本文選題：中國傳統(tǒng)醫(yī)學(xué) + 外國傳統(tǒng)醫(yī)學(xué)�。� 參考：《廣州中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：國內(nèi)外研究進展進入21世紀,仰賴公衛(wèi)制度的建立及醫(yī)療技術(shù)的進步,人類雖然平均壽命延長,卻也開始面臨高齡化社會及慢性病比例增加的考驗。近年來,主流的西方醫(yī)學(xué)發(fā)展?jié)u漸遇到瓶頸,人們也開始意識西醫(yī)治療所費不貲及西藥可能帶來的副作用危害,因此主打有療效且花費較低的傳統(tǒng)醫(yī)學(xué)又重新受到重視。傳統(tǒng)醫(yī)學(xué)目前在各國多為第二線醫(yī)療,在某些地區(qū)又被稱作補充或替代性療法,先前世界衛(wèi)生組織(World Health Organization[WHO],2002)發(fā)表的傳統(tǒng)醫(yī)療策略指出,傳統(tǒng)醫(yī)療(traditional medicine,TM)及補充替代醫(yī)療(complementary and alternative medicine,CAM)是此世紀醫(yī)療照護備受關(guān)切的議題,呼吁各國政府應(yīng)重視傳統(tǒng)醫(yī)療的發(fā)展并納入國家醫(yī)藥政策。本國中醫(yī)藥傳統(tǒng)醫(yī)學(xué)源遠流長,數(shù)百年來,藉由宗教或外交方式,中醫(yī)藥知識遠播日本、韓國或歐美地區(qū)等,甚至各國又將這些知識結(jié)合當?shù)匚幕?各自發(fā)展出具特色的傳統(tǒng)醫(yī)學(xué)理論。此外,印度、阿拉伯地區(qū)本身也都有著具特色及影響力的傳統(tǒng)醫(yī)學(xué)體系,然而長久已來,我國對各國傳統(tǒng)醫(yī)學(xué)的歷史及發(fā)展概況的了解并不深入,尤其缺乏各國與我國傳統(tǒng)醫(yī)學(xué)發(fā)展之對比研究。因此,有必要對各國傳統(tǒng)醫(yī)學(xué)產(chǎn)業(yè)的歷史演進、理論架構(gòu)、人才培養(yǎng)及產(chǎn)業(yè)發(fā)展政策規(guī)劃等面向作統(tǒng)合分析,以供未來我國傳統(tǒng)醫(yī)學(xué)本土發(fā)展及國際推廣政策擬定參考之用。研究目的與意義搜尋各國傳統(tǒng)醫(yī)學(xué)之相關(guān)文獻,可以發(fā)現(xiàn)目前對于傳統(tǒng)醫(yī)療體系的研究大多是針對單一個系統(tǒng)的介紹或是某一國家之傳統(tǒng)醫(yī)學(xué)與中醫(yī)的比較,故本研究目的是希望能全面比對并分析各國傳統(tǒng)醫(yī)學(xué)的歷史及醫(yī)療理論演變、教育、科學(xué)研究發(fā)展及產(chǎn)業(yè)管理政策成效等面向,尋找目前我國傳統(tǒng)醫(yī)藥本土及國際化發(fā)展的盲點及不足,期望歸納各國的成功經(jīng)驗,一方面提供國家政策擬定之參考,另外也可促進我國與其它國家傳統(tǒng)醫(yī)學(xué)的交流,并強化全球?qū)鹘y(tǒng)醫(yī)學(xué)產(chǎn)業(yè)的了解及信任。研究內(nèi)容1.對比分析各國傳統(tǒng)醫(yī)學(xué)現(xiàn)代發(fā)展現(xiàn)況與不同,包含歷史演進、理論發(fā)展、傳統(tǒng)醫(yī)學(xué)管理政策方針、執(zhí)業(yè)與科研人才培養(yǎng)、醫(yī)療資源與業(yè)務(wù)范圍及國際等方面。2.對比分析各國傳統(tǒng)醫(yī)學(xué)在理論架構(gòu)、人才教育、醫(yī)事制度規(guī)劃、產(chǎn)業(yè)營銷與專業(yè)服務(wù)等具體政策的成功經(jīng)驗,希望藉此點出當前我國傳統(tǒng)醫(yī)學(xué)本土及國際化發(fā)展的問題與不足。3.以上述研究結(jié)果為基礎(chǔ),針對我國傳統(tǒng)醫(yī)學(xué)發(fā)展的癥結(jié)與不足,提出相關(guān)解決方案或建議,以供有關(guān)單位政策擬定參考之用。研究方法本研究透過中國知識資源總庫CNKI系統(tǒng)數(shù)據(jù)庫、萬方數(shù)據(jù)知識服務(wù)平臺等電子資源整合系統(tǒng)平臺查閱大量文獻,檢索2000-2016年間與各國傳統(tǒng)醫(yī)學(xué)研究相關(guān)之文獻,去蕪存菁,整理出世界各國具有完整醫(yī)療理論系統(tǒng)的傳統(tǒng)醫(yī)學(xué)之源流、治療理論與方法、發(fā)展現(xiàn)狀、特點等方面。1.文獻分析法:廣泛收集國內(nèi)、外傳統(tǒng)醫(yī)學(xué)或補充替代醫(yī)學(xué),包含歷史、理論演變、國家政策規(guī)劃等相關(guān)文獻及書籍,并實際交叉分析、整理,以期歸納本國與其它國家傳統(tǒng)醫(yī)學(xué)之發(fā)展現(xiàn)況差異。2.比較研究法:本研究比較分析了各國傳統(tǒng)醫(yī)學(xué)的歷史演變、醫(yī)學(xué)流派發(fā)展或政府政策規(guī)劃及執(zhí)行成效等面向,從中得出各國的成功或失敗經(jīng)驗,并重點闡釋對我國傳統(tǒng)醫(yī)學(xué)國內(nèi)、外發(fā)展的啟發(fā)。主要研究結(jié)果我國傳統(tǒng)醫(yī)學(xué)在全球較先進國家的發(fā)展概況如下:根據(jù)加拿大中醫(yī)針灸管理局(CTCMA)2016年之年度報告,中醫(yī)師和針灸師在加拿大的注冊人數(shù)每年仍持續(xù)增加,加拿大的中醫(yī)藥市場仍持續(xù)擴展中。然而注冊針灸師的人數(shù)幾是注冊中醫(yī)師的雙倍,表示即便中醫(yī)于加拿大已立法承認,民眾對中醫(yī)的使用率仍未像針灸一樣普及;在美國目前針灸和推拿等已列入正規(guī)醫(yī)療體系中,中藥也加入聯(lián)邦保健計劃,且有保險公司負擔(dān)針灸、按摩療法等費用,但據(jù)美國國家衛(wèi)生統(tǒng)計中心(National Center for Health Statistics publications,NCHS)2016 年的出版數(shù)據(jù)顯示,成人使用針灸及按摩的保險無覆蓋率約七至八成,相對昂貴的費用使得這些療法的普及率仍不算高;在德國,中醫(yī)被歸類為互補與另類醫(yī)學(xué),不在主流醫(yī)學(xué)范疇內(nèi),但開始有大量研究累積并建立實證基礎(chǔ),其中疼痛療效研究最常被應(yīng)用于臨床。目前針灸在醫(yī)院中只是附屬于其他科別,醫(yī)療保險也只提供針灸治療,但德國將中藥飲片及中成藥歸類于藥品,跟西藥同等級,每年都有醫(yī)學(xué)相關(guān)工作者到中國中醫(yī)院校、中醫(yī)科研機構(gòu)進行考察、學(xué)習(xí),可看出在德國中醫(yī)藥的地位逐漸升高;中醫(yī)藥在英國發(fā)展相當迅速,使英國成為歐盟的第三大中草藥市場。英國已將針灸、中藥歸入國民保健計劃中,法律上也承認針灸的醫(yī)療地位,英國針灸師協(xié)會已有數(shù)千名會員。至2014年,英國國內(nèi)已有11所正規(guī)大學(xué)的衛(wèi)生學(xué)院設(shè)有中醫(yī)、針灸本科或碩士課程,相當于英國設(shè)有衛(wèi)生學(xué)院之大學(xué)數(shù)量的22%;中醫(yī)藥在澳洲已被立法承認,也加入了醫(yī)療保險體系,中醫(yī)教育在澳洲具有相當規(guī)模,澳洲是國外唯一正規(guī)大學(xué)設(shè)立中醫(yī)本科的國家。據(jù)澳大利亞中醫(yī)管理局(Chinese Medicine Board of Australia(CMBA))之調(diào)查,2013年-2016在澳洲單純注冊針灸師的人數(shù)以及同時擁有針灸師、中草藥師及中草藥配劑和具備針灸師及中草藥師之注冊人數(shù)仍在持續(xù)增加。然而從各國之中醫(yī)發(fā)展現(xiàn)況來看,雖然國際對中醫(yī)已有相當程度的認識,但大多數(shù)都是以針灸、推拿、按摩等形式被熟知或接受,許多國外研究著重點也是在針灸,因此,對傳統(tǒng)醫(yī)學(xué)而言,最大的挑戰(zhàn)在于如何找到方法讓傳統(tǒng)醫(yī)學(xué)被外界認可,并投注資源保護、保存?zhèn)鹘y(tǒng)醫(yī)學(xué)知識。一個有意義的醫(yī)學(xué)體系欲得到其他專業(yè)的尊重且想長久被保存與流傳,不可能單靠文化傳承的價值,除了擁有完善的思想理論外,當然最關(guān)鍵的還是臨床療效需有一定成果及特殊性。綜觀我國及其它各國傳統(tǒng)醫(yī)學(xué)現(xiàn)今的發(fā)展困境,其實大同小異,主要還是實證醫(yī)學(xué)的被質(zhì)疑。因此,我國傳統(tǒng)醫(yī)學(xué)若想在國內(nèi)或國際發(fā)揚光大,首先當破除過度玄化的缺點,以客觀的證據(jù)證明傳統(tǒng)醫(yī)學(xué)的臨床療效和不可取代性。所謂科學(xué)化的醫(yī)學(xué),乃以系統(tǒng)性的方法先擬定假設(shè),接著進行大量樣本的收集,最后再用嚴謹?shù)呐R床對照試驗方法來驗證假說,在有統(tǒng)計學(xué)上差異的前提下獲得客觀的臨床經(jīng)驗。就以最主張實證概念的歐美國家來說,德國/英國以往為了持續(xù)讓針灸治療被包含在醫(yī)療保險的范圍中,他們投入大量的資源作療效或原理探究,他們的研究在質(zhì)與量方面與我國相比,甚至有過之而無不及,這點在針灸推廣與療效實證上有不可被忽視的貢獻。由此可知,若傳統(tǒng)醫(yī)學(xué)能夠建立質(zhì)量佳的臨床對照試驗,取得等級高的堅實證據(jù)來證明其存在價值,一方面能讓世界注意到傳統(tǒng)醫(yī)學(xué),這對傳統(tǒng)醫(yī)學(xué)的推廣及人才培養(yǎng)有重大意義。我國相較歐美國家,甚至日本或韓國,不管在中醫(yī)理論的理解或中草藥的熟悉都占有文化上的優(yōu)勢,以往德國或英國作療效探討時,最大的困擾便在于不了解中醫(yī)經(jīng)絡(luò)理論及中醫(yī)典籍所強調(diào)的內(nèi)涵,因而在療效上會有落差,這點若由我國主導(dǎo)或協(xié)助相關(guān)研究,相信對整體傳統(tǒng)醫(yī)學(xué)的實證會有顯著幫助。再者,一旦傳統(tǒng)醫(yī)學(xué)的價值能在國際獲得認可,國內(nèi)相關(guān)管理機構(gòu)便有依據(jù)能讓傳統(tǒng)醫(yī)學(xué)進入國家正統(tǒng)的醫(yī)事制度,民眾求診便能獲得補助,避免傳統(tǒng)醫(yī)學(xué)逐漸被邊緣化或被其他專業(yè)并吞。另外,除了實證醫(yī)學(xué)的背書及醫(yī)事制度的建立外,后繼人才的銜接與質(zhì)量把關(guān)也很關(guān)鍵,而這則須仰賴教育體系的完善及證照制度的設(shè)立。傳統(tǒng)醫(yī)學(xué)相關(guān)執(zhí)業(yè)人員需接受一定時數(shù)的臨床訓(xùn)練及考核,要有傳統(tǒng)及現(xiàn)代醫(yī)學(xué)的素養(yǎng),才不至讓民眾的健康承擔(dān)風(fēng)險,這也對一般民眾對傳統(tǒng)醫(yī)學(xué)的觀感有直接關(guān)系�，F(xiàn)代醫(yī)學(xué)和傳統(tǒng)醫(yī)學(xué)之融合已成趨勢,中醫(yī)師不僅須熟稔中醫(yī)藥知識,也須了解現(xiàn)代醫(yī)學(xué)知識,這不只是能持續(xù)檢驗中醫(yī)典籍或手法的正確性,也由于民眾往往同時接受中、西醫(yī)療法,故中醫(yī)師須有能力判定怎樣的療程適合病人或中、西藥間是否會有交互作用的問題等,這對傳統(tǒng)醫(yī)學(xué)的整體發(fā)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.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R2-0

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