2015年诺贝尔奖对中国传统中医意味着什么

    一位终生致力于研究传统中药的科学家获得2015年生理学/医学奖一半的奖金。这一消息传出后，感到意外的肯定不止我一人。自1965年开始，屠呦呦和她的同事们一直在中国中医研究院（现为中国医学科学研究院）从事研究工作，她们可能同样对这个结果感到震惊。

    2011年，屠呦呦因发现青蒿素而荣获被视为诺贝尔奖风向标的拉斯克奖。青蒿素可取代标准的抗疟疾药物氯喹。在上世纪60年代，随着寄生虫耐药性的日益提高，氯喹的疗效下降。但对传统中药药理活性的科学研究，从未像现在这样引起如此广泛的国际认可。

    诺贝尔奖甚至从未考虑过世界各地的传统医学知识。直到现在，这种情况终于有所改变。那么，我们应该如何解释国际社会对传统中药的态度出现如此巨大的改变呢？

    从历史记录中发现的成果

    在负责颁发诺贝尔奖的卡罗林斯卡学院宣布评选结果之后的问答环节中，一位专家组成员强调，诺贝尔奖表彰的不仅是屠呦呦个人研究的质量，也是对有历史记录的实证经验的认可。

    他表示，早在1700年前，关于中药青蒿素对高热有治疗效果的理论就已经存在。屠呦呦是第一位从这种中药中提取出生物活性成分并阐述其作用原理的科学家。这一结果在医疗领域带来了一种范式转移，使青蒿素既可用于临床研究，也可进行大规模生产。

    屠呦呦一直强调，她从中国4世纪物理学家兼方士葛洪（约283 - 343年）的医学著作中得到了启发。

    葛洪的《肘后备急方》可以说是一本急诊药方的实践手册。这本书非常轻便，可以放在“肘后”，也就是中国古人的袖子里面，故而得名。古代中国男士有时候会在袖子里放随身物品。从葛洪对患者症状的敏锐描述中可以看出，古代的中国人不仅受到疟疾折磨，还要面临其他致命疾病，如天花、伤寒和痢疾等。

    除了记录青蒿素治疗高热的效果外，葛洪还在书中记录了麻黄如何有效治疗呼吸道问题，雄黄如何帮助控制某些皮肤病问题等。

    传统成分，现代医药

    我们不能因为一种化合物来自大自然并一直被传统医学使用，便对其产生轻视之心。

    大家或许记得在2004年，美国食品药品监督局曾禁售含有麻黄的膳食和增强机能的补充剂。它们不仅有严重的副作用，甚至造成数人死亡。尽管麻黄生产商向法院提出上诉，但这一禁令在美国依旧有效。但与其相关的药物麻黄素却被用于治疗低血压，也是非处方类哮喘药物的常见成分。

    至于雄黄，古代希腊人和中国人都深知它的毒性。但按照中医思想，巧妙服用的毒素可以成为其他毒素强有力的解毒剂。因此，雄黄作为一种解毒和杀虫药物目前依旧被中医使用。采用外敷的方式，雄黄可以治疗皮肤表面的疥疮、皮癣和疱疹；内服可排出小肠寄生虫，尤其是蛔虫。

    尽管生物医学目前并不使用雄黄或其相关矿物砷化物进行治疗，但中国研究人员一直在研究雄黄的抗癌作用。2011年，约翰霍普金斯大学华裔研究员刘俊（音译）和同事发现，一味中药雷公藤可有效治疗癌症、关节炎和皮肤移植排斥反应。

    事实上，全球有大量有关中药药理活性的科学研究，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，另外一种成功的抗疟疾药常山，便源自上世纪40年代中国大陆对中药开展的科学研究。

    这种传统中药在40年代被证实为抗疟疾药，为毛泽东在二十年后的60年代指示中国医学界找到治疗疟疾的药物奠定了基础。事实上，将屠呦呦的研究，放在整个20世纪（包括毛泽东时代在内）复杂的政治环境和中国政府对中药自上而下支持的大背景中，或许更容易理解。

    即便在中国大陆之外，这类研究也取得了不凡的成果。例如，在上世纪70年代，美国和日本的研究人员在研究制作红曲米的红曲霉素时，发现了可用于降低胆固醇的抑制素药物。

    数世纪前关于中药医疗功效的实验性证据，同样影响了这项研究最初的方向。

    医疗界的“两种语言”

    那么，诺贝尔奖授予屠呦呦的成果，是否意味着西方科学界已经改变了他们对其他医疗体系的态度？或许是，但也只是略有改变而已。

    卡罗林斯卡学院的一名专家组成员承认，科学家会从许多来源获得开发药物的灵感。我们不应该忽视历史经验。正如他所说，这些来源可能会带来启发，但这些古老的草药并不能按照原有的方式使用。另一位专家组成员总结称，不要低估屠呦呦从黄花蒿中提取活性青蒿素所用的复杂方法。

    因此，诺贝尔奖不仅是要表彰通过现代生物医学将中药变成有强大疗效的药物所付出的努力。表彰她的另一个重要原因是，这些药物的成功应用拯救了无数生命，尤其是在发展中国家。

    但相比另外两位诺贝尔医学奖获得者威廉姆·C·坎贝尔和大村敏，以及药理学界那些偏重西方医学的同事们，有一点令屠呦呦显得非同寻常。我认为，在她的个人经历和研究当中，屠呦呦充分彰显了医学双语主义——一种既能阅读两种医学语言，又能了解各自的历史和理念差异的能力；就这则出人意料的新闻而言，最重要的是，她还体现了目前的治疗干预措施的潜在价值。

    这种医学双语主义，正是那些尝试着将传统医学经验性知识和现代最高水平生物医学联系在一起的研究人员需要具备的品质。拥有了这种品质，他们或许也能像屠呦呦一样，受到诺贝尔奖的垂青。（财富中文网）

    本文作者为约翰霍普金斯大学医学历史专业助理教授。文章最初发表于《The Conversation》。

    译者：刘进龙/汪皓

    审校：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.