2022 Version Of Jiangxi Province's New Coronavirus Pneumonia Prevention And Treatment Plan With Traditional Chinese Medicine

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With the emergence of new-type coronavirus mutant strains such as B.1.617.2, the clinical manifestations of new-type coronavirus patients have new characteristics, and the epidemic prevention and control measures also need to be adjusted accordingly. In order to give full play to the role of traditional Chinese medicine in the prevention and control of the new coronavirus epidemic, in the national "New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 8)" and "Jiangxi Province Novel Coronavirus Pneumonia Prevention and Control Plan (Trial Version 3)" "Based on the experience of preventing and controlling mutant strains of traditional Chinese medicine from all over the country, this plan is specially formulated.

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1. Clinical manifestations

The incubation period is 1-14 days, mostly 3-7 days. The main symptoms are fever, dry cough, and fatigue. Some patients have the first symptoms such as loss of smell and taste, and a few patients are accompanied by symptoms such as nasal congestion, runny nose, sore throat, conjunctivitis, myalgia, and diarrhea. Severely ill patients often develop dyspnea and/or hypoxemia one week after the onset of symptoms, and severe cases can rapidly progress to acute respiratory distress syndrome, septic shock, metabolic acidosis that is difficult to correct, coagulation dysfunction, and many more. organ failure, etc. A very small number of patients may also have central nervous system involvement and avascular necrosis of the extremities. It is worth noting that severe and critically ill patients may have moderate to low fever or even no obvious fever during the course of the disease. Mild patients may present with low-grade fever, mild fatigue, disturbance of smell and taste, etc., without pneumonia. A small number of patients may have no obvious clinical symptoms after being infected with the new coronavirus. Most patients have a good prognosis, and a small number of patients are critically ill. They are more common in the elderly, those with chronic underlying diseases, women in late pregnancy and perinatal periods, and obese people. Children's cases are relatively mild, and some children and neonates have atypical symptoms, such as gastrointestinal symptoms such as vomiting and diarrhea, or only poor response and shortness of breath. A very small number of children may have multisystem inflammatory syndrome (MIS-C), with Kawasaki disease-like or atypical Kawasaki disease manifestations, toxic shock syndrome or macrophage activation syndrome, etc., mostly in the recovery period. The main manifestations are fever with rash, non-purulent conjunctivitis, mucosal inflammation, hypotension or shock, coagulation disorder, and acute gastrointestinal symptoms. Once it occurs, the condition can deteriorate sharply in a short period of time.

2. Laboratory examination

1. General inspection

In the early stage of the disease, the total number of white blood cells in the peripheral blood was normal or decreased, and the lymphocyte count was decreased. Some patients may have increased liver enzymes, lactate dehydrogenase, muscle enzymes, myoglobin, troponin, and ferritin. Most patients had elevated C-reactive protein (CRP) and erythrocyte sedimentation rate, and normal procalcitonin. Severe and critically ill patients may see increased D-dimer, progressive decrease in peripheral blood lymphocytes, and increased inflammatory factors.

2. Etiological and serological tests

(1) Etiological examination: RT-PCR and/or NGS methods can be used to detect novel coronavirus nucleic acid in nasopharyngeal swabs, sputum, and other lower respiratory tract secretions, blood, feces, urine, and other specimens. Detection of lower respiratory tract specimens (sputum or airway aspirates) is more accurate. Nucleic acid testing will be affected by factors such as the course of the disease, specimen collection, testing process, and testing reagents. In order to improve the positive rate of testing, specimens should be collected in a standardized manner, and specimens should be sent for inspection as soon as possible after collection.

(2) Serological examination: The new coronavirus-specific IgM antibody and IgG antibody were positive, and the positive rate within 1 week of onset was low. Due to the positive judgment value of the reagent itself, or the existence of interfering substances in the body (rheumatoid factor, heterophilic antibody, complement, lysozyme, etc.), or the cause of the specimen (hemolysis of the specimen, bacterial contamination of the specimen, long storage time of the specimen, incomplete coagulation of the specimen, etc.), the antibody test may have false positives. Generally, serological testing is not used as the basis for diagnosis alone, and comprehensive judgment should be made in combination with epidemiological history, clinical manifestations, and underlying diseases. The following patients can be diagnosed by antibody testing: ① patients with clinical suspicion of new coronary pneumonia and negative nucleic acid test; ② patients in the recovery period and negative nucleic acid test.

3. Chest imaging

In the early stage, there were multiple small patchy shadows and interstitial changes, especially in the extrapulmonary zone. It then develops into multiple ground-glass opacities and infiltration shadows in both lungs. In severe cases, pulmonary consolidation may occur, and pleural effusion is rare. On MIS-C, cardiac shadow enlargement and pulmonary edema are seen in patients with cardiac insufficiency.

4. Diagnostic criteria

(1) Suspected cases

Combined with the following comprehensive analysis of epidemiological history and clinical manifestations, there is any one of the epidemiological histories, and any two of the clinical manifestations are met. If there is no clear epidemiological history, meet any 2 of the clinical manifestations, and the new coronavirus-specific IgM antibody is positive; or meet 3 of the clinical manifestations.

1. Epidemiological history

(1) Travel history or residence history in the community where the case was reported within 14 days before the onset of the disease;

(2) There is a history of contact with patients with new coronavirus infection or asymptomatic infection within 14 days before the onset of the disease;

(3) Have been in contact with patients with fever or respiratory symptoms from the community where the case has been reported within 14 days before the onset of the disease;

(4) Clustered onset (2 or more cases of fever and/or respiratory symptoms within 2 weeks in a small area such as homes, offices, school classes, etc.).

2. Clinical manifestations

(1) Clinical manifestations related to COVID-19 such as fever and/or respiratory symptoms;

(2) Having the above-mentioned imaging features of COVID-19;

(3) The total number of white blood cells was normal or decreased in the early stage of the disease, and the lymphocyte count was normal or decreased.

(2) Confirmed cases

Suspected cases have one of the following etiological or serological evidence: 1. Real-time fluorescent RT-PCR detection of novel coronavirus nucleic acid is positive;

2. Virus gene sequencing, highly homologous to known new coronaviruses;

3. Positive for novel coronavirus-specific IgM antibody and IgG antibody;

4. The IgG antibody specific to the new coronavirus has changed from negative to positive or the IgG antibody titer in the recovery phase is 4 times or higher than that in the acute phase.

Traditional Chinese Medicine Prevention

(1) Drug prevention

1. Recipe I: American Ginseng 3g, Honeysuckle 3g, Huoxiang 3g, Mint 3g, Platycodon 3g, Licorice 3g, Lentil Flower 3g

Suitable crowd: general crowd

2. Substitute tea recipe II: American ginseng 5g, kudzu 3g, coix seed 3g, bergamot 3g, honeysuckle 3g

Suitable crowd: those with a weak body and easy to catch a cold (children take it at a reduced dose)

3. Prevention formula I: Atractylodes 6g, tangerine peel 5g, Huoxiang 5g, Yinhua 5g, Daqingye 5g, raw astragalus 10g, American ginseng 3g, lentil flour 5g

Functions: Aromatize turbidity, clear heat and detoxify nourish qi and solidify the surface Applicable crowd: general population

4. Prevention formula II: Astragalus 10g, Fangfeng 6g, Atractylodes 6g, Huoxiang 5g, Daqingye 5g, American ginseng 3g, Lentil flour 10g

Function: Nourishes qi and solidifies the surface, aromatizes turbidity, clears heat, and detoxifies.

(2) Prevention of heat-sensitive moxibustion (one moxa and three prescriptions)

(1) Smell the mugwort

Smell the mugwort of the heat-sensitive moxibustion sticks several times a day for 30 seconds each time. The aromatic components of pure moxa in heat-sensitive moxibustion sticks and the aromatic medicinal properties of Qianghuo, Duhuo, Asarum, and Chuanxiong have a good aroma and refreshment, sensitize the sense of smell, purify the internal environment of the nasopharynx, and improve the immunity of the nasopharynx. , Smelling Aixiang can spread lung qi and prevent exogenous pathogens from being affected.

(2) Apply moxibustion

Acupoint selection: Zhongwan, Shenque, Guanyuan

(3) Ai foot soaking

Put half a stick of heat-sensitive moxibustion moxa stick in 1000ml hot water for 30 minutes every day, until the skin on the forehead or the back of the neck is moist or slightly sweaty.

This plan uses moxa for three uses, through the fragrant smell of moxa sticks, to disperse lung qi; apply dynamic moxibustion techniques to effectively stimulate moxibustion deqi, mobilize the body's own anti-disease function, dispel dampness and transport the spleen; Wen assists Weiyang. Once a day.

TCM treatment

This disease belongs to the category of "epidemic" disease in traditional Chinese medicine. The cause is the feeling of an "epidemic virus". According to the condition, solar terms, local climate characteristics, and different physical conditions, various regions can refer to the following schemes for syndrome differentiation and treatment. When it comes to exceeding the pharmacopoeial dose, it should be used under the guidance of a physician.

1. Medical observation period

Clinical manifestation 1: fatigue with gastrointestinal discomfort

Recommended Chinese patent medicine: Huoxiangzhengqi Capsule (pills, water, oral liquid) Clinical manifestation 2: Fatigue with fever.

Recommended Chinese patent medicines: Jinhua Qinggan Granules, Lianhua Qingwen Capsules (granules), Shufeng Jiedu Capsules (granules), Plum Leaf Granules

2. Clinical treatment period (confirmed cases)

2.1 Qingfei Paidu Decoction

Scope of application: It is suitable for light, ordinary and severe patients, and can be reasonably used in combination with the actual situation of patients in the treatment of critically ill patients.

Basic formula: ephedra 9g, licorice 6g, almond 9g, gypsum 15-30g

(Fried first), Guizhi 9g, Alisma 9g, Polyporus 9g, Atractylodes 9g, Poria 15g, Bupleurum 16g, Scutellaria 6g, Ginger Pinellia 9g, Ginger 9g, Aster 9g, Winter Flower 9g, Shegan 9g, Asarum 6g, Yam 12g, Citrus citrus 6g, tangerine peel 6g, Huoxiang 9g

Dosage: Traditional Chinese medicine, decoction in water. One dose per day, twice in the morning and evening (forty minutes after meals), warm, three doses for a course of treatment.

If conditions permit, after taking the medicine, half a bowl of rice soup can be added, and those with a dry tongue and body fluid deficiency can take up to one more bowl. (Note: If the patient does not have a fever, the dosage of gypsum should be small, and the dosage of gypsum can be increased if the patient has a fever or strong fever). If the symptoms improve but are not cured, take the second course of treatment. If the patient has special conditions or other underlying diseases, the second course of treatment can modify the prescription according to the actual situation, and stop the drug if the symptoms disappear.

Source of prescription: "Notice on recommending the use of "Qingfei Paidu Decoction" in the treatment of pneumonia infected by novel coronavirus with integrated traditional Chinese and Western medicine" by the General Office of the National Health Commission and the Office of the State Administration of Traditional Chinese Medicine (Medical Policy Letter from the State Administration of Traditional Chinese Medicine [ 2020] No. 22).

2.2 Heat-sensitive moxibustion treatment

Scope of application: suitable for light type, ordinary type, the clinical observation period

2.2.1 Moxibustion position

The first group: Shenque, Tianshu

The second group: Zhongwan, Shenque, Guan Yuan

2.3 Lightweight

(1) Syndrome of cold-damp epidemic poison stagnation in the lung

Clinical manifestations: fever, fatigue, body aches, cough, expectoration, chest tightness and suffocation, anorexia, nausea, vomiting, and sticky stool. The tongue is pale, tooth-marked or reddish, the coating is white and thick, rotten or greasy, and the pulse is moist or slippery.

Recommended prescription: Dispelling cold, dehumidifying, and anti-toxic prescription

Raw Ephedra 6g, Almond 9g, Guizhi 9g, Zhigancao 6g, Fried Atractylodes 9g, Perilla 6g, Pinellia 9g, Chenpi 9g, Qianhu 9g, Platycodon 9g, Citrus Citrus 9g, Poria 9g, Ginger 9g, Jujube 9g

For those who have exchanges of cold and heat, add Bupleurum 9g and Scutellaria baicalensis 9g; for those with obvious vomiting and diarrhea, add Hehuoxiang Zhengqi San.

Dosage: One dose per day, decoct 400ml in water, take in two divided doses, once in the morning and once in the evening, before meals.

(2) Syndrome of damp-heat epidemic toxin stagnation in the lung

Clinical manifestations: low or no fever, slight aversion to cold, fatigue, heavy head and body, muscle aches, dry expectoration with little phlegm, sore throat, dry mouth and no desire to drink more, or accompanied by chest tightness and epigastric pain, no sweat or poor sweating, or nausea, nausea, loose stools or sticky stools. Pale red tongue, white thick greasy or thin yellow coating, slippery or moist pulse.

Recommended prescription: heat-clearing and damp-dampening anti-drug prescription

Almonds 9g, Scutellaria 9g, Forsythia 9g, Poria 9g, Cardamom 6g (back), Talc 9g (fried), Mulberry Leaf 9g, Raw Ephedra 6g, Raw Coix Seed 15g, Raw Licorice 6g

Bitter mouth, nausea, and vomiting, combined with Xiao Chai Hu Tang; nausea and vomiting accompanied by joint pain, combined with Chai Hu Gui Zhi Tang; asthma, chest tightness, combined with Xuanbi Tang in Shangjiao chapter of "Warm Disease Diagnosis".

Dosage: One dose a day, decoct 400ml in water, take in two doses, once in the morning and once in the evening.

2.4 Ordinary type

(1) Syndrome of damp-heat epidemic poison accumulating in the lungs

Clinical manifestations: fever, cough with little sputum, yellow sputum, suffocation, shortness of breath, abdominal distension, and constipation. Dark red tongue, fat tongue, yellow greasy or yellow dry coating, slippery pulse or string slippery.

Recommended prescription: addition and subtraction of heat-clearing and damp-proofing prescription

Almond 9g, Scutellaria 9g, Forsythia 9g, Poria 9g, Cardamom 6g (below), Talc 9g (fried), Mulberry Leaf 9g, Reed Root 9g, Winter Melon Seed 9g, Peach Kernel 6g, Coix Seed 15g. For mild diarrhea, add kudzu root 9g

Such as high fever, polydipsia, headache, dizziness, chest tightness, and epigastric sputum, or expectoration with bloody sputum, abdominal distension, vomiting and nausea, yellow and red urine, loose stools, red tongue with yellow greasy coating, slippery pulse.

Recommended prescription: Sanshi Decoction

Talc 9g (fried), Hanshui Stone 15g, Raw Gypsum 15g, Almond 9g, Bamboo Ru 9g, Yinhua 9g, Mung Bean 10g, Tongcao 6g

Such as fever, body heat, cold feet, cough, sore throat, bitterness in the mouth, thirst, sticky mouth, cough, phlegm not easy to expectorate, chest tightness, anorexia, abdominal distension, short yellow urine, red tongue with yellow greasy coating.

Recommended prescription: Ganlu Disinfection Dan Modified Bai Kou Ren 9g (after the next), Huoxiang 9g, Yinchuan 9g, Talc 9g (fried), Chuanmutong 3g, Shichangpu 9g, Scutellaria 9g, Forsythia 9g, Chuanbei 6g, Shegan 9g, Mint 6g (below)

Such symptoms include heat and sweating, thirst and upset, tiredness, lack of energy, lack of energy, short and red urination, a red tongue with little coating, and a weak pulse.

Recommended prescription: Wang's Qingshu Yiqi Decoction

American Ginseng 9g, Dendrobium 9g, Ophiopogon 9g, Coptidis 6g, Bamboo Leaf 9g, Lotus Stem 9g, Anemarrhena 9g, Licorice 6g, Japonica Rice 9g, Watermelon Cuiyi 30g

If the above is accompanied by cough with yellow phlegm, add 9g of golden buckwheat and 9g of Houttuynia cordata; if you cannot lie down due to cough, take Tingliao Dazao Xiefei Decoction together;

Dosage: One dose a day, decoct 400ml in water, take in two doses, once in the morning and once in the evening.

(2) Lung syndrome due to cold and dampness epidemic poison

Clinical manifestations: low-grade fever, low body heat, or no fever, dry cough, less phlegm, fatigue, fatigue, chest tightness, epistaxis, nausea, loose stools. Pale or reddish tongue, white or greasy coating, moist pulse.

Recommended prescription: addition and subtraction of cold-dispelling, dehumidifying and anti-drug prescriptions

Raw ephedra 6g, almond 9g, cinnamon twig 9g, licorice 6g, stir-fried Atractylodes 9g, Huoxiang 9g, Magnolia 9g, Poria 9g, tangerine peel 9g, Divine Comedy 9g, fried malt 9g, Dabupi 6g, Yin Chen 6g, Chai Hu 9g. Very thirsty, cough and phlegm is not easy to come out, add gypsum 9-15g

Such as fever and aversion to cold, chest and diaphragm tightness, nausea and vomiting, decreased sense of smell, greasy mouth but not thirst, limb fatigue, loose stools, white and greasy tongue coating, and wet pulse.

Recommended prescription: Huopu Xialing Decoction

Agaricus 9g, Magnolia 9g, Pinellia 9g, Poria 12g, White Columbine 6g (below), Almond 9g, Coix Seed 15g, Alisma 9g, Polyporus 9g, Tempeh 9g

Dosage: One dose a day, decoct 400ml in water, take in two doses, once in the morning and once in the evening.

2.5 heavy

(1) Epidemic virus closed lung syndrome

Clinical manifestations: fever, flushing, cough, yellow and sticky sputum, or blood in the sputum, wheezing, shortness of breath, fatigue, lassitude, dry and sticky mouth, nausea, inedible, poor stool, short and red urination. Red tongue, yellow and greasy coating, slippery pulse.

Recommended prescription: raw ephedra 6g, almond 9g, raw gypsum 15g, licorice 3g, Huoxiang 10g (below), Magnolia 10g, Atractylodes 15g, Caoguo 10g, Pinellia 9g, Poria 15g, raw rhubarb 5g (below) , Raw Astragalus 10g, Tinglizi 10g, Red Peony 10g

For those with obvious blood in the sputum, add Rhizoma Imperatae 9g.

Dosage: One to two doses a day, decocted in water, 100ml-200ml each time, two to four times a day, orally or nasally.

(2) Qi and blood burnt syndrome

Clinical manifestations: high fever and polydipsia, shortness of breath, delirium, dizziness, vision errors, rash, vomiting blood, epistaxis, or limb convulsions. Dark tongue with little or no moss, and pulse is fine and few or floating and large.

Recommended prescription: gypsum 30-60g (fried first), Anemarrhena 30g, raw land 30-60g, buffalo horn 30g (fried first), red peony 30g, Scrophularia 30g, forsythia 15g, paeonol 15g, Coptis 6g, bamboo leaf 12g, Tinglizi 15g, Raw Licorice 6g

Dosage: One dose a day, decocted in water, first decoct plaster and buffalo horn, 100ml-200ml each time, two to four times a day, orally or nasally.

Recommended Chinese patent medicines: Angong Niuhuang Pill, Xiyanping Injection, Xuebijing Injection, Reducing Injection, Tanreqing Injection, Xingnaojing Injection.

Drugs with similar efficacy can be selected according to individual conditions, or a combination of two can be used according to clinical symptoms. Traditional Chinese medicine injection can be used in combination with traditional Chinese medicine decoction.

2.6 Critical type (internal closure and external decertification)

Clinical manifestations: dyspnea, frequent wheezing or need for mechanical ventilation, accompanied by dizziness, irritability, sweating and cold limbs, dark purple tongue, thick greasy or dry coating, floating pulse without root.

Recommended prescription: 15g of ginseng, 10g of Heishun tablets (fried first), 15g of dogwood, take Suhexiang Pills or Angong Niuhuang Pills.

Recommended Chinese patent medicines: Xuebijing injection, Reducing injection, Tanreqing injection, Xingnaojing injection, Shenfu injection, Shengmai injection, Shenmai injection. Drugs with similar efficacy can be selected according to individual conditions, or according to clinical

Symptoms use a combination of both. Traditional Chinese medicine injection can be used in combination with traditional Chinese medicine decoction.

Note: Recommended usage of heavy and critical Chinese medicine injection

The use of traditional Chinese medicine injections is based on the principle of starting with a small dose and gradually adjusting according to the drug instructions. The recommended usage is as follows:

Viral infection or mild bacterial infection: 0.9% Sodium Chloride Injection 250ml, Jiaxiyanping Injection 100mg bid, or 0.9% Sodium Chloride Injection 250ml, Heduning Injection 20ml, or 0.9% Sodium Chloride Injection 250ml Jiatanreqing injection 40ml bid.

Hyperthermia with disturbance of consciousness: 0.9% sodium chloride injection 250ml plus Xingnaojing injection 20ml bid.

Systemic inflammatory response syndrome or/and multiple organ failure: 0.9% sodium chloride injection 250ml plus Xuebijing injection 100ml bid.

Immunosuppression: 0.9% sodium chloride injection 250ml plus Shenmai injection 100ml bid.

Shock: 0.9% sodium chloride injection 250ml plus Shenfu injection 100ml bid.

2.7 Recovery period

(1) Lung spleen deficiency syndrome

Clinical manifestations: shortness of breath, fatigue, anorexia, nausea, fullness, weak stools, and unpleasant loose stools. Tongue pale, greasy coating.

Recommended prescription: Pinellia 9g, tangerine peel 10g, Codonopsis 15g, Sunburn Astragalus 30g, Fried Atractylodes 10g, Poria 15g, Huoxiang 10g, Amomum 6g (after the bottom), Licorice 6g

Dosage: One dose a day, decoct 400ml in water, take in two doses, once in the morning and once in the evening.

Recommended Chinese patent medicine: Shenling Baizhu Powder, Xiangsha Liujun Pill