从半表半里论治新型冠状病毒感染验案3则

Treating 3 cases of COVID-19 from the aspect of half the surface and half the interior

在上海新型冠状病毒感染疫情救治中,中医药在防治方面发挥重要作用。在临床上发现有部分患者病情处于半表半里,如能及时治疗,可防止向里证转化,可能减少轻症或普通型患者向重症转化。“半表半里”的最早雏形见于《伤寒论》,由成无己首次提出,后世医家纳入三焦及膜原,对其概念进一步扩充。文章通过列举3例相关病案研究。患者甲辨证为痰热阻于膜原型新型冠状病毒感染,治疗以透达膜原、和解疏邪为法,予柴胡达原饮加减治疗;患者乙辨证为三焦不畅、阳虚水泛型新型冠状病毒感染,治疗以疏利三焦、温阳利水为法,予三仁汤、真武汤、麻黄附子细辛汤加减;患者丙辨证为少阳病新型冠状病毒感染,治疗以和解少阳、降逆消痞为法,予小柴胡汤合半夏泻心汤加减;三例患者均疗效显著。少阳、三焦、膜原均为半表半里,三者位置虽异,但均与气机有关,以半表半里立论辨治新型冠状病毒感染,重视调畅气机,以期对临床有所指导。

In the treatment of the corona virus disease 2019(COVID-19)in Shanghai,TCM medicine plays an important role in prevention and treatment.Clinically,it has been found that some patients are half exterior and half interior.If treated in time,it can prevent the conversion to interior syndrome,and may reduce the conversion of mild or ordinary patients to severe disease.The earliest rudiment of half exterior and half interior can be seen in the Shanghan Lun(《伤寒论》),which was first proposed by CHENG Wuji.Later generations of physicians included the triple energizer and membranous factor to further expand its concept.This article studies by listing 3 related cases.Patient A was identified as sputum heat resistance to Moyuan(膜原)type COVID-19,and the treatment was Chaihu Dayuan Yin(柴胡达原饮)based on penetrating Moyuan and relieving evil spirits.Patient B was diagnosed with three-jiao(三焦)poor and Yang(阳)deficiency water generic type COVID-19,and the treatment was the Sanren decoction(三仁汤),the Zhenwu decoction(真武汤)and the Mahuang Fuzi Xixin decoction(麻黄附子细辛汤)based on the method of unobstructed three-jiao and warm Yang to promote diuresis.Patient C was identified as the Shaoyang(少阳)disease of COVID-19,and the treatment was the Xiaochaihu decoction(小柴胡汤)and the Banxia Xiexin decoction(半夏泻心汤)to reconcile Shaoyang,reduce the reverse and eliminate ruffianism.All three patients had significant efficacy.Shaoyang,Sanjiao,and Moyuan are all half exterior and half interior,although the positions of the three are different,but they are all related to the Qi(气)machine,and the treatment of COVID-19 is based on half exterior and half interior,and the attention is paid to regulating Qi machine,in order to provide clinical guidance.