Using Chinese Herbal Products and Formulas in the Various Stages of Toxic‑Heat Invasion

by Jake Paul Fratkin, OMD

China has published guidelines for TCM treatment of the various stages of the current COVID-19 pandemic.

Guidance for Corona Virus Disease 2019: Prevention, Control, Diagnosis and Management

National Health Commission (NHC) of the PRC
National Administration of Traditional Chinese Medicine of the PRC
(WHO Collaborating Centre for Health Information and Publishing)

(People’s Medical Publishing House)

How COVID-19 (2019-nCoV) is Currently Treated in China with TCM
Translated and formatted by John Chen and Lori Hsu
Available from eLotus.org

8.4.1. Medial Observation Period (No lab confirmation of COVID-19)

Manifestation 1: Fatigue with GI upset

Px: Huo Xiang Zheng Qi Pian

Manifestation 2: Fatigue with fever

Px: Jinhua Qinggan Granules (unavailable)

Lianhua Qingwen Capsules (unavailable)

Shufeng Jiedu Capsules (unavailable)

My recommendation:

Gan Mao Ling

Zhong Gan Ling

Yin Qiao San

8.4.2. FOR CONFIRMED OR HIGHLY SUSPECTED CASES:
LUNG-CLEARING AND DETOXIFICATION SOUP

Use as foundation formula for all cases, mild to severe.
Adjust, reduce or modify according to case

Prescription:

Ephedra Ma Huang 9 (unavailable)

[Sub: Cinnamomum Gui Zhi ]

Glycyrrhiza Zhi Gan Cao 6

Armeniaca Xing Ren 9

Gypsum Shi Gao 15-30

Cinnamomum Gui Zhi 9

Alisma Ze Xie 9

Polyporous Zhu Ling 9

Atractylodes Bai Zhu 9

Poria Fu Ling 15

Bupleurum Chai Hu 16

Scutellaria Huang Qin 6

Pinellia Zhi Ban Xia 9

Zingiberis Sheng Jiang 9

Aster Zi Wan 9

Tussilago Kuan Dong Hua 9

Belamcanda She Gan 9

Asarum Xi Xin 6 (unavailable)

Dioscorea Shan Yao 12 g.

Aurantium Zhi Shi 6

Citrus Chen Pi 6

Agastache Huo Xiang 9

Recommended products:

Combine Xiao Chai Hu Tang with San Ren Tang

MILD OR EARLY STAGE

2-1. COLD-DAMPNESS STAGNATING THE LUNGS

SX: Fever, fatigue, cough with expectoration, chest tightness, nausea, sticky stool

Prescription:

Ephedra Ma Huang 6 (unavailable)

[sub: Cinnamomum Gui Zhi ]

Gypsum Shi Gao 15-30

Armeniaca Xing Ren 9

Notopterygium Qiang Huo 15

Lepidium Ting Li Zi 15

` Lumbricus Di Long 15

Cynanchum Bai Qian 15

Agastache Huo Xiang 15

Eupatorium Pei Lan 9

Atractylodes Cang Zhu 15

Poria Fu Ling 45

Atractylodes Bai Zhu 30

Hordeum (Charred) Mai Ya 9

Massa Medicata (Charred) Shen Qu 9

Crataegus (Charred) Shan Zha 9

Magnolia Hou Po 15

Areca (Charred) Da Fu Pi 9

Amomum Cao Guo 9

Zingiberis Sheng Jiang 15

Product: Combine Huo Xiang Zheng Qi Tang with Jing Fang Bai Du San

2-2. DAMP-HEAT ACCUMULATED LUNG

SX: Low or no fever, slight chills, body achy and heavy, dry cough, sore throat, dry mouth, chest tight, epigastric fullness, no sweating, nausea, stool loose or constipated

Prescription:

Areca Da Fu Pi 10 g.

Amomum Cao Guo 10

Magnolia Hou Po 10

Anemarrhena Zhi Mu 10

Scutellaria Huang Qin 10

Bupleurum Chai Hu 10

Paeonia Chi Shao 10

Forsythia Lian Qiao 15

Artemisia Qing Hao 10

Atractylodes Cang Zhu 10

Isatis Ban Lan Gen 10

Glycyrrhiza Gan Cao 5

Products: combine Xiao Chai Hu Tang with Gan Mao Ling or Zhong Gan Ling

GENERAL STAGE, MIDDLE STAGE

3-1. DAMP-TOXIN STAGNATING LUNG

Sx: Fever, cough with little phlegm, shortness of breath, abdominal distension.

T: dark red, yellow coat (dry or greasy)

P: Rapid and slippery

Prescription:

Ephedra Ma Huang 6 (unavailable)

[sub: Cinnamomum Gui Zhi ]

Armeniaca Xing Ren 15

Gypsum Shi Gao 30

Coix Yi Yi Ren 30

Atractylodes Cang Zhu 10

Agastache Huo Xiang 15

Artemisia Qing Hao 12

Polygonum Hu Zhang 20

Verbena Ma Bian Cao 30

Phragmites Lu Gen 30

Lepidium Ting Li Zi 15

Citrus Chen Pi 15

Glycyrrhiza Gan Cao 10

Products: Combine Qing Zao Jiu Fei Tang with Huo Xiang Zheng Qi Pian

3-2. COLD-DAMPNESS OBSTRUCTING THE LUNG

Sx: low fever or no fever, dry cough, no phlegm, fatigue, chest tightness, nausea, loose stool

T: pale or red, white fur; P: soft, floating

Prescription:

Atractylodes Cang Zhu 15 g

Citrus Chen Pi 10

Magnolia Hou Po 10

Agastache Huo Xiang 10

Amomum Cao Guo 6

Ephedra Ma Huang 6 (not available)

[Sub: Cinnamomum Gui Zhi ]

Notopterygium Qiang Huo 10

Zingiberis Sheng Jiang 10

Areca Da Fu Pi 10

Products: Combine Ban Xia Hou Po Tang with Ge Gen Tang or Gui Zhi Tang

SEVERE STAGE

4-1 LUNG BLOCKED BY EPIDEMIC TOXIN

Sx: high fever, flushing, harsh cough, small yellow sticky phlegm maybe with blood,

Wheezing or shortness of breath, dry mouth, nausea, poor stool movement, urine perhaps brown.

T: red with yellow coat, P: slippery, rapid

Prescription:

Ephedra Ma Huang 6 g (not available)

[sub: Cinnamomum Gui Zhi ]

Armeniaca Xing Ren 9

Gypsum Shi Gao 15

Glycyrrhiza Gan Cao 3

Agastache Huo Xiang 10

Magnolia Hou Po 10

Atractylodes Cang Zhu 15

Amomum Cao Guo 10

Pinellia Zhi Ban Xia 9

Poria Fu Ling 15

Rheum Da Huang 5

Astragalus Huang Qi 10

Lepidium Ting Li Zi 10

Paeonia Chi Shao 10

Products: combine Chai Ge Jie Ji Tang with Bai Hu Tang or Liang Ge San

4-2 FLARING HEAT IN THE QI AND YING

Sx: severe fever with thirst, dyspnea, delirium, blurred vision, rash, hematemesis or epistaxis, convulsion in limbs

T: dry, red; P: deep or large and rapid

Prescription:

Gypsum Shi Gao 30-60 g

Anemarrhena Zhi Mu 30

Rehmannia Sheng Di Huang 30-60

Cornus Bubali Shui Niu Jiao 30

Paeonia Chi Shao 30

Scrophularia Xuan Shen 30

Forsythia Lian Qiao 15

Moutan Mu Dan Pi 15

Coptis Huang Lian 6

Lophatherum Zhu Ye 12

Lepidium Ting Li Zi 15

Glycyrrhiza Gan Cao 6

Products: Combine Bai Hu Tang with Gan Mao Wan or Zhong Gan Ling

CRITICAL STAGE: INTERNAL BLOCK AND OUTWARD DESERTION

SX: lungs requiring ventilation, dizziness, irritability, cold sweaty limbs,

T: purple, thick or dry fur, P: large, floating

Prescription:

Ginseng Ren Shen 15 g

Aconite Fu Zi 10

Cornus Shan Zhu Yu 15

MY RECOMMENDATIONS FOR ACUTE STAGE

1) FOR ILLNESS WITH FEVER, the treatment principle is to clear toxic heat. Choose from:

* = most recommended

WU WEI XIAO DU YIN

Availability:

DANDELION & WILD CHRYSANTHEMUM COMBINATION (EG)

FIVE FLAVOR TEAPILLS (PF)

WU WEI XIAO DU YIN (BP, TL)

WU WEI XIAO DU YIN (EG)

* PATRINIA 7 (SF)

CHUAN XIN LIAN WAN *

Availability

ANDROGRAPHIS FORMULA (GF)

ANTIPHLOGISTIC FORMULA (K)

CHUAN XIN LIAN KANG YAN PIAN (BP)

CHUAN XIN LIAN PIAN (PF, PM)

CHUAN XIN LIAN WAN (HT)

ISATIS FORMULA (CC)

*antiVIRII (PX)

* ISATIS 6 (SF)

GAN MAO LING

Availability:

CHILDREN’S CLEAR AND RELEASE FORMULA (GF)

DR.SHEN’S GAN MAO LING (DS)

GAN MAO LING (K, PF)

GAN MAO LING FORMULA (GF)

GAN MAO LING JIE DU WAN (HT)

GANMAO TUIRE CHONGJI (PM)

GANMAOLING TABLETS (PM)

ZHONG GAN LING (zhòng gǎn ling 重感灵)

Availability:

COLD BURST (JD)

ZHONG GAN LING (HT, JD, K, PF, TL)

ZHONG GAN LING FORMULA (CC, GF)

ZHONG GAN LING WAN (HT)

ZHONG GAN QING PIAN/WAN (GC)

Important American-made products: (* = favorites)

ASTRA ISATIS (HC)

* BIDENS 6 (SF)

CHRYSANTHEMUM 9 (SF)

CHUAN XIN LIAN KANG YAN WAN (HT)

* CLEAR TOXIN (DrJake)

CLEAR HEAT (HC)

ENHANCE (HC)

FORSYTHIA 18 (SF)

* GZQ (DrJ)

* HERBAL ABX (EVG)

* ILEX 15 (SF)

ISATIS FORMULA (CC)

ISATIS GOLD (HC)

* PARIS 7 (SF)

* PATRINIA 7 (SF)

PURGE HEAT (CMS)

* VIOLA CLEAR FIRE FORMULA (GF)

2) LUNG FIRE, with harsh painful barking cough, difficulty breathing.

CHINESE-MADE FORMULAS:

QING ZAO JIU FEI TANG

Availability:

ERIOBOTRYA & OPHIOPOGON COMBINATION (EG)

QING ZAO JIU FEI WAN (HT, TL)

HUANG LIAN SHANG QING WAN *

Availability:

COPTIS, PHELLODENDRON & MINT FORMULA (EG)

HUANG LIEN SHANG CHING PIEN (PM)

HUANG LIEN SHANG QING PIAN (BE, PM)

QING FEI YI HUO PIAN *

Availability:

CHING FEI YI HUO TABLETS (PM)

QING FEI CLEARING FORMULA (K)

QING FEI YI HUO WAN (HT)

YANG YIN QING FEI WAN

YANG YIN QING FEI WAN (PM)

YANG YIN QING FEI TANG JIANG (PM)

AMERICAN-MADE PRODUCTS:

* BELAMCANDA 15 (SF)

* STEMONA TABLETS (SF)

* SVP LUNG (DrJ)

HERBAL COMPANY CODES

BP Blue Poppy

CC Chinese Classics

DrJ Doctor Jake Fratkin’s Formulas

EG “Standardized” extract granules or capsules from Taiwan and China (Acuherb, E-Fong, Evergreen, Guang Ci Tang, Herbal Times, KPC, Mintong, Nong’s, Plum Flower, Qualiherb, Sunten, etc)

EV Evergreen

GC Guang Ci Tang (Active Herb)

GF Golden Flower

HC Health Concerns

HS Honso (TCM Zone)

HT Herbal Times (Nuherbs)

JD Jade Dragon (Nuherbs)

K Kan Herbals and Traditionals

MS Minshan (China)

PF Plum Flower (Mayway)

PM Patent Medicine (various manufacturers, China)

PX Panexea

SF Seven Forest (Institute of Traditional Medicine)

TZ TCMZone (Honso)

TL Tanglong (China)

Many of these products can be found at:

Crane Herb Company: www.craneherb.com

Golden Needle: www.goldenneedleonline.com

eLotus has translated numerous articles from China for treating COVID-19

www.elotus.org/content/tcm-resources-covid-19

HOW COVID-19 (2019-NCOV) IS

CURRENTLY TREATED IN CHINA WITH TCM

Translated by John Chen and Lori Hsu

Prevention Phase

Influenza Phase

Pneumonia Phase

Recovery Phase

PREVENTION PHASE

Formula: Pneumonia Prevention #1

Huang Qi 黄芪 (Radix Astragali) 15 g

Bai Zhu 炒白术 (Rhizoma Atractylodis Macro), dry fried 10

Fang Feng 防风 (Radix Saposhnikoviae) 10

Guan Zhong 贯众 (Rhizoma Dryopteridis) 10

Jin Yin Hua 金银花 (Flos Lonicerae Japonicae) 10

Chen Pi 陈皮 (Pericarpium Citri Reticulatae) 6

Pei Lan 佩兰(Herba Eupatorii) 10

INFLUENZA PHASE

Diagnosis: Wind-Cold Invading the Exterior

Clinical Manifestations: Onset of fever (mostly low-grade fever), aversion to cold and fear of cold, chills, headache, ticklish throat, soreness of muscles of limbs, no sweat or night sweats.

Tongue is pale, coating is white and thin. Floating pulse

Treatment Strategy: Expel Wind, Release the Exterior; Clear Heat, Detoxify

Herbal Formula:
Ge Gen Tang (Kudzu Decoction) or Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Release the Muscle Layer)

FLU FORMULA #1

Ge Gen 葛根 (Radix Puerariae Lobatae) 15 g

Ma Huang 麻黄 (Herba Ephedrae) 10

Gui Zhi 桂枝 (Ramulus Cinnamomi) 6

Bai Shao 白芍 (Radix Paeoniae Alba) 15

Sheng Jiang 生姜 (Rhizoma Zingiberis Recens) 10

Gan Cao 生甘草 (Radix et Rhizoma Glycyrrhizae) 10

Da Zao 大枣 (Fructus Jujubae) 10

Jin Yin Hua 金银花 (Flos Lonicerae Japonicae) 20

with headache, add Bai Zhi 白芷(Radix Angelicae Dahuricae) 15g
with dry or ticklish throat, add She Gan射干 (Rhizoma Belamcandae) 15g

DIAGNOSIS: TOXIC HEAT ATTACKING THE LUNG

Clinical Manifestations: Fever, aversion to cold, sore and dry throat, dry cough, scanty sputum, sore and painful muscles in the limbs, weakness, headache

Treatment Strategy: Expel Wind, Release the Exterior; Clear Heat, Detoxify

Herbal Formula: Yin Qiao San and Qing Wen Bai Du San

FLU FORMULA #2

Jin Yin Hua 金银花 (Flos Lonicerae Japonicae) 10 g

Lian Qiao 连翘 (Fructus Forsythiae) 10

Jing Jie 荆芥 (Herba Schizonepetae) 10

Niu Bang Zi 牛蒡子 (Fructus Arctii) 10

Bo He 薄荷 (Herba Menthae) 10g

Gan Cao 生甘草 (Radix et Rhizoma Glycyrrhizae) 10

Dan Zhu Ye 淡竹叶 (Herba Lophatheri) 10

Lu Gen 芦根 (Rhizoma Phragmitis) 15

Huang Lian 黄连 (Rhizoma Coptidis) 6

DIAGNOSIS: DAMP COLD IN THE LUNG

Clinical Manifestations: Aversion to cold, fever or absence of fever, dry cough, dry throat, fatigue, weakness, chest stuffiness, epigastric distention, nausea, diarrhea. Pale tongue, white greasy coating, slippery pulse.

Treatment Strategy: Expel Wind, Release the Exterior; Dispel Damp Cold

Herbal Formula:

DAMP COLD FORMULA #1

Cang Zhu 蒼朮 (Rhizoma Atractylodis) 15 g

Chen Pi 陳皮 (Pericarpium Citri Reticulatae) 10

Hou Po 厚樸 (Cortex Magnoliae Officinalis) 10

Huo Xiang 藿香(Herba Pogostemonis seu Agastaches) 10

Cao Guo 草果 (Fructus Tsaoko) 6

Ma Huang 生麻黃 (Herba Ephedrae) 6

Qiang Huo 羌活 (Rhizoma et Radix Notopterygii) 10

Sheng Jiang 生薑 (Rhizoma Zingiberis Recens) 10

Bing Lang 檳榔 (Semen Arecae) 10

PNEUMONIA PHASE:

Diagnosis: Shaoyang Syndrome with Damp

Clinical Manifestations: Fever, which is more pronounced in the afternoon, alternating chills with fever, cough, absence of wheezing, bitter taste in the mouth, dry mouth, chest stuffiness, stifling sensation, chest and hypochondriac fullness and distention, irritability, nausea or vomiting, no appetite, weakness. Similar to the beginning stage of pneumonia.

Examination: CT scan reveals both lungs to have multiple scattered or large pieces of ground-glass opacity (GGO). Slightly red tongue, thick and greasy, white or yellow coating, slippery, rapid pulse.

Treatment Strategy: Harmonize Shaoyang Syndrome, Clear Damp-Heat

Herbal Formula:

Xiao Chai Hu Tang (Minor Bupleurum Decoction) with

San Ren Tang (Three-Nut Decoction)

or Gan Lu Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxins)

PNEUMONIA FORMULA #1

Chai Hu 柴胡 (Radix Bupleuri) 24 g

Huang Qin 黄芩 (Radix Scutellariae) 9

Sheng Jiang 生姜 (Rhizoma Zingiberis Recens) 10

Fa Ban Xia 法夏 (Rhizoma Pinelliae) 12

Ku Xing Ren 杏仁 (Semen Armeniacae Amarum) 15

Bai Dou Kou 白豆蔻 (Fructus Amomi Rotundus) 10

Yi Yi Ren 薏苡仁 (Semen Coicis) 30

Dan Zhu Ye 竹叶 (Herba Lophatheri) 15

Hua Shi 滑石 (Talcum) 15

Tu Fu Ling 土茯苓 (Rhizoma Smilacis Glabrae) 30

Gan Cao 生甘草 (Radix et Rhizoma Glycyrrhizae) 10

DIAGNOSIS: DAMP HEAT AFFLICTING THE LUNG

Clinical Manifestations: Low-grade fever or absence of fever, dry cough, scanty sputum, dry and sore throat, fatigue, weakness, poor appetite, chest stuffiness, epigastric distention, nausea or vomiting, loose stool.

Treatment Strategy: Transform Dampness, Detoxify; Disperse the Lungs and Expel Pathogens

Herbal Formula:

Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coicis, and Licorice Decoction)

Xiao Xian Xiong Tang (Minor Sinking into the Chest Decoction) a

and Cao Guo Zhi Mu Tang (Tsaoko and Anemarrhena Decoction)

PNEUMONIA FORMULA #2

Ma Huang 麻黄 (Herba Ephedrae) 10 g

Ku Xing Ren 杏仁 (Semen Armeniacae Amarum) 10

Yi Yi Ren 薏苡仁 (Semen Coicis) 30

Huang Lian 黄连 (Rhizoma Coptidis) 6

Fa Ban Xia 法夏 (Rhizoma Pinelliae) 10

Gua Lou Pi 瓜蒌皮 (Pericarpium Trichosanthis) 10

Cao Guo 草果 (Fructus Tsaoko) 10

Zhi Mu 知母 (Rhizoma Anemarrhenae) 10

Yu Xing Cao 鱼腥草 (Herba Houttuyniae) 15

Gan Cao 生甘草 (Radix et Rhizoma Glycyrrhizae) 10

Bai Dou Kou 白豆蔻 (Fructus Amomi Rotundus) 9

DIAGNOSIS: TOXIC STAGNATION OBSTRUCTING THE LUNG

Clinical Manifestations: Cough, stifling sensation, stuffiness and distention in the chest, asthma and wheezing that worsens with exertion, accelerated respiration, thirst, irritability, reddish yellow urine.

Treatment Strategy: Detoxify, Arrest Wheezing; Transform Blood Stasis and Open Collaterals

Herbal Formula: Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction)

with Si Tu Tang (Four Wild Decoction)

PNEUMONIA FORMULA #3

Shi Gao 石膏 (Gypsum Fibrosum) 30 g

Zhi Mu 知母 (Rhizoma Anemarrhenae) 10

Shan Yao 山药 (Rhizoma Dioscoreae) 15

Xi Yang Shen 西洋参 (Radix Panacis Quinquefolii) 5

Tu Fu Ling 土茯苓 (Rhizoma Smilacis Glabrae) 30

Tu Da Huang土大黄 (Radix Rumicis Obtusifolii) 10

Tu Bei Mu 土贝母 (Rhizoma Bolbostemmatis) 10

Tu Niu Xi 土牛膝 (Rhizoma Achyranthes Sylvestris) 10

Su Mu 苏木 (Lignum Sappan) 10

Tu Bie Chong 土鳖 (Eupolyphaga seu Steleophaga) 10

Ju Luo 橘络 (Vascular Citri Reticulatae) 15

Lai Fu Zi 莱菔子 (Semen Raphani) 20

Ting Li Zi 葶苈子(Semen Descurainiae seu Lepidii) 15

Si Gua Luo 丝瓜络 (Retinervus Luffae Fructus) 30

DIAGNOSIS: CLOSED INTERIOR AND ABANDONED EXTERIOR SYNDROME

Clinical Manifestations: Mental incoherence, irritability, burning or heat sensation in the chest and abdomen, cold extremities, accelerated respiration and need for assisted breathing, scarlet purple tongue, dry yellow or yellowish brown coating, floating, forceful pulse that is empty in the deep level, or rootless.

Treatment Strategy: Open the Closed, Consolidate the Abandoned, Detoxify, Rescue Reversal

Herbal Formula: Si Ni Jia Ren Shen Tang (Frigid Extremities Decoction plus Ginseng), taken with An Gong Niu Huang Wan (Calm the Palace Pill with Cattle Gallstone) and Zi Xue San (Purple Snow Powder)

PNEUMONIA FORMULA #4

Ren Shen 人参 (Radix et Rhizoma Ginseng) 10 g

Fu Zi 制附子(Radix Aconiti Lateralis Praeparata) 10

Serve with AnGong Niu Huang Wan (Calm the Palace Pill with Cattle Gallstone) and Zi Xue San (Purple Snow Powder)

RECOVERY PHASE:

Clinical Manifestations: Absence of fever, dry cough, chest stuffiness, shortness of breath, shortness of breath upon exertion, dry mouth, weakness.

Treatment Strategy: Tonify Qi, Nourish Yin, Tonify Lung and Open the Collaterals

Herbal Formula:

Sha Shen Mai Dong Tang (Glehnia and Ophiopogonis Decoction)

PNEUMONIA FORMULA #5

Sha Shen 沙参 (Radix Glehniae seu Adenophorae) 15 g

Mai Dong 麦冬 (Radix Ophiopogonis) 15

Wu Wei Zi 五味子(Fructus Schisandrae Chinensis) 15

Ren Shen 人参 (Radix et Rhizoma Ginseng) 12

Lai Fu Zi 莱菔子 (Semen Raphani) 15

Si Gua Luo 丝瓜络 (Retinervus Luffae Fructus) 15

Ju Luo 橘络 (Vascular Citri Reticulatae) 15

Zi Su Zi 苏子(Fructus Perillae) 12

Zhe Bei Mu 浙贝 (Bulbus Fritillariae Thunbergii) 12

Ku Xing Ren 杏仁 (Semen Armeniacae Amarum) 12

Huang Qin 黄芩 (Radix Scutellariae) 15

Gan Cao 生甘草 (Radix et Rhizoma Glycyrrhizae) 10

Jake Fratkin has been in TCM practice for over 40 years. His studies include one year in Chinese hospitals in 1987-1988. He has researched and taught on the TCM treatment of SARS and Swine Flu. Jake is an authority on Chinese herbal products, summing up his knowledge in his book Essential Chinese Formulas (2014). His website is www.drjakefratkin.com