Clinical of Chinese Medicine

                                           Clinical Service of Chinese Medicine
                                                               CHEN Ke-ji 1,2    
 

Clinical of Chinese Medicine

The clinical practice of traditional Chinese medicine (TCM) faces three major challenges: (1) How to enhance its contribution on overall medical service quality? (2) How to best address the unmet medical needs in the contemporary society? (3) How to guarantee that the traditional perspective for disease diagnosis and treatment not be neglected in clinical practice?

Heritance and Practice of Chinese Medicine
    
Over a long period of time in traditional Chinese medical history, there have been many medical sub-disciplines in Chinese medicine. Current medical practice should continue taking advantage of the rich body of knowledge and developing ways to apply it to daily medical practice. Decades of research and practice have provided efficacy evidence of ancient herbal formulas in modern diseases. My deceased teacher, Master of traditional Chinese medicine, Dr. YUE Mei-zhong had advocated that Chinese medical practitioners need to "Learn from three late famous doctors, and emphasize clinical service". The said three late famous doctors are Drs. ZHANG Zhong-jing, LI Dong-yuan and YE Tian-shi. Dr. YUE also pointed out that in clinical practice, one needs to exercise "careful observation, frequent analyses, cautious prescription, and constant information syntheses". His motto as a physician is "life is vulnerable to any malpractice and one should always treasure patients' life more than one's own life''(1).

    
Chinese medicine considers human body as an intact system and the treatment approach focuses on improving the overall body system. Chinese medicine emphasizes on the holistic idea and utilizes the differentiation of syndromes. For example, physicians in northern China may use the formulas of activating blood-circulation for the treatment of coronary heart disease(2), yet physicians in southern China may prefer to use the formulas of deleting-phlegm for the same disease(3). Each treatment is acceptable and the key attention is the safety and efficacy. Examples similar to this are numerous in the practice of Chinese medicine.

Improvement of Chinese Medicine Practice
    
There has not been a general guideline for practicing Chinese medicine. For modern medicine, efficacy and safety data from clinical studies, preferably large-scale and long-term studies, are served as the primary basis for the development of clinical practice recommendations or guidance. As information on new therapies or new information on existing treatment becomes available, the recommendations or guidance may be updated or modified as needed. Practice of Chinese
medicine follows thoughts and experiences collected from individual physicians, which emphasize visualization, single case analyses, personal experience, and intellectual analyses and hypotheses. Modern medicine focuses on randomized controlled trial (RCT) studies, but Chinese medicine stresses on single case study and treats each individual on a case-by-case basis(4). Understanding the fundamental differences between modern medicine and Chinese medicine, it is worth to raise the question of whether guidance for practicing Chinese medicine needs to be formulated and what would be the process going forward(5).
    
In addition to clinical practice guidance, a number of other limitations need to be addressed. These include (1) correct identification of the origin of crude herbs; (2) quality control of modified herbs; (3) standardized decoction methods; (4) proper usage of patent drugs; (5) collection and analyses of adverse drug reaction (ADR); and (6) proper evaluation of clinical effects, etc. A set of regulatory guidance should be developed to facilitate quality control of herbal medications as well as the conduct of clinical studies.
    
Finally, clinical practice of Chinese medicine should continue carrying forward the scientific approach. No false advertisements from some pharmaceutical companies and Chinese medicine practitioners are to be tolerated. Regulatory agencies and local government should enforce tight control on any such conduct and ensure a good public image of the clinical service of Chinese medicine(6).

REFERENCES
1.  Chen K J, ed. Medical works of Dr. YUE Mei-zhong. Taipei: Taiwan Qiye Publishing House, 1999: 38.
2.  Chen K J, Xu H, Shi DZ, et al. XS0601 reduces the incidence of restenosis: a prospective study of 335 patients undergoing percutaneous coronary intervention in China. Chin Med J 2006;119(1):6-13.
3.  Zhang MZ. The prevention and treament of restenosis in the era of drug-eluting stent. Chin J Integr Med 2007;13(1):6-7.
4.  Chen K J, Lu AP. From Chinese version of integrative medicine to globalized integrative medicine: impression on the 3rd World Integrative Medicine Congress. Chin J Integr Med 2007; 13(4):244-245.
5.  Avorn J. In defense of pharmacoepidemiology-- embracing  the yin and yang of drug research. N Engl J Meal 2007;357:2219-2221.
6.  Chen K J, Li LZ. Study of traditional Chinese  medicine-- which is after all the right way? Chin J Integr Med 2005;11 (4):241-242.

                                                       (Received July 16, 2008)