【源版】中西医结合在未来医学中的作用有待思路与方法的突破

中西医结合在未来医学中的作用

有待思路与方法的突破

GrowthoftheIntegrationofTraditionalChineseandWesternMedicineandIt'sEffectonFutureMedicineAwaitingaBreakthroughinThinkingRouteandWorkingMethod

河北医科大学中西医结合研究所中西医结合基础博士后科研流动站李恩LiEn,HebeiMedicalUniversity

前言

(Introduction)

1．“三个医学”并存共同发展的局面

2．基础理论研究促进了中药现代化，同时也丰富了基础医学相关的学科

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

3．临床研究中辨证与辨病相结合，宏观辨证与微观辨证显示了中医特色和中西医结合优势。

Inclinicalstudy,theeffectofsyndromedifferentiationanddifferentialdiagnosisexhibitsaspecialfeatureintraditionalmedicineandasuperiorityofIntegrationofTraditionalandWesternMedicine.Thepracticeofmacroscopicsyndromedifferentiationincompanywithmicroscopicdifferentialdiagnosisimprovesthequalityofbothdiagnosisandtreatment.

4．中西医结合进入了高层次研究阶段；全国现有中西医结合硕士点90个，博士学科点31个，博士后流动站6个。中西医结合教育体系正在形成中。

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

5．中西医结合有待思路与方法的突破创新能力三个要素：

(1)洞察性：即能通过事物的表面现象把握其内在含义和本质特性；

AdevelopmentexpectedbytheIntegrationofTraditionalandWesternMedicineawaitsabreakthroughofthinkingrouteandworkingmethod.Theabilityofbringingnewtrailsandnovelideasoughttoholdthreeessentialelement:(1)Insightability-tryingtoseethingsthroughtheappearancetotheessence.

(2)敏感性：即能够接受新事物，发现新问题；

(3)独创性：即产生新的非凡思想能力，表现为产生新奇、罕见、首创的观念和成就。

(2)Sensibility-anabilityapttoacceptnovelthingsandideasandfindoutnewproblems.(3)Originality-beingabletohaveapioneeringspiritoracreativeinitiationindoingsomethingwithastonishingachievement.一.医学发展的历史与当代医学的特点

TheErareflectedbycurrentmedicineanditsfeatures

二．三个医学的内涵与中西医结合“代桥”作用

Theconnotationof“ThreeMedicine"andtheeffectof

“GenerationBridge"ofIntegrationtheChinese

MedicineandWesternMedicine

●西医学：即现代医学。它是自然科学和社会科学两大门类相结合的一门科学。随着近代科学的发展，运用现代的科学理论和技术，研究人体的结构和功能，各种病因的致病作用，病理变化，以及对疾病的诊断、治疗和预防，从而达到增强健康和延缓衰老为目的的一门科学。

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

●中医学：中医学属于传统医学。传统医学是指：“它是在现代医学传播和发展以前就已存在几百年的有生命力的医疗实践，而且至今还在应用。这些实践由于各国社会传统和文化不同而存在很大差异(《WHO第八次工作纲要》)。”说明中医是产生在经验医学时代的经验医学，各国传统医学有着各自的理论体系。中医学是世界传统医学中理论最完整、经验最丰富的传统医学，包括汉医、蒙医、维吾尔医、藏医以及其他少数民族医等。

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

ThemedicineoftheIntegrationofTraditionalandWesternMedicineisasubjectofmedicineinwhichinvolvesthemodeofthinking,objectivecontentandobservationprocessabouttheevolutionandgrowth.Thesimilaritiesanddifferencesofbothmedicinearecheckedbycomparingeachothertoacquireanoutstandingincreasinganewsystemofmedicaltheory.InstudyingtheIntegrationofTraditionalandWesternMedicine.`

●人口谱和疾病谱的变化为中医发展

提供了历史机遇

ThealterationofthepopulationspectrumandthediseasespectrumprovidesahistoricalopportunityforthegrowthofChinesemedicine.●代谢性疾病与中医药的整体调节作用

Metabolicdiseaseandintegratedregulationofthe

TraditionalChineseMedicineandherbs

饮食结构变化与环境污染

代谢性疾病

糖尿病、肥胖症、骨质疏松、高脂血症(心脑血管疾病)、肿瘤、精神分裂症、先天畸形EntityregulationoftheTraditionalChineseMedicineandherbsTherapy:treatpatientbysyndromedifferentiationRecipeofChinesemedicinalherbs:aprincipleofLi,Fa,Fang,YnoandruleofJun,chen,Zuo,andShiDietarytherapy:makingthedrugsasthefoodAcupunctrueqigongtaijiquan●第三条给药途径与中医“内病外治”法

Thethirdrouteofadministrationand

“externaltreatmentforinternaldisease”四．中西医结合的难点与反思

ThedifficultpointsandrecallintheIntegrationofTraditionalandWesternMedicine.

▲对中医研究提出的新问题

1．藏象研究如何从单纯解剖学观点生理功能体系发展

2．证的本质是什么？能否寻找单一指标？ThenewproblemscomingoutinstudyingontheTraditionalChineseMedicine1.HowtotransformationofstudyonZangandXiangfromsimpleanatomytoPhysicalfunction.2.WhatistheessenceofsyndromeinTraditionalChineseMedicine.AretherethepeculiarindexforsyndromeinTraditionalChineseMedicine3．中医的整体调节用还原论分析方法，怎么反映整体变化4．医学模式转变与七情研究怎样客观化、标准化？3.HowtoinflecttheentitychangeundertheentityregulationofTraditionalChineseMedicinebytheanalyzedmethodofreductionism4.AlternationofmedicinemodelandtheobjectivationandstandardizationofQiQing(七情)5.WhethertheingredientofChineseMedicinalherbsisnotthealternativeoftherecipeofChinesemedicinalherbs.HowtoanalysistheoftherecipeofChinesemedicinalherbs.Whatisthemediumofdrugsleadingotherdrugsintothechannelanddrugsbelongingtothechannel.WhethertheusedChinesemedicinalherbsarenotthenewfunction.WhatisthemechanismofdiregulationofChinesemedicinalherbs.6.Whatistheessenceofchannelsandcollaterals.5.中药单体成分能否代表该药？复方如何分析？引经药、归经药作用介质是什么？中药有无“老药新用”？中药双向调节机理是什么？6.经络本质是什么？如何评价“实体”研究？“内病外治”与经络所属脏腑关系。五．中西医结合医学模式与思路方法

MedicalDevelopmentmodeloftheIntegrationof

TraditionalChineseMedicine(TCM)and

WesternMedicine(WM)

●中西医结合医学模式——对生物医学模式和恩格尔（GL.Enger）医学模式的评价

说明：

(Interpretations)

1．生物进化和演变，首先受自然环境的影响，适者生存。代谢类型决定物种的生存和进化。因此，研究健康与疾病，要体现“天人合一”的自然观。

2．人类属于生物属性。由于参加社会的群体交往，产生心理活动，具有社会属性。对健康与疾病的认识必然是身心统一的整体观。

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

3．同一种疾病在不同人身上，具有不同的表现，出现了个体差异。在治疗上，中医提出了同病异治和异病同治的个体医学，突出了中医辨证施治的治疗观。

4.随着人口谱和疾病谱的转变，自然环境的变化和社会的进步，运用天人合一的自然观，身心统一的整体观和辨证施治的治疗观(三观)，指导医学研究，必将促进医学发展。

3.Individualdifferencemeansthatdifferentsymptomsandsignsofthesamediseasemayappearindifferenthumanbeings.InTCM,that"sametreatmentfordifferentdiseaseanddifferenttreatmentsforonedisease",asakindofindividualizedmedicineisofferedgivingprominencetothetherapeuticconceptthattreatmentsarebasedonsyndromedifferentiation.4.Inpacewiththetransformationinthepedigreeofpopulationanddiseases,thechangeinnaturalenvironmentandtheprogressofthesociety,thedevelopmentofmedicinewillundoubtedlybepromotedbyapplyingtheabovethreeconceptsinmedicalstudies.◆中西医结合的思路与方法——需要解决的五个问题

ThethinkingrouteandworkingmethodintheIntegration

ofTraditionalandWesternMedicine—fiveproblemsmust

besolved1.思维上，形象思维与逻辑思维的统一●形象思维与中医自然哲学医学模式的形成●逻辑思维与生物医学模式●两种思维方式的统一：“从特殊到一般的道路是直觉的，而从一般到特殊的道路则是逻辑性”(爱因斯坦)●系统论、控制论、信息论为一切科学提供了新理论和新方法

Theintegratyofimagingthinkingandlogicthinking●imagingthinkingandforma-tionofnaturalphilosophicmedicineinTraditionalChineseMedicine●logicthinkingandBiomedicinemodel●theintegratyofimagingthinkingandlogicthinking:AsstatedbyEinstein:“Theroadfromparticularitytogeneralityisanintuitionalsenseandroadfromgeneralitytoparticularitybelongstologic.●thebirthofsystematology,cyberneticsandinformatics(threetheories)supplieanewtheoryandmethodforscientificresearchwork.2．局部和整体的关系

Therelationshipbetween"apart"and"awhole"●局部组织器官的作用与整体的关系●微观分子水平与宏观整体的统一(对抗癌疗效的评价)●中药复方研究的指导思想——二律背反规律●Therelationshipbetweenthefunctionofeachindividualpartandtheentity●Thecentralizationofthemacroin-tegratyandthemicromolecularity●TheleadingthinkinginstudyofRecipeofChinesemedicinalherbs——Itisknownthatanentiretyconsistsofsome"part",thatis(1+1=2).whilesometimesanentiretyislargerthanasumof"part",thatis(1+1=3)3．内因与外因的关系——人的生存和进化与自然环境和社会环境的关系

Therelationshipbetweeninternalandexternalcauses:

Theexistenceandevolutionofmankindisinitiallyinfluencedbythenaturalsurroundandsocialcircumstances.●食物是沟通人体与外界之间的桥梁，饮食在人类进化中起着决定性作用●心理因素在致病和治病的作用，研究和发展中医心理学(如五脏与五志)●Foodisabridgetolinkupthehumanbodyandtheexternalworld.Dietplaysadecisiveroleinman'sevolutionandgrowth.●Effectsofpsychologicalfactorsontreatingdiseaseandresultingindisease.Theemotionalchangesarereflectedontheviscera,whichisworthstudyingincurrentpsychology.4．客观指标与病人自觉状况的关系

Therelationshipofobjectiveindexandchief

complaintofpatient●新的仪器的发明和使用，扩大了对健康和疾病认识的视野●医生的经验与病人主诉和体征的作用●转变从“治病”到“治病人”的观念●Theinventionofnewapparatusmakesman'svisionfieldonhealthanddiseasebroadened.●Physician'seffortandthechiefcomplaintandsignofpatient●Transformationconceptionof"diseaseistreatedbyphysician"to"patientsarebyphysicians"5．分析与综合的统一

Theunityofanalysisandsynthesis●分析与综合的关系——分析是综合的基础，没有分析便没有综合●综合——分析——综合的研究方法●Therelationshipofofanalysisandsynthesis——analysisisthebasisofsynthesis.Ifthereisnoanalysis，nosynthesisisthebasisofsynthesis.Ifthereisnoanalysi