In 1980's till I retired from medical research in 1994. I was given the rare chance to be selected as one of the members of a powerful policy-making committee called
"Joint WHO-Ministry of Health-Institute for Medical Research (WHO-MOH-IMR) Expert Technical Committee"
There were some 25 members in the committee, most of them were directors from the different divisions of the Ministry of Health, some six of them from WHO, and only my boss and myself were from the IMR
The government in that committee, on the advice and recommendation of WHO wanted to integrate traditional and complementary systems of medicine into the main health-care system of this country.
During the meeting WHO officials who sat in that committee told us that in China all medical students, irrespective on conventional allopathic drug-based medicine, or on Traditional Chinee Medicine must learn at least 30 % of each other's system of medicine, and in the examinations at least 30 % of the examination papers contain questions from each system of medicine. On graduation, both doctors in conventional medicine and in TCM, work together side -by-side in the same hospital referring cases to each other using the best therapeutic approach or integrated approaches for different cases.
Today, having learnt much from such a powerful committee, I decided to write a paper on such a beautiful integrated system of medicine in China here:
Abstract
China has pioneered a distinctive model of medical education by integrating Western biomedicine and Traditional Chinese Medicine (TCM) into undergraduate training. All medical students, regardless of their primary program, are required to study both systems, with standardized curricula and examinations reflecting this dual approach. This paper reviews the rationale, structure, and outcomes of integrative medical education in China, situating it in its historical context and addressing global challenges in healthcare shaped by the pharmaceutical industry. It argues that integrative education fosters holistic, patient-centered care and has potential relevance for international health systems.
Introduction
Medical education worldwide is often polarized between Western biomedicine, which emphasizes scientific rigor and technological innovation, and traditional medical systems, which prioritize holistic and culturally embedded practices. China represents a unique exception. Since the 1980s, the Ministry of Education has mandated that all medical students, whether pursuing a Western MBBS or a TCM degree, receive training in both traditions, with at least 30% of coursework and examinations devoted to the “opposite” system (Zhao et al., 2019). This model reflects both the historical role of TCM in Chinese society and the government’s vision of healthcare as an integrative enterprise.
TCM Training for Western Medical Students
Standardized Curriculum
Western medical schools in China incorporate mandatory TCM modules into undergraduate programs. These courses cover TCM theory, diagnostics, and practical techniques such as acupuncture, moxibustion, and herbal pharmacology (Liu et al., 2015). The national curriculum ensures uniformity, with students expected to acquire not only theoretical knowledge but also clinical competence (Wang & Xu, 2021).
Holistic Perspectives
Studying TCM allows medical students to appreciate systems-based approaches to health, emphasizing prevention, balance, and individualized care. These perspectives contrast with biomedicine’s reductionist disease model and provide a complementary framework for patient management (Cheung, 2011).
Global Relevance
Even international students enrolled in English-medium MBBS programs in China are required to study TCM, underscoring its strategic role in promoting integrative medicine globally (Wu et al., 2019).
Western Medical Training for TCM Students
Biomedical Foundations
TCM universities likewise include Western medical sciences like anatomy, physiology, pathology, and pharmacology, within their curricula (Zhang et al., 2010). This ensures graduates are competent to work in modern clinical settings.
Integrated Clinical Practice
Affiliated hospitals provide dual-system rotations, where Western and traditional modalities are used side by side. Examples include combining acupuncture with anesthetics in surgical contexts or integrating herbal medicine with chemotherapy in oncology (Chen et al., 2020).
Institutional Models
Beijing University of Chinese Medicine and Shanghai University of Traditional Chinese Medicine exemplify this model, producing graduates who can navigate both paradigms effectively.
Rationale for Integration
Cultural and Historical Legacy
1. With over 2,500 years of history, TCM remains deeply woven into Chinese culture and public trust in healthcare (Lo & Chen, 2013).
2. Complementary Roles in Healthcare
In contemporary hospitals, TCM and Western medicine are often used together. During the COVID-19 pandemic, integrative protocols reflected this approach at scale (Zhao et al., 2021).
3. Global Recognition. The World Health Organization reports that over 80% of the world’s population uses some form of traditional medicine, affirming its global relevance (WHO, 2019).
Challenges
Evidence-Based Evaluation
The greatest challenge for integrative medicine is the need to evaluate TCM practices with rigorous scientific methodologies without disregarding their cultural value (Fønnebø et al., 2007).
Pharmaceutical Industry Influence
Globally, the pharmaceutical industry often resists integrative approaches, prioritizing patented synthetic drugs. This reflects a historical shift from natural remedies to profit-driven pharmaceuticals, beginning in the 19th century with the synthesis of morphine and aspirin, and expanding during the 20th century with antibiotics, statins, and other blockbusters (Greene & Podolsky, 2012; Light & Lexchin, 2012).
Patient Expectations
Patients with chronic diseases often express dissatisfaction with conventional treatments that focus on symptom control rather than cure. This has contributed to rising demand for integrative and holistic care (Hsu, 2020).
Historical Context: From Natural Remedies to Modern Pharmaceuticals
For most of human history, medicine relied on natural sources, plants, minerals, and animal products. With the industrial revolution, drug development shifted toward laboratory-based synthesis:
19th century: Isolation of morphine (1804) and synthesis of aspirin (1897).
20th century: Industrial production of antibiotics and expansion of patented synthetic drugs.
Contemporary era: Patent-driven pharmaceuticals dominate, with chronic disease therapies marketed for long-term use. While these advances have saved countless lives, they have also reinforced a profit-driven model often at odds with holistic care (Light & Lexchin, 2012).
Future Perspectives
China’s integrative medical education offers insights for global healthcare reform. The future may involve:
1. Science-based validation of both traditional and biomedical therapies.
2. Personalized medicine, accounting for genetics, lifestyle, and environment.
3. Preventive strategies, reducing reliance on pharmaceuticals in chronic disease.
4. Complementary roles, reserving pharmaceuticals for acute and emergency care, while employing TCM and other holistic methods for prevention and rehabilitation.
Just to emphasize once again in summary
The integration of conventional medicine and traditional healing systems remains a global challenge, often characterized by tension between evidence-based biomedicine and longstanding cultural practices. In China, however, medical education has institutionalized this integration. Since the 1980s, all medical students, whether enrolled in Western-style or TCM universities, must study at least 30% of each other’s systems during training, and examinations also assess both domains. This dual exposure aims to cultivate a more comprehensive understanding of health and disease, preparing practitioners for China’s pluralistic healthcare environment (Zhao et al., 2019).
Structure of TCM Education for Western Medical Students
Mandatory Integration
China’s Ministry of Education mandates that all undergraduate medical programs, including MBBS degrees, incorporate courses in TCM (Liu et al., 2015).
Standardized Curriculum
The curriculum is standardized nationally and includes theoretical instruction and practical training. Students learn the fundamentals of acupuncture, moxibustion, herbal pharmacology, and the classical texts of TCM (Wang & Xu, 2021).
Holistic Healthcare Understanding
By studying TCM, students are exposed to a systems-based, preventive philosophy of health. This complements the disease-focused model of Western biomedicine, encouraging practitioners to adopt a patient-centered and holistic perspective (Cheung, 2011).
International Programs
Even MBBS programs taught in English to international students include TCM components, reflecting the global importance of integrative healthcare (Wu et al., 2019).
Structure of Western Medical Education for TCM Students
Dual System Approach
Students in TCM universities are also required to study Western medical sciences, including anatomy, physiology, pathology, and pharmacology, so that they can function effectively in modern hospitals (Zhang et al., 2010).
Integrated Clinical Practice
Clinical rotations in Chinese hospitals expose students to integrated wards where TCM and Western interventions are used in parallel. For example, acupuncture may be combined with anesthetics during surgery, or herbal formulas with chemotherapy for cancer care (Chen et al., 2020).
Examples in Practice
Institutions such as Beijing University of Chinese Medicine and Shanghai University of Traditional Chinese Medicine exemplify this dual-system approach, producing graduates trained to operate at the intersection of both traditions.
Why Integration is Central in China
1. Historical and Cultural Legacy
2. TCM has been practiced for over 2,500 years and remains deeply embedded in Chinese culture and identity (Lo & Chen, 2013).
3. Complementary Role in Healthcare
4. Many Chinese patients receive care that combines TCM and Western medicine. During the COVID-19 pandemic, integrated protocols that used herbal medicines alongside antivirals and supportive care were widely implemented (Zhao et al., 2021).
5. Global Interest.
The World Health Organization recognizes the role of traditional medicine in primary healthcare, noting that over 80% of the world’s population uses some form of it, even in developed nations where patients often turn to alternative therapies after conventional treatments fail to provide cures (WHO, 2019).
Challenges and Critiques
Pharmaceutical Industry Influence
The global pharmaceutical industry, dominated by profit-driven models, often resists integrative medicine. The patent-driven approach prioritizes synthetic drugs with commercial potential, sidelining natural remedies despite centuries of efficacy. The historical trajectory of pharmaceuticals, from natural remedies to synthetic monopolies, reflects this shift (Greene & Podolsky, 2012).
Patient Dissatisfaction
Chronic disease management in biomedicine often emphasizes lifelong pharmacological control rather than cure, leading many patients to seek alternative or complementary approaches (Hsu, 2020).
Evidence and Standards
A key challenge is applying rigorous, science-based methods to evaluate TCM therapies without dismissing their cultural and experiential value. Integrative medicine should be personalized, preventive, and evidence-based, using pharmaceuticals where necessary but not exclusively (Fønnebø et al., 2007).
Historical Context: From Natural Medicines to Big Pharma
Early Natural MedicinesRise of Synthetic Drugs
Industrial Expansion
The Ideal Future: A Balanced Approach
Integrative medicine offers a pathway to more comprehensive and sustainable healthcare. This vision emphasizes:
1. Science-based validation of both traditional and biomedical interventions.
2. Personalized medicine, incorporating genetics, lifestyle, and environment.
3. Preventive strategies, reducing reliance on pharmaceuticals for chronic diseases.
4. Complementarity, using pharmaceuticals for acute/emergency care while leveraging TCM for prevention, rehabilitation, and chronic disease management.
China’s model of integrative medical education represents a bold attempt to reconcile the strengths of two medical paradigms. While challenges remain, particularly the influence of profit-driven pharmaceutical industries, integrative medicine provides an opportunity to reshape healthcare into a more holistic, patient-centered system. As patients worldwide increasingly demand alternatives to lifelong pharmacological management, integrative models rooted in science, culture, and prevention may become the future of global medicine.
In China TCM is so well recognized by all parties that Chinese basic medical insurance covers Traditional Chinese Medicine (TCM) services, with many TCM hospitals and treatments included in national and provincial insurance schemes in China. Both TCM and Western medicine are covered, and policies are designed to support the integrated use of both approaches for a wider range of health conditions.
In Malaysia too when the government has officially and legally recognized TCM, medical insurance coverage also applies to TCM as “adds on” for all registered and licensed TCM practitioners
By embedding integration within medical education, China has institutionalized a model that values both modern scientific advances and traditional wisdom. While challenges remain, particularly around evidence evaluation and the influence of global pharmaceutical industries, China’s dual training system prepares practitioners to provide patient-centered, culturally responsive, and scientifically grounded care. As healthcare worldwide confronts the growing burden of chronic disease, integrative education offers a pathway toward more balanced, holistic, and sustainable models of care.
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