The Traditional Chinese Medicine and Acupuncture Treatment for syndrome presentations related to COVID-19 as experienced in China
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Artical:
Traditional Chinese Medicine Program of the Chinese Government's "New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 7)"
(If there is any ambiguity in the following translations, the original Chinese shall prevail.)
1. Medical observation stage
Clinical manifestations No.1: fatigue with gastrointestinal discomfort
Chinese patent medicine is recommended: HuoXiang ZhengQi
JiaoNang(wan、shui、KouFuYe) / Agastache capsule to Rectify the
Qi (pill、Distilled water、oral liquid)Clinical manifestations
No.2: fatigue with fever
Recommended Chinese patent medicine: JinHua QinGan KeLi/ Flos Lonicerae expelling exterior syndrome granule, Lian Hua QinWen Jiaonang(KeLi)/Honeysuckle and Forsythia clear toxin capsule (granule), ShuFeng JieDu JiaoNiang/dispersing wind resolve toxin capsule(granule)
2. clinical treatment stage (clinically tested positive cases)
2.1. Qing Fei Pai Du Tang (clear the lung and detoxification decoction)
Suitable in: According to the clinical observation from multiple areas, this decoction is suitable for all light, regular, and heavy syndrome. When treating with critical stage patient, may use the formula according to the situation.
Base Formula:
Recommended Dosage and Instruction： For traditional raw herbs, use water to decoct. One pack of raw herbs each day, decocted to drink 40 minutes after meal (Bid, am&pm). Drink warm，3 packages of herbs per treatment plan. If possible, drink 1/2 bowl of rice soup after taking herbal decoction. Patients with dry tongue and body fluid deficiency, can take up to 1 bowl. ( If patient don’t have high fever, the dosage of Raw Gypsum (Sheng Shi Gao, Gypsum Fibrosum) should be
small; for patient with fever or extremely high heat, can increase the dosage.) If the symptoms are relieved but not cured, then take the second treatment plan. For patient with special condition or with other chronic disease, the second treatment plan can be modified according to the actual condition, and stop the medication when the signs and symptoms are gone
2.2. mild type
cold- damp stagnating in the lungClinical manifestation: fever, fatigue, soreness and pain all over the body, cough with sputum, chest tightness with feeling of breath stagnation, poor appetite, nausea, vomiting, sticky stool. Pale swollen tongue with tooth marks or pink tongue with white greasy thick coating, or white greasy coating, slippery or soggy pulse.
Recommended Dosage and instruction: 1 dose /day, 600ml decoction divided into Tid
(am, noon, pm), to be taken before meals
(2) Damp-heat accumulating in the lung
Clinical Manifestation: low grade fever or no fever, slightly aversion to cold, fatigue, heaviness in the head and the body, muscle soreness, dry cough with little sputum, sore throat, dry mouth but no desire to drink, or accompanied with stuffy feeling in chest and epigastric fullness; no sweat or impeded sweating, nausea and low appetite, diarrhea or sticky stool, pink tongue with white thick greasy coating or thin yellow coating. Slippery and rapid pulse, or soggy pulse
Recommended dosage and instruction : 1 dose/ day, boil the herbs with water, make it into400ml decoction. BID, am & pm.
2.3 Common type
(1)Toxin-dampness stagnation in the lung
Clinic manifestations: fever, coughing with little phlegm or yellow phlegm, chest oppression with polypnea, abdominal distention with constipation. Dull-red and swollen tongue with yellow greasy or dry yellow coating, slipper rapid or wiry
slippery pulse
The recommended Dosage and instruction: 1 dose each day, 400ml liquids after
decoction with water, Bid. Am & PM. 200ml/time.
(2) cold-dampness obstruction the lung Clinical manifestations:
lower grade fever、restrain fever or slightly
fever, dry coughing with little phlegm, lassitude, fatigue, chest oppression, epigastric fullness, or nausea, Loose stool, pale or light red and puffy tongue with white or white greasy coating, soggy pulse.
The recommended Dosage and instruction: 1 dose each day, 400ml liquids after decoction with water, Bid, Am& PM, 200ml/time
2.4 Severe type
1) Epidemic toxin obstructs Lung
Clinical Manifestations: fever and red face, cough with scanty yellow sticky phlegm, or blood in phlegm. Dyspnea and shortness of breath, feeling of tireness, dry mouth and bitter taste, nausea with no appetite, difficult defecation, scanty yellow urine. Tongue: red with yellow greasy coat，Pulse: Slippery and rapid
Recommend dosage and Instructions: 1 – 2 decoction per day, every time, 100ml –200ml, Bid to Qid per day. Oral or Nasal feeding
2) Heat burning at Qi and Ying Level
Clinical menifestation: high fever, irritability and big thirst, shortness of breath or difficulty breathing, delirium, rashes, vomit blood or nose bleed, convulsion. Tongue: Scarlet with scanty or no coat Pulse: deep, thready and rapid or Floating big and rapid
Recommended dosage and Instructions: 1 Decoction per day, Cook Gypsum (Shi gao, Gypsum Fibrosum) and Buffulo Horn (Shui Niu Jiao, Bubali Cornu) first, 100ml –200ml each time, Bid to Qid, oral or nasal feeding.
Recommended Chinese Patent medicine: Xi Yan Ping Injection, Xue Bi jing Injection, Re Du Ning injection, Tan Re Qing injection, Xing niao jing injection. Herbs with similar functions can be chosen with 1 depending on situation, or choose 2 depending on patient condition. Herb injection and herbal decoction can be used together
2.5 Critical condition:
Interior obstruction leading to collapse
Clinical Manifestations: Difficulty breathing, might require mechanical ventilator, coma, irritability, spontaneous cold sweat
Tongue: dark purple, thick dry or greasy coat
Pulse: Floating and big, but rootless
Use the above decoction to take Su He Xiang Wan (Liquid Styrax Pill) or An Gong Niu Huang Wan (Peaceful Palace Bovine Bezoar Pill)
Patient with Mechanical Ventilator, have abdominal distention constipation or difficulty defecation, could add Rhubarb Root and Rhizome (Raw Da Huang, Rhei Radix Et Rhizome), 5 – 10g. If patient and the mechanical ventilator are not
synchronized, after used of tranquilizer and muscle relaxant IV, could add Rhubarb Raw Root and Rhizome (Raw Da Huang, Rhei Radix Et Rhizome), 5 – 10g and Mirabilite, (Mang Xiao, Natrii Sulfas) 5 – 10g
Recommended patent medicine: Xue Bi Jing Injection，Re Du NingInjection，Xing Nao Jing Injection、Shen Fu Injuction, Sheng Mai Injuction, Shen Mai Injuction. May choose a functionally similar medicine according to the individual situation. Or combining two medication according to the patient’s signs and symptoms. Herbal injection can be used with the herbal decoction
NOTE: Instruction of Herbal injection for Severe and critical condition patient
Follow the instruction from the herbal injection booklet, start with low dosage, and gradually modify dosage depending on patient condition and reaction. Below is the recommended procedure:
Viral infection with mild bacterial infection: 0.9% sodium chloride 250ml plus Xi Yan ping Injection 100ml bid, or 0.9% sodium chloride 250ml plus Re Du Ning injection 20 ml, or 0.9% sodium chloride 250ml plus Tan Ren Qing injection 40 ml
bid.
High fever with consciousness problem: 0.9% Sodium Chloride 250 ml plus Xing Nao Jing injection 20 ml bid
Systemic infection reaction and/or organ function failure: 0.9% sodium chloride 250ml plus Xue Bi Jing injection 100ml bid
Immunosuppresion: Glucose 250ml plus Shen Mai injection 100ml or Sheng Mai injection 20-60ml bid.
2.6 Recovery Period
(1) Qi Deficiency of the Lung and Spleen
Clinical Manifestations: shortness of breath, lassitude, fatigue, poor appetite, nausea, vomiting, distending and fullness of the epigastric region or the abdomen, unable to defecation due to weakness, loose stool or diarrhea with incomplete, sticky sensation, pale puff tongue with white greasy coating
The Method of Preparation: 1 dose for each day. Boil all herbs in 1500ml water into400ml. And then add Amomum Fruit (Sha Ren, Fructus Amomi), let it boil gently for a moment. Discard the dregs. Divide the decoction into two parts. Each one has 200ml.
Recommended Dosage: 200ml for each time, Bid, AM and PM, and take it warm.
(2) Deficiency of Both Qi and Yin
Clinical Manifestations: fatigue, shortness of breath, dry mouth, thirst, palpitation,profuse sweating, poor appetite, low grade fever or no fever, dry cough with little phlegm, a dry tongue with little fluid, thready pulse or deficient forceless pulse.
The recommended formula: Glehnia Root (Bei Sha Shen, Radix Glehniae) 10g, Four leaf ladybell root (Nan Sha Shen,Radix Adenophorae) 10g, Ohiopogon Tuber (Mai Men Dong, Radix Ophiopogonis) 15g, American ginseng root (Xi Yang Shen, Radix Panacis Quinquifolii ) 6g, Schisandra Fruit (Wu Wei Zi, Fructus Schisandrae) 6g, Gypsum (Sheng Shi Gao, Gypsum Fibrosum) 15g, Lophatherum Stem and Leaves (Dan Zhu Ye, Herba Lophatheri) 10g, White Mulberry leaf(Sang Ye, Folium Mori) 10g, Reed Rhizome(Lu Gen, Rhizoma Phragmitis) 15g, Salvia Root (Dan Shen, Radix Salviae Miltiorrhizae) 15g, Licorice Root (Sheng Gan Cao, Radix Glycyrrhizae) 6g,
The Method of Preparation: 1 dose for each day. Boil all herbs in 1500ml water into 400ml. Discard the dregs. Divide the decoction into two parts. Each one has 200ml. The Recommended Dose: 200ml for each time,Bid, am & pm, and take it warm.
References:
1. 新型冠状病毒诊疗方案（ 试行第七版）
http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml
2. 实用中草药图谱， 徐洪华，楼步青， 广东科技出版社， 2012 年6 月第一版，ISBN 978-7-5359-5399-5
3. “Pinyin-English Cross Reference of Chinese Materia Medica Names”, Essentials
of Chinese Materia Medica and Medical Formulas, p.965-975. Shengyan Xi and
Yuewen Gong, Elvevier and Academic Press. 2017. ISBN: 978-0-12-812722-3
4. List of TCM Formulae, https://www.ctcmpao.on.ca/resources/forms-anddocuments/
List_of_TCM_Formulae.pdf
5. Index of Materia Medica, https://www.ctcmpao.on.ca/resources/forms-anddocuments/
Index_of_Materia_Medica.pdf
6. TCM Clinical Aid, software.