Prevention and Treatment of Infectious Diseases by Traditional Chinese Medicine - A Commentary - Ma - 2019 - APMIS - Wiley Online Library

6/26/2021 Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary - Ma - 2019 - APMIS - Wiley Online …
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APMIS / Volume 127, Issue 5 / p. 372-384
Review Article Free Access
Prevention and treatment of infectious diseases by traditional Chinese

medicine: a commentary
Yuexia Ma,Ming Chen,Yali Guo,Jian Liu,Weitao Chen,Mengyue Guan,Yue Wang,Xuehui Zhao,Xu Wang,
Haoyuan Li,Lingxin Meng,Yulong Wen,Yuguang Wang 
First published: 24 May 2019

https://doi.org/10.1111/apm.12928
Citations: 15
Abstract
The present review aimed to summarize the effectiveness and features of traditional
Chinese medicine (TCM) for the treatment of infectious diseases and to discuss the
limitation of the development of TCM. The personalized medicine with TCM exerts a
curative effect on viral and bacterial infectious diseases with unique advantages on the
improvement of clinical manifestation, pathogen inhibition, and organ recovery during
severe and drug-resistant infection. The deficiency of personalized medicine with TCM
lies in that the current research design of TCM primarily focuses on the study of the
effective components and material basis of Chinese herbs at the cellular, molecular, and
genetic level, while ignoring the guidance of the TCM syndrome differentiation theory,
which is the core concept of individualized treatment. Personalized medicine with TCM
has a broad prospective for infectious diseases due to the specific efficacy and
advantages. While the curative effect of individualized treatment with TCM cannot be
excluded from the TCM syndrome differentiation theory, the study of personalized
medicine with TCM for infectious diseases urgently requires a unified standardization of
the clinical syndrome differentiation and the evolution rule of infectious diseases by TCM
theory.
Changes in the ecological environment and the variation in the pathogens have led to a
surge in the number of new emerging infectious diseases. The mutation of bacteria and
viruses and multiple bacterial infections induced by drug-resistance strains and antibiotic
abuse had led to refractory infections that are responsible for a large number of deaths
https://onlinelibrary.wiley.com/doi/full/10.1111/apm.12928 1/23
worldwide. This indicates that the strategies of anti-pathogens through modern medicine
might not function appropriately. In order to resolve this issue of antibiotic resistance, a
study entitled ‘TCM replacing antibiotics for bacterial drug resistance’ has been underway in
China since 2016. TCM using syndrome differentiation to guide the medications could
manage the diseases proactively and timely; however, the pathogenesis of the emerging
infectious disease is yet unknown. Nevertheless, the treatment of infectious disease with
TCM presents several advantages, such as improving curative effect with the synergy of
Western medicine, reducing drug resistance, and promoting recuperation in the later course
of the disease. Thus, TCM has broad prospects for the treatment of infectious diseases.
Therapeutic principle of infectious diseases in TCM 1

The theory of ‘differentiation of syndromes by analysis of the condition of Wei,
Qi, Ying, and Xue Systems’ 2
Treatment according to syndrome differentiation is the principle of TCM. Syndrome
differentiation is a summary of the pathological signs of the body at a specific stage during
disease development which is based on the data collected by the synthesis of the four
diagnostic methods: observation, listening and smelling, asking, and palpation and pulse-
taking 3. These tools are utilized for the identification of the etiology, nature, location of the
disease, and the correlation between the pathogenic factors and healthy Qi. The information
is eventually summarized to designate the type of syndrome that would guide the therapy
and dialectically remove the pathogenic substances, including heat, poison, phlegm, and
blood stasis. According to the occurrence and development of infectious diseases, ancient
Chinese doctors established the theory of ‘Wei, Qi, Ying, Xue System’ to treat infectious
diseases dialectically, and divided the development process into various syndromes such as
WeiFen, QiFen, and YingFen, and XueFen in order to reveal the evolvement of these diseases
from the slight to severe stages 4.
WeiFen Syndrome is the early stage of the infectious disease. It is a series of clinical
symptoms induced by the invasion of pathogenic factors, including fever, mild cold, and dry
cough with less sputum accompanied by headache, body pain, and dry pharynx. In addition,
specific clinical manifestations with various pathogenic factors were observed, such as wind-
cold, wind-heat, heat-dampness, and dampness 5. At this stage, the early dispelling wind-
heat or wind-cold using Chinese herbs such as cassia twig, ephedra, Lonicera japonica, and
forsythia mitigated or interdicted the development of infectious diseases as the pathogenic
factors were superficial. The function of WeiFen is similar to the mucosal immune barrier
and innate immunity in modern medicine. TCM regulates the mucosal immunity and innate
immunity by strengthening the stability of mucosa, reducing the excessive permeability of
intestinal mucosa, promoting the intestinal peristalsis, increasing the intestinal mucosa
hemodynamics, maintaining the mechanical barrier of the intestinal tract, and enhancing the
phagocytosis function 6. TCM regulates the mucosal immunity by adjusting or equilibrating
the cytokines secreted by mucosal immune cells: for example, secretory immunoglobulin A
(SIgA) 7.
QiFen syndrome is the progression of disease from exterior to interior. The clinical
manifestations include high fever, reddish complexion, chest pain, cough, thick sputum, and
suffocation. Consecutively, this syndrome is often accompanied by abdominal distension,
full belly, and constipation. Correspondingly, the TCM treatment primarily focused on
clearing heat and detoxification applying some herbs such as Radix isatidis, Andrographis
paniculata, Chinese rhubarb, and Coptis chinensis. With respect to modern medicine, the
body's adaptive immune response against the pathogens at this stage and the clinical
symptoms is primarily induced by immunopathological damage. However, interrupting this
progression by clearing the heat from QiFen could decrease the mortality due to severe
infection.
YingFen and XueFen syndromes arise due to the invasion of pathogenic factors into Zang-Fu
organs. The clinical manifestations of these syndromes include high fever, hotness in the
palms and soles, irritability, delirium, skin eruption, and hemorrhages such as nosebleed
and hematemesis. Interestingly, TCM treatment mainly focuses on cooling blood and
activating blood circulation to remove blood stasis. On the other hand, modern medicine
considers this phase as the critical stage of infectious diseases, and the primary pathologies
include coagulation dysfunction and multi-organ failure, such as sepsis and systemic
inflammatory response syndrome (SIRS). The ‘toxicity’ in TCM is consistent with endotoxin
with respect to pathogenicity, and the ‘heat toxicity syndrome’ is similar to endotoxemia
caused by severe infection. Furthermore, the bacterial toxin leading to SIRS initiation, TCM
Reduqing injection (TCM injection, containing Artemisia apiacea, Lonicera japonica, and Fructus
gardeniae, approved by China Food and Drug Administration and used for the treatment of
both viral and bacterial infections), reduces endotoxin, enhance the body's phagocytic
function, and directly inhibits the bacteria 8. The method of clearing heat and toxic materials
can inhibit various SIRS-related inflammatory mediators, such as arachidonic acid (AA),
platelet activation factors (PCA), and several cytokines. The therapy of reinforcing Qi using
Astragalus, Liquorice, and Ginkgo leaf affects the oxidation resistance, scavenging, and
inhibition of the highly toxic-free radicals produced by SIRS in order to reduce or terminate
the release cycle of various inflammatory mediators. At this stage, the blood-activating herbs
alleviate the lesions of cells and organelles.
Infectious diseases such as SARS and H7N9 avian flu belong to the category of ‘warm
disease’ and ‘pestilence’ in TCM characterized by rapid progression and high mortality rate.
Strikingly, a microcirculation stasis has been detected in the QiFen Syndrome, and therefore,
the early addition of cooling blood and removing stasis herbs should be highly advocated to
sever the disease progression and prevent further deterioration. The pathological
mechanism underlying acute severe infection encompasses the cytokine storm, altering
continually, which is in accordance with the reactivity of the body and the infectious phases.
SIRS is a clinical syndrome that is characterized by a robust inflammatory response that is

typically induced by a major body insult, either infectious or non-infectious (for example,
pancreatitis and trauma). The normal host response to infection is a complex process that
localizes and controls the pathogenic invasion while initiating the repair of the injured tissue.
It involves the activation of circulating and fixed phagocytic cells, as well as the generation of
pro-inflammatory and anti-inflammatory mediators. The balance of pro-inflammatory and
anti-inflammatory mediators regulates the inflammatory processes, including adherence,
chemotaxis, phagocytosis of invading pathogens, and phagocytosis of debris from the
injured tissue. If the mediators balance each other and the initial infectious insult is
overcome, homeostasis is restored. The end result will be tissue repair and healing.
Nonetheless, in the case of severe infection, it is a prospective treatment for the timely
intervention on the cytokine storm and the secretion of inflammatory mediators. TCM also
consists of species of herbs for clearing heat and toxic materials, promoting blood
circulation, reinforcing qi, clearing and regulating the inflammatory mediators, which in turn,
ameliorates SIRS. The treatment for SIRS by TCM is based on syndrome differentiation. Thus,
achieving rebalance by controlling inflammatory response is remarkable in TCM. Taken
together, the theory of ‘Wei, Qi, Ying, Xue System’ mainly explores the evolvement rule,
especially the critical factors and biological essence of infectious diseases that influence the
prognosis.
A modern medical diagnosis can be auxiliary, which is a combination of subjective and

objective syndrome differentiation, as determined by various laboratory examinations using
biomarkers, while TCM diagnosis is based on the four diagnostic methods: ‘observation,
listening and smelling, asking, palpation and pulse-taking.’ Observation includes observation
of complexion, vitality, body figure, behavior, and exudates. As a result, the outward
manifestations of life activities, which determine the condition of a disease, can be
elucidated, and the pathological changes in the Zang-fu organs can be estimated. Listening
and smelling include smelling of odor and listening to sounds. Asking is mainly by asking the
patient in order to deduce the etiology. The method of palpation and pulse-taking is to
understand the pulse quality including the frequency, rhythm, vascular fullness, and beating
range of radial artery in order to confirm the disease location, nature of the disease, and the
disease condition. Among the four diagnostic methods, pulse diagnosis plays a major role in
TCM diagnosis. The comprehensive analysis of the pulse condition and syndrome can aid
the doctors in predicting the progress of the disease. With the development of modern
biomedical engineering, objectification and quantification instruments for TCM diagnosis
have appeared. For example, in palpation and pulse-taking diagnosis, the technology of
superconducting magnetic resonance imaging and three-dimensional vascular simulation
have been gradually used to visualize the pulse motion in order to quantify the diagnostic
information of TCM to guide the syndrome differentiation and the subsequent clinical
treatment.
Theory of ‘treatment chosen according to climate, locality, and individual’
The TCM theory of ‘treatment chosen according to climate, locality, and individual’ is
consistent with the epidemiological characteristics of infectious diseases, including epidemic,
regional, and seasonal features. As early as the 17th century, the ancient doctors recognized
infectious diseases as ‘Qi at non-its time,’ which was caused by epidemic pathogenic factors.
Therefore, climate, locality, and individual are crucial factors to estimate the nature of the
pathogen and the disease. In 2003, the SARS epidemic was dominated by the cold and damp
climate, which was suitable for the reproduction of the virus. Then, it had gradually
disappeared from the south to the north until the warm weather had arisen in June, 2003.
Although the pediatric hand-foot-mouth disease (HFMD) occurs in every season, the
outbreak primarily occurs in summer with high temperature and humidity 9. Therefore, TCM
syndrome differentiation for SARS and HFMD is mainly based on clearing heat and
dampness. ‘Warm and heat’ and ‘damp-heat’ are the main syndromes of infectious diseases
because the humid and hot environment is optimal for the proliferation of bacteria and
viruses. The property of some insect-borne diseases, such as dengue fever and Zika virus
infection, mainly epidemic in tropical and subtropical regions, is generally classified as a
damp-heat syndrome in TCM 10. Furthermore, TCM exerts bidirectional regulation on the
restoration of the self-stable balance among virus, host, and environment. Environmental
factors such as humidity and heat might affect the toll-like receptor (TLR) signal transduction
pathway in patients, which upregulate the activation of a pro-inflammatory factor, TLR7-
MyD88-NF-κB, which in turn, aggravate the infection and induce excessive inflammation 11.
While removing the dampness and heat with TCM, a series of pathological reactions caused
by the activation of this axis can be relieved.
Different individuals exhibit various TCM syndromes and are infected with the same
pathogenic microorganisms. Other studies 12 found that the elderly and those with chronic
bronchitis, coronary heart disease, and metabolic diseases usually present blood stasis
syndromes post-lung infection. Paraclinical tests showed that the hematocrit, fibrinolytic
enzyme activation, the amount of nitric oxide, whole blood viscosity, and platelet
aggregation are unusual in the patients with respiratory clinical manifestations such as
fever, chest tightness, and dyspnea were more severe as compared to non-blood stasis
syndrome patients. Therefore, the pulmonary infection treatment for senile patients with
chronic respiratory and cardiovascular diseases should involve activating the blood
circulation. Regarding the susceptibility of diseases, some studies found the existence of
susceptibility genes which is similar to the TCM constitution theory. Thus, the concepts of
personalized medicine and healthcare are gaining increasing attention in recent years 13.
The recurrent respiratory infection in pediatric patients can be mainly classified as Qi

deficiency syndrome (showing emaciation with a sallow complexion, cold limbs, and
insufficiency of Qi), phlegm-dampness syndrome (showing fatness and pale complexion with
skin sebum), and Yin deficiency syndrome (showing emaciated figure, flushed face, heat
sensation in the palms, soles and chest, and night sweat) based on the constitution theory
14. To avoid recurrent infection, it is essential to adjust the immunity with the TCM theory
during convalescence, which is remarkable in the treatment of recurrent infection and care
during convalescence in these children.
In conclusion, the complication and physique type of patients combined with climate and
locality in the epidemic areas should be considered in treating both bacterial pneumonia
and viral infection.
Strengthening physical resistance to eliminate pathogenic factors

According to TCM, healthy Qi refers to the subtle substances in the human body including
the functions of physical resistance, regulation, repairment, and removal of pathogenic
factors, such as essence of life, blood, and body fluid. The essence of healthy Qi is equivalent
to the physiological barrier of immunology, various immune cells and molecules, and other
disease-resistant factors in modern medicine. Pathogenic factors involve adverse
environmental conditions of wind, cold, dryness, dampness, fire, summer-heat, heightened
emotional sensitivity, and improper diet, which could damage the organs and inhibit
physical function. Both the immune dysfunction and microenvironment disorders belong to
the category of pathogenic factors. Therefore, the function of healthy Qi resisting the
pathogenic factors as assessed by Chinese medicine is similar to the defense and self-
stabilization of the immune system. When pathogenic factors attack the human body,
healthy Qi in the body fights naturally against these factors. The pathogenesis of infectious
diseases with complicated clinical manifestations does not involve the exuberance of
pathogenic factors, leading to the decline in healthy Qi. During the course of infectious
diseases, several pathological products such as toxic heat, phlegm-dampness, and stagnant
toxicity are observed when the conflict between healthy Qi and pathogenic factors is
intense, which results in excess syndrome. With the progression of infectious diseases,
healthy Qi becomes gradually insufficient indicating hypofunction of Qi, blood, body fluid,
and viscera which leads to a deficiency syndrome manifested as shortness of breath, fatigue,
and chills. Thus, the treatment of infectious diseases in TCM is not directly against
pathogens but by improving the body's healthy Qi that might adjust the body's immunity to
expel the pathogenic factors.
The holistic concept of TCM is to strengthen the body resistance in order to eliminate the
pathogenic factors by combination therapy of inhibiting pathogen and protecting and
adjusting the function of organs and body immunity 15. In severe infection, such as excess
syndrome, removal of pathological products by clearing heat, detoxification, cooling blood,
and dispersing stasis, which not only reduce the release of inflammatory mediators but also
improve the microcirculation disorders and tissue fibrosis. Under the condition of deficiency
syndrome when the body's compensatory function is impaired, and large doses of
antibiotics or antiviral drugs against pathogens are not efficient, the early addition of
Chinese herbs to tonify Qi and nourish Yin enhances the effect of the treatment 16.
Taken together, the therapy of infectious diseases should abide by the theory of ‘Wei, Qi,
Ying, Xue system’, and the phases of diseases and strengthening the body resistance to
eliminate the pathogenic factors should be emphasized similar to inhibiting the pathogenic
factors, simultaneously referring to the nature of the pathogen, the constitution, and the
underlying conditions of the patients.
Theory of incubative pathogenic factors and visceral manifestation

New and incubative pathogenic factors should be distinguished in the
treatment of infectious diseases 17
Infectious diseases classified as warm diseases in TCM are divided into infections induced by
new pathogenic factors and incubative pathogenic factors. New pathogenic factors such as
SARS, H1N1, and H7N9 are appropriate for the differentiation of syndromes by analyzing the
condition of the Wei, Qi, Ying, and XueFen, while incubative pathogenic factors, such as
conditioned pathogens, should be expelled from the interior along with syndrome
differentiation. Drug-resistant bacteria inducing acute exacerbation of repeated infection,
such as methicillin-resistant Staphylococcus aureus (MRSA) infection, is difficult to be cleared,
which is categorized as incubative pathogenic factors in TCM. Based on incubative
pathogenic factors, the patient's condition, infectious degree, the clearance rate of resistant
bacteria, mechanical ventilation time, and ventilator offline success rate were improved via
applying the therapy of expelling superficial pathogenic factors and heat from the interior
body. Infections induced by incubative pathogenic factors cannot be radically cured merely
by clearing the pathogen; however, the body's immune function is required to be aroused to
achieve the recovery. For example, Epstein–Barr virus (EBV) could attack the body repeatedly
and lead to a high incidence of nasopharyngeal cancer. Interestingly, Chinese herbal
medicines such as orange peel, astragalus, licorice, and burdock root can inhibit the EBV titer
to a large extent but are not ideal for the treatment of EBV infection. Therefore, the
medicinal herbs of clearing heat and toxic materials cannot clear the EBV thoroughly.
Nevertheless, adjusting the body function via the combination of clearing heat and toxicity
with supplementing Qi and replenishing Yin according to the guidance of TCM, alleviates the
efficiency rate of anti-EBV infection to 80% 18.
Theory of the manifestations of organs; large intestine is interior and exteriorly

related to the lung and guides the treatment of infectious diseases, especially
severe infection 19
The physiological correlation between the lung and large intestine was first recognized in the
Huang Di's Canon which provided instructions for the treatment of the disease in the lung
and large intestine. With an in-depth understanding of the visceral manifestation via modern
science, the correlation between lung and large intestine was constantly elucidated from the
aspect of microecology, histology, immunology, and neuroendocrine system 20. In clinical
practice, according to the theory of ‘lung and large intestine, ’ the patients with ventilator-
associated pneumonia concomitant with drug resistance are usually cured by TCM enema,
which might regulate the immunity, improve the blood supply, and adjust the intestinal flora
to alleviate the burden of lung ventilation. In the case of severe pneumonia, the
recuperation of gastrointestinal function via laxative remedy plays a key role in the
treatment and prognosis. In patients with both severe pneumonia and gastrointestinal
dysfunction with ambrosia, the oral medication can be substituted by rectal enema
(according to the theory of ‘channel-viscera correlativity’, the fluid and drugs absorbed by
large intestine are transported to the lung via channels) due to the advantages of high
bioavailability owing to the optimal blood supply of the intestine 17.
Characteristics of TCM in treating different infectious diseases

Several types of TCM dosage forms include oral intake of the decoction as the most common
form in clinical practice. However, the effective concentration of the decoction is limited to
varying degrees due to the individualized preparation. In addition, external drugs such as
nasal drops, throat sprays, and medicine aerosolization have been developed into new anti-
infection drugs with accurate and stable efficacy driven by modern science and technology.
The TCM pharmacopeia has specific regulations for the dosage of each medicinal herb.
Typically, a specific cut-off point for the use of TCM in clinical practice is not mentioned, and
it cannot be terminated until a distinct improvement in the clinical symptoms is detected.
Presently, the exploration of a single Chinese medicinal herb on different pathogens and its
effective components, active parts, as well as the molecular mechanism underlying the anti-
pathogenicity are relatively definite (Table 1). Also, Chinese medicine emphasizes the study
of compound prescription, especially TCM injections that are widely used in patients with
severe infection in a clinical setting (Table 2).
Table 1.
Study on the application of single TCM for different pathogens
Classification Common TCM Effective Mechanism

of diseases herbs constituent
Virus infection Forsythia, Isatis Tannins, Flavonoids, Direct or indirect inhibition of virus replication;
21 root, Folium Polysaccharides, Antioxidant; Inhibit macrophages from secreting
isatidis, Scutellaria Alkaloids inflammatory cytokines
baicalensis
Bacterial Rhubarb, Coptis Organic acids, Direct bacteriostasis, including disturbing the
infection 22 chinensis, Cypress Alkaloids, Flavonoids, metabolism of bacteria, affecting their structure
Quinones, Volatile Oils and function; Reverse bacterial resistance
Fungal Sophora sophora, Terpenoids, Direct inhibition of fungal growth

infection 23 Fructus conidium, Aldehydes,
Fructus kochiae Flavonoids, Alkaloids,
Phenols, Volatile Oils
Classification Common TCM Effective Mechanism

of diseases herbs constituent
Parasitic Betel nut, Stone- Alkaloids, Phenols Directly act on the parasite (such as paralyze and
infection 24 like Omphalia, kill the parasite, block its nutrient absorption,
Artemisia annua inhibit its metabolism); Excrete the parasite
Table 2.
Efficacy and indications of TCM injections commonly used in clinical practice
TCM Manufacturer Ingredients Efficacy Indications

injection
Xiyanping Jiangxi Qingfeng Andrographolide Antipyretic and anti- Bronchitis, tonsillitis,
injection Pharmaceutical sulfonate inflammatory, mycoplasma infection,

Co. Ltd, Ganzhou, relieve cough and bacterial dysentery, viral
China dysentery, anti-viral, infection
anti-bacterial
Reduning Jiangsu Kangyuan Gardenia, Anti-viral, anti- Upper respiratory infection
Injection Pharmaceutical Honeysuckle, bacterial, eliminate (URI), viral pneumonia,
Co. Ltd, Artemisia annua inflammation, influenza, viral enteritis,

Lianyugang, China improve immunity hand, foot and mouth
disease
Tanreqing Shanghai Kaibao Scutellaria, Antipyretic, relieve URI, pneumonia, acute

Injection Pharmaceutical Honeysuckle, Goat cough, reduce exacerbation and chronic
Co. Ltd, Fengxian horn phlegm obstructive of pulmonary
District, China disease, hand, foot and
mouth disease
Qingkailing Guangzhou Gardenia, Buffalo Antipyretic and anti- URI, pneumonia,

Injection Baiyunshan horn, Honeysuckle, inflammatory, cerebrovascular disease
Mingxing Isatis root tranquilizing effect

Pharmaceutical
Co. Ltd,
Viral infectious diseases

TCM rapidly relieves the clinical symptoms caused by viral infection with a
remarkable antifebrile effect
The overall characteristics of TCM in treating viral infectious diseases are that it can
significantly lighten the symptoms and bring down the fever quickly; however, the time of
viral nucleic acid to be negative in TCM is slower as compared to the chemical antiviral
drugs. Some randomized controlled trials showed that Maxingshigan decoction (a classical
TCM recipe that is commonly used for pneumonia composed of Chinese ephedra, apricot
kernel, gypsum, licorice), Yinqiaosan decoction (a famous TCM recipe mainly composed by
Lonicera japonica and Fructus forsythiae is commonly used for cough and sore throat caused
by virus infection), and modern Chinese patent medicine Lianhua qingwen capsules (a TCM
capsule, which is approved by the China Food and Drug Administration for the treatment of
flu) relieve the clinical symptoms of influenza patients and shorten the time of disease
progression 25. The characteristics of therapy for high fever induced by viral infection are a
gradual decrease in the body heat with a small amount of sweat without a rebound
phenomenon. According to the development rules of TCM, the pathological core of viral
infectious disease lies in the Qi and Ying Fen syndromes, which is applied to remove intense
heat and induce eruption from Qi and Ying systems generally by diaphoresis and laxative
remedy. The earlier application of removing heat from Qi and Ying systems will lead to
decreased mortality. The former reduces fever by generating sweat, while in the latter, the
fever is remedied with the flow. The early application of clearing heat from QiFen and
cooling heat of YingFen can largely reduce the mortality.
H7N9 avian influenza is an infection of apostasies with approximately 40% mortality. In a

case report 26 referring to seven severe H7N9 avian influenza patients, the average
temperature of these patients was sustained at 39 °C after the course of disease more than
5 days in spite of antiviral therapy. In TCM, due to the early clinical manifestation according
to the WeiFen and QiFen syndrome, clearing heat and expelling superficial pathogenic
factors, relieving cough and asthma were the main therapeutic methods effectuated using
honeysuckle, gypsum, ephedra, and almond. At this stage, the patients with a shiver and high
fever were administered Chinese herbs such as such as ginseng and licorice to reinforce Qi
and stomach in order to help the body counteract against the pathogenic factors by
sweating. Within 4–5 days after treatment, the temperature of three patients was still as
high as 39.7–40.3 °C or a recurrent high fever. Consecutively, these patients presented QiFen
and YingFen syndromes with the manifestations of shiver disappearance, restlessness,
deep-red tongue, and thick yellow tongue coating, which removed the heat from QiFen and
YingFen and relieved the mental stress using Rhinoceros horn, Lophatherum gracile, and
Scutellaria baicalensis, while the heat clearing from WeiFen was effectuated using Lonicera
japonica and thorowax. The sputum with blood streaks in patients indicated the invasion of
XueFen by pathogenic factors that should be treated with removing heat from the blood and
dissipating blood stasis by Lalang grass rhizome and Peach seed. In the later period of the
disease, all patients suffering from Qi deficiency mainly indicated fatigue, shortness of
breath, poor appetite, and dry tongue in order to supplement Qi in order to generate body
fluids by utilizing American ginseng (cold in property and encourages the production of body
fluids) rather than ginseng. The case report showed that the onset time of antifebrile role
was 5.7 h post-treatment, the temperature returned to normal after 80.8 h post-treatment,
and only one death occurred among seven severe H7N9 avian influenza patients. In
summary, after individualized treatment, TCM demonstrated a satisfactory antifebrile effect
on severe virus infection.
TCM has a generalized antiviral effect indicating the regulation on the direct
inhibition of virus, body immunity, and inflammatory response control
Present, several studies on the anti-virus activity of single Chinese medicinal herb, such as
Fructus forsythiae, Radix isatidis, and Scutellaria baicalensis, using modern technology
confirmed the effective constituent and materials, as well as the functional mechanism of
the relevant parts. A systematic analysis found that TCM decoction and Ganmao capsule (a
non-prescription Chinese patent medicine composed of some herbs for clearing heat and
toxicity is commonly used in treating cold and flu) had better effects on the treatment of
H3N2 and influenza B, respectively, than amantadine and ribavirin 27. In terms of anti-
inflammation, TCM can alleviate the damage caused by excess inflammatory reactions
initiated by a virus. The single and compound Chinese medicinal herbs which can cause
clearing heat and toxicity could decrease the cytokine storm resulting from the production
of several species of pro-inflammatory cytokines and anti-inflammatory cytokines aim to
improve the injury of tissue and organs. In turn, this phenomenon promotes blood
circulation and removes stasis, thereby confining the inflammation and promoting its
absorption. In the case of SARS, a rapidly spreading infectious disease, TCM combined with
corticosteroids during the early stage of the outbreak could decrease the mortality by
promoting innate immunity to relieve inflammation 28. Subsequently, the TCM compounds
of Chinese herbs analyzed based on the theory of strengthening healthy Qi and clearing
pathogenic factors with the feature of multicomponent, multi-channel, and multiple targets
exerted a synergistic effect on inhibiting the virus directly, relieving the immunopathological
injury, and controlling the inflammatory reaction caused by virus infection.
Treatment of viral infectious diseases by TCM requires the combination of

syndrome differentiation and virus differentiation 29
The innovation of combining the TCM syndrome and virus differentiation under the
guidance of TCM theory and mordern biotechnology gives rise to accurate prescriptions for
virus infectious diseases. At present, virus differentiation includes three aspects. The first
aspect is to identify specific types of virus tested by modern technology. The second is to
identify pathological reaction produced by the interaction between the virus and host. The
reaction is not only related to the nature of the virus but also related to the individual
constitution. In terms of SARS infection, the clinical manifestations and outcomes were
disparate corresponding to different treatment based on different stress reactions. The third
aspect is to assess the pathological products such as dampness, phlegm, and blood stasis
based on the understanding of the pathological reaction using Western medicine, combined
with precise syndrome differentiation and analysis of the pathological changes in TCM.
Taken together, virus differentiation requires micropositioning and deepening of syndrome
differentiation to improve the curative effect of TCM using modern technology and auxiliary
methods.
Bacterial infectious disease

Clinical efficacy can be improved by the combination of Chinese and Western
medicine in the treatment of bacterial infectious diseases
The combination of TCM intravenous preparations with conventional antibiotics can
effectively improve the clinical efficacy of community-acquired pneumonia (CAP) 30 and
promote the early rehabilitation of patients, thereby reducing the rate of mortality of the
patients. Previous studies showed that Xiyanping injection (TCM injections are approved by
the China Food and Drug Administration for the treatment of respiratory infection; the main
ingredient is andrographolide sulfonate) combined with piperacillin and sulbactam
significantly improved the clinical efficacy of pulmonary infection in the elderly 31.
Pulmonary infection is the most common complication and cause of death in stroke
patients. Compared to simple symptomatic support treatment, the recovery rate and
efficiency of Qingjin huatan decoction (famous TCM recipe composed of Scutellaria
baicalensis, Fructus gardeniae, Fritillaria thun-bergli, for clearing heat and reducing phlegm)
combined with Xiaochengqi decoction (purgative prescription) in the treatment of apoplexy-
related lung infection is greatly improved 32. The symptoms of patients with pulmonary
infection complicated with sepsis were significantly improved after treatment with the
addition of Shengjiang powder combined with basic Western medical treatment including
antibiotics and expectorant application. Consequently, the APACHE2 score was significantly
reduced, and the levels of inflammatory cytokines, such as CRP, TNF-α, and IL-6 were also
significantly reduced 33 (Fig. 1).
Figure 1
Open in figure viewer PowerPoint
Assessment of safety and efficacy on TCM injections commonly used in clinical practice 34-40. Notes: The acronyms in
the figure as follows: mycoplasma pneumonia (MP), community-acquired pneumonia (CAP), virus pneumonia (VP). The
current systematic reviews and meta-analysis about safety assessment and curative effect on TCM injections in these
three infectious diseases among which the observation group is mainly TCM injection combined with modern medicine
and the control group is pure modern medicine. *Indicates a least significant difference between the observation and
control groups (p < 0.05), while **indicates the maximum statistical difference between the above two groups (p < 0.01).
The results indicated of TCM injection combined with modern medicine are same as modern medicine; also, Reduning
injection is safer than that in the control group (p < 0.05). Moreover, the efficacy of combined remedy in each injection
group is significantly superior to that of pure modern medicine (p < 0.01).
The combination of Chinese and Western medicine remarkably inhibits tuberculosis,

especially the drug-resistant strain. A meta-analysis showed that 41 Baihe gujin decoction
combined with Western medicine was 1.28-fold more effective than Western medicine alone
in treating tuberculosis with obvious advantages regarding promoting the absorption of
lesions, improving the negative rate of sputum bacteria, and increasing the hole closure. The
treatment of tuberculosis by a combination of Chinese and Western medicine adjusts the
equilibrium of Qi, blood, Yin, and Yang of the whole human body, strengthens the spleen Qi,
and reinforces the deficiency in order to remove the pathological products such as phlegm
and dampness. These phenotypes not only supplements the healthy Qi to improve the
immunity and alleviate the lung damage but also eliminates the adverse reactions such as
nausea, vomiting, liver, and renal impairment induced by Western chemical medicine, as
well as delay the generation of drug resistance.
TCM syndrome differentiation by strengthening healthy Qi and removing

pathogenic factors can treat the refractory infections
In infectious diseases, the application of antibiotics, especially long-term broad-spectrum
antibiotics, cause an imbalance of bacteria in the respiratory tract and intestinal
microecology and drug-resistance, leading to the occurrence of refractory infections. The
generation of refractory pulmonary infection depends on the combined action of the
organism, microorganism, and antibacterial agent, among which the factors of the organism
are critical. The most common condition of refractory infection includes multidrug-resistant
bacterial infection and mixed infection. The patients, especially the elderly are mainly
immunocompromised with several underlying diseases. The treatment of refractory
infections by TCM should be based on the syndrome differentiation based on the principal
contradiction of each phase in the progression considering the personal constitution. The
core pathogenesis of TCM in refractory and severe infection includes deficiency of healthy
Qi, blood, Yin, and Yang mixed with superabundant pathogenic factors that require intensive
focus in strengthening healthy Qi and removing the pathogenic factors.
In this study, pneumonia treated by TCM in elderly is used as an example. It is one of the
leading causes of death among the elderly, especially those >90-years-old. Such patients are
often treated with a large number of antibiotics, which are usually invalid. In the past
30 years, the study by Li et al. 42 showed that the efficiency rate of TCM, about 40%, was
applied exclusively to treat elderly pneumonia in >80-year-olds with failed antibiotic
treatment. The study divided elderly pneumonia into three types of syndromes according to
the differences in pathological products indicating heat, phlegm or dampness, and cold or
heat sensation. In the progression of elderly pneumonia, the body gradually adopts the
condition of ‘persistent inflammation-immunosuppression-catabolism syndrome’
manifested as body debilitation, decreased appetite, and gradual consumption of physical
power 43. Therefore, evaluating the excess or deficiency between healthy Qi and pathogenic
factors for organic modulation and overall recovery is a vital phenomenon. Typically,
recuperation with warm herbs and hasty reinforce of Qi and Yin remedy was advocated in
the acute and convalescent phase of severe pneumonia. Moreover, symptomatic treatment
referring to short breath, fatigue, dizziness, dry mouth, and strengthening the physique
were primarily focused on in convalescent patients.
TCM protects the organ damage caused by severe infection

Sepsis is an organ dysfunction caused by a host reaction disorder due to infection. The
mortality due to severe sepsis is 25–30%. TCM applies the theory of ‘combined treatment of
bacteria and toxin’ to SIRS and MODS caused by bacterial infection, that is, combined
treatment of bacteria and endotoxin inflammatory mediators that exert a protective effect
on multiple organ injuries caused by sepsis.
Kidney is one of the most vulnerable target organs for sepsis. The incidence of acute kidney
injury caused by sepsis is 48%, and a considerable number of patients among these can
develop into the end-stage renal disease 44. The pathological basis of renal damage caused
by sepsis is the interaction between a large number of inflammatory mediators released by
sepsis and the activated body defense system, giving rise to SIRS that is characterized by the
self-destruction of cells. Rhubarb, astragalus, Polygonum cuspidatum, asiatica, motherwort, and
Ligusticum chuanxiong and their effective extracts can significantly reduce the levels of
various inflammatory factors such as TNF-α and IL-6, maintain redox reaction, promote the
excretion of blood urea nitrogen (BUN) and serum creatinine (Scr), reduce the renal injury,
and protect the renal function 45. TCM compounds, Qingwenbaidu and Xuebijing injection,
control the excessive release of inflammatory factors and cytokines by clearing heat,
detoxifying the blood circulation, removing the blood stasis, restoring the balance of pro-
inflammatory and anti-inflammatory reactions, reducing the injury of tissues and organs to
the maximum, and protecting the normal functions of the kidney 46.
In the case of myocardial damage caused by sepsis, TCM can alleviate the toxin damage by
clearing heat and detoxification, such as antipyretic decoction while activating blood
circulation and removing blood stasis. Moreover, Xuebijing injection can improve
hemodynamics, reduce the levels of inflammatory factors such as TNF-α, inhibit the
excessive inflammatory response, and mitigate the myocardial damage caused by sepsis.
Furthermore, by strengthening Qi and Yin, the use of Shenfu injection (composed of ginseng
and monkshood) can significantly reduce the damage of the myocardium and increase the
myocardial contractility by reducing the content of cardiac troponin I (cTn-I) and N-terminal
pro-B-type natriuretic peptide (NT-proBNP) 47.
The gastrointestinal dysfunction caused by sepsis is treated with rhubarb, glauber salt,
Frutus aurantii, Cortex magnoliae, and crude astragalus, which are commonly used among
Chinese herbs through oral or nasogastric administration 48. Therefore, catharsis plays a
major role in recovering gastrointestinal dysfunction caused by sepsis, which might have an
influence on inhibiting the bacterial migration, reducing the endotoxin absorption,
controlling the inflammatory response, and regulating the immunity.
TCM has specific advantages for drug-resistant bacterial infection

MRSA colonization belongs to ‘incubative pathogenic factors’ in Chinese medicine with the
core as the deficiency of healthy Qi and luxuriant toxicity interior. Another study
demonstrated that several ICU healthcare workers had MRSA colonization but were not
infected, rendering MRSA as opportunistic pathogens. Patients with MRSA infection were
mostly suffering from an insufficiency of Qi, and the pathogenesis is consistent with that of
incubative pathogenic factors manifesting fever, yellowish phlegm, reddish complexion,
wheezing, chest tightness, and skin ecchymosis.
TCM can restrain some infections induced by various drug-resistant bacteria. A large
number of studies 49 have shown that multiple TCM compounds, single herbs, and
monomers have effects on inhibiting drug-resistant bacteria in both in vitro and in vivo
studies such as MRSA, Acinetobacter baumannii, and Pseudomonas aeruginosa. The
mechanism of treating drug-resistant bacteria in TCM mainly includes the following two
aspects: eliminating plasmid and inhibition of the active efflux pump system. Forsythia
decoction can inhibit the active efflux pump of A. baumannii, resulting in the variation of an
adeB sequence of efflux pump coding gene 50. In addition, TCM has a large impact on the
production of the inactivating enzyme of antimicrobials to reverse the drug resistance. To
inhibit the growth and reproduction of bacteria, Chinese medicinal herbs can alter the
structure of bacterial cell wall to affect permeability. Some herbs such as rhubarb and
berberine can restrain the formation of biofilms to inhibit the MRSA 51. Notably, the
antibacterial activity of TCM with little side effects is equivalent to that of antibiotics. A study
showed that Chinese medicine, Mayushihuang decoction, has the same efficiency with
teicoplanin for clearing MRSA 52; however, distinct adverse effects were not detected in the
TCM group as compared to abnormal hepatorenal function in the teicoplanin group.
Deficiency of TCM in treating infectious diseases

Anti-infection studies in TCM are mainly focused on the screening of natural herbs or
monomer for anti-viral and anti-bacterial effects at the molecular and gene levels. Currently,
the scientific methods for exploring the biological effects of Chinese compound for
controlling the infectious diseases are lacking. Thus, additional studies are essential to
highlight the principle of differentiation of syndromes and holism concept for the
investigation of the mechanism underlying TCM.
The treatment of infectious diseases by the combination of TCM and Western medicine
should not only be the superposition application of these two therapies but should also
comprehensively analyze the pathological mechanism based on the deeper understanding
of the disease in both modern medicine and TCM in order to achieve macroscopic and
microcosmic determination of treatment. Currently, there is no unified standard for
evaluating the anti-infection strategy and efficacy of integrated therapy with TCM and
Western medicine. Moreover, only a few evidence-based studies are available on the TCM
treatment for infectious diseases. Therefore, establishing a clinical evaluation technology
system in line with the characteristics of TCM is critical.
In the case of education and training of TCM clinical professionals, inheritance and
innovation have always been two major aspects in the development of TCM, while
inheritance is the premise of innovation. Therefore, in addition to the education in medical
schools, the advancing of TCM professionals, via the system of mentor-disciple by the
guidance of famous TCM doctors is crucial for strengthening the TCM. The system of
mentor-disciple primarily involves the learning of the student with the mentor in clinical
practice, including studying the teacher's academic thoughts, clinical experience, and
technical expertise. During this time (2–3 years), the student should complete a specified
number of learning notes, learning ideas, and the summary of the typical cases, which were
treated by the mentor. Before the end of training, some studies reflected the tutor's
academic ideas and technical expertise, which were published in professional journals. The
mentor-disciple model is a shortcut for training the TCM clinical professionals. The unique
experience, diagnosis, and treatment skills from prestigious Chinese physicians through
daily clinical practice, unconscious imitation, and oral communication can rapidly improve
the ability of syndrome differentiation and treatment of the disease. Furthermore, this
model complements the deficiencies of the educational pattern of modern medicine and
ensures the team stability of TCM clinical professionals. On the other hand, it ensures the
effective inheritance of academic thoughts under the guidance of esteemed Chinese
physicians.
Conclusion
The personalized medicine with TCM has a definite curative effect in treating infectious
diseases with specific efficacy and advantages. Thus, seizing the essence of differentiation of
TCM syndrome and combining it with modern science would give rise to personalized
medicine, warranting further investigation.
This study was supported by a grant from the ‘The Beijing Natural Science Foundation (No.
7172099).’
Appendix 1:
TCM Paraphrase
terminology
Zang-Fu Organ It refers to five Zang-organs including the heart, lung, spleen, liver, and kidney and six fu-organs
including the gallbladder, stomach, large intestine, small intestine, bladder, and triple energizer.
(‘Zang’ with the function of storing essence Qi indicates a few organs that are mainly substantial
tissues located in the pectoral and abdomen cavity. While ‘Fu’ refers to some hollow organs,
which have the function of digesting food, absorbing nutrients, and excreting dross. Although
‘Zang Fu organ’ mostly has the same visceral name in modern medicine, its concept and
function are not completely identical)
‘Zang-Xiang’ ‘Zang,’ namely Zang-fu organs, refers to the internal organs; ‘Xiang’ is an image or a sign of the
theory human body. ‘Zang-Xiang’ theory in TCM is a theory that studies the rules of internal organs and
their mutual relations by observing the external signs of the human body
Visceral The viscera such as heart, lung, and others are stored inside the body, and their image
manifestation manifested outwardly
Qi It is the most essential substance to be derived from kidney essence, food nutrients, and fresh
air to sustain the life and activity of the human body
Blood fluid It is a collective term for various types of normal liquids in the body, such as gastric juice,
intestinal juice, nasal discharge, tear, sweat, and urine and those derived from the foodstuff
Pathogenic These include not only the pestilence but also abnormal changes in the weather, mental
factors stimulation, improper diet, and injury caused by insect or animal
Phlegm It not only refers to sputum expectorate from the throat but also includes nodules and thick
References 
1 Lu A, Jia H, Xiao C, Lu Q. Theory of traditional Chinese medicine and therapeutic method of

diseases. World J Gastroenterol 2004; 10: 1854– 6.
Crossref
| PubMed
| Web of Science® | Google Scholar
2 Tu Y, Fang Z, Yang A, Guo Y. Standardization of syndrome differentiation of Weifen, Qifen,

Yingfen and Xuefen and principle-method-recipe-medicines of YE Tian-shi. China J Tradit Chin Med
Pharm 2016; 3: 788– 93.
Google Scholar
3 Chen X, Wang T. Origin of TCM pulse diagnosis-medical knowledge derivation of ‘pulse’ and
origin of textual research of pulse sphygmology. Beijing J Tradit Chin Med 2016; 39: 797– 801.
Google Scholar
4 Zhu H, Li H, Shi X, Chen D. The correlation between the blood transfection of Wei Qi Ying Blood
and the immune function of severe influenza and the strategy of traditional Chinese medicine
against influenza. China J Integr Med 2017; 37: 603– 6.
Google Scholar
5 Di R, Tong Y. Relationship between damp heat syndrome and infectious diseases based on
distribution of disease. J Tradit Chin Med Literature 2003; 21: 28– 30.
Google Scholar
6 Wu Y, Jin Y, Wu J, Yu X, Hao Y. Effects of wogonin on inflammation related factors in alveolar

macrophages infected with influenza virus. China J Pathophysiol 2011; 27: 533– 8.
CAS
| Google Scholar
7 Wang L, Yuan J. Study and prospect of the prevention and treatment for infection with
traditional Chinese medicine by mucosal immunity accommodation. Modern J Intergr Tradition
Chinese Western Med 2010; 19: 4504– 5.
Google Scholar
8 Li M, Ye W, Deng Z, Lu F. The preventive-therapeutic effects of reduqing on endotoxin-lnduced

DIC in rabbits (continued) protection of hepatocytic microsomes, maintenance of calcium
homeostasis and reduction of oxygen free radicals. CJIM 1995; I: 223– 6.
Google Scholar
9 Hong K, Zhu Q, Nie F, Li H, Yuan H, Li X. Research on the pathogenesis and stage differentiation
of 2 115 cases with hand-foot-and-mouth disease. J Nanjing University Tradition Chinese Med 2012;
28: 429– 33.
Google Scholar
10 Du S, Fang Z, Qiu Y. Study on the relationship between the frequency of dengue fever in
guangdong province and five movements and six climates. China J Basic Med Tradition Chinese Med
2016; 10: 1340– 3.
Google Scholar
11 Lai P. Experimental and clinical study on the effects of internal and external damp heat on
TLRs-mediated immune response in respiratory virus infection. Guangzhou Univ Chin Med 2010.
Google Scholar
12 Yang P. Clinical observation of the patients with pulmonary infection combined with blood
stagnation pattern/syndrome. J Sichuan Tradition Med 2016; 00: 66– 8.
Google Scholar
13 Wang W, Russell A, Yan Y. Traditional Chinese medicine and new concepts of predictive,
preventive and personalized medicine in diagnosis and treatment of suboptimal health. EPMA J
2014; 5: 4– 4.
Crossref
| PubMed
| Google Scholar
14 Song Z, Xue Z. A literature study on the constitutional classification and discrimination of

children's recurrent respiratory infections. Acad J Shanghai Univ Tradition Chinese Med 2018; 1: 11–
4.
Google Scholar
15 Zhang L, Jin H. Reflection on MDR-TB treatment-the need for holistic view. Chin J Integr
Tradition Western Med 2015; 35: 1517– 21.
Google Scholar
16 Wang Q. Classification and diagnosis basis of nine basic constitutions in Chinese medicine. J
Beijing Univ Tradition Chinese Med 2005; 28: 1– 8.
Web of Science® | Google Scholar
17 Liu C, Sun L, Fu Z, Yuan G, Wang Y, He L. The effect of expelling method based on the theory of
incubativ pathogenic factors on the clearance rate of drug-resistant bacteria and the success rate
of offline in ICU patients with pulmonary infection. Beijing J Tradition Chin Med 2015; 2: 108– 12.
Google Scholar
18 Han T. Clinical efficacy of integrated traditional Chinese and Western medicine in the
treatment of EB virus infection. Shenzhen J Integr Tradition Chin Western Med 2017; 27: 35– 6.
Google Scholar
19 Chang W, Xu Z. The application of purgation therapy in severe pneumonia based on the

theory of “lung and large intestine”. J Emerg Tradition Chin Med 2016; 25: 647– 9.
Google Scholar
20 Liu T, Cheng Y, Dai C, Yuan J. Discussion on the biological basis of regulating lung-intestinal
micro-ecology to prevent respiratory tract infection Based on the Method of “Treating Intestine
from Lung”. Lishizhen Med Materia Medica Res 2017; 00: 1402– 4.
Google Scholar
21 Liu C, Yan Y, Lang S, He K, Gao Z. Research progress of traditional Chinese medicine against
influenza virus. J Res Pract Modern Chin Med 2018; 32: 82– 6.
Google Scholar
22 Wang S. Study on the resistance of Chinese herbal medicine to bacterial infection. Beijing J
Tradition Chin Med. 2002; 21: 249– 51.
Google Scholar
23 Song H, Dong P, Tong Z, Kong Q. Research progress and problems of antifungal action of
single traditional Chinese medicine and effective parts. J Integr Tradition Chin Western Med 2009; 1:
49– 51.
Google Scholar
24 Liu X, Chang Y. Application and research progress of traditional Chinese medicine in anti-
parasite. J Modern Animal Husbandry Sci Technol 2013; 00: 196.
Google Scholar
25 Wang Y, Jiang M, Wang R, Zha Q, Zhang S, Zhou G, et al. Duration of viral shedding of influenza
A (H1N1) virus infection treated with oseltamivir and/or traditional Chinese medicine in China: a
retrospective analysis. J Tradit Chin Med 2012; 32: 148– 55.
Crossref
| PubMed
| Google Scholar
26 Xi Z, Zhou X, Wang X, Rui Q, Chang N, Guo T et al. Analysis on Chinese medicine treatment of
severe cases of human infected avian influenza H7N9. Jiangsu J Tradition Chinese Med 2015; 47: 13–
7.
Google Scholar
27 Yang J, Liu J, Jiang L, Liu Q, Li X, Zhang S, et al. Guidelines on common cold for Traditional
Chinese Medicine based on pattern differentiation. J Tradit Chin Med 2013; 33: 417– 22.
Crossref
| PubMed
| Google Scholar
28 Liu Y. Summary of symposium on SARS treated by integrative traditional and western

medicine. Chinese J Intergr Tradition Western Med 2003; 23: 484– 5.
CAS
| Google Scholar
29 Tian J, Yang Z. Thinking, theoretical innovation and basic path of TCM for antivirus research.
Shandong J Tradit Chin Med 2018; 37: 439– 44.
Google Scholar
30 Duan Y. Effect analysis of the Tanreqing injection combined with antibiotics in the treatment
of pulmonary infection. Clin J Chinese Med 2016; 8: 70– 1.
Google Scholar
31 Chen Y. The curative effect of xiyanping combined with piperacillin-tazobactam in treating

senile pneumonia. Chinese Geriatric Med 2016; 14: 60– 1.
Google Scholar
32 Lv X. Effective evaluation on treating severe pneumonia and stoke with the Qingjin Huatan
decoction plus Xiao Chengqi decoction. J North Pharm 2017; 14: 110– 1.
Google Scholar
33 Guo J, Qian F, Zhao L, Wu X, Sun F, Qian Y. Influence of modified “Shengjiang Powder” on

inflammatory cytokines in patients with pulmonary infection and sepsis of toxin-heat excess.
Shanghai J Tradition Chin Med 2015; 7: 38– 40.
Google Scholar
34 Zeng J, Wu H, Yang Z. Meta analysis on the safety of xiyanping injection in clinical application. J
Rational Drug Use Clin 2018; 11: 84– 6.
Google Scholar
35 Wu S. Meta analysis of the clinical efficacy of xiyanping injection in the treatment of

community-acquired pneumonia. J Med Informat 2018; 31: 64– 9.
Google Scholar
36 Qi R, Fang S, Li D, Zhang H. Systematic evaluation and Meta analysis of xiyanping injection in

the treatment of adult viral pneumonia. Clin Appl Modern Chin Med 2018; 25: 29– 33.
Google Scholar
37 Zhang S. Meta analysis of xiyanping injection in the treatment of mycoplasma pneumonia in

children. J Tradition Chin Med Materia Medica 2016; 14: 192– 3.
Google Scholar
38 Huang X, Duan X, Wu J, Zhang S, Lin Q, Wang K, et al. A meta-analysis of the clinical evaluation
of reduning injection in the treatment of community-acquired pneumonia. Chin J
Pharmacoepidemiol 2018; 27: 573– 81.
Google Scholar
39 Hu Y. Meta analysis of reduning injection in the treatment of viral pneumonia in children. J

Yangtze Univ 2013; 10: 87– 90.
Google Scholar
40 Jin Y, Zhang W, Qi P. Meta analysis of adverse reactions of tanreqing injection. Capital Med
2009; 15: 28– 9.
Google Scholar
41 Wu L, Huang R, Liao L, Qiu J, Li Z, Lian B, et al. A systematic review of supplemented Baihe

Gujin decoction in the treatment of pulmonary tuberculosis and improvement of the pulmonary
lesions. Guiding J TCM 2018; 00: 104– 9.
Google Scholar
42 Li C, Li Z. Discussion of treatment rule for senile pneumonia with TCM. World J Integr Tradition
Western Med 2017; 12: 130– 3.
CAS
| Google Scholar
43 Ma X, Chen M. Persistent inflammation and immunosuppression: a common syndrome and

new horizon for surgical intensive care. Chin Crit Care Med 2012; 24: 514– 6.
Google Scholar
44 Mehta R, Bouchard J, Soroko S, Ikizler T, Paganini E, Chertow G, et al. Sepsis as a cause and
consequence of acute kidney injury: Program to improve care in acute renal disease. Intensive Care
Med 2011; 37: 241– 8.
Crossref
| PubMed
45 Wang W, Wang Q, Han D, Jiang C, Shi R. Progress study of early renal inflammatory response
in the treatment of sepsis with traditional Chinese medicine. Shanghai J Tradition Chin Med 2017;
51: 229– 61.
Google Scholar
46 Xiao S, Luo L, Liu X, Zhou Y, Liu H, Huang Z. Curative efficacy and safety of traditional Chinese
medicine Xuebijing injections combined with ulinastatin for treating sepsis in the Chinese
population: a meta-analysis. Medicine 2018; 97: e10971.
Crossref
| PubMed
47 Wang D, Wu Y, Wang X, Liu Q, Guo Y. Mechanism of myocardial injury in sepsis and current
status of diagnosis and treatment of traditional Chinese medicine. Beijing J Tradition Chin Med
2018; 2: 186– 91.
Google Scholar
48 Liu J, Fang X, Sun L, Zhang Y, Shen W, Wang S, et al. Characteristics of Chinese herbs in
treatment of sepsis with gastroenteric dysfunction based on literature analysis. J Emerg Tradition
Chin Med. 2018; 5: 781– 5.
Google Scholar
49 Pan J, Miao X, Liu Q, Deng L, Niu X, Li A. Research on 12 traditional Chinese medicine pellets
reversing the drug resistance of common bacteria in vitro. Lab Med 2016; 31: 503– 8.
Google Scholar
50 Huang R, Mu X, Bai C, Zhang D, Deng W. The Effect of forsythia on the active efflux pump
encoding gene adeB of multidrug resistant Acinetobacter baumannii. J Pathogen Biol 2011; 2: 111–
4.
Google Scholar
51 Wang Y, Wang H, Han X, Liu C, Sun Y, Liu B, et al. Inhibitory effect of Lianhua Qingwen water
extract on methicillin-resistant Staphylococcus aureus biofilm in vitro. Chin J Nosocomiol 2015; 4:
727– 9.
Google Scholar
52 Liu X, Li J. Study on combined use of Teicoplanin with Mayu Shihuang Decoction against
Pneumonia infected with Methicillin resistance Staphylococcus aureus. J Emerg Tradition Chin Med
2013; 22: 1017– 8.
Google Scholar
Citing Literature 
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6/26/2021 Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary - Ma - 2019 - APMIS - Wiley Online …

APMIS / Volume 127, Issue 5 / p. 372-384

Review Article Free Access

Prevention and treatment of infectious diseases by traditional Chinese

First published: 24 May 2019

Therapeutic principle of infectious diseases in TCM 1

SIRS is a clinical syndrome that is characterized by a robust inflammatory response that is

A modern medical diagnosis can be auxiliary, which is a combination of subjective and

Theory of ‘treatment chosen according to climate, locality, and individual’

The recurrent respiratory infection in pediatric patients can be mainly classified as Qi

Strengthening physical resistance to eliminate pathogenic factors

Theory of incubative pathogenic factors and visceral manifestation

Theory of the manifestations of organs; large intestine is interior and exteriorly

Characteristics of TCM in treating different infectious diseases

Classification Common TCM Effective Mechanism

Fungal Sophora sophora, Terpenoids, Direct inhibition of fungal growth

Phenols, Volatile Oils

Classification Common TCM Effective Mechanism

Artemisia annua inhibit its metabolism); Excrete the parasite

TCM Manufacturer Ingredients Efficacy Indications

Xiyanping Jiangxi Qingfeng Andrographolide Antipyretic and anti- Bronchitis, tonsillitis,

injection Pharmaceutical sulfonate inflammatory, mycoplasma infection,

China dysentery, anti-viral, infection

Reduning Jiangsu Kangyuan Gardenia, Anti-viral, anti- Upper respiratory infection

Injection Pharmaceutical Honeysuckle, bacterial, eliminate (URI), viral pneumonia,

Co. Ltd, Artemisia annua inflammation, influenza, viral enteritis,

Tanreqing Shanghai Kaibao Scutellaria, Antipyretic, relieve URI, pneumonia, acute

Qingkailing Guangzhou Gardenia, Buffalo Antipyretic and anti- URI, pneumonia,

Mingxing Isatis root tranquilizing effect

Viral infectious diseases

H7N9 avian influenza is an infection of apostasies with approximately 40% mortality. In a

Treatment of viral infectious diseases by TCM requires the combination of

Bacterial infectious disease

Open in figure viewer PowerPoint

group is significantly superior to that of pure modern medicine (p < 0.01).

The combination of Chinese and Western medicine remarkably inhibits tuberculosis,

TCM syndrome differentiation by strengthening healthy Qi and removing

TCM protects the organ damage caused by severe infection

TCM has specific advantages for drug-resistant bacterial infection

Deficiency of TCM in treating infectious diseases

air to sustain the life and activity of the human body

1 Lu A, Jia H, Xiao C, Lu Q. Theory of traditional Chinese medicine and therapeutic method of

2 Tu Y, Fang Z, Yang A, Guo Y. Standardization of syndrome differentiation of Weifen, Qifen,

6 Wu Y, Jin Y, Wu J, Yu X, Hao Y. Effects of wogonin on inflammation related factors in alveolar

8 Li M, Ye W, Deng Z, Lu F. The preventive-therapeutic effects of reduqing on endotoxin-lnduced

14 Song Z, Xue Z. A literature study on the constitutional classification and discrimination of

19 Chang W, Xu Z. The application of purgation therapy in severe pneumonia based on the

28 Liu Y. Summary of symposium on SARS treated by integrative traditional and western

31 Chen Y. The curative effect of xiyanping combined with piperacillin-tazobactam in treating

33 Guo J, Qian F, Zhao L, Wu X, Sun F, Qian Y. Influence of modified “Shengjiang Powder” on

35 Wu S. Meta analysis of the clinical efficacy of xiyanping injection in the treatment of

36 Qi R, Fang S, Li D, Zhang H. Systematic evaluation and Meta analysis of xiyanping injection in

37 Zhang S. Meta analysis of xiyanping injection in the treatment of mycoplasma pneumonia in

39 Hu Y. Meta analysis of reduning injection in the treatment of viral pneumonia in children. J

41 Wu L, Huang R, Liao L, Qiu J, Li Z, Lian B, et al. A systematic review of supplemented Baihe

43 Ma X, Chen M. Persistent inflammation and immunosuppression: a common syndrome and

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