Corona with a slice of time
Applying millennia-old TCM knowledge to gain an integrated perspective of COVID-19
With the current flood of info about the coronavirus on the internet, we wanted to take a moment and view COVID-19 from another lens, that of traditional Chinese medicine (TCM). Over the millennia that TCM was been practiced and refined, there have been numerous epidemics where TCM has played a critical role. Throughout TCM history there are many doctors who excelled at treating patients amid epidemics, among them Hua Tuo and Zhang Zhong Jing[i]. Applying this knowledge and experience to COVID-19 can give us insights into how to handle this novel disease.
The TCM strategy for COVID-19 involves two parts: prevention and treatment. It’s important to remember that TCM treats syndromes or types of diseases rather than generic diseases. Furthermore, as disease develops in the body, it can change in characteristic and type, and the treatment must also change accordingly. Although available information about causes, symptoms, transmission and severity is still lacking, we can analyze what we know so far to come to a TCM understanding of this new disease.
The first major symptom is fever, but some patients with mild cases can present without fever. In general, fever is highly indicative of an exterior condition, such as a tai yang disorder. However, for it to truly fit a tai yang pattern, the patient should present with fever and chills. Furthermore, that some infected patients exhibit no fever at all is indicative that this pathogen can bypass the tai yang level and strike deeper into the body.
There are two reasons why pathogenic factors would be able to bypass the tai yang level: the patient’s tai yang level is deficient, or the pathogenic factor is particularly strong. If we look at how contagious COVID-19 is, we can examine its transmissibility compared to other viruses. In epidemiology, R0 is used to quantify how contagious a pathogen is; the higher the R value the more contagious it is. For scale, a common flu has an R value of around 1.3[ii], and SARS, a much more virulent virus, had an R value of about 3[iii]. COVID-19 is currently thought to have an R value of about 2.2[iv]. This explains that COVID-19 is moderately contagious, and therefore according to TCM should generally only tend to infect those with weaker immune systems.
The second symptom is dry cough, which gradually leads to the third major symptom: difficulty breathing. A dry cough means that dampness is not a major factor for most patients. However, without further symptoms it is difficult to assess which pathogenic factor is responsible, since heat, cold, dryness and wind can all lead to a dry cough. And for severe cases, this can lead to pneumonia and potentially acute respiratory distress syndrome. Furthermore, post-mortem samples from a 50-year old male patient from Wuhan were taken from the lung, and examination showed bilateral diffuse alveolar damage[v]. Alveolar damage means the body can’t get enough oxygen into the blood, which leads to hypoxemia and weakness. This emphasizes that in addition to fighting off the virus, its also imperative to strengthen the lungs.
Lastly, in addition to hypoxemia, some severe cases present with other complications related to the blood. Some severe patients show problems with septic shock and dysfunction with bleeding and clotting[vi]. From the TCM perspective these blood conditions can be categorized as blood deficiency, blood stagnation and toxic heat. These all need to be considered when formulating prevention or treatment plans.
Prevention
Considering that the virus attacks the lungs and immune system, it’s essential to bolster the lung function and the immune system in general. In order to do this, TCM tonifies the lungs and spleen with a well-known formula called Yu Ping Feng San. The three herbs in this formula are huang qi (astragalus), bai zhu and fang feng. Together these herbs boost the immune system and digestion, thus warding off external pathogens. From a western perspective, evidence has shown that astragalus inhibits avian infectious bronchitis caused by avian coronavirus[vii].
Secondly, because some cases point to weakness in or attacks at the shao yang level, the second arm of this TCM prevention strategy is to proactively clear the shao yang level with a classic formula called Xiao Chai Hu Tang. This formula can clear any pathogenic factors from the shao yang level, and in smaller doses can do so preventatively. The two primary herbs in this formula are Chai Hu and Huang Qin; while one clears the exterior the other clears the interior, particularly the upper torso and chest. From a western perspective, Chai Hu and other plants in the same genus have been shown to inhibit flu viruses, Hep C virus, etc[viii],[ix],[x],[xi]. Furthermore, current research from Cell Research has shown that in vitro treatments of chloroquine have been effective at treating COVID-19[xii]. Chloroquine is traditionally an antimalarial drug, and Xiao Chai Hu Tang is a common TCM treatment for malaria.
Treatment
If patients have already contracted the disease, the above two formulas are not sufficient; Xiao Chai Hu Tang can be continued, but it is necessary to combine it with other herbs. Since the primary complication of COVID-19 is pneumonia, which usually manifests as a form of heat, it is important to clear the lungs either preventatively or curatively. Some common syndromes that more serious COVID-19 patients at this stage could present with include heat aggregating in the lungs (邪热壅肺), heat closing off the lungs (邪热闭肺), internally closed while externally failing (内闭外脱)[xiii]. However, this diagnosis would have to be done on a case-to-case basis due to individual symptoms and signs, such as pulse, tongue and other secondary symptoms. But as an example, one could include herbs like Sang Bai Pi and Di Gu Pi if the patient presented with lung heat symptoms, especially since Di Gu Pi also clears heat at the blood level. TCM often treats patients with the same disease differently based on their individual symptoms, progression of the disease and the patient’s constitution. And of course dosage would need to be adjusted accordingly as well.
To learn more about TCM prevention and treatment strategies, or about how TCM can help you improve your health in other ways, feel free to contact the author of this article: Dr. Steven Wong (steven@yellowmountainclinic.com) and Dr. Melati Stevens (drmelati@herb-and-legend.com).
For a FAQ about what the virus is and pointers about it, continue on:
What is a coronavirus? Are there more than one?
Coronaviruses are a large family of viruses which may cause illness in animals and/or humans. Typically, in humans, a coronavirus may cause respiratory infections ranging from the common cold to Severe Acute Respiratory Syndrome (SARS).
What is COVID-19?
COVID-19 is the name given to the infectious disease that is caused by the most recently discovered coronavirus, which began in Wuhan, China, in December 2019.
What are the Symptoms of COVID-19?
Although other symptoms of the disease have been documented, the most common symptoms of COVID-19 are elevated body temperature, dry cough, fatigue, and shortness of breath. Some other symptoms include runny nose, nasal congestion, sore throat, and diarrhea, although no evidence has surfaced that most, let alone all, symptoms must be present in positive cases of COVID-19.
Can a person without symptoms spread COVID-19?
Some people with COVID-19 become infected but do NOT develop outward symptoms of the disease and may not even feel unwell. That said, the primary method of spread for COVID-19 is through respiratory droplets expelled through coughing and/or sneezing. Because the vast majority (approximately 89%) of COVID-19 cases present with mild symptoms, it is reasonable to assume even those with a mild cough may be capable of spreading the disease.
Where in the world is COVID-19 currently located?
At this point, the diseases is fairly widespread across the globe. There are currently more than 122,000 cases of coronavirus across the world, with the biggest countries infected being China, the country of origin, Italy, Iran, South Korea, Spain, Germany, France, and the United States. As of March 11, 2020, over 1000 cases of coronavirus have been identified within the United States. At least 32 people have died due to the disease nationwide. Over 4,300 COVID-19 deaths have occurred across the globe thus far.
Who are the people highest at risk of developing severe symptoms of COVID-19?
While studies are ongoing to determine how COVID-19 may affect different groups of individuals, at present, it seems people who are elderly, people with pre-existing medical conditions (such as high blood pressure, lung disease, heart disease, diabetes, or cancer), and people with compromised immune systems are those most at risk to develop severe symptoms of the disease.
Do antibiotics work against COVID-19?
No, COVID-19 is a viral infection. Antibiotics do not work against viruses, only against bacterial infections.
Is there a vaccine or pharmaceutical treatment for COVID-19?
Not at present. To date, there is no vaccine available, and no pharmaceutical prescription that has proven to be affective at treating symptoms of or preventing contraction of COVID-19. However, just as with other diseases, patients should seek care in order to aid in recovery from the disease with as little complications as possible. Those whose symptoms progress to severe illness should be hospitalized.
Is COVID-19 more dangerous than the flu?
That remains to be seen. Yes, we currently know the flu, or influenza, is “deadlier” than COVID-19 insofar as the mortality count, but there are other factors at play that may change those statistics in the long-run. In this season alone, the influenza virus has caused an estimated 34 million illnesses, 350,000 hospitalizations, and 20,000 deaths, according to the Centers for Disease Control and Prevention (CDC). But scientists have known about, and studied, the flu for several decades and thus know what to expect each season. In contrast, we currently know very little about what COVID-19 can do in terms of damage. And we know, with a good amount of certainly, that as we end March and enter April, the number of flu cases are going to decrease, as they do nearly every year. With COVID-19, there are still a lot of unknowns, so only time will tell how the population fares with the coronavirus as we end the spring months and enter into summer.
Can a face mask protect me from contracting COVID-19?
Only wear a face mask if you yourself have already contracted COVID-19 and are coughing, or are currently caring for someone who may have the disease. A disposable face mask can only be worn once. If you are not ill or looking after someone who is ill, it is likely the face mask, which is in high demand, may be wasted. With the current world-wide shortage of masks, it’s important to allow resources to remain for those truly in need. Please see the most effective methods to prevent spread and contraction of COVID-19 below.
What are effective methods to prevent the spread and contamination of COVID-19?
Regularly and thoroughly clean your hands with an alcohol-based hand sanitizer or wash them for at least 20 seconds with soap and warm water.
Maintain at least 3 feet distance between yourself and anyone who is visibly coughing and/or sneezing.
Avoid regularly touching your face — especially your nose, mouth, and eyes.
Clean all of your commonly handled items, including your tech equipment (i.e., smart phone, computer keyboard, headphones, etc.) and your car (steering wheel, gear stick, seat belt hardware, etc.).
Follow good respiratory hygiene: cover your mouth and nose when you cough (ideally, with your sleeve/bent elbow or a tissue, rather than your hands). If using a tissue, dispose of it immediately in an appropriate receptacle.
Avoid hoarding N95 respirator masks — they are not one-size-fits-all, and without proper training, it’s likely the mask will allow for some permeation of the disease, which renders them useless. Leave them for the hospital staff and healthcare workers who really need (and know how to use) them.
Stay home if you feel ill, if you have a fever, cough, or difficulty breathing. Seek medical attention if symptoms multiply or worsen.
Avoid traveling if at all possible. This advice is especially pertinent if you are elderly, immune-compromised, or have pre-existing diabetes, lung or heart disease.
[i] https://link.springer.com/article/10.1007/s00381-011-1423-z
[ii] https://www.healthline.com/health/r-nought-reproduction-number
[iii] https://www.who.int/csr/sars/en/WHOconsensus.pdf (p.27)
[iv] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf (p.10)
[v] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf (p.5)
[vi] Sourced from http://www.chinanews.com/sh/2020/01-20/9065162.shtml
[vii] https://www.ncbi.nlm.nih.gov/pubmed/29170045
[viii] https://www.ncbi.nlm.nih.gov/pubmed/30203768
[ix] https://www.ncbi.nlm.nih.gov/pubmed/29039946
[x] https://www.ncbi.nlm.nih.gov/pubmed/28314599
[xi] https://www.ncbi.nlm.nih.gov/pubmed/30920421
[xii] https://www.nature.com/articles/s41422-020-0282-0.pdf
[xiii] https://www.zhihu.com/question/367393092?from=groupmessage