The demarcation problem aims to articulate the boundary between science and pseudoscience. Solutions to the problem have been notably raised by the logical positivists (verificationism), Karl Popper (falsificationism), and Imre Lakatos (methodology of research programmes). Due, largely, to the conclusions drawn by Larry Laudan, in a pivotal 1981 paper which dismissed the problem of demarcation as a “pseudo-problem”, the issue was brushed aside for years. Recently, however, there has been a revival of attempts to reexamine the demarcation problem and synthesize new solutions. My aim is to survey two of the contemporary attempts and to assess these approaches over and against the broader historical trajectory of the demarcation problem. These are the efforts of Nicholas Maxwell (aim-oriented empiricism), and Paul Hoyningen-Huene (systematicity). I suggest that the main virtue of the new attempts is that they promote a self-reflexive character within the sciences. A modern demarcation criterion should be sensitive towards the dynamic character of the sciences. Using, as an example, a case study of Traditional Chinese Medicine, I also suggest that the potential for conflict between demarcation conclusions and the empirical success of a pseudoscientific discipline is problematic. I question whether it is sensible to reject, as pseudoscientific, a discipline which seems to display empirical success in cases where the rival paradigm, contemporary western medicine, is not successful. Ultimately, I argue that there are both good theoretical and good pragmatic grounds to support further investigation into a demarcation criterion and that Laudan’s dismissal of the problem was premature. / Graduate / 0422 / 0402

Seventeen Cree anti-diabetic herbal medicines and eight Traditional Chinese Medicines have been examined for their potential to cause interactions with drugs, which is considered as a major reason for adverse drug effects. Specifically, the effect of these natural health products was examined on major Phase I drug metabolism enzymes including cytochrome P450, human carboxylesterase-1 and flavin-containing monooxygenases. Several of these natural health products have the potential to cause adverse drug effect through the inhibition of major drug metabolism enzymes. The results indicated that 7 Cree medicines plant extracts inhibited CYP3A4 activity, and 3 of them have been proven to cause potent mechanism-based inactivation of CYP3A4. Seven of eight Traditional Chinese Medicines have been identified as strong CYP3A4 inhibitors; the ethanol extract of Goji has identified as a potent inhibitor for CYP2C9 and 2C19. Goji juice showed universal inhibitory effects on most of the tested enzymes except flavin-containing monooxygenases 3.

The demarcation problem aims to articulate the boundary between science and pseudoscience. Solutions to the problem have been notably raised by the logical positivists (verificationism), Karl Popper (falsificationism), and Imre Lakatos (methodology of research programmes). Due, largely, to the conclusions drawn by Larry Laudan, in a pivotal 1981 paper which dismissed the problem of demarcation as a “pseudo-problem”, the issue was brushed aside for years. Recently, however, there has been a revival of attempts to reexamine the demarcation problem and synthesize new solutions. My aim is to survey two of the contemporary attempts and to assess these approaches over and against the broader historical trajectory of the demarcation problem. These are the efforts of Nicholas Maxwell (aim-oriented empiricism), and Paul Hoyningen-Huene (systematicity). I suggest that the main virtue of the new attempts is that they promote a self-reflexive character within the sciences. A modern demarcation criterion should be sensitive towards the dynamic character of the sciences. Using, as an example, a case study of Traditional Chinese Medicine, I also suggest that the potential for conflict between demarcation conclusions and the empirical success of a pseudoscientific discipline is problematic. I question whether it is sensible to reject, as pseudoscientific, a discipline which seems to display empirical success in cases where the rival paradigm, contemporary western medicine, is not successful. Ultimately, I argue that there are both good theoretical and good pragmatic grounds to support further investigation into a demarcation criterion and that Laudan’s dismissal of the problem was premature. / Graduate / 0422 / 0402

Studies in medical anthropology and health sociology have shown the intensification of exchanges between Chinese and Western medicine. However, there is a lack of literature exploring this phenomenon from the human communication perspective. To fill this gap, this study aims to analyze patterns and processes taking place during the interaction between Chinese and Western medicine by inquiring into professional identity of the Chinese medical practitioners. To implement this goal, a qualitative exploratory research was conducted in the Yusheng Chinese Medical Clinic, employing the methods of participant observation and interviewing. Drawing on the communication theory of identity and applying positioning as an analytical tool, it was found that professional ideology, adherence to Chinese medical theory, and sociohistorical situatedness were the most salient factors determining positional shifts in the discourses with Western medicine. In some discursive practices, the relationship between the two medical systems was dichotomized. In other ones, it was perceived in terms of partnership or even unification. Accordingly, the complex and dynamic picture of professional identity was captured. The shift from emphases on being a good physician to being a good Chinese medical physician, as well as discrepancies between perceived professional self and enacted professional self, were observed. Based on the findings, this study calls for the discussions on the relevance of the yin-yang mode in interpreting the interaction between Chinese and Western medicine in the context of globalization.

Made available in DSpace on 2015-04-17T15:02:12Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1512221 bytes, checksum: 7dc64327f8e2ec85cb976c68a426ed33 (MD5) Previous issue date: 2014-06-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The National Policy on Integrative and Complementary Practices (PNPIC) was implemented by the National Health System (SUS) in 2006, creating a range of possibilities to ensure the integrality in the health care practises. The medical training needs to be done so the student learn to look the person who he is taking care in a holistic way, in view of the current reality of showing the direction of the medical knowledge, because the practice is grounded in the biomedical conception. One starts from the assumption that the Traditional Chinese Medicine approaches enable to qualify the anamnesis, especially in elderly patients, in order to take into account their lifestyles, their emotions and their spirituality. The themes linked to the integrative practises should be debated in the academia, since the new medical training program searches for new perspectives of professional education. The goal of this thesis is to analyze the use of the Traditional Chinese Medicine on broadening the anamnesis done by medicine students, on medical visits for the elderly people on the Family Health Strategy. Its specific goals were: to know the anamnesis meaning for medicine students on elderly patients; to offer training to the students for the clinical handling under the Traditional Chinese Medicine light and to identify changes on the medical practice after the training offered. It is an action-research, with qualitative approach, with eight medicine students from a private college as subjects, during their internship of public health, carried out in a unit of family health in the cities of Cabedelo and João Pessoa, both on Paraíba State. In relation to the data collecting, in the first stage, recorded interviews were performed with the use of a semi-structured script. In the second phase, training was offered to the students to develop the anamnesis of the elderly, according to the techniques of Traditional Chinese Medicine. In the third stage, newly recorded interviews were conducted. To analyze the data, content analysis technique was used, on the theme mode. It was identified through the results that students have weaknesses in their approach with the patient and in his training, at the prospect of comprehensive, humane care and practiced with the use of knowledge of the integrative practices. We also observed little appreciation of the semiology knowledge needed to develop a wider anamnesis, according to the holistic concepto of health. However, the students were receptive to the new knowledge, when invited to attend the training in Traditional Chinese Medicine. In this respect, it was verified that the training conducted caused students to include new information about anamnesis theme, which leads to recommend educational strategies focused on action-research, could be employed in medical education in order to strengthen changes in the health care model. / A Política Nacional de Práticas Integrativas e Complementares foi implementada pelo Sistema Único de Saúde em 2006, abrindo um leque de possibilidades para garantir a integralidade na atenção à saúde. A formação médica necessita ser realizada de forma que o estudante aprenda a ver a pessoa de quem cuida de forma holística, tendo em vista a presente realidade de mostrar o direcionamento do saber médico, em função da prática ser fundamentada na concepção biomédica. Parte-se do pressuposto que as abordagens da medicina tradicional chinesa possibilitam qualificar a anamnese, sobretudo em pacientes idosos, de modo a levar em consideração, seus hábitos de vida, suas emoções e a espiritualidade. Os temas vinculados às práticas integrativas devem ser discutidos no meio acadêmico, uma vez que o novo currículo médico busca novas perspectivas na formação do profissional. Este estudo tem como objetivo geral analisar o uso de técnicas da Medicina Tradicional Chinesa, na ampliação da anamnese realizada por estudantes de medicina, na consulta à população idosa na Estratégia Saúde da Família. Como objetivos específicos foram: conhecer o significado da anamnese para estudantes de medicina na consulta ao idoso; oferecer capacitação aos estudantes para o manejo clínico à luz da Medicina Tradicional Chinesa e identificar mudanças em sua prática médica, após a capacitação oferecida. Trata-se de uma pesquisa-ação com abordagem qualitativa, que teve como sujeitos, oito alunos de uma faculdade de medicina da rede privada, em seu internato de saúde coletiva, realizado em uma unidade de saúde da família, cenários de Cabedelo e João Pessoa, PB respectivamente. No que concerne à coleta de dados, no primeiro momento foram realizadas entrevistas gravadas, mediante o emprego de roteiro semidirigido. No segundo momento, foi oferecida capacitação aos acadêmicos para desenvolverem a anamnese da pessoa idosa segundo a aplicação de técnicas da Medicina Tradicional Chinesa. Na terceira etapa foram feitas novas entrevistas gravadas. Para análise dos dados, foi utilizada a técnica análise de conteúdo, modalidade temática. Foram identificados através dos resultados obtidos que os alunos apresentam fragilidade em sua abordagem com o paciente e em sua formação na perspectiva do cuidado integral, humanizado e praticado com o uso de saberes de práticas integrativas. Observou-se ainda pouca valorização de conhecimentos de semiologia necessários ao desenvolvimento de um anamnese ampliada, segundo a concepção holística em saúde. No entanto, os alunos se mostraram abertos ao novo conhecimento, quando convidados a participar da formação em medicina tradicional chinesa. A esse respeito, verificou-se que a capacitação realizada fez com que os alunos incluíssem novos elementos sobre o tema anamnese, o que leva a recomendar que estratégias educativas, centradas na pesquisa-ação, possam ser empregadas na formação médica de modo a fortalecer mudanças no modelo de atenção em saúde.

The abstract of the diploma thesis is focused on the acupressure and its influence of backache of medical staff. We chose the theme of acupressure because it is a non-invasive treatment method which can be practiced by everyone in the comfort of the home and no aid is necessary to have, just the basic knowledge and training how to perform acupressure. Acupressure is not physically or time consuming and that is why it is considered as a suitable means as an additional treatment of pain and other health disorders. It can improve nursing care. The theoretical part deals with pain and pain of medical staff who are the highest risk group of backache in the lumbar region. The backache is the most frequent cause of incapacity for work. Furthermore, in the theoretical part we deal with acupressure, one of the methods of alternative medicine. For the processing of the theoretical part, we used the available foreign and Czech literary sources. The empirical part of the diploma thesis is a quantitative method. The results obtained from the research were processed in the overview tables and case reports. For the thesis we set two research objectives. The first objective was to find out the experience of medical staff with acupressure. The second objective was to verify the influence of the techniques of acupressure for backache of medical staff. On the basis of the aim two hypotheses were created. The first hypothesis should show whether the backache will be softened by application of the acupressure techniques. The second one shows whether there is the difference in approach of nurses and doctors to perform acupressure.

Made available in DSpace on 2015-07-22T20:50:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-04-28. Added 1 bitstream(s) on 2015-08-11T03:26:03Z : No. of bitstreams: 1 Publico-12535.pdf: 742021 bytes, checksum: 9518cc7caeeb58090e95e52453539267 (MD5) / A Medicina Tradicional Chinesa (MTC), com bases fundamentadas no estímulo à prevenção, visão holística e ênfase no autocuidado adequa-se às atuais Diretrizes Curriculares dos cursos da área da saúde e aos princípios do SUS, portanto vem sendo utilizada no sistema público de saúde no Brasil. Porém, a inserção de uma Medicina com bases filosóficas e culturais orientais em um contexto ocidental enfrenta numerosos desafios. Esta pesquisa tem como objetivo caracterizar o perfil profissional, as concepções, práticas e o processo de formação em MTC de profissionais que atuam em unidades do serviço público de saúde na cidade de São Paulo. Esta pesquisa descritiva exploratória foi realizada com abordagem qualitativa. A coleta de dados compreendeu a aplicação de formulários e entrevistas semiestruturadas a 12 profissionais que exercem MTC em duas unidades de saúde da região centro-oeste de São Paulo. A análise de conteúdo foi orientada pelos seguintes núcleos: perfil profissional, concepções e práticas, formação em MTC. Os resultados indicaram a configuração de dois grupos de profissionais que atuam com MTC, os médicos que praticam acupuntura e possuem formação mais normatizada e os não médicos que realizam práticas corporais e meditativas, com formação em diversas instituições que oferecem cursos com escassa normatização em relação à carga horária, aos conteúdos e requisitos de admissão. Os entraves na formação para ambos os grupos mencionados referem-se também à escassez de textos didáticos, docentes com insuficiente formação didático-pedagógica e ausência de apoio institucional para aprimoramento profissional em MTC. Os profissionais entrevistados expressam concepções condizentes com os princípios da MTC, contudo, o exercício da prática no cotidiano da unidade se vê prejudicado pela resistência da equipe multiprofissional, pelo escasso número de profissionais, carência de recursos materiais e falta de informação e divulgação da oferta e benefícios da MTC para usuários e profissionais da saúde. Os princípios da MTC e o perfil dos profissionais têm muito a contribuir com o atual modelo biopsicossocial de saúde no Brasil, embora medidas efetivas que incluam a aproximação das Instituições de Ensino Superior aos serviços de saúde devam ser estabelecidas para utilização e ampliação da MTC no serviço público, garantindo sua aplicação com segurança e qualidade visando à melhoria da saúde da população. / The Traditional Chinese Medicine, founded in the principles of stimulating prevention, holistic view and emphasis in self care, is appropriated in the current Curriculum Directive and to the Brazilian Unified Heath System, however, it has been used in the Brazil public health system. Nevertheless, the insertion of a Medicine with oriental philosophical and cultural approach in a western context has a number of challenges. The purpose of this search is to identify the professionals’ profile, the concepts, the practises and the education process of those professionals exercising Traditional Chinese Medicine in public centers in the city of São Paulo. This descriptive exploratory search was conducted with a qualitative approach. The data collection was through forms and semi-structured interviews with 12 professionals that exercise Traditional Chinese Medicine in two health public centers in the central west region of São Paulo. The content analysis was directed by: professional profile, concepts, practises and Traditional Chinese Medicine education. The results indicated the configuration of two professional groups that exercise Traditional Chinese Medicine: the doctors that practise acupuncture and have a formal academic education and the other professionals that give corporal and meditation practises and have a technical education acquired through several institutions that offer courses with limited regulation on minimum lecture and study hours, content and admission requirements. The issues regarding the education of both groups are also with respect to the limited availability of teaching material, teachers with insufficient teaching education and lack of institutional support for the professional improvement in Traditional Chinese Medicine. The traditional Chinese Medicine principles and the profile of the professionals have a lot to contribute with the current bio phiso social model of health in Brazil; nevertheless effective measures, which include the closer interaction between the universities and the health services, must be established in order for the Traditional Chinese Medicine to be used and amplified in the public service, safeguarding its qualified and secure application and aiming at the improvement of the heath standard of the population. / TEDE / BV UNIFESP: Teses e dissertações

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Shén神 é uma categoria chinesa de sentidos múltiplos e abrangentes, presente na filosofia e na medicina. Direcionaria o processo de surgimento de todas as coisas no universo, como uma força configuradora. Na pessoa, atuaria sobre todos os estágios de desenvolvimento corporal e pessoal, do nascimento até a morte, caracterizando-a como pessoa única no universo. Teve seus sentidos reduzidos pela Medicina Chinesa Contemporânea, hegemônica na China e instituída após a Revolução comunista. Costuma ser traduzida como Espírito ou Mente no ocidente e é indissociável do corpo físico. Está presente em todas as dimensões da Racionalidade Médica Chinesa, observando-se na literatura convencional, grande abrangência de sentidos quando tratada pela dimensão cosmológica, porém costuma ser reduzida aos sentidos de mente, segundo definições ocidentais, quando tratada pelas dimensões de ordem prática: diagnose e terapêutica. O desafio desta tese foi elaborar uma síntese entre os sentidos cosmológicos e as dimensões práticas. Para isso, procedeu a uma pesquisa teórico conceitual, a partir de leituras e interpretações ocidentais de textos clássicos chineses, elaboradas por autores com critério filológico apurado. Observou-se que os sentidos de Shén神 se fazem presentes em ressonância recíproca com diversas outras categorias da Doutrina Médica Chinesa, como Qì氣, Xuè血, Jīng精, Qìng情, Emoções, Zàng-Fǔ贓腑, Órgãos e Vísceras, entre outras. Cada uma delas com atribuições específicas, que, porém, se reorganizariam em ressonância com as outras. Assim, ao proceder a diagnose e instituir uma terapêutica direcionada a cada uma dessas categorias, o terapeuta estaria interferindo diretamente sobre Shén神 e vice versa. Shén神 poderia assumir sentidos diversos, numa visão de totalidade. A partir daí, percebeu-se a necessidade de estudar essas categorias em ressonância com Shén神, além da própria diagnose e da terapêutica, à luz das premissas do Pensamento Chinês. Categorias como processo, totalidade, potencial ou eficácia ajudaram a apreender, não só os amplos sentidos de Shén神, e suas ressonâncias, mas também as peculiaridades do ato de diagnosticar e tratar na Racionalidade Médica Chinesa. Foi, então, elaborada uma visão da Diagnose e da Terapêutica capaz de contemplar Shén神 e suas ressonâncias, que se espera poder utilizar nos serviços de saúde, contribuindo para estratégias de promoção da saúde, estreitamento de vínculos terapeuta-paciente e maior eficácia terapêutica na prática da Racionalidade Médica Chinesa. / Shén神 is a chinese category of multiple and ample senses, present in the philosophy and medicine. It would direct the process of the appearance of all the things in the universe, as a shaper force. In the person, it acts in all the phases of corporal and personal development, from birth to death, featuring him as the unique person in the universe. It had its meanings reduced by Contemporary Chinese Medicine, hegemonic in China and established after the communistic Revolution. It is often translated as Spirit or Mind, in the West, and it is never dissociated from the physical body. It is present in all dimensions of the Chinese Medical Rationality, and a great range of senses is mentioned, in the conventional literature, when referred to the cosmological dimension, but, it is often reduced to the senses of the mind, according to occidental definitions, when referred to the dimensions of practical order: diagnosis and therapy. The challenge of this thesis was to elaborate a synthesis among the cosmological senses and the practical dimensions. For that, a theoretical-conceptual research was carried out from occidental readings and interpretations of classical chinese texts, created by authors with highly accurate philological criterion. It was noticed that, the senses of Shén神 are present in reciprocal resonance with several other categories of the Chinese Medicine Doutrine, as Qì氣, Xuè血, Jīng精, Qìng情, Emotions, Zàng-Fǔ贓腑, Organs and Visceras, among others. Each one of them with specific attributions, which, however, would reorganize themselves, in resonance with the others. Thus, proceeding the diagnosis and initiating a therapy directed to each one of these categories, the therapist would be interfering, directly on Shén神 and vice versa. Shén神 might assume various meanings, in a vision of totality. From this point on, we understood the need of studying these categories, in resonance with Shén神, beyond the own diagnosis and therapy, in the light of the Chinese Thought premises. Categories like process, totality, potential or efficacy have helped to apprehend, not only the wide meanings of Shén神, and their resonances, but also the peculiarities of the act of diagnosing and treating in the Chinese Medical Rationality. Then, it was elaborated a vision of the Diagnosis and Therapy capable of contemplating Shén神 and its resonances, that we expect can be used in the healthcare services, contributing to health promoting strategies, straitening the therapist-patient biding and more therapeutical efficacy in the practice of the Chinese Medical Rationality.

Pendant des milliers d’années, la médecine chinoise jouit d’une notoriété importante. Cependant, après la première guerre de l’opium en 1840 et avant la promulgation de la Constitution de 1982, cette médecine locale a vécu une phase de lente décadence. Ce changement est dû à la mutation radicale de la société chinoise et à la confrontation avec la culture et de la médecine occidentales de l’époque. Dans le but de remédier à la situation délicate du moment et de pallier les difficultés sanitaires du pays, les pouvoirs politiques successifs ont tenté d’installer différents systèmes de santé systématisés, modernisés, voire occidentalisés : soit en privilégiant la médecine occidentale, parfois même avec une intention d’abolir la médecine chinoise, soit en stimulant une collaboration entre les deux médecines. En s’appuyant sur cette histoire de la rencontre et de la cohabitation souvent heurtée des médecines chinoise traditionnelle et occidentale moderne, ainsi que sur les particularités de chaque médecine, il parait judicieux de vouloir procéder à une collaboration des deux médecines avec plus de profondeur, afin de mieux gérer la santé publique. En effet, cette collaboration aurait le mérite de perfectionner le système de santé, de stimuler l’activité médicale, d’alléger les dépenses de santé et enfin d’améliorer la santé et le bien-être de la population. Bien entendu, aujourd’hui, améliorer la situation d’existence et de développement de la médecine traditionnelle est une obligation pressante / For millennia, Chinese medicine has been of some renown. However, during the period going from the first opium war of 1840 to the promulgation of the constitution of 1982, this medicine has slowly declined. This change is mainly due to the radical mutation of Chinese society on its whole, and to its increasing confrontation with western culture and medicine. Successive political regimes have tried to set up diverse health systems, which they modernized or westernized, in order to remedy the delicate health situation and relieve some burden from existing institutions. They either openly supported Western medicine, even to the point of wanting to abolish its Chinese counterpart, or tried to stimulate some form of collaboration between the two medicines. Based on this history of clashes and forced cohabitation, and on the specific aspects of each of them, it seems a sound goal to proceed to a deeper collaboration between these two medicines, to help and manage public health more efficiently. Indeed, this collaboration could in itself better the current health system, would stimulate medical activity, could reduce healthcare costs and finally should improve global health and wellbeing of the Chinese population. But of course, it is first and foremost a pressing duty to enhance the current status of existence and state of development of Chinese traditional medicine

This master's thesis is looking to expand on the previously written bachelor's thesis describing the current situation of Traditional Chinese Medicine (TCM) in the Czech Republic. It represents an attempt to interpret medicine as paradigm while reflecting the current political environment. The relevance of the topic is proved by the recently increasing interest of media which have been covering the Czech-Chinese Centre for TCM in Hradec Kralove and activities of the Ministry of Health in discussions about possible synergies between modern medicine and TCM. The thesis compares modern medicine and TCM from the perspective of the theory of paradigms and relativity of knowledge by Thomas Kuhn. It aims to test aspects of the theory by conducting research among practitioners and students of TCM. The thesis also tries to find parallels between the two medicinal approaches and to identify their respective advantages and disadvantages. It attempts to gauge how challenging it is for students of TCM to comprehend two different medicinal approaches and whether they had any issues understanding them. Among other goals of the thesis is to give some insight into the process and possible future trends of the legal basis of TCM in the Czech Republic. In order to accomplish these goals, a set of questionnaires was...