Traditional Chinese Medicine (TCM) is used in all settings in China for COVID19, with preliminary outcome data very, very strong. Indeed, outcome data using TCM for prevention and treatment of SARS Cov1 was equally strong. Listen to one of the most important and timely conversations I’ve had to date on New Frontiers with Dr. John Chen, one of the world’s leading experts in TCM (with western pharma training).
Framing TCM in language clear for the Western-trained clinician, and translating the early descriptive language, Dr. Chen (author of the seminal textbooks used in all the TCM training programs in the US) is actively following TCM in China, and shares his experience, insight, and observations with all of us. An incredible, and timely, conversation, worthy of your utmost attention. ~DrKF
In China: TCM (Traditional Chinese Medicine) for COVID19 with Dr. John Chen
Traditional Chinese Medicine (TCM) has a long history of being used during pandemics, and it can be a useful adjunctive treatment for the prevention and treatment of viral infections. As COVID19 threatens human health worldwide, TCM may help boost immunity and stave off infection, or help people recover more quickly if they do get the virus. In today’s episode of New Frontiers, Dr. Fitzgerald talks with Dr. John Chen, PharmD, PhD, about using TCM as part of a COVID19 prevention and treatment plan.
In this podcast you’ll learn about:
- Making differential diagnoses in TCM
- Key botanicals for respiratory infections, both bacterial and viral, at different stages of their development
- Key botanicals for dilating the lungs, reducing lung inflammation, and facilitating breathing
- Key botanicals for supportive care
- The importance of using Chinese herbs as part of multi-herb formulations
- The approach used by Traditional Chinese Medicine practitioners vs. the approach used by Western integrative medicine
- Understanding cytokine storms as one of the most significant things that happen in COVID19
- How clearing phlegm from the lungs can help ventilator interventions be more effective
- The potential of COVID19 to leave lasting damage in the lung tissue
- The best way for clinicians to expand and deepen their knowledge of TCM
Dr. John Chen is a recognized authority in both western pharmacology and Chinese Herbal Medicine, having combined formal training in both fields with extensive research ‘on the ground’ in China. He teaches at the USC School of Pharmacy, Emperor’s College, Yo San University of TCM, OCOM, Five Branches, AOMA and ACTCM, and has taught numerous professional seminars across the U.S. and internationally. Dr. Chen’s published works include Chinese Medical Herbology and Pharmacology (2003, AOM Press), Chinese Herbal Formulas and Applications (2008, AOM Press), and Chinese Herbal Formulas for Veterinarians (2012, AOM Press) for which works he is the lead author.
TCM in United States (Differs state to state; research through individual state licensing boards)
Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (7th Edition English translation)
Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine. I’m your host, Dr. Kara Fitzgerald, and I am thrilled to be interviewing really one of the best minds in traditional Chinese medicine today. We’re going to be talking about all things COVID-19 and the use of Chinese medicine, actually the long history of traditional Chinese medicine in pandemics.
With me today is Dr. John Chen. Dr. Chen is a PharmD PhD, a Doctor of Oriental Medicine, and a licensed acupuncturist. He practices on the West Coast. He’s a recognized authority in both Western pharmacology and Chinese herbal medicine and has formal training in both fields with extensive research on the ground in China. He teaches at the USC School of Pharmacy, Emperor’s College, Yo San University of Traditional Chinese Medicine, and many other universities. He’s taught here in the US, he teaches here in the US, he teaches internationally. His published works include Chinese Medical Herbology and Pharmacology, and that’s AOM Press in 2003, Chinese Herbal Formulas and Applications, in 2008, again AOM Press, and Chinese Herbal Formulas for Veterinarians in 2012, AOM Press. He’s the lead author on all of those.
I came across Dr. Chen’s work, actually I was introduced by Dr. Winston Cardwell, who’s been helping me think through and write about using Traditional Chinese Medicine in preparation for COVID-19 here in the US. Dr. Chen is indeed on the ground in Wuhan communicating with physicians there and publishing actively on his site. When you go to our shownotes page, you’ll see that I’ve gathered together his PowerPoints, his publications, and just really as much of a clearinghouse of his work in this area.
Dr. Kara Fitzgerald: Dr. Chen, welcome to New Frontiers.
Dr. John Chen: I’m glad to be here.
Dr. Kara Fitzgerald: You’re talking to clinicians primarily, our audience, we’re western-trained. The fact that you’ve got this east and west training is particularly useful for us. Tell us what’s happening in China. Talk to me about using TCM over there, and some of the results they’re getting.
Dr. John Chen: Well, this obviously first happened back in December of 2019, and so after they started noticing some cases of pneumonia, they realized this is very similar to the SARS back in 2003 and 2004. Within a short amount of time, the Chinese government has taken very drastic actions, as everybody knows. They start building hospitals in 10 days, they started to quarantine the whole city of Wuhan, and Hubei province, and all the surrounding cities and so on. Then, what they have also done is they started to treat the patients, and of course this is a novel coronavirus so most of the things they are trying to do is a little bit of trial and error.
They used the protocol they learned from SARS as the starting point, and they built on that, and they continue to try different things until they find the most effective approach. In fact, all the experience that’s learned, either on the ground in the local hospitals in Wuhan or the provincial hospitals or surrounding cities, what happened is whatever information they experienced, they gathered, they sent it all to the central government in Beijing and then Beijing will start to look at all this. They modify their treatment protocol and they send it back to all the hospitals both on a city level and also provincial level, so basically, it’s a process of trial and error and refinement, trial and error and refinement, and the information continues to be gathered and published.
In fact, they published a book called the … Let me give you the exact title here, one second. It’s The Guidance of Coronavirus Disease, 2019, and in fact we are in the seventh edition of the book already and the book is about 200 pages.
Dr. Kara Fitzgerald: Wow.
Dr. John Chen: It’s kind of like how they built a hospital in 10 days, how they published a book of the treatment protocols and they continue to update it every week, every other week. What, of the-
Dr. Kara Fitzgerald: That’s incredible.
Dr. John Chen: Yeah, and out of the seven editions, one of them is in fact an English version, so anyone that’s interested, it’s definitely available for download for free.
Dr. Kara Fitzgerald: Goodness. Okay. Well, if we can, we’ll link to it on our show notes page, folks, but you’ve got the name. We’ll certainly put the name there and with access instructions. Appreciate it. Is this looking at both TCM as well as Western approaches?
Dr. John Chen: They do both. Some of the smaller clinics or smaller hospitals in China are more traditional, so they pretty much treat it from a traditional perspective, meaning mostly herbal medicine and then to some smaller extent, acupuncture and others. What happened is this happened so fast, so quickly and so severely, that there’s really no time to do acupuncture treatment or anything else. In essence, what they did is they classified all the patients more or less into four major categories. The first category would be prevention. Second is when they show early signs and symptoms. Third is when they have pneumonia or acute phase, and then finally is recovery, or when they are discharged.
Within these four phases there is some differential diagnosis and then corresponding treatment, so once they made this broad category of differential diagnosis, they come up with the best treatment protocol and then patients get those set formulations. That way it’s a lot faster, it’s a lot more efficient because they just don’t have the time to write customized treatment based on each individual patient.
Dr. Kara Fitzgerald: I want to understand what is being prescribed for these four phases. If there’s significantly, just thinking about COVID-19 in general, I know that there are different symptom pictures. Is the intervention changing much in TCM? I want you to walk through all that, but I want to hear also, Dr. Chen, how are people responding to this approach in general?
Dr. John Chen: The first phase is the prevention phase, so that part is, the protocol is pretty much the same whether you are looking at the city, provincial, or national level. That is, the emphasis is to keep the patient as healthy and as strong as they possibly can. Let’s say people here, as well, right? There are people that maybe they party a lot, or they work a lot, they’re under a lot of stress, they don’t sleep very well. These are all many factors that can contribute to a weakened immune system. Okay? Whatever the cause may be, patients should realize these are factors that may weaken their immune system, so they need to correct that so they stay as strong as possible. As they are exposed to the virus, this will help them to minimize their chance of getting an infection.
Then as far as herb goes, generally speaking the herb of choice is an herb called astragulus or generally speaking, Chinese herbs are prescribed in a formulation so the herbs can help each other and maximize the effect. The formulation in this case is one called the Jade screen powder, and its Chinese name is called Yupingfeng San. This is the core formula used to help to boost the immune system for both the non-specific and also specific immunity, so the body can help to fight off the infection even before, when you are exposed. Let’s say if, for some reason, they are not able to, because COVID-19 is very contagious, okay. Then what happens is the patient will start to show early signs and symptoms, but at this point, the signs and symptoms are very vague. They are a little bit generic, right, so the patient may have fever, little bit of dry cough, some muscle aches and pain, and fatigue, but that doesn’t tell you anything as far as exactly what you have. It could be a common cold, it could be an influenza, or it could be in fact coronavirus. Okay? At this early phase, the treatment is to use herbs that, number one, help to treat the virus infection itself, or treat a bacterial infection, it could be a bacterial infection as well.
Dr. John Chen: Then, a lot of herbs also for supportive care. Okay? For example, if you have headache, something to relieve the headache. If they have muscle aches and pain, something to relieve the muscle aches and pain, and also to help with the blood circulation as well, because in early phase, a lot of people may have some chills and fever, and that is in part due to vasoconstriction. Okay? Once the blood vessel constricts, then you have less blood that flows to the peripheral parts of the body. That means the white blood cells cannot get to the diseased area. That means your mucus membrane is maybe a little bit thinner than it normally should be, so the virus can get into the body a little bit easier.
Anyways, the bottom line is, when they are in the early phase, it’s a little bit of antiviral approach to treat a virus, and also a little bit of supportive approach to support and relieve some of their signs and symptoms. Okay. Then the next phase is probably the most complicated, and that is the pneumonia phase.
Dr. Kara Fitzgerald: Before you jump into pneumonia, can you just talk to me about some of the key botanicals that you’re considering in the early phase.
Dr. John Chen: The early phase, there are a few. Some, or the one that I use the most, is probably lonicera flower, which is Jin Yin Hua, or forsythia fruit, which is Lian Qiao, or isatis root, and isatis leaves, which are Ban lan gen and Da quing ye. Okay, so these herbs traditionally are described as herbs that clear wind-heat. Okay? You have to think back a couple thousand years, and this is obviously before the discovery of bacteria and virus and microscopes and all that, right? What happened is, when somebody is under the weather, okay, and they are exposed to different weather conditions or maybe they are, they contracted a disease, and in the past, obviously you cannot see the bacteria, you cannot see the virus. Doctors in the past used the best description they can to describe what’s happening, and that is, when they are exposed to the wind or heat or rain or cold, they contract these infections. It’s kind of like common cold, right? It’s not really a cold, but it’s actually a viral infection. Herbs that are described to treat wind-cold or wind-heat, they normally are the ones that shows the initial effect to treat either bacterial or viral infection.
Dr. Kara Fitzgerald: I just wanted to make the comment to listeners, we can get many of these herbs in combination or as single herbs through some of our traditional distribution routes. For instance, Natural Partners or Fullscript or Emerson, you will find some of these products. At some point, I’ll just ask you, Dr. Chen, about dosing these and how we might think about, when not everyone is available, or when we can’t find those formulas, but let’s keep … Do you want to answer that now, or do you want to keep talking about the phases?
Dr. John Chen: Well, let’s talk about the phases. That way, it’s more continuous, and then the single herb, the formulas, and dosing, we can talk about that a little bit later. How Chinese herbal medicine uses herb is most likely very different from how naturopath herbalists or other modalities, how they use herbs.
Dr. Kara Fitzgerald: Yeah.
Dr. John Chen: So the next phase would be the pneumonia phase, and this is when the disease becomes acute, very severe, and also from the treatment perspective, it’s also very complicated, okay? Generally, in the beginning, the patient would then have shortness of breath, they would have wheezing, dyspnea. They will show a stifling sensation or feeling oppression in the chest, okay? This is an indication that the disease has probably moved from the exterior, where it’s early signs and symptoms of virus infection, to most likely there is some lung involvement. At this time, generally in the hospitals in China, they would follow up and do a CT or chest x-ray. When they see a cloudy appearance on the x-ray or CT, in combination with all the signs and symptoms, then they are likely to have the COVID-19 infection. Okay, but obviously if test is available for confirmation, that would be ideal. In China, they do that. In Korea, they do that very aggressively. In the US, we are still a few weeks behind as far as having the testing available.
In any case, at the beginning, at this point, supportive care becomes very important, because at this point the virus has gotten into the lung cells, has replicated, and there’s probably a lot of virus in the body already. Now, the body is in a full battle with the virus, so we need to support the patient as much as possible. Generally speaking, at this time, herbs are used to dilate the lung, to help with breathing. Herbs help to reduce body temperature, herbs are used to reduce inflammation, and so on. If you imagine, right, and once again this is from a historical perspective, obviously fever is a sign of heat. Okay? Inflammation is also a sign of heat. In fact, if you think about the western word -itis, right, whether it’s gastritis, pneumonitis, arthritis, all the words that end with -itis, -itis means to set on fire. Right? All these diseases, basically, are characterized by inflammation of some kind. Okay? Lung inflammation is the same. Historically, what happened is wherever there is inflammation in the body, Chinese medicine would describe it as heat in that part of the body, right? If the patient has pneumonia or bronchitis with inflammation of the lung, Chinese medicine generally will describe this as lung heat. Okay?
The herb used in this case generally will have two or three different pharmacological effects. One is antipyretic effect, to treat fever. One is antibacterial, or antiviral effect, to treat the lung infection itself, and also anti-inflammatory effect, to reduce the lung inflammation. Okay? Once the disease, again, goes from the outside of the body into the lung, the diagnosis in Chinese medicine is these patients now have lung heat condition. The treatment then is to use herbs to reduce fever, to treat lung infection, and also to treat lung inflammation. Okay?
One other thing that I want to point out that’s very important is cytokine storm is one of the significant things that happens in COVID-19. This happens when the immune system overreacts in a controllable fashion and starts to attack not just the virus but also the lung tissues and the lung linings. It also produces too much of the cytokines, which are the pro-inflammatory mediators. Now, you end up with severe inflammation and damage to the lung. Then, what happens is this in turn creates some fibrosis to the lung, as well as a lot of what they call the proteinaceous exudate, very sticky discharge, of the lung. Okay? What happens is, this is actually what blocks the patient from being able to breathe properly and get air into the lung and into the blood, because so much of the space is blocked by this very thick discharge. Then, what happens is, a lot of the time, if you ask the patient, “Do you have any sputum, do you have any phlegm?” They’ll say no, because they have a dry cough. Okay? What happened is they do in fact have a lot of sputum and phlegm, but it’s very, very dry and thick and sticky. In fact, it usually goes into the alveolar sacs, the air space. Okay, so they actually don’t know about this until they did a biopsy, in China, to open up the lung and see what’s actually happening to the lung.
Also, in the US, I think you will see in the New England Journal of Medicine, or JAMA, I forgot where I read it, but they also did biopsy in two of the patients with lung cancer who also have COVID-19. After they did the biopsy, they found out the exact same thing, that there is so much of the phlegm that’s deep inside the lung. This is one of the most important things when they are actually treating the severe pneumonia at this point. In Western medicine, obviously, if you watch TV, they talk about ventilator, respiratory, oxygen machines, all the time, right. This is going to help the patient to be able to breathe, but what happens is, you can imagine, right? You have all these exudates and phlegm and sputum that’s inside the lung. Now, if you force too much oxygen into the lung, where do you think the sputum and phlegm are going to go? They’re going to be pushed deeper into the air sacs, okay, so that may not be very helpful, because what was in the deep part, maybe there’s a chance to maybe get rid of it, either by dissolving it or by expectorating it outward. Now what happens is if all you do is push oxygen further deep in, then you push those phlegm and exudates further into the air sac.
I think this is one area where they found out in Chinese medicine, really, after they did the biopsy, that before the oxygen is pushed into the lung and forced deep, they need to clear the phlegm first. Once the phlegm is clear, then they might be able to breathe on their own, or they might still need the oxygen, but if you don’t clear the obstruction, then just pushing the air in may not do all the things they think it will do. Okay? That is one of the main things that they discovered after about a month or so, treating the patient with Chinese medicine, Western medicine, integrated medicine, which is combination of both, that they changed their protocol. What used to be just dilating the lung and supportive care then switched focus, and getting rid of the phlegm, getting rid of this discharge becomes a very important focal point. Okay? That is, in a very quick summary, how TCM treats the pneumonia phase in China.
Dr. Kara Fitzgerald: Can you talk to me about some of the top botanical considerations for that phase?
Dr. John Chen: Those are basically, those have a lot of the herbs that are primarily the seeds, okay? These seeds have a function, or in Chinese description, Chinese description of herb, for those of you who are not familiar, are very artistic. They are using what the eyes generally sees, and what the common sense generally describes. The Chinese description of herb is not like the pharmacology, where it’s specifically on the neurotransmitter or the receptor or the enzyme. The seeds in this case are described to be able to loosen up the phlegm so the body can expectorate it out, or somehow make it thinner so our body or our macrophages can engulf it and take care of it. Some examples include lepidium seed, which is Tin Li Zi include bitter almond seed, which is Ku Xing Ren includes perilla seed, which is Su Zi winter melon seed, which is Dong Gua Zi, okay, or there is a formula Quing Qi Hua Tan Wan which is to clear the chi and dissolve phlegm. Okay? These are some of the herbs and formulas that work well to get rid of the phlegm and to get rid of the sputum.
There is also another formula called She Gan Ma Huang Tang, which is Belamcanda and ephedra decoction and this is a formula historically used to specifically treat the deep-rooted phlegm in the lung that causes wheezing and dyspnea and asthma. In fact, that formula is very frequently used in China now, specifically to battle the phlegm aspect of the pneumonia patients, pneumonia phase in COVID-19 patients.
Dr. Kara Fitzgerald: Right, okay. Now, I would like to link to a document that he’s talking about these specific herbs you’re speaking to me about today. Would that be the YouTube presentation that you gave recently, or would it be this COVID-19 document, how COVID-19 is currently treated in China?
Dr. John Chen: Well, it’s both.
Dr. Kara Fitzgerald: Both? Ok
Dr. John Chen: I have written a few articles. The first one I wrote is more specific about what the Hubei province treatment protocol is, so that one’s the very first article. Then I came across quite a few others. One is the Wuhan Union Hospital and their treatment protocol, and the one that I mentioned earlier is the Central Government from Beijing, and their guidance for coronavirus disease 2019. In the end, what I did was I combined all these together along with additional Western information and also clinical research and pharmacological research, and that is what I presented in the presentation. It’s available on YouTube, and it’s also available at the eLotus website.
Dr. Kara Fitzgerald: Okay, perfect. All right. We’ll just corral together all of those references for you folks, but yeah. The YouTube is really useful, and we do have, we can link to that PowerPoint as well so you can actually have the PowerPoint that Dr. Chen’s going through in front of you to make notes. Talk to me about outcome. I mean, as China began to sort of dial in the formulas, yeah. Talk to me.
Dr. John Chen: Okay, well, let me finish the last part, which is the recovery phase, then I’ll mention the outcome. What happens is, as the patients are finally healed and recover and they are discharged from the hospital, obviously they are considered to be virus free, but their body has suffered some damage during this whole ordeal. What they have found is, with SARS, in 2003 and 2004, there’s severe damage, and the damage is generally severe pulmonary fibrosis. Okay? In COVID-19, if they are discharged, there is still some damage, and the damage in this case is a combination of both the lung function and also the lung form. What I mean by that is, form is referring to the organ itself. They find scarring of the lung tissues, they find damage to the inner lining that’s in the lung, and obviously when that happens, the function is compromised, so they end up with shortness of breath, wheezing, dyspnea and so on. A lot of the patients, even when they are discharged from the hospital, they still need a ventilator to help them breathing.
With the huge amount of shortage of ventilators in the US, that’s probably not going to happen, but this is an area where Chinese herb can help the patient quite a bit. There are a lot of herbs that can help to restore the function and improve the form, so their lung structure and their breathing can be back to normal as quickly as possible. Most of those are herbs that help to repair the lung, like Sa Shen, or Mai Dong, or a formula called Sa Shen Mai Dong Tang which is a combination of those two that I just mentioned as the chief herbs, and then plus some of the other supporting herbs. Okay?
Dr. John Chen: As far as the treatment outcome, I don’t know of the exact treatment outcome. I mentioned there are three main treatment protocols, right? One is the Wuhan Union Hospital, so that’s a city hospital protocol. One is the Hubei Provincial Hospital, that’s the state. What happened is, in the beginning, they were just so busy treating the patients, I don’t know if they had time to gather all the data and do any kind of randomized placebo control, or any kind of study like that. I haven’t come across specific studies or results. It’s not until a little bit later on when the Central Government gets all this information, they start to refine the study, before they will issue the herb, provide guidance of what formulas to use for what phase, and also try to gather data as far as the effectiveness of the treatment. Obviously when they did this, they tried to study both the drugs, which in this case are the antiviral drugs that used to be used for HIV, but they were using it for COVID-19, and also the herbs.
The herb, the herbal formula they were pushing or recommending the most is one called, let me look it up real quick so I can give you the data as well, called Quing Fei Pai Du Tang, which literally means clear the lung and eliminate toxins decoction or, some people translate it as clear the lung and detoxifying potion. Okay? It’s a formula that’s composed of four other formulas, meaning it takes ideas from four other formulas. Okay? I can go into those in detail a little bit later if the audience likes, or it’s all in my presentation in YouTube, but what they have found is, they have given this formula to patients that’s at the transition of early signs and symptoms and into the pneumonia phase, or right into the pneumonia phase. Basically, for patients that are confirmed to have COVID-19, and as the disease starts to progress from early signs into the pneumonia phase. What they have found is they gave this formula to 701 patients in 10 provinces, and the data that’s reported is 130 recovered and were discharged, 51 had resolution of signs and symptoms, 268 had improvement of signs and symptoms, 212 had stabilization of signs and symptoms. Their overall effective rate is 94.3%.
Dr. Kara Fitzgerald: Okay, and that would beat the antivirals, I would imagine.
Dr. John Chen: Well, this is a, like I said. This is the combination of four, actually four formulas, and the four formulas are basically aimed to treat both the symptoms, the signs, and to treat the virus, and also to speed up the recovery, so, yeah.
Dr. Kara Fitzgerald: I didn’t ask the question correctly. I meant that, this particular intervention probably outperformed the HIV antivirals. Is that correct?
Dr. John Chen: I believe so.
Dr. Kara Fitzgerald: Can you talk-
Dr. John Chen: The HIV antivirals were the HIV drugs, and in fact the results were just published last week. I believe it was also first reported by New England Journal of Medicine as well, and the results were basically called, quote-unquote, disappointing, because the drug showed no significant benefit compared to people that did not take the drug.
Dr. Kara Fitzgerald: Let’s see. What else do I want to ask you? Now, having … A lot of research went into SARS-COV-1, I mean, and there were preventative interventions used. This is when I began to sort of think about Chinese medicine, and find your work. I mean, they were using jade windscreen and another product I came across, Sang Ju Yin as preventatives in SARS-COV-1, and some very powerful outcome. Can you talk about that, and how that informed COVID-19 a little bit?
Dr. John Chen: Sure. That approach is very similar to the current prevention approach for COVID-19. The study was originally done in Hong Kong in 2005, and what it did was, they went to several hospitals and tried to recruit volunteers. Basically, what they did was, those that agreed to take the herb took the herb for 14 days, and those that did not take the herb becomes the control group or the non-herb group. At the end of the study, let me look up the results real quick. At the end of the study what they found is, of 1063 people in the herb group, 0% were infected with SARS. Then, with 15,374 people in the non-herb group, 64 individuals were affected, and these are all people that work in the hospital. Doctors, nurses, ancillary workers, and so on. The number of people that’s affected is 0.4%, okay, so the p-value is 0.035, which means the study was significant, that the herb worked well, we can say with 95% confidence, to prevent SARS. Okay? Then, there were some minor side effects. 1.8% of the people that took herbs experienced some nausea, sore throat, dizziness, and nausea, but nothing significant. Okay?
This was one of the studies that was done for SARS. This is for prevention, and what they have also done is, there were a lot of herbs that they looked into, and these ones again are mainly the herbs that treat wind-cold and wind-heat with antiviral effect, to see if they are effective against SARS virus. Again, they were herbs, formulas, and also individual compounds, that all showed promise. Then, the good news and bad news is, SARS came and go with a lot of fury. While it was there, it was quite significant, but also it didn’t last very long. A few months later, it just somehow resolved and disappeared. Obviously, part of it is they were very aggressive with quarantine, so in a way, this starved the virus out, where there were no additional people the virus could infect.
Dr. Kara Fitzgerald: Can you just say a little bit, I found it fascinating in your YouTube presentation, just the history of traditional Chinese medicine for pandemics. I mean, there’s a millennial-long history. Can you say a little bit about that?
Dr. John Chen: Yeah, of course. It’s not just China either. I mean, it’s also around the world. If you think about the world as a very small place now, right, I mean, anybody can hop on the airplane and go to a different country within a day, so basically the world is a very small place, like a country in the past. If you look at the last 20 years or so, we had the SARS, we had avian flu, we had swine flu, we had Ebola, we had COVID-19, so we’ve had quite a few. This kind of epidemic basically occurs every five years or so, and that rate is not that different from the history of China. The history of China is, from the Eastern Han Dynasty to the Qing Dynasty, which is roughly about 2000 years or so, there have been over 300 large-scale epidemics. Once again, it’s one every five or six years.
Chinese medicine has dealt with this for a long time, and a very general description of how Chinese medicine deals with this, is, the description is that these are the diseases that start from the exterior and then move to the interior. They can, in the process, be getting worse and worse, of course, and then it can affect different paths on the body or different part of the, different organs of the body. It could be from the outside first, with generic signs and symptoms, and then it could affect the lung, it could affect the stomach or digestive system, or different parts of the body. Then, generally speaking in the beginning, the description is just more excess, and excess refers to all the signs and symptoms. Those, there’s too much of, right. Too much of fever, too much of infection, too much of inflammation, and that’s usually during the battling stage as the immune system is trying to fight off the infection.
Then, as the disease continues to get worse, or if the immune system happens to fail, then toward the later phase, generally speaking, is described to be deficiency phase. At this point, the organs are getting damaged. The lung is getting scarring, is getting fibrosis, or maybe in the case of COVID-19, the oxygen is not getting into the blood and the organs are starving of oxygen, and they go into multiple organ failure. Now, what happens is, it’s no longer just one organ. It’s systemic wide, and also, the organs are failing, right, so there’s lack of function. That’s a deficiency, so the very quick description is that it goes from exterior to interior. It goes from excess to deficiency, and obviously if the patient cannot be treated properly or treated well, then they eventually expire.
It’s very different from Western treatment approach. Western treatment approach tends to be, they’re always trying to find the magic bullet. In this case, the race is on, literally, right, for all the drug companies to find the best antiviral drug or to come up with the best vaccination. Once they come up with an antiviral drug, ideally you can treat a patient that has COVID-19. If they come up, or when they come up with a vaccination, then that could be a cure, because that prevents people from getting it in the first place. Okay, so Western medicine generally focuses on treating the patient from the inside out. They focus on the virus or bacteria, they focus on the receptor or the enzyme, the very specific part of the body. Chinese medicine usually focus on the patient that has the disease, whatever the disease may be. What happens is, people that have the same infection may show completely different signs and symptoms, and what Chinese medicine does is they try to treat that person, try to support that patient. Right? Once you’re able to support the patient, then hopefully the patient can take care of the problem on his or her own.
Right, so if you think about it in the end, what happens is we are really hoping the immune system can fight off the virus, right, so people that develop immunity against COVID-19 disease, they are then cured, right? If the treatment in Western medicine is used to (convalescent sera) then they are taking the antibody from another patient, which is also from the immune system, to treat the disease. Same thing with vaccination. You are using a weakened or dead virus, or something, to trick the immune system to really cure or prevent the disease. Immune system, in the end, is basically the cure-all. It’s the only thing that can keep up with all the bacteria and all the virus and all the immune deficiency and all the resistance. You really cannot come up with a drug or herb fast enough to deal with all the mutating strains of the bacteria and virus. It’s just not possible, so in the end, your own body, your own health, your own immune system really is the best medicine. If you were to generalize how Chinese medicine and Western medicine work, is that Chinese medicine really helps the body, helps the patient to get to their optimal health so in the end, they can fight off whatever disease that they encounter.
Dr. Kara Fitzgerald: That really circles us back to where you started our conversation, on prevention, on being strong and mindful to live a good life, even before you’re exposed to the virus. What, I mean, can you speak to, and this is sort of a crude questions, but I mean, do you think TCM will ultimately be more effective than the western model, or are they working together? Is that the optimal approach? I mean, do you have any thoughts on that, being in both worlds?
Dr. John Chen: I think working together is by far the best approach. Okay, just basically put away the borders and boundaries and personal differences, and just work together. Whatever that works is something that we should adopt and help the patients. I think in this particular case with COVID-19, Chinese medicine I think is a very good option as far as prevention goes. If somebody is immune compromised, there is really nothing Western medicine can offer. Chinese medicine, with diet, nutrition, lifestyle, Qigong, meditation, and so on, I think would do a tremendous job to help the patient relax and improve their health, and basically help to fight off the infection even before they have it.
Dr. Kara Fitzgerald: Are there any studies on that? Diet, lifestyle, Qigong, meditation practice, and influence of some of the others?
Dr. John Chen: I’m sure there’s some. I’m sure there are some out there, but this is something that unfortunately most people probably wouldn’t want to spend the money to do the research. Part of the gap, the difficulty is, none of this can be patented, right? Qigong or meditation, so a double-blind placebo control, basically a clinical study, takes millions and millions of dollars and because there is no profit in the end, you’re not going to have private enterprise sponsoring something like this. It’s much like, if you are thirsty, would drinking water help with dehydration? Well, I don’t know if there’s a study on that, but common sense goes a long way to just tell you, of course it’s going to help.
Dr. Kara Fitzgerald: Right, that’s right. I’ve got a handful of additional questions for you. First of all, I want to ask. As we in the West, or in the United States are sort of at the precipice of this really becoming a big problem here … I mean, I’m in Connecticut, and we know that New York is now the epicenter. The clinicians listening to this are largely not trained in traditional Chinese medicine, but how might we access some of these tools? I mean, we’ll have links to your documents, but what would you say to us and where we want to start and how we want to think about it?
Dr. John Chen: Well, I think that in addition to Chinese medicine, I think there are many other modalities of medicine that can all be helpful, so we all have to play our role to best to help everybody get through this crisis at this time. I think Chinese herb is, Chinese medicine is very effective in the overall scheme of things. Ideally, it’s something that you’re already familiar with, and if not, then jump in it and try to learn as much within a short amount of time as you possibly can. The webinar I’ve done is about, well, the first one was an hour and a half because I spoke way too fast. I didn’t realize I was going to have 130 slides, so in my second one, I took about two hours, a little bit over two hours, so think of it as watching a movie. It’s about that duration of time, and so if you are familiar with TCM, which most of the audience I talk to regularly are, they catch on relatively fast. For those of you who may not be, again, try to watch it a couple times if you need to, and if you have any questions, you are more than welcome to send me questions. My email is listed at the end of the PowerPoint slides, so feel free to send me email questions.
Dr. Kara Fitzgerald: Absolutely.
Dr. John Chen: In any case, I think it’s something that would be very helpful. It’s also something that you need to spend, if you’re not familiar with Chinese herbal medicine, you need to spend at least many hours to get a good feel for it. Don’t just say, “Oh, this is the best formula,” like the Quing Fei Pai Du Tang that I mentioned. This is what mainly in China is advertised. “Oh, this is the one I like. I’m going to give it to every single one of my patients.” It doesn’t work that way, because once again like we mentioned, Chinese medicine treats a person that has a disease. It doesn’t really treat the virus itself, so this formula is for the patient who is in the late stage of early phase, at the early stage of pneumonia phase. It’s for a patient at that phase, okay, so make sure you understand that. You don’t want to use that formula for prevention, because if you use that formula for prevention, it’s a fairly powerful formula and it’s likely to drain the patient’s health even further when they are otherwise healthy during the prevention phase, so, yeah.
I would encourage a practitioner who wants to get their toes wet and learn Chinese herbal medicine, spend more than just a few hours and start to use it right away. Learn as much as you can, take additional online classes, talk to or consult with acupuncturists or herbalists, so perhaps work in a team approach. Chinese herbal practitioners do their part and Western medicine practitioners do their part, and together, offer the most effective treatment for the patient with least side effects, and that’s basically the ultimate goal. To maximize the effect and minimize the side effects.
Dr. Kara Fitzgerald: All right, so let me just ask you a couple of questions. One would be, where … Now we really are, we’re looking for traditional Chinese medicine trained clinicians, and what are good resources for finding clinicians in our area to refer patients to, or to collaborate with?
Dr. John Chen: Let’s see. I think, I don’t know the website, but I think there are national associations of acupuncturists and herbal practitioners. If you send me an email reminder, I will look for the link for the website. Other practitioners can find licensed acupuncturists, so they can cross refer and set up a network with each other.
Dr. Kara Fitzgerald: Perfect. I think this is really going to change the game here, with TCM. Now, for those of us interested in getting additional training, you’re on faculty at a number of different universities, so for somebody who’s already trained in Western medicine, where do you recommend they go for post-graduate TCM training?
Dr. John Chen: It depends on how in-depth they want to go. Let’s say, if they want to go all the way, there are master’s degrees and also doctorate degrees in acupuncture and oriental medicine, and there are no less than 50 or 60 schools, probably even more, all throughout the country that offer these programs. If the practitioner already has medical background, generally speaking you can exempt from taking a lot of classes, so it’s usually a three to four year program, but if they are health care practitioners already, most likely it’ll be about half, maybe a two-year program or so, so that depends on how much credit you have already and how many classes you don’t need to take. Beyond that, you have obviously many different state and national associations that have their annual conferences, so they can go to those conferences and take CU classes. Also, there are a lot of online CU classes as well. I’m affiliated with Lotus Institute, and that’s where I initially did the talk on COVID-19, so that webinar is available there along with many other topics. We talk about acupuncture, Chinese herb. We talk about Western medicine, meditation, Qigong, practice management. Basically anything and everything that helps a practitioner in any way. Okay? There are a lot of places that practitioners can go to learn more about Chinese medicine.
Dr. Kara Fitzgerald: Perfect, all right. We will corral together as many as possible in our show notes page to guide you. One final question, Dr. Chen. You’re the author a number of really important works in Chinese medicine. For the non-TCM trained clinician, what book would be a good starting point?
Dr. John Chen: Well, actually, I think the two, the three books that I wrote, I think are a great place to start. One is a book on individual herbs called Chinese Medical Herbology and Pharmacology, so that’s where we start. You can start as a building block, but what happens is, Chinese medicine generally doesn’t use one individual compound or one individual herb. We should put them together to treat the entire person, so the second book I wrote is called Chinese Herbal Formulas and Applications, so this is where you put together the herb, like a recipe, and then you treat specific patterns that you see in the patients. These two books go hand in hand, and they are the required textbooks in all the schools, and also for taking board exams. In the book, it’s pretty much like how I taught all my classes. Basically half of the book is describing the traditional Chinese herbology, and then the other half of the book is describing the pharmacology and clinical research and toxicology and herb-drug interactions. It’s about 50/50, so it’s both herbology and it’s also pharmacology.
Dr. Kara Fitzgerald: Okay, good, good. I actually, yeah. Herb-drug interactions, I just want to mention to folks, this is a good reason to have these books actually in practice now, if you’re considering using some of the patent formulas. I think probably, first and foremost would be collaborating with other, with folks trained in TCM.
Dr. Kara Fitzgerald: Dr. Chen, thanks so much for your time today. I am just really grateful for the work that you’re doing here, in bringing this knowledge and just broadcasting the knowledge of what’s happening in China, and sort of the quick and careful work they’ve done in figuring out what to do in COVID-19. I just appreciate you translating it and bringing it here to the US.
Dr. John Chen: Well, you’re very welcome. I do it with pleasure, and I’m happy to share with everyone in our medical community.
Dr. Kara Fitzgerald: All right, well to be continued, Dr. Chen. Thank you again.
Dr. John Chen: All right. Pleasure.
Dr. Kara Fitzgerald: Take care. Bye-bye.
Dr. John Chen: Goodbye.
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