🚩不可不知的兒童鉛中毒🚩

最近某議員全家因為吃非法中藥產生急性鉛中毒，到底鉛中毒有多可怕？不吃來路不明的藥品，就能避免鉛中毒嗎？

鉛是一種重金屬，經人體吸收後可以存在於骨骼、毛髮、血液等組織中，代謝時間很長，骨骼中的鉛半衰期可達20年。鉛主要影響人類的神經系統，以兒童而言，中毒症狀可分為兩大類：

⚠高濃度急性中毒 (血鉛>60μg/dL): 頭痛、腹痛、便祕、躁動、協調性不良、嗜睡；更嚴重者會產生意識障礙、抽搐、腎衰竭、休克甚至死亡

⚠低濃度慢性中毒 (血鉛>5μg/dL)：提高神經問題的風險。例如：智商下降、學習能力下降、過動症、行為問題、性格暴躁、反社會傾向、犯罪行為。此外母親的血鉛會透過胎盤傳給胎兒，影響胎兒出生體重及健康。

👉根據2016年美國兒科醫學會對兒童鉛中毒的建議，血中鉛濃度並沒有最低的安全標準，也就是只要血中有鉛，就算低於5μg/dL，也可能增加兒童神經發展的風險，所以目前建議兒童血鉛最好能低於2μg/dL。

👉一旦發生神經損傷，目前並沒有有效的治療可以逆轉鉛中毒的影響。

👉研究發現，住在被鉛汙染的環境中的孩童，血鉛大概在6~12個月大時開始上升，18~36個月大時達到高峰，接著開始下降。這項發現告訴我們，從寶寶開始在地上移動、會撿拾各種東西放嘴巴，就是鉛中毒最危險的時期。唯一預防鉛中毒的有效方法，就是避免環境受到鉛汙染。

📍兒童會接觸的環境鉛主要來源：

✅ 泥土：工業汙染、空氣汙染的鉛沉積物，例如道路旁的泥土有較多汽車排放廢氣的汙染

✅ 家庭裝修：含鉛油漆、含鉛玻璃、含鉛焊接方式……

✅ 粉塵：油漆剝落的碎片及塵土、父母由職場上帶回的鉛汙染物、燒香拜拜的煙灰……

✅ 飲水：含鉛自來水管、水龍頭、焊接點、容器

✅ 其它：玩具的塗漆及塑膠、含鉛釉料的陶器食具、玩具珠寶、民俗草藥等

美國從1970年代開始，進行一系列對鉛的限制措施，包含全面使用無鉛汽油、管制家用漆的含鉛量、使用無鉛水管等，四十多年來兒童的血鉛濃度有了大幅的下降。而台灣從民國60年代起開始禁用含鉛自來水管，且開始逐步汰換鉛管，但許多老舊房子的水管仍未替換。至於油漆，台灣直到2018年才開始逐步對各類油漆列管，整整慢了美國40年；含鉛量超高、常用在防鏽的紅丹漆，更是到處都買得到。

👌為了保護兒童避免鉛中毒，我們可以日常生活能做的有哪些呢？

⭕ 確保家中的室內油漆、水管、水龍頭是安全不含鉛的。若要裝修家裡，建議孩童最好不要住在家中同一空間。

⭕ 到公園遊玩時，遊具上的彩色油性漆有含鉛的危險，剝落的碎片千萬不要讓孩子放嘴巴，並養成勤洗手的習慣

⭕ 玩具最好要符合安全玩具標準，給兒童的食器最好經過專業機構的安全驗證

⭕ 家長若從事有鉛曝露可能性的工作，回家時應換室內鞋、換掉外出服，最好洗澡後再接觸幼童

⭕ 玩具最好要符合安全玩具標準，給兒童的食器最好經過專業機構的安全驗證

⭕ 有幼兒的家庭儘量不要在同空間燒香拜拜

參考資料：PEDIATRICS Volume 1 38, number 1 , July 2016: e2 0161493

【野獸派太太】

畫家進行肖像畫或練習時，除非是單獨委託案，要不然看著鏡中的自己或找另一半來當麻豆都是最方便省事的方式，因此有些畫家留下為數可觀的自畫像，最著名者大概就是兩位荷蘭畫家：林布蘭（Rembrandt Harmenszoon van Rijn，1606-1669）與梵谷（Vincent Willem van Gogh，1853-1890）；再者畫家為另一半畫下的肖像畫也相當多，只是根據個人風格各有不同表現。

《戴帽子的女人》（La femme au chapeau，1905）是野獸派（Fauvism）鼻祖-馬諦斯（Henri Matisse，1869-1954）為妻子艾蜜莉（Amélie Noellie Parayre，1898-1939）繪製的半身肖像畫，於1905年秋季沙龍（Salon d'Automne）展出時，曾讓整個畫壇無比震驚並掀起革命。

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現代藝術自從19世紀中期，由庫爾貝領軍寫實主義，馬奈、莫內發展印象主義，塞尚、梵谷、高更突破更多傳統，藝術改革風潮已如野火燎原，無法收拾。因此才會在1903年出現專供前衛藝術家好好表現的秋季沙龍，好抗衡已經僵化陳舊的官方學院品味。

本是收入穩定的地方法院行政官轉行為畫家，馬諦斯自然承受家庭與經濟壓力，幸好這位硬漢以堅強意志力挺了過來。從仰慕夏丹（Jean-Baptiste-Siméon Chardin，1699-1779）、普桑（Nicolas Poussin，1594-1665）等古典大師，到接觸印象派馬奈，都讓馬諦斯不斷內化成長。只是印象派發展後期太追求眼前所見，過於自然主義，忽略了情感、想像力、結構和穩定性等等藝術創作重要特質，已經走入限地，從而陸續出現反動風潮。

馬諦斯也是印象派反動者之一。在他的創作摸索階段，最關鍵在於1899年左右，被幾位後印象派畫家給撼動了。他見識到梵谷那充滿狂熱情感的強烈用色，讓色彩成為主體而忽略對象實際外觀；在高更鼓勵下，運用紅、綠對比色系架構畫面，而不在乎是否真實反映自然；以及1904年結識點描派代表人物席涅克（Paul Signac，1863-1935），使得他嘗試利用原色分色效果，將色彩轉成裝飾化。

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1905年夏天，馬諦斯與另一位畫家好友德漢（André Derain，1880-1954）來到法國南部柯里烏爾（Collioure）度假，這時候的馬諦斯還是個窮光蛋，號稱是度假，大概只能帶上畫具享受蔚藍海岸的燦爛陽光，重點還是藝術創作。

就在南法行不久前，馬諦斯和德漢在巴黎才被幾個非洲面具原始又自由的手法給狠狠震撼，再加上梵谷濃麗色彩和高更粗獷畫風的洗禮後，柯里烏爾的美麗假期，讓兩位野獸派先驅創作魂大爆發，催生出數百件油畫、素描和雕像，為接續的秋季沙龍展奠定了基礎。

由於色彩過於濃烈奪目，表現形式極度任性自由，壓根視古典藝術優雅協調品味於無物，起初甚至被秋季沙龍展的某些委員拒絕展出→連專供新銳藝術家發揮的秋季沙龍都受不了，可見有多嚇人。

幸好馬諦斯還算靠譜，也幸好他自己就是委員可以自肥→這是我說的，在他堅持下，三人作品，包含馬諦斯、徳漢與烏拉曼克（Maurice de Vlaminck，1876-1958），得以在同一展覽空間內同時展出，這樣才能讓觀者被艷麗炫目的色彩緊緊圍繞，強烈襲擊。

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《戴帽子的女人》也在秋季沙龍展品之列，同時造成軒然大波，簡直引燃了整個巴黎。

馬諦斯太太-艾蜜莉1897年於一場婚禮上與馬諦斯相遇，隔年兩人結婚，婚後自己在Chateaudun街開了間女帽店，她曾經是馬諦斯畫作中重要麻豆，至少在1939年大畫家遇上新歡助理兼麻豆-莉迪亞･德爾克特羅斯卡婭（Lydia Delectorskaya，1910-1998）之前是如此。

《戴帽子的女人》中，那頂華麗時髦的帽子便相當符合艾蜜莉女帽店老闆的身份，很有可能就是她本倫親自製作出品，雖說只強調色彩，忽略細節，乍看像是一盤熱帶水果，但我們或許還是可以想像它原來華麗的模樣。

除了帽子，艾蜜莉還戴著講究的長手套，手上拿著一把扇子，這在當時都是時尚標配，如果馬諦斯〝認真畫〞的話，應該會是一幅賞心悅目中產階級巴黎美人肖像畫，但要是那麼按部就班，就不是馬諦斯了。

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他把艾蜜莉的五官簡化，臉蛋先以黃和綠色系簡單刷幾下，兩道彎彎的眉毛用棕褐線條隨意帶過，理當誘人的雙唇和亮麗紅髮只刷上幾筆橘紅顏料意思意思一下，過分的是，鼻子是綠色的…鼻子是綠色的…鼻子是綠色的…

艾蜜莉身上原來美麗的服飾和背景，也都只用色塊堆砌而成。用這種方式畫女人，不只觀眾無法接受，想必艾蜜莉也很想暈倒，但為了支持丈夫的畢生志業，也只能咬著棉被含淚忍受，繼續〝真愛〞下去→這也是我說的。

風波至此尚未結束，沒有最過分，只有更過分。有人問馬諦斯，艾蜜莉究竟穿了甚麼顏色的衣服？他回答：「當然是黑色啊~」→你說是不是會讓人很想翻桌？

保守派藝評家路易斯･沃克斯勒（Louis Vauxcelles，1870-1943）將馬諦斯等三人畫作與文藝復興雕塑進行比較，並於1905年10月17日在Gil Blas日報上發表評論：〝Donatello chez les fauves ...〞，意即〝（被包圍）在野獸中的多納泰羅〞，從此『野獸派』一詞被廣泛流傳。另一位支持印象主義和象徵主義的藝評家卡米爾･莫克萊（Camille Mauclair，1872-1945）則說這些作品像是〝拿一桶油漆潑向眾人〞。

然而藝評家再毒舌，也無法抑制勢必爆發的新浪潮。

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《戴帽子的女人》標誌馬諦斯朝向更具表現力的風格變化，堪稱是他個人和藝術史上的一大步。

鮮豔顏色、不拘又鬆散的筆觸和〝未完成〞的粗糙質感，加上生動、非自然色彩被使用於所有物體，造成極大視覺震撼，並真切傳達出藝術家的情感特質。另外以不同色塊架構圖形的方式，透露他遵循偶像塞尚〝畫出真實所見，而非他人教你看見〞的原則，如此大膽用色和豪放筆觸更揭示現代藝術對於色彩的定義，以及由塞尚所開啟的現代簡約風潮。

現代藝術因為馬諦斯對於形式與色彩的前衛研究，以及推波裝飾藝術風潮的形成，又再度往前邁進。

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不過畫家終究要混口飯吃求生存，這麼大膽可怕的畫作賣得掉嗎？

還真的有人買，而且是畫展後沒多久，不用等到畫家本倫拜見上帝後。有對來自美國，定居巴黎的藏家-史坦兄妹，李歐･史坦（Leo Stein，1872 -1947)和葛楚･史坦（Gertrude Stein，1874-1946年）以500法郎買下《戴帽子的女人》。討價還價過程難免，最終還是藝術家獲得勝利，多賺了100法郎。

這對於手頭仍舊拮据的馬諦斯來說確實是很大鼓舞，即使並不是因為買主們喜歡這幅畫，應該是兄妹倆支持現代藝術的成分居多。據說，李歐曾表示這是他見過塗得最胡鬧糟糕的一坨顏料…

另外也有說法指出，史坦兄妹的大嫂莎拉･史坦（Sarah Stein）才是最初購買者。

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因為艾蜜莉頭上那頂帽子太像是一座塞滿了水果、鮮花和鳥類的熱帶叢林，讓某位舊金山藝評家於1928年提出此畫該重新命名為《風景》（Landscape）→那個…藝評家可以不要再來亂了嗎？

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有機會拜訪舊金山市區的現代藝術美術館（SFMOMA），千萬要來跟熱帶叢林〝野獸派太太〞打聲招呼，順便想像一下她一百多年前現身時，嚇壞眾多巴黎倫的風光模樣。野獸派太太身具鎮館之寶地位，通常會在二樓展間入口或顯眼處好整以暇地等著招呼大家。

然後還可以到一樓附設餐廳，由舊金山米其林三星餐廳Benu名廚Corey Lee所開設的In Situ用餐。In Situ菜單基於〝廚房博物館〞理念而設計，主要提供世界各地名廚最經典菜色，等於不用飛遍全球便能享用到眾多名菜。氣氛輕鬆愉快，酒單也很有可看性，這大概是你在西岸美術館裡所能享受到最可口有趣的滋味。

那天一定喝醉了，所有菜色幾乎都點過一輪，結果照片竟然已消失…（自己面壁

#野獸派太太超威
#馬諦斯 #野獸派 #現代藝術
#舊金山現代藝術美術館
#SFMOMA

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從非典到新冠肺炎

From SARS to Novel Coronavirus (COVID-19) - English version is in the second half

新冠肺炎，Novel coronavirus (2019-nCoV) 新型冠状病毒肺炎，疫情越來越嚴重，被證實可以人傳人，也在武漢以外的許多地方發現病例，造成世界各國及世界衛生組織（WHO）高度關切，當然也讓很多住在中國大陸及附近區域的華人非常緊張，就好像當年的非典肺炎疫情即將再一次大爆發一樣。

目前，現代醫學還沒有找到治療新冠肺炎的方法，只能針對某些症狀來處理，疫苗的研發更是遙遙無期。怎麼辦？每次遇到這種情況，中醫就會被搬出來，這次也不例外。新冠肺炎爆發後，網上馬上有許多中醫對付新冠肺炎的文章。當然，除非哪位中醫師看過、治好過大量的新冠肺炎病例，所有的討論都是猜想、假設。然而，有些猜想及假設值得參考，有些猜想及假設卻明顯在誤導大眾。

我還沒有治療過新冠肺炎，不能大肆評論。不過，我治好過很多禽流感、豬流感、及每年流感導致的嚴重肺炎及其它病變的病人。其中許多病人是被美國大型西醫院證實為嚴重肺炎，被要求醫院或居家隔離，偷偷溜出來找中醫看診的。也因此許多病人及討論中醫的網站，希望我能針對新冠肺炎發表一些意見。

我們以前就討論過，這些彪悍的流感病毒，經過那麼多年、那麼多次的變種（mutation），每年都不一樣，東漢時期傳下來的經典中醫，根本沒有遇到過現在的病毒，怎麼可能治療如此嚴重的肺炎呢？

中醫從來就不認識病毒，也不從病毒種類的角度來思考。中醫是探討人體受到外界因素破壞，失去平衡後，身體會有哪些現象、哪些反應，根據那些現象、那些反應來調整身體狀況，期待身體能恢復到平衡狀態，把外界因素帶來的破壞減到最小。我打個半開玩笑的比方，警匪槍戰時，我們注意到壞人哪個方向來的火力強大，造成我們部署在哪個位置的警員傷亡，這時我們會趕緊重新部署人員，或者想辦法增派警力，我們大概無暇去管壞人是用哪個牌子的槍、哪個工廠做的子彈！

雖然幾百年幾千年下來，病毒變種等等的外界因素改變了非常多，人體演化的改變卻非常有限。人體的功能，無論是怎麼被破壞的，某項功能被破壞而導致的症狀、反應、後續演變，卻依然有明顯的脈絡可循。也因為如此，在很多情況下，中醫以專注人體本身平衡狀態的治療方式，反而比西醫專注在外來敵人的治療方式來得有效許多。

依據多年累積大量的臨床病例觀察，無論是禽流感、豬流感、還是每年的流感，人體敗壞的進程依然如同傷寒雜病論探討的一樣，非常簡化的說，從一般桂枝湯證、葛根湯證等的表寒，轉變到小青龍湯證等的裡寒，津液不足、水道運化失調而化熱，變成比較嚴重的大青龍湯證，或者更嚴重肺臟的寒熱夾雜，金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇中的射干麻黃證、葶藶大棗瀉肺湯證、澤漆湯證、小青龍加石膏湯證等等混雜出現，搞得亂七八糟，也不再是什麼簡單方劑可以對應的。

然而，雖然進程很像，不同於一般外感的是，這些嚴重流感肺炎病情加重的改變速度快非常多，也來得猛烈頑強很多。一般的外感從桂枝湯證、葛根湯證等轉變到大青龍湯證或更複雜的病情，通常需要一兩週的時間。同時，還得病人自己非常不注意，或者醫生治療錯誤，一般感冒才會沒辦法自己好，反而變成嚴重的病症。這幾年的流感，從一開始覺得不太對勁，到嚴重複雜的病情，只需要三四天，而且有越來越快的趨勢。這大幅提高中醫師治療流感時，判斷功力及敏感度的要求，中醫師必須在許多症狀還沒有出現時，就得抓緊時間，趕緊行動，卻又不能預防過度，反而讓病情加重。換句話說，時機、劑量、藥材比例變得非常重要，稍有不慎，就無法反轉病情。

舉個例子，有些病人得了流感，咳嗽非常嚴重，痰非常多，呼吸困難。依照中醫的辨證，假如一致都是寒，舌苔白、小便清、怕冷等等，本來依照辨證論治，我們可能會開射干麻黃湯加減給病人。然而，因為流感的進程非常快速，中醫師得非常敏感，譬如看到舌苔白卻帶有一絲絲乾的感覺，就很可能得加上大寒的石膏來避免肺喪失津液，卻又不能加太多石膏，以免肺寒加重。又譬如聽到咳嗽聲音非常深沈，從肺的底部發出，又帶有膿痰的濁音，就很可能得加上瀉肺的葶藶來避免肺中水飲、痰飲大幅增加，卻又不能加太多葶藶，以免肺變得太虛弱。

我們回頭來看這次的新冠肺炎。根據有限的資訊，我們知道感染後有大約兩週的潛伏期，這段時間沒有什麼症狀，病人可能只會感到有些疲憊。剛開始發病時，很像一般的感冒，病人會發熱、乏力，並不嚴重，沒有什麼流鼻涕等上呼吸道的症狀，有的甚至沒有發熱。約一半的病人一週多後恢復，另一半的病人卻在一週後出現呼吸困難，有些病人會快速進展為急性呼吸窘迫綜合征、膿毒症休克、代謝性酸中毒、凝血功能障礙等等嚴重的問題，可能導致死亡。

從上面的敘述，我們不難發現，一開始很像一般中醫外感的桂枝湯證、葛根湯證，一半的病人也就自己恢復了，另一半的病人卻出現快速的入裡化熱現象，肺津液迅速流失，非常濃稠的痰飲沈積在肺部下方。同時，中醫認為肺為人體調節津液的源頭，肺金生水，好比天空下雨一般，而當肺的功能及津液調節出現嚴重障礙，很快就會拖累三焦水道、腎臟等的功能，導致上面提到的幾種嚴重病情。換句話說，新冠肺炎可以讓輕微的太陽證外感，迅速發展成嚴重的肺痿肺癰，再進一步瓦解人體其它功能的運作。

怎麼治療？在沒有直接治療武漢肺炎病人的情況下，我們也只能根據有限的資訊來推論，不過，以前大量的流感肺炎治療病例，可以讓我們比較有信心的面對新冠肺炎。當病人已經出現明顯新冠肺炎症狀時，大多已經入裡化熱，嚴重的肺痿肺癰。這個時候，得用大劑量的石膏清肺熱、加強肺津液運作。也得靠葶藶、大戟等把肺下方濃稠的痰飲及胸腔可能的積液去掉，痰飲積液不去，是無法修復肺家津液運作的。同時，肺氣不宣，就好像吸管上頭堵住了，吸管內的水無法上下，我們還得使用麻黃等宣肺、發陽的中藥來配合。另外，肺已經受損了，除了大動作急救外，比較穩定後，還得靠一些潤肺的藥來收尾，讓肺完全恢復。如果我們列一個可能加入的中藥單，大致有石膏、葶藶子、大戟、生半夏、麻黃、射干、紫菀 、款冬花、 生薑、炙甘草、紅棗、麥門冬、杏仁等等。當然，如前面所言，用藥的時機、劑量、藥材比例非常重要，每一個病人的差異也很大，嚴格考驗中醫師的功力與膽識，一旦判斷錯誤，不但沒有效果，反而可能會加重病情。

網上有些中醫師，說新冠肺炎或其它流感肺炎可以用板藍根清熱解毒來治好。也有些中醫師說可以用麥門冬湯等等的輕劑治好嚴重的肺炎。甚至還有些中醫師說多喝綠豆湯可以預防新冠肺炎！其實，真的遇過、治好過禽流感、豬流感等嚴重流感肺炎的中醫師，一看這些文章，就幾乎可以確定這些人根本沒有治療過嚴重肺炎的經驗，充其量只是在西醫治療下，在旁邊幫幫病人一些小忙而已。這樣的情況下，難怪中國政府平時大力推展中醫，真的有如同新冠肺炎這樣重大疫情爆發時，卻看不到中國政府大量使用中醫方法來治療病人、控制疫情。醫學是實戰的學問，沒有大量臨床病例，講得再好聽都是沒有用的，如果希望中醫真的在主流醫學裡站立起來，希望中醫真的能面對大規模的疫情，回歸最基本的臨床療效，才是最重要的，其它都只像是武術表演，而非實際作戰。

From SARS to Novel Coronavirus (COVID-19)

Written in Chinese by Dr. Andy Lee, January 21, 2020
Translated to English by Dr. James Yeh and Dr. Andy Lee, March 28, 2020

The epidemic from Novel Coronavirus is becoming much more serious. Transmissivity among people has been proven. (Note: It's now named COVID–19. The term “Coronavirus” will be used here.) Cases were found in areas beyond Wuhan. It has caused serious attentions from the WHO (World Health Organization) and many countries around the world. The residents in China and the surrounding regions are quite worried and wonder whether it will break out like SARS (2003). (Note: The article was written on January 21, 2020, before Coronavirus became a global pandemic.)

So far, the modern medical field has not found a cure for Coronavirus, but resorts to treating patients’ symptoms only. Any vaccine to treat Coronavirus is still no way in the sight. What do we do? Every time such a situation happens, the topic of using Traditional Chinese Medicine (TCM) is raised (at least among the Chinese communities). There is no exception this time. Many articles related to using TCM on Coronavirus have been popping up on the web. However, unless some TCM doctors who have actually treated many Coronavirus cases, all the discussion would be hypotheses or assumptions. Some hypotheses are worth considering while many others could be quite misleading.

Personally I have not treated patients cases related to Coronavirus. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully, and has published other later blogs which included his involvement in treating those patients. Please refer to his medical blog http://www.DrLee.us.) However, I did treat and cure patients inflicted by other viruses in the past, such as the Bird Flu, Swine Flu, and other influenza. A good amount of those patients were diagnosed as severe pneumonia by large hospitals and were required for isolation or self-quarantine. Hence many of patients and online medical forums online are asking for my opinions about Coronavirus.

As we discussed before, all these viruses from the outbreaks are either newly found or mutated from previous strands. The strand can be different every year. Therefore, people always ask how one can say that the TCM knowledge developed in East Han Dynasty (25-220 AD) would be any useful for treating the modern diseases, let alone the severe ones.

It turns out that TCM does not recognize any virus and does not deal with the concept of which type of virus is microscopically at work. TCM looks at how human bodies would become out-of-balance and react to external stimuli. Once the body is out of balance, what symptoms will exhibit and what reactions will be to adjust the body conditions to regain the balance, hence to reduce the damage to the body to the minimum. Let me take an example to illustrate: when there is a gunfight between the police and bandits, we want to see which direction the shots are coming from, causing casualties of the police force, so that we are able to adjust or reinforce the police power. We have no time to think about which brand of the guns or bullets the bandits use.

Over thousands of years, the external viruses have changed and evolved quite a bit, but the evolution of human beings was quite limited. The human body function, no matter how it was damaged, the symptoms due to the damage of the function, the reactions, and the following progression of the disease still follow certain paths. For this very reason, TCM’s focus on the balance of the human body often surpasses the effectiveness of Western medicine, which focuses more on external treats and the microscopic aspect of how human body’s cells are impacted by the external treats.

From the accumulation of many years of clinical treatment and observations, no matter it is Bird Flu, Swine Flu or other influenza, the bodily ‘damage’ and its progression by the viral attack still follow the description of the classic TCM literature “Treatise on Cold Damage on Miscellaneous Disease” (傷寒雜病論). In short summary, the disease usually starts with “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒), for which is matched to one of the several syndromes named with the corresponding herbal remedies such as “Gui Zhi Tang” (桂枝湯) and “Ge Geng Tang” (葛根湯). Then, the disease moves onto the next stage “Interior Coldness” (裡寒) or “Lung Coldness” (肺寒), which shows the syndromes named as “Xiao Qing Long Tang” (小青龍湯), etc. When the respiratory system is “affected by the coldness”, the body fluid function of the respiratory system gets affected. The circulation function of the lung becomes “Dry and Overheated” (燥热). This would lead to a more serious stage “Heated Interior” (入裡化熱) and would often be matched to its herbal remedy “Da Qing Long Tang” (大青龍湯). Or, even worse, it becomes so-called “mixed coldness and heat” (寒熱夾雜) in the lung. Such a complex situation was extensively discussed in Chapter 7 of the classic literature “Synopsis of Prescriptions of the Golden Chamber” (金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇). At this complex stage, the illness development varies significantly among patients of different preconditions and other variants. It is no longer the situation that a simple herbal remedy can be applied to all the situations. The TCM theory illustrates various treatments by those herbal remedies such as “She Gan Ma Hung Tang” (射干麻黃湯), “Ting Li Da Zao Xie Fei Tang” (葶藶大棗瀉肺湯), ”Ze Qi Tang” (澤漆湯), “Xiao Qing Long Jia Shi Gao Tang” (小青龍加石膏湯), and others.

However, even the disease progressions are similar, the more serious viral attacks like Coronavirus can and often do progress much faster with more severe consequences than the common flu. As described in the previous paragraph, normally the disease progression of the “External Coldness” stage to the more serious “Heated Interior” stage usually takes one to two weeks. It is also often due to the ignorance of the patient or misdiagnosis and treatment of the doctor, which prevents the patient from recovering from this “catching a cold”. In the recent several years though, the time period between the time that the patient did not feel well and the time that the patient is in a serious and complex situation can be as short as 3 to 4 days. We also see the trend that this period gets shorter and shorter. In other words, the disease progression is getting much faster. This phenomenon poses a much higher demand on TCM doctors’ ability to make a quick and proper judgment and sensitivity to the subject matter. TCM doctors must intercept the disease progression before it reaches to a more serious stage, even without obvious symptoms of the next stage. TCM doctors have to timely prescribe the proper herbal remedy in terms of the type of herbs and relative dosages of herbs. Too weak a dosage could not stop the progression while too strong a dosage could worsen the condition also. A misjudgment would not be able the turn the conditions around, but hurt the patient more.

The above can be illustrated by a simple example. A patient caught flu and has symptoms such as heavy coughing, lots of sputum, and difficulty in breathing. From the TCM dialectics, with observations of white tongue coating, clear urine, and feeling chilly, etc., it is clearly caused by “Coldness”. Such a patient typically should be prescribed with “She Gan Ma Hung Tang” (射干麻黃湯) or its variations. However, due to the fast progression of the modern flu, the TCM doctor would need to pay attention to much subtle details such as the dryness of the tongue although it still shows the white coating. In this case, Sheng Shi Gao (Gypsum, 生石膏) might need to be added to the herbal remedy to make sure that the lung would not suffer dryness. Given that Sheng Shi Gao (Gypsum, 生石膏) itself is an ingredicient that is “very cold” in nature, the dosage could not be too strong to make the lung too chilly. At the opposite end of the spectrum, if the sound of the coughing is very ‘deep’, like dense sputum coming from the bottom of the lung, the herbal remedy might need to add Ting Li (Sisymbrium indicum, 葶藶) to clear up the lung to avoid too much mucus in the lung. And again, the dosage of葶藶 could not be too much to weaken the lung. (Note: Handling the proper timing and proper remedy can be a real test to the ability and experience of the TCM doctor.)

Let’s go back to the discussion on Coronavirus. From the limited information available so far, we know that there are about two weeks of incubation period after the infection. There are little symptoms during this period and the patient may just feel more tired than usual. More obvious symptoms will start like those of common flu with fever, fatigue but not too serious. Upper respiratory symptoms like running nose are less common. Some patients may not even exhibit fever. About half of the patients infected will recover over a week or so. The other half of the patients will experience difficulty in breathing, or rapid progression to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulopathy, etc. Some patients had died due to these severe conditions.

From the above description, this Coronavirus, in the beginning, is very much like the common flu and will stay in stages of “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒). Half of the patients infected will recover by themselves as in common cold. The other half of the patients may exhibit situations of rapid penetration into inner organs and excess ‘heat’, which causes loss of fluidity of respiratory system and accumulation of dense sputum at the lower part of the lung. In the TCM theory, the lung serves as the initial “gating factor” of body fluids. When the lung fails to serve the proper function, other organs like the kidney will be adversely affected also. In other words, Coronavirus can turn a light “External Coldness” to extremely severe “Lung Atrophy” (肺痿) and “Lung Abscess” (肺癰), which in turn will impair the function of other organs.

How to treat? Without direct experience of treating Coronavirus patients, we can only postulate from our limited information available in hand. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully. The treatments were exactly as outlined in this article.) From the ample experience of dealing pneumonia cases caused by flu, we are confident that we can also treat Coronavirus successfully. When patients are showing the obvious Coronavirus symptoms, most of them would have entered the stage of “Heated Interior” (入裡化熱) with “Lung Atrophy” (肺痿) or “Lung Abscess” (肺癰) to a certain degree. At this stage, we will need large dosages of Sheng Shi Gao (Gypsum, 生石膏) to clear the heat to ensure the proper fluidity function of the lung. Also, we will rely on Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), etc. to clear up the dense mucus at the lower part of the lung and to remove the edema of the chest chamber. Without getting rid of the excess mucus and fluid, the lung cannot properly function. We need to use Ma Huang (Ephedra sinica Stapf., 麻黃), etc. to enhance the lung function (宣肺、發陽) and restore proper breathing. When the lung is damaged as in fibrosis, after the conditions stabilize, we need to “moisturize” the lung (润肺) to help the lung to recover fully. In other words, we will most likely use the herbal ingredients such as Sheng Shi Gao (Gypsum, 生石膏), Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), Sheng Ban Xia (Pinellia ternate, 生半夏), Ma Huang (Ephedra sinica Stapf., 麻黃), She Gan (Belamcanda chinensis, 射干), Zi Wan (Aster tataricus, 紫菀), Kuan Dong Hua (Tussilago farfara flower, 款冬花), Sheng Jiang (Ginger, 生薑), Zhi Gan Cao (processed Glycyrrhiza uralensis Fisch., 炙甘草), Hong Zao (Ziziphus jujube, 紅棗), Mai Men Dong (Ophiopogon japonicas, 麥門冬), Xing Ren (Prunus armeniaca, 杏仁), and others. As we discussed in previous paragraphs, the timing, dosage, the relative ratios of different herbal ingredients are very critical. Given that there are quite some variations in patient conditions, the challenges on TCM doctors’ comprehensive knowledge, judgment and courage are unprecedented.

In those articles online, some TCM doctors claimed that Coronavirus can be cured by Ban Lan Gen (Isatis tinctoria root, 板藍根), which is believed to have natural antibiotic chemicals to “clear up the heat and toxics”. Some TCM doctors suggested using a simple mild herbal remedy “Mai Men Dong Tang” (麥門冬湯), which mainly relies on the ingredient Mai Men Dong (Ophiopogon japonicas, 麥門冬). Some people even suggested that having the green bean soup could prevent Coronavirus. In fact, those TCM doctors who have good experience of treating Bird Flu, Swine Flu, and pneumonia caused by other influenza would know that the people making those claims never had the real experience of treating severe pneumonia. They at most helped in a minor way the patients under Western medicine treatments. Under such conditions, it is not a surprise that the China government has not used TCM as the primary method of treating Coronavirus, despite its big promotion of TCM in the recent years. (Note: After this writing, Coronavirus epidemic became so severe in China that the China government changed its strategy and started to use TCM extensively in treating many mild Coronaviurs cases.)

Medicine is the science based on real treatment results. Without a good amount of successful cases in clinical treatments, it is useless to promote any fancy idea of treating patients. If we would like TCM to be respected in the mainstream medicine and to be meaningfully used in a severe epidemic like Coronavirus, it is critical to focus on the most fundamental. That’s the clinical results. Like the martial arts, unless you can fight off the bad guys, it’s just a show of fancy movements.

（http://andylee.pro/wp/?p=7169）
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