世界针灸学会联合会

(CN/EN)Q&A from the International Lectures of COVID-19 by Dr Li Guangxi

author:WFAS source:WFAS Click:820 update:2020-04-14
  

Q1-Dr. Deng(Medical Director of the BendheimIntegrative Medicine Center at MSKCC): What are the criteria specifically for initiating IPPV (Intermittent Positive Pressure Ventilation)? 

问题1-邓博士(纽约斯隆肿瘤中心整合医学中心医务主任):启动呼吸机间歇正压通气模式的特殊指标有哪些?

Dr. Li : Depends on the patient’s saturation, according to our experience, once a patient basically gets a good saturation with a high flow of nasal oxygen support, that’s very important. Usually we give the patients about 65% or 70% FiO2, the device is high nasal flow of oxygen support. But if it still did not work, after three hours, the patient is still in bad situation, never reach 93%. Also the patient usually has a very strong cough, as you know, plus the fever. We must consider to interfere the patient as early as possible. We need to pay attention to the frequency of cough when the patient rests. I believe this is strong indicator for using ventilation. After strong cough, patients usually have very bad saturation, usually maybe decrease to 75% even.

李光熙博士:根据我们的经验,这取决于患者的血氧饱和度,重要的是在经鼻高流量氧疗支持下,患者基本能达到良好的指端氧饱和度。通常我们给病人约65%或70%的氧气,该装置是经鼻高浓度的氧气支持。但是如果三个小时后病人氧饱和度仍旧不好,那么状况会继续恶化,再也达不到93%的血氧饱和度。当病人咳嗽得很厉害,还伴有发烧时,我们必须考虑尽早对病人干预,病人休息时咳嗽的频率也要关注。我认为这是使用呼吸机间歇正压通气的重要指征。剧烈咳嗽后,患者的氧饱和度通常很差,通常甚至可能下降到75%。

Q2-Dr. Deng: The second question is because in the United States, there is a shortage of hospital beds, so a lot of patients has mild symptoms, were discharged to home for quarantine, even though when they have symptoms, such as low grade fever, some cough, some fatigue. You mentioned the key factors are to watch for high fever, dry cough and dyspnea. Unfortunately a lot people do not have the ability to monitor their ox-meter at home. So when you say high fever, is there any specific number? 38, 39 or 39,5 degree Celsius, anything like that?

问题2-邓博士:第二个问题是在美国,因为医院床位短缺,很多症状较轻的患者,即使存在低烧,咳嗽,乏力等症状,也要出院居家隔离。您提到要特别注意发热,干咳和呼吸困难。不幸的是,很多人不能在家使用血氧仪监测。所以,您说到的高热是不是有具体数字?比如38、39或39.5度? 

Dr. Li: Yes, so the criteria for high fever is more than 39 Celsius, which is very bad. That’s because of disease is usually like that—on the first 1 or second day, patients only have low degree fever, for example it’s usually less than 38.3 Celsius, but maybe after 3 to 5 days, the fever suddenly goes up. The temperature can be up more than 39.5 Celsius. So this stage is very dangerous. During that stage we need (to treat) the patient as early as possible. In China, most patients have the ox meter, maybe in New York they don’t have. In that case, you need to ask the patients to watch how much they can walk? How much distance they walk? And how is the movement? How is the activity related with cough? This correlation it’s usually tightly correlated, the patients usually walk, and then they cough, so that means some very strong indicator for the crucial disease. 

李光熙博士:高热是指腋窝温度在39℃到40℃之间,这是非常糟糕的。那是因为新冠肺炎在第一天或第二天通常只会出现低于38.3摄氏度左右的中等度热,但在第三天到第五天后可能突然升高到39.5℃以上。这个阶段非常危险,我们需要尽早治疗。在中国,大多数患者都有血氧仪,也许在纽约他们没有。在这种情况下患者需要注意他们能不能走路?能走多远?活动与咳嗽是否有关?这种相关性通常是紧密的,患者如果走着走着就咳嗽了,这意味着该病人进入到加重阶段了。

Q3-Dr. Deng: Very few people in the United States have home-oxygen- monitoring ox-meter. There was a saying about the patients: if you can take a deep breath, and hold the breath for 5 seconds, or 10 seconds, you are alright. If you cannot hold your breath for 5 seconds or 10 seconds, you have probably desaturation or dyspnea, then you may go to the hospital. Is there any adaptability like any of that?

问题3-邓博士:在美国,很少有人拥有家用氧气监测血氧仪。关于测试有个方法说是:如果您可以深呼吸,屏住呼吸5秒钟或10秒钟,您就没事了;如果您无法屏住呼吸5秒钟或10秒钟,则您的血氧饱和度低或有呼吸困难,需要医院治疗。这些适用吗?

Dr. Li: I think that the problem is at that stage, it’s little bit late. I still think you need to ask patients to do some activities, for example, to go to the restroom, if they go to restroom, and cough will increase, that’s the dangerous sign. 

李光熙博士:我认为到了那个阶段会有些晚了,活动时候咳嗽增加,例如去洗手间咳嗽增加就是很危险的信号。

Dr. Deng: That’s very helpful. To summarize high temperature of people in home quarantine is about 37.3 Celsius.

邓博士:非常有帮助,归纳一下,在家隔离的发热程度大约是37.3℃。

Dr. Deng: Dry cough especially when induced activities, or in short time dyspnea upon light activities, these are indications for acute phase and they should go to the hospital, are they all correct?

邓博士:干咳,特别是在活动时诱发咳嗽,或在轻微活动中出现短暂的呼吸困难,这些都是疾病急性加重的征兆,应该去医院,对吗?

Dr. Li: I think so, correct. 

李光熙博士:我是这样认为的。

Q4-Dr. Deng: The last question I have is about protection of medical personnel both in the intervention setting and more importantly in the regular care of the patients. I know in China, all these COVID-19 patients are coordinated into the hospital or floor. While here we are unable to do that, so patients still stay in the rooms, so they exercise droplet precaution basically mask, face shield and very light gown. And I see in China, people wear health mask like overall from top to the bottom, from head to shoes. Do you think that kind of protection is overdo or appropriate, or should be done?

问题4-邓博士:我最后一个问题关于医护人员防护程度,包括在呼吸介入环境中的防护,以及更重要的对患者的日常护理的防护。所有这些新冠肺炎患者在中国都安排进入医院或(隔离)楼层。在这里我们无法做到这一点,所以病人仍在普通病房里,医护人员对飞沫的防护基本上是口罩、面罩和薄薄的防护服。我看到在中国使用的是从头到脚的全身防护服。您认为这样的防护措施是过度的,适当的,还是应该采取的?

Dr.Li: I think you know regarding intervention situation is very dangerous procedure, and you must protect yourself very strictly, even though you know whereas in China, we still have physicians in Tianjin, he’s got infected right after the intervention. After intervention of 30 patients, he’s got infected. So that’s right now, probably we still need some kind of positive air, you know some of devices with mask like some small pipe machine. That’s very important for dangerous procedure like intervention bronchoscope,you need to be really careful. And you know regarding the regular people, when you do regular care of patients , you still need to wears the gowns, wear the masks, and also the face shield, to protect yourself from the droplet, and probably from the aerosol. Nobody confirm the aerosol for these patients, but I still think is very dangerous too. In China, all the nurses and physicians in Wuhan, nobody’s got infected, it’s zero. So that means all protection is appropriate, but I’m not sure in New York and other city in the United States, what’s percentage of the infection of health worker? I think if don’t do this kind of protection, the infection rate is still high. Because right now, as we are not sure what’s kind of transmission exactly? So in that case, we need to more be prepared, that’s better than unprepared.

李光熙博士:您知道,呼吸介入操作感染风险很高,您必须非常严格地保护自己。在中国天津有医生在给30位患者做呼吸介入后被感染了。现在我们也许仍然需要提供正压气流的装置,您知道有一些带有管道的电动口罩,这对插管和支气管镜这样的危险操作非常重要。至于日常护理,您仍然需要穿防护服,戴口罩以及面罩,以保护自己免受飞沫和气溶胶的侵害。虽然目前气溶胶传播途径尚未确凿,但我仍然认为这也是非常危险的。在中国,支援武汉的所有医护人员,没有人被感染,即感染率为零。因此,这意味着所有保护措施都是适当的,但是我不确定在纽约和美国的其他城市,医护人员的感染率是多少?如果不采取这种保护措施,我认为感染率仍然会很高。因为现在,我们不确定所有确切的传播途径?因此,在这种情况下,我们需要做更多的准备,这总比没有准备的好。

Q5-Dr. Deng: Thank you, I think that it’s too early to know, right now in New York and the States, we are still in the early stage, in care of regular COVID-19 patients, not doing invasive procedures, do we need N95 mask or just a regular surgical mask, face shield and gown will be in enough?

问题5-邓博士:谢谢,我认为现在对这个(感染率)的了解还为时过早,目前在纽约和美国,我们仍处于早期阶段,还在处理普通病人,没有采取侵入性程序治疗,我们是否需要N95口罩,或者普通的医用手术口罩、面罩和防护服就足够了?

Dr. Li:In China, a lot of physicians initially just wear like that with surgical mask, but actually quite a lot of physicians and nurses have got infected, so I think N95 is very necessary for health workers, and face shield. It’s very very very important.

李光熙博士:在中国很多医生开始也只是戴普通医用外科口罩,但实际上很多医生和护士都被感染了,我认为N95还有防护面屏对于医护人员还是非常必要的,非常重要。

Dr.Deng: Thank you. Right now there is a shortage of N95 mask, so we try to strike fight the use of them in the efficient way.

邓博士:谢谢。目前N95口罩短缺,因此我们努力以有效的方式争取能用上。

Q6-Marek Kalmus: Are any special advices how to treat SARS-Cov-2 infected pregnant women?

问题6-Marek Kalmus:请问对如何治疗SARS-Cov-2感染孕妇有什么特别的建议吗?

Dr. Li: We do have several cases of pregnant women got infected, I saw one patient, one pregnant women at the age of 27, and she died from Covid-19. I think if you are pregnant, you really should be very careful. You know, nobody has immunity of this virus basically, so everyone is vulnerable to this virus, especially for the pregnant women, they may need some kind of more lung capacity, so they really need be taken care of, greatly than other people.

李光熙教授:我们确实有几例孕妇被感染,我看到其中一名27岁的孕妇,她死于新冠肺炎。我认为,一旦怀孕应该非常小心。要知道基本上没有人对此病毒具有免疫力,因此每个人都容易感染该病毒,特别是孕妇,她们需要比普通人更大的肺通气容量(肺活量),因此需要对感染新冠肺炎的孕妇患者更加重视。

Q7-Marek Kalmus:How many asymptomatic COVID-19 carriers are estimated?

问题7-Marek Kalmus:估计有多少无症状COVID-19携带者?

Dr.Li: We don’t have the exact data for those asymptomatic patients, but we know, even for people with mild symptom, they don’t think they got infected. Actually, they just have some diarrhea, some fatigue. They never think they got infected, so we don’t have the exact data for that. There is quite a large population for those people, especially for children, young persons, young adults, they really don’t have bad symptoms, you know, they even don’t have any fever, they just have very mild fatigue, mild cough and mild diarrhea. We don’t know exactly how many got it, because they didn’t do the test for that. That’s we don’t have exact data for this question. 

李光熙博士:我们目前没有无症状感染者的确切数据,一些症状较轻的人,他们只有轻微的腹泻和乏力症状,认为自己没有被感染。这样的人很多,尤其是儿童和年轻人,他们没有严重症状,甚至没有发烧,只是非常轻度的乏力、咳嗽和腹泻。这部分人通常没有做病毒检测。我们没有确切数据。

Q8-Marek Kalmus:I have also question from medical doctors, she is TCM practitioner, she would ask could you describe the nature of corona virus according to TCM and penetration of this pathogen according to Wen Bing Lun or Shang Han Lun?

问题8-Marek Kalmus:我还有位中医的问题,她问您能描述冠状病毒的性质吗?您能根据中医描述这种冠状病毒的性质吗,依据《温病论》和/或《伤寒论》描述这种病原体(侵入)的渗透性吗? 

Dr. Li: I see. According to the first question, how we describe this pathogen in Chinese medicine, we think this coronavirus belongs to the cold, and belongs to the wet. So basically is the cold and wet, that means we need some medicine to expel the cold and dry the wet, so that’s how we describe the principle. 

Regarding the second question, what kind of book we need to use, actually you know, both books are good for this disease, you know we have different success with Chinese doctors, they tried different combinations, some doctors used Shang Han, some physicians used Wen Bing, so they all work. But I think regarding this disease I prefer Wen Bing, because this disease changed rapidly, you can see how fast the patients can deteriorate. So just you know, you can count after 5 days they may become acute lung injury, and they die after 10 days. So it’s very dangerous disease and very rapidly changed disease. Thank you.

李光熙博士:

  第一个问题:我们如何用中医描述这种疾病(病原体),在中医里这属于湿毒疫,大多数以寒湿为主,我们需要祛寒和祛湿的药(来治疗这种病毒),这就是我们的开方原则。

  第二个问题:我们需要依据哪本书来指导?实际上《温病论》和《伤寒论》两本书都对这种疾病都有效。中医医生们尝试了不同组合,有些医生用《伤寒论》,有些用《温病论》,都取得了疗效。我个人对于这种疾病倾向于用《温病论》。因为疾病传变迅速,患者恶化的速度很快,仅仅5天后就可能会变成急性肺损伤,而10天后患者可能死亡。因此,这是非常危险传变非常快的疾病。

Q9-Reginaldo(Director of Brazilian School of Chinese Medicine):My question is as now in Brazil the number of cases are increasing, and we are suggested to do quarantine. Actually in some states and cities, we are also enforced to quarantine right now. Do you recommend to people at home they can do something to improve their immunity, such as moxibustion, what’s your opinion on that?

问题9-Reginaldo(巴西中医学院院长):我的问题是由于当前巴西的感染人数正在增加,大多数人被建议进行隔离。您是否可以对艾灸的自我使用提出一些建议,帮助大家改善健康状况并扶助正气?

Dr. Li: Regarding the early quarantine, certainly it is very important, it’s the cause of infection of the majors. I think another thing is regarding moxibustion, it’s very good. But even after you do that, it doesn’t mean that you will not have this virus. You still can get it. So there is nothing really prevent us from this virus. Only thing we can do is we try to develop the vaccination of the disease. So it will not happen soon, I think it takes probably after 18 months. Even 18 months is very early, it’s a long way to go. But nothing can really work for prevention virus. Everyone is vulnerable to that. You certainly need to use some kind of Chinese Medicine to make yourself. Even you get it, you can make your symptom very mild, you don’t fall into the very severe stage, and very severe time. We are still suggest for people who had cold and wet in their stomach, you know, according to Chinese theories, so they still need moxibustion, they need do some acupuncture, they need to take some Chinese herbs. To have some for themselves. For the obesity patients, they need lose weight, I don’t know how they can lose weight within a week, what we saw most people are really having some kind of problems for obesity, this is one most of population they can fall into the stage of danger, so these patients need to take care of themselves even now.

李光熙博士:关于早期隔离,当然这很重要,大多数人都是因为没有隔离感染的。另外艾灸是非常好的,但是艾灸了不代表您不会感染此病毒,没有什么能真正阻止我们感染这种病毒。我们唯一能做的就是尝试开发这种疾病的疫苗,但它不会很快投入使用,我认为大概至少需要18个月,还有很长的路要走。目前没有能真正有效预防病毒的方法,每个人都可能感染。但是,即使感染了,您可以使用一些中药,可以使症状非常轻微,不会发展到非常严重的阶段。根据中医的理论,我们建议那些脾胃寒湿的人做艾灸、针刺,服用中药。对于肥胖症患者,他们需要减肥,我不知道他们如何在一周内减肥,我们看到大多数人的确患有肥胖症,他们是一群容易发展到危重症的人群,因此这些患者现在就要格外注意。

Q10-Reginaldo: My point is I totally agree and understand there is no such thing to avoid virus. The idea of moxibustion more to improve the health, so as be in good health could be a little bit stronger for body to fight virus, to contact with them. Right?

问题10-Reginaldo: 我完全同意并理解,没有一个方法可以避免病毒。艾灸助于改善健康状况,身体强壮时抵御病毒的力量会更强一点。对吗?

Dr. Li:Yes, absolutely. So you can regulate yourself to adapt while the virus comes into your body, basically you can regulate yourself to adapt to this the vulnerable situations, so you don’t get this inflammation storm  triggered, that’s really helpful. Patients you know, Chinese herbs, acupuncture, they all have do that. 

李光熙博士:是的,当然。当病毒进入你的身体时,你可以调节自身适应能力,不容易被感染,即使感染炎症风暴也不会触发,中药和针灸对此真的很有帮助。

Reginaldo:As Brazil now it is coming into autumn from summer right now, so this year my colleague and I offered acupuncture and application of herbs, summer treatment for winter diseases. For those patients, they experienced very good health right now. So I really believe on improving quality of life, and improving the health using Chinese medicine theory, and I encourage more people from other countries to consider that even in the countries where Chinese medicine is not officially accepted, but we shall teach and expand it for our patients.

Reginaldo:由于巴西现在正从夏季进入秋季,所以今年我和同事都在提供针灸和中药治疗,进行夏病冬治。这些患者现在身体非常健康。因此,我坚信使用中医理论可以改善生活质量和健康状况,我鼓励其他国家/地区的人们也考虑中医治疗,即使在那些中医尚未被正式认可的国家中,我们也应该这样告诉我们的病人并传播中医药疗法。

Dr. Li: Yeah, absolutely, I think this moxibustion and transdermal therapy you should use in this season, because that next pandemic will go to these countries like Brazil and Argentina. Right now the temperature will go like what we have in September or October, that’s very dangerous. 

李光熙博士:是的,完全正确,我认为您应该在这个季节使用这种艾灸和透皮疗法,因为接下来大流行将蔓延到巴西和阿根廷等国家。(你们)现在的气温类似我们这儿的9月或10月,这很危险。

Q11-Amir Hooman Kazemi(Vice President of WFAS from Iran):What is the syndrome differentiations of pulmonary effusion in TCM and which herbs can be useful?

问题11-Amir Hooman(伊朗世针联副主席):胸腔积液在中医中的辩证分型有哪些,哪些中药可用?

Dr.Li:Pulmonary effusion for the COVID-19 is rare, but you know that  if you have some other knowledge of effusion, then you certainly need to differentiate (it as) cold(寒), it’s from the weakness of qi and some other things. You can use some dongchouxiacao(冬虫夏草), cordyceps sinensis, it’s very helpful. Cordyceps and chaihu(柴胡)are good herbs, for this kind of symptoms.

李光熙博士:COVID-19的胸腔积液很少见,如果您对胸腔积液有其他了解,您会把它辨为寒邪,主要由于气虚和其他一些因素造成。可以使用冬虫夏草和柴胡,可以帮助缓解症状。

Q12-Amir Hooma:Which herbs are useful for prevention ( specially the herbs we can find in other countries?

问题12-Amir Hooman:哪些中药有预防作用(特别是我们能在中国以外的其他国家/地区可以找到的草药)?

Dr. Li: In Iran, zanghonghua(藏红花saffron crocus)is also very good. I think it is very popular in Iran. It is good, they already took that in every meal . I bought when I was there last year. I don’t know the what kind of herbs can be used in Iran, but maybe something is we can discuss later after they are showed to us, how are they called in your country.

李光熙博士:在伊朗,红花也很不错,我认为它在伊朗很受欢迎,使用在日常饮食中,我去年去那儿时就买了一些。我不知道在伊朗还可以使用哪种草药,也许再告诉我们详细情况,都有什么草药,我们可以进一步讨论。