新型冠状病毒感染的肺炎(COVID-19)与风寒湿疫

根据新型冠状病毒感染的肺炎(COVID-19)的临床表现,结合对时间、空间、人间"三间"以及大生态、小生态、微生态"三态"的分析,认为新冠肺炎属中医疫病范畴,病性为风寒湿,可称之为风寒湿疫。根据白长川名中医外感热病三二四理论,即"三纲脏腑定位,二化气血定性,四期虚实定势"的指导,认为本病可分为前驱期、进展期、危重期和恢复期四期进行辨治,治则是以祛邪为先。风寒湿疫毒由口鼻侵袭机体后直入脾肺,脾肺受损,表里俱病而偏于里,内有湿而外有寒是前驱期的基本病机,治宜健脾宣肺透邪为主,推荐《阴证略例》和《温病条辨》寒湿篇所载方药,如四、五加减正气散;进展期疫毒化热,湿阻气机,治宜表里双解,宣肺通腑,清泻湿热,推荐方药为宣白承气汤、升降散;危重期内闭外脱,根据寒闭、热闭的不同分别治以回阳复脉和开窍醒神,寒闭推荐四逆加人参汤,热闭推荐《温病条辨》凉开三宝,根据运气学说、伏气学说推断接下来更易于出现肺的热化之证,应注意固护阴液;恢复期邪去正虚,以健脾益肺为主,兼有阴虚者,兼以养阴生津,推荐六君子汤、生脉散、五味子汤。

Preliminary Discussion for COVID-19 and Wind Cold Dampness Plague

It is concluded that COVID-19 belongs to the plague in TCM based on the clinical manifestations,combined with the analysis of the "three states" of time, space and human world as well as the "three states" of large ecology, small ecology and micro ecology. As the disease wind cold dampness and so it can be called wind-cold-dampness plague. According to BAI Changchuan’s guidance of the theory about exogenous febrile diseases, namely "three classes of Zang-fu position, two changes of Qi-blood quality, four periods of deficiency and excessive conditions", it can be divided into prodromal stage,progressive stage, critical stage and recovery stage. The therapeutic principle is to dispel pathogenic first. The basic pathogenesis of the prodromal stage is the spleen and lung attacked by wind cold dampness. It is advisable to strengthen the spleen and promote lung to dispel pathogenic factors. Modified Jianzhengqi Powder can be recommended. The pathogenesis of the progressive stage is heat and blocking of Qi movement, Xuanbai Chengqi Decoction and Shengjiang Powder could be recommended. The pathogenesis of the critical stage is the blocking of Qi movement and decline of Yang Qi. Different treatments of cold blocking and heat blocking are respectively to make Yang recover and open the orifices to induce resuscitation. Sini Jia Renshen Decoction could be recommended to treat cold blocking syndrome. For heat blocking syndrome,three classical formulae in Wenbing Tiaobian can be recommended. Based on the theories of five Yun and six Qi and latent Qi,it is easier to develop lung heat syndrome, so we should pay attention to the fixation of body fluid. The pathogenesis of the recovery stage is Qi deficiency and the treatment is mainly to strengthen the spleen and invigorate the lung as well as to nourish Yin. Liujunzi Decoction,Shengmai Powder and Wuweizi Decoction can be recommended.