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WHO REport on traditional, oriental, drugless, alternative,
complementary and integrated medicine and therapies
The World Health Organization (WHO) acknowledges its
indebtedness to our Member States, regional offices, and WHO
Member State representative offices for actively providing
data on the practice and legal status of traditional and
complementary / alternative medicine in their countries and
regions. Thanks are also expressed to those international
professional organizations, such as the World Federation of
Acupuncture and Moxibustion Societies, World Federation of
Chiropractic, World Chiropractic Alliance, and Liga
Medicorum Homeopathica Internationalis, who provided
valuable information specific to their relevant therapies.
We especially thank Mr Neil Cummings (Canada), Mr Josh Gagne
(USA), Ms Sophie Lasseur (France), Ms Yong Li (China), Mr
Stefano Maddalena (Switzerland), Ms Magali Ramillien
(France), Ms Valerie Truong (Canada), and Mr Guoliang Zhang
(China) for drafting and revising the document and Ms
Kathleen Sheridan (Netherlands) and Ms Diane Whitney (USA)
for editing the final draft. Appreciation is extended to the
Norwegian Royal Ministry of Health and Social Affairs for
providing the financial support to print this review.
Foreword
National policies are the basis for defining the role of
traditional and complementary / alternative medicine in
national health care programmes, ensuring that the necessary
regulatory and legal mechanisms are created for promoting
and maintaining good practice; assuring authenticity, safety
and efficacy of traditional and complementary / alternative
therapies; and providing equitable access to health care
resources and information about those resources.
As seen in this review, national recognition and regulation
of traditional and complementary / alternative medicine vary
considerably. The World Health Organization works with
countries to develop policies most appropriate for their
situations. This document provides information on the legal
status of traditional and complementary / alternative
medicine in a number of countries. It is intended to
facilitate the development of legal frameworks and the
sharing of experiences between countries by introducing what
some countries have done in terms of regulating traditional
and complementary / alternative medicine. This information
will be beneficial not only to policy-makers, but also to
researchers, universities, the public, insurance companies
and pharmaceutical industries.
The preparation of this document took almost 10 years,
largely because of a lack of financial resources. Not only
was it difficult to obtain accurate, precise information on
the policies of all of the World Health Organization's 191
Member States, but because of the constant work of
policy-makers on health-related issues, it was impossible
for us to collect current data and keep it current
throughout the preparation and publication process. Although
we have worked tirelessly to collect data and keep it as up
to date as possible, new policies have made some information
included here obsolete and basic information for many
countries is still lacking. Regrettably, we were only able
to include 123 countries in this review. Some countries are
not included as we were unable to find sufficient
information and, for some countries that are included, we
may have mistakenly provided inaccurate or misleading
information. We deeply apologize for any omissions or
errors.
In this regard, we would sincerely appreciate countries and
organizations providing necessary corrections and keeping us
updated as their policies change, so that our next edition
of this important document will be as accurate and complete
as possible.
Dr Xiaorui Zhang
Acting Coordinator
Traditional Medicine
World Health Organization
Geneva, Switzerland
Terminology
In this document, medical providers and practices are
generally described as traditional,
complementary/alternative, or allopathic. "Provider" and
"practitioner" are used interchangeably. In a few cases,
particularly in the European section, the cumbersome term
"non-allopathic physician" is used to refer to medical
practitioners who are either not allopathic practitioners or
who are allopathic providers but not physicians.
Allopathic medicine
Allopathic medicine, in this document, refers to the broad
category of medical practice that is sometimes called
Western medicine, biomedicine, scientific medicine, or
modern medicine. This term has been used solely for
convenience and does not refer to the treatment principles
of any form of medicine described in this document.
Complementary / Alternative medicine
The terms "complementary medicine" and "alternative
medicine" are used interchangeably with "traditional
medicine" in some countries. Complementary / alternative
medicine often refers to traditional medicine that is
practiced in a country but is not part of the country's own
traditions. As the terms "complementary" and "alternative"
suggest, they are sometimes used to refer to health care
that is considered supplementary to allopathic medicine.
However, this can be misleading. In some countries, the
legal standing of complementary / alternative medicine is
equivalent to that of allopathic medicine, many
practitioners are certified in both complementary /
alternative medicine and allopathic medicine, and the
primary care provider for many patients is a complementary /
alternative practitioner.
Herbal preparations and products
Herbal preparations are produced by subjecting herbal
materials to extraction, fractionation, purification,
concentration, or other physical or biological processes.
They may be produced for immediate consumption or as the
basis for herbal products. Herbal products may contain
excipients, or inert ingredients, in addition to the active
ingredients. They are generally produced in larger
quantities for the purpose of retail sale.
Traditional medicine
Traditional medicine includes a diversity of health
practices, approaches, knowledge, and beliefs incorporating
plant, animal, and/or mineral-based medicines; spiritual
therapies; manual techniques; and exercises, applied singly
or in combination to maintain well-being, as well as to
treat, diagnose, or prevent illness.
The comprehensiveness of the term "traditional medicine" and
the wide range of practices it encompasses make it difficult
to define or describe, especially in a global context.
Traditional medical knowledge may be passed on orally from
generation to generation, in some cases with families
specializing in specific treatments, or it may be taught in
officially recognized universities. Sometimes its practice
is quite restricted geographically, and it may also be found
in diverse regions of the world (see the section on
complementary/alternative medicine, above). However, in most
cases, a medical system is called "traditional" when it is
practiced within the country of origin.
Widespread systems of traditional and complementary /
alternative medicine
Ayurveda
Ayurveda originated in the 10th century BC, but
its current form took shape between the 5th
century BC and the 5th century AD. In Sanskrit,
ayurveda means "science of life". Ayurvedic
philosophy is attached to sacred texts, the Vedas, and based
on the theory of Panchmahabhutas - all objects and living
bodies are composed of the five basic elements: earth,
water, fire, air, and sky. Similarly, there is a
fundamental harmony between the environment and individuals,
which is perceived as a macrocosm and microcosm
relationship. As such, acting on one influences the other.
Ayurveda is not only a system of medicine, but also a way of
living. It is used to both prevent and cure diseases.
Ayurvedic medicine includes herbal medicines and medicinal
baths. It is widely practiced in South Asia, especially in
Bangladesh, India, Nepal, Pakistan, and Sri Lanka.
Chinese traditional medicine
The earliest records of traditional Chinese medicine date
back to the 8th century BC. Diagnosis and
treatment are based on a holistic view of the patient and
the patient's symptoms, expressed in terms of the balance of
yin and yang. Yin represents the earth, cold, and
femininity. Yang represents the sky, heat, and masculinity.
The actions of yin and yang influence the interactions of
the five elements composing the universe: metal, wood,
water, fire, and earth. Practitioners of Chinese traditional
medicine seek to control the levels of yin and yang through
12 meridians, which bring energy to the body. Chinese
traditional medicine can be used for promoting health as
well as preventing and curing diseases. Chinese traditional
medicine encompasses a range of practices, including
acupuncture, moxibustion, herbal medicines, manual
therapies, exercises, breathing techniques, and diets.
Surgery is rarely used. Chinese medicine, particularly
acupuncture, is the most widely used traditional medicine.
It is practiced in every region of the world.
Chiropractic
Chiropractic was founded at the end of the 19th
century by Daniel David Palmer, a magnetic therapist
practicing in Iowa, USA. Chiropractic is based on an
association between the spine and the nervous system and on
the self-healing properties of the human body. It is
practiced in every region of the world. Chiropractic
training programmes are recognized by the World Federation
of Chiropractic if they adopt international standards of
education and require a minimum of four years of full-time
university-level education following entrance requirements.
Homeopathy
Homeopathy was first mentioned by Hippocrates (462-377 BC),
but it was a German physician, Hahnemann (1755-1843), who
established homeopathy's basic principles: law of
similarity, direction of cure, principle of single remedy,
the theory of minimum diluted dose, and the theory of
chronic disease. In homeopathy, diseases are treated
with remedies that in a healthy person would produce
symptoms similar to those of the disease. Rather than
fighting the disease directly, medicines are intended to
stimulate the body to fight the disease. By the latter half
of the 19th century, homeopathy was practiced
throughout Europe as well as in Asia and North America.
Homeopathy has been integrated into the national health care
systems of many countries, including India, Mexico,
Pakistan, Sri Lanka, and the United Kingdom.
Unani
Unani is based on Hippocrates' (462-377 BC) theory of the
four bodily humours: blood, phlegm, yellow bile, and black
bile. Galen (131-210 AD), Rhazes (850-925 AD), and Avicenna
(980-1037 AD) heavily influenced unani's foundation and
formed its structure. Unani draws from the traditional
systems of medicine of China, Egypt, India, Iraq, Persia,
and the Syrian Arab Republic. It is also called Arabic
medicine.
The situation in the use of traditional and complementary /
alternative medicine
Traditional and complementary / alternative medicine is
widely used in the prevention, diagnosis, and treatment of
an extensive range of ailments. There are numerous factors
that have led to the widespread and increasing appeal of
traditional and complementary / alternative medicine
throughout the world, particularly in the past 20 years. In
some regions, traditional and complementary / alternative
medicine is more accessible. In fact, one-third of the
world's population and over half of the populations of the
poorest parts of Asia and Africa do not have regular access
to essential drugs. However, the most commonly reported
reasons for using traditional and complementary /
alternative medicine are that it is more affordable, more
closely corresponds to the patient's ideology, and is less
paternalistic than allopathic medicine. Regardless of why an
individual uses it, traditional and complementary /
alternative medicine provides an important health care
service to persons both with and without geographic or
financial access to allopathic medicine.
Traditional and complementary / alternative medicine has
demonstrated efficacy in areas such as mental health,
disease prevention, treatment of non-communicable diseases,
and improvement of the quality of life for persons living
with chronic diseases as well as for the ageing population.
Although further research, clinical trials, and evaluations
are needed, traditional and complementary / alternative
medicine has shown great potential to meet a broad spectrum
of health care needs.
Recognizing the widespread use of traditional and
complementary/alternative medicine and the tremendous
expansion of international markets for herbal products, it
is all the more important to ensure that the health care
provided by traditional and complementary / alternative
medicine is safe and reliable; that standards for the
safety, efficacy, and quality control of herbal products and
traditional and complementary / alternative therapies are
established and upheld; that practitioners have the
qualifications they profess; and that the claims made for
products and practices are valid. These issues have become
important concerns for both health authorities and the
public. National policies are a key part of addressing these
concerns.
Each year the World Health Organization receives an
increasing number of requests to provide standards,
technical guidance, and informational support to Member
States elaborating national policies on traditional and
complementary/alternative medicine. The World Health
Organization encourages and supports Member States to
integrate traditional and complementary / alternative
medicine into national health care systems and to ensure
their rational use. Facilitating the exchange of information
between Member States through regional meetings and the
publication of documents, the World Health Organization
assists countries in sharing and learning from one another's
experiences in forming national policies on traditional and
complementary/alternative medicine and developing
appropriate innovative approaches to integrated health care.
In 1998, the World Health Organization Traditional Medicine
Team issued the publication Regulatory situation of
Herbal Medicines: A Worldwide Review. Although it only
includes information concerning the regulation of herbal
medicines, this document attracted the attention of the
national health authorities of World Health Organization
Member States as well as of the general public.
Legal Status of Traditional Medicine and
Complementary/Alternative Medicine: A Worldwide Review
is much more comprehensive. Both an update and an expansion
of the 1998 document, it includes information on the
regulation and registration of herbal medicines as well as
of non-medication therapies and traditional and
complementary / alternative medical practitioners. It is an
easy reference, providing summaries of the policies enacted
in different countries and indications of the variety of
models of integration adopted by national policy-makers.
Through country-specific sections on Background information,
Statistics, Regulatory situation, Education and training,
and Insurance coverage, it is designed to facilitate the
sharing of information between nations as they elaborate
policies regulating traditional medicine and complementary /
alternative medicine and as they develop integrated national
health care systems.
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