The diagnosis and treatment of New Coronavirus pneumonia (2019-NCP)
hello everyone! With the development of the epidemic situation, Chinese medicine experts have gradually participated in the diagnosis and treatment of NCP. As an ordinary Chinese medicine staff, although not directly involved in this major epidemic event, as a Chinese medicine person, I have been paying attention to the development of the epidemic situation. Although I can not contact patients, I have obtained the patients’ symptoms through media reports, the 2019-ncp diagnosis and treatment guidelines issued by the state and other information channels Through this information, combined with my years of clinical experience in traditional Chinese medicine, I will publish my thoughts on the diagnosis and treatment of traditional Chinese medicine in 2019-ncp, hoping to enlighten the staff of traditional Chinese medicine on the front line of the epidemic situation and make a little contribution to the control of the epidemic situation
In view of this epidemic situation, we should first make clear the name, etiology, pathogenesis (pathogenic nature) and location of the disease. Secondly, through syndrome differentiation to determine the principle of treatment, the development of diagnosis and treatment program and prescription.
Let’s take a look at the characteristics of the epidemic: (1) the disease is rapidly spreading from person to person. (2) The symptoms of the patients are basically the same, fatigue, fever, cough, asthma, nausea, epigastric distension, loose stool or constipation. (3) The onset season is in the winter of Jihai. From the beginning of winter to the beginning of spring. “The Yellow Emperor’s Canon of internal medicine” says: “the age of Jihai is the end of Qi, and its disease is warm and severe.”. That is to say, in the year of Jihai, Jueyin wind, mu Sitian and Shaoyang fire were in the spring. The main Qi of “the end Qi” is the cold water of the sun, which is called Shaoyang phase fire. When Shaoyang phase fire comes in the spring, Yang Qi is vented in the order of closing the reservoir. Therefore, winter should be cold but warm, and Yang Qi is vigorous. In this kind of climate is too abnormal, it is easy to have the syndrome of warm evil. “Differentiation of epidemic febrile diseases” says: “those with epidemic febrile diseases have wind temperature, warm heat, epidemic febrile diseases, toxic febrile diseases, heat dampness, damp temperature, autumn dryness, winter temperature and abuse of temperature.”. In his treatise on epidemic febrile diseases, Wu also states that “no matter how strong or weak the young and old are, they will get sick.”. That is to say, epidemic febrile disease is a kind of mutual infection caused by the evil of bad Qi. Regardless of the strength of young and old, the symptoms are similar. Combined with the characteristics and season of the epidemic, we can judge that the name of the epidemic is a kind of epidemic. The name of the disease is epidemic febrile disease.
The second disease location. The main symptoms of NCP were cough, asthma and extensive lung injury. Article 2 of “differentiation of febrile diseases” says: “all febrile diseases begin with Shangjiao and end in hand Taiyin.”. Therefore, the location of the disease is in the lung. There are also some people who have raised the question of whether gastrointestinal symptoms are located in the gastrointestinal tract. Lingshu · meridians: “the pulse of lung hand Taiyin originates from the middle Jiao, lower collaterals and large intestine, and also follows the appetite. The upper diaphragm belongs to the lung.”. In other words, the lung itself is connected with the stomach and large intestine meridians. If the lung has problems, the stomach and large intestine will also have symptoms. Therefore, the location of the disease is not in the gastrointestinal tract. There are also some cardiology doctors, the virus can invade the heart, leading to myocarditis. According to Wang Mengying’s Wenre Jingwei, the location of the disease lies in the heart. It is said that “when the pathogenic factors of warming go up, the lung is the first to attack and the pericardium is transmitted inversely.”. The lung is connected with the heart, and the lung heat is most likely to enter the heart, so the heart disease is also caused by the lung. The location of the disease is lung.
The third pathogenesis is the nature of pathogenic factors. According to media reports, there are two opinions on TCM syndrome differentiation. One is the nature of “cold dampness” put forward by academicians, that is, to feel the cold dampness epidemic virus and get sick. Another view is that because Wuhan is located in the middle and south of China, it is hot and humid, so the nature of “hot and humid” is put forward. It is believed that the disease is caused by the feeling of hot and humid pestilence. I don’t think either view is appropriate. First of all, let’s look at what is “cold epidemic”. According to the treatise on febrile diseases, it is often said that people suffering from febrile diseases hate cold and heat, and have a headache and pain. Although they are feverish, they are not thirsty. When they are in vogue, they are all in the lane. If they are infected, they are not febrile. They have a headache and pain, so they are called febrile diseases ear. The six Qi cold water is the spring of Si Tian, or the five Yun cold water is too old, or the six Qi plus Lin’s politeness is the cold water, no matter four seasons, or there is a syndrome. Let’s take a look at this year’s NCP. Although the onset of NCP is aversion to cold and fever, it is slight aversion to cold. Fever is low fever (37-38 ℃), while cold dampness is strong fever, that is, high fever, and aversion to cold, that is, severe aversion to cold. Obviously different from this outbreak. Moreover, this year’s year of Jihai is the spring of Shaoyang phase fire, not the cold water of the sun. In addition, although the initial manifestation of the disease was chilly fever, chilly fever was mild. “Differentiation of febrile diseases” says: “the pulse of Taiyin is not slow, and it moves a few when it is not tight, or it is only two inches large. It has hot feet, headache, slight evil, cold wind, body heat, sweating, thirsty or not thirsty, and it is called febrile disease when it is very hot in the afternoon. “。 Therefore, combined with the year, season and symptoms of the disease, the disease nature of “cold and dampness” epidemic virus is not appropriate, it should be the warm evil invading the lung.
Secondly, let’s analyze the viewpoint of the nature of “Damp heat”. The disease pathogen of damp heat nature is characterized by dampness, heavy turbidity, easy to be injected into the lower energizer, and mainly causes gastrointestinal diseases, such as cholera, dysentery and other epidemic diseases. The main manifestation of this disease is cough and asthma, which is lung damage. “Wenre Jingwei” said: “Wenxie shangshou, the first attack lung.”. This epidemic disease from the mouth and nose, for the upper, performance for cough and asthma, attack the lung. Therefore, it is a kind of warm evil, in addition, it is a kind of pestilence. Therefore, the nature of the disease is “warm epidemic virus”. Pathogenesis: epidemic virus of warm heat.
In addition, “typhoid” is even more impossible, typhoid mainly from the foot of the sun, skin hair orifices by evil. And the disease is from the mouth and nose, obviously “febrile disease”.
Because of no contact with patients, there is no actual clinical treatment, mainly from the Chinese medicine program released by the state to express their views. The disease can be divided into four stages: initial stage, middle stage, critical stage and recovery stage.
Initial stage: warm heat invades lung
Clinical manifestations: aversion to cold, fever or no fever, dry cough, dry throat, fatigue, chest tightness, abdominal distension, or vomiting, loose stool, light or reddish tongue, white and greasy fur, and moist pulse.
Recommended prescription: for the patients with exterior syndrome, according to the principle of “in the Wei and Khan”, the main method is to use the pungent and cool method to relieve exterior syndrome, and use Sangju drink to add or subtract. For those with dry cough, due to pathogenic heat invading the lung and damaging the body fluid, sangxing decoction or qingzaojiufei decoction can be added or reduced with the symptoms. To gastrointestinal symptoms, the treatment must be Xuanfei Sujiang method. Because the lung dominates the Qi of the whole body, the Qi will become damp, and the gastrointestinal symptoms are related to the lung. Do not use the medicine of sweating, attacking and moistening. You can use Sanren Decoction and Huoxiang.
In the middle stage, the lung was closed by pestilence
Clinical manifestations: body heat does not subside or exchanges of cold and heat, cough less phlegm, or yellow phlegm, abdominal distension and constipation, chest tightness and shortness of breath, cough and wheezing, wheezing when moving, red tongue, yellow greasy fur or yellow dryness, slippery pulse.
Recommended prescription: for those with body heat, cough and yellow phlegm, the method of Xuanfei Sujiang can be used, and Maxing Shigan decoction is selected. The disease is mainly caused by heat, so the dosage of gypsum must be large. For those with abdominal distension, constipation, cough and asthma, Xuanbai Chengqi Decoction should be used. Article 17 of differentiation of epidemic febrile diseases: “Yangming epidemic febrile diseases Xuanbai Chengqi Decoction can be used to treat patients with dyspnea, phlegm and saliva stagnation, right inch solid big, Lung Qi not falling. “。 The white here is the lung, so it is mainly to promote the lung and reduce the blood pressure.
Critical period: internal closure and external detachment
Clinical manifestations: dyspnea, dyspnea or need auxiliary ventilation, accompanied by dizziness, irritability, sweating, cold limbs, purple and dark tongue, thick and greasy fur or dryness, floating pulse and rootless.
Recommended prescription: Suhexiang pill can be used for cool closure; Angong Niuhuang Pill or Zixue pill can be used for hot closure. Shengmai Powder or Shengmai injection can be used for yintuo, and Shenfu Decoction or Shenfu injection can be used for YANGTUO.
Recovery period: Yin deficiency of lung and stomach
Clinical manifestations: shortness of breath, fatigue, fatigue, weak stool, red tongue and less moss.
Recommended prescription: warm pathogenic, the most likely to damage body fluid, warm disease often said, “save a little body fluid, leave a little vitality”, so choose Shashen Maimendong Decoction and Astragalus.
In addition, I would like to talk about the early intervention of traditional Chinese medicine, because in ancient times, the critical period (internal closure and external detachment) was reached, and few people were saved. However, modern medicine has many ways to save lives in critical period, which is also the early arrival of Western Medicine and ICU intensive care doctors in Wuhan, and traditional Chinese medicine can not play much role. The advantages of traditional Chinese medicine in the early and mid-term, early treatment of traditional Chinese medicine, can make the majority of patients, cured in junior high school. This is also my purpose of writing this article. I hope I can give you some help.