Herbal Medicine during the Pandemic
There have been some unique challenges presented during the past three years of the pandemic. Since it wasn’t possible to see infected people in person, it necessitated doing appointments via Zoom. The only thing that couldn’t be done remotely was taking the pulse. This turned out to be less of a challenge than anticipated, since the pulse is less crucial when there is a confirmed exterior attack. I send all remote patients a link to a video on taking good tongue photos, so that important diagnostic tool was retained. I have been using this excellent video to send to all patients. (Requires an account with TCM Hub education.): Tongue Photography Tutorial for Patients – TCM Hub Education
The most serious challenge occurred in 2020, when there was no immunity, either from previous infections or vaccinations, and many people were dying or spending time in crowded intensive care departments. Time was of the essence, and daily follow-up was critical in order to keep patients out of the critical phase. I would follow up daily via text, allowing modifications to the protocols as symptoms changed. Of course, I would advise people to report to the emergency room if their symptoms were severe, such as severe difficulty breathing. Fortunately, none of the patients I have treated so far had to get emergency treatment. One patient passed away in intensive care before she had a chance to take her herbs, and that experience illustrated how seriously this must be approached. Another family member was able to take those herbs and recovered.
Here are some important points to consider when treating an epidemic pathogen:
- Don’t delay treatment. If the patient is out of town, send the herbs by next-day shipping. In some areas, standard Priority Mail will arrive the next day. Use a local herbal pharmacy if available. Local patients can send someone to pick up the herbs. I have a lockbox outside my office door for that purpose.
- Be prepared to follow up daily for a week or more.
- Anticipate the possible progression and send extra formulas if necessary.
- Determine the stage or level and treat accordingly.
- Resist the temptation to tonify too soon, despite complaints of fatigue. Wait for 7 to 10 days after all symptoms are gone, aside from fatigue. Tonifying too soon will often lead to a relapse.
- Warn the patient that they should refrain from strenuous exercise while they have symptoms, as it will very often lead to a worsening or relapse.
- A negative home test should be followed by two, three, or more tests if there are symptoms. It may take that many tests before a positive result shows up.
- Be prepared to change your treatment strategy as the pathogen evolves. Symptoms and treatment have changed with each new evolution.
Having treated approximately 200 cases as of writing this article in early 2023, certain strategies have repeatedly proved to be effective. Since herbs have to be shipped to the patient in most cases, and since exterior attacks change rapidly, I have been sending multiple granular formulas and some single herbs to the patients instead of initially creating a custom formula. It is easy to modify their protocol by altering dosages of the component formulas. The typical combined daily dosage is 12 to 24 grams, but sensitive patients may only need 6 grams, and serious conditions may need 36 grams or more per day. Once their condition stabilizes, I will sometimes send them bulk formulas if the condition lingers. I had some vacuum packs of Ma huang formulas stored in a freezer that I could send for the more serious cases that occurred in the early days. Starting in 2022, I don’t recall many patients needing a Ma huang-based formula, but they were very important during the 2020 and 2021 phases.
Over the last three years, there have been some typical patterns that I have seen many times. These patterns have changed as it has evolved, and treatment strategies have evolved accordingly. I have found it to be particularly useful to employ Zhang Zhongjing’s six-stage theory as a guiding principle, as these principles were developed in response to epidemics in the past. Ye Tianshi’s 4-level theory, as well as some TCM formulations, have also been very useful.
Many cases have started with a Taiyang pattern, with chills, occipital headache, body aches, and nasal congestion. In the early days, there was frequently shortness of breath, wheezing, and chest pressure. There are a number of formulas that I have used for this stage, such as:
- Jing Fang Bai Du San
- Chuan Xiong Cha Tiao San
- Ma Huang Tang (modified)
- Xiao Qing Long Tang (modified)
- Qing Bi Tang
- Xin Yi San
This Taiyang phase will very frequently go into a Shaoyang stage, with alternating hot and cold sensations, one-sided ear or throat pain, and irritability. This, as well as the Taiyang stage, quickly develops internal heat as well. Some formulas that have been helpful at this stage are:
- Chai Hu Gui Zhi Tang
- Xiao Chai Hu Tang
- Chai Ge Jie Ji Tang
From the beginning, lung heat was the most prominent symptom, with a dry cough, shortness of breath, pain in the lungs, and pressure in the chest. Some formulas and herbs that were useful in those cases were:
- Da Qing Long Tang
- Bai Hu Tang
- Sang Bai Pi
- Shi Gao
- Xing Ren
- Ting Li Zi
- Di Gu Pi
- Sang Bai Pi
- She Gan
The most common lung symptom in more recent times has been phlegm heat, with a cough with difficult expectoration, yellow or green phlegm or sticky white phlegm, and coughing at night. I have turned to these formulas many times:
- Bei Mu Gua Lou San
- Gua Lou Zhi Shi San
- Zhi Sou San (when the phlegm becomes clear and easier to expectorate)
When there is nausea, diarrhea, a thick tongue coat, loss of taste and smell, I have found these formulas to be very helpful:
- Huo Xiang Zheng Qi Wan
- If persistent loss of taste and smell, add Shi Chang Pu
Finally, after the symptoms other than fatigue have been gone for a week, these have been excellent recovery formulas, depending on the individual:
- Bu Fei Tang
- Bu Zhong Yi Qi Tang
- Shi Quan Da Bu Tang
Case Study #1: Male, age 42 (August 2021)
- Tested positive more than 2 weeks prior to appointment.
- Initial symptoms: Sore throat, severe headache, nasal congestion, slight fever, stomach pain, intense chest and bowel pain, gas, violent diarrhea, vomiting of sticky bubbly foam, flashes of fire-like heat on neck and groin, cold water feels hot, dripping sweat on shins and between knees, very thirsty, intense nightmare-like dreams.
- Current symptoms: Exhaustion, couch-bound, dehydrated, lost 26 pounds, thirsty, orbital and temporal headache, blood oxygen 93-95, sense of taste and smell affected, occasional cough that hurts his head.
Treatment strategy: Clear qi level heat, release the muscle layer, clear lung heat
- Chai Ge Jie Ji Tang: 4 scoops, 3 times per day
- Qing Hao Su extract: 1 capsule (100 mg), 3 times per day
- Sang Bai Pi, Shi Gao, Xing Ren, Ting Li Zi, Di Gu Pi, Sang Bai Pi, She Gan: 4 scoops, 3 times per day
- Symptoms mostly resolved after one round of herbs. Refilled Chai Ge Jie Ji Tang to resolve minor residual headache. Had to convince him to take it easy for another week.
Case Study # 2: Female, age 55 (July 2022)
- Went to a very crowded fair. People she was with just tested positive. Currently just feeling fatigue, but is taking vitamin C, Echinacea, Vitamin D, and cold/flu tea as a preventive
- Advised her that she is likely infected (her second time), and to let me know if she develops further symptoms.
- Two days later, PCR test came up negative.
- Two days after that, home test came up positive.
- Severe sinus and nasal congestion and a mild cough are the main symptoms.
Treatment strategy: Harmonize Shaoyang, clear Toxic Heat, clear the sinuses and nasal passages. Dosage: 10 bags; one bag per day. Weights are in grams:
- 10 Chai Hu
- 10 Huang Qin
- 10 Jiang Ban Xia
- 6 Gan Jiang
- 6 Gan Cao
- 10 Dang Shen
- 10 Jin Yin Hua
- 10 Ban Lan Gen
- 10 She Gan
- 15 Bai Zhi
- 10 Cang Er Zi
- 10 Xin Yi Hua
- 10 Chuan Xiong
- 10 Zhi Ke
Symptoms resolved, other than fatigue.
Treatment strategy for residual fatigue: Tonify Qi, harmonize Ying and Wei, warm the Interior. 5 bags; one bag per 2 days:
- 10 Hong Ren Shen
- 30 Huang Qi
- 10 Bai Zhu
- 10 Gan Jiang
- 6 Gan Cao
- 10 Rou Gui
- 10 Bai Dou Kou
- 10 Chao Bai Shao
- 9 Ashwagandha (Ayurvedic)
- 10 Wu Wei Zi
- 10 Chuan Xiong
- 10 Zhi Ke
Went to the mountains afterward. Sinuses were clear; energy was good.
Case Study # 3: Male, age 27 (January 2022)
- Caught a mild case while traveling a month ago. Currently loss of taste and smell, body feels hot while hands and feet are cold.
Treatment strategy: Ventilate Heat pathogens, relieve constraint, clear exterior Dampness
- Huo Xiang Zheng Qi San: 4 scoops, 3 times per day
- Si Ni San: 4 scoops, 3 times per day
One week later, he stated that his feet started feeling warmer right away. Smell and taste improved, but still not back to normal.
- Refilled Si Ni San and Huo Xiang Zheng Qi San. Added Shi Chang Pu to open the sensory orifices: 1 scoop each time he takes the other two formulas.
One week later, he reported that his feet have been feeling warm, even on the colder days. His sense of taste and smell returned. He stated that he was “feeling great overall.”
Case Study # 4: Female, age 53 (May 2022)
- Symptomatic for the past 3 days. Explosive sneezing with very liquid mucus, feels hot and cold, very sleepy, roof of mouth feels burnt, fatigue.
Treatment strategy: Harmonize the Shaoyang, clear the nasal passages.
- Chai Hu Gui Zhi Tang: 4 scoops, 3 times per day
- Xin Yi San (modified): 4 scoops, 3 times per day
Most symptoms resolved after the first round of herbs, but then a cough with sticky dry phlegm developed.
Treatment strategy: Clear Heat phlegm and moisten the Lungs.
- Bei Mu Gua Lou San: 4 scoops, 3 times per day
Fully recovered after one round.
Case Study # 5: Male, age 66 (May 2022)
- Infection that started with flu-like headache, body aches, fever, lethargy, chills, and digestive issues.
- Current symptoms: Sore throat, stuffy nose, raspy voice, occasional cough with easily expectorated white phlegm, phlegm in the lower throat, recent night sweats, ears clogged.
Treatment strategy: Release Exterior, clear the nasal passages, clear the lungs.
- Chuan Xiong Cha Tiao San: 4 scoops, 3 times per day
- Xin Yi San: 4 scoops, 3 times per day
- Zhi Sou San: 4 scoops, 3 times per day
Initially felt better, but then took a turn for the worse after a couple of days. Dull headache, pain in the left side of chest when coughing, congestion, and wheezing. Brief bout of diarrhea.
Treatment strategy: Harmonize the Shaoyang, clear phlegm-Heat from the lungs.
- Xiao Chai Hu Tang: 4 scoops, 3 times per day
- Gua Lou Zhi Shi Tang: 4 scoops, 3 times per day
Began feeling much better the next day. Energy better, voice beginning to return, no nasal congestion or sore throat, energy improving. Digestion normal.
One week later, he noticed a mild sore throat when singing (professional singer about to perform in a concert later in the week).
Treatment strategy: Tonify the lungs, clear residual phlegm, open the voice.
- Bu Fei Tang: 4 scoops, 3 times per day
- Pang Da Hai seeds: 5 seeds in a cup of hot water before singing
No symptoms for over one week, aside from mild fatigue. Was able to sing 4 nights in a row at a concert. Advised him to continue another round of Bu Fei Tang.
I have used many other formulas, as well as custom bulk and granular formulas, during the past three years. Nearly 2000 years ago, Zhang Zhongjing was motivated to create a treatment strategy for epidemics after he lost many family members. It is a sign of his genius that many of his formulas and methods have been successfully used so many years later. While not all of my treatments use his formulas, I would have been lost without the guidance he provided so many years ago. This was especially crucial in 2020, when his Ma huang-based formulas literally saved lives.
About the Author
Dr. Bill Schoenbart, L.Ac., DAOM, has been practicing traditional Chinese herbal medicine since 1992 and maintains a clinical practice in Santa Cruz, California. Bill is the associate chair of the Department of Herbology at Five Branches University, and he teaches classes in Chinese herbal medicine and medical theory to acupuncture students. He is the author of two books on Chinese medicine, and he is also the current editor of the Botanical Safety Handbook and is an editorial reviewer for the American Herbal Pharmacopoeia. He works as a consultant to herbal product companies with the goal of providing sound advice regarding the development, manufacture, and maintenance of high quality, safe herbal products.