贾维刚 周泉宇 肖芙蓉 赵蕾 王博 张晓刚 刘清泉

〔摘要〕 目的 分析北方普通型新型冠狀病毒肺炎中医证候特点及区域内方案汤剂治疗效果。方法 回顾性总结区域内96例普通型新冠肺炎患者的临床证候及“黑龙江省方案（2021版）”中药汤剂的临床疗效;比较患者治疗前后白细胞计数、嗜酸性粒细胞计数与百分比（EOS、EOS%）、C-反应蛋白和降钙素原水平;统计患者治疗前、治疗1周、治疗后（出院前）的肺部CT感染灶变化情况。结果 患者干咳稍重于中等发热，口干、咽紧伴发全病程，乏力明显;舌干和齿痕舌多，舌苔多厚腻或浊腻。患者一转时间为9～15 （12.28±2.03） d，转阴时间为9～20 （17.31±4.62） d，住院时间为13～26 （20.17±3.19） d。转为重症者2例，恶化率2.08%。复阳者6例，复阳率6.25%。患者治疗前后EOS、EOS%、齿痕舌、舌干、黄腻苔、滑数脉比较，差异有统计学意义（P<0.05）。与治疗前比较，治疗1周后患者肺部的左上、右中区段炎症评分以及肺部炎症总评分明显下降，左上、左中和右下区段感染频次明显减少（P<0.05）;治疗后（出院前）患者肺部的左上、左中、右上区段炎症评分及肺部炎症总评分明显得到改善，各区段感染频次明显减少（P<0.05）。结论 北方普通型新冠肺炎以“湿毒化燥伤阴”为中医证侯特点，肺部感染程度不严重，但感染范围广泛且吸收偏慢，危重症和复阳率低。方案汤药能够促进嗜酸性粒细胞恢复正常和中医证侯好转，稳定病情、改善预后、降低复阳率。

〔关键词〕 普通型新型冠状病毒肺炎;浊毒;开窍;生津;北方

〔中图分类号〕R259       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.10.016

Observation on TCM Syndrome Characteristics and Therapeutic Effect of Decoction on 96

Patients with Common COVID-19 in Northern China

JIA Weigang1， ZHOU Quanyu1， XIAO Furong2， ZHAO Lei1， WANG Bo1， ZHANG Xiaogang3*， LIU Qingquan4

（1. Department of Emergency， Nangang Branch of Heilongjiang Academy of Chinese Medicine Sciences， Harbin， Heilongjiang 150001， China; 2. Department of Traditional Chinese Medicine of Harbin Infectious Diseases Hospital， Harbin， Heilongjiang 150036， China; 3. Department of Brain Surgery of China Red Cross Hospital of Harbin， Harbin， Heilongjiang 150020， China;

4. Beijing Hospital of Traditional Chinese Medicine， Capital Medical University， Beijing 100005， China）

〔Abstract〕 Objective To analyze the characteristics of traditional Chinese medicine （TCM） syndrome of common COVID-19 in northern China and the therapeutic effect of TCM decoction. Methods The clinical manifestations and TCM syndromes of 96 patients with common COVID-19 and the therapeutic effect of TCM decoction of "Heilongjiang Scheme （2021 Edition）" on it were retrospectively summarized. White blood cell count， eosinophil count and percentage （EOS， EOS%）， C-reactive protein and procalcitonin levels were compared before and after treatment. The Changes of pulmonary CT infection foci before treatment， one week after treatment and after treatment （before discharge） were numerical statement. Results The symptoms of dry cough were slightly more severe than moderate fever， while the dry mouth and the tight pharynx were accompanied by the whole course of the disease， and the fatigue was obvious. The dry tongue， the tooth marks tongue were more common， and the tongue coating more thick greasy or turbid greasy. The first conversion time was 9～15 （12.28±2.03） days， the negative conversion time was 9～20 （17.31±4.62） days， and the hospital stay was 13～26 （20.17±3.19） days. Two cases became severe， and the severe rate was 2.08%. There were 6 cases of repositive， the reactivation rate of nucleic acid was 6.25%. There were statistically significant differences in EOS， EOS%， tooth mark tongue， dry tongue， yellow greasy moss and slippery pulse before and after treatment （P<0.05）. Compared with before treatment， the inflammation scores of the upper left and middle right segments in lung and the total score of lung inflammation decreased significantly， as well as the frequency of infection of upper left， left and lower right region was significantly reduced after one week of treatment （P<0.05）， the inflammation scores of the upper left， middle left and upper right segments in lung and the total score of pulmonary inflammation were significantly improved， and the infection frequency of each segment was significantly reduced after treatment （before discharge） （P<0.05）. Conclusion The common COVID-19 in northern China is characterized by "dampness， poisoning， dryness and Yin injury" as the syndrome of TCM. There are non-seriously in degrees but widely in range and slowly in absorption of lung infection， and the rate of critical illness and positive recovery is low. The decoction can promote eosinophils to return to normal and TCM syndrome to improve， stabilize the condition， improve the prognosis and reduce the reactivation rate of nucleic acid.

〔Keywords〕 common COVID-19; turbidity toxin; orifice-opening; promoting fluid; northern China

新型冠状病毒肺炎（简称新冠肺炎）具有变异性快、传染性强、人群普遍易感的特点[1-3]，对全球价值链、外贸、金融、公共卫生等多领域造成了严重影响[4-7]。中医药防治新冠肺炎具有独特的优势和重要的作用，能够有效减轻症状，提高机体免疫力，进而稳定和遏制疫情的进展[8-9]。但同时也需要进一步健全应急体系、优化协同性、完善诊疗体系等[10]。研究[11-13]发现，新冠肺炎的发病和患者的中医证侯各具其地域特征，治疗方法也不尽相同。本文总结了96例北方普通型新冠肺炎患者的中医证侯特点，并观察了区域内诊疗方案中解毒祛湿、开窍生津、清肺化痰中药汤剂的治疗效果，现报道如下。……