摘要
解读《上海市新型冠状病毒感染的肺炎中医诊疗方案(试行)》与国家卫生健康委发布之《新型冠状病毒感染的肺炎诊疗方案(试行第五版)》的不同点及其变化立意。①在上海方案中,单列出恢复期,强调了在本病临床症状改善后的中医干预重点,即瘥后防复。②上海方案调整临床治疗期的中医证型,表述为湿毒郁肺型、热毒闭肺型、内闭外脱型;基于上海地区患者的临床特点,突出了"热"和"毒"的病理因素。③上海方案的临床治疗期中湿毒郁肺型,在其处方后新增辨症加减内容,即"有呕恶者,加黄连3 g、苏叶6 g",取苏叶黄连汤之意。④上海方案的临床治疗期热毒闭肺型,在处方中增加了姜黄9 g、僵蚕9 g,取升降散之意。⑤上海方案的临床治疗期热毒闭肺型,在推荐中成药部分,新增痰热清注射液,以切合本次新冠肺炎"湿、热、毒"的核心病机。(6)基于热退后患者往往还存在疲倦、舌少津、呼吸道和粪便中携带病毒的特点,上海方案的恢复期中,新增了气阴两虚的证型,用药主取沙参麦冬汤之意,佐以竹叶石膏汤、泻白散、升降散之类方药。
To interpret the differences and changes between the"TCM Diagnosis and Treatment Program for COVID-19 in Shanghai(Trial)"and the"Diagnosis and Treatment Program for COVID-19(Trail,Fifth Edition)"issued by the National Health Commission.①In the Shanghai program,the recovery period was listed separately,TCM intervention after the improvement of clinical symptoms of COVID-19 was emphasized,i.e.,prevention in the period from initial recovery to complete recovery.②According to the Shanghai program,TCM patterns in the clinical treatment period were adjusted,which were expressed as damp toxin stagnating the lung pattern,heat toxin blocking the lung pattern,and internal blocking causing collapse pattern;Based on the clinical characteristics of patients in Shanghai,the pathological factors of"heat"and"toxin"were highlighted.③In the clinical treatment period,the prescription for damp toxin stagnating the lung pattern was modified based on pattern identification in the Shanghai program,i.e.,"for patients with nausea and vomiting,add 3 g of Huanglian(coptis rhizoma)and 6 g of Suye(perillae folium)",taking the effect of Suye Huanglian decoction.④In the clinical treatment period,9 g Jianghuang(curcuma longa)and 9 g Jiangcan(bombyx batryticatus)were added to the prescription for the heat toxin blocking the lung pattern to achieve the effect of Shengjiang powder.⑤For the treatment of heat toxin blocking the lung pattern,Tanreqing injection was added to the Chinese patent medicine recommendation list as it met the core pathogenesis of"damp,heat and toxin"of COVID-19.⑥In the recovery period,the pattern of dual deficiency of qi and yin was added due to the characteristics of tiredness,lack of tongue fluid,and virus carrying in respiratory tract and feces in patients after abatement of fever,and Shashen Maidong decoction was used as the main formula,supplemented by Zhuye Shigao decoction,Xiebai powder,Shengjiang powder and other prescriptions.
作者
张炜
吴银根
张惠勇
陈伟
石克华
王振伟
ZHANG Wei;WU Yingen;ZHANG Huiyong;CHEN Wei;SHI Kehua;WANG Zhenwei(Department of Respiratory Disease,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Respiratory Disease,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Critical care,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Respiratory Disease,Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Department of Respiratory Disease,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)
出处
《上海中医药杂志》
2020年第3期1-4,共4页
Shanghai Journal of Traditional Chinese Medicine
基金
上海市卫计委临床重点专科建设项目(shslczdzk05101)
上海市中医内科学临床重点实验室项目(14DZ2273200)。
关键词
新型冠状病毒肺炎
中医诊疗方案
上海地区
热毒疫邪
瘥后防复
气阴两虚证
COVID-19
TCM diagnosis and treatment program
Shanghai area
epidemic pathogens of heat toxin
prevention of reoccurrence after initial recovery
dual deficiency of qi and yin
