基于“汤液经法图”的新型冠状病毒肺炎临床各期中药治疗复方的配伍原理及加减原则研究

Compatibility,addition and subtraction of compound Chinese medicine prescriptions for different stages of novel corona-virus pneumonia based on the “Tang-Ye-Jing-Fa Map”

从国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案》试行第四版开始,增加了中医辨证论治和选药组方,给出了初期、中期、重症期和恢复期的参照处方。本文从"汤液经法图"所示的五味补泻原理出发,阐明各期中药治疗方的配伍原理,并给出相应的组方加减原则,为深入理解、准确掌握和灵活运用这些中药复方提供参考。其中,初期寒湿郁肺阶段以辛味为主,定位在泻脾土补肝木;中期疫毒闭肺阶段以辛咸配伍为主,定位在泻肺金泻脾土;重症期内闭外脱阶段根据配伍苏合香丸或安宫牛黄丸的不同,分别定位在补肝木或泻心火泻肝木;恢复期肺脾气虚阶段以甘辛配伍为主,定位在补脾土。临床治疗时,可根据三因制宜原则,在不改变各期五脏补泻定位的前提下进行处方加减。例如,初期宜增加辛味药和甘味药,不宜增加酸味药;中期宜增加咸味药和辛味药;重症期宜根据凉开或温开的需要,分别增加苦味药和酸味药,或辛味药和咸味药;恢复期宜增加甘味药和酸味药。辛味药桂枝、生姜、柴胡、金银花,甘味药葛根、薏苡仁、百合、猪苓,酸味药麦冬、五味子、枳实、淡豆豉,咸味药旋覆花、地龙、白僵蚕、蝉蜕,苦味药黄芩、桔梗、薤白、白术等均是可选的加减用药。

Since the 4th Edition of diagnosis and treatment plan for the novel corona-virus pneumonia(COVID-19) published by National Health Commission of China, traditional Chinese medicine(TCM) syndrome differentiation was added. Reference prescriptions for the initial, middle, severe and recovery stages were also given. Based on the relationship shown in the "Tang-Ye-Jing-Fa Map", this paper clarified the compatibility principle of TCM formula in each stage and the corresponding addition and subtraction of the formula. which provided a reference for better understanding, more accurate mastering and flexible application of TCM treatments. Among them, for the early stage of cold and dampness ZHENG, bitter and pungent herbs were used which corresponded with debilitating spleen-earth and invigorating liver-wood;for the middle stage of epidemic toxin blocking lung ZHENG, pungent and salty herbs were used which corresponded with debilitating lung-metal and spleen-earth;in the severe stage, different compatibilities of Suhexiang pills and Angong Niuhuang pills, corresponded with invigorating liver-wood or debilitating heat-fire and liver-wood;while in the recovery stage with deficiency in the lung-qi and spleen-qi ZHENG, sweet and pungent herbs were to invigorate the spleen. In the clinical treatment, according to specific individual conbditions, addition and subtraction may be implemented without changing the location of invigorating or debilitating in each stage. For example, in the initial stage, it is better to add herbs with pungent and sweet nature, but not sour nature. In the middle stage, salty and pungent nature herbs should be added. In the severe stage, bitter and sour nature herbs, or pungent and salty nature herbs should be added respectively according to the need treatment. In the recovery period, sweet and sour nature herbs should be added. Cinnamon, ginger, bupleurum and honeysuckle with pungent property, Pueraria, coix seed, lily and Polyporus with sweet property, Ophiopogon japonicus, Schisandra chinensis, Fructus aurantii and light Douchi with sour property, Flos, earthworm, Bombyx Batryticatus, and cicada exuviate with salty property, Scutellaria, Platycodon grandiflorum, Allium macrostemon and Atractylodes macrocephala with bitter property were options.