This issue of the Newsletter mainly reports on the progress of work of the Chinese Medicine Practitioners Board ("CMPB") in the past four months, which includes the Chinese Medicine Practitioners Licensing Examination, matters related to renewal of practising certificates and Continuing Education in Chinese Medicine ("CME") for registered Chinese medicine practitioners ("CMPs") and findings of disciplinary inquiries. Some requirements under the Codes1 are also highlighted in this issue for the attention of CMPs.
With a view to facilitating CME for CMPs, the CMPB has been publishing the Newsletter and arranging for a quiz on the practice of Chinese medicine to be featured in every December issue. CMPs are invited to answer the questions and earn CME points. By reading the Newsletter, CMPs not only can grasp the latest information on the Chinese medicine profession, but also can earn CME points. Since the first publication of the CME Quiz in late 2011, the support and responses from registered CMPs have been overwhelming and encouraging. The CME Quiz for this year is enclosed herewith and active participation of registered CMPs is most welcome.
In accordance with the Chinese Medicine Ordinance ("CMO"), if registered CMPs practise Chinese medicine without valid practising certificates for a period exceeding six months since the expiry of their practising certificates, the CMPB may order removal from the Register the name of those registered CMPs. All registered CMPs are hereby reminded to take note of the validity of their practising certificate and submit a renewal application to the CMPB in a timely manner.
With regard to disciplinary inquiries, CMPs are specifically reminded to report court convictions to the CMPB. They should also observe the requirements stipulated in the CMO and the Codes, professional responsibility, information that must be included in prescriptions, points to note on keeping, preparing and handling Chinese medicines in the Chinese medicine clinics, practice advertising etc. This issue also includes the number of disciplinary cases in 2018 for the attention of all CMPs.
Information about research results of the "Identification of Easily Confused Species of Chinese Materia Medica in Hong Kong by Macroscopic and Microscopic Characteristics" project, "Strengthening the regulation of Chinese herbal medicines Herba Pteridis Multifidae", "Amendments to the Appendices of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) following the 18th Meeting of the Conference of the Parties" and "Elderly Health Care Voucher Scheme" are also provided in this issue. Further details can be found in the following pages.
On behalf of the CMPB, may I wish all CMPs all the best and good health in the coming year.
Ms WONG Yu-yeuk
Chairman of the Chinese Medicine Practitioners Board
1The Codes refer to the Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong and the Code of Conduct for Listed Chinese Medicine Practitioners.
The Clinical Examination of the 2019 CMPs Licensing Examination was conducted in August 2019. A total of 948 candidates attended the Clinical Examination, of which 346 candidates (36.5%) passed the Clinical Examination.
The Written Examination and the Clinical Examination of the 2020 CMPs Licensing Examination will be conducted in June and late July to August 2019 respectively. The application period for non-listed CMPs persons started on 20 September and ended on 31 October 2019, whereas the deadline for submitting applications for listed CMPs and repeaters is 31 March 2020. The Practitioners Board has notified all qualified listed CMPs by mail the enrollment period for taking the examination.
As at 15 November 2019, there were 7,581 registered CMPs, 33 CMPs with limited registration and 2,559 listed CMPs.
Pursuant to section 76 of the CMO, registered CMPs must hold valid practising certificates before they are allowed to practise Chinese medicine in Hong Kong. The usual validity period of a practising certificate is three years. Registered CMPs should fulfill the CME requirements prescribed by the CMPB before they can renew their practising certificates.
The CMPB will issue letters to notify the registered CMPs concerned of the arrangements for the renewal of their practising certificates about three months in advance of the expiry dates. To ensure timely processing of renewal application and update of the expiry date of the practising certificate on the Chinese Medicine Council of Hong Kong ("CMCHK") homepage, the CMPB hereby appeals to all registered CMPs to follow the advice in the notification letter and submit the application along with the prescribed fee at least six weeks before the expiry of the practicing certificate.
From 16 July to 15 November 2019, 798 registered CMPs had their practising certificates renewed. All registered CMPs who have their practising certificates renewed should report promptly to their CME Administrators their new CME cycles, required CME points and the validity period of their practising certificates.
The CMPB hereby reminds that:
if a registered CMP has decided not to renew his current practising certificate, he must stop practising Chinese medicine upon expiry of the certificate. Otherwise, he will contravene section 76(1) of the CMO.
in accordance with section 56(1)(d) of the CMO, if registered CMPs practise Chinese medicine without valid practising certificates for a period exceeding six months since the expiry of their practising certificates, the CMPB may order removal from the Register the name of those registered CMPs.
With a view to encouraging CMPs to read the Newsletter and facilitating CME for CMPs, the CMPB has arranged for a Quiz with ten questions on the practice of Chinese medicine to be featured in every December issue for CMPs to participate and earn CME points. These ten questions are based on the content of Issue 51 to 53 in 2019.
Two CME points would be awarded for successful attempt of six or more questions. The ceiling of CME points obtained through CME Quiz within each three-year cycle is 10% of the 60 CME points required in the same cycle, i.e. six points per cycle. The accumulated CME points obtained through CME Quiz and other self-study activities should not exceed 30 points per cycle.
The CME Quiz of 2019 is attached at Appendix I of this issue of the Newsletter. Registered CMPs may send the completed answer sheet to their respective CME Administrators by fax or by mail on or before 15 February 2020. The CME Administrators will assess and record the CME points awarded for the registered CMPs. No CME points would be awarded for any late submission.
The Secretariat of the CMCHK will not relay the answer sheets to the CME administrators for any CMPs. To avoid delay, CMPs are reminded to submit the completed answer sheets directly to their CME Administrators.
CMPs are welcome to read the previous issues of the Newsletters in the CMCHK homepage (www.cmchk.org.hk).
It is specified in the Application Form for "Registration as Registered Chinese Medicine Practitioner and Practising Certificate" that registered CMPs must provide their practising address as the registered address. For those who practise at more than one location, their principal practising address should be provided as the registered address.
In accordance with sections 52 and 53 of the CMO, registered address shall be recorded in the Register of CMPs and the Registrar shall publish in the Gazette from time to time the names, registered addresses and qualifications of all registered CMPs listed in the said Register. Such information will also be published in the website of the CMCHK.
In accordance with section 56(2) of the CMO, if registered CMPs fail to acknowledge within four months after the date of despatch the receipt of a registered letter addressed by the CMPB to them at their addresses recorded in the Register, then the CMPB may consider ordering the removal of their names from the Register.
For listed CMPs, the CMPB shall publish in the Gazette from time to time the list of listed CMPs under section 90(6) of the CMO. Such information will also be published in the website of the CMCHK.
To ensure that members of the public can verify the qualifications of CMPs from the Gazette or the website of the CMCHK, both registered and listed CMPs are required to update the CMCHK on their practising addresses. CMPs who wish to change their personal particulars should complete the form, namely "Change of Personal Particulars of Chinese Medicine Practitioners", enclosed at the Appendix II, and send it to the Secretariat of the CMCHK (Address: Room 2201, 22/F, Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong / Fax no.: 2121 1898 / E-mail: email@example.com).
The CMPB held disciplinary inquiries from 16 July to 15 November 2019 on four registered CMPs who were convicted of offences punishable with imprisonment and/or alleged breaching the Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong. Three of the registered CMPs were found guilty after inquiries. Upon inquiry, the CMPB reprimanded the three registered CMPs.
Summing up the above cases, the CMPB reminds all CMPs to take note of the following issues.
Reporting Court Convictions to the CMPB
According to the Codes, if a CMP has been convicted of an offence punishable with imprisonment in Hong Kong or elsewhere (irrespective of whether a prison term is imposed or not), he/she must report to the CMPB within 28 days, specifying the case number, date of conviction, venue, offence and sentence. If the CMP concerned fails to do so, the CMPB will take disciplinary actions in accordance with the Codes.
According to the provisions of section 2 of Part III of the Codes, CMPs shall be professionally responsible to their patients. They should diligently improve their professional knowledge and skills, so as to maintain high professional standards in providing medical service to patients. If the CMPB considers that a CMP, in the course of conduct of his profession, has conducted himself in a way which has fallen short of the reasonable standards of conduct expected among his professional colleagues, the CMP may have contravened the above-mentioned provisions of the Codes.
According to the provisions of section 2(5) of Part III of the Codes, CMPs should make medical referrals when necessary, and the registered medical professionals to whom a patient is referred should be able to provide the required treatment according to the diagnosis. The CMPB reminds all CMPs to make appropriate referral of patients when necessary and choose the medicines or apparatus that best serve the medical interest of patients according to their independent professional judgment.
Information that must be included in prescriptions
The CMPB has noticed that there are CMPs who did not list out the names of Chinese herbal medicines ("Chm") based on the names in the Schedules of the CMO in their prescriptions. According to the provisions of the Codes, the names of all Chm should be based on the names in the Schedules of the CMO. Names of Chm not listed in the Schedules should be based on the names in the "Pharmacopoeia of the People's Republic of China" (《中華人民共和國藥典》), the "Chinese Materia Medica", (written by XU Guojun, etc.) (《中國藥材學》(徐國鈞等著)), the "Dictionary of Chinese Herbal Medicines" (《中藥大辭典》) or the "Chinese Herbal Medicines" (《中華本草》). Regarding the information that must be included in the issued prescriptions, CMPs could take reference from the Codes.
All CMPs are reminded again that patients have the right to know clearly the details of the Chinese medicines being prescribed. In case of any medical incident, medical professionals can make use of the prescription to initiate investigation and take immediate follow up actions for the best benefit of patients.
Points to Note on Keeping, Preparing and Handling Chinese Medicines in the Chinese Medicine Clinics
To facilitate the provision of treatment to patients, the enacted CMO provides the following exemptions to CMPs for licensing application and the registration of proprietary Chinese medicines ("pCm") -
According to sections 158(2) and (4), a CMP shall be exempted from applying to the Chinese Medicines Board ("CMB") for a retailer license in Chm if the Chm in question are dispensed to a patient under his direct care and on a prescription given by him and at the premises where he practices; and
According to section 158(6)(a), a CMP shall be exempted from applying to the CMB for a manufacturer license in pCm if a pCm is compounded by or under the supervision of the CMP for a patient under his direct care at the premises where he practices. Moreover, the pCm in question shall be exempted from registration.
All CMPs are reminded to strictly observe the statutory requirements and to fulfill their professional responsibility towards patients to, among other things, ensure the safety and quality standards of the Chm prescribed. Proper management should be in place for processing herbal medicines, preparing pCm and dispensing Chm, with records maintained of all concerned staff and relevant procedures.
To promote the standards of practice of the Chinese medicines trade, the CMB under the CMCHK has prepared relevant trade guidelines2 to regulate all the aspects involved in operating the Chm and pCm business. The CMB advises CMPs to refer to the "Practising Guidelines for Retailers of Chinese Herbal Medicines" and "Practising Guidelines for Manufacturers of Proprietary Chinese Medicines" for compliance in their relevant business.
As stipulated in clause 6(2)(c) in Part 3 of the Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong, visiting cards in connection with the practice may only contain the following information: (i) Name of the registered Chinese medicine practitioner, and (where appropriate) the names of partners, assistants or associates in the practice; (ii) Gender of the registered Chinese medicine practitioner; (iii) Language(s) / dialect(s) spoken by the registered Chinese medicine practitioner; (iv) Chinese title of "香港中醫藥管理委員會註冊中醫","香港中醫藥管理委員會註冊中醫師", "註冊中醫" or "註冊中醫師" or English title of "registered Chinese medicine practitioner of the Chinese Medicine Council of Hong Kong" or "registered Chinese medicine practitioner" with one of the streams of practice "General Practice", "Acupuncture" or "Bone-setting" put in a bracket at the end of the title; (v) Academic titles and practising qualifications allowed by the Practitioners Board; Academic titles and practising qualifications that could be exhibited must follow the restrictions set out in Appendix I; (vi) Emergency service and emergency contact telephone number of the Chinese medicine practitioner; (vii) Address(es) of the clinic(s); (viii) Consultation hours; and (ix) Telephone and facsimile numbers, e-mail address and information, etc.
As regards listed CMPs, seven of the requirements for information that may be contained in visiting cards in connection with the practice as stipulated in clause 6(2)(c) in Part 3 of the Code of Conduct for Listed Chinese Medicine Practitioners are the same as those applicable to registered CMPs, apart from requirement (iv) regarding titles, visiting cards of a listed CMP may contain the Chinese title of "中醫" or "中醫師" or English title of "Chinese medicine practitioner".
If visiting cards of a CMP contain information other than those listed above, the CMP would be considered to have transgressed the relevant code of practice. The CMPB may, in its discretion, take disciplinary actions under section 98(3) (for registered CMPs) or section 91(2)(a) (for listed CMPs) of the CMO.
2The relevant guidelines have been uploaded to the website of the CMCHK (www.cmchk.org.hk).
In 2018, a total of 105 disciplinary cases were received by the CMPB, the details of the disciplinary figures are listed as follow:
The CMPB held 24 inquiries in 2018 in accordance with sections 91 and 98 of CMO, involving 14 CMPs. The outcomes of the inquiries are as follow:
31 registered CMP involving 3 disciplinary cases. After due inquiries conducted by the CMPB, 1 of the cases is not substantiated, while for the other 2 cases, the CMPB decided to remove the name of the CMP concerned for 6 months but with suspension of 24 months.
Incidents related to confusion over Chinese Materia Medica ("CMM") available in Hong Kong occurred occasionally. In view of this, the Government Chinese Medicines Testing Institute ("GCMTI") is conducting a research on "Identification of Easily Confused Species of CMM in Hong Kong by Macroscopic and Microscopic Characteristics" ("the Research ") to strengthen the ability of the industry and the public on CMM identification. The GCMTI would release the research results in stages.
As of the end of 2019, the GCMTI has published its results in form of 40 monographs. Besides covering information on the source, functions, and macroscopic and micro-morphological key identification features of the contrasting CMM, the monograph also includes content of microscopic key identification features and crude CMM information. One of the monographs is on Ramulus Euonymi (Gui jian yu) and Buchnerae Cruciatae Herba (Gui yu jian), and owing to the similarity of their names, occurrence of confusion over these 2 CMM are not uncommon.
Ramulus Euonymi is a CMM listed in Schedule 2 of the Chinese Medicine Ordinance, while Buchnerae Cruciatae Herba has been recorded in the Chinese Materia Medica Standards in Guangdong Province, it is not listed in the Chinese Medicine Ordinance. As the young branch of the Ramulus Euonymi has corky wing, it is named as "Gui jian" in the Ben cao gang mu, and named as "Gui jian yu" in the Ben cao shu gou yuan. According to Zhong hua ben cao, functions of Ramulus Euonymi include breaking blood to unblock the meridian, detoxification and dispersing swelling, and killing worms; while Buchnerae Cruciatae Herba can clear heat and detoxify, and cool the blood to stop bleeding. Despite similar names, these two CMM are different and possess different functions, thus their clinical uses should be differentiated.
In the 4th quarter of 2019, the GCMTI organised various publicity and educational activities for Chinese medicine practitioners ("CMPs"), Chinese medicines traders, research and testing institutes, and staff of the Hospital Authority Tripartite Chinese Medicine Centre for Training and Research. Registered CMPs were able to acquire CME points in the sharing session and workshop held in November.
The GCMTI will continue to release results and organise publicity and educational activities of the Research. For more information on the Research, please scan the QR codes or visit the websites below:
|Introduction of the Research
Table of Content of the Monograph
In addition, if you have any comments or suggestions on the above research project or easily confused Chinese medicines, please contact Ms Tang of the GCMTI at 2209 9476.
The Chinese Medicine Regulatory Office of the Department of Health ("DH") conducts market surveillance on Chinese herbal medicines ("Chm") prescribed in the CMO regularly. To monitor the quality and safety of Chm, inspection items of the market surveillance include macroscopic identification, determination of pesticide residues and heavy metal content. In 2018, the DH found that a batch of Chm, Herba Pteridis Multifida, exceeded the limits for arsenic set out by the Chinese Medicines Board ("CMB") of the CMCHK (i.e. no more than 1,500 microgram/day) in a market surveillance and made a notification on this matter. The relevant importer has also recalled this batch and other batches of Herba Pteridis Multifida from the market.
According to the CMO, Herba Pteridis Multifidae is any or the whole part of Pteris multifida Poir, a Chm specified in Schedule 2 of the CMO. According to literature research, Herba Pteridis Multifidae is an arsenic hyperaccumulator plant that can absorb arsenic from the soil through its roots and store a large quantity of arsenic in plant cells. The hyperaccumulative property of Herba Pteridis Multifidae make it reaches a high level of arsenic content. A preliminary assessment by the DH considers that neither CMPs nor the Chinese medicines industry are widely using it.
Arsenic is a heavy metal element that pervasive in the environment. Long-term intake of high concentration of Arsenic may cause adverse health effects. The limit of Arsenic content formulated by the CMCHK for Chm shall not exceed 1,500 micrograms per day (total intake).
(A) Regulatory Measures
After considering the characteristics of Herba Pteridis Multifidae, the market circulation and use of Chm Herba Pteridis Multifidae and proprietary Chinese medicines ("pCm") containing Herba Pteridis Multifidae, and the potential health risk of taking high concentration of Arsenic, the CMB endorsed the strengthening regulation of Chm Herba Pteridis Multifidae on 19 September 2019. The regulation restricts Chm wholesalers and pCm manufacturers that they shall ensure each batch of Herba Pteridis Multifidae obtained is tested and confirmed to be in compliance with the limit set by the CMCHK in respect of Arsenic content before it may be sold or used for manufacture pCm. The regulatory measures are as follows:
(1) Revision of Practising Guidelines
Appendix "Regulatory requirements for specific Chinese herbal medicines" was added in "Practising Guidelines for Wholesalers of Chinese Herbal Medicines" and "Practitising Guidelines for Manufacturers of Proprietary Chinese Medicines", and the following articles are added respectively:
"Practising Guidelines for Wholesalers of Chinese Herbal Medicines"
The wholesalers of Chm shall ensure that each batch of Herba Pteridis Multifidae obtained is tested and confirmed to be in compliance with the limit set by the CMCHK in respect of Arsenic content, before it may be sold.
"Practising Guidelines for Manufacturers of Proprietary Chinese Medicines"
The manufacturers of pCm shall ensure that each batch of Herba Pteridis Multifidae obtained is tested and confirmed to be in compliance with the limit set by the CMCHK in respect of Arsenic content, before it may be used for manufacturing pCm.
(2) Adding of Licensing Conditions
The following licensing conditions are added when the DH deal with new applications and renewal cases for Chm wholesalers and pCm manufacturers:
"Wholesaler Licence in Chinese herbal medicines"
The licence holder shall ensure that each batch of Herba Pteridis Multifidae obtained is tested and confirmed to be in compliance with the limit set by the CMCHK in respect of Arsenic content, before it may be sold.
"Manufacturer Licence in proprietary Chinese medicines"
The licence holder shall ensure that each batch of Herba Pteridis Multifidae obtained is tested and confirmed to be in compliance with the limit set by the CMCHK in respect of Arsenic content, before it may be used for manufacturing pCm.
The above mentioned regulatory measures have implemented on 1 December 2019. Wholesalers of Chm and manufacturers of pCm can use the certificate of analysis provided by the suppliers or perform the test of Herba Pteridis Multifidae through commissioned laboratories to meet relevant requirements of practising guidelines and licensing conditions.
(B) Grace Period
In order to facilitate the industry to adapt and cooperate with the new measures, the CMB agreed a grace period of six months after implementation (i.e. 1 December 2019 to 31 May 2020). During the grace period, if the Chm wholesaler or pCm manufacturer possesses Herba Pteridis Multifidae for sale or manufacture of pCm, and fails to provide the proof of analysis of Arsenic content for that batch of Herba Pteridis Multifidae, then the trader shall stop selling it or using it in manufacture of pCm immediately until the trader submits the relevant proof to confirm that it complies the limit set by the CMCHK. Under the circumstances that without compromising public health risks, DH will issue reminder letter to the relevant trader regarding the related requirements, and will not refer the cases to the CMB for disciplinary hearings.
After the grace period (i.e. starting from 1 June 2020), if a Chm wholesaler or a pCm manufacturer possesses Herba Pteridis Multifidae for sale or manufacture of pCm, and cannot provide a proof of analysis of Arsenic content of that batch of Herba Pteridis Multifidae, regardless of whether the Arsenic content of that batch of Herba Pteridis Multifidae exceeds the limit set by the CMCHK, it will be considered as a violation of the practising guidelines and licensing conditions. The trader shall stop selling it or using it in manufacture of pCm immediately until the trader submits the relevant proof to confirm that it complies the limit set by the CMCHK. DH will follow up the case, including referral of the case to the CMB to consider whether to take disciplinary actions.
According to the circular letter from Agriculture, Fisheries and Conservation Department (AFCD) issued on 1 November 2019, amendments to the appendices of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) following the 18th meeting of the Conference of the Parties (CoP18) has become effective on 26 November 2019. The amendments related to Chinese medicine (including Chinese herbal medicines and proprietary Chinese medicines) are as follows.
Circular letter on the above amendments can be found on the AFCD’s website (https://www.afcd.gov.hk/english/conservation/con_end/con_end.html). If you have any enquiries regarding the above, please email to firstname.lastname@example.org or contact AFCD (Tel: 2150 6969).
The Elderly Health Care Voucher ("EHV") Scheme was launched in 2009 to subsidise eligible elderly persons to use private primary healthcare services in the private sector, including Chinese medicine services. As of the end of September 2019, more than 3,000 registered CMPs have enrolled in the EHV Scheme and nearly 1.28 million eligible elders (accounting for about 97% of the total eligible elderly population) have used EHVs.
Although the procedures for making voucher claims for elders are simple, the enrolled CMPs must pay attention to the requirements of the EHV Scheme, e.g. elders must receive the healthcare services provided by the enrolled CMPs in person before they can use their vouchers to settle the fees. EHVs can neither be used for pre-paid healthcare services nor for the sole purchase of products such as health products, dried seafood, etc. Otherwise, the voucher claims will not be reimbursed by the Government or the CMPs concerned will be disqualified from participating in the EHV Scheme.
Besides, the enrolled CMPs are responsible for the safekeeping of the authentication token for accessing the eHealth System (Subsidies). While they can delegate staff in their medical organisations to enter the data to make voucher claims through "Data Entry Accounts" on their behalf, they are still liable for all the claims made under their "Enrolled Health Care Provider Accounts". It is therefore in the enrolled CMPs’ own best interests to neither allow other persons to use their "Enrolled Health Care Provider Accounts" nor their authentication token for accessing the eHealth System (Subsidies) to make voucher claims for healthcare services which they have not provided or are not professionally responsible for.
For details of the EHV Scheme, as well as some case sharing and points to note, please refer to the leaflet (Appendix III) as enclosed to this issue. In case of any enquiry on the EHV scheme, please contact the Health Care Voucher Division of the DH at 3582 4102.
In view of the re-organisation of the Department of Health with effect from 1 October 2019 (Tuesday), the Chinese Medicine Division has been renamed as "Chinese Medicine Regulatory Office (CMRO)". The address, telephone numbers, fax numbers and service hours of the office remain unchanged. For enquiries, please contact the Office during office hours:
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 CMPB. The form of Change of Personal Particulars of CMPs can be obtained from the Secretariat or downloaded from the CMCHK homepage (http://www.cmchk.org.hk).
Should you have any opinions regarding the content of the Newsletter, please send them to the Secretariat of the CMCHK by post, fax or email, indicating "Newsletter of the Chinese Medicine Practitioners Board". All published Newsletters are uploaded to the CMCHK 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
Telephone number: (852) 2121 1888
Fax Number: (852) 2121 1898
E-mail Address: email@example.com
Service Hours: Monday to Friday: 9:00 am to 5:30 pm
Closed on Saturdays, Sundays and Public Holidays