Writing the SARS Answer-Paper with Our National Medicine
I. "We should write about the TCMs treating SARS — we may be in more danger than the Western doctors"
On 29 May, when the reporter met Director Li Xiuhui of Beijing You'an Hospital's Integrated Chinese-Western Department, it was already 8 p.m.; Li was still discussing with colleagues. Five minutes later she finished her day's work and spoke with the reporter about the You'an TCM SARS-treatment effort she leads.
On 18 May a Beijing paper reported: through TCM treatment of 100 SARS cases, You'an had summed up TCM prescriptions for the various SARS patterns; these had entered the State 863 science-and-technology project. Facts proved: integrated Chinese-Western care for SARS effectively raised cure rate, lowered death rate, shortened course.
These 500-some words let the Beijing senior TCMs — anxious all along — put down their hearts. National-level TCM specialist, director of the Jingcheng Famous-Physician Hall, Professor Chen Wenbo, said: had those 100 cases not happened, we Beijing TCMs would have had no face to meet anyone. We are anxious. We cannot let TCM perish in our generation.
"TCM should go to the front!" Since SARS first broke out, many senior TCMs raised this cry. Without getting to the front, without seeing patients, TCM cannot bring out its role. It was only on 18 May that the seniors saw the You'an report.
The reporter asked Li: from March, when You'an began receiving SARS patients, you used Chinese medicines — why was this not made public? Li smiled: "I have followed one principle all along: do is more important than say."
Their doing was full of danger.
Like the Western doctors, each TCM doctor spends 5–6 hours per stretch in the ward. Unlike them, the TCM doctor must look at the patient's tongue, take the pulse — closer contact, more chances. They also photograph the tongue before and after treatment with a digital camera for research. To photograph the tongue close, the camera nearly touches it; to see the screen, the doctor must come close — almost zero distance with the patient. Li said: apart from intubation, Western doctors stay relatively far from the patient's head, and certainly do not have patients remove their masks. Li: "We should write about the TCMs treating SARS — we may be in more danger than the Western doctors."
II. "Spread TCM concepts among Western doctors"
As a Western infectious-disease hospital, why did You'an use Chinese medicines from the start? Li, helpless: "As always — patients not improving, the Western doctors come find us: please prescribe some Chinese medicine." "Some Chinese medicine" means: Western treatment continues; add Chinese medicines. It fits exactly the Ministry of Health document of April: TCM auxiliary auxiliary treatment.
It is the four-character auxiliary treatment that the TCM specialists cannot accept; the reporter heard at least 5 specialists say: "Painful inside!"
Chen Wenbo asked: why only auxiliary? Why cannot we openly take part? Western may use Western alone — why cannot Chinese use Chinese alone? National-level TCM specialist Professor Liang Yijun of Beijing University of Chinese Medicine: "The paper said Western had no special drug, but the last line said 'Chinese medicine as auxiliary' — I felt very hurt. Does it mean TCM has no way, only auxiliary? Later Vice-Premier Wu Yi clearly said this disease must be treated by integrated Chinese-Western, with TCM also leading, going in. Then I felt better."
Li said: stopping all Western drugs and using only Chinese medicine is not realistic. Before April, Li's team could not enter the isolation ward; Chinese medicines could only be injectables and fixed preparations; only when results were truly poor would Chinese decoctions be used by biàn zhèng lùn zhì. The front-line doctors are all Western, mostly not trained in biàn zhèng lùn zhì — they do not know yin-deficient, yang-deficient, cold-hot-warm-cool, under what conditions which Chinese medicine. So Li listed on paper: with this presentation, use Qingkailing injection; with that, Yuxingcao injection… She called it spreading TCM concepts among Western doctors.
Even so, a conclusion can already be drawn: using Chinese medicines beats not using them. With Chinese medicine, mortality fell sharply, cure rate rose sharply.
By now, Guangzhou University of Chinese Medicine's First Affiliated Hospital has summed up the integrated Chinese-Western results: mean fever time 2.97 days; chest-film inflammation cleared faster, mean 6.2 days; mean hospital stay 8.6 days. They have cured 97 SARS cases — not one staff infected; not one patient worsened into respiratory distress or died. Zero infection, zero transfer, zero death — the miracle. They consulted on 37 more severe outside cases; not one died. Li said You'an's pre-April-30 TCM-SARS summary will be out this month; their TCMs on the SARS front are also all uninfected.
National-level senior TCM, Guangzhou University of Chinese Medicine doctoral mentor, Professor Deng Tietao: treating viral disease is TCM's strong suit. He holds: Western has no targeted drugs; hormones over-dosed will leave dire sequelae. He compares: "Why is Canada's mortality high? Why is Guangzhou's low? In Beijing TCM was not at first let in; was the disease not severe? Was mortality not high? After TCM came in, did mortality not drop? Did the situation not improve? This makes the point!"
III. "Beijing has so many specialists, no weaker than Guangzhou — but we always feel a little …"
Most Beijing SARS patients were not as fortunate as You'an's. While You'an was quietly using integration —
On 13 April, the State Science-and-Technology Department's TCM-Strategic-Position project member, Professor Lin Zhongpeng, with members Jia Qian and Yang Juping, flew specially to Guangdong to study Guangdong's TCM-led results. On returning, Lin gave the group a theme report: Guangdong's clinical practice shows TCM treatment of SARS deserves serious summary and spread.
On 2 May, Hong Kong asked Guangdong for help. Director Lin Lin of Guangdong Provincial TCM Hospital's Respiratory Department and assistant director Yang Zhimin were invited to treat SARS; original plan was a month. Two weeks in, Hong Kong's Hospital Authority publicly said the two would stay three more months.
On 5 May, the first Director of the State Administration of TCM, holder of the Qing Wenbing lineage, the 90-year-old Professor Lü Bingkui led a group of TCM specialists in an urgent open letter: in this SARS war, bring out TCM's important role.
On 8 May Premier Wen Jiabao endorsed the letter: "In SARS prevention and treatment fully bring out TCM's role, practice integrated Chinese-Western… Forward to Comrade Wu Yi."
On the afternoon of 8 May, Vice-Premier Wu Yi presided over a Zhongnanhai meeting on TCM treatment of SARS. She stressed: TCM is an important force in fighting SARS; we must fully recognize its scientific value, actively use TCM resources, bring out the role of the broad TCM workforce, practice integration, complete the SARS task together.
On 10 May Beijing opened 5 hospitals encouraging TCM at the front line. On 17 May this rose to 13, and SARS-designated hospitals were paired with TCM hospitals; opinions on TCM participation in SARS work were issued to the relevant institutions. By the Beijing SARS Command's TCM Group, by 28 May over 50% of Beijing SARS patients had received TCM care.
But many senior TCMs regret: too late! If we could have entered a month earlier, how many lives might we have saved! National-level senior TCM, Beijing Hongshizihui Chaoyang Hospital (Capital Medical University) Professor Fang Heqian: "In April I asked Chaoyang's TCM-section director and the hospital party committee to send me — they only said I look spirited, then nothing followed." Liang Yijun: a doctor is to save life; not to enter at the time of urgency is a lifelong regret. Chen Wenbo, dissatisfied: "Guangdong has only about a dozen national-level senior TCMs; Beijing has many specialists, no weaker than Guangzhou — but we always feel a little …"
Patients generally welcomed TCM. Li said: patients love drinking Chinese medicines; if they can eat normally, they rarely refuse. One, they feel another method to beat the disease has been added; two, the result is good. At You'an, after improving on Chinese medicines, patients often asked the TCM to also prescribe for their friends and family.
Project member Lin Zhongpeng said bluntly: although integration in Guangdong had clear results and was affirmed by WHO experts, in the SARS work's overall deployment it still has not received sufficient weight; there is still serious human limitation and exclusion of TCM — not a wise move.
**IV. "Even 100 — or 1,000 — years later, with biàn zhèng lùn zhì, it can all be cured"**
In early April a reporter friend told me anxiously: "I'm scared — scared of catching SARS. If I do, what do I do?" The reporter comforted him: "Don't worry — if you catch it, tell me right away; I will find you a TCM specialist; you will surely be cured." He cried: "Then give me the formula now — at the first sign I'll take it!"
What seems an ordinary remark betrays most people's misunderstanding of TCM. Most are used to the Western thinking that with a disease-name there must be a drug — not knowing TCM thinks more, finer, more roundly.
Liang Yijun told her experience: in 1954 a Japanese-encephalitis-B outbreak in Shijiazhuang — chiefly treated with cool-acrid drugs, like large doses of raw gypsum, 250 g or even 500 g — results good. Next year Beijing had encephalitis-B; using Shijiazhuang's method did not work. The famed Pu Fuzhou was invited. Pu said: "You cannot fail to notice that this year damp-evil is heavy; using such great cold drugs — how can it work?" Switching to aromatic damp-resolving formulas, the patients all recovered.
This is TCM's biàn zhèng lùn zhì. In plain words: by season, climate, geography, environment, and individual constitution, all considered, treat with targeted regulation, so the body's inner environment no longer fits the outer evil. Deng Tietao's words: "Make the virus unable to live in the body; chase it out; the disease is cured." For killing the virus is not TCM's aim; chasing it out is.
So even treating an ordinary cold, at least divide into wind-cold and wind-heat. To treat complex SARS, none the less without pattern-discernment. Chen Wenbo told the reporter: one SARS patient, at a Western hospital, given Yuxingcao injection, only worsened — exactly the result of using TCM blindly without pattern-discernment.
Deng said: of course SARS treatment uses drugs, but a formula that works once is not a universal "good formula" for everyone — still by biàn zhèng lùn zhì. The frame: by this year's five-movements-six-qi, the epidemic has damp and cold; thus excessively cold drugs cannot be used. Then by the patient's specific condition. As in Hong Kong's ICU some patients had edema; Deng had them given fuzi, rougui, normally seen as hot drugs — the edema receded.
Li also said: the deepest lesson of this SARS war is the importance of biàn zhèng lùn zhì; not every fever calls for simple heat-clearing toxin-resolving — that surely fails. They found Beijing's SARS patients had a feature in the early phase: lowered immune function — TCM's qi-and-yin both deficient; so they added qi-boosting yin-nourishing drugs early. Deng stressed: TCM has, over millennia, found methods in fighting contagion — all proven useful. Chen: viruses always mutate, but TCM is not afraid; even 100 — or 1,000 — years later, with biàn zhèng lùn zhì, it can all be cured.
V. "Without treating acute, grave cases, how can you become a famous doctor? Famous doctors are forged in the fight"
The common impression: TCM is for chronic disease — for some odd complaint that does not yet threaten life, you may try TCM; for acute illness, find Western. The classic example: on 21 April Health Weekly page 1 carried Song Zuomin's interview Facing SARS, TCM Specialists Cannot Sit Still; some scoffed at it as one school's view. Through April, Beijing's senior TCMs had no gate to serve the country; from top to bottom, no one seemed to believe TCM could treat SARS.
But all TCM specialists interviewed said: acute disease is TCM's strong suit.
Deng told the reporter: though Chinese and Western drugs are both used now, in fact TCM alone can do it — with accurate pattern-discernment, two or three days will bring the fever down. Hemorrhagic fever — fiercer than SARS — TCM treats better than Western. The state's Seventh Five-Year Plan project on hemorrhagic fever — Nanjing Zhou Zhongying's group treated 1,127 cases, 812 by TCM, 314 by Western; TCM mortality 1.11%, Western 5.08%. Many patients saved by TCM.
Chen also: in the 1950s encephalitis-B and measles had far higher mortality than SARS; in the end Chinese medicines brought them down. In 1998–99 flu in Beijing, everyone went for Chinese medicines — because the fact was plain: Western drugs did not bring fever down; a few decoctions did. History shows TCM has always had fine methods for major pestilences.
Open the TCM canon — Shanghan Lun, Wenbing Tiaobian, Discourse on Pestilence — they record the experience of treating acute disease. When did TCM become chronic-disease medicine?
Deng holds it is the result of the state weighting Western and slighting TCM. He notes: hospitals built in the 1950s–70s were mostly Western; severe patients went to Western — so the impression formed that no Western means, no rescue. Deng: "Famous doctors are forged in the fight, not by giving may-be-or-not drugs!"
Deng gave examples of his own acute-case treatment:
"I often took part in rescues for myocardial infarction. Liao Chengzhi — I joined in his rescue. The first time, in Beijing, he was a month-plus recovering. When he relapsed in Guangzhou, I consulted; we added Chinese medicines; in over two weeks he recovered."
"This past month I rescued two severe-myasthenia-gravis patients in respiratory crisis. Many SARS patients die of respiratory crisis. One was treated at a famous Western hospital in Hunan; over 20,000 RMB spent, tracheostomized, on ventilator, not improving; the doctors advised the family to come to Guangzhou. I have now pulled him through; in two more weeks he can leave. Another was pulled through in just over a week; out in three weeks."
National-level senior TCM, Beijing TCM Hospital Professor Song Zuomin: he treated a SARS patient when the disease was not yet known. Patient: a week of high fever, dyspnea, X-ray showing tree-branch-like (now called net-like) shadows. Three days of decoctions broke the fever; one week, full recovery. After cure, X-rays and other tests confirmed SARS.
Deng said with pain: in our country weighting Western and slighting TCM is severe. Western with a small win is broadcast; TCM's success is met with "don't know if reliable", and even verified is then denied by every means. Deng holds: after this SARS, opinion on TCM should change. Western medicine in Hong Kong, so strong, so stubbornly excluding TCM, still invited two of our mid-career TCMs over as expert helpers — this shows we have something; we have level. TCM becoming chronic-disease medicine is not TCM's fault; the fault lies with certain administrators.
Liang Yijun stressed: our country has 1.3 billion; the nation's flourishing and society's progress — without our national medicine's safeguard, unimaginable. Western has its strengths, but Western has only been in our country 200 years; the people's health, over millennia — what kept it up? It was TCM.
"I have always held my head high in clinic — because what they cannot cure, I can"
The reporter asked Deng: with TCM's results in this SARS fight, do you feel proud? The 87-year-old Deng said proudly: "I have always held my head high in clinic — because what they cannot cure, I can!"
Things like this happen daily in Western hospitals: we have no good way — go try TCM; the same Western doctor in another setting may say flatly TCM doesn't work. For this many TCM specialists have indignantly told the reporter: "They always have us play dead-horse-as-live-horse; if we cannot save, they say we cannot."
The reporter has no wish to stir TCM-vs-Western strife. The two are different models, with different theoretical systems; their final aim is to defeat disease. Li to the reporter: "Whether they let me use Chinese medicines alone or not, so long as TCM was used and the patient's problem solved, I have reached the aim." When Western had not found the pathogen, when no special drug was at hand, the modern aircraft and cannon could not act; we should not, because TCM uses the roots and leaves left by our ancestors, say TCM does not work. That China has another method, another guarantee of health — why not?
Whether TCM works or not, SARS has proved it; TCM has grasped this chance. As Song Zuomin said: TCM treating SARS benefits not only China's patients — it may be a chance for TCM to walk to the world.
Originally in China Medical News, 2 June 2003. Health Weekly, page 2 · Special Focus.