China
Background of Medicinal System
Chronological development
| Century / Year | Historical Milestone |
| Antiquity – (~2000 B.C.) | The Yellow Emperor and Shen-nong are said to be the founders of TCM (1). |
| 200 B.C. | The earliest extant medical canon of TCM, known as the Yellow Emperor’s Classic of Internal Medicine (Huangdi Neijing), discussed the theory and philosophy of TCM, as well as the therapeutic benefits of acupuncture, herbs, diet and exercise (2). |
| 206 B.C. – 220 A.D. | In the East Han Dynasty, another valuable classic, the ‘Treatise on Diseases Caused by Cold Factors’ (Shanghan Zabing Lun), which was the first monograph on clinical medicine, was written by Zhang Zhongjing. This classic is an authoritative and practical guide to the treatment of illness even to the present day (2). |
| 1368- 1644 A.D. | Another well-known Chinese medical compendium is the Materia Medica (Ben Cao Gang Mu), compiled by the Ming Dynasty physician Li Shizhen (1518-93). This encyclopedic work includes descriptions of almost 2,000 different kinds of medicines and forms an important framework for TCM herbology (2). |
| 1644-1911 A.D. | The theoretical system of the six channels, four stages of Wei Qi (defensive Qi), Ying (Nutrient), Xue (blood) and Sanjiao (triple Energier) are methods of differentiating syndromes of seasonal febrile diseases, was developed in the Qing Dynasty as a specialty of TCM (2). |
| Early 1900s | TCM has made great contributions to the prosperity of China and undergoes influences of the Japanese, Europeans, and the Communist revolution. Changes can be seen by the usage of both terms, “Traditional Chinese Medicine and Traditional Oriental Medicine (TOM)” in the literature that explain these influences. Although these two terms are sometimes used interchangeably, TOM generally refers to the system of Chinese medicine practiced until the early 1900s (3). |
| 1928- 1949 | During this period, the Communist party under Chairman Mao encouraged the use of traditional Chinese remedies by public as there were minimal medical services available then. Furthermore, the remedies were trusted by the people as they were part of their tradition, inexpensive and skilled practitioners were already at hand in rural areas. (3) |
| 1940 | In 1940, it was proposed that traditional Chinese medicine should be studied scientifically in order to popularise it (3). Since then, the facilities to provide, teach and investigate TCM in China were established. |
| 1949 | National policy on TM/CAM was issued and the national office has been set up (4). |
| 1950s | Thousands of experimental and clinical studies have been carried out during 1950 as a measure to assess systematically the effectiveness of traditional medicine (5). |
| 1954 | The improvement of TCM and foundation of schools (6). |
| 1963 | The expert committee on TM/CAM was established and the Chinese pharmacopoeia was first published in 1963. (4). |
| 1982 | Allopathic and Traditional Chinese Medicine have been promoted (7) and a constitution being formed as for the development of TCM (6). |
| 1999 | TCM was introduced in the National Health Insurance (6). |
| 2006-2007 | Central government make up a reorganization team which later be an independent research institute to handle the reform healthcare (8). |
| 2007 | A preliminary medical insurance scheme for rural residents have been launched (8). |
| 2009 | Published an outline of policy reform with various methods of implementation (8). |
| November 2012 | Integration of medical services was done in Beijing through the formation of Chaoyang Hospital Medical Alliance (9). |
Current Practice
Nowadays, both TCM and Western medicine are being used in providing medical and health services in China. TCM in China is under the administration of State Administration of TCM and Pharmacology (10)
The government has been putting effort in integrating TCM into the National Health System. The effort includes (11):
- Protecting the development of Chinese medicine via state laws and regulations, in the endeavour to enhance the important role of Chinese medicine in the prevention and treatment of diseases along with modern medicine, as well as developing the industry of Chinese pharmacology. Currently, the government is establishing the legal system of Chinese medicine – Chinese Medicine Regulations of the People’s Republic of China.
- Including the development of Chinese medicine as one of the agenda in the National Economy and Social Development plan. The eleventh five-year (2006-2010) development plan for TCM has been formulated as an important guideline for the Chinese medical administrative institutions. In the period of year 2006 to 2010, further implementation of collaborating international scientific and technological parties for Chinese medicine will be carried out. Continuous implementation for modernizing Chinese medicine and development of TCM new products to meet the needs of clinical treatment are listed in the five-year plan as well.
- Providing financial support to the project and other plans related to the development of Chinese medicine from the state and regional government.
- Applying CM into the health service system in rural areas and also the urban community health service system, in order to strengthen and unify the planning and management of CM, CM premises, training for CM personnel, financial support, and the network of CM services as well as CM prevention and maintenance healthcare.
- Adopted the Chinese medicine medical services into the national insurance system in year 2003.
Up to December 2002, there were about 4,808,640 people working in 85,705 medical organizations in China, in which a total of 3,801 are TCM organizations (approximately 4.4%) with 435,082 TCM staffs (9.1%) (12). It was documented in 2008 that there were 253,233 registered TCM doctors and assistant doctors in the country (13).
The integration of traditional and Western medicine which began in the late 1950’s was considered the best way towards the health of the nation and the position of TCM is protected within China’s constitution.
Nowadays, there are roughly about 95% of general hospitals that have TCM departments (14). This integration is more common in primary healthcare and outpatient department.
For promoting more research, TCM research is regulated under the National Strategies, law and regulations which act as guideline for researchers.
The government encourages research and scientific-based education for TCM practitioners, in order to create harmonization between TCM and modern Western medicine.
Biomedicine and traditional Chinese medicine are fully integrated.
Prevalence
- About one third of outpatient services and a quarter of inpatient services are handled by TCM practitioners in the rural area.
- A survey conducted by SATCM (The State Administration of Traditional Chinese Medicine) shows that there are estimated 3.1 billion outpatient visits per year in China and most often to village health centers. Besides, it is estimated that there are about 38.9% of patients going to outpatient department of village health centers, followed by rural TCM hospitals (27%) (12).
- WHO stated that traditional herbal preparations account for 30%-50% of the total medicinal consumption in China (15).
- According to the survey conducted by the National Monitoring Center for Quality of TCM Healthcare Service, the demand for TCM service is more preferred in the urban areas compared to the rural areas with 79% of the services involve with the herbal medicine. They were mostly preferred acupuncture, followed by Tuina and physiotherapy as their choices for non-medicine therapies (13).
Administration
Official Body
State Administration of Traditional Chinese Medicine, SATCM
Contact
Address: State Administration of TCM, 13, Baijiazhuang, Dongli Chaoyang, Beijing 100026.
Contact No: +86-10-65063322
Fax No: +86-10-65950776
Email: [email protected]
Main Therapies
Policy & Regulations
- The national policy on TM/CAM was issued in 1949 (4).
- In 1954 national regulations of herbal medicine were issued in the same laws as for conventional pharmaceuticals and was regulated in 1963 (4, 7).
- According to the Chinese Ministry of Public Health’s Department of Traditional Chinese Medicine in 1985, a person should take the formal examinations followed by a completion of courses to be qualified as a traditional medical physician or assistant if he or she was formerly under the apprenticeship system (7).
- Diploma holder may practice TCM as a medical assistant and only permitted to open own practice in rural towns and villages (12)
- The State Administration of Traditional Chinese Medicine was established in 1986 (7). All the practitioners are regulated by the State Administration of Traditional Chinese Medicine (SATCM) in order to protect public health and consumers in China. (10)
- Qi gong regulations was legislated in 1989 stated that the practitioners must own medical Qi gong skills and be qualified as traditional Chinese medical physicians or assistants and they need to get approval from the local health authority before teaching in public areas provided the teaching must follows the scientific methods (7).
- 1989 regulations stated that the traditional Chinese medical assistants are permitted to open their own practice only in rural towns (7).
- TCM products are regulated in Anthology of Policies (SATCM 1997). There are national standards for TCM products before they can be marketed in or outside China. All the products must meet quality and safety standards. (12)
- In 1998, the State Drug Administration became responsible for regulatory issues relating to traditional medicine. (4)
- The Chinese Medicine Ordinance (CMO) was enacted in 1999. A person with recognized undergraduate degree of training in Chinese medicine have to pass the licensing examination if wants to be registered (16).
- China has published a national guidelines for clinical antimicrobial use in 2004 and establish policies on prescription drug management and non-prescription (OTC) drugs (9).
- A policy on deepening medical and pharmaceutical reforms by focusing on public hospital has been announced by the government in 2009 (9).
- TM medical institutions are ruled by the same national legislation on medical institutions as conventional medical institutions (16).
- China’s State Council has publicized a guideline on promoting the TCM development which includes the health maintenance, research, culture, and industry, coordination of service delivery, the government support and mobilization of social resources (13).
There are other policies and regulations pertaining to this country in its endeavor to regulate TCM. For further information, please review Legal Status of Traditional Medicine and Complementary/ Alternative Medicine: A Worldwide Review, WHO 2001.
Facilities
- There are about 95% of general hospitals in China which have traditional medicine departments (7,17). Up to December 2002, there are about 3801 TCM organization in China and around 2864 TCM government hospitals with a total of 272861 ward beds.
- Roughly, there are about 200 million outpatients receiving treatment annually in TCM hospitals and 50% of rural doctors are able to provide both traditional and allopathic medicine by offering one third of outpatient services and a quarter of inpatient services.
- Many hospitals are open on Saturday and Sunday due to high patient turnover every day and one does not need to make an appointment to consult a TCM doctor.
- China had a 65.2% general hospitals, 19.5% private hospitals, and 12.9% traditional Chinese medicine hospitals (9).
- The number of medical facilities that practicing TM was 3.85-28.6% of the number of facilities practicing CM and the ratio of medical facilities practicing CM to facilities that practicing TM was 24.99:1 respectively (6).
Insurance coverage
Since 1951, China have implemented medical insurance coverage of TM which includes acupuncture, moxibustion, cupping and manual therapies which completely covered for reimbursable treatments while herbal medicines are partially covered (6).
The herbal extracts are insured only if they are applicable for specific diseases. Most of the decoctions raw herbs except the one which does not nominated for the indication, the very precious medicine, and herbal paste are also insured (6).
There was 49% of the urban Chinese who had the insurance coverage while only 7% of rural Chinese who had it in the year of 1999 (18).
Health insurance covers treatment costs of both allopathic and traditional medicine (16).
Research Institute/s
In China, roughly about 15000 professionals are involved in scientific research on TCM because currently there is a move towards evidence-based medicine. The research emphasizes the standard of quality control and on systemic research. China Academy of Chinese Medical Sciences (CACMS) was established in 1955 previously named as China Academy of Traditional Chinese Medicine (CATCM). It is a national comprehensive institution for scientific research, clinical medicine and medical education on traditional Chinese Medicine (TCM). Some research institutes / universities:
- Nanjing University of Traditional Chinese Medicine.
- Institute of Acupuncture Research, Shanghai medical College
- Shanghai University of Traditional Chinese Medicine
Up to 2011, there was 388 top level laboratories, 103 research stations, and 133 healthcare centres (13).
Training & Education
- TCM education system is available in China and offers undergraduate programs, masters and doctorate degrees, open to local and overseas student.
- The ratio number of schools that teaches the CM and TM was 4.59:1 respectively (6).
- There are different types of TM education for undergraduate, masters and doctoral programs which include a 5-year, 6-year, 7-year and 8-year program (6).
- There were 34 universities and colleges offering pharmacology and TCM programs as being stated by the Chinese State Administration in 2003 (19) and 57 secondary schools teaching traditional Chinese medicine (4). Both allopathic medicines and TCM subjects are included in the curriculum.
- A department of TCM is included in every Western medical school (19).
- Once a student graduates, he or she will be assigned to work in TCM hospitals and other facilities related to TCM.
- Medical education in China is fully integrated. (20) There were more allopathic medical schools compared to the traditional medical schools, however there will always be one department of traditional medicine in every allopathic medical school and vice versa (7).
- To become a TCM physician, one has to possess a degree. One wishes to be specialized as a TCM practitioner will have to study from five to seven years (12).
- On the other hand, a pharmacist in TCM will have to study for a 4-year course which includes TCM pharmacology (15).
- The traditional medicine practitioners needs to learn and make use of innovations in allopathic medical technology according to the 1985 Management Stipulations for Physicians and Assistants of Traditional Chinese Medicine (7).
Links
- State Administration of Traditional Chinese Medicine : http://www.satcm.gov.cn/english.html
References
- History of TCM chronology [homepage on the Internet]. c2002-2005 [cited 2016 Aug 15]. Available from: http://www.shen-nong.com/eng/history/chronology.html
- Federation of Chinese Physicians and Medicine Dealers Associations of Malaysia TCM – FCPMDAM [homepage on the Internet]. No date [cited 2016 Aug 17]. Available from: http://fcpmdam.com/
- Chinese traditional medicine, an alternative and complementary medicine resource guide [homepage on the Internet]. c1998-2010 [updated 2010 May 6; cited 2016 Aug 18]. Available from: http://www.amfoundation.org/tcm.htm
- World Health Organization. National policy on traditional medicine and regulation on herbal medicines – report of a WHO global survey. Geneva: World Health Organization; 2005.
- Hesketh T, Zhu WX. Health in China. Traditional Chinese medicine: one country, two systems. BMJ. 1997;315(7100):115-117.
- Park HL, Lee HS, Shin BC, et al. Traditional medicine in China, Korea, and Japan: a brief introduction and comparison. Evid Based Complement Alternat Med. 2012;2012:429103.
- World Health Organization. Legal status of traditional medicine and complementary/alternative medicine: a worldwide review. Geneva: World Health Organization; 2001.
- The changing face of healthcare in China. KPMG [serial online]. 2010 [cited 2016 Aug 11]
- China’s healthcare system – overview and quality improvements. Sweden: Growth Analysis Studentplan; 2013.
- Schroeder T. Chinese regulation of traditional Chinese medicine in the modern world: can the Chinese effectively profit from one of their most valuable cultural resources? Pac Rim L & Pol’y J. 2002; 11(3):687-716.
- Shujiang Y. Integration of traditional Chinese medicine into national health system. Beijing: State Administration of Traditional Chinese Medicine; 2006.
- Bodeker G, Ong CK, Grundy C, Burford G, Shein K. WHO global atlas of traditional, complementary, and alternative medicine. Kobe, Japan: WHO Centre for Health Development; 2005.
- Qi Z, Liming Zhu, Van der Lerberghe W. The importance of traditional Chinese medicine services in health care provision in China. International Journal on Human Development and International Cooperation [serial online]. 2011 [cited 2016 Aug 9]; 2(2). Available from: Universitas Forum.
- Complementary and alternative medicine – current policies and policy issues in New Zealand and selected countries. Ministerial Advisory Committee on Complementary and Alternative Health, Ministry of Health; 2003.
- Traditional medicine [homepage on the Internet]. [updated 2003 May; cited 2016 Aug 22]. Available from: http://www.who.int/mediacentre/factsheets/2003/fs134/en/
- World Health Organization. WHO traditional medicine strategy: 2014-2023. Geneva: World Health Organization; 2013.
- Kemper, KJ, editor. Complementary therapies in medicine. The Journal for Integrated Health. 2016;27.
- Blumenthal D, Hsiao W. Lessons from the east – China’s rapidly evolving health care system. N Engl J Med. 2015;372(14):1281-1285.
- Yu F, Takahashi T, Moriya J, et al. Traditional Chinese medicine and Kampo: a review from the distant past for the future. J Int Med Res. 2006;34:231-239.
- Bodeker G. Lessons on integration from developing world’s experience. Br Med J. 2001;322(7279):164-167.
