10 Obstacles of the development of TCM
10 Obstacles of the development of TCM
Use
of medication, including herbs, minerals, and animals, according to some
orthodox formularies or some folk formula
Acupuncture
°w¨b
Practice
and use of "Qi" Éa(The internal flowing "Air"), and many small branchesThe use of Traditional Chinese Medication according the Chinese medical theory is the mainstream among Chinese people, because it is traditional, relatively cheap, lack of side effects and claim to be able to treat many type of disease which the western medical approach cannot deal with effectively.
TCM is now getting more attention. Because of the realization of limitation of western approach, people are seeking alternative approach to boost up the body against ageing, cancer, AIDS, and various immune diseases. TCM has fitted comfortably in these disease category by aiming to stimulate the body's support mechanism to enable it to heal itself.
After several successful clinical trial, e.g. St. John's Wort for the depression, Combination of Chinese herbs for Eczema, the use of TCM as an alternative approach is gaining ground among the West. Drug Trader are seeking opportunity to import TCM into the West as either health food product, or better as medicine to fill in the market.
The extent of TCM's world-wide significance was highlighted by the Chief Executive's Commission on innovation and Technology, and in his second Policy Address of October 1998 Tung Chee-hwa announced that Hong Kong needed to position itself to be a world centre for the development of health food and pharmaceuticals based on Chinese medicine. Besides, the new legislation to govern the practice, use and trading of Chinese medicine will soon be in place as the introduction of the Chinese Medicine Bill is scheduled for the first quarter of 1999.
However, after years of effort of integrating the TCM into the Western market, the impact is not that great. TCM reamins as a way to provide the lead compounds, but nothing more. Many obstacles, both internal and external, have to be overcome before the acceptance of TCM by the Westerner can be materialised.
Here are the summery of some of the major obstacles:
TCM
Internal Factors
1. Practising Theory
Disease
causing theory are very different from the Western medicine's.
The
theory are based on the philosophical Chinese theory which may give an
impression of unscientific reasoning.
The
terms for describing the theory are unfamiliar and difficult to understand
by westerner.
he
terms used are rather unspecified and hard to do outcome measurement.
Use
combination of herbs rather than a single ingredient
Poor
understanding of general anatomy, microbiology and pharmacology
No
genuine orthodox documentation or formularies are established, practitioners
tend to add "own" or folk remedy in addition to the traditional formula.
Use
in a combination of herbs, particular formula and dosage are according
to the need of a particular patient. i.e. Standard dosage regimen are difficult
to be established.
Most
of the effects of single herbs (or a single chemical component of such
a herb) were never established
Some
of the special formularies are considered to be private and trade secret,
unobtainable to the outsider.
Special
home made production are lengthy and troublesome.
The
decoction are often unpalatable to be drunk
No
standard method of naming ingredients: Scientific Latin names, common names
and latinised pharmaceutical names , Chinese translated names are all used.
Same
name of the formula but with different types of herbs contained and/or
with different strength.
Most
chinese proprietary medicines are not provided with sufficient information
about the ingredient, strength, number of herbs, expire, dose instructions.
Errors can be easily found in the number contained herbs, and in the strength.
The
quality ( The component of active ingredients) of the raw material and
product may vary dramatically due to different species, cultivation
method, region of plant, grow season, maturation, post treatment, storage,
manufacturing techniques, combination of herbs and dosage form.
Need
to obtain information of "marker" chemical in standardization process
Herbs
are easy misidentified.
Adulterated
or counterfeited TCM raw materials are not uncommon
Reliable
sources of raw material are hard to obtained.
QC
control are not emphasized in traditional practice; and modern instrumental
method are expensive and not many standard practise are set up.
Microbiological
and heavy metal contamination are very often
Many
of the modern dosage form, such as pills, tablets, sachets, capsules, may
not be as effective as the decoction that is done traditionally.
Natural
products are not eligible to obtain patent protection. Many "Me-Too" products
would be pushed into the market once a particular herb has been proved
with a therapeutical value. Investor is reluctant to invest in clinical
trail, promotion and formulation development.
The
mode of action cannot be described in modern scientific terms. And the
active component of a formula is not determined.
Delayed
action and outcome is hard to measure.
Holistic
approach, action cannot be easily measured in individual organ or parameter.
Traditional
practitioners are commonly lack of modern anatomical and pharmacological
knowledge.
Not
many with good English, not easy to communicate with other medical professionals
There
are many branch of practise and no unified standard is established within
the profession.
Not
as rich and as organized as the Western counterparts.
Experience
and case based practice
Some
of the raw material, especially those from the animal origin ,such as sea
horse*, tiger bone, are classified as endangered
species and protected by the Environmental Protection Regulation.
Due
to report of toxicity after consumption of some TCM, many western countries
has started to set up agent to control TCM import and sale. If the TCM
want to sell with a medicinal claim, the TCM have to pass through strict
assessment like the single ingredient entity. The financial burden of conducting
clinical trail without patent protection is so vast that the asian
investors are hesitated to forward.
TCM
claims are often cases based, large scale Western style clinical trials
of TCM in western world are required.
No
firm evidence that the TCM can dramatically control the medical condition
which western approach failed. The TCM approach may be comparatively slower
the disease progression and fewer side effect.
Only
several successful well constructed TCM clinical trial were done, more
extensive evidence need to be obtained.
The
reasoning of "5 Thousand Years of Practise must be truth!" doesn't
scientific sound.
Research
publications of TCM are often published in Chinese or in Asian journals
After
the Cold War ended, China becomes the major imaginary enemy of the West.
Anything from the East would received strict scrutiny, especially those
source is from the East.
Western
medical practitioner would not easy to share some of their "meal" resource.
Most
Insurance only covers and recognizes Western medical practise, the spending
in TCM cannot be claimed back. The "leave letter" can only be signed by
"registered medical practitioner", that excluding the TCM practitioners!
Some
reports of adulterated, counterfeited, poorly produced TCM were serious
damaged the trust to TCM.
