Chinese medicine treatment for COVID-19, how to use Chai Hu class formula

The current situation of COVID-19 epidemic in the world remains critical, with the number of confirmed cases and deaths still increasing. The emergence of the new Omicron strain has added another change to the global anti-epidemic situation. As we all know, Chinese medicine has made a great contribution in the prevention and treatment of COVID-19. In today’s article, Huang Shipei, a nationally renowned TCM practitioner, will further explore the advantages and characteristics of Sutra in the prevention and treatment of the epidemic for us, and talk about his thoughts and suggestions around the treatment of COVID-19 with Chai Hu formula.

According to reports, since COVID-19 has been rampant, the majority of TCM practitioners have actively participated in the prevention and treatment of this disease, and have increasingly shown the role of TCM. In fact, Zhang Zhongjing’s “Treatise on Typhoid and Miscellaneous Diseases” of Han Dynasty is a history of Chinese medicine against epidemics, which has been playing an important role for two thousand years, and today Chinese medicine can still play its role and must still play its role in the fight against epidemics.

This disease starts with fever and chills, bitter mouth, dry throat, tiredness, chest tightness, vomiting, loss of appetite, and white coating on the tongue, many of which are similar to the evidence of Xiao Chai Hu Tang (as I have not personally seen the patient, I can only say this. (Same below). As far as I know, there are also many first-line TCM practitioners and some agreed prescriptions using this formula. The following is a brief description of my personal experience with Chai Hu and Xiao Chai Hu Tang.

01

The dosage of Chai Hu. Most of this disease is mainly fever, the initial body temperature is not very high, and then the temperature rises quickly, some patients reach 39-40 ℃. Especially in the afternoon and evening, the next day slightly recede. That is to say, within a day or two days there are two “temperature peaks”, the so-called “bimodal fever”, the vicious cold has not stopped, this is the “exchange of cold and fever”. Don’t think that “cold and fever” means that you don’t have fever when you have a fever or fever when you have a cold. This is the indication for the use of Xiao Chai Hu Tang.

Chai Hu is a very good antipyretic. The mechanism of reducing fever may not be the same as that of other antipyretics. The normal dosage of Chai Hu (except Chai Hu Gui Zhi Tang and Chai Hu plus Mannite Tang) is the heaviest compared to other main medicines used in relieving fever, such as Gui Zhi and Ma Huang, in the Typhoid. The dosage is half a catty (eight taels), while the main herbs of Gui Zhi Tang and Ma Huang Tang, Gui Zhi and Ma Huang, are only three taels. Da Qing Long Tang Ephedra is only six taels. Therefore, the amount of Chai Hu used to reduce fever must be sufficient. My common amount for treating fever is 45 to 60 grams.

When I was young, I was caught by Ye’s words and was reprimanded by my master for not daring to use Chai Hu heavily, which I often kept in mind. I agree with Prof. Ke Xuefan’s testimony on the conversion of Chinese medicine dosage.

02

The formulae of the Chai Hu class, including Chai Hu Gui Zhi Tang, Da Chai Hu Tang, Chai Hu Gui Zhi Gan Jiang Tang, Chai Hu plus Mang Nian Tang, Chai Hu plus Long Bone Oyster Tang, and Chai Hu Goes to Half-xia plus Jun Jia Lou Tang, are all additions and subtractions of Xiao Chai Hu Tang. It is used in clinical practice with the evidence.

03

From the clinical data of COVID-19, many people have suggested that this disease is dampness and warmth, or obscene heat and poisonous evil ambushing the original category, and the use of San Ren Tang, Huo Pu Xia Ling Tang, Da Yuan Drink, Gan Lu Disinfectant Dan, etc. is not uncommon. However, the clinical practice should be carefully identified in order to receive the desired effect. For example, is the fever not rising? Is the moss like powder? Is the weakness due to lack of qi or dampness in the middle jiao?

04

Some people call Xiao Chai Hu Tang “Three Forbidden Soups”, that is, Shao Yang forbids sweating, vomiting, and downward movement, but I think we should not confine ourselves to this. I think we should not confine ourselves to this statement. It is only when we see the evidence that we should take the medicine, but don’t we have the evidence of Chai Hu plus Mannitang and Da Chai Hu Tang? How can we forbid the downward movement? The evidence of Xiao Chai Hu Tang can be solved by “the body is conditioned with heat and sweat”, and “if you repeat with Chai Hu Tang, it will be steamed and invigorated, but the fever and sweat will be solved”? Chai Hu itself is a very good sweating medicine. As for the desire to sweat with Chai Hu, I am used to combining it with the method of resting in Gui Zhi Tang, which always has the expected effect.

05

For those who have cold and fever, or whose lips and tongue are red, with thick yellow moss, irregular bowel movements and red urine, I can use Artemisia Scutellaria Clear Gall Bladder Soup, which is also a Shaoyang method. But I prefer to use my teacher’s famous formula, “Scutellaria Baicalensis and Comfrey Soup” by Mr. Chen Qunyi, a famous veteran herbalist in Guangzhou in the 1960s. This formula is actually a variation of Artemisia Scutellaria Clear Gallbladder Soup, and in the 1970s Chen had an article on its clinical application published in the New Chinese Medicine magazine. There is a story about this formula; in 1958, when there was a pandemic of influenza in Guangzhou, Chen visited another old Chinese doctor, Liu Zhiyong (also from a famous family, whose grandfather, Liu Jingsiang, cured Cen Chunxuan, the governor of the two provinces, of his spotting disease. It is estimated that also the epidemic, was elected to the Beijing for the Qing dynasty chamber of eunuchs. (There are books and medical case collections, father Liu Fuqian is also a famous doctor in the Republic of Guangzhou). It happened that Liu took a nap, so Chen reviewed his medical records on the consultation table, and saw that many patients with influenza used this formula, and patients reported satisfactory results, so he copied this formula. Later, when Liu returned, he asked for advice and was told that this formula was contained in his grandfather’s book “Qua Ying’s Medical Cases”. Since then, Chen Qunyi has used this formula to treat fever and has been effective repeatedly. Chen introduced this formula when he taught internal medicine in the early 60s. I kept it in mind and later added and subtracted it slightly, and it has been used for decades for influenza with outstanding results. I believe that once there is a bad cold, the symptoms need to be relieved. In 1983, I wrote an article about this formula: From July to September 1979, the Department of Traditional Chinese Medicine of our hospital observed 100 cases of outpatients with fever (above 38℃). The fever resolved within one day and did not return in 49 cases, the fever resolved in 44 cases with two doses, and 7 cases were ineffective (those who failed to resolve the fever with two doses).

The composition of this formula is as follows: Artemisia annua 15g (later), Elsholtzholtzholtzholtzholtz 15g, Scutellaria baicalensis 15g, Radix rehmanniae 20g, Baitou wong 30g (Guangdong used to call Baitou wong “northern purple grass”), Wild chrysanthemum 20g, gypsum 30g, licorice 10g. Take four bowls of water, decoct into half a bowl and take warm. Sip a bowl of hot porridge and cover with warmth to obtain sweat. Decoct the dregs of the medicine again after three hours. The dosing method is still similar to that of Gui Zhi Tang.

06

According to the observation of Director Zeng Xiangyu in Wuhan, at the early stage of the disease, dry mouth, bitterness or sore throat, fever, poor nausea and cough are common. Xiao Chai Hu Tang is the main formula at the early stage of the disease, and the initial heat symptoms are often heavy, but few patients I have seen have accumulated heat in the stomach and intestines.

The disease passes quickly, and Scutellaria Baicalensis and Zi Cao Tang or Xiao Chai Hu Tang have about 1 to 2 days of use. If the situation can be reversed and the evil goes away and the righteousness is at peace then the disease can be turned around. Due to the incandescence of evil in this time, some patients will have evil entering from the surface into the interior, manifesting as evil not retreating after sweating and trapped in yin evidence, mostly manifesting as sweating, weakness, fear of cold or diarrhea and vomiting, treatment should first save the interior, at this time it is necessary to use epiphytic agent.

After the impact of large doses of hormones and antibiotics, the tongue must appear greasy moss, fat tongue and other signs of cold and dampness, often without heat signs such as bitter mouth and dry mouth. The stable stage is mostly manifested as cough, dry cough without sputum. Treatment should be from Taiyin to warm the cold drinks, the genus of San Ren Tang is afraid that the power is not helpful. Ling Gan Wu Wei Jiang Xin Xia Xing Tang and She Gan Ma Huang Tang can be chosen.