刘保延、邹旭、龚亚斌国际抗疫专家大讲堂在线答疑集锦
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」第八讲是中英双语的针灸专场，由世界针联执委、副秘书长、中国针灸学会副会长喻晓春主持，三位针灸专家主讲：刘保延——世界针联主席、中国中医科学院首席研究员，邹旭——广东省名中医、主任医师、教授、博士研究生导师、广东省中医院胸痛中心主任及重症监护室大科主任、雷神山医院感染三科六病区(C6病区)主任，龚亚斌——主任医师、第四批国家中医医疗队队员、上海中医药大学附属岳阳中西医结合医院肿瘤一科副主任。本场讲座受到了来自全球36个国家近万人的观看。在答疑环节，三位专家解答问题汇总如下：
问题1：在新冠肺炎的治疗中，请问针灸治疗的频率(每天，或是每两天一次？)；一个疗程持续多长时间？是否可以结合针灸与拔罐和刮痧疗法？ ——法国传统自由中医学院 Q1: In the treatment of COVID-19, how often should acupuncture treatment been applied (every day, or every other day?); How long does a course last? Is it possible to combine acupuncture with cupping and scraping(guasha)? ——French Faculty free Traditional Chinese Medicine 龚亚斌教授：我们在病房里扎针（针刺治疗）每天一次，一个疗程12天。负压病房里不适合做拔罐，所以在负压条件下我们不建议拔罐治疗。我们病房收住的患者80%以上都是虚损型病人，患者体质虚弱，我们也不建议刮痧治疗。 Prof. Yabin Gong: We gave patient acupuncture treatment in the ward once a day for 12 days. Cupping is not suitable for negative pressure wards, so cupping treatment is not recommended. More than 80% of the patients admitted to our wards are patients with deficiencies. They are in weak constitution, so we do not recommend scraping treatment either. 问题2：我们了解到失去味觉和嗅觉的症状主要出现在欧洲人，亚洲人只有百分之十到十五的人出现这个症状，而欧洲人百分之九十左右都有这些症状，请问您怎么看？可以进行针灸治疗吗？ ——法国传统自由中医学院 Q2: We have learned that the symptoms of loss of taste and smell mainly occur in Europeans. Only 10% to 15% of Asians have these symptoms, while about 90% of Europeans suffer from them. What do you think? Can acupuncture help? ——French Faculty free Traditional Chinese Medicine 刘保延教授：在病毒感染以后人体出现嗅觉和味觉丧失或障碍的症状，这在病毒性疾病中也是常见的现象（症状）。对这种现象（症状），我想可能用针灸的方法来治疗效果会很不错的，2016年在中国中西医结合耳鼻咽喉科杂志上曾有报道《针灸及穴位注射治疗病毒感染后嗅觉障碍的临床研究》，文章中为90例病毒感染后嗅觉障碍患者随机分为3组，即针刺组、穴位注射组和空白组对照组，分别予双侧迎香穴、上迎香穴和鼻丘针刺，利多卡因迎香穴注射，以及单纯临床观察。治疗前后对比，结果针刺组和穴位注射组均能改善PVOD患者的嗅觉功能，都有显著的疗效。我想针对失去味觉和嗅觉的症状这些病人可以试试针刺疗法，应该会有很大的帮助。味觉障碍、嗅觉障碍可能也有中枢性的，基本都是由病毒感染外周而引起来的，那么对于味觉障碍的，如治疗面瘫患者时我们用针刺的方法治疗效果不错，这些疾病跟病毒的感染是有关系的。 为什么失去味觉和嗅觉的症状在欧洲人多见，而在亚洲人少见，这个问题还是值得我们进一步去研究，但我觉得用针刺疗法，可以参照这方面相关的研究和报道，值得我们很好地学习和实践。 Prof. Baoyan Liu: People show up symptoms of loss of smell or taste after the virus infection, which is also a common phenomenon.For these symptoms, I think it may be very effective to use acupuncture and moxibustion. In 2016, an article named “Therapeutic effect of acupuncture and acupoint injection on the condition of postvirus-infecting olfactory dysfunction” was published in the Chinese Journal of Otorhinolaryngology in Integrative Medicine.In the article, 90 virus--infected patients with the olfactory dysfunction were randomly divided into three groups, namely acupuncture group, acupoint injection group and blank control group, patients were given acupuncture on bilateral Yingxiang, Shangyingxiang and Biqiu points, lidocaine injection in Yingxiang point, and simple clinical observation respectively. Compared before and after treatment , the results showed that both the acupuncture group and the acupoint injection group could improve the olfactory function of PVOD patients, and they all had significant effects. I think these patients can try acupuncture therapy for the symptoms of loss of taste and smell, which should be of great help. Taste dysfunction and olfactory dysfunction may also be central, basically caused by virus infection from the periphery. Then for the facial paralysis patients with the taste dysfunction, the acupuncture treatment we use has good effect. And these diseases somehow are related to the virus infection. The reason why loss of taste and smell are more common in Europeans than Asians is still worthy of our further research. But I think that the use of acupuncture therapy can refer to relevant research and reports, it is worth our learning and practice. 问题3：新型冠状病毒肺炎是有很强传染性疾病,对一些针灸师没有很强的无菌性概念情况下如何注意操作和自我保护？ ——时空针灸学院西班牙分院 Q3: COVID-19 is a highly contagious virus. How can we practice and self-protect while some acupuncturists don’t have strong concept of sterility? ——Spanish Branch of the Space-Time Acupuncture College 邹旭教授：现在我们接触的是传染病人，在治疗扎针时要比平时更小心，我们穿防护服、戴手套，扎针时一定要动作慢。所以在针刺治疗时注意：第一选择的穴位不能太多，否则耗的时间也多；其次扎针时可能部分患者会出血或分泌物的情况，扎针前手要严格消毒，出现分泌物时要用水冲洗，甚至更换手套，扎一次穴位，换一次手套，消毒一次手，以防交叉感染；最后防止职业暴露，因为可能有出血或分泌物，所以要比平时扎针操作慢半拍。在针刺操作过程中，防护非常重要。 Prof. Xu Zou: Now we are in contact with infectious patients. We need to be more careful than usual. We should wear protective clothing and gloves. We must move slowly when we insert the needle. Therefore, during the acupuncture treatment: firstly, we should not choose too many acupuncture points, otherwise it will take more time; secondly, some patients may have bleeding or secretions when the needle is inserted. The hands must be strictly disinfected before needling. Rinse with water, even change gloves when secretion shows up. We should change gloves and disinfect hands right after each time of needling one point to prevent cross infection; finally, we should be slower than usual needle insertion to prevent occupational exposure, because there may be bleeding or secretions leaking. During the acupuncture treatment, protection is very important. 问题4：针灸师在临床操作时是否建议使用套管进针以避免直接接触患者皮肤？ ——时空针灸学院西班牙分院 Q4: Is it recommended that acupuncturist use a tube for needle insertion to avoid direct contact with the patient's skin? ——Spanish Branch of the Space-Time Acupuncture College 龚亚斌教授：如果有条件的话，尽量使用套管针，而且最好是每个病人有独立的一套套管针，所有的针都是单个套管。如果不是每根针都有单独套管的话，尽量保证一个病人用一个套管，避免交叉感染，而且在每一个病人扎针结束后，医生（或护士）的手都要进行严格地消毒。 Prof. Yabin Gong: If possible, use tube as much as possible, and it is better to have a separate set of guiding tube for each patient, and each needle should come with individual guiding tube. If not, try to ensure that patient get separate guiding tube to avoid cross-infection. The doctor (or nurse) must strictly disinfected their hands right after treatment. 问题5：在进行针灸治疗时医生更近距离接触患者，是否增加了被传染的可能性？ ——瑞士的中国-瑞士中医药中心 Q5: During the acupuncture treatment, doctors are in closer contact with patients than others. Does it increase the possibility of infection? ——China-Swiss Chinese Medicine Center in Switzerland 龚亚斌教授：所有的针刺肯定会接触病人，那么在接触病人时，特别是面对咳嗽或有痰症状的病人，风险会更大。但是我们尤其是雷神山医院的医生们，都要穿防护服、带防护眼镜，在进仓前，除了我们自己检查（防护）之外，还有专门感控的人员来检查我们的防护设备，确保自己的皮肤完全没有暴露。总之医生都会带2-3层手套、带护目镜，再加一层面屏，所以在严格防护的前提下，进针操作是安全的。 Prof. Gong Yabin: All needling will definitely touch the patient. So the risk will be greater when contacting the patient, especially those with cough or sputum symptoms. But we, especially the doctors at Lei Shen Shan Hospital, must wear protective clothing and protective glasses. Before entering the ward, there are specially controlled personnel to check our protective equipment in addition to our own inspection (protection) to make sure our skin is not exposed at all. In short, the doctor will always bring 2-3 layers of gloves, goggles, and a layer of face shield, so acupuncture treatment is safe under the premise of strict protection. 问题6：是否有单独用针而不用药治疗的病例？ ——瑞士的中国-瑞士中医药中心 Q6: Are there any cases where acupuncture is used alone without medication? ——China-Swiss Chinese Medicine Center in Switzerland 邹旭教授：现在治疗新冠肺炎的病人，主要是要快，不给它（病情）有变化（加重）的机会，就目前来说我们还没有单纯只针刺而不用药物来治疗。我们从伦理的角度考虑，万一只单独用针灸来治疗，病人的病情出现了变化（恶化），从我们医生护士的角度来说，在伦理上过不了关的，所以目前我们没有单独用针灸来治疗新冠肺炎患者。 Prof. Xu Zou: At present, the treatment of patients with COVID-19 has to be quick, we should not leave it (the condition) a chance to change (aggravate). As of now, we have not simply treated them with acupuncture and no drugs. From an ethical point of view, if one is treated with acupuncture alone and the patient’s condition has changed (deteriorated), it is not ethically acceptable from the perspective of our doctors and nurses. So we have not used acupuncture alone to treat patients with COVID-19. 问题7：是否有针药对比的研究病例吗？ ——瑞士的中国-瑞士中医药中心 Q7: Is there any research on comparing acupuncture and medication? ——China-Swiss Chinese Medicine Center in Switzerland 邹旭教授：因为要做这种对烈性传染病的研究呢，要高度对患者负责任，目前没有做这种针药对比的研究，如果做这个针药对比的研究病例，需要经过伦理，以及比较多的实践病例，所以目前我们还没有单单做针刺或药物治疗的对比研究。 Prof. Xu Zou: Because we need to be highly responsible to the patients to do research on this kind of severe infectious diseases, there is no such research on acupuncture and medication comparison at present. If we want to do this acupuncture-medication comparison, we need to go through ethical review procedure and acquire more practical cases, so we have not made a comparative research on acupuncture or medication treatment alone at present. 问题8：鉴于现在美国各州呼吸机短缺，如果针灸能够确实给予病人持续的改善呼吸功能，就是对整个支持治疗有非常好的帮助，请谈一谈武汉一线对针灸的临床应用。对轻，中，重证病人进行针灸治疗的选择。 ——来自美国的医师 海英 Q8: In view of the current shortage of ventilators in various states of the US, if acupuncture can indeed continuously improve respiratory function of patients, it is a very good for the entire supportive treatment. Could you please talk about the clinical application of acupuncture in Wuhan frontline? And the choice of acupuncture treatment for patients with mild, moderate and severe disease? ——Haiying, a physician from the United States 邹旭教授：关于这个问题如果是呼吸机短缺，专门用针灸来改善呼吸功能，根据我们这两个月治疗新冠肺炎的的经验，建议还是要综合治疗所取得效果是最好的。早期病邪在表，可用针灸来发汗祛邪，所以（早期）要尽快用中医来解表发汗。如果没有呼吸机兜底的话，大概有百分之十几的患者会从重症发展到危急重症，甚至有百分之三左右的患者会出现死亡，那么在这个时候还是要呼吸机来兜底。要用综合疗法来治疗，目前有西医的对症处理，特别通过鼻管吸氧、面罩吸氧，甚至是无创的呼吸机来供氧，加上中药（改善呼吸功能），再加上针灸疗效会更好。所以，对这个病毒能够早点干预我是认同的，哪怕是对轻症患者使用针灸和药物、综合疗法都是有效果的。总之，在治疗新冠肺炎过程中，综合疗法很重要，加上针灸激发人体的经气，防止它传变，我认为这个针药结合以及对症处理的经验是值得推广的。 Prof. Xu Zou: Regarding this problem, if there is a shortage of ventilators, use acupuncture and moxibustion specially to improve respiratory function. According to our experience in treating COVID-19 in the past two months, it is suggested that comprehensive treatment is still needed to achieve the best results. For example: in the early stage when the disease is in the exterior, TCM treatment such as acupuncture should be used as soon as possible to relieve exterior syndrome and sweat. If there is no ventilator, about 10% of the patients will develop from severe to critical, and even about 3% of the patients will die, so at this time we still need a ventilator in case. Comprehensive therapy should be used for treatment. At present, we use symptomatic treatments of Western medicine, especially oxygen supply through nasal tube, mask, or even non-invasive ventilator, plus Chinese medicine (to improve respiratory function) and acupuncture, the curative effect is better. Therefore, I agree to intervene in this virus early, even for mild patients, it is effective using comprehensive therapy with acupuncture and medications. In short, in the treatment of COVID-19, comprehensive therapy is very important. In addition, acupuncture stimulates the meridian Qi of the human body to prevent the transmission. I think the experience of combining acupuncture with medicine and symptomatic treatment is worth promoting.
世界针灸学会联合会