(13.03) Traditional Chinese Medicine is Making the World Healthier

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Traditional Chinese Medicine

Is Making The World Healthier

By Anita Tang

March 2013

Plans by the Chinese Government to improve health care for all Chinese people – along with modernization of Traditional Chinese Medicine – offers opportunities for furthering nutritional and other health-care education in the People’s Republic of China and the West.

Will the increasing acceptance and growing use of Traditional Chinese Medicine throughout the world help change the landscape in modern medicine by focusing more on preventive care? If so, does the world have the relevant knowledge and needed specialists to handle it?


“Healthy China 2020” Reform Points the Way

In 2008, the Chinese government set a target for year 2020 when a sound, basic medical and health system covering both urban and rural residents would be established, this reform is known as “Healthy China 2020”. The reform is introduced to ensure that everyone enjoys access to basic medical and health services.

In March 2009, the Chinese government promulgated the "Opinions on Deepening Reform of the Medical and Health Care Systems" with the goal to provide the entire nation with basic medical and health services as a public product, and ensure that everyone, regardless of location, nationality, age, gender, occupation and income, enjoys equal access to basic medical and health services.

As shown in Table 1, in 2009, there were 35 countries in the world that had per capita health expenditure of over US$ 2,000, adjusted to PPP. China ranked 111 on the list with a PPP-adjusted per capita health expenditure of US$ 347 (5.1% of GDP).

In 2011, the total health expenditure in China accounted for 5.1% of the country’s GDP, reaching RMB 2,434.591 billion (~US$ 386.44 billion) and representing RMB 1,806.95 (~US$ 286.82) per capita.

Liu Yuanli, Senior Lecturer on International Health at Harvard’s School of Public Health, is directly involved in the strategic planning of Healthy China 2020. He suggested that total health expenditure in China in 2020 should account for 6.5% of the country’s GDP. Since China’s GDP is expected to reach RMB 105-127 trillion (~US$ 16.67-20.16 trillion) then, 6.5% of it will translate to RMB 6.83-8.26 trillion (~US$ 1.08-1.31 trillion); at a projected population of 1.5 billion people, health expenditure per capita will be RMB 4,553.33 (~US$ 722.75).

Over the years, China has worked hard to develop its medical and health services with Chinese characteristics “in accordance with the policy of making rural areas the focus of its work, putting disease prevention first, supporting both traditional Chinese medicine (TCM) and Western medicine, relying on science, technology and education, and mobilizing the whole of society to join the efforts, improving the


people's health and serving socialist modernization.”

With its planned health expenditure, China can only achieve its Healthy China 2020 goal by using both TCM and Western medicine – complementary practices have already been used today in many of China’s hospitals and clinics.

Tradition Chinese Medicine

The History

In a white paper released in December 2012 by China’s Information Office of the State Council –“Medical and Health Services in China” – it noted that “Traditional Chinese Medicine has a long history in China, and is a medical science formed and developed by the Chinese people in their daily work and life as well as attempts to treat diseases. TCM is the crystallization of the wisdom of the Chinese people, and has made important contributions to the continuance and thriving of the Chinese nation. Known for its unique characteristics and advantages in curing common diseases, frequently occurring diseases and complicated diseases, TCM has also proved effective in treating infectious diseases and is very popular among the Chinese public for its low cost, satisfactory curative action and mild side effects. TCM plays an irreplaceable role in China's medical and healthcare endeavors, and the Chinese government has always supported and promoted its development.”

Based on a tradition of more than 2,000 years, TCM includes acupuncture, massage (tui na), cupping, gua sha, dei-da, exercise (qigong, tai chi), dietary therapy/Chinese food therapy, and various forms of herbal medicine.

Modernizing TCM in China

The white paper also point out that “A modernization drive for TCM has been initiated. The State has proactively promoted theoretical and technical innovations in TCM through the application of modern science and technology, and has gained important achievements in basic TCM theory, clinical diagnosis and treatment, TCM technology and other related areas. China promotes the industrialization and modernization of TCM, and as a result the industrial scale and technical level of TCM has increased markedly. Currently, there are about 1,500 manufacturers of TCM pharmaceuticals in China, and the variety, quantity and processing technique of TCM pharmaceuticals have improved by a wide margin. The State attaches importance to the protection of TCM's cultural values, and 41 TCM programs have been included on the nation's intangible heritage list.”


Traditional Chinese Medicine and the World

International exchanges and cooperation in TCM are actively being promoted. China has signed treaties with TCM contents or special TCM cooperation agreements with over 70 countries. Cooperation in TCM application in foreign countries, and TCM education and technical cooperation has steadily expanded. Currently, over 160 countries and regions around the world have access to TCM.

TCM is well accepted and widely practiced in Asia and countries in Africa. However, in the developed economies, TCM is not viewed as mainstream medicine; in the U.S., it is only considered one of the complementary and alternative medicines.

Acupuncture is the most widely recognized TCM therapy. Table 2 is adapted from “Understanding Acupuncture” by Birch and Felt, 1999 Churchill-Livingstone; it shows early European exposure to acupuncture.

Table 2, some 19th Century references to acupuncture in the West Date Country Author(s) Nature of Publication 1802 England W. Coley Article about the uses of acupuncture 1816 France L. Berlioz Book on acupuncture for chronic disorders 1820 Italy S. Bozetti Book on acupuncture 1821 England J.M. Churchill Article on use of acupuncture in treating rheumatism 1822 USA Anonymous Medical journal commentary favorable to acupuncture 1825 France J.B. Sarlandiere Article on the use of electron-acupuncture for gout 1825 Italy A. Carraro Article on uses of acupuncture 1826 USA F. Bache Article about uses of acupuncture 1826 England D. Wandsworth Article about using acupuncture for pain relief 1826 Germany G.E. Woorst Review article on status of acupuncture 1827 England J. Elliotson Article about acupuncture for rheumatism 1828 Germany J. Bernstein Article about acupuncture for rheumatism 1828 Germany L.H.A. Lohmayer Article about acupuncture for rheumatism 1828 France J. Cloquet, T.M. Dantu Book on acupuncture 1833 USA W.M. Lee Article about acupuncture for rheumatism 1834 Italy F.S. da Camin Described Sarlandier’s work on electro-acupuncture 1871 England T.P. Teale Article about acupuncture for pain relief

In Belgium, Denmark, France, Italy and the Scandinavian countries, acupuncture therapy must be performed only by medical doctors.

Germany

Since classical medicine has limitations in many chronic and difficult illnesses and may generate grave side effects, more and more German patients have sought after help from Chinese medicine clinics in recent years. Statistics of German TCM institutions show that Germany has 50,000 doctors who treat patients with Chinese medicine, accounting for one-sixth of the total in the country, and more than 2 million patients see Chinese doctors every year. There are increasing numbers of Sino-German joint ventures in the TCM area in Germany. Though millions of Germans favor the traditional medicine from China, and TCM has been proved effective in treating many chronic and difficult illnesses, government authorities and


national health-care insurance funds are still reluctant to give TCM a parallel status with classical medicine. Other than acupuncture being qualified for partial insurance reimbursement, TCM is basically excluded from Germany's health-care insurance system.

France

In France, the first TCM hospital was established in Paris in 1996, focusing on providing acupuncture, message, Chinese medicine, exercise and food-therapy treatments, and related research. A number of social health-insurance agencies have agreed to pay for TCM treatment; some people suggest that there is a possibility that application of herbal remedy can soon undergo clinical trial in France.

England

At present, an estimated 2.5 million English spend US$ 158 million (GBP 90 million) annually on therapies by TCM, such as acupuncture, massage, and herbal medicine. There are more than 350 Chinese medicine pharmacies in England, and 60 percent of Chinese medicines are imported from China. Not only is TCM well accepted in England, its colleges have started to offer degree programs in TCM.

Table 3 below is a list of member organizations of Euro TCM.

Table 3, TCM in Europe: Member Organizations of Euro TCM1

Country Abbreviation Full name Type

Austria MED CHIN

Medizinische Gesellschaft für Chinesische Gesundheitspflege in Österreich

College

PROTCM Austria Austrian Professional TCM Federation Professional org.

TCMA-W TCM Academy - Campus Wien College

TCM-U TCM University Private University

Belgium BAF Belgian Acupunctors Federation Professional org.

BATCM Belgian Association of Traditional Chinese Medicine Scientific org.

OTCG Opleidingsinsituut Traditionele Chinese Geneeswijzen College

Bulgaria BAAPT Bulgarian Acupuncture Association of Physical Therapists Professional org.

Czech Republic CSBS Ceskoslovenska Sinobiologicka Spolecnost College

CSBSPTCM Praktici TCM Acupuncture org.

NBJ Foundation of the white crane Professional org.

TCMB TCM Bohemia - Klinika Tradicni Cinske Mediciny Clinic

England BC Bodyharmonics Centre College

Germany ABZ Süd Ausbildungszentrum Süd College

1 Source: “Chinese Medicine in Italy, Integrated into the Modern Medical System, by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon.


DBVTCM Deutscher Berufsverband für TCM Professional org.

MFTCM Mercurius Chen Xing College

TCMA-B TCM Akademy Campus Berlin College

TCMA-M TCM Akademy Munchen College

Greece ESPKI Elleniko Sillogos Paradosiakis Kinezikis latrikis Professional org.

HAOTCM Hellenic Academy of TCM College

Hungary H.SH.T Hungarian Shaolin Temple College

Italy SIA Societa Italiana di Agopuntura College

Ireland ACMO Acupuncture and Chinese Medicine Organisation Professional org.

AFI Acupuncture Foundation TCM Training Programme College

AFPA Acupuncture Foundation Professional Association Professional org.

AIAc Association of Irish Acupuncturists Professional org.

Netherlands DDF Dutch Dao Foundation Professional org.

HTUTCM Hwa To University of Traditional Chinese Medicine College

OC Oriental College College

ZHONG Ned. Vereniging voor Traditionele Chinese Geneeskunde Professional org.

Serbia/Montenegro RHCI Railway Health Care Institute Professional org.

SJC Balkan Su Jok College College

Slovac Republic SINBIOS Slovenska Sinobiologicka Spolecnost College

Slovenia SAATCM Slovenian Association of Acupuncture and TCM Professional org.

Sweden CESAMQ Cesamq international TCM organization College

NJA Nei Jing College College

SAA-TCM Swedisch Acupuncture Association Professional org.

STCMS Society of Traditional Chinese Medicine Sweden Professional org.

YSTCM Yangtorp School of TCM College

United States

TCM is widely used in the United States. Although the exact number of people who use TCM in the United States is unknown, it was estimated in 1997 that some 10,000 TCM practitioners were treating more than one million patients a year. According to the 2007 National Health Interview Survey, which included questions on the use of various therapies, an estimated complementary and alternative medicines 3.1 million U.S. adults had used acupuncture in the previous year. In addition, according to this same survey, approximately 17 percent of adults use natural products, including herbs, making it the most


commonly used therapy. In another survey, more than one-third of the patients at six large acupuncture clinics said they also received Chinese herbal treatments at the clinics. Although TCM is used by the American public, scientific evidence of its effectiveness is, for the most part, limited. Acupuncture has the largest body of evidence and is considered safe if practiced correctly. There is limited scientific evidence as to whether some Chinese herbal remedies may be safe and others not.

Most states license acupuncture, but states vary in their inclusion of other TCM components (e.g., herbal medicine) in the licenses they issue. The federally recognized Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) accredits schools that teach acupuncture and TCM, and about one-third of the states that license acupuncture require graduation from an ACAOM-accredited school. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) offers separate certification programs in acupuncture, Chinese herbology, and Oriental bodywork. Almost all licensing states require completion of NCCAOM’s national written exam; some states also require a practical exam.

Chinese Herbal Medicine Makes News

New York Times, May 10, 2004: “After years of hesitation, world health agencies are racing to acquire 100 million doses of a Chinese herbal drug that has proved strikingly effective against malaria, one of the leading killers of the poor.”

However, the high-profile Chinese herbal drug procurement by world health agencies did not help Chinese herbal medicines take off in the developed economies.

The European Commission (EC) stipulated in 2004 that TCMs must be registered, before the end of April 2011, prior to being sold in the European Union (EU). Even though the EC allowed traditional herbal products to be imported, produced and marketed, after registration through a “simplified procedure”, isolating and identifying the active molecules in TCMs is difficult as they often consist of several herbs. As a result, very few TCMs were successfully registered during those seven years.

In 2010, China's TCM exports to the EU market were valued at US$ 250 million (GBP 152 million), accounting for 13 per cent of the nation's total TCM exports.


Beijing Tongrentang Group Co., the largest producer of TCM in China, started its overseas expansion in 1993. In 2001, it had 45 joint venture or wholly-owned stores in 16 countries and regions. Its sales were about RMB 10 billion with exports accounting for only US$25.4 million (RMB 162.56 million). Chinese-patented TCMs are sold as dietary supplements, not as medicines, in the European Union and the U.S. due to local regulations.

Two features of European drug regulation make the European market more hospitable to natural remedies – (1) it costs less and takes less time in Europe to approve medicines as safe and effective, and (2) a substance’s historical use is a valid way to document safety and efficacy in the absence of scientific evidence to the contrary.

To date, in the United States, there are still no standard regulations for herbal medicine; herbal products can be marketed only as food supplements. An herb manufacturer or distributor can make no specific health claims without FDA approval. FDA regulations for dietary supplements (including manufactured herbal products) are not the same as those for prescription or over-the-counter drugs; in general, the regulations for dietary supplements are less strict. Some Chinese herbal treatments may be safe, but others may not be. There have been reports of products being contaminated with drugs, toxins, or heavy metals or not containing the listed ingredients. Some of the herbs are very powerful and can interact with drugs, and may have serious side effects.

A historical moment for TCM happened on March 22, 2012 – The Dutch Medicines Evaluation Board (MEB) granted marketing authorization for Di'ao Xinxuekang capsules, making this Chinese herbal medicine the first Chinese therapeutic drug to receive marketing authorization in a western market.

Will this be the beginning of a new era of Chinese herbal medicine finally breaking into the mainstream market in the developed economy? Can TCM, a medical remedy that costs less than Western drugs, share the market with its Western counterpart?

Potential Opportunities for TCM Worldwide

TCM treats recurring symptoms of illness and draws on preventive care to boost one's immunity against illness and disease; its preventive care seeks to maintain the body's balance. It provides an option as a less expensive medical alternative – in terms of unit cost (per doctor’s visit) and cumulative cost (preventative translates to potentially fewer chances to get into big medical issues).


A 2009 report based on a 2007 survey by the U.S. Center for Disease Control and Prevention of more than 23,000 American adults nationwide found that more than one-third of them use alternative medicine. Some suggested that TCM and other alternative medicines fill a growing need in the current healthcare system while others insisted it is the growing number of uninsured individuals who are opting for less expensive alternatives.

1. Chinese Physicians/TCM Practitioners

Demand for alternative medicines will raise the demand for alternative-medicine practitioners in the U.S. Establish a TCM school in the U.S. can help fill the demand.

Establish a teaching institution in China and linking it with a U.S. counterpart presents added benefits: (1) Access to experts in both countries, especially in China where TCM was originated and widely

practiced, (2) Gain certification and license in both China and the U.S., (3) Attract enrollment from both the U.S. and China (or even other countries) to get trained in the

program and possibly get cross-trained in both campuses, (4) Provide students in the U.S. an extended job market in China, and Chinese students an extended

job market in the U.S.

2. Nutritionists

There are three different types of nutritionist certifications in China that are recognized by the government:

(1) Public nutritionist (公共营养师) – certificate issued by the Ministry of Labor and Social Security

(劳动和社会保障部), this is the most authoritative certificate in the industry.

(2) Nutritionist (营养师) – certificate obtained by passing the qualifying exam, issued by the Ministry

of Health (卫生部); only medical doctors/physicians are allowed to take the exam.


(3) Nutritionist (营养保健师) – certification obtained through training by the joint effort of the HR

department of the National Center of Mobile Personnel (人事部全国人才流动中心), a division directly under the Ministry of Human Resources and Social Security, and the China Healthcare

Association (中国保健协会). This is an industry qualification that may be useful in the health care area.

Since 2005, the government has started drafting a National Nutrition Ordinance, but it has yet to finalize and release. At present, there are some 5,000 certified public nutritionists in China – fewer than one nutritionist for every 250,000 people. It is estimated that China needs at least 400,000 nutritionists.

With China’s rising income and standard of living, there will be increasing demand for nutritionists. The one-child policy and the rapidly aging population (in 2011, there were 185 million people in China who are 60 or over; by 2050, 30% of China’s population will be over 80 years old) lead to increase demand for nutritionists in schools, hospitals, canteens, senior-related communities, and more.

Opportunity not only exists in the training of Western nutritionists but training of nutritionists with Western and Eastern guidance – infusing Chinese food therapy into the training. This category of hybrid nutritionists should be in big demand in China, the U.S. and other parts of the world.

Traditional Chinese Medicine Can Further Health of Nations

Traditional Chinese Medicine is highly embraced by the Chinese and the Chinese government, and exhibiting acceptance in other countries and regions. Not only will TCM provide some answers to helping China to reach its Healthy China 2020 goal, it is a culture and history that China is proud of and can be useful around the world.

TCM can be an area China may pursue to expand its soft power to the world. As China continues to expand its economy and its global influence, it will bring to the world its culture and history, while bringing back to China foreign cultures and history.

Opportunities with China exist in many areas, and Traditional Chinese Medicine is one of them – particularly in educating nutritionists for the Peoples’ Republic of China, and establishing cross-national, health-educations institutions and practitioners in China and Western nations.

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(13.03) Traditional Chinese Medicine is Making the World Healthier