Taiwan’s Best Kept Secret: The Ancient Healing Wisdom You Never Knew Existed!

Hello everyone, I'm Dr. Gao. Nice to meet you again. This is a very special lecture because I will introduce the Chinese medicine in Taiwan. If you have any questions, please contact me via email. Here is the outline. History of acupuncture in Taiwan. TCM education and the TCM system in Taiwan. Status of acupuncture in Taiwan. Problem of acupuncture in Taiwan. And conclusion. Let me introduce the history of acupuncture in Taiwan. Before 1661, most of the residents of Taiwan were indigenous people with only a few Han Chinese. In 1661, Poxinga or Zheng Chenggong occupied Taiwan and introduced Chinese medicine. By 1882, during the Qing Dynasty, Chinese medicine practitioners focused on internal medicine, rejecting acupuncture, leading to its decline. Therefore, after 1897, there were no doctors proficient in acupuncture in Taiwan. From 1895 to 1945, during the Japanese colonial period, the Japanese government promoted western medicine while restricting acupuncture practices. During these 50 years, there were less than 21 acupuncturists in Taiwan. In Japanese rule period, Kengo Kimura established the Kimura school for the blind and deaf. In 1928, this school became public and was renamed State Taipei Blind School. In southern Taiwan, the State Tainan Blind School was established. This is a photo of a class at the State Tainan Blind School. The standing person is the sighted teacher. This photo is a job advertisement for the Japan Acupuncture College in Shibuya, Tokyo, published in the Tainan Shinpo newspaper. The left photo is the third volume of the Taiwan Public Health Journal discussing the efficacy of moxibustion. The right photo shows acupuncture points and anatomy. This photo is a poster from the Taipei Preference Police Health Exhibition in 1925. White people were restricted from using moxibustion due to the risk and thus only used acupuncture. The blind schools didn't teach moxibustion. Then the Japanese colonial period ended. In 1946, the Chinese Medicine Association was established in Taiwan, and 28 practitioners obtained licenses in Taiwan province. In 1949, due to the Chinese Civil War, the Kuomintang government lost and moved to Taiwan, establishing the Central Institute of National Medicine and the Chinese Medical Doctors' Association. Some Chinese medicine doctors moved to Taiwan along with ancient Chinese medical taxes. Important figures in the Chinese medicine industry in Taiwan include Chen Bifu, Sun Peirong, Xiu Yongzhai, Wang Yun'an. Taiwanese acupuncture is divided into four major schools, Dong's Acupuncture, Ancient Acupuncture, Feijin Zouqi Manipulation, and Huatou Manipulation. However, the government's medical policy at that time emphasized western medicine and neglected Chinese medicine. Let me introduce the revival of Chinese medicine in the 1970s. In 1958, the China Medical College, current China Medical University, was established in Taichung. In 1963, the China Medical University Graduate School was established. In 1972, due to the global ambivalence of Chinese medicine and acupuncture, university acupuncture clubs were formed. Hospitals began offering acupuncture services and research institutions were established, increasing medical conferences and journals. In 1982, the National Yangming University Graduate School of Traditional Chinese Medicine was established. In 1987, the White Terror period officially ended. The exchange of traditional Chinese medicine between Taiwan and China is flourishing. In 1998, the Chang'an University Department of Traditional Chinese Medicine was established. In 2001, the Chang'an University Graduate School of Traditional Chinese Medicine was established. In the next video, I will introduce the TCM education and system in Taiwan. See you next time. Hello everyone, I am Dr. Gao. Nice to meet you again. If you have any questions, please contact me via email. Let me introduce acupuncture education and academic organizations in Taiwan. Before 1958, acupuncture education in Taiwan mainly followed the traditional apprenticeship system, where Chinese medicine practitioners recruited apprentices and taught them their techniques. With the establishment of China Medical University in 1958, formal education institutions were introduced. However, to preserve valuable Chinese medical techniques, the apprenticeship system is still essential. Many graduates from various medical universities still seek out experienced Chinese medicine practitioners to become their apprentices. Let me introduce the Chinese medical universities in Taiwan. The China University Department of Traditional Chinese Medicine was established in 1966 as Taiwan's first department of Chinese medicine with an enrollment of 108 students. The Chang'an University Department of Traditional Chinese Medicine was established in 1998 with an enrollment of 50 students. The China Medical University Post-Baccalaureate Department of Chinese Medicine was established in 1992 with an enrollment of 100 students. The Yishou University Post-Baccalaureate Department of Chinese Medicine was established in 2010 with an enrollment of 45 students. The Ciji University Post-Baccalaureate Department of Chinese Medicine was established in 2012 with an enrollment of 45 students. The post-baccalaureate departments accept graduates from other universities. Male graduates must have completed military service to qualify. Most of Chinese medical universities are private. The Chinese Medical University Department of Chinese Medicine has Group A and Group B. Group A is a double-major program where students can obtain licenses for both western and Chinese medicine requiring 8 years of study. Group B only provides a Chinese medicine license requiring 7 years of study. I am a graduate of Group B. The Chang'an University Department of Chinese Medicine is all Group A. The Chinese Medical University Post-Baccalaureate Department of Chinese Medicine is all Group B requiring 5 years of study. The post-baccalaureate department is for those who have graduated from a 4-year university and since general education credits are not required, the study period is shorter. The Yishou University Post-Baccalaureate Department of Chinese Medicine and the Ciji University Post-Baccalaureate Department of Chinese Medicine are both Group B requiring 5 years of study. The National Yangming Jiao Tong University, formerly Yangming University, is the only national graduate school of traditional medicine. Let me introduce the curriculum for Group B of the Chinese Medical University Department. First-year students take common subjects such as English, physics, and biology along with introductory courses in Chinese medicine, the history of Chinese medicine, basic acupuncture, and Chinese medical sociology. Second-year students study basic western medicine courses such as biochemistry and experiments along with traditional Chinese medicine manufacturing and experiments, environmental medicine, pathology, pharmacology, diagnostics, cold damage, Chinese medicine regimen. Third-year students focus on western medical courses such as anatomy, psychology, histology, pharmacology along with courses in herbal formulas and experiments and worm disease theory. Fourth-year students focus on western medical courses such as microbiology and immunology, pharmacology and experiments, medical law along with courses in basic acupuncture too, symptoms and treatment of Chinese medicine, and clinical acupuncture. Fifth-year students focus on clinical western medical subjects such as dermatology, endocrinology, gastroenterology along with courses in Chinese internal medicine, external medicine, gynecology, otonarinology, trauma and rehabilitation, and the pediatrics. From the sixth year, students undergo clinical rotations in hospitals known as the clerk system. This includes two months each in surgery, internal medicine, one month each in obstetrics and gynecology, pediatrics, and one month in other specialties such as one week each in rehabilitation, psychiatry, otonarinology, dermatology. The seventh year involves clinical rotations in Chinese medicine known as the intern system including internal medicine, trauma and rehabilitation, acupuncture, gynecology, and pediatrics. Let's introduce the national examination for Chinese medicine practitioners. The first Chinese medicine examinations focus on basic medical knowledge including subjects such as neijing, nanjing, basic Chinese medical theory, the history of Chinese medicine, pharmacology, formulas of medicine, and Chinese. An average score of 60 or above is required to pass. This examination can be taken after the third year of the Chinese medicine department or the second year of the post-baccalaureate Chinese medicine department. The second Chinese medicine examinations focus on clinical medicine including subjects such as cold damage, worm disease theory, essentials from the golden cabinet, symptoms and treatment of Chinese medicine, traditional Chinese medicine diagnostic, internal medicine, gynecology, pediatrics, external medicine, Chinese medicine trauma and rehabilitation, otonarinology, and acupuncture. Seeing the examination subjects, you may feel the importance of acupuncture as its scoring ratio is high requiring thorough study. An average score of 60 or above is required to pass. This examination can be taken after graduation from the Chinese medicine department or the post-baccalaureate Chinese medicine department. Passing both high-level examinations grants a Chinese medicine practitioner license. Let me introduce post-graduation training. After graduating from medical universities, physicians and Chinese medicine practitioners in Taiwan are required to undergo two years of post-graduate year training, PGI. Before 2014, Chinese medicine practitioners could obtain a license to open a clinic after working in hospitals and clinics for two years. Since 2014, Chinese medicine practitioners need to work in a medical department or PGI-accepting clinic to qualify for opening a clinic. The specialized physician system for Chinese medicine is still under consideration. Let me introduce acupuncture training seminars. These seminars are mainly held at China Medical University participants include Western physicians, dentists, and Chinese medicine practitioners. The seminar contents including an introduction to Chinese medicine, acupuncture, etc. Completing all credits allowed prescribing acupuncture. Here is the seminar contents. Introduction to Traditional Chinese Medicine 4-Hour, Introduction to Acupuncture, Acupuncture Pain Relief Physiology, Get-Heat, Meridian Studies, Acupoint Studies, Acupuncture, Multifunction, Cupping, Acupuncture Experiments, Auricular Acupuncture, Hand Acupuncture, Head Acupuncture, Electroacupuncture, Modern Research on Acupuncture, Therapeutics, Clerkship, Internship. After obtaining credits, physicians can do acupuncture and muxibustion. Let me introduce the Chinese Medicine Practitioners Association. There are national and local associations. The Chinese Medicine Practitioners Association National Federation is a national association offering services such as Chinese medicine policy, job information, and academic conferences. Local associations such as the Taipei City Physicians Association offer membership services, resignations, and postgraduate medical education. The image shows the number of members of the Chinese Medicine Practitioners Association in 2018. China Medical University is located in Taichung. So many Chinese medicine practitioners are concentrated in central Taiwan, including Taichung, Changhua, and Nantou. Next are major cities such as Taipei, New Taipei, and Kaohsiung City. Like western medicine, Chinese medical resources are concentrated in urban areas. In the next video, I will introduce the status of acupuncture in Taiwan. See you next time. Hello everyone, I'm Dr. Gao. Nice to meet you again. If you have any questions, please contact me via email. Let me introduce the current status of acupuncture in Taiwan. About healthcare providers in Taiwan, according to 2020 statistics, Taiwan has 25 medical centers, 75 regional hospitals, 313 local hospitals, and 66 other facilities. There are 22,653 clinics. Among healthcare providers in Taiwan, there are 4 specialized Chinese medicine hospitals, 122 hospital-affiliated Chinese medicine departments or units, and 4,036 Chinese medicine clinics. Chinese medicine clinics mainly provide herbal medicine services. How about my clinic? Generally, Chinese medicine clinics have several facilities. Just beyond the entrance is the reception area. Next to it is the prescription room for herbal medicines. There are also waiting rooms, consultation rooms, and treatment rooms. According to Taiwanese law, tuina is not considered a medical act. So, if a Chinese medicine clinic wants to offer tuina, the tuina room must be separated from the clinic's entrance. This photo shows the prescription room. All the shelves are filled with concentrated herbal medicines. To treat COVID-19 patients, online consultations have become indispensable. In the clinic, video calls are used to diagnose patients, and Taiwan's independently developed COVID-19 treatment, NRICM-101, is prescribed. This photo shows the acupuncture room. There are low consultation beds for patients with mobility issues. Our clinic has a tuina room too. Let me introduce Chinese medicine diagnosis. Chinese medical diagnosis involves four methods, inspection, osculation-olfaction, inquiry, and palpation. In inspection, the doctor observes the patient's face and tongue to diagnose illness. In osculation-olfaction, the doctor listens to the patient's symptoms and smells them. In inquiry, the doctor asks the patient's questions. In palpation, the doctor performs pulse diagnosis and abdominal diagnosis. While many doctors in Japan are skilled in abdominal diagnosis, it is not commonly practiced in Taiwan. In Taiwan, pulse diagnosis is more prevalent. Doctors have varying strengths in the four diagnostic methods. For example, I am skilled in pulse diagnosis but not as much in inspection. This diagram explains the four diagnostic methods. Generally, Chinese medicine practitioners use these methods simultaneously to diagnose. Due to the COVID-19 pandemic, online consultations have become popular. However, inspection and palpation are challenging via video calls. About the divisions of Chinese medical service in Taiwan, the Chinese medical industry has five divisions, internal medicine, acupuncture, traumatology, gynecology, and pediatrics. Common conditions treated in internal medicine include CODES, gastrointestinal disorders, heat stroke, and sleep disorders. Acupuncture commonly treats pain, sprains, nerve problems, and stroke rehabilitation. Traumatology treats sprains, muscle pain, and back pain with fewer fracture cases due to x-ray examinations. Gynecology treats menstrual problems, postpartum care, infertility, and urinary tract infections. Pediatrics treats CODES, gastrointestinal disorders, and enuresis. Currently, Chinese medicine in Taiwan accepts all types of clinical visits, diagnosing and treating a wide range of symptoms. However, the Ministry of Health and Welfare, Taiwan's health ministry, is still considering medical classifications. Let me introduce Chinese medical treatment methods in Taiwan. Generally, prescriptions suitable for internal medicine, gynecology, and pediatrics are prepared the herbal medicines are prescribed. Taiwanese herbal medicines come into two types. Powder concentrated preparation produced in pharmaceutical factories, mostly in powder form. These medicines are extracts absorbed onto starch and dried with long shelf lives easy and handling. They are also covered by health insurance. Herbal medicines seen in historical dramas from Korea and China. These are traditional homemade medicines, decoction pieces, entirely self-funded but more effective than concentrated herbal medicines. Acupuncture and traumatology treats acupuncture-related conditions, muscle pain can be treated with acupuncture or osteopathy, but nerve problems are better treated with acupuncture. These are raw herbs, including jujube and the tangerine peel. Let me introduce acupuncture treatment in Taiwan. The flow of acupuncture treatment starts with inquiry. The doctors created a medical record using a computer system during the inquiry. Next is diagnosis, followed by acupuncture treatment. Let me introduce acupuncture medical supplies in Taiwan. Stereo acupuncture needles, electro acupuncture, and moxibustion supplies include stick moxibustion, pedestal moxibustion, and moxibustion on acupuncture needles. Moxibustion on acupuncture needles is the most common. There are also infrared lamps, cans, laser acupuncture, small needle knives, and acupoint embedding. Common indication for acupuncture in Taiwan include low back pain, shoulder stiffness, sprains, headaches, relaxation, and chronic pain. Orthopedic conditions include HIVD, panderfasitis, carpal tunnel syndromes, tennis elbow, deep craniobias disease. Neurological conditions include piriformis syndromes, sciatica, post-stress sclera, Parkinson's disease, multiple sclerosis, facial nerve palsy, and migraines. Rheumatic conditions include ankylosing symbolomyelitis, rheumatoid arthritis, Guillain-Barre syndrome. ENT conditions include sudden sensorineural hearing loss, tinnitus, taste disorders, olfactory disorders, and Meniere's disease. Other treatments include cosmetic acupuncture and Sanputian moxibustion therapy, which involves applying medical herbs to the body to enhance resistance and prevent illness common in winter. Let me introduce traumatology treatment in Taiwan. The flow of traumatology treatment starts with inquiry. The doctor creates a medical record using a computer system during the inquiry. Next is diagnosis, followed by traumatology treatment. Chinese medicine practitioners can perform traumatology, including tuina, massage, and manipulation. The traumatology performed by Chinese medicine practitioner is considered a medical act and can be advertised for disease treatment. Non-medical personnel, such as tuina therapists, can perform tuina and massage, but these are not considered medical acts. They can only advertise for wellness and relaxation purposes. Due to the health insurance remuneration system, fewer Chinese medicine practitioners can perform traumatology. So, in Chinese medicine clinics, the Chinese medicine practitioners often focus on internal medicine and acupuncture, while tuina therapists handle massage treatments. Here is the TV media in Taiwan about traditional Chinese medicine clinic. Here is the shopping channel about traditional Chinese medicine clinic. In next video, I will introduce acupuncture in Taiwan. See you next time. Hello everyone, I am Dr. Gao. Nice to meet you again. If you have any questions, please contact me via email. Let me introduce the issues of acupuncture and health insurance in Taiwan. Taiwan's national health insurance system, which formally started in March 1995. The basic principles of national health insurance are promote social equality, improve service efficiency, improve the level of medical care. Health insurance is compulsory social insurance. All citizens pay insurance fees and receive equal medical services and rights. Foreigners can join the insurance system if they have a residence permit and have stayed in Taiwan for 6 months. The out-of-pocket cost for outpatient medications is low. Most of the medication costs are covered by health insurance. Let me introduce the medical call system for Chinese medicine clinics. For general health insurance subscribers, the initial consultation fee for internal medicine, gynecology, and pedestrians at the clinic is 100 to 150 NT dollars. And at the hospitals, Chinese medicine department is 50 to 150 NT dollars. This includes a 2-day prescription. If the prescription exceeds 2 days, there is an additional cost, 20 dollars for 3 to 5 days, and 40 dollars for 6 to 7 days. Herbal medicines are vacuum-packed after preparation, with an average self-pay cost of 250 dollars per day and can be prescribed for more than 5 days. Diet treatments are most self-paid, with raw herbal prescriptions costing 1,000 NT dollars per week. Acupuncture and traumatology follow a cycle system. One cycle includes 6 treatments. The initial consultation fee for the first treatment is 150 dollars, and for the second to 6 treatments, it is 50 to 150. During the treatment period, only one herbal prescription is allowed. Cosmetic acupuncture is a self-pay, with an average cost of 2,000 to 4,000 per treatment. Weight loss treatments are on expense, with thread embedding costing 1,000 dollars per week. Tuina and massage are mostly performed by tuina therapists. If a patient visits the clinic for the consultation and then goes to the tuina room, the self-pay cost is 50 to 100 per 10 minutes. To ensure remuneration for Chinese medicine practitioners and tuina therapists, Taiwanese clinics often adopt these methods. Massage parlors charge 2,000 dollars per hour, so many people prefer visiting Chinese medicine clinics over massage parlors. Let me introduce the remuneration system for Chinese medicine practitioners. Clinic remuneration is based on the point system. If the number of patients seen per day is less than 50, the remuneration is 310 to 220 per patient. If the number exceeds 50, it is 150 per patient. This applies to internal medicine, gynecology, and the pediatrics. For acupuncture and traumatology, only one treatment during the treatment period is eligible. One point is not equivalent to one empty dollar, as the amount changes according to the Health Insurance Bureau. Medical expenses fluctuate based on the Health Insurance Bureau's regulations. Next, a week's supply of herbal medicine is 210 points, the prescription fee is 13 to 23 points, and acupuncture and traumatology treatment fees are 210 points. For example, if Clinic A sees 40 patients a day, including 20 internal medicine patients and 20 acupuncture patients, the income is 20,860. The advantages of National Health Insurance include low cost, no initial consultation fee for low-income individuals, abundant medical resources, and guaranteed remuneration of young doctors. Without health insurance, patients could flock to renowned doctors, significantly reducing the number of patients seen by young doctors. The disadvantages of National Health Insurance include the fact that one point is not equivalent to one empty dollar, and generally one point is worth less than one empty dollar. Due to low medical costs, excessive medical shopping is not uncommon, and the average remuneration for doctors continues to decline. For example, the average monthly income for a physician with 7 years of services is 210,044, for the dentist is 191,846, and for Chinese medicine practitioners is 140,973. Therefore, the income for Chinese medicine practitioners is the lowest among physicians. Additionally, Taiwanese doctors are allocated an average of 25 patients per period, morning, afternoon, and evening. For renowned doctors, it can be more than 30 patients per period. With consultation times of less than 5 minutes, the quality of medical care declines. The quality of medicines also tends to decline with the prescription of generic drugs become common. Essentially, the cost of Chinese medicines often exceeds 30 dollars. However, the prescription points add on is only 30 points, leading to cost overruns. The remuneration of pharmacists is 23 points, making it difficult to employ them. The remuneration of acupuncture and tuina treatment is lower than that for internal medicine. So Chinese medicine practitioners study and research internal medicine to earn higher remuneration. As a result, fewer people study acupuncture and tuina, leading to lower treatment capabilities. Finally, I will introduce the penalties imposed by the Health Insurance Bureau. To control the health insurance budget, the Bureau imposes penalties. For example, if a doctor's medical record is incomplete, they perform unnecessary medical tests or prescribe drugs not suitable for these diseases. The points for the consultation will be deducted. Let me introduce the issues of the Chinese medicine industry. Chinese medicine is often mistaken for folk remedies. Folk remedies are based on erroneous knowledge and if there is a medical incident, Chinese medicine is scrutinized. In Taiwan, there is no licensing system for tuina and massage therapists. Due to the lack of medical knowledge among tuina therapists, medical incidents frequently occur. There is also a slight antagonism towards western medicine, with the general public's recognition of Chinese medicine declining. While young doctors face less antagonism, older doctors often view Chinese medicine as unscientific. Patients are told, don't go to Chinese medicine, putting pressure on Chinese medicine practitioners. The remuneration for Chinese medicine practitioners is significantly lower than that for western doctors and dentists. Some doctors focusing only on achievements and remuneration force patients into unnecessary self-pay treatments, leading to fewer patients visiting Chinese medicine clinics. Additionally, to increase turnover rates, some clinics have ordinary clerks illegally prescribe Chinese medicines. Furthermore, the PGI system in Taiwan is almost the same as the clinical training system internally, such as recording initial consultations, acupuncture for inpatients, and observation of consultations. There is little independent consultation, resulting in simple routine training content in insufficient clinical skills. After passing the PGI training, doctors qualify to open a clinic. However, there is a shortage of medical departments and clinics that can accept PGI doctors. To obtain training qualifications, PGI doctors often face low pay and heavy workloads, and some even work without pay. For example, this year's graduating medical students number 200. But the capacity of hospital and clinics that can provide training is only 160. Therefore, 40 students cannot receive training and must complete with next year's graduates. In next video, I will introduce acupuncture in Taiwan with evolution and achievements. See you next time. Hello everyone, I am Dr. Gao. Nice to meet you again. If you have any questions, please contact me via email. Let me introduce the evolution, achievements, and international exchanges of acupuncture in Taiwan. First, let me introduce the evolution of acupuncture science in Taiwan. The theory of acupuncture in Taiwan incorporates not only traditional Chinese medicine, but also Western medicine, scientifically analyzing acupuncture theory. The Department of Anesthesiology at the National Taiwan University Hospital research combined treatments of acupuncture with anesthesia, pain relief, cancer pain, post-operative pain, and chronic pain. They also study the scientific basis of meridian theory, observing the effects of acupuncture on pain thresholds through animal experiments. To research safe acupuncture methods, they have introduced cadaver dissection to study the safe depth of needle insertion and have held international academic conferences to promote the internationalization of Chinese medicine. The 3D digital media system for Dong's acupuncture, developed by Dr. Dong Jingchang, is also noteworthy. Next, I will introduce significant events in the development of acupuncture science in Taiwan. In 1975, the first National Science Council Symposium on Acupuncture Research was held. In 1973, the Acupuncture Research Center at the China Medical University was established, attracting foreign doctors from France, Japan, the United States, Canada, Singapore, South Korea, and Germany. In 1978, the Executive Yuan established the Acupuncture Research and Development Group. In 1982, the first International Acupuncture and Musculoskeletal Research Symposium was held. In 1989, Acupuncture and Musculoskeletal Research Development and Clinical Application Research Meeting was held. In 1998, the Chinese Medical Association of Acupuncture was established. Let me introduce Taiwan's most famous Chinese medicine practitioner. The person on the right in the photo is Professor Ling Zhaogeng. The person on the left is the ex-president Cai Yingwen. Professor Ling Zhaogeng is Taiwan's first Chinese medicine acupuncture doctorate and the only Chinese medicine academician in the Central Research Academy in Taiwan. He is also the only Chinese medicine practitioner from Taiwan to join the WHO. Currently, he is the president of the International Society of Traditional Medicine. He has published 182 SCI papers. Let me introduce Professor Ling Zhaogeng's publications. New Compendium of Acupuncture and Moxibustion. New Theory of Acupuncture and Moxibustion. Comprehensive Dictionary of Disease Names in Chinese and Western Medicine. New Complication of Acupuncture and Moxibustion in Color. Taiwanese Traditional Chinese Medicine During the Japanese Period. A Study of Acupuncture Depths. Let me introduce Professor Ling Zhaogeng's awards. In 1980, Saudi Arabia's Highest Honor Award. In 1990, Republic of El Salvador's Presidential Academic Contribution Award. In 1993, Taiwan's Presidential Cultural Award. Professor Ling Zhaogeng's achievements include becoming a royal physician in Saudi Arabia, editing the Comparison Dictionary of Chinese and Western Medical Words, and the most important achievement is researching the safe depths of acupuncture points on the chest and back using autopsy and CT scan, leading to safer acupuncture treatments and avoiding medical disputes. In summary, Chinese medicine in Taiwan is widely popular worldwide and provides effective and convenient medical care. The convenience of Chinese medicine is high, and there are many options, including out-of-pocket treatments. However, the remuneration for Chinese medicine practitioners is low, and the training period is long and difficult, so those considering the profession should carefully consider these factors. Well done. We finish the seminar. Although this seminar is very long and complicated, I think that it is very important for everyone. The Chinese medicine in Taiwan is a very mature medicine. If you are interested in Chinese medicine, welcome to visit Taiwan. See you next time.