新型冠状病毒肺炎中医预防及诊疗方案汇总分析

An Analyze of The Traditional Chinese Medicine Prevention and Treatment Interventions For COVID-19

目的尽可能全面地汇总国家及各省、自治区和直辖市,多位中医临床专家的新型冠状病毒肺炎(简称新冠肺炎)预防及诊疗方案,为该病的预防和治疗提供参考。方法检索2020年2月1日(含)之前网页及中国知网、万方数据库、维普数据库,收集国家及各省、自治区和直辖市卫生健康委员会(卫健委)、国家中医药管理局(中管局)及各省份卫健委、中管局的新冠肺炎相关诊疗方案,国医大师、院士、知名中医临床专家等通过公开渠道发表的见解,制定资料提取表,由两名研究者按照纳入排除标准独立进行文献筛选、资料提取,并达成共识。在筛选和资料提取过程中遇到分歧时,提请第三人共同决策。资料提取表内容包括基本信息(来源、发布时间、发布机构)、病机病位、分期、治法治则、症状、舌脉、注意事项、用药方式、药物加减、制定方法。结果本研究共纳入2020年2月1日(含)之前国家卫健委、国家中管局及17个省份的新冠肺炎防治方案以及14位中医专家的个人见解。其中江西、广东、广西、湖南、吉林、云南6个省和自治区根据《新型冠状病毒感染的肺炎诊疗方案(试行第三版)》、河北、山东、天津、甘肃、上海5个省和直辖市根根据《新型冠状病毒感染的肺炎诊疗方案(试行第四版)》制定了诊疗方案。官方防治方案的制定方法主要是组织专家讨论形成。16个省、自治区和直辖市的防治方案是在本省出现确诊病例的时点后颁布的。共提供预防方药83种、医学观察期方案8个、临床治疗初期方案31个、临床治疗中期方案22个、重症期方案17个以及恢复期方案16个。结论各方对该疾病的认识病位主要在肺,病因病机多为疫戾之气,以"湿"为主,但细节不尽相同,证型和处方亦不同,体现了本病的复杂性。大部分省、自治区和直辖市均根据疾病的发展情况(预防期、观察期、临床治疗初期、临床治疗中期、重症期、恢复期)发布了相对应的治疗方案,既体现出中医在用于新冠肺炎的防治过程中的积极参与,又体现出中医治疗的整体观念和同病异治的理念。权威机构需要及时将应急时的经验性诊疗方案快速升级为循证临床实践指南,以更好地服务临床急需。

Objective To summarize as comprehensively as possible the traditional Chinese medicine(TCM)prevention and treatment interventions for COVID-19,to inform clinical practice,the public and health policymakers.Methods We searched internet web pages and online Chinese literature databases,such as CNKI、VIP and Wanfang Data,and included publicly available prevention and treatment opinions and interventions announced by the National and Provincial Health Commissions and administrations of Traditional Chinese medicine,as well as opinions of TCM clinical experts for the control of COVID-19 before February 1,2020(inclusive).We developed the data extraction form,and the authors in pair independently screened the relevant literature according to the inclusion and exclusion criteria,extracted data,reached consensus and the methods of development.Results This study included one national and 17 provincial’s prevention and treatment interventions and protocols,as well as personal opinions from 14 TCM experts before February 1,2020(inclusive).Among them,six(Jiangxi,Guangdong,Guangxi,Hunan,Jilin,Yunnan)were based on the national COVID-19 Diagnosis and Treatment Protocols(test version 3 rd)"and five(Hebei,Shandong,Tianjin,Shanghai,Gansu)were based on the national"COVID-19 Diagnosis and Treatment Program(test version 4 th)".The official treatment protocols were developed mainly based on organized expert discussions.Treatment protocols in 16 provinces were issued after confirmed cases in their provinces.Treatment options for the prevention period(83),medical observation period(8),early stage pneumonia(31),intermediate stage pneumonia(22),severe stage pneumonia(17)and recovery period(16)were identified and included.Conclusion Opinions on the affected organ of COVID-19 infections was the lung,TCM etiology and mechanism of disease onset and progression was mainly due to epidemic qi(Yi-li-zhi-qi)which was characterized as"dampness".However,there were discrepancies in details.Also,TCM syndromes and treatment protocols varied,which reflected the complexity of the disease conditions.With further understanding of the condition,the cognition of the disease may change and need to be continuously followed.In most provinces,the corresponding treatment protocols were developed to cover all clinical stages from prevention period to all the treatment stages.Authorities need to quickly update the existed protocols to be evidence-based guidelines to meet the urgent clinical requirements.