On June 16, the Beijing Administration of Traditional Chinese Medicine issued a notice on the promulgation of the “Beijing Municipal Plan for the Prevention and Treatment of Novel Coronavirus Pneumonia with Traditional Chinese Medicine (Trial Version 5).”

A total of 17 proprietary Chinese medicines are included as reference preparations, namely Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, Xin Xue Granules, Zixue Dan, Angong Niuhuang Wan, Suhexiang Wan, Baileng Capsules, Jinshuibao Capsules, Huaiqihuang Granules, Tanreqing Injection, Xuebijing Injection, Reduoning Injection, Shenmai Injection, and Shenfu Injection.

1. Refer to proprietary Chinese medicines

Available options include Jinhua Qinggan Granules, Lianhua Qingwen Granules (capsules), Shuanghuanglian Granules (oral liquid), Qingkailing Capsules, and Shema Oral Liquid. The following symptoms may be treated with these products:

1. Close contacts of confirmed COVID-19 cases are currently classified as either under medical observation or in medical isolation.

Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, and others.

2. Applicable to cases with no obvious clinical symptoms, no radiographic evidence of pneumonia, and positive nucleic acid test results for SARS-CoV-2.

3. Initial presentation may include fever or no fever, aversion to wind and cold, fatigue, cough with copious or scanty sputum, heaviness and pain in the head and body, shortness of breath, dry mouth, fullness and distension in the epigastrium, or loose stools; the tongue is red, with a white, yellow, or greasy coating, and the pulse is slippery and rapid.

2. Refer to proprietary Chinese medicines

Intravenous infusion: Tanreqing Injection, Xuebijing Injection, Reduoning Injection, and others.

Oral administration: Xin Xue Granules, Zixue Dan, Jinhua Qinggan Granules, Lianhua Qingwen Granules (capsules), and others.

The following symptoms are applicable:

Fever, chest tightness and shortness of breath, dyspnea, cough with scanty, sticky sputum, fatigue and weakness, dry mouth with decreased thirst, distension and fullness of the epigastrium and abdomen, nausea and vomiting, constipation or loose, unformed stools, red or dark-red tongue, yellow and greasy coating, and slippery, rapid pulse.

3. Refer to proprietary Chinese medicines

Intravenous infusion: Xuebijing Injection, Tanreqing Injection, or Shenmai Injection, Shenfu Injection, etc.

Oral administration: For patients with delirium and high fever, add Angong Niuhuang Wan or Suhe Xiang Wan, among others.

The following symptoms are applicable:

Dyspnea, chest tightness or pain, wheezing and shortness of breath, dry cough with scant sputum, fatigue, weak and low voice, restlessness and agitation, in severe cases even confusion and delirium, cold sweats and cold extremities, purplish-dark lips, a dark-red tongue with yellow, greasy coating, and a deep, fine, almost imperceptible pulse.

4. Refer to proprietary Chinese medicines

Bailing Capsules, Jinshuibao Capsules, Huaiqihuang Granules, and others.

The following symptoms are applicable:

Recovery Phase Treatment Plan

Lung-Kidney Deficiency Syndrome

Shortness of breath on minimal exertion, fatigue and weakness, dyspnea, and spontaneous sweating. The tongue is pale red with tooth marks along the edges and a thin white coating.

 

To the Municipal Medical Administration Center, the Health Commissions of all districts, and all relevant medical institutions:

To provide guidance for the rational clinical application of traditional Chinese medicine in the prevention and treatment of novel coronavirus pneumonia, our bureau has organized experts to develop the “Beijing Municipal Plan for the Prevention and Treatment of Novel Coronavirus Pneumonia with Traditional Chinese Medicine (Trial Version 5).” This document is hereby distributed to you; please implement it accordingly. Should you encounter any issues or have any suggestions during implementation, please promptly submit your feedback to the Medical Administration Division of our bureau.

Contact persons: Mu Qianqian and Lin Wenhui

Contact numbers: 83970015, 83970039

Email: zyjyzc@zyj.beijing.gov.cn

Attachment: Traditional Chinese Medicine Prevention and Treatment Protocol for Novel Coronavirus Pneumonia in Beijing (Trial Version 5)

Beijing Administration of Traditional Chinese Medicine

June 14, 2020

Attachment

Traditional Chinese Medicine Prevention and Treatment Protocol for Novel Coronavirus Pneumonia in Beijing

(Provisional Version 5)

At present, the global situation regarding the novel coronavirus pneumonia (hereinafter referred to as COVID-19) remains grave, and recent local cases have emerged in Beijing. To further enhance the precision and standardization of TCM-based treatment for COVID-19, promote collaborative efforts between TCM and Western medicine to improve cure rates and reduce mortality, and build on the experience gained from earlier TCM interventions, the “Beijing Municipal Plan for TCM Prevention and Treatment of Novel Coronavirus Pneumonia (Trial Version 4)” has been revised to produce the “Beijing Municipal Plan for TCM Prevention and Treatment of Novel Coronavirus Pneumonia (Trial Version 5).” Clinical practitioners at all medical institutions may refer to the principles set forth in this plan when conducting syndrome differentiation and individualized treatment, as well as for preventive measures.

I. Etiology and Pathogenesis in Traditional Chinese Medicine

This disease falls under the category of “epidemic diseases” in traditional Chinese medicine. Pathogenic factors such as damp-toxin and epidemic miasma enter the body through the mouth and nose, obstructing the lungs and impairing the spleen. Clinically, patients may present with fever, cough, fatigue, loose or unsatisfactory stools, and in severe cases, shortness of breath. In some patients, dampness transforms into heat, which obstructs the lungs, leading to high fever, wheezing, and other critical manifestations; ultimately, this may result in a dangerous condition characterized by deficiency of vital qi, invasion of pathogenic factors, internal obstruction, and external collapse. During the recovery phase, patterns such as dual deficiency of qi and yin, insufficiency of the lung and kidney, and blood stasis obstructing the collaterals may be observed.

II. Clinical Treatment Protocol

(1) Traditional Chinese Medicine Treatment Protocol for Medical Observation Cases/Medical Isolation Cases

【Indications】Indicated for close contacts of confirmed COVID-19 patients who are currently under medical observation or medical isolation.

【Treatment Principle】Aromatic Damp-Drying, Qi-Boosting, and Detoxification

【Reference Formula】

9 g of raw Astragalus, 9 g of Glehnia root, 9 g of Anemarrhena, and 9 g of Forsythia.

Atractylodes rhizome 9 g, Perilla leaf 6 g, Agastache 6 g, Peppermint 3 g (added last).

Decoct in water to obtain 200 mL, to be taken orally once daily. Children who have had close contact with COVID-19 patients may, at the physician’s discretion, be administered the medication according to the adult regimen.

[Reference Traditional Chinese Patent Medicines]

Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, and others.

(II) Traditional Chinese Medicine Treatment Protocol for Confirmed Adult Cases

1. Syndrome of External Invasion by Pathogenic Factors

【Symptoms】Applicable to cases with no obvious clinical symptoms, no radiological evidence of pneumonia, and positive nucleic acid test results for SARS-CoV-2.

【Treatment Principle】Aromatize to transform damp-turbidity, resolve toxicity, and expel pathogenic factors.

【Reference Formula】

Atractylodes rhizome 10 g, Saposhnikovia root 10 g, Agastache herb 10 g, Honeysuckle flower 15 g

10 g of raw licorice, 10 g of perilla leaves, 15 g of scutellaria, and 15 g of raw astragalus.

Ophiopogon japonicus 10g

Decoct in water to yield 400 mL; take 200 mL each time, twice daily by mouth.

[Reference Traditional Chinese Patent Medicines]

Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, and others.

2. Syndrome of Epidemic Toxin Invading the Lungs

【Symptoms】At onset, there may be fever or no fever, aversion to wind and cold, fatigue, cough with copious or scanty sputum, heaviness and pain in the head and body, shortness of breath, dry mouth, fullness and distension in the epigastrium, or loose stools; the tongue is red, with a white, yellow, or greasy coating, and the pulse is slippery and rapid.

This finding is observed in mild cases and some ordinary-type cases.

【Treatment Principle】Transform Dampness, Disperse the Lungs, Support the Upright Qi, and Resolve the Pathogenic Factors

【Reference Formula】

10 g of processed Ephedra, 9 g of stir-fried Apricot Kernel, 15 g of Scutellaria, and 10 g of Anemarrhena.

White cardamom 6 g (crushed), raw coix seed 30 g, atractylodes rhizome 10 g, honeysuckle flower 15 g.

Forsythia fruit 15 g, Agastache rugosa 10 g, Astragalus root 10 g, Ophiopogon japonicus 15 g.

[Adjustments] For severe fever, add 30 g of raw gypsum (decocted first), 15 g of Artemisia annua, and 15 g of Bupleurum; for greasy tongue coating, add 10 g of Eupatorium fortunei, 10 g of Citrus peel, and 10 g of Perilla stem; for patients with diarrhea, omit Anemarrhena and add 9 g of Coptis.

[Reference Traditional Chinese Patent Medicines]

Jinhua Qinggan Granules, Lianhua Qingwen Granules (Capsules), Shuanghuanglian Granules (Oral Liquid), Qingkailing Capsules, Shema Oral Liquid, and others.

3. Syndrome of Epidemic Toxin Obstructing the Lungs

【Symptoms】Fever, chest tightness and shortness of breath, dyspnea with wheezing, cough, sticky but scanty sputum, fatigue and weakness, dry mouth with decreased thirst, distension and fullness in the epigastrium and abdomen, nausea and vomiting, constipation or loose, unformed stools, red or dark-red tongue, yellow and greasy coating, and slippery, rapid pulse.

This finding is observed in severe cases and some mild cases.

【Treatment Principle】Disperse the Lung, relieve wheezing, cool the Blood, and detoxify.

【Reference Formula】

Raw gypsum 45 g (decocted first), processed ephedra 10 g, apricot kernels 10 g, honeysuckle 15 g.

10 g of stir-fried Anemarrhena rhizome, 30 g of water buffalo horn slices, 10 g of Zhejiang Fritillaria bulb, and 30 g of Trichosanthes fruit.

Earthworm 20 g, Houttuynia seeds 15 g, Red Peony Root 20 g, Raw Astragalus 20 g

Rehmannia root 30 g, Moutan bark 15 g

[Adjustments] For marked shortness of breath and fatigue, add 10 g of American ginseng; for constipation, add 10 g of raw rhubarb (to be added last) and 15 g of magnolia bark.

[Reference Traditional Chinese Patent Medicines]

Intravenous infusion: Tanreqing Injection, Xuebijing Injection, Reduoning Injection, and others.

Oral administration: Xin Xue Granules, Zixue Dan, Jinhua Qinggan Granules, Lianhua Qingwen Granules (capsules), and others.

4. Internal Closure and External Deficiency Syndrome

【Symptoms】Dyspnea, chest tightness or chest pain, wheezing and shortness of breath, dry cough with scant sputum, fatigue, weak and low voice, restlessness and agitation, in severe cases even confusion and delirium, profuse sweating with cold extremities, purplish-dark lips, a dark-red tongue with yellow, greasy coating, and a deep, fine, almost imperceptible pulse.

This finding is observed in critically ill cases.

【Treatment Principle】Transform turbidity, open obstructions, tonify qi, and consolidate the vital essence.

【Reference Formula】

30 g of sun-dried ginseng, 30 g of raw astragalus, 15 g of black processed aconite slices (decocted first), and 30 g of salvia.

Ophiopogon japonicus 30 g, Curcuma wenyujin 10 g, Pheretima 15 g, Panax notoginseng tuber 9 g.

Semen Lepidii 15 g, Atractylodes lancea 15 g, Polyporus 30 g, Paeonia lactiflora 15 g

[Adjustments] For severe shortness of breath and fatigue, add 30 g of Cornus fruit; for constipation, add 15 g of Citrus aurantium immaturus, 10 g of raw Rheum palmatum (to be added last), 15 g of Scrophularia ningpoensis, 30 g of Ophiopogon japonicus, and 15 g of Rehmannia glutinosa.

[Reference Traditional Chinese Patent Medicines]

Intravenous infusion: Xuebijing Injection, Tanreqing Injection, or Shenmai Injection, Shenfu Injection, etc.

Oral administration: For patients with delirium and high fever, add Angong Niuhuang Wan or Suhe Xiang Wan, among others.

(3) Traditional Chinese Medicine Treatment Protocol for Confirmed Pediatric Cases

1. Syndrome of Pathogenic Toxin Accumulating in the Lungs

【Symptoms】Initial presentation includes chills, fever, cough, dry and sore throat, nausea and vomiting, poor appetite, constipation, a slightly red tongue tip, thick white coating on the tongue, a floating and rapid pulse, and a red fingerprint.

【Treatment Principle】Clearing heat, detoxifying, transforming dampness, and dispersing the lungs.

【Reference Formula】

4 g of炙麻黄, 20 g of raw gypsum (decocted first), 9 g of知母, and 10 g of杏仁.

10 g of Coix Seed, 10 g of Phragmites Rhizome, 6 g of Platycodon Root, and 10 g of White Mulberry Bark.

Honeysuckle 10g, Agastache 10g

2. Syndrome of Epidemic Toxin Obstructing the Lungs

【Symptoms】High fever, cough, rapid and coarse breathing, yellow sputum, possibly accompanied by constipation, thirst and dry throat, red tongue with yellow coating, floating, slippery, and rapid pulse, and purple fingerprint.

【Treatment Principle】Transform turbidity, open obstructions, nourish yin, and clear heat.

【Reference Formula】

4 g of炙麻黄, 20 g of raw gypsum (decocted first), 9 g of知母, and 10 g of杏仁.

10 g of raw coix seed, 10 g of whole trichosanthes fruit, 5 g of prepared rhubarb, and 10 g of ophiopogon.

Levisticum seeds 6 g, water buffalo horn slices 10 g, earthworm 10 g, ginseng 6 g.

This formulation is indicated for children aged 5 to 10 years; for patients outside this age range, the dosage should be adjusted as appropriate based on age and clinical condition.

(4) Recovery Phase Treatment Plan

1. Syndrome of Both Qi and Yin Deficiency

【Symptoms】Fatigue and lack of energy, spontaneous sweating, palpitations, poor appetite, dry mouth and throat, a red tongue with little body fluid or a tender, red tongue, and a yellow or slightly greasy coating.

【Treatment Principle】Tonify the Lung, Benefit Qi, Nourish Yin, and Moisturize Dryness

【Reference Formula】

Adenophora root 15 g, Ophiopogon root 15 g, Astragalus root 15 g, Shenqu 20 g.

Red Peony Root 15 g, White Mulberry Bark 15 g, Lycium Bark 15 g, Citrus Aurantium Peel 10 g

Artemisia annua 15 g, Rehmannia root 15 g

【Adjustments】For shortness of breath and wheezing, add 10 g of Schisandra; for irritability and insomnia, add 15 g of fried Ziziphus jujuba seed; for deficiency of both Lung and Spleen Qi presenting as poor appetite and loose stools, add 15 g of Codonopsis pilosula, 15 g of Poria, 9 g of Pinellia ternata, 10 g of Citrus reticulata pericarpium, and 6 g of Glycyrrhiza.

[Reference Traditional Chinese Patent Medicine] Shengmai Yin.

2. Lung-Kidney Deficiency Syndrome

【Symptoms】Shortness of breath on exertion, fatigue and weakness, and spontaneous sweating. The tongue is pale red with tooth marks along the edges and a thin white coating.

【Treatment Principle】Nourish the Spleen to Generate Metal and Tonify the Kidneys to Collect Qi

【Reference Formula】

10 g of ginseng, 20 g of cornelian cherry, 15 g of prepared rehmannia root, and 15 g of Chinese yam.

Moutan bark 10 g, Poria 15 g, Alisma 15 g, Goji berries 10 g.

30 g of Agrimonia pilosa, 15 g of Achyranthes bidentata, and 15 g of stir-fried Atractylodes macrocephala.

[Reference Chinese patent medicines] Bai Ling capsules, Jin Shui Bao capsules, and Huai Qi Huang granules may be selected.

3. Phlegm-Stasis Obstructing the Collaterals Syndrome

【Symptoms】Shortness of breath, chest tightness, cough, scanty sputum, a red or dark tongue, and a slightly greasy coating.

Observed in cases where pulmonary radiographic lesions have not completely resolved during the recovery phase.

【Treatment Principle】Activating blood, resolving stasis, transforming phlegm, and eliminating dampness.

【Reference Formula】

Salvia miltiorrhiza 15 g, stir-fried coix seed 30 g, codonopsis root 15 g, glehnia root 15 g.

Peach kernel 6 g, Trichosanthes fruit 20 g, Magnolia bark 10 g, Reed root 30 g.

Patrinia herb 30 g, Fritillaria thunbergii bulb 10 g

(5) Other Treatments

All of the above conditions can, under the guidance of a physician, be managed through acupoint patching, acupuncture, Baduanjin, Tai Chi, breathing and movement exercises, Qigong rehabilitation, physical exercise, psychological counseling, music therapy, and other approaches.

(6) For individuals who remain positive for SARS-CoV-2 nucleic acid over a prolonged period, or who experience recurrent positivity, treatment should be tailored to the specific clinical condition by reinforcing vital energy and eliminating pathogenic factors, in accordance with syndrome differentiation and individualized therapeutic principles.

III. Guiding Principles for Prevention in Traditional Chinese Medicine

(1) Preventive Traditional Chinese Medicine Prescription for Adults

[Preventive Formula No. 1] is intended for the prevention among the general adult population during epidemic periods.

Ophiopogon 3 g, Pseudostellaria 6 g, Chrysanthemum 3 g, Agastache 6 g.

Perilla leaf 6g

Take the above five ingredients as a tea substitute; or decoct in water to obtain 200 mL, to be taken orally once daily; or use the granule formulation according to the instructions. Continuous use for up to 6 days is permissible.

[Preventive Formula No. 2] is intended for prevention among individuals with chronic underlying conditions during epidemic periods, as well as among those undergoing home or centralized quarantine for medical observation and their management personnel, and among frontline clinical healthcare workers.

9 g of raw Astragalus, 9 g of Glehnia root, 9 g of Anemarrhena, and 9 g of Forsythia.

Atractylodes rhizome 9 g, Perilla leaf 6 g, Agastache 6 g, Peppermint 3 g (added last).

Decoct the above eight herbs in water to obtain 200 mL, to be taken orally once daily; or use the granular formulation as directed in the package insert. Continuous use for up to 6 days is permitted.

(2) Traditional Chinese Medicine Preventive Prescriptions for Children

[Preventive Formula] Used for the prevention of common childhood illnesses during epidemic periods.

Honeysuckle 3 g, Phragmites rhizome 6 g, Perilla leaf 3 g

The above three ingredients may be used as a tea substitute or decocted in water and taken orally. The dosage specified herein is suitable for children aged 5 to 10 years; for children outside this age range, the dosage should be adjusted appropriately based on age and body weight. The preparation may be taken continuously for 6 days.