Ayurveda, the traditional Indian medicine (TIM) and traditional Chinese medicine (TCM) remain the most ancient

yet living traditions. There has been increased global interest in traditional medicine. Efforts to monitor and regulate
herbal drugs and traditional medicine are underway. China has been successful in promoting its therapies with more
research and science-based approach, while Ayurveda still needs more extensive scientific research and evidence
base. This review gives an overview of basic principles and commonalities of TIM and TCM and discusses key
determinants of success, which these great traditions need to address to compete in global markets.

Introduction
Ayurveda, the traditional Indian medicine (TIM) and traditional Chinese medicine (TCM) remain the most ancient
yet living traditions. These are the two ‘great traditions’ with sound philosophical, experiential and experimental
basis. Increased side effects, lack of curative treatment for several chronic diseases, high cost of new drugs,
microbial resistance and emerging diseases are some reasons for renewed public interest in complementary and
alternative medicines (1). It has been postulated that by 2010 at least two-thirds of the United States population will
be using one or more of the alternative therapeutic approaches. Use of indigenous drugs of natural origin forms a
major part of such therapies; more than 1500 herbals are sold as dietary supplements or ethnic traditional medicines
(2). Pharmaceutical companies have renewed their strategies in favor of natural product drug development and
discovery (3). For instance, in Europe, AnalytiCon Discovery has stressed on drug discovery based on natural
product chemistry (4). In the Asia-Pacific region, MerLion Pharmaceuticals in Singapore has comprehensive
structures and capabilities necessary for natural productbased drug discovery (5). China has successfully promoted
its own therapies over the globe with a science-based approach. Growing popularity of TCM can be evidenced by
the rapid increase in number of licensed Chinese medicine providers in the United States. The Chinese government
has pledged to create several export-oriented TCM giants in the coming years (6). Continuous efforts in promotion
of the indigenous therapies by China have put TCM in a commendable position. Global acceptance of Ayurveda is
gearing up and there has been a steep rise in the demand for medicinal plants from India (7). The Pharmaceutical
Research and Development Committee report of Ministry of Chemicals, Government of India also underscores the
importance of traditional knowledge. The increasing use of traditional therapies demands more scientifically sound
evidence for the principles behind therapies and for effectiveness of medicines. Recent advancements in the
analytical and biological sciences, along with innovations in genomics and proteomics can play an important role in
validation of these therapies. Western scientific community views traditional medicines cautiously and stress the
concerns related to research, development and quality. This review delineates the challenges that TCM and TIM
need to address to become more acceptable to the world community.

The global pharmaceutical market was worth US $550 billionin 2004 (11) and is expected to exceed US $900 billion
by the year 2008. The herbal industry shares about US $62 billion with good growth potential. The World Bank
reports trade in medicinal plants, botanical drug products and raw materials is growing at an annual growth rate
between 5 and 15%. Within the European community, botanical medicine represents an important share of the
pharmaceutical market (13); the nutraceutical sector is also growing rapidly. In 2001, US $17.8 billion was spent in
the United States on dietary supplements, US $4.2 billion of it for botanical remedies (14). In
India the value of botanicals related trade is about US $10 billion per annum with annual export of US $1.1 billion
while China’s annual herbal drug production is worth US $48 billion with export of US $3.6 billion (16). Presently,
the United States is the largest market for Indian botanical products accounting for about 50% of the total exports.
Japan, Hong Kong, Korea and Singapore are the major importer of TCM taking 66% share of China’s botanical
drugs export (17). Globally, there have been concerted efforts to monitor quality and regulate the growing business
of herbal drugs and traditional medicine. Health authorities and governments of various nations have taken an active
interest in providing standardized botanical medications. United States Congress has fuelled rapid growth in the
nutraceutical market with passage of the Dietary Supplement Health and Education Act in 1994. US Food and Drug
Administration (FDA) has recently published the International Conference on Harmonization guidance Common
Technical Document addressing concerns related to quality of medicines that also includes herbals (18). The
National Center for Complementary and Alternative Medicine has been inaugurated as the United States Federal
Government’s lead agency for scientific research in this arena of medicine. Its mission is to explore complementary
and alternative healing practices in the context of rigorous science, support sophisticated research, train researchers,
disseminate information to the public on the modalities that work and explain the scientific rationale underlying
discoveries. The center is committed to explore and fund all such therapies for which there is sufficient preliminary
data, compelling public health need and ethical justifications (19,20). World Health Organization (WHO) is keen
regarding traditional medicine and has been active in creating strategies, guidelines and standards of botanical
medicines (21). The global scenario illustrates vividly both promise and challenges presented by the traditional
medicines. India needs to identify the extent to which Ayurvedic therapeutics is safe and effective so that it could
get wide global acceptance.

Basic Principles: TIM and TCM

Ayurveda and TCM have many commonalities. The focus of both the systems is on the patient rather than disease.
Both systems fundamentally aim to promote health and enhance the quality of life, with therapeutic strategies for
treatment of specific diseases or symptoms in holistic fashion. Almost half of the botanical sources used as
medicines have similarities; moreover, both systems have similar philosophies geared towards enabling
classification of individuals, materials and diseases. TCM considers the human at the center of the universe as an
antenna between celestial and earthly elements. Water, earth, metal, wood and fire are the five elements of the
material world. The world is a single unit and its movement gives rise to yin and yang, the two main antithetic
aspects. The actual meaning of the term yin and yang is ‘opposites’, such as the positive and the negative. However,
Chinese believe that yin and yang is not absolute but relative. Consistent with the modern view of homeostasis, yin
and yang are interchanged to meet the view that ‘yang declines and yin rises’ or ‘yang is raised to produce a decline
of yin’. The four bodily humors (qi, blood, moisture and essence) and internal organ systems (zang fu) play an
important role in balancing the yin and yang in human body. Proper formation, maintenance and circulation of these
energies are essential for health. When the two energies fall out of harmony, disease develops. The physician takes
into account this concept while treating patients. Drugs or herbs are used to correct this imbalance of yin–yang in the
human body (22,23).

Ayurveda considers that the universe is made up of combinations of the five elements (pancha mahabhutas). These
are akasha (ether), vayu (air), teja (fire), aap (water) and prithvi (earth). The five elements can be seen to exist in the
material universe at all scales of life and in both organic and inorganic things. In biological system, such as humans,
elements are coded into three forces, which govern all life processes. These three forces (kapha, pitta and vata) are
known as the three doshas or simply the tridosha. Each of the doshas is composed of one or two elements. Vata is
composed of space and air, Pitta of fire, and kapha of water and earth. Vata dosha has the mobility and quickness of
space and air; pitta dosha the metabolic qualities of fire; kapha dosha the stability and solidity of water and earth.
The tridosha regulates every physiological and psychological process in the living organism. The interplay among
them determines the qualities and conditions of the individual. A harmonious state of the three doshas creates
balance and health; an imbalance, which might be an excess (vriddhi) or deficiency (kshaya), manifests as a sign or
symptom of disease (24,25) (Figs 1 and 2).

Kampo
Kampo medicine differs from TCM in many respects.5 Although TCM derives its theories mainly from the Huangdi
Neijing ( ), Shennong Bencao Jing ( ), and Shan Hang Lung ( ) medical texts, all of which were written during the
Han Dynasty, these theories were expanded broadly. As mentioned above, Japan decided to follow the Shan Hang
Lung ( ) faithfully. Thus, although many of the original features of TCM and Kampo were the same, the two forms
of medicine have diverged more and more over the years, especially after World War II. In China, TCM was molded
and regulated by the government after the People’s Republic of China was founded. There are three major
differences between TCM and Kampo. First, TCM prescription is individualized at the herbal level, while Kampo
medicine is individualized at the formula level; second, the prescription pattern is simplified in Kampo medicine;
and third, abdominal findings are important for making diagnoses in Kampo medicine. Although abdominal
diagnosis was described in the Shan Hang Lung ( ), it is not valued in Chinese and Korean traditional medicine. In
Japan, abdominal diagnosis was uniquely developed and used widely.

Because the Meiji Government adopted a onelicense system for medical practitioners in Japan, there is no separate
medical license for traditional medicine in Japan. This differentiates Kampo from the use of traditional medicine in
China and Korea, where there are two distinct licenses. Only Western-style physicians are allowed to prescribe
Kampo drugs, and currently more than 70% of Japanese physicians (including nearly 100% of Japanese Ob/Gyns)
use Kampo medicine in daily practice, even in university hospitals, together with high-tech medical treatments such
as organ transplantation and robotic operations. Most practitioners use extract formulas. Kampo medicines are
government-regulated prescription drugs and currently 148 formulas are listed under the Japanese insurance
program. Kampo practitioners are also able to use decoction, selecting several herbs from among 243 kinds of herbs
available under the insurance system.8 In 2001, the Ministry of Education, Culture, Sports, Science and Technology
decided to incorporate Kampo medical education into the core curriculum of medical schools. Although a national
survey in 1998 reported that only 18 Japanese medical schools had either elective or required classes on Kampo
medicine,9 currently all 80 medical schools provide Kampo medical education.

Today in Japan, prescription of Kampo formulaeis limited to medical doctors. Physicians with profound understanding
of both conventional and Kampo medicine diagnose and treat patients from the two different approaches, bringing
significant benefit to patients. 􀠉Today in Japan, prescription of Kampo formulae is limited to medical doctors.
Physicians with profound understanding of both conventional and Kampo medicine diagnose and treat patients from
the two different approaches, bringing significant benefit to patients.

Traditional Chinese medicine (TCM), one of the oldest continuously surviving traditions, originated as a means of maintaining
good health and treating diseases in Chinese communities and has been adopted recently by other ethnic groups worldwide. 2
TCM is a complete system of healing that developed in China about 3000 years ago and reached a coherent, codified form about
2000 years ago. It includes herbal medicine, acupuncture, moxibustion and massage, etc. In recent decades, the use of TCM has
become more popular in its own right and also as a complement to Western medicine throughout the world.3 TCM has been
adopted in modified form in Far Eastern countries, such as Korea and Japan. 4 Traditional Japanese medicine has been used for
1500 years and includes Kampo, acupuncture and acupressure (Shiatsu). The word ‘Kampo’ (also written ‘Kanpo’) refers to the
herbal system used in China that developed during the Han dynasty (between 206 BC and AD 220); today the word is also used to
describe a unique system of Japanese herbal medicine. Kampo is widely practiced in Japan, where it is fully integrated into the
modern health-care system. Throughout the history of TCM and Kampo, the basic theories and the methods of diagnosis and
treatment have differed considerably from those of Western medicine. Western medicine uses diseasebased diagnosis, while
TCM and Kampo emphasize patient-based diagnosis. Kampo is based on TCM but is adapted to Japanese culture. It can be
characterized as a simplified, positivistic and pragmatic version of Chinese herbal medicine. 5 The process of diagnosis and
treatment differs between TCM and Kampo. In TCM the treatment is according to the differential diagnosis, whereas Kampo
uses a treatment ‘formulation corresponding to Sho’; Sho is the patient’s symptoms at a given moment. In this paper we review
these two forms of traditional medicine.

Traditional Japanese medicine has been used for 1500 years and includes Kampo, acupuncture and acupressure (Shiatsu). The
word ‘Kampo’ (also written ‘Kanpo’) refers to the herbal system used in China that developed during the Han dynasty (between
206 BC and AD 220); today the word is also used to describe a unique system of Japanese herbal medicine. Kampo is widely
practiced in Japan, where it is fully integrated into the modern health-care system. Throughout the history of TCM and
Kampo, the basic theories and the methods of diagnosis and treatment have differed considerably from those of Western
medicine. Western medicine uses diseasebased diagnosis, while TCM and Kampo emphasize patient-based diagnosis. Kampo is
based on TCM but is adapted to Japanese culture. It can be characterized as a simplified, positivistic and pragmatic version of
Chinese herbal medicine.5 The process of diagnosis and treatment differs between TCM and Kampo. In TCM the treatment is
according to the differential diagnosis, whereas Kampo uses a treatment ‘formulation corresponding to Sho’; Sho is the patient’s
symptoms at a given moment. In this paper we review these two forms of traditional medicine.

Doctors of Unani medicine can visualize the stateof a patient’s subtle body (jism al-latīf) properlonly through the
eye of the heart (ayn al-qalb), wherein the flowing, dynamic streams of humors lie. The doctor (hakīm) enlivens the
patient’s self-healing power or vital force (the vis medicatrix naturae), at the level of the subtle body to move him or
her toward health and wellness. A particular organizing principle of the hidden physiology of the subtle body (al
quwwa al-mudabbirah) effects a harmonizing reaction in the face of disease or illness. One can perceive the vis
medicatrix naturae as the thread that holds together the fabric of the human body, mind, and soul in close
collaboration with the spirit. Unani medicine posits the general medical theory of the healing power of nature as a
guiding principle upon which it builds more complex, specific understandings of human health and disease. Various
medical systems around the world offer their own understandings of the primary and essential functional
components that cause health to reign or disease to take root, progress, and finally show itself in constellations of
signs and symptoms of illness. Chinese medicine promotes physiologic concepts such as qi, blood, yin, and yang. In
conventional medicine, key concepts relating to body tissues and fluid dynamics dominate the understanding of
physiology.
Unani medicine’s key concepts fall under the strict heading of the principles of natural physiology (umūr al-tabī
‫ء‬iyyah), and they comprise seven natural components, forming the Doctrine of the Seven Naturals. These
components make up the basic knowledge required to understand the physiological systems that determine health or
disease. These components include (1) elements (arkān), (2) temperaments (mizāj), (3) humors (akhlāt), (4) organs
(a ‫ء‬dā’), (5) forces, drives, faculties, or powers Iquwwāt), (6) actions or functions (af ‫ء‬āl), and (7) pneumaor spirit
substance (rūh).

According to Unani medicine, health is considered as a state of body with humors in equilibrium and body
functions normal. Health is based on six essential elements: 1. Air 2. Drinks and food 3. Sleep and wakefulness 4.
Excretion and retention 5. Physical activity and repose 6. Mental activity and repose. This theory is indirectly
having partial similarity with the accepted definition of health as a state of physical, mental and social wellness.
Unani system of medicine addresses homeostasis of the body that depends on balance of the four humours and
disturbance in six essential factor such as atmospheric air, diet, sleep and wakefulness, elimination and retention,
mobility, psychological condition will become a cause of the disease. Understanding these doctrines to find the
cause is the key of treatment. Hence, the practical science is based on the fundamental principles rooted in the
oldest classical texts of Unani medicine. [3,14]

According to Unani medicine, health is considered as a state of body with humors in equilibrium and body
functions normal. Health is based on six essential elements: 1. Air 2. Drinks and food 3. Sleep and wakefulness 4.
Excretion and retention 5. Physical activity and repose 6. Mental activity and repose. This theory is indirectly
having partial similarity with the accepted definition of health as a state of physical, mental and social wellness.
Unani system of medicine addresses homeostasis of the body that depends on balance of the four humours and
disturbance in six essential factor such as atmospheric air, diet, sleep and wakefulness, elimination and retention,
mobility, psychological condition will become a cause of the disease. Understanding these doctrines to find the
cause is the key of treatment. Hence, the practical science is based on the fundamental principles rooted in the
oldest classical texts of Unani medicine. [3,14]