A Medical Service Model Based on TCM Expertise to Ensure the

Continuity of Medical Tour

Mujiexin Liu

, Dazheng Zhang

2, *

, Danyi Wen

and Zhidong Jia

Chengdu Ineye Hospital, Jinniu District, Chengdu 610084, Sichuan, China

Chengdu University of Traditional Chinese Medicine, Jinniu District, Chengdu 610075, Sichuan, China

Guihua Community Health Service Centre, Dujiangyan, Chengdu 611830, Sichuan, China

Chengdu Neusoft University, Qingchengshan, Dujiangyan, Chengdu 611844, Sichuan, China

Keywords: TCM Expertise, TCM Treatments and Prescriptions, Cost-Effectiveness, Efficiency, High-Quality Outcomes,

Medical Tour.

Abstract:

The global market of medical tour has been growing because people need other options of medical treatment

for various reasons. The biggest challenge for medical tour is to provide high-quality care and outcomes to

ensure its continuity. TCM, with the national initiative to go global, faces the scarcity of its expertise to serve

this purpose. To tackle this problem, this paper provides a service model that can help bring the limited

resources of TCM expertise into its full play. Therefore, the strengths of TCM in the aspects of accurate

clinical judgement and treatments, cost-effectiveness and the ability to get the whole body into equilibrium

state after the mile stones in different phases of treatments make it stand out among other options.

1 INTRODUCTION

Unlike medical-health-wellness tourism

(MHWT)which has become immensely popular for a

variety of economic, cultural, lifestyle and leisure

reasons (Nikezic, 2012; Lee, 2015; Wang, 2020),

medical tour (MT)is defined as "the travel of people

to a place other than where they normally reside, for

the purpose of obtaining medical treatment at that

location" (Tabish, 2012). Being a complex decision

process, the sustainability of medical tour is based on

the attributes of the host country, facilities of

healthcare professionals, reasonable cost, and the

service quality of hospitality and tourism (Chung,

2014; Fetscherin, 2016; Olya, 2021). Although

medical travel facilitators around the world operate

on a variety of different scales and market their

services differently, they all emphasize the consumer

experience through advertising quality assurance and

logistical support (Dalstrom, 2013). Though medical

tourism has been an expanding global phenomenon

(Chaulagain, 2021; Rokni, 2019; Rouland, 2020) and

millions of people take advantage of medical services

available abroad (Eltorai, 2018; Leggat, 2015),

quality and continuity of care are the problems

associated with medical tourism (Turner, 2007),

which heavily rely on the medical establishments that

can provide expertise/medical tourism products

(Heung, 2011) apart from the service delivery skills,

competencies, and kindness (From Servicescape to

Loyalty in the Medical Tourism Industry).

Whatever services or products, the

competitiveness is determined by the quality (From

Servicescape to Loyalty in the Medical Tourism

Industry). The level of perceived advantages, price

perception and willingness to stay all depend on the

medical results delivered by either special expertise

or advanced technologies. The increased cost of care

and the long waiting lists in western countries and the

middle east have resulted in patients moving to other

healthcare destinations or forced patients to look

towards the east (Mishra, 2021). Apart from

deteriorating state and the need for other options,

perceived value of medical and service quality is a

key predictor of tourist intentions (Wang, 2012). The

outcome quality and service quality (Qolipour, 2017)

are highly crucial for the continuity of MT. Even with

TCM going global as the national initiative and its

effectiveness highlighted in this long-lasting

pandemic, there is still a long way for the experienced

experts and TCM expertise to have their full play. For

TCM, a profession, only for the talented throughout

China’s thousands-years of history to put the logical

rules in use accurately, still faces the scarcity of

278

Liu, M., Zhang, D., Wen, D. and Jia, Z.

A Medical Service Model Based on TCM Expertise to Ensure the Continuity of Medical Tour.

DOI: 10.5220/0012019800003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 278-284

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

experienced TCM experts and TCM expertise even at

home. What in urgent need is a kind of service model

that can maximize the high-quality services of TCM

for accountable health outcomes and the continuity of

MT.

2 TCM EXPERTISE TO ENSURE

THE CONTINUITY

From a holistic view that cure diseases through

establishment of equilibrium in the human life, TCM

has been practiced for thousands of years and

attracted worldwide interest (Zhang, 2013). The

major advantage of TCM is based on the treatment of

various syndromes through the comprehensive

analysis of clinical information gained by the four

TCM diagnostic procedures (Lan, 2013; Sun, 2012):

Looking for signs of illness, Listening to patients’

account, Asking questions for the needed information

and Pause-feeling for further information to confirm

the already collected. Behind which, the rules,

developed from the Book of Changes, which is so far

the earliest and the only philosophical and

mathematical system about the universe, consist of

the relationships among the five basic elements

(metal, wood, water, fire, earth) in their form of qi,

the balance of Ying and Yang at the surface level and

that within each individual internal organ and their

interactions, and the changes of attributes of the six

pairs of meridians. They are validated and explained

in detail in the case analysis of books like

Shanghanlun, Jinkuiyaolue and so on that have been

practiced for thousands of years. The detailed

explanations, in ancient Chinese (which makes it hard

for most people today to drill into), have been given

by many famous doctors in Chinese history such as

Zhang Zhongjing, Li Shizhen, Huang Yuanyu to

teach and alarm learners not to make mistakes. Thus,

it is a total misunderstanding of TCM to say that the

traditional diagnostic approach is mainly based on

observation by doctor’s nude eyes, which is non-

quantitative and subjective.

Supported by the rules and philosophy of TCM,

clinical judgement and decisions are made and

confirmed by TCM experts by going through the four

diagnostic approaches, instead of using machines and

relying on all different kinds of tests that often fail to

give a full picture of the problem going on inside the

body. Upon the confirmed clinical decisions, the

treatment plan is made at the micro and macro levels

because TCM experts know how long and how many

phases it will take before reaching the final

equilibrium state or the best possible outcome. With

specific prescription, TCM experts only have to make

small changes suggested in the ancient classics for

formulae adjustments. At the micro level, urgent or

serious symptoms/problems are handled at once to

reduce and halt their harm and trouble on the patients.

At the macro level, the treatment plan is about the

phases that serve as the milestones for the upcoming

problems before getting the body into equilibrium

state, which doesn’t request any tests but only timely

communication with patients. During any phases with

the prescriptions given for the patients, it will allow

TCM experts time to take care of new patients, start

new files and make the needed research for

troublesome complications. This fully depicts how

TCM treat and prevent at the same time.

Phase 2 Prescriptions

Treatment & Prevention

Phase 1 Prescriptions

Treatment & Prevention

Phase 3 Prescriptions

Treatment & Prevention

Phase N Prescriptions

Treatment & Prevention

The Balance

between Yin &

Yang

Milestones

Figure 1: The Treatment Plan.

For any milestones, the effective use of TCM

medicine for dynamic changes in the cycles of

illnesses rather than operation and acupuncture plays

the dominant role. The prescriptions for different

syndromes have been unchanged and practiced for

thousands of years, which leave very limited room for

experienced experts to change one or two items of

herbs and their doses, but no room for any innovation.

As all the diseases are classified and the prescriptions

have been used and validated by generations for more

than five thousand years, why there should be any

need for TCM to reach the standards of western

medicine which has provided neither any rule for

clinical judgement and documentation of the

validations of treatment for different phases of

syndromes nor any medicine that has been used

effectively for more than one thousand years. Let’s

A Medical Service Model Based on TCM Expertise to Ensure the Continuity of Medical Tour

279

look at some examples. Gout is considered as

metabolic arthritis both in western medicine and

TCM, but is diagnosed and treated very differently.

In western medicine, the high level of uric acid in the

blood is an obvious sign and other blood tests like

white blood cell count, electrolytes, kidney function

and erythrocyte sedimentation rate (ESR) have to be

conducted as most people with raised uric acid levels

never develop gout (Schlesinger, 2010; Sturrock,

2000). But in TCM, the diagnose is as simple as

seeing the red swollen joints of the toes and knees.

And herbs are used to help drain the waste through

urine and perspiration while boosting energy

productivity of the kidneys [Jinkuiyaolue by Zhang

Zhongjing], which not only settle the acute attack but

also solve the problem without having to use any

preventative medicines like probenecid, febuxostat,

benzbromarone that are used in western medicine to

prevent further episode of gout, and colchicine

(Shekelle, 2017; Dalbeth, 2016; Kydd, 2014). And

people can eat as normal and just be careful enough

not to catch a cold or overeat. Also, in this pandemic

sweeping the world for years without a cure in

western medicine, all the syndromes and medicines

are given in the classic to help TCM experts to

diagnose the complications and give the matching

prescriptions. Contrary to the western medicine that

the affected patients have to be quarantined for

observation, TCM treat all the patients as early as

possible once they have any symptoms of cold or flu,

because the first two weeks are the only time left for

the affected people, especially the seniors

[ Shanghanlun by Zhang Zhongjing].

The safety of TCM prescriptions also lies in the

small amount and few doses for each syndrome.

Taking all the prescriptions recorded in the ancient

medical classics into consideration, more than 85%

only consist of 6- 8 types of herbs less than 10g

respectively. Only a few doses are needed for urgent

and acute syndromes, just one or two doses for non-

severe cases. For maintenance, the prescriptions that

help boost the energy may last for quite a long time

with very mild and common herbs in daily life, like

dates no more than 6 for each dose and ginger no

more than 3 pieces. [ Wenbing Tiaobian] This feature

of being able to cure the urgent and acute syndromes

in very short time with maintaining prescriptions that

can be taken away is most crucial for the continuity

of the medical tour. The herbs used as medicine are

from the same sources of food, which means that

most of them are used as ingredients of daily dishes.

Chinese medical cuisine is the best option for the

post-operation recovery, because they are enhanced

in flavour by certain herbs that can help the digestion

and absorption of the needed nutrition. The word

cuisine tells us that this kind of food can also be found

on the daily dining table with different recipes for

different seasons. They are very popular in the

southern part of China, where people need to make up

for the fast-consumed energy due to the hot weather.

This is why TCM prescriptions and medical cuisine

are highly recommended to patients for post-

operation recovery by the doctors of western

medicine in China.

Together with the cost-effectiveness, TCM can

never be matched by any other options in the world.

The total cost of medicine for the whole treatment

plan sometimes will be incomparably less than even

just the cost of tests in any hospital and any other

options, not to say the cost of operation and afterward

treatment in the western medicine. TCM also saves

the labour and cost for developing expensive new

medicines which become heavy burdens to the

patients without expected outcomes but often strong

side effects.

Apart from the safety and affordable cost of

overseas treatment, effective communication is

essential to medical practice. And medical ethicists

emphasize the importance of informed consent as a

dimension of effective communication (Manson,

2007). This is particularly important when

considering a medical procedure that is inherently

risky or poorly understood (Paling, 2003). This raises

important ethical concerns regarding processes such

as informed consent and the liability of brokers in the

event that complications arise from procedures

(Penney, 2011). There are no such worries in TCM

practice, as there is no need to consider any risks

about surgeries or operations. Even when the follow-

up treatment is concerned, the communication

doesn’t involve any special terms that may confuse

the patients and the language assistant. With today’s

advanced technology for distant communication, the

conversation is just about patients’ diet, the progress

and the current physical condition so as to confirm the

prescriptions for use in each different phase. It

doesn’t take much for the language training for such

communication.

The efficient-and cost-effective follow-up

treatments without the need for frequent visits, and

the quality outcomes that far exceed the expectations

are crucial for medical tour. TCM can cure many

complications in quite a short time that western

medicine fails, like chronic migraine and insomnia

that trouble many people and their normal lives. In

western medicine, they are considered as the

problems concerning the brain and nerve system. But

in TCM, it is never about the curing the specific part

ICBB 2022 - International Conference on Biotechnology and Biomedicine

280

of the body where the symptoms occur. Whenever our

body is in trouble, TCM take the whole body into

consideration, especial the work and coordination of

the internal organs rather than cells. Take the chronic

migraine for example. Migraine is a common disorder

that affects approximately 10%–12% of the

population of developed countries (18% of women

and 6% of men), with similar prevalence rates just in

North America and Europe (Láinez, 2013).

Approximately, 60%–95% and 50%–62% of patients

with migraines develop nausea and vomiting,

respectively, during migraine attacks (Mateos, 2009;

Bradley, 2007). But the pathophysiology of migraine

(in western medicine) has long been debated and

remains incompletely understood (Láinez, 2013).

More than two-thirds of the patients with migraine

experience vomiting during their migraine attacks

(Stovner, 2007; Vikelis, 2012). Both nausea and

vomiting are usually related to the intensity of pain

(Kelman, 2006), although the exact link between pain

and gastrointestinal symptoms in patients with

migraines is not completely understood in western

medicine (Láinez, 2013). And it’s never taken into

consideration why patients feel relieved for some

days after vomiting and why patients drink a lot of

water without much urine and sweet. But to TCM,

vomiting obviously means that the stomach fails to

function normally when it is weak for taking in and

passing down the food. When migraine lasts for

several days, this state of the weak stomach makes is

hard for patients to sleep and intensifies the pain in

the eyes, because the foul gas inside the stomach has

no way to go but to rise up to the chest and brain,

causing nausea and headache. When the stomach

becomes empty after vomiting, the headache goes

away for a while. As to the treatment, it is never about

the head. It takes several steps to get stomach and gall

bladder back into normal coordination by releasing

the accumulated heat in the chest, boosting the energy

productivity of the kidneys and helping the liver to

pass on the energy. When the migraine is gone, it

takes time to get the stomach and spleen back to

normal function so as to push the whole system back

to normal to stop its coming back.

The biggest advantage of TCM expertise lies in

the solutions for complications, which are the bad

consequences caused by the wrong and delayed

treatments. The methods of diagnosis and the

prescriptions for the treatments are also recorded in

the ancient classics, which explains why doctors of

western medicine in China have to visit TCM experts

when they and their family members are in serious

conditions. These solutions are of great value for the

purpose of medical tour.

To benefit more patients far and near, it is in high

need for a service model to maximize TCM expertise

so as to ensure the continuity of the medical tour.

3 A SERVICE MODEL TO

MAXIMIZE AND ENSURE THE

CONTINUITY

The shortage of experienced TCM experts is not just

a matter of numbers, but much more about making

full and effective use of them. In current service

model of the western medicine applied to TCM in

hospitals for more profits, it has been highly difficult

to make an appointment with these experts in any big

hospitals in China. As a result, patients in serious

conditions have to wait and come back again and

again after using each one prescription, making the

crowds bigger every day at the clinic and the waiting-

lists longer for hospital beds.

On the contrary, there had been no hospitals in

true sense in the long history of China before the first

western hospital was built in Canton in 1835. By

tradition, TCM physicians were invited to homes to

attend the patients, who often were found at

pharmacies or their own homes. And famous TCM

physicians were invited to travel to other places.

Being highly flexible and without the need of

machines, TCM physicians in the long history of

China had never been many in numbers because it has

been a very demanding profession for great sense of

responsibility, learning abilities, benevolence and

patience.

Today, in this computer aided society, EMR

system and telecommunication, it is possible for one

TCM expert to serve more people both at home and

abroad, as shown in figure 2. To carry out the

treatment plan after the diagnosis which is recorded

in EMR system, TCM physician can arrange

reminders by time and priorities according to the

condition of the patients. No matter how many phases

there will be, TCM experts can call and receive calls

on the appointments, supported by an assistant

/assigned interpreter to record the follow-up

decisions, suggestions and prescriptions. The only

need is to change the service model that not only

maximize the role of TCM experienced experts but

also largely reduce the visit frequencies of patients.

First of all, let’s take a look of a treatment plan so

that the requirement of the service model becomes

clear. Upon the first visit clinical judgement and

decision, TCM experts have the plan in mind, which

now has to be transferred into the EMR system simply

A Medical Service Model Based on TCM Expertise to Ensure the Continuity of Medical Tour

281

about the phases of the treatment needed and by some

guidelines for later reminding. In this way, the system

can compute how many follow-ups and how much

work and cost will be involved for reaching the final

goal of each case. A whole package of service will be

crystal clear to the patients with depicted benefits,

limited travels if necessary and the length of

treatment.

To carry out the plan, the role of the system

reminding is important. With the past records, it saves

time for further clinical judgements and spares more

time and efforts for TCM experts to communicate

with patients about the progress and current

problems. Supported by online camera, experts only

have to focus on looking for new signs and listening

for the needed information. Throughout the course of

communication, the assistant or interpreter help take

and enter the notes under the direction of the experts,

which will serve as reminders for further

communication. The same happens when patients call

in or required to report upon appointments.

TCM Expertise System

Phase 1

Phase 2

Phase 3

…...

Phase n

Treatment Goal

Patient’s Treatment Plan – If direct

communication is possible

Patients

Liaison & Record Services

Phase Interview &

Follow Up

Communication

Patient

Feedback

Call back & Emergenceis

Record Archiving & Upload

Figure 2: Medical Service Model based on TCM Expertise.

In this way, the number of patients can be

multiplied with limited resources of expertise

required for care and outcomes. And patients don’t

need to change hospitals and doctors for each disease

or syndromes. Aided with computer system and

assistant/interpreter, TCM expertise can be

maximized to its most extent for high quality

treatments and saving as many people as possible.

With the package of services for high quality

outcomes, hospitals don’t need to worry about the

revenue and TCM experts are relieved from the

pressure of number of patients they have to take care

each day. When there is time for communication,

TCM experts have the time to focus and work more

efficiently. From the patients’ perspective, the stress

is greatly reduced by the treatment plan and the

package of service to ensure the follow-up treatments

and final outcomes. Without the need to travel often

or afar, patients for most of the time are much more

comfortable and relaxed at home, which is the best

ICBB 2022 - International Conference on Biotechnology and Biomedicine

282

environment for recovery and life at the same time.

With the high-quality outcomes and the cost-

effectiveness, words of mouth become the best

advertisements to the long lasting the medical tour.

4 CONCLUSION

The application of this service model is more about

the change of business model for TCM in the

hospitals. Once it is in its full play, TCM experts can

reach out to the patients with more allowed time for

the communication and thinking for the best

solutions. The consistent treatment saves patients’

time, labor and money, while giving the opportunity

to TCM experts to care and look after much more

patients than they used to in one period. The cut in the

waiting time, the perceived value and the high-quality

outcomes, exactly what TCM expertise can provide,

will be brought to its greatest extent by this model,

which in turn will attract more patients to come and

stay in the future. The complete records of each

patient in the system will not only save the time and

efforts of TCM experts, but also become highly

valuable for the training of TCM physicians. With the

detailed records, the treatment plan and the profile of

reaching each milestone will give a full picture about

how each different syndromes are tackled, which will

be of great value for research as well. The assistants

will soon become experts themselves, who can join in

the team for the long-lasting medical tour services.

ACKNOWLEDGMENTS

This work was financially supported by:

1. The development and application

demonstration of the comprehensive service platform

for health maintenance and tour in Dujiangyan,

Chengdu Science and Technology Bureau (2020-

YF09-00010-SN)

2. Research on the ecosystem of the health

industry with traditional Chinese medicine as the

core, Sichuan Provincial Department of Education

(Xq20C03).

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