方舟子的Blog

中国计划实现中医现代化

英国《自然》2007年4月5日
记者：Jane Qiu
（方舟子翻译）

　　中国宣布了一项雄心勃勃的计划，试图让古老的中医药采用现代标准。中国政府称它将拓展基础和临床研究，并改进中药出口的检测和开发。但是批评者们质疑该研究是否会符合要获得国际认可所必需的科学标准。

　　虽然中国以前也投资中医药，但是该15年计划的方向有所改变，并将获得多得多的资金。该项目受到16个部委的支持，由科技部、卫生部和中医药管理局领头。

　　科技部分管卫生与生物技术的负责人邹建强说，中国政府拨款10亿元（1亿3千万美元）用于中医药研究和开发，在未来的五年总预算至少是以前7亿4千万元总资金的5到6倍。

　　在这个多数人口未能享受公共医疗并负担不起去医院看病的国家，用于与中医药有关的公共医疗的资金也增加了10倍，达到85亿元。“中医药自古就在为中国人民服务，现在在医疗中仍然起到重要的作用，特别是在那些人们没有机会用到或负担不起西医治疗的地区，”中医药管理局副局长于文明说。

　　这项措施是在遍及全国的有关中医药的激烈讨论之后产生的。去年，湖南长沙中南大学的一名学者张功耀在《医学与哲学》杂志上发表了一篇题为《告别中医中药》的文章，引发了一场全国性的辩论。张功耀争辩说，中医是伪科学，不应该是国家医疗体系和研究的一部分。

　　争论的各方都在焦急地等待政府的立场，结果它坚定地支持把中医当成科学来宣扬。中国极度渴望中药在海外能够获得管理部门的批准，并希望在2020年让中医药全球化。在过去的十年，中药的世界市场翻了一番，其中欧洲和美国是最大的进口国。但是来自中国的中药糟糕的安全记录导致其出口量持续下降，部分市场份额被日本、韩国等邻国占据。

　　因此中国的计划制定了提高标准的策略，包括对中药的安全性和有效性开展临床研究，促进国际合作，改进制造技术并对医药管理系统采用国际规范。

　　中国政府在方法方面的改变引发了更大的争议。要从中药开发出经科学检验的药物，以前的做法是注重从中药中分离出活性成分，一一进行筛选。这个做法获得了少数的新成果，例如用于治疗疟疾的青蒿素和减充血剂麻黄碱，但是获得批准的药物并未大量涌现。新的计划致力于开发出更有传统特色和原理的方法来检验中医药。这要求采用整体论的方法对待疾病的治疗，不是用一种药治疗一种特定的疾病，而是使用植物提取物的复杂混合。每一种混合物都是个体化的，针对某个病人的症状和特性。

　　中医药的从业者和研究人员还在等着看政府是否会真的给钱，但是他们一般来说都欢迎这个计划。“这是一个重大的进步，”上海中医药大学副校长刘平说。不过，有些人不愿附和。北京中国医学科学院一位要求匿名的教授认为，在经过数千年的实践和发展之后，中医已经近乎完善，让中医现代化只不过是歪曲了其实质。

　　美国培养的生物化学学者、现在在主持打击中国伪科学和科研不端行为的“新语丝”的网站的方是民也对这个计划不以为然，但是是出于相反的原因。他支持对中草药进行科学研究，但是认为对检验中医理论的强调是错误的。“中医的基本概念，例如阴阳、五行和经络理论，是对人体模糊的描述，近乎臆测，”他说，“政府已经花费了大量的资金试图证明中医理论的物质基础，但是一无所获。”

　　上海药物研究所药物国家新药筛选中心主任王明伟同意这个观点：“要真正让中医药现代化，我们必须首先去掉这些理论的神秘性。”

　　有些批评者也担心该计划没有设定足够严格的科学标准。虽然临床研究被列为首要任务之一，但是该计划并没有具体说明是否应该采用随机、对照、双盲（研究人员和病人都不知道谁获得药物谁获得安慰剂）的临床试验。而且，并没有要求中医药研究人员要在国际认可的刊物上发表论文。“过去有关中医药的研究多数质量都很差，而且只发表在没有经过同行评议的中国医学期刊上，”王明伟评论说，“如果政府对此没有清楚的立场，那么这种情况不太可能会发生改变。”

　　另一个大家关心的问题是政府没有具体说明它将如何管理科研资金的分配。有些批评者觉得，现在的资源只是被某些受优待的大学和研究所分享，他们争辩说，如果想要获得真正的进展，就应该对此进行改革，确保中医药的资金是择优分配的。否则的话，如上海交通大学药学院副院长贾伟所言，该措施将会只是“雷声大，雨滴小”。

　　邹建强说，政府注意到了围绕中医药的争论和问题，而该计划已经过广泛的商议，就是为了解决这些问题的。中医药管理局科技司副司长苏钢强指出该计划概括了中医药发展的总原则和长远方向，而不涉及细节，并说将来将会发布策略具体地说明如何实施这些框架。

　　中国政府在起草这些计划时是否会考虑批评者的担心，人们拭目以待，但是许多人表达了谨慎的乐观。“现在发展中医药势头正好，”贾伟说，“但愿不会错失良机。”

News
Nature 446, 590-591 (5 April 2007) | doi:10.1038/446590a; Published
online 4 April 2007

China plans to modernize traditional medicine
Jane Qiu, Beijing

Abstract
Government initiative aims to meet scientific standards.

China has announced an ambitious attempt to bring the ancient
practice of traditional Chinese medicine (TCM) into line with
modern standards. The government says it will expand basic and
clinical research, and improve the testing and developing of TCM
remedies for export. But critics question whether the research will
meet the scientific standards necessary for international
recognition.

Although China has invested in TCM before, the 15-year plan
involves a change of direction and will receive significantly more
money. The project is backed by 16 Chinese ministries, spearheaded
by the Ministry of Science and Technology (MOST), the Ministry of
Health and the State Administration of Traditional Chinese Medicine
(SATCM).

Zou Jian-qiang, director of MOST’s health and biotechnology
division, says the government has earmarked 1 billion yuan (US$130
million) for TCM research and development, with the total budget
over the next five years increasing to at least 5–6 times as much
as the previous total of 740 million yuan.

In a country where most of the population is not covered by the
public healthcare system and cannot afford to go to hospital, there
is also a tenfold increase in money for the TCM-related part of the
public healthcare system to 8.5 billion yuan. “Chinese medicine,
which has served the Chinese people since antiquity, still has an
important role in today’s healthcare, especially in areas where
people do not have access to, or could not afford, treatments based
on Western medicine,” says Yu Wen-ming, deputy director of
SATCM.

The initiative comes after heated discussions on TCM throughout
China. Last year, Zhang Gong-yao, a scholar at the Central South
University in Changsha, Hunan, sparked a national debate when he
published an article titled “Farewell to Traditional Chinese
Medicine” in the Chinese journal Medicine and Philosophy (27,
14–17; 2006). Zhang argued that TCM is a pseudoscience and should
not be part of public healthcare and research.

All sides of the argument have been keenly awaiting the
government’s stance, and it has come down firmly in favour of
promoting TCM as a science. China is desperate to earn regulatory
approval for TCM remedies abroad, and hopes to globalize TCM by
2020. The world market for Chinese herbal medicine has doubled over
the past decade, with Europe and the United States being the
biggest importers. But the patchy safety record of TCM from China
has led to a steady decline in its exports, and it has lost market
share to neighbouring nations such as Japan and South Korea.

So China’s plan specifies strategies to boost standards,
including conducting clinical research on the safety and efficacy
of TCM remedies, encouraging international collaboration, improving
manufacturing techniques and bringing the drug regulatory system
into line with international guidelines.

More controversial is the government’s shift in approach.
Previous attempts to develop scientifically tested drugs from TCM
have focused on isolating active ingredients from the remedies and
screening them one at a time. This has led to a handful of new
treatments, such as artemisinin for treating malaria and the
decongestant ephedrine, but there has been no goldrush of approved
drugs. The new plan aims to develop methodologies to test TCM’s
more traditional features and principles. The practice takes a
holistic approach to disease treatment, so rather than using one
drug to treat a particular disease, complex combinations of plant
extracts are used. Each mixture is personalized to the symptoms and
characteristics of the patient.

TCM practitioners and researchers are still waiting to see
whether the government will actually come up with the money, but
they have generally welcomed the plan. “It’s a significant step
forward,” says Liu Ping, vice-president of Shanghai University of
Traditional Chinese Medicine. Some, however, are reluctant to jump
on the bandwagon. A professor at the China Academy of Chinese
Medical Sciences in Beijing, who asked not be named, reckons that
after thousands of years of practice and development, TCM is
already close to perfect and that modernization will simply distort
its essence.

Shi-min Fang, a US-trained biochemist who now runs a website
called ‘New Threads’ that fights pseudoscience and research
misconduct in China, is also unimpressed by the plan, but for
opposite reasons. He is in favour of scientific research into
Chinese herbal remedies, but thinks the emphasis on testing the
theories of TCM is misplaced. “The basic concepts of Chinese
medicine, such as yin and yang, wu xing (the five elements) and the
qi (meridian) theory, are inaccurate descriptions of the human body
that verge on imaginative,” he says. “The government has already
spent a lot of money trying to prove their mechanistic basis, but
this hasn’t gone anywhere.”

Wang Ming-wei, director of the National Centre for Drug
Screening at the Shanghai Institute of Materia Medica, agrees: “To
truly modernize Chinese medicine, we must first demystify these
theories.”

Some critics also worry that the plan doesn’t set strict enough
scientific standards. Although clinical research is listed as a
priority, the plan doesn’t specify whether there should be
randomized, controlled trials in which neither practitioners nor
patients know who is receiving active remedy and who is getting a
placebo. And there is no requirement for TCM researchers to publish
in internationally recognized journals. “Most research on TCM in
the past is of poor quality, and is published only in Chinese
medical journals without proper peer-review processes,” remarks
Wang. “Without a clear position from the government, it is unlikely
that the situation will change.”

Another concern is that the government does not specify how it
will control the way in which research funding is allocated. Some
critics feel that resources are currently being circulated only
among certain favoured universities and institutes, and argue that
reform to ensure that TCM grants are based on merit is necessary if
any real progress is to be achieved. Otherwise, as Jia Wei,
associate dean of the pharmacy school at Shanghai Jiaotong
University, puts it, the initiative will be just “loud thunder,
small raindrops”.

Zou says that the government is aware of the controversy and
problems surrounding TCM, and that the plan, on which it has
consulted widely, is set to resolve these issues. Su Gang-qiang,
deputy director-general of SATCM’s science and technology
department, points out that the plan outlines overall principles
and long-term directions for the development of TCM, rather than
going into details, and says that further strategies will be
published to specify exactly how the schemes will be carried
out.

Whether the government will take critics’ concerns into account
while drafting these plans remains to be seen, but many are
cautiously optimistic. “The wind is now right for the development
of TCM,” says Jia. “Let’s hope this will not be a missed
opportunity.”