Traditional Medicine

Interview with Dr X. Zhang, WHO on traditional medicine

Dr Zhang, what is Traditional Medicine?

Traditional medicine (TM) is acquired knowledge received over many years from an individual, a community, a society to prevent, treat diseases and improve health conditions. TM is based on different cultures and history.

When did Traditional Medicine start?

Since human beings appeared on the earth, they use their own TM.

But when we speak in WHO of Traditional Medicine, to what countries does it apply?

Since Western medicine has been well developed and has been widely used in many countries, TM has been less used or even has disappeared.

However, in some countries where the population is strongly influenced by their long traditional civilisation such as in China, India, in some South-Asian and Far-Eastern countries, TM is still popularly used although Western medicine is available. In some African and Latin American countries, particularly in rural areas and indigenous communities, most people still believe in their traditional culture and their own traditional medicine. Although TM has no system, its traditional knowledge has been passed down from one generation to another.

Can we still find Traditional Medicine in the Occidental world?

In Switzerland, for example, in the Appenzel area, people use their own TM. In other European countries, many individuals still have some knowledge on how to use plants but this is not in a book and is not part of the national health care system. For example, grandmothers may often say to their families: “This plant in the garden is good for your digestion, please take it”. But in many countries, TM is more likely to be a complementary or an alternative medicine.

How can Traditional Medicine be applied or used?

The idea of using TM is to prevent and treat diseases, improve health conditions and this applies to Appenzel orother countries. However, in different countries and continents, people may use different plants and different therapies because the climate and the environment are different, the growing of medicinal plants is also quite different.

You said that some Traditional Medicine is not recorded in books?

There is rich traditional knowledge in using medicinal plants worldwide. Some of the traditional knowledge has been recorded in writing but most of them has been passed from one generation to another orally. In most countries, TM has not been integrated into the national health care system, resulting in no support from the authorities for the preservation of the knowledge. Research is also lacking, as research is important to prove whether TM is really efficient and safe. Since the discovery of newdrugs from traditionally used plants has brought great commercial benefit, there is more and more research on medicinal plants. However, most research stops at the laboratory level, there are no further clinical trials to finally prove the safety and efficacy. This is the general situation in the world.

To what extent efficacy can be evidenced?

As I mentioned earlier, most cases of research on herbal medicines stop at the laboratory level. There is a large distance between the results of a laboratory test and clinical trials. That means that laboratory research is not enough to finally prove the safety and efficacy of TM.

Clinical research is a very important step for gaining evidence-based results.

How to improve the safety and efficacy of Traditional Medicine?

In most countries, TM has not been completely integrated into the health care systems so it has not got enough support for research and education. This is why it is difficult to find complete research data including both preclinical research and clinical research. In countries like China, Vietnam, the Republic of Korea, the Democratic Republic of Korea, governments have integrated TM into their national health care systems. There is formal university education on both TM and Western medicine and there are many TM research institutions. You may find lots of research information including clinical research but the quality of the research may need to be further promoted.It is only when TM will be recognized by governments and due sup-port given to TM, to research and education, that the safety and efficacy of TM will be promoted.

What are the different therapies used?

Variety of forms exist. They can be divided into two groups:non-medication therapy such as acupuncture, manual therapies liketreatment massage, spiritual therapies and exercises therapies such as Yoga , Taiaji and Qiguong etc. Normally, these therapies don’t use any medicine but in some cases like massage, some essential oil of plants can be used.

Medication therapy includes the use of medicinal plants, animal parts and/or minerals. For example, China, India, Africa and Latin American countries use the deer horn, musk, insects, and mineral like gypsum.

How these materials are used?

It quite varies. In some cases, a single plant is used and in others mixed plants are used. In many Asian countries, the herbs, mineral materials and animal materials are mixed together. How to use the herbs, mineral and animal materials is heavily based on either individual experience or based on the theory and concept of the systems such as traditional Chinese medicine and Indian ayurveda medicine. Homeopathy is one of the most popularly used complementary and alternative medicine in European and South Asian countries. It was a German physician, Hahnemann (1755-1843) who established homeopathy’s basic principles and Homeopathy has its own concept of diagnosis, treatment and its medicines which consist of medicinal plants, mineral and animal materials.

What kind of diseases could be treated by Traditional Medicine therapies?

Normally, people use TM for treating chronic diseases, for prevention and to maintain a good health condition. For example, acupuncture is used to relieve pain, Ginkgo biloba (plant) which can be found in a drugstore and Garlic gel, are used in the prevention heart attack. But TM has also been used for the treatment of threatening diseases such as malaria and AIDS. For example, in China, a new anti malaria drug Artemisinin was discovered from a traditionally used anti-malaria plant. Artemisinin has been widely used worldwide. Herbal medicines have not only been used for treating malaria, in some countries, people also use medicininal plants for the prevention of malaria. For example, in some African and Asian countries, people cultivate lemon grass around their house and there are fewer mosquitoes.

Is there any hope to discover new drugs from Traditional Medicine to cure severe diseases?

Yes. The discovery of Artemisinin is one good example. Currently, some surveys in Europe and USA show that 60 to 70% of HIV positive and AIDS patients regularly use anti-retroviral treatment combined with complementary/alternative medicine or TM to reduce symptoms or side effects. However, in many developing countries, poor people with AIDS use TM for treating symptoms and improving their quality of life because the antiretroviral treatment is too expensive for them.

Traditional Medicine and Intellectual Property Right?

There is a case in China where they have discovered a new anti-Malaria drug from a TM plant. Since patents could bring large profits, many pharmaceutical industries and Western scientists are interested in discovering new drugs from plants. In many developing countries, vast knowledge in traditionally used medicinal plants exists and many poor people depend on TM for their primary health care. Therefore, the hot issue is how to protect traditional medicine knowledge and its owners (the poor people) and how to ensure an equitable distribution of the resulting profits.

Why is Traditional Medicine increasingly used in both the developing and developed world and give me an example?

In developing countries, the popularity of TM is due to its accessibility and affordability. It is still one of the important sources of health care. Following economic development and life style change as well as population ageing, the pattern of common diseases is changing. The common diseases are now hypertension, heart attack, stroke, cancer, AIDS. These diseases are closely related to life style. Therefore, prevention is important to reduce the risk of these diseases. Normally, using herbal medicines for prevention has fewer sideeffects if it is used properly. At present, many chronic diseases may not be very well treated or cured by Western medicine, therefore, people are looking for a complementary and alternative treatment. For example, acupuncture could be used to regulate the immune function, relieve pain and could be used for the treatment of arthritis.

What is the position of WHO vis-àvis Traditional Medicine?

WHO encourages and supports countries to establish a national policy, regulations, and to integrate TM into their national health care systems for ensuring safe and effective use.

Generally speaking, are Member States interested by Traditional Medicine?

In many countries, the public is becoming increasingly interested in the use of TM leading governments to face the real situation, to consider what is the TM function, and how to integrate it into their own national health care systems.

Was WHO approached by countries for that purpose

The use of TM varies from country to country and region to region. Countries would like to learn of experiences of other countries. Therefore, one of the important functions of WHO is to collect and disseminate information and facilitate information sharing between the Member States.Herbal medicines are the most popularly used therapies of TM. However, only 64 of 198 WHO Member States regulate herbal medicines. The safety and efficacy of using herbal medicines is a priority concern of the public and health authorities. To promote country capacity-building by the establishment of regulations governing herbal medicines is one of priority activities of the WHO strategy for traditional medicine.

What kind of support do countries need from WHO and why?

Besides requesting WHO to provide information on policy and regulation, many countries also request WHO to provide technical guidance and methods for research and evaluation on the safety and efficacy of TM. WHO has developed a series of technical guidelines to support countries in promoting the proper use of TM. This year, the Department of Essential Drugs and Medicines Policy has developed a WHO strategy for TM for the next 4 years. Policy and regulations are key to ensure the safety, efficacy and quality of TM.

What does the Department of Essential Drugs and Medicines Policy do in relation to Traditional Medicine?

Our department is in charge of all medicines including essential drugs and traditional medicine. Normative functions and country support are our main functions. We have four majorobjectives in WHO’s medicine strategy: policy, access, quality and safety.

Do we need guidelines on how to use Traditional Medicine?

It is a good question. Normally, the public and the consumer consider that TM is a natural medicine and therefore, it is safe and it can be freely used. However, cases are often reported of side effects or poisoning caused by over taking dosage of herbal medicines or misuse of medicinal plants. Compared with chemical drug, herbal medicines may have fewer side effects if properly used. However, any therapy or drug including traditional medicine therapy and herbal medicines has its own specific indication and correct dosage. They have to be properly used to ensure safety and efficacy. In order to promote the rational use of TM, we will develop the guidelines on the proper use of traditional medicine for the public and consumers in the near future.

Dr Zhang, do you use Traditional Medicine to treat yourself and is there a Traditional Medicine therapy against stress?

Yes. I do believe in TM. I am a traditional Chinese medical doctor and I have gained much benefit from TM. For example, last year, I had serious infection and several antibiotics provide by medical doctors in Geneva were ineffective. Finally I was completely cured by herbal medicines which I found in a pharmacy in Geneva. Not only that, I also use herbal medicines to maintain my good health. However, I do also believe that TM and modern medicines have their own advantages. The best way is in using them in a combined way. That means to select one, which has its advantage for your complaint, or use both advantages together to combat your problem.

There are many therapies which could be used against stress. For example, St John’s wort. It is a plant. This is very famous and popularly used for the beginning of mild depression and stress. But for severe cases, you are better to visit doctor for their advice. If you have no any medical knowledge, when you have health problem, I would suggest you visit the doctor first and identify what is your real problem. If your problem is not a serious disease, you may want to try TM. However, I would suggest you consult with qualified traditional medicine practitioners for their advice in view of safety and efficacy aspects. The qualified practitioner means he or she has been properly trained.

Dr Xiaorui Zhang
Acting Coordinator Traditional Medicine (TRM) Department of Essential Drugs and Medicines Policy (EDM) World Health Organization Website: http//www.who.int/medicines/organization/trm/orgtrmstrat.htm Email: zhangx@who.ch Tel. ( 4122) 791 3639; Fax( 4122) 791 4730.

Interview by Monique Eid, WHO