世界针灸学会联合会

(CN/EN)Q&A from the International Lectures of COVID-19 by Prof Huang Luqi

author:WFAS source:WFAS Click:1031 update:2020-05-19
  

欧洲中医基金会主席 拉蒙教授:

您知道大多数西方国家尚未对中医药进行立法,而在其它一些对中医有立法监管的国家,比如在澳大利亚,葡萄牙,智利,美国等等,甚至在中国,中医仍然被那些推崇西医者以“缺乏科学证据”为由而质疑中医药的功效。同时我们也知道,在大多数西方国家中,群众们对中医是普遍接受和高度评价的,而且,在这些国家中,从事中医专业人员百分之九十以上都不是西医执业医师。在大多数西方国家中,由于对中医(和中草药)没有立法监管,无法使用中药配方和中成药来治疗新冠肺炎患者,因为中药产品在这些国家未经注册,当地政府不允许进口,即使在目前如此特殊严重疫情下作为捐赠物资也不行。

As President of the China Academy of Chinese Medical Sciences, you know that Chinese medicine is NOT regulated in most western countries and that, in those countries where it is regulated, such as Australia, Portugal, Chile, USA, etc., and even in China, the efficacy of Chinese medicine is questioned, by defenders of Western medicine, based on its alleged "lack of scientific evidence." We also know that, in most Western countries, Chinese medicine is accepted and highly valued by citizens and that, in these countries, the majority of professionals who practice Chinese medicine (more than 90%) are NOT Western doctors. In most western countries, where Chinese medicine (and Chinese herbal medicine) are not regulated, it is NOT possible to use Chinese medicine formulas and patent medicines for the treatment of COVID-19, because the governments of these countries do not allow imports, since Chinese herbal medicine products are not registered, even though they are donations and at times as exceptional as those we are going through.

问题1: 根据您的介绍,很显然在中国中西医结合为预防、治疗和治愈新冠肺炎做出了巨大的贡献。我的问题是,您向我们介绍的这个现实是否得到中国政府本身的充分认可?

Q1: From your explanations, it is evident that, in the R.P. China, Chinese medicine has made great contributions, in combination with Western medicine techniques, in the prevention, treatment and cure of COVID-19.

My question is whether this reality, which you have explained to us is sufficiently recognized by the Chinese Government authorities themselves?

黄璐琦院士:这次我们在武汉抗击新冠肺炎疫情中所有的诊疗方案、各项救治措施,都是由中国政府来统筹组织与实施,坚持中西医并重是中国政府应对公共卫生的政策,以及刚才报告中所介绍的诊疗经验和科研成果,都得到了中国政府的充分认可,且在全国范围内进行推荐。

Prof. Huang Luqi:  All the diagnosis and treatment plans and various treatment measures in the fight against the COVID-19 epidemic in Wuhan this time are organized and implemented by the Chinese government. It is the public health policy of the Chinese government to attach equal importance to TCM and Western medicine. The diagnosis and treatment experience and scientific research results introduced in my report just now are fully recognized by the Chinese government and recommended nationwide.


问题2: 根据科学界可接受的标准,有关这一现实的文献是否可以按照“世界卫生组织2014-2023战略”文件的建议,帮助西方国家决定对中医药进行立法从而将其纳入国家卫生系统中使用?

Q2: If the documentation of this reality, based on criteria acceptable to the scientific community, can help Western countries, following the recommendations of the document of "WHO 2014-2023 Strategy", decide to regulate Chinese medicine and integrate it in their National Health Systems, as advised by the WHO?

黄璐琦院士:刚才在我的报告中,已介绍了我们所做的治疗新冠肺炎临床观察等相关经验,这些都是按照科学界可接受的标准,来研究设计如何获得高级别高质量的临床证据,我想现在我们所做的工作应该是能够获得科学界的认可,也是能够促进“世界卫生组织2014-2023战略”文件中所提出的“掌握利用传统和补充医学对健康、福祉和以人为本的卫生保健的潜在贡献”,所以在面对这样全球爆发的疫情中,我们基于中医药的临床疗效,一定能够为帮助西方国家更好地来认知中医药,从而促进中医药在所在国的立法,同时也希望像拉蒙教授一样的中医专家和同道们,能在西方国家积极宣传推荐中医,在临床中运用好中医。

Prof. Huang Luqi: In my report just now, I have introduced our relevant experience in the clinical observation of the treatment of COVID-19, which are all based on standards acceptable to the scientific community to study and design how to obtain high-level and high-quality clinical evidence. I think what we are doing now should be recognized by the scientific community and can promote “the potential contribution of mastering the use of traditional and complementary medicine to health, well-being and people-oriented health care” as proposed in the document "WHO 2014-2023 Strategy ”. Therefore, in the face of such a global outbreak, based on the clinical efficacy of traditional Chinese medicine, we can definitely help western countries to achieve a better understanding of TCM, thus promoting the legislation of TCM in the host country. At the same time, we also hope that TCM experts and colleagues like Professor Ramon can actively promote and recommend TCM in western countries and even make good use of TCM in clinical practice.

这次新冠肺炎疫情的研究是以临床研究为核心,在整个临床过程中,我们充分利用了国际上认可的现代科研方法,开展了包括临床研究、疾病机制和新药研发等各方面研究,我们已向世界卫生组织建议并提供了这些研究成果,希望世界卫生组织能组织国际专家对这些研究采取进一步评估;同时也希望通过世界卫生组织,能够把我们这些成熟的经验推广到世界各国或地区,为全球抗击新冠肺炎疫情作出更大的贡献。

The research on the COVID-19 epidemic is centered on clinical research. Throughout the clinical process, we have made full use of internationally recognized modern scientific research methods and carried out various researches including clinical research, disease mechanism and new drug research and development. We have proposed and provided these research results to WHO, hoping that WHO can organize international experts to take further evaluation of these researches. At the same time, I also hope that through WHO, we can spread our mature experience to all countries or regions in the world and make greater contributions to the global fight against the COVID-19 epidemic.


问题3: 对于我们这些在欧洲为有利于人民健康而传播促进中医教育,临床实践和科研的组织,您有什么建议?

Q3: What can you suggest to European organizations and those of the rest of the world, that we take care of promoting education, clinical practice and research in Chinese medicine, for the benefit of the citizens of our countries?

黄璐琦院士:对于欧洲这些中医教育、临床实践和科研的组织给予建议,我认为中医的教育是根本,通过中医教育做好基础,使民众认识、认知中医,对认识疾病或健康才能够更全方面地掌握。有了中医教育这样一个基础,再结合临床实践和科研,尤其是在这次新冠肺炎疫情中,如果能在当地运用中医,并体现出中医临床疗效的优势和特色,那么在欧洲一定能够更好地接受中医疗法,从而促进中医在当地的立法,为当地使用中医提供法律保障。

Prof. Huang Luqi: To give advice to European organizations of Chinese medicine education, clinical practice and scientific research, I think the education of Chinese medicine is the foundation, through which the public can have a better understanding of Chinese medicine so as to have a better understanding of diseases or health. With such a foundation of Chinese medicine education, combined with clinical practice and scientific research, especially in the COVID-19 epidemic, if Chinese medicine can be applied locally and the advantages and characteristics of clinical efficacy of Chinese medicine can be reflected, then Chinese medicine therapy will definitely be better accepted in Europe, thus promoting the local legislation of Chinese medicine and providing legal protection for the local use of TCM.


意大利针灸和传统中医协会会长 李国瑞教授:

问题4: 由于意大利的情况,欧洲法律规定许多草药、矿物和动物不允许进口到欧洲,只有数量有限的草药可供使用,而且市场上产品短缺。因此,意大利的一些中医师开具了以下方子(源自对清肺排毒汤的修改):

苏叶50g, 炙甘草10g, 杏仁10g, 生石膏15g,  桂枝10g, 泽泻10g,猪苓10g, 炒白术15g, 茯苓15g, 柴胡15g, 黄芩10g, 姜半夏10g,

紫苑10g, 冬花10g, 炒枳壳 5g, 陈皮 10g, 生姜25g

请问您对此方有什么看法?即使进行了修改,它仍然有效吗?

Q4: Because of the Italian situation, only a limited number of herbs is available because of the European regulations (there are many herbs, minerals and animals not allowed to be imported into the European territory) and there is a shortage of products on the market.

For the above reasons some TCM doctors in Italy are prescribing the below formula (derived from the QingFei PaiDu Formula, modified).

What is your opinion? Is it still effective, even if modified?

黄璐琦院士:这个方药是在清肺排毒汤基础上的组方加减,新方中减去了麻黄、射干、细辛、山药、藿香这5味药。其中减去麻黄,这个是非常能够理解,因为麻黄在欧洲是受管控的,担心麻黄里的麻黄碱兴奋交感神经,从而增加加快心率的风险,因此新方中去掉麻黄,用苏叶来代替。但是我想就这一点需要说明,新冠肺炎患者心率的加快,是由缺氧导致的交感神经兴奋(从而使心率加快),所以治疗的关键是要改善患者的缺氧状态。麻黄是中药里“宣肺平喘”最有效的一味药,苏叶虽有“清肺解表”之功,但是力不所及(麻黄),所以用苏叶代替麻黄,新方治疗效果肯定没有原方好。另外就是新方中去掉了藿香,众所周知,藿香具有芳香化湿的作用,在治疗中是祛湿的要药,在我所讲的化湿败毒方里也用到了藿香。所以从减掉的麻黄和藿香这两味药来看,我想新方的疗效肯定没有原方(清肺排毒汤)好。

Prof. Huang Luqi: This prescription is a modified formula based on QingFei PaiDu Decoction, and the new formula subtracts the five herbs which are Herba Ephedrae(Ma Huang), Rhizoma Belamcandae(She Gan), Herba Asari(Xi Xin), Rhizoma Dioscoreae(Shan Yao), and Herba Agastaches(Huo Xiang). The deduction of Ephedra (Ma Huang) is very understandable, because it is controlled in Europe and is worried that ephedrine in Ephedra excites sympathetic nerve, thus increasing the risk of heart rate acceleration. Therefore, Ephedra is removed and replaced by Folium Perillae(Su Ye) in the new prescription. However, I want to explain at this point that the acceleration of heart rate in COVID-19 patients is sympathetic nerve excitation caused by hypoxia (thus accelerating heart rate), so the key to treatment is to improve the anoxic state of patients. Ephedra is the most effective herb in Chinese medicine for "dispersing lung qi and relieving asthma". Although folium perillae(Su Ye) has the function of "clearing lung heat and relieving exterior syndrome", it is not capable (like ephedra). Therefore, the treatment effect of the new prescription is definitely not as good as that of the original one by replacing ephedra with folium perillae(Su Ye). In addition, Pogostemon rugose (Huo Xiang) is removed from the new prescription. It is well-known that it has the effect of aromatizing and dampening. It is the main medicine for removing dampness in the treatment. It is also used in the prescription of HuaShi BaiDu Formula. 

Therefore, judging from the two herbs of ephedra (Ma Huang) and Pogostemon rugose (Huo Xiang), I think the new prescription is definitely not as good as the original one (QingFei PaiDu Decoction).


问题5:中医诊断方法的帮助下,能否提前预测重症患者是否会出现凝血症?

Q5: With the help of TCM diagnosis, is it possible to understand in advance if a severe patient is going to develop coagulopathy?

黄璐琦院士:凝血症DIC是一个西医学的诊断概念,是指在重症患者病情发展过程中常见,以凝血功能障碍为特征的病理综合症,对应在中医里面可以归纳为血瘀的范畴,常见的临床特征是以针刺性的疼痛为主,比如胸痛、腹痛、下肢疼痛等,并且会出现面部的口唇紫暗、舌质暗等症状,通过中医的望闻问切、四诊合参可以辨别出患者是否有瘀血。此次我们在新冠肺炎疾病的临床中发现重型、危重型患者,普遍出现舌质暗、口唇紫暗等症状,有部分患者存在凝血指标的异常,这类患者发生凝血症DIC的风险高;但也有部分患者没有实验室指标的异常,这类患者没有出现凝血症DIC的风险或很低,因此可以说中医血瘀证比西医凝血症DIC更广泛。总的来说,临床中辩证为血瘀证的新冠肺炎患者,不一定会出现凝血症DIC及其相应的临床干预,在临床上我们建议还是要借助实验室指标来进一步明确诊断,以免延误患者病情。

Prof. Huang Luqi: Coagulation DIC is a western medical diagnostic concept. It refers to the pathological syndrome characterized by coagulation dysfunction, which is common in the development process of severe patients. It corresponds to the category of blood stasis in Chinese medicine. The common clinical features are mainly needle pricking like pain, such as chest pain, abdominal pain, lower extremity pain, etc., and facial symptoms such as dark purple lips and tongue, etc. Whether there is blood stasis in patients can be identified through combination of four TCM diagnostic methods: observation, auscultation and olfaction, interrogation, and palpation and pulse feeling. In clinical practice, it is found this time that symptoms such as dark tongue and purple lips generally occurs to severe and critical COVID-19 patients. Some patients have abnormal coagulation indexes, and this type of patients have a high risk of coagulation DIC. However, there are also some patients who do not have abnormalities of laboratory indexes, and the risk of coagulation DIC is not high or very low for such patients. Therefore, it can be said that blood stasis syndrome in Chinese medicine is more extensive than coagulation DIC in western medicine. In general, COVID-19 patients who are differentiated as blood stasis syndrome do not necessarily have coagulation DIC and its corresponding clinical interventions. In clinical practice, we suggest to further clarify the diagnosis with the help of laboratory indicators so as not to delay the patient's condition.


巴西中医学院院长 海金斯博士:

问题6:中国中医科学院是否做了关于新冠肺炎的中医治疗的研究?

Q6:Can you please tell us if there are researches from CACMS about Chinese Medicine treatment of Covid-19?

黄璐琦院士:中国中医科学院在新冠肺炎疾病的中医治疗研究方面,我们是从临床到实验室都有布局和研究,在我的报告中所介绍的那些工作,就是我们在武汉金银潭医院、东西湖方舱医院以及将军街社区医院等所做的相关临床研究,与此同时,我们也做了大量与临床相匹配的实验室研究,比如中国中医科学院中药研究所做了相关的动物模型方面的研究,还有中国医学科学院实验动物所所做的相关工作。

Prof. Huang Luqi: The CACMS has been doing clinical to laboratory research on TCM treatment of COVID-19 diseases. The work described in my report is the clinical research we did in Wuhan Jinyintan Hospital, Dongxihu makeshift hospital and Jiangjun Street Community Hospital. At the same time, we have also done a lot of laboratory research that matches the clinical research. Related work done by laboratory animals in the Academy of Medical Sciences. For example, our Chinese Herb Institute of the CACMS has done research on animal models, and Laboratory Animal Institute of the CACMS has also done related work.


问题7:在巴西新冠肺炎患者确诊病例数字每天都在增加。请问您建议如何预防?或者说如何扶助正气,以防感染?

Q7: In Brazil the numbers are increasing daily. What could you suggest for prevention? I mean to improve our 正气 in order to be more prepared for a possible infection

黄璐琦院士:关于预防,我认为借鉴中医经典《黄帝内经》里面的一句话“不相染者,正气存内,邪不可干,避其毒气”,实际上这里面 “正气存内”就是要提高人体的免疫力,如何来提高人体的免疫力呢?我们可以利用一些健身的方法,如太极拳、八段锦,也可以使用药食同源的中药产品、中药药膳,另外,中医还强调情志调节作用,所以我们要讲究劳逸结合、形神共养来提高机体的正气,预防感染。

Prof. Huang Luqi: Regarding prevention, I think to draw on the sentence in the classic Yellow Emperor's Internal Classics of Chinese Medicine, "People won’t get infected during pandemic is because their righteous Qi is strong inside, pathogenic influences cannot invade from the outside, and stay away from toxic Qi". That means people need to improve their immunity. But how? We can use some fitness methods, such as Tai Chi, Ba Duan Jin, and can also use cook some herbal food. In addition, Chinese medicine also emphasizes the role of emotion regulation, so we should pay attention to the combination of work and rest, Co-feeding of physical body and spirit to improve the body's righteous Qi and prevents infection.


美国 纽约斯隆肿瘤中心整合医学中心医务主任 Gary邓教授:

问题8:不少国家的民众对中药有需求,但货源和药品质量并不总是能够保障。国家在增加出口中药材药品的数量和质量上有什么统筹计划和措施吗?

Q8: In many countries, people have the demand for Chinese medicine, but the supply and the quality of medicines are not always guaranteed. Does the country have any overall plans and measures for increasing the quantity and quality of Chinese herbal medicines for export?

黄璐琦院士:在我们国家有关中药药品质量的问题主要是由国家药监局来进行监管的,如果通过正规的渠道或厂家(进行采购),是有相应的法律法规做保障。在国际合作方面,我曾在建议中提到,计划建立相应的国际抗疫联盟,主要由中医研究机构、医疗机构和企业所组成,通过这样一个国际抗疫联盟,中药药品质量和货源都可以有相应的保障。如果国际上各国有需求的话,我们中国中医科学院可以在这方面进一步推动和开展相关工作。

Prof. Huang Luqi: In our country, the quality of traditional Chinese herbs is mainly regulated by the National Pharmacopoeia. If they go through formal channels or manufacturers (for procurement), they are guaranteed by corresponding laws and regulations. In terms of international cooperation, I mentioned in the proposal that I plan to establish a corresponding international anti-epidemic alliance, which mainly composed of Chinese medicine research institutions, medical institutions and enterprises. The quality and supply chain of traditional Chinese medicines can be guaranteed through such alliance. If there is a demand from various countries, our CACMS can further promote and carry out related work in this regard.


问题9: 目前中国公布了无症状感染者的实时数据,对于无症状感染者是否需要进行治疗?请介绍一下针对这类无症状感染者中医预防或治疗方面相关经验。

Q9: At present, China has published real-time data on asymptomatic patients. Do they need to be treated? Please introduce the relevant experience in the prevention or treatment of traditional Chinese medicine for such asymptomatic infections.

黄璐琦院士:中医认为,无症状感染者应当归属于“夫邪易病”的范畴,这类人群已经有病毒感染的证据,如核酸检测为阳性,血清里面抗体呈阳性,只是还未出现明显的临床症状。对于这类无症状感染者,一般认为有两种可能:(1)正盛邪去,机体正处于祛邪外出的状态,故症状不显,这类患者可能会逐渐自愈;(2)正邪相持,蓄势待发,这类患者有三种情况,第一种正胜邪退而自愈,第二种正邪相持不下,邪气继续掩伏,可能会成为病毒慢性携带者,第三种是由内因或外因的引诱,正邪交争而发病,这类患者要及早治疗。我们在武汉时针对无症状感染者有提供药食同源方,并加工成代茶饮,使机体扶助正气以驱邪外出。

Prof. Huang Luqi: Chinese medicine believes that asymptomatic infections should fall into the category of "Pathogen hides inside and susceptible to be sick". Such people already have evidence of viral infections, such as nucleic acid test positive, Ig M antibody positive in serum, but no obvious clinical symptoms. For such asymptomatic patients, there are generally two possibilities: (1) Righteous Qi wins and Evil Qi goes away, the body is in a state of eliminating pathogens, so the symptoms are not obvious, and these patients may gradually heal themselves; (2) Righteous Qi and Evil Qi are fighting, the disease is on the edge to break out. There are three situations of this kind of patient. The first one is the victory of Righteous Qi and proceed to self-healing. The second one is Righteous Qi and Evil Qi are continuously fighting, pathogen remains hidden state, and the patient become a chronic virus carrier. The third one is Righteous Qi and Evil Qi fight each other, and the patient get induced by internal or external causes and show up symptoms. Such patients should be treated early. When we were in Wuhan, we drafted a herb and food homologue for asymptomatic infected patients, and processed it into herbal tea, so that the body can support Righteous Qi and drive out evil pathogen.

附:代茶饮“益小方”——药食同源的药物组成:

金银花2g 藿香2g 百合3g 茯苓5g 薄荷1g 桑叶1g 赤小豆5g 人参3g

“Yi Xiaofang”——Homology of medicine and food:

Flos Lonicerae Japonicae 2g,Herba PogoStemonis 2g,Bulbus Lilii 3g, Poria 5g, Herba Menthae 1g, Folium Mori 1g,  Semen Phaseoli 5g, Radix Ginseng 3g