全国各地区新型冠状病毒肺炎中医药诊治方案综合分析

Comprehensive Analysis of TCM Diagnosis and Treatment Schemes for COVID-19 in All Regions of China

目的梳理全国各地区新型冠状病毒肺炎(corona virus disease 2019,COVID-19)中医药诊治方案,了解中医药诊治COVID-19的专家共识意见,为其临床诊治决策提供参考。方法收集国家及各省、市、自治区和直辖市卫健委、中医药管理局等官方发布最新COVID-19中医药诊治方案,对疾病分期、辨证、推荐处方、中成药等信息进行提取并汇总,采用频数统计及关联分析方法进行统计。结果截止2月19日,共检索得到官方发布的COVID-19中医药诊疗方案33个,包括1个国家《方案》、32个地区《方案》。对其中26个诊治方案按照早期、进展期、危重期、恢复期四个阶段对COVID-19中医诊治的专家共识意见进行分析。①证分布情况,早期阶段以寒湿郁肺证(33.33%)、湿毒郁肺证(13.89%)为主,进展期多见热毒郁肺证(48.65%)、湿热蕴肺证(32.43%),危重期主要表现为内闭外脱证(60.53%)、热毒闭肺证(31.58%),恢复期则常见肺脾气虚证(51.61%)和气阴两虚证(38.71%)。②方剂使用情况,早期阶段常用达原饮(16.67%)、藿朴夏苓汤(16.67%)、不换金正气散(12.50%);进展期主要用麻杏石甘汤(28.74%)、达原饮(14.94%)、宣白承气汤(12.64%);危重期主要推荐参附汤(28.81%)、宣白承气汤(13.56%)、黄连解毒汤(10.17%);恢复期则以黄芪六君子汤(22.73%)、沙参麦冬汤(13.64%)、竹叶石膏汤(11.36%)为主。③中成药使用情况,早期阶段常用藿香正气胶囊(17.65%)、连花清瘟胶囊(8.82%)、金花清感颗粒(5.88%);进展期主要用喜炎平注射液(12.66%)、血必净注射液(12.66%)、痰热清注射液(8.86%);危重期主要推荐中成药为安宫牛黄丸(18.70%)、参附注射液(13.82%)、血必净注射液(13.82%);恢复期则以生脉冲剂(34.78%)、参麦注射液(17.39%)、生脉注射液(13.04%)为主。④药物分布情况,早期阶段常用广藿香(67.57%)、厚朴(64.86%)、苦杏仁(59.46%);进展期主要用苦杏仁(89.19%)、石膏(78.38%)、麻黄(59.46%);危重期主要用人参(56.41%)、山萸肉(53.85%)、附子(35.90%);恢复期则以茯苓(67.74%)、陈皮(58.06%)、砂仁(48.39%)为主。⑤药物配伍情况,早期阶段常用药对为"厚朴-广藿香""草豆蔻-厚朴";进展期以"石膏-苦杏仁""麻黄-苦杏仁"为主;危重期以"山萸肉-人参""附子-人参"为主;恢复期以"陈皮-茯苓""砂仁-茯苓"为主。结论诊治方案综合分析结果提示,诸多方案认为COVID-19发病早期多属感受湿邪疫毒,治疗上以辟秽化浊、宣肺透邪为原则。进展期"湿郁化热,热毒损肺",治疗上以宣肺通腑、清热解毒为大法,攻下泻热以助肺气宣降。危重期"热毒瘀阻,内闭外脱",治以开闭固脱,解毒救逆。恢复期患者"邪去正虚",治疗上以清解余邪,益气养阴健脾为主。

Objective To understand the consensus opinions of experts on the diagnosis and treatment of novel coronavirus pneumonia 2019(COVID-19)with traditional Chinese medicine(TCM),and to provide reference for its clinical diagnosis and treatment decisions.Methods To extract and summarize the information of stage,syndrome differentiation,recommended prescription and proprietary Chinese medicine,and use frequency statistics and correlation analysis to make statistics.Results Distribution of syndromes:in the early stage,the syndrome of"cold-dampness stagnation of lung"(33.33%)and"damp-toxin stagnation of lung"(13.89%)are the main syndromes;in the advanced stage,the syndrome of"heat-toxin stagnation of lung"(48.65%)and"damp-heat accumulation of lung"(32.43%)are the main syndromes;in the critical stage,the syndrome of"internal closure and external detachment"(60.53%)and"heat-toxin stagnation of lung"(31.58%)are the main syndromes;in the recovery stage,the syndrome of"lung-spleen deficiency"(51.61%)and"qi-yin deficiency"(38.71%)are the common syndromes.The usage of prescriptions:Dayuan Decoction(16.67%),Huopu Xialing Decoction(16.67%)and Buhuan Jinzhengqi Powder(12.50%)are commonly used in the early stage;in the advanced stage,Maxing Shigan Decoction(28.74%),Dayuan Drink(14.94%)and Xuanbai Chengqi Decoction(12.64%)were mainly used.Shen Fu Tang(28.81%),Xuan Bai Cheng Qi Tang(13.56%)and Huang Lian Jie Du Tang(10.17%)are mainly recommended in critical period.The recovery period was dominated by Huangqi Liujunzi Decoction(22.73%),Shashen Maidong Decoction(13.64%)and Bamboo Leaf Gypsum Decoction(11.36%).