替代医学

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替代醫學
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MeSH D000529

替代醫學英语:alternative medicine)是指任何声称有类似正规医学的医疗效果,但并非源於科学方法收集证据的医疗实践[n 1][n 2][n 3],不是生物醫學的一部分[n 1][n 4][n 5][n 6]或與科學證據及已確立的科學矛盾[7][8][9]。它包括各種衛生保健實踐、保健產品和療法,其在生物學角度上令人覺得貌似是合理的,但不是經過充分測試、與證據和科學矛盾,甚至是對人體有害或有毒[n 4][7][9][10][11][12] 。例子包括新型和傳統醫學措施,如順勢療法自然療法脊椎按摩療法能量醫學英语Energy medicine、各種形式的針灸中國傳統醫學阿育吠陀醫學柔道整復術英语Sekkotsu信仰療法英语Faith healing。那些療法不是依據科學的衛生保健系統的一部分並沒有明確的科學證據支持.[13][14][15][16]。儘管用於測試替代醫學的費用支出龐大,包括美國政府所花的25億美元,但幾乎沒有一種能表現出任何比虛假的治療(安慰劑)更大的疗效,替代醫學已被科學和醫學界傑出人物批評為騙術胡說八道欺詐不道德[17][18]

另類医学是與常規醫學治療併用的替代醫學,是一種信念使用它可以「補充」治療(提高療效),但其沒有得到科學方法證實[n 7][2][20][21]。CAM是補充和替代醫學(complementary and alternative medicine)的英語縮寫[22][23]整合医学是替代醫學和循證醫學的結合[24]

另類醫學診斷和治療不包括在醫學院講授的以科學為基的治療,並且在治療基於科學方法的醫療實踐中不被使用。替代療法缺乏科學的驗證,及其效果沒有被證明被科學否定英语Scientific evidence[n 8][7][2][3][26]。另類療法通常建基於宗教傳統迷信信仰超自然力量偽科學錯誤的推理、宣傳和欺詐[7][8][9][2]。替代醫學和醫療服務提供者的監管和許可,每一个國家都不盡相同。

科學界批評替代醫學為是基於誤導性陳述、騙術、偽科學、反科學、欺詐、差勁的科學方法。替代醫學的推廣亦被指責为危險和不道德的[n 9][28]。檢測替代醫學也被指責浪費稀缺的醫療研究資源[29][30]。批評者說,「真的沒有像替代醫學一樣的東西,只是替代醫學上認為是可行的但常規醫學則不同意[31]」「能否有合理的「替代」[醫學基於證據]?[32]

類型[编辑]

替代醫學包括一系列的衛生保健實踐、產品和療法。共同特徵是自稱能醫治病患,但不是基於科學的方法。替代醫學的根本和實踐方法多樣[13] 。它的實踐可能基於其文化淵源或信念類型而被区分[7][8][13][2]。實踐方法可能包含或基於特定的文化、民間知識、迷信[33]、精神信仰、超自然力量(反科學)、偽科學、錯誤的推理、宣傳、欺詐、關於健康與疾病的不同概念和其他沒通過科學方法證明的依據[7][8][9][2]。不同的民族有自己獨特的傳統或信仰,根據幾千年的發展或最新做法,去個別實踐和完整體系地實踐替代醫學。

不科學的體系[编辑]

替代醫學的體系可能基於不符合科學的事實,如自然醫學顺势疗法[13]

順勢療法[编辑]

順勢療法是一種信念如某物質能在健康的人身上,引起病人患某病時的病症,將此物質稀釋震盪處理後就能治療該病症[n 10]。它是在人类擁有原子分子的知識之前發展,基礎化學表明順勢療法中的反复稀釋只会產生水及其在科學上是不合理的[35][36][37][38]

自然療法[编辑]

一種信念認為身體能使用一種超自然的生命能量引導身體自愈[39],一種與循證醫學衝突的觀點[40]。許多自然療法支持者都反對接種疫苗[41],並且「科學證據並不支持自然療法支持者能治愈癌症或其他疾病的宣稱[42]。」

民族傳統體系[编辑]

替代醫學的體系可能基於傳統醫學的做法實踐,如中國傳統醫學印度傳統醫學或各地的文化實踐[13]

中國傳統醫學[编辑]

現成中藥合劑

中國傳統醫學是幾千年來中國的傳統習俗和信仰的結合發展,再加上中國共產黨所作的修定。常見的實踐包括中草藥、針灸(把針插進體內特定穴位或經絡)、推拿氣功和食療。實踐是基於稱為「氣」的超自然力量的信念、並基於占星術命理。中國傳統亦会使用草藥等物質,並認为舌苔具备反映了身體變化的功能,其解剖模型和內臟器官的生理功能亦是不正確[7][43][44][45][46][47]

中國共產黨創始人之一毛澤東为響應当時缺乏現代醫學從業者,復興針灸並改寫其理論,為拥护其政治、經濟及中國人口的醫療需求的必需品[48][页码请求]。在20世紀50年代,中國傳統醫學的「歷史」和理論在毛澤東的堅持下被改寫以宣傳共產主義,糾正所謂的西醫「資產階級思想」[49]。針灸在1972年美國時任總統理查德·尼克松訪問中國時受到關注,該代表團被展示一項大手術,被施手術者在完全清醒時被施行手術並在表面看來只在接受針灸,而不是麻醉。後來人們發現,選用於外科手術的患者既具有較高的疼痛耐受性英语Pain tolerance,又受到強烈的思想灌輸。這些展示病例也經常暗中打點滴嗎啡而觀者只被告知注射液只含有液體和營養成分[43] 。文獻回顧發現,針灸在廣泛的情況下都不是有效的[50]。回顧眾多的系統評價,發現對於減輕疼痛而言,真針灸並沒有比假針灸的效果更佳[51]。但是,其他回顧發現,針灸能成功地減輕慢性疼痛,其中假針灸並沒有發現比安慰劑及無針刺組的效果更佳[52]

阿育吠陀醫學[编辑]

阿育吠陀是印度的傳統醫學。阿育吠陀相信三種能量元素(Vata, Pitta, Kapha)的存在,並相信三種能量元素的平衡会令人健康,反之疾病是三種元素失衡的結果[53]。能量元素失衡時会使用傳統草藥、礦物質和重金屬進行調整和回復平衡。阿育吠陀強調使用以植物為基礎的藥物進行治療[54],有時会用一些動物製品 ,並添加礦物質,包括硫酸銅[55]

阿育吠陀已引起人們對其安全問題的關注,有兩項美國研究發現印度製造的阿育吠陀專利藥物20%左右的重金屬水平(如鉛、汞和砷)能使人中毒。其他問題包括使用含有毒化合物的草藥和缺乏對阿育吠陀設備的監管。在美國,部分的重金屬中毒事件已被歸因於使用這些化合物[56][57][11][58][59][60]

超自然力量和對物理上的能量的誤解[编辑]

替代醫學的體系可能基於相信物理科學尚未檢測到的超自然能量的存在,如生物场,或相信的能量的性質與物理定律不符,如能量醫學英语Energy medicine[13]

針灸以在體內插入針的方式來治療

生物场[编辑]

生物场英语Energy (esotericism)治療的目的是令它所聲稱的能量場包圍及滲入身體[13]。天體物理學家和科學懷疑論倡導者卡爾·薩根(1934-1996)指出缺乏經驗證據支持療法的前提-能量場的存在[61]

能量醫學[编辑]

磁療是一種基於生物電磁學英语Bioelectromagnetics的療法,使用可檢驗的電磁場,如脈衝場、交流電或非常規的直流電[13],磁療聲稱不主張超自然能量的存在,但認为利用磁力或磁場可以違反物理定律地治療疾病。在磁療使用的磁場強度太低,不足以實現任何生理上的變化,且所用的方法沒有科學有效性[62][63][64]

針灸是中國傳統醫學的一個組成部分,在針灸,人們認為被稱為「」的超自然能量流經宇宙和身體,並有助於推動血氣,其一旦堵塞会導致疾病的發生[44]。支持者認為能通過計算星象,以確定在身體哪些部位插入針,以恢復處於阻塞狀態的血氣流動,從而治療疾病[44]。但「」從未被直接觀測到,並與科學中使用的能量概念毫無關係[65][66][67]

在日本的靈氣療法,其相信科學未知且迄今無法檢測的宇宙能量(靈氣)的存在,從業者可以學習利用自己的雙手來操縱靈氣[68],並把能量傳輸到受者使受者身體回覆平衡。跟針灸一樣,氣從未被直接觀測到[69][70]

全人健康和心身醫學[编辑]

心身醫學英语Mind–body interventions以探索的身心靈之間的聯繫來維持人的健康。它的前提是心靈會影響「身體機能和症狀」[13]。心身醫學包括用於治療的瑜伽英语Yoga as exercise or alternative medicine冥想、深呼吸运动、引導想象法英语Guided imagery催眠療法英语Hypnotherapy漸進式肌肉放松法英语Progressive muscle relaxation氣功以及太極拳[13]

瑜伽,是傳統印度教中練習方法的延伸和冥想,也可以歸類為能量醫學的一種,因其治療效果被支持者認為是由於通過呼吸吸收「生命能量」到體內治療所致,並因此被認為能治好多種疾病和主訴[71]

90年代以來,太極班在美國的醫院、診所以及社區和老人中心變得流行。這是由於嬰兒潮那一代人口老化和太極是老年人的低強度锻練方法,令其名声逐漸為人所知[72][73]。練太極的主要目的出現一些分歧,有些人練太極的主要目的是用以自衛;有些人練太極是因為它的美感;有些則對它的身體和精神的益處更感興趣。

氣功,是以呼吸的調整、身體活動的調整和意識的調整以加强健康的一種做法,紮根於中國的傳統醫學、哲學和武術。氣功是傳統上被視為養氣和調息(氣)(或稱為「生命能量」)的一種實踐[74]

草藥和其他物質的使用[编辑]

基於利用在自然界中發現的物質的實踐,如草藥、食品、非補充維生素和大劑量維他命、動物和真菌的副產品以及礦物質,包括傳統醫療實踐中所使用的,也可能包括其他實踐方法[13][18][75],例子包括宣稱帶治療效果的非維生素補充劑(魚油Ω-3脂肪酸葡糖胺松果菊亞麻子油英语Linseed oil以及人參)[76],草藥醫學或植物療法英语Phytotherapy不僅包括植物產品,也可以包括動物和礦物產品[18]。它是替代醫學商業上最成功的分支之一,包括出售時被稱為「營養補充劑」的片劑、粉劑和酏劑[18]。只有非常小的百分比顯示出它們有任何療效,並且缺乏法規監管其安全性及其療效水平[18]。其中可能包括任何已知的有毒物質,如部份中藥材所含的[76]

手技療法[编辑]

手技療法和其他以身體為主的實踐,特點为身體部份的控制或移動,如體肌療法英语Bodywork (alternative medicine)脊椎矯正療法

骨科手法醫學英语Osteopathic manipulative medicine是一組與主流醫學區分的整骨和骨療技術[77]

宗教、信仰療法和祈禱[编辑]

基於宗教的治療實踐,如祈禱基督教信仰療法英语Faith healing中的手禮以及薩滿教,依托於神或心靈能干預治療的信念。

薩滿教是世界各地許多文化的實踐,其中實踐者達到意識改變狀態英语Altered state of consciousness,此狀態作为一个渠道,與靈界互動或引導超自然能量为患者治療[78]

無知的利用和存在缺陷的推理[编辑]

一些替代醫學實踐可能是基於偽科學、無知或存在缺陷的推理[79]。這可能會導致欺詐行為的發生[7]

基於電和磁的治療方法的實踐者可能故意利用病人對物理學的無知行騙[2]

圖片[编辑]

定義和用語[编辑]

替代醫學」的一個概括定義是一組產品、實踐以及理論,其使用者認為或感覺具有醫學上的治療效果[n 2][n 4],但其有效性尚未採用科學方法確定[n 3][7][9][25][26],其理論和實踐並不是生物醫學的一部分[n 4][n 1][n 5][n 6],或其理論和實踐與科學證據或在生物醫學中使用的科學原理矛盾[7][8][9]。「生物醫學」是醫學的一部分,其應用生物學生理學分子生物學生物物理學和其他自然科學的原理去臨床實踐,並採用科學的方法來確立實踐的有效性。替代醫學是多樣化的醫療保健系統、實踐和產品,其建立於生物醫學之外[n 1],不被視為生物醫學的一部分[13][80],沒有被生物醫學的專業 人員廣泛使用[81] ,並且不會在生物醫學的實踐技能中教授[81]。不同於生物醫學[n 1],替代醫學的產品或實踐不從科學或科學方法確立,而是建基於名人證言宗教傳統迷信信仰超自然力量偽科學錯誤的推理、宣傳、欺詐,或其他非科學來源[n 3][7][9][2]。用語「替代醫學」是指各種各樣的相關和不相關的產品,實踐和理論,起源於不同來源、文化、理論和信念體系,實踐從生物學角度上而言是似是而非的,產品和實踐由基於一些證據至與基礎科學和明確證據矛盾,及其產品已被證明是無效的,甚至有毒有害的[n 4][10][11]

「替代醫學」、「補充醫學」、「整體醫學」、「自然醫學」、「非正統醫學」、「邊緣醫學」、「非常規醫學」和「新時代醫學」在某些情況下可以互換使用並具有相同的含義(同義詞[82][83][84],但可能在其他情況下有不同的含義,例如,非正統醫學可以指不同於經常實踐的生物醫學、邊緣醫學也可能是指基於科學邊緣的生物醫學,其可能有科學根據,但不是主流。

替代醫學中的「替代」一詞的意義,並不在於它是否能實際有效地代替醫藥科學,儘管一些替代醫學的宣傳可能使用較寬鬆的術語定義去令人覺得医程有效的樣子[7]瑪西婭·安吉爾英语Marcia_Angell指出,「替代醫學」是「萬金油的一個新代名詞,它既可行又不可行[85]。」使用較寬鬆的用語也被用來暗指一個對立的存在(但它不是),如「西方醫學」和「東方醫學」這倆用語暗指所不同的是亞洲東部和歐洲西部之間的文化差異,而不是循證醫學和不可行的治療之間的差異[7]

補充醫學」是指與常規醫學治療併用的替代醫學,有人相信它能增加建基於科学的医学的有效性[86][87][88]。“補充醫學”的一個例子是針灸的利用,再加上採用科學為基礎的醫學,相信針灸能增加或「補充」建基於科學的醫學的有效性[88]。CAM是補充和替代醫學(complementary and alternative medicine)的英語縮寫[22][23]

整合醫學」這个用語有兩種意思,一種用法是指基於科學的醫學能與不基於科學的醫學「一體化」的一種信念;另一用法僅指一些具有科學論證其療效的替代醫學治療與常規治療的相結合,在這種情況下,它是與「補充和替代醫學」相同[24]。「整體醫學」(或整體健康)是一種替代醫學實踐,聲稱治療的是「全人」,而不僅僅是疾病本身。

傳統醫學」和「民俗醫學」指的是各地文化社會在近代科学以前發展起來的實踐,「東方醫學」通常是指在近代科学以前發展的亞洲傳統醫學。「西方医学」指的是現代的實踐,通常是指醫學科學,而不是指西方的替代醫學(歐洲美洲)。「西方醫學」、「生物醫學」、「主流醫學」、「醫學科學」、「基於科學的醫學」、「循證醫學」、「常規醫學」、「標準醫學」、「正統醫學」、「對抗性醫學」、「佔主導地位的衛生系統」以及「醫學」,當與替代醫學對比時可互換使用並具有相同的含義。但可能在其他情況下有不同的含義,例如,在醫學科學有些實踐沒有被嚴格的科學測試支持,所以「醫學科學」不是與「基於科學的醫學」嚴格相同、當與其他較少用或更少推薦使用的生物醫學作對比時,「標準醫療服務」可指代「最佳實踐[n 11][1][91]

定義問題[编辑]

科學界[31][92]和生物醫學界[3] 中的傑出人士宣稱把傳統醫學從替代医學分開的定義是沒有意義的,及「常規醫學」、「替代醫學」、「補充醫學」、「整合医学」以及「整體醫學」這些術語並沒有意義,不能具體描述任何事物[3][31][92][93]。他們試圖批評這種虛假的定義,包括:「沒有常規醫學/替代醫學/互補醫學/綜合醫學/整體醫學這樣的事物,只有可行或不可行的醫學[3][31][92]。」;「根據定義,替代醫學要么沒有被證明其可行性,要么被證明不可行,你知道他們稱已經證明可行的替代醫學为什麼?醫學[94]。」;「不可能有兩種醫學 - 常規醫學和替代醫學,只有目前已被充分測試的醫學和沒被充分測試的醫學、可行的醫學,和可能可行或不可行的醫學。一旦療法已經過嚴格測試,不管療法在當初就被認為替代醫學與否也無關緊要。如果它被認为是安全和有效的,它就會被接受[3]。」、「替代醫學並不存在,只有經過科學證明及实體數據支持的循證醫學或科學證據不足並未經證實的醫學[93]。」

生物醫學以及補充和替代醫學團體中的一些人指出,「補充和替代醫學」無法準確定義,它所包括的理論和實踐多元化,而且「補充和替代醫學」和生物醫學之間的界限重疊,並且在變化[1][95]。「補充和替代醫學」這个用語不能使用簡單的定義來界定,因為它的衛生系統和實踐模糊,及其界限定義不清[10][96][n 12]。它們的歷史淵源、理論基礎、診斷技術治療實踐和它們與主流醫學的關係可能會有所不同[98]。一些替代療法,如中國的傳統醫學阿育吠陀,它們在古代東亞或南亞起源,並完全是替代醫學系統[99];其他替代療法,如順勢療法、脊骨神經醫學,它們在歐洲或美國起源並在十八至十九世紀間出現;一些替代療法,如冥想和祈禱,是基於身心的干預療法[100]。在一處地方被認為是替代的療法,在另一處地方可被認為是常規的療法[101]。因此,脊骨神經醫學在丹麥不被認為是替代療法,同樣脊骨神經醫學不再在美國視為替代療法[101]

不同類型的定義[编辑]

眾多替代醫學的定義的一個共通點是其定性为正規醫學以外[102]。例如由美國國立衛生研究院國家補充與替代醫學中心英语National Center for Complementary and Integrative Health所制定及被廣泛引用[103]的描述性定義。稱它为「一組多樣化的醫療衛生保健系統、实践和產品未被普遍認為是常規醫學的一部分[13]。」對於常規醫學的醫務人員而言,這並不一定意味著替代醫學或它的從業者將不再被視為另類[n 13]

一些定義從社會和政治邊緣化的角度來定義替代醫學[106]。這指的是替代療法缺乏獲得來自醫療機構和相關機構在研究經費、醫學文獻及納入標準醫學課程上的支持[106]

註釋[编辑]

  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."[1]
  2. ^ 2.0 2.1 "[A]lternative medicine refers to all treatments but that have not been proven effective using scientific methods."[2]
  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."[3]
  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."[4]
  5. ^ 5.0 5.1 "An alternative medical system is a set of practices based on a philosophy different from Western biomedicine."[5]
  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."[6]
  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."[19]
  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."[25]
  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."[27]
  10. ^ 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."[34]
  11. ^ 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";[89] the same source states that, "Standard medical care" is "[a]lso called best practice, standard of care, and standard therapy."[90]
  12. ^ 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."[97]
  13. ^ As David J. Hufford, Professor and Director at the Doctors Kienle Center for Humanistic Medicine at the Penn State College of Medicine,[104] 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."[105]

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