1

Modernization of Chinese Medical Practice

- Chang Gung's Experience

Hen-Hong ChangCenter for Traditional Chinese Medicine,

Chang Gung Memorial Hospital

2

Modernized traditional Chinese medical practice

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

3

Chang Gung Memorial Hospital

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

4

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.

5

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

6

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

7

Chiayi

Kaohsiung

Taoyuan

Taipei

Keelung

Nursing home

Life nurturingculture village

Chang Gunguniversity

Chang GungInstitute oftechnology

Linkou

8

Keelung(854 beds)

Taipei(340 beds)

9

Taoyuan (1850 beds)

Linkou (3801 beds)

10

Chiayi(1500 beds)

Kaohsiung(2482 beds)

11

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

12

Internal medicine

13

Clinical Pathology

14

Department of traumatology

15

Department of acupuncture

16

WS Far Infrared Physiatric Unit

17

Electrical acupuncture

18

Laser acupuncture

19

Center of Health Promotion

TCM

Tuina

Meridian

massage

Aromatic

therapy

20

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.

21

TCM Clinical Trial Center

22

The Pharmacovigilence for Herbal Medicine

23

TCM Clinical Training Center

24

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.

25

Laboratory of TCM Diagnosis

26

Laboratory of TCM Diagnosis

1. Pulse diagnosis

2. Tongue diagnosis

3. Auscultation diagnosis

4. Meridian ( ARDK)

diagnosis

27

Pulse Diagnosis

28

29

Tongue Diagnosis

30

Auscultation Diagnosis

Qi-vacuity and control

31

Auscultation Diagnosis

Zero-crossing rate Peak-valley variation

32

Meridian Diagnosis (ARDK)

33

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.

34

Center for TCM, CGMH

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

35

TCM Hospitalization

Ankylosing spondylitisDegenerative arthritisCA radiotherapy and chemotherapy HIVDFractureStrokeBrain injury

36

Ward Station

37

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.

38

TCM Consultation

39

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

40

Decoction

External application-drugs

Medical paste

Automatic decoction machine

41

TLC scannerHPLC

GC-MS Chemiluminescence Analyzer

42

Decocting Pieces

43

Concentrated TCM powder

44

Conveyor Belt

45

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.

46

Related Business

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

47

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

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

52

International Communication

53

Traumatic intracranial hemorrhagea 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

54

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

55

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

BT 36.5GCS: 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

56

Neurological examination

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

57

Muscle Power DTR

1

1 33

O

O

Sensation

Neurological Examination

O

O

58

Parenchymal hemorrhage Intraventricular hemorrhage

59

Subdural hemorrhage Air fluid level in sphenoid sinus

60

Left femoral shaft fracture Pneumothorax

61Diastasis of pubic symphysisFracture lines

62

Acupuncture treatment

Arouse the brain and open orifices

Boost qi and move blood

3 times per week

63

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

64

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 LtRt

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

65

Herniation of L5/S1

66

DiagnosisTCM:

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

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

67

Electrical acupunctureBloodletting: , Paste: Medical bathing

1.5g 1.0g 1.0g 0.5g 0.5g 0.3g 0.2g 0.5 g

Electrical acupuncture

Blood letting: , Paste: 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(+)25-30Tender 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

68

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

69

Electrical Acupuncture

70

Blood Letting

71

Medical Bathing

72

TCM Manipulation

73

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)

74

4

4

2 18

() ()

4 6

2

2 2 3 4 2

1 1 1 1 2

2 () 3 2 // 2 1

1 () 1 2 2

2 1 2 1

2

1 2

1

1

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

6 3 4 3 2

() ()

4 2

() ()

4 2 6

2 1 3 1 1 1 4 2 1 1 1 1 1 1 1 1 2 1

1 1

1

(1)

2 1

(2)

1 2 1

1 6

18 18

48 2003/04/09

75

33 2

55

55 11 22

44

*

55 11 11 22

1*

44 44 44 22

4 44 2 2 1 1

3 1

11

3 1

6/1

* * *

4 2 2 1 1 1 1 1

45 2004/8/18

76

The TCM Universities Collaborated with Chang Gung University

77