The end of TCM

The week in TCM has been interesting. Dr. Chen and Dr. Ho have taught us so much and showed us their acupuncture techniques. Dr. Chen even put a needle in my hand to show me what it feels like. I was a little nervous about it and skeptical when people said that it just feels numb. But when Dr. Chen tapped the needle into my hand, I hardly felt it except when he moved it around. It felt very tingly and weird. I left it in for a bit while he saw a patient and then he took it out for me. I thought that as long as I had it in I might as well treat the point a little. The point he used is one that is used to treat motion sickness and since I have been sensitive to that lately, I thought that treatment couldn't hurt. It did help a little, as the next time I was on the bus with the crazy driver I didn't get as sick. It was a good experience for me. I think it is important to experience things for yourself to be able to empathize with others.

Dr. Ho taught us a little about his manipulative technique. He showed us what he is feeling for when he does his diagnostic exam. His palpatory skills are very good and I hope that someday I will have those skills. He is able to treat bones that are out of place and tightness in the tissues. He diagnosed several patients with a "twisted pelvis" and prescribed herbal remedies for it. This was interesting to me because I thought that he would use manipulation to fix it, but instead uses herbs. There was also a patient with a cervical spine injury that was seeking treatment. He said that the patient would first have to take some Chinese medicines first before starting acupuncture treatment. Dr. Ho said that the treatments will help but it will take time and that he wasn't sure how much it would help. Because the nerves might be damaged, acupuncture may not be able to fix anything.

On Thursday, TIHTC took us on a field trip. We went to the Geography Park where there are really interesting rock formations. It was fun to see the different shapes of the rocks and the natural erosion that is occurring. It is apparent that the Taiwanese like food; a lot of the rock formations are named after foods. But it was fun. They are very imaginative with the shapes and there are stories to go with them. In the afternoon we toured the Shenkeng Public Health Center, which is a facility that focuses on public health. They have a small clinic and a lot of educational programs for residents in that area. This was a nice trip and we were very lucky to have been able to go.

This last week in TCM has been a very educational week for me. I have learned so much about Chinese medicine and its uses. All of the doctors in the department were very kind and answered all of our questions. The last 4 weeks at Taipei Hospital have been very educational and have reminded me why I decided to go to medical school. Sometimes in all the studying it is easy to forget the clinical side of things and it is experiences like these that keep me pushing through it all. I have really enjoyed all of the clinical experience that I have gained and all of the pearls of knowledge that the doctors have given me.

TCM Rotation Day 3&5 (June 29 & July 1, 2011)

June 29, 2011 and July 1, 2011

We gained more understandings about TCM from Dr. Chen and Dr. Ho on the third and last days of our TCM rotation. From Dr. Chen, we received an introduction of the ten most commonly used acupuncture points and got the opportunity to perform acupuncture on our own. He also told us some rare and severe complication of acupuncture such as pneumothorax and kidney bleeding especially when long needles are used. From Dr. Ho, we got the opportunity to really touch some of his patients and felt the change in muscle tones or bone structure before and after his special Tui-Na. And we got to see how a patient who could not lift her arm to the level of shoulder can lift her arm after treatment. We also got to see a lot of stroke or cerebral palsy patients receiving acupuncture to facilitate recovery or relieve the symptoms. During this week of rotation in TCM department, I not only gained more understanding about TCM (especially acupuncture) but also got an idea about how to use TCM in weight loss. This experience gave me a more open mind toward using alternative medicine such as acupuncture in treating patients.

TCM Rotation Day 1&2 (June 27-28, 2011)

June 27, 2011

Our first day of traditional Chinese medicine (TCM) rotation started with observing Dr. Yen-Yi Ho, the director of TCM department of the hospital. This morning he had about sixty patients, and more than one-third were here for acupuncture. While I was still wondering if he can finish all these patients in time, he showed me how he could make it possible. Since he knows all of his patients really well (to the degree that he can make fun of them without offending them), he can spends less than five minutes on each patient without sacrificing quality of visit (such as patient-doctor interactions). He also used his time wisely so that he can finish multiple jobs in one time. For example, Dr. Ho used the acupuncture time as his “break” from sitting in front of table. Before the “break”, the nurse would have the patients who need acupuncture sit in chairs or lie on beds. Then Dr. Ho would walk between the chairs and beds to put the needles on rapidly. Since patients getting acupuncture need to have needles on for thirty minutes, Dr. Ho would get back to work and have the nurse take out the needles later. Through observing behind Dr. Ho, I got the idea about how to make outpatient visit more efficiently without sacrificing its quality. In the afternoon, Karen and I met and shadowed Dr. Chien-An Chen. We had a discussion about what’s OMM and what we want to learn from TCM, and he suggested that acupuncture would be a good topic to learn. He originally planned to give us an introduction of ten most common used acupuncture points. But since we needed to leave early for the case presentation, that lecture would be given next time.

June 28, 2011

In the morning, Karen and I reported to Dr. Shu-Ling Hsieh, the TCM physician who is specialized in weight loss. Her weight loss clinic only takes those with BMI >24.1 for male and BMI> 22 for female. According to Dr. Hsieh, the most important thing to make weight loss possible is diet control. And the herbal medicines and acupuncture she uses in the clinic is just to assist the change in diet habit easier. Since our bodies can absorb the calorie faster from carbohydrate than proteins or fat, her diet education to patients focuses on low-carb diet. Her patients are required not to have anything fried or sweet. They are told to eat mainly vegetables (not including the ones with a lot of starch like potato), fruits (no too sweet ones), and proteins (no too fatty or salty ones). Since a lot of Taiwanese people get used to have dishes with rice, she also suggests them to have dishes with soup instead. One of her patients she had today actually reported losing 17 kg in two months. This makes thinking maybe I can use what I just learned from Dr. Hsieh to help my family members and I lose weight. In the afternoon, we met Dr. Ho again in outpatient clinic. Today he still had a lot of patients visiting him for acupuncture. We observed him performing acupuncture on patients rapidly. And he is so experienced to acupuncture that he can use only palpation to find each acupuncture point precisely.

Week 4 TCM

Chinese medicine is more similar to Osteopathic medicine than I had expected. They both take the whole body approach to medicine and consider the patient as a person and not a disease. They also believe that the body is a unit and that everything affects everything else. So when treating the patient for back pain, you don't necessarily focus on the back because other factors could be playing a role.

At Taipei Hospital, the Chinese medicine department is quite busy. Dr. Ho, the chair of the department, sees about 60 patients for consultations and does about 20 acupuncture treatments in a morning or afternoon clinic session (about 4 hours). He is quite busy, but still manages to crack jokes with the patients. He includes a structural exam with his consultation and does some manipulative treatments with foot stomping and arm flailing. I'm not quite sure what he is doing, but he said he will explain it tomorrow. During his 4 hour clinic session, he sees patients for herbal consultation and does 2 sessions of acupuncture. The tables are all lined up and patients are called in as a group. Curtains separate each of the tables. Dr. Ho goes to each table and puts in whatever needles he thinks are needed and moves directly to the next patient. He somehow remembers each patient and doesn't need to refer back to the charts. A volunteer follows and counts the numbers of needles so that they can be sure to remove them all. After he applies needles to all the patients he goes back to seeing patients for herbal consultations.

The Chinese Medicine department also has a weight loss section. Dr. Hsieh comes in on Tuesday mornings to do acupuncture and consult patients who are trying to lose weight. She has a set of about 30 points that she uses on all her patients. She also gives them dietary instructions that are very similar to a low carb diet. She asks all the patients to eat less sugar, starch, and fat and to eat mostly proteins and produce. One patient came in who was just using the treatments to maintain her weight without dietary change and Dr. Hsieh told her that this treatment is for weight loss and dietary change is necessary. Patients are given the option of acupuncture and also electroacupuncture, which apparently stimulates the points more and creates more change in the body. Another patient that came in today had lost 16 kg in 2 months with this treatment, diet and exercise. This was her last visit for the treatment. This case in extraordinary and most people lose weight more slowly, which is supposed to be healthier. This treatment seems to be quite effective and patients seem to be quite happy. Dr. Hsieh consulted about 10 new patients to start treatment today.

Through research on the NIH website, I have been able to learn about research on acupuncture. Researchers have shown that by stimulating a point on the foot that is good for eyesight, the part of the brain responsible for the eye becomes active. I'm not sure if this phenomena can be explained scientifically yet, but it is quite interesting. It is believed that some hormones or neurotransmitters are released in response to the needle. Researchers have also shown that acupuncture changes resting-state brain activity causing analgesic effects. (All of these can be found at http://nccam.nih.gov/research/results/topics/index.php?title=Traditional_Chinese_Medicine). I am continuing to learn how acupuncture works through continuing education lectures on the National Center for Complementary and Alternative Medicine website.

6/6~6/10/2011 - General TCM - Jessica

I think Dr. Ho (何彥頤醫師) is one of the most memorable doctor I met during this trip not just because he it the first main preceptor I met during this trip but because of many reasons. If you ask me what I remembered the most about Dr. Ho, it would be his efficiency and his personality. Mickey and I was shocked during our very first day in Taipei hospital because of Dr. Ho. In one single afternoon outpatient clinic, Dr. Ho tended to around 80 patients, including regular office visit AND acupuncture rounds! Since I still have some recollection about the Taiwanese health system, I already knew that the patient load for Taiwanese physicians are very high compared to the US, I never expected it to be so heavy! Even though there were more patients than usual that day because Dr. Ho's Monday clinic was canceled due to a national holiday (Duan-Wu), the sheer number of patient was still unbelievable to Mickey and I. But what surprised us even more was Dr. Wu's ability to handle that amount of patient and still manage to connect with his patients in a personal level and even knows many of his patients' names and medical conditions by memory! What impressed us even more was Dr. Ho's ability to still keep his sense of humor throughout the entire shift and helped ease the stressed atmosphere with his good natured jokes. Even though he used mostly Taiwanese to communicate with his patients and I could only understand about 65% of it, I can already feel the sense of trust between the patient and the physician even during such short patient encounter. And I think that is what make Dr. Ho unique among physicians.

Of course, as a TCM doctor, Dr. Ho stood out even more for Mickey and I: since he is the only doctor we have observed throughout this trip that utilize manual diagnoses and treatment on patient. During our rotation, Mickey and I were able to observe and video tape Dr. Ho's treatment and even had the privilege of trying it ourselves. Considering how busy Dr. Ho is everyday, we were really grateful for his time and patience to all of our questions and request of video filming him. Mickey and I have learned many things from Dr. Ho, from patient interactions to tips on palpating skills and I sincerely hope that we can collaborate even more in the future to exchange knowledge between TCM and OMT.

TCM rotation and excursions 10-June-2011

Jessica and I started the day with Dr. Chen, Chien-An (Dr. 陳建安 ) of the TCM department to observe his acupuncture clinic for about an hour before we saw Dr. Chen, Chun-I (Dr.陳駿逸)from oncology walk in borrow some acupuncture needles from Dr. Chen, Chien-An to teach our other classmates that are rotating with him about acupuncture and its role in cancer treatment. Dr. Chen, Chien-An saw that it was a great opportunity for Jessica and I to learn more about acupuncture and told us to follow Dr. Chen, Chun-I to learn from him for the rest of the morning. We ended up meeting up with Amanda, Bor-Han and Sandy, and was given a very interesting power point presentation about acupuncture. I found it interesting that many of the concepts used in acupuncture could be found in our lectures from the OMM department, such as those regarding nociception. It appears that there is the theory that acupuncture works as a gate control to modulate pain. In other words you feel the sensation of the needle upstream which interrupts the pain signal downstream. Dr. Chen, Chun-I is very enthusiastic about evidence based medicine and believes that more research should be done on TCM. For his presentation he used most of the research that were done from peer reviewed journals that were done in English and noted that there was much more research that has been done in Asia but he felt that some of the publications were reviewed under the same rigor. The most exciting part of the morning was that we all given the opportunity to practice acupuncture on each other on points located in the upper and lower extremities, it almost felt like a mini-lab much like those that we are accustomed to in the OMM department at Touro.

In the afternoon Jessica and I went down to Dr. Ho’s clinic. At one point he jokingly told a patient that he doesn’t do more Tui Na because he patients have a hard time following his aftercare directions, such as not to cross their legs and not to place their feet on foot rests. Interestingly enough one my nursing friends sent me an article about leg crossing inducing lumbar scoliosis from a Taiwanese newspaper a few months ago and asked me to if it was possible to translate it to English. In any case here is the original Chinese version, I have not had time to translate it to English yet. By the way if anyone is interested in the project let me know.

After the first hour with Dr. Ho, we ended up getting excused to follow Dr. Chen, Chun-I again and had a very interesting presentation about acupuncture use as an adjuvant therapy in oncology. It appears that acupuncture is great at reducing some of the adverse effects of radiation and chemotherapy such as nausea and helps with overall recovery. I am excited that he allowed us to keep the power points that he presented and told us that it would be okay to present the material to the rest of the school if wanted at some point.

Overall the experience in the TCM department was a very exciting an interesting experience for me. I had some difficulty due to language barriers but I feel I was still able to get a lot out of my experience there and feel honored to have had such a great opportunity to learn from many amazing preceptors I have encountered so far.

6/10/2011- General TCM, Oncology TCM - Jessica

Today is the last day of our first week of rotation. Mickey and I, along with other groups, bought some small gifts to our respective preceptors. I left the gift I brought from the US at home, so Mickey and I bought some chocolate covered strawberries yesterday while grocery shopping at Carefour supermarket (next to IKEA) for our preceptors. However, we noticed that the preceptors in general showed great resistant to receiving the gifts. We were wondering if it is a hospital policy thing or just because it is inconvenient for the doctors to eat food during office time.

We started the day with Dr. Chen (陳建安醫師) who we rotated with before on Wednesday. However, he had a busier schedule today compare to Wednesday, so when Dr. Chen (陳駿逸醫師) from oncology came visit, Dr. Chen graciously agreed to take us in. Coincidentally, Dr. Chen (from oncology) also studied TCM, in fact, he and Dr. Chen (from TCM) were upper and lower classmen (學長弟) and he is about to teach Amanda, Bor-Han, and Sandy acupuncture basic principles today. So we end up tagging along with them and was given a quick overview of acupuncture. We were introduced to the basic acupuncture principles and some basic well-known acupuncture points. We were even given the chance to practice needling (on self or each other of course)! The whole experience was just eye-opening, fun, and interactive. We learned the points and its basic therapeutic effects and how to evaluate if the needle has reached the right point through the phenomenon of De Qì (得氣, the sense of numbness, pain, or tingling during needling that indicate successful stimulation of the acupuncture point). After observing so many days of acupuncture, I was very excited to be able to finally try it myself. Although it seemed a little traumatic for some of us, but I think all of us learned a lot during the session and actually had a lot of fun too.

We went to the basement restaurant again today for lunch and YuYu met us there to inform us that the schedule remained unchanged after all. We discussed a little bit more with YuYu about possible sight-seeing places for this weekend. Since both Amanda and I won't be around this weekend, the responsibility of tour guide rest solely on Bor-Han, and I was able to relieve my sacred duty! Toward the end of lunch, YuYu came again to inform us that there was a surgery meeting that we were welcomed to join. We all hurried there and learned about an adverse effect of phenytoin (Stevens-Johnson syndrome) that is significantly more prevalent in the Han-Chinese population.

One interesting thing was Amanda helped us figure out the exact price of the lunch set there. Although it is not that related to the academic experience, for the sake of future students who are fixated at eating good food like me, I will include the information here as well: the basic set for $NT50 includes rice, soup, and 4 courses (1 main entree/meat dish + 3 vegetable/side dishes), each additional entree cost $NT20, and each additional side dishes will cost $NT10 more.

In the afternoon, we started by following Dr. Ho again, observing his outpatient clinic until around 3pm. And then with Dr. Ho's permission, continued the morning acupuncture introduction with Dr. Chen in the remaining time. During this time, Dr. Chen continued with his introduction to acupuncture and also briefly covered some scientifically proven ways acupuncture can be used to support cancer treatments. I was surprised by how much research has already been done on acupuncture by the western medical field as well as by how enthusiastic Dr. Chen is at teaching students. I sincerely feel that we are very lucky indeed to be able to have preceptors like Dr. Chen who is truly committed to teaching the students and still feel such passion toward his field of study even after these many years.

6/9/2011-general TCM & Pathology - Jessica

After attending the morning internal medicine meeting, we went to Dr. Ho's outpatient clinic again. As before, his clinic was very busy and we rarely had time to ask him questions. But we did manage to slip in few questions in between. We asked if there are certain precautions we need to consider when needling the patients to avoid infection. Dr. Ho replied that first, the patient's hygiene is very important. For example, although alcohol wipes are often used, most time in outpatient settings, the needles are applied through the cloths, extra precaution need to be applied if the patient's clothes are soiled or poor personal hygiene is noted. However, since he knows most of his patients well, he does not need to worry about that often. Another important point to consider is if the patient has diabetes, which will prolong healing time and increase risk of infection. We also learned that since many of his patients are elderly patients with many of the chronic metabolic and cardiovascular disease, the goal for him is often to control and lower the condition enough using Chinese medicines to at least lower the amount of western medicine needed or even replace them to control the disease.

One of the highlights of the day was meeting with Dr. Lin and Superintendent Lin. It was great to have the chance to convey personally to him how thankful we are for the wonderful opportunity. We were each given a bag of gifts along with many much needed maps for tourist information! The TIHTC treated us again today to a wonderful lunch, there were so much food that even though all 9 of us (including Dr. Lin and YuYu) entered the restaurant with empty stomach, we could not finish all of the food. And the food was so good that even though we were probably all stuffed all the way up to our epiglottis with food, we still want to bring the left-over home! Once again, their hospitality really touched me and will always be part of my fondest memory of Taiwan.

This afternoon, due to a miscommunication, Mickey and I were not able to rotate in the afternoon TCM outpatient department. So we went to the pathology department with Sandy, Bor-Han, and Amanda. I was expecting to see a bunch of stained slides and huge amount of microscopes in the beginning. But what I saw first was actually the actual preparation of the tissue samples. Even though I knew that the slides must be made into slides from sample tissue somehow, but seeing it in real life is a different story. Just looking at the biopsied knee joint, it was hard to imagine that it once belong and was functioning within all that flesh and tendon of a living human being. But after the initial shock, I felt like it allowed me to gain a new respect to the job of a physician; that no matter how little one's interaction with the patients is, a physician's job, no matter in which specialty, will cause tremendous change in the patients' lives. Although the change is for the better or worse will solely depend on how serious the physician takes his or her job and how dedicated he or her is to the patients.

TCM Rotation Day 3 general clinic, pathology lab excursion 9-June-2011

It was a much shorter day with Dr. Ho due to the meeting we all had scheduled with the superintendent Lin before lunch. None the less it was another interesting morning filled with observations that have accumulated over the past few days. One thing I noticed is that the patient population Dr. Ho sees included many elderly which mostly seemed to be concerned about edema, hypertension, hyperlipidemia, hyperglycemia and a few musculoskeletal complaints. In those of working age most of the complaints were musculoskeletal and the few pediatric patients he has seen were either for neurological issues or were GI related (such as constipation). Interestingly one patient came in today that wanted use TCM to control his hypertension so he could reduce the dosage of his current western hypertension medication, which got me thinking about drug interactions between TCM and western medicine. It seemed that there are varying opinions about how to handle the drug interaction situation. Dr. Chen opinion was that there was very little research about the topic and he wanted to know more about it too, but with the currently knowledge available he would recommend caution when combining methods. Dr. Ho recommended a 1 hour gap between Chinese medicinal herbs and western medicine while Dr. Hsieh recommended a gap of at least 30 minutes between medications. In my own experiences I have always been told to leave a 4 hour gap between medications so I thought it was interesting to see a much shorter gap being recommended here.

In the afternoon the TCM department was too busy to accommodate Jessica and I, so we ended up going to the pathology lab, meeting up with Amanda, Sandy and Bor-Han. We ended up learning about how they prep specimens and other various things including having the chance to do a brief patient interaction with colon cancer patient through a nurse translator about her experiences that she had in the hospital and the course of her disease. We are all currently poised to do a case presentation about this patient to the pathology department within the next two weeks. I am planning on including something OMM related maybe about post operative care or an OMM perspective to the lower extremity pain she was having due to touch.

Also we finished editing parts of the TCM treatment video and added some subtitles although we had trouble uploading it or attaching it to e-mails. In any case it should be a fun exchange between TCM and OMM when we are able to get everything uploaded.

6/8/2011-TCM General Outpatient -Jessica

Today we begun our day with yet another new preceptor: Dr. Chen (陳建安醫師). Dr. Chen's specialty was oncology and the use of acupuncture to help alleviate the adverse effects of cancer treatment and also for recovery for stroke patients. Since it is a relatively slow morning, we spent much time talking to Dr. Chen, asking many of the questions that was raised from our observation of Dr. Ho yesterday. For example, we were curious about how the TCM doctors resolve the issue of simultaneous treatment by both western and Chinese medicine. Unfortunately, Dr. Chen does not think there is a well researched consensus among TCM doctors either on this issue. Some say at least 4 hours in between and some say 1 to 1.5 hour. We also asked about why we do not see any Tui-Na or traumatology in the clinics. To our surprise, Dr. Chen answered that Tui-Na is no longer practiced by the TCM doctors, instead, they are practiced mainly by chiropractors/massage therapists due to its low pay (problem with the national health insurance in Taiwan)  and its taxing nature on the practitioner's hands and physical energy. Although I was surprised that it is no longer practiced, I was not surprised that it pays little, since I think most manual medicine will probably face similar problem with the insurance agencies, nor was I surprised that it was also because it is too tiring for the practitioners, since that is also a problem with OMT for the DO doctors too.

 After asking our questions, Dr. Chen also gave us a short presentation covering many more commonly know acupuncture points, such as 合谷, 陽陵泉, 足三里...etc. I was pleasantly surprised that I actually know few of them just from observing Dr. Hsieh yesterday, which makes me even more excited for the afternoon session with Dr. Chen, since he would not be as busy as yesterday and will probably have more time to teach us and answer the questions we have for TCM.

TCM Rotation Day 2 General Clinic 8-June-2011

Jessica did a great job describing the obesity acupuncture points yesterday so I will start off the day with the acupuncture point protocol drawing that Dr. Hsieh (Dr. 謝) drew for Jessica and I yesterday below in case anyone wants to see a visual.

Jessica and I started the day in the TCM department with a new preceptor in the morning with Dr. Chen Chien-An (Dr. 陳建安) who is trained in both TCM and western medicine (radiation oncology). It was a rather slow day and only a few appointments were scheduled so we had time to converse about TCM with Dr. Chen. Topics included the inter-reliability problems in TCM much like OMM. As TCM is much of a clinical model, based off clinical experiences, he believes that the future of TCM is to have lab results and diagnostic exams correlated to treatments. He was very interested when I told him about how one of my TCM practitioners had used spinal X-rays to assess rotation and side-bending in my spine after initial treatment to target his Tui Na work. In addition to more rigorous research he was concerned with proper sanitary protocols to be used in TCM. He stated that while proper protocols like hand washing and proper preparation before acupuncture after every patient encounter needed to become more consistent.
In the afternoon we headed back to Dr. Ho’s clinic. It was a very exciting day as Dr. Ho spent time teaching us where and what he was feeling during his TART exam after we explained to him more about Osteopathic Medicine. He let us check for TART using our own method (Stiles screening) before and after treatment then showed us his how to use his own screening diagnostic method. From what I understand his contact appears to be more on the myofascial layer and he is able to find points of hypertonicity and restriction by assessing fascial drag. I was amazed at some of the restrictions that Dr. Ho was able to find with his hands. We also obtained permission to record some of the techniques that he used, so I will be editing the videos. He also seemed very interested in seeing some video of OMM done by one of our professors so we may work on getting something together after we clear it with the departments.
Any case off to more video editing.

TCM Rotation Day 1 TCM Weight management and general clinic 7-June-2011

We all got to sit in on the internal medicine meeting at the morning before our departmental rotations began at 9. The doctors presented an interesting case about a patient with depression and heavy alcohol use that was having vomiting after meals. It was interesting to see a real case broken down into differential diagnosis and have everything correlated to physical exam findings and lab results. I also found it exciting that we had gone over many of the concepts already in 1st year such as PTT, signs of shock and more.

At 9 Jessica and I got the chance to go down and learn about TCM weight management. Our preceptor, Dr. Hsieh, Shu-Ling (Dr. 謝抒玲 ), really welcomed us in and spent time to teach us about diet therapy, use of Chinese medicinal herbs and acupuncture as a combinational therapy for weight reduction. Much of the diet recommendations were similar to the recommendations in nutritional therapy, including the reduction of processed food, sugar and starch intake. The Chinese herbs prescribed are to be taken before meals used as an appetite suppressant. Acupuncture followed a specific protocol lasting 40 minutes with the same needle position on a need basis. I found it interesting that there is a BMI limit set up as a filter to prevent patients from enrolling if they are at risk for being under weight and it was interesting to see the success that many of the patients that Dr. Hsieh had.

In the afternoon we had a chance to sit in with Dr. Ho, Yen-Yi (Dr. 何彥頤) who runs two clinics (general and acupuncture) simultaneously from 2 to 5 pm. The clinic was exceptionally busy due to the long holiday, Dr. Ho had 80 patients schedule not including walk-ins for the day. Dr. Ho had a systematic approach to where he would stop general clinic to do an acupuncture run at 3 and 4 where he would treat 10 beds and 4 seat patients. It was surprising to see how he was able to be able to connect with each patient on such a personal level, he knew everyone by name, their family and about their everyday lives in addition to their medical history while working at such a fast upbeat pace. As Dr. Ho was very busy and Jessica and I ended up learning a lot through observation. It was challenging for me in that many of his patient spoke Taiwanese which I don’t understand at all but I found the experience very interesting and left with many question I want to ask him the next day that we see him. For the OMM fanatics out there I got a lot of out watching Dr. Ho physical examination, it appeared he would check several points as part of a screening exam, including PSIS, the thoracolumbar junction, cervicothoracic, cervical spine for TART from the posterior before moving to the anterior to check the costal margin, possibly for the diaphragm, and the ribs, in addition to the upper and lower extremities based on patient complaints. We witnessed two interesting techniques one involving the upper extremity where it appeared that he would use the arm as a long lever while doing some manipulation in the thoracic region and one where he would use the leg to induce passive stomping while working the ribs or diaphragm from the anterior. The technique seemed to work very quickly and effectively and we were very excited to see if Dr. Ho would have time to teach us more about it in the days to come.

Overall it was a whirlwind a day where I experienced many language challenges, takes some effort for me to comprehend mandarin, but I am glad I had the opportunity to observe so many exciting things about TCM.

6/7/2011-TCM Weight Loss Clinic-Jessica

Today we finally started our first rotation in Taiwan! We begun our day by attending the Internal Medicine Department's morning meeting. It was such an interesting experience and we were able to learn so much in just one hour! Not only did we get to walk through a real-life case study with the doctors, it also helped prepare us with case presentation for our future rotations in the US. I was surprised that even with only one year of medical education, although we did not know some of the specific clinical terms, we were able to understand almost all of the pathophysiology and differential reasoning behind the case and it was great to be able to utilize what we learned in classroom to real-life situation.

At 9 o'clock, Mickey and I went to the TCM department to officially start our rotation. This morning, we had the privilege of studying with Dr. 謝抒玲. Dr. Hsieh specializes in weight loss clinic and begun the rotation with a demonstration of acupuncture on a patient. It was interesting to see how fast and efficient she was at needling and finding the acupuncture points. Unlike the osteopathic points that we are familiar with, it seems like the TCM points relies little on palpation of landmarks. Dr. Hsieh taught us that the points are often measured relative to each other with the Chinese unit 寸, which is often approximated with 1/3 of the patients' finger length. She also added that although many acupuncture points, called 穴道 in Chinese, are fixed and have specific names and corresponding effect/function like 陰陵泉 and 足三里, many of them are fluid and dynamic, depend on the patient's body and do not have a specific name. These points are called 阿是穴 and are often effective acupuncture points that are not found on literature and specific only to each patient.

After the demonstration, we spend the rest of the morning observing Dr. Hsieh doing outpatient consultations. The first thing we noticed was how fast she went through each returning patient, with each patient encounter average about 5 minutes. However, for the first time patients, Dr. Hsieh will group several of them together and give a quick patient education: including explanation of food nutrition (avoiding fried food, starch, sugar...etc), possible adverse effects (palpitation, constipation, insomnia, thirst, dehydration...etc) with the Chinese medicine (made with several different Chinese herbs, has appetite reduction effect), followup in one week (to check for any adverse effect/reaction with the Chinese medicine)...etc. She also helps the patients set a healthy weight goal by BMI calculation. One striking difference we noticed between Dr. Hsieh and US physicians was her attitude toward patient. She seemed to be a firm believer of the paternal approach to patient interaction, often speaking to the patients in an authoritative way. However, even though it may seem strange and too forceful to us Americans, all the patients seemed to be responding well to her style, probably due to the traditional Chinese view toward physicians.

One other interesting thing we noticed was the general hospitality of the Taiwanese people. Just yesterday, the TIHTC staffs brought us around to attend the Dragon boat race in celebration of the holiday 端午節. Since it was a national holiday, the staffs could have stayed at home and avoid the 34C temperature outside, instead, they were there with us at noon time when the sun was the harshest just to give us the unique experience. In addition, after the race, they even treated us to a delicious meal of ShabuShabu! And today, even before meeting us, Dr. Hsieh brought us each a cup of latte, probably in anticipation to our jet-lag! It was so sweet of her! In addition, she even gave us her cell phone number in the end when she found out that we wouldn't have more rotation with her (she is only at Taipei hospital Tuesday mornings). Kind acts like these said so much about the Taiwanese people and had really touched our hearts.