医学到底可以有多少种体系？

中国人的答案是：两种，西医和中医（中华传统医学）；印度人的答案或许是：两种，西医和印医（印度传统医学）。

古老的印度文明是东方文明的重要组成成分和骄傲，在历史上，古印度文明对中华文明产生过深远的影响，无论是宗教，建筑，绘画还是天文。如果客观点讲，中华文明在相当领域师从于印度文明。只是当前，因边界瓜葛让彼此不睦，侧脸无视那些事实罢了。

下文是Priyanka Pulla发表在science上的一篇深度分析，作者力图立场“中立”，行文“客观”，但从中不难看出时下印度传统本草医学扶正自身以实现“科学化”之艰难。面对强势的现代西方医学，印度传统医学也如我中华传统医学一样，在打一场“生死攻坚战”。我中华传统医学追崇者难道不有同病相怜，有物伤其类之感？如若如此，也算这篇翻译为时下倡导的“中印友好”做了点贡献吧，即便它是一个副产物，原非本意。

多少世纪以来，印度传统医学的从业者们（被称作Ayurveda）依照一套程序来给患者分类，他们不是从症状、家族史或是关键体征入手，而是从确定人的“质”（prakriti），或叫身体类型（body type）开始。这种“质”体现的是三种神秘的体液（humors）：风型（windy）、胆汁型（bilious）和冷淡型（phlegmatic）的组合。印度传统医学的大夫要使用一种问卷，通过评估100多项特征指标将病人归于某种“质”，指标包括从关节的力量、对冷的敏感度到性情、抗应激能力等。基于对病人“质”的判断，对不同“质”而患相同疾病的人，处理的方式有显著的差别。

这种方式与西方医学完全不同，但在印度本土却十分流行，而且印度政府积极支持、力图证明印度传统医学是一种可靠的科学。在政府强力支持下，一个叫做“阿育基因组学”（ayurgenomics）的学科在印度多家顶级研究机构中为很多研究者所追捧，包括印度科学院（Indian Institute of Science）和海德拉巴细胞与分子生物学中心（Centre for Cellular & Molecular Biology）等。而且已经有“关于印度传统医学质这类表型的遗传基础”的相关文章发表。来自新德里基因组学和整合生物学研究所（Institute of Genomics & Integrative Biology）的细胞生物学家，从事阿育基因组学研究的Mitali Mukerji说：“我们正在让印度传统医学跟上时代的步伐”。

他们的奋斗却在西方医学界激起了层层批评的声浪。批评人士质疑为在印度传统医学调制的草本混合物中获取药物所做的努力，这些尝试常以失败告终。前些年，因在其非处方药料中检出重金属而使印度传统医学遭受重创。据新德里印度国家免疫学研究所的免疫学家Satyajit Rath说：“其它事件还包括生物医药工业在拆分复杂的印度草本配方中遇到巨大困难”。密歇根底特律Wayne州立大学的肿瘤生物学家David Gorski认为，“印度传统医学所持的论据本身就不是科学的，这侵蚀了所有试图基于这套理论而进行的研究（具有科学性的可能）。”“你可以拿伪科学研究采集的样本做基因组学，但别指望得到科学的结果”。

印度中央政府却对此满腔热情。2007年，政府为阿育基因组学研究提供了充足的资金，2012年批准了五年支持计划（至2017年），拨款$1.6千万支持该类研究。看来资助没有削弱的迹象，在一项竞选声明中，当前执政党表示阿育基因组学处在优先资助的选项中。“资助经费不会短缺”，前科学与工业研究局（Council of Scientific and Industrial Research）局长，阿育基因组学的拥护者Samir Brahmachari说。

阿育基因组学在2008年吸引了关注的目光，那是因为Mukerji研究团队报道说印度传统医学三种纯粹的“质”（即由单一体液主导的身体类型）与基因表达相关：不同“质”者其代谢、心血管、免疫和精神疾病相关基因的表达显著差异。Kapha“质”者其甘油三酯、胆固醇和其它心血管疾病相关标志物的水平更高，这与印度传统医学典籍所言Kapha“质”者更易患心脏病的论点完全吻合。怀疑论者则迅速给予回击，指出所谓的Kapha“质”者多数体型肥胖，仅此即可解释易患心脏病的倾向性。

尖锐的批评并未吓阻Mukerji，他们的团队2010年在Proceedings of the National Academy of Sciences上报道指出：Kapha“质”个体的一个基因变异与一型急性高空病的发生密切相关。其它变异形式多在非Kapha“质”个体中出现，因此非Kapha“质”个体能承受更高的海拔高度。质疑者认为 “质”的定义过于宽广难于据此进行基因相关研究。位于西孟加拉州生物医学基因组学国家研究所（National Institute of Biomedical Genomics）的人群遗传学家Analabha Basu认为： Mukerji团队虽然做了坚实的研究工作，但是如果他们将精力用于研究基因变异与人体表型相关性上回得到更具洞察性的结果，如果你能确定、揭示kapha“质”下某一表型的某一特征基因，你将更具有预测力。

来自阿育基因组学的最新报道还引来另外一种关注：是否他们的研究得到了充分的匿名评阅。上个月，阿育基因组学强有力的支持者，来自Manipal大学的心外科医师M. S. Valiathan发表了他的第一项试图将“质”分类与西方医学参数，诸如体重指数，关联起来的文章，这篇文章发表在印度传统医学与整合医学杂志（Journal of Ayurveda and Integrative Medicine）上，文章的一些作者也是该杂志的编辑。“难道他们就不能在其它杂志上发表吗？”印度科学院肿瘤生物学家K. Somasundaram质疑说。Pune大学的生物化学家Bhushan Patwardhan则认为这种质疑很不公平，“我作为文章作者之一只是一种巧合，将文章投递到这个杂志是文章主要作者的决定，而且文章符合常规的匿名评阅流程”。

阿育基因组学支持者已习惯于面对质疑。Mukerji坚持认为找到基于古老印度传统医学典籍的预测性和“质”的遗传学倾向性间的交汇点十分重要。在现代医学中，她说，“你不能通过观察一个健康人来预测他将倾向于患何种疾病，因为没有办法将健康人分类”。知名的基因组生物学家Brahmachari认为：越来越多的发现让他对阿育基因组学在这场辩论中最终胜出持乐观态度，“我们希望更多的人参与到这个领域中来，让它成为一项运动”。

全文链接：http://www.sciencemag.org/content/346/6208/410.full

文题：Searching for science in India's traditional medicine

For centuries, practitioners of Indian traditional medicine, or Ayurveda, have followed a standard protocol for sizing up patients. They don't start with symptoms, family history, or vital signs. Instead they identify a person's prakriti, or body type, which reflects a combination of three mystical humors: windy, bilious, and phlegmatic. To assign a prakriti, an Ayurvedic physician uses a questionnaire to assess more than 100 attributes, from joint strength and cold sensitivity to temperament and stress tolerance. Depending on the prakriti, treatment for the same illness can differ markedly.

The approach is alien to Western medicine, but the Indian government is pushing hard to show that Ayurveda, which remains popular throughout India, is based on sound science. With hefty government support, the nascent field of “ayurgenomics” has roped in dozens of researchers from leading institutions such as the Indian Institute of Science here and the Centre for Cellular & Molecular Biology in Hyderabad. And it has published papers on the genetic bases of Ayurvedic traits, some of them in leading journals. “We are trying to contemporize Ayurveda,” explains Mitali Mukerji, a molecular biologist who leads ayurgenomics research at the Institute of Genomics & Integrative Biology in New Delhi.

The effort has also stirred a rising chorus of criticism. Skeptics point to failed attempts to derive drugs from the herbal concoctions used in Ayurveda and other schools of traditional medicine. Ayurveda itself got a black eye several years ago after heavy metals were detected in some over-the-counter preparations. Another issue, says Satyajit Rath, an immunologist at the National Institute of Immunology in New Delhi, is that the biomedical industry has a tough time unraveling complex herbal preparations. To David Gorski, a cancer biologist at Wayne State University in Detroit, Michigan, the premise of prakritis is unscientific, which undermines any studies that rely on them. “You can do genomics on samples collected in studies of pseudoscience,” he says, “but that doesn't make it science.”

India's central government, on the other hand, has shown ample enthusiasm. It provided seed funding for ayurgenomics in 2007, and then in 2012 earmarked $16 million to the field for the 5-year plan ending in 2017. That support is unlikely to abate: In a campaign manifesto, the current ruling party cited ayurgenomics as a priority. “There is no shortage of funding,” says ayurgenomics adherent Samir Brahmachari, former director-general of the Council of Scientific and Industrial Research.

Ayurgenomics drew attention in 2008, when Mukerji's team reported that people categorized into the three “extreme” prakritis—body types dominated by a single humor—showed differences in expression of several genes implicated in metabolic, cardiovascular, immune, and psychiatric diseases. Biochemical markers such as lipid profiles were also strikingly different across the three body types. People with a kapha prakriti, in particular, had higher levels of triglycerides, cholesterol, and other known markers for cardiovascular disease, which jibes with Ayurvedic texts linking kapha prakriti with a higher susceptibility to heart disease. Skeptics, however, were quick to point out that people with that prakriti tend to be obese, thus explaining any propensity for heart disease.

Undeterred, Mukerji's group followed up with a 2010 report in the Proceedings of the National Academy of Sciences showing that a gene variant linked to an acute form of altitude sickness occurs more frequently in the kapha prakriti. Another variant that helps people tolerate high altitudes was more prevalent in a different prakriti, the group found. But skeptics argue that the concept of prakriti is at best too broad for gene-association studies. Analabha Basu, a population geneticist at the National Institute of Biomedical Genomics in West Bengal state, says that although Mukerji's team does solid work, their findings could be more insightful if they were to hunt for associations between gene variants and individual traits. “If you could directly characterize the gene with one of the traits of kapha, you might find a stronger association with better predictive power,” Basu argues.

The latest report from the ayurgenomics frontier raises another concern: whether studies are receiving adequate peer review. Last month, a team including one of the field's most visible backers, cardiac surgeon M. S. Valiathan of Manipal University, published the first attempt to yoke prakriti classification to scientific measures such as body mass index. But the report appeared in the Journal of Ayurveda and Integrative Medicine, and some of the authors are also editors of the journal. “Couldn't they find another journal to publish it in?” asks K. Somasundaram, a cancer biologist at the Indian Institute of Science. That criticism is unfair, responds Bhushan Patwardhan, a biochemist at the University of Pune. “My being a co-author is incidental,” he says. “The submission to the journal was done by the lead author of the paper, which has been processed through the routine peer-review process.”

Proponents of ayurgenomics are used to facing skepticism. But Mukerji insists that “striking” parallels between predictions in ancient Ayurvedic texts and genetic propensities of prakritis will prove important. In modern medicine, she says, “you aren't able to look at a healthy person and say he may be prone to a particular disease, because there is no way of stratifying healthy people.” Brahmachari, a well-respected genome biologist, says the accumulation of findings leaves him optimistic that ayurgenomics will win over critics. “We hope more people will start working in this field and it will become a movement,” he says.

上文由群晓科苑翻译整理，科学推广，服务民众。他人或机构如需使用，请提供该原始链接地址。

北京群晓科苑生物技术有限公司主要经营生物医药领域的试剂、耗材和仪器。群晓生物致力于为用户提供优质的材料、技术和实验整体性解决方案，完美配合用户的科研创意和灵感。群晓生物立志把一流的产品、专业的技术和完善的售后服务献给广大用户。

北京群晓科苑生物技术有限公司

www.qbioscience.com

www.qbiotec.com

Tel: 010-84504282/64880108

qbioscience@126.com