Traditional Chinese Medicine and the Novel Coronavirus - Part I

​How is COVID-19 diagnosed and treated using TCM?   

The Chinese-language newspaper Sing Tao (stnn.cc) reported earlier this year that 93.5% of COVID-19 patients in Guangdong had been treated with traditional Chinese medicine (TCM). Clinics encouraged the use of TCM as early intervention in mild cases of coronavirus infection. As of May 20th, 1481 of 1488 patients receiving TCM treatment were cured and subsequently discharged. 
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3000-YEAR HISTORY 
In traditional Chinese medicine, which is based on empirical observation and practical medical knowledge, the physician observes patterns in a multiplicity of clinical events to visualize a bodily landscape. Aspects of activity or illness in the body are corresponded to elements in nature and individual disharmonies are noted. A system of pre-technological medical thought, TCM has its own systems of the body and parallel notions of reharmonizing opposites. Diagnosis is based on recognizing and precisely describing patterns of disharmony and then reconciling hostile elements in the body. Extremes are balanced. The highly personalized diagnostic process attempts to capture the essence of the individual patient.
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Tools developed by Chinese medicine over 3000 years to diagnose, prevent, and cure disease: food as medicine, herbal remedies, acupuncture, moxibustion, tongue diagnosis, pulse diagnosis, and facial pallor. 

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​DISEASE THEORIES
Historically, TCM has categorized infectious disease as Shanghan (damaged by cold) and Wenbing (warm disease).
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Shanghan (伤寒)
Shanghan refers generally to heat (febrile) disease caused by exogenous pathogenic factors and specifically to acute diseases caused by exogenous cold-evil or malicious cold.
Shanghan in later Han Dynasty medical references is a pathological condition described as externally contracted heat disease with absence of sweating, stiff neck, and a tight floating pulse. 

In Shanghan theory, all heat diseases are of the cold damage kind. Stage 1 starts at the exterior, the respiratory tract, and manifests as chills and sniffles. Stage 2 progresses inward to the lungs and the digestive tract and may manifest as cough and gastrointestinal symptoms.
Stage 3 moves deeper into the digestive tract and the kidneys.
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Wenbing (温病) 
Wenbing is defined as any of various heat diseases due to exogenous pathogenic warmth or heat, characterized by rapid onset and shifts, pronounced heat signs, and a tendency to form dryness and damage the yin. It is infectious and seasonal in nature. Originating in the Ming Dynasty 500 years ago, Wenbing theory builds on earlier Shanghan concepts to elucidate the spread of pathogens from person to person. 

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​HOW DOES TRADITIONAL CHINESE MEDICINE CATEGORIZE COVID-19?
 
TCM views COVID-19 using concepts from Shanghan and Wenbing. In both theories, the disease progresses from the exterior to the interior. COVID-19 pneumonia is categorized as Wenbing. The main cause of this disease is damp heat with pestilent toxin, and the pathological features are “dampness, heat, stasis, toxin, and vacuity.”
 
In clinical practice, the COVID-19 patient may present with fever, fatigue, sore muscles, feeling of heaviness in the body, poor appetite, and greasy tongue coating – indicating that the pathogen is in the exterior. Most patients have cough, chest oppression, panting and/or urgent breathing. The fundamental pathogenic factors are dampness and heat. 

PATTERNS ASSOCIATED WITH COVID-19 DISEASE
 
COVID-19 manifests differently based on patient age, disease state, and geographic location. In assessing the patient, the TCM practitioner performs a thorough review of symptoms and selects the pattern that best describes the individual patient.

Pathogenic Damp Stagnation in the Lungs 邪湿郁肺型

Stagnation makes qi movement through this pivot difficult and interferes with the qi dynamic of the lungs. Early symptoms include low-grade fever or no fever, slight aversion to cold, sensation of heaviness and stuffiness in the head and body, muscle pain and soreness, fatigue, cough with scant phlegm, dry mouth with little intake of fluids, feeling of oppression in the chest, nausea, poor appetite, diarrhea, and thin stool. The tongue is pale red with a greasy white coating; the pulse is floating and slightly rapid.
 
Pathogenic Heat Obstructing the Lungs 邪热阻肺型

In this pattern, the lungs lose the ability to diffuse and descend. Symptoms include fever or high fever, cough, yellow or thick phlegm, fatigue, headache, pain and soreness throughout the body, dryness and bitter taste in the mouth, irritability, constipation, and reddish urine. Tongue is red with a greasy yellow coating. Pulse is slippery and rapid.
 
Damp-Warm Stagnation in the Lungs 湿温郁肺型

Symptoms include fever, strong or abnormal sensation of heat, slight aversion to cold, cough, yellow and thick phlegm, chest oppression, shortness of breath after exercise, lack of energy, dry mouth, lack of appetite, abdominal distention, dry and bound or sluggish stool, a sensation of incomplete defecation, and yellow urine. Pale red tongue with thin yellow greasy coating. Slippery and rapid pulse.

Pestilent Dampness Damaging the Lungs 疫湿伤肺型
Normal body temperature. Symptoms may include cough with little or no phlegm, chest oppression or shortness of breath after exertion, lethargy and fatigue, spontaneous sweating, palpitations, or poor appetite. Tongue is pale red with a white coating or slightly greasy. 

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​HOW DOES TRADITIONAL CHINESE MEDICINE TREAT COVID-19?

To treat COVID-19, TCM employs herbs that transform dampness and release toxins, as well as herbs that clear heat and resolve toxins. The goal is to diffuse the lungs to vent pathogens. TCM uses herbal formulas, moxibustion (mugwort burned at the skin over acupuncture points), and acupuncture in combination because the approaches act synergistically to improve symptoms. Treatment is tailored to the patient’s symptoms and based on the practitioner’s knowledge about local manifestations of the virus. ​
 
Guangdong Province The Chinese Medicine Protocol for Pneumonia Due to Novel Coronavirus released in Guangdong Province outlines the particular epidemiological features, clinical presentation, and clinical features of the progression of COVID-19 pneumonia in Guangdong.
The climate in southern China is damp and humid, and pestilent qi easily mixes with this dampness, first attacking the lung defenses, particularly in patients with a weak spleen and stomach. If the healthy qi is unable to defeat the pestilent unhealthy qi, then the pathogenic toxin moves to the interior and transforms into heat, harming the bodily fluids and depleting the humors, sometimes to the point of agitating the blood, which can create a critical situation.
 
Hubei Province The novel coronavirus first appeared in humans in the cold, damp winter of Wuhan, a central Chinese city situated on the Yangtze River. Clinical departments at Hubei Provincial Hospital of Traditional Chinese Medicine collaborated to investigate and formulate protocols for preventing and treating COVID-19-related pneumonia, which TCM practitioners termed “damp heat in the lungs.”

Critical viral respiratory disease formulas
Primary treatment strategies target latent heat and damage to qi and yin. TCM concludes that the cause of coronavirus is primarily dampness, which obstructs the spleen and blocks the lungs (湿困脾闭肺) and disrupts the bearing [rising and falling] of the qi dynamic (⽓机升降失司). Damp toxins are converted into heat, bowel repletion develops, damp toxins and stagnating heat are locked in, and the increasing heat leads to severe qi reversal and imbalance.
  
Next month: Overview of Herbal Formulas and the Properties of Individual Herbs
  

This blog introduces theories from traditional Chinese medicine. 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 supplement, or pharmaceutical remedy.

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