Can East meet West in medicine? Integration is a slow process
Liberian Joelle Karnwhine came to China two years ago to study Western medicine, but now she has expanded her discipline to include Chinese traditional medicine.
Now a postgraduate student at Shanghai University of Traditional Chinese Medicine, Karnwhine is taking courses that integrate Chinese and Western medicine.
"My clinical practice shows me that Chinese traditional medicine improves blood flow to the eyes in treating conditions such as dry eyes, optical nerve atrophy and diabetic macular edema," she said. "In addition, I found it can help treat insomnia, lower back pain, constipation, facial paralysis, and can even promote beauty."
Liberian Joelle Karnwhine, a Shanghai postgraduate student,sees great opportunities for traditional Chinese medicine in Africa.
She also found traditional treatment beneficial for herself.
Karnwhine said massage on several acupoints on her head helped ease her long-term migraines.
"Now whenever I feel the onset of a migraine, I begin to massage those acupoints, and the headache disappears instantly," she said. "For about eight months now, I have not taken any pills for migraine."
In recent years, traditional Chinese medicine has become more internationally recognized. Schools for its study have opened in the West. In US alone, about 50 programs are accredited by the American College of Acupuncture and Oriental Medicine.
Lawrence Tien, a doctor of acupuncture and Oriental medicine for 17 years in California, said there are more than 12,000 acupuncturists operating businesses around the US, where more than 10 million acupuncture treatments are administered annually.
Acupuncture has become popular in the US with office workers seeking to relieve muscle pain, lose weight.
"Because acupuncture is considered an 'invasive treatment' in California, it requires a license to practice, issued by the California Acupuncture Board," Tien said.
Most of Tien's clients are office workers seeking to relieve muscle pain, lose weight or promote general physical and emotional well-being.
"Although many people in the US believe that the theories and practices underlying traditional Chinese medicine are not based on scientific knowledge, I'm still fascinated by the rich culture behind it," Tien said. "It has a tradition of 'preventive' treatment. So for Chinese medicine, maintaining health is the goal and treating disease is just a means."
A US patient who identified herself only as Lisa M. said acupuncture cured her long-term TMJ disorder related to a clicking, painful jaw.
"All any dentist or doctor ever told me was, 'Yeah, there's something wrong with your jaw. Try not to open your mouth too wide or eat hard things'," she said.
But after a massage and acupuncture session, the symptom disappeared for the first time in 10 years.
While acupuncture and massage are becoming more commonplace in the US, herbal medicine is having a tougher time entering the mainstream market.
Tien said traditional Chinese medicines still are classed as "dietary supplements" and are not as strictly regulated as prescription or over-the-counter drugs. No license is required to sell them.
The road to these "supplements" being categorized as prescription or over-the-counter drugs is long and winding, especially for compound preparations. The requirement for three phases of clinical trials deters most Chinese makers of traditional medicine from seeking to enter the US market.
"It's an enormous investment, which might reach billions of dollars – way beyond the interests of most Chinese companies," said Dr Zhan Changsen, vice president of Shanghai Hutchison Pharmaceuticals.
One example is a type of "compound dripping" pill widely used in China to treat angina. Clinical experiments in the US have been conducted on and off for nearly two decades, but the treatment has yet to be approved by the US Food and Drug Administration.
"We need to find other ways to introduce our medicines to overseas market, but it depends on which market it is," Zhan said.
Shanghai Hutchison Pharmaceuticals' Danning brand herbal tablets are now sold in the Canadian market.
Hutchison makes a traditional medicine called "Danning tablets (胆宁片)" that has acquired a "natural product number" issued by Health Canada and is now available in Canadian pharmacies as an over-the-counter drug under the trade name Biliflow. The medicine is used to treat chronic gallbladder inflammation and constipation.
"Different countries have different requirements for herbal medicines," said Zhan. "Canada doesn't require three phases of clinical trials for the registration of compound traditional medicine preparations and recognizes data collected from China."
Before entering the Canadian market, Hutchison spent years to "standardize" Biliflow. It set up criteria for the whole process of production to ensure that every batch of Biliflow contains the same amount of active ingredients and has the same effectiveness.
"It was a great challenge to measure how active ingredients are metabolized in the body because the content is quite low generally," Zhan said.
Red sage (丹参)
Zhan explained that the effectiveness of traditional Chinese medicine is mainly questioned overseas because of the different theoretical systems underlying Western and Chinese medicine.
Under the Chinese system, prepared herbs are classified according to "taste and character (性味)" and "channel tropism (归经)." The later is a core feature of herbal property theory, which classifies drugs acting in the "body's viscera and meridians" to illustrate a drug's effects on a certain part of the body.
Under the Western system, a medicine is defined by its content, character, identification, composition and contaminants, in addition to other criteria.
Currently, 15 types of herbs, such as panax notoginseng (三七) and red sage (丹参), have been included in US pharmacopeia, and 14 in the EU system.
"But it is still a long way to go, especially for compound traditional medicine preparations to be globally recognized," Zhan said. "But the success of Biliflow broadened our horizon, and we believe there will be more herbal remedies reaching overseas markets."
Karnwhine is also confident about her future career in traditional medicine.
"I feel it has so much potential that most parts of the world have yet to experience," she said. "I intend to open a traditional Chinese medicine hospital back in my country someday and perhaps further expand into other African countries to give people access to effective and affordable treatment without heavy costs."
