附录1

Appendix 1

新型冠状肺炎中医治疗方案

关于印发新型冠状病毒肺炎恢复期中医康复指导建议（试行）的通知

新型冠状病毒肺炎恢复期中医康复指导建议(试行)

Chinese Medicine Treatment Protocol for Novel Coronavirus Pneumonia

Notice on Printing and Distributing Guidance and Suggestions for Rehabilitation with Traditional Chinese Medicine for Novel Coronavirus Pneumonia (Trial Version)

Novel Coronavirus Pneumonia Recovery Period TCM Rehabilitation Guidance Suggestions

（provisional version）

本建议适用于符合国家卫生健康委和国家中医药局联合印发的新型冠状病毒肺炎诊疗方案解除隔离和出院标准的恢复期人群。临床医师可参考本指导建议，根据患者个体情况给予相关治疗或康复指导，患者出院后亦可根据本建议采用适宜的自我干预方法。               

   国家卫生健康委员会办公厅

国家中医药管理局办公室

　　2020年2月22日

This set of recommendations is applicable to people in the recovery period who meet the criteria for release from quarantine and discharge from the hospital based on the criteria in the Novel Coronavirus Pneumonia Diagnosis and Treatment Plan jointly issued by the National Health and Health Commission and the State Administration of Traditional Chinese Medicine. Clinicians can refer to this guidance and give relevant treatment or rehabilitation guidance based on the individual situation of the patient. After discharge, patients can also adopt appropriate self-intervention methods included in this recommendation.

General Office of the National Health Commission

Office of the State Administration of Traditional Chinese Medicine

February 22, 2020

一、推荐中药

1.肺脾气虚证

临床表现：气短，倦怠乏力，纳差呕恶，痞满，大便无力，便溏不爽。舌淡胖，苔白腻。

推荐处方：法半夏9g、陈皮10g、党参15g、炙黄芪30g、炒白术10g、茯苓15g、藿香10g、砂仁6g(后下)、甘草6g。

服法：每日1剂，水煎400ml，分2次服用，早晚各1次。

推荐中成药：补气健脾类。

(A)Recommended Chinese Herbal Medicine

1.Spleen and Lung Qi Deficiency Pattern

Clinical Presentation: shortness of breath, fatigue and lack of strength, poor appetite with nausea and vomiting; fullness in the epigastric region, forceless bowel movements, incomplete and watery bowel movements, pale and enlarged tongue with white, greasy tongue fur.

Recommended Formula: Fa Ban Xia (Rhizoma Pinelliae Praeparatum) 9g, Chen Pi (Pericarpium Citri Reticulatae) 10g, Dang Shen (Radix Codonopsis Tangshen) 15g, Zhi Huang Qi (Radix Astragali Praeparata cum Melle), Chao Bai Zhu (Rhizoma Atractylodis Macrocephalae) 10g, Fu Ling (Poria) 15g, Huo Xiang (Herba Agastachis)10g, Sha Ren (Fructus Amomi) 6g (post-add), Gan Cao (Radix et Rhizoma Glycyrrhizae) 6g.

Adminstration: One bag per day; boil in 400mg of water and divide into two doses, take morning and evening.

Recommended Prepared Medicines: Formulas that build the spleen and tonify Qi.

2.气阴两虚证

临床表现：乏力，气短，口干，口渴，心悸，汗多，纳差，低热或不热，干咳少痰。舌干少津，脉细或虚无力。

推荐处方：南北沙参各10g、麦冬15g、西洋参6g、五味子6g、生石膏15g(先煎)、淡竹叶10g、桑叶10g、芦根15g、丹参15g、生甘草6g。

服法：每日1剂，水煎400ml，分2次服用，早晚各1次。

推荐中成药：益气养阴类。

2.Qi and Yin Deficiency Pattern

Clinical Presentation: weakness, shortness of breath, dry mouth, thirst, palpitations, sweating, low appetite, low-grade fever or no fever, dry cough with scant phlegm. Dry tongue with scant moisture; Thin pulse or vacuous, forceless pulse.

Recommended Formula: Nan Sha Shen (Radix Adenophorae) 10g, Bei Sha Shen (Radix Glehniae) 10g, Mai Dong (Radix Ophiopogonis) 15g, Xiyang Shen (Radix Panacis Quinquefolii) 6g, Wu Wei Zi (Fructus Schisandrae Chinensis) 6g, Sheng Shi Gao (Gypsum Fibrosum) 15g (pre-cook), Dan Zhu Ye (Herba Lophatheri) 10g, Sang Ye (Folium Mori) 10g, Lu Gen (Rhizoma Phragmitis) 15g, Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) 15g, Sheng Gan Cao (Radix et Rhizoma Glycyrrhizae) 6g

Administration: one bag per day; boil in 400mg of water and divide into two doses, take morning and evening。

Recommended Prepared Medicines: Boost qi and nourish yin formulas

二、中医适宜技术

1.艾灸疗法

常用选穴：大椎、肺俞、上脘、中脘、膈俞、足三里、孔最等。

2..经穴推拿

穴位按摩：太渊、膻中、中府、肺俞、肾俞、大肠俞、列缺、中脘、足三里等，咳嗽、咽痒、干咳者，可加少商、尺泽等。

经络推拿：手太阴肺经、手阳明大肠经、足阳明胃经、足太阴脾经、任脉、督脉等。

3.耳穴压豆

常用耳穴：支气管、肺、内分泌、神门、枕、脾、胃、大肠、交感等。

4.刮痧

手太阴肺经、手阳明大肠经、足太阳膀胱经等。

5.拔罐

背腧穴为主，如肺俞、膏肓、脾俞、肾俞、大椎等。

6.针刺疗法

常用选穴：太渊、曲池、肺俞、足三里、阴陵泉、关元等。

随症配穴：乏力、怕冷、舌淡者，可加膈俞、肾俞、大肠俞;食欲差、大便稀溏、舌淡者，可加中脘、天枢;咳嗽、咳痰、舌淡者，可加大椎或定喘、膏肓等。膏肓、肺俞、膈俞等穴局部肌肉薄，注意规范操作，避免引起气胸。

注：中药和中医适宜技术应在医师指导下使用。

(B)Suitable techniques of traditional Chinese medicine

1.Moxibustion Therapy

Commonly used points: Da Zhui (Du14); Fei Shu (UB13); Shang Wan (Ren 13); Zhong Wan (Ren12); Ge Shu (UB17); Zu San Li (ST36); Kong Zui (LU6)

2.Tuina-massage on Acupuncture Point and Channels

Acupuncture Points for Massage: Tai Yuan (LU9); Tan Zhong (Ren 17); Zhong Fu (LU1); Fei Shu (UB13); Shen Shu (UB23); Da Chang Shu (UB25); Lie Que (LU7). For cough, scratchy throat and dry cough, add Shao Shang (LI1); Chi Ze (LU5)

Channels for Tuina (Chinese medical massage therapy): Hand Taiyin Lung Channel, Hand Yang Ming Large Intestine Channel, Foot Yang Ming Stomach Channel, Foot Taiyin Spleen Channel, Conception Vessel; Governor Vessel

3.Commonly-used Auricular Points

Bronchial tubes, lung, endocrine, Shenmen, pillow, spleen, stomach, large intestine, sympathetic

4.Gua Sha (Scrapping)

Hand Taiyin Lung Channel, Hand Yang Ming Large Intestine Channel, Foot Uninary Bladder Channel

5.Cupping

Back Shu Points, including Fei Shu (UB13);Gao Huang (UB43), Pi Shu (UB20), Shen Shu (UB23), Da Zhui (Du14)

6.Acupuncture Therapy

Commonly-Used Points: Tai Yuan (LU9); Qu Chi (LI11), Fei Shu (UB13); Zu San Li (ST36); Yin Ling Quan (SP9), Guan Yuan (Ren 4)

Additional Points: If the patient has fatigue, aversion to cold, or a pale tongue you can add: Ge Shu (UB17); Shen Shu (UB23); Da Chang Shu (UB25). For poor appetite, loose stools or diarrhea and a pale tongue, add Zhong Wan (Ren12) and Tian Shu (ST25). For cough, cough with phlegm and a pale tongue, one can add Da Zhui (Du14) or Ding Chuan (stop-wheezing EXB1) and Gao Huang (UB43). 

Note that Gao Huang (UB43), Ge Shu (UB17) and Fei Shu (UB13) are all located in areas where the muscle layer is thin and one should be careful not to cause a pneumothorax. 

Note: Chinese herbal medicine and other treatment modalities should be used or applied under the supervision of a trained professional.

三、膳食指导

总体建议：膳食平衡、食物多样、注重饮水、通利二便，并注重开胃、利肺、安神、通便。

根据食物属性和患者情况，进行分类指导：

1.有怕冷、胃凉等症状的，推荐生姜、葱、芥菜、芫荽等;

2.有咽干、口干、心烦等症状的，推荐绿茶、豆豉、杨桃等;

3.有咳嗽、咯痰等症状的，推荐梨、百合、落花生、杏仁、白果、乌梅、小白菜、橘皮、紫苏等;

4.有食欲不振、腹胀等症状的，推荐山楂、山药、白扁豆、茯苓、葛根、莱菔子、砂仁等;

5.有便秘等症状的，推荐蜂蜜、香蕉、火麻仁等;

6.有失眠等症状的，推荐酸枣仁、柏子仁等。

(C)Recommendations for Dietary Therapy

General Recommendations: Eat a balanced diet with a wide variety of foods; drink plenty of water; maintain regular bowel movements and urinary output. Include foods that increase appetite, open the lungs, calm the spirit, and promote bowel movements.

Base your recommendations on the following categories and the patient’s condition.

1. For those who have aversion to cold or have a cold stomach: ginger, onion, mustard and coriander are recommended;

2. If there are symptoms such as dry throat, dry mouth and irritability, green tea, fermented soy beans and star fruit are recommended;

3. For cough, expectorating phlegm and related symptoms, add pears, lily bulb, apricots, gingko, black plums (ume plums), cabbage, orange peel, and basil.

4. For poor appetite, abdominal distention and other symptoms, hawthorn, yam root, lentils, Poria , Ge gen (Kuzu root), radish seed, and amomum are recommended;

5. For constipation we recommend honey, bananas, and Huo ma ren (hemp kernels).

6. For insomnia and related symptoms we recommend Suan zao ren (sour jujube kernel), Bai zi ren (cypress kernel) and similar herbs.

四、情志疗法

1.五行音乐疗法

聆听五音与五脏、五志配合的乐曲，鼓动血脉、调畅情志。

2.移情易性法

改变生活环境和方式，转移或分散患者某种思维的集中点，免于不良刺激，摆脱不良情绪。

(D)Therapy and Techniques for Mental-Emotional Support

1.Five-phase Music Therapy 

Listening to music that corresponds to the five phases, the five zang-organs and the five wills (aspects of consciousness) can quicken the blood in the vessels and lift our moods. 

2.Positively Influencing Mood and Attitude

Changing daily activities or the environment will help distract patients that are overly-focused on or worried about their current situation. This will help them to avoid negative stimulation and to let go of negative moods.

五、传统功法

新冠肺炎轻型及普通型患者出院后，可采取多种功法;重型或危重型患者出院后，根据自身恢复情况选择适当的传统功法。

1.八段锦

练习时间10～15 分钟左右，建议每天1~2次，按照个人体质状况，以能承受为宜。

2.太极拳

推荐每日1次，每次30～50分钟为宜。

(E)Traditional Martial Arts and Health Cultivation Techniques 

After discharge from the hospital, a variety of methods can be adopted for mild and ordinary patients with COVID-19；After discharge from hospital, the patients with severe or critical condition should choose proper traditional methods according to their own recovery

1.Eight Pieces of Brocade

This can be practices 1-2x per day for 10-15 minutes each time. Activity should be modified based on the patient’s condition, being careful not to exceed their capacity.

2.Tai Chi (Taiji Quan)

Once per day for 30-50 minutes is recommended.

六、其他方法

1.呼吸六字诀

“嘘(xu)、呵(he)、呼(hu)、呬(si)、吹(chui)、嘻(xi)”，依次每个字6秒，反复6遍，腹式呼吸方式，建议每天1~2组，根据个人具体情况调整当天运动方式及总量。

2.呼吸疗愈法

主动进行缓慢深长的腹式呼吸训练，可采用鼻子吸气，嘴巴呼气，或鼻吸鼻呼，释放和疗愈身心。

3.“三一二”经络锻炼法

“三”指合谷、内关、足三里三个穴的按摩，“一”是意守丹田、腹式呼吸，“二”是两下肢下蹲为主的体育锻炼。建议每天1~2次，按照个人体质状况，以能承受为宜。　　

(F)Other Methods

1.The Six Healing Sounds Breathing Method

The sounds can be intoned in the order of the five-phase generative cycle: “xu, he, hu, si, chui, xi.” Each one should be intoned for 6 seconds and the whole cycle can be repeated six times while engaging in abdominal breathing. One or two sets per day are usually appropriate but one can change the form and amount based on one’s condition each day. 

2.Breathing Therapy

Practice slow, deep abdominal breathing, either breathing in through the nose and out through the mouth or reversing and inhaling through the mouth and exhaling through the nose. This relaxes and heals the body and mind.

3.“3-1-2” Qi- Channel Practice

“Three”refers to massaging three points: He Gu (LI4), Nei guan (PC6), and Zu San Li (ST36). “One” refers to abdominal breathing and holding the intention on the Dan Tian (Hara) or energy center of the body. “Two” refers to using your two legs to perform squats for exercise. This can be done once or twice a day, depending on one’s condition and capacity.