The Herbal Divide: Why Asia embraces traditional medicine, while the West holds back

BY Mark Adams, CEO of CMC Hospital Dubai

As Western healthcare systems continue to encourage populations to adopt healthier lifestyles and become more health-conscious, it’s perhaps understandable that those same populations should look beyond Western medicine to see how other products might complement a renewed focus on healthy living, well-being, and disease prevention.

Herbal medicine (HM) has been around for centuries and is still the primary go-to treatment in many cultures. In Japan, its importance is such that Japanese Kampo-yaku medicine is completely integrated into mainstream medicine, with over 70% of physicians routinely prescribing it. In China, an overwhelming majority of Western-medicine hospitals offer Chinese herbal medicine (CHM) treatments.

Often referred to in the West as ‘alternative medicine,’ that term can itself be misleading, given that many of the medicines we rely on in orthodox pharmaceuticals have their origins in the extraction of active plant ingredients. Many will be familiar with the story behind the malaria drug artemisinin, developed from an active compound found in sweet wormwood, after a research team in the 1970s turned to traditional Chinese herbal medicine for clues on how intermittent fever was treated. Today, artemisinin is prescribed as a first- and second-line treatment for malaria.

It’s also worth remembering that, although successfully synthesised in the late nineteenth century, aspirin was derived from willow bark to treat pain and inflammation, and it had been in use 3,500 years earlier among the Egyptians. And Tamiflu, an antiviral medication for influenza, is derived from an acid drawn from star anise.

First used in Europe in the 1700s to treat gout, colchicine was extracted from the autumn crocus, a purple flower native to Europe. It is used today as a precision anti-inflammatory drug to treat rare genetic diseases and cardiovascular conditions, as well as its original use in the treatment of gout.

In fact, the World Health Organization estimates that around 40% of modern drugs draw heavily from nature and traditional medicine, and it recognises herbal medicine as “an essential component of primary healthcare.”

As preventive medicine becomes ever more important for the health of today’s populations, are modern Western healthcare systems missing a trick by not incorporating herbal medicine more fully into their treatment options?

Herbal medicine today: where are we?

Herbal medicine has no shortage of advocates in the Middle East or the West, and a variety of influences across different cultures has driven its current market size. Twenty-first-century Western societies have shown increasing distrust of modern synthetic pharmaceuticals due to excessive or unpleasant side effects, while also registering growing consumer preferences for holistic and organic herbal remedies to prevent, treat, or mitigate chronic disease, sleep disturbance, and stress, as well as to promote body-and-mind well-being. And given the widespread use of dietary supplements to counter the imbalance in our modern diets—from vitamin D and vitamin B12 to heavy-metal supplements such as zinc, iron, and magnesium—populations that are already taking complementary dietary supplements or treatments are naturally predisposed to try alternative remedies that are seen and marketed as natural or organic.

Meanwhile, traditional Chinese herbal medicine (CHM) continues to make inroads in Western cultures where modern pharmaceuticals are ineffective for some. For example, CHM has proved effective for patients suffering migraines, and clinical trials in China demonstrate improvements in the frequency and severity of migraine attacks after taking commonly used herbs.

In Middle Eastern countries, where information on clinical trials of herbal medicine is at best patchy, complementary or alternative medicine is nevertheless popular. In Saudi Arabia, even though the government currently excludes the costs of all alternative medicines from its largely free medical cover, various studies reveal that somewhere between 60% and 75% of KSA residents take alternative medicine, with herbal remedies the most commonly used.

Herbal medicine forms an important part of Emirati heritage and culture, with widespread use and high levels of trust in its efficacy amongst Emiratis. So far, its integration into our mainstream modern healthcare system has been limited to just one or two primary healthcare centres, but the government is actively looking at ways to promote further integration, and the formation earlier this year of the UAE Council for Integrative Medicine will look at ways of “combining modern medical practices, traditional healing, and complementary therapies.”

The popularity of herbal medicine seems to be driven not simply by culture or a distrust of modern synthetic pharmaceuticals alone—the high incidence of chronic lifestyle diseases like obesity and diabetes is actively driving demand. This is because sufferers are looking for additional ways to manage chronic disease, while non-sufferers are increasingly attracted to natural preventive herbal treatments such as turmeric, ginseng and ashwagandha to avoid developing chronic disease in the first place.

As a result, the sometimes unregulated and often unstandardised global herbal medicine market is estimated to be worth over USD 70 billion and is expected to more than double in size, exceeding USD 150 billion by 2032. That may sound significant, but it still represents only a fraction of the global market in modern pharmaceuticals, which in 2024 was worth over USD 1.6 trillion and is expected to grow to USD 2.3 trillion by 2030.

Can traditional and modern medicine be successfully integrated?

Herbal medicine is extremely popular among the Chinese public for both prevention and treatment, but unlike many Western countries, China has policies designed to address a growing disease burden among an ageing population and wholeheartedly supports the use of herbal medicines.

As alluded to above, Japan’s Kampo-yaku herbal medicine is fully integrated into mainstream healthcare, while most of China’s Western-medicine hospitals offer CHM treatments. As if to illustrate the extent to which CHM is integrated into modern Western medicine in China, traditional Chinese medicine pharmacies account for around 50% of pharmaceutical revenues at Western medicine hospitals, while exclusively traditional CM hospitals dispense a large proportion of Western pharmaceuticals.

Integrating traditional healing methods into modern Western medicine requires a holistic, personalised approach to treatment. As Western medicine moves towards greater precision—designing treatments based on individual genetics and health profiles—it creates an opportunity for a successful, precise integration with traditional approaches.

But barriers still exist. In western societies with regulatory regimes driven by the need for demonstrable and indisputable evidence, a paucity of scientific and clinical validation remains a barrier to adoption for many modern healthcare systems. In particular, the absence of large-scale randomised clinical trials—an absolute prerequisite for the licensing of modern pharmaceuticals—promotes scepticism among many health practitioners and physicians in Western healthcare.

That barrier to universal adoption isn’t helped by the lack of accepted global standards for herbal products, making it difficult to gain regulatory approval for their use in hospitals or primary healthcare settings in many countries. The absence of unified production standards means that the resulting inconsistencies in healthcare outcomes can be used as a stick to beat the HM market, with pervasive scepticism often leading physicians and patients alike to reach the unfair and unfounded conclusion that ‘alternative’ herbal medicine is nothing more than glorified quackery.

In short, HM manufacturers need to win over sceptical minds in pharmacology and regulatory circles and consistently demonstrate that HM results that are comparable to, or better than, those of their orthodox modern pharmaceutical counterparts.

Bridging the gap

While further quantitative and qualitative research is clearly needed, the fact that so many modern pharmaceuticals owe their existence to the traditional and sometimes ancient practice of extracting active ingredients from plants should make us think twice.

If we’re genuinely trying to foster a culture in which health-conscious populations assume responsibility for their own health and take adequate preventative measures to avoid disease, as well as limit future healthcare costs, it seems counterintuitive to discount or exclude the potential benefits of herbal medicine from the mix of available holistic treatments in Western healthcare.