By Dr Luo Anming

New Coronavirus Pneumonia Overseas Chinese Medicine Prevention and Treatment

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Trial Version 1

By Dr. Luo Anming of Wuhan Xinzhou Chinese Medicine Hospital

Compiled and Translated by Dr. Greta Young Jie De (Ph.D)

New coronavirus pneumonia, referred to as “new coronary  pneumonia”, named by the World Health Organization as “2019 Corona Virus Disease 2019” (COVID-19). This is in reference to the infection caused by the novel coronavirus (2019 novel Coronavirus, 2019-nCoV).  Pneumonia is generally susceptible to the population with transmission via the respiratory tract droplets and close contact is the main pathway of transmission. There is a possibility of transmission through aerosols when exposed to high concentrations of aerosols for a long time in a relatively closed environment. A total of 209 countries and regions worldwide have confirmed cases of new coronary pneumonia. WHO believes that the current new coronary pneumonia epidemic can be called a global pandemic (Pandemic).

China as the first country with the initial outbreak of the epidemic, through the adoption of a series of effective preventive, medical treatment and strict lockdown measures, the epidemic in China has basically been fully contained. China ’s successful experience in the prevention and treatment of New Coronary Pneumonia can be regarded as a shining example that Chinese medicine plays an active and effective role in the prevention, treatment and rehabilitation of COVID-19. Currently, the number of cases worldwide is still on the rise, the virus has no bounds hence this deadly epidemic does not distinguish between races. Traditional Chinese medicine is a National treasure of Chinese civilization with TCM application stems back thousands of years and it is our firm conviction that Chinese medicine can be a major contributor towards any future outbreaks of global epidemic.

Historically, Chinese medicine has rich experience in the treatment of epidemic with many road-tested strategies going back more than 3000 years with records dated back from”Shi Ji 史记in 243 BC. According to the statistics of Deng Tuo’s “History of Disaster Relief in China”, there were 238 major epidemics in China from Zhou to Qing Dynasty. Based on the characteristics of this epidemic, New Coronary Pneumonia is under the scope of  “warm disease 温病” in Chinese medicine　closely associated as a warm epidemic. As early as in the Yellow Emperor’s Internal Classics, important guidelines for the prevention and treatment of epidemic diseases were recorded. “If The Zheng Qi is in tact, there is no attack by the pathogenic qi and one should avoid contact with pathogenic qi .” According to this principle, combined with the clinical experience of the first-line anti-epidemic in Wuhan, China, a set of practical TCM prevention and treatment regimes are proposed from the aspects of prevention, treatment and rehabilitation. For the clinical characteristics and diagnosis of COVID-19, the main reference is the “New Coronavirus Pneumonia Diagnosis and Treatment Program” issued by the China National Health Commission and the State Administration of Traditional Chinese Medicine (trial version 7).

1.  Clinical Features:

(1) Clinical manifestations:

Based on the epidemiological investigation, the incubation period is 1-14 days, mostly 3-7 days.

The clinical manifestations are mainly fever, dry cough, and fatigue. In severe cases, dyspnea and hypoxemia usually occur one week after the onset. In severe cases, they can quickly progress to acute respiratory distress syndrome (ARDS), septic shock, and difficult to correct Metabolic acidosis, multiple organ failure, etc. In addition, severe and critically ill patients may have moderate to low fever, or even no fever.

Symptoms of some children and neonates may be atypical presented with  gastrointestinal symptoms such as vomiting and diarrhoea, or only with mental tardiness and rapid breathing.

Mild patients only shows low fever, slight fatigue, and no pneumonia.

2. Laboratory examination

     (1) General examination

During the early phase, patients may have normal or reduced peripheral blood leukocyte count (WBC), decreased lymphocyte count (LY), and increased liver enzymes, lactate dehydrogenase (LDH), and myoglobin may be seen in some cases. Most patients have elevated CRP and ESR, while procalcitonin (PCT) is normal. In severe cases, D-Dimer aggregates are elevated, and inflammatory factors are often elevated in severe and critical patients.

2. Pathology and serology

(1) Pathogenic examination: RT-PCR and NGS methods detected new coronavirus nucleic acids.

(2) Serological examination: the new coronavirus-specific IgM antibody is positive (3-5 days after onset), and the recovery period of IgG antibody is 4 times or even higher than that in the acute phase.

3. Chest Imaging:

Early stage will exhibit obvious multiple small patch shadows and interstitial changes in the outside of the lungs. Continued development of multiple ground glass (GGO) and infiltration shadows in the lungs. As for more severe cases,  chest imaging will exhibit pulmonary consolidation while pleural effusions are rare.

Diagnostic Criteria

(1) Suspected case study

1. History of Epidemiology

14 days before the onset of the disease, there is a history of contact with a confirmed infected person, a history of travel or residence in the epidemic area, and a cluster of onset.

2. Clinical manifestations

(1) Fever and / or respiratory symptoms;

(2) Imaging features of new coronary pneumonia;

(3) Early WBC count and LY count are normal or decreased;

Diagnosis basis: Those with a history of epidemiology must meet any of the two clinical manifestations. Those without a clear history of epidemiology meet the 3 in the clinical manifestations.

     Confirmed case Study

     Suspected cases with one of the following aetiological or serological evidence:

1. RT-PCR nucleic acid test of new coronavirus is positive;
2. Viral gene sequencing, highly homologous to known new coronavirus;
3. Serum New Coronavirus specific IgM and IgG antibodies are positive; IgG antibodies change from yin to yang or the recovery period is 4 times higher than the acute period.

Clinical typing:

According to clinical characteristics, it can be divided into mild, ordinary, severe and critical. For details, please refer to the relevant content of the “New Coronavirus Pneumonia Diagnosis and Treatment Program” (trial 7th version) issued by the China National Health Commission and the State Administration of Chinese Medicine

Comprehensive Prevention of Traditional Chinese Medicine

Preventative measure to adopt:

The epidemic is highly contagious and has a wide range of infectious prevalence. As stated in the “Su Wen: Ci Fa Lun” Chapter 72 quote: ” the five epidemics can be highly contagious with similar symptoms.” The indicated approach is to support the zheng qi and avoid toxic qi.

1. Isolation at home to minimize going out and close contact with people.

“Isolation” is a necessary measure to prevent infectious diseases. Through physical isolation, it blocks the rapid transmission from person to person . Thus, reducing the liklihood of infecting additional healthy people. At the same time, it is conducive to epidemiological investigation, tracing the source and controlling the infection. Therefore, you should try to isolate in your home as much as possible to reduce going out.

2. Exercise social distancing and hygiene formality. Wearing a mask when going out. Avoid crowd gathering in public places, especially places with poor air quality. Keep a distance of 1.2 to 1.5 meters away from people. It is best to wear gloves when contacting public objects in public places; after returning from public places, wash hands for twenty seconds with soap before meals and use hand to cover oneself when coughing.
3. Main a healthy lifestyle with regular exercise. Ensure sufficient rest at night with 7~8 hours per night. Avoid strenuous activities. Practise tai chi, yoga or walking for 15~30 minutes once or twice daily.
4. Mental relaxation and reasonable diet

Maintain a peaceful state of mind, void of anxiety, ambition and greed. “Shang Gu Tian Zhen Lun” Chapter one said: “When one is completely free from desire, ambitions and distracting thoughts, indifferent to fame and gain, the true energy will come in the wake of it. When one concentrates his spirit internally and keeps a sound mind, how can any illness occur?” Keep a balanced diet with fresh and easily digestible food, avoid greasy and rich food. Do not eat excessively and avoid eating cold food and steer clear of ingesting wild animal meats. Drink at least 1500 ml of water daily.

5. Preventative Chinese formula

(1) Wu Mei Jin Shui Liu Jun Jian

Dang Shen 15g; Dang Gui 15g; Hei Dou 15g; Chen Pi 6g; Qing Ban Xia 3g; Fu Ling 10g; Sheng Gan Cao 10g; Wu Mei 20g; Dou Chi 6g; Bai Bian Dou 10g; Sheng Jiang 6g; Bai He 20g. One pack per day for 7~10 days. Decoct in water to be taken warm twice daily.

Jin Shui Liu Jun Jian can support the zheng qi with a focus on sour medicinal as sour and sweet can nourish yin and support the spleen; sour can nourish the liver yin, regulate the liver and spleen to ensure the preservation of zheng qi.

(2) Fragrant Sachet

Traditionally, Chinese medicine resorts the use of fragrant sachet to ward off turbidity in an endeavour to prevent epidemic diseases. It is under the scope of external treatment of Chinese medicine, Sachets are generally sewn from rags and filled with coarse powders of Chinese medicine ( Bai Zhi, Chuan Xiong, Qiang Huo, Cang Zhu, Chai Hu, Da Huang, Ai Ye, Wu Zhu Yu, Gan Song, Ding Xiang etc) to grind into powder to be worn in the chest to avoid epidemic toxin.

（3）Sesame Oil

The sesame oil, also known as Ma You 麻油,  has a cool and sweet taste with the effects to moisten, detoxify and generate flesh. The ancients used sesame oil on their nose for epidemic prevention. The Qing Dynasty Zhao Xue Min’s book entitled “Chuan Ya Nei Wai Bian” has recorded that sesame oil can prevent epidemic.  “Everyone who enters a plague house, coats his nostrils with sesame oil, before entering the house as this may prevent infection. When you are out, use a paper twist to probe your nose to induce sneezing. ” External pathogen often invades the body via the mouth and nose. When it is applied to the nostrils, it can obstruct the invasion of external pathogen. It has the connotation of aromatic flavour can ward off turbidity.

(4) Nose Bath

Nose bath is to clean the nostrils. When bathing the nose, soak the nose, soak the nostrils in the water, use the nostrils to absorb the water, and then raise your head. The nose leaves the water and exhales the water. The breath is counted as a bath, and it is washed 10-20 times a day. Nose bathing can keep the nose clean, increase the resistance of the nose to outside temperature changes, and prevent various rhinitis and respiratory infections. Chinese medicine believes that the nose is the orifice to the lungs; Warm pathogen will invade the lung first, thus, bathing the nose plays a certain role in preventing an attack by warm pathogen.

(5) Dietary Therapy

Si Dou Tang (Four Beans Soup) : Hei Dou, Huang Dou (Soybean); Bai Bian Dou,　Lu Dou (Mung bean) with ratio of 3:2:1:1. Decoct the above four beans in water and drink or make into a soy milk drink, or add water and rice, and cook into a gruel to eat. According to different constitution of the person modify the drink accordingly .Person with deficiency of yin, add Shan Yao; for more damp, add Yi Ren; for qi dficiency, add Dang Shen or Xi Yang Shen; for blood stasis, add Chi Xiao Dou etc

(6) Chinese Patent Medicine:

According to the different constitution, they are: Yu Ping Feng San, Xiang Sha Liu Jun Zi wan; Gui Pi Wan, Bu Zhong Yi Qi Wan; Huo Xiang Zheng Qi Liquid; Xiao Chai Hu granules; Jin Shui Bao, Bai Ling Capsule etc.

2. Treatment

Mainly targeted at COVID-19 mild and ordinary patients and those with asymptomatic infections, outpatient treatment was adopted with the implementation of home isolation As for the severe and critically ill patients, they will be  hospitalized.

COVID-19 is a highly contagious febrile disease characterized by intrinsic deficiency. Treatment is to combined disease identification with syndrome differentiation. The pathogenesis involves heat in the upper jiao, cold in the lower jiao with dampness in the middle. Treatment is to tonify the kidney, replenish the essence, nourish yin, astringe the liver, tonify the spleen, transform phlegm and loosen the chest. As a general rule of thumb, stick with the Shang Han Lun teaching ie “Observe the pulse sign, know what error you have made and treat accordingly.” The other treatment principle is to base your treatment on one symptom without having to wait  for the manifestation of other symptoms. (Ref: Shang Han Lun Cluase 101 on application of Xiao Chai Hu Tang). Guided by these two key treatment principles coupled with the characteristic of the pattern, we recommend the following formulas: (1) Jin Shui Liu Jun Jian indicated for poor appetite, glomus and fatigue; (2) Xia Qi Tang indicated for chest oppression and cough; (3) Xiao Chai Hu Tang indicated for rib-side discomfort or fever in the afternoon or at night; (4) Ban Xia Xie Xin Tang indicated for heat in the upper jiao and coldness in the lower jiao; (5) Zhi Shi Yin Ju San indicated for thirst and unresolved fever. It must be emphasized that parching, lifting the yang and sweat promotion herbs are contraindicated; purging and warm tonifying herbs are also prohibited.

1. Jin Shui Liu Jun Jian Pattern:

Clinical features: Poor appetite, glomus, fatigue, dry hacking cough with little phlegm or difficulty to expectorate the phlegm; parched throat and dry mouth, red tongue with

white,slippery or thin greasy tongue coating; wiry and thready or slippery pulse. These are more prevalent with the mild and ordinary type of COVID-19 patients.

Herbal ingredients: Fu Ling 15g; Fa Ban Xia 15g; Chen Pi 15g; Dang Gui 10g;Dang Shen 15g;Hei Dou 20g; Wu Mei 15g;Sheng Gao Can 10g;Yi Ren 30g; Bai Bai Dou 15g;Bai He 15g;Dan Shen 15g; Chi Shao 15g; Chi Xiao Dou 15g; Yin Yang Huo 15g; Tai Zi Shen 15g; Shan Yao 30g;Chao Gu Mai Ya 15g each.

Action: Nourish yin, transform phlegm; augment qi and tonify the kidney.

Method: Decoct in water to get 400ml and take one pack to be given morning and night half hour before meals.

2. Xia Qi Tang:

Clinical features: Chest oppression, cough, wheezing, fatigue, thirst with no desire to drink; dull tongue with greasy tongue coating, submerged and thready pulse. More prevalent with ordinary and severe type of COVID-19 patients.

Herbal ingredients: Fu Ling 9g; Zhi GanCao 6g; Pi Pa Ye 9g; Xing Ren 9g; Chen Pi 9g; Bai Shao 9g; Dan Pi 9g;Nan Sha Shen 15g; Chuan Bei 9g; Hei Dou 15g;Wu Mei 9g; Shan Yao 30g; Tai Zi Shen 15g; Fa Ban Xia 9g; Dan Shen 15g; Dang Shen 15g;Bai Bu 9g; Zhi Qiao 9g; Jie Geng 9g

Action: Loosen the chest, downbear qi; nourish yin and transform phlegm

Method: Decoct in water to get 400 ml to be taken warm morning and evening half hour after meals.

3. Zhi Shi Yin Ju San:

Clinical features: Fever, cough, aversion to cold, generalilzed ache, thirst, red tongue with white or yellow tongue coating and a rapid pulse. More prevalent for ordinary or early severe type of COVID-19 patients.

Herbal ingredients: Zhi Shi 9g; Jie Geng 9g;l Zhu Ye 9g; Jin Yin Hua 9g;Ju Hua 9g; Yu Zhu 9g; Mai Dong 9g;Tian Hua Fen 9g; Zhi Mu 9g;ChuanBai 9g; Bo He 9g;Qing Hao 9g;Bie Jia 15g; Gui Ban 15g; Yin Chai Hu 9g;Di Gu Pi 15g.

Note: Bia Jia and Gui Ban can be substituted with Xuan Shen 15~30g; Sheng Shu Di 15g~30g each. Sha Ren can be added to negate the cloying property of Shu Di.

Action: Nourish yin,clear heat, diffuse lung and regulate qi.

Method: Decoct in water to get 600ml to be taken warm morning and evening half hour before meals.

4. Xiao Chai Hu Tang:

Clinical features: Chest and rib-side discomfort, cough, parched mouth, fatigue, or fever in the afternoon and evening; thin white or slippery tongue coating; wiry and thready pulse. More prevalent with ordinary and late stage of severe COVID-19 patients.

Herbal ingredients: Chai Hu 9g; Huang Qin 9g; Fa Ban Xia 9g; Dang Shen 15g; Sheng Gao Cao 9g; Wu Mei 9g; Bie Jia 15g; Gui Ban 15g;Chuan Bei 9g; Hei Dou 15g; Xuan Shen 15g; Sheng Di 15g; Wu Wei Zi 9g;Chi Shao 9g; Zhi Qiao 9g; Chao Mai Ya 15g;Chao Gu Ya 15g.

Action: Disperse constrained liver, resolve fever, nourish yin and regulate qi.

Method: Decoct in water to to 400ml to be taken morning and evening half hour after meals.

5. Ban Xia Xie Xin Tang:

Clinical features: Vexation heat in the chest; cough, cold limbs, fatigue, cough, thirst with desire to drink hot drinks; borborygmus; diarrhoea, thin,yellow and greasy tongue coating and wiry and rapid pulse. Most prevalent for severe type of COVID-19 patients.

Herbal ingredients: Fa Ban Xia 9g;Huang Qin 9g; Huang Lian 3g; Pao Jiang 9g; Dang Shen 15g; Zhi Gan Cao 9g; Wu Mei 9g; Hei Dou 15g; Du Zhong 15g; Xu Duan 15g;Xing Ren 9g;l Su Zi 9g;Yu Zhu 9g; Tian Hua Fen 9g; Bai He 15g; Chen Pi 9g; Dan Shen 15g; San Qi 6g; Wu Wei Zi 9g.

Action: Clear upper jiao heat and warm lower jiao coldness; nourish yin and harmonize the stomach.

Method: Decoct in water to get 400ml to be taken warm morning and evening half hour after meals.

6 Modifications:

(1) For Respiratory symptoms: For copious phlegm and greasy tongue coating; Add Si Gua Lou30g; Fu Hai Shi 15g; for incessant cough,add Zi Wan 15g; Ke Zi 10g; for itchy throat and cough,add Jie Geng 9g;Mu Hu Tie 9g;Ke Zi 9g.

(2) For gastro-intestinal symptoms: Poor appetite, add Chao Shen Qu 10g or Chao Shan Za 15g; for sloppy stool, add Chao Bai Zhu 15g; or Cang Zhu 10g or Lian Zi 30g;

(3) For metabolic disorders symptoms:

Thirst, add Xi Gua Cui Yi (Melon Skin) 30g;He Ye 10g; for excessive urination, reduce the dosage of Wu Mei and add Yi Zhi Ren 10g; for nocturanl sweating,add Wu Wei Zi 10g or Huang Bai 10g.

(4) Other discomfort symptoms:

Unabated chest oppression, add Hong Jing Tian 15g; for insomnia add He Huan Pi 15g or Yuan Zhi 10g; or Bai He 30g; for fatigue and weak limbs add Mu Gua 15g; Niu Xi 15g; Qian Shi 30g; for stubborn continuous positive nucleic acid swat test add Yi Ren 30g;Bai Zhu 15g;Huang Qi 15g;Fang Feng 10g or Sheng Ma 15g.

3. Convalenscence:
4. Criteria for convalenscent COVID-19 patients:

1) The body temperature returns to normal for more than 3 days;

(2) Respiratory symptoms improved significantly;

(3) Imaging of the lungs show a significant improvement in acute exudative lesions;

(4) Two consecutive negative nucleic acid tests on respiratory specimens (sampling time at least 1 day apart); or negative stool nucleic acid tests.

Those who meet the above criteria will be classified as convalenscent patients but they must still be isolated at home or stay in a designated isolation location.

(2). Lift the isolation standard

During the convalenscent period, the nucleic acid test and the COVID-19 antibody are reviewed at week 2 and week 4. If the nucleic acid test is negative, IgM is positive or negative, and IgG is positive, the isolation is released.

(3). Chinese medicine will be given during the ensuing period to consolidate.

(1) Spleen Qi Deficiency :

Clinical feature: Shortness of breath, fatigue and lethargy, poor appetite and nausea, forceless defecation, sloppy bowel movement, pale and swollen tongue with white and greasy tongue coating.

Prescription: Xiang Sha Liu Jun Wan modified: Fa Ban Xia 9g;Chen Pi 10g; Dang Shen 15g;Zhi Huang Qi 30g; Chao Bai Zhu 10g; Fu Ling 15g; Sha Ren 6g (to be added afterwards);Shan Yao 15g;Yi Ren 15g;Bai He 15g;Gan Cao 6g.

(2) Qi and Yin Deficiency

Clinical features: Fatigue, shortness of breath, parched mouth, thirst, heart palpitations; sweating, poor appetite; low-grade fever or no fever, dry hacking cough with scant phlegm; dry tongue which lacks moisture; thready or deficient and forceless pulse.

Herbal formula: Sheng Mai Yin modified: Nan Bei Sha Shen 10g each; Mai Dong 15g; Xi Yang Shen 6g; Wu Wei Zi 6g; Bie Jia 15g (decoct first); Gui Ban 15g;Dan Shen 15g; Hong Jing Tian 15g;Dang Shen 15g; Bai Bu 9g; Sheng Gan Cao 6g.

The above recommended Chinese medicine is 1 pack per day with a total of 400ml to be taken warm twice daily (morning and evening).

During the recovery period, it is appropriate to eat millet porridge or glutinous rice porridge to nourish the stomach. Based on the pattern differentiation  Lian Zi, Da Zao, Bai He, chestnut, Shan Yao, Fu Ling, Yu Zhu, Huang Jin; Dang Shen, Xi Yang Shen, Qian Shi, Bian Dou, Gui Yuan Rou, Yi Ren, Chi Xiao Dou to be added to the gruel . It is recommendable for COVID-19 convalenscent patients to do some mild exercise such as walking, aerobic, slow jogging and avoid unnecessary exertion. Apart from this, acupuncture, gua sha, auricular acupuncture and massage can also be incoporated.

About Dr Luo Anming

Dr Luo Anming 罗安明 is the Deputy Chief Physician and Director of the Department of Oncology at Xinzhou District Traditional Chinese Medicine Hospital, Wuhan City, Hubei Province, China. Concurrently he serves as the executive director of the World Assoc…Read more