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Modernization of Chinese Medical Practice

- Chang Gung's Experience

張恒鴻

Hen-Hong ChangCenter for Traditional Chinese Medicine,

Chang Gung Memorial Hospital

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Modernized traditional Chinese medical practice

Collaboration between modern medicine should involve combining traditional knowledge and modern science to enhance the progress of medicine.

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Chang Gung Memorial Hospital

Established its Chinese medical department in 1996.Extending it throughout its facilities in Keelung, Taipei, Linkou, Taoyuan, Chiayi, and Kaohsiung.

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Center for TCMDedicate to pass on the precious knowledge, wisdom, and thousands of years of experience of 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 life nurturing.

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Chang Gung Memorial Hospital Organization

Board of Trustees

Chang Gung Steering

CommitteeMedical Committees Administration

Taoyuan

AreaKaohsiung

Area

Keelung

Area

Linkou medical center

Chiavi

Area

Life nurturing culture village

NursingHome

Taoyuan KaohsiungKeelung

Children

Chiayi

Taipei TCM

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The organization of Center for TCM

Center for

TCMTCM Education Committee

TCM qualification Committee

TCM Pharmacy

Linkou Taipei KaohsiungKeelung

Department of TCM

Division of TCM

Department of TCM

Taoyuan

Division of TCM

Chiayi

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Chiayi

Kaohsiung

Taoyuan

Taipei

Keelung

● Nursing home

● Life nurturingculture village

● Chang Gunguniversity

● Chang GungInstitute oftechnology

Linkou

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Keelung(854 beds)

Taipei(340 beds)

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Taoyuan (1850 beds)

Linkou (3801 beds)

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Chiayi(1500 beds)

Kaohsiung(2482 beds)

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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 center

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Internal medicine

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Clinical Pathology

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Department of traumatology

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Department of acupuncture

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WS Far Infrared Physiatric Unit

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Electrical acupuncture

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Laser acupuncture

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Center of Health Promotion

•TCM

•Tuina

•Meridian

massage

•Aromatic

therapy

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Education Program for Resident Doctors

There are two curricula for resident doctors in the center for TCM: 5-year program (2 years of TCM, 3 years of Western medicine) and 4-year program (3 years of TCM, 1 year of Western medicine). Assessment for residents: monthly, quarterly, and annual.Contemporary TCM and scientific concepts are thoroughly integrated into the training for resident doctors.Education in complementary TCM/Western medicine strives to produce the highest quality in health care services.

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TCM Clinical Trial Center

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The Pharmacovigilence for Herbal Medicine

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TCM Clinical Training Center

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Characteristics of the Education Program

A problem-based learning curriculum as part of theTCM education program.An educational and clinical exchange program withChina mainland. As of this year, more than 80 professionals have been invited to teach class and to lecture on special topics.

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Laboratory of TCM Diagnosis

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Laboratory of TCM Diagnosis

1. Pulse diagnosis

2. Tongue diagnosis

3. Auscultation diagnosis

4. Meridian ( ARDK)

diagnosis

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Pulse Diagnosis

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Tongue Diagnosis

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Auscultation Diagnosis

Qi-vacuity and control

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Auscultation Diagnosis

Zero-crossing rate Peak-valley variation

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Meridian Diagnosis (ARDK)

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Chang Gung Memorial Hospital

At present, Chang Gung's Chinese medicine facilities have 44 attending physicians and 27 resident doctors who work in close collaboration with the western medical departments.

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Center for TCM, CGMH

Out patient clinic In-patient facilitiesIntegrated in-patient careIntegrated out patient clinicCombined in-patient consultation

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TCM Hospitalization

Ankylosing spondylitisDegenerative arthritisCA radiotherapy and chemotherapy HIVDFractureStrokeBrain injury

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Ward Station

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Chinese Medical Nursing

Chinese medical nurses have to engage in training courses to gain 9 additional credits in seven subjects. They contribute to the previously mentioned services, as well as providing health education and counseling home nursing, and hospice care.

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TCM Consultation

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Traditional Chinese Pharmacy

The work of pharmacists includes :Dispensing traditional pills, powders, pastes, and elixirs463 concentrated powder medicinesPreparing decoctions for patients, making pillsProviding pharmaceutical counseling

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Decoction

External application-drugs

Medical paste

Automatic decoction machine

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TLC scannerHPLC

GC-MS Chemiluminescence Analyzer

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Decocting Pieces

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Concentrated TCM powder

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Conveyor Belt

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Health Promotion

Peripheral products and services contributing to health care include health-food products and health-care equipment.

With our nursing home and life nurturing culture village, we provide a diverse range of health-care services.

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Related Business

Biotechnology, health foodCosmetic, maintenance Medical apparatusNursing homeLife nurturing culture village

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Chang Gung Biotechnology

Health food

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Formosa Biomedical Technology Corp.

Cosmetic and maintenance

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Chang Gung Medical Supplies and Equipment Corp.

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Nursing Home Life Nurturing Culture Village

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Education Facility

Chang Gung University and Chang Gung Technical College are education facilities that provide the basic training and post-graduate education.

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International Communication

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Traumatic intracranial hemorrhage–a case report

A 17y/o female suffered from traffic accidence Condition at Emergency room Feb-5

GCS: E2M2V1SBP: 99mmHg, heart rate: 150/min Pupil : 4/7mm, no light reflex bilateralGeneral convulsionEndotracheal intubationBrain CT: subarachnoid and subdural hemorrhagePelvic and left femoral fracture Hemodynamic unstable — due to hemoperitoniumVaginal lacerationOtorrhea — R/O skull base fracturePneumothorax — on chest tube

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Clinical courseFeb-08 Operation:

External fixation for pelvic fractureInternal fixation for femoral fractureRepair vaginal lacerationTracheostomy

Feb-09 On tracheal maskFeb-13 Pneumothorax subsideFeb-18 Consult TCMFeb-19 Abdominal wound infection---ORSA

Wound debridement On antibiotics

Feb-23 Transfer to orthopedic wardMar-08 GCS: E4VTM6

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Physical examinationVital signs: BP 236/111mmHg; PR 182/min; RR 34/min

BT 36.5℃GCS: E1VTM2Condition: ventilator support, on Foley, on NG tubeHEENT

Sclera: anicteric Conjunctiva: not paleNeck supple, no palpable lymph node, no jugular vein engorgement

Chestregular heart beat without murmurbreathing sound: bilateral rale

Abdomen: soft, bowel sound hypoactive Extremity: no pitting edema

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Neurological examination

Cranial nerves:Pupil: 2.0mm/4.5mm, L/R: +/－Ptosis left side Eye of movement: fullnessDysphagia

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Muscle Power DTR

1

1 33

O

O

＋＋＋

＋＋＋

＋＋＋＋＋＋＋

＋＋

＋＋＋

＋＋＋

＋＋＋

＋＋＋

Sensation

Neurological Examination

O

O

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Parenchymal hemorrhage Intraventricular hemorrhage

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Subdural hemorrhage Air –fluid level in sphenoid sinus

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Left femoral shaft fracture Pneumothorax

61Diastasis of pubic symphysisFracture lines

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Acupuncture treatment

Arouse the brain and open orifices上星透百會、印堂、內關、三陰交、人中、湧泉

Boost qi and move blood百會、神庭、中脘、氣海、曲池、太淵、手三里、內關、足三里、三陰交

3 times per week

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Lumbar HIVD case report

Emergency room treatmentMefenamic acid 250mg/cap Nalbuphine 10mg/ml/amp Magnesium oxide 250mg/tab Methocarbamol 500mg/tabRefuse surgical operationHospitalized in TCM ward,Department of orthopedic and traumatology

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Physical examinationTender points:

L5/S1 Rt（+） Lt（+－）L4/L5 Rt（+） Lt（+－）

Straight leg raising test:Rt(+) 25-30° Lt(－)

Knee reflex: Lt (++) Rt (++)Achilles' tendon reflex: Lt (++) Rt (+)Muscle power:

Ankle dorsiflexion NPBig toe extension NPAnkle Plantar flexion Lt＞Rt

Paresthesia: Rt leg, (L5, S1)Muscle atrophy(－)

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Herniation of L5/S1

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DiagnosisTCM:

(1) Damage to the lumbar sinew(2) Qi stagnation and blood stasis

Western medicine: (1) HIVD (2) Lumbago(3) Myalgia and myositis

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Electrical acupunctureBloodletting: 委中, 丘墟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 g

Electrical 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

P

HIVDDamage to the lumbar sinew, Qi stagnation and blood stasis

HIVDDamage to the lumbar sinew, Qi stagnation and blood stasis

HIVDDamage to the lumbar sinew, Qi stagnation and blood stasis

A

Red tongue, yellow and greasy fur, string slippery fast pulse

Red tongue, yellow and greasy fur, string slippery fast pulse

SLRT:Rt(+)25-30°Tender points: Rt L4-L5(+); L5-S1(+)

O

Rt low back pain improve, but Rt leg still aching and numbness

Rt low back pain improve, but Rt leg still aching and numbness

Rt low back pain, refer to Rt leg and foot

S

Mar/01Feb/28Feb/27Date

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Daily Treatment ScheduleAM 09:00 Herbal extractionAM 10:00 Electrical acupuncture

Blood lettingAM 11:00 TCM manipulation

Dao-inHerbal paste

PM 01:00 Herbal extractionPM 03:00 Medical bathingPM 04:00 Rehabilitation

Herbal pastePM 06:00 Herbal extraction

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Electrical Acupuncture

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Blood Letting

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Medical Bathing

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TCM Manipulation

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The Curriculum for TCM DepartmentGeneral Education (32)…..1st to 2nd yearBasic Education (42)..…1st to 2nd yearBasic medical science...................3rd to 4th year

WM (82)TCM (49)

Clinical medicine ….………..…..5th to 6th yearWM (79)TCM (27)Integrated ( 5)

InternshipWM (48)..…7th yearTCM (45)..…8th year

Total credit …………….(409)

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西醫專業課程第一學年 第二學年 第三學年

上學期 學分 下學期 學分 上學期 學分 下學期 學分 上學期 學分 下學期 學分

大體解剖學 4

大體解剖學實驗 4

入門講座課程（必修） 基礎核心課程（必修）

2 18

領域選修課程(必選修) 全校選修課程(必選修)

4 6

胚胎學 2

普通生物學 2 普通生物學 2 有機化學 3 生物化學 4 組織學 2

普通生物學實驗 1 普通生物學實驗 1 有機化學實驗 1 生物化學實驗 1 組織學實驗 2

普通物理學 2 普通化學(含分析) 3 行為科學 2 醫師/病人/社會 2 影像解剖學 1

普通物理學實驗 1 普化實驗(含分析) 1 高階醫學英文 2 生物統計學 2

微積分 2 圖書資訊 1 物化生物學 2 生死學 1

人文及社會醫學導論

2

世界醫學史 人文及社會醫學實作

1 2

醫學研究介紹

1

神經解剖學 神經解剖學實驗 生理學 生理學實驗 寄生蟲學 寄生蟲學實驗 微生物學 免疫學 微生物免疫學實驗 醫學細胞分子學 遺傳醫學 醫學導論 營養學 社區醫學（1）

1 1 4 1 2 1 2 2 1 1 2 1 1 1

第四學年 第五學年 第六學年

上學期 學分 下學期 學分 上學期 學分 下學期 學分 上學期 學分 下學期 學分

病理學 6 公共衛生學 3 婦產科學（全學年 4 學分） 病理學實驗 3 實驗診斷學 2

內科學(上) 小兒科學(上)

4 2

內科學(下) 小兒科學(下)

4 2 外科學（全學年6 學分）

公共衛生學 2 實驗診斷學實驗 1 影像診斷學 3 眼科學 1 皮膚科學 1 麻醉科學 1 藥理學 4 臨床診斷學 2 神經科學 1 牙科學概論 1 核醫學 1 放射治療學 1 藥理學實驗 1 臨床診斷學見習 1 復健科學 1 耳鼻喉科學 1 管理與法規概論 2 醫學倫理學 1

國際英文醫學溝通醫病關係

1 1

法醫學 1

精神醫學 醫學論文寫作(1)

2 1

醫學與生物資訊 病態生理學 社區醫學(2)

1 2 1

臨床技巧與醫療相關照護 基礎與臨床醫學系統整合

1 6

臨床見習（全學年18學分） 臨床見習（全學年18學分）

第七學年為西醫臨床實習 48 學分 2003/04/09 修訂

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第一學年度 第二學年度 第三學年度 修習科目 學分 修習科目 學分 修習科目 學分 修習科目 學分 修習科目 學分 修習科目 學分

中中醫醫基基礎礎理理論論 中國醫學史

33 2

中中醫醫診診斷斷學學 55 方方劑劑學學 方方劑劑學學實實習習 醫醫古古文文

55 11 22

傷傷寒寒論論 44

暑假必修科目 暑假必修科目 暑假必修科目 中中醫醫藥藥物物學學 中中藥藥炮炮製製學學

中中藥藥炮炮製製學學實實驗驗 經絡腧穴學

中醫診斷學見習*

55 11 11 22

1*

內內經經 金金匱匱要要略略 溫溫病病學學

中中醫醫英英文文

44 44 44 22

中醫內科學 中醫內科學見習 中中醫醫各各家家學學說說 針灸治療學

針灸治療學見習 難經

4 44 2 2 1 1

第四學年度 第五學年度 第六學年度 修習科目 學分 修習科目 學分 修習科目 學分 修習科目 學分 修習科目 學分 修習科目 學分

中中藥藥藥藥理理學學 中中藥藥藥藥理理學學實實驗驗

3 1

中醫外科學 中醫皮膚科學

11

中醫婦科學 中醫婦科學見習

3 1

暑假必修科目 暑假必修科目 暑假必修科目【6/1 起西醫實習】 中西醫內科學

中醫兒科學 中醫傷科學

中醫耳鼻喉科學 中醫眼科學

中西醫內科學見習* 中醫兒科學見習* 中醫傷科學見習*

4 2 2 1 1 1 1 1

第八學年為中醫臨床實習 45 學分 2004/8/18 修訂

中醫專業課程

76

The TCM Universities Collaborated with Chang 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

湖南中醫學院

江西中醫學院

浙江中醫學院

山東中醫藥大學

廣州中醫藥大學

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