各地中医药防治方案针对新型冠状病毒肺炎重型患者的诊疗策略汇总分析

Analysis of Diagnosis and Treatment Strategy of Regional Scheme of TCM in Preventing and Controlling Severe COVID-19

目的对各地中医药防治方案中针对新型冠状病毒肺炎重型患者的辨治内容进行汇总分析,梳理地方方案在国家方案基础上修订补充的诊疗策略。方法检索国家及各地卫生健康委员会、中医药管理局官网以及中文文献数据库,查找可纳入的中医药防治方案与方案解读,提取信息并进行标准化处理,对数据进行描述性统计与系统聚类分析。结果①地方方案针对重型患者在国家方案基础上进一步突出了燥热病机的重要性,同时提到了其所处阶段湿浊郁化燥热与燥热炼结痰瘀的转化相兼情况,并提到了卫气营血顺逆传化与膜原三焦传化等传化相兼情况;②地方方案针对重型患者证候可归为疫毒、热毒、湿毒病邪属性偏重不同的三类,或蕴肺壅肺与邪炽肺闭轻重不同的两类;③地方方案针对重型患者着重修订补充了从燥热论治的方药选用思路与方法,并针对本型患者所处阶段的疫毒之邪与邪炽肺闭之变,着重修订补充了以痰浊为中心论治以及从脏腑表里同病论治的思路与方法。结论对本型所处阶段病机演变认识是决定其治疗策略的关键,基于对本型所处阶段病机演变认识的进一步充实,地方方案在国家方案基础上又提供了一些新的诊疗策略,可作为国家方案实施与修订的有益补充。

OBJECTIVE To analyze the contents of syndrome differentiation in the regional schemes of TCM in preventing and controlling severe COVID-19,and review the revised supplementary diagnosis and treatment strategies of local programs based on national programs.METHODS We searched the official websites of national and regional health committees,the administration of traditional Chinese medicine,and the Chinese literature Database,sought TCM prevention and control programs and related interpretations and fetched information with standardization disposal.Descriptive statistics and systematic cluster analyses were performed on the data.RESULTS Firstly,compared with the national scheme,regional schemes for severe patients further highlighted the significance of dryness-heat pathogenesis and the transformation and combination of damp-turbidity constraint transforming into dryness-heat,dryness-heat bind phlegm-stasis,wei-qi-ying-blood transformation,along with pleurodiaphragmatic spaces and triple energizer.Secondly,regional schemes categorized severe patients'symptoms into three abnormal exuberance pathogenic factors,including epidemic,heat and dampness toxin,or two kinds,that is,constrained and obstructed lung,as well as intense-heat blocking the lung.Thirdly,regional schemes revised the national one and implemented the thoughts and methods of prescription to treating dryness-heat.Besides,as for the symptoms induced by epidemic toxin and intense lung heat and block,the local scheme supplemented the thoughts and methods of syndrome differentiation from phlegm-turbidity and zang-fu disease involving both the exterior and the interior.CONCLUSION Differentiation on pathogenesis of COVID-19 in different stages is critical to define the diagnosis and treatment strategy.On the basis of further understanding of pathogenesis evolution,the new diagnosis and treatment strategy offered by regional schemes can be viewed as an effective supplement to the national scheme.