Chapter Two: Infectious Diseases

97.76%, achieving satisfactory results.⑥ Other traditional Chinese medicine therapies: Li Bingmao et al. treated 300 cases of influenza with Shang Gan Tong Masks (Musk, Ice Flake, Ma Huang, Xin Yi, Da Qing Ye, Xian He Cao), and set up a Western medicine control group (Amantadine) for antiviral treatment, with 200 cases treated. Results showed that 162 cases in the treatment group were markedly effective, 132 were effectively treated, and 6 were ineffective, with an overall effective rate of 98%, significantly higher than the control group (46%). Acupuncture is also one of the methods of traditional Chinese medicine in treating influenza; compared with drug therapy, it shows no significant difference in efficacy, and is more simple, convenient, inexpensive, and fast, making it suitable for patients who find it inconvenient to take medication. Yu Shenghua treated 150 cases of influenza with three-pronged bloodletting therapy (taking Dachui, Shaoshang, Hegu, and Tonsil points), comparing it with single-drug treatment (Penicillin, Virazole, etc.), finding that 96 cases were cured after a single bloodletting session, 48 cases were cured after two sessions, and 6 cases were cured after three or more sessions.⑦ Traditional Chinese medicine treatment for influenza complications: Influenza complications can be broadly divided into pulmonary complications and extra-pulmonary complications. Common complications include primary viral pneumonia, secondary bacterial pneumonia, and mixed viral-bacterial pneumonia; Reye’s syndrome has also been frequently reported. Sun Huisheng chose to modify Qing Ying Tang, combining it with Western medicine treatments such as oxygen therapy, anticonvulsants, intracranial pressure reduction, antibiotics, and supportive care, achieving relatively satisfactory results in treating Reye’s syndrome. Yuan

Chapter Two: Infectious Diseases

Shun Rui et al. observed the efficacy of Chuang Xu Ning Injection in treating 122 cases of viral pneumonia, discovering that Chuang Xu Ning, whose main component is traditional Chinese medicine extract of Chuan Xin Ya, could inhibit the pathological processes caused by pathogens and toxins, correct functional disorders and tissue damage in the body, accelerate the recovery of damaged tissue functions, and so on. The efficacy of Chuang Xu Ning was significantly superior to Virazole in terms of shortening the course of illness and improving clinical symptoms, with 105 cases showing marked improvement, and an overall effective rate of 86.1%. Sun Yuan et al. reported that Fishy Herb Injection possesses antipyretic and detoxifying effects, significantly inhibiting hemolytic streptococcus, Staphylococcus aureus, influenza bacilli, and pneumococci, while also suppressing cellular lesions caused by influenza viruses. They treated 100 cases of viral pneumonia with Fishy Herb Injection, achieving satisfactory results. The article also pointed out that adding Fishy Herb Injection to conventional Western medical treatment for viral pneumonia can yield good therapeutic effects. Yi Ping reported that the combined use of Jia Wei Jin Yin Hua Tang (Jin Yin Hua, Fishy Herb, Apricot Kernel, Ji Que, Raw Licorice, Bai Bu) in conjunction with Western medicine for treating pediatric viral pneumonia could significantly increase the cure rate compared to using Western medicine alone (Acyclovir), shorten the healing time, and reduce the recurrence rate. Li Zhi Wen treated 32 cases of viral pneumonia with Ma Xing Wei Jing Tang combined with Shuang Huang Lian Powder Intravenous Infusion. Results showed 12 cases were markedly effective, 15 were effectively treated, with an overall effective rate of 84.38%. It is evident that traditional Chinese medicine and integrated Chinese-Western medicine treatments for viral pneumonia achieve significant effects in shortening the course of illness, improving clinical symptoms, and many other aspects. Huang Minghong et al. observed the efficacy of Shu Sa Lin combined with traditional Chinese medicine in treating 40 cases of acute bacterial pneumonia, finding that Shu Sa Lin combined with traditional Chinese medicine achieved an effective rate of 95%, with a pathogen clearance rate of 87.2%, and a resistance rate of only 2% for strains. The drug exhibited strong antibacterial activity against Streptococcus pneumoniae, Staphylococcus aureus, Hemolytic Streptococcus, Escherichia coli, Pseudomonas aeruginosa, and other bacteria, while adverse reactions and strain resistance rates were lower than those of using Amoxicillin/Sulbactam alone for respiratory infections. Jiao Yang et al. treated bacterial pneumonia caused by resistant bacteria using a method of activating blood circulation and detoxifying the body; among 57 patients, 16 were cured, 28 showed marked improvement, and 5 were effectively treated, with good results. Based on the theory that “the lung corresponds to the large intestine” and “clearing the intestines to release heat,” Ye Feng treated patients with bacterial pneumonia accompanied by constipation (who were diagnosed in traditional Chinese medicine as having heat accumulation and yin deficiency) with Zeng Ye Cheng Qi Tang, comparing it with a group treated with Western medicine alone. Observations showed that the time to begin a decrease in body temperature, the time to return to normal body temperature, and the time to restore WBC levels were all significantly better in the group treated with Zeng Ye Cheng Qi Tang compared to the group treated with Western medicine alone. Wang Yanhui reported that Ma Xing Shi Gan Tang could effectively inhibit and kill viruses, improve oxygen supply to the lungs, eliminate inflammatory responses in lung tissue, restore alveolar breathing function, relieve tracheal and bronchial spasms, thereby quickly and thoroughly curing the disease. Using this formula to treat 82 cases of severe viral pneumonia, 78 were cured, 4 improved, with an overall effective rate of 100%. Liu Weiqing believed that integrated Chinese-Western medicine treatment for severe childhood pneumonia involved using Western medicine for antibacterial, anti-inflammatory, oxygen therapy, fever reduction, cardiac support, diuresis, sedation, and cough suppression during the acute phase, while in the recovery phase, traditional Chinese medicine was used to clear heat and detoxify, relieve cough and promote phlegm, open the lungs and relieve asthma, strengthen the spleen and benefit qi, and aid in restoring righteous qi and eliminating pathogenic factors. He used Ma Xing Shi Gan Tang or Yang Yin Qing Lung Tang combined with modifications, observing 100 cases of severe pneumonia, with an overall effective rate of 99%. It is evident that traditional Chinese medicine and integrated Chinese-Western medicine treatment for severe pneumonia provide quick results, short treatment courses, and satisfactory therapeutic effects. (Hubei Journal of Traditional Chinese Medicine, 2008.5)

Liu Chaoyang randomly divided 76 patients into two groups: the traditional Chinese medicine group received 38 cases orally with Ma Huang Xing Ren Gan Cao Shi Gong Tang, while the Western medicine control group received 38 cases orally with Amantadine, Aspirin, antibiotics, etc.; both groups followed a 2-week treatment cycle. Results showed that the traditional Chinese medicine group had 19 cured cases, 11 markedly effective cases, 5 effectively treated cases, and 3 ineffective cases. The Western medicine control group had 17 cured cases, 9 markedly effective cases, 7 effectively treated cases, and 5 ineffective cases. Comparing the two groups, the differences in cure rates and marked effectiveness were both statistically significant (p<0.05). Conclusion: Ma Huang Xing Ren Gan Cao Shi Gong Tang demonstrates significant efficacy in treating influenza. (Henan Journal of Traditional Chinese Medicine, 2009.5)

IV. Western Medical Treatment (1) General Nursing Care

Patients should generally rest in bed, drink plenty of boiled water, keep the air in the room fresh, and eat easily digestible foods. During an epidemic, avoid gatherings; regularly ventilate public spaces, spray bleach solution, or add 5–10ml of vinegar per cubic meter of space, dilute with 1–2 parts water, heat and fumigate for 1–2 hours once daily or every other day, for 3–6 consecutive days.

When an epidemic is imminent, prioritize influenza vaccination for key populations.

(2) Western Medical Treatment

Since there are no specific antiviral drugs available, symptomatic treatment with compound aspirin for fever and pain relief is primarily employed. For patients with obvious toxic symptoms or dehydration, appropriate fluid replacement is recommended; in cases of bacterial infection, antibiotics may be used as needed.

(3) Other Treatments

Acupuncture: Main acupoints include Feng Chi, Dachui, Hegu; for high fever, add Qu Chi; for headache, add Tai Yang and Yin Tang; for cough, add Lie Que, Tian Tu, Fei Yu, Tai Yuan, Chi Ze; for nasal congestion, add Lie Que and Ying Xiang; for foot pain, add Zu San Li and Qu Chi; for vomiting, add Nei Guan; for throat pain, add Shao Shang; for limb pain, add Zu San Li and Qu Chi.

Ear acupuncture: Nei Bi, Feng Lu, Adrenal Gland, Subcortical Area.

Topical treatments: ① Apply nasal ointment (10g of Di Yu, 10g of Garlic, 10ml of Vinegar, 4g of Ice Flake, 2g of Thin Lotus); ② Mix 15g each of Scallion White and Fresh Ginger, along with 3g of Salt (or a small amount of Baijiu can also be added), pound the mixture into a paste, wrap it in gauze, and apply to areas such as the chest, back, soles of the feet, palms, elbow creases, and popliteal fossa—often leading to sweating and a reduction in fever. (Huang Hui Zhao, Qiao Fu Qu, Wu Bin)

Chapter Three: Influenza A(H1N1) – Overview

Influenza A(H1N1) is a newly emerging respiratory infectious disease. In March 2009, an outbreak of “human infection with swine flu” occurred in Mexico and quickly spread globally. The World Health Organization (WHO) initially referred to this type of influenza as “human infection with swine flu,” later renaming it “Influenza A(H1N1).” China’s Law on the Prevention and Control of Infectious Diseases now classifies this disease as a Category B infectious disease.

There are three types of influenza viruses: Type A influenza infects mammals and birds; Type B influenza only infects humans, and its severity is typically milder than that of Type A viruses; Type C influenza only infects humans and does not cause severe illness.

The genetic material of Influenza A(H1N1) contains genetic segments from swine flu, avian flu, and human influenza viruses. Influenza A(H1N1) belongs to the Orthomyxoviridae family, specifically the Influenza A virus genus. Typical viral particles are spherical, with a diameter ranging from 80 to 120 nm and a lipid envelope. The envelope features numerous radiating glycoproteins, including hemagglutinin (H), neuraminidase (N), and matrix protein M₂. Inside the viral particle is a nucleocapsid, arranged in a helical symmetry with a diameter of 10 nm. This virus is a single-stranded negative-sense RNA virus, with a genome of approximately 13.6 kb, composed of eight independent fragments of varying sizes. There are 1–15 types of H1N1 influenza virus, and 1–9 types of N. Both H and N are type 1, hence the name Influenza A(H1N1).

The virus is sensitive to common disinfectants such as ethanol, povidone-iodine, and iodine tincture, and is highly susceptible to heat; it can be inactivated at 56°C for 30 minutes.

Influenza A(H1N1) is primarily transmitted through droplets via the respiratory tract, but it can also be spread through direct or indirect contact with mucous membranes in the mouth, nose, eyes, and other areas. Contact with patients’ respiratory secretions, bodily fluids, and items contaminated by the virus can also lead to infection. Transmission via aerosols remains to be further confirmed.

The general population lacks immunity and is prone to infection. The incubation period ranges from 2 to 7 days. Early symptoms are similar to those of common influenza, including fever, cough, sore throat, generalized body aches, and headache; some individuals may also experience diarrhea or vomiting, muscle soreness, fatigue, and red eyes. In rare cases, the condition becomes severe, progressing rapidly, with high fevers exceeding 39°C, potentially leading to viral pneumonia and various complications—often resulting in death due to respiratory failure or multiple organ dysfunction. China’s Law on the Prevention and Control of Infectious Diseases classifies this disease as a Category B infectious disease and implements preventive and control measures equivalent to those for Category A infectious diseases. China has developed vaccines to prevent Influenza A(H1N1), allowing susceptible populations to receive vaccinations for protection.

As this Influenza A(H1N1) is a newly emerging disease, its patterns of disease remain to be further observed and studied. II. Diagnosis (1) Epidemiological History

Individuals who have traveled to affected areas or who have had close contact with infected pigs or patients, and who develop influenza-like clinical symptoms within one week, should be classified as medically monitored cases and subject to 7 days of medical observation.

(2) Laboratory Examinations

1. Peripheral blood tests show that the total white blood cell count is usually normal or decreased. Chapter Two: Infectious Diseases

2. Blood biochemistry tests reveal hypokalemia in some cases, while creatine kinase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels are elevated in a few cases.

3. Pathogen detection involves viral nucleic acid testing: RT-PCR (real-time RT-PCR is preferred) is used to detect viral RNA in respiratory samples—including pharyngeal swabs, oral rinses, nasopharyngeal or tracheal aspirates, sputum, etc.—with positive results for Influenza A(H1N1) virus.

Virus isolation: Influenza A(H1N1) virus can be isolated from respiratory samples. When viral pneumonia is present, the virus can also be isolated from lung tissue.

4. Serological testing involves dynamic monitoring of paired serum samples to assess the level of influenza A(H1N1) virus-specific neutralizing antibodies, which should increase by a factor of 4 or more.

(3) Chest Imaging Examinations When pneumonia is present, patchy shadows may be observed in the lungs.

III. Traditional Chinese Medicine’s Understanding and Treatment of Influenza A(H1N1) (1) Historical Medical Views on Similar Influenza A(H1N1) Cases

Although ancient medical texts did not use the term “Influenza A(H1N1),” they often referred to “seasonal colds” as similar to influenza A(H1N1). Traditional Chinese Medicine viewed Influenza A(H1N1) as an infection caused by epidemic pathogens.

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Input: The pathogen is characterized by the "five epidemics" mentioned in the Inner Canon of Huangdi: "When the five epidemics arrive, they all spread easily, regardless of size or age, with similar symptoms." The disease has a rapid onset, strong infectivity, and is generally highly contagious among the population. It is an acute respiratory infectious disease that, as described in "Wen Re Lun," "is caused by warm evil invading the upper part of the body, first affecting the lungs." This disease shares similarities with previous outbreaks of influenza, while traditional Chinese medicine also recognizes that "when two people do not come into contact, righteous qi remains within the body; evil cannot take hold. By avoiding toxic air, one can prevent the invasion of evil..." Throughout history, especially since the Ming and Qing dynasties, Chinese medical practitioners have accumulated considerable experience in the treatment and prevention of seasonal epidemics. The theory of the Five Movements and Six Energies, as outlined in "Su Wen · Zhi Zhen Yao Da," provides therapeutic principles for treating this disease: "When the energy of the Yin branch prevails, treat it with pungent cold properties, supplemented by bitter and salty flavors, and treated with sweet flavors." Therefore, for the prevention and treatment of H1N1 influenza, traditional Chinese medicine practitioners can choose herbs that are pungent, cold, salty, or sweet in nature.

(2) Traditional Chinese Medicine’s Understanding of the Pathogenesis of H1N1 Influenza

H1N1 influenza is a type of influenza. From a TCM perspective, influenza arises when external pathogens invade the lung meridians, obstructing the clear pathways of the lungs, preventing lung qi from descending. As a result, patients often experience clear nasal discharge, fever, chills, headache, and body aches. Treatment should focus on dispersing and releasing the pathogenic factors, using formulas such as Gui Zhi Tang, Ma Huang Tang, or Ge Gen Tang. If left untreated, the condition may progress to internal injury, leading to depletion of kidney yang and the accumulation of cold yin. When the kidney meridian connects with the lung meridian, insufficient yang energy in the heart and lungs fails to regulate fluid transport, causing clear nasal discharge. Patients often exhibit no signs of external infection, instead feeling sluggish and lacking energy, experiencing frequent sneezing, cold feet, or even coldness in the lower limbs. Treatment should focus on supporting yang energy, using formulas like Si Ni Tang, Bai Tong Tang, Feng Su Dan, Ma Huang Fu Zi Xi Xin Tang, or Jiang Gui Tang.