8/2/2019 The Global is at Ion of Chinese Medicine

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P R E S E N T A N D F U T U R E

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I n 1929, Chinese medicinewas almost legally abolishedby the Republicangovernment. 70 years later,traditional Chinese medicine(TCM) is a fully institution-alised and governme nt-support ed part of the Chinesehealth-care system, with the same legal status there aswestern biomedicine. It delivers almost 40% of totalhealth-care serffices in contempora ry China . Likebiomedicine, TCM in Chin a is predominantly hospitalbased. Besides almost 3000 dedicated hospitals, over 95%of western medical hospitalsalso have fully-fledged Chinesemedicine wards and outpatientdepartments.

Officially, there are threedistinct methods by which TCMis integrated into China'shealth-care system. The firstis the use of TCM drugsor treatment techniques bybiomedical physicians to enhancethe effectiveness o f biomedicaltreatment or to treat its side-effects. The second is the use of Chinese medicine marketTCM as a medical system in itsown right; and the third consists of the integration ofChinese and western medicine. In practice, the boundarybetween the three metho ds is difficult to draw. Biomedicalideas and concepts have been assimilated into Chinesemedicine, biomedical drugs are routinely prescribed inChinese-medicine wards and outpatient departments, andTCM physicians face pressure from hospitals to userevenue-genera ting biomedical diagnostic facilities such asultrasound and computed tomography.

Given its commitment to modemisation and thedevelopment of science and technology, the Chinesegovernment is pressing hard for the systematisation ofTCM disease categories, diagnostic standards, andtherapeutic techniques, and to enforce a more stringentevaluation of therapeutic outcomes. At the same time,however, the scientific status of TCM is decreed by thestate as a fact a priori rather than defined throughinterprofessional struggles. TCM is thus developing as acomplex hybrid at the interface of tradition, modernity,and postmodemity, and cannot be reduced to one singlesystem of practice.

TCM is also used by the Chinese state to promoteChina's culture. The definition of TCM as a nationaltreasure removes its defin ition as a science even furtherfrom the field of debate. However, efforts to heighten thepositive perception of TCM abroad also force internalchanges--for example, efforts to prohibit the use ofendangered species in preparation of TCM drags, and touse research acceptable to an intern ational audience in theassessment of TC M.

Public support for Chinese medicine in China remainsimpressive. Exercises such as qigong and taijiquan arepractised daily by millions of Chinese people. Self-prescribing with ready-made Chinese medicines is animportant part of lay-people's therapeutic regimens. Andalthough most Chinese believe in the superior diagnosticpowers of biomedicine, many prefer TCM treatment

The globalisation ofChinese medicine

Volker Scheid

particularly for chronic diseaseswhere the side-effects ofbiomedicine may be judged tooutweigh its benefits.

TCM is now practised inone form or another by morethan 300 000 practitioners in over 140 countries. The firsthospital for Chinese medicine in Europe, was opened inGerm any in 1990. British GPs are increasingly contractingout for acu punct ure services, public health-insurancecompanies in Ger man y routinely refund part o f the costs ofacupuncture treatment provided by trained doctors, and in

France, acupuncture is a widelyaccepted part of health-careprovision. Degree programmes inChinese medicine are nowoffered at several Britishuniversities, and courses i n TC Mare established at Europeanmedical schools. Tong RenTang, Beijing's oldest pharmacyfounded in the 17th century,opened a branch in centralLond on in 1995.Given the worldwide hegemo-ny of biomedicine throughoutmost of this century, theglobal emergence of TCM is a monumental event.

Indeed, proponents already speak of the 21st century asthe "century of TCM". More likely is a continuedintegration of TCM into existing health-care systemsworldwide.

The outcome of this process is difficult to predict andwill be subject to local contingencies. Three outcomes arepossible. TCM may be destroyed as an independentmedical tradition by the biomedical establishment, whichassimilates some tools (acupuncture, massage, somepharmaceuticals) but discards core concepts and practicesof Chinese medicine, such as qi (matter-influences) andzangfu (visceral systems of function). TC M may beinstitutionalised along the Chinese model with similarlong-term outcomes. Or TCM may develop into aheterogeneous, vibr ant tradition that eschews political andeconomic power for the sake of clinical efficacy, groundedin personal experience andin mo dem research.

The future of Chinesemedicine in the west willalso depend largely onwhat answers can beprovided about safety andefficacy. Addressing theequation of harm versusbenefit involves subjectivechoices and is thusan intrinsically politicalproblem. Ideally, theseissues would be addressedby interdisciplinary researchinvolving epidemiologists,anthropologists, sinologists,experts in the culturalstudies of science, as well asclinicians.

The Lancet 2000 354 Decemb er 1999 s I v l0