Traditional Chinese Medicine - Introduction

Tuesday, October 30, 2012
Pressure from the payers in developed markets with publicly funded healthcare plans to curb drug spending growth, patent expiries, the entry of lower-cost alternatives and declining growth rates in developed markets are major challenges the global pharmaceutical market faces. In addition, the pharmaceutical industry's research and development programs have to adjust to the broad availability of low-cost generic options in many chronic therapy areas. Higher growth will occur in therapy areas with significant unmet clinical need, high-cost burden of disease, and innovative science that can bring new treatment options to patients.

IMS Health, an international consulting firm servicing the pharmaceutical industry, reports that the market reached a size of US$837 billion in 2009. Whilst emerging markets are expected to grow at a 14 - 17 percent rate, developed markets will only grow by 3 - 6 percent. The U.S. will remain the single largest market, with 3 - 6 percent growth expected annually in the next five years and reaching US$360 - US$390 billion in 2014.

China is not only assessed to become the world's third-largest market in 2011, it also fuels the gross output of Traditional Chinese Medicine (TCM) which has been growing at a pace faster than the average rate of the entire pharmaceutical industry. In 2008, the size of the TCM market was about US$26 billion and the yields totaled 1.2 million tons. By November 2009, the cumulative sales value of the TCM industry increased by 23 percent and amounted to RMB 222.166 billion, approximately US$32 billion.

Xinhua News Agency reported that in 2006 China exported traditional Chinese medicine to 164 countries and regions around the world, with export earnings reaching an all-time high of US$830 million. The export earnings represented a 14.5 percent increase from the previous year.

The implementation of the new medical reform as well as the launch of the Project of the Developing Traditional Chinese Medicine Industry stressed the backup and promotion of the TCM industry from the Chinese government. TCM is gaining on popularity for the environmentally friendly and holistic and alternative way of therapy it represents.

TCM Going Global

In 2006, more than 3,000 clinics of traditional Chinese medicine have been opened in Britain. Some 2.5 million British people spend a total of 90 million pounds annually to receive treatment of traditional Chinese medicine, including Chinese herbal medicine, massage and acupuncture. In France, there are 2,600 clinics of traditional Chinese medicine with 7,000 to 9,000 acupuncturists.
The United States has more than 20,000 traditional Chinese acupuncturists and 400 companies specializing in the sale of Chinese herbal medicine.

Traditional Chinese Medicine Demystified - History and Philosophy

To find the origins of TCM we have to go back in time. Way back, into ancient history. Into the China of over 2,000 years ago and entering the mythical world of Fu Xi, Shen Nong and Huang Di, three legendary rulers.

Fu Xi created the Book of Changes and developed the trigrams of Yi Jing (I Ching). Trigrams are eight diagrams used in Taoist cosmology to represent the fundamental principles of reality, seen as a range of eight interrelated concepts (Heaven, Lake, Fire, Thunder, Wind, Water, Mountain, and Earth). Each consists of three lines, each line either "broken" or "unbroken," representing yin or yang, respectively.

Shen Nong, the "Divine Farmer" and legendary emperor, is seen as the founder of herbal medicine who taught people how to farm. In order to determine the nature of different herbal medicines, Shen Nong sampled various kinds of plants, ingesting them himself to test and analyze their individual effects.

The first written documentation on traditional Chinese medicine and thus being the oldest medical textbook in the world is the Hung-Di Nei-Jing (Yellow Emperor's Cannon of Internal Medicine), dating back to between 800 BCE and 200 BCE. It extensively summarizes and systematizes the previous experience of treatment and theories of medicine, such as the meridian theory, and includes topics on physiology, pathology, prevention, diagnosis, treatment and acupuncture.

TCM has a long and rich history, and is the third oldest form of medicine with only Egyptian and Babylonian medicine predating it. To be still in use today, after thousands of years, is a tribute to its value as a form of health care.

TCM, relating to the philosophy of Taoism and Buddhism, reflects the Chinese belief that the life and activity of individual human beings have an intimate relationship with the environment at all scales. TCM considers the human at the center of the universe and as an antenna between celestial and earthly elements.

Water, earth, metal, wood and fire are the five elements of the material world. The world is a single unit and its movement gives rise to yin and yang, the two main antithetic aspects. The actual meaning of the term yin and yang is 'opposites', such as the positive and the negative.

The four bodily humors of qi, blood, moisture and essence and internal organ systems play an important role in balancing the yin and yang in human body. Proper formation, maintenance and circulation of these energies are essential for health. When the two energies fall out of harmony, disease develops. The physician takes into account this concept while treating patients. Drugs or herbs are used to correct this imbalance of yin-yang in the human body.

TCM's Benefits

As traditional Chinese medicine is based on differentiation of symptoms, not everyone will be treated the same way for the same problems. Thus, each person's treatment is personalized. As opposed to traditional western approaches to diagnosing and treating illness, TCM places more emphasis on the pattern of the symptoms involved. In treating the body, TCM practitioners focus on harmonizing the entire body because the body, mind, and spirit are united.

Traditional Chinese medicine has been reported to offer many benefits for individuals who use it. It is reputed to have the ability to improve a person's general health, is usually less costly than traditional medicine, and is not dependent on pharmaceutical products that very often cause side effects and sometimes require the use of additional pharmaceuticals simply to combat such side effects.

"Made in China" - A Label of Concern?

About 95% of general hospitals in China have traditional medicine departments and formal TCM training is an integral part of the national health program. This helps to ensure quality standards in health care delivery and China became successful in integrating TCM in the national health care system. Science-based approaches were utilized and introduced in the education of TCM with emphasis on research. As per a paper by the State Administration of traditional Chinese medicine of the People's Republic of China and released by the Shandong University in 1997, hospitals practicing TCM treat more than 200 million outpatients and almost 3 million in patients annually.

On a global basis, there have been concerted efforts to monitor quality and regulate the growing business of herbal drugs and traditional medicine. For example, the National Center for Complementary and Alternative Medicine has been inaugurated as the United States Federal Government's lead agency for scientific research in this arena of medicine. Its mission is to explore complementary and alternative healing practices in the context of science and research. The center is committed to explore and fund all such therapies for which there is sufficient preliminary data, compelling public health need and ethical justifications. In addition, the World Health Organization (WHO) has been active in creating strategies, guidelines and standards of botanical medicines.

Locally, the Law of the People's Republic of China on Guarding State Secrets, Provisional Rules on the Management of State Science and Technology Plans and Regulations on Protection of Traditional Chinese Medicines designed strict protection measures on TCM and let it enjoy much longer protection time than other medicines.

On an operational and provincial basis measures to effectively prevent counterfeiting and enhancing the quality of Chinese herbal medicine, track and trace was introduced. For example, the Hebei Province Food and Drug Administration issued new regulations and as of November 2009, Chinese Herbal Medicine production enterprises are required to use non-toxic non-harm and transparent packaging material. Labels must indicated the name, place of origin, specifications, manufacturer name, drug production license number, the product batch number, and production date.

The Future of TCM

On the future of TCM, Professor Yu, head of the Department of Oncology at the Beijing Hospital of Traditional Chinese Medicine and vice-chairman of the Beijing Anti-Cancer Association, commented that we are coming to the close of the 1st decade in the 21st century and TCM is projected to develop even further. Advancements in proteomics, genomics, molecular biology and stem cell research have enabled even more research directions for Modern TCM. In addition, well-conducted research into the mechanism of action of TCM will give it scientific credence.

Combining TCM and modern western medicine's use of differential diagnosis will lead to a more holistic understanding of the patient's disease as well as objectivity, and enable the doctor to understand the underlying pathology and reasons for loss of homeostasis.

Modern western medicine now leans in this direction as well. Current targeted therapy is more specific. For example ER/ PR (oestrogen receptor / progesterone receptor) positive breast cancers are amenable to treatment with endocrine therapy. TCM will continue to develop with current 21st century medical advancements and the practice of medicine in China will continue to modernize. The combination of TCM with western medicine will contribute greatly to global medicine.