111例新型冠状病毒肺炎患者中医辨治临床观察

Diagnosis and treatment of novel coronavirus pneumonia with traditional Chinese medicine based on clinical observation of 111 cases

目的报道中医辨治111例新型冠状病毒肺炎患者的临床疗效,探讨新型冠状病毒肺炎的中医病因及病机。方法广东省中医医疗队于2020年1月29日至2020年2月11日接管湖北省中西医结合医院收治的111例新冠肺炎患者,在西医治疗基础上按轻型、普通型、重型、危重型进行中医辨证施治,均给予中药汤剂或者颗粒剂。分别进行总体疗效评价及症状改善情况统计。结果111例新型冠状病毒肺炎患者中出院37例,病情改善62例,病情无变化3例,病情恶化转入ICU病房1例,死亡8例(其中4例为医疗队接管病区后12 h内死亡)。主要症状改善情况:轻型、普通型患者症状100%消失,重型、危重型患者发热、咳嗽、腹泻、便秘、恶心呕吐等显著改善。结论新型冠状病毒肺炎隶属中医疫病范畴。湿毒疫邪是最主要的致病因素,湿邪困脾、疫毒闭肺是核心病机,湿邪贯穿始终,随疾病进展及个体禀赋差异可出现化热、化燥,少数可见寒化。治疗应中西医并重,中医药全程参与,辨证施治,可以取得良好的临床疗效。

Objective To report the clinical effectiveness of traditional Chinese medicine(TCM)in the treatment of novel coronavirus pneumonia(NCP)and explore the TCM understanding of this disease including its etiology,pathogenesis and treatment approaches.Methods 111 patients diagnosed with NCP from January 29 to February 11,2020 were enrolled at Hubei Provincial Hospital of Integrated Chinese&Western Medicine in the city of Wuhan and treated by Guangdong TCM medical team with Chinese medicine decoction or granule on the basis of conventional supportive therapy.TCM treatment was individualized based on patient categories of mild,moderate,severe and critical conditions under the guidance of pattern differentiation principle.Global improvement and symptom relief were evaluated after treatment.Results Among the 111 patients,37 patients were recovered and discharged.62 patients were improving.Disease conditions of 3 cases remained unchanged.One patient deteriorated and was transferred to ICU,and 8 cases died(among which,4 cases died within 12 hours since the Guangdong medical team took them over on January 29).Symptoms of patients with mild and moderate conditions were 100%gone.For severe and critical cases,their symptoms like fever,cough,diarrhea,constipation,nausea and vomiting were significantly relieved.Conclusion NCP falls into the category of epidemic diseases in TCM.Epidemic dampness toxin seemed to be the main etiological factor.Pathogenic dampness encumbering the spleen and epidemic toxin blocking the lung are the core pathogenesis while pathogenic dampness is persistent throughout the disease and may easily transform into heat,dryness and occasionally cold during disease progression.TCM therapies based on pattern differentiation should be offered alongside standard care of modern medicine throughout the course of disease as favorable clinical outcomes are now observed with this integrative approach.