COVID-19: Updates

TCM Treatment for COVID-19

Original 上海中医药大学针灸问鼎 Today

点击上方问鼎，悦读英文中医经典

Diagnosis and Treatment Protocol for COVID-19

(Trial Version 7)

Traditional Chinese Medicine Treatment

新型冠状病毒肺炎诊疗方案（试行第七版)

中药处方部分

Translated by Shanghai University of Traditional Chinese Medicine (上海中医药大学), PRC and Specialty Committee of Translation, WFCMS (世界中联翻译专业委员会), and organized and approved by Specialty Committee of Translation, WFCMS (世界中联翻译专业委员会)

In traditional Chinese medicine (TCM), the COVID-19 falls under the category of “pestilences”, which occur as a result of exposure to epidemic pathogens. This Protocol represents standard TCM pattern identification and treatment. Modifications can be made to satisfy the patients’ actual conditions, local climate, or individualized body constitutions. Consult with a doctor first before using a higher-than-recommended dosage by the Pharmacopoeia of the People’s Republic of China.

1. Medical Observation

Clinical manifestations #1:

Fatigue and gastrointestinal discomfort

Recommended Chinese patent medicine:

Huoxiang Zhengqi Jiaonang/Wan/Shui/Koufuye

(Agastache Qi-Correcting Capsules/Pills/Water/Oral Liquid)

Clinical manifestations #2:

Fatigue and fever

Recommended Chinese patent medicine:

Jinhua Qinggan Keli

(Honeysuckle Flower Cold-Relieving Granules);

Lianhua Qingwen Jiaonang/Keli

(Forsythiae and Honeysuckle Flower Pestilence-Clearing Capsules/Granules);

Shufeng Jiedu Jiaonang/Keli

(Wind- Expelling and Toxin-Removing Capsules/Granules)

3D Medical Animation Coronavirus Structure (Wikipedia)

2. Clinical Treatment (Confirmed Cases)

2.1 Qingfei Paidu Tang (Lung-Cleansing and Toxins-Removing Decoction)

[Indications]
Clinical observations have suggested that this formula can be used for mild, moderate or severe cases; it may also be used for critically ill patients on an as-needed basis.

[Ingredients]

Ma Huang (Herba Ephedrae) 9g
Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) 6g,

Xing Ren (Almond) 9g
Shi Gao (Gypsum) 15-30g*
Gui Zhi (Ramulus Cinnamomi) 9g
Ze Xie (Rhizoma Alismatis) 9g
Zhu Ling (Polyporus) 9g
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 9g
Fu Ling (Poria) 15g

Chai Hu (Radix Bupleuri) 16g
Huang Qin (Radix Scutellariae) 6g
Zi Yuan (Radix et Rhizoma Asteris) 9g
Dong Hua (Flos Farfarae) 9g
She Gan (Rhizoma Belamcandae) 9g
Xi Xin (Radix et Rhizoma Asari) 6g
Shan Yao (Rhizoma Dioscoreae) 12g
Zhi Shi (Fructus Aurantii Immaturus) 6g
Chen Pi (Pericarpium Citri Reticulatae) 6g
Huo Xiang (Herba Agastachis) 9g

Note: *a smaller dose for patients without a fever and bigger dose for those with a fever/high fever.

[Method]

Decoct the above ingredients (prepared slices) with water, one formula a day. Drink the decoction warm in two divided doses, once in the morning and once in the evening. A treatment course consists of three formulas. Continue with the second treatment course if the symptoms are improved but not fully resolved. Modify the formula if patients have emerging or other pre-existing conditions. Discontinue the formula when the symptoms resolved.

[Tips]

If conditions allow, drink 1/2 bowl of rice soup after taking the warm decoction; patients with a dry tongue can drink a bowl.

[Source of the formula]

The Notice on Recommending the Use of “Qingfei Paidu Tang” in Integrated Traditional Chinese & Western Medicine Treatment for COVID-19 issued by the General Office, National Ministry of Health Commission, and the Office, National Administration of Traditional Chinese Medicine (NATCM) (2020 File No 22, Medical Administration Bureau, NATCM).

2.2 Mild cases
2.2.1 Cold-dampness stagnating in the lung

[Signs and symptoms]

Fever, fatigue, generalized body aches, cough, expectoration, chest tightness with labored breathing, a poor appetite, nausea, vomiting, and sticky stools with a feeling of incomplete bowel movement. The tongue is pale and swollen with teeth marks and white, thick and curd-like coating. Alternatively, the tongue may be pale red, and the tongue coating may be white and greasy. The pulse is soft or slippery.

[Recommended formula]

Ma Huang (Herba Ephedrae) 6g
Shi Gao (Gypsum) 15g
Xing Ren (Almond) 9g
Qiang Huo (Rhizoma et Radix Notopterygii) 15g

Ting Li Zi (Semen Lepidii) 15g

Guan Zhong (Rhizoma Cyrtomii) 9g
Di Long (Pheretima) 15g
Xu Chang Qing (Radix et Rhizoma Cynanchi Paniculati) 15g

Huo Xiang (Herba Agastachis) 15g
Pei Lan (Herba Eupatorii) 9g
Cang Zhu (Rhizoma Atractylodis) 15g

Yun Ling (Poria) 45g
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 30g

Jiao Mai Ya (Fructus Hordei Germinatus Praeparata) 9g

Jia Shan Zha (Fructus Crataegi Praeparata) 9g
Jiao Shen Qu (Massa Medicata Fermentata) 9g
Hou Po (Cortex Magnoliae Officinalis) 15g
Jiao Bing Lang (Semen Arecae Praeparata) 9g
Wei Cao Guo (Fructus Tsaoko Praeparata) 9g
Sheng Jiang (Fresh Ginger) 15g

[Method]

Decoct with water to get 600ml, one formula a day. Drink the decoction in three divided doses (morning, noon and evening) before meals.

2.2 Mild cases

2.2.2 Damp-heat accumulating in the lung

[Signs and symptoms]
Low-grade or no fever, mild aversion to cold, fatigue, a heavy sensation in the head and body, dry coughs with scanty phlegm, sore throat, and a dry mouth with no desire to drink water. Alternatively, chest tightness, epigastric fullness, absence of sweating or inhibited sweating, vomiting, a poor appetite, and loose stools or sticky stools with a feeling of incomplete bowel movement may also be present. The Tongue is pale red with a white, thick and greasy or thin, yellow coating. The pulse is soft or slippery and rapid.

[Recommended formula]

Bing Lang (Semen Arecae) 10g

Cao Guo (Fructus Tsaoko) 10g

Hou Po (Cortex Magnoliae Officinalis) 10g

Zhi Mu (Rhizoma Anemarrhenae) 10g

Huang Qin (Radix Scutellariae) 10g
Chai Hu (Radix Bupleuri) 10g

Chi Shao (Radix Paeoniae Rubra) 10g
Lian Qiao (Fructus Forsythiae) 15g
Qing Hao (Herba Artemisiae Annuae) 10g (decoct later)

Cang Zhu (Rhizoma Atractylodis) 10g
Da Qing ye (Folium Isatidis) 10g
Gan Cao (Radix et Rhizoma Glycyrrhizae) 5g

[Method]

Decoct with water to get 400ml, one formula a day. Drink the decoction in two divided doses, once in the morning and once in the evening.

2.3 Moderate cases
2.3.1 Damp toxin stagnating in the lung

[Signs and symptoms]
Fever, cough with scanty or yellow phlegm, chest tightness, shortness of breath, abdominal distension, and constipation with difficult defecation. The tongue is dark red and enlarged with a yellow, greasy or dry yellow coating. The pulse is slippery and rapid or wiry and slippery.

[Recommended formula]
Ma Huang (Herba Ephedrae) 6g

Cao Guo (Fructus Tsaoko) 10g
Xing Ren (Almond) 15g
Shi Gao (Gypsum) 30g
Yi Yi Ren (Semen Coicis) 30g
Cang Zhu (Rhizoma Atractylodis) 10g
Huo Xiang (Herba Agastachis) 15g
Qing Hao (Herba Artemisiae Annuae) 12g

Hu Zhang (Rhizoma Polygoni Cuspidati) 20g

Ma Bian Cao (Herba Verbenae) 30g

Gan Lu Gen (dried Rhizoma Phragmitis) 30g

Ting Li Zi (Semen Lepidii) 15g
Ju Hong (Exocarpium Citri Rubrum) 15g
Gan Cao (Radix et Rhizoma Glycyrrhizae) 10g

[Method]

Decoct with water to get 400ml, one formula a day. Drink the decoction in two divided doses, once in the morning and once in the evening.

2.3 Moderate cases

2.3.2 Cold-dampness obstructing the lung

[Signs and symptoms]

Low-grade fever, a feverish sensation without a high temperature, dry coughs with scanty phlegm, lassitude, fatigue, chest tightness, and epigastric fullness. Alternatively, absence of fever, nausea, vomiting, and loose stools may be present. The tongue is pale or pale red with a white or white and greasy coating. The pulse is soft.

[Recommended formula]

Cang Zhu (Rhizoma Atractylodis) 15g

Chen Pi (Pericarpium Citri Reticulatae) 10g

Hou Po (Cortex Magnoliae Officinalis) 10g

Huo Xiang (Herba Agastachis) 10g
Cao Guo (Fructus Tsaoko) 6g

Sheng Ma Huang (Herba Ephedrae) 6g
Qiang Huo (Rhizoma et Radix Notopterygii) 10g

Sheng Jiang (Fresh Ginger) 10g
Bing Lang (Semen Arecae) 10g

[Method]

Decoct with water to get 400ml, one formula a day. Drink the decoction in two divided doses, once in the morning and once in the evening.

2.4 Severe cases
2.4.1 Epidemic toxin blocking the lung

[Signs and symptoms]

Fever with a red face, cough with scanty, yellow and sticky phlegm, chest tightness, shortness of breath, lassitude, fatigue, a dry, bitter and sticky mouth, nausea, loss of appetite, difficult defecation, and dark, scanty urine. Alternatively, blood-stained phlegm may be present. The tongue is red with a yellow, greasy coating. The pulse is slippery and rapid.

[Recommended formula]

Huashi Baidu (Dampness-Resolving & Toxin-Removing) formula

Ma Huang (Herba Ephedrae) 6g

Xing Ren (Almond) 9g

Shi Gao (Gypsum) 15g
Gan Cao (Radix et Rhizoma Glycyrrhizae) 3g
Huo Xiang (Herba Agastachis) 10g (decoct later)

Hou Po (Cortex Magnoliae Officinalis) 10g
Cang Zhu (Rhizoma Atractylodis) 15g
Cao Guo (Fructus Tsaoko) 10g
Fa Ban Xia (Rhizoma Pinelliae Praeparatum) 9g
Fu Ling (Poria) 15g
Da Huang (Radix et Rhizoma Rhei) 5g (decoct later)

Huang Qi (Radix Astragali) 10g
Ting Li Zi (Semen Lepidii) 10g
Chi Shao (Radix Paeoniae Rubra) 10g

[Method]

Decoct with water to get 100-200 ml, one or two formulas a day. Drink the decoction in two-4 divided doses or feed via a nasal tube.

2.4 Severe cases

2.4.2 Flaring heat in both qi and ying phases

[Signs and symptoms]

High-grade fever with excessive thirst, chest tightness, shortness of breath, delirium, unconsciousness, and blurred vision. Alternatively, skin rashes (in patches), vomiting blood, nosebleed, and convulsions of the four limbs may also be present. The tongue is crimson with scanty or no coating. The pulse is deep, thready and rapid or floating, big and rapid.

[Recommended formula]

Shi Gao (Gypsum) 30-60g (decoct first)
Zhi Mu (Rhizoma Anemarrhenae) 30g
Sheng Di (Radix Rehmanniae) 30-60g
Shui Niu Jiao (Cornu Bubali) 30g (decoct first)

Chi Shao (Radix Paeoniae Rubra) 30g

Xuan Shen (Radix Scrophulariae) 30g

Lian Qiao (Fructus Forsythiae) 15g

Dan Pi (Cortex Moutan) 15g
Huang Lian (Rhizoma Coptidis) 6g

Zhu Ye (Herba Lophatheri) 12g

Ting Li Zi (Semen Lepidii) 15g
Gan Cao (Radix et Rhizoma Glycyrrhizae) 6g

[Method]

Decoct Shi Gao (Gypsum) and Shui Niu Jiao (Cornu Bubali) with water first and then add the rest of the ingredients to decoct and get 100-200 ml, one formula a day. Drink the decoction in two-4 divided doses.

[Recommended Chinese patent medicine]

Name	Ingredients
Xiyanping injection	sulfonated andrographolide
Xuebijing injection	Hong Hua (Flos Carthami), Chi Shao (Radix Paeoniae Rubra), Chuan Xiong (Rhizoma Chuanxiong), Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Dang Gui (Radix Angelicae Sinensis).
Reduning injection	Qing Hao (Herba Artemisiae Annuae), Jin Yin Hua (Flos Lonicerae Japonicae), and Zhi Zi (Fructus Gardeniae).
Tanreqing injection	Huang Qin (Radix Scutellariae), Xiong Dan Fen (Fel Ursi powder), Shang Yang Jiao (Radix et Rhizoma Sophorae Tonkinensis), Jin Yin Hua (Flos Lonicerae Japonicae), and Lian Qiao (Fructus Forsythiae).
Xingnaojing injection	Moschus, borneol, Fructus Gardeniae, etc.

Note: One or two injections can be used together, in combination with traditional Chinese medicine decoction.

2.5 Critical cases

Internal blocking causing external collapse

[Signs and symptoms]

Difficulty breathing, panting upon exertions (mechanical ventilation may be required), unconsciousness, restlessness, sweating, and cold limbs. The tongue is dark purple with a thick, greasy or dry coating. The pulse is floating, big and rootless.

[Recommended formula]

Take Suhexiang Wan (Storax Pill) or Angong Niuhuang Wan (Peaceful Palace Bovine Bezoar Pill) with the decoction of Ren Shen (Radix et Rhizoma Ginseng) 15g, Hei Fu Zi (Radix Aconiti Lateralis Praeparata) 10g, and Shan Zhu Yu (Fructus Corni) 15g.

[Modifications]

For abdominal distension, constipation or difficult defecation following mechanicalventilation, use 5-10g of Da Huang (Radix et Rhizoma Rhei).

For patient-ventilator asynchrony (PVA), 5-10g of Da Huang (Radix et Rhizoma Rhei) and Mang Xiao (Natrii Sulfas) can be used in combination with sedative and muscle relaxants.

[Recommended Chinese patent medicine]

Name	Ingredients
Xuebijing injection	Hong Hua (Flos Carthami), Chi Shao (Radix Paeoniae Rubra), Chuan Xiong (Rhizoma Chuanxiong), Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Dang Gui (Radix Angelicae Sinensis).
Reduning injection	Qing Hao (Herba Artemisiae Annuae), Jin Yin Hua (Flos Lonicerae Japonicae), and Zhi Zi (Fructus Gardeniae).
Tanreqing injection	Huang Qin (Radix Scutellariae), Xiong Dan Fen (Fel Ursi powder), Shang Yang Jiao (Radix et Rhizoma Sophorae Tonkinensis), Jin Yin Hua (Flos Lonicerae Japonicae), and Lian Qiao (Fructus Forsythiae).
Xingnaojing injection	Moschus, borneol, Fructus Gardeniae, etc.
Shenfu injection	Hong Shen (Radix et Rhizoma Ginseng Rubra) and Hei Fu Zi (Radix Aconiti Lateralis Praeparata Nigrum)
Shengmai injection	Hong Shen (Radix et Rhizoma Ginseng Rubra), Mai Dong (Radix Ophiopogonis) and Wu Wei Zi (Fructus Schisandrae Chinensis).
Shenmai injection	Hong Shen (Radix et Rhizoma Ginseng Rubra) and Mai Dong (Radix Ophiopogonis)

Note: One or two injections can be used together, in combination with traditional Chinese medicine decoction.

[Recommended use of Chinese medicine injections for severe and critically ill cases]

It’s worth noting that traditional Chinese medicine injections should start from a smaller dose and gradually increase.

For viral infection or combined viral and bacterial infection, add 100mg Xiyanping

injection (bid) to 250ml sodium chloride 0.9%; or add 20 ml Reduning injection to 250ml sodium chloride 0.9%; or add 40ml (bid) Tanreqing injection to 250ml sodium chloride 0.9%.

For high-grade fever with disturbance of consciousness, add 20ml (bid) of Xingnaojing injection to 250ml sodium chloride 0.9%.

For systemic inflammatory response syndrome and/or multiple organ failure (MOF), add 100ml (bid) Xuebijing injection to 250ml sodium chloride 0.9%.

For immunosuppression, add 100ml Shenmai injection or 20-60ml (bid) Shengmai injection to 250ml sodium chloride 0.9%.

2.6 Convalescence

2.6.1 Qi deficiency of the lung and spleen

[Signs and symptoms]
Shortness of breath, lassitude, fatigue, a poor appetite, nausea, vomiting, abdominal fullness, weak bowel movements, and a sense of incomplete evacuation. The tongue is pale and swollen with a white, greasy coating.

[Recommended formula]

Fa Ban Xia (Rhizoma Pinelliae Praeparatum) 9g
Chen Pi (Pericarpium Citri Reticulatae) 10g
Dang Shen (Radix Codonopsis) 15g
Zhi Huang Qi (Radix Astragali Praeparata cum Melle) 30g
Chao Bai Zhu (Rhizoma Atractylodis Macrocephalae Praeparata) 10g

Fu Ling (Poria) 15g

Huo Xiang (Herba Agastachis) 10g
Sha Ren (Fructus Amomi) 6g (decoct later)

Gan Cao (Radix et Rhizoma Glycyrrhizae) 6g

[Method]

Decoct with water to get 400ml, one formula a day. Drink the decoction in two divided doses, once in the morning and once in the evening.

2.6 Convalescence

2.6.2 Deficiency of qi and yin

[Signs and symptoms]

Fatigue, shortness of breath, a dry mouth, thirst, palpitations, profuse sweating, a poor appetite, a low-grade or no fever, and dry coughs with scanty phlegm. The tongue is dry. The pulse is thready or weak.

[Recommended formula]

Nan Sha Shen (Radix Adenophorae) 10g

Bei Sha Shen (Radix Glehniae) 10g
Mai Dong (Radix Ophiopogonis) 15g
Xi Yang Shen (American ginseng) 6g

Wu Wei Zi (Fructus Schisandrae Chinensis) 6g

Shi Gao (Gypsum) 15g
Dan Zhu Ye (Herba Lophatheri) 10g
San Ye (Folium Mori) 10g
Lu Gen (Rhizoma Phragmitis) 15g
Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) 15g

Gan Cao (Radix et Rhizoma Glycyrrhizae) 6g

[Method]

Decoct with water to get 400ml, one formula a day. Drink the decoction in two divided doses, once in the morning and once in the evening.

Links of English TCM Articles

敬请点击阅读下方英文中医系列文章