Liu Zili Li Ming Yunnan University of Traditional Chinese MedicineKunMing city,YunNan Province,P.R.China 650011.Combined with the traditional Chinese medicine rush throughout the world, as the earliest university in Yunnan which has carried out specialized overseas education, Yunnan university of Traditional Chinese Medicine has made great efforts to extend the influence of traditional Chinese medicine in Europe and Asia, and set up diploma education and non-diploma education of traditional Chinese medicine which directly meet the people of different professions, ages, cultures and backgrounds.As one of the supervisors and participants of these activities, we’d like to communicate with you all on the achievements and experience of the foreign cooperation.1. Europe1.1. Diploma Education :In November, 1990, our university signed a ten-year cooperation agreement with The National Physician Association of catalona, Spain, and the cooperation project was called "Catalonian --Yunnan " College of Traditional Chinese Medicine. In the Third Session of China-Spain Mixed Commission of Scientific and Technical Cooperation, Catalonian --Yunnan college of Traditional Chinese Medicine was formally established as the cooperation project between the two nations, and both of the two countries confirmed that this college would become a professional and formal Chinese medicine school. The five majors set up in this college are traditional Chinese medicine, traditional Chinese pharmacy, science of acupuncture, massage therapy and Qigong of health care.In July, 1995, Catalonian --Yunnan college of Traditional Chinese Medicine incorporated with Spain Institution of Chinese Traditional Medicine, and its original board of directors was renamed as "European Traditional Chinese Medicine Foundation ". Catalonian --Yunnan college of Traditional Chinese Medicine is in charge of the two-year teaching work of traditional Chinese medicine in that school. And our university has made detailed teaching program for it, compiling text books for both acupuncture and massage therapy majors, and translating them into Spanish. By 2002, our university has sent out twelve teachers who can spoke Spanish to give instruction in Madrid, Barcelona and ānbōsītǎ etc. They have not only taught there, but also instructed clinical works. Thousands of patients had been made a diagnosis and given treatment there. From the school"s opening on Nov. 8th, 1994 to 2000, Catalonian --Yunnan college of Traditional Chinese Medicine had cultivated hundreds of talented people who had got normal academic qualifications majored in traditional Chinese medicine in Spain and Europe.1.2. Non-diploma EducationIn order to improve the European practitioners’ skills, Yunnan university of Traditional Chinese Medicine has sent eleven professors to Spain successively to hold European short term training courses (24 terms) since Nov. 2003, teaching advanced practical skills of traditional Chinese medicine, which has brought up 700 people. And the college has sent five experts to France to hold Chinese traditional health care and health preserving training course, which has brought up over 500 people.1.3. Knowledge and RealizationAs one of the professors in Yunnan university of Traditional Chinese Medicine who were firstly sent to Spain to hold training courses, we have got an overview about the cooperation of European traditional chinese medicine.1.3.1. The education of traditional Chinese medicine has gradually entered into main medical regions in Europe and America.a)、Sixty percent of American medical colleges have set up alternative medicine courses concerning traditional Chinese medicine, such as Harvard, Yale, Stanford and Cornell.. In 1996, American National Institutes of Health established post doctorate of alternative medicine and continuing education program of traditional Chinese medicine.b)、Britain"s Middle -Sex University has cooperated with Beijing University of Traditional Chinese Medicine to start undergraduate education jointly, which is a five-year program. The courses they studied are basically the same with those of Beijing University of Traditional Chinese Medicine.c)、Australia: There are five regular universities now offering traditional Chinese medicine education: Melbourne Institute of Technology, Sydney University of Science and Technology, Victoria University of Science and Technology, University of Sydney and University of Western Sydney. Among them, the profession of traditional Chinese medicine in Melbourne University is a five-year program, granting a bachelor"s degree. It"s six-year for Sydney University of Science and Technology, and a bachelor"s degree of Chinese herbal medicine and health science will be granted. In addition, there are master and doctor degree programs in another two directions.d)、Austria Li Shizhen University of Traditional Chinese Medicine: It offers three-year master"s degree programs.1.3.2. Course Designwe found during our teaching in Europe that the licensed herb doctors of different countries were in different levels because lots of private colleges of traditional Chinese medicine were established in Europe. By reason of the equipments and other limited conditions of Western private schools, combined with strict distinction of measures between Chinese and Western licensed doctors, as well as legal restrictions, most of the trainees, except that who has a background of western medicine, have a weaker foundation in Western medicine, than the Chinese graduate of same profession or major, and fall short of the clinical model which integrates TCM and western medicine. Take acupuncture doctor as an example, if he/she doesn"t have a solid foundation in acu-point topography, medical negligence even fatalities will more likely to happen during their practices. Thinking in both Chinese medicine and Western medicine ways is necessary for the practitioner of traditional Chinese medicine. In this way, they can take the advantages of traditional Chinese medicine legitimately, make a right diagnose and further more avoid medical negligence or accident. For example, in the therapy of tumor, it"s necessary to combine traditional Chinese and Western medicine. Take another example of the extrauterine pregnancy, someone would mistakenly diagnose it as the indication of acupuncture, which will causes medical lawsuit. China"s higher educational system of traditional Chinese medicine has established in 1956, which has a history of over 50 years. Curriculum mainly compose of 3 parts: a、traditional Chinese medicine; b、modern medical basic courses c、other relevant common curriculums.. The fifty-year facts has proved that this kind of human resources training model is basically correct and successful.. This model has been borrowed by the traditional Chinese medicine departments of Britain"s Middle -Sex University, Australia"s Royal Melbourne Institute of Technology, Hong Kong Baptist University, Hong Kong University and Nanyang Technological University. The ratio of TCM courses to Modern medicine courses is 7:3, revealing that it"s necessary for traditional medicine experts to be trained by regular institutions of higher education.2. Asia:2.1. Indonesia: On March 21, 2007, Yunnan TCM university and Indonesian Health Healthy Institute altogether constructs the " Yunnan east Javan Traditional Chinese medicine college ". Will jointly sponsor the Chinese medicine school record education project official start in Indonesia, will set up the Chinese medicine, the acupuncture massages two specialized undergraduate course school record education2.2. . Thailand 2.2.1. Chinese Language TeachingThe higher institutions of traditional Chinese medicine uphold Chinese traditional essences of language, culture and medicine. Its special features decide that its teachers and students all should have a high-level knowledge of Chinese language and culture. Therefore, those institutions have the strength and potential to teach Chinese as a foreign language. Our university has carried out seven activities along with Thailand Prince of Songkla University on the theme of jointly Chinese language teaching. In that context, 474 Thailand students came to our university to learn Chinese Language .2.2.2. Medical treatment cooperation :2.2.2.1.Dr.Panya General Hospital program in Bangkok:2.3.2.4.From April, 2000 to August, 2003, our university had sent four teacher- doctors to Dr. PanYa General Hospital of Bangkok, Thailand to prepare to build traditional Chinese acupuncture department. The writer participated in its establishment and operation in about three years. That department had run successfully, and been withdrawn from Thailand in 2003 owning to the policies of its health ministry.2.2.2.2. Yunnan Chinese medicine university – Qing Lai Rajabhat University north acupuncture and moxibustion training center project:This project started in November, 2006, YunNan TCM university sends out the expert to go to this center to carry on teaching, traning North of Thailand local traditional medicine practioners, the modern medicine GP and the amateur ,for 3 months to a year located in junior middle high-level acupuncture and moxibustion practical skill training course., the student later period go to the Yunnan Chinese medicine university affiliated hospital carry out clinical practice, this project has brought into the Thai health Ministry national acupuncture and moxibustion training system.2.2..3.Collaboration with Ubon Rathathani Rajabhat University: The union project will cultvate the high-level talents which understand both the TCM and traditional Thai medicine .2.2.4..Experience and RealizationOn July 1st, 2000, Thailand government declared that traditional Chinese medicine had been legislated as a legal profession. Owning to Thai people"s culture and their blood ties with Chinese people, there are a great number of ethnic Chinese in Thailand. (1/4). Chinese medicine has a good basis of the broad masses of the people in Thailand. Up to now, 217 people have passed the exam held by Thailand Health ministry, and were granted practical license as Chinese medicine practitioners. But the problems are as follows:1) Traditional Chinese medicine doesn"t have a high status: Compared with TCM doctors in China, those doctors there are inferior.. Western medicine ranks first, and traditional Thai medicine (Thai nationality doctor) is the second, while traditional Chinese medicine is in the third position.2) The practitioners of traditional Chinese medicine are of different levels: Up to now, Mahidol University and Huachiew Chalermprakiet University have set up five-year Chinese medicine bachelor degree program, and the professionals trained by regular universities will be the hope of Chinese medicine in Thailand.3) Traditional Chinese medicine has been excluded by Western medicine: The reason, firstly, is that private Chinese medicine practitioners have no complete knowledge system of Chinese and Western medicines. On the other hand, the contest of patient leads to this result.4) Traditional Chinese medicine falls short of clinical base: Except for huaqiao TCM hospitals, there has no enough influential traditional Chinese medicine teaching hospital.3. Diploma- Education and Non-diploma Education of oversea Students in YunNan TCM university.3.1 Diploma EducationUp to now, Yunnan university of Traditional Chinese Medicine has enrolled 120 students majored in traditional Chinese medicine who respectively come from 14 countries, Hong Kong and Taiwan. Among them, there are 13 postgraduate students, 90undergraduates, 13 former undergraduates and 9 former master-degree students.3.2 Non-diploma Education.Our university has accepted altogether 780 traditional Chinese medicine major students, practitioners and amateurs came from more than ten countries and regions to receive various short-term and long-term non-curricula advanced studies, clinical practices and special trainings.3.3 Realization and Assumption3.3.1 The Necessity to Set Up Preparatory Classes of Traditional Chinese MedicineTraditional Chinese medicine is based on Chinese culture and knowledge, and its specialty decides that international students must have a good Chinese capacity. As for western students, it"s comparatively difficult for them to understand traditional Chinese medicine owning to the difference of cultural background. If they throw away the cultural foundation for quick success and instant benefit, and learn it only from the technological aspect, the consequence will range from the weakening of technology to the departure of academic system. The preparatory classes of traditional Chinese medicine should enroll the students who have a HSK 4-5 Chinese language level, and should be one year in duration. The meaning of it lies in:1) Before going to study undergraduate courses, a solid foundation should be laid, and one of Chinese cultural courses--Chinese cultural history of philosophy should be learned.2) To set up the access to traditional Chinese medicine: Relevant courses include: Chinese medical history, basic theory of traditional Chinese medicine.3) To make a good preparation for ancient Chinese medical language: Ancient Chinese Language and Culture should be learned.3.3.2 To establish priorities based on credit system: According to the situation of different countries, particular stress should be laid on some subjects, such as acupuncture, traditional Chinese medicine.General practioner of TCM major etc.3.3.3 To adopt tutorial system and Specialist system in practice: During the fifth year’s internship, the trainees should have been appointed with tutor and comparatively oriented major, such as department of dermatology, tumor department and so on. . And special subject and disease should be focused on, so as to provide specialized training on certain diseases.3.3.4 To improve construction of clinical base: Although the prior education is carried out abroad, it often falls short of clinical practice. In that context, the construction of clinical base should be strengthened, and much attention should be paid to specialized subject and disease, so as to reflect the feature of traditional Chinese medicine.-----Above Script come from “The 2nd International Conference Multidisciplinary Research and Practice on Human Development ” 2-3 July 2008 Organized by Ubon Ratchathani Rajabhat University,Thailand
中医药国际教育合作经验与探讨International TCM Educational Cooperation Experience And Discussion 刘自力1 李铭2 ( 云南中医学院临床医学院, 云南中医学院对外合作交流中心,云南昆明白塔路6号 老校区, 650011)liu zi-li Li-ming (YunNan TCM University,6#Baita Rd,KunMing 650011)结合世界范围内的中医热,作为云南省最早在境外开展专业对外教育的高校,云南中医学院在欧洲、亚洲努力扩大中医药的影响,开办针对不同职业、年龄、文化、背景的中医药学历和非学历教育。作为这些活动的管理者和参与者之一,兹将主要对外教育合作的成就与经验、体会与设想分述如下。一、欧洲部分(一)学历教育1990年11月,我院与西班牙塔拉戈那国家医师联合会签订了“加泰罗尼亚——云南”中医学院为期十年的合作协议,经中国和西班牙两国科技合作混合委员会第三次会议,正式确定加泰罗尼亚——云南中医学院为我国与西班牙两国政府间合作项目,中西双方确定该学院将办成一所具有中医学、中药学、针灸学、推拿学及中医保健气功学等五个专业的正规中医学校。1995年7月,加泰罗尼亚——云南中医学院与西班牙中国传统医学高等学校合并,原加泰罗尼亚——云南中医学院董事会改名“欧洲中医基金会”。加泰罗尼亚——云南中医学院负责该校西学中班二年制教学工作,我院为该校制定了详细的教学计划,编写了针灸、推拿两个专业的教材,并翻译成西班牙语教材,至2002年学院派出懂西班牙语教师12人次分别在马德里、巴塞罗那、安波斯达等教学点授课,讲学并指导临床工作,诊治各类患者数以千计次。自1994年11月8日正式开学至2000年,加泰罗尼亚——云南中医学院已培养西班牙及欧洲中医药正规学历人才数百人。(二)非学历教育为提高欧洲传统医学从业者的业务水平,云南中医学院从2003年11月至今先后派出11名教授赴西班牙举办中医高级实用技能欧洲短期培训班24期,培训人员700余名,派出专家5人次赴法国举办中国传统保健养生功法培训班,共培训人员达500余人次。(三)认识和体会笔者之一作为云南中医学院第一个派赴西班牙举办培训班的主讲教授,对欧洲传统医学合作情况有一定认识形成一定看法:1、中医药教育已逐渐进入欧美主流医学领域。(a)、美国60%的医学院开设替代医学课程,内容涉及中医,包括哈佛、耶鲁、斯坦福、康乃尔等名校。1996年,美国国立卫生院设立了补充替代医学博士后项目,此外,还有传统中医学的继续教育项目。(b)、英国的Middle-sex大学与北京中医药大学合办本科教育,学制5年,学习的课程基本上和北京中医药大学课程相同。(c)、澳洲:目前共有5所正规大学提供中医教育:墨尔本理工学院、悉尼科技大学、维多利亚科技大学、悉尼大学和西悉尼大学,其中墨尔本大学的中医专业学制为5年,授学士学位,悉尼科技大学学制6年,授中草药卫生科学学士学位,此外,还有2个方向的中医硕士和博士培养课程。(d)、奥地利李时珍中医药大学:提供三年制硕士学位课程。2、课程设置问题笔者在欧洲讲学中发现,由于欧洲私立中医学院很多,各国执业中医师水准不一,缘由西方私立大学的设备和条件限制加之中西医执业使用手段的严格区分和法律限制,除少数有西医背景的学员外,大多数学员西医方面的根基较中国相同专业毕业生差,缺乏中西医病证结合诊断模式,就针灸医师而言,如果没有牢固的局部解剖及经穴解剖基础,在执业过程中难免留下医疗事故的隐患,有中西医两套思维,中医从业者对合理发挥中医所长,判断疾病的危重及预后,避免医疗事故的发生是极其必要的,如肿瘤治疗中,中西医结合必要性。急腹症,如宫外孕的判断而非针灸的适应症,以免医疗纠纷的发生。中国的高等中医教育制度建立于1956年,有50多年历程。课程设置包括:a、中医药学知识b、现代医药学知识c、其他相关公共课程。50年的事实证明,这种人才培训模式虽然不能说是十分完善的,但它基本上是正确的、成功的。英国的Middle-sex大学、澳大利亚的皇家墨尔本理工大学、香港浸会大学、港大、新加坡南洋理工大学的中医专业都借鉴这个模式,中西课程的比例大致为7:3,启示了传统医学人才正规军由高等学府培养的必要性。二、亚洲部分:(一)印尼:2007年3月21日,中国云南中医学院与印尼卫生健康学院共建“云南东爪哇中医学院”,在印尼联合举办中医药学历教育项目正式启动,将开办中医针推专业本科(二)泰国:(1)泰国宋卡王子大学汉语教学项目高等中医药院校秉承了中国传统语言、文化和医药等知识精粹,其专业特点决定了中医药院校教师及学生的汉语水平和文化知识的掌握比较高,中医药院校具有对外汉语教学的实力和潜力,我院与泰国宋卡王子大学开展了联合汉语教学项目七届,共有474名泰国学生到我院学习中文。(2)潘雅医院医疗教育合作项目2000年4月——2003年8月,我院先后派出4名教师前往泰国曼谷Dr.PanYa医院讲学并筹建中医针灸部,笔者之一亲自参与中医针灸部讲学及其前后三年余的筹建和运转过程,该部运作非常成功,由于泰国卫生部的政策问题,2003年撤出。(2)云南中医学院清莱皇家大学泰北针灸培训中心该项目2006年11 月正式启动,由我院派出专家赴该中心举办面向泰国北部地区的传统医学从业人员现代医学执业者及爱好者为期3个月至一年的初中高级针灸实用技能培训班,受训人员后期到云南中医学院附属医院临床实习,该项目已纳入泰国卫生部全国针灸人才培训体系中。(三)经验和体会2000年7月1日,泰国政府宣布中医合法化,缘于泰国人民的文化及血缘与中国的联系,泰国众多的华裔人口( 1/3 ),中医药在泰国有广大的群众基础,到目前为止有217人通过泰卫部考试获得中医师行医执业证书,但泰国问题如下:1、中医地位不高:中医师地位与中国相比还不高,西医第一,泰古医(泰民族医)第二,中医师第三。泰古医可独立开设诊所,中医师只能在综合医院设立传统医学部或与泰医合作,不能独立开设诊所。2、中医从业人员层次参差不齐:目前为止,玛希朵大学及华侨崇圣大学已开办了5年制中医专业,正规大学中医专业人才的培养为泰国中医的希望。3、西医排斥中医:由于民间中医师缺乏中西两套知识系统遭西医歧视,原因之二为中西医师相互间的病源争夺。4、中医临床基地缺乏:除华侨中医院外,尚缺乏具有影响力的中医教学医院。三、国内留学生学历及非学历教学(一)学历教育至目前为止,云南中医学院已招收14个国家和香港特别行政区、台湾省的120余名中医药专业学历教育生,其中硕士研究生13人,本科90余人,已毕业于本科生13人,硕士生8人。(二)、非学历教育已接收10多个国家和地区的中医药专业学生、从业人员及爱好者780余人到学院进行多种形式的非学历长短期进修学习、临床实习和专项培训。(三)、体会及设想1、中医预科班设立的必要性中医建立在中国文化知识载体之上,中医的专业性决定了留学生必须有较好的中文能力,对西方学生来说,由于文化背景的差异,理解中医相对困难,如果丢掉文化根基急功近利,单纯从技术层面教授中医,轻则造成技术层面的浅化,重则偏离学术体系,中医预科班宜招收汉语水平为HSK4-5级的学员,学制为一年,其意义在于:(1)入本科前,需打下扎实汉语基础,体验中国文化课程之一为中国文化哲学史。(2)奠定了解中医的窗户:相应课程包含中国医学史、中医基础。(3)打好古汉语基础:古代汉语。2、学分制基础上相对分科:根据所在国家不同偏重于针灸、中药、中医全科。3、实习采用导师制、专科制:第五年毕业实习时指定导师,相对定向专科,如皮肤科、肿瘤科等。加重专科专病实习时间,使学生在某一疾病上有专科培养。4、完善临床基地建设:虽然前期教育在国外,但往往缺乏临床实践,加强附属医院对外教育临床基地建设,重点培植重点专科专病项目,体现中医特色。----原载于中医教育杂志--2008,27:132
贝尔氏麻痹(Bell Palsy,BP)是因茎乳孔内急性非化脓性面神经炎引起的周围性面神经麻痹,该病系临床常见病多发病,我国患病率为427.7/10万人口[1],其确切病因未明,长期以来认为本病与嗜神经病毒,特别是单纯疱疹病毒感染有关,受凉或上呼吸道感染后发病。可能是茎乳孔内的面神经急性病毒感染和水肿所致面神经受压或局部血液循环障碍,而产生面瘫,BP病理主要是面神经水肿,髓鞘肿胀、脱失,晚期可有不同程度的轴突变性,以在茎乳孔和面神经管内的部分尤为显著[2]。作为常见病、多发病,目前现代医学对BP还没有特异性的有效疗法,现代医学治疗贝尔氏麻痹主要采用药物和手术,如类固醇皮质激素治疗(强的松等)维生素治疗(vitb1、vitb12、甲钴铵片等)、神经营养药治疗(神经生长因子,神经节苷脂)、血管扩张剂,理疗,功能锻炼及手术治疗,在急性期(发病7-10天以内)治疗方面,由于肾上腺皮质激素具有抑制炎症反应,减轻面神经局部水肿等功能,故BP急性期采用激素治疗几乎已经成为广泛应用方法[3]。 国外有研究结果表明[4],早期使用强的松非常有利,临床恢复比阿昔络韦(ACV)好,可减少面瘫失神经损害的机会和痉挛的的后遗症,不能使用强的松的病人再考虑使用阿昔络韦,Kiniski[5]发现应用类固醇类药物治疗的完全性贝尔氏面瘫87%恢复,而进行维生素和扩血管的治疗者,只有68%治愈,手术疗效至今尚难肯定,只宜在严重病例试用[1] 。 针灸治疗面瘫已有两千余年历史,其疗效是肯定的,现代医学对针灸治疗面瘫已予肯定,1998年1月1日起,美国医学会主编新的《通用医疗程序编码》已将针灸列入其中,有临床研究报道贝尔氏麻痹患者在发病10-20天的急性期没有明显好转者,行针刺治疗有85%治愈,92.3%明显好转。 各种文献报道和临床研究表明,BP的治疗关键在于急性期(发病7-10天以内),急性期面神经发生水肿、髓鞘肿胀、脱失,继而轴突变性,最终产生不可逆的病理损害,急性期能否针对性治疗,及早消除面神经水肿压迫、防止神经变性,为是否留下后遗症,尽早痊愈的关键。在急性期常规使用激素能减轻炎症水肿,但对病毒感染无特异性有效疗法, 笔者在数十年的针灸临床工作中,发现病毒感染的BP急性期患者,使用专科中药配合针灸方法能对病毒感染的BP急性期患者起到针对性的治疗作用,较以往传统疗法大大缩短了病程,提高了痊愈率,估计针刺十中药新疗法是针对BP急性期面神经炎变水肿起到抗病毒、消炎及脱面神经水肿的作用而起效的。主要参考文献(1)马英主编,面瘫防治300问,北京:中国中医药生版社1998年9月第1版P90。(2)吴江主编,神经病学,北京:人民卫生出版社,2005年8月第1版P120。(3)李瑛,针灸治疗贝尔麻痹临床多中心大样本随机对照研究,中国优秀博士硕士论文库。(4)Juan I, Maria P,maria Jetal.Idiopathic Facial Paralysis:A Randomized, Prospective,and Controlled study using single-Dose Prednisone versus Acyclovir Three Times Daily.Laryngoscope,1998,108:573-575(5)Kinishi Metal. Arch otolaryngol Head Neck Surg,1993,119:221-225