TCM's quest for healthy 'yang gold'

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Hong Kong's ongoing search for new sources of business to replace its previous manufacturing base has, in recent years, seen a parade of potential money spinners placed on the table. Some, like the development of its creative industries, including product and clothing design; and the emergence of a digital entertainment industry, have been welcome surprises.

However, one sector that was once touted as a promising industry for the city never quite found its "yang" tonic after enjoying the briefest of attentions in the media spotlight.

When Hong Kong returned to China in 1997, then Chief Executive Tung Chee-hwa pledged to promote the city as an international hub of traditional Chinese medicine (TCM), with TCM updated and modernized for today's consumers.

By 2000, when Hong Kong's economy had become moribund, the drive to promote TCM as a possible saviour had grown in momentum. The city was hailed as a prime location for research and development and a manufacturing hub for this industry. So what went wrong?

Robert Ko, an associate professor in the department of biochemistry, Hong Kong University of Science and Technology, believes there was a lot of talking, with "certain businessmen looking around for an excuse to create another property development".

He should know. Ko is at the forefront in research into the benefits or otherwise of Chinese medicines and through his association with product manufacturers and as a member of the Chinese Medicines Board of the Chinese Medicines Council of Hong Kong, he witnesses the industry first-hand.

"The reality is that Hong Kong as a market for TCMs is very small," he said. "We do not have a large population compared to the mainland, and they have research facilities there, so why would the mainland businesses want to come here? Because of this, I believe it would be very difficult for the city to develop into a hub for TCM in Asia."

That a market for TCM exists, among the local Chinese at least, is nevertheless beyond doubt. Scattered throughout the city, on main roads and down nondescript side streets, in just about every district of the city, can be found a multitude of shops selling all manner of dried herbs, plants, roots and preserved remains of creatures once alive, to a never-ending stream of customers seeking relief from one ailment or another. And this humble market is part of a growing demand for herbal medicine that rings cash registers to the tune of over US$20 billion globally per year, according to Trade and Development Council estimates.

Locally, these dispensaries, Chinese equivalents of a Western pharmacy, are all part of a surprisingly well-monitored industry dealing in TCMs, that includes registered practitioners, licensed shop owners and qualified dispensers that answer to government established regulatory bodies and industry representatives like the medicines council, says Ko. But while having such a system in place is a step in the right direction, it can only go so far.

The hurdles

Where the industry has trouble, he says, is with research into the medicines themselves. "We need to ensure there is sufficient analysis of the herbs and substances that go into Chinese medicines. Traditionally, Chinese medicine has had its own scientific system that explains the use of these herbs and guides the treatment of diseases for patients. But it is a science that is not understood by modern (medical) practitioners. What we need to do is take these (medical) claims and substantiate them using modern means."

Also, "at the moment, we do not conduct clinical trials on all the products that are sold here. This is standard practice with Western medicines, where they use a 'double blind' method during the trials, but this is not done with all TCMs. One reason is because we lack the regulatory body to ensure medicines meet certain standards. Now all medicines sold from either Hong Kong or the mainland require clinical studies to be carried out before they can be sold, but this requirement does not apply to medicines already in the market.

"The testing of Chinese medicines is still in its infancy (here). Most researchers do work related to typical academic research, so we do not have the sufficient resources or manpower to carry out such trials. And the medical community has been reluctant to participate until they can see evidence that these medicines work. So again it falls back to us."

Another hurdle to overcome before gaining acceptance among the broader medical community and proponents of Western medicine is attaining a consistency during the manufacturing stages, says Ko.

"TCMs are, for the most part, made up of herbs and other natural ingredients. Being all natural, there is a great variation in their composition - depending on the season, the location they were grown, the climate conditions when they were harvested. All these factors will have an effect on the products. Furthermore, the way in which these compounds are combined to make the medicines varies from product to product. No two (batches) are the same. So it is very difficult to conduct reliable analysis and test the effects of these medicines."

By comparison, Ko believes Western medicines are much easier to analyze and control.

"Western medicines are usually based on a molecule or a combination of molecules. The effect of these compounds is already known, so it is easy to conduct trials to see if the desired effect is achieved. And being non-natural and composed of specific ingredients, they can be manufactured in a lab exactly the same every time. With Chinese medicine, it is difficult to do this."

Holistic cool

Despite the challenges, Ko is unswayed in his belief in the benefits of TCM.

"One of the biggest hurdles we face is getting acceptance in the broader market and the world of Western medicine." And this, he says, is where the Department of Biochemistry comes in.

The department, which carries out the work required in research contracts entered into by the university itself, does the all-important analysis of compounds put forward by manufacturers for inspection. It also develops bioengineering processes with the aim of developing consistent methods of medicine production utilizing specific techniques such as distillation, extraction, crystallization and chromatography.

The leading academic and researcher believes with the right manufacturing processes, inconsistencies and variations in compounds, which hamper research, can be negated.

"Most importantly, we describe the properties and the (chemical) processes which take place in TCMs in modern medical terms." This is vital if they are to gain acceptance in the medical community, he adds.

"At the moment, only the big mainland companies and companies for which we do research, are having their products analyzed. They have the budget and resources to do this. And they choose products which they believe will be strong performers in the market. Our particular strength is in chemical processing, because we have the only chemical processing department in Hong Kong."

With an increasing number of sufferers of ailments, from cancer to diabetes, not finding satisfaction with Western medicines, that future may be now as they turn to alternative forms of medicine, including TCM, for help. And Ko is in no doubt as to why.

"Western medicine and Chinese medicine have developed along different paths because they look at sickness in a completely different way," he says. "With Western medicine, the drugs that are developed and given to patients target the disease itself. This is done by flooding the body with chemicals in order to wipe out the illness. It cannot destroy the disease completely and so it is left to the body's immune system to get rid of the rest.

"But the strength of these chemicals causes other problems. It may impair the function of other organs in the body. And they can damage or disable the body's immune system, so it is unable to remove the virus completely. So people will experience side effects, even other illnesses, because of the medicines and because the body is weak, the disease can return.

"Chinese medicine, on the other hand, takes a holistic approach. Some medicines are given for the disease itself, but others are given to help heal the body. If you have a disease, an imbalance has been created in the body. Vital organs, which are linked to the rest of the body, may not function properly and this will affect the whole. TCMs look at the arrangement of the body's functions in its sickened state and try to restore the balance. A healthy body is then better able to fight the disease."

An added advantage is gained from using ingredients that are natural, he says. If taken in the wrong proportions or combination they will, at worst, have a diminished or zero effect, but not be harmful.

The specialist and veteran researcher is heartened by what he sees is a trend as the Western world looks more and more to Chinese medicine for insights and advances in curing illness. This will only raise the profile and status of TCM even further.

And while Hong Kong may not develop into a key hub, what it can offer is its superior research and testing facilities and business acumen to help mainland companies develop their products for the global market. It can also help in areas like marketing, handling and repackaging of goods to improve their image, he says. At least one high-profile mainland company, Tong Ren Tang has done just that, with the recent announcement that it is building its first production base for TCMs outside the mainland at the Hong Kong Science and Technology Park in Tai Po.

"Right now, we are in a transition phase," says Ko. "We are making important advances, but everyone should realize this takes time. Western medicine did not develop overnight and it is the same with Chinese medicine."

From ChinaDaily