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WHO Traditional Medicine Strategy WHO Library Cataloguing-in-Publication Data WHO traditional medicine strategy: 2014-2023. 1.Medicine, Traditional. 2.Complementary therapies. 3.Health planning. 4.Delivery of health care. 5.Health policy. I.World Health Organization. ISBN 978 92 4 150609 0 (NLM classification: WB 55) © World Health Organization 2013 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased 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 non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/ copyright_form/en/index.html). 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 Hong Kong SAR, China 3 WHO Traditional Medicine Strategy Contents Acknowledgements..................................................................................... 5 Foreword .................................................................................................... 7 Acronyms used in this document................................................................. 9 Executive Summary.................................................................................... 11 1. Introduction..................................................................................... 15 2. Global progress................................................................................ 21 2.1 Policy and regulations......................................................................... 21 2.2 Practices....................................................................................... 22 2.3 Education and research................................................................. 22 3. Global review of T&CM.................................................................... 25 3.1 Continuing demand for T&CM products, practices and practitioners................................................................................ 25 3.2 Use of T&CM............................................................................... 26 3.3 Regulation of T&CM products, practices and practitioners........... 30 3.4 Universal health coverage and integration of T&CM.................... 35 3.5 Opportunities and challenges...................................................... 40 4. Strategic objectives, strategic directions and strategic actions... 43 4.1 Strategic objective 1: To build the knowledge base for active management of T&CM through appropriate national policies....... 44 4.2 Strategic objective 2: To strengthen the quality assurance, safety, proper use and effectiveness of T&CM by regulating products, practices and practitioners............................................................ 49 4.3 Strategic objective 3: To promote universal health coverage by integrating T&CM services into health care service delivery and self-health care............................................................................. 53 5. Implementing the strategy............................................................. 57 References................................................................................................. 59 Annex A – Selected examples of notable T&CM initiatives by region/country.......................................................................... 63 Annex B – Information on selected global T&CM professional organizations............................................................................. 68 Annex C – Selected WHO publications on T&CM....................................... 70

Eastern Healing
(630)653-4358
peter@easternhealing.org
A Fertile Soul Clinic
ACUPUNCTURE ENHANCES REPRODUCTIVE FUNCTION WORLDWIDE –
A HISTORICAL PERSPECTIVE

Chinese medicine has treated infertility for thousands of years in Eastern Cultures.
It wasn’t until the early 1990’s, however, that the World Health Organization of the
United Nations issued a statement that acupuncture was effective at treating infertility.
That statement was enough to encourage the world’s reproductive community to evaluate
the validity of this claim. Since that time, scientific studies are proving that acupuncture
has measurable effects on:

- Balancing hormones
- Reducing the sympathetic nervous system response
- Increasing blood flow to the reproductive organs
- Improving implantation and pregnancy rates
Some of the first controlled studies were conducted in Eastern countries,
evaluating the effect acupuncture had on reducing the sympathetic nervous system (fight
or flight) response. One study, published in 1991, evaluated the hand skin temperature as
the measurable variant. When acupuncture was performed at various points, the hand
temperature increased. This exciting finding was beginning to show that acupuncture had
some measurable effect of reducing the sympathetic nervous system’s contractile
function, increasing beta-endorphins, and moderating the release of GnRH from the
hypothalamus, and shifting the body’s emphasis toward the reproductive function.

ACUPUNCTURE & ELECTRO-THERAPEUTICS RES., Vol. 16, pp. 1-5, 1991 - Relationship
Between Blood Radioimmunoreactive Beta-Endorphin and Hand Skin Temperature During The
Electro-Acupuncture Induction of Ovulation, Chen Bo Ying M.D. Lecturer of Neurobiology,
Institute of Acupuncture Research, and Yu Jin, MD., Prof of Gynecology Obstetricus and
Gynecology Hospital Shanghai Medical University Shanghai, People's Republic of China
Abstract: Thirteen cycles of anovulation menstruation in 11 cases were treated with Electro-
Acupuncture (EA) ovulation induction. In 6 of these cycles which showed ovulation, the hand skin
temperature (HST) of these patients was increased after EA treatment. In the other 7 cycles
ovulation was not induced. There were no regular changes in HST of 5 normal subjects. The level
of radioimmunoreactive beta-endorphin (rß-E) fluctuated, and returned to the preacupunctural
level in 30 min. after withdrawal of needles in normal subjects. After EA, the level of blood rß-E in
cycles with ovulation declined or maintained the range of normal subjects. But the level of blood
rß-E and increase of HST after EA (r=-0.677, P <0.01). EA is able to regulate the function of the
hypothalamic pituitary-ovarian axis. Since a good response is usually accompanied with the
increase of HST, monitoring HST may provide a rough but simple method for prediciting the
curative effect of EA. The role of rß-E in the mechanism of EA ovulation induction was discussed.

In 1992, a four year study conducted by the Obstetrical & Gynecological
Hospital, Zhejiang Medical University, China, reported acupuncture’s measurable ability
to induce ovulation in cases where women who developed ovarian hyperstimulation
syndrome, and therefore could not safely be administered HCG for ovulation induction.

In 1996, a groundbreaking study from the University of Gothenburg, Sweden,
Department of Obstetrics and Gynecology, revealed that eight electroacupuncture
treatments significantly reduced the blood flow impedence of the uterine arteries, due to
central inhibition of sympathetic activity. This resulted in vasodilation in the uterine
arteries, improving the response to IVF medication.

Reduction of blood flow impedance in the uterine arteries of infertile women with
electro-acupuncture, Elisabet Stener-Victorin[1.4], Urban Waldenström[2], Sven A.
Andersson[3] and Matts Wikland[2]. [1]Department of Obstetrics and Gynaecology [2]Fertility
Centre Scandinavia. Department of Obstetrics and Gynaecology and [3]Department of
Physiology University of Gothenburg. S-413 45 Gothenburg, Sweden [4]To whom correspondence
should be addressed: Department of Obstetrics and Gynecology. Kvinnokliniken Sahlgrensh
sjukhuset, S- 413 45 Golhenburg, Sweden. Source: European Society for Human Reproduction
and Embryology

In order to assess whether electro-acupuncture (EA) can reduce a high uterine artery blood flow
impedance, 10 infertile but otherwise healthy women with a pulsatility index (PI) ≥3.0 in the
uterine arteries were treated with EA in a prospective, non-randomized study. Before inclusion in
the study and throughout the entire study period, the women were down-regulated with a
gonadotrophin-releasing hormone analogue (GnRHa) in order to exclude any fluctuating
endogenous hormone effects on the PI. The baseline PI was measured when the serum oestradiol
was ≤0.1 nmol/l, and thereafter the women were given EA eight times, twice a week for 4 weeks.
The PI was measured again closely after the eighth EA treatment, and once more 10-14 days after
the EA period. Skin temperature on the forehead (STFH) and in the lumbosacral area (STLS) was
measured during the first, fifth and eighth EA treatments. Compared to the mean baseline PI, the
mean PI was significantly reduced both shortly after the eighth EA treatment (P < 0.0001) and 10-
14 days after the EA period (P < 0.0001). STFH increased significantly during the EA treatments.
It is suggested that both of these effects are due to a central inhibition of the sympathetic activity.
In July of 2000, the Society of Reproduction, Inc., reported another Swedish study
in which a group of rats, injected with estradiol valerate developed polycystic ovaries,
associated with increased nerve growth factor, and increased ovarian weight. In the rats
that developed PCOs, electroacupuncture reduced the effects of the experimentally
induced polycystic ovaries. Those in the control group remained unchanged.
Effects of Electro-Acupuncture on Nerve Growth Factor and Ovarian Morphology in Rats with
Experimentally Induced Polycystic Ovaries1 Elisabet Stener-Victorin,[2,3] Thomas Lundeberg,[4]
Urban Waldenström,[3] Luigi Manni,[5] Luigi Aloe,[5] Stefan Gunnarsson,[6] and Per Olof
Janson[3] Department of Obstetrics and Gynecology,[3] Göteborg University, SE-413 45
Goteborg, Sweden Department of Physiology and Pharmacology,[4] Karolinska Institutet, SE-164
01 Stockholm, Sweden, Institute of Neurobiology (CNR),[5] Rome, Italy; Department of
Evolutionary Biology,[6] SE-752 36 Uppsala, Sweden

ABSTRACT: Despite extensive research on the pathogenesis of polycystic ovary syndrome
(PCOS), there is still disagreement on the underlying mechanisms. The rat model for
experimentally induced polycystic ovaries (PCO)--produced by a single injection of estradiol
valerate--has similarities with human PCOS, and both are associated with hyperactivity in the
sympathetic nervous system. Nerve growth factor (NGF) is known to serve as a neurotrophin for
both the sympathetic and the sensory nervous systems and to enhance the activity of
catecholaminergic and possibly other neuron types. Electro-acupuncture (EA) is known to reduce
hyperactivity in the sympathetic nervous system. For these reasons, the model was used in the
present study to investigate the effects of EA (12 treatments, approximately 25 min each, over 30
days) by analyzing NGF in the central nervous system and the endocrine organs, including the
ovaries. The main findings in the present study were first, that significantly higher concentrations
of NGF were found in the ovaries and the adrenal glands in the rats in the PCO model than in the
control rats that were only injected with the vehicle (oil or NaCI). Second, that repeated EA
treatments in PCO rats resulted in concentrations of NGF in the ovaries that were significantly
lower than those in non-EA-treated PCO rats but were within a normal range that did not differ
from those in the untreated oil and NaCI control groups. The results in the present study provide
support for the theory that EA inhibits hyperactivity in the sympathetic nervous system.
In the summer of 2000, a small prospective study published in the Medical
Acupuncture Journal reported that acupuncture may be a useful adjunct to gonadotropin
therapy to produce follicles in women undergoing in vitro fertilization.
Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection Sandra
L. Emmons, MD Phillip Patton, MD: Medical Acupuncture, A Journal For Physicians By Physicians
Spring / Summer 2000- Volume 12 / Number 2 ABSTRACT Background Little information exists
regarding the use of acupuncture in combination with allopathic treatment of infertility. Objective
To describe the use of acupuncture to stimulate follicle development in women undergoing in vitro
fertilization. Design, Setting, and Patients Prospective case series of 6 women receiving
intracytoplasmic sperm injection and acupuncture along with agents for ovarian stimulation. Main
Outcome Measures Number of follicles retrieved, conception, and pregnancy past the 1st trimester
before and after acupuncture treatment. Results No pregnancies occurred in the non-acupuncture
cycles. Three women produced more follicles with acupuncture treatment (mean, 11.3 vs 3.9 prior to
acupuncture; P=.005). All 3 women conceived, but only 1 pregnancy lasted past the 1st trimester.
Conclusion Acupuncture may be a useful adjunct to gonadotropin therapy to produce follicles in
women undergoing in vitro fertilization.

In one of the most publicized studies on acupuncture and fertility, published by
the ASRM in April 2002, acupuncture used 25 minutes before and 25 minutes after fetal
embryo transfer dramatically improved pregnancy rates. Patients in this study were
controlled for age, previous cycles, diagnostic criteria for infertility, endometrial
thickness, pulsatility index of uterine arteries. Still, acupuncture rates were dramatically
higher for the acupuncture group (42.5%) vs. the non-acupuncture group (26/3%).
FERTILITY AND STERILITY® VOL. 77, NO. 4, APRIL 2002 ©2002 American Society for
Reproductive Medicine Wolfgang E. Paulus, M.D.,[a] Mingmin Zhang, M.D.,[b] Erwin Strehler,
M.D.,[a] Imam El-Danasouri, Ph.D.,[a] and Karl Sterzik, M.D.[a]
Objective: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction
therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before
and after embryo transfer with a control group receiving no acupuncture. Design: Prospective
randomized study. Setting: Fertility center. Patient(s): After giving informed consent, 160 patients
who were undergoing ART and who had good quality embryos were divided into the following two
groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer
without acupuncture (n = 80).
Intervention(s): Acupuncture was performed in 80 patients 25 minutes before and after embryo
transfer. In the control group, embryos were transferred without any supportive therapy.
Main Outcome Measure(s): Clinical pregnancy was defined as the presence of a fetal sac during
an ultrasound examination 6 weeks after embryo transfer.
Result(s): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture
group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.
Conclusion(s): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

In December of the same year, Cornell published a retrospective study of the
literature, reporting that acupuncture seems to be able to: normalize function of the HPO
axis; increase peripheral vascularization, and reduce the body’s response to stress.
Role of acupuncture in the treatment of female infertility Raymond Chang, M.D.[a,b] Pak H.
Chung, M.D.[b] and Zev Rosenwaks, M.D.[c] The Institute of East-West Medicine and the Center
for Reproductive Medicine and Infertility, Weill Medical College of Cornell University, New York,
New York. Received June 24, 2002; revised and accepted July 19, 2002. Reprint requests: Pak H.
Chung, M.D., The Center for Reproductive Medicine and Infertility, Weill Medical College of
Cornell University [a]The Institute of East-West Medicine. [b]The Department of Internal Medicine,
Weill Medical College of Cornell Unversity. [c]The Center for Reproductive Medicine and
Infertility.

Objective: To review existing scientific rationale and clinical data in the utilization of acupuncture
in the treatment of female infertility. Design: A MEDLINE computer search was performed to
identify relevant articles. Result(s): Although the understanding of acupuncture is based on ancient
medical theory, studies have suggested that certain effects of acupuncture are mediated through
endogenous opioid peptides in the central nervous system, particularly ß-endorphin. Because these
neuropeptides influence gonadotropin secretion through their action on GnRH, it is logical to
hypothesize that acupuncture may impact on the menstrual cycle through these neuropeptides.
Although studies of adequate design, sample size, and appropriate control on the use of acupuncture
on ovulation induction are lacking, there is only one prospective randomized controlled study
examining the efficacy of acupuncture in patients undergoing IVF. Besides its central effect, the
sympathoinhibitory effects of acupuncture may impact on uterine blood flow. Conclusion(s):
Although the definitive role of acupuncture in the treatment of female infertility is yet to be
established, its potential impact centrally on the hypothalamic-pituitary-ovarian axis and
peripherally on the uterus needs to be systemically examined. Prospective randomized controlled
studies are needed to evaluate the efficacy of acupuncture in the female fertility treatment. (Fertil
Steril® 2002;78:1149-53. ©2002 by ASRM.)

September 2005 – a single blind, randomized, controlled trial using sham
acupuncture conducted by the University of South Astrialia, reported these results: Two
hundred twenty-eight subjects were randomized. The pregnancy rate was 31% in the
acupuncture group and 23% in the control group. For those subjects receiving
acupuncture, the odds of achieving a pregnancy were 1.5 higher than for the control
group. The ongoing pregnancy rate at 18 weeks was higher in the treatment group (28%
vs. 18%).

In 2006 the ASRM’s Fertility & Sterility Journal reported a prospective,
ramdomized trial performed in Denmark, entitled: Acupuncture on the day of embryo
transfer significantly improves the reproductive outcome in infertile women, concluding
Acupuncture on the day of ET significantly improves the reproductive outcome of
IVF/ICSI, compared with no acupuncture.
Again the same year, Fertility & Sterility 2006 published a randomized,
prospective, controlled clinical study jointly conducted in Germany and China, reporting
that pregnancy rates were significantly higher when acupuncture was employed during
the luteal phase after IVF/ICSI:

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm
injection: a randomized, prospective, controlled clinical study. Stefan Dieterle, M.D.,a Gao Ying,
M.D.,a,b Wolfgang Hatzmann, M.D.,a and Andreas Neuer, M.D.a Division of Reproductive
Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/
Herdecke, Dortmund, Germany; and b Department of Obstetrics and Gynecology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Objective: To determine the effect of luteal-phase acupuncture on the outcome of
IVF/intracytoplasmic sperm injection (ICSI). Design: Randomized, prospective, controlled clinical
study. Setting: University IVF center. Patient(s): Two hundred twenty-five infertile patients
undergoing IVF/ICSI. Intervention(s): In group I, 116 patients received luteal-phase acupuncture
according to the principles of traditional Chinese medicine. In group II, 109 patients received
placebo acupuncture. Main Outcome Measure(s): Clinical and ongoing pregnancy rates.
Result(s): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%,
respectively) were significantly higher than in group II (15.6% and 13.8%).

Conclusion(s): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI. (Fertil
Steril ©2006 by American Society for Reproductive Medicine.)

In 2007, the Journal of Neuroendocrinology published a favorable study on clinical
evidence in the use of acupuncture to treat PCOS:
This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and
evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is
the most common female endocrine disorder and it is strongly associated with hyperandrogenism,
ovulatory dysfunction and obesity. PCOS increases the risk for metabolic disturbances such
as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension
and an increased likelihood of developing cardiovascular risk factors and impaired mental health
later in life. Despite extensive research, little is known about the aetiology of PCOS. The syndrome
is associated with peripheral and central factors that influence sympathetic nerve activity.

Thus, the sympathetic nervous system may be an important factor in the development and
maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological
approaches are effective but have adverse effects. Therefore, nonpharmacological treatment
strategies need to be evaluated. Clearly, acupuncture can affect PCOS via modulation of
endogenous regulatory systems, including the sympathetic nervous system, the endocrine and
the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic
ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert
long-lasting beneficial effects on metabolic and endocrine systems and ovulation.
Fertility & Sterility, July 2008 reported on the positive role of acupuncture in the
management of subfertility, ovulation induction, enhanced blood flow, increased sperm
motility, and stress reduction
.
Ernest Hung Yu Ng, M.D., Wing Sze So, B.Sc., Jing Gao, B.Sc., Yu Yeuk Wong, M.D. and Pak Chung
Ho, M.D. Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
Special Administrative Region, People’s Republic of China Objective: To review systematically the
use of acupuncture in the management of subfertility. Design: A computer search was performed via
several English and Chinese databases to identify journals relevant to the subject. Result(s): The
positive effect of acupuncture in the treatment of subfertility may be related to the central
sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and
stress reduction. Acupuncture may help restore ovulation in patients with polycystic ovary
syndrome, although there are not enough randomized studies to validate this. There is also no
sufficient evidence supporting the role of acupuncture in male subfertility, as most of the studies are
uncontrolled case reports or case series in which the sample sizes were small. Despite these
deficiencies, acupuncture can be considered as an effective alternative for pain relief during oocyte
retrieval in patients who cannot tolerate side effects of conscious sedation. The pregnancy rate of
IVF treatment is significantly increased, especially when acupuncture is administered on the day of
embryo transfer. Conclusion(s): Although acupuncture has gained increasing popularity in the
management of subfertility, its effectiveness has remained controversial. (Fertil Steril 2008;90:1–13
ASRM.)
To date, it appears that although almost every single study conducted over the last
twenty years around the world demonstrates improved reproductive function,
acupuncture remains controversial as an accepted treatment. Because Chinese medicine is
not meant to be randomized or controlled, perhaps it can be concluded that although
acupuncture has been demonstrated to improve overall fertility and pregnancy rates,
acupuncture does not conform well to scientific measurement.

Agopuntura e Organizzazione Mondiale della Sanita

:: Themes & Keywords

Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials

(2003; 87 pages) 

Table of Contents

Acknowledgements Introduction 1. General considerations 2. Review of clinical trial reports 2.1. Pain 2.1.1. Head and face 2.1.2. Locomotor system 2.1.3. Gout 2.1.4. Biliary and renal colic 2.1.5. Traumatic or postoperative pain 2.1.6. Dentistry 2.1.7. Childbirth 2.1.8. Surgery 2.2. Infections 2.3. Neurological disorders 2.4. Respiratory disorders 2.5. Digestive disorders 2.6. Blood disorders 2.7. Urogenital disorders 2.8. Gynaecological and obstetric disorders 2.9. Cardiovascular disorders 2.10. Psychiatric disorders and mental disturbances 2.11. Paediatric disorders 2.12. Disorders of the sense organs 2.13. Skin diseases 2.14. Cancers 2.15. Other reports 3. Diseases and disorders that can be treated with acupuncture 4. Summary table of controlled clinical trials References