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<\/div>\n<\/div>A practitioner of traditional Chinese medicine treats a patient in Zhejiang province in China.<\/span>Credit: China Daily\/Reuters<\/p>\n<\/figcaption><\/figure>\n <\/p>\n <\/p>\n Choi Seung-hoon thought he had an impossible assignment. On a grey autumn day in Beijing in 2004, he embarked on a marathon effort to get a couple of dozen representatives from Asian nations to boil down thousands of years of knowledge about traditional Chinese medicine into one tidy classification system.<\/p>\n Because practices vary greatly by region, the doctors spent endless hours in meetings that dragged over years, debating the correct location of acupuncture points and less commonly known concepts such as \u2018triple energizer meridian\u2019 syndrome. There were numerous skirmishes between China, Japan, South Korea and other countries as they vied to get their favoured version of traditional Chinese medicine (TCM) included in the catalogue. \u201cEach country was concerned how many terms or contents of its own would be selected,\u201d says Choi, then the adviser on traditional medicine for the Manila-based western Pacific office of the World Health Organization (WHO).<\/p>\n But over the next few years, they came to agree on a list of 3,106 terms and then adopted English translations \u2014 a key tool for expanding the reach of the practices.<\/p>\n And next year sees the crowning moment for Choi\u2019s committee, when the WHO\u2019s governing body, the World Health Assembly, adopts the 11th version of the organization\u2019s global compendium \u2014 known as the International Statistical Classification of Diseases and Related Health Problems (ICD). For the first time, the ICD will include details about traditional medicines.<\/p>\n The global reach of the reference source is unparalleled. The document categorizes thousands of diseases and diagnoses and sets the medical agenda in more than 100 countries. It influences how physicians make diagnoses, how insurance companies determine coverage, how epidemiologists ground their research and how health officials interpret mortality statistics.<\/p>\n The work of Choi\u2019s committee will be enshrined in Chapter 26, which will feature a classification system on traditional medicine. The impact is likely to be profound. Choi and others expect that the inclusion of TCM will speed up the already accelerating proliferation of the practices and eventually help them to become an integral part of global health care. \u201cIt will definitely change medicine around the world,\u201d says Choi, now the board chair of the National Development Institute of Korean Medicine in Gyeongsan.<\/p>\n Whether this is a good thing depends on whom you talk to. For Chinese leaders, the timing could not be better. Over the past few years, the country has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market.<\/p>\n Medical-tourism hotspots in China are drawing tens of thousands of foreigners for TCM. Overseas, China has opened TCM centres in more than two dozen cities, including Barcelona, Budapest and Dubai in the past three years, and pumped up sales of traditional remedies. And the WHO has been avidly supporting traditional medicines, above all TCM, as a step towards its long-term goal of universal health care. According to the agency, traditional treatments are less costly and more accessible than Western medicine in some countries.<\/p>\n Many Western-trained physicians and biomedical scientists are deeply concerned, however. Critics view TCM practices as unscientific, unsupported by clinical trials, and\u00a0sometimes dangerous<\/a>: China\u2019s drug regulator gets more than 230,000 reports of adverse effects from TCM each year.<\/p>\n With so many questions about TCM\u2019s effectiveness and safety, some experts wonder why the WHO is increasing support for such practices. One of them is Donald Marcus, an immunologist and professor emeritus at Baylor College of Medicine in Houston, Texas, and a prominent TCM critic. In his opinion, \u201cat some point, everyone will ask: why is the WHO letting people get sick?\u201d<\/p>\n <\/p>\n <\/p>\n A pharmacy in a traditional-medicine hospital in Beijing dispenses medications.<\/span>Credit: David Gray\/Reuters<\/p>\n<\/figcaption><\/figure>\n <\/p>\n TCM is based on theories about qi, a vital energy, which is said to flow along channels called meridians and help the body to maintain health. In acupuncture, needles puncture the skin to tap into any of the hundreds of points on the meridians where the flow of qi can be redirected to restore health. Treatments, whether acupuncture or herbal remedies, are also said to work by rebalancing forces known as yin and yang.<\/p>\n Practitioners of TCM and Western-trained physicians have often eyed each other suspiciously. The Western convention is to seek well-defined, well-tested causes to explain a disease state. And it typically requires randomized, controlled clinical trials that provide statistical evidence that a drug works.<\/p>\n From the TCM perspective, this is too simplistic. Factors that determine health are specific to individuals. Drawing conclusions from large groups is difficult, if not impossible. And the remedies are often a mix of a dozen or more ingredients with mechanisms that cannot, they say, be reduced to a single factor.<\/p>\n There has, however, been something of a d\u00e9tente. Organizations steeped in the Western conventions, such as the US National Institutes of Health (NIH), have created units to research traditional medicines and practices. And TCM practitioners are increasingly looking for proof of efficacy in clinical trials. They often speak of the need to modernize and standardize TCM.<\/p>\n Chapter 26 is meant to be a standard reference that all practitioners can use to help diagnose disease and assess possible causes. For example, \u2018wasting thirst syndrome\u2019 is characterized by excessive hunger and increased urination and explained by \u201cfactors which deplete yin fluids in the lung, spleen or kidney systems and generate fire and heat in the body\u201d. On the basis of those observations, physicians can work out how to treat them. The patient, who would probably be diagnosed as diabetic by a Western doctor, would probably be prescribed acupuncture, various tonics and moxibustion \u2014 in which practitioners burn herbs near the skin of the patient. Spinach tea, celery, soya beans and other \u2018cooling\u2019 foods would also be recommended.<\/p>\n TCM practitioners around the world are gearing up for Chapter 26, which is set to be implemented by WHO member states in 2022. \u201cFor the first time in history, ICD codes will include terminology such as Spleen Qi Deficiency or Liver Qi Stagnation,\u201d reads a post on the website of Five Branches University, a TCM training and research institution based in San Jose, California, which worked with the WHO on a field trial of the diagnostic criteria in Chapter 26.<\/p>\n <\/p>\n A patient is treated with heated cups at a traditional-medicine clinic in south China\u2019s Hainan Province.<\/span>Credit: Xinhua\/Avalon.red<\/p>\n<\/figcaption><\/figure>\n <\/p>\n Critics argue that there is no physiological evidence that qi or meridians exist, and scant evidence that TCM works. There have been just a handful of cases in which Chinese herbal treatments have proved effective in randomized controlled clinical trials. One notable product that has emerged from TCM is artemisinin. First isolated by Youyou Tu at the China Academy of Traditional Chinese Medicine in Beijing, the molecule is now a powerful treatment for malaria and\u00a0won Tu the Nobel Prize in Physiology or Medicine<\/a>\u00a0in 2015.<\/p>\n But scientists have spent millions of dollars on randomized trials of other TCM medicines and therapies with little success. In one of the most comprehensive assessments, researchers at the University of Maryland school of medicine in Baltimore surveyed 70 systematic reviews measuring the effectiveness of traditional medicines, including acupuncture. None of those studies could reach a solid conclusion because the evidence was either too sparse or of poor quality1<\/sup>. The NIH\u2019s National Center for Complementary and Integrative Health in Bethesda, Maryland, concludes that \u201cfor most conditions, there is not enough rigorous scientific evidence to know whether TCM methods work for the conditions for which they are used\u201d.<\/p>\n In response to queries by\u00a0Nature,\u00a0<\/i>the WHO said that its Traditional Medicine Strategy \u201cprovides guidance to Member States and other stakeholders for regulation and integration, of safe and quality assured traditional and complementary medicine products, practices, and practitioners\u201d. It emphasized that the goal of the strategy \u201cis to promote the safe and effective use of traditional medicine by regulating, researching and integrating traditional medicine products, practitioners and practice into health systems, where appropriate\u201d.<\/p>\n![\"A](\"https:\/\/media.nature.com\/w800\/magazine-assets\/d41586-018-06782-7\/d41586-018-06782-7_16142738.jpg\")
<\/div>\n<\/div>Different approach<\/h6>\n
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