Benchmarks for Training in Traditional Chinese medicine Benchmarks for training in traditional/complementary and alternative medicine 中药往是制少了改炎的 基本知识,是告诉针就具体点 的位置,值得存不同的阵列很 特别的地方替代医学,由非常 World Health w事实上,它是唯的药,有
Benchmarks for training in traditional complementary and alternative medicine Benchmarks for Training in Traditional Chinese medicine World health Organization
Benchmarks for training in traditional / complementary and alternative medicine Benchmarks for Training in Traditional Chinese Medicine
WHO Library Cataloguing-in-Publication Data Benchmarks for training in traditional /complementary and alternative medicine: benchmarks for training in traditional Chinese medicine 1. Medicine, Chinese traditional. 2. Complementary therapies 3. Benchmarking. 4. Education. I World Health Organization. ISBN9789241599634 (NLM classification: WB 55. C4) o World Health organization 2010 hts reserved. Publications of the world Health Organization can be obtained from Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland ( tel :+41 22 791 3264; fax: +41 22 791 4857: e-mail: bookorders @who int). Requests permission to reproduce or translate WHo publications whether for sale or for noncommercial distribution - should be addressed to wHo Press. at the above address (fax:+41 22 791 4806; e-mail: permissions @who int) The designations employed and the presentation of the material in this publication do imply the expression of any opinion whatsoever on the part of the World Health ganization concerning the legal status of any country, territory, city or area or of its maps represent approximate border lines for which there may not yet be full agreemen authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines The mention of specific companies or of certain manufacturers' products does not imply names of proprietary products are distinguished by initial capital letl o h in preference to that they are endorsed or recommended by the world Health Organizatio others of a similar nature that are not mentioned. errors and omis All reasonable precautions have been taken by the world Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the world Health Organization be liable for damages arising from its use. Printed in Switzerland
WHO Library Cataloguing-in-Publication Data Benchmarks for training in traditional /complementary and alternative medicine: benchmarks for training in traditional Chinese medicine. 1.Medicine, Chinese traditional. 2.Complementary therapies. 3.Benchmarking. 4.Education. I.World Health Organization. ISBN 978 92 4 159963 4 (NLM classification: WB 55.C4) © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Switzerland
Contents Contents Acknowledgements..... Foreword Preface Introduction….11 1. The origin and principles of traditional Chinese medicine 1.1 The development of Traditional Chinese medicine 1.2 Chinese Materia Medica 2. Training traditional Chinese medicine practitioners 7 21 Categories of training programmes…… 2.2 Benchmark learning outcomes 2.3 a benchmark curriculum for training tCM practitioners 3. Training traditional Chinese medicine dispensers and distributors 3.1 A benchmark training curriculum for TCM dispensers 3.2 a benchmark training curriculum for TCM distributors 17 4. Safety issues 4.1 Incompatibility of Chinese Materia Medica 4. 2 Contraindications in pregnancy 4.4 Prevention of complications from TCM clinical practice. 4.3 Dietary considerations 4.5 Quality of medicines. References Annex: WHO Consultation on Phytotherapy, Milan, Italy, 20-23 November 2006: list of participants
Contents iii Contents Contents.......................................................................................................................... iii Acknowledgements ........................................................................................................ v Foreword........................................................................................................................ vii Preface .............................................................................................................................. ix Introduction ..................................................................................................................... 1 1. The origin and principles of traditional Chinese medicine ........................... 3 1.1 The development of Traditional Chinese medicine........................................ 3 1.2 Chinese Materia Medica...................................................................................... 4 2. Training traditional Chinese medicine practitioners....................................... 7 2.1 Categories of training programmes................................................................... 7 2.2 Benchmark learning outcomes........................................................................... 8 2.3 A benchmark curriculum for training TCM practitioners ............................. 9 3. Training traditional Chinese medicine dispensers and distributors......... 15 3.1 A benchmark training curriculum for TCM dispensers............................... 15 3.2 A benchmark training curriculum for TCM distributors ............................. 17 4. Safety issues........................................................................................................... 21 4.1 Incompatibility of Chinese Materia Medica................................................... 21 4.2 Contraindications in pregnancy....................................................................... 22 4.3 Dietary considerations....................................................................................... 23 4.4 Prevention of complications from TCM clinical practice ............................. 23 4.5 Quality of medicines.......................................................................................... 23 References....................................................................................................................... 25 Annex: WHO Consultation on Phytotherapy, Milan, Italy, 20–23 November 2006: list of participants................................................................ 27
enchmarks for training in traditional Chinese medicine
Benchmarks for training in traditional Chinese medicine iv
Acknowledgements The World Health Organization(WHO) greatly appreciates the financial and technical support provided by the Regional Government of Lombardy, Italy, for the development and publication of the basic training documents, as part of the implementation of collaborative projects with WHO in the field of traditional medicine. The Regional Government of Lombardy kindly hosted and provided financial support for the WHO Consultation on Phytotherapy, held in Milan, Italy in november 2006 WHO also wishes to express its sincere gratitude to the State Administration of Traditional Chinese Medicine of the People's Republic of China for preparing the original text. A special acknowledgement of appreciation for his work on further WHO Collaborating Centre for Traditional Medicine at the School of Health Sciences, RMIT University, Bundoora, Victoria, Australia WHO acknowledges its indebtedness to 274 reviewers, including experts and national authorities as well as professional and nongovernmental organizations, in 114 countries who provided comments and advice on the draft text Special thanks are due to the participants of the WHO Consultation on Phytotherapy(see Annex)who worked towards reviewing and finalizing the draft text, and to the WHO Collaborating Centre for Traditional Medicine at the State University of Milan, Italy, in particular to Professor Umberto Solimene, Director, and Professor Emilio Minelli, Deputy Director, for their support to WHO in organizing the Consultation
Acknowledgements v Acknowledgements The World Health Organization (WHO) greatly appreciates the financial and technical support provided by the Regional Government of Lombardy, Italy, for the development and publication of the basic training documents, as part of the implementation of collaborative projects with WHO in the field of traditional medicine. The Regional Government of Lombardy kindly hosted and provided financial support for the WHO Consultation on Phytotherapy, held in Milan, Italy in November 2006. WHO also wishes to express its sincere gratitude to the State Administration of Traditional Chinese Medicine of the People's Republic of China for preparing the original text. A special acknowledgement of appreciation for his work on further developing this document is due to Professor Charlie Changli Xue, Director, WHO Collaborating Centre for Traditional Medicine at the School of Health Sciences, RMIT University, Bundoora, Victoria, Australia. WHO acknowledges its indebtedness to 274 reviewers, including experts and national authorities as well as professional and nongovernmental organizations, in 114 countries who provided comments and advice on the draft text. Special thanks are due to the participants of the WHO Consultation on Phytotherapy (see Annex) who worked towards reviewing and finalizing the draft text, and to the WHO Collaborating Centre for Traditional Medicine at the State University of Milan, Italy, in particular to Professor Umberto Solimene, Director, and Professor Emilio Minelli, Deputy Director, for their support to WHO in organizing the Consultation
enchmarks for training in traditional Chinese medicine
Benchmarks for training in traditional Chinese medicine vi
Foreword Foreword The oldest existing therapeutic systems used by humanity for health and well- being are called Traditional Medicine or Complementary and Alternative Medicine(TM/CAM) Increasingly, TM/CAM is being formally Ms can hel existing health-care systems. When practised correctly, TM/CAN protect and im citizens health and well-being. The appropriate use of TM/CAM therapies and products, however, requires consideration of issues of safety, efficacy and quality. This is the basis of consumer protection and is no different, in principle, from what underpins modern medical practice. Upholding basic requirements for the modern practice of TM/CAM therapies can support national health authorities in the establishment of adequate laws, rules, and licensing practices These considerations have guided the work of the Regional Government of Lombardy in TM/CAM which was first included in the Regional Health Plan 2002-2004. Clinical and observational studies in the region of Lombardy have provided a crucial step in the evaluation of TM/CAM. With the help of data from these studies, a series of governmental provisions have been used to create a framework for the protection of consumers and providers. The cornerstone of this process was the first Memorandum of Understanding (Mou) for the Quadrennial Cooperation Plan which was signed between the Regional Government of Lombardy and the World Health Organization. The MO highlighted the need for certain criteria to be met including: the rational use of TM/CAM by consumers; good practice; quality; safety and the promotion of clinical and observational studies of TM/CAM. When they were published in 2004, the Who guidelines for developing consumer information on proper use of traditional, complementary and alternative medicine were incorporated into this first MOU In the region of Lombardy, citizens currently play an active role in their health care choices. The awareness of the advantages as well as of the risks of every type of care is therefore critical, also when a citizen actively chooses to use TM/CAM Consumers have begun to raise new questions related to the safe and effective treatment by all providers of TM/CAM. For this reason, the Regional Government of Lombardy closely follows WHo guidelines on qualified practice of TM/CAM in order to guarantee appropriate use through the creation of laws and regulations on skills, quality control, and safety and efficacy of products, and clear guidelines about practitioner qualifications. The Regional Government of Lombardy has also provided support and cooperated with WHO in developing series of benchmark documents for selected popularly used TM/CAM therapies including Ayurveda, naturopathy, Nuad Thai, osteopathy, traditional Chinese medicine, Tuina, and Unani medicine Modern scientific practice requires a product or a therapeutic technique to be safe and effective, meaning that it has specific indications and evidence for care supported by appropriate research. Practitioners, policy-makers and planners
Foreword vii Foreword The oldest existing therapeutic systems used by humanity for health and wellbeing are called Traditional Medicine or Complementary and Alternative Medicine (TM/CAM). Increasingly, TM/CAM is being formally used within existing health-care systems. When practised correctly, TM/CAM can help protect and improve citizens’ health and well-being. The appropriate use of TM/CAM therapies and products, however, requires consideration of issues of safety, efficacy and quality. This is the basis of consumer protection and is no different, in principle, from what underpins modern medical practice. Upholding basic requirements for the modern practice of TM/CAM therapies can support national health authorities in the establishment of adequate laws, rules, and licensing practices. These considerations have guided the work of the Regional Government of Lombardy in TM/CAM which was first included in the Regional Health Plan 2002-2004. Clinical and observational studies in the region of Lombardy have provided a crucial step in the evaluation of TM/CAM. With the help of data from these studies, a series of governmental provisions have been used to create a framework for the protection of consumers and providers. The cornerstone of this process was the first Memorandum of Understanding (MOU) for the Quadrennial Cooperation Plan which was signed between the Regional Government of Lombardy and the World Health Organization. The MOU highlighted the need for certain criteria to be met including: the rational use of TM/CAM by consumers; good practice; quality; safety; and the promotion of clinical and observational studies of TM/CAM. When they were published in 2004, the WHO guidelines for developing consumer information on proper use of traditional, complementary, and alternative medicine were incorporated into this first MOU. In the region of Lombardy, citizens currently play an active role in their healthcare choices. The awareness of the advantages as well as of the risks of every type of care is therefore critical, also when a citizen actively chooses to use TM/CAM. Consumers have begun to raise new questions related to the safe and effective treatment by all providers of TM/CAM. For this reason, the Regional Government of Lombardy closely follows WHO guidelines on qualified practice of TM/CAM in order to guarantee appropriate use through the creation of laws and regulations on skills, quality control, and safety and efficacy of products, and clear guidelines about practitioner qualifications. The Regional Government of Lombardy has also provided support and cooperated with WHO in developing this series of benchmark documents for selected popularly used TM/CAM therapies including Ayurveda, naturopathy, Nuad Thai, osteopathy, traditional Chinese medicine, Tuina, and Unani medicine. Modern scientific practice requires a product or a therapeutic technique to be safe and effective, meaning that it has specific indications and evidence for care supported by appropriate research. Practitioners, policy-makers and planners
Benchmarks for training in traditional Chinese medicine der to guarantee the safetv and the efficacy of medicines and practices fo their citizens. Furthermore, safety not only relates to products or practices per se, but also to how they are used by practitioners. Therefore it is important that policy-makers are increasingly able to standardize the training of practitioners or it is another fundamental aspect of protecting both the providers and the consumers Since 2002, the Social-Health Plan of the Lombardy Region has supported the principle of freedom of choice among different health-care options based on evidence and scientific data. By referring to the benchmarks in this present series of documents, it is possible to build a strong foundation of health-care options which will support citizens in exercising their right to make informed choices about different styles of care and selected practices and products The aim of this series of benchmark documents is to ensure that TM/CAM practices meet minimum levels of adequate knowledge, skills and awareness of indications and contraindications. These documents may also be used to facilitate establishing the regulation and registration of providers of TM/CAM Step by step we are establishing the building blocks that will ensure consume safety in the use of TM/CAM. The Regional Government of Lombardy hopes that the current series will be a useful reference for health authorities worldwide and that these documents will support countries to establish appropriate legal and regulatory frameworks for the practice of TM/CAM. Luciano bresciani Giulio boscagli Regional Minister of Health Regional Minister of Family Regional Government of Lombardy and Social Solidarity Regional Government of Lombardy
Benchmarks for training in traditional Chinese medicine viii both within and outside ministries of health, are responsible for adhering to this, in order to guarantee the safety and the efficacy of medicines and practices for their citizens. Furthermore, safety not only relates to products or practices per se, but also to how they are used by practitioners. Therefore it is important that policy-makers are increasingly able to standardize the training of practitioners for it is another fundamental aspect of protecting both the providers and the consumers. Since 2002, the Social-Health Plan of the Lombardy Region has supported the principle of freedom of choice among different health-care options based on evidence and scientific data. By referring to the benchmarks in this present series of documents, it is possible to build a strong foundation of health-care options which will support citizens in exercising their right to make informed choices about different styles of care and selected practices and products. The aim of this series of benchmark documents is to ensure that TM/CAM practices meet minimum levels of adequate knowledge, skills and awareness of indications and contraindications. These documents may also be used to facilitate establishing the regulation and registration of providers of TM/CAM. Step by step we are establishing the building blocks that will ensure consumer safety in the use of TM/CAM. The Regional Government of Lombardy hopes that the current series will be a useful reference for health authorities worldwide, and that these documents will support countries to establish appropriate legal and regulatory frameworks for the practice of TM/CAM. Luciano Bresciani Regional Minister of Health Regional Government of Lombardy Giulio Boscagli Regional Minister of Family and Social Solidarity Regional Government of Lombardy
Pref Preface There has been a dramatic surge in popularity of the various disciplines collectively known as traditional medicine(TM) over the past thirty years. For example, 75% of the population in Mali and 70% in Myanmar depend on TM and TM practitioners for primary care, while use has also greatly increased in many developed countries where it is considered a part of complementary and alternative medicine(CAM). For instance, 70% of the population in Canada and 80% in Germany have used, in their lifetime, traditional medicine under the title complementary and alternative medicine Integration of traditional medicine into national health systems Traditional medicine has strong historical and cultural roots. Particularly in developing countries, traditional healers or practitioners would often be well known and respected in the local community. However, more recently, the increasing use of traditional medicines combined with increased international mobility means that the practice of traditional medicines therapies and treatments is, in many cases, no longer limited to the countries of origin. This can make it difficult to identify qualified practitioners of traditional medicine in some One of the four main objectives of the WHO traditional medicine strategy 2002 2005 was to support countries to integrate traditional medicine into their own health systems. In 2003, a WHO resolution( WHA56.31)on traditional medicine urged Member States, where appropriate, to formulate and implement national policies and regulations on traditional and complementary and alternative medicine to support their proper use. Further, Member States were urged to integrate TM/CAM into their national health-care systems, depending on their relevant national situations Later in 2003, the results of a global survey on policies for TM/CAM conducted y WHO showed that the implementation of the strategy is making headway For example, the number of Member States reporting that they have a national policy on traditional medicine rose from five in 1990, to 39 in 2003, and to 48 in 2007. Member States with regulations on herbal medicines rose from 14 in 1986 to 80 in 2003 and to 110 in 2007. Member States with national research institutes of traditional medicine or herbal medicines rose from 12 in 1970, to 56 in 2003 and to 62 in 2007.4 Presentation by the Governments of Mali and Myanmar at the Congress on Traditional Medicine, Beijing, People's Republic of China, 7-9 November 2008 Perspectiv Complementary and Alternative Health Care, a collection of papers prepared for Health Canada, Ottawa, Health Canada, 2001 Annette Tuffs Heidelberg. Three out of four Germans have used complementary or natural remedies, British Medical Journal 2002, 325: 990(2 November) WHO medicines strategy 2008-2013 and Report from a WHo global survey on national policy on traditional medicine and regulation of herbal medicines, 2005
Preface ix Preface There has been a dramatic surge in popularity of the various disciplines collectively known as traditional medicine (TM) over the past thirty years. For example, 75% of the population in Mali and 70% in Myanmar depend on TM and TM practitioners for primary care,1 while use has also greatly increased in many developed countries where it is considered a part of complementary and alternative medicine (CAM). For instance, 70% of the population in Canada2 and 80% in Germany3 have used, in their lifetime, traditional medicine under the title complementary and alternative medicine. Integration of traditional medicine into national health systems Traditional medicine has strong historical and cultural roots. Particularly in developing countries, traditional healers or practitioners would often be wellknown and respected in the local community. However, more recently, the increasing use of traditional medicines combined with increased international mobility means that the practice of traditional medicines therapies and treatments is, in many cases, no longer limited to the countries of origin. This can make it difficult to identify qualified practitioners of traditional medicine in some countries. One of the four main objectives of the WHO traditional medicine strategy 2002- 2005 was to support countries to integrate traditional medicine into their own health systems. In 2003, a WHO resolution (WHA56.31) on traditional medicine urged Member States, where appropriate, to formulate and implement national policies and regulations on traditional and complementary and alternative medicine to support their proper use. Further, Member States were urged to integrate TM/CAM into their national health-care systems, depending on their relevant national situations. Later in 2003, the results of a global survey on policies for TM/CAM conducted by WHO showed that the implementation of the strategy is making headway. For example, the number of Member States reporting that they have a national policy on traditional medicine rose from five in 1990, to 39 in 2003, and to 48 in 2007. Member States with regulations on herbal medicines rose from 14 in 1986, to 80 in 2003, and to 110 in 2007. Member States with national research institutes of traditional medicine or herbal medicines rose from 12 in 1970, to 56 in 2003, and to 62 in 2007.4 1 Presentation by the Governments of Mali and Myanmar at the Congress on Traditional Medicine, Beijing, People’s Republic of China, 7-9 November 2008. 2 Perspectives on Complementary and Alternative Health Care, a collection of papers prepared for Health Canada, Ottawa, Health Canada, 2001. 3 Annette Tuffs Heidelberg. Three out of four Germans have used complementary or natural remedies, British Medical Journal 2002, 325:990 (2 November). 4 WHO medicines strategy 2008-2013 and Report from a WHO global survey on national policy on traditional medicine and regulation of herbal medicines, 2005
