Traditional and Complementary Medicine Businesses in Kota Kinabalu
David Matanjun1*, Mohammad Saffree Jeffree1, Fredie Robinson1, Md Shamsur Rahman1, Falah Abass Mohamed Salih1
1 Faculty of Medicine and Health Sciences, University Malaysia Sabah
*Corresponding Author: [email protected]
Accepted: 15 December 2020 | Published: 28 December 2020
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Abstract: Traditionally, many TCM practices (Traditional and Complementary Medicine;
also known as CAM or Complementary and Alternative Medicine) have emphasized health promotion; TCM practitioners has been seen as a public health resource to increase the population’s access to certain “clinical preventive services”. As part of the integration of TCM practices into the public health arena, as encouraged by the WHO, it is important to investigate first the availability of TCM practices in the local environment. The objective of this study is to determine the prevalence of Traditional and Complementary Medicine (TCM) Practice in the City of Kota Kinabalu (KK), and how that may translate to the extent of the business of TCM in KK. KK has a population of about 470,000. This survey identified TCM premises based on prevalence and types in Kota Kinabalu, (excluding the districts of Penampang and Putatan).
TCM was defined as the use of any methods and products not included in conventional allopathic western medicine. Surveys conducted from January-April on 547 “clinics" and premises offering in a singular mode or multitherapy. One hundred and fifty two types of TCM were identified, encompassing 9 basic types of TCM. The most common TCM providers were massage therapists (75.7%), traditional Chinese medicine (10.5%) and herbalists (5.9%). A wide range of TCM use was documented in this study. Our results at this preliminary stage of the study indicate that quite a variety of TCM therapy is available and thriving in this small city alongside conventional medicine.
Keywords: business, traditional medicine Sabah
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1. Overview
The aim of this study is to ascertain the prevalence of Traditional and Complementary (TCM) Practice in the City of Kota Kinabalu (KK), and how that may translate to the extent of the business of TCM in KK. KK (excluding the districts of Penampang and Putatan), has a population of about 470,000. Traditionally, many TCM practices (also known as Traditional and Complementary Medicine or, simply Traditional Medicine) have stressed health promotion; TCM practitioners has been seen as a resource of public health to raise the availability for the general population to certain “services in clinical prevention”. As part of the assimilation of TCM practices into the public health domain, as encouraged by the WHO, it is important to investigate first the availability of TCM practices in the local environment (Nurul Ain Mohd Tahir, et. al., 2015).
The majority of the populations (roughly 60-90%) in underdeveloped countries are still dependent on the comparatively low cost and easily obtainable TCM treatment, giving rise to a large market for TCM in meeting the needs for health care.
Surveys conducted from January-April on “clinics" and premises offering in a singular mode or multitherapy. There were 315 TCM-practice premises identified, encompassing 11 basic types of TCM. The most common TCM providers were massage therapists (51.1%). Other types of TCM include Traditional Chinese medicine (TCM) (9.2%) and herbalists (7.3%).
Premises which provide massage therapy mostly claim to offer reflexology (85.1%). Among the TCM practitioners 48.3% offered specifically acupuncture. In the premises which offer herbalism, 65.2% offered it as the sole TCM therapy while 33.3% were available in premises which offer more than one form of therapy.
As in many other places in the world, there are numerous types of TCM that are utilized in Sabah. (Chang, MLD and Tam, YLA, 2015) TCM in Sabah consists mainly of manipulative practices and herbalism.
Table 1: TCM Based on Types and Frequencies (%) In Kota Kinabalu
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TYPE OF TCM FREQUENCY (%)
Massage: Reflexology 96 (44.2%)
Massage: others 16 (7.4%)
Ethnomedicine: TCM: Acupuncture 8 (3.7%) Ethnomedicine: TCM: general 12 (5.5%)
Ethnomedicine: Thai 1 (0.5%)
Herbal medicine 15 (6.9%)
Yoga 10 (4.6%)
Naturopathy 3 (1.4%)
Wellness therapy 29 (13.4%)
General TCM Therapy 16 (7.4%)
Product 11 (5.1%)
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TOTAL 217 (100%)
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2. Manipulative-Practices
The most common TCM providers in Kota Kinabalu are massage therapists (51.1%). Premises which provide massage therapy mostly claim to offer reflexology (85.1%). In premises where reflexology is offered, reflexology is offered as the only type of TCM therapy in 70.1% of cases. With other types of massage therapy, it is offered as the only type of TCM therapy in two-third of cases while it is offered together with other types of TCM therapy in one-third of cases. Traditional massage as well as other manipulative- practices, based on the manipulation and physical motility of parts of the body, are also favoured because of their simpleness and seemingly quick curative effect that can be attained by the sick or consumer.
In reflexology, suitable pressure is applied to specific points and regions on the limbs, or ears (Embong, N. H., et. al., 2015). The practitioner believe that these reflex areas are associated to various organs and areas in the body, and that applying pressure on them has an advantageous effect on the person's health. “Reflexology” in western society such as the USA, usually
requires some proper high-level training be it at diploma, degree and even at the doctorate level (i.e. the Reflexologist in America may actually have a “Doctorate in Reflexology”). In contrast, the term “reflexology” in local usage may be used too casually where a novice with strong hands and ample stamina may claim to be a reflexologist with just a few days of
“apprenticeship”. In this survey, the premises labelled as a Reflexology Practice is accepted and counted as such, at face value, and no attempt is made to “accredit” the premise at this preliminary stage of the survey,
Other types of manipulative therapy are available. In Urut Melayu, hands, or mechanical means,are used to massage and manipulate the soft tissues of the body, especially the muscles.
Hence the aim of massage is to relax, stimulate and rejuvenate the relevant parts of the body or even the whole body. It makes the muscles more pliant, stimulate circulation and lessen stress. Indonesians from Aceh brought with them knowledge about urut (traditional massage), which became incorporated in the local medicinal regime (Jamal, JA, 2006).
With Balinese/Javanese Massage: Positioning himself above the patient, the practitioner combine rub down strokes, rolling of the skin, and massage with the foot. After the massage is completed, spices-augmented coconut oil is applied and rubbed in.
3. Ethnomedicine
Other types of TCM include ethnomedicine in the form of Traditional Chinese medicine (TChM) (9.2%). Acupuncture is intrinsically TChM and is the closest form of TCM (or CAM, for that matter) that can be said to have some degree of scientific basis. In premises where acupuncture is offered, 57.1% offer it as the sole TCM therapy. Where TChM is offered 80%
of the premises offer it as the sole type of TCM.
TChM business is booming in China (Juncai Xu and Zhijie Xiab, 2019), and so with many countries with a sizeable Chinese or oriental population, as in Malaysia and the ASEAN region.
Under the purview of western medical science, however, it is still asked “Is ThCM clinically effective?” Indeed, can the booming business and globalization of TChM be translated into medical efficacy and safety.
Ethnomedicine is a branch of medical anthropology related to the study of traditional medicines, including those that have pertinent documented sources (e.g. TCM, Ayurveda), but particularly those, where the knowledge and practices have been passed down orally over hundreds of years. In the scientific area, the study of ethnomedicine, as well as ethnopharmacology, the approach is more anthropological, rather than biomedical. The focal point of these studies is therefore the concept and environment of use of traditional medicines, rather than their bioevaluation. Ethnopharmacology can be said to be a scientific study relating ethnic groups, their health, physical traits and mode of use in producing and exploiting medicines; one of its aim is bioevaluation of the effectiveness of traditional medicine.
4. Herbalism
Another popular type of TCM is herbal therapy (7.3%). In premises where herbalism is practiced, 65.2% offer it as the sole form of TCM therapy.
Sales of herbs or herbal medicinal products have grown significantly in recent years. Starting this business has great prospects. To start this type of business, you need to have prior
knowledge in traditional medicine. You do not need degrees or certificates, but knowledge and experience with herbs. In fact, there are no generally recognized diplomas or certificates that make you a herbalist.
You can’t start this business unless you have previous knowledge and experience in traditional medicine. True success requires an equal love of herbs and educating people about the benefits from them.
There are estimates of up to 70,000 kinds of medicinal plants used in the world, of which about 3000 are traded; however less than 1000 are produced under controlled cultivation.
Many plants can now be found in herbal products, as part of the traditional Sabah health care system, and because of their perceived therapeutic efficacy. In the process of researching a natural product used as medicine by a particular ethnic group, it is imperative that the methodology of harvesting, extraction, preparation are comparable, if not identical to that practiced by the relevant ethnic group, to ensure that the same safe process and practice continue to be used and maintained with no break in the safety record (Kulip. J, 2003).
Worldwide, provision of healthcare comprises of about 10-30% of conventional medicine and the remaining 70-90% are various types of Traditional and Complementary medicine. Folk medicine in many ethnic cultures include the use of plants and herbal products. In traditional ethnic cultures, information about plants and herbs are routinely collected and documented well into recent times, indeed some of the pharmacopoeia of modern medicine was derived from traditional herbal practice.
Many medicinal plants, which are used by the diverse native cultures in Sabah, have been determined. Traditional knowledge may be lost due to various reasons including loss of communication between elderly practitioners and the younger generation, particularly in terms of the youths spending less time with their elders in the fields leading to minimal exposure to herbs; modern schools and educational practice lead to little or no time spent learning about herbalism, which are also not part of the national curriculum; youths, having little or no interest, may rather migrate away from the rural areas; easy availability of hospitals, health clinics &
pharmaceutical drugs, replacing herbal plants; as they practice traditional medicines less and less, village elders will forget the intricacies and practice of folk medicine; as the need decline, the passing of traditional knowledge through the apprenticeship system will eventually be lost and forgotten; some religions discourage the practice of herbalism due to the perception that prohibited taboos and magic are associated with the practice of traditional medicine. (Ahmad, FB & Holdsworth, DK, 2003)
Rural natives in the villages may still have a lot of knowledge about types of herbal plants and their medicinal utility; there is a tendency to use TCM for simple illnesses and injuries; while seeking conventional medicine at the local health clinics or hospitals for more serious diseases;
many still have faith in the effectiveness of modern conventional medicines, but they may still opt for TCM and herbalism first when they become ill. Hence TCM and modern medicine may therefore be said to complement each other.
The local herbal medicine market has undergone a substantial growth. Regulatory efforts by the Ministry of Health and some research activities by local tertiary institutions aim to ensure herbal medicines translate into quality, efficacious and safe products for human use.
5. Miscellaneous
Other types of TCM practices include Yoga (11 premises or 3.5% of the total number of premises offering TCM therapy), Naturopathy (5 premises or 1.6%) and Wellness therapy (39 premises or 12.4%). Spiritualism, which may be regarded as a particular attribute of the mind- body medicine aspect of TCM, still have its practitioners and followers among the indigenous races of Sabah (Florey, MJ and Wolff, XY, 1998). However, in the mainland urban areas of Kota Kinabalu, spiritualism had not been detected as a form of TCM in this preliminary study.
6. Conclusion
A wide range of TCM use was documented in this study; our results at this preliminary stage of the study indicate that quite a variety TCM therapy is available and thriving in this small city alongside with the singular conventional allopathic medicine.
The business of TCM, or Traditional Medicine is an intrinsic part of Southeast Asian society, and as such is often regarded as both a prospective competitor and a complemental treatment to modern pharmaceuticals; however, many of these traditional therapies have the proclivity to have adverse effects, directly or indirectly. Nonetheless, TCMs must be regarded within the contending set for many competing product types, as they are so ingrained in societal belief of many Sabahans and Malaysians.
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