RESIGNIFICANCE AND INTERNATIONALIZATION OF TRADITIONAL CHINESE MEDICINE: THE STRATEGIC COMMUNICATION OF ITS USE AGAINST SARS AND COVID-19
Abstract
The People's Republic of China (PRC) is a world power that has repositioned itself in the international system and in this process has sought to re-signify and internationalize its ancient culture. The objective of this article is to understand the process of resignificance and internationalization of Traditional Chinese Medicine (TCM) as a central element of its culture, through the analysis of the strategic communication used by the Asian giant to show its use in the fight against the SARS epidemic and the COVID-19 pandemic. Chinese journalistic sources such as Xinhua, People's Daily and China Hoy are used, contrasted with other international agencies, as well as official sources like the White Paper on TCM and the document “Guidelines for using acupuncture and moxibustion to treat COVID-19” analyzed with a qualitative approach. It is proposed, at a hypothetical level, that Covid-19 pandemic has given new impetus to China's efforts to internationalize its traditional medicine, which it had already tried with the SARS epidemic in the Hu Jintao government. Through strategic communication, which emphasizes the positive effects of its use, it seeks to make it clear that, as stated by President Xi Jinping, TCM is a treasure of Chinese scientific heritage and therefore a sample of legacy of the Chinese civilization to the development of humankind in the "new era".
Desde el estallido social chileno a la pandemia COVID-19: aproximaciones de un cambio profundo
Resumen
La República Popular China (RPCh) es una potencia mundial que se ha reposicionado en el sistema internacional y en ese proceso ha buscado re-significar e internacionalizar su cultura milenaria. El objetivo de este artículo es comprender el proceso de resignificación e internacionalización de la Medicina Tradiciona China (MTC) como un elemento central de su cultura, a través del análisis de la comunicación estratégica que utiliza el gigante asiático para mostrar su uso en el combate contra la epidemia del SARS y la pandemia de COVID-19. Se utilizan fuentes periodísticas chinas como Xinhua, People´s Daily y China Hoy, contrastadas con otras agencias internacionales, así como también fuentes oficiales como el Libro Blanco sobre MTC y el documento “Pautas para el uso de acupuntura y moxibustión para tratar el COVID-19” analizadas con un enfoque cualitativo. A nivel de hipótesis se plantea que la pandemia de COVID-19 le ha dado un nuevo impulso a los esfuerzos de China por internacionalizar su medicina tradicional, los que ya había intentado con la epidemia de SARS en el gobierno de Hu Jintao. A través de una comunicación estratégica, que pone relevancia en los efectos positivos de su uso, busca dejar en claro que, como planteó el presidente Xi Jinping, la MTC es un tesoro del patrimonio científico chino y por lo mismo una muestra del legado de la civilización china al desarrollo de la humanidad en la “nueva era”.
Keywords
China, COVID19, Internationalization, Resignificance, SARS, Strategic Communication, Traditional Chinese Medicine, TCM
INTRODUCTION
The People's Republic of China (PRC) is no longer a rising power, but has already positioned itself in the international system. In conjunction with this repositioning process, which led it to its current position, a process of re-signification of its millenary culture has been generated through a new valorization and internationalization of the same. Following Alvarez, we understand the concept of resignification as a fundamental pillar of the Chinese repositioning process, which implies projecting, although without changing the essence of the actor involved, a renewed image that allows access to a new stage of global interference and participation (2017. p. 29). This idea is also in line with the postulates of China's "new era" announced by Xi Jinping at the 19th Congress of the Communist Party of China (Xinhua, March 18, 2018), whose objective is to restore China's greatness as a world power.
The general feeling in China is that this return to the most influential countries in the international system is nothing more than the natural restitution of its status as a "central country" and as one of the world's great civilizations, with great contributions to human progress such as paper, gunpowder or the compass. In this sense, it can be argued that China has redefined and enhanced the value of its millenary culture as a contribution to world civilization.
One of the examples of the resignification of Chinese culture has been the revaluation of Traditional Chinese Medicine (TCM), both within the PRC and its health system, as well as abroad. The process of re-signification of TCM goes hand in hand with its internationalization, on a path that began in 1979 when the World Health Organization drew up guidelines on the safety of acupuncture, but which has gained much strength under the governments of Hu Jintao and Xi Jinping. In this sense, many Chinese believe that their traditional medicine is one of the great contributions that China has made to human development.
When we speak of Traditional Chinese Medicine, we refer to a set of clinical practices that have been recently compiled and evaluated by the PRCh and the WHO. They are thus a type of modern evaluation of millenary treatments. According to the WHO definition, TCM has been in use in China for over two thousand years and has its own unique theories for treating disease and improving health. There are many modalities included in TCM, such as herbal medicine (herbal medicine), moxibustion, acupuncture, tuina or qigong. TCM also utilizes traditional Chinese medicines, including herbs, herbal materials, preparations and finished products that have been documented in the classical and modern TCM literature. These elements of Chinese Materia Medica may contain non-plant elements and substances, such as animal parts and minerals (WHO, 2010). The World Health Organization recognizes its effectiveness especially as a palliative treatment for chronic diseases and encourages its regulation and supervision (WHO, 2013).
According to WHO:
Today there is a sophisticated body of knowledge built up over centuries, including basic theory, diagnostic procedures and treatment approaches. TCM is commonly used for chronic diseases, but also for some acute conditions. It has also been used in areas such as internal medicine, gynecology, pediatrics, traumatology, external medicine, dermatology, emergency medicine, ophthalmology and otolaryngology. According to the theory of traditional Chinese medicine, it is used to treat not only secondary manifestations (Biao), but also the main causes (Ben) of various conditions (WHO, 2010. p. 3. Translated by the author).
This article seeks to analyze the process of re-signification and internationalization of TCM in the strategic communication that occurs with its use in the fight against the SARS epidemic (2002-2003) and in the COVID-19 pandemic that begins in 2019. In this sense, we seek to answer the questions: What are the characteristics of the resignification of TCM and how are they expressed in the strategic communication of the fight against SARS and COVID-19?
As a hypothesis, the COVID-19 pandemic has given new impetus to China's efforts to internationalize its traditional medicine, which had already been attempted with the SARS epidemic during the Hu Jintao government. Through a strategic communication, which emphasizes the positive effects of its use, it seeks to make it clear that, as President Xi Jinping stated, TCM is a treasure of China's scientific heritage and therefore a sign of the legacy of Chinese civilization to the development of humanity in the "new era".
OBJECTIVES
The general objective of the paper is to understand the process of resignification and internationalization of TCM, through the analysis of the strategic communication used by China to show its use in the fight against SARS and COVID-19.
To this end, three specific objectives will be addressed:
1. Describe the process of re-signification and internationalization of TCM in the China of Hu Jintao and Xi Jinping.
Analyze press sources reporting the use of TCM in combating SARS and COVID-19
3. To establish what are the guidelines of China's strategic communication discourse regarding the use of TCM in combating SARS and COVID-19.
METHODOLOGY
The work articulates different theoretical perspectives that mix the history of the present time, international studies and strategic communication. This implies an analytical look at the process of international repositioning of the People's Republic of China, through its communication strategy of resignification of an element of its millenary culture such as Traditional Chinese Medicine. In this sense, we understand strategic communication as defined by Tironi and Cavallo (2004): "Strategic communication is the practice that aims to convert the link between organizations and their cultural, social and political environment into a harmonious and positive relationship from the point of view of their interests or objectives" (p. 33).
In this sense, we must also understand that:
The task of Strategic Communication is to project the identity of organizations in an image that arouses confidence in its relevant environment and adhesion in its target public. [...] In other words, Strategic Communication acts to gather and manage the stock of prestige and credibility that every organization needs to achieve its purposes and face the tensions and crises characteristic of the current times" (Tironi and Cavallo, 2004, p. 33).
The methodology of the article will be qualitative through document analysis, specifically Chinese press sources such as Xinhua News, People's Daily and China Today, contrasted with international press sources such as BBC or El País. Chinese official primary sources such as the document "Traditional Chinese Medicine in China" known as the "White Book" on Chinese Medicine published in 2016 (The State Council Information Office of the People's Republic of China) and the document "Guidelines on the Use of Acupuncture and Moxibustion to Treat COVID-19 (Second Edition)" published by the Chinese Academy of Acupuncture and Moxibustion (2020) are also analyzed.
THE RE-SIGNIFICATION OF THE MTC AND THE SEARCH FOR INTERNATIONAL POSITIONING
China's resurgence as a regional power in the 1980s and as a world power in the early 21st century has been highlighted by various authors2. But as Álvarez states, we must understand that: "China's repositioning has involved a work of repositioning itself in the international system, but not only from an economic vision, but also as a global political actor" (2017. P. 29). In this perspective, the Asian giant would once again occupy the position that gives it its name: "the central country" (Zhōngguó).
Within this repositioning, China has also manifested a process of re-signification of its traditional culture in various fields. One of them is its traditional medicine, which presents the phenomena of re-signification and internationalization. TCM is one of the oldest medical practices in the world and, as has been pointed out, includes a wide range of treatments from herbal medicines to acupuncture and Qigong. It is popular in China across generational lines, although its use is hotly debated in the West. As an example of its popularity in China, we can point out that according to figures from the White Paper on TCM published by the PRCh in 2016, it is noted that in 2015, 910 million visits were made to Traditional Chinese Medicine medical and health service units throughout the country and 26,915,000 hospitalized patients were treated with this ancestral medicine.
This paper argues that China is seeking to expand the appeal of TCM both within and beyond its borders. However, many scientists and practitioners trained in "Western" medicine are skeptical about its usefulness, even though there are important international voices endorsing it, such as WHO and UNESCO. To face this problem, China generates a discourse of strategic communication of its traditional medicine to position it in China and the world in a re-signified way, that is to say, in a new valorization.
The questioning of TCM is not new even in China. In fact, in 1942 Mao Zedong had ordered the Red Army to "banish shamanistic beliefs and superstitions" and had scorned traditional doctors, calling them "circus performers, creepy-crawly salesmen and traveling peddlers" (Gámiz, February 26, 2015). However, he changed his position after the triumph of the revolution. Once in power, in 1954, five years after the founding of the People's Republic, he validated traditional medicine by creating the State Administration of Traditional Chinese Medicine, under the wing of the Ministry of Public Health.
Since the early 2000s and especially under the government of Hu Jintao (2003-2013), Traditional Chinese Medicine has experienced a new boom, according to Zhang Boli, director of the Academy of Chinese Medical Sciences. For example, in 2010 acupuncture was inscribed on the Representative List of the Intangible Cultural Heritage of Humanity, which is drawn up every year by UNESCO, with this recognition also giving support to this medicine of millenary tradition (UNESCO, 2010). But in addition to its cultural value, in 2013, traditional medicine accounted for a business of 560 billion yuan (almost 79 billion euros), a third of the total medical industry in China (Gámiz, February 26, 2015).
The international press highlights that President Xi Jinping is a real fan of this ancient health practice, which, as we have noted, he has called a "treasure of Chinese civilization" (Jakhar, June 30, 2020). Indeed, in January 2017, President Xi Jinping officially presented the WHO with a bronze statue depicting acupuncture points on the human body (Xinhua, February 22, 2017). That gift to the WHO is a sign of the resignification of Chinese medicine, both for the Asian giant's own healthcare system and for the rest of the world. This is demonstrated by the categorical way in which Xi Jinping has expressed himself on the subject, stating that: "Traditional Chinese medicine is a gem of the national scientific heritage and, therefore, alternative therapies will have the same governmental support as Western medicine" (Jimenez, December 1, 2017).
President Xi Jinping has called the 21st century a new golden age for Traditional Chinese Medicine, highlighting its potential for reducing costs and obtaining innovative treatments, as well as increasing China's prestige in the world. For these kinds of reasons, the Chinese president has made it a key part of the Asian country's health policy (Gwin, January 2019). In fact, China set out to reach the quota of four experts in traditional medicine per 10,000 inhabitants by 2020 and to reach 30% of the country's pharmaceutical expenditure.
The Chinese commitment to the promotion of TCM has also been expressed in the so-called "White Paper" published in 2016 by the State Council Information Office, entitled "Traditional Chinese Medicine in China" (The State Council Information Office of the People's Republic of China, 2016). This text manifests the commitments and successes of the Chinese government to ensure the development of this traditional health practice. In addition, this book points out that the Chinese government appreciates and protects the cultural value of this medicine and tries to establish a system to transmit the traditional culture of this medicine (Xinhua, December 6, 2016a).
Some press media pointed out that the White Paper marked the Chinese strategy to equate its traditional medicine with Western medicine, as the book argues that TCM has had a positive impact on the progress of human civilization and has proven its usefulness in combating modern epidemics such as influenza A, the HIV virus or SARS (EMOL, December 6, 2016).
Through the White Paper and other initiatives, China has launched a plan to bring its traditional medicine to equal status with Western allopathic medicine. In making the presentation of the White Paper, Chinese Vice Minister of Health and Family Planning, Wang Guoqiang noted in 2016, that such "equal status" involves matching efforts in terms of funding, academic development and legal protection (EMOL, December 6, 2016).
It should be noted that the White Book was published a year after Dr. Tu Youyou won the Nobel Prize in Medicine, the first ever in the discipline, for the discovery of artemisinin, a TCM compound used to treat malaria. According to Wang, this international recognition, together with others, such as the fact that acupuncture and moxibustion are recognized as UNESCO Intangible Heritage, or that several vademecums compiled by Chinese doctors millennia ago are included in that organization's Memory of the World, have enabled TCM to be at a "historic moment of development" (EMOL, December 6, 2016).
As we have noted, China has made the development of TCM a national strategy. The Communist Party of China (CPC) and the government have attached greater importance to the development of its traditional medicine and have made a series of important policy decisions, adopting several plans since the 18th CPC National Congress held in 2012.
Currently, public health policy in China has a mixed logic of complementarity between traditional and allopathic or Western medicine. Most commonly, Chinese patients frequently resort to their traditional medicine in the treatment of not very serious or chronic diseases, for example, for pain relief, but instead use drugs and techniques of Western medicine in serious ailments, emergencies and surgeries.
As noted in the White Paper (2016), there are currently 3,966 hospitals devoted entirely to traditional medicine in China, with 452,000 practitioners and 910 million medical attendances per year, in addition to 752,000 students in the nearly 250 training centers, most of which combine TCM with Western science.
In 2015, the executive meeting of the State Council approved the draft of the Traditional Chinese Medicine Law and submitted it to the Standing Committee of the National People's Congress for deliberation and approval, aiming to provide a stronger policy environment and legal basis for the development of Traditional Chinese Medicine.
Subsequently in 2016, the CPC Central Committee and the State Council issued the draft Healthy China Plan 2030, a roadmap for improving the health of Chinese citizens over the next 15 years. The document sets out a series of tasks and measures to carry out the program and the development of TCM. In the same year, the State Council released the draft of the Strategic Plan on the Development of Traditional Chinese Medicine (2016-2030), making the development of TCM a national strategy, with systematic plans for its development in the "new era" announced by President Xi Jinping.
The "Healthy China 2030 Plan" project announced in 2016, envisaged the opening of specialized clinics in general hospitals and publicly funded maternal and child care centers and mandated the proper qualification of practitioners. It calls for the use of technology and special protection for formulas considered state secrets, as well as medicinal resources, which implies the cultivation without toxic pesticides of rare and endangered species, in addition to the supervision of raw materials. This implies the inclusion of TCM as an essential component of the plan to improve the health of the Chinese people by 2030. But experts insist on bringing the sector's procedures in line with international standards, in order to expand promotion in foreign markets. Other voices advocate strengthening education and public campaigns within China on the usefulness and value, especially in the younger generation (Martinez, June 6, 2020).
All these signs mark the process of re-signification of TCM, which is also highlighted in the White Paper:
These decisions and plans have outlined a grand project that focuses on the complete revitalization of traditional Chinese medicine, the accelerated reform of the medical and health care system, the construction of a medical and health care system with Chinese characteristics, and the advancement of the country's Healthy China Plan, ushering in a new era in the development of traditional Chinese medicine (Xinhua, December 6, 2016b).
In addition to its incentive within the healthcare system, the Chinese government is supporting the global development of traditional medicine. In this regard, the White Paper also highlights the development of this discipline worldwide. For example, acupuncture is recognized as a medical method in more than a hundred countries, and 18 of them even include Oriental treatments in their medical insurance for their citizens. In addition, China has sent medical teams versed in its traditional medical practices to more than 70 countries, with special attention to regions such as Latin America or Africa (EMOL, December 6, 2016). The White Paper, highlights the country's efforts in promoting international exchanges and cooperation in Traditional Chinese Medicine and indicates that it has spread to 183 countries and regions around the world (America Economia, December 7, 2016).
According to Chinese government initiatives, the 62nd and 67th World Health Assemblies passed two resolutions on Traditional Chinese Medicine, and urged member states to implement the WHO Traditional Medicine Strategy 2014-2023 (WHO, 2013). In addition to this, the Chinese government has signed 86 TCM cooperation agreements with other countries and international organizations and has supported the construction of 10 TCM centers abroad (America Economia, December 7, 2016).
The White Paper also highlights China's efforts to provide TCM medical assistance overseas. So far, China has sent medical teams to more than 70 countries in Asia, Africa and Latin America and almost all of them included TCM practitioners, who accounted for 10% of the total number of personnel. In addition, a project has been launched to build TCM centers in African countries and specialized Traditional Chinese Medicine stations have been opened in Kuwait, Algeria, Tunisia, Morocco, Malta and Namibia (America Economia, December 7, 2016).
China's National Health Commission reported that in 2019, the number of professionals certified to work in traditional medicine (TCM), considered one of the country's millenary treasures, increased to 767,000. According to that authority, 625 thousand are doctors and the rest are pharmacists specialized in that form of healing. Also last year, another 5,071 TCM centers were installed, totaling 65,809, with about 1.33 million hospital beds for those seeking these treatments (Martinez, June 6, 2020).
In addition, to promote the orderly development of TCM worldwide and to ensure that it is applied safely, efficiently and accurately, China has facilitated the establishment of the ISO/TC249 of Traditional Chinese Medicine. Its secretariat is in Shanghai and has issued a series of ISO standards on TCM.
Importantly, TCM's international profile was raised in 2019, after the World Health Organization included this traditional medicine in the new version of the International Classification of Diseases (ICD-11). Thanks to China's efforts, the world health body once again gives it formal recognition. On that occasion, Robert Jakob, a member of the WHO's statistics department, pointed out that: "Chinese medicine can play a role outside Asia. Acupuncture can reduce the need to use pain medicine or anesthesia in Western countries" (ESMTC, January 28, 2019).
However, this decision was criticized by part of the international medical community as shown in an article in El País criticizing the acceptance of illnesses based on the Chinese concept of Chi (Qi) (De Vera, January 17, 2019). In fact, the WHO was caught in a controversy in 2020 after it removed the warnings on the use of traditional remedies to treat COVID-19 in its English and Chinese language recommendations (Jakhar, June 30, 2020).
Despite the controversies, President Xi Jinping speaks of a new golden age for Chinese medicine, and from the perspective of scientific research, it may very well be a golden age. Indeed, scientists at leading universities in the United States and Europe, including UCLA, Duke, and Oxford, as well as many others in Asia, are analyzing the scientific underpinnings of some traditional treatments for diseases such as cancer, diabetes, and Parkinson's (Gwin, January 2019). To these we add the use of TCM against SARS and COVID-19, whose strategic communication we will discuss below.
CHINESE STRATEGIC COMMUNICATION OF THE USE OF MTC AGAINST SARS AND COVID-19
TCM against SARS
In 2003, when President Hu Jintao was just coming to power in the People's Republic of China, he had to face the health crisis caused by Severe Acute Respiratory Syndrome (SARS). This first crisis of Hu Jintao's government, implied a problem that questioned his power, but ultimately strengthened it (Ramirez, 2018, p. 266). At first, the choice was made to hide what was happening, but in the face of criticism from the World Health Organization, measures were taken to increase transparency and collaboration with UN health authorities (Ramirez, 2018, p. 267).
It is important to note that the use of TCM in the current fight against the COVID-19 coronavirus has antecedents in the experience of the fight against SARS, which affected Asia in 2002-2003. At that time physicians discovered that steroids prescribed to reduce inflammation had harmful side effects such as bone destruction and it was posited that TCM would mitigate some of these adverse reactions (Wee, February 15, 2020, p. 27).
Following the SARS epidemic, the WHO studied the use of TCM against SARS and determined that it was safe and showed some potential to alleviate symptoms such as fatigue and shortness of breath. Researchers in the United States and Taiwan also found that certain herbs could suppress the virus if prescribed at specific concentration levels. But other studies also claimed that their findings had been inconclusive (Wee, February 15, 2020, p. 27).
On the other hand, the Chinese discourse expressed in the White Paper noted that the WHO had confirmed the contribution of TCM and integrated Chinese and Western medicine in the treatment of SARS and along with this further noted that Traditional Chinese Medicine treatment for the H1N1 subtype of the influenza A virus had yielded satisfactory results, which aroused widespread interest from the international community (America Economia, December 7, 2016).
This use of TCM against SARS was also echoed in the West, for example, the Cochrane center, which conducts high-quality, relevant and up-to-date systematic reviews of scientific evidence to inform health decision-making, published in its library an article entitled "Chinese herbs combined with Western medicine for the treatment of severe acute respiratory syndrome (SARS)" (Liu, 2012). The article points out, that integrated Chinese and Western medicine played an important role in the treatment of SARS and that it is possible that different Chinese herbs combined with Western medicines may improve symptoms, quality of life and lung infiltrate absorption, and decrease the dose of corticosteroids, although the evidence is weak due to the low quality of the included trials.
TCM versus COVID-19
The current COVID-19 pandemic comes at a time when Beijing is keen to promote the use of Traditional Chinese Medicine within and outside its borders (BBC News World, June 30, 2020). In 2020, while different scientific teams around the globe are trying to develop a vaccine against the new coronavirus, China has again been promoting the use of TCM to treat infected people. The Chinese news agency, Xinhua, has noted that TCM has played an important role in the treatment of confirmed COVID-19 patients (Xinhua, July 6, 2020) and a recent document published by the Chinese government claims that 92% of Covid-19 cases in the country had been treated with this type of medicine (Jakhar, June 30, 2020).
In fact, China's National Health Commission has a special TCM chapter in its recommendations for the treatment of coronavirus, while the official press again highlights its role in the response to the SARS epidemic in 2003 (Jakahr, June 30, 2020). In this regard, Chinese experts point out that the combination of Traditional Chinese and Western medicine in the treatment of COVID-19 has proven to be effective. According to the spokesman of the Chinese Ministry of Health, Yu Yanhong, the combined method can quickly improve the condition of patients with mild symptoms, such as fever, cough, sore throat, weakness and lack of appetite (Europa Press, February 20, 2020). This news, originally published by Xinhua, has been echoed by other news agencies and also by other complementary medicine institutions such as the Natural Therapies Foundation (April 5, 2020).
In the second version of the COVID-19 treatment plan, the Health Commission has added more traditional medicines to the formula. And according to a report in the state-run Beijing News, authorities in Wuhan stated that coronavirus patients with mild to moderate symptoms should be treated with TCM. This is in line with testimony from the representative of a TCM product manufacturer in Hubei, Zhu Mao, who noted that he was generating more than 20,000 prescriptions daily at the request of the Chinese government (Wee, February 15, 2020. p. 27).
The combined approach: the complementarity of TCM and Western medicine
Since the outbreak of COVID-19, Chinese central authorities have on many occasions emphasized the application of Traditional Chinese Medicine combined with Western medicine in the treatment of patients. According to the National Administration of TCM, medical expert teams in 31 regions at the provincial level include TCM specialists, and most regions have conducted localized traditional medicine treatment schemes for the disease (Europa Press, 2020). In fact, on January 25, 2020, the State Administration of Traditional Chinese Medicine sent 25 teams of therapists to Wuhan (Wee, February 15, 2020, p. 27).
Although it is necessary to point out that the discursive bet always emphasizes complementarity. For example, Zhang Bolí noted, "Western medicine offers important life-support measures, such as respiratory and circulatory assistance, while traditional Chinese medicine focuses on improving patients' physical conditions and immune function. They complement each other" (Xinhua, February 18, 2020). But it is certainly also emphasized that those recovered in China have the common factor of having been treated with TCM.
In addition, Yu Yanhong, who is also the deputy director of the National Administration of Traditional Chinese Medicine, has explained that combined treatment with TCM may help reduce the length of hospital stays. Experts also contend that the combination may help prevent the development of mild symptoms in severe and critical conditions, which reduces the mortality rate of the disease. A study of 102 mild cases showed that the clinical symptoms of those who received the combination treatment disappeared two days earlier than the control group, and the recovery rate improved by 33 percent. In addition, it has been observed that TCM can effectively improve the number of lymphocytes, an indicator of patient recovery (Europa Press, February 20, 2020).
In another study on cases of serious conditions, patients who received the combined treatment stayed an average of two days less in the hospital than the control group, with multiple indicators of improvement. For this reason, Yu Yanhong said, "In the future, we will further improve the treatment plan of traditional and Western medicine to give it a greater role in saving patients" (Europa Press, February 20, 2020). Such statements reaffirm China's position on the use of its traditional medicine and the confidence placed in it in its public health strategy.
In February 2020 the Chinese National Health Commission instructed that all COVID-19 patients be treated with TCM and Western medicine. The first group of sufferers to benefit from this practice was in Wuhan, the Chinese city where the coronavirus was detected. Li Xucheng, head of the emergency department of Wuhan TCM Hospital, said 675 COVID-19 patients were treated there. Of those, 60% were over 65 years of age and "No one in the hospital went from mild to severe condition" (Salerno, July 1, 2020).
Due to Chinese government guidelines, some hospitals began using a combination of Western and Chinese medicines. In February 2020, the Beijing Health Department reported that two patients who were discharged had been treated with traditional Chinese medicines and other unspecified drugs. In Guangzhou (Guangzhou), health officials reported that fifty patients who had used TCM in conjunction with other medicines had reported no longer having fever and half of them claimed that their cough had disappeared (Wee, 2020, p. 27).
China is currently advising doctors to consider mixing Western antiviral drugs with other TCM drugs to address the treatment of coronavirus. In this regard, in addition to the use of allopathic (Western) antiviral drugs, the Chinese government is recommending the use of other TCM treatments, such as the Peaceful Palace Bovine pill, a traditional medicine containing bovine gallstones, buffalo horn, jasmine and pearl (Wee, 2020, p. 26). With this formula, the Chinese government is looking for ways to complement treatment with Western medicines - such as some used for HIV treatment - with other TCM treatments, which is a medicine that is embedded in its national identity.
The National Health Commission's COVID-19 treatment plan, published on February 5, 2020, recommended the use of TCM remedies that could be used in conjunction with HIV antiretroviral drugs such as lopinavir and ritonavir. At that time it was also suggested to try the Peaceful Palace Bovine pill to mitigate symptoms such as wheezing and shortness of breath (Wee, 2020, p. 27).
According to the Natural Therapies Foundation, after proving the effectiveness of the combined treatment with TCM, 2,2000 TCM specialists were sent to Hubei Integrated Medicine Hospital on February 14, and in addition, a temporary hospital was opened that mainly uses TCM, also offering acupuncture and Taichi treatments to boost patients' immune system (Natural Therapies Foundation, April 5, 2020).
The contribution of TCM to the fight against the coronavirus
The use of TCM against the new coronavirus has also been disseminated through CGTN en Español, the platform for projecting China's political, economic and cultural reality to the Spanish-speaking world that comes out of China Central Television (CCTV). In a report entitled "Frontline of COVID-19: How does TCM work in the fight against COVID-19?", it is shown how Liu Qingquan, director of the Beijing Hospital of Traditional Chinese Medicine, summarized the contribution that Traditional Chinese Medicine has made in the fight against COVID-19. And it is noted that the rate of TCM use reached 90.5 percent in Hubei province, showing that TCM can play a key role in treating patients with the new coronavirus (CGTN, April 4, 2020).
In that report Dr. Liu noted, "Quarantine and the use of Traditional Chinese Medicine have achieved a fundamental victory in stopping the spread of the disease" (CGTN, April 4, 2020, Min. 1:13-1:15). And to the question "Can Traditional Chinese Medicine be used to prevent the new coronavirus?" the answer was, "Chinese medicine has a certain preventive effect on the new coronavirus" (Min. 1:18-1:23).
According to the TCM usage logic outlined, six traditional remedies have been announced as treatment for COVID-19. The two most prominent are Lianhua Qingwen-which contains thirteen herbs such as Forsythia suspensa and Rhodiola rosea-and Jinhua Qinggan, which was developed during the H1N1 outbreak in 2009 and is made with 12 components including peppermint, licorice, and honeysuckle, among others (Jakhar, June 30, 2020).
By February 25, 2020, 4,900 specialist were dispatched to about 600 TCM hospitals and also 5 teams of 757 TCM specialists from the Academy of Medical Sciences and other elite medical institutions. In total 60,000 infected cases were treated with TCM (Natural Therapies Foundation, April 5, 2020).
Wang Jie, chief researcher of the Chinese Academy of Medical Sciences, said, "Traditional Chinese medicine has convinced and impressed many COVID-19 pneumonia patients and their families with its therapeutic efficacy" (Xinhua, May 21, 2020). Wang Jie, who is also a Chinese national political advisor made these remarks before the opening of the third session of the 13th National Committee of the Chinese People's Political Consultative Conference and also pointed out that TCM specialists have provided personalized diagnosis, prescription and treatment for Covid-19 patients.
It is interesting to show how China tries to highlight the use of TCM against COVID-19, for example, one of the headlines in People's Daily points out "Spirit of consecration: Traditional Chinese Medicine expert saves COVID-19 patients". The article describes how Zhang Boli, a researcher at the Chinese Academy, along with other colleagues established the first temporary TCM hospital to treat patients with COVID-19 and bring new actions and ideas in the fight against the virus. Zhang Boli, who is also president of Tianjin University of Traditional Chinese Medicine, was summoned on February 12 to help Wuhan curb the outbreak with the use of TCM (People Online, April 24, 2020).
Zhang noted that "I also understood this mission as an opportunity to promote the values of TCM, which proved to be very effective in the battle against SARS." And as The People Online notes, Zhang's TCM team made a great contribution in 2003 to curbing the spread of SARS and that "their prescriptions and good practices were praised by the World Health Organization WHO and recommended to the world" (People Online, April 24, 2020).
Between February 14 and March 10, the makeshift TCM hospital where Zhang worked received 564 patients, of whom 392 recovered completely, while the others were sent to other hospitals to provide better follow-up care. During this period, none of the patients developed critical illnesses and there were also no health care workers among those infected (People Online, April 24, 2020).
According to the Hunan health commission, TCM was used in the treatment of nearly 95 percent of patients admitted to hospitals. Among those discharged, more than 90 percent underwent integrated treatment of TCM and Western medicine (Xinhua, February 18, 2020). It is also noted that TCM shortened treatment time and reduced medical expenses for seven patients discharged from COVID-19, who took herbal soups or capsules (Xinhua, Feb. 18, 2020). As stated by Zhang Nianzhi, chief physician of the respiratory medicine department of Anhui Provincial TCM Hospital, "The patients showed accelerated fever reduction after receiving TCM treatment, and obvious relief of certain symptoms such as cough, tiredness and loss of appetite. Some critical patients became non-critical" (Xinhua, February 18, 2020).
Liu Qingquan, director of the Beijing Hospital of Traditional Chinese Medicine, also explained at a press conference that the team of experts has established the principle that asymptomatic cases or those with mild symptoms are mainly treated with TCM. However, severe and critical patients are addressed through a joint consultation combining TCM and Western medicine. Liu pointed out as an example that seven out of 10 patients who had been discharged after recovery were cured with TCM treatments as primary therapy. For infected people with mild or asymptomatic conditions, doctors prescribed TCM decoction in order to "remove heat, detoxify and cool the blood." They also employed proprietary Chinese medicines such as Jinhua Qinggan and Yindan Jiedu granules and Huoxiang Zhengqi capsules (Xinhua, July 6, 2020).
The proposal has its defenders and its detractors. Among the first ones we find the professor of pharmacology of the Yale School of Medicine, Cheng Yung-Chi, who points out that the approach is correct and that it is necessary to give it the benefit of the doubt and then observe the evidence. It is also suggested that while there is no clinical evidence that the roots of some plants, or Peaceful Palace Bovine, can help fight COVID-19 directly, different doctors have stated that it can alleviate some symptoms such as inflammation in the lungs with few side effects. Dr. Cheng, who is also president of the Consortium for the Globalization of Chinese Medicine, noted that a group of physicians is conducting clinical trials to examine the effectiveness of Traditional Chinese Medicine in Wuhan, the epicenter of the COVID-19 outbreak (Wee, 2020, p. 26-27).
Personalized treatments and different therapeutic tools
Zeng Puhua, vice president of the affiliated hospital of the Hunan Academy of Traditional Chinese Medicine, commented, "Clinical experience has repeatedly shown that TCM plays an active and effective role in treating pneumonia-related epidemics" (Xinhua, Feb. 18, 2020). And it further raises the issue of TCM's ability to deliver personalized treatments. According to a testimonial from Xiong Jibai, a TCM expert and consultant of the Hunan province coronavirus treatment group, "Compared with Western medicine, TCM offers varied prescriptions for each patient based on their particular conditions during different stages of the disease, which is more flexible and specific" (Xinhua, Feb. 18, 2020).
In this regard, TCM traditionally advocates a personalized prescription for each patient. However, in the midst of the coronavirus epidemic, three Chinese patent medicines and three TCM prescriptions have been used in a general way. These general complementary treatments have been combined with other personalized comprehensive treatment methods such as massage (Tuina), auricular therapy (auriculotherapy), acupuncture-moxibustion, and Tai Chi and Baduanjin body exercises (Wu, May 4, 2020).
Tong Xiaolin, an academician of the Chinese Academy of Sciences and head of the treatment group of the state administration of TCM, also noted that non-drug treatments, such as cupping, acupuncture and scraping (gua sha), which are also characteristic of TCM, can help patients recover more effectively after hospital discharge (Xinhua, Feb. 18, 2020).
The effectiveness of TCM
Indeed, Traditional Chinese Medicine has been widely applied in the treatment of patients with the new COVID-19 disease in China. According to Wang Xianbo, a specialist at Beijing Ditan Hospital, "Since the admission of the first Covid-19 case to our hospital, medical professionals from the traditional Chinese medicine department have been involved in the treatment process" (Europa Press, February 20, 2020). In addition, Wang stated that TCM proved to be effective in reducing symptoms of fever, cough and fatigue in mild cases and to greatly improve some severe cases when used in combination with Western medicine.
The TCM administration in Zhejiang City, east China, has claimed that none of the patients in designated hospitals in the province had developed severe cases after timely application of TCM. While at the Mianyang Hospital of Traditional Chinese Medicine in Sichuan province, southwest China, TCM was applied to 18 medical workers who had close contact with a confirmed COVID-19 patient during the quarantine period (Europa Press, February 20, 2020).
Zhang Boli, a researcher at the Chinese Academy of Engineering and president of Tianjin University of Traditional Chinese Medicine, noted that the already patented traditional Chinese medicine drugs - Chinhua Qinggan Granule, Lianhua Qingwen Capsule and Xuebijing Injection - have been shown to be clinically effective in the treatment against COVID-19 (Zou Shuo, April 16, 2020). It is further posited that these TCM drugs have been chosen after more than two months of clinical research, among hundreds of other TCM drugs that are effective in the treatment of cold and flu.
Benefit in elderly patients
It has also been highlighted that TCM benefits elderly patients. Dr. Zhang Jun, a member of Wuhan Hospital of Traditional Chinese Medicine, noted that TCM can reduce the side effects of medications and minimize the pain of elderly patients. One of the recovery cases treated by Dr. Zhang was Xu Ming, a 95-year-old retired engineer. About his case Dr. Zhang noted, "From the perspective of Western medicine, a large amount of concentrated sodium had to be injected. However, considering Xu's age, such a procedure would cause further electrolyte imbalance, so we turned to traditional Chinese medicine" (Wu, May 4, 2020).
According to Li Xucheng, chief physician of the emergency department at Wuhan Hospital of Traditional Chinese Medicine, a total of 675 COVID-19 patients were treated at the center, 60 percent of whom were over 65 years old. The hospital combined TCM and Western medicine to cure the patients of the new coronavirus. Dr. Li noted, "TCM has been used on all our patients, and no one in the hospital went from mild to severe condition. [...] What we are pursuing is not a 100 percent TCM treatment, but one that benefits our patients" (Wu, May 4, 2020). Which again refers to the combined approach.
The preventive and self-healing factor
Another element of the strategic communication discourse on TCM and COVID-19 is to highlight its preventive and self-healing factor in patients by strengthening the immune system. Instead of eliminating the virus, TCM aims to improve people's immunity, and as detailed by Dr. Li Xucheng, since there is no effective cure, what TCM does is to support patients' lives and consolidate their immunity so that they can better fight the virus (Wu, May 4, 2020).
According to Zhang Boli:
Considering the World Health Organization (WHO) figures that about 13 percent of mild cases become severe worldwide, practices at the Jiangxia temporary hospital demonstrated the special effect of TCM in preventing deterioration and improving the self-healing rate (Wu, May 4, 2020).
In the document "Guidelines on the use of acupuncture and moxibustion to treat COVID-19", it is also noted that:
Modern clinical and experimental studies show that acupuncture-moxibustion can also regulate the immune system and act against inflammation and infection. Acupuncture-moxibustion plays an active role in the prevention and treatment of infectious diseases. In the face of COVID-19, acupuncture and moxibustion therapy have actively helped in the prevention and control of the disease with good results. With further understanding of COVID-19 and clinical experience in acupuncture and moxibustion therapy, and in accordance with the Diagnosis and Treatment Plan for COVID-19 (sixth trial version) and the indications on rehabilitation with traditional Chinese medicine during convalescence of COVID-19 (trial version). (Chinese Academy of Acupuncture and Moxibustion, 2020, p. 1).
Internationalization of TQM
The area of internationalization is also present in the Chinese discourse, for example, it is noted that the Lianhua Qingwen capsule has already obtained approval to enter the Thai market, and French researchers plan to conduct clinical research on its use (Zou Shuo, April 16, 2020). In addition, Zhang Boli expounded that "By making these TCM drugs available for overseas, we hope they can save more lives, especially now that the pandemic continues to worsen globally" (Zou Shuo, April 16, 2020).
In fact, in the international arena, different voices echo the Chinese strategic communication on the use of TCM. For example, an article on the Cuban site Infomed, dedicated to serious respiratory infections caused by coronavirus, highlights an article from Telesur entitled: "Traditional Chinese medicine is considered effective for treating Covid-19". In the article, the spokesman of the Beijing Municipal Health Commission, Gao Xiaojun, expressed that TCM has been effective in the treatment of COVID-19 patients. And the Chinese official explained that the overall response rate of patients to TCM treatment was 92% as of February 22, 2020. He also noted that since the outbreak of the virus, Beijing has combined TCM with Western medicine to treat patients. Stating that "TCM has played an active role in decreasing mortality" (Telesur, February 24, 2020).
Proponents of TCM argue that its use has no negative consequences, but other experts claim that rigorous scientific testing is needed before such remedies can be considered safe. Despite these detractors, TCM continues to grow in China and is seeing increasing demand in the international market. In fact, the Chinese government estimated last year that the TCM industry could account for some $420 billion by the end of 2020 (Jakhar, June 30, 2020), which could increase if the effectiveness of combined TCM treatments combined against COVID-19 begins to be demonstrated.
Other voices such as those of Dr. Ramón María Calduch, vice-president of the Foundation of Natural Therapies, are in favor of the use of TCM against COVID-19. Dr. Calduch led the elaboration of a medical report of compilation and scientific evidence of the use of TCM in the treatment of COVID-19 that reflected the benefits of the use of this medicine. After this, he was the promoter of the translation into Spanish of the Diagnostic and Treatment Protocol for COVID-19 recommended by the Chinese government (Natural Therapies Foundation, April 5, 2020).
However, despite Beijing's persistent efforts to internationalize TCM, many people outside China are still unaware of it. Moreover, critics claim that China is using the pandemic as a way to promote it abroad, something the official press denies (Jakhar, June 30, 2020). What can be verified is that, in the context of the pandemic, China has demonstrated a new type of cooperation in health matters as Constanza Jorquera pointed out in an interview with the Chinese agency Xinhua (July 24, 2020).
In this regard, China has been sending TCM supplies and experts along with conventional drugs and equipment to Africa, Central Asia and Europe. On this issue, Yu Yanhong, a top official of the National Administration of Traditional Chinese Medicine, noted in March this year, "We are willing to share the 'Chinese experience' and 'Chinese solution' for the treatment of covid-19 and let more countries know, understand and use Chinese medicine" (Jakhar, June 30, 2020).
Certainly, the use of these ancient Chinese remedies and practices coincides with President Xi Jinping's effort to harness them as a source of national pride (Wee, 2020, p. 27). In fact, he has stated that doctors and officials should give equal importance to Traditional Chinese Medicine as to Western medicine. This logic is also found in the quest for internationalization of TCM, as the Chinese government has called for its traditional remedies to be promoted through its trade routes (Wee, February 15, 2020, p. 27), which could mean a great boom of TCM considering the Chinese Smart Power strategy signified by the New Silk Road or One Belt-One Road (Sanchez, 2019).
For internationalization purposes, guidelines have also been generated on areas of Traditional Chinese Medicine such as acupuncture and moxibustion. In this regard, the Chinese Academy of Acupuncture and Moxibustion (2020) has already published the second revised edition of the document "Guidelines on the use of acupuncture and moxibustion to treat COVID-19", where it is noted that "in order to support global action against the epidemic, the secretary of the World Federation of Acupuncture and Moxibustion Association has immediately translated the guideline into English" (p.1). It further adds:
COVID-19 falls into the category of "epidemic" diseases according to traditional Chinese medicine. For thousands of years, traditional Chinese medicine has accumulated rich experience in long-term medical practice in the fight against epidemics. As an important part of traditional Chinese medicine, acupuncture and moxibustion have a number of distinctive features and advantages over other therapies, and has made important contributions in the fight against epidemics in China. There are various writings on acupuncture and moxibustion for the prevention and treatment of epidemics in the classical writings of traditional Chinese medicine (Chinese Academy of Acupuncture and Moxibustion, 2020, p. 1).
Yanzhong Huang, senior research fellow on public health at the Council on Foreign Relations, believes that promoting TCM abroad is tantamount to boosting China's "soft power" or persuasiveness and attractiveness. In this regard, he notes that, "The official narrative presenting TCM as effective in the face of covid-19 also serves to promote the superiority of China's anti-covid-19 approach at a time when Western efforts appear to be ineffective in containing the spread of the virus" (Jakhar, June 30, 2020).
The years of history and the check on Western medicine
Wang Jie's speech, already mentioned above, also stated that during the battle against the pandemic, doctors have reflected on the legacy and innovation of Traditional Chinese Medicine, emphasizing the Asian giant's long history of fighting epidemics since the Western Han Dynasty (206 BC-25 AD), when 350 epidemic outbreaks have been recorded. In this context, he said: "With a strong heritage and constant innovation, we believe that traditional Chinese medicine will continue to play an important role in clinical treatment to save lives" (Xinhua, May 21, 2020). This discourse has also been replicated in the West, for example, a compilation text of articles on the use of TCM and Covid-19 published in Spain by Mandala Ediciones, notes that "History and experience show that traditional Chinese medicine is effective against epidemic diseases" (Cabal, 2020. p. 102); this is also evidenced in the Spanish translation of the document "Guidelines on the use of acupuncture and moxibustion to treat COVID-19" (2020) already cited.
Jiang Xianfeng, a TCM practitioner at United Family Health, a major clinic for Beijing's upper class, said traditional remedies are safe, effective and readily available. He further noted that Western medicine has no better answers to the new virus, adding, "Chinese people have experienced this kind of plague many times over thousands of years of history. If traditional Chinese medicine were not effective, our people would have been exterminated by now" (Wee, February 15, 2020, p. 27).
Dr. Zhang also stated that "Since modern medicine has not yet developed effective vaccines or drugs to combat the new coronavirus, TCM provides an alternative and has already succeeded in treating countless patients" (People Online, April 24, 2020). This is complemented by some headlines from the Chinese press agency Xinhua such as "Traditional Chinese medicine brings Eastern wisdom to the fight against coronavirus" (February 18, 2020).
In sum, according to various Chinese and international sources, TCM has played a key role in the prevention, treatment and recovery of COVID-19. Official figures indicate that 91.6% of hospitals in Hubei province and 92.4% of patients in the entire PRC were treated with TCM. It is also noted that it proved to be effective in alleviating symptoms, preventing mild cases from developing into severe cases, improving the recovery rate and reducing the mortality rate, and promoting patients' recovery in their rehabilitation process (Natural Therapies Foundation, April 5, 2020). However, all these claims are challenged through a critical discourse that affects the communication that China has developed on the use of its traditional medicine.
CONCLUSIONS
China seeks to communicate the re-signification and enhancement of its millenary culture as a contribution to world civilization. One of the examples that has been discussed in this article is TCM, which for the Chinese is one of the great contributions that the "central country" has made to human development. In this sense, one of the characteristics of the resignification of TCM is to consider it as a contribution to health care with Chinese characteristics. This is in line with the discourse of TCM as a treasure of Chinese scientific heritage and therefore a contribution to the improvement of humanity in the new era.
This new valorization of TCM and its strategic communication is associated with China's role as a global player and therefore seeks to expand the attractiveness of TCM along with its influence in the international system. In this sense, if TCM is considered a "treasure" and a "gem", then it implies a valuable contribution from China to the world, which is not only a central part of its own health system, but also has great global potential, delivering low-cost health and innovative treatments, which would mean a positive impact on human civilization, driven by the PRC. This implies that, according to Chinese discourse, we are at a historic juncture of development in the "new era".
The revitalization of TCM not only seeks to improve the health of the Chinese people, but is also promoted worldwide through exchanges and international cooperation. To this end, the health crises caused by SARS and COVID-19 have provided good showcases for the internationalization of the revitalization of TCM.
China's articulation of a strategic discourse regarding the use of its traditional medicine is an issue that goes beyond health and crosses global politics between health, political, diplomatic and environmental issues. Moreover, it involves a debate that goes beyond the cases of diseases such as SARS or COVID-19, although the crisis generated by these diseases are a good example of how the Chinese communicational strategy on TCM works.
Certainly, as could be seen, China used TCM in the fight against SARS and is also using it in its health strategy against COVID-19. However, there is some scientific uncertainty about the use of TCM against these diseases, but that does not stop the Chinese government in its intention to promote and internationalize TCM in the world.
Despite the reluctance of many experts, China continued with the mixed strategy of complementing traditional Chinese medicine with Western allopathic medicine. On the one hand, confidence in its ancestral wisdom means that the use of TCM does not require empirical evidence of efficacy, but it is through use that the Chinese government ascertains its effectiveness. This is shown in the Chinese discourse that points to quarantine and TCM as the fundamental elements to stop the spread of the pandemic in China, as well as highlighting its preventive effects.
As can be seen so far, the opinion on TCM in general and in its use in the fight against SARS and COVID-19 has different nuances. On the one hand, Chinese articles present only positive assessments of their traditional medicine. While the foreign press varies between discrediting and negatively assessing its use, there are nuanced critical views that expose both supporters and detractors of its use. All sources from China have a positive view and assessment of the use of Traditional Chinese Medicine in combating SARS and COVID-19. However, in Western publications such as Europa Press, BBC, El País, El Mercurio, New York Times or La Nación, although these Chinese sources are presented, they are contrasted with critical positions on the effectiveness of TCM in the fight against the virus.
The fact that Chinese sources always have positive evaluations shows us the existence of the development of a strategic communication in tune with the resignification of TCM in China. But this re-signification also seeks internationalization. Therefore, although the Chinese position of strategic communication can even be considered propaganda, the truth is that it articulates many more aspects, involving Chinese prestige and even nationalism.
Within the strategic communication of the use of TCM in general, the Chinese position is important, but so are other spokespersons who legitimize its use and thus contribute to its internationalization. Two examples are the WHO and UNESCO, together with voices from medical science that give value to this medicine.
China's strategic discourse on TCM projects that its goal is not to replace Western medicine, but to bring together the best of each to achieve the best results. That same approach is being communicated with respect to past SARS and current COVID-19. In addition, much emphasis is placed on the extent of its use in China for COVID-19 (over 90%) and the contribution that has been made from prevention and symptom treatment; added to the possibility of treatment diversity and treatment customization. Its effectiveness in the elderly and the millenary historical experience of TCM in cases of pandemics have also been highlighted. Finally, it is proposed that it is a viable treatment possibility, since COVID-19 has left Western medicine in check, with no better answers to give. All these topics imply managing the prestige stock of TCM in order to generate an image of trust, which also projects China as a credible power worthy of imitation, which implies strengthening its soft power.
Also, an important point, is how Chinese strategic communication on TCM and COVID-19 has echoed in Western circles. Although this is still an ongoing process, we can point out as an example the publication of a selection of articles on the prevention and treatment of COVID-19 from Acupuncture and Traditional Chinese Medicine, entitled "El coronavirus COVID-19 desde la Medicina Tradicional China (TCM)", published in Spain by Mandala Ediciones (Cabal & Coord, 2020) and the translation into English and Spanish of the document "Pautas sobre el uso de acupuntura y moxibustión para tratar el COVID-19" (Guidelines on the use of acupuncture and moxibustion to treat COVID-19). These examples show how the internationalization of TCM has generated advances to establish a harmonious relationship with different international actors through its strategic communication.
Certainly, the quest for internationalization is also demonstrated in the PRC's effort to make TCM drugs and treatments available abroad, along with the idea of sharing the "Chinese experience and solution" against the pandemic, through the impetus that the Belt and Road Initiative (New Silk Road) can provide.
Faced with the questioning of TCM, a reasonable doubt is that, although China has made a commitment to the re-signification of its traditional medicine and has not only given it value for the Chinese reality and its health system, but has also launched an internationalization plan that involves its use within its foreign policy and the enhancement of its soft power, it is worth asking the question: would the PRC then risk endorsing a medicine that does not work? It should be considered that while the foreign press presents the doubts that Western medical science has about TCM, China's strategic communication about its traditional medicine reflects what they consider to be, not only part of their cultural ethos, but also a gift of their health wisdom to the world. It can even be posited that TCM is also laced with nationalistic considerations. It would then be very strange for the PRCh to make such a strong bet on a medicine that does not work, which would make it "lose face" (Diūliǎn), i.e., lose dignity in front of the international community.
Finally, China's strategic communication discourse also poses a threat to its internationalization objectives, since the criticism of the use of its traditional medicine in the world is once again gaining strength in the context of a pandemic that is far from coming to an end, generating tensions that its strategic communication must resolve. For this reason, it is also necessary to analyze the critical discourse on the use and effectiveness of TCM, which remains a pending task.