Introduction
With thousands of years of inheritance and development, traditional Chinese medicine (TCM) has developed a distinctive and systematic diagnosis and treatment system; it has also profoundly influenced world civilization, as well as the development of human society and the Chinese nation [
1]. As one of the unique cultural treasures of Chinese people, TCM represents a significant feature and prominent advantage of the healthcare cause in China.
In recent years, TCM has gained growing acceptance and recognition around the world. The World Health Organization (WHO) has drafted and released a series of strategies, policies, and standards to expedite the development of traditional medicines, including TCM, across the world. TCM has spread to over 180 countries and regions; it has been used by roughly two thirds of Chinese people, including Chinese nationals and Chinese living abroad, and one third of the local population. Incomplete statistics show that about 100 000 TCM clinics on the planet, excluding those in China, and more than 500 000 medical professionals have received TCM training. Moreover, approximately 1500 TCM teaching institutions and 3000 trade companies marketing TCM products exist in over 170 countries and regions.
A WHO investigation [
2–
7] showed that 80% of 129 surveyed countries now recognize the use of acupuncture (Fig. 1A) and that the Member States have established national policies and regulations on T&CM (referred to as traditional medicine or complementary medicine in some countries) and herbal medicines, the use of which have increased annually (Fig. 1B and 1C). In addition, 43.5% of the countries have established regulations on T&CM practitioners (Fig. 1D). The number of Member States providing high-level T&CM education programs, including Bachelor, Masters, and Doctoral degrees at university level, has increased from only a few to 39, representing 30% of the surveyed countries (Fig. 2A). The number of Member States reporting a national research institute for T&CM has increased significantly as well (Fig. 2B). However, numerous difficulties in relation to the national policies, law and regulation, quality, safety, and effectiveness of T&CM, as well as universal health coverage are still evident from a global review (Fig. 3). Fig. 1 shows that the regulation and insurance coverage regarding the use of acupuncture are yet to be well established although numerous countries have acknowledged the application of this Chinese medical practice. Nonetheless, TCM has made great strides toward its worldwide presence and is gathering momentum to expand on to untapped markets.
TCM has witnessed rapid development in Europe after China adopted the reform and opening-up policy. Several TCM therapists left China and practiced in European countries. As a result, the awareness on the characteristics and merits of TCM increased among Europeans who began to embrace TCM therapies and Chinese-style care [
8]. The UK government legalized acupuncture therapy in 2000. In Germany, TCM therapists practice in private clinics and mainstream hospitals. In the Catalonia region of Spain, alternative therapies, such as TCM, have been legalized by local parliament and are covered by medical insurance. These examples suggest that TCM has established a solid foundation in Europe and now enjoys a vast development space in the continent.
However, many challenges still stand in the way of advancing TCM development in foreign countries. TCM has spread offshore for over a thousand years ago, leading to both successful experiences and bitter lessons. This paper introduces the current situation of TCM in Europe, analyzes the opportunities and challenges in its development, and identifies preliminary strategies and suggestions in the hope of facilitating TCM development in Europe and broadening its application around the world.
Data were collected from WHO, Chinese Bureau of Statistics, China National Knowledge Infrastructure, and PubMed. Studies from the past 10 years were selected for analysis. The processes for research selection as well as for data extraction and analysis were completed and repeated by two individuals separately to avoid the risk of bias of individual studies. The summary process was also carried out by two researchers.
Current situation of TCM development in Europe
TCM enjoys a robust development momentum, and an overall layout begins to take shape
In recent years, TCM has been welcomed by Europeans for its safety, convenience, and affordability. The demand for TCM has been rising in the European market, and TCM clinics and acupuncture clinics are found in numerous locations. At present, approximately 3000 TCM clinics are situated in Britain and over 1600 are in the Netherlands. About 20 000 TCM practitioners are in Switzerland and over 200 complementary therapies, including TCM therapies, are available in the country [
9]. Owing to the increasingly relaxed and flexible market environment in the Netherlands, TCM has flourished in the country. Today,the Netherlands is home to more than 1600 TCM clinics, in which about 15% of patients prefer to see a TCM therapist.
Acupuncture has been generally accepted and broadly applied across Europe. In most part of West Europe, acupuncture has been legitimized and covered by medical insurance. Many hospitals and clinics offer acupuncture. In Germany, roughly 50 000 doctors or 20% of the country’s practitioners are certified acupuncturists; every year, 1.5 million German patients receive acupuncture or other TCM therapies, which cost 33% of the country’s medical insurance spending. Furthermore, acupuncture has been brought into the national medical system in Italy with 200 000 patients receiving acupuncture treatment annually. In countries such as Germany, Britain, and Switzerland, the cost of acupuncture treatments can be partially paid by the government or by private medical insurance companies [
10]. In 2010, Chinese acupuncture was added to UNESCO’s list of intangible cultural heritages [
11]. Such inclusion has accelerated the treatment’s promotion around the world.
Moreover, TCM is attracting a great deal of interests from European researchers, who have established TCM centers and associations. TCM-related books, magazines, and web pages have increased rapidly as well [
10]. Acupuncture and TCM associations in Norway, Spain, and Switzerland have also begun to form.
TCM and Chinese medicinal products have been available across Europe, and the demand is still rising [
12]. Used as alternatives to chemical drugs, traditional medicines cure a long list of complicated and chronic diseases that are resistant to western drugs and help European countries reduce their burdensome healthcare costs as well as create a vast amount of job opportunities.
Tough and tortuous road ahead for TCM legislation, but unremitting efforts bring a glimpse of hope
Despite its robust development in Europe, TCM has long been struggling to deal with the dilemma of it being well received by the public in contempt of the stringent scrutiny by the government. The governments of several European countries have been equivocal in issues such as the role and position of TCM, the market access of Chinese medicine, and the qualification certification for TCM professionals.
Acupuncture has gained a legal status in many countries and has been included into the medical insurance system of some nations [
2]. However, only a few countries have written laws to protect TCM. In most countries, TCM is only regarded as an alternative therapy; thus, it is not managed and regulated by medical institutions, and TCM practitioners are not licensed doctors. Despite 10 years of relentless efforts and struggles in Britain, TCM remains as an alternative medicine, and no qualification standards are still available to certify TCM therapists, who can only practice by being registered as acupuncturists or herbalists. In a number of nations, acupuncture is mistaken as a synonym for TCM, and their parliaments even believe that acupuncture is or includes TCM. TCM therapies have not been covered by medical insurance at a large majority of countries, thereby causing enormous economic burden for many patients eyeing the treatment of TCM therapies. In countries such as Austria and France where TCM has taken a solid root, TCM treatment is mainly received by high-income people because patients have to pay for the entire costs with their own money.
The good news is that Australia became the first developed country in 2012 to adopt a legislation recognizing TCM. This move prompted European countries to enact similar legislative actions. The parliaments in Britain, Germany, Switzerland, France, Sweden, and the Netherlands are also pushing for TCM legislation. The French Ministry of Health has allowed Chinese herbal preparations to be used in Sino-French hospitals as early as 1996. The Medical Association of France has also recognized TCM as a part of the legitimate medical practice. Some health insurance companies have agreed to pay for TCM treatment as well. In 2009, Switzerland passed a referendum to put TCM treatment under the coverage of basic medical insurance, which drove TCM development in the country and continent [
13]. The Netherlands has incorporated acupuncture into its medical insurance system, such that the government pays a large part of the treatment cost. In 2014, acupuncture began to be covered by Belgium’s medical insurance. The TCM practitioners in Europe are increasingly becoming aware of the importance of self-regulation and standardized development, and they are communicating with local governments and using other means to try to secure an independent and legitimate status for TCM.
Unlike a general commodity, the largest obstacle in exporting TCM is registration. According to the European Directive on Traditional Herbal Medicinal Products (Directive 2004/24/EC) in 2004, the traditional herbal medicinal products sold in the EU market must be registered according to the new directive before they are allowed to reenter the market, and there was a seven-year transition period [
14]. The EU ban has made it more difficult for TCM products to be registered as medicines in the European market. However, the number of herbal products with traditional use registration within Europe indicated an obvious yearly increase after 2011. Approximately more than 1300 herbal products were registered with the simplified procedure from the law’s implementation in 2004 until December 2013 (Fig. 4) [
15].
Regrettably, no Chinese company was successfully registered during the transition period. Di’aoXinxuekang Soft Capsule was the only TCM drug permitted to hit the market in the Netherlands as a curative medicine [
16]. Most of the TCM products from China are registered as foods or food supplements to be exported to Europe today. In addition, different regulatory requirements in different markets result in increased uncertainty to TCM development. In spite of numerous trade barriers in the international market, China’s TCM enterprises maintain their persistent efforts to explore overseas markets. Tong Ren Tang Group has set up chain drugstores in foreign countries to develop the TCM service trade business. Tasly Pharmaceutical Group and Yiling Pharmaceutical Co., Ltd. seek to register their TCM drugs in European and US markets to expand their presence in the mainstream western market.
The TCM practitioners in Europe received varying degrees of TCM education or training. Take Switzerland for instance. In general, TCM practitioners are classified into four types, including western doctors with short-term TCM training, TCM therapists educated at local TCM schools, TCM professionals coming from China, and non-medical professionals who received short-term TCM training [
13]. The TCM therapists from China are mostly professionals with formal school education, but they can hardly practice in Switzerland because the government caps the number of foreign professionals allowed to work in the country. For the remaining three types of TCM practitioners, their professional skills vary because of an unsatisfactory training and a relatively low trade threshold. The situation is more or less the same in other European countries.
TCM education and scientific research witness rapid progress, whereas academic strength lags
Owing to the growing demand for TCM talents across Europe, TCM education institutions have witnessed rapid development. These institutions adopt various models to cultivate TCM talents. Furthermore, numerous European universities open their own TCM programs or collaborate with China’s TCM universities to do so. Several European universities have already opened a Chinese medical science department or established a Chinese medicine specialty [
2]. As international exchange intensifies, an increasing number of European universities seek to partner with domestic and foreign counterparts to offer TCM programs [
17,
18]. Several European universities as well as research and clinical institutes have initiated partnerships with China’s prestigious medical colleges, such as Beijing University of TCM, Shanghai University of TCM, and Nanjing University of TCM, to carry out the joint cultivation of talents specializing in TCM, acupuncture, and massage. Hundreds of European college students yearly arrive in China to acquire TCM knowledge and to learn practical clinical skills. The European Foundation of Traditional Chinese Medicine has cultivated over 1000 TCM professionals by collaborating with Chinese partners since its establishment in 1989. On the sideline of the 12th World Congress of Chinese Medicine in September 2015, a graduation ceremony was held for postgraduate students jointly educated by the European Foundation of Traditional Chinese Medicine and the Yunnan College of TCM. This ceremony marked new heights for TCM education in Europe.
The statistics published by China’s Ministry of Education indicated that the number of international students continuously increases over the past 10 years, which makes China the third largest destination in the world for international students. In 2015, 377 054 foreign students from 203 countries and regions arrived in China to study; this statistics is up 5.77% from the prior year, accounting for 8% of the world’s total international students. Data from the China Scholarship Council indicated that TCM is the second most popular subject, in terms of student number, for international students. Furthermore, TCM draws more international students than any other subject in the natural sciences [
19].
The TCM education in Europe has witnessed a progressive development from its early stage during which TCM education was mainly driven by practical demands; however, many problems remain unresolved. In most European countries, the Chinese medical science can hardly be integrated with the local medical education system, and the legality of TCM education remains a thorny issue. Other issues include a lack of emphasis on medicinal treatment and theories as well as symptom discrimination during the instruction process [
17]. Moreover, the quality and effect of TCM education are affected by the lack of highly competent faculty, clinical practice bases, well-drafted teaching plans and textbooks, as well as the varying quality of students.
With the advancements in TCM clinical practice, related scientific research begins to gain prominence in Europe. A number of medical institutions, universities, and pharmaceutical companies started to conduct studies on Chinese-medicine-related historic documents, the pharmacological effects of Chinese medicine, and the relation between modern medicine and traditional medicine in the hope of finding science-based evidence to demonstrate the efficacy of Chinese medicine and to accelerate its modernization and internationalization. However, selecting the best approach for the study, including the analysis and use of the development rules of Chinese medicine, is still a huge challenge.
Sluggish TCM export amid fierce market competition
The export quantity and value of medical products in China increased yearly from 2008 to 2013 (Fig. 5). The international demands for herbal medicines have recently grown rapidly, and the competition in the TCM market has become increasingly fierce. China’s TCM exporters are plagued with numerous concerns. The domestic TCM market has exceeded RMB 410 billion a year, although the value of TCM exports was only US$ 2.499 billion in 2012 and US$ 3.138 billion in 2013 [
20]. In 2012, the world herbal products market share was around US$ 100 billion (about half is represented by herbal medicines, and the others are cosmetics, health care products, and food additives). In China, the total industrial output value of Chinese patent medicine is about US$ 120 billion. If healthcare products are included, then the value is about US$ 1000 billion.
The export quantity and value of prepared Chinese medicine in China demonstrated negative growths in 2012 and 2013 [
20] (Fig. 6). Chinese exports are dominated by plant extracts and herbal tablets, which represent approximately 80% of the total exports in China (Fig. 7). Plant extracts are primarily supplied to foreign drug companies to be used as raw materials and, strictly speaking, should not be counted as Chinese medicines. The export of Chinese patent medicines, the most distinctive examples of TCM, has remained sluggish for a long time. Owing to the unreasonable product structure and low-added value, China’s TCM producers are not extremely competitive in the international market. China’s ambition is to bring Chinese medicines to the international market by threatening the downgrades to bring Chinese medicinal materials to such market.
Most of the herbal products in the European market are from Germany and US. According to the statistics provided by China Customs, China’s export of Chinese medicinal products to EU logged a steady growth between 2001 and 2011. The export value rose from US$ 73 million in 2001 to US$ 420 million in 2011, translating into a compound annual growth rate of 19.1%. From the perspective of product structure, over 96% of the exports are plant extracts, Chinese medicinal materials, and herbal tablets, and only 3% to 4% are Chinese patent medicines [
20]. To some extent, the export of Chinese patent medicines indicates the internationalization of Chinese medicine. According to the statistics provided by China Chamber of Commerce for Import & Export of Medicines & Health Products, China’s export of Chinese patent medicines to EU has begun to decline since the implementation of the European Directive on Traditional Herbal Medicinal Products on April 30, 2011. The value of such exports increased by 6.4% in 2011 to US$ 13.32 million, but plunged by 22% in 2012 to US$ 10.34 million. The figure fell by 5.85% year on year in 2014 to US$ 11 million because of the weak demand from EU, especially the UK market [
21]. However, the different concept of herbal products and drugs, food additives, healthcare products, and medical cosmetics should be considered. In other countries, the value of herbal production remains unclear.
International exchange intensifies, prospect for TCM cooperation brightens
The TCM-themed exchange and cooperation between China and other countries have recently increased rapidly. The Resolution on Traditional Medicine, initiated by China, was adopted at the 62nd World Health Assembly. The International Organization for Standardization passed China’s proposal to establish the Technical Committee of Chinese Medicine and decided to locate the committee’s secretariat in China. China has signed nearly 100 intergovernmental agreements on Chinese medicine with more than 70 countries. The cooperation between China and Europe on running medical schools, developing medical talents, and conducting scientific research has increased [
22]. Numerous countries and regions have begun to develop and produce Chinese medicines, and several people are beginning to accept treatments with such medicines.
China has established TCM research centers and associations in European countries and held TCM-themed academic conferences, planned symposiums, seminars, and inspections on a regular basis. China is preparing to establish the European Center of Chinese Medicine Development and Promotion. The center will facilitate trades in TCM education, healthcare, culture, creative, and services. The European Association of Jingfang Traditional Chinese Medicine, which was inaugurated in October 2015 in Frankfurt, Germany, aims to promote academic exchange and international training and to popularize Chinese medicines. The World Congress of Chinese Medicine, the world’s largest and highest-level academic conference in Chinese medicine, has successfully held 12 annual sessions in China, France, and Spain. The European Foundation of Traditional Chinese Medicine, founded in 1989, has set up 11 clinics across Spain in partnership with Guang’anmen Clinics, and these clinics receive over 20 000 patients a year. The Journal of Traditional Chinese Medicine along with numerous TCM publications were translated into Spanish and published in the country. These activities created a platform for international exchange and cooperation and have profoundly influenced the initiative for academic exchange, international communication, and international talent cultivation, in addition to the promotion of TCM culture.
Furthermore, China’s relevant departments have dispatched TCM therapists to provide free clinic services in foreign countries. These departments have also offered health lectures, provided training to overseas TCM practitioners, encouraged European hospitals to cooperate with their Chinese counterparts, and strengthened communication with TCM industry associations to enhance the professional skills and image of TCM practitioners in Europe and to further expand TCM’s global influence.
China has opened overseas institutions that encourage learning of Chinese language by drawing from experiences of foreign countries and by promoting their own languages. As of December 7, 2014, a total of 475 Confucius Institutes and 851 Confucius Classrooms in 126 countries and regions have been established. Among these academies were 159 Confucius Institutes in 39 European countries and 211 Confucius Classrooms in 25 European countries. These Confucius Institutes are actively integrating themselves into a local society, offering Chinese language courses and hosting various exchange activities. The Confucius Institute for Traditional Chinese Medicine in London is the world’s first TCM-themed Confucius Institute. The Institute mainly provides TCM courses, promotes Chinese medicines, and collaborates with global universities, research institutes, and clinic organizations to share and exchange their achievements in teaching and conducting scientific research and to spread the cultural context behind Chinese medicine.
Opportunities and challenges
Along with the shifts in public health perception and changes in medical models, TCM exerts a great influence in Europe and garners unprecedented attention from the international community, which in turn brings rare development opportunities for TCM. However, these developments also result in stiff international competition that poses a grave threat to China’s TCM industry. Thus, the European market is now in the doldrums. The huge cultural difference between China and the West hampers the development of TCM in Europe. In sum, multiple challenges and difficulties lie ahead.
Opportunities
Favorable government policies guide TCM producers to explore overseas market
China has always attached great importance to international exchanges on Chinese medicine. The State Council and relevant ministries have issued a series of notices encouraging TCM producers to explore the overseas market. Chinese President Xi Jinping once made important instructions regarding the promotion of Chinese medicine. He said that the science of Chinese medicine is a valuable treasury of China’s ancient science and a key to the treasure house of the Chinese civilization; intensive study and scientific summarization of our achievements are of great significance to enriching the global medicinal study and advancing life science research. Li Zhaoxing, China’s former foreign minister, said in his speech at the 2015 Boao Forum that he hoped TCM would make contributions to the well-being of the Chinese people and to other people around the world.
Since the 18th National Congress of the CPC, TCM has gained great prominence from the top leadership as an integral part of China’s diplomatic strategy. The top leadership made a series of important instructions and directives, and relevant ministries also increased their efforts to improve the TCM sector. In 2011, the Ministry of Health and the State Administration of Traditional Chinese Medicine released the Medium & Long-term Plan of TCM International Exchange and Cooperation 2011–2020. In 2012, the Ministry of Commerce, the State Administration of Traditional Chinese Medicine, and other 12 national ministries introduced a series of policies, including Suggestions on Expediting Development of TCM Service Trade. These policies have greatly accelerated the development of the TCM sector.
China is laying out a national strategy to expand the presence of Chinese medicines in offshore markets. The government has regarded TCM development as part of the social and economic development and of the Belt and Road strategy in a state-level initiative for international exchange and cooperation. In 2015, a special project of TCM international cooperation was created to analyze and address the difficulties and problems that have long kept Chinese medicines from entering the international market, promote the worldwide recognition of China’s distinctive TCM theories, culture, services, and products, obtain an upper hand in the global traditional medicine market, and build a new global and regional landscape for the TCM market.
The government’s high attention and policy support have created a favorable policy environment and a powerful social basis for TCM internationalization, and the deepening economic, trade, and cultural connections between China and Europe provide policy support and great opportunities for TCM development in Europe.
“Belt and Road” strategy boosts TCM presence
China conceptualized the “Belt and Road” strategy in 2014. Under the strategy, countries along the “Belt and Road” will carry out extensive exchanges and collaborations in numerous fields, such as transport connections, industrial development, financial service, and international trade. The General Office of the State Council said in the Development Plan for TCM Health Services (2015–2020) that TCM development has become an integral part of China’s implementation of the “Belt and Road” strategy.
Countries along the “Belt and Road” have a profound history of using Chinese medicines or other traditional medicines and have a solid understanding of the TCM culture. People from these countries have a relatively high level of acceptance of Chinese medicines, and they account for more than 50% of the total trade value of Chinese medicines. In recent years, the trade activities of the traditional medical services in the “Belt and Road” countries are increasing and growing to a certain scale. The TCM sector has become a new source of growth for many economies. As China continues to push for TCM exchange and cooperation, the international community has been increasingly aware of the treatment mechanism and curative effect of Chinese medicines, making the “Belt and Road” countries realize the tremendous development potential and promising outlook for the TCM industry. The Chongqing–Xinjiang–Europe railway opens a new bridge for intensive cooperation between China and Europe. The “Belt and Road” initiative caters to the common demands of the countries involved and brings a new window of opportunity so they can complement one another’s advantages and pursue open development. The initiative offers a new platform for international cooperation. Through the implementation of the national strategy, China can strengthen TCM exchange and cooperation with Spain and other Maritime Silk Road nations. The prospect for such exchange and cooperation is extremely promising.
Major European market provides large development space
People around the world are becoming increasingly aware of the importance of a healthy life, and this increased awareness leads to a fundamental change in medical ideas. The primary objective of medical science has switched from treating diseases to protecting one’s health. The unceasing division has enhanced the development of modern medicine; however, the division of medicine has also brought some disadvantages. Over-specialization fails to help healthcare providers develop a comprehensive view on the truth of life. Without an overall view, a doctor diagnosing a disease is similar to a blind man determining the image of an elephant only by feeling some parts of the animal. Holistic Integrative Medicine emphasizes the same weight of western medicine and TCM and of treatment and prevention. TCM permeates with the concept of “the unity of man and nature” and the concept “wholism” is well in accordance with such idea [
23]. Natural medicines now account for more than 30% of the global medicine market, and this figure indicates the large potential for Chinese medicines in the international market. In addition, as the elderly population increases around the world, most countries face mounting pressure brought by growing medical expenses. For example, about 20% of the population in Italy is at least 65 years old, making this country have the most aging population in Europe and the second worldwide. Japan has the largest population of elderly in the world. European countries are struggling to deal with chemical drugs’ toxicity, side effects, and resistance as well as the growing fiscal burden stemming from the universal insurance coverage. TCM has the advantages of preventing illnesses, treating chronic diseases, and providing rehabilitation treatment [
1]. Developing new drugs from chemical substances is becoming increasingly difficult; nonetheless, many possibilities for extracting natural botanical medicines from plant species remain.
The European demand for Chinese medicines has been increasing. EU is the world’s largest botanical medicine market, accounting for over 40% of the global market and with annual sales reaching as high as 10 billion Euros. Data show that more than 60% of Europeans have used traditional medicines. At present, nearly 2000 types of drug-making plants are sold in the EU market, and about one-third of these plants and 20% of botanical extracts are imported. The WHO predicted that the global traditional medicine market will reach US$ 93 billion in 2015 and that the European market will have an increased demand for Chinese medicines. This large demand brings many opportunities for Chinese medicines made from natural materials and characterized by satisfactory curative effect, low toxicity, and minor side effects. China and Europe have immense potential for cooperation in the production, R&D, and trade of Chinese medicines.
Government-to-government dialogs warrant successful win-win cooperation on TCM
In addition to the market model and business operations, government-to-government communication and exchange is crucial to the successful promotion of Chinese medicine in Europe. China acknowledges the importance of strengthening dialog and communication with European governments, and bilateral diplomatic relationships have been progressing well as both sides have witnessed the frequent exchange of high-level visits.
2015 marks the 40th anniversary of the establishment of diplomatic ties between China and the EU. This year also marks the start of implementing important consensuses of peace, growth, reform, and civilization as Chinese President Xi Jinping reached out to EU leaders during his 2014 visit to the EU Headquarters. Chinese Vice Premier Liu Yandong visited the EU and Britain in September 2015 to chair two meetings on establishing humanity exchange mechanisms. The meetings further deepened the humanity exchanges between China and the EU and between China and Britain, advanced the four partnerships between China and the EU, and reinforced the social and public opinion foundation of the China–Britain relations. Chinese Premier Li Keqiang paid a visit to Britain in June 2014. The trip further strengthened the bilateral trade and economic cooperation as well as enriched the friendship between the two countries. China and France also pay high attention to cooperation and exchange and have hosted about 800 activities to celebrate the 50th anniversary of the establishment of diplomatic relations. So far, the two countries have sent approximately 50 000 exchange students to study at each other’s countries.
A summit encouraging Chinese enterprises to make investments in Europe was held in Beijing in January 2014. The China–France Economic and Trade Cooperation Zone will provide assistance to Chinese enterprises, hoping to make investments in Europe. In 2015, Chinese Vice Premier Liu Yandong attended the opening ceremony of the Chinese Culture Center in Brussels and the inauguration ceremony of the Confucius Institute for Traditional Chinese Medicine in London. Leaders of China and the Czech Republic officiated the inauguration ceremony for the “Traditional Chinese Medicine Center” jointly built by the two countries. This program was China’s first health project under the “Belt and Road” strategy. The Czech government has decided to launch legislative deliberations to make a law governing the registration of TCM therapists and the introduction of Chinese medicines into the local market.
Owing to extensive high-level political dialogs, Chinese medicines are gaining widespread welcome and acceptance across Europe. China has signed TCM-themed cooperation agreements with several countries. Different forms of extensive overseas cooperation bring additional opportunities to expanding the use of Chinese medicines in Europe and other parts of the world.
Challenges
Dramatic divergence between the Chinese and western cultures
Chinese medicine is more than only a medical discipline; it is an extraordinary component of the profound Chinese culture. During a ceremony celebrating the inauguration of the Confucius Institute for Traditional Chinese Medicine at the University of Melbourne in 2010, President Xi Jinping pointed out that TCM and pharmacy contains profound philosophical wisdom as well as health protection ideas and practices accumulated by our ancestors throughout thousands of years, and it represents the most essential part of the Chinese culture. TCM and western medicines are full of different and opposite thinking and interpretations of life, which are actually caused by different points of view; both types of medicines have their own advantages and limitations [
24]. TCM practitioners perceive and apply natural medicines based on the traditional Chinese culture [
25] because Chinese medicine is given a profound implication of the Chinese culture; for example, cold, heat, warm, cool, four gases, and five flavors are added from the traditional experience of Chinese medicine application. In turn, the practices become guidelines and bases for the clinical use of drugs. Putting aside the TCM theories, cold, heat, warm, and cool are simply terms for temperature, and flavors are only terms for taste. With these simple terms, we cannot understand the real functions of Chinese medicines.
Due to the sharp divergence between the Chinese and western cultures and their different medical systems, a major difference exists in understanding and perceiving Chinese medicine. Western medicine focuses on evidence-based practice, qualitative study, and quantitative study at the cellular and molecular levels, whereas TCM considers all factors and makes a systematic study at the macro-level [
23]. In studying Chinese medicine with modern science and technology, western researchers stress that the study must be guided by western medical theories and the western way of thinking. In their minds, the basic requirement is that every drug should have an explicit list of chemical compositions. For compounded preparations, these researchers need to make clear the efficacy of each chemical substance as well as the interactions among different substances and their effect on efficacy and toxicity. This approach deviates from the guidance of TCM theory. “With the skin gone, to what can the hair attach itself?” TCM theory is similar to a signboard, and setting the theory aside and considering Chinese medicine only as a natural medicine are not feasible. Even until today, modern pharmacology cannot explain all the mysteries behind the role of TCM, and modern scientific theories cannot explain the classic TCM theories concerning yin–yang and five elements, as well as organs and meridians.
The People’s Daily Overseas Edition published a commentary in December 2013, identifying some reasons for the failure of TCM to take root beyond China. China’s TCM practitioners cannot justify the lack of studies on the fundamental TCM theories. The publicity and promotion of TCM culture is insufficient, and scant publicity makes western misunderstanding and prejudice entrenched and difficult to eliminate. We no longer exist at a time when “good wine needs no bush.” If China’s TCM continues to stand still and refuses to move forward, then the road ahead is doomed to be long and rough.
Difficult mission for Chinese medicines to penetrate the European market
Another formidable challenge that prevents the entry of Chinese medicines to the European market is the invincible legal barriers.
First, most European countries have yet to completely recognize the legitimacy of Chinese medicine. TCM development is not balanced across the continent, with varying levels of acceptance among lawmakers and the general public in different countries. Britain is the first European nation to legislate laws on supplementary and alternative medicine, but the British government made a surprise announcement in 2011, stating that it would no longer protect the title of TCM practitioners, who would have to be registered as herbalists instead. Thus, the TCM legislation in the country’s parliament has been in a standstill. Italy permits acupuncturists to perform medical services, but it does not recognize TCM therapists. The Czech Republic, Sweden, and other European countries have not made any law to regulate Chinese medicines and have no specific regulatory body to deal with issues related to Chinese medicine. Given that Chinese medicines are not legally protected in these countries and are not covered by the national medical insurance, most people are discouraged from receiving TCM treatment because they have to pay the medical cost on their own. With the absence of legal protection, some TCM therapists have occasionally been harassed, threatened, defamed, and even arrested and charged with practicing without a license.
TCM and acupuncture are two therapeutic approaches within the TCM theoretical framework and cannot be separated. In some European countries, these approaches are considered two separate means of treatment. Acupuncturists are not allowed to be called TCM therapists. Some countries only permit western doctors to perform acupuncture. These misunderstandings and restrictions threaten to undermine the integrity of the TCM theoretical framework, not only disrupting the TCM legislative efforts across Europe but also bringing extremely unfavorable effects to TCM practitioners.
Second, the EU directive on traditional botanical medicines has limited the access of Chinese medicines to the European market. Some EU members required suppliers of Chinese medicines to make a series of certifications and registrations. The Traditional Herbal Medicinal Products Directive has restricted the access of Chinese medicines to the EU market and even prevented entry for some Chinese patent medicines. The directive has far-reaching implications on TCM development, and the effect is not only felt in Europe but throughout the world as well. Medicinal products such as Chinese herbal tablets and single-herb granules can be branded and sold as food or food supplements but not as drugs. Chinese herbal medicine usually contains more than one medicinal material, and its efficacy can be measured accurately through scant clinical data and pharmacology analysis. Moreover, China’s production and processing of herbal medicinal materials can hardly meet the standards set by the developed countries. This difficulty brings barriers to the registration and exportation of these medicines to the western market.
Third, China’s TCM industry is not competitive in the international market, and most companies show only minimal interest of becoming registered in overseas markets. Europe is an important botanical medicine market worth tens of billions of dollars. Germany is a powerful producer of botanical medicines, and Britain and Poland also have a considerable number of herbal products. After the implementation of the 2004/24/EC directive, a total of 514 herbal reparations have been registered in the EU. In breaking down the numbers by country, Germany has the largest number of registered herbal preparations at 209, followed by Austria with 37 and Sweden with 33. China enjoys a commanding advantage in the production of herbal medicines. However, so far, only one Chinese herbal preparation (i.e., Di’aoXinxuekang) has been successfully registered in the Netherlands. The EU is a large market, but Chinese enterprises appear to be less prepared to set foothold in this market. China has not outlined a forward-looking strategic plan to steer the international development of its traditional drugs. Many small drug companies exist in China, and they are struggling with meager profit margins. For instance, more than 300 Chinese companies produce Liuwei Dihuang Pills, and 96% of them are SMEs. Numerous types of Chinese drugs come from China, but they are mostly processed by South Korea and are marketed by Japan. Finally, the US and Europe end up as the largest beneficiaries. Chinese enterprises would rather exhaust efforts to fight for a larger share in the domestic market than attempting to establish and expand their presence in the EU market. The widespread shortsightedness and underestimate of the EU market have made China’s TCM producers struggle to take root in the immense market.
In general, overseas TCM practitioners are struggling to deal with a low social status and a lack of legal protection. TCM has yet to gain enough acceptance from European governments and does not have a legitimate position in the market.
TCM practitioners have varying levels of professional skills
With the low-threshold requirements to enter the trade, European TCM practitioners have different levels of professional skills and medical ethics. Most medical schools offer TCM courses at their spare time, but they are unable to provide a formal TCM curriculum to learners. Some countries have standard TCM programs such as Chinese medicine courses in the UK and acupuncture courses in France, but the quality of teaching has been weighed by inadequate education funding, insufficient faculty resources, as well as a lack of excellent textbooks and teaching facilities. The professional expertise of TCM therapists trained in China and practicing in Europe may also vary sharply.
Some TCM therapists only pursued advanced studies for a couple of months, and some even opened clinics despite their scant TCM knowledge and expertise. These therapists lack knowledge in diagnosing and treating diseases with TCM theories and approaches, and some practices run counter to the basic principle that diagnosis and treatment should be based on an overall analysis of the illness and the patient’s condition. The malpractices cannot cure the illnesses and may even lead to serious consequences because of the improper use of the Chinese medicinal products. In addition, the widespread popularity of Chinese medicine has emboldened some ill-disposed people. To make more money, these people do whatever they can to cheat patients, prescribing unnecessary Chinese medicines and exaggerating the effect of medicines. Some of them claim that they come from a family of doctors, that they have secret prescriptions handed down from their ancestors, and that the prescriptions can cure all kinds of incurable and complicated diseases. Some therapists even resort to non-science tricks such as superstition, witchcraft, and religious acts to fool patients.
These unqualified practitioners and their dishonest behaviors undermined consumer interest, drew a barrage of negative coverage from mainstream European media, seriously tarnished the reputation and image of Chinese medicine, and brought worrisome consequences.
Varying quality of Chinese medicinal materials
Another factor restraining TCM development in Europe is the lack of guarantee for the quality and safety of some Chinese medicinal materials.
In recent years, European countries have strengthened quantitative examinations on the active substances, heavy metals, pesticide residue, and microorganisms contained in Chinese medicines. The excessive concentrations of harmful substances found in Chinese medicines have been extensively covered. China’s state broadcasting network CCTV exposed in 2013 that a Guangdong pharmaceutical company produced Vitamin C Yinqiao tablets with the branches and leaves of Lonicera Confusa. The UK’s Medicines and Healthcare Products Regulatory Agency issued a warning stating that some Chinese medicines, such as BakFoong Pills and Zhengtian Pills, imported from China contain excessive heavy metals and could damage human organs. An international environmental group collected some medicine samples produced in China and exported to seven countries, including the US and the UK, and it found pesticide residues in medicines made by nine large Chinese pharmaceutical companies such as Tongrentang and Yunnan Baiyao. In 2015, Gujinwan capsules made by Shanxi Huakang Pharmaceuticals Co., Ltd. were found to contain the carcinogenic chemical Sudan Red. A spate of quality scandals have dented the international reputation of Chinese medicines and attracted international concerns about the safety of Chinese drugs. Statistics show that more than 60% of Chinese medicines were denied access to foreign markets because of “green barriers,” and the staggering number illustrates the high price for poor drug quality.
A prominent reason for the poor quality of exported Chinese medicines is that some pharmaceutical companies, which are lured by exorbitant profits, use substandard medicinal materials and even non-drug materials to make drugs. Another factor is that some medicinal materials are not processed in accordance with the prescribed procedures, and drug quality is also affected by the different sources of medicinal materials [
8]. Moreover, many companies do not pay sufficient attention to pesticide residue and excessive heavy metals. In some cases, western drug substances were detected in some Chinese medicines.
In terms of regulation, the government’s quality control on exported drug products is still not strict enough, and a set of internationally recognized standards and norms have yet to be set in place. Many drug companies produce the same drug, but their products contain different ingredients, or different producers use different names for the same drug. For instance, more than 300 companies manufacture Liuwei Dihuang Pills, but they use a dozen different names on the label. “Ganmaoling” is a cold drug manufactured by more than 100 pharmaceutical companies in China. These drugs share the same name, but have different compositions. Some are entirely made from Chinese medicinal materials, whereas some add vitamin elements, and some add western drug substances. If these drugs enter the international market, then the chaotic situation will deal a heavy blow to the image of China’s TCM industry. Before the unanimously agreed international standards regulating the maximum content of heavy metals in Chinese medicines were enacted in August 2015, some disputes and controversies had been raised on the issue.
Advice on strategies
The objectives of TCM development in Europe should be more than bringing Chinese medicines into a specific or regional European market and carrying out sporadic exchanges and cooperation with individual countries. Instead, we should make a systematic, comprehensive, and sustainable push in TCM therapy, healthcare, education, research, culture, and industry development, among others. The ultimate goal is to advance the all-round cooperation between China and European countries in the political, economic, cultural, and diplomatic areas. We must make full preparations and take active and vigorous steps to seize the opportunities.
Taking advantage of cultural appeal to advance TCM development
An important technique for advancing TCM development across Europe is popularizing the traditional Chinese culture in the continent. The first step should be getting Europeans understand TCM instead of simply saying “Yes” or “No.” Understanding the traditional Chinese culture is a precondition to understanding TCM culture and subsequently accepting Chinese medicine. Promoting Chinese medicine in Europe is a process of cultural and technological exchanges between China and the West. In addition to a viable business model, significant publicity and communications are also essential in making the process successful.
TCM, martial arts, tea art, and many others are distinct features of China. We should take full advantage of these features to hold a variety of cultural activities and strengthen publicity with a view of helping more Europeans have an objective understanding of China’s profound TCM culture. The Confucius Institute opens a window for Europeans to catch a glimpse of the Chinese culture and serves as a bridge for the two peoples to strengthen their emotional bond and enrich their traditional friendship. The Confucius Institute can offer courses about TCM culture to students worldwide, spur their interest in TCM culture, and pave the way for the internationalization of Chinese medicine [
18].
Turning crisis into opportunity and pushing for TCM legislation
A law on TCM management is a basic condition for Chinese medicines to be granted access to Europe’s mainstream medical systems. Such a law provides legal guarantee to expedite TCM development in overseas markets. The survival and success of TCM in Europe hinges on whether legal protection is in place. Standardized TCM management can assure patients of the quality of medical service they receive and create conditions for Chinese medicines to be given access to the national medical insurance system. An unregulated market would actually threaten the survival of TCM. Therefore, the European restrictions also mean opportunity for Chinese medicines. When legal protection is present, China’s TCM industry seeks to “thrive;” otherwise, the industry struggles to “survive.”
(1) The strategic position of TCM development in Europe should be made clear and the legislation on TCM management should be promoted. Chinese pharmaceutical companies appear to show minimal desire of entering the large EU market. A superficial reason is that no Chinese company can get its medicines registered on time, but the underlying reason is that Chinese medicines are denied access to the European medical insurance system. As a result, Chinese exports of herbal medicines to Europe are extremely limited. Moreover, complicated application procedures make the drug exports very costly. Drug companies can hardly make a profit from the business because of the tepid exports and high cost. In the Netherlands, Chinese medicines are recognized by a large majority of insurance companies, who would pay for at least 70% of patients’ medical cost stemming from TCM treatment. This policy has made TCM therapy economically affordable and allowed Chinese medicines to survive the local market.
The government plays a crucial role in the push for legislation on TCM management. We need to have a clear strategic position of TCM development in Europe, be fully aware of the need and urgency of TCM legislation, strengthen high-level contacts and dialogs with European governments, and study and make use of European countries’ existing laws, regulations, and traditional drug management rules. We should take full advantage of international rules, technical approaches, and legal means to negotiate with relevant countries and push them to speed up legislation, give a legitimate status to Chinese medicines, and include the medicines into their medical insurance system. If these objectives are achieved, then they will provide a relaxed policy environment to facilitate TCM development in Europe.
(2) Government and enterprises join hands to expedite the registration of Chinese medicines in the European market. Europe is a decisive market worldwide for Chinese medicines. At present, EU regulators adopt western drug standards and even food standards to examine imported Chinese medicines, setting many roadblocks for the medicines to enter the European market. The government and pharmaceutical companies should work together to study European regulations and strengthen resources to formulate the market access standards. Pharmaceutical companies should choose typical products that have good odds to be granted access to the European market and to the European medical insurance system; beforehand, they should carry out evidence-based medicine reviews and pharmacoeconomic reviews in accordance with EU requirements on the quality of botanical drugs [
26]. If some Chinese medicines are successfully registered, then this registration would be a great boost to the image of Chinese medicine brands and to their promotion in the international market.
(3) Acupuncture and TCM should not be separately managed under any legislation. The UK plans to introduce separate laws to regulate acupuncture and TCM. Unfortunately, other European countries are weighing similar legislative proposals. Acupuncture and TCM are inseparable and integral components of the Chinese medicine framework, and a rightful and reasonable legislation should protect the integrity. As we call for speedy European legislation, we should make clear that TCM and acupuncture are integral and inseparable, and a proposed law should attempt to address problems such as TCM therapist registration; acupuncturists are barred from prescribing drugs, and therapists are barred from performing acupuncture services. We hope that the UK and other European nations can give an appropriate legal status to recognize the distinctiveness of TCM and protect its integrity and unity.
Promoting education internationalization and standardization of medical practice
Talent cultivation is crucial to fundamentally changing the status quo that competent and unqualified TCM practitioners coexist in the European market. We should build a group of TCM therapists equipped with profound theoretical knowledge and rich practical experience. On the one hand, by sending a group of excellent therapists to practice in Europe and provide consummate TCM services, we can lift the added value of China’s pharmaceutical exports and spread the TCM culture to a broader population. To that end, we need to introduce additional training programs to foster talents who can overcome language barriers and practice abroad.
On the other hand, TCM development in Europe should not be solely dependent on Chinese therapists who cross the border to practice there. We should help European countries foster their local TCM therapists by offering assistance in building a talent training platform, working out teaching plans, and compiling textbooks. For therapists who are currently practicing, we can provide them with advanced studies at different training sessions. We can open TCM training centers and schools to offer systematic, scientific, standard, and consistent programs and to transform local students into high-level professional therapists. During the training, basic TCM theories should be given greater prominence to change the status quo that many European therapists have excellent practical skills but scant basic knowledge, and they prefer to perform acupuncture rather than identify different symptoms to diagnose and treat illness.
At the same time, we should consolidate domestic and foreign resources to encourage and support exchange and cooperation between China’s TCM schools, research and clinical institutes, and their European counterparts; establish a steady mechanism to cultivate TCM talents with international perspective; optimize the structure of the existing talent pool; and push for more extensive rollout of TCM education across the world. In addition, we can initiate high-level government-to-government negotiations to encourage European countries to recognize TCM degrees obtained in China so that excellent TCM therapists can practice in Europe as legitimate practitioners. We suggest that the industry should elevate the threshold for membership to enhance the professionalism of the practitioners. We should continue to urge European countries to regulate the TCM practitioners to protect the quality of TCM services.
In summary, an international perspective should be used to approach and develop education. The fundamental goal of education internationalization is to produce large numbers of internationalized talents who possess international visions, are well-versed in international rules, and with an ability to engage themselves in international affairs and competitions [
27].
TCM must live up to European standards to set a foothold in the market
Efficacy and safety are vital to TCM’s survival and success in the European market and are a key component of China’s strategy to bring Chinese medicines to the international market. In recent years, European countries have tightened regulations on imported traditional drugs and formulated or strengthened the technical requirements. The UK has released pharmacopeia standards for commonly used Chinese medicines such as angelica and astragalus. France has already drafted pharmacopeia standards for 60 commonly used Chinese medicines. These standards will greatly improve quality control on Chinese medicines exported to Europe. High quality standards amount to additional trade barriers, but they would also pressure China’s pharmaceutical companies to live up to the stringent quality, safety, and efficacy standards to gain access to the European market.
Strengthening efforts to build a TCM standardization system
Building a reasonable and effective quality standard system is the primary issue. Prof. Zhang Boli, an academician at the Chinese Academy of Engineering, once said that a major challenge against TCM internationalization is that China’s drug research and production standards are still less stringent than the international standards. He suggested that China should consider western standards as reference from aspects such as the source of medicinal materials, extraction and separation, R&D and production, and quality control. He added that China should also consider TCM characteristics and explore its own standards.
We suggest that relevant government authorities should establish a quality standard system in line with international standards for botanical medicines on the basis of the characteristics of TCM production and the challenges facing TCM exporters [
28]. The system shall set standards for the entire process from the cultivation of medicinal materials, production, harvesting, and processing to packaging and sale. According to the Medium & Long-term Development Plan of TCM Standardization (2011–2020), China will accelerate efforts to establish a set of TCM standard systems, including basic standards, technical standards, and management standards. China will also strengthen liaison and communication with international organizations, such as the International Organization for Standardization (ISO) and the WHO, to ensure that its national and industry standards and industry association standards are consistent with the corresponding international standards and to further increase its influence in setting international standards [
9].
Enhancing the safety of Chinese medicines
China should introduce quantitative limits on pesticide residues, heavy metals, and microorganisms contained in Chinese medicines. The 2015 edition of the Chinese Pharmacopoeia sets high quality standards on Chinese medicinal materials and herbal tablets and tightens limits on heavy metals and toxic and harmful substances. In August 2015, the ISO released on its website Traditional Chinese Medicine — Determination of Heavy Metals in Herbal Medicines Used in Traditional Chinese Medicine. The international standard was compiled by a team led by Chinese experts. Relevant departments and Chinese medicine producers should keep track of the latest research data and make persistent efforts to improve drug safety, overcome international trade barriers on heavy metal limits, and bring more Chinese medicines to foreign markets.
Many challenges regarding the implementation of TCM standards remain unresolved, including the insufficient supply of standard production bases, which means that the quality of some medicinal materials cannot be monitored, shortage of talents familiar with other countries’ pharmacy administration policies, as well as the standardization of professionals. According to the Chinese Herbal Medicine Protection and Development Plan (2015–2020), Chinese herbal medicine is China’s distinctive and strategic resources, and we should keep with the basic principle of increasing output and improving quality. Among the seven objectives set out in the Plan, six are related to TCM quality assurance. TCM standardization is a long and complicated process and requires concerted efforts by multiple parties. We must establish a special regulatory body to oversee the TCM standardization and to improve the application and promotion of relevant standards to ensure that the exported Chinese medicines keep up with the foreign quality standards.
Joining overseas Chinese to build a bridge of development
Incomplete statistics show that more than 60 million Chinese people are living abroad. Chinese people in Europe have been working hard to develop their business and career; at the same time, they have been actively participating in activities and events that aim to promote Chinese culture, tell stories about China’s development, show the positive image of overseas Chinese people, and enhance local people’s understanding of China. In addition, these people have been attempting to facilitate economic, trade, culture and humanity exchange, and cooperation between Europe and China, and they have played special and significant roles in pushing China to deepen reforms and broaden market openness.
President Xi Jinping said that the Chinese people living abroad and at home share the same root of our nation, the same soul of our culture and the same responsibility to rejuvenate the Chinese nation. He called for all Chinese people, regardless of where they live, to unite with one heart and one mind and to make concerted efforts to achieve the “China Dream.” Overseas Chinese can play an irreplaceable role in establishing and expanding the presence of Chinese medicines in Europe. The role played by this population is more than an intermediary to help build business ties between Chinese enterprises and European partners. More importantly, these individuals can induce political and cultural influence. TCM development requires favorable international environment and must overcome cultural, safety, and language barriers, while overseas Chinese people can play crucial roles in resolving these challenges.
Thus, given that we seek to accelerate TCM development in Europe, we should give great prominence to the roles played by the local Chinese. The government can implement a series of preferential measures targeting overseas Chinese people so that they can have a harmonious and relaxed environment to develop their business, advance their career, and integrate with the local society. In the meantime, we should encourage them to make full use of their distinctive advantages in culture, language skills, and technology expertise; push for communication and exchange between Chinese and western cultures; enhance understanding between Chinese and Europeans; as well as take part in and support TCM development in Europe. In other words, they can make substantial contributions to enrich the friendly ties and increase mutual economic benefits between China and Europe and even between China and the rest of the world.
Conclusions
In recent years, Integrated Medicine is a reformation of the traditional medicine, symbolizing a new stage of development from specialization to integration in the medical course
[ 21]. TCM has made rapid inroads into the European market. In the early years, only the acupuncture service was introduced to Europe. Chinese medicines were then later exported, and cooperation has extended to the whole TCM industry chain from medical service, education, and scientific research to trade and culture. The Chinese government is committed to reform and development and has made remarkable economic achievements. The government has also seen significant improvement in its national strength and international influence. China is laying more emphasis on TCM development, inheritance, and innovation. A Chinese medical researcher, Tu Youyou, was awarded the Nobel Prize in 2015. The accolade significantly influenced the world, inspired China’s TCM industry, and offered a good chance for TCM to secure widespread international recognition, heralding unprecedented development opportunities for China’s TCM.
However, at the same time, we must have a clear picture about the current situation and about the serious challenges hampering TCM development in Europe. Against the backdrop of the intensifying competition in the drug market and new technologies and standards emerging one after another, expecting a few companies and a limited variety of blockbuster medicinal products to make successful inroads into the international market is unrealistic, with multiple cultural, legal, institutional challenges as well as talent shortage as barriers. Chinese medicines confront a long and rough road ahead in establishing and expanding footprints in the European market.
TCM development in overseas markets has shifted from spontaneous trade activities to a national strategy spearheaded by the government and participated by multiple stakeholders. We should have not only excellent practical skills but also extraordinary professional ethics; we should not only care about the current situation but also take the long view; we should not only follow the established TCM principles but also abide by local laws. The 12th World Congress of Chinese Medicine was convened in Spain in September 2015. The congress was themed, “Traditional Medicine Systems derived from Ancient Chinese Medicine in Modern Health Care.” Bringing traditional Chinese medicines to the worldwide market and allowing them to play a role with modern medicines to safeguard public health are the ultimate goals that we are trying to achieve through TCM inheritance and development. We believe that with the joint efforts made by all parties concerned, TCM, which is an integral part of the time-honored Chinese civilization, will soon be able to show its broadness and profoundness to the whole world and bring substantial health benefits to the world population.
Some limitations are found in this study, such as incomplete retrieval of identified research at the review-level.
Higher Education Press and Springer-Verlag Berlin Heidelberg
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