Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A worldwide Review



Dr Xiaorui Zhang, World Health Organization

Publication Identity

World Health Organization



In this document, medical providers and practices are generally described as traditional, complementary/alternative, or allopathic. “Provider” and “practitioner” are used interchangeably. In a few cases, particularly in the European section, the cumbersome term “non-allopathic physician” is used to refer to medical practitioners who are either not allopathic practitioners or who are allopathic providers but not physicians.

Allopathic medicine
Allopathic medicine, in this document, refers to the broad category of medical practice that is sometimes called Western medicine, biomedicine, scientific medicine, or modern medicine. This term has been used solely for convenience and does not refer to the treatment principles of any form of medicine described in this document.

Complementary/Alternative medicine
The terms “complementary medicine” and “alternative medicine” are used interchangeably with “traditional medicine” in some countries. Complementary/alternative medicine often refers to traditional medicine that is practised in a country but is not part of the country’s own traditions. As the terms “complementary” and “alternative” suggest, they are sometimes used to refer to health care that is considered supplementary to allopathic medicine. However, this can be misleading. In some countries, the legal standing of complementary/alternative medicine is equivalent to that of allopathic medicine, many practitioners are certified in both complementary/alternative medicine and allopathic medicine, and the primary care provider for many patients is a complementary/alternative practitioner.

Herbal preparations and products
Herbal preparations are produced by subjecting herbal materials to extraction, fractionation, purification, concentration, or other physical or biological processes. They may be produced for immediate consumption or as the basis for herbal products. Herbal products may contain excipients, or inert ingredients, in addition to the active ingredients. They are generally produced in larger quantities for the purpose of retail sale (1).

Traditional medicine
Traditional medicine includes a diversity of health practices, approaches, knowledge, and beliefs incorporating plant, animal, and/or mineral-based medicines; spiritual therapies; manual techniques; and exercises, applied singly or in combination to maintain well-being, as well as to treat, diagnose, or prevent illness.
The comprehensiveness of the term “traditional medicine” and the wide range of practices it encompasses make it difficult to define or describe, especially in a global context. Traditional medical knowledge may be passed on orally from generation to generation, in some cases with families specializing in specific treatments, or it may be taught in officially recognized universities. Sometimes its practice is quite restricted geographically, and it may also be found in diverse regions of the world (see the section on complementary/alternative medicine, above). However, in most cases, a medical system is called “traditional” when it is practised within the country of origin. Widespread systems of traditional and complementary/alternative medicine

Ayurveda originated in the 10th century BC, but its current form took shape between the 5th century BC and the 5th century AD. In Sanskrit, ayurveda means “science of life”. Ayurvedic philosophy is attached to sacred texts, the Vedas, and based on the theory of Panchmahabhutas — all objects and living bodies are composed of the five basic elements: earth, water, fire, air, and sky (2). Similarly, there is a fundamental harmony between the environment and individuals, which is perceived as a macrocosm and microcosm relationship. As such, acting on one influences the other. Ayurveda is not only a system of medicine, but also a way of living. It is used to both prevent and cure diseases. Ayurvedic medicine includes herbal medicines and medicinal baths. It is
widely practised in South Asia, especially in Bangladesh, India, Nepal, Pakistan, and Sri Lanka.

Chinese traditional medicine
The earliest records of traditional Chinese medicine date back to the 8th century BC (3). Diagnosis and treatment are based on a holistic view of the patient and the patient’s symptoms, expressed in terms of the balance of yin and yang. Yin represents the earth, cold, and femininity. Yang represents the sky, heat, and masculinity. The actions of yin and yang influence the interactions of the five elements composing the universe: metal, wood, water, fire, and earth. Practitioners of Chinese traditional medicine seek to control the levels of yin and yang through 12 meridians, which bring energy to the body. Chinese traditional medicine can be used for promoting health as well as preventing and curing diseases. Chinese traditional medicine encompasses a range of practices, including acupuncture, moxibustion, herbal medicines, manual therapies, exercises, breathing techniques, and diets (4). Surgery is rarely used. Chinese medicine, particularly acupuncture, is the most widely used traditional medicine. It is practised in every region of the world.

Chiropractic was founded at the end of the 19th century by Daniel David Palmer, a magnetic therapist practising in Iowa, USA. Chiropractic is based on an association between the spine and the nervous system and on the self-healing properties of the human body. It is practised in every region of the world. Chiropractic training programmes are recognized by the World Federation of Chiropractic if they adopt international standards of education and require a minimum of four years of full-time university-level education following entrance requirements.

Homeopathy was first mentioned by Hippocrates (462–377 BC), but it was a German physician, Hahnemann (1755–1843), who established homeopathy’s basic principles: law of similarity, direction of cure, principle of single remedy, the theory of minimum diluted dose, and the theory of chronic disease (2). In homeopathy, diseases are treated with remedies that in a healthy person would produce symptoms similar to those of the disease. Rather than fighting the disease directly, medicines are intended to stimulate the body to fight the disease. By the latter half of the 19th century, homeopathy was practised throughout Europe as well as in Asia and North America. Homeopathy has been integrated into the national health care systems of many countries, including India, Mexico, Pakistan, Sri Lanka, and the United Kingdom.

Unani is based on Hippocrates’ (462–377 BC) theory of the four bodily humours: blood, phlegm, yellow bile, and black bile. Galen (131–210 AD), Rhazes (850–925 AD), and Avicenna (980–1037 AD) heavily influenced unani’s foundation and formed its structure. Unani draws from the traditional systems of medicine of China, Egypt, India, Iraq, Persia, and the Syrian Arab Republic (5). It is also called Arabic medicine.

The situation in the use of traditional and complementary/alternative medicine

Traditional and complementary/alternative medicine is widely used in the prevention, diagnosis, and treatment of an extensive range of ailments. There are numerous factors that have led to the widespread and increasing appeal of traditional and complementary/alternative medicine throughout the world, particularly in the past 20 years. In some regions, traditional and complementary/alternative medicine is more accessible. In fact, one-third of the world’s population and over half of the populations of the poorest parts of Asia and Africa do not have regular access to essential drugs.
However, the most commonly reported reasons for using traditional and complementary/alternative medicine are that it is more affordable, more closely corresponds to the patient’s ideology, and is less paternalistic than allopathic medicine. Regardless of why an individual uses it, traditional and complementary/alternative medicine provides an important health care service to persons both with and without geographic or financial access to allopathic medicine.

Traditional and complementary/alternative medicine has demonstrated efficacy in areas such as mental health, disease prevention, treatment of non-communicable diseases, and improvement of the quality of life for persons living with chronic diseases as well as for the ageing population. Although further research, clinical trials, and evaluations are needed, traditional and complementary/alternative medicine has shown great potential to meet a broad spectrum of health care needs.

Recognizing the widespread use of traditional and complementary/alternative medicine and the tremendous expansion of international markets for herbal products, it is all the more important to ensure that the health care provided by traditional and complementary/alternative medicine is safe and reliable; that standards for the safety, efficacy, and quality control of herbal products and traditional and complementary/alternative therapies are established and upheld; that practitioners have the qualifications they profess; and that the claims made for products and practices are
valid. These issues have become important concerns for both health authorities and the public. National policies are a key part of addressing these concerns.

Each year the World Health Organization receives an increasing number of requests to provide standards, technical guidance, and informational support to Member States elaborating national policies on traditional and complementary/alternative medicine. The World Health Organization encourages and supports Member States to integrate traditional and complementary/alternative medicine into national health care systems and to ensure their rational use. Facilitating the exchange of information between Member States through regional meetings and the publication of documents, the World Health Organization assists countries in sharing and learning from one another’s experiences in forming national policies on traditional and complementary/alternative medicine and developing appropriate innovative approaches to integrated health care.

In 1998, the World Health Organization Traditional Medicine Team issued the publication Regulatory situation of Herbal Medicines: A Worldwide Review. Although it only includes information concerning the regulation of herbal medicines, this document attracted the attention of the national health authorities of World Health Organization Member States as well as of the general public.

Review is much more comprehensive. Both an update and an expansion of the 1998 document, it includes information on the regulation and registration of herbal medicines as well as of non-medication therapies and traditional and complementary/alternative medical practitioners. It is an easy reference, providing summaries of the policies enacted in different countries and indications of the variety of models of integration adopted by national policy-makers. Through country-specific sections on Background information, Statistics, Regulatory situation, Education and training, and Insurance coverage, it is designed to facilitate the sharing of information between nations as they elaborate policies regulating traditional medicine and complementary/alternative medicine and as they develop integrated national health care systems.