中医药研究论丛

25S.3 COVID-19病例报告:结合中西医观点初探新冠肺炎之临床特性
TJ TCM.25(S) : 21-26, 2022
COVID-19 病例报告:结合中西医观点初探新冠肺炎之临床特性
Case Report: A Preliminary Study on the Clinical Features of COVID-19 Combining the Viewpoints of Traditional Chinese and Western Medicine
张育佳1* 黄建荣2 程怡华3
1 悦展中医诊所,台北,台湾
2 台北市中医师公会,台北,台湾
3 中国中医科学院广安门医院西单门诊部,北京,中国大陆
【摘要】
面对新冠肺炎千变万化的证型及临床症状,本文望能结合中西医学的观点做一初步探讨。根据笔者的中医临床观察及西医文献回顾,归纳出新冠肺炎的三大特性,第一个特性是新冠肺炎会造成体内水液代谢的失衡,进而导致发炎及血栓的产生,此乃新冠肺炎病毒透过结合血管张力素转换酶进入人体,影响肾素-血管张力素-醛固酮系统的路径所致;其影响相当於中医的气血水道失调,且尚需厘清是五脏六腑或三焦水道的损伤,更提出新冠肺炎造成燥湿互见的特殊病理环境。第二个特性是引起内皮细胞的发炎,不单单只是肺部的上皮细胞,也包含肠道细胞及血管内皮细胞,影响层级遍布全身;相当於中医「血瘀」的概念,而血瘀系肇因於热邪、血寒、气滞、气虚亦或燥邪致瘀,则须医者留心鉴别。第三个特性是长期情绪压力患者,容易导致预後较差。此乃由於长期肝木之气偏盛,木火刑金,导致易作肺病。了解此三大特性,在染疫急性期、恢复期甚至预防阶段,中医药皆可发挥重要角色,缩短病程,协助病人尽速恢复日常生活步调。
【关键词】燥湿互见、血瘀、木火刑金、中医、新冠肺炎、COVID-19
 
Yuh-Chia Chang1* Chien-Jung Huang2 I-Hua Cheng3
1Yueh-Tsan TCM Clinic, Taipei, Taiwan
2Taipei Chinese Medical Association, Taipei, Taiwan
3Xidan Outpatient Department, Guang’anmen Hospital of Chinese Academy of traditional
Chinese medicine, Beijing, China
【Summary】
The symptoms of COVID-19 are miscellaneous in different stages and are difficult to target. With the goal of developing effective strategies of treating infectious patients, we here conclude three main features of COVID-19 according to the clinical observation and literature review. Firstly, the entry of SARS-CoV2 into the cells down-regulates ACE2 receptors, which amplify the imbalance between the AT1 and AT2 receptors. It then causes detrimental effects such as inflammation and thrombosis. In the viewpoint of Traditional Chinese medicine, we need to take the circulation of the qi, blood and water into consideration. The pathological environment shows signs of lung dryness and spleen dampness.
Secondly, the injury and inflammation of endothelial cells results in damage in not only lung and gut epithelia but also vascular endothelia. The status of “blood stasis” may be caused by pathogenic heat, congealing cold, qi stagnation, qideficiency or dryness and fluid depletion, which need further care and attention.
Thirdly, Patients with long-term history of stress disorders are prone to poor prognosis, which could be related to the functional disturbances of the liver, the liver fire in turn insults the lung. With these three features in mind, we present a case report. Therefore, we could have bigger picture when confronting COVID-19 pandemic, from prevention to infectious to recovery stage. Traditional Chinese medicine can surely play a significant role in shortening the course of the disease.
【Keywords】COVID-19; TCM; fluid imbalance; thrombosis; stress disorders