雙語閱讀｜中藥有望與西藥並駕齊驅

FANG YUAN gazes around his crowded shop and says happily that business is booming. He has a reliable supplier in Russia and hospitals andpharmaceuticalcompanies are queuing up to buy what he sells: antlers. Tangles of them lie in huge meshes on the floor. Thousands more, sliced into discs, fill glass boxes. They are used to treat breast disease in traditionalChinesemedicine(TCM). The shop looks a bit like a Scottish baronial hall. Deer-head trophies gaze down from the walls, as does a red-fronted gazelle with black horns like scimitars. 「I don』t sell those,」 he says hastily. 「Endangered list.」

方元（音譯）四處看著他那人頭攢動的店，開心地說自己生意非常好。他有一位可靠的俄羅斯供應商，還有很多醫院和製藥企業都在排著隊等著買他的貨：鹿角。這些鹿角被放在地板上的一張大網內。幾千個鹿角，切成薄片，放在玻璃箱里。在中醫學裡，鹿角可以用來治療乳腺疾病。這間店鋪有點像蘇格蘭富麗堂皇的大廳，鹿頭狀的獎盃掛在牆上，俯視下面，好像是頭頂彎刀般黑角的赤額瞪羚。「我不賣這些動物，」他急忙說道。「它們是瀕危物種。」

Mr Fang is a trader at the world』s largest market for TCM, a system of diagnosis and treatment that goes back 2,500 years. The scale of the business is staggering. The small town where the market is located, Bozhou, is three hours drive from the nearest railway station. Yet the main market (pictured) is the size of a football stadium. Mr Fang is one of almost 10,000 traders—four times as many as there are shops in the colossal Mall of America in Bloomington, Minnesota.

方元是全球最大的中藥材市場上的一位經銷商——中醫是一套診治體系，有2500多年的歷史。中藥材市場的發展規模令人震驚。這個市場位於一個小鎮亳州，距離最近的火車站有三小時車程。不過，主市場有足球場那麼大。方元只是一萬個經銷商中的一員——這個數目是美國明尼蘇達州布盧明頓超大商城的所有店鋪的四倍之多。

They sell every medicinal ingredient imaginable. There are chips of agarwood, smoke from which is said to clean the lungs. There are dried frogs, gekkos and deer penis which, dissolved in alcohol, supposedly aids recovery from athletic injuries. And there are boxes of Tibetan caterpillar fungus or 「the Viagra of the Himalayas」, a gram of which can sell for more than the same weight of gold. This is the market that sets prices for Chinese herbal medicine throughout the country. Before 9am its sampling room is overflowing with wholesale buyers.

他們出售所有想到的藥材，有沉香片（據說它的煙能清肺），還有干蛙、壁虎和鹿鞭，泡在酒里，能恢復運動損傷。還有成盒成盒的冬蟲夏草，也稱「喜馬拉雅偉哥」，一克重的冬蟲夏草比一克金子還要值錢。這個市場為全中國的中藥定價。每天上午9點前，在樣品室就會擠滿批發商。

The market in Bozhou is both a symbol of an extraordinary boom in TCM, and a consequence of it. The number of hospitals offering TCM in the country of its birth (either by itself or in combination with regular medicine) grew from roughly 2,500 in 2003 to 4,000 at the end of 2015. Since 2011 the number of licensed practitioners has increased almost 50% to 452,000. Around 60,000 TCM medicines have been approved by thegovernment』s food and drug regulator. These account for almost a third of China』s pharmaceutical market, the world』s second largest. In 2015 patients made 910m visits to TCM hospitals anddoctors, which, the government said, accounted for 16% of total medical care, up from 14% in 2011.

亳州市場不僅是中藥格外繁榮的象徵，更是中醫繁榮的結果。全國中醫院的數量從2003年的2500所左右增加到2015年底的近4000所。自2011年以來，中醫執業醫師的數量達到了45.2萬人左右，增長了近50%。大約有6萬種中藥材通過了國家食品藥品監督管理局的批准，幾乎佔到了中國藥品市場的三分之一。中國是全球第二大藥品市場。在2015年，前往中醫院看病的患者達到9.1億人次。政府表示，該數量佔到總醫療服務人數的16%，高於2011年的14%。

It has been a stunning resurgence for a practice that was rejected as superstitious after the fall of the Qing dynasty in 1911. TCM is still regarded with deep suspicion by Western-trained doctors and scientists. It has developed partly because of huge demand for preventive medicines that people believe will help avoid the need for more expensive treatment in hospital. And for some, acquiring the costliest TCM products such as caterpillar fungus has become a status symbol. 「In the past few years,」 says Li Ning of Kang Mei Medicine, a large health-care company, 「there has been wider recognition [of TCM] because people have more money in their pocket and care more about their well-being.」

在1911年清朝滅亡之後，中醫曾被當作迷信，被大家拒之門外，而如今，中醫能夠復甦真是讓人為之驚訝。受過西方教育的醫生和科學家依然對中藥充滿疑慮。中醫藥之所以能夠得到很好的發展，一個原因是人們對預防保健藥品的大量需求。人們認為這樣可以省去去醫院治病所需的大量費用。對於一些人來說，購買冬蟲夏草等最昂貴的中藥變成了一種身份象徵。「在過去的幾年裡，」大型醫療保健公司康美葯業的李寧說道，「越來越多的人開始認可中藥，因為人們口袋裡的錢多了，更加關心自己的身體狀況了。」

TCM has also benefited from the attention paid to it by Xi, China』s president. Mr Xi calls it 「the gem of Chinese traditional science」 and says he uses it. 「TCM is in its golden age,」 he claims. He urges practitioners to 「push for TCM to step onto the world stage」. Since 2012, the year Mr Xi came to power, the Communist Party has been insisting thattraditional medicinebe made equal in status to what China calls 「Western medicine」 (ie, the modern form). Since then, the government has issued a stream of plans, policies and instructions aiming to make it readily available to everyone in China by 2020.

中藥的發展還得益於中國主席的重視。他稱中醫是「中國古代科學的瑰寶」，並表示自己也在服用中藥。「中醫學發展現在處於黃金時期，」他說道。他還督促執業醫生「推動中藥走上世界舞台。」自2012年習擔任國家主席以來，中國政府就一直堅持對中醫和「西醫」（中國人稱現代藥物其為「西藥」）一視同仁、平等對待。此後，政府就發布了一系列規劃、政策和指示，要到2020年每個中國人都用到中藥的目標。

More doses of one』s own medicine

更多使用中藥

Early in 2016 the government published a blueprint for developing TCM over the next 15 years. Traditional medicine, it said, should have equal status in law with modern medicine; it should also be regulated like other types. A 「white paper」 issued at the end of last year said TCM would play a big role in reforming the health-care system because of its relatively low cost.

2016年初，政府公布了一個規劃綱要，提出未來15年中藥的發展方案。綱要指出，中藥在法律上應該享有和西藥同等的地位；它也應該像其他行業一樣得到管理。去年年底發布的一份白皮書稱，中藥的成本相對較低，在醫療保健體制改革方面發揮了重要的作用。

Then, in July, came China』s first TCM law, which lays down safety standards for TCM drugs and the ingredients that go into them. It imposes controls on farms which grow medicinal herbs (banning certain fertilisers, for instance) and on medical manufacturers which produce TCM pills. It also loosens some professional requirements. In the past, TCM doctors had to qualify as conventional doctors first and then be licensed for traditional medicine. The new law makes it possible to become a licensed TCM doctor by passing local exams in practical skills and getting recommendations from two others with licences. Some health professionals worry that this opens the door to more quackery.

接著在7月份，中國頒布了首部中醫藥法律（《中華人民共和國中醫藥法》），規定了中醫藥及其製作原料的安全標準。這部法律加強了對生產草藥的農場及生產中藥片的醫藥廠商的監管（例如禁止生產草藥的農場使用化肥）。與此同時，降低了對醫生專業技能的要求。在過去，中醫醫生必須要首先獲得傳統醫生的資格，然後還要有傳統醫藥學的從業資格。新法律規定，只要通過了當地的實踐技能考試，擁有其他兩位執業醫師的推薦信就可以成為一名執業醫師。一些衛生專業人士擔心這樣會招來更多的庸醫。

Its proponents respond that TCM can improve both public health and the health-care system. Traditional medicine relies on herbal and other natural remedies, not expensive diagnostic machines. According to the white paper, average inpatient expenses per visit at public TCM hospitals were 24% lower than at general public hospitals; outpatient expenses were 12% lower. If TCM is as effective as Western medicine—a big if—then it would appear to be an efficient means of improving health.

支持者們回應稱，中藥能提高公眾的健康水平，完善醫療體制。中藥依賴草本治療和其他自然療法，而不是昂貴的診斷機械。據白皮書稱，每次去公立中醫院看病的平均住院費用要比一般公立醫院低24%；門診費用要低12%。如果中藥和西藥一樣有效的話——如果效果顯著——中藥將會是增進健康的有效方法。

If only there were proof

能證明療效就好

But evidence that TCM works is scanty. Clinical trials in scientific journals have reported some examples of effective TCM treatments, for example against migraines and obesity. They have found some cases where TCM works well in combination with Western medicine, for example, in treating schizophrenia. However, the overall record is poor.

不過，很難證明中醫有效。在一些科技期刊上，一些臨床試驗報告一些有效的中藥治療的例子，比如說治療偏頭痛和肥胖症。他們還發現一些中西結合療法取得成效的病例，例如治療精神分裂症。然而，從總體上來講，效果卻比較差。

America』s National Institutes of Health looked at 70 systematic reviews of TCM treatments. In 41 of them, the trials were too small or badly designed to be of use. In 29, the studies showed possible benefits but problems with sample sizes and other flaws meant the results were inconclusive. Shu-chuen Li of Newcastle University in Australia found that only a quarter of the studies he looked at showed some benefits, but most of these were marginal.

美國國家衛生研究院觀察了70個中藥治療的系統性審核報告。其中有41個治療因效果甚微或設計不當而不能投入使用。研究表明，其中29個治療方案可能會有用，但是由於樣品數量存在問題以及其它一些缺陷，使得結果不確定。澳大利亞紐卡斯爾大學的李樹泉教授發現，他所觀察的研究當中有四分之一確實有一些效果，但是大多數收效甚微。

One aspect of TCM that may be of some help is its focus on prevention rather than cure, says Martin Taylor of the World Health Organisation』s mission in Beijing. TCM doctors aim to see their patients often, partly because the remedies they offer are supposed to be tailored to the individual and need fine-tuning. An axiom of TCM is that good doctors cure diseases before they appear.

世界衛生組織駐北京代表團的馬丁·泰勒認為，中藥比較有用處的一面就是它注重預防而不是治療。中醫醫生會經常看望他們的病人，一是因為他們提供的治療方案都是量身定做的，需要細微的改動和調整。中醫界的一個公理就是：好的醫生是未病先治。

As a result, more attention to traditional medicine implies more attention to primary health care, which is best able to of patients with lifestyle-related ailments (such as obesity) and the diseases of ageing. Though a middle-income country, China has the disease burden of a rich one: diseases such as heart disease and diabetes cause 85% of all deaths. If TCM doctors can suggest better diets or persuade the half of adult men who smoke to give up, then they could make a big difference.

因此，對傳統醫藥的更多關注就意味著更加重視基礎醫療衛生，可以很好地監視病人的病情，主要針對那些患有與生活習慣相關的病症（如肥胖症）以及老齡化疾病的患者。中國作為一個中等收入國家，卻要背負一個富裕國家的疾病負擔：在所有的死亡病例中，85%是源於心臟病、糖尿病等非傳染性疾病。如果中醫醫生能夠建議大家養成更好的飲食習慣，或是說服一半成年男性煙民戒煙，那麼他們就能實現大大改觀現狀。

A government document called Healthy China 2030 says that without better primary services, the health-care system will not be able to keep up with the demands of the ageing population. But an acute shortage of general practitioners is a huge impediment. Even a patient with a minor ailment usually goes to see a specialist. This adds both to costs, since consultations with such doctors are expensive, and to horrible overcrowding in hospitals. The government would like more people to visit local clinics instead. But many people are reluctant to seeGPs, regarding them as inferior to specialists. They might, however, be willing to go to a TCM clinic. Opening more of them could offer some relief to the hospital system.

中國政府發布的一份「健康中國2030」文件顯示，如果沒有更好的基礎醫療衛生服務，整個醫療衛生體系就無法滿足日益老齡化的人口需求。但是，全科醫生的嚴重缺乏是一個巨大的障礙。甚至一個人只是有點小毛病，卻通常要去看專家。這樣就會造成兩個不便：一是成本問題，因為專家問診的費用都很高；二是會造成醫院人滿為患、過度擁擠。相反，政府更願意讓老百姓去社區診所看病。不過，很多人都不願意去看全科醫生，他們覺得全科醫生不如專家。他們可以更願意去中醫診所看病。因此，多開放一些中醫診所可以為醫院減輕壓力。

When administered with caution, TCM can sometimes help people, at least as a placebo. But China』s efforts to promote it as an equal of conventional medicine are fraught with danger. They could result in even more patients with serious illnesses shunning regular treatments in favour of traditional ones. They could also pose an even greater threat to rare species that are often—despite bans on their use—turned into TCM drugs. To reduce such risks, big reforms are needed in the way China manages TCM.

如果管理得當的話，中藥有時候能讓人們受益，至少可以在心理上起到安慰的作用。可是，中國想要將中藥吹捧到擁有和傳統醫藥一樣的地位，可謂是危險重重。這可能會導致更多患有嚴重疾病的人不選擇常規療法而青睞於中醫療法。除此之外，這種做法還會給那些稀有植物造成威脅，因為要用這些稀有植物製成中藥，儘管國家禁止使用它們。為了減少這些危險，中國的中醫藥管理之路還需要幾次大的改革。

Far tighter controls on the use of animals and plants are needed. According to Meng Zhibin of the Institute of Zoology in Beijing, 22% of the 112 most commonly used natural ingredients for TCM are on various endangered-species lists. Some are from herbs that can be grown on farms, but some are from rare animals that are usually captured and smuggled into the country. Trade in pangolin, an anteater, is banned worldwide. But Wang Weiquan of the Chinese Medicine Association says smuggling continues because domestic pangolin farms are not big enough. TCM proponents do not seem to care. They worry about the future of traditional medicine itself. Wen Jianmin of the Wangjiang TCM hospital in Beijing says the ban on the use of some animals has already led to the extinction of some famous traditional remedies. 「If we don』t protect TCM better, Chinese medicine will exist only in name,」 he says.

政府需要對某些動植物的使用加大管控力度。根據北京動物研究所得孟志斌稱，在製作中藥的112種最常用的天然原料中，有22%屬於瀕危物種。有些是從在農場養殖的草藥中提取的，有些是從珍稀動物身上提取的，而這些珍稀動物通常是被捕殺後偷運到國內的。買賣穿山甲（一種食蟻動物）在世界範圍內都是禁止的。但是，中國醫藥協會的王衛權稱，走私現象依然存在，因為國內的穿山甲農場還不夠大。中醫學的支持者似乎並不在乎這一點。他們擔心的是傳統醫藥本身的未來。北京望京中醫院的溫建民認為，禁止使用某些動物導致了一些著名傳統療法的滅亡。「如果我們不能更好地保護傳統中藥，那麼中藥將形同虛設，」他說道。

The government also needs to improve safety standards. One example: a genus of plants called aristolochia, used against arthritis, turns out to be carcinogenic. But the government』s desire to improve safety implies more standardisation, and that contradicts the TCM belief that each treatment shoulda. In 2016 the food and drug regulator revoked 81 licences of TCM makers. Yan Xijun, of Tasly group, a medical firm, says that of TCMpharmaceuticalcompanies that do have licences, 「it』s fair to say 50-60% of them more or less have problems that need solving.」

政府也需要提高其安全標準。例如：一種名叫馬兜鈴的植物，可以用來治療關節炎，卻發現能致癌。不過，政府想要提高安全水平的願望意味著更高的標準化要求，這也與傳統中醫的理念相悖，即要根據患有具體病例制定具體治療方案。2016年，食品藥品監督局吊銷了81家中藥製造商的營業執照。醫療企業天士力集團的董事局主席閆希軍稱，中醫藥企業確實有營業執照，「當然，50%到60%的中醫藥企業或多或少有問題。」

Training TCM doctors in modern medicine would also be a huge help. The government says thattraditional medicineshould complement the normal kind. That will require doctors who are skilled in both types and who can advise patients when they should be using modern methods of treatment. However, few TCMdoctorsin China can straddle the two disciplines. The new law, which relaxes requirements that they understand medical science, is a step in the wrong direction.

以現代醫藥學的方式來訓練中醫醫生，這會很有幫助。政府稱，傳統醫藥應該彌補常規醫藥的不足之處。這就需要醫生能夠精通兩種醫術，在病人需要接受現代療法時建議他們去採用現代療法。然而，中國沒有幾個能同時精通中西醫術的醫生。新法律降低了所謂的醫療科學的門檻。這無疑是一個錯誤的舉動。

The long-term goal should be to establish a health-care system that relies on modernmedicineand that provides the kind of preventive treatment that TCM claims to offer. Thegovernmentis exaggerating TCM』s effectiveness. Use of it is so widespread in China partly because few are willing to challenge the science behind it. TCM is distinctlyChinese—to question it is often construed as unpatriotic. Striving for modernity while clinging to tradition is a familiar struggle in China. As the problems ofTCMshow, achieving the right balance is harder than it looks.

長遠目標應當是建立一個依賴現代醫學，並能提供中醫所謂的預防性措施的醫療體系。政府在誇大中藥的療效。它在中國的使用如此廣泛，其中一部分原因是很少有人願意去質疑其背後的科學性。中藥是中國的特色——質疑中藥通常會認為是不愛國的行為。追逐現代化還是堅守傳統，這一直是中國經常面臨的難題。隨著中藥暴露出來的種種問題，實現中西藥的平衡要比表面看起來難得多。

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