中西医结合视域下家庭医生对亚健康人群的健康管理

Family Doctor-Led Health Management for Sub-Healthy Populations in the Context of Integrated Traditional Chinese and Western Medicine

摘要: 目的：系统梳理中西医结合视域下家庭医生对亚健康人群健康管理的研究现状，明确亚健康管理的理论框架、干预方法及服务模式，识别当前研究中存在的热点与难点，为该领域的理论发展与实践优化提供参考依据。背景：亚健康已成为影响我国居民健康水平、加重慢性疾病负担的最突出公共卫生问题之一，我国家庭医生签约服务覆盖率稳步提升，但现有服务在亚健康干预领域存在服务同质化、干预不规范、人才短缺、机制不健全等问题。中西医结合的整体观念与“治未病”理念与亚健康的复杂性高度契合，将两者深度融合具有重要的现实基础与战略价值。方法：检索中国知网、万方数据、维普、PubMed、Web of Science及Cochrane Library等中英文数据库，检索时限为各数据库建库至2025年12月。纳入标准为：(1) 研究对象为亚健康人群或与亚健康高度相关的状态；(2) 涉及家庭医生、全科医生或基层健康管理服务；(3) 包含中西医结合评估、干预或管理方案；(4) 研究类型包括随机对照试验、队列研究、横断面调查、系统综述等。最终纳入28篇中英文文献进行系统分析。采用NOS量表、Cochrane RoB 2.0工具、AMSTAR 2工具及CASP检查表进行质量评价。结果：国外对慢性疲劳综合征、职业倦怠等亚健康相关状态已建立成熟的早期识别、分层评估和长期随访机制，数字化健康技术已得到广泛应用，部分国家已将中医理念与技术纳入基层全科服务流程。国内研究主要从五个方面展开：(1) 亚健康流行病学特征方面，城市中老年居民亚健康普遍存在，大学生检出率达51.2%，中青年职场人群高发；(2) 评估方法方面，当前以主观量表为主、缺乏客观指标，亚健康作为转化医学新维度的理论框架，中医体质辨识与西医指标融合建立多维亚健康风险评估模型；(3) 家庭医生服务方面，重点人群签约率达75%，但存在“重签约、轻履约”问题，干预方式单一、缺乏闭环管理机制；(4) 中西医结合干预效果方面，该模式在改善症状方面有显著效果；(5) 数字化应用方面，可穿戴设备应用尚处初级阶段，数据标准化和服务整合面临挑战。现有研究存在服务标准化缺失、卫生经济学评价滞后、数字化融合不足、人才机制不健全等关键瓶颈。结论：中西医结合家庭医生服务模式在亚健康早期识别、综合干预和连续性管理方面具有独特优势，能够有效改善亚健康症状、降低慢性病发病风险。建议未来着力构建标准化服务规范、完善人才培养与激励机制、加速推进智能化健康管理平台建设、深入开展卫生经济学评价研究，为提升基层健康服务质量、助推医疗卫生服务模式向健康为中心转型、实现“健康中国”目标提供理论支撑和实践路径。

Abstract: Objective: To systematically review the current research landscape of family physician-led health management for sub-health populations through the lens of integrated traditional Chinese and Western medicine, to delineate the theoretical frameworks, intervention modalities, and service models of sub-health management, and to identify prevailing research hotspots and challenges, thereby providing an evidence-based reference for theoretical advancement and practical optimization in this field. Background: Sub-health has emerged as one of the most pressing public health concerns affecting the overall health status of Chinese residents and exacerbating the burden of chronic diseases. While the coverage rate of contracted family physician services in China has steadily increased, existing services are confronted with considerable challenges in sub-health intervention, including service homogenization, non-standardized interventions, shortage of qualified personnel, and inadequate institutional mechanisms. The holistic paradigm of integrated traditional Chinese and Western medicine, together with the principle of “preventive treatment of disease” (Zhi Wei Bing), aligns intrinsically with the complexity of sub-health conditions. The deep integration of these two approaches thus holds substantial practical significance and strategic value. Methods: A comprehensive systematic search was performed across Chinese and English databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science, and the Cochrane Library, covering the period from database inception to December 2025. Studies were eligible for inclusion if they met the following criteria: (1) study populations comprised individuals with sub-health status or conditions closely related to sub-health; (2) studies addressed family physicians, general practitioners, or primary health management services; (3) studies incorporated integrated traditional Chinese and Western medicine assessment, intervention, or management protocols; and (4) study designs included randomized controlled trials, cohort studies, cross-sectional surveys, systematic reviews, and other relevant types. A total of 28 Chinese and English-language studies were ultimately included for systematic analysis. Quality appraisal was conducted using the Newcastle-Ottawa Scale (NOS), the Cochrane Risk of Bias 2.0 tool (RoB 2.0), the AMSTAR 2 instrument, and the Critical Appraisal Skills Programme (CASP) checklists. Results: Internationally, mature mechanisms for early identification, stratified assessment, and long-term follow-up have been established for sub-health-related conditions such as chronic fatigue syndrome and occupational burnout. Digital health technologies have been widely adopted, and several countries have incorporated traditional Chinese medicine concepts and techniques into primary general practice service workflows. Domestic research has primarily concentrated on five domains: (1) Epidemiological characteristics of sub-health: Sub-health is highly prevalent among urban middle-aged and elderly residents, with a detection rate of 51.2% among university students and a particularly high incidence among young and middle-aged working populations. (2) Assessment methodologies: Current approaches rely predominantly on subjective scales and lack objective biomarkers. A theoretical framework positioning sub-health as a new dimension of translational medicine has been proposed, and multi-dimensional sub-health risk assessment models integrating traditional Chinese medicine constitution identification with Western medicine indicators have been developed. (3) Family physician services: The contracted service coverage rate for key populations has reached 75%; however, problems persist, including an emphasis on contract signing over contract fulfillment, monotonous intervention approaches, and the absence of closed-loop management mechanisms. (4) Effectiveness of integrated traditional Chinese and Western medicine interventions: This model has demonstrated significant efficacy in alleviating sub-health symptoms. (5) Digital health applications: The application of wearable devices remains at an early exploratory stage, and data standardization and service integration present ongoing challenges. Critical bottlenecks identified across existing studies include the lack of service standardization, lagging health economics evaluation, insufficient digital integration, and underdeveloped talent cultivation mechanisms. Conclusion: The integrated traditional Chinese and Western medicine family physician service model demonstrates distinctive advantages in the early identification, comprehensive intervention, and continuous management of sub-health, effectively ameliorating sub-health symptoms and reducing the risk of chronic disease onset. Future efforts should prioritize the establishment of standardized service protocols, the refinement of talent cultivation and incentive mechanisms, the accelerated development of intelligent health management platforms, and the in-depth implementation of health economics evaluation research. These endeavors will provide theoretical support and practical pathways for enhancing the quality of primary health services, facilitating the transformation of the healthcare delivery model toward a health-centered paradigm, and achieving the “Healthy China” strategic goal.