The Role of The Role of Traditional Medicine (TM) and Traditional Medicine (TM) and
Complementary and Complementary and Alternative Medicine (CAM) to Alternative Medicine (CAM) to
Health CareHealth Care
Professor LIU LiangProfessor LIU Liang
The School of Chinese MedicineThe School of Chinese Medicine
Hong Kong Baptist UniversityHong Kong Baptist University
TerminologyTerminology
The Terminology of TM and CAM is almost sameThe Terminology of TM and CAM is almost same CAM is a new terminology used in USA and widesprCAM is a new terminology used in USA and widespr
ead to other countriesead to other countries TM/CAM contains mainly traditional Chinese mediciTM/CAM contains mainly traditional Chinese medici
ne, India ayurveda, Arabic Unani medicine, Naturopane, India ayurveda, Arabic Unani medicine, Naturopathy, Osteopathy and Chiropractice therapies.thy, Osteopathy and Chiropractice therapies.
It is considered that about 70% of the contents in CAIt is considered that about 70% of the contents in CAM is Traditional Chinese Medicine (TCM)M is Traditional Chinese Medicine (TCM)
What is Traditional Chinese What is Traditional Chinese Medicine (TCM)Medicine (TCM)
A highly developed system, well documented A highly developed system, well documented and with its own body of theoryand with its own body of theory
A kind of most popular traditional medicine in A kind of most popular traditional medicine in the worldthe world
Being highly acceptable by Chinese populatioBeing highly acceptable by Chinese population, exported to neighbouring countries such as Jn, exported to neighbouring countries such as Japan, Korea and Vietnam, and widespread in apan, Korea and Vietnam, and widespread in North America, Europe and AustraliaNorth America, Europe and Australia
TCM is an integral part of the Chinese culture TCM is an integral part of the Chinese culture and has been well developed based on its indiand has been well developed based on its indigenous theories, ancient phylosophies, beliefs genous theories, ancient phylosophies, beliefs and experiences as well as evidence in clinicaand experiences as well as evidence in clinical practice.l practice.
TCM practices with a holistic approach of meTCM practices with a holistic approach of medication therapy of herbal medicines (usually dication therapy of herbal medicines (usually using formula) and non-medication therapies using formula) and non-medication therapies such as acupunture and manual therapy.such as acupunture and manual therapy.
Treatment techniques of TCM Treatment techniques of TCM comparing with other therapies of comparing with other therapies of
traditional medicinestraditional medicines
TCMTCM Indian ayIndian ayurvedaurveda
ArabicArabic
UnaniUnani
NaturopathyNaturopathy OsteopathyOsteopathy Chiro-praChiro-practicctic
Herbal Herbal medicinesmedicines
AcupunctureAcupuncture/acupressure/acupressure
Manual/Manual/therapiestherapies
Spiritual Spiritual therapiestherapies
ExercisesExercises QQ i i gonggong
YogaYoga RelaxationRelaxation
Status of TCM in China MainlandStatus of TCM in China Mainland
0
500
1000
1500
2000
2500
3000
1980 1986 1995
TCM hospitals inChina (number ofhosptial)678
2050
2522
Status of TCM in China MainlandStatus of TCM in China Mainland
198158
128784
49977
•Number of staff and ward beds in TCM Hospitals in China
0
50000
100000
150000
200000
250000
300000
350000
400000
1980 1986 1995
Staff
Beds
353375
236060
73458
Integrative approach to TCM in China National policy on TCM: constitution contains policy on
TCM (1949) Department within Ministry of Health: State
Administration of TCM (1986) Human resources of TCM: TCM doctors 825000, TCM
pharmacists 83000, TCM associate doctors 72000 Health insurance coverage for treatment and products:
Full National research institutes: 170 Official education at university level : 28 TCM in the public health care and medical system: yes
Status of TCM in Hong KongStatus of TCM in Hong Kong
TCM has been used in the community for hundreds TCM has been used in the community for hundreds of yearsof years
At present, about 22% of the medical consultations in At present, about 22% of the medical consultations in Hong Kong are currently provided by Chinese Hong Kong are currently provided by Chinese medicine practitionersmedicine practitioners
Starting from the 80’s, society’s concern towards Starting from the 80’s, society’s concern towards TCM grows and the Hong Kong Government TCM grows and the Hong Kong Government approached to review and regulate the practice and approached to review and regulate the practice and use of TCM in Hong Konguse of TCM in Hong Kong
Government policy on TCM since 1997Government policy on TCM since 1997 Article 138 of the Basic Law of the Hong Kong Article 138 of the Basic Law of the Hong Kong
Special Administrative Region: “the Government Special Administrative Region: “the Government of the Hong Kong Special Administrative Region of the Hong Kong Special Administrative Region shall, on its own, formulate policies to develop shall, on its own, formulate policies to develop western and traditional Chinese Medicine and to western and traditional Chinese Medicine and to improve medical and health services. Community improve medical and health services. Community organizations and individuals may provide various organizations and individuals may provide various medical and health services in accordance with medical and health services in accordance with law.”law.”
To establish a statutory framework to recognize thTo establish a statutory framework to recognize the professional status of TCM practitioners;e professional status of TCM practitioners;
To regulate the use, manufacture and sale of ChineTo regulate the use, manufacture and sale of Chinese medicines;se medicines;
To develop Hong Kong over time into an internatiTo develop Hong Kong over time into an international centre for manufacture and trading of chinese onal centre for manufacture and trading of chinese medicine, for research, information and training in medicine, for research, information and training in the use of Chinese medicine, and for the promotion the use of Chinese medicine, and for the promotion of this approach in medical care.of this approach in medical care.
Advancement of TCM in Hong Kong in the Advancement of TCM in Hong Kong in the recent yearsrecent years Chinese Medicine Ordinance was passed in July of Chinese Medicine Ordinance was passed in July of
1999 by the Legislative Council1999 by the Legislative Council Chinese Medicine Council of Hong Kong was Chinese Medicine Council of Hong Kong was
established in September 1999established in September 1999 A registration system for Chinese medicine A registration system for Chinese medicine
practitioners has been adopted since year 2000.practitioners has been adopted since year 2000.
Up to now, there are around 4000 registered CM Up to now, there are around 4000 registered CM practitioners and around 3500 listed CM practitioners and around 3500 listed CM practitioners in Hong Kongpractitioners in Hong Kong
A registration system for Chinese medicine A registration system for Chinese medicine products has been adopted since year 2003products has been adopted since year 2003
A formal high Chinese medicine educational A formal high Chinese medicine educational program was firstly launched in 1998 by Hong program was firstly launched in 1998 by Hong Kong Baptist University, and a training system Kong Baptist University, and a training system including undergraduate, postgraduate as well as including undergraduate, postgraduate as well as continuing education of Chinese medicine has continuing education of Chinese medicine has been developed in Hong Kongbeen developed in Hong Kong
The Hong Kong Jockey Club Chinese medicine The Hong Kong Jockey Club Chinese medicine Institute Limited was establish in 2001Institute Limited was establish in 2001
Chinese medicine clinics for outpatient services in the Chinese medicine clinics for outpatient services in the public hospitals have began in 2003public hospitals have began in 2003
General speaking, the standards and levels of TCM General speaking, the standards and levels of TCM including medical services, education, research and including medical services, education, research and product development have been greatly enhanced.product development have been greatly enhanced.
Sorry to say: no health insurance coverage for TCM Sorry to say: no health insurance coverage for TCM treatment and product and no in patient service in treatment and product and no in patient service in public hospitals availablepublic hospitals available
Status of TCM/CAM in other example Status of TCM/CAM in other example countries outside Chinacountries outside China
SouthSouth
KoreaKorea
VietViet
NamNam
JapanJapan AustraliaAustralia
National policy on National policy on TM/CMTM/CM
yesyes yesyes NoNo NoNo
Dept within Dept within ministry of Healthministry of Health
Oriental Oriental Medicine Medicine BureauBureau
Dept of TMDept of TM NoNo Yes, in some Yes, in some statesstates
Regulation on Regulation on TM/CAMTM/CAM
YesYes YesYes YesYes Yes, herbal Yes, herbal productsproducts
TM/CAM practised TM/CAM practised in hospitalin hospital
107107 4848 In some state In some state hospitalshospitals
In some state In some state hospitalshospitals
Health insurance Health insurance coveragecoverage
FullFull FullFull Yes Yes PartialPartial
TM/CAM research TM/CAM research institutesinstitutes
11 33 YesYes NoNo
Official education Official education at University levelat University level
1111 55 NoNo YesYes
Status of TCM/CAM in other example Status of TCM/CAM in other example countries outside Chinacountries outside China
USAUSA CanadaCanada United United KingdomKingdom
GermanyGermany
National policy on National policy on TM/CMTM/CM
NONO YesYes YesYes NoNo
Dept within Dept within ministry of Healthministry of Health
NoNo YesYes NoNo NoNo
Regulation on Regulation on TM/CAMTM/CAM
YesYes YesYes YesYes Yes Yes
TM/CAM practised TM/CAM practised in hospitalin hospital
In some state In some state hospitalshospitals
In some state In some state hospitalshospitals
In some state In some state hospitalshospitals
In some state In some state hospitalshospitals
Health insurance Health insurance coveragecoverage
PartialPartial PartialPartial PartialPartial PartialPartial
TM/CAM research TM/CAM research institutesinstitutes
Yes Yes Yes Yes NoNo NoNo
Official education Official education at University levelat University level
NoNo NoNo NoNo NoNo
The module of incorporation of TM/CAM The module of incorporation of TM/CAM into national health care systeminto national health care system
In an integrative system of TM/CAM and modIn an integrative system of TM/CAM and modern medicineern medicine Officially recognized and incorporated into all areas oOfficially recognized and incorporated into all areas o
f health care provision, TM/CAM is included in the rf health care provision, TM/CAM is included in the relevant country’s national drug policy; providers and elevant country’s national drug policy; providers and products are registered and regulated; TM/CAM theraproducts are registered and regulated; TM/CAM therapies are available at hospitals and clinics (both public pies are available at hospitals and clinics (both public & private); treatment with TM/CAM is reimbused un& private); treatment with TM/CAM is reimbused under health insurance; relevant research is undertaken der health insurance; relevant research is undertaken and education in TM/CAM is available.and education in TM/CAM is available.
Countries attaining an integrative system: China, RepubCountries attaining an integrative system: China, Republisc of Korea, Democratic people’s Republic of Korea, lisc of Korea, Democratic people’s Republic of Korea, VietnamVietnam
42%48%
31%
• An inclusive system recognized TM/CAM, but has not yet fully integrated it into all aspects of health care
• percentage of population which used CAM at least once in selected developed countries operating an inclusive system
49%
70%
0%
10%
20%
30%
40%
50%
60%
70%
Belgium USA Australia France Canada
Intensive increase in use of TM/CAM Intensive increase in use of TM/CAM including TCM for health care in the worldincluding TCM for health care in the world
Acceptability of provision of TM/CAM for the populationAcceptability of provision of TM/CAM for the populationJapan: 60-70% of allopathic doctors prescribe KimboJapan: 60-70% of allopathic doctors prescribe Kimbo medicines for the patientsmedicines for the patientsChina: around 40% all health care deliveredChina: around 40% all health care deliveredChile: 71% of the population have used TCMChile: 71% of the population have used TCMColombia: 40% Colombia: 40% Australia: 46%Australia: 46%France: 49%France: 49%Canada: 70%Canada: 70%Swiss: 46%Swiss: 46%USA: 42%USA: 42%
Provision of acupuncture to the publicProvision of acupuncture to the public At least 78 countries using acupunctureAt least 78 countries using acupuncture At least 50000 acupuncturists in Asia and 15000 At least 50000 acupuncturists in Asia and 15000
acupuncturists in Europeacupuncturists in Europe At least 12000 licensed acupuncturists in USA and in 42 At least 12000 licensed acupuncturists in USA and in 42
states the CM practitioners use acupuncture for treatment states the CM practitioners use acupuncture for treatment legally legally
In Germany, 77% of pain clinics provide acupunctureIn Germany, 77% of pain clinics provide acupuncture In the United Kingdom, 46% of allopathic doctors In the United Kingdom, 46% of allopathic doctors
recommend patients for acupuncture treatmentrecommend patients for acupuncture treatment
Example of increase in sales of the most Example of increase in sales of the most popular herbal products (in the USA 1997-popular herbal products (in the USA 1997-
1998)1998)
HerbHerb Sales in US$ millionSales in US$ million
19971997 19981998 % increase in sales% increase in sales
Total herbal Total herbal supplementssupplements
292292 587587 101101
GinkgoGinkgo 5252 126126 143143
GingsengGingseng 7676 9696 2626
EchinaceaEchinacea 3333 6464 242242
GarlicGarlic 6666 8181 2424
Expenditure for CAM in some countries in Expenditure for CAM in some countries in 19971997 USA: US$ 2700 millionUSA: US$ 2700 million U.K.: US$ 2300 millionU.K.: US$ 2300 million Canada: US$ 2400 millionCanada: US$ 2400 million Malaysia : US$ 500 millionMalaysia : US$ 500 million
The world market for herbal medicines was The world market for herbal medicines was estimated at US 60000 million in 1998estimated at US 60000 million in 1998
Example of using TM/CAM for patientsExample of using TM/CAM for patientsUse of CAM by patients living with HIV/AIDS in the USAUse of CAM by patients living with HIV/AIDS in the USA
regular CAM users
non-CAM users
regular CAM users
non-CAM users
60%
40%
78%
22%
General adult population People living with HIV/AIDS
Example of using TM/CAM for patientsExample of using TM/CAM for patientsCAM funding is increasing significantly in the USACAM funding is increasing significantly in the USA
0102030405060708090
92 93 94 95 96 97 98 992000
Million
US
$
2.0 2.0 4.0 5.5 7.8 11.519.5
49.5
68.3
Positive-features and developing trendsPositive-features and developing trends
DiversityDiversity FlexibilityFlexibility AccessibilityAccessibility Broad acceptance in developing countriesBroad acceptance in developing countries Increasing popularity in developed countriesIncreasing popularity in developed countries Relative low costRelative low cost Low level of technological inputLow level of technological input Relative low side effects and medical damageRelative low side effects and medical damage Growing economic importanceGrowing economic importance
Holistic approach for health care using Holistic approach for health care using modern medicine and TM/CAMmodern medicine and TM/CAM
Health maintenance prevention of disease
Balance making of the body
Treatment of diseases and injury
Rehabitation of Diseases and Health recovery
TM/CAM TM/CAM TM/CAMWM WMWM
+
+
TM/CAM for health managementTM/CAM for health management
Features of the health management of TM/CAMFeatures of the health management of TM/CAM Emphasis on health maintenance and prevention of Emphasis on health maintenance and prevention of
diseasesdiseases Integrative and comprehensive care for disease conIntegrative and comprehensive care for disease con
ditions with medication and non-medication therapditions with medication and non-medication therapiesies
Individualized therapies for individual patientsIndividualized therapies for individual patients Emphasis on the concept of wholism and balance bEmphasis on the concept of wholism and balance b
etween the inner body and external environmentetween the inner body and external environment
Fitness to health problems and disease conditionsFitness to health problems and disease conditions Functional disorders of the internal organsFunctional disorders of the internal organs Chronic diseases such as autoimmune diseases cardiovascular diChronic diseases such as autoimmune diseases cardiovascular di
seases, diabetes and mental disordersseases, diabetes and mental disorders Virus infection diseases such as hapititis B and CVirus infection diseases such as hapititis B and C Musculoskeletal problemsMusculoskeletal problems Cancers with radiotherapy, chemotherapy or in the late phase of Cancers with radiotherapy, chemotherapy or in the late phase of
diseasedisease Aging problemAging problem Serious side effects of drugsSerious side effects of drugs Rehabitation of diseases and injuryRehabitation of diseases and injury
TM/CAM :What needs to be done?TM/CAM :What needs to be done?
National policy and regulatory frameworksNational policy and regulatory frameworks Safety, efficacy and qualitySafety, efficacy and quality Rational UseRational Use
National policy and regulatory frameworksNational policy and regulatory frameworks Lack of official recognition of TM/CAM providers Lack of official recognition of TM/CAM providers
in some countriesin some countries TM/CAM not integrated into public health care TM/CAM not integrated into public health care
system in most of countries and areas including HKsystem in most of countries and areas including HK Lack of regulatory and legal mechanismsLack of regulatory and legal mechanisms Inadequate allocation of resources for TM/CAM Inadequate allocation of resources for TM/CAM
development and capacity buildingdevelopment and capacity building
Safety, efficacy and qualitySafety, efficacy and quality Lack of research methodologyLack of research methodology Inadequate evidence-based for TM/CAM therapies and productsInadequate evidence-based for TM/CAM therapies and products Lack of international and national standards for ensuring safety, Lack of international and national standards for ensuring safety,
efficacy and quality control of TM/CAM therapies and productsefficacy and quality control of TM/CAM therapies and products Lack of adequate regulation and registration of herbal medicineLack of adequate regulation and registration of herbal medicine Lack of registration of TM/CAM providersLack of registration of TM/CAM providers Inadequate support of researchInadequate support of research
Rational UseRational Use Lack of training for TM/CAM providers and on Lack of training for TM/CAM providers and on
TM/CAM for allopathic practitionersTM/CAM for allopathic practitioners Lack of communication between TM/CAM and Lack of communication between TM/CAM and
allopathic practitioners and consumersallopathic practitioners and consumers Lack of information for public on rational use of Lack of information for public on rational use of
TM/CAMTM/CAM
Key elements for improvement of TM/CAM Key elements for improvement of TM/CAM practicepractice Definition of government’s role in developing Definition of government’s role in developing
TM/CAMTM/CAM Provision for creation or expansion of regulation of Provision for creation or expansion of regulation of
herbal medicinesherbal medicines Provision for safety and quality assurance of TM/CAM Provision for safety and quality assurance of TM/CAM
therapies and products including setting up a series of therapies and products including setting up a series of international and national standardsinternational and national standards
Provision for formal education and training of Provision for formal education and training of TM/CAM providersTM/CAM providers
Provision for promotion of proper use of TM/CAMProvision for promotion of proper use of TM/CAM Provision for capacity building of TM/CAM human reProvision for capacity building of TM/CAM human re
sources, including allocation of financial resourcessources, including allocation of financial resources Provision for coverage by state health insuranceProvision for coverage by state health insurance Support for evidence-base clinical research into use of Support for evidence-base clinical research into use of
TM/CAMTM/CAM Development of national standards, technical guidelinDevelopment of national standards, technical guidelin
es and methodology for evaluating safety, efficacy and es and methodology for evaluating safety, efficacy and quality of TM/CAMquality of TM/CAM
Identification of the advantages and shortages of TM/Identification of the advantages and shortages of TM/CAM for retional use of TM/CAMCAM for retional use of TM/CAM
Thank you! Thank you!