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MYANMAR EXPERIENCE

IN INTEGRATING

TRADITIONAL MEDICINE

INTO MODERN MEDICINE

PRESENTED BY

PROF. MYAT MOE

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Introduction

• MTM –in the form of familiar remedies• Provision of health,disease prevention &

treatment• partly based on works by many famous

physicians• adapting Lord Buddha's teaching & sermons• adapting some Ayurvedic theories

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MYANMAR TRADITIONAL MEDICINE EXISTED SINCE TIME IMMEMORIAL

BAGAN

PINYA

INWA

KONBAUNG

YADANABON

INHERITED FROM ONE DYNASTY TO ANOTHER

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• Under the colonial rules –declined gradually

• patriotic Trad. physicians tried to revive

• During 2nd world war –most rely on TM

• TM has been given increasing interest and encouragement by the authorities concerned, and thus Myanmar are now rely more on TM for their health care

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HEALTH POLICY AND TRADITIONAL MEDICINE

LAID DOWN IN 1993

FOR TRADITIONAL MEDICINE

THE POLICY SAID....

THE SERVICES AND RESEARCH ACTIVITIES OF INDIGENOUS MEDICINE WOULD BE REINFORCED TO INTERNATIONAL LEVEL AND TO INVOLVE IN COMMUNITY HEALTH CARE ACTIVITIES

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In order to succeed in attaining the goal, " Health for All", the NHP in Myanmar has

emphasized all useful approaches to be employed and all possible resources to be mobilized, among which, includes various

kinds of indigenous practices.

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MYANMAR SYSTEM OF TRADITIONAL MEDICINE

BASED ON BUDDHIST PHILOSOPHY AND AYURVEDIC CONCEPT

FOUR MAIN COMPONENTS

THE DESANA SYSTEM

THE BETHITSA SYSTEM

THE ASTROLOGICAL SYSTEM

THE VIZZADARA SYSTEM

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INTEGRATION OF TRADITIONAL MEDICINE AND MODERN MEDICINE

• Approach of TM is holistic, multiple causes

• Simple, not require lab tests

• using mainly herbs• close relationship bet:

physician & patient

• Modern medicine is disease orientated

• spend more time on lab investigation &modern tech:

• using synthetic & chemicals

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THE BASIC KNOWLEDGE OF ALLOPATHIC DEPENDS ON MODERN AND SCIENTIFIC MEDICINE, BIOLOGY, MICROBIOLOGY, PATHOLOGY, PHARMACOLOGY, ETC.

THE BASIC KNOWLEDGE OF TRADITIONAL MEDICINE BASED

LIFESTYLE, BEHAVIOUR, , NUTRITIONAL, ENVIRONMENTAL,

ALTHOUGH TWO SYSTEMS OF MEDICINE IS TOTALLY DIFFERENT THEY CAN SURELY BE INTEGRATED IN SOME AREAS

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Integrated medicine refers to the integration of appropriately validated

complementary and alternative medicine into mainstream medical practice

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INTEGRATING IN HEALTH CARE SYSTEM

80% OF MYANMAR POPULATION RESIDED IN RURAL AREA. DEPEND ON TRADITIONAL MEDICINE.

TRADITIONAL MEDICINE

THERE ARE—

12 TM HOSPITALS

200 TM CLINICS

ALLOPATHIC MEDICINE

HOSPITALS

RURAL HEALTH CENTERS

SUB -RHC

MINISTRY OF HEALTH

INTEGRATION AND

REFERRAL IN HEALTH CARE

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Efforts have now been made to functionally integrate TM into existing country health system through

-suitable training and orientation programs on the concept of essential drugs and rational drug use

-development of standard treatment schedule for prevalent diseases

-development of referral systems bet: dif: health care systems

-upgrading available resources (man, materials)

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INTEGRATING IN LABORATORY RESEARCH

TRADITIONAL MEDICINE

PLANT ORIGIN

ANIMAL ORIGIN

MINERALS

DIFFICULT TO STANDARDIZE

detection of foreign matter organoleptic evaluation, macro and microscopic examination, volatile content, ash value, pesticide residue, detection of heavy metals, microbial load, radioactive contaminants and recording of fingerprint chromatographic profile.

the efficacy, acute and chronic toxicity and side effects, both in vitro and in vivo

Scientific research

Integration

plants

formulations

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There will be inconsistency in medicinal plant material due to non-adoption of appropriate post-harvest technology, including collection, harvesting, drying, packing and storage.Therefore standardization is needed for good quality and safe traditional drugs.The remedies have been used for a long time without any scientific standardization; quality was controlled organoleptically.

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CLINICAL BENEFICIAL

INTEGRATING IN CLINICAL RESEARCH

Modern medicine can cure a lot of diseases, there are some incurable diseases that can be cured by traditional medicine. Besides, side effects and toxicity of the modern drugs are much pronounced. Traditional medicine also, although can cure many illnesses, there are some failures. Some diseases, which cannot be cured by the traditional medicine, can be cured by modern medicine.

MODERN MEDICINE (ADVANTAGE/DISADVANTAGE)

TRADITIONAL MEDICINE (DISADVANTAGE/ADVANTAGE)

+ INTEGRATION

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*In Myanmar, some illnesses such as diabetes, pulmonary TB that does not respond to standard treatment regime have been treated with the combined therapy of two systems.*Modern medicine cured the diseases while TM promotes the immune system.*Prognosis recorded in the scientific ways found to be satisfactory.* Integrated management could cure some illnesses

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Diabetes mellitus

• Some reputed med plants- proven to have anti-diabetic actions

• Increasingly used in the control of NIDDM by physicians of both TM & MM

• Explore ways& means of achieving individual and better control

• Integrated approach to the treatment of diabetes should be developed

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Pulmonary Tuberculosis

• Greatest threat is the MDR TB – progressively increased during the last decade

• 2nd line drugs – not only extremely expensive,but were less effective and more toxic ; greater defaulter rate & non-compliance make these regimes impracticable

• MDR patient who cannot afford –left to their fate

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However, there is a great danger that it is the small, seemingly insignificant, left-out population, which will continue to spread of MDR strains, adding a great burden to the already constrained National Tuberculosis Programme.

Many patients started taking reputed plants suggested by TM practitioners in addition to their usual first-line drugs.

Some surprisingly showed good response.

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• DMR in collaboration with DTM made in vitro screening for anti-TB properties of some reputed plants.

• Plants showing most promising results were then used for the treatment of MDR TB patients in addition to their usual second line anti-TB regime to which they had shown little or no rsponse.

• TB patients admitted to the Mandalay Tuberculosis hospital were assessed and viewed by both modern and traditional physicians for planning of integrated approach to the treatmentof MDR TB.

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INTEGRATING IN CLINICAL PRACTICE

TRADITIONAL MEDICINE

MODERN MEDICINE

CHRONIC DISEASES

DIABETES

DRUG RESISTANT TB

? HIV/AIDS

MALARIA

CHRONIC ARTHRITIS

CHRONIC SKIN DISEASES

ETC.

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INTEGRATING IN MEDICAL EDUCATION

HEALTH PERSONNEL

TRADITIONAL MEDICINE

MODERN MEDICINE

PROMOTION

PREVENTION

CURATIVE

REHABILITATION

INDIVIDUAL

COMMUNITY

COMBINED KNOWLEDGE WILL LED TO KNOW HOW TO USE AVAILABLE RESOURCES, MODERN DRUGS, HERBAL DRUGS, MANIPULATION, ETC.

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INTEGRATING IN PHARMACEUTICAL PRODUCTION

1.SAFETY

2.QUALITY

4.AFFORDA-BILITY

5.ACCESSIB-ILITY

TRADITIONAL KNOWLEDGE

AGRICULTURAL KNOWLEDGE

SCIENTIFIC ACCESSMENTS

MODERN TECHNOLOGY

LEGAL CONTROL

+

+

+

+

3.EFFICACY

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CONSTRAINT

The allopathic physicians believe that traditional medicine is conservative, subjective, backward and not scientific.

The traditional physicians believe that "western drugs" were not traditional and not available before; while the traditional drugs cure diseases even before the western drugs were introduced in the country.

Allopathic medicine used synthetic and chemical drugs, which were scientifically tested and approved.

Traditional medicine is simple, and does not require laboratory tests and sophisticated equipment, and most of all expenses are much less.

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CONSTRAINT

Main constraints are:

1. Different system, approach, and philosophy.

2. Difficult in negotiation their different views.

3. Ethical issue in research activity.

4. Integration may be possible, but belief may not be changed.

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Conclusion• Myanmar is moving towards the development of

integrated medicine, which is comprehensive , in which treatment techniques are more complementary to each other, rather than mere alternative, that offers the best possible care for a patient in need.

• This approach promotes a co-operative relationship between health personals with diverse experience and different backgrounds to lead to improve health care for an individual patient not satisfactorily managed by each separate discipline when applied separately.

• It is believed that more research and application towards clinical practice of integrated medicine will be conducted in future.

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