A Unified Concept of Health and Disease
A Unified Concept of Health and Disease
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健康与疾病的统一概念
DOI：
10.1353/pbm.1960.0020
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发表时间：
2015
影响因子：
1
通讯作者：
G. L. Engel
中科院分区：
文献类型：
--
作者：
G. L. Engel
从最广泛的意义上讲，医学关注的是健康和疾病问题，更具体地说，关注的是维持健康或疾病发展的机制和过程。健康和疾病是相对的概念，不容易给它们下简单的定义。Romano提出了以下表述(2)：“健康和疾病不是静态的实体，而是生命的各个阶段，在任何时候都依赖于由设备维持的平衡，由基因和经验决定，旨在满足需求，适应和控制可能来自生物体内部或外部的压力。”从积极意义上说，健康是指机体保持平衡的能力，在这种平衡中，机体可以合理地免于过度的痛苦、不适、残疾或行动限制，包括社交能力。”疾病对应于有机体作为一个整体或其任何系统的生长、发育、功能和调整方面的失败或干扰。显然，这样的定义过于宽泛，没有实际价值。此外，它还包括价值术语——“合理自由”、“故障”、“干扰”——但没有对它们进行定义。尽管如此，它作为一个起点还是很有用的，因为它没有限制我们使用任何一个参数。例如，它与疾病的细胞概念形成对比，细胞概念主要关注细胞内部的变化作为疾病的基本组成部分，实际上限制了对一个方面的关注
I. Unitary Concept ofHealth and Disease versus Unit-Causes Medicine is concerned in the broadest sense with the problems ofhealth and disease and, more specifically, with the mechanisms and the processes whereby health is maintained or disease develops. Health and disease are relative concepts which do not easily lend themselves to simple definition. Romano has proposed the following formulation (2): "Health and disease are not static entities but are phases of life, dependent at any time on the balance maintained by devices, genically and experientially determined, intent on fulfilling needs and adapting to and mastering stresses as they may arise from within the organism or from without. Health, in a positive sense, consists in the capacity of the organism to maintain a balance in which it may be reasonably free of undue pain, discomfort, disability or limitation of action, including social capacity." Disease corresponds to failures or disturbances in the growth, development, functions, and adjustments of the organism as a whole or of any of its systems. Clearly, such a definition is too broad to be of practical value. Further, it includes value terms— "reasonably free," "failures," "disturbances"—without defining them. Still, it is useful as a starting point since it does not restrict us to any one parameter. It is to be contrasted, for example, to the cellular concept ofdisease, which, by focussing primarily on changes within the cell as the basic component ofdisease, actually restricted attention to only one aspect