《温疫论》治疫思想在新型冠状病毒肺炎辨治中的应用

Thoughts of Treating Pestilence in Treatise on Warm Pestilence Used in Differentiating and Treating Coronavirus Disease 2019

吴又可《温疫论》论治疫病提出“杂气致疫”的观点,杂气致病特点可归纳为:其来无时,其着无方;来而不知,感而不觉;某气专入,专发某病。疫病治疗大法以逐邪为第一要义,顾护正气、攻补兼施为主要治疗特点,同时注重生活起居、养护正气。在疫病调护方面,吴又可以安养调神、顾护阴液为主,并依据患者现有身体状况和平素体质实施个性化调护。基于膜原理论,结合新型冠状病毒肺炎(COVID-19)流行病学特征以及临床表现,运用文献梳理的方法从吴又可疫病发病观、治疗观、调护观以及治疗特点探讨COVID-19病因病机、发病特点、临床分期论治,病后以防复阳的相关问题。在COVID-19临床治疗中,以达原饮作为基础方之一,并结合三因制宜的观念化裁运用。吴又可提出疫邪首尾通行为治,COVID-19重型患者进入休克状态时配合下法,运用通腑之法能调神治脑,临床取得一定疗效。

WU Youke put forward the viewpoint of“miscellaneous qi causing pestilence”in the treatment of pestilence in Treatise on Warm Pestilenc,and we summarized the pathogenic characteristics of miscellaneous qi as follows:non-seasonal and non-regional disease onsets;no obvious symptoms in the early stage of the disease;different miscellaneous qi entering specific organs and meridians,resulting in specific diseases.The treatment method is based on expelling pathogen as the first key principle,protecting healthy qi,reinforcing healthy qi and eliminating pathogen as the main treatment characteristics,and at the same time paying attention to daily life and maintaining healthy qi.In terms of caring the patient with pestilence,WU Youke focused mainly on calming and restoring mind and protecting yin fluid,and implemented personalized care based on the patient's current physical condition and constitution.Based on the membrane source theory,combined with the epidemiological characteristics and clinical manifestations of coronavirus disease 2019(COVID-19),the etiology,pathogenesis,clinical characteristics,clinical staging and treatment of COVID-19 as well as preventing relapse are discussed from the perspective of WU Youke’s viewpoints of pathogenesis,treatment,caring and treatment characteristics through literature review.In the clinical treatment of COVID-19,Dayuan Decoction(达原饮)is used as one of the basic formulas,combined with the concept of three considerations of time,person and place in treatment.WU Youke pointed out that the epidemic pathogens should be eliminated by purgation.Therefore,in clinical treatment of severe COVID-19 patients in shock state,purgation should be applied to regulate mind and treat brain,which has achieved certain clinical efficacy.