Covid19: Acute Infections Presenting With Lung (Phlegm) Symptoms

March 19, 2023

For this next blog article, we are going to spend some time on the acute treatment of Covid19 based on research for herbal formulas that has come out of China followed by insights and strategies in our next blog post for long Covid.

What is the Best Strategy?

Covid19 is considered a SARS-CoV-2 coronavirus causing a multitude of signs and symptoms, depending on the individual’s constitution. Some patients are asymptomatic, and others die from the infection. The variety of afflictions is not something, that we are unfamiliar with in the TCM world, we always look at the individual first and then establish our clinical reasoning according to the manifestation of the imbalance pattern. And in most cases, we will address the disharmony with our treatment. However, sometimes, we are under pressure that our treatment must work fast, create efficient result and be uncomplicated for our patients. In my experience (and I have succumbed to the pressure in the past), it’s best to work with the TCM framework, apply TCM principles and treat what you see. In Australia, there were not many opportunities to see acute Covid19 patients due to the extensive lockdowns. Consequently, I have based this compilation on the research that came out China.

Research from China

China’s research efforts using Chinse herbal medicine (CHM) is based upon preventing and combating Covid19 and it has been exceptional. No other country has produced the amount of research for herbs. But in China, the practice setting is different, as most practitioner work in a hospital setting. Consequently, research efforts are based on both Biomedical and TCM paradigms. In 2020, Pharmacological Research (Elsevier) published a systematic review with a meta-analysis. The researcher screened databases to find research papers (randomised controlled trials only) and created a meta review. A systematic review is considered high quality evidence and hence my choice for this article. In the short period of time when Covid19 was recognised as a pandemic and the systematic review they produced, 18 high quality randomised controlled trials (RCTs) were included. This is an impressive result given the short time frame.

In 2020, another group of researchers produced more details on treating Covid19, especially in its early stages which was published in Phytomedicine. Their herbal formula suggestions base on the concept of the close relationship in Zang Fu and acupuncture channel theory of the Lung and Large Intestine which form an interior-exterior relationship. It is further grounded in pathologies of the Lung which are caused by insufficiently descending Lung Qi or weakened Lung Qi. In both scenarios and in close relationship with an inadequate Spleen function, accumulates phlegm (insufficient dispersion of liquids) and pathogenic phlegm impairs breathing, causes coughing and facilitates asthma. The large intestine as “Minister of Transportation” discharges excessive liquids through defecation. Consequently, formulas addressing the partnership of the Lung, Large Intestine as well as Spleen are commonly used to address the excessive phlegm accumulation causing obstruction.

In the following table, I have listed 14 internal formulas that came out of the systematic review (not mentioning Yuping Feng San and Huoxiang Zhengqi Liquid, Buzhong Yiqi Tang or herbal injections) and compared it with the formulas from the second publication in Phytomedicine:

Systematic review (2019)Forefront battle (2020)
Maxing Shigan Tang

Ma Huang, Xing Ren, Shi Gao, Gan Cao

Maxing Shigan Tang

Ma Huang, Xing Ren, Shi Gao, Gan Cao

Pneumonia #1 formula

Chai Hu, Huang Qin, Ban Xia, Dang Shen, Gua Lou Ren, Bing Lang, Cao Guo, Hou Po, Zhi Mu, Bai Shao, Gan Cao, Chen Pi, Hu Zhang

Qingfei Paidu Tang

Ma Huang, Gan Cao, Shi Gao, Gui Zhi, Ze Xie, Zhu Ling, Bai Zhu, Fu Ling, Chai Hu, Huang Qin, Jiang Ban Xia, Sheng Jiang, Zi Wan, Kuan Dong Hua, She Gan, Xi Xin, Zhi Shi, Chen Pi, Huo Xiang

Pneumonia #2 formula

Ma Huang, Xing Ren, Ban Xia,  Zhi Shi, Gua Lou Ren, Huang Lian, Zhe Bei Mu, Jie Geng, Bai Bu, Qian Hu, Zi Wan, Kuan Dong Hua, Bai Ying, Bai Jiang Cao, Pu Gong Yin, Zi Hua Di Ding

Shegan Mahuang Tang

She Gan, Ma Huang, Sheng Jiang, Xi Xin, Zi Wan, Kuan Dong Hua, Da Zao, Jiang Ban Xia, Wu Wei Zi

Powerful Pneumonia #1 formula

Chai Hu, Huang Qin, Ban Xia, Bing Lang, Cao Guo, Gua Lou Ren, Gan Cao, Hu Zhang, Huang Lian, Zhi Shi, Zhe Bei Mu, Jie Geng, Bai Bu, Qian Hu, Zi Wan, Kuan Dong Hua, Huo Xiang, Pei Lan

Lianhua Qingwen capsule

Lian Qiao, Jin Yin Hua, Ma Huang, Xing Ren, Shi Gao, Ban Lan Gen, Mian Ma Guangzhong, Yu Xing Cao, Huo Xiang, Da Huang, Hong Jing Tian, Can Cao, Menthol

Damp-toxin obstructing lung formula

Xing Ren, Hua Shi, Cang Zhu, Bai Zhi, Ban Xia, Huo Xiang, Fu Ling, Ma Huang, Da Huang, Chan Tui, Niu Bang Zi, Gan Cao

Toxin-blocking lung formula

Xing Ren, Shi Gao, Gua Lou Ren, Da Huang, Ma Huang, Ting Li Zi, Tao Ren, Cao Guo, Bing Lang, Cang Zhu

Qingfei Touxie Fuzheng formula

Ma Huang, Shi Gao, Xing Ren, Jin Yin Hua, Lian Qiao, Lu Gen, Yi Yi Ren, Jiang Can, Chan Tui, Hu Zhang, Jiang Huang, Bai Shao, Tai Zhi Shen, Gan Cao

Toujie Quwen granules

Lian Qiao, Shan Ci Gu, Jin Yin Hua, Huang Qin, Da Qing Ye, Chai Hu, Qing Hao, Chan Tui, Qian Hu, Chuan Bei Mu, Zhe Bei Mu, Wu Mei, Xuan Xhen, Huang Qi, Fu Ling, Tai Zi Shen

Shufeng Jiedu capsules

Hu Zhang, Lian Qiao, Ban Lan Gen, Chai Hu, Bai Jiang Cao, Ma Bian Cao, Lu Gen, Gan Cao

Lianhua Qingwen granules and capsules

Lian Qiao, Jin Yin Hua, Ma Huang, Xing Ren, Shi Gao, Ban Lan Gen, Mian Ma Guangzhong, Yu Xing Cao, Huo Xiang, Da Huang, Hong Jing Tian, Can Cao, Menthol

Ganlu Xiaodu pills

Hua Shi, Huang Qin, Yin Chen Hao, Huo Xiang, Lian Qiao, Shi Chang Pu, Bai Dou Kou, Bo He, Tong Cao, She Gan, Chuan Bei Mu

Reyanning mixture

Pu Gong Yin, Hu Zhang, Bai Jiang Cao, Ban Zhi Lian

Jinhua Qinggan granules

Jin Yin Hua, Shi Gao, Ma Huang, Xing Ren, Huang Qin, Lian Qiao, Zhe Bei Mu, Zhi Mu, Niu Bang Zi, Qing Hao, Bo He, Gan Cao

Maxing Xuanfei Jiedu Tang

Ma Huang, Xing Ren, Shi Gao, Zhe Bei Mu, Chan Tui, Jiang Can, Jiang Huang, Jie Geng, Zhi Ke, Cao Guo, Bai Dou Kou


It is apparent, that the initial treatment focuses on treating the pathogen, clear phlegm and dampness and re-establish proper Lung function to eliminate moisture.

The Damp-Heat-Toxin Invasion

The authors also discussed that Covid19 doesn’t exist in TCM as such, but they considered it belonging to a damp-heat or damp-toxin epidemic. They further argued that the best treatment approach involves three phases:

  • the acute treatment (when all yang channels are inflicted),
  • followed by phlegm-heat affecting the lungs
  • and finally addressing the deficiency of lung and spleen qi during recovery.

CHM treatment for Covid19 patients was deemed relatively safe as the reported adverse effects were not severe and the reported courses were between five and fifteen days. It is worthwhile to mention that Covid19 cases in a very early stage may be prevented from becoming difficult, if formulas to release the exterior are used swiftly.

Does This Strategy Work for Other Variants of Covid19?

The Covid19 virus has affected individuals in various ways. At first, it seems that older patients which might have less resistance or a weaker immune system (Lung, Spleen, Kidney weaknesses) have more difficulties to combat the initial stages. I see my part as TCM practitioner to make sure that our patients are optimally prepared for any external pathogen invasion and hence, I think, that examples of the above Chinese herbal strategies can be mixed and matched according to what the situation of our patients requires. I would also like to add that we require an open mind to use warming herbal substances if there are signs of cold. Only because Covid19 was named a damp-heat-toxin invasion doesn’t mean that our patients do not require warming. As a Jing Fang practitioner myself (Shang Han Lun and Jin Gui Yao Lue formulas), I will often decide to warm before I use too many cooling substances, or at least make sure, that the patient will not have any adverse effects from cold herbs.

Brigitte Linder
Brigitte Linder was born in Zurich and has lived near Melbourne on the south coast of Australia since 2008. She operated Safflower – Chinese Herbs Expertly Dispensed until mid-2023. Safflower is an herbal dispensary business operating under the banner of the Therapeutic Goods Administration (TGA). It was issued a GMP licence. Acuneeds acquired the company in January 2024 and intended to offer all services to practitioners in Australia and New Zealand.Brigitte completed a master's degree in 2023 with NICM Health Research (Western Sydney University). Her thesis involved creating a case report guideline for Chinese herbal medicine. In 2019, she published her first book and has since mentored TCM graduates to better transition to full-fledged practitioners. She has been consulting patients for 20 years and enjoys working with children and patients with complex conditions. She is a diplomat of the Institute of Classics in East Asian Medicine (ICEAM) and prescribes Eastern Han-era herbal formulas, namely Shang Han Lun and Jin Gui Yao Lue. Brigitte has always been interested in uniting a strong, cohesive TCM community. She continues to invest time and effort to ensure practitioners and the profession receive support and recognition.
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