Practical Internal Medicine in Combination with Western Medicine

Practical Internal Medicine in Combination with Western Medicine For nausea and vomiting, add Zhuyu, Chen Pi, and Su Jing; for diarrhea, use Poria, Coix Seed, and Slaked Stone to strengthen the spleen and eliminate dampness; for weak vital energy, poor rash breaking through, and pale rash colors, add Dang Shen and Dang Gui to support the body’s righteous qi and promote rash breakthrough; during the recovery phase, when the rash has broken through, but heat toxins have damaged fluids, switch to Sha Shen, Mai Dong, Yu Zhu, Sang Ye, Zhu Ye, Lu Gen, Roasted Loquat Leaf, Chuan Bei, and Fu Jing to nourish yin and generate fluids, clearing residual toxins. Administer one dose per day, decocted in water and divided into two doses. After 3–10 days of treatment, 79 cases were clinically cured, and 7 cases showed improvement. (Chinese Journal of Integrated Medicine, 2006.6) Yang Jianmin treated 52 measles patients with obvious liver function abnormalities and elevated myocardial enzyme levels. In addition to conventional Western medical treatments, he also used traditional Chinese medicine to clear the exterior with a refreshing and cooling approach, clearing heat and detoxifying. The formula consisted of: Ge Gen and Huang Qin each 15g, Huang Lian 9g, Gan Cao 6g, Chai Hu, Jie Bing, Chan Tui, Jie Sui, and Mo Han each 12g, plus 60g of Shui Niu Jiao powder. For cases where the rash was purplish-red and densely clustered, add Zi Cao 9g and Dan Pi 12g; as the rash gradually faded and the fever decreased, and residual heat remained, add Sha Shen, Mai Dong, and Artemisia annua each 12g; for corneal opacity and dry eyes, add Caotang 15g, and for eye irritation, add Cao Jing Cao and Chrysanthemum each 12g. Administer one dose per day, decocted in water. Treatment results showed that 52 patients had normal body temperatures within 2–4 days, and the measles subsided completely 5–10 days after the fever subsided. Liver function and myocardial enzyme levels returned to normal within 15–20 days, and all patients were clinically cured and discharged. (Shanxi Traditional Chinese Medicine, 2007.8) Zhang Feng and his colleagues treated 32 cases of measles complicated with pneumonia, using 0.3–0.5ml/kg·d of Tan Re Qing Injection in combination with 5% glucose solution via intravenous drip, once daily. The average time to stabilize body temperature, the time to resolve lung rales, and the average length of hospital stay were all shorter than those in the conventional treatment group (p<0.01). (Medical Theory and Practice, 2006.5) Zhang Guoxi also achieved ideal therapeutic effects when treating measles complicated with pneumonia using Bai Hua She Tiao Cao. (Traditional Chinese Medicine Magazine, 2007.8) Wang Xian and his colleagues treated 35 patients with measles complicated with pneumonia, using Ma Xing Shi Gan Tang with additions to the formula. The composition included: Roasted Ma Huang 6g, Xing Ren 9g, Sheng Shi Gao 30g, Gan Cao 6g, Yu Xing Cao 6g, Lian Qiao 6g, Jin Yin Hua 12g. Administer one dose per day, decocted in water twice, mixed together, and administered in 2–5 doses over 7 days as a course of treatment. During the prodromal stage, add Jing Jie, Mo Han, and Chan Tui to clear the exterior with a refreshing and cooling approach; during the rash stage, add Niu Ang Zi, Huang Qin, and Zhi Zi to clear heat and detoxify; during the recovery phase, add Sha Shen, Mai Dong, and Bei Mu to nourish yin and clear the lungs. The treatment group saw 32 cases with marked improvement, 3 cases with effective treatment, and a total effective rate (marked improvement plus effective treatment) of 100.0%; the hospital stay ranged from 3 to 8 days, with an average of 6.3 days, including 2–5 days spent breaking through the rash, averaging 2.6 days. In the Western medical conventional treatment group, 20 cases showed marked improvement, 15 cases were effective, and the total effective rate was 100.0%; the hospital stay ranged from 5 to 13 days, with an average of 8.2 days, including 3–8 days spent breaking through the rash, averaging 4.3 days. Neither group had any ineffective cases. The treatment group demonstrated significantly superior effectiveness and faster rash-breaking times compared to the control group, with a statistically significant difference (p<0.05). (Clinical and Experimental Medicine Journal, 2008.9) IV. Western Medical Treatment (I) General Care Patients should be isolated for treatment, ensuring good ventilation in the room and paying attention to cleaning the oral cavity, nasal cavity, and skin. Protect the eyes and avoid strong light exposure; if eye discharge is excessive, rinse with a 3% boric acid solution. For dry lips, apply plant oil. Provide adequate fluids and calories, and consider giving vitamin B₁, C, and other nutrients. (II) Western Medical Treatment In the early stages, use Viral Lin and Ban Lan Gen injection. For high fever, use physical cooling methods or administer small doses of antipyretics. For patients who are irritable, give phenobarbital orally or inject diazepam intramuscularly. For severe cough, prescribe cough syrups or cough tablets. For secondary infections, select antibiotics as appropriate. (III) Complication Treatment For patients with complications such as pneumonia, laryngitis, encephalitis, or heart failure, please refer to the relevant chapters for specific treatment guidelines. Qiao Fu Qu believed that for measles with poor rash breakthrough or what traditional Chinese medicine refers to as “white rash,” the cause lies in microcirculatory disorders, and he found that using 654-2 therapy was highly effective, with the added benefit of preventing complications. (Li Yu Ying, Wu Kai Chang, Qiao Fu Qu, Wu Bin)

Chapter Six: Infectious Diseases – Chapter Six: Chickenpox (Including Herpes Zoster) I. Overview Chickenpox is an acute, eruptive infectious disease caused by the varicella-zoster virus. It presents with mild systemic symptoms and a phased appearance of macules, papules, vesicles, and crusts on the skin and mucous membranes. The lesions contain fluid, are clear and bright, without pus or cloudy vesicle contents. This disease is prevalent during winter and spring seasons. After infection, most individuals develop lifelong immunity, though it can sometimes lead to herpes zoster (see below). The varicella-zoster virus belongs to the herpesvirus family and is highly susceptible to environmental factors. It can be detected in the nasal passages, pharynx, secretions, blood, and vesicles of infected patients. The virus primarily enters the body through the respiratory tract, grows and multiplies on the mucous membranes, then enters the bloodstream and lymphatic system, reproduces a second time within reticular endothelial cells, causing viremia and systemic lesions. The primary sites of infection are the skin, though internal organs may also be affected. The rash appears on the first day of illness, and approximately 1–4 days later, as antibodies in the blood emerge and viremia subsides, the rash gradually fades. Lesions primarily affect the spinous layer and the deeper layers of the epidermis, with cells exhibiting balloon-like changes, cellular edema, and degenerated cells surrounding the edema, forming vesicles filled with large amounts of virus. The fluid in the vesicles is initially transparent, but becomes turbid as epithelial cells shed and white blood cells infiltrate. Secondary infections may transform the vesicles into pustules. Because dermal inflammation is relatively mild, no scars remain after the crusts form. Vesicles can also appear on the oral, nasal, pharyngeal mucosa, or conjunctiva, and they are prone to ulceration. II. Diagnosis If a patient has a history of contact with chickenpox patients during winter or spring, develops a fever within one day and subsequently develops a rash, often localized to the trunk in a “centripetal” distribution, then the diagnosis of this disease can be considered. The rash appears in phases, and multiple stages of macules, papules, vesicles, and crusts can be observed simultaneously. However, it is important to differentiate this condition from other eruptive diseases.

1. Smallpox This condition is seen in individuals who have never been vaccinated against smallpox, or who have not been vaccinated for many years, or who have never received vaccination. Mild cases of smallpox can be confused with severe cases of chickenpox, but smallpox typically presents with a rash that appears 3 days after fever onset, often distributed on the head, face, and limbs in a “centrifugal” pattern. The rash is deeper, denser, and harder, leaving scars after crusting (commonly referred to as “smallpox marks”). Smallpox has long since disappeared.
2. Herpes Zoster The rash appears along specific peripheral nerves, presenting as clustered vesicles that do not extend beyond the midline of the torso, accompanied by local pain (burning, dullness, or tingling).
3. Lichenoid rashes are common in infants and young children. The rash at the tip resembles a vesicle, but is smaller and firmer than chickenpox, often appearing on the limbs and trunk, with red papules appearing in batches, accompanied by itching. Many patients have a history of allergies or insect bites, or intestinal roundworm infections.
4. Pustular rashes are common in children, especially during hot seasons, frequently occurring around the nose, lips, or exposed areas of the limbs. Initially, they appear as vesicles, then progress to pustules; once ruptured, the pus can spread to surrounding skin, causing new pustules, but they do not occur on mucous membranes. III. Traditional Chinese Medicine Understanding and Treatment of Chickenpox (A) Historical Medical Perspectives on Chickenpox

Song Dynasty physician Qian Yi’s “Children’s Medicine Testimony” includes a description of this disease: “The rash has five names: the liver produces vesicles, which ooze like water, their color is blue and small; the lungs produce pustules, which are thick and cloudy, their color is white and large; the heart produces spots, whose blood color is red and small, following closely behind the vesicles; the spleen produces rashes, smaller than the spots, whose blood is responsible for the redness, thus the vesicles are red and thick, boiling and cloudy.” According to “Baby’s Hundred Questions,” “After a fever lasts for one or two days, when the vesicles appear and then disappear, this is called chickenpox.” Ming Dynasty physician Wang Kentang’s “Standardized Diagnosis and Treatment” pointed out the differences between smallpox and chickenpox: “The rash in children differs between ‘zheng dou’ and ‘chickenpox,’ … the skin is thin like a pool, and once broken, it…” Practical Internal Medicine in Combination with Western Medicine In the case of “clearing,” only Qian and others mentioned in “Medical Canon ·” discussed the causes and treatments of chickenpox: “Chickenpox arises from damp-heat, and the external manifestations…”

The same shape, round tips containing clear liquid, easily swollen and blistered, not filled with pus or pus-like material; initially, use Jingfang Baidu San, with additional red beans to follow.” Qian… Chen Feixia’s “Young Children’s…” described the characteristics of chickenpox: “Chickenpox is similar to smallpox, with a red face and red lips, eyes like water, coughing and sneezing, thick, sticky mucus, and a fever lasting two or three days, but the rash is clear and as pure as a water bubble, shaped like a small bean, with thin skin and crusts at the center, smaller circular rings, easy to break through and blister.” Qian… Hua Shu’s “Ma Ming” proposed: “All… the color of chickenpox is pink, … clear and bright, with water bubbles… some are even reddish like rouge, also known as ‘red smallpox.’” (B) Traditional Chinese Medicine Understanding of the Pathogenesis of Chickenpox

This disease is caused by external pathogenic toxins, often entering through the mouth and nose, accumulating in the lungs and spleen. The lungs connect to the skin and hair, governing the descending function; when external pathogens invade the lungs, their ascending and descending functions are disrupted, leading to pulmonary symptoms such as fever, cough, and runny nose in the early stages. If damp-heat accumulates in the stomach and intestines, or if the virus penetrates deeply, symptoms related to the Qi level may appear. The spleen governs the muscles; when pathogenic toxins clash with internal dampness, they manifest externally on the skin, resulting in chickenpox eruptions. This disease is often classified as a mild case of wind-heat, where clearing the external pathogenic toxins allows the condition to resolve. Since the pathogenic toxins in this disease…

Generally, they only affect the Wei and Qi levels, rarely penetrating into the Ying and Blood vessels, so the condition is milder than smallpox or measles, with a good prognosis and fewer complications. A small number of children, however, experience severe heat-toxin attacks, affecting the Qi and Blood, and in severe cases, the Blood may be compromised, leading to high fever, irritability, red face, dense, dark-colored rash, and other severe symptoms.

(C) Traditional Chinese Medicine Differentiation and Treatment Methods

1. Wind-Heat Type The main symptoms include no fever or only a mild fever, with rash appearing within 1–2 days. Red, small papules appear first on the trunk and face, with a rosy, fresh color, clear vesicle fluid, and a red halo around the base that is not prominent; the rash is sparse, and may be accompanied by nasal congestion and runny nose, coughing and sneezing. The pulse is floating and rapid, the tongue is pale red with a thin white coating. Treatment focuses on dispersing wind, opening the exterior, clearing heat and detoxifying, or assisting with draining dampness. The formula uses Yin Qiao San with adjustments: 15g of Jin Yin Hua, 15g of Lian Qiao, 12g of Niu Ang Zi, 10g of Bo He, 10g of Jie Bing, 6g of Jing Jie, 6g of Zhu Ye, 20g of Fresh Mao Gen, 15g of Zi Hua Di Ding, 15g of Ban Lan Gen, 6g of Gan Cao. Decocted in water and taken orally, one dose per day. If dampness is severe, add herbs like Shu Shi and Mu Tong to drain dampness and promote water metabolism; if the rash has a red halo around the edges, add Dan Pi and Chi Shu; for severe skin itching, add Chan Yi and Jiang Can.
2. Heat-Toxin Type The main symptoms include high fever, or persistent high fever, irritability, thirst, red face and red eyes, dense chickenpox rash, and dark purple rash colors.

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Input: Lu Gen 30g, Dan Pi 10g. Decocted in water and taken orally, once daily.

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(4) Lung obstruction due to damp-toxins: Symptoms include high fever that does not subside, severe cough, shortness of breath with nasal flaring, noisy phlegm in the throat, rash that does not break through the skin, and in severe cases, cyanosis of the lips and tongue, red and darkened tongue, thin yellow coating, and a slippery, rapid pulse. Treatment should focus on clearing heat and detoxifying, opening the lungs and resolving phlegm; use a modified Ma Xing Shi Gan Tang: Ma Huang 6g, Xing Ren 10g, Sheng Shi Gao 30g, Jin Yin Hua 12g, Lian Qiao 12g, Yu Xing Cao 30g, Zi Cao 10g, Chan Tui 6g, Tian Zhu Huang 19g. Decocted in water and taken orally, one dose per day.

(5) Heart Yang Deficiency leading to collapse: Symptoms include pale complexion, cold hands and feet, profuse cold sweat, rash that does not break through the skin, confusion and restlessness, pale tongue with white coating, and a deep, fine pulse. Treatment should focus on restoring yang and rescuing the vital energy, using a modified Canfu Tang: Ren Shen 12g, Fu Pi 6g (previously decocted), Huang Qi 30g, Gui Zhi 9g, Wu Wei Zi 10g, Mai Dong 10g, Long Gu 10g, Gan Cao 9g. Decocted in water and taken orally, one dose per day.

(6) Evil obstructing the heart and pericardium: Symptoms include high fever, confusion, delirium, irritability, flushed face, labored breathing, rash that does not break through easily, or rash that is densely purple, accompanied by occasional convulsions, red and darkened tongue, yellow and dry coating, and a slippery, rapid pulse. Treatment should focus on clearing heat, detoxifying, opening the orifices, and awakening the spirit; use Qing Ying Tang with An Gong Niu Huang Wan or Zi Xue Dan. Rhinoceros Horn 3g (replacing 30g of Water Buffalo Horn), Rehmannia Root 12g, Gardenia Fruit 10g, Coptis Chinensis 9g, Paeonia Lactiflora 10g, Earthworm 10g, Purple Grass 12g, Atractylodes Macrocephala 10g, Curcuma Longa 9g. Decocted in water and taken orally, one dose per day.

(7) Damp-toxin attacking the throat: Symptoms include sore throat, hoarseness, choking cough and vomiting, irritability, and even difficulty breathing, mouth open and shoulders raised, facial cyanosis, red tongue with yellow coating, and a floating, rapid pulse. Treatment should focus on clearing heat, detoxifying, and relieving throat congestion and swelling; use Qing Yan Li Ge Tang with modifications: Jin Yin Hua 12g, Lian Qiao 12g, Xuan Shen 12g, Ji Ge 10g, She Gan 10g, Niu Lao Zi 12g, Purple Grass 12g, Ba Da Hai 10g, Gan Cao 6g. Decocted in water and taken orally, one dose per day.