Regulation of Chinese medicine in Poland

Introduction

The first European who studied Chinese medicine at its source (in 1644–1659), also having access to Chinese medicine classics in the imperial library, was Michał Piotr Boym SJ; Bǔ Mígé (1612–1659), a Polish Jesuit missionary, who was also one of the pioneers of sinology throughout the world. As the official Chinese envoy of the last Ming dynasty Emperor Yongli he arrived in Rome with the imperial letter to the Pope in the Vatican, and took this opportunity to bring with him numerous manuscripts about Chinese medicine, and published his early works on China¹ (1-3,5).

Poland also contributed to the further development of Chinese medicine in the West: two of the first 10 doctoral theses in Europe on the subject were the works of Poles. In 1828 Antoni Baranowski received a Doctor of Medicine degree from Vilnius University for his work on moxibustion. Meanwhile, Dr. Joseph Domaszewski’s work on acupuncture has been defended at the Jagiellonian University in Krakow in 1830.

In 1978, Prof. Dr. Zbigniew Garnuszewski began to use simplified acupuncture in Warsaw, and starting from 1979 he began to teach physicians in the field of simplified Medical Acupuncture. Due to his efforts, in 1986 acupuncture was officially recognized as a method of healing by the Ministry of Health and Social Welfare, and Prof. Zbigniew Garnuszewski was nominated as a National Acupuncture Specialist. Unfortunately, when he died in 1998, no other National Acupuncture Specialist was appointed and the official position of Medical Acupuncture was reduced between the medical doctors and the Ministry of Health and Social Welfare.

The real traditional Chinese medicine (TCM) has been taught in Poland since 1986. Initially, privately organized courses in Krakow² were later transformed into regular institutionalized teaching covering the whole area of traditional and classical Chinese medicine, including theory, diagnostics, preventive and therapeutic TCM dietetics, acupuncture, herbal medicine and Tui Na massage, for beginners and advanced.³

Since 2016 International Congresses of TCM have been organized in Krakow by the Polish Society of Traditional Chinese Medicine (PTTMC).

Regulation and reality of studies in acupuncture and Chinese medicine in Poland

TCM in Poland is not taught at any university. Only a few medical universities allow lectures on medical acupuncture used symptomatically for pain treatment; these are carried out for few hours only as one of the subjects in the program of post-graduate studies for pain treatment. Acupuncture is also not a separate medical specialization.

Polish Society of Acupuncture (PTA) is providing courses of medical acupuncture mainly for medical doctors. For many years it covered only 100 hours of education, but now, since 2016, it is about 200 hours.

Knowledge of TCM can be acquired in non-public colleges of higher education in the profession of acupuncturist and herbalist-physiotherapist or numerous courses for beginners and advanced, where you can complete a full learning program of TCM. These courses are usually conducted by Continuing Education Institutions registered by local municipal authorities of education and working under the power of the Ministry of Education, or provided by different private companies. Unfortunately, standards of TCM education and certification in Poland are not regulated and different TCM schools have their own curricula, levels and duration of education. Some schools are very professional and provide high level of education lasting 2, 3–5 years, but there are also so called “schools of acupuncture” (or TCM), with very short curricula and providing very superficial level of education.

Currently, TMC is taught regularly in:

• Krakow: (I) Instytut Medycyny Chińskiej i Profilaktyki Zdrowia [Institute of Chinese Medicine and Health Prophylaxis] (since 1989), that runs the Institute of Chinese Medicine, TCM Continuing Education Institution; (II) Instytut Tradycyjnej Medycyny Chińskiej i Integracyjnej DAO [Institute of TCM and Integrative Medicine DAO] (since 2015);
• Katowice: AcuArt International School of Acupuncture (since 2017, previously under the name Compleo, since 2008);
• Poznan: Orkiszowe Pola [Center of Natural Nourishment and Treatment];
• Warsaw: 1. Centrum Sztuk Zdrowotnych [Health Arts Center] (Since 1995) and 2. Raszyn near Warsaw (TCM courses of Dr. Tadeusz Błaszczyk MD);
• Bydgoszcz: Szkoła Akupunktury Tradycyjnej w Bydgoszczy [School of Traditional Acupuncture in Bydgoszcz (since 2006)];
• Gdansk: Trójmiejski Ośrodek Medycyny Orientalnej, TOMO [Tricity Oriental Medicine Centre] (since 2006) and Institute Baoku (since 2018);
• Wroclaw: (I) Wrocławska Akademia Akupunktury i Medycyny Naturalnej [Wroclaw Academy of Acupunture and Natural Medicine] (since 2017) and (II) Avicenna Polska (since 2014);
• TCM is also taught on a smaller scale in some other places, but the level of education is not always good enough.

Some Polish educational institutions of TCM (Institute of Chinese Medicine and Health Prophylaxis in Krakow as well as TOMO in Gdansk) enable clinical internship trips to China for their advanced TCM students, where they can participate in clinical internship and deepen their knowledge at renowned universities of TCM and local university clinics.

So, there is no possibility to receive the official title of “TCM doctor” in Poland, but you can become a professional TCM therapist (e.g., acupuncturist). For now, the educational and certification standards in Poland are not formally defined, so PTTMC recommends going in line with the international standards set by the WHO and ETCMA.

In recent years, the first Polish students began TCM education at master’s level at Nanjing University starting extramural MA Programme run by Shulan College of Chinese Medicine in Manchester, UK. There are also few Polish students who went to China to study a master’s degree in TCM (Xi’an, Nanjing).

Regulation and reality of the professional practice of acupuncture and Chinese medicine

Legal status of TCM in Poland

TCM is not prohibited in Poland, but there is lack of proper legal regulations on standards of education, certification etc.

In 2010, following a decision of the Minister of Labour and Social Policy, the profession of «acupuncturist» was included in the official list of professions (4), as a paramedical profession⁴. Thus, there is no medical college education requirement and the profession is clearly defined as unrelated to the practice of medicine—this is how some members of the medical community still claim it by mistake.

In 2014, following a decision of the Minister of Labour and Social Policy, the profession of «herbalist-phytotherapist” (in general, not only in TCM) was included in the official list of professions (6), as a paramedical profession⁵.

TCM associations

In Poland there are six associations for acupuncture and TCM: PTA, PTTMC, Polish-Chinese Society of TCM and Acupuncture (since 2016), Polish Society of Chinese Medicine and Acupuncture (since 2016), Polish Society of Professional Acupuncturists (since 2017) and the Society of Classical Chinese Medicine (since 2019). All TCM societies are registered as NGO associations by the court in the National Registry of NGOs and companies.

Two of them are in fact really active:

In 1989 the PTA⁶ was established, founded by Prof. Garnuszewski. PTA brings together acupuncturist physicians and provides basic training for medical doctors in the field of Medical Acupuncture, mainly acupuncture analgesia.

In 2007, a nationwide PTTMC was established in Krakow (and officially registered by the court in 2009) (7), bringing together medical doctors and TCM therapists practicing all methods of traditional Chinese medicine. Some of Chinese doctors of TCM who are practicing in Poland are also among the members of PTTMC. In 2012, PTTMC became a full member of the European Traditional Chinese Medicine Association (ETCMA), an organization of 25 European TCM associations (plus Israel). Representatives of PTTMC have also taken an active part in setting European standards for Chinese medicine education (8)—it was very important because in Poland there are no officially accepted standards of Chinese medicine education until now. In December 2017, PTTMC became a full member of the World Federation of Acupuncture-Moxibustion Societies (WFAS) and President of PTTMC, Marek Kalmus was elected to the 9^th Executive Committee of WFAS. Members of PTTMC can buy professional insurance for full spectrum of TCM clinical practices.

TCM practice in Poland

Polish law does not prohibit the practice of Chinese medicine, but there is lack of regulations in that matter. The only existing regulation is a listing of acupuncturist and herbalist-phytotherapist in the official list of professions issued by the Ministry of Labour and Social Policy (4,6). TCM therapists usually practice on the basis of registration in the Business Activity Register, reporting their activity as paramedics, while medical doctors make an extension of their registered practice. Since there are no legal regulations, the Polish Association of Traditional Chinese Medicine (PTTMC) recommends following the guidelines and recognized international standards and in the meantime takes actions to formulate educational and certification standards and certification for the profession of acupuncturist and TCM herbal therapist.

Chinese medicine can be practiced in Poland both by medical doctors properly trained in the field of TCM and TCM therapists who have not had a previous medical profession⁷.

In 1988, Stołeczne Centrum Akupunktury (The Capital Acupuncture Centre) specialized in the treatment of pain was established at the initiative of Prof. Garnuszewski, but unfortunately it was closed in 2008. Now acupuncture is also performed in a number of pain treatment clinics by medical doctors and these treatments are reimbursed by the National Health Fund (NFZ), but it is not very popular with medical doctors and is not respected enough by them.

Unlike Medical Acupuncture, TCM is developing dynamically in Poland, responding to the growing demand of patients who are seeking help in cases where Western medicine fails. There is a considerable number of patients who prefer the natural methods of treatment free from numerous side effects.

TCM is recognized among Polish patients, as well as some medical doctors only, as a safe and very effective method, provided it is applied by appropriately qualified persons. Acupuncture is considered a cheap, effective and fast acting, and also safe method of treatment, shown in thousands of scientific papers published around the world and scientific studies based on metadata—more at: www.evidencebasedacupuncture.org

The exact number of TCM doctors and TCM therapists is unknown—we can estimate that it is practiced by a few dozen, maybe over a hundred trained doctors of Western medicine. There are also a few TCM doctors who have completed higher TCM education in the USA or in UK. In addition, there are an unknown number (but probably not more than 100) of practicing TCM physicians from China and Mongolia in Poland, who are graduates of local universities of TCM. The number of practicing TCM therapists in Poland can be estimated at approximately 200–300. The number of TCM dietitians actively practicing can be estimated at a maximum of 50 (however, this number is probably overstated). These data refer to those who practice acupuncture, Chinese herbal medicine, Tui Na massage (these may be practitioners who use one of these methods, some of them or all of them) and who use Chinese diagnostics—only in this case we can speak of the practice of Chinese medicine.

You can also add to the above number probably no more than a few dozen, a hundred of active practitioners of Western medicine, who completed acupuncture courses run by the PTA—despite training of approximately 1,200 physicians (since 1979), most of them did not practice or abandoned it after some time. It should also be noted that most of them use simplified medical acupuncture, without applying classical Chinese diagnostics.

Regulation and reality of Chinese phytotherapy

Chinese herbs and individual recipes can be ordered from several companies in Poland. Some of them are official representatives of Western companies that trade with Chinese herbs or supplements based on Chinese herbs. However, herbs cannot be officially sold as medicinal products, but as components of herbal teas and as supplements, among dietary products under the control and registration of the General Sanitary Inspector (GIS).

Patent formulas can be registered by the GIS as food supplements and can be sold in clinics, on the Internet and also in some herbal shops, as well as in organic and health food stores. Also, some Chinese herbs are available separately from such shops too—officially as ingredients for herbal teas.

Level of acceptance by the population in Poland

In Poland, Chinese medicine is often the last resort when Western medicine fails, for example, it is unable to clearly recognize the disease, discontinues further treatment, or only treats symptoms, without eliminating the actual cause of the disease. The unified treatment procedures of Western medicine in many cases limit the role of a physician, and the patient just feels like a cog in the bureaucratic health care system. Meanwhile, Chinese medicine treatment methods brings effective help in a large number of these cases, without causing adverse side effects, improving the patients’ quality of life. The efficacy of Chinese medicine is much greater in case of many diseases.

On the one hand, there is still strong resistance from the general medical community rejecting TCM, but on the other hand, the number of physicians learning TCM and treating by Chinese medicine or combining it in an integrated way with Western medicine is growing.

Also, the weakness of the health care system in Poland, bureaucracy and rigid procedures make proper treatment difficult despite the efforts of doctors. This discourages many patients who are looking for other safe and effective treatments. TCM makes it possible for them and that is why the number of patients in Chinese and integrative medicine clinics is growing every year.

Many patients are also looking for integrative treatment which combines Western and Chinese medicines. Medical doctors who are trained in TCM can provide it in private clinics only. Also, some private clinics are providing combined treatment when the medical doctor is cooperating with a TCM practitioner or acupuncturist. Unfortunately, in public hospitals and clinics (where treatment is controlled and reimbursed by NHS) the practice of TCM is prohibited due to rigid procedures and legal regulations based on the Law on the profession of the physician, etc.

Acknowledgments

I owe my interest in Chinese medicine to Claude Diolosa, who was my first teacher since 1986 for many years. Then he was joined by Matthias Hunecke, Dr. Tadeusz Błaszczyk, Radha Thambirajah, Donald B. Halfkenny, Prof. Elisabeth Rochat de La Vallee, Dr. Yair Maimon, Mazin Al Khafaji, Hamid Montakab, Aaron Zizov, Michael Uhrhan. Chinese teachers: Sun Peilin, Li Jie, Wang Weixiang, Tianjun Wang, Shulan Tang, Yifan Yang, Zhijun Shu, Jeffrey Yuen and Hu Kaming as well as Prof. Jong Baik from Korea allowed me to deepen my knowledge and understand the essence of Chinese medicine and Chinese culture. I am also extremely grateful to many other outstanding lecturers and friends practicing TCM in many countries—thanks to them I had the opportunity to compare the regulations and principles of TCM practice and teaching in their countries and to improve the curriculum of our TCM School, the Institute of Chinese Medicine and Health Prophylaxis in Krakow. Many thanks for support and advices to my friends from the ETCMA and the WFAS. The cooperation with the International Faculty of Education of Guanxi University of Chinese Medicine in Nanning as well as the International Faculty of Education of Shanghai University of Traditional Chinese University, and previously also with the Chengdu University of Traditional Chinese Medicine has been and is very important to me and gave important support to our TCM School. Without the support and advice of Polish friends: lecturers, translators, TCM therapists and former and current students, I would not do much in the field of promotion and development of TCM in Poland. The most important was the cooperation with Dr. Wiesław S. Nowak, Agnieszka Krzemińska, Bartosz Chmielnicki, Mariusz Giżycki and Izabela Miętka. Thanks to Prof. Dr. Ramon Calduch, for the inspiration and invitation to write this article. Finally, I would like to thank my wife Bożena and my son Lukas for their understanding and joint management of the TCM School, as well as the support in my other TCM activities. Thank you so much.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editor (Ramon Calduch Farnòs) for the series “Regulation of Chinese Medicine in the Different Countries of the World” published in Longhua Chinese Medicine. The article has undergone external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/lcm-20-38. The series “Regulation of Chinese Medicine in the Different Countries of the World” was commissioned by the editorial office without any funding or sponsorship. MK reports that he was a founder, President and now Honorary President of Polish Society of TCM (PTTMC), as well as he was also a founder and Director of TCM School in Krakow—now under the name Institute of Chinese Medicine and Health Prophylaxis.The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

¹The most famous work of Michal Piotr Boym is the “Chinese Flora” (Flora Sinensis) (1). This work, published in Vienna in 1656, contains a description of the use of Chinese medicinal plants. Just after Boym’s death his works were used by Andreas Clayer, who published them under his own name. Fortunately, the second edition of Boym’s work “The Key to Medical Science” (Clavis medica ad Chinarum doctrinam de pulsibus autore r.p. Michaele Boymo e Soc. Jesu et in China missionario) was published in Nuremberg in 1686 under the name of Boym (2). This book contains a description of the different therapeutic and diagnostic methods of Chinese medicine as well as many classic prescriptions (this work is known also under the name of «The Prescription of Chinese Medicine”). Another work of Boym was “The Handbook of Chinese Medicine” containing descriptions of many medicines and anatomical tables with marked meridians and acupuncture points (3,4).

²The first lecturer of TCM in Poland was a Frenchman, Claude Diolosa, founder of the Avicenna Institute (Germany, France and Italy), internationally recognized as a specialist and teacher of TCM. He is now visiting professor of Chengdu University of TCM.

³These trainings are conducted by the Instytut Medycyny Chińskiej i Profilaktyki Zdrowia in Krakow (Institute of Chinese Medicine and Health Prophylaxis, www.medycyna-chinska.com).

⁴The acupuncturist as a profession has an entry with No. 323001 in the group: 3230 Practitioners of Unconventional or Complementary Methods of Treatment. (4) p29

⁵The herbalist-phytotherapist as a profession has an entry with No. 323012 in the group: 323012 Practitioners of Unconventional or Complementary Methods of Treatment. (6) p32

⁶Polskie Towarzystwo Akupunktury (PTA; www.akupunktura.org) is a member of the International Council of Medical Acupuncture and Related Techniques.

⁷TCM therapists, who have no prior medical education must take the special course “Foundations of Western medicine” —not less than 200 education hours.

References

1. Boym MP. Flora Sinensis. Viehnae, 1656.
2. Boym MP. Clavis Medica ad Sinarum Doctrinam de Pulsibus autore r.p. Michaele Boymo e Soc. Jesu et in China Missionario, editor Clayer A., second edition, Norimbergae 1686.
3. Boym MP. Medicamenta Simplicita quae á Chinensibus ad usum Medicum adhibentur, in: idem, Specimen Medicinae Sinicae sive Opuscula Medica ad Mentem Sinensium. Frankfurt u. Mein, 1682:25-54.
4. Ordinance of the Minister of Labour and Social Policy of 27 April 2010 on the classification of professions and professional specializations for the needs of the labor market and its scope of application (Journal of Laws of 2010. No. 82 pos. 537). Available online: http://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20100820537/O/D20100537.pdf
5. Boym MP. Specimen Medicinae Sinicae sive Opuscula Medica ad Mentem Sinensium. Frankfurt u. Mein, 1682.
6. Ordinance of the Minister of Labour and Social Policy of 7th August 2014 on the classification of professions and professional specializations for the needs of the labor market and its scope of application (Journal of Laws of 2014, pos. 1145). http://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20140001145/O/D20141145.pdf
7. PTTMC. Polskie Towarzystwo Tradycyjnej Medycyny Chińskiej. KRS No. 0000331282. Available online: http://www.krs-online.com.pl/polskie-towarzystwo-tradycyjnej-medycyny-krs-315888.html
8. Minimum Educational Criteria for Membership of the ETCMA. Available online: https://www.etcma.org/files/minimum-educational-criteria-for-membership-of-the-etcma-2013.pdf