国际抗疫专家大讲堂 葛又文、王伟教授在线答疑汇总
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」第十九讲邀请“清肺排毒汤”拟方人、中国中医科学院特聘研究员葛又文和国家中医药管理局应急专项“清肺排毒汤”专家组组长、北京中医药大学副校长王伟。两位专家分别围绕“清肺排毒汤”讲解了配套针灸处方以及临床救治和科研进展。在答疑环节，解答问题汇总如下：
连线嘉宾1——胡曼医生，世界针联伊朗副主席；德黑兰医科大学传统医学院副院长
Dr Amir Hooman Kazemi, Vice President of WFAS from Iran; Vice President of Traditional Medicine School of Tehran University of Medical Sciences
问题1：从中医辨证的角度来讲，清肺排毒汤对哪种证型效果更突出？比如寒湿还是湿热？
Q1: According to the Bian Zheng principles, the Qing Fei Pai Du Tang（QFPDT） is to treat which symdrome? Like damp heat? or damp cold?
王伟：至于清肺排毒汤对哪种证型效果比较好，刚才在讲解中也谈到，因为这个新冠肺炎的病情非常复杂，有寒湿、燥热、湿热、气机瘀滞等，所以在拟定这个清肺排毒汤的方子时，对各个证型都考虑的比较全面，不是只针对某一证型，它是个普适性的方子，适用范围比较广。
Wang Wei: As for the syndrome type of QFPDT with better effect, it’s mentioned in the explanation just now. Because the condition of COVID-19 is very complicated, including cold-dampness, dry-heat, damp-heat and qi stagnation, etc. When formulating the prescription of QFPDT, each syndrome type has been considered. So it’s a comprehensive formula. It is not just for a certain syndrome. It is a universal prescription with a wide application range.
葛又文：从中医辩证的角度讲，要从两个方面来看清肺排毒汤，一是对新冠肺炎疾病的核心病机，另一个是对新冠肺炎表现出的外在症状。此病的核心病机就是寒湿，外在症状会表现有燥和热，开始拟定这个方剂的时候就全面考虑到了核心病机与症状这两方面，我们不能仅仅靠这个症状去判断用药，要注重症状背后的机理才是最根本的，所以这是个标本兼治的方剂，兼顾了各个证型。
Ge You Wen: From the point of view of syndrome differentiation of TCM, QFPDT should be viewed from two aspects, one is the core pathogenesis of COVID-19 and the other is the external symptoms of COVID-19. The core pathogenesis of this disease is cold and dampness, and external symptoms may show dryness and heat. Since the beginning of the formulation of this prescription, the two aspects of core pathogenesis and symptoms were fully considered. We cannot rely on a certain symptom to judge the medication, but should pay attention to the mechanism behind the symptoms, which is very fundamental. So this prescription treats both the symptoms and root causes, taking into account the various syndromes.
问题2：服用清肺排毒汤是否有用药禁忌？有没有任何副作用？或者是否与西药有互斥的作用？
Q2: Is there any contraindications for that? Is there any side effects? Is there any interaction with western medicine?
王伟：目前服用清肺排毒汤没有特别的禁忌，至于副作用，可以关注一下消化道的反应，当然很多新冠肺炎的病人服用了抗病毒药物后，本身就易出现腹泻等消化道问题，在这种情况下服用清肺排毒汤就不耐受，可能会有腹泻加重等反应。从临床实际情况来看，很多新冠肺炎病人有合并症，如果说病人有严重高血压，服用这个药之后，可能会心率加快，血压升高，主要是在未解表（未出汗）之前血压会有些波动，这时要慎用清肺排毒汤，或者减量服用。
Wang Wei: At present, there is no special contraindications for taking QFPDT. As for the side effects, we can pay attention to the reaction of digestive tract. Of course, many COVID-19 patients are prone to diarrhea and other digestive tract problems after taking antitoxic drugs. In this case, after taking QFPDT, their bodies are intolerant and there may be reactions such as worsening diarrhea. According to the actual clinical situation, many COVID-19 patients have complications. If the patient suffers from severe hypertension, after taking this medicine, the heart rate and the blood pressure may increase, mainly because the blood pressure may fluctuate before the exterior symptoms are relieved (without sweating). Then QFPDT should be used with caution or taken in reduced doses.
葛又文：在临床中我们有很多儿童服用此方，注意儿童的使用剂量应当减半，目前没有发现任何不良反应，另外不建议感染新冠肺炎的孕妇服用此方。
Ge You Wen: In clinical practice, we gave this prescription to many children. Note that the dosage of children should be halved. At present, no adverse reactions have been found. In addition, it is not recommended for pregnant women infected with COVID-19.
问题3：请问目前清肺排毒汤是否在其他国家有过应用？如果有的话是有哪些国家？效果如何？这些研究对外国医务工作者来说很重要。
Q3: Has Qing Fei Pai Du Tang used in any other country? If yes, which country and how about the results?
王伟：清肺排毒汤在中国以外的其他国家也有应用，目前在意大利、英国、美国，日本，马来西亚等国家都有服用此方，主要是当地华人中医师在推广使用这个方，反馈的效果还是不错的。
Wang Wei: QFPDT is also used in other countries outside of China. At present, it is used in Italy, the United Kingdom, the United States, Japan, Malaysia and other countries. It is mainly used by local Chinese TCM doctors. The feedback effect is good.
问题4：清肺排毒汤针对新冠肺炎的哪些症状效果最好？
Q4: Which symptoms of COVID-19 are best treated by QFPDT?
王伟：在刚才的讲座中提到，清肺排毒汤对新冠肺炎患者改善最快的是发热症状，其次对乏力和气喘效果也很好，其他大部分症状都能普遍得到改善。
Wang Wei: It was mentioned in the lecture just now that the most rapid improvement of QFPDT in COVID-19 patients is fever symptoms, followed by fatigue and asthma. And most other symptoms can be generally improved.
连线嘉宾2——卡尔姆斯医生，波兰中医药学会名誉主席
Dr Marek Kalmus, Honorary President of Polish Society of Traditional Chinese Medicine
问题5：您能否提供有关清肺排毒汤功效的官方数据？在西方，我们需要来自科学出版物的数据来证实这种配方的功效。没有这些，我们将无法与西医医生和官方以及负责医疗保健的机构进行交谈，因为他们将不会信任我们。我们需要发表循证医学论文或中国官方正式发布的数据，作为有关中药在新冠肺炎治疗中的有效性和安全性的论据。这是在波兰甚至大多数西方国家引入中医治疗的唯一途径。这样可以使我们有机会与西医合作，并引入中西医结合治疗以造福患者。另外这个问题也同样针对新冠肺炎治疗中针灸的使用。
Q5: Could you please provide us the official data on the effectiveness of the Qing Fei Pai Du Tang recipe? In the West, we need data from scientific publications confirming the extremely high effectiveness of this recipe. Without that we can’t talk with Western medicine doctors and authorities as well as institutions responsible for health care, because they will not trust us. We need published Evidence-Based Medicine papers or officially stated data by Chinese authorities as the argument about the effectiveness and safety of Chinese medicine in the COVID-19 treatment. It is the only way to introduce TCM treatment not only in Poland, but in most Western countries. It can give a chance for us to work together with Western medicine and introduce Integrative treatment for the benefit of the patients. The same applies to the use of acupuncture-moxibustion in COVID-19 treatment.
王伟：我们在疫情爆发初期，首先是想如何尽快地救治患者，所以当时救治第一、科学第二，然后才是临床科研一体化。目前我们还在继续观察新冠肺炎患者诊治情况，包括部分境外的输入型病例，关于治疗这个传染病的相关科研数据、详细资料等都还在统计当中。刚才讲座中我们报告了前期阶段性总结数据，现在我们仍在积极整理这些工作，之后会陆续在一些权威的杂志上进行发表关于中医治疗新冠肺炎的具体研究数据，包括中医有效性和安全性的论据，治疗最佳时间等等都会呈现出来，供各国在抗击疫情中参考使用。
Wang Wei: In the early stage of the outbreak, we first wanted to treat patients as soon as possible, so treatment was the first, science was the second, and then clinical research integration. At present, we’re still observing the diagnosis and treatment of COVID-19 patients, including some imported cases abroad, and relevant scientific research data and detailed information about the treatment of this infectious disease are still under statistics. Just now, we reported the preliminary stage data. Now we are still actively collating and analyzing these, and we will continue to publish specific research data on TCM treatment of COVID-19 in some authoritative magazines, including the effectiveness and safety of TCM, optimal treatment time, etc. will be presented for reference by countries in the fight against the epidemic.
问题6：清肺排毒汤需要服用多长时间才能获得最佳的治疗效果？这个时间是基于研究证明的还是根据经验得出的？
Q6: How long do you need to use the Qing Fei Pai Du Tang for the best healing effect? Is it proofed by any research or based only on your experiences?
王伟：清肺排毒汤服用时间的长短，需要根据每个患者的具体情况和症状来看，一般情况下，轻症患者服用一两天就有了明显改善，普通型患者需要服用一至两个疗程就达到最佳治疗效果，而重型患者可能需要三个疗程会有很不错的疗效。
Wang Wei: The duration of taking QFPDT depends on the specific conditions and symptoms of each patient. In general, mild patients have a significant improvement after taking one or two days, and ordinary patients need to take one to two courses to achieve the best treatment effect, and severe patients may require three courses of treatment with very good results.
问题7：目前已有几种不同的中药预防方。有些是已经公开发布的，其他的则是由在欧洲执业的中医教授开的方子。这些方剂通常是针对外感的寒湿疫。请您能否推荐一个权威的新冠肺炎预防方？该方剂应该服用多长时间？尤其是因为现在我们很快要进入一个干燥而炎热的季节了。
Q7: There are several different Chinese preventive formulas advised to protect against COVID-19 infection. Some have been already published, others were given by Chinese TCM professors practicing TCM in the Europe. They are generally designed against external pathogens Cold-Dampness with toxins. Could you please give the main formula currently recommended for COVID-19 prophylaxis? How long should it be used - especially when we will have dry and hot weather soon?
王伟：我认为预防确实是很复杂的事情，轻易不谈哪个预防更有效，证明起来很困难, 但是中医有自己一些观点和认识，可以通过扶助正气来提升人的免疫力、抵抗力。至于这些中药方哪个是非常权威，这一点我们现在还没有对比研究，现在还不好去随意评价。
Wang Wei: I think prevention is indeed a very complicated thing, we don’t talk about which prevention is very effective easily, and it’s difficult to prove. However, some views and understandings of TCM can improve people's immunity and resistance by supporting righteous Qi. We have no comparative research on which of these TCM formulas is the most authoritative, so it’s hard for us to judge now.
问题8：我们知道，在剑桥（英国）和德国的实验室里发现了另一个新冠病毒基因组：基因组C，与在武汉以及东亚各地流行的主要病毒基因组类型B有所不同。请问，如果说清肺排毒汤对于中国和其他亚洲国家来说是十分有效的话，在西方是否会同样有效，还是应该根据中医辩证做一些改变？
Q8: We know form research in Cambridge (UK) and Germany that another SARS-CoV-2 virus genomes occurs in the West (genome C) than in China (genome A and B). Wuhan’s major virus type, 'B’, was prevalent in patients from across East Asia. Do you know if the formula Qing Fei Pai Du Tang – which was perfect for China and other Asian countries – will be equally effective in the West? Or some changes should be made according to TCM?
葛又文：在清肺排毒汤拟定之初就考虑到这些问题，如同我之前打个比喻—水，它在不同的温度下会呈现出不同的形态，但是它的本质是水，永远不会变。中医治病就是求本，拟定清肺排毒汤来治疗此病，一是通过新冠肺炎病人的症状和临床反应，二是根据五运六气理论的根源，包括这个疾病从发生到对人体产生哪些危害，以及季节的变化，我们在设计方药时都已经考虑以上的各个方面。我们从治疗境外输入型的这些病例来看，从北欧、中东等多个国家输入到中国的病例，也都服用了清肺排毒汤，治疗效果都是不错的。至于季节的变化，天气越冷，清肺排毒汤的治疗效果越明显；随着气温的升高，这个病毒的致死率也会下降。所以清肺排毒汤主要是治疗疾病的根（核心病机），不会因为新冠病毒基因的变化，而丧失其有效性。
Ge You Wen: These problems were considered at the beginning of the preparation of QFPDT, just like I made an analogy before-water, it will show different forms at different temperatures, but its essence is water, which will never change. Treating the disease with traditional Chinese medicine is to seek the roots. To formulate QFPDT to treat the disease. First, the symptoms and clinical response of COVID-19 patients, and second, the roots of the theory of five movements and six qi, including what the disease is from the generation to the human body hazards, as well as seasonal changes. We have considered the aspects above when designing the prescription. Judging from the treatment of these imported cases abroad, cases were from Northern Europe, the Middle East and other countries have also taken QFPDT, and the treatment results are good. As for the change of seasons, the colder the weather, the more obvious the therapeutic effect of QFPDT; as the temperature increases, the lethality of this virus will also decrease. Therefore, QFPDT is treating the root of the disease, and it will not lose its effectiveness due to the change of the covid virus’ gene.
连线嘉宾3——雷福医生，巴西自然疗法和针灸学院国际教育研究部主任
Ephraim Ferreira Medeiros，Director of the International Education and Research Department of Acupuncture and Alternative Medicine Study Centre-Brazil/China
问题9：新冠病毒是一种新的疾病，目前正在逐渐被人们所了解。每天都有新的信息和变化出现。也许其中最引人注目的是出现了血液学上的表现，比如说在完全没有基础病史的患者中出现了血液凝固的问题，甚至是中风。我想知道教授是否有什么治疗上的分享或建议，特别是对于有较明显的血液学表现的患者。
Q9: COVID-19 is a new disease that is gradually being understood. Each day new information and transformations arise. Perhaps one of the most striking is the emergence of hematological manifestations such as clotting problems or even stroke in patients with no history of comorbidity. I would like to know if the professor has anything to share or suggest in terms of strategy specifically for patients with more evident hematological manifestations ?
葛又文：这个问题肯定是源于新冠肺炎的临床，因为血液出现凝固甚至中风问题，这是临床中会出现的情况。之前有讲过，庚子年的一个底线，就是木气，即人的肝气，人的肝气一旦瘀滞，太冲穴的气交于厥(阴)，人体的疏泄能力出现问题，包括血管，如血的循环、气的循环、水液的循坏等都会淤堵，今年面临着木气受克，而清肺排毒汤中桂枝、细辛、麻黄、柴胡的用药，正好就是应对这个主要问题，在一开始拟定这个方剂的时候就考虑到了这点，所以在临床中我建议可以对太冲穴采用一穴两针，加强太冲穴的脉气，对于出现了危症，或者西医治疗时的炎症风暴，太冲穴的作用非同小可。而且通过新冠肺炎临床中大量舌苔等四诊来看，大多数患者的舌质暗紫，出现肝郁的现象，所以清肺排毒汤及配套的十八个穴的针法都可以解决这个问题。
十八个穴位即：液门、支沟、昆仑、通谷、太溪、侠溪、太冲、列缺、尺泽、太白、阴陵泉、丰隆、后溪、风池、风府、少商、商阳、关冲。
Ge You Wen: This problem must come from the COVID-19 clinic, because the blood coagulation or stroke problems will certainly occur in the clinic. As I have said before, one of the bottom lines of the Gengzi year (2020) is wooden qi, i.e. human liver qi. Once the liver qi stagnates, the qi at the Taichong acupoint will be passed to Jueyin, and there will be problem with ability of conveyance and dispersion including the blood vessels. Then blood circulation, qi circulation, and water circulation will all be blocked. The wooden qi is blocked this year. So the herbs such as Guizhi(cassia twig), Xixin(Asarum), Mahuang(Ephedra) and Chaihu (Bupleurum) in QFPDT are used to deal with this major problem. This was taken into account when formulating the prescription at the beginning. So in clinic practice, I suggest that two needles can be put on one Taichong point to strengthen the meridian qi at this acupoint, which plays a very important role in the occurrence of critical phase or inflammatory storms during western medicine treatment. Moreover, according to a large number of tongue coatings and other information with four TCM diagnosis methods in the clinic of COVID-19, most patients have dark purple tongues and liver stagnation. Therefore, QFPDT together with the needling method of 18 matched acupoints can solve this problem.
The eighteen acupoints are:
SJ2(Yemen), SJ6(Zhigou), BL60(Kunlun), BL66(Tonggu), KI3(Taixi), GB43(Xiaxi), LR3(Taichong), LU7(Lieque), LU5(Chize), SP3(Taibai), SP9(Yinlingquan), ST40(Fenglong), SI3(Houxi), GB20(Fengchi), DU16(Fengfu), LU11(Shaoshang), LI1(Shangyang), and SJ1(Guanchong).
问题10：按照这个逻辑，我也想知道教授是否对这些问题有什么特殊的针灸操作手法？如“烧山火”或“透天凉”或其他任何一种。
Q10: Following this reasoning I would also like to know if the professor suggests any special kind of manipulation on these points such as shāo shān huŏ（烧山火） or tòu tiān liáng（透天凉） or any other.
葛又文：首先针刺穴位补泻作用已经体现在选穴上了，给予推荐的这些穴位的穴性已经决定了它的补与泻，所以在针刺穴位操作时，用平补平泻的手法即可。至于“烧山火、透天凉”的针刺操作手法，我建议可以在三焦经上施用“烧山火” 的手法，余穴平补平泻即可。
Ge You Wen: First of all, the reinforcing and purging effect of acupuncture points has been reflected in the selection of points, and the nature of these recommended acupoints has determined its reinforcing and purging effect, so when doing acupuncture, it is sufficient to use the Ping Bu Ping Xie (mild reinforcement and attenuation) manipulation technique. As for the acupuncture manipulation of “burning mountain fire(shao shan huo)” and “letting the sky cool(tou tian liang)”, I suggest that the manipulation of “burning mountain fire(shao shan huo)” can be applied to the triple energizer(sanjiao) meridian, and the Ping Bu Ping Xie (mild reinforcement and attenuation) manipulation technique can be used on the rest ones.