In a traditional Chinese medicine store in central Beijing, part of the Tongrentang chain founded 342 years ago, three white-coated workers follow traditions that stretch even further back in time. They sort and chop an exotic variety of herbs and roots for customers to take home and boil up.
The black liquid that results "tastes very bad," David Zhang, the chief engineer at Tongrentang Health Pharmaceutical, says grimacing. At its high-tech lab in the Chinese capital, Zhang and his research team are hustling to provide more drugs in tablet, soft-capsule or powder form, like Western medicine, plus more ingredient details and scientific explanations of why ancient solutions work.
"We want to make Chinese medicine more acceptable to Western consumers," Zhang says.
So does Beijing. In August, China's health ministry launched a government-backed industry-university alliance to promote traditional Chinese medicine in the global market. As the number of foreign countries already using such medicine rises, exports are now worth almost $1.5 billion a year, says Wang Guoqiang, director of the State Administration of Traditional Chinese Medicine.
But challenges remain before China can fully exploit this cornerstone of its culture. Even in China, the scale of traditional medicine production lags far behind China's Western medicine manufacturers. Much of the export volume comprises simple herbal plants and extracts, rather than finished drugs.
In some world markets, China's government is pushing an open door. In Ghana, where traditional medicine is highly popular, Chinese authorities will begin clinical trials on its medicines and establish a large plantation to grow herbal plants for drugs, according to the Ghana News Agency.
The United States is a different matter. U.S. Food and Drug Administration rules require three highly expensive phases of clinical trials before new drugs receive approval to hit the market. Last month, the Compound Danshen Dripping Pill, a herbal treatment for angina and coronary heart disease, became the first Chinese traditional drug to pass Phase 2 -- but it still may be 2013 before it can enter the U.S. market.
"The Chinese people have made clinical trials for over 3,000 years," Tongrentang's Zhang says.
One of the world's oldest medical systems, traditional Chinese medicine views the body as a network of interconnected systems and energies. There is a focus on remedying underlying causes rather than treating symptoms. Presenting it in a scientific manner is a challenge.
"When I lecture in the U.S.A., no one will recognize yin and yang, or the need for balance," says Zhang, who has studied in the U.S. and Europe. "If we can explain how it works, using Western medicine experience and methods, then more Westerners will accept it, and more young Chinese, too," he hopes.
Yang Weirui, who works for an information technology firm in Beijing, can still taste the bitter infusions her mother prepared for her as a child.
"Chinese young people take less traditional Chinese medicine than their parents," says Yang, 27, but this week she visited a traditional Chinese medicine store to buy products for her parents -- and herself.
"Chinese medicines are more like Western pills now," Yang says. "We Chinese often choose a pill including both Western and Chinese elements."
A three-year survey of traditional Chinese medicine use in China, conducted by the Horizon Research Group, found almost 90 percent of the 100,000 respondents had used such medicine. Almost 50 percent said they chose traditional Chinese medicine over Western medicine because it costs less, according to the survey.
"Traditional Chinese medicine has a great role in building China's international relations, but we should not exaggerate what practices such as acupuncture can do," says Wang Hongcai, deputy director of the China Beijing International Acupuncture Training Center.
As with most branches of medicine, there are multiple claims and counterclaims for the efficacy of traditional Chinese medicine. Acupuncture has been shown to be effective at treating chronic lower-back pain, according to a study in the July issue of the New England Journal of Medicine. But a study in the Canadian Medical Association Journal in September concluded that acupuncture does not speed recovery after a stroke.
Wang remembers sitting in fascination as a child while his father treated patients with acupuncture. "They were poor, as it was the time of the Cultural Revolution, but they brought him an egg or a few dates to show their respect," he says. His daughter has gone to the U.S. to study economics.
"Younger Chinese prefer the U.S.A. and its culture," Wang says with a sigh.
Martina Tam, from Seattle, is studying acupuncture for six months at the center. In her first day at a clinic last month, Tam and other students were allowed to pull needles out. On the second day, they stuck them in.
"Americans are more ready to give acupuncture a go, and many medical schools have already started research," says Tam, who is half-Chinese.
She says she hopes to take her new knowledge back to medical school in the U.S. next year, and ultimately offer free acupuncture in community centers, because the high cost in the U.S., up to $70 a session, prevents many people from accessing acupuncture, she says.
China wants to more than double its foreign student numbers to 500,000 in 2020, from a record high of 240,000 in 2009, according to the Ministry of Education. Some 13.5 percent of foreign students study medicine, while about 60 percent study Chinese.
Outside China, concern remains about the use of animal parts in traditional Chinese medicine, especially those of endangered species. Within the country, more people worry about issues such as fake drugs and even fake "masters" of traditional Chinese medicine: Two high-profile health gurus were exposed as frauds this summer. Yu Chun, president of Tongrentang Health Pharmaceutical, looks for the bright side.
"Consumers must not choose blindly; it's good for them to show judgment," says Yu, whose state-owned firm will soon break ground on a huge research and production facility in Beijing. "Our products are safe, natural and have no side effects," he says. "Look at me -- I'm proof of that, as I personally try many of our products every day."
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