摘要
1.研究目的
目前,对于九七年前后香港中医药发展变化研究尚未见到。本课题通过对九七年前后中医药的发展变化进行研究。香港回归祖国已十多年,中医药发展仍存在不少问题,与回归时社会对香港中医药发展的期望,仍有一段距离,研究九七年后香港中医药发展变化具检讨性意义。
本论文为求完整研究,务求论述有所依,以相关文献为根据,再深入剖析其思想脉络。在形式上,则以九七前后中医发展概况、中药发展概况、中医医疗系统概况、中医药教育概况、社会对中医药的认识、市民使用中医的情况、香港政府中医药发展政策为研究的主要架构。
2.研究方法
历史研究方法：分析及解释97年前后中医药发展及演变的现象。分析及解释过去所发生,藉以了解过去,预测未来。过程主要包括搜集、记录、分类、分析和研究。文献的来源可从专业性的期刊、报告、学术性的书籍、论文等等。文献可分的类型：
印刷资料包含期刊、报告、学术性书籍、论文、政府文件等等。二.非印刷数据包含影音录像,还有数字化数据如互联网信息等等。搜集文献途径可以通过访谈、问卷调查、图书馆、博物馆、互联网、政府机构等。问卷调查方式：收集调查资料,了解现今香港市民对香港中医发展现状的认识及期望。
本课题通过对九七年前后香港中医药发展变化的文献记载,从不同领域进行前瞻性和回顾性收集研究,分别探讨中医的发展概况、中药发展概况、中医医疗系统概况、中医药教育概况、社会对中医药的认识、市民使用中医情况、香港政府中医药发展政策等情况。为香港中医药发展提供客观分析,作为未来香港中医药发展参考依据。
3.研究结果
百年以来,香港中医药处于困难的时期,随着香港回归祖国,政府对中医药立法规管,香港中医药事业渐露曙光。现时香港中医发展已有改进,九七年前香港中医药主要是通过民间力量推动,九七年后政府渐对香港中医药重视,我们认识到中医药事业的发展必须具备两个先决条件：(1)立法地位的基础,(2)政府扶持及社会大众的推动。
现时香港中医药发展仍存在不少问题：(1)香港中医药发展起步迟,人才缺乏,素质参差。(2)香港中医药教育与内地相比有很大的差距,香港没有中医院,中医毕业生缺乏中医临床实习机会,只可往内地中医院实习,由于制度不同,内地中医院多以中西药并用,香港法例规定中医只可用中药,实习未能配合香港实际需要。(3)由于中医注册过程宽松,香港中医近百年的混乱,今天依然存在。(4)专科中医师制度短期难见实现。由于缺乏系统性大型中医临床训练以及师资明显不足。(5)政府现时设有十四间中医小型诊所,应届毕业生相对接纳程度很小,中医大学毕业生现正面对就业困难,工资低工作时间长。(6)《中医药条例》现已生效,但近年香港市民因误服中药中毒的情况,亦时有发生。与九七年前相比中药配药员的水平更参差,香港老一辈有经验的中药配剂员已很少,由于工资偏低、工作时间长,很少人愿意担当此职。现时的中药配剂员大多只有初中程度,或只曾接受短期中药培训,因此对市民健康未有保障。(7)中医药教育、研究与医疗尚未被广泛认识和理解,歧视与偏见仍很严重。
现时香港中医药的发展主要体现在：(1)香港中医药管理委员会成立,负责实施多项中医药的规管措施,奠定了香港中医药发展的良好基础。(2)在《中医药条例》的机制下,内地中医专家可来港进行临床研究及教学工作,可提高本港的中医专业水平。(3)政府设立的“专业服务发展资助计划”,目的是资助各有关业界推行发展项目,中医药机构亦受到优惠。(4)政府落实开设中医诊所计划,中医药服务亦得以推广(5)香港贸易发展局为中医药业界提供大型国际性交流与合作的贸易平台,每年均举办大型的国际中医药及健康产品展览会。(6)中药检测是中药监管制度,药的检测是中药监管制度的一个重要环节。政府鼓励中药业界定期为中药产品进行基本测试,以监控其产品的品质。促进中药检测服务的发展,拓展商机,并加强本港在检测服务业的优势。提升产业在国际认受性,通过检测及认证服务,促进中医中药发展。现时香港《税务条例》,在计算业务的应课评税利润时,可扣除该业务为商品进行检测的经常性开支。(7)香港中药的研究现况,香港衛生署制定60种香港常用中药材的质量标准。研究的内容主要包括药材的命名、来源、性状、鉴别、榆查、浸出物和含量测定。其中的部分内容参考了中国药典的项目规定,重金属、晨残和黄曲霉毒素的检查则是中国药典没有收录的榆查项目。成立中药研究院为了促进本港中药的科研与创新,增强香港中药在国际的竞争力。(8)香港中医水平标准,按《中医药条例》基本要求是不少于5年的全日制中医本科学位课程及不少于30周的毕业实习。毕业后必须通过执业资格考试,才可申请成为注册中医。(9)香港中医与内地机构合作方向,为了方便教育或科研机构聘请符合资格人士担任中医药临床教学或研究工作,《中医药条例》设立了有限制注册制度。有限制注册必须由教育或科研机构代为申请。(10)香港中医与内地机构合作方向,另外,根据《内地与香港关于建立更紧密经贸关系的安排》,香港和内地在中医药产业合作领域会加强合作,促进双方的共同发展。(11)97后香港新一代中医,都必需接受5年中医全科教育,科目广泛,毕业后需通过中医全科执业试,才可执业。现时市民对中医治疗信心已增,门诊病例也十分广泛包括内科、肿瘤科、妇科、皮肤科、呼吸系统科、消化系统科、臀科、遇敏病科等。(12)香港中药市场现况,目前香港是内地中成药出口额最大的出口地区,香港本身中成药消费量并不大,输入香港的中成药大部分再转口出港。
4.研究结论
香港中医药发展变化,可追溯到1841年香港开埠初期,当时香港政府为安抚华人社会,颁布”官厅执政治民,概依中国律例、风俗习惯”条例。传统中医一直不受医生条例的管制。西方医学兴起,不是香港中医药衰落的主要原因,主要取决于香港政府的中医药政策。九七年前香港政府基于历史原因,对中医中药采取“不干扰不鼓励”政策。华人在香港用传统医术行医,当局不加干预,亦无立例管制,造成庸医充斥,名誉严重受损。中医不受重视,并没有纳入公共医疗体系。
70年代,是香港药材业的高峰期,中药开始需求大增,药材铺也随之急促增加。80年代后,在内地开放的政策下,零售店容易直接往内地购货,中药业竞争激烈,部分相继倒闭结业。九七年前香港欠缺中医药政策,中医中药没有正式规管。西药却严格管制,因中药不受规管,往过曾有市民误服中药,因而对服用中药也会感不安及恐惧。
随着1997年香港回归祖国,中医药业界积极争取于《香港特别行政区基本法》内明确了解中医药未来发展的政策,《基本法》第138条宣称：香港政府自行制定发展中西医药和促进医疗卫生服务的政策。而《中医药条例》的中医管理制度,包括有注册制度、考试制度和纪律制度。中药的管理制度,包括有中药经营商的发牌制度、中成药的注册制度和制定香港中药材标准等。《雇佣条例》修订已于2006年12月1日起生效,注册中医及有限制注册中医签发的病假证明书均有法定效力。现时情况与1997年前大为不同。中医药的立法无疑已开始增强广大市民的信心和提升业界的信誉。
香港俱备独特的优势：(1)香港有中西文化行政管理、研究与发展基础、有发展中医药的配套资源。(2)香港有发展中医药的配套资源,包括科技、资讯、多学科科技人才、资金等。(3)香港中医药已有过百年历史,有一定民众的基础。(4)香港法制及管理制度,受国际社会接受。(5)香港尊重知识及重视人才,因此能吸引更多中医药专业人才来港,协助发展中医药业。
香港中医药发展展望：(1)政府现正实施的中医注册制度,能加快实行中药注册制和中药制成品审评制度,确保中医药业的发展能法制化和规范化,全面提升业界的法律地位和专业水平,进一步增强中医药的社会公信力。(2)政府要正视及解决表列中医存在的问题,加强中医水平透明度,使市民能选择合适的中医。(3)政府应尽快实施注册中药师及注册中药配剂员,避免误配中药而中毒的情况不时出现。(4)政府应借镜香港西医的培训方式去培训中医,每间中医医学院有临床医院提供实习。提供在职中医专科培训训练。(5)政府应定合理的中医薪金表,现时初级中医师薪金比新入识西医低数倍。(6)建议政府认真调查研究,探讨建中医院的可行性,以及制定有关的中西医转介和中西医并用等法规和制度,提升市民的健康质素。(7)政府应该作出修改过时的法例,使中医师有权转介各项化验,如验血、验大便、小便,X光诊断等,提高诊断上的客观标准,使辨证与辨病相结合。(8)加强中药监管,建立中药材及其中药产品的登记、注册和监管制度,尤其要尽快制定《香港常用中药材质量标准》。提升中医药的服务素质,增强广大市民对中药的信心,同时促进香港的中药材出口。(9)香港要尽快及大力开展中医药的应用研究,尤其是中医药标准化和中药新产品的开发研究以及中医药资讯库的建立,提升香港在中医药研究和产品开发的国际竞争力。(10)香港需要通过国内外合作,开展中医药教育、研究和科技开发,补己之短。
1. Objective
Currently, the ninety-seven before and after changing of development of Chinese medicine in Hong Kong have not yet seen. By the ninety-seven, this topic before and after the development and changes in medical research. Reunification has been ten years, development of Chinese medicine are still many problems with the handover of Hong Kong society's expectations of development of Chinese medicine, there are still some distance to study Chinese medicine in Hong Kong after 1997 with a review of the significance of the development and changes.
For completeness of this paper is in order to discuss according to the literature as the basis for further in-depth analysis of its ideological context. In the form, places the ninety-seven before and after the development of TCM Coming, Coming to the development status of Chinese medicine, Chinese medical system overview, overview of Chinese medicine education, the community's understanding of Chinese medicine, public use of Chinese medicine, the Hong Kong government policy of development of Chinese medicine the main structure.
2. Research Methods
Historical research methods:analysis and explanation of Chinese medicine 97 years ago after the development and evolution of the phenomenon. Analysis and interpretation of what happened in the past in order to understand the past, predict the future. Process includes collecting, recording, classification, analysis, and research must be objective and logical manner, and obtain the correct conclusion. Sources are from professional journals, reports, scholarly books, papers and so on. Literature can be divided into types:Printed materials include journals, reports, scholarly books, papers, government documents and so on. Non-print data contains video and audio and digital data, such as Internet information and more. Ways to collect documents through interviews, questionnaires, libraries, museums, the Internet, and government agencies.
Questionnaire:survey data collected to understand the current devel-opment of Chinese medicine in Hong Kong, Hong Kong people's understanding and expectations of the status.
By the ninety-seven this topic before and after changes in Chinese Medicine literature, from different areas of prospective and retrospective collection of, respectively, guide to the status of the development of Chinese medicine, Chinese medicine guide to the development status of the system overview of Chinese medicine, Chinese medicine education profile, the community's understanding of Chinese medicine, the public use of Chinese medicine, the Hong Kong government, pharmaceutical development policy and so on. Development of Chinese medicine in Hong Kong provides objective analysis of the development of Chinese medicine in Hong Kong as a future reference.
3. The results
For centuries, Chinese medicine in Hong Kong through a difficult period, with reunification, the Government introduces legislation to regulate Chinese medicine, the pharmaceutical industry grew out of Hong Kong in the light of day. Development of TCM in Hong Kong has improved, the ninety-seven Chinese medicine in Hong Kong before the major push by people power, in 1997 the government gradually after the attention of Chinese medicine in Hong Kong, we recognize the development of Chinese medicine must have two prerequisites: (1) The status of the foundation, (2) Government support and promotion of the public.
Development of Chinese medicine in Hong Kong there are still many problems: (1) The development of Chinese medicine in Hong Kong started late, lack of talent, quality varies. (2) Hong Kong Chinese medicine education, compared with a large gap between the Mainland, Hong Kong has no hospital of Chinese medicine, Chinese medicine clinical practice the lack of opportunities for graduates can only practice to the Mainland Chinese medicine hospital, due to different systems, mostly in the western mainland Chinese Medicine Hospital and use, is available only to laws of Hong Kong Chinese medicine, practice failed to meet the actual needs of Hong Kong. (3) Hong Kong Chinese in recent years of confusion still exist today, due to loose due to the process of registration of Chinese medicine. (4) The microscopic realization of short-term specialist Chinese medicine system, which a large TCM clinic due to lack of systematic training and faculty is clearly insufficient. (5) Chinese college graduates are facing employment difficulties, low wages and long working hours, the Government has a fourteen small Chinese medicine clinics, the relative acceptance of graduates is small. (6) "Chinese Medicine Ordinance, " now in force, in recent years, Hong Kong people from Chinese medicine poisoning cases wrongly, also occur. Ninety-seven years ago with the level of Chinese medicine dispensers more varied, with experience in Hong Kong Chinese older dispensers have been few, due to low wages, long working hours, few people are willing to take this position. Now most of medicine dispensers only junior secondary education, or had only short-term training in Chinese medicine, public health and therefore not protected. (7) Chinese medicine education, research and health care has not been widely recognized and understood, discrimination and prejudice are still very serious.
Development of Chinese medicine in Hong Kong mainly include:(1) the establishment of the Chinese Medicine Council of Hong Kong responsible for the implementation of a number of regulatory measures for Chinese medicine, Chinese Medicine has laid a good foundation. (2) "The Chinese Medicine Ordinance, " the mechanism, the Mainland to Hong Kong Chinese medicine experts to conduct clinical research and teaching, can improve the professional standards of Chinese medicine in Hong Kong. (3) The Government line is established, "Professional Services Development Assistance Scheme" to finance the implementation of various development projects in the industry, the medical institutions are also subject to discount. (4) Implement a plan to open hog clinic, Chinese medicine services are to be promotion. (5) Hong Kong Trade Development Council for the Traditional Chinese Medicine industry to provide large-scale international trade platform for exchanges and cooperation, held every year large-scale international exhibition of Chinese medicine and health products. Chinese government encourages Chinese medicine products industry on a regular basis for the basic test in order to monitor product quality. (6) Chinese medicine regulatory system is detected, the drug testing of Chinese medicine an important part of the regulatory system. Chinese government encourages Chinese medicine products industry on a regular basis for the basic tests to monitor the quality of their products. Testing services to promote the development of Chinese medicine, business opportunities, and strengthen our advantages in the detection services. Enhance the industry in the international recognition, through testing and certification services, and promote development of Chinese medicine. Hong Kong, "the Inland Revenue Ordinance", in the calculation of taxable business profits tax assessment may be deducted as a commodity that business to detect the recurrent expenditure. (7) The current research of Chinese medicine in Hong Kong, Hong Kong 60 Hong Kong Department of Health to develop quality standards commonly used in Chinese herbal medicines. Study includes the naming of ingredients, sources, properties, check, extract and determination. Which Part of the project reference to the provisions of the Chinese Pharmacopoeia, heavy metals, pesticide residues and aflatoxin inspection is not included in Chinese Pharmacopoeia inspect. Setting up of Chinese medicine in Hong Kong Institute of Chinese Medicine to promote research and innovation, and enhance Hong Kong Chinese Medicine in the international competitiveness. (8) The level of the Hong Kong Chinese standards, according to "the Chinese Medicine Ordinance," the basic requirement is less than 5 years full-time Chinese medicine degree courses and not less than 30 weeks internship. Graduate qualifications necessary to pass examination before applying for registration. (9) Hong Kong Chinese co-operation with the Mainland authorities the direction, in order to facilitate the educational or research institutions to employ qualified persons in the clinical teaching or research in medicine, "the Chinese Medicine Ordinance, " a limited set registration system. Have limited registration must be made by applying for educational or research institutions. (10) Hong Kong Chinese co-operation with the Mainland authorities the direction of the other, according to the "Mainland and Hong Kong Closer Economic Partnership Arrangement", Hong Kong and the Mainland areas of cooperation in the pharmaceutical industry will strengthen cooperation and promote common development of both sides. (11) 97 a new generation of Hong Kong after Chinese medicine, Chinese medicine are required to accept 5-year general education courses are widely after graduation to be tested by general practitioners of Chinese Medicine before practice, the confidence of the public on Chinese medicine treatment has increased, out-patient cases are ten broad, including internal medicine, oncology, gynecology, dermatology, Respiratory, Digestive diseases, renal, allergic disease Branch. (12) Hong Kong Status of Chinese medicine market of proprietary Chinese medicines in Hong Kong is the Mainland's largest exporter exports, consumption of our own medicine is not large, the majority of proprietary Chinese medicine is into Hong Kong re-export port.
4. Conclusions
Development and change of Chinese medicine in Hong Kong, dating back to the early days of Hong Kong in 1841, when the society of Hong Kong Government An Fuhua, promulgated the "implementation of the political people Guanting, shall in accordance with Chinese statutes, customs, " Ordinance. From a doctor of traditional Chinese medicine has been the control of the Ordinance. Rise of Western medicine, is not the main reason for the decline of Chinese medicine in Hong Kong, depending on Chinese medicine in the Hong Kong Government. Ninety-seven years ago, the Hong Kong Government for historical reasons, Chinese medicine to take "no interference will not encourage" policy. Chinese traditional medical practice in Hong Kong, the authorities without intervention, there is no legislation to control, resulting in full of charlatans, reputation severely damaged. Chinese are not taken seriously, and not included in the public health system.
70 years, is the medicine industry in Hong Kong, the peak of Chinese medicine began to demand, herbal shop also will be rapid increase.80 years later, under the open policy in the Mainland, retail purchases easily directly to the Mainland, the highly competitive Chinese medicine, some have been closed down out of business. Ninety-seven years ago, the lack of Chinese medicine in Hong Kong, Chinese medicine is no formal regulation. Western medicine is strictly controlled, confined to traditional Chinese medicine is not regulated to the reach of Chinese people over layer, taking the medicine will be disturbed and fear.
With the 1997 reunification, the Chinese medicine sector to actively strive for the "Basic Law" in a clear understanding of the policy of the future development of Chinese medicine, "Basic Law" declared Article 138:The Hong Kong government to enact its own development of Western medicine and improve medical and health services policy. The Chinese management system, include a registration system, examination system and discipline system. Management system of Chinese medicine includes Chinese operators licensing system, registration system for proprietary Chinese medicines and the development of standards in Hong Kong. "Employment Ordinance" was revised December 1,2006 come into effect, registered Chinese medicine practitioners and Chinese medicine practitioners with limited registration of sick leave certificates issued by both legal affect. The present situation significantly is different before 1997. Legislative Chinese medicine has started to doubt the confidence of the general public and enhance the reputation of the industry.
Hong Kong ready unique advantages:(1) The administration of Hong Kong Chinese and Western cultures, research and development base, supporting the development of Chinese medicine resources. (2) The development of Chinese medicine in Hong Kong supporting resources, including technology, information, multi-disciplinary scientific and technological personnel, and funding. (3) Hong Kong Chinese medicine has over a hundred years of history, the basis of certain people. (4) Hong Kong legal system and the pipe system, accepted by the international community. (5) The importance of respecting knowledge and talents, so they can attract more professionals in Chinese medicine in Hong Kong to assist the development of Chinese medicine.
Prospects for the Development of Chinese medicine in Hong Kong:(1) The Government is to implement the registration system, registration system to speed up the implementation of traditional Chinese medicine and Chinese medicine manufactures review system to ensure that the development of Chinese medicine to legalization and standardization, to enhance the legal status of the industry and professional standards, and further enhance public trust in medicine. (2) The Government should address and solve the problems listed Chinese medicine practitioners, Chinese medicine to enhance the level of transparency so the public can choose the right medicine. (3) The Government should as soon as possible up in the manning of pharmacists and registered Chinese medicine, traditional Chinese medicine to avoid mismatches to avoid poisoning the situation from time to time. (4) The Government should learn from the Hong Kong Doctors training methods to train Chinese medicine, Chinese medicine practitioners in each hospital to provide medical clinical practice. Specialist trainning provides in-service trainning in Chinese medicine. (5) The Chinese government should set a reasonable salary scale, the current salaries of junior practitioners lower than the new times into the Western consciousness. (6) Suggest that serious investigation and study to explore the feasibility of the hospital under construction and the development of the referral and the TCM and Western medicine with such rules and regulations. Improve the quality of public health. (7) The Government should amend outdated legislation so that practitioners have the right to refer the laboratory, such as blood tests, stool, urine, X-ray diagnosis, improve the diagnosis of the objective standard, so that the combination of syndrome differentiation with disease differentiation. (8) Strengthen the supervision of TCM, Chinese herbal medicine and Chinese medicine products to establish the registration, registration and monitoring system, in particular, establishment of "quality standards for Chinese herbal medicines used in Hong Kong. " Chinese medicine to enhance the quality of services, and enhance the public's confidence in Chinese medicine, Chinese herbal medicines in Hong Kong while promoting exports. (9) Hong Kong as soon as possible and vigorously carry out applied research in medicine, especially the standardization of Chinese medicine and Chinese medicine research and development of new products and the establishment of Chinese medicine information database to enhance Hong Kong in Chinese medicine research and product development of international competitiveness. (10) Hong Kong needs through domestic and international cooperation, carried out in medical education, research and technology development, make our own weaknesses.
引文
[1]谢永光.香港中医药史言话.三联书店(香港)1998
[2]谢永光.香港中医药百年沧桑“J”.中华医史杂志,1997 27(3)129-137
[3]束华三院一百三十年香港：该院,[2000]212页
[4]陈永光.回归前夕话香港中医药“J”.厦门科技,：32
[5]铿锵集.中医传承[录影资料].香港：香港电台电视部,1999(23分)
[6]王如跃.香港中医药之回顾与前瞻.医学与哲学2000,5(21)：34-54
[7]庄永竞.略论香港中药业发展的对策“J”.中医药管理杂志,1997 7(3)：15-16
[8]新闻稿.香港特区政府公布《中医药条例草案》“J”.湖南中医药导报,1999,5(7)：
[9]周超凡.建议成立香港中医医院“J”.中医药管理杂志,1996,6(4)：48-49
[10]林立佳,苏晶.香港中医教育现状与展望“J”.中医教育,2002,4(21)：49-51
[11]刘舂光.香港的中医教育现状与展望趋势“J”.中医教育,1997,4(16)11,17
[12]江润祥,车镇涛.香港中医药展望“J”.家庭中医药,23-29
[13]梁挺雄.香港的中医药发展“J”.南京中医药大学学报,2004,20(6)：123,223,323
[14]郭素华,张晖.香港中医药的现状及展望趋势“J”.福建中医学院学报,2002,12(1)：64-65
[15]陈抗生.香港中医药的现状舆展望“J”.世界中医药,2007,2(2)：20-22
[16]龚琼模.访问香港中医药界见闻“J”.江西中医学院学报,1997,9(1)：38
[17]香港中医药管理委员会网页
[18]二零零九年香港的中医药业特刊,2010年香港统计处
[19]二零零八年香港的中医药业特刊,2009年香港统计处
[20]二零零七年香港的中医药业特刊,2008年香港统计处
[21]二零零六年香港的中医药业特刊,2007年香港统计处
[22]二零零五年香港的中医药业特刊,2006年香港统计处
[23]二零零四年香港的中医药业特刊,2005年香港统计处
[24]二零零三年香港的中医药业特刊,2004年香港统计处
[25]沈志祥,黄璐琦.关于香港地区发展中药业的探讨“J”.中国中医药信息杂志,1999,6(12)：76-77
[26]新华社.香港发展中医药的四大方向“J”.中国中医药信息,2002,9(7)：61
[27]陈克敏,胡秀清.香港特别行政区振与中医策略初“J”1999,10(8)：
[28]宋景政,徐宏喜.香港中药注册制度和研究开发概况“J”.亚太传统医2005,1(20)：17-20
[29]1997年香港政府施政报书
[30]2005年香港政府施政报书
[31]2009年香港政府施政报书
[32]2001年香港政府施政报书
[33]张水生.香港执业中医师及中医教育现状“J”.中医教育,1994,2：45-46
[34]新闻稿.香港特区政府公布《中医药条例草案》“J”,1999,5(7)：
[35]2009年香港政府施政报书