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!