My teacher, Li Yan, is the director of Rheumatology and Nephropathy Department of Kaifeng Traditional Chinese Medicine Hospital. She has been engaged in Chinese medicine for more than 30 years. During her 30-year medical career, she has never left patients and clinical frontline, and is a veritable Chinese medicine clinician. But I only followed the research for less than two years. In this short time, Mr. Li Yanmin not only gave me technical guidance, but also taught me what medical ethics is. She believes that "medicine is benevolence" and "as a doctor, we should treat patients as relatives and treat them sincerely, so that sick patients can drink the sweet spring of oranges and the honey fruit of apricot trees, get rid of difficulties and step into the smooth road."

Specializing in the treatment of difficult and severe diseases is a major clinical feature of Li Yanmin. It is difficult for anyone to count how many serious illnesses she has cured and saved.

For example, an aunt who suffered from heart disease for a long time was sentenced to no medicine in the West Hospital. The patient's aunt found Li Yan's democratic appointment with a glimmer of hope. After detailed examination, Li Yan Democratic Ren felt that the treatment of this difficult and serious disease was very difficult, but a doctor's sense of responsibility urged her to save the patient. So, she studied the condition and wrote the first prescription. In the future, the prescription will be constantly adjusted according to the changes in the condition to encourage patients to strengthen their confidence. After taking more than 50 doses, the patient miraculously recovered and could lead a normal life.

Another example is a patient with splenomegaly who went to many hospitals without finding out the cause. He also listened to the patient's introduction and found Li Yanmin, the director who specializes in treating intractable diseases. Under the detailed consultation and examination of Li Yan's democratic appointment, he helped patients find the cause-parasites! Saved the patient's life!

Another example is Jack who flew here from New Zealand. Blank, replace the heel with a ridge with a head, stumble. Various therapies at home and abroad are almost exhausted. This time, he will try to treat his low back pain with director Li Yanmin. The magical Chinese medicine made him stand firm, straighten up and take a solid step. After returning home, he excitedly telegraphed the benefactor to report the good news: Ms. Li Yanmin, thank you very much for curing my low back pain with magical medical skills. Everything feels good. Although I am 6 1 year-old, my body is as energetic as a teenager of 16 years old.

Li Yan Democratic Ren is proficient in Chinese medicine, gynecology and pediatrics, especially in internal medicine. He has profound attainments in kidney disease, heart disease, spleen and stomach disease, rheumatism, febrile disease and diabetes, and has unique clinical characteristics, rich experience and outstanding curative effect.

Li Yan's democratic appointment not only inherited the superb medical skills of the sages, but also inherited the excellent medical ethics of the Chinese nation. Under the training of "great doctors are sincere", she forged a heart of "saving lives". She worships Zhongjing's incisive exposition, and admires Zhongjing's sincerity of "going down to earth to save the poor and help the poor". Although she has a long reputation, she has no reputation as a famous doctor. Over the years, she has worked tirelessly and patiently received every patient. Generally speaking, most people in Li Yan's democratic office suffer from serious or difficult diseases. It is often seen that after working for a long time, she is still taking good care of those patients nicknamed "No.1", especially those rural patients who come from afar or can't hang up for a while, preferring to sacrifice rest for treatment. Some patients follow them home, or stop on the road. She always receives them kindly, arranges time for their patients' diagnosis and treatment, and never gets bored. For some patients who call for medical treatment, she always replies seriously, or adjusts the prescription, or encourages patients to enhance their confidence. Therefore, many patients not only regard her as a doctor who saves lives, but also regard her as their friend, spiritual sustenance and hope for recovery.

As a native of Kaifeng Traditional Chinese Medicine Hospital, Li Yan Democratic Ren promoted the development of Kaifeng Traditional Chinese Medicine Hospital with his superb medical skills and indomitable scientific research style. Many patients came here for treatment, and the Department of Rheumatology and Nephropathy of Kaifeng Traditional Chinese Medicine Hospital was established on 20 10. Li Yan's solid theoretical foundation of traditional Chinese medicine, accurate diagnosis and treatment and rich clinical experience enable her to practice superior medical technology. How many so-called "incurable" patients have recovered under her careful treatment. She is modest and prudent and never satisfied with her achievements. Although she has many patients, she still perseveres in her pursuit.

Since August, seven comrades from the Department of Traditional Chinese Medicine of Wanshou Road Community Health Service Center have participated in the academic experience inheritance of the fourth batch of famous and old Chinese medicine practitioners in Beijing and the first batch of famous and old Chinese medicine practitioners in Haidian District respectively. They have been studying with their teachers for nearly a year. Through this year's study, doctors in Chinese medicine department are deeply influenced by teachers' words and deeds, regardless of their basic theories, clinical skills and medical ethics, and they are quite touched and experienced.

My teacher, Director Lu Peiwen, is the former director of surgery in Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University. She graduated from the Department of Medicine of Capital Medical University in _ _ and was assigned to Beijing Hospital of Traditional Chinese Medicine for clinical and teaching work in the 1970s. Traditional Chinese medicine was initiated by famous old surgeons such as Zhao Bingnan and Fang Zhixuan. In the surgical treatment of various sores, breast diseases, peripheral vascular diseases, such as vasculitis, arteriosclerosis obliterans, Takayasu arteritis and other diseases, the medical skills should be rigorous, serious and meticulous, and there is no end to learning. 199 1 year, in order to save the medical heritage of the motherland and carry forward traditional medicine, Director Lu Peiwen became the academic heir of Professor Wang, inheriting Professor Wang's 50 years of medical skills, such as syndrome differentiation and treatment of breast diseases, syndrome differentiation of yin and yang of chronic ulcers, and the production and use of some traditional external medicines. Teacher Lu has been a doctor for 40 years and has rich clinical experience. I have the honor to be her student and study the knowledge of Chinese medicine surgery with her. As a community general practitioner of traditional Chinese medicine, I have just participated in clinical work for nearly three years, and my clinical experience is absolutely insufficient. I have never been exposed to the knowledge of traditional Chinese medicine surgery in the past, so these three years of study will be a very valuable experience and process for me.

Since I studied Chinese medicine surgery, my clinical thinking has been broadened. Traditional Chinese medicine internal medicine and traditional Chinese medicine surgery are both parts of traditional Chinese medicine, but they have many different concepts. From the internal medicine of traditional Chinese medicine, the common dialectical thinking focuses on the syndrome differentiation of zang-fu organs, which lies in the whole patient and often ignores the part of the patient; However, Lu Lao believes that as a surgeon of traditional Chinese medicine, apart from overall syndrome differentiation, local syndrome differentiation is also very important, and the overall syndrome differentiation should be combined with local syndrome differentiation. Because the most remarkable feature of surgical diseases is the existence of local lesions, they generally have obvious external manifestations. It mainly includes redness, fever, pain, suppuration, numbness, ulcers, nodules, lumps, itching, dysfunction and various skin lesions. Because of the intuitive existence of local lesions, it can effectively provide objective basis for clinical syndrome differentiation. There are also some systemic diseases, mainly in the local area. However, due to the different causes and degrees of the disease, it is far from obedient. Therefore, although surgical syndrome differentiation mostly starts with local lesions and focuses on local symptoms, it must not be based on local symptoms in isolation. Only by starting from the overall concept, combining local and systemic syndrome differentiation, combining external manifestations with pathological changes of five internal organs, seeking the cause of syndrome differentiation, comprehensively analyzing the essence of the disease, comprehensively differentiating syndrome, and grasping the main pathogenic factors of syndrome differentiation can we provide reliable basis for treatment.

In addition, Lu Lao always insists on the combination of traditional Chinese and western medicine, combining disease differentiation with syndrome differentiation, paying attention to clinical physical examination in clinic, and consolidating the basic knowledge of western medicine while using drugs based on syndrome differentiation. In addition to the four diagnoses of traditional Chinese medicine, Lu Lao also attaches great importance to clinical physical examination and has profound clinical knowledge of western medicine. All patients in need, whether they are first-time or follow-up, she patiently examines, asks carefully and palpates one by one. Surgical patients are special, such as diabetic foot, breast abscess and other traumatic diseases, and some patients can't stand the pus and stench of local wounds. However, Mr. Lu is not afraid of being dirty or tired, and checks carefully one by one. And carefully check the patient's western medicine examination report, explain the condition and related matters needing attention, so that patients can have a deeper understanding of their own condition and win the gratitude and gratitude of patients. Teacher Lu's professionalism and good doctor-patient relationship remind us that the younger generation of doctors should learn the basic knowledge of western medicine, pay attention to the most basic clinical physical examination, don't always rely on various auxiliary examinations, and at the same time communicate well with patients to enhance their confidence in treating diseases.

One year's study with the teacher is fleeting. Although through this period of study, I have a preliminary understanding and experience of western medicine diagnosis and Chinese medicine treatment of surgical diseases such as mammary gland hyperplasia, peripheral vascular disease and eczema, but these are not enough. There is still a big gap between the stage expected by myself and my teacher and the requirements put forward by my superiors. I will continue to work hard, cherish the study with teachers in the remaining two years, and continue to move forward on the road of inheritance and development of traditional Chinese medicine. Self-improvement, constantly improve their technical level, live up to the expectations of hospital leaders, colleagues and teachers, and strive to become an excellent community Chinese medicine practitioner and a guardian of the health of community residents.

The development of theoretical system of traditional Chinese medicine is mostly based on the experience summarized by predecessors, but what is lacking in learning now is clinical experience and the guidance and answering questions of the previous generation, which makes learning completely theoretical and too abstract to make theoretical knowledge more solid with practice.

During my one-year study as a teacher, I got careful guidance from Mr. Chen Ming in learning Chinese medicine. I still clearly remember the first day with my teacher. Mr. Chen Ming kindly asked me about the difficulties in my study and what I wanted to know more. Because Mr. Chen Ming is in the Chinese medicine class, he recommended us to recite the three-character medical classics and teach us to recite them more. Memory is the basis and the most important thing in the learning process of TCM. Even if you can't fully understand the essence of the contents in the book, you must rely on rote learning, so that you can fully understand the will in the book in clinical practice. After making the study plan, the teacher took me around the whole hospital and patiently told us some hospital stories.

In the process of following the teacher, you can learn a lot of knowledge that you can't learn in class. In the conversation with the teacher, I can learn what good methods she has in reading classics. I can also get a deeper understanding from a shallow understanding and correct my biased understanding. When learning any subject, the most precious thing is to get the guidance and instruction of predecessors. While strengthening the learning objectives, it can also deepen understanding and expand the knowledge field. Most of the great men in the world have succeeded on the shoulders of others. Only with the experience of previous failures can we start to study from more other aspects. It is precisely because of the successful experience of predecessors that more people can have the confidence to strengthen their goals and achieve more and better success. It is precisely because of the experience of our predecessors that we can succeed faster and better, and we can continue to learn at a higher and deeper level on the basis of success. Only in this way can society progress. In the course of my life, following the teacher is a great gain, which makes me have a deeper understanding of Chinese medicine learning, and also makes me understand the distance between theory and practice and the importance of combining theory with practice. In the process of learning Chinese medicine, we often feel the abstraction of theoretical knowledge, so that we can't really understand its meaning, have no solid theoretical foundation, and can't fully understand its theoretical meaning in actual clinic.

Therefore, in the process of learning from teachers, we must lay a solid theoretical foundation and memorize more theoretical knowledge, which is for better combination with clinic, better integration into clinic and better use of what we have learned. This month, we can attend the surgeon seminar again. Everyone is divided into groups. In each group, besides studying together, we can also discuss the problems encountered in clinic and exchange different opinions on dealing with diseases. In our communication, we can learn more people's ideas and learn to understand the same problem from different aspects.

It also exercises our expressive ability. Therefore, I hope this system can continue and let us learn more knowledge. As the old saying goes, "One day as a teacher, one life as a father". In the process of learning, we should get along with teachers, respect each other and advocate some traditional good behaviors. When we meet the truth over time, teachers will definitely give their knowledge to each other.

As we all know, Chinese medicine is the national treasure and quintessence of our country, which has played an important role in the health of our people and national reproduction for thousands of years. Acupuncture is a cultural treasure of our country. It is a profound, comprehensive and rich knowledge. For thousands of years, it has occupied an important position in the medical history of China with its unique characteristics. Acupuncture therapy has the advantages of wide indications, remarkable curative effect, convenient application, economy and safety. It is loved not only by the people of China, but also by more and more people all over the world. Many people want to know it and learn it, but perhaps because of its profundity, many people think they can't learn it and don't know where to start. As a nurse, I have been engaged in clinical diagnosis and treatment of traditional Chinese medicine acupuncture with Dr. Zhu Bao for several years, and I am deeply fascinated by this ancient medical skill, just as it is recorded in Huangdi Neijing that "a needle just falls, which is heavy and harsh". During several years' practice, three nurses in our hospital have mastered several appropriate techniques of traditional Chinese medicine, such as acupuncture, cupping, wax therapy, fumigation and massage, through their own study and the guidance of clinicians, and achieved certain results in clinical work. Now, according to our learning experience, we will talk about some experiences of acupuncture therapy.

First, follow the overall concept of traditional Chinese medicine and strengthen the curative effect of acupuncture.

Chinese medicine attaches great importance to the unity and integrity of human body and the relationship between human body and nature. It holds that the human body is an organic whole and constitutes all groups of the human body.

Among all the components, they are inseparable in structure, coordinated and utilized in function and influenced each other in pathology. At the same time, it is also recognized that the human body is closely related to the natural environment, and human beings maintain the normal life activities of the body in the struggle of actively adapting to and transforming nature. This concept of the unity of the internal and external environment and the integrity of the body itself is called the holistic concept. In clinical acupuncture treatment, the overall concept is particularly important. We should not only consider the physiological and psychological factors of patients, but also pay attention to the influence of seasonal climate, morning and evening, and region on patients. Professor Wang Wenyuan, the founder of balance acupuncture and an expert in balance acupuncture of Beijing Military Region General Hospital, believes that the human body itself is a self-balancing system with its own functions of adjustment and repair. Therefore, in the process of acupuncture, it is necessary to make patients move towards a comfortable position, actively communicate with patients, make patients fully understand acupuncture therapy and curative effect, relieve patients' psychological scruples and fear of pain, and actively cooperate with doctors in order to achieve better curative effect through the adjustment and balance of the human body itself. In addition, pay attention to the patient's state and physique. Hungry patients should not have acupuncture. If acupuncture is needed, it is advisable to take fewer points and prick lightly. Acupuncture is not suitable for people who are too full. If acupuncture is needed, it is not suitable for deep needling or straight needling in the upper abdomen. For those who are sweating, bleeding, old and weak, acupuncture should be light; It is not advisable to prick the needle immediately after strenuous exercise. Third, under the influence of different seasons, the human body adapts with different physiological functions. For example, in spring and summer, the yang rises outward, and qi and blood are easy to float on the body surface, so the skin is slack and the human body adjusts by sweating and radiating heat. In autumn and winter, the yang converges and qi and blood are trapped inside, so the skin is dense and sweating is reduced, and the water in the body must be discharged from the stool. Therefore, after acupuncture in spring and summer, the patient's skin is slack and vulnerable to wind evil, so he must bite.

Tell the patient not to rush to take a shower and blow-dry, so as not to aggravate the condition.

Second, master the principle of acupoint matching and choose acupoints flexibly.

1. Flexible application sequence Because the main functions of various acupoints in the human body are different, there are main points and matching points when selecting acupoints. Under the guidance of Dr. Zhu Bao in our hospital, we have mastered the "Eight-point Qu" which is widely used in acupuncture clinic: leave the abdomen for three miles, find the center of the waist and back, find the first deficiency, close the mouth and grain, take out the chest, plot the lower abdomen, bone spurs jumping around, and leg pain. These eight sentences are * * * forty words. Speaking of an acupoint in each sentence and five words in each sentence means talking about an acupoint and the part it treats. For beginners of acupuncture and moxibustion, we have great enlightenment in acupoint matching. Dr Zhu Bao also emphasized the order of acupoint selection. In clinical application, the order of acupoint selection should be flexibly grasped according to the patients' priorities. Such as paroxysmal pain, it is easy to puncture far away first, and the pain can be improved by the method of guiding qi through the remote induction of meridians, so as to avoid muscle tension caused by pain and allergy in the affected part, which will make it difficult to enter the needle and aggravate the pain. For another example, stomachache often pricks the distal Zusanli point first, and then pricks the middle; Trigeminal neuralgia first purges the valley, and then takes the head and face points. It can be seen that the different order of acupoint selection directly affects the clinical curative effect.

2. The principle of selecting points along meridians is suitable for clinical symptoms. Dr. Zhu Bao advocated selecting points on his own or related meridians according to the principle of "selecting points along meridians" and the theory of viscera and meridians. On the premise of clear differentiation of symptoms and signs, the acupoints on the meridians related to the disease are directly selected for treatment. Clinically, the acupoints at the far end of the meridian are often selected as the main acupoints, and these acupoints are in the meridian.

Up and down, in and out of the place, with the function of far and near contact, has a direct therapeutic effect on diseases such as the head, face, trunk and organs of meridians. The aforementioned "Eight-Fan Acupoint Selection Qu" is a high-level summary of clinical acupoint selection methods along meridians. In clinical application, it is more common to select points by this channel and other channels. For example, angina pectoris and palpitation caused by hand-Jue Yin meridian disease take Neiguan, cough caused by hand-Taiyin meridian disease takes Chi Ze, and hemoptysis takes the most points. In addition, there are many methods of acupoint selection, such as acupoint selection next to middle disease, acupoint selection near and far, etc., which are applied clinically according to the condition.

3. Acupoint selection for pain is based on the principle of "taking pain as pleasure". On the basis of selecting acupoints along the meridian, directly select the acupoints reached by the meridians of the affected part, with local acupoint selection as the main method. Such as eye disease mystery, ear disease hearing palace, knee pain stabbing calf nose.

4. Flexible reinforcing and reducing, dialectical treatment In the application of reinforcing and reducing manipulation, Dr. Zhu Bao attaches importance to acupuncture manipulation and thinks that the correct application of reinforcing and reducing manipulation is the key to acupuncture efficacy. He believes that after acupuncture of middle qi, it should be treated according to different physiological and pathological conditions and the rise and fall of qi and blood, with different acupuncture intensity, frequency and duration, and the reinforcing and reducing needles are divided into three categories: light supplement, heavy supplement and heavy supplement. For different patients or even the same patient, it should not be static, but should be treated according to the changes of the condition. For example, in the treatment of patients with biliary colic, at the beginning, acupuncture at Yangling Spring was used to relieve pain, and then acupuncture at other acupoints was used to keep menstruation smooth, thus achieving the therapeutic purpose.

Through the study of integrating theory with practice, we have mastered the methods of acupuncture and physiotherapy and gained some experience, but it is vast.

In the world of traditional Chinese medicine, these are only superficial. I want to sum up my experience and learn from my colleagues. Please forgive my shortcomings.

Clinical research of traditional Chinese medicine is a process of combining theory with practice. How to apply the theoretical knowledge to clinical practice and master it well is what every student who enters the clinical stage expects to achieve. However, after students enter the clinic, they find that there is a great difference between clinical learning and theoretical learning, which is difficult to master for a while. There is always a feeling that they are anxious to see a doctor every day but get little. After studying with the teacher for so many days, let's talk about how to be clinical with the teacher according to my learning experience.

First, we should pay attention to cultivating practical ability.

The practical ability of traditional Chinese medicine is the exercise of observing, smelling, asking and palpating. The "four diagnoses" of traditional Chinese medicine is definitely not an "advanced technology" that can be simply replaced by a photo once. We must combine past knowledge with present symptoms; It can only be obtained through instant random communication with patients. At the same time, the "clear knowledge" that can be accurately expressed and recorded in books is only a small part. More knowledge of human beings is something that can only be understood but difficult to express. As the saying goes, "A word is true and thousands of books is false." Only by learning from teachers and setting an example can we master the essence of traditional Chinese medicine. Clinical practice has proved that in the development of diseases, the changes of tongue are rapid and vivid, and it is like a mirror of internal organs. The deficiency of viscera, the rise and fall of qi and blood, the profit and loss of body fluid, the depth of disease and the prognosis can all be objectively reflected from the tongue picture, which becomes an important basis for doctors to diagnose diseases. If you see a pale white tongue, it is mostly qi and blood deficiency or yang deficiency; If you see red tongue, it is mostly heat syndrome. If you see purple tongue, it means that the blood flow is not smooth. Clinical observation is needed to obtain accurate information. Another example is "to treat exogenous fever in children, we must look at the tongue first and then examine the throat", and the throat is a "yin place", which is of great significance to distinguish between cold and heat deficiency and excess. For example, the throat is red and swollen, which is the real fire; Red dryness is yin deficiency; Not red or swollen, it is yang deficiency; A sore throat that is not red or swollen is really hot in winter vacation, and a sore throat that is red and swollen but shows cold syndrome all over the body is really hot and fake cold. You should pay attention to skills in consultation, and also learn the methods and skills of teacher consultation when you learn from teachers. This is a long-term training process.

When I first went to the clinic, I often tried to be perfect and detailed according to the method of western medicine asking about medical history, but after asking, my mind was at a loss and I didn't understand until I imitated the teacher's consultation. The consultation of traditional Chinese medicine depends on the theoretical level and clinical skills of doctors. The main purpose of consultation is to confirm a disease or a syndrome or to exclude a disease or a syndrome. As for pulse diagnosis, we must first master the characteristics of pulse condition. If the pulse condition of floating pulse is characterized by shallow pulse position, you can take it gently and put it down, and then press it slightly but not empty, such as floating wood like water. Reflect the location of the disease in the table. The pulse condition of deep pulse is characterized by deep pulse position, which should not be taken lightly, but should be weighed as heavy as a stone sinking into the water. Reflect that the disease is located in the hospital. After mastering the characteristics of pulse conditions, it is best to start with several common and simple pulse conditions, such as floating, sinking, late, counting, string, thin and red, under the guidance of a teacher with rich experience in pulse feeling, and make a careful clinical experience. Second, experience it often. Learning to feel the pulse is like playing a ball, which emphasizes the "feel" and must be persevered and often trained consciously. Over time, you will learn something. When I followed my teacher to the clinic for the first time, the teacher pointed to an old man with high blood pressure and asked me to take my pulse and see what it was. I can blurt out the pulse characteristics of more than 20 pathological pulse conditions in books. I also read the book Hu Ling Pulse Sutra very well, but once I went to the clinic, I was "hard to understand" and said timidly, "The pulse condition is so hard, like a tight rope". The teacher smiled and said, "Yes. I suddenly realized, isn't the string pulse "straight and long, like pressing a string" From then on, I was no stranger to string pulse, and realized that seeing the string pulse of middle-aged and elderly people, especially the left closed pulse, is strong and powerful, which is mostly a precursor to the hyperactivity of liver yang and even the movement of liver wind. Be sure to take large doses of products that calm the liver and suppress yang, calm the liver and calm the wind, and prevent problems before they happen.

Second, we should make medical records.

When you go out with your teacher every day, you should make a good medical record. The principle of recording should be detailed, including your tongue pulse for future reference. Some common diseases can be recorded simply, while difficult and rare diseases should be recorded in detail, including the teacher's medication.

Carefully recording medical records is the best way to collect original data. Whenever I encounter intractable diseases in clinic, I always review my previous medical records several times and often find some good solutions.

Third, be diligent in thinking.

Follow the teacher's clinic to ask about the medical history, take the pulse, record and think about the teacher's prescription. After four consultations, I thought about what syndrome type this disease is, what main prescription to use, and how to add and subtract. Then see if it is consistent with the dialectical thinking of the teacher and whether the prescription and medication are the same. If they are the same, you will know that your dialectical thinking is basically consistent with the teacher's. If not, you should consider where your gap is, and even ask the teacher to point out the maze. What's wrong with my thinking? Which medicine is useless and which one is right, teacher.

Why do you use it like this? Wait a minute. Sometimes teachers must carefully consider special prescriptions or special doses.

Fourth, learn to get along with patients.

Treat patients like relatives, be considerate of patients, let patients cooperate with you better, let you have an examination and answer your questions. Finally, we should "study hard, see a doctor hard, sum up hard, and be a man hard". These experiences in reading, clinic and being a man are hard for us to learn in class and books.

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