顺势医学的诊治特点及其对中医学的启示

【作者】 QUNCE ZHANG（张群策）；

【导师】 王天芳；

【作者基本信息】 北京中医药大学 ， 中医诊断学， 2012， 博士

【摘要】 顺势医学俗称顺势疗法,是当今盛行于欧洲、北美及部分亚洲地区的一种相对独立的医学体系,在西医为主流医学的欧美医疗保健体系中,它与中医学一起被归属为另类医学。顺势医学和中医学分属于不同的医学知识体系,根植于东西方不同的文化背景,其临床信息的处理方法、认知模式和治疗手段等虽有所差异,但其基本的哲学理念和宏观诊治观点较为相近。方法：本研究采用定性研究的方法。首先,通过美国国家图书管医学杂志文献查阅系统做一简要的数据调查,根据过去10年间专业期刊杂志上顺势医学科研文章的发表状况,对顺势医学的整体科研状态、研究者对之关注的程度等予以评估。其次,检索和查阅了1989-2010年间有关顺势医学诊治研究的中外文献,在回顾顺势医学在海内外发展和研究现状的基础上,首次对顺势医学的历史渊源、哲学理念、发展现状、研究现状、理论依据、诊治过程、诊治原理、诊治特点等予以系统梳理和总结,并在此基础上运用分析、对比、归纳的方法,与中医学的诊治理念、诊治原则、诊治方法和诊治手段等方面做以横向对比。目的：取长补短,借鉴和汲取其它医学诊治理论和临床应用之精华,为深化和完善中医诊治理论,提高临床诊治水平,促进中医国际化提供一些启示和思路。同时,抛砖引玉,促进中国和世界医药界的学术交流,共同为人类的健康事业做贡献。结论：顺势医学以相似性法规和微元律定律为其基本理论依据,其临床诊治具有相似性、整体性、动态性、个体性、根治性、温和性等特点,整个诊治是一个运用“定性排序-量化分级”的诊断模式、定性与定量相结合的计量诊断方法,对获得的主观症状体征进行逐一评估、甄辨和寻找“相似药剂”的过程；顺势医学重视人之生物和社会双重属性,把精神情志的异常作为诊治的重要依据,提倡“心智／精神”为先的原则,并将之落实在整个诊治过程的始终；顺势医学运用高速震荡且极度稀释的天然制剂,通过激发和促进人体的自愈能力达到防病治病的目的。其治疗剂量微小、易于服用、安全性高的特点深受广大病患的青眯。在国际社会高速发展、主流医学模式也随之转换的今天,汲取其它医学之精华,深化和完善中医理论,跟上时代的进程已势在必行。通过审视、梳理和分析顺势医学的诊治特点和其科学价值,笔者认为如下几个问题值得我们深化研究和探讨：(1)探讨顺势医学症候群的中医证候属性。顺势医学“相似性法规”的特点决定了顺势药剂的适应证是一症候群,顺势医学对疾病的认识是建立在对症候群的认知基础上。这些症候群与中医“证”的内涵有着一致性,反映了“证”的属性和特征。进一步探索顺势医学症候群的中医证候归属性,为中医“证”的实质的研究提供思路和启迪。同时,也为扩大中医临床治疗手段等提供研究线索和理论依据。(2)顺势医学“相似性”特点对建立中医证型动物模型的启示。中医证候动物模型的研究有30余年的历史,其基本造摸方法乃依据中医理论病因病机学说和中药或西药的药理作用。研制和运用中存在的不足,致使中医证候动物模型研究长期停留在造模阶段,难以深化和实际应用。尝试采用顺势药剂造模,以症候群为切入点,有预知性较大、制作类型宽泛、发应结果可控性高、较西医药理制模其毒副作用干扰少等诸多优势。(3)顺势医学计算机诊疗系统对中医计算机诊疗系统的启示。中医界引入电子计算机技术有30余年的历史,至今中医计算机诊疗系统的研究仍处于人工模拟阶段,还无法代替医生对各种复杂疾病进行诊断和决策。顺势医学计算机诊治系统在欧美的应用相当广泛,传统和现代顺势医学诊疗系统各有千秋,准确、无创、客观化、无副作用是其共同的特点。吸收和借鉴顺势医学计算机诊疗系统的方法和相关技术,从多学科多领域进行研究,对建立符合中医诊断本质特点的计算机诊断系统将有所帮助。(4)顺势医学“定性排序和量化分级”诊断模式对中医诊断规范化的启示。中医诊断规范化的研究已有50余年的历史,虽从文献、临床和实验等不同角度和层次进行了大量的研究,但至今仍缺乏公认的诊疗评价体系。顺势医学集唯心形而上学与唯物形而上学的世界观为一体,采用“定性排序和量化分级”相结合的综合认知模式,以等级计量诊断的方法分析临床信息、揭示疾病的本质。中医学与顺势医学的临床信息有着共同特征,即非特异性、多维性和主观性等,顺势医学的诊治模式值得我们深入研究、参考和借鉴,以弥补中医症状规范化研究中的不足。(5)顺势医学“微元律定律”对中药剂型改革的启示。顺势医学的治疗以简便、温和、剂量小为特点,顺势医学的药剂更是剂量微小、无色无味、易于服用、方便携带、安全性高。这些特点是由顺势医学本身的治疗宗旨、特殊的药理机制、严格的制作标准和规范的制作工艺所决定。中药毒副作用少,临床疗效肯定,但其主要剂型的“口服汤剂”仍存在着体积大、用量多、味道差、质量及疗效难于掌控和评估等多方面的不足。目前的新型中药剂型,匮乏稳定性、生物利用度及药代动力学方面研究,中药剂型化学成分的定性定量与药效间相互关联的研究也缺乏足够的深度,与目前国际上对药品的要求存在一定距离。顺势医学药剂的作用机制和制作原理,值得我们的专业人员深入挖掘和重点研究,取长补短,以促进中药现代化的进程。更多还原

【Abstract】 Homeopathic medicine (Homeopathy) is an independent medical system well known in Europe, North America and partical area in Asia. It is categorized as a form of complementary and alternative medicine in the Europe and North America healthcare system.Although homeopathic medicine and traditional Chinese medicine (TCM) belong to different medical system and are rooted from the different culture backgrounds, they share similar philosophical and holistic view on human health and diseases.Research method:A qualitative research was conducted based on the review of articles and literatures published between the years 1989 and 2010 on the development and research status of homeopathic medicine. Analytical and inductive methods were used to systematically card and analyze the diagnostic approach, treatment method, and characteristics of homeopathic medicine. A horizontal comparison was then made between the homeopathic medicine and TCM based on diagnostic approach, treatment principles, and treatment mechanism and methods.Research objective:This is the first research paper of its kind. The study seeks to (1) stimulate the learning of unique diagnostic approach and treatment method of homeopathic medicine; (2) apply those insights to inspire and advance the theory and clinical application of TCM.Research results:Homeopathic medicine is characterized by its similarity, integrity, dynamicity, individuality and geniality. It applies a comprehensive treatment which focuses on the root of a condition. It is viewed as a process that uses a combination of qualitative arrangement and quantitative classification to evaluate and analyze signs and symptoms, and search for medicines for the treatment.Homeopathic medicine pays more attention to human’s biological and social dual natures; it believes that "mind/spirit" is the first principle of diagnosis and treatment, and with emphasis on the consideration of psychological and mental disorders during the entire treatment. In homeopathy, substances are diluted in a stepwise fashion and shaken vigorously between each dilution. This "potentization" process is believed to transmit some form of information or energy from the original substance to the final diluted remedy. Homeopathic remedies are very popular due to its small dosages, ease of ingestion, and low side effects.Medicine is constantly evolving, and the traditional biomedical model has now been replaced by the modern biopsychosocial medical model. There are many elements from homeopathic medicine that TCM could learn and adapt from to help TCM keep up with the pace of modern medicine. Through the analysis and comparison, it is believed that the following issues are worthy of deeper study and further exploration:(1) The nature of homeopathic syndrome from the TCM syndrome’s perspective. The indication of homeopathic remedies is characterized by the syndrome that is determined by the characteristics of homeopathic "similarity". Homeopathic medicine and TCM share similar connotation regarding syndrome. The characteristics of homeopathic syndrome also reflect the attributes and nature of TCM syndrome. This reasonable cognation is based on the understanding of TCM syndrome, not symptoms. This exploration may offer insights to the nature of TCM syndrome, provide clues on the correlation between homeopathic remedies and TCM syndrome, and provide theoretical basis on extending clinical treatment methods.(2) The inspiration of using homeopathic remedies to establish TCM syndrome on animal models. The study of TCM on animal models has historically been slow due to shortcomings in the research and implementation. Currently there are two basic methods to establish this on animal models:one based on TCM theory of pathogenesis, the other based on pharmacology from Chinese herbal medicine and Western medicine. Using homeopathic remedies to establish TCM syndrome in animal models/animal models of TCM syndrome might be a better and more viable option. This method may allow better focus on the syndrome, greater predictability, higher controllability, lower side effects, and induce wider range of syndromes.(3) The learning from homeopathic software to enhance TCM diagnostic software. Even though computers and software have been studied in TCM for over 30 years, its use in TCM diagnosis is still in the artificial simulation phase, and cannot replace doctors in making medical diagnosis on a variety of complex diseases. The application of homeopathic diagnostic software on the other hand is very popular in Europe, North America and some areas of Asia due to its accuracy, noninvasiveness, objectivity, and fewer side effects. Learning the approach and logic behind homeopathic software and studying from multidisciplinary field may help TCM develop better diagnostic software that meets the standards of TCM diagnosis.(4) The use of qualitative arrangement and quantitative classification in homeopathy to facilitate the standardization of TCM diagnosis. The standardization of TCM diagnosis has been well researched in literature reviews, clinical trials, and experimental studies for over 50 years. However, there still lacks a generally accepted, standardized TCM diagnosis and treatment evaluation system that can be used in everyday practice. Homeopathic medicine is characterized by its idealist metaphysics and metaphysical materialist world view. Thus it uses a mixed mode of qualitative arrangement and quantitative classification, and semi-quantitative methods to evaluate diseased conditions and reveal the nature of a disease. Homeopathy and TCM share similarities on the nature of clinical data. They are both characterized by non-specific, multidimensional and subjective qualities. Learning from homeopathic diagnostic mode may help remedy imperfects in TCM diagnosis standardization research.(5) The inspiration of the Law of Minimum Dose from Homeopathy to refine the form of Chinese herbal products. Homeopathic remedies are very popular due to its small dosages, colorless and tasteless form, ease of ingestion and low side effects. These characteristics are rooted in its unique pharmacological mechanism, strict production standards, and standard processing techniques. Chinese herbal products on the other hand are also effective and contain low side effects, but its main form as an oral decoction has had difficulties in getting patient compliance due to its large dosages and poor tastes. In addition, studying the efficacy and quality of Chinese herbs has been challenging, and to date they have not met the international requirements for drugs. There is still an insufficient amount of knowledge on the stability, bioavailability, and pharmacokinetics of new herbal products, as well as its correlation between chemical composition and efficacy. Re-applying the pharmacological mechanism and production methods of homeopathic medicine will overcome the quality and efficacy barriers of Chinese herbal products.Exploring these areas and resolving relevant issues may have value in speeding up modernization of TCM, and strengthening the competitiveness of Chinese herbal products in the international stage.更多还原