Traditional Chinese medicine: one country, two systems (1)

Health in China: Traditional Chinese medicine: one country, two systems


Summary

China is the only country in the world where Western medicine and traditional medicine are practised alongside each other at every level of the healthcare system. Traditional Chinese medicine has a unique theoretical and practical approach to the treatment of disease, which has developed over thousands of years. Traditional treatments include herbal remedies, acupuncture, acupressure and massage, and moxibustion. They account for around 40% of all health care delivered in China. The current government policy of expansion of traditional facilities and manpower is being questioned because many hospitals using traditional Chinese medicine are already underutilised and depend on government subsidies for survival. Research priorities include randomised controlled trials of common treatments and analysis of the active agents in herbal remedies. As more studies show the clinical effectiveness of traditional Chinese medicine, an integrated approach to disease using a combination of Western medicine and traditional approaches becomes a possibility for the future.


An ancient textbook

Over thousands of years traditional Chinese medicine has developed a theoretical and practical approach to the treatment and prevention of disease. The first documented source of Chinese medical theory, the Huangdi Nei Jing ("Inner Classic of the Yellow Emperor") was written between 300 BC and 100 BC. It describes the diagnosis and treatment of a huge range of disorders and gives advice about healthy lifestyles, exercise, and diet which conforms remarkably well with current recommendations for the prevention of chronic disease. There is also accurate dietary advice about how to avoid micronutrient deficiency diseases such as beri-beri, xerophthalmia, and goitre.1

As with most forms of traditional medicine, the theoretical and diagnostic basis of traditional Chinese medicine cannot be explained in terms of Western anatomy and physiology. It is rooted in the philosophy, logic, and beliefs of a different civilisation and leads to a perception of health and disease that is alien to Western scientific thinking. But it is an entirely coherent system, with internal logic and consistency of thought and practice.

In the early 1950s it was feared that traditional Chinese medicine would be superseded by the "more modern" Western medicine. To counter this, a systematic assessment of the effectiveness of the traditional treatments was thought necessary. So thousands of experiments and clinical studies were carried out during the 1950s. Most were case series of patients with a specific Western disease who were then treated with traditional techniques—for example, a series of 112 cases treated for angina pectoris and another of 121 cases of bronchial asthma treated with subcutaneous acupuncture. The result of all this research activity was that in 1958 it was declared that traditional Chinese medicine and Western medicine should be given equal respect and place in the healthcare system. 1 Since then there has been a consistent policy of support for the traditional system.

The treatments

The main traditional treatments are herbal remedies, acupuncture, acupressure and massage, and moxibustion. Acupuncture and herbal medicine are most widely used. The basic idea of acupuncture is that the insertion of fine needles into certain points can restore internal balance; it is the internal imbalance which leads to illness. Each acupuncture point has a defined therapeutic action, and a range of points is usually used. Acupressure simply means applying pressure to the acupuncture points, and moxibustion means applying heat to them. In the West acupuncture has become associated with analgesia, its appeal being increased by plausible biological mechanisms for its action (such as the gate theory and endorphin release). It also gained fame for its use in operative anaesthesia, but it is rarely used for this now.

Herbs are used much more commonly than acupuncture. The first pharmacopoeia was written at the time of the Nei Jing. The substances used range from herbs and minerals to rather strange animal products such as cows' gallstones or parotid gland secretions. The traditional doctor usually chooses from around 500 common classical prescriptions. Typically these are combinations of some five to 15 herbs that are boiled up together to make a drink.1 Nowadays many formulations are available in the more convenient form of tablets, capsules, and ampoules. The pharmaceutical industry is booming: sales of Chinese medicine increased by 52% between 1988 and 1992 (and sales of Western medicine increased by 51%).2 The licensing of drugs and official regulation of their sale is equally stringent for Western and Chinese medicines. But in these days of the market economy, unregulated medicines are widely sold and many products are available over the counter. It is estimated that only 20% of China's hospitals buy medicines from licensed state wholesalers, because the black market products are much cheaper.

(to be continued)