On the first working day after the Lunar New Year holiday at the end of January this year, a crowd of people squeezed into Ming Xin Clinic in Zhongli City, northwest Taiwan, awaiting treatment from Peng I-chun, a practitioner of traditional Chinese medicine (TCM). Some of those waiting viewed TCM as a complementary or alternative form of treatment, while others saw it as picking up where Western medicine leaves off. What was evident from the scene is that many Taiwanese still embrace TCM as they have for generations.
The development of TCM in Taiwan can be traced back to the end of the Ming dynasty (1368-1644) when large-scale migration from mainland China took place. Those settlers brought with them the ancient art and knowledge of TCM, including that of Chinese herbal medicine (CHM). No matter how the social or political environment has changed, CHM has been deeply rooted in Taiwanese culture ever since.
One thing that has changed, though, is the processing and final form of the herbs themselves. The traditional style is for an individual clinic to source its own herbs and then provide patients with the raw materials to boil at home into a decoction. A newer trend is for clinics to rely on larger scale manufacturers to obtain the raw materials and provide products such as concentrated herbal extracts in pills, capsules or powdered form or even do the work of cooking up individual treatments.
Peng I-chun's clinic is a good example of a traditional practice. In comparison with a large hospital, the clinic, which has been open for more than 30 years, looks humble. Peng has no receptionist and his practice is small, consisting of one room for seeing patients, one waiting room and one dispensing room for the herbal medications.
After being diagnosed, most patients get a large batch of herbs comprised of three smaller packages designed to last for one week of treatment. There can be some 50 ingredients in each package.
Only the Best
"Peng uses only the very best herbs. We've heard how he bargains with the herb providers, but although the herbs are becoming more and more expensive, he insists on ordering those of high quality," says Yang Li-chi, who accompanied his wife to the clinic from Keelung, northern Taiwan. "We have trust in what they offer here. People have to boil it at home to get a traditional herbal decoction that is pretty strong, but it's not so bitter."
However, it takes time to prepare the medicinal decoction at home, and for those who are short on time or would rather not go to the trouble, some newer clinics are doing the work for them. ChanDer Clinic is a good example of a modern TCM practice that will provide medicinal decoctions for patients and even offers a home delivery service for the remedies.
Located on the third floor of a high-rise in downtown Taipei City, ChanDer Clinic was founded in 2000 and is run by a group of TCM doctors, each holding at least a master's degree in the field. Sunshine filters in through French windows in the big waiting room, as peaceful music plays in the background and waiting patients watch a large screen presenting updated information about the clinic.
"Life in modern society is more complex than before, so people come to our clinic for different reasons," says Chang Yu-xin, president of ChanDer Clinic. "In addition to patients, many Taiwanese without any special illness visit us just because they want to improve their physique or complexion. Our doctors can prescribe different kinds of herbal medicines depending on one's personal needs," he says. "We can give a patient powder or capsules, or for those who are willing to take decoctions, we offer the service to boil and even send them to their homes."
Staff at ChanDer Clinic dispense raw herbs. (Photo by Huang Chung-hsin)
All of the doctors at ChanDer Clinic are equipped with knowledge of both Western medicine and TCM, Chang explains, adding that they received formal education at the China Medical University in Taichung, central Taiwan, which is renowned for its TCM training.
"In comparison with mainland China, Taiwan has an advantageous position because Taiwan has preserved the original theories of TCM. TCM knowledge has been passed through the generations in Taiwan without the disasters of the Cultural Revolution in mainland China from 1966 to 1976," Chang says.
Chang also notes a key trend in CHM--the movement to standardize the raw ingredients for herbal medicines. "We are taught to take care of a patient's well-being as a core value. Safety and effectiveness are the most important factors for our doctors in prescribing medicine. We strictly scrutinize the source and the quality of raw herbs and use products from Sun Ten Pharmaceutical Co., which enjoys credibility as a leader in the CHM pharmaceutical industry," Chang says.
Setting the Standards
The growing popularity of traditional remedies and the trend toward natural health products in the international and domestic markets are also driving the government to focus on the safety and quality of CHM products. One way it is doing so is via Department of Health (DOH) regulations requiring manufactures to follow Good Manufacturing Practice (GMP) guidelines for their products.
"To ensure adequate drug safety standards and to help local pharmaceutical companies meet international standards, the DOH announced that it would enforce GMP regulations on all domestic pharmaceutical companies engaging in the manufacture of herbal medicine, starting from March 1, 2005," says Lin I-hsin, chairperson of the Committee on Chinese Medicine and Pharmacy under the DOH.
"This effort is intended to stop industry-damaging practices such as the selling of spurious Chinese medicine ingredients, adulteration of herbal medicine with Western pharmaceuticals, the selling of herbal medicine on the streets and the broadcast of commercials containing unsubstantiated claims about a particular herbal product," Lin says.
There are currently 118 Chinese pharmaceutical companies in Taiwan that already implement GMP. Sun Ten Pharmaceutical Co., whose products are used at the ChanDer Clinic, is one of those companies.
Started in 1946, Sun Ten Pharmaceutical Co. is now well known for its concentrated herbal extracts. It is also currently one of the herbal medicine companies whose products are certified by the DOH for coverage under the National Health Insurance scheme.
After bringing the techniques for extracting CHM ingredients from Japan to Taiwan in 1963, Hsu Hong-yen, founder of Sun Ten Pharmaceutical Co., devoted the rest of his life to researching and modernizing the production of Chinese herbal extracts. His dedication and pioneering spirit earned him a reputation as the "father of scientific Chinese herbal medicine," with the term "scientific" referring to Chinese herbal extracts in the modern form of powder, capsules or medicinal soup.
A show room of Sun Ten Pharmaceutical Co. displays a range of Chinese herbal medicines. (Photo by Huang Chung-hsin)
"There are three sectors in our company," says Wang Hsueh-lin, president of Sun Ten Pharmaceutical Co. "The main job for the pilot factory and research institute is research, botanical identification and the development of analysis methods. For sourcing the herbs, we looked for the best growing place for each raw herb in mainland China and signed agreements with those farmers to guarantee the herbs are unpolluted. You know, almost every province [in mainland China] has one of our farms," she says.
"For manufacturing, our factory is located in Taichung, central Taiwan. Decoction and recovery of the therapeutic essential oils, low temperature vacuum concentration, and spray drying are the steps in manufacturing the extracts," Wang says.
"Due to the good quality of the extracts serving a growing market, our products have been recognized not only in Taiwan but also overseas. For example, we won GMP certification from the Australian Therapeutic Goods Administration in 1992," she says.
"Our products have also been approved by the Japanese Health Insurance System since 1975 and the American Specialty Health Project since 1997 as reimbursable prescriptions," Wang says. Sun Ten Pharmaceutical Co. has opened stores in North America, Europe, Israel, Asia, Australia and New Zealand as a result of global interest in the use of CHM.
Natural Approach
Behind the use of the new forms of traditional medicines are the theories of CHM in general, which are different from those of Western medication, practitioner Peng I-chun stresses. In lieu of driving out the root of a disease, Western medicine tries to suppress the bacteria or virus that causes it, so that a lot of harmful material still accumulates in the body, he says. "Actually we can use more natural ways to get rid of waste and poison from a person's body. For example, patients with the flu or a cold can eat hot rice soup plus ginger and brown sugar to let the body sweat out the fever along with waste liquids, while strengthening a patient's energy to fight against the disease. Food and herbs are better than chemical compounds to meet our body's needs," Peng adds.
In fact, it is widespread dissatisfaction with Western medicine, especially in treating rare or chronic ailments, that often drives people to visit TCM clinics. "Western medicine doctors tend to prescribe antibiotics, which seemed to work for my son in the beginning," says Tu Wan-yu, a woman waiting with her son at Peng's clinic, "but apparently didn't get all of the germs because, after a brief interval, all the symptoms returned."
Most CHM patients say herbal medicine has fewer side effects than Western medication, but even if a reaction is more intense, many are willing to take it to cure their ills. "After taking it several times, patients have symptoms such as vomiting and diarrhea to excrete the poison. That's the way my wife's tumor naturally disappeared," says Yang Li-chi while waiting with his wife in Peng's clinic.
While not everybody accepts these ideas about the treatment of diseases, it would be difficult to deny the amount of interest in CHM. "Maybe you don't believe in it, or don't agree with it, but you can't ignore it," Yu Chia-li, an internist at National Taiwan University Hospital--one of the largest and most established centers of Taiwan's mainstream medicine--says of TCM in general.
A study by Ting Chih-yin, an associate professor at National Taiwan University's School of Public Health, seems to confirm Yu's point. The study found that 75 percent of respondents had resorted to CHM, and that combining mainstream and alternative medicine had become common practice in Taiwan. "Individuals have already integrated the two on their own. Today, they use one method and tomorrow, something else," Ting says.
The fast tempo of life in modern society has set off tremendous interest and changes in the way people approach CHM. It is a trend that has gained the attention of TCM clinics and herbal pharmaceutical companies, which are promoting new services and products to meet consumer demand. Such a tendency will require the integration of the government, industry and CHM practitioners to provide the public with the maximum benefits of the modernization of this traditional form of medicine.
Write to Tso Lon-di at londi@mail.gio.gov.tw