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Web-only Exclusives
November 30, 2000

From Our Correspondent: Hirohito and the War
A conversation with biographer Herbert Bix

From Our Correspondent: A Rough Road Ahead
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From Our Correspondent: Making Enemies
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Asiaweek Time Asia Now Asiaweek story

A Leaf From The Book Of Life

What's behind the drive to bring Chinese herbal medicine into the Mainstream

By Jonathan Sprague

special report:
your health
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Health In Brief A quick look at the world of well-being

AS A BABY NEARS birth, it is supposed to turn over in order to be born head first. If it doesn't do so in the final weeks of pregnancy, doctors have three choices: massage the mother's abdomen to push the baby out of the dangerous "breech" position, get ready for a Caesarian section - or burn some mugroot next to the mother's little toenail. Mugroot? It is a Chinese herb, also called moxa, and right by the nail of the little toe is an acupuncture point. A recent study found that the moxibustion technique worked for 75% of 130 women. In the control group, the baby turned on its own for just half of the expectant mothers. But the amazing thing is not that the technique is effective. Chinese herbalists have known that for centuries. What is striking is that the study was recently published in a bastion of orthodox Western medicine - the Journal of the American Medical Association (JAMA).

Traditional Chinese medicine (TCM) is coming of age. That may seem to be an odd thing to say about a discipline with 2,000 years of recorded history. But the past decade has seen growing confluence of several trends: TCM doctors approaching the tradition on a more scientific basis; Western doctors and researchers recognizing that Chinese herbs offer much that they do not know; and patients becoming more open to non-Western practices. That confluence is now a flood of activity. China is scrambling to modernize its vast TCM infrastructure and grab more of the growing world market for herbal cures. Hong Kong, Singapore and Taiwan are hoping to leverage their Chinese heritage and advanced economies to become TCM centers. Western pharmaceutical giants are stalking the region in search of potentially lucrative TCM partnerships (the world market for herbal medicines is estimated to grow to about $12 billion over the next 10 years). And patients everywhere will (hopefully) benefit from better medicines and better practices based on traditional as well as Western cures.

TCM? Isn't that where an old guy in a funny smelling store lined with drawers full of dried sticks and animal parts takes your pulse and mumbles about excess humidity of the kidneys? Well, yes. Skeptics say that the ancient way of healing is mumbo jumbo, treating vague symptoms that hardly correspond to specific diseases and explaining its effect in terms of qi, a life energy that no instrument can measure. But there is more to it. Science-based research is finding out how TCM works in the body, pinning down which treatments fight which diseases, and gradually winning over Western-oriented doctors and patients. "We can't just say that we've been using a herb for 2,000 years and expect others to use it," says Dr. Kong Yun-cheung, director of the school of Chinese medicine at the Chinese University of Hong Kong (CUHK). Yao Naili, executive vice president of the Chinese Academy of Traditional Chinese Medicine in Beijing, says the ultimate quest is still to find qi. But the academy's 4,000 staff are looking for practical and provable TCM applications. "It's mostly cancers, hear and liver diseases that we're working on," he says.

And new medicines are coming up fast. Last week, researchers from the City University of Hong Kong and the Guangzhou University of Traditional Chinese Medicine said they produced a pill based on phyllanthus, a herb discovered in China's Hainan province, that can reduce the recurrence of hepatitis B. In May, researchers at the University of California, San Francisco, revealed cancer-battling properties in an over-the-counter cure. The compound, made up of eight Chinese herbs, including the saw palmetto, significantly lowers the level of prostate-specific antigen, an indicator of cancer cells, in men with advanced prostate cancer. Swiss pharmaceutical giant Novartis has registered patent rights in 41 countries for a new malaria drug based on a derivative of the Chinese herb artemisinin - the result of a decade-long collaborative effort with China's Institute of Microbiology and Epidemiology and the Kunming Pharmaceutical Corp. In January, the drug won approval to be sold in Switzerland, its first Western market.

In a sense there is nothing surprising about the newfound attention traditional cures are winning. After all, a drug is a drug, and scientists are looking for potential cures in everything from Amazon insects to Pacific sponges, as well as traditions like Indian Ayurvedic medicine. "Drugs are used chemically for the treatment of disease, regardless of whether they come from natural products or are synthesized," says Chen Chieh-fu, director of Taiwan's National Research Institute for Chinese Medicine. But TCM also has a long clinical history that today's scientists can use as a guide. Chen's institute has compiled a database of the possible curative effects of herbs based on traditional texts and is working to identify the active ingredients in the most promising ones. Commercial pharmaceutical companies think the same. "You know from Chinese history what herbs cure a particular disease," says Dr. Zhao Jian, medical director of Beijing Novartis Pharmaceutical. "Therefore you have a direction to follow rather than swim in a sea of chemical compounds."

But the nature of traditional applications makes research according to orthodox scientific standards difficult. Any given herb contains a multitude of chemical compounds, and TCM doctors tailor combinations of herbs to match the symptoms of individual patients. Western medicine demands evidence that an ingredient acts in measurable ways on a specific disease in a large number of patients. "We have to find an active substance or a molecule from the herb before we can study its effects," explains Zhao. "That alone will take you at least a year." But the effort cannot be avoided, not just because the science demands it, but because that is the only route to winning patents, regulatory approval and markets. "What makes developing traditional medicine difficult is that it's hard to identify a single active ingredient necessary for patent rights," says Dr. Helen Chan, managing director of Vita Green Health Products (the Hong Kong company is working to develop products from lingzhi - a highly prized Chinese fungus containing natural antioxidants). "As a result," says Chan, "there's no prospect of breaking even, let alone profits, in sight."

Even more daunting is winning regulatory approval for TCM medications. New Jersey-based contract drug developer Covance last year opened an office in Beijing and hopes to shepherd two traditional Chinese medicines used to treat cardiovascular diseases through the approval process of the U.S. Food and Drug Administration. Even though the cures are widely used in China, Covance reckons that getting even one of them approved as a prescription drug in the U.S. could take eight years and $40 million to $60 million. In fact, no traditional Chinese medicine has ever won FDA approval as a drug - TCM products in the U.S. are sold as dietary supplements, like vitamins, which come under much less stringent rules. But such health aids are not easy to develop either, if done right. CUHK's Kong and his team recently began marketing a tea for colds and flus, containing three varieties of a Chinese holly colloquially called dong qing cho. It took 15 scientists three years and $1.3 million to develop.

The search for new drugs that can fit into orthodox practice is not the only challenge for traditional medicine. Perhaps the greater task is upgrading the practice and infrastructure of TCM so that it can stand shoulder to shoulder with orthodox therapy. "With enough studies into the benefits of both Western and Chinese medicine, doctors can switch from one to another or apply both at the same time," says Professor Hu Shilin, of the Hong Kong Baptist University's TCM division. The two traditions have different strengths. Generally, orthodox medicine is regarded as superior in treating acute illnesses. TCM has little surgical tradition. On the other hand, it has been shown to be effective in fighting chronic or slow-developing illnesses and in preventive medicine. Wang Jian, a Beijing-based AIDS specialist, says TCM in combination with Western treatment can help prolong the lives of patients and alleviate some harsh symptoms. "Both disciplines can supplement each other," Wang says.

One problem TCM faces is a lack of standards. Practitioners in China generally are graduates of specialist schools, and many American states require some sort of licensing. That is not the case in Hong Kong, Taiwan and Singapore, where most practitioners learned their craft as apprentices. Often, diagnoses take place in a shop corner or across a counter. But that is starting to change. All three territories are moving to register their practitioners. Hong Kong and Singapore also plan to require licensing exams. Three Hong Kong universities have started offering TCM degrees. In April, medical group Quality Healthcare Asia opened a modern TCM clinic in the SAR in cooperation with the Baptist University, with doctors in private consultation rooms and prescriptions put together by trained pharmacists. "This clinic sets a benchmark for further development," says company adviser John Crawford. "It is not a trial-and-error exercise. There is full quality control." And since Quality Healthcare operates a network of about 100 clinics in Hong Kong, referrals between them can provide patients with the best of both worlds.

In some places, both healing disciplines coexist fairly happily. In much of China, TCM is the main form of therapy, if only because it costs less and can be more easily taught. In Japan, 70% of orthodox doctors will give prescriptions based on kampo - the Japanese offshoot of TCM that literally means the Chinese way - although Western medicine remains dominant. But there clearly is resistance in the medical establishment to Chinese therapies. Some of it is practical. "As TCM develops well in preventive care, you might not go to see doctors when you have some minor symptoms of flu, but most doctors make money from treating minor sicknesses," says CUHK's Kong, who is trained in embryology. But more than livelihood is involved. Despite centuries of clinical use, most TCM treatments have not undergone the controlled studies that Western practices are put through to prove efficacy and safety. Even the study of moxibustion to turn babies in breech position, which then-JAMA editor Dr. George Lundberg said produced very good data, was just one experiment involving a mere 260 subjects over a short time span.

Given the uneven standards for training and licensing, orthodox doctors worry that patients who turn to TCM will not receive the best possible medication. Sometimes that is not such a bad thing. "Maybe 30% of the population have minor psychological disorders," says Dr. Kao Chi-yu, a general practitioner in Taiwan. "Western doctors do not give them enough time, and it's the attention they need." But a health problem could get worse if a patient relying on TCM delays more effective orthodox treatments. Old-style cures can also cause adverse side effects if taken in the wrong combination or dosage. Further, some over-the-counter medications contain dangerous quantities of mercury, steroids and other substances. Growing interest in TCM may put extra pressure on endangered species too. The plight of the tiger and rhinocerous is well known, and there is strong effort within the TCM community to find and use substitutes. But less glamorous plants, for example, wild ginseng, which can command $13,000 for a piece less than 100 grams, already face extinction. "With more people wanting to use TCM, certain endangered plants will be in great demand," worries Judy Mills, East Asia director of TRAFFIC, a non-governmental group devoted to tracking trade in threatened flora and fauna.

The great hope is that as TCM develops, better regulation, improved training and rising investment will cure its shortcomings. China and Taiwan are already starting to clamp down on sloppily made traditional products that contain illegal or harmful compounds. And globally, advocates hope that greater scientific understanding of Chinese medicine, better and more standardized drugs and treatments, and improved training of practitioners will raise the tradition's profile, respectability and usefulness. Hong Kong has mapped out a 10-year plan to turn the territory into a TCM hub, with researchers packing laboratories, certified medicines on shelves and drugmakers listed on the stock market. Singapore and Beijing signed an agreement to trade the latter's knowledge of TCM for the former's expertise in healthcare management. Western researchers and pharmaceutical companies are continually expanding their interest in the ancient yet new tradition.

Forward-looking practitioners argue that doctors should eventually be able to use either Western or Easter cures - or both - to best treat the patient. "TCM will absorb more and more of the technical and scientific advantages of Western medicine - that's good," says Yao of the Chinese Academy in Beijing. "Eventually TCM as a different discipline will disappear. It will be integrated into worldwide medical science. But I am looking far, far into the future."

- With reports by Yulanda Chung / Hong Kong, Anne Meijdam / Beijing and Jane Rickards / Taipei

This edition's table of contents | Asiaweek home


U.S. secretary of state says China should be 'tolerant'

Philippine government denies Estrada's claim to presidency

Faith, madness, magic mix at sacred Hindu festival

Land mine explosion kills 11 Sri Lankan soldiers

Japan claims StarLink found in U.S. corn sample

Thai party announces first coalition partner


COVER: President Joseph Estrada gives in to the chanting crowds on the streets of Manila and agrees to make room for his Vice President

THAILAND: Twin teenage warriors turn themselves in to Bangkok officials

CHINA: Despite official vilification, hip Chinese dig Lamaist culture

PHOTO ESSAY: Estrada Calls Snap Election

WEB-ONLY INTERVIEW: Jimmy Lai on feeling lucky -- and why he's committed to the island state


COVER: The DoCoMo generation - Japan's leading mobile phone company goes global

Bandwidth Boom: Racing to wire - how underseas cable systems may yet fall short

TAIWAN: Party intrigues add to Chen Shui-bian's woes

JAPAN: Japan's ruling party crushes a rebel at a cost

SINGAPORE: Singaporeans need to have more babies. But success breeds selfishness

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