各地中医药防治方案针对新型冠状病毒肺炎重型患者的诊疗策略汇总分析
Analysis of Diagnosis and Treatment Strategy of Regional Scheme of TCM in Preventing and Controlling Severe COVID-19
-
摘要: 目的 对各地中医药防治方案中针对新型冠状病毒肺炎重型患者的辨治内容进行汇总分析,梳理地方方案在国家方案基础上修订补充的诊疗策略。方法 检索国家及各地卫生健康委员会、中医药管理局官网以及中文文献数据库,查找可纳入的中医药防治方案与方案解读,提取信息并进行标准化处理,对数据进行描述性统计与系统聚类分析。结果 ①地方方案针对重型患者在国家方案基础上进一步突出了燥热病机的重要性,同时提到了其所处阶段湿浊郁化燥热与燥热炼结痰瘀的转化相兼情况,并提到了卫气营血顺逆传化与膜原三焦传化等传化相兼情况;②地方方案针对重型患者证候可归为疫毒、热毒、湿毒病邪属性偏重不同的三类,或蕴肺壅肺与邪炽肺闭轻重不同的两类;③地方方案针对重型患者着重修订补充了从燥热论治的方药选用思路与方法,并针对本型患者所处阶段的疫毒之邪与邪炽肺闭之变,着重修订补充了以痰浊为中心论治以及从脏腑表里同病论治的思路与方法。结论 对本型所处阶段病机演变认识是决定其治疗策略的关键,基于对本型所处阶段病机演变认识的进一步充实,地方方案在国家方案基础上又提供了一些新的诊疗策略,可作为国家方案实施与修订的有益补充。Abstract: OBJECTIVE To analyze the contents of syndrome differentiation in the regional schemes of TCM in preventing and controlling severe COVID-19, and review the revised supplementary diagnosis and treatment strategies of local programs based on national programs. METHODS We searched the official websites of national and regional health committees, the administration of traditional Chinese medicine, and the Chinese literature Database, sought TCM prevention and control programs and related interpretations and fetched information with standardization disposal. Descriptive statistics and systematic cluster analyses were performed on the data. RESULTS Firstly, compared with the national scheme, regional schemes for severe patients further highlighted the significance of dryness-heat pathogenesis and the transformation and combination of damp-turbidity constraint transforming into dryness-heat, dryness-heat bind phlegm-stasis, wei-qi-ying-blood transformation, along with pleurodiaphragmatic spaces and triple energizer. Secondly, regional schemes categorized severe patients' symptoms into three abnormal exuberance pathogenic factors, including epidemic, heat and dampness toxin, or two kinds, that is, constrained and obstructed lung, as well as intense-heat blocking the lung. Thirdly, regional schemes revised the national one and implemented the thoughts and methods of prescription to treating dryness-heat. Besides, as for the symptoms induced by epidemic toxin and intense lung heat and block, the local scheme supplemented the thoughts and methods of syndrome differentiation from phlegm-turbidity and zang-fu disease involving both the exterior and the interior. CONCLUSION Differentiation on pathogenesis of COVID-19 in different stages is critical to define the diagnosis and treatment strategy. On the basis of further understanding of pathogenesis evolution, the new diagnosis and treatment strategy offered by regional schemes can be viewed as an effective supplement to the national scheme.
-
Key words:
- COVID-19 /
- intensive case /
- TCM /
- diagnosis and treatment strategy /
- expert consensus
-
[1] YANG Y, LU QB, LIU MJ, et al. Epidemiological and clinical features ofthe 2019 novel coronavirus outbreak in China [J/OL]. Med Rxiv[2020-07-25].https://doi.org/10.1101/2020.02.10.20021675. [2] GUAN WJ, NI ZY, HU Y, et al. Clinical characteristics of 2019 novel coronavirus infection in china[J/OL]. Med Rxiv[2020-07-25].http://dx.doi.org/10.1101/2020.02.06.20020974. [3] 中华预防医学会新型冠状病毒肺炎防控专家组.新型冠状病毒肺炎流行病学特征的最新认识[J]. 中华流行病学杂志,2020,41(2): 139-144. [4] 王玉光,齐文升,马家驹,等.新型冠状病毒肺炎中医临床特征与辨证治疗初探[J].中医杂志,2020,61(4):281-285. [5] 钱志成,宋旭妍,李姗姗,等.重型及危重型新型冠状病毒肺炎的流行病学和临床特征[J].武汉大学学报(医学版),2020,41(4):533-536. [6] 中华人民共和国卫生部. GB/T 16751.2-1997,中医临床诊疗术语证候部分[M].北京:中国标准出版社,1997:20-23. [7] 周仲瑛,周学平.中医病机辨证学[M].北京:中国中医药出版社,2015. [8] 彭怀仁. 中医方剂大辞典[M]. 北京: 人民卫生出版社,1997. [9] 国家药典委员会.中华人民共和国药典[M].北京:中国医药科技出版社,2015. [10] 南京中医药大学.中药大辞典[M].上海:上海科学技术出版社,2006. [11] 王传池,吴珊,江丽杰,等.全国各地区新型冠状病毒肺炎中医药诊治方案综合分析[J].世界科学技术-中医药现代化,2020,22(2):257-263. [12] 冯哲,薛博瑜,叶放,等.病机十九条后“十六字”提示的病机辨治方法——病机十九条应用模式与方法探微之二[J].中华中医药杂志,2019,34(12):5566-5569. [13] 李建生,李素云,谢洋,等.河南省524例新型冠状病毒肺炎患者临床特征及中医证候分布[J].中医杂志,2020,61(16):1391-1396. [14] 方三高,魏建国.新型冠状病毒肺炎临床病理研究进展[J/OL].重庆医学[2020-07-25].http://kns.cnki.net/kcms/detail/50.1097.R.20200325.1157.002.html. [15] 冯哲,叶放,周学平,等.试论杨栗山三焦伏邪观与分消双解法[J].中国中医基础医学杂志,2018,24(3):310-312,317. [16] 陈夕,童瑾,向建华,等.139例新型冠状病毒肺炎患者流行病学特点对重症化影响的回顾性研究[J/OL].重庆医学[2020-07-25].http://kns.cnki.net/kcms/detail/50.1097.R.20200313.1537.004.html.
点击查看大图
计量
- 文章访问数: 392
- HTML全文浏览量: 9
- PDF下载量: 372
- 被引次数: 0