上海市卫生和计划生育委员会ShanghaiMunicipalHealthandFamilyPlanningCommission

上海市中医药发展办公室ShanghaiMunicipalOfficeforDevelopmentofTraditionalChineseMedicine

2015.6

郑 锦ZhengJin

中医在医疗保健中的作用RoleofTraditionalChineseMedicine(TCM)in

ModernHealthcareSystem

中医学在世界传统医学中独树一帜，自最早的经典著作《黄帝内经》问世两千余年来，历代医家通过不断的探索、实践和创新，使中医学术得到不断发展，为中华民族的繁衍昌盛作出了卓越的贡献。21世纪的今天，古老的中医学依然魅力不减。

TCM is a distinctive part of traditional medicine across the world. Thefundamental framework was recorded in the Huang Di Nei Jing (Yellow Emperor'sInternal Classic). Thanks to the efforts of physicians in different generations inexploration, practice and innovation, the past two thousand years have witnessedits continuous academic development. TCM has done extraordinary contributionto the health and prosperity of Chinese nation. It still remains popular today inthe 21st century.

中国上海的中医实践TCMPracticeinShanghai,China地理位置：中国长江三角洲前缘Geographiclocation: ThetipoftheYangtzeRiverDelta(atriangle-shapedterritoryofShanghaiCity,JiangsuProvinceandZhejiangProvince)

占地面积：6340.5平方公里Area: 6340.5squarekilometers

常住人口：2425万Permanentresidents:24.25million

经济总量：23560.94亿人民币Totaleconomicvalue: 23560.94trillionRMB(Yuan)

中医医疗服务受到欢迎TCMHealthService

16%

84%

门诊

中医门诊量TCM

西医门诊量Westmedicine

10%

90%

住院

中医出院人数TCM西医出院人数Westmedicine

中医门诊服务总量：4100万/年TCMoutpatientservice: 41million patients/year

中医住院服务总量：35.2万/年TCMinpatientservice:352,000 patients/year

积极开展中医公共卫生服务InitiativesofTCMPublicHealthService

0-3岁儿童中医药健康调养 11.76万人/年TCMdietandnutritionforchildrenaged0-3:117,600kids/year

65岁以上老年人体质辨识 56.79万人/年Constitutionaldifferentiationforpeopleaged65andover:567,900/year

覆盖面超过50%健康管理人群Theseinitiativesofhealthmanagementcoverover50%ofthepopulation.

发放中医养生保健知识读本750万户TheTCMManualonHealthPreservationhasbeendeliveredto7.5millionfamilies.

中医和西医共同维护上海市民健康IntegrativeChineseandWesternmedicalserviceinShanghai

• 户籍人口期望寿命：82.29岁Theaveragelifeexpectancyofregisteredpopulation:82.29 yearsold

• 户籍人口5岁以下儿童死亡率：2.90/千Themortalityrateofchildrenunder5yearsold:2.9‰

• 户籍人口孕产妇死亡率：4.27 /10万人Thematernalmortalityrateofregisteredpopulation:4.27/100,000

目次 TableofContents

中医理论体系 TCMTheoreticalSystem中医医疗保健实践 TCMPractice

中医学具备完善的理论体系TCMhasacompletetheoreticalsystem

一、确立“天人合一”的医学观I.MedicalviewofMan-NatureUnity

—人是自然界的产物，遵循同一规律Manisproductofnatureandfollowsthesamelawwiththenature.

—人与自然要和谐，人与社会要和谐

Manshouldbeinharmonywiththenatureandsociety.

中医医疗不仅注意患者的“病”,更注重生病的“人”

TCMhighlightsboththe'illness' andthe'patient'.

二、强调“整体观”把握生命规律II.Holisticview

阴阳理论Yin-yangtheory

五行理论Five-elementtheory

藏象理论Zang-xiangtheory

经络理论Meridiantheory

—人体的组织器官是一个有机整体Humantissuesandorgansareanorganicwhole.

—在结构、功能上、病理上相互影响Theyinteractinstructure,functionsandpathology.

三、重视“治未病”的预防思想III.Preventiveconceptof'treatmentbeforeonsetofillnesses'

Ø 未病先防Treatmentbeforeonsetofanillness

Ø 既病防变Preventionoftransmissionafteronsetofanillness

Ø 愈后防复Preventionofrecurrenceafterrecovery

不能“渴而穿井，斗而铸锥”It’stoolateto‘digawellwhenyouarethirsty’andto‘prepareaweaponwhenafightstarts’.

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四、倡导养生防病，取法自然IV.Stayhealthybyfallingthenature

根据自然界春生、夏长、秋收、冬藏，调节生活秩序以及精神活动Oneneedstoadapttolifestylesandregulateemotionsbyfallingthenaturallaw:birthinSpring,growthinSummer,harvestinautumnandstorageinwinter.

调神养生 四时养生

饮食养生 运动养生

Preservehealthbyfouraspects:emotionalregulation,seasonalchanges,dietandexercise.

五、突出”辨证论治”的个体化诊疗V.Syndromedifferentiationandindividualizeddiagnosisandtreatment

u 因人因时因地制宜Treatmentbyindividualizedconstitution,timeandgeographicfeatures

u 急则治其标Treatsymptomsfirstinacuteconditions

u 缓则治其本Treattherootcauseinchronicconditions

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中医学 AboutTCM

u关于健康的医学，具有医疗、预防、保健、康复的作用TCMisabouthealth.Itinvolveshealthcare,prevention,wellnessandrehabilitation.

u符合现代医学目的调整和医学模式转变的核心价值TCMmatchesthecorevalueintransformationofmedicalpurposeandmedicalmodel.

u具有简、便、验、廉、效的特点Itissimple,convenient,effectiveandlow-cost.

u具有让人不得病、少得病、晚得病的优势TCMhelppeopletoavoid,reduceordelayillnesses.

疗效确切的医疗保健实践Healthcarepracticeandaccurateefficacy

r张亭栋教授、陈竺院士等采用中药砒霜及

中药复方制剂治疗白血病所取得的成果引

起国内外重视

Academician Chen Zhu, Prof. Zhang Tingdong, andother experts raised international attention by usingTCM arsenic trioxide and TCM compound to treatleukemia.

中药治疗白血病TCMforLeukemia

PNAS105:12,4826-4832,2008

17

r 2011年中国中医科学院屠呦呦教授和全国大协作的研究团队所成功研制的青蒿素类抗疟新药，获得了美国

医学大奖拉斯克奖

In 2011, Professor Tu Yoyo from China Academy of Chinese Medical Sciences wasconferred the Lasker Medical Research Awards for successful research anddevelopment of new anti-malarial drugs-Artemisinin and its derivatives, whichwas completed by her and other Chinese scientists.

抗疟新药青蒿素研究Studyonartemisininanditsderivativesasnewanti-malariadrugs

青蒿用于治疗疟疾最早记载于“肘后备急方”This herb was first recordedin the Zhou Hou Bei Ji Fang(Emergency Formulas to KeepUp One’s Sleeve) (281-340AD) for treatment of malaria.

青蒿 (QingHao)HerbaArtemisiaeAnnuae

l 中医医院和中西医结合医院TCMandIntegrativeChineseandWesternMedicalHospitals

l 综合医院中医临床科室TCMsubspecialtiesingeneralhospitals

l 社区卫生服务中心中医临床科室TCMsubspecialtiesincommunityhealthcarecenters

l 社会办中医医疗机构PrivateTCMhealthcareorganizations

22

134

242

341

数量Numbers

2014以上海为例的医疗实践TakemedicalpracticeinShanghaiforexample中医医疗保健服务体系完备CompleteTCMhealthcareservicesystem

教学和研究不断提高医疗水平Education andresearch help to improve the quality of medical treatment

Ø 上海中医药大学有7所附属医院TheShanghaiTCMUniversityhas7 affiliatedhospitals.

Ø 留学生数在上海高校名列前茅，涉及30个国家Internationalstudentsfrom30countriesarestudyingattheUniversity.

Ø 上海市中医药研究院ShanghaiAcademyofTraditionalChineseMedicine

Ø 国家中医药临床研究基地NationalClinicalResearchStationforTraditionalChineseMedicine

Ø 国家研究型中医医院NationalResearch-orientedTCMHospital

独特的中医“治未病”技术：冬病夏治Distinctivemethodsin'treatmentbeforeonsetofanillness':treatingwinterdiseasesinsummer

冬病：支气管哮喘、老慢支在寒冬季节容易发病或病情容易加重。“冬病”的根本在于寒邪强盛和阳气亏损Winter diseases refer to medical conditions that are often seen or aggravated in cold winter days, such asbronchial asthma and chronic bronchitis. The root causes of 'winter diseases' are excess of cold anddeficiency of yang qi.

夏治：在炎热的夏季采取各种相应的防治措施Treatment in summer: Adopt prevention and therapeuticmeasures in hot summer days.

夏季三月，阳气最盛之时Yangqiflourishesin(3)summermonths.

治疗机制 Therapeuticmechanism“春夏养阳”助阳气升发之势

Liftandreinforceyangqiinspringandsummer

“三伏”有利于药物的吸收

EasymedicinalabsorptioninHottestsummerdays.

穴位注射 Pointinjection

足三里穴Zusanli(ST36)

穴位敷贴 Pointapplication

天突穴Tiantu(CV22)

大椎穴Dazhui(GV14)

冬病夏治方法Treatmentofwinterdiseasesinsummer

独特的中医“治未病”技术：中医冬令膏方Distinctivemethodsin'treatmentbeforeonsetofanillness':Gaofang (condensedherbaldecoction)inwinter

u膏方——是中药八大剂型之一Gaofang isoneoftheeightdoseformsofChinesemedicine.

u作用——延年益寿、补虚疗疾Actions:Prolongslife,benefitshealth,reinforcesdeficiencyandremovesillnesses.

u适用人群——亚健康、慢性病人、手术后体虚Indications:sub-healthstatus,chronicconditionsandpostoperativeweakconstitution.

u特点——因人施膏，扶正补虚，动静结合，整体调理Characteristics:Individualizedformula,reinforcehealthyqiandregulatethewholebody.

u服用时间——冬季，45天-60天Timeofadministration:45-60daysinwinter

u组成——饮片类、名贵中药材、动物胶类、糖酒等敷料等熬制Compositions:Herbalpieces,valuableherbs,animalglueandsugar/alcohol,etc.

u全国都有，江南最盛行PopularacrossChina,especiallyinsoutheasternpartofChina.

u上海冬季定制14万人Atotalof140,000peopleinShanghaiorderGaofang inwinter.

中医诊疗实例一：中西医结合治疗胰腺癌Case#1:IntegrativeChinese&WesternMedicineforPancreaticCancer

u各项资助合计超过500万美元，完成10余项临床研究Atotalof5millionUSdollarswereinvestedandmorethan10clinicalstudieshavebeencompleted.

u复旦大学肿瘤医院和美国 MDAnderson肿瘤中心合作CollaborationbetweentheFudanUniversityShanghaiCancerCenter(FUSCC)andMDAndersonCancerCenter(MDACC)

u共同成立了国际整合医学肿瘤中心(ICIO)EstablishmentoftheInternationalCenterofIntegrativeOncology(ICIO)

u美国NIH/NCI和中国国家科技部支持SupportedbyNIH/NCIandMinistryofScienceandTechnologyofChina

FUSCC MDACC

清胰化积为主的中西医结合治疗IntegrativeChinese(QingYiHuaJi)andWesternMedicalTreatment

处方：清胰化积方Formula:QingYiHuaJi

功效：清热化湿，扶正祛邪Actions:Clearsheat,resolvesdampness,reinforceshealthyqiandremovespathogenicfactors

主治：胰腺癌Indication:Pancreaticcancer

中位生存期MOS(months)

1年生存率1year(%)

3年生存率3years(%)

5年生存率5years(%)

中西医结合治疗ChineseMedicine+Chemo

7.6 25 14.1 8.4

化疗ChemoAlone

5.4 10 2.9 0

结果:Results:

SkiactsastherapeutictargetofQingYiHuaJiformula inthetreatmentofSW1990pancreaticcancer.IntegrCancerTher2010;90(1):50-58

中医诊疗实例二：针药复合麻醉Case#2:Anesthesiausingacupunctureandanesthetics

选择常规情况下需使用传统气静全麻方式才能完成的手术病种，采用针刺复合麻醉药物技术，在非气管插管的条件下，完成上述病种手术的一种麻醉模式。

As for some operations that require general anesthesia, combined acupuncture andanesthetics are used to complete the operationwithout endotracheal intubation.

上海中医药大学附属曙光医院ShuguangHospital,ShanghaiUniversityofTraditionalChineseMedicine

u 1958年中国根据针刺镇痛原理，首创针刺麻醉手术In 1958, operation with acupuncture anesthesia wasinitiated in China on the basis of acupuncture analgesicprinciple.

u 1958年-1979年 针麻手术超过200万例手术种类涉及临床各科达90余种，包括脑瘤摘除

术、二尖瓣窄分离术、胃切除术、子宫切除术、脾切除术以及肾、膀胱癌手术等Between 1958 and 1979, there were a total of 2 million operations using acupunctureanesthesia. The operations involve more than 90 conditions, such as removal of brain tumor,separation of the mitral valve stenosis, gastrectomy, hysterectomy, splenectomy andsurgeries of kidney or bladder cancer, etc.

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针药复合麻醉下心脏外科手术Combinedacupunctureandanestheticforopen-heartsurgery

取穴：云门-中府，列缺-内关Points:Yunmen(LU2)—Zhongfu(LU1),Lieque(LU7)—Neiguan(PC6)

功效：术前针刺诱导Action:acupunctureinducingpriortooperation

Zhou et al. were able to demonstrate its effectiveness once again.This landmark article bodes well for the future of acupunctureanesthesia for open heart surgery, not only because of its soundphysiologic basis, simplicity in clinical application, significant benefitto the patient and favorable cost effectiveness, but also for itspositive impact on healthcare cost.

Editorial

Acupuncture anesthesia for open heart surgery incontemporary China，International Journal of Cardiology150 (2011) 12–16

手术中患者保持自己正常的腹式呼吸，并与医生对话。Duringtheoperation,thepatienthadnormalabdominalbreathingandcouldtalktothesurgeon.

手术后病人立即饮水，突破全麻禁忌Thepatientdrankwaterimmediatelyaftertheoperation.

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时 间：2006年9月5日性 别：男年 龄: 39岁

针药复合麻醉下开颅左侧天幕海绵状血管瘤全切除术Totalresectionofleftcavernoushemangiomaoftentoriumwithcombinedacupunctureandanesthetics

Time:September5,2006Sex:MaleAge:39Diagnosis：leftcavernoushemangiomaoftentorium

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针刺攒竹、太冲Acupuncturepoints:Cuanzhu(BL2)andTaichong(LR3).

手术耗时1个半小时

患者保持清醒 Thepatientremainedconsciousduring the1.5-houroperation.

辅助药物：Lidocaine,常规剂量400mg/支,皮下注射,局部麻醉Auxiliaryanesthetic:Lidocaine,standarddose400mg,subcutaneousinjectionforlocalanesthesia

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针刺麻醉的优点 Advantagesofacupunctureanesthesia

u 减少或避免因麻醉药物引起的副作用Reducesoravoidssideeffectsinducedbyanesthetics.

u 使用安全，适应范围广Safetyandextensiveindications.

u 患者始终处于清醒状态Thepatientsremainconsciousduringoperation.

u 术中生理干扰少Avoidsphysiologicaldisturbancesduringoperation.

u 利于术后康复Benefitspostoperativerecovery.

u 降低医疗费用Reducesmedicalcost.

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中医诊疗实例三：中医综合治疗肺癌Case#3:ComprehensiveTCMtreatmentforlungcancer

方法：中医综合治疗Method:ComprehensiveTCMtreatment

功效：扶正治癌Actions:Reinforcehealthyqiandfightagainstcancer

结果Results:

鳞癌

腺+鳞

腺+鳞

腺+鳞

腺+鳞

腺+鳞 腺

+鳞

鳞癌

腺+鳞

腺+鳞

腺+鳞

腺+鳞

Adenocar-cinoma+SC

SCAdenocar-cinoma+SC

Adenocar-cinoma+SC

Adenocar-cinoma+SC

Adenocar-cinoma+SC

晚期肺癌中位生存时间比较Comparisonofmediansurvivaltimeinpatientswithterminallungcancer

成果：中医综合治疗中位生存期比单纯化疗提高5.27月Achievement：Comparedwithchemotherapy,ThemediansurvivaltimeofTCMcomprehensivetreatmentincreasedby 5.27months

上海中医药大学附属龙华医院LonghuaHospital,ShanghaiUniversityofTraditionalChineseMedicine

中医诊疗案例四：扶正化瘀片抗丙型肝炎肝纤维化Case#4:FuZhengHuaYuTabletsforliverfibrosisinchronichepatitisC

治则：扶正化瘀Treatmentstrategy: Toreinforcehealthyqiandresolvestasis(FuZhengHuaYu)组成：丹参、虫草菌丝、五味子、绞股蓝、松花粉、桃仁等Ingredients: DanShen(RadixetRhizomaSalviaeMiltiorrhizae),ChongCaoJunSi(Cordyceps),WuWeiZi(FructusSchisandraeChinensis),JiaoGuLan(RhizomaseuHerbaGynostemmatisPentaphylli),SongHua Fen(PollenPini)andTaoRen(SemenPersicae),etc.

Results: FuZhenHuaYutabletsshowgoodeffectforliverfibrosis结果:扶正化瘀片对肝纤维化有满意疗效

单独或联合使用中医药/植物药对抗肝纤维化具有好效果，需要更多研究和进展UsealoneorincombinationofChinesemedicineandphytomedicinehasshowngoodeffectsforliverfibrosis;however,furtherstudiesandupdatesareneeded.

上海中医药研究院肝病研究所TheResearchInstituteofLiverDiseases,ShanghaiAcademyofTraditionalChinesMedicine

已在美国完成II期临床试验，正在准备Ⅲ期临床试验ThephaseIIclinicaltrialofFuZhengHuaYu tabletshasbeencompletedintheUS.ThephaseIIIclinicaltrialisnowunderpreparation.

中医学TraditionalChineseMedicine

整体观Conceptofholisticview

辨证论治Treatmentbasedonsyndromedifferentiation

治未病Treatmentbeforediseaseonset

五志七情Fivewillsandsevenemotions

五运六气Five evolutive phasesand six climaticfactors

现代医学WesternMedicine

系统、环境、生态医学System,environmentandecologicalmedicine

个体化诊疗Individualized diagnosis and treatment

预防、预测医学Preventiveandpredictivemedicine

心理、精神、心身医学Psychology,psychiatryandpsychosomaticmedicine

动态、时相医学Dynamicandchronomedicine

东西方医学的交汇TheConvergencebetweenEasternandWesternMedicine

结语Conclusion

探索 生命科学

Explorelifescience应对 当代面临的全球健康挑战

Addressglobalhealthchallenges推动 当代医学模式的转变

Promotetransformationofmedicalmodel

建立中国——捷克“中医中心”

TosetupaChina-CzechTCMCenter

共同Worktogetherto

东西方医学汇聚TheConvergencebetweenEasternandWesternMedicine

谢谢！Thankyou!