湿瘟为病,疏利透达--上海地区新型冠状病毒肺炎中医临床证治探析

Application of the dispersing-draining-expelling method in the treatment of damp pestilence induced disease--analysis on TCM pattern identification and treatment of COVID-19 in Shanghai

基于对近百例上海地区新型冠状病毒肺炎(简称"新冠肺炎")患者的诊疗经验,探析本病的中医病因病机、临床特点及治法方药。根据此次疾病特点,结合上海地区的气候、居民体质的特点,认为新冠肺炎当属中医"湿瘟"范畴;病因乃湿毒疫邪侵袭,病位主要在肺,弥漫膜原、三焦;病机关键在于湿毒疫邪侵袭犯肺、郁而化热,湿毒、郁热搏结,弥漫膜原、三焦,化燥伤津、耗气伤阴,部分重症患者可深入营血分、热陷心包。本病治疗当以"祛邪"为第一要义、疏利透达为关键治法,以尽早使湿毒之邪有出路。早期当化湿解秽、宣透疏利,若湿毒郁而化热当兼清郁热,若化燥伤津当顾护津液;中期当清肺泻热、宣肺通腑、透达膜原、疏通三焦,着眼于祛湿毒、清热毒、化瘀毒,及时截断病势、顾护阴津;危重期当及时提供重症支持治疗,以及开闭固脱之方药;恢复期当注意清彻余邪、益气养阴、瘥后防护。中医药干预本病重在尽早(初、中期)祛除毒邪,截断病势,改善患者症状,帮助恢复期调护。

The etiology,pathogenesis,clinical characteristics and therapeutic methods and prescriptions of the COVID-19 were analyzed based on the diagnosis and treatment experience of nearly 100 patients with COVID-19 in Shanghai.According to the characteristics of the disease,combined with the characteristics of the climate and residents’physique in Shanghai,it is believed that COVID-19 belong to the category of"damp pestilence"in Traditional Chinese Medicine(TCM).The cause of the disease is the invasion of damp toxin and epidemic pathogens.The location of the disease mainly lies in the lungs,diffusing to the peuro-diaphragm and triple energizers.The key of the pathogenesis is that the damp toxin and epidemic pathogens attack the lungs,pathogens stagnated in the lungs transform into heat,and damp toxin and stagnation of heat are tangled up to diffuse to the peuro-diaphragm and triple energizers,transforming into dryness and consuming fluid,exhausting qi and impairing yin.For patients who are critically diseased,pathogens may go deeper into the nutrient-blood phase and heat pathogen may enter the pericardium.The treatment should take the principle of"eliminating pathogen"as the first priority,and the key treatment method is to disperse,drain and expel so as to give the pathogens of damp toxin a way out as soon as possible.At the early stage,it is necessary to resolve dampness and dispel turbidity,to diffuse and expel,and to disperse and drain.If the damp toxin stagnates and transforms into heat,clearing the stagnated heat should be considered as a complementary treatment method.If the damp toxin transforms into dryness and consumes body fluid,protecting fluid should be of great importance.At the middle stage,it is necessary to clear the lungs and purge the fire,diffuse the lungs and unblock the bowels,dredge the peuro-diaphragm and regulate the triple energizers,with the focus on dispelling damp toxin,clearing heat toxin and resolving stasis toxin,so as to stop the disease progress and protect yin and fluid in time.In the critical period,supportive treatment should be provided and formulas for opening obstruction and preventing desertion should be prescribed for severe cases.In the recovery period,attention should be paid to clear away residual pathogens,invigorate qi and nourish yin,as well as prevention and healthcare after initial recovery.TCM focuses on eliminating toxin and pathogens as early as possible(at the primary and middle stages)to stop the progress of COVID-19,improve the symptoms of patients,and facilitate the health care and recovery.