Traditional medicine

Traditional medicine has a long history. It is the sum of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health and the prevention, diagnosis, improvement or treatment of physical and mental illness.

See WHO definitions of traditional, complementary and herbal medicines.

For centuries, traditional and complementary medicine (T&CM) has been an integral resource for health in households and communities. One hundred seventy countries reported on the use of traditional medicine, with acupuncture being the most common form of practice in 113 countries. Many developed countries have also begun recognizing and integrating traditional medicine into their healthcare systems.

According to 2012 data, almost half the population in many industrialized countries now regularly uses some form of T&CM (United States, 42%; Australia, 48%; France, 49%; Canada, 70%); considerable use of some form of T&CM exists in many other countries, such as Chile (71%), Colombia (40%) and up to 80% in some African countries. 

For centuries, traditional, indigenous and ancestral knowledge has been an integral resource for health in households and communities, and it continues to form a significant part of healthcare in many regions. One hundred seventy of WHO’s 194 Member States have reported on the use of herbal medicines, acupuncture, yoga, indigenous therapies and other forms of traditional medicines. Many countries recognize traditional medicine as a valuable source of healthcare and have taken steps to integrate practices, products and practitioners into their national systems.  

Today, traditional medicine has become a global phenomenon; the demand is growing, with patients seeking greater agency and ownership of their health and well-being and seeking more compassionate and personalized health care.  For millions, especially those living in remote and rural areas, it continues to be the first choice for health and well-being, offering care that is culturally acceptable, available and affordable.  

WHO’s work on traditional medicine is a response to the requests from countries for evidence and data to inform policies and practice, global standards and regulations to ensure safety, quality and equitable access.

The 2018 Declaration of Astana on primary health care acknowledges the need to include traditional medicine knowledge and technologies in the delivery of primary health care – a cornerstone of health systems – in pursuit of health for all.

WHO recognizes the diversity of traditional, complementary and integrative medicine (T&CM) practices across countries of the world and its contribution to health, well-being, people-centred health care and universal health coverage. Appropriately integrated T&CM can improve health outcomes by increasing the availability of services, especially at the level of primary health care. Many countries have a long history of traditional medicine and practitioners that are important in providing care to populations, and WHO recognizes that traditional, complementary and alternative medicine has many benefits.

Integration of T&CM with national health system and the mainstream of health care must be done appropriately, effectively and safely, based on the latest scientific evidence. WHO assists countries that want to embrace traditional medicine practices to do so in a science-based manner to avoid patient harm and ensure safe, effective and quality health care. An evidence-based approach is crucial; even if traditional medicines are derived from longstanding practice and are natural, establishing their efficacy and safety through rigorous clinical trials is critical.  This not only guarantees that treatment is effective and safe, but provides the rigorous evidence needed for the recommendation of traditional medicines in WHO guidelines. Non-medicinal therapies (e.g. yoga, acupuncture, etc.) provide an additional challenge in that there is clearly wide variability in their practice and performing randomly controlled trials is extremely difficult if not impossible. This means that we must push hard to develop new methodologies that provide credible and robust evidence to recommend their use for specific conditions. 

The WHO traditional medicine programme started in 1976; today, through its Traditional, Complementary and Integrative Medicine Unit, WHO is working with countries to develop standards and benchmarks for the training and practice of different systems of traditional medicine, and for their evidence-based integration in the International Classification of Diseases (ICD). 

The 11^th revision of ICD (ICD-11), which came into effect on 1 January 2022, includes a chapter on traditional medicine for dual and optional coding, which is based on traditional medicine originated in ancient Chinese medicine (now commonly used in China, Japan, Republic of Korea and elsewhere around the world). WHO is developing the next module in traditional medicine chapter, which will include diagnostic terms of Ayurveda, Unani and Siddha systems of medicine.  

WHO is implementing its second Traditional Medicine Strategy 2014–2023, focused on developing norms, standards and technical documents based on reliable information and data to support Member States in providing safe, qualified and effective traditional and complementary medicine services, and their appropriate integration into health systems. The development of an updated strategy for 2025–2034 period was requested by the Member States at the World Health Assembly in May 2023.

In 2022, with the support of the Government of India, WHO set up the WHO Global Traditional Medicine Centre in response to the increased global interest and demand for evidence-based traditional medicine.  It is the first and only WHO global centre dedicated to traditional medicine. This knowledge hub focuses on partnership, evidence, data, biodiversity and innovation to optimize the contribution of traditional medicine to global health, universal health coverage and sustainable development, and is guided by respect for local heritages, resources and rights.

The third global survey on traditional medicine is designed to monitor the progress in the performance of traditional and complementary systems, to better understand their role, function and impact in countries’ health systems and to align with WHO and global monitoring frameworks. The results will support the development of new traditional medicine strategy 2025–2034. The survey is building on the previous global surveys conducted in 2001 and 2012, with follow-up data collected between 2016 and 2018. The results were published in the 2019 WHO Global report on traditional and complementary medicine. Two T&CM indicators were included in the Global reference list of 100 core health indicators (plus health-related SDGs).  

The first principle in medicine is to do no harm and safety is always a fundamental principle in the provision of any health-care treatment and procedures. WHO has consistently advocated for the integration into national health systems of traditional medicine practices and products that meet the standards of quality, safety and efficacy.

Herbal remedies and treatments such as acupuncture and homeopathy are widely used in traditional medicine systems. Most are readily available and easy to use. Because many are considered natural, they are perceived to be safe and healthier than pharmaceutical substances. However, contrary to popular belief, traditional medicine products are not always safe and can have negative health consequences, particularly when used in combination with other medicines (see here) or when taken in high doses.

Users need to be better informed as to the actual benefits and properties of traditional forms of therapy and their potential hazards, and that they have access to the information that is reliable, clear and easily available. Improper use puts consumers at risk for potentially serious side effects as a result of allergies, drug interactions, contamination of the products with pesticides, heavy metals and other substances, or trauma inflicted by inexperienced or poorly trained practitioners.

Any T&CM product or therapy should follow strict protocol and be subjected to tests and clinical trials for quality, efficacy and patient safety.

T&CM can offer several benefits when used in conjunction with conventional medical treatments for many health conditions, such as access to a wider range of treatments, palliative care in managing the side effects of conventional treatments, improved mental and emotional well-being, and increased patient satisfaction.

Traditional products and practices can be integrated with modern medicine to support overall health and safe and effective treatment of health conditions but should not be a replace or delay seeking conventional health care.

People who have serious and time critical medical conditions (e.g. an aggressive cancer or a high fewer in a young child) need to see their health provider and use all effective conventional medicine treatments available to them.

With traditionally derived medicines, there is much we can do to investigate the potency, efficacy and safety of the treatment in well-controlled trials. Modern pharmacological techniques, such as AI screening, can also help springboard from traditional treatments with good potential but stability and consistency problems, to modern well-controlled medicines. The challenge of non-medicinal traditional interventions will require new thinking on the methodologies of definitive trials, to provide evidence that is sufficiently conclusive and robust to lead to policy recommendations. We must be prepared to accept that the apparent benefits of some interventions may be a placebo effect, while others are empirical examples of modern scientific principles. Only rigorous scientific investigation will answer these questions. 

Many WHO Member States have a long and rich heritage of traditional medicines and have integrated it into their national health-care delivery systems to varying degrees. One of the common challenges is monitoring the safety of traditional medicine products, especially setting up systems of pharmacovigilance for traditional medicine products. 

Given the reality of wide use of traditional medicine worldwide, monitoring its safety is an important and prioritized area of work. WHO encourages Member States to establish integrated pharmacovigilance system for both conventional pharmaceuticals and T&CM products (which some countries already have).

Generally speaking, T&CM products and practices are subjected to the same scrutiny (regulation, safety and quality control) as pharmaceuticals; 124 WHO Member States have passed laws or regulation for herbal medicines. 

To support Member States in this effort, WHO has published a number of guidelines for the quality, safety and efficacy of herbal medicine, including:

• WHO guidelines on selection of substances of herbal origin for quality control of herbal medicines
• Quality control methods for herbal materials
• WHO guidelines on assessing quality of herbal medicines with reference to contaminants and residues
• WHO guidelines on good manufacturing practices for herbal medicines
• WHO guidelines on good agricultural and collection practices for medicinal plants

Around 40% of pharmaceutical products today have a natural product basis, and landmark drugs derive from traditional medicine. Traditional medicine and traditional knowledge have contributed to breakthrough medical discoveries and there is a long history of herbal medicine being translated into effective treatments for health conditions.

The discovery of aspirin drew on traditional medicine formulations using the bark of the willow tree; the contraceptive pill was developed from the roots of wild yam plants; and child cancer treatments have been based on the rosy periwinkle. Nobel-prize winning research on artemisinin for malaria control started with a review of ancient Chinese medicine texts. The discovery of the smallpox vaccine, which has led to the eradication of the disease, was inspired by ancient inoculation practices by communities around the world.  

A remarkable and rapid modernization of the ways traditional medicine is being studied can help realize the potential and promise of traditional medicine and traditional knowledge, for health and well-being. Taking clues from traditional uses, new clinically effective drugs can be identified through research methods such as ethnopharmacology and reverse pharmacology.

The application of new technologies in health and medicine can open new frontiers of knowledge on traditional medicine. Artificial intelligence (AI) has emerged as a game-changer, revolutionizing the study and practice of traditional healing systems. AI’s advanced algorithms and machine learning capabilities can allow researchers to explore extensive traditional medical knowledge, map evidence and identify once elusive trends.