Promotion of Traditional Chinese Medicine in China
Planning treatment based on syndrome differentiation shall prevail
On the eve of the celebration for the 61st anniversary of the nation, we were proud to be invited to attend the grand prize presentation ceremony for the activities held in the past three years and the large-scale educational and promotional activities of the "Promotion of Traditional Chinese Medicine in China" which was launched by over 22 departments and units under the State Administration of Traditional Chinese Medicine of the People's Republic of China. Under the theme of "inheritance of quintessence of Chinese medicines, promotion of fine culture and creation of a healthy and harmonious society", the whole event demonstrated the long history, theories, special method and good curing effect of Chinese medicines. It gave full play to the key role of Chinese medicines in safeguarding the health of the people. During the visit, a certificate was presented to the Chinese Medicine Council of Hong Kong (CMCHK) as a token of thanks from the State Administration of Traditional Chinese Medicine for the support given to the activities held under the "Promotion of Traditional Chinese Medicine in China" by the Chinese medicines trade in Hong Kong. It also denotes an assurance on the development of Chinese medicines in Hong Kong. Besides, this certificate serves as an encouragement and inspiration to the CMCHK and all Chinese medicine practitioners (CMPs) in Hong Kong.
The core scientific concept of the practice of traditional Chinese medicine is "planning treatment based on syndrome differentiation". By application of the studies of Yellow Emperor on syndrome and palpation differentiation, CMPs are good at differentiation of Yin and Yang, exterior and interior, cold and heat, deficiency and excess syndromes before treatment and prescription are confirmed. WANG Chong, a philosopher of the Eastern Han Dynasty, pointed out in Lunheng that "a competent medical practitioner is able to adopt prescriptions for all kinds of diseases to treat the diseases of different patients" He aimed to tell the descendants "not to apply only one prescription or medication to fight against different diseases but to collect a wide range of prescriptions and medications for prevention of different diseases." A Chinese medicine practitioner should familiarise himself with different kinds of prescriptions, possess a sound knowledge of the nature of herbs and have a good memory on meridians, collaterals and acupoints. He who applies acupuncture and medications together with Daoyin manipulation for different patients depending on season and environment to prevent and manage the occurrence of different syndromes including the rarely-seen diseases and to promote methods of health preservation, shows his sincere dedication to the practice of traditional Chinese medicine. Currently, we will uphold the scientific development concept for further study and research that enable us to perceive and comprehend the principle of "planning treatment based on syndrome differentiation" which is so profound and extensive. As such, the scientific system of "planning treatment based on syndrome differentiation" can be entrenched and enhanced.
Finally, I would like to welcome the new members of the committees under the Chinese Medicine Practitioners Board, including WONG Kwun-ming, NG Sze-tuen, CHAN Kar-chack, FUNG Mei-seung and WONG Wing-ho who are CMPs. Meanwhile, I also take this opportunity to thank the CMPs who are past members of the Board for their devoted efforts and contributions. And I wish all CMPs a great progress, good health and happiness in the coming year.
Mr. Wong Ngar-kok James
Chairman of the Chinese Medicine Practitioners Board
At the end of November 2010, there were 6,233 registered Chinese medicine practitioners (CMPs)，66 CMPs with limited registration, and 2,772 listed CMPs.
The Clinical Examination of the 2010 CMPs Licensing Examination was conducted in August 2010. A total of 457 candidates attended the Clinical Examination, and 236 candidates (51.6%) passed the Clinical Examination.
The Written Examination and the Clinical Examination of the 2011 CMPs Licensing Examination would be conducted in June and August 2011 respectively. The application period for non-listed CMP persons was from 16 September to 29 October 2010, whereas the deadline for submitting applications for listed CMPs and repeaters would be 31 March 2011. The Chinese Medicine Practitioners Board had issued a letter to notify all qualified listed CMPs the enrollment period for taking the examination.
In accordance with section 76 of the Chinese Medicine Ordinance, a registered CMP must apply for a valid practising certificate before he/she is allowed to practise Chinese medicine in Hong Kong. The usual validity period of a practising certificate is three years. Before a registered CMP is issued with the renewed practising certificate, he/she must fulfill the requirements of continuing education in Chinese medicine, as determined by the Practitioners Board. From July to November 2010, 449 registered CMPs renewed their practising certificates.
In accordance with the Chinese Medicine Ordinance, if a registered CMP practises Chinese medicine without obtaining a practising certificate over a period exceeding 6 months since the expiry of his/her practising certificate, the Practitioners Board may act in accordance with section 56(1)(d) of the Chinese Medicine Ordinance, to order the removal from the Register the name of that registered CMP.
Under Section 82 of the Chinese Medicine Ordinance, the system of continuing education in Chinese medicine (CME) for registered Chinese medicine practitioners (CMPs) has been implemented by the Chinese Medicine Practitioners Board of Chinese Medicine Council of Hong Kong since 28 February 2005. Reviews on the system should be made by the Chinese Medicine Practitioners Board on a regular basis. Taken into account of the principles of the setting up of the system of continuing education in Chinese medicine (CME) and the continuing education programmes provided by CME programme Providers, the Chinese Medicine Practitioners Board has decided to remove Hong Kong Institute of Vocational Education (Chai Wan), Vocational Training Council (CME-PP0005), Li Ka Shing Institute of Professional and Continuing Education, The Open University of Hong Kong (CME-PP0013) and School of Continuing and Professional Education (SCOPE), City University of Hong Kong (CME-PP0028) from the List of CME programme Providers accredited by the Chinese Medicine Practitioners Board. The above mentioned institutions can still apply for the accreditation of individual CME programmes.
The Practitioners Board held the disciplinary inquiries for nine CMPs who were convicted of an offence punishable with imprisonment or breached the codes of practice from August to November 2010. Eight of CMPs were found guilty after inquiries. The Practitioners Board ordered to remove the name of one registered CMP for 6 months, to remove the name of one registered CMP for 3 months, but suspended the applications for 12 months, reprimanded one registered CMP, and warned three registered CMPs. The Practitioners Board also decided to remove the name one listed CMP, and put the decision for one listed CMP on record for future reference after the inquiry.
Summing up the above cases, the Practitioners Board reminds all CMPs to take note of the issues below.
It is stipulated in the codes of practice that a CMP should maintain personal medical records for patients under his / her care. CMPs are required to record in the personal medical records patients' names, gender, consultation dates, contact details, diagnosis, treatments applied, etc. In case there is a medical incident, the medical professionals to whom a patient is referred can use the medical record and history as reference. Therefore, a professional CMP should provide the above mentioned information to the medical professionals for taking follow up actions.
The codes of practice also state that a CMP must provide patients with prescription. The writing on the prescription must be clear and easily recognized. The requirement of the Practitioners Board on writing is: members of the public with average Chinese literacy should be able to read the prescription. A clear prescription is useful in three ways: (1) Patients have the right to know the names and dosages of the Chinese medicine used in the prescription. It is a basic right for consumers to know what medicine they take or will take. (2) Chinese medicine dispensers (including those at a premise different from that of the CMP) should be able to read the prescription. Any ambiguity or unclear writing may lead to wrong dispensation of medicine which is a very serious medical incident. (3) If there is any medical incident resulted from taking the prescribed medicine, the prescription could provide important information on what drugs the patients have taken and this could be used as the basis for investigation, which could help medical personnel identify the medicines and dosages as soon as possible. If the writing and the dosages are not clear on the prescription, it may cause difficulties when treating the patients.
It is also stipulated in the codes of practice that a CMP must prescribe medicine in accordance with the professional standards. They shall not misuse any drugs. CMPB believes that the misuse of drugs means inappropriately excessive dosages or using an excessive number of medicines. The drugs are not prescribed according to the theory of Chinese medicine, or proper diagnosis, or the principles, methods, formulas and medicines. Generally speaking, CMPs should prescribe medicine as indicated by the condition of the patients. The principle of pattern identification and treatment should be used and a basic prescription should be adopted before making any modification. The prescription should be based on the principle of sovereign, minister, assistant and courier and a basic prescription should be adopted before making any modification. If a CMP prescribes inappropriately excessive dosages or an excessive number of medicines without referring to any therapeutic principles, treating methods or the principle of treating the acute before the chronic, or against the principle by which medicines are combined, the treatment of the patients would be adversely affected.
The current Labour Laws (including the Employment Ordinance, the Employees' Compensation Ordinance and the Pneumoconiosis and Mesothelioma (Compensation) Ordinance) recognise the medical treatment, examination and certification given by registered CMPs for the purpose of employees' entitlement to benefits under the relevant ordinances. Under the Employment Ordinance, registered CMPs can issue sick leave certificates and pregnancy-related certification to employees. Under the Employees' Compensation Ordinance, registered CMPs can issue sick leave certificates to employees with temporary incapacity resulting from work injuries. A certain amount of medical expenses shall be reimbursable to such employees. In performing the medical functions stipulated in the Labour Laws, registered CMPs shall take reference to the "Reference Guide on Issuance of Sick Leave Certificate by Registered CMPs" compiled by the Practitioners Board on the issuance of sick leave certificates. They should use their professional judgment and pay attention to the health condition of patients in order to give appropriate recommendation in granting sick leave.
Under the Labour Laws, sick leave certificates issued by registered CMPs are recognised under the Employment Ordinance. Individual employers may make their own decisions on whether to recognise the sick leave certificates issued by listed CMPs. The Practitioners Board reminds all listed CMPs to avoid using words like "registration number" or "registered CMP" in the sick leave certificates, prescriptions or related documents issued to patients to avoid misunderstanding. If a CMP issues professional documents which are untruthful or misleading, the Practitioners Board would handle any complaints received with accordance to the set disciplinary procedure.
The Practitioners Board announced the principles regarding academic title(s) and qualifications that could be exhibited to the public by CMPs in last issue of this Newsletter. All details are now formulated. The revised codes of practice will be distributed to all registered and listed CMPs in end December, and will also be uploaded to the website of the Chinese Medicine Council of Hong Kong (http://www.cmchk.org.hk). Except the clauses regarding "Signs and Signboards at clinics" which will be promulgated on 1 July 2011, the other parts of the revised codes will be effective from 1 January 2011.
To safeguard public health and safety, the Chinese Medicine Ordinance (Cap. 549) (the Ordinance) was enacted in 1999. The Chinese Medicine Council of Hong Kong and its Chinese Medicine Practitioners Board and the Chinese Medicines Board (CMB) were established to formulate and implement regulatory measures stipulated under the Ordinance. The registration system for proprietary Chinese medicines (pCm) was commenced in December 2003 and registration applications should be submitted to the CMB as required. CMB will consider each application in terms of safety, quality and efficacy with professional and executive support provided by the Department of Health. In view of the long history of sale of pCm in Hong Kong, section 128 of the Ordinance provides that pCm manufactured, sold or supplied for sale on 1 March 1999 in Hong Kong shall be eligible for transitional registration.
CMB has processed the registration application of pCm as required by the arrangements and situations stipulated in the Ordinance, and issued three types of documents to products meeting the vetting requirements, these include:-
Details of products issued with the "Notice of confirmation of transitional registration of proprietary Chinese medicines", "Notice of confirmation of (non-transitional) registration of pCm" and products to be issued with the "Certificate of Registration" are uploaded to: http://www.cmchk.org.hk/pcm/eng/#main_dis.htm.
In view that CMB has processed and vetted all applications for transitional registration of pCm, the legislative provisions related to the mandatory registration of pCm and the requirements of label and package inserts will be commenced. The mandatory registration of pCm in Section 119 under the Ordinance shall come into effect on 3 December 2010. Thereafter, no person shall sell, or import, or possess any pCm that has not been registered. Sections 143 and 144 under the Ordinance on the labelling and package inserts requirements for pCm shall come into effect on 1 December 2011. Thereafter, no person shall sell any pCm without label or package inserts as required by sections 26 to 28 of the Chinese Medicines Regulation (the Regulation). Any person who violates the above shall be liable upon conviction to a Level 6 fine (i.e. HK$100,000) and imprisonment for two years. Details of the provisions under the Ordinance and the Regulation are available at http://www.legislation.gov.hk.
As a practising Chinese medicine practitioner (CMP), you are reminded to comply with the aforementioned legal requirements, that is, to procure and provide registered pCm. Attention should be paid to the descriptions on pCm labels and package inserts as required under the law.
Also, CMPs should note the exemptions given to the pCm administered or supplied by a registered or listed CMP as stipulated under section 158(6) of the Ordinance, and the pCm entrusted to be manufactured by a licensed pCm manufacturers. Details of the provisions are available at http://www.legislation.gov.hk.
The above information is for reference only. For details of the commencement of the mandatory registration of proprietary Chinese medicines, the Chinese Medicine Ordinance and Chinese Medicines Regulation shall prevail. If you have any enquiries concerning the above, please feel free to contact the Chinese Medicines Section of the Chinese Medicine Division at 2319 5119.
A letter to the registered CMPs from the Department of Health (DH) is attached to this issue of the Newsletter. DH cordially invites you, as registered CMPs in private practice but yet to participate in the Scheme, to join it right now. Also, you are encouraged to introduce the Scheme to the elderly and their care-takers more often.
Since 20 December 2010, the Chinese Medicine Division of Department of Health has moved their office from 32/F, Wu Chung House, Wanchai to 16/F, Two Landmark East, 100 How Ming Street, Kwun Tong, Kowloon. The Chinese Medicines Section of the Chinese Medicine Division will also move their office from 2/F, Public Health Laboratory Centre, 382 Nam Cheong Street, Kowloon to the same new address on 10 January 2011. All Chinese Medicine Practitioners please note the change of office addresses.
All CMPs are requested to notify the Secretariat as soon as possible if there are changes in their registered address, correspondence address, practising address, telephone number, fax number and other personal data which have been previously reported to the Practitioners Board. Enclosed please find the form for notification of change of personal data. It may also be obtained from the Secretariat if needed.
Should you have any opinions regarding the contents of the Newsletter of the Chinese Medicine Practitioners Board, please send them to the Secretariat by post, fax or email, indicating "Newsletter of the Chinese Medicine Practitioners Board". All published Newsletters of Chinese Medicine Practitioners Board have been uploaded to the Council's homepage (http://www.cmchk.org.hk). CMPs are cordially invited to visit the above website.
Chinese Medicine Council of Hong Kong
Room 2201, 22/F, Wu Chung House, 213 Queen's Road East,
Wanchai, Hong Kong
Enquiry telephone: (852) 2121 1888
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