Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.
Humans ; Climate Change ; Delivery of Health Care ; Singapore ; Conservation of Natural Resources ; Sustainable Development ; Environment

Traditional Chinese medicine(TCM) resources are an important foundation for the theory and practice of TCM. Rare and endangered TCM, as a significant component of these resources, plays an essential role. Conducting research on substitutes for rare and endangered TCM resources is of great significance for alleviating resource shortages, promoting the sustainable utilization of TCM, and advancing TCM modernization. This paper reviews the conservation achievements of rare and endangered Chinese medicinal materials in China and organizes the substitution methods for these materials. Currently, the main substitution approaches include introduction and domestication, tissue culture, varietal replacement, and artificial synthesis. Furthermore, this paper proposes the following approaches for researching the application scenarios of rare and endangered medicinal materials, i.e., tracing the historical context of their use to clarify foundational principles; verifying disease classifications to strengthen the clinical application scenarios of these materials; analyzing the evolution patterns of prescription formulations to strengthen the mining of the compatibility application scenarios of rare and endangered medicinal materials; scientifically evaluating to strengthen the application scenario research and development of endangered Chinese patent medicine industry. These efforts aim to promote the scientific substitution and sustainable utilization of rare and endangered medicinal materials and their substitutes.
Drugs, Chinese Herbal/chemistry* ; Humans ; Medicine, Chinese Traditional ; China ; Plants, Medicinal/growth & development* ; Endangered Species ; Conservation of Natural Resources ; Animals

Climate and land use changes may significantly impact the habitat distribution of Gastrodia elata, an endangered traditional medicinal plant. Accurately predicting its future potential suitable habitats is crucial for its conservation and sustainable development. This study integrates current distribution data of G. elata with 56 environmental variables and uses the MaxEnt model to predict changes in its suitable habitats under current climate conditions and four future climate scenarios(SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). The results show that October precipitation and December minimum temperature are key environmental factors influencing its distribution. Under the current climate, optimal habitats for G. elata are concentrated in montane forest areas in Sichuan, Yunnan, Guizhou, and Hubei, which meet the species' requirements for understory growth. Across all future scenarios, the suitable habitat of G. elata consistently shows a stable northward shift, with a steady increase in suitable areas, extending to the middle and lower reaches of the Yangtze River and the Huang-Huai region, and even expanding into Liaoning, Jilin, and southern Heilongjiang. Land use analysis, taking into account the protection of arable land and the utilization of forest resources, indicates that by 2100, under future climate conditions, arable land in medium-to high-suitability areas is expected to increase by 30%-124%. While the conversion of non-suitable forest land into suitable habitats is projected to increase by 5%-52%, the growth of medium-to high-suitability areas within forests is relatively modest, ranging from 1% to 24%. These findings highlight the need to balance agricultural expansion with forest resource conservation to ensure the long-term sustainability of G. elata and provide scientific guidance for future suitable habitat management.
Ecosystem ; China ; Climate Change ; Gastrodia/growth & development* ; Conservation of Natural Resources ; Plants, Medicinal/growth & development*

Endangered Chinese medicinal materials have a wide range of applications and play an indispensable role in the system of traditional Chinese medicine(TCM). The protection of these endangered medicinal materials has always been a crucial task in the development of TCM. This paper systematically reviewed the changes in regulatory bodies for the protection of endangered Chinese medicinal materials and their related management policies since 1949, and conducted an in-depth discussion of the current laws and regulations governing the protection of endangered Chinese medicinal materials. At the same time, the paper comprehensively organized the current situation of endangered Chinese medicinal material protection in China, analyzed its causes, pointed out deficiencies in the current protective measures, and proposed countermeasures and suggestions for improvement, with the aim of providing references and guidance for the sustainable development of Chinese medicinal materials. Through this review, the paper aimed to raise public and governmental awareness of the importance of protecting endangered Chinese medicinal materials, thereby promoting the sustainable and healthy development of TCM. Additionally, the paper hopes to provide ideas for the formulation and implementation of relevant policies and contribute to the further improvement and deepening of the protection efforts for endangered Chinese medicinal materials.
Drugs, Chinese Herbal/analysis* ; China ; Endangered Species/legislation & jurisprudence* ; Medicine, Chinese Traditional ; Plants, Medicinal/chemistry* ; Conservation of Natural Resources/legislation & jurisprudence* ; Humans

Traditional Chinese medicine(TCM) is the pillar for the development of motherland medicine, and animal medicine has a long history of application in China, characterized by wide resources, strong activity, definite efficacy, and great benefits. It has significant potential and important status in the consumption market of raw materials of TCM. In the context of global climate change, farming system alterations, and low renewability, the depletion of wild medicinal animal resources has accelerated. Accordingly, the conservation and sustainable utilization of wild resources of animal medicinal materials has become a problem that garners increasing attention and urgently needs to be solved. This paper summarizes the current situation of domestic and foreign medicinal animal breeding and research progress in industrial application in recent years and points out the issues related to standardized breeding, germplasm selection and breeding, and quality evaluation standards for medicinal animals. Furthermore, this paper discusses standardized breeding, quality standards, resource protection and utilization, and the search for alternative resources for rare and endangered medicinal animals. It proposes that researchers should systematically carry out in-depth basic research on animal medicine, improve the breeding scale and level of medicinal animals, employ modern technology to enhance the quality standards of medicinal materials, and strengthen the research and development of alternative resources. This approach aims to effectively address the relationship between protection and utilization and make a significant contribution to the sustainable development of medicinal animal resources and the animal-based Chinese medicinal material industry.
Animals ; Breeding ; China ; Medicine, Chinese Traditional ; Conservation of Natural Resources

Analyzing the spatial distribution pattern and formation factors of medicinal plant resources can provide a scientific basis for the protection and development of traditional Chinese medicine(TCM) resources. This study is based on the survey data of medicinal plant resources in 104 county-level administrative regions of Anhui province in the Fourth National Survey of TCM Resources. The global spatial autocorrelation analysis, trend surface analysis, local spatial autocorrelation analysis, hotspot analysis, and a geodetector were employed to analyze the spatial distribution pattern of medicinal plant richness, and its relationship with natural factors was explored. The results can provide a basis for the formulation of development strategies such as the protection and utilization of TCM resources, as well as offer a scientific foundation for the establishment of regional planning schemes for TCM resources in Anhui province. The results indicated that the richness of medicinal plant resources in Anhui province had significant spatial heterogeneity, exhibiting highly clustered distribution characteristics. Cold spots and hot spots presented clustered distribution patterns, with cold spots mostly located north of the Huaihe River and hot spots south of the Yangtze River. Overall, the distribution of medicinal plant resources in Anhui province showed an overall trend of high in the south and low in the north, which was consistent with the overall geomorphic trend of this province. In addition, natural factors such as altitude, precipitation, and vegetation type played an important role in the diversity and spatial distribution pattern formation of medicinal plant resources. The extraction and analysis of the spatial distribution characteristics of natural factors in cold and hot spot regions discovered that the heterogeneity of eco-environments constituted a fundamental condition for the formation of species diversity.
Plants, Medicinal/classification* ; China ; Spatial Analysis ; Conservation of Natural Resources ; Biodiversity

Traditional medicine, deeply rooted in cultural practices and historical wisdom, has faced surging challenges due to the escalating demand for plant-based remedies. This comprehensive review critically emphasizes the urgent need for sustainable practices within traditional medicine, with a special focus on the potential of plant part substitution. Case studies that illuminate successful instances of substituting plant parts and providing a deep insight into viable alternatives to conventional practices are presented. Opportunities and challenges inherent in plant part substitution are discussed by addressing key considerations such as phytochemical and pharmacological aspects, safety and toxicity profiles, cultural insights, standardization, clinical validation, and regulatory compliance. This review serves as a guide for navigating the delicate balance between tradition and conservation within indigenous medicine practices. It underscores the importance of embracing sustainable approaches through plant part substitution, ensuring the preservation of cultural heritage while meeting the evolving healthcare needs of society. Please cite this article as: Srivastava B, Sharma H, Meena AK, Bharthi V. Balancing tradition and conservation: exploring plant part substitution in traditional medicine. J Integr Med. 2025; 23(3): 209-217.
Medicine, Traditional/methods* ; Humans ; Plants, Medicinal/chemistry* ; Phytotherapy/methods* ; Conservation of Natural Resources

Traditional Chinese medicine(TCM) resources refer to the total reserves of plants, animals, and minerals that can be used as raw materials of TCM(including Chinese medicial materials, TCM decoction pieces, TCM dispensing granules, traditional Chinese patent medicine, and TCM hospital preparation) and folk herbal medicine, which served as the material basis of inheritance, innovation, and development of TCM. In recent years, the sustainable utilization of TCM resources has received high attention and acquired a series of significant achievements in resource survey, quality evaluation, resource protection, innovative technology, and development and utilization, which effectively promoted the sustainable utilization of TCM resources and high-quality development of the TCM industry. The most urgent issue currently is to shift the focus of the research on the sustainable utilization of TCM resources from a sustainable utilization technology system to a sustainable utilization evaluation indicator system. Therefore, in order to objectively evaluate the ability, level, and trend of the sustainable utilization of TCM resources, an evaluation indicator system for sustainable utilization of TCM resources(EIS-TCMRSU) and methods for measuring and determining various standards and indicators were innovatively constructed. With the support of economic policies and scientific regulation of TCM policies, emerging technologies and new tools and methods could be applied to achieve the strategic goals of sustainable utilization and sustainable development of TCM resources. Based on the driving force-pressure-state-impact-response(DPSIR) model, key indicators including resource driving force, environmental pressure, resource state, socio-economic impact, and management response were determined by analyzing the industry chain bottleneck problems and development factors related to the sustainable utilization of TCM resources. According to the scientific, systematic, comparable, dynamic, and operable principles, the EIS-TCMRSU theoretical system was constructed to accurately reflect the ability and development trend of the sustainable utilization of TCM resources and promote the EIS-TCMRSU research from theoretical exploration to practical application. It ensured objective evaluation of the level and ability of sustainable utilization of TCM resources and provided a theoretical basis and practical guidance for the sustainable utilization and sustainable development of TCM resources. In addition, it is of great significance for promoting high-level safety supervision of TCM and high-quality development of the TCM industry.
Medicine, Chinese Traditional/economics* ; Drugs, Chinese Herbal/economics* ; Humans ; China ; Conservation of Natural Resources ; Plants, Medicinal/chemistry*

Chinese medicinal resources are the material basis for the survival and development of traditional Chinese medicine(TCM)and the sustainable development of Chinese medicinal resources is also an important project for the modernization of TCM in China. With the increasing demand for Chinese medicinal resources in China, over-exploitation has destroyed Chinese medicinal resources, resulting in a shortage of many natural medicinal resources in China and making the sustainable development of TCM in trouble. The introduced new foreign medicinal resources have become effective supplement and replacement for Chinese medicinal resources to some extent. However, the development and utilization of new foreign medicinal resources in China are different. To fully understand the development of new foreign medicinal resources in China, this paper, taking 43 new foreign medicinal resources such as Acacia nilotica as objects, sorted out the introduction forms and policies of new foreign medicinal resources, overviewed its current development status in China, summarized the application experience of new foreign medicinal resources in the place of origin, as well as the research progress and problems of new foreign medicinal resources in China and abroad, and analyzed the research situation, which can enrich Chinese medicinal resources and other uses, promote the sustainable development of Chinese medicinal resources, and provide ideas for further development and research of new foreign medicinal resources.
Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Conservation of Natural Resources ; Sustainable Development ; Internationality ; China

The wild plant Dactylorhiza hatagirea commonly used in Tibetan medicine. In recent years, it is on the verge of extinction due to improper excavation and habitat deterioration. Based on the literature review, and the meteorological and ecological data of Qinghai Province and data derived from the field survey, this study took the altitude, humidity index, annual average wind speed, monthly average sunshine, precipitation and temperature in growing season, soil type and vegetation type as the zoning indexes, and applied ArcGIS software for spatial superposition analysis. The results showed that the D. hatagirea was primarily found in the alpine meadow in the east and south of Qinghai Province. The overall suitable area was about 30 700 km~2. Taking Qinghai Lake as the boundary for reference, the area in the south appeared to be more suitable, while the area in the east appeared to be secondary in suitability. Henan County, Zeku County, Jiuzhi County and Banma County were the main suitable areas covering the expanse of 12 454 km~2. Through the field verification, such zoning results appeared to be accurate, precise and illustrative. The spatial distribution of ecological suitability provides the decision-making basis for the resource investigation, environment protection and comprehensive resource management. It also provides the empirical case for developing the interdisciplinary research method in the suitability study of medicinal plants.
Altitude ; China ; Conservation of Natural Resources ; Ecosystem ; Plants, Medicinal ; Soil