Q1: A patient of mine was suspected of having coronavirus (there was contact with confirmed case). After treatment with Chinese medicine, all symptoms disappeared, left only occasionally cough, but with pain in the liver and spleen area. Scrapping and hot compress are recommended, but cough still repeats itself. Today, the patient has dry stools and colic (the patient has had cystitis cured a month ago). Due to inconvenient transportation, we can only do our best with what we already have. Could Dr. Dong give us some advices?
——Portugal Health land, Wang Ke
Dr. Dong Shanjing: I think this patient first has a history of contact with a diagnosed COVID-19 patient, then we cannot rule out the possibility that this patient is a confirmed COVID-19 patient. If conditions permit, it is best to determine whether he is a confirmed COVID-19 patient through his clinical manifestations, blood tests, imaging examination, and nucleic acid tests. Once he is confirmed a COVID-19 patient, you should pay special attention to protection during external treatment methods such as Chinese medicine or acupuncture. For example, when doing operations like scraping, the risk of infection is very high if the doctor does not take good protection.
From the patient's tongue coating, we can see that the first one is white and greasy, which shows the invasion of pathogenic cold and dampness. There is no mention of initial symptoms of the patient, but from the description, there should also be symptoms such as cough, fatigue, fever, etc. After treatment, these main symptoms of cough or other serious symptoms are relieved, but occasional coughing shows that it has not been cured.
In the second one, the tongue body is fat and tongue coating is yellowish and greasy, that is to say, the disease (not cured) turns into heat, and the tongue coating shows the sign of damp heat. The patient came to see a doctor today with main symptoms of dry stool and abdominal pain.If the patient cannot go to the hospital or clinic for treatment, we suggest to use simple methods to guide the operation. For example, by pressing the acupoints such as Zhigou(SJ6), Hegu(LI4), Tian Shu(ST25), Zusanli(ST36) and Taichong(LR3). These acupoints can be selected to moisten the bowels and smooth the qi. For dry stool, you can also use massage manipulation. Put one hand on top of the other on the navel and massage clockwise to promote the excretion of stool and give some relief from abdominal pain.
Q2: COVID-19 Rehabilitation Clinics have been established in Wuhan. What are the main symptoms of the patients in the recovery period? Did you treat them only with Chinese medicine? How long is the treatment? Please introduce your experience. Thank you!
Dr Zhou Zhongyu: In our Hubei Provincial Hospital of Traditional Chinese Medicine, it is also the designated hospital for the rehabilitation of COVID-19. In the recovery stage, the main symptoms of those patients coming to our hospital are chest tightness and palpitation, followed by symptoms such as fatigue, night sweat, spontaneous sweat, insomnia and epigastric discomfort. These are the main symptoms. In terms of treatment, our rehabilitation clinic is mainly based on pure Chinese medicine, and we adopt MDT mode, that is, multi-disciplinary team cooperation mode. The treatment uses integrated therapies such as Chinese medicine, acupuncture, auricular acupuncture, acupoint application, psychological counseling intervention, and traditional methods.
According to the actual situation of the patient, generally a course of treatment is about two weeks, we will adjust as the patient's symptoms improve. For the COVID-19 patients in the recovery period, if he(she) lives far away and the cost of medical treatment is high, we often give him(her) some long-term treatments, such as Chinese medicine for 10 to 14 days. In addition, we will also guide the patient do moxibustion at home with an one-on-one online management between doctors and patients through the platform of the internet. The methods of "one medicine, one moxibustion, one function and one bath", that is, Chinese medicine, moxibustion, traditional exercise and foot bath therapy, are the most commonly used treatment method in our rehabilitation clinic.
Q3: Is there any difference between diarrhea symptoms in patients with COVID-19 and that caused by common cold? What are the similarities and differences in treatment? Besides, how TCM doctors distinguish COVID-19 from flu and cold? Was there a blank control group when using moxibustion to treat diarrhea in COVID-19 patients?
——member of CAAM
Dr. Dong Shanjing: There should be little difference between the diarrhea symptoms of COVID-19 patients and the diarrhea caused by the common cold in terms of clinical accompanying symptoms, the frequency of diarrhea and the characteristics of stool, but there should be some differences in treatment and TCM pathogenesis. Because COVID-19 is epidemic caused by cold, dampness and toxin, the disease is more ferocious, there are few exterior lung symptoms, but more spleen deficiency symptoms manifested by the straight attack of the pestilence to Taiyin (spleen). That is, the symptoms of diarrhea is caused by spleen dysfunction. However, the symptoms of common cold are mainly lung-defense exterior syndrome and Taiyang syndrome, then merged with Yangming syndrome. So there are differences in pathogenesis and treatment between them. For the diarrhea caused by COVID-19, the main treatment is strengthening the spleen to dissipate dampness, and warming yang to disperse the cold. While for diarrhea caused by the common cold, it is mainly concerned with relieving the heat or dispelling cold, of course, the symptoms of diarrhea must also be considered. This is about the symptoms of diarrhea, the pathogenesis of traditional Chinese medicine and the difference in treatment.
In addition to diarrhea symptoms, COVID-19, flu, and common cold are all respiratory diseases, and there are certain differences. First of all, the difference between common cold and flu, common cold mainly shows upper respiratory symptoms, such as nasal congestion, runny nose, sneezing and other catarrhal symptoms, as well as some mild cough and low fever, which is not contagious. There is no serious headache, the general condition and the prognosis is better, and it is basically not contagious.
Compared with the common cold, flu is more severe, with more serious symptoms, stronger oncoming force and faster progress. There will be a high fever, cold, headache, fatigue and other obvious symptoms, at the same time can be accompanied by cough and chest tightness. In the early stage of COVID-19, fever, fatigue, and dry cough are the main manifestations. It is not distinguishable from common cold in terms of symptoms. The symptoms of COVID-19 patients are generally mild in the first few days. Often after a week of onset, the condition will suddenly worsen, with symptoms such as chest tightness and asthma. Also of particular concern is whether people in contact with the same symptoms. And special attention should be paid to whether the people in contact also have the same or similar symptoms.
Regarding the use of moxibustion in the temporary hospital to treat diarrhea symptoms in COVID-19 patients, we did not set up a control group. The diarrhea patients we treated were compared before and after moxibustion, and there was indeed a significant effect.
Q4: How is the effect of moxibustion on fever, fatigue, dry cough and other symptoms?
Director Dong Shanjing: It is said that the main symptoms of COVID-19 are fever, fatigue and dry cough. If moxibustion can treat those similar symptoms, it means that it will have a pretty curative effect on COVID-19. The patients in the Module Hospital are mainly diarrhea. Of course, from the perspective of etiology, pathogenesis and pathology, the etiology and pathogenesis are cold-damp pestilent toxin impairing lungs. So we can use the moxibustion to warm yang and consolidate body resistance, remove cold and warmly dredge the body to deal with the pathogenesis of cold-damp. According to previous experience, the patients were treated in Dazhui (GV14), Fengmen (BL12), Feishu (BL13), Guanyuan (CV4), Qihai (CV6), Zusanli (ST36) and other parts, and corresponding symptoms like cough were improved. These require us to conduct systematic research. There are still many patients with COVID-19 in the world and we can have further study and discuss in the future.
Q5: Now the confirmed cases in China are basically cleared, but there are some asymptomatic cases. Improving self-immunity is particularly important. In Wuhan, what preventive measures have you made for front-line medical workers to improve their resistibility?
——member of CAAM
Director Zhou Zhongyu: What we usually called immunity or resistance is actually healthy qi in TCM theory—improving immunity is equals to enhance healthy qi. Whether a person will fall sick or not is related to his own constitution—it is said that where healthy qi stored in bodies, the pathogenic qi won’t intervene, and where pathogenic qi gathers, the healthy qi there is rare (huangdi neijing). Ancient literature research, experimental mechanism and clinical practice all showed that moxibustion can improve human bodies’ healthy qi and their ability to resist diseases and pathogens.
At the initial time of the epidemic, our hospital set up a moxibustion physiotherapy room targeting doctors and nurses with yang deficiency and cold-damp constitution to develop yuan qi and stimulate the bodies by moxibustion in Shenque (CV8), which can raise yang, warm channel for dispelling cold and promote healthy qi to play a role in prevention and health care. We also have developed the home care moxibustion program of COVID-19 protection, aiming at guiding people to do moxibustion and point selection, and matters for attention, etc. Moxibustion can remove dampness and improve yang qi, we hope that in this way it will assist to prevent the disease. For the frontline staffs who cannot use fire moxibustion, we gave out moxibustion stick we developed, which was convenient and possessed effect of heat and medicine, to indicate them apply it at home according to the points. Additionally, our hospital also distributed tea balls to prevent pneumonia for the frontline personnel. Meanwhile, we attach significant attention to their mental health and psychological counseling—there are special psychologists participating in anti-epidemic teams. The above several measures can the promotion of healthy qi to achieve the effects of storing healthy qi and banish pathogenic qi.
Q6: Moxibustion, especially Artemisia Argyi, sulfur, Rhizoma Atractylodis, calamus, rhubarb, and other household smokes have a good anti-plague effect from the ancient times. Now that China has achieved staged victory against coronavirus, while the overseas pandemic is still grim. I would like to know that, how to guide the public to carry out simple and efficient moxibustion to prevent the virus and its precautions?
——Chinese Traditional Massage Acupuncture Association (Mauritius)
Director Dong Shanjing: It is actually two questions. The first question is how to use Artemisia Argyi, Rhizoma Atractylodis, sulfur, calamus, rhubarb, and other household smokes have a good anti-plague effect. These effective experiences and methods are summarized by ancient people by fighting against epidemics. In the past, we hung Artemisia Argyi in front of the door to drive away evil, and burning Artemisia Argyi to dispel filth with aroma. Just now I mentioned that in Module Hospital or any other hospitals can use Artemisia Argyi to dispel filth with aroma. In a relatively confined space like Module Hospital, 84 Disinfectant pnly kills the surface of the object and the ground rather than the air, while Artemisia Argyi and Calamus should work in a certain extent. But the environment of Module Hospital is not suitable to burn it. So how to disinfect the room in our daily life? Artemisia Argyi or its tomentum is appropriate. Place it in a metal vessel to burn and close the window. Get out of the room and open the window after 30 minutes, so as to dispel filth with aroma.
The second question is how to use warm moxibustion in health care. “excessive fire takes away qi, while less fire multiply qi” (Annotations on ‘The Yellow Emperor’s Inner Classic’) and “general acupuncture treatment must have enough fire and qi, in order to recover” (Golden Mirror of the Medical Tradition) are two aspects. The first aspect is we are supposed to differentiate according to patients’ constitutions, and secondly, therapeutic effect should be achieved when applying moxibustion. If the patient belongs to yang excessiveness, do not use too strong moxibustion for it is warm treatment; if the patient belongs to deficient and cold constitution, use strong and long time moxibustion. So according to the patients’ different constitutions, apply different treatment—they relate to each other. As for COVID-19, which is strongly communicable, everyone is susceptible to it. Therefore, Chinese medicine has put forward some suggestions on how to protect people at home. For instance, “where healthy qi stored in bodies, the moxibustion in Zusanli (ST36), Guanyuan (CV4), Qihai (CV6), Dazhui (GV14) and other points to improve our immunity, enhance resistance, so as to avoid the invasion of the epidemic.