Traditional Chinese medicines

Editor, – The authors of 'The quality and safety of traditional Chinese medicines' (Aust Prescr 2003;26:128-30) recommend the establishment of a quality testing system for Chinese herbs and their derivatives, in order to minimise mislabelling and identify undeclared components. This is based on the claims that the 'chemistry of herbal medicines is the foundation of their pharmacology', and that 'for most Chinese medicines the active components responsible for their pharmacological activities and clinical applications are not well defined'. The authors also point to the Chinese Medicine Registration Act in Victoria as an example of statutory regulation which will encourage the safe use of traditional Chinese medicines.

These recommendations are unexceptionable. However, these recommendations contain an irony, or a threat, depending on whether you subscribe to Western or Chinese medical systems. What is proposed is the application of Western scientific methods of analysis to Chinese medicines, in order to classify them as safe. In other words, the Chinese medical system, in order to survive in the dominant scientific culture, must subject itself to that culture's rules. This means that it cannot survive as a distinct and autonomous paradigm.

Mechanisms designed to ensure that Chinese medicines and practice (and any other traditional systems) continue to be recognised and respected, will ultimately ensure their demise.

Malcolm Parker
Associate Professor of Medical Ethics
School of Medicine
University of Queensland

Dr George Li, Dr Colin Duke and Professor Basil Roufogalis, the authors of the article, comment:

The letter raised the issue of the philosophy and position of complementary medicine. There are integrated and plural approaches. The article is in favour of an integrative approach. The recommendations are consistent with the recent report of the Expert Committee on Complementary Medicines.¹

We appreciate the concern about the possible overzealous application of modern scientific principles to the analysis of traditional medicines which have a different philosophical basis. In this article we addressed the issue of quality and safety of Chinese medicine, and we believe that the evaluation of safety of any device or therapeutic agent overrides cultural considerations. We agree that the assessment of safety of Chinese herbal medicines is complex, as they are made up of multiple components and used by practitioners in specific ways. Nevertheless, Chinese medicines contain chemical components that have specific biological actions requiring knowledge of the quality and nature of the ingredients.

The recommendations in our article do not address other aspects of Chinese medicine, whose principles can be maintained subject to appropriate evidence-based review. The recent report has recommended that governments introduce legislation to regulate practitioners of traditional Chinese medicine and dispensers of Chinese herbs.1This development recognises the use and importance of traditional medicine systems in our society while requiring practitioners to be appropriately trained and accredited. The integrative approach to health care should aim to further develop the traditional system and bring it into the mainstream health care system. It should certainly not try to eliminate a traditional system that has been shown to be safe and effective.