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While the recent debate to abolish traditional Chinese medicine (TCM) from official medical system has been fading from media spotlight, it has ignited a wide and continuous discussion on the approaches for the TCM modernization.

"The primary reason for the call to abolish TCM from the medicine is it is less scientific. It seems to me that the term 'scientific' has been used in a misleading way," said Zhang Shitian, a former drug evaluator at the State Food and Drug Administration (SFDA) and now a consultant to Health, Welfare and Food Bureau of Hong Kong Special Administrative Region.

The debate on the fate of TCM was aroused by Zhang Gongyao, a professor of philosophy of science at Changsha-based Central South University.

In early October, Zhang posted an article in his blog (http://hexun.com/zhgybk), suggesting the government abolish TCM from the official medical system but still retain it as an unfunded, grass-roots service. He said that TCM had too many unscientific components, high toxicity and uncertain therapeutic effects.

The blog article quickly triggered wide-spread public debate. By the end of last month, most denounced Zhang as ignorant of TCM.

An online survey launched by the popular news portal Sina.com.cn attracted more than 40,000 votes by the end of October, and more than 80 per cent supported TCM.

The professor fell, not answering calls and responding to any e-mail.

Zhang's call to abolish TCM from official medical system occurred amidst several widely reported cases concerning TCM toxicity and irregular practices.

In August, the UK drug authorities banned a TCM Fufang Luhui Jiaonang, a capsulated compound based primarily on aloe used as nutritious supplements in that country because they have been found with high amount of mercury 11,700 times of the UK standard.

In mid October, three kinds of anti-diabetes TCM were found by Shanghai drug authorities to illegally contain chemical compounds. These compounds were found to have a fast effect to reduce blood sugar, but their side effects were so major that they had been banned in the mid 1980s.

In China, adding chemical compounds into TCM to compose a Chinese-Western joint medicine is theoretically legal, as long as it is strictly reviewed and approved by the SFDA.

However, Song Jun, a TCM doctor with Beijing Xiyuan Hospital affiliated to the Chinese Academy of Chinese Medical Sciences (CACMS), said if the TCM makers add chemical compounds to their medicine, their drugs were very unlikely to be approved.

Mao Qun'an, spokesperson for the Ministry of Health, has rebuffed Zhang's proposal by saying it is ignorant of the Chinese history.

While calling Zhang's proposal an irresponsible farce, Fang Shuting, deputy director of the State Administration of TCM, vowed that China will continuously support the development of TCM and its modernization.

Meanwhile, at a time when genes and proteins are dominating the attention in the medical researches, studies have yet to reveal the genetic or molecular mechanism of TCM-based therapies in lab experiments.

For Wang Xudong, a professor of TCM at Nanjing University of TCM, however, the medicine's lack of results in the molecular level should not be considered as its failure. "Modern Western medicine and TCM are two totally different approaches. For the previous one, all therapeutic approaches are based on a clear understanding of the pathogenic targets; but for TCM, its role is mainly embodied in strengthening the natural human functions. You cannot bet everything (of TCM) be clearly understood in the molecular level before using it," Wang said.

Most doctors and experts involved in the TCM debate, however, say that the prosperity of TCM relies on how well TCM comply with modern medical sciences. "You cannot explain all the traditional philosophy such as yin and yang backing TCM to an era featured with genes and proteins," said Wang Zhao, a professor of natural medicine at Tsinghua University.

Yet Zhang Shitian argued that TCM's complying with modern medical sciences does not mean it must be totally evaluated with the paradigm of modern sciences.

"It has been stressed that TCM is not modernized until each pharmaceutical molecule of a TCM prescription is well understood and its function in human bodies clearly elaborated in the molecular level," Zhang said at the 10th Healthcare Industry Forum, organized by Beijing Pharma and Biotech Centre late last month.

"But for TCM, which commonly involves several herbal ingredients for a single prescription, this is impossible and often unnecessary, because they have been tested in human bodies for thousands of years," Zhang Shitian told China Daily.

Despite the accumulated efforts in China over the past 50 years, no more than 10 TCM-based herbals have been clearly understood in the single molecule level.

Wang Zhimin, director of natural herb department at the CACMS, argued that the lack of research results in the molecule level does not mean the scientific studies on TCM are less successful.

"In the process of the studies, we have better understood the TCM mechanism and our understanding can be accelerated with the better combination of TCM and modern molecular biology," Wang said.

Zhang said that the right way is to use modern chemistry or molecular biology to purify and standardize the most pharmaceutically active compounds of TCM no matter they are a single molecular or a group of molecules whose very names remain unknown.

"In this way, we can ensure to maximize the therapeutic effects of TCM while minimizing its side effects and toxicity," Zhang said.

Ye Zuguang, a famous researcher at CACMS, agreed. While the molecular studies on TCM herbs are necessary in the basic research, strict procedures for clinical trial can be introduced to re-evaluate the efficiency and safety of the existing TCM and newly approved ones, Ye said.

"The molecular studies and the practical re-evaluation of TCM can be combined together. With this innovative approach, TCM can keep a new and booming life in China," Ye concluded.

(China Daily November 22, 2006)