In his office in Kuching, Sarawak, Dr Tan Kit Weng is busy with a patient.
Sitting in his consultation room, he checks the patient's pulse and takes notes on his complaints and ailments.
"You need to drink more hot water. Take this medicine at night before you sleep. One tablet per day," he says briskly.
This is a typical day for Tan, who has practised traditional and complementary medical (TCM) treatment for nearly five decades. The walls of his office are hung with certificates and his shelves are filled with glass jars stuffed with Chinese herbs.
While he was trained in Western, science-based medicine, he was not satisfied with the field and turned instead to traditional Chinese treatments.
"I went to Miri and learnt about all of this from traditional Chinese doctors," he said.
"I became friends with them, and they taught me how to cure people using herbal medication and other healing techniques."
Most of the herbal mixtures he produces are for patients with chronic diseases.
Today, though, his focus has shifted to include the virus that has been plaguing the world for more than two years now: Covid-19.
When the pandemic first began, he and his team got to work analysing the properties of herbs to uncover their medicinal value for the treatment of Covid-19.
"During the lockdown, we produced a herbal medicine called PC19," he said.
"At that time, our associations distributed 500 doses daily to our frontliners at hospitals across the state."
And according to him, the response has been good.
"The increasing demand from Covid-19 patients has created an opportunity for our members, who are asking us to help them set up more TCM centres to cater to the requests for appointments.
"So we are planning to help our physicians operate new centres," he said.
TCM throughout the years
Although the practice of traditional medicine has yet to be scientifically proven, it remains a popular option for patients, especially those suffering from diseases for which Western medicine has no cure.
For example, Tan said many cancer patients come to him seeking to ease the side effects of chemotherapy such as nausea.
Others come even for common ailments like diarrhea and coughs.
And since the onset of Covid-19, TCM practitioners have been receiving a steady stream of patients seeking treatments for Covid-related symptoms.
But despite its market boom, the efficacy and safety of such treatments are still under question.
Speaking to MalaysiaNow, health director-general Dr Noor Hisham Abdullah said the health ministry had yet to include TCM practices as part of its Covid-19 management plan.
While Malaysia signed a memorandum of understanding with China early this year as part of its commitment to the development of traditional medical practices, Noor Hisham said TCM still lacked the proper trials and scientific evidence to prove the efficacy of herbal remedies for Covid-19.
"We have also learnt from the TCM experts in China that the TCM herbal formulas for treating Covid-19 should be adjusted according to the needs and characteristics of the individual patient, and the local climate and geographical conditions," he said.
"Local studies are needed to support the use of herbal medicine in the prevention or treatment of Covid-19, to ensure that it is safe and effective."
Nevertheless, he also cited a recent report by the World Health Organization including the use of TCM, describing it as a positive development in efforts to promote traditional Chinese medical practices in the global healthcare system.
"With reference to the effectiveness of herbal medicine in Covid-19 management, the health ministry is aware that countries like China are using TCM in the treatment of Covid-19 which has shown positive results," he said.
"Besides that, from the recent WHO Expert Meeting Report on Evaluation TCM in the treatment of Covid-19 (2022), one of the key findings was that TCM is beneficial in reducing the risk of progression from mild-to-moderate cases when administered as add-on interventions to conventional treatment."
The Federation of Chinese Medicine and Physicians Sarawak said the development of TCM in Malaysia had always been a "grey area".
Despite the success of the industry, it said, practitioners had yet to be formally endorsed in government healthcare systems.
"The role of TCM in helping Covid-19 patients has proved that TCM plays an important role in modern healthcare. We need recognition in the government to ensure the safety and efficacy of herbal medicines," vice-secretary Albert Lee Joo Hee said.
Noor Hisham meanwhile cautioned against falling for misinformation and false claims on unregistered products, saying these could cause serious harm to health.
"The health ministry is aware that patients might choose to use herbal medicine to manage the signs and symptoms of Covid-19 infection," he said.
"It is the right of the patient if he or she would like to take traditional herbs in managing his or her sign and symptoms of Covid-19 infection."
Nonetheless, he added, modern medicine should be the main source of treatment for Covid-19 if patients feel unwell.
He also advised the public to seek the appropriate treatment under the conditions prevalent in Malaysia if they prefer to take herbal medicine.
For example, he said, the Lian Hua Qing Wen capsule was one of several herbal formulations recommended for the relief of Covid-19 symptoms, but contained ephedra – a prohibited substance not allowed in registered traditional medicine products by the Drug Control Authority.
"In Malaysia, there are registered products of Lian Hua Qin Wen with modified formulation (without ephedra) with the indication to reduce body heatiness and relieve cough and phlegm based on its traditional philosophy which can relieve some signs and symptoms faced by the patients.
"The public should follow the directives issued by the health ministry and the use of herbal medicine should not stop them from seeking appropriate treatment from ministry healthcare facilities or being vaccinated against Covid-19."