2落后过时生物医学模式统治我国医疗卫生领域的现状不能再继续下去了中篇详解.docVIP

落后过时生物医学模式统治我国医疗卫生领域的现状不能再继续下去了（中） 【编者按：本文分三部分，上篇讨论我国现状：虽然生物医学模式已经落后过时，新的生物-心理-社会-环境医学模式已经产生，但目前我国医疗卫生领域仍然深受生物医学模式影响。新医改近期重点实施方案处处可见生物医学模式思维的影子。上篇已发表在本杂志健康研究2009年6月,29卷第三期171-176页 要理解为什么落后过时生物医学模式还在统治我国医疗卫生领域，我们有必要回顾主要医学模式的演变过程，并将医学模式在中国的演变史放在近代和现代史的大背景下进行思考和探讨，以期找到病源，彻底治本。医学模式是人类解释健康-疾病现象的信仰系统。历史上有代表性的主要医学模式有：1）超自然的“神道医学”模式，见诸于所有古代文明。在医学的最原始阶段，人类用神灵或魔鬼来解释健康-疾病现象。祈祷和驱邪是当时维护健康，治疗疾病的主要手段。2）来源于实践的经验医学模式，有代表意义的是《黄帝内经》中的阴阳平衡学说与《希波克拉底文集》中的体液平衡学说。医生的具体治疗手段主要是提供关于生活方式治疗的意见，给予非特异性的药物和其他辅助手段来支持身体功能的恢复，缓解疾病的进程。3) 以生物医学为基础的理性医学模式，认为最重要的医学问题必须在微生物中求得解决，健康与疾病的问题必须用生理学和生物化学的实验结果来回答。4）多因多病的生物-心理-社会-环境新医学模式，认为疾病的产生除了生物学原因之外，人的心理、社会、环境因素也会发挥很大影响。由于历史的原因，中国目前基本没有实现医学模式的转变。 To understand why the out-of-the-date biomedical model is still dominant China’s health care system, we need to review the evolution process of major medical models in human history，to put it into considerations under the Chinese historical background so as to identify the cause of the phenomena and to solve the problem. Medical model is a belief system that human beings use to explain health-disease phenomena. The representative medical models in the human history are: 1) super-natural model that can be seen in all ancient civilizations. In many ancient societies, the spirits and gods were?believed to make their presence known through disease. 2) experience-based medical model that originated from clinical practice. The representatives are the Ying-Yan Balance theory from 《Yellow Emperor s Inner Canon》and the theory of an imbalance in the body of the four humours from 《Hippocratic Corpus》. The concrete treatments from physicians were mainly to provide suggestions regarding to lifestyle changes and to provide non-specific medications and other methods to support recovery of the body functions and delay of the disease process. 3) Biomedical based rational medical model that believe the solutions of the most important medical issues must be solved by microbiology, the problems relating to health-diseases must b