基于湿毒疫辨析SARS-CoV-2感染后神经系统病变

Analysis on Neurological Diseases after SARS-CoV-2 Infection Based on Damp-Toxin Epidemic

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)又称为新型冠状病毒,是引起新型冠状病毒感染(COVID-19)的病原体,感染后神经系统病变率极高,西医阐述其机制为SARS-CoV-2延嗅神经/三叉神经通路逆运转或穿过血脑屏障直接感染中枢神经系统或直接侵袭周围神经及肌细胞,或引发炎症反应与系统性因素等间接导致神经或脑损伤,中医认为SARS-CoV-2感染属“湿毒疫”范畴,并将其所致的神经系统病变归属于神志异常和脑病,中医病机为湿毒疫邪外袭,直入口鼻,上阻头面;浊邪害清,玄府阻滞,邪扰三焦;痰瘀内生,日久化热、精微不达。治疗以芳香化湿,升清降浊,行气通窍;破痰消瘀,清热救逆,开闭固脱;慎用燥湿,益气养阴为原则。在此基础上探讨湿毒疫邪致神经系统病变与现代医学机制的相关性,以及总结归纳辨疫病之性在古今治疗疫病引发神经系统病变的应用,为SARS-CoV-2相关神经系统损伤病症的治疗、疫病导致神志病脑病提供新的研究思路以及科学依据。

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is also called novel coronavirus and is the causative agent of corona virus disease 2019(COVID-19),with extremely high rate of neurological diseases.Western medicine explains that the mechanism is that SARS-CoV-2 reversely transports along the olfactory nerve/trigeminal nerve pathway or crosses the blood-brain barrier to directly infect the central nervous system or directly invade peripheral nerves and muscle cell,or trigger inflammatory reaction and systemic factors,which indirectly lead to nerve or brain damage.Traditional Chinese medi⁃cine recognizes that SARS-CoV-2 infection belongs to the category of“damp-toxin epidemic”and the neurological diseases belong to mental disorders and brain diseases.The pathogenesis of traditional Chinese medicine is the external attack of damp and toxin,which directly enters the mouth and nose and obstructs the head and face.Turbid evil harms the clear Qi,Xuanfu is blocked,and the evil disturbs Sanjiao.Phlegm and blood stasis are caused and the heat is dissipated and the essence is reduced.The treatment is to resolve dampness with aromatic herbs,to ascend the clear Qi and reduce the turbidity,to improve Qi movement and dredge the orifices,to eliminate phlegm and remove blood stasis,to clear heat and save the severe symptom,to induce resusci⁃tation and to nourish Qi andYin with careful use of drying dampness method.On this basis,this paper discussed the correlation between neurological diseases caused bydamp-toxin epidemic evil and modern medical mechanism,and summarized the applica⁃tion of disease differentiation in the treatment of nervous system lesions caused by ancient and modern diseases,and provided new research ideas and scientific basis for the treatment of encephalopathy caused by SARS-CoV-2.