Emergent quality issues in the supply of Chinese medicinal plants: A mixed methods investigation of their contemporary occurrence and historical persistence

Quality issues that emerged centuries ago in Chinese medicinal plants (CMP) were investigated to explore why they still persist in an era of advanced analytical testing and extensive legislation so that a solution to improve CMP quality could be proposed. This is important for 85% of the world’s population who rely on medicinal plants (MP) for primary healthcare considering the adverse events, including fatalities that arise from such quality issues. CMP are the most prevalent medicinal plants globally. This investigation used mixed-methods, including 15 interviews with CMP expert key informants (KI), together with thematic analysis that identified the main CMP quality issues, why they persisted, and informed solutions. An unexplained case example, Eleutherococcus nodiflorus (EN), was analysed by collection of 106 samples of EN, its known toxic adulterant Periploca sepium (PS), and a related substitute, Eleutherococcus senticosus (ES), across mainland China, Taiwan and the UK. Authenticity of the samples was determined using High-performance thinlayer chromatography. Misidentification, adulteration, substitution and toxicity were the main CMP quality issues identified. Adulteration was found widespread globally with 57.4% EN found authentic, and 24.6% adulterated with cardiotoxic PS, mostly at markets and traditional pharmacies. The EN study further highlighted that the reason CMP quality issues persisted was due to the laboratory-bound nature of analytical methods and testing currently used that leave gaps in detection throughout much of the supply chain. CMP quality could be more effectively tested with patented analytical technology (PAT) and simpler field-based testing including indicator strip tests. Education highlighting the long-term economic value and communal benefit of delivering better quality CMP to consumers was recommended in favour of the financial motivation for actions that lead to the persistence of well-known and recurrent CMP quality issues

Walking on a Bridge You Also Built: Practitioners’ Experience Navigating the Borderland Between Western and Chinese Medicine

In the United States, medicine, and its understanding of how the human body functions, is predominantly explained by reducing life processes, discomfort and disease into biological and chemical reactions. Alternatively, Chinese medicine, such as the practice of acupuncture and herbal therapy, relates health to the movement of an energy force (qi), and the balance of five elements that correspond to both anatomical and conceptual structures. Many of these structures remain invisible to biomedicine, even with advanced imaging technology. The inability of biomedical tools or language to fully describe Chinese medical concepts challenges Americans who wish to understand and practice it, and limits its acceptance into American medical institutions. The differences and contradictions between Western and Chinese medical knowledge creates and shapes the landscape of a “borderland” between the two. Observing the practitioners who inhabit this borderland reveals three adaptive strategies developed to successfully navigate this borderland: 1) the separation, at least symbolically, between each healing modality to facilitate easier transitions between them, 2) the recognition that two very different diagnostic realities may exist simultaneously, and 3) the utilization of physical experiences, guided by touch, visualizations, and metaphors, in order to encourage a more a personal and instinctive understanding of the abstract and unfamiliar concepts of Chinese medicine. Identifying these personal adaptive strategies can help inform better institutional integration of Chinese medicine in America, and encourage a more open, relativistic approach to healthcare

Covering health: healthworlds of first-generation Chinese immigrants in Boston Chinatown

This study examines the healthworlds of first-generation Chinese immigrants in Boston's Chinatown. Through participant observation and interviews conducted within a local church and a local park community, three key issues emerged: how the space of Chinatown influences people's post-immigration healthworlds; the dynamics of community health supports and health challenges; and the daily health lives of these immigrant individuals within their respective families. Likewise, complex understandings of health coverage emerge that include not only health insurance, but also social forms of insurance. Community integration becomes not only a cultural tradition, but also how health resources and health support are linked and provided. This social form of insurance makes it possible for community members to reach out cultural and religious health resources and support in the context of everyday life

Routledge Handbook of Chinese Medicine

The Routledge Handbook of Chinese Medicine is an extensive, interdisciplinary guide to the nature of traditional medicine and healing in the Chinese cultural region, and its plural epistemologies. Established experts and the next generation of scholars interpret the ways in which Chinese medicine has been understood and portrayed from the beginning of the empire (third century BCE) to the globalisation of Chinese products and practices in the present day, taking in subjects from ancient medical writings to therapeutic movement, to talismans for healing and traditional medicines that have inspired global solutions to contemporary epidemics. The volume is divided into seven parts: Longue Durée and Formation of Institutions and Traditions Sickness and Healing Food and Sex Spiritual and Orthodox Religious Practices The World of Sinographic Medicine Wider Diasporas Negotiating Modernity This handbook therefore introduces the broad range of ideas and techniques that comprise pre-modern medicine in China, and the historiographical and ethnographic approaches that have illuminated them. It will prove a useful resource to students and scholars of Chinese studies, and the history of medicine and anthropology. It will also be of interest to practitioners, patients and specialists wishing to refresh their knowledge with the latest developments in the field. The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 licens

Healing At The Borderland Of Medicine And Religion: A Folklore Study Of Health Care In Taiwan

This study is about popular healing and its relation to culture. It is based on my field research in Taiwan from 2014 to 2016. In addition to modern medicine and scientific Chinese medicine, my field research focused on the connections between different systems of popular healing and the role of lay people in their own healthcare. The correlations between them are ambiguous, inexplicit, superimposed upon or intermeshed with one another. In Taiwan, health care and the healing process is part of popular culture. I make evident the vital role of lay people, which often has been overlooked. Lay people includes all non-professionals──popular ritual practitioners ignorant of orthodox teaching, local medicinal healers without a national license, and followers who disregard religious doctrines but believe in divine power. There are many laymen devoted to religion. All the lines are blurred. Each healer performs rites of various origins, intertwining popular concepts of religion and medicine to compete for survival and prestige. Healers are easily accessible and play a central role in the daily life of the community. Three subjects──medicine in temples, possessed healers who prescribe herbal formulas, and rituals that use drugs──are examples where popular religion and medicine overlap. By setting them in a framework, it is possible to better understand how people receive, perceive and disseminate health care

Faculty Of Education UNHI

Faculty Of Education UNH

Adverse reaction of Chinese herbal medicines.

Hin-Chung Chu.Thesis submitted in: July 2002.Thesis (M.Phil.)--Chinese University of Hong Kong, 2003.Includes bibliographical references (leaves 281-306).Abstracts in English and Chinese.Cover (English & Chinese version) --- p.I中文封面 --- p.IIAbstract (English version) --- p.III-IV中藥不良反應論文摘要 --- p.VAcknowledgements --- p.VIAbbreviations --- p.VII-VIIIPublication in press --- p.IXContent --- p.X-XVLists of Table --- p.XVIChapter Chapter 1 --- Introduction --- p.1-3Chapter Chapter 2 --- Chinese herbal medicines used in Hong Kong. --- p.4-15Chapter 2.1 --- Overview --- p.4-5Chapter 2.2 --- The Policy In Hong Kong -- Past And Present --- p.5-1Chapter 2.3 --- The Preparatory Committee on Chinese Medicine (PCCM) --- p.7-8Chapter 2.4 --- The Chinese Medicine Council of Hong Kong --- p.8-10Chapter 2.5 --- Development of Standards --- p.10Chapter 2.6 --- Development of Centres of Good Clinical Practice --- p.10-11Chapter 2.7 --- Establishment of a Good System of Education and Training --- p.11Chapter 2.8 --- Investigation of Suspected Herbal Toxicity Cases --- p.12-13Chapter 2.8.1 --- Herbal Safety Surveillance --- p.13-14Chapter 2.9 --- Conclusion --- p.14-15Chapter Chapter 3 --- Herbal medicines used in other countries --- p.16-45Chapter 3.1 --- Overview --- p.16Chapter 3.2 --- China --- p.16-19Chapter 3.3 --- Macau --- p.22-23Chapter 3.4 --- Taiwan --- p.23-26Chapter 3.5 --- Japan --- p.27-30Chapter 3.6 --- Singapore --- p.30-31Chapter 3.7 --- Australia --- p.31-34Chapter 3.8 --- Others Asian countries --- p.35Chapter 3.9 --- USA --- p.35-39Chapter 3.10 --- United Kingdom --- p.39-41Chapter 3.11 --- Europe --- p.41-43Chapter 3.12 --- Germany --- p.43-45Chapter Chapter 4 --- Adverse reaction -- General Aspect --- p.46-63Chapter 4.1 --- Overview --- p.46Chapter 4.2 --- Traditional Chinese medicine --- p.47-49Chapter 4.2.1 --- Compound Prescriptions to Reduce Toxicity --- p.50Chapter 4.2.2 --- Processing Of Chinese Herbs --- p.50-51Chapter 4.2.2.1 --- The Aims of Herbal Drug Processing --- p.51-52Chapter 4.2.2.2 --- The Methods of Herbal Drug Processing --- p.52Chapter 4.2.2.3 --- External processing (simple treatment by trimming) --- p.52-53Chapter 4.2.2.4 --- Water processing --- p.53-54Chapter 4.2.2.5 --- Fire processing --- p.54Chapter 4.2.2.6 --- Water-fire processing --- p.54-55Chapter 4.2.2.7 --- Other methods --- p.55Chapter 4.3 --- Practical Problem in Traditional Chinese Medicine --- p.55-57Chapter 4.4 --- Evaluation of herbal adverse reactions --- p.57Chapter 4.4.1 --- Type A reactions --- p.57Chapter 4.4.2 --- Type B reactions --- p.58Chapter 4.4.3 --- Type C reactions --- p.58Chapter 4.4.4 --- Type D reactions --- p.58Chapter 4.5 --- Chinese Proprietary medicine --- p.58-59Chapter 4.6 --- Potential Risks for Herbal Adverse Reaction --- p.59Chapter 4.6.1 --- Misidentification --- p.59-60Chapter 4.6.2 --- Lack of standardisation --- p.60Chapter 4.6.3 --- Contamination --- p.60Chapter 4.6.4 --- Incorrect preparation / dosage --- p.60Chapter 4.6.5 --- Excessive dosage --- p.60-61Chapter 4.6.6 --- Individual errors --- p.61Chapter 4.6.7 --- Individual response --- p.61Chapter 4.6.8 --- Unqualified Herbal Practitioner with Wrong Prescription --- p.61-62Chapter 4.6.9 --- Interaction with Western medicine --- p.62Chapter 4.6.10 --- Prolonged Usage --- p.62Chapter 4.6.11. --- Coexisting disease --- p.62-63Chapter 4.7 --- Conclusion --- p.63Chapter Chapter 5 --- "Substitution, Adulteration or Misusing with Toxic Herbs" --- p.64-84Chapter 5.1 --- Overview --- p.64-65Chapter 5.2 --- Adulteration by Guijiu --- p.65-68Chapter 5.3 --- Anticholinergic reactions Caused by --- p.69-74Chapter 5.4 --- Overdosage --- p.74Chapter 5.4.1 --- Overdose of Aconitine --- p.74-78Chapter 5.4.2 --- Overdose of Liquorice ('Gancao') --- p.78-80Chapter 5.4.3 --- Overdose of --- p.80Chapter 5.5 --- Misusing - Personal abuse --- p.80Chapter 5.5.1 --- --- p.80-81Chapter 5.6 --- Discussion --- p.81-84Chapter 5.7 --- Conclusion --- p.84Chapter Chapter 6 --- Chinese Patent Medicine - General Aspect --- p.85-112Chapter 6.1 --- Chinese Patent Medicine --- p.85Chapter 6.1.1 --- Introduction --- p.85-87Chapter 6.1.2 --- Herbal Injection and Infusion --- p.87-88Chapter 6.1.2.1 --- Variety & Processing --- p.88Chapter 6.1.2.2 --- Stabilization --- p.88-89Chapter 6.1.2.3 --- The Molecular Size --- p.89-90Chapter 6.1.3 --- Adverse Reactions Caused by Chinese Proprietary Medicines --- p.90Chapter 6.1.3.1 --- Aconitine poisoning --- p.90Chapter 6.1.3.2 --- Nan Lien Chui Fong Toukuwan' --- p.90-91Chapter 6.1.3.3 --- Jin Bu Huan' --- p.91Chapter 6.1.3.4 --- Baoyingdan' --- p.91Chapter 6.1.4 --- Heavy metals in CPM --- p.91Chapter 6.1.5 --- The Necessarity to Develop Randomise Herbal Clinical Trial. --- p.91-92Chapter 6.1.6 --- Recommendation --- p.92-93Chapter 6.1.7 --- Conclusion --- p.93-94Chapter 6.2 --- Adulteration by synthetic therapeutic substances --- p.95-104Chapter 6.2.1 --- The Experiences in China --- p.91-99Chapter 6.2.2 --- The Experiences in Hong Kong --- p.99-101Chapter 6.2.3 --- The Experience in Taiwan --- p.101-102Chapter 6.2.4 --- Discussion --- p.102-104Chapter 6.3 --- Oil of Wintergreen (Methyl salicylate) --- p.104-112Chapter 6.3.1 --- Overview --- p.104-111Chapter 6.3.2 --- Prevention --- p.111-112Chapter Chapter 7 --- Adverse effects of Ginseng. --- p.113-123Chapter 7.1 --- Overview --- p.113Chapter 7.2 --- Botany --- p.113-114Chapter 7.3 --- Pharmacological Effects --- p.114-115Chapter 7.4 --- Adverse reaction of Ginseng --- p.115Chapter 7.4.1 --- Overdosage --- p.115-116Chapter 7.4.2 --- Substitution with cheaper and more toxic herbs --- p.116-121Chapter 7.5 --- Drug - herb Interaction --- p.121-122Chapter 7.6 --- Conclusion --- p.123Chapter Chapter 8 --- Herbal Medicines With Cardiovascular Adverse Reactions --- p.124-123Chapter 8.1 --- Overview --- p.124Chapter 8.2 --- Hypertension --- p.124Chapter 8.3 --- Atherosclerosis --- p.124-125Chapter 8.4 --- Arrhythmias --- p.125-126Chapter 8.5 --- Cardic Failure --- p.126Chapter 8.6 --- Angia Pectoris --- p.126Chapter 8.7 --- Thromboembolic Disorders --- p.126-127Chapter 8.8 --- Discussion --- p.127-128Chapter 8.8.1 --- Herbal Medicine Used in Cardiovascular System --- p.131Chapter 8.8.1.1 --- Ginseng --- p.131-133Chapter 8.8.1.2 --- Ma huang (Ephedra sinica) --- p.133-136Chapter 8.8.1.3 --- Yellow oleander (Thevetia neriifolia) --- p.136-137Chapter 8.8.1.4 --- Stephania tetrandra --- p.137-138Chapter 8.8.1.5 --- Danshen (Salvia miltiorrhiza) --- p.138Chapter 8.8.1.8 --- Ginkgo biloba --- p.138-140Chapter 8.8.1.9 --- Dong Quai (Angelicae Sinensis) --- p.140-141Chapter 8.8.1.10 --- Licorice (Glycyrrhiza Glabra) --- p.141-143Chapter 8.8.1.11 --- Berberine --- p.143Chapter 8.8.2 --- Potential Problem Caused by Chinese Proprietary Medicine --- p.143-144Chapter 8.9 --- Other Herbal Adverse Effects And Drug Interaction --- p.144-145Chapter 8.10 --- Conclusion --- p.145Chapter Chapter 9 --- Review of the Adverse Reactions to herbal treatments of Obesity --- p.146-150Chapter 9.1 --- Overview --- p.146Chapter 9.2 --- Combined With Unknown medication --- p.146-147Chapter 9.3 --- Dietary Supplements and Herbal Preparations --- p.147-149Chapter 9.4 --- Conclusion --- p.149-150Chapter Chapter 10 --- Adverse Effects of CHM used for Diabetes --- p.151-159Chapter 10.1 --- Introduction --- p.151Chapter 10.2 --- Traditional Chinese medicine used in Diabetes --- p.151Chapter 10.3 --- Adverse Reaction of Alternative Diabetic Treatment --- p.152-158Chapter 10.4 --- Conclusion --- p.159Chapter Chapter 11 --- Review of Herbal Hepatotoxicity --- p.160-194Chapter 11.1 --- Introduction --- p.160-161Chapter 11.2 --- Drug-induced hepatic injury --- p.161-163Chapter 11.3 --- Types of Liver Injury --- p.163Chapter 11.3.1 --- Pyrrolizidine alkaloid (PA) --- p.163Chapter 11.4 --- Hepatotoxicity Herbs --- p.163Chapter 11.4.1 --- Tripterygium wilfordii --- p.163-164Chapter 11.4.2 --- Rhizoma Discoreae Bulbiferae --- p.164-165Chapter 11.5 --- Consumption of Insect herbs --- p.165Chapter 11.6 --- Hepatotoxicity Cause by Chinese Proprietary Medicine --- p.165-166Chapter 11.6.1 --- Jin Bu Huan --- p.166-168Chapter 11.6.2 --- Chi R Yun (Breynia officinalis) --- p.168Chapter 11.6.3 --- Sho-saiko-to --- p.168-169Chapter 11.6.4 --- Shou-Wu-Pian --- p.169-171Chapter 11.7 --- Importance of Drug-Herb and Herb-Herb Interactions --- p.171-172Chapter 11.8 --- Diagnosis of Herbal Hepatotoxicity --- p.172-173Chapter 11.9 --- Recomandation --- p.173-174Chapter 11.10 --- Conclusion --- p.175Table --- p.176-180Chapter Chapter 12 --- Review of Herbal Nephropathy --- p.181-194Chapter 12.1 --- Introduction --- p.181Chapter 12.2 --- Aristolochia acids (AA) --- p.181-183Chapter 12.2.1 --- Intoxication of Aristolochia in Worldwide --- p.183-184Chapter 12.2.2 --- Morphological findings --- p.184-185Chapter 12.2.3 --- Carcinogenic --- p.185-187Chapter 12.3 --- MuTong (Aristolochia manshuriensis) --- p.187-188Chapter 12.4 --- Ma-dou-ling (Fructus Aristolochiae) --- p.188Chapter 12.5 --- Tripterygium wilfordii --- p.188-189Chapter 12.6 --- Gastrodia Elata --- p.189Chapter 12.7 --- Licorice (Glycyrrhiza glabra) --- p.190-191Chapter 12.8 --- Hippocampus (Sea Horse) --- p.191Chapter 12.9 --- Milabris Phanalerata --- p.191-192Chapter 12.10 --- Chinese Proprietary Medicine --- p.192-193Chapter 12.11 --- Conclusion --- p.193-194Chapter Chapter 13 --- Adverse Reaction of Herbal Medicine in Dermatology. --- p.195-217Chapter 13.1 --- Overview --- p.195-196Chapter 13.2 --- Chinese Herbal Medicine Used in Psoriasis --- p.196Chapter 13.2.1 --- Tripterygium wilfordii --- p.197Chapter 13.2.2 --- Radix Angelicae pubescentis and Radix Angelicae dahuricae --- p.197-198Chapter 13.2.3 --- Radix macrotomiae seu Lithospermi Injection --- p.198Chapter 13.3 --- Chinese Herbal Decoction For Atopic Dermatitis --- p.198-200Chapter 13.3.1 --- Tea Extracts --- p.200-201Chapter 13.4 --- Potential Adverse Effect with Herbal Medicine --- p.201Chapter 13.4.1 --- Allergic skin reactions --- p.201-202Chapter 13.4.2 --- Stevens-Johnson syndrome --- p.202Chapter 13.4.3 --- Photosensitization --- p.202-204Chapter 13.4.4 --- Pellagra --- p.204Chapter 13.4.5 --- Hepatotoxic Effects --- p.204-205Chapter 13.4.6 --- Others Adverse Reaction --- p.205Chapter 13.4.7 --- Potential Adverse Reaction Caused by Interactions --- p.205Chapter 13.5 --- Potential Adverse Reaction Caused by Contamination of Herbal Product --- p.206Chapter 13.5.1 --- Herbal creams adulterated with corticosteroids --- p.206-207Chapter 13.5.2 --- Arsenic dermatoses --- p.207Chapter 13.5.3 --- Mercury poisoning --- p.207-208Table --- p.208-211Chapter 13.6 --- Dermatological Adverse Reaction Caused by Herbs --- p.211Chapter 13.7 --- Contact Dermatitis Caused by CPM --- p.211-212Chapter 13.7.1 --- Liushenwan' --- p.211-212Chapter 13.7.2 --- Heiguiyou' --- p.212Chapter 13.7.3 --- 101 Hair Regrowth Liniment' --- p.212-213Chapter 13.7.4 --- Zhenggushui' --- p.213Chapter 13.7.5 --- Tiedayaoiing' --- p.213-214Table --- p.214-215Chapter 13.8 --- Non-dermatological adverse effects of systemic herbal treatments used for dermatological conditions --- p.215-216Chapter 13.9 --- Conclusion --- p.216-217Chapter Chapter 14 --- "Chinese Herbal Medicine in Pregnancy, Infants & Children," --- p.218-229Chapter 14.1 --- Overview --- p.218-219Chapter 14.2 --- Asian Cultures for Pregnancy --- p.219-223Chapter 14.3 --- Teratogenic Herbs --- p.224-225Chapter 14.4 --- Chinese proprietary medicines --- p.225Chapter 14.4.1 --- "“Tse Koo Choy""" --- p.225-226Chapter 14.4.2 --- "“Lu Shen Wan""" --- p.226Chapter 14.4.3 --- "“Po Ying Pills""" --- p.226-227Chapter 14.4.4 --- """Jin Bu Huan Toxicity"" in Children" --- p.227Chapter 14.6 --- Topical Preparations --- p.227-228Chapter 14.7 --- Dietary supplement --- p.228-229Chapter 14.8 --- Conclusion --- p.229Chapter Chapter 15 --- Heavy metals poisoning in traditional Chinese medicines. --- p.230-251Chapter 15.1 --- Introduction --- p.230-232Chapter 15.2 --- LEAD --- p.232Chapter 15.2.1 --- Overview --- p.232Chapter 15.2.2 --- Poisoning Cases of Boa Ning Dan --- p.233-235Chapter 15.2.3 --- Lead Poisoning in Worldwide --- p.235-238Chapter 15.3 --- MERCURY --- p.238Chapter 15.3.1 --- Overview --- p.238-239Chapter 15.3.2 --- Cinnabar --- p.239-240Chapter 15.3.3 --- Presentation --- p.240-241Chapter 15.3.4 --- Poisoning Cases --- p.241-242Chapter 15.4 --- ARSENIC --- p.242Chapter 15.4.1 --- Overview --- p.242-243Chapter 15.4.2 --- Arsenic toxicity --- p.243-244Chapter 15.4.3 --- The toxicologic mechanisms of inorganic arsenic --- p.244-246Chapter 15.4.4 --- Poisoning Cases --- p.246Chapter 15.4.5 --- Discussion --- p.247-248Chapter 15.5 --- Conclusion --- p.248Table --- p.249-251Chapter Chapter 16 --- Herb - Drug Interactions --- p.252-269Chapter 16.1 --- Overview --- p.252-254Chapter 16.2 --- Effects of Herb-drug interactions --- p.255Chapter 16.2.1 --- Gastrointestinal system --- p.255-256Chapter 16.2.2 --- Cardiovascular system --- p.256Chapter 16.2.3 --- Central nervous system --- p.257Chapter 16.2.4 --- Endocrine system --- p.257Chapter 16.3 --- Reason regard to herb-drug interactions --- p.257Chapter 16.3.1 --- Lack of Knowledge About Herbs --- p.257Chapter 16.3.2 --- Mislabelling or Adulteration --- p.258Chapter 16.3.3 --- Lack of Patient Communication About Use of Botanicals --- p.258Chapter 16.3.4 --- Lack of Practitioner Knowledge About Potential Interactions --- p.258Chapter 16.4 --- Metabolism of Herb-Drug Interaction --- p.258-259Chapter 16.5 --- Pharmacologic Interactions --- p.259-260Chapter 16.5.1 --- Interaction with Antibiotics --- p.260Chapter 16.5.2 --- Interaction with Nonsteroidal Anti-inflammatory Drugs --- p.260-261Chapter 16.5.3 --- Interaction with Sedatives --- p.261-262Chapter 16.5.4 --- Interaction with Anticoagulants --- p.262-263Chapter 16.5.5 --- Interaction with Anti-hypertensives and Diuretics --- p.263Chapter 16.5.6 --- Interaction with Spironolactone --- p.264Chapter 16.5.7 --- Interaction with Corticosteroids and Cyclosporine --- p.264-265Chapter 16.5.8 --- Interaction with Estrogen Replacement Therapy --- p.265Chapter 16.5.9 --- Interactions Between Natural Product and Drug --- p.265-266Chapter 16.6 --- Herb-to-Herb Interactions --- p.266-267Chapter 16.7 --- Conclusion --- p.268-269Chapter Chapter 17 --- Recommendation --- p.270-264Chapter 17.1 --- Overview --- p.270Chapter 17.2 --- The need to evaluate the clinical effectiveness of traditional Chinese medicine --- p.270-271Chapter 17.3 --- For the Pharmaceutical Industries --- p.211-212Chapter 17.4 --- For the physicians & patient --- p.272-274Conclusion --- p.274Chapter Chapter 18 --- Conclusion --- p.275-280Chapter Chapter 19 --- Reference --- p.281-30