Current status and innovation attempt of compiling textbooks of Chinese medicine in medical colleges in China

Qing-Xian Liu, Jing-Yi Liu

1Zhejiang Rongjun Hospital (the Third Hospital Affiliated to Jiaxing University),Department of Neurology,Jiaxing,China; 2University of Sydney, Department of Media and Communications, Australia.

Abstract At present, there are two modes in the compilation of textbooks of traditional Chinese medicine, one is stuck in one's own way and the other is to copy Western medicine completely.The reason is that the textbooks of traditional Chinese medicine colleges and universities are reduced into a hodger with no purpose, or the other is to cater to Western medicine system and give up the academic system of traditional Chinese medicine and lose the essence of traditional Chinese medicine.Through the "diagnosis and treatment strategy" and "knowledge link" of the new Chinese medicine textbooks, the author tries to make a breakthrough in the compilation, and puts forward the compilation ideas of rectifying the position of Chinese medicine textbooks, starting from the learning thinking of Western medicine students, and reflecting the characteristics of Chinese medicine and modern research results.

Keywords: Chinese medicine; teaching materials; compilation; innovation

Introduction

I have participated in the compilation of the National Medical College Undergraduate Planning Textbook"Traditional Chinese Medicine" (2013 edition) by the People's Military Medical Press.After 7 years of clinical teaching, this textbook has been well received by teachers and students.Based on the feedback on the understanding of Chinese medicine textbooks,clinical teaching and students’ usual learning, I will now talk about some of my views on the general problems existing in the textbooks of Chinese medicine in Western hospital schools and the current round of reform ideas.

1.Current shortcomings in TCM teaching materials

The content of the current textbook "Chinese Medicine" is basically compiled according to the basic theories of Chinese medicine, Chinese herbal medicine,prescriptions, clinical subjects, and acupuncture.The content is roughly equivalent to the textbooks "Basic Chinese Medicine" and "Chinese Medicine".Coediting and streamlining of multiple courses such as Diagnostics, Chinese Materia Medica, Prescriptions,various clinical subjects and acupuncture.The specific performance is:

1) Poor relevance and disorder in the arrangement of teaching materials.Sometimes some academic concepts will be discussed in later chapters, but the concept has already existed in the previous articles.As a result, readers will encounter confusion and difficulty in understanding.If the essence of "qi" has not been mentioned, the previous article has already appeared in the previous article to explain the heart function, the lung governs the qi of the whole body, and the liver governs the smoothing of the qi.The content layout is repetitive and tedious, such as discussing the pathology of yin and yang.In the chapters of yin and yang theory, pathogenesis, and syndrome differentiation,repeated detailed explanations are time-consuming and labor-intensive [1].When explaining the efficacy of Chinese medicine, it is written based on several diseases that the Chinese medicine can treat, but the actual clinical thinking is that a certain disease and a certain syndrome need to be treated with a certain type of Chinese medicine.This teaching method of reverse thinking makes no It is difficult for medical students with clinical experience to understand, let alone go to school to apply it.

2) Some academic content lacking clinical value,some textbooks are expounded in considerable length,such as Qihengzhifu, Zongqi, etc.; some expressions that have been recognized as false by the academic world are still rumored, such as qi is a substance and It is a function, and the relationship between material function is yin and yang.This misleads students.On the contrary, the textbooks have turned a blind eye to the widely used and clinically valuable content, such as nourishing the kidney and producing essence to produce blood and nourishing blood, and the treatment of blood system diseases is quite instructive.Sticking to the concept of "essence producing blood" and refusing to discuss the above-mentioned meaningful clinical effects and theories in the chapter on syndrome differentiation and treatment, these are contrary to the original intention of medical students to learn Chinese medicine [2].

3) Modern scientific and technological research.The rapid development of Chinese medicine and the integration of Chinese and Western medicine has achieved many world-renowned achievements.For example, arsenic (arsenic trioxide) in the treatment of leukemia and artemisinin in the treatment of malaria have achieved world-recognized achievements, but the textbooks are not mentioned.And there are many more mature achievements, such as kidney research,blood circulation and blood stasis, Chinese medicine pharmacology, acute abdomen treatment, which are lacking in the textbooks, but the "reference materials"attached to the drug are some related pharmacological knowledge about weight loss , But it is divorced from reality and remains unchanged for decades, making it impossible for students to use modern scientific knowledge to absorb and understand Chinese medicine knowledge.

4) Chinese medicine is a clinical subject with strong practicality, which is specifically manifested in the application of Chinese medicine and prescription treatment methods.However, some of the current textbooks are too much stuck on knowledge of Yin and Yang, the five elements, viscera, etiology, pathogenesis,diagnosis methods, syndrome differentiation, etc.These"esoteric" basic theories that medical students cannot fully understand are only considered when it comes to the principles and methods of treatment.A bit of clinical practice knowledge, but half of the teaching time has passed; when it comes to Chinese herbal medicine, most of the time has passed, and the clinical content cannot be deepened.The textbooks of Chinese medicine have become simple theoretical courses of Chinese medicine, and most of the time is about the basic theories of Chinese medicine.However, the students are really interested in how Chinese medicine treats diseases, but the clinical content becomes insignificant.The result is that students have no interest in learning Chinese medicine and the teaching effect is poor.To a certain extent, medical school students lack interest in Chinese medicine, and textbooks must bear certain responsibilities [3].

2.Some thoughts on the creative compilation of teaching materials

1) Teaching materials are responsible for the task of cultivating medical students' sense of identity and interest in Chinese medicine

Some medical students are very interested in Chinese medicine and are highly motivated to learn, and some students are not very interested in Chinese medicine.These students reflect "Chinese medicine theory is profound and knowledge is abstract".Since learning Chinese medicine requires excellent knowledge of ancient culture, and medical students belong to science students, modern science has taught them logical thinking ability, but Chinese medicine may require more image thinking, which restricts students' interest in learning Chinese medicine and their ability to understand [4] .In order to enable medical students to better learn Chinese medicine knowledge and diagnosis and treatment techniques, and to better serve the grassroots patients in the future, it is necessary to select each chapter of Chinese medicine in accordance with the training plans and goals, service targets, and service content of each specialty.Set as compulsory and selfstudy two parts.For example, clinical medicine majors can include Yin and Yang, Five Elements, Zangxiang,etiology, diagnosis, treatment, syndrome differentiation,prescriptions, and acupuncture as key content, and they can be classified as compulsory courses; other content such as prevention can be arranged as selfstudy content.Clinical medicine majors need to master the diagnosis and treatment methods and techniques of Chinese medicine, and gradually establish the concept of dominant Chinese medicine diseases in the process of diagnosis and treatment of diseases, which is beneficial to promote the development of Chinese medicine clinical and integrated Chinese and Western medicine.

2) Taking the thinking characteristics of students in medical colleges as the starting point, the position of teaching materials of traditional Chinese medicine should be straighted out

There is a big difference between the knowledge structure and thinking mode of medical college students and TCM college students.The modern medical system is in the same line with their inherent high school science knowledge, so that they fully follow the more rigorous logical thinking mode of modern science and technology, and they are also accustomed to the absorption and application of knowledge.In this way,although they have also been trained in ancient Chinese cultural knowledge at the high school level, they have a certain ancient cultural foundation, but it is similar to the traditional Chinese medicine college students who are immersed in Chinese medicine and ancient humanistic atmosphere, and have good historical and cultural knowledge.By comparison, the sense of identity with knowledge of Chinese medicine is obviously vastly different.Therefore, Chinese medicine textbooks in medical universities must master this feature and provide them with a concept.There is a medical system outside the Western medicine system.Some Western medicines cannot diagnose or treat.Diseases with poor results can be diagnosed and treated by another medical method.Accepting this knowledge education of the Chinese medical system can provide them with a rational understanding of different medical methods.The original intention of this set of teaching materials has been achieved.If technical support is provided for them to adopt this kind of Chinese medicine treatment, it will make a positive contribution to the research and promotion of Chinese medicine in many disciplines.

3) The compilation of textbooks should suit the characteristics of medical students' learning ability and understanding thinking

In order to make the students of Western Medical University understand the overall concept of traditional Chinese medicine and the spirit of syndrome differentiation and treatment, preliminarily master the basic theory of traditional Chinese medicine and the skills of diagnosis and treatment of common diseases, and use acupuncture and moxibustion therapy to lay the foundation for the work of combining traditional Chinese medicine with western medicine,it is necessary to design and teach the current course of traditional Chinese medicine according to the teaching objectives, overall curriculum and students'characteristics of Western Medical University We should carry out appropriate reform and innovation in the content.

For the new results of the theoretical research of Chinese medicine, we adopt the multi-level perspective of syndrome differentiation to organize the basic theories.We must have a clear hierarchy, a rigorous structure, and a reasonable layout to avoid the logical confusion of the previous textbooks.We must highly inductively analyze the essence of the five elements of Yin and Yang.Deficiency of Yin and Yang is the general outline of syndrome differentiation.qi, blood and body fluid treatment is not only the concretization of the general outline, but also has a common meaning for the differentiation of the viscera.This is the second level; the syndrome of the viscera and the six evils Symptom treatment is the central link and specific content of syndrome differentiation and treatment.It progresses gradually and constitutes a complete syndrome differentiation and treatment system.

TCM textbooks need to continuously absorb modern scientific and technological achievements and delete and modify outdated academic content.Combining clinical practice, select the current research results of traditional Chinese medicine and integrated traditional Chinese and western medicine, such as "syndrome"research, clinical pharmacology research, etc.[5];teaching materials should use strict logic to eliminate the duplication of previous teaching materials and the confusion of concepts.Basically eliminate or reduce the duplication of content knowledge.To make clear the confusion in the order of the long-existing academic concepts, those that are not clearly explained but used first, cannot be clearly explained but are applied should be basically eliminated, so that The entire teaching material system is more compact and lean, the main themes are more prominent, and the teaching hours of basic theories are shortened.

Legislation with "symbols", "syndrome" drugs,prescription drugs, and disease syndromes are directly linked to prescription drugs, so that the teaching material system and teaching content conform to the path of clinical thinking, suitable for learning and application, making students easy to accept, understand and easy use.And strengthen practicability, integrate theory with practice.For example, using kidneytonifying drugs to treat blood diseases, although it lacks the support of ancient Chinese medicine theory,clinical practice has created obvious curative effects.For this reason, the textbook adds the physiological and pathological content of "Essence and Blood" in the chapter of "Zang Fu" based on clinical practice.

4) Reform of teaching methods and teaching time

This textbook uses each chapter divided into two parts: compulsory and self-study.Because Chinese medicine is a highly practical technical subject, adding case-based teaching can not only strengthen and urge teachers to complete classroom teaching content and teaching goals, but also allow students Within the class hours, to maximize the understanding of the basic theoretical knowledge of Chinese medicine and the mastery of diagnosis and treatment skills in classroom teaching, this is not only the purpose of implementing the teaching of Chinese medicine in medical universities, but also the key content of the reform of Chinese medicine teaching in medical universities.

Although the publication and compilation of teaching materials are different in time, the main body of learning should not be divided into the former and the latter.The teaching materials should be closely around the basic theory and skills of traditional Chinese medicine, highlighting the clinical application.According to the educational system and category,we should strictly define the teaching objectives of traditional Chinese medicine, determine which basic knowledge and skills of traditional Chinese medicine should be mastered, and form a unified textbook content, so that teachers can unify the content and grasp the objectives in specific teaching.Secondly,we should reasonably determine the chapters and contents of the teaching materials according to the class hours required by the syllabus and the class hours of traditional Chinese medicine courses in medical colleges, so as to form a close connection between the teaching materials and teaching and achieve the unity of teaching and learning.Otherwise, teaching materials can only become books in a certain sense, and can not really play its guiding role in teaching [6].

3.A breakthrough attempt in compiling textbooks of traditional Chinese Medicine

It has always been difficult to make innovations and breakthroughs in the compilation of Chinese medicine textbooks, which has a certain relationship with the nature of the discipline of Chinese medicine.Comparatively speaking, the traditional Chinese medicine community advocates antiquity and believes that the more "classic" the more "authoritative", so far, all the Chinese medical literature is based on"ancient", otherwise the foundation is not deep and the authority and reliability are questioned.Looking at the textbooks of Chinese medicine, everyone has been trying to innovate in recent years, but most of them are old wine in new bottles, which is not much different from the textbooks 20 or even 50 years ago.Even when searching for references for the compilation of this textbook, The need to look for books from thirty years ago made our authors feel very frustrated and sad for Chinese medicine.Therefore, the compilation of this textbook is an attempt to break through the above dilemma, and at least some improvement and innovation under the condition of following the traditional Chinese medicine system.This is mainly manifested in two aspects.

1) "Diagnosis and treatment strategy" highlights the characteristics and advantages of traditional Chinese medicine, and provides clear guidance for treatment selection

This TCM textbook has specially designed a section of "Diagnosis and Treatment Strategies", which is completely different from previous TCM textbooks.It is based on the following consideration: the traditional Chinese medicine textbooks used by medical universities in the past are often compressed versions or simplified versions of several courses in universities of Chinese medicine.When western medicine students study, they feel confused and at a loss.Even though the students of the University of Chinese Medicine have studied Chinese medicine for five years, they still don’t know how to conduct diagnosis and treatment when they encounter patients in the clinic, not to mention the learning effect of the students of western medicine, so they simply abandon it and lose the course.The purpose of this textbook, based on decades of development of traditional Chinese medicine and integration of traditional Chinese and Western medicine, to screen the dominant diseases or treatment methods of traditional Chinese medicine in clinical medicine, or to guide the thinking of Chinese medicine diagnosis and treatment,and to facilitate the choice of Chinese medicine in clinical treatment.

For example, for chronic obstructive pulmonary disease(COPD), winter disease and summer treatment and acupoint application therapy are adopted.Traditional Chinese medicine has been developed for decades and has achieved satisfactory results.It has also been recognized by modern medicine.The number of patients who participate in winter disease and summer treatment each year Millions, but this achievement is often ignored in previous textbooks and is not reflected in the chapters.This textbook elaborates on this relatively mature treatment method in the diagnosis and treatment strategy.At the same time, it explains the immunomodulatory mechanism of the study of winter disease and summer treatment: "Winter disease and summer treatment can enhance the body's non-specific immunity and significantly reduce blood addiction.The number of acidic granulocytes can significantly increase the level of cortisol, regulate the function of immune proteins, reduce the response of β receptors,and improve the immune status of the body.Acupoint patching also stimulates the absorption and metabolism of acupoints and the absorption and metabolism of drugs and related physical effects on the lungs.,Chemoreceptors have an impact, directly and indirectly adjust the autonomic nervous system function of the cerebral cortex, improve the body's responsiveness, and enhance disease resistance." It enables medical students to understand from the perspective of modern medicine that winter disease and summer treatment can reduce symptoms or delay disease deterioration.Have a solid theoretical foundation.The interest and trust in Chinese medicine is based on tangible clinical facts and modern technology.

2) The subsection "Knowledge Connection" is an extension of the breadth of TCM knowledge and a realistic basis for the modernization of TCM

"Knowledge connection" is another feature of this textbook.Its foothold is to adapt to the modern scientific thinking of medical college students, and to learn a lot of outstanding achievements made by using modern medicine or modern scientific and technological methods to study Chinese medicine.It is short, concise and simple.The easy-to-understand language demonstrates the solid scientific foundation of Chinese medicine for college students, deepens and improves their understanding of Chinese medicine, and can overlook the youthful breath of ancient Chinese medicine from the perspective of modern technology.

①Actively promote and disseminate new technologies and developments in the development of Chinese medicine

Acupotomy medicine has emerged in the folks in the past two decades.It is a traditional Chinese medical method that has entered regular hospitals.It is easy to operate, clear curative effect, and convenient to promote.It is welcomed by both doctors and patients.The knowledge connection part details the method of acupotomy medicine on lumbar disc herniation.Acupotomy therapy is divided into two types:extraspinal and intraspinal lysis.For patients with low back and leg pain, the nerve roots and surrounding tissues are deformed by the adhesion of the nerve roots and the surrounding tissues.The needle knife directly touches the sheath of the nerve root to change the relative position of the nerve root and the herniated disc, so that the adhesion can be loosened by itself.This textbook analyzes the mechanism of the effect of needle knife medicine: 1.The needle knife penetrates into the spinal canal and touches the nerve root sheath.It is to adjust the body's own defense and self-repair mechanism.The position of the nerve root changes relative to the surrounding The adhesion of the tissue is loosened or partially loosened.2.Acupotomy activates the endogenous analgesic system when performing surgery in the spinal canal, and acts through the diffuse injury-inhibiting control system to reduce the tissue's ability to distinguish pain, increase the pain threshold in various areas of the body, and improve pain tolerance ability.3.The needle-knife mechanical touch stimulation directly acts on the spinal canal, and the generated mechanical heat directly reaches the disease site, capillary expansion, increased metabolism,and gradually reduced or eliminated nerve root edema or sterile inflammation.The significance of the promotion of acupotomy medicine in the treatment of intervertebral disc herniation lies in the fact that acupotomy spinal nerve stimulation has changed the current mode of treatment for herniated disc lesions in various surgical therapies for lumbar disc herniation.The promotion of low-cost, effective, easy-to-learn,conforms to the spirit of medical reform, and provides in-depth development space for the development of Chinese medicine.

②Actively disseminate the theoretical achievements made in the research on the development of Chinese medicine itself

The National Stroke Collaboration Group led by Academician Wang Yongyan, after more than ten years of research, has put forward a new theory of stroke theory in Chinese medicine—the theory of stroke toxins [8].This is the biggest achievement made by the Chinese medical profession in the past 20 years.No previous textbooks have involved or mentioned it.

Acute cerebrovascular disease part in "knowledge connection", this textbook succinctly elaborated on such a theory: "Dysfunction of viscera and qi and blood in a disease state prevents the physiological or pathological products in the body from being discharged in time and accumulates too much in the body.Such as wind, fire, phlegm and blood stasis, etc.,are all poisonous evils, and stagnation of poisonous evils and blood stasis, pattern of disharmony between nutrien and defense, the endogenous fire toxin, which in turn damages the meridian, and the brain and mental damage, these are the pathological mechanisms that make it difficult to heal from stroke."

In addition, the modern pathological basis of the new theory of stroke is introduced: "During the occurrence of stroke, brain nerve cells arechemia and hypoxia caused a variety of reactions, free radicals metabolize toxic substances and glutamate toxicity and other damage to microvascular endothelial cells and nerve cells."

Under the guidance of this theory, based on the old medicine Angong Niuhuang Wan, etc., new medicines such as Xingnaojing and Qingkailing have been developed, making heat-clearing and detoxifying therapy a new treatment method for acute cerebral infarction.The textbook also systematically reveals The new use of these old drugs contains new modern connotations: "effectively prevent or inhibit cerebral ischemia leading to neuronal apoptosis, reduce the damage to the functional connection of the cerebral ischemic area, have a good neuroprotective effect,and even induce neurons The synthesis of growthrelated proteins promotes the regeneration of neurites and achieves good neuronal plasticity changes in the injured brain area and the associated brain area."

At the same time, from the perspective of integrated traditional Chinese and western medicine, we pay attention to the acute cerebral edema stage of stroke,emphasizing that "patients with liver and kidney yin deficiency and liver wind internal movement should be cautious in the use of drugs for nourishing yin and promoting fluid in the early stage of stroke.Within one week of onset is a critical period for cerebral edema.Modern medicine Conventional dehydration therapy is used for treatment.At this time, it is also the stage when body fluid turns into pathological phlegm.The treatment is nourishing yin and generating fluid, and evidence of aggravation of cerebral edema will appear in clinical imaging.At this time, it is enrich water to moisten wood, and cerebral edema dehydration when treating, you need to pay attention to weighing the pros and cons" [9].

The latest research results of stroke "toxicity damage brain collaterals" are based on modern pathophysiological theory, combined with the theories of phlegm, heat, wind, fire, and blood stasis in previous dynasties, to make students realize that the new theory of stroke is in line with modern technology development standards.Innovate boldly on the basis of inheritance.The breakthrough development of the theory of the etiology and pathogenesis of stroke has played a guiding role in guiding and encouraging students who are interested in the career of integrating Chinese and Western medicine in the future.

The "knowledge connection" part also introduces more modern pharmacological research of Chinese medicine, which has a guiding effect on understanding Chinese medicine and digging out Chinese medicine.

In short, through studying Chinese medicine courses,medical students have a preliminary grasp of Chinese medicine knowledge, can use Chinese medicine methods to treat some common diseases, and at the same time establish the concept of two medical systems and dominant diseases, cultivate reserve talents for the integration of Chinese and Western medicine, and promote The development of integrated Chinese and Western medicine.