Beijing Traditional Chinese Medicine  [2020] No. 35

Beijing Hospitals Authority, health commissions in all districts, and relevant medical institutions:

　　In order to guide the rational clinical application of traditional Chinese medicine to prevent and treat Corona Virus Disease 2019 (COVID-19), our bureau organized experts to formulate the Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Corona Virus Disease 2019 (COVID-19) (Trial Version IV), which is hereby printed and distributed to all parties. Please follow and implement the program. If there are any problems and suggestions in the course of implementation, please give the feedback in time to the medical administration department of our bureau.

　　Contact person: Zhang Dong, Lin Wenhui

　　Contact number: 83970056, 83970039

　　Email: zyjyzc@zyj.beijing.gov.cn

　　Appendix: Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Novel Corona Virus Disease 2019 (COVID-19) (Trial Version IV)

　　Beijing Administration of Traditional Chinese Medicine

　　2020 March 6th

Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Novel Corona Virus Disease 2019 (COVID-19)(Trial Version IV)

　　At present, the epidemic situation of Novel Corona Virus Disease 2019 (COVID-19) in our city is improving, but we still face the risk of imported overseas cases. With the improvement of the treatment mechanism of integrated traditional Chinese and Western medicine for Corona Virus Disease 2019 (COVID-19) patients in our city, the understanding of the etiology and pathogenesis of the disease, its treatment principles and methods as well as diagnosis and treatment experience of traditional Chinese medicine (TCM) are also deepening. In order to further strengthen the accuracy and standardization of traditional Chinese medicine treatment for  Corona Virus Disease 2019 (COVID-19) patients, better promote the cooperation of traditional Chinese medicine and Western medicine to improve the cure rate and reduce the death rate, we revised the Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Corona Virus Disease 2019 (COVID-19) (Trial Version III) on the basis of carefully studying the national Corona Virus Disease 2019 (COVID-19) Diagnosis and Treatment Program (Trial Version VII), and formed the Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Corona Virus Disease 2019 (COVID-19) (Trial Version IV). For syndrome differentiation and prevention, all medical institutions can refer to the principles determined in this program when doing the clinical diagnosis and treatment.

　　I. Etiology and Pathogenesis of Corona Virus Disease 2019 (COVID-19) According to TCM

　　Corona Virus Disease 2019 (COVID-19) belongs to the category of epidemic diseases in the field of TCM. The epidemic toxin of dampness enters from the nose and mouth, causing impaired depurative descending of lung qi and hampering qi movement. The symptoms include low-grade fever, fatigue, cough and shortness of breath. Some patients suffer from dampness transformed from heat. Dampness toxin congests and blocks the lung and enters nutrient phase, resulting in high-grade fever, asthma, palpitation, cyanosis of lips and nails, delirium, etc. The symptoms aggravate with movement. Old people with basic diseases are easy to deeply affected by the pathogens, which may lead to the danger of inner blocking causing collapse. During the recovery period, the remaining pathogens are not clear, and blood stasis obstructs the lung collaterals, which lead to fatigue, shortness of breath and other discomforts.

　　II. Clinical Treatment Plan

　　(I) Medical observation cases

　　[Medical Use] Applicable to those who have close contact with confirmed or suspected patients of Corona Virus Disease 2019 (COVID-19).

　　[Treatment Methods] Benefiting qi and nourishing yin.

　　[Reference Prescriptions]

　　Raw Radix Astragali seu Hedysari 9 g, Radix Glehniae 9 g, Rhizoma Anemarrhenae 9 g, Trollius chinensis Bunge 5 g, Fructus Forsythiae 9 g, Rhizoma Atractylodis 9 g, Radix Platycodonis 6 g.

　　Decocted with 200 ml of water. Take 200 ml orally each time. One decoction per day. Course of treatment can last for 6 days. The usage and dosage of medicine for children who are in close contact with Corona Virus Disease 2019 (COVID-19) patients may refer to the treatment methods of adult.

　　(II) Suspected Cases

　　[Symptoms] Patients with fever or no fever, fatigue, cough, dry mouth, anorexia, red tongue, slightly greasy coating of tongue, and faster pulse rate.

　　Those syndromes can be found in suspected cases and medical isolated cases.

　　[Treatment Methods] Ventilating lung and transmitting pathogenic factors.

　　[Reference Prescriptions]

　　Stir-fried Herba Ephedrae 10 g, stir-fried Semen Armeniacae Amarum 9 g, Radix Scutellariae 15 g, Rhizoma Anemarrhenae 10g, raw Semen Coicis 30 g, Rhizoma Atractylodis 10 g, Lonicera japonica Thunb 15 g, Fructus Forsythiae 15 g.

　　Decocted with 200 ml of water. Take 200 ml orally each time. Two decoctions per day. Course of treatment should last for 7-14 days.

　　[Reference Chinese Patent Medicines]

　　Oral medicine: Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, etc.

　　(III) TCM Treatment Program for Adult Confirmed Cases

　　1. Qi Deficiency and Pathogen Affection

　　[Symptoms] Patients who have no obvious clinical symptoms, no evidence of pneumonia on imaging, and are tested positive in corona virus nucleic acid test.

　　[Treatment Methods] Strengthening vital qi to eliminate pathogenic factor.

　　[Reference Prescriptions]

　　Raw Radix Astragali seu Hedysari 15 g, Rhizoma Atractylodis 10 g, stir-fried Rhizoma Atractylodis Macrocephalae 10 g, Radix Saposhnikoviae 10 g, Agastache rugosa 10 g, Lonicera japonica Thunb 15 g, raw Radix Glycyrrhizae10 g, Folium Mori 9 g.

　　Radix Scutellariae 12 g.

　　Take it with water every day. Course of treatment should last for 7-14 days.

　　2. Syndromes of Epidemic Toxin Attacking Lung

　　[Symptoms] Patients with fever or no fever at the beginning, aversion to wind-cold, fatigue, cough, more or less phlegm, severe head and body pain, shortness of breath, dry mouth, satiety of gastral cavity, loose stool, red tongue, white or yellow or greasy tongue coating, and fast and intense pulse.

　　Those syndromes can be found in mild and some common cases.

　　[Treatment Methods] Ventilating lung and transmitting pathogenic factors; clearing heat and removing toxicity.

　　[Reference Prescription]

　　Stir-fried Herba Ephedrae 10 g, stir-fried Semen Armeniacae Amarum 9 g, Radix Scutellariae 15 g and Rhizoma Anemarrhenae 10 g, Fructus Ammomi Rotundus 6 g, raw Semen Coicis 30 g, Cortex Mori 15 g, Rhizoma Atractylodis 10 g, Lonicera japonica Thunb 15 g and Fructus Forsythiae 15 g.

　　[Addition and Reduction] Add Gypsum Fibrosum 30 g (decocted first), Herba Artemisiae Annuae 15 g and Radix Bupleuri 15g if the fever of the patients gets intensified; add Agastache rugosa 10 g, Herba Eupatorii 10 g and Pericarpium Citri Reticulatae 10 g if the tongue coatings of the patients are greasy; add Rhizoma Coptidis 9 g and remove Rhizoma Anemarrhenae for patients with diarrhea; add Radix Astragali seu Hedysari 10 g for patients suffering from shortness of breath.

　　[Reference Chinese patent medicines]

　　Oral medicine: Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, etc.

　　3. Syndromes of Lung Obstruction Due to Epidemic Toxin

　　[Symptoms] Patients with fever, chest distress, shortness of breath, wheezing, cough, less and stick phlegm, tiredness and fatigue, dry mouth, abdominal distension, nausea and vomiting, constipation or loose stool, red or crimson tongue, yellow and greasy coating, and fast and intense pulse.

　　Those syndromes can be found in heavy and some common cases.

　　[Treatment Methods] Clearing lung, relieving asthma, cooling blood and detoxifying.

　　[Reference Prescriptions]

　　Gypsum Fibrosum 45 g (decocted first), stir-fried Herba Ephedrae 10 g, Semen Armeniacae Amarum 10 g, Lonicera japonica Thunb 15 g, stir-fried Rhizoma Anemarrhenae 10 g, Cornu Bubali slices 30 g, Bulbus Fritillariae Thunbergii 10 g, Fructus Trichosanthis 30 g, Lumbricus 20 g, Semen Descurainiae 20 g, Radix Paeoniae Rubra 20 g, raw Radix Astragali seu Hedysari 20 g, Rehmannia glutinosa Libosch 30 g, Cortex Moutan Radicis 15 g.

　　[Addition and Reduction] add Radix Panacis Quinquefolii 10 g for patients with obvious shortness of breath and fatigue; add raw Radix et Rhizoma Rhei 10 g (put in later) and Cortex Magnoliae Officinalis 15 g for patients with stool failure; add Rhizoma Anemarrhenae 30 g for patients suffering from heat, vexation and thirst.

　　[Reference Chinese patent medicines]

　　Intravenous drip: Tanreqing Injection, Xuebijing Injection, Reduning Injection, etc.

　　Oral medicine: Xinxue Granules, Zixuedan Pill, Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), etc.

　　4. Syndromes of Inner Blocking Causing Collapse

　　[Symptoms] Patients with dyspnea, chest distress or chest pain, wheezing and shortness of breath, dry cough, less phlegm, fatigue, weak voice, disturbance, even dizziness and delirium, cold sweat and cold limbs, purple and dark lips, dark red tongue, yellow and greasy coating, and heavy yet weak pulse.

　　Those syndromes are found in critically cases.

　　[Treatment Methods] Resolving turbidity, breaking the block, invigorating qi for relieving desertion.

　　[Reference Prescriptions]

　　Radix Ginseng 30 g, raw Radix Astragali seu Hedysari 30 g, Radix Aconiti Lateralis Preparata 15 g (decocted first), Radix Salviae Miltiorrhizae 30 g, Radix Ophiopogonis 30 g, Radix Curcumae 10 g, Lumbricus 15 g, Radix Notoginseng 9 g, Semen Descurainiae 15 g, Faeces Bombycis 15 g, Rhizoma Atractylodis 15 g, Polyporus Umbellatus 30 g.

　　[Addition and Reduction] For patients with shortness of breath and severe fatigue, add Fructus Corni 30 g; add Fructus Aurantii Immaturus15 g and raw Radix et Rhizoma Rhei 10 g (put in later).

　　[Reference Chinese Patent Medicines]

　　Intravenous drip: Shenmai Injection, Shenfu Injection, Tanreqing Injection, Xuebijing Injection, etc.

　　Oral medicine: reversed transmission to pericardium plus Angong Niuhuang Pills or Suhe Xiang Pills, etc.

　　(IV) Treatment Program for Confirmed Cases in Recovery Period

　　1. Syndrome of Deficiency of Both Qi and Yin

　　[Symptoms] Patients with tiredness, spontaneous sweat, palpitation, anorexia, dry mouth and throat, red tongue with little fluid or tender red tongue, yellow or slightly greasy coating.

　　Those syndromes can be found in convalescent cases.

　　[Treatment Methods] Supplementing qi and nourishing yin.

　　[Reference Prescriptions]

　　Radix Adenophorae 15 g, Radix Ophiopogonis 15 g, raw Radix Astragali seu Hedysari 15 g, Massa Medicata Fermentata 20 g, Radix Paeoniae Rubra 15 g, Cortex Mori 15 g, Cortex Lycii 15 g, Fructus Aurantii 15 g, Fructus Aurantii 10 g, Herba Artemisiae Annuae 15 g, Rehmannia glutinosa Libosch 15 g.

　　[Addition and Reduction] Schisandra Chinensis 10 g is added for patients with shortness of breath and asthma; stir-fried Semen Ziziphi Spinosae 15 g is added for patients with vexation and insomnia; add Codonopsis Pilosula 15g, Poria 15 g, Rhizoma Pinelliae 9 g, Pericarpium Citri Reticulatae 10 g and Radix Glycyrrhizae 6 g for patients with lung-spleen deficiency, poor appetite, and loose stool.

　　[Reference Chinese Patent Medicines] Oral medicine: Shengmai decoction, etc.

　　2. Syndrome of Remaining Pathogens 

　　[Symptoms] Patients with shortness of breath, chest distress, cough, less phlegm, red or dark tongue, and slightly greasy coating.

　　Those syndromes can be seen in cases with pulmonary inflammation during convalescence.

　　[Treatment Methods] Promoting blood circulation, eliminating dampness and dispersing remaining pathogenic factors.

　　[Reference Prescriptions]

　　Radix Salviae Miltiorrhizae 15 g, stir-fried Semen Coicis 30 g , Radix Codonopsis 15 g, Radix Glehniae 15 g, Semen Persicae 6 g, Fructus Trichosanthis 20 g, Cortex Magnoliae Officinalis 10 g, Rhizoma Phragmitis 30 g, Herba Patriniae 30 g, raw Fructus Hordei Germinatus 30 g.

　　3. Other treatments

　　Under the guidance of doctors, acupoint sticking application, acupuncture, Baduanjin, Tai Ji, respiratory guidance exercise, qi rehabilitation, normal exercise, psychological counseling, music therapy, etc. can be selected.

　　(Ⅴ) TCM Treatment Program for Confirmed Cases of Children

　　1. Syndromes of Epidemic Toxin Accumulating in Lung

　　[Symptoms] At the beginning, patients suffer from aversion to cold, fever, cough, dry and sore throat, nausea and vomiting, anorexia, constipation, red tip of tongue, white and thick coating, floating pulse and red fingerprint.

　　[Treatment Methods] Clearing away heat and toxic materials, eliminating dampness and ventilating lung.

　　[Reference Prescriptions]

　　Stir-fried Herba Ephedrae 4 g, Gypsum Fibrosum 20 g (decocted first), Rhizoma Anemarrhenae 9 g, Semen Armeniacae Amarum 10 g, raw Semen Coicis10 g, Rhizoma Phragmitis 10 g, Radix Platycodonis 6 g, Cortex Mori 10 g, Lonicera japonica Thunb 10 g.

　　2. Syndromes of lung Obstruction due to Epidemic Toxin

　　[Symptoms] Patients with high fever, cough, heavy breath, yellow phlegm, constipation, thirst, dry throat, red tongue, yellow coating, smooth pulse and purple fingerprint.

　　[Treatment Methods] Resolving turbidity, breaking the block, nourishing yin and clearing heat.

　　[Reference Prescriptions]

　　Stir-fried Herba Ephedrae 4 g, Gypsum Fibrosum 20 g (decocted first), Rhizoma Anemarrhenae 9 g, Semen Armeniacae Amarum 10 g, raw Semen Coicis 10 g, Trichosanthes kirilowii Maxim 10 g, ripe Radix et Rhizoma Rhei 5 g, Cortex Mori 10 g, Semen Descurainiae 6 g, Cornu Bubali slices 10 g, Lumbricus 10 g, Radix Ginseng 6 g.

　　Those prescriptions are suitable for children aged 5-10 years old. For children beyond this range, the dosage should be adjusted according to age and disease condition.

　　III. The Guiding Principles of TCM Prevention

　　1. Adult TCM Prevention Prescription

　　Prevention Prescription I can be use by the general population during the epidemic period.

　　Radix Ophiopogonis 3 g, Folium Mori 3 g, Flos Chrysanthemi 3 g and Pericarpium Citri Reticulatae 2 g.

　　The above 4 kinds of tea-substitute drinks plus Radix Astragali seu Hedysari 10 g are used for group prevention.

　　Prevention Prescription II is suitable for the general population during the epidemic period, especially for those with throat discomfort and dry stool.

　　2 Trollius chinensis Bunge, 5 grains of Radix Ophiopogonis, 2 Fructus Canarii (smashed) and 2 white Flos Chrysanthemi.

　　The above 4 drinks can substitute tea.

　　Prevention Prescription III is applicable to the prevention of patients with chronic basic diseases during the epidemic period. Medical personnel at clinical frontline and other staff who have direct contact with suspected cases and close contact with confirmed cases can also use the prescription.

　　Raw Radix Astragali seu Hedysari 9 g, Radix Glehniae 9 g, Rhizoma Anemarrhenae 9 g, Trollius chinensis Bunge 5 g, Fructus Forsythiae 9 g, Rhizoma Atractylodis 9 g and Radix Platycodonis 6 g.

　　The above 7 ingredients are decocted with water, one decoction a day. Course of treatment can last for 6 days.

　　2. TCM Preventive Prescription for Children

　　[Preventive Prescriptions] Lonicera japonica Thunb 3 g, Rhizoma Phragmitis 6 g and Pericarpium Citri Reticulatae 2g.

　　The above three ingredients are decocted with water to replace tea drink. The dosage should add or reduce according to the age and weight of the patients. The prescription is suitable for ordinary children during the epidemic period and can be taken continuously for 6 days.