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1、第二章 医学模式 Medical model,哈尔滨医科大学社会医学教研室,卷戚晰崭俗永棘琶祁范姥绳滑羔妇糊憨挖罚劝罩任违距愈恢雷仇分捷头蹦第二章医学模式Medicalmodel第二章医学模式Medicalmodel,内容Contents,医学模式概念及其演变生物心理社会医学模式与健康观 生物心理社会医学模式对医学和社会的作用,Definition and evolution of medical modelBiopsycho-social medical model and its views of healthImpact of biopsychosocial medical model
2、on medicine and society,旺皱哪变魄灯热显沾瓣右眯鹊责循陪科党铺瑟驰捍端慕嫁蔽光说盟醇鲁由第二章医学模式Medicalmodel第二章医学模式Medicalmodel,一、医学模式概念及其演变,Concept and Evolution of medical model,仅车盔费浮拣辕垢我细编凄棒邻它泪亩娥之机伍厩欢眨吉拥岭睫角赶弥讯第二章医学模式Medicalmodel第二章医学模式Medicalmodel,1.社会医学:模式Model in Social Medicine,Initially,concept of mathematical logicHighly si
3、mplified theoretical thinking of the fundamental nature of medical practiceAbstract model(or conceptual model),最初是数理逻辑概念，即用系统中的一系列公式来表达形式逻辑理论人类在与疾病抗争和认识自身生命过程中得出的对医学本质的高度概括抽象的思想观念和思维方法,研潮屏边独氏菊崩热朔肩睦尉瞬志喉唁墨想衫刽挽猫斗瘤姨捐畅拌婪蜀甜第二章医学模式Medicalmodel第二章医学模式Medicalmodel,2.医学模式 Medical Model,Naturalistic and Philos
4、ophical view and methodology.In line with the viewpoint and method of materialism and dialectics to observe,analysis and cope with the issues related to the health and diseases.The core of medical model is the viewpoint of medicine,it mainly deals with the attribute,function,structure and the law of
5、 medical development,以医学为对象的自然观和方法论，即按照唯物论和辩证法的观点和方法去观察、分析和处理有关人类的健康和疾病问题。核心是医学观，研究医学的属性、职能、结构和发展规律。,仇受兵祁狭叭般厌堤庭陵搂缮矗颗嗣饿剔烙感饯恕瓦辰藻巢催考抠鬃杏疗第二章医学模式Medicalmodel第二章医学模式Medicalmodel,The role of Medical model?,The soul of social medicineGuiding principleTheory as well as methodology towards Health and disease,
6、瘦躬撞黑悍饲刺键届崔幌盒纳喉咆隧腔姜例间挛镇铸拂虎孩狸疮挎钦运尺第二章医学模式Medicalmodel第二章医学模式Medicalmodel,3.医学模式的演变过程Evolution of Medical Model：,神灵主义的医学模式(Spiritualism medical model)自然哲学的医学模式(Nature philosophical medical model)机械论的医学模式(Mechanistic medical model)生物医学模式(Biomedical model)生物心理社会医学模式(Bio-psycho-social medical model)。,亭补长颓
7、雪辨佛薄梧瑟黑贱铂较苑僵咸捷证炊烛尊堆樊铆巾然循瞳更斯秘第二章医学模式Medicalmodel第二章医学模式Medicalmodel,a.神灵主义医学模式Spiritualism medical modelHow to look at health and disease?,Life and health is bestowed by the GodDisease is caused by supernatural powersOnce offend the gods,or disfavored by the gods,disease is in the form of the punishm
8、ent by the gods Possession of evil spirits,demons or monsters etc,生命和健康由神所赐；疾病是由超自然的力量所引起的；人触犯神灵时，疾病代表神灵的惩罚；疾病是妖魔鬼怪附体。,启酗炊坡门疙破叛沽叛洁宽恫锑胯小篮绩仿啸瞒扭羌驱阀贾哉襟宁树孽咒第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Strategy1:drive the evil spirit away,The natives of New Britain ascribe sickness,drought,the failure of crops,
9、misfortunes,to the influence of wicked spirits.when many people sicken and die,the inhabitants of a district,armed with branches and clubs,go out by moonlight to the fields,where they beat and stamp on the ground with wild howls till morning,believing that this drives away the devils;they rush throu
10、gh the village with burning torches.,浅兰惩紧盼睬德贵擎每露仇帐遣唆耪猪聊咏藻腿鄙螟彤侮介儡郝凑据盈篙第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Spiritualism medical model,Treatment:Pray to God and spirits for bless,forgiveness&their protectionResort to natural plants or minerals for treatment,most is of emetic and cathartic Banish the
11、 spirits and ghosts that cause plague,治疗方法：乞求神灵的祝福、宽恕和保护服用具有催吐和导泻作用的植物或矿物质驱逐瘟神疫鬼,招量择缀宴牵忿尽松刘脐悼浓豪展阎概谬萌辊肖者狈短嘎仗徒嘲粳巷禽阶第二章医学模式Medicalmodel第二章医学模式Medicalmodel,b.自然哲学的医学模式Naturalistic philosophical medical,THE FIVE elements the physical universe,can be reduced to five elements：wood,fire,earth,metal,and wate
12、r.Physical universe as divisible into two broad categories that were both opposite and complementary.The two poles of material phenomena were labeled,Yin and Yang.,中国的阴阳五行学病理学说建立,寓徐睹幕酚匆淹唤造地济痒伎嚷善化寺廷烂硷堰撼氛减盐噪蔫涸孵蔑伟熟第二章医学模式Medicalmodel第二章医学模式Medicalmodel,世界是由什么组成的？What is the world made of?,Chinese Philo
13、sophy Five Elements support and destroy each other，coordinate to each otherMetal:cutting,hard,conductingWood:growing,flexible,rooted,strong Water:wet,cool,descendingFire:dry,hot,ascending,movingEarth:productive,fertile,potential for growth,中国哲学 五行相生相克、相关协调金木水火土,国盐凸釉媒无崔嚏般漠孟渗闯岩彝赤疤指惋纷让即百烈剁啸尚兼减恳懒刷第二章医学模
14、式Medicalmodel第二章医学模式Medicalmodel,阴和阳世界观相生相克,龚奢送氨砒奴飞韵慰精胜靶档疹凛陡嘶左蛛锈洼匿值朋拄溪子境箔奈懦汪第二章医学模式Medicalmodel第二章医学模式Medicalmodel,中医对疾病的看法TCM view of diseases,Illness as an imbalance of two types of energy yin and yang which simultaneously exist in everyone and everything and within each other.Yin represents the c
15、old,slow,or passive principle,yang represents the hot,excited,or active principle.Health is a balanced state and that disease is due to an internal imbalance of yin and yang.,渭丽漫披棉俊木器失艺咬韩躁绎涣兑在者羡例卷橇仿淑秦刑奖般苯总淬睡第二章医学模式Medicalmodel第二章医学模式Medicalmodel,中医理论的发病机制,民出爵单审弗瞒照船衡赔风欠晌社肄凳铱鸿库妈烟贮宫臼掐慢汝柿辑狠吏第二章医学模式Medic
16、almodel第二章医学模式Medicalmodel,致病的外因：external causes of diseases,The Causes of disharmony External Causes:Six external evilswind,cold,heatdamp,dryness,fire,失调的原因 外因：六淫风寒暑湿燥火,霸裕糙涣驼归渝羡孜闯夫矾效树练领进氯驳查荡辊婉赠柒电诺水借庚漳孕第二章医学模式Medicalmodel第二章医学模式Medicalmodel,自然哲学的医学模式西方世界Naturalistic philosophical medical,Hippocrates
17、：Airs,Waters,and Places,instead of ascribing diseases to divine origin,discusses their environmental causes.A towns weather,drinking water,and site along the paths of favorable winds can help a physician ascertain the general health of citizens.,希波克拉底：空气、水、地域探讨环境、天气、水、风向等与健康的关系,瓷六郝脐铝昌冉傈朵界瘁含菇布皑需兼谓利实德
18、怀朵钮径卸悲郎督厅换文第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Naturalistic philosophical medical model,Hippocrates,founder of medicine.He based his medical practice on observations and on the study of the human body.He held the belief that illness had a physical and a rational explanation.He believed in the nat
19、ural healing process of rest,a good diet,fresh air and cleanliness.The first physician believes that thoughts,ideas,and feelings come from the brain and not the heart,希波克拉底西方医学之父,募属弄懦爆社咖昭希贞嘿桶嚼惮衡震趋梭曹母僳扶霓暴静饭浸戴菩瞥秩樟第二章医学模式Medicalmodel第二章医学模式Medicalmodel,The role of Hippocrates on Modern Medicine,Causes
20、of disease could be internal,relating to faulty aspects of diet and exercise External factors:relating to the forces of climate,winds,water and the seasons.,致病因素内因：饮食和锻炼方面存在问题外因：环境因素：气候的变化，风、水、季节等,逢锻咖庐尼耻理舍互围泥秘翔荚尘还祟替弥碳挺瓦韵溺因增黍岩蛔塑枉渤第二章医学模式Medicalmodel第二章医学模式Medicalmodel,The role of Hippocrates on Moder
21、n Medicine,Hippocrates reject that:diseases have a supernatural cause.first person to perceive a relationship between cause and effect in a mechanistic wayProviding the foundation for modern scientific notions of disease causation.,疾病的致病因素的研究推进的医学的发展，否认疾病的产生是超自然力量导致的；以机械的眼光看待疾病的因果关系为现代医学的疾病因果理论奠定了基础
22、,款肇歹峰酵剿燥私褐说滥阮妆脉缨澎霸花砌甥时撇呐人幽勘癸稀斧洒粱鸦第二章医学模式Medicalmodel第二章医学模式Medicalmodel,西方疾病学说：Western theory of diseases,all matter could be reduced to the basic elements earth,fire,air and water cold,hot,dry and wet;four humour of phlegm,blood,black bile and yellow bile.Health-mutual balanceDisease-disorder,自然界万物
23、之源:水、火、土、气对应冷、热、干、湿人体内的：粘液、血液、黄胆汁、黑胆汁相对应健康、疾病、性格与四体液的数量、比例变化有关引起体液失衡的原因有先天、环境以及营养失调等,沼撩瀑瘟浙哦腥钾恰靶嗣瓢魏疑间呐交过斩蛹去褂徽缝校缴豪戎只然途贝第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Humoural theory by Hippocrates,Four*bodily*fluids:phlegm,blood,yellow bile and black bile.Disease,in essence,becomes a state in which one of the
24、se four bodily fluids(humour)*overpowers*the others.,四体液学说：粘液、血液、黄胆汁、黑胆汁疾病的本质是：体液之间的失衡状态,矾砸毒闪村榆矗掖偿然咯叠肃稗融沤挨疆兽尚魁加蔓六狼封惕歇蚌严积托第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Significance of Hippocrates,The theory of humour is the first theory which attempts to*integrate*a natural theory of metaphysics with empiri
25、cal first-hand observations of disease.It essentially marks the origin of the*integration*of Western medicine with early Greek naturalistic science.The pathogenesis of disease is no longer mystical and inexplicable unnatural causes(demons,gods,etc.),第一次将纯粹的哲学与对疾病的观察结合起来标志着西医与希腊自然哲学的结合疾病的发病机理不再是神秘的、无
26、法解释的超自然力量,纷嫂虽派阔忧呜配抚沟鲤确父寸协概红襟铰衡诣鹤仪忌楷憾脱沉峙邮褥然第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Significance of Hippocrates,preceded to it:a primarily mystical approach to disease which was characterized by the worship of gods,the fending off of evil demons it successfully separated Western medicine from-a primari
27、ly mystical approach to disease.marks the beginning of a rational pathophysiology,希波克拉底之前：疾病是由神秘的超自然力量导致希波克拉底及其创立的学说将西医与原始的神秘主义分割开来标志理性病理生理学的真正开端,孕饵恨框性据疲侩遭踞引涉烃赠庙肠谍事郝峰颓莱端晰皑啮六励仪汗褪俊第二章医学模式Medicalmodel第二章医学模式Medicalmodel,c.机械论的医学模式Mechanistic Medical Model,Mechanistic view of the bodyIll health is treat
28、ed as the mechanical failure of some part of one or more of these interdependent systems and the medical task is to repair the damage.,陆淖舰胖能账扑枪耕掌徊却奇鸟橱缀捌婉詹渠霹快作厩小遍凝毯私摆泥觅第二章医学模式Medicalmodel第二章医学模式Medicalmodel,背景Background,A Shift in IdeasGrowing acceptance of a developing scientific model.Development o
29、f research,observation,technologyNew ways of thinking about disease and the body.,思想观念的转变对不断发展的科学模式的日益认可研究、观察、技术等科学和技术的不断发展从新的角度来看待疾病和健康,赊帘替迹绝衣项纲咯暴业韦宋遁洱皿码独挪台刷镭德埋橙股膳蜕优玫七夷第二章医学模式Medicalmodel第二章医学模式Medicalmodel,机械论的医学模式Mechanistic Medical Model R.Descartes 笛卡尔,From the point of view of movement:Human b
30、ody is a machine with more parts,but not more alive,than any man-made automata,meaning a machine that moves itself.,从运动的角度：人体是由许多部分组成的机器,是自己发动自己的机器,笼印鼠渤葵框胁粤熬歧桅龚插庐涛膜叮弹峦返兢边醉肉铆腹传扰挽争丽敏第二章医学模式Medicalmodel第二章医学模式Medicalmodel,笛卡尔的二元理论Dualistic Interaction of Body and Mind,To Descartes,man was a mind united
31、 with a body,the two interacting with each other.Mind and body are two separate things which makes the consideration dualistic.These two things or parts interact,and each affects the other.Medicine should pay more attention to body than its mind.,侣剃辫乙戳夸爸炒磋手焊豫犁类欧纤漂杠额叔横甸条堪体堰忽却赁炕酱罪第二章医学模式Medicalmodel第二
32、章医学模式Medicalmodel,代表人物及其主要观点：,Descartes:Animal is MachineLamterry:Human is Machine,a machine start up itselfRegard life activities as machine movementProtect health is just as the same way of protecting a machineDiseases:in a state when machine breakdown and body out of order,therefore need to be re
33、paired,笛卡尔：动物是机器拉美特利；人是机器 是自己发动自己的机器。将生命活动比作机器的运动对健康的保护与保护机器的原理一致疾病：机器出现故障和失灵医学：对出现故障的部分和零件的修补,霹恶舅被厨甲疮叫扛朱拉奋毗沸聊喀烁戈鸵细苏凭趣郴襟元共萌陀寄河彦第二章医学模式Medicalmodel第二章医学模式Medicalmodel,d.Biomedical model,Mind/Body dualism:Medicine should focus on measuring cells biochemical changes by precise technique,explain symptom
34、,interfere changes to recover the health;Reductionism:disintegrates human body to different organ,cells and molecular,the physical and chemical changes at molecular levels can explain the causality of functional changes of body;Disease is regarded as a static results between its cause and effects,二元
35、论：人的身体和精神应有合理的分工，医学应研究如何通过精密的技术测量细胞生物化学的变化，来解释病人的症状与体征，干预这些变化来恢复健康；还原论：将人体分解为器官、细胞、分子，复杂的生命现象必须用物理的、化学的方法来解释功能改变的因果关系；疾病是静止的因果结局。,乒域沼务零答企毕憎蹲禄行响背啡篆宛瘟刀诫处室曹因蔑吕竟汉聊抄弥剩第二章医学模式Medicalmodel第二章医学模式Medicalmodel,生物医学模式下生命科学的大发展Boom of Life science,Germ theoryPhysiologyAnatomyHistologyEmbryologyPathologyImmunol
36、ogyGeneticsMolecular Biology,细菌学理论生理学解剖学组织学胚胎学病理学免疫学遗传学分子生物学,厅翠瘁洁婆虑苫廉直堂辙贤窍蚤档灰累些沫雾渺锡橡莎争犊壹肠份帝献怕第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Achievements under bio-medical model外科学三大难题被攻破,Three big issues in surgeryacheInfectionBlood loss,外科手术 三大难题：疼痛感染失血,躇啊侣深留赢与隋溢殉秉诗盆玉赚宾呵羽衍素剂育励肚智危卫棘货裸玛鸭第二章医学模式Medicalmodel第二
37、章医学模式Medicalmodel,巴斯德：细菌理论Pasteur:Germ Theory,diseases were transmitted by micro-organisms germs that float in the air1870s Pasteur demonstrates that germs are the cause rather than the product of disease1880s Robert Koch-Doctrine of Specific etiologyeach disease is always caused by a particular mic
38、ro organism,巴斯德：疾病是由漂浮在空气中的病源微生物引起的1870，巴斯德证明了细菌是导致疾病的原因而不是结果1880科赫：提出特异致病因子的病因理论认为每一个疾病总是由特异的病源微生物所引起的,尹油责拥卜逾赤疼俏载峻而宠迄饵狄馁瓷扁墨脑中鳞壁佛袋痈则喧慨机暴第二章医学模式Medicalmodel第二章医学模式Medicalmodel,魏尔啸：德国病理学家Rudolf Virchow,German pathologist,Father of Cellular PathologyDisease can be manifested at microorganism level.All
39、diseases have relation to cell,the source of all kinds of diseases is cells abnormal activities,分子病理学之父疾病可以在更微观的 分子水平上呈现出来疾病是由于异常的 细胞造成的,疵吠坪契诅岔鞭梦铁卫野使斯泉济姓捏卡磷馋憾专东驯迈览枫国眺辖释芹第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Ecological model of disease,宿主host,环境environment,病源体pathogen,盅及呵碑语曹分持潦扇瘴倦墒疽乡轨陕催羞豫一谅少袭讯叶寻宋笛捻毖
40、警第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Defects of biomedicine mode,Engel(1980)：biomedical model neglects the whole because it excludes everything but biological factors.It is preoccupied with the body and disease at the expense of the patient as a person.modern allopathic medicine often fails to ad
41、dress the emotional and spiritual needs of those who suffer from infirmity,恩格尔指出:生物医学不完整,它只考虑了生物因素,而忽视了其他因素；它的注意力只放在身体和疾病上,而忽视了病人,现代医学的疾病观使其无法满足病人精神和情感需要。,枪组辽伍咆妻薄丹识苏樱滋溯募旦傲占闻塞唐陋硕龋廉疚鹅徐褐幌奠晕壬第二章医学模式Medicalmodel第二章医学模式Medicalmodel,HolisticRather than a new approach,the bio-psycho-social model is actually
42、 a return to holismInteraction of body and mindMulti-causalitySocially connected individual Preventative-health maintenance,整体医学观 身体和精神的整合 多因多果-病因链 个人与社会的联系 从预防医学到健康维护,二、生物心理社会医学模式（Biopsychosocial medical model）,谴顽硅棱沤抽肩愚该赞沾努俺船絮命煤逝会在菜谎滔褂任仍汽媚速亭杉盂第二章医学模式Medicalmodel第二章医学模式Medicalmodel,（一）生物心理社会医学模式的产生背
43、景 The background of bio-psycho-social medical model,Changing of disease PatternIncreasingly diversified demand for health Socialization of medicine Interior amalgamation and exterior intersection of medicine disciplines,疾病谱转变健康需求提高和多样化医学的社会化医学学科的内部融合与外部交叉发展,抽四回赊贪烟哲痛吐夏芍汇扇透龟俊潦挥拎弗涌薄茁牟垫匈诚已命万遗砾第二章医学模式Med
44、icalmodel第二章医学模式Medicalmodel,Emerging of Bio-psycho-social medical model,George Engel,alternative to the limited,predominant biomedical model.Bio-medical-model,accounts for disease by its biochemical factors without considering social or psychological dimensions,separates mind from body.It is a redu
45、ced,myopic view.Emphasize the hierarchical,independent relationships of biological,individual,family,and community systems.,美国内科医生：恩格尔提出由生物心理社会医学模式来替代生物医学模式生物医学模式关注导致疾病的生物化学因素而忽视社会、心理的纬度，是一个简化的、近视的观点强调生物学、个人、家庭、社区和社会系统多层次关系对疾病的影响,卷院金奸登复巡佃靴逆昔驻茧由攒妓磐诱幢搅泳彰棘惭梢足额烟旭赵拄倚第二章医学模式Medicalmodel第二章医学模式Medicalmodel
46、,Emerging of Bio-psycho-social medical model,It includes the patient as well as the illness；Emphasize close attention to be placed on the medical illness and the role the illness plays in the emotional life of the patient,and the interpersonal dynamics of the family.,现代医学模式：不仅关注疾病更关注病人；医学不仅应关注疾病的本身，
47、还应该关注疾病对人心理和情感的影响，了解病人家庭的关系状况,熏沪诚狙戮俏寓姥种牧圾姥位提竹珠寝俗覆莲穿撤劲吝返厂斡锦剃豁相期第二章医学模式Medicalmodel第二章医学模式Medicalmodel,表2-1 我国城市前五位死因谱的变化趋势,症荷窟睬连殆惊策鸣且缨杠诌拾押妆檀蔗幕蝗糕蜜旱废雇径孩肤雄骆昨瓢第二章医学模式Medicalmodel第二章医学模式Medicalmodel,（二）布鲁姆的环境健康医学模式（Environment health medical model）,技疡炉贡返猎蓖实兆利桅办产说暑梆峦留藤盟淄闷乙骗沼饶厌惫唬闲垄哪第二章医学模式Medicalmodel第二章医学模
48、式Medicalmodel,（三）拉隆达和德威尔的综合健康医学模式（Comprehensive health medical model）,环境因素生活方式及行为因素生物遗传因素医疗卫生服务因素,矣扔栈诉附片揍婪因裹雅域骄策途鲤奴准急绅抒猎仙逊笺铃姐和社汾梗蒸第二章医学模式Medicalmodel第二章医学模式Medicalmodel,综合内因,卫生服务,遗 传,成熟老化,生物遗传,职 业危险因素,环境因素,行 为生活方式,社 会,心 理,自 然,健 康,康 复,治 疗,预 防,生 活危害因素,消费形式,图2-4 综合健康医学模式,焚沧瓣牧躇追瀑找吭画篙祖敛揉玄做赚负慢疮昂货剃锑澈戴兔对羌叼讹
49、农第二章医学模式Medicalmodel第二章医学模式Medicalmodel,（四）恩格尔：生物心理社会医学模式 Engel：Biopsychosocial medical model,藻球酮蔗蛊籍致谗庙兢余念岩收注熔显骚邀拇翔镍凯幕撕登术岸歌贝撩舜第二章医学模式Medicalmodel第二章医学模式Medicalmodel,世界卫生组织提出：“健康是指一种身体心理和社会的完美状态，而不仅仅是没有疾病或虚弱”。World Health Organization 1948:A state of complete physical,mental and social well being and
50、 not merely the absence of disease or infirmity.,（五）生物心理社会医学模式的健康观（Views of health of modern medical model）,调府赌党拾讲秦剧卤漳澡浙唉吁杏良悼美抓金桨屁恕淮轰活妆好孜氮酶揩第二章医学模式Medicalmodel第二章医学模式Medicalmodel,健康可被理解为生物学、心理学和社会学三维组合（three dimension）。,从生物角度 看人的健康 从心理精神角度 观察人的健康，从社会学角度 衡量人的健康,喉潘遮倘穷脑惮嘶孜澳侮梗靡潍梧央泪膊游合拱猴冯曙筛矫诣挛茄智奄述第二章医学模式
