract, is burned on top of ginger slices
on a man's back at a Traditional Chinese Medicine hospital in Fuzhou, China.
With
a 3,000-year history, such treatments are seeking greater recognition in western
circles
It's a long road to legitimacy.
Traditional Chinese medicine, which has been tried and tested on its home turf
over three millennia, is working hard to gain mainstream acceptance in the
west, where there are stricter regulations and requirements for therapeutic
trials.
Based on a range of remedies
inherited from Taoist scholars, and also on acupuncture, traditional Chinese
medicine is derived from Confucianism. But it would be a mistake to suppose that what is
now officially known as TCM has traversed so many centuries unchanged.
"TCM is a political
construct dating from the 1950s, following on from the1949
revolution," says Professor Paul Unschuld of Berlin Medical
University, who chairs the International
Society for the History of East Asian Science, Technology and Medicine.
"It includes selected aspects of historical Chinese medicine, but it is
also influenced by the rationale and concepts of modern science."
Despite the slow acceptance,
there have been advances. In Europe, where little was known about Chinese
practices, TCM gained traction in the 1970s as part of the movement towards
alternative therapies. A World Health Organisation congress emphasised the
legacy of such medicine in a 2008 declaration, though stressed the need to
hasten its modernisation and acceptance.
China, too, has realised the need
to integrate and advance, and has been working since 2007 to abandon some
outdated methods.
"Many Chinese medicinal
herbs are used in south-east Asia, in Singapore and Indonesia, but also Russia
and Australia," says Professor Guo De-an, chief scientist at the Shanghai
Institute of Materia Medica and a member of the Chinese Academy of Sciences.
"But Europe and the United States account for the major part of the global
pharmaceutical market."
To gain a foothold in the market
for prescription drugs in the US and Europe,
manufacturers must comply with the standards set by the agencies tasked with
regulating healthcare products. They must satisfy requirements for both
pharmacological effectiveness and overall quality.
"There is still no
appropriate methodology for assessing the effects of TCM," says Guo.
"It is not sufficient to measure blood pressure … the question is how to
carry out group studies of individualised treatment."
Robert Verpoorte, the head of the
Natural Products laboratory at Leiden University in the Netherlands, advocates
a new approach to studying traditional Chinese medicine. "We should base
our approach on the effects produced by a medicinal plant on living organisms
resulting from the activity of its many components," he says. "This
approach is used in systems biology and metabolomics, which studies all the
metabolites present in a cell or organism."
Guo sees two ways ahead for
medicinal plants used in TCM: "Either they can be authorised, through a
simplified procedure, as traditional plant-based treatments; or they may obtain
the status of herbal medicinal products for human use as defined by the
European Medicines Agency," he says.
The Chinese government has
encouraged efforts to obtain US and EU authorisation of TCM-derived drugs for
treating heart disease and menopause-related disorders.
"For the time being there is
no alternative to western assessment criteria and we must work hard to provide
the data required by the US and EU agencies," he says.
As these therapies seek to gain
greater recognition, the question of side effects also looms. Chinese advocates
have tended to assert that TCM remedies are safe.
But at a recent conference on
such treatments in Bologna, one speaker diverged from this position.
Defending an approach based on
strict clinical trials, Bian Zhao-xiang, the head of the clinical division of
the School of Chinese Medicine at Hong Kong Baptist University, said: "We
must improve reporting of side effects."
Co-operation between China and
the west is developing. "Several major western drug firms have invested in
industrial co-operation projects," says Guo.
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