|Year : 2020 | Volume
| Issue : 4 | Page : 456-460
Successful treatment of coronavirus disease with integrated traditional chinese and western medicine: A case report
Ya-Li Guo1, Bo Wang2, Jin-Lian Cheng3, Yu-Guang Wang1
1 Department of Respiratory Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Dongcheng District, China
2 Department of Respiratory Medicine, Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Fengtai District, China
3 Department of Acupuncture, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Dongcheng District, China
|Date of Submission||23-Mar-2020|
|Date of Acceptance||28-Jun-2020|
|Date of Web Publication||16-Dec-2020|
Prof. Bo Wang
Department of Respiratory Medicine, Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100 072
Source of Support: None, Conflict of Interest: None
Background: Coronavirus disease (COVID-19) is a new outbreak infectious disease, caused by severe acute respiratory syndrome coronavirus 2. Nearly 80,000 people have got infected in China in just 2 months. Up to now, there still has no specific effective treatment for this disease. While integrated traditional Chinese and Western medicine has definite curative effect, could significantly reduce the disease mortality and shorten the course of treatment. Case Report: Here we report a 31-year-old female case of COVID-19 in a family cluster in Beijing. She reported low fever, cough with a little white sputum, fatigue, watery diarrhea, anorexia on admission. The COVID-19 in Traditional Chinese Medicine (TCM) belonged to plagues caused by dampness toxin. The patient was treated with TCM from dampness combined with antiviral drug abidol. After four visits, the patient was significantly improved with symptoms disappearing, chest-computed tomography dissipating, viral nucleic acid turning negative. She discharged and donated 200 ml convalescent plasma after 19 days hospitalization. Conclusion: The present case demonstrated that integrated traditional Chinese and Western medicine could treat COVID-19 effectively. However, clinical randomized controlled trials are warranted to verify the precise clinical efficacy.
Keywords: Coronavirus disease, dampness toxin, pestilence, traditional Chinese medicine
|How to cite this article:|
Guo YL, Wang B, Cheng JL, Wang YG. Successful treatment of coronavirus disease with integrated traditional chinese and western medicine: A case report. World J Tradit Chin Med 2020;6:456-60
|How to cite this URL:|
Guo YL, Wang B, Cheng JL, Wang YG. Successful treatment of coronavirus disease with integrated traditional chinese and western medicine: A case report. World J Tradit Chin Med [serial online] 2020 [cited 2021 Jan 25];6:456-60. Available from: https://www.wjtcm.net/text.asp?2020/6/4/456/303541
| Introduction|| |
In December 2019, a series of acute respiratory illness, known as Novel Coronavirus Pneumonia (NCP), emerged in Wuhan, and spread rapidly throughout China, then to the world. On February 11, 2020, the International Committee on Taxonomy of Viruses Coronaviridae Study Group has officially named the virus as “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), the disease caused by the virus as Coronavirus disease (COVID-19). The virus has strong human-to-human transmission capacity and been susceptible to the general population. As of February 28, 2020, a total of 78,959 COVID-19 cases in China have been confirmed, including 2791 cases of death. Internationally, 4371 cases have been reported outside China., To date, no specific treatment has been proven to be effective for COVID-19.
Once the epidemic occurred, Traditional Chinese Medicine (TCM) health-workers quickly joined the fight against the epidemic and played an important role in clinical. Combination of Traditional Chinese and Western medicine has definite curative effect, could significantly reduce the disease mortality and shorten the course of treatment. This report describes a case of COVID-19 in a family cluster, who was treated with TCM and Western Medicine, and achieved good clinical efficacy.
| Case Report|| |
On January 31, 2020, a 32-year-old female was transferred to an isolation room in the ward for infectious diseases at Beijing Fengtai Hospital of Integrated Traditional and Western Medicine from Beijing Youan Hospital, with a 5-day history of fever. She disclosed that she travelled from Beijing to Jingshan (Hubei) via Wuhan (Hubei) by train with her father-in-law and mother-in-law on January 18, and reported a fever of 37.4°C accompanied by mild diarrhea on January 24 without diagnosis and treatment, then returned to Beijing via Xiangyang (Hubei) by train on January 25. Her father-in-law became febrile on January 28 and were diagnosed as COVID-19 on January 29. Her mother-in-law later developed fever on January 29. They both visited Beijing You'an Hospital and were eventually diagnosed as COVID-19 by positive oropharyngeal swab real-time reverse transcription polymerase chain reaction (rRT-PCR) assay on January 30 [Figure 1].
|Figure 1: Chronology of symptom onset and identifcation of positive severe acute respiratory syndrome coronavirus 2 findings on real-time reverse transcription polymerase chain reaction among the Family Cluster. rRT-PCR: Real time reverse transcription polymerase chain reaction|
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On admission, the patient reported low fever, cough with a little white sputum, fatigue, watery diarrhea, anorexia, no dyspnea or other discomfort. The patient was healthy in the past. The physical examination revealed a body temperature of 37.4°C, blood pressure of 116/69 mmHg, pulse of 67 beats/min, respiratory rate of 16 breaths/min, and oxygen saturation of 98% while breathing ambient air. The rest of the physical exam was unremarkable, except for pharyngeal congestion. Chest X-ray showed small infiltrates of the right lung [Figure 2]a. The blood counts were normal (white blood cell count 7.44 × 109/L; lymphocyte count 2.05 × 109/L). C-reactive protein level was <0.49 mg/L. Liver and kidney function, and other biochemical indicators were within normal. No other respiratory pathogens were detected.
|Figure 2: Dynamic changes of chest radiographs and tongue image during hospitalization. Notes: The tongue color in pictures may have a slight difference with what we have seen, due to light sources and brightness|
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According to the epidemiological, clinical, laboratory, radiological characteristics and real-time RT-PCR result of the respiratory specimens, the patient was diagnosed as COVID-19. Empirical antibiotic therapy was initiated with moxifloxacin 400 mg qd on day 4 of admission for 4 days to cover the common pathogens of community-acquired pneumonia and then antiviral therapy abidol 200 mg tid was started on day 7 of admission for 7 days [Figure 3]. Within 6 h of admission, Chinese medicine was intervened. The TCM diagnosis and treatment process was recorded as follows.
|Figure 3: Symptoms, maximum body temperatures and treatment according to day of illness and day of Hospitalization, January 24 to February 18, 2020. N = not measured. R'-1 to R'-5 means five different formula along with the disease progression|
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At first visit, she reported low fever, aversion to wind, cough with little white phlegm, bitter taste, dry throat, thirst with preference for hot drink, watery diarrhea, fullness of the abdomen, fatigue, anorexia. She had a pale and enlarged tongue with white and thick fur [Figure 2]d. She was usually deficiency of lung and spleen, manifested as aversion to wind and cold, poor appetite. These symptoms in TCM were ascribed as dampness obstructing the middle energizer, insufficiency of lung and spleen. The core principle of treatment was tightly surrounded the dampness, the spleen, the stomach and the lungs. The therapeutic principle was dissipating dampness, replenishing spleen and lung. Modified Chai Ping Decoction was used, which was consisted of Cangzhu (Rhizoma atractylodis) 15 g, Houpo (Cortex magnoliae officinalis) 9 g, Zhishi (Fructus aurantii immaturus) 6 g, Chenpi (Pericarpium citri reticulatae) 12 g, Banxia (Rhizoma pinelliae) 9 g, Fuling (Poriae) 30 g, Muxiang (Radix aucklandiae) 9 g, Sharen (Fructus amomi) 6 g, Chaihu (Radix bupleuri) 9 g, Guizhi (Ramulus cinnamomi) 9 g, Ganjiang (Rhizoma zingoberis) 9 g, Dangshen (Radix codonopsitis pilosulae) 15 g, Zhigancao (Honey-Fried Licorice) 6 g. One decoction was taken per day. There were three classical prescriptions in the formula. Pingwei Powder (Cangzhu, Houpo, Chenpi) combined with the Xiangsha Six Gentlemen Decoction (Dangshen, Cangzhu, Banxia, Chenpi, Fuling, Muxiang, Sharen) were applied to promoting flow of Qi, eliminating dampness, resolving phlegm, activating spleen and regulating the stomach. Low fever, bitter taste and dry throat implicated the presence of heat transforming from stagnant water-rheum. Chaihu, Zhishi, Guizhi, Ganjiang were added to warm and transform water-rheum, clear and out-thrust depressed heat.
Two days later (February 2), the patient reported that diarrhea, fullness of the abdomen, bitter taste, thirst had disappeared. But she still complained low fever with noticeably fatigue, cough sometimes with a little yellow sputum, sore throat. Her tongue fur changed significantly, from white-thick turning to thin-moist [Figure 2]d. All of which indicated that the damp pathogen had eased a little, while the internal heat gradually increased. The syndrome was described as deficiency of spleen and dampness retention, failing to ascend of clear yang, presence of heat conversion of the dampness stagnancy. The therapeutic principle of this visit was replenishing the lung and spleen, eliminating dampness, ascending Yang and purging heat. The formula was modified from Bupiwei Xieyinhuo Shengyang decoction, which was aimed to relieve fever with sweet and warm-natured drugs combined with the method of purging heat with bitter-cold herbs. The formula was consisted of Dangshen (Radix codonopsitis pilosulae) 15 g, Zhihuangqi (Astragalus sunburn) 15 g, Cangzhu (Rhizoma atractylodis) 15 g, Fuling (Poriae) 30 g, Banxia (Rhizoma pinelliae) 9 g, Muxiang (Radix aucklandiae) 9 g, Sharen (Fructus amomi) 6 g, Chenpi (Pericarpium citri reticulatae) 9 g, Shenqu (Massa medicate fermentata) 15 g, Qinghao (Herba artrmisiae chinghao) 9 g, Huangqin (Radix scutellariae) 3 g, Chaihu (Radix bupleuri) 9 g, Shengma (Rhizoma cimicifugae) 6 g, Zhigancao (Honey-Fried Licorice) 6 g. Qinghao and Huangqin were added to clear the residual dampness and heat.
Four days later (February 6), she reported afebrile and improved fatigue, while sputum and sore throat had disappeared 2 days ago. Since taking moxifloxacin, she emerged epigastric pain, acid reflux, nausea and diarrhea with stool three times a day. Her tongue fur turned to sticky greasy [Figure 2]d. These symptoms in TCM were ascribed as retention of dampness in middle energizer, incoordination between spleen and stomach, adverse rising of stomach Qi. The therapeutic principle was eliminating dampness and activating the spleen-promoting Qi and mitigating the stomach. The formula was consisted of Cangzhu (Rhizoma atractylodis) 15 g, Houpo (Cortex magnoliae officinalis) 9 g, Zhishi (Fructus aurantii immaturus) 6 g, Chenpi (Pericarpium citri reticulatae) 12 g, Banxia (Rhizoma pinelliae) 9 g, Fuling (Poriae) 30 g, Shenqu (Massa medicate fermentata) 15 g, Muxiang (Radix aucklandiae) 9 g, Sharen (Fructus amomi) 6 g, Huoxiang (Herba Pogostemonis) 6 g, Peilan (Herba eupatorii) 6 g. This formula was modified from Pingwei Powder combined with Huopu Xialing decoction. In the prescription, Huoxiang and Peilan were to dissolving the damping with aromatics. As antiviral drug abidol was available, it was added according to the protocol.
At the fourth visit (February 10), she reported afebrile, slight fatigue, dry mouth, a slight shortness of breath after exertion, mucoid stools. Her tongue coating was thick, greasy and slightly yellowish [Figure 2]d. These symptoms were belonged to the syndrome of retention of dampness-heat in middle energizer-preponderance of dampness over heat, disturbance of Qi movement. The therapeutic principle was dispelling filth and resolving the turbid, removing the stagnated heat. This formula was modified from Dayuan Decoction which included Binglang (Semen arecae) 9 g, Houpo (Cortex magnoliae officinalis) 6 g, Caoguo (Fructus tsaoko) 9 g, Zhimu (Rhizoma anemarrhenae) 15 g, Zhishi (Fructus aurantii immaturus) 6 g, Chaihu (Radix bupleuri) 9 g, Huangqin (Radix scutellariae) 6 g, Shashen (Radix adenophorae) 15 g, Maidong (Radix ophiopogonis) 15 g.
Three days later (February 13), she reported that all symptoms had resolved with exception of a slightly thirsty. The previous bilateral lower-lobe rales on chest computed tomography (CT) were dissipated [Figure 2]b and [Figure 2]c. The tongue was red with little coating. The syndrome was residual pathogen, qi-yin insufficiency. Sangxing decoction combined with Shashen Maidong decotion were used to clear away residual pathogen, tonify qi and nourish yin. The prescription consisted of Sangye (Folium mori) 9 g, Juhua (Flos chrysanthemi) 6 g, Kuxingre (Semen armeniacae amarae) 9 g, Lugen (Rhizoma phragmitis) 15 g, Shashen (Radix adenophorae) 15 g, Maidong (Radix ophiopogonis) 15 g, Cangzhu (Rhizoma atractylodis) 10 g, Chenpi (Pericarpium citri reticulatae) 9 g, Houpo (Cortex magnoliae officinalis) 6 g.
Oropharyngeal specimens obtained on February 13 and 15 were tested negative for SARS-CoV-2. Besides, blood, urine, stool specimens were all negative. Serologic tests for SARS-CoV-2 antibody were positive for IgM (+++) and IgG (+). She discharged on February 18 and donated 200 ml convalescent plasma.
| Discussion|| |
COVID-19 was a new outbreak infectious disease, which could easily transmit from people to people. Conventional routes of transmission of SARS-CoV-2 consisted of respiratory droplets and direct contact. The clinical manifestations of COVID-19 are largely heterogeneous from asymptomatic to severe dyspnea. The most common symptoms were fever (88.7%), cough (67.8%), fatigue (38.1%), sputum production (33.7%), shortness of breath (18.7); nausea or vomiting (5.0%) and diarrhea (3.8%) were uncommon. Compared with SARS, Middle East respiratory syndrome, COVID-19 appears to have a lower overall case-fatality rate of 2.3%, with about 80% patients being considered as mild pneumonia. To date, there has no specific effective treatment for SARS-CoV-2 infection.
In TCM, COVID-19 belongs to the category of pestilence. According to the classical TCM text the Yellow Emperor's Canon of Medicine·Plain Conversation (Su Wen), Huangdi said, “I have heard that five kinds of pestilence all can spread from people to people. No matter in children or in adults, the symptoms are the same.” Qian Huang, a doctor in Qing Dynasty, said “the external pathogens infected are hard to know, but can be recognized once the onset of disease.” COVID-19 mainly manifested as hiding fever, dry cough, fatigue, anorexia, thick slimy tongue fur. Comprehensive analysis of four examination, the nature of disease was belonging to dampness. Our ancestors emphasized the correspondence between nature and human. Since December 2019, Wuhan has a warm winter climate. At the time of the Beginning of Winter to Greater Cold, the cold climate didn't arrive correspondence with the season. Meanwhile, the haze and cold rainy weather, which was not the marked climate, lingered several days. This abnormal phenology was the external cause of the outbreak in Wuhan. Base on the theory of assessing the syndromes and seeking the etiology, the COVID-19 belongs to plagues caused by the evil of dampness toxin. The pathogenic characteristics of dampness are viscosity, stagnation, heaviness, and turbidity. Dampness by nature descends and is easy to encumber spleen and block the movement of Qi. So that patients mainly report hiding fever, tired, stuffiness in chest, shortness of breath, anorexia and sticky stool. Qibo said “Xieqi usually gets into and out of the body through the nose.” Ye Tianshi said “warm pathogen main attacks upper and start from lung.” The main location of disease was lung and spleen. The core pathogenesis was dampness, heat, poison, stasis, and deficiency. There were obvious stages in the progression of disease. In the early stage, the pathogenesis was dampness toxin stagnating in the upper energizer and pleurodiaphragmatic interspace. If the dampness toxin transformed into heat, then entering nutrient-blood, even transmitting to pericardium in reverse, the disease would progress rapidly. COVID-19 should be diagnosed early and interfered with Chinese herbs as early as possible. The most important principle of treatment was to expel evilness. The methods of treatment were dispelling filth with aroma, dispersing qi, respectively expelling evils from upper and lower, dispelling stasis and dredging collaters. Dispelling dampness was predominant than clearing heat. If the treatment is timely and effective, the disease could be prevented from progressing to severe conditions, and recover more quickly.
The patient in this report was a young female with confirmed COVID-19. She was a case in a family cluster with SARS-CoV-2 infection. Her condition was relatively mild, and has typical manifestations of attacked by dampness toxin. She received TCM once admitted into hospital. Antiviral treatment abidol was given on 7th day after admission as it was not available at the beginning. In TCM, she was usually insufficient lungs and spleen. Spleen in body was correspond to dampness-soil in nature. While dampness was easy to encumber spleen. When attacked by external dampness toxin, spleen-stomach and lung was damaged, internal dampness then produced. At the early stage, dampness was the core pathogenesis, while heat was not obvious. The slightly bitter, warm, and acrid herbs were used to promote flow of Qi and eliminate dampness. When internal heat transformed from stagnant dampness appearing, the clearing intensity of clearing heat would be increased appropriately. Dampness was turbid-yin pathogen, aromatic herbs also could be chosen. “Treating root and accompanying symptoms simultaneously for mild case,” take care of spleen-stomach when making up a prescription. After four visits, her condition improved significantly, with symptoms disappearing, chest-CT dissipating, viral nucleic acid turning negative. Warm pathogen was apt to damage fluid and liquid. In recovery period, acrid-sweet cool-moist herbs were chosen to clear away residual pathogen and tonify qi-yin.
Present studies did not find any effects of dual combination antiviral treatment (interferon-α2b combined with lopinavir/ritonavir or abidol) in patients with COVID-19. The triple combination antiviral treatment (abidol combined with lopinavir/ritonavir and interferonα-2b) was slightly better than the dual combination antiviral treatment., The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group (15.0 ± 5.0) days. In the triple combination antiviral drug group, in the starting antiviral therapy time >5 days after the symptom onset sub-group, the time from the symptom onset to the negative of viral shedding was 21 (18–24) days, and the time from antiviral therapy to the negative of viral shedding was (11.2 ± 4.3) days. This patient received Chinese medicine intervention once admitted, with a 7 days history of fever and cough. On the 13th day after the onset, she received Abidol mono-antiviral treatment for 7 days. The time from antiviral therapy to the negative of viral shedding was 10 days, while the time from the symptom onset to the negative of viral shedding was 23 days. The effect was equal or even better than the triple combination antiviral treatment, which was worthy of recognition.
| Conclusion|| |
Retrospective studies have observed definite curative effect in patients treated with combination of traditional Chinese and Western medicine. This case report in detail indicates the effect of combined with TCM in SARS-CoV-2 infection patients. Besides, it also could reduce the use of antiviral drugs, anyway reduce medical expenses. Nevertheless, a comprehensive clinical randomized controlled trial is needed to verify the precise efficacy of this treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Yali Guo: Patient data collection, background research on COVID-19 and writing the original draft. Bo Wang: Therapeutic assessment and treatment recording. Jinlian Cheng: Writing-review and editing. Yuguang Wang: Performing treatments, and taking overall responsibility. All the authors have read and approved the final report.
Financial support and sponsorship
This work was supported by “Optimization of TCM Diagnosis and Treatment Protocol for NCP (No: Z201100005420009)” and “Special Project of TCM Guidance in Regional Designated Hospital for NCP in Beijing (Daxing, Shunyi, Huairou, Pinggu).”
Conflicts of interest
There are no conflicts of interest.
This article has been informed and agreed by the patient mentioned and his family.
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