中医临床实践、循证医学及伦理学问题探讨

Discussion on clinical practice,evidence-based medicine and ethics in traditional Chinese medicine

中医药国际化与现代化发展,在很大程度上与中医临床研究科研方法的优劣密切相关。当前以循证医学为主的跨学科技术探索,为传统医学研究提供着更广泛的思路。在过去二十余年,循证医学研究的概念已占据了中医临床实践或其他卫生保健很大部分的医学研究文献,并在科学性、社会及哲学层面引发着广泛的争议。然而,对于循证医学的基本推论即其开展的伦理合理性分析,在当前鲜有文献进行报道。文章围绕上述核心问题从中医临床实践及循证医学的发展现状、中医临床医学循证及其证据解读、中医临床循证研究与医学伦理合理性分析等方面展开论述,并就中医临床实践、循证医学与医学伦理的整合思维进行相关探讨,以期为当前中医临床实践与医学循证决策提供参考。

It is increasingly recognized that the internationalization and modernization of Chinese medicine(CM) are closely associated with the key methodology in clinical research.The present interdisciplinary formulation focusing on evidencebased medicine(EBM),to some extents,provides a potential basis for further research of traditional medicine.Since the past two decades,the concepts of EBM have occupied most of published literatures in clinical practice.This process also caused widespread controversy in scientific,social and philosophical domains.However,for the basic conclusions i.e.the ethical rationality of EBM progression,there are few studies noted in the publications.Based on the core problem and principles,this article attempted to discuss the issues such as the development of CM clinical practice in EBM context,the interpretation of CM clinical evidence,rationality analysis of ethics in CM evidence-oriented practice,and further integrated exploration between CM practice,evidence of EBM and medical ethics,etc.We hope these considerations can provide references to the better understanding of EBM research and decision-making in CM medical practice.