Weijun Zhang, DrPH, MS, BMed, is Assistant Professor in the Division of General Internal Medicine & Health Services Research at the UCLA Department of Medicine. As the Director of China Affairs at UCLA Center for East-West Medicine, he leads the efforts in developing educational exchange between China and the United States to advance the global impact of integrative medicine (IM). His research focuses on studying optimal IM services, including factors affecting IM approaches and models, and IM-flavored primary care practice transformation. He is also interested in utilizing his multidisciplinary expertise in IM, computer science, and public health to develop a digital infrastructure for trustworthy and readily available information on CAM and IM for both providers and consumers.
He obtained his bachelor of Medicine in Chinese Medicine and Master of Science in IM from Beijing University of Chinese Medicine. He completed his Doctor of Public Health (DrPH) at the UCLA Fielding School of Public Health. Prior to joining UCLA CEWM in September 2003, Dr. Zhang had worked as a clinician-researcher in China for five years.
Why has traditional Chinese medicine held its appeal? How has it prevailed over the centuries despite the emergence of modern medicine?
First of all, clinical efficacy of Chinese medicine is the key for success. Over time, Chinese medicine has demonstrated its success in some specific conditions, for example, chronic pain, GI issues, mental health. Secondly, its two principles, such as treating the person as a whole and pattern differentiation are also gradually being accepted by modern biomedicine in patient care and research, compared to reductionistic approach in biomedicine.
I often ask my students what they think about the integrative medicine approach in China 100 or more years ago when Western medicine was introduced into China. Opposed in current approaches when Western medicine was the dominating factor in the healthcare system, Chinese medicine played a dominant role. So at that time, it would be Chinese medicine practitioners calling for integrating Western medicine for its weakness. That is the first stage. The second stage has to trace back to 1949, when the Communist Party took power of China. Chinese medicine has undergone a painful process of modernization, such as using modern technology to study and analyze Chinese medicine, and integrating Western medicine with Chinese medicine. Most importantly, the Chinese government fully supports Chinese medicine. One of the health policies is to put “equal emphasis on both medicines” and to “support integrative medicine.”
In summary, for the past 100 years, Chinese medicine underwent three phases of development. The first phase is when Western medicine initially entered China and some visionary experts in Chinese medicine tried to incorporate Western medicine into their practice. The second phase is when new China tried to modernize Chinese medicine to better serve the population. This phase is still ongoing. The third phase is the blending of Chinese medicine and western medicine. Currently, the size of Chinese medical service providers is about 20% of total medical services in Chia.
What is the medical community’s consensus on the efficacy of traditional Chinese medicine if there is one?
This depends on whether you are talking about the perception in China or in the West. In general, the mainstream medical community is willing to see efficacy of traditional Chinese medicine, especially for those conditions Western medicine fails to treat. However, high quality research was still lacking, including research methodology, design, and implementation. This is not simple to adopt a most advanced and golden standard of research methodology, for example, randomized, controlled trial for clinical study. This is not always appropriate for Chinese medicine study.
Artemisia, the research by Tu Youyou, who received the 2015 Nobel Prize for physiology and medicine, is one example of Chinese medicine-originated research, meaning that they got ideas from Chinese medicine theory or classics. Recently, there were a few high-quality publications of original research. For example, tai chi for fibromyalgia in the British Medical Journal by Chenchen Wang from Tufts University and acupuncture on urinary leakage among women with stress urinary incontinence in the Journal of American Medical Association.
E-jiao used to be prescribed primarily to supplement lost blood and balance yin and yang. Today, it is sought for a range of ills, from delaying aging and increasing libido to treating side effects of chemotherapy to preventing infertility and miscarriage. E-jiao is not the only substance deemed to have unique properties. There are many others. Can you speak to the education and science behind the claims of their effects?
Based on the theory of Chinese medicine, e-jiao can supplement lost blood and tonify yin. It is mostly used for women’s health. Of course, it can be used in other conditions. I am not an expert of herbal medicine. But for population health perspectives, e-jiao has been used in community health promotion widely.
Because of the aforementioned alleged health benefits of e-jiao, it is becoming hugely popular, making the Chinese demand for donkey hide increase substantially. This heightened demand has led to the theft and slaughter of donkeys throughout Africa and other developing countries, causing the donkey population to severely decline in countries that depend on donkeys for survival. China has a reputation for using rare and expensive resources for its medicinal purposes. Is there anything the Chinese government can do to mitigate the impact of certain Chinese cultural practices on scare global resources?
Business interests make bold decisions, even though not in the public. But privately, they still sell those products. The Chinese government banned the sale of rare wildlife; however, the ordinary consumer still believes that those rare animal parts used by traditional Chinese medicine centuries ago ascribes extraordinary health benefits. This is a cultural issue for ordinary customers. Protecting endangered animals is also priority for the government. But in reality, how to implement it is a critical issue. There are herbal alternatives that do not involve harming endangered animals. I don’t see any hospitals use animal parts or any reputable pharmaceutical company’s products contain that type of parts.
How is traditional Chinese medicine perceived in China today? Who is the particular audience that traditional medicine appeals to, both in and outside China?
One pillar of China’s Health policy is to develop modernized Chinese medicine and blending Chinese and Western medicine to serve the people. This is the perspective from the government. I participated in a large training program in Shanghai from 2013 to 2016. The training program is to train 12,000 non-Chinese medicine community health practitioners in Shanghai about the appropriate use of Chinese medicine in their practice. This program came from a need from communities. According to a previous study, about one sixth of residents in general and 75% of 60 year-olds or elders will choose Chinese medicine as their first choice treatment method. 72% of all residents want to receive combined treatment. However, there is only 15% of physicians licensed in Chinese medicine and others lack knowledge and skills in Chinese medicine to serve the needs in communities.
How is traditional Chinese medicine regulated in the West?
In the 1970s, traditional Chinese medicine or acupuncture were only practiced in Chinese communities. In 1975, California passed a law to allow acupuncturists practice independently, without supervision of physicians. The California Acupuncture Board regulates the licensing, clinical practice, and credentials of acupuncturists. It is also responsible for monitoring the quality of educational programs for acupuncture or Chinese medicine schools. There is also a requirement of 300 hours of training for physicians to provide acupuncture services.
What do you think is the trajectory for the market of traditional Chinese medicine? Will it maintain its appeal only inside China or will it evolve and become a widely accepted field of modern medicine?
The market for Chinese medicine is small in the West. For example, herbal medicine is only sold through supermarkets, herbal stores, and acupuncturists. There are about 35,000 acupuncturists in the United States. They are considered as complementary medicine practitioners. Unlike Chinese medicine physicians in China, they cannot prescribe Western medicine drugs and have less communication with Western medicine physicians. So the market should be focused on China, but should also pay attention to the development in the West. The practice of Chinese medicine in the West can develop to the size of China’s market and China can adopt the global standards of the West. I believe Chinese medicine will evolve and become widely accepted in modern medicine if it can develop carefully in both markets.