基于“三因制宜”原则探讨新冠肺炎不同中医方案的差异性

Discussing Differences of Different Traditional Chinese Medicine Schemes of COVID-19 Based on Principle of "Treatment in Accordance with Three Categories of Etiologic Factors"

摘要:

新型冠状病毒肺炎（新冠肺炎）爆发以来，中医药及时介入并发挥了重要作用，可以显著改善患者的临床症状、退热、止咳、缩短病程及降低轻中重病情转化率，同时在提高患者的生存率、改善患者的预后及生存质量等方面具有明显优势。为了更好地发挥中医药的治疗作用，尽早战胜疫情，各个省、市、自治区结合本地地域、气候和疫情情况，陆续出台了本地中医药治疗方案。该文从三因制宜角度分析了各地治疗方案的异同性，认为发病时令相同，治疗方案差异性多取决于地域和气候因素，结果显示全国七大区域，温湿地区如华中、华南、华东、西南早期证候表现多以“湿、温、热、毒”为特点，治疗方案多用清热解毒、健脾化湿类方药；寒冷地区如华北、东北、西北，早期证候表现多以“寒、湿、风、毒”为特点，治疗方案突出祛风散寒、化湿解毒作用。其中，以湖北疫情作为重要参照的国家方案，逐渐从各期的证候属性单一演变为寒热证型兼具与施治方法多样。随着疾病进展，疫毒、邪热闭肺为中期主要证候特点，治疗多侧重泄热解毒；重症期则以内闭外脱为主，治疗多急用开闭固脱之法；恢复期以肺脾气虚、气阴两虚为主，治疗多用健脾补肺，益气养阴方药；因体质因素多体现于预防方案，治疗方案中较少见。各地区新冠肺炎中医治疗方案显示出了明显的差异性，通过分析这些差异性，并总结出相应规律，这对于差异性防治类似新冠肺炎这类传染性疾病具有重要的意义。

Abstract:

Since the outbreak of corona virus disease-2019 (COVID-19), the timely intervention of Chinese medicine has played an important role， it can significantly improve the clinical symptoms of patients, alleviate fever, cough, shorten the course of disease and reduce the conversion rate of mild disease to severe disease， moreover, it has obvious advantages in improving survival rate, prognosis and quality of life in patients. In order to make better use of the therapeutic effect of Chinese medicine and overcome the epidemic situation as soon as possible, various provinces, municipalities and autonomous regions have introduced local Chinese medicine treatment schemes in accordance with the geography, climate and epidemic situation. In this article, we have analyzed the similarities and differences among treatment schemes from the perspective of three factors, and it is believed that the onset season is the same for this disease, and the differences between treatment schemes mainly depend on geographical and climatic factors. The results showed that in seven regions of China, the early symptoms in warm and humid regions such as Central China, South China, East China and Southwest China were characterized by "wet, warm, hot, and toxic", and treatment schemes mainly adopted the recipes with clearing heat and detoxifying, strengthening spleen and removing dampness functions. The early symptoms in cold regions such as Northeast China, North China, and Northwest China were mostly characterized by "cold, wet, wind, and toxic", and the therapeutic recipes emphasized on the effects of expelling wind and cold, removing toxicity and dampness. Among them, the national plan with the Hubei epidemic situation as an important reference has gradually evolved from a single syndrome attribute of each period to both cold and hot syndromes with multiple treatment methods. With the development of the disease, epidemic toxin and toxic heat in the lungs are the main characteristics in the medium term, when the treatment mainly focuses on purging heat and removing toxins. In severe cases and advanced stage, internal block and outward desertion are the main symptoms, when the treatment mainly focuses on block dredging and relieving desertion. In the recovery period, deficiency of lung and spleen Qi, and deficiency of Qi and Yin are the main symptoms, when the treatment is mainly used to invigorate the spleen, tonify the lungs, and nourish Qi and Yin. The physical factors are mostly reflected in the prevention program, so they are rarely mentioned in the treatment program. The Chinese medicine treatment schemes of COVID-19 in different regions show obvious differences. It is of great significance to analyze these differences and sum up the corresponding laws for the differential prevention and treatment of infectious diseases like COVID-19.