重型新型冠状病毒肺炎患者痰黏难咯的辨治思路与案例分析

Differentiation reasoning for treatment of patients with difficulty in expectoration of sticky sputum induced by severe coronavirus disease 2019 and case analysis

新型冠状病毒肺炎(简称新冠肺炎)患者肺部病理学检查显示,病变部位聚焦在肺部,切面可见大量黏液性分泌物从肺泡内溢出.然而在临床中,新冠肺炎重症者却以干咳为多见,少见咯痰,说明痰涎并非存在于主气道内,其病位较深,难以主动咯出.痰黏难咯是导致重型新冠肺炎患者病情加重的重要原因,本研究从宣肺祛痰、润肺稀痰、肺脾同治、分消水湿4个方面辨证论治重型新冠肺炎痰黏难咯之症.作者认为在临床上治疗新冠肺炎重症患者的痰黏难咯之症,需顾护肺的宣发肃降功能,治疗时可投以辛温类或芳香类药物开宣肺气,同时增加化痰祛湿之品;如临床常表现有干咳、痰黄黏少或痰中带血、口干苦、胸闷短气、舌质暗红、苔黄腻或黄燥、脉滑数或弦滑等症者,治疗时需给予清润气道的药物;中医学亦有"脾为生痰之源,肺为贮痰之器"的理论,因此在临症时也可肺脾同治;此外除通过排痰方式消除痰饮外,亦可通过发汗、利小便的方式分消水湿.现通过解析辨治思路、列举方药、病案分析加以说明.

The lung pathological examination of patients with coronavirus disease 2019(COVID-19)showed that the lesions primarily localed in lungs.and a large amount of mucous secretion exuded from pulmonary alveoli on cutting section of the lung.However,clinically in COVID-19 patients,dry cough is common,but sputum expectoration is rarely observed,indicating that phlegm fluid is not found in the main airway,and its location is very deep,so as it is dificult to be expelled oul.Difficulty in expectoration of sticky phlegm is an important cauuse for aggravalion of rdisease situation in severe COVID-19 patients.In this study,according to traditional Chinese medicine(TCM)dfferentiation of syndromes and treatment,four aspects of measures can bre used to treat phlegm stickiness and difculy in expectoration in patients with COVID-19,such as diffusing the lung and dispelling phlegm,moistening lung and reducing(diluing)phlegm,treating lung and spleen together,and resolving water and dampness separately.The author thinks that severe COVID-19 patients with dificuly in expelling sticky phlegm are required to protect the lung functions of dispersing.punifying and descending.When the patients with COVID-19 are treated,the warm or aromatice drugs can be used to release the lung qi,and increase the dosages of expectorant and clearing dampness products.For example.for the patients with clinical maifestations such as dry cough,small amount of yellow and sticky phlegm,or phlegm with bood,dry and biter mouth,chest tightness,short breath,tongue body dark red in color,tongue coating yellowr and greasy or yellow and dry,pulse sippery and quick or string and sippery,etc.it is necessary to give the patients with dnugs for clearing and moistening the airway;in TCM,there is a theory"the spleen is the source of phlegm,and the lung is the organ of phlegm storage",therefore,the lung and the spleen can be treated together in elinical treatment based on differentation of syndrome:in addition,besides through expectoration to eliminate phlegm and retained luid,water dampness can be removed by sweating and urination.Now through explaining and analyzing dialetical thinking,enumerating prescriptions and medical case reords,the problem can be ilustrated clearly.