Two months ago, Zhou Ping'an, a TCM doctor for nearly 40 years, was invited to offer advice to the medical staff at the Beijing You'an and Ditan hospitals.
The two specialist hospitals for infectious diseases were among the first in Beijing to treat SARS patients.
Zhou was called for because he is one of the leading TCM experts in respiratory diseases and the director of the departments of internal medicine and respiratory diseases at Dongfang Hospital, which is attached to the Capital University of Chinese Medicine.
The days since then have been quite a trial for Zhou.
"From my clinical experience, I've found no good curative effects could be achieved in treating SARS patients when we simply apply Western medicine or traditional Chinese medicine alone," he said.
"However, when combining the two on the same patient, better effects have been shown."
Although TCM clinical treatment is not carried out on a large scale, the experiences Zhou and other TCM doctors have gathered are allowing the medical group to get an ever clearer picture of what TCM can do to help SARS sufferers.
Nature of Disease
Zhou and Chao Enxiang, a leading TCM doctor with the China-Japan Friendship Hospital, have both examined quite a number of patients.
Chao took part in the group consultation in Guangzhou as early as January when the number of feidian (atypical pneumonia, the Chinese equivalent of SARS) cases had increased.
They both found the patients mostly developed what TCM considers as "heat toxin," represented by the symptoms of a continuous high fever and quick pulse, accompanied by "dampness," characterized by nausea and diarrhea.
Their urine is yellow, also a symptom of fever, and they have a thick white, slimy fur coating on their tongue - the sign of "dampness."
By applying TCM diagnostic and analytical theories, they have concluded that SARS - already proven to be highly infectious - is a kind of disease belonging to the so-called "hot diseases" family.
The two elements of "heat toxin" and "dampness" combine to impair the lung qi or the vital energy and fluids in the lung, they suggest.
Can TCM Help?
Western medication, known for its quick effect, has been applied as standard treatment to rescue patients from the grip of SARS.
So far, there is no known effective medicine to kill the new coronavirus identified as the main pathogen that causes the disease.
Clinical experience has shown that a lot of recovery is determined by a person's immune system.
However, the Western medicine presently used for treating SARS patients is also creating trouble and that is where TCM should be integrated to help reduce side effects, said Wang Shuchen, head of Xiyuan Traditional Chinese Medicine Hospital at the Chinese Academy of TCM in Beijing.
For example, injecting some cortical hormones will restrain not only the virus, but also people's immune functions, which means many bacteria or moulds may create other infections in patients, especially those with chronic illnesses.
New infections have been killing SARS patients, Wang noted.
Globin or serum taken from people who have recovered from SARS have become a widely used effective practice in saving lives. But Wang noted that present test measures hardly ensured that the blood was safe and that it would not create new infections.
TCM can play a unique role to help reduce the side effects of Western medicine and improve the body's immune system, Wang said.
TCM Rules
The TCM doctors have formulated their own rules in joining the battle against SARS.
The difference between Western medicine and TCM lies in that the former is designed to directly attack the virus, while the Chinese variety aims to lessen symptoms and help restore a patient's immune system, Chao says.
The TCM doctors especially point out they must first notice differences between the locations and individuals.
According to long-established TCM concepts, differences in geography and climate contribute to diagnosis and treatment.
Chao said the symptoms of patients in South China's Guangdong Province and those of people with the disease in North China were different, although they looked the same to Western doctors.
Since April, northern China - Beijing, Tianjin, Shanxi, Hebei and Inner Mongolia - has had the most SARS cases, accounting for some 67 percent of the national total.
"The SARS patients in Guangdong show more dampness with more cases of diarrhea since it is humid and warm in southern China," Chao said.
"In comparison, there is more heat among patients with more cases of continuous high fever in North China as it's been dry and relatively hot here."
Also, it is essential to conduct individual treatment, which may mean adjusting medicine according to changes in a patient's condition, Zhou said.
How Can TCM Help?
In treating what TCM regards as a contagious "hot disease," the system works well to help reduce fever, restore the qi, promote the natural flow of bodily fluids and drive away dampness, TCM doctors note.
Zhou said the earlier TCM entered into the clinical treatment, the better the curative effect, especially for patients with light symptoms or suspected cases.
According to their clinical observation, in some suspected cases when TCM was used, patients' fevers were brought under control in three days.
Even though some of the patients were later confirmed as having SARS, their conditions were still much more alleviated.
What Prescriptions?
For a better clinical command of the relatively complex TCM system, Zhou, together with Chao, Wang and other experts, have formulated a basic scheme to treat the infectious disease.
The plan, which is being documented by the Ministry of Health, will be introduced to the major SARS-designated hospitals in the nation's capital, according to Zhou.
They have also worked out three simple and convenient prescriptions to be followed in three different stages of the virus.
In the early fever stage, SARS patients or suspected cases usually display the symptoms of fever, chills, headaches, muscular pain and malaise. Some of the patients may have diarrhea, a dry cough and a lack of phlegm.
The basic treatment involves reducing the fever to clear of the "heat" and dissolve the virus "toxin," ameliorating the cough and invigorating the qi in the lung.
"The volume of patients at this stage is the largest," Zhou said.
"So there might be a wide use of traditional Chinese medicine to curb the state of illness from developing towards the malignant or serious direction."
Generally, after three to five days, a patient's temperature would be falling. However, their condition could further develop into the second stage.
Although the temperature is reduced, inflammation of the lungs progresses.
The main symptoms are a shortness of breath and tightening of the chest.
"In this stage, the patients could even lose the strength to hold chop sticks or a spoon," Zhou said.
At this stage, according to TCM theory, the qi in the lungs is being drained, blood circulation is becoming static and a poisonous virus is accumulating in the lungs.
It means the treatment should focus on boosting the qi, transforming stasis, clearing heat to reduce the fever, and dissolving the virus toxin.
"From start to finish, the treatment should always emphasize the importance of clearing heat by reducing the fever and dispersing the toxic virus," Zhou said.
Zhou says it is of vital importance for treating serious SARS patients, which is a key to reducing the fatality rate. "Once the patients hold on through the second stage to enter recovery, they will be OK," he said.
When the patients are heading into the recovery stage, the fever recedes completely.
However, most of them may feel bloated and will have no appetite.
"So we help build up the patients' health and restore their general body functions," Zhou said.
But when they proceed to the critical serious stage, neither Western medicine nor TCM seems to be very effective.
"There has been no prominent curable effects in cases where traditional Chinese medicine has been used when SARS patients enter the serious stage," Zhou said.
Due to the complexity of TCM, the experts have formed a task force and are getting themselves involved in supervising clinical treatment.
Zhou is optimistic about the SARS therapy.
"After a period of clinical treatment, both the Western medicine and the traditional Chinese medicine circles have developed their own experiences in combating the epidemic," he said.
"I believe that the killer disease will be controlled."
(China Daily May 20, 2003)
