英國《自然》: 中國計劃實現中醫現代化

英國《自然》2007年4月5日

記者：Jane Qiu

　　中國宣布了一項雄心勃勃的計劃，試圖讓古老的中醫藥採用現代標準。中國
政府稱它將拓展基礎和臨床研究，並改進中藥出口的檢測和開發。但是批評者們
質疑該研究是否會符合要獲得國際認可所必需的科學標準。

　　雖然中國以前也投資中醫藥，但是該15年計劃的方向有所改變，並將獲得多
得多的資金。該項目受到16個部委的支持，由科技部、衛生部和中醫藥管理局領
頭。

　　科技部分管衛生與生物技術的負責人鄒建強說，中國政府撥款10億元（1億3
千萬美元）用於中醫藥研究和開發，在未來的五年總預算至少是以前7億4千萬元
總資金的5到6倍。

　　在這個多數人口未能享受公共醫療並負擔不起去醫院看病的國家，用於與中
醫藥有關的公共醫療的資金也增加了10倍，達到85億元。「中醫藥自古就在為中
國人民服務，現在在醫療中仍然起到重要的作用，特別是在那些人們沒有機會用
到或負擔不起西醫治療的地區，」中醫藥管理局副局長於文明說。

　　這項措施是在遍及全國的有關中醫藥的激烈討論之後產生的。去年，湖南長
沙中南大學的一名學者張功耀在《醫學與哲學》雜誌上發表了一篇題為《告別中
醫中藥》的文章，引發了一場全國性的辯論。張功耀爭辯說，中醫是偽科學，不
應該是國家醫療體系和研究的一部分。

　　爭論的各方都在焦急地等待政府的立場，結果它堅定地支持把中醫當成科學
來宣揚。中國極度渴望中藥在海外能夠獲得管理部門的批准，並希望在2020年讓
中醫藥全球化。在過去的十年，中藥的世界市場翻了一番，其中歐洲和美國是最
大的進口國。但是來自中國的中藥糟糕的安全記錄導致其出口量持續下降，部分
市場份額被日本、韓國等鄰國佔據。

　　因此中國的計劃制定了提高標準的策略，包括對中藥的安全性和有效性開展
臨床研究，促進國際合作，改進位造技術並對醫藥管理系統採用國際規範。

　　中國政府在方法方面的改變引發了更大的爭議。要從中藥開發出經科學檢驗
的藥物，以前的做法是注重從中藥中分離出活性成分，一一進行篩選。這個做法
獲得了少數的新成果，例如用於治療瘧疾的青蒿素和減充血劑麻黃鹼，但是獲得
批准的藥物並未大量湧現。新的計劃致力於開發出更有傳統特色和原理的方法來
檢驗中醫藥。這要求採用整體論的方法對待疾病的治療，不是用一種葯治療一種
特定的疾病，而是使用植物提取物的複雜混合。每一種混合物都是個體化的，針
對某個病人的癥狀和特性。

　　中醫藥的從業者和研究人員還在等著看政府是否會真的給錢，但是他們一般
來說都歡迎這個計劃。「這是一個重大的進步，」上海中醫藥大學副校長劉平說。
不過，有些人不願附和。北京中國醫學科學院一位要求匿名的教授認為，在經過
數千年的實踐和發展之後，中醫已經近乎完善，讓中醫現代化只不過是歪曲了其
實質。

　　美國培養的生物化學學者、現在在主持打擊中國偽科學和科研不端行為的
「新語絲」的網站的方是民也對這個計劃不以為然，但是是出於相反的原因。他
支持對中草藥進行科學研究，但是認為對檢驗中醫理論的強調是錯誤的。「中醫
的基本概念，例如陰陽、五行和經絡理論，是對人體模糊的描述，近乎臆測，」
他說，「政府已經花費了大量的資金試圖證明中醫理論的物質基礎，但是一無所
獲。」

　　上海藥物研究所藥物國家新葯篩選中心主任王明偉同意這個觀點：「要真正
讓中醫藥現代化，我們必須首先去掉這些理論的神秘性。」

　　有些批評者也擔心該計劃沒有設定足夠嚴格的科學標準。雖然臨床研究被列
為首要任務之一，但是該計劃並沒有具體說明是否應該採用隨機、對照、雙盲
（研究人員和病人都不知道誰獲得藥物誰獲得安慰劑）的臨床試驗。而且，並沒
有要求中醫藥研究人員要在國際認可的刊物上發表論文。「過去有關中醫藥的研
究多數質量都很差，而且只發表在沒有經過同行評議的中國醫學期刊上，」王明
偉評論說，「如果政府對此沒有清楚的立場，那麼這種情況不太可能會發生改
變。」

　　另一個大家關心的問題是政府沒有具體說明它將如何管理科研資金的分配。
有些批評者覺得，現在的資源只是被某些受優待的大學和研究所分享，他們爭辯
說，如果想要獲得真正的進展，就應該對此進行改革，確保中醫藥的資金是擇優
分配的。否則的話，如上海交通大學藥學院副院長賈偉所言，該措施將會只是
「雷聲大，雨滴小」。

　　鄒建強說，政府注意到了圍繞中醫藥的爭論和問題，而該計劃已經過廣泛的
商議，就是為了解決這些問題的。中醫藥管理局科技司副司長鋼強指出該計劃概
括了中醫藥發展的總原則和長遠方向，而不涉及細節，並說將來將會發布策略具
體地說明如何實施這些框架。

　　中國政府在起草這些計劃時是否會考慮批評者的擔心，人們拭目以待，但是
許多人表達了謹慎的樂觀。「現在發展中醫藥勢頭正好，」賈偉說，「但願不會
錯失良機。」

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."

（方舟子翻譯）

(XYS20070408)

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