A practitioner of traditional Chinese medicine
treats a patient in Zhejiang province in China.
Credit: China Daily/Reuters
the World Health Organization
will recognize traditional medicine
in its influential
global medical compendium.
Why Chinese medicine
is heading for clinics around the world
On a grey autumn day in
Beijing in 2004, he embarked on a marathon effort to get a couple of
dozen representatives from Asian nations to boil down thousands of
years of knowledge about traditional Chinese medicine into one tidy
There were numerous skirmishes between China, Japan, South Korea and other countries as they vied to get their favored version of Traditional Chinese Medicine (TCM) included in the catalogue.
But over the next few
years, they came to agree on a list of 3,106 terms and then adopted
English translations - a key tool for expanding the reach of the
For the first time, the
ICD will include details about traditional medicines.
It influences how
physicians make diagnoses, how insurance companies determine
coverage, how epidemiologists ground their research and how health
officials interpret mortality statistics.
Choi and others expect that the inclusion of TCM will speed up the already accelerating proliferation of the practices and eventually help them to become an integral part of global health care.
Whether this is a good thing depends on whom you talk to.
For Chinese leaders, the
timing could not be better. Over the past few years, the country has
been aggressively promoting TCM on the international stage both for
expanding its global influence and for a share of the estimated
US$50-billion global market.
And the WHO has been
avidly supporting traditional medicines, above all TCM, as a step
towards its long-term goal of universal health care. According to
the agency, traditional treatments are less costly and more
accessible than Western medicine in some countries.
Critics view TCM
practices as unscientific, unsupported by 'clinical
trials,' and sometimes dangerous: China's drug regulator gets
more than 230,000 reports of adverse effects from TCM each year.
One of them is Donald Marcus, an immunologist and professor emeritus at Baylor College of Medicine in Houston, Texas, and a prominent TCM critic.
In his opinion,
A pharmacy in a
traditional-medicine hospital in Beijing
Credit: David Gray/Reuters
In acupuncture, needles puncture the skin to tap into any of the hundreds of points on the meridians where the flow of qi can be redirected to restore health.
acupuncture or herbal remedies, are also said to work by rebalancing
forces known as
yin and yang.
And it typically requires
randomized, controlled clinical trials that provide statistical
evidence that a drug works.
Organizations steeped in the Western conventions, such as the US National Institutes of Health (NIH), have created units to research traditional medicines and practices. And TCM practitioners are increasingly looking for proof of efficacy in clinical trials.
They often speak of the need to modernize and standardize TCM. Chapter 26 is meant to be a standard reference that all practitioners can use to help diagnose disease and assess possible causes.
For example, 'wasting thirst syndrome' is characterized by excessive hunger and increased urination and explained by,
On the basis of those observations, physicians can work out how to treat them.
The patient, who would probably be diagnosed as diabetic by a Western doctor, would probably be prescribed acupuncture, various tonics and moxibustion - in which practitioners burn herbs near the skin of the patient.
Spinach tea, celery, soya
beans and other 'cooling' foods would also be recommended.
...reads a post on the website of Five Branches University, a TCM training and research institution based in San Jose, California, which worked with the WHO on a field trial of the diagnostic criteria in Chapter 26.
at a traditional-medicine clinic
in south China's Hainan Province.
There have been just a handful of cases in which Chinese herbal treatments have proved effective in randomized controlled clinical trials. One notable product that has emerged from TCM is artemisinin.
First isolated by
Youyou Tu at the China Academy of Traditional Chinese
Medicine in Beijing, the molecule is now a powerful treatment
for malaria and won Tu the Nobel Prize in Physiology or Medicine in
None of those studies could reach a solid conclusion because the evidence was either too sparse or of poor quality. 1
The NIH's National Center for Complementary and Integrative Health in Bethesda, Maryland, concludes that,
In response to queries by Nature, the WHO said that its Traditional Medicine Strategy,
It emphasized that the goal of the strategy,
China's support of TCM started with former leader Mao Zedong, who reportedly didn't believe in it but thought it a could reach under-served populations.
Current Chinese President Xi Jinping has strongly supported TCM and, in 2016, the powerful state council developed a national strategy that promised universal access to the practices by 2020 and a booming industry by 2030.
That strategy includes supporting TCM tourism, which steers large numbers of people to clinics in China.
Every year, tens of
thousands of mostly Russian tourists flock to Hainan off the
southern coast seeking relief through TCM. The government has plans
to build 15 TCM 'model zones' similar to the one in Hainan by 2020.
The ties are paying off. Sales of TCM herbal medicines and other related products exported to Belt and Road countries surged by 54% between 2016 and 2017, to a total of US$295 million.
In Beijing in November 2016, Chan gave an address full of praise for China's advances in public health and its plans to spread traditional medicine.
China's president Xi Jinping talks with Margaret Chan,
then director-general of the World Health Organization.
In 2014, the WHO released a ten-year strategy that aims to integrate traditional medicines into modern medical care to achieve universal health coverage.
The document calls on
member states to develop health-care facilities for traditional
medicine, to ensure that insurance companies and reimbursement
systems consider supporting traditional medicines and to promote
education in the practices.
Chan wrote that traditional medicines are,
In a 2016 speech in Singapore, Chan said that TCM has excelled at preventing or delaying heart disease because it,
But many Western physicians and scientists doubt that the herbal remedies and various other components of TCM or other traditional medicines have much to offer in their current use.
They grant that TCM herbs
might turn up useful molecules (many Western drugs are derived from
plants, after all), but worry that TCM could replace proven drugs or
be potentially dangerous.
He thinks that WHO
documents should pay more attention to the risks of remedies that
contain the chemical, which are still widely used.
Many physicians and researchers also find the WHO's declarations about traditional medicine hard to parse.
Various WHO documents call for the integration of,
But the agency does not say which traditional medicines and diagnostics are proven.
Wu Linlin, a WHO representative in the Beijing office, told Nature that the,
But that stands in sharp contrast to the WHO's actions in other areas.
The agency gives member countries specific advice on what vaccines and drugs to use and what foods to avoid. With traditional medicines, however, the specifics are mostly omitted. The WHO website carries some warnings and states that aristolochic acid is a carcinogen.
But with the repeated emphasis on integrating traditional medicine, the message is clear, says Marcus.
In his view,
Nature tried to contact Chan multiple times through the WHO, but the agency says that she is not answering questions on matters related to the WHO.
Peto says that Chapter 26 could help researchers to gather data on adverse reactions and what kinds of traditional treatments people are getting.
For those steeped in Western medicine, the continued spread of traditional treatments is worrisome.
TCM practitioners increasingly talk of replacing proven Western medicines with traditional substitutes, where there is a cost advantage. Grollman thinks that ICD-11 is heading in that direction.
Seventy per cent of money spent on health care globally is reimbursed or allocated on the basis of ICD information.
Now TCM will be part of that system.
Many others agree that the WHO's decision will help the spread of TCM. Inclusion in ICD-11 is,
...says Ryan Abbott, a medical doctor who has also trained in TCM and is a faculty member at the University of California, Los Angeles, Center for East–West Medicine.
The WHO's action regarding TCM, he says,