Significant therapeutic effects have been achieved in treating fungal pneumonia.

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① Yeast-like fungi are repeatedly found in sputum, and they exhibit a bran-like structure. ② Further identification of the fungal species can be performed through sputum culture; animal inoculation tests may be conducted if necessary. ③ Chest X-rays show nonspecific findings, such as increased and disordered lung markings, nodular or patchy infiltrates in the middle and lower lung fields, or large confluent lesions. Repeated examinations within a short period (e.g., 2–3 days) may reveal obvious dynamic changes, possibly accompanied by pleural involvement; prolonged disease courses may result in fibrotic shadows. ④ A sweet wine-like odor is present in the cavity or sputum. In cases of hematogenous dissemination, the same fungus can be detected in blood, urine, stool, cerebrospinal fluid, and other specimens.

Significant therapeutic effects have been achieved in treating fungal pneumonia. 4. Mycoplasma Pneumonia (1) Typically has a slow onset. Most patients exhibit upper respiratory tract infection symptoms, and dry or moist rales may sometimes be heard. (2) X-ray findings are non-specific, showing patchy, sheet-like, or uniformly blurred opacities, more prominent near the hilum and more common in the lower lobes; occasionally, the opacities are migratory. (3) Etiological diagnosis should be based on clinical presentation. About two weeks after onset, approximately half of the cases show positive cold agglutination tests (titers ≥1:32). Specific antibodies can be detected in serum 10–14 days after onset (complement fixation test positive). If conditions permit, mycoplasma cultures can be performed using patient sputum or nasopharyngeal swabs. (II) Western Medical Treatment Principles and main measures of Western medical treatment: (1) Once diagnosed, antibiotic therapy should be initiated immediately. For pneumococcal pneumonia, penicillin G is the drug of choice; for Klebsiella pneumonia, aminoglycosides, cephalosporins, and broad-spectrum penicillins can be used; for Legionella, Mycoplasma, and Chlamydia, macrolides are preferred; for resistant strains, antibiotics should be adjusted promptly based on susceptibility testing. Dosage should be determined according to the severity of the condition. (2) In severe pneumonia complicated by extrapulmonary infections, such as empyema, pericarditis, endocarditis, metastatic abscesses in the heart, brain, and kidneys, or arthritis, high-dose, sensitive antibiotics should be selected. (3) Elderly patients, those with severe underlying diseases, or immunocompromised hosts have a poorer prognosis. Pneumonia caused by Gram-negative bacilli, Staphylococcus aureus, especially MRSA, has a higher mortality rate. Treatment should focus on strengthening the body, preventing upper respiratory tract infections, and selectively administering vaccines in high-risk patients. (4) For patients with shock, in addition to anti-infection therapy, systemic tissue perfusion should be improved to restore and protect metabolic and organ functions. For syndromes characterized by phlegm-heat internal obstruction, Qingkailing Injection 40 ml can be added to 250–500 ml of 5% glucose solution for intravenous drip, twice daily. Alternatively, Xuebijing Injection or Tanreqing Injection can be used. For wind-fire and phlegm-heat syndromes, Niuhuang Qingxin Wan can be administered orally, 1–2 pills each time, 3–4 times daily. For patients with excessive phlegm transforming into heat, fresh bamboo sap can be taken, 10 ml each time, 2–3 times daily, or Chuanhong Ning drip therapy can be used. (5) For patients with respiratory failure or heart failure, symptomatic treatment should be provided in addition to intensified anti-infection therapy. (6) Antibodies appear relatively late after viral pneumonia, so their effect on controlling infection is limited. Interferon has a protective effect against viral infection of susceptible cells, helping to prevent disease progression and spread. However, it often causes side effects such as fever. III. Professor Pei Zhengxue’s Thinking Method The term “lung heat disease” first appeared in “Plain Questions · On Acupuncture Heat”: “In lung heat disease, one first gradually becomes cold, hair stands on end, feels aversion to wind and cold, tongue turns yellow, body becomes hot, when heat intensifies, there is wheezing and coughing, pain radiates to the chest and back, cannot take deep breaths, headache is unbearable.” During the Han Dynasty, Zhang Zhongjing in “Treatise on Cold Damage · Differentiation of Solar Disease Symptoms and Treatment” stated: “In solar disease, if there is fever and thirst but no aversion to cold, it is warm disease. If after sweating, the body remains scorching hot, it is called wind-warm disease.” During the Ming Dynasty, Wang Shishan proposed the concept of new-type warm disease, saying: “In winter, one is injured by cold… and in spring, it manifests… this is latent warm disease; there are also cases where people fall ill without being injured by cold in winter, which is specific spring warm disease, which can be named spring plague, similar to winter cold damage, autumn dampness injury, and summer heatstroke—this is new-type warm disease.” Ye Tianshi and Chen Pingbo, as representatives of warm disease scholars, summarized a complete set of theories and methods for diagnosing and treating wind-warm and lung heat diseases. Ye Tianshi pointed out in “External Warm Heat Chapter” that “Warm pathogenic factors first attack the lungs, then reverse and affect the pericardium.” He advocated “first using pungent-cool herbs to clear the upper burner,” elaborating on the etiology, transmission patterns, and treatment principles of this disease. In “On Warm Heat Theory,” Ye Tianshi introduced the Wei-Qi-Ying-Xue differentiation system, summarizing the rules for syndrome differentiation and treatment of heat-related illnesses. He said: “Generally speaking, after Wei comes Qi, after Ying comes Blood. It is acceptable to sweat out Wei, but only when Qi arrives should one clear Qi; once entering Ying, one can still dissipate heat, but must then transform Qi and decompose, like rhinoceros horn①, Xuan Shen, antelope horn, etc.; as for entering Blood, one fears depleting Blood and stirring Blood, so one must cool Blood and disperse Blood, such as Sheng Di, Dan Pi, A Jiao, Chi Shao, etc.” Wu Jutong’s “Differential Diagnosis of Warm Diseases” states: “Warm diseases enter through the mouth and nose; nasal qi connects to the lungs, oral qi connects to the stomach; if lung disease reverses, it affects the pericardium; if upper burner disease is left untreated, it spreads to the middle burner, affecting the stomach and spleen; if middle burner disease is left untreated, it spreads to the lower burner, affecting the liver and kidneys; starting from the upper burner and ending at the lower burner.” Thus, the theory of warm diseases has formed a complete system of principles, methods, ① Rhinoceros horn: now banned, water buffalo horn can be used instead. formulas, and medicines. Professor Pei Zhengxue points out that pneumonia belongs to the category of “wind-warm lung heat disease” in traditional Chinese medicine. This disease often arises due to imbalance between cold and warmth, overwork, leading to deficiency of vital energy, weakened lung defense, and subsequent invasion of wind-heat pathogens or transformation of wind-cold into heat, resulting in illness. At the onset, pathogenic factors invade the lung defense, causing disharmony of Wei Qi and impaired lung function of dispersing and descending, leading to symptoms such as aversion to cold, fever, and cough. When external pathogens penetrate deeper, heat invades the lungs, phlegm-heat stagnates, and lung Qi is obstructed, resulting in cough, yellow phlegm, chest pain, and accelerated breathing that damages lung meridians, causing blood in sputum, qi stagnation leading to blood stasis, heat accumulating in the lungs and qi flow becoming unfavorable, resulting in difficulty breathing and cyanosis of the lips. If the pathogenic factors are mild and the body’s resistance is strong, or if treatment is timely, the righteous energy will overcome the evil, and phlegm-heat will dissipate. However, if righteous energy is weak and evil remains, residual heat may persist, or even though the heat has subsided, symptoms of qi-yin deficiency may still appear. For example, if heat injures Ying and Blood, and heat closes the pericardium, one may experience confusion and muttering; if heat is extreme and generates wind, convulsions may occur; if evil prevails and righteous energy declines, one may also experience cold extremities and a faint pulse—a critical condition. At the same time, he points out that the School of Cold Damage and the School of Warm Diseases are both schools for treating exogenous heat diseases. For a long time, the two schools have held opposing views, with the School of Cold Damage attributing disease to cold pathogens and the School of Warm Diseases attributing disease to heat pathogens. The School of Cold Damage focuses on the cold nature of heat-related diseases and the characteristics of yang deficiency, emphasizing pungent-warm exterior-releasing and emergency yang-restoring methods; while the School of Warm Diseases focuses on the heat nature of heat-related diseases and the characteristics of yin depletion, emphasizing pungent-cool exterior-releasing and yin-nourishing, fire-lowering methods. However, for the same heat-related disease, it is possible to simultaneously possess dual characteristics of both cold and warm, and clinical manifestations of both cold and warm may alternate. Therefore, strictly separating the diagnostic and treatment methods of cold and warm clearly does not meet the objective needs of clinical diagnosis. Integrating the diagnostic and treatment approaches of the two schools forms a unified diagnostic method for heat-related diseases in traditional Chinese medicine. Professor Pei Zhengxue points out that pneumonia falls under the category of lung heat syndrome, with the disease located in the upper burner. Treatment should prioritize clearing heat and cooling herbs along with herbs that regulate qi and resolve phlegm. However, cooling herbs often harm the stomach and impair its function, and improper use can damage the Yangming stomach qi in the middle burner, thereby affecting therapeutic efficacy. Therefore, when treating warm heat diseases, one should avoid blindly using large doses of bitter-cold, drying, and damp-dispelling herbs, lest they damage the spleen and stomach, causing excessive vomiting and diarrhea in patients, further exacerbating “yin deficiency” and violating the principle of avoiding unnecessary depletion. Thus, one should first avoid using excessive amounts of cooling herbs that clear the lungs, or using herbs with heavy settling properties, or herbs with a bitter taste, or taking too much medication at once. For atypical pneumonia and novel coronavirus pneumonia, Professor Pei Zhengxue believes that their basic pathogenesis is characterized by heat toxin, phlegm stasis, blockage of lung meridians, intense heat and evil, internal accumulation of dampness, depletion of qi and yin, and in severe cases, even acute respiratory distress and collapse. The subtypes include heat toxin attacking the lungs, damp-heat obstructing, exterior cold with interior heat mixed with dampness, damp-heat harboring toxins, intense heat toxin, righteous energy weakening and about to collapse, simultaneous damage to qi and yin, and weakness of both lungs and spleen. IV. Traditional Chinese Medicine Syndrome Differentiation and Formulas 1. Wind-Heat Invading the Lungs Symptoms: Fever and aversion to cold, headache and chest tightness, no sweat or little sweat, cough and shortness of breath, slight thirst, red tip of the tongue, white or yellow coating, floating and rapid pulse. Treatment principle: Pungent-cool exterior-releasing and clearing the lungs to resolve phlegm. Formula: Modified Yinqiao San. Lianqiao 10g, Yin Hua 10g, Jiegeng 10g, Bohe 10g, Zhuye 10g, Gan Cao 6g, Jingjing 10g, Douzhi 10g, Niubangzi 10g, Xian Lugen 15g, Sangbai Pi 10g, Xingren 10g, Yuxingcao 10g. For excessive yellow phlegm that is difficult to cough up, add Beimu and Guapi; for sore throat, add Xuan Shen and Banlangen; for dry mouth and thirsty tongue, since it’s heat injuring yin fluids, add Mai Dong, Xuan Shen, pollen, and Bai Mao Gen; for chest tightness and yellow greasy tongue coating, add Huoxiang, Peilan, Liuyi San, and Ke; for severe sore throat, add Shegan and Xuan Shen. 2. Phlegm-Heat in the Lungs Symptoms: High fever without chills, sweat that doesn’t relieve the heat, frequent coughing, phlegm sounds and wheezing, flared nostrils and shortness of breath, yellow or rust-colored phlegm, chest pain and abdominal distension, thirst and irritability, dark red urine and hard stools, dry and reddened lips with bluish tinge, dry red tongue with yellow coating, slippery and rapid pulse. Treatment principle: Clearing heat and detoxifying, dispersing the lungs to resolve phlegm. Formula: Modified Maxing Shigan Tang combined with Weijing Tang. Mahuang 10g, Xingren 10g, Sheng Shigao 30g, Gan Cao 6g, Weijing 10g, Yiren 30g, Donggua Zi 10g, Taoren 10g, Yuxingcao 30g, Sang Bai Pi 10g, Huang Qin 20g. If phlegm-heat injures yin fluids, add Shashen, Tiandong, and Tianhua Fen to nourish yin and generate fluids; if phlegm contains blood, add Ou Jie and Ce Bai Tan; for chest tightness, add Yu Jin; for constipation, use Da Huang and Shi. 3. Internal Heat-Toxin Symptoms: High fever that won’t subside, restlessness and agitation, cough and shortness of breath, blood in phlegm, dry and thirsty mouth, occasional speech, even convulsions and coma, tongue is red and purplish with no coating or yellow-black coating, pulse is thin and rapid. Treatment principle: Clearing heat and detoxifying, clearing the heart and opening the orifices. Formula: Modified Qingying Tang. Yinhua 15g, Lianqiao 15g, Sheng Di Huang 12g, Xuan Shen 10g, Mai Dong 10g, Dan Shen 20g, Sheng Shigao 30g, Shi Chang Pu 10g, Yu Jin 6g, Lian Zi Xin 10g, Shui Niu Jiao 10g. For those with excessive phlegm, add Zizhi, Qingshi, Haifushi, and Dan Douzhi; for those with abundant heat-phlegm, add Zhu Li and Li Zhi to clear heat and resolve phlegm; for those with convulsions, add Lingyang Jiao and Quan Xie; even for those in a coma, add Angong Niuhuang Wan and Zixue Dan. 4. Weak Righteous Energy with Remaining Evil Symptoms: Low-grade fever that won’t subside, fatigue and weakness, sweating and aversion to wind, pale complexion, white and sticky phlegm, poor appetite and bowel movements; tongue is pale and white, pulse is soft and fine—this indicates qi deficiency. Or, intermittent fever that won’t subside, restlessness, red lips and dry mouth, five-heart heat, dry cough without phlegm, night sweats, tongue is red and has little coating, pulse is thin and rapid—this indicates yin deficiency. Treatment principle: Tonify yang and benefit qi, or nourish yin and clear heat. Formula: For qi deficiency, use Buzhong Yiqi Tang with modifications; for yin deficiency, use Qinghao Biejia Tang with modifications. Dang Shen 10g, Huang Qi 30g, Bai Shu 10g, Gan Cao 6g, Dang Gui 10g, Chen Pi 6g, Sheng Ma 3g, Chai Hu 6g. Qinghao 15g, Biejia 15g, Sheng Di 12g, Zhi Mu 10g, Dan Pi 10g 5. Weak Righteous Energy About to Collapse