La Medicina Tradicional China es Capaz de Curar los Casos Severos de COVID-19

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Autor: Doctorado Andy Lee 李宗恩

Traductores: Inés 徐依丽, Javier 邵伟航, Selina 孙玉洁

Revisión: David Fonfría

El 21de enero de 2020 publiqué, en chino, el ensayo “From SARS to Novel Coronavirus” (http://andylee.pro/wp/?p=7169). En ese momento, traté dehablar sobre los posibles tratamientos con Medicina Tradicional China (MTC) para el Covid-19, basándome en mi experiencia clínica en el tratamiento denumerosos casos severos de neumonía causados por la gripe y otras enfermedades.Desde entonces, he participado directa e indirectamente en tratamientosexitosos con pacientes con Covid-19. He mantenido debates con muchos doctoresmientras luchábamos en primera línea contra la epidemia, como también conmuchos doctores mientras desarrollaban sus investigaciones relacionadas y heleido muchos informes sobre esta materia. Aunque el “Novel Coronavirus Pneumonia”se haya denominado como “Covid-19” (Enfermedad del Coronavirus 2019) y el nombre del virus haya sido oficialmente renombrado de “2019-nCoV” a “SARS-CoV-2”, actualmente creo firmemente quemis juicios iniciales, pensamientos e interpretaciones son correctos. Para facilitar la lectura, comprensión y facilidad de intercambio de este ensayo, he estado reorganizando misdiscusiones y debates anteriores, y he incluido también algunas explicacionessobre ciertas confusiones. En primerlugar, existen numerosas provincias y ciudades chinas donde se está utilizandola MTC para combatir el “COVID-19” (Utilizaré el término de Coronavirus de ahora en adelante). Independientemente de si los tratamientosprincipalmente estaban utilizando la MTC o una combinación de MTC y los métodosde la medicina occidental, se ha producido una significante cantidad deresultados positivos.

Porotro lado, los puntos de vista sobre cómo usar la MTC para el tratamiento y eluso de las correspondientes fórmulas herbales varían significativamente.Incluso cuando los remedios de la MTC fueron efectivos, ¿por qué algunospacientes se recuperaron completamente y fueron dados de alta en loshospitales, mientras otros pacientes aún no han podido tener la”confirmación negativa” del virus en los exámenes de ADN?

Muchos doctores de la MTC que han tomado parteen los tratamientos y discusiones a menudo ven el problema del Coronavirus desde un solo punto de vista, el del estado del paciente en un momentoespecífico. Algunos interpretaron la enfermedad como “humedad” (湿), “sequedad” (燥), “frío” (寒), o “calor” (热).

Desdeel punto de vista de la práctica clínica, aquellos tratamientos basados entales interpretaciones contradictorias, obtuvieron todos efectos positivos hastacierto grado. Entonces, ¿cuál interpretación es la “correcta”? Dehecho, todas estas interpretaciones simples poseen algún mérito, pero noabarcan completamente el tema en su totalidad. A pesar de que la MTC estábasada en el “tratamiento dialéctico” (辩证论治), es decir el tratamiento se deriva de “la observación y eldiagnóstico” de los síntomas complejos de los pacientes, lo más importantees que la enfermedad no debería verse como un problema aislado en un momentoespecífico.

Nosólo debemos observar y hacer un diagnóstico de la enfermedad, sino que tambiéntenemos que comprender el desarrollo temporal de ésta y proyectar como laenfermedad se desarrollará en el futuro. Para un paciente individual,deberíamos ser capaces de centrarnos en los resultados clínicos de esepaciente. Pero en el caso de las epidemias debemos observar un panorama muchomás amplio y tener en cuenta cómo el Coronavirus desarrolla problemas para lasalud en el interior del cuerpo humano, desde la perspectiva de la MTC.

En lostratamientos clínicos, necesitamos considerar también muchas variables causadaspor la condición inicial de cada paciente y las fuerzas que posea para lucharcontra la enfermedad. Desde mi experiencia de curación con numerosos pacientesafectados por neumonía inducida por la gripe, y sus complicaciones asociadas,unido a mi reciente participación en el tratamiento y curación de pacientes con Coronavirus, sería apropiado resumir que, con independencia de si el virus es Coronavirus, gripe aviar, gripe porcina o gripe común, encontramos que eldeterioro corporal causado por el virus, en general, sigue la descripción de lateoría de la MTC mencionada por primera vez en el antiguo Tratado sobre “El Daño Frío en diversas enfermedades” (Shang Han Za Bing Lun, 《伤寒杂病论》), obra clásica de la MTC. Sinembargo, las evoluciones de la enfermedad en estos virus especiales son muchomás rápidas, más severas, y más persistentes que las de la gripe común. Elpropio estado de salud original del paciente también complica la evolución.

Comoexpliqué con anterioridad, la teoría de la MCT establece que para la gripe o elresfriado común, la enfermedad comienza con una “Deficiencia Exterior oDebilidad” Es decir, el “exterior” del cuerpo es sido invadido por un”agente patógeno externo” (外邪), comoun virus, que tiene reacciones adversas. (Nota: Aquí el “exterior” no significa solo lasuperficie exterior del cuerpo, como la piel, sino todas las superficiesexpuestas morfológicamente al exterior, como el revestimiento de la garganta,la nariz y los bronquios) Esta es la primera fase de la enfermedad. Confrecuencia puede ser tratada de manera efectiva mediante la prescripción dehierbas como la “Gui Zhi Tang” (桂枝汤). Si elpaciente no recibe los tratamientos adecuados, los fluidos del cuerpo bajo lasuperficie de la piel y los músculos no podrán funcionar correctamente, y laenfermedad pasará a la segunda etapa, el “Exceso Exterior” con los remediosherbales correspondientes, como “Ge Gen Tang” (葛根汤), “Ma Huang Tang” (麻黄汤), entre otros. La infección viral en este estadio de laenfermedad se identifica con alguno de los diferentes síndromes denominadoscomo sus correspondientes remedios de hierbas, Ge Gen Tang” (葛根汤), “Ma Huang Tang” (麻黄汤), entre otros. La teoría de la MCT llama a este estadio “Frialdad Externa”. Durante la historiamuchos doctores de la MTC consideraron este estado como el daño producido en elcuerpo por el frío exterior (伤于寒) o simplemente por cogerfrío. Sin embargo, esto es un malentendido. Mientras el frío en el exterior esuna de las causas que conducen al estado de “FrialdadExterna”, no es su única causa. Cuando los fluidos corporales no funcionande la manera adecuada, estos fluidos que tienen capacidad y fluidez paracircular y satisfacer funciones vitales se transforman en un pozo de “AguaMuerta”, es decir agua derrochada que no puede satisfacer sus funcionesvitales. En otras palabras, El Tratado sobre el Daño Frío en diversas enfermedadeses mucho más que la simple interpretación de cómo tratar la enfermedad causadapor el “daño frío” sino más bien una obra clásica que explica exhaustivamentela fisiología y las patologías de las funciones del cuerpo humano. La gripe yel resfriado común se detienen en la etapa del “frío exterior” (表寒). Los pacientes suelen poder recuperarse solos, sin tratamientos.Cuando el “frío exterior” (表寒) comienza adesarrollarse hacia el interior del cuerpo, generalmente los pulmones y elsistema respiratorio, los cuales se comunican directamente con el mundoexterior, son los primeros afectados. El “frío exterior”(表寒) se convierte entonces en el “frío interior” (里寒) y el “frío pulmonar” (肺寒), y lospacientes comienzan a padecer más síntomas, como la tos y la moquita, partes deun síndrome que se cura con la decocción “Xiao Qing Long Tang” (小青龙汤). Cuando los pulmones y las partes del cuerpo relacionadas se enfrían,los fluidos pulmonares comienzan a dejar de funcionar como deberían, de igualforma que cuando el líquido refrigerante de un automóvil deja de funcionarbien. Los pulmones comienzan a sufrir el calor y la sequedad asociadas a lafalta de fluidos, y la enfermedad entra en la siguiente etapa, llamada”frío exterior convertido en calor interior” (入里化热), en la que los síntomas empeoran. Estos síntomas mencionados, en laMTC, comparten el nombre con su remedio correspondiente, la decocción “Da Qing Long Tang” (大青龙汤). Esta es la etapa quegeneralmente en la medicina occidental, se denomina neumonía. Sin embargo, evolucionar hacia la etapa de “frío exterior convertido en calorinterior” (入里化热) y padecer el síndrome de “Da Qing Long Tang” (大青龙汤) no significa que los pulmonesse calienten y se sequen completamente, ya que muchos pacientes con neumoníatienen una “mezcla de frío y calor” (寒热夹杂) enlos pulmones. Por ejemplo, mientras la parte superior de los pulmones sufresequedad y calor, en la inferior se puede producir una acumulación abundante democos espesos. Incluso es posible que tengan hidrotórax y derrame pleural. Enesta etapa compleja, el desarrollo de la enfermedad varía significativamenteentre pacientes con diferentes condiciones previas y demás singularidades. Yano es posible aplicar un remedio sencillo a base de hierbas para todas lassituaciones. La teoría clásica de la MTC ha hablado mucho de esta complejidad ypara cada síndrome ha ilustrado un tratamiento específico con los remediosherbales como “She Gan Ma Huang Tang” (射干麻黄汤), “Ting Li Da Zao Xie Fei Tang” (葶苈大枣泻肺汤), “Ze Qi Tang” (泽漆汤), “Xiao Qing Long Jia ShiGao Tang ”(小青龙加石膏汤), entre otros. Esto no significa que sedeba elegir una de estas recetas para tratar a un paciente directamente, sinoque la teoría de la MTC las utiliza para enseñar a sus médicos cómo pensar ycrear un remedio adecuado en función de las condiciones de cada pacientedeterminado.

Porejemplo, entre los casos graves de neumonía causada por COVID-19, existe unfenómeno extraño que a muchos expertos de la medicina occidental les cuestaentender: algunos pacientes graves tienen fibrosis pulmonar, como la neumoníapor SARS, mientras que algunos otros pacientes que no la sufren, en cambio,tienen una gran cantidad de moco espeso acumulado en los pulmones, que en elcaso de algunos pacientes críticos incluso les provocó la muerte por asfixia.Este fenómeno no es nada sorprendente desde el punto de vista de la medicinachina, ya que la fibrosis pulmonar es un resultado típico de la exacerbacióndel síndrome de “Da Qing Long Tang” (大青龙汤) del calor interior pulmonar, que se llama “atrofiapulmonar” (肺痿) según la teoría de la MTC. En cuanto ala mucosidad espesa acumulada en los pulmones, encontrada mediante la disecciónde los pacientes fallecidos, se corresponde con el fenómeno del “abscesopulmonar” (肺痈), un cambio severo de los síndromes de”She Gan Ma Huang Tang” (射干麻黄汤) y de “TingLi Da Zao Xie Fei Tang” (葶苈大枣泻肺汤). La “atrofiapulmonar” (肺痿) y el “absceso pulmonar” (肺痈) son los dos caminos de evolución de este virus, dependiendo de quécamino se desarrolle más rápido, o incluso simultáneamente, lo que ocurre confrecuencia. De acuerdo con los informes actuales, la neumonía por SARS tiende atener el síndrome correspondiente a la cocción”Da Qing Long Tang”(大青龙汤), mientras que lossíntomas de la neumonía por COVID-19 coinciden más bien con los síndromes de”She Gan Ma Huang Tang” (射干麻黄汤) y de “TingLi Da Zao Xie Fei Tang” (葶苈大枣泻肺汤).

Habiendoexplicado anteriormente las progresiones de la gripe y otras epidemias causadaspor infecciones de virus, ahora ya se puede entender por qué diferentesdoctores de la MTC tienen opiniones distintas sobre el Covid-19 y proponendiferentes recetas médicas, las cuales, en su totalidad, han dado resultadospositivos parciales. Si el diagnóstico de un médico de MTC en un momentoparticular fue un leve calor del pulmón, algunas hierbas suaves para”limpiar el calor” (清热解毒轻剂), usualmente utilizada por la doctrina de la “escuela del sur” (温病派) podrían aliviar los síntomas del paciente, pero si el diagnóstico deun doctor de la MTC en un momento diferente de la progresión observóacumulación mucosa masiva, una dosis de hierbas fuertes, usada habitualmentepor la doctrina de la “escuela clásica del norte” (经方派) sería necesaria para tratar el “absceso pulmonar” (肺痈). Es por ello que hemos visto algunos informes de la “fórmula No.1 dela neumonía” (肺炎一号) usada en la ciudad de Guangzhou,la cual se basa en hierbas suaves para reducir el “calor”, y quetiene efectos positivos en Guangzhou, pero que no son tan efectivos enShanghai. Algunos médicos de la MTC tuvieron que cambiar a hierbas más fuertes,con componentes que se encuentran habitualmente en las fórmulas “Da QinLong Tang” y “She Gan Ma Huang Tang” mencionadas anteriormente.Esto es debido a la diferencia entre distintos patrones climatológicos y a ladiferencia entre pacientes. Es decir, diferentes patrones de progresión comolos descritos en los párrafos anteriores. En otras palabras, desde el momentoespecífico de diagnóstico del doctor, las dos opciones son correctas. Sinembargo, ninguna de ellas logró comprender la progresión temporal de esta graveenfermedad.

Otropunto planteado anteriormente fue ¿por qué algunos pacientes se recuperaroncompletamente mientras que otros no? Según la información proporcionada por losmédicos en la línea del frente, existen los llamados “tratamientoscombinados de medicina occidental y MTC” en los que se trató a lospacientes continuamente con medicamentos de la medicina occidental y al mismotiempo se administraron hierbas de la MTC como suplementos. Es posible que lasfórmulas de la MTC agregadas al tratamiento funcionaran, ya que aparecieronefectos positivos que ayudaron una recuperación más rápida en algunos casos.Pero, ¿qué hacemos con los pacientes que no mejoran después de los tratamientosoccidentales complementados con la MTC? Según los médicos en primera línea,realmente no se pensó en las diferentes etapas de progresión de la enfermedad,como se ha discutido anteriormente ni en variar los diferentes remedios de laMTC, sino que solo se aumentó la dosis de medicamentos de la medicinaoccidental como el interferón Interferón (干扰素), lacloroquina fosfato Cloroquina Fosfato (磷酸氯喹) (usado paratratar la malaria), Arbidol (阿比多尔) (usado para tratar lagripe), etc. Las fuertes dosis de tales medicamentos tuvieron graves efectossecundarios y secuelas para los pacientes. En esos tratamientos”combinados”, los equipos médicos no tenían suficiente experiencia enla MTC para tomar decisiones acertadas sobre los remedios herbales. Simplementeusaron hierbas de la MTC como “ayuda adicional”.

¿Quétal los tratamientos principalmente con remedios de la MTC? El principalexperto en medicina occidental, quien lidera la lucha contra el Coronavirus, el Dr. Nanshan Zhong, admitió bajo presión política que la MTC era útil contrasituaciones de amenaza leve o incluso mediana de Coronavirus, pero insistió enque la MTC no podía curar los casos graves. Su declaración se basó en sucreencia de que no hay ningún ingrediente en las hierbas de la MTC que puedamatar el Coronavirus. Lamento decir que el Dr. Zhong está equivocado alrespecto. Basándonos en evidencias sólidas conprobadas con pacientes , la MTCpuede curar casos graves de infección por Coronavirus y otras infeccionesrelacionadas con la gripe. Cuando no lo han hecho, ha sido debido a quedeterminados médicos de la MCT no dominaban toda la teoría y metodología de laMTC . Sin embargo hay una afirmación que el Dr. Zhong enunció correctamente yes que ningún componente en las hierbas de la MTC puede “matar” elvirus. Pero el tratamiento de la MTC no se basa en la capacidad de matar elvirus. Muchas personas todavía tienen el nivel de comprensión limitada de quela MTC solo puede mejorar la capacidad de inmunización o que algunas hierbascomo el/la Banlangen (Radix Isatidis, 板蓝根) tienealgunos efectos antibióticos naturales. Tal comprensión es lamentablemente muypobre y limitada. Aunque la ciencia médica moderna aún no pueda comprendercompletamente la teoría de la MTC y sus resultados clínicos contra el Coronavirus, el mejor argumento es que los remedios de la MTC pueden”mejorar el entorno interno del cuerpo humano”. Expresado conpalabras simples, cuando el virus causa más mucosidad, los remedios de la MTC reducen la mucosidad, y cuando el virus causa fibrosis, los remedios MTC reducen el “nivel de calor” del pulmón. Los remedios de la MTC tienden a trasladar al cuerpo y a sus órganos a los estados saludablesoriginales. Una vez que el entorno no sea favorable para que el virus sigareplicándose, los pacientes tendrán mayores posibilidades de erradicar el viruspor sí mismos y recuperarse. Probablemente se pueda decir que esta explicacióny método es similar a la idea de usar el Interferón de la medicina occidental,pero sin efectos secundarios graves. Es decir, la MTC no puede curar porquetenga la capacidad de “matar” el virus con algunos agentes activos, sino la de ayudar a restaurar el “equilibrio interno” de los pacientes a unestado más saludable que evite que el virus se propague rápidamente.

Ahoravolvamos al tema de cómo clínicamente la MTC puede tratar y curar a losenfermos de COVID-19. Para los casos leves, la mayoría de las diferentesmetodologías de tratamiento con la MTC podrían ayudar. Para los casos medios yseveros, como mencioné en mi ensayo anterior, necesitamos utilizar ciertashierbas:

- Sheng Shi Gao (yeso, 生石膏): para reducir el calor dentro de los pulmones (清肺热) y mejorar la circulación de líquidos en el sistema respiratorio (加强肺津液运作)

- She Gan (Iris doméstica, 射干), Zi Wan (Aster tataricus, 紫菀), Kuan Dong Hua(Flor de tusilago fárfara, 款冬花), Sheng Ban Xia (Pinelliaternata, 生半夏), Ting Li (Semilla de draba nemorosa, 葶苈), Da Ji (Euphorbia pekinensis Rupr., 大戟),etc.: para reducir la acumulación de mucosidad excesiva y líquidosesparcidos dentro del sistema respiratorio (去肺下方浓稠痰饮、肺积水、胸腔积液等)

- Ma Huang (Ephedra sínica Stapf., 麻黄), etc.: para mejorar la función de lospulmones (宣肺发阳)

- Mai Men Dong (Ophiopogon japonicus, 麦门冬), Xing Ren: para hidratar los pulmones(润肺)

Esdecir, necesitamos combinar la teoría y las respuestas específicas de losdiversos remedios herbales como “Da Qin Long Tang” (大青龙汤), “She Gan Ma Huang Tang” (射干麻黄汤), “Ting Li Da Zao Xie Fei Tang ” (葶苈大枣泻肺汤), “ ZeQi Tang ” (泽漆汤), etc. como se discutió anteriormente, yajustar adecuadamente las dosis y proporciones de ingredientes para que seajusten a las necesidades de los pacientes individuales en función de suscondiciones. Además, si los pacientes padecen de otras dolencias, esascondiciones también deben tenerse en cuenta, por ejemplo:

- Para “frialdad y humedad del abdomen medio y bajo” (中下焦寒湿) o “función renal deficiente” (肾阳不足): añadir Pao Fu Zi (raíz de Aconitum carmichaelii Debx procesado, 炮附子), Xi Xin (Asarum sieboldii, 细辛), etc.

- Cuando la función hepática es débil o dañada por grandesdosis de medicamentos de medicina occidental como el Interferón: añadir Chai Hu (Bupleuri Radix, 柴胡), HuangQin (raíz de Scutellaria Baicalnsis Geprgi, 黄芩), etc.

No hay duda de que es muy difícil luchar contra el Coronavirus. Los tratamientos clínicos evaluarán seriamente la comprensiónprofunda de los médicos de la MTC sobre MTC y su capacidad y coraje para tomarlas dosis correctas bajo mucha presión. Por otro lado, también es un buenmomento para demostrar que la medicina tradicional china puede usarseeficazmente para combatir varios virus de una manera excelente, rápida, conpocas secuelas y a un costo mucho más bajo.

Para combatir una epidemia de virus tan nueva y agresiva,no hay una sola fórmula herbal de la MTC que pueda tratar todas lassituaciones. Se debe tener un conocimiento profundo de las etapas de laenfermedad, junto con exámenes minuciosos de las condiciones previas de lospacientes, para poder usar la receta más efectiva para interceptar y revertirlos síntomas. Por otro lado, en muchas provincias y ciudades de China, seproporcionaron pautas de MTC para tratamientos contra el Coronavirus y fórmulasherbales preestablecidas para abordar las demandas de los ciudadanos sobre unremedio herbal para “uso común”.Entre ellos, larecomendación actual de la Administración Nacional de MTC de China me parecióla más adecuada para un buen porcentaje de pacientes con Coronavirus. Elremedio de hierbas, denominado recientemente como “Qing Fei Pai DuTang” (清肺排毒汤), que probablemente podría traducirsecomo “limpiar el pulmón y eliminar el tóxico”. En línea con ladiscusión anterior, esta fórmula de hierbas específica incluye Ma Huang(Ephedra sínica Stapf., 麻黄), Zhi Gan Cao (RadixGlycyrrhizae Preparata, 炙甘草), Xing Ren (Prunus armeniaca, 杏仁), Sheng Shi Gao (yeso, 生石膏), Gui Zhi (RamulusCinnamomi, 桂枝), Ze Xie (Alisma orientalis, 泽泻), Zhu Ling (Polyporus umbellatus, 猪苓), Bai Zhu(Atractylodes macrocephala Koidz., 白术), Fu Ling (Poria, 茯苓), Chai Hu (Bupleuri Radix, 柴胡), Huang Qin(Scutellaria baicalnsis Geprgi root, 黄芩), Jiang Ban Xia(Pinellia ternate, 姜半夏), Sheng Jiang (jengibre, 生姜), Zi Wan (Aster tataricus, 紫菀), Kuan Dong Hua(Flor de Tussilago fárfara, 款冬花), She Gan (Belamcandachinensis, 射干), Xi Xin (Asarum sieboldii, 细辛), Shan Yao (Dioscorea oppositifolia, 山药), Zhi Shi(Citrus aurantium, 枳实), Chen Pi (Citrus reticulata Blanco, 陈皮) y Huo Xiang (Pogostemon cabin, 藿香). Dado que dicho remedio de hierbas fue diseñado para un “uso común”,tuvo que considerarse todos los grados de gravedad de la enfermedad. Por lotanto, las dosis no pueden ser demasiado pesadas, ya que en la mayoría de loscasos, los pacientes son leves. Como resultado, el/la “Da Qing LongTang” (大青龙汤) mencionado anteriormente se haconvertido en una fórmula de hierbas más ligera llamada “Ma Xing Gan ShiTang” (麻杏干石汤). Los ingredientes de hierbas másfuertes, como Ting Li (Sisymbrium indicum, 葶苈) y Da Ji (Euphorbia pekinensis Rupr., 大戟) para tratar el derramepleural y la hidronefrosis no están incluidos. Por lo tanto, para casosseveros, el remedio de hierbas de la Administración Nacional de MTC de Chinadebe mejorarse con ingredientes adicionales y dosis mayores.

Enresumen, siempre que los médicos de la MTC tengan suficiente conocimiento yexperiencia clínica, aplicando la metodología adecuada, la MTC solo es capaz decurar los casos graves del Covid-19. En este momento, no existe un “Medicamentoespecífico” en la medicina occidental para curar el Coronavirus, sino que sedebe recurrir a la cortisona, los antibióticos, el Interferón, losantipalúdicos, y los medicamentos contra la gripe para poder mantener con vidaa los pacientes y esperar que sus cuerpos reaccionen y puedan encontrar supropia manera para cambiar la situación. Incluso entonces, los medicamentos dela medicina occidental, mencionados anteriormente, pueden llegar a provocarefectos secundarios y secuelas importantes.

Lospacientes con casos graves pueden salvarse de la muerte, pero lo más probablees que vivan con daños y secuelas permanentes en el cuerpo.

El Dr.Zhong, principal experto en medicina occidental en China durante la epidemia de Coronavirus, también advirtió que el camino actual para desarrollar un“Medicamento específico”, probablemente conduciría a secuelas graves para lospacientes. Dado que este es el caso, ¿por qué no realizamos muchos másesfuerzos para desarrollar completamente el tratamiento de la infección viralpor medio de la MTC, no solo para el Coronavirus, sino también para los virusque aparecerán en el futuro?

（http://andylee.pro/wp/?p=7794）
#當張仲景遇上史丹佛

TCM Treatments of COVID-19

Written in Chinese by Dr. Andy Lee, March 7, 2020 (http://andylee.pro/wp/?p=7660)

Translated to English by Dr. James Yeh, March 13, 2020

I published an essay “From SARS to Novel Coronavirus” in Chinese on January 21, 2020 (http://andylee.pro/wp/?p=7169). At that time, I tried to discuss possible Traditional Chinese Medicine (TCM) treatments of Novel Coronavirus based on my clinical experience of treating many severe cases of pneumonia caused by various influenza and other diseases. Since then, I have directly and indirectly participated in treating patients of Novel Coronavirus successfully, had discussions with many doctors fighting the epidemic at the front line and many researchers conducting related researches, and read many reports on this subject. Although the “Novel Coronavirus Pneumonia” has been renamed to “COVID-19” (coronavirus disease 2019) and the name of the virus has officially named from “2019-nCoV” to “SARS-CoV-2”, I now firmly believe that my original judgment, views, and interpretations are correct. For the sake of easiness for people to read and share, in this essay, I am reorganizing my previous discussions and including some explanations on certain confusions as well.

First, there are numerous provinces and cities in China using TCM to fight the “COVID-19” (I will use the term “Coronavirus” from now on.) No matter whether the treatments were primarily using TCM or the combination of TCM and the methods of Western medicine, there have been a significant amount of positive outcomes. On the other hand, the views of how to use TCM to treat and the use of corresponding herbal formulas vary quite a bit. Even when TCM remedies were effective, why did some patients fully recover and were discharged from the hospitals but other patients still could not get the virus-free “negative confirmation” from virus DNA tests?

Many TCM doctors participating in the treatments and discussions often look at the Coronavirus issue from a single “Point” or the condition of the patient at that specific moment. Some interpreted the disease as “Dampness” (濕), “Dryness” (燥), “Cold” (寒), or “Heat” (熱). (Translator’s note: These interpretations are often the opposite ends of the spectra, like Dampness is opposite to Dryness; and Cold is opposite to Heat.) From the clinical practice point of view, those treatments based on such conflicting interpretations all had positive effects to some degrees. Then, which interpretation is the “correct one”? In fact, those simple interpretations all have some merits but don’t fully cover the subject in hand. Although TCM is based on “Dialectical Treatment” (辯證論治), i.e. treatment is derived from “observation and diagnosis” of patients’ complex symptoms, the most important thing is that disease shouldn’t be viewed as an isolated problem at a specific time, but the whole development of symptoms along a timeline. Not only we need to observe and diagnose the current ailment but also we have to understand the development history of the disease and to project how the disease will develop in the future. For a single patient, we might be able to focus on the clinical results of this patient. But for epidemics, we have to look at a bigger picture and take into account how this Coronavirus develops health issues inside the human body from TCM’s perspective. And, in clinical treatments, we also need to consider many variants caused by each patient’s preconditions and one’s strength to fight off the disease.

From my experience of curing many patients who were inflicted with flu-induced pneumonia and complications, and the recent participation in treating and curing Coronavirus patients, it is proper to summarize that no matter whether the virus is Coronavirus, bird flu, swine flu, or the “common” flu, we found that the bodily deterioration caused by the virus, in general, follows the description from the TCM theory first covered in the ancient literature “Treatise on Cold Damage on Miscellaneous Disease ” (傷寒雜病論). However, the progressions of the disease from such special viruses are much faster, more severe, and/or more persistent than that of the common flu. Patients’ own original “health” condition also complicates the progression. (Translator’s note: For example, the infliction rate of young children is much smaller than that of adults for Coronavirus.)

As I explained before, the TCM theory discussed that for the common flu or “catching a cold”, the disease starts with “Exterior Deficiency or Weakness” (表虛). That is, the “exterior” of the body is invaded by the “External Pathogen” (外邪), like virus, and has adverse reactions. (Translator’s note: Here the exterior doesn’t mean just the outside surface of the body like the skin, but all the surfaces topologically exposed to the outside like lining of throat, nose, and bronchus of the body.) This is the first stage of the whole episode and often can be effectively treated with the herbal prescriptions such as “Gui Zhi Tang” (桂枝湯). If the patient is not properly treated, the body fluids within the surface and muscles could not function properly. It will cause the transition to the next stage “Exterior Excess” (表實). (Translator’s note: The word Excess has various meanings: excessive reactions all the way to neoplasm, excessive wasteful things, etc.) Viral infection at this stage is matched to one of the several syndromes named with the corresponding herbal remedies such as “Ge Geng Tang” (葛根湯), “Ma Huang Tang” (麻黃湯證), and others. The TCM theory calls this stage “Exterior Coldness” (表寒). In history, many TCM doctors considered this stage as the body being hurt by outside coldness (傷於寒) or in plain words “Catching Cold”. However, that is a misunderstanding. While outside coldness is one of the causes leading to the stage “Exterior Coldness”, it is not the only cause. When the body fluids could not function properly, the normal body fluids which had proper fluidity to circulate and to fulfill vital functions (活水) became a pot of “Dead Water” (死水), i.e. wasteful water which can’t fulfill vital functions. In other words, the ancient literature “Treatise on Cold Damage on Miscellaneous Disease” (傷寒雜病論) is much beyond the simple interpretation of how to treat the ailment caused by “cold damage”, but a classical literature of explaining both the physiology and pathology of human body functions.

Normally, the ailment or symptoms of the common flu would be limited at this stage of “Exterior Coldness”. Even without any treatment, the human body often could fight off the virus with an immune response and fully recover. But when the effects of Exterior Coldness started to penetrate into the interior of the body, the first common organs to be affected will be the organs that have a short path to the outside. (Translator’s note: Topologically, trachea and lung are only a membrane distance away from the outside air.) Then the Exterior Coldness gets transformed into the next stages such as “Interior Coldness” (裡寒) and “Lung Coldness” (肺寒). (Translator’s note: Here “Lung” means the whole respiratory system, not only the lung organ.) Clinically, the patients start to show symptoms of the syndrome named after its herbal remedy “Xiao Qing Long Tang” (小青龍湯). At this stage, the patients have serious coughing and running nose. When the respiratory system is “affected by the coldness”, the body fluid function of the respiratory system gets affected. Just like when the cooling system of a car malfunctions, the engine would overheat. The circulation function of the lung becomes “Dry and Overheated” (燥热). This would lead to the next stage of “Heated Interior” (入裡化熱) and often be matched to its herbal remedy “Da Qing Long Tang” (大青龍湯). At this stage, it does not mean that the whole lung is “dry and heated”. In fact, many pneumonia patients exhibit “mixed coldness and heat” (寒熱夾雜) in the lung. For example, while the upper part of the lung is “dry and heated”, the lower part of the lung might suffer excessive mucus of a high density. Pleural effusion and hydronephrosis might start to develop quickly.

Such a complex situation was extensively discussed in Chapter 7 of the ancient literature “Synopsis of Prescriptions of the Golden Chamber” (金匱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. It doesn’t mean that one of the herbal remedies should be selected to treat a patient directly. Instead, the TCM Theory used these herbal remedies to teach its practitioners how to “think” and create a proper herbal remedy based on the conditions of a specific patient.

For example, the Coronavirus has quite a puzzling situation that many Western medicine doctors haven’t yet fully understood. Some severely affected patients exhibited fibrosis of the lung like the SARS phenomenon. Other severely affected patients did not have SARS-like lung fibrosis but had massive liquid cumulated in the lung, which even “drown” some patients to death. From the TCM point of view, it is not strange at all. Fibrosis of the lung is the typical following stage of Heated Interior matching to “Da Qing Long Tang” (大青龍湯). It was named as “Lung Atrophy” (肺痿) in the TCM theory. And the situation that one suffers from massive dense liquid accumulation is matched to symptoms of severe development after the stages matched to “She Gan Ma Hung Tang”( 射干麻黃湯) , “Ting Li Da Zao Xie Fei Tang” (葶藶大棗瀉肺湯), and others as discussed earlier. The TCM theory called it “Lung Abscess” (肺癰). In the TCM theory, Lung Atrophy and Lung Abscess are two progression paths of this virus depending on which path develops faster or even simultaneously. From the past and current reports, SARS virus tilts toward the path of Lung Atrophy, while the Coronavirus tilts a little more toward Lung Abscess.

The above explained the progression of flu and other epidemic virus infections. Now you might understand how different TCM doctors had different views or treatment methods, but all of the treatments had some partially positive effects. If a TCM doctor’s diagnosis at one particular moment was slight hotness of the lung, some mild herbs to “clean up the heat” (清熱解毒輕劑), often used by the “Southern School” doctrine (溫病派), might relieve the patient’s symptoms. But if a TCM doctor’s diagnosis at a different point of the progression was massive mucus accumulation, heavy dosage of strong herbs, often used by the “Northern or Classic School” doctrine (經方派) might be needed to treat Lung Abscess (肺癰). That is why we saw some reports that the “Pneumonia Formula One” (肺炎一號) used in Guangzhou city, which was based on mild herbs to reducing the “heat”, had some positive effects in Guangzhou but not so effective in Shanghai. In Shanghai, many TCM doctors had to switch to stronger herbal ingredient often found in “Da Qing Long Tang” (大青龍湯) and “She Gan Ma Hung Tang”( 射干麻黃湯) as discussed earlier. This was due to different weather patterns and different patients, i.e. different progression paths described in the previous paragraphs. In other words, from the specific moment of the doctor’s diagnosis, both views were correct. But neither of them grasped the progression timeline of this severe illness.

Another point raised earlier was why did some patients fully recover while others did not? According to the information given by the doctors on the front line, there were so-called “Western medicine and TCM combined treatments” in which Western medicine drugs were continuously given to the patients and TCM herbs were used as supplements. When adding TCM herbs had a positive effect and made a speedier recovery, it was all goodness. But when adding TCM herbs did not have positive results, then what? According to the doctors on the front line, the medical team did not really think through the stages of disease progression as discussed earlier and switch to different TCM remedies, but only increased the dosage of Western medicine drugs such as Interferon (干擾素), Chloroquine phosphate (磷酸氯喹) used to treat malaria (抗瘧疾藥物), Arbidol (阿比多爾) used to treat influenza (抗流感藥物), and others. Heavy dosages of such drugs had severe side effects and sequelae. In those “combined” treatments, the medical teams didn’t have enough TCM expertise to make sound decisions on herbal remedies. Instead, they simply used TCM herbs as “extra help”.

How about treatments primarily with TCM remedies? The chief Western medicine expert who leads the fight against the Coronavirus, Dr. Nanshan Zhong, admitted under political pressure that TCM was useful against light or even medium threat situations of Coronavirus but insisted that TCM could not cure severe cases. His statement was based on his belief that there is no ingredient in TCM herbs that could kill Coronavirus. I am sorry to say that Dr. Zhong is incorrect in this aspect. With solid patient cases as proof, TCM can actually cure severe cases of Coronavirus infection and other flu-related infections. When it did not, it is the particular TCM doctors who had not mastered the whole theory and methodology of TCM. But one thing that Dr. Zhong said correctly was that no ingredient in TCM herbs can “kill” the virus. However, the TCM treatment isn’t based on the ability to kill the virus. (Translator’s note: Western medicine drugs could not kill the virus either.) Many people still have the level of limited understanding that TCM can only improve the immunization ability or some herbs such as the root of Isatis tinctoria (板藍根) has some natural antibiotic chemicals. Such understanding is unfortunately poor and very limited. Although modern medical science still could not fully comprehend TCM theory and its clinical outcome, against Coronavirus, the better explanation is that TCM remedies can “improve the internal environment of the human body”. (Translator’s note: So that the patient would not fall into the adverse conditions that the organs fail to function.) In plain words, when the virus causes more mucus, TCM remedies reduce the mucus. When the virus causes fibrosis, TCM remedies reduce the “heat level” of the lung. TCM remedies tend to push the body and organs back to the original healthy states. Once the environment is unfriendly for the virus to keep replicating, the patients will have higher chances to eradicate the virus by themselves and recover. One can probably say that this explanation and method is similar to the idea of using Western medicine Interferon but without severe side effects. That is, TCM can cure not because it has the ability to “kill” virus by some ingredients but to help to restore patients’ “internal environment” to healthier conditions that prevent the virus from replicating quickly. (Translator’s note: If one buys the same argument made by Dr. Zhong that a medication needs to have ingredients to kill the Coronavirus, then all the medications used today would not qualify. Then do we give up? In fact, why TCM was not selected to treat severe cases was because those stronger and less commonly used herbs were not applied properly or the TCM doctors at hand had less confidence for doing so. )

Now, we can go back to discuss how clinically TCM can treat and cure Coronavirus patients. For light to mild cases, most of the different TCM treatment methodologies could help. For medium to severe cases, as I discussed in my previous essay, we need to utilize the strength of certain herbs:

- Sheng Shi Gao (Gypsum, 生石膏): To reduce heat inside the lung (清肺熱) and enhance the liquid circulation in the respiratory system (加強肺津液運作)

- She Gan (Belamcanda chinensis, 射干)、Zi Wan (Aster tataricus, 紫菀) 、Kuan Dong Hua (Tussilago farfara flower, 款冬花)、Sheng Ban Xia (Pinellia ternate, 生半夏)、Ting Li (Sisymbrium indicum, 葶藶)、Da Ji (Euphorbia pekinensis Rupr., 大戟), etc.: To reduce accumulation of excessive mucus and wasteful fluids inside the respiratory system (去肺下方濃稠痰飲、肺積水、胸腔積液等)

- Ma Huang (Ephedra sinica Stapf., 麻黃), etc.: To enhance the lung function (宣肺、發陽)

- Mai Men Dong (Ophiopogon japonicas, 麥門冬)、Xing Ren (Prunus armeniaca, 杏仁): To moisturize the lung (潤肺)

That is, we need to combine the theory and targeted responses of the various herbal remedies such as “Da Qing Long Tang” (大青龍湯), “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)“, etc. as discussed earlier, and properly adjust the dosages and ratios of ingredients to fit the requirements of individual patients based on their conditions. In addition, if the patients have other ailments, those conditions need to be taken into account also, such as:

- For “Coldness and Wetness of the Middle and Lower Abdomen“ (中下焦寒濕) or “Deficient Kidney Function” (腎陽不足): Add Bao Fu Zi (processed Aconitum carmichaelii Debx root, 炮附子)、Xi Xin (Asarum sieboldii, 細辛), etc.

- When the liver function is weak or damaged by heavy dosages of Western medicine drugs such as interferon: Add Chai Hu (Bupleuri Radix, 柴胡)、Huang Qin (Scutellaria baicalnsis Geprgi root, 黃芩), etc.

There is no question that it is very challenging to fight off the Coronavirus. The clinical treatments will seriously test TCM doctors’ thorough understanding of TCM and their ability and courage to call the right shots under a great amount of pressure. On the other hand, it is also a good time to prove that TCM can be effectively used to fight various viruses in a superb and speedy fashion with little sequelae and at a much lower cost.

For fighting such a new and aggressive virus epidemic, there is no single TCM herbal formula that can treat all situations. One must have deep knowledge of the stages of the disease, along with close examinations on patients’ preconditions, so one can use the most effective prescription to intercept and turn the symptoms around. On the other hand, many provinces and cities in China provided TCM guidelines on Coronavirus treatments and pre-fixed herbal formulas to address people’s demands on a herbal remedy for “common usage”. Among them, I found the current recommendation from the Chinese National TCM Administration the most appropriate for a good percentage of Coronavirus patients. The herbal remedy was recently named as “Qing Fei Pai Du Tang” (清肺排毒湯), which could probably be translated to “clean up the lung and get rid of the toxic”. In line with the discussion above, this specific herbal formula includes Ma Huang (Ephedra sinica Stapf., 麻黃), Zhi Gan Cao (processed Glycyrrhiza uralensis Fisch., 炙甘草)、Xing Ren (Prunus armeniaca, 杏仁)、Sheng Shi Gao (Gypsum, 生石膏)、Gui Zhi (Ramulus Cinnamom, 桂枝)、Ze Xie (Alisma orientalis, 澤瀉)、Zhu Ling (Polyporus umbellatus, 豬苓)、Bai Zhu (Atractylodes macrocephala Koidz., 白朮)、Fu Ling (Poria, 茯苓)、Chai Hu (Bupleuri Radix, 柴胡)、Huang Qin (Scutellaria baicalnsis Geprgi root, 黃芩)、Jiang Ban Xia (Pinellia ternate, 薑半夏)、Sheng Jiang (Ginger, 生薑)、Zi Wan (Aster tataricus, 紫菀)、Kuan Dong Hua (Tussilago farfara flower, 款冬花)、She Gan (Belamcanda chinensis, 射干)、Xi Xin (Asarum sieboldii, 細辛)、Shan Yao (Dioscorea oppositifolia, 山药)、Zhi Shi (Citrus aurantium, 枳實)、Chen Pi (Citrus reticulata Blanco, 陳皮)、and Huo Xiang (Pogostemon cabin, 藿香). Since such an herbal remedy was designed for “common usage”, it has to consider all degrees of disease severity. Therefore, the dosages can’t be too heavy, as the majority of the patient cases are light to mild. As the result, “Da Qing Long Tang” (大青龍湯) discussed earlier became a lighter herbal formula named as “Ma Xing Gan Shi Tang” (麻杏甘石湯). The stronger herbal ingredients such as Ting Li (Sisymbrium indicum, 葶藶) and Da Ji (Euphorbia pekinensis Rupr., 大戟) to treat pleural effusion and hydronephrosis are not included. Hence, for severe cases, the herbal remedy from the Chinese National TCM Administration needs to be enhanced with additional ingredients and larger dosages.

In summary, as long as the TCM doctors have sufficient knowledge and clinical experience, by applying the proper methodology, TCM alone is capable of dealing with severe Coronavirus infections. (Translator’s note: There is much to do to develop a comprehensive diagnostic and treatment methodology which can help many TCM doctors to pinpoint the patient’s condition and stages of the infection to make the proper decision, especially when fully qualified TCM doctors are of short supply.) At this moment, there is no “special drug” in Western medicine to cure Coronavirus, but to resort to cortisone, antibiotics, interferon, anti-malaria, anti-flu drugs to maintain the lives of patients and passively wait and hope that the patients’ bodies can find their own way to turn the situation around. Even then, the Western medicine drugs mentioned above all potentially have significant side effects and sequelae. Patients with severe cases might be able to get out of the deathbed but most likely live with some permanent damages to the body. Dr. Zhong, China’s chief Western medicine expert on the Coronavirus epidemic, also warned that the current path of developing the “special drug” would most likely lead to severe sequelae to the patients. Given that is the case, why don’t we put much more effort to fully develop the TCM treatment of viral infection, not just for Coronavirus but also for future viruses which will bound to happen in the future?

(Translator’s note: As China is getting good control of the virus spread and gradually recovers from this epidemic, the knowledge learned will be invaluable to the rest of the world. Europe and the United States are on the exponential rise of new cases as of the writing on 3/14/2020. Various models predict that in the US alone Coronavirus infections can reach millions, as discussed in the Opinion Column of New York Times, “How Much Worse the Coronavirus Could Get, in Charts” by Nicholas Kristof and Stuart A. Thompson, March 13, 2020. China should continue to put efforts to develop TCM diagnostic and treatment methodology so that millions of people in the rest of the world can be helped and saved. TCM is not just for science, it is for humanity.)

（http://andylee.pro/wp/?p=7729）
#當張仲景遇上史丹佛

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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