5 Antiviral Treatment

For severe cases meeting the criteria for acute lung injury, regular use of glucocorticoids is recommended to reduce pulmonary 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, with adjustments made based on the specific 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, gradually reduce the dosage and discontinue treatment; generally, a reduction of 1/3 every 3–5 days is recommended.

(5) Antiviral Treatment

Currently, no specific drugs targeting SARS-CoV have been identified. Retrospective clinical analyses indicate that commonly used antiviral medications like ribavirin do not demonstrate significant therapeutic effects for this disease. Proteinase inhibitors such as Kaletra, Lopinavir, and Ritonavir may be considered as alternatives.

(6) Immunotherapy

The efficacy of thymosin, interferon, and gamma globulin—non-specific immune enhancers—has not yet been confirmed for this disease and is not recommended for routine use. Clinical efficacy of SARS recovery serum has not been proven; however, for high-risk patients with a clear diagnosis, trial use under close observation is possible.

(7) Antibacterial Drug Use

Appropriate antibacterial agents 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 widespread papular-rash lesions throughout the body. Ancient Chinese medical texts have long recorded cases of rashes; since the Northern Song Dynasty, records of measles gradually increased, and it was recognized as an infectious disease. The earliest records in Western Europe 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, the first instance involved injecting measles patient secretions 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, resulting in a mortality rate as high as 10–20%. After the founding of New China, the state vigorously launched efforts to prevent and control measles; especially after the widespread application 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, a member of the paramyxovirus family, measuring 90–150 μm in diameter—a round particle capable of growing and multiplying in tissue culture, where eosinophilic inclusion bodies form within infected cells’ nuclei and cytoplasm. The measles virus is highly unstable outside the body; it loses its activity within 30 minutes in circulating air or sunlight. It is sensitive to common disinfectants and can be rapidly inactivated by ultraviolet light; however, it exhibits strong resistance to cold and dry conditions. Proteins protect the measles virus, allowing it to remain viable for over five years when stored at -70°C. This disease is transmitted via 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, causing viremia, which then travels throughout the body, primarily affecting mucous membranes, skin, respiratory tract, gastrointestinal tract, and other organs. The virus proliferates within cells, destroying cells and triggering inflammation. Clinical symptoms may result from inflammation, or they may arise from the products of necrotic cells. Modern medicine refers to “measles” as a term borrowed from traditional Chinese medicine.

(2) Diagnostic Criteria

1. Epidemiological Factors During measles season, there should be 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, pinkish spots may appear on 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 papules, then gradually becomes darker red, with normal skin between the lesions. The rash typically appears within 3–5 days. As the rash subsides, it may present with bran-like scaling, leaving behind brown pigmentation that takes about 2–3 weeks to fully disappear.
4. Complications: Some cases may develop complications such as pneumonia, laryngitis, acute heart failure, and encephalitis.
5. Laboratory Tests ① Blood count: White blood cell counts are reduced, while lymphocyte levels are relatively elevated; ② Polymorphonuclear leukocytes can be found in nasal and pharyngeal secretions; ③ Fluorescent antibody testing: By examining respiratory epithelial cells in nasal and pharyngeal mucus, as well as urinary sediment, measles virus can be detected within hours, enabling a definitive diagnosis; ④ Virus isolation: Using chicken embryos and tissue cell cultures, measles virus can be isolated from patients’ blood, eyes, nose, 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 papules that are scattered and resolve within 1–2 days without scaling or pigmentation, accompanied by mild lymph node enlargement, mainly in the neck, behind the ears, and at the occipital region.
7. Medication-induced rashes: A history of medication use prior to rash onset is common. The rash appearance varies in size and shape, often accompanied by noticeable itching. Typically, there is no fever or upper respiratory tract infection, and the rash does not progress further after discontinuing the medication. White blood cell counts may show an increase in eosinophils.
8. Scarlet fever: Within 1–2 days of fever, pinhead-sized red rashes appear all over the body, with congested skin between the rashes, a bright red color that fades upon pressure, facial congestion without rash, accompanied by a strawberry tongue, a pale ring around the mouth, and extensive peeling skin after the rash subsides. White blood cell counts are elevated, with neutrophils predominating in the white blood cell count.
9. Enterovirus infections, such as Coxsackie and Echovirus, often accompany rashes, particularly in summer and autumn. Before the rash appears, patients may experience fever, cough, and diarrhea; most rashes appear during fever, though occasional rashes appear after the fever subsides. The rash can vary widely, presenting as macules, papules, vesicles, urticarial rashes, or purpuric spots, with no fixed order of appearance, and the rash resolves without scaling or pigmentation. Three. Traditional Chinese Medicine’s Understanding and Treatment of Measles (1) Historical Medical Views on Similar Conditions

In traditional Chinese medicine, measles was known as “Ji,” “Ji Zi,” “Ma Zi,” “Ma Zheng,” “Sha,” “Tang Chuang,” “Fu Zi,” and other names. In ancient China, measles was referred to as “ban,” later evolving into “herpes,” and the distinction between measles and smallpox was long maintained. It wasn’t until the Ming Dynasty, with the publication of “Mai Zhen Shi Wei,” that measles and smallpox were treated separately; Gong Xin was the first to introduce the name “measles” in his work “Gujin Yijian.” Ancient medical texts, such as “Jinkui Yaolüe,” contained discussions about rashes, though the text was brief and descriptions were incomplete. Since the Northern Song Dynasty, records of measles gradually increased; Qian Yi wrote in “Xiao Er Yao Zheng Zhi Jue”: “Children’s herpes presents with dry skin on the face, red cheeks, red conjunctiva, sneezing and drowsiness, alternating between cool and hot temperatures, coughing and sneezing, cold hands and feet, restless sleep, and rashes—this is a disease of the heavenly cycle.” This was the first description of measles, capturing symptoms with remarkable accuracy and clearly indicating that this disease was an infectious illness. Later, in “Shanghan Zongbing Lun · Ban Zhen He Lun,” measles was distinguished from smallpox, noting that “there are two types of this disease: one causes rashes, commonly called ‘Ma Zi,’ whose toxicity is somewhat lighter.” In “Youke Quanshu · Yuan Zhen Fu,” further discussion was given to the pathogenesis and treatment of measles: “Toxins originate in the spleen, heat flows to the heart, and damage occurs in the viscera, with the lungs being particularly affected.” “If the rash appears too late, it’s best to release the exterior; if it appears too early, it’s better to detoxify.” “It seems like a beautiful pattern, yet only nineteen times out of ten is effective; it looks like coal, yet only one time out of a hundred is cured.” “The New Book of Measles” provided detailed descriptions of measles symptoms: “In the early stages of measles, before the rash appears, the body feels hot and cold, with headache and cough, possibly vomiting or nausea, diarrhea or abdominal pain, clear nasal discharge, sneezing and yawning, swollen eyelids, watery eyes, red cheeks, and body aches—restless and irritable…” During the Ming Dynasty, measles and smallpox were still separated; “Pian Yu Dou Zhen” even compared measles with milk measles (equivalent to infantile measles). Additionally, valuable experiences were accumulated in the care and prevention of measles. For example, it was said: “When a rash first appears, avoid wind and cold; do not eat fried, spicy, or salty foods; favor light flavors. If you accidentally consume sour or salty foods, it will increase phlegm and cough, prolonging the illness and making it difficult to recover. If you accidentally eat fried foods, it will generate heat and toxins, turning the excess heat into lingering heat. Those exposed to wind and cold may experience coughing and wheezing, or feel feverish, leading to countless complications that are hard to cure.” The Qing Dynasty physician Xie Yujiong’s “Mai Zhen Huo Ren Quan Shu” can be considered a comprehensive compilation of measles knowledge, offering concise yet profound insights into the etiology, pathogenesis, differential diagnosis, and treatment of measles: “Measles arises entirely from heat; when the body is not hot, the rash does not appear. When the body is warm and balanced, it is favorable; if heat is absent, it is not a good sign.” He pointed out that the cause of measles was “although measles originates from fetal toxins, it often follows seasonal patterns—when the climate is hot and humid, it is transmitted through people’s daily lives.” He further elaborated on the reversal of measles symptoms and prognosis: “In the early stages, the fever is similar to that of a cold, with swollen eyelids and tears flowing constantly, sneezing and yawning, and the nasal passages filled with mucus. There is little appetite, fatigue, and swelling of the body; the skin shows rashes, resembling scabies, with a bright red hue. The rash lasts for three days, then subsides, with wheezing and shortness of breath, no cough, no sweating, and the rash appears in patches—though the rash may be dark red, it is easier to heal without medication. But if the rash appears as blackened coal, then it is unlikely to be cured.” He emphasized that “the reversal of measles requires careful observation in clinical practice.”

(2) Traditional Chinese Medicine’s Understanding of Measles Pathogenesis As early as the Song and Yuan Dynasties, there was a theory that “fetal toxins are internally generated.” According to “Xiao Er Yao Zheng Zhi Jue,” “Children are born with the blood and impurities of the five internal organs; once they are born, their toxins begin to emerge.” Later, through extensive clinical practice, the idea emerged that fetal toxins could be combined with external pathogenic factors—such as what was noted in “Ren Duan Lu”: “Although measles originates from fetal toxins, it always follows seasonal patterns.” By the Qing Dynasty, it became increasingly clear that measles occurred because of “seasonal patterns,” triggered by exposure to “harsh energies,” and external pathogenic factors were acknowledged as the primary causes of measles. As stated in “Mai Zhen Hui Tong,” “Measles arises from fetal toxins, always following seasonal patterns—when the climate is hot and humid, it is transmitted through people’s daily lives.” In “Mai Zhen Shi Wei,” it was said: “Measles often arises from the harsh energy of heaven, transmitted through doors and alleys, spreading across the land.”

Pathogenic toxins enter through the mouth and nose, primarily affecting the Lung and Spleen meridians. The Lung governs the skin and hair; when pathogenic toxins attack the Lung, damaging the Lung’s defensive qi, fever, cough, and runny nose may occur. The Spleen governs the extremities and muscles; when heat rises in the Spleen, it manifests as poor appetite, fatigue, and swollen skin, with numerous rashes appearing on the body. The Heart governs blood; when pathogenic toxins flow toward the Heart, they clash with qi and blood, creating conflict between the righteous and the evil forces, and toxins may penetrate outward, causing the rash to turn bright red. If pathogenic toxins stagnate in the Liver Meridian, they rise to the eyes, causing redness and photophobia, with tears streaming down the face. Measles is a Yang toxin that generates heat and fire, consuming fluids and injuring fluids, leading to signs of Yin deficiency in the later stages. This is the favorable course of measles—where righteousness prevails over evil, the rash appears smoothly, and after the rash clears, the toxins follow the rash, leading to a better prognosis.

However, if a child is young and weak, lacking sufficient righteous qi to drive toxins out of the body; if pathogenic toxins are intense and generate heat, injuring Yin; or if proper care is lacking and treatment is inappropriate, causing toxins to become trapped inside the body, various adverse conditions and complications may arise. When toxins invade the Lung, the Lung’s meridians become blocked, and lung qi fails to descend, causing cough and shortness of breath; when toxins are intense and attack the throat, hoarseness and difficulty breathing may occur; when toxins block the Lung and move upward to the Pericardium, disturbing the mind and spirit, delirium and confusion may result; when toxins are intense and generate heat and fire, and heat becomes extreme, causing wind, convulsions may occur in the limbs; if pathogenic heat seeps into the blood, causing blood to flow abnormally, bleeding may occur—or “black measles” (hemorrhagic measles); when toxins move to the Large Intestine, diarrhea may develop; when heat scorches the intestinal meridians, causing stagnation and pus formation, bloody stools may appear (post-measles diarrhea). When the righteous qi is deficient and the evil forces are strong, the rash may not come out smoothly, appearing intermittently, with constant changes and a poor prognosis.

(3) Traditional Chinese Medicine’s Differentiation and Treatment Methods

1. Differentiation-Based Treatment (1) Pathogenic Invasion of Lung and Defensive Qi (Early Stage): The main symptoms include fever and chills, sneezing and coughing, red eyes and tearing, fatigue and sleepiness, and red rashes on the cheeks. The tongue coating is thin and white or slightly yellow, with a floating, rapid pulse. Treatment focuses on refreshing and dispersing the exterior, using a modified Yin Qiao San formula: 12g of Honeysuckle, 12g of Forsythia, 12g of Burdock Seed, 10g of Water Hyacinth, 10g of Peppermint, 10g of Dried Soybean, 6g of Cicada Slough, 6g of Radix Hedysari, 10g of Pueraria Root. Brew the herbs in water and take one dose daily.