新型冠状病毒肺炎的经典名方治疗策略与思考

Treatment strategy and thought on classical herbal formulae for coronavirus disease 2019

新型冠状病毒肺炎(COVID-19)是指2019新型冠状病毒感染导致的肺炎,其传染性强,传播速度快,影响范围广,在全球多个国家暴发,为国际关注的突发公共卫生事件。中医药治疗瘟疫历史悠久,病毒性疾病是中医药的临床优势所在。在当前尚无特效药物治疗的前提下,中医药在此次COVID-19的治疗中取得一定疗效,备受关注,并且已被升级为国家战略。关于中医药治疗新型冠状病毒肺炎,研究认为,在中医学病名方面,应当重新认识"寒温一统"的现代内涵,并且主张根据临床具体方证和指征用药。在病机方面,COVID-19存在由轻到重,由表入里,由实转虚的病机演变规律,应该重视初期的湿疫伤及太阳,中期的少阳、阳明合病,危重期的痰热壅肺,后期的肺脾亏虚。在临床治疗策略方面,早期予达原饮解表宣散,中期注重小柴胡汤合麻杏石甘汤表里双解,危重期酌情联合葶苈大枣泻肺汤、苇茎汤、宣白承气汤、小陷胸汤、三子养亲汤化痰清热,后期注重竹叶石膏汤、沙参麦冬汤、六君子汤益气健脾。值得注意的是,无论是在初期的轻症阶段,中期及危重期阶段,还是在后期的恢复阶段,中医药都发挥了重要作用,包括防止轻症转重症,缩短退热时间,改善咳嗽症状,提升血氧饱和度,减少死亡率。诸多研究表明,经典名方能够减轻细胞因子风暴、调节免疫失衡,通过多成分、多靶点、多途径产生协同治疗COVID-19的潜在作用。

Coronavirus disease 2019(COVID-19)refers to the pneumonia caused by novel coronavirus(2019-nCoV)infection in 2019.It is highly infectious,with quick spreading and a wide range of impact.It has been broken out in many countries around the world and has become a public health emergency of international concern.Chinese medicine has a long history in treating plague,and viral disease is the clinical advantage in Chinese medicine.Under the premise that there is currently no specific drug treatment,Chinese medicine has achieved certain effects in the treatment of COVID-19,which has attracted much attention and has been upgraded to a national strategy.Regarding the treatment of COVID-19 with Chinese medicine,it is believed that in terms of the name of Chinese medicine,the modern connotation of"uniform of typhoid and febrile disease"should be re-recognized,and it is advisable to use drugs based on specific clinical prescriptions and indications.In terms of pathogenesis,the COVID-19 has the pathogenesis rules including from the mild to severe conditions,from the surface to the inside,from the excess syndrome to the deficiency syndrome.We should pay attention to the Taiyang syndrome damaged by wet disease in initial stage,Shaoyang syndrome complicated with Yangming syndrome in the middle stage,phlegm-heat obstructing lung in critical period,lung and spleen deficiency in the recovery stage.In terms of clinical treatment strategies,Dayuan Yin is recommended to induce sweat and disperse the stasis in early stage.Xiaochaihu Decoction and Maxing Shigan Decoction is used to relieve both exterior and interior symptoms in middle stage.In critical stage,Tingli Dazao Xiefei Decoction,Weijing Decoction,Xuanbai Chengqi Decoction,Xiaoxianxiong Decoction,and Sanzi Yangqin Decoction are considered to reduce phlegm and clear heat.We should pay attention to nourishing Qi and strengthening the spleen by Zhuye Shigao Decoction,Sha-shen Maidong Decoction,and Liujunzi Decoction in the later recovery period.It shall be noted that,no matter in the initial mild stage,the middle and critical stages,or in the later recovery stage,Chinese medicine plays an important role,including preventing mild to severe disease,shortening the fever time,improving cough symptoms,increasing blood oxygen saturation and reducing mortality.Many studies have shown that the classical herbal formulae can alleviate the cytokine storm,regulate the immune imbalance,and produce the potential effect of synergistic treatment for COVID-19 through multiple components,multiple targets,and multiple pathways.