从伏邪理论探讨新型冠状病毒肺炎的发病特点

Exploring the disease characteristics of Corona Virus Disease 2019 from the theory of the hidden pathogen

目的探索新型冠状病毒肺炎(简称“新冠肺炎”)的发病特点、病因及病机演变,为疫情防控与治疗提供参考。方法(1)数据统计:依据2020年1月—2022年6月明确记录患者入院时寒热情况的相关文献15篇,统计新冠肺炎患者入院时寒热类型对应的病例数及频率。依据2022年7月前新冠肺炎变异株临床诊疗文献12篇,统计新冠肺炎不同变异株的病因属性。(2)文献研究:查阅新冠肺炎相关理论探讨文献,采用文献研究法从新冠肺炎临床表现、治疗原则、治法方药等方面讨论新冠肺炎的发病特点及病机演变。结果新冠病毒及其变异株主要病因属性为湿疫毒。新冠肺炎早期可见恶寒、发热,以低中热为主,部分表现为往来寒热、身热不扬等。一些新冠肺炎无症状感染者已有肺部炎症表现。肺部影像学呈现多发小斑片影及肺间质改变,并有外周血白细胞计数降低、淋巴细胞计数降低等实验室指标改变。新冠肺炎中期临床表现以肺系病变和脾胃病变为主,重症期可见呼吸困难、神志异常,严重者可发展为急性呼吸窘迫综合征、急性肾损伤、肝功能损害等。此外,临床部分痊愈者存在核酸检测复阳现象。临证中应用解表清里、化湿解毒的治法多有较好疗效。结论新冠肺炎的发病过程为湿疫毒从口鼻而入,潜伏于上焦膜原。初期湿疫毒自上焦膜原向外出表,表现为表里同病。中期湿疫毒向内传变,影响肺脾,以湿阻中焦为核心病机。重症期湿疫毒化热,传入营血,或气分未罢、病及营血,表现为气营两燔。恢复期病机为正气亏虚,余邪未尽。

Objective To explore the pathogenic characteristics,etiology,pathogenesis,and evolution of Corona Virus Disease 2019(COVID-19),with the aim to provide a reference for the prevention,control,and treatment of epidemics.Methods(ⅰ)Data statistics.Using 15 studies that documented the cold and heat conditions of patients with COVID-19 on admission from January 2020 to June 2022,we counted the number and frequency of cases corresponding to the cold and heat types upon hospital admission.Based on 12 clinical reports on variant strains of COVID-19 before July 2022,we evaluated the etiological properties of different variants of COVID-19.(ⅱ)Literature research.By referring to the literature on the related theories of COVID-19,we discuss the pathogenic characteristics and evolution of COVID-19 from the aspects of clinical manifestations,principles and methods of treatment,prescriptions,and drugs.Results Damp pestilence epidemic toxin is the main etiological property of COVID-19 and its variant strains.Aversion to cold and fever can be seen in the early stage.Most patients showed low or moderate fever,while some present alternate attacks of cold and fever,or hiding fever.Some asymptomatic infected patients with COVID-19 had pulmonary inflammation manifestations.Pulmonary imaging may show multiple small patchy shadows and pulmonary interstitial changes,as well as altered laboratory indicators such as decreased leukocyte and lymphocyte counts.The mid-term clinical manifestations are mainly pulmonary system lesions and spleen and stomach system lesions.Patients with severe disease may showed dyspnea,mental disorder,acute respiratory distress syndrome(ARDS),acute kidney injury,liver function impairment,and other complications.Besides,some recovered patients displayed re-positive result in nucleic acid testing.In clinical practice,relieving superficies and clearing interior,eliminating dampness,and removing toxicity can achieve better efficacy.Conclusion The pathogenesis of COVID-19 involves damp pestilence epidemic toxin entering from the mouth and nose,before remaining latent in the upper pleurodiaphragmatic spaces.In the early stage of the disease,the damp pestilence epidemic toxin may leave the upper pleurodiaphragmatic spaces.At this time,the patient showed symptoms of both superficies-syndrome and interior syndrome.In the middle stage,the damp pestilence epidemic toxin changes inward,affecting the lung and spleen,with damp blockage of the middle energizer serving as the core pathogenesis.In the severe stage,the toxin heats of damp pestilence epidemic might enter yingfen and xuefen.The symptoms of some patients’qi syndrome still exist,the damp pestilence epidemic toxin has entered into yingfen and xuefen,which manifests as intense heat in both qi and ying systems.In the recovery period,the main pathogenesis is the lack of vital qi with lingering remnant pathogen.