1. 医学观察期
临床表现1：乏力伴随肠胃不适
推荐中成药：藿香正气胶囊（丸、水、口服液）
推荐中成药:金花清感颗粒、莲花清瘟胶囊（颗粒）、疏风解毒胶囊（颗粒）
Chinese patent medicine is
recommended: HuoXiang ZhengQi JiaoNang(wan、shui、KouFuFe) /
Agastache capsule to Rectify the Qi (pill、Distilled
water、oral liquid)
Recommended Chinese patent
medicine: JinHua QinGan KeLi/ Flos
Lonicerae expelling exterior syndrome granule, Lian Hua QinWen Jiaonang(KeLi)/
Honeysuckle and Forsythia clear toxin capsule (granule), ShuFeng JieDu JiaoNiang/
dispersing wind resolve toxin capsule(granule)
2. 临床治疗期（确诊病例）
2.1 清肺排毒汤
适用范围： 结合多地医生临床观察，适用于轻型、普通型、重型患者，在危重型患者救治中可结合患者实际情况合理使用。
基础方剂：麻黄9g、炙甘草6g、杏仁9g、生石膏15-30g（先煎）、桂枝9g、泽泻9g、猪苓9g、白术9g、茯苓15g、柴胡16g、黄芩6g、姜半夏9g、生姜9g、紫菀9g、冬花9g、射干9g、细辛6g、山药12g、枳实6g、陈皮6g、藿香9g。
服法：传统中药饮片，水煎服。每天一付，早晚各一次（饭后40分钟），温服，三付一个疗程。
如有条件，每次服完药可加服大米汤半碗，舌干津液亏虚者可多服至一碗。（注：如患者不发热则生石膏的用量药小，发热或壮热可加大生石膏用量）。若症状好转而未痊愈则服用第二个疗程，若患者有特殊情况或其他基础病，第二疗程可以根据实际情况修改处方，症状消失则停药。
处方来源：国家卫生健康委办公厅 国家中医药管理局办公室《关于推荐在中西医结合救治新型冠状病毒感染的肺炎中使用“清肺排毒汤”的通知》（国中医药办医政函（2020）22号）。
2. clinical treatment stage (clinically tested positive
cases)
2.1. Qing Fei Pai Du Tang (clear the lung and detoxification
decoction)
Suitable in: According to the clinical observation
from multiple areas, this decoction is suitable for all light, regular, and heavy
syndrome. When treating with critical stage patient, may use the formula
according to the situation.
Base formula: Ephedra (Ma Huang, Herba Ephedrae) 9g、Licorice
Root (Zhi Gan Cao, Radix Glycyrrhizae) 6g、Bitter
Apricot Seed (Xing Ren, Semen Armeniacae Amarum) 9g、Raw
Gypsum (Sheng Shi Gao, Gypsum Fibrosum) 15-30g (To be decocted first)、Cassia Twig (Gui Zhi, Ramulus Cinnamomi) 9g、
Water Plantian Rhizome（Ze Xie，
Rhizoma Alismatis) 9g、Polyporus (Zhu Ling,Polyporus
Umbellatus) 9g、White Atractylodes Rhizome (Bai Zhu,
Rhizoma Atractylodis Macrocephalae) 9g、Poria (Fu Ling
,Poria) 15g、Bupleurum (Chai Hu ,Radix Bupleuri) 16g、Scutellaria Root (Huang qin, Radix Scutellariae) 6g、Pinellia Rhizome (Jiang Ban Xia, Rhizoma Pinelliae) 9g、Fresh
Ginger (Sheng Jiang, Rhizoma Zingiberis Recens) 9g、Tatarian
Aster Root (Zi Wan, Radix Asteris) 9g、Common Coltsfoot
Flower (Dong Hua ,Flos Farfarae) 9g、Blackberry Lily
Rhizome (She Gan, Rhizoma Belamcandae) 9g、 Manchurian
Wild Ginger (Xi Xin,Herba Asari) 6g、Common Yam
Rhizome(Shan Yao, Rhizoma Dioscoreae) 12g、Immature
bitter orange (Zhi Shi, Fructus Aurantii Immaturus) 6g、Aged
Tangerine Peel (Chen Pi, Pericarpium Citri Reticulatae) 6g、Wrinkled
Giant hyssop (Huo Xiang, Herba Pogostemonis) 9g。
Decoction method and dosage： For
traditional raw herbs, use water to decoct. One pack of raw herbs each day,
decocted to drink 40 minutes after meal (Bid, am&pm). Drink warm，3 packages of herbs per treatment plan
If possible, drink 1/2 bowl of rice soup after taking herbal
decoction. Patients with dry tongue and body fluid deficiency, can take up to 1
bowl. ( If patient don’t have high fever, the dosage of Raw Gypsum (Sheng Shi
Gao, Gypsum Fibrosum) should be small; for patient with fever or extremely high
heat, can increase the dosage.) If the symptoms are relieved but not cured,
then take the second treatment plan. For patient with special condition or with
other chronic disease, the second treatment plan can be modified according to
the actual condition, and stop the medication when the signs and symptoms are
gone.
Reference:
2.2. mild type
(1)cold- damp stagnating in
the lung
Clinical manifestation: fever,
fatigue, soreness, cough, sputum, chest tightness, poor appetite, nausea,
vomiting, sticky stool. Pale tongue with tooth marks or light red tongue with
white greasy thick coating, or white greasy coating, slippery or soggy pulse.
Recommend
formula: Ephedra（Sheng Ma Huang，Herba Ephedrae)6g,
Gypsum (Sheng Shi Gao,
Gypsum Fibrosum) 15g, Bitter Aprecot seed (Xing Ren, Semen Armeniacae
Amarum), Notoptetygium Root (Qiang Huo, Rhizoma Seu Radix Notopterygii) 15g,
Pepperweed Seed (Ting Li Zi,Semen Lepidii) 15g, Cyrtomii Rhizoma (Guan Zhong,Cyrtomium rhizoma)
9g, Earth Worm (Di Long, Lumbricus)15g, Paniculate Swallowwort Root (Xu Chang
Qing, Radix Cynanchi Paniculati)15g, Wrinkled Giant hyssop (Huo Xiang, Herba
Pogostemonis)15g, peilan(herba eupatorii)9g, Chinese Atractylodes Rhizome
(Cangzhu, Rhizoma Atractylodis) 15g, Poria (Yun Ling, Poria )45g, Raw White
Atractylodes Rhizome（Sheng Bai Zhu，Rhizoma Atractylodis
macrocephalae) 30g, Scrotch
Fried Three Ingredients (Jiao San Xian, Massa trimedicata usta) 9g each,
Magnolia Bark (Hou Po, Cortex magnoliae officinalis)15g, Scrotch Fried Areca
Seed (Jiao Bin Lang, Semen Arecae Prepareta)9 g, Tsaoko Fruit (Wei Cao Guo,Toasted Fructus Fsaoko)9g,
Fresh Ginger (Sheng Jiang, Rhizoma Zingiberis Recens) 15g
Dosage: 1 dose /day, 600ml
decoction devided into Tid (am, noon, pm), to be taken before meals
(2) Damp-heat accumulating in
the lung
Clinical Manifestation: low
fever or no fever, slightly aversion to cold, fatigue, heaviness feeling at
head and body, soreness of muscle, dry cough with little sputum, sore throat,
dry mouth and no desire to drink or
accompanied by chest pain and stuffy feeling in chest; no sweat or impeded
sweating, nausea， diarrhea or sticky stool, slight red
tongue with white thick greasy coating or thin yellow coating. Slippery or soggy pulse
Recommended formula: Betel Nut
(Bin Lang, Semen Arecae )10g, Tsaoko Fruit（Cao Guo，Fructus Tsaoko )10g , Magnolia Bark (Hou Po，Cortex
Magnoliae Officinalis)10g, Common Anemarrhena Rhizome (Zhi Mu, Rhizoma
Anemarrhenae)10g , Scutellaria (Huang Qin, Radix Scutellariae)10g, Bupleurum
(Chai Hu, Radix hupleuri)10g, Red Peony Root (Chi Shao, Radix Paconiac
Rubra)10g, Weeping Forsythia Capsule (Lianqiao, Fructus Forsythiae)15g, Sweet
Wormwood (Qing Hao, Fructus forsythiae)10g ( To be decocted later), Chinese
Atractylodes Rhizome (Cangzhu，Rhizoma Atractylodis)10g,
Indigowoad Leaf (Da Qing Ye, Folium Isatidis)10g, Raw Licorice Root (Sheng Gan
Cao,Radix Glycyrrhizae)5g
Dosage: 1 dose/ day, 400ml
decoction. BID, am & pm.
2.3 普通型
服法：每日1剂，水煎400ml，分2次服用，早晚各一次。
(1)Toxin-dampness stagnation in the lung
Clinic manifestations: fever,
coughing with little phlegm or yellow phlegm, chest oppression with polypnea,
abdominal distention with constipation. Dull-red and swollen tongue with yellow
greasy or dry yellow coating, slipper rapid or wiry slipper pulse.
The recommend formula: Ephedra
(Sheng Ma Huang, fresh Herba Euphedrae) 6g, Bitter Apricot Kernel (Ku Xing Ren,
Semen Armeniacae Amarum) 15g, Gypsum (Sheng Shi Gao, Gypsum Fibrosum) 30g, Coix
Seed (Yi Yi Gen, Radix Coicis) 30g, Chinese Atractylodes Rhizomes (Mao Cang
Zhu, Rhizoma Areactylodis Lanceae) 10g、Wrinkled Giant
hyssop (Guang Huo Xiang, Herba Pogostemonis) 15g、Sweet
Wormwood (Qing Hao, Herba Artemisiae Annuae) 12g、Giant
Knotweed Rhizome (Hu Zhang, Rhizoma Polygoni Cuspidati) 20g、Vervain
Herb (Ma Bian Cao,Verbena
officinalis L.) 30g、Reed Rhizome (Lu Gen, Rhizoma Phragmitis) 30g、Pepper weed seed (Ting Li Zi, Semen Lepidii) 15g、Pummelo Peel (Hua Ju Hong, Exocarpium Citri Grandis) 15g、Raw Licorice root (Sheng Gan Cao, fresh Radix en Rhizoma
Glycyrrhizae) 10g
The recommended Dosage and Direction:
1 dose each day, 400ml liquids after decoction with water, Bid. Am &
PM. 200ml/time.
(2) cold-dampness obstruction the lung
(2) 寒湿阻肺证
临床表现：低热、身热不扬、或微热，干咳、少痰、倦怠乏力、胸闷、脘痞、或呕恶，便溏。舌质淡或淡红，舌体胖，苔白或白腻，脉濡。
服法：每日1剂，水煎400ml，分2次服用，早晚各一次。
Clinic manifestations:
lower grade fever、restrain fever or slightly
fever, dry coughing with little phlegm, lassitude, fatigue, chest oppression,
epigastric fullness, or nausea, Loose stool, pale or light red and puffy tongue
with white or white greasy coating, soggy pulse.
The recommend formula: Atractylodes Rhizome (Cang Zhu,
Rhizoma Atractylodis) 15g, Aged Tangerine Peel (Chen Pi, Pericarpium Citri
Reticulatae) 10g, Magnolia Bark (Hou Po ,Cortex Magnoliae Oficinalis) 10g,
Wrinkled Giant hyssop (Huo Xiang, Herba Pogostemonis) 10g, Tsaoko Fruit (Cao
Guo /Fructus Tsaoko )6g, Ephedra (Sheng Ma Huang, fresh Herba Euphedrae) 6g,
Notoptetygium Root (Qiang Huo, Radix Seu Rhizoma Notopterygii) 10g, Fresh
Ginger (Sheng Jiang, Rhizoma Recens Zingiberis) 30g, Betel Nut (Bin Lang, Semen
Arecae )10g
The recommended Dosage and Direction: 1 dose each day, 400ml
liquids after decoction with water, Bid, Am& PM, 200ml/time.
2.4 Severe type
1) Epidemic toxin obstructs Lung
Sign and Symptoms: fever and red face, cough with scanty
yellow sticky phlegm, or blood in phlegm. Dyspnea and shortness of breath,
feeling of tireness, dry mouth and bitter taste, nausea with no appetite,
difficult defecation, scanty yellow urine.
Tongue: red with yellow greasy coat
Pulse: Slippery and rapid
Recommended formula: Hua Shi Bai Du Fang
Ingredients: Ephedra(Raw Ma Huang, Ephedrae Herba) 6g,
Bitter Apricot seed (Xing Ren, Armeniacae Semen) 9g, Raw Gypsum (Sheng Shi Gao,
Gypsum Fibrosum) 15g, Raw Licorice root (Sheng Gan Cao, fresh Radix en Rhizoma
Glycyrrhizae) 3g, Wrinkled Giant hyssop (Huo Xiang, Herba Pogostemonis) 10g
(Cook later), Magnolia Bark (Hou Po, Magnoliae Officinalis Cortex) 10g,
Atractylodes Rhizome (Cang Zhu, Atractylodis Rhizoma) 15g, Tsaoko Fruit (Cao
Guo, Tsaoko Fructus) 10g, Pinellia Rhizome (Ban Xia, Pinelliae Rhizoma Preparatum)
9g, Poria (Fu Ling, Poria) 15g, Rhubarb Root and Rhizome (Raw Da Huang, Rhei
Radix Et Rhizome) 5g (Cook later), Astragalus Root (Raw Huang Qi , Astragali
Radix) 10g, Pepperweed Seed (Ting Li Zi, Semen Lepidii seu Descurainiae) 10g,
Red Peony Root(Chi Shao, Paeoniae Radix Rubra) 10g
Instructions: 1 – 2 decoction per day, every time, 100ml –
200ml, Bid to Qid per day. Oral or Nasal
feeding
2) Heat burning at Qi and Ying Level
Signs and Symptoms: high fever, irritability and big thirst,
shortness of breath or difficulty breathing, delirium, rashes, vomit blood or
nose bleed, convulsion.
Tongue: Scarlet with scanty or no coat
Pulse: deep, thready and rapid or Floating big and rapid
Recommended Herbs: Gypsum (Raw Shi Gao, Gypsum Fibrosum)
30-60g (cook first), Common Anemarrhena Rhizome (Zhi Mu, Anemarrhenae Rhizoma)
30g, Rehmannia (Sheng Di, Rhemanniae Radix) 30-60g, Buffalo Horn (Shui Niu
Jiao, Bubali Cornu) 30g (Cook first), Red Peony Root (Chi Shao, Paeoniae Radix
Rubra) 30g, Figwort Root (Xuan Shen ,Scrophulariae Radix) 30g, Weeping
Forsythia Capsule (Lian Qiao, Forsythiae Fructus) 15g, Tree Peony Bark (Dan Pi,
Moutan Cortex) 15g, Coptis Rhizome (Huang Lian, Coptidis Rhizome) 6g,
Lophatherum Stem and leaves(Zhu ye, Lophatheri Herba) 12g, Pepperweed seed
(Ting Li zi, Semen Lepidii seu Descurainiae) 15g, Raw Licorice Root (Sheng Gan
Cao, Glycyrrhizae Radix) 6g
Instructions: 1 Decoction per day, Cook Gypsum (Shi gao,
Gypsum Fibrosum) and Buffulo Horn (Shui Niu Jiao, Bubali Cornu) first, 100ml –
200ml each time, Bid to Qid, oral or nasal feeding.
Recommended Patent medicine: Xi Yan Ping Injection, Xue Bi
jing Injection, Re Du Ning injection, Tan Re Qing injection, Xing niao jing injection. Herbs with similar functions can be chosen
with 1 depending on situation, or choose 2 depending on patient condition. Herb
injection and herbal decoction can be used together.
2.5 Critical condition:
Interior obstruction leading to collapse
Signs and Symptoms: Difficulty breathing, might require
mechanical ventilator, coma, irritability, spontaneous cold sweat
Tongue: dark purple, thick dry or greasy coat
Pulse: Floating and big, but rootless
Recommended Herbs: Ginseng (Ren Shen, Ginseng Radix) 15g,
Aconite Root(Hei Shun Pian, Aconiti Radix lateralis Prepareata) 10g (cook
first), (Shan Zhu Ru, Corni Fructus) 15g.
Use the above decoction to take Su He Xiang Wan (Liquid
Styrax Pill) or An Gong Niu Huang Wan (Peaceful Palace Bovine Bezoar Pill)
Patient with Mechanical Ventilator, have abdominal
distention constipation or difficulty defecation, could add Rhubarb Root and
Rhizome (Raw Da Huang, Rhei Radix Et Rhizome), 5 – 10g. If patient and the mechanical ventilator are
not synchronized, after used of tranquilizer and muscle relaxant IV, could add
Rhubarb Root and Rhizome (Raw Da Huang, Rhei Radix Et Rhizome), 5 – 10g and
Mirabilite, (Mang Xiao, Natrii Sulfas) 5 – 10g
NOTE: Instruction of Herbal injection for Severe and
critical condition patient
Follow the instruction from the herbal injection booklet,
start with low dosage, and gradually modify dosage depending on patient
condition and reaction. Below is the
recommended procedure:
Viral infection with mild bacterial infection: 0.9% sodium
chloride 250ml plus Xi Yan ping Injection 100ml bid, or 0.9% sodium chloride
250ml plus Re Du Ning injection 20 ml, or 0.9% sodium chloride 250ml plus Tan
Ren Qing injection 40 ml bid.
High fever with consciousness problem: 0.9% Sodium Chloride
250 ml plus Xing Nao Jing injection 20 ml bid
Systemic infection reaction and/or organ function failure:
0.9% sodium chloride 250ml plus Xue Bi Jing injection 100ml bid
Immunosuppresion: Glucose 250ml plus Shen Mai injection
100ml or Sheng Mai injection 20-60ml bid.
2.6 Recovery Period
(1) 肺脾气虚证
临床表现:气短,倦怠乏力,纳差呕恶,痞满,大便无力,便溏不爽。 舌淡胖,苔白腻。
推荐处方:法半夏9g、陈皮10g、党参15g、炙黄芪30g、炒白术10g、茯苓15g、藿香10g、砂仁6g(后下)、甘草6g。
服法:每日1剂,水煎400ml,分2次服用,早晚各1次。
(1) Qi Deficiency of the Lung and Spleen
Manifestations: shortness of breath, lassitude, fatigue,
poor appetite, nausea, vomiting, distending and fullness of the epigastric
region or the abdomen, unable to defecation due to weakness, loose stool or
diarrhea with incomplete, sticky sensation, pale puff tongue with white greasy
coating.
The recommended formula: Pinellia Rhizome (Ban Xia, Rhizoma Pinelliae) 9g,
Aged Tangerine Peel (Chen Pi, Pericarpium Citri Reticulatae) 10g, Codonopsis
Root (Dang Shen, Radix Condonopsis Pilosulae)15g, Processed Astragalus Root
(Zhi Huang Qi ,Radix Astragali seu Hedysari Preparata) 30g, Stir fried
Atractylodis Macrocephalae Rhizoma (Chao Bai Zhu, Rhizoma Atractylodis
Macrocephalae) 10g, Poria (Fu Ling, Poria) 15g, Wrinkled Giant hyssop (Huo
Xiang, Herba Pogostemonis) 10g, Amomum Fruit (Sha Ren, Fructus Amomi) 6g(decocted
after) , Licorice Root(Gan Cao, Radix Glycyrrhizae).
The Method of Preparation: 1 dose for each day. Boil all
herbs in 1500ml water into 400ml. And then add Amomum Fruit (Sha Ren, Fructus
Amomi), let it boil gently for a moment. Discard the dregs. Divide the
decoction into two parts. Each one has 200ml.
The Recommended Dose: 200ml for each time, twice a day on
morning and evening and take it warm.
(2) 气阴两虚证
临床表现:乏力,气短,口干,口渴,心悸,汗多,纳差,低热或不热,干咳少痰。 舌干少津,脉细或虚无力。
推荐处方:南北沙参各10g、麦冬15g、西洋参6g,五味子6g、生石膏15g、淡竹叶10g、桑叶10g、芦根15g、丹参15g、生甘草6g。
服法:每日1剂,水煎400ml,分2次服用,早晚各1次。
(2) Deficiency of Both Qi and Yin
Manifestations:
fatigue, shortness of breath, dry mouth, thirst, palpitation, profuse sweating,
poor appetite, lower grade fever or no fever, dry cough with little phlegm, a
dry tongue with little fluid, a thready or deficient, forceless pulse.
The recommended formula: Glehnia Root (Bei Sha Shen, Radix
Glehniae) 10g, Four leaf ladybell root (Nan Sha Shen,Radix Adenophorae) 10g,
Ohiopogon Tuber (Mai Men Dong, Radix Ophiopogonis) 15g, American ginseng root
(Xi Yang Shen, Radix Panacis Quinquifolii ) 6g, Schisandra Fruit (Wu Wei Zi,
Fructus Schisandrae) 6g, Gypsum (Sheng Shi Gao, Gypsum Fibrosum) 15g,
Lophatherum Stem and Leaves (Dan Zhu Ye, Herba Lophatheri) 10g, White Mulberry
leaf(Sang Ye, Folium Mori) 10g, Reed Rhizome(Lu Gen, Rhizoma Phragmitis) 15g,
Salvia Root (Dan Shen, Radix Salviae Miltiorrhizae) 15g, Licorice Root (Sheng
Gan Cao, Radix Glycyrrhizae) 6g,
The Method of Preparation: 1 dose for each day. Boil all
herbs in 1500ml water into 400ml. Discard the dregs. Divide the decoction into
two parts. Each one has 200ml.
The Recommended Dose: 200ml for each time,Bid, am & pm,
and take it warm.
References:
1.
新型冠状病毒诊疗方案（试行第七版）http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml
2.
实用中草药图谱， 徐洪华，楼步青， 广东科技出版社， 2012年6月第一版，ISBN
978-7-5359-5399-5
3.
“Pinyin-English Cross
Reference of Chinese Materia Medica Names”, Essentials of Chinese Materia
Medica and Medical Formulas, p.965-975. Shengyan Xi and Yuewen Gong, Elvevier
and Academic Press. 2017. ISBN: 978-0-12-812722-3
4.
List of TCM Formulae, https://www.ctcmpao.on.ca/resources/forms-and-documents/List_of_TCM_Formulae.pdf
5.
Index of Materia Medica, https://www.ctcmpao.on.ca/resources/forms-and-documents/Index_of_Materia_Medica.pdf
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