Notes and Reflections from the Clinical Front of TCM SARS Treatment
Editor's note
Since SARS broke out in Beijing, Dr. Wang Xinyuan has been on the front line for a month and a half. The ward in his charge — where TCM is consistently used, with treatment matched to person, time, and pattern — has had zero deaths, and patients fare better than the controls. He has also kept his own health with TCM-based preventive measures. His experience is precious; his reflections are deep. Concise and to the point, the essay deserves careful reading.
Notes and Reflections from the Clinical Front of TCM SARS Treatment
Wang Xinyuan
I.
In April 2003 I had the opportunity to treat SARS patients directly with TCM in the isolation ward, with some results, many reflections.
SARS and atypical pneumonia are Western names; in TCM, this is pestilence pattern (yi zheng).
A pestilence pattern is brought on by a foul qi between Heaven and Earth, the joint working of many factors of nature and the human. TCM holds Heaven-and-the-human-as-one, Heaven-and-the-human-same-build — can grasp the factors of pestilence's arising and, from there, its general law and the features of each outbreak. From clinical observation, re-reading the classics, applying five-movements and six-qi theory and noting climate and geography, the conclusion: this pestilence is damp-heat pestilence; readily induced by qi-stagnation; rapidly transforming; readily blocks the qi-mechanism; chiefly injures the lung.
Of the thirty-plus patients seen, damp-heat evil chiefly entered through mouth and nose, directly into the lung channel.
Lung-channel pent heat, damp blocking the qi-mechanism. If damp and heat have not combined — only heat-evil carrying damp injures — the picture is: fever with slight chill; light sweat; sore throat; dry or sticky mouth; dry cough or chest oppression; poor appetite; loose, unsettled stool. Tongue red, coating white-greasy; pulse floating with soggy quality. Cool-pungent surface-releasing, clear heat, transform damp. Use Yinqiao San with huoxiang, peilan, baimaogen and the like.
If damp and heat have combined: afternoon fever, slight chill; head and body heavy and aching; sticky mouth, no thirst; dry cough, chest oppression; poor appetite; loose stool. Tongue red, coating white, thick and greasy; pulse string-thin-soggy, or sinking-thin. Heat is yang-evil; damp is yin-evil; the two — like oil mixed in flour — are hard to separate. The Wenbing Tiaobian notes for this pattern three taboos: sweating, purging, moistening. Treat by open the upper, free the middle, drain the lower. Sanren Tang with modifications.
These are the milder patterns; with correct herbs, they recover and do not progress.
Damp-heat lingering in the qi-aspect: unrelenting high fever, worse in the afternoon, body heavy; tongue red, coating yellow-greasy; pulse mostly sinking-thin-rapid. Ganlu Xiaodu Dan with modifications works well.
The severe cases are mostly damp-heat-phlegm blocking the lung; lung-qi pent and shut, losing diffusion and descent. Picture: chest oppression and pain; severe shortness of breath; dry cough with hard-to-expectorate phlegm; spirit-fatigue and lassitude; tongue red, coating yellow-thick-greasy; pulse mostly sinking-thin-rapid. Untreated, prognosis is very poor; most deaths come from this. The Wenbing Tiaobian — Upper Jiao says: "For taiyin-damp-warmth panting, master with Qianjin Weijing Tang plus apricot kernel and talc." Formula: lugen 15 g, yiyiren 15 g, taoren 6 g, donggua zi 6 g, xingren 9 g, huashi 9 g; may add huoxiang-peilan, yujin. With it, danger commonly turns to safety.
The above are common patterns in the natural progression. In practice, by patient constitution and prior treatment, many variant patterns appear. Then "look at the pulse and signs, know what error has been committed, treat by the pattern."
E.g., Li, male, 40. After onset, fever was slight; poor appetite, nausea, stomach pain, loose stool — body usually weak in spleen-stomach; the pestilent evil turned cold and lodged in the middle jiao. Huoxiang Zhengqi San with modifications, cured.
Fu, female, 40. Cold drugs overused; diarrhea seven or eight times daily; shortness of breath, rapid pulse. The Shanghan Lun: "In Taiyang Guizhi pattern, the doctor wrongly purges; if pulse is rapid, the surface is unresolved; if there is panting with sweat, master with Gegen Huangqin Huanglian Tang." By this, she improved.
Some patients had blood-streaked sputum or nasal discharge. By tongue, pulse, and signs the evil had not truly reached the ying-xue aspect; remove warming-and-acrid blood-stirring items from the prior formula, add cool-blood items, and that suffices.
Points to note:
- Do not abuse tonics. Damp-excess often resembles vacuity, but this disease is externally caused, mostly excess; tonifying recklessly shuts the door and keeps the bandit, helps the evil. Even when right qi is too weak to fight, only modest non-evil-binding right-supporting agents may be used. Sweet-warm stagnating, sour-astringent gathering — absolutely off-limits. As recovery progresses and the lingering evil clears, then one may tonify freely.
- Do not lightly use heavy doses of cold-cool herbs. Damp is yin-evil, easily causing qi-mechanism block; over-cold-cool causes more block (cold gathers and stalls), the evil cannot exit, and may be forced inward. The Wenre Lun: "In the wei-aspect, sweat it." Especially at onset, watch for this.
- "In treating the upper jiao, use the light — heavy will not lift it." The disease is mostly in the upper jiao; herbs and dose must be light; do not over-shoot.
- In the active stage, the evil readily stirs blood; use blood-quickening herbs cautiously.
II.
SARS struck suddenly; views vary widely. On TCM and SARS, the questions concentrate on two: Can TCM treat SARS? and What kind of TCM doctor can treat SARS?
Pestilences in human history are not rare, harming nations and peoples greatly. In their prevention and treatment, TCM has made huge contributions to the Chinese people's flourishing. On forecasting, prevention, diagnosis, and treatment of pestilences, TCM theory is complete, methods rich, efficacy recognized worldwide. Across history great names abound: in Han, the medical sage Zhang Zhongjing; in Ming, Wu Youke; in Qing, Yu Shiyu and Wang Mengying; in modern times, Kong Bohua and Pu Fuzhou — all turned tides, saved many lives, left lasting benefit. Without exception they diligently sought the ancient teachings, widely gathered the formulas; strictly followed TCM tradition while adapting to time, place, and person — only so did they reach magical effect. In this SARS work too: Guangdong's TCM hospital, treating by spring-warm theory, has had striking results. Beijing clinical practice and my own shallow notes likewise confirm: follow TCM tradition and there is result; defy TCM's basic principles, strike "new" notes, depart the canon — punishment follows. From both sides this proves: TCM theory reflects objective fact, is truth, is science — and must be observed.
If pure TCM can treat SARS beyond doubt, why is the picture not yet satisfying? The human can broaden the Way; the Way does not broaden the human. No matter how fine the medicine, only through the doctor is it applied. TCM's succession is thin is no secret; the issue is mainly not numbers but inner quality. How many young and middle-aged TCM practitioners can in fact learn and follow TCM tradition and apply it in practice to save lives? In the clinic one sees a strange thing: certain TCM doctors prescribe Chinese herbs by Western-medical theory. Integration is a beautiful wish, still being explored; at present, parallel-and-cooperative use is workable. But we must see: Western medicine is a branch of modern Western science; TCM is inseparable from Chinese tradition. Both are scientific, but the cultural gap is vast; organic integration is very hard, and simple piling-up loses both. E.g., SARS being viral and capable of suppressing immunity — heavy use of heat-clearing, evil-resolving herbs for "antiviral" effect, plus sweet-warm or sour-astringent tonics to "boost immunity," seems reasonable. In fact, Chinese-herb pharmacology is complex; Western pharmacology cannot yet fully explain it; so this does not support such use. From the TCM angle, it offends both taboos of damp-heat-pestilence treatment as above — and worse, it violates basic formula-construction rules. Pseudo-science; the result is foreseeable.
Mercifully, the TCM world is not without insight. Doctors fearless before SARS, faithful to TCM tradition, are quietly saving patients. They are TCM's hope.
In the face of this national trouble, we must call out: in treating SARS, draw out TCM's role; follow TCM tradition. Engage talent without prejudice; invite from across the country the clear-seeing masters who truly know TCM's pestilence theory, to fully guide clinical care — the miraculous effect that ought to appear will appear, to benefit the world.
This SARS episode exposes a chain of long-standing problems in medicine, deserving reflection. In the long view, while we push Western and integrated medicine, should we not leave room for pure TCM to develop freely? — this concerns education, research, clinic, in every part. The burden is heavy. But it touches the well-being of countless people. To mend the fold after a sheep is lost is not too late.