从戾气学说谈新型冠状病毒肺炎的中医诊治

Discussion About Diagnosis and Treatment of COVID-19 with TCM Based on Theory of Epidemic Pathogens

新型冠状病毒,传染性强,人感染后出现的症状相似,且病情变化迅速,病死率较高,与中医学所述之戾气相似。从此次戾气致病的临床表现来看,为寒湿疫,侵犯人体途径为侵卫犯肺,直犯营血,逆传心包,邪气也可直趋中道,伏于膜原。病情传变可由表入里,又窜走六经、三焦。新型冠状病毒肺炎是一种急性感染性肺炎,在疾病发展不同时期,表现症状略有不同。早期病机为湿毒郁肺,枢机不利,宜化湿解毒、宣肺行气,方选藿朴夏苓汤合三仁汤、小柴胡汤加减;中期病机为热毒闭肺,腑气不通,宜清热宣肺、通腑泻热,方选麻杏石甘汤合黄连解毒汤加减;极期病机为内闭外脱,宜开闭固脱、清热救逆,方选四逆汤合安宫牛黄丸、紫雪丹加减;恢复期病机为气阴两虚,肺脾两虚,余邪未尽,宜益气养阴,补脾肺,祛余热邪毒,方用二陈汤合参苓白术散、王氏清暑益气汤加减。在预防方面,应提高人体自身免疫力,可用玉屏风散加味益气固表。

The novel coronavirus is highly infectious and has similar symptoms after human infection,and its condition changes rapidly and the mortality rate is relatively high,similar to epidemic pathogens in TCM.According to Wuhan climatic environment and the clinical manifestations of COVID-19,Wuhan's epidemic pathogens are caused by cold-damp plague.The route of invading human body is from defense qi to the lung,directly attacking ying-blood,reversely transmitting the pericardium.Epidemic pathogens may also move towards the middle way and hide in the membrane.The disease can be transmitted from the exterior to the interior,and then to the six meridians and triple energizer.COVID-19 is a kind of acute infectious pneumonia,with slightly different symptoms in different stages of disease development.In the early stage,the pathogenesis is dampness and toxicity stagnated in the lung,and the axis is unsmooth,so the treatment should focus on resolving dampness and removing toxicity,dispersing lung-qi and promoting qi circulation.Modified Agastache and Magnolia and Pinellia and Poria Decoction combined with Three Kernels Decoction and Minor Bupleurum Decoction can be chosen.In the middle stage,the pathogenesis is toxic heat blocking the lung leading unsmooth fu qi,so the treatment should focus on clearing away heat and dispersing lung-qi,dredging bowels and purging heat.Modified Ephedra and Apricot Kernel and Gypsum and Licorice Decoction combined with Coptis Toxin-Resolving Decoction can be chosen.In the extreme stage,the pathogenesis of the disease is internal closure and external collapse,so the treatment should focus on open closure and strengthen collapse,clearing away heat and reviving yang for resuscitation.Modified Frigid Extremities Decoction combined with Peaceful Palace Bovine Bezoar Pill and Purple Snow Elixir.In the recovery stage,the pathogenesis is deficiency of both qi and yin,deficiency of both lung and spleen,and incomplete residual pathogenic factors.It is advisable to replenish qi and yin,nourish the spleen and lung,and remove residual heat and pathogenic toxin.Modified Two Matured Substances Decoction combined with Ginseng,Poria and White Atractylodes Powder and Master Wang's Decoction for Removing Summer Heat and Nourishing qi can be adopted.In terms of prevention,it is necessary to improve the immunity of human body.Supplemented Jade Wind-Barrier Powder can be used to replenish qi and strengthen the exterior.