Traditional Chinese herbal medicine in European Union: State of art, challenges, and future perspectives focusing on Italian market

Traditional Chinese herbal medicine (TCM) has been used in China for thousands of years as an integral part of the healthcare system.The use of botanical products deriving from plants from TCM has become very spread and rooted in European Union (EU), generating a manufacturing industry of pronounced size, in particular the segment of food supplements, but recently also medical devices and cosmetics based on plants from TCM, especially in Italy. Only seven Herbal Medicinal Products (HMP) based on plants from TCM are present in EU besides more than 100 monographs on TCM plants are present in the European Pharmacopoeia. Indeed, the number of herbal monographs of European Medicine Agency (EMA) which report the main data on safety and efficacy of medicinal plants from TCM are very limited and this could be a reason for the limited number of HMP based on herbal drugs used in TCM. It is clear that those botanicals based on TCM but not classified as HMP can represent a sort of "borderline" products. Very likely, they are present on the European market because of the simpler authorization when compared with HMP. Some examples of these categories (food supplements and medical devices) containing plants from TCM and marketed in Italy are reported in this review. Consequently, it is urgent the need to clarify their categorization, also fundamental for the consumer protection. It is imperative the establishment of EU quality standards and official registration for Chinese herbal medicinal products, even if they are marketed as food supplements, medicinal devices or cosmetics because the international quality standards International Organization for Standardization Technical Committee 249-Traditional Chinese Medicine (ISO/ TC249) can harmonize the quality control and promote the trading internationally. Governmental organizations together with companies producing TCM should work together to accelerate the legislation of laws pertaining to TCM, and generate an environment where TCM does not just continue to exist but truly develop.

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