北京地区新型冠状病毒肺炎中医证候及病机特点初探

Preliminary study on the characteristics of TCM syndromes and pathogenesis in corona virus disease 2019 in Beijing

目的通过分析首都医科大学附属北京佑安医院新型冠状病毒肺炎(COVID-19)的临床资料,探讨北京地区COVID-19的中医证候特点和发病机制,为进一步指导临床救治提供依据。方法北京佑安医院截至2020年2月5日收治的COVID-19患者67例,分析有完整舌象资料的27例患者的临床表现及中医证候特点。结果27例患者中有发热症状22例(81.48%);发热是最多见的首发症状,有17例(62.96%),其次为倦怠乏力11例(40.74%)、周身疼痛9例(33.33%)等。舌象表现:舌质淡红3例(11.11%),舌红15例(55.56%),舌暗红9例(33.33%);舌苔腻27例(100%),其中舌苔黄腻17例(62.96%)。27例患者中疫毒袭肺证15例(55.56%),其中兼有气阴两虚证1例,病邪均属热重于湿;湿毒郁肺证12例(44.44%),均为湿重于热。结论北京地区COVID-19患者的中医病性为“湿热证”,舌质红和苔黄说明热象突出,“热重于湿”更多见。中医药治疗要本着“三因治宜”的原则进行辨证论治。

Objective To explore the characteristics of TCM syndrome and pathogenesis by analyzing the clinical data of corona virus disease 2019 patients in the Beijing Youan Hospital,so as to provide further support for the clinical treatment.Methods There were 67 patients with corona virus disease 2019 hospitalized in the Beijing Youan Hospital until February 5,2020.And 27 patients of them who had complete information of tongue manifestations were selected to analyze the clinical manifestations and characteristics of TCM syndrome.Results Among 27 patients,fever was present in 22(81.0%),and there were 17(62.96%)cases presenting fever as the most common syndrome,then the second and third were lassitude in 11 cases(40.74%),general aching in 9 cases(33.33%).About the tongue manifestations,all 27 cases had thick sticky tongue coating,of them there were 3 cases(11.1%)of slightly red tongue,15 cases(55.6%)of red tongue,9 cases(33.3%)of dark red tongue.And all 27 cases had sticky tongue coating,including 17 cases(62.9%)of yellowish and greasy tongue coating.Among 27 cases,syndrome of epidemic toxin attacking lung was seen in 15 cases(55.56%),including 1 case of qi and yin deficiency,all of these had more pathogenic heat than pathogenic damp;syndrome of toxic damp accumulating in the lung was found in 12 cases(44.44%),all of these had more pathogenic damp than pathogenic heat.Conclusion The patients with the corona virus disease 2019 in Beijing are manifested as syndrome of accumulated dampnessheat.The red tongue and yellow fur imply obvious heat syndrome,and heat syndrome was more serious than dampness syndrome generally.The syndrome differentiation and treatment of TCM for the corona virus disease 2019 should follow the principle of“treatment in accordance with seasonal-local conditions and patient’s individuality.”