Recent media reports have again warned that traditional Chinese medicine pharmacies are disappearing and might vanish altogether within the next 15 years.
Yet viewed through the broader lens of social and economic change, the rise and fall — or transformation — of industries is rarely the result of a single factor, nor is it inherently negative.
Taiwan itself offers a clear parallel. Once renowned globally for manufacturing, it is now best known for its high-tech industries. Along the way, some businesses successfully transformed, while others disappeared. These shifts, painful as they might be for those directly affected, have not necessarily harmed society as a whole. The same perspective should be applied to the evolution of the traditional Chinese medicine sector.
The distinction between “Chinese” and “Western” medicine is a semantic classification. Once a drug enters the body, it exerts physiological effects regardless of its cultural origin. Yet many people still assume that Chinese herbal medicine is inherently gentle, safe for frequent use or suitable for routine health maintenance in the absence of illness.
This misconception can be dangerous. Without guidance from pharmacists, self-medication carries real risks. There have been situations in which herbs such as dang gui (當歸, Angelica sinensis or female ginseng) were taken with blood pressure medication, leading to dangerously low blood pressure.
It was precisely because of such risks that Taiwan, in its comprehensive 1993 revision of the Pharmaceutical Affairs Act (藥事法), firmly established the principle that there should be no regulatory distinction between Chinese and Western medicines. All medicines, regardless of origin, must be dispensed and supervised by qualified pharmaceutical professionals.
Article 28, Paragraph 2 of the act explicitly requires that “dealers of Chinese medicines and their sales shall have a full-time resident Chinese medicine doctor or a pharmacist or assistant pharmacist who has received training in Chinese medicines to an appropriate level for management.”
The first and second paragraph of Article 29 mandates that “manufacturers of Western pharmaceuticals shall have a full-time resident pharmacist to supervise the manufacturing. Manufacturers of Chinese medicines shall have a full-time resident Chinese medicine doctor or a pharmacist who has received training in Chinese medicines to an appropriate level to supervise the manufacturing.
In addition to the provisions of the preceding paragraph, if a manufacturer of Chinese medicines plans to manufacture Chinese medicines in the form of Western pharmaceuticals or to adulterate Western pharmaceuticals in Chinese medicines, there shall be an additional full-time pharmacist to supervise the manufacturing.”
The message in the legislation is clear: Traditional Chinese medicine falls squarely within the professional domain of licensed pharmacists and traditional Chinese medicine physicians.
To protect the livelihoods of those already engaged in the traditional medicine trade at the time, the law also introduced a “sunset clause” in Article 103, intended solely to safeguard the rights of traditional Chinese medicine vendors operating prior to the 1993 revision.
However, the provision has generated controversy. A 1998 amendment loosened its restrictions and, more recently, it has given rise to disputes over what critics argue is an unlawful expansion of its interpretation by the Ministry of Health and Welfare.
Pharmacists are among the most accessible healthcare providers in everyday life. While the number of traditional herb shops has declined, pharmacies that also dispense and retail traditional Chinese medicine have steadily increased — from 3,071 in 2011 to 5,247 last year.
Likewise, the number of traditional Chinese medicine retailers managed on-site by pharmacists or assistant pharmacists has risen to 1,392 from 969.
The figures suggest that pharmacists are not abandoning the sector; on the contrary, they are entering it.
Industries inevitably evolve alongside changing social and economic conditions. Just as Taiwan has moved from an agrarian to an industrial and to a high-tech economy, the decline of traditional Chinese medicine shops reflects not the death of the industry, but its transformation. If the transition allows professionally trained pharmaceutical personnel to take the lead — ensuring the safe use of Chinese and Western medicines — it is hard to argue that the outcome would be anything but beneficial.
For the goal of a healthier Taiwan, the gains in drug safety and professional oversight are likely to far outweigh the losses.
Huang Shyh-shyun is chairman of the Chinese Medicine Development Committee of the Taiwan Pharmacist Association.
Translated by Lin Lee-kai
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