Background information

What is now classified as Bhutanese traditional medicine was introduced into Bhutan in the beginning of the 16^th century by Lam Shabdrung Ngawang Namgyal (187). This medical system has roots in Buddhism and Tibetan traditional medicine. During its early practice in Bhutan, providers of traditional medicine were trained in Tibet.

In addition to medications, Bhutanese traditional medicine includes acupressure, acupuncture, moxibustion, cupping, cauterization, medicated oil massage, herbal and steam baths, and the application of cold and warm poultices to the body (187).

In 1988, a research unit was established in the Institute of Traditional Medicine Services (187). This unit conducts research for further quality control of raw materials and finished products for traditional medicines as well as developing new products. It also ensures the sustainability of traditional medicine services and looks for ways to increase the cost-effectiveness of traditional medicine.

Statistics

There is a hospital for traditional medicine in Thimphy, the capital city of Bhutan. An additional 15 traditional medicine units across the country provide services to about 60% of the country's population. The Government plans to establish more units, to cover all 20 districts in the country (187).

There are more than 2990 different medicinal plants used in Bhutanese traditional medicines (187). About 130 traditionally used formularies are made from 110 different herbal preparations. About 70% of the raw materials used in these preparations are available in the country, both as wild and cultivated stocks. The remaining 30% are imported from India. There are more than 300 herbal products produced in Bhutan. Most are compound forms, with three to 90 ingredients (187).

Regulatory situation

In 1967, in an effort to promote and preserve traditional medicine, it was formally recognized and institutionalized as an integral part of the national health system of Bhutan (187). In 1979, the Institute of Traditional Medicine Services (187) was founded. It is housed in an allopathic hospital in order to encourage the integration of traditional and allopathic medicine, particularly mutual consultation, treatment, and referrals, and to enable patients to have greater access to a range of health care choices.

Bhutan's Institute of Traditional Medicine Services is charged with establishing a traditional medicine system that is scientifically sound and technologically appropriate, and which meets the needs of the population. To fulfil this mandate, the Institute works to provide access to traditional medicine for the entire population; to attain self-reliance in raw materials for the production of traditional medicines, including the conservation, cultivation, rotational collection, and preservation of rare and endangered species of medicinal plants; to improve the quality of traditional medical services through training practitioners; and to increase the production of traditional medicines for export. Profits from exporting traditional medicines are to be used to strengthen traditional medicine within Bhutan.

Small-scale mechanised production of traditional medicines started in 1982 with the assistance of the World Health Organization; previously, all medicines had been prepared manually (187). All herbal products are now produced mechanically following good manufacturing practices, with an emphasis on quality control. Herbal products take the form of pills, tablets, medicated ointments, syrups, and capsules and are purely natural - no artificial chemicals are used.

Education and training

Officially recognized formal training of traditional medical doctors (drungtsho) began in 1971 with the establishment of a five-year drungtsho programme. In 1978, the training curriculum was standardized. In 1979, the programme became part of the National Institute of Traditional Medicine (187). The course now consists of five years of institutional training followed by a six-month internship: three months in an allopathic hospital and three months in the traditional medicine hospital and a traditional medicine unit. During the three-month internship in the allopathic hospital, interns are introduced to allopathic medicine and the health sciences (187).