Traditional Medicine in Asia Edited by Ranjit Roy Chaudhury Uton Muchtar Rafei World Health Organization Regional Office for South-East Asia New Delhi Traditional Medicine in Asia SEARO Regional Publications No. 39 ISBN 92 9022 2247 © World Health Organization 2001 This document is not issued to the general public, and all rights are reserved by the World Health Organization. The document may not be reviewed, abstracted, quoted, reproduced or translated, in whole or in part, without the written permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form by any means - electronic, mechanical or other without the prior written permission of WHO. The views expressed in this publication are those of the authors and do not necessarily reflect the decisions or stated policy of the World Health Organization; however they focus on issues that have been recognized by the Organization and Member States as being of high priority. Photographs on cover page (clockwise) z Acupuncture is widely used in hospitals of western medicine (courtesy Prof. Chen Qui-Ting) z Yoga posture z A herbalist, preparing fresh herbal medicines z Crocus sativus - source of saffron Layout and Design by New Concept Information Systems Pvt. Ltd. New Delhi, India ii Contents Preface All countries in the South-East Asia Region of the World Health Organization (WHO) have a heritage of traditional systems of medicine. There are large numbers of traditional medicine practitioners who provide help and service to the ill and the needy. Some of these practitioners are qualified doctors who have taken a five-year course in the system of medicine they practise; there are others who have learnt their system of medicine and the use of the different plants from their forbears, while there are still others who offer their services after working with practitioners and learning from them. It is important that this unique knowledge, often found in ancient texts, be utilized by countries to the maximum extent possible without endangering the environment and destroying the very plants which are the source of the medicine. Unfortunately, this too is happening. There are many ways in which the practitioners of these systems and the products and plants they use could be more effectively utilized for the benefit of the countries and their people. Greater use could be made of these medicinal plants at the primary health care level so that all persons could have recourse to herbal medicine–particularly those living in areas without any allopathic health care coverage. Further research directed at a few of the chronic diseases against which more drugs are needed, such as diabetes, bronchial asthma and arthritis, could lead to the discovery of new drugs for these conditions. Regulated and selective export of some of these medicinal plants being eagerly sought after in other parts of the world could considerably enhance the foreign exchange earnings of countries with this biodiversity. Careful planning is needed so that such a programme could be launched without detriment to the environment and without reducing the availability of the medicinal plants in the countries. The very large numbers of trained and semi-trained practitioners of the traditional systems of medicine could become more involved in the national health care systems of the countries. Such involvement can come about only as a result of some regulation of the systems being followed, the products used for health care and the practitioners of such systems. iii Traditional Medicine in Asia It is important also to take steps to ensure that unethical and unjustified exploitation of these plants, which have been used for centuries, is prevented– particularly the patenting in western countries of these remedies. At the same time, it is necessary to protect the discoveries being made in the countries of the Region by scientists and research workers who are carrying out research and discovering and documenting the effectiveness of the plants used. The WHO Regional Office for South-East Asia has published this book in order to present to the governments, policy-makers, clinical investigators, regulatory authorities, doctors, practitioners of traditional systems of medicine and the public, the state of the art in these wide and many-faceted fields. It is felt that the information in this publication, presented by some of the most eminent international authorities, would help not only in our understanding of these systems of medicine but also in making better use of them. The book is divided into three sections. The first section describes broadly several of the systems of traditional medicine in the countries of the Region. The second discusses policy issues such as harmonization of traditional and modern medicine, the role of traditional systems of medicine in national health care, a framework for cost-benefit analysis of traditional and conventional medicines, and the development of training programmes. The third section discusses technical issues such as legislation and regulation, standardization, pre-clinical toxicology and clinical evaluation, including ethical considerations and protection of traditional systems of medicines and research, drug development and manufacture of herbal drugs. Finally, the last part of the third section contains a brief description of the current status of traditional medicine in each of the 10 countries of the Region. We are grateful to the contributors for not only accepting readily our invitation to contribute to this book but also for adhering to the time frame. We are also indebted to Dr Palitha Abeykoon of the Regional Office for his help in planning the book, and to Mr S. Khanna, Administrative Assistant at the Delhi Society for the Promotion of Rational Use of Drugs, for his contribution at all stages in the preparation of this book. Professor Uton Muchtar Rafei, Professor Ranjit Roy Chaudhury, Regional Director, Emeritus Scientist, World Health Organization National Institute of Immunology, South-East Asia Region New Delhi New Delhi iv Contents Contents SYSTEMS Ayurveda 3 Dr. P.N.V. Kurup An overview of traditional Chinese medicine 17 Dr. Hongguang Dong Dr. Xiaorui Zhang Unani medicine 3 1 Hakim Syed Khaleefathullah Traditional system of medicine in Indonesia 4 7 Dr. Lestari Handayani Dr. Haryadi Suparto Dr. Agus Suprapto Koryo system of medicine in DPR Korea 6 9 Dr. Choe Thae Sop Chinese Acupuncture-Moxibustion 7 5 Prof. Deng Liangyue Fundamentals of Yoga 9 3 Swami Niranjanananda Saraswati and Dr. Rishi Vivekananda Saraswati v Traditional Medicine in Asia POLICY ISSUES Harmonization of traditional and modern medicine 115 Prof. Zhu-fan Xie Role of traditional systems of medicine in national health care systems 135 Mrs. Shailaja Chandra A framework for cost-benefit analysis of traditional medicine 159 and conventional medicine Dr. G. Bodeker Development of training programmes for traditional medicine 183 Dr. Palitha Abeykoon Dr. O. Akerele TECHNICAL ISSUES Legislation and regulation of traditional systems of medicine– 195 systems, practitioners and herbal products Dr. D.C. Jayasuriya Dr. Shanti Jayasuriya Standardization, pre-clinical toxicology and clinical evaluation of 209 medicinal plants, including ethical considerations Prof. Ranjit Roy Chaudhury Dr. Mandakini Roy Chaudhury Protection of traditional systems of medicine, patenting and promotion 227 of medicinal plants Prof. Carlos M. Correa Research, drug development and manufacture of herbal drugs 247 Dr. B.B. Gaitonde vi Contents CURRENT STATUS - COUNTRY SITUATION Traditional medicine in the WHO South-East Asia Region 273 Dr. Kin Shein Traditional medicine in Bangladesh 275 Dr. Md. Aftabuddin Khan & Dr. S.K. Chowdhury Traditional medicine system in Bhutan 279 Drungtsho Dr. Pema Dorji Koryo medicine of Korea 281 Dr. Choe Thae Sop Indian system of medicine and homoeopathy 283 Mr. L.V. Prasad Native traditional medicine in Indonesia 287 Dr. Ketut Ritiasa & Dr. Niniek Sudiani Dhivehibeys in Maldives 289 Dr. Abdulla Waheed Indigenous medicine in Myanmar 291 Dr. U. Kyaw Myint Tun Traditional medicine in Nepal 295 Dr. Rishi Ram Koirala Indigenous system of medicine in Sri Lanka 299 Dr. Lal Rupasinghe Thai traditional medicine as a holistic medicine 301 Dr. Pennapa Subcharoen List of contributors 307 vii Systems Ayurveda Dr. P.N.V. Kurup An overview of traditional Chinese medicine Dr. Hongguang Dong Dr. Xiaorui Zhang Unani medicine Hakim Syed Khaleefathullah Traditional system of medicine in Indonesia Dr. Lestari Handayani Dr. Haryadi Suparto Dr. Agus Suprapto Koryo system of medicine in DPR Korea Dr. Choe Thae Sop Chinese Acupuncture-Moxibustion Prof. Deng Liangyue Fundamentals of Yoga Swami Niranjanananda Saraswati and Dr. Rishi Vivekananda Saraswati Traditional Medicine in Asia 2 Ayurveda Ayurveda P.N.V. Kurup yurveda, which means the Science of The Netherlands and Hungary have ALife, is the oldest medical science in recognized Ayurveda as an alternative the Indian subcontinent and has been medicine. A White House Commission for practised since the 12th Century BC. Alternative Medicine has been constituted Ayurveda is not merely a system of medicine; in the US to find ways and means of rather it is a way of life. Its objective is to recognizing alternative medicine, which accomplish physical, mental, social and includes Ayurveda also for the purpose of spiritual well-being by adopting preventive practice. and promotive approaches as well as treating diseases with the holistic approach.1 Four