2015年諾貝爾獎對中國傳統中醫意味著什么

????一位終生致力于研究傳統中藥的科學家獲得2015年生理學/醫學獎一半的獎金。這一消息傳出后，感到意外的肯定不止我一人。自1965年開始，屠呦呦和她的同事們一直在中國中醫研究院（現為中國醫學科學研究院）從事研究工作，她們可能同樣對這個結果感到震驚。

????2011年，屠呦呦因發現青蒿素而榮獲被視為諾貝爾獎風向標的拉斯克獎。青蒿素可取代標準的抗瘧疾藥物氯喹。在上世紀60年代，隨著寄生蟲耐藥性的日益提高，氯喹的療效下降。但對傳統中藥藥理活性的科學研究，從未像現在這樣引起如此廣泛的國際認可。

????諾貝爾獎甚至從未考慮過世界各地的傳統醫學知識。直到現在，這種情況終于有所改變。那么，我們應該如何解釋國際社會對傳統中藥的態度出現如此巨大的改變呢？

????從歷史記錄中發現的成果

????在負責頒發諾貝爾獎的卡羅林斯卡學院宣布評選結果之后的問答環節中，一位專家組成員強調，諾貝爾獎表彰的不僅是屠呦呦個人研究的質量，也是對有歷史記錄的實證經驗的認可。

????他表示，早在1700年前，關于中藥青蒿素對高熱有治療效果的理論就已經存在。屠呦呦是第一位從這種中藥中提取出生物活性成分并闡述其作用原理的科學家。這一結果在醫療領域帶來了一種范式轉移，使青蒿素既可用于臨床研究，也可進行大規模生產。

????屠呦呦一直強調，她從中國4世紀物理學家兼方士葛洪（約283 - 343年）的醫學著作中得到了啟發。

????葛洪的《肘后備急方》可以說是一本急診藥方的實踐手冊。這本書非常輕便，可以放在“肘后”，也就是中國古人的袖子里面，故而得名。古代中國男士有時候會在袖子里放隨身物品。從葛洪對患者癥狀的敏銳描述中可以看出，古代的中國人不僅受到瘧疾折磨，還要面臨其他致命疾病，如天花、傷寒和痢疾等。

????除了記錄青蒿素治療高熱的效果外，葛洪還在書中記錄了麻黃如何有效治療呼吸道問題，雄黃如何幫助控制某些皮膚病問題等。

????傳統成分，現代醫藥

????我們不能因為一種化合物來自大自然并一直被傳統醫學使用，便對其產生輕視之心。

????大家或許記得在2004年，美國食品藥品監督局曾禁售含有麻黃的膳食和增強機能的補充劑。它們不僅有嚴重的副作用，甚至造成數人死亡。盡管麻黃生產商向法院提出上訴，但這一禁令在美國依舊有效。但與其相關的藥物麻黃素卻被用于治療低血壓，也是非處方類哮喘藥物的常見成分。

????至于雄黃，古代希臘人和中國人都深知它的毒性。但按照中醫思想，巧妙服用的毒素可以成為其他毒素強有力的解毒劑。因此，雄黃作為一種解毒和殺蟲藥物目前依舊被中醫使用。采用外敷的方式，雄黃可以治療皮膚表面的疥瘡、皮癬和皰疹；內服可排出小腸寄生蟲，尤其是蛔蟲。

????盡管生物醫學目前并不使用雄黃或其相關礦物砷化物進行治療，但中國研究人員一直在研究雄黃的抗癌作用。2011年，約翰霍普金斯大學華裔研究員劉俊（音譯）和同事發現，一味中藥雷公藤可有效治療癌癥、關節炎和皮膚移植排斥反應。

????事實上，全球有大量有關中藥藥理活性的科學研究，屠呦呦在青蒿素方面取得的突破性成果只是冰山一角。比如，另外一種成功的抗瘧疾藥常山，便源自上世紀40年代中國大陸對中藥開展的科學研究。

????這種傳統中藥在40年代被證實為抗瘧疾藥，為毛澤東在二十年后的60年代指示中國醫學界找到治療瘧疾的藥物奠定了基礎。事實上，將屠呦呦的研究，放在整個20世紀（包括毛澤東時代在內）復雜的政治環境和中國政府對中藥自上而下支持的大背景中，或許更容易理解。

????即便在中國大陸之外，這類研究也取得了不凡的成果。例如，在上世紀70年代，美國和日本的研究人員在研究制作紅曲米的紅曲霉素時，發現了可用于降低膽固醇的抑制素藥物。

????數世紀前關于中藥醫療功效的實驗性證據，同樣影響了這項研究最初的方向。

????醫療界的“兩種語言”

????那么，諾貝爾獎授予屠呦呦的成果，是否意味著西方科學界已經改變了他們對其他醫療體系的態度？或許是，但也只是略有改變而已。

????卡羅林斯卡學院的一名專家組成員承認，科學家會從許多來源獲得開發藥物的靈感。我們不應該忽視歷史經驗。正如他所說，這些來源可能會帶來啟發，但這些古老的草藥并不能按照原有的方式使用。另一位專家組成員總結稱，不要低估屠呦呦從黃花蒿中提取活性青蒿素所用的復雜方法。

????因此，諾貝爾獎不僅是要表彰通過現代生物醫學將中藥變成有強大療效的藥物所付出的努力。表彰她的另一個重要原因是，這些藥物的成功應用拯救了無數生命，尤其是在發展中國家。

????但相比另外兩位諾貝爾醫學獎獲得者威廉姆·C·坎貝爾和大村敏，以及藥理學界那些偏重西方醫學的同事們，有一點令屠呦呦顯得非同尋常。我認為，在她的個人經歷和研究當中，屠呦呦充分彰顯了醫學雙語主義——一種既能閱讀兩種醫學語言，又能了解各自的歷史和理念差異的能力；就這則出人意料的新聞而言，最重要的是，她還體現了目前的治療干預措施的潛在價值。

????這種醫學雙語主義，正是那些嘗試著將傳統醫學經驗性知識和現代最高水平生物醫學聯系在一起的研究人員需要具備的品質。擁有了這種品質，他們或許也能像屠呦呦一樣，受到諾貝爾獎的垂青。（財富中文網）

????本文作者為約翰霍普金斯大學醫學歷史專業助理教授。文章最初發表于《The Conversation》。

????譯者：劉進龍/汪皓

????審校：任文科

????I’m sure I’m not the only one surprised by the announcement that half of the 2015 Nobel Prize in Physiology or Medicine has gone to a researcher who spent her entire career researching traditional Chinese medicine. Based at the Chinese Academy of Traditional Chinese Medicine in Beijing (now the China Academy of Chinese Medical Sciences) since 1965, scientist Youyou Tu, her colleagues, and home institution may well be just as stunned today as I am.

????Being granted the Lasker Award is often a good predictor of Nobel Prize prospects. Tu received one in 2011 for her discovery of Artemisinin as an alternative malaria cure to the standard chloroquine, which was quickly losing ground in the 1960s due to increasingly drug-resistant parasites. Scientific research on the pharmaceutically active properties of traditional Chinese medicinals, however, has never been a predictor for such widespread international recognition.

????Traditional medical knowledge anywhere in the world has not even been on the radar for Nobel Prize prospects. Until now, that is. So how should we interpret this arguably seismic shift in international attention on traditional Chinese medicine?

????Discoveries to be made in historical record

????In the question-and-answer session after the announcement at the Karolinska Institute, which awards the Nobels, one of the panelists emphasized not just the quality of Tu’s scientific research, but also the value of recorded empirical experience in the past.

????The antifebrile effect of the Chinese herb Artemisia annua (qinghaosu 青蒿素), or sweet wormwood, was known 1,700 years ago, he noted. Tu was the first to extract the biologically active component of the herb — called Artemisinin — and clarify how it worked. The result was a paradigm shift in the medical field that allowed for Artemisinin to be both clinically studied and produced on a large scale.

????Tu has always maintained that she drew her inspiration from the medical text of a fourth-century Chinese physician and alchemist named Ge Hong 葛洪 (circa 283-343).

????His Emergency Formulas To Keep at Hand (Zhouhou beijifang 肘後備急方) can best be understood as a practical handbook of drug formulas for emergencies. It was a book light enough to keep “behind the elbow” (zhouhou), namely, in one’s sleeve, where Chinese men sometimes carried their belongings. We can discern from Ge’s astute description of his patients’ symptoms that people then suffered not only from malaria but also from other deadly diseases including smallpox, typhoid and dysentery.

????Beyond recording the fever-fighting qualities of Artemisia annua, Physician Ge also wrote about how Ephedra sinica (mahuang 麻黃) effectively treated respiratory problems and how arsenic sulphide (“red Realgar,” xionghuang 雄黃) helped control some dermatological problems.

????Traditional ingredients, modern drugs

????Just because a compound has natural roots and has long been used in traditional medicine is no reason to take it lightly.

????You might remember that in 2004, the FDA actually banned ephedra-containing dietary and performance-enhancing supplements. They’d been the cause not only of serious side effects but also several deaths. The ban remains in effect in the U.S. despite a court challenge from ephedra manufacturers. Related drug ephedrine, however, is used to treat low blood pressure and is a common ingredient in over-the-counter asthma medicines.

????As for Realgar, its toxicity was well-known in both ancient Greece and Chinese antiquity. In Chinese medical thought, though, skillfully administered toxins may also be powerful antidotes for other toxins. Realgar thus continues to be used in Chinese medicine as a drug that relieves toxicity and kills parasites. Applied topically, it treats scabies, ringworm and rashes on the skin’s surface; taken internally, it expels intestinal parasites, particularly roundworms.

????Although biomedicine does not currently use Realgar or its related mineral arsenicals in treatments, Chinese researchers have been studying their anticancer properties for some time now. In 2011, a Chinese researcher at Johns Hopkins University, Jun Liu (with other colleagues), also discovered that the Chinese medicinal plant Tripterygium wilfordii Hook F (lei gong teng 雷公藤 “Thunder God Vine”) is effective against cancer, arthritis and skin graft rejection.

????Tu’s groundbreaking work on artemisinin, in fact, can be seen as the tip of the iceberg of the extensive and global scientific study of pharmacologically active Chinese medicinals, including another successful antimalarial Dichroa febrifuga (changshan 常山) that has roots in the new scientific research on Chinese medicinals in 1940s mainland China.

????It was validation of this traditional drug as an antimalarial in the 1940s, in fact, that set the foundation for Chinese leader Mao Tse Tung’s directive two decades later in the late 1960s to find a cure for malaria. Indeed, Tu’s research is best understood within the complex politics and history of top-down support from the Chinese government of Chinese medicine in mainland China during the long durée of the 20th century, and not just in the Maoist period.

????Even outside mainland China, though, such research has yielded results. In the 1970s, for example, U.S. and Japanese researchers developed the statin drugs used to lower cholesterol from studying the mold Monascus purpureus that makes red yeast rice, well, “red.”

????Empirical evidence of the medical efficacy in the rich Chinese medical archive from centuries earlier similarly influenced the initial direction of this research.

????Medically bilingual

????So is this Nobel Prize for Tu’s discovery a signal that Western science has changed how it perceives alternative systems of medicine? Perhaps, but only slightly.

????One of the Karolinska Institute panelists acknowledged that there are many sources from which scientists draw inspiration to develop drugs. Among them, we should not ignore the long history of experiences from the past. As he clarified, such sources may be inspirational, but the old herbs found there cannot be used just as they are. Don’t underestimate the sophisticated methods Tu used to extract the active Artemisinin compound from Artemesia annua, another one of the panelists concluded.

????So the Nobel Prize is not only acknowledging this complete transformation of a Chinese herb through modern biomedical science into something powerfully efficacious, but also the millions of lives saved because of its successful application worldwide, particularly in the developing world.

????But there’s something else that marks Tu as extraordinary vis-à-vis both her two fellow Nobel Laureates for medicine, William C Campbell and Satoshi ōmura, and her more Western medically oriented colleagues in pharmacology. She embodies, in both her history and her research, what I call medical bilingualism — the ability not only to read in two different medical languages but to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.

????This medical bilingualism is a quality that current researchers mining the same fine line between the empirical knowledge of traditional medical traditions and the highest level of modern biomedical science would be lucky to share with Nobel Laureate Youyou Tu.

????Marta Hanson is an associate professor of history of medicine at John Hopkins University. This article originally appeared on The Conversation.