Traditional Chinese Medicine is Winning Hearts,from Michael Phelps to Lady Gaga

Traditional Chinese Medicine is stepping onto the global stage, with traditional practices like acupuncture and cupping gaining acceptance among patients beyond China. What challenges does TCM face in its broader application, and what advantages does it offer? Insights from Zhang Boli's speech will shed light on these questions.
April 28, 2024
Zhang Boli
Academician of Chinese Academy of Engineering President of the Tianjin Univerisity of Traditional Chinese Medicine

【 Remarkable Achievements in the Modernization of Traditional Chinese Medicine (TCM) 】

Before the initiation of the strategy for the modernization of Traditional Chinese Medicine, the industrial output value of TCM in our country was only about 20 billion yuan. By 2017, after more than 20 years of development, the industrial output value of TCM reached nearly 800 billion yuan. In over two decades, there has been an increase of more than 30 times from the original 20 billion yuan.

During the process of modernization, the experimental conditions for TCM have significantly improved. In the pharmaceutical laboratories of Tianjin University of Traditional Chinese Medicine, modern experimental equipment allows teachers and students to obtain experimental data on various aspects ranging from the extraction, separation, and preparation of TCM components to pharmacodynamic evaluation. This advancement facilitates both qualitative and quantitative analysis of TCM. In the research of TCM components, China has advanced to the forefront globally.

In 1996, when the strategy for TCM modernization was just launched, there were only a few dozen SCI-indexed papers published on TCM nationally, accounting for only 4% globally. By 2013, the number of papers published nationally soared to over 3,000, making up 34% of the global total.

Currently, 183 countries are promoting and applying TCM techniques, and China has signed intergovernmental agreements with 86 countries. Several TCM centers have been established overseas, and tens of thousands of international students come to China annually to study TCM. Globally, there are about 200,000 TCM clinics, employing several hundred thousand people, including a significant number of locals in addition to Chinese practitioners.

In today’s scientific era, how can the ancient practices of TCM be rejuvenated? The answer lies in adhering to the original principles while embracing innovation. To adhere means to preserve the essence, and to innovate means to incorporate advanced techniques and methods from other disciplines to serve TCM, allowing it to embody the characteristics of the modern era and reach contemporary scientific standards. This serves the people of China and the world better. This is the purpose of TCM modernization.

【 The Two Main Issues Currently Facing Traditional Chinese Medicine 】

There are primarily two issues currently facing traditional Chinese medicine (TCM).

Firstly, there is a need to improve the quality of Chinese medicinal materials, namely the quality of Chinese herbal slices, to ensure that the public has access to reliable medications. The output value of Chinese medicine has grown from over 20 billion yuan to 800 billion yuan, a more than thirtyfold increase. However, the natural resources for Chinese herbs have not increased to the same extent, resulting in a shortage of wild medicinal materials. What do we do when there is a shortage? We must resort to cultivation. However, cultivated plants are not the same as their wild counterparts. Firstly, we lack experience in this area, and secondly, there is a lack of technical standards. Now, we advocate for the “Three Noes and One Full” genuine medicinal material brand. “Three Noes and One Full” refers to “no sulfur fumigation, no aflatoxin contamination, and no-pollution standardized cultivation, with full traceability management.” TCM values authentic medicinal materials to ensure the basic medicinal effects and provide reliable Chinese medicine to the public.

Secondly, there is a need to provide more clinical evidence of the effectiveness of TCM. Chinese medicine has thousands of years of medicinal use, which is incredibly valuable, but modern evidence is also necessary. The TCM system should be studied and validated using modern science, including contemporary medical knowledge, not only clarifying the active substances but also explaining the mechanisms of action and providing robust evidence-based proof. This is a fundamental prerequisite for the internationalization of TCM.

Our team has collected and analyzed clinical data on 1596 traditional Chinese patent medicines and established a database, including over 80,000 RCT (randomized controlled trial) papers and more than 4,000 meta-analyses. We analyze the clinical data for each Chinese patent medicine to reveal its mechanisms of action, ensuring clinically rational use of the medicine and better control over its quality.

Fudan University conducted a study on severe pneumonia in the elderly across 33 hospitals in 16 provinces and cities, involving 675 patients. Researchers added a traditional Chinese patent medicine called “Xuebijing” to the standardized Western medical treatment. The study found that after 28 days of treatment, the mortality rate of patients who received this medicine was reduced by 8.8%, with a relative mortality risk reduction of 35%. This is an example of evidence-based proof.

We have now conducted this rigorous evidence-based assessment on hundreds of Chinese patent medicines. We hope that Chinese medicine enterprises can collaborate with hospitals and universities to clarify the clinical applications of each Chinese herb: what exactly does it treat? At what stage of the illness should it be introduced? Compared to Western medicine, what are its advantages? How can it work synergistically with Western medicine?… Clarifying these aspects will bring greater benefits to the public.

【 Unified Standards, Moving Towards Internationalization 】

A sign of maturity in any discipline is the establishment of standards. Therefore, we need to establish unified standards in the training of traditional Chinese medicine (TCM) practitioners.

Firstly, we have established standards for undergraduate TCM education. These standards were not developed solely by us but in collaboration with experts from overseas. This marks the first international standard in our nation’s higher education, now adopted by over 50 countries and regions.

With standards in place, textbooks are also necessary. We organized more than 500 experts from both within China and abroad to compile undergraduate TCM textbooks. It took four years to complete the textbooks, followed by another two years to translate them into English. In 2019, this set of textbooks was finally completed and launched at the World Congress of Chinese Medicine in Hungary, receiving widespread acclaim.

With this set of textbooks and established standards, TCM practitioners around the world can communicate better. This not only allows TCM to truly benefit humanity but also represents a contribution of the Chinese nation to the world.

For TCM to be accepted worldwide, it first needs a “household registration.” In 2019, the World Health Organization included the classification of TCM patterns and diseases in the 11th revision of the International Classification of Diseases, with a special section added on traditional medicine. TCM was formally incorporated into this international mainstream medical classification system. In this section, the names, diagnostic criteria, and treatment medications of TCM patterns and diseases are all listed. Thus, TCM is gradually moving towards global acceptance and recognition.

【 Chinese Medicine and Western Medicine Have Their Own Advantages and Can Complement Each Other 】

Traditional Chinese medicine is an ancient medical practice from China, with thousands of years of history and rich experience. It has played a significant protective role in the reproduction and survival of the Chinese nation. However, in modern times, TCM has faced many challenges. Some people do not understand it and consider it unscientific because they perceive it as ancient, old, and outdated, which is an overly arbitrary viewpoint.

Chinese medicine and Western medicine have different philosophical principles. The scientific nature of TCM cannot be judged by the standards of Western medicine because they are two different systems.

Let’s consider the differences between Chinese and Western medicine. In terms of thinking, Chinese medicine emphasizes symbolic and holistic thinking, while Western medicine focuses on intuitive and linear thinking. Theoretically, Chinese medicine stresses the functions of organs, meridians, yin and yang, and qi and blood, whereas Western medicine is based on anatomy, physiology, and pathology. In terms of research subjects, Chinese medicine emphasizes an individual’s self-perception, while Western medicine focuses more on organ functions and physiological and pathological states.

The methods of research and diagnosis also differ between the two. Western medicine relies more on objective examinations; Chinese medicine values “inspection, listening and smelling, questioning, and pulse-taking,” assessing the internal from the external. Western medicine emphasizes chemical drugs and surgery; Chinese medicine employs herbal treatments and emphasizes holistic care, including acupuncture, massage, dietary therapy, medicinal cuisine, and comprehensive approaches like Tai Chi and Ba Duan Jin.

Therefore, these two medical systems each have their strengths, which can complement each other, but they cannot replace one another.

Salvia droplet pill used to treat coronary heart disease, have effects that cannot be replaced by Western medicines. To register this medicine in the United States, it must undergo reevaluation. The U.S. drug evaluation system is stricter, requiring three phases of clinical trials. The first phase focuses on drug safety, the second on efficacy, and the third involves clinical research on different populations, dosages, and drug combinations. The results, after studies involving over 1,000 patients across eight countries and 127 clinical centers, concluded that Salvia droplet pills have a definite therapeutic effect. They not only dilate coronary arteries and protect blood vessels and heart muscles but also have central regulatory and anti-inflammatory effects, with a comprehensive impact comparable to Western medicines.

How many such Chinese medicines exist? We already have dozens of Chinese medicines that have reached this level. I believe that as the modernization of Chinese medicine progresses, we will reveal more about the effects and mechanisms of action of Chinese medicines, playing a greater and better role in disease treatment.

【 The Scientific Nature of Traditional Chinese Medicine is Undeniable 】

Traditional Chinese Medicine (TCM) has a history of several thousand years. Some say that ancient remedies cannot completely cure modern diseases. However, I believe that this statement is not entirely comprehensive. Internationally, TCM is considered the leader among traditional medicines. TCM has been practiced for nearly 5,000 years, with an unbroken tradition that stretches back to the inscriptions on oracle bones, which include medical knowledge. The system of TCM is comprehensive, encompassing theories, methodologies, formulas, and pharmacology, as well as anatomy, physiology, and pathology, all forming a well-rounded medical framework. Hence, TCM has not been fundamentally overturned but has continued to develop and adapt over millennia.

In modern times, many cutting-edge approaches in medicine, such as personalized medicine, preventive medicine, and combination drug therapies, share similarities with concepts proposed by TCM thousands of years ago. These include holistic approaches, syndrome differentiation and treatment, health preservation, and complex formulations. Although the terminologies differ, the underlying principles are strikingly similar. Therefore, the philosophy of Traditional Chinese Medicine (TCM) is not outdated; it is only the technology that was relatively undeveloped, as advanced technologies had not yet emerged at the time. In fact, during the development of TCM, practitioners throughout the ages have incorporated the most advanced elements available into their practice.

In the past, we did not know which components in herbal decoctions were effective and which were inactive. As a result, we have introduced the concept of component-based Chinese medicine. “Components” refer to the individual elements within a mixture, including the effective ones. What are the components of Chinese medicine? What activities do they have? What are their pharmacological effects? By fully understanding the components of Chinese medicine, we can eliminate ineffective components and retain those that are effective or moderately effective. Guided by TCM theories, we re-formulate classic prescriptions into modern complex Chinese medicines and conduct further pharmaceutical research. This is the essence of component-based Chinese medicine.

Tianjin University of Traditional Chinese Medicine hosts the largest physical repository of Chinese medicine in our country, with over 60,000 samples and pieces of information on component-based Chinese medicines. By mastering the effective components and pharmacological effects of Chinese medicine, researchers can selectively combine herbs based on the characteristics of diseases and the ancient principles of TCM, thus significantly increasing the success rate of new drug development.

For example, a Chinese medicine named QiShenYiQi Dropping Pills mainly includes ingredients such as Astragalus, Salvia miltiorrhiza (Danshen), Panax notoginseng (Sanqi), and borneol. The active component of Astragalus is its saponins, which protect mitochondria and improve immune function; the active component of Danshen is salvianolic acid, which controls inflammation, inhibits apoptosis, and promotes angiogenesis; the active component of Sanqi is total saponins, enhancing immune function and protecting blood vessels; borneol has anti-inflammatory properties. Together, they are effective in treating coronary heart disease. In parallel studies with aspirin, we found that both have comparable therapeutic effects.

TCM is not static; its core content, theoretical foundations, and philosophical ideas remain unchanged, while the techniques for diagnosis and treatment evolve almost daily. These continuously changing diagnostic and therapeutic methods are the internal driving force propelling TCM forward. Undoubtedly, TCM is a science.

【Practical Benefits of TCM】

Traditional Chinese Medicine (TCM) also has a significant characteristic: it is simple, convenient, affordable, and effective. “Simple” refers to the ease of its methods; “convenient” means adapting to local conditions and using local resources; “affordable” indicates its low cost; and “effective” signifies its efficacy.

Michael Phelps, an American swimmer, won five gold medals at the Rio Olympics. What also made a deep impression was the cupping marks on his body, dubbed the “China marks.” Phelps trained six to seven hours a day, and at night he would experience muscle soreness, with stiffness returning the next morning. He had to perform extensive warm-up activities before he could commence training. Since starting cupping therapy, he felt much more relaxed and was able to reduce the time needed for his warm-ups, leading him to continue with the therapy.

Besides cupping, other simple and effective methods like acupuncture play a significant role in TCM treatment. Clinical research has found that acupuncture can treat about 500 diseases, addressing both chronic and acute conditions. For example, acupuncture treatment for high blood pressure does not have the side effects associated with medications and can reduce the burden on the patient’s heart, brain, and kidneys by maintaining proper blood pressure levels.

Consider another example. Middle-aged and elderly women often suffer from a condition called “stress urinary incontinence,” which involves difficulty in controlling urine. This condition is more common in women who are overweight or tall due to increased abdominal pressure. There are no satisfactory treatments for this condition in Western medicine, and the available drugs can have side effects and diminish in effectiveness over time. However, acupuncture can be an effective treatment. Professor Liu Baoyan from the Chinese Academy of TCM and his team used acupuncture to treat stress urinary incontinence with notable results. Their findings were published in the prestigious international medical journal JAMA, causing a sensation both domestically and internationally. After the publication of this paper, some countries included acupuncture for stress urinary incontinence in their health insurance coverage. Thus, a simple method from TCM has alleviated the suffering of many.

Currently, the difficulties and high costs of healthcare are common issues worldwide. Our country values both Chinese and Western medicine. By leveraging the advantages of the simplicity and cost-effectiveness of Chinese medicine, we can provide the public with better healthcare with less investment, offering more medical care and support. It can be said that it is precisely because of this national treasure of Chinese medicine that we can enjoy the dual benefits of both Traditional Chinese and Western medicine.


Zhang Boli
Academician of Chinese Academy of Engineering President of the Tianjin Univerisity of Traditional Chinese Medicine
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