中医药防治新型冠状病毒肺炎方证规律分析

Analysis on pattern of prescriptions and syndromes of traditional Chinese medicine for prevention and treatment of COVID-19

通过对新型冠状病毒肺炎中医药诊疗方案的分析,研究方证规律,为临床辨证用药和相关研究提供参考信息。通过收集国家和各省市卫生主管部门发布的新型冠状病毒肺炎诊疗方案,对该病的分期、证型、处方用药等信息进行汇总,采用频数统计和关联分析方法,分析中医药辨证和处方用药规律,并进一步探讨该病病机及演变规律。通过检索共获得26个中医药防治新型冠状病毒肺炎诊疗方案(1个国家方案,25个地方方案),其中16个包括预防和治疗2个方面,7个仅为治疗方案,3个为预防方案。病程可分为初期、中期、重症期、恢复期。新型冠状病毒肺炎的致病因素为湿毒,核心病机为湿毒壅肺、阻遏气机,病理特点可概括为"湿、毒、闭、虚"。该病病位在肺,多涉及脾、胃,重症波及心、肾。各期的核心治法依次为芳化湿浊、宣肺透邪(初期),清热解毒、宣泄肺热(中期),开闭固脱、回阳救逆(重症期),清解余热、益气养阴(恢复期)。全国中医药防治新型冠状病毒肺炎诊疗方案较多,不同地域的诊疗方案具有一定的个性,但总体上遵循国家方案,在病程分期、证候分型、治则治法和处方用药方面具有共性特征,均围绕湿毒致病的核心病机及传变规律进行防治。随着对疾病认识的深化,相关诊疗方案还需要进一步细化和标准化,希望重视重症期和恢复期的化瘀通络治法。

To investigate the regularity of prescription and clinical syndromes by analyzing the diagnosis and treatment protocols of traditional Chinese medicine(TCM)for coronavirus disease 2019(COVID-19),so as to provide references for syndrome differentiation and relevant researches.The diagnosis and treatment protocols of COVID-19 published by national and regional health authorities were searched,and information was extracted in regard to disease stages,type of syndromes,and prescriptions,etc.Frequency statistics and relative analysis were used to analyze the rule of syndrome differentiation and prescription with TCM,and further discussion on the pathogenesis and progress of the disease.A total of 26 diagnosis and treatment protocols of TCM for COVID-19 were retrieved after screening(including 1 national scheme and 25 regional ones),among which 16 contained aspects of both prevention and treatment,7 only involved treatment contents and 3 were prevention schemes.The courses of COVID-19 can be divided into early stage,middle stage,severe stage and recovery stage.The pathogeny of COVID-19 in TCM is damp-toxin,with the core pathogenesis of damp-toxin retention in lung and Qi repression.Its pathological features can be summarized as"damp,toxin,obstruction,deficiency".The location of the disease is lung,always involving spleen and stomach,and may further affect heart and kidney in severe cases.The major treatments for each course are Fanghua Shizuo,Xuanfei Touxie(early stage);Qingre Jiedu,Xuanxie Feire(middle stage);Kaibi Gutuo,Huiyang Jiuni(severe stage);Qingjie Yure,Yiqi Yangyin(recovery stage).There were many diagnosis and treatment protocols for COVID-19 have been published,which generally followed the national edition,through with certain personalities in different regional protocols.There were common features with respect to the disease stage,syndrome differentiation,therapeutic principles and methods,as well as prescriptions;the treatment were generally carried out against the core pathogenesis and progress of the disease.Along with the deepening recognition of COVID-19,the diagnosis and treatment protocols are still need further concretization and standardization.We hope researchers and decision-makers can pay more attention to the treatment of Huayu Tongluo in severe and recovery period.