中醫在SARS及COVID-19嚴重流行疫病臨床應用之系統性回顧

2003年嚴重急性呼吸道症候群（SARS）肆虐全球，2019年12月在中國武漢發生的新型冠狀病毒肺炎（COVID-19），到6月下旬即已蔓延全球188國，感染逾一千萬人，將近五十萬人死亡。COVID-19與SARS兩者都屬新型冠狀病毒致病，都可引起嚴重肺炎而致死。WHO在2020年3月11日正式宣布COVID-19為全球性大流行（pandemic），目前仍無明確療效之藥物，而疫苗也仍處於研發階段。本文擬探討中醫藥治療與預防在COVID-19中的角色。透過搜尋資料庫包括PubMed、華藝線上圖書館及中國期刊全文數據庫，分析歷代典籍與當代國內外文獻，並參酌中國發布的SARS與COVID-19之診療方案，以探討SARS與COVID-19中醫臨床分期表現、病因、證型、病機及臨床治則與病程演變之關聯性比較。此外，本文亦分析COVID-19臨床通用方（清肺排毒湯）之組方機理，探討體質差異對於COVID-19等臨床表現之影響，並提出中醫介入治療COVID-19的關鍵時機，以截斷病勢，進而改善嚴重流行疫病（時疫）患者之預後。期望藉由本論文的發現能有助於加速中醫藥在COVID-19之相關研究，進一步擴展中醫在相關嚴重流行疫病之臨床應用。

關鍵字

SARS ； COVID-19 ；全球性大流行；中醫；清肺排毒湯；嚴重流行疫病

並列摘要

The outbreak of severe acute respiratory syndrome (SARS) threatened the world in 2003. Almost two decades later, a novel Coronavirus Disease 2019 (COVID-19), which erupted in December 2019 in Wuhan, China, has spread to 188 countries and resulted in more than ten million cases infected and nearly 500,000 deaths worldwide in less than six months. Both of SARS and COVID-19 are all caused by novel coronavirus and can lead to severe pneumonia or death. Consequently, the World Health Organization (WHO) has officially announced that COVID-19 became pandemic on March 11th, 2020. Furthermore, no specific effective treatment for COVID-19 has been proved till now, and vaccines potentially useful for prophylaxis are still only in the clinical trial stage. In this study, we explored the roles of Traditional Chinese Medicine (TCM) in treatment and prevention of COVID-19. We retrieved the published articles from the online resources including PubMed, Airiti Library, and China Academic Journals Fulltext Database (CJFD). Subsequently, we analyzed the retrieved articles related to the SARS and COVID-19, and identified the clinical manifestations, etiologies, syndromes, pathogenesis, and therapeutic principles at different stages of the diseases based on the official reports of China Health authorities. We also evaluated the ingredients and the underlying therapeutic principle of the most commonly used Chinese herbal formula named ＂Qingfei Paidu Decoction＂ to treat COVID-19. Moreover, we identified the constitutional factors to explain the various clinical manifestations and outcomes of COVID-19 from the theory of TCM. Lastly, we proposed the opportune timing of TCM treatment to block the clinical progression and to improve the prognosis of COVID-19 patients. We expect our findings will contribute to vigorous progress on clinical treatment and research of TCM against COVID-19, and we are optimistic to see that TCM will play a more important role in the management of severe epidemic diseases in the future.