国外传统医学的发展以及对中医学国际化影响的研究

发布时间：2018-04-19 23:40

本文选题：中国传统医学 + 外国传统医学　；参考：《广州中医药大学》2017年博士论文

【摘要】：国内外研究进展进入21世纪,仰赖公卫制度的建立及医疗技术的进步,人类虽然平均寿命延长,却也开始面临高龄化社会及慢性病比例增加的考验。近年来,主流的西方医学发展渐渐遇到瓶颈,人们也开始意识西医治疗所费不赀及西药可能带来的副作用危害,因此主打有疗效且花费较低的传统医学又重新受到重视。传统医学目前在各国多为第二线医疗,在某些地区又被称作补充或替代性疗法,先前世界卫生组织(World Health Organization[WHO],2002)发表的传统医疗策略指出,传统医疗(traditional medicine,TM)及补充替代医疗(complementary and alternative medicine,CAM)是此世纪医疗照护备受关切的议题,呼吁各国政府应重视传统医疗的发展并纳入国家医药政策。本国中医药传统医学源远流长,数百年来,藉由宗教或外交方式,中医药知识远播日本、韩国或欧美地区等,甚至各国又将这些知识结合当地文化,各自发展出具特色的传统医学理论。此外,印度、阿拉伯地区本身也都有着具特色及影响力的传统医学体系,然而长久已来,我国对各国传统医学的历史及发展概况的了解并不深入,尤其缺乏各国与我国传统医学发展之对比研究。因此,有必要对各国传统医学产业的历史演进、理论架构、人才培养及产业发展政策规划等面向作统合分析,以供未来我国传统医学本土发展及国际推广政策拟定参考之用。研究目的与意义搜寻各国传统医学之相关文献,可以发现目前对于传统医疗体系的研究大多是针对单一个系统的介绍或是某一国家之传统医学与中医的比较,故本研究目的是希望能全面比对并分析各国传统医学的历史及医疗理论演变、教育、科学研究发展及产业管理政策成效等面向,寻找目前我国传统医药本土及国际化发展的盲点及不足,期望归纳各国的成功经验,一方面提供国家政策拟定之参考,另外也可促进我国与其它国家传统医学的交流,并强化全球对传统医学产业的了解及信任。研究内容1.对比分析各国传统医学现代发展现况与不同,包含历史演进、理论发展、传统医学管理政策方针、执业与科研人才培养、医疗资源与业务范围及国际等方面。2.对比分析各国传统医学在理论架构、人才教育、医事制度规划、产业营销与专业服务等具体政策的成功经验,希望藉此点出当前我国传统医学本土及国际化发展的问题与不足。3.以上述研究结果为基础,针对我国传统医学发展的症结与不足,提出相关解决方案或建议,以供有关单位政策拟定参考之用。研究方法本研究透过中国知识资源总库CNKI系统数据库、万方数据知识服务平台等电子资源整合系统平台查阅大量文献,检索2000-2016年间与各国传统医学研究相关之文献,去芜存菁,整理出世界各国具有完整医疗理论系统的传统医学之源流、治疗理论与方法、发展现状、特点等方面。1.文献分析法:广泛收集国内、外传统医学或补充替代医学,包含历史、理论演变、国家政策规划等相关文献及书籍,并实际交叉分析、整理,以期归纳本国与其它国家传统医学之发展现况差异。2.比较研究法:本研究比较分析了各国传统医学的历史演变、医学流派发展或政府政策规划及执行成效等面向,从中得出各国的成功或失败经验,并重点阐释对我国传统医学国内、外发展的启发。主要研究结果我国传统医学在全球较先进国家的发展概况如下:根据加拿大中医针灸管理局(CTCMA)2016年之年度报告,中医师和针灸师在加拿大的注册人数每年仍持续增加,加拿大的中医药市场仍持续扩展中。然而注册针灸师的人数几是注册中医师的双倍,表示即便中医于加拿大已立法承认,民众对中医的使用率仍未像针灸一样普及;在美国目前针灸和推拿等已列入正规医疗体系中,中药也加入联邦保健计划,且有保险公司负担针灸、按摩疗法等费用,但据美国国家卫生统计中心(National Center for Health Statistics publications,NCHS)2016 年的出版数据显示,成人使用针灸及按摩的保险无覆盖率约七至八成,相对昂贵的费用使得这些疗法的普及率仍不算高;在德国,中医被归类为互补与另类医学,不在主流医学范畴内,但开始有大量研究累积并建立实证基础,其中疼痛疗效研究最常被应用于临床。目前针灸在医院中只是附属于其他科别,医疗保险也只提供针灸治疗,但德国将中药饮片及中成药归类于药品,跟西药同等级,每年都有医学相关工作者到中国中医院校、中医科研机构进行考察、学习,可看出在德国中医药的地位逐渐升高;中医药在英国发展相当迅速,使英国成为欧盟的第三大中草药市场。英国已将针灸、中药归入国民保健计划中,法律上也承认针灸的医疗地位,英国针灸师协会已有数千名会员。至2014年,英国国内已有11所正规大学的卫生学院设有中医、针灸本科或硕士课程,相当于英国设有卫生学院之大学数量的22%;中医药在澳洲已被立法承认,也加入了医疗保险体系,中医教育在澳洲具有相当规模,澳洲是国外唯一正规大学设立中医本科的国家。据澳大利亚中医管理局(Chinese Medicine Board of Australia(CMBA))之调查,2013年-2016在澳洲单纯注册针灸师的人数以及同时拥有针灸师、中草药师及中草药配剂和具备针灸师及中草药师之注册人数仍在持续增加。然而从各国之中医发展现况来看,虽然国际对中医已有相当程度的认识,但大多数都是以针灸、推拿、按摩等形式被熟知或接受,许多国外研究着重点也是在针灸,因此,对传统医学而言,最大的挑战在于如何找到方法让传统医学被外界认可,并投注资源保护、保存传统医学知识。一个有意义的医学体系欲得到其他专业的尊重且想长久被保存与流传,不可能单靠文化传承的价值,除了拥有完善的思想理论外,当然最关键的还是临床疗效需有一定成果及特殊性。综观我国及其它各国传统医学现今的发展困境,其实大同小异,主要还是实证医学的被质疑。因此,我国传统医学若想在国内或国际发扬光大,首先当破除过度玄化的缺点,以客观的证据证明传统医学的临床疗效和不可取代性。所谓科学化的医学,乃以系统性的方法先拟定假设,接着进行大量样本的收集,最后再用严谨的临床对照试验方法来验证假说,在有统计学上差异的前提下获得客观的临床经验。就以最主张实证概念的欧美国家来说,德国/英国以往为了持续让针灸治疗被包含在医疗保险的范围中,他们投入大量的资源作疗效或原理探究,他们的研究在质与量方面与我国相比,甚至有过之而无不及,这点在针灸推广与疗效实证上有不可被忽视的贡献。由此可知,若传统医学能够建立质量佳的临床对照试验,取得等级高的坚实证据来证明其存在价值,一方面能让世界注意到传统医学,这对传统医学的推广及人才培养有重大意义。我国相较欧美国家,甚至日本或韩国,不管在中医理论的理解或中草药的熟悉都占有文化上的优势,以往德国或英国作疗效探讨时,最大的困扰便在于不了解中医经络理论及中医典籍所强调的内涵,因而在疗效上会有落差,这点若由我国主导或协助相关研究,相信对整体传统医学的实证会有显著帮助。再者,一旦传统医学的价值能在国际获得认可,国内相关管理机构便有依据能让传统医学进入国家正统的医事制度,民众求诊便能获得补助,避免传统医学逐渐被边缘化或被其他专业并吞。另外,除了实证医学的背书及医事制度的建立外,后继人才的衔接与质量把关也很关键,而这则须仰赖教育体系的完善及证照制度的设立。传统医学相关执业人员需接受一定时数的临床训练及考核,要有传统及现代医学的素养,才不至让民众的健康承担风险,这也对一般民众对传统医学的观感有直接关系。现代医学和传统医学之融合已成趋势,中医师不仅须熟稔中医药知识,也须了解现代医学知识,这不只是能持续检验中医典籍或手法的正确性,也由于民众往往同时接受中、西医疗法,故中医师须有能力判定怎样的疗程适合病人或中、西药间是否会有交互作用的问题等,这对传统医学的整体发展是非常重要的。
[Abstract]:The progress of research at home and abroad has entered the twenty-first Century, depending on the establishment of the public health system and the progress of medical technology. Although the average life span of human beings is prolonged, it is also beginning to face the test of the increasing proportion of the aging society and chronic diseases. In recent years, the mainstream of Western medical development has gradually encountered bottlenecks. Traditional medicine, which is more effective and less expensive, has been revalued. Traditional medicine is currently in many countries for second line medical treatment, and in some areas is called complementary or alternative therapy. The traditional medical strategy published by the previous WHO (World Health Organization[WHO], 2002) pointed out that Traditional medicine (traditional medicine, TM) and complementary alternative medicine (complementary and alternative medicine, CAM) are the issues of concern for medical care in this century, calling on governments to attach importance to the development of traditional medical care and to incorporate the national medical policy. The traditional Chinese medicine has a long history of traditional medicine, and for hundreds of years, by religion or diplomacy In the way, the knowledge of traditional Chinese medicine is broadcast in Japan, South Korea or Europe and the United States. Even countries combine these knowledge with local culture and develop their own traditional medical theories. In addition, India and Arabia have their own traditional medical systems with distinctive features and influence. However, the history of traditional medicine has long come to our country. There is no deep understanding of the history and development situation, especially the comparative study of the development of traditional medicine in China. Therefore, it is necessary to analyze the historical evolution of the traditional medical industry, the theoretical framework, the training of talents and the planning of the industrial development policy, so as to provide the local development of traditional medicine and the administration of the international promotion in the future. The purpose and significance of the research are to search for the relevant literature of traditional medicine in various countries. It is found that most of the research on traditional medical system is a single system or the comparison of traditional medicine and traditional Chinese medicine in one country. The purpose of this study is to compare and analyze the traditional medicine in a comprehensive way. The development of history and medical theory, education, scientific research and development, and the effectiveness of industrial management policy, look for the blind spots and shortcomings of the local and international development of traditional medicine in our country. We hope to sum up the successful experiences of various countries. On the one hand, we can provide the reference of the formulation of national policies, and also promote the exchange of traditional medicine in China and other countries. Flow, and strengthen the understanding and trust of the traditional medicine industry in the world. 1. comparison and analysis of the current situation and different of the modern development of traditional medicine in various countries, including historical evolution, theory development, traditional medical management policy, practice and scientific research personnel training, medical resources and business scope and international.2. comparison and analysis of traditional medicine in various countries. On the basis of the successful experience of the specific policies of the theoretical framework, talent education, medical system planning, industrial marketing and professional services, we hope to make a point of the problems and shortcomings of the local and international development of traditional medicine in China at present, based on the above research results, and to put forward relevant solutions to the crux and shortcomings of the development of traditional medicine in China. A case or proposal is used to provide reference for the policy of the unit concerned. The research method, through the CNKI system database of the China General Library of knowledge resources, the platform of the Wanfang Data knowledge service platform, and other electronic resources integration system platform, consulted a large number of documents and retrieved the literature related to the traditional medical research in 2000-2016 years. .1. literature analysis in the origin of traditional medicine, the theory and method of treatment, the status of development, and the characteristics of the traditional medical theory system in the whole country, such as the extensive collection of domestic, external and complementary medicine, including history, theoretical evolution, national policy planning and other documents and books, and the actual cross analysis and arrangement, in order to sum up. The difference of the current status of traditional medicine between the country and other countries.2. comparative study: This study compares and analyzes the historical evolution of traditional medicine in various countries, the development of the school of medicine or the planning of government policy and the effectiveness of its implementation, from which the success or failure experiences of various countries are drawn, and the enlightenment to the domestic and external development of traditional medicine in China is illuminating. The main research results of the development of Chinese traditional medicine in more advanced countries are as follows: according to the annual report of the Canadian Chinese acupuncture and moxibustion Administration (CTCMA) 2016, the number of Chinese medicine practitioners and acupuncturists in Canada continues to increase every year, and the market of Chinese medicine in Canada continues to expand. However, the number of registered acupuncturists is few. It is the double of registered Chinese medicine, which means that even though Chinese medicine has already been recognized in Canada, the use rate of traditional Chinese medicine is still not as popular as acupuncture; in the United States, acupuncture and massage have already been included in the regular medical system, and Chinese medicine has also joined the Federal health care program, and the insurance companies bear the cost of acupuncture and massage therapy, but according to the American state Published data from the National Center for Health Statistics publications, NCHS in 2016, the insurance coverage for adults using acupuncture and massage is about seven to 80%, and the relatively expensive cost makes the rate of these treatments still not high; in Germany, Chinese medicine is classified as complementary and alternative medicine, not in mainstream medicine. In the field of study, there is a large amount of research accumulated and an empirical basis, of which the research of pain efficacy is most often applied to clinical. At present, acupuncture is only attached to other departments in hospitals, medical insurance is only provided with acupuncture and moxibustion, but in Germany, Chinese medicine and Chinese medicines are classified into drugs, with the same grade as western medicine, and each year has medical correlation. In the study of Chinese medicine colleges and universities of Chinese medicine and research institutions of traditional Chinese medicine, the status of traditional Chinese medicine in Germany is gradually rising, and the development of traditional Chinese medicine is very rapid in Britain, making Britain the third largest Chinese herbal medicine market in the European Union. There are thousands of members of the British acupuncturist Association. By 2014, there were 11 regular universities in the UK with Chinese medicine, acupuncture undergraduate or master's courses, equivalent to 22% of the number of universities in the UK. Chinese medicine has been recognized by legislation in Australia and added into the medical insurance system, and traditional Chinese medicine has a phase in Australia. According to the Chinese Medicine Board of Australia (CMBA) of the Australian administration of traditional Chinese medicine (Board of Australia (CMBA)), the number of acupuncturists, Chinese herb pharmacists and Chinese herbal medicines, as well as acupuncturists and Chinese herbal remediers, were also registered in Australia in 2013. However, the number of registrations is still increasing. However, from the current situation of the development of traditional Chinese medicine in various countries, although the international Chinese medicine has a considerable understanding of traditional Chinese medicine, most of them are well known or accepted by acupuncture, massage, massage and so on. Many foreign research focuses on acupuncture and moxibustion. Therefore, the greatest challenge for traditional medicine is to find out how to find it. Methods to allow traditional medicine to be recognized by the outside world, and to keep the resources protected and preserve traditional medical knowledge. A meaningful medical system wants to be respected by other specialties and wants to be preserved and circulated for a long time. It is impossible to rely on the value of cultural heritage alone. In addition to having a perfect ideological theory, the most critical or clinical effect must be certain. In our country and other countries, the development plight of traditional medicine in China and other countries, in fact, is much the same, but the main reason is that the positive medicine is questioned. Therefore, if the traditional medicine in our country wants to develop in the country or the world, we should first break the shortcomings of excessive metaphysics and prove the clinical effect and inadvisability of traditional medicine with objective evidence. Generation. The so-called scientific medicine, in a systematic way, first draws up assumptions, then carries out a large collection of samples, and then verifies the hypothesis with a rigorous clinical control test, and obtains objective clinical experience on the premise of statistically discrepancy. In Europe and the United States, Germany / Britain, with the most positive concept, is in the past. In order to keep acupuncture and moxibustion treatment included in the scope of medical insurance, they have invested a large amount of resources for curative effect or principle exploration. Their research is even better than our country in terms of quality and quantity, which can not be ignored in the promotion of acupuncture and moxibustion and the effect of curative effect. It can be seen that if traditional medicine can be built, it can be found that the traditional medicine can be built. It is of great significance to the promotion of traditional medicine and the cultivation of talent in the world, which is of great significance to the promotion of traditional medicine and the cultivation of talents. Cultural advantages, in the past, when German or British curative effect is discussed, the greatest trouble is that there is no understanding of the connotation of traditional Chinese medicine meridian theory and traditional Chinese medicine books, so there will be a drop in the curative effect. If our country leads or assists the relevant research, it is believed that the empirical evidence of traditional traditional medicine will be greatly helped. The value of learning can be recognized internationally. The relevant management institutions in China have the basis for the traditional medicine to enter the orthodox medical system of the state, and the people will be able to obtain subsidies to avoid the gradual marginalization of traditional medicine or the annexation of other specialties. In addition, in addition to the endorsement of the empirical medicine and the establishment of the medical system, the title of the successor is the successor. It is essential to connect with the quality control, which depends on the improvement of the educational system and the establishment of the certification system. The traditional medical practitioners need to receive a certain number of clinical training and assessment, to have the quality of traditional and modern medicine, and not to risk the health of the people. This also gives the general public a direct view of traditional medicine. Connection. The combination of modern medicine and traditional medicine has become a trend. Chinese medicine teachers must not only know the knowledge of traditional Chinese medicine, but also know the knowledge of modern medicine. This is not only a continuous test of the correctness of traditional Chinese medicine books or techniques, but also because the people are often accepted and treated with western medicine at the same time, so the Chinese doctor must be able to determine what course of treatment is suitable for patients. Or whether there is interaction between western medicine and Western medicine, which is very important for the overall development of traditional medicine.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R2-0

【参考文献】