【源版】中西醫(yī)結(jié)合在未來醫(yī)學(xué)中的作用有待思路與方法的突破

中西醫(yī)結(jié)合在未來醫(yī)學(xué)中的作用

有待思路與方法的突破

GrowthoftheIntegrationofTraditionalChineseandWesternMedicineandIt'sEffectonFutureMedicineAwaitingaBreakthroughinThinkingRouteandWorkingMethod

河北醫(yī)科大學(xué)中西醫(yī)結(jié)合研究所中西醫(yī)結(jié)合基礎(chǔ)博士后科研流動(dòng)站李恩LiEn,HebeiMedicalUniversity

前言

(Introduction)

1．“三個(gè)醫(yī)學(xué)”并存共同發(fā)展的局面

2．基礎(chǔ)理論研究促進(jìn)了中藥現(xiàn)代化，同時(shí)也豐富了基礎(chǔ)醫(yī)學(xué)相關(guān)的學(xué)科

Inasituationofco-existenceofChinesemedicine,westernmedicineandIntegrationofTraditionalandWesternMedicineforminganewaspectofthree-medicinegrowingincommon.BasistheorystudypromotedofthemodernizationtheChineseHerbs,atthesametime,enrichingtheBasisMedicine—relatedsubjects.

3．臨床研究中辨證與辨病相結(jié)合，宏觀辨證與微觀辨證顯示了中醫(yī)特色和中西醫(yī)結(jié)合優(yōu)勢(shì)。

Inclinicalstudy,theeffectofsyndromedifferentiationanddifferentialdiagnosisexhibitsaspecialfeatureintraditionalmedicineandasuperiorityofIntegrationofTraditionalandWesternMedicine.Thepracticeofmacroscopicsyndromedifferentiationincompanywithmicroscopicdifferentialdiagnosisimprovesthequalityofbothdiagnosisandtreatment.

4．中西醫(yī)結(jié)合進(jìn)入了高層次研究階段；全國(guó)現(xiàn)有中西醫(yī)結(jié)合碩士點(diǎn)90個(gè)，博士學(xué)科點(diǎn)31個(gè)，博士后流動(dòng)站6個(gè)。中西醫(yī)結(jié)合教育體系正在形成中。

Presently,alongsidethegrowthoftheIntegrationofTraditionalandWesternMedicine,theresearchworkofwhichhasenteredaseniorstage.Now,91master'sstudystationsconcerningtheIntegrationofTraditionalandWesternMedicineareestablished.Inaddition,thereare31doctor'sand6mobilespotsforpostdoctoralstudent,showingthatasystemoftheIntegrationofTraditionalandWesternMedicineisshapingupandgoingtodevelop.

5．中西醫(yī)結(jié)合有待思路與方法的突破創(chuàng)新能力三個(gè)要素：

(1)洞察性：即能通過事物的表面現(xiàn)象把握其內(nèi)在含義和本質(zhì)特性；

AdevelopmentexpectedbytheIntegrationofTraditionalandWesternMedicineawaitsabreakthroughofthinkingrouteandworkingmethod.Theabilityofbringingnewtrailsandnovelideasoughttoholdthreeessentialelement:(1)Insightability-tryingtoseethingsthroughtheappearancetotheessence.

(2)敏感性：即能夠接受新事物，發(fā)現(xiàn)新問題；

(3)獨(dú)創(chuàng)性：即產(chǎn)生新的非凡思想能力，表現(xiàn)為產(chǎn)生新奇、罕見、首創(chuàng)的觀念和成就。

(2)Sensibility-anabilityapttoacceptnovelthingsandideasandfindoutnewproblems.(3)Originality-beingabletohaveapioneeringspiritoracreativeinitiationindoingsomethingwithastonishingachievement.一.醫(yī)學(xué)發(fā)展的歷史與當(dāng)代醫(yī)學(xué)的特點(diǎn)

TheErareflectedbycurrentmedicineanditsfeatures

二．三個(gè)醫(yī)學(xué)的內(nèi)涵與中西醫(yī)結(jié)合“代橋”作用

Theconnotationof“ThreeMedicine"andtheeffectof

“GenerationBridge"ofIntegrationtheChinese

MedicineandWesternMedicine

●西醫(yī)學(xué)：即現(xiàn)代醫(yī)學(xué)。它是自然科學(xué)和社會(huì)科學(xué)兩大門類相結(jié)合的一門科學(xué)。隨著近代科學(xué)的發(fā)展，運(yùn)用現(xiàn)代的科學(xué)理論和技術(shù)，研究人體的結(jié)構(gòu)和功能，各種病因的致病作用，病理變化，以及對(duì)疾病的診斷、治療和預(yù)防，從而達(dá)到增強(qiáng)健康和延緩衰老為目的的一門科學(xué)。

Thewesternmedicinenamelythemodemmedicinewhichintegratestwomajordepartmentsofnaturalsciencewithsocialsciencetogether.Alongwiththeprogressofcurrentscience,themodernscientifictheoriesandtechniquesareusedtostudythestructuresandfunctionsofthehumanbody,etiology,pathologyandclinicaldiagnosis,treatmentandprevention,soastostrengthenone'shealthandtopostponeone'saging.

●中醫(yī)學(xué)：中醫(yī)學(xué)屬于傳統(tǒng)醫(yī)學(xué)。傳統(tǒng)醫(yī)學(xué)是指：“它是在現(xiàn)代醫(yī)學(xué)傳播和發(fā)展以前就已存在幾百年的有生命力的醫(yī)療實(shí)踐，而且至今還在應(yīng)用。這些實(shí)踐由于各國(guó)社會(huì)傳統(tǒng)和文化不同而存在很大差異(《WHO第八次工作綱要》)?！闭f明中醫(yī)是產(chǎn)生在經(jīng)驗(yàn)醫(yī)學(xué)時(shí)代的經(jīng)驗(yàn)醫(yī)學(xué)，各國(guó)傳統(tǒng)醫(yī)學(xué)有著各自的理論體系。中醫(yī)學(xué)是世界傳統(tǒng)醫(yī)學(xué)中理論最完整、經(jīng)驗(yàn)最豐富的傳統(tǒng)醫(yī)學(xué)，包括漢醫(yī)、蒙醫(yī)、維吾爾醫(yī)、藏醫(yī)以及其他少數(shù)民族醫(yī)等。

TheChinesemedicine,whichbelongstothetraditionalmedicinewhichdemonstratesthatbeforethespreadandgrowthofwesternmedicine,theChinesemedicinehadexistedandpractisedclinicallyforseveralhundredsyearswithitsgreatvitalitytilttoday.Thereisasignificantdifferencebetweenthistwokindsofmedicalpracticeowingtothevariationsofsocialtraditionalcultures.ChinesemedicineisregardedasanexperiencedmedicineoriginatedfromtheageofexperiencemedicineThetraditionalmedicineinvaryingcountriespossesstheirowntheorysystem,onlytheChinesemedicineremainsthebestintegratyofitsowntheoryandtherichestexperienceofpracticewhichincludesthemedicineofHan,medicineofMongoliaandmedicineofUrguretc.

ThemedicineoftheIntegrationofTraditionalandWesternMedicineisasubjectofmedicineinwhichinvolvesthemodeofthinking,objectivecontentandobservationprocessabouttheevolutionandgrowth.Thesimilaritiesanddifferencesofbothmedicinearecheckedbycomparingeachothertoacquireanoutstandingincreasinganewsystemofmedicaltheory.InstudyingtheIntegrationofTraditionalandWesternMedicine.`

●人口譜和疾病譜的變化為中醫(yī)發(fā)展

提供了歷史機(jī)遇

ThealterationofthepopulationspectrumandthediseasespectrumprovidesahistoricalopportunityforthegrowthofChinesemedicine.●代謝性疾病與中醫(yī)藥的整體調(diào)節(jié)作用

Metabolicdiseaseandintegratedregulationofthe

TraditionalChineseMedicineandherbs

飲食結(jié)構(gòu)變化與環(huán)境污染

代謝性疾病

糖尿病、肥胖癥、骨質(zhì)疏松、高脂血癥(心腦血管疾病)、腫瘤、精神分裂癥、先天畸形EntityregulationoftheTraditionalChineseMedicineandherbsTherapy:treatpatientbysyndromedifferentiationRecipeofChinesemedicinalherbs:aprincipleofLi,Fa,Fang,YnoandruleofJun,chen,Zuo,andShiDietarytherapy:makingthedrugsasthefoodAcupunctrueqigongtaijiquan●第三條給藥途徑與中醫(yī)“內(nèi)病外治”法

Thethirdrouteofadministrationand

“externaltreatmentforinternaldisease”四．中西醫(yī)結(jié)合的難點(diǎn)與反思

ThedifficultpointsandrecallintheIntegrationofTraditionalandWesternMedicine.

▲對(duì)中醫(yī)研究提出的新問題

1．藏象研究如何從單純解剖學(xué)觀點(diǎn)生理功能體系發(fā)展

2．證的本質(zhì)是什么？能否尋找單一指標(biāo)？ThenewproblemscomingoutinstudyingontheTraditionalChineseMedicine1.HowtotransformationofstudyonZangandXiangfromsimpleanatomytoPhysicalfunction.2.WhatistheessenceofsyndromeinTraditionalChineseMedicine.AretherethepeculiarindexforsyndromeinTraditionalChineseMedicine3．中醫(yī)的整體調(diào)節(jié)用還原論分析方法，怎么反映整體變化4．醫(yī)學(xué)模式轉(zhuǎn)變與七情研究怎樣客觀化、標(biāo)準(zhǔn)化？3.HowtoinflecttheentitychangeundertheentityregulationofTraditionalChineseMedicinebytheanalyzedmethodofreductionism4.AlternationofmedicinemodelandtheobjectivationandstandardizationofQiQing(七情)5.WhethertheingredientofChineseMedicinalherbsisnotthealternativeoftherecipeofChinesemedicinalherbs.HowtoanalysistheoftherecipeofChinesemedicinalherbs.Whatisthemediumofdrugsleadingotherdrugsintothechannelanddrugsbelongingtothechannel.WhethertheusedChinesemedicinalherbsarenotthenewfunction.WhatisthemechanismofdiregulationofChinesemedicinalherbs.6.Whatistheessenceofchannelsandcollaterals.5.中藥單體成分能否代表該藥？復(fù)方如何分析？引經(jīng)藥、歸經(jīng)藥作用介質(zhì)是什么？中藥有無“老藥新用”？中藥雙向調(diào)節(jié)機(jī)理是什么？6.經(jīng)絡(luò)本質(zhì)是什么？如何評(píng)價(jià)“實(shí)體”研究？“內(nèi)病外治”與經(jīng)絡(luò)所屬臟腑關(guān)系。五．中西醫(yī)結(jié)合醫(yī)學(xué)模式與思路方法

MedicalDevelopmentmodeloftheIntegrationof

TraditionalChineseMedicine(TCM)and

WesternMedicine(WM)

●中西醫(yī)結(jié)合醫(yī)學(xué)模式——對(duì)生物醫(yī)學(xué)模式和恩格爾（GL.Enger）醫(yī)學(xué)模式的評(píng)價(jià)

說明：

(Interpretations)

1．生物進(jìn)化和演變，首先受自然環(huán)境的影響，適者生存。代謝類型決定物種的生存和進(jìn)化。因此，研究健康與疾病，要體現(xiàn)“天人合一”的自然觀。

2．人類屬于生物屬性。由于參加社會(huì)的群體交往，產(chǎn)生心理活動(dòng)，具有社會(huì)屬性。對(duì)健康與疾病的認(rèn)識(shí)必然是身心統(tǒng)一的整體觀。

1.Firstofall,thebiologicalevolutionisinfluencedbythenaturalenvironment,leadingtothesurvivalofthefittest.Theexistenceandevaluationofthespeciesisdeterminedbydifferentmetabolictypes.Thus,theconceptonnaturethatnatureandmancorrespondtoeachothershouldbeincarnatedinstudyingthehealthanddisease.2.Humanspeciesbelongtothebiologicalattributionbutalsopossesssocialpropertyduetothejoininginsocialcommunicationandtheproducingofpsychologicalactivities.Thecognitiontohealthanddiseasesmustbeinconformitywithintegratedconceptthatphysicalandmentalactivitiesareunited.

3．同一種疾病在不同人身上，具有不同的表現(xiàn)，出現(xiàn)了個(gè)體差異。在治療上，中醫(yī)提出了同病異治和異病同治的個(gè)體醫(yī)學(xué)，突出了中醫(yī)辨證施治的治療觀。

4.隨著人口譜和疾病譜的轉(zhuǎn)變，自然環(huán)境的變化和社會(huì)的進(jìn)步，運(yùn)用天人合一的自然觀，身心統(tǒng)一的整體觀和辨證施治的治療觀(三觀)，指導(dǎo)醫(yī)學(xué)研究，必將促進(jìn)醫(yī)學(xué)發(fā)展。

3.Individualdifferencemeansthatdifferentsymptomsandsignsofthesamediseasemayappearindifferenthumanbeings.InTCM,that"sametreatmentfordifferentdiseaseanddifferenttreatmentsforonedisease",asakindofindividualizedmedicineisofferedgivingprominencetothetherapeuticconceptthattreatmentsarebasedonsyndromedifferentiation.4.Inpacewiththetransformationinthepedigreeofpopulationanddiseases,thechangeinnaturalenvironmentandtheprogressofthesociety,thedevelopmentofmedicinewillundoubtedlybepromotedbyapplyingtheabovethreeconceptsinmedicalstudies.◆中西醫(yī)結(jié)合的思路與方法——需要解決的五個(gè)問題

ThethinkingrouteandworkingmethodintheIntegration

ofTraditionalandWesternMedicine—fiveproblemsmust

besolved1.思維上，形象思維與邏輯思維的統(tǒng)一●形象思維與中醫(yī)自然哲學(xué)醫(yī)學(xué)模式的形成●邏輯思維與生物醫(yī)學(xué)模式●兩種思維方式的統(tǒng)一：“從特殊到一般的道路是直覺的，而從一般到特殊的道路則是邏輯性”(愛因斯坦)●系統(tǒng)論、控制論、信息論為一切科學(xué)提供了新理論和新方法

Theintegratyofimagingthinkingandlogicthinking●imagingthinkingandforma-tionofnaturalphilosophicmedicineinTraditionalChineseMedicine●logicthinkingandBiomedicinemodel●theintegratyofimagingthinkingandlogicthinking:AsstatedbyEinstein:“Theroadfromparticularitytogeneralityisanintuitionalsenseandroadfromgeneralitytoparticularitybelongstologic.●thebirthofsystematology,cyberneticsandinformatics(threetheories)supplieanewtheoryandmethodforscientificresearchwork.2．局部和整體的關(guān)系

Therelationshipbetween"apart"and"awhole"●局部組織器官的作用與整體的關(guān)系●微觀分子水平與宏觀整體的統(tǒng)一(對(duì)抗癌療效的評(píng)價(jià))●中藥復(fù)方研究的指導(dǎo)思想——二律背反規(guī)律●Therelationshipbetweenthefunctionofeachindividualpartandtheentity●Thecentralizationofthemacroin-tegratyandthemicromolecularity●TheleadingthinkinginstudyofRecipeofChinesemedicinalherbs——Itisknownthatanentiretyconsistsofsome"part",thatis(1+1=2).whilesometimesanentiretyislargerthanasumof"part",thatis(1+1=3)3．內(nèi)因與外因的關(guān)系——人的生存和進(jìn)化與自然環(huán)境和社會(huì)環(huán)境的關(guān)系

Therelationshipbetweeninternalandexternalcauses:

Theexistenceandevolutionofmankindisinitiallyinfluencedbythenaturalsurroundandsocialcircumstances.●食物是溝通人體與外界之間的橋梁，飲食在人類進(jìn)化中起著決定性作用●心理因素在致病和治病的作用，研究和發(fā)展中醫(yī)心理學(xué)(如五臟與五志)●Foodisabridgetolinkupthehumanbodyandtheexternalworld.Dietplaysadecisiveroleinman'sevolutionandgrowth.●Effectsofpsychologicalfactorsontreatingdiseaseandresultingindisease.Theemotionalchangesarereflectedontheviscera,whichisworthstudyingincurrentpsychology.4．客觀指標(biāo)與病人自覺狀況的關(guān)系

Therelationshipofobjectiveindexandchief

complaintofpatient●新的儀器的發(fā)明和使用，擴(kuò)大了對(duì)健康和疾病認(rèn)識(shí)的視野●醫(yī)生的經(jīng)驗(yàn)與病人主訴和體征的作用●轉(zhuǎn)變從“治病”到“治病人”的觀念●Theinventionofnewapparatusmakesman'svisionfieldonhealthanddiseasebroadened.●Physician'seffortandthechiefcomplaintandsignofpatient●Transformationconceptionof"diseaseistreatedbyphysician"to"patientsarebyphysicians"5．分析與綜合的統(tǒng)一

Theunityofanalysisandsynthesis●分析與綜合的關(guān)系——分析是綜合的基礎(chǔ)，沒有分析便沒有綜合●綜合——分析——綜合的研究方法●Therelationshipofofanalysisandsynthesis——analysisisthebasisofsynthesis.Ifthereisnoanalysis，nosynthesisisthebasisofsynthesis.Ifthereisnoanalysi