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    AH

    andb

    ooko

    f Traditional andComplementary

    Medicine Programme inMalaysia

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    This handbook was crafted through generous mentoring and

    encouragement. Special acknowledgement is due to Dato Dr.

    Maimunah bt A. Hamid, Deputy Director General of Health

    (Research and Technical Support), Ministr y of Health Malaysia, for

    sparking the idea. Similarly, special acknowledgement is given to

    Dr. Ramli bin Abd. Ghani, Director of the Traditional and

    Complementary Medicine Division, Ministry of Health Malaysia, for

    his continuous support and endless encouragement.

    Also, the Traditional and Complementary Medicine Division greatly

    appreciates the valuable work of every individual who contributed

    to the success in the preparation of this handbook.

    Last but not least, special appreciation to the reviewers for their

    valuable comments and input.

    Editorial Committee

    Traditional & Complementar y Me dicine Division

    October 2011

    Acknowledgement

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    Medicine is in the new e ra. In the past century, the health care

    system has seen major changes not only within the modern

    medicine but also, the integration of traditional and

    complementary medicine into the modern medical system.

    Th is is du e to th e fa ct th at th e wo rl d po pu la ti on is

    increasingly seeking natural or drugless remedies or

    solutions to their health problems. Realising this, Malaysia

    strives to achieve a balanced and safe use of both modern

    and traditional and complementary medicine.

    Thi s han dbook is a reect ion of what trans pire d, what was

    planned and achieved by the Government of Malaysia in

    realising the dream of integrating both types of medical

    systems. The contents of this handbook have been carefully

    selected and organised in such a way that it delivers muc h of the

    needed information to the public as well as the professionals

    involved.

    I would like to convey my deepest appreciation to the editorial

    committee who have worked hard to put together this

    remarkable book for the benet of the people of Malaysia.

    Foreword

    Dato Dr. Maimunah bt A. Hamid

    Deputy Director General of Health

    (Research and Technical Support)

    Ministry of Health Malaysia

    October 2011

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    Preface

    Dr. Ramli bin Abd. Ghani

    Director

    Tra dition al and Compl eme nta ry Med ic in e D ivi sio n

    Ministry of Health Malaysia

    October 2011

    Today, Traditiona l and Com plement ar y Medici ne (T&CM) is an

    important component of the healthcare system. It co-exists with

    modern medicine to improve health and the quality of life.

    T&C M plays a cr ucial role in the aspect of pr event ion, hea lth

    promotion and healing. In the local community, traditional

    remedies are commonly sought after to accelerate the process

    of healing and in maintaining health after treatment or

    diagnosis from an allopathic medical practitioner.

    Thi s han dbook mar ks our r st att empt to pr ovi de a general

    overview of the practice of T&CM in a localised setting whilst

    promoting public awareness towards i ts safety and quality.

    The idea of thi s han dbook came fr om Dat o Dr. Mai munah bt A.

    Hamid, Deputy Director General of Health (Research and

    Tech nical Support), Ministry of Hea lth Mala ysia . The informati on

    and facts in this handbook are intended for the people of

    Malaysia from all walks of life who care about the society they

    live in and the people whom they share their lives with.

    I would like to thank the editorial committee for devoting their

    time with genuine interest and enthusiasm to ensure the

    realisation of this book.

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    CHAPTER 1

    Introducing... Traditional & Complementary Medicine 1 6

    Overview

    Denitions

    Classications of T&CM in Malaysia

    Roles and Functions of T&CMD

    CHAPTER 2

    Development of T&CM Globally and Locally 7 19

    Global Development

    International Collaboration in Traditional &Complementary Medicine

    Development of T&CM Programme in MalaysiaT&CM Practice s Ava ilable at the Int egrative Hospitals

    T&CM Uni ts at the Integ rative Hospitals

    CHAPTER 3

    Modalities in T&CM 20 23

    The rapeut ic Ver sus We lln es s Con cept

    Home-grown Modalities

    The Scope of Pra ct ice of T&C M Modalities

    CHAPTER 4

    EBP in Supporting Development of T&CM Practices 24 28

    EBP Evidence-based Practice

    Steps involved in the EBP Process

    Use of EBP in Developing T&CM Guidelines

    CHAPTER 5

    Education & Training 29 32

    CHAPTER 6

    Research in T&CM 33 35

    CHAPTER 7

    Promotional, Enforcement & Public Education Activities 36 44

    Promotional Activities

    Inspection Activities

    Public Education

    GLOSSARY 45 49

    EDITORIAL COMMITTEE50

    Contents

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    Traditiona l Medici ne (TM) is an anc ient medical pr actice which

    existed in human societies before the application of modern

    science to health. It has evolved to reect dierent

    philosophical backgrounds and cultural origins. The practice of

    modern medicine may be widespread but the use of traditional

    medicine is still practiced in many countries although it is not

    always included as a part of the healthcare system recognised

    by the government. It is one of many types of non-standardisedhealth care services which involve varying levels of tr aining and

    eciency.

    TM/ CAM (Co mplemen tar y & Alt er nat ive Med ic ine) has be en

    widely utilised by the world population for decades. In some

    Asian and African countries, 80% of the population depend on

    traditional medicine for primary health care purposes. In many

    developed countries, 70% to 80% of the population have usedsome form of complementary or alternative medicine, with

    herbal treatments being the most popular form of TM.

    In the West, the umbrella term CAM is widely accepted as

    including both TM and other recent forms of non-standardised

    medicine. In Malaysia, the term Traditional and Complementary

    Medicine (T&CM) is used to denote a practice of medicine that is

    other than the practice of medicine or dental practices utilised

    by registered medical or dental practitioners.

    In accordance with the World Health Organization (WHO)

    Trad it ional Medicine Strateg y 200 2 20051, member countries

    are:-

    To deve lop a policy that pr omotes the int egr ati on of TM/ CAMinto the national health care system.

    To pr omo te saf ety, ecacy, and qual it y of TM/ CAM serv ices

    and products.

    To i ncre ase the ava ilabil ity and aordabil it y of TM/CAM and

    To p romote rationale use of TM/ CAM.

    The se senti ments wer e repeated in the Beij ing Declarat ion

    20082

    , in which WHO states that participating countries should,in accordance with national capacities, priorities, relevant

    legislation and circumstances:

    a) Respect, preserve, protect and communicate widely and

    appropriately the knowledge of traditional medicine,

    treatments and practices;

    Chapter 1 Introducing... Traditional & Complementary Medicine

    Overview

    1

    1

    1.

    2.

    3.

    4.

    1World Health Organisation (2002) WHO Traditional Medicine Strategy. Geneva: WHO2Anon. (2011) Beijing Declaration 2008 [Online]. Switzerland: WHO. Retrieved from: http://www.who.int/medicines/areas/traditional/congress/beijing_declaration/en/index.html[Accessed 14th February 2011

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    b) Governments should formulate national policies, regulations

    and standards to ensure appropriate, safe and eective use

    of traditional medicine,

    c) To integrate traditional medicine into national health systems,

    d) To further develop traditional medicine based on research

    and innovation,

    e) To establish systems for qualication, accreditation or

    licensing of traditional medicine practitioners,

    f ) To strengthen the communication between conventional

    and traditional medicine providers.

    Trad it ional medicine has made a signi cant contribution to the

    health care of the Malaysian community. It continues to be

    patronised by our people in their bid to seek treatment for

    diseases and in maintaining health. In a recent study by Z.M Siti

    et al. published in the Journal of Complementary Therapy in

    Medicine in November 2009, it is found that the prevalence of

    use of T&CM amongst Malaysians in their lifetime was 69.4%

    (67.671.2%) and 55.6% (53.857.4%) within the last period of12 months of the study3. Realising this, the Ministry of Health

    took a positive and proactive approach in nurturing traditional

    and complementary medicine to ensure the quality and safety

    of practices and products of T&CM. The National Policy of

    Traditiona l and Complem entar y Medicine 2007 states tha t:

    Traditional/complementary medicine (T&CM) system shall be an

    important component of the healthcare system. It will co-exist

    with modern medicine and contributes towards enhancing the

    health and quality of life of all Malaysians.

    The gover nme nt wi ll faci litate the devel opmen t of T&C M in the

    country and ensure the quality and safety of practices and

    products of T&CM. It will support the identication of its health,

    economic and social benets.

    Thus, the Traditional and Complementary Medicine Unit was born

    in 1996 and later upgraded to the Traditional and ComplementaryMedicine Division (T&CMD) in the Ministry of Health in 2004.

    Denitions

    Malaysian perspective

    Currently, there is no universally

    agreed denition for Traditional

    Medicine and/or Complementary

    Medicine. However, the denition

    below shall be the basis of the

    Malaysian Governments approac h

    to the development of T&CM.

    2

    3Z.M. Siti, A. Tahir, A. Ida Farah, S.M. Ami Fazlin, S. Sondi, A.H. Azman, A.H. Maimunah, M.A. Haniza, M.D. Siti Haslinda, A.K. Zulkarnain, I. Zakiah, W.C. Wan Zaleha (2009) Use of traditional andcomplementary medicine in Malaysia: a baseline study', Complementary Therapies in Medicine, Vol. 17, No. 5, pp. 292-299.

    4Anon. (2007) The National Policy of Traditional and Complementary Medicine . 2nd ed. Kuala Lumpur: Traditional and Complementary Medicine Division.

    Figure 1.1: National Policy of Traditional and

    Complementary Medicine (Second Revision, 2007)

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    Traditional and Complementary Medicine is a form of

    health-related practice designed to prevent, treat, and/or manageillnesses and/or preserve the mental and physical well-being of

    individuals and includes practices such as traditional Malay

    medicine, Islamic medical practice, traditional Chinese medicine,

    traditional Indian medicine, homeopathy, and complementary

    therapies, and excludes medical or dental practices utilised by

    registered medical or dental practitioners.

    National Policy of Traditional & Complementary Medicine

    Ministry of Health Malaysia (2007)

    Globally

    a. WHO

    Traditional medicine is dened as diverse health practices,

    approaches, knowledge and beliefs incorporating plant,

    animal, and/or mineral based medicines, spiritual therapies,

    manual techniques and exercises applied singularly or in

    combination to maintain well-being, as well as to treat,

    diagnose or prevent illness.

    WHO Traditional Medicine Strategy 2002-2005

    Complementary medicine, in practice refers to a wide range

    of health interventions originating from dierent cultures

    across thousands of years of history.

    Scottish Oce Department of Health, Complementary Medicineand the National Health Services (London, November 1996)

    b. USA

    Complementary and Alternative Medicine (CAM) as dened

    by the National Center for Complementary and Alternative

    Medicine (NCCAM) is a group of diverse medical and health

    care systems, practices, and products that are not generally

    considered part of conventional medicine.

    NCCAM, USA (2007)

    c. UK

    Complementary and Alternative Medicine (CAM) is a title

    used to refer to a diverse group of health-related therapies

    and disciplines which are not considered to be a part of

    mainstream medical care. Other terms sometimes used to

    describe them include 'natural medicine', 'non-conventional

    medicine' and 'holistic medicine'.

    House of Lords, Parliament, U.K (November 2000)

    3

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    Classications of T&CM in Malaysia

    In Malaysia, Traditional and Complementary Medicine

    are classied into si x major groups. They are:

    1. Traditional Malay Medicine

    2. Traditional Chinese Medicine

    3. Traditional Indian Medicine

    4. Homeopathy

    5. Complementary Medicine

    6. Islamic Medical Practice

    Roles and functions of Traditional and

    Complementary Medicine Division (T&CMD),

    Ministry of Health Malaysia1. To regulate the practice of T&CM practitioners through

    T&CM Bo dies us in g a phas ed appr oach, fr om

    self-regulation to statutory regulations.

    2. To facilitate the development of T&CM practices and its

    integration into the national healthcare system.

    3. To establish a registry of all T&CM practitioners.

    4. To ensure all T&CM practitioners undergo a formalised

    system of education and training.

    5. To facilitate the developme nt of standards and criteria

    in T&CM, regulation and monitoring of accredited

    learning centres, setting the quality and standards of

    T& CM pr og ra mm es, an d to ev al ua te th ei r ee ct iv en es s.

    6 . To faci l itate and as a col laborator in research and

    scientic evaluation of T&CM modalities; towards

    promoting evidence-based medicine.

    The T&CM Division is situated at Jalan Cenderasari,

    Kuala Lumpur, with ve T&CM branch oces to

    date located in Pulau Pinang, Terengganu, Johor,

    Sarawak dan Sabah (Figures 1.2 and 1.3).

    4

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    T&CMD Headquarter and Branch Oces

    TRADITIONAL AND

    COMPLEMENTARY MEDICINE DIVISION

    MINISTRY OF HEALTH MALAYSIA

    BLOK E, JALAN CENDERASARI,

    50590 KUALA LUMPUR

    Tel No. : 0 3-2 69 85077

    Fax No.: 03-26911259

    http://tcm.moh.gov.my/

    Figure 1.2: Contact details of the Traditional & Complementary Medicine Division Headquarter,

    Ministry of Health Malaysia

    5

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    Figure1. 3: Contact details of T&CM Branch Oces.

    6 Contact details of T&CM Branch Oces

    7

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    The use of tr adit ional and complem ent ar y medicine is incr eas ing wor ldwide. In low - and middle -income count ries, up to 80% of the

    population may rely on T&CM for their primary health care needs. In many high-income countries, CAM utilisation is becoming

    increasingly popular, with up to 65% of the pop ulation reporting that they have used this form of medicine (Figure 2.1).

    Chapter 2 Development of T&CM - Globally and Locally

    Global Development

    60% 60%

    70% 70% 70%

    90%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    90%

    100%

    Uganda Tanzania Benin Rwanda India Ethiopia

    Use of Traditional Medicine to Help Meet Primary Health Care Needs in Developing Countries

    Figure 2.1: Percentage of use of T&CM amongst the populations of developing countries.

    Source: WHO Traditional Medicine Strategy: 2002 2005

    7

    8

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    Figure 2.2: Percentage of Populations in Developed Countries who have used

    CAM at least once.

    Source: WHO Traditional Medicine Strategy: 2002-2005

    48% 50%42%

    75%

    0%

    20%

    40%

    60%

    80%

    100%

    Populations in developed countries who have used CAM

    at least once

    40%

    Belgium

    Australia

    Canada

    USA

    France

    8

    Figure 2.3: Percentage of CAM use in USA.Credit: National Center for Complementary and AlternativeMedicine, NIH, DHHS

    9

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    Table 2 .1: Use of C AM f rom a pra ctit ion er (all t herap ies) in t he

    past 12 months by geographical region in Britain (2004)

    Source: Thomas K, Coleman P. Use of CAMs in a General Population in

    Great Britain. Journal of Public Health 2004 Vol. 26, No. 2, pp. 152157.

    Region Received CAM % 95% CI n = 100%

    Frequency

    England 152 10.0 8.611.7 1513

    Wales 10 10.0 5.517.4 100

    Scotland 17 9.8 2.315.1 174

    North 20 4.3 2.86.5 469Midlands and East Anglia 67 14.4 11.517.9 464

    London 12 7.4 4.312.5 162

    South East 32 12.5 9.017.1 256

    South West 21 13.0 8.619.0 162

    Figure 2.4: Percentage of CAM use by Race/Ethnicity among adults in US 2007.

    Credit: National Center for Complementary and Alternative Medicine, NIH, DH HS

    9

    10

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    International Collaboration in Traditional &Complementary Medicine

    Togethe r with the World Healt h Org ani sation (WHO ), Malay siahas made a signicant number of collaborations with many

    ASEAN countries, India and China in an eort to strengthen the

    base for traditional and complementary medicine in the

    country. An example is the Memorandum of Understanding

    (MOU) signed between Malaysia and the Peoples Republic of

    China in 2005 regarding cooperation on policy-making,

    regulation and promotion of traditional medicine. Five years

    later, Malaysia signed its second memorandum with India on thetraditional system of Indian Medicine.

    In 2008, Dr. Ramli Abd. Ghani, Director of T&CM Division was

    appointed as WHO temporary consultant for Interventional

    Regulatory Conference for Harmonisation (IRCH) on TM,

    marking a milestone for Malaysia in being recognised as a

    signicant contributor in T&CM. He subsequently attended IRCH

    meetings held in Montreal (2009) and Dubai (2010). Thereafter,

    several other bilateral meetings in T&CM were conductedbetween Malaysia and Thailand, Brunei and Indonesia.

    In 2009, Malaysia and WHO successfully organised a workshop

    on the Development of Harmonized Policy and Standards of

    Integrative Medicine amongst ASEAN countries. In 2010, at

    the 2nd ASEAN Traditional Medicine Conference in Vietnam,

    the separation of pharmaceutical products from traditional

    Source: Nahin, RL, Barnes PM, Stussman BJ, and Bloom B. Costs of

    Complementary and Alternative Medicine (CAM) and Frequency of

    Visits to CAM Practitioners: United States, 2007.

    National Health Statistics Reports; No. 18. Hyattsville,

    MD: National Centre for Health Statistics. 2009.

    Figure 2.5

    * Self care costs includes CAM products, classes and material.

    Relaxation techniques include relaxation, guided imagery, progressiverelaxation and deep breathing exercises.

    10

    Yoga, Tai Chi, Qi Gong

    classes $4.1 billion(12.0%)

    Homeopathic Medicine

    $2.9 billion (8.6%)

    Relaxation Techniques

    $0.2 billion (0.6%)

    CAM Out-of-Pocket Spending: Self-care* vs. Practitoner Costs

    Nonvitamin, Nonmineral, Natural

    Products $14.8 billion (43.7%)

    Practitioner Costs $11.9 billion

    (35.2%)

    Total Self-care Costs$22.0 billion (64.8%)

    Total Practitioner Costs$11.9 billion (35.2%)

    11

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    medicine was decided upon. In addition to that, two Malaysian

    representatives namely Dr. Shamsaini Binti Shamsuddin from the

    Traditiona l & Com plement ar y Medicine Division and Dr. Zakiah

    Ismail from the Institute for Medical Research were appointed as

    focal points of the TM Section in ASEAN countries.

    From time to time, Malaysia has aggressively pursued

    opportunities for cooperation whilst strengthening ties with

    both ASEAN and non-ASEAN countries through ocial visits,

    international conferences, seminars and attachment

    programmes to nurture the grounds of T&CM in Malaysia .

    Development of Traditional and ComplementaryMedicine Programme in Malaysia

    Before the 15th century, indigenous or traditional native medicine

    is the type of medicine practised by the Orang Asli of the Malay

    Peninsular and the Pribumi of Sabah and Sarawak. During this

    period, traditional Malay medicine was strongly inuenced by the

    animistic culture of Hindu-Buddhism, which ori ginated from India.

    Subsequently, with the introduction of Islam and with the

    arrival of the Chinese, the practice of medicine began to change,

    incorporating these new set of values. At about the same time,

    Traditional Chinese Medicine practices were intr oduc ed and

    Traditional Indian Medicine too began to take root in the soils of

    Malaya.

    At the end of the 19th century, modern medicine was br ought

    in by the British and was taken up quickly due to its ease of

    practice and eectiveness. During this period, complementary

    medicine also started to appear in the country.

    By the 20th century, modern medicine was the mainstream

    medicine practised i n Malaysia, with T&CM treatments available

    as a complement.

    Figure 2.6 (next page), demonstrates the chronology of events

    of development of T&CM in Malaysia. Subsequent pages show

    the T&CM Units at various hospitals and the services they

    provide.

    11

    12

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    Figure 2.6 : Timeline depicting the development of T&CM in Malaysia.

    2001

    Launch of NationalPolicy on T&CM

    1987

    Preparation ofproposal for

    research in

    alternative medicine

    1998

    Establishment of theT&CM Standing

    Committee

    1996

    Formation of theTraditional &

    Complementary

    Medicine (T&CM)

    Unit under theFamily Health

    Develoment

    Division

    2000

    Launch of HerbalMedicine Research

    Centre

    1999

    Formation of veUmbrella Bodies for

    T&CM

    2002

    Establishment ofGlobal Information

    Hub and National

    Committee in R&D

    on Herbal Medicine

    2004

    Establishment of theT&CM Division in

    Ministry of Health

    (MOH)

    2007

    Establishment of therst Integrated

    Hospital in Kepala

    Batas, Pulau Pinang

    2008

    Establishment ofT&CM services in

    Putrajaya Hospital,

    Putrajaya and

    Sultan Ismail

    Hospital, Johor

    2009

    Establishment ofregional T&CM

    oces in MOH:

    oNorthern region Pulau Pinang

    oSouthern region Johor Bahru

    oEastern region Kuala Terengganu

    oSabah KotaKinabalu

    oSarawak -Kuching

    2009

    Establishment ofT&CM Units at

    Sultanah Nur

    Zahirah Hospital in

    Kuala Terengganu,Duchess of Kent

    Hospital in

    Sandakan, Sabah

    and Sarawak

    General Hospital

    2011

    Establishment ofT&CM Unit in

    Sultanah Hajah

    Kalsom Hospital,

    Cameron Highlands,Pahang

    2010

    Establishment ofT&CM Units in Port

    Dickson Hospital,

    Negeri Sembilan

    and Sultanah

    Bahiyah Hospital in

    Alor Setar, Kedah

    12

    13T&CM Units at Integrated Hospitals in the Ministry of Health (2011)

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    Figure2.7: T&CM Units at Integrated Hospitals in the Ministry of Health (2011)

    13T&CM Units at Integrated Hospitals in the Ministry of Health (2011)

    14

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    Acupuncture

    Putrajaya Hospital

    Sultan Ismail Hospital

    Kepala Batas Hospital

    Sultanah Nur ZahirahHospital

    Duchess of Kent Hospital

    Sarawak Public Hospital

    Port Dickson Hospital

    Sultanah Bahiyah Hospital

    Sultanah Hajah KalsomHospital

    Malay

    Massage

    Putrajaya Hospital

    Sultan Ismail Hospital

    Kepala Batas Hospital

    Sultanah Nur ZahirahHospital

    Duchess of Kent Hospital

    Sarawak Public Hospital

    Port Dickson Hospital

    Sultanah Bahiyah Hospital

    Sultanah Hajah KalsomHospital

    Herbal Therapy as

    an Adjunct

    Treatment for

    Cancer Patients

    Hospital Umum Sarawak

    Kepala Batas Hospital

    Sultan Ismail Hospital

    Putrajaya Hospital

    Hospital Umum Sarawak

    Sultan Ismail Hospital

    Putrajaya Hospital

    Malay

    Postnatal

    Treatment

    T&CM Practices Available at the Integrated Hospitals

    Table 2 .2: T&CM Prac tice s ava ilabl e at the I ntegrated Hosp itals

    14

    15

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    T&CM Units at the Integrated HospitalsT&CM Units at the Integrated Hospi

    T&CM Unit

    Kepala Batas Hospital

    Jalan Bertam 2

    13200 Kepala Batas

    Pulau Pinang

    Tel: 604- 5793333, ext 113

    Fax: 604-5791088

    Email: [email protected]

    T&CM Unit

    Putrajaya Hospital

    Ground FloorPutrajaya Hospital

    Precinct 7, 62250 Putrajaya

    Tel: 603- 83124200

    Fax: 603-88880137

    Email: [email protected]

    16

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    T&CM Units at the Integrated Hospitals&CM Units at the Int

    T&CM Unit

    Sultan Ismail Hospital

    Jalan Persiaran Mutiara Emas Utama

    Taman Moun t Austi n

    81100 Johor Bahru Johor

    Tel: 607- 3565000

    Fax: 607-3565034

    T&CM Unit

    Sultanah Nur Zahirah Hospital

    Jalan Sultan Mahmud

    20400 Kuala Terengganu

    Terengganu

    Tel: 609- 6212121, ext: 2394

    Fax: 609-6221820/ 609-6227139

    Email: [email protected]

    17

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    T&CM Units at the Integrated HospitalsT&CM Units at the Integrated Hos

    T&CM Unit

    Duchess Of Kent HospitalKM 3.2 Jalan Utara

    90000 Sandakan

    Sabah

    Tel: 6089-212111

    Fax: 6089-219359

    Email: [email protected]

    T&CM Unit

    Sarawak General Hospital

    Jalan Tun Ahmad

    Zaidi Adruce,93586, Kuching,

    Sarawak

    Tel: 6082-276666, ext 51 50

    Fax: 6082-276703

    Email: [email protected]

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    T&CM Unit

    Port Dickson Hospital

    KM 11, Jalan Pantai 71050 Si Rusa

    Port Dickson

    Negeri Sembilan

    Tel: 606- 66263 33

    Fax: 606-6625003

    Email: [email protected]

    T&CM Unit

    Hospital Sultanah Hajah Kalsom

    Jln Persiaran

    Dayang Endah

    39000 Tanah Rata

    Pahang

    Tel: 05 49119 66

    Fax: 05 4913355

    T&CM Units at the Integrated Hospitals

    Unit

    Port Dickson Hospital

    KM 11, Jalan Pantai 7

    Port Dick

    &CM Units at the Int d

    Tel: 05 49119 66

    Fax: 05 4913355

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    T&CM Unit

    Sultanah Bahiyah Hospital

    Blok T

    Sultanah Bahiyah Hospital

    Lebuhraya Darulaman

    Alor Setar

    Kedah

    Tel: 04-740 6233

    Fax: 04-735 0232

    T&CM Units at the Integrated Hospitals

    T&

    Sult

    Blok

    Sul

    Leb

    Alor

    Ked

    Tel:

    ax:

    osp ta s

    20

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    Chapter 3 Modalities in T&CM

    The modern med ical syste m intr oduces fou r

    main concepts that are curative, therapeutic,

    and palliative or wellness. However, T&CM a

    adopts the concept of therapeutic and wellness

    only only (Table 3.1).

    The rapeutic conce pt refer s to hea ling, such as a

    form of medicine or therapy that has the

    capability to help in treating a disease or

    disability. It is used for either physical and

    mental health, which may be a drug, substance

    or an activity that supports the healing of one's

    mental or emotional health.

    On the other hand, wellness concept refers to

    modalities that assist in balancing positivehealth in an individual as exemplied by quality

    of life and a sense of well-being.

    Therapeutic Versus Wellness ConceptTreatment conceptType of practice

    Therapeutic Wellness

    Islamic Medical

    Practice

    Islamic Medical Practice

    (Ruqyah)

    Traditional Malay

    Medicine

    Herbal Medicine

    Urut Melayu (Malay Massage)

    Indigenous Massage

    Bekam (Cupping)

    Urut Melayu

    (Malay Massage)

    Indigenous Massage

    Traditional

    Chinese Medicine

    Herbal Medicine

    Acupuncture andMoxibustion

    Tuinalogy

    Cupping

    Qi Gong

    Tabl e 3 .1: Modal it ies in T&C M Pra ct ic es.

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    The re are a number of modalities estab lished by

    Malaysians which creatively infuses dierent

    knowledge and techniques into a new,

    combined form of therapy. Colour Vibration

    The rapy and Aur a Metaphy sic are examp les of

    home-grown modalities.

    Home-grown ModalitiesTreatment conceptType of practice

    Therapeutic Wellness

    Traditional Indian

    Medicine

    Ayurveda

    Siddha

    Unani

    Yoga

    Homeopathy Homeopathy

    Complementary

    Medicine

    Chiropractor

    Naturopathy

    Osteopathy

    Nutritional therapy

    Hypnotherapy

    Psychotherapy

    Therapeutic Massage

    Spa Therapy

    Reexology

    Aromatherapy

    Thai massage

    Swedish massage

    Balinese/Javanese massage

    Shiatsu massage

    Colour Vibration TherapyCrystal Healing

    Reiki

    Aura metaphysic

    Raoha

    Ozone Therapy

    Chelation Therapy

    Note: Please refer the Glossary, for description of each modality.

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    The pr actitione r must exe rt pr ofe ssional ism at

    all times especially during consultation sessions

    with the client and should follow the rules and

    regulations as stipulated in the Code of Ethicsand Conduct of T&CM Practitioners. Listed below

    is a guide to what a practitioner is allowed and

    not allowed to practice for a particular modality.

    The Scope of Practice of T&CM Modalities

    Permitted Practices Prohibited PracticesType of practice

    Islamic Medical

    Practice

    Islamic Medical Practice

    (Ruqyah)- Based on Al-Quran

    Misuse of the Holy Quran (physically and

    Quranic verses) Bedah batin (virtual surgery)

    Use ofazimat(amulet), tangkal(talisman), susuk(charm needles)

    Use of black magic

    Traditional Malay

    Medicine

    Herbal Medicine Misuse of the Holy Quran (physically andQuranic verses)

    Bedah batin (virtual surgery)

    Use ofazimat(amulet), tangkal(talisman), susuk(charm needles)

    Use of black magic

    Traditional

    Chinese Medicine

    Urut Melayu(Malay Massage),Indigenous Massage

    Tabl e 3.2 : Wh at is all owed or not a llo we d t o be pra cti ced for eac h T&CM modal ity. List

    of permitted practices for each T&CM modality.

    Bekam (Cupping) Bekam lintah (Leech Therapy)

    Acupuncture using gadgets

    TraditionalIndian Medicine

    AyurvedaSiddhaUnaniYoga

    Yoga cannot be practised by Muslim as it isprohibited by the religion (refer to Fatwa

    Majlis Kebangsaan Bagi Hal Ehwal Ugama

    Islam Malaysia Kali Ke-83)

    Homeopathy Homeopathy

    Acupuncture andMoxibustion

    Herbal Medicine

    Tuinalogy

    Cupping

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    All T&CM Practitoners are required to adhere to

    guideline for ethical conduct, as outlined in the

    Code of Ethics and Code of Practice for

    Traditiona l and Complemen tar y MedicinePractitioners (Figure 3.1) at all times during the

    provision of services to the public.

    Figure 3.1: Code of Ethics & Code Of Practice for T&CM Practitioners.Note: Claims of treating acute conditions are prohibited

    Permitted PracticesSubgroupType of practice

    Complementary

    Medicine

    Manipulative therapy Chiropractic

    Reexology

    Osteopathy

    Massage:

    Therapeutic

    Swedish

    Thai

    Balinese/Javanese

    Shiatsu

    Energy medicine Reiki

    Aura metaphysics

    Colour vibration therapy

    Crystal healing

    Bach ower

    Raoha

    Biological based Aromatherapy

    Nutritional therapy

    Mind-body therapy Hypnotherapy

    Meditation

    Psychotherapy

    Others Chelation & Ozone Therapy is only for

    practitioners with a medical degree(allopathic medicine)

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    Chapter 4 EBP in Supporting Development of T&CM Practices

    EBP Evidence-Based Practice

    EBP is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual

    patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research5.

    Evolution of the denition:

    EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient

    care. Clinical expertise r efers to the clinician's c umulated experience, education and clinical skills. The patient brings to the encounter

    his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant

    research that has been conducted using sound methodology6.

    Evidence-based Medicine

    Evidence-based medicine (EBM)

    is the conscientious, explicit and

    judicious use of current best

    evidence in making decisions

    about the care of individual

    patients

    Evidence-based Healthcare

    Evidence-based health care

    (EBH) is the conscientious use of

    current best evidence in making

    decisions about the care of

    groups of individuals or the

    delivery of health services

    Evidence-based Practice

    Evidence-based practice (EBP) is

    the application of such principles

    across the broad field of health

    care, including policy making,

    education, practice management

    and health economics

    5Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn't [Online]. US: BMJ Publishing Group Ltd. Retrieved from: http://www.bmj.com/content/312/7023/71.full [Accessed 1st February 2011].

    6Anon. (2010) Introduction to Evidence-Based Practice [Online]. US: Duke University Medical Center Library and Jill Mayer University of North Carolina at Chapel Hill Health Sciences Library. Retrievedfrom: http://www.hsl.unc.edu/services/tutorials/ebm/index.htm [Accessed 1st February 2011].

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    The evidence does not mak e a decision but it ca n hel p

    to support the patient care process. Integration of these

    three components into clinical decisions enhances the

    opportunity for optimal clinical outcomes and patients

    quality of life. The practice of EBP are usually attemps at

    answering questions about the eects of therapy, utility

    of diagnostic tests, prognosis of diseases, or the

    etiology of disorders triggered by patient encounter.

    Evidence-Based Practice requires a clinician to obtain

    new skills such as ecient literature searching and

    evaluation of the clinical literature by applying formal

    rules of evidence.

    Even though EBP has evolved over the years based on

    allopathic medicine, there should be no barriers in

    applying the process to T&CM practices.

    Steps involved in the EBP Process

    ASSESS

    the patient

    1. Start with the patient a clinical problem

    or question that arises form care of thepatient

    ASK

    the question

    1. Construct a well built clinical question

    derived from the case

    ACQUIRE

    the evidence

    3. Select the appropriate resource(s) and

    conduct a search APPRAISE

    APPRAISE

    the evidence

    4. Appraise that evidence for its validity

    (closeness to the truth) and applicability

    (usefulness in clinical practice)

    APPLY:talk with thepatient

    5. Return to the patient integrate thatevidence with clinical expertise, patient

    preferences and apply it to practice

    Self-

    evaluation

    6. Evaluate your performance with this

    patient

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    Use of EBP in Developing T&CM Guidelines

    An immediate attraction of EBP is that it integrates medical

    education and clinical practice. It has the potential of improving

    continuity and uniformity of care through the common

    approaches and guidelines developed by its practitioners. It

    provides common framework for problem solving and helps

    providers make use of limited resources by enabling them to

    evaluate clinical eectiveness of treatments and services, whilst

    eliminating unsound and unsafe practices.

    Upon approval of the proposal to set up an Integrative Medical

    Programme by the Malaysian Cabinet in January 2006, severalguidelines that are supported by EBP were developed to

    support the T&CM services provided at selected government

    hospitals. The Integrative Medical Programme aims to

    incorporate selected T&CM practices into the mainstream

    healthcare system, and the hospitals involved are termed as

    Integrated Hospitals. Incorporating T&CM practices into the

    mainstream healthcare system does not only achieve a holistic

    approach towards enhancing health and improving quality oflife, but also enables the protection and preservation of

    valuable traditional knowledge.

    To suppor t the impleme ntati on of T&CM in the countr y, T&C M

    Division produces two types of guidelines, aiming at two

    dierent categories of practitioners;

    At the time of publication of this book, T&CM Division has

    published the following guidelines (Table 4.1a and 4.1b) which

    have been used in integrating T&CM practices into the mainstream

    healthcare system.

    PracticeGuideline

    For the use of practitioners in theIntegrated Hospitals

    Good PracticeGuidelines

    Consensus guidelines forpractitioners practicing in Malaysia

    Tabl e 4. 1a: Gui de lin es dev elo ped by T &CM D iv is ion.27

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    Old Publication (2007) Revised Publication (2009)

    Developed Guidelines

    (2007)

    Reviewed Guidelines

    Guideline on Herbal Therapy as an

    Adjunct Treatment for Cancer

    Standard Operating Procedures

    for T&CM Unit

    Standard Operating Procedures

    for T&CM Unit

    Gui deline on Malay Postnatal Care Guideli ne on Malay Massage Gui deli ne o n Malay Massage

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    Work in progress is directed towardsthe following guidelines;

    1. Practice Guideline on Shirodhara

    2. Practice Guideline on Homeopathy

    3. Practice Guideline on Chiropractic

    4. Garis Panduan Pengubatan Islam (Practice

    Guideline on Islamic Medical Practice)

    Tabl e 4 .1b: Gui de lin es dev elo ped by T &CM Divis ion.

    Old Publication (2007) Revised Publication (2009)

    Reviewed Guidelines

    Good Practice Guidelines (2010)

    Guideline on Acupuncture Guideline on Acupuncture

    Good Practice Guideline

    on Malay Massage

    Good Practice Guideline

    on Acupuncture

    Good Practice Guidelines (2011)

    Good Practice Guideline

    on Reexology

    Garis Panduan Perkhidmatan Spa

    (Spa Services Guideline)

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    Chapter 5 Education & Training

    Thr oug h colla borations between the T&C M Division with

    various governmental agencies, several education and trainingprogrammes were developed for the various T&CM modalities.

    The aim of the se pr ogramme s wer e to ens ur e tha t all T&C M

    practitioners acquire standardised and internationally accepted

    knowledge and skills through means of formal education to

    ensure the delivery of T&CM servic es of the highest quality.

    In Malaysia, the education pathway is compri sed of three higher

    educational sectors, as outlined by the Malaysian Qualications

    Framework (MQF) in Figure 5.1. They are the skills, vocational

    and technical and academic (university) sector. Each sector is

    supported by lifelong education pathways and is dierentiated

    by learning outcomes, credit hours and student learning time.

    In total, there are eight levels of qualications. Levels 1 to 3 are

    Skills Certicates awarded by the Skills Sector. Academic and

    Vocational and Technical Certicates are at Level 3. Meanwhile,

    Diploma and Advanced Diploma are at Levels 4 and 5. BachelorDegree is at Level 6, Masters Degree at Level 7 and for the

    Doctorates, Level 87.

    T&C M Division classie s the level of education and training

    programmes for each T&CM modality based on the therapeuticor wellness concept (as discussed in Chapter 3). Modalities that

    fall under the therapeutic concept are to follow the academic

    pathway whilst those in the wellness concept are to be obtained

    through the certicate training programme (or the skills sector).

    For the academic sector, thirteen standards and criterias for

    diploma and bachelor degree have been developed to support

    the provision of education programmes by both the public and

    private centres of higher education. To date, seven bachelor

    degree programmes and six programmes for diploma, as

    outlined in Table 5.1, have been established and the courses are

    presently being oered by the local institutions listed in Table

    5.2.

    In addition, the Malaysian Public Service Department has

    recognised three universities from the Peoples Republic of

    China to award the degree programmes listed in Table 5.3.

    MQF BASED QUALIFICATION LEVEL AND EDUCATIONAL PATHWAY30

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    Figure 5.1: Malaysian Qualifications Framework.

    * Further information can be obtained from the Malaysian Qualications Agency (MQA) at www.mqa.gov.my.

    Bachelor Educational Programme

    Bachelor of Traditional Chinese Medicine (Acupuncture)

    Bachelor of Traditional Chinese Medicine

    Bachelor of Complementary Medicine (Natural Medicine)

    Bachelor of Homeopathy

    Bachelor of Malay Medicine

    Bachelor of Ayurveda Medicine

    Bachelor of Chiropractic

    Diploma Training Programme

    Diploma in Malay Massage

    Diploma in Traditional Chinese Medicine (Acupuncture)

    Diploma in Natural Medicine

    Diploma in Aromatherapy

    Diploma in Islamic Medicine

    Diploma in Reflexology

    Tabl e 5 .1: Bac hel or s a nd di plo ma educa tion al pro gr amm es de vel ope d by MQA.

    The ed cational pr ogramme s be lo are pr esentl being pr o ided b the follo ing p bl ic and pr i ate ins ti t tions

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    Source: Public Sector Department of Malaysia (http://pengiktirafan.jpa.gov.my)

    Tabl e 5.3 : T&CM de gre e c ou rse s and uni ver si ties fro m Peop les Rep ubl ic of Ch ina whi ch are rec ognised by the Mal ays ian Pub lic Sec tor Dep ar tme nt .

    Tabl e 5.2 : I nst itut ions pro viding T &CM cou rse s in Ma lay sia.

    The educational pr ogramme s be low are pr esently being pr ovided by the follo wing publ ic and pr ivate ins ti tutions :

    InstitutionsNo.

    1. Southern College, Skudai University Foundation For Degree Programme (Traditional

    Chinese Medicine)

    Bachelor Degree of Traditional Chinese Medicine 4+1 incollaboration with Xiamen University, China

    2. Tunku Abdul Rahman University (Sungai Long Campus) Bachelor of Traditional Chinese Medicine (Hons)

    3. INTI International University College Bachelor of Traditional Chinese Medicine (Hons)

    4. Cyberjaya University College of Medical Sciences (CUCMS) Bachelor of Homeopathy (Hons)

    5. Management and Science University (MSU) Bachelor in Traditional Chinese Medicine (Hons)

    Diploma in Traditional Chinese Medicine

    6. International Medical University (IMU)

    Bachelor of Science (Hons) Chinese Medicine Bachelor of Science (Hons) Chiropractic

    7. Malacca College of Complementary Medicine Diploma in Natural Medicine

    Courses Oered

    To date , three univer sities fr om the Peo ples R epublic of China hav e been re cogni sed by the Pub lic Sect or Dep ar tme nt of Mal ays ia

    to provide the following education programmes:

    InstitutionsNo.

    1. Beijing University of Chinese Medicine (BUCM) Bachelor of Chinese Medicine

    2. Nanjing University of Chinese Medicine (NUCM) Bachelor of Chinese Medicine (Clinical Medicine)

    3. Shanghai University of Traditional Chinese Medicine (SHUTCM) Bachelor of Medicine (Traditional Chinese Medicine)

    Courses Oered

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    Currently, T&CM Division together with the Ministry of Higher

    Education and the Malaysian Accreditation Agency (MQA) have

    introduced an Advanced Diploma for Urut Melayu as a Training

    of Trainers programme. It is a one-o, one year programme at

    the Sultan Salahuddin Abdul Aziz Shah Polytechnic, Shah Alam.

    The rst batch o f students will be graduat ing in August 201 1.

    In the skills sector, the standards and criteria for the issuance of

    a skills certicate are dened in the National Occu pational Skills

    Standard (NOSS). NOSS is a specication of the competencies

    expected of a skilled wor ker, who wishes to gain employment in

    Malaysia for an occupational area and level.

    Development of NOSS involves the participation of industrial

    experts from the Department of Skills Development (DSD),

    under the auspices of the Ministry of Human Resources. NOSS is

    used by DSD accredited training centres to oer skills training

    for the specied modalities. Individuals who have completed

    their training under the skills programme will be awarded the

    Skills Certicate by DSD, which is a formal recognition to

    individuals who has shown capabilities and competencies to

    carry out the specied modality. These skills training

    programme are being oered by the government in Malaysia,

    and not by a Non-Governmental Organisation as practiced in

    other countries.

    As of 2010, six T&CM modalities have been developed under the

    Malaysian Skills Qualications. This includes reexology,

    aromatherapy, massage, manual lymph drainage, crystal

    healing and spa. These NOSSs are part of the eort to promote

    lifelong training and development, upgrading the competen-

    cies and enhancing the competitiveness of Malaysians involved

    in the industry. More Malaysian Skills Qualications will be

    developed for T&CM modalities in the near future. More

    information on NOSS can be obtained from the Department of

    Skills Development at www.dsd.gov.my.

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    Chapter 6 Research in T&CM

    T&CM is curr ently consi dere d an im port ant component of the

    healthcare system. Its co-existence with modern medicinecontributes towards enhancing the health and quality of life of

    Malaysians. In support of the Malaysian National Policy on

    T&CM, especiall y in ensuri ng the quali ty and saf e use of T&CM

    products and practices, Research and Development (R&D)

    Section was formalised in T&CM Division in August 2008.

    The objectives of this section are:

    1. To prioritise, encourage, facilitate and conduct research

    on T&CM practices and products

    2. To establish methods and technologies for quality

    control, safety and ecacy of herbal medicines and

    traditional remedies

    3. To set up T&CM information database to support

    information needs for healthcare providers, consumers,

    manufacturers and other related agencies

    The intr oduction of T&C M mod al it ie s in integ rated hospit als in

    Malaysia opens the opportunity for more T&CM research in

    clinical practice.

    Current research eorts carried out by the R&D section focuses

    on integrative medicine such as urut Melayu, acupuncture and

    use of herbal medicine as an adjunct therapy in oncology.

    Presently, the studies conducted uses case reports, surveys andqualitative techniques. Future studies will look into areas of

    eectiveness of these modalities.

    The T&C M R& D sect ion colla bora tes closely with the National

    Institutes of Health (NIH), Ministry of Health in the conduct of its

    research. This section participates actively in presentations at

    scientic meetings and conferences.

    The r st ar ticle on urut Melayu was published in the Journal ofAlternative and Complementary Medicine (JACM), November

    2010 edition and more publications shall be pursued.

    One of the activities to promote research on herbal medicines

    was the annual workshops conducted in collaboration with the

    National Conference for Clinical Research (NCCR). Currently,

    eorts are being made for product development under the

    National Key Economic Areas (NKEA) based on ve selected

    herbs such as Tongkat Ali, Kacip Fatimah, Misai Kucing,

    Hempedu Bumi and Dukung Anak. It is a crucial step to ensure

    the availability of raw products as Malaysia strives to become

    the leader in the production of nutraceuticals and botanical

    drugs8.

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    Another initiative by the Malaysian government in promoting

    integrative medicine is through the development of a portal for

    information sharing: Global Information Hub on Integrated

    Medicine (GLOBINMED) at www.globinmed.com.

    Apart from conducting researches, T&CM R&D section provides

    consultation for interested parties to conduct researches on

    T&CM modalities, in a bid to incr ease the availab il it y of

    evidences, thus promoting evidence based practice.

    For those interested to conduct research on T&CM in the

    Ministry of Health institutions and facilities, the NIH Guidelines

    for Conducting Research in the MOH Institutions and Facilities,

    provides the guide and it can be downloaded from the NIHwebsite at www.nih.gov.my.

    The gui deline re quir es:

    1. Registration of all research that involves MOH personnel or

    that is to be conducted in MOH facilities or to be funded by

    MOH research grants

    2. Review and approval of the research by a designated entity

    to whom authority has been delegated for the purpose

    3. Research involving human subjects requires prior review and

    approval by the MOH Research and Ethics Committee (MREC)

    4. Approval from the Director General of Health for all research

    publications, whether in the form of research report, journal

    article or conference proceeding, by the NIH initially and

    thereafter by the Director General of MOH

    Figure 6.1: GLOBINMEDs homepage

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    A Qualitative Study On Urut Melayu The Traditional Malay Massage

    8th Ministry of Health Malaysia Academy of Medicine of Malaysia Scientic Meeting 2009

    Urut Melayu for Post-Stroke Patients: A Qualitative Study

    Asia-Pacic Primary Care Research Conference 2009

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    Chapter 7 Promotional, Enforcement & Public Education Activities

    Promotional Activities

    In order to increase consumer knowledge and awareness aboutT&C M serv ices in Malay sia, T&C M Division has condu ct ed

    numerous promotional activities through road shows,

    exhibitions and public talks, including television and radio talks

    since the year 2007. These activities involve the participation of

    various parties such as government agencies, practitioner

    bodies and non-governmental organisations (NGOs).

    Apart from that, the T&CM Division regularly organise ContinuingMedical Education (CME) and Continuing Professional Development

    (CPD) activities for sta members of the Ministry of Health as well

    as conferences, workshops and public forums for the general public.

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    T& CMD B ull eti n Vol ume 1

    (Sept Dec 2006)

    T&C MD Bul let in Vo lum e 2

    (Jan Jun 2007)

    T& CMD Bul let in Vo lum e 3

    (Jun Dec 2007)

    T&C MD Bul let in Vo lum e 4

    (2008)

    T& CMD Bul let in Vo lum e 5

    (Jan Jun 2009)

    T&C MD Bul let in Vo lum e 6

    (Jun Dec 2009)

    T& CMD Bul let in Vo lum e 7

    (Jan Jun 2010)

    T&C MD Bul let in Vo lum e 8

    (July Dec 2010)

    During the course of these promotional activities, we have distributed various pamphlets, posters, books and bulletins to stimulate

    public awareness towards the various typ es and benets of T&CM modalities.

    Tabl e 7 .1 : T &CM Divis ion Bul let in s.

    Tabl e 7 2: Pos ter s by T &CM Divis ion

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    Traditional Malay Massage:

    A Qualitative Study

    Traditional Malay Massage for Post

    Stroke Patients: A Qualitative Study

    Haram Practices in

    Trad it io nal Med ic in e

    Services in T&CM Units in

    Integrated Hospitals

    T&C MD Ann ual Rep or t 2007 T& CMD An nua l R epo rt 2008 T&C MD Ann ual Rep or t 2009 T& CMD A nnu al Rep or t 2010

    Tabl e 7. 2: Pos ter s by T &CM Divis ion.

    Tabl e 7. 3: Ann ual Re por ts.

    Table 7 4 : P amp hle ts

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    Table 7.4 : P amp hle ts.

    Traditional Malay Practices in Post Natal CareAcupuncture Traditional Malay Massage

    Common Mistakes Found in the Practice of T&CMPhilosophy and Function of T&CMD

    Promotion of T&CM Modalities

    Public Education

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    e-Pengamal Registration forTraditional & Complementary Medicine Practitioners

    Guidelines Before SeekingTraditional & Complementary Services in Malaysia

    8 Registered Practitioner BodiesIn Malaysia

    Public Education

    Inspection Activities

    The Inspectorate and Enforceme nt Se ct ion (I&E) of T&CM

    Division have successfully carried out enforcement activities

    such as mapping and inspection of premises as well as

    consumer/ public education throughout Malaysia. The I&E

    section have collaborated with other governmental agencies

    such as the Pharmacy Enforcement Division, Immigration

    Department, Private Practice & Medical Control Section (CKAPS)

    and City & Local Government Councils in carr ying out integrated

    enforcement activities. In addition, I&E section also contri buted

    to the development of the Traditional and Complementary

    Medicine Bill which is planned to be tabled in the Parliament

    late 2011. Once gazetted, surveillance of T&CM services in

    strengthened will be strengthened whereby only qualied

    T&CM pr acti tioners ar e eli gible to re giste r with the Ministry of

    Health and be allowed to practice.

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    Public Education

    Consumer education is the best way to ensure public safety.

    T&CM Division actively or gan ises consu mer edu cation activities

    and publications that primarily educates the public on variousT&C M mod al it ie s, the impleme nta tion, safet y and ecacy of

    T&C M serv ices in Malay sia as wel l the re quirement for

    registration for all T&CM practitioners of traditional and

    complementary medicine.

    Some examples on the messages for the public are highlighted

    below:

    You might ask #2

    I chanced upon an advertisement which featured a new

    concept in alternative medicine (previously unheard of)

    and was deemed capable of treating various diseases. Can

    I believe this statement?

    Our answer to you: Understand the newtreatment concept

    Dear consumer, do not be deceived by new treatment

    concepts with miraculous claims. All treatment types, be it

    modern, traditional or complementary should be

    supported with existing proles of quality, safety and

    ecacy. Each treatment has to be subjected to a battery

    of clinical trials over a period of time before it can be

    safely introduced to the public. Do not try any of these

    treatments if you are not condent of its safety and

    eectiveness and check with the Ministry of Health if you

    have any doubts.

    You might ask #1

    There are adver tisements that provide statements such as

    scientically proven, proven eective, based on Western

    technological advancement, acknowledged by the Ministry

    of Health and many more. Are these statements for real?

    Our answer to You: Questionable statements

    and testimonials

    Advertisements that provide statements such as scientically

    proven, proven eective, based on Western technological

    advancement, acknowledged by the Ministry of Health etc

    should be conrmed before one places condence or believes in

    a particular treatment. When in doubt, do not hesitate in seeking

    advice from a doctor or a Ministry of Health representative.

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    What should you do rst?

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    1. Ask the practitioner for his valid certicate. Why?

    Practicing certicates are issued by Practitioner Bodies appointed by the Ministry of Health

    Malaysia. This certicate will indicate that the practitioner is qualied. Cant identify which

    certicate is the genuine one? These are the logos of the currently appointed Practitioner

    Bodies.

    Federation of Chinese Physicians

    & Acupuncturists

    Association of Malaysia

    (FCPAAM)

    Pertubuhan

    Perubatan Tradisional

    India Malaysia

    (PEPTIM)

    Federation of Chinese Physicians

    and Medicine-Dealers

    Associations of Malaysia

    (FCPMDAM)

    The Federation of Complementary

    & Natural Medicine

    Association Malaysia

    (FCNMAM)

    Malaysian

    Chinese Medical Association

    (MCMA)

    Persatuan Kebajikan

    dan Pengubatan

    Islam Darussyifa

    Majlis Perubatan

    Homeopathy Malaysia

    (MPHM)

    Gabungan Pertubuhan Pengamal

    Perubatan Tradisional

    Melayu Malaysia

    (GAPERA)

    1.

    ra

    Ma

    cer

    o

    Fed

    The

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    2. Do nt be ea si ly in uen ced by the fron t title Dr. Why?

    Besides the Doctor of Philosophy (PhD), only those registered with

    the Malaysian Medical Council, under the Medical Act 1971, can

    use the title Dr. Otherwise, it is ag ainst the Act. Do be alert on this

    when you enter any traditional or complementary medicine centre.

    3. Ask the practitioner whether he has been registered

    with a Practitioner Body or the MOH. Why?

    Registration with a Practitioner Body will conrm his qualication

    to practice. Normally they will be given a practicing certicate by

    the Practitioner Body. MOH has begun its registration on all

    pra ct it ione rs si nc e Novem ber 2008 . To ch ec k, pl ease emai l us at

    [email protected] call us at 03-26985077.

    4. Ensure that the health products or herbal medicines

    supplied are registered with MOH. Why?

    In ou r mar k e t s u r v e y , 12% of T& CM p r ac t i t i one r s we r e f ou nd

    supplying unregistered products to their customers. How do

    y ou c he ck ? S im pl e, j us t l ook fo r t he pr odu c t re gi s tr at i on nu

    mb e r ( e . g. : MAL 05051150TC) and t he Mi ni s t r y of He al t h

    ( MO H) hol ogr am s t i c k e r . S t i l l i n d ou b t ? Che c k onl i ne at

    ht t p : //p or t al . b p f k. gov . my /pr od u c t _ s e ar ch. c f m

    44

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    5. If you are a woman, please do not be alone with any

    T&CM male practitioners during treatment. Why?

    There have been incidences of molestation, pederasty and rape

    reported when women were found alone with T&CM male

    pra cti ti oners .

    45

    Glossary

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    Glossary

    Description of Traditional & Complementary Medicine Modalities

    TYPE OF PRACTICE TYPE OF MODALITY

    Islamic Medical Practice Islamic Medical The eort at seeking treatment for physical and spiritual ailments; done by a Muslim who is

    Practice knowledgeable and skilled in treatment methods using Quranic verses, Hadith, the practices

    of the pious and righteous scholars, and of the venerated religious teacher; and also skilled

    with the use of methods or materials permitted by the Islamic law.

    Traditional Malay Malay Herbs The herbs are used as a complement to various physical diseases/conditions or for wellness

    Medicine based on Malay community beliefs

    Urut Melayu Massage is the use of hands, or mechanical means, to manipulate the soft tissues of the body,

    (Malay Massage) particularly muscle. It can be used for relaxation, stimulation or rehabilitation of the whole

    body or part of it. It promotes suppleness of the muscle, improves circulation and reduces stress.

    Bekam (Cupping) Bekam (cupping) is a form of traditional medicine practice found in many cultures worldwide.

    It involves placing cups containing reduced air or pressure (creating suction or a relative

    vacuum) on the skin. It is known in other languages as badkesh, bahnkes, nuhang, bantusa,

    kuyukaku, gak hoi, hijamah and many other names.

    Traditional Chinese Acupuncture & Technique of inserting and manipulating ne liform needles into specic points on the body

    Medicine Moxibustion to relieve pain or for therapeutic purposes associated with or without moxibustion that

    involves the burning of mugwort, a small, spongy herb, to facilitate healing.

    Chinese Herbs The herbs are used as a complement to various physical diseases/conditions or for wellness

    based on Chinese community beliefs and based on the Chinese Materia Medica.

    DESCRIPTION

    Spa Therapy The term spa is associated with water treatment which is also known as balneotherapy.

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    Therapy for the promotion of water-based treatments which include body wraps, body

    scrubs, baths, etc. Whose main services consist of water based applications.

    Reexology Is the practice of massaging, squeezing, or pushing on parts of the feet, or sometimes the

    hands and ears, with the goal of encouraging a benecial eect on other parts of the body, or

    to improve general health and well being.

    Thai Massage Incorporates elements of mindfulness, gentle rocking, deep stretching, and rhythmic

    compression to create a singular healing experience

    Swedish Massage Refers to a variety of techniques specically designed to relax muscles by applying pressure

    to them, and rubbing in the same direction as the ow of blood returning to the heart.

    Balinese/Javanese Positioned above the client, the Balinese/Javanese massage therapist performs a

    Massage combination of kneading strokes, skin rolling, and foot massage. Treatment is followed by an

    application of coconut oil infused with spices.

    Shiatsu Massage Also known as acupressure massage. The therapist applies pressure with his thumbs, nger,

    and palms to specic areas of the client's body that have been determined during an

    assessment period prior to the massage session.

    Aromatherapy Uses volatile liquid plant materials, known as essential oils (EOs), and other aromatic

    Massage compounds from plants for the purpose of aecting a person's mood or health.

    Aromatherapy massage combines the therapeutic benets of using essential oils with

    Swedish massage techniques.

    Colour Vibration Colour vibration therapy utilizes the aromatherapy concept as a nutrient for the brain/mind.

    Therapy The aromatherapy - called 'Essential Nutrition' will calm those who inhale it. The white rose is

    the most essential element in the aroma vibration oil.

    Crystal Healing Crystal healing is the use of crystals to bring about healing and positive changes in the mind

    and body

    Complementary Medicine(Energy Medicine)Deals with energy eldsof two types: Veritable, which can be

    measured Putative, which have

    yet to be measured

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    Homeopathy Homeopathy A system for treating disease based on the administration of minute doses of a drug that in

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    massive amounts produces symptoms in healthy individuals similar to those of the disease

    itself.

    Nutritional A system of healing based on the belief that food provides the medicine we need to obtain

    Therapy and maintain a state of health: our food is our medicine and our medicine is our food.

    Naturopathy Emphasizes the body's intrinsic ability to heal and maintain itself. Natural remedies such as

    herbs and foods are used.

    Chelation Therapy Chelation therapy is an intravenous treatment designed to bind heavy metals in the body in

    order to treat heavy metal toxicity. Proponents claim it also treats coronary artery disease and

    other illnesses that may be linked to damage from free radicals (reactive molecules).

    Ozone Therapy Ozone is known to eliminate microorganisms such as fungus, viruses, bacteria, etc. and also

    helps oxidize toxins such as heavy metals, pesticides, hydrocarbons and other environmental

    pollutants.

    Chiropractic A health care approach that emphasises diagnosis, treatment and prevention of mechanical

    disorders of the musculoskeletal system, especially the spine, under the hypothesis that

    these disorders aect general health via the nervous system.

    Osteopathy Treatment of the musculoskeletal system (bones, muscles and joints) facilitates the

    recuperative powers of the body.

    Therapeutic Therapeutic massage involves the manipulation of the soft tissue structures of the body to

    Massage prevent and alleviate pain, discomfort, muscle spasm, and stress; and, to promote health and

    wellness.

    ComplementaryMedicine (Biologicalbased Practice)The domain includes,but is not limited to,botanicals, animal-derived extracts,vitamins, minerals, fattyacids, amino acids,proteins, prebiotics andprobiotics, whole diets,

    and functional foods.

    ComplementaryMedicine (Manipulativebased Practices)Focus on the structuresand systems of thebody, including thebones and joints, softtissues, circulatory andlymphatic systems.

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    Reiki The belief is that the energy will ow through the practitioner's hands whenever the hands

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    are placed on, or held near a potential recipient, who can be clothed

    Aura Metaphysic The combination of three parts of knowledge which is Aura, Meta, and Physic. Aura is a wave

    energy or bioelectromagnetic frequency while meta is something that crosses the

    expectations and physics means natural or nature. Thus, combination of these can be

    dened as a philosophy or knowledge of unusual or unexpected natural law that exist in ourlife

    Roaha Therapy for optimize the oxygenation of cell via alkaline water through detoxication and

    increase body immunity

    Bach Flower They gently restore the balance between mind and body by casting out negative emotions,

    such as, fear, worry, hatred and indecision which interfere with the equilibrium of the being

    as a whole.

    The Remedies allow peace and happiness to return to the suerer so that the body is free to

    heal itself

    Phytobiophysics Utilization of the innite energy of owers and plants to harmonize and balance the

    disturbances of humanity on all levels of consciousness: Spiritual, Mental, Emotional and

    Physical

    Hypnotherapy Often applied in order to modify a subject's behaviour, emotional content, and attitudes, as

    well as a wide range of conditions including dysfunctional habits, anxiety, stress-related

    illness, pain management, and personal development.

    Psychotherapy Intentional interpersonal relationship used by trained psychotherapists to aid a client in

    problems of living.

    Aims to increase the individual's sense of well-being and reduce their subjective sense of

    discomfort.

    Complementary Medicine(Mind Body Soul Therapy)Focuses on theinteractions among thebrain, mind, body, andbehaviour, and on thepowerful ways in whichemotional, mental,

    social, spiritual, andbehavioural factors candirectly aect health.

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    Editorial Committee

    INTERNAL REVIEWER

    DR. RAMLI ABD GHANI

    MR. JAAFAR LASSA

    EXTERNAL REVIEWER

    PROF. DR. SYED MOHSIN SAHIL JAMALULLAIL

    PROF. DR. ABD RASHID ABD RAHMAN

    DR. ZAKIAH ISMAIL

    ADVISOR

    DATO DR. MAIMUNAH BT A. HAMID

    CHIEF EDITOR

    DR. SHAMSAINI SHAMSUDDIN

    EDITORS

    DR. AIDATUL AZURA ABD RANI

    DR. MARIA SAFURA MOHAMAD

    DR. NUR HIDAYATI ABDUL HALIM

    MR. MOHD HADI MOHD ZIN

    MDM. WONG WEI CHYI

    MDM. ASMIRAH MD REDZUAN

    MDM. NUR HAZIRAH KAMARUDIN

    MS. NG ANGELINE

    Copyright 2011 Ministry of Health Malaysia

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    Copyright 2011, Ministry of Health Malaysia.

    All rights reserved. No part of this book may be reproduced,

    stored, or transmitted in any form or by any means, electronic

    or otherwise, including photocopying, recording, internet

    or any storage and retrieval system without prior writtenpermission from the publisher.

    Published by:

    Traditional and Complementary Medicine Division

    Ministry of Health Malaysia

    ISBN 978-967-10715-0-2

    Designed by GNG Signature Sdn Bhd

    Printed by Pencetakan Alfa Gemilang Sdn Bhd

    Notes

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    Notes

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    Traditional and Complementary Medicine DivisionMinistry of Health, Malaysia

    Block E, Cenderasari Road,50590 Kuala LumpurTel: 603 2698 5077Fax: 603 2691 1259

    Email: [email protected]: http://tcm.moh.gov.my