Various T&CM practice guidelines have been published by the MOH, including for the Ayuverdic technique of Shirodhara seen here. — Photos: Filepic
Traditional and complementary medicine (T&CM) has long been a part of our country’s informal healthcare landscape.
However, concerns have been raised, particularly among modern healthcare practitioners, regarding the safety of T&CM practices.
Many doctors have encountered cases where patients delay proper medical treatment after seeking care from T&CM practitioners, leading to adverse outcomes.
Acknowledging the importance of T&CM in Malaysian society – where traditional medicine is deeply rooted in cultural practices – the Health Ministry (MOH) has taken proactive steps to safeguard public health.
Malaysia’s T&CM landscape is highly diversified, reflecting our country’s rich history, languages, philosophies and cultural heritage.
T&CM therapies are often sought for their holistic approach, addressing physical, mental and spiritual well-being.
The popularity of these practices is evident from the results of the 2015 National Health and Morbidity Survey (NHMS), which estimated that 29.3% of the population had used T&CM with consultation in the past 12 months, and 69.4% had used T&CM at some point in their lifetime.
This widespread usage underscores the need for stringent safety measures to protect consumers from potential risks.
In line with this, the MOH has established a robust regulatory framework to oversee T&CM practices.
A key milestone was the establishment of the T&CM Division within the ministry in 2004 to regulate the safety and quality of T&CM services.
This division is responsible for the development and enforcement of T&CM-related policies and regulations.
The introduction of the T&CM Act 2016 [Act 775] further strengthened the regulatory framework, leading to the establishment of the T&CM Council on Jan 16, 2017.
The T&CM Council, chaired by the Health director-general, comprises up to 22 members and is tasked with regulating recognised T&CM practices, including traditional Malay medicine, traditional Chinese medicine, traditional Indian medicine, homeopathy, chiropractic, osteopathy, and Islamic medical practice, which was gazetted on July 28, 2017.
Practitioners who wish to practise in these areas must register with the T&CM Council, where their eligibility and academic qualifications are thoroughly vetted.
Safety first
Safety is a paramount concern in T&CM practice.
The MOH has outlined several safety principles that T&CM practitioners and service providers must adhere to.
Various T&CM practice guidelines have been published since 2005 to guide T&CM practitioners working in MOH facilities.
These include the Traditional Malay Medicine – Malay Massage (3rd edition, 2018), Traditional Chinese Medicine – Acupuncture (3rd edition, 2017), Herbal Therapy as Adjunct Treatment for Cancer (2nd edition, 2018), and Traditional Indian Medicine – External Basti Therapy (1st edition, 2015), Varmam therapy (1st edition, 2016) and Shirodhara (2nd edition, 2019), among others.
These guidelines serve as a guide for clinical practice, based on the best available evidence at the time of development, and are reviewed every five years or when new evidence emerges.
The development of these T&CM practice guidelines involves a committee of experts in the field, along with internal and external reviewers, to ensure comprehensiveness.
Each guideline includes information such as referral criteria, indications, contraindications, standard operating procedures (SOPs) for treatments, requirements for treatment rooms and equipment, types of medicines, treatment regimes, and monitoring of treatment responses.
Additionally, templates for T&CM clerking sheets (for healthcare professionals to fill in the patient’s relevant medical information), consent forms in English and Bahasa Malaysia, and patient management flow charts, are provided.
Regarding the safety of T&CM practices, each guideline lists potential adverse events.
For instance, in Shirodhara (an Ayurvedic technique where oil or other liquids are dripped onto the patient’s forehead), patients may experience side effects such as discomfort at the occipital region of the brain, headaches, neck pain, light-headedness, and allergic reactions caused by the oil used.
The guidelines provide clear instructions on identifying and reporting adverse events.
Adverse reactions related to T&CM medicine are to be documented in the T&CM Unit’s Adverse Reaction Form and submitted to the National Pharmaceutical Regulatory Agency (NPRA) for further investigation.
These guidelines also incorporate treatment outcome scales, such as the Ministry of Health Pain Scale; Depression, Anxiety and Stress Scale – 21 Items (DASS-21); and Pittsburgh Sleep Quality Index (PSQI).
These allow the measurement of the efficacy of T&CM treatments using modern medical scales, in line with the era of evidence-based medicine.
Establishing professional standards
In addition to practice guidelines, the Code of Professional Conduct for T&CM Practitioners, published in 2021, ensures compliance with professional standards.
It is essential that T&CM services are provided in a safe and hygienic environment, following established protocols in order to minimise patient risks.
T&CM practitioners must be competent and continuously enhance their knowledge and skills.
The code also addresses advertising, stating that T&CM practitioners must comply with the Medicines (Advertisement and Sale) Act 1956 [Act 290] and other related legal provisions.
T&CM practitioners are prohibited from using titles and abbreviations such as Doctor of Medicine, Dr, Physician or Medical Consultant, in a way that misleads the public into believing they are qualified to practise modern medicine or perform surgery under the Medical Act 1971 [Act 50].
They are also prohibited from using terms like “clinic”, “dispensary” or “hospital” in their business names.
Their most recent annual practising certificate (APC) must be prominently displayed within their premises.
A two-way communication mechanism between registered medical practitioners (modern medicine) and T&CM practitioners in MOH hospitals was established, with the 3rd edition of the SOP published last year (2023).
This SOP provides guidance on the operation of T&CM units in MOH facilities, covering organisational structure; roles and responsibilities of T&CM personnel; human resources; procurement and storage of T&CM-related items; infection control; planned preventive maintenance (PPM); medical records management; reports and statistics; and quality management; which are all designed to ensure the safety of T&CM operations in hospitals.
To maintain T&CM service standards, it is essential that such services are provided in a safe and hygienic environment, following established protocols to minimise patient risks.
The Guidelines for Traditional and Complementary Medicine Healthcare Facilities and Services in Malaysia, published last year (2023), serves as a vital reference for new and existing private T&CM healthcare service providers.
These guidelines also assist local authorities in approving new applications or renewals for business licenses, ensuring that T&CM facilities operate in accordance with MOH standards.
As this is only a guideline, it is anticipated that a law equivalent to the Private Healthcare Facilities and Services Act 1998 (Act 586) & Regulations 2006 (PHFA) will be introduced and gazetted soon.
This law is crucial for the T&CM industry to secure insurance coverage, and ensure both the practitioner and the place of practice are adequately governed.
The T&CM Division has also published the Virtual Consultation Implementation Guidelines for T&CM Practitioners in response to the growing demand for virtual consultations post-Covid-19.
These guidelines outline the protocols for conducting virtual consultations for registered T&CM practitioners in public and private healthcare facilities.
However, virtual consultations are not permitted for patients with mental health problems, those under 18 years of age (except in the presence of a guardian/parent), patients with cognitive impairment, patients under the influence of drugs/alcohol, or those deemed unsuitable for virtual consultations by the T&CM practitioner.
Additionally, the Guideline on Traditional Chinese Medicine Nursing Procedures in Private Healthcare Facilities, published in July (2024), acknowledges the critical role that nurses play in assisting in procedures and monitoring patients, particularly in private practices with traditional Chinese medicine inpatient services.
There is hope that a post-basic course in T&CM practices will soon be developed and adopted by the Nursing Board.
Providing data and evidence
With the launch of the Framework on T&CM Research in Malaysia and the Guideline for Herbal Medicinal Research by the MOH in April 2023, Malaysia is leading the way in harmonising modern clinical research methodologies with traditional medicine principles and theories.
This initiative provides a comprehensive guide for researchers interested in developing and conducting T&CM research, representing a significant step towards the professionalisation of the T&CM industry.
Scientific research is crucial for demonstrating the safety and quality of T&CM treatments.
With this research framework in place, it is anticipated that more rigorous T&CM research will be conducted by local universities with T&CM programmes, in collaboration with T&CM stakeholders in Malaysia.
In summary, the integration of T&CM into Malaysia’s healthcare system comes with a strong commitment to safety and professionalism.
The MOH continues to take significant steps to ensure that T&CM practices are regulated, safe and effective, benefiting all Malaysians while preserving the rich cultural heritage of traditional medicine.
Assistant Professor Dr Teo Chiah Shean is trained in both Western and traditional Chinese medicine, and is UCSI University’s Traditional and Complementary Medicine School head. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
