Historical Medical Exchanges Following the Confluence of Traditional Chinese Medicine and Western Medicine: Coexistence and Mutual Development : Chinese Medicine and Culture

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Historical Medical Exchanges Following the Confluence of Traditional Chinese Medicine and Western Medicine: Coexistence and Mutual Development

Chen, Shi-Yun1; Qu, Kun2; Liu, Xiao-Jie3; Chen, Zhan2,✉

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doi: 10.1097/MC9.0000000000000024
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Abstract

1 Introduction

Traditional Chinese medicine (TCM), which has spread throughout the world, remains strong and remarkably inclusive of other medical systems. The wide spread of TCM not only influences other medical systems but also promotes the development of TCM itself and has made substantial contributions to the development of the global medical industry. Following its introduction in China, Western medicine (WM) had a huge impact on TCM concepts, diagnostic and treatment methods as well as its pedagogical methods, even prompting a survival crisis for TCM. However, the eastward dissemination of WM also created underlying conditions for the revival and advancement of TCM. Given the Chinese government’s current attention to and strong support for TCM, it has regained its vitality and is making new contributions to the development of the global medical system.

2 Brief history and general trends of medical exchanges between China and foreign countries

2.1 Brief history of medical exchanges between China and foreign countries

China’s medical exchanges with foreign countries were first initiated with eastern neighbors, notably Japan and Korea. During the Han dynasty (202 BCE to 220 CE), such exchanges gradually expanded westward to Central Asia and Western Asia. During the Ming and Qing dynasties (1368 CE to 1912 CE), they expanded to Europe, America, and other parts of the world.

The earliest medical exchanges between China and foreign countries can be traced back to the Western Zhou dynasty (1100 BCE).1 At that time, medical exchanges had already been initiated between China and Korea. According to Shi Ji (《史记》 Historical Records), after Ji Zi (箕子) explained his great idea about how to govern a country, King Wu of the Zhou dynasty (周武王) was deeply impressed and appointed him as the minister of Korea.2 During their exchange, they discussed the theory of five elements and the concepts of yin and yang. The medical exchanges between China and Japan dated back to around 1000 BCE. Xu Fu’s (徐福) adventure to Japan on a quest for immortality was a historical event of great influence, which was recorded in Shi Ji, Taiping Yulan (《太平御览》 Imperial Readings of the Taiping Era) and Yi Yu Zhi (《异域志》 Records of Exotic Areas). Sino-Vietnamese medical exchanges have a long history. In 257 BCE, Cui Wei (崔伟), a TCM physician, cured a Vietnamese official of asthenia.3 Medical exchanges between China and India can be traced back to the pre-Qin period (before 221 BCE), with the earliest exchanges between the two countries being linked to the introduction of Indian Buddhism in China. The translation of Buddhist scriptures into Chinese and the visits of Indian monks brought Indian medicine to China.

During the Han dynasty (202 BCE to 220 CE), frequent medical exchanges took place between China and countries in Central Asia and Western Asia. Zhang Qian (张骞) of the Western Han dynasty (202 BCE to 8 BCE) and Ban Chao (班超) of the Eastern Han dynasty (25 CE to 220 CE) served as envoys to countries in Central Asia and Western Asia and brought back a variety of medicinal plants from the Central Asian countries.

During the period of the Three Kingdoms (220 CE to 280 CE), Korea actively sought access to Chinese medical theory and experience. Before the Meiji Restoration, Chinese medicine and herbs played a major role in Japan.

From the Western Jin dynasty (265 CE to 316 CE) to the Southern and Northern dynasties (420 CE to 581 CE), exchanges between China and Southeast Asia became increasingly close. Tortoise shell, ivory, and various spices were introduced into China.4

During the Sui and Tang dynasties (581 CE to 907 CE), the medical exchanges between China and other countries, including Korea, Japan, India, and Arabia, were active and frequent unprecedentedly. A large number of Chinese medical works were disseminated to many countries or regions, such as Korea, Japan, and Arabia. Both Japan and Korea emulated China’s medical systems and imported a complete set of medical education systems, teaching materials, and curricula. The relationship between China and the Central Asian countries also advanced considerably. Nestorians not only introduced WM and Arabic medicine to China, but also brought TCM to Arabia. Chinese alchemy was disseminated to Arabia, which had considerable influence on alchemists in Arabia.

During the Song and Yuan dynasties (960 CE to 1368 CE), many Arabic drugs were introduced into China, such as Xi Jiao (犀角 Cornu Rhinocerotis) and Ru Xiang (乳香 Olibanum). Some Arabian pharmaceutical preparations and prescriptions began to circulate in China,5 which sparked the development of pharmaceutical preparation methods in China.

During the Ming and Qing dynasties (1368 CE to 1912 CE), Chinese variolization was first introduced in Korea and Japan,6 then later in Russia and Turkey, and finally, in the United Kingdom and other parts of Europe. At this time, missionary physicians began to introduce WM in China by carrying out frequent medical activities and establishing new clinics and hospitals. The penetration of WM became ever wider, and by the beginning of the 19th century, WM had gradually gained a foothold in China.

WM was introduced into China from Japan during the modern era, and has since been evolving continuously in China. At the same time, acupuncture and moxibustion were widely disseminated in Europe and the United States,7 and TCM expanded its presence globally. From the 20th century onward, WM knowledge has been widely disseminated and understood in China, ensuring that WM in China has kept pace with world medicine. Moreover, WM has established its own system in China, and has been disseminating more widely as a force that has kept pace with TCM in safeguarding people’s health.

2.2 General trends of medical exchanges between China and foreign countries

The history of medical exchanges between China and foreign countries shows clear trends during different stages. At an early stage, TCM spread to neighboring countries in East Asia, and then to Southeast Asia, South Asia, Arabia, and other parts of the world. After the Ming and Qing dynasties, this trend was reversed. The eastward dissemination of WM became predominant, and WM gradually gained a foothold in China and continued to advance in the country.

3 Contributions of medical exchanges between China and foreign countries to the development of global medicines

Medical exchanges between China and foreign countries not only enriched TCM knowledge and the diversity of systems of medicine but also contributed to the establishment of medical systems and the development of medical education in various countries. At the same time, they have helped to preserve the content of many medical works that were not successfully handed down by past generations in foreign books. Medical exchanges have had a positive impact on the development of medicine in countries around the world and have contributed greatly to the world’s medical work.8

3.1 Promoting the development of medicine in countries around the world

During the Sui and Tang dynasties, the rapid development of TCM had a profound impact on medical cultures in various countries. The knowledge of TCM penetrated into the medical works of these countries.

In 808 CE, Japanese physicians compiled 100 volumes of the Categorized Collection of Medical Formulas in Datong Era (だいどうるいじゅほう) based on the following Chinese classics: Su Wen (《素问》 Basic Questions), Huangdi Zhenjing (《黄帝针经》 Huangdi’s Classic of Acupuncture), Zhenjiu Jiayi Jing (《针灸甲乙经》 The Systematic Classic of Acupuncture and Moxibustion), and Xinxiu Bencao (《新修本草》 Newly Revised Materia Medica).9Prescriptions with Physicians’ Benevolence (いしんほう) cited a total of 204 medical and non-medical works as well as 10,877 articles, most of which were from ancient Chinese medical works. In the 16th century, innovative research was performed in Japan, where TCM knowledge was used to develop a different medicine that evidently originated from TCM, namely Kampo or Huanghan medicine. During the Edo Period (1608 CE to 1868 CE), Japanese physicians compiled and published more than 1,000 books on Kampo medicines by studying, researching, and developing TCM.

In 1433, The Grand Compendium of Medical Herbs (향약집성방), which referred to 212 Chinese medical works, was compiled in Korea. The Categorized Collection of Medical Formulas (의방유취), compiled in 1445, cited 153 medical works of the pre-Ming dynasties in China. Korean practitioners strived to integrate medical experience derived from TCM into their own culture, philosophy, medicines, and pharmacopeia, and established their own medical system, which became known as “Oriental Medicine.”

3.2 Promoting the establishment of medical systems and the development of medical education in various countries

During the Sui and Tang dynasties, Japan introduced a comprehensive system of Chinese medical education. Following the dispatch of envoys by the Japanese Empress, Suiko, to China under the Sui dynasty, Japan began to actively introduce Chinese laws and regulations, including the Chinese medical management system. The Medical Code (いしちりょう) in The Taiho Code (たいほうりつりょう) was Japan’s earliest formulation of a coded medical management system, which almost completely imitated the Chinese medical system under the Sui and Tang dynasties. The medical textbooks referred to in The Taiho Code were also from China and included Zhenjiu Jiayi Jing, Mai Jing, Xinxiu Bencao, and Huangdi Zhenjing.

Under Korea’s Unified Silla era (676 CE to 935 CE), the medical education system, teaching materials, and curricula that prevailed during the Sui and Tang dynasties were introduced into Korea. During the reign of Wen Zong (文宗) of the Goryeo dynasty (918 CE to 1392 CE), systems of medical management and medical education were established, which emulated those of the Song dynasty.10 Medical systems and institutions were also established, which were similar to those in China at that time, that is, the Imperial Medical Bureau and the Bureau of Administration of Royal Medicinal Affairs. Medical education institutions were set up to teach medicine, and a medical examination system was implemented throughout Korea.

3.3 Promoting the development of TCM

Whereas TCM was widely disseminated outside of China, it also absorbed experiences from different foreign countries, which contributed to the introduction of many valuable medicinal materials in China, and thereafter the initiation of medicinal materials trade with China.11 At the same time, not only drugs but also medical works and formulas from all over the world were introduced in China. For example, a formula from Korea for treating beriberi was recorded in Waitai Miyao (《外台秘要》 Arcane Essentials from the Imperial Library). Many famous medical works from the Tang, Song, Yuan, and Ming dynasties were incorporated and compiled in Korean medical works, such as Prescriptions with Physicians’ Benevolence, The Grand Compendium of Medical Herbs, and Precious Mirror of Oriental Medicine (동의보감), which helped to preserve dozens of medical works that were not transmitted in the course of Chinese history. These works were subsequently reintroduced into China and had a significant impact on TCM. They provided rich materials from which later generations could acquire information about ancient medical works and were also of great value to TCM clinical practice, medical history, literature, and collection of books in different versions.

Indian medicine was introduced to China via Buddhism. According to the records of Sui Shu (《隋书》 The Book of the Sui Dynasty), more than 10 Indian books were translated into Chinese, including the Nagarjuna Bodhisattva Formularies (नागार्जुनबोधिसत्व). Indian formulas and therapeutic methods for treating eye diseases were introduced in China, and they promoted the development of TCM ophthalmology. Some of them are still used in contemporary clinical practice.

Huihui Yaofang (《回回药方》 Medicinal Formulas of the Hui People) compiled during the period of the late Yuan dynasty was based on concepts in Arab medicine, but it also recorded many TCM formulas and terms. It reflected the integration of medical experiences of Hui nationality and TCM at that time. This text recorded orthopedic knowledge in Arab medicine, including the causes, pathogenesis, diagnosis and treatment of soft tissue injuries and joint dislocations, as well as some of their complications. Its main contribution to the progress of TCM lay in the fields of surgery and orthopedics.

During the Meiji Restoration period, although Kampo medicine was abolished in Japan, about 570 important Japanese works on Kampo medicine were widely disseminated in China. These works were of considerable academic value, which included the annotation and textual research of Huangdi Neijing (《黄帝内经》 The Yellow Emperor’s Inner Classic), research on Zhang Zhongjing’s (张仲景) theory, and the clinical application and experience of Kampo medicine.12 They not only provided a way to understand mainstream medicine in Japan but they also greatly enriched TCM knowledge and provided many important reference works about TCM practice in Japan.

3.4 Preserving lost medical works in works from other countries

Most of the ancient medical works in China were engraved on oracle bones or written on silk cloth, bamboo slips, or wooden slips. Therefore, it was difficult to preserve them well over a period of about 2000 years. In addition, numerous wars in ancient China, coupled with the policy of the Qin dynasty (221 BCE to 207 BCE) of burning books and burying Confucian scholars alive, resulted in the loss of many medical works. However, some of them had been disseminated to foreign countries before they were lost, so these works were fortunately well preserved. For example, a large number of Chinese medical works had been printed in many other countries, such as Korea and Japan. Although many medical works in China were lost, versions of these works with reliable texts still exist in Japan and Korea. In 1093, a Korean delegation respectfully presented the lost classic, Huangdi Zhenjing, to Emperor Zhe Zong (哲宗) of the Song dynasty, which attracted considerable attention from the government and the public.13 The two ancient versions of Shang Han Lun (《伤寒论》 Treatise on Cold Damage) were respectively edited during the Campion era and the Koji era of Japan. Moreover, Wang Bing’s (王冰) Zhu Huangdi Suwen (《注黄帝素问》 Annotations on Huangdi’s Basic Questions) were also well-preserved because of their earlier dissemination to Japan.

Some Chinese medical works preserved in foreign medical works had considerably referential value for the restoration of other medical works. For example, the Korean medical work, Categorized Collection of Medical Formulas, and the Japanese medical work, Prescriptions with Physicians’ Benevolence, were two such important medical works. Jingxiao Chanbao (《经效产宝》 Valuable Experience in Obstetrics), the first Chinese obstetrics text, was restored on the basis of the Categorized Collection of Medical Formulas. Prescriptions with Physicians’ Benevolence was compiled mainly on the basis of Zhubing Yuanhou Lun (《诸病源候论》 Treatise on the Origins and Manifestations of Various Diseases) and more than 80 other medical works from the Sui and Tang dynasties. Therefore, Prescriptions with Physicians’ Benevolence was very helpful for obtaining a general idea of the lost Chinese medical works. These examples illustrate the important role of medical exchanges between China and foreign countries in the protection and restoration of lost works.

3.5 Enriching the varieties of Chinese medicinal materials

The medical exchanges between China and foreign countries enriched varieties of Chinese medicinal materials as well as knowledge of materia medica. At the beginning of the Eastern Han dynasty, Ma Yuan (马援) brought back a large amount of Yi Yi (薏苡 Semen Coicis) from Jiao Zhi (交趾 the ancient Chinese name for Vietnam). During the Southern and Northern dynasties, China imported Chen Xiang (沉香 Lignum Aquilariae Resinatum) and Su He Xiang (苏合香 Styrax) from Vietnam.14Bencaojing Jizhu (《本草经集注》 Collective Commentaries on the Classic of Materia Medica) recorded many Korean medicinal materials, such as Wu Wei Zi (五味子 Fructus Schisandrae Chinensis) and Wu Yi (芜荑 Fructus Ulmi Macrocarpae Praeparata). During the Tang dynasty, medicinal materials such as Hu Po (琥珀 Succinum) were introduced into China.14Xinxiu Bencao and Bencao Shiyi (《本草拾遗》 Supplement to ‘The Grand Compendium of Materia Medica) recorded medicinal materials imported from Vietnam, such as He Li Le (诃黎勒 Terminalia chebula Retz.) and Su Fang Mu (苏方木 Caesalpinia Sappan L.). During the Five dynasties (907 CE to 960 CE), Li Xun (李珣) collected and sorted out medicinal materials from overseas, provided theoretical explanations, and then wrote Haiyao Bencao (《海药本草》 Materia Medica from the Southern Seaboard Area). The medical work recorded medicinal materials from Korea, including Bai Fu Zi (白附子 Rhizoma Typhonii), Hai Song Zi (海松子 Pinus koraiensis Sieb. et Zucc.), and Xuan Hu Suo (玄胡索 Rhizoma Corydalis).15 Shi Jun Zi (使君子 Fructus Quisqualis), an effective medicine for ascariasis, was imported from Vietnam during the Northern Song dynasty. Zhu Fan Zhi (《诸蕃志》 Chau Ju-kua: His Work on the Chinese and Arab Trade in the Twelfth and Thirteenth CenturiesEntitled Chu-fan-chi) recorded medicinal materials imported from Arabia into China, such as Mo Yao (没药 Myrrha), Ru Xiang (乳香 Olibanum), and Xue Jie (血竭 Sanguis Draconis). Arabic merchants also introduced Hu Lu Ba (葫芦巴 Semen Trigonellae) to China. These medicinal materials introduced from foreign countries enriched China’s pharmacological knowledge base and the varieties of Chinese medicinal materials.

4 Huge impact on TCM caused by the eastward dissemination of WM

The eastward dissemination of WM has developed rapidly since the onset of the modern era. Its influence has enabled some blanks to be filled in China’s medical field, which has benefited from particular strengths of WM, especially in the areas of chemotherapy, antibiotic treatment, and surgical methods. Due to its curative effects, WM has strong market competitiveness and good development opportunities. However, the introduction of WM disrupted the unified pattern of TCM development in China, which even resulted in a crisis period for TCM, threatening its continued survival for a time. WM has an advantage over TCM in that it often has an immediate curative effect, and thus becomes the standard to evaluate medicine. This situation affects TCM research methods and education and also leads to deviations of TCM clinical practice from its normal paths, constraining the development of TCM’s modern medical practice.16

4.1 Change of China’s traditional mainstream medical system

TCM was the mainstream medicine system in China for thousands of years. It has demonstrated significant clinical efficacy in the treatment and prevention of disease as well as health preservation. Prior to the introduction of WM into China, TCM saved countless lives and made substantial contributions to safeguarding the health of people all over China. The introduction of WM broke the dominance of TCM in China, and created a situation of coexistence of the two systems of medicine.17 WM has had the lion’s share of the medical market because of its comprehensive departments, advanced equipment, rational division of labor, standardized operations, evident curative effects, and convenient drugs, which effectively meet the developmental needs of the times. However, the development of TCM has been greatly constrained because of its failure to break through some of its own limitations and adapt to the needs of modern people and a fast-paced lifestyle.

4.2 Survival crisis faced by TCM for a time

The eastward dissemination of WM had significant impacts. The Japanese government and public advocated comprehensive westernization in medicine and medical education. Consequently, during the Meiji Restoration period, the government introduced a policy to abolish TCM and gradually implemented a ban on Kampo medicine. In 1873, Sensai Nagayo, who had studied WM in the Netherlands, became the director of the Health Bureau of Japan’s Ministry of Education, Culture and Sports. Immediately after assuming office, he began to advocate the use of WM and introduced a series of regulations to abolish TCM. The most harmful in these regulations was the “Rules for the Academic Examination of Physicians,” which required Kampo physicians to pass the “Physician Examination Rules,” “Medical Practice Examination Rules,” and “Physician License Rules” originally issued for WM physicians. Seven WM subjects were included in the examination.18 Only those who passed the above tests would be granted a license for medical practice. These regulations were strongly opposed by Kampo physicians, who spared no effort to dialog with the government and called for the revival of Kampo medicine. However, these efforts ultimately failed, and Kampo medicine entered a period of steady decline. Even in the 20th century, Japanese Kampo medicine had still not returned to its former state.19

Perhaps influenced by Japan’s decree to abolish Kampo medicine, the government of the Republic of China (1912–1949) also passed a motion to abolish traditional medicine. In February 1929, the Health Ministry held the first health convention at the level of the central government. At the meeting, Yu Yunxiu (余云岫), Chu Minyi (褚民谊), and others put forward four related proposals, which included the abolition of TCM, with the aim of destroying TCM.20 To protect and preserve TCM, the TCM community took various measures, such as organizing associations to protest the move for abolition and submitting petitions to the government. Consequently, the proposals were not implemented. During this process, the TCM community also made many efforts to popularize TCM knowledge and compete for living space alongside WM, making major contributions to the preservation and development of TCM. However, the struggle for TCM’s survival meant that it had to make many concessions to WM. Consequently, the development of TCM was greatly restricted.

4.3 Reflection on TCM research methods and therapeutic ideas

WM is the result of the continuous development of modern science and technology in multiple disciplines and fields. It focuses on microscopic world and accuracy, relies on instruments and equipment, and excels in the diagnosis and treatment of diseases. However, TCM attaches great importance to macroscopic world and holism, pays more attention to personal feelings by means of inspection, auscultation, inquiry and palpation, and excels in analogy. The practice of TCM is objective and effective, but in terms of detection accuracy and precision, it cannot compare with modern scientific instruments in WM. This has resulted in the incompatibility between TCM and WM.

TCM excels in differentiating disease patterns, while WM is efficient at differentiating diseases. Although there are many differences between them, if the differentiation of disease patterns and diseases are combined, WM can make up for the limitation of TCM in diagnosing the diseases which is hard to differentiate patterns. Similarly, TCM pattern differentiation can also make up for the deficiencies of WM. For example, many patients are diagnosed disease-free in WM but they feel discomfortable by themselves, or some are diagnosed with a difficult and complicated disease in WM, but the curative effect is not good. In TCM, pattern differentiation helps to directly grasp the pathological state of body. Therapeutic methods, such as acupuncture and Chinese herbs, can be applied to adjust the body’s potential self-regulating abilities, comprehensively mobilize the body’s resistance to disease, and rebuild the body’s yin-yang balance.21 These are the advantages of pattern differentiation and treatment in TCM.

However, in the current diagnosis and treatment, many practitioners in both TCM and WM understand diseases and disease patterns from different perspectives, without fully considering their connection. Specifically, they do not notice that the same pattern may indicate different diseases, and the same disease may have different patterns, nor do they notice their different pathogenesis and clinical symptoms. Therefore, to improve the diagnosis and treatment level of TCM, it is necessary to combine the research on TCM disease patterns and WM diseases, and carry out the modern research on TCM clinical pattern differentiation. The combination of pattern differentiation in TCM and disease differentiation in WM will become the main mode of case selection in the current TCM clinical research, and one of the main ways for clinical integration of TCM and WM.

4.4 Optimization of traditional TCM education

Apprentice-style education, the traditional way to train TCM physicians, is to teach by words and deeds. WM physicians, on the other hand, are trained by a college-style education, which trains medical practitioners in batches with roughly the same teaching materials, basically the same teaching methods, as well as specimens and experimental operations with little difference. In modern times, to enable TCM education to enter the school education system, TCM universities and colleges have to set up TCM courses by imitating the education system of WM, and generally adopt the teaching mode of WM. These TCM colleges and universities have cultivated a large number of TCM practitioners to be actively engaged in clinical work, and have made outstanding contribution to China’s medical work.

Apprentice-style education emphasizes the importance of medical practice and the cultivation of clinical ability. It follows the basic laws of TCM formation and development. Therefore, it is still popular in TCM education today and make positive contributions to TCM’s further development. However, this way focuses on inheriting the experience of a few physicians, which tends to be narrow-minded and has sectarian views. The college-style education helps to solve this problem. More than 50 years of educational practice in China have proved that the education of TCM colleges and universities has become the main way for cultivating TCM practitioners.

Both apprentice-style education and college-style education play important roles in the cultivation of TCM practitioners, but both of them have their own shortcomings. One of the key points in today’s education reform is to emphasize the philosophy of aptitude-oriented teaching and individualized education, which is especially vital for TCM education. Therefore, the traditional apprentice-style education should be organically integrated into the modern college-style education of TCM. This helps to promote the inheritance of TCM experience and the cultivation of high-quality TCM practitioners with individual characteristics. In this way, TCM can be inherited and developed in a healthy way.22

5 Promotion effect of WM’s eastward dissemination on TCM

The eastward dissemination of WM introduced the hospital system to TCM, refined its labor division, and provided TCM with modern medical technology, enabling its expansion beyond its original scope and fields of treatment. At the same time, this shift has prompted the realization of the importance of cultural confidence and TCM revival among the Chinese population. The Chinese government should therefore develop the TCM culture, giving full play to its own advantages to help accelerate the international dissemination and refinement of TCM.8

5.1 Refining the labor division of TCM and expanding its therapeutic field

The introduction of the WM hospital system and the popularization of modern medical concepts have transformed the modes of clinical diagnosis and treatment used by TCM physicians, who have begun to follow the WM physicians to adopt a labor division model within different departments. In addition to internal medicine and surgical departments, more sophisticated departments, such as respiratory, cardiovascular, cerebrovascular, and endocrinology departments, become increasingly evident. The establishment of TCM hospitals indicates that more medical facilities could be applied to TCM treatment, which helps to promote TCM modernization and advances in medical science and technology. The wide application of surgical methods has made TCM break through its original treatment scope and its treatment field has been continuously expanding.

Influenced by the eastward dissemination of WM, patients are no longer bound to TCM clinics. A large number of TCM hospitals and departments have been established all over China, and modern diagnosis and treatment facilities are provided for TCM physicians for the convenience of patients seeking medical treatment, constituting a systematic medical system with a better division of labor and cooperation between the systems of TCM and WM.23

5.2 Objective promotion of TCM innovation and development

The eastward dissemination of WM has prompted innovations of basic theories, Chinese medicinal materials as well as diagnostic and treatment techniques in TCM, which are continuously applied to clinical practice. Recent studies on TCM are proliferating, and Chinese medicinal materials enjoys broad prospects. Under the guidance of traditional medical theory as well as clinical diagnosis and treatment practice, TCM can avail of modern Western science and technology to sort out and identify different varieties of Chinese herbs, which brings new and advanced knowledge about the microstructure and chemical properties of Chinese herbs.17 Through systematic and comprehensive experimental verification of the efficacy of traditional Chinese herbs, many new efficacious herbs that are not recorded in works on materia medica have been discovered and applied in clinical diagnosis and treatment. Scientific methods are used to extract chemical components from traditional Chinese herbs, whose active subcomponents would be further developed into new medicines.

For example, under the guidance of TCM theory, antimalarial drugs were screened and artemisinin was extracted to treat malaria worldwide. The medicine proved better curative effects than Western drugs. With the improvement of compound preparations of Chinese herbal medicines and the mass production of Chinese patent medicines, many drugs have been produced to treat common diseases, such as Huo Xiang Zheng Qi Liquid (藿香正气水) and Dan Shen Dripping Pill (丹参滴丸). In the present context in which COVID-19 is still prevalent, Chinese herbal medicines are widely used to treat it, which may not only reduce the incidence of critical illness but also alleviate the harm caused by the sequelae of the disease. Many Chinese herbal medicines with remarkable curative effects, which are available at relatively low cost and have minimal side effects, have once again attracted attention globally. TCM has made great progress in becoming an international medical system, and will stick to the path.24

6 Conclusion and future perspectives

This article has presented a brief review of the history of medical exchanges between China and foreign countries to identify general trends and draw on historical experiences. On the one hand, it is important to understand the contributions of medical exchanges to the development of medicines globally, and gain historical experiences from the process of medical exchanges. The historical experiences could provide both domestic and foreign references for the development of TCM. On the other hand, understanding the process of the eastward dissemination of WM and its huge impact on TCM helps to elucidate the reasons why WM has gradually been gaining strength, whereas TCM still faces many difficulties in both its development and worldwide dissemination. In light of this understanding, it is expected that TCM should get rid of its minor position by making up for its weaknesses and deficiencies and promote its development.

In the history of medical exchanges between China and foreign countries, TCM is in an ever-changing course to pursue both its coexistence with WM and its further development. The reason why WM has become the mainstream medicine system in modern times lies in its well-recognized scientific nature. By contrast, some people think that TCM is “unscientific” because modern scientific theories are sometimes unable to explain TCM or find it difficult to do so. However, TCM has many unique advantages over WM. TCM physicians do not just seek the causes of diseases within the human body itself but they also consider them comprehensively from many aspects. The curative effects of TCM do not come from scientific research under the guidance of standards in WM25; rather, they stem from long-term practice in medical treatment. Although TCM was suppressed by WM over a long period, it has achieved remarkable success in many aspects. In conclusion, TCM and WM are two approaches for treating diseases. If they can be used effectively and rationally by complementing each other, they will surely benefit both human health and social development.

Acknowledgments

The authors are deeply grateful to the anonymous reviewers and the editors, as well as Mr. De-Chao Lu (College of International Education, Shandong University of Traditional Chinese Medicine) for helpful suggestions in structure and assistance in language editing of this manuscript.

Funding

This study was financed by the grants from The National Social Science Fund of China (No. 20BSS065), Social Science Planning Research Project of Shandong Province (No. 20CLYJ68), and Cultivation Project of Shandong University of Traditional Chinese Medicine Science and Technology History Discipline (No. 2021KJSKFKT-A02).

Ethical approval

This study does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

Zhan Chen and Xiao-Jie Liu designed the study; Shi-Yun Chen and Kun Qu wrote the manuscript; Xiao-Jie Liu and Zhan Chen edited and revised the manuscript. This manuscript has been read and approved by all the authors.

Conflicts of interest

The authors declare no financial or other conflicts of interest.

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Keywords:

Historical medical exchanges; Medical development; Traditional Chinese medicine; Western medicine

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