SARS Origins & Prevention

[Guest guest]

April 2, 2003

 

Dear Listmembers,

 

I have been following the outbreak of SARS (severe acute respiratory syndrome) epidemic (through on-line Chinese language newspapers)since a friend travelled to Hongkong and southern China last February. As far as I can establish, the phenomenon of SARS started from Metropole International Hotel jing hua guo ji jiu dian in Honkong when a medical profesor from Sun Yat Sen University in Kwangzhou came to Hongkong for a visit . During his stay in HK, he succumbed from fever and pneumonia type illness. He was admitted to the Kwong Wah Hospital on Feb. 22nd and later passed away on March 2nd. Subsequently, seven other people suffered from similar conditions .Some of these people infected by the virus subsequently travelled to Canada, Singapore , Taiwan and other internatioal cities. At this point, the conditions has been referred to as 'atypical pneumonia. ' On the basis of specimens gathered from patients in HK, Canada and US, the CDC and Honkong University have isolated the virus suposedly causing this epidemic--corona virus ( which normally can cause the common colds). The Sing Tao news paper (29/3/ 03) reported that the epidemic might have started in the prefectures of Fo Shan and He Yuan in the southern provice of Kwangdong

 

In Honkong a comprehansive measures are being taken by the health department to prevent the spread of the disease. Three ' magic weapons' san bao are being used to prevent being afflicted as well as staunching the spread of SARS i.e. surgical mask, disposable alchohol swabs and plain alchohol. Four million surgical masks have been distributed in HK. Blood tansfusion (containing antibodies from patients who have recovered from the disease) is also being used. A quick test to establish the presence of the virus has also been developed, but vaccination is still five years off. Western drugs such as ribavirin and steriods are also being used. Ban lan gen is also being distributed for free to some factory workers. White vinegar fumigation is also being used to ward off the effects of the virus.

 

In Southern China, it seems SARS is being dealt with as a type of flu epidemic liu gan . This is based upon an account by the February 13th on-line issue of the Southern Daily Nanfang Bao . The article is entitled " The Prevention and Treatment of the Fierce Flu Epidemic " outlines some preventative measures in dealing with the epidemic including (for those not yet afflicted by the disease).

1. Physical exercises to increase ones immune resistance and enhance one's adaptability to the environment.

2. Improved ventillation in homes and workplaces. " Ventillation is the best disinfectant " for the flu virus is spread through the athmosphere.

3. Reduce huge collective activities. Avoid crowded places.

4. Pay attention to changes in climactic temperatures and wear appropriate clothing.

5. When going outdoors wear face masks.

6. To prevent being afflicted by the disease , boil 15 grams each of the herbs ban langen, guan zhong, da qing ye, and jin yin hua . Drink the decocttin for 3-5 days . For children use half of the dose.

7. Flu vaccination for those who have weak immune resistance such as elderly people, children and those suffering from chronic nephritis, diabetes, and those suffering from tumors .

8. Vinegar fumigation and disinfection.This involves mixing a percentage of vinegar and water to be used as a vaporizer or mouth and nasal wash.

 

For herbal treatment of the disease, the following herbal preparations cheng yao are being prescribed and used according to the Nanfang Daily :

1. Qing Kai Ling Kou Fu Ye (injection, granules and capsules)

2. Chong Gan Ling

3. Zheng Chai hu yin chong ji

4. ban lan gen chong ji

5. yin qiao jie du pian

6. bi yan shu kou fu ye

7. yi zhou gan mao qing

8. chai hu zhu she ye

9. xiao er qing re jie du kou fu ye

10. xiao er liu gan tang jiang

11. xiao er gan mao chong ji

12. fu fang da qing ye he ji

13. fu rong kang liu gan wan

14. fu fang yin huang kou fu ye

15. wang ye jie du chong ji

16. gan mao zhi ke chong ji

17. shsuang huang lian kou fu ye

18. jing zhi yin qiao jie du pian

19. kang bing du kou fu ye

20 kang gan jie du pian

21. ling qiao jie du pian

22. liu gan cha (Flu Tea)

23. Vitamin C yin qiao chong ji

 

Sincerely yours,

 

Rey Tiquia

Phd Candidate

Dept. of History and Philosophy of Science

University of Melbourne

 

 

[Guest guest]

Rey:

 

Thanks for the details. Do you know which of the formulas mentioned

has been effective, and to what extent? And, do they describe SARS

in terms of SHL?

 

 

Jim Ramholz

 

 

 

, " rey tiquia " wrote:

> April 2, 2003

>

> Dear Listmembers,

>

> I have been following the outbreak of SARS (severe acute

respiratory

> syndrome) epidemic (through on-line Chinese language newspapers)

since a

> friend travelled to Hongkong and southern China last February. As

far as I

> can establish, the phenomenon of SARS started from Metropole

International

> Hotel jing hua guo ji jiu dian in Honkong when a medical profesor

from Sun

> Yat Sen University in Kwangzhou came to Hongkong for a visit .

During his

> stay in HK, he succumbed from fever and pneumonia type illness. He

was

> admitted to the Kwong Wah Hospital on Feb. 22nd and later passed

away on

> March 2nd. Subsequently, seven other people suffered from similar

> conditions .Some of these people infected by the virus subsequently

> travelled to Canada, Singapore , Taiwan and other internatioal

cities. At

> this point, the conditions has been referred to as 'atypical

pneumonia. ' On

> the basis of specimens gathered from patients in HK, Canada and

US, the CDC

> and Honkong University have isolated the virus suposedly causing

this

> epidemic--corona virus ( which normally can cause the common

colds). The

> Sing Tao news paper (29/3/ 03) reported that the epidemic might

have started

> in the prefectures of Fo Shan and He Yuan in the southern provice

of

> Kwangdong

>

> In Honkong a comprehansive measures are being taken by the

health

> department to prevent the spread of the disease. Three ' magic

weapons' san

> bao are being used to prevent being afflicted as well as

staunching the

> spread of SARS i.e. surgical mask, disposable alchohol swabs and

plain

> alchohol. Four million surgical masks have been distributed in HK.

Blood

> tansfusion (containing antibodies from patients who have recovered

from the

> disease) is also being used. A quick test to establish the

presence of the

> virus has also been developed, but vaccination is still five years

off.

> Western drugs such as ribavirin and steriods are also being

used. Ban lan

> gen is also being distributed for free to some factory workers.

White

> vinegar fumigation is also being used to ward off the effects of

the virus.

>

> In Southern China, it seems SARS is being dealt with as a

type of flu

> epidemic liu gan . This is based upon an account by the February

13th

> on-line issue of the Southern Daily Nanfang Bao . The article is

entitled

> " The Prevention and Treatment of the Fierce Flu Epidemic "

outlines some

> preventative measures in dealing with the epidemic including (for

those not

> yet afflicted by the disease).

> 1. Physical exercises to increase ones immune resistance and

enhance one's

> adaptability to the environment.

> 2. Improved ventillation in homes and workplaces. " Ventillation is

the best

> disinfectant " for the flu virus is spread through the athmosphere.

> 3. Reduce huge collective activities. Avoid crowded places.

> 4. Pay attention to changes in climactic temperatures and wear

appropriate

> clothing.

> 5. When going outdoors wear face masks.

> 6. To prevent being afflicted by the disease , boil 15 grams each

of the

> herbs ban langen, guan zhong, da qing ye, and jin yin hua . Drink

the

> decocttin for 3-5 days . For children use half of the dose.

> 7. Flu vaccination for those who have weak immune resistance such

as elderly

> people, children and those suffering from chronic nephritis,

diabetes, and

> those suffering from tumors .

> 8. Vinegar fumigation and disinfection.This involves mixing a

percentage of

> vinegar and water to be used as a vaporizer or mouth and nasal

wash.

>

> For herbal treatment of the disease, the following herbal

preparations

> cheng yao are being prescribed and used according to the Nanfang

Daily :

> 1. Qing Kai Ling Kou Fu Ye (injection, granules and capsules)

> 2. Chong Gan Ling

> 3. Zheng Chai hu yin chong ji

> 4. ban lan gen chong ji

> 5. yin qiao jie du pian

> 6. bi yan shu kou fu ye

> 7. yi zhou gan mao qing

> 8. chai hu zhu she ye

> 9. xiao er qing re jie du kou fu ye

> 10. xiao er liu gan tang jiang

> 11. xiao er gan mao chong ji

> 12. fu fang da qing ye he ji

> 13. fu rong kang liu gan wan

> 14. fu fang yin huang kou fu ye

> 15. wang ye jie du chong ji

> 16. gan mao zhi ke chong ji

> 17. shsuang huang lian kou fu ye

> 18. jing zhi yin qiao jie du pian

> 19. kang bing du kou fu ye

> 20 kang gan jie du pian

> 21. ling qiao jie du pian

> 22. liu gan cha (Flu Tea)

> 23. Vitamin C yin qiao chong ji

>

> Sincerely yours,

>

> Rey Tiquia

> Phd Candidate

> Dept. of History and Philosophy of Science

> University of Melbourne

[Guest guest]

April 2,2003

Dear Jim,

 

The herbal formulae were featured in the Southern Daily. It is

difficult to assess the efficacy of these preparations vis-a-vis

cases of 'epidemic flu' (not SARS) that they are confronting in

Guandong Province. In addition some of the names of the

preparations are actually 'brand names' which makes it difficult

to know the specific herbal ingredients of each formulation

and which company in China manufactured them. However,

some of the preparations that I am familiar with and which are

used effectively in the prevention and and treatment purposes

are ban lan gen chong ji, yin qiao jie du pian, jing zhi yin qiao jie

du pian, ling qiao jie du pian etc.

 

Yin Qiao jie du pian is a reconstituted formula from the

oriiginal prescription (yin qiao san or Lonicera & forsythia

formula) formulated by the Qing dynasty medical scholar Wu

Tang(1736-1820) . It is featured in his book wen bing tiao bian .

 

Regards ,

 

Rey Tiquia

 

 

 

, " James

Ramholz " <jramholz> wrote:

> Rey:

>

> Thanks for the details. Do you know which of the formulas

mentioned

> has been effective, and to what extent? And, do they describe

SARS

> in terms of SHL?

>

>

> Jim Ramholz

>

>

>

> -

[Guest guest]

At 4:10 AM +0000 4/2/03, James Ramholz wrote:

And, do they describe

SARS

in terms of SHL?

--

 

The origin of the disease is Vietnam and Southern China, so it

seems more likely they would be using Wen Bing theory.

 

Rory

--

[Guest guest]

, Rory Kerr <rorykerr@w...>

wrote:

> At 4:10 AM +0000 4/2/03, James Ramholz wrote:

> >And, do they describe SARS

> >in terms of SHL?

> --

>

> The origin of the disease is Vietnam and Southern China, so it

seems more likely they would be using Wen Bing theory.

 

 

Rory:

 

Do you have enough information to plot it out in Wen Bing? I am

interested in seeing how CM theories apply---perhaps they are just

treating it symptomatically.

 

 

Jim Ramholz

[Guest guest]

At 7:18 PM +0000 4/2/03, James Ramholz wrote:

Do you have enough information to

plot it out in Wen Bing? I am

interested in seeing how CM theories apply---perhaps they are

just

treating it

symptomatically.

--

 

Well, there isn't a whole lot of detail to go on, but it appears

to fit as an epidemic pestilential qi, and the description I've seen

seems to be a qi level illness with lung heat. Given that it

originated in a tropical regions, I wonder if some of the cases would

have manifested with damp heat.

 

Rory

--

[Guest guest]

I have the same thoughts, Rory and Jim.

 

SARS certainly seems to fit the wen bing category of shi bing/seasonal

disease, perhaps a spring-warmth disease with latent heat effecting the

qi and possibly ying aspects. As you mention, Rory, we need more info,

including pulses, tongue descriptions, more detailed symptoms from a CM

perspective.

 

In Guohui Liu's Warm Disease book, he mentions recent successes in

epidemics in China by using warm disease prescriptions. One example

was Pu Fuzhou, who succeeded in stemming two meningitis epidemics in

northern China in the 20th century with 'wen bing style' prescriptions.

 

In Marta Hansen's Ph. D. thesis on warm disease, " Inventing a Tradition

in " , she discusses the history of the warm disease

school. Basically, it was a response to new epidemic diseases, just

as Shang Han Lun was developed as a similar response centuries before.

 

Modern medicine has little or no treatment for SARS. It would make

sense for biomedicine to 'share the stage' with Chinese medicine to

develop effective treatment. Warm disease theory would seem to be the

ticket in the present scenario.

 

 

On Wednesday, April 2, 2003, at 07:13 PM, Rory Kerr wrote:

 

> At 7:18 PM +0000 4/2/03, James Ramholz wrote:

>

> Do you have enough information to plot it out in Wen Bing? I am

> interested in seeing how CM theories apply---perhaps they are just

>

> treating it symptomatically.

>

> --

>

> Well, there isn't a whole lot of detail to go on, but it appears to

> fit as an epidemic pestilential qi, and the description I've seen

> seems to be a qi level illness with lung heat. Given that it

> originated in a tropical regions, I wonder if some of the cases would

> have manifested with damp heat.

>

> Rory

>

> --

>

>

<image.tiff>

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

>

>

>

[Guest guest]

Z'ev - do you know where Marta Hansen's Ph. D. thesis on warm disease may be found - and had?

 

thanks - Will

 

 

In Marta Hansen's Ph. D. thesis on warm disease, "Inventing a Tradition in ", she discusses the history of the warm disease school. Basically, it was a response to new epidemic diseases, just as Shang Han Lun was developed as a similar response centuries before.

[Guest guest]

At 10:54 PM -0800 4/2/03, wrote:

>SARS certainly seems to fit the wen bing category of shi

>bing/seasonal disease, perhaps a spring-warmth disease with latent

>heat effecting the qi and possibly ying aspects. As you mention,

>Rory, we need more info, including pulses, tongue descriptions, more

>detailed symptoms from a CM perspective.

--

 

IMO, SARS should not be not be classified as spring warmth. Prior to

the point at which it is clear that the illness is SARS, it may

present as a seasonal illness. However, once the disease progresses

and becomes evident, I believe it should be classified as

pestilential qi (li qi). To classify the illness as a seasonal warm

illness would lead to treatment that may not be strong enough to

defeat the pathogen. To classify the disease as pestilential qi leads

to the use of much stronger herbs to counter warm toxins.

 

Rory Kerr

--

[Guest guest]

, " " wrote:

> Modern medicine has little or no treatment for SARS. It would

make sense for biomedicine to 'share the stage' with Chinese

medicine to develop effective treatment. Warm disease theory would

seem to be the ticket in the present scenario. >>>

 

 

Z'ev:

 

It will be interesting to see how SARS situation develops and is

resolved---if it is. There should be someone in China with CM

experience who has already diagnosed and treated some of these

patients. With all the people on this list someone should have

contact with the hospitals there; shouldn't we hear something soon?

It's situations like this where the rubber hits the road.

 

 

Jim Ramholz

[Guest guest]

Modern medicine has little or no treatment for SARS. It would make sense for biomedicine to 'share the stage' with Chinese medicine to develop effective treatment. Warm disease theory would seem to be the ticket in the present scenario.>>>>As long as we understand its only hypothetical and theoretical

alon

[Guest guest]

I am not so sure I agree, but at the same time, we are speculating as

long as we don't have the complete symptom pattern.

 

Spring-warmth involves latent heat from cold damage in the wintertime,

entering the shao yin channel. It can be quite severe in nature,

because of the preponderance of internal heat signs.

 

 

On Thursday, April 3, 2003, at 05:08 AM, Rory Kerr wrote:

 

> At 10:54 PM -0800 4/2/03, wrote:

>> SARS certainly seems to fit the wen bing category of shi

>> bing/seasonal disease, perhaps a spring-warmth disease with latent

>> heat effecting the qi and possibly ying aspects. As you mention,

>> Rory, we need more info, including pulses, tongue descriptions, more

>> detailed symptoms from a CM perspective.

> --

>

> IMO, SARS should not be not be classified as spring warmth. Prior to

> the point at which it is clear that the illness is SARS, it may

> present as a seasonal illness. However, once the disease progresses

> and becomes evident, I believe it should be classified as

> pestilential qi (li qi). To classify the illness as a seasonal warm

> illness would lead to treatment that may not be strong enough to

> defeat the pathogen. To classify the disease as pestilential qi leads

> to the use of much stronger herbs to counter warm toxins.

>

> Rory Kerr

> --

>

>

[Guest guest]

Sorry, I misspelled her name: It is Marta Hanson. You can get her

thesis from www.umi.com. Her website is at

http://japan.ucsd.edu/Marta/home/.

 

 

 

 

On Thursday, April 3, 2003, at 07:00 AM, WMorris116 wrote:

 

> Z'ev - do you know where Marta Hansen's Ph. D. thesis on warm disease

> may be found - and had?

>

> thanks - Will

>

>

> In Marta Hansen's Ph. D. thesis on warm disease, " Inventing a Tradition

> in " , she discusses the history of the warm disease

> school.  Basically, it was a response to new epidemic diseases,  just

> as Shang Han Lun was developed as a similar response centuries before.

>

>

>

>

<image.tiff>

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

>

>

>

[Guest guest]

No, I don't agree here. The only thing that makes warm disease theory

'hypothetical and theoretical' is the present political-socioeconomic

scenario. Warm disease theory was not developed as an intellectual

mind-game, it was developed to save lives from new epidemics during the

qing dynasty era. And as I mentioned earlier, a 'warm-disease'

practitioner's work was able to alleviate two meningitis epidemics in

northern China mid 20th century.

 

I think we potentially have a great role to play here.

 

For more, read Marta Hanson's text on warm disease.

 

 

On Thursday, April 3, 2003, at 07:06 AM, Alon Marcus wrote:

 

> Modern medicine has little or no treatment for SARS. It would make

> sense for biomedicine to 'share the stage' with Chinese medicine to

> develop effective treatment. Warm disease theory would seem to be the

> ticket in the present scenario.

> >>>>As long as we understand its only hypothetical and theoretical

> alon

>

[Guest guest]

At 7:33 AM -0800 4/3/03, wrote:

I am not so sure I agree, but at the

same time, we are speculating as

long as we don't have the complete symptom pattern.

 

Spring-warmth involves latent heat from cold damage in the

wintertime,

entering the shao yin channel. It can be quite severe in

nature,

because of the preponderance of

internal heat signs.

--

 

Z'ev,

 

I've found a more complete description, which I've extracted

below from a MMWR report on the CDC site:

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5212a5.htm>.

 

I've also talked to a physician at the CDC about unreported case

information, and she told me that their is really nothing to

distinguish this at the early stages from other common colds/flu's.

She said that the only GI symptoms reported have been diarrhea in only

a very few cases; and constipation in no cases.

 

On the issue of latency, for many patients it seems that the

genesis is recent exposure. So while it may have originated as a

latent pathogen in the first cases, for those recently visiting SE

Asia, and then becoming ill on return home, this appears not to be the

case.

 

Rory

 

=========

Preliminary Clinical

Description of Severe Acute Respiratory Syndrome

 

As of March 21,

2003, the majority of patients identified as having SARS have been

adults

aged 25--70 years who were previously healthy. Few suspected cases of

SARS have been

reported among children aged <15 years.

 

The incubation period for SARS is typically 2--7 days; however,

isolated reports have

suggested an incubation period as long as 10 days. The illness begins

generally with a

prodrome of fever (>100.4°F [>38.0°C]). Fever often is high,

sometimes is associated with

chills and rigors, and might be accompanied by other symptoms,

including headache,

malaise, and myalgia. At the onset of illness, some persons have mild

respiratory

symptoms. Typically, rash and neurologic or gastrointestinal findings

are absent; however,

some patients have reported diarrhea during the febrile prodrome.

 

After 3--7 days, a lower respiratory phase begins with the onset of a

dry, nonproductive

cough or dyspnea, which might be accompanied by or progress to

hypoxemia. In 10%--20% of

cases, the respiratory illness is severe enough to require intubation

and mechanical

ventilation. The case-fatality rate among persons with illness meeting

the current WHO

case definition of SARS is approximately 3%.

 

Chest radiographs might be normal during the febrile prodrome and

throughout the course of

illness. However, in a substantial proportion of patients, the

respiratory phase is

characterized by early focal interstitial infiltrates progressing to

more generalized,

patchy, interstitial infiltrates. Some chest radiographs from patients

in the late stages

of SARS also have shown areas of consolidation.

 

Early in the course of disease, the absolute lymphocyte count is often

decreased. Overall

white blood cell counts have generally been normal or decreased. At

the peak of the

respiratory illness, approximately 50% of patients have leukopenia and

thrombocytopenia or

low-normal platelet counts (50,000--150,000/µL). Early in the

respiratory phase, elevated

creatine phosphokinase levels (as high as 3,000 IU/L) and hepatic

transaminases (two to

six times the upper limits of normal) have been noted. In the majority

of patients, renal

function has remained normal.

 

The severity of illness might be highly variable, ranging from mild

illness to death.

Although a few close contacts of patients with SARS have developed a

similar illness, the

majority have remained well. Some close contacts have reported a mild,

febrile illness

without respiratory signs or symptoms, suggesting the illness might

not always progress to

the respiratory phase.

 

Treatment regimens have included several antibiotics to presumptively

treat known

bacterial agents of atypical pneumonia. In several locations, therapy

also has included

antiviral agents such as oseltamivir or ribavirin. Steroids have also

been administered

orally or

intravenously to patients in combination with ribavirin and other

antimicrobials. At present, the most efficacious treatment regimen, if

any, is unknown.

 

--

[Guest guest]

No, I don't agree here. The only thing that makes warm disease theory 'hypothetical and theoretical' is the present political-socioeconomic scenario

>>I am not talking about the theory only application to SARS

alon

[Guest guest]

What I am hoping for, Alon, is simply that we will engage our

conceptual tools and try to figure out what is going on with SARS. I

have little hope for a practical application in the West, but I am

hoping that the CM community in China will have some active role and

comment. None has appeared in the Western media yet, and according to

Ken, little discussion is going on publicly over there.

 

The N.Y. Times has a good article on SARS in China in this morning's

addition 4/3/03.

 

 

On Thursday, April 3, 2003, at 09:42 AM, Alon Marcus wrote:

 

> >>I am not talking about the theory only application to SARS

> alon

>

[Guest guest]

What I am hoping for, Alon, is simply that we will engage our conceptual tools and try to figure out what is going on with SARS.

>>>>I agree with that, but like always i like to point out that just because one can look at possible symptom signs of a new a disease and hypothetically apply a theory does not mean clinical results

alon

[Guest guest]

I think its worth a try. I just don't think we'll get the chance.

 

Z'ev

On Thursday, April 3, 2003, at 12:10 PM, Alon Marcus wrote:

 

> What I am hoping for, Alon, is simply that we will engage our

> conceptual tools and try to figure out what is going on with SARS. 

> >>>>I agree with that, but like always i like to point out that just

> because one can look at possible symptom signs of a new a disease and

> hypothetically apply a theory does not mean clinical results

> alon

>

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

> What I am hoping for, Alon, is simply that we will engage our

> conceptual tools and try to figure out what is going on with SARS.

> >>>>I agree with that, but like always i like to point out that just

because one can look at possible symptom signs of a new a disease and

hypothetically apply a theory does not mean clinical results

> alon

 

Alon

 

I think that is only half correct. If there is no prior knowledge of

a new disease, one cannot attack the disease directly. However one

can always treat the pattern. Because the pattern really reflects the

body's response to illness, there are varying degrees of improvement

that can occur with this approach regardless of the disease. While

this might not be as effective as treating both disease and pattern,it

still might make a difference in survival rates. In the absence of

any standard treatment, it would not hurt to just improve the

patient's health. But I do agree that one cannot assume that wen bing

theory (for example) would yield any miracles in SARS.

 

 

[Guest guest]

I think that is only half correct. If there is no prior knowledge ofa new disease, one cannot attack the disease directly. However onecan always treat the pattern.

>>>I agree that treating the pattern is what we do when confronted with this type of situation and then we hope for a better outcome. However,just as wen bing came about, presumably because earlier theories did not work, so is the outcome of any new disease will remain speculative. Again in clinic at this point we have no other choice and therefor we should use what we can just like WM is doing

Alon