關於 甘草乾薑湯劑量 ，我們在網路上蒐集到這些相關的討論、資訊與評價

老實說，受西方醫學教育的我本來並不清楚生化湯到底是什麼成分。參考羅珮琳中醫師的文章發現，標準的生化湯主要為當歸、川芎、桃仁、炮薑、炙甘草，而各家配方、劑量稍有不同，也另有其他加減的處方如紅花、澤蘭。而服用生化湯的目的，不外乎大抵包括兩個：幫助排出惡露、補血養氣。

＊＊惡露並非髒血，且會自然排出

先釐清一下，到底什麼是惡露。過去，大家並不清楚什麼是惡露，也無從得知惡露是否排乾淨，許多人甚至認為惡露是在子宮內累積九個多月的髒血，排出的量越多，代表髒污清除得越乾淨。也因此，才會想靠著生化湯來幫助惡露的排出。

其實，惡露並非什麼髒血，而是胎盤剝離後、子宮內壁截斷的血管產生的血球組織和子宮內膜。產後，子宮會慢慢收縮、變小回到骨盆腔，這個收縮的力量一方面可幫助惡露的排出，一方面也可透過收縮，達到止血的效果。

因此子宮收縮是否良好、子宮縮小的速度、惡露排出的量是否正常，都是產後恢復的重要指標。而在胎盤分娩出來後，產科醫師通常也會使用子宮收縮劑、子宮按摩等來加強宮縮。此外，當媽媽開始哺餵母乳時，也會刺激腦部分泌天然催產素，幫助子宮收縮。

想知道惡露或胎盤組織有沒有排乾淨，可利用超音波來判斷。絕對不是量越多越乾淨。一般來說，生產後的三到四天，惡露呈鮮紅色，兩週左右開始變少、且轉成淡粉、咖啡色，約六週後，漸漸停止。

如果發現產後子宮收縮不良，醫師就會持續給予子宮收縮劑。因為如果惡露排得太慢積在子宮腔內，反而會反過來影響子宮收縮能力，惡性循換下，可能使得胎盤剝離後的出血面無法收縮止血，造成產後大出血。

生化湯中的當歸，的確也可促進子宮收縮、幫助惡露排出，但從上面的討論可知，�其實，透過產婦自然的生理機制與現代醫療的輔助，在產後護理階段喝生化湯絕非必要。而如果產婦的子宮收縮功能非常差，光靠生化湯其實效果也有限。

再加上當歸同時也有活血、抑制血小板凝集的效果。如果產婦本身凝血功能差不好、血小板數目偏少，就有可能造成惡露太多，甚至是產後大出血的狀況。

不過對於有些人說，「生化湯是造成產後大出血的主因」，我也要幫生化湯說句公道話。因為產後大出血最常見的原因還是子宮收縮不良、胎盤沒有完整排出，不見得都跟生化湯有關。只是國人習慣在產後十到十四天喝生化湯，剛好也是延遲性產後大出血最常發生的時機，有些產婦剛好喝完生化湯後合併大出血，就很容易將兩者視為因果關係，讓生化湯成了「代罪羔羊」。

＊＊補血養氣，攝取足夠蛋白質、鐵質更有效

至於補血養氣，以我的觀點，月子飲食只需特別留意營養均衡、補充足夠的蛋白質、鐵質（每日45 mg)，只要媽媽本身造血功能正常，自然而然就可以「回血」。如果在懷孕後期就已經發生貧血，或是生產時出血較多，則可以補充鐵劑。
產後傷口不痛，就該下床多活動，可促進血液循環 ,育兒的大小事身邊的伴侶能全力合作，其他人少用過去坐月子的習慣去檢視媽媽的食衣住行， 媽媽自然「神清氣爽」。

綜合以上，我認為產後喝生化湯對於促進產後恢復沒有明顯的助益，就算不喝也可以恢復良好。但如果妳有已知的凝血功能異常，我會建議不要喝，避免增加產後大出血的機率。

有喝過生化湯的媽媽們，來分享自己的經驗吧!!

診所對抗新冠肺炎疫情的現況

從一月下旬開始幫忙河南開封通許縣人民醫院對抗新冠肺炎，經過了許多繁忙緊張的白天與輾轉難眠的黑夜。除了幫助治療確診病人外，參與各方的討論，推展中醫治療新冠肺炎，也遇到及幫忙應付許多非醫學因素的阻力。到了二月底，中國疫情減緩，參與中國抗疫的時間與精力逐漸減少。本來以為可以輕鬆下來，沒想到才進入三月沒幾天，美國疫情開始大爆發。再過來的一個月，美國疫情越演越烈，到現在已經超過三十萬人感染，八千多位病患死亡，目前疫情也還沒有減緩的趨勢！

許多病人及讀者問我，診所如何對抗美國的新冠肺炎疫情，那我們就來談談目前的情況。首先，雖然加州處於「居家避難」（Shelter in Place），診所為醫療機構，依然正常看診。舊金山灣區許多中小型診所都因為害怕被感染而停止看診，那我們會不會擔心？雖然疫情仍未結束，不敢說大話，然而，診所同仁及許多病人告訴我，他們覺得我們診所大概是最安全的地方！除了我們有治癒新冠肺炎重症的經驗，診所每天備有預防中藥茶，讓診所同仁和看診病人飲用，診所也準備了基本治療通方，讓病人及他們親友在來不及看診的情況下，先行服用來試圖減緩病情惡化。診所也嚴格消毒，從桌椅、門把、水龍頭、到所有可能碰到或沾到飛沫的東西，一天消毒好幾次，每間診間在上一位病人看診後，先進行診間消毒，再讓下一位病人看診。診所也有多台UV-C紫外線的空氣過濾機，UV-C紫外線可以破壞病毒RNA結構，達到消毒的作用。另一方面，面對中國全面停工及中美貨運幾乎停止，美國的中藥材存貨已經非常吃緊。診所未雨綢繆，早在一個月前開始大量購入中藥材。許多味重要的中藥材，各個中藥材進口商有多少存貨，我們就購入多少。一百多大箱的中藥材，堆積在診所藥房及走廊上，應該可以應付中藥材的需求好一陣子。

我們如何為新冠肺炎症狀的病人看診？為了保護其他病人及診所同仁，更避免疫情的擴散，無論有沒有確診，有任何新冠肺炎症狀或任何疑慮的病人，一律改為視頻看診。診所已經為美國不同地方的許多病人遠程看診，目前療效很不錯，病例會慢慢整理出來討論，這裡我們先談談一位白人女士的病例。

這位白人女士，40多歲，就住在舊金山灣區。病人自述她本來好好的，開車到超市買食物，買完後推著購物車往停車位置走，突然覺得呼吸困難，身體無力，幾乎要倒在地上。她認知到情況的嚴重性，馬上去舊金山灣區Kaiser Permanente的大型西醫院看診。醫生檢查她後，告訴她幾乎可以確定是新冠肺炎，但Kaiser沒有足夠的核酸檢測盒，無法幫她檢測，而她也還沒有到「非常嚴重」，不能讓她住院，只能給她一些退燒藥、抗生素，要她回家自我隔離。病人回家後，全身無力，整天躺在床上，鼻腔被大量鼻涕痰飲完全阻塞住，不斷的咳嗽，胸口非常緊，呼吸困難，身體多處強烈刺痛，病人用「going through the hell（走進地獄）」來形容。在診所一位舊病人的推薦下，病人毫不猶豫的聯絡診所視頻看診。以我的經驗看來，明顯和美國季節性流感不同，幾乎不需要核酸檢測就知道是新冠肺炎，我依照她的症狀開方，方向還是如我之前文章討論的，以射干麻黃湯、大青龍湯等加減為主。

這位病人服用中藥一天後回報，她說她的症狀開始緩解，咳嗽明顯減少，呼吸比較順暢，身體刺痛減少，讓她立即覺得中藥有效。不過，病人說她服用中藥後，有一種像喝太多咖啡的興奮感，她平時就對咖啡因很敏感，她問我中藥裡是不是有咖啡因。我跟她解釋，應該是中藥方中的麻黃造成她這樣的感覺，要她先改成每次服用半碗，暫時減少身體對麻黃的反應，等一兩天後再看情況調整。

過了兩天，病人再次回報。她說中藥量減到半碗後，不到一天，病情馬上惡化。她說她不想死，管不了什麼像咖啡因過多的興奮感，她毅然決然恢復到每次服用中藥一碗，病情又再度好轉。自從病人視頻看診後，連續服用中藥不到一周，病人告訴我她康復了，所有症狀幾乎都消失了，精神好得很，只有偶而喉嚨有些癢癢的，但完全不礙事。她說她不會回去Kaiser Permanente的大型西醫院看診，那些醫生根本幫不了忙。另外，她特別聯絡了一位在紐約執業的白人中醫師，她說這位白人中醫師在中國學習中醫15年，以前幫她下針解決病痛都挺有效的，她要這位白人中醫師跟我學習如何治療新冠肺炎，讓他在紐約幫助新冠肺炎病患。這位白人中醫師已經來跟我請教，雖然我不確定他是不是真的理解我的解說，只要有中西醫願意學習經典中醫智慧，我都很樂意花時間教導他們。

在這裡對Kaiser Permanente這家大型醫療系統再抱怨一些。另外一位病人，嚴重咳嗽很久，也到Kaiser Permanente的大型西醫院看診。看診的醫生擔心他是新冠肺炎，卻沒有核酸測試盒幫他檢測。不過，這位醫生「聽說」新冠病毒有一段RNA和愛滋病HIV病毒的一段RNA雷同，於是幫這位病人做HIV病毒檢測，希望這樣能確診！還好這位病人HIV病毒檢測結果為陰性，如果檢測結果為陽性，那麼病人到底是新冠肺炎呢？還是有愛滋病？這樣不但沒辦法解決病人的問題，反而大幅增加病人的心理負擔。開半個玩笑，病人回家後是不是要告訴太太：「醫生不確定我為什麼咳嗽，不過醫生要幫我檢查有沒有愛滋病」？

（注：很多人留言或聯絡診所，詢問診所用的預防中藥茶為何。我之前文章及採訪解釋了許多，但為了大家方便，這裡是預防中藥茶配方：桂枝6克、白芍6克、乾薑6克、炙甘草6克、紅棗12克、白朮9克、茯苓9克、豬苓6克、澤瀉9克 - 9碗水大火煮成2碗，早晚各服用一碗，如果經濟負擔重，可以用此方煮成一小鍋藥茶，當成一天的茶飲，全家人隨意分著喝。另外，診所中藥材為高品質，如果買不到高品質的中藥材，藥材劑量得酌量增加。）

(http://andylee.pro/wp/?p=7845)
#當張仲景遇上史丹佛

從非典到新冠肺炎

From SARS to Novel Coronavirus (COVID-19) - English version is in the second half

新冠肺炎，Novel coronavirus (2019-nCoV) 新型冠状病毒肺炎，疫情越來越嚴重，被證實可以人傳人，也在武漢以外的許多地方發現病例，造成世界各國及世界衛生組織（WHO）高度關切，當然也讓很多住在中國大陸及附近區域的華人非常緊張，就好像當年的非典肺炎疫情即將再一次大爆發一樣。

目前，現代醫學還沒有找到治療新冠肺炎的方法，只能針對某些症狀來處理，疫苗的研發更是遙遙無期。怎麼辦？每次遇到這種情況，中醫就會被搬出來，這次也不例外。新冠肺炎爆發後，網上馬上有許多中醫對付新冠肺炎的文章。當然，除非哪位中醫師看過、治好過大量的新冠肺炎病例，所有的討論都是猜想、假設。然而，有些猜想及假設值得參考，有些猜想及假設卻明顯在誤導大眾。

我還沒有治療過新冠肺炎，不能大肆評論。不過，我治好過很多禽流感、豬流感、及每年流感導致的嚴重肺炎及其它病變的病人。其中許多病人是被美國大型西醫院證實為嚴重肺炎，被要求醫院或居家隔離，偷偷溜出來找中醫看診的。也因此許多病人及討論中醫的網站，希望我能針對新冠肺炎發表一些意見。

我們以前就討論過，這些彪悍的流感病毒，經過那麼多年、那麼多次的變種（mutation），每年都不一樣，東漢時期傳下來的經典中醫，根本沒有遇到過現在的病毒，怎麼可能治療如此嚴重的肺炎呢？

中醫從來就不認識病毒，也不從病毒種類的角度來思考。中醫是探討人體受到外界因素破壞，失去平衡後，身體會有哪些現象、哪些反應，根據那些現象、那些反應來調整身體狀況，期待身體能恢復到平衡狀態，把外界因素帶來的破壞減到最小。我打個半開玩笑的比方，警匪槍戰時，我們注意到壞人哪個方向來的火力強大，造成我們部署在哪個位置的警員傷亡，這時我們會趕緊重新部署人員，或者想辦法增派警力，我們大概無暇去管壞人是用哪個牌子的槍、哪個工廠做的子彈！

雖然幾百年幾千年下來，病毒變種等等的外界因素改變了非常多，人體演化的改變卻非常有限。人體的功能，無論是怎麼被破壞的，某項功能被破壞而導致的症狀、反應、後續演變，卻依然有明顯的脈絡可循。也因為如此，在很多情況下，中醫以專注人體本身平衡狀態的治療方式，反而比西醫專注在外來敵人的治療方式來得有效許多。

依據多年累積大量的臨床病例觀察，無論是禽流感、豬流感、還是每年的流感，人體敗壞的進程依然如同傷寒雜病論探討的一樣，非常簡化的說，從一般桂枝湯證、葛根湯證等的表寒，轉變到小青龍湯證等的裡寒，津液不足、水道運化失調而化熱，變成比較嚴重的大青龍湯證，或者更嚴重肺臟的寒熱夾雜，金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇中的射干麻黃證、葶藶大棗瀉肺湯證、澤漆湯證、小青龍加石膏湯證等等混雜出現，搞得亂七八糟，也不再是什麼簡單方劑可以對應的。

然而，雖然進程很像，不同於一般外感的是，這些嚴重流感肺炎病情加重的改變速度快非常多，也來得猛烈頑強很多。一般的外感從桂枝湯證、葛根湯證等轉變到大青龍湯證或更複雜的病情，通常需要一兩週的時間。同時，還得病人自己非常不注意，或者醫生治療錯誤，一般感冒才會沒辦法自己好，反而變成嚴重的病症。這幾年的流感，從一開始覺得不太對勁，到嚴重複雜的病情，只需要三四天，而且有越來越快的趨勢。這大幅提高中醫師治療流感時，判斷功力及敏感度的要求，中醫師必須在許多症狀還沒有出現時，就得抓緊時間，趕緊行動，卻又不能預防過度，反而讓病情加重。換句話說，時機、劑量、藥材比例變得非常重要，稍有不慎，就無法反轉病情。

舉個例子，有些病人得了流感，咳嗽非常嚴重，痰非常多，呼吸困難。依照中醫的辨證，假如一致都是寒，舌苔白、小便清、怕冷等等，本來依照辨證論治，我們可能會開射干麻黃湯加減給病人。然而，因為流感的進程非常快速，中醫師得非常敏感，譬如看到舌苔白卻帶有一絲絲乾的感覺，就很可能得加上大寒的石膏來避免肺喪失津液，卻又不能加太多石膏，以免肺寒加重。又譬如聽到咳嗽聲音非常深沈，從肺的底部發出，又帶有膿痰的濁音，就很可能得加上瀉肺的葶藶來避免肺中水飲、痰飲大幅增加，卻又不能加太多葶藶，以免肺變得太虛弱。

我們回頭來看這次的新冠肺炎。根據有限的資訊，我們知道感染後有大約兩週的潛伏期，這段時間沒有什麼症狀，病人可能只會感到有些疲憊。剛開始發病時，很像一般的感冒，病人會發熱、乏力，並不嚴重，沒有什麼流鼻涕等上呼吸道的症狀，有的甚至沒有發熱。約一半的病人一週多後恢復，另一半的病人卻在一週後出現呼吸困難，有些病人會快速進展為急性呼吸窘迫綜合征、膿毒症休克、代謝性酸中毒、凝血功能障礙等等嚴重的問題，可能導致死亡。

從上面的敘述，我們不難發現，一開始很像一般中醫外感的桂枝湯證、葛根湯證，一半的病人也就自己恢復了，另一半的病人卻出現快速的入裡化熱現象，肺津液迅速流失，非常濃稠的痰飲沈積在肺部下方。同時，中醫認為肺為人體調節津液的源頭，肺金生水，好比天空下雨一般，而當肺的功能及津液調節出現嚴重障礙，很快就會拖累三焦水道、腎臟等的功能，導致上面提到的幾種嚴重病情。換句話說，新冠肺炎可以讓輕微的太陽證外感，迅速發展成嚴重的肺痿肺癰，再進一步瓦解人體其它功能的運作。

怎麼治療？在沒有直接治療武漢肺炎病人的情況下，我們也只能根據有限的資訊來推論，不過，以前大量的流感肺炎治療病例，可以讓我們比較有信心的面對新冠肺炎。當病人已經出現明顯新冠肺炎症狀時，大多已經入裡化熱，嚴重的肺痿肺癰。這個時候，得用大劑量的石膏清肺熱、加強肺津液運作。也得靠葶藶、大戟等把肺下方濃稠的痰飲及胸腔可能的積液去掉，痰飲積液不去，是無法修復肺家津液運作的。同時，肺氣不宣，就好像吸管上頭堵住了，吸管內的水無法上下，我們還得使用麻黃等宣肺、發陽的中藥來配合。另外，肺已經受損了，除了大動作急救外，比較穩定後，還得靠一些潤肺的藥來收尾，讓肺完全恢復。如果我們列一個可能加入的中藥單，大致有石膏、葶藶子、大戟、生半夏、麻黃、射干、紫菀 、款冬花、 生薑、炙甘草、紅棗、麥門冬、杏仁等等。當然，如前面所言，用藥的時機、劑量、藥材比例非常重要，每一個病人的差異也很大，嚴格考驗中醫師的功力與膽識，一旦判斷錯誤，不但沒有效果，反而可能會加重病情。

網上有些中醫師，說新冠肺炎或其它流感肺炎可以用板藍根清熱解毒來治好。也有些中醫師說可以用麥門冬湯等等的輕劑治好嚴重的肺炎。甚至還有些中醫師說多喝綠豆湯可以預防新冠肺炎！其實，真的遇過、治好過禽流感、豬流感等嚴重流感肺炎的中醫師，一看這些文章，就幾乎可以確定這些人根本沒有治療過嚴重肺炎的經驗，充其量只是在西醫治療下，在旁邊幫幫病人一些小忙而已。這樣的情況下，難怪中國政府平時大力推展中醫，真的有如同新冠肺炎這樣重大疫情爆發時，卻看不到中國政府大量使用中醫方法來治療病人、控制疫情。醫學是實戰的學問，沒有大量臨床病例，講得再好聽都是沒有用的，如果希望中醫真的在主流醫學裡站立起來，希望中醫真的能面對大規模的疫情，回歸最基本的臨床療效，才是最重要的，其它都只像是武術表演，而非實際作戰。

From SARS to Novel Coronavirus (COVID-19)

Written in Chinese by Dr. Andy Lee, January 21, 2020
Translated to English by Dr. James Yeh and Dr. Andy Lee, March 28, 2020

The epidemic from Novel Coronavirus is becoming much more serious. Transmissivity among people has been proven. (Note: It's now named COVID–19. The term “Coronavirus” will be used here.) Cases were found in areas beyond Wuhan. It has caused serious attentions from the WHO (World Health Organization) and many countries around the world. The residents in China and the surrounding regions are quite worried and wonder whether it will break out like SARS (2003). (Note: The article was written on January 21, 2020, before Coronavirus became a global pandemic.)

So far, the modern medical field has not found a cure for Coronavirus, but resorts to treating patients’ symptoms only. Any vaccine to treat Coronavirus is still no way in the sight. What do we do? Every time such a situation happens, the topic of using Traditional Chinese Medicine (TCM) is raised (at least among the Chinese communities). There is no exception this time. Many articles related to using TCM on Coronavirus have been popping up on the web. However, unless some TCM doctors who have actually treated many Coronavirus cases, all the discussion would be hypotheses or assumptions. Some hypotheses are worth considering while many others could be quite misleading.

Personally I have not treated patients cases related to Coronavirus. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully, and has published other later blogs which included his involvement in treating those patients. Please refer to his medical blog http://www.DrLee.us.) However, I did treat and cure patients inflicted by other viruses in the past, such as the Bird Flu, Swine Flu, and other influenza. A good amount of those patients were diagnosed as severe pneumonia by large hospitals and were required for isolation or self-quarantine. Hence many of patients and online medical forums online are asking for my opinions about Coronavirus.

As we discussed before, all these viruses from the outbreaks are either newly found or mutated from previous strands. The strand can be different every year. Therefore, people always ask how one can say that the TCM knowledge developed in East Han Dynasty (25-220 AD) would be any useful for treating the modern diseases, let alone the severe ones.

It turns out that TCM does not recognize any virus and does not deal with the concept of which type of virus is microscopically at work. TCM looks at how human bodies would become out-of-balance and react to external stimuli. Once the body is out of balance, what symptoms will exhibit and what reactions will be to adjust the body conditions to regain the balance, hence to reduce the damage to the body to the minimum. Let me take an example to illustrate: when there is a gunfight between the police and bandits, we want to see which direction the shots are coming from, causing casualties of the police force, so that we are able to adjust or reinforce the police power. We have no time to think about which brand of the guns or bullets the bandits use.

Over thousands of years, the external viruses have changed and evolved quite a bit, but the evolution of human beings was quite limited. The human body function, no matter how it was damaged, the symptoms due to the damage of the function, the reactions, and the following progression of the disease still follow certain paths. For this very reason, TCM’s focus on the balance of the human body often surpasses the effectiveness of Western medicine, which focuses more on external treats and the microscopic aspect of how human body’s cells are impacted by the external treats.

From the accumulation of many years of clinical treatment and observations, no matter it is Bird Flu, Swine Flu or other influenza, the bodily ‘damage’ and its progression by the viral attack still follow the description of the classic TCM literature “Treatise on Cold Damage on Miscellaneous Disease” (傷寒雜病論). In short summary, the disease usually starts with “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒), for which is matched to one of the several syndromes named with the corresponding herbal remedies such as “Gui Zhi Tang” (桂枝湯) and “Ge Geng Tang” (葛根湯). Then, the disease moves onto the next stage “Interior Coldness” (裡寒) or “Lung Coldness” (肺寒), which shows the syndromes named as “Xiao Qing Long Tang” (小青龍湯), etc. When the respiratory system is “affected by the coldness”, the body fluid function of the respiratory system gets affected. The circulation function of the lung becomes “Dry and Overheated” (燥热). This would lead to a more serious stage “Heated Interior” (入裡化熱) and would often be matched to its herbal remedy “Da Qing Long Tang” (大青龍湯). Or, even worse, it becomes so-called “mixed coldness and heat” (寒熱夾雜) in the lung. Such a complex situation was extensively discussed in Chapter 7 of the classic literature “Synopsis of Prescriptions of the Golden Chamber” (金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇). At this complex stage, the illness development varies significantly among patients of different preconditions and other variants. It is no longer the situation that a simple herbal remedy can be applied to all the situations. The TCM theory illustrates various treatments by those herbal remedies such as “She Gan Ma Hung Tang” (射干麻黃湯), “Ting Li Da Zao Xie Fei Tang” (葶藶大棗瀉肺湯), ”Ze Qi Tang” (澤漆湯), “Xiao Qing Long Jia Shi Gao Tang” (小青龍加石膏湯), and others.

However, even the disease progressions are similar, the more serious viral attacks like Coronavirus can and often do progress much faster with more severe consequences than the common flu. As described in the previous paragraph, normally the disease progression of the “External Coldness” stage to the more serious “Heated Interior” stage usually takes one to two weeks. It is also often due to the ignorance of the patient or misdiagnosis and treatment of the doctor, which prevents the patient from recovering from this “catching a cold”. In the recent several years though, the time period between the time that the patient did not feel well and the time that the patient is in a serious and complex situation can be as short as 3 to 4 days. We also see the trend that this period gets shorter and shorter. In other words, the disease progression is getting much faster. This phenomenon poses a much higher demand on TCM doctors’ ability to make a quick and proper judgment and sensitivity to the subject matter. TCM doctors must intercept the disease progression before it reaches to a more serious stage, even without obvious symptoms of the next stage. TCM doctors have to timely prescribe the proper herbal remedy in terms of the type of herbs and relative dosages of herbs. Too weak a dosage could not stop the progression while too strong a dosage could worsen the condition also. A misjudgment would not be able the turn the conditions around, but hurt the patient more.

The above can be illustrated by a simple example. A patient caught flu and has symptoms such as heavy coughing, lots of sputum, and difficulty in breathing. From the TCM dialectics, with observations of white tongue coating, clear urine, and feeling chilly, etc., it is clearly caused by “Coldness”. Such a patient typically should be prescribed with “She Gan Ma Hung Tang” (射干麻黃湯) or its variations. However, due to the fast progression of the modern flu, the TCM doctor would need to pay attention to much subtle details such as the dryness of the tongue although it still shows the white coating. In this case, Sheng Shi Gao (Gypsum, 生石膏) might need to be added to the herbal remedy to make sure that the lung would not suffer dryness. Given that Sheng Shi Gao (Gypsum, 生石膏) itself is an ingredicient that is “very cold” in nature, the dosage could not be too strong to make the lung too chilly. At the opposite end of the spectrum, if the sound of the coughing is very ‘deep’, like dense sputum coming from the bottom of the lung, the herbal remedy might need to add Ting Li (Sisymbrium indicum, 葶藶) to clear up the lung to avoid too much mucus in the lung. And again, the dosage of葶藶 could not be too much to weaken the lung. (Note: Handling the proper timing and proper remedy can be a real test to the ability and experience of the TCM doctor.)

Let’s go back to the discussion on Coronavirus. From the limited information available so far, we know that there are about two weeks of incubation period after the infection. There are little symptoms during this period and the patient may just feel more tired than usual. More obvious symptoms will start like those of common flu with fever, fatigue but not too serious. Upper respiratory symptoms like running nose are less common. Some patients may not even exhibit fever. About half of the patients infected will recover over a week or so. The other half of the patients will experience difficulty in breathing, or rapid progression to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulopathy, etc. Some patients had died due to these severe conditions.

From the above description, this Coronavirus, in the beginning, is very much like the common flu and will stay in stages of “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒). Half of the patients infected will recover by themselves as in common cold. The other half of the patients may exhibit situations of rapid penetration into inner organs and excess ‘heat’, which causes loss of fluidity of respiratory system and accumulation of dense sputum at the lower part of the lung. In the TCM theory, the lung serves as the initial “gating factor” of body fluids. When the lung fails to serve the proper function, other organs like the kidney will be adversely affected also. In other words, Coronavirus can turn a light “External Coldness” to extremely severe “Lung Atrophy” (肺痿) and “Lung Abscess” (肺癰), which in turn will impair the function of other organs.

How to treat? Without direct experience of treating Coronavirus patients, we can only postulate from our limited information available in hand. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully. The treatments were exactly as outlined in this article.) From the ample experience of dealing pneumonia cases caused by flu, we are confident that we can also treat Coronavirus successfully. When patients are showing the obvious Coronavirus symptoms, most of them would have entered the stage of “Heated Interior” (入裡化熱) with “Lung Atrophy” (肺痿) or “Lung Abscess” (肺癰) to a certain degree. At this stage, we will need large dosages of Sheng Shi Gao (Gypsum, 生石膏) to clear the heat to ensure the proper fluidity function of the lung. Also, we will rely on Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), etc. to clear up the dense mucus at the lower part of the lung and to remove the edema of the chest chamber. Without getting rid of the excess mucus and fluid, the lung cannot properly function. We need to use Ma Huang (Ephedra sinica Stapf., 麻黃), etc. to enhance the lung function (宣肺、發陽) and restore proper breathing. When the lung is damaged as in fibrosis, after the conditions stabilize, we need to “moisturize” the lung (润肺) to help the lung to recover fully. In other words, we will most likely use the herbal ingredients such as Sheng Shi Gao (Gypsum, 生石膏), Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), Sheng Ban Xia (Pinellia ternate, 生半夏), Ma Huang (Ephedra sinica Stapf., 麻黃), She Gan (Belamcanda chinensis, 射干), Zi Wan (Aster tataricus, 紫菀), Kuan Dong Hua (Tussilago farfara flower, 款冬花), Sheng Jiang (Ginger, 生薑), Zhi Gan Cao (processed Glycyrrhiza uralensis Fisch., 炙甘草), Hong Zao (Ziziphus jujube, 紅棗), Mai Men Dong (Ophiopogon japonicas, 麥門冬), Xing Ren (Prunus armeniaca, 杏仁), and others. As we discussed in previous paragraphs, the timing, dosage, the relative ratios of different herbal ingredients are very critical. Given that there are quite some variations in patient conditions, the challenges on TCM doctors’ comprehensive knowledge, judgment and courage are unprecedented.

In those articles online, some TCM doctors claimed that Coronavirus can be cured by Ban Lan Gen (Isatis tinctoria root, 板藍根), which is believed to have natural antibiotic chemicals to “clear up the heat and toxics”. Some TCM doctors suggested using a simple mild herbal remedy “Mai Men Dong Tang” (麥門冬湯), which mainly relies on the ingredient Mai Men Dong (Ophiopogon japonicas, 麥門冬). Some people even suggested that having the green bean soup could prevent Coronavirus. In fact, those TCM doctors who have good experience of treating Bird Flu, Swine Flu, and pneumonia caused by other influenza would know that the people making those claims never had the real experience of treating severe pneumonia. They at most helped in a minor way the patients under Western medicine treatments. Under such conditions, it is not a surprise that the China government has not used TCM as the primary method of treating Coronavirus, despite its big promotion of TCM in the recent years. (Note: After this writing, Coronavirus epidemic became so severe in China that the China government changed its strategy and started to use TCM extensively in treating many mild Coronaviurs cases.)

Medicine is the science based on real treatment results. Without a good amount of successful cases in clinical treatments, it is useless to promote any fancy idea of treating patients. If we would like TCM to be respected in the mainstream medicine and to be meaningfully used in a severe epidemic like Coronavirus, it is critical to focus on the most fundamental. That’s the clinical results. Like the martial arts, unless you can fight off the bad guys, it’s just a show of fancy movements.

（http://andylee.pro/wp/?p=7169）
#當張仲景遇上史丹佛