万维百科

替代医学

替代医学
MeSH D000529

替代医学(英语:alternative medicinefringe medicinepseudomedicinequestionable medicine,也称另类医学)指任何声称产生医疗效果,但并非源于科学方法收集证据的医疗实践。替代医学不是生物医学的一部分,由于其疗效宣称与科学共识及已确立的科学定律矛盾,所以它们通常是被证明无效的、未经证明的,或者无法证明的。替代医学包括各种卫生保健实践、保健产品和疗法,其在生物学角度上令人觉得貌似是合理的,但不是经过充分测试、与证据和科学矛盾,甚至是对人体有害或有毒 。替代医学的例子包括顺势疗法自然疗法脊椎按摩疗法能量医学英语Energy medicine、各种形式的针灸中国传统医学阿育吠陀医学柔道整复术英语Sekkotsu信仰疗法。检测替代医学疗效的费用庞大,美国政府曾花费高达25亿美元来测试各类替代医学。然而与虚假治疗(即使用安慰剂)相比,几乎没有一种替代疗法能表现出更佳的疗效。

另类医学是与常规医学治疗并用的替代医学,是一种使用它可以“补充”治疗(提高疗效)的“信念”,但其没有得到科学方法证实。CAM补充和替代医学(英语:complementary and alternative medicine)的英语缩写。整合医学是指替代医学和循证医学的结合。

另类医学诊断和治疗不包括在医学院讲授的、以科学为基的治疗。替代疗法缺乏科学的验证,及其效果没有被证明被科学否定英语Scientific evidence。另类疗法通常建基于宗教传统迷信信仰信念超自然力量伪科学错误的推理宣传欺诈。每一个国家对替代医学和医疗服务提供者的监管和许可都不尽相同。

替代医学受到科学界的批评通常为使用误导性陈述、庸医胡说八道伪科学、反科学、欺诈和使用蹩脚的科学方法。对替代医学的推广亦被指责为危险和不道德的。对没有科学依据的替代医学进行检测也被指责浪费稀缺的医疗研究资源。批评者说:“真的没有像替代医学一样的东西,只是替代医学支持者认为是可行的,但常规医学则不同意”“能否有合理的‘替代’[医学基于证据]?”

定义和用语

替代医学”的一个概括定义是一组产品、实践以及理论,其使用者认为或感觉具有医学上的治疗效果,但其有效性尚未采用科学方法确定,其理论和实践并不是生物医学的一部分,或其理论和实践与科学证据或在生物医学中使用的科学原理矛盾。“生物医学”是医学的一部分,其应用生物学生理学分子生物学生物物理学和其他自然科学的原理去临床实践,并采用科学的方法来确立实践的有效性。替代医学是多样化的医疗保健系统、实践和产品,其建立于生物医学之外,不被视为生物医学的一部分,没有被生物医学的专业 人员广泛使用 ,并且不会在生物医学的实践技能中教授。不同于生物医学,替代医学的产品或实践不从科学或科学方法确立,而是建基于名人证言宗教传统迷信信仰理念超自然力量伪科学错误的推理、宣传、欺诈,或其他非科学来源。用语“替代医学”是指各种各样的相关和不相关的产品,实践和理论,起源于不同来源、文化、理论和信念体系,实践从生物学角度上而言是似是而非的,产品和实践由基于一些证据至与基础科学和明确证据矛盾,及其产品已被证明是无效的,甚至有毒有害的。

“替代医学”、“补充医学”、“整体医学”、“自然医学”、“非正统医学”、“边缘医学”、“非常规医学”和“新时代医学”在某些情况下可以互换使用并具有相同的含义(同义词),但可能在其他情况下有不同的含义,例如,非正统医学可以指不同于经常实践的生物医学、边缘医学也可能是指基于科学边缘的生物医学,其可能有科学根据,但不是主流。

替代医学中的“替代”一词的意义,并不在于它是否能实际有效地代替医药科学,尽管一些替代医学的宣传可能使用较宽松的术语定义去令人觉得医程有效的样子。玛西娅·安吉尔英语Marcia_Angell指出,“替代医学”是“万金油的一个新代名词,它既可行又不可行。”使用较宽松的用语也被用来暗指一个对立的存在(但它不是),如“西方医学”和“东方医学”这俩用语暗指所不同的是亚洲东部和欧洲西部之间的文化差异,而不是循证医学和不可行的治疗之间的差异。

补充医学”是指与常规医学治疗并用的替代医学,有人相信它能增加建基于科学的医学的有效性。“补充医学”的一个例子是针灸的利用,再加上采用科学为基础的医学,相信针灸能增加或“补充”建基于科学的医学的有效性。CAM是补充和替代医学(complementary and alternative medicine)的英语缩写

整合医学”这个用语有两种意思,一种用法是指基于科学的医学能与不基于科学的医学“一体化”的一种信念;另一用法仅指一些具有科学论证其疗效的替代医学治疗与常规治疗的相结合,在这种情况下,它是与“补充和替代医学”相同。“整体医学”(或整体健康)是一种替代医学实践,声称治疗的是“全人”,而不仅仅是疾病本身。

传统医学”和“民俗医学”指的是各地文化社会在近代科学以前发展起来的实践,“东方医学”通常是指在近代科学以前发展的亚洲传统医学。“西方医学”指的是现代的实践,通常是指医学科学,而不是指西方的替代医学(欧洲美洲)。“西方医学”、“生物医学”、“主流医学”、“医学科学”、“基于科学的医学”、“循证医学”、“常规医学”、“标准医学”、“正统医学”、“对抗性医学”、“占主导地位的卫生系统”以及“医学”,当与替代医学对比时可互换使用并具有相同的含义。但可能在其他情况下有不同的含义,例如,在医学科学有些实践没有被严格的科学测试支持,所以“医学科学”不是与“基于科学的医学”严格相同、当与其他较少用或更少推荐使用的生物医学作对比时,“标准医疗服务”可指代“最佳实践” 。

定义问题

科学界和生物医学界 中的杰出人士宣称把传统医学从替代医学分开的定义是没有意义的,及“常规医学”、“替代医学”、“补充医学”、“整合医学”以及“整体医学”这些术语并没有意义,不能具体描述任何事物。他们试图批评这种虚假的定义,包括:“没有常规医学/替代医学/互补医学/综合医学/整体医学这样的事物,只有可行或不可行的医学。”;“根据定义,替代医学要么没有被证明其可行性,要么被证明不可行,你知道他们称已经证明可行的替代医学为什么?他们就称‘可行的替代医学’为医学。”;“不可能有两种医学 ——常规医学和替代医学,只有目前已被充分测试的医学和没被充分测试的医学、可行的医学和可能可行/不可行的医学。一旦疗法已经过严格测试,不管疗法在当初被认为替代医学与否也无关紧要。如果它被认为是安全和有效的,它就会被接受。”、“替代医学并不存在,只有经过科学证明及实体数据支持的循证医学或科学证据不足并未经证实的医学。”

生物医学以及补充和替代医学团体中的一些人指出,“补充和替代医学”无法准确定义,它所包括的理论和实践多元化,而且“补充和替代医学”和生物医学之间的界限重叠,并且在变化。“补充和替代医学”这个用语不能使用简单的定义来界定,因为它的卫生系统和实践模糊,及其界限定义不清。它们的历史渊源、理论基础、诊断技术治疗实践和它们与主流医学的关系可能会有所不同。像中国传统医学阿育吠陀般的替代疗法,源于古代东亚或南亚;像顺势疗法、脊骨神经医学般的替代疗法则源于十八至十九世纪的欧洲或美国;一些替代疗法,如冥想和祈祷,是基于身心的干预疗法。在一处地方被认为是替代的疗法,在另一处地方可被认为是常规疗法。因此,脊骨神经医学在丹麦不被认为是替代疗法,同样脊骨神经医学不再在美国视为替代疗法。

不同类型的定义

众多替代医学的定义的一个共通点是其定性为正规医学以外。例如由美国国立卫生研究院国家补充与替代医学中心英语National Center for Complementary and Integrative Health所制定及被广泛引用的描述性定义。称它为“一组多样化的医疗卫生保健系统、实践和产品未被普遍认为是常规医学的一部分。”对于常规医学的医务人员而言,这并不一定意味着替代医学或它的从业者将不再被视为另类。

一些定义从社会和政治边缘化的角度来定义替代医学。这指的是替代疗法缺乏获得来自医疗机构和相关机构在研究经费、医学文献及纳入标准医学课程上的支持。

分类与类型

替代医学包括一系列的卫生保健实践、产品和疗法。共同特征是自称能医治患者,但其方法不是基于科学。替代医学的根基和实践方法十分多样 ,并可能基于其文化渊源或信念类型而区分。实践方法可能包含或基于特定的文化、民间知识、迷信、灵性信仰、超自然力量(反科学)、伪科学、错误的推理、宣传、欺诈、关于健康与疾病的不同概念等没通过科学方法证明的依据。不同的民族有自己独特的传统或信仰,根据几千年的发展,去不完全实践/完整地实践替代医学。

不科学的体系

替代医学的体系可能基于不符合科学的事实,如自然医学顺势疗法

顺势疗法

顺势疗法是一种疗法,基于如某物质能在健康的人身上,引起病人患某病时的病症,将此物质稀释震荡处理后就能治疗该病症的信念。它是在人类拥有原子分子的知识之前发展的,基础化学表明顺势疗法中的反复稀释只会产生水,其在科学亦为不合理。

尿疗法

尿疗法是通过饮用尿液来达到治疗疾病的目的,同时亦有采用尿液清洗皮肤、清洗毛发的做法。医学专家表示尿疗法是无稽之谈。喝尿治病则无法实现临床验证,是没有任何科学根据的。尿液中主要成分是水,身体健康的人喝下自己的尿,一般不会对身体产生太大副作用,但是如果身体有严重疾病,服用药物过后,毒素可能通过尿液排出来,这种尿液就很可能对人体造成危害。虽然目前没有研究结果,但这些本已排出体外的代谢废物重新被吸收,对人体健康肯定没有益处。也有专家认为,那些自称喝尿治好病的,不排除存在心理暗示作用的可能。

自然疗法

自然疗法建基于一种与循证医学冲突的观点——认为身体能使用一种超自然生命能量引导身体自愈。许多自然疗法支持者都反对接种疫苗,且“科学证据并不支持自然疗法支持者能治愈癌症或其他疾病的宣称。”

民族传统体系

替代医学的体系可能基于传统医学的做法实践,如中国传统医学印度传统医学或各地的文化实践。

中国传统医学

现成中药合剂

中国传统医学是几千年来中国的传统习俗和信仰的结合发展,再加上中共所作的修定。常见的实践包括中草药、针灸(把针插进体内特定穴位或经络)、推拿气功和食疗。基是基于称为“气”的超自然力量的信念、占星术命理。中国传统亦会使用草药等物质,并认为舌苔具备反映了身体变化的功能,其解剖模型和内脏器官的生理功能亦是不正确。

中国共产党创始人之一为响应当时缺乏现代医学从业者,复兴针灸并改写其理论,为拥护其政治、经济及中国人口的医疗需求的必需品[页码请求]。在20世纪50年代,中国传统医学的“历史”和理论在***的坚持下被改写以宣传共产主义,纠正所谓的“资产阶级思想”-西医。针灸在1972年美国时任总统理查德·尼克松访问中国时受到关注,该代表团遭展示一项大手术,被施手术者在完全清醒时被施行手术并在表面看来只在接受针灸,而不是麻醉。后来人们发现,选用于外科手术的患者既具有较高的疼痛耐受性英语Pain tolerance,又受到强烈的思想灌输。这些展示病例也经常暗中打点滴吗啡而观者只被告知注射液只含有液体和营养成分 。文献回顾发现,针灸在广泛的情况下都不是有效的。回顾众多的系统评价,发现对于减轻疼痛而言,真针灸并没有比假针灸的效果更佳。但是,其他回顾发现,针灸能成功地减轻慢性疼痛,其中假针灸并没有发现比安慰剂及无针刺组的效果更佳 。

阿育吠陀医学

阿育吠陀是印度的传统医学。阿育吠陀相信三种能量元素(Vata、Pitta、Kapha)的存在,并相信三种能量元素的平衡会使人健康,反之疾病是三种元素失衡的结果。能量元素失衡时,会使用传统草药、矿物质和重金属进行调整和回复平衡。阿育吠陀强调使用以植物为基础的药物进行治疗,有时会用一些动物制品,并添加像般硫酸铜的矿物质。

阿育吠陀已引起人们对其安全问题的关注,有两项美国研究发现约20%印度制造的阿育吠陀专利药物的重金属水平(如铅、汞和砷)能使人中毒。其他问题包括使用含有毒化合物的草药和缺乏对阿育吠陀设备的监管。在美国,部分的重金属中毒事件已被归因于使用这些化合物。

民间疗法

民间疗法,大部分是一些没有精密科学依据,但又在民间传说中,号称具有特定成效的治病方式。又称偏方。民间疗法的一个特色是只能问相信不相信,但不能证明真实不真实 。

超自然力量和对物理上的能量的误解

替代医学的体系可能基于相信物理科学尚未检测到的超自然能量的存在,如生物场。或相信的能量的性质与物理定律不符,如能量医学英语Energy medicine

针灸以在体内插入针的方式来治疗

生物场

生物场英语Energy (esotericism)治疗的目的是令它所声称的能量场包围及渗入身体。天体物理学家和科学怀疑论倡导者卡尔·萨根(1934-1996)指出缺乏经验证据支持疗法的前提——能量场的存在。

能量医学

磁疗是一种基于生物电磁学英语Bioelectromagnetics的疗法,使用可检验的电磁场,如脉冲场、交流电或非常规的直流电,磁疗声称不主张超自然能量的存在,但认为利用磁力或磁场可以违反物理定律地治疗疾病。在磁疗使用的磁场强度太低,不足以实现任何生理上的变化,且所用的方法没有科学有效性。

针灸是中国传统医学的一个组成部分,在针灸,人们认为被称为“”的超自然能量流经宇宙和身体,并有助于推动血气,其一旦堵塞会导致疾病的发生。支持者认为能通过计算星象,以确定在身体哪些部位插入针,以恢复处于阻塞状态的血气流动,从而治疗疾病。但“”从未被直接观测到,并与科学中使用的能量概念毫无关系。

在日本的灵气疗法,其相信科学未知且迄今无法检测的宇宙能量(灵气)的存在,从业者可以学习利用自己的双手来操纵灵气,并把能量传输到受者使受者身体回复平衡。跟针灸一样,气从未被直接观测到。

全人健康和心身医学

心身医学英语Mind–body interventions以探索的身心灵之间的联系来维持人的健康。它的前提是心灵会影响“身体机能和症状”。心身医学包括用于治疗的瑜伽英语Yoga as exercise or alternative medicine冥想、深呼吸运动、引导想象法英语Guided imagery催眠疗法英语Hypnotherapy渐进式肌肉放松法英语Progressive muscle relaxation气功以及太极拳

瑜伽,是传统印度教中练习方法的延伸和冥想,也可以归类为能量医学的一种,因其治疗效果被支持者认为是由于通过呼吸吸收“生命能量”到体内治疗所致,并因此被认为能治好多种疾病和主诉。

90年代以来,太极班在美国的医院、诊所以及社区和老人中心变得流行。这是由于婴儿潮那一代人口老化和太极是老年人的低强度锻练方法,令其名声逐渐为人所知。练太极的主要目的出现一些分歧,有些人练太极的主要目的是用以自卫;有些人练太极是因为它的美感;有些则对它的身体和精神的益处更感兴趣。

气功,是以呼吸的调整、身体活动的调整和意识的调整以加强健康的一种实践,扎根于中国的传统医学、哲学和武术。气功是传统上被视为养气和调息(气)(或称为“生命能量”)的一种实践。

草药和其他物质的使用

基于利用在自然界中发现的物质的实践,如草药、食品、非补充维生素和大剂量维他命、动物和真菌的副产品以及矿物质,包括传统医疗实践中所使用的,也可能包括其他实践方法,例子包括宣称带治疗效果的非维生素补充剂(鱼油Ω-3脂肪酸葡糖胺松果菊亚麻子油英语Linseed oil以及人参),草药医学或植物疗法不仅包括植物产品,也可以包括动物和矿物产品。它是替代医学商业上最成功的分支之一,包括出售时被称为“营养补充剂”的片剂、粉剂和酏剂。只有非常小的百分比显示出它们有任何疗效,并且缺乏法规监管其安全性及其疗效水平。其中可能包括任何已知的有毒物质,如部分中药材所含的毒。

手技疗法

手技疗法和其他以身体为主的实践,特点为身体部分的控制或移动,如体肌疗法英语Bodywork (alternative medicine)脊椎矫正疗法

骨科手法医学英语Osteopathic manipulative medicine是一组与主流医学区分的整骨和骨疗技术。

宗教、信仰疗法和祈祷

基于宗教的治疗实践,如祈祷基督教信仰疗法中的手礼以及萨满教,依托于神或心灵能干预治疗的信念。

萨满教是世界各地许多文化的实践,其中实践者达到意识改变状态英语Altered state of consciousness,此状态作为一个渠道,与灵界互动或引导超自然能量为患者治疗。

无知的利用和存在缺陷的推理

一些替代医学实践可能是基于伪科学、无知或存在缺陷的推理。这可能会导致欺诈行为的发生。

例如,基于对的治疗方法的实践者,可能故意利用病人对物理学的无知行骗。

投机与科幻推理

一些没有医学实证,不合科学常理及生物医学,靠科幻式投机的医疗方法和技术,纯粹花钱买技术来寄望未来科技可以复生

人体冷冻技术

人体冷冻技术,以超低温保存在临床上已死亡的人体,并希望未来科技可以解冻及复生。目前并没有成功个案把已冷冻的人类大脑、人体或哺乳类动物解冻后可复生,也没有足够科学证据证明有复生的可能。

参见

注释

  1. ^ 1.0 1.1 1.2 1.3 1.4 "The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, "complementary and alternative medicine" could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base."
  2. ^ 2.0 2.1 "[A]lternative medicine refers to all treatments but that have not been proven effective using scientific methods."
  3. ^ 3.0 3.1 3.2 "It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work... speculation, and testimonials do not substitute for evidence."
  4. ^ 4.0 4.1 4.2 4.3 4.4 "Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."
  5. ^ 5.0 5.1 "An alternative medical system is a set of practices based on a philosophy different from Western biomedicine."
  6. ^ 6.0 6.1 "CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."
  7. ^ The Final Report (2002) of the White House Commission on Complementary and Alternative Medicine Policy states: "The Commissioners believe and have repeatedly stated in this Report that our response should be to hold all systems of health and healing, including conventional and CAM, to the same rigorous standards of good science and health services research. Although the Commissioners support the provision of the most accurate information about the state of the science of all CAM modalities, they believe that it is premature to advocate the wide implementation and reimbursement of CAM modalities that are yet unproven."
  8. ^ According to the Tzu Chi Institute, a Canadian centre established to evaluate complementary and alternative therapies, "alternative therapies are those lacking scientific validation that are excluded from medical school training programs and uninsured by health plans."
  9. ^ "Kessler refers to a lack of efficacy but never pushes back at Hatch by enumerating the dangers that unregulated products pose to the public, the dangers that fill the pages of Offit’s book."
  10. ^ The National Cancer Institute's Dictionary of Cancer Terms, states that, "Orthodox medicine [is] ... also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and Western medicine"; the same source states that, "Standard medical care" is "[a]lso called best practice, standard of care, and standard therapy."
  11. ^ Mary Ruggie in Chapter 2 of Marginal to Mainstream: Alternative Medicine in America said, "By the mid-1990s, the notion that some alternative therapies could be complementary to conventional medicine began to change the status of...alternative medicine. The 21st century is witnessing yet another terminological innovation, in which CAM and conventional medicine are becoming integrative."
  12. ^ As David J. Hufford, Professor and Director at the Doctors Kienle Center for Humanistic Medicine at the Penn State College of Medicine, has argued: "Simply because an herbal remedy comes to be used by physicians does not mean that herbalists cease to practice, or that the practice of the one becomes like that of the other."
  13. ^ In his book The Homœopathic Medical Doctrine Samuel Hahnemann the creator of homeopathy wrote: "Observation, reflection, and experience have unfolded to me that the best and true method of cure is founded on the principle, similia similibus curentur. To cure in a mild, prompt, safe, and durable manner, it is necessary to choose in each case a medicine that will excite an affection similar (ὅμοιος πάθος) to that against which it is employed."

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