基于脏腑和气血辨证理论探讨新型冠状病毒肺炎的肺外表现＊

新型冠状病毒肺炎现已被认为是具有广泛表现的多器官疾病,除肺以外,可累及多系统。张忠德教授根据临床抗疫经验,结合温病理论和中医脏腑、气血辨证理论,提出疫疠之气从口鼻入肺,借助肺朝百脉随气血抵达深层脏腑,继而相应脏腑气血功能失常的病机观念。在消化道,可表现为邪留三焦,里结阳明等证候;在心脏血管系统,可表现为心肾阳衰,热入营血等证候。在治疗中,张教授主张治肺为本,平调五脏,早期扶正,全程扶正。强调在疾病传变阶段,面对多系统表现时,抓住主（重）症和变化的症状。此外,张教授在《伤寒论》大柴胡汤和四逆汤基础上加减化裁,自拟柴胡解毒方和扶正救肺方,治疗重症新冠肺炎收到良好疗效,为中医药治疗本病提供了经验和思路。

Exploring the Extrapulmonary Manifestations of COVID-19 Based on the Theory of Viscera and Qi-Blood Syndrome Differentiation

COVID-19 is now recognized as a multiorgan disease with broad manifestation, involving multiple systems in addition to the lungs. Professor Zhang Zhongde combined the clinical experience in fighting against epidemics with the febrile disease theory and TCM viscera, qi and blood syndrome differentiation theory. He put forward the pathogenesis concept which indicates that the disease enters from the mouth and nose into the lung, and with the help of all vessels converging in lung, the disease reached to the deep viscera, leading to the dysfunction of the corresponding viscera qi and blood. In the digestive tract, it can be manifested as pathogen retaining in Sanjiao, internal knotting Yangming and other syndromes; in the cardiovascular system, it can be manifested as heart and kidney yang failure, heat into Ying blood and other syndromes. In the treatment, Professor Zhang advocated treating the lung as the basis, balancing the five internal organs, strengthening the body at an early stage and throughout the whole process. He emphasizes on grasping the main (severe) symptoms and changing symptoms when faced with multiple system manifestations in the stage of disease transmission. In addition, Professor Zhang developed two decoctions: Chaihu Jiedu Decoction and Fuzheng Jiufei Decoction that are respectively based on Dachaihu Decoction and Sini Decoction from Treatise on Febrile Diseases, which received good results in the treatment of severe COVID-19 and provided experience and ideas of Chinese medicine treatment of this disease.