中醫藥研究論叢

25S.3 COVID-19病例報告:結合中西醫觀點初探新冠肺炎之臨床特性
TJ TCM.25(S) : 21-26, 2022
COVID-19 病例報告:結合中西醫觀點初探新冠肺炎之臨床特性
Case Report: A Preliminary Study on the Clinical Features of COVID-19 Combining the Viewpoints of Traditional Chinese and Western Medicine
張育佳1* 黃建榮2 程怡華3
1 悅展中醫診所,台北,台灣
2 台北市中醫師公會,台北,台灣
3 中國中醫科學院廣安門醫院西單門診部,北京,中國大陸
【摘要】
面對新冠肺炎千變萬化的證型及臨床症狀,本文望能結合中西醫學的觀點做一初步探討。根據筆者的中醫臨床觀察及西醫文獻回顧,歸納出新冠肺炎的三大特性,第一個特性是新冠肺炎會造成體內水液代謝的失衡,進而導致發炎及血栓的產生,此乃新冠肺炎病毒透過結合血管張力素轉換酶進入人體,影響腎素-血管張力素-醛固酮系統的路徑所致;其影響相當於中醫的氣血水道失調,且尚需釐清是五臟六腑或三焦水道的損傷,更提出新冠肺炎造成燥濕互見的特殊病理環境。第二個特性是引起內皮細胞的發炎,不單單只是肺部的上皮細胞,也包含腸道細胞及血管內皮細胞,影響層級遍佈全身;相當於中醫「血瘀」的概念,而血瘀係肇因於熱邪、血寒、氣滯、氣虛亦或燥邪致瘀,則須醫者留心鑑別。第三個特性是長期情緒壓力患者,容易導致預後較差。此乃由於長期肝木之氣偏盛,木火刑金,導致易作肺病。了解此三大特性,在染疫急性期、恢復期甚至預防階段,中醫藥皆可發揮重要角色,縮短病程,協助病人儘速恢復日常生活步調。
【關鍵詞】燥濕互見、血瘀、木火刑金、中醫、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