3 Differentiation of Syndromes and Formulas in TCM

(3) Differentiation of Syndromes and Formulas in TCM According to the treatment guidelines outlined in the 3rd edition of the Ministry of Health’s “Diagnosis and Treatment Protocol for H1N1 Influenza,” published in 2009, the following treatment approaches are recommended:

1. Treatment for Mild Cases (1) Wind-Heat Invading the Wei Channel: Main symptoms include fever or no fever at the onset, red throat with discomfort, mild cough with little phlegm, and no sweating. Tongue and pulse: Red tongue with thin or slightly greasy coating, floating and rapid pulse. Treatment principle: Disperse wind and clear heat. Basic formula: 15g of Lonicera japonica, 15g of Forsythia suspensa, 10g of Gentiana scabra, 10g of Chrysanthemum morifolium, 10g of Platycodon grandiflorus, 15g of Coptis chinensis, 6g of Bamboo Leaf, 30g of Rhizoma Polygoni cuspidati, 3g of Peppermint (added later), 3g of Licorice root. Prepare the decoction by boiling in water, taking 400ml per dose, 200ml each time, twice daily; if necessary, take 2 doses daily, each time 200ml. Adjustments: For thick, greasy coating on the tongue, add Patchouli or Poria; for severe cough, add Apricot Kernel or Loquat Leaves; for diarrhea, add Coptis chinensis or Atractylodes macrocephala; for severe throat pain, add Gardenia jasminoides. Commonly used traditional Chinese medicines include those with wind-dispersing and heat-clearing properties, such as Shu Feng Jie Du Capsules, Xiang Ju Capsules, Yin Qiao Jie Du preparations, Sang Ju Gan Mao preparations, and Shuang Huang Lian oral formulations; as well as Huo Xiang Zheng Qi and Ge Gen Qin Lian preparations.

(2) Heat-Toxin Invading the Lung: Main symptoms include high fever, cough, sticky phlegm that is difficult to expectorate, thirst with a desire to drink, sore throat, and red eyes. Tongue and pulse: Red tongue with yellow or greasy coating, slippery and rapid pulse. Treatment principle: Clear lung and resolve syndrome. Basic formula: 3g of Ephedra sinica, 10g of Apricot Kernel, 10g of Licorice root, 30g of Gypsum (first boiled), 10g of Anemarrhena asphodeloides, 10g of Fritillaria cirrhosa, 15g of Platycodon grandiflorus, 15g of Gardenia jasminoides. Prepare the decoction by boiling in water, taking 400ml per dose, 200ml each time, twice daily; if necessary, take 2 doses daily, each time 200ml. Adjustments: For constipation, add Rheum officinale; for persistent high fever, add Artemisia annua or Cortex Phellodendri. Commonly used traditional Chinese medicines include those that clear the lung and detoxify, such as Lian Hua Qing Wen Capsules, Yin Huang preparations, and Lotus Clear Heat preparations.

2. Treatment for Severe and Critical Cases (1) Heat-Toxin Accumulating in the Lung: Main symptoms include high fever, cough with phlegm, yellow phlegm, shortness of breath and wheezing; or palpitations, restlessness, and confusion. For severe and critical cases, the tongue and pulse may be red and swollen, with a slippery and rapid pulse. Treatment principle: Clear heat and drain lung toxins, resolve toxin and disperse stasis. Basic formula: 3g of Ephedra sinica,

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Yellow 5g, 30g of Gypsum (first boiled), 10g of Apricot Kernel, 10g of Anemarrhena asphodeloides, 15g of Herba Lysimachiae, 10g of Fructus Perilla, 10g of Coptis chinensis, 10g of Rhizoma Polygoni cuspidati, 10g of Rheum officinale, 10g of Cortex Phellodendri, 15g of Artemisia annua. Prepare the decoction by boiling in water, taking 400ml per dose, 200ml each time, twice daily; if necessary, take 2 doses daily, each time 200ml. Adjustments: For persistent high fever and delirium, add An Gong Niu Huang Wan; for convulsions, add Antelope Horn, Silkworm Moths, Earthworms, etc.; for abdominal distension and constipation, add Citrus Aurantium Fruit or Black Pepper Powder. Commonly used traditional Chinese medicines include Xian Yan Ping, Tan Re Qing, and Qing Kai Ling Injection.

(2) Qi and Ying Both Burned: Main symptoms include high fever, thirst, irritability, and in severe cases, delirium, cough, or hemoptysis, chest tightness, and shortness of breath. Tongue and pulse: Red and dark red tongue, yellow coating, fine and rapid pulse. Treatment principle: Clear qi and cool the Ying. Basic formula: 30g of Buffalo Horn, 15g of Rehmannia glutinosa, 10g of Radix Paeoniae Alba, 15g of Lonicera japonica, 15g of Forsythia suspensa, 10g of Ophiopogon japonicus, 6g of Bamboo Leaf, 30g of Trichosanthes kirilowii, 30g of Gypsum (first boiled), 12g of Gardenia jasminoides. Prepare the decoction by boiling in water, taking 400ml per dose, 200ml each time, twice daily; if necessary, take 2 doses daily, each time 200ml. Adjustments: For constipation, add Rheum officinale; for severe fever and limb convulsions, add Antelope Horn powder. Commonly used traditional Chinese medicines include An Gong Niu Huang Wan, Xue Bi Jing, and Xing Nao Jing Injection.

(4) Relevant TCM Resources on Syndrome Differentiation and Treatment of This Disease In the article “Clinical Analysis of 324 Cases of H1N1 Influenza in Gansu Province,” we summarize 324 confirmed cases of H1N1 influenza, which were all cases occurring within 43 days of the disease’s onset in the province. There was no significant difference in incidence between males and females, with the majority of cases occurring between the ages of 7 and 20, with the oldest case being 37 years old. The disease is highly contagious. Among the 324 cases, most presented with fever, sore throat, cough, red tongue, and a rapid pulse—these symptoms fall within the scope of traditional Chinese medicine’s “warm diseases.” In the treatment of these 324 cases, 41.0% utilized pungent and cooling formulas to dispel exterior pathogens, 38.3% employed antibiotics, and 51.9% of patients received treatments such as Lotus Clear Heat Capsules and Strong Silver-Clearing Tablets, which suggest that the virus initially combined with upper respiratory tract infections. Professor Pei Zhengxue adopted a method of pungent and cooling formulas to dispel exterior pathogens and regulate lung qi, modifying the Rou Ju Yin formula with additions and subtractions (including Mulberry Leaves, Chrysanthemum Flowers, Platycodon Grandiflorus, Bamboo Root, Lonicera Japonica, Forsythia Suspensa, Dandelion, Bidens Pilosa, White Flower Snake Tongue Herb, Half-Branch Lily, Ephedra Sinica, Apricot Kernel, Gypsum, and Licorice). These modifications enhanced the effects of clearing heat and detoxifying, yielding remarkable therapeutic results. Patients who were treated quickly recovered, and none of the individuals who came into contact with them took Pei’s Fuzheng Chongji or Lotus Clear Heat Capsules, yet none developed the disease. Therefore, it is recommended that once a patient is identified as newly infected, rather than deploying excessive manpower and resources for transportation and isolation, local treatment should be implemented, and appropriate medication should be administered to contacts to prevent further spread. (Gansu Medical Journal, 2009.12)

1. Prevention (1) Lifestyle and Daily Routine: Maintain indoor hygiene and ensure good air circulation; adjust clothing according to temperature changes, adding or removing layers as needed; avoid crowded public places; eat light, nutritious meals; get adequate rest, ensuring sufficient sleep and reducing academic stress; keep hands clean and wash them properly; cover mouth and nose with tissues when sneezing or coughing, and avoid spitting on the ground; try to avoid contact with flu-like patients, and wear masks when in close proximity; engage in regular physical exercise to enhance your immune system. (2) Medicinal Prevention: Formula 1: 6g of Lonicera japonica, 6g of Forsythia suspensa, 6g of Indigofera tinctoria, 6g of Perilla frutescens. Suitable for children with normal constitutions. Preparation method: Boil in water until approximately 100–150ml, divide into 2–3 doses, taking 1 dose daily; 3–5 doses are recommended. Formula 2: 10g of Astragalus membranaceus, 6g of Atractylodes macrocephala, 6g of Ledebouriella seseloides, 6g of Forsythia suspensa. Suitable for children with deficiency of qi and blood, who are prone to fatigue, sweat excessively, have pale complexions, poor appetite, and loose stools. Preparation method: Boil in water until approximately 100–150ml, divide into 2–3 doses, taking 1 dose daily; 5–7 doses are recommended. Formula 3: 6g of Forsythia suspensa, 6g of Scutellaria baicalensis, 6g of Mentha haplocalyx, 3g of Rheum officinale, 6g of Rehmannia glutinosa. Suitable for children with internal heat, who often have red throats, bad breath, and dry stools. Preparation method: Boil in water until approximately 100–150ml, divide into 2–3 doses, taking 1 dose daily; 3–5 doses are recommended. Formula 4: 6g of Ho Xiang, 6g of Perilla frutescens, 3g of Amomum villosum, 6g of Raphanus sativus. Suitable for children with damp-heat constitution, who tend to be overweight, have loose muscles, often experience excessive phlegm, and are prone to abdominal bloating and loose stools, with thick, greasy tongue coatings. Preparation method: Boil in water until approximately 100–150ml, divide into 2–3 doses, taking 1 dose daily; 3–5 doses are recommended. (3) Precautions: ① Take the medication under the guidance of a physician. ② Do not take the medication for too long; generally, take it for 3–7 days. ③ The dosage of the above medications is based on the reference dosage for children aged 4–7; other age groups should adjust the dosage accordingly.
2. Treatment (1) Mild Cases: ① Wind-Heat Invading the Wei Channel presents with fever, cough, headache, nasal congestion, sneezing, runny nose, red throat, red tongue, thin yellow coating, and a floating, rapid pulse. Treatment principle: Disperse wind and clear heat. Prescription: Add adjustments to Yin Qiao San. Commonly used herbs include Lonicera japonica, Forsythia suspensa, Arctium lappa, Peppermint, Peucedanum praecox, Platycodon grandiflorus, Indigofera tinctoria, Dandelion, Bupleurum chinense, Scutellaria baicalensis, Rehmannia glutinosa, Herba Lysimachiae, Bamboo Root, and Licorice. For those with both Wei qi and Yang qi imbalanced, use Yin Qiao Bai Hu Tang with adjustments; for those with exterior cold and interior heat, adapt the Cha Ge Jie Ji Tang formula. Commonly used traditional Chinese medicines include Shu Feng Jie Du Capsules, Pediatric Lung Heat Cough and Asthma Oral Liquid, Pediatric Chi Qiao Qing Re Granules, and Zixue Dan. ② Dampness Blocking Wei Qi presents with fever, heavy head and body, difficulty in sweating, fatigue, nausea, vomiting, abdominal pain, loose stools, poor appetite, dry mouth and lack of thirst, thick, greasy tongue coating, and a floating, rapid pulse. Treatment principle: Aromatic and dispersing. Prescription: Ho Pu Xia Ling Tang or San Ren Tang with adjustments. Commonly used herbs include Ho Xiang, Hou Po, Fā Ban Xia, Poria, Dandelion, Slaked Stone, Apricot Kernel, Amomum villosum, Coix Seed, Alisma, Bamboo Leaf. For those with heavy damp-heat, use Gan Lu Xiao Du Dan with adjustments. Commonly used traditional Chinese medicines include Ho Xiang Zheng Qi Water. (2) Severe Cases: ① Heat-Toxin Blocking the Lung presents with high fever, shortness of breath, frequent coughing, severe chest pain, yellow phlegm, restlessness, purple lips, dry mouth and thirst, constipated stools, short, yellow urine, red tongue with yellow, greasy coating, and a floating, rapid pulse. Treatment principle: Clear heat and disperse lung toxins, resolve phlegm and relieve asthma. Prescription: Ma Xing Shi Gan Tang with adjustments. Commonly used herbs include Gypsum, Anemarrhena asphodeloides, Gardenia jasminoides, Scutellaria baicalensis, Coptis chinensis, Buffalo Horn, Rehmannia glutinosa, Yellow Flower, Peony Bark, Red Peony, Forsythia suspensa, Platycodon grandiflorus, Bamboo Leaf, and Rehmannia glutinosa. Commonly used traditional Chinese medicines include An Gong Niu Huang Wan, Zixue Dan, Qing Kai Ling Injection, and others. (3) Critical Cases: When clinical conditions arise such as respiratory failure, toxic shock due to infection, multiple organ dysfunction, or other serious clinical situations requiring intensive care, treatment should be carried out based on Western medical emergency protocols. ① Heart Yang Deficiency: Suddenly, the face becomes pale, lips and extremities turn bluish-purple, breathing becomes increasingly difficult, forehead sweat is cold, limbs become cold and clammy, the patient is restless and agitated, liver is enlarged in the right flank, tongue is pale purple, coated with thin white coating, and pulse is weak and nearly absent. Treatment principle: Warm and tonify heart yang, rescue the vital energy and stabilize the body. Prescription: Shen Fu Long Mu Rescue Reverse Tang with adjustments. Commonly used herbs include Ginseng, Aconite, Dragon Bone, Oyster Shell, Salvia miltiorrhiza, Peach Kernel, White Peony, Licorice. Commonly used traditional Chinese medicines include Shen Mai Injection, Sheng Mai Injection, Shen Fu Injection, and Compound Danshen Injection. ② Evil Entering the Jueyin: High fever, delirium, limb convulsions, jaw stiffness, upward gaze, red and dark red tongue, and a fine, rapid pulse. Treatment principle: Calm the liver and extinguish the wind, clear the heart and open the orifices. Prescription: Antelope Horn, Hook Vine, Scutellaria baicalensis, Forsythia suspensa, Salvia miltiorrhiza, Bamboo Leaf, Zhejiang Beibu, and other herbs, with added An Gong Niu Huang Wan. Commonly used traditional Chinese medicines include An Gong Niu Huang Wan, Heat Toxin Ning Injection, and Xing Nao Jing Injection. (4) Recovery Phase: When residual evils remain and qi and yin are both damaged, symptoms include low-grade fever or no fever, fatigue, poor appetite, thirst, red tongue with little saliva, and a fine, rapid pulse. Treatment principle: Clear residual evils and replenish qi and yin. Prescription: Sha Shen Mai Dong Tang with adjustments. Commonly used herbs include North Sand Ginseng, Mai Dong, Yu Zhu, Mulberry Leaves, White Kidney Beans, and Licorice. As the night grows warmer and the day cools, the fever subsides without sweating, the patient eats well despite being thin, and when evil remains in the yin aspect, use Qing Hao Bie Jia Tang with adjustments. Commonly used traditional Chinese medicines include Yang Yin Qing Fei Oral Liquid. (Chinese Journal of Traditional Chinese Medicine, 2010.1)

IV. Western Medical Treatment (1) Symptomatic Supportive Care:

Once H1N1 influenza is diagnosed, patients should be isolated and treated. Currently, the primary approach is comprehensive symptomatic support care. Rest, plenty of fluids, proper nutrition, and close monitoring of disease progression are essential; fever-reducing treatments can be administered for cases with high fever. The first 48 hours after onset are the optimal period for treatment.

(2) Medication Therapy

1. Antiviral Therapy: The H1N1 influenza virus is sensitive to neuraminidase inhibitors such as oseltamivir (Tamiflu) and zanamivir (Relenza). For cases requiring oseltamivir treatment, administration should occur as early as possible—within 48 hours of onset, with a course of 5 days. The adult dosage of oseltamivir is 75mg twice daily. Children aged 1 year and older should be dosed according to weight: for those weighing less than 15kg, administer 30mg twice daily; for those weighing 15–23kg, administer 45mg twice daily; for those weighing 23–40kg, administer 60mg twice daily; for those weighing over 40kg, administer 75mg twice daily. For children who have difficulty swallowing capsules, oseltamivir suspension can be used. For high-risk cases and severe cases, antiviral therapy should be administered early. For mild cases with few complications and a tendency toward self-limiting illness, most patients can recover through symptomatic supportive care without active antiviral drug use.
2. Antibiotics: If bacterial infections develop, antibiotics can be used. (3) Other Treatments (1) If hypoxemia or respiratory failure occurs, timely treatment measures should be taken, including oxygen therapy or mechanical ventilation. (2) In cases of shock, provide appropriate anti-shock treatment. (3) When other organ functions are compromised, provide supportive care accordingly. (4) When toxic shock due to infection, multiple organ dysfunction, or organ failure occurs, transfer the patient to an ICU equipped with the necessary control and monitoring facilities, depending on local medical infrastructure. (5) Discharge Criteria: Body temperature returns to normal for 3 days, other flu-like symptoms largely disappear, clinical condition stabilizes, and nasopharyngeal swabs test negative for H1N1 influenza virus for 2 consecutive days.