Observation of Xing Ren Decoction in the Treatment of COVID-19

SUMMARY: According to one of the most famous Traditional Chinese Medicine (TCM) ancient literature “Wen Bing Tiao Bian: Volume 1” (《溫病條辨・卷一》), Xing Ren Decoction (杏仁湯) is used to treat severe lung condition with “white tongue coating, thirst, frequent cough, chills that induced by heat” (舌白渴飲,咳嗽頻仍,寒從背起,伏暑所致, 名曰肺瘧, 杏仁湯主之). As the “dampness-heat/toxin obstructing lung” syndrome described is similar to the signs and symptoms of novel coronavirus disease (COVD-19), several accredited TCM professionals and sources, such as Dr. Bingcai Wu and “”Jiangxi Province Novel Coronavirus Disease Chinese Medicine Prevention and Treatment Program (Trial Version 3)” (《江西省新冠肺炎中醫藥防治方案(試行第三版)》), suggested using Xing Ren Decoction as the principal formula for COVID-19-related condition.  According to one study conducted in the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Xing Ren Decoction was used to treat 18 patients with uncomplicated COVID-19. All subjects met the diagnostic criteria of “Damp-heat resulting in impairment of fluid” (濕熱傷津) and showed signs and symptoms of: low-grade fever or no fever, no perspiration or minimal perspiration, dry cough, minimal phlegm, dry throat, dry mouth lack desire to drink, fatigue, chest tightness, chest and epigastric fullness, nausea, anorexia, loose stools or sticky stools, red tongue with thick white or thin yellow coating. Ingredients of Xing Ren Decoction include: Xing Ren 9g (杏仁 Semen Armeniacae Amarum), Huang Qin 9g (黃芩 Radix Scutellariae), Lian Qiao 9g (連翹 Fructus Forsythiae), Fu Ling 9g (茯苓 Poria), Bai Dou Kou 9g (白豆蔻 Fructus Amomi Rotundus, to be added in before the end of decoction), 滑石9g, Hua Shi 9g (滑石 Talcum, packaged in a cloth bag during decoction), Sang Ye 9g (桑葉 Folium Mori), Li Pi half slice (梨皮Pyrus pyrifolia), and 生甘草6g Gan Cao 6g (甘草 Radix Glycyrrhizae). The clinical efficacy of using Xing Ren Decoction to treat uncomplicated COVID-19 was shown to be positive.  As signs can symptoms may be varied in different patients, it is important to modify the formula accordingly. In one case study, a 36 years old male patient diagnosed with COVID-19 was treated with modified Xing Ren Decoction. The subject presented with fever mainly in the afternoon with highest body temperature of 37.8℃, no aversion to cold or wind, no nasal congestion or runny nose, mild sweating in the neck, no body aches, severe cough with shortness of breath mainly during the day, minimal phlegm, occasional cough with tinge of blood, mild chest tightness, heavy and wrapping sensation in the head, occasional fatigue and weakness, mild dry mouth, no bitter taste in the mouth, sticky sensation in the mouth, mild dry nose, no dryness or itchiness in the pharynx, no chest pain, no abdominal pain or diarrhea, appetite decreased, no nausea and vomiting, well-formed stool, soft, non-sticky, bowel movement once a day, yellow urine, not urgency or burning sensation, tongue red with teeth mark and sticky yellow coating, pulse slippery and rapid. The patient was diagnosed with “Damp-heat/toxin obstructing lungs” and the treatment principle was to “clear heat and resolve dampness, nourish the lung and arrest cough” with the addition of “clear heat in Yang-Ming meridian”. As a result, Ge Gen Qin Lian Tang (Kudzu, Scutellaria and Coptis Decoction, 葛根芩連湯) was used with Xing Ren Decoction. Patients showed significant improvement after 3 days of treatment and was tested negative for COVID-19 with clear CT scan result by the 9th day of treatment.  According to the theory of TCM, it is important to expel the pathogen in order to completely recover from the disease. In Xing Ren Decoction, Xing Ren is known to regulate and nourish Lung Qi in the upper Jiao, Fu Ling and Bai Dou Kou are known to support Spleen function to resolve dampness in middle Jiao, Huang Qin, Lian Qiao, Hua Shi are known to clear heat through different passages in the body, San Ye and Li Pi are known to clear heat while nourishing the fluid, and Gan Cao is known to clear heat and toxin. Xing Ren Decoction and its modified formula have shown to be effective and safe in treating patient with COVID-19 that present with syndrome of “damp heat-toxin obstructing the lung”, as it is effective in regulating the Qi, clear heat, dampness and toxin. 

Yuanbing Zhang et al.TCMJ. 2020. 19 (4): 1-3.