Presenter/Author:

WANG Zhongbin

Other Author:

NA

Author Affiliation:

Renji Medical Center, Belgium

Keywords:

Online Clinic; COVID-19; Chinese Medicine

Abstract:

For more than two years, under the framework of the new anti-epidemic model - WeChat online clinic, I have used traditional Chinese medicine to treat hundreds of patients with COVID-19 remotely, and all of them achieved satisfactory results. Most of them are of moderate severity, and there are also some severe patients with no underlying diseases. Under certain protective measures, nearly 100 COVID-19 convalescent patients and patients with the long-term complication of COVID-19 have been treated. Acupuncture and traditional Chinese medicine comprehensive therapy have been used, and the clinical effect is satisfactory.

First part：Wechat online clinic

At the beginning of 2020, the COVID-19 epidemic spread to Europe, and Belgium gradually became the epicenter of COVID-19. Due to the limited capacity of local hospitals, many patients can’t receive timely diagnosis and treatment. They had to undergo home quarantine to deal with the virus. Patients and their relatives often feel anxious and terrified. In March 2020, many overseas Chinese who traveled to Belgium, unfortunately, were infected with COVID-19. With unclear diagnosis and limited access to hospital, they sought help from Chinese doctors, including traditional Chinese medicine and Western medicine. Therefore, they received timely and proper treatment, and their health condition gradually improved, finally recovered.

In order to control the spread of virus，cities were put on lockdown, and border of countries are closed, under this situation, I mainly used WeChat video or audio calls to provide telemedicine for these COVID-19 confirmed or highly suspected cases, and tried every means to give Chinese medicine treatment; I even contacted family doctors for patients or help them establish WeChat network connections. In the end, traditional Chinese medicine and western medicine, collaboratively or separately provide telemedicine for patients, which effectively saved these patients and achieves the shared goal of doctors and patients - curing COVID-19.

In this way, a new anti-epidemic model, the WeChat online clinic was innovated. And the article "微信方舱：一种可以救命的抗疫新模式" was also officially published on May 2 in 《浮刺医学》 and became a hot topic. This provides an effective way for Chinese medicine practitioners in Europe and America to fight COVID-19 timely.

The composition of the WeChat online clinic is described as follows:
Team: One traditional Chinese medicine practitioner, one western doctor (mostly family doctors), patients and their relatives, and one volunteer can form an online clinic team. It would be better if the above members are overseas Chinese, who are able to communicate in Chinese, and understand WeChat operations.
Equipment: Mainly mobile phones, computers/tablets as well.
Software: mainly WeChat. Zoom, VooV, Skype, or email can also be used if necessary.
Operation: You can establish a WeChat online clinic group for relevant personnel to discuss the health condition, diagnosis, prescription, medical advice, medicine delivery method, and diet regulation, etc. Certainly, if you can maintain close contact with each other, a Wechat group may not be necessary.

In this way, a Chinese medicine practitioner and a Western medicine respect each other, support each other, carry out their duty, and fight alongside, coupled with the cooperation of patients, their relatives, and volunteers, a practical and efficient WeChat online clinic team is formed. Including patients and their relatives into the team are one of the requirements for the WeChat online clinic.

A specific division of labor: Chinese medicine practitioners should give patients the appropriate amount of traditional Chinese medicine according to their situation, such as five-day doses of decoction, and proprietary Chinese medicine, such as a bottle of Huo-Xiang-Zheng-Qi Pill if necessary. Then, carefully explain the precautions to the patient's relatives through WeChat, such as: How to decoct Chinese medicine, how to take it, dietary restrictions and recuperation.

Western medicine, after prescribing electronic prescriptions through tele-medicine, such as antiviral drugs, antibiotics, antipyretic analgesics, vitamins, etc. Volunteers or friends can pick up medicines at pharmacies. Various laboratory sheets, chest scan application forms, and even COVID-19 nucleic acid-related checklists can also be prescribed for patients according to their conditions. If necessary, the patient can also ask for hospitalization. Relatives assist the patient in completing the necessary examination.

Volunteers or friends help collect Chinese or Western medicines and deliver to a safe area near the patient's home. Chinese medicine can also be mailed to patients. Patients should take medicine, intake food and drink, and rest on time according to medical advice. Relatives of patients should protect themselves from COVID-19, take care of the patients, observe changes in the condition, and report to the doctor timely. At the same time, relatives will also be responsible for preparing traditional Chinese medicine for the patient, arranging patient's diet and nutrition, and taking care of the patients based on doctor's advice.

This type of integration of Chinese and Western medicine together with assistance provided by the patient's relatives and volunteers, can often stop the disease progression within five days.. It is a successful example demonstrating a safe and effective remedial model of integrated Chinese and Western medicine. when the diagnosis is clear, Chinese medicine practitioners can operate the Wechat online clinic even without the participation of western medicine.

In conclusion, the WeChat online clinic is simple, practical, effective, cost effective, helpful, and worth recommending. Especially suitable for those overseas Chinese infected with COVID-19.

Second part: differentiate symptoms and signs to identify etiology, and provide treatment based on syndrome differentiation, strive for individualized treatment

Under the framework of WeChat online clinic, tele-medicine treated hundreds of patients infected with COVID-19 using classical and modern formulas of Chinese medicine, mainly 2-3 formulas merged and adjust after full consideration of the actual situation. Finally, a satisfactory result was achieved. Today, I would like to share with all of you, a case study of three members’ families collected during the first wave of COVID-19 in Belgium, in March 2020. The details are as below:

(1) Case of Xiao Chai Hu Tang and Huo Xiang Zheng Qi San

Case 1: Mr. Liu, male, 48 years old, was admitted to my Wechat online clinic on 20th March, 2020 due to five days of fever and three days of diarrhea. The patient had been sick since March 15, with fever and chills, body temperature fluctuating between 37.5-38.8 degrees. Taking paracetamol can temporarily reduce the fever, but soon the fever will return. Sometimes the throat is itchy with little phlegm, mostly whitish. The patient was not very thirsty, with no obvious cough, no chest pain and chest tightness, and no wheezing. Because there is an oxygen bag at home, the patient often inhales oxygen by himself, so there is no obvious dyspnea as the main complaint. Since 18th March, the patient had abdominal pain, diarrhea, loose stools, and even watery stools, 2-5 times a day, but there is no tenesmus, and there is no burning sensation in the anus. Accompanied by nausea and vomiting, anorexia, lack of appetite, mental fatigue, and slightly generalized weakness, the obvious loss of taste and smell, and insomnia. Tongue examination found a pale red tongue, white, medium-thick and slightly greasy coating, pulse unmeasured. He denied any contact history with patients with COVID-19 at that time. But later recalled contact history with suspected patients with coughs and fever. The patient repeatedly emphasized that he did not feel any obvious discomfort in his chest, and did not have obvious coughing and shortness of breath. However, a chest X-ray showed inflammatory changes in the lungs, with ground glass-like opacities. The doctor believes that it is in line with the diagnosis of COVID-19, and has taken viral nucleic acid throat swab sampling. Five days later, the nucleic acid result was positive and diagnosis confirmed. This case was classified as "severe COVID pneumonia". I prescribed Xiao-Chai-Hu-Tang and Huo-Xiang-Zheng-Qi-San to the patient. (Bupleuri radix 12g, Scutellaria baicalensis 12g, Pinellia ternata 8g, Agastache rugosa 6g, Eupatorium fortunei 6g, Citri Reticulatae Pericarpium 6g, Perilla Caulis 8g, Arecae Pericarpium 10g, Codonopsis Radix 10g, Glycyrrhizae Radix et Rhizoma 5g, Magnoliae Officinalis Cortex 10 g, Atractylodes Rhizoma 8 g, Poria 10 g, Armeniacae Semen Amarum 10 g, Mori Folium 10 g) per day, separated into 2 times, in total five days of medicine. Also take Huo-xiang-Zheng-qi Pills, 3 times a day, 8 capsules each time. Then follow up through WeChat video once a day. The patient immediately took the Huo-xiang-zheng-qi Pill once the Chinese medicine arrived. Instantly, abdominal discomfort, and diarrhea were significantly reduced. Two days after taking traditional Chinese medicine, diarrhea and watery stools stopped, the stool gradually shaped, and other symptoms such as fever gradually eased, body temperature back to normal (37.5 degrees), no chills, and sensation of taste and smell gradually recovered. On 24th March, the patient went to the hospital. His signs and symptoms had improved significantly. The only problem is shortness of breath, and low fever (body temperature 37.3 degrees). Supposedly he didn’t need to be hospitalized, but he got mild hypoxia, so that he was admitted to the hospital for further treatment, oxygen therapy and oral hydroxychloroquine are mainly used. The virus nucleic acid test results on 25th March were positive, and he is clearly diagnosed with COVID-19. But the patient’s sense of smell and taste has already improved. After hospitalization, his body temperature remained normal, his remaining symptoms improved and he was discharged on 30th March. Consultation through tele-medicine on 30th March afternoon showed that the patient still got a little cough, little yellow phlegm, dry mouth and thirst, sometimes fatigue, no more fever and chills, normal excretion, urination, and appetite. Tongue examination showed pale red tongue, yellow and white coating not greasy. I prescribed Zhu-Ye-Shi-Gao-Tang (Common Lophatherum Herb 10 g, Gypsum Fibrosum 30 g (wrapped , can be replaced by Anemarrhenae Rhizoma, Rhragmitis Rhizoma), Ophiopogonis Radix 10 g, Codonopsis Radix 10 g, Pinelliae Rhizoma 8 g, Glycyrrhizae Radix et Rhizoma 5 g, Scutellariae Radix 10 g, Eriobotryae Folium 10 g, Forsythiae Fructus 10 g, Stemonae Radix 10 g, Trichosanthis Radix 10 g, Taraxaci Herba 10 g, Asteris Radix et Rhizoma 10 g. Five more doses. After taking 2 doses of this prescription, once occur diarrhea and watery stools 3-4 times a day. I asked the patient to stop taking the prescription and switch to Huo-xiang-zheng-qi Pill. After the diarrhea stopped and rest for a few days, take the prescription again but change to half dose each day, and the patient fully recovered. The patient had face-to-face consultation in June, with rosy-cheeked, bright-eyed, breathing gently, sleeping well, normal appetite, and normal bowel movement. Tongue examination showed a pale red tongue, thin white coating, and gentle pulse. He is fully recovered without any sequelae. Note: This is my first COVID-19 case. The main complaint is five days of fever and three days of diarrhea, accompanied by chills, but no obvious cough and sputum. The patient was in good health condition, had a strong personality, and seldom shed tears. After being infected with COVID-19, he had no way to seek medical treatment and was hospitalized. He is feared, and cried bitterly many times. Fortunately, TCM provided timely assistance, with attentive tele-medicine service, diagnosis and treatment were basically correct, so TCM prescriptions worked effectively. Except for the youngest daughter, the patient’s other four family members were also infected. One of the children was an asymptomatic patient, and the others were all common and severe type COVID-19 patients. The oldest family member was frailer and suffered from various underlying diseases, after being infected with COVID-19, her health deteriorated so quickly and finally passed away without any TCM treatment. Two of the family members were diagnosed promptly and the rest were diagnosed two months later by serologic testing for IgM against SARS-CoV-2.

(2) Case study of Ma-Xing-Shi-Gan Tang and Yin-Qiao San

Case 2: Ms. Mo, 45 years old, is the wife of Mr. Liu in the first case. She received tele-medicine service on 24th March, 2020. Her main complaint was fever and cough for two days, accompanied by chest tightness, shortness of breath, and slight fatigue. Body temperature fluctuated between 37.6-38.3 degrees, self-feeling of burn in chest and lungs, sometimes even felt suffocation, loss of appetite, and normal stool. Tongue examination showed a red tongue, a thin yellow coating but thick in the middle area, normal sense of taste. The sense of smell has been ineffective for a long time due to sinusitis. This case was diagnosed as a "Common Type of COVID-19". She did not receive the virus nucleic acid test at that time, but she had serologic testing for IgM against SARS-CoV-2 after recovery, which was strongly positive and was diagnosed retrospectively. Prescribed with Ma-Xing-Shi-Gan Tang and Yin-Qiao San. (Ephedrae Herba 5 g, Armeniacae Semen Amarum 10 g, Gypsum Fibrosum (wrapped) 15 g, Glycyrrhizae Radix et Rhizoma 5 g, Bupleuri Radix 8 g, Scutellariae Radix 8 g, Lonicerae Japonicae Flos 10 g, Mori Folium 10 g, Forsythiae Fructus 10 g, Platycodonis Radix 6 g, Aurantii Fructus 6 g, Menthae Haplocalycis Herba 5 g ) Five doses. On 30th March, fever subsided for three days, cough is relieved, small amount of phlegm in white color and sticky, thirsty, and heart rate is 110 beats/min. Modified prescription: Ephedrae Herba 5 g, Armeniacae Semen Amarum 10 g, Gypsum Fibrosum (wrapped) 30 g, Lophatheri Herba 10 g, Coicis Semen 15 g, Trichosanthis Radix 15 g, Lonicerae Japonicae Caulis 15 g, Scutellariae Radix 10 g, Nelumbinis Plumula 5 g) Five doses. After taking the above prescription, the patient sometimes has diarrhea, so I asked her to reduce or even take away Gypsum Fibrosum. Her symptoms gradually diminished, and she practiced Baduanjin, massaged Dazhui, Lungshang, Zusanli, and performed moxibustion by herself, also paid attention to diet nutrition and rest. In June, we had a follow-up face-to-face consultation, and the patient fully recovered without any sequelae. Note: The pathogenesis of this case is damp-heat lung plague caused by damp-heat and epidemic toxin obstructed the lung pattern, so that heat is difficult to disperse, and keep blazing in the interior. Using Ma-Xing-Shi-Gan Tang and Yin-Qiao San together can clear away heat and toxin material, eliminating phlegm and dispelling mass, meanwhile attaching great importance to the protection of lung function, so that COVID-19 can be cured.

(3) The case of Sang-Ju Yin and Ma-Xing-Shi-Gan Tang

Case 3: Female, 70 years old, mother of Ms. Mo, living together with Mr. Liu. In the beginning, she got low-grade fever but no chills, itchy throat, dry mouth, desire to drink, cough with yellow and sticky phlegm, but no nasal congestion and runny nose. Body temperature keeps rising, fluctuating between 37.6-38.4 degrees, and sometimes felt fatigued and shortness of breath. Tongue examination showed a pale red tongue, a thin yellow coating. She asked for telemedicine consultation on 30th March, 2020. She denied any history of heart disease, diabetes, and hypertension. This case belongs to the "common type of COVID-19", which was later confirmed retrospectively through serologic testing for IgM against SARS-CoV-2 also. I prescribed Sang-Ju Yin and Ma-Xing-Shi-Gan Tang to the patient: Mori Folium 10 g, Chrysanthemi Flos 10 g, Platycodonis Radix 6 g, Glycyrrhizae Radix et Rhizoma 5 g, Armeniacae Semen Amarum 10 g, Gypsum Fibrosum 20 g (dococt first)(can be replaced by Anemarrhenae Rhizoma or Phragmitis Rhizoma), Ephedrae Herba 5 g (can be replaced by Moslae Herba), Forsythiae Fructus 10 g, Lonicerae Japonicae Flos 10 g, Lophatheri Herba 8 g, Menthae Haplocalycis Herba 5 g, Eriobotryae Folium 5 g, Pseudostellariae Radix 12 g, Atractylodis Rhizoma 5 g, Peucedani Radix 10 g) One dose per day, 2 servings per dose, for a total of five doses. After taking three doses of TCM, symptoms gradually relieved, and body temperature gradually drop, but the patient started to have diarrhea. I instructed the patient to reduce the amount of bitter-cold medicinals in the prescription, and take a half dose per day. And add Huo-Xiang-Zheng-Qi Pills, 8 pills each time, three times a day. After diarrhea was relieved, Sang-Ju Yin and Yin-Qiao-Jie-Du tablets were given for one week in regular dosage, and the patient gradually recovered. The only problem left is vexation and insomnia; I prescribed An-Shen-Bu-Xin Pill and Bai-Zi-Yang-Xin Pill for the patient. Later, she had a face-to-face consultation in June, all symptoms disappeared, and she continued to have sedative and tranquilizing formulas to stabilize sleeping quality. Note: This patient is old, and fortunately, she has no serious underlying diseases, and she received Chinese medicine treatment in time, so she can recover after COVID-19 without any sequelae. Her husband, who suffered from severe heart and kidney disease and diabetes, developed critically severe COVID-19 once infected, he passed away after three days of hospitalization without TCM treatment.

As we all know, in TCM, COVID-19 is caused by “pestilential qi”. It is like the wind but not wind, like cold but not cold, like summer-heat but not summer-heat, like damp but not damp, like dryness but not dryness, like fire but not fire, it is actually a kind of mixed turbidity and poisoning of various non-seasonal qi in the environment. An epidemic pathogenic factor, is the COVID-19 virus. Although the etiology of COVID-19 is this epidemic pathogenic factor, its clinical signs and symptoms are various; patients’ main complaints and pathogenesis are also generally different.

The above three cases came from the same family, but their main complaints and pathogenesis were different. Therefore, their prescriptions were not the same, but they were all cured. That is why, we must carefully treat every single patient, differentiate symptoms and signs to identify etiology, and provide treatment based on syndrome differentiation, always provide individualized treatment. It is also necessary to fully consider the constitution and medical history of the patient. To treat COVID-19, you need to walk on eggshells. It is better not to govern if it is disorderly and blindly governed, In view of the strict epidemic prevention policy in various countries, overseas Chinese medicine often provides telemedicine services for COVID-19 patients, and the Wechat online clinic is a very practical new mode to combat the COVID-19 outbreak. However, the disadvantage of telemedicine is also obvious. For example, the sign and symptoms collected are inevitably insufficient, especially since the pulse diagnosis is mostly absent. Therefore, the prescriptions should focus on strengthening the body’s resistance to eliminate pathogenic factors, and protect the spleen-stomach transportation and transformation function. Avoid prescribing a high dose in order to prevent damage to the body. Every time combine two or three methods to use out of eight therapeutic methods. Be careful not to sweat excessively, purge excessively, or use too many herbal medicines with a bitter flavor and cold properties.

Third part: A case study analysis



This picture introduces the changes in tongue examination of a COVID-19 patient in the early, middle and late stages.

From green thick phlegm with pain all over, to fever with dry cough and a small amount of white phlegm, then to yin-damaged with dry mouth and scanty phlegm, until all symptoms disappeared. The entire disease progression. Through telemedicine service, the four diagnostic materials are not complete, the pulse diagnosis is lacking, and the tongue examination is relatively more important.
1st to 3rd photo: It is probably the process of disease at the early stage, from epidemic Wind-dampness, to epidemic cold-dampness, and transforms to epidemic heat.
4th to 6th photo: After the treatment of TCM and diet therapy, the condition has improved, but a small amount of tongue coating has been peeled off, indicating yin-damaged of the lung and stomach.
7th to 9th photo: After giving the method of nourishing the lungs, enriching yin and resolving toxin, the condition further improved. Until the epidemic toxin is totally released, yin of the lung and stomach is gradually enriched.
The entire treatment lasted for nearly two weeks. The patients and their relatives were satisfied. The curative effect is good.

Fourth part: Treatment principles to manage a persistent cough after COVID-19

Dealing with this kind of patient, it is still necessary to adhere to the basic principles of differentiating symptoms and signs to identify etiology, and provide treatment based on syndrome differentiation, never misuse TCM treatment. Clinically, it is necessary to clear and resolve epidemic toxins and stop coughing together, and personalized medicine is preferred. The treatment of COVID-19-related persistent cough, regardless of whether the patient has phlegm or not, should generally focus on releasing the lung in the early stage, assisted by descending the lung; in the middle stage, it is necessary to combine both diffusing and descending medicine according to the severity of cough; in the later stage, treatment should focus on descending the lung, assisted by diffusing the lung. Definitely, we should modify the prescription according to the patient’s condition, with exterior-releasing, clearing the lungs, resolving toxin, dampclearing, eliminating epidemic toxin, phlegm-expelling, relieving cough, replenishing qi and nourishing the lung etc. Below, we focus on introducing some commonly used methods of diffusing and downbearing the lung, warm-nourishing and cool-nourishing.

Persistent cough at the late stage of COVID-19 and chronic cough are common in epidermic disease. Generally, based on symptoms and signs differentiate to identify etiology, and provide treatment based on syndrome differentiation, we can choose <> Zhi-Sou-San and <> Sang-Xing-Tang as the basic prescription. On this basis, add and subtract TCM according to the syndrome, especially pay attention to the balance between diffusing and descending the lung, warm-nourishing and cool-nourishing. This method can be widely used in the clinical practice of similar coughs.

Reference:

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Funding Source:

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Conflict of Interests:

The author reports no conflicts of interest related to this study.