負(fù)責(zé)任的中醫(yī)行醫(yī)范圍

1、Scope of Responsible Practice for TCM負(fù)責(zé)任的中醫(yī)行醫(yī)范圍 It is essential that practitioners maintain and actively promote the integrity of Chinese medicine and be scrupulous in evaluating any diagnostic or therapeutic approach which is not an authentic part of TCM that might be incorporated into a TCM practi

2、ce.中醫(yī)執(zhí)業(yè)者應(yīng)維護(hù)并積極促進(jìn)中醫(yī)藥的完整性，并對(duì)任何不是真正意義上屬于中醫(yī)但有可能會(huì)包含在中醫(yī)實(shí)踐中的診斷和治療方法進(jìn)行嚴(yán)謹(jǐn)?shù)脑u(píng)價(jià)。Many practitioners in the West have quickly added to their TCM practice both diagnostic and therapeutic methods that have these characteristics: they have no basis in TCM; they have no support in modern medicine (the accepted medica

3、l system in the Western culture); and they can taint the field of TCM for all practitioners. 許多西方從醫(yī)人員很容易把一些診斷和治療方法添加到他們的中醫(yī)學(xué)實(shí)踐中去，這些診斷和治療方法具有如下特點(diǎn)：它們沒(méi)有中醫(yī)理論基礎(chǔ)，沒(méi)有現(xiàn)代醫(yī)學(xué)（即西方文化中接受的醫(yī)學(xué)體系）支撐，它們可能會(huì)給所有中醫(yī)執(zhí)業(yè)者所從事的傳統(tǒng)中醫(yī)帶來(lái)不良影響。One of the primary attractions of TCM is that it has a long history of use, that it has been

4、and continues to be extensively used in its country of origin, and that its component parts are unified by a relatively consistent dogma.傳統(tǒng)中醫(yī)的一大魅力在于它具有悠久的應(yīng)用歷史，無(wú)論是過(guò)去還是現(xiàn)在都在其發(fā)源地國(guó)家廣泛應(yīng)用，同時(shí)其組成部分在相對(duì)一致的理念下被整合在一起。Patients going to practitioners of Chinese medicine have a reasonable expectation of being provi

5、ded authentic TCM services, reflecting the best and safest practices from China (or, under the heading Oriental medicine, from Japan, Korea, and other countries that adopted Chinese medical concepts and practices).到中醫(yī)師處就醫(yī)的患者自然期望能夠得到純正的、體現(xiàn)中國(guó)（或者來(lái)自日本、韓國(guó)等其他國(guó)家采納中醫(yī)學(xué)理論和實(shí)踐的東方醫(yī)學(xué)）最好的、最安全的中醫(yī)診療服務(wù)。Chinese medici

6、ne is recognized as being a system that, like other health care systems, is liable to be adversely affected by deception, quackery, practice by untrained people, and similar problems whereby patients might be exploited by practitioners either willfully or without realizing it (even with best of inte

7、ntions).中醫(yī)被認(rèn)為是一種體系，和別的醫(yī)療體系一樣，很容易因?yàn)橐恍](méi)有受過(guò)培訓(xùn)的人員的欺詐、平庸醫(yī)術(shù)和行醫(yī)行為以及類似的問(wèn)題而受到不利影響，患者可能會(huì)被行醫(yī)者有意或無(wú)意地利用（即使出于行醫(yī)者最好的意圖）。Traditional Chinese medicine literature refers to many instances where these problems arose in China. Patients going to practitioners who are licensed by their respective State governments have a

8、 reasonable expectation that such fraudulent and non-authentic or amateur practices have been weeded out via the required educational process, the testing and licensing processes, and monitoring of practitioners once they have set up their medical business.傳統(tǒng)中醫(yī)文獻(xiàn)提到在中國(guó)出現(xiàn)過(guò)很多這類問(wèn)題。患者找政府認(rèn)證批準(zhǔn)的醫(yī)生看病都懷著合理的期望

9、，認(rèn)為經(jīng)過(guò)正規(guī)教育、考試和認(rèn)證以及對(duì)行醫(yī)者開設(shè)醫(yī)療業(yè)務(wù)的監(jiān)管，那些騙人的、非正統(tǒng)或者業(yè)余的行醫(yī)行為已經(jīng)被消除。However, there are defects in the current system that allow practitioners to ignore their scope of practice and incorporate techniques not consistent with authentic TCM and not consistent with the high standards of education and monitoring that

10、are expected.然而，現(xiàn)行的體系也有缺陷，使得中醫(yī)師們無(wú)視他們的行醫(yī)范圍，運(yùn)用那些與正統(tǒng)中醫(yī)以及與教育和監(jiān)管高標(biāo)準(zhǔn)不相符合的技術(shù)。Patients can reasonably expect that practitioners of TCM have undergone rigorous, prolonged training and appropriate internship in order to understand their field of expertise and carry out its techniques with adequate knowledge a

11、nd skill.理所當(dāng)然，患者期望中醫(yī)執(zhí)業(yè)人員經(jīng)過(guò)長(zhǎng)期嚴(yán)格的培訓(xùn)和適當(dāng)?shù)膶?shí)習(xí)來(lái)理解他們的專業(yè)知識(shí)，并用足夠的知識(shí)和技能進(jìn)行醫(yī)療實(shí)踐。Practitioners usually graduate from accredited schools, work (while being students) in professionally supervised clinics, and meet requirements for competence and understanding that are to be maintained and expanded through approved

12、continuing education, as established by state and national organizations.理所當(dāng)然，患者期望中醫(yī)執(zhí)業(yè)人員經(jīng)過(guò)長(zhǎng)期嚴(yán)格的培訓(xùn)和適當(dāng)?shù)膶?shí)習(xí)來(lái)理解他們的專業(yè)知識(shí)，并用足夠的知識(shí)和技能進(jìn)行醫(yī)療實(shí)踐。中醫(yī)執(zhí)業(yè)人員通常畢業(yè)于經(jīng)過(guò)認(rèn)證的學(xué)校，（在學(xué)生時(shí)期）曾在有專業(yè)指導(dǎo)人員的診所工作，達(dá)到能力和知識(shí)的要求，通過(guò)州或者國(guó)家機(jī)構(gòu)認(rèn)可的繼續(xù)教育保持并拓展這些能力和知識(shí)。Unfortunately, when adding other techniques to the practice of TCM, a practitioner might

13、 receive little training and the training might be provided by a person who would not meet qualifications consistent with accreditation of schools; the techniques may be ones that are not acceptable within the approved programs or in accordance with their standards, or the board responsible for moni

14、toring and approving such courses may fail to do its important duty of careful oversight.遺憾的是，當(dāng)中醫(yī)醫(yī)療中加入其他醫(yī)療技術(shù)時(shí)，中醫(yī)師可能受到的相關(guān)培訓(xùn)很少，并且這種培訓(xùn)經(jīng)常由達(dá)不到學(xué)校資格認(rèn)證的人員提供。而且，這些醫(yī)療技術(shù)很可能無(wú)法在獲批項(xiàng)目中應(yīng)用，或者是不符合技術(shù)自身的標(biāo)準(zhǔn)，或者負(fù)責(zé)監(jiān)管和批準(zhǔn)這些（培訓(xùn)）課程的委員會(huì)沒(méi)有起到審慎監(jiān)管的重要責(zé)任。Practitioners and their patients will not have a means for evaluating the train

15、ing that is received nor the level of competence gained in use of these methods.醫(yī)生和患者無(wú)法評(píng)價(jià)他們所受的培訓(xùn)，也無(wú)法評(píng)估他們使用這些方法所獲得的能力水平。TCM is regarded, by most practitioners and educators in the field, as a system of great depth, one which requires years of effort to master, far beyond the basics learned in a colle

16、ge program.中醫(yī)在大多數(shù)中醫(yī)執(zhí)業(yè)者以及教育人士眼中是一種很高深的體系，需要長(zhǎng)年累月的努力才能夠掌握，遠(yuǎn)遠(yuǎn)超出大學(xué)課程中學(xué)到的基本知識(shí)。By adopting non-TCM approaches into the clinical work, the practitioner may be diverted from further investigation of his/her field of expertise and licensing, particularly if the adopted methods are proclaimed (usually without

17、proof) to resolve difficulties of practice that would otherwise require much study and effort.將非中醫(yī)方法運(yùn)用到臨床工作可能會(huì)使執(zhí)業(yè)者無(wú)法專注并深入研究其領(lǐng)域的專業(yè)知識(shí)和執(zhí)業(yè)要求，尤其是這些方法被宣稱能解決中醫(yī)執(zhí)業(yè)中遇到的困難（一般無(wú)任何證據(jù)），而解決這些困難本來(lái)需要很多研究工作和精力。The problem is compounded when practitioners adopt non-TCM methods soon after completing their basic training

18、, before getting a depth of knowledge and experience from working with TCM; because of limited experience, they may not be able to distinguish between authentic TCM and other methods that are popular fads. 如果醫(yī)生們?cè)诮邮芡昊居?xùn)練后不久、還沒(méi)有從中醫(yī)實(shí)踐中深入了解體會(huì)中醫(yī)學(xué)的情況下就開始采用非傳統(tǒng)中醫(yī)的方法，會(huì)使問(wèn)題變得更加復(fù)雜。由于缺乏經(jīng)驗(yàn)，他們可能無(wú)法區(qū)分正統(tǒng)中醫(yī)學(xué)以及其他流行一時(shí)的治

19、療方法。That these basic issues are not new and not unique to the Western situation can be illustrated by quoting from Qing Dynasty authors. Huai Yuan wrote a warning to physicians of his day, in a book dating from 1808:這些基本問(wèn)題不是最近才出現(xiàn)，也不僅僅發(fā)生在西方，這可以從清朝作者懷遠(yuǎn)的引文中看出，他早在1808年在一本書中就警示同時(shí)代的醫(yī)生：In medical practice

20、one cannot act at ones own discretion. Patients entrust physicians with the decision over their life and their death. the physician searches for the causes and considers the consequences. He knows the normal and understands the changes. 醫(yī)生行醫(yī)切不可隨心武斷?；颊邔⒆约旱纳澜唤o醫(yī)生。醫(yī)生要檢查病因，考慮后果；要了解疾病的常態(tài)，知曉病情變化。A physici

21、an plans in detail and thinks comprehensively. He observes a disease and takes precautions against it to avoid a second. He is glad over a success and yet he is aware that one cannot repose on this醫(yī)生要制定詳細(xì)方案，要全面思考。要仔細(xì)觀察疾病，及時(shí)采取預(yù)防措施，防止病情復(fù)發(fā)。醫(yī)生因成功而喜悅，但也要意識(shí)到不可沉浸于此。Those, however, who surrender to fashiona

22、ble trends do not carry out their practice conscientiously. They place themselves in the greatest light and make use of the need of others in order to appropriate their material goods to themselves.然而，那些隨波逐流的醫(yī)生并未用心執(zhí)業(yè)，他們把自己放在高高在上的位置，利用他人的需要為自己謀取物質(zhì)利益。A physician has to love and respect himself; only t

23、hen will he, when he faces a grave disease, possess enough trust in himself. 醫(yī)生要自尊自愛，唯有如此，在診治重癥疾病時(shí)他才會(huì)足夠自信。I have studied at great length and in any diagnosis of a disease, I proceed with exactitude and conscientiousness; how could I carelessly acquit myself of that which others have entrusted to me

24、and which I have promised to them? .我曾經(jīng)努力鉆研，在診治任何患者時(shí)，我都認(rèn)真對(duì)待，不差分毫。患者對(duì)我的信任以及我對(duì)患者的承諾，我怎么能隨隨便便就推卸掉？Every patient has to consider the practicing physician a trustworthy person. A physician may examine the respectable methods without any further consideration. Yet, if he meets with the disreputable, he is

25、 first to assure himself of all the details related to it before making a decision.每個(gè)患者唯有把醫(yī)生當(dāng)作可信任之人。醫(yī)生可能會(huì)沒(méi)有經(jīng)過(guò)深思熟慮就采用行之有效的診治方法，但如果診治方法毫無(wú)效果，那么首先要確保所有相關(guān)細(xì)節(jié)都沒(méi)有差錯(cuò)，方可再行決斷。Xu Dachun, (writing 50 years earlier, in 1757), also warned physicians about the ease of deceiving patients with wrong ideas: The fact i

26、s that patients are people who do not know anything about medicine.徐大椿（于1757年，比懷遠(yuǎn)早50年）也寫了一篇文章警示醫(yī)生不要輕易用錯(cuò)誤的想法蒙騙患者：事實(shí)就是這樣：患者們完全不了解任何醫(yī)藥知識(shí)。 When the patients meet someone who knows a little about medical principles, and who offers clear-cut discourse and discussion, they will believe what they hear, espe

27、cially if he displays extraordinary concern and if emotions and face are involved. 當(dāng)患者們遇到某個(gè)懂點(diǎn)醫(yī)理的人，而此人還能頭頭是道地給他們講解、分析，尤其當(dāng)此人關(guān)懷備至、真情外露、表情真摯時(shí)，他們就會(huì)信其所聞。 Who knows that this talk is based on superficial reading and stands for nothing but gossip? Before the people offering these things have considered what

28、 will happen to the patients following their advice, the patients will have already followed them. 誰(shuí)會(huì)知道這些言辭只不過(guò)是基于粗淺的閱讀，除了市井閑言別無(wú)它用？在這些熱心之人還沒(méi)考慮患者在接受他們建議后會(huì)發(fā)生什么時(shí)，患者可能已經(jīng)對(duì)他們言聽計(jì)從了。 As a result, they recklessly treat peoples illnesses and if these illnesses heal, they consider this their own achievement. If

29、 the patient dies, they have done no wrong. They cling only more strongly to their one-sided views. 結(jié)果他們給患者胡亂治病。一旦病愈他們便將功勞歸于自己；萬(wàn)一患者死了，他們也沒(méi)做錯(cuò)什么。他們只會(huì)更加堅(jiān)持那種片面的想法， they go on and write books and establish doctrines of their own, and thusly bequeath harm even to later generations. There are so many such

30、peopleone cannot count them.他們繼續(xù)行醫(yī)，并且著書立說(shuō)，將這些危害遺留給后世子孫。如此之人實(shí)在太多，數(shù)不勝數(shù)。Although Xu mentions the extreme case of a person dying, which is usually not the situation in modern times, he gives a good analysis; it is easy for a person to claim credit for any improvements that a patient has, and to disregar

31、d failures:雖然徐大椿提到的患者致死的極端例子現(xiàn)代社會(huì)一般不會(huì)出現(xiàn)，但他分析合理。醫(yī)生很容易將患者病情好轉(zhuǎn)歸功于自己，但卻無(wú)視自己的失敗。 in the modern situation, a patient doesnt die but simply decides not to come back for another treatment; the practitioner doesnt see a failure because of keeping awareness only of those who come back again and again. 現(xiàn)在的情況是患者

32、不會(huì)死，只是（治不好就）不會(huì)再來(lái)看病。醫(yī)生看不到失敗，因?yàn)樗麄冎蛔⒁獾侥切﹣?lái)了又來(lái)的患者。Huai, Xu, and other Chinese commentators were aware that many practitioners of TCM could easily be distracted from their medicine by promulgators of disreputable techniques and from hearing presentations by charismatic speakers. 懷遠(yuǎn)、徐大椿以及其他中國(guó)評(píng)論家們都知道，很多中醫(yī)執(zhí)業(yè)

33、者在看到了那些效果不好的醫(yī)療技術(shù)或是聽了一些有魅力的演講者的演說(shuō)之后，很容易不再專注于醫(yī)學(xué) 。They worried about people doing superficial investigations and introducing methods that were based on gossip and emotion-based claims. The same can and does happen in the modern world. 他們擔(dān)心醫(yī)生們不做深入調(diào)查，把一些基于閑言雜語(yǔ)、情緒化主張的方法運(yùn)用到中醫(yī)。這種情況在現(xiàn)代世界會(huì)發(fā)生，也已經(jīng)發(fā)生過(guò)。 Practitio

34、ners of TCM in the West are particularly susceptible because they are working within a culture that is not inherently supportive of their efforts, where the medicine they are licensed to practice is already considered an alternative to what is widely accepted. 西方的中醫(yī)執(zhí)業(yè)者特別容易受到影響，因?yàn)樗麄兯幍奈幕h(huán)境并不支持他們的工作，在這里他們被批準(zhǔn)從事的是廣泛開展的西醫(yī)學(xué)之外的替代醫(yī)療。 As a result, the ethical barrier to invasive, superficial, and distracting ideas, a valuable barrier that should exist, is sometimes left too porous or removed altogether. 因此，建立能夠阻止西方文化進(jìn)攻、防止中醫(yī)流于表面化