Source: Beijing Municipal Administration of Traditional Chinese Medicine

Jin Zhong Yi Zheng Zi〔2020〕No. 89

　　To Beijing Municipal Medical Management Center, all Beijing district health commissions and all relevant medical institutions:

　　To guide the rational clinical application of Traditional Chinese Medicine (TCM) in the prevention and treatment of Covid-19, the Bureau has organized experts to formulate the "Beijing Municipal TCM Prevention and Treatment Plan for Covid-19 (5th Trial Version)", which is hereby being shared with you to abide by. Please provide a timely response to our medical department if you have any questions or suggestions in the process of implementation of this plan.

　　Contact: Mu Qianqian, Lin Wenhui

　　Tel.: 83970015, 83970039

　　Email: zyjyzc@zyj.beijing.gov.cn

　　Appendix: Beijing Municipal TCM Prevention and Treatment Plan for Covid-19 (5th Edition for Trial)

　　Beijing Municipal Administration of Traditional Chinese Medicine

　　June 14, 2020

　　Appendix

　　Beijing Municipal TCM Prevention and Treatment Plan for Covid-19 

(5th Trial Version)

　　At present, the global Covid-19 epidemic situation is still severe and new locally transmitted cases have been discovered recently in Beijing. To further strengthen Covid-19 prevention, apply proper treatments utilizing traditional Chinese medicine and the integrated traditional Chinese and western medicine to improve the Covid-19 recovery rate and reduce the fatality rate, we have amended the 4th trial version of "Beijing Municipal TCM Prevention and Treatment Plan for Covid-19" and released its 5th trial version. All medical institutions can conduct syndrome differentiation for treatment and prevention by referring to the principles determined in the scheme. 

　　I. TCM etiological factors and pathogenesis

　　This disease belongs to the epidemic disease category of traditional Chinese medicine. The lung and spleen are trapped by the gas of the pestilence through the mouth and nose. Clinical symptoms include fever, cough, fatigue, loose stools or unpleasant diarrhea, and even shortness of breath. For some patients, dampness rising from heating obstructs the lung, resulting in high fever, asthma and other severe conditions, and finally leading to the crisis of asthenia of healthy qi and pathogenic factors, inner blocking causing collapse. Qi and Yin deficiency, lung and kidney deficiency, blood stasis obstruction collateral can be observed during the recovery period.

　　II. Clinical treatment strategies

　　ⅰ. TCM treatment plan for medical observation and isolation cases

　　【Indications】Applicable to cases of close contact with people who are confirmed as Covid-19 patients under medical observation or isolation.

　　【Treatment】Resolving dampness with aromatics and replenishing qi and detoxicating

　　【Reference and prescription】 

　　Raw astragalus 9g, northern ginseng 9g, rhizoma anemarrhenae 9g, forsythia 9g, atractylodes lancea 9g, herba periliae 6g, epimedium fragrance 6g, thin charge 3g (decoct later)

　　It should decoct in 200ml water and the patients take orally once a day. Children who have a close contact with Covid-19 patients may be given appropriate medication in accordance with the adult scheme.

　　【Reference for Chinese patent Medicine】

　　Jinhua Qinggan granules, Lianhua Qingwen granules (capsule), Shuanghuanglian granules (oral liquid), Qingkailing capsules, Shema oral liquid, etc.

　　ⅱ. TCM treatment plan for adult confirmed cases

　　1. Syndrome of external disease

　　【Symptom】 Applicable to cases with no obvious clinical symptoms, no manifestation of pneumonia in the diagnose imaging, and novel coronavirus nucleic acid tested positive.

　　【Treatment】Transforming damp turbidity with aromatics, detoxicating and eliminating pathogenic factors

　　【Reference and prescription】

　　Atractylodes lancea 10g, radix saposhnikoviae 10g, epimedium fragrance 10g, honeysuckle 15g, raw licorice 10g, herba periliae 10g, scutellaria 15g, astragalus 15g, radix ophiopogonis 10g 

　　Decocting in 400ml water, the patients take 200ml each time and take orally twice a day.

　　【Reference for Chinese patent medicine】

　　Jinhua Qinggan granules, Lianhua Qingwen granules (capsule), Shuanghuanglian granules (oral liquid), Qingkailing capsules, Shema oral liquid, etc.

　　2. Syndrome of epidemic virus attacking on lung

　　【Symptom】 Fever or no fever at the beginning, bad wind and cold, fatigue, cough, sputum or little sputum, heavy head and body pain, shortness of breath, dry mouth, appetite, loose stool, red tongue, white or yellow or thick tongue coating, and smooth pulse

　　This syndrome can be seen in mild and some common cases.

　　【Treatment】Removing dampness and promoting lung function, nourish qi and permeate evil

　　【Reference and prescription】

　　Stir-fried ephedra 10g, almond 9g, Scutellaria 15g, rhizoma anemarrhenae 10g, Cardamom 6g (smashed), coix seed 30g, atractylodes lancea 10g, honeysuckle 15g, herba epimedii 15g, astragalus 10g, ophiopogon japonicus 15g, ophiopogon japonicus 15g

　　【Addition or reduction】For patients with high fever, adding 30g gypsum (fried first), 15g artemisia annuum, 15g bupleurum bupleurum; for patients with thick tongue coating, adding 10g herba eupatorii, 10g tangerine peel and 10g sessile stem; for patients with diarrhea, adding 9g coptis and removing rhizoma anemarrhenae.

　　【Reference for Chinese patent medicine】

　　Jinhua Qinggan granules, Lianhua Qingwen granules (capsule), Shuanghuanglian granules (oral liquid), Qingkailing capsules, Shema oral liquid, etc.

　　3. Syndrome of epidemic virus closing lung

　　【Symptom】Fever, chest congestion and shortness of breath, wheezing, cough, little phlegm, tiredness and fatigue, dry mouth without the desire to drink, abdominal fullness and distention, nausea and vomiting, constipation or loose stool, red or purple tongue, yellow and thick tongue coating, slippery and rapid pulse

　　This syndrome can be seen in severe and some common cases.

　　【Treatment】Clearing lung, relieving asthma, cooling blood and detoxifying

　　【Reference and prescription】

　　Gypsum 45g (Fried first), processed ephedra nut 10g, honeysuckle 15g, stir-fried anemone 10g, buffalo horn tablet 30g, thunberg fritillary Bulb 10g, trichosanthes 30g, drillong 20g, pepperweed Seed 15g, radix paeoniae rubra 20g, astragalus 20g, rehmanniae praeparatum 30g, cortex moutan 15g

　　【Addition or reduction】For patients with breath shortness and apparent weakness, adding 10g west ginseng; for patients with constipation, adding 10g rhubarb (decoct later) and 15g magnolia officinalis

　　【Reference for Chinese patent medicine】

　　Intravenous infusion: Tanreqing injection, Xuebijing injection, Reduning injection, etc.

　　Oral administration: Xinxue granules, Zixuetan, Jinhua Qinggan granules, Lianhua Qingwen granules (capsule), etc.

　　4. Syndrome of internal closure and external detachment

　　【Symptom】Dyspnea, chest tightness or chest pain, shortness of breath, dry cough, little phlegm, lack of power, low voice, dryness and restlessness, even delirium tremens, cold sweating limbs, purple lips, dark red tongue, yellow and thick tongue coating, deep and delicate pulse.

　　This syndrome is seen in critical cases.

　　【Treatment】Eliminating turbid pathogen and nourishing qi to stop collapse

　　【Reference and prescription】

　　Suncured ginseng 30g, raw astragalus 30g, Heishun tablets 15g (fried first), salvia miltiorrhiza 30g, ophiopogon japonicus 30g, radix curcumae 10g, earthworm 15g, panax notoginseng 9g, pepperweed seed 15g, atractylodes lancea 15g, grifola 30g, radix paeoniae rubra 15g

　　【Addition or reduction】 For patients with short breath and fatigue, adding 30g mountain cornus; for patient with dry stools, adding immature 30g bitter orange, 10g raw rhubarb (decoct later), 15g radix scrophulariae, 30g radix ophiopogonis, 15g radix rehmanniae

　　【Reference for Chinese patent medicine】

　　Intravenous infusion: Xuebijing injection, Tanreqing injection, Shenmai injection, Shenfu injection, etc.

　　Oral administration: for patients who faint from high temperature, adding Angong Niuhuang pill or Suhexiang pill.

　　ⅲ. TCM treatment scheme for confirmed cases of children

　　1. Syndrome of epidemic virus accumulating in lung

　　【Symptom】 Initial bad cold, fever, cough, dry sore throat, nausea and vomiting, poor appetite, constipation, reddish tip of tongue, white and thick tongue coating, rapid floating pulse, red fingerprint

　　【Treatment】 Clearing heat to remove toxicity and removing dampness to promote lung function

　　【Reference and prescription】

　　Processed ephedra 4g, gypsum 20g (fried first), rhizoma anemarrhenae 9g, apricot kernels 10g, raw coix seed 10g, reed rhizome 10g, platycodon grandiflorum 6g, mulberry white bark 10g, honeysuckle 10g, agastache rugosa 10g

　　2. Syndrome of epidemic virus closing lung 

　　【Symptom】 High fever, cough, coarse breath, yellow phlegm with constipation, thirst and dry throat, red tongue, yellow tongue coating, rapid floating pulse, purple fingerprint

　　【Treatment】 Eliminating turbid pathogen, nourishing yin and clearing heat

　　【Reference and prescription】

　　Roasted ephedra 4g, gypsum 20g (fried first), rhizoma anemarrhenae 9g, apricot kernels 10g, raw coix seed 10g, fructus trichosanthis 10g, ripe rhubarb 5g, radix ophiopogonis 10g, pepperweed seed 6g, buffalo horn tablet 10g, earthworm 10g, ginseng 6g

　　This prescription is applicable to children aged 5-10 years. For children beyond this scope, the dosage should be adjusted according to age and condition.

　　ⅳ. Therapeutic scheme at the recovery stage

　　1. Qi and Yin deficiency syndrome

　　【Symptom】Tired and idle in spirit, sweating, palpitation, numb, dry mouth and throat, red or tender-red tongue, yellow or slightly thick tongue.

　　【Treatment】 Nourishing lung to invigorate qi, nourishing Yin to moisten dryness

　　【Reference and prescription】Radix adenophorae 15g, radix ophiopogonis 15g, raw astragalus 15g, Chinese herbal Shenqu 20g, radix paeoniae rubra 15g, white mulberry root 15g, cortex lycii radicis 15g, fructus aurantii 10g, sweet wormwood herb 15g, rehmanniae praeparatum 15g

　　【Addition and Reduction】For patients short of breath asthma, adding fructus schisandrae; for patients with insomnia, adding fried jujube kernel; for patients with lung-spleen qi deficiency, poor appitite and loose stool, adding 15g codonopsis pilosula, 15g poria cocos, 9g pinellia ternata, 10g tangerine peel, 6g liquorice

　　【Reference Chinese patent medicine】Pulse promoting drink

　　2. Syndrome of lung and kidney deficiency 

　　【Symptom】Wheezing in a state of motion, fatigue, shortness of breath and sweat, light-red tongue, tongue edge tooth mark, thin and white tongue coating.

　　【Treatment】Cultivating soil (spleen) to generate metal (lung) and nourishing kidney to nourish qi

　　【Reference and prescription】

　　Ginseng 10g, cornus officinalis 20g, rehmannia glutinosa 15g, yam 15g, cortex moutan 10g, poria15g, rhizoma alismatis 15g, fructus lycii 10g, agrimonia pilosa 30g, achyranthes bidentata15g, fried atractylodes 15g

　　【Reference Chinese patent medicine】Bailing capsule, Jinshuibao capsule, Huaiqi Yellow granules are applicable.

　　3. Syndrome of phlegm and blood stasis 

　　【Symptom】Shortness of breath, chest tightness, cough, little sputum, red or dark tongue, slightly thick tongue coating.

　　For the cases of pulmonary imaging lesions with incomplete absorption at recovery phase

　　【Treatment】Activating blood circulation and removing stasis and phlegm

　　【Reference and prescription】

　　Salvia miltiorrhiza 15g, fried semen coicis 30g, codonopsis pilosula 15g, radix adenophorae 15g, peach kernel 6g, fructus trichosanthis 20g, thick fructus trichosanthis 10g, reed rhizome 30g, herba patriniae 30g, thunberg fritillary bulb 10g

　　ⅴ. Other treatment

　　Under the guidance of the doctor, patients with above symptoms can select the treatment such as point application, acupuncture, Baduanjin, Taijiquan, breathing guidance exercise, qigong rehabilitation, exercise, psychological counseling, music therapy, etc.

　　ⅵ. For patients with positive Covid-19 nucleic acid for a long time, or re-positive Covid-19 nucleic acid, the treatment can be based on the syndrome differentiation to correct the pathogenic factors.

　　III. TCM precautionary guidelines

　　ⅰ. TCM preventive prescription for adults

　　【Preventive prescription one】Applicable to the prevention of the general population of adults during the epidemic

　　Radix ophiopogonis 3g, radix pseudostellariae 6g, chrysanthemum 3g, epimedium fragrance 6g, herba periliae 6g

　　Drink with above five Chinese herbs instead of tea; or decoct them with 200ml water, once a day orally; or take granule according to the instructions. Take it continuously for 6 days.

　　【Preventive Prescription two】Applicable to the prevention of people with chronic basic diseases during the epidemic, medical observation personnel at home or in centralized isolation and their management personnel, and clinical front-line medical personnel.

　　Raw astragalus 9g, northern ginseng 9g, rhizoma anemarrhenae 9g, forsythia 9g, atractylodes lancea 9g, herba periliae 6g, epimedium fragrance 6g, mint 3g (decoct later)

　　ⅱ. TCM preventive prescription for children

　　【Preventive Prescription】For ordinary children during the epidemic.

　　Honeysuckle 3g, reed rhizome 6g, herba periliae 3g

　　Drink with above three Chinese herbs or decoct them with water. This dosage is suitable for children aged 5-10 years. For children beyond this age, the dosage should be added or reduced according to age and weight. Take it continuously for 6 days.