Liu Tianchi,Zhang Xiaopo,Wang Yitao,Zeng Yu

(1.Institute of Chinese Medical Sciences (ICMS),University of Macao,Macao 999078,China;2.Institute of Pharmacy,Hainan Medical College,Haikou 571199,China;3.Laboratory of Quality Research in Chinese Medicine (SKL-QRCM),University of Macao,Macao 999078,China;4.Hainan South China Sea Health Industry Research Institute,Haikou 570145,China)

Abstract Objective To develop the internationalization and modernization of Hainan’s TCM industry,explore the development direction and fill in the research gap.Methods Design qualitative approaches,including fieldwork,semi-structured interviews,and policy analysis,were employed to identify development challenges for the cooperation between Hainan and Macao in TCM industry.Ten interviews with key TCM industry stakeholders in Hainan and Macao were conducted in 2020.These stakeholders are from schools,hospitals,companies,and governments.Hainan Province is the only free trade port with Chinese characteristics.Macao is an international free trade port that has special economic relations with European and Portuguese-speaking countries.Therefore,this study focuses on the cooperation in the traditional Chinese medicine (TCM) industry between Hainan and Macao.Besides,it investigates the traditional Chinese medicine industry in Hainan and Macau according to the SWOT model.Results and Conclusion The study revealed strengths,weaknesses,opportunities,and threats for cooperation between Hainan and Macao in TCM industry.Cooperation between Hainan and Macao can be taken as a priority outline and a standard for the internationalization and modernization of Hainan’s TCM industry.

Keywords: traditional Chinese medicine (TCM);industrialization;internationalization;modernization;Hainan;Macao

1 Introduction

Traditional Chinese medicine (TCM) has been a great contribution to the reproduction of the Chinese nation and has had a positive impact on the progress of world civilization.In October 2016,the CPC Central Committee and the State Council released the “Outline of the 2030 Plan for a Healthy China”[1].In December of the same year,the standing committee of the National People’s Congress passed the “Law of the People’s Republic of China on Traditional Chinese Medicine”[2].In 2019,the “Opinions of the CPC Central Committee and the State Council on Promoting the Heritage,Innovation and Development of Traditional Chinese Medicine” were released and implemented[3].The opinion clearly suggested that special projects should be implemented for international cooperation and the formulation of international standards for TCM should be made as well.In 2020,the “Report on the Work of the State Council” emphasized the revitalization of TCM[4].

In the area of more than 2 million square kilometers under the jurisdiction of Hainan Island,a large number of China southern medicinal plants,Li ethnic medicine,and marine drugs are important resources for the TCM industry[5].The high-tech industry (including the TCM industry) is one of the three major areas of Hainan’s future development[6],and the output value of the pharmaceutical industry was approximately 26 billion yuan in 2019[7].In 2019,the Hainan provincial Party committee and government issued the “Hainan Provincial Health Industry Development plan (2019-2025)”[8]to support Hainan’s comprehensively deepening reform and opening up[9].The plan clearly proposed to organize the cooperation of the TCM industry between Hainan and Macao,developing Chinese patent medicine,exploring hospital TCM preparations,and simplifying the registration approval process when the TCM compound preparation goes on the market.In 2020,the CPC Central Committee and the State Council issued the “Overall Plan for the Construction of Hainan Free Trade Port”,which clearly stated its requirements for promoting the joint development of the Guangdong-Hong Kong-Macao Greater Bay Area.Therefore,we can take full advantage of Hainan’s rich natural resources,unique geographical location and its backing to the large-scale domestic market and hinterland economy[10].In 2022,Hainan Province issued the “Implementation Opinions on Promoting the Inheritance,Innovation and Development of TCM in Hainan Free Trade Port”,which proposed to build a modern industrial system of TCM,key projects and demonstration bases of TCM service trade,and to create a new format and model of TCM health tourism in combination with the actual situation of the free trade port[11].

After more than 30 years of development,Hainan’s TCM industry chain is relatively perfect,but the main bottleneck of development is the lack of high-tech talents and a low level of research and development (R&D).Although Sanya TCM Hospital in Hainan was approved as the national TCM service export base in 2018[12],Hainan’s TCM products have not gone abroad.In particular,Hainan Province has few cooperation projects with Macao.

The “Policy Address of the Macao Special Administrative Region for the Fiscal Year 2020”declared that it would promote the moderate and diversified development of economy and explore the development of high-tech industries[13].Besides,it would focus on the development of TCM and health industries.For example,it would take advantage of Macao’s TCM State Key Laboratory to develop classical famous prescriptions and establish a platform for innovation,R&D and transformation of TCM.“Regulations on the Boao Lecheng Pilot Zone of International Medical Tourism in Hainan Free Trade Port” suggested that the government should promote the international cooperation and service trade of TCM and encourage state key laboratories to set up branches in this pilot zone[14].The “Development Plan for Promoting the High-quality Integration of TCM into the Joint Construction of the ‘Belt and Road Initiative’(2021-2025)”proposed to strengthen the coordination and docking with regional strategies,including the construction of a TCM highland in the Guangdong-Hong Kong-Macao Great Bay area,supporting the development of TCM in the Hengqin-Guangdong-Macao cooperation zone,and the opening-up in the field of TCM to a higher level[15].In the same year,the “14th Five-Year Plan for the Development of TCM in Guangdong Province” proposed to strengthen the construction of international centers and bases of TCM,promote the overseas development of TCM in countries along the “Belt and Road Initiative”,and support TCM medical institutions,enterprises,social groups and various forms of overseas cultural dissemination activities of TCM[16].The “Law on TCM Activities and Registration of Chinese Patent Medicines” officially entered into force on January 1,2022.The purpose of the law is to improve the supervision of TCM production and introduce the registration system of traditional Chinese patent medicines to maintain public health,support the development of the TCM industry,and enhance the export competitiveness of Macao’s manufactured traditional Chinese patent medicines[17].However,there are still many obstacles for Macao’s TCM products to enter the market in Chinese mainland.

At present,the research on the cooperation between Hainan and Macao in TCM industry is inadequate.This article uses policy research,semistructured interviews and fieldwork to provide the following suggestions.Firstly,the cooperation strategy should be complementary and mutually beneficial.Secondly,the Central Government should cooperate with the Hainan government to formulate international standards for Hainan genuine medicinal materials in Hainan.Thirdly,clinical real-world data should be applied to hospital TCM preparations as soon as possible.Fourthly,high-end technology and talents from Macao universities should be introduced actively.

2 Methodology

2.1 Participant recruitment

The participants were invited because they were in middle to high level management positions in respective organizations of the TCM industry who could provide constructive advice.A purposive sampling strategy was employed to recruit participants from the Standing Committee of Hainan Provincial People’s Congress,Hainan Medical Products Administration,Hainan Branch of Chinese Academy of Medical Sciences,Hainan Medical College,Hainan South China Sea Health Industry Research Institute,Hainan Provincial Hospital of TCM,the University of Macau,Hainan Bikai Pharmaceutical Co.,Ltd.,and Hainan Jiuzhitang Pharmaceutical Co.,Ltd.The participants were composed of expert government officials,academics,company managers,and a clinician.

2.2 Study design and setting

The interview was designed in combination with the relevant national policies of TCM as below.In 2022,the “14th Five-Year Plan for the Development of TCM” deployed ten key tasks,including building a high-quality and efficient TCM service system,improving the health service capacity of TCM,and building a team of high-quality TCM talents[18].The “14th Five-Year Plan for the Development of Pharmaceutical Industry” emphasized the creation of new international competitive advantages.First,global pharmaceutical innovation factors should be attracted to gather domestically.Second,domestic pharmaceutical enterprises should be promoted to enter the international market at a higher level.Third,the foundation of international pharmaceutical cooperation should be consolidated[19].The “Notice on Several Policies and Measures to Accelerate the Development of TCM Features” proposed to consolidate the foundation of TCM talents,including improving the overall level of TCM education and strengthening the evaluation and incentive of TCM talents[20].

Therefore,the main goal is to promote the internationalization and modernization of Hainan’s TCM industry.And the interview covers some topics of TCM talent training.Three data collection methods were adopted to ensure data adequacy.Authoritative and instructive documents were collected based on a search in the policy database as a source of information about the background of the TCM industry in Hainan and Macao.Based on the SWOT model (strengths,weaknesses,opportunities,and threats),an interview guide was developed that focused on three parts.First is the current situation of the TCM industry in Hainan and Macao.The second is the strengths,weaknesses,opportunities,and threats of the TCM industry in Hainan and Macao.The third is the development direction of the TCM industry in Hainan and Macao.

2.3 Data collection

The interviews were conducted in February 2020.Due to the travel inconvenience during the epidemic,four interviews were face-to-face interviews,and the others were online video interviews.All the interviews were conducted in Chinese and audio-recorded following written consent.The average duration of each interview was approximately 60-90 minutes.

The first author,a doctoral candidate,conducted the interviews,recording the discussions and organizing the meeting minutes.A professor,a member of the Standing Committee of Hainan Provincial People’s Congress,and the founder of higher pharmacy education in Hainan,was the first interviewee (Participant 2) who later also attended the other interviews.He is familiar with qualitative research methodology and the context of pharmacy practice in China.

2.4 Data analysis

First,the audio recordings of the interviews were transcribed verbatim prior to the analysis,and they were translated into English by the first author.Second,key themes were identified by using open coding and categorizing to ensure that the analysis represented all perspectives.Third,the coding was discussed and checked,and analytical results were reviewed and refined by the first author and the accompanying author.

3 Results

3.1 Hainan TCM planting

According to the interviews with Participant 3,the director of teaching and research section of Medicinal Plants and Pharmacognosy,Hainan Medical College,and Participant 4,an associate researcher of Hainan Branch of Chinese Academy of Medical Sciences,and Participant 10,the party secretary of Hainan Provincial Hospital of TCM and the national celebrated TCM expert,the following conclusions are drawn.

3.1.1 The status and strengths

There are more than 2 400 kinds of medicinal plants in Hainan.Among them,some medicinal plants are only suitable for growing in Hainan (the only tropical island in China),such asArecae semen,Alpinia oxyphyllaMiq.andDalbergia odoriferaT.Chen.Some native species are dominant in Hainan.First,lpinia oxyphyllaMiq.,Alpinia officinarumHance,Morinda citrifoliaandKaempferia galanfaare mainly used in the medicinal materials market or processing into health products.Second,Arecae semenis easy to grow,and a large amount is acquired.It is mainly processed intodried food.Third,compared with Guangdong,Guangxi,and Yunnan provinces,Aquilaria sinensis(Lour.) Gilg cultivation technology in Hainan has the advantage of artificial incense making.Its market demand is stable with high price.Fourth,Aloe vera(Haw.) Berg is used to produce cosmetics that is mainly purchased by foreign countries.Because of the low price,it is increasingly planted.

Moreover,Hainan also has many raw materials bases.First,Callicarpa nudifloraHook.et Arn.planting base of Jiuzhitang Pharmaceutical Co.,Ltd.is approximately 2 million square meters.Second,Jinguang and Wuzhishan Pharmaceutical Co.,Ltd.have possessed approximately 4.5 million square meters ofNauclea officinalisPierre.ex Pitard.Third,Bikai Pharmaceutical Co.,Ltd.succeeded in transplantingCurcuma wenyujinY.H.Chen et C.Ling from Zhejiang Province.Now,it has a planting base of approximately 2 million square meters.

3.1.2 The weaknesses

First,since farmers have mature technology for planting melons and vegetables with stable income,they are not willing to learn the technology of growing herbs.Although herbal planting technology is not high,the demand for medicinal material resources is low.Second,land rent and labor costs are both high,so Hainan is more suitable for the cultivation of high-income medicinal materials such asAquilaria sinensis(Lour.) Gilg,Dalbergia odoriferaT.Chen andMillettia speciosaChamp.The above deficiency causes the price fluctuations and output instability in Hainan medicinal plants.

3.1.3 The threats

There is no local market for medicinal material,so enterprises have to rely on the TCM market in Yulin City,Guangxi Province.

3.1.4 Suggestions

First,in combination with national poverty alleviation policies,farmers should be encouraged to grow medicinal plants such asHevea brasiliensis,Areca catechu,Alpinia oxyphyllaMiq.andArecae sementrees.Second,5G and Internet technologies should be used to manage indoor cultivated medicinal materials,such asDendrobium officinaleKimura et Migo.Third,water fertilizer integration and unmanned aerial vehicles should be used to spray pesticides.

3.2 Hainan TCM manufacturing

According to the interviews with Participant 1,the president of Hainan South China Sea Health Industry Research Institute and the former director of Hainan Medical Products Administration,Participant 5,a senior engineer and general manager of Hainan Jiuzhitang Pharmaceutical Co.,Ltd and Participant 6,a senior engineer and the chairman of Hainan Bikai Pharmaceutical Co.,Ltd.,the following conclusions are drawn.

3.2.1 The status

There are fewer than 100 pharmaceutical enterprises in Hainan,and ninety-nine percent of them are privately owned.Fifty enterprises have TCM products,and there are no enterprises that only focus on TCM products.

3.2.2 The weaknesses

Although there are more than 2 400 kinds of medicinal plants and approximately 300 kinds of them are recorded in the pharmacopoeia,the number of wild medicinal herbs involved in their production is insufficient[21].

3.2.3 The opportunities

The launch of the Hainan Free Trade Port is a huge benefit to the development of TCM industry.In addition,in 2019,the “Notice on Printing and Distributing the Implementation Plan of Supporting the Construction of Boao Lecheng Pilot Zone of International Medical Tourism” clearly proposed that the government should carry out the application of clinical real-world data[22].Therefore,Macao’s mature in-hospital prescription preparations can be taken to the pilot zone and registered as the domestic drug.

3.2.4 The threats

The National Medical Products Administration approves few TCM product varieties every year,so most of Hainan pharmaceutical enterprises focus on the secondary development of proprietary TCM products.Since 2014,the government has required Hainan enterprises to have their own extraction workshop or purchase the extract with the document number for producing Chinese patent drugs,so many enterprises are restricted in production.

3.2.5 Suggestions

First,international standards of Hainan medicinal materials should be formulated to bring more products to the international market.Second,enterprise and university should have cooperation in enterprise R&D projects.For example,Professor Wang Yitao at the University of Macau can make a concrete contribution to Hainan TCM products in terms of pharmacology.

3.3 Hainan TCM education

According to interviews with Participant 2 and Participant 7,the vice president and a professor in the Department of Pharmacy,Hainan Medical College,the following conclusions are drawn.

3.3.1 The status

In 2001,Hainan Medical College began to enroll pharmacy undergraduates.Then it set up some majors in TCM,clinical pharmacy and marine pharmacy.In 2014,it began to recruit pharmaceutical postgraduate students with a number of 10 to 15 every year.However,it has not established a PhD project in related fields.

3.3.2 The weaknesses

The R&D development of TCM still relies on the Provincial Key Laboratory of Tropical Medicinal Plants at Hainan Medical College.However,there are few national-level projects.Additionally,there are few TCM enterprises with R&D capability.

3.3.3 Suggestions

Hainan Medical College may jointly establish a Hainan Center with the State Key Laboratory of Quality Research in Chinese Medicine at the University of Macau to apply for the government funds of Macao and the mainland of China.

3.4 Macao TCM education

The following conclusions are drawn according to the interviews with Participant 8 and Participant 9 at the University of Macau.Participant 8 is an associate professor and deputy director of the Institute of Chinese Medical Sciences.Participant 9 is an associate professor and program coordinator of Biomedical Sciences (PhD).

3.4.1 The status and advantages

The TCM state key laboratories have played an important role in promoting science and technology in Macao.At the Institute of Chinese Medical Sciences in the University of Macau,much work has been done on the effectiveness,safety,stability,controllability,policies and laws of TCM.

3.4.2 The weaknesses

First,Macao does not have many medicinal plant resources and TCM cultivation bases.Second,the industrial foundation of TCM is weak.For example,there are approximately ten pharmaceutical departments engaged in TCM products,with a small factory scale and a few employees.Most of TCM products are for tourists,such as safflower oil.Third,the market capacity is small because the population of Macao is lower than one million,and the number of tourists is approximately 30 million every year.Fourth,insufficient efforts have been made to transform scientific research results into products.The state key laboratories mainly focus on basic science research.

3.4.3 The opportunities

In 2020,the chief executive of Macao,Ho Iat Seng,highlighted the development of TCM,and proposed the introduction of a proprietary TCM registration policy that would use TCM state key laboratories to develop new products[13].

3.4.4 Suggestions

Firstly,Hainan should establish a Macao-Hainan-Guangdong-Guangxi advanced innovation platform for the cooperation of TCM R&D.Secondly,cooperating with the University of Macau,Hainan University should recruit TCM doctoral students.

4 Discussion

In the era of building Hainan free trade port,new requirements for modernization and internationalization of the TCM industry are put forward.This research shows that the main problems are the lack of top talents and innovation ability.It is suggested the joint training with the universities in Macao should be carried out.Second,the policy of “application of clinical real world data” should be implemented as soon as possible,so that hospital preparations can become registered Chinese patent drugs[21].Third,the global window of the Macao free trade port should be made full use to enable Hainan TCM products to enter the European countries market.The SWOT model of the Hainan TCM industry is shown in Table 1.

Table 1 SWOT model of the Hainan TCM industry

Now Macao advocates diversified economic development moderately,and TCM is an essential area in government planning[13].This research shows that the State Key Laboratory of Quality Research in Chinese Medicine at the University of Macau,and the State Key Laboratory of Quality Research in Chinese Medicines at Macau University of Science and Technology can take advantage of their R&D strength and top TCM talent training base to exploit the Hainan TCM Market.The SWOT model of the Macao TCM industry is shown in Table 2.

Table 2 SWOT model of the Macao TCM industry

But this study also has some limitations.First,the Hainan TCM industry can cooperate with other regions and achieve internationalization and modernization as well.Second,the inclusion of up to 2 representatives from the key stakeholder categories may not be able to provide the maximum capacity to reflect on the complete view about the interview questions.Therefore,more extensive sampling is required in future studies.

5 Conclusion

When Hainan becomes the only free trade port with Chinese characteristics,it will bring much financial support from the government to TCM industry.Meanwhile,challenges still exist.Then,we try to reach the demand of Hainan and the advantage of Macao to find the direction of complementary cooperation,so that bottleneck problems in the development of Hainan’s TCM industry can be solved.Cooperation between Hainan and Macao is conducive to the internationalization and modernization of Hainan’s TCM industry.