全國中醫師醫療院所感染管理控制研究計畫北區子計畫 (2-2)

楊賢鴻
長庚紀念醫院
隨著醫學發展的日新月異，對於疾病的認識及治療更是發展迅速，但是對於所謂新興傳染病的防治包括禽流感、漢他病毒、腸病毒、及最近才發生的嚴重性呼吸道症候群（SARS）等，造成公共衛生防疫及治療上的衝擊，仍是有待努力。尤其是SARS，在醫療史上的流行是史無前例的，更造成全人類生命及公共衛生上的威脅，也顛覆了以往傳染病治療的經驗法則。所謂「院內感染」（nosocomial）是指住院期間得到的感染，但不包括入院時即有或已潛伏的感染。廣義的對象包括住院病人、門診病人、以及院內工作人員。陽明醫院的院內感染看護工事件更將醫院感染管制的範圍擴大至所有在醫院工作的人員，不僅僅只是醫院編制內的員工而已。中醫藥是幾千年來中華文化的結晶，更是祖先遺留下來寶貴的財產，中國傳統醫學源遠流長，數千年來在與病毒性感染性疾病的對抗中累積了豐富的經驗，中國醫學對抗疫疾已有三千多年的經驗，從典籍文獻的記載中，影響較大的疫疾包括鼠疫、傷寒、霍亂、流感、肺炎、腦炎、瘧疾、痢疾、天花、麻疹、白喉、猩紅熱、寄生蟲等疾病。而中醫學也從嚴酷的疫疾打擊中不斷修正與發展。中醫對傳染性疾病稱為疫病。在《黃帝內經》《素問．熱論篇》說：“五疫之至，皆相染易，無問大小，症狀相似。”明代吳又可《溫疫論》對疫病的病因認為是“乃天地間別有一種異氣所感”，把袪邪作為治疫第一要務，創著名方劑達原飲。清代葉天士、吳鞠通等醫家，對溫病的病因、傳變規律和防治方法都有卓越貢獻，並認為溫疫應包括在溫病範圍之內。其後還有戴天章《廣溫疫論》、楊栗山《傷寒溫疫條辨》、余師愚《疫疹一得》，在吳又可學說基礎上，對疫病的理論和臨床作了補充和發展。近年來，由於中醫可彌補現有西醫治療未全之處，因此有漸漸受到世界各國的注意，在國內，民眾對中醫的接受度也普遍提升，但台灣中醫過去數十年來，因中醫臨床長期侷限於基層醫療工，導致中醫醫療對於疾病的確切診斷，治療過程中的追蹤及統計都無法落實，更遑論醫療院所有關院內感染管控之觀念。
關鍵字：院內感染；SARS；溫病；溫疫

The Infection Control Programe for Traditional Chinese Medicine Clinicle and Hospital –North Areal(2-2)

Sien-Hung Yang
Center of Traditional Chinese Medicine, Chang Gung Memorial Hospital
With the development of Medicine, the evolve to cognition and therapy the disease is more quickly. To avoid the newly coming disease which include bird influenza,HBHanta virus,HBEnterovirus and SARS, cause the impact to the public sanitation and the therapy. Its still need to improve. Especially the SARS, prevailing in the medical history which is never been happened. It caused the threat for our human beings and the public sanitation, also overturn the experience method to cure the infection. Alleged that nosocomial means the duration of hospitalized infect, but not include infects before hospitalize. Broadly speaking, the Yung-Ming hospitals nursing event even makes the infection control management enlarged to all staff in the hospital. The Traditional Chinese Medicine is the crystal of our Chinese culture, its the treasure that our ancestor bequeath. With Thousands of years, the Traditional Chinese Medicine had been accumulative plentiful experience in competing virus. In recent years, the Traditional Chinese Medicine remedies the imperfect of the western medicine. Generally, the populaces acceptance degree of the Traditional Chinese Medicine is also promoted. In the past decade of Taiwan, because of the Chinese Medical Clinics have the problems of definitely diagnosis, the trace and statistics cant be ascertain, not to say the nosocomial control management.
關鍵字：Nosocomial；Sars；Warm disease；Warm epidemic