關於 flu vaccine type ，我們在網路上蒐集到這些相關的討論、資訊與評價

恐慌嘅時候，更需要睇清楚啲。

肥人知道呢篇文真係寫得遲，本來我乜都唔想寫，依家見到個勢係全世界順水推舟圍堵中共就更加唔想寫，但係姣婆係好難守寡既，尤其是呢排成日俾班極度恐慌既人trigger… 我決定代肥控制員寫，因為我呢邊收視率高過佢。

好，開波！
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“We had better learn to doubt our inflated fears before they destroy us. Valid fear have their place; they cue us to danger. False and overdrawn fears only cause hardship. Even concerns about real dangers, when blown out of proportion, do demonstrable harm.” – Barry Glassner, American sociologist, author of The Culture of Fear.

網絡世界千奇百趣，好多網上既意見同評論，如果同傳媒製造既輿論結合（不論有心定無意），係會對社會有非常深切既影響。例如以前有政權會向群眾灌輸恐懼，挑起群眾之間既仇恨，或令群眾不知所措，進而控制群眾。呢種手法，不論以前納粹德國、現存或者已覆亡既共產國家、甚至自命民主自由既開放社會如美國都有出現。當政者及其黨羽，就係利用群眾既錯誤認知，以感性因素去扭曲大家既認知同決策能力，咁就可以達到佢地既政治目的啦。咩政治目的？好多種既，下至失敗政府要掩飾施政失誤，上至衝出國際統治全世界都有。

所以唔好話咁樣係「誇張」、「陰謀論」、同「乜都拉埋政治來講」呀，因為人類歷史就係充滿呢種叫 fearmongering既手段－用有目的地散播同誇大一樣不愉快既事情既手法，去引起大家既恐懼來控制群眾。現今世界，庸碌無能之輩當政比比皆是，唔識控制群眾既情緒，點樣遮掩政府既無能同做錯事既後果？不過肥人今次唔講法律，我學下一般既KOL咁「跨界別評論」先，所以呢篇文我講生物醫學，particularly 係將近來我係周遭聽聽埋埋既恐慌言論歸納一齊，逐點解釋。
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首先，等肥人我同大家重溫一下近來有關武漢肺炎既新聞標題：

信報報導「河南超長潛伏期病例疑94天確診」
HK01就話「逾5000疫廈元朗區最多　衛生署拒回應真偽」
Business Focus既報導就恐怖啦，話「肺炎突變新冠腦炎?　北京醫院首證病毒能侵襲中樞神經系統　感染肺炎併發腦炎北京醫院：患者意識曾陷入混亂」
CCTVB報導「私家醫生可收患者呼吸道樣本交政府陳肇始稱可及早減低傳播」

仲有零零星星報導例如：

「伊朗新冠肺炎疫情增至145死55歲國會議員不治」
「伊朗新型冠狀肺炎疫情失控，再有一位高級官員病逝。」
「【新冠肺炎・伊朗】數名官員先後染病身亡　23國會議員確診」
「新型冠狀病毒南韓確診個案累計增至逾7千宗死亡人數維持在44人。」
「【新冠肺炎．最新疫情】意大利確診個案逾萬　美國突破千宗」
上面堆報導實在睇到好多人好恐慌，尤其是本來對科學／病毒／醫療／疾病無咩認知既人，呢兩個月睇新聞就好似睇恐怖熱線咁。於是搞到好多心理質素差，表面受過教育既人墮入恐慌之中。

然後，我聽到身邊好多人竭斯底理咁驚叫：

「個肺花！個肺花！個肺花！個肺花呀！」
「呢個唔係流感呀！唔好再錯誤同流感比較啦！」
「潛伏期變長呀！無病徵既隱形病人都會傳染人架！」
（隔離果個choke到，咳兩聲）「我以後唔同你坐埋一齊呀！我唔想死呀！」
「如果唔係香港人衛生意識好，堅持戴口罩，香港一早淪陷啦！依家已經無新病例！你睇鬼佬幾污糟！又唔戴口罩，病又話唔使入醫院，返屋企休息，依家美國同意大利都爆發啦！」
「呢D廢老唔戴口罩，鬼唔望佢地中招死全家！政府應該強制人戴口罩！」

以上說話我全部聽過人講，最後一句我最撚火滾，你自己恐慌就好啦，咒人死仲要政府好 draconian 咁立法同執法？俾個民主自由既國會你仲可以普選，你都會選班人渣出來，然後大比數通過立法強制抽血抽組織，強制所有人有無問題都要戴口罩，仲可能要將人tag完再限制人出入自由。1984呀！

我日日做mon post狗睇網上既post，好多share出來又會令人恐懼既post，大部份都係有好多空間令人胡思亂想，如果你對科學尤其是 research methods, medical science, microbiology, virology等等唔認識的話，你鐵定會誤讀誤解再誤判… oh wait，睇返上面「利用群眾既錯誤認知，以感性因素去扭曲大家既認知同決策能力」，BINGO! 咁就搞掂你啦。為咩事要搞掂你？唔講啦，因為你會用陰毛論、陳雲信徒、唔好乜都政治化來駁我。

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依家太多post講呢個新型冠狀病毒，例如Facebook有個印度人既 Infographics on Covid-19，好詳盡，但咁又點呢？大家對病毒以致肺炎、流感、醫療系統等等都毫無認識，講到咁深入你地都會誤解或者一頭霧水。咁樣樣，好多人因為無足夠既basic knowledge，又先入為主咁因為自己既恐慌情緒相信左錯既資訊，要同佢地「解毒」，就好似同藍絲講咩叫法治一樣困難，真係太監洞房無撚用。

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好，依家開始【法網肥人講病毒】！

1. 眾所鳩知，武漢肺炎係由新型既冠狀病毒 Covid-19引起。Covid-19係冠狀病毒科 Coronaviridae裡面其中一種，佢係屬於 positive-sense, singled stranded RNA virus (正鏈單股核醣核酸病毒) 。RNA病毒有好高突變率，因為病毒既RNA polymerases缺乏 DNA polymerase 既proofreading能力，所以佢地好難有 nearly identical既 sequence。仲有一點好重要，病毒同病菌唔同，病毒係需要靠 host cell (宿主細胞)先可以生存，離開 host cell 佢地不能複製，不能運作，只有死路一條。所以一開始就話新病毒同SARS個sequence有幾多幾多 percent 相似，我即刻叮左一下，然後好多人傳話新病毒點點點可以生存好耐，我更加叮多兩下…. 邊個放呢D料出來既？

2. 另外，呢隻病毒並非 retrovirus (逆轉錄病毒, class VI single-stranded RNA-Reverse Transcriptase)，唔會將自己既RNA用 reverse transcriptase (逆轉錄酶)塞入host cell既基因裡面，然後適時復發。咩係retrovirus呢? 例如會引起 T Cell Leukemia 既 Human T-cell lymphotropic virus type 1 (HTLV-1)，或者引起愛滋病既 Human Immunodeficiency Virus (HIV)。呢個病毒，亦唔係好似肝病毒科乙型肝炎咁，唔係 retrovirus 但會有reverse transcriptase去將 viral genome incorporate 入host cell，所以就算不幸中左，都唔會話咩病者會成世帶住個病。所以我每一次聽到人講「就算中左都一世帶病呀」就會好抆，冠狀病毒變愛滋，黐L線！

3. 冠狀病毒既結構好簡單：一個 viral envelope，外面有protein spike，裡面有RNA，that’s it。佢地個replication mechanism (複製機制) 就係病毒接觸host cell後進入 host cell，然後係host cell個細胞核nucleus裡面複製。複製完之後就由host cell cytoplasm (細胞質)裡面製造既 necleocapsid (核蛋白衣) 加埋細胞核既 endoplasmic reticulum (內質網) 既phospholipid membrane (磷脂層)包住病毒RNA，經由host cell 既Golgi apparatus (高氏體)帶出host cell 繼續傳染人。呢個複製過程，當然會破壞甚至殺死 host cell啦。咁知道呢點有咩用？Phospholipid membrane係lipid bilayer (脂質雙分子層)，lipid bilayer係怕番梘soap既！咁勤D用番梘洗手就得啦，使撚用甲醇咩屌你，你嫌命長？

4. 有人話：「咁基因突變都得架嘛！個病毒咪做到所有野囉！」喔，係咩？如果咁簡單，呢個世界既大學就唔需要有生物系，而且達爾文應該無人理。首先，病毒點解會有基因變異？簡單講就係 replication 之中，有polymerases 抄錯條 sequence，例如本來係 ATCG 既，抄成 ATTG，跟住無 proofread 就掉出去。又有一種變異，就好似屬於Orthomyxoviridae 既influenza A virus咁，裡面有八條 RNA segments，可以係 replication既時候洗牌。呢種 replication 既錯誤或者洗牌，積埋積埋，小則變成 genetic drift/antigenic drift，大則變成 genetic shift/antigenic shift。前者可能將某一個半個 surface protein 結構變左少少，整體來講人體免疫系統仲認得出，變異後既病毒殺傷力有限。後者可能將原有病毒變成新既 subtype，大部份人既免疫系統都認唔出而死傷無數。假設，新既冠狀病毒係由舊有冠狀病毒（包括 SARS）天然 antigenic shift 變出來既，咁點可能係短短兩三個月再次 antigenic shift 呢？如果基因突變去到呢個地步，肯定顛覆生物學界既認知。但好多本來就無讀過生物既人會唔認同，佢地會搏命咁話基因變異點能夠預測！肥人話你知，唔係預測，而係不符合現實同暫時無人能夠推翻既理論。如果新病毒可以係短時間內變成 retrovirus，可以無任何條件下生存好耐，隨意改變 latent period潛伏期，隨意改變傳染力同殺傷力的話，科學家應該點 classify 佢呢？簡單講，長頸鹿頸長先叫做長頸鹿，如果長頸鹿變成 Mike Tyson 條頸咁短，咁我地應該叫佢做 Mike Tyson 定長頸鹿？如果新冠狀病毒有 HTLV-1既retrovirus能力，有hepatitis B 既 reverse transcriptase，有 flu A 可以 shuffle RNA 既能力，又有 HIV 既超長 latent period，你會叫佢做 coronavirus 定 super virus?

5. 講基因變異，要一個變異既病毒基因可以流傳，病毒本身必須要不斷繁衍，宿主傳宿主咁一代傳一代，病毒先可以續存。呢個就係進化論，survival of the fittest。古代有好多生物不能續存，就係因為被環境淘汰，例如有理論認為三葉蟲因為蛻變機制 (instar and molting) 有問題，結果難以生存，最後被大自然淘汰。如果病毒勁到咩人都可以一野就殺死佢的話，佢點傳播？宿主死左，無人帶佢地去傳染其他人嘛！病毒唔係病菌，可以係環境種生存好耐，病毒只要離開宿主好快就會死，就算有飛沫帶住，我地環境中既太陽紫外光、oxidizing agents、濕度與氣溫等等會令佢地好快收皮。病毒唔係倪匡衛斯理《藍血人》裡面隻「獲殼依毒間」，可以變成游離電波周圍飄。大家明白進化論，就會明白病毒學101既常識，從而 debunk 左一個不斷流傳既流言：「隻病毒好勁，好多人死架，傳播得又快！」傳播得快，不等如勁，而太勁既病毒，難以傳播。係呢度，傳播得快，同隻病毒之間並無關係。病毒殺傷力勁，傳播範圍就會窄，傳播速度都會慢；病毒殺傷力一般如普通流感的話，傳播範圍先會闊，傳播速度先會快。如果新聞瘋狂報導好多人死就等如勁，咁非洲同中東都有好多基督徒男女老幼被人大規模屠殺，你會唔會覺得信耶穌係死路一條？

6. 又有人話：「呢隻病毒唔同流感呀！唔好再同流感比啦！呢隻病毒會死人架！呢隻病毒無藥醫架！」首先，除左冠狀病毒同流感病毒，仲有 Respiratory Synctical Virus (人類呼吸道合胞病毒) 同 Rhinovirus (鼻病毒) 都會引起呼吸道感染疾病，隻隻都係病毒，病毒一向未必有有效既藥物醫治，隻隻都會死人。你地以為流感有得醫？用 Tamiflu 都未必得架，而且有可能有嚴重副作用。咁冠狀病毒同流感病毒有咩唔同? 有人話death rate高，無vaccine，latent period又長又短，病人無病徵，但呢堆因素唔係用來分別病毒勁唔勁囉。Death rate 高低由咩決定，點計？Vaccine有咩用，target 咩？latent period 點解會長短不一？有無病徵同嚴重性有咩關係，係咪好似異形咁，你怕有人無病徵但會 sudden death？你地睇得太多 WhatsApp D人無啦啦訓低既片段啦，你又知人地係武漢肺炎死？New England Journal of Medicine 有篇叫 First Case of 2019 Novel Coronavirus in the United States既文，提到美國華盛頓州有個病人1月19日入廠，20日確診，一直都係 supportive care，直到染病第11日，即係入廠第7日，醫生先用 IV 俾 remdesivir (瑞德西韋)，然後佢就退燒，其他症狀都消失或者減輕。咁又點解會係無得醫？大家記住remdesivir (瑞德西韋)，遲下會再講。

7. 仲有，我最憎既「個肺花！個肺花！個肺花！個肺花呀！」呢句，我想同講呢句既人講，肺花，係因為照 X-ray 既時候個肺有 consolidation/infiltration，呢個問題唔單止係肺炎，肺癆甚至cancer都會肺花。你怕咩肺花？流感去到嚴重的話，都可能肺花，因為你有 pulmonary consolidation or infiltration。肺花係因為你個肺 filled with liquid, exudate, pus 甚至 blood from hemorrhage。理性少少，冷靜D，肺花講一次就得，repeat 幾次無幫助。

8. 孤勿論點，呢隻病毒都只係一隻呼吸道感染既病毒，一隻真病毒，一隻同流感一樣會令人病，亦會令人死既病毒，只係流感令人鼻塞，但一樣有機會令人肺炎。呢個新病毒佢所有既威力都係傳媒、WhatsApp片段、社交媒體既報導俾佢，就好似有D 人，你聽佢大名如雷灌耳，一見到真人原來係柒碌又無料到一樣（我懷疑我自己都係咁）。其實有無人真正去了解上面我所講既野？無人話你聽你可以當呢隻病毒無到，話之佢死，但係一開始就進入恐慌狀態，咁你係咪俾人耍緊呢？

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講完上面既病毒既基本知識，不如講多少少基本病毒檢測既知識。好，依家開始【法網肥人化身肥控制員】！

外面成日有人話：「哎呀，個病人21日後先確診呀！」「哎呀，佢隻狗弱陽性呀！」「哎呀，本來係陰性依家係陽性呀！」「哎呀，南韓同意大利爆發，突然好多人確診呀！」Now TV 更報導「鑽石公主號在日確診香港人　康復回港後再檢測呈陽性」

究竟，呢堆確診數字信唔信得過？我意思唔係話邊個國家信唔信得過，而係呢個 test method 同個 protocol 信唔信得過，會唔會有 uncertainty 或者error? 一開始，我地可以睇下 Journal of the American Medical Association 3月9日既文章，Diagnostic Testing for the Novel Coronavirus，裡面有講到 false positive/false negative 既問題，仲有病毒測試既regulation，測試既 guideline等等。文中有提到，開初發展出來既病毒測試有 false negative，顯示出呢個測試既設計應該係有問題。另外，FDA，CDC與美國各州政府之間都有分歧，州政府當然想為居民檢驗啦，但因為個測試係新開發，有大量問題同 uncertainy，所以FDA “made clear that laboratories were encouraged to develop tests but could not use them for clinical diagnosis without FDA’s “approval, clearance, or authorization during an emergency declaration.” 咁 what does that means? 如果你讀 law 的話，我expect你可以 read between the lines。

講返個測試，檢驗新病毒一般都係會用 RT-PCR (Reverse transcriptase-polymerase chain reaction 逆轉錄聚合酶鏈式反應)。好多人，包括肥人好多行家與同事甚至客仔，一聽到咩DNA測試，就以為呢個 test 無L敵啦，一定準確啦。Oh Sorry，no! 撇除所有「中國的會爆炸」同「中國有咩係真」呢兩個因素，一個test既結果是否可信係建基於樣本收集同檢驗方法，無論你係美國，意大利，南韓，日本定中國，樣本收集同檢驗方法先係 main point！

檢驗呼吸道感染疾病，你地話收集咩樣本好呀？Saliva? Sputum? Nasopharyngeal aspirate (NPA)? Bronchial lavage? 如果係上呼吸道病毒，咁 NPA都足夠既，sputum 都可以，但saliva 就應該要reject。但有時呢類既樣本都未必有足夠既病毒樣本去驗，病毒深入氣管去到肺氣泡(alveoli)，樣本可能要係bronchial lavage先夠做。仲有，收集樣本既手法，部位，儲存方式，收集時間與檢驗時間既差距，樣樣都會影響結果。支棉花棒「了」得唔好，你或者都會無 result。

好啦，到講 RT-PCR啦。RT-PCR係需要 medical scientist 去砌一段 primer 出來開始做test。為左檢驗結果既可靠性，scientist通常會係新病毒入面抽一段比較穩定既 RNA segment 出來做 primer。可惜，有好多情況下，RT-PCR會俾個錯既答案你。

第一，primer 既設計好影響結果，上面都話段 primer 要係抽病毒一段比較穩定既 RNA segment 出來做，咁如果你抽錯左呢？第二，樣本既 DNA/RNA sequence 既integrity好差，甩頭甩骨咁，結果就會受影響。即係上面所講既樣本收集出現問題呀！第三，樣本純度低，或者份量少，又即係上面所講既樣本收集出現問題呀！咁個 tech 或者 scientist 要係咁加 PCR cycle去 amplify 個 sample，咁 amplify 出來既樣本就有好大機會係 false positive，呢點會影響所謂確診既可信度，亦係咁肥人我見到漁護處話瑞士花園個阿婆患者隻狗呈現弱陽性反應，我當下笑 L97 左出來。大佬呀，你是咪無足夠 sample 就鳩 amplify，然後個 result 根本有問題你都聽長官意志，鳩簽個名話係弱陽性呀？陽就陽，陰就陰。Result 唔 significant 或者 inconclusive，你出咩報告jack? Invalid 啦！仲有呀，病毒係 host specific 架，會傳染人既病毒，又點會無啦啦傳染狗? 眾所鳩知冠狀病毒係靠人類細胞上既 ACE2 (Angiotensin-converting enzyme 2，血管收縮素轉化酶2)來進入人體細胞啦，狗 ACE2既同人既一樣？

寫下寫下，喂，原來未寫數據演繹同政策問題，太長啦，下次再續！

#跨界別吹水
#本來要免於恐懼唔跟隨共匪起舞
#依家又俾共匪睇穿你班人既心理
#個勢變啦全世界同共匪切割了

從非典到新冠肺炎

From SARS to Novel Coronavirus (COVID-19) - English version is in the second half

新冠肺炎，Novel coronavirus (2019-nCoV) 新型冠状病毒肺炎，疫情越來越嚴重，被證實可以人傳人，也在武漢以外的許多地方發現病例，造成世界各國及世界衛生組織（WHO）高度關切，當然也讓很多住在中國大陸及附近區域的華人非常緊張，就好像當年的非典肺炎疫情即將再一次大爆發一樣。

目前，現代醫學還沒有找到治療新冠肺炎的方法，只能針對某些症狀來處理，疫苗的研發更是遙遙無期。怎麼辦？每次遇到這種情況，中醫就會被搬出來，這次也不例外。新冠肺炎爆發後，網上馬上有許多中醫對付新冠肺炎的文章。當然，除非哪位中醫師看過、治好過大量的新冠肺炎病例，所有的討論都是猜想、假設。然而，有些猜想及假設值得參考，有些猜想及假設卻明顯在誤導大眾。

我還沒有治療過新冠肺炎，不能大肆評論。不過，我治好過很多禽流感、豬流感、及每年流感導致的嚴重肺炎及其它病變的病人。其中許多病人是被美國大型西醫院證實為嚴重肺炎，被要求醫院或居家隔離，偷偷溜出來找中醫看診的。也因此許多病人及討論中醫的網站，希望我能針對新冠肺炎發表一些意見。

我們以前就討論過，這些彪悍的流感病毒，經過那麼多年、那麼多次的變種（mutation），每年都不一樣，東漢時期傳下來的經典中醫，根本沒有遇到過現在的病毒，怎麼可能治療如此嚴重的肺炎呢？

中醫從來就不認識病毒，也不從病毒種類的角度來思考。中醫是探討人體受到外界因素破壞，失去平衡後，身體會有哪些現象、哪些反應，根據那些現象、那些反應來調整身體狀況，期待身體能恢復到平衡狀態，把外界因素帶來的破壞減到最小。我打個半開玩笑的比方，警匪槍戰時，我們注意到壞人哪個方向來的火力強大，造成我們部署在哪個位置的警員傷亡，這時我們會趕緊重新部署人員，或者想辦法增派警力，我們大概無暇去管壞人是用哪個牌子的槍、哪個工廠做的子彈！

雖然幾百年幾千年下來，病毒變種等等的外界因素改變了非常多，人體演化的改變卻非常有限。人體的功能，無論是怎麼被破壞的，某項功能被破壞而導致的症狀、反應、後續演變，卻依然有明顯的脈絡可循。也因為如此，在很多情況下，中醫以專注人體本身平衡狀態的治療方式，反而比西醫專注在外來敵人的治療方式來得有效許多。

依據多年累積大量的臨床病例觀察，無論是禽流感、豬流感、還是每年的流感，人體敗壞的進程依然如同傷寒雜病論探討的一樣，非常簡化的說，從一般桂枝湯證、葛根湯證等的表寒，轉變到小青龍湯證等的裡寒，津液不足、水道運化失調而化熱，變成比較嚴重的大青龍湯證，或者更嚴重肺臟的寒熱夾雜，金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇中的射干麻黃證、葶藶大棗瀉肺湯證、澤漆湯證、小青龍加石膏湯證等等混雜出現，搞得亂七八糟，也不再是什麼簡單方劑可以對應的。

然而，雖然進程很像，不同於一般外感的是，這些嚴重流感肺炎病情加重的改變速度快非常多，也來得猛烈頑強很多。一般的外感從桂枝湯證、葛根湯證等轉變到大青龍湯證或更複雜的病情，通常需要一兩週的時間。同時，還得病人自己非常不注意，或者醫生治療錯誤，一般感冒才會沒辦法自己好，反而變成嚴重的病症。這幾年的流感，從一開始覺得不太對勁，到嚴重複雜的病情，只需要三四天，而且有越來越快的趨勢。這大幅提高中醫師治療流感時，判斷功力及敏感度的要求，中醫師必須在許多症狀還沒有出現時，就得抓緊時間，趕緊行動，卻又不能預防過度，反而讓病情加重。換句話說，時機、劑量、藥材比例變得非常重要，稍有不慎，就無法反轉病情。

舉個例子，有些病人得了流感，咳嗽非常嚴重，痰非常多，呼吸困難。依照中醫的辨證，假如一致都是寒，舌苔白、小便清、怕冷等等，本來依照辨證論治，我們可能會開射干麻黃湯加減給病人。然而，因為流感的進程非常快速，中醫師得非常敏感，譬如看到舌苔白卻帶有一絲絲乾的感覺，就很可能得加上大寒的石膏來避免肺喪失津液，卻又不能加太多石膏，以免肺寒加重。又譬如聽到咳嗽聲音非常深沈，從肺的底部發出，又帶有膿痰的濁音，就很可能得加上瀉肺的葶藶來避免肺中水飲、痰飲大幅增加，卻又不能加太多葶藶，以免肺變得太虛弱。

我們回頭來看這次的新冠肺炎。根據有限的資訊，我們知道感染後有大約兩週的潛伏期，這段時間沒有什麼症狀，病人可能只會感到有些疲憊。剛開始發病時，很像一般的感冒，病人會發熱、乏力，並不嚴重，沒有什麼流鼻涕等上呼吸道的症狀，有的甚至沒有發熱。約一半的病人一週多後恢復，另一半的病人卻在一週後出現呼吸困難，有些病人會快速進展為急性呼吸窘迫綜合征、膿毒症休克、代謝性酸中毒、凝血功能障礙等等嚴重的問題，可能導致死亡。

從上面的敘述，我們不難發現，一開始很像一般中醫外感的桂枝湯證、葛根湯證，一半的病人也就自己恢復了，另一半的病人卻出現快速的入裡化熱現象，肺津液迅速流失，非常濃稠的痰飲沈積在肺部下方。同時，中醫認為肺為人體調節津液的源頭，肺金生水，好比天空下雨一般，而當肺的功能及津液調節出現嚴重障礙，很快就會拖累三焦水道、腎臟等的功能，導致上面提到的幾種嚴重病情。換句話說，新冠肺炎可以讓輕微的太陽證外感，迅速發展成嚴重的肺痿肺癰，再進一步瓦解人體其它功能的運作。

怎麼治療？在沒有直接治療武漢肺炎病人的情況下，我們也只能根據有限的資訊來推論，不過，以前大量的流感肺炎治療病例，可以讓我們比較有信心的面對新冠肺炎。當病人已經出現明顯新冠肺炎症狀時，大多已經入裡化熱，嚴重的肺痿肺癰。這個時候，得用大劑量的石膏清肺熱、加強肺津液運作。也得靠葶藶、大戟等把肺下方濃稠的痰飲及胸腔可能的積液去掉，痰飲積液不去，是無法修復肺家津液運作的。同時，肺氣不宣，就好像吸管上頭堵住了，吸管內的水無法上下，我們還得使用麻黃等宣肺、發陽的中藥來配合。另外，肺已經受損了，除了大動作急救外，比較穩定後，還得靠一些潤肺的藥來收尾，讓肺完全恢復。如果我們列一個可能加入的中藥單，大致有石膏、葶藶子、大戟、生半夏、麻黃、射干、紫菀 、款冬花、 生薑、炙甘草、紅棗、麥門冬、杏仁等等。當然，如前面所言，用藥的時機、劑量、藥材比例非常重要，每一個病人的差異也很大，嚴格考驗中醫師的功力與膽識，一旦判斷錯誤，不但沒有效果，反而可能會加重病情。

網上有些中醫師，說新冠肺炎或其它流感肺炎可以用板藍根清熱解毒來治好。也有些中醫師說可以用麥門冬湯等等的輕劑治好嚴重的肺炎。甚至還有些中醫師說多喝綠豆湯可以預防新冠肺炎！其實，真的遇過、治好過禽流感、豬流感等嚴重流感肺炎的中醫師，一看這些文章，就幾乎可以確定這些人根本沒有治療過嚴重肺炎的經驗，充其量只是在西醫治療下，在旁邊幫幫病人一些小忙而已。這樣的情況下，難怪中國政府平時大力推展中醫，真的有如同新冠肺炎這樣重大疫情爆發時，卻看不到中國政府大量使用中醫方法來治療病人、控制疫情。醫學是實戰的學問，沒有大量臨床病例，講得再好聽都是沒有用的，如果希望中醫真的在主流醫學裡站立起來，希望中醫真的能面對大規模的疫情，回歸最基本的臨床療效，才是最重要的，其它都只像是武術表演，而非實際作戰。

From SARS to Novel Coronavirus (COVID-19)

Written in Chinese by Dr. Andy Lee, January 21, 2020
Translated to English by Dr. James Yeh and Dr. Andy Lee, March 28, 2020

The epidemic from Novel Coronavirus is becoming much more serious. Transmissivity among people has been proven. (Note: It's now named COVID–19. The term “Coronavirus” will be used here.) Cases were found in areas beyond Wuhan. It has caused serious attentions from the WHO (World Health Organization) and many countries around the world. The residents in China and the surrounding regions are quite worried and wonder whether it will break out like SARS (2003). (Note: The article was written on January 21, 2020, before Coronavirus became a global pandemic.)

So far, the modern medical field has not found a cure for Coronavirus, but resorts to treating patients’ symptoms only. Any vaccine to treat Coronavirus is still no way in the sight. What do we do? Every time such a situation happens, the topic of using Traditional Chinese Medicine (TCM) is raised (at least among the Chinese communities). There is no exception this time. Many articles related to using TCM on Coronavirus have been popping up on the web. However, unless some TCM doctors who have actually treated many Coronavirus cases, all the discussion would be hypotheses or assumptions. Some hypotheses are worth considering while many others could be quite misleading.

Personally I have not treated patients cases related to Coronavirus. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully, and has published other later blogs which included his involvement in treating those patients. Please refer to his medical blog http://www.DrLee.us.) However, I did treat and cure patients inflicted by other viruses in the past, such as the Bird Flu, Swine Flu, and other influenza. A good amount of those patients were diagnosed as severe pneumonia by large hospitals and were required for isolation or self-quarantine. Hence many of patients and online medical forums online are asking for my opinions about Coronavirus.

As we discussed before, all these viruses from the outbreaks are either newly found or mutated from previous strands. The strand can be different every year. Therefore, people always ask how one can say that the TCM knowledge developed in East Han Dynasty (25-220 AD) would be any useful for treating the modern diseases, let alone the severe ones.

It turns out that TCM does not recognize any virus and does not deal with the concept of which type of virus is microscopically at work. TCM looks at how human bodies would become out-of-balance and react to external stimuli. Once the body is out of balance, what symptoms will exhibit and what reactions will be to adjust the body conditions to regain the balance, hence to reduce the damage to the body to the minimum. Let me take an example to illustrate: when there is a gunfight between the police and bandits, we want to see which direction the shots are coming from, causing casualties of the police force, so that we are able to adjust or reinforce the police power. We have no time to think about which brand of the guns or bullets the bandits use.

Over thousands of years, the external viruses have changed and evolved quite a bit, but the evolution of human beings was quite limited. The human body function, no matter how it was damaged, the symptoms due to the damage of the function, the reactions, and the following progression of the disease still follow certain paths. For this very reason, TCM’s focus on the balance of the human body often surpasses the effectiveness of Western medicine, which focuses more on external treats and the microscopic aspect of how human body’s cells are impacted by the external treats.

From the accumulation of many years of clinical treatment and observations, no matter it is Bird Flu, Swine Flu or other influenza, the bodily ‘damage’ and its progression by the viral attack still follow the description of the classic TCM literature “Treatise on Cold Damage on Miscellaneous Disease” (傷寒雜病論). In short summary, the disease usually starts with “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒), for which is matched to one of the several syndromes named with the corresponding herbal remedies such as “Gui Zhi Tang” (桂枝湯) and “Ge Geng Tang” (葛根湯). Then, the disease moves onto the next stage “Interior Coldness” (裡寒) or “Lung Coldness” (肺寒), which shows the syndromes named as “Xiao Qing Long Tang” (小青龍湯), etc. When the respiratory system is “affected by the coldness”, the body fluid function of the respiratory system gets affected. The circulation function of the lung becomes “Dry and Overheated” (燥热). This would lead to a more serious stage “Heated Interior” (入裡化熱) and would often be matched to its herbal remedy “Da Qing Long Tang” (大青龍湯). Or, even worse, it becomes so-called “mixed coldness and heat” (寒熱夾雜) in the lung. Such a complex situation was extensively discussed in Chapter 7 of the classic literature “Synopsis of Prescriptions of the Golden Chamber” (金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇). At this complex stage, the illness development varies significantly among patients of different preconditions and other variants. It is no longer the situation that a simple herbal remedy can be applied to all the situations. The TCM theory illustrates various treatments by those herbal remedies such as “She Gan Ma Hung Tang” (射干麻黃湯), “Ting Li Da Zao Xie Fei Tang” (葶藶大棗瀉肺湯), ”Ze Qi Tang” (澤漆湯), “Xiao Qing Long Jia Shi Gao Tang” (小青龍加石膏湯), and others.

However, even the disease progressions are similar, the more serious viral attacks like Coronavirus can and often do progress much faster with more severe consequences than the common flu. As described in the previous paragraph, normally the disease progression of the “External Coldness” stage to the more serious “Heated Interior” stage usually takes one to two weeks. It is also often due to the ignorance of the patient or misdiagnosis and treatment of the doctor, which prevents the patient from recovering from this “catching a cold”. In the recent several years though, the time period between the time that the patient did not feel well and the time that the patient is in a serious and complex situation can be as short as 3 to 4 days. We also see the trend that this period gets shorter and shorter. In other words, the disease progression is getting much faster. This phenomenon poses a much higher demand on TCM doctors’ ability to make a quick and proper judgment and sensitivity to the subject matter. TCM doctors must intercept the disease progression before it reaches to a more serious stage, even without obvious symptoms of the next stage. TCM doctors have to timely prescribe the proper herbal remedy in terms of the type of herbs and relative dosages of herbs. Too weak a dosage could not stop the progression while too strong a dosage could worsen the condition also. A misjudgment would not be able the turn the conditions around, but hurt the patient more.

The above can be illustrated by a simple example. A patient caught flu and has symptoms such as heavy coughing, lots of sputum, and difficulty in breathing. From the TCM dialectics, with observations of white tongue coating, clear urine, and feeling chilly, etc., it is clearly caused by “Coldness”. Such a patient typically should be prescribed with “She Gan Ma Hung Tang” (射干麻黃湯) or its variations. However, due to the fast progression of the modern flu, the TCM doctor would need to pay attention to much subtle details such as the dryness of the tongue although it still shows the white coating. In this case, Sheng Shi Gao (Gypsum, 生石膏) might need to be added to the herbal remedy to make sure that the lung would not suffer dryness. Given that Sheng Shi Gao (Gypsum, 生石膏) itself is an ingredicient that is “very cold” in nature, the dosage could not be too strong to make the lung too chilly. At the opposite end of the spectrum, if the sound of the coughing is very ‘deep’, like dense sputum coming from the bottom of the lung, the herbal remedy might need to add Ting Li (Sisymbrium indicum, 葶藶) to clear up the lung to avoid too much mucus in the lung. And again, the dosage of葶藶 could not be too much to weaken the lung. (Note: Handling the proper timing and proper remedy can be a real test to the ability and experience of the TCM doctor.)

Let’s go back to the discussion on Coronavirus. From the limited information available so far, we know that there are about two weeks of incubation period after the infection. There are little symptoms during this period and the patient may just feel more tired than usual. More obvious symptoms will start like those of common flu with fever, fatigue but not too serious. Upper respiratory symptoms like running nose are less common. Some patients may not even exhibit fever. About half of the patients infected will recover over a week or so. The other half of the patients will experience difficulty in breathing, or rapid progression to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulopathy, etc. Some patients had died due to these severe conditions.

From the above description, this Coronavirus, in the beginning, is very much like the common flu and will stay in stages of “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒). Half of the patients infected will recover by themselves as in common cold. The other half of the patients may exhibit situations of rapid penetration into inner organs and excess ‘heat’, which causes loss of fluidity of respiratory system and accumulation of dense sputum at the lower part of the lung. In the TCM theory, the lung serves as the initial “gating factor” of body fluids. When the lung fails to serve the proper function, other organs like the kidney will be adversely affected also. In other words, Coronavirus can turn a light “External Coldness” to extremely severe “Lung Atrophy” (肺痿) and “Lung Abscess” (肺癰), which in turn will impair the function of other organs.

How to treat? Without direct experience of treating Coronavirus patients, we can only postulate from our limited information available in hand. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully. The treatments were exactly as outlined in this article.) From the ample experience of dealing pneumonia cases caused by flu, we are confident that we can also treat Coronavirus successfully. When patients are showing the obvious Coronavirus symptoms, most of them would have entered the stage of “Heated Interior” (入裡化熱) with “Lung Atrophy” (肺痿) or “Lung Abscess” (肺癰) to a certain degree. At this stage, we will need large dosages of Sheng Shi Gao (Gypsum, 生石膏) to clear the heat to ensure the proper fluidity function of the lung. Also, we will rely on Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), etc. to clear up the dense mucus at the lower part of the lung and to remove the edema of the chest chamber. Without getting rid of the excess mucus and fluid, the lung cannot properly function. We need to use Ma Huang (Ephedra sinica Stapf., 麻黃), etc. to enhance the lung function (宣肺、發陽) and restore proper breathing. When the lung is damaged as in fibrosis, after the conditions stabilize, we need to “moisturize” the lung (润肺) to help the lung to recover fully. In other words, we will most likely use the herbal ingredients such as Sheng Shi Gao (Gypsum, 生石膏), Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), Sheng Ban Xia (Pinellia ternate, 生半夏), Ma Huang (Ephedra sinica Stapf., 麻黃), She Gan (Belamcanda chinensis, 射干), Zi Wan (Aster tataricus, 紫菀), Kuan Dong Hua (Tussilago farfara flower, 款冬花), Sheng Jiang (Ginger, 生薑), Zhi Gan Cao (processed Glycyrrhiza uralensis Fisch., 炙甘草), Hong Zao (Ziziphus jujube, 紅棗), Mai Men Dong (Ophiopogon japonicas, 麥門冬), Xing Ren (Prunus armeniaca, 杏仁), and others. As we discussed in previous paragraphs, the timing, dosage, the relative ratios of different herbal ingredients are very critical. Given that there are quite some variations in patient conditions, the challenges on TCM doctors’ comprehensive knowledge, judgment and courage are unprecedented.

In those articles online, some TCM doctors claimed that Coronavirus can be cured by Ban Lan Gen (Isatis tinctoria root, 板藍根), which is believed to have natural antibiotic chemicals to “clear up the heat and toxics”. Some TCM doctors suggested using a simple mild herbal remedy “Mai Men Dong Tang” (麥門冬湯), which mainly relies on the ingredient Mai Men Dong (Ophiopogon japonicas, 麥門冬). Some people even suggested that having the green bean soup could prevent Coronavirus. In fact, those TCM doctors who have good experience of treating Bird Flu, Swine Flu, and pneumonia caused by other influenza would know that the people making those claims never had the real experience of treating severe pneumonia. They at most helped in a minor way the patients under Western medicine treatments. Under such conditions, it is not a surprise that the China government has not used TCM as the primary method of treating Coronavirus, despite its big promotion of TCM in the recent years. (Note: After this writing, Coronavirus epidemic became so severe in China that the China government changed its strategy and started to use TCM extensively in treating many mild Coronaviurs cases.)

Medicine is the science based on real treatment results. Without a good amount of successful cases in clinical treatments, it is useless to promote any fancy idea of treating patients. If we would like TCM to be respected in the mainstream medicine and to be meaningfully used in a severe epidemic like Coronavirus, it is critical to focus on the most fundamental. That’s the clinical results. Like the martial arts, unless you can fight off the bad guys, it’s just a show of fancy movements.

（http://andylee.pro/wp/?p=7169）
#當張仲景遇上史丹佛

流感疫苗誤很大 2019-20年版

流感疫苗公費第一批這個禮拜11/15要開打了，奶爸Dr.整理了一些常見的流感疫苗誤解, 先幫大家解惑一下。

「孩子還沒吃過雞蛋，需要先吃雞蛋才能打流感疫苗嗎？」
根據美國CDC疾病管制署所公布的最新資料：雞蛋過敏,已經不再是流感疫苗的禁忌症，換句話說:雞蛋過敏,也可以施打。沒有吃過雞蛋的孩子,也可以直接施打,不需要先吃蛋。

未滿九歲且去年本來要打兩次的孩子,因為某種原因例如:缺貨、當時發燒、感冒等緣故,而去年只有施打一次的話,今年最好還是要施打兩次。(相隔至少一個月) （以上是根據美國CDC疾病管制署的學理面的看法，但是台灣CDC的政策是不用補打，所以請各位家長自行斟酌要不要自費補打）

「想要等到開始大流行或者其他白老鼠們都已經打完,確定沒什麼特殊狀況傳出之後,才去打的話。」
一般注射之後,要兩星期到四個星期,才會產生抗體。另外如果是想施打自費4價流感的話,各位要盡快預約,因為聽說很多地方,已經都被搶光了。

「聽說今年的疫苗,內容其實跟去年的都一樣?」
並不是,每一年的抗原都會更新,並不會一樣。

「聽說打完流感疫苗,感冒會更嚴重!」

才怪，拜託，別鬧了
這一點,每一年都會再翻炒一次。
但是問題出在哪裡呢?
答案是:季節與巧合
秋冬季節本來就會很多奇奇怪怪的病毒細菌出現,所以特別多人會感冒生病。剛好打流感疫苗的前後,又得到別的感冒,就會所有罪狀都會歸功於疫苗身上。

p.s: 突然間想起以往有一部超級好看的電影：偶然與巧合 （https://www.youtube.com/watch?v=C-uOAE1H4Z4 ）
自從當上父母後，更有感覺

「母乳的媽媽去打就好了,寶寶不需要打,母乳給他的保護力就足夠了。」
雖然母乳裡面,會含有少量的IgG抗體(母乳的抗體大部分是IgA型抗體),但是並不能夠取代疫苗的保護力。
結論：寶寶還是要打，才能有保護力

#老人家或身體差才需要疫苗
免疫系統不好的族群的確是高危險族群，但是也請不要忘記孕婦 兒童「身邊」的最重要的保護者，也有責任保護他們，預防自己被感染。愛護家人愛護自己，都應考慮施打疫苗

去年2018到2019年度公費疫苗品質的確是風波不斷，所以今年品管特別嚴格，由疾管局替大家把關

最後要跟大家提醒一下：
三歲以下兒童的疫苗，以法國巴斯德為主
三歲以上的疫苗，以台灣國光疫苗為主

所以如果您有品牌的偏好，想要打進口的。並不是任何人都有辦法打到法國巴斯德的疫苗喔。

另外，從去年開始，三歲以下不需要減半量，不論年紀體重星座，一樣都是打0.5ml

#左手拉起袖子_右手按追蹤我的Instagram📸： https://instagram.com/drblackeye

#流感疫苗公費時程： https://www.instagram.com/p/B3GTjztFNhj/?igshid=1a7zhrni6n9wl

#流感疫苗比較表：https://www.instagram.com/p/B4ChVpLlpP0/?igshid=6oaeulu2r2i4

參考資料:
https://www.cdc.gov/flu/prevent/keyfacts.htm

https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm

偶然與巧合：
https://www.imdb.com/title/tt0120588/