Ying MEI, Fang CHEN, Ran ZHAO, Ming LIU, Dong LIU, Zhibin JIANG, Xiaogang LI
Abstract This study was conducted to explore the construction of scaffolding teaching mode of Traditional Chinese Medicine under the background of "Internet+". The students of Grade 2018 majoring in traditional Chinese medicine were selected as the object， and some chapters of the textbook of traditional Chinese medicine were selected and taught by the traditional teaching mode while interspersing the scaffolding teaching mode， in order to help the implementation of the scaffolding teaching model. We adopted the methods of setting up situational scaffolding， question scaffolding and guide scaffolding to carry out relevant teaching contents. The scaffolding instruction model has a good degree of participation， and to a certain extent， it stimulates students self-consciousness and enthusiasm， and improves their ability of analyzing and solving problems and their spirit of innovation.
Key words Traditional Chinese medicine; Scaffolding teaching; Internet+
Received：
November 26， 2022 Accepted：
February 3， 2023
Supported by 2017 Teaching Quality and Teaching Reform Project of Guizhou University of Traditional Chinese Medicine （3045-045170035）; 2018 School-level Undergraduate Teaching Engineering Construction Project of Guiyang College of Traditional Chinese Medicine （GZY-JG（2018） 03）.
Ying MEI （1978-）， female， lecturer， master， devoted to research about compound compatibility of prescription， and teaching reform of the course "Chinese Medicine".
*Corresponding author. E-mail：
37979960@qq.com.
Traditional Chinese Medicine is a course to study the theory and clinical application of traditional Chinese medicine. It is a required professional basic course and main course for all majors related to traditional Chinese medicine in universities and colleges of traditional Chinese medicine in China. It is also a required professional core course for the major of traditional Chinese medicine. The course has strong theoretical and clinical practicality. It not only follows the guidance of traditional Chinese medicine theory， but also lays a foundation for clinical courses such as Science of Prescriptions and Internal Medicine of Traditional Chinese Medicine. However， the course of tradition Chinese medicine involves a large number of Chinese herbs， the relationship among which is unclear and the efficacy scopes of which are wide， which increases the learning difficulty for students majoring in traditional Chinese medicine. The traditional teaching mode is based on teachers teaching. Although it is conducive to the play of teachers leading role， it ignores the status of students as the cognitive subject which is in the position of object， and they passively accept knowledge， and lack the initiative and participation in learning. According to many teachers， after instilling a lot of knowledge of traditional Chinese medicine into the students， students accept it at a low level and harvest a small amount， and the feedback situation is not optimistic， far from reaching the goal set by teaching， which will inevitably restrict the teaching development of traditional Chinese medicine. Therefore， students must be placed in the main position in teaching， emphasizing student-centered， and advocating students to learn independently under teachers guidance.
The theoretical core of the scaffolding teaching model under the constructivist teaching theory is advocating independent learning with students as the center［1］. Specifically， "scaffolding" used in the construction industry is used as a figurative metaphor for the conceptual framework， in which the concepts are required for developing students further understanding of the problem， that is， the framework should be established according to the "Zone of Proximal Development" of students intelligence［2］， and the scaffolding role of such scaffolding can promote students learning and understanding from one level to another new and higher level. The scaffolding teaching model puts more emphasis on giving full play to students initiative， enthusiasm and initiative， and finally achieving the goal of effectively realizing the meaning construction of the current knowledge. Teachers design meaningful questions with thinking value according to the content to be learned， so that students can think and try to solve them. It reflects the relationship between teaching and learning. Teachers teaching is only to build learning scaffoldings for students， helping rather than replacing students learning. Using the scaffolding teaching theory to guide teaching not only puts forward new and higher requirements for teachers， but also makes teaching work more creative.
In recent years， the rapid development of network information technology has provided abundant teaching information resources for teachers and students. When combining network information teaching with scaffolding teaching mode， on the one hand， students can use network situation creation to complete knowledge sharing， collaborative division of labor， group discussion， information exchange and other work; and on the other hand， with the help of "scaffolding"， students use network information resources and teachers guidance to achieve leaps in self-knowledge construction［3］. It provides a new opportunity and way for the implementation of scaffolding teaching mode in the teaching of traditional Chinese medicine. According to the characteristics of the course of traditional Chinese medicine， this paper organically integrated the network information teaching method and the scaffolding teaching mode， and preliminarily discussed the teaching mode of traditional Chinese medicine based on the "Internet+" background.
Analyzing the Learning Situation based on Various Thinking Scaffoldings
Learning situation analysis is one of the important factors that affects the final design of the learning system in the instructional design system. It studies the actual needs， ability levels and cognitive tendencies of students， so as to provide a fundamental basis for teachers to design teaching plans， optimize the teaching process， effectively achieve teaching objectives， and improve teaching efficiency. Through the form of thinking scaffolding such as questionnaire survey and distribution of question forms， students learning situation is analyzed to facilitate the later teaching design.
Understanding the overall learning situation with questionnaires as a scaffolding
On the Superstar Learning was published a questionnaire， which was used as a scaffolding to understand the current learning objectives， the original knowledge base and the existing cognitive skills of students， and to conduct an overall analysis of the learning situation （Table 1）.
Understanding the specific learning situation with question table as a scaffolding
The former Soviet educator Vygotskys "Zone of Proximal Development" theory attaches great importance to students mastery of original knowledge and transferable knowledge. In the process of teaching， we should also further look for the "Zone of Proximal Development" of students specific learning and carry out systematic analysis to solve various problems that may arise in teaching. For example， when learning the "five flavors" theory， we considered using the form of question table as a scaffolding to analyze students grasp of the pre-knowledge and transferable knowledge of the five-element theory and the theory of viscera in Basic Theories of Chinese Medicine （as shown in Table 2）， so as to understand students zone of proximal development and their levels in this course and prepare for the formulation of subsequent teaching objectives and strategies.
Therefore， we could understand students mastery of the previous knowledge through the previous pre-knowledge point， and formulate teaching objectives and strategies. Meanwhile， students mastery of later-stage transferable knowledge could be obtained through teaching observation in class or investigation and interview after class （or online） to facilitate teaching reflection and improvement.
Carrying out Teaching and Learning based on Various Teaching Scaffoldings
Bloomes classification of educational objectives put forward that the knowledge dimension can be divided into four categories：
factual knowledge， conceptual knowledge， procedural knowledge and metacognitive knowledge. When we sort out teaching problems， we can learn from its ideas， determine teaching objectives， clarify teaching problems， and design teaching scaffoldings. For example， the distribution of knowledge points in the course， property "five flavors" of Chinese herbs， included the concept of "five flavors"， the determination basis of "five flavors"， the role of herbs represented by "five flavors" and the main treatment of diseases and syndromes， and the application of the combination of property and flavor in clinical practice， and referring to Bloomes classification of educational objectives and combining with scaffolding teaching mode， we sorted out the problems to be solved in this course （as shown in Table 3）， which could not only reflect the knowledge dimension， but also provide clear problem orientation for teaching， so that we could carry out teaching activities in combination with appropriate scaffolding mode.
Building a situational "scaffolding" and mobilizing students interest in learning based on network environment
Situational teaching means that in the teaching process， teachers purposefully introduce or create vivid and concrete scenes having certain emotional color and with images as the main body to arouse students certain attitude experience. Based on the "Internet+" background， building a situational "scaffolding" relying on the network platform has a certain degree of authenticity of life， can vividly and effectively connect textbooks and life， and provide students with a visual learning environment. With situational scaffoldings as a support， students can move from specific thinking to abstract thinking， and promote students to in-depth understanding of knowledge.
Situational scaffolding
We could build a situational scaffolding that is closely related to daily life， taking the property "five flavors" of Chinese herbs as an example.
Creating a situation ①：
After class， students first watched the episode of "Harmony of Five Flavors" in the first season of "A Bite of Chinese Food" on the Internet to enter a familiar life situation. Students experienced the sweet taste of sugar and scallion， the bitter taste of tangerine peel， the salty taste of sea salt， the sour taste of vinegar， and the spicy taste of chilli.
Creating a situation ②：
Students should contact real experience in daily life， discuss situation ① actually， and further feel the role of "five flavors". For example， when discussing the feeling of eating spicy hot pot， we often think of a classmate who is eating hot pot with a big mouthful while constantly wiping the sweat on his head and body. It is the role played by spicy chilli and Chinese pepper inside hot pot， and it is also a typical example of the spreading of the pungent taste. Another example is the hot summer， when people feel the heat evil easily， and everyone may eat bitter gourds to clear away the fire， which is the clearing performance of bitter herbs. There is ice on the road in winter， and we will see sanitation workers sprinkle salt on the road. Ice is hard， but it will be thawed if it contacts salt， which reflects the role of salty herbs in softening hardness to dissipate stagnation. Everyone actively participated in the discussion， cited various examples seen in life， and understood the role of five flavors， respectively. With the five flavors， both ancient and modern people can classify food， and each food has its corresponding flavor and characteristics， and the "property （and） flavor" in Chinese medicine comes from this.
Creating a situation ③：
Introduced from the "Diet Instructions" of Jia Ming in the Yuan Dynasty， following content was demonstrated to students：
"Salt is salty in taste and cold in nature. Eating salt too much hurts the lungs and induces coughs， makes the lungs lose color and debilitates the muscles. People suffering from edema and asthma should not eat…Muscovado is sweet in taste and warm in nature. Eating too much muscovado can cause heartache， let worms grow， eliminate muscles， damage teeth and induce cyanosis…Mint is pungent in taste and cold in nature. It can cause diabetes in weak people who eat it for a long time…Vinegar is sour and sweet in taste and bitter and slightly warm in nature. It can remove toxins from fish， meat， melons and vegetables. Rice vinegar is good. Eating too much vinegar damages muscles and bones， stomach qi， and it is not suitable for men. It can damage teeth and face， and disperse toxins”. Creating such situations could let students associate their own experiences and discuss the taboos of the four seasons and five flavors in daily life， and the adverse consequences of overeating the five flavors.
Expected effects
① The first basis for students to understand the "five flavors" of traditional Chinese medicine through situational scaffoldings is the true taste of herbs or food. Through situational scaffoldings， the original meaning of the "five flavors"， i.e.， the true taste of medicines or food， could be presented to students. The taste of Chinese herbs and food can be detected by tasting. Because for Chinese herbs and food， "the taste could be feel in the mouth and the nature could be known in the stomach"， and the ancients linked the taste and functions of Chinese herbs and food， and explained the functions of Chinese herbs and food with the taste.
② Situational scaffoldings could facilitate the understanding on the dietary wisdom of "Harmony of Five Flavors"， and the dietetic view of "Cereals （staple foods） are the basis for peoples survival， while fruits， vegetables and meats are all auxiliary， complementary to staple foods" in the Inner Canon of Huangdi. Then， they could understand the effect of the "five flavors" of Chinese herbs on human body.
③ Students further understood the adverse consequences of overdose of food or medicines. When using the "five flavors" to treat diseases， we must keep in mind that everything is biased， which is useful， but also harmful. Through the study of the "five flavors"， students could not only grasp the role of "five flavors" and its clinical application， but also remind students to pay more attention to how to reflect the effectiveness and safety of drug use.
Building a question "scaffolding" to guide students thinking development in combination with online teaching
The question scaffolding is a purpose scaffolding， learning scaffolding and thinking scaffolding constructed for students. The questions are necessary for learners to acquire knowledge， expand knowledge and promote the development of thinking. Before class， we can decompose complex learning objectives into several scaffolding questions， so as to gradually make learners understand and think deeper. Learners can also ask questions in the learning process to further understand the knowledge learned from different perspectives. Through question scaffoldings， students thinking can be improved to a new level.
Under the background of "Internet+"， Superstar learning platform has strengthened online and offline communication between teachers and students， allowing students to easily obtain required information online， and promoting the improvement of learning efficiency. Students can complete library borrowing query， electronic resources search and download and library information browsing on Superstar learning platform themselves， and also learn school courses and conduct group discussions. We can use this convenient platform to combine online and offline teaching， build a question scaffolding， expand and explore knowledge from two aspects， guide students to construct knowledge， and promote multi-dimensional development of students thinking patterns， thereby deepening the learning and understanding of knowledge in Chinese medicine course， and effectively promoting students to form good thinking quality and innovation awareness.
Teachers ask questions and guide discussion
Teachers put forward questions to students on the Superstar learning platform， guide students to participate in the discussion in the Superstar learning platform discussion area， and find out answers to the questions. The study of the "five flavors" theory was also taken as an example.
【Question scaffolding 1】Teachers example：
Red ocher having a bitter taste almost has no real taste， and it is expressed as faint smell and light taste. However， because of its effect of calming the liver and suppressing yang， calming the adverse-rising energy， cooling blood and stopping bleeding， which are related to the bitter taste， red ocher is attributed to Chinese herbs with the property flavor of bitter and cold. Gypsum with a pungent taste is also expressed as faint smell and light taste， but it can relieve exterior syndrome， which is related to the pungent flavor， and it is pungent and sweet， greatly cold in property and flavor. Semen Ziziphi Spinosae is mature seeds of wild jujube. The pulp is sour， but the seed taste is not sour. However， because of its functions of arresting sweating and promoting fluid production， its property and flavor are sweet， sour and neutral.
Students were guided to think about following questions：
Is the basis for determining the "five flavors" of Chinese herbs only their true taste？ In other words， is the production of "five flavors" a reflection of the real taste of Chinese herbs？ Can the real taste of a Chinese herb completely summarize its efficacy？
【Expected effects】Students understood the second basis for determining the "five flavors" of Chinese herbs under the guidance of the question scaffolding， that is， the efficacy of Chinese herbs. In addition to being reflected the real taste of Chinese herbs， the "five flavors" is more reflected from long-term clinical observation. Different flavors of Chinese herbs act on the human body， generate different reactions， and produce different therapeutic effects， and the theory of "five flavors" is thus summarized. That is to say， Students further realized that the "five flavors" are not only the true reflection of the taste of Chinese herbs， but also the high-level summary of the effects of Chinese herbs. The "flavor" of the "five flavors" has gone beyond the scope of taste and is based on the efficacy.
Students put forward difficulties and participate in discussions
Difficulties encountered by students in the process of learning can also be put forward on the Superstar learning platform， and teachers and students can participate in the discussion. "Dampness-resolving herbs" were taken as an example.
【Question scaffolding 2】 Before teaching "dampness-resolving herbs"， students were required to watch teaching videos on the Superstar learning platform for preview. Some students asked questions after watching the videos：
Patchouli in dampness-resolving herbs has the effect of relieving summer-heat， while the summer-heat evil that is easily felt in summer is the evil of yang heat， and patchouli is warm， so why does patchouli have the effect of relieving summer-heat？
Students actively participated in the discussion on the Superstar learning platform. Some students thought：
"Patchouli capable of internalizing the turbid dampness of the middle energizer， waking up the spleen， stopping vomiting and dispersing the wind-cold on the surface of muscles refers to the summer-heat dampness pattern/syndrome， the wind-cold at the initial onset of dampness-heat and in the summer months， and the external symptoms caused by internal injury and cold. Patchouli is spicy， warm and fragrant， and it can open interstices of the flesh externally， penetrate the hair orifices and disperse the external evil， and can remove turbid dampness and eliminate dirty and greasy things in the body after oral administration". Another student pointed out：
"Patchouli has the functions of relieving summer-heat and resolving dampness. Most people will get summer-heat together with dampness， and the dampness and heat are deeply attached to each other. The only way is to clear away and disperse them. Patchouli is warm in nature， so it is good at getting into the heat without the worry of rejection. Patchouli has a clear fragrance， and its nature is good at rising and penetrating， so it can separate the dampness and heat. Therefore， patchouli warm in nature can also relieve summer-heat".
【Expected effects】After students online discussion， teachers discussed and answered relevant questions in the class. For example， in which season is summer-heat evil more common？ What are its characteristics？ Does it cause disease alone or mixed diseases easily？ When students answered that summer-heat is more common in summer， they further guided them to think that when people drink cold drink because of the hot weather in summer， it is easy to see the yin summer-heat pattern/syndrome， so that students could understand that the summer-heat-relieving effect of patchouli is mainly reflected in its ability to remove dampness by means of aromatics and relieving exterior syndrome by its spicy characteristic， and students learning and understanding of patchouli is further enhanced.
In offline classroom teaching， due to the limited class hours， it is difficult for students to fully discuss the questions and obtain better learning results. In combination with online teaching， building a question scaffolding and guiding students to actively speak and discuss on the online platform can not only make up for this shortcoming， but also enable students to upload the information they have consulted and their own cognition when participating in the discussion， so as to realize the sharing of network resources. It also contributes to the cultivation of students thinking ability and improves their learning enthusiasm.
Building a guide scaffolding to stimulate students learning motivation using teaching videos
A guide scaffolding is the summary and collection of questions， suggestions and other fragments according to a certain topic， aiming to give students systematic guidance and methodology.
On the Superstar learning platform， the teaching and research section of our school uploaded the teaching video of Traditional Chinese Medicine， in which the key herbs in the textbook were selected for video explanation. Teachers built a guide scaffolding in advance to guide students to learn relevant knowledge independently by watching videos.
【Guide scaffolding 1】Representative herbs， such as purgative herbs， tranquillizing herbs， resuscitation-inducing herbs and other small chapters were selected， and starting with online teaching videos， students watched independently with set learning requirements， learning content， learning tasks and completion deadline. Meanwhile， the flipped classroom model was also integrated. Teachers and students roles were exchanged， and students completed the preparation， teaching， organization and discussion of lessons in a learning group， and teachers play the role of the initiator and coordinator of the course. It fully mobilized the enthusiasm of students to actively participate in learning of the course， and effectively improved the teaching effect of Chinese medicine.
【Expected effects】Through this teaching mode and the property theory of Chinese herbs， students could deeply understand the characteristics and laws of the efficacy and application of various Chinese herbs， and master the analytical method of determining their property， indications and syndrome taboos through the efficacy of Chinese herbs. After class， teachers could also comprehensively summarize the characteristics and shortcomings of the course implementation process and the learning effect of students， and make a comprehensive evaluation.
【Guide scaffolding 2】 Based on students study of the property theory of some traditional Chinese herbs in the general introduction， the thesis of Xu Dachun， a famous doctor in the Qing Dynasty， that "Chinese herbs have their own specialties" was put forward， pointing out that in traditional Chinese medicine， the property of Chinese herbs guides the treatment of diseases， and many Chinese herbs have the same property， which is the common characteristic. There are also different personalities in the common characteristic， which means that "Chinese herbs have their own specialties". Students were required to understand that the purpose of being a doctor is to heal the wounded and rescue the dying. Under the premise of accurate diagnosis， it is always our goal to explore efficient and effective treatment methods， and the "Chinese herb specialtiy" is an important content here［4］.
【Expected effects】It was hoped that under the guidance of guide scaffolding 2， while learning the common characteristics of Chinese herbs and understanding their common efficacy and application， students could present the similarities and differences in efficacy and application of Chinese herbs of the same type in the form of mind maps to reflect the differences in personalities of Chinese herbs， and further learn and understand the personalities of Chinese herbs， so as to guide specific clinical practice， lay a foundation for learning the science of prescriptions and clinical Chinese medicine， and cultivate the thinking of traditional Chinese medicine such as syndrome differentiation and treatment.
Evaluation
According to relevant documents of the "Distance Education and Training Program" （DGX III） of the European Community， scaffolding teaching is defined as：
"scaffolding teaching should provide a conceptual framework for learners to build their understanding of knowledge." It mainly focuses on students independent learning， thinking and exploration， and the subsequent effect evaluation mainly focuses on the evaluation of students learning effect， including the embodiment of independent learning ability， the contribution to group collaborative learning and whether the meaning construction of the learned knowledge is completed. Therefore， we made a corresponding evaluation quantification table， and determined the dimensions of scaffolding teaching effect evaluation as follows：
ability to raise questions （Do students think when they study independently？）， problem-solving strategies （Can students use various ways， such as internet and books， to find answers to questions？）， problem-solving attitude （reflecting learning attitude）， the effectiveness of problem solving （whether existing problems have been solved and deeper problems have been raised） and the application of learning methods （as shown in Table 4）.
Conclusions
Traditional Chinese medicine is a discipline that studies the basic theory and clinical application of traditional Chinese medicine. It is a professional basic course for all majors of traditional Chinese medicine. Through the teaching of this course， students can master the basic theory of traditional Chinese medicine and the property of commonly used Chinese herbs， apply theoretical knowledge and skills， and lay a foundation for learning the science of prescriptions and various professional courses of traditional Chinese medicine. To enable students to learn Chinese medicine well and lay a good foundation， the teaching mode of Chinese medicine should also keep pace with the times， highlight students status as the subject of knowledge in the teaching process fully based on the diversity of scaffolding teaching mode and the richness of teaching resources in the context of "Internet+"， cultivate students independent learning ability， improve the teaching quality and efficiency of Chinese medicine， and help the cultivation of Chinese medicine talents.
References
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