title: From medical tradition to traditional medicine: A Tibetan formula in the European framework.
abstract: BACKGROUND
  The increasing prevalence of complex multi-factorial chronic diseases and multimorbidity reveals the need for an enlargement of the therapeutic options. Potent multicompound herbal formulations from traditional medicine systems such as Tibetan Medicine might meet the requirements. With its practice over the centuries Tibetan Medicine is one of the important medical heritages of the world. In the 20th century Tibetan formulas came to Switzerland, where the formula Gabur-25 was then registered as medicine in 1977 (Padma 28, Swissmedic No 35872). The new European directive 2004/24/EC opened the avenue for traditional herbal medicinal products and registrations followed in Austria (HERB-00037) and the UK (39568/0001). The aim of this review was to analyse not only the critical points and hazards but also chances that occur in the endeavour of bringing a ethnopharmacological based preparation to the market within a modern Western medical and regulatory framework and to discuss the necessary transformation steps from a traditional herbal formula towards a modern pharmaceutical product with the example of the Tibetan formula Gabur-25.
  
  
  METHODS
  The historic transformation process from the 19th to the 21st century is analysed, using the registration documents and other material from the library of Padma AG, Hinwil, Switzerland.
  
  
  RESULTS
  The transformation of a traditional formula into a modern traditional herbal medicinal product according to the present EU regulations is a multi faceted process. The modern indication represents only a small part of the possible traditional indications. Quality and product labelling has to be adopted to modern standards. The formula, once registered, is a fixed combination of herbal and mineral ingredients. Contrary to this the concept of Asian medical tradition allows a certain flexibility in the composition of an herbal formula. The ingredients are constantly adapted to local conditions, availability of raw material and therapeutic situation.
  
  
  CONCLUSIONS
  The example shows that in principle complex herbal formulas from Asian medicine can meet the requirements of the European regime of traditional herbal medicinal products. A structured process of transformation from a traditional herbal formula to a modern medicinal product has to include selection of a suitable formula, development of an analytic concept and selection of a suitable indication with regard to the empirical set of possible indications. To extend the range of high quality medicinal products from other medical traditions within the European context the European legislators have to re-evaluate the imposed restrictions given in directive 2004/24/EC. Without amendment of the prerequisite of 15 years documented use in the EU and the limitation of indications for traditional herbal medicinal products, European citizens will be excluded from access to high quality medical traditions with their accumulated empirical knowledge.
authors.affiliation: Padma AG, Unterfeldstrasse 1, 8340 Hinwil, Switzerland. Electronic address: h.schwabl@padma.ch.
authors.forename: Herbert
authors.initials: H
authors.lastname: Schwabl
authors.affiliation: Padma AG, Unterfeldstrasse 1, 8340 Hinwil, Switzerland.
authors.forename: Cécile
authors.initials: C
authors.lastname: Vennos
mesh_terms: D005062:European Union; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008519:Medicine, Traditional / Q000266:history*; D010936:Plant Extracts / Q000627:therapeutic use; D018609:Tibet
chemical_list: D010936:Plant Extracts; C066069:Padma 28
keywords: Complementary and Alternative Medicine (CAM); Padma Circosan; Regulatory affairs; Tibetan Medicine; Traditional Herbal Registration (THR); Traditional herbal medicinal product (THMP)