Traditional medicine
by the World Health Organization

What is traditional medicine?

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.

Countries in Africa, Asia and Latin America use traditional medicine (TM) to help meet some of their primary health care needs. In Africa, up to 80 percent of the population uses traditional medicine for primary health care. In industrialized countries, adaptations of traditional medicine are termed “Complementary“ or “Alternative” (CAM).

Increasing use and popularity

TM has maintained its popularity in all regions of the developing world and its use is rapidly spreading in industrialized countries.

• In China, traditional herbal preparations account for 30 percent-50 percent of the total medicinal consumption.

• In Ghana, Mali, Nigeria and Zambia, the first line of treatment for 60 percent of children with high fever resulting from malaria is the use of herbal medicines at home.

• WHO estimates that in several African countries traditional birth attendants assist in the majority of births.

• In Europe, North America and other industrialized regions, over 50 percent of the population have used complementary or alternative medicine at least once.

• In San Francisco, London and South Africa, 75 percent of people living with HIV/AIDS use TM/CAM.

• 70 percent of the population in Canada have used complementary medicine at least once.

• In Germany, 90 percent of the population have used a natural remedy at some point in their life. Between 1995 and 2000, the number of doctors who had undergone special training in natural remedy medicine had almost doubled to 10,800.

• In the United States, 158 million of the adult population use complementary medicines and according to the USA Commission for Alternative and Complementary medicines, $17 billion (in US dollars, as are all such figures in this article) was spent on traditional remedies in 2000.

• In the United Kingdom, annual expenditure on alternative medicine is  $230 million.

• The global market for herbal medicines currently stands at over $60 billion annually and is growing steadily.

Safety and efficacy issues

Scientific evidence from randomized clinical trials is only strong for many uses of acupuncture, some herbal medicines and for some of the manual therapies. Further research is needed to ascertain the efficacy and safety of several other practices and medicinal plants.

Unregulated or inappropriate use of traditional medicines and practices can have negative or dangerous effects.

For instance, the herb “Ma Huang” (Ephedra) is traditionally used in China to treat respiratory congestion. In the United States, the herb was marketed as a dietary aid, whose over dosage led to at least a dozen deaths, heart attacks and strokes.

In Belgium, at least 70 people required renal transplant or dialysis for interstitial fibrosis of the kidney after taking a herbal preparation made from the wrong species of plant as slimming treatment.

Biodiversity and sustainability

In addition to patient safety issues, there is the risk that a growing herbal market and its great commercial benefit might pose a threat to biodiversity through the over harvesting of the raw material for herbal medicines and other natural health care products. These practices, if not controlled, may lead to the extinction of endangered species and the destruction of natural habitats and resources.

Another related issue is that at present, the requirements for protection provided under international standards for patent law and by most national conventional patent laws are inadequate to protect traditional knowledge and biodiversity.

Tried and tested methods and products

• 25 percent of modern medicines are made from plants first used traditionally.

• Acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, nausea and vomiting resulting from chemotherapy, and dental pain with extremely low side effects. It can also alleviate anxiety, panic disorders and insomnia.

• Yoga can reduce asthma attacks while Tai Ji techniques can help the elderly reduce their fear of falls.

• TM can also have impact on infectious diseases. For example, the Chinese herbal remedy Artemisia annua, used in China for almost 2000 years has been found to be effective against resistant malaria and could create a breakthrough in preventing almost one million deaths annually, most of them children, from severe malaria.

• In South Africa, the Medical Research Council is conducting studies on the efficacy of the plant Sutherlandia Microphylla in treating AIDS patients. Traditionally used as a tonic, this plant may increase energy, appetite and body mass in people living with HIV.

WHO efforts in promoting safe, effective and affordable traditional medicine

The World Health Organization launched its first ever comprehensive traditional medicine strategy in 2002. The strategy is designed to assist countries to:

• Develop national policies on the evaluation and regulation of TM/CAM practices;

• Create a stronger evidence base on the safety, efficacy and quality of the TAM/CAM products and practices;

• Ensure availability and affordability of TM/CAM including essential herbal medicines;

• Promote therapeutically sound use of TM/CAM by providers and consumers;

• Document traditional medicines and remedies.

At present, WHO is supporting clinical studies on antimalarials in three African countries; the studies are revealing good potential for herbal antimalarials.

Other collaboration is taking place with Burkina Faso, the Democratic Republic of the Congo, Ghana, Mali, Nigeria, Kenya, Uganda, and Zimbabwe in the research and evaluation of herbal treatments for HIV/ AIDS, malaria, sickle cell anemia and Diabetes Mellitus.

In Tanzania, WHO, in collaboration with China, is providing technical support to the government for the production of antimalarials derived from the Chinese herb Artemisia annua. Local production of the medicine will bring the price of one dose down from $6 or $7 to a more affordable $2.

In 2003, WHO support has so far facilitated the development and introduction of traditional and alternative health care curricula in seven tertiary education institutions in the Philippines.

Training workshops on the use of traditional medicines for selected diseases and disorders have also been organized in China, Mongolia and Vietnam.

Priorities for promoting the use of traditional medicines

Over one-third of the population in developing countries lack access to essential medicines. The provision of safe and effective TM/CAM therapies could become a critical tool to increase access to health care.

While China, the Democratic People’s Republic of Korea, the Republic of Korea and Vietnam have fully integrated traditional medicine into their health care systems, many countries are yet to collect and integrate standardized evidence on this type of health care.

70 countries have a national regulation on herbal medicines but the legislative control of medicinal plants has not evolved around a structured model. This is because medicinal products or herbs are defined differently in different countries and diverse approaches have been adopted with regard to licensing, dispensing, manufacturing and trading.

The limited scientific evidence about TM/CAM’s safety and efficacy as well as other considerations make it important for governments to:

• Formulate national policy and regulation for the proper use of TM/CAM and its integration into national health care systems in line with the provisions of the WHO strategies on Traditional Medicines;

• Establish regulatory mechanisms to control the safety and quality of products and of TM/CAM practice;

• Create awareness about safe and effective TM/CAM therapies among the public and consumers;

• Cultivate and conserve medicinal plants to ensure their sustainable use.