新型冠状病毒肺炎患者中医辨证规律

目的 探索新型冠状病毒肺炎（COVID-19）患者的中医辨证规律。方法 采取横断面调查的方法，对湖北省妇幼保健院光谷院区756例在院COVID-19患者进行中医四诊信息收集，按早期（起病时）、中期（病程为7～ 30 d）、后期（病程>30 d）不同病程阶段用频数法统计患者主要临床症状发生率，运用层次聚类法对常见症状（出现率>5.0%）进行聚类分析，并结合专家经验总结其证候规律。结果 COVID-19患者早期（756例）症状以发热（52.25%， 395例）、咳嗽（43.25%，327例）、乏力（27.25%，206例）、胸闷（26.72%，202例）、气喘（17.59%，133例）及咯痰（5.03%，38例）最为常见，层次聚类分析将除咯痰外的5个症状聚为一类，提示该阶段湿遏肺卫的病机。COVID-19患者中期（383例）症状以苔腻（64.49%，247例）、苔黄（43.86%，168例）、苔厚（40.21%，154例）、咳嗽（34.73%，133例）、舌红（32.38%，124例）、大便不畅（25.85%，99例）、气喘（25.33%，97例）、乏力（25.07%，96例）、纳差（23.76%，91例）、口苦（14.36%，55例）、苔燥（12.01%，46例）、舌紫（12.01%，46例）、虚汗（11.49%，44例）、便秘（10.18%，39例）、白痰（8.62%，33例）、失眠（7.31%，28例）、恶心（7.05%，27例）、腹泻（6.79%，26例）和黄痰（6.27%，24例）为最常见，层次聚类分析将这19个变量聚为3类，分别提示该阶段湿阻肺脾、湿热内蕴和湿热化燥的病机。COVID-19患者后期（373例）症状以苔腻（50.94%，190例）、乏力（39.41%，147例）、咳嗽（37.80%，141例）、舌红（33.78%，126例）、气喘（32.17%，120例）、虚汗（23.86%，89例）、口干（22.79%，85例）、纳差（20.11%，75例）、大便不畅（19.30%，72例）、口苦（15.01%，56例）、白痰（10.72%，40例）、心悸（8.31%，31例）和苔少（8.04%，30例）为常见症状，层次聚类分析将这13个变量聚为2类，分别提示该阶段气阴两虚兼余湿未清和肺脾气虚兼余湿未清的病机。结论 COVID-19不同疾病阶段的中医证候呈现由表入里、由湿化热、由实转虚的规律性变化，症状上具有明显的自身特点。

Traditional Chinese medicine syndrome differentiation of coronavirus disease 2019 patients

Objective To explore the rule of traditional Chinese medicine (TCM) syndrome differentiation of coronavirus disease 2019 (COVID-19) patients. Methods The symptoms of 756 cases with COVID-19 in Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province were collected by cross sectional survey. The incidence rates of the symptoms were recorded by frequency method at different courses of the disease:prodromal stage (onset), middle stage (7-30 days), and later stage (>30 days). The common symptoms (incidence rate>5.0%) were analyzed by systematic clustering. With expert experience, the rule of TCM syndrome differentiation of COVID-19 patients was summarized. Results Fever (52.25%, 395 cases), cough (43.25%, 327 cases), asthenia (27.25%, 206 cases), chest distress (26.72%, 202 cases), asthma (17.59%, 133 cases) and expectoration (5.03%, 38 cases) were the most common symptoms in the prodromal stage (756 cases) of the disease, which were clustered into one category except expectoration, indicating the pathogenesis of both lung and body surface suppressed by dampness. In the middle stage (383 cases), the 19 common symptoms including greasy fur (64.49%, 247 cases), yellow fur (43.86%, 168 cases), thick fur (40.21%, 154 cases), cough (34.73%, 133 cases), red tongue (32.38%, 124 cases), poor stool (25.85%, 99 cases), asthma (25.33%, 97 cases), asthenia (25.07%, 96 cases), poor appetite (23.76%, 91 cases), bitterness of mouth (14.36%, 55 cases), dry fur (12.01%, 46 cases), purple tongue (12.01%, 46 cases), perspiration (11.49%, 44 cases), constipation (10.18%, 39 cases), white phlegm (8.62%, 33 cases), insomnia (7.31%, 28 cases), nausea (7.05%, 27 cases), diarrhea (6.79%, 26 cases) and yellow phlegm (6.27%, 24 cases), were clustered into three groups, indicating the pathogenesis of damp-heat accumulation, obstruction of lung and spleen by dampness, and dryness due to dampness-heat. In the later stage (373 cases), the 13 common symptoms including greasy fur (50.94%, 190 cases), asthenia (39.41%, 147 cases), cough (37.80%, 141 cases), red tongue (33.78%, 126 cases), asthma (32.17%, 120 cases), perspiration (23.86%, 89 cases), dry mouth (22.79%, 85 cases), poor appetite (20.11%, 75 cases), poor stool (19.30%, 72 cases), bitterness of mouth (15.01%, 56 cases), white phlegm (10.72%, 40 cases), palpitation (8.31%, 31 cases) and little fur (8.04%, 30 cases), were clustered into two groups, indicating the pathogenesis of deficiency of Qi and Yin with residual dampness, and deficiency of lung Qi and spleen Qi with residual dampness. Conclusion The TCM syndromes of COVID-19 patients in different stages have its own typical characteristics, with a regular change from exterior to interior, from dampness to dampness-heat and from excess to deficiency.