Traditional Chinese medicine is going global. Earlier this year, Chinese state media reported that 57 traditional medicinal centers were under development in places as far-flung as Poland, the United Arab Emirates, Germany, and France. By some counts, TCM can now be found in more than 180 countries—almost all the world’s recognized nations—and the industry is worth more than $60 billion a year.
Now, for the first time, the World Health Organization (WHO) is planning to include traditional medicine diagnoses in its influential medical compendium—making it easier for a traditional Chinese medicine diagnosis such as “wood overacting Earth” to come to a clinic near you. The condition involves stress-related indigestion and is often treated with acupuncture and herbal medicine.
Uses of TCM date back more than 2,500 years and are based on concepts such as finding harmony between opposing yet complementary forces. To treat or prevent health problems, practitioners use remedies derived from herbs or animal parts, as well as various mind and body practices, such as tai chi. Robust scientific evidence for the effectiveness of many of these measures is limited.
Including traditional medicine in this WHO list, the International Classification of Diseases (ICD), is “a really positive step recognizing traditional Chinese medicine as a medical option to help people,” says Lixin Huang, executive director of the American College of Traditional Chinese Medicine, at the California Institute of Integral Studies, in San Francisco. “I think at the beginning, this will be symbolic because many doctors do not have knowledge of how to include this in their treatments, but now they will recognize this would be an option.”
In the United States, TCM practices already have a large following. Acupuncture illustrates how widespread some aspects of TCM have become in hospitals and doctor’s offices. “Forty years ago in the U.S. no one would recognize acupuncture, and it would be illegal to practice, but look at today,” Huang says. The American College of Traditional Chinese Medicine states that acupuncturists are licensed as a profession in 44 states and the District of Columbia, with approximately 27,000 providers offering services.
Not everyone is sanguine about greater reliance on TCM. Some conservationists worry that the WHO’s decision, on top of TCM’s growing popularity, may seal the fate of endangered species historically used for traditional curatives—and even send ones not currently threatened into a death spiral because of elevated demand.
“It would be totally wrong if respecting the cultural beliefs of one country, China, led to the extinction of Africa’s biological heritage,” says Cathy Dean, chief executive officer of Save the Rhinos, a London-based charity that raises money for rhino conservation. Rhinos and pangolins, she says, are among the beleagured species trafficked to Chinese markets for TCM, and she hopes that the WHO “will take a strong line against the use of animal products, let alone those from endangered species.”
The WHO document, which includes all the international codes for medical diagnoses, is scheduled to be submitted to the executive board in January and then be adopted at the World Health Assembly, in Geneva, in May. More than 400 of its codes will pertain to traditional medicine, and each has a specific definition, says Marilyn Allen, who served on the WHO committee incorporating traditional medicine into the ICD. The codes describe a patient’s condition as defined by traditional medicine so there won’t be direct codes for any herbs, says Allen, the public relations and marketing director at the American Acupuncture Council—a group that sells acupuncture malpractice insurance.
The ICD could still be modified “based on scientific evidence and needs from the field,” according to the WHO. Some environmental groups are pushing for decision makers to take a second look and more clearly spell out caveats around what wildlife could or should be used—something this compendium for medical diagnoses typically wouldn’t do.
“It’s no coincidence that the species most sought after with the TCM trade are the most critically endangered species,” says Chris Shepherd, executive director of Monitor, a British Columbia-based organization combating illegal wildlife trade. “There are a number of species that are already threatened or critically endangered because of the traditional medicine trade. Any growth in that area or in demand for these species could be devastating,” he says, pointing to pangolins, big cats, rhinos, and other threatened animals.
The change to the official International Classification of Diseases is not just a matter of paperwork. The ICD is the foundational document for all health trends and statistics globally. It provides the international standard for reporting diseases and health conditions. And it’s used to make insurance reimbursement decisions.
In its current draft form, the WHO document explains that the eleventh version of the influential compendium will include codes for “disorders and patterns which originated in ancient Chinese medicine and are commonly used in China, Japan, Korea, and elsewhere around the world. This list represents a union set of harmonized traditional medicine conditions of the Chinese, Japanese and Korean classifications.”
Because scant standardized data exist for traditional medicines, the WHO maintains that internationally comparable data on such diagnoses would be a good thing—providing a basis for doing further research into and evaluation of their efficacy. Creating diagnostics categories to report this information in a standardized and internationally comparable manner acknowledges that a condition exists and that it should be counted and compared, the WHO told National Geographic.
“Inclusion in the ICD is not a recommendation of a treatment’s efficacy; inclusion acknowledges that a disease or symptom or condition exists and that it should be measured,” WHO spokesman Gregory Hartl wrote in an email. It “does not mean we recommend or condone the use of animal parts such as rhinoceros horns: WHO recommends the enforcement of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), which protects rhinos, tigers, and other species,” he said. Hartl says the WHO acknowledges the growing demand for better integration of TCM into mainstream health care and that this ICD addition will help smooth the way.
Despite existing legal prohibitions for endangered species, the black market in illegal animal products is flourishing, with many poached animals destined for China—both for traditional medicine and other uses. Pangolins, for example, which are believed to be the most trafficked mammal in the world, are barred from international trade by CITES. Nevertheless, the International Union for the Conservation of Nature, which sets the conservation status of species, estimates that more than a million have been poached from the wild during the past decade. The scaly animals are used in traditional medicine in China and Vietnam and are also poached for their meat.
“While species may be protected by national laws and listed by CITES,” Shepherd notes, “It doesn’t mean trade is being adequately regulated; that’s just on paper.”
Monitor’s Shepherd, along with his colleague Jordi Janssen, recently published a paper in the peer-reviewed Journal of Asia-Pacific Biodiversity noting how species that aren’t officially regulated by CITES could be threatened by international trade for various purposes. “A lot of trade is not listed by CITES, and often these are low-profile species, not tigers or lions,” says Shepherd. (Read more: The vast majority of animals in the wildlife trade are not protected.)
Separate work has found that TCM, in particular, is a driver for such trade. One example Shepherd has studied is the tokay gecko a creature which may be dried and used to combat various maladies. “The tokay gecko is harvested from much of its range in Southeast Asia and sent to China where it is used in TCM by the millions,” he says. “This species is not yet on CITES but surely should be. Many other species of reptiles (snakes and lizards) are exported to China for use in TCM, however very little work has been done on this issue.” (Learn more about the trade in tokay geckos: How the international trade in geckos is a scam.)
TCM advocates counter that growth in traditional medicine practices need not harm vulnerable species. There’s never just one traditional treatment for any given malady, Huang says, and students of TCM are taught hundreds of different formulas.
More than two decades ago when the World Federation of Chinese Medicine Societies—the official group that dictates what can be used in traditional Chinese medicine—removed rhino horn and tiger bone from its list of products approved for use on patients, substitutes were available to treat the maladies rhino horn and tiger bone were targeting, Huang notes. (Recently, China lifted the ban on using those products for medical purposes but then quickly reinstated it, pending further research.)
Alternative options in TCM are often not a one-to-one substitution but instead a formula of various products. Take pangolin, which could be prescribed to reduce swelling or to disperse blood stasis. Depending on the diagnosis, 125 alternatives are available, says Steve Given, a California-based acupuncturist, TCM expert, and American College of Traditional Chinese Medicine dean involved in some of the WHO negotiations. Indeed, practitioners can find alternatives—and need to use them so these species do not go extinct, he says.
“Traditional practitioners such as myself in the United States have very successful, happy careers without ever endangering a species,” Given assures. And “many folks in the United States that use TCM are often likely to be vegetarians and don’t want to use any animals.” Instead of using antelope horn—traditionally used to curb tremors—alternative plant substances include Unicaria rhynchophylla (sometimes called cat’s claw herb because of its curled leaves) or an herb in the orchid family called Gastrodia elata, he says. And instead of using tiger bone—traditionally used to treat pain and strengthen ligaments and tendons—a variety of plant products can be substituted in, Given explains. For pain, one could use a plant in the mint family called Salvia miltiorrhiza (otherwise known as red sage) and to help strengthen tendons and ligaments, one could use a different plant in the mistletoe family called Sāng jì sheng (otherwise known as Taxillus chinensis Danser).
Conservationists and TCM advocates also agree that the responsibility to safeguard wildlife also extends to consumers themselves. People need to become informed about what cures they’re using and whether their status in the wild is satisfactory, says Thomas Lovejoy, a George Mason University professor and senior fellow at the United Nations Foundation who’s a leading proponent of biodiversity studies.
“This is a real concern because we’re in a world where we are running out of ecological resources,” he says. “What may have been a reasonable thing to do—say, using whatever animal or plant for traditional medicine—50 or 100 years ago may not be reasonable to do today.”