试论新型冠状病毒肺炎重症“寒湿水饮闭肺,命门之火不振”之变  

Discussion on the Change of Cold-dampness and Retained Fluid Blocking Lung with Fire Deficiency of Mingmen(the gate of life)in Severe Patients with Coronavirus Disease 2019

作　　者：鹿振辉[1] 邱磊 张少言[1] 江锋[2] 张惠勇[1] 肖臻[1] 张洪春[3] 郑培永[1] LU Zhenhui;QIU Lei;ZHANG Shaoyan;JIANG Feng;ZHANG Huiyong;XIAO Zhen;ZHANG Hongchun;ZHENG Peiyong(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Dongzhimen Hospital of Chinese Medicine Affiliated to Beijing University of Chinese Medicine,Beijing 100700,China;China-Japanese Friendship Hospital,Beijing 100029,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]北京中医药大学东直门医院,北京100700 [3]中日友好医院,北京100029

出　　处：《中国中医药信息杂志》2020年第8期15-17,共3页Chinese Journal of Information on Traditional Chinese Medicine

基　　金：国家“十三五”传染病重大专项课题(2017ZX10305501-002);上海市中医药防治新型冠状病毒肺炎应急专项(2020COVID-19001);上海市科委“国内科技合作领域和长三角科技联合攻关领域”项目(18495810600)。

摘　　要：随着临床介入程度的逐渐加强,中医对新型冠状病毒肺炎的认识不断深入,尤其“湿毒”作为重要病理因素已基本达成共识,然其病机及传变规律仍需尽快完善,以推动优化形成更加有效的中医药诊疗共性方案。本文基于一线临床和相关文献,审证求因,提出“寒湿水饮闭肺,命门之火不振”为新型冠状病毒肺炎重症患者的重要病机,治当“以火治水,三焦同治”,拟方可参照射干麻黄汤、真武汤、附子理中汤等温煦三焦以固其本,兼以解毒通腑利水之法而治其标。该方案体现标本兼治、寒温并用、攻补兼施,灵活辨证组方,谨守药性之平衡,可为临床辨治新型冠状病毒肺炎提供参考。Traditional Chinese Medicine(TCM)practitioners have deepened their understanding of the disease theory with the gradually increasing degree of clinical intervention of coronavirus disease 2019(COVID-19).Especially,“Dampness Toxin”as the core of TCM pathogenesis has reached consensus.However,the comprehension on the pathogenesis and transmission laws of COVID-19 still need to be quickly improved in order to promote optimization to form a more effective common regimen for diagnosis and treatment of TCM on COVID-19.The author's team based on first-line clinical and academic data verified the cause and proposed that“cold-dampness and retained fluid blocking lung with fire deficiency of Mingmen”be important pathogenesis of severe patients with COVID-19.And the treatment principle should follow“ruling water with fire,and treating tri-jiao simultaneously”.The prescription should refer to Shegan Mahuang Decoction,Zhenwu Decoction,Fuzi Lizhong Decoction and other formulas to warm tri-jiao,which aims to consolidate the essence of human body.“Detoxification,dredging six-Fu organs and diuresis”also need to be considered to alleviate the symptoms at the same time.This regimen reflects the consideration of both the symptoms and causes,the combination of cold and warm medicinal herbs,tonification and purgation in combination,flexibility in syndrome differentiation and prescription and careful grasp of the balance of the property of herbs,which can provide a reference for clinical diagnosis and treatment on COVID-19.

关 键 词：新型冠状病毒肺炎 重型 寒湿水饮 命门之火 以火治水 三焦同治 

分 类 号：R259.631[医药卫生—中西医结合]