新型冠状病毒肺炎的中医认识及治疗

Discussion About COVID-19 Treated with TCM

新型冠状病毒肺炎(corona virus disease2019,COVID-19,简称新冠肺炎)以乏力、发热、干咳为主要临床表现,属于中医“疫病”范畴。温病学说的卫气营血辨证、三焦辨证是瘟病理论对新冠肺炎疾病分期的依据,疾病初期为上焦病证,在肺卫;疾病中期为中焦病证,在脾胃;疾病后期为下焦病证,在肝肾,同时应考虑疾病是顺传还是逆传。新冠肺炎疾病初期病理因素多为“寒、湿、热、毒”,病位多在肺卫,病机为寒湿郁肺、湿热壅肺、毒热闭肺等;疾病中期湿聚成痰,病位多在肺和脾胃,病机为痰热壅肺、湿困脾胃;疾病后期,邪去正虚,加之前期常用清热燥湿之药,导致阴液损伤,致气阴两虚。虽然各医家治疗新冠肺炎的处方及药物不同,但治疗方向差异不大。疾病初期,病在上焦肺卫,以解表清肺化痰为主,为防止疾病传变,应提前使用顾护脾胃的药物;疾病中期,病在中焦脾胃,用药以调畅中焦气机为主,为防止伤津化燥、损伤阴液,需少用苦寒之品或适当加用补阴益气之品,但不可过量,以防加重中焦病情;疾病后期,病在下焦肝肾,多见气阴两虚证,用药以滋阴补气、恢复正气为主。此外,应根据地域、气候、个人体质等情况,随证治之。在预后防护中也应做到“观其脉证,知犯何逆,随证治之”。

Corona virus disease 2019(COVID-19)is characterized by fatigue,fever and dry cough,and belongs to the category of “epidemic diseases”in TCM.Defense-qi-nutrient-blood syndrome differentiation,and triple-energizer syndrome differentiation are the basis for the disease stage treatment.In the early stage of the disease,the disease syndrome is in the upper energizer,in the lung defense-qi;in the middle stage of the disease,the disease syndrome is in the middle energizer,in the spleen and stomach;in the later stage of the disease,the disease syndrome is in the lower energizer,in the liver and kidney,and at the same time,it should be considered whether the disease is transmited in sequence or in reverse.In the early stage of COVID-19,the pathological factors are cold,dampness,heat and toxicity,the location is in the lung defense-qi;and the pathogenesis is cold and dampness stagnated in the lung,dampness and heat accumulated in the lung,and toxicity and heat closing the lung.In the middle stage,dampness is transformed into phlegm;the location is in the lung,spleen and stomach;and the pathogenesis is phlegm and heat stagnated in the lung,dampness blocked in the spleen and stomach.In the later stage,the pathogenic factors have been removed and healthy qi has become deficient.Besides,the drugs for clearing heat and drying dampness are often used in the earlier stage,which results in yin fluid damage and deficiency of both qi and yin.Although the prescriptions and drugs are different,there is lit-tle difference in treat ment direction.In the early stage,the treatment should mainly focus on relieving exterior syndrome,clearing lung heat and resolving phlegm.In order to prevent transmission and change,proper drugs should be used in advance to protect the spleen and stomach.In the middle stage,the treatment should mainly focus on regulating qi movement of the middle energizer.In order to prevent from damaging yin fluid and transforming dryness,it is necessary to use a litle bitter and cold products or proper-ly add yin tonic and qi tonic products,but not too much to prevent aggravation of disease in middle energizer.In the later stage,for both qi and yin deficiency,the treatment should mainly focus on nourishing yin and qi and restoring healthy qi.In addition,it should be treated according to the region,climate and individual constitution.In the process of prognosis and protection,we should also observe the pulse syndrome,know what is the cause and treat based on syndrome differentiation.