An Interview with Prof Chen Jiaxu
PROF CHEN JIAXU
Prof Chen Jiaxu is the Dean of the School of Traditional Chinese Medicine at Jinan Unversity in Guangzhou. He is a Distinguished Professor of the Changjiang Scholars Programme and a prized talent under China’s “New Century Talent Programme”. He is committed to teaching, research and clinical work in Traditional Chinese Medicine (TCM) diagnostics. His research interests are on the standardisation of TCM diagnosis and the biological basis of syndromes.
How did you become interested in TCM? What made you decide to build an academic and research career out of it?
Without even realising it, I have already been engaged in the teaching and research of TCM for more than 30 years. My interest in Chinese medicine stems from my childhood memories. Growing up in a rural area in China, I was weak and fell sick easily as a child. I have recollections of an old TCM doctor examining the meridians and collaterals on my hu kou (虎口, the area between the thumb and the index finger), and I still remember the bitter taste of the herbal medicine he prescribed. The memory of villagers drinking water boiled with pine needles to fight off epidemics is still very vivid to me today. As for academic research, my supervisor, Professor Yang Weiyi (杨维益) at the Beijing College of Traditional Chinese Medicine (now known as Beijing University of Chinese Medicine) had a profound influence on me. Prof Yang was the TCM consultant to the World Health Organization (WHO) and the Founding Professor at the School of Traditional Chinese Medicine of Hong Kong Baptist University. He believes that academic research is an important link in the learning and development of TCM. For TCM to be accepted by the world, academic research is necessary. Following his guidance, I embarked on this journey, and my research has won me many honours and awards, including the National Outstanding Doctoral Dissertation award, National Science Fund for Distinguished Young Scholars, and the title of Changjiang Scholar of the Ministry of Education. As a visiting scholar, I’ve held teaching and clinical positions at the University of California, Los Angeles (UCLA) and the National Institutes of Health (NIH) in the US, and Nanyang
Technological University in Singapore.
In your opinion, what are the most significant differences between TCM and Western medicine?
TCM is based on the theory of jing qi (精气, vital essence), yin and yang (阴阳), the Five Elements (五行) of ancient Chinese philosophy, as well as the Eight Principles of syndrome differentiation (八纲辨证) and Four-aspect Pattern identification as the theoretical framework. The diagnostic process follows the four methods of wang (望, observation) wén (闻, auscultation and olfaction) wèn (问, inquiry) and qie (切, pulse feeling and palpation), which adopt a comprehensive approach and treatment according to the syndrome differentiation. TCM emphasises the human body as being holistic, dynamic and interconnected.
Western medicine, on the other hand, is based on anatomy, physiology, pathology, biochemistry and other disciplines. It mainly diagnoses diseases through modern scientific and technological means such as physical and chemical examinations and instrumental probing, which makes the diagnosis concrete and visible. Western medicine is more inclined to treat symptoms and target specific parts of the body as isolated from the rest of it.
The differences between Chinese and Western medicine are deeply rooted in their cultures, mental frameworks and treatment methodologies. Culturally, the terminology of TCM is closely related to Chinese ancient philosophy, with such terms as Five Elements, yin and yang, and jun (君, monarch), chen (臣, minister), zuo (佐, assistant), and shi (使, envoy) used in prescriptions. TCM looks at one’s entire wellbeing, whereas Western medicine zooms in on diseases at the micro level. Hence there is a saying: Chinese medicines treat a person in his entirety; Western medicine treats the disease itself. As for treatment methodology, TCM focuses on improving or moderating the overall conditions of the human body under the principles of ‘strengthening vital qi and dispelling pathogenic factors, coordinating yin and yang’; Western medicine aims to treat pathogenic causes and remove pathological abnormalities. Therefore, TCM and Western medicine have been viewed as two distinct and divergent medicines. But both offer benefits, and integrating the two can be useful in treatment.
What is the status of TCM practice in China today? Is there a strong demand for TCM treatments among the general public? How does this demand compare to that for Western medicine?
In China, various types of medical institutions offer TCM treatments. They include TCM hospitals (including specialised TCM hospitals, integrated TCM and Western medicine hospitals, and ethnic traditional medicine hospitals), TCM outpatient departments, TCM clinics (including specialised TCM clinics, integrated TCM and Western medicine clinics, and ethnic traditional medicine clinics), TCM clinical departments in Western medicine hospitals, and community health service centres or stations. In 2020, the TCM patient volume in these institutions accounted for 16.8% of the total nationwide patient volume, which indicates that the demand for Western medicine is still dominant.
With a series of policies introduced by the government to regulate and promote TCM, the services and treatments offered by TCM medical institutions have significantly improved, and the TCM industry has gradually embraced standardisation and modernisation. Over years of comparison with Western medicine, TCM has shown great benefits in regimen and well-being, chronic disease prevention and treatment, post-surgical rehabilitation, and the treatment of TCM-specific diseases. In addition, health awareness has also generally improved, and TCM – which is rich in a health preservation culture – has increasingly attracted more public attention. Therefore, I foresee the demand for TCM will increase over time.
Growing TCM market
China exported a total value of USD4 billion of TCM products in 2019, according to a Statista research. Vietnam, India, and Malaysia were the fastest growing markets for China's TCM goods, registering an annual growth rate in export at 69%, 34% and 25% respectively in 2019. Photo: Imaginechina Limited / Alamy Stock
“With a series of policies introduced by the government to regulate and promote TCM...the TCM industry has gradually embraced standardisation and modernisation.”
How is TCM being practised in China? Are TCM treatments widely available in hospitals and clinics?
The current healthcare system in China recognises both TCM and Western medicine as mainstream medicine, and they complement each other. However, the public tends to choose Western medicine over TCM. In terms of the number of diagnoses and treatment services and the types of medicine used, Western medicine is dominant in every aspect. Although the acceptance and use ofChinese medicine have been severely challenged by Western medicine in recent years, TCM has won the people’s hearts and minds in certain locations in China with its reputation of being naturopathic. For example, Guangdong province has a strong TCM tradition, and TCM has been more widely adopted there.
In China, the Ministry of Health has always emphasised the importance of both TCM and Western medicine, especially TCM’s role in disease prevention and control, public health emergencies and healthcare services. Hence, most cities have at least one TCM hospital, and each Western medicine hospital has a TCM department. Being a significant supplement to mainstream healthcare, TCM commands considerable public endorsement.
Getting ahead of winter diseases in summer
As the dog days of summer begin in early July, many people visit hospitals hoping to prevent illness by receiving acupuncture, acupoint sticking and cupping therapy. This technique is known as “curing winter diseases in the summer.” Photo: Hap / Quirky China News / Shutterstock
What is the situation of TCM education in China? Are there enough young people interested in pursuing a TCM career to sustain its existence and growth?
TCM education in China is mainly conducted either in the traditional apprenticeship model or through the formal higher education system.
The master-apprentice system is part of TCM tradition, which simply passes on both theoretical and practical knowledge from practitioners to apprentices. It is usually perceived to be a form of high-quality training.
Most TCM practitioners today are trained through formal higher education. The major TCM educational institutions we see today were set up between 1956 and 1958, and nearly every province has a TCM college or university that offers comprehensive undergraduate and postgraduate programmes. Students are usually selected for undergraduate programmes based on their scores in gao kao (高考, the National College Entrance Examination). They will have foundation courses in the first two years, and hands-on clinical training in Years 3 and 4, followed by clinical attachment in Year 5. After graduation, most graduates will continue with residency programmes. To obtain specialist qualifications, practitioners need to undergo three years of specialist training.
TCM education in China plays an essential role in the development of TCM. Every year tens of thousands of undergraduate students graduate from these TCM schools. The China Health Statistical Yearbook 2021 states that there are currently about 830,000 TCM practitioners and assistant practitioners. From the demand perspective, the number of outpatient visits has also been increasing over the years.
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Acupuncture for pets
TCM has been increasingly applied to pets across China in recent years. Treatments are primarily for pets suffering paralysis, nerve damage, diarrhoea and diseases that cannot be cured by Western medicine. Therapies such as electric acupuncture and moxibustion are used to help animals recover. Photo: Imaginechina Limited / Alamy Stock Photo
“The World Health Organization appreciates the value of TCM and recognises the fact that TCM is being widely used in China and internationally. Many experts see it as a milestone in the internationalisation Of TCM.”
How well is TCM accepted outside of China? What efforts have been made to promote TCM globally?
The WHO estimates that about 80% of the world’s population (about four billion people) currently use herbal medicine for healthcare. There are as many as 120,000 TCM physicians and acupuncturists in Europe alone. Some countries have accepted acupuncture and herbal medicine as forms of treatment and recognise the practice of TCM as a profession. More than 70 countries have regulations on the use of herbal medicine, and 183 countries and regions have established various types of traditional medical institutions. It is estimated that there are about 500,000 TCM practitioners globally, with the ‘millennials’ forming the majority.
In 2019, the WHO approved the Eleventh Revision of the International Classification of Diseases (ICD-11), which for the first time included a chapter on TCM. The WHO Director-General’s Report states that “ICD-11 includes a supplementary chapter (Traditional medicine conditions – Module 1), which classifies traditional medicine conditions that originated in ancient China and are now commonly used in China, Japan, Republic of Korea and other countries. These categories are intended for optional dual coding of traditional medicine diagnoses and patterns. They do not refer to – nor endorse any form of treatment.… The inclusion of a supplementary chapter on traditional medicine in ICD will for the first time enable the counting of traditional medicine services and encounters, measurement of their form, frequency, effectiveness, safety, quality, outcomes, cost, comparison with mainstream medicine and research due to standardized terms and definitions nationally and internationally.” This reflects that the WHO appreciates the value of TCM, and recognises the fact that TCM is being widely used in China and internationally. Many experts see it as a milestone in the internationalisation of TCM. In many countries, public acceptance of TCM is constrained by cultural differences and insurance restrictions, and TCM remains a complementary medicine. For TCM to be recognised as mainstream medicine, much more needs to be done to convince the global medical community. We need to demonstrate the long-term efficacy of TCM treatments, gain international recognition systematically, assimilate ourselves into the established network, and build up the relevant human capital through training and education. In short, we have a long way to go.
We know that acupuncture has become quite well-accepted in the West after many years of effort. Which branch of TCM do you think will be next in getting global acceptance?
TCM is a great Chinese creation, a product of ancient Chinese scientific wisdom and the key to the treasure of Chinese civilisation. In my opinion, the naturopathic treatments in TCM, such as massage, moxibustion and cupping, are more acceptable in the Western communities. Take cupping as an example: during the 2004 Athens Olympics, the red cupping marks on the body of the swimmer Grant Hackett, the 1,500-metre freestyle champion, attracted the attention of the world.
In the Tokyo Olympics last year, more athletes were spotted with cupping marks, which once again sparked heated discussions on TCM. These Olympic athletes chose cupping as a treatment because, being naturopathic, it is non-invasive and effective. Another example is the new qualitative and quantitative framework for heat-sensitive non-contact moxibustion (热敏灸) proposed by the Jiangxi University of Traditional Chinese Medicine in 2006. This technical framework complements TCM with modern technology and uses red-light to infrared-light devices for treatment. It has been well-received globally.
Not a bad tattoo
Michael Phelps, the swimming legend who has won 23 Olympic gold medals in his career, is one of a number of Olympic athletes practising cupping to heal sore muscles. The purple circular marks spotted on his shoulders at the Rio 2016 Olympic Games aroused great public interest and media coverage in the West. Photo: Shutterstock
“Integrative medicine combines the best of both worlds with an emphasis on safety and evidence-based treatment.”
In your opinion, how should TCM adapt itself in order to become even more acceptable outside of the Chinese communities?
To become more acceptable outside Chinese communities, TCM needs to modernise. Firstly, the teaching and learning of TCM need to be more innovative and creative. Secondly, an online platform for TCM development must be set up to facilitate knowledge exchange and experience sharing. Thirdly, a scientifically robust system needs to be established for the evaluation of TCM efficacy. Most importantly, we need to do a much better job in communicating TCM culture, theories and clinical practices. To reach out to the world, we need to convey TCM messages in a language that is clear, convincing and acceptable to the target audience, on an open and accessible communication platform on the internet.
There have been some attempts to provide “integrative medicine” with the intention of complementing Western medicine with TCM and other traditional medicines. How successful is this in reality? What should we expect in future in this area?
The idea of integrating Western medicine with TCM in medical treatments can be traced back to the Opium War in the 1840s. At that time, “East-West integrative medicine” meant integrating the medical theory of TCM with the science and technology of Western medicine, with TCM’s syndrome differentiation and Western medicine’s disease diagnosis complementing each other.
TCM has also been adopting modern techniques and methodologies in medical research. For example, animal testing designed with the TCM syndrome model is widely used for assessing the effectiveness of TCM treatments. Today, degree programmes in integrative medicine offered by TCM universities and integrative medicine treatments in hospitals are quite common in China.
Foreign TCM teacher in China
German Tim Vukan is one of the few foreigners who have completed undergraduate and graduate studies in TCM in China. He is a certified TCM practitioner and a lecturer at Zhejiang Chinese Medical University. He also founded Wushan TCM (wushantcm.com) – a TCM network that provides TCM online education courses and medical treatments to foreigners. Photo: Imaginechina Limited / Alamy Stock Photo
Integrative medicine combines the best of both worlds with an emphasis on safety and evidence-based treatment. Western medicine has acquired knowledge of the chemical structure of drugs and of specific ‘unhealthy’ targets, which has made it possible to elucidate the molecular mode of action. On the other hand, TCM takes a holistic approach to health and wellness. It views health as “life in balance”, and aims to restore the equilibrium of yin and yang in the body so that the body is strong, fortified and resilient. Take tumour treatment as an example: Western medicine controls tumour growth and advocates removal, which may damage healthy tissues in the process. TCM treatment focuses on stimulating blood and qi circulation, clearing blocked meridians, strengthening the immune system, discharging toxins and even considers coexistence with the tumour. Each of these approaches has its pros and cons.
TCM has more than 100,000 prescriptions for all kinds of ailments, accumulated over more than 2,500 years of history. Exploring and examining these prescriptions using Western medicine’s analytical tools will be invaluable to medical research and development.
Medical technologies like telemedicine, predictive healthcare (based on big data and AI) and robotic devices are helping Western medicine to provide more effective healthcare solutions, especially when coexistence with COVID-19 is becoming the new normal. Is the TCM sector trying to make use of such technology to adapt and grow as well?
The answer is yes. “Internet + Healthcare” is a key component of the national strategy “Internet +” in China. Since 2018, enterprises have been allowed to collaborate with medical institutions to develop “internet hospitals”. An internet hospital not only provides online diagnostic services, but also uses big data for disease prediction and prevention. Under “Internet + Healthcare”, TCM has also innovated its diagnoses and treatments. Some examples of such innovations are remote pulse-sensing devices, tongue diagnosis instruments and the mobile emergency TCM pharmacy. The contribution of “Internet + Healthcare” has been significant during the COVID-19 pandemic.
In addition, a TCM diagnostic instrument was deployed in the Chinese space station to monitor the astronauts’ health. The “10 Seconds” TCM Experience Hall at the Beijing Winter Olympics demonstrated the magical charm of TCM to the world. Technology definitely gives TCM a modern look.
As a non-profit organisation aiming to help improve healthcare in Asia, what do you suggest THF focuses on so as to maximise its impact?
As far as I know, The HEAD Foundation has been helping to improve education and healthcare in Asian communities. On the healthcare front, I would suggest the Foundation considers contributing in the following ways: promote the culture and health benefits of TCM in the region so as to expand its acceptance outside of the Chinese communities; help make available free TCM consultation services to encourage members of the public to try out TCM; support naturopathy research and applications; and launch a high-quality English medical journal on TCM to help bridge the gap between TCM and Western Medicine.
Advancing the understanding of TCM through clinical research
In September 2019, Prof Chen represented Jinan University’s School of TCM to sign an MOU to participate in a clinical research supported by THF to study the efficacy of TCM Tuina vis-à-vis physiotherapy in treating chronic lower back pain. Mayo Clinic and Singapore General Hospital are also participating in the same study which will eventually involve more than 600 patients.
MARCH 2022 | COMMEMORATIVE ISSUE
Healthcare and Education for Asian Development
