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Translating the yin and yang of TCM
By Li Anlan

Traditional Chinese medicine, involving concepts of yin and yang, balance and harmony, has been keeping people healthy for more than 2,000 years and practitioners want to share traditional healing with more people around the world.

TCM already has a following in many countries and acupuncture is widely recognized as a useful treatment for various conditions, notably pain management. Still, it's often regarded as alternative medicine.

TCM, which is based on Chinese philosophy, culture and accumulated experience, is essentially holistic and very different from "scientific" Western medicine that typically treats symptoms and is based on systematic, reproducible findings.

But practitioners in Shanghai and elsewhere are seeking wider acceptance for TCM, saying it can work where Western medicine fails.

"Practice has proved that in some areas the theories and clinical efficacy of TCM can supplement the deficiency of contemporary medicine. It is distinctive and complementary, a major feature of Chinese medicine," says Yan Shiyun, chairman of the Shanghai Association of Traditional Chinese Medicine and vice chairman of the China Association of Traditional Chinese Medicine.

The two organizations are promoting the Shanghai International TCM Forum that will open on Friday in Shanghai, focusing on advances in TCM, progress in standardizing it and promoting it worldwide. Experts from Asia and the US will attend the two-day annual event, in its fourth year, at the Shanghai International Convention Center.

Advocates say TCM has advantages, not only in treating diseases, but also in prevention, recovery and preserving health. It is widely used in China where many believe that year-round TCM keeps them in tune with the universe and is more beneficial than Western medicine.

Unlike Western medicine that typically treats symptoms through medication or surgery with applied knowledge of science and technology, TCM is not evidence-based, but rooted in traditions of more than 2,000 years. There is also a strong cultural component, including many ideas about the universe and human body that Chinese people take for granted, such as the five elements (water, earth, wood, fire, metal). It is difficult to explain these metaphysical ideas in the wider international community that relies heavily on Western medicine and the scientific method.

"The biggest difficulties are the East-West cultural differences," Yan says.

Language is one big problem in TCM's journey abroad. To translate its terms and culture into other languages and explain the philosophy behind it require time, effort and research.

"TCM scholars are working to translate TCM into local languages," Yan says. "The languages, as well as the cultural connection with other countries, are research processes that take a long time, not in just one step."

Every year, many international students study TCM in China, in both short- and long-term courses. They take TCM knowledge back home and help internationalize TCM.

"After these students study TCM in China, some cultural conversion of East and West can happen in their brain," Yan says.

It is important to help people understand the thinking behind TCM by relating it to many examples familiar to other cultures, he says.

Another issue impeding international acceptance is standardization of ingredients and equipment to ensure quality and safety.

Codifying and standardizing can be difficult because TCM treatment is tailored to each individual's condition, their flow of qi (life energy) and balance of yin-yang energy. Different TCM practitioners may prescribe different treatment for the same condition in different patients.

Quality control and safety of TCM products have concerns.

In September 2009, the International Organization for Standardization (ISO) launched Technical Committee 249 (ISO/TC 249), focusing on standardizing quality and safety of TCM raw materials. The relatively new committee has 24 participating countries and eight observer nations.

The ISO is an international standards-setting body comprised of representatives of national standards organizations. Founded in 1949, it promulgates global proprietary, industrial and commercial standards.

"The committee was created as TCM is applied in wider ranges internationally, but it lacks standards," says Shen Yuandong, secretary of ISO/TC 249.

ISO/TC 249 has five working groups specializing in quality and safety of raw materials, manufactured TCM products, acupuncture needles, medical devices other than acupuncture needles and "informatics" of TCM. The two standards and projects of the TC 249 Secretariat are single-use sterile acupuncture needles and ginseng seeds and seedlings.

TCM is applied in more than 160 countries and regions, 90 countries regulate herbal medicines and eight countries have legislation on TCM, according to ISO TC 249.

US drug trials

TCM-based drugs are also being introduced overseas for assessment. Shanghai Shuguang Hospital, affiliated with the Shanghai University of Traditional Chinese Medicine, has submitted a hepatitis drug called Fu Zheng Hua Yu (扶正化瘀) for assessment to the United States Food and Drug Administration. It treats chronic hepatitis C.

According to clinicaltrials.gov, a service of the US National Institutes of Health, a significant number of individuals with hepatitis C "will not clear the virus with current approved antiviral therapy, leaving them no options to manage their hepatic fibrosis."

Fu Zheng Hua Yu has been found through numerous studies in China to have "a satisfactory effect on chronic liver injury and formed liver fibrosis." Preliminary studies also indicate that it has a "good safety and tolerability profile with promising efficacy," according to the website.

Delivered in capsule form, the main ingredients include salvia miltiorrhiza (dan shen 丹参), pollen pini (song hua fen 松花粉) and fiveleaf gynostemma herb (jiao gu lan 绞股蓝).

The drug is in Phase II clinical trials in the US. On July 30, 2011, 86 patients were enrolled in the trial to be completed this December, according to Shuguang Hospital. Trials are expected to be complete in 2014.

For more detail and info on TCM and TCM treatment, contact Shanghai Association of TCM International Exchange Center (Bldg 7, 2601 Xietu Rd, 3469-5300).

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