周仲瑜、董善京国际抗疫专家大讲堂在线答疑集锦
由世界针灸学会联合会、中华中医药学会、中国针灸学会主办的「国际抗疫专家大讲堂系列讲座」第十讲邀请到了湖北省中医院针灸科主任、针灸研究所所长，中华中医药学会民间特色诊疗技术研究分会常务委员、中国针灸学会理事周仲瑜主任与河南中医药大学人民医院急诊科副主任、河南省援鄂方舱医疗队郑州队队长董善京主任两位专家，在直播中向海内外医疗工作者介绍针灸在新冠肺炎中的介入与治疗。在答疑环节，两位专家解答问题汇总如下：
问题1：一病人疑似新冠（有和确诊新冠病人接触），经过中医药治疗，所有症状都消失，但偶尔有咳，咳时会感觉肝区脾脏区痛，有交代刮痧和热敷，但反反复复。今日大便干结，大肠绞痛（病人一个月前有得膀胱炎已痊愈）。由于交通不便，我们只能用身边所取物尽力而为。请董主任给出建议。（附三次舌诊图） ——葡萄牙康复（健康）海岸，王科 Q1: A patient of mine was suspected of having coronavirus (there was contact with confirmed case). After treatment with Chinese medicine, all symptoms disappeared, left only occasionally cough, but with pain in the liver and spleen area. Scrapping and hot compress are recommended, but cough still repeats itself. Today, the patient has dry stools and colic (the patient has had cystitis cured a month ago). Due to inconvenient transportation, we can only do our best with what we already have. Could Dr. Dong give us some advices? ——Portugal Health land, Wang Ke 董善京主任：我认为这个患者首先与确诊的新冠肺炎患者有接触史，那么我们就不能排除该患者是确诊的新冠肺炎患者的可能性，如果有条件的话，最好是通过他的临床表现、血液检查、影像学检查以及核酸的检测，来确定他是不是确诊的新冠肺炎患者。如果是确诊的新冠肺炎患者，那么在中医或针灸等外治法治疗时应特别注重防护，比如刮痧这些操作，作为医者没有做好防护，感染疾病的几率就会非常大。 我们从病人的舌苔上来看，第一次舌苔是白腻苔，可见寒湿之邪侵袭，这里没有提到最初患者的一些症状，但从描述上来讲，应该也会出现咳嗽、乏力、发烧等症状，经过治疗后咳嗽这些基本症状，或者其他严重的症状得到缓解，但偶尔有咳嗽，说明还没有痊愈。第二次舌苔是舌体胖大黄腻苔，也就是说这个疾病（没有痊愈）入里化热，舌苔表现出湿热之象。患者今天来就诊，主要症状是大便干结和腹部疼痛，如果不能到医院或诊所进行治疗，我们建议用简便的方法来指导操作，比如点按穴位，可选择支沟、合谷、天枢、足三里和太冲等穴位进行按压，起到润肠通便，调畅气机的作用；对于大便干结，也可以运用按摩手法，两手叠加放于脐部，顺时针按摩，从而促进大便的排泄，对腹部的疼痛也有一定的缓解作用。 Dr. Dong Shanjing: I think this patient first has a history of contact with a diagnosed COVID-19 patient, then we cannot rule out the possibility that this patient is a confirmed COVID-19 patient. If conditions permit, it is best to determine whether he is a confirmed COVID-19 patient through his clinical manifestations, blood tests, imaging examination, and nucleic acid tests. Once he is confirmed a COVID-19 patient, you should pay special attention to protection during external treatment methods such as Chinese medicine or acupuncture. For example, when doing operations like scraping, the risk of infection is very high if the doctor does not take good protection. From the patient's tongue coating, we can see that the first one is white and greasy, which shows the invasion of pathogenic cold and dampness. There is no mention of initial symptoms of the patient, but from the description, there should also be symptoms such as cough, fatigue, fever, etc. After treatment, these main symptoms of cough or other serious symptoms are relieved, but occasional coughing shows that it has not been cured. In the second one, the tongue body is fat and tongue coating is yellowish and greasy, that is to say, the disease (not cured) turns into heat, and the tongue coating shows the sign of damp heat. The patient came to see a doctor today with main symptoms of dry stool and abdominal pain.If the patient cannot go to the hospital or clinic for treatment, we suggest to use simple methods to guide the operation. For example, by pressing the acupoints such as Zhigou(SJ6), Hegu(LI4), Tian Shu(ST25), Zusanli(ST36) and Taichong(LR3). These acupoints can be selected to moisten the bowels and smooth the qi. For dry stool, you can also use massage manipulation. Put one hand on top of the other on the navel and massage clockwise to promote the excretion of stool and give some relief from abdominal pain. 问题2：在武汉已经开设了新冠肺炎康复门诊，在您接诊的这些恢复期患者主要还会有哪些症状？治疗是以纯中医疗法为主吗？疗程多久？请您介绍下相关经验，谢谢！ Q2: COVID-19 Rehabilitation Clinics have been established in Wuhan. What are the main symptoms of the patients in the recovery period? Did you treat them only with Chinese medicine? How long is the treatment? Please introduce your experience. Thank you! 周仲瑜主任：在我们湖北省中医院也是新冠肺炎康复的定点医院，来咱们医院就诊的恢复期病人，主要症状以胸闷、心慌的最多，其次是乏力、盗汗、自汗、失眠、胃脘部不适。在治疗方面，我们康复门诊是以纯中医治疗为主，我们采用的是MDT模式，也就是多学科团队协作模式，治疗采用中药、针灸、耳穴压豆、穴位敷贴、心理咨询干预、传统功法等综合疗法。 根据病人的实际情况，一般来说一个疗程是两周左右，我们会随着病人症状的改善程度进行调整。对于新冠肺炎的恢复期病人，如果这个病人住的很远，来往就医成本很高的话，我们常常会给予一些长效的治疗方法，比如说中药开10至14天；另外我们还会指导患者在家做艾灸，通过互联网的平台，实现医生对患者在线上一对一的管理，“一药一灸一功一浴”，即中药、艾灸、传统功法锻炼和足浴疗法，这是我们康复门诊最常用的治疗方法。 Dr Zhou Zhongyu: In our Hubei Provincial Hospital of Traditional Chinese Medicine, it is also the designated hospital for the rehabilitation of COVID-19. In the recovery stage, the main symptoms of those patients coming to our hospital are chest tightness and palpitation, followed by symptoms such as fatigue, night sweat, spontaneous sweat, insomnia and epigastric discomfort. These are the main symptoms. In terms of treatment, our rehabilitation clinic is mainly based on pure Chinese medicine, and we adopt MDT mode, that is, multi-disciplinary team cooperation mode. The treatment uses integrated therapies such as Chinese medicine, acupuncture, auricular acupuncture, acupoint application, psychological counseling intervention, and traditional methods. According to the actual situation of the patient, generally a course of treatment is about two weeks, we will adjust as the patient's symptoms improve. For the COVID-19 patients in the recovery period, if he(she) lives far away and the cost of medical treatment is high, we often give him(her) some long-term treatments, such as Chinese medicine for 10 to 14 days. In addition, we will also guide the patient do moxibustion at home with an one-on-one online management between doctors and patients through the platform of the internet. The methods of "one medicine, one moxibustion, one function and one bath", that is, Chinese medicine, moxibustion, traditional exercise and foot bath therapy, are the most commonly used treatment method in our rehabilitation clinic. 问题3：新冠肺炎患者出现的腹泻症状与普通感冒引起的腹泻是否有区别？治疗上有何异同？除了腹泻症状外，中医师如何从症状上来鉴别新冠肺炎与流感及感冒？您在用艾灸治疗新冠肺炎患者腹泻症状时有没有做空白对照组？ ——中国针灸学会会员 Q3: Is there any difference between diarrhea symptoms in patients with COVID-19 and that caused by common cold? What are the similarities and differences in treatment? Besides, how TCM doctors distinguish COVID-19 from flu and cold? Was there a blank control group when using moxibustion to treat diarrhea in COVID-19 patients? ——member of CAAM 董善京主任：对于新冠肺炎患者出现的腹泻症状，与普通感冒所引起的腹泻，在临床伴随症状、腹泻的次数和大便的性状来讲的话，应该是区别不大，但是在治疗上、中医的病机上还是有所区别的，因为新冠肺炎它是寒湿疫毒邪所致，病邪比较凶猛，肺卫表症很少，而是（病邪）直中太阴所表现出脾虚症状，即脾失健运而导致的腹泻症状；但普通的感冒一般是以肺卫表症、太阳病为主，进而合并阳明，所以说他们两者病机上有所区别的，在治疗上也有区别，对于新冠肺炎所引起的腹泻，主要是以健脾化湿、温阳散寒为主，而对于普通感冒所引起的腹泻，主要是关注解表散热或祛寒，当然也要兼顾着腹泻的症状，这是关于腹泻症状、中医病机以及在治疗上的区别。 对于腹泻症状以外，新冠肺炎和流感、普通感冒都是呼吸道的疾病，也是有一定的区别的。首先，普通型感冒和流感的区别，普通感冒主要表现上呼吸道症状，比如鼻塞、流鼻涕、打喷嚏等这些卡他症状，还有一些轻微的咳嗽、低烧，它的传染性不强，没有很严重的头疼，一般情况恢复比较好，预后较好，基本上没有传染性；流感相对普通感冒来讲，症状比较重，来势比较猛，进展比较快，会出现高烧、恶寒、头疼、乏力等明显症状，同时可伴有咳嗽的症状，胸闷。新冠肺炎早期以发热、乏力、干咳为主要表现，从其症状上讲与普通的感冒并不好鉴别，新冠肺炎患者前几天症状一般较轻，往往发病一周后病情会突然加重，如出现胸闷气喘症状。另外需要特别关注的是相接触的人是否也出现相同类似的症状。 关于在方舱里使用艾灸治疗新冠肺炎患者腹泻症状时，我们没有设置对照组，我们治疗的这些腹泻患者，在施用艾灸前后进行了对照，确实有显著疗效。 Dr. Dong Shanjing: There should be little difference between the diarrhea symptoms of COVID-19 patients and the diarrhea caused by the common cold in terms of clinical accompanying symptoms, the frequency of diarrhea and the characteristics of stool, but there should be some differences in treatment and TCM pathogenesis. Because COVID-19 is epidemic caused by cold, dampness and toxin, the disease is more ferocious, there are few exterior lung symptoms, but more spleen deficiency symptoms manifested by the straight attack of the pestilence to Taiyin (spleen). That is, the symptoms of diarrhea is caused by spleen dysfunction. However, the symptoms of common cold are mainly lung-defense exterior syndrome and Taiyang syndrome, then merged with Yangming syndrome. So there are differences in pathogenesis and treatment between them. For the diarrhea caused by COVID-19, the main treatment is strengthening the spleen to dissipate dampness, and warming yang to disperse the cold. While for diarrhea caused by the common cold, it is mainly concerned with relieving the heat or dispelling cold, of course, the symptoms of diarrhea must also be considered. This is about the symptoms of diarrhea, the pathogenesis of traditional Chinese medicine and the difference in treatment. In addition to diarrhea symptoms, COVID-19, flu, and common cold are all respiratory diseases, and there are certain differences. First of all, the difference between common cold and flu, common cold mainly shows upper respiratory symptoms, such as nasal congestion, runny nose, sneezing and other catarrhal symptoms, as well as some mild cough and low fever, which is not contagious. There is no serious headache, the general condition and the prognosis is better, and it is basically not contagious. Compared with the common cold, flu is more severe, with more serious symptoms, stronger oncoming force and faster progress. There will be a high fever, cold, headache, fatigue and other obvious symptoms, at the same time can be accompanied by cough and chest tightness. In the early stage of COVID-19, fever, fatigue, and dry cough are the main manifestations. It is not distinguishable from common cold in terms of symptoms. The symptoms of COVID-19 patients are generally mild in the first few days. Often after a week of onset, the condition will suddenly worsen, with symptoms such as chest tightness and asthma. Also of particular concern is whether people in contact with the same symptoms. And special attention should be paid to whether the people in contact also have the same or similar symptoms. Regarding the use of moxibustion in the temporary hospital to treat diarrhea symptoms in COVID-19 patients, we did not set up a control group. The diarrhea patients we treated were compared before and after moxibustion, and there was indeed a significant effect. 问题4：艾灸对患者发热、乏力，干咳等其他症状效果如何？ Q4: How is the effect of moxibustion on fever, fatigue, dry cough and other symptoms? 董善京主任：应该说新冠肺炎表现出来的症状主要就是以发烧、乏力、干咳为主。如果说艾灸能治疗类似症状的话，那也就是说它会对新型冠状病毒肺炎有非常好的疗效，我们在方舱医院治疗的这些患者，主要以腹泻为主，当然，我们从病因、病机和病理上来考虑，新冠肺炎的病因病机，都是寒湿疫毒之邪所损伤肺体之症，我们可以通过艾灸来温阳固本、祛寒温通，针对着新冠肺炎的寒湿这一病机。我们通过以往的经验，在患者的大椎、风门、肺俞、关元、气海、足三里等部位进行施治，咳嗽等相应的症状有所改善。这些需要我们进行系统的研究，现在国际上新冠肺炎患者还是比较多的，以后我们可以进一步研究和探讨。 Director Dong Shanjing: It is said that the main symptoms of COVID-19 are fever, fatigue and dry cough. If moxibustion can treat those similar symptoms, it means that it will have a pretty curative effect on COVID-19. The patients in the Module Hospital are mainly diarrhea. Of course, from the perspective of etiology, pathogenesis and pathology, the etiology and pathogenesis are cold-damp pestilent toxin impairing lungs. So we can use the moxibustion to warm yang and consolidate body resistance, remove cold and warmly dredge the body to deal with the pathogenesis of cold-damp. According to previous experience, the patients were treated in Dazhui (GV14), Fengmen (BL12), Feishu (BL13), Guanyuan (CV4), Qihai (CV6), Zusanli (ST36) and other parts, and corresponding symptoms like cough were improved. These require us to conduct systematic research. There are still many patients with COVID-19 in the world and we can have further study and discuss in the future. 问题5：现在国内的确诊病例已基本治愈，但是又出现了一些无症状感染者，提高自身免疫力尤为重要，在武汉，我们针对一线的医务人员做了哪些预防措施来提高医生抵抗力，请您分享一下？ ——中国针灸学会会员 Q5: Now the confirmed cases in China are basically cleared, but there are some asymptomatic cases. Improving self-immunity is particularly important. In Wuhan, what preventive measures have you made for front-line medical workers to improve their resistibility? ——member of CAAM 周仲瑜主任：我们平时说的免疫力或抵抗力其实就是中医所说的正气，提高自身的免疫力就是要提升正气。一个人受病与否，与人的体质强弱有关，正所谓“正气存内，邪不可干；邪之所凑，其气必虚”，从古代的文献研究、实验机制、临床实践均表明艾灸能够扶助人体的正气，提升人体抗御病邪的能力。 在疫情初期，我们医院就成立了专门针对一线医护人员的艾灸理疗室，对阳虚寒湿体质的医护人员予以培元固本灸，施灸神阙穴，以扶阳升阳、温经散寒、提升正气，从而起到预防保健的作用。我们还制定了新冠肺炎防护的居家养护中医艾灸方案，目的是指导大家在家里如何做灸、如何取穴、告知注意事项等，通过艾灸起到温经散寒祛湿气、提升阳气保健康的作用，发挥未病先防的作用。那么对于不能使用明火艾灸的一线医护人员，就发放我们研制的隔物灸贴，隔物灸贴有热+药的效应，携带非常方便，我们指导医务人员在家里对照穴位自行贴敷。另外，我们医院为一线的抗疫人员还分发了预防肺炎的代泡茶饮，同时也非常注重心理健康，注重医护人员的心理疏导，有专门的心理医生参与到一线的抗疫队伍中。通过以上这几项措施，可以达到提升正气的目的，起到“正气存内、邪不可干”的效果。 Director Zhou Zhongyu: What we usually called immunity or resistance is actually healthy qi in TCM theory—improving immunity is equals to enhance healthy qi. Whether a person will fall sick or not is related to his own constitution—it is said that where healthy qi stored in bodies, the pathogenic qi won’t intervene, and where pathogenic qi gathers, the healthy qi there is rare (huangdi neijing). Ancient literature research, experimental mechanism and clinical practice all showed that moxibustion can improve human bodies’ healthy qi and their ability to resist diseases and pathogens. At the initial time of the epidemic, our hospital set up a moxibustion physiotherapy room targeting doctors and nurses with yang deficiency and cold-damp constitution to develop yuan qi and stimulate the bodies by moxibustion in Shenque (CV8), which can raise yang, warm channel for dispelling cold and promote healthy qi to play a role in prevention and health care. We also have developed the home care moxibustion program of COVID-19 protection, aiming at guiding people to do moxibustion and point selection, and matters for attention, etc. Moxibustion can remove dampness and improve yang qi, we hope that in this way it will assist to prevent the disease. For the frontline staffs who cannot use fire moxibustion, we gave out moxibustion stick we developed, which was convenient and possessed effect of heat and medicine, to indicate them apply it at home according to the points. Additionally, our hospital also distributed tea balls to prevent pneumonia for the frontline personnel. Meanwhile, we attach significant attention to their mental health and psychological counseling—there are special psychologists participating in anti-epidemic teams. The above several measures can the promotion of healthy qi to achieve the effects of storing healthy qi and banish pathogenic qi. 问题6： 艾灸特别是艾草、硫磺、苍术、菖蒲、大黄等家居烟熏从古至今对瘟疫都有良好的防瘟避瘴作用。如今国内新冠疫情取得了阶段性胜利，海外疫情依然严峻，请问专家我们从《阴阳应象大论》：“壮火食气，少火生气。”到《医宗金鉴·刺灸心法要诀》的：“凡灸诸病必火足气到，始能求愈”。如何指导民众进行简便高效的温灸的防疫操作及注意事项？ ——毛里求斯针推协会 Q6: Moxibustion, especially Artemisia Argyi, sulfur, Rhizoma Atractylodis, calamus, rhubarb, and other household smokes have a good anti-plague effect from the ancient times. Now that China has achieved staged victory against coronavirus, while the overseas pandemic is still grim. I would like to know that, how to guide the public to carry out simple and efficient moxibustion to prevent the virus and its precautions? ——Chinese Traditional Massage Acupuncture Association (Mauritius) 董善京主任：其实这是两个问题，第一个问题是如何运用艾叶、苍术、硫磺、菖蒲、大黄等居家烟熏来防治瘟疫与瘴气，这些是我们古代的劳动人民从抗击疫情中总结出来的经验和方法，以前我们有在门前悬挂艾叶驱邪，或通过艾叶的燃烧，驱除邪毒疫气。刚才我也提到在方舱医院或者其他医院在疫情期间可以运用艾叶烟熏的方法，来起到芳香辟秽的作用，在方舱医院这种相对密闭的空间内，用84消毒液就只是对物体的表面和地面起到消毒作用，但是对于空间内的空气还是需要其他一些方法，如果运用艾叶、菖蒲等的燃烧来芳香辟秽，应该是能起到一定作用的，当然方舱医院内有患者入住的情况下不适合燃烧艾叶。那么我们平时如何在房间内消毒呢？我们可以用干艾叶或者艾绒，放置在一个金属的器皿中燃烧，并把窗户关闭，人到房间外，30分钟后再进屋开窗通风，这样就可以对房间内的空气起到一个很好的芳香辟秽作用。 第二个问题，如何运用温灸的方法起到保健作用。“壮火食气，少火生气”和“凡灸诸病必火足气到，始能求愈”这是两个方面。第一个方面是我们对于病人的体质要辩证，其次在施灸的时候要达到治疗效果。如果患者属于阳盛体质，就不要用太强的灸治疗法，因为艾灸是温热疗法；如果患者是虚寒体质，可以用灸法，多壮且长时间灸治。所以根据病人不同的体质，用不同的灸法、不同的疗程，这是有一定的关系的。对于现在这个疫情，疾病的传染性特别强，我们每个人都是易感，所以对于我们居家之人如何防护，中医提出了一些建议，比如说“正气存内、邪不可干”，那么如何提高我们的正气呢？可以通过艾灸足三里、关元、气海、大椎等穴位来提高我们自身的免疫力，增强抵抗力，以免于受到疫情的侵袭而发病。 Director Dong Shanjing: It is actually two questions. The first question is how to use Artemisia Argyi, Rhizoma Atractylodis, sulfur, calamus, rhubarb, and other household smokes have a good anti-plague effect. These effective experiences and methods are summarized by ancient people by fighting against epidemics. In the past, we hung Artemisia Argyi in front of the door to drive away evil, and burning Artemisia Argyi to dispel filth with aroma. Just now I mentioned that in Module Hospital or any other hospitals can use Artemisia Argyi to dispel filth with aroma. In a relatively confined space like Module Hospital, 84 Disinfectant pnly kills the surface of the object and the ground rather than the air, while Artemisia Argyi and Calamus should work in a certain extent. But the environment of Module Hospital is not suitable to burn it. So how to disinfect the room in our daily life? Artemisia Argyi or its tomentum is appropriate. Place it in a metal vessel to burn and close the window. Get out of the room and open the window after 30 minutes, so as to dispel filth with aroma. The second question is how to use warm moxibustion in health care. “excessive fire takes away qi, while less fire multiply qi” (Annotations on ‘The Yellow Emperor’s Inner Classic’) and “general acupuncture treatment must have enough fire and qi, in order to recover” (Golden Mirror of the Medical Tradition) are two aspects. The first aspect is we are supposed to differentiate according to patients’ constitutions, and secondly, therapeutic effect should be achieved when applying moxibustion. If the patient belongs to yang excessiveness, do not use too strong moxibustion for it is warm treatment; if the patient belongs to deficient and cold constitution, use strong and long time moxibustion. So according to the patients’ different constitutions, apply different treatment—they relate to each other. As for COVID-19, which is strongly communicable, everyone is susceptible to it. Therefore, Chinese medicine has put forward some suggestions on how to protect people at home. For instance, “where healthy qi stored in bodies, the moxibustion in Zusanli (ST36), Guanyuan (CV4), Qihai (CV6), Dazhui (GV14) and other points to improve our immunity, enhance resistance, so as to avoid the invasion of the epidemic.
World Federation of Acupuncture-Moxibustion Societies