世界中医药

作者	单位
马月霞1,2，赵京霞1,3,4，郭玉红1,3，刘清泉1,3,4，王玉光1,3	1 首都医科大学附属北京中医医院，北京，100010； 2 北京怀柔区中医医院，北京，101400； 3 中医感染性疾病基础研究北京市重点实验室，北京，100010； 4 北京市中医研究所，北京，100010

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中文摘要:

目的：通过对我国广东地区1例输入性MERS病例回顾性研究，初步探讨本例MERS传遍特点及核心病机。方法：回顾性整理该例患者入院前流行病学特点及2015年5月28日入院第1天至2015年6月11日入院第15天住院期间的临床症状及治疗经过。结果：本例患者流行病学特点主要表现为中年男性，有甲亢基础病史，与MERS患者有明确接触史。该例病程发展具有一定阶段性，根据病情的变化分为以下四期：初期，进展期，极期和恢复期。初期：病程1~5 d，病位在肺，患者发热、肌肉酸痛，无恶寒，无咳嗽咳痰咽痛，此期主要特点为热邪侵犯肺卫，表邪轻而里热已盛。2）进展期：病程7~12 d，病位在肺，高热，无恶寒寒战，干咳少痰，口渴口苦，活动后气促，热邪深入气分。3）极期：病程12~22 d，病位在肺、胃、大肠，此期患者逐渐热退或低热，时有烦躁，气促开始减轻，头痛，咳少量血丝痰，腹胀无腹痛，腹泻，热邪入营血分。在此期间，发病第17~18天为病情最重的时期，主要表现为头痛剧烈，咳血丝痰，腹泻，此期应用抗病毒、抗感染、免疫增强剂治疗。4）恢复期：病程第22天后，无发热，血丝痰消失，偶有干咳、头痛，头痛休息可缓解，腹泻减轻。结论：本例MERS患者始动因素及根本因素为温热疫毒，热邪为本病的关键，毒、瘀表现不明显，中医证候演变符合温病卫气营血传变规律，卫气同病，营血分症状不重，与SARS、甲型H1N1流感、H7N9禽流感相比病情稍轻。

English Summary:

To explore the epidemiological characteristics and major pathogenesis in Chinese Medicine according to the retrospective study of the first imported MERS case from Guodong province．Methods: The data from May 28, 2015 to June 11, 2015 of the epidemiology, syndromes and treatment of the case were collected and analyzed. Results: The patient was a middle-aged man with epidemiology characteristics roughly consistent with the previous investigation and had a history of hyperthyroidism and contact with confirmed cases of MERS. There were four stages as follows in the course of disease according to his changes of health condition. Firstly, at initial stage, disease location was in lung in the duration of first to fifth days. The patient was in fever with aching muscle but no chills, no sore throat, no cough or expectoration. The case in this period was mainly characterized with invading lung, light external pathogen while heavy interior evil. Secondly, in the developing period, the disease location was still in the lung, in the duration from seventh to 12th days. The patient had high fever without chills, dry cough with a little phlegm, thirst and bitter taste, shortness of breath. In this period heat evil was deep in qi. Thirdly, the very period, 12th to 22th days duration, the disease location was in the lung, stomach and large intestine. The patient had mild fever and abatement of fever, irritability, shortness of breath began to ease, headache, cough with a small amount of blood sputum, abdominal distension, no abdominal pain, diarrhea, fever, blood into the camp. During this period, the the 17th-18th was the most severe period, mainly manifested with headache, cough blood sputum, diarrhea, and was treated with antiviral, anti infection, immune enhancement agents. Fourthly, the recovering stage, the patient in this course after 22 days had no fever, disappeared sputum with blood, occasional dry cough, endurable headache and diarrhea alleviated. Conclusion: The initiating and fundamental factors in this case were warm febrile and epidemic toxin. Heat pathogen was the critical factor rather than toxin and blood stasis. The transform of symptoms conformed to defense-qi-nutrient-blood mode in febrile disease in TCM. Qi and defense level became ill at the same time. And the nutrient and blood level were not severe. Therefore, the patients condition in this case was not as severe as SARS, H1N1 influenza, H7N9 avian influenza.

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