关于将循证医学运用到中医中的讨论及其局限性

1、THE DEBATE AND LIMITATIONS OF APPLYING EVIDENCE-BASED MEDICINE TO TRADITIONAL CHINESE MEDICINE关于将循证医学运用到中医中的讨论及其关于将循证医学运用到中医中的讨论及其局限性局限性The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine1 Over the past decade biomedical health care institutions have increa

2、singly united around evidence-based medicine (EBM) as the preferred method for determining the most efficacious way to provide health care to patients. 1 近十年来，生物医学医疗机构越来越达成一个共识：在判断何种方式才能为患者提供最有效的医疗上，循证医学是首选依据。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medic

3、ineEBM has been constructed as an empirical challenge to conventional assumptions about treatment efficacy, which have often been based more on untested theories of mechanism, the authority of mentors, or clinical experience, rather than on scientific evidence.循证医学已经对有关疗效的传统观点提出了挑战。传统观点更多地是基于未经证实的机制

4、理论、专家的权威或者临床经验，而不是科学证据。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineThe “gold standard” of evidence for treatment efficacy within EBM has come to be a systematic review of randomized clinical trials (RCTs) with double-blinding and placebo or sham proc

5、edures.循证医学评价药效的“金标准”是基于采用安慰剂或者假处理对照组的临床随机双盲试验进行的系统综述。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineAlthough not discounted entirely, other forms of evidence, such as that resulting from observational research or case studies, are considered much lower

6、 down on the evidentiary hierarchy.其他比如从观察性研究或个案研究得到的证据，虽然不能说完全不重要，但它们在整个证据层级中处于比较低的位置。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine2 Considerable debate has arisen concerning whether EBM constitutes a truly legitimate approach to find the best ways t

7、o care for patients, or instead represents a naive view of scientific objectivity, a depersonalized bureaucratization of care,or a veiled calculus for cutting costs and wresting control from clinicians.2 循证医学到底是不是真正合理的可用于寻求最佳治疗方案的方法？或者只是一种关于科学客观性的天真的看法？一种非人性化的按章办事的“治疗手段”？又或是暗地里为节省开支与临床医师争夺控制权的一种隐蔽手段

8、？这其中存在着很大的争议。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineDifficulties have been raised for biomedicine and complementary and alternative medicine (CAM) alike, but more so for the latter.生物医学以及补充和替代医学也都面临困境，尤其是后者。The Debate and Limitations of Applying

9、 Evidence-Based Medicine to Traditional Chinese MedicineSome sources have argued that CAM can be “evidence based,” while others have refuted this assertion.一些人认为补充和替代医学可以算是“以证据为基础”，但另一些人驳斥了该论断。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine3 Chinese med

10、icine provides an important vantage point from which to explore this debate.3 中医为探究上述争论提供了一个很好的切入点。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineChinese medicine is a broad set of healing theories and practices whose practitioners trace its origins to

11、ancient Chinese texts dating back over 2000 years.中医包含了一系列广泛的治疗理论和医疗实践，其从业者将其源头追溯至2000多年前的中国古代典籍中。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineToday Chinese medicine is not only widely practiced in China through an officially sanctioned reformulation

12、known as Traditional Chinese Medicine (TCM) dating back to the late 1950s, but is frequently used by Chinese in diaspora, and is becoming increasingly popular among non-Chinese in many countries.20世纪50年代末，中医（TCM）获得中国官方认可，如今中医不仅仅在中国得到广泛运用，在移居海外的中国人中也广受欢迎，而且越来越受到外国人的青睐。The Debate and Limitations of Ap

13、plying Evidence-Based Medicine to Traditional Chinese MedicineTheories commonly associated with Chinese medicine include notions of the flow of qi and the balancing of complementary opposites; associated therapeutic practices include acupuncture and herbal medicine.中医相关的理论包括行气学说、对立统一平衡观点等。中医治疗实践有针灸和

14、中草药等。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine4 Recent literature on Chinese medicine addresses epistemological, ontological, methodological, and strategic challenges involved in incorporating RCTs and the standards of EBM.4 近来的中医专业文献资料论述了中医在引入临床随

15、机对照试验和循证医学标准过程中所面临的认识论、本体论、方法论和策略论上的一些质疑。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineA few authors contend that Chinese medicine should not be evaluated based on RCTs, detailing their reasons against modern Western scientific methods of determining e

16、fficacy.一些作者认为对中医的评估不该建立在临床随机对照试验上，并详细阐述了他们反对采用现代西方科学方法判断疗效的理由。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineA far greater number of sources advocate for applying RCT and EBM standards to Chinese medicine and propose a variety of innovative strategies

17、of mutual accommodation.但大多数的人提倡将临床随机对照试验和循证医学标准运用到中医，并提议多种相互包容的创新策略。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine5 While possessing compelling logic in many respects, these arguments against applying the standards of RCTs and EBM to Chinese medicine

18、are limited in at least three respects.5 以上反对将临床随机对照试验和循证医学标准运用到中医的论点虽然在很多方面有着无可辩驳的逻辑，但这些观点至少在以下三个方面存在局限性。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineFirst, the case against RCTs for Chinese medicine is arguably unrealistic when suggesting that Chine

19、se medicine practitioners either simply refuse to go along with current formulations of EBM or propose a dual standard system. This involves ignoring the current “legitimizing context in which both biomedicine and Chinese medicine are currently embedded both in China and abroad.首先，反对将临床随机对照试验应用到中医领域

20、的人不是简单地拒绝遵从循证医学的现行准则，就是倡议一个双重标准系统，这些观点可以说都是不现实的，也忽视了现今国内外生物医学和中医相交融这个“合理背景”。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineRefusing to participate is becoming increasingly difficult as the value placed on RCTs spreads globally through channels such as t

21、he Cochrane database project.临床随机对照试验的价值通过Cochrane数据库项目等渠道传播至全球各地，很难拒绝将其运用到中医。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineAttempting to establish a dual standard for efficacy is also unlikely to be viable since it would be easily construed as a doubl

22、e standard that sets inferior criteria for Chinese medicine.企图建立一个评估疗效的双重标准也不可行，因为容易被认为是替中医设置了较低的标准。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineAlso, in practice many biomedical clinicians strive to tailor treatments to individual patient circumstanc

23、es and feel that there are treatments not yet formally researched which clinical experience has shown to be effective.而且，许多生物医学临床医生在医学实践中力求根据病人的个体情况调整治疗方法，他们觉得一些富有成效的临床经验还未经过正规研究。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine6 Second, the arguments aga

24、inst RCTs for Chinese medicine presented above tend toward an oversimplified view of Chinese medicine, biomedicine, EBM, and RCTs.6 其次，反对者对中医、生物医学、循证医学和临床随机对照试验的认识过于简单化。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineThe tendency to exaggerate difference

25、s and underestimate similarities between Chinese medicine and biomedicine has been remarked upon in broader context by scholars such as Scheid.蒋熙德等学者从更广阔的背景下对此进行了评论，他们夸大了中医和生物医学的差异，而对他们的相似之处认识不足。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineIn this cas

26、e, the above arguments overlook the fact that EBM and the priority it places on RCTs were initially instituted precisely because biomedical clinicians were engaged in many of the practices that are typically aligned with Chinese medicineacting on the basis of subjective experience, case observations

27、, and the advice of mentors.在这种过于简单化认识的情况下，上述论点忽略了一个事实：循证医学及其对临床随机对照试验的重视，其最初形成的原因正好和中医一致，这些生物医学的临床医师所进行的许多医学实践也是建立在主观经验、病例观察和有经验的专家的指导之上的。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineThey also fail to note how effects of EBM on the regulatory environ

28、ment are frustrating for many biomedical clinicians who want to maintain control over clinical decision-making and provide personalized care.反对者也未能注意到循证医学对监管环境产生的影响，这让那些想保留临床决定权和提供个性化治疗的生物医学医生非常失望。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineIn the pr

29、ocess of comparison, they forget the diversity that sits under the umbrella of biomedicine.在比较过程中，他们忽略了生物医学范畴的多样性。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine7 These arguments rejecting RCTs also gloss over much of the social complexity that has cons

30、tituted Chinese medicine both at present and in the past. This is related to not adequately distinguishing between ideals and practice and between representations and reality.7 这些拒绝将临床随机对照试验应用到中医的论点大多掩盖了使得中医代代相传的一个构成因素社会复杂性，这与它们无法充分认清理想和实践、表象与事实的区别有关。The Debate and Limitations of Applying Evidence-B

31、ased Medicine to Traditional Chinese MedicineWhile Chinese medicine is popularly viewed today as a longstanding unitary tradition constituting a “coherent body of knowledge,” in fact, Chinese medicine is a continually evolving mlange comprised of a wide diversity of theories and practices which have

32、 only recently been recognized as one “tradition.”现在普遍认为中医源远流长，是一个统一整体，具有 “连贯的知识体系”。但实际上，它是一个“混合体”，由一系列丰富多样的理论和实践经不断演变而成，直到近来才被视为一项“传统”。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineWhile often presented as ancient tradition, Chinese medicine today is

33、very different from what it was prior to concerted contact and competition with biomedicine over the last century.虽然中医常被视为一种古代传统，但经过与生物医学一个世纪的相互联系和竞争，如今的中医已大不同于从前。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineAlthough represented as tailoring treatment

34、 to individuals and to multiple situational factors in a virtuoso-like manner, in clinical practice Chinese medicine is sometimes dispensed in a rather woodenly formulaic way.中医体现技艺非凡的因人因势治疗，但在临床实践中有时十分公式化。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese Medicine

35、Observations in contemporary China show that some practitioners who work in busy clinics have little time to spend with each patient.观察表明，中国当代一些执业医师诊所工作十分忙碌，几乎没有时间好好了解每个病人的情况。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineSome past and present physician

36、s have prided themselves on gaining all the information they need for a diagnosis from the pulse, without requiring the patient to tell them their complaint.古今的一些内科医生很自豪自己无需询问病人哪里不舒服，光凭诊脉就能获得他们所需的信息。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineIn addi

37、tion, some Chinese medicine practitioners in China today see incorporating more technology and laboratory tests into their practice as a way to advance Chinese medicine.另外，当今中国的一些中医执业医生认为将更多的技术成分和实验室测试运用到临床实践是促进中医发展的一种方式。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional C

38、hinese Medicine8 Emphasis in these arguments on the importance of pattern differentiation in determining treatment is a prime example of the mismatch between representations and reality.8 以上论点中对于辨证论治重要性的强调很好地证明了表象和事实之间的割裂。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional

39、Chinese MedicineBianzheng lunzhi can be translated as “determining treatment on the basis of discerning the pattern.”辨证论治可以译为“根据辨证的结果确定相应的治疗方法”。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineChina scholars have elaborated that this entails deciding on t

40、reatment based on the complex pattern of symptoms and signs observed in the patient within the context of his or her distinctive constitution, current circumstances such as the season, and the present constellation of his or her bodily processes.中国学者对辨证论治的阐述如下：基于观察到的复杂的体征和症状，并结合患者的具体体质、当前季节等环境因素和患者当

41、时的一系列身体新陈代谢状况，确定治疗方法。The Debate and Limitations of Applying Evidence-Based Medicine to Traditional Chinese MedicineAs in Fans paper, the special efficacy of Chinese medicine is commonly said today to be rooted in bianzheng lunzhi.正如范（音译）在其论文中所说，当今常说中医的特殊疗效根植于“辨证论治”。The Debate and Limitations of Appl

42、ying Evidence-Based Medicine to Traditional Chinese Medicine In this vein, discussions of the difficulty of applying the RCT design to Chinese medicine stress that while biomedicine assigns standardized treatment based on disease categories such as diabetes, Chinese medicine tailors individualized t