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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 10

Successful intervention with traditional Chinese medicine for severe Coronavirus Disease 2019: A case report


1 Department of Nursing, Longhua Hospital, Shanghai, China
2 Department of Emergency, Longhua Hospital, Shanghai, China
3 Department of Emergency, Longhua Hospital; Institute of Emergency and Critical Care Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Date of Submission21-Mar-2022
Date of Decision23-Apr-2022
Date of Acceptance01-Jun-2022
Date of Web Publication19-Aug-2022

Correspondence Address:
Prof. Bangjiang Fang
Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2773-0387.348715

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  Abstract 


Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, is a major public health threat worldwide. However, there are no clinically approved antiviral drugs for COVID-19. Traditional Chinese medicine (TCM) is an important part of complementary and alternative medicine. Based on the TCM principles of pathogenesis, our team proposed “San Tong strategies” (san tong liao fa) and the “Truncation and Reversion strategy” (jie duanniu zhuan ce lve) and developed a Chinese herbal medicine formula to dispel external pathogens, clear heat, drain fire, and detoxify. A 50-year-old man with severe COVID-19 was admitted and received our oral Chinese herbal formula, acupoint plaster application, and moxibustion for 14 days. The computed tomography manifestations of COVID-19 showed marked improvements, and the patient achieved complete remission of fever, cough, fatigue, dizziness, nasal congestion, and rhinorrhea. This case provides a specific TCM treatment plan and effective reference for the treatment of COVID-19.

Keywords: Traditional Chinese medicine; acupoint application; moxibustion; coronavirus disease 2019


How to cite this article:
Lu W, Zhang W, Xu X, Guo Q, Fang B. Successful intervention with traditional Chinese medicine for severe Coronavirus Disease 2019: A case report. Integr Med Nephrol Androl 2022;9:10

How to cite this URL:
Lu W, Zhang W, Xu X, Guo Q, Fang B. Successful intervention with traditional Chinese medicine for severe Coronavirus Disease 2019: A case report. Integr Med Nephrol Androl [serial online] 2022 [cited 2022 Sep 27];9:10. Available from: https://journal-imna.com//text.asp?2022/9/1/10/348715




  Background Top


The outbreak of coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus-2 has overwhelmed most countries. The incidence and mortality rates of COVID-19 are rising alarmingly, and on 22nd April 2022 there were more than 505817953 confirmed cases and 6213876 deaths worldwide.[1] The common symptoms of COVID-19 include fever, fatigue, cough, expectoration, anorexia, et al.[2]

There is currently no specific medication available to prevent COVID-19, and the effectiveness of antiviral medications is controversial. Traditional Chinese medicine (TCM) is widely used as an adjuvant therapy in the management of infectious diseases. This report aimed to evaluate the effectiveness of TCM in treating a patient with severe COVID-19.


  Case Report Top


A 50-year-old man developed a fever, followed by coughing, fatigue, dizziness, nasal congestion, and rhinorrhea for 7 days. Computed tomography (CT) performed in the outpatient department of another hospital showed obvious lesions in the bilateral lower lung fields. Nucleic acid testing was positive for COVID-19 on 22nd February 2020. The patient was diagnosed with severe COVID-19 and admitted to Wuhan Lei Shen Shan Hospital on 22nd February 2020.

On admission, he had a cough, fatigue, nasal congestion, dyspnea, and rhinorrhea. Physical examination revealed tachypnea (20 breaths/min), fever (39.1°C), and tachycardia (128 beats/min). The accessory examination findings are shown in [Table 1]. Chest CT performed on 24th February 2020 showed multiple patchy and ground-glass opacity shadows in both lungs [Figure 1]A.
Table 1: Clinical laboratory results before and after treatment.

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Figure 1: Computed tomography findings. A: Image obtained on 24th February 2020 before the initiation of TCM treatment for COVID-19. B: Image obtained on 4th March 2020 after 14 days of TCM treatment for COVID-19. TCM, traditional Chinese medicine; COVID-19, coronavirus disease 2019.

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treatment and clinical outcomes

The TCM diagnosis was “exterior evil inward invasion” and dampness-warm toxin constraint in the lung pattern . A Chinese herbal medicine (CHM) decoction was prescribed [Table 2]. The herbs were bathed in 400 mL of cold water, and then boiled and concentrated to approximately 200 mL. The decoction was taken orally twice daily. The patient also received acupoint herbal plaster treatment. The herbal paste comprised Psoralea corylifolia Linn. (Bu gu zhi) (10 g), Taxillus sutchuenensis (Lecomte) Danser (Sang ji sheng) (15 g), and Epimedium brevicornu Maxim. (Yin yang huo) (15 g) ground into powder and mixed with ginger juice. A sterile gauze was used to apply the paste to the acupoints Feishu (BL 13) and Zusanli (ST 36). The paste was retained on the acupoints for 45 minutes per day for 2 weeks. Moxibustion was administered at Geshu (BL 17) for 15 minutes once daily for 2 weeks. The patient also received nasal oxygen to improve pulmonary oxygenation, moxifloxacin hydrochloride in sodium chloride (0.4 g/day intravenously) to prevent infection, doxofylline (0.1 mg/ day intravenously) to attenuate asthma, and reduced glutathione (2.4 g/day intravenously) to protect against liver injury.
Table 2: Ingredients of the Chinese herbal medicine formula

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After 5 days of treatment, the cough and fever were markedly reduced, and the sputum volume had clearly decreased. The laboratory examination findings are shown in [Table 1].

After 14 days of treatment, the symptoms of COVID-19 had markedly improved. The patient had a mild cough with white phlegm, but no fever, dyspnea, or fatigue. The body temperature changes are shown in [Figure 2]. Chest CT performed on 4th March 2020 showed that the pulmonary lesions had markedly improved [Figure 1]B. On 7th March 2020, the abnormal indexes had improved, the patient was discharged on 8th March 2020 [Table 1].
Figure 2: Graph showing the patient's body temperature fluctuations and peak during hospitalization. TCM therapy was initiated on the first day of hospitalization. TCM, traditional Chinese medicine.

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The patient was followed up by phone in April and May 2020. He was free of fever, productive cough, dyspnea, and sputum, and was able to work and exercise. There was no fever recurrence at final follow-up in May 2020.


  Discussion Top


We report a patient with severe COVID-19 who experienced rapid and substantial improvements in his symptoms and imaging findings following adjuvant TCM treatment. In TCM theory, COVID-19 belongs to the category of “pestilence”. COVID-19 is caused by a dampness-warm toxin that is likely to trap Qi, causing symptoms such as fever, cough, fatigue, dizziness, nasal congestion, and rhinorrhea.[3] Based on the TCM principles of pathogenesis, our team proposed “San Tong strategies”[4]? to relieve the exterior syndrome, diarrhea, and diuresis, and the “Truncation and Reversion strategy” (jie duan niu zhuan ce lve)[5] to clear the large intestine to rapidly treat the disease. We prescribed a CHM formula, an optimized combination of Maxing Shigan decoction and our hospital’s experiential prescription Jinhong decoction for the pestilence. Maxing Shigan decoction ventilates the lungs, clears heat, and alleviates asthma, while Jinhong decoction dispels external pathogens, clears heat, drains fire, and detoxifies. The components of our CHM formula are listed in [Table 2].

Jinhong decoction inhibits the concentrations of some inflammatory cytokines,[6] and protects against excessive infiammatory responses.[7] Maxing Shigan decoction is a classic TCM formula with antipyretic, anti-inflammatory, antiviral and antitussive that has been used to treat COVID-19.[8] We chose Ephedra equisetina Bge. (Ma Huang), gypsum fibrosum (Shi Gao), talcum powder (Huashi), and Rheum palmatum L. stem (Dahuang) as the major components of our CHM because of their effects in discharging heat and detoxifying. We added Verbena officinalis L. (Ma bian cao) and Beauveria bassiana (Bals.) Vuill. (Jiang can) to increase the effects of clearing heat and resolving toxicity. Scutellaria baicalensis (Huang qin), Atractylodes lancea (Thunb.) DC. (Cang zhu), and Eupatorium fortunei Turcz. (Pei Lan) act to clear heat, dry dampness, and eliminate exopathogens. Belamcanda chinensis (L.) Redouté (She gan), and Aster tataricus L. f. (Zi wan) strongly reduce phlegm and clear the lungs.[9]

Severe COVID-19 often leads to Qi deficiency, which hinders recovery, as Yang Qi is considered the root of life. Non-pharmacological interventions stimulate the acupoints on the body surface, thereby dredging the meridians and regulating the balance of Yin and Yang to relieve disease. Previous studies have revealed that electroacupuncture at Zusanli (ST 36) can reduce the lung inflammatory response and improve lung function in chronic obstructive pulmonary disease.[6],[8] The application of Chinese herbs at Feishu (BL 13) and Geshu (BL 17) reportedly achieve greater absorption into the blood circulation and distribution in target tissue compared with application at other acupoints.[8],[10]


  Conclusion Top


We report a case in which severe COVID-19 was successfully managed using TCM with antipyretic, anti-inflammatory, antitussive, purgation, and diuretic effects. Further investigations are warranted to verify the effectiveness and mechanism of TCM treatments for COVID-19.

Conflicts of interest

There are no conflicts of interest.

Authors contribution

Lu W drafted the manuscript and searched the literature. Zhang W and Xu X contributed to manuscript revision. Guo Q treated and followed up the patients. Fang B contributed to writing the manuscript and searching the literature, treating and evaluating the patients. All authors read and approved the final manuscript for publication.

Financial support and sponsorship

This work was supported by the Emergency Committee of the World Federation of Chinese Medicine Societies and Shanghai Society of Traditional Chinese Medicine, Novel Coronavirus Pneumonia Emergency Tackling Key Project (SJZLJZ.N01) and the National Key Research and Development Program of China (2018YFC1705900).

Ethics approval and consent to participate

This trial complies with the principles of Declaration of Helsinki and the regulations of quality management of clinical trials in China. The study has been approved by the Medical Ethics Committee of Huangshi Hospital of Traditional Chinese Medicine (approval number HSZY- PJ-2020-001-01) and registered with the Chinese Clinical Trial Registry (ChiCTR2000029777). Signed informed consent forms will be obtained from all qualified participants before enrollment.



 
  References Top

1.
Meo SA, Meo AS, Al-Jassir FF, Klonoff DC. Omicron SARS- CoV-2 new variant: global prevalence and biological and clinical characteristics. Eur Rev Med Pharmacol Sci 2021;25:8012-8.  Back to cited text no. 1
    
2.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 2
    
3.
Xiao M, Tian J, Zhou Y, Xu X, Min X, Lv Y, et al. Efficacy of Huoxiang Zhengqi dropping pills and Lianhua Qingwen granules in treatment of COVID-19: A randomized controlled trial. Pharmacol Res 2020;161:105126.  Back to cited text no. 3
    
4.
Fang B, Qi W, Huang Y. Handbook of integrated traditional Chinese medicine and Western medicine in prevention and treatment of novel coronavirus (COVID-19). Beijing: People’s Medical Publishing House, 2020:25-27.  Back to cited text no. 4
    
5.
Zhang W, Fang BJ, Wang G, Chen ZY, Ye MQ, Deng D, et al. The basic theory and practical application of catharsis large intestine and truncating and reversing in the prevention and treatment of sepsis. Chin J Integr Tradit West Med 2020;40:102-5.  Back to cited text no. 5
    
6.
Zhu PT, Zhang JZ, Gao J, Zhang Xl, Wang ZG, Shen P, et al. Experimental study on “Jinhong Pill” in regulating cytokine and preventing intestinal mucosal barrier of acute biliary tract infection in rats. Shanghai J Tradit Chin Med 2001;2001:39-42.  Back to cited text no. 6
    
7.
Li J, Ye Z, Gu HG, Cai B. Effect of serum inflammatory factors on rats with sepsis by Jinhong decoction. Jilin Journal of Chin Med 2018;38:947-50.  Back to cited text no. 7
    
8.
Wang ZY, Sun YZ, Qu RD, Liu BY, Fan Z, Tian JZ, et al. Pharmacological study on mechanism of Maxing Shigan Decoction in treatment of coronavirus disease 2019 (COVID-19). Chin Tradit Herb Drugs 2020;8:1996-2003.  Back to cited text no. 8
    
9.
Chinese Pharmacopoeia Commission. Chinese Pharmacopoeia(2020 version). Beijing: China Press of Traditional Chinese Medicine, 2020:250, 334, 448, 478, 543.  Back to cited text no. 9
    
10.
Xu L, Xu H, Gao W, Wang W, Zhang H, Lu DP, Treating angina pectoris by acupuncture therapy. Acupunct Electrother Res 2013;38:17-35.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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