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June 24, 2011

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TCM team-up

THE Chinese mainland and Taiwan are teaming up to promote traditional Chinese medicine globally and aim to jointly develop drugs for the international market. Li Huizi and Fu Min report.

Traditional Chinese medicine has long been fighting for status in a world dominated by Western medicine, and now advocates from the Chinese mainland and Taiwan are joining forces to pursue global recognition for TCM.

Under a TCM cooperation agreement, both sides are also expected to jointly develop new medicines for the international market, including treatments for cancer, infectious disease and autoimmune disease, according to Wang Chengde, director of the department in charge of exchanges with Hong Kong, Macau and Taiwan under the State Administration of TCM.

He addressed a recent seminar at the third Straits Forum in the southeastern city of Xiamen, Fujian Province.

He did not elaborate.

In Taiwan, TCM is considered an alternative medicine, TCM hospitals are banned and TCM treatments represent only around one-twentieth of the Taiwan market. Still, Taiwanís TCM promoters are diligent and have reached out to other countries.

The Chinese mainland and Taiwan use different standards and techniques for their TCM preparations, which cannot be sold in each otherís markets. Taiwan imports 90 percent of the ingredients for TCM from the mainland.

Taiwanís TCM is more advanced in manufacturing and produces standardized granular extracts which are sold in capsules. On the mainland, herbs are usually decocted, a more laborious process.

Both the mainland and Taiwan attach great importance to TCM as ìan indispensable part of Chinese culture,? according to Yu Wenming, deputy director of state administration of TCM. He addressed the same seminar.

Taiwan has more experience and advantages in hospital management, health care, drug research and development and international marketing, whereas the mainland boasts great development resources and a huge market, Yu said. The Chinese government has made development of TCM an important part of its medical reform plan.

ìThe two sides have broad room for collaboration,? he said.

Cross-Strait cooperation on TCM started in the late 1980s, but in the past, both sides focused on short-term benefits, but now they have a shared goal ó to jointly promote TCM globally, Yu said.

A tough new European Union directive on traditional herbal medicinal products, fully implemented in May, shocked Chinaís ambitious TCM sector that has wanted to enter the global market.

The directive requires all herbal medicinal products to obtain a medical license from any EU member state before it can be allowed in the EU market. Not a single Chinese herbal medicinal product has been licensed so far, mainly due to the prohibitive registration cost and lack of required evidence to prove the product has a 30-year history of safe use, including 15 years in the EU.

Hard sell abroad

By elevating the threshold, the directive appears to be trying to block Chinaís TCM producers from the EU market.

ìOn one hand, the EU doesnít believe that science can prove the efficacy of TCM, which is used by the EU as a reason for its policy,? said Shau Yio-Wha, general director of the Biomedical Technology and Device Research Laboratories of Taiwanís Industrial Technology Research Institute.

ìOn the other hand, the EU member states covet the profits of the herbal medicine market and have invested heavily in it themselves,? he said. ìGermany began herbal medicine research many years ago; therefore, the directive also aims to protect its own industry.?

Despite this, TCM promoters are not giving up. On June 1, the Foci Pharmaceutical Co, based in Lanzhou in northwestern Chinaís Gansu Province, applied for a product license for a medication containing concentrated Chinese angelica herb from the Swedish drug administration. It was the first TCM producer to apply for a license in the EU. If the medication is authorized in Sweden, it will be accepted by other EU countries.

As the worldís largest market for herbal medicinal products, the EU takes up more than 40 percent of market share.

TCM did not enter the EU market until the mid-1990s, when it was sold as food supplements instead of drugs.

While TCMís export value to the EU only made up 14 percent of the total in 2010,.

ìActually, itís unnecessary to worry about TCMís development after the EU ban, since the mainland has a huge market and official support,? Shau said.

He said the world heritage of TCM should be ìwidely promoted and shared by all mankind in order to pass it to future generations.? Last November, acupuncture, a TCM therapy, was listed by the UNESCO as an intangible part of cultural heritage.

The key to TCMís globalization is to make it understood by Westerners, Shau said, adding that practitioners should ìmodernize it and use science to prove it.?

TCM reflects China's dialectic philosophy and has been passed down over thousands of years. In TCM, the understanding of the human body is based on the holistic understanding of the universe as described in Taoism, and the treatment is based primarily on the diagnosis and differentiation of syndromes. It includes herbal medicine, acupuncture, massage and dietary therapies, which are common throughout East Asia.

Western medicine, developed over only hundreds of years and encompassing methods such as surgery and radiation, cannot cure all diseases and is weak in preventing infectious disease, which is exactly TCM's strength, according to Shau. "TCM has every reason to develop and thrive," he said.

Honeysuckle, a major TCM ingredient, sold out during an outbreak of the A/H1N1 influenza in 2009, which caused nearly 180 deaths in China, since the herb was said to prevent the infectious disease. Its price surged 10-fold due to the high demand.

Despite TCM's seemingly magical effects, it's not a testable method, which complicates research on TCM's efficacy. TCM uses different physiological and disease models from that of modern medicine, and makes assumptions that are inconsistent with scientific principles.

"It's very difficult to explain TCM to Western medicine practitioners, as the two have fundamentally different language systems and for them, TCM is a foreign language," said Professor Wang Yanhui of Xiamen University's Medical College.

Shau said the mainland and Taiwan should together improve TCM's "clinical evidence," introduce new methods such as "using genes to prove its curative effect," and draw up a standard in order to surmount international hurdles.

"Currently, there are no standards for TCM, so the mainland and Taiwan should work together to formulate one accepted by the global market," Shau said.

However, Professor Wang said a standard is "hard to establish," as it is difficult to "quantify" TCM therapies. For example, different physicians would prescribe different medicine to different patients even if they share the same illness, but practitioners of both sides look forward to a standard.


"In Taiwan, many practitioners turned to outside markets, especially the West, decades ago, to persuade Westerners to understand or accept TCM," Shau said, saying Taiwan should share its experience of overseas promotion and the medicine's modernization.

On the mainland, boiling and decoction is common, either at home or in a pharmacy, but it's not convenient for many people.

"Busy people prefer 'pill' instead of decoction, and instead of pure treatment, some use TCM for health care and disease prevention," Shau said. The granules are exported to many countries.

Long ago, Taiwanese practitioners set up clinics overseas. According to a cross-Strait medical cooperation accord signed last December, both sides will increase cooperation on ensuring safety of herbal ingredients, clinical research and academic study.

Under the agreement, Wang said, the two sides could and would jointly develop new drugs and share qualification and clinical data to speed market entry.


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