摘要
新型冠状病毒肺炎(简称新冠肺炎,corona virus disease 2019,COVID-19)临床表现以发热、咳嗽、乏力、头身疼痛、胸闷或呼吸急促、纳差、咽痛、畏寒、腹泻、恶心或呕吐为主,无恶寒,病机与《伤寒论》所述之外感表邪,内热伤津证病机类似,属温病中“温疫”范畴。六经辨证中,COVID-19初期,患者外受温邪,津伤内热,在采用辛散解表药物治疗的同时,配合滋阴清热药物;患者出现恶心、呕吐时,应轻疏表邪,和解少阳;患者出现恶心呕吐、食不下、腹泻等太阴脾虚湿盛证,兼有头身疼痛等太阳表证时,则考虑太阴病里虚夹表证,应以温润脾阳,健脾利湿为治则,根据表里偏重对证施治;患者出现下利、吐、哕,甚至反复发热,并四肢厥冷时,病机为里虚寒热错杂,治宜寒热并用,顾护人体正气。患者出现精神极度衰惫的昏迷状态时,无论寒化证还是热化证,均为六经中最危重的阶段,应扶阳、育阴,寒化证扶阳时宜温补,热化证育阴时宜清里热。卫气营血辨证和三焦辨证中,COVID-19初期为卫分证候,邪在表,在上焦,病位在肺,宜用清疏宣化肺卫之剂;若余邪未及时祛除或病邪直入气分,病位在上焦或中焦,宜用清肺降气化痰、辛开理气利湿之品;气分热盛阶段,在辨脏腑病变同时,结合疾病阶段性需要,给予清热生津养阴、开窍凉血熄风之品;若出现阴竭阳脱的下焦病证,病位在肾,在对症支持治疗同时,给予清热凉血、解毒活血、滋阴育阳类药物。COVID-19早期,结合三阳经证、卫分证、气分证早期及上焦、中焦早期病证进行辨治;COVID-19危重期,结合少阴经证,营血分证及下焦病证进行辨治。
The main clinical manifestations of Corona Virus Disease 2019(COVID-19)are fever,cough,fatigue,head and body pain,chest distress or shortness of breath,poor appetite,pharyngeal pain,chills,nausea or vomiting,but without aversion to cold.The pathogenesis is similar to that of exogenous contraction hurting fluid described in Treatise on Cold Damage Diseases,belonging to the category of"pestilence"in febrile diseases.In syndrome differentiation of six meridians,at the early stage of the disease,the pathogenesis is exogenous contraction and internal heat.The medicinals for releasing exterior with pungent and dispersing nature combined with the ones for nourishing yin and clearing away heat should be used.For the patients with nausea and vomiting,the treatment should focus on releasing exterior pathogens,and harmonizing shaoyang.For the ones with syndrome of taiyin spleen deficiency and dampness manifested as nausea and vomiting,poor appetite,diarrhea,combined with taiyang exterior syndrome manifested as head and body pain,the pathogenesis may be taiyin disease due to interior deficiency affecting exterior,so the treating principle should be warming and moistening spleen yang,fortifying the spleen and draining dampness.And the treatment should be given according to the severity of the exterior and the interior syndromes.For those with diarrhea,vomiting,even repeated fever,limb coldness,the pathogenesis may be interior deficiency,intermingled cold and heat,so protecting healthy qi is the most important.When the patient is in a coma state of extreme mental exhaustion,no matter cold syndrome or heat syndrome,it is the most critical stage in the six meridians,so supporting yang and nourishing yin are necessary.When the patient has cold syndrome,warming and nourishing are necessary when supporting yang.When the patient has heat syndrome,clearing away interior heat is necessary when nourishing yin.According to defense-qi-nutrient-blood syndrome differentiation and triple energizer syndrome differentiation,at the early stage
作者
陈婷婷
史文川
朱佩枫
袁征
CHEN Ting-ting;SHI Wen-chuan;ZHU Pei-feng;YUAN Zheng(Nanjing University of CM,Nanjing,Jiangsu,China,210046;Affiliated Hospital of Nanjing University of CM,Nanjing,Jiangsu,China,210023)
出处
《河南中医》
2020年第3期339-343,共5页
Henan Traditional Chinese Medicine
关键词
新型冠状病毒肺炎
寒温融合辨证
六经辨证
卫气营血辨证
三焦辨证
Corona Virus Disease 2019(COVID-19)
differentiation and treatment of cold and warm fusion
syndrome differentiation of six meridians
defense-qi-nutrient-blood syndrome differentiation
triple energizer syndrome differentiation
