chinese research paper

Research Guide for Chinese Studies

New/ on trial databases, harvard-yenching library digital collections, digital scholarship projects, research guides for east asian studies, chinese studies at harvard.

• Historical Texts / Modern & Contemporary Texts / Gazetteers / Year Books / Rare Books / E-Books
• Journals / Dissertations / Proceedings
• Media / Newspapers
• Maps / Arts / Images
• Reference Tools
• Bibliographies / Union Catalog
• Archival Materials and Finding Aids
• Useful Links for East Asian Studies

This guide provides an introduction to selected electronic resources for Chinese studies.  Any suggestions, questions or comments, please contact  Xiao-he Ma, Sharon Li-shiuan  Yang  .  Thanks!

• The Accessible World
• Harvard-Yenching Library  
• Harvard Library
• Harvard University
• Harvard Library Event Calendar
• Harvard University Event Calendar
• News and Events from the Harvard-Yenching Institute  
• HYL Linktree
• How to Search Harvard-Yenching Library Rare Books ( YouTube clip)
• Harvard-Yenching Chinese Rubbings Title List 中文拓片清單
• Harvard-Yenching Classification Scheme 哈佛燕京分类号
• HYL Book Stacks Guide
• Manchukuo Postcard title list 满洲国明信片清单
• Naxi manuscripts - HYL access number vs. new number cross reference table
• Naxi manuscripts - Rock's access number vs. new number cross reference table
• Key Information for Using HYL Materials and Services
• Harvard-Yenching Library Research Orientation Schedule, Spring 2024
• Ainosco Search 是科探索 New more... less... Ainosco Search是科探索：https://www.ainoscosearch.com/ ID: hu2022 Password: 2022hu 試用期間: 即日起到2023/3/31 使用方式很簡單，只要搜尋關鍵字即可找到該關鍵字出現在那些圖書全文中。 搜尋結果的左邊可選擇只出現"本館館藏"的圖書，或是有電子書全文的圖書，但由於目前是試用，電子書全文提供與否是按貴館是否有採購而呈現。 如貴館正式訂購此數據庫就可以進行線上電子書使用。
• China Research Gateway (CRG) On Trial
• ERUDITION Zhongguo yi shu ku 爱如生中国艺术库 New
• Fan yun wen xian 繙云文獻- 台灣文獻, 近代報刊, 滿鐵文獻 On Trial (till 2024.6.30) Access through Harvard VPN more... less... Created by 得泓資訊有限公司, Taiwan
• Gale. China and the Modern World: Records of the Maritime Customs Service of China 1854–1949 New
• History of the Communist Party of China Database 中共党史经典文献数据库 On Trial (till 2024.6.30) more... less... Access through VPN
• Keledge E-Book Platform 可知电子书平台 New
• SuperStar. Bailian Academic Search 百链学术搜索 New
• Wenxinge Full-text database of Chinese & Japanese Ancient Books 文心閣古籍數據庫 ( Diaolong Database 雕龍全文數據庫) On Trial (till 2023.3.31)
• Bao Juan 寶卷 OPEN ACCESS
• Carter D. Holton Photos Collection 海映光牧师中国甘青地区少数民族信仰文化老照片 OPEN ACCESS
• Chinese Maritime Collection 中國舊海關資料 OPEN ACCESS
• Chinese Old Local Gazetteers 中國舊方志 OPEN ACCESS
• Chinese Rare Books- CURIOSity Digital Collection 中文善本特藏 OPEN ACCESS
• Chinese Republican Period Collection 民國時期文獻 OPEN ACCESS
• Chinese Rubbings- CURIOSity Digital Collection 中文拓片 OPEN ACCESS
• Christianity Collection 基督教傳教士文獻 OPEN ACCESS
• Dazibao and Woodcuts from 1960s China 大字报
• Digital Maps- China, Japan, Korea, Vietnam, Taiwan, Hong Kong, Macau 数字地圖 OPEN ACCESS
• Edwards Bangs Drew Chinese Maritime Customs Services Photographs 爱德华兹班德鲁中国旧海关服务时期老照片
• Er Qi Collection 二齊 (齊耀琳, 齊耀珊) 藏书 OPEN ACCESS
• Hart Collection 哈特教授藏書 OPEN ACCESS
• Harvard-Yenching Library Digital Maps 数字地图 OPEN ACCESS
• Harvard-Yenching Library Online Photographs
• Hedda Morrison Photograph Albums more... less... https://id.lib.harvard.edu/alma/990152811020203941/catalog
• Hedda Morrison Photographs of China 赫逹莫里森中國老照片, 1933-1946 OPEN ACCESS more... less... All of the photographs contained in the 28 albums assembled by Hedda Morrison and beaqueathed to Harvard-Yenching Library have been cataloged and digitized and can be viewed in VIA (Visual Information Access), the union catalog of visual resources at Harvard. This site provides information about the collection and strategies for effectively searching for Hedda Morrison photographs in VIA.
• Japanese Rare Books 日文善本古籍 OPEN ACCESS
• John K. Fairbank and Edwin O. Reischauer "Rice Paddies" Lantern Slide Collection 费正清教授，海肖爾教授 “稻田” 课程教學幻燈片 OPEN ACCESS
• Joseph F. Rock Collection 约瑟夫.洛克中国老照片
• Korean Rare Books 韓文善本古籍 OPEN ACCESS
• Manchukuo Collection- Digital maps 滿洲國收藏- 地圖類 OPEN ACCESS
• Manchukuo Collection- Postcards 滿洲國收藏- 明信片 OPEN ACCESS
• Manchu Rare Books 滿文古籍 OPEN ACCESS
• Ming-Qing Women's Writings 明清婦女著作 (McGill University Library 合作項目) OPEN ACCESS
• Mongolian Rare Books 蒙文古籍 OPEN ACCESS
• Naxi Manuscripts 納西東巴經 OPEN ACCESS
• North Korean Posters 北朝鲜海报 more... less... Korea Institute - Harvard-Yenching Library North Korean poster digitization project
• Prof. Hanan's Personal Collection 韩南教授藏书 OPEN ACCESS
• Qi Rushan Collection 齊如山藏書 OPEN ACCESS
• Rev. Claude L. Pickens, Jr. Collection on Muslims in China 畢敬士中國穆斯林和基督教传教士老照片 OPEN ACCESS
• Souvenir de Chine photos 中日二次战争照片集 OPEN ACCESS
• (CBDB) China Biographical Database 中國歷代人物傳記資料庫 OPEN ACCESS
• Academia Sinica Digital Humanities Research Platform 中央研究院數位人文研究平台
• Academia Sinica Digital Humanities Research Platform 中研院數位人文研究平台操作說明 YouTube playlist (Chinese only)
• Academia Sinica Text Recognition and Proofreading Platform 中央研究院文字辨識與校對平台
• Archive it - Greater China Archival Resources Web Archive 檔案指南 OPEN ACCESS New more... less... For a blog post that may be redistributed across the Confederation, please see the following: https://ivpluslibraries.org/2020/09/iplc-launches-the-greater-china-archival-resources-web-archive/.
• BiogRef- Distributed Metadata Sharing for Online Biographical Information OPEN ACCESS
• Buddhist Studies Authority Database Project 佛學規範資料庫 OPEN ACCESS
• CBDB Ontology on WebVOWL
• CBDB Ontology 上海图书馆 CBDB 本体
• China Historical GIS 中国历史地理信息系统 OPEN ACCESS
• Chinese Ancient Text Electronic Resources Cross-cat Query System 电子汉籍联合目录 OPEN ACCESS
• Chinese Iconography Thesaurus 中國圖像誌索引典 OPEN ACCESS
• Chinese Text Project (ctext.org ) 中國哲學書電子化計劃 OPEN ACCESS
• Contemporary Chinese Village Gazetteers Data (CCVG ) 数字村庄
• CrossAsia Fulltext Search
• Cultural Japan
• DASH (Digital Access to Scholarship at Harvard)
• Data Science Services 哈佛定量社會科學分析中心IQSS
• Digital Collections for Chinese Studies (Dashboard link)
• Digital Collections for Chinese Studies（WebApp link)
• Digital Dunhuang 數字敦煌 OPEN ACCESS
• Digital Humanities Platform of Shanghai Library 上海圖書館歷史人文大數據平台
• DocuSky BETA 工具集
• Exploring Republican China in the USC Digital Library- An Experimental Metadata Analysis
• THE FIRST EMPEROR OF CHINA(秦始皇) - Global Memory Net Project
• Han Cloud Search Platform 漢雲平台
• Harvard Dataverse Support
• Harvard University Digital Scholarship Events
• Harvard University Digital Scholarship Support Group
• Harvard WorldMap OPEN ACCESS
• Historical Document Crowd Sourcing Platform 上海图书馆历史文献众包台
• Huihui Islamic Scholars in Late Ming and Early Qing 明末清初回回伊斯兰学者行迹图
• The International Dunhuang Project: The Silk Road Online (IDP) 國際敦煌項目 OPEN ACCESS
• MARKUS- Text Analysis and Reading Platform for Literary Chinese 瑪庫斯平台 OPEN ACCESS more... less... .With MARKUS you can upload a file in classical Chinese and tag personal names, place names, temporal references, and bureaucratic offices automatically. You can also upload your own list of key terms for automated tagging. You can then read a document while checking a range of reference works at the same time, or compare passages in which the same names or keywords appear. Or, you can extract the information you have tagged and use it for further analysis in our visualization platform and other tools. The March 2015 release includes: -improvements in automated markup: emperor names have been added and alternate names markup improved to reduce superfluous alternate name markup -inline text editing: correct mistakes or add punctuation to the base text -switching between markup modes: choose between modes from the left bar; no need to re-upload files -new keyword markup functionality: automatically discover keywords and select appropriate ones for markup -additional dictionaries in reading mode: trials for Buddhist and medical term dictionaries -full Chinese language version -links to relevant tools: starting with the newly released CBDB name/official title lookup tool -updated and expanded help text and videos -FAQ: for technical problems and useful markup tips Also added two new tools: 1) The CBDB Mac Dictionary allows readers to search China Biographical Database by either using Mac OS X integrated Spotlight or by selecting any name or partial name in any software programme; 2) The CBDB Name/Title Lookup helps readers identify persons for whom only part of the name AND an official title or part thereof are known.
• MeToo and the Women’s Movement in China. Collected by: Ivy Plus Libraries Confederation
• Old Maps Online- the search engine for historical maps OPEN ACCESS
• Open LoGaRT- Rare Local Gazetteers at Harvard-Yenching Library: Open Access Collection
• Research Platform of Peking University Digital Humanities Research Center 北京大学数字人文研究中心研究平台
• TextRef- Distributed Metadata Sharing for Online Historical Textual Resources 電子漢籍綜目 OPEN ACCESS
• Harvard-Yenching Library Archival Materials
• People's Republic of China Legal Research
• Republic of China (Taiwan) Legal Research
• Research Guide for East Asian Studies
• Research Guide for Japanese Studies
• Research Guide for Korean Studies
• Streaming Video Resources at Harvard
• Asia Center
• China Public Policy Program
• Columbia-Harvard 中国与世界研究项目 China and the World Program
• Committee on Regional Studies -- East Asia
• Department of East Asian Languages and Civilizations
• East Asian Legal Studies
• Fairbank Center for Chinese Studies
• Harvard-Yenching Institute
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• Last Updated: Apr 23, 2024 5:12 PM
• URL: https://guides.library.harvard.edu/Chinese

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Page 1 of 23

“Qi Nan” agarwood restores podocyte autophagy in diabetic kidney disease by targeting EGFR signaling pathway

Diabetic kidney disease (DKD) is a microvascular complication of diabetes mellitus, contributing to end-stage renal disease with limited treatment options. The development of DKD is attributed to podocyte inju...

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Compound Shenma Jingfu granule alleviates cerebral ischemia via HIF-1α-mediated promotion of angiogenesis

Shenma Jingfu Granule, a traditional Chinese medicine formula, has been used clinically for the treatment of cerebral circulation insufficiency. However, the mechanism involved in alleviating cerebral ischemia...

Bazi Bushen ameliorates age-related energy metabolism dysregulation by targeting the IL-17/TNF inflammatory pathway associated with SASP

Chronic inflammation and metabolic dysfunction are key features of systemic aging, closely associated with the development and progression of age-related metabolic diseases. Bazi Bushen (BZBS), a traditional C...

NBR1-p62-Nrf2 mediates the anti-pulmonary fibrosis effects of protodioscin

Idiopathic pulmonary fibrosis is a persistent disease of the lung interstitium for which there is no efficacious pharmacological therapy. Protodioscin, a steroidal saponin, possesses diverse pharmacological pr...

Oleuropein alleviates myocardial ischemia–reperfusion injury by suppressing oxidative stress and excessive autophagy via TLR4/MAPK signaling pathway

Myocardial ischemia/reperfusion injury (MIRI) is an important complication of reperfusion therapy, and has a lack of effective prevention and treatment methods. Oleuropein (OP) is a natural strong antioxidant ...

Danggui Sini decoction alleviates oxaliplatin-induced peripheral neuropathy by regulating gut microbiota and potentially relieving neuroinflammation related metabolic disorder

Danggui Sini decoction (DSD), a traditional Chinese medicine formula, has the function of nourishing blood, warming meridians, and unblocking collaterals. Our clinical and animal studies had shown that DSD can...

Natural products as potential drug treatments for acute promyelocytic leukemia

Acute promyelocytic leukemia (APL), which was once considered one of the deadliest types of leukemia, has become a curable malignancy since the introduction of all-trans retinoic acid (ATRA) and arsenic trioxi...

Medicinal plants and natural products for treating overactive bladder

Overactive bladder (OAB) presents a high prevalence of 16–18% worldwide. The pathophysiology of OAB is still poorly understood while effective therapy or countermeasure are very limited. On the other hand, med...

Formononetin reverses Treg/Th17 imbalance in immune-mediated bone marrow failure mice by regulating the PI3K/Akt signaling pathway

Severe aplastic anemia (SAA) is a syndrome of bone marrow failure which is life-threatening. Recent studies have demonstrated that CD4 + T cell subsets, including T regulatory (Treg) and T helper 17 (Th17) cel...

Cordyceps sinensis relieves non-small cell lung cancer by inhibiting the MAPK pathway

To determine the pharmacodynamic mechanism underlying Cordyceps sinensis relief in a murine model of non-small cell lung cancer (NSCLC).

Total iridoid glycoside extract of Lamiophlomis rotata (Benth) Kudo accelerates diabetic wound healing by the NRF2/COX2 axis

Lamiophlomis rotata (Benth.) Kudo ( L. rotata ), the oral Traditional Tibetan herbal medicine, is adopted for treating knife and gun wounds for a long time. As previously demonstrated, total iridoid glycoside extra...

Juglone induces ferroptosis in glioblastoma cells by inhibiting the Nrf2-GPX4 axis through the phosphorylation of p38MAPK

Ferroptosis, a non-apoptotic form of cell death induced by accumulation of free iron ions and lipid peroxidation, its importance for cancer treatment is gradually being recognized. Research on the anti-cancer ...

Chemodiversity, pharmacological activity, and biosynthesis of specialized metabolites from medicinal model fungi Ganoderma lucidum

Ganoderma lucidum is a precious fungus, particularly valued for its dual use as both medicine and food. Ganoderic acids (GAs), the distinctive triterpenoids found in the Ganoderma genus, exhibit a wide range of p...

TCMNPAS: a comprehensive analysis platform integrating network formulaology and network pharmacology for exploring traditional Chinese medicine

The application of network formulaology and network pharmacology has significantly advanced the scientific understanding of traditional Chinese medicine (TCM) treatment mechanisms in disease. The field of herb...

Recent advances in the potential effects of natural products from traditional Chinese medicine against respiratory diseases targeting ferroptosis

Respiratory diseases, marked by structural changes in the airways and lung tissues, can lead to reduced respiratory function and, in severe cases, respiratory failure. The side effects of current treatments, s...

The combination of Schisandrin C and Luteolin synergistically attenuates hepatitis B virus infection via repressing HBV replication and promoting cGAS-STING pathway activation in macrophages

HBV infection can result in severe liver diseases and is one of the primary causes of liver cell carcinoma-related mortality. Liuwei Wuling tablet (LWWL) is a traditional Chinese medicine formula, with a prote...

Chinmedomics: a potent tool for the evaluation of traditional Chinese medicine efficacy and identification of its active components

As an important part of medical science, Traditional Chinese Medicine (TCM) attracts much public attention due to its multi-target and multi-pathway characteristics in treating diseases. However, the limitatio...

Salvianolic acid C attenuates cerebral ischemic injury through inhibiting neuroinflammation via the TLR4-TREM1-NF-κB pathway

Stroke is a leading cause of mortality and disability with ischemic stroke being the most common type of stroke. Salvianolic acid C (SalC), a polyphenolic compound found in Salviae Miltiorrhizae Radix et Rhizoma,...

Cryptotanshinone inhibits PFK-mediated aerobic glycolysis by activating AMPK pathway leading to blockade of cutaneous melanoma

Cutaneous melanoma is a kind of skin malignancy with low morbidity but high mortality. Cryptotanshinone (CPT), an important component of salvia miltiorrhiza has potent anti-tumor activity and also indicates thera...

A multi-center cross-sectional study of Chinese Herbal Medicine-Drug adverse reactions using active surveillance in Singapore’s Traditional Chinese Medicine clinics

This study aimed to investigate the rates and causality of patient-reported adverse events (AEs) associated with concomitant Chinese Herbal Medicine (CHM) and Western Medicine prescription drug (WMPD) consumpt...

Electroacupuncture pretreatment mediates sympathetic nerves to alleviate myocardial ischemia–reperfusion injury via CRH neurons in the paraventricular nucleus of the hypothalamus

Myocardial ischemia–reperfusion can further exacerbate myocardial injury and increase the risk of death. Our previous research found that the paraventricular nucleus (PVN) of the hypothalamus plays a crucial r...

Cayratia albifolia C.L.Li exerts anti-rheumatoid arthritis effect by inhibiting macrophage activation and neutrophil extracellular traps (NETs)

Cayratia albifolia C.L.Li (CAC), commonly known as “Jiao-Mei-Gu” in China, has been extensively utilized by the Dong minority for several millennia to effectively alleviate symptoms associated with autoimmune dis...

LanGui tea, an herbal medicine formula, protects against binge alcohol-induced acute liver injury by activating AMPK-NLRP3 signaling

LanGui tea, a traditional Chinese medicine formulation comprising of Gynostemma pentaphyllum (Thunb.) Makino, Cinnamomum cassia (L.) J. Presl, and Ampelopsis grossedentata (Hand-Mazz) W.T. Wang, has yet to have i...

Platycodon D protects human nasal epithelial cells from pyroptosis through the Nrf2/HO-1/ROS signaling cascade in chronic rhinosinusitis

Pyroptosis has been demonstrated being closely associated with the inflammatory progression in chronic rhinosinusitis (CRS). However, platycodon D (PLD) has emerged as a key anti-inflammatory mediator in the i...

Golden bile powder prevents drunkenness and alcohol-induced liver injury in mice via the gut microbiota and metabolic modulation

Drunkenness and alcoholic liver disease (ALD) are critical public health issues associated with significant morbidity and mortality due to chronic overconsumption of alcohol. Traditional remedies, such as bear...

Traditional Chinese Medicine Shi-Bi-Man ameliorates psoriasis via inhibiting IL-23/Th17 axis and CXCL16-mediated endothelial activation

Psoriasis is a chronic inflammatory genetic disease, mainly manifesting in the skin. Conventional therapies, such as glucocorticosteroids and corticosteroids, have adverse effects that limit drug use. Hence, i...

Trachelogenin alleviates osteoarthritis by inhibiting osteoclastogenesis and enhancing chondrocyte survival

Osteoarthritis (OA) is a prevalent global health concern associated with the loss of articular cartilage and subchondral bone. The lack of disease-modifying drugs for OA necessitates the exploration of novel t...

A novel network pharmacology strategy to decode mechanism of Wuling Powder in treating liver cirrhosis

Liver cirrhosis is a chronic liver disease with hepatocyte necrosis and lesion. As one of the TCM formulas Wuling Powder (WLP) is widely used in the treatment of liver cirrhosis. However, it’s key functional c...

A review on traditional Chinese medicine natural products and acupuncture intervention for Alzheimer’s disease based on the neuroinflammatory

Alzheimer’s disease (AD) is a neurodegenerative disease with insidious onset and progressive development. It is clinically characterized by cognitive impairment, memory impairment and behavioral change. Chines...

The combination of Tanshinone IIA and Astragaloside IV attenuates myocardial ischemia–reperfusion injury by inhibiting the STING pathway

Astragaloside IV (As-IV) and Tanshinone IIA (Ta-IIA) are the main ingredients of traditional Chinese medicinal Astragalus membranaceus (Fisch.) Bunge and Salvia miltiorrhiza Bunge, respectively, both of which hav...

Determination of ITS1 haplotypes of Fritillariae Cirrhosae Bulbus by amplicon sequencing

Fritillariae Cirrhosae Bulbus is an antitussive and expectorant Chinese medicinal material derived from the dried bulbs of six Fritillaria species. In the 2015 edition of the Chinese Pharmacopoeia, the polymerase...

Bufei Yishen formula protects the airway epithelial barrier and ameliorates COPD by enhancing autophagy through the Sirt1/AMPK/Foxo3 signaling pathway

Bufei Yishen formula (BYF), a traditional Chinese medicine alleviates COPD symptoms and suppresses airway epithelial inflammation. In this study, we determined whether BYF protects the airway epithelial barrie...

SKP alleviates the ferroptosis in diabetic kidney disease through suppression of HIF-1α/HO-1 pathway based on network pharmacology analysis and experimental validation

Diabetic kidney disease (DKD) represents a microvascular complication of diabetes mellitus. Shenkang Pills (SKP), a traditional Chinese medicine formula, has been widely used in the treatment of DKD and has ob...

Optimized New Shengmai Powder modulation of cAMP/Rap1A signaling pathway attenuates myocardial fibrosis in heart failure

Optimized New Shengmai Powder (ONSMP) is a traditional Chinese medicine formula with significant anti-heart failure and myocardial fibrosis effects, but the specific molecular biological mechanisms are not ful...

Exploring the chemical components of Kuanchang-Shu granule and its protective effects of postoperative ileus in rats by regulating AKT/HSP90AA1/eNOS pathway

Postoperative ileus (POI) is a common obstruction of intestinal content passage caused by almost all abdominal operations that seriously strokes the quality of life of patients. Kuanchang-Shu granule (KCSG), a...

Immunopotentiating effects of herb-partitioned moxibustion on the spleens of cyclophosphamide-induced immunosuppressed rats

To investigate the effec of the herb-partitioned moxibustion on T-lymphocyte activity in immunosuppressed rats through differential modulation of the immune checkpoint molecules CD28 and CTLA-4.

Total flavonoids of Astragalus protects glomerular filtration barrier in diabetic kidney disease

Diabetic kidney disease (DKD) is a prevalent complication of diabetes and the leading cause of end-stage renal disease. Recent evidence suggests that total flavonoids of Astragalus (TFA) has promising effects ...

Paclitaxel combined with Compound K inducing pyroptosis of non-small cell lung cancer cells by regulating Treg/Th17 balance

Immune checkpoint inhibitors, which have attracted much attention in recent years, have achieved good efficacy, but their use is limited by the high incidence of acquired drug resistance. Therefore, there is a...

Natural products in osteoarthritis treatment: bridging basic research to clinical applications

Osteoarthritis (OA) is the most prevalent degenerative musculoskeletal disease, severely impacting the function of patients and potentially leading to disability, especially among the elderly population. Natur...

Tanreqing injection inhibits dengue virus encephalitis by suppressing the activation of NLRP3 inflammasome

Encephalitis caused by dengue virus (DENV) is considered a manifestation of severe dengue. Tanreqing injection (TRQ) is a well-known Chinese patented medicine, which has been used to treat brain-related disord...

Comparative transcriptome analysis and identification of candidate R2R3-MYB genes involved in anthraquinone biosynthesis in Rheum palmatum L.

Rheum palmatum L. has important medicinal value because it contains biologically active anthraquinones. However, the key genes and TFs involved in anthraquinone biosynthesis and regulation in R. palmatum remain u...

Identification and expression analysis of expansin gene family in Salvia miltiorrhiza

Expansins (EXP) are important enzymes that are involved in the extension of plant cells and regulation of root configurations, which play important roles in resisting various stresses. As a model medicinal pla...

Integrated traditional Chinese and Western medicine in the prevention and treatment of non-alcoholic fatty liver disease: future directions and strategies

Traditional Chinese medicine (TCM) has been widely used for several centuries for metabolic diseases, including non-alcoholic fatty liver disease (NAFLD). At present, NAFLD has become the most prevalent form o...

Gromwell ameliorates glucocorticoid-induced muscle atrophy through the regulation of Akt/mTOR pathway

Muscle atrophy is characterized by decreased muscle mass, function, and strength. Synthetic glucocorticoids, including dexamethasone (Dexa), are commonly used to treat autoimmune diseases. However, prolonged e...

Decoction regulating phytochemicals’ micromorphology changes and anti-inflammation activity enhancements originated from herb medicine supermolecules

Mahuang Fuzi decoction (MGF) is composed of three herb medicines that has been clinically used to treat inflammatory diseases for a long history. At present, more and more active phytochemicals’ aggregations h...

Zhuifeng Tougu capsules in the treatment of knee osteoarthritis (cold dampness obstruction syndrome): a randomized, double blind, multicenter clinical study

In Traditional Chinese Medicine (TCM) theory, cold dampness obstruction is one of the common syndromes of osteoarthritis. Therefore, in clinical practice, the main treatment methods are to dispel wind, remove ...

Comprehensive review of dibenzocyclooctadiene lignans from the Schisandra genus: anticancer potential, mechanistic insights and future prospects in oncology

Cancer remains one of the leading causes of mortality worldwide. The search for novel and effective anticancer agents has been a significant area of research. Dibenzocyclooctadiene lignans (DBCLS), derived fro...

Ganoderma lucidum polysaccharide ameliorates cholesterol gallstone formation by modulating cholesterol and bile acid metabolism in an FXR-dependent manner

Cholesterol gallstone (CG) disease is a worldwide common disease characterized by cholesterol supersaturation in gallbladder bile. Ganoderma lucidum polysaccharide (GLP) has been shown to possess various benefici...

The effects of Chinese proprietary medicine and vaccination on patients with COVID-19: a retrospective study in Macao

COVID-19 is continuing to ravage globally and has resulted in a huge health and financial burden. Chinese proprietary medicines, such as Lianhua Qingwen (LHQW) and Huoxiang Zhengqi (HXZQ) capsules, have been r...

Interpreting the efficacy enhancement mechanism of Chinese medicine processing from a biopharmaceutic perspective

Chinese medicine processing (CMP) is a unique pharmaceutical technology that distinguishes it from natural medicines. Current research primarily focuses on changes in chemical components to understand the mech...

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• Evid Based Complement Alternat Med
• v.2015; 2015

Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

Foon yin fung.

1 Traditional Medicine Information Service, Department of Pharmacy, Singapore General Hospital, Singapore

Yeh Ching Linn

2 Department of Haematology, Singapore General Hospital, Academia, 20 College Road, Singapore 169856

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM.

1. Introduction

Evidence-based medicine (EBM) is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research [ 1 ]. In just over two decades since its first introduction, the EBM movement has created a paradigm shift to become the standard of modern medical practice, elevating it to a higher level and with greater accuracy, efficacy, and safety.

Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago. In contrast to the disease-targeted approach adopted by Western medicine where there is a standard treatment protocol defined for each disease entity, TCM takes a holistic approach in treating the individual with customized treatment based on the concept of “Syndrome Differentiation.” The basic theories of TCM were derived from the Chinese philosophy of Yin-Yang and Five Elements, and its fundamental concepts such as the Zang-fu (viscera) concept, Qi (vital energy), and meridians have yet to be mapped by scientific equivalents or clearly elucidated in scientific terms.

While TCM is widely practiced in Asian populations such as China, Hong Kong, Taiwan, and Singapore, many non-Asian countries have, in recent decades, also recognized the huge therapeutic potential of this traditional practice and have been actively tapping into the benefits of TCM so as to provide patients with an additional option in their health management. In 1991, a TCM hospital was opened in KoÈtzting, Germany, whereby trained TCM physicians from China administered treatment according to the traditional practice [ 2 ]. In the United States, UCLA Center for East-West Medicine was founded in 1993 to provide integrative medicine treatment [ 3 ]. In 1998, the National Institutes of Health within the US Department of Health and Human Services set up the National Center for Complementary and Alternative Medicine with the mission to “define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions (including TCM) and their roles in improving health and health care” [ 4 ]. In 2007, the National Institute of Complementary Medicine at the University of Western Sydney was established by the Australian and New South Wales Governments with a research focus on Chinese medicine via laboratory analysis, clinical trials, and translation into practice [ 5 ]. In 2014, Cleveland Clinic opened a hospital-based Chinese herbal therapy clinic in their Center for Integrative Medicine to provide supplementary options for patients seeking a holistic, natural approach to their care [ 6 ]. According to interim data from 2nd WHO TRM global survey as of 11 June 2012, 80% of the 129 member states now accept the use of acupuncture as a treatment modality [ 7 ].

Despite the growing prevalence of TCM usage and the worldwide interest in its therapeutic benefits, the fundamental issue hindering its acceptance by the Western medicine community and integration into mainstream healthcare is still the lack of robust evidence from the EBM perspectives. In order for TCM to be rationally used for patients who may benefit from it, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence using methods which are accepted in the evaluation of mainstream medicine, that is, in accordance with evidence-based medicine. In the EBM system, different types of evidences are prioritized into a set of hierarchical levels. Randomized controlled trials (RCTs) or systematic reviews of RCTs are the golden standard for the highest level of evidence, followed by other types of evidences such as cohort studies, case-control studies, case series, case reports, animal/ in vitro studies, and expert opinion. Whether the EBM model can be applied to TCM has long been a subject of debate and an area where much effort has been focused on.

This review aims at (1) discussing the current status of research in TCM, (2) exploring the evidences available on the efficacy and safety of Chinese herbal medicine and acupuncture, and (3) highlighting the issues and challenges faced in applying EBM to TCM.

2. Current Status of Research on TCM Intervention

Vast amount of basic research has been conducted on TCM herbs, mostly in characterizing the multiple-herb constituents, isolating active components from the herbs, and testing their pharmacological activities in the pursuit of new drug discovery. The US Pharmacopeial Convention published the Herbal Medicines Compendium, which is an online database that provides such standards for herbs. Each herbal monograph contains specifications including tests for critical quality attributes of the herbal ingredient, as well as analytical test procedures and acceptance criteria for specified tests [ 8 ]. In China, the TCM systems of pharmacology database and analysis platform were developed as a comprehensive source of herb pharmacochemistry, pharmacokinetic properties, and so forth to help drive drug discovery from herbal sources [ 9 ]. Two famous examples of active ingredients effectively extracted from TCM and since proven to be clinically successful are artesunate derived from Artemisia annua used for severe malaria [ 10 , 11 ] and arsenic trioxide used for treatment of acute promyelocytic leukaemia [ 12 , 13 ]. Taking up the challenge of fulfilling the stringent requirements of good clinical practice, a few TCM formulations are currently undergoing FDA clinical trials. These include Danshen dripping pill ( Salvia miltiorrhiza , Radix notoginseng , and Borneol) for stable angina in phase III trial, Kanglaite injection (coix seed oil and excipients) for cancer, Xuezhikang capsule (red yeast) for hyperlipidemia, and Fuzheng Huayu capsule ( Salvia miltiorrhiza , peach seed, pine pollen, Gynostemma pentaphylla , and Schisandra chinensis ) for liver fibrosis in phase II trials [ 14 ].

Quantitatively, there is no shortage of clinical studies in TCM conducted worldwide. A search on the Clinicaltrials.gov found 436 trials on TCM and 607 acupuncture trials globally (as of November 2014), while a search on online scientific journal portals, for example, Pubmed, Chinese National Knowledge Infrastructure (CNKI), yielded more than ten thousand research papers covering a wide spectrum of research topics studying TCM from various approaches. The critical problem, however, lies in the dearth of good quality evidence and lack of strong research rigor in the plethora of studies published, which undermine the credibility of the evidences.

A screening of all the TCM-related systematic reviews published by the Cochrane database to date found that almost all of the reviews commented on the lack of high quality clinical trials done with good methodology, thereby negating any definitive conclusion on the efficacy of herbal or acupuncture interventions. Some of the specific criticisms cited in these reviews included lack of trials that tested the same herbal medicine, lack of details on cointerventions, unclear methods of randomisation, poor reporting, high risks of bias, and the need for well-designed and conducted trials with sufficient numbers of participants to perform subgroup analyses [ 15 ]. The lament on the suboptimal quality of clinical studies on TCM was also echoed by two systematic reviews of reports on RCTs of TCM published in China from 1999 to 2004 and those indexed in the CNKI database from 2005 to 2012, respectively. The former found that the mean Jadad score (a scoring system for the methodology quality of a clinical trial on a scale of 0 to 5) of the 7422 RCTs identified was 1.03 overall, with a mean score of only 0.85 in 1999 (746 RCTs) and 1.20 in 2004 (1634 RCTs) [ 16 ]. The latter concluded that although the quality of reporting RCTs of TCM has improved in 2011-2012 (2861 trials) compared to 2005–2009 (4133 trials), the percentages of high quality reports remained low-mean Jadad scores of 1.22 versus 1.25, with only 15.15% and 19.71% of the reports having a score of 2 [ 17 ]. These results highlighted the present state of huge disparity between the quantity and quality of TCM RCTs and demonstrated that much more work needs to be done to improve on the latter aspect.

3. Some Challenges of Applying EBM to TCM Clinical Trials

One fundamental challenge in conducting valid RCTs in TCM is the batch-to-batch variation of the active constituents contained in the herbal formulation used. Product-to-product variation arising from different manufacturers, brands, or formulation further hinders the fair comparison of the findings among similar studies. Such inconsistencies may result in lack of reproducibility between clinical trials and even challenge the validity of generalizing the findings of clinical trials to routine use. However this is something that can potentially be overcome by technological advancement. Newly developed analytical tools and techniques have made it possible to profile the constituents of herbs, for example, by using high-pressure liquid chromatography to establish a chemical fingerprint of the herb, where the profiles of different batches can be compared to ensure no significant variability [ 18 ]. Precise reporting of such information by clinical trials has to be implemented to assure validity of TCM trials. In parallel, legislation to define the required standard of proprietary products will eventually be required for acceptance of the clinical trial findings and efficacy of TCM products by the Western medicine practitioners.

Another challenge is the difficulty in creating an appropriate placebo for multiple-herb herbal decoctions, which compromises the effectiveness of blinding. While it is feasible to create placebos for capsules, pills, and tablets, it is technically challenging to create an indistinguishable placebo for a multiple-herb formulation in the form of decoction. However, with multiple-herb formulations in the form of granules being more favored over decoction due to its convenience of use, it is not impossible to overcome the aforementioned challenge. In addressing this need for good quality placebo in TCM clinical research, one recent research in China has described a novel technique which claims feasibility in creating a good quality placebo in granule form that has similar appearance, smell, and taste as the original preparation but with no pharmacological activity [ 19 ]. Besides herbal medicine, designing appropriate placebo for acupuncture trials is yet another challenge, though researchers have come up with various control measures such as nonacupuncture inert controls, placebo acupuncture, sham acupuncture, real acupuncture with a decoy treatment, waiting list controls, standard care controls, and adjunctive care comparisons [ 20 ].

Incorporating TCM principles in an RCT poses another challenge as it appears that the standardized treatment approach required by RCTs is in discordance with the individualized treatment approach inherent in TCM practice. This difference in approach, however, is not entirely irreconcilable. In order to accommodate TCM principle, that is, replicating the diagnosis using “Syndrome Differentiation” and giving the corresponding individualized treatment within the rigorous framework of EBM, a systematic process for assessing symptoms and signs, the identification, and the quantification of TCM syndrome for a sample group of study subjects with the same Western medical diagnosis can be applied before and after treatment [ 21 ]. To quantify a syndrome for diagnosis, the signs and symptoms of each subject could be tabulated and matched against the typical signs and symptoms which characterize a particular TCM syndrome. The percentage match between the two could then serve as the score for a certain syndrome and a corresponding treatment protocol would be administered, allowing an “individualized” treatment in a standardized and reproducible way [ 21 ]. One way of assessing the intervention effects could be done by comparing the change in scores.

4. Efforts to Improve the Quality of TCM Research

It is encouraging that the need to modernize the methodology of clinical trials in TCM is being recognized and actively addressed. A group of Chinese medicine researchers, practitioners, journal editors, and epidemiologists have established the Chinese CONSORT Group for TCM and proposed the Consolidated Standards for Reporting Trials (CONSORT) of Traditional Chinese Medicine [ 22 ]. To improve the quality of TCM research, some of the recommendations made by the group include the precise reporting of TCM interventions and outcome measures detailed as follows [ 22 , 23 ].

Precise Reporting of TCM Interventions in RCTs

• name, dosage format, and registration;
• composition and quality of intervention;
• pharmaceutical processing and quality control;
• stability of final product and quality control;
• function and safety description;
• dosage and treatment course;
• control group.
• name of active compound(s);
• original source of active compounds(s);
• the brief process obtaining active compound(s);
• percentage of active compound in final product;
• added materials and their quality and quantity control.

Precise Reporting of Outcome Measures of RCTs of TCM

• Identifying the primary and secondary outcomes based on the purpose and hypothesis of the trial;
• defining the primary and secondary outcomes clearly;
• presenting the rationale of selection;
• presenting the method with aims to standardize the assessment process;
• presenting the method to improve the reliability of assessment;
• stating the termination criteria in the trial.

More recently in 2009, the Good Practice in Traditional Chinese Medicine Research Association was launched. This was the European Union's first coordination action dedicated to TCM research, funded by the European Commission under its 7th Framework Programme to coordinate EU-China dialogues and collaborations in TCM research. This project has since engaged more than 200 scientists and clinicians in discussions on good practice issues related to various aspects of Chinese herbal medicine and acupuncture research [ 24 ].

5. Examples of Level 1 Evidences Supporting TCM Intervention

Despite the paucity of high quality evidences available, there are nevertheless a few examples of well-conducted RCTs with precise reporting, which attested to the feasibility of producing high quality evidence for TCM and provided valuable insight into this challenging undertaking.

5.1. Efficacy of TCM Formulation in Irritable Bowel Syndrome, 1998

In a study on patients with irritable bowel syndrome (IBS) [ 25 ], patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations ( n = 38), a standard 20-herb Chinese herbal formulation ( n = 43), or placebo ( n = 35), all in capsule form. Patients were treated for 16 weeks and evaluated regularly by a traditional Chinese herbalist and a gastroenterologist. In this randomized, double-blinded, placebo-controlled trial, TCM formulation was shown to be effective in the management of IBS. Patients who received the standard formulation fared best during the course of treatment, while patients who received the individualized formulations maintained their improvement up to 14 weeks beyond the treatment period. This study is a good illustration of the potential efficacy of TCM for common conditions such as IBS which to date has no good solution by Western medicine other than symptomatic treatment. One unique feature of this study is that it compared the effect of standardized TCM formulation with individualized formulation. TCM practice has always emphasized on individualized treatment and syndrome-directed modification of TCM formulation regularly throughout the course of treatment, which may not be cost-effective or convenient from the patients' perspective. Further trials incorporating such comparisons would help to shed light on the relative superiority of customized treatment over standard formulation.

5.2. Efficacy of Maxingshigan-Yinqiaosan as Compared to Oseltamivir in Treating H1N1 Influenza, 2011

A prospective, nonblinded, randomized, controlled, multicenter trial was conducted in young patients in eleven hospitals from 4 provinces in China to compare the efficacy and safety of Oseltamivir and a TCM decoction “Maxingshigan-Yinqiaosan” in treating uncomplicated H1N1 influenza [ 26 ]. “Maxingshigan-Yinqiaosan” is a 12-herb formulation combining two classical TCM formulae for their “diaphoretic and heat-clearing” activities to treat respiratory tract infection. Subjects were randomized into four groups: Oseltamivir group ( n = 102), Maxingshigan-Yinqiaosan group ( n = 103), Oseltamivir plus Maxingshigan-Yinqiaosan group ( n = 102), and control group with no intervention ( n = 103). The study found that Oseltamivir and “Maxingshigan-Yinqiaosan,” whether used alone or in combination over a course of 5 days, resulted in a comparable time to fever resolution in patients with H1N1 influenza virus infection, superior to control group. This data therefore suggests that “Maxingshigan-Yinqiaosan” may be used as an alternative treatment to Oseltamivir for H1N1 influenza virus infection. This trial also illustrates two important facts: that the TCM formulation is as effective as Oseltamivir and that it is safe to be used in combination with Oseltamivir. The former is of relevance in terms of cost consideration, and the latter is relevant in terms of safety for the common layman practice of consuming both Western and traditional medicines with the hope of attaining enhanced therapeutic effect.

5.3. CHInese Medicine Neuroaid Efficacy on Stroke Recovery (CHIMES) Study, 2013

MLC601 (Trade name: Neuroaid) is a TCM formulation “Danqipiantan jiaonang” containing 9 herbs and 5 animal components [ 27 ]. A systematic review of six RCTs provided evidence that MLC601 could be effective in improving functional independence and motor recovery as an add-on to standard treatment and is safe for patients with primarily nonacute stable stroke [ 28 ]. The CHInese Medicine Neuroaid Efficacy on Stroke recovery (CHIMES) study, a multicentre, randomized, double-blinded, placebo-controlled trial ( n = 1099) comparing MLC601 with placebo in patients with acute ischemic stroke of intermediate severity in the preceding 72 hours, is one of the largest-scale TCM trials in the recent years with subject recruitment from various countries in South East Asia [ 29 ]. Although MLC601 is statistically no better than placebo in improving outcomes at 3 months when used among patients with acute ischemic stroke of intermediate severity, a post hoc analysis found that the MLC601 group had significantly less early vascular events compared to the placebo group [ 30 ]. The safety profile of MLC601 was also validated by the lack of significant difference in adverse events between treatment and placebo group. This study illustrated a few important lessons: while dispelling unrealistic hope on expedited recovery, it revealed the unexpected findings of reduced vascular events of a magnitude much larger than what aspirin has been shown to produce [ 31 ]. It also exemplified a well-conducted cum precisely reported TCM trial done in compliance with good clinical practices. Results from the ongoing extension study [ 32 ] investigating the longer-term efficacy over a 2-year follow-up from the initial course of intervention are eagerly awaited. A positive finding will be indicative of the value in conducting long-term assessments after initial short-course therapy, a method which may be relevant in evaluating TCM efficacy since TCM interventions aim at restoring balance and may thus have the potential to achieve long-term and sustained benefit rather than temporary symptomatic relief.

5.4. Efficacy of Tianqi Capsule in Patients with Impaired Glucose Tolerance, 2014

In a double-blind, randomized, placebo-controlled, multicenter trial, Tianqi capsule containing 10 TCM herbs was found to significantly decrease the incidence of progression to type 2 diabetes mellitus in subjects with impaired glucose tolerance, after a course of 12-month treatment ( n = 210) as compared with the placebo group ( n = 210) [ 33 ]. This particular study is laudable in that it reported in detail the subject inclusion and exclusion criteria and the randomization and blinding method as well as adverse events, which are often omitted or not elaborated on in most TCM clinical studies. It also conducted and described the chemical analysis of the composition of Tianqi capsule, quantifying the constituents of the formulation, which is in line with the precise reporting recommendations to improve the quality of TCM studies [ 22 ].

5.5. Efficacy of Acupuncture for Pain Management Based on Systematic Reviews

A Cochrane review of 33 trials ( n = 2293) found consistent evidence that acupuncture provides additional benefit in the treatment of acute migraine attacks compared to routine care and that acupuncture is at least as effective as or possibly more effective than prophylactic drug treatment and has fewer adverse effects. The review recommended acupuncture as a possible treatment option for patients who are willing to undergo this treatment [ 34 ]. Another review of 11 trials ( n = 2317) also concluded that acupuncture could be a valuable nonpharmacological tool in patients with frequent episodic or chronic tension-type headaches [ 35 ]. A review on efficacy of acupuncture on neck pain concluded that there is also moderate evidence that acupuncture is better at relieving neck pain compared with some sham treatments. It found that at short-term follow-up, patients who received acupuncture reported less pain than those on a waiting list and that acupuncture is more effective than inactive treatments for relieving pain after treatment and this effect is maintained at short-term follow-up [ 36 ]. A systematic review (12 trials, n = 1763) reported that acupuncture use is associated with significant reductions in pain intensity and improvement in functional mobility as well as quality of life in patients with osteoarthritis [ 37 ].

While these level 1 evidences on the whole prove the efficacy of certain TCM treatments, one shortcoming among these studies is the lack of incorporation of TCM principles in the study design. For example, with the exception of the IBS study, the principal concept of “Syndrome Differentiation” which guides TCM diagnosis and treatment was not applied. Subjects were recruited based on their diagnosis by Western medicine without further subcategorization into different TCM syndromes for which different formulations would be required correspondingly. Under such circumstances, the assessment of the efficacy of TCM treatment may be flawed because the methodology does not replicate the real-life practice of TCM, and any lack of efficacy demonstrated could arguably be a result of the deviation from the well-tested TCM principles. As advocated by some, study designs guided by TCM theory are necessary to validate and improve future RCTs in TCM [ 38 ].

6. Current Status of Available Evidence on Safety Issues of TCM Usage

Efficacy issues aside, one much neglected aspect of TCM is the safety issues of its usage, for which there is currently little available evidence but warrants great attention. We believe that the prerequisite for TCM to be accepted into mainstream healthcare lies in addressing the safety concerns including adverse herb reaction and herb-drug interactions. The following sections therefore elaborate on evidence available on the safety aspects of TCM.

As highlighted by the Chinese CONSORT for TCM, it is important for RCTs to transparently report not only efficacy but also all the related adverse effects [ 39 ]. In general, adverse effects (AE) of the TCM interventions can be classified into 5 types as summarized below [ 39 ]. We will discuss more toxicity inherent to the herbs and the important issue of herb-drug interaction.

Types of Adverse Effects of TCM Interventions

• AEs under proper TCM principles and guidelines, for example, acute/chronic toxicity and allergy;
• AEs due to improper usage without following TCM principles, involving without following the TCM therapeutic principles, over-dosage, improper processing and preparation methods, and improper formula strategy;
• AEs due to contamination, such as heavy metal and pesticides contaminations in TCM interventions and intentional or unintentional contamination with drugs;
• AEs due to replacement of TCM herbs;
• AEs due to drug-herb interaction.

6.1. Toxicity

Evidence of adverse effects can come from various levels, from careful monitoring in RCTs, to case series and case reports on observed toxicity. Evidence from animal or in vitro studies may be deemed as low level from the perspective of proving efficacy, but their role in providing safety information is much greater. Biomedical research on herb pharmacology and toxicity are crucial to ensure the safe and appropriate use of herbs. Conclusive evidences from modern studies should be continually updated into the Chinese herbal pharmacopoeia and taken into consideration in the current practice of TCM regardless of whether they were mentioned in ancient Chinese literature.

“Chinese Herb Nephropathy” is the unfortunate term coined after the misuse of Guang Fang Ji ( Aristolochia fangchi ) instead of Han Fang Ji ( Stephania tetrandra ) in slimming pills in a few European centers, which led to interstitial nephritis, renal failure, and urothelial carcinoma [ 40 ]. This is an example of evidence of toxicity learned the hard way. While ancient TCM literature did not caution against such toxicity, with modern technology we now know that Aristolochic acid is one of the most potent carcinogens known [ 41 ]. Such evidence of toxicity based on laboratory research is most clinically relevant and the physician's knowledge of such should prevent catastrophic adverse effects in clinical practice.

Another example of toxic alkaloids found in TCM herbs which are still widely used clinically is aconitine which is found in Aconitum species such as Fuzi/Chuanwu ( Aconitum carmichaelii ) and Caowu ( Aconitum kusnezoffii ). These herbs are often used for their analgesic and cardiotonic properties. Aconitine poisoning resulting from overdosing or inappropriate processing of herbs before consumption could lead to cardiovascular, gastrointestinal, and neurological toxicities such as palpitations, arrhythmias, hypotension, and perioral and limb paraesthesia [ 42 , 43 ]. Another known toxic herbal compound is ephedrine, the main active ingredient in Mahuang ( Ephedra sinica ) which is frequently used in respiratory condition for its antiasthmatic activity. Studies have found that misusing Mahuang at higher dosages could lead to hypertension and cardiac arrhythmia due to its sympathomimetic activity [ 44 ]. These are examples where the known pharmacological and toxicological properties of herbs, corroborated by even small case series which are low in the hierarchy in the pyramid of evidence levels, can constitute important evidence for developing guidelines on the safe dosage and contraindications in the use of herbs.

Apart from the above examples which are known to have toxicities, certain TCM herbs which are not known to be toxic may also pose health risks if consumed inappropriately. For example, Gancao ( Glycyrrhiza uralensis ) is a frequently used herb in TCM formulations for its Qi -tonifying effect. However, evidence provided from biochemical studies demonstrated that Gancao has corticosteroidal activity. Glycyrrhizin, the principal active ingredient in Gancao, and its hydrolysed metabolite Glycyrrhetinic acid are inhibitors of the oxidative function of the 11 β -hydroxysteroid dehydrogenase, thereby preventing the metabolism of cortisol. As such, cortisol could then bind to mineralocorticoid receptors, leading to pseudoaldosteronism, resulting in hypertension and hypokalemia [ 45 ]. The clinical significance of this experimental finding was ascertained by a few adverse case reports of pseudoaldosteronism caused by consumption of Gancao at high doses [ 46 ]. Further work to better define the safe dose of Gancao in prolonged usage will provide important evidence for physicians to utilize this herb safely in modern day practice.

The use of Huang Lian ( Rhizoma coptidis ) and Huang Bai ( Cortex phellodendri ) and products containing the alkaloid Berberine has been prohibited in Singapore since 1972 based on sporadic cases and circumstantial evidence that Berberine could cause kernicterus in glucose-6-phosphate dehydrogenase (G6PD) deficient neonates. This ban was lifted four decades later, after an extensive review process by the local authority. Evidence came from scientific publications and surveillance of adverse reactions reported in the Asian countries which practise TCM; all of which did not suggest major safety concerns when Berberine was used appropriately, with the provision that it should still be avoided in infants and G6PD deficient individuals of all ages as well as pregnant and breastfeeding women [ 47 , 48 ]. This illustrates that continuous research and review of herb toxicity against its therapeutic potential based on current evidence are important in guiding the rational use of herbs.

6.2. Herb-Drug Interactions

In communities where Western medicine is the primary mode of treatment and TCM is supplementary, there is a high prevalence for concomitant use of both drugs and herbs, raising the safety concern of potential herb-drug interactions. Interactions between drugs and herbs can generally occur at the pharmacodynamics level, whether the herbs may potentiate or antagonize the biological activities of the drugs by acting on the same target or at the pharmacokinetics level, where herbs may affect the absorption, distribution, metabolism, or excretion of the drugs [ 49 , 50 ]. Specifically, herbs can induce or inhibit cytochrome P450 family proteins which are the main metabolizing enzymes or interfere with the efflux activity of P-glycoprotein which can actively pump absorbed drugs back into the intestinal lumen, thus affecting the bioavailability of concomitant drugs. This is of particular concern in patients who are taking drugs with narrow therapeutic index, for example, warfarin, cyclosporine A, and phenytoin, where certain herbs may potentially result in undesirable consequences of toxic effects or therapeutic failure [ 49 , 50 ]. While such interactions are better studied in herbs used in Western folk medicine, for example, St John's Wort, Echinacea, and Milk thistle [ 49 , 51 ], clinical evidence for the interaction potential of TCM herbs with drugs is hugely lacking and needs to be established clearly.

An example of possible adverse interaction is that between Danshen ( Salviae miltiorrhizae ) and warfarin, as demonstrated by some published evidences. Danshen is a TCM herb with “Blood-invigorating” property commonly used in cardiovascular conditions. There are case reports of patients stable on warfarin experiencing elevated international normalized ratio and bleeding after consuming Danshen-containing formulations [ 52 , 53 ]. Preclinical studies investigating the interaction between Danshen and warfarin reported that the herb extract inhibited warfarin hydroxylation and increased its concentration in rats [ 54 ]. Furthermore, there were in vitro studies reporting that Danshen extract inhibited platelet aggregation [ 55 ]. Such evidences serve to provide preliminary but crucial information alerting on the potential problems with certain herb-drug pairs, which will mandate close monitoring in both clinical trials and real-life practice involving such combinations.

Contrary to the common assumption, not all herb-drug interactions are necessarily harmful. For instance, a study investigating the potential pharmacokinetic and pharmacodynamics interactions of a TCM formula CMF1 (Yinqiaosan and Sangjuyin) with Oseltamivir found that the antiviral activity of the Oseltamivir was enhanced by the herbal combination in healthy volunteers ( n = 14) [ 56 ]. This suggests that the combined use of CMF1 and Oseltamivir could achieve a better therapeutic effect against influenza without compromising on safety. That said, more studies need to be done in this area to establish the information needed to guide the appropriate use of herbs in patients on concomitant drugs so that the therapeutic effect of either is not compromised and undesired toxic side effects can be avoided.

7. Approaches of Some Asian Countries

There are plenty of in vitro and animal studies exploring herb-drug interactions. However, much variation exists among the studies in aspects such as the methodology used and dose of herb tested resulting in inconclusive interpretations of the results collectively. Interpretation of these findings is further complicated by the incongruence of results, where the same herb could be reported in different studies to have opposing effects. Moreover, it is difficult to assess the clinical significance of these preliminary research findings. Nonetheless, it is essential that we maximize the use of what is available such that this mass of evidence is systematically collected and transcribed into meaningful databases to provide clinicians with an objective assessment of the current evidences and assist them in making an informed decision. With this as the main objective, we in the Singapore General Hospital established a Traditional Medicine Information Service (TMIS) in 2011 as an extension to the Drug Information Service in the Department of Pharmacy, with the committee formed by a medical doctor, pharmacists, and licensed TCM practitioner. TMIS provides evidence-based information on traditional medicines (TCM, Jamu, Ayurveda herbal medicine, etc.) by conducting literature searches and critically reviewing the current evidences. It has embarked on the development of a warfarin-herb interaction database which serves as readily available information for reference by pharmacists within the hospital. At the National University of Singapore, an online oncology drug interaction database “OncoRx” [ 57 ] has been developed by an informatics team led by a pharmacist to allow quick searches on interactions between different combinations of anticancer agents and herbal medicines.

In addressing the safety issue of TCM herbs, in Hong Kong, a multidisciplinary team consisting of a pharmacist, a chemical pathologist, a scientific officer, and a physician was formed to provide an advisory service on herbal safety to healthcare professionals of all public hospitals since 2000 [ 42 ]. As part of the investigation of adverse events associated with herbal products, the products and biologic samples would be screened for the presence of synthetic drugs and natural toxins, for example, aconitine, ephedrine, and aristolochic acids using various analytical tools [ 42 ].

On the national level, various Asian countries have their own adverse reaction reporting and capturing systems for TCM, mostly based on voluntary reporting. The Chinese SFDA has its system established in 1989 [ 58 ] and Taiwan has a similar reporting system established in 1998 [ 59 ], relatively late considering the long history of use of TCM in both countries. In Hong Kong, this aspect is governed by the territory-wide Drug and Poisons Information Bureau [ 42 ], while in Singapore the Health Sciences Authority has an Adverse Event Monitoring unit for the reporting and investigation of dubious products suspected to be linked with the adverse events [ 60 ]. These pharmacovigilance efforts have the primary objectives of ensuring public safety, but their databases built up over time should also be an invaluable source of preliminary evidence and serve as the basis for further laboratory and clinical research to establish definitive evidence of adverse reaction and herb-drug interactions.

8. Future Directions

Many issues surrounding the efficacy and safety of TCM use in modern society remain unresolved and these hinder the potential benefits of TCM from being safely and effectively harnessed. Applying EBM to TCM is vital for the traditional practice to gain acceptance by Western medical practitioners and become an integral component of the healthcare system. This is a necessary step when exploring TCM as cost-effective treatment options to help tackle healthcare issues such as functional diseases, chronic illnesses in ageing populations, and rising healthcare costs. High quality evidences via RCTs assessing efficacy and safety are needed to substantiate the use of TCM in suitable conditions.

However, EBM should not be rigidly imposed onto TCM but rather adapted with flexibility taking into consideration the unique characteristics of TCM practice. As advocated in a review by Tang, a pragmatic approach towards TCM research by adopting an efficacy-driven approach instead of the conventional mechanism-based approach may be more applicable to TCM. This approach starts with evaluating safety and efficacy in humans by RCTs, from which efficacious interventions are identified before undertaking studies on mechanisms and active substances. This would avoid unnecessary basic research on inefficacious interventions and better channel resources to further study beneficial treatments. Most importantly, this strategy may provide high-level evidence for the expedited recognition of effective TCM interventions [ 61 ].

With the advancement of technology and research tools, continuous effort in conducting rigorous research into toxicities and drug-interacting potential of herbs as well as correlation of laboratory findings with clinical observations are essential. This provides new insights about the herbs to help us utilize the herbs in a more rational and safe way in the modern clinical setting. Stringent quality control in the manufacturing of herbal products, strict regulatory controls on TCM herbal products, and active safety surveillance to detect adverse events are crucial to safeguard the risks that TCM users are exposed to.

There are many challenges in applying EBM to TCM, but these can be overcome by various approaches. In the era of advanced technology and EBM, with the wise application of basic and clinical research methodology to provide the relevant evidence, TCM as an ancient science and art is poised to be brought to a greater height for its ultimate mission of benefiting human health.

Acknowledgment

The first author is employed under the Traditional Medicine Information Service which is a project funded by the Ministry of Health Healthcare Quality Improvement & Innovation Fund.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Chinese Journal Review

Chinese Journal Review: How to Find Chinese-Language Academic Research

A very rough guide to navigating cnki.

First, a quick plug — last week, I published this essay in Foreign Policy with my colleague Macon Phillips . We argue that the West has a lot to learn from Taiwan on fighting disinformation. Take a look.

Second, since I started this newsletter last year, many of you have asked how I source essays to translate and to summarize. Below is a (very) rough guide. Thank you to ChinaTalk’s Jordan Schneider for suggesting that I write this up.

Navigating Chinese Academia

Whether at school or in your career, I suspect that you have used a service like JSTOR , which is a digital library that of books, newspapers, academic publications, and more. China’s version of JSTOR is called CNKI , the China National Knowledge Infrastructure, hosted by Tsinghua University with support from the Chinese government. To access CNKI directly visit cnki.net .

There is a lot inside of CNKI. Like JSTOR, it serves as a repository for newspaper articles, patents, government documents, and other reference materials. For the purpose of this walkthrough, I’m only going to explain how to search through top academic journals, but many aspects of this walkthrough should be applicable to other parts of the CNKI portal.

Before you get started, a note about language. Most of CNKI is in Chinese. If you don’t read Chinese that well, I’d encourage you to install this Google Translate Chrome extension. There is an English version of CNKI, which you can access by clicking this link , but I have found that it times out a lot, so I usually use the Chinese version of CNKI and will also frequently use the Chrome extension on top of it, which does a pretty good job translating most of the time.

Step 1. Get registered (not required to search and view paper abstracts)

Many universities have subscriptions to CNKI and provide access to the service to current students and alumni. Columbia University affiliates can access CNKI via this link , for example.

If you don’t have access to CNKI via a higher education institution or your place of work, fret not. You do not need an account (or need to have money in your account) to search for articles or to view abstracts. 

You will need to have a funded account, however, if you would like to download full-length articles.

To create an account click here or click on the link at the top-right part of the CNKI webpage. Once you do that, you’ll need to fund your account. At the time of this writing, the only ways to pay are via AliPay, WeChat, and UnionPay. PayPal, which used to be an option, is no longer available. 

Step 2. Navigate to the search page

Once you’re ready to search through academic journals, you can access the academic journals part of the CNKI portal from the home page or by clicking here . 

Then, click on the “Advanced Search” button, which you can also access directly by clicking here .

Once you’re in the Advanced Search part of the site, you can build queries according to different parameters, including by subject area, keyword, and journal name. I usually go a step further and navigate to the “Professional Search” tab where you can build even more customized queries, including to search many journals at once.

Step 3. Start searching top journals

CNKI provides access to thousands of academic journals of varying degrees of quality and influence. To source content for the Chinese Journal Review newsletter, I typically only search through the top journals in politics, international affairs, law, and economics. 

To determine which journals count as “top” sources, I combed through this part of CNKI’s website, which contains information about the total number of times that articles from different journals have been cited and downloaded. CNKI has also assigned many top journals a “composite impact score.” The higher the impact score, the more influential the journal.

Taking into account these criteria (citations, downloads, and composite impact scores), I created this list of top journals in the politics, legal affairs, international affairs, and economics fields:

POL/LEGAL 中国法学 China Legal Science POL/LEGAL 中外法学 Peking University Law Journal POL/LEGAL 法商研究 Studies in Law and Business POL/LEGAL 法学家 The Jurist POL/LEGAL 政法论坛 Tribune of Political Science and Law POL/LEGAL 法律科学 Science of Law (Journal of Northwest University of Political Science and Law) POL/LEGAL 世界经济与政治 World Economics and Politics POL/LEGAL 法学论坛 Legal Forum POL/LEGAL 法学研究 Chinese Journal of Law POL/LEGAL 法学 Law Science POL/LEGAL 政治学研究 CASS Journal of Political Science POL/LEGAL 当代法学 Contemporary Law Review POL/LEGAL 清华法学 Tsinghua University Law Journal POL/LEGAL 外交评论 Foreign Affairs Review ECON 经济研究 Economic Research Journal ECON 中国工业经济 China Industrial Economics ECON 数量经济技术经济研究 The Journal of Quantitative & Technical Economics ECON 世界经济 The Journal of World Economy ECON 金融研究 Journal of Financial Research ECON 国际金融研究 Studies of International Finance ECON 中国农村经济 Chinese Rural Economy ECON 管理世界 Management World

And these journals in the information technology field:

IT 计算机学报 Chinese Journal of Computers IT 电力系统自动化 Automation of Electric Power Systems IT 自动化学报 Acta Automatica Sinica IT 软件学报 Journal of Software

As well as these additional regional and international affairs journals:

REGIONAL 东北亚论坛 Northeast Asia Forum REGIONAL 当代亚太 Journal of Contemporary Asia-Pacific Studies REGIONAL 国际安全研究 Journal of International Security Studies REGIONAL 南亚研究 South Asian Studies REGIONAL 西亚非洲 West Asia and Africa REGIONAL 太平洋学报 Pacific Journal REGIONAL 欧洲研究 Chinese Journal of European Studies REGIONAL 东南亚研究 Southeast Asian Studies REGIONAL 美国研究 The Chinese Journal of American Studies REGIONAL 亚太安全与海洋研究 Asia-Pacific Security and Maritime Affairs

If you want to search across all of these journals at once, as I often do, you can copy and paste the following code and enter this text into the professional search field. I use the query code JN=(“ “) to indicate that I want to search multiple journals, but you can use other codes such as SU=(“ “) for subject or AU=(“ “) for author.

JN=("中国法学"+"中外法学"+"法商研究"+"法学家"+"政法论坛"+"法律科学"+"世界经济与政治"+"当代亚太"+"法学论坛"+"法学研究"+"法学"+"政治学研究"+"当代法学"+"清华法学"+"外交评论"+"经济研究"+"中国工业经济"+"数量经济技术经济研究"+"世界经济"+"金融研究"+"国际金融研究"+"中国农村经济"+"管理世界"+"计算机学报"+"电力系统自动化"+"自动化学报"+"软件学报"+"东北亚论坛"+"当代亚太"+"国际安全研究"+"南亚研究"+"西亚非洲"+"太平洋学报"+"欧洲研究"+"欧洲研究"+"东南亚研究"+"美国研究"+"亚太安全与海洋研究")

In addition to entering custom search content, you may also want to filter based on date of publication.

Sometimes, especially if you don’t apply any filters, this query will time out. If that happens, you should either a) further restrict the time period that you are searching or b) limit the number of journals you are searching to just 10-15 or so at a time.

Step 4. Look at your results

Assuming that you don’t time out, once you click search, your results should surface (it can take up to 20-30 seconds for that to happen, so be patient).

Once I have my results, I typically sort and choose articles to summarize first according to the number of article citations, followed by downloads. If an article is published by a journal affiliated with the state-affiliated Chinese Academy of Social Sciences (e.g. Management World ), I’ll also look at that article before I navigate to others. (Note: At some point in the future, I’ll update the online version of this email newsletter to include information about which entity publishes each journal listed above. Check back in a few weeks.) 

Once you’ve surfaced your results, click on any article to learn more information about it, including to see the article abstract, details about the authors, and other information. Again, if you don’t read Chinese, you may want to download the Google Translate Chrome extension . 

If you want to download the article, you’ll need to have a funded account (or you’ll need to be logged in via an educational institution that has access to CNKI). See Step 1, above, for more information about this point. 

And that’s it! There is a lot more to CNKI, so I encourage you to click around and see what you can discover. This guide is designed just to get first-time searchers up and running.

If you encounter any hiccups, feel free to email and I’ll try to help out. In the meantime, I’ll try to keep this page updated, especially if the site goes through any major changes. Until then, happy searching!

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• UW Libraries Journal Search Search for journals within the UW Libraries. Request interlibrary loan (ILL) if needed.

Academic Journals - Mainland China

• National Social Sciences Database 国家哲学社会科学学术期刊数据库 Full-text open access database of PRC social science and humanities journals.
• PubScholar 公益学术平台 A public academic platform built by the Chinese Academy of Science that contains full-text articles from CAS journals and index, pre-prints mainly on science and technology subjects.
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• Taiwan's Center for Chinese Studies Subject Databases 臺灣漢學研究中心專題資料庫 Full-text Database of CCS Publications: Chinese Studies 漢學研究，Newsletter for Research in Chinese Studies 漢學研究通訊, CCS Research Series 叢刊論著類, CCS Bibliography Series 叢刊目錄類, Contents of the Combined Collections of Ming Authors 明人文集聯合目錄
• Taiwan Citation Index - Humanities and Social Sciences (TCI-HSS) 臺灣人文及社會科學引文索引資料庫 Provides an index of Chinese language humanities and social journals journals (from the year 2000), dissertations, monographs, and conference proceedings published in Taiwan (or in some cases elsewhere), with citation and impact metrics. Produced by the National Central Library and its partners.
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• Journal of the Royal Asiatic Society Hong Kong Branch The journal contains a fascinating collection of articles on the history and culture of China and Asia, with special reference to Hong Kong which includes historical buildings, social organizations, popular beliefs, vegetation, fauna and change and development.
• Ming Pao Monthly 明報月刊 Call Number: AP95.C4 M56 One of the oldest periodical on culture, society, and politics in Hong Kong and abroad founded in 1966 by Mr. Cha Liangyong (Jin Yong).
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• CiNii Articles Index of Japanese journal articles; full-text available for some.
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• Monthly China Research Report 中国研究月報 Chūgoku kenkyū geppō An academic journal that covers all fields of research related to China in Japanese published by the China Research Institute.
• Journal of Oriental Studies 東方學報 Tōhō gakuhō Published by Institute for Research in Humanities at Kyoto University.
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Journals and Magazines - Pre-1949

• Periodicals in Late Qing Dynasty 晚清期刊 Taiwan's National Central Library provides this free database of digital facsimiles (not full-text searchable) of various late Qing dynasty periodicals held by the library. Current titles include 點石齋畫報, 新新小說, and 游戲世界; others are being added.
• Early Chinese Periodicals Online (ECPO) Pre-1949 Chinese-language magazines and xiaobao 小報 (entertainment newspapers) and some China-based foreign-language newspapers. Combines the following databases: 1. “Chinese Women’s Magazines in the Late Qing and Early Republican Period” (WoMag); 2. Xiaobao; 3. Modern History Databases 近代史數位資料庫; 4. Funü zazhi 婦女雜誌 (Women's Magazine)
• The Eastern Miscellany Full-text Database 东方杂志全文数据库 Full-text Database includes 44 volumes and 819 periods of Eastern Miscellany from March 1904 to December 1948, including over 30,000 articles, over 12,000 pictures, and over 14,000 advertisements.
• Modern History Data Platform 抗日战争与近代中日关系文献数据平台 [Data Platform for Documents on the War of Resistance against Japan and Modern Sino-Japanese Relations] An open access database providing a large number of books, newspapers, and magazines, and a smaller number of archival documents, images, and audiovisual materials, mostly from the first half of the 20th century. Materials relate to many topics, not just the second Sino-Japanese War and modern Sino-Japanese relations. It includes many literary works from the period. Individual registration is required to download materials (as JPG files). Some types of sources are searchable by tables of contents; none support full-text search.

Bibliography / List of Journal Titles

• Hua yi xian shang tu shu guan = Airiti Library: Taiwan Electronic Periodical Services (TEPS) - Journal Titles List List of the almost three thousand journal titles included in the TEPS database, as of January 2021.
• List of University of Washington print holdings of pre-1949 journals Browse list of UW's excellent print collection of late Qing and Republican period journals.
• NLC Taiwan Periodical Literature 國家圖書館期刊文獻資訊網 Provides bibliographic information on periodicals published in Taiwan, Hong Kong and Macao and selected periodicals published in mainland China before 1945.

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China now publishes more high-quality science than any other nation – should the US be worried?

Milton & Roslyn Wolf Chair in International Affairs, The Ohio State University

Disclosure statement

Caroline Wagner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

The Ohio State University provides funding as a founding partner of The Conversation US.

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By at least one measure, China now leads the world in producing high-quality science . My research shows that Chinese scholars now publish a larger fraction of the top 1% most cited scientific papers globally than scientists from any other country.

I am a policy expert and analyst who studies how governmental investment in science, technology and innovation improves social welfare. While a country’s scientific prowess is somewhat difficult to quantify, I’d argue that the amount of money spent on scientific research, the number of scholarly papers published and the quality of those papers are good stand-in measures.

China is not the only nation to drastically improve its science capacity in recent years, but China’s rise has been particularly dramatic. This has left U.S. policy experts and government officials worried about how China’s scientific supremacy will shift the global balance of power . China’s recent ascendancy results from years of governmental policy aiming to be tops in science and technology. The country has taken explicit steps to get where it is today, and the U.S. now has a choice to make about how to respond to a scientifically competitive China.

Growth across decades

In 1977, Chinese leader Deng Xiaoping introduced the Four Modernizations , one of which was strengthening China’s science sector and technological progress. As recently as 2000, the U.S. produced many times the number of scientific papers as China annually. However, over the past three decades or so, China has invested funds to grow domestic research capabilities, to send students and researchers abroad to study, and to encourage Chinese businesses to shift to manufacturing high-tech products.

Since 2000, China has sent an estimated 5.2 million students and scholars to study abroad . The majority of them studied science or engineering. Many of these students remained where they studied, but an increasing number return to China to work in well-resourced laboratories and high-tech companies.

Today, China is second only to the U.S. in how much it spends on science and technology . Chinese universities now produce the largest number of engineering Ph.D.s in the world, and the quality of Chinese universities has dramatically improved in recent years .

Producing more and better science

Thanks to all this investment and a growing, capable workforce, China’s scientific output – as measured by the number of total published papers – has increased steadily over the years. In 2017, Chinese scholars published more scientific papers than U.S. researchers for the first time.

Quantity does not necessarily mean quality though. For many years, researchers in the West wrote off Chinese research as low quality and often as simply imitating research from the U.S. and Europe . During the 2000s and 2010s, much of the work coming from China did not receive significant attention from the global scientific community.

But as China has continued to invest in science, I began to wonder whether the explosion in the quantity of research was accompanied by improving quality.

To quantify China’s scientific strength, my colleagues and I looked at citations. A citation is when an academic paper is referenced – or cited – by another paper. We considered that the more times a paper has been cited, the higher quality and more influential the work. Given that logic, the top 1% most cited papers should represent the upper echelon of high-quality science.

My colleagues and I counted how many papers published by a country were in the top 1% of science as measured by the number of citations in various disciplines. Going year by year from 2015 to 2019, we then compared different countries. We were surprised to find that in 2019, Chinese authors published a greater percentage of the most influential papers , with China claiming 8,422 articles in the top category, while the U.S had 7,959 and the European Union had 6,074. In just one recent example, we found that in 2022, Chinese researchers published three times as many papers on artificial intelligence as U.S. researchers; in the top 1% most cited AI research, Chinese papers outnumbered U.S. papers by a 2-to-1 ratio. Similar patterns can be seen with China leading in the top 1% most cited papers in nanoscience, chemistry and transportation.

Our research also found that Chinese research was surprisingly novel and creative – and not simply copying western researchers. To measure this, we looked at the mix of disciplines referenced in scientific papers. The more diverse and varied the referenced research was in a single paper, the more interdisciplinary and novel we considered the work. We found Chinese research to be as innovative as other top performing countries.

Taken together, these measures suggest that China is now no longer an imitator nor producer of only low-quality science. China is now a scientific power on par with the U.S. and Europe, both in quantity and in quality.

Fear or collaboration?

Scientific capability is intricately tied to both military and economic power. Because of this relationship, many in the U.S. – from politicians to policy experts – have expressed concern that China’s scientific rise is a threat to the U.S., and the government has taken steps to slow China’s growth. The recent Chips and Science Act of 2022 explicitly limits cooperation with China in some areas of research and manufacturing. In October 2022, the Biden administration put restrictions in place to limit China’s access to key technologies with military applications .

A number of scholars, including me, see these fears and policy responses as rooted in a nationalistic view that doesn’t wholly map onto the global endeavor of science.

Academic research in the modern world is in large part driven by the exchange of ideas and information. The results are published in publicly available journals that anyone can read. Science is also becoming ever more international and collaborative , with researchers around the world depending on each other to push their fields forward. Recent collaborative research on cancer , COVID-19 and agriculture are just a few of many examples. My own work has also shown that when researchers from China and the U.S. collaborate, they produce higher quality science than either one alone.

China has joined the ranks of top scientific and technological nations, and some of the concerns over shifts of power are reasonable in my view. But the U.S. can also benefit from China’s scientific rise. With many global issues facing the planet – like climate change , to name just one – there may be wisdom in looking at this new situation as not only a threat, but also an opportunity.

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Entrepreneurship and High-Quality Development of Enterprises—Empirical Research Based on Chinese-Listed Companies

• Published: 20 April 2024

Cite this article

• Tannek Marcel 1 ,
• Zhang Zenglian 2 ,
• Obina Ayele Reve Yanick 1 &
• Bezafy Paulin 3  

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This paper deeply discusses the far-reaching influence, function, and internal mechanisms of entrepreneurship in promoting the development of high-quality economies by taking a-share listed companies in Chongqing and Chengdu from 2015 to 2022. In order to quantify the impact of entrepreneurship, this paper adopts a comprehensive index, which is constructed by the principal component analysis method and supplemented by total factor productivity as a strict robustness test. These paper’s findings emphasize the key role of entrepreneurship in promoting China’s rapid economic growth and show that entrepreneurs can realize the extraordinary development of enterprises by using internal control and directing a large amount of investments to R&D. This could lay the foundation for high-quality growth, which is becoming more and more important in the face of economic uncertainties. Our research is an indispensable resource for policymakers and entrepreneurs in China, providing them with valuable insights and strategies to meet the complex challenges in the process of pursuing high-quality economic development. In the changing economic environment, a subtle understanding the role of entrepreneurs could promote future economic growth and innovation of China.

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China now publishes more high-quality science than any other nation

The u.s. can benefit from china's scientific rise, expert says, originally published in , by caroline wagner, milton & roslyn wolf chair in international affairs, john glenn college of public affairs.

In 2022, Chinese researchers published more scientific papers on artificial intelligence than any other nation. Mf3D/E+ via Getty Images

By at least one measure, China now leads the world in producing high-quality science . My research shows that Chinese scholars now publish a larger fraction of the top 1% most cited scientific papers globally than scientists from any other country.

I am a policy expert and analyst who studies how governmental investment in science, technology and innovation improves social welfare. While a country’s scientific prowess is somewhat difficult to quantify, I’d argue that the amount of money spent on scientific research, the number of scholarly papers published and the quality of those papers are good stand-in measures.

China is not the only nation to drastically improve its science capacity in recent years, but China’s rise has been particularly dramatic. This has left U.S. policy experts and government officials worried about how China’s scientific supremacy will shift the global balance of power . China’s recent ascendancy results from years of governmental policy aiming to be tops in science and technology. The country has taken explicit steps to get where it is today, and the U.S. now has a choice to make about how to respond to a scientifically competitive China.

Growth across decades

In 1977, Chinese leader Deng Xiaoping introduced the Four Modernizations , one of which was strengthening China’s science sector and technological progress. As recently as 2000, the U.S. produced many times the number of scientific papers as China annually. However, over the past three decades or so, China has invested funds to grow domestic research capabilities, to send students and researchers abroad to study, and to encourage Chinese businesses to shift to manufacturing high-tech products.

Since 2000, China has sent an estimated 5.2 million students and scholars to study abroad . The majority of them studied science or engineering. Many of these students remained where they studied, but an increasing number return to China to work in well-resourced laboratories and high-tech companies.

Today, China is second only to the U.S. in how much it spends on science and technology . Chinese universities now produce the largest number of engineering Ph.D.s in the world, and the quality of Chinese universities has dramatically improved in recent years .

Producing more and better science

Thanks to all this investment and a growing, capable workforce, China’s scientific output – as measured by the number of total published papers – has increased steadily over the years. In 2017, Chinese scholars published more scientific papers than U.S. researchers for the first time.

Quantity does not necessarily mean quality though. For many years, researchers in the West wrote off Chinese research as low quality and often as simply imitating research from the U.S. and Europe . During the 2000s and 2010s, much of the work coming from China did not receive significant attention from the global scientific community.

But as China has continued to invest in science, I began to wonder whether the explosion in the quantity of research was accompanied by improving quality.

To quantify China’s scientific strength, my colleagues and I looked at citations. A citation is when an academic paper is referenced – or cited – by another paper. We considered that the more times a paper has been cited, the higher quality and more influential the work. Given that logic, the top 1% most cited papers should represent the upper echelon of high-quality science.

My colleagues and I counted how many papers published by a country were in the top 1% of science as measured by the number of citations in various disciplines. Going year by year from 2015 to 2019, we then compared different countries. We were surprised to find that in 2019, Chinese authors published a greater percentage of the most influential papers , with China claiming 8,422 articles in the top category, while the U.S had 7,959 and the European Union had 6,074. In just one recent example, we found that in 2022, Chinese researchers published three times as many papers on artificial intelligence as U.S. researchers; in the top 1% most cited AI research, Chinese papers outnumbered U.S. papers by a 2-to-1 ratio. Similar patterns can be seen with China leading in the top 1% most cited papers in nanoscience, chemistry and transportation.

Our research also found that Chinese research was surprisingly novel and creative – and not simply copying western researchers. To measure this, we looked at the mix of disciplines referenced in scientific papers. The more diverse and varied the referenced research was in a single paper, the more interdisciplinary and novel we considered the work. We found Chinese research to be as innovative as other top performing countries.

Taken together, these measures suggest that China is now no longer an imitator nor producer of only low-quality science. China is now a scientific power on par with the U.S. and Europe, both in quantity and in quality.

On August 9, 2022, President Joe Biden signed the CHIPS and Science Act into law to support the growth of U.S. research and technology firms as a way to counter China’s scientific growth. The White House/Flickr

Fear or collaboration?

Scientific capability is intricately tied to both military and economic power. Because of this relationship, many in the U.S. – from politicians to policy experts – have expressed concern that China’s scientific rise is a threat to the U.S., and the government has taken steps to slow China’s growth. The recent Chips and Science Act of 2022 explicitly limits cooperation with China in some areas of research and manufacturing. In October 2022, the Biden administration put restrictions in place to limit China’s access to key technologies with military applications .

A number of scholars, including me, see these fears and policy responses as rooted in a nationalistic view that doesn’t wholly map onto the global endeavor of science.

Academic research in the modern world is in large part driven by the exchange of ideas and information. The results are published in publicly available journals that anyone can read. Science is also becoming ever more international and collaborative , with researchers around the world depending on each other to push their fields forward. Recent collaborative research on cancer , COVID-19 and agriculture are just a few of many examples. My own work has also shown that when researchers from China and the U.S. collaborate, they produce higher quality science than either one alone.

Caroline Wagner , Milton & Roslyn Wolf Chair in International Affairs, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article .

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China overtakes the US in scientific research output

Between 2018 and 2020 China published 23.4% of the world’s scientific papers, eclipsing the US

China has overtaken the US as the world leader in both scientific research output and “high impact” studies, according to a report published by Japan’s science and technology ministry.

The report, which was published by Japan’s National Institute of Science and Technology Policy (NISTP) on Tuesday, found that China now publishes the highest number of scientific research papers yearly, followed by the US and Germany.

The figures were based on yearly averages between 2018 and 2020, and drawn from data compiled by the analytics firm Clarivate.

The Japanese NISTP report also found that Chinese research comprised 27.2% of the world’s top 1% most frequently cited papers. The number of citations a research paper receives is a commonly used metric in academia. The more times a study is cited in subsequent papers by other researchers, the greater its “citation impact”.

The US accounted for 24.9% of the top 1% most highly cited research studies, while UK research was third at 5.5%.

China published a yearly average of 407,181 scientific papers, pulling ahead of the US’s 293,434 journal articles and accounting for 23.4% of the world’s research output, the report found.

China accounted for a high proportion of research into materials science, chemistry, engineering and mathematics, while US researchers were more prolific in research into clinical medicine, basic life sciences and physics.

The report was published on the day US president Joe Biden signed the Chips and Science Act, legislation that would authorise $200bn in research funding over 10 years to make US scientific research more competitive with China.

The Chinese embassy in the US said last month that China was “firmly opposed” to the bill which it said was “entrenched in [a] cold war and zero-sum game mentality”.

The “high impact” finding is in keeping with research published earlier this year , which found that China overtook the US in 2019 in the top 1% measure, and passed the European Union in 2015.

Papers that receive more citations than 99% of research are “works that are seen as being in the class of Nobel prize winners, the very leading edge of science”, study co-author Dr Caroline Wagner said at the time. “The US has tended to rank China’s work as lower quality. This appears to have changed.”

The US still spends more on research and development in the corporate and university sectors than any other country, the report also found. “China has the largest number of researchers in the corporate and university sectors among major countries. In the corporate sector, the United States and China are on par with each other, and both are showing rapid growth.”

“China is one of the top countries in the world in terms of both the quantity and quality of scientific papers,” Shinichi Kuroki of the Japan Science and Technology Agency told Nikkei Asia . “In order to become the true global leader, it will need to continue producing internationally recognised research,” he said.

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