Further examination of formulas and herbs in traditional Chinese medicineHERBS AND FORMULAS DEPLOYED IN COVID-19 TREATMENT As a Chinese to English medical translator, I regularly translate case studies that integrate modern pharmaceutical medicine with Chinese herbal formulas. Here, I explore herbal formulas currently used as part of COVID-19 treatment. COVID-19 FORMULAS Ma Xing Yi Gan Tang (⿇杏薏甘汤) resolves the exterior with warmth and acridity, dispels wind-dampness, and resolves phlegm. Its main ingredients are mahuang (麻黃), xingren (杏仁), yiyiren (薏苡仁), and gancao (甘草). Da Yuan Yin (达原饮) is used to treat epidemic disease and contagious diseases attributed to epidemic pestilential qi. The formula eliminates dampness, opens the membranes, pacifies the liver and gallbladder, clears disease evil, and transforms turbidity. It includes binglang (槟榔), houpo (厚朴), caoguo (草果), zhimu (知母), baishao (白芍), huangqin (黄芩), and gancao (甘草).  Hou Po Xia Ling Tang (厚朴夏苓汤) diffuses the qi dynamic, dries dampness, and disinhibits water. It is mainly used to treat people with damp-heat pathogens in qi and heavy dampness. Components include huoxiang (藿香), houpo (厚朴), banxia (半夏), xingren (杏仁), fuling (茯苓)*, zhuling (猪苓), zexie (泽泻), and yiyiren (薏苡仁). Huo Xiang Zheng Qi San (藿香正气散) treats exogenous wind-cold, internal injury, and damp stagnation. It releases the exterior, transforms dampness, regulates qi, and harmonizes the middle burner. Used for symptoms of heat effusion, headache, aversion to cold, sweating, and generalized pain. Its ingredients are huoxiang (藿香), houpo (厚朴), chenpi (陈皮), zisu (紫苏), baizhi (白芷), banxia (半夏), baizhu (⽩术), fuling (茯苓)*, jiegeng (桔梗), shengjiang (生姜), dazao (大棗), and gancao (甘草). Yin Qiao San (银翘散) clears heat, eliminates exterior wind, and relieves toxicity. It is used to treat conditions of heat effusion attributed to seasonal wind-toxin and internal damp-heat that compromise the body’s defenses. Yin Qiao San comprises jinyinhua (⾦银花)*, lianqiao (连翘)*, jiegeng (桔梗), niubangzi (牛蒡子), bohe (薄荷), jingjie (荆芥), lugen (芦根), and gancao (甘草). Guangdong Pneumonia No. 1 Formula (肺炎一号). See my February 2020 blog post for more information. Chai Ge Jie Ji Tang (柴葛解肌湯) formula addresses exterior patterns marked by sweating with coolness and acridity and clears heat. Used for pronounced generalized heat effusion, slight aversion to cold, slight sweating, thirst, thin yellow tongue fur, and rapid floating pulse. Ingredients include chaihu (柴胡)*, gegen (葛根), baizhi (白芷), gancao (甘草,) baishao (白芍,) shengshigao (生石膏), shengjiang (生姜), and dazao (大棗). Qing Fei Pai Du formula (清肺排毒) is used to treat mild, moderate, and severe cases and, depending on the circumstances, for the care of critical patients. See my February 2020 blog post for more on this formula. The website of the State Administration of Traditional Chinese Medicine (satcm.gov.cn) lists 21 components: mahuang (麻黄), gancao (甘草), xingren (杏仁), shengshigao (生石膏), guizhi (桂枝), zexie (泽泻), zhuling (猪苓), baizhu (白术), fuling (茯苓)*, chaihu (柴胡)*, huangqin (黄芩), banxia (半夏), shengjiang (生姜), ziwan (紫菀), donghua (冬花), sheqian (射千), xixin (细辛), shanyao (山药)*, zhishi (枳实,), chenpi (陈皮), and huoxiang (藿香).  PROPERTIES OF INDIVIDUAL HERBS Baishao (白芍) or Paeonia lactiflora (white peony) is an antipyretic, hemostatic, and antiseptic. It has affinity for the liver and is indicated for all symptoms of heat excess, blood deficiency syndrome, and sweating. Baishao tonifies blood and yin-energy, softens and comforts the liver, and alleviates pain (muscle spasms, abdominal pain). It is combined with guizhi for cold damage and with gancao for gastric pain. May cause drowsiness. Contraindicated for concurrent diarrhea. Baizhi (白芷) or Angelica dahuricae (angelica root) eliminates dampness, unblocks the nasal passages, alleviates pain, disperses cold, and induces perspiration. It works in the lung meridian and possesses affinity for the respiratory tract. Indicated for cold, headache, pain, and congestion. Tonic for respiratory conditions. Contraindicated in pregnancy, in patients with blood deficiency, and in those with febrile disorders. May inhibit liver microsomal cytochrome P-450 and thereby increase plasma concentrations of other drugs. Baizhu (⽩术) or Atractylodes macrocephala tonifies the spleen, tonifies the qi, dries dampness, and stabilizes the exterior. Indicated for fatigue, diarrhea, phlegm, and swelling due to damp-excess. Protects the liver, promotes urination, and reduces blood sugar. May enhance the inhibitory effect of PPIs. Use with caution with the anticoagulants heparin and warfarin. Concurrent use with diuretics may lead to increased elimination of water and/or electrolytes. Banxia (半夏) or Pinellia ternata dries dampness, transforms phlegm, and harmonizes the stomach. Expectorant, antiemetic. Prevents hardening of the spleen and reduces stagnation. Indicated for nausea and vomiting, chronic cough, excess phlegm, and gastritis. Avoid use in pregnancy. Use the prepared herb because the fresh herb is toxic. Dazao (大棗) or Ziziphus jujuba (jujube) strengthens the spleen, tonifies qi, and moderates and harmonizes the harsh properties of other herbs. Nourishes the blood and the liver, indicated for deficiency perspiration. Cardiotonic. Contraindicated in pregnancy. Gancao (甘草) or Glycyrrhizae radix (licorice root) tonifies the spleen and qi. Moderates and harmonizes the properties of other herbs, generates fluids, alleviates thirst, moistens the lungs, resolves phlegm, stops cough, and clears heat. Indicated for swollen and sore throat, coughs, and asthma. Anti-inflammatory, demulcent to the lungs, and expectorant. Gancao is the most commonly used Chinese herb. It benefits all organs and its flavor improves the taste of all prescriptions. Used for the respiratory tract because it dilates the bronchi. Lessens the harsh properties of other herbs. Combined with mahuang and xingren for cough or wheezing due to wind-cold attacking the lungs. Avoid in hypertension, low blood potassium, and cardiac disease. Avoid use in pregnancy. Possible choleretic effects. Avoid in type I diabetes. Avoid prolonged use.  Houpo (厚朴) or Magnolia officinalis (magnolia) is indicated for ailments of damp excess in the spleen and stomach, oppression in the chest, excess phlegm in the respiratory tract, and shortness of breath. Transforms dampness, promotes qi movement, warms and invigorates the spleen, and tamps down rebellious qi. Combined with banxia and fuling for phlegm that obstructs the qi. Enhances the effects of benzodiazepines. Huangqin (黄芩) or Scutellaria baicalensis (skullcap) clears heat and dries dampness. Huangqin is an antispasmodic, nerve tonic, sedative, and restorative for the nerves, it is used to support and nourish the nervous system. Contraindicated with antidepressant medications. Affects absorption of cyclosporine. Huoxiang (藿香) or Agastache rugosa (hyssop) aromatically transforms dampness in the body, harmonizes the stomach, inhibits influenza, and relieves vomiting. Huoxiang is indicated for damp excess in the stomach and spleen, oppression in the chest, sluggishness due to summer colds, and external injuries of wind-cold. Combined with zisu and houpo for fever and chills, stifling sensation in the chest, and cough and nausea due to wind-cold with dampness. Combined with banxia, fuling, and houpo for early stages of damp-warmth when dampness predominates with fever. Jiegeng (桔梗) or Platycodon grandiflorum suppresses cough, reduces sputum, opens the lungs, and expels phlegm. Indicated for sore throat, hoarseness, and cough. Enters at the lung meridian, detoxifies the liver, and induces secretions to dilute accumulated phlegm. Contraindicated in those with chronic cough from yin deficiency; contraindicated in those with hemoptysis. Mahuang (麻黃) or Ephedra sinica induces sweating, releases the exterior, disseminates and facilitates lung qi, calms wheezing, stops coughing, promotes urination, and reduces edema. Affinity for the lungs and bladder. Dilates the bronchi. Indicated for wind-cold chills and fever. Overuse may cause excess sweating. Use with cardiac glycosides may lead to cardiac arrhythmia. Do not combine with sympathomimetic drugs, may reduce the effects of beta blockers. Use with diuretics may lead to increased elimination of water. Hypertension noted with high doses of mahuang. Avoid prolonged use. Xingren (杏仁) or Prunus armeniaca (apricot kernel) stops cough and calms wheezing, moistens the intestines, and unblocks the bowels. Indicated for constipation. Indicated for cough due to heat or cold and for wind-dry cough. Contraindicated in children. Yiyiren (薏苡仁) or Coix lacryma-jobi (Job’s tears) promotes urination, decongests the lungs, leaches out dampness, clears heat, strengthens the spleen, and dispels dampness. Indicated for dark and scanty urine, swelling, and painful joints due to damp excess. Indicated for any damp-heat condition. Avoid use in pregnancy.  *See February 2020 blog post.
**See November 2019 blog post for more information about Astragalus. Disclaimer: This blog is an overview of herbal information from Chinese and English references. It is provided for educational purposes only. If you have COVID-19 symptoms, please contact your local public health service or a physician. Seek the advice of a qualified healthcare practitioner before taking any herbal medicine, dietary supplements, or pharmaceutical remedies.
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