"Americans are recognizing the effect of traditional Chinese medicine," he said, while attending the first International Symposium on Education in Traditional Chinese Medicine held at the Beijing University of Chinese Medicine early this week.

"A corresponding education system, especially the acupuncture institute, has been developed and is maturing in the United States," He said. "From my personal experience, the clinical skills of many American students have even outperformed their Chinese peers."

The interest in traditional medicine has been growing as people are turning more and more to alternative and herbal medicines to keep them healthy and to treat diseases that modern medicines have failed to treat.

More than 3,500 foreigners come to China to study traditional medicine every year, over 1,000 of them on undergraduate courses. Among the foreign students studying natural science in China, traditional medicine students account for the largest percentage, according to He Xingdong of the State Administration of Traditional Chinese Medicine and Pharmacology.

The increasing worldwide popularization of traditional medicine warrants the development of systematic traditional medicine education on a global base, as the forum participants agreed.

"Education is the basis for a globalized traditional Chinese medicine," said Mei Wanfang of the London College of Traditional Chinese Medicine in Britain. "Without emphasizing education, the internationalization of traditional Chinese medicine would become a garden with no good gardeners and a field with no good farmers," added Mei.

Challenges

However, the forum participants recognized that there are barriers to building a traditional medicine education system on a global basis.

For instance, it is difficult to develop systematic courses that teach traditional Chinese medicine theories, which should be important components in systematic medical curricula.

The technical parts of traditional Chinese medicine, such as acupuncture and massage, are comparatively easier to understand and accept on the part of learners outside China. People can really see or feel the magical effect of those techniques, and the forceful results enable them to accept it.

In fact, acupuncture is becoming more and more popular around the world. According to Yi Qiao of the Accreditation Commission for Agriculture and Oriental Medicine in the United States, there are about 20,000 licensed acupuncturists in the United States today.

Florida and New Mexico designate acupuncture providers as primary-care practitioners, while California recognizes acupuncturists as primary-care physicians under its Workers' Compensation System. Other states in the United States require physician referrals for acupuncture.

However, the conceptual part of traditional medical theories are often confusing for foreign learners because it applies a specific Chinese culture and way of thinking to explain the phenomena of life and diseases, said Cheng Wei, vice-president of Heilongjiang University of Traditional Chinese Medicine in Northeast China.

In the traditional Chinese cultural system, theory and techniques are integrated with each other, and the Chinese practitioners of traditional medicine accept the theories naturally, Cheng said.

Traditional Chinese medicine is a subject very closely associated with Chinese culture and ancient Eastern philosophies, such as yin and yang, the Five Elements, qi and Taoism, explained Lin Zhixiu, a professor from Middlesex University in London.

However, most traditional Chinese medicine students outside China have little understanding and knowledge about this intrinsic cultural background. Therefore, they find it very difficulty to appreciate and learn the subject.

Language is another substantial obstacle to learning traditional Chinese medicine in Western culture, as most of the literature is based on the abstruse and profound expressions of archaic Chinese.

Problems

The forum participants -- most of them senior teachers -- pointed out that they should work together to help build a standardized educational formula for international students of traditional Chinese medicine.

According to He Yuxin, a standardized textbook and syllabus for traditional Chinese medicine students from outside China should be a priority.

At present, there is a wide variety of traditional Chinese medicine textbooks in Western countries, and different versions have different academic views, expressions and shortcomings.

Teachers select the reference books by themselves, as do their students, which only results in confusion among the students.

Student feedback has already exposed several problems with the English-language textbooks of traditional Chinese medicine published in China, according to Jiang Dan of Middlesex University's Asante Academy of Chinese medicine.

First, the expressions used in traditional medicine's basic theory are wordy and inaccurate. Generally speaking, most of the traditional Chinese medicine reference books are not translated by the medical practitioners themselves. As a result, the logic, coherence, accuracy and vividness are greatly diminished.

Also, the texts are written according to the Chinese way of thinking, which makes it difficult for international students to understand.

Practitioner Zeng Dafang elaborated his ideas on the compilation of international textbooks on the medicine -- especially an officially approved herbal medicine textbook -- based on his 10 years' experience observing and teaching traditional Chinese medicine fundamentals, herbal medicine and clinical practice in the three major traditional Chinese medicine schools in California.

According to Zeng, the references recommended by the licensing organizations have been adopted as herbal medicine textbooks. The most popular and widely adopted one is Chinese Herbal Medicine: Materia Medica, compiled by Dan Bensky and Andrew Gamble and published by Eastland Press in Seattle. It has 470 entries on herbs.

On the other hand, the book The Chinese Materia Medica, compiled by the Beijing University of Traditional Chinese Medicine and published by Academy Press in Beijing, focuses on only 277 commonly used Chinese herbs.

When Zeng attended herbal medicine class as a student 25 years ago, his teachers required him to learn 339 herbs at three different levels, from elementary to advanced.

A shortcoming of the textbook Chinese Herbal Medicine: Materia Medica is its structure. The presentation of herbs is divided into function, indication and combination. Students have difficulties memorizing a herb's different features as each is introduced separately.

Herbal medicine is one of the fundamental courses in traditional Chinese medicine, Zeng said. An advanced course must be considered, especially with regard to herbal formulas.

In order to deepen students' understanding of herbs and help them memorize their properties and differentiate and apply them, textbooks should emphasize when a herb should be used, its effects and its possible integration with other herbs. Chinese herbal medicine textbooks have been compiled in this way for decades and from the perspective of teaching.

Zeng pointed out the lack of correct concepts has made it difficult for international students to differentiate herbs.

Chinese Herbal Medicine: Materia Medica uses correct English but its understanding of traditional Chinese medicine theory is not very accurate.

Take the categories of "warm pungent herbs to release the exterior" and "herbs that warm the interior," for example. The former is used mostly for treating illnesses that come from what traditional medicine doctors call "exterior cold", while the latter is to treat ailments caused by so-called "interior cold."

Key to differentiating the application of the two is an understanding of the symptoms of wu han -- such as aversion to cold and failure to be relieved by wearing extra clothes -- and symptoms of wei han, such as fear of the cold, which can be resolved by adding extra clothes.

However, these two phrases are used interchangeably in the US textbook. As a result, students are unable to distinguish between the two.

Possible solutions

To solve such problems, Zeng called for the establishment of an international organization to arrange the co-ordination, planning and establishing of contacts for publishing textbooks.

Jian of Asante Academy said that the Chinese publishers of English-language textbooks on traditional Chinese medicine should collaborate more with overseas Chinese experts to produce textbooks that are authoritative.

Professor Lin said that he and his colleagues have developed two modules of a traditional Chinese medicine program at Middlesex University.

One of the modules is the history and philosophy of traditional Chinese medicine, the other covers Eastern and Western philosophies underpinning medical practice. After completing the two modules, the students have sufficient background knowledge on the cultural and philosophical aspects of traditional Chinese medicine, Lin said.

The program at Middlesex University also pays great attention to the study of the Chinese language. When students complete the three-year language program, they are able to read simple Chinese and fully comprehend the meaning of traditional medicine terminology.

(China Daily November 22, 2002)