新型冠状病毒肺炎病案举例与诊疗心得  

Analysis of Diagnosis and Treatment of Proved COVID-19 Cases

作　　者：庄步辉[1] 姜廷枢[2] 张波[3] 杨宇 倪小红[4] 贾新华[5] ZHUANG Buhui;JIANG Tingshu;ZHANG Bo;YANG Yu;NI Xiaohong;JIA Xinhua(Linyi Hospital of Traditional Chinese Medicine,Linyi 276003,China;Yantai Yuhuangding Hospital,Yantai 264000,China;Taian City Central Hospital,Taian 271000,China;Huanggang City Central Hospital,Huanggang 438000,China;The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]临沂市中医医院,山东临沂276003 [2]烟台毓璜顶医院,山东烟台264000 [3]泰安市中心医院,山东泰安271000 [4]黄冈市中心医院,湖北黄冈438000 [5]山东中医药大学附属医院,山东济南250014

出　　处：《山东中医杂志》2020年第5期433-437,共5页Shandong Journal of Traditional Chinese Medicine

摘　　要：通过对病案的总结分析,认为新型冠状病毒肺炎(新冠肺炎)是寒、湿、燥邪共同致病,其中早期以寒湿邪为主,根据患者自身体质的不同,部分患者从阳化热,表现为湿热毒邪致病,有的则从阴化寒使寒湿益盛,中后期则主要为燥邪伤阴、热盛伤阴。治疗上分期辨治,早期阶段多见表证,发热恶寒者给予解表散寒祛湿之品,腹泻者多予健脾利湿、温阳散寒类药物,需清热时则多用甘寒类药物;中后期患者多以四君子汤合沙参麦冬汤加减,乏力明显则增加红参、黄芪、炙甘草用量,口干者增加沙参、生地黄用量,盗汗者增加山药、山茱萸、白芍用量。同时广泛采取以中药熏蒸为主的外治法。通过对新冠肺炎的分析,认为戾气实为两种以上邪气夹杂为患,且必然包含阳性邪气如温热之邪或燥邪,正因其夹杂阳性邪气才使得传播迅速。Through the summarization and analysis of the medical cases,it is concluded that COVID-19 is caused by the simultaneous attack of cold,dampness and dryness evils. In the early stage,cold evil and dampness evil are common,due to the difference in the constitution of patients,the pathogenesis of some patients is the heat being transformed from yang,which is characterized by diseases caused by damp-heat toxin,while the pathogenesis of some patients is the cold being transformed from yin,showing the disease caused by cold-dampness. In the middle and later stages,dryness damaging yin and excessive heat damaging yin are predominant. On the medication,in the early stage,the patients usually show the exterior syndrome,manifesting as fever and cold,and therefore they should be given the medicinals for releasing the exterior,dispersing cold and removing dampness.Those with diarrhea were given the medicinals for invigorating spleen and draining dampness,warming yang and dispersing cold,also mdicinals of sweet and cold could be applied in the case of clearing heat. In the middle and later stages,patients usually are given the Sijunzi Decoction (四君子汤) and Shashen Maidong Decoction (沙参麦冬汤) with modification,and Hongshen(Ginseng Radix et Rhizoma Rubra),Huangqi(Astragali Radix) and Zhigancao(Glycyrrhizae Radix et Rhizoma Praeparata cum Melle)could be applied in the case of extreme tiredness,Shashen and Shengdihuang could be used in the large dosages for patients with dry mouth,and Shanyao(Dioscoreae Rhizoma),Shanzhuyu(Corni Fructus) and Baishao(Paeoniae Radix Alba) could be used in the large dosages for night sweats. At the same time,the external treatment method like traditional Chinese medicine fumigation is widely adopted. Through the analysis of COVID-19,we hold the pestilential qi is the combination of more than two evils,therefore including yang evils like warm and hot evil and dry evil,leading to the widespread of pestilential qi.

关 键 词：新型冠状病毒肺炎 寒湿邪 燥邪伤阴 戾气 阳性邪气 验案 

分 类 号：R259.631[医药卫生—中西医结合]