PENGOBATAN TRADISIONAL (OT)

(Traditional medicines in therapy overview)

Prof Dr dr M T KAMALUDDIN, MSc, SpFK

BAGIAN FARMAKOLOGI
FK UNSRI
Palembang, 2015
Traditional, Complementary
and Alternative Medicine
 I think that TCAM …

1. belongs to the trash bin

2. has no role or place in health
care given its lack of a “scientific
base’’
3. has some therapeutic
possibilities
The Economist – Dec 13th -19th 2003 The Economist Dec 13th-19th 2003
 Key facts
• In some Asian and African countries, 80% of
the population depend on traditional medicine
(TM) for primary health care.
• Herbal medicines are the most lucrative form
of traditional medicine, generating billions of
dollars in revenue.
• Traditional medicine can treat various
infectious and chronic conditions: new
antimalarial drugs were developed from the
discovery and isolation of artemisinin from
Artemisia annua L., a plant used in China for
almost 2000 years.
• Counterfeit, poor quality, or adulterated
herbal products in international markets are
serious patient safety threats.
• More than 100 countries have regulations for
herbal medicines.
 Users of TM
• In some Asian and African countries,
80% of the population depend on
traditional medicine for primary health
care.
• In many developed countries, 70% to
80% of the population has used some
form of alternative or complementary
medicine (e.g. acupuncture).
• Herbal treatments are the most popular
form of traditional medicine, and are
highly lucrative in the international
marketplace. Annual revenues in
Western Europe reached US$ 5 billion in
2003-2004. In China sales of products
totaled US$ 14 billion in 2005. Herbal
medicine revenue in Brazil was US$ 160
million in 2007.
 Background
• Traditional medicine (TM) has always
maintained its popularity worldwide. In
addition, over the last decade, we have seen
an increasing use of complementary and
alternative medicines (CAM) in many
developed and developing countries. The
safety and efficacy of traditional medicine and
complementary and alternative medicines, as
well as quality control, have become important
concerns for both health authorities and the
public.
• Various traditional medicine practices have
been developed in different cultures in
different regions, but without a parallel
development of international standards and
appropriate methods for evaluating traditional
medicine Therefore, sharing national
experience and information is crucial.
Herbal medicines
users
 TCAM Research
• Institute for Traditional Medicines (CSIR,
MRC & WHO)
• Indigenous Knowledge Systems
• National Research Foundation
• Universities
• Useful Plants Garden - Kirstenbosch
• Ethno veterinary practice
Ref: Moorman & Pick, 1998
 Distribution

• "Ezinyangeni" - the place of

healers -

Mai Mai: muti capital of Jo'burg

 Distribution
• Sangomas normally detect two kinds of bad luck

• One is inflicted through witchcraft, usually by a

jealous rival, the other is caused by unhappy
ancestors. It is here that patients are counseled
to slaughter a beast to appease and rekindle
relations with the ancestors.

• Sangomas diagnose and prescribe

• Inyangas generally heal, although they can also

prescribe, depending on the nature of the
problem or whether their ancestors give them
the power to help a patient
 Prescription

Once the muti is obtained, it can be taken

in various ways, depending on its form
and nature. While some muti is just good
for washing with, smearing on one's body,
or for burning and inhaling, other muti is
designed for elaborate uses like
ukuphalaza (regurgitating), ukuchatha
(applying by means of an enema), or
nokugquma (steaming).
BMJ 2001;322:164-167
( 20 January )
 Prescription
• "Isende lehashi" (horse penis)
"Zamafufunyane" (for nightmares and
hysteria), "Owobusoka" (guaranteed to
improve the romantic fortunes of a
bachelor), "Zikatokoloshe" (to ward off an
imaginary evil goblin said to spread terror
at night)
Zimbabwe healer moots
magic chastity potion
 Ayurvedic Preparations
• Bronchial asthma, ischaemic heart
disease and hyperlipidaemia
• Curcumin - rheumatoid arthritis
• Acute viral hepatitis
• Pterocarpus marsupium effective in
reducing levels of blood glucose and
glycosylated haemoglobin in patients with
non-insulin-dependent diabetes mellitus
• Fistula-in-ano patients were randomised
to surgery or application of medicated
thread (Ksharsootra). Surgical treatment
led to a faster cure but recurrence rates
were lower with medicated thread.
 Traditional Chinese
Systems of Medicine

• Herbal remedies, acupuncture,

acupressure, massage and moxibustion
• 40% of all health care delivered in
China
• The first documented source of Chinese
medical theory, the Huangdi Nei Jing
("Inner Classic of the Yellow Emperor")
was written between 300 BC and 100
BC
Traditional Chinese
Systems of Medicine

BMJ 1997;315:115-117 (12 July)

 Origin of Traditional Chinese
Medicine
• Recorded history over
4,000 years old
• earliest books on the
foundation of TCM,
originating as early as
1000 B.C.

Huang Di Nei Jing or “Yellow Emperors

Classic of Medicine”
 Taoist Philosophy

• TCM derived from

Taoist philosophy
• belief that human
experience is affected
by causative principles
in the environment
• principles, correlate to
fate as decreed by
heaven
BaGua
 Development of Traditional Chinese
Medicine

• originally handed down only through personal

apprenticeship
• now 25 major colleges of TCM
• totaling about 20,000 students in each school
at any given time
• courses range from undergraduate to the
doctoral, in both Western medicine and TCM
 International Status of TCM
• Asia - most countries use the TCM methods of
acupuncture and moxibustion

• Europe- used regularly

• U.S. - developing from the coasts inward, recently

reaching into the Midwest
 Basic Characteristics of Chinese
Medicine
Zheng Ti Guan Nian :Theory of Holism
• central idea in TCM
• bears directly on preventing and treating diseases
• emphasis on harmony
• Two main components:
1. the human body is regarded as a single, integrated
unit
2. special attention paid to integration and interaction
between human body and the environment
TCM: Attention to Body and Nature

• the
human body is an organic whole
• components complement one another, functionally
and pathologically
• changes of nature constantly influence the human
body

For Example:
Seasonal variations of the pulse: pulse in spring is
somewhat taut like a string; in summer, somewhat
full; in autumn, somewhat floating or superficial; in
winter, somewhat deep
Methods of Treatment

Acupuncture
Herbs
Tui Na
 How does TCM work?
• Vital energy called Qi is the life force that drives
all living things. Qi flows through meridians (also
called channels) in the body similar to water
flowing in a river.
• Twelve primary meridians, each associated with
an organ system
• Disease occurs with imbalance, resulting in
excess of deficient amounts of Qi in the
meridians.
• TCM works to alleviate this imbalance and
restore harmony
 How does Acupuncture work?

• points are located throughout the body and act as

gateways to influence, redirect, increase or decrease
the vital “substance” of Qi
• corrects imbalances that cause disease
• research programs have been conducted towards
understanding the mechanism of acupuncture with
impressive results.
Ancient Acupuncture: Nine needles
 About Chinese Herbs
• important component of TCM
• herbal formulas are as effective now as they
were more then 4,000 years ago when they
were first introduced
• formulas contain 2 - 18 different types of
herbs
• used to treat a wide variety of symptoms
while stimulating the body’s natural healing
process
• not addictive, powerful nutritional agents
Chinese Herb Leaves
 What is Tui Na?
• relatively new to the western world
• combines the work of massage therapy,
chiropractic and TCM
• establishes a more harmonious flow of Qi
throughout the system of channels and collaterals,
allowing the body to naturally heal itself.
• Tui Na encompasses three techniques
1. Massage to treat the soft tissue (muscles and
tendons of the body
2. Acupressure to affect the flow of the Qi
3. Adjustments for realignment
Tui Na Hand Positions
TCM Broad Range of Treatments
Asthma Allergies Cold/Flu
Cough/Bronchitis Headaches TMJ

Tinnitus Arthritis Osteoporosis

Back/neck ache Sciatica Pain Mgmt
Infertility Depression Stress
Addictions Skin diseases Fibromyalgia
PMS Rhinitis Vision
Hemilplegia Sexual High blood
dysfunction pressure
Stroke High Cholesterol Injuries
Trauma Children's Frozen Shoulder
Diseases
 Bian Zheng Lun Zhi
Bian Zheng : the way TCM recognizes and analyzes
diseases

Lun zhi : the way TCM formulates a definitive

therapeutic program proper therapeutic program.

For example, at the early stage of a disease, the patient

may experience fever and chills, no sweating,
headache, general body aching, no thirst, thin whitish
coating of the tongue, superficial and tense pulse,
etc.
• “Exterior syndrome of Wind and Cold”
• Treatment: employ diaphoretics of a pungent and hot
nature.
 Main Concept of TCM: Yin Yang
•Theory that everything in the universe contains the two aspects of Yin and Yang,
which are in opposition and also in unison.They are polar opposites inherent and
discernable in everything, and are never absolute.
•Yang qualities: dynamic, external, upward, ascending, brilliant, progressive,
hyperactive, superficial, heat, light, open, energy
•Yin qualities: static, internal, downward, descending, dull, retrogressive, hypoactive,
dark wet, cold, matter
 Wu Xing: Five Phases (elements)

•originally a philosophical theory in ancient China,

later adapted to medical practice, becoming an
important part of TCM theory
•universal interdependence of all things and events
•used to explain and expand a series of medical
problems by comparing with and deducing from
mutual relationships
 Two Examples of Relationships
Between Phases:

Xiang Ke ( inter- inhibition, or control ) : wood inhibits

earth, earth inhibits water, water inhibits fire, fire
inhibits metal, and metal inhibits wood

Xiang Sheng ( inter-generation ): wood generates fire,

fire generates earth, earth generates metal, metal
generates water, and water generates wood
 Jing Luo (Channels or Meridians) and
Their Collaterals
• passages through which Qi ( energy ) and blood circulate
• connect the Viscera with the limbs, connect the upper and lower parts with the interior
and exterior of the body, and regulate the mechanisms of the various parts of the body
• include the jing-mai ( the channels or meridians ) and luo-mai ( the collateral
channels ); it is specifically through these structures that the human body becomes an
an organic whole
• no objective proof as to the actual existence of Jing and Luo. However, the channels
have long been confirmed through clinical usage, and they are also confirmable
subjectively
Distribution of the 14 meridians of the hand and foot
 Zang Fu Viscera
Internal organs, viscera: in TCM emphasis is laid on the
physiological functions of an organ rather than on its
anatomical structure.

1. WuZang ( the five parenchymatous organs) : heart,

liver, spleen, lung and kidney. According to TCM,
these terms may either refer to the actual organs, or
chiefly to the external reflections of their functional
activities and pathologic processes. Hence, each of
them has their own intrinsic characteristics.

2. LiuFu ( the six hollow organs ): gallbladder, stomach,

large intestine, small intestine, urinary bladder and
triple heater
 Zang Fu Relationship with the Vital
Substances of the Body

The Zang Fu ensure the proper making of,

maintenance, replenishment, movement, and
transformation of the vital substances of the body.
• Heart governs blood
• Liver stores blood &regulates the movement of Qi
• Lungs govern Qi & disperse & descend body fluids
• Spleen transforms and transports Gu (food) Qi, holds
blood in the vessels, and influences body fluids
• Kidneys store essence and influence body fluids
Zang Fu Relationships with Tissues
There are energetic/functional relationships between
organs and their corresponding tissue, therefore the
health of tissues can be seen through the health of
the corresponding Zang Fu.
• Heart controls blood vessels and shows its health on
the facial complexion
• Liver controls the sinews (tendons) and shows its
health on the nails
• Lungs control the skin and show their health on the
body hair
• Spleen controls the muscles and shows its health on
the lips
• Kidneys control the bones and show their health on
the hair on the head
 Zang Fu Relationships to the
Sensory Organs
The health and wellness of sensory organs rely on
the care and nourishment of its corresponding
Zang Fu.
• Heart controls the tongue and taste
• Liver controls the eyes and sight
• Lungs control the nose and smell
• Spleen controls the mouth and taste
• Kidneys control the ears and hearing
 Zang Fu Relationships with the
Emotions
• Qi, the basis for all physiological activities of the body
is also responsible for the emotional processes
• utmost importance in TCM medical theory
• health of the Zang Fu organs will effect the emotions,
and the emotions will effect the health of the Zang Fu
organs – especially when they are excessive and
occur for long periods of time
• treatment of organs therefore helps emotional health,
and treatment of emotions can improve health of
internal organs
• Liver relates to anger - Heart relates to Joy - Liver
relates to anger - Lungs relate to sadness & worry -
Spleen relates to pensiveness, over thinking or
obsessive ness, and worry - Kidneys relate to fear
 Zang Fu Relationships to Climate and
Environment

Different climactic factors effect different

Zang Fu organ functions. Excessive weather
conditions for prolonged periods of time can
adversely effect internal organ processes.
• Heart is effected by heat -Liver is effected by
wind - Lungs are effected by dryness -
Spleen is effected by dampness - Kidneys are
effected by cold
 Etiology and Pathogenesis
In TCM there are 14 categories of etiological factors:

• Liu Yin: six excessive (or untimely) atmospheric

influences. Wind, cold, summer heat, dampness,
dryness, and fire
• Qi Qing: seven emotions. Overjoyed, anger,
melancholy, anxiety, sorrow, fear and fright. The
emotions are considered to be endogenous factors
causing diseases if in excess
• Injury: which includes acute and chronic
 For Example
• Over joy makes Qi makes heart sluggish ( e.g.
unable to concentrate the mind )
• Anger impairs the liver: rage causes the Qi of Liver to
flow adversely upward, causing a stuffy feeling in the
chest, headache and redness of eyes may occur.
• Anxiety impairs the spleen: anxiety makes the Qi of
spleen depressed, often resulting in indigestion.
• Sorrow impairs the lung: sorrow consumes the Qi of
lung.
• Fear impairs the kidney: fear causes the Qi of the
kidney to sink, and as a result, incontinence of urine
and stool and seminal discharge may occur.
• Fright impairs the heart: fright make the Qi of the
heart disturbed, resulting in palpitation, restlessness,
 Methods of Diagnosis
Si Zhen Ba Gang
1. Smelling (olfaction) eight guiding principles,
2. Listening or eight parameters
(auscultation ) for diagnosis
3. Looking ( inspection ) 1-2 Yin and Yang
4. Asking 3-4 exterior and interior
5. Pulse taking 5-6 cold and heat
6. Palpation 7-8 deficiency and
excessiveness
Is it a Communist plot?

Norwegian Law Brings Alternative

Medicine to the Mainstream

Journal of the National Cancer Institute, Vol. 96, No. 4, 254-255, February 18, 2004
 Blue Ribbon Panel
USA - 1996
• complementary medicine in medical &
nursing education
• philosophical / spiritual paradigm
• scientific foundation
• practice & evidence of efficacy & safety
• develop national centres of excellence
• 30 medical schools involved
 World Health Organisation…
• adopted a number of resolutions
• has a Traditional Medicine programme
• 19 collaborating centres in 10 countries
• 1996 – 28 monographs of 28 plants
South Africa…
• political support
• NRF / MRC support
• various educational initiatives (UKZN, Limpopo, UCT, UWC, Zululand)
•Traditional Healers legislation
 Is the grass greener?

Minnesota
Medicine
Published monthly by the Minnesota Medical Association
July 2000/Volume 83

Error in Medicine:
What Have We Learned?
Integrated Medicine Initiative

• integration
• complementarities
• rivalry
• co-existence
Review of TCAM – major domains

• traditional & alternative systems

• mind – body interventions

• biological – based therapies
• manipulative & body movement
methods
• energy therapies
What are we doing?
• enhance curriculum
• development of
service sites
• resource mobilisation
(local & international)
• documentation
• academic exchange
& research support
Learning Opportunities

• Alternative &
Complementary
• African systems
• Indian systems
• Chinese systems
 Research agenda…
• basic principles & assumptions (rigor &
relevance)
• strategies for peer review, evaluation &
validation research
• priority areas may be paediatrics, cancer,
mental health & cardiovascular disease,
HIV/AIDS
• horizontal integration with ethno-
botanists, chemists, anthropologists
Operational Research agenda…
• develop adverse effects registry
• credentialing & practice numbers
• coding
• billing system
• record keeping
• values
Conceptual & Contextual Issues
• Diagnostic classification
• Adequacy of treatment
• Placebo vs non-placebo
• Outcome measures
• Assumptions about randomisation
Program mix

Academic development

• certificate
• diploma
• degree
Together…
 International diversity
• Traditional medicine
practices have been
adopted in different
cultures and regions
without the parallel
advance of international
standards and methods
for evaluation.
 Different concept
• Complementary/alternative medicine (CAM): often
refers to a broad set of health care practices that are
not part of a country’s own tradition and are not
integrated into the dominant health care system.
• Other terms sometimes used to describe these health
care practices include “natural medicine”,
“nonconventional medicine” and “holistic medicine”.
• Herbal medicine: plant derived material or
preparations with therapeutic or other human health
benefits, which contain either raw or processed
ingredients from one or more plants. In some
traditions, material of inorganic or animal origin may
also be present.
• Traditional medicine (TM): is the sum total of
knowledge, skills and practices based on the theories,
beliefs and experiences indigenous to different
cultures, whether explicable or not, used in the
maintenance of health as well as in prevention,
diagnosis, improvement or treatment of physical and
mental illnesses.
 WHO response
• WHO and its Member States cooperate to
promote the use of traditional medicine for
health care. The collaboration aims to:
• support and integrate traditional medicine into
national health systems in combination with
national policy and regulation for products,
practices and providers to ensure safety and
quality;
• ensure the use of safe, effective and quality
products and practices, based on available
evidence;
• acknowledge traditional medicine as part of
primary health care, to increase access to
care and preserve knowledge and resources;
and
• ensure patient safety by upgrading the skills
and knowledge of traditional medicine
providers.
 Evidence-based medicines ?
• A total of 129 countries
answered this question; for
the detailed responses.
• The category chosen by the
most countries was that of a
lack of research data (109
countries), followed by lack of
appropriate mechanisms for
the control of herbal
medicines (93 countries), lack
of education and training (86
countries), lack of expertise
within the national health
authorities and control
agency (70 countries) and
other (33 countries).

WHO, 1991
• Tujuan terapi adalah
1. Memperpanjang harapan hidup dengan
harapan mencegah kematian lebih dini.
2. Memperpanjang kualitas hidup (quality of
life ) sehingga kecacatan akibat suatu
penyakit dapat dihindari atau diminimalisir.
3. Mengatasi keluan atau gejala yang menjadi
masalah penderita.
• Adapun cara mencapai tujuan tersebut
melalui penanganan penderita secara
komprehensip yang meliputi upaya promotif,
preventif, kuratif dan rehabilitatif.
 CAM
- Pelengkap
-- pilihan lain
--- diversifikasi
 CAM and Traditional Medicine Use
in the USA
Prevalence and
demographics
• Use 75%
– p year 62%
• Female > male
• Higher education level
www.CDC.gov: 2002 NHIS survey
• Ethnicity determines
type of CAM used
Herbal medicines Shiatsu Homeopathy
• Hospitalized p year
Qi gong Osteopathy Tai ji Unani Tuina Acupuncture/acupressure Chinese medicine
Ayruveda Chiropractic Naturopathy Siddha Native American Yoga Curanderismo
Folk practices Laying on of hands Kampo
 CAM becomes “popular”
• 1995
– NIH Office of Dietary Supplements
– FDA declassifies Acupuncture
needles as experimental product

• 1996
– NIH Consensus Conference on Acupuncture

• 1997
– First large trial of CAM therapy, St. John’s
Wort for depression
• 1998
– National Center for Complementary &
Alternative Medicine (NCCAM) established
http://nccam.nih.gov/
– First full scale article in JAMA on herbal
medicine
– Office of Cancer Complementary and
Alternative Medicine (OCCAM) established
http://www.cancer.gov/cam/

• 2001
– CAM on PubMed (NCCAM and NLM)

• 2009 - $296 million in NIH CAM research

 Impact of CAM
• CDC Report (2007)
– 38% of adults used some form of CAM
– Children whose parent used CAM were 2x as
likely to have used CAM
– CAM use more prevalent for: women, adults aged
30-69, higher levels of education, adults who
were not poor, adults living in the West, and
former smokers

• Full report:
http://nccam.nih.gov/news/camstats/
 Complementary and Alternative
Medicine (CAM)
• Complementary medicine
• Used together with conventional medicine
– Also called allopathy, Western, mainstream, orthodox,
biomedicine

• Alternative medicine
• In place of conventional medicine
• Generally incorporates a holistic approach, focus on
treating whole body and mind
• Changes as some CAM practices become more
mainstream
– Used widely throughout the world
 Complementary and Alternative
Medicine (CAM)
• Who uses it?
– 36% of adults in U.S. used CAM within the past
12 months
• More women than men
• People with higher education levels
• Those hospitalized within the last year
• Former smokers
• People with back, neck, head, joint aches or other
painful conditions
• Those with gastrointestinal disorders or sleeping
problems
Complementary and Alternative
Medicine (CAM)

• CAM in the U.S. today

– Relaxation
– Chiropractic
– Massage
– Self-help
– Energy healing
– Other therapies
Reasons Adults in the United
States Use CAM

Figure 17.1
 Alternative Medical Systems
• Traditional Chinese medicine
– Proper balance of Qi (“chi”)
– Acupuncture, herbal medicine, massage,
qigong
• Ayurveda
– Traditional in India
– “Science of life”
• Homeopathy
– “Like cures like”
– Herbal medicine, minerals, and chemicals in
diluted forms
 Alternative Medical Systems
• Naturopathy
– Restore health rather than cure disease
– Diet, clinical nutrition, homeopathy,
acupuncture, herbal medicine, hydrotherapy,
manipulation, light therapy, therapeutic
counseling, pharmacology

• Have you ever used one of these non-

traditional practices?
Complementary and Alternative
Medicine (CAM)

• Major domains of CAM (nonallopathic)

– Manipulative and body-based practices
– Energy medicine
– Mind-body medicine
– Biologically based practices
The Domains of Complementary
and Alternative Medicine

Figure 17.2
Manipulative and Body Based
Practices
• Chiropractic medicine
• Massage therapy
• Body work
– Feldenkrais
– Rolfing
– Shiatsu
– Trager bodywork
• Energy medicine

– Biofields
– Qigong
– Reiki
– Therapeutic touch
 Energy Medicine

• Acupuncture
– Needles inserted at critical points (meridians)
– Qualifications
– Many get relief
• Acupressure
– Uses pressure instead of needles
 Mind-Body Medicine

• Psychoneuroimmunology (PNI)
– Excessive stress can lead to immune system
dysfunction
– Activities that involve quieting the mind
 Biologically Based Practices
• Foods as healing agents
– Functional foods
– Nutraceuticals
 Assessing the Risks and
Benefits of CAM Treatments

Figure 17.3
Diseases and Conditions
Top CAM Therapies
 Asean users
• WHO South-East Asia Region:
Bangladesh, Bhutan, Democratic
People’s Republic of Korea, India,
Indonesia, Maldives, Myanmar,
Nepal, Sri Lanka, Thailand, Timor
Leste2.

• 2 Not a WHO Member State at the

time of distribution of the
questionnaire, and therefore not
included in the Global Survey.
•
 DRAFT REGIONAL STRATEGY
FOR TRADITIONAL MEDICINE

 Traditional medicine is the knowledge, skills

and practice of holistic health care, recognized
and accepted for its role in the maintenance of
health and the treatment of diseases.

 It is based on Indigenous (originating where it

is found) theories, beliefs and experiences
that are handed down from generation to
generation.
 DRAFT REGIONAL STRATEGY
FOR TRADITIONAL MEDICINE

 In the West, the umbrella term complementary and

alternative medicine (CAM) is widely accepted as
including both traditional medicine and more recent
forms of non-standard medicine.

 A recent modification of the well-known

Cochrane definition described CAM as including: "all
such practices and ideas self-defined by their users
as preventing or treating illness or promoting health
and well-being.
DRAFT REGIONAL STRATEGY
FOR TRADITIONAL MEDICINE
• WHO will work with countries:
• to ensure the safe and effective use of traditional
medicine of an acceptable quality; and
• to promote the recognition of traditional
medicine and to support its integration into
mainstream health services.
 DRAFT REGIONAL STRATEGY
FOR TRADITIONAL MEDICINE
• Traditional medicine has an established promotive,
preventive, curative and rehabilitative role.

• It can be the main form of health care, or an integrated

component of mainstream health care, or an alternative or
complement to the main form of health care.
 DRAFT REGIONAL STRATEGY
FOR TRADITIONAL MEDICINE
• The WHO Regional Committee has adopted
two resolutions,

• WPR/RC36.R6 in 1985 and the

WPR/RC38.R16 in 1987, recognizing that
traditional medicine practices, particularly
herbal medicine and acupuncture, constitute
appropriate health practices that can be
integrated into national health strategies.
 DRAFT REGIONAL STRATEGY
FOR TRADITIONAL MEDICINE
• Countries are encouraged to identify how
far traditional medicine has been
recognized and integrated into mainstream
health services.
• The formulation of strategic goals, action
plans and time frames depends on the
level of recognition and integration in each
country.
 Utilization patterns

• Different reasons bring consumers to traditional

medicine. Cultural beliefs may still be the major
reason for using traditional medicine.

• people living in rural and remote areas in developing

countries often seek first line health service from
traditional systems of medicine because they are the
only available and affordable form of health care.
 Utilization patterns

• Some patients may go to traditional medicine after

unsatisfactory treatment from modern medicine.

• In all these cases, the effectiveness of traditional medicine

and consumer satisfaction with services plays an important
role in maintaining and increasing public interest in
traditional medicine.
 Utilization patterns

• In some countries, traditional medicine is

practised not only at the primary health
care level but also in hospitals providing
secondary and tertiary care.

• In other countries, traditional medicine is

used mainly as family and community-
based practice.
 Need for an evidence-based approach

• Demands from the public have led to increasing

involvement in traditional medicine by the scientific
community. Many medical doctors have begun to
use traditional remedies and techniques in their daily
practice.

• Universities and medical schoolsoffer full-time

degree courses or short introductory courses on
traditional medicine.
 Need for an evidence-based approach
• Engaged in research on traditional medicine. Some
researchers are attempting to evaluate the safety and
efficacy of traditional medicine, while others are engaged
in research into new drugs and other products derived
from plants.
 Need for an evidence-based approach

• An evidence-based approach to traditional

medicine will be an important step
towards in harmonizing traditional and
modern medicine and enabling the two
systems to work effectively side by side.
 PARADIGMA BARU
UNDANG-UNDANG RI No.36/2009
(HAK INISIATIF DPRRI)
tentang KESEHATAN, mendorong Reformasi dan
Reorganisasi Kemenkes RI
PASAL 48 Ayat 1
UPAYA KESEHATAN
TERDIRI DARI 17 JENIS PELAYANAN

(2) Pelay. KESEHATAN TRADISIONAL

di Puskesmas (utamanya Promotif dan Preventif)

di Rumah Sakit (utamanya Kuratif dan Rehabilitatif)
24/11/2019 104
Pembangunan Kesehatan Nasional

Akademisi Pelaku
Pemerintah Masyarakat
Usaha

Medis Preventif, Perilaku hidup

Promotif, sehat
Kuratif,
Rehabilitatif
Swamedikasi Olah Raga

Tradkom Tradkom

UUD’45 HDI
 VISI dan MISI
VISI
“Masyarakat Sehat yang mandiri dan Berkeadilan”
MISI
1. Meningkatkan derajat kesehatan masyarakat, melalui
pemberdayaan masyarakat, termasuk swasta dan
masyarakat madani.
2. Melindungi kesehatan masyarakat dengan menjamin
tersedianya upaya kesehatan yang paripurna, merata,
bermutu, dan berkeadilan.
3. Menjamin ketersediaan dan pemerataan sumberdaya
kesehatan.
4. Menciptakan tata kelola kepemerintahan yang baik.
 PELAYANAN KESEHATAN
(WHO)

MODERN MEDICINE TRAD. MEDICINE

Disebut juga : Disebut juga :
• Allophatic • Komplementer
• Alternatif
• Konvensional
• Non Konvensional
• Biomedisin
• Oriental Medicine
• Scientific medicine • Holistik
• Western medicine • Alamiah
• Natural
107
 KLASIFIKASI BATTRA
(Pasal 59 ayat 1 UU 36/2009)

Dikelompokkan berdasarkan metode

yang dominan digunakan

RAMUAN KETERAMPILAN

MANUAL ALAT/TEKNOLOGI MENTAL/O.FIK

Battra Battra Battra Battra

reiki, qigong,
Jamu, Gurah, pijat urut, akupunktur, kebatinan,
Homoeopath, shiatsu, chiropraksi, tenaga
Aromaterapi, patah battra bekam, dalam,
SPA terapi, tulang, Pnta-kecantikan paranormal,
Sinshe, refleksi, Hipnoteraphi
Api/sengat terapi akupressur 108
 ALUR PROSES INTEGRASI YANKES
TRADKOM
INTEGRASI
YANKES
TIMUR
BARAT
(KONVENSIONAL) (NON KONVENSIONAL)

EVIDENCE BASED EVIDENCE BASED BUKTI EMPIRIS

HILIR HULU
WESTERN/MODERN KESTRAD TERUJI KESTRAD
DOKTER DOKTER Plus
(Fas Kes) (Fas Kes)

MASYARAKAT MASYARAKAT
-UKBM -UKBM
-BATTRA PENAPISAN -BATTRA
- KAJI
- UJI
- LIT

JEJARING LITBANG
(termasuk SP3T/BKTM/LKTM) 109
 17 UPAYA KESEHATAN
(Ps 48 ayat 1 UU 36/2009 ttg Kesehatan)
1. PELAYANAN KESEHATAN
2. PELAYANAN KESEHATAN TRADISIONAL
3. PENINGKATAN KESEHATAN DAN PENCEGAHAN PENYAKIT
4. PENYEMBUHAN PENYAKIT DAN PEMULIHAN KESEHATAN
5. KESEHATAN REPRODUKSI
6. KELUARGA BERENCANA
7. KESEHATAN SEKOLAH Pasal 47 : Up.Kes diselengg dalam
8. KESEHATAN OLAHRAGA Bentuk keg dg pendekatan Promotif,
9. Preventif, Kuratif dan Rehab yang
PELAYANAN KESEHATAN PADA BENCANA
10. PELAYANAN DARAH dilaks sec TERPADU, MENYELURUH
11. KESEHATAN GIGI DAN MULUT dan BERKESINAMBUNGAN
12. PENANGGULANGAN GANGGUAN PENGLIHATAN DAN GANGGUAN
PENDENGARAN
13. KESEHATAN MATRA
14. PENGAMANAN DAN PENGGUNAAN SEDIAAN FARMASI DAN ALAT
KESEHATAN
15. PENGAMATAN MAKANAN DAN MINUMAN
16. PENGAMANAN ZAT ADIKTIF, DAN/ATAU
17. BEDAH MAYAT

110
 PASIEN DATANG
K
O
PEMERIKSAAN & DIAGNOSA OLEH DOKTER N
( Penegakan Diagnosa Tetap secara Konvensional) S
E
Pilihan terapi yang diberikan dokter: P
• Konvensional saja
• Konvensional +Yankes Tradisional (komplement) I
• Murni Yankes Tradisional (alternatif) N
T
E
Terapi dapat diberikan oleh: G
• Dokter yg telah memiliki sertifikat kompetensi R
• Tenaga kesehatan yg mendapat pelatihan khusus A
dibidang Tradkom (dalam pengawasan dokter) S
I
 Rencana Stratregis ’09 – ‘14
No INDIKATOR 2010 2011 2012 2013 2014

1. Cakupan kab/kota yg menye

lenggarakan progr bina 10% 20% 30% 40% 50%
yankestrad, alternatif dan
komplementer

2. Jlh RS yang menyelenggara

kan yankestrad yg aman dan 26 36 46 56 70
bermanfaat sbg yankes
alternatif dan komplementer

112
 NSPK
1. Pedoman Pelayanan Kesehatan Tradisional Ramuan
2. Ped Pembinaan Pengobat Tradisional Akupresur Bagi Pet Kesehatan
3. Pedoman pengelolaan dan pemanfaatan TOGA
4. Formularium Obat Herbal Asli Indonesia
5. Pedoman Pembinaan Salon Kecantikan
6. Tata Laksana BKTM/LKTM (Permenkes No 002 Tahun 2012)
7. Pedoman Penyelenggaraan Pel Kes Trad Ketrampilan
8. Pedoman Pendayagunaan Pengobat Tradisional Asing (PTA)
9. Standar Pelayanan Medik Akupunktur
10. Kurikulum dan Modul TOT Tenaga Pelatih Akupresur di Propinsi
11. Kurikulum dan Modul Pelatihan Akupresur Bagi Pet.Kes di Pusk
STRATEGI 2012  IMPLEMENTASI
PRIORITAS PROGRAM 2012
1. Implementasi NSPK dan Penegakan Regulasi dengan
pendekatan pembinaan, kompetensi, tertib dan
bertanggungjawab pada fasilitas Yankestrad Pemerintah dan
Masyarakat.
2. Implementasi Integrasi pelayanan kesehatan Tradkom di
fasilitas kes formal/konvensional sesuai sasaran Renstra Kes
2010-2014.
3. Penguatan peran 17 Sentra P3T dan pengemb fungsi
pelayanan di BKTM/LKTM, serta mendorong pembentukan 9
SP3T baru di Provinsi.
4. Penguatan kerjasama Kemitraan Lintas Program untuk
penguatan Yankestrad Pemerintah dan kemitraan LS untuk
peningkatan ketersediaan bahan/OT.
5. Mendukung pencapaian MDG’s, meningkatkan
pemberdayaan masyarakat di wilayah DTPK/DBK melalui
kemandirian pemanfaatan ramuan dan Yan Tradisional.
 Conclusion
• TM, CAM use should
follow therapeutic concept
based on dynamic
homeostatic aspects.

• Users should be aware of

adverse reaction since no
guarantee manner as no
evidence-based medicines
HARAPAN BERSAMA