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Four Treatment Principles, Three Formulas, Two Years Later

Originally published February 14, 2022

Here at Mayway, we receive many inquiries about the latest information coming from China, and I am not just talking about the supply lines issues which are still affecting the importation of Chinese herbs. For the past two years, a sizable portion of questions have been pandemic related. While cases in the US have dropped 70% since January 15, deaths continue to exceed 2400 per day, the total recently passing 900,000, with long COVID affecting approximately one third of those infected.

Mayway shared with everyone the original information from China in an article from April 2020 for Novel Formulas that Release the Exterior. This article outlined information that was clearly and thoroughly defined in the Guidance for Corona Virus Disease 2019, edited by the National Health Commission of the People's Republic of China. The Sixth Edition of the English language version of this 138-page book can be downloaded here.  The customer feedback we have received is that practitioners have successfully prevented and treated patients using this information and the formulas and templates that Mayway created for this purpose.

I confess that I have not contemplated the Greek alphabet since I was briefly in a fraternity 50 years ago, but I think most of us are becoming rather familiar with it now. These days we are talking about Ο, and it was not that long ago that everyone feared Δ. Today in the US, about 99% of new cases are Ο and the symptom presentation differs significantly from both Α (i.e., pre-Δ, the ancestral strain) and Δ itself. Positive Ο symptomology has significant overlap with those from seasonal flu or colds, although potentially more severe, and this is especially true for the unvaccinated. Adding to the complicated clinical picture is that there is an active flu season and the endemic “common cold” has not disappeared. (See table below).

Symptom Chart

Before reviewing current treatment protocols in China, I would be remiss if I did not remind everyone about prevention. The first line of defense is Jade Wind Screen (Yu Ping Feng San) or an augmented version of this classic formula such as Wuhan Tonify Wei Qi. Second, any bona fide analysis of the statistics proves the importance of vaccination, including a booster after six months, to reduce the risk of serious disease.

China’s Current Covid Strategy

China has developed seven vaccines and has vaccinated 1.2 billion of their 1.4 billion people. The two major Chinese COVID-19 vaccines: Sinovac and Sinopharm have been approved by the World Health Organization (WHO) for emergency approval and are widely used in lower-income countries. However, there are some legitimate questions about the efficacy of China’s vaccines when compared to the mRNA technology used in the US, which is significantly more effective, even with Ο.

Liang Wannian, a disease control expert with the National Health Commission, said that the current vaccination campaign has not yet built a solid herd immunity barrier against the virus, which many believe will consist of a combination of vaccination and naturally acquired immunity. Zhang Boli, an academician of the Chinese Academy of Engineering, has said that vaccination can protect the human body from severe illness and reduce mortality. China's "preventing foreign import and preventing internal rebound" control strategy is still effective for Ο and the wearing of effective masks, frequent handwashing, indoor ventilation, and personal health monitoring is still required.

Interestingly, this strategy has strengthened China's stance toward Ο, which is “zero tolerance.” They have shut down entire cities if there is even a minor outbreak, as happened recently in Tianjin, Lanzhou, Henan, et al. They have also prohibited some Chinese citizens from attending the Winter Olympics and implemented a partial travel ban during Chinese New Year, which affected some 300 million people. Liang believes that the country's strategy is capable of curbing new outbreaks effectively, reducing severe cases and deaths, avoiding an overstretched hospital system, and minimizing the pandemic's impact on socioeconomic development.

One result of this zero-tolerance policy is that the Chinese have much less experience with treating this variant. Δ remains the dominant variant in China, and their number of cases, hospitalizations, and death continues to remain surprising low, in fact, among the lowest in the world. Whether these zero tolerances with Ο can be maintained in China remains to be seen and epidemiologists are watching for changes in the transmissibility rates of Ο after the Olympics are over. Already, there are worrisome signs in Hong Kong.

According to Zhang Zhongde, head of the State Medical Administration's leading the work group responding to the new corona epidemic, it was clinically found that the proportion of patients infected with the Δ mutant strain exceeded 80%, with symptoms such as high fever, aversion to cold, headache, dry throat, fatigue, abdominal distension, and loss of appetite. With Ο the symptoms of acute depletion such as spontaneous sweating are more obvious, and the proportion of such symptoms is relatively high. The presence of Damp in these cases seems to be less, but not absent entirely. After in-depth discussion and comprehensive analysis by the expert group, the current phase of the epidemic still belongs to Dampness and Stagnation, and the core etiology and pathogenesis of traditional Chinese medicine treatment has consequently not changed significantly. The difference is that the focus on Damp Heat is diminished, and now there are also manifestations of Cold, Heat, Dryness, and Phlegm. Emphasis has been placed on careful evaluation of environmental and constitutional factors, and treatment plans must be adjusted accordingly.

tcm pulse

According to a recent study, published in December 2021, all confirmed COVID-19 cases in China were treated with standard care under the guidelines issued by the National Health Commission (NHC) and the State Administration of Traditional Chinese Medicine (TCM) of China. (See the link above to Guidance for Corona Virus Disease 2019 at the beginning of this article.) Multiple Chinese Herbal Medicines (CHM) were recommended by China's NHC in this guidance, and 91.5% (or 74,187 individuals) of COVID-19 patients were treated with some form of Chinese Herbal Medicine. In some of the moderate cases, CHM was exclusively used for symptom management.

An early study regarding the use of Qingfei Paidu Tang (decoction) plus standard hospital care, across 30 COVID-19 specific hospitals in 14 provinces of China and across a total of 1,476 adult patients, resulted in a total symptom relief rate of 90.0%–94.8% over a treatment course of 3–9 days. Based on this experience, Qingfei Paidu Tang was widely prescribed throughout China, to pronounced effect. Today, China's standard TCM treatment protocol has been “three medicines and three TCM prescriptions”. All are prescribed according to the various stages or phases (early, middle, and late) of a patient's viral infection. Specifically, the “three medicines” refer to Jinhua Qinggan granules, Lianhua Qingwen capsules, and Xuebijing injections, while the “three TCM prescriptions” refer to Qingfei Paidu decoction, Huashi Baidu decoction, and Xuanfei Baidu decoction.

However, in practice, many provinces in China created their own custom herbal formulas designed by their local expert doctors, hospitals, and medical schools and experienced comparable effectiveness. This is due to classical styles of TCM diagnostics and treatment, where “specific CHM for a specific person” is prescribed via pattern differentiation because each person or case may exhibit specific symptomology based on their individual patterns and circumstances. In many cases, herbs were prescribed based on empirical knowledge of locally available herbs, sophisticated analysis of systems medicine, and in consideration of the patient’s constitutional ability to self-heal.

This engagement includes the use of herbs in promoting immunity, anti-inflammatory, analgesic, hemostasis, anticoagulation, detoxification, and emergency or stress response, as well as tissue repair and regeneration. An analysis of these experiences led to a categorization of four major treatment principles: (1) focusing on eliminating toxins in the early stage of the disease, (2) tonifying deficiency of the body throughout the entire disease course, (3) treating the affected lung and intestine simultaneously based on visceral interactions, and (4) cooling Blood and removing Blood stasis at the later stage.

What We Should Do

What does all this mean to practitioners of Chinese herbal medicine in the US, especially in light of the newest variant, for which the Chinese have little direct experience? First, realize that TCM practitioners will have little or no opportunity to treat patients whose conditions require hospitalization. Otherwise, keep to the principles. TCM physicians and experts have accumulated solid experience in applying CHM to fight various epidemics throughout the history of China. For example, the Qingfei Paidu decoction in the “three medicines and three TCM prescriptions” is a combination of several classic Chinese herbal formulas in the Shāng Hán Lùn.

For unaffected individuals, augment the Wei Qi.

For the recently infected, Eliminate the Evil Qi by Releasing the Exterior using appropriate herbs that Clear Wind Cold, Wind Heat, or Toxic Heat. Use Chinese herbs that have specific anti-viral properties. This does not require special or unique formulations. You already have the tools in your dispensary to address these principles. Determine if there is Dampness present and Resolve and/or Drain Damp. Assess whether there is imbalances of Yin, Yang, Qi, or Blood and Tonify as appropriate. Treat digestive system and intestinal inflammation, diarrhea, constipation, and maintain intestinal flora.

In advanced cases, especially with those with serious co-morbidities, we must be resigned to standard hospital care.

For patients suffering from long Covid, consider Harmonizing the Shao Yang before clearing any signs of organ or systemic inflammation as organ Heat or Yin Deficiency Heat, tonifying any deficiency. See the article "Recovery Formulas for Lingering Evil Qi” for more details.

In conclusion, one hopes that this phase of the pandemic will soon be behind us. However, since the world is far from, and may never reach, herd immunity, we must be prepared for new variants. We must rely on prevention, mitigation, acquired immunity, and treatment. As practitioners of Chinese herbal medicine, we have an important and unique role to play, and the education of our patients is paramount.


References

Bio: Skye Sturgeon, DAOM

Skye is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.
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