新型冠状病毒肺炎五脏传变浅析

五脏功能相互影响,一脏病变可累及五脏六腑。新型冠状病毒肺炎(corona virus disease 2019,COVID-19,简称新冠肺炎),可以从肺发病。肺在窍为鼻,外邪由鼻咽进入肺部,治不及时或误治,传脾胃肠道,致脾胃运化功能失常;影响肾主水的功能,肝肾同源,金克木,肺经热盛,肝木受损,致肝肾功能皆有损伤;肾水不能上济于心,致心脏功能失调,最终致五脏功能皆伤。故在治疗上,除清肺热、补肺阴外,需补益脾胃。新冠肺炎患者可首先表现为脾胃症状,脾胃功能受损,累及于肺;肺病日久,又影响于脾,致脾运化水湿功能失调;脾胃运化功能失常,土能克水,脾土热盛,耗伤肾阴;土侮木,肝气郁结化热,日久伤阴,肝肾同源,肝肾之阴皆伤;肾阴不足,不能上济于心,则心火偏亢,终致心功能失常,五脏功能失司。故对于以脾胃症状为首发症状的新冠肺炎患者,治以解表祛湿,清热解毒,疗效显著。肝气郁结化火,损伤肝肾之阴;肝木克土,导致脾胃功能失常;肾水不能养心,致心功能损伤,最终导致五脏俱损。故治疗多用柴胡类方,以调畅气机,疏肝解郁。在了解脏腑传变的基础上,对新冠肺炎患者进行早预防、早干预和早治疗,可明显缩短轻型、普通型患者的治疗时间,同时减少重症、危重症患者的转化率,改善预后。

An Analysis of Transmission and Change of Five Zang-Organs of COVID-19

The functions of the five zang-organs interact with each other,and the pathological changes of one zang organ may involve the five zang-organs and six fu-organs.Corona virus disease 2019(COVID-19)may occur from the lungs.The lung governs the nose.If exogenous pathogens enter the lung from nasopharynx,if the patient is not treated in time or mistakenly,it will spread to the spleen and stomach and intestines,resulting in abnormal spleen and stomach transport function.It will affect the function of kidney controlling fluid.Liver and kidney are from the same source.Metal restricts wood.If the lung meridian has excessive heat,liver wood will be damaged,resulting in liver and kidney function damaged.If kidney water cannot reach the heart resulting in cardiac dysfunction,and ultimately five zang-organ function will be injured.Therefore,in the treatment,in addition to clearing lung heat and nourishing lung yin,it is necessary to invigorate the spleen and stomach.Patients with COVID-19 can be first manifested as spleen-stomach symptoms.Impaired spleen and stomach involves the lung.The long-term lung disease also affects the spleen,resulting in the dysfunction of the spleen's translating and transforming function.Because earth restricts water,excessive heat in the spleen will injure kidney yin.Earth counter-restricts wood.Stagnated liver qi transforms into heat and will hurt yin.Because liver and kidney are from the same source,liver-kidney yin is both damaged.Deficient kidney yin results in failure to nourish the heart,the heart fire will be excessive,which leads to cardiac dysfunction,and five viscera dysfunction.Therefore,for the patients with COVID-19 with first spleen-stomach symptoms,the treatment should focus on relieving exterior syndrome and removing dampness,clearing away heat and detoxification,and always has good efficacy.If liver qi is stagnated and transforms into fire,yin of liver and kidney will be damaged.Liver wood restricts earth leading to dysfunction of spleen and stomach.Kidney water can't nourish the heart,leading to damage of heart function,eventually to damage of all five zang-organs.Therefore,the types of Bupleurum Decoction are mainly used to regulate qi movement and relieve stagnated liver qi.On the basis of understanding transmission and change of five zang-organs,early prevention,early intervention and early treatment of COVID-19 can significantly shorten the treatment time of light and ordinary patients,reduce the conversion rate of severe and critical patients,and improve their prognosis.