(CN/EN)国际专家抗疫大讲堂第十二讲 黄璐琦院士在线答疑问题整理

来源:世界针联

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」第八讲邀请到了首批国家中医医疗队领队、中央指导组专家、国家中医药管理局医疗救治专家组组长、中国工程院院士、中国中医科学院院长黄璐琦教授,与我们分享了中医药在抗疫过程中发挥的重要作用以及后续研究成果。黄院士所带领的医疗队在金银潭医院主要开展了重型和危重型患者的救治,还在东西湖方舱医院、社区医院积极开展轻型和普通型患者的救治。黄璐琦院士表示,本次疫情期间,中医药参与度、受关注度之高,在新中国成立以来前所未有。答疑环节,三位专家解答问题汇总如下


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 countriesand 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 westerncountries, 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 notallow 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 areorganized 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 allbased 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 “thepotential contribution of mastering the use of traditional and complementary

mdicine to health, well-being and people-oriented health care” as proposed in thedocument "WHO 2014-2023 Strategy ”.

Therefore, in the face of such a globaloutbreak, 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,


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