... centre for manufacture and trading of chinese medicine

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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

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Terminology

• The Terminology of TM and CAM is almost same
• 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.
• It is considered that about 70 of the contents
  in CAM is Traditional Chinese Medicine (TCM)

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What is Traditional Chinese Medicine (TCM)

• A highly developed system, well documented and
  with its own body of theory
• 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

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• 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.

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• 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.

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Treatment techniques of TCM comparing with other
therapies of traditional medicines
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(No Transcript)
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Status of TCM in China Mainland
2522
2050
678
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Status of TCM in China Mainland

• Number of staff and ward beds in TCM Hospitals in
  China

353375
236060
198158
128784
73458
49977
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• 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

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Status of TCM in Hong Kong

• 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
• Starting from the 80s, societys concern towards
  TCM grows and the Hong Kong Government approached
  to review and regulate the practice and use of
  TCM in Hong Kong

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• 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.

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• To establish a statutory framework to recognize
  the professional status of TCM practitioners
• 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.

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• 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 Council of Hong Kong was
  established in September 1999
• A registration system for Chinese medicine
  practitioners has been adopted since year 2000.

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• 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 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

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• 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
• 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

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Status of TCM/CAM in other example countries
outside China
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Status of TCM/CAM in other example countries
outside China
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The module of incorporation of TM/CAM into
national health care system

• 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 countrys 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 peoples Republic
  of Korea, Vietnam

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• An inclusive system recognized TM/CAM, but has
  not yet fully integrated it into all aspects of
  health care

70
48
49
42
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• percentage of population which used CAM at least
  once in selected developed countries operating an
  inclusive system

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Intensive increase in use of TM/CAM including TCM
for health care in the world

• Acceptability of provision of TM/CAM for the
  population
• Japan 60-70 of allopathic doctors prescribe
  Kimbo
• 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

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• Provision of acupuncture to the public
• At least 78 countries using acupuncture
• 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
• In Germany, 77 of pain clinics provide
  acupuncture
• In the United Kingdom, 46 of allopathic doctors
  recommend patients for acupuncture treatment

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Example of increase in sales of the most popular
herbal products (in the USA 1997-1998)
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• Expenditure for CAM in some countries in 1997
• USA US 2700 million
• U.K. US 2300 million
• Canada US 2400 million
• Malaysia US 500 million
• The world market for herbal medicines was
  estimated at US 60000 million in 1998

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• Example of using TM/CAM for patients
• Use of CAM by patients living with HIV/AIDS in
  the USA

General adult population
People living with HIV/AIDS
22
40
60
78
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• Example of using TM/CAM for patients
• CAM funding is increasing significantly in the USA

68.3
Million US
49.5
19.5
11.5
7.8
4.0
5.5
2.0
2.0
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Positive-features and developing trends

• Diversity
• Flexibility
• Accessibility
• Broad acceptance in developing countries
• Increasing popularity in developed countries
• Relative low cost
• Low level of technological input
• Relative low side effects and medical damage
• Growing economic importance

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Holistic approach for health care using modern
medicine and TM/CAM
Health maintenance prevention of disease Balance
making of the body
Rehabitation of Diseases and Health recovery
Treatment of diseases and injury


TM/CAM
TM/CAM
WM
WM
TM/CAM
WM
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TM/CAM for health management

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

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

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TM/CAM What needs to be done?

• National policy and regulatory frameworks
• Safety, efficacy and quality
• Rational Use

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• National policy and regulatory frameworks
• 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
• Lack of regulatory and legal mechanisms
• Inadequate allocation of resources for TM/CAM
  development and capacity building

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• Safety, efficacy and quality
• Lack of research methodology
• 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 adequate regulation and registration of
  herbal medicine
• Lack of registration of TM/CAM providers
• Inadequate support of research

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• Rational Use
• 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 information for public on rational use of
  TM/CAM

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• Key elements for improvement of TM/CAM practice
• Definition of governments role in developing
  TM/CAM
• 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 formal education and training of
  TM/CAM providers

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• 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 coverage by state health insurance
• 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
• Identification of the advantages and shortages of
  TM/CAM for retional use of TM/CAM

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• ?Thank you! ?