dr.

HARDHI PRANATA
P.D.H.M.I
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): 2
nd
conference on
traditional medicine in asian countries
Integration of traditional medicine into the
National Healthj Care Systems:
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 as
o 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 peoples 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 peoples 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 products 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
The Core PROGRAM
Implementation of MoHs Decree No 3/2010 regarding Jamu
Scientification + No. 1109/2007 regarding CAM practitioner leading
to Govt Regulations draft of Trad.Med (as mandatedby Health Act
No 36/09) + revitalization of SP3T
SJ DIAGNOSTIC : down-stream approach by developing dual
JAMUs skilled researcher + practitioner (physician+dentist) +
scientific labeling of JAMU MEDICAL ("concentrate")
SJ THERAPEUTICALS : "up-stream approach by developing
community/clinical pharmacist + JAMUs 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
JAMUs Dr use empirical - rational herbs (art. 104 para 2)
TRAD.HEALTH standards
Competence based of professionalism : using JAMUs 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 JAMUs 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)
KOMNAS
SJ
Kuali
INDIVIDU
kuanti
Prevent Infection
Preventive
PUBLIC HEALTH
OTONOM
YANMED
HOSPITAL





BINKES

SENTRA
P3T
Medicina
l
Materials
GP
JAMU
IAI
GP
FARMASI
Physician/dentist
RPP BATTRA
Dual Clinics Network
Res through Services
Hierarchy of health worker
S.J. NAS
REVITALIZATION
Kohort prospektif-
Mass Clinical observation
JAMU for FITNESS
AESTHETICs JAMU
ANTI-AGINGs JAMU
Clin Trial
Label Saintifik
IDI
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 Medik/Concentrate
Jamu saintifik Nas
Jamu Saintifik Lokal
JAMU NON MEDIK/OTC
OHT
FITO
FARMA
KA
JAMKESMAS
JAMKESDA ??
CURRENT PARADIGM
HIGEST LEVEL EBM :
DB, RCT, MA
Is RI has an
infrastructure??
HOW MUCH RIS PHYTOFARMAKA ARE BESTSELLER
VALUE :
HOW JAMU AS A
HOST IN RI???
GOVERNMENT GUARANTEE THE DEVELP & MTANANCE Batra & Raw Materials
USE OF TRADITIONAL MEDICINE SOURCE - article 100 of Law 36/09 of Health
Obat Herbal
Jamu
Herbal Terstandar
Fitofarmaka
FUTURE PARADIGM
OPINION EXPERT
FROM THOUSAND
OF EXPERT ?
KONTEKS DUET : DR PENELITI + YAN
RI BUILDING AN
RESEARCHS
INFRASTRUCTURE
+
CREATING MARKET
5 W + 1 H JAMU BECOME
A KEY COMPONENT IN
FORMAL HEALTH SYSTEM


BATTRA CAM MUDAH dan MURAH





Diluar ilmu Kedokteran
Dan Keperawatan Belum diakui




J






JAMUS DR : BROAD-MINDED & PROFESSIONAL
KONVENSIONAL
Hereditary = peer review
Doctor herbal researcher
PALIATIF
HOME CARE
Contextual features
Patients preference

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 JAMUs 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.meds herbs
material (JAMU) NIHRDs function
Educating & training the safe & effective JAMU
BPSDMs function
Providing JAMU as approved model DG of
Medical Services
Fitofarmakas clinical trial NIHRDs function

jamu
Manufacturer
Riset
Dokter
Rumah
Sakit
Rumah Sakit
Mitra
Non Dokter/
SP3T
Non Dokter/
SP3T
Praktisi
Jamu
Standar
Rumah Sakit
MEDICAL-JAMU R & D System Based on Health Services - Permenkes 3 / 10
Article 7
Komite
Ilmiah
Komite etik
Holistik
Unit Teknis Sentra P3T
BP, PUSKESMAS, RS, SWASTA
BKTM & LKTM
BBTOOT
TIPE A
Dual research-service =
Double ID-board
.
BIOLOGI KIMIA FISIKA
ANATOMI FISIOLOGI BIOKIMIA HISTOLOGI
PSIKONEUROIMUNOENDOKRINOLOGI
PATOLOGIK
D/ KLINIS
TH/ KLINIS
FISIK MENTAL SOSIO
SPIRI
TUAL
THERAPI HOLISTIK
ETIKOLEGAL - PROFESIONALISM
DIAGNOSTIK HOLISTIK
KEBUGARAN
Wellness
Index
SJ
METPEN
NETWORK
LEVEL
INDEP
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
.
DOKTER
SJ
BLOK 1
METODOLOGI PENELITIAN
BLOK 4
MEDIKO-ETIKOLEGAL
BLOK 3
FARMAKODINAMIK JAMU
BLOK 2
DIAGNOSTIK HOLISTIK
SAINTIFIKASI DR JAMU
(LANGKAH AWAL NAKES JAMU)
SAINTIFIKASI JAMU
(OBAT TRAD BRAND RI)
PRAKTISI KRITIS +
JEJARING PENELITI
PRAKTISI LEGAL PROFESIONAL
Persyaratan Perizinan
Jenis Registrasi
Nakes
Izin Nakes Registrasi
Komplementer-
Alternatif
Surat
Tugas/Surat
Izin Kerja
Komplement
er-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 512,725,1109-07
Konsep Ijin Ganda krn blm diakui metodenya
Dalam Faskes
Konvensional :
INTEGRASI
SINERGI
Dinkes Prop a/n Menkes
Ps 17
PKKAI
Ijazah
Sumpah
Sertifikat
Kompetensi
Rekomen-
dasi IDI

Sehat
Kompeten

PDSp
PDSm

Etis

Anggota
FK-FKG
Kolegium +/- Kol CAM
KKI
DINKES KAB/IKOTA
tataran individu Nakes
multi-metodologi, ps 1 ay 7
KEWENANGAN TOLAK
Ps 24
UJI KOMP
MTK 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 6
KAPUSRENGUN
CATATAN REGISTRASI NAS
Poltekes
Akademi
Nakes
WNA/LULUSAN LN, ps 19
Berlaku 1 th (ps. 25)
KUOTA MAX : 3 TP
BADAN KAJIAN KA
?