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中药有望与西药并驾齐驱-双语翻译


FANG YUAN gazes around his crowded shop and says happily that business is booming. He has a reliable supplier in Russia and hospitals and pharmaceutical companies are queuing up to buy what he sells: antlers. Tangles of them lie in huge meshes on the floor. Thousands more, sliced into discs, fill glass boxes. They are used to treat breast disease in traditional Chinese medicine (TCM). The shop looks a bit like a Scottish baronial hall. Deer-head trophies gaze down from the walls, as does a red-fronted gazelle with black horns like scimitars. “I don’t sell those,” he says hastily. “Endangered list.”

方元(音译)四处看着他那人头攒动的店,开心地说自己生意非常好。他有一位可靠的俄罗斯供应商,还有很多医院和制药企业都在排着队等着买他的货:鹿角。这些鹿角被放在地板上的一张大网内。几千个鹿角,切成薄片,放在玻璃箱里。在中医学里,鹿角可以用来治疗乳腺疾病。这间店铺有点像苏格兰富丽堂皇的大厅,鹿头状的奖杯挂在墙上,俯视下面,好像是头顶弯刀般黑角的赤额瞪羚。“我不卖这些动物,”他急忙说道。“它们是濒危物种。”

 

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

方元是全球最大的中药材市场上的一位经销商——中医是一套诊治体系,有2500多年的历史。中药材市场的发展规模令人震惊。这个市场位于一个小镇亳州,距离最近的火车站有三小时车程。不过,主市场有足球场那么大。方元只是一万个经销商中的一员——这个数目是美国明尼苏达州布卢明顿超大商城的所有店铺的四倍之多。

 

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

他们出售所有想到的药材,有沉香片(据说它的烟能清肺),还有干蛙、壁虎和鹿鞭,泡在酒里,能恢复运动损伤。还有成盒成盒的冬虫夏草,也称“喜马拉雅伟哥”,一克重的冬虫夏草比一克金子还要值钱。这个市场为全中国的中药定价。每天上午9点前,在样品室就会挤满批发商。

 

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

亳州市场不仅是中药格外繁荣的象征,更是中医繁荣的结果。全国中医院的数量从2003年的2500所左右增加到2015年底的近4000所。自2011年以来,中医执业医师的数量达到了45.2万人左右,增长了近50%。大约有6万种中药材通过了国家食品药品监督管理局的批准,几乎占到了中国药品市场的三分之一。中国是全球第二大药品市场。在2015年,前往中医院看病的患者达到9.1亿人次。政府表示,该数量占到总医疗服务人数的16%,高于2011年的14%。

 

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

在1911年清朝灭亡之后,中医曾被当作迷信,被大家拒之门外,而如今,中医能够复苏真是让人为之惊讶。受过西方教育的医生和科学家依然对中药充满疑虑。中医药之所以能够得到很好的发展,一个原因是人们对预防保健药品的大量需求。人们认为这样可以省去去医院治病所需的大量费用。对于一些人来说,购买冬虫夏草等最昂贵的中药变成了一种身份象征。“在过去的几年里,”大型医疗保健公司康美药业的李宁说道,“越来越多的人开始认可中药,因为人们口袋里的钱多了,更加关心自己的身体状况了。”

 

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

中药的发展还得益于中国主席的重视。他称中医是“中国古代科学的瑰宝”,并表示自己也在服用中药。“中医学发展现在处于黄金时期,”他说道。他还督促执业医生“推动中药走上世界舞台。”自2012年习担任国家主席以来,中国政府就一直坚持对中医和“西医”(中国人称现代药物其为“西药”)一视同仁、平等对待。此后,政府就发布了一系列规划、政策和指示,要到2020年每个中国人都用到中药的目标。

 

More doses of one’s own medicine

更多使用中药

 

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

2016年初,政府公布了一个规划纲要,提出未来15年中药的发展方案。纲要指出,中药在法律上应该享有和西药同等的地位;它也应该像其他行业一样得到管理。去年年底发布的一份白皮书称,中药的成本相对较低,在医疗保健体制改革方面发挥了重要的作用。

 

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

接着在7月份,中国颁布了首部中医药法律(《中华人民共和国中医药法》),规定了中医药及其制作原料的安全标准。这部法律加强了对生产草药的农场及生产中药片的医药厂商的监管(例如禁止生产草药的农场使用化肥)。与此同时,降低了对医生专业技能的要求。在过去,中医医生必须要首先获得传统医生的资格,然后还要有传统医药学的从业资格。新法律规定,只要通过了当地的实践技能考试,拥有其他两位执业医师的推荐信就可以成为一名执业医师。一些卫生专业人士担心这样会招来更多的庸医。

 

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

支持者们回应称,中药能提高公众的健康水平,完善医疗体制。中药依赖草本治疗和其他自然疗法,而不是昂贵的诊断机械。据白皮书称,每次去公立中医院看病的平均住院费用要比一般公立医院低24%;门诊费用要低12%。如果中药和西药一样有效的话——如果效果显著——中药将会是增进健康的有效方法。

 

If only there were proof

能证明疗效就好

 

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

不过,很难证明中医有效。在一些科技期刊上,一些临床试验报告一些有效的中药治疗的例子,比如说治疗偏头痛和肥胖症。他们还发现一些中西结合疗法取得成效的病例,例如治疗精神分裂症。然而,从总体上来讲,效果却比较差。

 

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

美国国家卫生研究院观察了70个中药治疗的系统性审核报告。其中有41个治疗因效果甚微或设计不当而不能投入使用。研究表明,其中29个治疗方案可能会有用,但是由于样品数量存在问题以及其它一些缺陷,使得结果不确定。澳大利亚纽卡斯尔大学的李树泉教授发现,他所观察的研究当中有四分之一确实有一些效果,但是大多数收效甚微。

 

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

世界卫生组织驻北京代表团的马丁·泰勒认为,中药比较有用处的一面就是它注重预防而不是治疗。中医医生会经常看望他们的病人,一是因为他们提供的治疗方案都是量身定做的,需要细微的改动和调整。中医界的一个公理就是:好的医生是未病先治。

 

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

因此,对传统医药的更多关注就意味着更加重视基础医疗卫生,可以很好地监视病人的病情,主要针对那些患有与生活习惯相关的病症(如肥胖症)以及老龄化疾病的患者。中国作为一个中等收入国家,却要背负一个富裕国家的疾病负担:在所有的死亡病例中,85%是源于心脏病、糖尿病等非传染性疾病。如果中医医生能够建议大家养成更好的饮食习惯,或是说服一半成年男性烟民戒烟,那么他们就能实现大大改观现状。

 

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

中国政府发布的一份“健康中国2030”文件显示,如果没有更好的基础医疗卫生服务,整个医疗卫生体系就无法满足日益老龄化的人口需求。但是,全科医生的严重缺乏是一个巨大的障碍。甚至一个人只是有点小毛病,却通常要去看专家。这样就会造成两个不便:一是成本问题,因为专家问诊的费用都很高;二是会造成医院人满为患、过度拥挤。相反,政府更愿意让老百姓去社区诊所看病。不过,很多人都不愿意去看全科医生,他们觉得全科医生不如专家。他们可以更愿意去中医诊所看病。因此,多开放一些中医诊所可以为医院减轻压力。

 

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

如果管理得当的话,中药有时候能让人们受益,至少可以在心理上起到安慰的作用。可是,中国想要将中药吹捧到拥有和传统医药一样的地位,可谓是危险重重。这可能会导致更多患有严重疾病的人不选择常规疗法而青睐于中医疗法。除此之外,这种做法还会给那些稀有植物造成威胁,因为要用这些稀有植物制成中药,尽管国家禁止使用它们。为了减少这些危险,中国的中医药管理之路还需要几次大的改革。

 

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

政府需要对某些动植物的使用加大管控力度。根据北京动物研究所得孟志斌称,在制作中药的112种最常用的天然原料中,有22%属于濒危物种。有些是从在农场养殖的草药中提取的,有些是从珍稀动物身上提取的,而这些珍稀动物通常是被捕杀后偷运到国内的。买卖穿山甲(一种食蚁动物)在世界范围内都是禁止的。但是,中国医药协会的王卫权称,走私现象依然存在,因为国内的穿山甲农场还不够大。中医学的支持者似乎并不在乎这一点。他们担心的是传统医药本身的未来。北京望京中医院的温建民认为,禁止使用某些动物导致了一些著名传统疗法的灭亡。“如果我们不能更好地保护传统中药,那么中药将形同虚设,”他说道。

 

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

政府也需要提高其安全标准。例如:一种名叫马兜铃的植物,可以用来治疗关节炎,却发现能致癌。不过,政府想要提高安全水平的愿望意味着更高的标准化要求,这也与传统中医的理念相悖,即要根据患有具体病例制定具体治疗方案。2016年,食品药品监督局吊销了81家中药制造商的营业执照。医疗企业天士力集团的董事局主席闫希军称,中医药企业确实有营业执照,“当然,50%到60%的中医药企业或多或少有问题。”

 

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

以现代医药学的方式来训练中医医生,这会很有帮助。政府称,传统医药应该弥补常规医药的不足之处。这就需要医生能够精通两种医术,在病人需要接受现代疗法时建议他们去采用现代疗法。然而,中国没有几个能同时精通中西医术的医生。新法律降低了所谓的医疗科学的门槛。这无疑是一个错误的举动。

 

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

长远目标应当是建立一个依赖现代医学,并能提供中医所谓的预防性措施的医疗体系。政府在夸大中药的疗效。它在中国的使用如此广泛,其中一部分原因是很少有人愿意去质疑其背后的科学性。中药是中国的特色——质疑中药通常会认为是不爱国的行为。追逐现代化还是坚守传统,这一直是中国经常面临的难题。随着中药暴露出来的种种问题,实现中西药的平衡要比表面看起来难得多。

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