In early 2020, the academic team of the Beijing Traditional Chinese Medicine Research Institute, led by Director Liu Zhijie, released the first and second editions of the “Traditional Chinese Medicine Treatment Plan for COVID-19” and related popular science articles, which helped many patients and frontline clinical doctors based on the characteristics of COVID-19 cases at that time and the relevant treatment data published by the state.
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1. Traditional Chinese Medicine Treatment Plan for COVID-19 (First Edition) 2. Traditional Chinese Medicine Treatment Plan for COVID-19 (Second Edition) 3. Two cases of Traditional Chinese Medicine treatment for COVID-19 infection 4. Is Traditional Chinese Medicine suitable for pneumonia prevention? … How to prevent it? 5. Traditional Chinese Medicine prevention and control of external pathogenic epidemics 6. Excerpts from “Classical Formulas and Treatment”: Overview of External Pathogenic Diseases As the virulence of the COVID-19 virus weakens, its transmissibility increases, and the symptoms shift primarily to the upper respiratory tract, the treatment plan should also be revised accordingly. To facilitate medical personnel in accurately differentiating syndromes and selecting herbal prescriptions, our institute has renamed the treatment target to “COVID-19 External Pathogenic Disease” based on the observation that most current COVID-19 cases initially do not exhibit “pneumonia” characteristics but primarily present as typical Traditional Chinese Medicine “External Pathogenic Disease”.
At the same time, our institute has launched the third edition of the treatment plan based on the analysis and summary of the clinical course of over a thousand patients observed recently (including reasonable treatments and rapid alleviation of cases, misdiagnosed cases, and untreated cases), continuing to provide our treatment ideas for colleagues fighting on the clinical front lines and contributing to the control and treatment of epidemics through Traditional Chinese Medicine.
COVID-19 External Pathogenic Disease
Traditional Chinese Medicine Treatment Plan
Table of ContentsI. Characteristics of the Disease and PathogenesisII. Treatment Guidelines and PrecautionsIII. Differentiation and Treatment of Traditional Chinese Medicine Classical Formulas(1) Primarily External Pathogenic Disease of the Taiyang (Greater Yang) (2) Primarily External Pathogenic Disease of the Shaoyin (Lesser Yin) (3) External Pathogenic Disease combined with Shaoyang (Lesser Yang) (4) External Pathogenic Disease combined with Jueyin (Terminal Yin) (5) Modifications and Treatment during RecoveryIV. Use of Chinese and Western Medicines
V. Simple Prevention and Treatment
I. Characteristics of the Disease and Pathogenesis
Since the second half of 2022, the COVID-19 epidemic across the country still falls under the category of Traditional Chinese Medicine “External Pathogenic Disease”, but the disease location has shifted from the “lungs” to primarily the upper respiratory tract. Since November, most COVID-19 cases have developed rapidly, with symptoms changing quickly, typically progressing from initial throat discomfort to fever (38-40°C), chills, body and joint pain, and fatigue within 12 hours. By the second or third day of illness, symptoms such as throat pain, cough, sputum production, nasal congestion, runny nose, loss of smell or taste, nausea, dry heaving, and diarrhea may also appear.Although the symptoms of cases in different regions vary slightly due to factors such as the natural environment (for example, cases in northern and central China tend to have more severe fever and pain, while southern cases tend to have milder pain or predominantly soreness, and southwestern cases often present with cold and damp symptoms), the basic pathogenesis in Traditional Chinese Medicine is primarily characterized by external pathogenic cold syndrome, or combined with external pathogenic wind and external pathogenic dampness, while pure external pathogenic heat (warm disease) is relatively rare. Additionally, due to individual constitution, it often combines with internal injury diseases (commonly seen are Taiyang, Shaoyin, Shaoyang, and Jueyin diseases).Most cases exhibit a tongue body that is often red at the edges and tip, with a dry tongue body, and some may show tooth marks; the tongue coating is often thin white, with the root of the tongue slightly thick and white or slightly yellow.This indicates that the syndrome still centers on external pathogenic surface syndrome, where the external pathogenic evil and the righteous qi contend at the surface, resulting in a pathological state of mixed cold and heat, with the pathological products primarily being obstruction of fluid distribution leading to qi stagnation, or accompanied by water retention, food accumulation, and blood stasis often related to underlying diseases.Older or weak patients often present with mixed cold and heat external pathogenic disease combined with Jueyin disease; younger or healthier patients often present with Taiyang external pathogenic disease or external pathogenic disease combined with Shaoyang disease; children often present with Taiyang external pathogenic disease or combined with Taiyang and Yangming.In summary, the recent COVID-19 epidemic primarily presents as external pathogenic surface syndrome, with the degree of internal transmission of the pathogenic evil being relatively lighter than in the past, and the combined syndromes mostly resulting from the original disease being affected by this disease.
If during the illness there is misdiagnosis or mistreatment (as detailed in the next section) or poor recovery, it is easy to see internal injury syndromes of Taiyin or Yangming during the recovery period, often manifesting as fluid retention or diarrhea.
II. Treatment Guidelines and Precautions
1. In recent COVID-19 cases, the following three situations can be observed: infected individuals without symptoms such as fever and body pain often do not require (or need) medication; patients with obvious symptoms who have received reasonable antipyretic and analgesic treatment generally stabilize and reduce fever within 2-3 days; patients with obvious symptoms who have not received treatment are less frequently observed, with some experiencing persistent or recurrent fever for several days.2. With reasonable and timely treatment using Traditional Chinese Medicine classical formulas, patients generally experience relief from fever and body pain after slight sweating from medication, with stable fever reduction within 12 to 24 hours, significant symptom relief within 1-2 days, and no occurrence of throat pain symptoms, with viral tests turning negative around 3-5 days, and basic recovery within 1 week, with complete recovery time related to individual constitution, pre-existing conditions, and adherence to treatment.3. Reasonable hydration and normal disease expulsion responses are particularly important for recovery, such as correct sweating (covering oneself after taking medication to induce slight sweating, feeling sweat on the body is sufficient), drinking warm water appropriately after sweating (just to quench thirst and replenish body fluids), coughing to expel phlegm (detoxification process), and ensuring smooth bowel and bladder movements are crucial for ensuring therapeutic efficacy.4. Failure to adhere to treatment, improper treatment, or weaker constitutions may lead to symptoms such as coughing, a sensation of foreign body in the throat, loss of smell and taste, gastrointestinal discomfort that are difficult to relieve or recurrent, requiring targeted consolidation treatment.5. It should be noted that many patients using ibuprofen either do not show significant antipyretic effects or experience large fluctuations in body temperature, with other symptoms recovering slowly, while patients using acetaminophen, Gankang and other medications generally show relatively obvious and stable antipyretic and analgesic effects. This is related to the different degrees of these medications’ effects on the body’s fluid regulation.For those with significant fluid deficiency or weak constitutions, caution is advised when using ibuprofen.6. Recently, many patients taking Lianhua Qingwen or other clearing heat and detoxifying Traditional Chinese Medicine preparations or decoctions have either shown poor antipyretic effects or although symptoms may temporarily alleviate, the recovery period is significantly prolonged, with other symptoms alleviating and treatment slowing down. This is related to the fact that recent cases primarily present with cold damage syndrome, and these medications are only for symptomatic treatment, but their cold nature may lead to retention of evil, causing symptoms such as cough, sputum production, runny nose, diarrhea, and loss of appetite to persist and recur, making it more likely to cause evil retention for a prolonged period, leading to warm toxic heat diseases in the following spring and summer.In other words, influenced by winter climate, for patients primarily presenting with external pathogenic cold damage syndrome, if antipyretic and analgesic medications, clearing heat and detoxifying medications, or clearing heat and purging medications are used improperly, it is easy to lead to recurrent or prolonged illness. Incorrect use of cold medications may also easily cause adverse reactions such as liver damage.For example, when using Angong Niuhuang Wan to treat persistent high fever, it is important to continue taking the appropriate formula after fever reduction to address residual external pathogenic evil, to prevent the evil from penetrating internally or transforming.7. Before recovery, it is advisable to avoid eating cold or overly sweet foods and fruits to prevent inducing or exacerbating symptoms such as coughing, sputum production, nausea, abdominal distension, and diarrhea; it is essential to avoid exposure to wind or cold from bathing, or to avoid bathing during the illness, as this can easily lead to symptom recurrence.
8. COVID-19 and other epidemic diseases are easily influenced by seasonal, climatic, and geographical factors. For example, if the climate warms or a specific environmental condition leads to the emergence of warm heat disease syndromes, reference can be made to the relevant formulas in the “Modifications and Adjustments” section for differentiation and treatment.
III. Differentiation and Treatment of Traditional Chinese Medicine Classical Formulas
External pathogenic disease refers to diseases caused by external pathogenic evils, whether induced by abnormal natural environmental factors disrupting the body’s internal environment or by bacteria and viruses (referred to as epidemics in Traditional Chinese Medicine) invading the body, all fall under the category of external evils causing external pathogenic diseases.Similar to the past, recent COVID-19 symptoms are still primarily caused by the evil of epidemics, presenting as external pathogenic wind-cold or mixed with dampness and warmth in surface syndromes, and may also combine with pre-existing internal injury diseases. Therefore, when diagnosing and treating this disease, the focus should be on treating the external pathogenic surface syndrome while also addressing internal injuries.The difference is that previous COVID-19 cases exhibited significant differences between mild and severe types, while recent COVID-19 cases are mostly mild (rarely showing significant organic changes or lung involvement), and severe cases are primarily seen in patients with multiple or severe underlying conditions, requiring treatment in designated medical institutions. Therefore, the target of this treatment plan is mainly mild COVID-19 patients.
During the diagnosis and treatment process, in addition to clarifying the cold-heat tendency of the symptoms and the pathological products, it is especially important to pay attention to the differentiation of the “external pathogenic disease” syndrome types, carefully inquiring about the degree of fever, chills, sweating, thirst, pain severity and location, with pulse diagnosis as the primary method and tongue diagnosis as a supplementary method, to clarify the abundance or deficiency of body fluids, which will allow for more precise selection of herbal prescriptions.
Differentiation Guidelines
1. The syndrome types of recent COVID-19 cases primarily focus on distinguishing between cold damage (chills, no sweating, head and body pain, cough, wheezing, pulse floating and tight, etc.), wind syndrome (aversion to wind and cold, sweating, head and body pain, pulse floating and rapid, etc.), and dampness syndrome (aversion to wind and cold, joint pain and discomfort, body swelling or joint redness and pain, etc.). Secondly, it is important to distinguish between Taiyang external pathogenic disease (with obvious elevated body temperature or high fever) and Shaoyin external pathogenic disease (with no obvious elevated body temperature, low fever, slight fever, or no fever), so as to clearly select the basic formula types.
2. Recently, most cases exhibit symptoms of fever, chills, no sweating, head and body pain, thus the majority are classified as Taiyang external pathogenic cold syndrome, with a small number of patients presenting with Shaoyin external pathogenic syndrome.3. Some cases, influenced by factors such as constitution, often present typical combined syndromes of Shaoyang and Jueyin, therefore it is essential to conduct targeted and detailed inquiries about the patient’s condition based on the outlined syndromes to avoid misdiagnosis and treatment that only addresses external pathogens, leading to syndrome transformation.4. A small number of patients may develop combined internal injuries of Yangming or Taiyin at the onset of illness or after misdiagnosis.5. Based on the above characteristics, this treatment plan will be discussed in the following five sections. For detailed discussions on external pathogenic diseases, please refer to the relevant chapters in “Classical Formulas and Treatment”.6. This plan is applicable to the diagnosis and treatment of other external pathogenic epidemics.
Note
The dosages of the following formulas are based on Han Dynasty measurements, i.e., 1 tael = 15g, 1 liter = 200mL, and should be adjusted according to actual clinical situations. For such infectious diseases with strong contagion and rapid progression, the dosage should not be too small, otherwise, the medicinal effect will not counteract the disease, making it difficult to achieve good and rapid efficacy.Recommended dosage of 1 tael: For adults or those with good constitutions, 10-15g; for elderly or weak patients, 5-10g; for children, 3-5g.Click to enter the above mini-program to query more formula content.
(1) Primarily Taiyang External Pathogenic Disease
As mentioned above, in recent COVID-19 cases, Taiyang external pathogenic disease is the primary syndrome type, with Taiyang external pathogenic cold syndrome and wind-cold dual invasion syndrome being the most common, with a small number combined with external pathogenic dampness.1. Taiyang External Pathogenic Cold SyndromeSyndrome manifestations: Fever or high fever, aversion to cold, no sweating, pain in the head, body, joints, or muscles; or dry mouth and thirst, or cough and throat pain; pulse floating, tight, and rapid; tongue pale red or red at the edges, with thin white or slightly yellow coating.Recommended basic formulas: 1) If the onset is rapid, symptoms are relatively singular, or the patient is robust or a child, Ma Xing Shi Gan Decoction is recommended.2) If there is high fever, no sweating, and significant agitation and body pain, Zhongjing Da Qinglong Decoction is recommended.3) If the patient is elderly or weak, or has accompanying wheezing or coughing, Xia Qi Ju Pi Decoction is recommended.2. Taiyang Wind-Cold Dual Invasion SyndromeSyndrome manifestations: Fever or high fever, aversion to wind and cold, sweating, little or no sweating, pain in the head, body, joints, or muscle soreness; or itching; or cough and throat pain; pulse floating, slightly rapid; tongue pale red or red at the edges, with thin white or slightly yellow coating.Recommended basic formulas: 1) For typical cases, Ma Gui Ge Ban Decoction is recommended.2) If there is significant aversion to wind and cold, no sweating, or accompanying neck and throat symptoms, or diarrhea, Ge Gen Decoction is recommended.3) If there is fever or slight fever, accompanied by nausea, dry heaving, chest tightness, wheezing, significant joint pain, nasal congestion, and runny nose, Zhongjing Xiao Qinglong Decoction is recommended.4) If there is persistent or severe wheezing, Hou Po Ma Huang Decoction is recommended.3. Taiyang External Pathogenic Dampness or Wind-Damp Dual Invasion SyndromeSyndrome manifestations: Fever, aversion to wind and cold, sweating or no sweating, joint or muscle pain, often accompanied by edema or redness and swelling; pulse floating, soft, and scattered; tongue pale red or red at the edges, with tooth marks, and water-slippery or greasy coating.
Recommended basic formula: Ma Xing Shi Gan Decoction is recommended as the main formula.
Related formulas 1.Ma Huang Xing Ren Gan Cao Shi Gao DecoctionMa Huang (remove nodes, 120g), Xing Ren (20g), Zhi Gan Cao (20g), Shi Gao (240g)Combine the four ingredients, boil with 7 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 2 liters, strain, and take 1 liter warm.Related text:For Taiyang cold damage, if the person has aversion to cold and fever, dry mouth and no sweating, and cough and wheezing, Ma Xing Shi Gan Decoction is the main treatment. (“Key to Classical Formulas”)After sweating or purging, do not continue with Gui Zhi Decoction. If sweating occurs and there is no high fever, it can be combined with Ma Huang Xing Ren Gan Cao Shi Gao Decoction. (According to Song Dynasty revision)2. Zhongjing Da Qinglong DecoctionMa Huang (remove nodes, 180g), Shi Gao (120g), Sheng Jiang (90g), Gui Zhi (20g), Zhi Gan Cao (20g), Xing Ren (10g), Da Zao (10 pieces)Combine the seven ingredients, boil with 9 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 3 liters, strain, and take 1 liter warm, inducing slight sweating. If sweating is excessive, take warm powder. If sweating occurs, stop taking; if taken again, excessive sweating may lead to loss of Yang, resulting in aversion to wind, agitation, and insomnia.Related text:For Taiyang cold damage, with floating tight pulse, fever, aversion to cold, body pain, and no sweating but agitation, Zhongjing Da Qinglong Decoction is the main treatment. (“Key to Classical Formulas”)3. Xia Qi Ju Pi DecoctionJu Pi (3g), Zi Wan (3g), Ma Huang (3g), Xing Ren (2g), Dang Gui (2g), Gui Zhi (2g), Zhi Gan Cao (2g), Huang Qin (3g)Combine the eight ingredients, cut, and boil with 7 liters of water, boil to obtain 3 liters, divide into three doses, if not cured, repeat. Avoid seaweed, cabbage, and green onions.Related text:For treating spring and winter cold damage, autumn and summer cold damp cough, with a sound in the throat, and difficulty in breathing, this formula is effective. (“Ancient and Modern Verified Formulas”)4. Ma Gui Ge Ban Decoction(Recommended dosage ratio)Ma Huang, Gui Zhi, Chi Shao, Sheng Jiang (each 90g), Xing Ren, Zhi Gan Cao (each 60g), Da Zao (12 pieces)Combine the seven ingredients, boil with 7 liters of water, first boil Ma Huang for 1-2 boils, remove the foam, add the other ingredients, boil to obtain 4 liters, strain, and take 1 liter warm, inducing slight sweating, no need to take porridge, and follow the method of Gui Zhi Decoction for rest, taking it all at once, if not cured, take again.Related text:For Taiyang external pathogenic disease, if it lasts for 8-9 days, with symptoms resembling malaria, fever and aversion to cold, with more heat than cold, and no vomiting, clear stools, it may occur 2-3 times a day. If the pulse is weak and slow, it indicates a desire for recovery; if the complexion is hot, it indicates no desire for resolution, as they cannot achieve slight sweating, and the body will itch, Gui Zhi Ma Huang Ge Ban Decoction is recommended. If the pulse is weak and there is aversion to cold, both Yin and Yang are deficient, and further sweating, purging, or vomiting is not advisable. (Han Dynasty revision)For Taiyang cold damage, if they cannot achieve slight sweating, the body will itch, Gui Zhi Ma Huang Ge Ban Decoction is recommended. (“Key to Classical Formulas”)5. Ge Gen DecoctionGe Gen (120g), Ma Huang, Sheng Jiang (each 90g), Gui Zhi, Zhi Gan Cao, Shao Yao (each 60g), Da Zao (12 pieces)Combine the seven ingredients, chop, and boil with 10 liters of water, first boil Ma Huang and Ge Gen, reduce by 2 liters, remove the white foam, add the other ingredients, boil to obtain 3 liters, strain, and take 1 liter warm, inducing slight sweating, no need to take porridge. The rest follows the method of Gui Zhi Decoction for rest and taboos, all soups follow this method.Related text:For Taiyang cold damage, with stiffness in the neck and back, no sweating, aversion to wind, or combined with Yangming heat, Ge Gen Decoction is the main treatment. If vomiting occurs, add Ban Xia (15g). (“Key to Classical Formulas”)6. Zhongjing Xiao Qinglong DecoctionMa Huang (remove nodes), Shao Yao, Xi Xin, Gan Jiang, Zhi Gan Cao, Gui Zhi, Wu Wei Zi (each 90g), Ban Xia (120g)Combine the eight ingredients, boil with 10 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 3 liters, strain, and take 1 liter warm.Related text:For Taiyang cold damage, combined with Taiyin, with water qi in the heart, dry heaving, fever, and cough. If thirsty, or diarrhea, or difficulty urinating, or fullness in the lower abdomen, or wheezing, or fluid retention, or lingering pain, Zhongjing Xiao Qinglong Decoction is the main treatment. If the person has no fever, it is a Shaoyin external pathogenic disease, and Shao Yao should be removed. (“Key to Classical Formulas”)7. Hou Po Ma Huang DecoctionHou Po (150g), Ma Huang, Ban Xia, Shi Gao (each 120g), Wu Wei Zi, Xing Ren (each 90g), Gan Jiang, Xi Xin (each 60g), Xiao Mai (240g)Combine the nine ingredients, boil with 12 liters of water, first boil the wheat until cooked, remove the residue, add the other ingredients, boil to obtain 3 liters, take 1 liter warm, three times a day.Related text:For cough with floating pulse, Hou Po Ma Huang Decoction is the main treatment. (“Jin Kui Yao Lue Supplement”)8. Ma Huang Xing Ren Yi Gan Cao DecoctionYi Gan Cao (180g), Ma Huang (remove nodes, 120g), Xing Ren, Zhi Gan Cao (each 60g)Combine the four ingredients, boil with 5 liters of water, take 2 liters, divide into two doses, sweating will lead to recovery.Related text:For Taiyang dampness, if the patient has pain all over, fever, and no sweating, and the symptoms worsen in the afternoon, it is called wind-damp. This disease is caused by sweating in the wind or prolonged exposure to cold. It can be treated with Ma Huang Xing Ren Yi Gan Cao Decoction. (“Key to Classical Formulas”)
(2) Primarily Shaoyin External Pathogenic Disease
The differentiation focus of Shaoyin external pathogenic disease is on low fever or no obvious fever, with treatment principles primarily focusing on warming and dispersing to expel cold, and caution in using clearing heat medications. Recent cases of Shaoyin external pathogenic syndrome are mostly characterized by cold damage syndrome, with pure wind syndrome being rare.Shaoyin External Pathogenic Cold or Wind-Cold SyndromeSyndrome manifestations: No fever or low fever, aversion to wind and cold, body coolness, preference for warmth, no sweating, headache, neck stiffness, throat pain, nasal congestion, sneezing, body aches, cold hands and feet, cough and wheezing, but desire to sleep; pulse weak, fine, floating, or tight; tongue pale red or pale white, or with tooth marks, thin white coating.Recommended basic formulas: 1) For typical cases, with rapid onset and relatively singular symptoms, Han Chuan Xiao Qinglong Decoction (Zhongjing Ma Huang Decoction) is recommended.2) For typical cases with significant heavy joint pain, or cold pain in the neck, shoulders, and back, with a slightly heavy pulse, Han Chuan Da Qinglong Decoction is recommended.3) If there is significant coldness in the body or cold hands and feet, or heavy pain in the head and body, with cough and wheezing, Ma Huang Fu Zi Xi Xin Gan Cao Decoction is recommended.
4) If there is aversion to wind and cold with sweating, it may be appropriate to combine Gui Zhi Decoction or Gui Zhi Decoction without Shao Yao plus Fu Zi Decoction based on the above.
Related formulas
1. Han Chuan Xiao Qinglong Decoction (Ma Huang Decoction)Ma Huang (remove nodes, 90g), Gui Zhi, Xing Ren (each 60g), Zhi Gan Cao (30g)Combine the four ingredients, boil with 9 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 2.5 liters, strain, and take 1 liter warm, inducing slight sweating. No need to take porridge, and follow the method of Gui Zhi Decoction for rest.Related text:For Shaoyin cold damage, with headache, no fever, aversion to cold, body pain, waist pain, joint pain, aversion to wind, and no sweating but wheezing, Ma Huang Decoction is the main treatment. (“Key to Classical Formulas”)Appendix: For Shaoyin wind-dampness, with no sweating and aversion to cold, body discomfort and pain, Ma Huang plus Bai Zhu Decoction (add 120g Bai Zhu) is recommended to induce sweating. (“Key to Classical Formulas”)2. Han Chuan Da Qinglong DecoctionMa Huang (remove nodes), Gui Zhi, Xi Xin, Wu Wei Zi, Zhi Gan Cao (each 90g), Xing Ren (60g), Ban Xia (120g)Combine the seven ingredients, boil with 10 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 3 liters, strain, and take 1 liter warm.Related text:For Shaoyin cold stagnation, with body coolness and preference for warmth, when sweating is expected but does not occur, and the body is heavy and painful, it is called fluid retention, and the person is short of breath and thirsty, with cold limbs and joint pain, or one arm does not move, and the pulse is deep and fine, indicating fluid retention. Da Qinglong Decoction is the main treatment. (“Key to Classical Formulas”)3. Ma Huang Fu Zi Xi Xin Gan Cao DecoctionMa Huang (remove nodes), Xi Xin, Zhi Gan Cao (each 60g), Fu Zi (1 tael; if raw, start with 5g for adults)Combine the four ingredients, boil with 7 liters of water, first boil Ma Huang for 1-2 boils, remove the foam, add the other ingredients, boil to obtain 3 liters, strain, and take 1 liter warm, three times a day.Related text:For Shaoyin cold damage with all symptoms present, if the person is cold, Ma Huang Fu Zi Gan Cao Decoction is the main treatment. If there is heavy pain in the head and body with cough, Ma Huang Fu Zi Xi Xin Decoction is the main treatment. (“Key to Classical Formulas”)
(3) External Pathogenic Disease Combined with Shaoyang Disease
This type of disease often occurs when the patient has pre-existing Shaoyang disease, or due to external pathogenic evils inducing Shaoyang disease, or due to misdiagnosis or mistreatment at the onset leading to the evil penetrating internally while the surface syndrome remains unresolved, resulting in external pathogenic disease combined with Shaoyang disease.Syndrome manifestations: In addition to the typical manifestations of the above external pathogenic disease, symptoms may include alternating chills and fever, sudden cold and heat, or initial fever with sweating followed by body coolness and aversion to cold, dizziness, dry eyes, dry mouth or throat, chest fullness and discomfort, nausea, dry heaving, irritability, poor appetite, abdominal cold pain, loose stools, or diarrhea; pulse floating and wiry; often seen with a red tongue, thin white or greasy or slightly yellow coating.Recommended basic formula: 1) For relatively typical and mild Shaoyang disease manifestations, Han Chuan Xiao Yin Dan Decoction is recommended;
2) For relatively complex and severe Shaoyang disease manifestations, or when the stomach qi is disordered, Han Chuan Da Yin Dan Decoction (Xiao Qian Hu Decoction) is recommended.
Related formulas
1. Xiao Yin Dan DecoctionQian Hu (120g), Huang Qin (45g), Zhi Gan Cao (30g), Sheng Jiang (30g)Combine the four ingredients, boil with 7 liters of water, boil to obtain 3 liters, take 1 liter warm, three times a day.Related text:For Shaoyang disease, with body heat, sweating, and aversion to coolness, headache, red eyes, irritability, dry heaving, and abdominal pain with diarrhea, Xiao Yin Dan Decoction is the main treatment. (“Key to Classical Formulas”)2. Da Yin Dan Decoction(Xiao Qian Hu Decoction)Qian Hu (120g), Huang Qin (45g), Ren Shen (30g), Zhi Gan Cao (30g), Sheng Jiang (30g), Da Zao (12 pieces), Ban Xia (120g)Combine the seven ingredients, boil with 12 liters of water, boil to obtain 6 liters, strain, and take 1 liter warm, three times a day.Related text:For Shaoyang disease, with dizziness, dry throat, preference for dry heaving, poor appetite, fullness in the chest and sides, abdominal cold pain with diarrhea, and alternating chills and fever, Da Yin Dan Decoction is the main treatment. (“Key to Classical Formulas”)
(4) External Pathogenic Disease Combined with Jueyin Disease
Patients with pre-existing Jueyin disease, multiple underlying conditions, or weaker constitutions are prone to develop these symptoms after external pathogenic disease.1. Mixed cold and heat, belonging to Jueyin disease, common syndrome manifestationsSyndrome manifestations: Fever or slight fever, aversion to cold, body coolness or cold hands and feet, throat pain or redness and swelling, cough, sputum production, or coughing up purulent blood, chest tightness or discomfort, or difficulty breathing, loose stools or persistent diarrhea; pulse deep and slow; tongue red or pale red, with white or yellow coating, or with purplish spots.Recommended basic formula: Ma Huang Sheng Ma Decoction is a key formula for treating Jueyin disease combined with external pathogenic wind-cold or epidemics, widely used in prevention and treatment at various stages of the disease. This formula can address surface cold, surface heat, upper jiao heat, middle jiao cold dampness, irritability, fluid deficiency, blood stasis mixed, mixed cold and heat, and mixed deficiency and excess of Jueyin pathogenesis, making it suitable for various complex symptoms and atypical symptoms.For elderly patients with mixed deficiency and phlegm-heat, or those with cold and heat mixed, or respiratory failure, Ma Huang Sheng Ma Decoction is more suitable as a basic treatment.1) For mild cases or insufficient constitutions, modified formulas are recommended.2) For severe cases or tolerant constitutions, Qian Jin Formula is recommended.2. Mixed cold and heat, belonging to Jueyin disease, with obvious surface and interior symptomsSyndrome manifestations: Aversion to wind and cold, fever, slight fever or no fever, pain in the head and body, cough, sputum production or wheezing, throat discomfort or pain, dry mouth, nausea, poor appetite, abdominal distension or pain, loose stools or constipation.Recommended basic formula: Shi Shen Decoction.Related formulas1. Han Chuan Modified Ma Huang Sheng Ma DecoctionSheng Ma Huang, Sheng Ma, Dang Gui, Dan Shen (each 15g), Cao Guo, Zhi Mu, Huang Qin, Yu Zhu (each 10g), Bai Zhu, Gan Jiang, Gui Zhi, Fu Ling, Zhi Gan Cao, Chi Shao, Tian Dong, Shi Gao (each 5g)Combine the fourteen ingredients, boil with 10 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 3 liters, take 1 liter warm, inducing slight sweating. Avoid seaweed, cabbage, green onions, vinegar, peaches, plums, and sparrows. (Boiling method from “Secret Essentials of External Medicine”)2. Qian Jin Ma Huang Sheng Ma DecoctionMa Huang, Zhi Mu, Yu Zhu, Huang Qin (each 90g), Sheng Ma, Shao Yao, Dang Gui, Gan Jiang, Shi Gao, Fu Ling, Bai Zhu, Gui Xin, Gan Cao, Tian Men Dong (each 60g)Combine the fourteen ingredients, chop, and boil with 10 liters of water, first boil Ma Huang, reduce by 2 liters, remove the foam, add the other ingredients, boil to obtain 3 liters, take 1 liter warm, inducing slight sweating. (“Qian Jin Essentials”)Related text:For external pathogenic disease or epidemics, if the pulse is deep and slow, with cold hands and feet, and the lower pulse is not palpable, with throat discomfort, purulent blood, and persistent diarrhea, it is difficult to treat, Ma Huang Sheng Ma Decoction is the main treatment. (“Key to Classical Formulas”)3. Shi Shen DecoctionChen Ju Pi, Ma Huang (remove roots and nodes), Chuan Xiong, Zhi Gan Cao, Xiang Fu, Zi Su, Sheng Ma, Chi Shao (each 120g), Ge Gen (180g)Combine into a fine powder, take three large coins (10-15g), boil with 1.5 cups of water, add five slices of ginger, boil until reduced to 70%, remove the residue, take hot, no time limit. If there is fever and headache, add three green onions; if there is fullness and gas, add several pieces of Zhi Ke to boil and take. (Measurement is based on Song Dynasty standards, and the herbs can be measured proportionally)Related text:For seasonal irregularities, epidemics, and widespread diseases, this medicine can be taken regardless of Yin and Yang, or wind, cold, or dampness. (“Expanded Taiping Huimin Formula”)
(5) Modifications and Treatment during Recovery
The following formulas or medications can often be used after selecting the appropriate basic formulas above for modification or symptomatic adjustment.
1. Commonly Used Modified Formulas
1) For external pathogenic warm diseases, warm damage, or Taiyang dryness-heat syndrome, leading to muscle surface, upper jiao heat toxin or children’s febrile diseases, presenting with high fever, no aversion to cold, sweating, thirst, or throat pain, or headache, or heat toxin rashes, or even convulsions, Shao Yao Si Wu Jie Ji Decoction can be used.2) If Shao Yao Si Wu Jie Ji Decoction syndrome or heat syndrome cough is present, combined with external pathogenic wind-cold dampness, Ma Xing Shi Gan Decoction or Ma Xing Yi Gan Decoction can be used.3) If external pathogenic warm disease is predominant, mixed with wind-cold, presenting with fever, excessive sweating, body pain, thirst, agitation, cough, and slight aversion to wind-cold, Zhi Mu Jie Ji Decoction can be used.4) If the pathogenic evil penetrates internally or worsens, leading to lung disease, causing upper jiao phlegm-heat, presenting with chest tightness or chest pain, yellow-green sputum, or difficulty in sputum production, or slightly dry and difficult bowel movements, Xiao Xian Xiong Decoction can be used.5) If there is pleural effusion, Ting Li Da Zao Xie Fei Decoction can be combined.6) If accompanied by water retention in the middle jiao, presenting with thirst but no desire to drink, chest tightness, shortness of breath, dizziness, palpitations, pale tongue with tooth marks, Ling Gui Zhu Gan Decoction can be combined.7) If there is stagnation of water in the middle jiao, presenting with poor digestion, nausea, vomiting, abdominal distension or pain, loose stools or diarrhea, and symptoms worsen with cold food, or irritability, insomnia, Wen Dan Decoction, Li Zhong Decoction, etc. can be combined.
2. Commonly Used Modified Medications
1) For treating external pathogenic epidemics, it is usually necessary to use Ma Huang, Sheng Ma, Gui Zhi, Ge Gen, Huang Qin and other medications with good antiviral effects.2) Depending on the abundance or deficiency of body fluids, fever, sweating, body pain, etc., Ma Huang, Sheng Ma, Qiang Huo, Ge Gen, Shi Gao, Zhi Mu can be adjusted accordingly.3) Taking decoctions containing Sheng Ma may easily lead to vomiting as a detoxification response, which should be communicated to patients in advance.4) If there is internal fullness with abdominal distension and constipation, Chi Shao, Zhi Ke, Da Huang can be added as appropriate.5) If there is accompanying blood stasis, based on cold and heat, add blood-activating and stasis-removing medications. For example, if heat is predominant, add Dan Shen, Sheng Di; if cold is predominant, add Dang Gui, Chuan Xiong; for severe cases, add Tao Ren, Tu Chong, Wu Chong, etc.
3. Treatment Formulas for the Recovery Period
During the recovery period, the external pathogenic surface symptoms have mostly diminished or disappeared, but many patients may experience phlegm retention or damp-heat due to improper treatment at the onset or pre-existing internal injury diseases, or the pathogenic evil may have penetrated from the surface to the interior, injuring body fluids and stomach qi, leading to various internal injury combined syndromes or individual symptoms that recur and prolong.Therefore, treatment during the recovery period should focus on protecting stomach qi and body fluids, regulating the patient’s digestive function, and emphasizing the treatment of the disease location and pathological products, specifically addressing phlegm-dampness, qi stagnation, and food accumulation.1) For phlegm-dampness in the middle jiao, with disordered stomach qi, Wen Dan Decoction or Li Zhong Decoction can be used.2) For cold-dampness syndrome, Huo Xiang Zheng Qi San/Liquid can be used.3) For damp-heat, with obvious surface and interior symptoms, Fang Feng Tong Sheng San/Pill can be used.4) For irritability and insomnia, due to overexertion or food recovery, Zhi Zi Chi Decoction or add Zhi Ke can be used.5) For mild surface symptoms but significant Shaoyang symptoms, with irritability, fluid deficiency, and mixed interior cold, Qian Hu Gui Zhi Gan Jiang Decoction can be used.6) For mild surface symptoms but leaning towards Jueyin, Han Chuan Modified Ma Huang Sheng Ma Decoction can be used.7) For unresolved cough and wheezing due to phlegm retention, San Zi Yang Qin Decoction (Zi Su Zi, Bai Jie Zi, Lai Fu Zi) can be used.
8) The throat pain that often occurs on the second or third day of illness is mostly caused by the toxic evil injuring body fluids and accumulating in the throat, which can be treated with Sheng Ma, She Gan, Jie Geng, Chen Pi, and Zhi Gan Cao, in small equal parts boiled in water and taken warm.
Related formulas
1. Shao Yao Si Wu Jie Ji DecoctionShao Yao, Huang Qin, Sheng Ma, Ge Gen (each 90g)Combine the four ingredients, boil with 6 liters of water, boil to obtain 3 liters, strain, and take in three doses.Related text:For Taiyang dryness-heat or warm damage, with high fever, sweating, thirst, or throat pain, headache, or heat toxin rashes, Shao Yao Si Wu Jie Ji Decoction is the main treatment. (“Key to Classical Formulas”)2. Zhi Mu Jie Ji DecoctionMa Huang (remove nodes), Zhi Gan Cao (each 60g), Shi Gao, Zhi Mu, Ge Gen (each 90g)Combine the five ingredients, chop, and boil with 7 liters of water, boil to obtain 3 liters, divide into three doses. If already purged and self-purged, and the heat has not subsided, remove Ma Huang, add Zhi Mu and Ge Gen; if the heat has not subsided due to dreams, remove Ma Huang and add Bai Wei and Ren Shen, each 60g, to stop.Related text:For treating warm diseases with headache, body pain, dry mouth, and irritability, or summer heat with external cold, Zhi Mu Jie Ji Decoction is the main treatment. (“Ancient and Modern Verified Formulas”)3. Xiao Xian Xiong DecoctionHuang Lian (30g), Ban Xia (120g), Gua Lou Shi (180g)Combine the three ingredients, boil with 6 liters of water, first boil Gua Lou, take 3 liters, remove the residue; add the other ingredients, boil to obtain 2 liters, strain, and take in three doses warm.Related text:For small chest diseases, located in the heart, pressing causes pain, with floating and slippery pulse, Xiao Xian Xiong Decoction is the main treatment. (“Shang Han Lun”)4. Ting Li Da Zao Xie Fei DecoctionTing Li (10-15g, cooked until yellow), Da Zao (12 pieces)First boil with 3 liters of water, take 2 liters, add Ting Li, boil to obtain 1 liter, take warm.Related text:For pleural effusion, with difficulty breathing, Ting Li Da Zao Xie Fei Decoction is the main treatment. (“Jin Kui Yao Lue”)5. Ling Gui Zhu Gan DecoctionFu Ling (120g), Gui Zhi (90g), Bai Zhu, Zhi Gan Cao (each 60g)Combine the four ingredients, boil with 6 liters of water, boil to obtain 3 liters, take in three doses warm, urination will be smooth.Related text:For Taiyin cold stagnation, with body coolness and preference for warmth, fullness in the heart, qi rising to the chest, causing dizziness, with a deep and tight pulse, Ling Gui Zhu Gan Decoction is the main treatment. (“Key to Classical Formulas”)6. Wen Dan DecoctionSheng Jiang (120g), Ju Pi (90g), Ban Xia, Zhu Ru, Zhi Shi, Fu Ling (each 60g), Zhi Gan Cao (30g), Da Zao (12 pieces)Related text:For treating post-illness irritability and insomnia, this is due to cold in the gallbladder, and it is advisable to take this formula. (“Qian Jin Essentials”)7. Li Zhong DecoctionGan Jiang, Bai Zhu, Zhi Gan Cao, Ren Shen (each 90g)Combine the four ingredients, chop, and boil with 8 liters of water, boil to obtain 3 liters, take in three doses. If not cured, take three doses at once.Related text:For Taiyin disease, with diarrhea, abdominal pain, and poor digestion, this indicates middle jiao deficiency and cold, Li Zhong Decoction is the main treatment. (“Key to Classical Formulas”)8. Qian Hu Gui Zhi Gan Jiang DecoctionQian Hu (120g), Huang Qin (45g), Gui Zhi (30g), Gan Jiang (30g), Mu Li (30g), Zhi Gan Cao (30g), Gua Lou Gen (120g)Combine the seven ingredients, boil with 12 liters of water, boil to obtain 6 liters, strain, and take 1 liter warm, three times a day. If the first dose causes slight agitation, the second dose will induce sweating and lead to recovery.Related text:For Taiyang cold damage or wind syndrome, if it does not resolve after five or six days, or if sweating occurs and is followed by purging, with symptoms of fullness in the chest and slight binding, difficulty urinating, thirst without vomiting, only sweating, alternating chills and fever, and irritability, Qian Hu Gui Zhi Gan Jiang Decoction is the main treatment. It is also effective for Jueyin combined with Taiyang wind syndrome. (“Key to Classical Formulas”)
9. Zhi Ke Zhi Zi Decoction
Zhi Ke (120g), Zhi Zi (30g), Dou Chi (120-240g)
Combine the three ingredients, boil with 7 liters of clear water, boil to obtain 4 liters; add Zhi Ke and Zhi Zi, boil to obtain 2 liters, add Dou Chi, boil for five or six boils, remove the residue, take warm. If there is food retention, add Da Huang (5-6 pieces) to treat.(Note: The ancient Zhi Shi is now Zhi Ke.)
Related text:
For post-illness recovery, if there is fatigue, Zhi Ke Zhi Zi Decoction is the main treatment. (“Song 393”)
For Shaoyang disease, with fever, cold feet, irritability, insomnia, chest tightness, abdominal distension, and dry stools, Zhi Ke Zhi Zi Decoction is the main treatment. (“Expanded Taiping Huimin Formula”)
IV. Use of Chinese and Western Medicines
Based on extensive case observations, the efficacy of Chinese patent medicines is not as good as that of Chinese herbal decoctions, but in the absence of herbal pieces, the following Chinese and Western patent medicines can be selected to alleviate or treat related diseases or symptoms.Patients should use these under the guidance of a physician, and it is not advisable to use multiple medications indiscriminately. Western medications should not be used frequently in a short period, and those with heart, liver, kidney, or other organ dysfunction should strictly follow medical advice.The following medications can be stopped once symptoms alleviate, and should not be taken for long periods.1. Ge Gen Decoction Granules: For fever, aversion to cold, no sweating or slight sweating, body and joint pain, cough, or diarrhea, etc.2. Gui Huang Qing Re Granules: For fever, aversion to cold, body and joint pain, no sweating, agitation, dry mouth, etc.3. Xiao Qinglong Granules: For fever, aversion to wind and cold, cough and wheezing, phlegm production, nasal congestion, chest tightness, or loss of smell and taste, with pale red tongue or red at the edges, tooth marks, white coating, etc.4. Xiao Chaihu Granules: For alternating chills and fever, or fever followed by chills, dizziness, dry eyes, dry mouth, chest tightness, nausea, dry heaving, poor appetite, abdominal pain, or diarrhea, etc.5. Pediatric Chai Gui Antipyretic Granules: For fever, sweating, not afraid of cold, body and joint pain, dry mouth, yellow urine, red tongue, etc.6. Huo Xiang Zheng Qi Tablets/Liquid: For nausea, vomiting, stomach discomfort or bloating, diarrhea, pale red tongue, etc.7. Fang Feng Tong Sheng Pills: For body heat, body pain, throat pain, dry stools, yellow urine, red tongue with thick yellow coating, etc.8. Ding Chuan Zhi Sou Pills, Ke Lou Oral Liquid, Chuan Bei Zhi Ke Syrup: For cough and wheezing during the recovery period.9. Benadryl: For temporary cough relief.10. Bing Bor San, Liu Shen Wan: For temporary relief of red and swollen throat walls.11. Gankang, Acetaminophen, Nimesulide Granules, etc.: For temporary antipyretic and analgesic effects, alleviating fever, body pain, etc.12. Meilin, Tylenol: For temporary fever reduction in children.
V. Simple Prevention and Treatment
1. Food-Medicine Homology Formulas1) Fresh ginger (60g), white scallions (3 stalks), red dates (3 pieces), black tea or brown sugar as needed, boil in water and drink.After taking, cover with a blanket to induce slight sweating, feeling sweat on the body is sufficient, and avoid excessive sweating.This method has a definite early treatment and pain relief effect, and the dosage needs to be large, especially effective when there is aversion to cold. After sweating, drink warm water appropriately to quench thirst.Avoid raw, cold, or overly sweet foods.2) At night, you can use fresh ginger and mugwort to boil water for foot baths.3) For those with cough or excessive sputum, you can use white radish and perilla leaves (in appropriate amounts) boiled in water to drink.4) For sore throats, you can use one peppercorn to suck on until relief is felt, then spit it out.2. Non-Drug Therapies1) For fever reduction: For high fever without sweating, you can puncture Da Zhui or add Shao Shang points to release blood; for fever with sweating or non-high fever, Gua Sha is sufficient.2) For throat pain, cough, or difficulty expelling phlegm, you can perform Gua Sha or Jiu Sha on the neck area where discomfort is felt.3) During recovery, you can use moxibustion (combined with appropriate warm water) or hot compresses or massage the Zu San Li area to improve recovery efficiency.3. Simple Prevention MethodsIn addition to wearing masks reasonably, applying sesame oil evenly in the nasal cavity can enhance protection of the nasal mucosa, thereby relatively improving prevention against viruses.
Guidance｜Liu ZhijieText｜Guan Linyang, Sun Jianchen, Liu YunzhuCase Information Provided｜Liu Yunzhu, Liang Xiaoguang, Yang Changqing, Dai Zhirong, Zhu Peifu, Liao Dongyang, Guan Linyang, Sun Jianchen, Deng Zecheng, Hu Yunfeng, Liu Qianqian, Pang Yaobin, Hong Xueqin, Yuan Ziting, Cheng Zhifang, Yang Yaolu, and other members and students of the Traditional Chinese Medicine academic team.