A Handbook of. Traditional and Complementary Medicine Programme in Malaysia

Transcription

1 A Handbook of Traditional and Complementary Medicine Programme in Malaysia

2 Acknowledgement 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), Ministry 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 & Complementary Medicine Division October 2011

3 Foreword Dato Dr. Maimunah bt A. Hamid Deputy Director General of Health (Research and Technical Support) Ministry of Health Malaysia October 2011 Medicine is in the new era. 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. This is due to the fact that the world population 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. This handbook is a reflection of what transpired, 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 much 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 benefit of the people of Malaysia.

4 Preface Dr. Ramli bin Abd. Ghani Director Traditional and Complementary Medicine Division Ministry of Health Malaysia October 2011 Today, Traditional and Complementary Medicine (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&CM plays a crucial role in the aspect of prevention, health 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. This handbook marks our first attempt to provide a general overview of the practice of T&CM in a localised setting whilst promoting public awareness towards its safety and quality. The idea of this handbook came from Dato Dr. Maimunah bt A. Hamid, Deputy Director General of Health (Research and Technical Support), Ministry of Health Malaysia. The information 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.

5 Contents CHAPTER 1 Introducing... Traditional & Complementary Medicine 1 6 Overview Definitions Classifications 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 Malaysia T&CM Practices Available at the Integrative Hospitals T&CM Units at the Integrative Hospitals CHAPTER 3 Modalities in T&CM Therapeutic Versus Wellness Concept Home-grown Modalities The Scope of Practice of T&CM Modalities CHAPTER 4 EBP in Supporting Development of T&CM Practices EBP Evidence-based Practice Steps involved in the EBP Process Use of EBP in Developing T&CM Guidelines CHAPTER 5 Education & Training CHAPTER 6 Research in T&CM CHAPTER 7 Promotional, Enforcement & Public Education Activities Promotional Activities Inspection Activities Public Education GLOSSARY EDITORIAL COMMITTEE 50

6 1 Chapter 1 Introducing... Traditional & Complementary Medicine 1 Overview Traditional Medicine (TM) is an ancient medical practice which existed in human societies before the application of modern science to health. It has evolved to reflect different 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-standardised health care services which involve varying levels of training and efficiency. TM/CAM (Complementary & Alternative Medicine) has been 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 used some form of complementary or alternative medicine, with herbal treatments being the most popular form of TM. 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) Traditional Medicine Strategy , member countries are:- 1. To develop a policy that promotes the integration of TM/CAM into the national health care system. 2. To promote safety, efficacy, and quality of TM/CAM services and products. 3. To increase the availability and affordability of TM/CAM and 4. To promote rationale use of TM/CAM. These sentiments were repeated in the Beijing Declaration , in which WHO states that participating countries should, in accordance with national capacities, priorities, relevant legislation and circumstances: 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 a) Respect, preserve, protect and communicate widely and appropriately the knowledge of traditional medicine, treatments and practices; 1 World Health Organisation (2002) WHO Traditional Medicine Strategy. Geneva: WHO 2 Anon. (2011) Beijing Declaration 2008 [Online]. Switzerland: WHO. Retrieved from: who.int/medicines/areas/traditional/congress/beijing_declaration/en/index.html [Accessed 14th February 2011

7 2 b) Governments should formulate national policies, regulations and standards to ensure appropriate, safe and effective 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 qualification, accreditation or licensing of traditional medicine practitioners, f ) To strengthen the communication between conventional and traditional medicine providers. Traditional medicine has made a significant 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% ( %) and 55.6% ( %) within the last period of 12 months of the study 3. 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 Traditional and Complementary Medicine 2007 states that: 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 government will facilitate the development of T&CM in the country and ensure the quality and safety of practices and products of T&CM. It will support the identification of its health, economic and social benefits. Thus, the Traditional and Complementary Medicine Unit was born in 1996 and later upgraded to the Traditional and Complementar y Medicine Division (T&CMD) in the Ministry of Health in Definitions Malaysian perspective Currently, there is no universally agreed definition for Traditional Medicine and/or Complementary Medicine. However, the definition below shall be the basis of the Malaysian Government s approach to the development of T&CM. Figure 1.1: National Policy of Traditional and Complementary Medicine (Second Revision, 2007) 3 Z.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 and complementary medicine in Malaysia: a baseline study', Complementary Therapies in Medicine, Vol. 17, No. 5, pp Anon. (2007) The National Policy of Traditional and Complementary Medicine. 2nd ed. Kuala Lumpur: Traditional and Complementary Medicine Division.

8 3 Traditional and Complementary Medicine is a form of health-related practice designed to prevent, treat, and/or manage illnesses 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 defined 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. b. USA Complementary and Alternative Medicine (CAM) as defined 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) WHO Traditional Medicine Strategy Complementary medicine, in practice refers to a wide range of health interventions originating from different cultures across thousands of years of history. Scottish Office Department of Health, Complementary Medicine and the National Health Services (London, November 1996)

9 4 Classifications of T&CM in Malaysia In Malaysia, Traditional and Complementary Medicine are classified into six 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 Malaysia 1. To regulate the practice of T&CM practitioners through T&CM Bodies using a phased approach, from 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 development of standards and criteria in T&CM, regulation and monitoring of accredited learning centres, setting the quality and standards of T&CM programmes, and to evaluate their effectiveness. 6. To facilitate and as a collaborator in research and scientific evaluation of T&CM modalities; towards promoting evidence-based medicine. The T&CM Division is situated at Jalan Cenderasari, Kuala Lumpur, with five T&CM branch offices to date located in Pulau Pinang, Terengganu, Johor, Sarawak dan Sabah (Figures 1.2 and 1.3).

10 T&CMD Headquarter and Branch Offices 5 TRADITIONAL AND COMPLEMENTARY MEDICINE DIVISION MINISTRY OF HEALTH MALAYSIA BLOK E, JALAN CENDERASARI, KUALA LUMPUR Tel No.: Fax No.: Figure 1.2: Contact details of the Traditional & Complementary Medicine Division Headquarter, Ministry of Health Malaysia

11 6 Contact details of T&CM Branch Offices Figure1. 3: Contact details of T&CM Branch Offices.

12 7 Chapter 2 Development of T&CM - Globally and Locally Global Development The use of traditional and complementary medicine is increasing worldwide. In low- and middle-income countries, 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 population reporting that they have used this form of medicine (Figure 2.1). Use of Traditional Medicine to Help Meet Primary Health Care Needs in Developing Countries 100% 90% 90% 80% 70% 60% 60% 60% 70% 70% 70% 50% 40% 30% 20% 10% 0% Uganda Tanzania Benin Rwanda India Ethiopia Figure 2.1: Percentage of use of T&CM amongst the populations of developing countries. Source: WHO Traditional Medicine Strategy:

13 8 Populations in developed countries who have used CAM at least once 100% 80% 75% 60% 40% 40% 48% 50% 42% 20% 0% Belgium Australia Canada USA France Figure 2.2: Percentage of Populations in Developed Countries who have used CAM at least once. Source: WHO Traditional Medicine Strategy: Figure 2.3: Percentage of CAM use in USA. Credit: National Center for Complementary and Alternative Medicine, NIH, DHHS

14 9 Table 2.1: Use of CAM from a practitioner (all therapies) in the past 12 months by geographical region in Britain (2004) Region Received CAM % 95% CI n = 100% Frequency England Wales Scotland North Midlands and East Anglia London South East South West 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 Figure 2.4: Percentage of CAM use by Race/Ethnicity among adults in US Credit: National Center for Complementary and Alternative Medicine, NIH, DHHS

15 10 CAM Out-of-Pocket Spending: Self-care* vs. Practitoner Costs International Collaboration in Traditional & Complementary Medicine Nonvitamin, Nonmineral, Natural Products $14.8 billion (43.7%) Practitioner Costs $11.9 billion (35.2%) 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%) Together with the World Health Organisation (WHO), Malaysia has made a significant number of collaborations with many ASEAN countries, India and China in an effort 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 People s 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 the traditional system of Indian Medicine. Total Self-care Costs $22.0 billion (64.8%) * Self care costs includes CAM products, classes and material. Relaxation techniques include relaxation, guided imagery, progressive relaxation and deep breathing exercises. Figure 2.5 Total Practitioner Costs $11.9 billion (35.2%) 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, National Health Statistics Reports; No. 18. Hyattsville, MD: National Centre for Health Statistics 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 significant 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 conducted between 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

16 11 medicine was decided upon. In addition to that, two Malaysian representatives namely Dr. Shamsaini Binti Shamsuddin from the Traditional & Complementary 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 official visits, international conferences, seminars and attachment programmes to nurture the grounds of T&CM in Malaysia. At the end of the 19th centur y, modern medicine was brought in by the British and was taken up quickly due to its ease of practice and effectiveness. During this period, complementary medicine also started to appear in the country. By the 20 th century, modern medicine was the mainstream medicine practised in 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. Development of Traditional and Complementary Medicine 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 influenced by the animistic culture of Hindu-Buddhism, which originated 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 introduced and Traditional Indian Medicine too began to take root in the soils of Malaya.

17 Preparation of proposal for research in alternative medicine 1998 Establishment of the T&CM Standing Committee 2000 Launch of Herbal Medicine Research Centre 2002 Establishment of Global Information Hub and National Committee in R&D on Herbal Medicine 2007 Establishment of the first Integrated Hospital in Kepala Batas, Pulau Pinang 2009 Establishment of regional T&CM offices in MOH: o Northern region Pulau Pinang o Southern region Johor Bahru o Eastern region Kuala Terengganu o Sabah Kota Kinabalu o Sarawak - Kuching 2010 Establishment of T&CM Units in Port Dickson Hospital, Negeri Sembilan and Sultanah Bahiyah Hospital in Alor Setar, Kedah 1996 Formation of the Traditional & Complementary Medicine (T&CM) Unit under the Family Health Develoment Division 1999 Formation of five Umbrella Bodies for T&CM 2001 Launch of National Policy on T&CM 2004 Establishment of the T&CM Division in Ministry of Health (MOH) 2008 Establishment of T&CM services in Putrajaya Hospital, Putrajaya and Sultan Ismail Hospital, Johor 2009 Establishment of T&CM Units at Sultanah Nur Zahirah Hospital in Kuala Terengganu, Duchess of Kent Hospital in Sandakan, Sabah and Sarawak General Hospital 2011 Establishment of T&CM Unit in Sultanah Hajah Kalsom Hospital, Cameron Highlands, Pahang Figure 2.6 : Timeline depicting the development of T&CM in Malaysia.

18 T&CM Units at Integrated Hospitals in the Ministry of Health (2011) 13 Figure2.7: T&CM Units at Integrated Hospitals in the Ministry of Health (2011)

19 14 T&CM Practices Available at the Integrated Hospitals Acupuncture Malay Massage Herbal Therapy as an Adjunct Treatment for Cancer Patients Malay Postnatal Treatment Putrajaya Hospital Putrajaya Hospital Sultan Ismail Hospital Sultan Ismail Hospital Putrajaya Hospital Kepala Batas Hospital Kepala Batas Hospital Putrajaya Hospital Sultanah Nur Zahirah Hospital Sultanah Nur Zahirah Hospital Duchess of Kent Hospital Duchess of Kent Hospital Sultan Ismail Hospital Sarawak Public Hospital Sarawak Public Hospital Hospital Umum Sarawak Hospital Umum Sarawak Port Dickson Hospital Port Dickson Hospital Sultan Ismail Hospital Sultanah Bahiyah Hospital Sultanah Bahiyah Hospital Kepala Batas Hospital Sultanah Hajah Kalsom Hospital Sultanah Hajah Kalsom Hospital Table 2.2: T&CM Practices available at the Integrated Hospitals

20 15 T&CM Units at the Integrated Hospitals T&CM Unit Kepala Batas Hospital Jalan Bertam Kepala Batas Pulau Pinang Tel: , ext 113 Fax: [email protected] T&CM Unit Putrajaya Hospital Ground Floor Putrajaya Hospital Precinct 7, Putrajaya Tel: Fax: [email protected]

21 16 T&CM Units at the Integrated Hospitals T&CM Unit Sultanah Nur Zahirah Hospital Jalan Sultan Mahmud Kuala Terengganu Terengganu Tel: , ext: 2394 Fax: / T&CM Unit Sultan Ismail Hospital Jalan Persiaran Mutiara Emas Utama Taman Mount Austin Johor Bahru Johor Tel: Fax:

22 17 T&CM Units at the Integrated Hospitals T&CM Unit Sarawak General Hospital Jalan Tun Ahmad Zaidi Adruce, 93586, Kuching, Sarawak Tel: , ext 5150 Fax: T&CM Unit Duchess Of Kent Hospital KM 3.2 Jalan Utara Sandakan Sabah Tel: Fax:

23 18 T&CM Units at the Integrated e Hospitals T&CM Unit Hospital Sultanah Hajah Kalsom Jln Persiaran Dayang Endah Tanah Rata Pahang Tel: Fax: T&CM Unit Port Dickson Hospital KM 11, Jalan Pantai Si Rusa Port Dickson Negeri Sembilan Tel: Fax: [email protected]

24 19 T&CM Units at the Integrated Hospitals T&CM Unit Sultanah Bahiyah Hospital Blok T Sultanah Bahiyah Hospital Lebuhraya Darulaman Alor Setar Kedah Tel: Fax:

25 20 Chapter 3 Modalities in T&CM Therapeutic Versus Wellness Concept The modern medical system introduces four 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). Table 3.1: Modalities in T&CM Practices. Type of practice Treatment concept Therapeutic Wellness Islamic Medical Practice Islamic Medical Practice (Ruqyah) Therapeutic concept refers to healing, 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. Traditional Malay Medicine Herbal Medicine Urut Melayu (Malay Massage) Indigenous Massage Bekam (Cupping) Urut Melayu (Malay Massage) Indigenous Massage On the other hand, wellness concept refers to modalities that assist in balancing positive health in an individual as exemplified by quality of life and a sense of well-being. Traditional Chinese Medicine Herbal Medicine Acupuncture and Moxibustion Tuinalogy Cupping Qi Gong

26 21 Type of practice Traditional Indian Medicine Ayurveda Siddha Unani Therapeutic Treatment concept Yoga Wellness Homeopathy Homeopathy Home-grown Modalities There are a number of modalities established by Malaysians which creatively infuses different knowledge and techniques into a new, combined form of therapy. Colour Vibration Therapy and Aura Metaphysic are examples of home-grown modalities. Complementary Medicine Chiropractor Naturopathy Osteopathy Nutritional therapy Hypnotherapy Psychotherapy Therapeutic Massage Spa Therapy Reflexology Aromatherapy Thai massage Swedish massage Balinese/Javanese massage Shiatsu massage Colour Vibration Therapy Crystal Healing Reiki Aura metaphysic Raoha Ozone Therapy Chelation Therapy Note: Please refer the Glossary, for description of each modality.

27 22 The Scope of Practice of T&CM Modalities The practitioner must exert professionalism at all times especially during consultation sessions with the client and should follow the rules and regulations as stipulated in the Code of Ethics and 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. Table 3.2: What is allowed or not allowed to be practiced for each T&CM modality. List of permitted practices for each T&CM modality. Type of practice Islamic Medical Practice Traditional Malay Medicine Permitted Practices Islamic Medical Practice (Ruqyah) - Based on Al-Quran Herbal Medicine Urut Melayu (Malay Massage), Indigenous Massage Prohibited Practices Misuse of the Holy Quran (physically and Quranic verses) Bedah batin (virtual surgery) Use of azimat (amulet), tangkal (talisman), susuk (charm needles) Use of black magic Misuse of the Holy Quran (physically and Quranic verses) Bedah batin (virtual surgery) Use of azimat (amulet), tangkal (talisman), susuk (charm needles) Use of black magic Traditional Chinese Medicine Bekam (Cupping) Acupuncture and Moxibustion Herbal Medicine Tuinalogy Cupping Bekam lintah (Leech Therapy) Acupuncture using gadgets Traditional Indian Medicine Ayurveda Siddha Unani Yoga Yoga cannot be practised by Muslim as it is prohibited by the religion (refer to Fatwa Majlis Kebangsaan Bagi Hal Ehwal Ugama Islam Malaysia Kali Ke-83) Homeopathy Homeopathy

28 23 Type of practice Complementary Medicine Subgroup Manipulative therapy Permitted Practices Chiropractic Reflexology Osteopathy Massage: Therapeutic Swedish Thai Balinese/Javanese Shiatsu 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 Traditional and Complementary Medicine Practitioners (Figure 3.1) at all times during the provision of services to the public. Energy medicine Reiki Aura metaphysics Colour vibration therapy Crystal healing Bach flower 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) Note: Claims of treating acute conditions are prohibited Figure 3.1: Code of Ethics & Code Of Practice for T&CM Practitioners.

29 24 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 research 5. Evolution of the definition: 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 EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated 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 methodology 6. 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: 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. Retrieved from: [Accessed 1st February 2011].

30 25 Steps involved in the EBP Process ASSESS the patient 1. Start with the patient a clinical problem or question that arises form care of the patient The evidence does not make a decision but it can help to support the patient care process. Integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and patient s quality of life. The practice of EBP are usually attemps at answering questions about the effects 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 efficient 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. ASK the question ACQUIRE the evidence APPRAISE the evidence APPLY: talk with the patient Selfevaluation 1. Construct a well built clinical question derived from the case 3. Select the appropriate resource(s) and conduct a search APPRAISE 4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) 5. Return to the patient integrate that evidence with clinical expertise, patient preferences and apply it to practice 6. Evaluate your performance with this patient

31 26 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 effectiveness 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, several guidelines 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 of life, but also enables the protection and preservation of valuable traditional knowledge. Practice Guideline Good Practice Guidelines 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. For the use of practitioners in the Integrated Hospitals Consensus guidelines for practitioners practicing in Malaysia To support the implementation of T&CM in the country, T&CM Division produces two types of guidelines, aiming at two different categories of practitioners;

32 Table 4.1a: Guidelines developed by T&CM Division. 27 Developed Guidelines (2007) Reviewed Guidelines Old Publication (2007) Revised Publication (2009) Guideline on Herbal Therapy as an Adjunct Treatment for Cancer Standard Operating Procedures for T&CM Unit Standard Operating Procedures for T&CM Unit Guideline on Malay Postnatal Care Guideline on Malay Massage Guideline on Malay Massage

33 28 Table 4.1b: Guidelines developed by T&CM Division. Reviewed Guidelines Old Publication (2007) Revised Publication (2009) Good Practice Guidelines (2011) Guideline on Acupuncture Guideline on Acupuncture Good Practice Guideline on Reflexology Garis Panduan Perkhidmatan Spa (Spa Services Guideline) Good Practice Guidelines (2010) Good Practice Guideline on Malay Massage Good Practice Guideline on Acupuncture Work in progress is directed towards the 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)

34 29 Chapter 5 Education & Training Through collaborations between the T&CM Division with various governmental agencies, several education and training programmes were developed for the various T&CM modalities. The aim of these programmes were to ensure that all T&CM practitioners acquire standardised and internationally accepted knowledge and skills through means of formal education to ensure the delivery of T&CM services of the highest quality. In Malaysia, the education pathway is comprised of three higher educational sectors, as outlined by the Malaysian Qualifications 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 differentiated by learning outcomes, credit hours and student learning time. In total, there are eight levels of qualifications. Levels 1 to 3 are Skills Certificates awarded by the Skills Sector. Academic and Vocational and Technical Certificates are at Level 3. Meanwhile, Diploma and Advanced Diploma are at Levels 4 and 5. Bachelor Degree is at Level 6, Masters Degree at Level 7 and for the Doctorates, Level 8 7. T&CM Division classifies the level of education and training programmes for each T&CM modality based on the therapeutic or 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 certificate 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 offered by the local institutions listed in Table 5.2. In addition, the Malaysian Public Service Department has recognised three universities from the People s Republic of China to award the degree programmes listed in Table 5.3.

35 30 MQF BASED QUALIFICATION LEVEL AND EDUCATIONAL PATHWAY Figure 5.1: Malaysian Qualifications Framework. 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 Table 5.1: Bachelors and diploma educational programmes developed by MQA. * Further information can be obtained from the Malaysian Qualifications Agency (MQA) at

36 31 The educational programmes below are presently being provided by the following public and private institutions: No. Institutions Courses Offered 1. Southern College, Skudai University Foundation For Degree Programme (Traditional Chinese Medicine) Bachelor Degree of Traditional Chinese Medicine 4+1 in collaboration 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 Table 5.2: Institutions providing T&CM courses in Malaysia. To date, three universities from the People s Republic of China have been recognised by the Public Sector Department of Malaysia to provide the following education programmes: No. Institutions Courses Offered 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) Table 5.3: T&CM degree courses and universities from People s Republic of China which are recognised by the Malaysian Public Sector Department. Source: Public Sector Department of Malaysia (

37 32 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-off, one year programme at the Sultan Salahuddin Abdul Aziz Shah Polytechnic, Shah Alam. The first batch of students will be graduating in August In the skills sector, the standards and criteria for the issuance of a skills certificate are defined in the National Occupational Skills Standard (NOSS). NOSS is a specification of the competencies expected of a skilled worker, 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 offer skills training for the specified modalities. Individuals who have completed their training under the skills programme will be awarded the Skills Certificate by DSD, which is a formal recognition to individuals who has shown capabilities and competencies to carry out the specified modality. These skills training programme are being offered 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 Qualifications. This includes reflexology, aromatherapy, massage, manual lymph drainage, crystal healing and spa. These NOSSs are part of the effort to promote lifelong training and development, upgrading the competencies and enhancing the competitiveness of Malaysians involved in the industry. More Malaysian Skills Qualifications 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

38 33 Chapter 6 Research in T&CM T&CM is currently considered an important component of the healthcare system. Its co-existence with modern medicine contributes towards enhancing the health and quality of life of Malaysians. In support of the Malaysian National Policy on T&CM, especially in ensuring the quality and safe use of T&CM products and practices, Research and Development (R&D) Section was formalised in T&CM Division in August 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 efficacy 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 introduction of T&CM modalities in integrated hospitals in Malaysia opens the opportunity for more T&CM research in clinical practice. Current research efforts 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 and qualitative techniques. Future studies will look into areas of effectiveness of these modalities. The T&CM R&D section collaborates closely with the National Institutes of Health (NIH), Ministry of Health in the conduct of its research. This section participates actively in presentations at scientific meetings and conferences. The first article on urut Melayu was published in the Journal of Alternative 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, efforts are being made for product development under the National Key Economic Areas (NKEA) based on five 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 drugs 8.

39 34 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 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 NIH website at The guideline requires: 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: GLOBINMED s homepage 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 increase the availability of evidences, thus promoting evidence based practice.

40 35 A Qualitative Study On Urut Melayu The Traditional Malay Massage 8th Ministry of Health Malaysia Academy of Medicine of Malaysia Scientific Meeting 2009 Urut Melayu for Post-Stroke Patients: A Qualitative Study Asia-Pacific Primary Care Research Conference 2009

41 36 Chapter 7 Promotional, Enforcement & Public Education Activities Promotional Activities In order to increase consumer knowledge and awareness about T&CM services in Malaysia, T&CM Division has conducted numerous promotional activities through road shows, exhibitions and public talks, including television and radio talks since the year 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 Continuing Medical Education (CME) and Continuing Professional Development (CPD) activities for staff members of the Ministry of Health as well as conferences, workshops and public forums for the general public.

42 37 During the course of these promotional activities, we have distributed various pamphlets, posters, books and bulletins to stimulate public awareness towards the various types and benefits of T&CM modalities. Table 7.1: T&CM Division Bulletins. T&CMD Bulletin Volume 1 (Sept Dec 2006) T&CMD Bulletin Volume 2 (Jan Jun 2007) T&CMD Bulletin Volume 3 (Jun Dec 2007) T&CMD Bulletin Volume 4 (2008) T&CMD Bulletin Volume 5 (Jan Jun 2009) T&CMD Bulletin Volume 6 (Jun Dec 2009) T&CMD Bulletin Volume 7 (Jan Jun 2010) T&CMD Bulletin Volume 8 (July Dec 2010)

43 38 Table 7.2: Posters by T&CM Division. Traditional Malay Massage: A Qualitative Study Traditional Malay Massage for Post Stroke Patients: A Qualitative Study Haram Practices in Traditional Medicine Services in T&CM Units in Integrated Hospitals Table 7.3: Annual Reports. T&CMD Annual Report 2007 T&CMD Annual Report 2008 T&CMD Annual Report 2009 T&CMD Annual Report 2010

44 39 Table 7.4: Pamphlets. Promotion of T&CM Modalities Acupuncture Traditional Malay Practices in Post Natal Care Traditional Malay Massage Public Education Philosophy and Function of T&CMD Common Mistakes Found in the Practice of T&CM

45 40 Public Education Guidelines Before Seeking Traditional & Complementary Services in Malaysia e-pengamal Registration for Traditional & Complementary Medicine Practitioners 8 Registered Practitioner Bodies In Malaysia Inspection Activities The Inspectorate and Enforcement Section (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 carrying out integrated enforcement activities. In addition, I&E section also contributed to the development of the Traditional and Complementary Medicine Bill which is planned to be tabled in the Parliament late Once gazetted, surveillance of T&CM services in strengthened will be strengthened whereby only qualified T&CM practitioners are eligible to register with the Ministry of Health and be allowed to practice.

46 41 Public Education Consumer education is the best way to ensure public safety. T&CM Division actively organises consumer education activities and publications that primarily educates the public on various T&CM modalities, the implementation, safety and efficacy of T&CM services in Malaysia as well the requirement 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 #1 There are advertisements that provide statements such as scientifically proven, proven effective, 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 scientifically proven, proven effective, based on Western technological advancement, acknowledged by the Ministry of Health etc should be confirmed before one places confidence or believes in a particular treatment. When in doubt, do not hesitate in seeking advice from a doctor or a Ministry of Health representative. 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 new treatment 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 profiles of quality, safety and efficacy. 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 confident of its safety and effectiveness and check with the Ministry of Health if you have any doubts.

47 42 What should you do first? 1. Ask the practitioner for his valid certificate. Why? Practicing certificates are issued by Practitioner Bodies appointed by the Ministry of Health Malaysia. This certificate will indicate that the practitioner is qualified. Can t identify which certificate is the genuine one? These are the logos of the currently appointed Practitioner Bodies. Federation of Chinese Physicians and Medicine-Dealers Associations of Malaysia (FCPMDAM) Federation of Chinese Physicians & Acupuncturists Association of Malaysia (FCPAAM) Malaysian Chinese Medical Association (MCMA) Majlis Perubatan Homeopathy Malaysia (MPHM) The Federation of Complementary & Natural Medicine Association Malaysia (FCNMAM) Pertubuhan Perubatan Tradisional India Malaysia (PEPTIM) Persatuan Kebajikan dan Pengubatan Islam Darussyifa Gabungan Pertubuhan Pengamal Perubatan Tradisional Melayu Malaysia (GAPERA)

48 43 2. Don t be easily influenced by the front 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 against the Act. Do be alert on this when you enter any traditional or complementary medicine centre. the Practitioner Body. MOH has begun its registration on all practitioners since November To check, please us at [email protected] or call us at Ensure that the health products or herbal medicines supplied are registered with MOH. Why? In our market sur vey, 12% of T & C M practitioners were found supplying unregistered products to their customers. How do you check? Simple, just look for the produc t registration nu mber (e.g.: MAL TC ) and the M inistr y of Health (MOH) hologram sticker. Still in doubt? Check online at h t t p : / / p or tal. b p f k. g ov.my/produ c t _ s e arch.cfm 3. Ask the practitioner whether he has been registered with a Practitioner Body or the MOH. Why? Registration with a Practitioner Body will confirm his qualification to practice. Normally they will be given a practicing certificate by

49 44 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 practitioners.

50 45 Glossary Description of Traditional & Complementary Medicine Modalities TYPE OF PRACTICE TYPE OF MODALITY DESCRIPTION Islamic Medical Practice Islamic Medical The effort 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 (Malay Massage) Bekam (Cupping) Massage is the use of hands, or mechanical means, to manipulate the soft tissues of the body, 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) 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 fine filiform needles into specific 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.

51 46 Spa Therapy The term spa is associated with water treatment which is also known as balneotherapy. Therapy for the promotion of water-based treatments which include body wraps, body scrubs, baths, etc. Whose main services consist of water based applications. Reflexology Thai Massage Swedish Massage Balinese/Javanese Massage Shiatsu Massage Aromatherapy Massage 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 beneficial effect on other parts of the body, or to improve general health and well being. Incorporates elements of mindfulness, gentle rocking, deep stretching, and rhythmic compression to create a singular healing experience Refers to a variety of techniques specifically designed to relax muscles by applying pressure to them, and rubbing in the same direction as the flow of blood returning to the heart. Positioned above the client, the Balinese/Javanese massage therapist performs a combination of kneading strokes, skin rolling, and foot massage. Treatment is followed by an application of coconut oil infused with spices. Also known as acupressure massage. The therapist applies pressure with his thumbs, finger, and palms to specific areas of the client's body that have been determined during an assessment period prior to the massage session. Uses volatile liquid plant materials, known as essential oils (EOs), and other aromatic compounds from plants for the purpose of affecting a person's mood or health. Complementary Medicine (Energy Medicine) Deals with energy fields of two types: Veritable, which can be measured Putative, which have yet to be measured Colour Vibration Therapy Crystal Healing Aromatherapy massage combines the therapeutic benefits of using essential oils with Swedish massage techniques. Colour vibration therapy utilizes the aromatherapy concept as a nutrient for the brain/mind. 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 is the use of crystals to bring about healing and positive changes in the mind and body

52 47 Homeopathy Homeopathy A system for treating disease based on the administration of minute doses of a drug that in massive amounts produces symptoms in healthy individuals similar to those of the disease itself. Complementary Medicine (Biological based Practice) The domain includes, but is not limited to, botanicals, animalderived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics and probiotics, whole diets, and functional foods. Nutritional Therapy Naturopathy Chelation Therapy Ozone Therapy A system of healing based on the belief that food provides the medicine we need to obtain and maintain a state of health: our food is our medicine and our medicine is our food. Emphasizes the body's intrinsic ability to heal and maintain itself. Natural remedies such as herbs and foods are used. 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 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. Complementary Medicine (Manipulative based Practices) Focus on the structures and systems of the body, including the bones and joints, soft tissues, circulatory and lymphatic systems. Chiropractic Osteopathy Therapeutic Massage 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 affect general health via the nervous system. Treatment of the musculoskeletal system (bones, muscles and joints) facilitates the recuperative powers of the body. Therapeutic massage involves the manipulation of the soft tissue structures of the body to prevent and alleviate pain, discomfort, muscle spasm, and stress; and, to promote health and wellness.

53 48 Complementary Medicine (Mind Body Soul Therapy) Focuses on the interactions among the brain, mind, body, and behaviour, and on the powerful ways in which emotional, mental, social, spiritual, and behavioural factors can directly affect health. Reiki Aura Metaphysic Roaha Bach Flower Phytobiophysics Hypnotherapy Psychotherapy The belief is that the energy will flow through the practitioner's hands whenever the hands are placed on, or held near a potential recipient, who can be clothed 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 defined as a philosophy or knowledge of unusual or unexpected natural law that exist in our life Therapy for optimize the oxygenation of cell via alkaline water through detoxification and increase body immunity 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 sufferer so that the body is free to heal itself Utilization of the infinite energy of flowers and plants to harmonize and balance the disturbances of humanity on all levels of consciousness: Spiritual, Mental, Emotional and Physical 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. 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.

54 49 Editorial Committee 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 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

55 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 written permission from the publisher. Published by: Traditional and Complementary Medicine Division Ministry of Health Malaysia ISBN Designed by GNG Signature Sdn Bhd Printed by Pencetakan Alfa Gemilang Sdn Bhd

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58 Traditional and Complementary Medicine Division Ministry of Health, Malaysia Block E, Cenderasari Road, Kuala Lumpur Tel: Fax: Website: