Modernization Of Chinese Medical Practice - Chang Gung's .

Modernization of Chinese MedicalPractice- Chang Gung's Experience張恒鴻Hen-Hong ChangCenter for Traditional Chinese Medicine,Chang Gung Memorial Hospital1

Modernized traditional Chinesemedical practice Collaboration between modern medicine shouldinvolve combining traditional knowledge andmodern science to enhance the progress ofmedicine.2

Chang Gung Memorial Hospital Established its Chinese medical department in1996.Extending it throughout its facilities in Keelung,Taipei, Linkou, Taoyuan, Chiayi, andKaohsiung.3

Center for TCM Dedicate to pass on the precious knowledge,wisdom, and thousands of years of experienceof the ancestors.Integrate TCM with modern medical science,TCM/Western medicine.Pursue the three objectives of health care,education, and research.Prevention, treatment, rehabilitation and lifenurturing.4

Chang Gung Memorial Hospital OrganizationBoard of TrusteesChang Gung SteeringMedical CommitteesAdministrationCommitteeLinkou medical eaLife nurturingculture ohsiungChiayi5

The organization of Center for TCMCenter forTCMTCM Education CommitteeTCM PharmacyTCM qualificationCommitteeTaoyuanLinkouDepartment ofTCMTaipeiKeelungKaohsiungChiayiDivision ofTCMDepartment ofTCMDivision ofTCM6

Linkou Nursinghomenurturingculture villageKeelungTaipei LifeTaoyuan ChangGunguniversity ChangGungInstitute oftechnologyChiayiKaohsiung7

Keelung(854 beds)Taipei(340 beds)8

Linkou(3801 beds)Taoyuan(1850 beds)9

Chiayi(1500 beds)Kaohsiung(2482 beds)10

Chang Gung Memorial HospitalCenter for TCM Internal medicine, gynecology, pediatrics,acupuncture, and traumatology departmentsChinese medical nursing and pharmacyDiagnostics research divisionTCM clinical trial centerThe pharmacovigilence for herbal medicineTCM clinical training center11

Internal medicine12

Clinical Pathology13

Department of traumatology14

Department of acupuncture15

WS Far Infrared Physiatric Unit16

Electrical acupuncture17

Laser acupuncture18

Center of Health Promotion TCM Tuina Meridianmassage Aromatictherapy19

Education Program for Resident Doctors There are two curricula for resident doctors in the center forTCM: 5-year program (2 years of TCM, 3 years of Westernmedicine) and 4-year program (3 years of TCM, 1 year ofWestern medicine).Assessment for residents: monthly, quarterly, and annual.Contemporary TCM and scientific concepts are thoroughlyintegrated into the training for resident doctors.Education in complementary TCM/Western medicine strives toproduce the highest quality in health care services.20

TCM Clinical Trial Center21

The Pharmacovigilence for Herbal Medicine22

TCM Clinical Training Center23

Characteristics of the Education Program Aproblem-based learning curriculum as part of theTCM education program. An educational and clinical exchange program withChina mainland. As of this year, more than 80professionals have been invited to teach class and tolecture on special topics.24

Laboratory of TCM Diagnosis25

Laboratory of TCM Diagnosis1. Pulse diagnosis2. Tongue diagnosis3. Auscultation diagnosis4. Meridian ( ARDK)diagnosis26

Pulse Diagnosis27

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Tongue Diagnosis29

Auscultation DiagnosisQi-vacuity and control30

Auscultation DiagnosisZero-crossing ratePeak-valley variation31

Meridian Diagnosis(ARDK)32

Chang Gung Memorial Hospital At present, Chang Gung's Chinese medicinefacilities have 44 attending physicians and 27resident doctors who work in closecollaboration with the western medicaldepartments.33

Center for TCM, CGMH Out patient clinicIn-patient facilitiesIntegrated in-patient careIntegrated out patient clinicCombined in-patient consultation34

TCM Hospitalization Ankylosing spondylitis Degenerative arthritis CA radiotherapy and chemotherapy HIVD Fracture Stroke Brain injury35

Ward Station36

Chinese Medical Nursing Chinese medical nurses have to engage intraining courses to gain 9 additional credits inseven subjects.They contribute to the previously mentionedservices, as well as providing health educationand counseling home nursing, and hospice care.37

TCM Consultation38

Traditional Chinese Pharmacy The work of pharmacists includes :Z Dispensing traditional pills, powders, pastes, andelixirsZ 463 concentrated powder medicinesZ Preparing decoctions for patients, making pillsZ Providing pharmaceutical counseling39

Medical pasteExternal application-drugsDecoctionAutomatic decoction machine40

HPLCGC-MSTLC scannerChemiluminescence Analyzer41

Decocting Pieces42

Concentrated TCM powder43

Conveyor Belt44

Health Promotion Peripheral products and services contributingto health care include health-food productsand health-care equipment. With our nursing home and life nurturingculture village, we provide a diverse range ofhealth-care services.45

Related Business Biotechnology, health foodCosmetic, maintenanceMedical apparatusNursing homeLife nurturing culture village46

Chang Gung BiotechnologyHealth food47

Formosa Biomedical Technology Corp.Cosmetic and maintenance48

Chang Gung Medical Supplies andEquipment Corp.49

Nursing HomeLife Nurturing Culture Village50

Education Facility Chang Gung University and Chang Gung TechnicalCollege are education facilities that provide the basictraining and post-graduate education.51

International Communication52

Traumatic intracranial hemorrhage–a case report A 17y/o female suffered from traffic accidenceCondition at Emergency room Feb-5ZZZZZZZZZZZGCS: E2M2V1SBP: 99mmHg, heart rate: 150/minPupil : 4/7mm, no light reflex bilateralGeneral convulsionEndotracheal intubationBrain CT: subarachnoid and subdural hemorrhagePelvic and left femoral fractureHemodynamic unstable — due to hemoperitoniumVaginal lacerationOtorrhea — R/O skull base fracturePneumothorax — on chest tube53

Clinical course Feb-08 Operation:Z External fixation for pelvic fractureZ Internal fixation for femoral fractureZ Repair vaginal lacerationZ TracheostomyFeb-09 On tracheal maskFeb-13 Pneumothorax subsideFeb-18 Consult TCMFeb-19 Abdominal wound infection---ORSAZ Wound debridementZ On antibioticsFeb-23 Transfer to orthopedic wardMar-08 GCS: E4VTM654

Physical examination Vital signs: BP 236/111mmHg; PR 182/min; RR 34/minBT 36.5 GCS: E1VTM2Condition: ventilator support, on Foley, on NG tubeHEENTZ Sclera: anictericZ Conjunctiva: not paleZ Neck supple, no palpable lymph node, nojugular vein engorgement ChestZ regular heart beat without murmurZ breathing sound: bilateral raleAbdomen: soft, bowel sound hypoactiveExtremity: no pitting edema55

Neurological examination Cranial nerves:Z Pupil: 2.0mm/4.5mm, L/R: /－Z Ptosis left sideZ Eye of movement: fullnessZ Dysphagia56

Neurological Examination11OOSensation33OOMuscle Power DTR57

Parenchymal hemorrhageIntraventricular hemorrhage58

Subdural hemorrhageAir –fluid level in sphenoid sinus59

Left femoral shaft fracturePneumothorax60

Fracture linesDiastasis of pubic symphysis61

Acupuncture treatment Arouse the brain and open orificesZ �中、湧泉 Boost qi and move bloodZ 百會、神庭、中脘、氣海、 �三陰交 3 times per week62

Lumbar HIVD case report Emergency room treatmentMefenamic acid 250mg/capNalbuphine 10mg/ml/ampMagnesium oxide 250mg/tabMethocarbamol 500mg/tabRefuse surgical operationHospitalized in TCM ward,Department of orthopedic and traumatology63

Physical examination Tender points:Z L5/S1 Rt（ ） Lt（ －）Z L4/L5 Rt（ ） Lt（ －）Straight leg raising test:Z Rt( ) 25-30 Lt(－)Knee reflex: Lt ( ) Rt ( )Achilles' tendon reflex: Lt ( ) Rt ( )Muscle power:Z Ankle dorsiflexion NPZ Big toe extension NPZ Ankle Plantar flexion Lt RtParesthesia: Rt leg, (L5, S1)Muscle atrophy(－)64

Herniation of L5/S165

Diagnosis TCM:(1) Damage to the lumbar sinew(2) Qi stagnation and blood stasis Western medicine:(1) HIVD(2) Lumbago(3) Myalgia and myositis66

DateFeb/27Feb/28SRt low back pain, refer to Rtleg and footOSLRT:Rt( )25-30 Tender points: RtL4-L5( ); L5-S1( )Mar/01Rt low back pain improve,but Rt leg still aching andnumbnessRt low back pain improve,but Rt leg still aching andnumbnessRed tongue, yellow andgreasy fur, string slipperyfast pulseRed tongue, yellow andgreasy fur, string slipperyfast pulseHIVDAHIVDDamage to the lumbar sinew,Qi stagnation and bloodstasisHIVDPElectrical acupuncture大腸俞 關元俞 小腸俞秩邊 環跳 委中 丘墟Blood letting: 阿是, 承山Paste: 金黃散Medical bathing知柏地黃丸 1.5g身痛逐瘀湯 1.0g正骨紫金丹 1.0g延胡索 0.5g 丹參 0.5g乳香 0.3g 沒藥 0.2g薏苡仁 0.5 gDamage to the lumbar sinew, Damage to the lumbar sinew,Qi stagnation and bloodQi stagnation and bloodstasisstasisElectrical acupunctureBloodletting: 委中, 丘墟Paste: 金黃散Medical bathing67

Daily Treatment Schedule AM 09:00 Herbal extractionAM 10:00 Electrical acupunctureBlood lettingAM 11:00 TCM manipulationDao-inHerbal pastePM 01:00 Herbal extractionPM 03:00 Medical bathingPM 04:00 RehabilitationHerbal pastePM 06:00 Herbal extraction68

Electrical Acupuncture69

Blood Letting70

Medical Bathing71

TCM Manipulation72

The Curriculum for TCM Department General Education(32) .1st to 2nd yearBasic Education(42). 1st to 2nd yearBasic medical science.3rd to 4th yearWM(82)TCM(49)Clinical medicine . . .5th to 6th yearWM(79)TCM(27)Integrated( 5)InternshipWM(48). 7th yearTCM(45). 8th yearTotal credit .(409)73

�域選修課程(必選修)18 會醫學實 ��學4 神經解剖學61大體解剖學實驗 4 實驗1生物化學4 組織學2 寄生蟲學21生物化學實驗1 組織學實驗2 寄生蟲學實驗2醫師/病人/社會 2 影像解剖學1 �學(上)4內科學(下)4婦產科學（全學年 4 學(上)2小兒科學(下)2外科學（全學年 6 醫學系統整合6醫學論文寫作(1) 第七學年為西醫臨床實習 48 學分臨床見習（全學年18 學分）臨床見習（全學年18 學分）2003/04/09 修訂74

�科目學分中醫基礎理論 3 5 傷寒論5 ��藥理學實驗 1暑假必修科目 第八學年為中醫臨床實習 45 修習科目 學分 ��年度學分 修習科目 學分 修習科目學分3中醫外科學 1 中醫婦科學中醫皮膚科學 1 中醫婦科學見習 1暑假必修科目【6/1 起西醫實習】42211111752004/8/18 修訂

The TCM Universities Collaborated withChang Gung University 北京中醫藥大學 成都中醫藥大學 福建中醫學院 南京中醫藥大學 黑龍江中醫藥大學 �院山東中醫藥大學廣州中醫藥大學76

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culture village Chang Gung university . Chang Gung Biotechnology Health food. 48 Formosa Biomedical Technology Corp. Cosmetic and maintenance . 49 Chang Gung Medical Supplies and Equipment Corp. 50 Nursing Home Life Nurturing Culture Village. 51 Education Facility