Traditional Chinese Medicine (TCM) has a long and storied history in China, spanning more than 2,200 years. Its basic concept is that ‘qi’ – the vital force of life – surges through the body and any imbalance to it can cause illness. Chinese herbs, cupping, massage and acupuncture are all types of TCM therapies – but this balanced, holistic approach to preventing, diagnosing and treating diseases has often stood at odds with Western medicine, with some scientists claiming a lack of evidence for many TCM treatments and remedies. Either way, millions of people in China and beyond swear by the benefits of TCM and, as a result, the industry is big money.
Macao is now also looking at the benefits of TCM. However, the city’s interest lies largely in the financial advantages of the industry as it seeks to diversify its economy away from being so reliant on the gaming sector. In November, Chief Executive Ho Iat Seng pledged to intensify the city’s efforts to revive its economy in the wake of COVID-19 during his Policy Address for the Fiscal Year 2021 – and one of his focuses was clearly on further growth in Macao’s TCM industry. The SAR government’s Five-Year Development Plan, launched in 2016, already highlighted its interest in nurturing the industry as a way ‘to promote moderate economic diversification’.
Also in November, the city’s Legislative Assembly unanimously passed a government-initiated bill in general terms at a parliament plenary session. The bill – which will become ‘The Traditional Chinese Medicine Activities and the Registration System of Proprietary Chinese Medicines’ if passed – regulates the licensing of TCM products in Macao, such as their import, export, production, wholesale and retail sale, aiming at better ensuring the quality of TCM products in the local market, as well as increasing the export competitiveness of locally manufactured products and promoting the development of the industry in the city as a whole. It has now entered its second phase, meaning it will be reviewed this year before becoming law. And when the Legislative Assembly does that, it should mean that all kinds of TCM products will have to be registered before they can be sold in the local market, showing just how serious the government is on making this industry a fully regulated success.
There are 130 TCM pharmacies, 10 firms engaged in the import or export of TCM products, and five TCM manufacturers in Macao alongside more than 260 people working in local TCM pharmacies. And then there’s the nearby island of Hengqin, a key cog in the government’s plans to expand the industry in the future. In 2011, the governments of both Guangdong province and Macao committed to developing the Guangdong-Macau Traditional Chinese Medicine Technology Industrial (GMTCM) Park on Hengqin in a bid to facilitate the internationalisation and standardisation of TCM and to help the economic diversification of Macao. There are already 199 companies registered at the park with 46 of them from Macao as of the end of last year’s count. It has also been reported that the Hengqin branch of the Zhuhai People’s Hospital earlier this year signed contracts with 53 Macao doctors who are now able to practice directly at the hospital. Many of them are said to specialise in TCM.
Another feather in the cap of Macao’s TCM industry is the State Key Laboratory of Quality Research in Chinese Medicine (SKL-QRCM). Since 2011, this national platform for the development of Chinese medical research has been based at both the University of Macau (UM) and the Macau University of Science and Technology (MUST). Dr Zhou Hua, a full professor at the SKL-QRCM and dean of the Faculty of Chinese Medicine at MUST, says he can foresee the long-term success of the TCM industry in Macao as it can ‘leverage the existing policy advantages permitted by the central government’ while also ‘benefitting from the growing international recognition’ that TCM has garnered over recent years. Indeed, the World Health Organisation (WHO) has played no small part in this as in 2018 it announced it will, for the first time, include TCM in its globally used diagnostic tool for epidemiology, health management and clinical purposes, giving the ancient Chinese medical approach new-found international gravitas.
“Generally speaking,” says Dr Zhou, “the developmental trend of Chinese medicine in the international arena is very positive given the central government has been promoting its standardisation and modernisation in and outside of China for the past three decades. For example, Australia and Portugal have already enacted TCM legislation and both the Korean and Japanese TCM industries have developed very well – both of which originated from ancient China.” Dr Zhou adds that there are also many practicing TCM doctors around the world ‘who studied TCM in China or even in their own countries’.
The dawn of a new millennium brought TCM into the economic conversation in Macao, claims Dr Zhou. “The development of TCM in Macao started from the founding of TCM education in the city in 2000,” he says. “The TCM scientific research centres were founded in 2011. Then we started forming patents and transforming products. Now, we believe the next stage is to use everything we have created and learned over 21 years and transform all the research results into an entire industry in Macao. I think there will be tremendous changes in the city’s TCM industry over the next five to 10 years and that will contribute in no small way to the economic diversification of Macao.”
“I can foresee the long-term success of the TCM industry in Macao.”
Dr Zhou Hua
Local and national benefits
In order to establish a rounded and profitable TCM industry in Macao, the city needs to capitalise on the benefits of both local and national TCM policies, according to Dr Zhou. “Currently in China,” he says, “TCM has its own legislation that is separate from Western medicine. This is a way to further promote the development of TCM. Unique policies and projects can accelerate the industrialisation of TCM in the Greater Bay Area.” The GBA covers Macao and Hong Kong, as well as nine other Chinese cities in the region. Industrial and economic success in one city can add to the success of the GBA as a whole.
Dr Zhou gives a good example. He says that the ‘Work Plan for Regulatory Innovation and Development of Pharmaceutical and Medical Device in the Guangdong-Hong Kong-Macao Greater Bay Area’, which was promulgated by the central government at the end of last year, will give Macao and Hong Kong residents the chance to seek ‘suitable healthcare services’ in the mainland cities of the GBA, should they choose. It will also help further promote the development of TCM across the GBA as it brings healthcare institutions closer together. Dr Zhou points out that, under the plan, power will be given to the government of Guangdong province ‘to grant approval’ for Hong Kong or Macao-registered drugs and ‘medical devices’ – and that this application process will be simplified. He says this move will ‘highly enhance the convenience for pharmaceutical enterprises to expand their businesses in Macao’.
“The GMTCM Park provides a platform for TCM doctors in Macao to communicate with the young and famous doctors across the country.”
Dr Lai Ka Meng
In terms of local policy, Dr Zhou says that the TCM industry in Macao will truly be able to ‘take off’ when the ‘Traditional Chinese Medicine Activities and the Registration System of Proprietary Chinese Medicines’ bill is passed. “Since 1999,” he says, “Macao’s three Chief Executives have established a sound foundation for the city’s TCM industry at different stages by educating talents, launching services and scientific research, researching technology and implementing policies. All that’s lacking now is the Chinese Traditional Patent Medicine Registration Law.” Dr Zhou says that there’s a ‘long registration process’ for any TCM product made in Macao right now. He notes that an individual request must be made to the city’s Health Bureau for every new batch but he says that when the registration law – which has been under review since 23 October – is in force, the process will be smoother and ‘will not only help to standardise the use of registered TCM products in the city but also allow them to go out to market across the GBA’.
Dr Zhou sees the potential of the TCM industry in Macao but he does note that its development will be ‘a gradual and arduous process that requires the collaborative efforts of academia, government and the people’ as well as ‘support elements from mainland China’. “There is a huge gap in the level of industrial manufacturing between Macao and mainland Chinese TCM,” he says. “In Macao, there are only around a dozen small-scale registered pharmaceutical factories. Moreover, to achieve such a well-established TCM industry, it will require massive resources and investment of up to RMB 100 million (MOP 124 million). Therefore, it is necessary to introduce larger capital and domestic companies, such as the China National Pharmaceutical Group – also known as Sinopharm – and other pharmaceutical companies.”
“Another challenge we are facing,” continues Dr Zhou, “is that we need more professionals in the TCM industry. Previously, we have been focusing on the training of TCM talents in the scientific research and development sector. Therefore, we need to make adjustments to the current policy on talents. For example, the production stages of TCM products can be done in the pharmaceutical companies in Guangdong, with later key stages done in Macao. This will promote the development of the TCM production industry in Macao and create a much wider pool of talent in the city. Thus, how to attract these talents should be outlined in the policy.”
Dr Lai Ka Meng is a registered TCM doctor at Cheng Mio Medical Centre in the heart of Macao. He boasts a decade of work experience in the field and believes that the city’s current TCM talent policies have actually put local TCM practitioners in a strongly competitive position. He says: “There is an incentive-based policy for local TCM doctors called the Closer Economic Partnership Arrangement (CEPA). This allows statutory and registered TCM doctors in Macao to work on the mainland for at least three years. And we are exempt from the one-year internship requirement that’s standard for the biggest hospitals on the mainland, as well as the mainland’s qualification examination.” Dr Lai adds that local TCM doctors are also offered exchange and work opportunities in Portuguese-speaking countries across the world.
Dr Lai welcomes the Macao government’s drive to create a strong TCM industry in the city. “Macao’s TCM market is relatively standardised,” he says. “Similar to the measures on the mainland, we also have an examination and training system for TCM practitioners to ensure quality. Also, one of the advantages of Macao is that the government’s Department for Pharmaceutical Affairs (DAF) can regulate the quality and efficacy of the TCM ingredients more effectively due to the city’s small size. This enables a more reliable regulatory regime to ensure the safety and quality of the clinical practice of TCM. This kind of industrialisation may not have a breakthrough effect in the short-term as scientific research takes a long time but I believe the industrialisation of TCM will be beneficial to the economic diversification of Macao in the long run. Maybe, in the future, Macao can become not only a trading base for TCM but also a patented platform for quality monitoring in the city or over at the GMTCM Park in Hengqin.”
The GMTCM Park is already a ‘good bridge between the TCM industry and TCM practitioners’ in the GBA and Macao, according to Dr Lai. “It provides a platform for TCM doctors in Macao to communicate with the young and famous doctors across the country,” he says, “or even to communicate with TCM doctors in Portuguese-speaking countries. This all helps in the effective promotion of TCM across the world.” He adds that the GMTCM Park not only assists enterprises in the production of TCM products but also in the areas of quality control and policy research. He notes that the park was involved in ‘providing opportunities for talent exchanges and merchandise sales’ at a TCM conference in Lisbon, Portugal, in 2018, and it also held a ‘very innovative’ TCM training course in the Portuguese language in 2019. Also, in 2016 and 2017, TCM training courses were organised for young Mozambique students in their home country by both the Mozambique Ministry of Health (MISAU) and the GMTCM Park in partnership.
Dr Zhou admits the development of the GMTCM Park has taken much time so far and has been ‘difficult’, not least because there was a whole new way of working when enterprises from Macao and the mainland first joined forces. But he says that now the park is into its ‘development period’, with ‘industrial, factory and equipment construction’ at its heart, it’s all coming together. “Next,” he says, “manufacturing production and sales will gradually develop.”
In addition to this, the TCM industry should also provide an abundance of opportunities for businesses to fuel innovation. Already there are resort businesses appearing on Hengqin with TCM therapies as a highlight, such as the Ruilian (Hengqin) Wellness Resort that caters to visitors and the Serensia Woods retirement and tourism lifestyle project that we detail in our feature on Building the woods.
Setting out the law
As mentioned earlier, new laws are crucial to the success of the TCM industry in Macao. The bill that should lead to a law regulating the licensing of TCM products in Macao was discussed just a few weeks ago by the government. Topics discussed included the punishments that anyone who counterfeits or illegally supplies TCM products, ingredients and ‘decoction pieces’ would get once the bill becomes law. According to the chairman of the First Standing Committee of the Legislative Assembly, Ho Ion Sang, during government sessions last month, counterfeiters could be sentenced to a maximum of five years in prison if they fall foul of the law when it comes into force. Ho said that the law aims to provide a sustainable developmental framework for the TCM industry and ensure the safety of TCM. The bill will be further optimised and inspected over the coming months.
The Health Bureau arm of the government plays an active role in supporting and facilitating the development of the TCM industry in Macao, including in the establishment of the legal system surrounding the industry, as well as with the promotion of TCM professionals’ training and international exchanges between TCM professionals. A spokesman for the bureau tells us that the bill, which has a Chinese and a Portuguese name that translates to ‘Traditional Chinese Medicine Activities and the Registration System of Proprietary Chinese Medicines’, has been passed by the city’s Legislative Council ‘in general terms’ and has also ‘been deliberated in detail’ by the government’s First Standing Committee.
“At present,” says the spokesman, “all parts of the world require that imported products be registered in the place of origin. The bill proposes a registration system for proprietary Chinese medicines which can fill in the gaps in the existing legislation, which can further ensure the safety, effectiveness and quality of proprietary Traditional Chinese Medicines in the city’s market and also improve the competitiveness of our export sector.” The spokesman adds that the bill ‘also introduces Good Manufacturing Practices (GMP)’, meaning that ‘all new pharmaceutical factories must comply with GMP standards and be in line with international standards in the future’.
“After the introduction of the bill,” continues the spokesman, “it will provide a legal basis for the registration and listing of proprietary Traditional Chinese Medicines in Macao and for it to ‘go global’, which will help enhance the competitiveness of our export sector and attract more mainland manufacturers to produce proprietary Traditional Chinese Medicines in Macao.” The spokesman adds that, in the meantime, ‘designated medical institutions operating in nine cities in the Greater Bay Area’ are allowed to ‘use urgently needed medicines’ that are on the market in Macao ‘for clinical use after getting approved by the Guangdong Provincial Food and Drug Administration’ and that ‘such medicines can also be sold in the Greater Bay Area’.
The spokesman says that, in the future, ‘Macao will work closely with the mainland’s drug regulatory authorities’ to develop the Greater Bay Area, ‘a market with a population of 70 million’. “This is an important step to establish a Macao brand for the proprietary Traditional Chinese Medicines circulating in Macao,” adds the spokesman. “At the same time, this bill establishes the qualification requirements for technical supervisors in different places, providing room for job and development opportunities for Traditional Chinese Medicine doctors, Traditional Chinese Medicine practitioners and Chinese pharmacists. This can create favourable conditions for the young Traditional Chinese Medicine professionals to further develop, which is in line with the government’s policy principles.”
The ‘Medical Staff Professional Qualifications and the Legal System for Practice Registration’ – translated from its Chinese and Portuguese name – law is due to come into effect in Macao on 1 October. The spokesman says this ‘will regulate the professional qualifications and practice registration of 15 types of medical professionals, including Traditional Chinese Medicine practitioners and Chinese pharmacists’. “To ensure the practice level of TCM practitioners and pharmacists,” says the spokesman, “the new regulation also includes a credit system, which can ensure a sustainable professional development of the industry. It is one of the conditions for the practitioners to licence renewal so that the practitioners can acquire the most up-to-date medical knowledge and skills, thus protecting public safety and health.”
“Macao will work closely with mainland China’s drug regulatory authorities to develop TCM in the Greater Bay Area.”
Health Bureau spokesman
The Health Bureau spokesman says that the WHO Collaborating Centre for Traditional Medicine (Macao) was established in 2015 and has ‘organised many inter-regional and local training workshops and expert meetings to promote talent training and exchanges in the industry’. By last year, says the spokesman, the centre had provided training to around 2,400 health officials and local professionals from all over the world. In addition, during the pandemic last year, the fourth ‘thematic training on the transmission of clinical experiences by recognised TCM doctors’ sessions were held, ‘providing online training for more than 400 local registered Chinese doctors’, as well as TCM practitioners. Two online training courses have already been held this year by the centre ‘which attracted about 200 participants’. In addition, the spokesman says that ‘the centre will hold inter-regional training workshops in Macao every year’ until 2023 and ‘will continue to invite TCM masters and famous TCM doctors from mainland China to come to Macao to provide clinical teaching and topical seminars’.
“In order to deepen talent cultivation in the TCM industry,” says the spokesman, “the Health Bureau will actively co-operate with GMTCM Park and continue to carry out more Traditional Chinese Medicine training programmes, as well as actively support the young Chinese medicine practitioners in Macao to gain a deeper understanding of the development of the Greater Bay Area and to be part of the development plan of the Greater Bay Area.” The spokesman adds that the bureau will continue to play a role in the WHO centre and is ‘actively preparing for the first training course’ for TCM practitioners ‘in order to further elevate the level of’ TCM professionals. And ‘with the aim to create more favourable conditions’ for the development of the Greater Bay Area market, a dedicated TCM service development department ‘will also be established to boost the overall development’ of TCM medicine services.
Macao is certainly well on its way to having a strong, well-regulated TCM industry in the city, on Hengqin and connected to the wider GBA TCM network. The potential is enormous and although it will take a few more years yet to see a comprehensive and relatively large TCM industry in the SAR, all the preparatory work is being done now by the lawmakers, the government, the TCM practitioners and everyone else connected with the industry in the city. The debate over whether TCM is ‘better’ or ‘more effective’ than Western medicine will likely rage on globally but it doesn’t make any difference to Macao. The city is dedicated to the blossoming of an industry which may crucially help it to economically diversify in the future. That, to many people, will be just what the doctor ordered.
Resorting to TCM
A new wellness resort on Hengqin will focus on TCM
Hengqin Island is quickly becoming an important centre for Macao and the Greater Bay Area’s TCM industry. And that doesn’t just mean for research and development. That also means for leisure too. Take the Ruilian (Hengqin) Wellness Resort, which is due to open its doors later this year. Owned by the GMTCM Park and managed by Banyan Tree Hotels and Resorts, this is the first TCM wellness resort on the island.
Located by the estuary of the Zhujiang River in Hengqin and overlooking vast wetlands, Ruilian is set to offer holistic wellness and hotel services, featuring 214 wellness rooms and suites and 18 villa units alongside three wellness-orientated food and beverage outlets. There’s a heavy TCM presence here as the resort’s core service team is made up of a group of renowned TCM experts.
There are personalised TCM services available to guests, as well as TCM-related cuisine on the menu.
Ruilian’s focus is on ‘hotel, healthcare and medicine’ with TCM healing experiences at the heart of the programme. Richard Chan, the resort’s area general manager, says it’s the ‘perfect encounter of TCM and Banyan Tree Hotels and Resorts’, aiming ‘to create a personalised wellness destination based on TCM theory and wellness’. “As government entities continue to support wellbeing programmes for the health of citizens,” he says, “wellness travel appeals to more and more people, and TCM continues to be one of the main interests among people of all ages. Our target groups are those people who embrace services from science to spirit, seek wellness and enjoy a healthy lifestyle.”