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发表于 2007-4-10 05:28
[中国计划实现中医现代化]
英国《自然》2007年4月5日
记者：Jane Qiu
（方舟子翻译）
中国宣布了一项雄心勃勃的计划，试图让古老的中医药采用现代标准。中国
政府称它将拓展基础和临床研究，并改进中药出口的检测和开发。但是批评者们
质疑该研究是否会符合要获得国际认可所必需的科学标准。
虽然中国以前也投资中医药，但是该15年计划的方向有所改变，并将获得多
得多的资金。该项目受到16个部委的支持，由科技部、卫生部和中医药管理局领
头。
科技部分管卫生与生物技术的负责人邹建强说，中国政府拨款10亿元（1亿3
千万美元）用于中医药研究和开发，在未来的五年总预算至少是以前7亿4千万元
总资金的5到6倍。
在这个多数人口未能享受公共医疗并负担不起去医院看病的国家，用于与中
医药有关的公共医疗的资金也增加了10倍，达到85亿元。“中医药自古就在为中
国人民服务，现在在医疗中仍然起到重要的作用，特别是在那些人们没有机会用
到或负担不起西医治疗的地区，”中医药管理局副局长于文明说。
这项措施是在遍及全国的有关中医药的激烈讨论之后产生的。去年，湖南长
沙中南大学的一名学者张功耀在《医学与哲学》杂志上发表了一篇题为《告别中
医中药》的文章，引发了一场全国性的辩论。张功耀争辩说，中医是伪科学，不
应该是国家医疗体系和研究的一部分。
争论的各方都在焦急地等待政府的立场，结果它坚定地支持把中医当成科学
来宣扬。中国极度渴望中药在海外能够获得管理部门的批准，并希望在2020年让
中医药全球化。在过去的十年，中药的世界市场翻了一番，其中欧洲和美国是最
大的进口国。但是来自中国的中药糟糕的安全记录导致其出口量持续下降，部分
市场份额被日本、韩国等邻国占据。
因此中国的计划制定了提高标准的策略，包括对中药的安全性和有效性开展
临床研究，促进国际合作，改进制造技术并对医药管理系统采用国际规范。
中国政府在方法方面的改变引发了更大的争议。要从中药开发出经科学检验
的药物，以前的做法是注重从中药中分离出活性成分，一一进行筛选。这个做法
获得了少数的新成果，例如用于治疗疟疾的青蒿素和减充血剂麻黄碱，但是获得
批准的药物并未大量涌现。新的计划致力于开发出更有传统特色和原理的方法来
检验中医药。这要求采用整体论的方法对待疾病的治疗，不是用一种药治疗一种
特定的疾病，而是使用植物提取物的复杂混合。每一种混合物都是个体化的，针
对某个病人的症状和特性。
中医药的从业者和研究人员还在等着看政府是否会真的给钱，但是他们一般
来说都欢迎这个计划。“这是一个重大的进步，”上海中医药大学副校长刘平说。
不过，有些人不愿附和。北京中国医学科学院一位要求匿名的教授认为，在经过
数千年的实践和发展之后，中医已经近乎完善，让中医现代化只不过是歪曲了其
实质。
美国培养的生物化学学者、现在在主持打击中国伪科学和科研不端行为的
“新语丝”的网站的方是民也对这个计划不以为然，但是是出于相反的原因。他
支持对中草药进行科学研究，但是认为对检验中医理论的强调是错误的。“中医
的基本概念，例如阴阳、五行和经络理论，是对人体模糊的描述，近乎臆测，”
他说，“政府已经花费了大量的资金试图证明中医理论的物质基础，但是一无所
获。”
上海药物研究所药物国家新药筛选中心主任王明伟同意这个观点：“要真正
让中医药现代化，我们必须首先去掉这些理论的神秘性。”
有些批评者也担心该计划没有设定足够严格的科学标准。虽然临床研究被列
为首要任务之一，但是该计划并没有具体说明是否应该采用随机、对照、双盲
（研究人员和病人都不知道谁获得药物谁获得安慰剂）的临床试验。而且，并没
有要求中医药研究人员要在国际认可的刊物上发表论文。“过去有关中医药的研
究多数质量都很差，而且只发表在没有经过同行评议的中国医学期刊上，”王明
伟评论说，“如果政府对此没有清楚的立场，那么这种情况不太可能会发生改
变。”
另一个大家关心的问题是政府没有具体说明它将如何管理科研资金的分配。
有些批评者觉得，现在的资源只是被某些受优待的大学和研究所分享，他们争辩
说，如果想要获得真正的进展，就应该对此进行改革，确保中医药的资金是择优
分配的。否则的话，如上海交通大学药学院副院长贾伟所言，该措施将会只是
“雷声大，雨滴小”。
邹建强说，政府注意到了围绕中医药的争论和问题，而该计划已经过广泛的
商议，就是为了解决这些问题的。中医药管理局科技司副司长钢强指出该计划概
括了中医药发展的总原则和长远方向，而不涉及细节，并说将来将会发布策略具
体地说明如何实施这些框架。
中国政府在起草这些计划时是否会考虑批评者的担心，人们拭目以待，但是
许多人表达了谨慎的乐观。“现在发展中医药势头正好，”贾伟说，“但愿不会
错失良机。”
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."
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楼主: FORRESTFU
