4 TCM Resources on Differentiation and Treatment of This Disease

Early Stage: Typically occurring around 1–5 days after onset, the pathogenesis is characterized by damp-heat obstruction and simultaneous involvement of defensive qi. Treatment emphasizes clearing and transforming the Qi. Common subtypes include:

1. Damp-Heat Obstructing Lung Qi: Patients present with fever, mild aversion to cold, body pain and fatigue, dry mouth and little drinking water, or accompanied by chest tightness and abdominal discomfort, without sweating or with poor sweat drainage, or experiencing nausea, vomiting, loss of appetite, loose stools, pale red tongue with thin, white, greasy coating, and a floating, slightly rapid pulse. Treatment: Focus on transforming damp-heat and releasing the evil to the outside. Formula: Sanren Tang combined with Shengjia San, with modifications. Ingredients: Apricot kernels 12g, talc 15g, grass herb 6g, white bean skin 5g (crushed and added later), bamboo leaves 10g, magnolia bark 6g, raw Coix Seed 20g, Pinellia Rhizome 10g, Silkworm Moth 6g, turmeric 9g, cicada shell 6g, Atractylodes Rhizome 6g, Artemisia 10g (added later), Scutellaria 10g. When dampness is prominent but heat is not obvious, Huopu Xia Ling Tang with modifications can also be used. 2. Table Cold and Interior Heat Combined with Dampness: Patients present with pronounced fever, chills, even violent shivering, accompanied by headache, joint pain, dry throat or sore throat, dry mouth and little drinking water, dry cough with little phlegm, a red tongue with a yellowish, slightly greasy coating, and a floating, rapid pulse. Treatment: Use pungent and cool herbs to resolve exterior cold, open the lungs and transform dampness. Formula: Mashi Xinggan Tang combined with Shengjia San, with modifications. Ingredients: Roasted ephedra 6g, raw gypsum 30g (boiled first), roasted apricot kernels 10g, roasted licorice 6g, Silkworm Moth 10g, turmeric 9g, cicada shell 6g, Forsythia 15g, Honeysuckle 15g, Scutellaria 10g, Rehmannia Root 15g, Rehmannia Root 15g, and fresh Coix Seed 20g.

Mid-Stage: Typically occurring around 3–10 days after onset, the pathogenesis is characterized by damp-heat accumulating toxins, latent pathogenic factors residing in the membrane origin, and obstruction of the Shaoyang meridian. Treatment emphasizes clearing damp-heat and regulating Qi flow. 1. Damp-Heat Accumulating Toxins: Patients present with fever, especially in the afternoon, poor sweat drainage, chest tightness and abdominal discomfort, dry mouth and little drinking water, dry cough or choking, or accompanied by sore throat, bitter taste in the mouth, or a sticky feeling in the mouth, a yellowish, greasy coating on the tongue, and a floating, rapid pulse. Treatment: Clear heat, transform dampness, and detoxify. Formula: Ganlu Disinfection Pill with modifications. Ingredients: Raw gypsum 30g (boiled first), roasted apricot kernels 10g, Herba Lysimachiae 15g, Polygonum Cuspidatum 15g, white bean skin 6g (crushed and added later), talc 20g, Pinellia Rhizome 10g, Silkworm Moth 10g, cicada shell 6g, Forsythia 15g, Honeysuckle 15g, Scutellaria 10g, Rehmannia Root 15g, fresh Coix Seed 20g.

Mid-Stage: Typically occurring around 3–10 days after onset, the pathogenesis is characterized by damp-heat accumulating toxins, latent pathogenic factors residing in the membrane origin, and obstruction of the Shaoyang meridian. Treatment emphasizes clearing damp-heat and regulating Qi flow. 1. Damp-Heat Accumulating Toxins: Patients present with fever, choking cough, sticky phlegm that does not come up, sweating, chest tightness, irritability, dry mouth and bitter taste, nausea, loss of appetite, diarrhea, fatigue, and a white, slightly yellowish, or yellowish-greasy tongue coating, and a floating, rapid pulse. Treatment: Clear heat, clear dampness, and detoxify. Formula: Haoqin Qingdan Tang with modifications. Ingredients: Artemisia 10g (added later), bamboo shoots 10g, Pinellia Rhizome 10g, Red Poria 15g, Scutellaria 10g, Chaihu 15g, Pinellia Rhizome 10g, fresh Coix Seed 30g, talc 20g, Forsythia 15g, Qingdaibai 6g (wrapped and boiled), Atractylodes Rhizome 6g, Turmeric 10g.

Late Stage (Peak Period): Typically occurring around 7–14 days after onset, the clinical hallmark is marked by significant shortness of breath and wheezing, or accompanied by cyanosis. The pathogenesis is characterized by severe damp-heat toxicity, consumption of Qi and Yin, and internal congestion of blood; in some cases, heat enters the blood, leading to Qi depletion and respiratory failure. While removing the evil, treatment must also focus on supporting the body’s vital energy; formulas like Baihu Plus Ginseng Tang, Qingying Tang, or Xijiao Tang can be used in combination with herbs that promote blood circulation and eliminate blood stasis, along with intravenous administration of Shenfu Injection, Shenmai Injection, or Danshen Injection. 1. Heat Entering the Blood, Consuming Qi and Yin: Patients present with fever at night, shortness of breath and irritability, even inability to move, choking cough or hemoptysis, dry mouth, shortness of breath and fatigue, sweating, a red and dark tongue with a thin coating, and a fine, rapid pulse. Treatment: Clear the blood, detoxify, and replenish Qi and Yin. Formula: Qingying Tang combined with Shengmai Powder with modifications. Ingredients: Water Buffalo Horn 30g, Rehmannia Root 15g, Xuan Shen 15g, Honeysuckle 15g, American Ginseng 5g (separate and decocted), Ophiopogon 10g, Cornus Fruit 15g. Intravenous infusion of Shenmai Injection can also be used to replenish Qi and Yin. 2. Severe Pathogenic Factors, Deficiency of Vital Energy, Internal Closure and External Collapse: Patients present with fever that is not particularly pronounced, significant shortness of breath, lethargy, unable to move, unable to speak, a fine, shallow, rapid pulse, weak energy, and a purplish-blue complexion; or sweating profusely, cold extremities, and a pulse that is faint and nearly gone. Treatment: Supplement Qi and strengthen the defenses, or use pungent and cool herbs to open the orifices. Ingredients: Large doses of Shenmai Injection or Shenfu Injection, along with Shenfu Tang or Shengmai Powder (soup) to administer An Gong Niu Huang Wan or Zixue Dan.

Recovery Phase: Typically occurring after 10–14 days after onset, the pathogenesis is characterized by deficiency of vital energy and lingering evil, with a tendency toward dampness and blood stasis. The main symptoms include damage to both Qi and Yin, Qi deficiency combined with dampness and blood stasis. Treatment emphasizes supporting the vital energy while removing the evil, focusing on transforming dampness and promoting blood circulation. 1. Qi and Yin Damage: Patients present with fever subsiding, irritability, dry mouth, sweating, fatigue, shortness of breath, poor appetite, a pale red tongue with tender texture, little or thin coating, and a fine or slightly rapid pulse. Treatment: Supplement Qi and nourish Yin. Formula: Shenmai Powder or Shaoshan Mai Dong Tang with modifications. Ingredients: Prince’s Ginseng 15g, Shaoshan 10g, Ophiopogon 10g, Broad Bean 12g, roasted licorice 3g, Chinese Yam 10g, Bamboo Shoot 10g, Pinellia Rhizome 6g, Rehmannia Root 15g, Peppermint 15g, Forsythia 15g, Red Sage 10g, Angelica Sinensis 10g, Red Peony 12g, Clematis Armandii 30g. 2. Qi Deficiency Combined with Dampness and Blood Stasis: Patients present with shortness of breath, fatigue, slight shortness of breath after activity, poor appetite, a pale red tongue with a slightly dark hue, a thin, greasy coating, and a fine pulse. Treatment: Supplement Qi, transform dampness, and promote blood circulation. Formula: Depending on whether the condition is deficient or excess, different formulas can be selected, such as Li’s Qingshu Yi Qi Tang, Shenling Bai Zhu San, or Xuefu Zhu Yu Tang with modifications. Ingredients: Prince’s Ginseng 15–30g, raw Atractylodes Rhizome 15g, Poria 15g, Broad Bean 10g, raw Coix Seed 30g, Peppermint 10g, Turmeric 10g, Pinellia Rhizome 10g, Peach Kernel 10g, Salvia 12g, Angelica Sinensis 10g, Red Peony 12g, Ligustrum Lucidum 30g. (Tianjin Journal of Traditional Chinese Medicine, SARS Special Issue, 2003.6)

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

This disease aligns with the principle in the Suwen – Discussion on Treatment Methods that “when the five plagues arrive, they all spread easily, affecting everyone regardless of age, with similar symptoms.” It falls under the category of epidemic diseases and heat-related illnesses in traditional Chinese medicine. The cause of the disease is epidemic toxins entering through the mouth and nose, primarily affecting the lungs, though it can also impact other organs; the basic pathogenesis is that the evil toxins settle in the lungs, dampness and phlegm obstruct the lungs, lung Qi becomes blocked, and Qi and Yin are depleted. The principles of TCM treatment are early intervention, emphasis on removing the evil, early support of vital energy, and prevention of disease progression. The following formulas are taken from the “Diagnosis and Treatment Plan for Infectious Atypical Pneumonia (SARS)” published by the Chinese Medical Association and the Chinese Society of Traditional Chinese Medicine.

1. Differentiation and Treatment (1) Epidemic Toxin Attacking the Lungs: Often seen in the early stages. Symptoms include initial fever, or aversion to cold; headache, body pain, limb stiffness; dry cough, little phlegm, or sore throat; shortness of breath, fatigue, dry mouth. Tongue coating is either white or yellow, pulse is floating and rapid. Treatment: Clear the lungs, detoxify, transform dampness, and release the evil. Basic formula and reference dosages: Honeysuckle 15g, Forsythia 15g, Scutellaria 10g, Chaihu 10g, Artemisia 15g, White Pepper 6g (crushed), roasted apricot kernels 9g, raw Coix Seed 15g, Shaoshan 15g, Rehmannia Root 15g, with modifications: if no sweating, add peppermint; if heat is severe, add raw gypsum and Chinese motherwort; if coating is greasy, add Ho Xiang and Peppermint; if diarrhea occurs, remove Chinese motherwort and add coptis and prepared ginger; if nausea and vomiting occur, add processed pinellia and bamboo shoots.

(2) Epidemic Toxin Congesting the Lungs: Often seen in the early stages and during the progressive phase. Symptoms include high fever, persistent sweating despite heat reduction, body pain; cough, little phlegm, chest tightness, shortness of breath; diarrhea, nausea Can be uncomfortable or constipated, or stools may be loose and not very regular; dry mouth and little desire to drink, shortness of breath, fatigue; in severe cases, restlessness and agitation. Tongue is red or coated, coating is yellowish-greasy, pulse is floating and rapid. Treatment: Clear heat, detoxify, open the lungs and transform dampness. Basic formula and reference dosages: Raw gypsum 45g (boiled first), Chinese motherwort 10g, roasted ephedra 6g, Honeysuckle 20g, roasted apricot kernels 0, raw Coix Seed 15g, Zhejiang Beihua 10g, Prince’s Ginseng 10g, raw licorice 10g. Modifications: For restlessness and a red, dry tongue, add Rehmannia Root, Red Peony, and Dendrobium; for shortness of breath, fatigue, and severe dry mouth, remove Prince’s Ginseng and add American Ginseng; for nausea and vomiting, add processed pinellia; for constipation, add melon seeds and raw rhubarb; for abdominal bloating and loose stools, add roasted betel nut and wood fragrance.

(3) Lung Blockage and Wheezing: Often seen in the progressive phase and in severe cases of SARS. Symptoms include persistent high fever or a gradual decrease in fever; difficulty breathing, chest tightness, wheezing; or dry cough, little phlegm, or blood in the phlegm; shortness of breath, fatigue. Lips are purple-dark, tongue is red or dark red, coating is yellowish-greasy, pulse is floating. Treatment: Clear heat, drain the lungs, eliminate stagnation and turbidity, while supporting the vital energy. Basic formula and reference dosages: Lepezi 15g, Mulberry Bark 15g, Scutellaria 10g, Whole Loquat 30g, Turmeric 10g, Forsythia 12g, Silkworm Moth 10g (wrapped), Salvia 15g, Bidens Pilosa 30g, American Ginseng 15g. Modifications: For shortness of breath, fatigue, and severe wheezing, add Chinese Hawthorn; for abdominal bloating and poor appetite, add Poria and malt; for cyanotic lips, add Tripterygium Wilfordii and Motherwort.

(4) Internal Closure and External Collapse: Seen in severe cases of SARS. Symptoms include respiratory distress, chest tightness and wheezing, with more inhalations than exhalations; voice is low and quiet, restless and agitated, even with confusion, cold sweat and cold limbs. Lips are purple-dark, tongue is dark red, coating is yellowish-greasy, pulse is deep and fine, almost gone. Treatment: Supplement Qi and Yin, restore yang, solidify the defenses, and clear turbidity while opening and closing. Basic formula and reference dosages: Red Ginseng 10–30g (separate and decocted), Prepared Aconite 10g, Chinese Hawthorn 30g, Mulberry 15g, Turmeric 10g, Tripterygium Wilfordii 6g. Modifications: For confusion, send An Gong Niu Huang Wan to the patient; for cold sweats, add calcined Longmu; for cold limbs, add Cinnamon Twig and Dry Ginger; for throat sounds, add Houzao San.

(5) Qi and Yin Deficiency, Phlegm Stagnation Blocking the Meridians: Often seen in the recovery phase. Symptoms include chest tightness, shortness of breath, fatigue, and increased breathlessness with movement; or coughing; feeling feverish or mildly hot, self-sweating, anxiety, insomnia, poor appetite, dry mouth and throat. Tongue is red and lacking moisture, coating is yellow or greasy, pulse often shows deep, fine, and weak. Treatment: Supplement Qi and Yin, transform phlegm and open the meridians. Basic formula and reference dosages: Party Ginseng 15g, Shaoshan 15g, Mulberry 15g, Rehmannia Root 15g, Red Peony 12g, Aster 15g, Zhejiang Beihua 10g, Malt 15g. Modifications: For severe shortness of breath and wheezing, and a dark tongue, add Tripterygium Wilfordii, Schisandra, and Chinese Hawthorn; for fever or heat in the heart, and a dark tongue, add Artemisia, Gardenia, and Dendrobium; for loose stools, add Poria and Atractylodes Rhizome; for anxiety, add processed bupleurum and fragrant angelica; for insomnia, add roasted ziziphus seeds and longan; for liver function impairment with elevated transaminases, add Ophiopogon and Schisandra.

2. Application of Chinese Patent Medicines: Chinese patent medicines should be used based on individual differentiation and should be combined with herbal formulas.

(1) Fever-Reducing Medicines: Suitable for early and progressive phases of fever, including Guasong Fever-Reducing Capsules, Zixue, XinXue Granules, Xiao Chaihu Tablets (or Granules), ChaiYin Oral Liquid, etc.

(2) Heat-Clearing and Detoxification Medicines: Suitable for early and progressive phases of epidemic toxin attacking the lungs, epidemic toxin congesting the lungs, and lung blockage and wheezing. Injectable medications can include Qingkai…

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Input: Ling Injection, Fish Herb Injection, Shuanghuanglian Powder Injection, Compound Kusun Injection, etc. For oral formulations, you can choose Qingkai Ling Oral Liquid (capsules), Qing Heat Detox Oral Liquid (granules), Shuanghuanglian Oral Liquid, Jinlian Clear Heat Granules, Kusun Granules, Ge Gen Qin Lian Micro Pills, Meihua Dian She Dan, Zijin Ding, etc.

(3) Blood Circulation-Enhancing and Stasis-Resolving, Dampness-Dispersing and Phlegm-Reducing Categories: Suitable for the pulmonary obstruction and dyspnea syndrome in the progressive stage and severe cases of SARS. Injectable formulations include Danshen Injection, Xiangdan Injection, Chuanxiong Injection, Dengzhan Xixin Injection, etc. Oral formulations include Xuefu Zhu Yu Oral Liquid (or granules), Compound Danshen Drops, Huoxiang Zhengqi Oral Liquid (capsules), Houzao San, etc.

(4) Qi-Boosting Category: Suitable for patients with deficiency of righteous qi at all stages. Injectable formulations include Shengmai Injection, Shenmai Injection, Shenfu Injection, Huangqi Injection, etc. Oral formulations include Shengmai Decoction, Bailing Capsules, Jinshui Bao Capsules, Ningxin Bao Capsules, Nuodikang Capsules, Liuwei Dihuang Wan, Buzhong Yiqi Wan, etc. Although the treatment principles for severe cases of SARS often involve natural remission in most patients, approximately 30% of cases are classified as severe, some of which may progress to acute lung injury or ARDS, and even lead to death. Therefore, severe patients must be closely monitored dynamically, with enhanced care, timely respiratory support, appropriate use of glucocorticoids, strengthened nutritional support and organ function protection, attention to water, electrolyte, and acid-base balance, prevention and treatment of secondary infections, and prompt management of complications.

The traditional Chinese medicine approach to SARS prevention emphasizes “treating disease before it occurs,” meaning that when a particular disease is likely to develop, corresponding medications are used to prevent its onset, progression, and transformation into more severe conditions. Based on the understanding that SARS falls under the category of “epidemic diseases,” the “Fanggan Tang” series of preparations—principled around clearing heat and detoxifying, dispersing dampness and transforming turbidity, and promoting diuresis to clear excess moisture—were developed to help improve the body’s internal damp-heat environment, while leveraging the power of diuresis to invigorate the body’s yang energy and resist external pathogenic factors.