長新冠咳嗽與中醫三焦之臨床新探

Clinical Exploration on the Relationship of Long COVID-19 Cough and Features of San Jiao (the Triple burner)

長新冠咳嗽（long COVID-19 cough）為感染COVID-19後常見的臨床症狀，面臨患者的病程由急性期轉至亞急性期、慢性期，中西醫學的思考與介入方式能否有相互學習與借鏡的地方，為本研究所欲探討的方向，因此我們從臨床上觀察新冠後遺症於三焦的表現，進一步在歷代文獻中探尋三焦與咳嗽的關聯，分析其理論的形成、發展源流與病機脈絡，從中細繹與現代醫學的連結，推論三焦的其中一個面向可以理解為發炎反應，由分子層次論述細胞激素（cytokines）與中醫三焦的「熱性」、「別使」概念相互印證，其能影響交感神經，導致神經發炎（neuroinflammation），同時也能刺激膜上受體，致使黏液過度分泌（mucus hypersecretion），此過程能與三焦的氣機與水道功能對照，最後回歸臨床治療層面，由樞轉三焦的概念切入，探討柴胡類方在新冠後遺症治療上的應用，以幫助緩解長新冠咳嗽與其他多系統的症狀。

Cough is one of the most common symptoms of COVID-19 infection, whether in the acute stage, subacute stage or chronic stage. Our target is to discover the relationship of thinking process and treatment between traditional Chinese medicine and modern medicine. Therefore, by observing the symptoms of post COVID-19 conditions which are associated with the function of San Jiao (triple burner) in the theory of traditional Chinese medicine, we infer that one of the aspects of San Jiao, which can be understood as inflammation by molecular level, is similar to the features of cytokines. The activation of cytokines can lead to neuroinflammation of sympathetic nerve and influence transmembrane receptors which can induce mucus hypersecretion. This mechanism represents the function of San Jiao which can regulate the movement of Qi and fluid. In conclusion, using the prescriptions involving Chaihu (Bupleurum chinense) as the treatment of long COVID-19 cough to balance San Jiao may help to relieve long COVID-19 cough and other multisystem symptoms.