中西医结合治疗新型冠状病毒反复核酸阳性患者1例

新型冠状病毒反复核酸阳性患者入院时,发热、咳嗽,相关检查提示感染较重,胸部CT显示双肺感染。为邪入上焦,以疫邪外袭,湿毒郁肺为主。在西医抗炎、抗病毒、止咳化痰及激素治疗的基础上,给予中药宣肺祛邪,疏肝理气,方用达原饮加减。中期炎症吸收,症状好转,胃肠道症状多因使用抗病毒、抗炎、激素类药物引起。此为邪入中焦,需健脾化湿,祛痰解毒,方用小半夏加茯苓汤合三仁汤。后期症状明显好转,但出现肝功能不良,核酸检测反复阳性。考虑为疫病后期,余毒未消,气阴两伤,治宜补气养阴,祛邪复正,方用复脉汤合护阳和阴汤。患者新型冠状病毒核酸检测呈阴性后,舌淡紫,脉细。考虑为温病后期,余毒已出,气阴未复,采用补肾滋阴,疏肝理气法,方用生脉散合一贯煎加减。中西医结合治疗,终使毒邪祛,正气复,病毒清,核酸转阴。

One Case of Repetitive Nucleic Acid Positive of COVID-19 Treated with Integrated Traditional Chinese and Western Medicine

When the patient with corona virus disease 2019(COVID-19)with recurrent nucleic acid positive fever and cough were admitted to hospital,the related examinations showed severe infection.Chest CT showed double lung infection.The disease is mainly caused by external attack of pathogenic factors into the upper energizer,especially dampness and toxin stagnated in the lung.On the basis of anti-inflammatory,antiviral,antitussive and expectorant therapy and hormone therapy in Western medicine,the method of dispersing lung qi and eliminating pathogenic factors,soothing liver and regulating qi were adopted.Modified Dayuan Decoction(达原饮,DYD)was adopted.In middle stage,inflammation was absorbed and symptoms improved.Gastrointestinal symptoms were mostly caused by the use of antiviral,anti-inflammatory and hormone drugs.This meant that pathogenic factors entered the middle energizer,so it was necessary to strengthen the spleen and resolve dampness,dispel phlegm and detoxification.Poria Decoction plus Banxia(Rhizoma Pinelliae)combined with Three Kernels Decoction was adopted.In the later stage,the symptoms improved obviously,but the liver function was not good,and the nucleic acid test was positive repeatedly.It meant that in the later stage of the epidemic,the residual toxin had not been eliminated,and qi and yin were both injured.Therefore,supplementing qi and nourishing yin,dispelling pathogenic factors and restoring healthy qi were used.Pulse-Restoring Decoction combined with Yang-Protecting and Yin-Harmonizing Decoction was adopted.When the nucleic acid test was negative,the tongue was pale purple and the pulse was thin.It meant that in the later stage of febrile disease,the residual toxin had been released,and qi and yin had not been restored.Therefore,the treatment focused on tonifying the kidney and nourishing yin,soothing the liver and regulating qi.Modified Pulse-Engendering Powder combined with Effective Integration Decoction was adopted.The combination of traditional Chinese and Western medicine can eliminate toxin and pathogenic factors,recover healthy qi,remove virus and turn nucleic acid into yin.