ComplementaryandAlternativeMedicine公共卫生学系课件.pptx

1、定義名詞與概念 Unorthodox Marginal Unconventional Unofficial Outside biomedicine Nonscientific Orthodox Mainstream Conventional Official Inside biomedicine ScientificFrom Alternative to Complementary to IntegrativeAlternative除此之外、其他的、非我族類除此之外、其他的、非我族類次要的、非正統的次要的、非正統的 、非正式的、非正式的Residual definitions are seld

2、om satisfactory (Wardwell, 1994:1061)Complementary補充的、輔助的補充的、輔助的定義What is not taught in medical schools or not covered by insurance (Eisenberg et al., 1993)Interventions neither taught widely in medical schools nor generally available in U.S. hospitals (Eisenberg et al., 1998) Every strategy of heal

3、ing outside mainstream medicine (Blecourt and Usborne, 1999)Use David M. Eisenberg (1993, 1998) 1990 1997nUse in previous year 33.8% 42.1%nProbability of visit CAM 36.3% 46.3%nDisclosure 39.8% 38.5%nEntire out-of-pocket payment 64.0% 58.3%nTotal visit(extrapolation, million) 47.3% 427 629nTotal CAM

4、professional exp (billion)( 45.2%) 21.2 Out-of-pocket ( all US hospitalization) 12.2nTotal out-of-pocket CAM expenditure (billion) 27.0 (=out-of-pocket for US physician service)Medical education in US AMA (1996-1997 survey) 46 school Wetzel et al. (1997-1998 survey) Elective/topics in required cours

5、es 75 school Total courses 123 Formats Lectures Practitioner lecture/demonstration Patients presentation Topics chiropractic, acupuncture, homeopathy, herbal therapy, mind-body techniques AMA (1999-2000 survey) 82 schoolResearch InstituteU.S. National Institutes of HealthOffice of Alternative Medici

6、ne (1992) $3 millionNational Center for Complementary and Alternative Medicine (1995) $50 millioncomplementary and alternative medicine (CAM) NCCAM CAM is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, o

7、ther than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting well-being. Boundaries within CAM and between the

8、CAM domain and the domain of the dominant system are not always sharp or fixed. (1995)Taxonomy of CAM - NCCAM1. Alternative medical systems homeopathy, naturopathy, Chinese medicine, Ayurveda2. Mind-body interventions meditation, prayer, mental healing, art/music/dance therapies3. Biologically based

9、 therapies herbs, organic foods, dietary supplements, natural substance4. Manipulative and body-based methods chiropractice, osteopathy5. Energy therapies Biofield: qi-gong, Reiki, therapeutic touch Bioelectromagnetic-based: electromagnetic fields/ current整合醫學整合醫學(Integrative medicine) Integrative m

10、edicine combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. (NCCAM) AyurvedaMetabolic body types: VataDoshas Pitta Kaphan Physical constitutionGrasping ones body type;taking appropriate measuresAyurveda (diseas

11、e & treatment)nHealth: a soundness and balance b/w body, mind, and soul, and an equilibrium b/w the doshasnHarmony disruption, when:nGenetic, congenital, internal/external trauma;nSeasonal/natural tendencies or habitsnMagnetic and electrical influences Ayurveda (treatments)n Dietn Exercisen Meditati

12、onn Herbsn Massagen Sunn BreathingHomeopathyHomeopathy (同類/順勢療法） nHemeo: similar; Pathos: suffering/diseasenPremise: Disruption of vital force/self-healing Health problems/diseasesnStimulating the bodys own healing responsesLike cures LikenGiving very small doses of substances (remedies) produce the

13、 same of similarsymptoms of illness in healthy people if given in larger dosesnIndividualized healing/Tailoring to each person: symptoms, life style, emotion, and mental states.NaturopathyNaturopathy (Naturopathic medicine)nSupporting health combating diseasesnPremise: Nature has a healing power Liv

14、ing organisms have the power to maintain/return to a state of balance and health, and to heal themselves Nature cure movementnBenedict Lust (German USA)nRestoring health through a return to naturenAdvocating therapies like: gentle exercise, herbal medications, wholesome dietary, and exposure to sun

15、and air.nRise and fall and rise Reaching its peak in the 1920s1930s (USA) Declining while drug (antibiotics) and other “technologies” developed Reemerging in the 1970s under holistic health movementChiropracticChiropractic(脊骨神經醫學）nCheir: hand; Praxis: actionnPremise:uThe body has a powerful self-hea

16、ling abilityuStructure (spine) and function of body are closely related healthnNormalizing the relationship b/w structure and functionChiropracticnDaniel David Palmer in 1895 in Davenport, IowanMisalignments of the spine can interfere with the flow of energy needed to support healthnNormalize the fu

17、nction of the nervous system, especially the spinal cordChiropractic (healing strategies) Combining the use of spinal adjustments with several other treatments and approaches such as:nHeat and icenElectrical stimulationnRestnRehabilitative exercisenCounseling about diet, weight loss, and other lifes

18、tyle factorsnDietary supplementsAromatherapyAromatherapynA unique branch of herbal medicinenUse of essential oils from plants to support and balance the mind, body, and spirit medicinal propertiesnThe misleading term of “aromatherapy” suggesting an exclusive role for the aroma in the healing process

19、Aromatherapy (essential oils)Cold-pressingSteam distillationVolatile, fragrant essence Flowers, leaves, Branches, rootsUsing energy from the sun and elements from the air, soil, and waterVery concentrated(220lbs lavender1 lb essential oil)Administering aromatherapynInhalation: diffuser/placing drops

20、 of oils near the bodynTopical/external treatment: applying to the surface of the body diluted formmassage, add oils in bathwater, lotions, or dressingsnInternal application: oral, rectal, vaginal interfaces Aromatherapy benefited conditions nBacterial and viral infectionsnSkin conditionsnMuscular d

21、isordersnArthritisAromatherapy in the homenDaily hygienenDigestive and stress-related discomfortnBruises and sports injuriesnMosquito and other insect bitesnBurnsnEnergynRelaxationnNauseaReikiReikinRei: Universal spirit; Ki: qi, life energynBelonging to energy medicinenImproving the flow and balance

22、 of energy in a beneficial wayEnergy medicine Using forces of two types:1. Observable, measurable forces (related to electromagnetic fields)2. Unobserved, unmeasured but believed to surround and penetrate the human bodyThe physical properties of biofields is waited to be studied為何興起為何興起New medical c

23、ultureHolistic health movement (1970s) End of medicine, a new paradigm, a new medicineThe rise or the re-mergence of CAM phenomenon: A belief in holism An emphasis on the integration of body, mind and spirit A view of health as a positive state on a continuum with illness A belief that the body is s

24、uffused with the flow of energy A belief in vitalism A distinctive view of the healing processFrom Biomedical to BioculturalDouble codingCharles Jencks: postmodernism in ArchitectureTwo different codes or style coexisting in a single composition.A pluralistic age for innovative hybrids or synergiesM

25、edical pluralismMultiplicityContext: lack of monopoly, dominance, and hegemony of biomedical systemSocial and cultural organization of healing practitioners, also a political phenomenonPluralistic health seeking台灣的狀況台灣的狀況 A surveyTitle:台灣民眾對另類與補充療法的使用台灣民眾對另類與補充療法的使用 Instrument: development and prete

26、stData collection: telephone interviewSample: 1517CAM的使用 (2002) 過去一年，您有沒有因為身體不舒服或生病而用以下的方法處理？(請逐一詢問請逐一詢問)a.中藥 1.有 2.無 99.不知是什麼/沒聽過 (若有則詢問費用) 草藥、生機飲食/有機飲食、健康食品、芳香精油、 腳底按摩/指壓按摩、推拿、整脊、刮痧、拔罐、針灸、 大腸水療、風水、童乩、收驚、道士儀式 除了剛才提到的以外，還有用過哪些非西醫的治療方法嗎？若有，是什麼? _（請訪員紀錄）（請訪員紀錄） Others: 電療（電療（n=13）、水及溫泉療法、）、水及溫泉療法、 身體活

27、動（身體活動（內、外丹功、太極、氣功、瑜珈等，內、外丹功、太極、氣功、瑜珈等，n=16） 冥想、靜坐、心靈訴求（冥想、靜坐、心靈訴求（念佛、祈求、看聖經，念佛、祈求、看聖經，n=7） 民間秘方食療、吃蒜頭、藥酒（民間秘方食療、吃蒜頭、藥酒（n=2） 算命、靈療。算命、靈療。範疇物質攝入及吸收物質攝入及吸收以外力操動身體部位、物理療法以外力操動身體部位、物理療法體能動作及身心靈的修持與調和體能動作及身心靈的修持與調和超自然調控超自然調控 整體使用型態整體使用型態 物質攝入及吸收44.124.319.518.615.70 05 510101515202025253030353540404545中藥

28、中藥健康食品健康食品生/有機生/有機草藥草藥芳香精油芳香精油以外力操動身體部位、物理療法24.824.221.117.116.47.70510152025推拿推拿刮痧刮痧按摩按摩針灸針灸拔罐拔罐整脊整脊體能動作及身心靈的修持與調和1.10.50 00.20.20.40.40.60.60.80.81 11.21.2體能動作體能動作身心靈修持身心靈修持超自然調控物質攝入及吸收物質攝入及吸收中藥、草藥、生機飲食、健康食品、特殊飲食、芳香療法0(35.8)、1(28.1)、2(20.2)、3+(16.0)1.23/1.91以外力操弄身體部位、以外力操弄身體部位、物理療法物理療法按摩、推拿、整脊、刮痧拔

29、罐、針灸、水療0(49.4)、1(20.6)、2(12.2)、3+(8.2)0.51/2.26體能動作及身體能動作及身心靈的修持與心靈的修持與調和調和太極、瑜珈、氣功祈求、念佛經、靜坐、讀聖經 (23)超自然調控超自然調控風水算命、童乩、收驚、道士儀式0(86.1)、1(10.1)、2+(3.8)0.14/1.38Domain (%) 24.5 31.6 21.1 9.0 8.9 2.6Modality (%) 0 24.5 1 18.4 2 15.9 3 12.1 4 8.7 5 7.2 6+ 13.2 2.56/3.39使用者的輪廓使用者的輪廓n社會人口特質: 無區隔性n健康狀況、無法治癒

30、根除的病痛最關鍵n認知因素： 對健康的關切 抗生物醫學信念 病因觀 科學信念 自覺健康狀況與CAM的使用0 00.50.51 11.51.52 22.52.53 33.53.54 4樣式樣式範疇範疇非常好非常好好好普通普通不/非常不好不/非常不好平平均均值值過去一年有無看病看不好之經驗及CAM的使用0 00.50.51 11.51.52 22.52.53 33.53.54 4樣式樣式範疇範疇無無有有平平均均值值自覺健康狀況及對超自然調控CAM之使用0 02 24 46 68 8101012121414收驚收驚其他其他非常好非常好好好普通普通不/非常不好不/非常不好過去一年有無看病看不好之經驗及

31、對超自然調控CAM的使用0 02 24 46 68 81010121214141616收驚收驚其他其他無無有有平時與人談論健康醫療話題與CAM的使用0 00.50.51 11.51.52 22.52.53 33.53.5樣式樣式範疇範疇經常如此經常如此有時如此有時如此很少如此很少如此從不如此從不如此平平均均值值收聽看醫藥衛生報導康醫療話題與CAM的使用0 00.50.51 11.51.52 22.52.53 33.53.5樣式樣式範疇範疇經常如此經常如此有時如此有時如此很少如此很少如此從不如此從不如此各教學醫院傳統醫學中心各教學醫院傳統醫學中心醫院部門名稱備註台北榮總傳統醫學研究中心設有內科、

32、針灸科、三伏貼門診台中榮總中醫科設有內科、婦科、兒科、針灸科、傷科高雄榮總傳統醫學中心網站尚未有相關資料林口長庚中醫醫院設有內科、婦兒科、針灸科、骨傷科、養生健康中心高雄長庚中醫部設有內科、傷科、針灸科高醫中醫部設有內科、婦兒科、傷科、針灸科中國醫藥大學附設醫院中西醫合作醫療中心 / 中西醫整合科設有內科、婦兒科、傷科、針灸科、中西醫整合科中山醫學大學附設醫院中西醫整合醫療科設有內婦兒科、針傷科、特別門診北醫傳統醫學科設有內科、婦科、兒科、傷科、針灸、三伏貼門診三總中醫部設有內科、婦科、兒科、傷科、針灸科萬芳醫院中醫科內科、婦科、針傷科亞東醫院傳統醫學科設有內科、婦科、兒科奇美醫院中醫部設有內

33、婦兒科、針傷科、特別門診花蓮慈濟醫院中醫科設有內科、婦兒科、針灸科、骨傷科彰化基督教醫院中醫部設有內科、婦科、兒科、骨傷科、針灸科、皮膚科對西醫的信念與適應性的使用n西醫通常治標不治本n您曾經因為害怕西藥的副作用太大而儘量避免看西醫嗎？n請問你會不會先到西醫那邊去診斷疾病(如驗血、照X光)，然後再用其他方式治療？ n您覺得人類所有的病當中，西醫有辦法治療的佔幾成？n那麼如果得到您剛說的(認為西醫治不好的病），您還會去看西醫嗎？ 1.最好不要 2.還是要，為什麼？ 因為也沒更好的辦法了 但可以用別的方法補充 多少可以舒緩或暫時控制病情 西醫通常治標不治本 %同意 32.6部分同意 29.7不同意

34、 27.8不知道/無意見 9.9西醫可治療的人類疾病 %絕大多數 14.6約七八成 34.7一半左右 19.4只有三四成 1.9相當有限 2.2不知道 27.3害怕西藥副作用而儘量避免看西醫 %一向如此 15.0有時如此 19.8很少如此 60.0不一定/不知道 5.2西醫診斷、其他方式治療西醫診斷、其他方式治療 %曾經如此 48.5從不曾如此 51.4拒答/不知道 0.1如果得到你所提到西醫比較治不好的病，還會看西醫？如果得到你所提到西醫比較治不好的病，還會看西醫？(n=1343) %最好不要 21.3還是要，因為也沒有其他辦法了 21.2還是要，但可以用別的方法補充 23.8還是要，多少可

35、舒緩症狀控制病情 17.6不知道 16.2對西醫的適應性用法 (adaptive use) 病因觀對下列敘述的同意程度體質不同，生的病也不同體質不同，生的病也不同無形的東西作怪會使人生病無形的東西作怪會使人生病 住的地方風水不好會使人生病住的地方風水不好會使人生病 遭人詛咒或作巫術會讓人生病遭人詛咒或作巫術會讓人生病 有些病是命中注定的劫數或厄運有些病是命中注定的劫數或厄運人的身上有穴道人的身上有穴道 心理長期鬱悶會使人生病心理長期鬱悶會使人生病Other issuesnAdaptation/professionalization of CAM practitionersnInteractions of CAM & mainstream medicinenRegulation of CAM practices: safety & qualityThe End