从清肺排毒汤辨治新型冠状病毒肺炎论麻黄在温热病中的应用

Discussion on Application of Mahuang(Ephedrae Herba)in Epidemic Febrile Disease from Qingfei Paidu Decoction(清肺排毒汤)Differentiating and Treating Coronavirus Disesse 2019

在中医药治疗新型冠状病毒肺炎过程中,清肺排毒汤以及麻黄经典类方一直是国家《新型冠状病毒感染的肺炎诊疗方案》的主打方药。辛温发汗药麻黄针对外感疫毒、饮邪阻肺病机,发挥了“散邪-宣肺-化饮”的重要作用,也是传统中医“汗法”宣通郁闭、散邪解毒的应用范例。清肺排毒汤及麻黄的成功应用,对于指导现代临床正确处方用药,特别是纠正在中医抗病毒及治温疫中泛用、滥用、误用清热解毒、苦寒泻火现象,具有重要意义。《神农本草经》及《药性论》等认为麻黄有祛邪热、治温疫的功效,其在温热病中的应用包括:治太阳伤寒之发热证、表邪束肺之痰饮病、表邪入里之郁热证以及寒毒疟瘴之温热病。现代研究显示,在本次抗疫方药中,麻黄应用频次排位前三;实验研究也证实,麻黄有确切的抗流感病毒等药效,并发现有16个与新型冠状病毒靶点重合的活性成分。麻黄应用也多有禁忌,因此“谨守病机,各司其属”方为要义。

In the treatment of coronavirus disease 2019(COVID-19)with traditional Chinese medicine,Qingfei Paidu Decoction(清肺排毒汤)and classic formulas containing Mahuang(Ephedrae Herba)have always been the main prescriptions in the National Diagnosis and Treatment Protocol for COVID-19.Mahuang,pungent in flavor and warm in property for inducing sweating,has played an important role in“dissipating pathogen-ventilating lungs-resolving fluid retention”for the pathogenesis of exogenous epidemic toxin and fluid retention blocking the lungs,which is also the application paradigm of“sweating method”in traditional Chinese medicine(TCM)for diffusing and activating stagnation and block as well as dissipating pathogen and removing toxin.The successful application of Qingfei Paidu Decoction and Mahuang is of great significance to guide the correct prescription in modern clinical medication,especially to correct the phenomenon of overuse,abuse and misuse of clearing heat and removing toxin,purging fire with bitter cold in the treatment of anti-virus and pestilence in TCM.Mahuang has the efficacy of removing pathogenic heat and curing pestilence in Shennong’s Classic of Materia Medica and Treatise on Medicinal Property.The application of Mahuang in treating febrile diseases has been summarized,including the treatment of Taiyang exterior heat syndrome of cold damage,phlegm-fluid retention syndrome of wind-cold fettering lung,heat stagnation syndrome of inward penetration of exogenous pathogen as well as epidemic febrile syndrome of cold toxic and miasmic malaria.Modern studies show that Mahuang ranks top three in this application frequency of anti-epidemic prescriptions.Experimental studies have also confirmed that Mahuang has definite efficacy against influenza virus,and there are total 16 active components which coincide with novel coronavirus targets.However,there are many contraindications to the application of Mahuang,so the gist is to“cautiously grasp pathogenesis to recognize what every symptom or sign is attributed to.”