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HERBAL MEDICINE
dr. HARDHI PRANATA
P.D.H.M.I
Perkembangan herbal medicine di
indonesia
National Commitment
• 27 Mei 2008: President of Indonesia (SBY) declare “Gelar Kebangkitan Jamu” to integrate Jamu in formal health system and jamu as a national heritage
• UU no.36 – 2009: Traditional health should be included in National Health Care
• Permenkes 2010: Scientification of Jamu
Global Commitment
• 2009, Ranggoon (Myanmar): WHO regional meeting on the use of herbal medicine in primary health care
• 2010, Hanoi (Vietnam): 2nd conference on traditional medicine in asian countries “Integration of traditional medicine into the National Healthj Care Systems:
CLINICAL GUIDE
ROLE OF HERBAL MEDICINE (Medical Plant)
Promotive Preventive Curative Rehabilitative Palliative
Food +
Supplement + +
Complement + + + + +
Drug + + + +
HERBAL MEDICINE (Medicinal Plant)
• 54,3 % Indonesian people use it as traditional medicine
• Hippocrates (Father of Modern Medicine):“ Let food be your medicine and medicine be your food”
• Medicinal plant in Indonesia use aso Food (ginger, turmeric, chili, garlic, celery, etc)o Supplement (garlic, white curcuma, etc)o Complementary (guava, Phaleria macrocarpa)o Drug (Phyllantus niruri, gotukola, andrographis paniculata,
celeri)
SWOT Analysis of Medicinal Plant
• STRENGTH– Biological more compatible to human body– Could be used as food supplement, complement, drug– Less side effect, one herbs, multi compound, that acts
synergistically– Indonesia is the fifth mega biodiversity– About 33.000 potentially plant could be used as medicine– Traditionally used for thousand years– Cheap– Broad indication as health promotion, preventive, curative,
rehabilitative, palliative of diseases
• WEAKNESS– Raw material contamination with bacterial, mold, heavy
metal– Quality and quantity depend on soil, environment, season,
climate changes– Has a complex formula – depends on people’s experience– Less evidence based and Mostly empirical based
experience– In Indonesia only a few phytopharmaca
• OPPORTUNITY– Trend of ‘Back to Nature’– Economical value potential– Indonesia is a mega diversity country– Degenerative disease and metabolism disorder tends to be
increased in this millenium ages
• THREAT– Global warming and climate changes– Environment contamination with pesticide, heavy metal,
and pollution– Less numbers of medicinal plants caused by urban
development
PRINCIPLE USE OF MEDICINAL PLANT
• RIGHT DOSE– Empirical herbs depends on people’s tradition like the numbers
of use of leaf, stem, or root in making medicinal herbs– The product made by manufacturer should be consumed in a
right dose as its written on the back of the product’s side
• RIGHT TIME– Irritating-stomach Herbs should be taken after a meal
e.g: Rosella tea, morinda, ginger, garlic, orange, andrographis paniculata, chili
− Herbs that reduce uterine contraction like cabai jawa (Piper retrofractum) should not be used in the late pregnancy
• RIGHT ROUTE OF USE– Herbs like cajuput oil should be used externally– Datura metel Leaf (kecubung) should be smoked for asthmatic
patient
• RIGHT PATIENTS– Most of medicinal plant like chemical drug must be used
carefully for the pregnant, lactating women
• RIGHT INDICATION– Catharantus roseus (Tapak dara) could reduce numbers of
leucocyte in blood
MEDICINAL PLANT CHARATERISTIC
• COMPLEMENTARY EFFECT– Thyme (Thymus vulgaris) contains thymol, calvacrol, and
polymethoxyflavon * Thymol acts as an expectorant* Calvacrol acts as an antibacterial* Flavon enhances immune system
• SYNERGIC EFFECT– Misai Kucing (Orthosiphon stamineus) contains
polymetoxyflavon, saponin, potassium that synergicly act as diuretic
• ANTAGONISTIC EFFECT– Tobacco leaf (Rheum officinale) contains anthraquinone as
laxans but also contains tannin as an antidiarrhea
• SIDE EFFECT ELIMINATING SUBSTANCES (SEES)– Sugar cane (Saccharum officanarum L) that produces sugar
contains Sacharant as an anti diabetic
INTERACTION BETWEEN MEDICINAL PLANT AND CHEMICAL DRUG
• ACTION ON P450– Hypericin, Garlic, Ginseng, Silymarin, Melatonin
• SYNERGIC EFFECT– Misai Kucing/ Kumis Kucing (Orthosiphon stamineus) contains
polymetoxyflavon, saponin, potassium that synergicly act as diuretic
• ACTION ON CYP3A4 and CYPP2O6– Curcuma heyneana, Piper nigrum, Punica granatum, Catharantus
roseus, Piper cabeba, Alyxia reinwardtii, andrographis paniculata, Cymbopogon nardus, Glycyrrhiza glabra, Rheum palmatum, Santalun album, Syzygum aromaticum, Tinospora crispa, Alstonia scholaris, Zingiber aromaticum
SIDE EFFECT OF HERBAL MEDICINE
1. GASTROINTESTINAL– Stomachache– Diarrhea– Nausea– Vomiting
2. NERVE SYSTEM– Headache– Dizziness– Insomnia– Sleepy
3. CARDIOVASCULAR SYSTEM– Increasing or decreasing of blood pressure– Palpitation– Syncope– Cold sweat
4. ALLERGIC REACTION– Anaphylactic– Urticaria– Steven Johnson Syndrome
5. METABOLISM– Drop of glucose level in blood
NO Nama Tanaman Bagian Indikasi Potensi
1. Garlic (Alium savitum) Umbi lapis Candidiasis, hyperlipidemia
2. Benalu Teh (Loranthus spec) Batang Megarah ke antikanker
3. Brotowali (Tinospora rumphii) Batang Antimalaria, diabetes
4. Ceguk (Quisqualis indica) Biji Askariasis, oksiuriasis
5. Daun ungu (Graptophylum pictum) Daun Haemorrhoid
6. Delima putih (Punica granatum) Kulit buah Antiseptik. Antidiare
7. Dlingo (Acorus calamus) Rimpang Sedativa
8. Inggu (Ruta graveolens) Daun Analgetika, antipiretika
9. Jahe (Zingiber officinale) Rimpang Analgetika, antipiretik, antiinflamasi
10. Jambu biji (Psidium guajava) Daun Antidiare, DBD
11. Jambumede (Anacardium occidentale) Daun Analgetika
12. Jati belanda (Guazuma ulmifolia) Daun Hiperlipidemia
13. Jeruk nipis (Citrus aurantifolia) Buah Antitusif
14. Katuk (Sauropus androgynus) Daun Meningkatkan produksi ASI
15. Kejibeling (Strobilantus crispus) Daun Nefrotiliasis, diuretika
DAFTAR TANAMAN OBAT PROSPEKTIF UNTUK FITOFARMAKA
NO Nama Tanaman Bagian Indikasi Potensi
16. Kumis kucing (Ortosiphon stamineus) Daun Diuretika
17. Kunyit (Curcuma domestica) Rimpang Hepatitis, artritis, antiseptik
18. Labu merah (Cucurbita moschata) Biji Taenasiasis
19. Pegagan (Centella asiatica) Herba Diuretika, antiseptik, antikeloid
20. Pala (Myristica fragrans) Buah Sedativa
21. Pare (Momordica charantia) Buah/ biji Diabetes
22. Pepaya (Carica papaya) Getah, daun, biji Sumber papain, antimalaria
23. Saga telik (Abrus precatorius) Daun Stomatis, aftosa
24. Sambiloto (Andrographis panicullata) Herba Antiseptik, diabetes
25. Seledri (Apium graveolens) Daun Hipertensi
26. Sembung (Blumea balsamifera) Daun Analgetika, antipiretika
27. Sidowayah (Woodfordia floribunda) Bunga Antiseptika, diuretica
28. Sirih (Piper betle) Daun Antiseptic
29. Tempuyung (Sonchus arvensis) Daun Nefrotiliasis, diuretica
30. Temulawak (Curcuma xantorrhiza) Rimpang Hepatitis, artritis
DAFTAR TANAMAN OBAT PROSPEKTIF UNTUK FITOFARMAKA
No. Organ Affected Herbs
1. Heart Digitalis leaf, Oleander leaf
2. Autonomous nervous system Datura metel (kecubung), Saga seed,Jatroba seed
3. Central nervous system Cocaine leaf
4. Digestive system Widuri leaf
5. Repiratory system Cashew skin
6. Female reproduction system (Abortivum) Maja leaf, Kelor root, young pineaple,
7. Male reproduction system - Decrease libido: cotton seed- weakens spermatozoa: Pare seed
8. Urethra - Strong diuretic: Meniran, kejibeling- Renal stone: Spinach, Pineapple
9. Liver Comfrei, mimba and fermented alcohol
10. Increasing level of uric acid in blood Beans
11. Decreasing numbers of leucocytes Vinca rosea (Tapak dara)
CAUTIOUSLY SIDE-EFFECT HERBS
HERBS THAT HAVE NARROW LD50
NO RAW HERBS FAMILIA LD50
1. Daun Majakan(Quercus lucitanica Roxb.) Fagaceae 16,45 mg/kgBB
2. Bunga Nagasari(Mesua ferea L.) Guttiferae 20,93 mg/kgBB
3. Buah sukmadiluwih(Gunera macrophyla Bl.) Halorrhagidaceae 21,91 mg/kgBB
4. Bunga Sidowayah(Woodfordia floribunda) Litraceae 24,22 mg/kgBB
5. Kulit buah delima (Punica granatum L.) Punicaceae 29,0 mg/kgBB
• Immunomodulator: Meniran, Lidah buaya, Sambiloto, Temulawak
• Anti-Inflammation : Temulawak, Lempuyang, jahe, Lengkuas
• Anti-Parasite : Leuchena leucocephala, Tinospora (brotowali), Temuireng for treating:Brugia malayi, Brugia timori, Wuchereria bancrofti
• Anti-viral : Meniran, Pasak Bumi, Beluntas, dan Jambu Biji
• Anti-biotic : Meniran, Beluntas, Lengkuas dan Tabat Barito,
• Anti Hypercholesteremia : Labu Siam, Temulawak, Salam, Kunyit, Sambiloto, dan Mengkudu
• Anti Hypertension : Belimbing Wuluh, Seledri, Garlic, Leunca, Kayu Manis, Rosella, Pegagan
• Anti Oxydant : Temulawak, Cabai, Buah Mengkudu, Lengkuas, Daun Salam, Teh, Lada Hitam
• Diabetes mellitus : Pare, Salam, Jamblang, Kayu Manis, Brotowali, Mengkudu, Sambiloto, Kunyit
• Uric acid: Sidaguri, Anting-anting, Kepel, Salam
• Fever : Sambiloto, Pule, Temulawak
• Tooth ache : Cengkeh, Jambu Mede
• Obesity : Kemuning, Gamboge, Jati Belanda
• Anorexia : Lempuyang wangi, temulawak, temu mangga, temu ireng, temu kunci
• Nephrolithiasis: Tempuyung, keji beling, Meniran, Sembung
• Dyspepsia : Pare, Pala, Jahe, Temulawak, Kunyit
• Nausea & vomitting : Jahe , ketumbar
• Cancer palliative & supportive : Sirsak, pegagan, kunyit putih, sambiloto, ceplukan, manggis, keladi tikus
• Heart & Vascular disease : Pegagan, garlic, dewa, temulawak, kunyit
• Gastritis: Kunyit, Temulawak, Pegagan
• Arthritis : Cabe, Sereh, Kayu putih, Cengkeh, Jahe, Temulawak, Tapak liman, salam
• Constipation: Lidah buaya, senna, wungu
• Cough: Saga, Adas, Kencur, Jahe
• Gastroentritis: Jambu biji, Tapak liman, Sambiloto
• Insomnia: Pala, Valeria
• Hepatoprotector: Temulawak, Paliasa, Kunyit, Meniran, Sambiloto
• Erectile dysfunction : Purwoceng, Som jawa, Cabe jawa
• Hemorrhoid: Wungu
• Upper Respiratory Tract Infection: Adas, Sambiloto
• Skin disease: Lengkuas, Ketepeng Cina, Pegagan
REGULATION
The Core PROGRAM• Implementation of MoH’s Decree No 3/2010 regarding Jamu
Scientification + No. 1109/2007 regarding CAM practitioner leading to Govt Regulation’s draft of Trad.Med (as mandatedby Health Act No 36/09) + revitalization of SP3T
• SJ DIAGNOSTIC : “down-stream” approach by developing dual JAMU’s skilled researcher + practitioner (physician+dentist) + scientific labeling of JAMU MEDICAL ("concentrate")
• SJ THERAPEUTICALS : "up-stream“ approach by developing community/clinical pharmacist + JAMU’s producer using local wisdom potency
• Escorted by the National Commission and Regional Commission of SJ
• Central Java as a pioneer model
Dasar yuridis (UU KES baru)
• OT = bag sediaan farmasi (ttp khusus) – ps 1(4)• Obat tradisional adalah bahan atau ramuan
bahan yang berupa bahan tumbuhan, bahan hewan, bahan mineral, sediaan sarian (galenik), atau campuran dari bahan tersebut yang secara turun temurun telah digunakan untuk pengobatan, dan dapat diterapkan sesuai dengan norma yang berlaku di masyarakat – ps 1 (9)
Dasar yuridis yankestra
• Pelayanan kesehatan tradisional adalah pengobatan dan/atau perawatan dengan cara dan obat yang mengacu pada pengalaman dan keterampilan turun temurun secara empiris yang dapat dipertanggungjawabkan dan diterapkan sesuai dengan norma yang berlaku di masyarakat – ps 1 (16)
• Ps 48 : yankestra = salah satu upaya kes• Jamu : salah satu ramuan yankestra (ps 59 -1.b) yg
hrs AMAN & MANFAAT n memerlukan PP
Yankestra (2)
• Orang (Dr/Non Dr) yankestra pakai alkestek perlu ijin dinkes (ps 60) perlu standar tindakan yankestra
• Masyarakat blh meningkatkan yankestra via a.l. “Rumah Sehat” (ps 61)
• BB TOOT jamin bahan baku OT (ps 100 – ay 1)• GP Jamu atas dasar PP membuat JAMU
MEDIK/konsentrat = sbg sediaan farmasi utk kuratif sbg sinergi/integrasi yankes formal (SELAIN JAMU NON MEDIK/OTC utk promotif-preventif-rehab)
INDONESIAN JAMU Practitioners & Health Act 36/2010
• JAMU’s Dr use empirical - rational herbs (art. 104 para 2) TRAD.HEALTH standards
• Competence based of professionalism : using JAMU’s research method : qualitative method =/> quantitative (Art 105) 50 HOURS special TRAINING (Permenkes SJ No 3/2010)
• Trad.Health Standard ethicolegal approach by establishing specific subdivisions in MKEK IDI leading to forming JAMU’s College recoqnized by KKI
• Advocating the establishing : THE BOARD OF LECTURER as college of JAMUOLOGI by IDI / PDGI after CAM EB of IDI
• Making JAMU Medical/concentrates led by clinical/community pharmacist (art. 108) supported by JAMU MANUFACTURER as partner of network of DUAL-ID BOARD practitioner (Permenkes No. 1109/2007)
KOMNASSJ
KualiINDIVIDU
kuantiPrevent Infection
PreventivePUBLIC HEALTH
Prevent Infection
PreventivePUBLIC HEALTH
OTONOM INTEGRASI
BATTRA
YANMEDHOSPITAL
BINKES
SENTRA
P3T
Medicinal
Materials
GPJAMU
IAI
GPFARMAS
I
Metode Riset
GRANDDESIGN
Physician/dentist
FASYANKESRPP BATTRA
Dual Clinic’s NetworkRes through Services
Hierarchy of health worker
S.J. NAS
REVITALIZATION
Kohort prospektif-Mass Clinical observation
Meta-sintesis-Deskriptif-exploratif
JAMU for FITNESSAESTHETIC’s JAMUANTI-AGING’s JAMU
Meta-analysis
Clin Trial
Label SaintifikIDI
PDGI
35
Formal Health Care System
Indigenous Health Care
System (Jamu)
Folk Health Care System
Synergizing & Integrating TRAD.MED. into Formal Health care System
JAMU SCIENTIFICATION NETWORK of dual-profession : JAMU researcher + practitioner and SCIENTIFIC LABELIZATION
of MEDICAL JAMU + NON MEDICAL JAMU
JAMU SCIENTIFICATION NETWORK of dual-profession : JAMU researcher + practitioner and SCIENTIFIC LABELIZATION
of MEDICAL JAMU + NON MEDICAL JAMU
Jamu Medik/Concentrate
Jamu saintifik Nas Jamu Saintifik Lokal
JAMU NON MEDIK/OTC
OHTFITO
FARMAKA
JAMKESMAS
JAMKESDA ??
CURRENT PARADIGM
HIGEST LEVEL EBM :DB, RCT, MA
Is RI has aninfrastructure??
HOW MUCH RI’S PHYTOFARMAKA ARE “BESTSELLER”
VALUE :HOW JAMU AS AHOST IN RI???
GOVERNMENT GUARANTEE THE DEVELP & MTANANCE Batra & Raw MaterialsUSE OF TRADITIONAL MEDICINE SOURCE - article 100 of Law 36/09 of Health
Obat Herbal
Jamu
Herbal Terstandar
Fitofarmaka
FUTURE PARADIGM
OPINION EXPERTFROM THOUSANDOF EXPERT ?
KONTEKS DUET : DR PENELITI + YAN
RI BUILDING ANRESEARCH’SINFRASTRUCTURE+CREATING MARKET
5 “W” + 1 “H” JAMU BECOMEA KEY COMPONENT IN FORMAL HEALTH SYSTEM
BATTRA CAM MUDAH dan MURAH
Biomedik
Diluar ilmu Kedokteran Dan Keperawatan Belum diakui
PREPATOGENESIS
JAMU HERBAL Terstandar Patologi = Konvensional
ALUR PENGOBATAN HERBAL
GOLDEN STANDARD FITOFARMAKA
JAMU’S DR : BROAD-MINDED & PROFESSIONAL
KONVENSIONALHereditary = peer review Doctor herbal researcher
PALIATIFHOME CARE
Contextual featuresPatient’s preference
REHABILITASI
Quality of Life
IDI / PDGI AREA SHOULD HORIZONS& CARE OF INTEREST NATION
Integrasi Yankes• Penyatuan/penggabungan sebagian atau
seluruh aspek pengobatan komplementer-alternatif pada pelayanan kesehatan di semua tingkatan fasilitas pelayanan kesehatan, termasuk aspek regulasi, pembiayaan, serta kebijakan mengenai penyelenggaraan pelayanan dan obat yang digunakan.
– Pasal 1- butir 8 Permenkes 1109/2007
DUET YAN-LITBANG : PERLU DR/G & NAKES BERWAWASAN LITBANG
BATTRA – SALAH SATU UPAYA KES – ps 48 UU Kes no 36/09 Tata cara & jenis = RPP Battra (ps 59)
Sinergi yankes – ps 1-7 Permenkes 1109/07
• Penggabungan metoda pengobatan non konvensional dengan pengobatan konvensional yang akan memberikan manfaat/khasiat pengobatan yang lebih baik dibandingkan dengan manfaat satu jenis pengobatan saja.
Implisit : multi-metodologi dlm litbang pendampingan dlm yankes (integrasi)Juga : KE-JANGAN-SOMBONG-AN kedokteran konvensional
Getting JAMU’s scientific evidences among skilled and practicing doctors (and dentists) as the noble & oath-taking professions, as the complementary & alternative medicine for promotive, preventive, rehabilitative, palliative remedies and finally curative as well at formal health care facilities.
Networking dual function practitioners : research through service in various JAMU clinic at primary and secondary care facilities.
Principles of SAINTIFIKASI JAMU PERMENKES 3/2010& 1109/2007
Sentra P3T (as dev & implementing clinic of trad.med) – Permenkes 584/95
• Screening, doing research of trad.med’s herbs material (JAMU) NIHRD’s function
• Educating & training the safe & effective JAMU BPSDM’s function
• Providing JAMU as approved model DG of Medical Services
• Fitofarmaka’s clinical trial NIHRD’s function
jamu Manufacturer
Riset
Dokter Dokter
Rumah Sakit
Rumah SakitMitra
Dokter UmumKonvensional
Non Dokter/ SP3T
Non Dokter/ SP3T
Praktisi Jamu
Self Treatment Self Treatment
Standar Rumah Sakit
MEDICAL-JAMU R & D System Based on Health Services - Permenkes 3 / 10Article 7
Komite IlmiahKomite etik
Rumah SehatTradisional/ CAM
Holistik
Unit Teknis Sentra P3TBP, PUSKESMAS, RS, SWASTA
BKTM & LKTM
BBTOOT TIPE A
Dual research-service =Double ID-board
.
BIOLOGI KIMIA FISIKA
ANATOMIFISIOLOGI BIOKIMIAHISTOLOGI
PSIKONEUROIMUNOENDOKRINOLOGI
PATOLOGIKD/ KLINIS
TH/ KLINIS
FISIK MENTAL SOSIO SPIRITUAL
THERAPI HOLISTIK
ETIKOLEGAL - PROFESIONALISM
DIAGNOSTIK HOLISTIK KEBUGARANWellness
Index
SJMETPEN
NETWORK
LEVELINDEP LINGK
50 jam
100 jam
BK-KA IDI +BALITBANG
BK-KA IDI + MKEK
HOLISTIC MR
DOUBLE ID BOARD
Konsep Diklat SJ – 50 jam awal Sinergi Praktek Konvensional – Non Konvensional
.
DOKTERSJ
BLOK 1METODOLOGI PENELITIAN
BLOK 4MEDIKO-ETIKOLEGAL
BLOK 3FARMAKODINAMIK JAMU
BLOK 2DIAGNOSTIK HOLISTIK
SAINTIFIKASI DR JAMU(LANGKAH AWAL NAKES JAMU)
SAINTIFIKASI JAMU(OBAT TRAD – BRAND RI)
PRAKTISI KRITIS + JEJARING PENELITI
PRAKTISI LEGAL PROFESIONAL
Persyaratan PerizinanJenis Registrasi
NakesIzin Nakes Registrasi
Komplementer- Alternatif
Surat Tugas/Surat Izin Kerja
Komplementer-Alternatif
Dokter-dokter gigi, apoteker
STR/STRA SIP SBR-TPKA ST-TPKA
Tenaga kesehatan lainnya
SURAT IZIN /REGISTRASI (DINKES PROV)
SIP/SIK SBR-TPKA ST-TPKA/SIK-TPKA
Batra (jamu) Surat Terdaftar Batra di Dinkes Kab/Kota
STR+SBR
TPKA, ps 16
SIP+ST TPKA, ps 22 ay1
PETA PERIJINAN UUPK/Pmks 512,725,1109-07Konsep Ijin Ganda krn “blm diakui metodenya”
Dalam Faskes Konvensional :INTEGRASI
SINERGI
Dinkes Prop a/n MenkesPs 17
PKKAI
IjazahSumpah
SertifikatKompetensi
Rekomen-dasi IDI
SehatKompetenPDSp
PDSmEtis Anggota
FK-FKG
Kolegium +/- Kol CAM
KKI
DINKES KAB/IKOTA
tataran individu Nakesmulti-metodologi, ps 1 ay 7
KEWENANGAN TOLAKPs 24
UJI KOMPMTK P/KAB
Berlaku 5 thn (ps 20)TPKA ASING : 1 th (ps 33 ay 6
KTP (-)
KAJIAN INSTITUSI, ps 5(1)
RS ps 9
KLINIK, ps 8
Ps 16 ay 6KAPUSRENGUN
CATATAN REGISTRASI NAS
PoltekesAkademi
Nakes
WNA/LULUSAN LN, ps 19
Berlaku 1 th (ps. 25)
KUOTA MAX : 3 TPBADAN KAJIAN KA
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