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Nuclear Medicine ..................................................................................... 2

Preventive Medicine................................................................................. 8

Diagnostics .............................................................................................. 14

Geriatrics ................................................................................................ 24

Traditional Chinese Medicine ............................................................... 30

Rehabilitation Medicine ........................................................................ 59

Biomedical Information Retrieval........................................................ 62




                                                      1
                     Syllabus for Clinical Nuclear Medicine


Introduction to Nuclear Medicine

Students are supposed to understand:

1. Concept of nuclear medicine and its contents.

2. Development of nuclear medicine, its role and function in medical science.

3. How to learn nuclear medicine ?

Chapter 1 Basic Physics
After completion of this chapter, the student shall:

1. Master the composition and notation of nucleus

2. Master the concept of nuclide and its classification

3. Be familiar with modes of radioactive decay

4. Master the decay of radioactivity

5. Understand the interaction of charged particles and high-energy photons with matter

6.

Chapter 2 Nuclear medicine instruments and computer
After completion of this chapter, the student shall:

1. Master the basic composition and principle of nuclear medicine instruments

2. Master the basic composition and principle of scintillation detector

3. Be familiar with the basic principle of other detectors

4. Master the principle of pulse-height analyzer

5. Master the basic composition and principle of gamma camera, SPECT and PET

6. Master computer applications in nuclear medicine

7. Understand nuclear counting statistics

8. Understand quality control of nuclear medicine instruments

Chapter 3 Radiopharmaceuticals
Upon completion of this chapter, you should be able to:

1. Master the basic mechanisms of commonly-used radiopharmaceutical localization.


                                                       2
2. Master the physical characteristics of commonly-used single-photon radionuclides used in clinical

    nuclear medicine.

3. Be familiar with and correctly use the following terms:

    radiopharmaceuticals     radiochemicals      radionuclidic purity    radiochemical purity

4. Understand Molybdenum-99/Technetium-99m generator systems; Technetium chemistry and

    radiopharmaceutical preparation; Quality assurance of Technetium-99m-labeled

    radiopharmaceuticals.

Chaper 4 Brain Imaging
Students are required to review the anatomy and physiology of brain.

Upon completion of this chapter, you should be able to:

1. You are supposed to master:

     (1) The principle of brain perfusion imaging.

     (2) Commonly employed radiopharmaceuticals for brain perfusion imaging.

     (3) Image interpretation and clinical application of brain perfusion imaging.

     (4) The principle of cerebral spinal fluid (CSF) imaging of cisternography.

     (5) Image interpretation and clinical application of cerebral spinal fluid (CSF) imaging of

         cisternography.

2. You are supposed to familiar with:

     The Clinical protocol for brain perfusion imaging and cerebral spinal fluid (CSF) imaging of

     cisternography.

3. You are supposed to understand:

     (1) The principle, clinical protocol and application of brain metabolism imaging.

     (2) The principle, clinical protocol and application of brain receptor imaging.

     (3) The principle, clinical protocol and application of planar brain imaging (function of brain blood

         barrier).

Chapter 5 Endocrine System
Students are required to review the anatomy and physiology of thyroid.

By the end of this chapter, you should be able to:

Master: (1) The principle of radioactive iodine uptake (RAIU) test, its results explanation and


                                                     3
            clinical significance.

       (2) The principle and clinical indications for thyroid imaging.

       (3) Interpretation of thyroid image (hot nodule, warm nodule, cold nodule).

       (4) Clinical application of thyroid imaging.

Be familiar with: (1) Clinical procedure of RAIU.

                  (2) Factors affecting RAIU.

                 (3) Clinical procedure and technical consideration of thyroid imaging.

Understand: (1) Parathyroid imaging.

            (2) Adrenal imaging (adrenal cortex imaging and medulla imaging).



Chapter 6 Cardiovascular System
Students are required to review cardiac anatomy and physiology.

By the end of this chapter, you should be able to:

Master: (1) Myocardial perfusion imaging (principle, image analysis and clinical application).

       (2) Myocardial glucose metabolism imaging (principle, image analysis and clinical

            significance).

       (3) Multiple gated cardiac blood pool imaging (principle, clinical indication, results

            analysis).

Be familiar with: (1) Imaging protocols, indication of Myocardial perfusion imaging.

                  (2) Commonly used radiopharmaceuticals for Myocardial perfusion imaging.

                 (3) Infarct-avid imaging (myocardial hot spot imaging).

                 (4) Radionuclide angiocardiography

Understand: (1) Myocardial fatty acid metabolism imaging.

            (2) Radionuclide venography.

            (3) Cardiac receptor imaging.

Correctly use of the following terms:

     Redistribution      treadmill exercise testing       pharmacologic stress testing

     Reversible ischemia       fixed defects     polar map analysis

     fluorin-18-deoxyglucose (18F-FDG)          myocardium viability        stunning myocardium


                                                      4
     hibernating myocardium        ejection fraction       phase analysis

Chapter 7 Gastrointestinal System
Students are required to review the relevant anatomy and physiology.

Upon completion of this chapter, you should be able to:

Master: (1) Localization of gastrointestinal bleeding (principle and image analysis).

         (2) Detection of Meckel’s diverticulum (principle and clinical application).

       (3) Gastric empting (principle and clinical application).

       (4) Salivary gland imaging (principle and clinical application).

Be familiar with: (1) Clinical procedure of gastrointestinal bleeding imaging.

                 (2) Gastroesophageal reflux (principle and clinical application).

Understand: (1) Clinical application of gastrointestinal bleeding imaging.

            (2) Clinical procedure of Gastroesophageal reflux.



Chapter 8 Liver and hepatobiliary imaging
Students are required to review the relevant anatomy and physiology.

Upon completion of this chapter, you should be able to:

Master: (1) Hepatobiliary imaging (clinical indications, normal appearance and clinical

            applications).

        (2) Liver blood perfusion and blood pool imaging (principle, normal appearance, clinical

            indications and evaluation).

Be familiar with: (1) Radiopharmaceuticals for hepatobiliary imaging.

                 (2) Liver colloidal imaging.

Understand: (1) Clinical procedure of hepatobiliary imaging.

            (2) Hepatocarcinoma imaging.

            (3) Radiopharmaceuticals and imaging techniques for Liver blood perfusion and blood pool

               imaging.

Chapter 9 Respiratory System
Students are required to review the anatomy and physiology of respiratory system.

Upon completion of this chapter, you should be able to:

                                                       5
Master: (1) Pulmonary perfusion imaging (principle, clinical indications and applications).

       (2) Pulmonary ventilation imaging (principle, clinical indications and applications).

Be familiar with: (1) Imaging procedure and image interpretation of pulmonary perfusion imaging.

                    (2) Imaging procedure and image interpretation of pulmonary ventilation imaging.

Understand: (1) Pulmonary tumor imaging.



Chapter 10 Skeletal System
Students are required to review the anatomy and physiology of skeletal system.

Upon completion of this chapter, you should be able to:

Master: Bone imaging (principle, clinical indications and applications).

  Be familiar with: Imaging procedure, radiopharmaceuticals and image interpretation of bone imaging.

Correctly use of the following terms:

  Bone dynamic imaging (three-phase bone imaging) superscan flare phenomenon



Chapter 11 Blood and Lymph System
Students are required to review the relevant anatomy and physiology.

Upon completion of this chapter, you should be able to:

Master: (1) Bone marrow imaging (principle, clinical indications, clinical application and evaluation).

        (2) Lymphatic scintigraphy (principle, clinical indications, clinical application and evaluation).

Be familiar with: (1) Radiopharmaceutical, imaging procedure and image interpretation of bone marrow

            imaging.

                   (2) Radiopharmaceutical, imaging procedure and image interpretation of lymphatic

            scintigraphy.

Understand: Spleen imaging.



Chapter 12 Genitourinary System
Students are required to review the relevant anatomy and physiology.

By the end of this chapter, you should be able to:

Master: (1) Renogram and diuresis ranogram (indications, results analysis and clinical applications).

                                                     6
          (2) Renal imaging (perfusion imaging and static imaging): principles,      indications, results

            analysis and clinical applications.

Be familiar with: (1) Measurement renal glomerular filtration rate.

                 (2) Measurement of effective renal plasma flow.

Understand: Scrotal imaging.



Chapter 13         Radionuclide Therapy
By the end of this chapter, you should be able to:

Master: (1) Radioiodine therapy for hyperthyroidism (principle, indications and contra-indications,

            therapeutic reactions and patient management, patients’ follow-up).

        (2) Radioiodine therapy for thyroid carcinoma (clinical significance, indications and

            contra-indications of ablating thyroid remnants with radioiodine for differentiated thyroid

            cancer).

        (3) Radioiodine therapy for the metastases of differentiated thyroid cancer (DTC): indications

            and contra-indications, therapeutic protocols.

Be familiar with: (1) Patient preparations and protocols of radioiodine therapy for hyperthyroidism.

                       (2) Patient preparations and therapeutic reactions of radioiodine therapy for

                            DTC.

Understand: Treatment of bone metastases with radionuclide (153-samarium-EDTMP, 89-strontium).




Required reading: Nuclear Medicine The Requisites/Second Edition, JAMES H. THRALL, HARVEY

A. ZIESSMAN. 2001 by Mosby, Inc.



Suggested reading: Review of nuclear Medicine Technology ANN M. STEVES. 1996 by the Society

of nuclear medicine, Inc.




                                                     7
                           Syllabus of Preventive Medicine
Preface
    Preventive medicine is a discipline that studies and emphasizes the promotion of health and

well-being of human being through a realistic, supportive, and holistic approach, which includes, but is

not limited to, disease prevention and reversal. All medical students should acquire and maintain basic

knowledge, theories and skills in preventive medicine, which is an integral part of the stream of

medicine.

    Preventive medicine covers a wide range of components. This subject will illustrate the impacts of

biological, human behavior and life style, environmental, and healthcare factors on health and introduce

the essential principles and methodology in preventive medicine. The aims and objectives are to enable

the students to organize population-based health activities and to evaluate health outcomes of

community interventions.

    Students are expected to gain their knowledge and skills through attending lectures, participating

group discussion, reading, and completing assignments.

    Lecturing time: 52 hours

             1. Introduction                                                       2
             2. Determinants of health                                             4
             3. Biological factors and health                                      6
             4. Human behaviour and health                                         4
             5. Environments (Chemical and physical) and health                    14
             6. Social environments and health                                     4
             7. Health risk appraisal                                              4
             8. Population health measurement                                      6
             9. Quality of life assessment                                         4
             10. Primary health care and social approach to health                 4




                                                   8
                                            Introduction
[Objectives]

     Master: the basic concepts of public health, health promotion, and preventive medicine.

     Familiar with: the principles of preventive practice.

     General understanding of: history and evolution of preventive medicine

[Lecture time] 2 hours

[Lecture contents]

     1. Concept of public health;

     2. Concept of preventive medicine;

     3. Concept of health promotion;

     4. Concept of community health services;

     5. History and evolution of preventive medicine and public health;

     6. Three tier prevention: primary, secondary, and tertiary.



                                          Determinants of health
[Objectives]

     Master: WHO definition of health; health risk factors defined in Dever model; Bio-psycho-social

medical model;

     Familiar with: Biomedical model and it’s impact on health service delivery; International trend in

organizing health care services.

     General understanding of: transform of medical model and it’s impact on the pattern of service

delivery.

[Lecture Time]       4 hours

[Lecture contents]

     1. WHO definition of health;

     2. Bio-psycho-social medical model;

     3. Four categories of health risk factors and importance of holistic approach to health;

     4. Contribution and limitation of biomedical model in health service system;

     5. Transform of medical model.


                                                     9
                                      Biological factors and health
[Objectives]

     Master: epidemic process of infectious and communicable diseases; control methods of

communicable disease.

     Familiar with: Roles of environments and human behaviour in the impact of biological factors on

health (agent-host-environment); epidemic characteristics of influenza and AIDS.

    General understanding of: International trend of disease pattern; reasons for the outbreak of

infectious diseases.

[Lecture time] 6 hours

[Lecture contents]

     1. Change of disease pattern;

     2. Reasons for the outbreak of infectious diseases;

     3. The epidemic process of infectious diseases;

     4. Control of infectious diseases through environment and behaviour interventions;

     5. Influenza and AIDS.



                                     Human behaviour and health
[Objectives]

     Master: concept of health-related behavior and its characteristics.

     Familiar with: The basic theory, principle and mechanism in behavior changes;

     General understanding of: Major behavior issues with related to health, including smoking, alcohol and drug abuse,

lack of exercises, and unbalanced diet.

[Lecture time]    4 hours

[Lecture contents]

     1.   Relationship between human behavior and health;

     2.   Factors that shape human behavior;

     3.   Basic theory and principles of social psychology;

     4.   Six steps in changing behavior;

     5.   Smoking and health.

                                                             10
                 Environments (Chemical and physical) and health
[Objectives]

    Master: health significance of environmental factors, such as metal exposure, chemical substances,

and physical environment.

    Familiar with: handle occupational health issues

  General understanding of: Food chain and mechanism of environmental factors impacting on health.

[Lecture time]    14 hours

[Lecture contents]

    1. Ecosystem, food chain, and bioconcentration;

    2. Climate and health;

    3. Occupational hazards.

    4. Lead and health;

    5. Mercury and health;

    6. Pesticide and health;

    7. Noise and health;

    8. Food hygiene and nutrition;




                               Social environments and health
[Objectives]:

    Master: the influences on health of economy and family.

    Familiar with: the influences on health of social class, culture and education.

    General understanding of: the influences on health of culture, Mechanism of social factors

impacting on health.

[Lecture time] 4 hours

[Lecture contents]

    1. Economic development and health;

    2. Social class and health;

    3. Culture and health;

    4. Family and health;

                                                   11
     5. Education and health.




                                      Health risk appraisal
[Objectives]

     Master: Concept of health risk factors and health risk appraisal;

     Familiar with: appraisal age and achievable age; steps of HRA technique;

     General understanding of: stage of chronic illness and mechanism of preventing and controlling

chronic conditions.

[Lecture Time] 4 hours

[Lecture contents]

     1. Health risk factors;

     2. Stages of occurrence of chronic conditions;

     3. Health risk appraisal technique;

     4. Application of health risk appraisal in health education and insurance arrangement;

                               Population health measurement
[Objectives]

     Master: How to measure population health and to explain the implications of indicators of

population health.

     Familiar with: different population health indicators representing magnitudes and severity of health

problems, such as incidence, prevalence, birth rate, fertility rate, mortality, morbidity, standard

prevalence, burden of disease, PYLL and QALY.

     General understanding: Data quality and information infrastructure developing in measuring

population health and it’s implication in policy making.

[Lecture time] 6 hours

[Lecture contents]

     1. Methods to measure status of population health;

     2. Population health indicators and implications;

     3. Information needs for measuring population health.



                                                    12
                                  Quality of life assessment
[Objectives]

    Master: concept, domains and characteristics of quality of life;

     Familiar with: How to use quality of life assessment in evaluating health service programs;

     General understanding of: How to develop instrument that assesses quality of life.

[Lecture time] 4 hours

[Lecture contents]

    1. Concept of quality of life;

    2. Domains and components in assessing quality of life;

    3. Using health related quality of life assessment in evaluating health service outcomes;

    4. Developing quality of life assessment instruments.




                 Primary health care and social approach to health
[Objectives]

  Master: concept of primary health care; health service utilization analysis.

    Familiar with: Ala Malta Declaration and Ottawa Charter.

    General understanding of: social approach to health; institutional arrangements of public health

services and community health services.

[Lecture time] 4 hours

[Lecture contents]

    1. Health for all and primary health care;

    2. Community oriented primary care;

    3. Ala Malta Declaration and Ottawa Charter;

    4. Social approach to health.




                                                    13
                           Teaching Outline for Diagnostics
Reference:

textbook of physical diagnosis –history and examination (4th edition)

by Mark H.Swartz



The Outline of Clinical Record
1. Master the basic framework of clinical record:
●General information of Patient

Patient’s basic data: patient’s full name, sex, age and occupation, date of admission, and the date of

recording case report, et al.

 ● History

①Chief Complaint

②History of Present Illness

③Past Medical history

④Review of Systems

⑤Personal History

⑥Marital History

⑦Menstrual and reproductive History

⑧ Family History

 ● Physical Examination

 ● Lab. Exam and Other Special Exams

 ● Abstract of the Case

 ● Impression and Signature



2. Be familiar with the skills for writing chief complaint and history of present illness; the main points
for whole physical examination record



3. Recognize the writing skills for accuracy, fluency, clearness and standardization, especially the
                                                    14
process of occur, development, treatment and response of disease.



The outline of

                             physical examination for skin, head and neck

Ⅰ. Skin
    Give the explanation and definition of the following nomenclature which state the common

menifestations of skin in pathological conditions.

A. Color-related abnormalities: pallor, cyanosis, redness, pigmentation, vitiligo, and jaundice (icterus).

B. Skin texture: rough and dry (as seen in hypothyrodism), velvety smooth (as in hyperthyroidism)

C. Elaslicity. Loss of elasticity(in ageing, dehydration)

D. Skin eruption (rashed):maculae, papules, urticaria, and maculopapulae, etc.

E. Subcutaneous hemorrhage.

F. Spider angioma (common region)

G. Edema. Location(eyelids, face, ankle, pretibular or generalized), pitting or non-pitting. Specify the

underlying conditions.

H. Hirsutism

I. Subcutaneous nodule

Ⅱ. Head
Inspection

A. Importance of appearance of face. Facial expression and the expression of eyes are the windows ones

healthy conditions physically and psychologically.

nephrotic appearance, Cushing’s appearance, mitral appearance, hepatic and hyperthyroidic appearance,

cachexia, myxedema, cretinism. “moon face”.

B. Hair. distribution pattern of (sex determined) dry and brittle(hypothyroidism or chemical injury). fine

texture, loss of moustache or beard (hypoandrogenism)

C. Skull (cranium)

shale/size, micro- and macro-encephalus, features of acromegaly, deformity of the skull as seen in

Paget’s desease or hydrocephalus.

Ⅲ. Neck
A. Topography of the neck

                                                     15
  Schematically illustrate the useful anatomical markers in neck: the sternocleidomastoid muscle, the

sternal and clavicular bones, the anterior and posterior triangles, the supraclavicular fossa, the thyroid

cartilage and the thyroid gland.

B. Inspection: pulsation of jugular vein, goiter, nuchal mass.

C. Palpation:

    a. Cervical lymph node----size, texture, consistency, tenderness? Movable of adherent to

      surrounding tissues. Superficial or deep node location: submental, submandibular, jugular

      posterior cervical and supreclavicular.

      The implication of “sentinel node”, or “virchow’s node.”

    b. The palpation of thyroid gland. Specify the skill of exam: The anterior approach and the posterior

      approach.Ismuth and lobes of the glands, size, texture, the presence or absence of tenderness,

      nodules, thrill.

    c. Trachea. Deviation of trachea. The displacement of this organ may be pushed to the opposite side,

      or be pulled toward the affected side by various desorders.

    d. Supple or stiff neck, the latter is seen in meningitis

D. Ausculation. Bruit of vessels over the thyroid gland (thyrotoxicosis)




An outline of

                              physical examination for skin, head and neck

                                                Vital signs
1. Equipment Needed

   A thermometer

   A watch displaying seconds

   Sphygmomanometer

   A stetescope

2. General Considerations

① Measure body temperature

   Body temperature can be measured in several different ways


                                                      16
    Learn how to measure the axillary body-temperature with a nercury thermometer.

    The patient should not have had alcohol, tobacco, caffeine, or performed vigorous exercise within

       30 minutes of the exam.

② Measure respiratory rate

    Best done immediately after taking the patient's radial pulse. Don’t announce that you are

         measuring respirations.

    Count breaths for 30 seconds and multiply this number by 2 to yield the respiratory rate per minute.

    The depth and thythm of respitation should also be noticed.

③ Measure pulse

    Learn how to measure the patient’s pulse and record the rate and rhythm.

    Note whether the pulse is regular or irregular and intensity.

④ Measure blood pressure

    Learn how to use the Sphygmomanometer correctly.

    Learn how to measure blood pressure.

    Note positions of the patient , the cuff and the blood-pressure meter.

    Blood pressure should be taken in both arms at the first visit.

    Record the blood pressure as systolic over diastolic ("120/75 mmHg" for example).

--------------------------------------------------------------------------------

Head
    Observe scars, lumps, rashes, hair including color, density, lustre and distribution, or other lesions.

    Look for facial asymmetry, involuntary movements, or edema.

    Palpate the entire skull to identify any areas of tenderness or deformity.

Eyes

    Test for near vision and visual acuity.

    Observe cornea, sclera, conjunctiva and lacrimal puncta.

    Evaluate extraocular muscle function.

    Learn how to check pupillary direct and consensual response to light.

    Learn how to check for convergence and accommodation.

Ears


                                                             17
    Obeserve and palpate the auricles and the mastoid processes for tenderness or deformity.

    Learn how to evaluate auditory acuity.

Nose
    Observe and palpate external nose.
    Observe nasal vestibule without otoscope.
    Press accessory sinuses of nose for tenderness.
Mouth
    Observe lips, teeth, gums, tougue and floor of mouth under the tougue.

    Learn how to use a wooden tongue blade and a good light source to inspect the inside of the

       patients mouth including the mucosa and the posterior oropharynx includng tonsils.

    Note edema, ulcers , neoplasm, etc.

--------------------------------------------------------------------------------

Neck
    Inspect the neck for asymmetry, scars, or other lesions.

    Palpate the neck to detect areas of tenderness, deformity, or masses.

    Be familiar with locations of the various lymph node groups and learn how to palpitate facial and

       cervical lymph nodes for size, number, hardness, mobility, tenderness and so on.

Thyroid Gland
    Inspect the neck looking for the thyroid gland. Note whether it is visible and symmetrical.

    Learn how to palpate the thyriod gland for the size, symmetry, position of the lobes and presence of

       any nodules or masses.

    Palpation for the thrill and auscultation for the bruit.

Carotid artery
    Learn how to palpate carotid artery.

Trachea
    Learn how to palpate reachea to determine its position.

--------------------------------------------------------------------------------

Skin
    Inspect and palpate the hair nail. Note color, density, lustre and distribution of hair.


                                                             18
      Inspect and palpate skin of face and neck to evaluate the color, moisture, turgor and texture of the

        skin.

      Note the scars, lumps, rashes, tenderness and other lesions,

      Some slides shown for abnormal skin.




The Outline of The Chest
1.Purpose & Requirement
●Understand how to use the technique of inspection, palpation, percussion and auscultation in the

examination of the chest.

●Understand the causes and the mechanisms of the normal and the common abnormal signs, and their

clinical significance.

2.Component
●Introduction of the topographic landmarks on the body surface and their clinical significance.

●Physical examination:

 ·inspection: Inspect the patient’s facial expression, posture, neck and the configuration of the chest.

Assess the respiratory rate and pattern.

 ·palpation: Assess areas of tenderness, symmetry of the chest and tactile fremitus.

 ·percussion: The method of percussion and the normal and abnormal sounds.

 ·auscultation: Four types of normal breath sound and their characteristics. Abnormal breath sound and

adventitious sounds. Vocal resonance, pleural friction rub.

●Be familiar with the main symptoms and signs of pulmonary diseases.



The Outline of

                                               The Heart
• Specific Symptoms
 Chest pain
 Objectives, the students should be able to

1.     Understand the common causes of chest pain.


                                                      19
2.     Remember questions which should be asked during history taking.

3.     Differentiate angina from chest pain caused by other causes.

 Palpitations
 Objectives, the students should be able to

1. Understand the common causes of palpitations

2. Remember questions which should be asked during history taking

 Dyspnea

 Objectives, the students should be able to

1. Understand the common causes of dyspnea.

2. Describe the clinical features of Paroxymal nocturnal dyspnea, Dyspnea on exertion and Trepopnea.

Syncope
     Objectives, the students should be able to

1. Understand the common causes of syncope.

2. Remember questions which should be asked during history taking.

 Fatigue
 Objectives, the students should be able to

1. Understand the common causes of fatigue.

2. Remember questions which should be asked during history taking.

 Dependent edema
 Objectives, the students should be able to

1. Remember questions which should be asked during history taking.

2. Differentiate edema caused by congestive hear failure from edema caused by other causes.

 Hemoptysis

 Objectives, the students should be able to describe the clinical features of hemoptysis caused by mitral

stenosis.

• Physical Examination

 Inspection
 Objectives, the students should be able to

1. Understand what to be observed during inspection, including :general appearance, the skin, the nail,


                                                     20
    the facies, the eyes, the mouthes, the neck, the chest configuration, the extremities.

2. Describe the clinical significance of the abnormal appearances.

 Blood pressure Assesment
 Objectives, the students should be able to

1. Understand the principles of blood pressure assessment.

2. Determine blood pressure by palpation and auscultation .

3. Rule out orthostatic hypotention, supravavular aortic stenosis, cardiac tamponade.

 The Arterial Pulse
Objectives, the students should be able to

1. Determine the cardiac rate and cardiac rhythm from the palpation of the arterial pulse.

2. Understand how to palpate the carotid artery and evaluate the characteristics of the pulse.

 The Jugular Venouse Pulse
 Objectives, the students should be able to

1. determine the jugular wave form and estimate the jugular venouse pressure.

2. Evaluate the hepatojugular reflux.

Percussion
 Objectives, the students should be able to understand how to percuss the heart′s borders.

 Palpation
 Objectives, the students should be able to

1. Understand how to palpate the point of maximum impulse, localized motion, generalized motion,

    thrills.

2. Understand the clinical significances of these examinations.

Auscultation
 Objectives, the students should be able to

1. Discribe the standard auscultation positions, the location of the five cardiac areas:aortic, pulmonic,

    tricuspid, mitral and the erb′s area.

2. Describe any murmur present and pericardial rubs.




                                                     21
 Examination for Edema
 Objectives, the students should be able to test for edema.

• Clinicopathologic Correlations
Objectives, the students should be able to understand the clinical significances of the abnormalities of

the first and second heart sound, systolic clicks, diastolic opening snap, murmurs.



The outline of diagnosis

Abdomen
1. Common symptoms of abdominal disease
         Abdominal Pain

  Understand     the causes, the mechanisms and the key points of diagnosis of pain.

  Understand the location, localization, character, radiation and nature of pain, the time of occurrence

and factors that aggravate or alleviate the symptoms, accompany symptoms and physical signs.

  Be familiar with referred pain.

   Change in Bowel Movement

  Understand the concept and the mechanisms of diarrhea.. the common causes and character of acute

and chronic diarrhea.

  Be familiar with the causes and character of constipation.

   Rectal Bleeding

  Understand the character and clinical significance of rectal bleeding.

  Be familiar with hematochezia , tenesmus and melena .

   Jaundice

  Understand classification, mechanisms, etiology and clinical manifestation of jaundice.

2. Physical Examination
   Understand inspection, auscultation, percussion, palpation of abdomen. The key point is palpation

      of abdomen, especially its method and contents.

   Be familiar with the common physical signs and its clinical significance.

3. small group
   students practice inspection, auscultation, percussion, palpation of abdomen with each other under

                                                    22
     teacher’s guidance.

   Bedside teaching

    Study the common and important physical signs, including peptic ulcer, cholecystitis,

hepatomegaly, splenomegaly, ascites, mass and alteration of bowel sounds, et al. learn how to detect the

above physical signs, and explain its clinical significance.

        Kinescope, abdominal physical examination and common abdominal abnormal physical signs.




                                                     23
                           Teaching Outline for Geriatrics


                                               COPD
1. Learning objective:

     1) Understand the definition, risk factors, diagnosis and classification of COPD

     2) Know How to manage the stable or exacerbation of COPD

     3) Familiar with how to assess and monitor this disease

2. Content:

Epidemiology of COPD                         10 minute

Definition of COPD                           10minute

Risk factors of COPD                         10minute

Pathogenesis of COPD                         10 minute

Diagnosis of COPD                            10minute

Objective of Manegement                      10minute

Assess and Monitor of COPD                   10minute

Management stable COPD                       10 minute

Management exacerbation                      10 minute

3.    Duration of teaching                 2hours

4.    Reference

          MERCK MANUAL




Syncope
1. Learning objective:

     1) Understand the diagnosis and differential diagnosis of syncope

     2) Know the aetiology and Pathophysiology of syncope

     3) Familial with the symptom and sign of syncope

2. Content:


                                                    24
     1) Definition                             5’

     2) Aetiology                              10’

     3) History                                20’

     4) Examination                              10’

     5) Clinical diagnosis                       20’

     6) Differential diagnosis                   10’

     7) Prognosis and treatment                  20’

3.   Duration of teaching               2hours

4.   Reference

          MERCK MANUAL




Hypertension
1.    Learning objective:

     1) To understand the definition, diagnosis, general principles of classification and step

         manegement of Hypertension

     2) Know about the epidemiology, risk factors, pathogenesis of Hypertension

     3) Familiar with how to assess and monitor this disease

2.    Content:

Epidemiology of Hypertension                     5 minute

Definition of Hypertension                       2 minute

Risk factors of Hypertension                     3 minute

Pathogenesis of Hypertension                     5 minute

Diagnosis of Hypertension                        5 minute

Objective of Manegement                          2 minute

Assess and Monitor of Hypertension               3 minute

Step Management Hypertension                     20 minute

3.   Duration of teaching               2hours

4.   Reference


                                                    25
          MERCK MANUAL




Coronary Artery Disease
1. Learning objective:

     1)Understand the diagnosis,differential diagnosis and manegement of Angina,Myocardial Infarction

     2)Know the aetiology and Pathophysiology of Angina,Myocardial Infarction

     3)Familial with the symptom ,sign and complication of Angina,Myocardial Infarction



2.    Content:

          a)   Definition                                    2’

          b)   Prevalence                                    3’

          c)   Aetiology                                     3’

          d)   Clinical diagnosis and Differential diagnosis 10’

          e)   Management                                    10’

          f)   Complication and Prognosis                    5’

3.   Duration of teaching                 2hours

4.   Reference

          MERCK MANUAL




Asthma in the elderly


1. Educational Obejectives

1) to understand definition,characteristics of asthma in the elderly.

2) to be familiar with clinical manifestations of asthma in the elderly.

3) to grasp diagnosis and management principle of asthma in the elderly.

2. Contents


                                                    26
pulmonary function in the elderly                                  5 minutes

definition and characteristics of asthma in the elderly            10 minutes

epidemiology of asthma in the elderly                               5 mintues

diagnostic issues of asthma in the elderly                         10 minutes

therapy of asthma in the elderly(stepped approach)                 10 minutes

prognosis of asthma in the elderly                                  5 minutes

3. Duration of teaching          2 hours

4. Reference

     THE MERCK MANUAL OF GERIATRICS

     GERIATRICS AT YOUR FINGERTIPS

     The diagnosis and management of asthma is much tougher in older patients (Curr Opin Allergy

               Clin Immunol 2002,2:175-181)

  Underdiagnosis and undertreatment of asthma in the elderly.

                (CHEST 1999,116:603-613)




                                     Pneumonia and The Elderly
1. Educational Obejectives

1).to undersand definition,epidemiology,etiology,classification of pneumonia in the elderly.

2).to be familiar with symptoms,signs,and diagnosis of pneumonia in the elderly.

3).to know well treatment and prognostic factors of pneumonia in the elderly.

2. Contents

waning of the immune system in the elderly                                2 minutes

epidemiology of pneumonia in the elderly                                   3 minutes

etiologic agent of pneumonia in the elderly                               5 minutes

pathogenesis                                                              5 minutes

clinical presentation and diagnosis of CAP in the elderly                 5 minutes

prognostic factors of pneumonia in the elderly                            5 minutes

treatment of CAP in elderly                                               10 minutes

hospital-acquired pneumonia                                               5 minutes


                                                     27
prevention                                                          5 minutes

3. Duration of teaching             2 hours

4. Reference

THE MERCK MANUAL OF GERIATRICS

Geriatric Respiratory Medicine CHEST 1998,114:1704-1733




Diabetes Mellitus
1.    Learning objective:

     1)To understand the definition, diagnosis, general principles of classification and manegement of

     diabetes mellitus in elderly

     2)Know about the epidemiology, risk factors, pathogenesis of diabetes mellitus

     3)Familiar with how to assess and monitor this disease

2. Content:

Epidemiology of diabetes mellitus in elderly                      5 minute

Characteristics of diabetes mellitus in elderly                   12minute

Risk factors of diabetes mellitus                                 3 minute

Pathogenesis of diabetes mellitus                                  5minute

Diagnosis of diabetes mellitus                                     10 minute

Objective of Manegement of DM in elderly                           2 minute

Complications of diabetes mellitus in elderly                      8 minute



3.   Duration of teaching                     2hours

4.   Reference

          MERCK MANUAL




                                                       28
        Osteoporosis
1.    Learning objective:

     1)To understand the definition, diagnosis, general principles of classification and manegement of

     Osteoporosis

     2)Know about the epidemiology, risk factors, pathogenesis of Osteoporosis

     3)Familiar with how to assess and monitor this disease

2.   Content:

Epidemiology of Osteoporosis in elderly                          5 minute

Characteristics of Osteoporosis in elderly                       12minute

Risk factors of Osteoporosis                                     3 minute

Pathogenesis of Osteoporosis                                     5minute

Diagnosis of Osteoporosis                                        18 minute

Objective of Manegement of Osteoporosis in elderly                2 minute

3.   Duration of teaching                2hours

4.   Reference

          MERCK MANUAL




                                                  29
          Teaching Outline of the Traditional Chinese Medicine
                                                Preface
【Objectives】

. To understand the basic characteristic of Traditional Chinese Medicine theory: holistic Concept,

syndrome Differentiation.

. To know about the history of TCM’s devolopment.

【Teaching contents】

1. The origin, formation and development of TCM theory system

    TCM at ancient time of china.

    . 《Huangdi neijing》was compiled at time between ZhanGuo and Qin & Han dynasty

    . Zhang zong jin wrote the first clinical medical work of china at the end of East Han dynasty:

    《Shanghan zabing lun》

    .Sun si miao wrote 《Golden Prescriptions》

    .Many different medical sects with its characteristics during the time from Song dynasty to Jin and

    Yuan dynasty.

          Liu wansu “Cold and Cool school”

          Zhang congzheng “purging school”

          Li gao “Strenthenging earth school”

          Zhu zheng heng “Nourishing Yin school”

“Wen Deseases”suddenly to the fore at time of Ming-qing dynasty.

Wu you ke pointed out that “Wen diseases is different from “six pathogenic factors”

Ye tianshi in Qing dynasty established the syndromes differentiation with Wei,Qi,Nutrient and blood or

with Sanjiao(The triple energizer) for Wen deseases.

2. Fundamental characters of TCM

    (1)        The whole concept

           1) Human body is a holistic whole

           2) Human and nature is an inter-related whole

    (2)        Syndrome differentiation

           1) Implication of syndrome differentiation


                                                   30
         2) The relationship between syndrome differentiation and disease differentiation



Chapter 1     Yin-yang and the five elements
1. Yin-yang
【Objectives】

   To understand the Yin-yang theory’s basic concept and

   To know about the applications of the theory of yin-yang in TCM.

【Teaching contents】

 1. The implication of yin-yang and the categorization of things according to the nature of yin-yang.

     (1). The implication of yin-yang

     (2). The categorization of things according to the nature of yin-yang .

 2. Interaction between yin and yang

     (1). Opposition of yin and yang.

     (2). Interdependence between yin and yang

     (3). Wane and wax between yin and yang

     (4). Mutual transformation between yin and yang

 3. Application of the theory of yin and yang in TCM

     (1). Explanation of the histological structure of the human body

     (2). Explanation of the relationship between structure and function

     (3). Explanations the pathogenesis

          1. Predominance of yin and yang

          2. Decline of yin and yang

    (4). Diagnosis and syndrome differentiation

    (5). Guiding clinical treatment

            1. Deciding the therapeutic principles

            2. Generalization of the properties of drugs.



                            2. WUXING (the five elements)
【Objectives】


                                                   31
   To understand the five elements concept and

   To know about the application of the five elements in TCM.

【Teaching contents】

1. The implication of the five elements and the categorization of things according to the theory of the

    five elements

    (1) The implication of the five elements

    (2) Categorization of things according to the theory of the five elements

2. Interaction among the five elements

    (1). Inter-promotion and inter-restraint among the five elements :

         1. Inter-promotion

         2. Inter-restrain

         3. The relationship between inter-promotion and inter-restrain

    (2) Over restraint and reverse restraint among the five elements

         1. Over restraint

         2. Reverse restraint

3. The implication of the five elements in TCM(teach yourself)

           Charter 2         Zangxiang (Viscera and their manifestations)
【Objectives】

  To understand the basic of the “Zangxiang” theory

  To understand the functional characteristics of five Zang-organs and six fu-organs

【teaching contents】

 1. Concept of the Zangxiang

 2. Primary of Zangxiang theory

  3. The functional characteristics of five Zang-organs and six fu-organs



1. The five zang-organs
【Objectives】

To understand the physiological functions of Wuzang

【teaching contents】


                                                   32
1. The heart

      The physiological function of the heart

         1. Governing blood

         2. Controlling the mind

    The relationship between the heart and the body, the sensory organs and the orifices

         1. The heart governs the vessels

         2. The heart opens into the tongue

         3. External manifestation on the face

               Appendix: The pericardium

2. The lung

      The physiological function of the lung

         1. Dominating QI

         2. The regulation of water passage

    2.2 The relationship between the lung and the body, the sensory organs and the orifices

        1. The lung governing the skin

        2. The lung opening into the nose

        3. External manifestation on the body hair

3. The liver

    3.1 The physiological function of the liver

      1. To dredge and regulate

      2. To store blood

   3.2 The relationship between the liver and the body, the sensory organs and the orifices

      1. The liver governing the tendons

      2. The liver opening into the eyes

      3. External manifestation on the nails

4.The spleen

    4.1 The physiological function of the spleen

        1. To govern the transportation and transformation

        2. To command blood

   4.2 The relationship between the spleen and the body, the sensory organs and the orifices

                                                   33
        1. The spleen governing the muscles and the four limbs

        2. The spleen opening into the mouth

        3. External manifestation on the lips

5. The kidney

   5.1 The physiological function of the kidney

       1. To govern growth and development

       2. To govern reproduction

       3. To govern water

       4. To govern reception of Qi

       5. To produce marrow to enrich the brain and transform blood

       6. To nourish and warm the viscera

    5.2 The relationship between the heart and the body,the sensory organs and the orifices

       1. The kidney governing the bones

       2. The kidney opening into the ears, the external genitals and anus

       3. External manifestation on the hair

       Appendix: Mingmen (Life-gate)



2. The six Fu-organs
【Objectives】

To understand the physiological function of the six fu-organs

【teaching contents】

1. The gallbladder: To store and excrete the bile

2. The stomach: To receive and digest food

3. The small intestine

    Too receive the chyle

    To separate the lucid from the turbid

4. The large intestine: To transmit the waste of food

5. The bladder: To store and excrete urine

6. Sanjiao (the triple energizer)

    The conception of the triple energizer

                                                    34
    The physiological function of the triple energizer

            1. A generalization of yuan-qi (primordial qi) and water passage

            2. A generalization of the physiological functions of certain internal organs



3. The extraordinary fu-organs
                                               (self-study)



4. The relationships among the zang-organs and the fu-organs
                                               (self-study)



Chapter 3 Qi, blood and body fluid


【Objectives】

To understand the originate and functions of qi, blood and body fluid

To know about the relationship among qi, blood and body fluid

【teaching contents】



1. Qi
1. The basic concept of qi

2. The production of qi

3. The physiological functions of qi

    Propelling function

    Warming function

    Protecting function

    Fixating function

    Qi-transforming function

4. The moving styles of qi

5. The classification of qi and its production, distribution and functional characteristics

    Yuan-qi(primordial qi)

            1. The production of the primordial qi

                                                    35
            2. The distribution of the primordial qi

            3. The functional characteristics of the primordial qi

      Zong-qi(the pectoral qi)

              1. The production of the primordial qi

             2. The distribution of the primordial qi

            3.The functional characteristics of the primordial qi

    Ying-qi(nutrient-qi) and wei-qi(defensive qi)

              1. The production of the nutrient qi and the defensive qi

              2.The distribution of the primordial qi

              3.The functional characteristics of the primordial qi



2. Blood
The basic concept of blood

The production of blood

The physiological functions of blood

The circulation of blood



3. Body fluid
1. The basic concept of body fluid

2. The production of body fluid

3.The physiological functions of body fluid

Moistening and nourishing

The transformation of blood

The transportation of the turbid qi

4. The transportation and metabolism of body fluid



4. The relationships among qi, blood and body fluid
4.1 The relationship between qi and blood

   4.1.1 The effects of qi on blood


                                                    36
                   1) Qi producing blood

                   2) Qi promoting the circulating of blood

                   3) Qi controlling blood

   4.1.2 The effects of blood on qi

              1) Blood carrying qi

              2) Blood producing qi

4.2 The relationship between qi and fluid

   4.2.1 The effects of qi on body fluid

              1) Qi producing body fluid

              2) Qi promoting the flow of body fluid

              3) Qi controlling body fluid

   4.2.2 The effect of body fluid on qi

               1) Body fluid carrying qi

               2) Boody fluid producing qi

 4.3 The relationship between blood and body fluid



Chapter 4      Causes of disease
【Objectives】

1.To understand the concept, nature, pathogenic characters and main clinic manifestations of the six

pathogenic factors

2. To understand the natures, pathogenic characters and main clinic manifestations of the phlegm,rheum

and blood stasis

3. To understand the pathogenic characters and main clinic manifestations of the seven emotions

4. To know about pestilence, improper diet, overwork and over-rest, five endogenous pathogenic factors,

injury and parasites.

【Teaching contents】



1. six pathogenic factors
1. The concepts and differences between six pathogenic factors and six climatic factors(six qi)

2. The general pathogenic characters of six pathogenic factors

                                                   37
    Wind

           1)     Wind tends to float

           2)     Wind tends to move

           3)     Wind tends to change

           4)     Wind tends to be complicated by other pathogenic factors

    Cold

           1) Cold tends to impair yang

           2) Cold tends to coagulate

           3) Cold tends to contract

    Summer-heat

           1) Summer-heat is hot

           2) Summer-heat tends to disperse

           3) Summer-heat is often complicated by dampness

    Dampness

           1) Dampness is heavy and turbid

           2) Dampness tends to block qi

           3) Dampness is sticky and stagnant

           4) Dampness tends to move downward

    Dryness

           1) Dryness is exerotic and unsmooth

           2) Dryness tends to impair the lung

    Heat (fire)

           1) Heat (fire) tends to flame up

           2) Heat (fire) tends to consume qi and impair body fluid

           3) Heat (fire) tends to produce wind and disturb blood

           4) Heat (fire) tends to cause swelling and ulceration

Appendix: Pestilence and five endogenous pathogenic factors (self-study)




                                                    38
2. Internal impairment due to seven emotions
1.The concept of Internal impairment due to seven emotions

2.Pathogenic characters of Internal impairment due to seven emotions

      1) Directly impairing the internal organs

      2) Disordering the activity of qi

      3) Triggering or aggravating certain diseases



3. Improper diet
1. Starvation and avereating

2. Unhygienic food

3. Food partiality

    1) partiality to cold or hot food

    2)Partiality to the flavors



4. Overwork and over-rest
1. Overwork

2. Over-rest



5. Diseases caused by phlegm, rheum and blood stasis
5.1 Phlegm and rheum

      5.1.1The basic concept of phlegm and rheum

      5.1.2The formation of phlegm and rheum

      5.1.3The pathogenic characteristics of phlegm and rheum

               1) Hindering the flow of qi and blood

               2) Hindering the ascent and descent of qi

               3) Frequently confusing the mind

               4) Complicated symptoms and constant change

2. Blood stasis

  2.1 The basic concept of blood stasis


                                                  39
  2.2 The formation of blood stasis

             1) Qi stagnation

             2)Qi deficiency

             3) Blood-cold

             4) Blood-heat

             5) Traumatic injury

             6) Hemorrhage

2.3The pathogenic characteristics of blood stasis

        1) Pain

        2) Lump

        3) Hemorrhage

        4) Cyanosis

        5) Tongue variations

        6) Pulse variations



Chapter5        Pathogenesis
【Objectives】

1.To understand the pathogenesis of diseases in TCM

2.To know about the mechanism of diseases develop and change

【Teaching contents】



1. Causes of disease
1.Occurrence of disease and the relationship between pathogenic factors and the healthy qi

    Deficiency of healthy qi and invasion of pathogenic factors: two important aspects of the occurrence

of disease

    The different effects of healthy qi and pathogenic factors on the occurrence of disease

                 1) Insufficiency of healthy qi: the intrinsic cause of disease

                 2) Invasion of pathogenic factors: an important condition for the occurrence of disease

2. Constitution and disease (self-study)



                                                     40
                           2. Mechanism of pathological changes
1.Predomination and decline of pathogenic factors and healthy qi

      1.1 Predomination and decline of pathogenic factors and healthy qi and the changes of deficiency

and excess

              1) Excess syndrome

              2) Deficiency syndrome

              3) Mixture of deficiency syndrome and excess syndrome

              4) Mutual transformation between deficiency syndrome and excess syndrome

      1.2 The relationship between the prognosis of disease and the state of pathogenic factors and

healthy qi

              1)        Domination of healthy qi and decline of pathogenic factors

              2)        Domination of pathogenic factors and decline of healthy qi

2.Imbalance between yin and yang

    Relative predomination and decline of yin and yang

               1) Relative predomination of yin and yang

               2) Relative decline of yin and yang

    Inter-consumption of yin and yang

              1) Deficiency of yin affecting yang

              2) Deficiency of yang affecting yin

    Inter-rejection of yin and yang

               1) Predomination of yin rejecting yang

               2) Predomination of yang rejecting yin

    Inter-transformation of yin and yang

              1)   Transformation of yang into yin

              2)   Transformation of yin into yang

    Loss of yin and yang

              1)     Loss of yang

              2)     Loss of yin


                                                  41
 3. Disorder of qi, blood and body fluid

    Disorder of qi

               1) Insufficiency of qi

               2) Disturbance of qi

    Disorder of blood

                1) Insufficiency of blood

                2) Disturbance of blood

    Disorder of body fluid

              1) Insufficiency of body fluid

              2) Disturbance of body fluid



Chapter 6       Prevention and therapeutic principles
【Objectives】

               1. To understand the concepts of prevention and therapeutic principles in TCM

               2. To understand the main therapeutic principles in TCM

【Teaching contents】



1. Principles of prevention
1.Theory of prevention

   1.1 Importance of prevention

   1.2 The theoretical basis of the principles of prevention

   1.3 The guiding ideology of the principles of prevention

             1) Emphasis on holistic concept

             2) Emphasis on the protective effect of healthy qi

             3) Emphasis on the integration of the body and the mind

2. The preventive methods

    Giving prevention the priority

                     1) Regulating psychological state

                     2) Proper diet

                     3) Proper living habits

                                                    42
                       4) Exercising the body

                       5) Avoiding attack of pathogenic factors

    Prevention transmission and change

                              1) Early treatment

                              2) Controlling the transmission and change



2. Therapeutic principles
1. Concentrating treatment on the root cause

   1.1 Significance

   1.2 Application

             1)        Treating biao in emergency

             2)        Contrary treatment

2. Strengthening healthy qi and eliminating pathogenic factors

    Significance

                  1)     Strengthening healthy qi

                  2)     Eliminating pathogenic factors

    Application of strengthening healthy qi and eliminating pathogenic factors

                         1) Purgation prior to tonification

                         2) Tonification prior ro purgation

                         3) Simultaneous application of purgation and tonification

    Regulation of yin and yang

                       1) Reducing excess

                       2) Supplementing insufficiency

    Abidance by individuality, locality and seasons

                         1)     Abidance by individuality

                         2)     Abidance by locality

                         3)     Abidance by seasons



Chapter7 Diagnostic methods
【Objectives】

                                                          43
     To understand the main concept of the four diagnostic methods and their clinical significance.

     To understand the sense of spirit.

     To know about the content, principle and investigative progress about the diagnostic methods.



1. Inspection
【Teaching content】

     The aspect for inspection include patient’s spirit, complexion, body, tongue, excreta and vomit us.

1.Inspection of the whole body

1.1 Inspection of spirit

   The concept of the spirit and the main points of insertion

     1) Existence of spirit

     2) Lack of spirit, also known as insufficiency of spirit

     3) loss of spirit, also known as depletion of spirit

     4) False spirit

     5) Mental derangement

1.2 Inspection of complexion

     1) Normal complexion

     2) Morbid complexion

1.3 Inspection of body

     1) Physical strength and weakness

     2) physical obesity and emaciation

     3) Deformity

1.4 Inspection of postures

     1) Inspection of postures in tranquility and action

     2) Inspection of abnormal movements

2 Inspection of local regions

     The emphasis is inspecting eyes lips skin and excreta

2.1 Inspection of head and heir

2.2 Inspection of the five sense organ


                                                      44
2.3 Inspection of neck

2.4 Inspection of skin

     1) Inspection of colour

     2) Inspection of shape

     3) Inspection of skin disorders

2.5 Inspection of infantile index finger veins self-study

2.6 Inspection of excreta

     1) Inspection of sputum

     2) Inspection of spittle and saliva

     3) Inspection of snivel

     4) Inspection of vomitus

3 Inspection of tongue

     3.1 Methods for inspection of tongue

     3.2 Normal states of the tongue

     3.3 Inspection of the tongue body

     1) colour of the tongue

     2) shape of the tongue

     3) Movement of t he tongue

     3.4 Inspection of tongue fur

     1) Nature of the tongue fur

     2) The colour of tongue fur

     3.5 Comprehensive analysis of the body of the tongue and tongue fur



2. Listening and olfaction
【Teaching content】

1. Listening to sounds

1.1 Speech

     1) Voice

     2) Par aphasia

     3) Slurred speech

                                                     45
1.2 Respiration

     1) Rapid and weak respiration

     2) Dyspnea and bronchial wheezing

     3) Shortness of breath and weak breath

1.3 Cough

1.4 Hiccup and belching

     1) Hiccup

     2) Belching

2 Olfaction

2.1 Smelling body odor

  1) Foul breath

  2) Sputum and snivel odor

  3) Body odor

  4) Odor of feces and urine

  5) Menstruation odor

2.2 Odor in room



3. Inquiry
【Teaching content】

1. General information

2. Inquiry of chief complaint and history of present illness

2.1 Inquiry of chief complaint

2.2 Inquiry of the history of present illness

     1) Occurrence

     2) Development of disease

     3) Procedure of diagnosis and treatment

3. Inquiry of the present symptoms

3.1 Inquiry of fever and cold

     1) Aversion to cold and fever

     2) Cold without fever

                                                     46
     3) Fever without cold

     4) Alternate cold and fever

3.2 Inquiry of sweating

     1) Anhidrosis

     2) Hidrosis

3.3 Inquiry of pain

     1) Inquiry of the pain location

     2) Inquiry of the nature of pain

3.4 Inquiry of sleep

     1) Insomia

     2) Dreaminess

     3) Somolence

3.5 Inquiry of diet and partiality

     1) Thirst and drinking of water

     2) Appetite and repast

     3) Taste

3.6 Inquiry of urination and defecation

     1) Defecation

     2) Urination

3.7 Inquiry of the head and face

     1) Vertigo

     2) Tinnitus

     3) Deafness and diplacusis

     4) Dizziness

     5) Ocular itching

     6) Oculor pain

     7) Blurred vision, night blindness and diplopia

     8) Pain and numbness of the tongue

3.8 Inquiry of chest and abdomen

     1) Chest oppression

                                                   47
     2) Palpitation

     3) Hypochondrial distension

     4) Epigastric distress

     5) Abdominal distension

     6) Borborygmus

3.9 Inquiry of the symptoms over the loins, back and four limbs

     1) Cold sensation

     2) Aching loins

     3) Heaviness of the body

     4) Numbness of the four limbs

3.10 Inquiry of symptoms in andropathy

     1) Impotence

     2) Seminal emission

     3) Immature ejaculation

3.11 Inquiry of symptoms in gynecology

     1) Inquiry of menstruation

     2) Inquiry of leukorrhea

3.12 Inquiry of symptoms in pediatrics (self-study)

4 Inquiry of anamnesis

4.1 Inquiry of past physique

4.2 Inquiry of previous illness

5 Inquiry of family history



4. Pulse-taking and palpation
【Teaching content】

1. Pulse-taking

  The clinical significance of pulse-taking

1.1 Regions for methods for taking pulse

     1) Regions and taking pulse

     2) The methods for taking pulse

                                                      48
1.2 Normal pulse

     1) The shape of the normal pulse

     2) The characteristics of the normal pulse

     3) Main factors to affect the normal pulse

1.3 Morbid pulse (the most common morbid pulse)

     1) Floating pulse

     2) Sunken pulse

     3) Slow pulse

     4) Fast pulse

     5) Weak pulse

     6) Powerful pulse

     7) Slippery pulse

     8) Astringent pulse

     9) Full pulse

     10) Thin pulse

     11) Taut pulse

     12) Tense pulse

     13) Slow and intermittent pulse

     14) Slow-intermittent-regular pulse

2. Palpation

2.1 Methods for palpation

     1) Postures

     2) Techniques for palpation

2.2 Pressing the chest and abdomen

     1) Pressing the chest

     2) Pressing the hypochondrium

     3) Pressing epigastrium and abdomen

2.3 Palpation of the four limbs

     1) Detection of cold and heat

     2) Palpating the skin form inner side of the elbow of the transverse lines on the wrist

                                                    49
     3) Palpation of swelling and distension

2.4 Palpation of accompanist



Chapter 8 Differentiation of syndrome
【Objectives】

1. To understand the concept of differentiation of syndrome

2. To know about the category of differentiation of syndrome

【Teaching content】



                    1. Syndromes differentiation with eight principles
【Objectives】

1. To understand the concept of eight principles

2. To understand the concept, cause, location and differentiation points of external and internal

syndrome.

3. To know about the relationship among the eight principal syndromes.

4. To know about the concept of cold syndrome, heat syndrome, Asthenia syndrome and sthenia

syndrome.

【Teaching content】

Eight principles mean yin and yang, internal and external aspects, cold and heat as well as asthenia and

sthenia, which are the general principles among differentiation of syndrome.

1. External and internal differentiation of syndromes

1.1 External syndrome

1.2 Internal syndrome

appendix: Half external and half internal syndrome (self-study)

2. Syndrome differentiation of cold and heat

2.1 Cold syndrome

2.2 Heat syndrome

3. Syndrome differentiation of asthenia and sthenia

3.1 Asthenia syndrome


                                                      50
3.2 Sthenia syndrome

4. Syndrome differentiation of yin and yang

4.1 Yin syndrome and yang syndrome

     1) Yin syndrome

     2) Yang syndrome

4.2 Yin asthenia syndrome and yang asthenia syndrome

     1) Yin asthenia syndrome

     2) Yang asthenia syndrome

4.3 Yin depletion syndrome and yang deletion syndrome

     1) Yin depletion syndrome

     2) Yang depletion syndrome

5. Relationship among the eight principal syndromes

5.1 Relationship between two principles in a pair

     1) Relationship between external and internal syndromes

     2) Relationship between cold and heat syndromes

     3) Relationship between asthenia and sthenia syndromes

5.2 Relationship between different pairs of principles

     1) External cold syndrome

     2) External heat syndrome

     3) External sthenic syndrome

     4) External asthenic syndrome

     5) Infernal sthenic cold syndrome

     6) Infernal asthenic cold syndrome

     7) Infernal sthenic heat syndrome

     8) Infernal asthenic heat syndrome



2. Syndrome differentiation of qi, blood and body fluid
【Objective and essential】

1. To understand the concept of the differentiation of syndromes of qi, blood and body fluid.

2. To know about the main kinds of syndrome differentiation of qi, blood and body fluid.

                                                    51
3. To know about the key points of differentiating the syndromes of qi, blood and body fluid.

[Teaching content]

1. Syndrome differentiation of qi disorders.

1.1 Qi asthenia syndrome

1.2 Qi sinking syndrome

1.3 Qi stagnation syndrome

1.4 Qi reversion syndrome

2 Syndrome differentiation of blood disease

2.1 Blood asthenia syndrome

2.2 Blood stasis syndrome

2.3 Blood cold syndrome

2.4 blood heat syndrome

3 Syndrome differentiation of simultaneous disorders of qi and blood.

3.1 Asthenia of both qi and blood

3.2 Qi asthenia and hemorrhagia syndrome

3.3 Depletion of qi with bleeding syndrome

3.4 Qi asthenia and blood stasis syndrome

3.5 Qi stagnation and blood stasis syndrome

4. Syndrome differentiation of fluid disorder

4.1 Insufficiency of body fluid

4.2 Phlegm syndrome

4.3 Fluid-retention syndrome

4.4 Edema

     1) Yang edema

     2) Yin edema



Chapter9 The Chinese Materia Medica
【Objectives】

1.To understand the basic knowledge of the Chinese traditional drugs, which include four properties and

five flavors.

                                                   52
2.To know about the channel tropism and the action of lifting, lowering, floating and sinking of the

Chinese traditional drugs.

3.To know about the most common poisonous traditional Chinese drugs and the incompatibility of drugs

in a prescription.

4.To know about the general condition about the research on traditional Chinese drugs at present.

【Teaching content】

1.The theory about the characters and function of the traditional Chinese drugs.

1.1 The drugs’ denomination (self-study)

1.2 The characters and function of the traditional Chinese drugs.

1.2.1 Four properties refers to the cold, hot, warm or cool nature of a drug.

  1) The cold-or cool natured drugs have the effects of clearing heat, purging fire, removing toxic

substances, and cooling blood, and are used to cure heat syndromes.

  2) The hot or warm-natured drugs have the effects of warming up the interior, dispersing cold,

supporting yang, and clearing out the arteries and veins, and are used to treat the cold syndromes.

  3) The neutral drugs which is neither hot nor cold in nature.

1.2.2 Five flavour refer to the tastes of drugs include pungent, sweet, sour, bitter and salty.

  1) Pungent flavour: Drugs that are pungent in flavour have the effects of dispersing exopathogens

from superficies of the body and promoting the circulation of the vital energy and blood.

  2) Sweet flavour: Dugs of sweet flavour have the effects of nourishing, replenishing, tonifying, or

enriching the different parts or organs of the body, normalizing the function of the stomach and spleen,

harmonizing the properties of different drugs, relieving spasm and pain.

  3) Sour flavour: Drugs of sour flavour have the effect of inducing astringency and arresting discharge.

  4) Bitter flavour: Drugs of Bitter flavour have the effect of clearing heat, purging fire, sending down

the adverse of qi to treat cough and vomiting, relaxing the bowels, eliminating dampness.

  5) Salty flavour: Drugs of this taste have the effects of relieving constipation by purgation, and

softening and resolving hard mass.

  6) Tasteless flavour: Drugs of the flavour have the effects of excreting dampness and inducing

diuresis.

1.2.3 Channel tropism

     Channel tropism refers to a drug’s selective therapeutic effects on a certain part of the body.

                                                      53
1.2.4 Actions of lifting, lowering, floating and sinking.

     Action of lifting, lowering, floating and sinking refer to a drug’s selective therapeutic tendency to a

certain part of the body.

     Lifting and floating drugs have upward and outward actions and are used flow elevating yang,

relieving exterior syndrome by means of diaphoresis, dispelling superficial wind and cold, inducing

vomiting.

     Lowering and sinking drugs have downward and inward actions and are used for clearing heat,

purgation, removing dampness, checking the exuberance of yang, sending down an adverse flow of qi to

stop vomiting, relieving cough and asthma, etc.

2. The application of drugs

2.1 Compatibility: two or more drugs are used together.

2.1.1 Mutual reinforcement:

     Two or more drugs of similar characters and function are used in coordination.

2.1.2 Mutual Assistance

     Drugs similar in certain aspects of their characters and functions can be used together, with one as

the principal and the other or others as subsidiary, to help increase the effects of the principal.

2.1.3 Mutual Detoxication

     One drug can lessen or remove the toxicity and side effects of the other.

2.1.4 Mutual Inhibition

     One drug can weaken or lose the original effects of the other.

2.1.5 Incompatibility

     When two drugs are used in combination, toxicity or side effects may result.

2.2 Contraindications

2.2.1 Incompatibility of drugs in a prescription

     Some drugs that are mutual inhibition or incompatibility should not be used together.

2.2.2 Contraindication during pregnancy

     Drugs are very poisonous or drastic should be prohibited during pregnancy.

     Drugs which should be given cautiously are usually those which remove blood stasis to restore

menstruation, or relieve stagnation of qi, or those with hot property and pungent flavour.

     Appendix: 1) Eighteen incompatible medicaments

                                                      54
                 2) Nineteen medicaments of mutual antagonism.

2. Classification of drugs (self-study)



Chapter10 Composition and modification of the prescriptions
【Objectives】

1. To understand the principle of the composition of prescriptions

2. To know about the history of formation and development of the prescriptions.

3. To know about the modification of a prescription

[Teaching contents]



1. Composition of Prescriptions
1.The principle of composition

1.1 The theory of composition in a prescription

1.1.1 The peculiar principle of monarch(jun), minister(chen), adjuvant(zuo) and guide(shi).

  1) Monarch drug: Being an essential ingredient in a prescription, it play a leading curative role aiming

at the cause or the main syndrome of a disease.

  2) Minister drug

  3) Adjuvant drug

  4) Guiding drug



2. Modification of a prescription
1. Modification of drugs

2. Modification of dosage

3. Modification of forms



3. Common Form of Prescription
                                               (self-study)

                                     Chapter 11 Zhenjiuxue
                                             【objectives】


                                                   55
1. learn about the origin, shape and progress of the meridians.

2. grasp the main content of the meridians (definition, component, names of the forteen meridians,

    exterior-interior relationship and function) and the distributing law of the twelve channels.

3. learn about the classification of the needle, the function of the moxibustion , the indication and the

    contraindication of the moxibustion, and other treatment about acupuncture and moxibustion.

4. grasp the preparation prior to acupuncture treatment. Needling methods, management of possible

    accidents, definition and classification of moxibustion.

5. learn about the general introduction of the points, oriertition channel tropism and indication of the

    thirty points which are often used.

6. learn about the concept of acupuncture prescription and the acupuncture treatment about the

    commonly seen diseases in clinic.



1. The theory of the channel and collaterals, meridians
【main contents of teaching】
1. the origin, shape and progress of the meridians

2. the definition of the meridians

3. the components of the meridians

    (1).the twelve channels

      .name

      .distribution

      .course, direction, joint of the twelve channels

        exterior-interior relationship

        flowing order of the twelve channels

  (2).the eight extra channels----Chong, Reng, Du, Dai, Yingqiao, yangqiao, Yinwei, and Yangwei

channels.

    (3).the fifteen collaterals

4. the function of the meridians

     in physiology

     in pathology


                                                     56
     in the clinical application



2. The basic knowledge of Acupuncture and moxibustion
【main contents of teaching】
1. Acupuncture techniques

    Classification of the needle

    Preparation prior to acupuncture. (selection of the patients postures and steirilization)

    Needling methods (four insertions, angle and depth of insertions, manipulation and arrival of Qi,

    retaining and withdrawing the needle)

    Management of possible accidents (emphasize fainting)

2. Moxibustion

    Definition of the moxibustion

    Classification of the moxibustion (moxa sticks, moxa cone, cupping)

    Function of the moxibustion

    Indication and contraindication of the moxibustion

3. other treatments about acupuncture and moxibustion (ear acupuncture therapy, scalp acupuncture,

    electrotherapy, magnetotherapy and point injection)



3. Points
【main contents of teaching】
1. the general introduction of the points (definition, classification, location, function)

    definition

     classification (points, extra-points, A-shi points)

     orientation (bone measurement, anatomy character, finger-length measurement)

     function (short and long distance and special treatment function)

2. orientation, channel tropism and indication of the thirty points which are often used.

    The lung channel of Hand-Taiyin: Chize (Lu5), LieQue (Lu7)

    The large intestine channel of Hand-Yangming: Hegu (LI4), Quchi (LI11), Yingxiang (LI20)

    The stomach channel of Foot-Yangming: Jiache (SI6), Tianshu (ST25), Zusanli (ST36)


                                                      57
   The spleen channel of Foot-Taiyin: Sanyinjiao (SP6), Xuehai(SP10)

   The heart channel of Hand-shaoyin: Shenmen (HT7)

   The small intestine channel of Hand-taiyang: Houxi (SI3), Tinggong (SI19)

   The urinary Bladder channel of Foot-Taiyang: Wuzhangshu, cuanzhu(BL2), Weizhong(BL40),

   Zhiyin(BL67)

   The Kidney channel of Foot-shaoyin: Fuliu (KI7)

   The Pericardium channel of hand-Jueyin: Neiguan (PC6)

   The triple warmer (Sanjiao ) channel of Hand-Shaoyang: Waiguan (SJ5 ), Yifeng (SJ17)

   The   Gall    Bladder    channel     of   Foot-shaoyang:   Tongziliao   (GB1),    Fengchi    (GB20),

   Yanglingquan(GB34), Xuanzhong (GB39)

   The Liver channel of Foot-Jueyin: Taichong (LR3)

   The Du channel : Dazhui (DU14), Baihui (DU20), Shuigou (DU26)

   The Ren channel :Guanyuan (RN4),Zhongwan (RN12),Tanzhong (RN17)



                                4. Acupuncture treatment
【main contents of teaching】
   1. principle for acupuncture prescription

     (1).principles for points selection

         selection of local points

         selection of adjacent points

         selection of distant points

         selection of symptomatic points

     (2).principles for combination points

         combination of the Back-shu points and the Front-mu points

         combination of the short and long distant points

         combination of the upper and lower points

         combination of the synthetical points

         combination of symptomatic points

   2. treatment of clinical diseases (facial paralysis, retention of urine, hiccup and wind stroke)


                                                   58
               Teaching Outline of Rehabilitation Medicine
                              for International Students
                                            Content
                                            QU YUN
                                      M.D., M.Sc, M.OT, PhD

1.   Overview of rehabilitation medicine (Preview Page 1-12)
2.   Development Across the Life Span
3.   Evaluation and assessment (Preview Page 12-46)
4.   Physical agent modalities and Electrotherapy (Preview Page 47-74)
5.   Manipulation, massage, traction (Preview Page 75-100)
6.   Joint Mobilization and Therapeutic exercise (Preview Page 101-126)
7.   Activities of daily living and Occupational Therapy concept (Preview Page 129-146)
8.   Stroke Rehabilitation (Preview Page 156-214, 262-284)
9.   Orthoses and prosthesis (Preview Page 225-260, 306-312)


                                      Outline of lecture

1___ Introduction to RM
        What is rehabilitation
        What is Rehabilitation program
        How many Rehabilitation therapy
        Clinic Classification of Rehabilitation
        Physiatric history and physical examination
        Description of the Levels of Function and Their Scores: (FIM)
        Functional Activities
        Activities of daily living
        Classification Assessment Surveys & Terminology Group
        ICF(World Health Organization)


2___ Development Across the Life Span
     Life Span
     How Do We Know It Is Change?
     Development and Aging of Body Systems
     Development of the Skeletal System
     Sensory System Development
     Motor Development:
         Infancy
         The Preschool Years
         Middle Childhood
         Adolescence

                                                 59
       Early Adulthood
       Middle Adulthood
       Late Adulthood
       elder

3___ Evaluation & Assessment
       What’s Evaluation & Assessment
       Evaluation Vs Assessment
       Three planes of motion
       Muscle actions
       Manual Muscle Test
       ROM
       Gait Analysis
       ADL Evaluation


4___ Physical agent
       Modalities
       Intervention Strategies
       Heat Effects
       Heat types
       Heat Effects
       Cryotherapy Types
       Cryotherapy Effects
       Electrotherapy effects


5___ Massage, Traction, and Manipulation
       Definition of Massage
       Basic massage concepts
       Types of massage
       Types of basic Western massage
       Eastern massage
       Massage technique
       Effects of massage
       TRACTION
       Effects of traction
       Contraindications to traction
       MANIPULATION
       Definition of manupulation
       Counterstrain of manupulation
       Functional techniques of manupulation
       Type of manupulation
       Side effects of manipulation


6___ Joint Mobilization And Therapeutic Exercise
       Basic of Joint Mobilization

                                            60
        Concept of Joint Mobilization
        The Four Types of Joint Receptors
        Basic Principles of MJM
        The Four Grades of Mobilization
        Function of The Four Grades of Mobilization
        Therapeutic exercise
        Concept of Therapeutic exercise
        Type of Therapeutic exercise
        Goals of Therapeutic exercise
        Application to patients
        Techniques for the maintenance of flexibility
        Other therapeutic exercise routines


7___ ADL and OT
        Concept of OT
        Basic ADL
        Instrumental ADL
        Activities performance areas
        ADL Evaluation and assessment
        Treatment of ADL impairment
        ADL Training
        Daily living aids



8___ Motor Recovery In Stroke and Neuromuscular Facilities
          Stroke
          Mortality/Morbidity
          Background
          Stroke Deficit
          Theories of recovery
          Mechanisms of recovery of neurologic function
          Recovery of movement
          Rehabilitation Program
          Bobath - Neurodevelopmental training (NDT)
          Knott, Voss - Proprioceptive neuromuscular facilitation (PNF)
          Brunnstrom - Enhances specific synergies through use of cutaneous/proprioceptive stimuli;
central facilitation using Twitchell's recovery


9___ Orthoses and Prosthesis
        Concept of Orthoses and Prosthesis
        Final exam




                                                61
              BIOMEDICAL INFORMATION RETRIEVAL
                                  Teaching Outline
                               (For foreign medical students)

Objectives
     Biomedical Information Retrieval is a course of scientific methods. The aim of
this course is to equip students with an understanding of the nature of biomedical
literature and the skills required to retrieve information. By the end of the course
students will be able to:
      Find the resources in the Sichuan University Library.
      Understand the basic principle of biomedical information retrieval.
      Identify key databases within biomedicine.
      Formulate search strategies for a variety of databases.
      Master the search skill for a variety of biomedical databases.
      Know biomedical resources in Internet.

Method
Lecture and practice.
CHAPTER 1. LIBRARY GUIDE
Master: how to find material in the Sichuan University Library.
CHAPTER 2. BASIC CONCEPTS AND TECHNIQUE
Master: search process and how to perfect search strategies
CHAPTER 3. MEDLINE
Master: search skills for MEDLINE.
Know: how to access full text in electronic format or in print.
CHAPTER 4. CA ON CD
Know: search skills for CA on CD.
CHAPTER 5. CSA
Know: search skills for CSA.
CHAPTER 6. ELECTRONIC JOURNALS
Master: how to access electronic full text held by SCU Library.
CHAPTER 7. MICROMEDEX HEALTHCARE SERIES
Know: search skills for MECROMEDEX.

CHAPTER 8. BIOMEDICAL RESOURCES ON THE WORLD WIDE WEB

Know: search engines and famous biomedical web sites.



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