At present, the global epidemic situation of coronavirus pneumonia (hereinafter referred to as the COVID-19) is still very serious. Recently, cases have appeared in Beijing again. In order to further strengthen the accuracy and standardization of traditional Chinese medicine (TCM) treatment of patients with COVID-19, better promote the cooperation of TCM and Western medicine to improve the curative rate and reduce the death rate, we revised the Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Coronavirus Disease 2019 (COVID-19) (Trial Version IV), and formed the Traditional Chinese Medicine Prevention and Treatment Program of Beijing for Coronavirus Disease 2019 (COVID-19) (Trial Version V). For syndrome differentiation and prevention, all medical institutions can refer to the principles determined in this program when doing the clinical diagnosis and treatment.
1. Etiology and Pathogenesis of COVID-19 According to TCM
Coronavirus Disease 2019 (COVID-19) belongs to the category of epidemic disease in the field of TCM. The epidemic toxin of dampness attacks the nose and mouth, and affects lungs and spleen in a negative way. The clinical symptoms include fever, cough, fatigue, loose or uneasy stools, and even shortness of breath. Some patients suffer from dampness transformed from heat. Dampness toxin congests and blocks the lung and causes severe symptoms such as high fever and shortness of breath. Finally, they are at the risk of lacking positive matters, and are deeply affected by the pathogens, which may lead to the danger of inner blocking causing collapse. During the recovery period, patients may lack qi and yin. Their lungs and kidneys do not function well. And blood stasis may cause collateral obstruction.
2. Clinical Treatment Plan
(1) TCM treatment plan for medical observation cases/medical isolation cases
[Medical Use] Applicable to those who have close contact with confirmed patients of COVID-19, those who now belong to medical observation cases or medical isolation cases.
[Treatment Methods] Resolving dampness with aromatics, benefiting qi and removing toxicity.
[Reference Prescription]
Raw Radix Astragali seu Hedysari 9 g, Radix Glehniae 9 g, Rhizoma Anemarrhenae 9 g, Fructus Forsythiae 9 g, Rhizoma Atractylodis 9 g, Folium Perillae 6 g, Agastache rugosa 6 g, Herba Menthae 3 g
(Decocted with 200 ml of water. Take it orally, one time per day. The usage and dosage of medicine for children who are in close contact with COVID-19 patients may refer to the treatment methods of adult.
[Reference Chinese Patent Medicine]
Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsule), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema oral liquid, etc.
(2) TCM Treatment Plan for Confirmed Cases of Adults
(i) Epidemic pathogen affection
[Symptoms]
Applicable to patients who have no obvious clinical symptoms, no evidence of pneumonia on imaging, and are tested positive in COVID-19 nucleic acid test.
[Treatment Methods]
Resolving dampness with aromatics, removing toxicity and eliminating pathogen.
[Reference Prescription]
Rhizoma Atractylodis 10 g, Radix Saposhnikoviae 10 g, Agastache rugosa 10 g, Lonicera japonica Thunb 15 g, raw Radix Glycyrrhizae10 g, Folium Perillae 10 g, Radix Scutellariae 15 g, Raw Radix Astragali seu Hedysari 15 g
Decocted with 400 ml of water. Take 200 ml orally each time, twice a day.
[Reference Chinese Patent Medicine]
Jinhua Qinggan Granules, Lianhua Qingwen Granules (capsule), Shuanghuanglian Granules (oral liquid), Qingkailing capsule, Shema oral liquid, etc.
(ii) Syndrome 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.
This syndrome 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 10 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 Herba Eupatorii 10 g, Pericarpium Citri Reticulatae 10 g and Caulis Perillae 10 g if the tongue coatings of the patients are greasy; add Rhizoma Coptidis 9 g and remove Rhizoma Anemarrhenae for patients with diarrhea.
[Reference Chinese patent medicines]
Jinhua Qinggan Granules, Lianhua Qingwen Granules (capsule), Shuanghuanglian Granules (oral liquid), Qingkailing Capsules, Shema oral liquid, etc.
(iii) Syndrome 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.
This syndrome can be found in heavy and some common cases.
[Treatment Methods]
Clearing lung, relieving asthma, cooling blood and detoxifying.
[Reference Prescription]
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 Granuless, Zixuedan Pill, Jinhua Qinggan Granuless, Lianhua Qingwen Granuless (Capsules), etc.
(iv) Syndrome 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.
This syndrome is found in critically cases.
[Treatment Methods]
Resolving turbidity, breaking the block, invigorating qi for relieving desertion.
[Reference Prescription]
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, Rhizoma Atractylodis 15 g, Polyporus Umbellatus 30 g, Radix Paeoniae Rubra 15 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), Radix Scrophulariae 15 g, Radix Ophiopogonis 30 g, and Radix Rehmanniae Recens 15 g.
[Reference Chinese Patent Medicines]
Intravenous drip: Xuebijing Injection, Tanreqing Injection, or Shenmai Injection, Shenfu Injection, etc.
Oral medicine: Patients who feel dizzy and have high-grade fever should take in addition Angong Niuhuang Pills or Suhe Xiang Pills, etc.
(3) TCM Treatment Program for Confirmed Cases of Children
(i) Syndrome 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 Prescription]
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, Rhizoma Atractylodis 10 g.
(ii) Syndrome 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 Prescription]
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, Radix Ophiopogonis 10 g, Semen Descurainiae 6 g, Cornu Bubali slices 10 g, Lumbricus 10 g, Radix Ginseng 6 g.
This prescription is suitable for children aged 5-10 years old. For children beyond this range, the dosage should be adjusted according to age and disease condition.
(4) Treatment Program for Confirmed Cases in Recovery Period
(i) 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.
[Treatment Methods] Recovering the lung function and supplementing qi. Nourishing yin for moistening dryness.
[Reference Prescription]
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 Medicine]
Oral medicine: Shengmai Decoction
(ii) Syndrome of Ill-functioned Lungs and Kidneys
[Symptoms]
Patients suffer from shortness of breath when moving, fatigue, tiredness, and heavy sweat, whose tongues are pale red and teeth-printed with thin and white coating.
[Treatment Methods]
Invigorating spleen for benefiting lung. Improving inspiration and invigorating the kidney.
[Reference Prescription]
Radix Ginseng 10 g, Fructus Corni 20 g, Radix Rehmanniae Preparata 15 g, Rhizoma Dioscoreae 15 g, Cortex Moutan Radicis 10 g, Poria 15 g, Rhizoma Alismatis 15 g, Fructus Lycii 10 g, Herba Agrimoniae 30 g, Radix Achyranthis Bidentatae 15 g, Stir-fried Rhizoma Atractylodis Macrocephalae 15 g
[Reference Chinese Patent Medicines]
Bailing Capsule, Jinshuibao Capsule, Huaiqihuang Granules, etc. may be considered.
(iii) Syndrome of Collateral Obstruction Caused by Phlegm and Stasis
[Symptoms]
Shortness of breath, chest distress, coughing, little phlegm, red or dark tongue, and slightly greasy coating.
Symptoms can be seen in cases of incomplete absorption of lung lesion shown in images during recovery.
[Reference Prescription]
Radix Salviae Miltiorrhizae 15 g, stir-fried Coix lacryma-jobi 30 g, Radix Codonopsis 15 g, Radix Glehniae 15 g, Semen Persicae 6 g, Trichosanthes kirilowii Cortex 20 g, Magnoliae Officinalis 10 g, Rhizoma Phragmitis 30 g, Herba Patriniae 30 g, Bulbus Fritillariae Thunbergii 10 g
(5) 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 to treat the syptoms mentioned above.
(6) For those who have been tested positive to the coronavirus 2019 for a long time, or those appear positive again in the nucleic acid test, treatment should be made according to the conditions. Syndrome differentiation is needed.
3. 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, Radix Pseudostellariae 6 g, Flos Chrysanthemi 3 g, Agastache rugosa 6 g, Folium Perillae 6 g
The above 4 ingredients are decocted to replace tea drink; or decocted with 200 ml water. Take it orally, once per day; or take Granules under the guidance of instruction book. It can be taken continuously for 6 days.
Prevention Prescription II is applicable to the prevention of patients with chronic basic diseases during the epidemic period, people under home quarantine or collective isolation and medical observation, managers and medical staff working at the frontlines.
Raw Radix Astragali seu Hedysari 9 g, Radix Glehniae 9 g, Rhizoma Anemarrhenae 9 g, Fructus Forsythiae 9 g, Folium Perillae 6 g, Agastache rugosa 6 g, Herba Menthae 3 g (put in later)
The above 8 ingredients are decocted with water. Take it orally, once per day; or take Granules under the guidance of instruction book. It can be taken continuously for 6 days.
(2) TCM Preventive Prescription for Child Patients
[Preventive Prescription] It is used for disease prevention for ordinary children during the epidemic period.
Lonicera japonica Thunb 3 g, Rhizoma Phragmitis 6 g and Folium Perillae Reticulatae 2 g.
The above 3 ingredients are decocted to replace tea drink; or decocted with water. This dosage is suitable for children aged 5-10 years. For children beyond this age, the dosage should be appropriately increased or decreased according to age and weight. It can be taken continuously for 6 days.