Traditional Chinese Medicine in China

III. Carrying Forward the Tradition and Ensuring the Development of TCM

Establishment of a TCM medical care system covering both urban and rural areas. An urban TCM medical care network, mainly comprising hospitals for TCM (including ethnic minority medicine and integrated Chinese and Western medicine), TCM clinics and general hospitals' TCM clinical departments, and community health centers, has been formed. A rural TCM medical care network has been established, mainly composed of county-level TCM hospitals, TCM clinical departments of general hospitals (specialized hospitals and maternal & child health centers), TCM departments of township-level health centers, and village health clinics, which provides basic TCM healthcare services.

Statistics collected at the end of 2015 show that there were 3,966 TCM hospitals across the country, including 253 hospitals of ethnic minority medicine and 446 hospitals of integrated Chinese and Western medicine; there were 452,000 practitioners and assistant practitioners of TCM (including practitioners of ethnic minority medicine and integrated Chinese and Western medicine); there were 42,528 TCM clinics, including 550 for ethnic minority medicine and 7,706 for integrated medicine; there were 910 million visits that year to TCM medical and health service units across the country and 26,915,000 inpatients treated.

In addition to making contribution to the prevention and treatment of common, endemic and difficult diseases, TCM has played an important role in the prevention and treatment of major epidemics and medical relief in public emergencies and natural disasters. The contribution of TCM and integrated Chinese and Western medicine in treating SARS (severe acute respiratory syndrome) has been affirmed by the World Health Organization (WHO). TCM treatment of influenza A virus subtype H1N1 has yielded satisfactory results, arousing widespread attention in the international community. In addition, TCM has made distinctive contributions to the prevention and control of epidemics such as HIV/AIDS (Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome), HFMD (Hand, Foot and Mouth Disease), and Influenza A virus subtype H7N9 in humans, as well as to medical relief following the Wenchuan earthquake, the Zhouqu mudslide and other public emergencies and natural disasters.

Expedited development of TCM disease prevention and healthcare services. The system of TCM disease prevention and healthcare services has been expedited by establishing preventative healthcare departments at TCM hospitals at/above the second class and providing TCM preventative medical care services at community-level medical and health service institutions, maternal & child health centers and rehabilitation centers. Also seen is rapid growth in the number of privately run TCM healthcare institutions. Endeavor has been made to promote the development of TCM health services and carry out TCM health tourism and TCM integrated treatment and convalesce. TCM health management program has been incorporated as a separate category into the national basic public health service program, gradually releasing the potential and strengths of TCM in public health services, thus fostering a shift from treatment of serious diseases to comprehensive health management in the mode of health development.

Important role played by TCM in the reform of the medical care system. In the course of advancing the reform, TCM's distinct strengths, such as its clinical effectiveness, its unique role, flexible ways of treatment and relatively low cost in disease prevention and healthcare, have been fully exploited to augment benefits of reform for the people and enriched the connotation of China's basic medical care system with distinct characteristics. With relatively low cost, TCM has contributed rather a higher share of services in relation to the resources it is entitled to. The medical care services provided by TCM institutions in the national total increased from 14.3 percent to 15.7 percent in the few years from 2009 to 2015. In 2015, out-patient expenses per visit and in-patient expenses per capita at public TCM hospitals were, respectively, 11.5 percent and 24 percent lower than those at general public hospitals.

Building a distinctive system of training for TCM professionals. Training of professionals is essential for the development of TCM. Thus, great efforts have been made to promote development of education in TCM, basically putting in place a system of training for TCM professionals that features an organic link-up between college, graduate and continuing education, and run through master-apprenticeship training. This, together with a mechanism for training of practical TCM professionals geared toward the needs of the urban and rural communities that has also been initially established, forms a multi-dimensional education network covering multiple disciplines at different levels, including TCM, traditional Chinese pharmacology, integrated Chinese and Western medicine, and ethnic minority medicine at secondary and higher vocational schools, colleges, postgraduate and doctoral studies. By the end of 2015, there were throughout the country 42 institutions of higher learning in TCM (including 25 TCM colleges), and more than 200 Western medicine institutions of higher learning or non-medical higher learning institutions offering programs in TCM, enrolling in total as many as 752,000 students.

In the course of implementing the program of training professionals for inheritance and innovation in TCM, efforts have been made to conserve and disseminate the academic ideas and practical experience of the fifth batch of prominent TCM experts. By 2015, 1,016 studios had been set up for carrying forward their expertise; 200 studios had been set up for passing on the expertise of prominent TCM experts at the grassroots level; 64 studios had been established for promoting various schools of TCM.

TCM training programs targeted at professionals at both grassroots and higher levels have been held, such as training in TCM knowledge and skills for village doctors, training for conserving special traditional pharmacological skills, and advanced training for outstanding TCM clinical practitioners. Together, 124 researchers are finishing postdoctoral studies in TCM inheritance at the Chinese Academy of Chinese Medical Sciences and their work is being evaluated. Exploration has been made in establishing an incentive mechanism for outstanding TCM workers to come to the fore. By 2015, the title of TCM Master had been awarded to a total of 60 experts practicing TCM and ethnic minority medicine.

Positive progress made in TCM scientific research. Sixteen national TCM clinical research bases have been built as part of the clinical research system for preventing and treating infectious diseases and chronic non-infectious diseases with TCM. This, together with a number of key research centers and labs covering all disciplines of TCM and national engineering (technology) research centers and labs in this respect, have brought into being a TCM sci-tech innovation system that is based on independent TCM research institutes, TCM universities, and TCM hospitals at and above the provincial level, and participated by comprehensive universities, general hospitals and TCM enterprises.

In recent years, 45 TCM research achievements have been awarded national sci-tech prizes, of which five were first-prize winners of the National Science and Technology Progress Award. Tu Youyou won the 2011 Lasker Award in clinical medicine and the 2015 Nobel Prize in Physiology or Medicine for discovering qinghaosu (artemisinin). Wang Zhenyi and Chen Zhu were awarded the Seventh Annual Szent-Gyorgyi Prize for Progress in Cancer Research for combining the Western medicine ATRA and the TCM compound arsenic trioxide to treat acute promyelocytic leukemia (APL).

A pilot program for Chinese medicinal resources survey has been implemented, forming a dynamic information and technology system with one central platform, 28 provincial-level centers, and 65 monitoring stations. Sixteen seed and seedling bases for Chinese medicinal plants and two germplasm banks have been established. Organizational work has been done for collation of literature and screening of appropriate skills of ethnic minority medicine, involving 150 works on ethnic minority medicine and 140 appropriate skills. The transformation and application of these research results has provided support for enhancing clinical effectiveness, ensuring the quality of Chinese medicine, and fostering the sound development of the TCM pharmaceutical industry.

Rapid development of the TCM pharmaceutical industry. A number of laws and regulations have been enacted and implemented on strengthening the protection of TCM wild medicinal resources; a number of national and local nature reserves have been established; research has been conducted on the protection of rare and endangered Chinese medicinal resources; and artificial production or wild tending have been carried out for certain scarce and endangered resources.

A registration management system has been basically established for TCM pharmaceuticals under the guidance of theories of traditional Chinese medicine and pharmacology, highlighting the strengths of TCM, setting great store by clinical practice and encouraging innovation. To date, 60,000 TCM and ethnic minority medical drugs have been approved, and 2,088 pharmaceutical enterprises that have been approved by the Good Manufacturing Practice (GMP) of Medical Products are manufacturing Chinese patent medicines. The dosage forms of TCM medicines have increased from a traditionally limited number of forms such as pills, powders, ointments and pellets into more than 40, including dropping pills, tablets, pods and capsules, indicating marked improvement in the technological level of Chinese medicinal drug production, and initial establishment of a modern Chinese medicine industry based on the production of medicinal materials and industrial production and tied together by commerce.

In 2015, the total output value of the TCM pharmaceutical industry was RMB786.6 billion, accounting for 28.55 percent of the total generated by the country's pharmaceutical industry, and becoming a new source of growth in China's economy. Planting Chinese medicinal herbs has become a key means of adjusting the rural industrial structure, improving the eco-environment, and increasing farmers' incomes. Trade in Chinese medicinal products has maintained rapid growth, and the export value of Chinese medicines amounted to US$3.72 billion in 2015, signifying the great potential of Chinese medicines in overseas markets. The TCM pharmaceutical industry has gradually developed into an industry with distinctive strengths and broad market prospects, which is of strategic importance to national economic and social development.

New progress in TCM culture. The Chinese government treasures and protects the cultural value of TCM, and endeavors to build a system for passing on the traditional culture of TCM. In total, 130 TCM elements have been incorporated into the Representative List of National Intangible Cultural Heritage, with TCM acupuncture and moxibustion being included in the Representative List of the Intangible Cultural Heritage of Humanity by UNESCO, and the Huang Di Nei Jing (Yellow Emperor's Inner Canon) and Ben Cao Gang Mu (Compendium of Materia Medica) are listed in the Memory of the World Register. Efforts have been reinforced to promote public awareness in TCM healthcare, including events under the campaign of Traditional Chinese Medicine Across China. Public talks have been organized through media and TCM education bases popularizing basic knowledge and skills of TCM healthcare and prevention and treatment of illnesses. In this way, public awareness of and ability to practice TCM healthcare has been enhanced, and general public health has improved.

Positive progress in TCM standardization. The Outline of the Medium- and Long-term Development Plan for the Standardization of Traditional Chinese Medicine (2011-2020) has been issued and implemented, putting in place initially a system of TCM standards which amount to 649, showing an average annual growth of 29 percent. Five national technical committees of standardization have been established for, respectively, Chinese medicine, acupuncture and moxibustion, TCM drugs, integrated Chinese and Western medicine, and seeds and seedlings of Chinese medicinal plants, with local standardization technical committees of traditional Chinese medicine and pharmaceuticals being set up in Guangdong, Shanghai, Gansu and some other localities. The building of 42 research and application bases for TCM standardization is proceeding smoothly, and the clinical application of guidelines for TCM diagnosis and treatment of commonly seen diseases and guidelines for acupuncture and moxibustion is proving effective.

Steady progress has also been witnessed in standardization of ethnic minority medicine, so has been orderly advancement in the formulation of guidelines for diagnosis and treatment of commonly seen diseases. In this regard, Uyghur medicine has taken the lead, with the publishing of 14 guidelines for disease diagnosis and treatment, and curative effect evaluation. The first local technical committee for standardization of Tibetan medicine has been established in the Tibet Autonomous Region. Constant improvement has been observed in the competence and efficiency of institutions and workers in relation to the standardization of ethnic minority medicine and pharmacology.

IV. International Exchanges and Cooperation in TCM

Promoting the globalization of TCM. Traditional Chinese medicine has been spread to 183 countries and regions around the world. According to the World Health Organization, 103 member states have given approval to the practice of acupuncture and moxibustion, 29 have enacted special statutes on traditional medicine, and 18 have included acupuncture and moxibustion treatment in their medical insurance provisions. TCM medicines have gradually entered the international system of medicines, and some of them have been registered in Russia, Cuba, Vietnam, Singapore, United Arab Emirates, and other nations. Some 30 countries and regions have opened a couple of hundred TCM schools to train native TCM workers. The World Federation of Acupuncture-Moxibustion Societies, headquartered in China, has 194 member organizations from 53 countries and regions, and the World Federation of Chinese Medicine Societies has 251 member organizations from 67 countries and regions. Traditional Chinese medicine has become an important area of health and trade cooperation between China and the ASEAN, EU, Africa, and Central and Eastern Europe, a key component in people-to-people exchanges between China and the rest of the world and between Eastern and Western cultures, and an important vehicle for China and other countries to work together in promoting world peace, improving the well-being of humanity, and developing a community of shared future.

Supporting the global development of traditional medicine. The Chinese government is dedicated to promoting the development of traditional medicine throughout the world, and works closely with the WHO to contribute to progress in traditional medicine around the globe. China has summarized its successful TCM practices and offers them to the world. It hosted the first WHO Congress on Traditional Medicine in Beijing in 2008, and played an important role in drafting the Beijing Declaration. In accordance with initiatives of the Chinese government, the 62nd and 67th World Health Assemblies passed two resolutions on traditional medicine, and urged its member states to implement the WHO's Traditional Medicine Strategy 2014-2023. Currently, the Chinese government has signed 86 TCM cooperation agreements with other countries and international organizations, and has supported the building of 10 TCM centers overseas.

Promoting standard management of TCM internationally. To promote the orderly development of TCM around the globe and ensure its safe, efficient and targeted application, China has facilitated the founding of the ISO/TC249 Traditional Chinese Medicine in the ISO. With its secretariat in Shanghai, it has now issued a series of ISO standards on TCM. Thanks to China's efforts, the WHO has included traditional medicine, represented by TCM, in the new version of the International Classification of Diseases (ICD-11). China is working actively to promote international exchange and cooperation in the supervision and management of traditional medicine, in an effort to ensure that it is safe and effective.

Providing TCM medical aid overseas. While seeking its own development, within its capacity China has persisted in providing aid and assistance to other developing countries, fulfilling its due international obligations. To date, China has sent medical teams to over 70 countries in Asia, Africa, and Latin America, with TCM professionals in almost every team, accounting for 10 percent of the total number of staff. A project has been launched to build TCM centers in African countries, and specialized TCM stations have opened in Kuwait, Algeria, Tunisia, Morocco, Malta, and Namibia. The Chinese government has sponsored 10 TCM centers overseas. In recent years, China has strengthened work in the prevention and control of AIDS and malaria in developing countries, and in African countries in particular, sending a total of 400 TCM specialists to more than 40 countries including Tanzania, Comoros, and Indonesia. Chinese medical teams have treated complicated and refractory diseases with TCM, acupuncture and moxibustion, medical massage, and methods combining Chinese and Western medicine, saving many lives and winning extensive appreciation from governments and people concerned.

Conclusion

China's economic development has entered a new historical period. TCM has come to play an increasingly significant role in the socio-economic development; it has become a unique resource in terms of healthcare, an economic resource with great potential, a scientific and technological resource with originality advantages, an outstanding cultural resource, and an ecological resource of great importance. The time has come for TCM to experience a renaissance.

China will learn from the achievements of modern civilization, uphold the principle of making the ancient serve the contemporary, and strive to promote the modernization of TCM by making every effort to carry on the good traditions and practices of Chinese medicine, and promote the innovative development of TCM for health preservation, so that TCM will be incorporated into the modern outlook on health to serve the people. By 2020, every Chinese citizen will have access to basic TCM services, and by 2030 TCM services will cover all areas of medical care. Meanwhile, China will also actively introduce TCM to the rest of the world, and promote the integration of TCM and other traditional medicine with modern technology, so as to explore a new model of healthcare to improve the well-being of all people of the world, and make a full contribution to global progress and a brighter future for mankind.