《温病条辨》中与新型冠状病毒肺炎临床表现相关条文病机和方药分析

Analysis of pathogenesis clauses and prescriptions of“Treatise on differentiation and treatment of epidemic febrile disease”related to clinical symptoms of COVID-19

目的收集新型冠状病毒肺炎(COVID-19)临床症状,探索、分析《温病条辨》中与COVID-19相关的条文、方药,为临床治疗COVID-19遣方用药提供参考。方法以"新型冠状病毒""2019 Novel Coronavirus"为检索词在数据库CNKI和PubMed进行文献检索,将文献中出现的症状按频数分类,并与《温病条辨》中相关症状对比,结合《新型冠状病毒肺炎诊疗方案(试行第六版)》分析相关条文及方药。结果共纳入中英文文献20篇,累计报道样本647例。临床表现共计28种,分为呼吸道症状,如发热、咳嗽等;消化道症状,如食欲减退、恶心呕吐、腹泻等;其他症状,如肌痛、乏力等。其中发热(558例)、咳嗽(395例)、乏力(257例)3种症状出现次数最多。通过分析,筛选《温病条辨》中对应的条文15条、方剂18首、药物46种。其中上焦篇条文2条,中焦篇条文9条,下焦篇条文4条。治疗湿热类方剂7首,寒湿5首,温热6首。药物出现次数较多的为半夏(6次),桂枝、通草(各5次),茯苓、滑石、黄连、薏苡仁(各4次)。湿温类疾病主要以半夏、桂枝、黄连、黄芩、干姜等辛开苦泄,以茯苓、通草、滑石、薏苡仁等淡渗利湿,以杏仁、白豆蔻、厚朴等开通气机;对于温热病,主要以知母、生石膏、连翘等清热泻火解毒。在疾病医学观察期可选用三仁汤、薏苡竹叶散;临床治疗期轻型、普通型可参照选用三仁汤、薏苡竹叶散、杏仁薏苡汤、五苓散、白虎加桂枝汤、苓姜术桂汤等,重型可参照选用黄芩滑石汤、杏仁滑石汤、茯苓皮汤;危重型可参照选用椒梅汤、减味乌梅丸、四逆汤、桃花粥;恢复期可参照选用麦冬麻仁汤、五汁饮、牛乳饮等。结论经典指导临床,《温病条辨》所载方药可为临床治疗COVID-19提供参考。

Objective To collect the clinical symptoms of novel coronavirus pneumonia,explore and analyze the clauses and prescriptions related to the clinical symptoms of 2019 novel coronavirus pneumonia in"Treatise on differentiation and treatment of epidemic febrile disease",in order to provide a reference for clinical treatments of the disease.Methods Searching literature from the databases CNKI and PubMed by entering"novel coronavirus"(in Chinese)and"2019 Novel Coronavirus"as key words,classifying typical symptoms depending on their reported frequencies of occurrence,comparing with related pathogenesis in"Treatise on differentiation and treatment of epidemic febrile disease",and analyzing clauses and prescriptions combined with the sixth version of"New coronavirus pneumonia diagnosis and treatment scheme".Results We optimized 20 literatures published in Chinese or English for the review,in which,a total of 647 clinical cases were reported.Based on that,28 typical symptoms were summarized,including respiratory symptoms,such as fever and cough;Gastrointestinal symptoms,such as poor appetite,nausea,vomiting,diarrhea;Other symptoms,such as myalgia,fatigue,and so forth.Among them,fever(558 cases),cough(395 cases),and fatigue(257 cases)were the top three clinical symptoms.By analysis,we optimized 15 clauses,18 prescriptions,and 46 traditional Chinese medicines from"Treatise on differentiation and treatment of epidemic febrile disease",including two clauses in the upper energizer,nine in the middle energizer,and four in the lower energizer;A total of seven prescriptions for treating dampness-heat,five for cold-dampness,and six for warm-heat diseases;as well as Chinese medicines Pinellia ternata(mentioned for six times),Cinnamomi Ramulus(five times),Tetrapanacis Medulla(five times),Poria cocos(four times),Talcum(four times),Coptis chinensis(four times)and Coicis Semen(four times),etc.P.ternata,Cinnamomi Ramulus,C.chinensis,Scutellaria baicalensis,and Zingiberis Rhizoma were selected to treat dampness-heat diseases,in order to"pungency opening and bitter discharging";P.cocos,Tetrapanacis Medulla,Talcum,and Coicis Semen were selected for"eliminating dampness with bland medicinal";Almond,Amomum kravanh,and Magnolia officinalis were used to"regulating qi movement";Anemarrhenae Rhizoma,Gypsum Fibrosum,and Forsythiae Fructus were used to treat warm-hot diseases for"purging fire and removing toxin".The formula of Sanren Decoction,Yiyizhuye Powder can be used for people in the stage of medical observation period;Sanren Decoction,Yiyizhuye Powder,Xingrenyiyi Decoction,Wuling Powder,Baihujiaguizhi Decoction,and Lingjiangzhugui Decoction for treating mild cases;Huangqin Huashi Tang,Xingren Huashi Decoction,and Fulingpi Decoction for severe cases;Jiaomei Decoction,Jianweiwumei Pill,Sini Decoction,and Taohua Porridge for critical patients,and Maidong Maren Decoction,Wuzhi Yin,and Niuru Yin for convalescents.Conclusion The prescriptions of"Treatise on differentiation and treatment of epidemic febrile disease"can provide reference for the clinical treatments of 2019 novel coronavirus pneumonia.