从中医体质学说浅析新型冠状病毒肺炎的预防与早期干预

An Analysis of Prevention and Early Intervention of COVID-19 from the Theory of TCM Constitution

体质是辨证的基础,决定着临床证候的类型,不同体质感邪后表现为不同的证型。平和质对疾病抵抗力较强,病邪入体后也更易恢复,预防以益气药物为主,也可不服药。气虚质、阳虚质者,因正气虚弱,可多症并发,若平素有基础疾患,脏腑失和,则更易转为重症,预防需益气固表,扶正解毒,多以玉屏风散为基础方。气郁质、血瘀质者,易气滞血瘀,感邪后恢复较慢,预防需调畅气机,补肾活血与益气祛邪兼顾,可用黄芪、当归、川芎、补骨脂等药物。痰湿质、湿热质者,平素湿盛于内,易出现肺气郁闭证、湿邪困脾证、阳明热盛证和阳明腑实证。痰湿质者预防需芳香化湿,开窍醒神,以藿香正气散为基础方;湿热质者预防需调和表里,扶正解毒,湿热同祛,以小柴胡汤为基础方;阴虚质者,平素阴液亏虚,可发展为阴阳俱虚、正气衰微之证,预防需益气养阴生津,补肺阴肝阴,可用北沙参、西洋参、百合、桑叶、菊花等。早期(轻症)阶段,除注意患者平素体质,需以辨证分型为重。若平素阳盛,可转化为表里俱热的实热证,多用清热解毒方剂如清瘟败毒饮、银翘散等,或外寒内热,可用大青龙汤等。若平素气虚、阳虚,正气虚弱,易出现阳虚寒凝证,可用麻黄加术汤等;若热毒邪气逆传心包,或者毒邪内陷、肺气衰败,要注意内闭外脱之危证。气郁质和血瘀质者,可用达原饮等;痰湿质、湿热质者,可用藿香正气丸等;阴虚质者,可用甘露消毒丹、人参败毒散等。

Constitution is the basis of syndrome differentiation,which determines the type of clinical syndrome.Different constitution can be manifested as different syndrome types.The mild constitution has strong resistance to disease,and it is easier to recover after the invasion of pathogenic factors.The prevention is mainly based on qi-replenishing medicinals,or medicinals may not be needed.In terms of qi deficiency constitution and yang deficiency constitution,because healthy qi is weak,multiple symptoms may occur.If there are basic diseases and internal zang-fu organs lose harmony,it is more likely to become severe.To prevent it,it is necessary to replenish qi and consolidate exterior,strengthen the body,and remove toxin.Jade Wind-Barrier Powder is often used as the basic prescription.Qi stagnation and blood stasis constitutions are easy to cause qi stagnation and blood stasis,and the recovery is slow after being attacked by pathogenic factors.In order to prevent the disease,it is necessary to regulate qi movement,invigorate the kidney and promote blood circulation,as well as invigorate qi and eliminate pathogenic factors.Huangqi(Radix Astragali),Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong),Buguzhi(Fructus Psoraleae),etc.are often used.Those with phlegm dampness and heat dampness constitutions usually have excessive dampness in the interior,and are prone to lung qi stagnation syndrome,syndrome of dampness stagnated in the spleen,syndrome of excessive heat in yangming and yangming fu-organ excess syndrome.For those with phlegm dampness constitution,in order to prevent COVID-19,it is necessary to resolve dampness with aromatic herbs,activate brain for resuscitation.Agastache Qi-Correcting Water is often regarded as the basic prescription.For those with dampness heat constitution,in order to prevent COVID-19,it is necessary to harmonize exterior and interior,strengthen healthy qi and remove toxin,remove dampness and heat together.Minor Bupleurum Decoction is often regarded as the basic prescription.Those with yin deficiency constitution usually have deficient yin fluid syndrome which can develop into deficiency of both yin and yang and the decline of healthy qi.In order to prevent COVID-19,it is necessary to replenish qi,nourish yin and generate fluid,tonify lung-liver yin.Beishashen(Radix Glehniae),Xiyangshen(Radix Panacis Quinquefolii),Baihe(Bulbus Lilii),Sangye(Folium Mori),Juhua(Flos Chrysanthemi),etc.are often used.In the early stage(with light symptoms)of COVID-19,in addition to paying attention to the patient′s constitution,it is necessary to focus on syndrome differentiation and typing.Constant yang excess may transform into excess heat syndrome with both exterior and interior heat.The prescriptions for clearing away heat and removing toxin,such as Golden Leaf Antidotal Granule,Lonicera and Forsythia Powder,etc.,were often used.For external cold and internal heat,Major Green Dragon Decoction can be used.Constant qi-yang deficiency syndrome has weak healthy qi,may develop into syndrome of yang deficiency and congealing cold.Ephedra Decoction plus Rhizoma Atractylodis Macrocephalae can be used.If heat and toxin are transmitted back to the pericardium,or the toxin invades inwardly,and the lung qi is decayed,the danger of internal block and external collapse should be paid attention to at this time.For qi stagnation constitution and blood stasis constitution,Dayuan Decoction(达原饮,DYD),etc.can be used.For phlegm dampness constitution;and damp heat constitution,Agastache Qi-Correcting Pill,etc.can be used.For yin deficiency constitution,Sweet Dew Toxin-Removing Elixir,Ginseng Toxin-Resolving Power,etc.can be used.