Four. Western Medical Treatment

For those with relatively severe internal heat and prone to constipation, the Fanggan Tang No. 1 formulation is recommended. It consists of 10g of Guanzhong, 10g of Wild Chrysanthemum, 15g of Banlangen Root, 10g of Lianqiao, and 5g of Gancao. Take one dose daily for 3 days. Reduce the dosage for children accordingly. Its effects include clearing heat and detoxifying, resolving excessive heat and toxins within the body, thereby achieving the principle of “the yin is balanced, the yang is secure, and the spirit is healed.”

For those with spleen and stomach deficiency-cold and who tend to sweat easily while being susceptible to external pathogens, the Fanggan Tang No. 2 formulation is recommended. It comprises 10g of Huangqi, 10g of Jingjie, 10g of Guanzhong, 10g of Huangqin, 10g of Banlangen Root, and 5g of Gancao. Take one dose daily for 3 days. Reduce the dosage for children accordingly. Its effects include combining cleansing with tonification, preventing cold and harsh herbs from harming the middle burner, while utilizing diuretic herbs to invigorate the defensive yang and defend against external pathogens.

For those who are overweight and prone to dampness due to excessive smoking and alcohol consumption, the Fanggan Tang No. 3 formulation is recommended. It consists of 10g of Huoxiang, 10g of Peilan, 10g of Guanzhong, 10g of Huangqin, 10g of Lianqiao, 10g of Banlangen Root, 10g of Jingjie, and 5g of Gancao. Take one dose daily for 3 days, reducing the dosage for children accordingly. Its effects include clearing heat and transforming dampness, promoting diuresis to eliminate pathogenic factors.

A Chinese medicine screening team composed of experts from the China Academy of Traditional Chinese Medicine, Beijing University of Chinese Medicine, and other institutions focused on alleviating symptoms and controlling conditions, aiming to reduce mortality. By examining 30 commonly used traditional Chinese medicines in clinical settings—such as Guangzhou and Beijing—8 such medicines were selected as potential treatments for SARS: Qingkai Ling Injection, Fish Herb Injection, Banlangen Root Granules, Dengzhan Xixin Injection, Compound Kusun Injection, and Xiangdan Injection. Among these, ① Qingkai Ling Injection, Fish Herb Injection, and Banlangen Root Granules have shown good efficacy in improving acute lung inflammation; ② Xin Xue Granules and Jinlian Clear Heat Granules are effective in quickly and sustainably reducing high fever symptoms; ③ Qingkai Ling Injection and Dengzhan Xixin Injection can effectively alleviate acute respiratory distress syndrome; ④ Qingkai Ling Injection, Compound Kusun Injection, and Xiangdan Injection demonstrate significant protective effects against multi-organ damage. These eight traditional Chinese medicines played an extremely important role in treating SARS during its early, mid, severe, and recovery phases, playing a role that Western medicine cannot replace. (China Journal of Traditional Chinese Medicine, 2003.6)

Four. Western Medical Treatment (1) General Treatment and Condition Monitoring

Rest in bed, pay attention to maintaining water and electrolyte balance, and avoid strenuous activity or violent coughing. Closely monitor changes in the patient’s condition. In the early stages, continuous nasal cannula oxygen therapy is generally administered.

(2) Symptomatic Treatment

1. For patients with a fever exceeding 38.5°C or severe systemic pain, antipyretic and analgesic medications can be used. In cases of high fever, physical cooling methods such as ice packs or alcohol rubs can be employed.
2. For patients experiencing cough or expectoration, cough suppressants and expectorants can be prescribed.
3. Patients with impaired organ function—such as heart, liver, or kidney—should receive appropriate treatment tailored to their specific conditions.
4. Patients with diarrhea should be carefully monitored for fluid replacement and correction of water and electrolyte imbalances. (3) Respiratory Support Therapy

In severe cases, even at rest, patients may exhibit hypoxia; a decrease in SpO₂ after activity is an early sign of respiratory failure. Timely provision of continuous oxygen therapy is essential to maintain SpO₂ at 93% or higher. If the oxygen flow rate exceeds 5 L/min or the oxygen concentration reaches 40%, but SpO₂ remains below 93%, or if the respiratory rate exceeds 30 breaths per minute and the respiratory load remains elevated, non-invasive or invasive positive pressure ventilation should be considered promptly to alleviate respiratory distress, improve pulmonary oxygenation, and help patients navigate the critical phase.

(4) Use of Glucocorticoids

For severe cases meeting the criteria for acute lung injury, glucocorticoids should be administered regularly to reduce lung exudation, tissue damage, and subsequent pulmonary fibrosis, while also improving pulmonary oxygenation. The current adult dosage used in most hospitals is equivalent to 80–320 mg of methylprednisolone per day, though the dosage can be adjusted based on the severity of the condition and individual differences. For a small number of critically ill patients, short-term (3–5 days) methylprednisolone shock therapy (500 mg/day) may be considered. Once the condition improves or chest X-rays show absorption, the dosage can be gradually reduced and discontinued; typically, the dosage is reduced by one-third every 3–5 days.

(5) Antiviral Treatment

Currently, no specific drugs targeting SARS-CoV have been identified. Retrospective clinical analyses indicate that common antiviral medications like ribavirin do not provide significant therapeutic benefits for this disease. Protease inhibitors such as Kaletra, Lopinavir, and Ritonavir may be considered as alternative options.

(6) Immunotherapy

The efficacy of thymosin, interferon, and immunoglobulin G as non-specific immune enhancers has not yet been confirmed, and they are not recommended for routine use. Clinical efficacy of SARS recovery serum has not yet been established; however, for high-risk patients with clear diagnoses, these agents may be considered under close observation.

(7) Antibacterial Drug Use

Appropriate antibacterial drugs should be selected to treat and control secondary bacterial and fungal infections. New quinolones or beta-lactam antibiotics combined with macrolides may be used.

(Wu Bin)

Practical Internal Medicine in Integrated Chinese and Western Medicine, Chapter 5: Measles – I. Overview

Measles is an acute respiratory infectious disease caused by the measles virus, characterized by fever, cough, runny nose, conjunctival congestion, oral mucosal rash, and generalized maculopapular rash. Ancient Chinese medical texts have long recorded cases of maculopapular rashes; since the Northern Song Dynasty, records of measles gradually increased, and it was recognized as an infectious disease. The earliest European records date back to the 10th century; in 1846, a measles epidemic in the Faroe Islands provided a relatively complete description, confirming that measles is transmitted between humans via the respiratory tract. In 1911, measles patients’ secretions were injected into animals, triggering clinical symptoms. Before the founding of New China, measles had a very high incidence, with large-scale outbreaks occurring every 2–3 years, with a mortality rate as high as 10–20%. After the founding of New China, the state vigorously carried out measles prevention and control efforts; especially after the widespread use of domestically produced attenuated measles vaccines in 1965, the incidence dropped sharply, and the mortality rate fell below 1%. The causative agent of measles is the measles virus, belonging to the paramyxovirus family, a circular particle measuring 90–150 μm in diameter, capable of growing and multiplying in tissue culture. Infected cells form eosinophilic inclusion bodies within their nuclei and cytoplasm. The measles virus is highly unstable outside the body, losing its activity within 30 minutes in circulating air or sunlight. It is sensitive to most disinfectants and can be rapidly inactivated by ultraviolet light; however, it exhibits strong resistance to cold and dry conditions. Protected by proteins, the measles virus can remain viable for over 5 years when stored at -70°C. This disease is transmitted through respiratory droplets, with patients serving as the sole source of infection. It is most prevalent in winter and spring, though sporadic cases occur in other seasons as well. Individuals who have never had measles and have not been vaccinated against it are generally susceptible, with infants aged 6 months to 5 years having the highest incidence rate (accounting for 90%). In recent years, the incidence among adults has been increasing. After contracting measles, individuals develop lasting immunity, and second infections are rare. The measles virus enters the bloodstream through the nasopharynx and conjunctiva, forming viremia, then travels throughout the body, primarily affecting mucous membranes, skin, the respiratory tract, and the gastrointestinal tract; other organs can also be affected. The virus replicates inside cells, destroying them and causing inflammation. Clinical symptoms may result from inflammation, or they may arise from the products of necrotic cells. Modern medicine refers to “measles” as a name borrowed from traditional Chinese medicine.

II. Diagnosis (1) Diagnostic Criteria

1. Epidemiology: During measles season, there is a history of close contact with measles patients. Individuals who have never had measles and have not been vaccinated against it are at risk.
2. Early Manifestations: Initial symptoms include fever, cough, runny nose, eyelid swelling, photophobia and tearing; 2–3 days after onset, maculopapular rashes may appear in the oral mucosa.
3. Typical Rash: After 3–4 days of fever, the rash begins to appear, starting behind the ears and along the hairline, gradually spreading to the head, face, and neck, soon spreading to the trunk and limbs. The rash initially presents as rose-colored maculopapular lesions, which later become dark red and densely clustered, leaving behind a patchy texture with normal skin between the lesions. Typically, the rash appears within 3–5 days. As the rash subsides, it may leave behind bran-like scales, accompanied by brownish pigmentation, which completely disappears within about 2–3 weeks.
4. Complications: Some cases may develop pneumonia, laryngitis, acute heart failure, or encephalitis.
5. Laboratory Tests: ① Blood count: White blood cell count decreases, while lymphocytes increase relative to other white blood cells; ② Polymorphonuclear leukocytes can be found in nasal and pharyngeal secretions; ③ Fluorescent antibody testing: Detecting measles virus in nasal and pharyngeal mucus, as well as in urinary sediment, can facilitate diagnosis within hours; ④ Virus isolation: Using chicken embryos and tissue cell cultures, measles virus can be isolated from patients’ blood, eyes, nasal secretions, and pharyngeal secretions in the early stages. (2) Differential Diagnosis
6. Rubella is more common in children aged 5–15. Symptoms of upper respiratory tract inflammation and systemic symptoms are relatively mild, with no oral mucosal rash. The rash typically begins on the face, then spreads to the trunk and limbs within a day, appearing as fine, pale red maculopapular rashes scattered across the body. The rash is initially a few small, pale red papules, which later become dense and dark red, with normal skin between the lesions. Generally, the rash appears within 3–5 days. When the rash subsides, it leaves behind bran-like scales, with brownish pigmentation remaining, and the rash fully resolves within about 2–3 weeks.
7. Complications: Some cases may develop complications such as pneumonia, laryngitis, acute heart failure, or encephalitis.
8. Laboratory Tests: ① Blood count: White blood cell count decreases, with a relative increase in lymphocytes; ② Polymorphonuclear leukocytes can be found in nasal and pharyngeal secretions; ③ Fluorescent antibody testing: Detecting measles virus in nasal and pharyngeal mucus, as well as in urinary sediment, can facilitate diagnosis within hours; ④ Virus isolation: Using chicken embryos and tissue cell cultures, measles virus can be isolated from patients’ blood, eyes, nasal secretions, and pharyngeal secretions in the early stages. (2) Differential Diagnosis
9. Rubella is more common in children under 2 years old, presenting with sudden high fever and occasional convulsions. A sudden drop in fever after 3–5 days is a hallmark of the disease. The rash first appears on the trunk, face, and lower limbs, and within a day, it becomes scattered, with small, pale red maculopapular rashes that fade within 1–2 days without scaling or pigmentation. The rash is often accompanied by mild lymph node enlargement, mainly in the neck, behind the ears, and at the occipital region.
10. Medication History: The rash may appear after medication use. The rash varies in size and shape, often accompanied by noticeable itching. Typically, there are no fever symptoms or upper respiratory tract infection symptoms, and the rash does not progress further after stopping the medication. White blood cell classification shows an increase in eosinophils.
11. Scarlet Fever: After 1–2 days of fever, pinhead-sized red rashes appear all over the body, with congested skin between the rashes, a bright red color, and a bluish tint on the face. The rash is accompanied by a strawberry tongue, a pale ring around the mouth, and extensive peeling skin after the rash subsides. White blood cell counts increase, with neutrophils predominating in the white blood cell count.
12. Enterovirus Infections: Coxsackievirus and Echovirus infections often present with rash, particularly in summer and autumn. Before the rash appears, patients may experience fever, cough, and diarrhea; most rashes appear during fever, though occasionally the rash appears after the fever subsides. The rash can vary widely, including maculopapular rashes, papular rashes, vesicles, urticarial rashes, and petechial rashes. The rash does not follow a fixed order, and the rash subsides without scaling or pigmentation. Three. Traditional Chinese Medicine Understanding and Treatment of Measles (1) Historical Medical Views on Similar Conditions