2 Traditional Chinese Medicine’s Understanding of Influenza’s Pathogenesis

(2) Traditional Chinese Medicine’s Understanding of Influenza’s Pathogenesis Influenza is a common warm-disease prevalent in winter and spring, caused by wind-heat or wind-cold pathogens. It is triggered by sudden temperature changes, poor lifestyle habits, or inherent weaknesses in the body’s defensive mechanisms—when the body’s protective energy is weakened, the exterior defense system fails, and the body’s innate resistance to external pathogens is insufficient. When the pathogen enters the body, it initially targets the lung and defensive mechanism (“Warm evil enters the lungs first; when the wind harms the body, it first affects the lungs”). The primary routes of entry include wind-heat, which often enters through the mouth and nose, while wind-cold often enters through the skin and hair, or even via the Da Zuo acupoints like the Da Xu and Fei Yu. However, “When wind evil attacks, no matter where it enters, it will always return to the lungs,” meaning the lungs are the first line of defense. Clinically, wind-evil often invades the lung and defensive mechanism, affecting the lung and Qi levels, and rapidly spreading to the heart and liver (“reverse transmission to the heart and pericardium”). Generally, after exposure to the pathogen, the defensive Yang is suppressed, the circulation of Ying and Wei is disrupted, and the Taiyang meridian’s acupoints are blocked. The defensive Qi struggles against the pathogen, preventing the defensive Yang from flowing outward, leading to chills, fever, nasal congestion, clear nasal discharge, sore throat, cough, and other signs of lung and defensive pathology. If the Ying Qi is not properly contained, sweating occurs. The Taiyang meridian runs from the forehead, over the top of the head, through the back, and down to the feet; when pathogenic factors obstruct the meridians, Qi becomes stagnant, causing pain in the head, body, and joints (“if it doesn’t flow, it hurts”), even stiffness in the neck and back. As the pathogen penetrates deeper, it reaches the Qi level and returns to the lungs, causing high fever without chills, excessive thirst, and profuse sweating. The lungs are delicate organs, connected to the skin and hair, and directly communicating with the nose. When external pathogenic factors attack the lungs, the airways become obstructed, unable to clear the Qi, and unable to descend; when lung Qi rises upward, coughing occurs, and when Qi is blocked, nasal congestion and wheezing result. When pathogenic factors force fluids out, nasal discharge increases, and when heat is intense, nasal discharge becomes yellow or cloudy. The throat is closely associated with the lungs; wind-cold causes itching, while heat accumulation leads to pain. When pathogenic factors collide and clash in the throat, breathing becomes noisy or the voice becomes heavy. The lungs and large intestine are in a complementary relationship: when pathogenic factors move downward to the large intestine, abdominal pain and diarrhea may occur (gastrointestinal-type influenza). If the body cannot overcome the pathogen, and the Ying and Blood become disturbed, causing them to spread to the heart and liver, symptoms such as confusion and convulsions may appear. (3) TCM Differentiation and Classification, and Herbal Formulas

Currently, TCM classification methods vary across regions, but they generally fall into three categories: ① based on etiology and syndrome patterns; ② based on the Six Meridians of Shaoyang and the theory of warm diseases; ③ based on Western clinical classifications combined with TCM differentiation and classification. Differentiation often focuses on the lung and defensive mechanism type (equivalent to simple influenza), wind-heat blocking the lungs type (equivalent to pneumonia-like influenza), wind-damp invading the intestines type (equivalent to intestinal-type influenza), and heat entering the heart and liver type (equivalent to brain-type influenza). “Wind is the root of all diseases, so it often precedes the loss of vital energy”; due to different seasons, and because pathogenic factors often coexist with seasonal illnesses, distinctions are made between wind-cold, wind-heat, wind-heat with summer, and wind-damp with dampness.

1. The main symptoms of pathogenic invasion of the lung and defensive mechanism include chills and fever, headache and body aches, nasal congestion with clear nasal discharge, a pale red tongue with a thin white coating, and a floating, rapid pulse. Treatment focuses on dispersing wind, releasing the exterior, clearing heat, and detoxifying. The formula Silver-Clearing Decoction is adjusted as follows: 12 g of Lonicera japonica, 12 g of Forsythia suspensa, 3 g of peppermint (added later), 9 g of Platycodon grandiflorus, 9 g of Fritillaria cirrhosa, 9 g of Mulberry leaves, 9 g of Flower pollen, 9 g of Scutellaria baicalensis. Brew the herbs in water and take one dose per day.

2. The main symptoms of wind-heat blocking the lungs include high fever and thirst, coughing and wheezing with cyanotic lips, and even coughing up blood; the tongue is red, coated with yellow, and the pulse is rapid. Treatment focuses on clearing heat, detoxifying, and opening the lungs to relieve cough and wheezing. The formula Ma-Xing-Shi-Gan Decoction is adjusted as follows: 4.5 g of Ephedra sinica, 9 g of Apricot kernels, 30 g of Gypsum, 15 g of Indigo leaf, 6 g of Radix Isatidis, 15 g of Fish Mint. Brew the herbs in water and take one dose per day.

3. The main symptoms of intestinal damp-heat include persistent high fever, unrelenting sweating, abdominal fullness and limb discomfort, a red tongue with a greasy yellow coating, and a slippery, rapid pulse. Treatment focuses on clearing heat and transforming dampness. The formula New Fragrant Summer Decoction is adjusted as follows: 12 g of Lonicera japonica, 12 g of Forsythia suspensa, 15 g of Perilla frutescens, 9 g of Poria cocos, 9 g of Agastache rugosa, 9 g of Peperomia, 3 g of Scutellaria baicalensis, 15 g of Talc, 3 g of Licorice, 12 g of Agastache. Brew the herbs in water and take one dose per day.

4. The main symptoms of pathogenic invasion of the heart and liver include high fever, delirium, stiff neck and limb spasms, a red or purplish tongue with little yellow, dry, and tense pulse. Treatment focuses on clearing the heart and descending liver qi, calming spasms and opening the orifices. The formula Clearing Official Soup is adjusted as follows: 3 g of Rhinoceros horn (grinded and taken orally) or 30 g of Buffalo Horn (first decocted), 9 g of Bamboo Leaf, 12 g of Forsythia suspensa, 12 g of Ophiopogon japonicus, 12 g of Rehmannia glutinosa, 12 g of Antiarthrum, 12 g of Chrysanthemum, 9 g of Earthworm, 9 g of Uncaria rhynchophylla, 9 g of Bamboo Shoot. Brew the herbs in water and take one dose per day.

(4) TCM Resources on Syndrome Differentiation and Treatment of This Disease

In recent years, formulas such as “Influenza Decoction” have been used with adjustments. The formula composition includes: 30 g of Indigo leaf, 9 g of Aster yomena, 30 g of Gypsum, 12 g of Scutellaria baicalensis, 12 g of Apricot kernels, 9 g of Peppermint, 9 g of Cinnamon twig. For common adjustments in treating this disease, those with severe cold may choose Ephedra sinica, Cinnamon twig, Suan Ye, or Fang Feng; those with cold combined with fire may add Gypsum and Scutellaria baicalensis; for high fever, use Artemisia annua, Reed root, or Duckweed; for severe toxicity, select Lonicera japonica, Forsythia suspensa, Indigo leaf, Blackberry root, or Dandelion; for irritability, use Bamboo Leaf and Gardenia; for thirst, use Paeonia lactiflora and Reed root; for hoarseness, add Butterfly Pea and Bigleaf Chaste Tree; for throat pain, add Radix Isatidis and Mountain Bean Root; for nasal bleeding, use White Grass Root; for conjunctival congestion, use Woodlice, Chrysanthemum, or Gentiana; for headaches due to heat, use Vinegar Plant and Chrysanthemum; for wind-cold headaches, use Ligusticum chuanxiong and Ligusticum chuanxiong; for forehead pain, use Kudzu root and Angelica dahurica; for bilateral temporal pain, use Bupleurum and Ligusticum; for body aches, use Qianghuo and Duhuo; for nasal congestion and clear nasal discharge, add Cicada Shell and Herba Taraxaci; for cough, add Apricot kernels and Platycodon grandiflorus; for vomiting, use Agastache and Bamboo Shoot; for food-related issues, use Shen Qu and Hawthorn; for convulsions, use Uncaria rhynchophylla and Earthworm; for yang deficiency, add Aconite and Asarum; for yin deficiency, add Ophiopogon japonicus and Rehmannia glutinosa; for qi deficiency, add Ginseng and Astragalus; for blood deficiency, add Dang Gui and Collagen. Additionally, research indicates that in wind-cold cases, nasal mucosal smears often show predominantly single ciliated cell degeneration, often due to viral infection; in wind-heat cases, smears often indicate mixed infections, frequently accompanied by bacterial infections.

There are also reports that compound formulas such as Silver-Clearing Decoction, Jingfang Baidu Decoction, Huoxiang Zhengqi Decoction, Gegen Decoction, and Lei Ji Decoction have shown anti-influenza virus effects. Shen Jian’s “Cold One Needle” formula was developed, targeting the Yongmen acupoint (the depression between the fourth and fifth metacarpal joints on the back of the hand when the fist is clenched). (Henan Traditional Chinese Medicine, 1988.4)

A report titled “Analysis of 201 Cases Treated with Traditional Chinese Medicine for Influenza” documented outbreaks of Type A and Type B influenza in Beijing during the winter and spring of 1989–1990. All patients presented with symptoms of pathogenic toxins attacking the lung and defensive mechanism, as well as the Qi level. Treatment involved: 20 g of Lonicera japonica, 15 g each of Forsythia suspensa and Indigo leaf, 20 g each of Jingjue and Shegan, 10 g each of Fangfeng, Chaihu, Gegen, Apricot kernels, and Yinchen, 40 g of Gypsum, and 6 g of Licorice. Before taking the medication, consume a small bowl of warm porridge; after taking the medicine, cover yourself and sweat—after the first sweat, allow the sweat to gradually release. While the fever still persists, take two doses per day, administering each dose every 2 hours, taking small, frequent doses throughout the day; after the fever subsides, take one dose per day, dividing it into three doses. After taking the medication for 1–2 doses, 88.6% of patients experienced fever reduction within 1 day. (Chinese Journal of Traditional Medicine, 1991.1)

Clinically, many individual prescriptions are commonly used: ① Lingyang Cold Tablets (prepared medicine): 2–4 tablets each time, three times daily (for wind-heat cold); ② YinQiao Detoxification Tablets (pill): 4 tablets each time (1 pill), three times daily (for wind-heat cold); ③ Two pieces of Noon Tea, steeped in boiling water or boiled for 5 minutes (for wind-heat cold); ④ 98 slices of fresh ginger, a small amount of brown sugar, brewed in water (for wind-cold cold); ⑤ 15 g of Dandelion, 15 g of Wild Chrysanthemum, 30 g of Lonicera japonica, 30 g of Indigo leaf, brewed in water; ⑥ 15–30 g each of Indigo leaf, Indigo root, and Woodlice, along with 15–30 g of Forsythia suspensa, brewed in water; ⑦ 30 g of Horsewhip Herb, 15 g of Half-Branch Lotus, brewed in water; ⑧ 45 g of Duckweed, 30 g of Shouyangquan, brewed in water; ⑨ 15 g each of Green Onion and Fresh Ginger, 3 g of Salt, crushed into a paste, wrapped in gauze, and applied to the five points of the body (front chest, back, palms and soles, elbows, and armpits).