从《温疫论》探讨新型冠状病毒肺炎的中医诊疗思路——新型冠状病毒肺炎中医探讨之二

Discussion on Traditional Chinese Medcine Diagnosis and Treatment of COVID-19 from Plague Theory--A Series of Discussion,Part 2

《温疫论》是我国第一部讨论瘟疫类疾病的专著,对疫病的病因、病机、传变、病情演变、治疗等都有独到见解。新型冠状病毒肺炎属于中医学“疫病”“瘟疫”范畴,根据其临床表现及发病特点,结合中医瘟疫传统理论,目前认为其主要病因是感受疫毒,病性为湿毒,疫毒内窜是本病的直接病机,湿、毒相合,闭阻肺络是本病的核心病机,病机演变以湿毒为中轴,外有寒湿郁闭,内有湿毒阻络,邪伏膜原而致上焦化燥,中焦困阻,三焦凝滞,病位以肺为主,旁涉脾胃,累及多脏,最后多以邪入肺络,气机闭阻而亡。治则以宣肺解毒,通络化痰,透达募原贯穿始终。本文同时探讨《温疫论》中急症治则在新型冠状病毒肺炎中的应用,以期为治疗新型冠状病毒肺炎提供思路。

“Plague theory”is the first treatise on pestilence in China,which has original views on the etiology,pathogenesis,transmission,disease evolution and treatment of epidemic diseases.COVID-19 falls into the category of“epidemic infectious disease”in traditional Chinese medicine(TCM).According to the clinical manifestations and pathogenic features from the angel of TCM,it is currently believed that the main etiology is epidemic Toxin,more specifically,the Dampness Toxin;the internal movement of the epidemic Toxin can be treated as the direct pathogenesis and the blockage of Lung collateral due to the Damp-toxin should be considered as the core pathogenesis.The evolution of the disease is based on Damp-toxin as the central axis,with Cold-damp obstructing the exterior,and Damp-toxin blocking the Collaterals,and latent pathogen in the pleurodiaphragmatic interspace.As a result,the upper Jiao become dry;the middle Jiao become trapped,and the three Jiao become stagnant.Lung is the main location of the disease,involving Spleen and Stomach and other organs.At the final stage,the pathogen enters Lung Collateral and obstructs Qi movement.The treatment principle is to exfoliate Lung and detoxify,remove phlegm and dredging Collaterals,penetrate into the original.Meanwhile,the application of the emergency principle in the theory of plague in the treatment of COVID-19 is discussed,so as to provide ideas for the treatment of COVID-19.