应用“理肺清肠,通腑泻热”法治疗新型冠状病毒感染重症肺炎病1例
Application of the Lung-Clearing and Intestinal Heat-Clearing, Purging the Bowels to Remove Heat Method in the Treatment of Severe COVID-19 Pneumonia: A Case Report
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1.广州医科大学,广州 510182
2.广州医科大学附属第一医院,中医科 510000
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胡远龙,戴诗婷,张大鹏,等.应用“理肺清肠,通腑泻热”法治疗新型冠状病毒感染重症肺炎病1例[DB/OL].(2023-12-18)[2023-12-18].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46082061&Fpath=home&index=0&lang=zh
HU YuanLong,DAI ShiTing,ZHANG DaPeng,et al.Application of the Lung-Clearing and Intestinal Heat-Clearing, Purging the Bowels to Remove Heat Method in the Treatment of Severe COVID-19 Pneumonia: A Case Report[J].,
胡远龙,戴诗婷,张大鹏,等.应用“理肺清肠,通腑泻热”法治疗新型冠状病毒感染重症肺炎病1例[DB/OL].(2023-12-18)[2023-12-18].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46082061&Fpath=home&index=0&lang=zh DOI:
HU YuanLong,DAI ShiTing,ZHANG DaPeng,et al.Application of the Lung-Clearing and Intestinal Heat-Clearing, Purging the Bowels to Remove Heat Method in the Treatment of Severe COVID-19 Pneumonia: A Case Report[J]., DOI:.
病史摘要,2,钟某,男,62岁,江西人。因“反复发热、气促、咳嗽半年,加重半月”于2023年7月13日请中医会诊。患者半年因感时疫出现发热,咳嗽,胸闷等症状,辗转多家医院治疗效果不佳,病情不断加重。2023年6月28日患者再次发热,咳嗽,气促,口炎舌痛,纳差,以“肺部感染”收入我院呼吸危重症科。经予抗菌、抗病毒等药物并对症支持治疗后,症状仍反复,病情加重并出现中度贫血,气促明显,需平卧辅助无创机械通气,鼻饲进食。遂邀会诊。症见:精神倦怠,身热时起,面色晦暗不泽,目睛有神,讲话时口角有痰沫飞溅,喉中多痰,舌痛,纳差,头痛,肩背不举,腰痛难以转侧,四肢倦怠,脐周有压痛,大便不调,夜寐烦躁,多汗。舌尖红,舌面有碎裂感及溃疡,苔腐腻,舌根部有块状痰浊附着,脉涩不畅。中医诊断 肺炎喘嗽(痰热壅肺证)。西医诊断 重症肺炎、机化性肺炎、贫血(重度)、巨细胞病毒性肺炎、侵入性肺曲霉病等。干预措施 中医以理肺清肠,表里双清为法,结合患者的体质特点,寓补于泻,以泻为补,通补兼施。疗效转归 服药后邪有出路,风湿疫毒有外达之机,热退身凉,咳减,精神好转明显,胃气渐复。出院后,在我科门诊继续中药及导引外治加强排痰等肺康复综合治疗。
Medical History Summary, Mr. Zhong, a 62-year-old male from Jiangxi province, presented with a history of "repeated fever, dyspnea, and cough for six months, worsening over the past two weeks." He sought a consultation with Traditional Chinese Medicine (TCM) on July 13, 2023. The patient had experienced fever, cough, chest tightness, and other symptoms during the past six months, seeking treatment at multiple hospitals without significant improvement. The condition continued to worsen. On June 28, 2023, the patient experienced recurrent fever, cough, dyspnea, stomatitis, tongue pain, poor appetite, and was admitted to our Respiratory Intensive Care Unit (RICU) with a diagnosis of "pulmonary infection." Despite treatment with antibiotics, antiviral drugs, and supportive care, the symptoms persisted, and the condition worsened, accompanied by moderate anemia and marked dyspnea, requiring supine position-assisted non-invasive mechanical ventilation and nasogastric feeding. Thus, a TCM consultation was requested. ,Clinical presentation ,The patient appeared fatigued, experienced heat rising in the body, had a dull complexion lacking luster, bright eyes, and sputum splattering when speaking. The throat had excessive phlegm, tongue pain, poor appetite, headache, inability to lift shoulders and back, difficulty turning sides due to lower back pain, fatigue in the limbs, tenderness around the navel, irregular bowel movements, restlessness during sleep, and excessive sweating. The tongue tip was red with a sense of fragmentation and ulcers on the tongue surface. The tongue coating was thick and greasy, with a lump of turbid phlegm adhering to the posterior part of the tongue, and the pulse was rough and obstructed.,TCM diagnosis, phlegm-heat obstructing the lungs in the context of pneumonia and cough (phlegm-heat stagnating the lung pattern).,Western medicine diagnosis, severe pneumonia, organizing pneumonia, severe anemia, cytomegalovirus pneumonia, invasive pulmonary aspergillosis,.,Intervention measures, TCM intervention focused on clearing the lungs and clearing the intestines, simultaneously addressing the external and internal aspects of the condition. Considering the patient's constitutional characteristics, the treatment approach combined tonification with purgation, emphasizing the use of purgation as a means of tonification and promoting both tonification and purgation.,Therapeutic outcome, After taking the prescribed medication, the pathogenic factors were expelled, and there was an opportunity for the elimination of rheumatism and epidemic toxins. The fever subsided, the body felt cool, the cough decreased, there was a significant improvement in mental state, and gastric qi gradually recovered. After discharge, the patient continued with TCM treatment and comprehensive pulmonary rehabilitation, including herbal medicine and external therapies for enhancing sputum clearance, at our outpatient department.
理肺清肠通腑泄热新型冠状病毒感染重症肺炎
clearence of the lungs and the intestinesintestinal heat-clearingCOVID-19 infectionsevere pneumonia
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