30例SARS患者的中医辨证诊治研究

Study on traditional Chinese medical diagnosis and treatment based on differentiation of syndromes and signs in 30 severe acute respiratory syndrome patients

目的 :探讨严重急性呼吸综合征 (SARS)的中医证型特点 ,评价中西医结合治疗 SARS的价值。方法 :2 0 0 3年 4月 19日— 5月 1日东直门医院收治 30例 SARS患者 ,在糖皮质激素、抗病毒、机械通气、对症治疗等综合措施基础上 ,对患者进行中医辨证论治并采用相应中药方剂。结果 :患者入院时均表现为高热等气分症状 ,卫分症状极少出现 ,其中 4例病程中出现腹泻。 SARS病程中经历气分、气营两燔和血分 3个阶段 ,疫疠犯肺、气分热盛阶段根据不同证型以清热宣肺、涤痰止咳和清热解毒、泻肺开闭为治则 ,方用五虎汤合葶苈大枣泻肺汤加减 ;浊热不解、气营两伤阶段以清气凉营、泻火涤痰为治则 ,方用清瘟败毒饮合礞石滚痰汤加减 ;热入营血、蒙闭清窍阶段以凉血清心、涤痰开窍为治则 ,方用犀角地黄汤合桃红四物汤加减。在营血阶段加用丹参注射液 ,在气营两伤阶段加用生脉注射液效果更好。 30例患者至 5月 1日转入定点医院时出院 3例 ,死亡 4例 ,余病情平稳 ,重症患者已脱离呼吸机 ,X线胸片显示肺部阴影基本吸收或吸收。结论 :SARS发病基本遵循卫气营血辨证规律。中西医结合治疗可明显改善症状 ,中医活血化瘀治疗应贯穿治疗全过程。

Objective:To investigate the traditional Chinese medical features of the different symptomatic types of severe acute respiratory syndrome(SARS) and assess the effects of integrated traditional Chinese and western medicine. Methods: According to the different symptomatic types of 30 SARS patients in Dongzhimen Hospital from April 19 to May 1, 2003, they were treated by traditional Chinese medicine herbs based on general treatment including steroid, antivirus medicine, mechanical ventilation, symptomatic messure and so on. Results:At initial stage 30 cases all had Qifen(气分) syndrome such as high fever. They seldom had light fever as Weifen(卫分) syndrome. Four cases of them suffered diarrea. As traditional Chinese medicine theory SARS patients had three stages: heatevil at Qifen, flaming of heatevil at Qifen and Yingfen(营分), heatevil at Xuefen(血分). Patients of Qifen type were treated with clearing away the heatevil at Qifen, releasing inhabited lungenergy and dissipating phlegm, clearing away heat and toxic materials. The Chinese medicine prescriptions were Wuhu decoction(五虎汤) and Tingli Dazao Xiefei decoction(葶苈大枣泻肺汤). Patients of QiYingfen(气营分) type were treated with clearing away the heatevil and phlegm located at QiYingfen. The Chinese medicine prescriptions were Qingwen Baidu drink(清瘟败毒饮) and Mengshi Guntan decoction(礞石滚痰汤). Patients of Xuefen type were treated with cooling blood and clearing away the heatevil, phlegm in the pericardium and waking up the patients from unconsciousness. The Chinese medicine prescriptions were Xijiao Dihuang decoction(犀角地黄汤) and Taohong Siwu decoction (桃红四物汤) . Salvia miltiorrhiza injection(丹参注射液) were used in YingXuefen syndrome. Shengmai injection(生脉注射液) were used in shortage of energy and blood. They were very effective. Up to May 1 among 30 SARS patients, 3 cases recoverd and discharged, 4 cases were dead, the others were transferred to the special hospital, they felt much better. Severe patients had weaning from mechanical ventilation, and the changes in clest Xray radiogram were improved. Conclusion: According to traditional Chinese medicine theory , SARS belongs to seasonal febrile disease. Its development follows Wei, Qi, Ying, Xue(卫气营血) regulation . The symptom of SARS patients can be obviously improved by the treatment of integrated traditional Chinese and western medicine. The method of activating blood circulation to dissipate blood stasis can be used at every stage.