key: cord-0834497-dqb6em7g
authors: Wang, Wan-Ying; Zhou, Hua; Yang, Ya-Feng; Sang, Bin-Sheng; Liu, Liang
title: Current Policies and Measures on the Development of Traditional Chinese Medicine in China
date: 2020-09-09
journal: Pharmacol Res
DOI: 10.1016/j.phrs.2020.105187
sha: 557397d20be1a6058141e0e97bae9f8ed10d0a70
doc_id: 834497
cord_uid: dqb6em7g

Traditional Chinese Medicine (TCM) is a medical science and cultural heritage empirically applied and reserved by Chinese people for thousands of years. With comprehensive prosperity of China and rapid elaboration of technology, healthcare status of Chinese people has become one of the most crucial concerns of the country. Nearly 30 policies and measures regarding TCM development have been issued since the 18(th) National Congress of the Communist Party of People’s Republic of China in 2012. This review introduced a detailed evolutionary course of TCM in China with an emphasis on understanding the roadmap of TCM related policies and measures in China.

Traditional Chinese Medicine (TCM) is one of the most important achievements of Chinese civilization which is also a medical science inherited over thousands of years. During the process of fighting against diseases, Chinese people formed and developed TCM empirically in their daily life.

Recently, people in China and around world were infected by SARS-COV-2 who might exhibit severe lung injury and lymphopenia [1] . TCM has made great contributions to the treatment of COVID-19 [2] with over 90% involvement all over China [3] and showed high effective rate in a multicenter, prospective, randomized controlled clinical trial [4] . These effects are probably through the mechanism of inhibiting the SARS-COV-2 replication and reducing pro-inflammatory cytokines [5] [6] [7] . With its long history of absorption and innovation, TCM is not only a method of treatment, it also made great impacts on people's pattern of life. The remedies of TCM against diseases combines a holistic view of harmony, individuality, simplicity and preventive treatment which is on account of assimilation from natural science and humanities [8] . The State Council has issued a new guideline to implement the country's Healthy China 2030 initiative focusing on disease prevention and health promotion [9] . TCM as a crucial contributor for enhancing Chinese people's health status, a large series of laws and policies have been issued for the heritage and innovation of TCM. The awarding of Nobel Prize in 2015 of Tu Youyou also highlighted the contributions of TCM to her research and raised artemisinin to a new status worldwide as "A gift from Traditional Chinese Medicine to the World" [10] . Since the launching of the 12 th Five-year Plan, great efforts have been made to improve the development of TCM: Sixty-three State Science and Technology Awards were honored to the research in the field of TCM; Four TCM drugs have been allowed to conduct phase III clinical trial in US and a number of Chinese patent medicines have been recorded in European and US Pharmacopoeia [11] . It is undoubted that the central government and regulatory department are making every effort to promote the development of TCM with the aim of modernization, standardization and informatization so as to provide a precise treatment with a wider coverage.

The international recognition of TCM is at the same time growing with the wide access of TCM across 183 countries and regions worldwide. TCM acupuncture and moxibustion have been recognized as important parts of the intangible heritage of mankind by UNESCO [12] and the Chinese medical classics Huangdi Neijing (Inner Canon of the Yellow Emperor) [13] and Bencao Gangmu (Compendium of Materia Medica) [14] have been included in the UNESCO Memory of the World. According to statistics from the WHO, 103 member states have authorized the use of acupuncture and moxibustion, of which 29 have established laws and regulations promoting traditional medicines, and 18 states have included acupuncture and moxibustion in their medical insurance systems [15] . The latest 2019 global report on traditional and complementary medicine [16] and WHO traditional medicine strategy: 2014-2023 [17] have emphasized the contributions of traditional and complementary medicine to the goal of universal health coverage by improving equitable access to safe, quality and effective traditional and complementary medicine services. The global burden of chronic disease also urged the development and enhancement in the collaboration between conventional and traditional medicine [17] . International Organization for Standardization (ISO) created TCM technical committee ISO/TC 249 in 2009 focusing on quality and safety of raw materials, manufactured products and medical devices and of informatics [18] . In [19] . Sharing one set of standards could help with the development of TCM globally.

The developmental status of TCM in China could be introduced in the following five sections including TCM resources, the operation and service of TCM medical establishment, TCM education, TCM research & development (R&D) and financial appropriation income of TCM. (Fig.1) 

For the cultivation of TCM characteristic talents, higher education in TCM subjects serves as a solid support. Although the number of TCM institutions of higher education is almost the same (43), more and more western medicine and non-medical institutions are setting up TCM subjects. Moreover, the number of current and graduated students is increasing gradually including college students, bachelor students, master students and PhD students. The proportion of the education level is almost the same that most TCM-subjected students (nearly 90%) are general undergraduates and continuing education undergraduates, but the percentage of PhD students for TCM research is only around 0.7%.

TCM R&D is also carried on by ministerial, provincial and local organizations with published scientific articles and academic work, accepted and licensed patents, drug approval certificates, and other achievements at national standards. The number of professionals in TCM scientific research and technical development has increased steadily with more than half from provincial organizations working on scientific and technological activities. The key subjects involving R&D of TCM are evaluated by the number of agencies conducting them, including Chinese herbal medicine, J o u r n a l P r e -p r o o f traditional Chinese medicine, integrated traditional Chinese & western medicine, pharmaceutical chemistry etc. The total income of TCM R&D organizations has increased in the latest years which is comprised of scientific activities, production and operation and other incomes which has nearly reached one billion.

Funding from the government and domestic and abroad non-government organizations also increased nearly 30% for supporting TCM research and development. Detailly, around 7% of national fiscal expenditure has been spent on the section of medical and healthcare, among which, 3% of the money is for health administration and further divided 0.23% goes for TCM agencies.

Both the amount of appropriation and its proportion increased gradually since 2010. From the aspects of healthcare departments, the appropriation specific for TCM occupies less than 1% of the health administration budget and almost half of them is earmarked from TCM agencies [20] .

Therefore, TCM has improved gradually in the latest ten years in the above five sections but comparing with its proportion in the whole healthcare system, there still remains large number of challenges to be solved in the future.

On the other hand, there still exist obstacles that TCM has to face because of the huge healthcare demand in China [21] . First of all, current TCM medical care system does not have a full coverage across the rural communities because of a limited number of infrastructure and practitioners [22] .

According to the statistics in 2017, around 80% of TCM practitioners serve in urban areas while only 20% are in rural areas. Secondly, insufficient number of high-level TCM experts leads to a weak point during the operation of TCM inheritance and innovation program. According to a survey of current status of TCM, there are only three TCM practitioners every ten thousand people [23] . The TCM doctors are responsible for more than 7 person-time patients every day, which is slightly higher than the average number of general hospitals but the annual income of TCM doctors are only 80% of the average income of all doctors national wide. The income of TCM hospitals is less than 40% of that of general hospitals which could explain the lower annual income of TCM doctors [20] . Thirdly, J o u r n a l P r e -p r o o f the sustained development of TCM is threatened by the destruction of ethnic minority medicine and the declined quality of Chinese medical resources which also triggers a relatively low concentrated pharmaceutical industry. Chinese crude drugs even have the highest disqualification exposure rate of all the products examined by the regulatory departments in China [24] . There is an urgent request for the completeness of a TCM management system so as to increase its competitiveness under the global environment [22] . Fortunately, in order to overcome these difficulties, the government has not stopped guiding the direction in improving the environment for TCM development.

The Chinese government has set great store by TCM and rendered vigorous support to its development consistently after the founding of People's Republic of China in 1949. More importantly, since the 18 th National Congress of the Communist Party of China (CPC) in 2012, the government has issued nearly 30 major policy decisions and plans on TCM so as to improve its normative implementation and development to the rule by law [25] . In President's report to the 19 th CPC National Congress, the necessity to pay equal attention to the development of TCM and Western medicine and carrying forward the tradition and ensuring the development of TCM was emphasized [26] . TCM is therefore ready for its renaissance with the modernized technologies, normalized system and devoted professionals. The development of TCM is ushering in a fresh age with an integrated scope of treatment, fitness, research, education, industry and culture. People all over the world would benefit enormously from the TCM services in terms of both healthcare and economy.

TCM has always been a significant component of traditional Chinese culture since it grows with the course of Chinese history [8] . Dating back to the remote antiquity, Chinese ancestors had applied certain creatures, plants and minerals to relieve their symptoms. By assimilating the essence from natural science and humanity, the theories and methods of TCM were gradually formed and recorded in written works. The four diagnostic methods: inspection, auscultation & olfaction, inquiry and J o u r n a l P r e -p r o o f palpation was summarized by Bian Que in the Spring and Autumn and Warring States Period (770-221BC) [27] . The theoretical frame work for TCM came in to place during the Qin and Han times (221BC-AD220) described in the Huang Di Nei Jing (Yellow Emperor's Inner Canon) [28] . One of the most important theoretical foundation of TCM was the Shang Han Za Bing Lun (Treatise on Febrile Diseases and Miscellaneous Illnesses) created by Zhang Zhongjing in the Eastern Han Dynasty (25-220), which discoursed how to propose corresponding diagnosis by differentiating the patterns of miscellaneous illnesses [29] . During the same period, the foundation of TCM pharmaceutical theory was advanced by the masterpiece: the Shen Nong Ben Cao Jing (Shennong's Classic of Masteria Medica) which guided the prescription and safety application of TCM so as to enhance their therapeutic effects [30] . Later in the Ming Dynasty (1368-1644), Li Shizhen complied the Ben Cao Gang Mu (Compendium of Materia Medica), the first book in the world that categorized medical herbs scientifically, which enriched the TCM pharmaceutical theory in details [31] . These books transformed the clinical experience into summation of theories of TCM which systematically exposed its principles and methods of treatment, the human physiology, the symptoms of illness, and the preventative treatment.

The application of TCM also prospered with the development of the People's Republic of China (PRC) since 1949. In the early period of PRC, one of the three guidelines for health work was uniting Chinese and Western medicine. The first edition of Chinese Pharmacopoeia was published in 1953 for guiding the pharmaceutical industry in China while TCM was first recorded in the second edition of Pharmacopoeia in 1963 [32, 33] . Later in 1978, the CPC Central Committee transmitted the Ministry of Health's "Report on Implementing the Party's Policies Regarding TCM and Cultivating TCM Practitioners" across the country which forcefully promoted the development of TCM.

Furthermore, the Constitution of the PRC stipulates the promotion of modern medicine and TCM to protect the health of Chinese people [8] . In 1986, a relatively independent administration of TCM was founded by the State Council, following by the establishment of respective TCM administrations in all provinces, autonomous regions and municipalities which functioned as basic organization of [38] . In August 2019, the Drug Administration Law of the People's Republic of China was revised in order to ensure the quality of drugs in China with several sections regarding the approval, production, circulation etc. of TCM drugs [39] . These statements revealed the management rules for TCM which adhering to safety first, risk management, whole-process management and control, scientific supervision, and social co-governance.

These historical events from ancient China to the latest days provide strong evidence on the importance of TCM which is the backbone of Chinese society and Chinese culture. The prosperity of TCM would play a critical role in the completeness of a medical and healthcare system providing better healthcare service with Chinese characteristics. Chapter of this plan emphasized that fully taking the superior advantage of TCM would play a significant role of improving the medical service in China [9] . 

The aim of these policies and measures on TCM development is to resolve the major obstacles met by TCM so as to improve the health status of Chinese people. The holistic characteristic of TCM could explicate its thriving impacts on a number of subsequent fields.

Construction of a complete scientific framework of TCM has been a long-term goal for a breaking- Internationally, TCM has played an important role in the professionals, production and finance supply chain overseas especially along the "one-belt, one-road" countries [65, 66] .

The development of TCM has achieved enormous progress after the 18 th CPC National Conference.

The primary reason is the emphasis and support from the National People's Congress and the Central 

The Central Committee of the Party together with the State Council and TCM administration departments have made great efforts on the renaissance of TCM. These policies and measures guide the principle of TCM development with detailed tasks in terms of healthcare, economy and culture.

The implementation of these policies would contribute to a brighter future for TCM and benefit the well-being of mankind. In conclusion, people should have a strong faith in the reliability of TCM since the government is leading the administrators and experts to make every endeavor to support the development of TCM.

J o u r n a l P r e -p r o o f

LL and BSS supervised all research and revised the manuscript. WYW, HZ and YFW collected information. WYW and HZ analyzed the data and prepared the manuscript.

The authors declare no conflicts of interest. 

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