Traditional Chinese Medicine in China

The State Council Information Office of the People's Republic of China

December 2016

First Edition 2016

Contents

Preface

I. The Historical Development of TCM II. Policies and Measures on TCM Development

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

IV. International Exchanges and Cooperation in TCM

Conclusion

Preface

Humanity has created a colorful global civilization in the long course of its development, and the civilization of China is an important component of the world civilization harboring great diversity. As a representative feature of Chinese civilization, traditional Chinese medicine (TCM) is a medical science that was formed and developed in the daily life of the people and in the process of their fight against diseases over thousands of years. It has made a great contribution to the nation's procreation and the country's prosperity, in addition to producing a positive impact on the progress of human civilization.

TCM has created unique views on life, on fitness, on diseases and on the prevention and treatment of diseases during its long history of absorption and innovation. It represents a combination of natural sciences and humanities, embracing profound philosophical ideas of the Chinese nation. As ideas on fitness and medical models change and evolve, traditional Chinese medicine has come to underline a more and more profound value.

Since the founding of the People's Republic of China in 1949, the Chinese government has set great store by TCM and rendered vigorous support to its development. TCM and Western medicine have their different strengths. They work together in China to protect people from diseases and improve public health. This has turned out to be one of the important features and notable strengths of medicine with Chinese characteristics.

I. The Historical Development of TCM

1. History of TCM

In remote antiquity, the ancestors of the Chinese nation chanced to find that some creatures and plants could serve as remedies for certain ailments and pains, and came to gradually master their application. As time went by, people began to actively seek out such remedies and methods for preventing and treating diseases. Sayings like "Shennong (Celestial Farmer) tasting a hundred herbs" and "food and medicine coming from the same source" are characteristic of those years.

The discovery of alcohol in the Xia Dynasty (c. 2070-1600 BC) and the invention of herbal decoction in the Shang Dynasty (1600-1046 BC) rendered medicines more effective.

In the Western Zhou Dynasty (1046-771 BC), doctors began to be classified into four categories - dietician, physician, doctor of decoctions and veterinarian.

During the Spring and Autumn and Warring States Period (770-221 BC), Bian Que drew on the experience of his predecessors and put forward the four diagnostic methods - inspection, auscultation & olfaction, inquiry, and palpation, laying the foundation for TCM diagnosis and treatment.

The Huang Di Nei Jing (Yellow Emperor's Inner Canon) compiled during the Qin and Han times (221 BC-AD 220) offered systematic discourses on human physiology, on pathology, on the symptoms of illness, on preventative treatment, and on the principles and methods of treatment. This book defined the framework of TCM, thus serving as a landmark in TCM's development and symbolizing the transformation from the accumulation of clinical experience to the systematic summation of theories. A theoretical framework for TCM had been in place.

The Shang Han Za Bing Lun (Treatise on Febrile Diseases and Miscellaneous Illnesses) collated by Zhang Zhongjing in the Eastern Han Dynasty (25-220) advanced the principles and methods to treat febrile diseases due to exogenous factors (including pestilences). It expounds on the rules and principles of differentiating the patterns of miscellaneous illnesses caused by internal ailments, including their prevention, pathology, symptoms, therapies, and treatment. It establishes the theory and methodology for syndrome pattern diagnosis and treatment differentiation. The Shen Nong Ben Cao Jing (Shennong's Classic of Materia Medica) - another masterpiece of medical literature appeared during this period - outlines the theory of the compatibility of medicinal ingredients. For example, it holds that a prescription should include at the same time the jun (or sovereign), chen (or minister), zuo (or assistant) and shi (or messenger) ingredient drugs, and should give expression to the harmony of the seven emotions as well as the properties of drugs known as "four natures" and "five flavors." All this provides guidance to the production of TCM prescriptions, safe application of TCM drugs and enhancement of the therapeutic effects, thus laying the foundation for the formation and development of TCM pharmaceutical theory. In the late years of the Eastern Han Dynasty, Hua Tuo (c. 140-208) was recorded to be the first person to use anesthetic (mafeisan) during surgery.

The Zhen Jiu Jia Yi Jing (AB Canon of Acupuncture and Moxibustion) by Huangfu Mi during the Western Jin time (265-316) expounded on the concepts of zangfu (internal organs) and jingluo (meridians and collaterals). This was the point when theory of jingluo and acupuncture & moxibustion began to take shape.

Sun Simiao, a great doctor of the Tang Dynasty (618-907), proposed that mastership of medicine lies in proficient medical skills and lofty medical ethics, which eventually became the embodiment of a moral value of the Chinese nation, a core value that has been conscientiously upheld by the TCM circles.

A herbology and nature masterpiece, the Ben Cao Gang Mu (Compendium of Materia Medica) compiled by Li Shizhen in the Ming Dynasty (1368-1644) was the first book in the world that scientifically categorized medicinal herbs. It was a pioneering work that advanced TCM pharmaceutical theory.

The Wen Re Lun (A Treatise on Epidemic Febrile Diseases) by Ye Tianshi during the Qing Dynasty (1644-1911) developed the principles and methods for prevention and treatment of pestilential febrile diseases. It represents the theory and results of the practice of TCM in preventing and treating such diseases.

Following the spread of Western medicine in China from the mid-Qing Dynasty, especially during the period of the Republic of China (1912-1949), some TCM experts began to explore ways to absorb the essence of Western medicine for a combination of TCM with Western medicine.

2. Characteristics of TCM

During its course of development spanning a couple of millennia, TCM has kept drawing and assimilating advanced elements of natural science and humanities. Through many innovations, its theoretical base covered more ground and its remedies against various diseases expanded, displaying unique characteristics.

First, setting great store by the holistic view. TCM deems that the relationship between humans and nature is an interactive and inseparable whole, as are the relationships between humans and the society, and between the internal organs of the human body, so it values the impacts of natural and social environment on health and illness. Moreover, it believes that the mind and body are closely connected, emphasizing the coordination of physical and mental factors and their interactions in the conditions of health and illness.

Second, setting great store by the principle of harmony. TCM lays particular stress on the importance of harmony on health, holding that a person's physical health depends on harmony in the functions of the various body organs, the moderate status of the emotional expression, and adaption and compliance to different environments, of which the most vital is the dynamic balance between yin and yang. The fundamental reason for illness is that various internal and external factors disturb the dynamic balance. Therefore, maintaining health actually means conserving the dynamic balance of body functions, and curing diseases means restoring chaotic body functions to a state of coordination and harmony.

Third, emphasis on individuality. TCM treats a disease based on full consideration of the individual constitution, climatic and seasonal conditions, and environment. This is embodied in the term "giving treatment on the basis of syndrome differentiation." Syndrome differentiation means diagnosing an illness as a certain syndrome on the basis of analyzing the specific symptoms and physical signs collected by way of inspection, auscultation & olfaction, inquiry, and palpation, while giving treatment means defining the treatment approach in line with the syndrome differentiated. TCM therapies focus on the person who is sick rather than the illness that the patient contracts, i.e., aiming to restore the harmonious state of body functions that is disrupted by pathogenic factors.

Fourth, emphasis on preventative treatment. Preventative treatment is a core belief of TCM, which lays great emphasis on prevention before a disease arises, guarding against pathological changes when falling sick, and protecting recovering patients from relapse. TCM believes that lifestyle is closely related to health, so it advocates health should be preserved in daily life. TCM thinks that a person's health can be improved through emotional adjustment, balanced labor and rest, a sensible diet, and a regular life, or through appropriate intervention in the lifestyle based on people's specific physical conditions. By these means, people can cultivate vital energy to protect themselves from harm and keep healthy.

Fifth, simplicity. TCM doctors diagnose patients through inspection, auscultation & olfaction, inquiry, and palpation. In addition to medication, TCM has many non-pharmacological alternative approaches such as acupuncture and moxibustion, tuina (massage), cupping and guasha (spooning). There is no need for complex equipment. TCM tools, for example, the small splints used in Chinese osteopathy, the spoons used in guasha, or the cups used in cupping therapy, can draw from materials close at hand, so that such treatments can spread easily.

3. TCM's Contributions

TCM is an important component and a characteristic feature of traditional Chinese culture. Applying such principles as "man should observe the law of the nature and seek for the unity of the heaven and humanity," "yin and yang should be balanced to obtain the golden mean," and "practice of medicine should aim to help people," TCM embodies the core value of Chinese civilization. TCM also advocates "full consideration of the environment, individual constitution, and climatic and seasonal conditions when practicing syndrome differentiation and determining therapies," "reinforcing the fundamental and cultivating the vital energy, and strengthening tendons and bones," and "mastership of medicine lying in proficient medical skills and lofty medical ethics," all concepts that enrich Chinese culture and provide an enlightened base from which to study and transform the world.

TCM originated in the Chinese culture. It explains health and diseases from a macro, systemic and holistic perspective. It shows how China perceives nature. As a unique form of medicine, TCM exercises a profound influence on the life of the Chinese people. It is a major means to help the Chinese people maintain health, cure diseases, and live a long life. The Chinese nation has survived countless natural disasters, wars and pestilences, and continues to prosper. In this process, TCM has made a great contribution.

Born in China, TCM has also absorbed the essence of other civilizations, evolved, and gradually spread throughout the world. As early as the Qin and Han dynasties (221 BC-AD 220), TCM was popular in many neighboring countries and exerted a major impact on their traditional medicines. The TCM smallpox vaccination technique had already spread outside of China during the Ming and Qing dynasties (1368-1911). The Ben Cao Gang Mu (Compendium of Materia Medica) was translated into various languages and widely read, and Charles Darwin, the British biologist, hailed the book as an "ancient Chinese encyclopedia." The remarkable effects of acupuncture and moxibustion have won it popularity throughout the world. The discovery of qinghaosu (artemisinin, an anti-malaria drug) has saved millions of lives, especially in developing countries. Meanwhile, massive imports of medicinal substances such as frankincense and myrrh have enriched TCM therapies.

II. Policies and Measures on TCM Development

China lays great store by the development of TCM. When the People's Republic was founded in 1949, the government placed emphasis on uniting Chinese and Western medicine as one of its three guidelines for health work, and enshrined the important role of TCM. In 1978, the Communist Party of China (CPC) Central Committee transmitted throughout the country the Ministry of Health's "Report on Implementing the Party's Policies Regarding TCM and Cultivating TCM Practitioners," and lent great support in areas of human resources, finance, and supplies, vigorously promoting the development of TCM. It is stipulated in the Constitution of the PRC that the state promotes modern medicine and traditional Chinese medicine to protect the people's health. In 1986, the State Council set up a relatively independent administration of TCM. All provinces, autonomous regions, and municipalities directly under the central government have established their respective TCM administrations, which has laid an organizational basis for TCM development. At the Fourth Meeting of the Seventh National People's Congress, equal emphasis was put on Chinese and Western medicine, which was made one of the five guidelines in China's health work in the new period. In 2003 and 2009, the State Council issued the "Regulations of the People's Republic of China on Traditional Chinese Medicine" and the "Opinions on Supporting and Promoting the Development of Traditional Chinese Medicine," gradually forming a relatively complete policy system on TCM.

Since the CPC's 18th National Congress in 2012, the Party and the government have granted greater importance to the development of TCM, and made a series of major policy decisions and adopted a number of plans in this regard. At the National Conference on Hygiene and Health held in August 2016, President Xi Jinping emphasized the importance of revitalizing and developing traditional Chinese medicine. The CPC's 18th National Congress and the Fifth Plenary Session of the 18th CPC Central Committee both reiterated the necessity to pay equal attention to the development of traditional Chinese medicine and Western medicine and lend support to the development of TCM and ethnic minority medicine. In 2015, the executive meeting of the State Council approved the Law on Traditional Chinese Medicine (draft) and submitted it to the Standing Committee of the National People's Congress for deliberation and approval, intending to provide a sounder policy environment and legal basis for TCM development. In 2016 the CPC Central Committee and the State Council issued the Outline of the Healthy China 2030 Plan, a guide to improving the health of the Chinese people in the coming 15 years. It sets out a series of tasks and measures to implement the program and develop TCM. The State Council issued the Outline of the Strategic Plan on the Development of Traditional Chinese Medicine (2016-2030), which made TCM development a national strategy, with systemic plans for TCM development in the new era. These decisions and plans have mapped out a grand blueprint that focuses on the full revitalization of TCM, accelerated reform of the medical and healthcare system, the building of a medical and healthcare system with Chinese characteristics, and the advancement of the healthy China plan, thus ushering in a new era of development for TCM.

The basic principles and main measures envisioned to develop TCM are:

Putting people first, and making achievements in TCM development accessible to everyone. TCM roots deep among the public, and the philosophies it contains are easy to understand. To meet the people's demand for healthcare, China endeavors to expand the supply of TCM services, improve community-level TCM health management, advance the integral development of TCM with community service, care of the elderly and tourism, spread knowledge of TCM and advocate healthy ways of life and work, enhance welfare for the public, and ensure that the people can enjoy safe, efficient, and convenient TCM services.

Equal attention to TCM and Western medicine. Equal status shall be accorded to TCM and Western medicine in terms of ideological understanding, legal status, academic development, and practical application. Efforts shall be made to improve system of administration related to TCM, increase financial input, formulate policies, laws and regulations suited to the unique features of TCM, promote coordinated development of TCM and Western medicine, and make sure that they both serve the maintenance and improvement of the people's health.

Making TCM and Western medicine complementary to each other, and letting each play to its strengths. The state encourages exchanges between TCM and Western medicine, and creates opportunities for Western medical practitioners to learn from their TCM counterparts. Modern medicine courses are offered at TCM colleges and universities to strengthen the cultivation of doctors who have a good knowledge of both TCM and Western medicine. In addition to the general departments, TCM hospitals have been encouraged to open specialized departments for specific diseases. General hospitals and community-level medical care organizations have been encouraged to set up TCM departments, and TCM has been made available to patients in the basic medical care system and efforts have been made to make it play a more important role in basic medical care. A mechanism has been established for TCM to participate in medical relief of public emergencies and the prevention and control of serious infectious diseases.

Upholding the dialectical unity of tradition and innovation, i.e., maintaining TCM's characteristics while actively applying modern science and technology in TCM development. A system has been established to carry forward the theories and clinical experience of well-known veteran TCM experts, and efforts have been made to rediscover and categorize ancient TCM classics and folk medical experience and practices. A system of technological innovation has been established to advance TCM progress, and efforts have been made to carry out systemic research on the fundamental theories, clinical diagnosis and treatment, and therapeutic evaluation of TCM. Interdisciplinary efforts have been organized in joint research on the treatment and control of major difficult and complicated diseases and major infectious diseases, as well as research on the prevention and treatment of common diseases, frequently occurring diseases, and chronic diseases using TCM. Endeavor has been made in the R&D of new TCM medicines, and medical devices and equipment.

Making overall plans for integrated, coordinated and sustainable development of TCM. The state makes overall plans for the coordinated development of TCM, integrating such areas as TCM clinical practices, healthcare, R&D, education, industry, and culture. Efforts have been made to improve community-level TCM services and the TCM medical care system. A health promotion project featuring preventative treatment of diseases has been launched to enhance TCM medical care. China has built research bases for TCM clinical studies, developed a system of coordination and innovation for the prevention and treatment of major diseases with TCM, and launched programs for training professionals necessary for TCM inheritance and innovation, and improving the quality of the ranks of TCM workers. The state has set out to promote the green development of the entire TCM industrial chain, and vigorous efforts have been made in the development of non-pharmacological therapies. Further efforts have been made to upgrade the TCM industry and develop it into an emerging strategic industry. A nationwide program has been conducted to promote the core values of TCM.

Promoting TCM development by way of government support and multi-party participation. The government has made TCM an important component of economic and social development, and has included it in relevant plans and provided financial support. The state has strengthened the supervision and administration of TCM practices, and initiated a market access system for TCM practitioners, TCM medical institutions, and TCM medicines, and improved the standards for the quality and safety of TCM service. The government has developed preferential policies to let the market play a full and decisive role in allocating resources, and is striving to create a market environment characterized by equal participation and fair play, so as to maximize the potential and vitality of TCM. Encouragement has been given to social capital to support the development of TCM, and to private investors to establish TCM healthcare institutions.