Development Trend and Thinking of International Traditional Chinese Medicine in the Late and Postpandemic Era

Abstract There are mainly following 10 aspects of the trends in the development of international traditional Chinese medicine (TCM) in the late and postepidemic era. (1) Rehabilitation intervention of TCM in the recovery period is the focus of international TCM clinical antiepidemic practice in the later stage of the epidemic. (2) The epidemic has accelerated the development of the internet toward high-tech online education and medical care. (3) The epidemic has forced overseas TCM to transform from the “agricultural era” to the “postindustrial era.” (4) It has become a trend that the proportion of theory courses in online teaching will increase dramatically. (5) The limited number of practical training courses and the simultaneous online and offline rotation of teaching will become a useful medium of exploration. (6) Online sharing of high-quality courses can save costs and is also the direction of future development. (7) It will become the norm for the adoption of online TCM conferences that break traditional barriers of locale and time zone. (8) The renewal of the heavy TCM clinical and teaching equipment is the trend of future development. (9) The involvement of finance and venture capital will catalyze the development of the field of corporate international chains of TCM and acupuncture. (10) Changes in the international political situation may affect the speed of the development of international Chinese medicine but will not stop its progress.


Introduction
The outbreak of the coronavirus disease 2019 (COVID-19) pandemic in Wuhan, China happened in January 2020. As the Chinese government adopted a decisive localized closure to isolate the source of infection, the mobile cabin hospital was established to treat mild and severe patients separately and traditional Chinese medicine (TCM) participated on a large scale in the whole process as an antiepidemic measure. It successfully reduced the epidemic's growth rate in China and soon the epidemic situation in China was under control.
In the early stage of the COVID-19 pandemic, with no special drugs and vaccines, the diagnosis and treatment plan for COVID-19 using TCM and the integration of Chinese and Western medicine had become an important feature and advantage of the Chinese plans. TCM participates in the control and treatment of the epidemic process on a large scale by effectively relieving symptoms, reducing the development of mild and general types to serious symptoms, improving the healing rate, reducing the mortality rate, and boosting recovery. 1 Keywords ► COVID-19 ► late period of the epidemic ► postpandemic era ► TCM

Abstract
There are mainly following 10 aspects of the trends in the development of international traditional Chinese medicine (TCM) in the late and postepidemic era. (1) Rehabilitation intervention of TCM in the recovery period is the focus of international TCM clinical antiepidemic practice in the later stage of the epidemic. (2) The epidemic has accelerated the development of the internet toward high-tech online education and medical care. (3) The epidemic has forced overseas TCM to transform from the "agricultural era" to the "postindustrial era." (4) It has become a trend that the proportion of theory courses in online teaching will increase dramatically. (5) The limited number of practical training courses and the simultaneous online and offline rotation of teaching will become a useful medium of exploration. (6) Online sharing of high-quality courses can save costs and is also the direction of future development. (7) It will become the norm for the adoption of online TCM conferences that break traditional barriers of locale and time zone. (8) The renewal of the heavy TCM clinical and teaching equipment is the trend of future development. (9) The involvement of finance and venture capital will catalyze the development of the field of corporate international chains of TCM and acupuncture. (10) Changes in the international political situation may affect the speed of the development of international Chinese medicine but will not stop its progress. Now, the epidemic in China has been basically under control and has entered the late stage of the epidemic. Canada and other countries in the world are fighting for time to popularize vaccination as soon as possible, hoping to achieve the effect of universal immunization. However. not all the countries have the same opportunities and the time to enter the late stage of the epidemic depends on many factors such as the economic strength, medical level, national governance capabilities, and political decisions of countries to purchase vaccines. It is predicted that the epidemic in some countries may extend to the second half of 2023 or 2024. However, the late and postepidemic era has already become foreseeable.
The epidemic has changed the way people live, work, and study and will also form inertia and impact the original methods before the epidemic. Research on the direction and trend of international Chinese medicine development in the late and postepidemic era have been put on the agenda, and it is worthy of discussion and to think over carefully.

Rehabilitation Intervention of Traditional
Chinese Medicine in the Recovery Period Is the Focus of International Traditional Chinese Medicine Clinical Antiepidemic in the Late stage of the Epidemic Due to medical regulations overseas, TCM practitioners are not eligible to directly participate in the treatment of COVID-19. However, TCM rehabilitation intervention during the recovery period will be the focus of international TCM clinical antiepidemic medicine in the later stages of the epidemic.
The sequelae of the recovery period account for approximately 20% of the total number of patients. This includes conditions such as postviral fatigue, depression, pulmonary fibrosis, fibromyalgia, heart failure, loss of smell, loss of taste, infertility, etc. Western medicine treatment is basically centered around the treatment of initial symptoms, and the recovery of recovery period symptoms is not ideal.
After the COVID-19 virus turns negative and the patient is discharged from the hospital, TCM practitioners can legally carry out rehabilitation interventions during the recovery period. In addition to Chinese medicinals, TCM combined strategies such as Chinese psychology, acupuncture, massage, cupping, Qigong, Tai Chi, etc., as well as theoretical considerations such as "syndrome differentiation" and "disease differentiation" treatment may add the additional benefit of focusing on enhancing the immune system resistance.

The Epidemic Has Accelerated the Development of Internet Toward High-Tech Online Education and Medical Care
The epidemic has forced everyone to work from home or take online courses. Recently, several academics and their teams have used the "Cloud Lecture" method to deliver successful COVID-19 academic lectures on TCM treatment to TCM practitioners around the world, which greatly enhanced the fighting spirit and confidence of overseas TCM practi-tioners. We have established the "Canada Overseas Chinese TCM Online Consultation Service" to facilitate online consultation for international students and Chinese expats. "Express mail" can solve the need for medical supplies, and technological advancements have developed "noncontact remote auscultation" and other equipment to assist online diagnosis.
In my article which was published in 2015 and named "The Top Ten Trends & Strategic Thinking of the International Development of Traditional Chinese Medicine and Acupuncture in the 21st Century," I pointed out, "With the further development of IT technology, the instant translation and conversion of different languages on the internet will become more mature and practical in a few years. TCM can be taught by teachers in different countries. Due to the improvement of image recognition technology and the development of portable medical equipment, internet remote diagnosis and TCM treatment will gradually become a reality. This predicts that it will play a special role, especially in the TCM treatment for sub-health and longevity medicine. Different types of WeChat groups nowadays have achieved a certain degree of professional exchange. 'Cloud Lecture' provides free time and space for continuing education. " 2 These predictions have been accelerated in the epidemic situation.
We believe that in the latter part of the pandemic and the postpandemic era, there will be a group of "unicorns" in the field of general health and a promising growth in the TCM industry at home and abroad.

The Epidemic Forces Overseas Traditional Chinese Medicine to Transform from the Agricultural Era to the Postindustrial Era
The characteristics of the agricultural era are based on selfsufficiency and a self-management model. The characteristic of the industrial era is large-scale production and a collective mindset with a need to cooperate with each other. The rapid development and application of IT in the postindustrial 5G era have cut the spatial distance between countries, and instant translation has solved the problem of language barriers. Extensive information sharing has become the norm in people's daily lives.
Before the pandemic, overseas TCM practitioners opened clinics with the three-finger diagnosis technique and lived a life of self-sufficiency in the "agricultural era." The characteristics of this agricultural era made overseas TCM practitioners more fragmented and independent of each other which at the same time, resulted in the lack of progressive mechanisms like discussing cases between peers in China. This sudden outbreak has forced everyone to learn to use postindustrial technologies such as online diagnosis and treatment and directly bypass the industrial era and go from the agricultural era to the postindustrial era. In the process of paradigmatic "leap frog," some people may not keep up and will end up being eliminated from the market. If we master and use the technology of the postindustrial era properly, it will make TCM stronger and allow it to go further.

It Has Become a Trend that the Proportion of Theory Courses in Online Teaching Will Increase Exponentially
People are forced to work and study at home due to the epidemic, and online teaching has become the only choice for teachers and students. In the beginning, teachers and students were not very comfortable. After more than a year, both teachers and students have not only adapted but also tasted the sweetness of home-based online learning. Remote learning can save a lot of time travelling to and from campus, especially in a sparsely populated country like Canada, this model will save people the inconvenience of daily transportation and its associated costs in fuel and parking.
For more than a year of online teaching, a complete set of learning, supervision, and assessment techniques and methods have been established and perfected. All theoretical courses can be successfully implemented in online teaching.
In the later stages of the epidemic, although students can return to school one after another to participate in face-toface instruction, for safety reasons, students will be arranged to return to school in installments and batches, so some students still need to attend online courses at home.
Even after entering the post-epidemic era, due to the inertia and advantages of online learning at home, the proportion of theoretical lessons remaining in online teaching is predicted to be around 30% and the proportion of theoretical lessons in online teaching will continue to increase exponentially. This has already become a foreseeable trend.

The Limited Number of Practical Training Courses and the Simultaneous Online and Offline Rotation of Teaching Are Useful Exploration
During the epidemic, we divided the training courses into several groups and limited the number of people in each group to 5 to 7 and conducted online and offline simultaneous teaching. For example, in the first class, the first group of students participated in face-to-face training in the classroom, while the second and third groups took the online classes at home; in the second class, the second group of students participated in face-to-face training in the classroom for practical training, first reviewing the practical operation of the first class and then learning this practical operation. The third group and the first group studied online at home; in the third class, the third group of students participated in classroom face-to-face instruction for practical training, reviewing the first and second practical training operations first, and then learning this practical operation. The first and second groups learned online at home; in this cycle of learning, each student had face-to-face instruction opportunities for practical operations and kept a safe distance for purposes of epidemic prevention.
In the later stages of the epidemic and the post-epidemic era, the limited number of practical training courses and simultaneous online and offline lectures in rotating groups are not only useful explorations during the epidemic, but for those who have long distances such as 100 km to travel with each round trip taking 2 to 3 hours or more, and this medium will still be a useful choice.

Online Sharing of High-Quality Courses Can Save Costs and Is Also the Direction of Future Development
Online sharing of high-quality courses can save costs. For example, the branded courses of Ontario College of Traditional Chinese Medicine are as follows: for the Tuina major "Dr. Wu's head massage;" for acupuncture majors, "Advanced Acupuncture Techniques;" for Qigong majors, "Medical Qigong" and "Basic Chinese Medicine;" and so on. When teaching, students of Toronto City Branch School and Markham City Branch School can participate at the same time which can save teaching costs and facilitate the promotion and dissemination of high-quality courses.
Many colleges and universities are projected to share high-quality courses in online middle schools, which will become one of the trends and directions in the later stages of the epidemic and the future development of international Chinese medicine education.

It Will Become the Norm for Online Traditional Chinese Medicine Conferences to Break Through the Barriers of Locale and Time Zone
Before the epidemic, the international TCM conference was a face-to-face communication. Due to various factors, such as the region, time, and visa of each country, the desired result of international sharing was difficult to achieve.
During the epidemic, to promote epidemic prevention, the international TCM conference was changed to an online format, thus breaking through barriers associated with region and time zone and eliminating the trouble of visa uncertainty. For example, from August 29th to 30th, 2020, our college and Yunnan University of TCM successfully held the "2020 Canadian Acupuncture and TCM Continuing Education Conference," and from August 28th to 29th, 2021, the three parties of our college and Hebei University of TCM and Yiling Pharmaceutical Co, Ltd. jointly successfully held the "2021 Canadian Acupuncture and TCM Continuing Education Conference," and used the time difference between Canada and China to create a 24 hour a day new conference model in which the main venues in the eastern and Western hemispheres take turns to host.
It is foreseeable that in the late and postepidemic eras it will become the norm for the online and offline international TCM conferences, and it will also be the trend and direction of future development.

The Renewal of the Heavy Traditional Chinese Medicine Clinical and Teaching Equipment Is the Trend of Future Development
Compared with Western medicine, TCM is simpler in both clinical and teaching equipment and lacks heavy equipment updates. Western medicine's heavy equipment such as X-ray, color Doppler ultrasound, computed tomography, magnetic resonance imaging, etc. makes patients feel more intuitive and objective than TCM's observation, smell, inquiry, and touch.
Modernization is not the patent of Western medicine, and TCM should actively use modern technologies as much as possible. Fortunately, in recent years, a multitude of clinical and teaching equipment has been developed in combination with multiple disciplines, such as the English/Chinese bilingual materials used in clinical teaching purchased by our College "3D TCM Meridian and Acupoint Anatomy Platform," English/Chinese bilingual "TCM Pulse Apparatus" and "TCM Tongue Surface Apparatus." The renewal of TCM teaching equipment has armed TCM teaching even more powerfully. It will also change the outside world's perception of backward TCM technology and poor equipment. TCM clinical and teaching hardware updates are the trend and the only way for future development.

The Involvement of Finance and Venture Capital Will Catalyze the Development of the International Chains of Traditional Chinese Medicine and Acupuncture
With the development of overseas TCM and acupuncture today, we have the conditions to form an international chain of TCM and acupuncture clinics. This epidemic has made TCM a global topic and will develop rapidly if finance and venture capital are involved.
For nearly half a century, TCM and acupuncture have been developed in the form of individual, professional households overseas. The investment threshold is low, and it is not easy to be valued by finance and venture capital. The key was that the industry had no legislation. Nearly 10 years have passed, the "right time" has been formed. The "geographical advantage" for such a project should be in countries like Canada, the United States, and Australia who have (partial) insurance coverage. Financial and venture capital will inject the industry with vitality and talented management groups will integrate scattered but reputable clinics, it will form a chained and listed industry. It is expected to be established in 5 to 8 years and to take shape in 10 to 15 years.
After the epidemic has passed, as national policy favors TCM and acupuncture, it is expected to accelerate the development of the international chain of TCM and acupuncture.

Changes in the International Political Situation May Affect the Speed of the Development of International Chinese Medicine, But Will not Stop Its Progress
The development of overseas TCM has gone through three stages: germination, development, and maturity. The TCM acupuncture legislation of the host country is a sign of its maturity. On February 28, 2022, the "black swan" incident of The Traditional Chinese Medicine Repeal Act broke out in Ontario, Canada. The provincial parliament passed the first reading of The Traditional Chinese Medicine Repeal Act in the by-law 5 of the 2022 Act No. 88 Labor Law. There should be no change in the following days because the proposed ruling party has a majority in the provincial assembly, it would have quickly passed the second and third readings and become a new law.
If The Traditional Chinese Medicine Repeal Act passed, it would have repealed the Traditional Chinese Medicine Act 2006, which has been in place for 16 years, would have revoked the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO), which was established in 2013 and has been in operation for nine years, and would have allowed untrained individuals invasive acupuncture under the dermis and mucous membranes, as well as diagnostics and treatments that are unique to TCM, would have directly threatened public safety and removed TCM and acupuncture from the 26 regulated health care professions in Ontario, forcing TCM practitioners to be positioned as ordinary skilled workers.
The act of The Traditional Chinese Medicine Repeal Act was of course met with strong opposition from the TCM and acupuncture industry, the public recipients of these services, and all sectors of society, as well as large-scale law-protecting actions. From the incident on February 28 to March 7, it took only 7 days because of the industry's resistance to turn the "crisis" into an "opportunity" for development; the provincial government revoked The Traditional Chinese Medicine Repeal Act and canceled the original plan of the dissolution of CTCMPAO, and decided to set up a Chinese Language qualification examination for TCM acupuncturists in Ontario, protecting the TCM act has achieved a complete victory. This shows that the successive legislation of TCM in various countries is the historical trend of the development of international TCM, and the international political situation will only speed up its development and will not stop its progress.
Crisis is also an opportunity for development. The epidemic has caused many people to lose their jobs and need to switch to another industry to study again. The TCM education industry can develop against the trend. For example, Ontario College of Traditional Chinese Medicine is approved by the Canadian Federal Department of Immigration to recruit international students, and the students enjoy the same treatment as public universities and can obtain the government's student loan funding.
During the epidemic, Ontario College of Traditional Chinese Medicine recruited more new students than in previous years. In the later and postepidemic eras, the unemployed needed to switch jobs and study again. People pay more attention to the health of themselves and their family members. We believe that the TCM education industry can buck the trend and its development will continue with lots of space for improvement.

Conclusion
In the last century, Nixon's visit to China in 1972 was the first climax of Chinese medicine going to the world. Nearly half a century has passed, 67 countries have recognized the legal status of TCM and acupuncture and 183 countries in the world are applying TCM.