羅綸謙 財團法人彰化基督教醫院

台灣為中醫知識與臨床技能發展的核心地區，然而長年以來臨床醫師對於中醫診斷相關名詞的客觀解釋卻很難有一致性的共識。為使病患獲得客觀、明確且科學化的中醫服務，建立統一的診斷規範，應是台灣中醫界現今除醫療服務外首要的任務。因此，本研究擬透過醫學中心中醫部專家學者，討論溝通凝聚共識的方式，建構出中醫症狀術語的標準化共識。目前台灣中醫臨床治療以辨證論治為主，辨證論治以中醫四診症狀的擷取為依據，來進行病因病機的分析，中醫四診症狀的判定標準直接決定了辨證的一致性與精準度，長期以來，台灣和大陸中醫專家對症狀術語及診斷基準的研究一直沒有建立共識，臨床上完全依賴醫者的學識與經驗而定，若辨證標準無法客觀統一，不僅在研究或溝通上均有困難，也造成在中醫學術傳承與臨床研究上的困境，將嚴重影響中醫學術發展的延續性及中醫研究論文在國際上的可信度。清‧吳謙等著《醫宗金鑑‧四診心法要訣》中指出“望以目察，聞以耳占，問以言審，切以指參。明斯診道，識病根源，能合色脈，可以萬全。”指出醫者要識萬病之根源，就必須明白掌握望聞問切的診斷技巧，並將所獲取的症狀進行病機的分析，即所謂的四診合參，則臨床的識病辨證才能萬舉萬當。可見“明斯診道”是何等重要，讓醫者對診斷技巧能有一致性與客觀性，並提高症狀操作及判定的精準度，並建立中醫四診症狀判定的操作規範將是當務之急。而未來操作規範的建立，可在臨床上建立中醫學術基礎的共同語言，當症狀以及診斷流程均能有一致化、標準化的定義及操作後，才能進一步讓中醫界能有共識性的語言，並讓中醫持續朝實證醫學邁進，在國際上發光發熱。 本研究期望建立症狀作業標準流程，由各醫學中心中醫部門臨床醫師組成專家小組制定症狀術語之定義和作業規範，經由定期月會討論取得共識，並且舉辦全國性的研討會，發表專家共識並取得各方意見，進而產生凝聚台灣中醫界共識之中醫症狀診斷術語。

關鍵詞：中醫、症狀、診斷、標準化

The Consensus of Standardization Operational Procedure for Terminologies in Traditional Chinese Medicine Symptom

Lun-Chien Lo Changhua Christian Hospital

It is the core region of traditional Chinese medicine（TCM）knowledge and the development of clinical skills in Taiwan, however, clinicians have different views on the definition and interpretation of the terminology of traditional Chinese medical diagnosis for many years. To enable patients to obtain an objective, clear and scientific TCM services, it is an important mission to integrate differences and establish a unified diagnostic criterion in Taiwan. Therefore, it will build a standardized diagnostic terminology of TCM symptoms by this study through forming a consensus. Currently, the treatment based on syndrome differentiation and disease differentiation is a characteristic of TCM in Taiwan.The syndrome differentiation and treatment is on the basis of the four diagnoses in TCM to analysis the etiology and pathogenesis. The criteria of the four diagnoses in TCM determine the consistency and accuracy of syndromes differentiation. The diagnosis of diseases differentiation with the modern medicine is objective and accurate. For a long time, the Chinese medicine scholars in Taiwan and the mainland China made many contributions to the study about the benchmark of syndrome diagnosis, however, the skills of the diagnosis and definition of the terminology in TCM has not been a consensus and standard. The four diagnoses depend by the doctors’ knowledge and experience. Thus, the development in TCM and the quality of research papers will be affected in the heritage of TCM and clinical research. The main contents of diagnostics of Chinese medicine are the four examinations and the eight principles. The four examinations are the methods of understanding the condition of the patient including inspection, listening and smelling, inquiry and palpation. it is important to enable doctors to have the consistency and objectivity of diagnostic skills and to improve the accuracy of diagnostic the symptoms. So, it is priority to establish operative skills of four diagnostic symptoms in TCM. In the future, we need to unify the clinical TCM terms by operation specifications to enable to make the "quantitative" and "internationalization" possible. When a large number of research results are based on the same harmonization and standardization operation, it may be closer to the goal of evidence-based medicine. In this study, we expect to unify the standardization of operational procedure for diagnostic terms in traditional Chinese medicine symptom and formulate the definition of symptom terms and the operational specifications by panel meeting composed of the experts from department of Chinese Medicine in medical center. We hope to form a consensus by a regular monthly meeting of discussion, get opinions from all sides by holding a national seminar, and reach a consensus of the standardization of operational procedure for diagnostic terms in TCM symptoms by the medical profession.