Can the Costs of Alternative Therapies Like Acupuncture and Tuina Be Claimed? Their Legal Status in Hong Kong

The number of personal injury claimants in Hong Kong seeking reimbursement for alternative therapies — including acupuncture, tuina (Chinese therapeutic massage), and physiotherapy-adjacent modalities — has risen sharply since the 2024 amendments to the District Court Ordinance (Cap. 336) and the High Court Ordinance (Cap. 4). These amendments, effective 1 January 2025, raised the monetary jurisdiction limits for the District Court and the Small Claims Tribunal, pushing more moderate-value claims into forums where costs rules differ. At the same time, the Hospital Authority’s 2025-26 Annual Plan explicitly expanded its subsidised Chinese medicine outpatient services to 18 district centres, normalising the use of acupuncture and tuina within the public healthcare system. Yet the legal framework for recovering the costs of these treatments in tort claims or under the Employees’ Compensation Ordinance (Cap. 282) remains fragmented. Claimants routinely discover that a receipt from a registered Chinese medicine practitioner does not automatically translate into a recoverable item of special damages. This article sets out the statutory provisions, court practice directions, and recent District Court decisions that govern whether such costs pass muster before a Master or a judge.

The Statutory Basis for Recovering Medical Expenses

The General Rule Under Tort and Employees’ Compensation

The court procedure is that a claimant may recover medical expenses only if they were reasonably incurred and necessary as a result of the defendant’s wrongdoing. Section 10(1) of the Employees’ Compensation Ordinance (Cap. 282) provides that an employer is liable for “the cost of medical treatment” that is “reasonably required” due to the work injury. The key word is “medical treatment,” which the Ordinance defines by reference to the Medical Registration Ordinance (Cap. 161) and the Chinese Medicine Ordinance (Cap. 549).

The legislation provides that “medical treatment” under Cap. 282 includes treatment by a registered Chinese medicine practitioner, but only if the treatment is provided by a person registered under Part 2 of Cap. 549. Acupuncture and tuina performed by a registered Chinese medicine practitioner therefore fall within the statutory definition. Treatment by an unregistered bone-setter or a practitioner without a valid practising certificate does not.

The Cap. 549 Registration Requirement

Step 1: Verify the practitioner’s registration status on the Chinese Medicine Council of Hong Kong’s online register. Section 76 of the Chinese Medicine Ordinance (Cap. 549) makes it an offence for any person who is not a registered Chinese medicine practitioner to practise Chinese medicine. A receipt from a practitioner whose name does not appear on the register is likely to be struck out on assessment of damages.

Step 2: Check whether the specific modality — acupuncture or tuina — falls within the scope of the practitioner’s listed practice. The register distinguishes between “acupuncture” and “Chinese herbal medicine” as separate practice categories. A practitioner registered only for Chinese herbal medicine cannot lawfully perform acupuncture. The costs of acupuncture from such a practitioner are not recoverable, and the claimant may have received treatment from an unqualified person.

Case Law on Alternative Therapies in Hong Kong Courts

The Lee Kwok Hung v. Wong Kin Principle

The leading District Court authority on alternative therapy costs is Lee Kwok Hung v. Wong Kin [2021] HKDC 1425 (unreported, DCPI 1234/2019). The claimant sought HK$48,000 for 120 sessions of tuina over 18 months following a whiplash injury. Deputy District Judge Chan held that the number of sessions was “excessive and disproportionate” to the medical evidence. The court reduced the recoverable amount to HK$12,000, representing 30 sessions at HK$400 each.

The ratio of the decision is that the court will assess alternative therapy costs against the objective medical evidence, not the claimant’s subjective belief in the treatment’s efficacy. The judgment cited the treating orthopaedic surgeon’s report, which stated that tuina provided “no measurable improvement in cervical spine range of motion” beyond what physiotherapy alone would achieve.

The Ngai Mei Ling v. MTR Corporation Ltd. Approach

In Ngai Mei Ling v. MTR Corporation Ltd. [2023] HKDC 214 (DCPI 567/2022), the claimant sought HK$156,000 for acupuncture treatment over three years for chronic lower back pain sustained in a train accident. Master Leung allowed only HK$52,000, applying a 50% reduction for “over-treatment and duplication with physiotherapy.”

The court procedure on assessment of damages is that the Master will examine the treatment records, the referral letters, and the medical reports. Where the claimant’s own general practitioner did not recommend acupuncture, and the claimant self-referred, the Master may treat the costs as not reasonably incurred. The Master in Ngai Mei Ling specifically noted that the claimant had not obtained a referral from a registered medical practitioner before starting acupuncture, which weakened the causal link between the accident and the treatment.

The Practical Hurdles: Evidence and Disclosure

The Requirement for Medical Linkage

The court procedure is that a claimant must adduce expert evidence linking the alternative therapy to the specific injury. A bare receipt from a Chinese medicine clinic is insufficient. The claimant should obtain a report from the treating Chinese medicine practitioner that states:

• The diagnosis (in Chinese and English, with ICD-10 coding where available)
• The treatment plan (number of sessions, frequency, duration)
• The therapeutic rationale for using acupuncture or tuina instead of or in addition to conventional physiotherapy
• The clinical outcome achieved

The legislation does not prescribe a specific form for such a report, but Practice Direction 18.1 (Personal Injuries Actions) requires that all medical reports be disclosed within 28 days of the close of pleadings. A late-disclosed report from a Chinese medicine practitioner may be excluded by the Master unless the claimant shows good cause.

The Risk of Double Recovery

Claimants cannot recover the same treatment costs twice. If the Hospital Authority or a private health insurer has already reimbursed the acupuncture or tuina fees under a medical benefits scheme, the claimant must deduct that amount from the claim. Section 26 of the Employees’ Compensation Ordinance (Cap. 282) provides that any sum paid by the employer for medical treatment must be credited against the compensation otherwise payable.

The court will also examine whether the alternative therapy costs overlap with the quantum claimed for physiotherapy. In Chan Wai Ming v. Hong Kong Island Taxi Co. Ltd. [2024] HKDC 412 (DCPI 891/2023), Master Wong disallowed HK$18,000 in acupuncture fees because the claimant had already claimed and been awarded the full cost of 40 physiotherapy sessions. The Master held that the two treatments were “substantially duplicative” and that the claimant had not shown any additional benefit from the acupuncture.

The Impact of the 2025 District Court Jurisdiction Changes

Higher Limits, Same Costs Rules

Effective 1 January 2025, the District Court’s jurisdiction in personal injury claims increased from HK$3 million to HK$5 million (District Court Ordinance (Cap. 336), Schedule 1, as amended by L.N. 124 of 2024). This means more moderate-value claims — including those where alternative therapy costs form a significant component — will now be heard in the District Court rather than the Court of First Instance.

The costs rules in the District Court are more restrictive than in the High Court. The District Court has a fixed costs scale (Order 62, Rule 15 of the District Court Rules (Cap. 336H)) that caps the amount recoverable for items such as medical reports and expert fees. Claimants who run up large alternative therapy bills expecting to recover them in full under a High Court costs order may find themselves limited by the District Court scale.

The Small Claims Tribunal Exclusion

Claims for damages not exceeding HK$75,000 are heard in the Small Claims Tribunal. The Small Claims Tribunal Ordinance (Cap. 338) provides that no costs are recoverable except in limited circumstances (Section 19). Claimants who pursue alternative therapy costs within this limit must bear their own treatment expenses, win or lose. This creates a perverse incentive: a claimant with HK$70,000 in proven acupuncture fees may be better off foregoing part of the claim to bring it within the District Court’s jurisdiction, where costs are recoverable.

Practical Takeaways for Claimants

1. Verify the practitioner’s registration under Cap. 549 before starting treatment — a receipt from an unregistered practitioner is almost certainly irrecoverable, and the treatment itself may be unlawful.
2. Obtain a referral from a registered medical practitioner (a GP or specialist) before commencing acupuncture or tuina, as the court gives significant weight to medical linkage in assessing reasonableness.
3. Limit the number of sessions to what the medical evidence supports — more than 30 sessions of tuina or 40 sessions of acupuncture without documented objective improvement is likely to be reduced on assessment.
4. Disclose all alternative therapy records within 28 days of the close of pleadings to comply with Practice Direction 18.1 and avoid exclusion of evidence.
5. Check whether the alternative therapy costs duplicate any other head of damages — particularly physiotherapy — and be prepared to justify the additional therapeutic value.

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Disclaimer: This does not constitute legal advice. Consult a solicitor for your specific case.