藏医临床疗效评价的方法学思考(1)
[摘要]藏医临床疗效的评价，是藏医发展过程中面临的重要科学议题。本研究介绍了国内外藏医临床疗效评价的现状和问题;通过比较分析藏医和中医在临床疗效评价方面的异同，指出两者的差异应属于细节而非本质上的差异，故藏医可有选择性地借鉴中医临床研究的经验，并结合自身特色，构建藏医临床疗效评价的方法学体系;还探讨了藏医临床疗效评价面临的方法学挑战，包括尚未制定符合藏医自身特色的临床研究指导原则、藏医病证诊断标准等;最后提出了改进藏医临床疗效评价的若干建议，包括多种研究方法的综合应用、基于整体系统研究的思路评价藏医复杂干预的疗效、选取公认、客观的疗效评价结局指标等。
[关键词]藏医;疗效评价;临床研究;方法学思考
[收稿日期]2014-05-28
[基金项目]中国藏学研究中心重点课题
[通信作者]*罗辉，研究方向为循证医学与藏医药临床疗效评价，Tel：(010)64927080，E-mail：luohui09@hotmail.com
, 百拇医药
Study on methodology for evaluating clinical efficacy of traditional Tibetan medicine
LUO Hui*， ZHONG Ge-jia
(Institute for Traditional Tibetan Medicine， China Tibetology Research Center， Beijing 100101， China)
[Abstract]The evaluation on clinical efficacy of traditional Tibetan medicine (TTM) is an important scientific subject during the development of TTM. Firstly， the authors introduced the current situations and problems in evaluation on clinical efficacy of traditional Tibetan medicine both at home and abroad in this study. Secondly， they compared the similarities and differences between TTM and traditional Chinese medicine (TCM) in evaluation on clinical efficacy， define their differences in details but not in nature， and proposed that TTM could selectively learn TCM′s experiences in clinical research and build a specific methodology system for evaluation on clinical efficacy according to its own characteristics. Thirdly， they discussed the methodological challenges in evaluation on clinical efficacy of TTM， including the pending clinical research guidelines and disease diagnosis standards according to its own characteristics. Finally， they propound some suggestions for promoting the evaluation on clinical efficacy of TTM， including the comprehensive application of multiple research methods， overall research-based evaluation on efficacy of TTM complex intervention and selection of accepted and objective outcome indexes for efficacy evaluation.
, 百拇医药
[Key words]traditional Tibetan medicine; efficacy evaluation; clinical research; methodological study
doi：10.4268/cjcmm20150130
藏医学是中华民族传统医学的重要组成部分，数千年来，以其独特的疗效优势，在保障我国青藏高原地区人民的健康和生命中发挥了巨大的作用，并传播至国内其他地区、南亚、蒙古乃至欧洲等地。目前，藏医在西藏和其他藏区的医疗卫生体系中仍占有重要地位，在内地也成为许多患者选择的疗法之一。疗效是藏医生存和发展的基石。在当前医学模式改变、民众健康需求提高、循证医学理念的普及等背景下，评价和比较不同疗法的疗效和安全性，从而选择安全、有效的疗法，已成为全社会的共识。因此，如何科学、客观地评价藏医的疗效，已成为藏医发展过程中所面临的亟待解答的重大课题。本研究针对藏医临床疗效评价的现状、藏医与中医临床疗效评价的异同点、面临的方法学挑战等问题进行初步的探讨和思考。
1藏医临床疗效评价的现状
藏医具有独特而完善的理论体系，通过数千年的临床实践，对临床各科常见疾病的诊疗均积累了丰富的经验，特别是在青藏高原的农牧区，藏医以其独特的疗效和经济优势，受到农牧民群众的欢迎，至今仍是许多患者的首选疗法。在内地，对藏医感兴趣、接受藏医治疗的患者也日益增多。然而，由于长期以来缺乏疗效评价的临床数据收集和整理分析，使藏医的应用受到诸多限制[1]。, 百拇医药(罗辉 仲格嘉)
[关键词]藏医;疗效评价;临床研究;方法学思考
[收稿日期]2014-05-28
[基金项目]中国藏学研究中心重点课题
[通信作者]*罗辉，研究方向为循证医学与藏医药临床疗效评价，Tel：(010)64927080，E-mail：luohui09@hotmail.com
, 百拇医药
Study on methodology for evaluating clinical efficacy of traditional Tibetan medicine
LUO Hui*， ZHONG Ge-jia
(Institute for Traditional Tibetan Medicine， China Tibetology Research Center， Beijing 100101， China)
[Abstract]The evaluation on clinical efficacy of traditional Tibetan medicine (TTM) is an important scientific subject during the development of TTM. Firstly， the authors introduced the current situations and problems in evaluation on clinical efficacy of traditional Tibetan medicine both at home and abroad in this study. Secondly， they compared the similarities and differences between TTM and traditional Chinese medicine (TCM) in evaluation on clinical efficacy， define their differences in details but not in nature， and proposed that TTM could selectively learn TCM′s experiences in clinical research and build a specific methodology system for evaluation on clinical efficacy according to its own characteristics. Thirdly， they discussed the methodological challenges in evaluation on clinical efficacy of TTM， including the pending clinical research guidelines and disease diagnosis standards according to its own characteristics. Finally， they propound some suggestions for promoting the evaluation on clinical efficacy of TTM， including the comprehensive application of multiple research methods， overall research-based evaluation on efficacy of TTM complex intervention and selection of accepted and objective outcome indexes for efficacy evaluation.
, 百拇医药
[Key words]traditional Tibetan medicine; efficacy evaluation; clinical research; methodological study
doi：10.4268/cjcmm20150130
藏医学是中华民族传统医学的重要组成部分，数千年来，以其独特的疗效优势，在保障我国青藏高原地区人民的健康和生命中发挥了巨大的作用，并传播至国内其他地区、南亚、蒙古乃至欧洲等地。目前，藏医在西藏和其他藏区的医疗卫生体系中仍占有重要地位，在内地也成为许多患者选择的疗法之一。疗效是藏医生存和发展的基石。在当前医学模式改变、民众健康需求提高、循证医学理念的普及等背景下，评价和比较不同疗法的疗效和安全性，从而选择安全、有效的疗法，已成为全社会的共识。因此，如何科学、客观地评价藏医的疗效，已成为藏医发展过程中所面临的亟待解答的重大课题。本研究针对藏医临床疗效评价的现状、藏医与中医临床疗效评价的异同点、面临的方法学挑战等问题进行初步的探讨和思考。
1藏医临床疗效评价的现状
藏医具有独特而完善的理论体系，通过数千年的临床实践，对临床各科常见疾病的诊疗均积累了丰富的经验，特别是在青藏高原的农牧区，藏医以其独特的疗效和经济优势，受到农牧民群众的欢迎，至今仍是许多患者的首选疗法。在内地，对藏医感兴趣、接受藏医治疗的患者也日益增多。然而，由于长期以来缺乏疗效评价的临床数据收集和整理分析，使藏医的应用受到诸多限制[1]。, 百拇医药(罗辉 仲格嘉)