Traditional medicine wins the global recognition of policies | Think global health

meIn March 2024, researchers, policy makers and other experts from more than 40 countries met in India to map out a roadmap for the World Health Organization (WHO) World Center for Traditional Medicine.

This initiative aims to bring together knowledge about the world’s many traditional medicine systems and apply this knowledge to improve global health and sustainable development. The meeting built on the success of the inaugural WHO World Summit on Traditional Medicine, held in August 2023, also in India, which culminated in the first WHO declaration focusing on traditional medicine

For Kenji Watanabe, a traditional medicine practitioner in Japan, the two meetings also marked a rewarding personal victory that he has been working on since 2005.

Watanabe studied Western medicine at Keio University in Tokyo and then moved to Stanford University to conduct postdoctoral research in immunology. But he always knew his interest was primarily in kampo, a type of traditional herbal medicine practiced in Japan. After Watanabe returned to Japan from the United States, he undertook further training to learn kampo. He became a professor at Keio University and director of its Kampo Medicine Center.

In 2005, Watanabe began chairing the traditional medicine unit of the World Health Organization’s International Classification of Diseases (ICD), a global medical platform that provides health reports on causes, scope and consequences of death and disease. In 2022, Watanabe’s efforts resulted in the inclusion of traditional East Asian medicine in the ICDa, a first for traditional medicine since the platform was established more than 10 years ago. This moment was a major victory in ensuring that international public health efforts took into account more than a narrow Western perspective on medicine and disease.

Watanabe retired from his chair in 2023, but as director of the Otsuka Kampo Clinic in Tokyo he continues to see patients. He is also an advisor to the president of Yokohama University School of Pharmacy.

Think global health: You have built a career around kampos research and administration. Can you tell me more about this traditional medicine system?

Kenji Watanabe: Kampo originated about 2,000 years ago. It came from China and was transmitted to Japan in the 5th century. Since then, it has become distinctly Japanese. The definition of traditional medicine by the WHO is medicine that was developed only in a certain region, so we must respect regional differences.

Think global health: Are the herbs used in China and Japan the same?

Kenji Watanabe: Some are native to Japan, but most come from China because we follow the ancient Chinese textbook. Today, about 80% of the herbs used in kampo are imported to Japan from China. It wasn’t always like that, though. Diplomatic interactions between China and Japan only resumed in 1972. Before that, we did not have an official relationship. Fewer types of herbs were available.

A worker prepares traditional Chinese medicinal herbs at Capital Medical University Beijing Traditional Chinese Medicine Hospital in Beijing, China on May 25, 2011.
REUTERS/David Gray

Think global health: Does kampo use specific methods different from other healing modalities in East Asia?

Kenji Watanabe: A feature of the kampo is fukushin, or abdominal diagnosis.

Sometimes Korean or Chinese medical professionals come to Japan to study it. It is unique in Kampo, its history goes back to the beginning of the 15th century. It is a useful method for making a diagnosis and helping with treatment decisions. For example, several articles show long-term effectiveness for COVID. Abdominal pulsations detected using fukushin can help determine the quality of the vagus system.

Think global health: How does the philosophy of the kampo approach differ from that of Western medicine?

Kenji Watanabe: When I was an endocrinologist, I saw patients who had diabetes and thyroid disease. I did not see any patients, however, who had pain in the knee joints or headaches. Western medicine is specialized, and doctors sometimes see patients not as individuals but as their disease. I think it’s a big problem in the modern western medical system.

Kampo, on the other hand, is a holistic medical system for treating the whole patient. It is a one-stop shop system. The patients I see are variable. They may have cancer, vertigo, gastric problems or autoimmune or neurodegenerative diseases. Sometimes it is not possible to provide cures, but we can provide care for patients while they receive other treatments, including Western medicine.

In Japan, we have a well-developed integration between traditional kampo medicine and Western medicine. Unlike China or Korea, we only have one medical license. Thus, almost 90% of general practitioners in Japan use kampo.

Think global health: Have you done any research on kampo from a western scientific lens or any other kind of lens?

Kenji Watanabe: In fact, the measurements are always western because it is established and authorized. Articles on kampo accessible on PubMed, many of which show effective results, number in the thousands.

For example, I conducted a five-year open-label study that tested the use of goshajinkigan, a multi-herb formula, to treat complications of type 2 diabetes mellitus. Numbness and new neural complications were lower in the treatment group, but we found no difference between groups for kidney disease or retinal damage. So some results were good, but some were not. This is common in these studies.

More important than any specific treatment is the ancient idea behind many traditional medicine systems of humans and nature living together

Think global health: Can you tell me about your efforts to include kampo and other forms of traditional medicine in the WHO ICD?

Kenji Watanabe: The ICD began around 1900 as a global health reporting system. At that time, however, the word “world” meant only European and other Western countries. All thinking was European-centric, so the classification system did not take traditional medicine into account at all.

That started to change in 2005. It was a long, long journey. First, the WHO Western Pacific Regional Office in Manila, which includes 37 member states in the area, initiated a project that attempted to classify traditional medicine diagnoses. I was appointed chairman of this project.

In 2009, the project was taken over by WHO headquarters in Geneva. Later that year, WHO organized a meeting in Hong Kong and invited experts from all kinds of traditional medicine modalities from around the world to discuss the issue. In 2010, the WHO officially established the goal of including traditional Asian medicine in the ICD, and I was appointed co-chair of the project.

From the beginning we faced two major challenges. First, some Western medical specialists and government officials disliked traditional medicine. They saw it as a myth, not as science or medicine. These conservative people strongly opposed including a traditional medicine chapter in the ICD. It was not only my efforts that helped overcome this, but also the efforts of WHO as a whole. WHO officials were very keen to include traditional medicine in the ICD and persuaded the naysayers to comply.

The second challenge was to harmonize the philosophies and different prescriptions and vocabularies of China, Korea and Japan to create the ICD chapter. These respective medical modalities are approximately 90% similar. The challenge was how to agree on the 10% difference. In the discussions, China, of course, wanted to dominate, and Korea also tried to emphasize that its medicine is the best. At one important meeting, however, I said to everyone, “Yes, we can fight for these 10% differences, but at the same time, we will lose a great opportunity to be included in mainstream medicine.”

They listened to us and we became a good team. This was in part thanks to several rules we established early on. The first thing was that we fixed the membership list, because if new members of the government came in, for example, they would immediately want to dominate with their views. The second was that we should first decide on our basic principles and then discuss the details. The third was that once something was decided, we would never go back. Otherwise, the same arguments would be repeated over and over again.

East Asian traditional medicine was finally introduced in the eleventh version of the ICD, which came into effect in 2022. Even very recently, no one imagined that traditional medicine would ever be included in the ICD. So I was especially proud and happy.

Think global health: Besides the personal satisfaction of achieving this goal, why was this such a significant victory?

Kenji Watanabe: Traditional medicine cannot be ignored. More important than any specific treatment is the ancient idea behind many traditional medicine systems of humans and nature living together. We should relearn this wisdom now. Otherwise, we will lose a lot in the future.

Niiwa Anzai packs shiitake mushrooms at the Anzai family farm near Fukushima, Japan on April 5, 2011.
REUTERS/Carlos Barria

Rachel Nuwer is a freelance science journalist and author who regularly contributes to the New York Times, Scientific American, Nature, and more.

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