Introduction

The outbreak of infections atypical pneumonia in the recent month caused death of many people in the whole world, and aroused again attention of the medical profession on the virus.  In fact, human beings should draw a lesson from this episode of SARS dissemination and make effort to prevent relapse of the spread of the virus, and at the same time, we should not ignore the combination of TCM and western medical treatment.

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Inadequate knowledge about the virus

The spread of atypical pneumonia has much frightened the people in Hong Kong.  Not long before, some people in Hong Kong teased the panic buying of acetic acid and gauze masks in the interior, without sufficient self alert on the condition.  The present status is that a widely growing sense of fear disseminates in Hong Kong, blaming the government incapable of preventing and treating the disease.  In fact, these viruses cause infection upon people all over the world and many medical workers have been infected and some unfortunately died of it.  We must admit that up to the present our knowledge about the virus is very inadequate.

Before the spring festival in Hong Kong, there were scattered epidemics of influenza in South china and some other parts of the world.  The Hong Kong government had spent much money and efforts to prevent the attack of fowl influenza (including the death of park birds) upon human beings.  At the present time, the weather, the geographic conditions, the communication developments and the rules of nature all can affect the dissemination of diseases.  The larger epidemics of influenza, once in several years, have drawn much attention of the health and anti-epidemic departments.  It is not strange to see that, in the recent years, antibodies inside the body of the people have gradually decreased on account of the effectiveness of preventive measures.  And this, in turn, induces the present particularly large epidemic episode (it is said by some that the pathogenic agent is coronavirus or chlamydia) causing a world wide spread in which a small part of the infected people showed the complication of atypical pneumonia and some of them dies.  According to traditional Chinese medicine it is dissemination of “spring pestilential disease”.  The relation of the former fowl influenza causing large amounts of death with the present epidemic is still obscure.

Now, what kind of pathogenic virus causes the infection is not important because dissemination of the virus is, in fact, very wide.  (Coronavirus usually causes human gastrointestinal symptoms, so, confirmation of the pathogen should still be done). Actually, the present so called atypical pneumonia presents “influenza” symptoms in the early stage and the Hong Kong epidemic is only part of the world “influenza” epidemic.  The body build of infected individuals are different from one another and most people present only common cold symptoms which are not serious and therefore easily neglected.

TCM drugs yield effective results

Atypical pneumonia is not fearful, because it is only a complication of influenza in the late stage.  TCM drugs were used to treat virus disease for thousands of years; TCM drugs and herbs, in fact, can effectively inhibit the progress of development of may virus disease and cut off the damage to the humane body by the virus.  Early diagnosis and early prevention and treatment with TCM drugs allow influenza patients pass a smooth course and atypical pneumonia can be prevented and cured, and the mortality can be greatly lowered.

Serious cases come from secondary infection especially chronic liver disease

We are actually very fortunate because our ancestors had left us thousands of years of experience of prevention and treatment of diseases with TCM drugs, which are very effective in treating virus disease.  Hong Kong and China have the tradition of using TCM drugs and most of the people there take TCM drugs in the early stage of the disease, so that, in this stage, it is comparatively easy to alleviate or eliminate the symptoms and also may lower the incidence of atypical pneumonia.  Patients presenting atypical pneumonia symptoms usually belong to the serious or acute type and their health conditions are originally poor or they might have been suffering from chronic diseases (especially chronic liver disease) and having lowered resistance and detoxication capacity.  These conditions promote the development of atypical pneumonia or if, in the recovery stage, there are secondary infection by bacteria or other pathogenic organisms, pneumonia, myocarditis, septicemia or other severe intervening episodes, serous conditions may be produced and death may result in some cases.

Virus Pneumonia are largely caused by hepatophilic viruses

In medical practice, it is demonstrated that virus pneumonia can be produced by a variety of viruses, including influenza a virus and parainfluenza virus, adenovirus, respiratory syncytial virus, cytomegalovirus, measles varicella, herpes virus, rhinovirus, coronavirus, Coxsackie virus, ECHO virus.  Most of them are hepatophilic viruses that induce chronic hepatitis.  It is not clear that the virus in the present epidemic disease is hepatophilic virus or not, but it is estimated that after the acute phase of the epidemic, the chronic hepatitis cases in various districts might turn into the “active stage”.  Hepatogenic upper respiratory tract infection patients might increase significantly, presenting repeated nasal hypersensitivity, upper respiratory tract infection, bronchitis and asthmatic clinical symptoms and signs.  These cases would respond poorly to antibiotics, but if given TCM drugs for treatment of virus hepatitis, the therapeutic effect would be comparatively ideal.

The common characteristic for virus diseases

In fact, virus disease have a common characteristic, that is, in the early stage of infection, there are clinical symptoms of upper respiratory tract catarrh; these are nasal obstruction, mucous discharge, dryness of pharynx, sorethroat, hoarseness, headache, chilliness, fever, soreness of loin and back and pain of extremities.  If sever, the patient may have a acute onset, dull appearance, lethargy, persistent high fever, chilliness, generalized pain and arthritic pain of extremities and may even have coughing, shortness of breath, nares flaring, asthmatic breathing, cyanosis of face and lips and eventually, coma, convulsions and death may ensue.  Although the types of virus are may.  The symptoms produced may be mild or sever. The clinical outcome different, but the TCM principle of treatment determination based on syndrome differentiation can suit every individual and obtain abrupt effectiveness.  From the TCM point of view, no matter it is Sang Ju Yin (桑菊飲) or Yinqiao Jiedu Tang (銀翹降毒湯), Ma Xing Shi Gan Tong (麻杏石甘湯), they are all effective in treating acute and serious influenza.  There are some effective elements in TCM drugs that can eliminate virus and terminate the progress of the disease.  The marvelous point is that TCM drugs are definitely effective in dealing with virus diseases.

TCM drugs can drive virus out of the body

In the recent twenty years, in TCM therapy of chronic hepatitis caused by hepatophilic virus, we are extremely certain that some TCM formulas are effective in anti-virus treatment.  In our clinic, among 3277 cases of abnormality of area of percussion dullness over hepatic region, those having liver stagnation lung dryness respiratory symptoms amounted to 1502 cases (occupying 45.83%).  These patients had their liver returned to normal boundary after taking three or more parcels of TCM drugs.  After 6 weeks of systemic TCM treatment, clinical cure was obtained.  The use of these TCM drugs to combat virus together with western medicine treatment in the management of atypical pneumonia should yield a good result.  The following is the formula which might be helpful for those engaged in the same pursuit.

Note:

l          If high fever does not abate and the disease aggravates, the peripheral circulation collapses, and the asthmatic symptoms become severe, the addition of Gypsum Fibrosum (石膏), Herba Ephedrae (麻黃) should be considered.

2          If constipation occurs, Radix et Rhizoma Rhei (大黃) may be added; in case of bloody sputum or hemoptysis, Rhizoma Bletillae (白芨) may be added, and in severe cases, the boiled liquid medicine should be given by nasal feeding.

TCM and WM shall yield good results

The combined TCM and WM (western medicine) treatment is imperative, especially in cases requiring intensive care.  When atypical pheumonia is complicated with toxic shock, there is failure of cardiopulmonary function and presence of virus myocarditis and this means further aggravation of the disease.  WM treatment can give support systemically to the patient and relieve his symptoms (abatement of high fever, maintain patent respiratory passage, oxygen inhalation, relieve dehydration, and provide nutritional support).  Proper use of corticosteroids can avoid abnormal immunologic response, so that atypical pneumonia patients may experience less suffering during the course of illness; and if combined with the above TCM drugs, the symptoms of the disease would be more relieved, the disease process more stable and the mortality further lowered.

The fight against influenza in Hong Kong and the interior during the fifties in the previous century is a recommendable experience.  The old TCM formulas can be used today and corrected according to time, place and individual.  It is worthwhile to mention that Ma Xing Shi Gan Tang (麻杏石甘湯) plus anti-virus TCM drugs give a definitely effective result in atypical pneumonia.  Form the point of pharmacology, Gypsum Fibrosum (石膏) can clear heat and expel fie and also can decrease anxiety and stop thirsty sensation.  Herba Ephedrae (麻黃) can promote sweating, calm asthmatic breathing, cause diuresis and eliminate edema.  These drugs have good effect in the relief of high fever, thirst, lung heat and asthmatic cough, headache, generalized soreness, hypersensitivity and anti-shock in atypical pneumonia.

The above mentioned TCM mixtures often times can promote the excretion of antigen-antibody complex of the body in a short time.  In western medicine, they used an extract from Herba Ephedrae (麻黃) called ephedrine hydrochloride to form cough mixtures which were used in the fifties to treat influenza and atypical pneumonia and were shown in the early stage to the effective in the abatement of fever.  Cardiotonic, stoppage of asthma, improvement in failure of microcirculation and anti-shock are the characteristic pharmacologic effects of TCM drugs. They do not kill the viruses directly, but only drive them out, improve the internal environment of the human body and strengthen the immunologic capacity.  It may be compared to a troop in war; it does not attack directly but aims at cutting off the enemies’ food supply.  When the enemy troops have not enough food they would collapse themselves, without direct attack of the challenger.  Although this strategy is different form the direct killing tactics of WM, it yields the same result.

1. Keep room humidity below 50℃: Spring pestilence occurs in spring at which time the weather has a high humidity and there is frequent alternation of coldness with hotness. The room humidity is high and this facilitates the spreading of virus loaded tiny droplets suspended in the air.  Therefore, dwelling houses should choose natural ventilation and maintain the air fresh (like open the inlet hale of air conditioner, start the ventilator).
   It is advisable to use home dwelling facilities to make an environment unlike spring, such as using the ventilator to form a humidity below 50 degrees (even lower, if no one stays in, but pay attention that it must not be too low, otherwise dryness of mouth and sorethroat may ensue).  Use air conditioner to maintain a 17-20℃ room temperature.  Because air in the room is in contact with the brass tube of air conditioner or ventilator, warm vaporized steam may condense to form water which would flow into the water container and be discarded.  Dryness of room air would lessen greatly virus loaded droplets.

2. Pay attention to personal hygiene: Patients having liver disease in the past should pay more attention to personal hygiene and rest.  It is advisable to take more nutritious food (take more broth and soup that nourish yin (陰) and supplement kidney and also take protein hydrolysate and amino-acids.  We should take less chicken, pigeon, mutton that might promote dryness and flaring up of fire.  Stop drinking wine, no roasting food and acrid diets.  If one feels dry and hot, one should take soups composed of Radix Puerariae as well as clearing, supplementing and cooling ingredients.  The congee composed of duck eggs preserved in lime and salty meat is recommended.  Drinks of the alkaline nature like cream soda are helpful because it can alkalinize the body fluid and increase resistance.

3. Use ultra-violet rays for epidemic districts and boiling method for dwelling house in disinfection of virus: Some viruses do not have strong resistance to physical factors, for example, heat. Influenza virus loses its pathogenic capacity in several minutes under 56℃.  In the common dwelling house, boiling is the usual method in disinfection of materials and the addition of soap powder in boiling for ten minutes eliminates bacteria and virus.  Dryness, ultra-violet rays, alcohol, ether, carbolic acid and bleaching powder all can be used in the inactivation of viruses.  Therefore, in epidemic districts, the use of ultra-violet rays and artificial exhaustion of moisture for air disinfection may be considered.

4. Regular check for body temperature for infants and the old : Infants or children and the old in the family feeling discomfort should be routinely tested for body temperature every night to avoid neglect.

5. Give back up support to medical professionals: Avoid contact with seriously ill patients. As to professional contact, the taking of TCM drugs for prevention and alleviation of symptoms is advisable.  If there are common cold symptoms, one may consider the taking of the above TCM drugs.

6. Prevent secondary bacterial infection: Influenza patients, often relief of clinical symptoms, relapse because of inadequate nutrition, rest and overwork. They show aggravation of cough, recurrence of high fever, purulent sputum and nasal discharge with yellowish, greenish color or blood tinged or even hemcptysis and chest pain.  These presentations indicate that secondary bacterial infection had taken place.  This condition is serious and medical treatment should be given early.

7. On-the-spot Isolation : one of the preventive measures is to isolate the infected patients on-the-spot. It is necessary to post the message at the door of the infected house to alert passes-by, outsiders and relatives so as to avoid cross infection.  From the medical point of view, it is not fearful to be infected as the body will produce antibody.  More important is the close surveillance of the development of the disease and it is ideal to use TCM to combat the further development of the disease.

8. Avoid infection, do not go to crowded places, if possible, do not go to hospital to visit patients; decrease visits to places with central air condition, because single air condition system may decrease chance of respiratory system infection.

9. Earlier treatment is advisable: Patients with common cold symptoms like high fever, chilliness, generalized soreness of body, marked feeling of weakness, breathing with efforts and aggravation of illness should visit hospital early.

By WONG Kwok Hung,
on 10th April 2003
Translated by Professor Zheng Hua En on 18^th April 2003