TCM Outside China: United States, Europe and Latin America

United States

• No single national system. The National Center for Complementary and Integrative Health (NCCIH) says there is no standardized national system for credentialing complementary health practitioners; state governments decide what credentials a practitioner needs. [1]
• Acupuncture. NCCIH says that in most states acupuncturists must be certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) or pass its exams to be licensed. [1] Its TCM fact sheet adds that most states and the District of Columbia have laws regulating acupuncture practice. [2]
• Herbs. In a 2006 guidance document, the Food and Drug Administration (FDA) explained that a botanical product is regulated according to how it is labeled and intended to be used: as a drug, a dietary supplement or a food. [3] A product marketed to treat a disease would generally be regulated as a drug, while a botanical taken by mouth and labeled as a dietary supplement would generally be regulated as a supplement. [3] More on supplement rules is in how supplements are regulated.
• Needles. The FDA regulates acupuncture needles as class II medical devices, but not the practice of acupuncture itself. [3]
• Quality. NCCIH reports that some Chinese herbal products have been contaminated with undeclared drugs, heavy metals, pesticides or incorrect herbs. [2] See Chinese herbal products: quality and interactions.

Europe

• European Union. A simplified registration route for traditional herbal medicines was introduced by Directive 2004/24/EC. [4] A product can use it if it has been used for at least 30 years, including at least 15 years within the EU. [5] No clinical trials on safety and efficacy are required if safety data are sufficient and efficacy is plausible, and the assessment mostly uses published sources. [5] Manufacturing and quality requirements are the same as for a full marketing authorisation. [4]
• What this does not say. These are general rules for herbal medicines, not rules written for Chinese herbs. We did not find a source that lists which Chinese herbs are registered, so we do not say.
• England. The NHS says the health service does not use herbal medicines, and that you should look for a traditional herbal registration (THR) mark and product code from the Medicines and Healthcare products Regulatory Agency (MHRA) on the pack. [6] It also says herbal medicine practitioners and most complementary therapists do not need to be registered by law, and suggests choosing one registered with a professional body accredited by the Professional Standards Authority. [6]

Latin America

• Brazil. The Ministry of Health says the public health system (SUS) offers 29 integrative and complementary practices, and its list includes "Medicina Tradicional Chinesa – acupuntura". [7] Some practices, such as acupuncture, may need a referral from a health team professional. [7]
• Mexico. A journal article on the history of acupuncture there describes the standard NOM-017-SSA3-2012, which allows acupuncture to be practiced by a health professional with a legally issued degree or specialty certificate from an officially registered institution. [8]
• Argentina. A practitioner-affiliated journal article states there is no national law on TCM "strictly speaking", only administrative resolutions from the national health ministry, and that provinces must be checked one by one. [9]

At a glance

Questions to ask wherever you live

Ask which state, provincial or national body licenses or registers the practitioner and how you can check it yourself; our guides on qualifications and licensing and choosing a practitioner explain how. Tell every clinician about herbs you take: telling your doctor about TCM. NCCIH advises not using TCM to replace or delay conventional care. [2]