As the saying goes, "one key opens one lock." In the field of medicine, each technique, theory, or medication has its own indications or targeted problems. There's no one-size-fits-all cure or miraculous solution.
Entering the 21st century, with the shift in the spectrum of diseases threatening human life and health, such as hypertension, diabetes, cardiovascular diseases, and malignant tumors, the traditional diagnostic and treatment theories and methods primarily focused on infectious diseases face unprecedented systemic challenges. Addressing the threat posed by functional chronic diseases to people's lives and health is the question that the era poses to modern medicine.
The shift from a disease-centered approach to a people-centered approach in the new medical paradigm indicates that future medicine will adopt a more holistic and systematic cognitive perspective, diverse observational and analytical angles, varied methodological pathways, multidimensional interpretations, and a broader range of tools to provide a brand-new functionality to modern medicine, answering the questions of the modernization era in medicine.
Therefore, focusing on the concepts and methods of medical philosophy itself, reflecting on the epochal value of different philosophical approaches, and emphasizing the holistic and systematic understanding of medical life and health can provide valuable reference for seeking more effective "medical keys," developing strategies for the modernization of medicine, and enhancing the well-being of the people.
Medical Primacy: The Context of Modern Medicine Emergence
Since the 18th century, medicine has been the most direct source of inspiration and confidence for people's lives, becoming the most intuitive and inspiring field of "progress" and the most prosperous discipline among the numerous followers of Newtonian theory. Because only medicine can awaken people's expectations of longevity, no other discipline has such a mass foundation.
The modernization of medicine, as accompanied by Western modern enlightenment thought, born with the tremendous progress achieved through the scientific research paradigm and experimental methods, marked by advances in physiology, pharmacology, preventive medicine, anatomy, proper obstetrics, sensible disease classification, and the specialization of surgery. Modern medicine not only almost eradicated infectious diseases such as typhoid fever and smallpox, but also revived people's hopes and courage at that time, deepening the enlightenment movement and thoughts in people's hearts, making modern medicine the mainstream medicine in the world.
It is worth noting that the emergence of modern medicine was closely related to the scientific revolution from the very beginning, and the scientific revolution emerged from the philosophical matrix, essentially a revolution in philosophy. From a philosophical perspective, Western civilization from the 17th century to the 20th century has always been dominated by "rational philosophy." Rationality, distinguished from non-rational factors such as desires, emotions, and will, emphasizes the pursuit of certainty, logic, eternity, and transparency of thought and knowledge. The main task of modern society is to rationalize all realities and rationalize all aspects of people's lives, placing humanity above nature, controlling and legislating for nature, with the human body also regarded as part of the "natural world" subject to study, use, and transformation. The practical consequence of this teleological thinking is the totalization of technology under instrumental rationality.
In such a background, medicine also highlights the thinking mode of mechanistic reductionism, using technological means to dominate the body and health. At that time, people firmly believed that the body's functions were the synthesis of various mechanical parts, and the interactions between them were not yet clear. This mode of thinking and method dominated the development of modern medicine for nearly two centuries, constituting the most significant feature of this period's medical thought and cultural history.
Health Primacy: Reintegration of History and Logic
The proposal of the "Healthy China" strategy and the promulgation of the "Healthy China 2030 Outline Plan" mark the arrival of an era deeply concerned with humanistic care, heralding the transition from disease treatment to health care prevention in the era of health medicine.
Looking back at the history of medicine, borrowing the summary from the Italian medical historian Castiglioni in his work "A History of Medicine": "The history of medicine is not only a history of technological achievements, but also a history of art and spiritual pursuits; the history of medicine is not just a history of facts, but also a history of personalities, and even more so a history of concepts." This suggests that the history of medicine runs through a chain of human self-life cognition methods, through which adjustments in concepts in various historical periods can be seen.
Today, it has been confirmed that human life and health include both the biological-physiological dimension, the "entity," and the spiritual-mental dimension, the "entity." Medicine includes not only natural scientific methods but also humanistic and social scientific methods; it is inseparable from instrumental rationality as well as humanistic rationality; it involves analysis as well as synthesis. Neglecting any perspective or method violates the inherent laws of human life and health and will encounter setbacks in clinical diagnosis and treatment in reality.
A large number of examples constantly remind medical professionals that what logically holds true may not necessarily work in practice. The ultimate decision in diagnosis and treatment is made between "what can be done" and "what should be done," and the final decision is made after the patient is fully informed. The individual medical history, family environment, economic conditions, occupational background, personality, and other factors under unique spatiotemporal conditions all become systemic influencing factors in current health events. Therefore, starting from the individual as a whole, replacing the mechanistic, abstract, and rigid defects of mechanistic reductionism with complexity theory and methods, acknowledging the inherent systematic, complex, uncertain, and irreversible nature of human life and health problems, and reintegrating history and logic organically is a medical philosophy and methodology that urgently needs attention in the era of health medicine.
Since the beginning of the 21st century, the disease spectrum and mortality spectrum presented in the World Health Statistics Report published by the World Health Organization clearly show that chronic non-communicable diseases have accounted for more than 70% of total deaths in recent years. Chronic functional diseases such as hypertension, diabetes, malignant tumors, and chronic respiratory diseases are essentially imbalances in the self-organizing system coordination of organisms. And systemic issues can only be addressed through systemic interventions. This indicates that aspects of human lifestyle, dietary habits, mental disposition, social interactions, interpersonal relationships, and spiritual life, distinct from medical testing data, are incorporated into the scope of clinical diagnosis and treatment. The changing trends in the spectra of diseases and mortality continually remind us that in the current era where human understanding of the mysteries of life remains limited, modern medicine is undergoing a shift in values from primarily curing diseases to focusing on preventing diseases and maintaining health. This signifies a reshaping of the paradigms of medical life and health.
Human-centeredness: The Imperative of Modern Medicine Human-centeredness refers to the innate inclusion of humans within the natural cosmos and the historical context of human society. Health issues of individuals inevitably arise and evolve under the dual influences of innate and acquired factors. Here, the emphasis lies in transcending the narrow disciplinary perspectives of medicine, comprehending "humans" through a systemic approach, continuously questioning the anthropological implications of medicine, grounding in the human life system, understanding the inherent relationship between medicine and individuals, their knowledge, emotions, perplexities, and significance. It involves deep reflection on the dual nature of medical technology, the serious consideration of its appropriateness and rationality, the introduction of the social and humanistic aspects of medicine, transcending the biomedical model's singular biological perspective on human health, and reshaping medical perspectives with a holistic view of life to achieve new medical functions through novel conceptual approaches.
Medicine stands as the "greatest benefaction to humanity." In the 21st century, we need to stand at the forefront of the global community for health and draw upon all beneficial wisdom and scientific achievements in life and health from both Eastern and Western cultures. Together, we can advance the construction of a Healthy China, promote the transformation and reshaping of the biomedical-psychosocial medical model, lead with new perspectives on life and health, and aim to enhance health expectancy, effectively improve health quality, and reshape the new pattern of modernized health medicine with Chinese characteristics in the 21st century.
We should pay more attention to the systematic structure of concepts and methods, means and objectives, processes and outcomes, emotions and spirits, self-discipline and heteronomy, physiology and psychology, as well as the overall relational structure between humans and nature, humans and society, and humans with one another. We should strengthen the awareness of comprehensive health under the human-centered perspective, innovate and construct a future philosophy of health medicine, and adapt to the interdisciplinary trends of comprehensiveness, systematicity, openness, and growth in medicine.
The pursuit of health and longevity is the future trend of medical modernization. Once health and longevity become the theme of the era, they metaphorically represent the pursuit of a better life. Faced with the questions of the medical era regarding health needs, besides emphasizing early detection, prevention, and treatment, we should start from more fundamental lifestyle aspects, integrate the anthropological contents of humans' relationship with nature, society, others, and themselves into the modern medical ecological perspective, and regard the cultural significance of human life values as an organic part of medical culture. Modern medicine should not only focus on the body but also on human life and the entire ecological world of nature. Only from such a comprehensive perspective can we align with the essence of life and health wisdom, endowing modern medicine with functional significance.
(The author is a professor at the People's Liberation Army General Hospital and Vice Chairman of the Humanistic Medicine Professional Committee of the Chinese Medical Association)
