从“逆传心包”角度认识新型冠状病毒肺炎相关心脏并发症(1)
摘要 新型冠状病毒肺炎(COVID-19)属广义温病的范畴，遵循温病卫气营血传变规律，除了典型的呼吸系统症状外，还可出现心脏并发症。本文从逆传心包角度分析了肺炎相关心脏并发症的可能原因，并根据目前的诊疗指南总结其证候及治疗。原因可能与体质因素、疫毒致病力、失治误治相关，根据疫毒扰神、邪闭心包、心阳虚脱、气虚络阻证等不同的证候采取相应的针药治疗，并针对心脏轻症提出了治疗建议。中医药应发挥在救治传染病和危重症方面的优势，尽早干预，全程参与。
关键词 新型冠状病毒肺炎;温病;湿毒;卫气营血;逆传心包;心脏并发症;理论探讨
To Understand the Novel Coronavirus Pneumonia Related Cardiac Complications from the Perspective of Reversed Transmission to Pericardium
SUN Yize1，WANG Zheyi1，HOU Jiqiu1，LIU Biyuan1，SHI Zhaofeng1，ZHAO Haibin2
(1 Beijing University of Chinese medicine， Beijing ， 100029，China; 2 Oriental Hospital， BeijingUniversity of Chinese Medicine， Beijing ，100078，China)
Abstract he Coronavirus Disease 2019(COVID-19) belongs to the category of general warm disease， follows the transmission rule of Wei， Qi， Ying and Xue， it brings about cardiac complications besides the typical respiratory symptoms. In this paper， the possible causes of the cardiac complications were analyzed from the perspective of reversed transmission to pericardium， the TCM symptoms and treatment were summarized according to the current guidelines. The possible causes may relate to constitution， virulence of COVID-19， missed diagnosis and mistreatment. Herb or acupuncture should be given according to the four syndromes which are epidemic virus disturbing mind， pathogen blocking the pericardium， heart Yang desertion， Qi deficiency obstructing the collaterals. The treatment suggestions for mild heart disease were put forward. TCM should take advantages in treating infectious diseases and critical illness， intervene as early as possible and participate in the whole process.
Keywords COVID-19;Warm disease;Dampness toxin; Wei，Qi，Ying and Xue;Reversed transmission to pericardium;Cardiac complications;Discusstion
中圖分类号：R254.3;R256.19;R512.99 文献标识码：A doi： 10.3969/j.issn.1673-7202.2020.04.010
新型冠状病毒属于β属的冠状病毒，有包膜，颗粒呈圆形或椭圆形，常为多形性，直径60～140 nm，是感染人类的冠状病毒家族的第七个成员[1]。自2019年12月以来，湖北省武汉市陆续出现新型冠状病毒感染的肺炎(Coronavirus Disease 2019，COVID-19)病例，该传染病迅速先后蔓延至全国其他地区[2]。根据世界卫生组织最新报道，截止2020年2月26日24时全国累计确诊COVID-19患者78 191例，重症病例8 346例，死亡2 718例[3]。COVID-19给社会经济和健康负担带来极大压力[4]。
1 中医对COVID-19的认识
COVID-19的中医病名尚未统一，有“肺瘟”[5]“湿毒疫”[6]“温疫”[7]“寒湿疫”[8]等命名。《温病条辨》曰：“温病者，有风温、有温热、有温疫、有温毒、有暑温、有湿温、有秋燥、有冬温、有温疟”。COVID-19中医病名涉及到的湿、温、疫、毒均属广义温病的范畴。其病位主要在肺，具温疫传染性、流行性的特点;病理性质涉及湿、热、毒、虚、瘀;病因多为疫疠之气，湿毒为原[9]，贯穿始终。
未病先防，既病防变，各省根据疾病的发展情况(预防期、医学观察期、初期、中期、重症期、恢复期)制定了相应的方案，根据目前的诊疗方案[5，10]，可以观察到该病有卫气营血之传变规律[11]。初起疫邪犯表，邪伏膜原，卫表失和;病邪由表入里，疫毒郁闭肺气，或结于胸膈，或传入阳明，热结肠燥，肺壅腑实;疫毒内侵，气血两燔。血分证向恶，可逆传心包。, 百拇医药(孙怿泽 王哲义 侯季秋 刘碧原 石兆峰 赵海滨)
关键词 新型冠状病毒肺炎;温病;湿毒;卫气营血;逆传心包;心脏并发症;理论探讨
To Understand the Novel Coronavirus Pneumonia Related Cardiac Complications from the Perspective of Reversed Transmission to Pericardium
SUN Yize1，WANG Zheyi1，HOU Jiqiu1，LIU Biyuan1，SHI Zhaofeng1，ZHAO Haibin2
(1 Beijing University of Chinese medicine， Beijing ， 100029，China; 2 Oriental Hospital， BeijingUniversity of Chinese Medicine， Beijing ，100078，China)
Abstract he Coronavirus Disease 2019(COVID-19) belongs to the category of general warm disease， follows the transmission rule of Wei， Qi， Ying and Xue， it brings about cardiac complications besides the typical respiratory symptoms. In this paper， the possible causes of the cardiac complications were analyzed from the perspective of reversed transmission to pericardium， the TCM symptoms and treatment were summarized according to the current guidelines. The possible causes may relate to constitution， virulence of COVID-19， missed diagnosis and mistreatment. Herb or acupuncture should be given according to the four syndromes which are epidemic virus disturbing mind， pathogen blocking the pericardium， heart Yang desertion， Qi deficiency obstructing the collaterals. The treatment suggestions for mild heart disease were put forward. TCM should take advantages in treating infectious diseases and critical illness， intervene as early as possible and participate in the whole process.
Keywords COVID-19;Warm disease;Dampness toxin; Wei，Qi，Ying and Xue;Reversed transmission to pericardium;Cardiac complications;Discusstion
中圖分类号：R254.3;R256.19;R512.99 文献标识码：A doi： 10.3969/j.issn.1673-7202.2020.04.010
新型冠状病毒属于β属的冠状病毒，有包膜，颗粒呈圆形或椭圆形，常为多形性，直径60～140 nm，是感染人类的冠状病毒家族的第七个成员[1]。自2019年12月以来，湖北省武汉市陆续出现新型冠状病毒感染的肺炎(Coronavirus Disease 2019，COVID-19)病例，该传染病迅速先后蔓延至全国其他地区[2]。根据世界卫生组织最新报道，截止2020年2月26日24时全国累计确诊COVID-19患者78 191例，重症病例8 346例，死亡2 718例[3]。COVID-19给社会经济和健康负担带来极大压力[4]。
1 中医对COVID-19的认识
COVID-19的中医病名尚未统一，有“肺瘟”[5]“湿毒疫”[6]“温疫”[7]“寒湿疫”[8]等命名。《温病条辨》曰：“温病者，有风温、有温热、有温疫、有温毒、有暑温、有湿温、有秋燥、有冬温、有温疟”。COVID-19中医病名涉及到的湿、温、疫、毒均属广义温病的范畴。其病位主要在肺，具温疫传染性、流行性的特点;病理性质涉及湿、热、毒、虚、瘀;病因多为疫疠之气，湿毒为原[9]，贯穿始终。
未病先防，既病防变，各省根据疾病的发展情况(预防期、医学观察期、初期、中期、重症期、恢复期)制定了相应的方案，根据目前的诊疗方案[5，10]，可以观察到该病有卫气营血之传变规律[11]。初起疫邪犯表，邪伏膜原，卫表失和;病邪由表入里，疫毒郁闭肺气，或结于胸膈，或传入阳明，热结肠燥，肺壅腑实;疫毒内侵，气血两燔。血分证向恶，可逆传心包。, 百拇医药(孙怿泽 王哲义 侯季秋 刘碧原 石兆峰 赵海滨)
参见：首页 > 医疗版 > 疾病专题 > 耳鼻喉科 > 耳疾病 > 中耳疾病 > 颅外并发症