AACMA-Published by China Health Committee Diagnosis and Treatment Protocol for COVID-19

Published by China Health Committee Diagnosis and Treatment Protocol for COVID-19

Published by National Health Commission of PRC

Diagnosis and Treatment Protocol for COVID-19

(trial version 7-full version)

Since December 2019, a number of COVID 19 patients have been found in wuhan, hubei province. With the spread of the epidemic, similar cases have been found in other parts of China and abroad.This disease, as an acute respiratory infectious disease, has been included in the "law of the People's Republic of China on the prevention and treatment of infectious diseases" as a class b infectious diseases, as a class infectious diseases management.
(add) through a series of preventive and control measures and medical treatment, the rising momentum of the epidemic in China has been contained to a certain extent, the epidemic has been alleviated in most provinces, but the number of cases outside China is on the rise.As the in-depth understanding of the disease clinical manifestations, pathology and clinical experience, in order to further strengthen the early detection of the disease treated early, raise the cure rate, decrease the rate of deaths, the greatest possible avoid nosocomial infection, and draw attention to foreign imported cases lead to the spread and diffusion, we to the COVID - 19 medical 6 (trial version) "amended, formed the COVID - 19 medical 7 (trial version)".
I. characteristics of etiology
A novel coronavirus is a coronavirus of the genus etinus. It is enveloped and has round or elliptic particles, usually pleomorphic, with a diameter of 60-140nm.Its genetic characteristics were significantly different from those of sarsr-cov and mersr-cov.At present, the homology of bat sars-like coronavirus (bat-sl-covzc45) is more than 85%.Novel coronavirus (original: 2019-nCoV) can be found in human respiratory epithelial cells in 96 hours in vitro, while it takes about 6 days to isolate and culture in Vero E6 and huh-7 cell lines.
The understanding of the physical and chemical characteristics of coronavirus mainly comes from the study of sars-cov and mers-cov.The virus is sensitive to ultraviolet light and heat. 30 minutes at 56°C, ethyl ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid, chloroform and other lipid solvents can effectively inactivate the virus, chlorhexidine can not effectively inactivate the virus.
2. Epidemiological characteristics
(1) source of infection.
At present, the virus was mainly infected by novel coronavirus patients.Asymptomatic infections can also be a source of infection.
(2) means of transmission.
Transmission by respiratory droplets and contact is the main route of transmission.It is possible to spread by aerosol when exposed to high concentrations of aerosol for a long time in a relatively closed environment.(add) since novel coronavirus can be isolated from feces and urine, note that feces and urine cause aerosol or contact transmission to the environment.
(3) susceptible groups.
The crowd is generally susceptible.
3. Pathological changes (more pathological changes than the 6th edition)
According to the present limited autopsy and biopsy histopathological findings are summarized as follows.
(1) the lungs
The lungs show varying degrees of consolidation.
Serous fibrin exudate and transparent membrane were observed in alveolar cavity.Exudate cells are mainly mononuclear and macrophage, and polynuclear giant cells are easy to see.Type II alveolar epithelial cells proliferate markedly, with some cells exfoliated.Inclusion bodies are seen in il-type alveolar epithelial cells and macrophages.The alveolar septa is congested and edematous. Mononuclear and lymphocyte infiltration and clear intravascular thrombosis are seen.Focal hemorrhage and necrosis of lung tissue may occur with hemorrhagic infarction.Partial alveolar exudate is institutionalized and interstitial fibrosis occurs.
Part of the epithelium of the bronchial mucosa in the lung has been detached.A few alveolar hyperinflation, alveolar septum rupture or cystic cavity formation.
Coronavirus particles were seen in the cytoplasm of bronchial mucosal epithelium and il-type alveolar epithelial cells under electron microscopy.Immunohistochemical staining showed that some alveolar epithelium and macrophages were positive for novel coronavirus antigen, and rt-pcr showed positive for novel coronavirus nucleic acid.
(2) spleen, hilar lymph nodes and bone marrow.
The spleen has shrunk markedly.The number of lymphocytes was significantly reduced, focal hemorrhage and necrosis were found, and macrophage proliferation and phagocytosis were observed in the spleen.Lymph node lymphocytes are few in number and necrosis is seen.Immunohistochemical staining showed a decrease in CD4+T and CD8+T cells in the spleen and lymph nodes.The number of three lines of bone marrow cells decreased.
(3) heart and blood vessels.
The cardiomyocytes are denatured and necrotic, with a few monocytes, lymphocytes, and/or neutrophils infiltrating the stroma.Partial vascular endothelial exfoliation, intimal inflammation and thrombosis.
(4) liver and gallbladder.
Volume increases, dark red.Hepatocyte degeneration, focal necrosis with neutrophil cell infiltration;Hepatic sinus hyperemia, infiltration of lymphocytes and mononuclear cells in the portal area, microthrombus formation.The gallbladder is highly filled.
(5) kidney.
Proteinaceous exudate is seen in the glomerular balloon lumen. Tubular epithelium is denatured and detached.There is interstitial hyperemia with microthrombus and focal fibrosis.
(6) other organs.
Brain tissue hyperemia, edema, some neuronal degeneration.Focal necrosis is seen in the adrenal gland.The mucosal epithelium of esophagus, stomach and intestine is denaturated, necrotic and exfoliated to different degrees.
Iv. Clinical characteristics
(I) clinical manifestations.
Based on the current epidemiological investigation, the incubation period is 1-14 days, most of which are 3-7 days.
With fever, dry cough, fatigue as the main performance.A few patients were accompanied by nasal congestion, runny nose, sore throat, myalgia, and diarrhea.In severe cases, dyspnea and/or hypoxemia usually occur one week after the onset of the disease. In severe cases, acute respiratory distress syndrome, septic shock, refractory metabolic acidosis, coagulation dysfunction and multi-organ failure can be rapidly advanced.It is worth noting that in the course of the severe and critical patients, the fever can be moderate or low, or even no obvious fever.
(add) some children and neonates have atypical symptoms, presenting as vomiting, diarrhea and other gastrointestinal symptoms or presenting only as weak spirit and shortness of breath.
The mild patients only showed low fever, slight fatigue, and no pneumonia.
At present, most patients have a good prognosis and a few are in critical condition.The elderly and those with chronic underlying diseases have poor prognosis.(increase) the clinical course of maternal patients with COVID-19 is similar to that of patients of the same age.In children, the symptoms are relatively mild.
(2) laboratory inspection.
1. General inspection
In the early stage of the disease, the total number of peripheral blood leukocytes was normal or decreased, and the lymphocyte count was decreased. In some patients, liver enzymes, lactate dehydrogenase (LDH), myoglobin and myoglobin were increased.Increased troponin is seen in some critical patients.In most patients, c-reactive protein (CRP) and serum sedimentation were increased, and procalcitonin was normal.In severe cases, d-dimer increased and peripheral blood lymphocytes decreased progressively.Severe and critical patients often have elevated inflammatory factors.

2.Aetiology and serological examination
(1) etiological examination: novel coronavirus nucleic acid was detected in nasopharyngeal swabs, sputum and other lower respiratory secretions, blood, feces and other specimens by rt-pcr or/and NGS.Detection of lower respiratory tract specimens (sputum or airway extract) is more accurate.Samples will be sent for inspection as soon as possible after collection.
(2) serological examination: novel coronavirus specific lgM antibodies were mostly positive in 3 ~ 5 days after onset, and the titer of lgG antibody in the recovery period was 4 times higher than that in the acute phase.
(3) chest imaging.
In the early stage, there were multiple small patches and stromal changes, and the lung extraneous zone was obvious.Then, it developed into multiple ground-glass shadows and infiltrating shadows in both lungs. In severe cases, lung consolidation may occur, and pleural effusion is rare.
V. diagnostic criteria
(1) suspected case.
Combined with the following epidemiological history and clinical manifestations:
1. Epidemiological history
(1) travel history or residence history of wuhan and surrounding areas or other communities with reported cases within 14 days before onset;
(2) a history of exposure to novel coronavirus infection (nucleic acid positive) within 14 days prior to onset;
(3) in the 14 days before onset, the patient had been exposed to fever or respiratory symptoms from wuhan city and surrounding areas, or from the community with case report;
(4) cluster disease (2 or more cases of fever and/or respiratory symptoms in a small area such as home, office, school and class within 2 weeks).
2. Clinical manifestations
(1) fever and/or respiratory symptoms;
(2) with the above covid-19 imaging characteristics;
(3) the total number of white blood cells in the early stage of the disease was normal or decreased, and the lymphocyte count was normal or decreased.
It has any epidemiological history and conforms to any 2 clinical manifestations.If there is no clear epidemiological history, it conforms to 3 clinical manifestations.
(2) confirmed cases.
Suspected case with one of the following etiological evidence:
1. Detection of novel coronavirus nucleic acid positive by real-time fluorescence rt-pcr;
2. Virus gene sequencing, and known novel coronavirus highly homologous;
3. Serum novel coronavirus specific lgM antibody and lgG antibody were positive;The serum novel coronavirus specific IgG antibody changed from negative to positive or the recovery period was 4 times or more higher than the acute period.

Vi. Clinical typing
(1) light weight.
The clinical symptoms were mild, and no signs of pneumonia were found on imaging.
(2) common type.
With fever, respiratory tract and other symptoms, imaging evidence of pneumonia.
(3) heavy duty.
(additional) an adult meets any of the following criteria:
1. Shortness of breath, RR≥30 times/min;
2. At rest, oxygen saturation ≤93%;
3. Arterial partial oxygen pressure (Pa02)/oxygen absorption concentration (FiO2) ≤300 mmHg (1 mmHg= o.133 kPa).
Correction of Pa02/Fi02 at high altitudes (above 1000 m) shall be made according to the following formula: PaO2/FiO2 x [atmospheric pressure (mmHg) /760]
Pulmonary imaging showed significant progression of > lesions within 24-48 hours.
(add) the child meets any of the following criteria:
1. Shortness of breath (<2 months old, RR≥60 times/min;2-12 months old, RR≥50 times/min;1-5 years old, RR≥40 times/min;>5 years old, RR≥30 times/min), excluding the influence of fever and crying;
2. At rest, oxygen saturation ≤92%;
3. Assisted breathing (moaning, flapping of nose wing, three concave signs), cyanosis, intermittent apnea;
4. Drowsiness and convulsions;
5. Food resistance or feeding difficulties, with signs of dehydration.
(4) critical type.
Meeting one of the following conditions:
1. Respiratory failure, requiring mechanical ventilation;
2. Shock;
3. Complications of other organ failure require ICU care.
Vii. Severe and critical clinical early warning indicators (more early warning indicators than the sixth edition)
(1) adults
1. Progressive decline of peripheral blood lymphocytes;
2. Inflammatory factors in peripheral blood such as il-6 and c-reactive protein increased progressively;
3. Progressive increase of lactic acid;
4. Intrapulmonary lesions progress rapidly in a short period of time.
(2) children
1. Increased breathing rate;
2. Poor mental reaction and drowsiness;
3. Progressive increase of lactic acid;
4. Imaging showed bilateral or multi-lobe infiltration, pleural effusion or rapid progression of lesions in a short period of time;
5. Infants under the age of 3 months may have basic diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory tract malformation, abnormal hemoglobin, severe malnutrition, etc.) and have immune deficiency or hypoxia (long-term use of immunosuppressive agents).
Viii. Differential diagnosis
A novel coronavirus infection should be differentiated from an upper respiratory tract infection caused by another virus.
(2) covid-19 is mainly differentiated from influenza virus, adenovirus, respiratory syncytial virus and other known viral pneumonia and mycoplasma pneumoniae infection. In particular, as far as possible, methods including rapid antigen detection and multiple PCR nucleic acid detection should be adopted to detect common respiratory pathogens.
(3) still want with noninfective disease, be like vasculitis, skin flesh is phlogistic wait for differentiation with mechanical sex pneumonia.
Vii. Discovery and report of cases
All kinds of medical institutions at all levels of medical staff found that satisfies the definition of cases after suspected cases, shall be immediately for single isolation treatment, hospital specialists or the attending physician consultation, still consider suspected cases, for network within 2 hours straight, and samples were taken will be coronavirus nucleic acid detection, at the same time, in the premise to ensure transportation safety immediately suspected patients were transferred to the designated hospital.In patients who have close contact with a novel coronavirus infection, it is recommended to conduct novel coronavirus pathogen detection in time even if the common respiratory pathogen test is positive.
(add) a suspected case of two consecutive novel coronavirus nucleic acid test negative (sampling time at least 24 hours apart) and 7 days after the onset of novel coronavirus specific antibodies IgM and lgG is still negative can be excluded from the suspected case diagnosis.

Eight, treatment,
(1) determine the treatment site according to the patient's condition.
1. Suspected and confirmed cases shall be isolated and treated in a designated hospital with effective isolation conditions and protection conditions. Suspected cases shall be isolated and treated in a single room.
2. Critical cases should be admitted to ICU for treatment as soon as possible.
(2) general treatment.
1. Bed rest, strengthen supportive treatment, and ensure adequate heat;Pay attention to water and electrolyte balance to maintain internal environment stability;Closely monitor vital signs, oxygen saturation, etc.
2. Blood routine, urine routine, CRP, biochemical indicators (liver enzyme, myocardial enzyme, kidney function, etc.), coagulation function, arterial blood gas analysis, chest imaging, etc.Cytokine detection is feasible with the condition.
3. Timely delivery of effective oxygen treatment measures, including nasal catheter, mask to give oxygen and high nasal flow oxygen treatment.(increase) if possible, mixed inhalation of hydrogen and oxygen (H2/O2:66.6%/33.3%) can be used for treatment.
4. Antiviral treatment:Can try alpha interferon (adult 5 million U or equivalent dose at a time, to join the sterilization 2 ml water for injection, atomization inhalation) 2 times a day, that horse /, the wei (200 mg/adult 50 mg/grain, every time 2 grain, 2 times daily, treatment is not more than 10 days) and ribavirin (suggestion and interferon or los horse that wei/joint application, the wei, adult 500 mg/time, 2 to 3 times a day by intravenous infusion, treatment is not more than 10 days), chloroquine phosphate (adult (change) 18-65 years old.If the weight is more than 50 kg, 500 mg each time, 2 times a day, a course of treatment for 7 days;If the weight is less than 50 kg, 500 mg each time on the first day and the second day, 2 times a day, 500 mg each time on the third to the seventh day, 1 time a day), abidor (adult 200 mg, 3 times a day, the course of treatment does not exceed 10 days).
Be aware of adverse reactions, contraindications (such as chloroquine for people with heart disease) and interactions with other drugs.To further evaluate the efficacy of the currently used drugs in clinical application.It is not recommended to apply 3 or more antiviral drugs at the same time, and should stop using related drugs when there are intolerable toxic and side effects.(add) the treatment of maternal patients should consider the number of weeks of gestation, as far as possible to choose drugs with little impact on the fetus, and whether to terminate the pregnancy before treatment, and other issues, and informed.
5. Antimicrobial therapy: avoid blind or inappropriate use of antimicrobial agents, especially in combination with broad-spectrum antimicrobial agents.
(3) treatment of severe and critical cases.
1. Treatment principle: on the basis of symptomatic treatment, actively prevent and treat complications, treat basic diseases, prevent secondary infections, and timely support organ functions.
2. Respiratory support:
(1) oxygen therapy: in severe patients, oxygen should be inhaled by nasal catheter or mask, and respiratory distress and/or hypoxemia should be timely evaluated for remission.
(2) high-flow nasal catheter oxygen therapy or noninvasive mechanical ventilation: in cases where respiratory distress and/or hypoxemia cannot be relieved after standard oxygen therapy, high-flow nasal catheter oxygen therapy or noninvasive ventilation may be considered.If the condition does not improve or even worsen within a short period of time (1-2 hours), endotracheal intubation and invasive mechanical ventilation should be performed promptly.
(3) invasive mechanical ventilation: the lung protective ventilation strategy was adopted, namely the neap tidal volume (modified) 6-8 ml/kg ideal body weight) and (modified) low level airway platform pressure (≤30 cmH20) for mechanical ventilation to reduce ventilator related lung injury.(add) when ensuring that the platform pressure of the airway is no more than 35 cmH20, high PEEP can be appropriately used to keep the airway warm and moist, avoid prolonged sedation, wake the patient early and conduct pulmonary rehabilitation treatment.More patients are not synchronous, should be timely use of sedation and muscle relaxant.(add) according to the situation of airway secretions, select closed sputum aspiration, when necessary, bronchoscopy to take corresponding treatment.
(4) salvage treatment: for patients with severe ARDS, pulmonary reconstruction is recommended.With adequate human resources, prone ventilation should be performed for more than 12 hours per day.If conditions permit, ECMO should be considered as soon as possible.(add) its correlation indicators: (1) at FiO2>90%, the oxygenation index is less than 80 mmHg, lasting more than 3-4 hours;(2) port platform pressure ≥35 cmH2O.Vv-ecmo mode was preferred for patients with respiratory failure alone.If loop support is required, the va-ecmo pattern is selected.When the underlying disease is under control and cardiopulmonary function shows signs of recovery, the machine withdrawal test can be started.
3. The loop support: on the basis of fully liquid recovery, improve microcirculation, the use of vasoactive drugs, close monitoring of patients with blood pressure, heart rate (increase) and the change of urine, and arterial blood gas analysis of lactic acid and alkali, remaining necessary for noninvasive or invasive hemodynamic monitoring, such as ultrasonic doppler, echocardiography, invasive blood pressure or continuous cardiac output (PiCCO) monitoring.In the process of treatment, pay attention to the liquid balance strategy, avoid excessive and insufficient.
If the sudden increase in heart rate is greater than 20% of the basal value or the blood pressure drops by more than 20% of the basal value, the patient should be closely observed for the presence of septic shock, gastrointestinal bleeding or heart failure if accompanied by skin perfusion disorder and decreased urine volume.
4. Renal failure and renal replacement therapy: in critically ill patients with renal injury, the causes of renal injury should be actively sought, such as hypoperfusion and drug factors.For the treatment of renal failure patients should pay attention to fluid balance, acid-base balance and electrolyte balance, in the nutritional support treatment should pay attention to nitrogen balance, heat and trace elements and other supplements.Continuous renal replacement therapy (CRRT) is available for severe patients.The indications include: hyperkalemia;(2) acidosis;(3) pulmonary edema or water overload;(4) fluid management when multiple organ functions are not complete.
5. Plasma treatment for recovered patients: it is suitable for patients with rapid disease progression, severe disease and critical disease.Usage and dosage refer to COVID-19 convalescent plasma clinical treatment program (trial (modified) second edition (original: first edition)).
6. Blood purification treatment: the blood purification system includes plasma exchange, adsorption, perfusion, blood/plasma filtration, etc., which can remove inflammatory factors and block the "cytokine storm", so as to reduce the damage caused by the inflammatory response to the body. It can be used for the early and middle treatment of severe and critical patients with cytokine storm.
7. Immunotherapy: tozumab can be used to treat patients with extensive bilateral lung lesions and patients with severe lung diseases, and those with elevated il-6 levels detected in the laboratory.The first dose was 4-8 mg/kg, the recommended dose was 400 mg, 0.9% saline diluted to 100 ml, and the infusion time was more than 1 hour.For patients with poor efficacy of the first dose, an additional dose can be applied after 12 hours (the dose is the same as before), with a maximum of 2 cumulative doses and a maximum of 800 mg for a single dose.Note that allergic reactions, such as tuberculosis and other active infection is contraindicated.
8. Other therapeutic measures
For oxygenation index progressive deterioration, imaging progress quickly, the body's inflammatory response, excessive activation of the state of the patients, as appropriate, in the short term (3 to 5) using glucocorticoid, recommended dose not more than the equivalent of methyl prednisolone 1 ~ 2 ml/kg/day, should pay attention to the larger doses glucocorticoid due to immune inhibition, delay of coronavirus cleared;100 ml of blood can be given intravenously, 2 times a day;Intestinal microecological regulator can be used to maintain intestinal microecological balance and prevent secondary bacterial infection.(deletion) in critically ill patients with high inflammatory response, plasma exchange, adsorption, perfusion, blood/plasma filtration and other in vitro blood purification techniques may be considered if possible.
Iv infusion of gamma globulin may be considered in children with severe or critical disease.Pregnant women with severe or critical COVID-19 should actively terminate their pregnancy, with c-section as the preferred option.
Patients often have anxiety and fear, should strengthen psychological counseling.

(4) traditional Chinese medicine treatment.
This disease belongs to the category of "epidemic" disease of traditional Chinese medicine, because of the feeling of "epidemic" of qi, according to the condition, local climate characteristics and different constitutions, according to the following plans for treatment.Excessive pharmacopoeial doses are involved and should be used under the guidance of a physician.
1. Medical observation period
Clinical manifestation 1: fatigue with gastrointestinal discomfort
Recommended Chinese patent medicine: huoxiang zhengqi capsule (pills, water, oral liquid)
Clinical manifestation 2: fatigue with fever
Recommended proprietary Chinese medicine: jinhua qinggan granules, lianhua qingwen capsules (granules), shufeng jiedu capsules (granules)
2. Clinical treatment period (confirmed cases)
2.1 lung-clearing and detoxification soup
Scope of application: it is applicable to the clinical observation of doctors in many places, and is suitable for light, ordinary and heavy patients. It can be reasonably used in the treatment of critical patients according to their actual conditions.
Basic prescription: ephedra 9g, roasted licorice 6g, almond 9g, gypsum 15~30g (Fried first), cassia twig 9g, alisma 9g, porus 9g, atractylodis 9g, poria cocos 15g, bupleurum 16g, astringent 6g, radix astringulae 9g, radix astringulata 9g, radix astringulata 9g, radix astringulata 9g, radix astringulata 9g, radix astringulae 9g, radix astringulata 9g, radix astringulae 9g, radix astringulae 9g, radix astringulae 9g, radix astringulae 9g, radix astringulae 9g, radix astringulae 9g, radix astringulae 9g, radix asarum 6g, Chinese yam 12g, orange tangerine 6g, radix tangerine 6g, radix tangerina 9g, radix tangerina 9g
How to take it: decoction of traditional Chinese medicine with water.Once a day, twice in the morning and evening (40 minutes after meals), warm, three to pay a course of treatment.
If have condition, every time take medicine can add take rice soup half bowl, tongue dry body fluid deficient person can take to a bowl more.(note: if the patient does not have fever, the amount of gypsum should be small, fever or strong heat can increase the amount of gypsum).If the symptoms are improved but not cured, take the second course of treatment. If the patient has special conditions or other basic diseases, the prescription can be modified according to the actual situation in the second course of treatment. If the symptoms disappear, stop the drug.
"Notice on recommending the use of" lung clearing and detoxification soup "in the treatment of novel coronavirus pneumonia by combining traditional Chinese and western medicine" (medical administration letter of the state council of traditional Chinese medicine [2020] no. 22), office of the state administration of traditional Chinese medicine, general office of the state health commission.
2.2 light
(1) cold and wet lung stagnation syndrome
Clinical manifestations: fever, fatigue, soreness, cough, cough up phlegm, chest tightness, tolerance, nausea, vomiting, stool sticky.Tongue quality light fat tooth mark or light red, moss white thick rot greasy or white greasy, pulse moisten or smooth.
Recommended prescription: raw ephedra 6g, gypsum 15g, almond 9g, qiang activity 15g, draba 15g, guanzhong 9g, drong 15g, xu changqing 15g, huoxiang 15g, perrin 15g, peilan 9g, atractylodis atractylodis 15g, yunling 45g, atractylodis 30g, each 9g, hopu 15g, 9g, burnt fruit 9g, ginger 15g.
Dosage: 1 dose daily, 600 ml water, 3 times, 1 time in the morning, 1 time in the evening and 1 time in the evening, before meals.
(2) dampness and heat accumulate lung syndrome
Clinical manifestations: low fever or no fever, slight aversion to cold, fatigue, heavy head and body fatigue, muscle ache, dry cough with little phlegm, sore throat, dry mouth and no desire to drink more, or accompanied by chest pain, no sweat or sweat is not free, or see nauseous aversion to stay, loose stool or sticky discomfort.Tongue light red, moss white thick greasy or thin yellow, pulse number or moisten.
Recommended prescription: betel nut 10g, grass fruit 10g, magnolia officinalis 10g, anemone 10g, yellow cen 10g, bupleurum 10g, red peony root 10g, forsythia 15g, artemisia annua 10g (bottom), atractylodis atractylodis 10g, daisuya leaf 10g, licorice 5g.
Dosage: 1 dose daily, 400 ml water, divided into 2 times, 1 time in the morning and 1 time in the evening.
2.3 normal
(1) dampness, poison and lung stagnation
Clinical manifestations: fever, cough with little sputum, or yellow sputum, stuffy breath, abdominal distension, constipation.Tongue quality dark red, tongue body fat, moss yellow greasy or yellow dry, pulse number or string slip.
Recommended prescription: 6g raw ephedra, 15g bitter almond, 30g gypsum, 30g raw coix seed, 10g atractylodes, 15g patchpatchi, 12g artemisia, 20g cuspidatum, 20g verbena, 30g dried reed root, 15g semen leiocarpa, 15g red tangerine, 15g licorice.
Dosage: 1 dose daily, 400 ml water, divided into 2 times, 1 time in the morning and 1 time in the evening.
(2) cold and wet syndrome of pulmonary obstruction
Clinical manifestations: low fever, body heat does not spread, or not hot, dry cough, little phlegm, fatigue, chest tightness, wan PI, or vomiting, loose stool.Tongue quality light or light red, moss white or white greasy, pulse moisten.
Recommended prescription: atractylodis atractylodis 15g, tangerine peel 10g, magnolia officinalis 10g, huoxiang 10g, grass fruit 6g, raw ephedra 6g, qiang activity 10g, ginger 10g, betel nut 10g.
Dosage: 1 dose daily, 400 ml water, divided into 2 times, 1 time in the morning and 1 time in the evening.
2.4 heavy
(1) epidemic virus closed lung syndrome
Clinical manifestations: fever red, cough, sputum yellow sticky little, or sputum with blood, breathlessness, fatigue, dry mouth sticky, nausea not food, defecate not free, short red urine.Tongue red, moss yellow greasy, pulse slip number.
Recommended prescription: wet toxic formula
Basic prescriptions: ephedra 6g, almond 9g, gypsum 15g, licorice 3g, ageron 10g (lower posterior), cortex magnolia officinalis 10g, atractylodes 15g, herbaceous fruit 10g, pinellia methodicum 9g, pachycocos 15g, rhubarb 5g (lower posterior), radix astragali 10g, semen leiocarpa leiocarpa 10g, red peony root 10g.
Dosage: 1~2 doses daily, 100~200 ml each time, 2~4 times a day, oral or nasal feeding.
(2) two gas camp burnt certificate
Clinical manifestations: excessive heat and thirst, shortness of breath, delirious delirium, confusion of vision, or macular eruption, or vomiting of blood, epistaxis, or convulsions of limbs.Tongue purple less moss or no moss, pulse sink fine number, or floating and number.
Recommended prescription: 30~60g of gypsum (Fried first), 30g of anemarrhena anemarrhena, 30~60g of raw land, 30g of buffalo horn (Fried first), 30g of red peony root, 30g of radix ginseng, 15g of forsythiae forsythiae, 15g of paeoniae root, 15g of rhizome, 15g of rhizoma coptidis, 6g of rhizoma coptidis, 12g of bamboo leaves, 15g of draba lepidii, and 6g of licorice root.
Dosage: 1 dose daily, decocted in water, first decocted in plaster and buffalo horn, followed by medication, 100~200 ml each time, 2~4 times a day, oral or nasal feeding.
Recommended Chinese patent medicine: xiyanping injection, blood bijing injection, rejiangning injection, tanreqing injection, xingnaojing injection.Drugs with similar efficacy may be selected according to individual conditions, or may be used in combination according to clinical symptoms.Chinese medicine injection can be used in combination with Chinese medicine decoction.
2.5 critical type
Internal closure and external detachment
Clinical manifestations: dyspnea, frequent wheezing or need mechanical ventilation, accompanied by dizziness, irritability, cold limbs after sweating, purple and dark tongue, thick and greasy moss or dryness, large and rootless pulse.
Recommended prescription: ginseng 15g, heishun tablets 10g (Fried), cornus officinalis 15g, send suhexiang pills or an gong bezoar pills.
(add) appear mechanical ventilation with abdominal distension constipation or defecate not free, can use raw rhubarb 5~10 g.In the case of man-machine unsynchronization, in the case of sedation and muscle relaxant use, can be used raw rhubarb 5~10 g and mirabilite 5~10 g.
Recommended Chinese patent medicine: xubijing injection, retoxonine injection, tanreqing injection, xingnaojing injection, shenfu injection, shengmai injection, shenmai injection.Drugs with similar efficacy may be selected according to individual conditions, or may be used in combination according to clinical symptoms.Chinese medicine injection can be used in combination with Chinese medicine decoction.
Note: the use of heavy and critical TCM injections is recommended
The use of TCM injections should follow the principle of starting with small dose and gradually adjusting the syndrome differentiation in the drug instructions. The recommended usage is as follows:
Virus infection or mild bacterial infection: 0.9% sodium chloride injection 250 ml plus xiyanping injection 100 mg bid, or 0.9% sodium chloride injection 250 ml heating toxic injection 20 ml, or 0.9% sodium chloride injection 250 ml plus 40 ml bid.
High fever with consciousness disorder: 0.9% sodium chloride injection 250 ml plus xingnaojing injection 20 ml bid.
Systemic inflammatory response syndrome or/and multiple organ failure: 0.9% sodium chloride injection 250 ml plus 100 ml bid.
Immunosuppression: 250 ml glucose injection plus 100ml shenmai injection or 20~60 ml bid.
Recovery time is 2.6
(1) deficiency of lung and spleen
Clinical manifestations: shortness of breath, weariness and fatigue, tolerance and vomiting, ruffian man, weak stool, loose stools.The tongue is light and fat, and the moss is white and greasy.
Recommended prescription: method pinellia 9g, tangerine peel 10g, codonopsis codonopsis 15g, processed astragalus 30g, Fried atractylodes 10g, poria cocos 15g, huoxiang 10g, sand kernel 6g (after the bottom), licorice 6g.
Dosage: 1 dose daily, 400 ml water, divided into 2 times, 1 time in the morning and 1 time in the evening.
(2) qi and Yin deficiency syndrome
Clinical manifestations: fatigue, shortness of breath, dry mouth, thirst, palpitations, excessive sweating, poor tolerance, low or no heat, dry cough with little phlegm.Dry tongue with little fluid, veins fine or weak.
Recommended prescription: 10g of s. chinensis, 15g of ophiopogonis, 6g of American ginseng, 6g of schisandra chinensis, 15g of gypsum, 10g of bamboo leaves, 10g of mulberry leaves, 15g of reed roots, 15g of salviae miltiorrhiza, 6g of licorice root.
Dosage: 1 dose daily, 400 ml water, divided into 2 times, 1 time in the morning and 1 time in the evening.

Ix. Discharge standards and matters needing attention after discharge
(I) discharge standards
1. Body temperature returns to normal for more than 3 days;
2. Respiratory symptoms improved significantly;
3. Pulmonary imaging showed significant improvement in acute exudative lesions;
4. Negative nucleic acid test of respiratory tract specimens such as sputum and nasopharyngeal swabs for two consecutive times (sampling time at least 24 hours apart).
Those who meet the above conditions can be discharged from the hospital.
(2) matters needing attention after discharge.
1. The designated hospital should make contact with the primary medical institutions where the patients live, share medical records, and timely push the information of discharged patients to the area under the jurisdiction of the patients or the neighborhood committee of the residence and the primary medical and health institutions.
2. After the patient is discharged from the hospital, it is recommended that the patient continue to be isolated for 14 days for management and health monitoring, wear a mask, live in a single room with good ventilation if possible, reduce close contact with family members, eat separately, do good hand hygiene, and avoid outdoor activities.
3. It is recommended to visit the hospital for follow-up and follow-up in the second and fourth week after discharge.
X. transshipment principle
In accordance with the work plan for the transshipment of pneumonia cases infected by novel coronavirus (trial) issued by us.
Nosocomial infection control
In strict accordance with the technical guidelines on the prevention and control of novel coronavirus infection in medical institutions (first edition), and the guidelines on the scope of use of common medical protective equipment in the protection against pneumonia by novel coronavirus (trial).

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