This article describes what knowledge TCM practitioners in German-speaking countries had about Covid-19 by March 10, 2020, and what therapeutic measures are being taken to prevent and also treat initial symptoms of Covid-19. How have European TCM practitioners interpreted and applied the experience of Chinese medical experts who designed treatment protocols during the outbreak in Wuhan?¹

The Medical Treatment Unit of Wuhan’s Covid-19 Prevention and Control Headquarters issued a “Notice Regarding the Agreement to Recommend the Use of Chinese Medicine in the Treatment of Pneumonia Due to Infection from the Novel Coronavirus” (Chen and Hsu 2020; regularly updated here). This Notice was quickly distributed among TCM practitioners in German-speaking countries. It instructed all designated medical institutions in Wuhan to ensure that all infected patients took TCM formulas (in the form of decoctions or granules) before midnight on February 3, 2020. A collaboration between biomedicine and TCM was undoubtedly welcome news, especially as the results from the frontline in Wuhan have been promising. Patients in Europe inquired about methods of preventing Covid-19, since conventional medical treatment was symptomatic rather than curative, and there is no vaccine yet available.

Another source of information that quickly spread among TCM practitioners in Europe was an interview with Liu Qing-Quan, a TCM practitioner and scholar who led a nationwide team of Chinese medical experts in designing a treatment protocol for SARS-CoV-2. Accordingly, on January 21, 2020, the head of the Beijing Chinese Medical Hospital, Liu Qing-Quan, and the head of the China Academy of Chinese Medical Sciences Guang An Men Hospital Emergency Department, Qi Wensheng, arrived in Wuhan as part of the first delegation of Chinese medical specialists. They were appointed by the National Administrative Bureau of Chinese Medicine and the National Health Bureau to take part in the frontline battle against the coronavirus.

They came to the conclusion that from a TCM perspective the cause of this disease is primarily “dampness.” Dampness obstructs the spleen and blocks the lung (湿困脾 闭肺), upbearing and downbearing qi dynamics are disrupted (⽓气机升降失司), damp toxins are converted into heat (yang ming 湿毒化热), brightness bowel repletion develops, damp toxins and stagnating heat are locked in, and with increasing heat comes severe qi reversal (Ning 2020). They selected the formulas called Ma Xing Yi Gan Tang, Sheng Jiang San, Da Yuan Yin, Hou Pu Xia Ling Tang, Huo Xiang Zheng Qi San, and Yin Qiao San (⿇麻杏薏⽢甘汤、升降散、达原饮、厚朴夏苓汤、藿香正⽓气散、银翘散等⽅方剂为基本 ⽅方) as the base formulas and implemented a Chinese medicine treatment protocol.

At the time of the early outbreak in Wuhan and in the fight against the cases of pneumonia caused by SARS-CoV-2 (then still called 2019-nCoV) infection, the Hubei Provincial Hospital of Traditional Chinese Medicine collaborated with relevant departments to study and formulate programs for preventing and treating Covid-19-related pneumonia, which TCM practitioners would express using the term “damp heat in the lungs.” Below is the recently developed TCM formula and the related acupuncture and moxibustion protocols for the prevention of Covid-19 symptoms. Herbs, moxa, and acupuncture are used in combination for two reasons. First, they can be implemented relatively easily on a large scale (unlike, for example, individual nutritional advice or massage). Second, they are considered to improve symptoms especially in their combination. As I understand, this formula is based on Yu Ping Feng San—Jade Windscreen Powder (玉屏風散) by Zhu Dan-Xi (1281–1358), to which the last four ingredients are added:

TCM Formula: Pneumonia Prevention #1 (肺炎预防1号)

Huang Qi 黄芪 (Radix Astragali) 15g
Bai Zhu 炒白术 (Rhizoma Atractylodis Macrocephalae), dry-fried 10g
Fang Feng 防风 (Radix Saposhnikoviae) 10g
Mian Ma Guan Zhong 贯众 (Rhizoma Dryopteridis) 10g
Jin Yin Hua 金银花 (Flos Lonicerae Japonicae) 10g
Chen Pi 陈皮 (Pericarpium Citri Reticulatae) 6g
Pei Lan 佩兰 (Herba Eupatorii) 10g

In addition to this particular formula, Chen (2020) recommends acupuncture and moxa treatment for suspected Covid-19 cases in order to strengthen the immune system, to help alleviate early symptoms, and to shorten the duration of the virus in the body. The points for both moxa and acupuncture are as follows: Bilateral Zusanli (ST 36), Qihai (CV 6) and Zhongwan (CV 12). Method and frequency: Moxa applied to the point Zusanli (ST 36) on both sides for 15 minutes. Moxa applied to the point Qihai (CV 6) or Zhongwan (CV 12) for 10 minutes (alternating from treatment to treatment). The moxa should be given twice a day, once in the afternoon and once at night.

In Austria there was a great demand for this combined treatment regime of herbs, moxa, and acupuncture. Thus, the herb Pei Lan 佩兰 (Herba Eupatorii) was already unavailable on March 9, 2020, and further deliveries were not expected until two weeks later. A group of doctors of the ÖAGTCM (Austrian Educational Society for Traditional Chinese Medicine) held a meeting on March 3, 2020, where they reformulated the above-mentioned formula with herbs in good, tested quality, and easily available in European pharmacies. The reformulation method was two-fold: the effect of the TCM formula as a whole and the effects of its individual ingredients were analyzed in terms of the flavor and nature of the herbs. Then, substitutes from herbs available in Europe were chosen to create a local formula that works in a similar way to the TCM formula:

Angelica root (Radix Angelicae Archangelicae) 4g
Common Yarrow (Herba Millefolii) 4g
Wild Pansy (Herba Violae) 4g
Coneflower (Radix Echinaceae) 3g
Marigold (Flos Calendulae) 3g
Wormwood (Herba Absinthii) 1g
Mandarin peel (Pericarpum Citri Reticulatae) 5g

This formula quickly became widespread and was supplied by numerous European pharmacies as a preventive measure. TCM practitioners in German-speaking countries came to the conclusion that TCM is not only suitable for the prevention of pneumonia due to viral infections, but can also support infected patients before getting symptomatic biomedical treatment in a hospital. According to Gunter Neeb (2020), centuries-old experience combined with modern experience is the best of both worlds for the benefit of patients. Thus integrating biomedicine and TCM can contribute to the well-being of Covid-19 patients.

Notes

1. For a translation of Beijing’s fifth edition of a new coronavirus pneumonia diagnosis and treatment plan, which was introduced to most TCM physicians in German-speaking countries for the first time by John Chen and Lori Hsu (2020), see Xin and Hsu, this series.