Three learning experiences of traditional Chinese medicine surgery

Surgery of traditional Chinese medicine is a clinical specialized course. Under normal circumstances, the practice of surgery of traditional Chinese medicine accounts for about one third of the whole graduation practice stage. The following are three articles that I have with me. I hope you like it!

Learning experience of surgery of traditional Chinese medicine 1 If a worker wants to be good at something, he must sharpen his tools first. The learning methods and paths of TCM are the first problems to be discussed. Many friends didn't think about this problem before studying Chinese medicine. There are various ways to start. Some of them plunged into the classics such as Treatise on Febrile Diseases, studied hard for several years and memorized a lot of classics. Clinically, they are all at a loss, so they make mistakes as soon as they open their mouths, and then doubt the classics and Chinese medicine.

Some people are obsessed with pharmacology and become traditional Chinese medicine and unilateral doctors. They regard individual Chinese medicines and prescriptions as top secret, and the more they look for them, the more curious they become. They think that unless they are magical medicines in the mountains and forests, or strange prescriptions, they can't cure diseases.

Others seek the easy way, confuse traditional Chinese medicine with qigong and religion, argue irrationally, mystify and not mention it.

I don't think these are the original intentions of my friend to study medicine.

Although I came from a family of traditional Chinese medicine, I also took many detours in medicine, and the pursuit of clinical efficacy once made me feel very hard. Looking back on the course of studying medicine for more than 20 years, my biggest feeling is that Chinese medicine was originally a simple and easy-to-learn subject, but it was covered with layers of mysterious coats intentionally or unintentionally.

In this era of pursuing efficiency everywhere, it is the most meaningful thing for me to restore the true nature of TCM, get rid of TCM superstition and save the energy and time of future generations. Only in this way can Chinese medicine attract outstanding young people and carry it forward.

Ways and means of learning-starting with a correct attitude.

Many people have said this question, each with its own reasons. I want to emphasize that the following learning methods are suitable for people who have a certain foundation and want to master the Chinese medicine system in depth. It is also suitable for people who have studied medicine for several years, or those who are still confused after finishing Chinese medicine school and are willing to study again.

First, macro before micro.

First of all, we should have a general impression of the academic system of traditional Chinese medicine, browse it first, and then learn specific knowledge, instead of falling into various secret recipes and technologies at once.

Clinically, many doctors claim that they can overcome the terminal illness, and as a result, they caught a cold, and they still can't tell whether it is wind-cold or wind-heat. The basic concepts are all in a mess. How can you enter the room?

Second, cultivate and improve critical thinking ability, and don't emphasize rote learning.

One of the reasons why Chinese medicine is daunting is to recite a lot of content. Is this necessary? My experience is that there are not many things that Chinese medicine needs to recite. Far less than law, foreign languages and other majors.

A lot of content will be remembered after understanding, but what's the use of not understanding and remembering? Of course, there are levels of understanding, from shallow to deep, from general to special.

The knowledge of TCM is vast, and people's energy and time are limited. Doctors can't learn everything, nor can they cure all diseases. The key is to establish your own academic system and make achievements within a certain range.

I remember reciting hundreds of prescriptions in those years, which was not used clinically at all. There are no more than 50 prescriptions that can be memorized now, and there is no case that prescriptions cannot be written in clinic, hehe.

I will discuss the problem of learning prescription separately in the future. To sum up, a clinician really doesn't need to learn so many ways. A thousand moves is not as good as one move. On the one hand, the variable method is integrated, on the other hand, the variable method is thoroughly understood.

Many old doctors like to show off how they never forget anything and memorize it by rote. Recite a lot first, and then understand slowly. This is of course reasonable for young children to study medicine.

But if adults have poor memory and strong understanding, they should not learn like this. What's more, many of these eloquent old gentlemen really don't have a good clinical level, but unfortunately, they have suffered the crime of endorsement.

The traditional learning method is three years as a handyman, three years as a pharmacist and three years as a copywriter, and it takes more than ten years to get started. I don't have much time to really study medicine. These rules include the cruel exploitation of apprentices.

In my opinion, a person who has no medical foundation at all, with moderate qualifications and suitable learning conditions and methods, can reach a relatively high level in three years.

This is my conclusion through practice. With regard to the examination of medical practitioners, several students I have instructed can pass the full mark of 100. It can also be proved that this method is equally effective in dealing with exam-oriented education.

Third, maintain the critical spirit of traditional Chinese medicine.

We must first establish our own medical system, and then study various academic fields.

Learn from the previous experience with suspicion and verify it with clinical efficacy.

Any scientific system must have understandable logic, and what cannot be understood can be put aside.

This is because you don't have a certain foundation, you can't distinguish right from wrong, and it is easy to turn into a war of words in various academic disciplines of traditional Chinese medicine, except for being more confused, there is no other gain.

I often say, look at a person's medical level and what books he has bought, and you will know that 89 is the same.

Learning experience of traditional Chinese medicine surgery II. My biggest gain is that I learned to change the medicine simply. In fact, ignoring the patient's wound and dressing change is a very artistic process. If I do it myself, I will feel more at ease. I think if someone around me has this similar disease and wound in the future, I can still do basic cleaning and surgery.

Secondly, the external washing prescription here is very effective and has been verified by countless patients, so I still have a good impression on the external washing prescription of Chinese medicine here. Kochia scoparia, Fructus Cnidii, Cortex Lycii, Cortex Erythrinae and Cortex Pseudolaricis are the main medicinal materials. Washing the wound with boiling water is very helpful to prevent infection.

Then I read some ancient books about surgery, and recently copied the teacher's notes from the teacher, which mentioned the concept of transforming qi to induce evil many times. This reminds me that in ancient books, Astragalus membranaceus is often used for surgical diseases, especially for reducing swelling. I thought it was strengthening the body resistance and benefiting water. Later, it was found that, as Mr. Wang said, Astragalus membranaceus is not so much invigorating qi as transforming qi, and it is also transforming the qi of triple energizer. It is mentioned in the Four Holy Sources. Carbuncle is shallow and gangrene is deep, shallow is light and deep is heavy. Carbuncle, camp outside, gangrene, qi and blood blocked inside. The stagnation of the camp guards is full and dissatisfied, so the swelling is different. When the point opens, the cold enters, and the cold stagnates into heat, and it goes out with the point, so it is round. Gangrene, stiff and firm skin, carbuncle, thin and shiny skin, shallow and deep yin and yang. ? A lot of swelling is not a problem of too much water in the body, but a problem of blockage. Blindly clearing away heat and promoting diuresis is not very desirable. Moreover, during my internship in the hospital, I also observed that many patients with peripheral vascular diseases are divided into cold and heat, and the lower limbs, especially the feet and the distal ends of blood vessels, are cold. Even if sores and swelling appear, the basal temperature of the foot is low in the later stage. However, according to the syndrome differentiation of Shangjiao, there are many hot phenomena. Personally, I think it is obvious that the medium coke also needs to be turned. The source of the Four Sages gives me the deepest impression that the central function of the spleen and stomach in the middle energizer is like a bearing rotating, which makes it rise and fall. In case of disharmony, I especially think that the separation of cold and heat is a manifestation of yin-yang imbalance, focusing on the spleen and stomach. The treatment method proposed by Sixian Xinyuan is to clear the upper fluid and lower the temperature.

In the prescription prescribed by a doctor and teacher for a patient, the dosage of aconite root, phellodendron bark and talc is high, and the lung governs the whole body's qi, supplemented by platycodon grandiflorum and ephedra to disperse the lung, Achyranthes bidentata to lower the medicine, Poria to strengthen the spleen and promote diuresis, and others are all drugs for clearing heat and promoting diuresis. On the whole, I always feel something is missing. I always thought we could add Astragalus and Bupleurum. When I asked the patient, the patient mentioned right hypochondriac pain.

Unfortunately, I have never learned to write medical history at all, and my computer is limited. Letting a new person play computer will slow down the whole department. Plus, I'm not very keen on playing medical history. One doesn't want to play and the other doesn't want to suffer, so playing medical history is blank. I wonder if the teacher will think I'm too motivated. Most of my time in the office is not to help seniors share computer work, but to hide on the sofa and read books. But I think it's good to learn something. You can try to change the medicine for the patient yourself. That little sense of accomplishment is enough to satisfy me.

Learning experience of traditional Chinese medicine surgery III. Brief introduction of practice hospital

First affiliated hospital of Guangzhou university of traditional Chinese medicine

The First Affiliated Hospital of Guangzhou University of Chinese Medicine was founded in 1964. It is a large comprehensive Chinese medicine hospital integrating medical treatment, teaching, scientific research, rehabilitation and health care. It is the first batch of third-class first-class Chinese medicine hospitals, demonstration Chinese medicine hospitals and the first batch of famous Chinese medicine hospitals in Guangdong Province, and the designated hospital for the 20 15 Guangzhou Asian Games. In fact, 1250 beds have been opened, and the medical service has been growing continuously every year. In 2065,438+05, the number of outpatients exceeded 2.25 million, and the number of inpatients exceeded 30,000. The number of outpatients and emergency patients ranks among the top three in all hospitals in Guangzhou (including traditional Chinese medicine hospital and western hospital). Experts include? Master of traditional Chinese medicine? Professor Deng Tietao, well-known professors Wang Jianhua and Ou Ming are one of the important bases for clinical education, medical treatment and scientific research of higher Chinese medicine in South China and even the whole country, and also one of the most powerful Chinese medicine hospitals in China. The hospital has a strong medical strength, with eight national key specialties (hip joint specialty, oncology department, gynecology department, cardiovascular disease specialty, acupuncture department, otolaryngology department, diabetes specialty, and national emergency clinical base of traditional Chinese medicine), which ranks among the hospitals with the largest number of national key specialties, and many of them have become the leaders or deputy heads of the national cooperation group. In 2007, the Ministry of Health ranked the best hospitals in China (Chinese and Western hospitals tied together), ranking eighth in hospital gynecology, ninth in orthopedics, and first in Guangdong Province and even the whole country. The hospital is also the first clinical medical college of Guangzhou University of Chinese Medicine, with 13 teaching and research sections, which undertake the classroom teaching task of 13000 hours per year. It is one of the largest clinical teaching hospitals of traditional Chinese medicine in South China and even the whole country. The college has 4 national key disciplines, 3 national key disciplines in state administration of traditional chinese medicine, 2 post-doctoral mobile stations, and 3 national-level excellent courses in gynecology of traditional Chinese medicine, treatise on febrile diseases and febrile diseases. It is the clinical medical college with the largest number of top-quality courses at home in China.

The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine

The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine was founded in 1904. Its predecessor is Jinan Railway Central Hospital, which is the first batch of comprehensive third-class first-class hospitals in Shandong Province and Jinan City. From June 5438 to February 2004, the whole system was handed over to Shandong University of Traditional Chinese Medicine and became the second affiliated hospital and the second clinical medical college of Shandong University of Traditional Chinese Medicine. From September, 2065438 to September, 2005, it was recognized by Shandong provincial government as a hospital of integrated traditional Chinese and western medicine in Shandong province, becoming the only provincial hospital of integrated traditional Chinese and western medicine in the province. The hospital is an international baby-friendly hospital, state administration of traditional chinese medicine? Nip in the bud? The pilot unit of preventive health care and state administration of traditional chinese medicine approved to be included in the construction unit of the national key hospital of integrated traditional Chinese and western medicine. The hospital has senior medical talents, such as experts enjoying the special allowance of the State Council, outstanding clinical talents of traditional Chinese medicine in China, scholars from distinguished professor and Taishan in Shandong Province, young and middle-aged experts with outstanding contributions in Shandong Province, famous experts of traditional Chinese medicine in Shandong Province, thousands of well-known technical experts in Shandong Province, outstanding academic leaders of traditional Chinese medicine in Shandong Province, and outstanding academic leaders of health system in Shandong Province. Owning state administration of traditional chinese medicine? Eleventh five-year plan? Two key specialties (diseases) (ophthalmology, neurology), 1 state administration of traditional chinese medicine key discipline (clinical practice of integrated traditional Chinese and western medicine), 1 Taishan scholar distinguished professor post setting unit (ophthalmology), 1 Ministry of Health technology access specialty (reproductive medicine), 1 national industrial injury rehabilitation pilot institution (rehabilitation medicine). There are two tertiary laboratories (visual analysis laboratory and assisted reproductive technology laboratory) in state administration of traditional chinese medicine, four key specialties (neurology, nephrology diagnosis and treatment center, ophthalmology and rehabilitation medicine) in Shandong Province, and universities in Shandong Province? Eleventh five-year plan? Shandong University of Traditional Chinese Medicine has 1 Key Laboratory (IVF Laboratory of Integrated Traditional Chinese and Western Medicine) and three key disciplines (ophthalmology, obstetrics and gynecology, pediatrics). Now it has become a leading unit in medical treatment, teaching and scientific research of integrated traditional Chinese and western medicine in our province.

Second, the internship overview

Worked as an intern in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine for one month, including gastrointestinal thyroid surgery, gynecology, pediatrics, emergency general practice, acupuncture, spinal orthopedics and endocrinology. In the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, I worked as an intern for two weeks in nephrology clinic, gastroenterology, respiratory medicine, cardiology, neurology, reproductive center, orthopedics, hematology oncology, urology, pediatrics, electrocardiogram room, special laboratory, radiology, neurosurgery and cardiothoracic surgery. During the internship, I can abide by the rules and regulations of hospitals and departments, and strictly demand myself to actively participate in various academic activities organized by hospitals and departments as interns, so that my medical knowledge can be further consolidated and improved, and my clinical operation skills can be greatly exercised.

(1) Medical knowledge has been further consolidated and improved.

During my internship, I got a preliminary understanding of the clinical manifestations, diagnosis, differential diagnosis and treatment principles of common and frequently-occurring diseases in various departments. Such as stomachache, should be differentiated from angina pectoris. At this time, ECG can provide the basis for differentiation, and combined with the patient's medical history, a diagnosis can be made. At the same time, we also learned about the use of commonly used drugs in clinic. For example, in the internship of respiratory medicine, I initially mastered the standardized use of antibiotics; During my internship in nephrology clinic, I initially mastered the indications and contraindications of using hormones, and so on. During my internship, I also encountered acute myocardial infarction, upper gastrointestinal bleeding, appendicitis and other emergencies, and personally participated in thrombolysis, hemostasis, surgery and other treatment processes. Have a deeper understanding of the disease-related knowledge learned in textbooks.

(2) Clinical skills have been greatly exercised.

Under the guidance of the teaching teacher, I focused on the clinical skills required in the internship outline. During my internship in internal medicine, I basically mastered the essentials of general physical examination and mastered basic clinical operations such as blood pressure measurement. During the operation, I mastered the basic operation, such as washing hands, wearing surgical gown, wearing sterile gloves, sewing, knotting, thread reduction and dressing change. In the ECG room, we have mastered the operation method of ECG machine and the ECG manifestations of atrial premature beats, ventricular premature beats, atrial fibrillation, atrioventricular block and bundle branch block. In the special inspection department, I am familiar with the writing of reports such as color Doppler ultrasound, gastroscopy and B-ultrasound. In radiology, I am familiar with the X-ray features of osteoarthritis, bronchitis and tuberculosis, and the CT manifestations of cervical and lumbar disc herniation, cerebral infarction and cerebral hemorrhage. In the reproductive center, I mastered the making method of smear and the use of microscope. In the acupuncture department, patients can be treated independently, such as acupuncture, ginger moxibustion and massage. In the outpatient department, I mastered the key points of consultation and the writing of outpatient medical records, and in the ward, I basically mastered the writing of admission records, the course of the first visit and the course of the disease.

Third, internship experience

In the process of practice, I have my own superficial understanding and experience on the development of Chinese and Western medicine and the handling of the relationship between doctors and patients. As the internship captain who went to Guangzhou for internship, he led the students in his internship team to promote exchanges between the two universities, broaden their horizons and increase their knowledge.

(A) to learn from a strong province of traditional Chinese medicine

Guangdong is a strong province of Chinese medicine, with a good atmosphere of Chinese medicine, and the people trust Chinese medicine. It is worthy of Chinese medicine propaganda, foreign exchange and teaching reference.

1. Effective publicity is of great significance for creating a strong atmosphere of traditional Chinese medicine.

Major Chinese medicine hospitals in Guangzhou regularly disseminate knowledge of Chinese medicine to the masses through free clinics, lectures and other forms on weekends. The publicity column of the hospital will also regularly update the medical popular science articles published by hospital experts in major newspapers and periodicals, which are suitable for public reading. Each department introduces the characteristics of TCM diagnosis and treatment in detail in the ward corridor. These practices have effectively spread Chinese medicine culture to the public. In addition, there are customs such as using Chinese medicine to make soup in Guangdong, which makes the atmosphere of Chinese medicine in Guangdong particularly strong.

2. Actively introduce advanced technologies at home and abroad.

In Guangzhou, Chinese medicine hospitals will invite famous scholars at home and abroad to give lectures to doctors from time to time, so that everyone can understand the most advanced diagnosis and treatment concepts and technologies. For example, I once listened to a lecture by Professor Liu Lihong, a famous Guangxi TCM doctor and the author of Thinking about TCM. At the same time, Chinese medicine hospitals in Guangdong are trying to develop traditional Chinese medicine diagnosis and treatment methods such as bee needle, abdominal needle and ointment. It is not only a characteristic diagnosis and treatment of traditional Chinese medicine, but also actively introduces advanced instruments and technologies of western medicine. In the hospital where I practiced, the comprehensive strength of gynecology and orthopedics ranks in the top ten in the national hospitals, which is inseparable from the active introduction of advanced technology.

3. Clinicians have a strong sense of teaching.

The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine is also the first clinical medical college in the school, which undertakes teaching tasks at undergraduate, master and doctoral levels. Hospital doctors have a strong sense of teaching. They attach importance to students' participation in the whole process, from accepting patients to issuing wills, to writing admission records and course records, and dare to give students opportunities for clinical operation. From the first day of internship, each intern was assigned a responsible hospital bed, which increased the students' sense of responsibility and enthusiasm. Each department has a special teacher to manage teaching, arrange each intern's duty, and let students experience the doctor's work all the time. The department will also regularly arrange teaching courses for interns to make our progress faster.

(B) properly handle the relationship between doctors and patients

During my internship, I really realized the tension between doctors and patients, especially in Guangzhou. In view of the tense doctor-patient relationship, my personal experience is as follows:

1. A solid medical foundation is the prerequisite for reducing medical disputes.

As a doctor, a solid medical foundation and superb clinical skills are the basis for gaining the trust of patients and the prerequisite for reducing medical disputes. Quack doctors not only can't alleviate the pain of patients, but also bring more pain to patients because of misdiagnosis and mistreatment. It can effectively alleviate the pain of patients, think for patients from the perspective of patients, and patients will thank doctors from the heart, thus effectively reducing the occurrence of medical disputes.

2. Noble medical ethics is the lubricant to improve the doctor-patient relationship.

In a relatively advanced hospital, doctors, especially famous experts, have to see more than 100 patients a day. It is unrealistic for non-medical patients to explain their illness in detail in a limited time, but the noble medical ethics of serving patients wholeheartedly should always be upheld. In practice in ECG room, it is necessary to brush some water on the patient's chest in order to make the chest lead of ECG machine produce images better. It was still cold, so I changed the cold water into warm water. The patient was moved by this small move for a long time. In medical work, if doctors can have a better attitude, smile more and think more about patients, the doctor-patient relationship will be more harmonious.

3. Actively popularize medical knowledge to the broad masses.

The contradiction between doctors and patients sometimes stems from the lack of patients' own medical knowledge. I once saw a patient go to the hospital because of high blood pressure, and the doctor asked her to do color Doppler echocardiography. The patient thought that the doctor asked her to do this test because she wanted to make money, so she swore. Obviously, she knows nothing about the structural changes of the heart caused by hypertension. It is far from enough to rely solely on doctors to educate patients. Nowadays, there are more and more health programs in the media. If the masses can? Choose the good one and follow it? It is undoubtedly beneficial to know the basic medical knowledge and pay attention to the prevention and health care of diseases.

4. Learn to protect your legitimate rights and interests with legal weapons.

Is there a special one in society now? Medical problems? Groups have seriously affected the normal medical environment of hospitals. For patients, if medical disputes occur, they should safeguard their legitimate rights and interests in accordance with relevant national laws and regulations. For doctors, they should also strictly abide by the relevant provisions of the Medical Practitioner Law, Tort Liability Law and other laws, and give patients standardized and reasonable treatment according to the requirements of clinical pathway. Under no circumstances should doctors and patients use force to solve problems.

Fourth, problems that need to be improved.

During my internship, I am also constantly learning from excellent classmates and constantly reflecting on my own gaps and shortcomings, so as to do better in my future study and work. The future needs to be improved from the following three aspects.

(A) more strict with themselves

In the hospital, rounds, doctor's orders, dressing changes and other work are often carried out in the morning, and the afternoon is relatively free. Sometimes I am not strict with myself during my internship, and I didn't go to the hospital on time in the afternoon. Now that I think about it, it is a good opportunity to communicate with teachers when I am not busy in the afternoon. I can ask the teacher about the treatment of common diseases in the department, the writing of medical documents, the skills of doctor-patient communication and so on. It is also a good opportunity to communicate with patients and their families in the hospital bed, know the treatment effect of patients in time, and enhance patients' trust in themselves.

(b) Internship initiatives need to be strengthened.

In practice, out of concern for patients' feelings and fear of mistakes, the initiative and enthusiasm of some clinical operations need to be strengthened. For example, when I was practicing gynecology, because of the patient's feelings, I couldn't give the patient a gynecological examination independently. It's a pity to think about it now. I'm afraid it's now or never. This point should be paid attention to in future practice and work. After mastering the operation essentials in the book and observing the teacher's operation repeatedly, you should take the initiative to apply to the teacher and practice more under the guidance of the teacher in order to have a deeper understanding.

(C) timely return to textbooks

Sometimes after a busy day in the hospital, I just want to have a rest when I get back to the dormitory. Inertia sometimes prevents me from returning to the textbook in time, systematizing the knowledge I have learned in clinic, and losing a good opportunity to deepen my impression and memory. ? Learning without thinking is useless, thinking without learning is dangerous? . In the future, we should strive to overcome our laziness, sum up what we learned that day in time, and don't let go of any details that we don't understand easily, so that we can learn solidly and make progress.

The one-year internship will soon be over, with gains and regrets. Every experience in life is a foreshadowing for the future, constantly summing up experiences and lessons, and practicing hard in future study and work. I think it is not far from realizing my wish to be a good doctor.

?