Thesis (doctoral)--Uppsala University, 1991. / Includes bibliographical references (p. 201-207) and index.

Resumo: Ao longo da história, o tema da hereditariedade apresentou-se sob interpretações variadas. O desenvolvimento das ciências biológicas permitiu, por um lado, maior conhecimento sobre seus mecanismos; por outro, tornou imprescindível a reflexão sobre determinismos teóricos que parecem recair, principalmente, sobre o campo das ciências da Saúde. A história do movimento eugenista é um evento que permite importantes reflexões sobre o passado e o presente. O termo \"eugenia\" foi criado por Francis Galton em 1883 para nomear uma ciência que visava o melhoramento do patrimônio biológico da humanidade. Para tanto, deveria oferecer teorias e métodos rumo à perfectibilidade física e mental. Renato Kehl (1889-1974), médico e farmacêutico paulista, foi um dos principais expoentes da eugenia brasileira, tomando para si, com afinco, a tarefa de publicista e articulador das sociedades eugênicas que aqui se formaram nas primeiras décadas do século XX. Algumas noções de progresso versus decadência contidas em suas obras em prol do movimento médico-eugenista - publicadas majoritariamente entre 1917 e 1940 - são tratadas nesta dissertação. Fizeram parte da campanha eugenista brasileira os debates acerca da esterilização dos \"indesejados\", das restrições matrimoniais e imigratórias e do confinamento dos chamados \"denegerados\". Nesse contexto o movimento eugenista foi apresentado pelos seus defensores como solução contra a supostamente inevitável e alarmante decadência que acometia o país que se formava / Throughout history the subject of heredity showed up in varied interpretations. The development of life sciences has greater insight into its mechanisms; on the other hand, it becomes indispensable to reflect on theoretical determinisms that appear to fall mainly on the field of Health Sciences. The history of the eugenics is an event that allows important reflections on the past and present. The term \"eugenics\" was coined by Francis Galton in 1883 to name the science of the improvement of the biological heritage of humanity. It should offer theories and methods towards mental and physical perfectibility. Renato Kehl (1889-1974), brazilian physician and pharmacist, was one of the main exponents of Brazilian eugenics, publicist and articulator of eugenic societies formed in the early decades of the twentieth century. Some notions of progress versus decay contained in his works - mostly published between 1917 and 1940 -are treated in this dissertation. Part of the Brazilian eugenics campaign debates about the sterilization of \"unwanted\", about marriage and immigration restrictions and confinement of so-called degenerate. In this context the eugenics movement was presented by its enthusiasts as a solution against the supposedly inevitable and alarming decay that affected the nation

INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema \"pluralismo epistemológico\". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam \"consultas\" em \"encontros terapêuticos\". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de \"feita sob medida\") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a segunda aplicação do QSDF. RESULTADOS: 1) Não houve diferenças entre os grupos e subgrupos com respeito ao número de pacientes, quanto à distribuição por sexo, idade e frequência de uso de medicação de resgate. 2) Dos 131 pacientes do estudo 74 (56,5%) completaram o tratamento e 57 (43,5%) abandonaram antes do término. Não há diferença significativa entre os grupos A (n = 30) e B (n = 44) quanto à proporção de pacientes que terminaram seu tratamento (p = 0,076). 3) Nos subgrupos B1 e B2, 79,5% e 80% dos pacientes, respectivamente, alcançaram a redução de 50% e mais no escore do QSDF, contra apenas 22,2% e 41,7% dos pacientes dos subgrupos A1 e A2. A diferença entre os subgrupos é significante (p < 0,001). CONCLUSÕES: Neste estudo o atendimento médico \"encontro terapêutico\" foi (2,65 vezes) mais eficaz do que a \"consulta médica tradicional\". A excelência técnica é fundamental para a boa prática da medicina, mas ela é mais eficaz quando associada à arte / INTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic \"epistemological pluralism\" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform \"consultation\" in \"therapeutic encounters.\" According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the \"tailor made\") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second application of QSFD. RESULTS: 1) There were no differences between the groups and subgroups with respect to the number of patients, according to the distribution by gender, age and frequency of use of rescue medication. 2) Among the 131 patients in the study 74 (56.5%) completed treatment and 57 (43.5%) dropped out before completion. There is no significant difference between groups A (n = 30) and B (n = 44) as the proportion of patients who completed their treatment (p = 0.076). 3) In subgroups B1 and B2, 79.5% and 80% of patients, respectively, achieved a reduction of 50% and more in the score QSFD, against only 22.2% and 41.7% of patients in subgroups A1 and A2. The difference between the groups is significant (p <0.001). CONCLUSIONS: In this study the \"therapeutic encounter\" was (2.65 times) more effective than \"traditional medical consultation\". Technical excellence is fundamental to good medical practice, but it is more effective when combined with art

INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema \"pluralismo epistemológico\". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam \"consultas\" em \"encontros terapêuticos\". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de \"feita sob medida\") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a segunda aplicação do QSDF. RESULTADOS: 1) Não houve diferenças entre os grupos e subgrupos com respeito ao número de pacientes, quanto à distribuição por sexo, idade e frequência de uso de medicação de resgate. 2) Dos 131 pacientes do estudo 74 (56,5%) completaram o tratamento e 57 (43,5%) abandonaram antes do término. Não há diferença significativa entre os grupos A (n = 30) e B (n = 44) quanto à proporção de pacientes que terminaram seu tratamento (p = 0,076). 3) Nos subgrupos B1 e B2, 79,5% e 80% dos pacientes, respectivamente, alcançaram a redução de 50% e mais no escore do QSDF, contra apenas 22,2% e 41,7% dos pacientes dos subgrupos A1 e A2. A diferença entre os subgrupos é significante (p < 0,001). CONCLUSÕES: Neste estudo o atendimento médico \"encontro terapêutico\" foi (2,65 vezes) mais eficaz do que a \"consulta médica tradicional\". A excelência técnica é fundamental para a boa prática da medicina, mas ela é mais eficaz quando associada à arte / INTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic \"epistemological pluralism\" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform \"consultation\" in \"therapeutic encounters.\" According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the \"tailor made\") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second application of QSFD. RESULTS: 1) There were no differences between the groups and subgroups with respect to the number of patients, according to the distribution by gender, age and frequency of use of rescue medication. 2) Among the 131 patients in the study 74 (56.5%) completed treatment and 57 (43.5%) dropped out before completion. There is no significant difference between groups A (n = 30) and B (n = 44) as the proportion of patients who completed their treatment (p = 0.076). 3) In subgroups B1 and B2, 79.5% and 80% of patients, respectively, achieved a reduction of 50% and more in the score QSFD, against only 22.2% and 41.7% of patients in subgroups A1 and A2. The difference between the groups is significant (p <0.001). CONCLUSIONS: In this study the \"therapeutic encounter\" was (2.65 times) more effective than \"traditional medical consultation\". Technical excellence is fundamental to good medical practice, but it is more effective when combined with art

儒醫是宋以後經過醫學文本訓練的，男性醫者的，文化認同/角色/定位。道醫、巫醫和女性醫者等其他醫者漸成為邊緣他者。儒醫宣稱比其他醫療實踐者更加深諳醫學經典、更加理性。儒醫攀附儒自居，模仿理學門戶互相攻訐，有學派之分。元代婺州朱震亨，「丹溪學派」的創始者，是明代儒醫的典範。本文將以朱震亨和「丹溪學派」為個案，一方面探討儒醫如何建構醫學身體、疾病觀念及其實踐，另一方面探討「丹溪學派」的思想和社會史。 / 第一、二、三章分別從三個角度探討元明儒醫的身體觀。首先，在強烈的「南人」認同之下，元代江浙的士人強調「南/北」身體的差異，「北醫」的療法不適合「南人」的身體，朱震亨被塑造為「南醫」的典範。其次，自劉完素以後，「火」不是日常生活中的火熱之氣，也不是推算運氣的術語，成為元明醫家對身體疾病的想像。據此，朱震亨提出「陽有餘而陰不足」的身體觀，是明代「丹溪學派」遵守的教條。第三，鬼神病因漸漸從儒醫的身體觀中淡出。道教醫學中的「傳尸勞瘵」，混雜了鬼邪和血氣病因，宋元儒醫卻劃分血氣「虛勞」和鬼邪「勞瘵」的界線。朱震亨將「勞瘵」解釋為「陰不足」病。追隨丹溪之後，虞摶病人見鬼實際上是「心神不寧」，清醫吳瑭認為「祝由科」是巫術，儒醫無法容忍鬼邪病因和儀式療法。 / 第四、五章討論儒醫多樣化的實踐。在臨床實踐中如何治療「陰不足」病，「丹溪學派」並不一致，王綸提倡的「補陰丸」在明代江浙醫者的實踐中廣受歡迎，但來自學派內部嚴厲的批評聲同時存在。明代醫家認為唐宋方書治「勞瘵」的天靈蓋「殘忍」，但紫河車卻是明代常用的治療「勞瘵」藥物。儒醫反對儀式療法，但某些驅除鬼邪的針灸療法，改頭換面依然留存在醫學實踐中，比如「秦承祖灸鬼法」。 / 第六、七章指出，從朱震亨到「丹溪學派」，是元代婺州地方士人建設宗族組織、講習理學、建構地方認同背景之下的社會史，也是蘇州城市醫者專業化、組織化的結果。元明政權更迭之後，「丹溪」弟子進入太醫院，依靠政治權威提升「丹溪」的醫學地位。1450年代以後「丹溪」成為商業書坊的暢銷本，注重師承關係的學派逐漸消解，「丹溪」成為大眾通俗的醫學入門文本作者。清代，考據醫學「丹溪」為通俗庸醫，「丹溪」不再是醫者撰寫醫書、醫療實踐的必引權威。 / This thesis aims to explain how Confucian physicians (儒醫) constructed the medical thoughts and practice. A Confucian physician is supposed to be a well-educated gentleman (儒) and a master of the medical classics. From the 12th century on, Confucian physicians gradually became a new identity of the orthodox doctors, while the Taoists, shamans, midwives and surgical practitioners all became the “others. At the same time, among the Confucian Physicians, different schools appeared. The Danxi School (丹溪學派) was a group of disciples following Zhu Zhenheng (朱震亨1282-1358) from the 14th to 15th centuries in Jiangnan (江南) . Zhu was a gentleman from Wuzhou, who was treated as an ideal model of “Confucian physicians through the whole Ming dynasty. / The first three chapters focus on the medical thoughts of Confucian phycians. Chapter One studies on the body of the “Southerners (南人). People living in the territory of Southern Song identified themselves as the “Southerners. This identity was strengthened by the unequal racial policy under the Mongol reign. It motivated the Jiangnan literati to appeal for a medical knowledge body specifically for the “Southerners, which would focus on treating the ailments caused by the “southern environment and dietary habits. Chapter Two explores the concept of “fire. In the Song dynasty, “fire is an element of the prevalent cosmological theory of “the five circulatory phases and the six seasonal influences (五運六氣) . However, in Liu Wansu (劉完素1132-1208) ’s innovative interpretation, the concept of “fire was internalized into the body structure. Zhu Zhenheng inherited this concept of bodily “fire and developed the theory of “yang is always in excess, yin is always deficient (陽有餘而陰不足) , which was later strictly followed by the Danxi School. Chapter Three investigates the disease of “laozhai (勞瘵) . According to the Taoist interpretation, the disease of “laozhai was due to the ancestor’s sin. However, Confucian physicians developed a new meaning in the context of Danxi’s “yin is deficient body. Demons were gradually excluded from the etiology of the Danxi School. / Chapter Four and Five study on the practice of Confucian physicians. The Danxi School didn’t have consensus on how to treat the “yin is deficient disease. Therefore, the therapy of “nourishing yin (滋陰) was quite differential in individual practices. However, it is certain that Confucian physicians tended to use herbs to treat patients who declared themselves suffering from demons. Religious rituals of expelling demons were excluded from their clinical practice. However, Confucian physicians didn’t refuse to use some unusual herbal remedies such as the placenta, or moxibustion that might function as Taoist rituals of expelling demons. / Chapter Six and Seven analyze the rise and fall of the Danxi School. The reason why Zhu became a powerful medical master lies not only in his medical thoughts or skills but in his social activities. He was very active in the lineage organization and local administration. In the local society, Zhu gained the power and fame as an authoritative Confucian gentleman, though he had never received any governmental position. After the death of Zhu, his disciples achieved successful careers as professional doctors in Suzhou (蘇州) . Later when the Ming Empire was established in Nanjing, most of Danxi’s disciples went into the Imperial Medical Service (太醫院) . After the 1450s, Zhu Zhenheng became a best-selling author and a symbol of the popular medicine. The popularity of his works eventually destroyed the structure of the master-disciple relationship in the Danxi School. The Danxi School gradually disappeared. In the end, because the mid-Qing physicians preferred ancient masters such as Zhang Zhongjing (張仲景 fl. 168-196) to the modern, vulgar Danxi, the Danxi School and their medical master faded away from the mainstream medicine. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 張學謙. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 197-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Zhang Xueqian. / 導論 --- p.1 / Chapter 一、 --- 儒醫：宋元明清醫者的身份認同 --- p.2 / Chapter 二、 --- 儒醫的理性與實踐 --- p.6 / Chapter 三、 --- 丹溪學派：醫學思想的社會史 --- p.11 / Chapter 四、 --- 研究說明 --- p.16 / Chapter 第一章 --- 元代醫學的「南/北」身體觀 --- p.18 / Chapter 一、 --- 南宋和元：「南人」認同的多層含義 --- p.18 / Chapter 二、 --- 「南/北」身體觀論述 --- p.24 / Chapter 三、 --- 製造「南醫」/「北醫」 --- p.32 / Chapter 四、 --- 結論 --- p.38 / Chapter 第二章 --- 丹溪學派的口號：「陽有餘而陰不足」的身體觀 --- p.40 / Chapter 一、 --- 五運六氣與宋人的身體觀 --- p.40 / Chapter 二、 --- 內丹對醫學身體觀的影響 --- p.46 / Chapter 三、 --- 朱震亨的相火論 --- p.50 / Chapter 四、 --- 結論 --- p.59 / Chapter 第三章 --- 宋明儒醫的「理性化」：以「勞瘵」為中心 --- p.60 / Chapter 一、 --- 《道藏》文本中「勞瘵」的界定 --- p.62 / Chapter 二、 --- 儒醫文本中「勞瘵」的界定 --- p.68 / Chapter 三、 --- 儒醫「勞瘵」與明代社會身體 --- p.73 / Chapter 四、 --- 明代儒醫對「祝由」的困惑 --- p.77 / Chapter 五、 --- 結論 --- p.85 / Chapter 第四章 --- 「陰虛」病與療法 --- p.87 / Chapter 一、 --- 丹溪「陰虛」病及療法 --- p.87 / Chapter 二、 --- 補陰丸與人參之爭 --- p.93 / Chapter 三、 --- 薛己、趙獻可：從補陰血到補陰精 --- p.99 / Chapter 四、 --- 結論 --- p.103 / Chapter 第五章 --- 儒醫的實踐 --- p.105 / Chapter 一、 --- 道醫「追蟲」儀式 --- p.105 / Chapter 二、 --- 儒醫勞瘵療法 --- p.108 / Chapter 三、 --- 天靈蓋與紫河車在明代醫學中的不同遭遇 --- p.113 / Chapter 四、 --- 從「秦承祖灸鬼法」到「灸鬼哭穴」 --- p.121 / Chapter 五、 --- 結論 --- p.125 / Chapter 第六章 --- 從朱震亨到「丹溪學派」的社會史 --- p.126 / Chapter 一、 --- 朱震亨的出身與赤岸朱氏宗族的建構 --- p.129 / Chapter 二、 --- 「儒醫」朱震亨與地方社會 --- p.136 / Chapter （一） --- 朱震亨之行醫 --- p.137 / Chapter （二） --- 朱震亨之醫療產業 --- p.140 / Chapter （三） --- 朱震亨在地方社會的角色 --- p.142 / Chapter 三、 --- 元代婺州的「丹溪」門徒 --- p.147 / Chapter （一） --- 地方醫療資源與組織 --- p.147 / Chapter （二） --- 婺州地方士族的網絡 --- p.151 / Chapter 四、 --- 元末蘇州的「丹溪」門徒 --- p.155 / Chapter 五、 --- 明代太醫院的「丹溪」門徒（1368-1450） --- p.162 / Chapter 六、 --- 結論： --- p.166 / Chapter 第七章 --- 「丹溪」的大眾化與清代醫學的轉折 --- p.167 / Chapter 一、 --- 「丹溪」文本的製造與流傳 --- p.168 / Chapter （一） --- 「丹溪」文本的製造 --- p.168 / Chapter （二） --- 「丹溪」文本的印刷與晚明私人的商業書坊 --- p.178 / Chapter 二、 --- 「丹溪」權威的下降 --- p.183 / Chapter （一） --- 明清醫者對「南/北」身體觀、療法的不同意見 --- p.184 / Chapter （二） --- 「陰不足」到「命門火衰」 --- p.186 / Chapter （三） --- 考據醫學之批評「丹溪」 --- p.188 / Chapter 三、 --- 結論 --- p.192 / 結論 --- p.193 / 參考書目 --- p.197 / Chapter 一、 --- 一手文獻 --- p.197 / Chapter (一) --- 醫書 --- p.197 / Chapter (二) --- 正史 --- p.200 / Chapter (三) --- 文集 --- p.201 / Chapter (四) --- 地方志和家譜 --- p.203 / Chapter (五) --- 筆記和其他： --- p.204 / Chapter 二、 --- 工具書： --- p.206 / Chapter 三、 --- 近人研究： --- p.207 / Chapter (一) --- 中文專書 --- p.207 / Chapter (二) --- 英文專書 --- p.209 / Chapter (三) --- 中文論文 --- p.212 / Chapter (四) --- 英文論文 --- p.214