1. The Role of Traditional Medicine (TM) and Complementary and Alternative Medicine (CAM) to Health Care Professor LIU Liang The School of Chinese Medicine Hong Kong Baptist University

2. Terminology The Terminology of TM and CAM is almost same The Terminology of TM and CAM is almost same CAM is a new terminology used in USA and widespread to other countries CAM is a new terminology used in USA and widespread to other countries TM/CAM contains mainly traditional Chinese medicine, India ayurveda, Arabic Unani medicine, Naturopathy, Osteopathy and Chiropractice therapies. TM/CAM contains mainly traditional Chinese medicine, India ayurveda, Arabic Unani medicine, Naturopathy, Osteopathy and Chiropractice therapies. It is considered that about 70% of the contents in CAM is Traditional Chinese Medicine (TCM) It is considered that about 70% of the contents in CAM is Traditional Chinese Medicine (TCM)

3. What is Traditional Chinese Medicine (TCM) A highly developed system, well documented and with its own body of theory A highly developed system, well documented and with its own body of theory A kind of most popular traditional medicine in the world A kind of most popular traditional medicine in the world Being highly acceptable by Chinese population, exported to neighbouring countries such as Japan, Korea and Vietnam, and widespread in North America, Europe and Australia Being highly acceptable by Chinese population, exported to neighbouring countries such as Japan, Korea and Vietnam, and widespread in North America, Europe and Australia

4. TCM is an integral part of the Chinese culture and has been well developed based on its indigenous theories, ancient phylosophies, beliefs and experiences as well as evidence in clinical practice. TCM is an integral part of the Chinese culture and has been well developed based on its indigenous theories, ancient phylosophies, beliefs and experiences as well as evidence in clinical practice.

5. TCM practices with a holistic approach of medication therapy of herbal medicines (usually using formula) and non-medication therapies such as acupunture and manual therapy. TCM practices with a holistic approach of medication therapy of herbal medicines (usually using formula) and non-medication therapies such as acupunture and manual therapy.

6. Treatment techniques of TCM comparing with other therapies of traditional medicines

7. TCM Indian ayurveda ArabicUnaniNaturopathyOsteopathy Chiro- practic Herbal medicines Acupuncture /acupressure Manual/ther apies Spiritual therapies Exercises Ｑ i gong YogaRelaxation

8. Status of TCM in China Mainland 678 2050 2522

9. Status of TCM in China Mainland 198158 128784 49977 Number of staff and ward beds in TCM Hospitals in China 353375 236060 73458

10. 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

11. Status of TCM in Hong Kong TCM has been used in the community for hundreds of years TCM has been used in the community for hundreds of years At present, about 22% of the medical consultations in Hong Kong are currently provided by Chinese medicine practitioners At present, about 22% of the medical consultations in Hong Kong are currently provided by Chinese medicine practitioners Starting from the 80 ’ s, society ’ s concern towards TCM grows and the Hong Kong Government approached to review and regulate the practice and use of TCM in Hong Kong Starting from the 80 ’ s, society ’ s concern towards TCM grows and the Hong Kong Government approached to review and regulate the practice and use of TCM in Hong Kong

12. Government policy on TCM since 1997 Government policy on TCM since 1997 Article 138 of the Basic Law of the Hong Kong Special Administrative Region: “ the Government of the Hong Kong Special Administrative Region shall, on its own, formulate policies to develop western and traditional Chinese Medicine and to improve medical and health services. Community organizations and individuals may provide various medical and health services in accordance with law. ” Article 138 of the Basic Law of the Hong Kong Special Administrative Region: “ the Government of the Hong Kong Special Administrative Region shall, on its own, formulate policies to develop western and traditional Chinese Medicine and to improve medical and health services. Community organizations and individuals may provide various medical and health services in accordance with law. ”

13. To establish a statutory framework to recognize the professional status of TCM practitioners; To establish a statutory framework to recognize the professional status of TCM practitioners; To regulate the use, manufacture and sale of Chinese medicines; To regulate the use, manufacture and sale of Chinese medicines; To develop Hong Kong over time into an international centre for manufacture and trading of chinese medicine, for research, information and training in the use of Chinese medicine, and for the promotion of this approach in medical care. To develop Hong Kong over time into an international centre for manufacture and trading of chinese medicine, for research, information and training in the use of Chinese medicine, and for the promotion of this approach in medical care.

14. Advancement of TCM in Hong Kong in the recent years Advancement of TCM in Hong Kong in the recent years Chinese Medicine Ordinance was passed in July of 1999 by the Legislative Council Chinese Medicine Ordinance was passed in July of 1999 by the Legislative Council Chinese Medicine Council of Hong Kong was established in September 1999 Chinese Medicine Council of Hong Kong was established in September 1999 A registration system for Chinese medicine practitioners has been adopted since year 2000. A registration system for Chinese medicine practitioners has been adopted since year 2000.

15. Up to now, there are around 4000 registered CM practitioners and around 3500 listed CM practitioners in Hong Kong Up to now, there are around 4000 registered CM practitioners and around 3500 listed CM practitioners in Hong Kong A registration system for Chinese medicine products has been adopted since year 2003 A registration system for Chinese medicine products has been adopted since year 2003 A formal high Chinese medicine educational program was firstly launched in 1998 by Hong Kong Baptist University, and a training system including undergraduate, postgraduate as well as continuing education of Chinese medicine has been developed in Hong Kong A formal high Chinese medicine educational program was firstly launched in 1998 by Hong Kong Baptist University, and a training system including undergraduate, postgraduate as well as continuing education of Chinese medicine has been developed in Hong Kong

16. The Hong Kong Jockey Club Chinese medicine Institute Limited was establish in 2001 The Hong Kong Jockey Club Chinese medicine Institute Limited was establish in 2001 Chinese medicine clinics for outpatient services in the public hospitals have began in 2003 Chinese medicine clinics for outpatient services in the public hospitals have began in 2003 General speaking, the standards and levels of TCM including medical services, education, research and product development have been greatly enhanced. General speaking, the standards and levels of TCM including medical services, education, research and product development have been greatly enhanced. Sorry to say: no health insurance coverage for TCM treatment and product and no in patient service in public hospitals available Sorry to say: no health insurance coverage for TCM treatment and product and no in patient service in public hospitals available

17. Status of TCM/CAM in other example countries outside China SouthKoreaVietNamJapanAustralia National policy on TM/CM yesyesNoNo Dept within ministry of Health Oriental Medicine Bureau Dept of TM No Yes, in some states Regulation on TM/CAM YesYesYes Yes, herbal products TM/CAM practised in hospital 10748 In some state hospitals Health insurance coverage FullFullYesPartial TM/CAM research institutes 13YesNo Official education at University level 115NoYes

18. Status of TCM/CAM in other example countries outside China USACanada United Kingdom Germany National policy on TM/CM NOYesYesNo Dept within ministry of Health NoYesNoNo Regulation on TM/CAM YesYesYesYes TM/CAM practised in hospital In some state hospitals Health insurance coverage PartialPartialPartialPartial TM/CAM research institutes YesYesNoNo Official education at University level NoNoNoNo

19. The module of incorporation of TM/CAM into national health care system In an integrative system of TM/CAM and modern medicine In an integrative system of TM/CAM and modern medicine Officially recognized and incorporated into all areas of health care provision, TM/CAM is included in the relevant country ’ s national drug policy; providers and products are registered and regulated; TM/CAM therapies are available at hospitals and clinics (both public & private); treatment with TM/CAM is reimbused under health insurance; relevant research is undertaken and education in TM/CAM is available. Officially recognized and incorporated into all areas of health care provision, TM/CAM is included in the relevant country ’ s national drug policy; providers and products are registered and regulated; TM/CAM therapies are available at hospitals and clinics (both public & private); treatment with TM/CAM is reimbused under health insurance; relevant research is undertaken and education in TM/CAM is available. Countries attaining an integrative system: China, Republisc of Korea, Democratic people ’ s Republic of Korea, Vietnam Countries attaining an integrative system: China, Republisc of Korea, Democratic people ’ s Republic of Korea, Vietnam

20. 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%

21. Intensive increase in use of TM/CAM including TCM for health care in the world Acceptability of provision of TM/CAM for the population Acceptability of provision of TM/CAM for the population Japan: 60-70% of allopathic doctors prescribe Kimbo medicines for the patients medicines for the patients China: around 40% all health care delivered Chile: 71% of the population have used TCM Colombia: 40% Australia: 46% France: 49% Canada: 70% Swiss: 46% USA: 42%

22. Provision of acupuncture to the public Provision of acupuncture to the public At least 78 countries using acupuncture At least 78 countries using acupuncture At least 50000 acupuncturists in Asia and 15000 acupuncturists in Europe At least 50000 acupuncturists in Asia and 15000 acupuncturists in Europe At least 12000 licensed acupuncturists in USA and in 42 states the CM practitioners use acupuncture for treatment legally At least 12000 licensed acupuncturists in USA and in 42 states the CM practitioners use acupuncture for treatment legally In Germany, 77% of pain clinics provide acupuncture In Germany, 77% of pain clinics provide acupuncture In the United Kingdom, 46% of allopathic doctors recommend patients for acupuncture treatment In the United Kingdom, 46% of allopathic doctors recommend patients for acupuncture treatment

23. Example of increase in sales of the most popular herbal products (in the USA 1997-1998) Herb Sales in US$ million 19971998 % increase in sales Total herbal supplements 292587101 Ginkgo52126143 Gingseng769626 Echinacea3364242 Garlic668124

24. Expenditure for CAM in some countries in 1997 Expenditure for CAM in some countries in 1997 USA: US$ 2700 million USA: US$ 2700 million U.K.: US$ 2300 million U.K.: US$ 2300 million Canada: US$ 2400 million Canada: US$ 2400 million Malaysia : US$ 500 million Malaysia : US$ 500 million The world market for herbal medicines was estimated at US 60000 million in 1998 The world market for herbal medicines was estimated at US 60000 million in 1998

25. Example of using TM/CAM for patients Example of using TM/CAM for patients Use of CAM by patients living with HIV/AIDS in the USA 60% 40% 78% 22% General adult populationPeople living with HIV/AIDS

26. Example of using TM/CAM for patients Example of using TM/CAM for patients CAM funding is increasing significantly in the USA Million US$ 2.0 4.05.5 7.8 11.5 19.5 49.5 68.3

27. Positive-features and developing trends Diversity Diversity Flexibility Flexibility Accessibility Accessibility Broad acceptance in developing countries Broad acceptance in developing countries Increasing popularity in developed countries Increasing popularity in developed countries Relative low cost Relative low cost Low level of technological input Low level of technological input Relative low side effects and medical damage Relative low side effects and medical damage Growing economic importance Growing economic importance

28. Holistic approach for health care using modern 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 WM + +

29. TM/CAM for health management Features of the health management of TM/CAM Features of the health management of TM/CAM Emphasis on health maintenance and prevention of diseases Emphasis on health maintenance and prevention of diseases Integrative and comprehensive care for disease conditions with medication and non-medication therapies Integrative and comprehensive care for disease conditions with medication and non-medication therapies Individualized therapies for individual patients Individualized therapies for individual patients Emphasis on the concept of wholism and balance between the inner body and external environment Emphasis on the concept of wholism and balance between the inner body and external environment

30. Fitness to health problems and disease conditions Fitness to health problems and disease conditions Functional disorders of the internal organs Functional disorders of the internal organs Chronic diseases such as autoimmune diseases cardiovascular diseases, diabetes and mental disorders Chronic diseases such as autoimmune diseases cardiovascular diseases, diabetes and mental disorders Virus infection diseases such as hapititis B and C Virus infection diseases such as hapititis B and C Musculoskeletal problems Musculoskeletal problems Cancers with radiotherapy, chemotherapy or in the late phase of disease Cancers with radiotherapy, chemotherapy or in the late phase of disease Aging problem Aging problem Serious side effects of drugs Serious side effects of drugs Rehabitation of diseases and injury Rehabitation of diseases and injury

31. TM/CAM :What needs to be done? National policy and regulatory frameworks National policy and regulatory frameworks Safety, efficacy and quality Safety, efficacy and quality Rational Use Rational Use

32. National policy and regulatory frameworks National policy and regulatory frameworks Lack of official recognition of TM/CAM providers in some countries Lack of official recognition of TM/CAM providers in some countries TM/CAM not integrated into public health care system in most of countries and areas including HK TM/CAM not integrated into public health care system in most of countries and areas including HK Lack of regulatory and legal mechanisms Lack of regulatory and legal mechanisms Inadequate allocation of resources for TM/CAM development and capacity building Inadequate allocation of resources for TM/CAM development and capacity building

33. Safety, efficacy and quality Safety, efficacy and quality Lack of research methodology Lack of research methodology Inadequate evidence-based for TM/CAM therapies and products Inadequate evidence-based for TM/CAM therapies and products Lack of international and national standards for ensuring safety, efficacy and quality control of TM/CAM therapies and products Lack of international and national standards for ensuring safety, efficacy and quality control of TM/CAM therapies and products Lack of adequate regulation and registration of herbal medicine Lack of adequate regulation and registration of herbal medicine Lack of registration of TM/CAM providers Lack of registration of TM/CAM providers Inadequate support of research Inadequate support of research

34. Rational Use Rational Use Lack of training for TM/CAM providers and on TM/CAM for allopathic practitioners Lack of training for TM/CAM providers and on TM/CAM for allopathic practitioners Lack of communication between TM/CAM and allopathic practitioners and consumers Lack of communication between TM/CAM and allopathic practitioners and consumers Lack of information for public on rational use of TM/CAM Lack of information for public on rational use of TM/CAM

35. Key elements for improvement of TM/CAM practice Key elements for improvement of TM/CAM practice Definition of government ’ s role in developing TM/CAM Definition of government ’ s role in developing TM/CAM Provision for creation or expansion of regulation of herbal medicines Provision for creation or expansion of regulation of herbal medicines Provision for safety and quality assurance of TM/CAM therapies and products including setting up a series of international and national standards Provision for safety and quality assurance of TM/CAM therapies and products including setting up a series of international and national standards Provision for formal education and training of TM/CAM providers Provision for formal education and training of TM/CAM providers

36. Provision for promotion of proper use of TM/CAM Provision for promotion of proper use of TM/CAM Provision for capacity building of TM/CAM human resources, including allocation of financial resources Provision for capacity building of TM/CAM human resources, including allocation of financial resources Provision for coverage by state health insurance Provision for coverage by state health insurance Support for evidence-base clinical research into use of TM/CAM Support for evidence-base clinical research into use of TM/CAM Development of national standards, technical guidelines and methodology for evaluating safety, efficacy and quality of TM/CAM Development of national standards, technical guidelines and methodology for evaluating safety, efficacy and quality of TM/CAM Identification of the advantages and shortages of TM/CAM for retional use of TM/CAM Identification of the advantages and shortages of TM/CAM for retional use of TM/CAM

37.  Thank you! 