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090321 千葉漢方連続講座

090321 千葉漢方連続講座

●漢方を活用するのが日本版家庭医である
 慶応義塾大学漢方医学センター 准教授 渡辺賢治先生

世界はICD-11(2015改定)
それに向けて、代替医療の情報化が進んでいる
(「日本はガラパゴス」)

WHO ヨーロッパのみが世界
 アジアとアフリカは無視されている
→東アジア伝統医学はアジアが自己主張!
 (他、アーユルヴェーダ・ホメオパチーが入った)

NIH、FDAはwhole medical systemsとしている
日本だけが、漢方は低いものを見ている


コード化を通じて、すりあわせを5年くらいやってきた
「証」がわかりにくくて、ふつうのひとは引いちゃう

中国の証は、1625
韓国の証は、2300
…再現性はまったくない

系が複雑であるほど、情報化社会は負けるに決まっている

日本の漢方専門医は1500人程度
一般医師はシンプルに!
日本は40程度の証

日本からのシンプルな提案
・虚実
・寒熱
・六病位(急性疾患なら)
・気血水
・腹診

…陰陽は、ハチコウベンショウからは上下がある

(質問)舌は? 脈は?

今、家庭医療で議論
毎日漢方を勉強しても勉強してもしょうがない
週に一回、漢方の先生のところにいって学んで、実地で使う。3ヶ月程度

慶応には海外からしょっちゅう学生がきている
1ヶ月あれば言葉の壁を越えても理解できる

Common diseaseで漢方がfirst choiceはけっこうある

日本の社会はどうやって情報化を生き残るか


25日夜21時
土屋班のまとめ
家庭医総合医は3〜5割

漢方の壁
・個別化
・訴えを重んじる
  数字だけでは無理。訴えでジャッジする
  西洋医学も、測れる血圧などはevidenceあるけれど、そうでないものは…
  患者中心医療
 →タッチパネルで解析


なぜ情報化できなかったか
昔はひとつのスパコンが必要だったが、今は分散できるようになった


●漢方医学を知り、地域医療を経験した者からの提言
 千葉大学 並木隆雄先生

「住民の望む医療」「医者が考える医療」のずれ

西洋医学 ばらばらにしていくので全体が見えにくくなる
漢方医学 まとめていこうするので対立が見えにくくなる

→ 西洋の総合診療科 …診断科になっているところもある
  漢方での救急・急性期が苦手

欧米と日本の漢方の違い
<<保険医療>>
米「普通の医学部で教えない、普通の病院では扱わない…」

・地域住民の願い
専門だけでなく全般をみれる医師
 〜癌を見落としてほしくない
体の相談にのってくれる先生
 〜家族背景を推察でき食事療法にも精通している
・簡単な病気なら、専門外でもファーストエイドができる
・(当然)西洋医学ができる先生

…自分たちで使い分けている

健康 サプリメント
未病 漢方薬、一部製要約
病気 西洋薬 漢方薬


日本漢方は民族差を考慮している
 例 リウマチもパターンが違う
   日本人は水毒が強い
来日直後の中国人には効かないことがある

・アドヒアランス
粉薬は入れ歯のひとには好まれない

●WS 総合医家庭医の漢方到達目標

「逃げない漢方」

急性期は脈を診る


・上部消化管症状
PPI
大腸炎が5%ある!

pHモニターなどしていない。除外診断

家庭医 …検査ができないときにぽっとうかぶ3つ

サンオウシャシントウ

便秘
ダイオウを使うのがFirst choise
 使わないのは専門医レベル

実 シャす ダイオウを使う
虚 長の動きをよくしてあげる
 そこに寒熱を考える

大建中湯 を要求するか?


日本の患者
便秘 →売薬で管理している
下痢 →医者にかかる

ダイオウで腹痛や、下痢がでるひとを、ダイオウ出す前に決める

大建中湯は時間がかかる 機能改善剤
〜効いた感触が少ない
押してだめなら…と大建中湯を出すのはいい
 腹部膨満があるなら、機能改善だから…と使える


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