Made in China

OUTLOOK TRADITIONAL ASIAN MEDICINE TCM Made in China Although modern medicine is established in Asia, traditional medicine also plays a big role in people’s healthcare — and is gaining in popularity in other countries too. BY FELIX CHEUNG medicine is commonly called Kampo. In these problems, cough or phlegm, and sniffs to detect countries, different traditional medicines any body odours that might indicate ill health. raditional medicine — a system of ancient might use different prescriptions or methods of Next, the practitioner questions how the medical practice that differs in substance, diagnosis, but the underlying philosophy and patient feels overall: if they are hot or cold; methodology and philosophy to modern principles are similar because they all originate whether they are sweating; how their stools Tmedicine — plays an important role in health in China. look; if the patient is thirsty, and so forth. maintenance for the peoples of Asia, and is TCM encompasses a wide range of practices, Finally, the TCM practitioner palpates the becoming more frequently used in countries including some that are familiar to the West, such patient’s wrist to feel the quality of the pulse in the West. Despite their growing popularity, as herbal medicine and acupuncture, plus others and so assess overall health. there are misunderstandings about what these that remain peculiar to most Westerners, such as It is the pattern of all these signs and symp- traditional medicines comprise and the stand- cupping (heated cup therapy), tuina (massage), toms that determines the diagnosis, and the ards they conform to. Here we aim to clear up qigong (movement and breathing exercises) and practitioner would then prescribe a treatment some of the common misconceptions. moxibustion (burnt mugwort therapy). Investi- regimen consisting of any or all of the above- Within Asia, traditional Chinese medicine gating whether these therapies have underlying mentioned therapies to resolve the problem. (TCM) is the system with the longest history. mechanisms of action is now a central task in Within TCM, the healthy human body is viewed TCM was developed through thousands of TCM research. This Nature Outlook will focus as an entity in equilibrium — the ultimate goal years of empirical testing and refinement. It mainly on herbal medicines, which are the most of treatment is to restore the qi (energy) and yin- was the only medical practice in China before comparable to modern pharmaceuticals. yang (balance) of this complex system. Although the early nineteenth century, when English mis- the concept might seem strange to Western per- sionaries arrived, bringing with them the drugs, TCM TREATMENT ceptions, many TCM practitioners draw a paral- devices and practices of modern medicine. A visit to a TCM practitioner involves four lel with the well-understood scientific concepts Outside China, in other Asian countries examinations. First, the patient’s skin com- of metabolism (roughly equivalent to energy), including Japan, South Korea, Malaysia and plexion, physique and tongue condition are and immunity and homeostasis (balance) (see Vietnam, traditional medicine has formed its inspected. The TCM doctor then listens to the ‘All systems go’, page S87’). own distinct culture. In Japan, the traditional patient’s voice to see if there are any breathing Most people who visit a TCM practitioner ANCIENT CHINA Two important Clockwise from The system of traditional Chinese medicine has developed books were top left: Wang over thousands of years and features many classic texts that written in the Shuhe and an are still read today. Han dynasty: excerpt from his Shennong’s Pulse Classic; Shennong Yandi Huangdi’s Internal Classic, Classic of Materia (Red Emperor); one of the earliest Medica, – the Huangfu Mi. collections of TCM, was rst book to cover medicinal probably completed In the Jin during the Warring States herbs, minerals and animal dynasty, period. It is still regarded Huangfu Mi as a must-read for all parts in the rst century AD, compiled The TCM students and A–B Classic of practitioners. and Zhang Zhongjing's Acupuncture Treatise on Cold and Moxibustion (259 AD) and The Yellow Emporer, Damage and Wang Shuhe Huangdi, is shown presenting Miscellaneous compiled the books containing medical Diseases in Pulse Classic knowledge to Lei Gong, the 200 AD. (300 AD). Thunder Duke (right). 475 BC–2 BC 206 BC–220 AD 266–420 68–907 WAING STATES HAN JIN TANG 500 BC 250 BC 0 250 AD 500 750 000 S82 | NATURE | VOL 480 | 22 DECEMBER 2011 TRADITIONAL ASIAN MEDICINE OUTLOOK do so because they are feeling unwell. However, that, in the United Kingdom, approximately one collaborating centres for traditional medicine: others visit a TCM practitioner while perfectly in ten people had used CAM in the past year, 7 in China, 5 in Africa, 3 in Europe, 2 in each of healthy. The reason is that TCM stresses the whereas in Switzerland and the Scandinavian Japan, South Korea, India and the United States, importance of preventive treatment — that is, countries, the equivalent figures were between and 1 in both North Korea and Vietnam. These its practitioners claim to determine a patient’s three and five out of ten. centres aim to encourage research into tradi- state of qi and, if it is thought to be weak, attempt Australia has even higher figures: a national tional medicine, provide professional advice to to strengthen it before a problem surfaces. survey found that two-thirds of the population support the development of WHO guidelines had used CAM in the past year and, at 69 mil- and, if necessary, provide training. TCM PREVALENCE lion, the number of visits by Australian adults to Pharmaceutical companies are also taking an Millions of patients around the world use CAM practitioners was almost identical to the active interest in TCM research. For instance, TCM or a related practice. In Hong Kong and number of visits made to medical doctors. London-based GlaxoSmithKline has established mainland China, approximately 60% of the a research and development base in Shanghai, population has consulted traditional medicine PROSPECTS OF TCM RESEARCH China, and is actively seeking to expand its practitioners at least once. According to the lat- Modern medicine often clashes with traditional operations in traditional medicine. Most of est national survey data, anywhere from 60% to medicine such as TCM because of the inher- these companies are hoping to find the next 75% of the populations of Taiwan, Japan, South ent difficulties both sides have of appreciating ‘miracle’ drug like artemisinin, an antimalarial Korea and Singapore use traditional medicine the others’ principles and concepts. In an effort drug extracted from the medicinal plant sweet at least once a year. to promote integration of traditional medicine wormwood, which has saved millions of lives. Elsewhere around the world, the use of TCM with modern medi- Ensuring the safety, efficacy and quality is also common. The United States is the biggest cine, the World Health of TCM requires a great deal of research and importer of TCM products from China, having Investigating Organization (WHO) development. Investment from the central Chi- spent US$7.6 billion in 2010. According to the whether these endorsed an inter- nese government is substantial. The total fund- Centers for Disease Control and Prevention in therapies have national agreement ing allocated to TCM research was 4.9 billion Atlanta, Georgia, four out of ten US adults use underlying drawn up in Beijing yuan (US$770.5 million) in 2010 — more than complementary and alternative medicine (CAM) mechanisms in November 2008 quadruple its 2001 level. In 2010, according to in a given year. The CAM category includes TCM of action is to support the safe the State Administration of Traditional Chi- and other herbal medicines, as well as non-tradi- now a central and effective use of nese Medicine, 6,093 Chinese scientists were tional medicines such as homeopathy — so using task in TCM traditional medicine employed in TCM research — a 53% increase CAM as a proxy for TCM might overestimate its research. within the modern since 2001. use, but it does indicate a general willingness to healthcare systems of As of May 2011, China has signed 91 TCM seek alternative forms of therapy. member states. partnership agreements with more than 70 Europe, too, is experiencing a growth in the Countries are pursuing this type of integra- countries, which aim to promote greater use of TCM. In 2010, exports of TCM products tion in various ways. For instance, between 2006 recognition of TCM around the world. ■ from China to European countries amounted and 2010, Malaysia opened 12 hospitals that to nearly US$2 billion, and that figure is rising practice both modern and traditional medi- Felix Cheung is editor of Nature China in at 10% per year. National surveys have found cine. In addition, the WHO has established 25 Hong Kong. During the In 1578, Li Shizhen Protestant missionaries peaceful Tang compiled The (below) arrive in 1807, MODERN CHINA Dynasty, TCM Compendium of bringing Western In 1967, Mao Zedong initiated spread to other Materia Medica, the doctors and medical Project 523 that led to the countries and most comprehensive knowledge. The rise of development of artemisinin to continued to documentation of Western medicine combat malaria, which evolve. In 659, the use of medicinal accelerated after the reinvigorated TCM the Chinese herbs, minerals and Opium Wars in development. In 2003, when government animal parts. 1839–1842 and severe acute respiratory issued the 1856–1860 (left). syndrome (SARS) hit China, Newly Revised TCM was used to fend o SARS, Materia Medica, The Qing dynasty giving further encouragement. ocially collapsed in 1911 replacing and the Republic of Shennong's China was founded. Classic. Below: A patient receives Foreign powers had moxibustion in modern-day China.

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