结合中医疮疡理论辨证论治惠州地区新型冠状病毒感染的疗效观察

Observation on the Clinical Effect of Syndrome Differentiation and Treatmentof Novel Coronavirus Infection in Huizhou Area Based on Sore andUlcer Theory of Traditional Chinese Medicine

【目的】观察结合中医疮疡理论辨治惠州地区新型冠状病毒感染(简称新冠感染)的疗效。【方法】基于对新冠感染的病因病机、症状及传变特点与中医疮疡理论高度契合的认识,运用疮疡理论“早期透、中期清、晚期补”(简称“透、清、补”)的辨证思路制定新冠感染诊疗方案,即:早期风热犯肺证予解表祛邪消毒方(银翘散加减)治疗,中期痰热蕴肺证予清热化痰托散方(麻杏石甘汤合桑白皮汤加减)治疗,后期气阴两虚证予益气养阴扶正方(生脉散合沙参麦冬汤加减)治疗。回顾性观察其对本院收治的能坚持中医药治疗且临床资料完整的58例惠州地区新冠感染患者的治疗效果。【结果】(1)中药使用情况:58例新冠感染患者共接受中医诊疗186次,患者的平均住院天数为(16.12±6.39)d,平均服用中药天数为(11.80±5.90)d,中药治疗的总有效率达100%。(2)症状改善情况:首发症状为发热者36例(占62.07%),平均体温为(38.53±0.56)℃,退热天数为1~12 d,平均(2.93±2.76)d;其他症状如恶寒、咳嗽、咯痰、气喘气促、乏力不适、头晕头痛、肌肉酸痛、鼻塞流涕等经治疗后均显著改善。(3)核酸转阴情况:经治疗后,58例患者核酸全部转为阴性,平均核酸转阴时间为(7.07±3.73)d。(4)影像学改善情况:胸部CT或胸片检查提示肺部有病变者55例(占94.83%),经治疗后,肺部病变改善吸收时间为(6.84±3.30)d。【结论】新冠感染患者在病因病机、症状及传变上与中医疮疡理论高度契合,结合疮疡理论,辨证运用“透、清、补”法进行治疗,能有效改善新冠感染患者临床症状,防止患者由轻症转为重症。

Objective To observe the clinical efficacy of syndrome differentiation and treatment of novel coronavirus 2019 infection(2019-nCoV infection)in Huizhou area based on sore and ulcer theory of traditional Chinese medicine(TCM).Methods For the etiology,pathogenesis,symptoms and transmission of 2019-nCoV infection were highly compatible with the sore and ulcer theory in the field of TCM,we made the protocol of the diagnosis and treatment of 2019-nCoV infection by expelling pathogens in the early stage,clearing lung phlegm and heat in the middle stage,and supplementing qi and yin in the late stage.In the early stage,the patients were predominated by the syndrome of wind-heat attacking the lung,and could be treated with the formula derived from modified Yinqiao Powder for relieving exterior,eliminating pathogens and removing toxin;in the middle stage,the patients were predominated by the syndrome of phlegm-heat accumulating in the lung,and could be treated with the formula derived from modified Maxing Shigan Decoction plus Sangbaipi Decoction for clearing heat and resolving phlegm,and expulsing and expelling the pathogens;in the late stage,the patients were predominated by the syndrome of both qi and yin deficiency,and could be treated with the formula derived from Shengmai Powder plus modified Shashen Maidong Decoction for invigorating qi,nourishing yin and supporting healthy qi.The therapeutic effect of 58 cases of 2019-nCoV infection admitted to Huizhou Municipal Central People’s Hospital who were able to adhere to TCM treatment and whose clinical data were complete were retrospectively observed.Results(1)Use of Chinese medicine:58 patients with 2019-nCoV infection received a total of 186 consultations with Chinese medicine.The average hospitalized time was(16.12±6.39)days,and the average medication time for taking Chinese medicine was(11.80±5.90)days.The total effective rate of Chinese medicine treatment reached 100%.(2)Improvement of symptoms:The first symptom was fever in 36 cases(62.07%),and the average temperature was(38.53±0.56)℃;the antipyretic time was 1-12 days,with an average of(2.93±2.76)days.Symptoms of aversion to cold,cough,expectoration,dyspnea and shortness of breath,fatigue,dizziness,headache,muscle aches,nasal congestion and runny nose were all significantly improved after treatment.(3)Nucleic acid conversion:After treatment,the nucleic acid of all the 58 patients became negative,with the mean time to negative-conversion of nucleic acid being(7.07±3.73)days.(4)Improvement in imaging changes:55 cases(94.83%)had pulmonary lesions indicated by chest CT or chest X-ray imaging before treatment,and the pulmonary lesions were improved after treatment,the average time for inflammation absorption being(6.84±3.30)days.Conclusion The etiology,pathogenesis,symptoms and transmission of 2019-nCoV infection patients are highly compatible with the sore and ulcer theory in the field of TCM.According to the sore and ulcer theory,the application of expelling,clearing and tonifying therapies based on the syndrome differentiation for the treatment of patients with 2019-nCoV infection is effective to improve the clinical symptoms and to prevent from the mild cases developing into serious cases.