系统科学视域下的中医现代化——新冠肺炎疫情下中医药的循证验药之思

Reflections on Traditional Chinese Medicine's Evidence-based Practice and Efficacy Verification During the COVID-19 Pandemic——The Modernization of Traditional Chinese Medicine from the Perspective of Systems Science

中医药是中国在新冠肺炎的特效药和疫苗产出之前对抗病毒的重要力量。然而,从“废医存药”“告别中医中药”再到“废医验药”,近代以来围绕着中医药的争议一直不断;其中,对中医药的一个关键指责在于它不是循证的。系统科学视域下的现代中医学以“可实证”为基本特征,而循证医学主张对临床研究中的证据进行检验,强调证据质量与推荐强度在等级上的系统匹配,尽管证据质量并非决定推荐强度的唯一因素。传统中医实践虽有经验归纳作为依据,但通常缺乏实验验证,相关证据质量一般相比于临床试验而言较低,而对其推荐强度又时有相对夸大之嫌。面对当前遭受的非议,不少中医药正通过走循证的道路来提升相关证据质量的等级,以更系统地验证自身的有效性和安全性。与此同时,为推动中医药的健康、有序、可持续发展,具有中医药特色的临床证据分级和推荐系统也应争取尽早获得统一规范与国际认可。

Traditional Chinese Medicine(TCM)has become an important force to fight against the COVID-19 pandemic in China before the specific drugs and vaccines are produced.However,since modern times,there have been many controversies around TCM.One of the key accusations against TCM is that it is not evidence-based.Modern TCM from the perspective of systems science is characterized by“verifiability”,while evidence-based medicine(EBM)emphasizes the systematic matching between the levels of evidence and strength of recommendations.Although the TCM practice is based on the induction of experience,it is usually lack of experimental verification,thus the quality of relevant evidence is generally worse than clinical trials,while the strength of recommendation is sometimes relatively exaggerated.In the face of the current criticisms,many TCMs are taking the evidence-based approach to improve the quality of relevant evidence,in order to verify their efficacy and safety more systematically.For the sake of the healthy,orderly and sustainable development of TCM,the levels of evidence and strength of recommendations system with specific TCM characteristics should also strive to obtain unified norms and international recognition.