From Mild Illness to White Lung: My Empirical Formulas for Treating COVID-19

Doctor zhou December 28, 2022

I have recently taken part in treating a great many people infected with COVID-19, and from my practical experience I have developed a pattern-differentiation and treatment approach to COVID-19 infection. In the clinic, following this system I worked out, I pattern-differentiate and medicate COVID-19 and almost invariably achieve immediate effect with a single dose. So I venture to write this article to share my treatment experience and insights with the public.

The course of COVID-19 infection can be roughly divided into three stages: the early cold-damage (shanghan) stage, the middle mixed cold-heat stage, and the late stage of intermingled cold, heat, phlegm and stasis.

The first stage occurs basically within 1–3 days of infection; over 90% of patients present with aversion to cold, body pain and fever—a typical Taiyang cold-damage pattern. At this stage symptoms can be relieved by drugs or by natural therapy. Representative formulas are Mahuang Tang, Gegen Tang, Guizhi Tang and Guizhi Jia Gegen Tang.

Mahuang Tang: Mahuang (Ephedra) 15 g, Guizhi (Cinnamon twig) 10 g, Xingren (Apricot kernel) 10 g, Zhi Gancao (honey-fried licorice) 5 g. This is for patients who cannot sweat. Doses are for adults; infants 0–3 years take one third, children 3–10 years take half, children over 10 take the adult dose. An ordinary patient takes one dose, all at once, and is relieved.

Patients taking Mahuang Tang must show the following: marked aversion to cold not relieved by covering up, inability to bear touching cold things or ice packs, no dry or parched mouth, generalized body pain, fever, and clear urine. After one dose, if sweating is successfully induced, do not continue this formula; if fever persists, switch to Guizhi Tang.

Guizhi Tang: Guizhi 15 g, Baishao (White peony) 15 g, Zhi Gancao 10 g, Shengjiang (fresh ginger) 7 slices, Dazao (jujube) 7 pieces. This is for patients with aversion to cold and body pain who can sweat. Adult dose; 0–3 years one third, 3–10 years half, over 10 adult dose.

Patients taking Guizhi Tang must show: aversion to cold and wind, ability to sweat (even profuse sweating), no dry or parched mouth, intolerance of cold objects or ice packs, generalized body pain, fever, and clear urine.

Gegen Tang: Gegen (Pueraria) 20 g, Mahuang 15 g, Guizhi 10 g, Baishao 10 g, Zhi Gancao 10 g, Shengjiang 7 slices, Dazao 7 pieces. This is for hypertensive patients and those with neck-and-back pain who cannot sweat. Adult dose; 0–3 one third, 3–10 half, over 10 adult dose. Take 1–2 doses a day, divided into 2–3 portions.

Patients taking Gegen Tang must show: marked aversion to cold not relieved by covering, intolerance of cold objects or ice packs, no dry or parched mouth, generalized body pain, neck-and-back pain, headache, soaring blood pressure poorly controlled by antihypertensives, fever, and clear urine. If sweating is successfully induced, do not continue this formula; if fever persists, switch to Guizhi Jia Gegen Tang to consolidate.

Guizhi Jia Gegen Tang: Gegen 20 g, Guizhi 15 g, Baishao 15 g, Zhi Gancao 10 g, Shengjiang 7 slices, Dazao 7 pieces. This is for hypertensive patients and those with neck-and-back pain who can sweat. Adult dose; 0–3 one third, 3–10 half, over 10 adult dose.

Patients must show: aversion to cold and wind, intolerance of cold objects or ice packs, no dry or parched mouth, generalized body pain, neck-and-back pain, headache, soaring blood pressure poorly controlled by antihypertensives, fever, and clear urine.

Severe patients taking Guizhi Tang or Guizhi Jia Gegen Tang may take 2–3 doses during the day and one more at night; each dose is divided into 2–3 portions taken every 1–2 hours.

None of these formulas should be decocted long; briefly soak for three to five minutes or skip soaking, bring to a boil over high heat, and take.

If no medicine is available, that is fine—at this stage patients can rely entirely on natural therapy. They can induce sweating by any combination of the methods below; as long as sweating is induced (whether or not they are prone to sweating, they must sweat), symptoms are basically relieved, and the great majority will not worsen or progress to the middle or late stages.

Natural sweating methods:

The most effective natural method is to blow warm air from a hairdryer over the coccyx, where nerves are densest; high-intensity warm air for 2–5 minutes usually induces sweating in anyone. When using the hairdryer, have the patient lie in bed covered up to help sweating. Once sweating occurs, fever can break within 3–5 minutes. Most patients fever returns after it breaks, but repeat the method to induce sweating again and it again brings the fever down quickly. This works better and faster than all the herbal formulas above, usually restoring a settled state within a day.

My own family all solved the problem by hairdryer-induced sweating; the three of us had only one day of severe symptoms and on the second day were markedly relieved—no longer feverish, strength returning. Afterwards we did have sore throat, cough and rhinitis, but all mild.

We did not aim the hairdryer specifically at the coccyx; instead we blew hot air into the bedding until the whole bed was hot, stopping when the forehead sweated faintly. Whether feverish or not, we blew hot air every few minutes or ten-odd minutes. Hot air in the bedding feels wonderfully soothing, generalized pain eases markedly, and once sweating occurs the fever breaks. I wrote up my treatment experience in an article "The Twenty-Four Hours from Onset of COVID-19 to Recovery"; interested readers can read it themselves.

Those who use hairdryer sweating at the very beginning basically do not progress to the middle or late stages; even if later they develop sore throat and cough, these are milder than in other patients, and they recover quickly. After hairdryer sweating, the patient should drink some hot water or hot congee in moderation; if sweating heavily, take light salt water or vegetable soup to replace salts.

If the patient cannot tolerate this method, they may instead drink ginger-scallion water or ginger-garlic water (hot water brewed with适量 ginger, scallion and garlic to taste) or plain hot water, while soaking their feet in hot water to promote sweating. Electric blankets and sitting by the fire also work to induce sweating.

If the patient is not allergic to chili, very spicy hot noodle soup, combined with the methods above, helps induce sweating. Even with a sore throat they can eat very spicy hot noodles or drink very hot water, because this disease at the outset is a cold-damage syndrome; as long as the patient is at the early stage, spicy food and hot drinks will not worsen the throat but effectively relieve it. Using this method in the middle or late stages would be inappropriate.

This heat-therapy method I introduced has been read hundreds of thousands of times and used by countless people; the great majority of feedback so far is positive. The effect is immediate—relief within minutes.

The second stage is the mixed cold-heat stage. Patients who fail to take correct treatment in stage one easily enter stage two on days 3–5 of illness. Some patients linger in stage two for over ten days without relief; many of my patients back in Hubei are like this, possibly related to the damp-cold local weather.

Stage two is characterized by recurrent or absent fever, sometimes aversion to cold and sometimes hot and restless, night sweats, irritability and insomnia, generalized pain, unbearable headache, sore throat and cough, poor appetite, and loss of smell and taste. This stage has both a Taiyang exterior pattern and a Shaoyang half-exterior-half-interior pattern.

I treat stage-two patients with Chaihu Guizhi Tang; so far every patient I have treated with it has been relieved with a single dose. One dose is divided into two portions; after taking both, the above symptoms ease markedly and the illness seems to vanish. Successfully relieving stage two promptly keeps patients from progressing to stage three.

Chaihu Guizhi Tang: Guizhi 9 g, Huangqin (Scutellaria) 9 g, Renshen (ginseng) 9 g, Zhi Gancao 6 g, Fabanxia (processed Pinellia) 12 g, Baishao 9 g, Chaihu (Bupleurum) 24 g, Dazao 12 pieces, Shengjiang 7 slices, decoct in water. Adult dose; 0–3 one third, 3–10 half, over 10 adult dose.

Patients should not grab up medicines; the patients I treat basically resolve with one dose, and only a very few need two. TCM holds that once the disease responds, stop the drug; more is useless. So do not hoard medicine; patients whose symptoms have eased should pass their leftover drugs on to relatives and neighbors.

I have compared Xiao Chaihu Tang with Chaihu Guizhi Tang and found that in stage two, Chaihu Guizhi Tang is the best; other circulating Chaihu-type formulas are not as effective.

Most stage-two patients need medication; no natural therapy solves this stage. Of course, COVID-19 is self-limiting, and most patients without underlying disease can get through this stage without drugs and avoid stage three. But a subset find it very hard to get through; if symptoms persist seven days without relief, take Chaihu Guizhi Tang promptly.

Stage three is the severe phase. A minority of patients with underlying disease or advanced age enter the late course of intermingled cold and heat with phlegm and stasis binding together. The main symptom is dyspnea/shortness of breath, with very low blood oxygen saturation, universal fatigue, low fever or no fever, and a heavy, cumbersome body.

These patients are the most dangerous. Treating them follows the TCM principle of simultaneously resolving exterior and interior and resolving phlegm and expelling stasis. Some develop white lung. Whether or not there is white lung, stage-three patients can be treated with a combined, modified Chaihu Guizhi Tang plus Huangqi Fangji Tang. Below is my empirical formula for this stage (including white-lung patients).

Guizhi 9 g, Huangqin 9 g, Renshen 9 g, Zhi Gancao 6 g, Fabanxia 12 g, Danannanxing (bile Arisaema) 12 g, Tianhuafen (Trichosanthes root) 12 g, Sangbaipi (Morus bark) 30 g, Baishao 9 g, Chaihu 24 g, Sheng Huangqi (raw Astragalus) 30 g, Han Fangji (Stephania) 30 g, Fuling (Poria) 30 g, Zhuling (Polyporus) 10 g, Baizhu (Atractylodes) 30 g, Tinglizi (Descurainia) 30 g, Laifuzi (radish seed, or dried shredded radish) 30 g, Cheqianzi (Plantago seed) 15 g, Huainiuxi (Achyranthes) 15 g, Dilong (earthworm) 9 g, Dazao 12 pieces, Shengjiang 7 slices.

Critical white-lung patients should not take only one dose a day. If symptoms improve after taking it, consider 2–3 doses over a day and night, taking a portion every 1–2 hours. Decoct each dose twice and use both decoctions. Within three days patients should feel markedly relieved; after relief, switch to one dose a day in three portions.

Patients who have entered the late course are harder to save, and they have multiple underlying diseases, but the formula above markedly relieves symptoms and reduces pleural effusion. Elderly patients with cold hands and feet may also take Jinkui Shenqi Wan or Guifu Dihuang Wan; those with hot palms and soles may take Zhibai Dihuang Wan. Complex cases should receive other concurrent hospital treatment for their underlying diseases.

The above regimen does not cover every patient, but in my clinical practice over consecutive days it has repeatedly proved effective, which is why I venture to make it public. If colleagues try it in their practice, verify its efficacy, save more patients and reduce casualties, I will be immensely comforted.

Finally, I want to tell patients: COVID-19 is a newly emerging disease with no specific therapy yet. Have a rational expectation of efficacy. With the above regimens, most patients can relieve the main symptoms—fever, body pain, fatigue, poor appetite—but mild sore throat and cough require waiting for the body to recover on its own. Do not expect drugs to remove every symptom; that is impossible. Doctors worldwide have only just begun to study COVID; over-high expectations are unrealistic.

Wishing everyone a speedy recovery! If I gain more effective insights in coming clinical practice, I will share them promptly. Except for the last formula, which I myself modified by adding herbs to Zhang Zhongjing base formulas, all the above come directly from Zhang Zhongjing Han-dynasty classic *Shanghan Lun* (Treatise on Cold Damage).

My focus has shifted to treating severe patients these days. Those with mild, non-life-threatening illness should patiently read my recent articles rather than consulting me and taking my time; you can find solutions to your problems there. If I work out effective treatments for COVID sequelae, I will publish them promptly.

The above regimens suit most people. A few patients with underlying disease, however, never develop the above symptoms from the start; they should not use these formulas and should seek timely, individualized medical care. This disease is self-limiting: the great majority of young patients need only the drug-free heat therapy I recommended early on, no medication. I hope everyone will avoid scrambling for drugs and leave life-saving resources for the more dangerous patients.

One more point about washing hair and bathing. In my own family of three and among the relatives and friends I treated, after improvement under my treatment, not a single person relapsed from washing hair or bathing. Patients whose symptoms worsen after washing do so only because they have not received proper treatment; washing is not inherently to blame. This disease must not be treated as a wind-heat cold; those who abuse wind-heat remedies are committing contrary treatment. As Zhang Zhongjing wrote in *Shanghan Lun*: "One contrary treatment may still prolong the days; a second contrary treatment hastens the end." Beware—take heed!

You should also read: