基于温病辨证体系探讨新型冠状病毒肺炎辨治

Discussion About Syndrome Differentiation and Treatment of Novel Coronavirus Pneumonia Based on Syndrome Differentiation System of Warm Disease

新型冠状病毒肺炎(简称新冠肺炎)病位主要在肺,涉及脾、胃、心包,病机特点包括湿、毒、热、寒、瘀、闭、虚。虽为新发疫病,其病变过程仍遵循温病辨证体系之卫气营血辨证、三焦辨证、湿热三焦辨证所涵盖的疾病发展规律。疫邪上受,首先犯肺,肺卫失宣,此为卫分阶段,属上焦肺之病变,治宜清宣肺气,疏泄达邪;若初起邪阻膜原,又宜疏利化浊,透达膜原。上焦肺卫之邪不解,进一步发展,出现疫邪阻肺、肺气郁闭、湿阻脾胃等证,此时邪入气分,治宜宣肺燥湿,辟秽化浊,根据病性寒热不同,或清热平喘,或温化祛湿,兼燥者润燥肃肺;若疫邪上受,由肺直趋中道,发病即见明显肺与脾胃证候,属于卫气同病,为上、中焦之病变,治宜芳香化浊,宣畅气机,开肺建中。若气分之邪不解,深入营分、传入上焦心包者,可清营养阴、透热转气、清心开窍。疫邪炽盛,正气虚馁,疫毒闭阻于内,或初起疫邪由肺逆传心包,出现内闭外脱证候,治宜清心开窍、生津救逆、回阳固脱等。部分患者初期或病变过程的某一阶段表现出寒湿性质,但随着疾病演变,多呈现出“湿热疫”或“温热疫”病变特点,仍可用温病辨证体系指导辨治。

Novel coronavirus pneumonia(COVID-19 for short)is mainly located in the lung,involving the spleen,stomach and pericardium.Its pathogenesis features include dampness,toxin,heat,cold,blood stasis,closure and deficiency.Although it is a new epidemic disease,its pathological process still follows the disease development law covered by syndrome differentiation of defense and qi and nutrient and blood,syndrome differentiation of triple energizer,syndrome differentiation of dampness-heat triple energi-zer.When the pathogen occurs,it first invades the lung,and the lung fails to disperse.This is a stage of defense aspect,which be-longs to the pathological changes of the upper energizer lung.It is appropriate to clear the lung qi and relieve the pathogenic fac-tors.If the pathogenic factors block the interpleuro-diaphragmatic space at the beginning,it is also appropriate to expel diuresis and resolve turbidity,and reach the interpleuro-diaphragmatic space.If the pathogen in the lung defense aspect is not removed and fur-ther develops,there are syndromes such as epidemic pathogen blocking the lung,lung qi stagnation,dampness blocking the spleen and stomach.At this time,pathogen enters qi aspect,and it is appropriate to treat it by dispersing the lung and drying dampness,dispelling filth and removing turbidity.According to the different nature of cold and heat,it can either clear away heat and asthma,or warm and dispel dampness,and for dryness,it is proper to moisten and eliminate the lung.For patients with dampness and heat,it is necessary to decide the priority order of dampness and heat.If the pathogenic factor affects on the upper part,it will go straight from the lung to the middle pathway,and there will be obvious lung and spleen-stomach syndrome at the onset of the disease.It be-longs to the same disease of defense qi,and is the lesion of the upper and middle energizers.The treatment should remove turbidity with aromatics,disperse qi movement,open the lung and establish middle energizer.If the pathogen of qi aspect is not removed and has entered into defense aspect and pericardium in the upper energizer,the treatment should focus on clear nutrient and nourish yin,expel heat and change qi,clear the heart and open the orifices.If the epidemic pathogen is blazing,and the healthy qi is defi-cient,the epidemic toxin is blocked inside,or at the beginning,the epidemic pathogen passes from the lung to the pericardium in-versely,and the syndrome of internal closure and external detachment occurs,the treatment should be to clear the heart and open the orifices,generate fluid and rescue the counter-flow of qi,restore yang and consolidate collapse,etc.Some patients show the na-ture of cold and dampness in the initial stage or at a certain stage of the disease process,but with the evolution of the disease,they often show the pathological characteristics of"dampness-heat epidemic"or"warm-heat epidemic",and the syndrome differentia-tion system of warm disease can still be used to guide the differentiation and treatment.