（CN/EN）国际专家抗疫大讲堂第十讲 周仲瑜、董善京在线答疑汇总

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 thispatient is a confirmed COVID-19 patient. If conditions permit, it is best todetermine

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 isvery 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 arethe 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 suchas 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 longterm 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 termsof 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 spleendeficiency 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 syndromeand 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, thesymptoms 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 alrespiratory 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 isno 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.