Traditional Chinese Medicine and the Current Pandemic

Sally Shaw L.Ac., Dipl.Ac.

I am an acupuncturist and Chinese medicine herbalist in the process of transitioning my practice and joining with CDA Acupuncture and Holistic Healing. I am very excited to joint the team in the coming weeks and looking forward to sharing my knowledge and healing experience with this community to help patients rebalance their body, mind, and spirit.   As luck would have it, I picked a very adventurous time to make this move.

 Who thought in our life time we would live through a world pandemic? Certainly not me, but here we are finding ourselves wondering…. What in the world is going on.  Are you like many people who are uncertain of the accuracy of information being poured all over the news and social media. Are you scared and not sure what your best options are to stay heathy. Recently a live webinar hosted by Dr. John Chen, Ph.D., Pharm. D., O.M.D., L.Ac. was made available to people in the medical community focusing on Traditional Chinese Medicine (TCM). My goal with this blog is to summarize and break down the information in the webinar, explaining what the Coronavirus (Covid-19) is, the pathology, symptoms and treatment options that are being discussed today in both Western conventional medicine and TCM and then focus on TCM’s role in treatment, prevention and recovery.

The corona virus outbreak was confirmed to have started in Wuhan, China late last year, around December 2019. The Virus is an RNA virus. It started as SARS and with replication a new strain has immerged SARS COV-2 which is the cause of Covid-19.

Incubation time (meaning the time you start to show symptoms) is between 2-14 days (average 4-5). Onset symptomology includes: fever, dry cough, sneezing, runny nose, sputum production, nasal congestion, shortness of breath (S.O.B), lethargy, muscle pain, headache and dehydration. 5-10% of the population can also present with gastrointestinal symptoms such as diarrhea and nausea before fever and S.O.B.

The pathophysiology of the virus has to do with the shape/structure of the virus. Picture a ball with spikes. This spiky ball enters the lungs and attaches to the lung receptors and begins to replicate. The virus can uncontrollably multiply, causing dysfunction in the immune cells of the lungs, ultimately resulting in some patients as a cytokine storm. This is a severe immune reaction in which the body releases too many cytokines (signals sent out by immune cells) into the blood too quickly. Cytokines play an important role in a normal immune response, but having a large amount of them released in the body all at once can be extremely harmful. A cytokine storm can occur as a result of an infection, autoimmune condition, or other disease.  A cytokine storm in the lungs can cause severe inflammatory disease, shortness of breath, inflammation of the airways and finally acute respiratory distress syndrome and multiple organ failure.

          In normal patients, the lungs are like a sponge allowing them to expand and contract. Upon Biopsy of patients with this virus, the lungs are filled with edema  (fluid) along with a lot of phlegm and sputum in the lung cells making the lungs rubbery and difficult to stretch.

          Western Diagnosis is based on signs and symptoms, nasopharyngeal swab, chest x-ray, CT scan or CBC (blood test meaning complete blood count) lymphopenia (decrease in white blood cells) is commonly seen in 80% of patients, making it increasingly harder to fight the infection.

          Western conventional treatment (all treatments at this time are experimental and there is no standard treatment at this time) includes: acetaminophen, aspirin, antivirals such as remdesivir (e-boli drug), lopinavir and ritonavir (HIV antivirals, concluded to be ineffective), chloroquine (malaria drug used as an attempt to slow entry into the body), immuno-suppressants (these decrease inflammation but can make secondary infection worse), ventilators and ECMO. Less common treatments in conventional medicine include: convalescent plasma - internally produce antibodies to prevent the virus from re-occurring. This can be used as an attempt to treat new patients so they can develop immunity to the virus. Two ways to cure the virus include: 1) most of the population develops their own immunity similar to the chicken pox. 2) Develop a vaccine (most likely 1-2 years away).

          We are nomadic creatures, we travel a lot. This allows the virus to spread rapidly around the world making the prognosis of contracting the virus high. This is why governments have issued a shelter in place order to help slow the progression of the virus and allow for hospitals to not get overwhelmed.  Prognosis: 50 to 70% of people will get Covid-19. Most will only experience mild symptoms that do not require hospitalization or any medical attention at all. People age 18 years or younger make up 2.4% of reported cases. Individuals 60 years or older with preexisting conditions (ex. asthma, diabetes) have an increased risk of contracting the virus. Hospitalization with intubation accounts for 3 - 10% of the population and it is estimated that 2 - 5% of those infected can die. Survivors may still need ventilators due to pulmonary fibrosis.  

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In China, Tradition Chinese Medical (TCM) providers are working on the front lines along with Western conventional medical doctors to fight this pandemic. They had a few months start ahead of us here in the U.S. and they have been sharing what has been helpful in this fight to limit infection, severity of symptoms and saving lives in China. I would like to share and simplify Dr. John Chen’s explanation of TCM Diagnosis and the role of TCM providers in prevention, treatment and recovery.  
 
TCM diagnosis and treatment is based on an individual’s presentation of disease based on the symptoms which are experienced.   For Cold induced disorders, which often includes colds, respirataory infections, the flu and other viruses – these are also often called wind-cold invasion disease (based on the classic Shang Han Lun written about 2000 years ago). This theory, breaks down the levels of illness into different stages, starting from external, less serious to the internal more serious and more severe.
 
Taiyang (External) - Early onset with symptoms including: fever, dry cough, sneezing, runny nose, nasal congestion, shortness of breath, lethargy, muscle pain, headache and dehydration.
 
Yangming (External) - More severe symptoms: fever, shortness of breath, inflammation in airways, phlegm deep in the Lungs
 
Shaoyang  (External) - symptoms become more severe, leading to cytokine storm.

Taiyin (Internal) - Cytokine storm leading to acute respiratory distress and Lung damage
 
Shaoyin (Internal) - Severe respiratory distress and Lung damage
 
Jueyin (Internal) - Muliple organ failure or death
 
The theory of Warm Diseases (Wen Bing) can also be broken down as levels from outside to inside, less severe to severe.
 
Wei (Defensive) - symptoms of Taiyang level
 
Qi (Energy level) - (Yangming): Edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Fibroblastic plugs were noted in airspace.  TCM differential diagnosis: Damp and phlegm in the Lung. – Lung heat, with Lung cold
 
Ying (Nutrutive level) - ( similar to Shang Han Lun’s Shaoyang, Taiyin, Shaoyin levels):.

Xue (Blood level) - In addition to hyperinflammatory injury, the lungs suffer physical injury (diffuse alveolar damage including hyaline membranes and physiological compromise. TCM differential diagnosis: Lung Yin deficiency, Lung Qi deficiency
 
Herbal Formulas presented for the purpose of this article are based on treatments that can be applied in the United States for prevention and recovery stages only. If you would like to see all treatments based on Dr. John Chen’s recommendations of Chinese herbal formulas for all levels of progression of disease please see Dr. John Chen’s full lecture here.
 
Prevention Formulas:
 
          Yu Ping Feng San (Jade Wind Screen Formula), the clinical application in TCM include:

1. Supplements Wei Qi and Stabilizes the Exterior and Lungs
2. Stops Spontaneous Sweating from Qi Deficiency
3. Disperses External Wind Pathogens

 
Patient may exhibit a pale tongue, with a thin white coat; pulse may be floating, soggy, and or weak. Western application include: common cold, influenza, chronic rhinitis, and allergic rhinitis.
 
          Sang Ju Yin Formula, the clinical application in TCM include:

1. Release the Exterior
2. Clear Wind Heat
3. Resolve Toxins
4. Arrest Cough
5. Descend and Arrest Lung Qi
6. Dispel Pathogenic Wind

 
Patient may exhibit a thin white coat; pulse may be floating and rapid.
Common Western uses include: common cold, influenza, acute early stage bronchitis, acute tonsillitis, and epidemic conjunctivitis.
 
Along with single herbs may be used in conjunction with above formulas:
 
Da Qing Ye (Isatis leaf), clinical application in TCM include:
1)  Reduces Heat and Relieves Toxicity
2)  Reduces Throat Pain and Swelling
3)  Cools the Blood and Reduces Skin Eruptions
4)  Clears Stomach and Large Intestine Damp-Heat
 
Western application include: Febrile disease, especially for epidemic and contagious diseases such as influenza, meningitis and pneumonia, and has an affinity for treating the lungs and the throat.
 
Huang Qin (Scutellaria baicalensis), clinical application in TCM include:

1. Clear Heat and Dries Damp
2. Clears Qi level Heat and Drains Fire
3. Cools the Lungs
4. Clears Heat and Stops bleeding

 
Western application include: High fever, cough, irritability, sputum that is thick and yellow, headache, red eyes, bitter taste in the mouth, hypertension, diarrhea, painful urination, blood in stool, epistaxis or vomiting with blood
 
Recovery Formulas:
 
Sha Shen Mai Men Dong Formula, the clinical application in TCM includes:

1. Tonify Lung Yin and Generates Fluid
2. Tonify Lung Qi
3. Clears Heat Transforms Phlegm

 
Patients may Exhibit a red tongue with little coating, pulse can be weak and rapid.
Western application include: Dry throat, thirst, hacking cough with little sputum, bronchitis, pneumonia, pulmonary tuberculosis, chronic gastritis and diabetes mellitus.
 
Warning! These formulas are based on differential diagnosis by a licensed TCM practitioner. Please do not attempt to take these formulas/ herbs by yourself. These formulas along with a variation of herbs may be given to patients to help prevent the onset of a virus or the very early signs of one as well as recovery to strengthen the lungs and the body. A formula similar to this one along with specific acupuncture points are suggested to be administered daily for at least two weeks. Please contact your local licensed acupuncturist to see what treatment may be right for you.

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CDC: How to Protect Yourself
Viruses that cause colds can spread from infected people to others through the air and close personal contact. You can also get infected through contact with stool (poop) or respiratory secretions from an infected person. This can happen when you shake hands with someone who has a cold, or touch a surface, like a doorknob, that has respiratory viruses on it, and then touch your eyes, mouth, or nose.
You can help reduce your risk of getting a cold:

• Wash your hands often with soap and water. Wash them for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer. Viruses that cause colds can live on your hands, and regular handwashing can help protect you from getting sick.

• Avoid touching your eyes, nose, and mouth with unwashed hands. Viruses that cause colds can enter your body this way and make you sick.
  
  
• Stay away from people who are sick. Sick people can spread viruses that cause the common cold through close contact with others.

Practice good cough and sneeze etiquette: always cough and sneeze into a tissue or your upper shirt sleeve, completely covering your mouth and nose.

How to Protect Others:
If you have a cold, you should follow these tips to help prevent spreading it to other people:

• Stay at home while you are sick and keep children out of school or daycare while they are sick.

• Avoid close contact with others, such as hugging, kissing, or shaking hands.
• Move away from people before coughing or sneezing.
• Cough and sneeze into a tissue then throw it away, or cough and sneeze into your upper shirt sleeve, completely covering your mouth and nose.
• Wash your hands after coughing, sneezing, or blowing your nose.
• Disinfect frequently touched surfaces and objects, such as toys and doorknobs.
  
  

What If I Am Asymptomatic?
If you are asymptomatic meaning showing no symptoms you can still be a carrier for the virus and pass it along to others. These people can then become extremely ill. This is why it is so important to take the above precautions and listen to what health experts are advising.

Other ways to stay Healthy:
Drink a lot of water 8- 10 glasses a day. Stay away from sugar and dairy, they can cause inflammation in the body. Load up on fresh fruits and veggies, and make healthy food choices 70% of your immune system is in your gut. Get fresh air. Try to keep a positive attitude, it goes a long way! And finally, be kind, be patient, we are all going through this together. Take care of yourselves.

References:
  
Dr. John Chen, Ph.D., Pharm. D., O.M.D., L.Ac. https://www.elotus.org/sites/default/files/coursenotes/jchen_txcovid19_handout.pdf, retrieved February 2020
 
https://www.cdc.gov/features/rhinoviruses/index.html retrieved February 2020
 
Bensky, D., Barolet, R., Scheid, V., & Ellis, A. (2009). Chinese Herbal Medicine
Formulas and Strategies (2nd ed.). Seattle, WA: Eastland Press.