Presented at the Second World Education Congress of Chinese Medicine, 29^th October 2011 in Beijing  第二届世界中医药教育大会, 2011年10月29日 中国北京

[Abstract]

One of the prerequisites for globalisation of Chinese Medicine education is a thorough analysis of the strategy and direction of such a process. An analysis can only be achieved through a consideration of the various factors in the current international medical education. Firstly, the contradictions between, and the possible synthesis of, the different medical system methodologies must be analysed in order to provide possible solutions to the challenges facing integration. Secondly, in order to initiate an evolutionary approach to integration in medicine we must analyse the existing infrastructure and institutional dynamics involved in medical education and which characterise the cultural and social establishment of each region or country in the world. Thirdly, the content of medical education must be measured in relation to the clinical needs of the society that it is serving. When introducing Chinese Medicine as part of the mainstream medical education we need to know what benefits this will bring to the doctors and patients.

This paper proposes a patient-centred approach to medical education as a directional solution for a future medicine. A synthesis between conventional Western medicine and Chinese Medicine is therefore required so that the two complement each other to achieve a better result in the treatment of diseases and improve the general healthcare of the people. Therefore, to forward the agenda for integration in medical education must take the patient-centred approach. The argument between methodologies and the evaluation of medical evidence can only be resolved by involving patients as the central objective of any medicine. Medicine is both science and philosophy which is why the education of the physicians of the future will require a multi-disciplinary approach before any specialisation. These are the central themes in the strategy and direction for the globalisation of Chinese Medicine.

[Keywords]

Integrative medicine, Patient-centred medicine, Globalisation of Chinese Medicine, Mainstream medical education, Syndrome Differentiation.

概述

关于中医教育的国际化，最重要的先决条件是对整个过程有着战略性和方向性的透彻分析。通过对当前国际医药教育形式下各种因素的考虑，以下的分析应该是比较可行的。

首先，为了给结合医学带来的挑战提供可能性的解决方法，要对两者之间的矛盾,可能存在的共性以及不同的医疗系统方法论加以分析。其次，为了对结合医学发展一个循序渐进的办法，必须要分析医学教育现有的基础设施和机构性动力，围绕全球不同地区的文化和社会特征找出相应的答案。第三，医学教育的内容必须能反映社会的需求和适应病人的临床需要，当中医药被介绍作为主流医学教育的一部分，我们必须了解这将给医生带来怎样的效益以及病人最终获得的疗效。

本文提出了医学教育必须‘以人为本’的理论来作为未来医学的发展方向，并指出传统中医需要和西医更好地有机结合，让两者相得益彰，从而使对疾病的治疗达到更好的效果，以提高全民的健康水平，因此要通过以人为本的医学原则来推动中西医结合。关于方法论和医学证据的评估中存在的争议也可以通过把相关的病人在治疗后的结果进行评论来得到解决。医学是科学也是哲学，这也是为什么未来的医师教育在专科化之前需要有多学科的培养。 以上这些就是中医教育全球化在策略和方向上的主题内容。

关键词

Integrative medicine (结合医学)， Patient-centred medicine （医学以人为本）, Globalisation of Chinese Medicine （中医药全球化），Mainstream medical education （主流医学教育）, Syndrome Differentiation（辨证论治）.

Current Dynamics in International Medical Education and Methodology

When considering the globalisation of Chinese medicine education, we need to first consider the key factors of resistance that exist within the international mainstream medical environment. Mainstream medicine is dominated by the scientific methodology of Evidence Based Medicine (EBM) and the acceptance of another medical system will only be resolved through vigorous debates and solutions of problems involving social and economic polemics. Medical schools will only be willing to integrate Chinese medicine within their conventional medical education if there is a consensus that Chinese Medicine is beneficial to patients and, therefore, a necessary requirement for the education of physicians. Clinical efficacy of Chinese Medicine, however, cannot be fully evaluated by the currently dominant medical methodology of EBM, through Randomised Controlled Trials (RCT) and Meta Analysis. A new evaluation methodology – such as patient outcome or patient centred assessment – needs to be accepted as a precondition for the clinical efficacy of the Syndrome Differentiation approach of Chinese Medicine. An innovative solution is therefore necessary in order to commence the introduction of Chinese Medicine education within conventional medical education. The process of persuading medical educators – and its success – depends on establishing an integrative approach in medical evaluation. A global task force of experts should be set up to provide authoritative findings and guidance in this direction.

Hitherto, Chinese Medicine and Western medicine education in China have been conducted in separate medical schools. Although there is an encouragement for integration in education, in reality, there has been no real attempt to cohesively synthesise the two medical systems together, either within the theoretical or clinical education of doctors in China. Thus far, integration has been superficial even within the clinical practice of Chinese hospitals. In considering the strategy and direction of global Chinese Medicine education, we must consider in depth the theoretical and clinical problems involved in education. This will then point towards a structure for an integrative medical education model. Before we discuss the questions of syllabus and methodology of teaching, we need to have an intellectual solution to the problems facing integration. We first need to formulate the nature and content of twenty-first century medicine. The essence of both Chinese Medicine and Western medicine should first be distilled for the optimal benefit of the patients and only then we can found the basis for the education of our future doctors and physicians – who should be one and the same. This is the patient-centred approach to medicine education that this paper is discussing.

The question for the medical education of the future is clear. We have to decide whether Western medicine education and Chinese Medicine education should be conducted in parallel in reference to each other, or whether a serious attempt should be made in the direction of integration towards the synthesis of a new medicine. In the global perspective, should we adopt the Chinese model, as described above, or develop true integration in medical education? This is a directional problem we have to solve. In the author’s opinion, we need both inheritance and innovation in the final resolution of this contention. Then it will be possible for us to begin a discussion on the syllabus and methodology of teaching as part of an integrative Chinese-Western approach to medicine. This is the first directional decision for a global medical education task force.

Content of Medical Education in Relation to the Patient’s Needs and Clinical Excellence

When we are considering the syllabus and content for Chinese Medicine education within the conventional medical education, we must examine the clinical deficiencies of conventional Evidence Based Medicine. Medical education must reflect the clinical needs of patients. For instance, chemotherapy produces negative side-effects but they can be substantially reduced by Chinese herbal medicine and acupuncture. Indeed, the side-effects of drugs like steroids and anti-depressants can all be minimised by Chinese Medicine. Pain management with acupuncture and TENS (经皮神经电刺激) has also proven to be a medical breakthrough with the discovery of the neurotransmitter and Gate Control mechanisms. These are some of the examples to be used for incorporating the positive clinical content of Chinese Medicine within medical education. Similarly, the advantage of Chinese gynaecology in the treatment of infertility and menopausal syndromes as well as the Chinese Medical approach to andrology in the treatment of impotence and prostrate-related disorders can also be considered as focused content for the Chinese Medicine syllabus to be taught to medical school students. Patients also find amazing results with Chinese Medicine for dermatological diseases such as eczema and psoriasis. The acupuncture treatment of stress and the Chinese herbal formulations for depression are all an important part of integrative content in future mainstream medical education.

In the final analysis, the necessity for an integrated medical education should be measured according to the advancement of medical treatment and the improvement of health of the general public that such integration can produce. This will also depend, to a large extent, on the patients’ demand and reaction to the integrative approach. Within such framework for integration, the safety and the quality of life of the patient are also an important factor for consideration. Chinese Medicine will bring a more humanistic and less invasive aspect to medical practice.

Patient-centred Approach as the Directional Solution

The ultimate aim of any medicine should be to cure the patient. While not causing any more harm, medicine should at least have the effect of improving the well-being and longevity of the patient. In order for integrative medicine to be established as the general medical norm in research, education and clinical practice we must be satisfied that the new form of medicine provides better solutions to the clinical problems of the 21^st Century. Civilisations progress only on the continuous substantiation of knowledge and the development of wisdom corresponding to the higher values in social attainment.

Medicine is not exempt from this social process. In our age of science and technology there is a trend of a return to nature as people are preferring natural foods and natural medicines. The arrival of Chinese Medicine on the global scene is timely in the wake of the renaissance of Chinese culture. Yet it has to be modernised in order to provide a substantial challenge to Western Evidence-Based Medicine, and so the prerequisite

elements are in place for a medical synthesis. The complex dynamics of the modern world are shaping individualised medicine of the future where patients are at the centre of all aspects of healthcare and medical students will have to adapt to this situation. Medical education will have to train the future physicians in line with the modern requirements and trends in society and culture. The expectations of the patients have dramatically risen with the transparency of medical knowledge within the world wide web. Clinical services must adapt to the modern patient who takes ownership of their own health, is well-informed and is adverse to invasive intervention. The future medical education model must, in turn, take this into account since the medicine of the future will be a patient-centred medicine.

Strategic Considerations for the Globalisation of Chinese Medical Education – Towards an Integrative Medicine Education Model

In order for Chinese Medicine to globalise we have to consider the future model of an integrated medicine in which Chinese Medicine will play its role. Strategically, Chinese Medicine has to define its contribution to modern medicine. In the author’s view, the key areas for consideration are:

1. Syndrome Differentiation, as a diagnostic procedure, is of strategic importance to establishing an individualised patient-centred model for future medicine. Syndrome Differentiation is the essence of Chinese Medicine; it takes the holistic view of the pattern of diseases by identifying the features and developments of the patient’s health problems. A structured investigation in the logic and methodology of Syndrome Differentiation in line with the modern theory of knowledge is a strategic consideration that must be made when incorporating Chinese Medicine education within mainstream medical schools.

2. This opens up an important discourse on the intellectual relationship between the science of medicine and the philosophy of medicine. If we are able to synthesise the technical advancements of science with the philosophical understanding of the human body accumulated into Chinese Medical theories then there we have a theoretical basis for integration. The answer lies in marrying the Chinese philosophical concepts of Yin and Yang, Qi, Balance and Harmony with the dynamics discovered in new physics such as quantum mechanics（量子力学） and the Supersymmetry theory（超对称理论） in the standard model of particle physics（粒子物理学的标准模式）. This research direction should be considered as strategically important for an integrative medicine education and as a step forward for the globalisation of Chinese Medicine.

3. Western Evidence-Based Medicine trains doctors with technical skills and knowledge of medicine. Medical specialisation has been increasingly dominant in medical education. For instance, a surgeon performing a heart surgery during their entire medical career will find it difficult to acquaint himself with the other important fields of medicine. Whereas a Chinese Medical physician connects the heart with other organs with the holistic theory of Zhang Fu and he will have a fuller picture of the patient’s pattern of disease and how a heart operation may affect the other organs of the body. Chinese Medicine therefore sees the body as a holistic, complex web rather than as a sum of its parts. This unique feature of Chinese Medicine should be considered when integrating Chinese Medicine education with conventional medical education and promoting a multi-disciplinary（多学科）approach to medical education and should be pursued as strategically important.

In summary, the strategy and direction for integrating Chinese Medicine globally lies in persuading conventional medical schools that Chinese Medicine can contribute positively to clinical treatment through such key features as Syndrome Differentiation, its unique philosophical theories and the less invasive treatment modality of herbal medicine and acupuncture. The strategic considerations bring us to a patient-centred medicine that may provide a model for a future integrated medicine which is based on both scientific evidence and philosophical analysis. Chinese Medicine education can only be forwarded if the environment discussed above is created within the medical community. This will also ensure acceptance and approval from governmental and medical authorities. These are the challenges that we have to overcome in an international context in order to promote the globalisation of Chinese Medicine education.

Man Fong Mei

29 ^th October 2011 in Beijing, China

梅万方

2011年10月29日 中国北京