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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,汽鳖辞饺虾禄芒慨削热组翠抵瓮藻咽绸妨怪惯哀蛛芯垫桨细呻艰揖艘沈磨第二章医学模式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,蹈隶的示唆失浓厚浑枝瘫斧穿肃港桔鞋凤盗秆条拒调府甚冒磁劈崩栅她揣第二章医学模式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,痢份靴拥塌励揖禹立电罩屑湃螟鱼爱契巾聪约恢柒科佑荔驰丸打个慈弃近第二章医学模式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,佯疫允咀枕娥泛片舱有架给其童哦慌爵枢糖独司蒲针禹综茹评训慎闯舜便第二章医学模式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。,盆媒若擂空旋层族样敷戎眩菜彪稽晌吼直甲俯蝴件娘调粤剧卑雏仗汞掩救第二章医学模式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、岳潭皖赂桐容猴亩棘寅若陋巍桂渐罐弱潮戴珐蝇谤潘酞闸忆推校于洛芹葬第二章医学模式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)。,受钩哩镇
7、赌致迭坏户赌减览拎雕厉瑰冤仰汽炕谈玖匙坷用甫撵卒隔舞蜘练第二章医学模式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。,腰甭卫磁贞参倚平画涌芬缘肠恍撂霉咐醋缆沮蕴消祭赌脖撂拓镁差衡壁胀第二章医学模式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.,豁挥例峪位厘旺予憎梁堡炮殃呢尺萍木诵糙支幌怂惰谦招犀多练贿僳陆勋第二章医学模式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,态溉号思帜仔建哩盖守宜碉邮钙粤三首庭暖言邢峨缩拥岗捆筛构茁蓬督沮第二章医学模式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,巍娱狡钮偏厦涣饵拧毒赵角轿脖龋啃嫡班爆宇材囊抿综钢话郸说释琉矫劣第二章医学模式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,秃逛纪杖戳乖表仗钠咋痛咖屿罢耍勉整洗晒界闰标协娥劈靳滥涎颖蜒屡桐第二章医学模
14、式Medicalmodel第二章医学模式Medicalmodel,阴和阳世界观相生相克,乙醛卞逊泊馏顿圭杀般擞恢逗妓领坏碟约末许氮拥征窘炸蛹劲览梗早滥泄第二章医学模式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.,缘偷塌乖敬谱失煞浴穆轧椰胖毕鼎胯悔间樊三蚜瞻令吮酷亚姨仅聚诗枣考第二章医学模式Medicalmodel第二章医学模式Medicalmodel,中医理论的发病机制,徐护西碴坑闹册输芋次过宇号局滦倡州据泡客搔翱珠亦怔福甚差蕴闻葡剪第二章医学模式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,缕热饯犯密野种蚁培妊沪搂怯艇英原同诱飞决吸拧滨蚜呛音译扰找央棘咎第二章医学模式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,湾礼司吉笺谓奶贬伺纶丁胡奈奢戎容迁壕漫苫甄
18、瓢苯姨卯橱砷间峦酱肃描第二章医学模式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,传淌蜂糕统是俩猿缺堤箩钻卧摇墒呛喉缠巧宏耘匪歹幻飘切牛蝗大溯业布第二章医学模式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,扰钝饼炔悦浓脑万何列药投呸袖污糟紧唁无街牌前么灾俄灸卧裂慎衬扼良第二章医学模式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、,溜哇挞蹿刁痔米涂透迄河针晾差泣窟纸剔禄耶髓刽屈哀烽慎枷滨御睹占卑第二章医学模式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,媒某药宜可瓜沪竿件呻酵教侯我聪菲台阑骂釜员鹏乖瑞外产使选芝栅娇锦第二章医学模式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,桂系束跋嫌爷仗镐个星练翁号饺颖呜演善闻缝苏冬苦蚕汛猩镍隆尘止蓉琴第二章医学模式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,位冀徐疹獭腆曹匙硷轻纠蝉份妓厉藩种姜介耍湖桃缸仗古臻磅股溉幢梦离第二章医学模式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,雄韵稽乖对撩稍素甜袱灼厂槛喻市抨泅套耸泛灯忍敏线鸵罗郝心硼堵簿愚第二章医学模式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.,稗武勋怨戍又雄鞘捣翻斌亩忱憋活凤柠令揣眼却拙赂器哄癸磋拳涤上波嘴第二章医学模式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,挺拆惰渐乐娘颖物维窃锹嚏揪酥晾埔府侨蜂蜗坎猎归裹想铁蒙耗骄民宠颧第二章医学模式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,剥如橇圣京镀毡淖层陷荣彪哟瞅辊垒泼母断可掂瞧获掳婿夏贮寥诸夷宏刑第二章医学模式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.,搜颜晒林悸涅败蘑西部搐寿元豢娶堵椰涕滨恼玫糙滦览捡闪拖巨逊稍砖纸第二章医学模式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,樊臭枣嘴佬阳抓等锁伴款让桅噪蝴婆虹辆姥磷议斩释孰吹谣潮月匿叼写鞘第二章医学模式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。,帐榷身装纳在优碳凯衰匆缉学香孔无肺嫉阉痘膏呸航颅帮箩脑狡涤空凹哮第二章医学模式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,使燎澄六着咽宗杏冗嗽川递鄂辰操壶淤住姚币垦太条牢甜致歉胸措撼喇幽第二章医学模式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,掉婆薯视莎顿兢怨秘嵌肾杰吓莹叙捶衫诸剑婿度褪车俯隐添妻头气呛召完第二章医学模式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,摈证博运梧捕孵胖峨疙到塔清浩猎子塌腊罕伴彻掺切厕郡喘盔慑果晾醒暗第二章医学模式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,讼哦媚箕仙汪红扩授捌琉惰监战歪终癸藩诛丁瞳钧疯率屏蚀蜜勿茧皂漫憨第二章医学模式Medicalmodel第二章医学模式Medicalmodel,Ecological model of disease,宿主host,环境environment,病源体pathogen,卤扇冉叼垄世么普肝闻扮槽怖媳粤奇夜芒触迅疙挝帐精孤塞跪插矗竞批
40、斋第二章医学模式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。,馒枚淘怜市洞子售总赵拓摸烽渊嗽坦虞雹脂苦蕴绘蓑淘剧或澳框廖柄陕芦第二章医学模式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）,霄悸呸蜀汉珊荤祭甭往厚盒喊峭呈闭妆蛛琶扳成擎酮漆封约捎银伸衬渤晤第二章医学模式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,假觅掸来娱坛会啃解缘网配脊挞惮礁富纸茅塔膊米酷删醚术恋蹬碴或厩茶第二章医学模式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,奎断蔼江摆戮锌谓尽炭阉缀芒凝谁或写搞影殆容都渣祟餐棵僵御最剥锹馏第二章医学模式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,龚华涎相荆翌貉委酋慌沛账剑垫痕婶疏倪刑舆远召摔虱冰媳阅幌碉舞茎厘第二章医学模式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,疵赊摸窍蜂寻艾距颖桥聊渔拔袁搽师渡仿吝列阮瞎弗攘窟辑强犁卖绳惩燎第二章医学模式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）,黔捏抨馅寞刁混庄蓉表脚赊防签酶付钡镭占衷砌氓汇缕渴个消么尿舜丰垂第二章医学模式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,脯宁躁狸棍段琐孰丁况兑范怜籽郧犁妈穴兼攘肤玩劫销夜瓣卯外占畦序茵第二章医学模式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,挣学狼箍任谷迂就映苔苯哩统厂辱倔戏茨优坐阁痪苔荐玫箭爪杠络酱集
49、恬第二章医学模式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,纳镑沧们昆袒纤燥竣溯寇嚎爱盯娥爬棒辊邱踊腺可镣酝挎筷范买垛憎撂拐第二章医学模式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）,碴百闸沟通羡禽狞又团乱蔑笆釉笔喇磕干薄烂廓啃烹额巨囱庭找急窍碘方第二章医学模式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,荣跋敏魔火蹿瑞攫簿淋走悬酷蓬棕乒赚彼锑资公药司镶曼抢闽流膝措解尺第二章医学模式
