Exploring Traditional Medicine (pg 2)
Symposium Report (cont'd)
In the final session, on pharmacology, a range of commercially available products based on ethnobotanical knowledge and follow-up scientific evaluation were introduced. These included Fanalarofy and Fanalanendo, two products patented in Madagascar to treat convulsions, epilepsy and headaches, with ingredients derived from the endemic resurrection plant (Myrothamnus moschatus). Likewise, Ebenezer Farombi introduced Kolaviron (derived from Garcinia kola), now being marketed in Nigeria. His studies show that Kolaviron has potent antioxidant activities that can help in modulating chemopreventive or chemoprotective effects in the liver, brain or testes.
Finally, a herbal tea, Primus, is now on sale in Croatia after medical historian Stella Fatovic-Ferencis tracked down an old recipe that referred to cancer-healing properties of the burr parsley (Caucalis platycarpos). A combination of investigative work in the field to track down the rare plant, and in the lab to uncover the properties of its component compounds, contributed to the launch of this product. The start-up company that produces Primus, Fitofarmacija, also now grows burr parsley in efforts to ensure supplies.
These three examples, plus several of the others presented, confirm that developing products from traditional medicines can be done, but it is difficult – without ‘unlimited funds’ – to refine those products into single-component pharmaceuticals required in allopathic medicine. Instead they are often marketed locally, and often not as medicines but under labels such as ‘functional foods’ or ‘supplements.’ Despite big pharma’s interest in natural products (with a high proportion of products released over the past 30 years being derived from naturally-occurring compounds), the cost-benefit ratio of building on small-scale laboratory studies and local releases of herbal products are not attractive to multinational companies, while local companies are often non-existent or lack the resources to develop their own products for an international market.
Summing up, Lai Meng Looi noted: “From the very first we noted accurate attention to controlled trials, the search for ethical approvals both institutionally and nationally, and that outcomes were measured using objective international standards. There was also a willingness to see traditional medicine with new eyes, including through the use of ‘big data’.
“Even though several of the studies presented have been published in reputable journals, others still require further validation to address some of the questions raised,” she continued. “These uncertainties refer to issues such as potential toxicity, long-term side effects, and the interaction of traditional medicines with other drugs. Other challenges, too, were raised during the meeting and will need further consideration, including the regulation of traditional medicine practitioners, quality control of traditional medicines, the conservation of the source plants of traditional products, and intellectual property rights – including the feedback of benefits to the communities of origin and not just to commercial companies.”
Lab visits / Hospital tour
The final day of the symposium provided the opportunity for the delegates from outside China to visit three CACMS institutes: the Institute of Acupuncture and Moxibustion, the Institute of Chinese Materia Medica, and Data Centre of TCM.
While many of the visiting experts were familiar with the practice of acupuncture, few of the countries represented had integrated it into their national healthcare systems. There was great interest, therefore, in seeing some of the experimental practices that are being used to validate and improve acupuncture procedures. Among the 156 staff members are 28 researchers and 52 assistant researchers responsible for managing 125 research projects, many of them funded by the National Natural Science Foundation, the main funding agency for scientific research in China.
Moxibustion involves burning ‘moxa’, or dried mugwort (Artemisia argyi), which is applied indirectly via acupuncture needles, or burnt on the patient's skin. It plays an important role in the traditional medical systems of China.
The Institute of Chinese Materia Medica, CACMS, is one of the oldest national institutions engaged in research on Chinese materia medica. In 1983, it was recognized as a WHO Collaborating Centre for Traditional Medicine. With more than 400 staff, the institute focuses on the identification, preparation, biotechnology, quality control, pharmacology and toxicology of Chinese materia medica. Using a high-tech array of equipment such as gene sequencers, nuclear magnetic resonance (NMR) spectrometers, liquid chromatography-mass spectroscopy systems, and others, the institute has averaged an output of more than 100 research papers per year over the past three years.
CACMS’ Data Centre of TCM has a shorter history, being formally established in 2014. It collects, stores and assists with the retrieval of patient data from 16 collaborating hospitals around China. It also uses the latest data mining and analysis techniques to extract information from these huge data sets.
The final day of the event, 24 September, included a visit to Giang’anmen Hospital, part of the CACMS system, and a TCM manufacturing base of the Beijing Tong RenTang Group – the largest TCM producer in China and which is listed on the Shanghai stock exchange.
Giang’anmen Hospital, one of more than 3,000 TCM hospitals in China, has 600 beds and treats 10,000 outpatients per day. Doctors practicing there must first obtain medical degrees before specializing in TCM.
The IAMP delegation was introduced to some of the procedures in use in the hospital, including acupuncture – as an alternative to drugs – to help sedate a patient suffering from Parkinson’s disease, and a method to relieve back pain using heat – in this case fire – to drive volatile compounds from a herbal mixture through the skin to the site of the pain.
The hospital’s pharmacy is responsible for preparing the herbal concoctions prescribed by the doctors from a stock of 600 different material medica. Carefully weighing the correct proportions of each constituent, typically aqueous extracts are prepared for each patient.
“The information provided by the professor who conducted us through the facility and the other who informed us how the hospital manages its patients with the use of clinical doctors trained in herbal medicine and herbal products was inspiring,” confirmed one of the invited experts, Festus Tolu of the Kenya Medical Research Institute, after his trip to Beijing.
For people requiring – or seeking – less personalized treatment, there is also a huge market in China – and elsewhere – for TCM products. China exports some 240,000 tons of medicines annually, of which 200,000 tons are traded as raw herbs. In 2010, China’s TCM market was estimated at RMB317.2 billion (more than US$40 billion), and it is estimated that the total TCM market in China will rise to more than US$100 billion by 2025.
Indeed, more than 3,000 enterprises are engaged in processing TCMs, and leading companies are quoted on the international stock exchanges in Shanghai and Hong Kong. The largest company is the Beijing Tong RenTang Group (TRT), and symposium participants also had an opportunity to visit one of their production bases in the city where they learned that they also have more than 800 retail stores in China, and more than two dozen joint-venture stores in 15 other countries.
Following the symposium, the lab visits, and the tours of the hospital and the manufacturing facility, the IAMP delegates were certainly left with the impression that TCM is taken seriously in China and that there are opportunities for collaboration with both their national research systems to develop new drugs, herbal remedies or functional foods, and their national healthcare systems as they seek to integrate and regulate traditional medical practices within their current healthcare structures.
“We will continue to talk, to share and to collaborate with our partners and develop new ways to work together,” confirmed Lai Meng Looi at the conclusion of the symposium. “It will be important to cultivate the new friendships formed here in Beijing and to follow up with the different projects. I hope this symposium will mark a new beginning and offer new impetus to overcome the remaining barriers between different medical systems, allowing us to further tap and harness traditional medicine and provide it with the recognition that it deserves.”
For IAMP, the next step in this project is to develop the case studies presented during the symposium into a book that will be made freely available in hard copy and online. Publication is set for early/mid 2016. IAMP will also continue to work with its member academies while it continues to explore the synergies between traditional and allopathic medical systems.
Visiting the Institute of Chinese Material Medica
Institute of Aucupuncture and Moxibustion at CACMS
CACMS Data Centre