????一位終生致力于研究傳統(tǒng)中藥的科學(xué)家獲得2015年生理學(xué)/醫(yī)學(xué)獎(jiǎng)一半的獎(jiǎng)金。這一消息傳出后，感到意外的肯定不止我一人。自1965年開始，屠呦呦和她的同事們一直在中國(guó)中醫(yī)研究院（現(xiàn)為中國(guó)醫(yī)學(xué)科學(xué)研究院）從事研究工作，她們可能同樣對(duì)這個(gè)結(jié)果感到震驚。

????2011年，屠呦呦因發(fā)現(xiàn)青蒿素而榮獲被視為諾貝爾獎(jiǎng)風(fēng)向標(biāo)的拉斯克獎(jiǎng)。青蒿素可取代標(biāo)準(zhǔn)的抗瘧疾藥物氯喹。在上世紀(jì)60年代，隨著寄生蟲耐藥性的日益提高，氯喹的療效下降。但對(duì)傳統(tǒng)中藥藥理活性的科學(xué)研究，從未像現(xiàn)在這樣引起如此廣泛的國(guó)際認(rèn)可。

????諾貝爾獎(jiǎng)甚至從未考慮過世界各地的傳統(tǒng)醫(yī)學(xué)知識(shí)。直到現(xiàn)在，這種情況終于有所改變。那么，我們應(yīng)該如何解釋國(guó)際社會(huì)對(duì)傳統(tǒng)中藥的態(tài)度出現(xiàn)如此巨大的改變呢？

????從歷史記錄中發(fā)現(xiàn)的成果

????在負(fù)責(zé)頒發(fā)諾貝爾獎(jiǎng)的卡羅林斯卡學(xué)院宣布評(píng)選結(jié)果之后的問答環(huán)節(jié)中，一位專家組成員強(qiáng)調(diào)，諾貝爾獎(jiǎng)表彰的不僅是屠呦呦個(gè)人研究的質(zhì)量，也是對(duì)有歷史記錄的實(shí)證經(jīng)驗(yàn)的認(rèn)可。

????他表示，早在1700年前，關(guān)于中藥青蒿素對(duì)高熱有治療效果的理論就已經(jīng)存在。屠呦呦是第一位從這種中藥中提取出生物活性成分并闡述其作用原理的科學(xué)家。這一結(jié)果在醫(yī)療領(lǐng)域帶來了一種范式轉(zhuǎn)移，使青蒿素既可用于臨床研究，也可進(jìn)行大規(guī)模生產(chǎn)。

????屠呦呦一直強(qiáng)調(diào)，她從中國(guó)4世紀(jì)物理學(xué)家兼方士葛洪（約283 - 343年）的醫(yī)學(xué)著作中得到了啟發(fā)。

????葛洪的《肘后備急方》可以說是一本急診藥方的實(shí)踐手冊(cè)。這本書非常輕便，可以放在“肘后”，也就是中國(guó)古人的袖子里面，故而得名。古代中國(guó)男士有時(shí)候會(huì)在袖子里放隨身物品。從葛洪對(duì)患者癥狀的敏銳描述中可以看出，古代的中國(guó)人不僅受到瘧疾折磨，還要面臨其他致命疾病，如天花、傷寒和痢疾等。

????除了記錄青蒿素治療高熱的效果外，葛洪還在書中記錄了麻黃如何有效治療呼吸道問題，雄黃如何幫助控制某些皮膚病問題等。

????傳統(tǒng)成分，現(xiàn)代醫(yī)藥

????我們不能因?yàn)橐环N化合物來自大自然并一直被傳統(tǒng)醫(yī)學(xué)使用，便對(duì)其產(chǎn)生輕視之心。

????大家或許記得在2004年，美國(guó)食品藥品監(jiān)督局曾禁售含有麻黃的膳食和增強(qiáng)機(jī)能的補(bǔ)充劑。它們不僅有嚴(yán)重的副作用，甚至造成數(shù)人死亡。盡管麻黃生產(chǎn)商向法院提出上訴，但這一禁令在美國(guó)依舊有效。但與其相關(guān)的藥物麻黃素卻被用于治療低血壓，也是非處方類哮喘藥物的常見成分。

????至于雄黃，古代希臘人和中國(guó)人都深知它的毒性。但按照中醫(yī)思想，巧妙服用的毒素可以成為其他毒素強(qiáng)有力的解毒劑。因此，雄黃作為一種解毒和殺蟲藥物目前依舊被中醫(yī)使用。采用外敷的方式，雄黃可以治療皮膚表面的疥瘡、皮癬和皰疹；內(nèi)服可排出小腸寄生蟲，尤其是蛔蟲。

????盡管生物醫(yī)學(xué)目前并不使用雄黃或其相關(guān)礦物砷化物進(jìn)行治療，但中國(guó)研究人員一直在研究雄黃的抗癌作用。2011年，約翰霍普金斯大學(xué)華裔研究員劉俊（音譯）和同事發(fā)現(xiàn)，一味中藥雷公藤可有效治療癌癥、關(guān)節(jié)炎和皮膚移植排斥反應(yīng)。

????事實(shí)上，全球有大量有關(guān)中藥藥理活性的科學(xué)研究，屠呦呦在青蒿素方面取得的突破性成果只是冰山一角。比如，另外一種成功的抗瘧疾藥常山，便源自上世紀(jì)40年代中國(guó)大陸對(duì)中藥開展的科學(xué)研究。

????這種傳統(tǒng)中藥在40年代被證實(shí)為抗瘧疾藥，為毛澤東在二十年后的60年代指示中國(guó)醫(yī)學(xué)界找到治療瘧疾的藥物奠定了基礎(chǔ)。事實(shí)上，將屠呦呦的研究，放在整個(gè)20世紀(jì)（包括毛澤東時(shí)代在內(nèi)）復(fù)雜的政治環(huán)境和中國(guó)政府對(duì)中藥自上而下支持的大背景中，或許更容易理解。

????即便在中國(guó)大陸之外，這類研究也取得了不凡的成果。例如，在上世紀(jì)70年代，美國(guó)和日本的研究人員在研究制作紅曲米的紅曲霉素時(shí)，發(fā)現(xiàn)了可用于降低膽固醇的抑制素藥物。

????數(shù)世紀(jì)前關(guān)于中藥醫(yī)療功效的實(shí)驗(yàn)性證據(jù)，同樣影響了這項(xiàng)研究最初的方向。

????醫(yī)療界的“兩種語言”

????那么，諾貝爾獎(jiǎng)授予屠呦呦的成果，是否意味著西方科學(xué)界已經(jīng)改變了他們對(duì)其他醫(yī)療體系的態(tài)度？或許是，但也只是略有改變而已。

????卡羅林斯卡學(xué)院的一名專家組成員承認(rèn)，科學(xué)家會(huì)從許多來源獲得開發(fā)藥物的靈感。我們不應(yīng)該忽視歷史經(jīng)驗(yàn)。正如他所說，這些來源可能會(huì)帶來啟發(fā)，但這些古老的草藥并不能按照原有的方式使用。另一位專家組成員總結(jié)稱，不要低估屠呦呦從黃花蒿中提取活性青蒿素所用的復(fù)雜方法。

????因此，諾貝爾獎(jiǎng)不僅是要表彰通過現(xiàn)代生物醫(yī)學(xué)將中藥變成有強(qiáng)大療效的藥物所付出的努力。表彰她的另一個(gè)重要原因是，這些藥物的成功應(yīng)用拯救了無數(shù)生命，尤其是在發(fā)展中國(guó)家。

????但相比另外兩位諾貝爾醫(yī)學(xué)獎(jiǎng)獲得者威廉姆·C·坎貝爾和大村敏，以及藥理學(xué)界那些偏重西方醫(yī)學(xué)的同事們，有一點(diǎn)令屠呦呦顯得非同尋常。我認(rèn)為，在她的個(gè)人經(jīng)歷和研究當(dāng)中，屠呦呦充分彰顯了醫(yī)學(xué)雙語主義——一種既能閱讀兩種醫(yī)學(xué)語言，又能了解各自的歷史和理念差異的能力；就這則出人意料的新聞而言，最重要的是，她還體現(xiàn)了目前的治療干預(yù)措施的潛在價(jià)值。

????這種醫(yī)學(xué)雙語主義，正是那些嘗試著將傳統(tǒng)醫(yī)學(xué)經(jīng)驗(yàn)性知識(shí)和現(xiàn)代最高水平生物醫(yī)學(xué)聯(lián)系在一起的研究人員需要具備的品質(zhì)。擁有了這種品質(zhì)，他們或許也能像屠呦呦一樣，受到諾貝爾獎(jiǎng)的垂青。（財(cái)富中文網(wǎng)）

????本文作者為約翰霍普金斯大學(xué)醫(yī)學(xué)歷史專業(yè)助理教授。文章最初發(fā)表于《The Conversation》。

????譯者：劉進(jìn)龍/汪皓

????審校：任文科

????I’m sure I’m not the only one surprised by the announcement that half of the 2015 Nobel Prize in Physiology or Medicine has gone to a researcher who spent her entire career researching traditional Chinese medicine. Based at the Chinese Academy of Traditional Chinese Medicine in Beijing (now the China Academy of Chinese Medical Sciences) since 1965, scientist Youyou Tu, her colleagues, and home institution may well be just as stunned today as I am.

????Being granted the Lasker Award is often a good predictor of Nobel Prize prospects. Tu received one in 2011 for her discovery of Artemisinin as an alternative malaria cure to the standard chloroquine, which was quickly losing ground in the 1960s due to increasingly drug-resistant parasites. Scientific research on the pharmaceutically active properties of traditional Chinese medicinals, however, has never been a predictor for such widespread international recognition.

????Traditional medical knowledge anywhere in the world has not even been on the radar for Nobel Prize prospects. Until now, that is. So how should we interpret this arguably seismic shift in international attention on traditional Chinese medicine?

????Discoveries to be made in historical record

????In the question-and-answer session after the announcement at the Karolinska Institute, which awards the Nobels, one of the panelists emphasized not just the quality of Tu’s scientific research, but also the value of recorded empirical experience in the past.

????The antifebrile effect of the Chinese herb Artemisia annua (qinghaosu 青蒿素), or sweet wormwood, was known 1,700 years ago, he noted. Tu was the first to extract the biologically active component of the herb — called Artemisinin — and clarify how it worked. The result was a paradigm shift in the medical field that allowed for Artemisinin to be both clinically studied and produced on a large scale.

????Tu has always maintained that she drew her inspiration from the medical text of a fourth-century Chinese physician and alchemist named Ge Hong 葛洪 (circa 283-343).

????His Emergency Formulas To Keep at Hand (Zhouhou beijifang 肘後備急方) can best be understood as a practical handbook of drug formulas for emergencies. It was a book light enough to keep “behind the elbow” (zhouhou), namely, in one’s sleeve, where Chinese men sometimes carried their belongings. We can discern from Ge’s astute description of his patients’ symptoms that people then suffered not only from malaria but also from other deadly diseases including smallpox, typhoid and dysentery.

????Beyond recording the fever-fighting qualities of Artemisia annua, Physician Ge also wrote about how Ephedra sinica (mahuang 麻黃) effectively treated respiratory problems and how arsenic sulphide (“red Realgar,” xionghuang 雄黃) helped control some dermatological problems.

????Traditional ingredients, modern drugs

????Just because a compound has natural roots and has long been used in traditional medicine is no reason to take it lightly.

????You might remember that in 2004, the FDA actually banned ephedra-containing dietary and performance-enhancing supplements. They’d been the cause not only of serious side effects but also several deaths. The ban remains in effect in the U.S. despite a court challenge from ephedra manufacturers. Related drug ephedrine, however, is used to treat low blood pressure and is a common ingredient in over-the-counter asthma medicines.

????As for Realgar, its toxicity was well-known in both ancient Greece and Chinese antiquity. In Chinese medical thought, though, skillfully administered toxins may also be powerful antidotes for other toxins. Realgar thus continues to be used in Chinese medicine as a drug that relieves toxicity and kills parasites. Applied topically, it treats scabies, ringworm and rashes on the skin’s surface; taken internally, it expels intestinal parasites, particularly roundworms.

????Although biomedicine does not currently use Realgar or its related mineral arsenicals in treatments, Chinese researchers have been studying their anticancer properties for some time now. In 2011, a Chinese researcher at Johns Hopkins University, Jun Liu (with other colleagues), also discovered that the Chinese medicinal plant Tripterygium wilfordii Hook F (lei gong teng 雷公藤 “Thunder God Vine”) is effective against cancer, arthritis and skin graft rejection.

????Tu’s groundbreaking work on artemisinin, in fact, can be seen as the tip of the iceberg of the extensive and global scientific study of pharmacologically active Chinese medicinals, including another successful antimalarial Dichroa febrifuga (changshan 常山) that has roots in the new scientific research on Chinese medicinals in 1940s mainland China.

????It was validation of this traditional drug as an antimalarial in the 1940s, in fact, that set the foundation for Chinese leader Mao Tse Tung’s directive two decades later in the late 1960s to find a cure for malaria. Indeed, Tu’s research is best understood within the complex politics and history of top-down support from the Chinese government of Chinese medicine in mainland China during the long durée of the 20th century, and not just in the Maoist period.

????Even outside mainland China, though, such research has yielded results. In the 1970s, for example, U.S. and Japanese researchers developed the statin drugs used to lower cholesterol from studying the mold Monascus purpureus that makes red yeast rice, well, “red.”

????Empirical evidence of the medical efficacy in the rich Chinese medical archive from centuries earlier similarly influenced the initial direction of this research.

????Medically bilingual

????So is this Nobel Prize for Tu’s discovery a signal that Western science has changed how it perceives alternative systems of medicine? Perhaps, but only slightly.

????One of the Karolinska Institute panelists acknowledged that there are many sources from which scientists draw inspiration to develop drugs. Among them, we should not ignore the long history of experiences from the past. As he clarified, such sources may be inspirational, but the old herbs found there cannot be used just as they are. Don’t underestimate the sophisticated methods Tu used to extract the active Artemisinin compound from Artemesia annua, another one of the panelists concluded.

????So the Nobel Prize is not only acknowledging this complete transformation of a Chinese herb through modern biomedical science into something powerfully efficacious, but also the millions of lives saved because of its successful application worldwide, particularly in the developing world.

????But there’s something else that marks Tu as extraordinary vis-à-vis both her two fellow Nobel Laureates for medicine, William C Campbell and Satoshi ōmura, and her more Western medically oriented colleagues in pharmacology. She embodies, in both her history and her research, what I call medical bilingualism — the ability not only to read in two different medical languages but to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.

????This medical bilingualism is a quality that current researchers mining the same fine line between the empirical knowledge of traditional medical traditions and the highest level of modern biomedical science would be lucky to share with Nobel Laureate Youyou Tu.

????Marta Hanson is an associate professor of history of medicine at John Hopkins University. This article originally appeared on The Conversation.