III. Traditional Chinese Medicine’s Understanding and Treatment of Upper Respiratory Tract Infections

III. Traditional Chinese Medicine’s Understanding and Treatment of Upper Respiratory Tract Infections

(1) Medical Records from Past Dynasties on Similar Upper Respiratory Tract Infections

Traditional Chinese Medicine views this disease as falling under the categories of "shang feng" or "guan feng," representing one of the most common external infections. The primary cause is the invasion of wind evil, as stated in "Su Wen · Bone Void Theory": "Wind enters from the outside, causing chills, sweating, headache, and a heavy body with cold." Such infections often occur when the climate changes suddenly, or when temperatures fluctuate drastically. Often, poor living habits—such as getting caught in the rain, being exposed to cold, or overworking—lead to loose skin pores and weakened defensive qi, allowing wind evil to enter the body through these vulnerabilities. Wind evil, when it enters the body, often manifests differently depending on the season and the prevailing weather conditions: in winter, it is more likely to be wind-cold; in spring, it is more likely to be wind-heat; in summer, it is often accompanied by summer dampness; and in autumn, it may also be associated with dry air. This understanding aligns closely with Western medicine’s view that human immunity can weaken due to mental and physical fatigue, as well as lifestyle imbalances, making people susceptible to viral or bacterial infections that trigger upper respiratory tract inflammation throughout the year.

(2) Traditional Chinese Medicine’s Understanding of the Pathogenesis

The pathogenic factor enters through the mouth and nose, attacking the lung and defensive qi, leading to symptoms such as nasal congestion, cough, chills and fever, and headache. The disease is generally mild, with few complications and a recovery time of just a few days.

(3) Traditional Chinese Medicine’s Differentiation and Treatment Methods

1. Wind-Cold Cold Symptoms include severe chills, mild fever, lack of sweat, nasal congestion, clear nasal discharge, headache, body aches, or cough with white phlegm; the tongue coating is thin and white, and the pulse is floating. Treatment focuses on warming and dispersing exterior pathogens, with adjustments to Jing Fang Baidu San: 10g each of Jing Jie, Fang Feng, Qiang Huo, Qian Hu, and Bai Zhi, along with 3 slices of fresh ginger. Brew the herbs in water and take once daily. Alternatively, use 15g of Su Ye, 3 slices of fresh ginger, and brew in water, or take 1–2 pills of Tong Xuan Li Fei Wan twice daily.
2. Wind-Heat Cold Symptoms include severe fever, mild chills, sore throat, thirst, or cough with yellow phlegm; the tongue coating is thin and yellow, and the pulse is floating and rapid. Treatment focuses on cooling and dispersing exterior pathogens, with adjustments to Yin Qiao San: 15g each of Jin Yin Hua and Lian Qiao, 10g each of Jie Jing and Shan Dou Gen, and 6g each of Zhu Ye, Bo He, and Gan Cao. Brew the herbs in water and take once daily. Alternatively, use 15g each of Jin Yin Hua, Lian Qiao, Da Qing Ye, and Ge Gen, brew in water, or take 1–2 pills of Yin Qiao Jie Du Wan twice daily.
3. Summer-Damp Cold Symptoms include fever and chills, head fullness, body fatigue, chest tightness, or vomiting and diarrhea. The tongue coating is thin and yellowish, and the pulse is slow and moist. Treatment focuses on clearing summer dampness, dispersing exterior pathogens, with adjustments to Xin Jia Xiang Ru Yin: 20g each of Jin Yin Hua and Lian Qiao, 20g of fresh reed roots, 15g of Bean Pod, and 10g each of Xiang Ru, Huo Xiang, Pei Lan, and Hou Pu. Brew the herbs in water and take once daily. Alternatively, use 15g each of Huo Xiang and Pei Lan, 6g of Bo He, and brew in water once daily. Or, take 1–2 pills of Huo Xiang Zheng Qi Wan twice daily. For preventive purposes, use Guan Zhong and Ban Lan Gen in winter and spring, and use Jin Yin Hua, Huo Xiang, and Pei Lan in summer, brewed as tea.

(4) Traditional Chinese Medicine Resources on the Diagnosis and Treatment of This Disease

In recent years, many reports have highlighted the use of traditional Chinese medicine preparations—such as Shuang Huang Lian, Qing Kai Ling, Tan Re Qing, and YU XING Cao—as single medications or in combination with Western medicine to treat upper respiratory tract infections, offering both convenience and good therapeutic outcomes.

A report titled "Summary of 305 Cases Treated with Xiang Ju Guan Feng Granules for Cold and Fever" noted that 10g each of Huo Xiang and Qing Hao, 6g of Xiang Ru, and 15g of Ye Hua were used to prepare the granules. The initial dose was 20g, followed by 15g, and the medication was taken three times daily with boiling water. A total of 94 cases were treated for wind-cold type, 149 cases for wind-heat type, and 62 cases for summer-damp type, with a total effective rate of 95.4% and an average fever-reduction time of 1.72 days. This product is suitable for all types of colds throughout the four seasons, with no adverse reactions reported. (Sichuan Traditional Chinese Medicine, 1991.1) Li Chun Sheng et al. observed the efficacy of Qing Kai Ling in 400 patients with acute upper respiratory tract infections, administering 120ml, 160ml, or 200ml of Qing Kai Ling three times daily, while using 1.8ml of Jie Mei Injection as a control. The results showed that Qing Kai Ling had a cure rate of 84.14%, while Jie Mei had a cure rate of 75.83%; Qing Kai Ling demonstrated superior efficacy compared to Jie Mei.

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Input: (p<0.01) . Qingkai Ling (single, conventional dose) reduces the average time to onset of body temperature reduction (12.6 hours), which is shorter than that of gentamicin (17.6 hours). Qingkai Ling demonstrates superior efficacy compared to patients with a disease course of less than 1 day, especially when compared to patients with a disease course of 3 days or more. However, there was no significant difference in efficacy between the three dosages (p > 0.05). The effects of Qingkai Ling at each dosage level, as well as its overall effect on reducing total white blood cell count, were comparable to those of gentamicin. For patients whose throat swab cultures showed the presence of pathogenic bacteria, Qingkai Ling exhibited excellent in vivo antibacterial activity. Conclusion: Qingkai Ling is an effective and rapidly acting medication for treating acute upper respiratory tract infections. (China Journal of Integrated Traditional and Western Medicine, 19994) Jiang Yuejuan et al. reported a study on the combined use of traditional Chinese medicine and Western medicine to treat 289 cases of acute upper respiratory tract infection, comparing them with a control group treated solely with Western medicine, consisting of 287 cases. The Western medicine group received standard antipyretic, cough-relieving, and anti-infective medications; the combined TCM-Western medicine group, in addition to the Western medicine regimen, added one packet (6 g) of Jiuwei Qianghuo Wan (granules) to the Western medicine regimen for wind-cold types, and one packet (6 g) of YinQiao Jiedu Wan (granules) to the Western medicine regimen for wind-heat types; for wind-heat types, they also administered one bottle (10 ml) of Zhongcheng Huahe Shui to the Western medicine regimen; for phlegm-heat stagnation in the lungs, they used 4 ml of Yuxing Cao, twice daily; for lung-stomach heat, they took four tablets of Sanhuang Pian, once daily (reducing the dosage to three tablets per dose if bowel movements were normal). Both groups discontinued all other medications, and the treatment duration did not exceed 6 days. Treatment outcomes: The combined TCM-Western medicine group achieved a cure rate of 263 cases (91.0%), a marked improvement in 16 cases (5.5%), and no improvement in 10 cases (3.5%), resulting in a total effective rate of 96.5%; the Western medicine group had a cure rate of 202 cases (70.4%), a marked improvement in 38 cases (13.2%), and no improvement in 47 cases (16.4%), with a total effective rate of 83.6%. There was a statistically significant difference in the overall effective rate between the two groups (p < 0.05). (China Folk Therapy, 2004.12) Zeng Guoping observed the therapeutic effects of Shuanghuanglian, Manqi, and Shuanghuanglian + Manqi across 186 patients with acute upper respiratory tract infection. The Shuanghuanglian treatment group and the Manqi treatment group had effective rates of 85.9% and 87.1%, respectively, with no statistically significant difference between the two groups (p > 0.05). However, the Manqi plus Shuanghuanglian group demonstrated an effective rate of 98.3%, which was significantly higher than the previous two groups (p < 0.01). (Journal of the People’s Armed Police Medical College, 2008.10)

IV. Western Medicine Treatment (1) General Care Get adequate rest and drink plenty of boiled water. Maintain a regular daily routine, engage in appropriate physical exercise, and pay attention to changes in weather temperature—adjusting clothing accordingly to help prevent this illness. (2) Medicinal Treatment For viral upper respiratory infections without specific causes, antibiotics are generally used. Symptomatic treatment includes using 1% ephedrine solution for nasal congestion; for dry, painful nasal passages, use mint lozenges for oral consumption; for headaches and fever, take one tablet of compound aspirin three times daily. (Huang Hui Zhao, Wu Bin) Chapter Two: Influenza I. Overview

Influenza, often abbreviated as “flu,” is a highly contagious acute respiratory disease caused by influenza viruses. This disease spreads rapidly and is widespread, often causing many people to fall ill within a short period of time, quickly spreading to large regions—and even leading to global pandemics. Influenza is classified into three types: A, B, and C. Type A frequently causes recurring outbreaks and pandemics, while Type A can occur sporadically in everyday life. Clinically, it is characterized by high fever, severe fatigue, generalized body aches, and relatively mild respiratory symptoms. The incidence rate is high, and the mortality rate is also high. In traditional Chinese medicine, influenza is categorized under terms such as “Tian Xing Bing,” “Shi Xing Bing,” “Shi Yi,” “Shi Xing Gan Mao,” “Feng Wen,” and “Dong Wen.” This disease is most common during winter and spring, though it is not limited by seasonal conditions. All age groups are generally susceptible.

The influenza virus is an RNA virus, spherical in shape, with a diameter ranging from 80 to 120 nanometers. The nucleoprotein has type-specific characteristics, as do the membrane proteins in the inner layer of the envelope; the outer layer consists of lipids, bearing hemagglutinin (HA) and neuraminidase (NA), which exhibit subtype and variant-specific properties. Based on differences in nucleoprotein antigenicity, influenza viruses are divided into three types: A, B, and C. They were first isolated in 1933, 1940, and 1946, respectively. Depending on differences in HA and NA antigenicity, they are further subdivided into several subtypes. Type A is highly variable; since 1918, it has undergone five major mutations, often triggering pandemics. Type B is less variable and typically appears as sporadic outbreaks. Type C remains stable and is often sporadic. The virus primarily spreads through droplets, and the general population is susceptible; after infection, individuals develop a certain degree of immunity. Influenza viruses invade and replicate within the ciliated columnar epithelial cells of the respiratory tract, causing cellular degeneration, necrosis, and shedding. Clinical manifestations include an incubation period of 1–2 days. Typical flu begins suddenly, with chills and high fever, accompanied by significant fatigue, headache, body aches, dryness and redness in the throat. Fever subsides after 3–4 days, but fatigue may persist for more than 2 weeks. Severe flu cases are more common in infants, elderly individuals, or those with pre-existing chronic conditions; these patients often present with atypical symptoms but experience rapid deterioration, developing pneumonia, myocarditis, or meningitis, and often die within 5–10 days. Some patients may also experience gastrointestinal symptoms such as vomiting and diarrhea. When influenza does not involve bacterial infections, white blood cell counts are either normal or reduced, with a relative increase in lymphocytes in the differential count. Early detection involves examining nasal mucosal smears for influenza virus inclusion bodies and fluorescent antibody tests for antigens, as well as inoculating throat washes onto chicken embryos or tissue cultures to isolate the virus—a method that provides early, specific diagnostic tests. Later, both early and 2-week post-infection serum samples can be tested using hemagglutination inhibition and complement fixation assays as specific diagnostic methods.

II. Diagnosis (1) Diagnostic Criteria

1. Epidemiology: History of exposure and contact, often occurring during winter and spring, with a short incubation period.
2. Typical clinical manifestations: Rapid onset of high fever, mild upper respiratory symptoms, and prominent systemic toxic symptoms (body aches, loss of appetite, fatigue); the disease course typically lasts 2–3 days, with some cases lasting up to a week, and cough may persist for 2–3 weeks after fever subsides.
3. Laboratory tests reveal decreased white blood cell counts and neutrophil reduction. Microscopic examination of lower nasal concha smears may reveal inclusion bodies within the cytoplasm of columnar epithelial cells, aiding in diagnosis; the positive rate is generally high within 4 days of onset (80–95%). Fluorescent antibody staining further enhances early diagnosis. Virus isolation and serological testing of antibodies in the blood are crucial for definitive diagnosis. (2) Differential Diagnosis: Pay close attention to distinguishing influenza from other viral and bacterial respiratory infections, as well as other early-stage acute infectious diseases. Common viral colds have a slower onset and milder systemic symptoms; other viral respiratory infections are primarily diagnosed through virus isolation and serological testing; bacterial respiratory infections often show elevated white blood cell counts and neutrophils. Other infectious diseases may present with upper respiratory symptoms in their prodromal stages, but later clinical features and disease progression, along with etiological examinations, can aid in differentiation.

III. Traditional Chinese Medicine’s Understanding and Treatment of Influenza (1) Historical Perspectives on Influenza

In classical Chinese medical texts, the “Shanghan Lun” contains references to similar conditions. Subsequently, Chinese medical texts on febrile and warm diseases became increasingly detailed. For example, “Wen Yi Lun” (Ming Dynasty) states: “Epidemics arise from the malignant qi of heaven and earth; regardless of age, strength, or constitution, anyone who comes into contact with this qi will become ill, with the pathogen entering through the mouth and nose.” The term “cold” first appeared in the Northern Song Dynasty’s “Ren Zhai Zhi Zhi Fang · Zhu Feng Bian.”