Expert Consensus of Guangdong Province on Prevention and Treatment of Coronavirus Disease 2019 with Integrated Chinese and Western Medicine(Trial Version I)

1 Scope

This consensus includes contents concerning etiology, epidemiology, pathological changes,clinical features, etiology and pathogenesis of traditional Chinese medicine, diagnostic criteria,differential diagnosis, prevention and treatment with traditional Chinese and Western medicine, etc. of COVID-19. This consensus is suitable for healthcare workers including doctors and nurses who diagnose and treat COVID-19 patients at fever clinic,emergency department, respiratory department,intensive medicine department as well as scienti fic researchers.

2 Normative References

Diagnosis and Treatment Plan of CoronavirusDisease 2019(Trial Version VII) issued by the National Health Commission and National Administration of Traditional Chinese Medicine

Treatment of Coronavirus Disease 2019 by Chinese Medicine of Guangdong Province(Trial Version II) issued by the Health Commission and the Traditional Chinese Medicine Bureau of Guangdong Province

Rehabilitation Program for Discharged Patients Recovered from Coronavirus Disease 2019(Trial Version) issued by the National Health Commission

Rehabilitation Suggestions on Traditional Chinese Medicine During Convalescence ofCoronavirus Disease 2019 Patientsissued by the National Health Commission and National Administration of Traditional Chinese Medicine

3 Etiological Characteristics

Novel Coronavirus (2019-nCoV) belongs to the enveloped beta-coronavirus category. It has round or elliptic and often pleomorphic form, and a diameter of approximately 60–140 nm. In genetic terms, 2019-nCoV is different from SARS-CoV and MERS-CoV Studies have shown that its genome had more than 85% nucleotide identity with that of bat SARS-like coronavirus (bat SL-CoVZC45).It takes about 96 hours to detect 2019-nCoV in isolated and cultured human respiratory epithelial cells and about 6 days in isolated and cultured in Vero E6 and Huh-7 cells.

The studies of SARS-CoV and MERS-CoV contribute to our understanding of the physical and chemical characteristics of 2019-nCoV. The virus is sensitive to ultraviolet rays and heat. It can be effectively inactivated by being heated to 56℃ for 30 minutes or exposed to lipid solvents including ether(75%), ethanol, chlorine-containing disinfectant,peroxyacetic acid and chloroform except for chlorhexidine.

4 Epidemiologic Features

4.1 Sources of infection

Currently, the major source of infection is the patients infected with 2019-nCoV. Asymptomatic infected persons represent another important contributor to the prevalence currently.

4.2 Route of transmission

Respiratory droplets and close contact between individuals are the main routes of transmission.Aerosol transmission is possible under the conditions of prolonged exposure to high concentrations of aerosols in a relatively enclosed environment. Since Novel Coronavirus can be isolated from stool and urine, caution should also be used against aerosol or contact transmission from environmental pollution caused by feces and urine.

4.3 Susceptible population

In terms of susceptible populations, all groups are generally susceptible to COVID-19 regardless of age or gender.

5 Pathological Changes

According to the current limited results of autopsy and pathological observation of punctured tissues, the findings are summarized as follows.

5.1 Lung

Lungs show varying degrees of consolidation.

Serous fluid, proteinaceous exudates and transparent membrane can be seen in the alveolar space. Exudative cells are mainly monocytes and macrophages, and multinucleated giant cells are easy to see. The alveolar type II epithelial cells proliferate significantly and some cells fall off.Inclusion bodies can be seen in alveolar type II epithelial cells and macrophages. Congestion and edema of alveolar septal vessels can be seen, with infiltration of monocytes and vascular thrombosis.Focal hemorrhage and necrosis of lung tissues may lead to hemorrhagic infarction. Part of alveolar exudate organize and pulmonary interstitial fibrosis occurs. Part of the epithelium of bronchial mucosa in the lung falls off, and mucus and mucus plugs are formed in the cavity. A few alveoli are overin flated, or their alveolar septum are broken, or cystic cavity is formed. Under electron microscope,coronavirus particles can be seen in the cytoplasm of bronchial mucosal epithelium and alveolar type II epithelial cells. Immunohistochemical staining for novel coronavirus antigen in some alveolar epithelium and macrophages is positive, and RTPCR detects Novel Coronavirus nucleic acid as positive.

5.2 Spleen, Hilar Lymph Nodes and Bone Marrow

The spleen is obviously shrunk. The number of lymphocytes decreases significantly. Focal hemorrhage and necrosis occur. Macrophages proliferation in spleen and phagocytosis can be seen.Lymphocytes number in lymph nodes are relatively less and necrosis happens. Immunohistochemical staining results showed that the counts of CD4 and CD8 T cells in spleen and lymph nodes are substantially reduced. The numbers of three primary types of bone marrow cells are also decreased.

5.3 Heart and Blood Vessels

Degeneration and necrosis in myocardial cells,and infiltration of a few monocytes, lymphocytes and/or neutrophils in stroma can be seen. Some vascular endothelium falls off. Intimal inflammation and thrombosis are present.

5.4 Liver and Gallbladder

Liver and Gallbladder are enlarged and dark red in color. Symptoms includes hepatocyte degeneration, focal necrosis with neutrophil infiltration; congestion of hepatic sinusoids,lymphocytes and monocytes in filtrated in portal area,and microthrombus. Gallbladder is highly filled.

5.5 Kidney

proteinaceous exudates can be seen in glomerular balloon cavity. Renal tubular epithelium degenerates and falls off and hyaline casts can be seen. Interstitial hyperemia occurs, and microthrombus and focal fibrosis can be seen.

5.6 Other Organs

Congestion and edema of brain tissue and degeneration of some neurons. Focal necrosis of adrenal gland. Varying degrees of degeneration,necrosis and falling-off of mucosal epithelium of esophagus, stomach and intestine.

6 Clinical Characteristics

6.1 Incubation time

Generally, within 3 to 7 days and up to 2 weeks. Fever, fatigue and dry cough are the main symptoms. A few patients suffer from nasal obstruction, nasal discharge, sore throat, myalgia,diarrhea and other symptoms. In mild cases, patients only underwent low-grade fever, slight fatigue and other symptoms but pneumonia. Severe patients mostly suffer from dyspnea and/or hypoxemia one week after onset. Critical patients can rapidly progress to the conditions of acute respiratory distress syndrome, septic shock, metabolic acidosis that is difficult to treat, coagulation disorders and multiple organ failure, etc. It is worth noting that severe and critical patients may have regular or lowgrade fever or even no obvious fever during the course of the disease. The symptoms in children and newborns may be atypical, which may include digestive tract symptoms such as vomiting and diarrhea or only showing mental weakness and shortness of breath.

6.2 Chest imaging characteristics

Multiple small patches and interstitial changes are present in the early stage, especially obvious in lung periphery, and then ground-glass opacity and infiltration opacity usually appear in both lungs. In severe cases, lung consolidation may occur, yet pleural effusion is rare.

6.3 laboratory tests

The total number of peripheral leukocytes is normal or decreased in the early stage of the disease, along with a decrease in lymphocyte count. Most patients have elevated C reactive protein, erythrocyte sedimentation rate, and normal procalcitonin. Some patients have increased liver enzyme, lactate dehydrogenase (LDH), muscle enzyme and myoglobin. In some critical cases,troponin is elevated. In severe cases, D-dimer increased and peripheral blood lymphocytes progressively decreased. Severe and critically ill patients had elevated in flammatory factors.

Nucleic acid of novel Coronavirus can be detected in nasopharyngeal swabs, sputum and other secretions of lower respiratory tract, as well as blood, feces, urine and other samples by RT-PCR or/and NGS methods. It is more accurate to detect the lower respiratory tract specimens (sputum or airway extracts) submitted for inspection as soon as possible after collection.

Under most circumstances, novel Coronavirusspecific IgM antibodies appears positive 3-5 days after the patients get ill, and the titer of IgG antibody in recovery period is 4 times or more higher compared to that of in acute period.

6.4 Prognosis

Based on the treated cases, most patients have good prognosis expect for a few critical patients.The prognosis of the elderly and those with chronic underlying diseases is poor. The clinical process of pregnant patients suffering from COVID-19 is similar to that of ordinary patients of the same age. The symptoms of infected children are relatively mild.

7 Cause and Mechanism in views of Traditional Chinese Medicine

According to the cl inical symptoms of COVID-19, the disease can belong to the category of "pestilence" in traditional Chinese medicine.The disease is caused by feeling the "epidemic pathogen". The disease is located in the lung, affects the spleen and stomach, reverses transmission to the pericardium and extends to the heart and kidney.The basic mechanism is the invasion of epidemic pathogen, de ficiency of healthy qi and lung infection.The mechanism is characterized by "dampness,heat, blood stasis, toxin and de ficiency".

This COVID-19 first found in Wuhan, which is located in the eastern part of Jianghan Plain and the middle reaches of the Yangtze River. It is close to the Yangtze River and the Han River and has a subtropical humid monsoon climate.Guangdong is located in the south of the Lingnan areas. Its climate is rainy and humid all yearround. The residents' constitution is characterized by spleen deficiency with dampness. At the turn of winter and spring, the climate is constantly changeable between cold and warm. The disease is caused by the epidemic pathogen together with wind-cold, dampness and heat enter from the nose and mouth, penetrates into the membrane source, assails the lung, whose functions are affected, thus causing fever and cough. If the epidemic pathogen stagnates in the stomach and intestines, it will affect the function of the spleen by which the essence is transformed from food and drink, absorbed, and distributed to all parts of the body, and cause qi movement stagnation,resulting in abdominal distension, poor appetite,vomiting, loose stool and even diarrhea. Epidemic pathogen stays in the body, heat congests the lung and invades the stomach, obstructs qi movement,which easily leads to chest distress and shortness of breath. It can even reverse transmission to the pericardium and loss of consciousness or delirious speech. If the prosperity epidemic pathogen is not expelled and damage to healthy qi. Symptoms include sweat ing and reversal cold of the extremities. If treated properly in time, the patients can get rid of dampness, heat, toxin and blood stasis, but still lose qi and yin, therefore may lead to low-grade fever, lack of qi and laziness, fatigue,dry mouth, poor appetite, loose stool, etc.

The disease is mainly characterized colddampness and dampness-heat at the beginning.As the disease progresses, dampness, heat,toxin and blood stasis will further aggravate the disease, with excess syndrome as the main factor.If the epidemic pathogen cannot be expelled, the pathogenic toxin will flourish and healthy qi will decline, and the disease will be based on true deficiency with false excess. During the recovery period, due to the dissipation of qi and yin by epidemic pathogen, patients' body conditions can be weak. Those who are old or weak, or those whose heat are hidden heat in the lungs and stomachs, are easily inward invasion of epidemic pathogen. The epidemic pathogen spreads rapidly, and develops into deteriorated and severe cases, resulting in dangerous symptoms.

8 Diagnosis

8.1 Suspected cases

Combined with the following epidemiological history and clinical manifestations, a comprehensive analysis has been made.

8.1. 1 Epidemiological history

(1) Travel history or residence history of Wuhan City and its surrounding areas or other communities with reported case within 14 days before the onset of the disease.

(2) Contact history with Novel Coronavirus infected persons (positive for nucleic acid test) within 14 days before onset of the disease.

(3) Exposure to patients with fever or respiratory symptoms from Wuhan City and its surrounding areas or from communities with reported case within 14 days before the onset of the disease.

(4) Clustering outbreak (Within 2 weeks, 2 or more cases of fever and/or respiratory symptoms occur in small areas such as home, of fices, school classes, etc.)

8.1. 2 Clinical Manifestations

(1) Fever and/or dry cough, nasal obstruction,nasal discharge, sore throat and other respiratory symptoms;

(2) With the fore mentioned imaging features of the COVID-19;

(3) In the early stage of the disease, the counts of white blood cells and the lymphocyte are normal or decreased.

If individual with epidemiological history and has any two of the clinical manifestations, or has no epidemiological history but three of the clinical manifestations, he/she should be treated as a suspected case.

8.2 Con firmed Cases

8.2.1 Suspected cases with one of the following etiological or serological evidences:

(1) Positive for Real-time RT-PCR detection of Novel Coronavirus nucleic acid.

(2) Highly viral gene homologous to the Novel Coronavirus by sequencing.

(3) Positive for serum Novel Coronavirusspecific IgM antibody and IgG antibody; Serum Novel Coronavirus-specific IgG antibody changes from negative to positive or increases 4 times or more in convalescence than in acute phase.

8.2. 2 Clinical Classi fication

(1) Mild Case

With mild clinical symptoms and no signs of pneumonia imaging

(2) Common Case

Fever, respiratory tract abnormality and other symptoms, and visible signs of pneumonia imaging.

(3) Severe Case

The adult meets any of the following:

Based on pulmonary imaging, if the progression rate of the disease reaches more than 50% within 24-48 hours, the person will be treated as severe case.

The child meets any of the following:

① Shortness of breath (< 2 months old, RR60 times/min; 2-12 months old, RR50 times/min;1-5 years old, RR40 times/min; > 5 years old,RR30 times/min). Exclude the effects of external heat and crying; ② In the resting state, oxygen saturation92%; ③ Assisted respiration (moaning,flaring alae nasi, three depressions sign), cyanosis,intermittent apnea; ④ Hypersomnia and convulsion occur; ⑤ Resisting food or difficult to feed, with signs of dehydration.

(4) Critical Case

Patient meets one of the following:

① Respiratory failure occurs and requires mechanical ventilation; ② Shock; ③ Other organs failures and requires ICU monitoring and treatment.

8.2. 3 Clinical Early Warning Indicators for Severe

and Critical Patients

(1) Adults

① Progressive decline of peripheral blood lymphocytes; ② Progressive increase of peripheral blood inflammatory factors such as IL-6 and C-reactive protein; ③ Progressive increase of lactic acid; ④ Rapid progress of pulmonary lesion in a short period of time.

(2) Children

① Rapid increase of respiratory rate; ② Poor mental response and hypersomnia; ③ Progressive increase of lactic acid; ④ Bilateral or multiple pulmonary lobe infiltration, pleural effusion or rapid progression of lesions in a short period of time by imaging. ⑤ Infants under 3 months old or children with basic diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory tract malformation, abnormal hemoglobin, severe malnutrition, etc.), or with immunodeficiency or hypoimmunity (long-term use of immunosuppressive agents).

9 Differential Diagnosis

9.1 Mild manifestations of Novel Coronavirus infection should be distinguished from upper respiratory tract infection caused by other viruses.

9.2 COVID-19 should be distinguished from other known viral pneumonia and Mycoplasma pneumoniae infection such as those caused by influenza virus, adenovirus, respiratory syncytial virus. In particular, suspected cases should be detected by methods including rapid antigen detection and multiplex PCR nucleic acid test to identify common respiratory pathogens.

9.3 The Pneumoniae should also be differentiated from non-infectious diseases, such as vasculitis, dermatomyositis and organized pneumonia.

10 The Discovery and Reporting of Infected Cases

Once found by medical personnel of all levels and types of medical institutions, suspected patients should be immediately quarantined for treatment.Consultation of in-hospital experts or doctors in charge should be carried out immediately. Patients should still be considered as suspected cases and their conditions should be directly reported online within 2 hours. Specimens should be collected for Novel Coronavirus nucleic acid test. Meanwhile under the premise of ensuring the safety of transfer,suspected subjects should be transferred to designated hospitals immediately. For those who have close contact with Novel Coronavirus infected person, even if positive for the common respiratory tract pathogens, it is highly recommended to perform Novel Coronavirus etiological tests in a timely manner.

Suspected cases which are negative for Novel Coronavirus nucleic acid tests twice in a row(sampling time interval is at least 24 hours) and Novel Coronavirus-specific antibodies IgM and IgG are still negative 7 days after the onset of the disease, can be ruled out for tests.

11 Prevention and Treatment with Traditional Chinese and Western Medicine

The prevention and treatment with traditional Chinese medicine (TCM) shall be based on the following schemes and shall be used under the guidance of TCM doctors. In the treatment of critically ill patients, it can be reasonably used according to the actual situation of the patients.

11.1 Preventive strategies

11.1.1 Lifestyle modif i cation

Adapt to climate change and adjust clothes and quilts in time to avoid wind chill. Keep the living and working environment clean and tidy, and live in a place with air circulation, sufficient sunshine and proper temperature. Try to remain indoors, cancel gatherings, wear masks (preferably medical masks)when going out, and wash hands regularly before the meals, after going out and using the toilet. The diet should be light, regular, nutritious and full of fruits and vegetables. Do not eat pungent or spicy food. Ceases smoking, limits alcohol, drinks water frequently. Work and rest regularly, and do not stay up late. Keep in good moods. Have more physical exercise. Uses traditional health care methods such as Taijiquan, Wuqinxi, Baduanjin and various exercises according to his/her own ability.

11.1.2 Prevention with TCM

Adjust the excessiveness or decline of qi,blood, yin and yang in the Viscera and Bowels of the human body, so that the yin and yang reach a balanced state. Healthy qi is stored in the body,and pathogenic factors cannot prevail. According to the body constituents of residents in Lingnan area, which are spleen deficiency with dampness,the prevention of this disease lies in fortifying the spleen to dispel dampness, tonifying qi to secure the exterior, and eliminating the pathogenic factors of wind, cold, damp, heat and other pathogens in time. The medication should be suitable in nature of medicinal.

(1) Oral TCM prescription

① For people who are usually lack of strength,profuse sweating, and easy to catch a cold

Treatment: fortifying the spleen, replenish qi and secure the exterior

Prescription:Astragali Radix Praeparata Cum Melle(Zhi Huang Qi) 15 g,Atractylodis Mac rocephalae Rhi zoma(Bai Zhu) 20 g,Saposhnikoviae Radix(Fang Feng) 10 g,Poria(Fu Ling) 20 g,Lonicerae Japonicae Flos(Jin Yin Hua)10 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 5 g,Pseudostellaria Radix(Tai zi shen) 10 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

② For people who are usually aversion to wind and heavy body, and who are prone to catch common cold, with headache and generalized pain as the main symptoms.

Treatment: dispelling wind and securing the exterior, dissipating cold and eliminating dampness

Prescription:Fici Simplicissimae Radix(Wu Zhi Mao Tao) 15 g,Atractylodis Macrocephalae Rhizoma(Bai Zhu) 20 g,Saposhnikoviae Radix(Fang Feng) 10 g,Poria(Fu Ling) 10 g,Chuanxiong Rhizoma(Chuan Xiong)10 g,Aurantii Fructus(Zhi Qiao) 10 g,Notopterygii Rhizoma Et Radix(Qiang Huo) 10 g,Platycodonis Radix(Ji Geng) 10 g,Schizonepetae Herba(Jing Jie) 10 g,Lonicerae Japonicae Flos(Jin Yin Hua) 10 g,Glycyrrhizae Radix Et Rhi zoma(Sheng Gan Cao) 5 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

③ Subjects with abdominal distension and sticky stool

Treatment: securing the exterior and resolving dampness, regulating qi and harmonizing the spleen and stomach

Prescription:Astragali Radix Praeparata Cum Melle(Zhi Huang Qi) 15 g,Atractylodis Macrocephalae Rhizoma(stir-baked) (Chao Bai Zhu) 15 g,Saposhnikoviae Radix(Fang Feng)10 g,Pogostemonis Herba(Huo Xiang) 10 g (put in later),Atractylodis Rhizoma(Cang Zhu) 10 g,Poria(Fu Ling) 10 g,Citri Reticulatae Pericarpium(Chen Pi) 10 g,Magnoliae Officinalis Cortex(Hou Po) 10 g,Massa Medicata Fermentata(Shen Qu) 10 g,Perillae Caulis(Su Geng) 10 g,Fici Simplicissimae Radix(Wu Zhi Mao Tao) 15 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

④ For people with dry mouth, bitter taste and sore throat

Treatment: Regulating qi and securing the exterior, heat-clearing and detoxicating

Prescription:Saposhnikoviae Radix(Fang Feng)10 g,Lonicerae Japonicae Flos(Jin Yin Hua) 10 g,Forsythiae Fructus(Lian Qiao) 10 g,Scutellariae Radix(Huang Qin) 10 g,Citri Sarcodactylis Fructus(Fo Shou) 10 g,Eupatorii Herba(Pei Lan) 10 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao)5 g,Fici Simplicissimae Radix(Wu Zhi Mao Tao) 15 g,Atractylodis Macrocephalae Rhizoma(Bai Zhu) 15 g,Arctii Fructus(Niu Bang Zi) 15 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Usage: 1 dose per day, boiled with 400ml, and take twice a day, in the morning and in the evening,respectively.

(2) Medicinal Diet Prescription

Prescription:Imperatae Rhizoma(Bai Mao Gen) 15 g,Poria(Fu Ling) 10 g,Citri Reticulatae Pericarpium(Chen Pi) 10 g,Lablab Semen Album(Bian Dou) 20 g,Dioscoreae Rhizoma(Shan Yao)20 g,Fici Simplicissimae Radix(Wu Zhi Mao Tao)30 g,Pseudostellaria Radix(Tai Zi Shen)10 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Ef ficacy: securing the exterior and harmonizing the body, resolving turbidity and detoxicating

Usage: Proper amount of lean meat stew, 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening,respectively.

(3) Prescription of Externally-used Sachets

Prescription:Atractylodis Rhizoma(Cang Zhu) 20 g,Chuanxiong Rhizoma(Chuan Xiong)15 g,Angelicae Dahuricae Radix(Bai Zhi) 15 g,Artemisiae Argyi Folium(Ai Ye) 20 g,Pogostemonis Herba(Huo Xiang) 15 g,Eupatorii Herba(Pei Lan)15 g,Menthae Haplocalycis Herba(Bo He) 5 g,Santali Albi Lignum(Tan Xiang) 10 g.

Efficacy: The aromatic qi of TCM has the functions of dispelling filth with aroma, resolving turbidity, enlivening the spleen, unblock the meridian and activating collaterals, tranquilizing and opening the ori fices.

Usage: Wear the sachets made of powdered TCM.

(4) Acupoint Heal th Care and Disease Prevention

Selection of Acupoints: Zusanli (ST36),Qihai(RN6), Guanyuan(RN4) and other health-care acupoints

Methods: Methods such as moxibustion,massage, and acupoint application can enhance the healthy qi of human body to achieve the purpose of preventing and eliminating diseases.

11.2 Treatment of Suspected Cases

Treatment place: Suspected cases should be treated in a single ward of the designated hospital with effective isolation and protection conditions.

11.2.1 General Treatment

(1) Proper rest in bed accompanied by general supportive treatment. Monitoring vital signs, finger oxygen saturation, etc.

(2) Appropriate oxygen therapy through nasal catheter.

11.2.2 TCM Treatment Based on Syndrome Differentiation

(1) Clinical manifestations: lack of strength accompanied by nausea, torpid intake, abdominal distension, diarrhea and other gastrointestinal discomfort.

Treatment: release the exterior and resolving dampness, regulating qi and harmonizing the spleen and stomach

Prescription:Pogostemonis Herba(Huo Xiang)20 g (put in later),Atractylodis Rhizoma(Cang Zhu)10 g,Eupatorii Herba(Pei Lan) 10 g,Perillae Folium(Zi Su) 10 g,Poria(Fu Ling) 10 g,Citri Reticulatae Pericarpium(Chen Pi) 10 g,Magnoliae Officinalis Cortex(Hou Po) 10 g,Scutellariae Radix(Huang Qin) 10 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 5 g,Atractylodis Macrocephalae Rhizoma(Bai Zhu) 15 g,Bambusae Caulis In Taenias(processed with ginger) (Jiang Zhu Ru) 15 g.

Usage: 1 dose per day, boiled with 400ml water, divided into two pieces, one in the morning and one in the evening.

(2) Clinical manifestations: lack of strength with fever.

Treatment: dispelling wind and eliminating dampness, heat-clearing and detoxicating

Prescription:Lonicerae Japonicae Flos(Jin Yin Hua) 15 g,Forsythiae Fructus(Lian Qiao) 10 g,Scutellariae Radix(Huang Qin) 10 g,Atractylodis Rhizoma(Cang Zhu) 10 g,Eupatorii Herba(Pei Lan) 10 g,Ephedrae Herba(Sheng Ma Huang)5 g,Artemisiae Annuae Herba(Qing Hao) 10 g (put in later),Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 5 g,Arctii Fructus(Niu Bang Zi) 15 g,Fici Simplicissimae Radix(Wu Zhi Mao Tao) 15 g,Fritillariae Thunbergii Bulbus( Zhe Bei Mu) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

11.3 Treatment for Con firmed Cases

Treatment Place: Confirmed cases should be treated in a designated hospital with effective isolation and protection conditions, and multiple people can be treated in the same ward. Critical cases should be transferred to ICU for treatment as soon as possible.

11.3.1 Mild Cases

(1) Common Treatment

① Proper rest in bed accompanied by general supportive treatment. Monitoring vital signs, finger oxygen saturation, etc.

② Appropriate oxygen therapy through nasal catheter.

(2) TCM Treatment Based on syndrome differentiation as follows:

① Syndrome of wind-cold with dampness Clinical manifestations: low-grade fever or no fever,aversion to cold, the whole bodyaching, heavy head and fatigue, absence of sweating, nasal congestion and deep turbid voice, nasal discharge snivel, itchy throat, pale mouth without thirst, mild cough, chest distress, nausea, torpid intake, rotten or normal stool. Pale red tongue, white and thick or slimy fur.The pulse is floating and tight or soggy.

Treatment: dispelling wind and releasing the exterior, diffusing the lung and dissipating cold

Prescription: Modi fied Jingfangbaidu Powder

Schizonepetae Herba(Jing Jie) 10 g,Saposhnikoviae Radix(Fang Feng) 10 g,Bupleuri Radix(Chai Hu) 10 g,Notopterygii Rhizoma Et Radix(Qiang Huo) 10 g,Angelicae Pubescentis Radix(Du Huo) 10 g,Aurantii Fructus(Zhi Qiao)10 g,Glycyrrhizae Radix Et Rhizoma(Gan Cao) 10 g,Ephedrae Herba(Sheng Ma Huang)10 g,Atractylodis Rhizoma(Cang Zhu) 15 g,Pogostemonis Herba(Guang Huo Xiang) 15 g (put in later),Perillae Folium(Zi Su Ye) 10 g,Forsythiae Fructus(lian qiao) 10 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

② Syndrome of wind-heat with dampness

Clinical manifestations: fever, slight aversion to wind-cold, unsmooth sweating, headache, nasal congestion, turbid nasal discharge, dry mouth and thirst, dry, itchy and pain throat, dry cough, few phlegm, heavy head and fatigue, chest distress,nausea, poor appetite, reddish urine, rotten or sticky stool. Red tongue, yellow and thick or yellow and slimy fur, and the pulse is floating and slippery pulse.

Treatment: dispersing wind and releasing the exterior, heat-clearing and diffusing lung

Prescription: Yinqiao Powder and Sanao Decoction

Lonicerae Japonicae Flos(Jin Yin Hua)15 g,Forsythiae Fructus(Lian Qiao) 10 g,Ephedrae Herba(processed with honey) (Zhi Ma Huang)10 g,Magnoliae Officinalis Cortex(Hou Po)20 g,Armeniacae Semen Amarum(Xing Ren) 15 g,Eriobotryae Folium(Pi Pa Ye) 10 g,Arctium lappa L. (Niu Bang Zi) 15 g,Osmundae Rhizoma(Guan Zhong)15 g,Platycodonis Radix(Ji Geng) 10 g,Pogostemonis Herba(Huo Xiang) 10 g (put in later),Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao)10 g,Citri Reticulatae Pericarpium(Chen Pi) 10 g,Asteris Radix Et Rhizoma(Zi Wan) 10 g,Bambusae Caulis In Taenias(processed with ginger) (Jiang Zhu Ru) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

11.3.2 Common Cases

(1) Common Treatment

① Rest in bed, st rengthen suppor t ive treatment, ensure sufficient energy intake; Keep the balance of water and electrolyte to maintain the stability of the internal environment; closely monitor vital signs, finger oxygen saturation, etc.

② According to the disease condition, perform blood routine examination, urine routine examination,CRP, biochemical indexes (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function,arterial blood gas analysis, chest imaging, and so on. Cytokine examination can be done if possible.

③ Provide suf ficient oxygen therapy including nasal catheter, mask oxygen supply and nasal high-flow oxygen therapy. When conditions permit,mixed inhalation of hydrogen and oxygen (H2/O2:66.6%/33.3%) can be used for treatment.

(2) Treatment based on syndrome differentiation of TCM.

① Syndrome of epidemic pathogen accumulate in lung and stomach

Clinical manifestations: fever, with or without aversion to cold, unsurfaced fever, lack of strength,the whole bodyaching, cough, expectoration,oppression in the chest, suffocation, torpid intake,nausea, vomiting, and sticky stool. The tongue is pale, its coating white and thick or white and slimy,and the pulse is soggy or slippery.

Treatment: resolving turbidity and harmonizing the body, diffuse the lung to suppress cough

Prescription: Huopo Xialing Decoction and Sanao Decoction

Pogostemonis Herba(Huo Xiang) 15 g (put in later),Magnoliae Of ficinalis Cortex(Hou Po) 10 g,Poria(Fu Ling) 15 g,Coicis Semen(Yi Yi Ren) 20 g,Amomi Fructus Rotundus(Bai Kou Ren) 10 g,Polyporus(Zhu Ling) 15 g,Alismatis Rhizoma(Ze Xie) 10 g,Aurantii Fructus(Zhi Qiao) 10 g,Scutellariae Radix(Huang Qin) 10 g,Ephedrae Herba(Sheng Ma Huang) 6 g,Armeniacae Semen Amarum(Xing Ren) 10 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 5 g,Zingiberis Rhizoma Recens(Sheng Jiang) 10 g,Bambusae Caulis In Taenias(processed with ginger) (Jiang Zhu Ru)15 g,Artemisiae Annuae Herba(Qing Hao)15g (put in later).

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

② Syndrome of Dampness- -heat depression of lung

Clinical manifestations: fever, or unsurfaced fever, lingering heat, little and unsmooth sweating,oppression in the chest and shortness of breath, or cough and dyspnea, dry and bitter mouth, lack of strength and fatigue, poor appetite, unsmooth stool,reddish urine, red tongue, yellow thick or yellow thick greasy slimy fur, slippery and rapid pulse.

Treatment: heat-clearing and dispel dampness,diffuse the lung to calm panting

Prescription: Ma Xing Shi Gan Decoction and Da Yuan Yin

Ephedrae Herba(processed with honey) (Zhi Ma Huang) 10 g,Gypsum Fibrosum(Sheng Shi Gao)20 g,Armeniacae Semen Amarum(Ku Xing Ren)10 g,Coicis Semen(Yi Yi Ren) 30 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 6 g,Arecae Semen(Bing Lang) 10 g,Tsaoko Fructus(Cao Guo)10 g,Magnoliae OfficinalisCortex (Hou Po) 10 g,Anemarrhenae Rhizoma(Zhi Mu) 10 g,Scutellariae Radix(Huang Qin) 10 g,Phragmitis Rhizoma(Lu Gen) 30 g,Trichosanthis Pericarpium(Gua Lou Pi)10 g,Mori Cortex(Sang Bai Pi) 10 g,Ganoderma(Bao Gai Ling Zhi) 15 g,Houttuyniae Herba(Yu Xing Cao) 15 g,Artemisiae Annuae Herba(Qing Hao) 15 g (put in later).

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

(3) Antiviral therapy:

① α-interferon: 5 million U or equivalent dose (unit conversion: 10 g = 1 million IU, 50 g = 5 million IU) for adults, added 2ml of sterilized saline,inhalation twice per day.

② Lopinavir(200mg/tablet)/ritonavir(50mg/tablet):2 tablets each time, twice per day, with a course of treatment no more than 10 days. Attention should be paid to the adverse reactions such as diarrhea,nausea, vomiting, liver function damage and the interaction with other drugs. At present, the clinical effectiveness of lopinavir/ritonavir in the treatment of COVID-19 remains to be confirmed and should be closely monitored during the treatment.

③ Chloroquine phosphate: suitable for COVID-19 patients aged between 18 to 65. The dosage for individuals with body weight of 50kg or more is 500mg each time, twice per day, and the course of treatment is 7 days. Those who weigh 50kg or less should take 500mg/time, twice per day,for the first two days and then keep 500mg/day for the rest of days of 7-day treatment course. Normal electrocardiogram is necessary before taking this medicine. It is forbidden to use quinolones,macrolide antibiotics and other drugs that may lead to QT interval prolongation at the same time.Meanwhile, ensure normal levels of the electrolytes(potassium, sodium, chlorine) and blood glucose,liver and kidney functions in patients.

④ Abidol: for adults, 200mg/time, 3 times per day, no more than 10 days. At present, the effectiveness of Abidol for COVID-19 treatment remains to be confirmed and should be closely monitored during the treatment.

⑤ Ribavirin: It is recommended to use it in combination with interferon or lopinavir/ritonavir,500mg/time for adults, intravenous infusion 2 to 3 times per day, and the course of treatment should be no more than 10 days.

It is not recommended to use three or more antiviral drugs simultaneously, and relevant drugs should be stopped when intolerable side effects occur. At present, the ef ficacy of antiviral drugs still needs to be further evaluated in clinical application.

(4) Ant ibac ter ial drug therapy: Avoid unselective or inappropriate administration of antibiotics, especially the combined use of broadspectrum antibiotics.

11.3.3 Severe and Critical Cases

On the basis of symptomatic treatment and antiviral treatment, actively prevent and treat complications, treat basic diseases, prevent secondary infection, timely support organ function,and cooperate with TCM treatment.

(1) Respiratory support:

① Oxygen therapy: Severe patients should receive treatment of nasal catheter or mask oxygen inhalation, and should be timely evaluated whether respiratory distress and/or hypoxemia are relieved.

② High-flow nasal catheter oxygen therapy or non-invasive mechanical ventilation: when respiratory distress and/or hypoxemia cannot be relieved after receiving standard oxygen therapy,high-flow nasal catheter oxygen therapy or noninvasive ventilation may be considered. If the condition does not improve or even deteriorate within a short period of time (1-2 hours), tracheal intubation and invasive mechanical ventilation should be carried out in time.

③ Invasive mechanical ventilation: lung protective ventilation strategy is adopted, i.e. low tidal volume (4-8ml/kg ideal body weight) and lowlevel airway plateau pressure (plateau pressure< 30cmH2O) for mechanical ventilation to reduce ventilator-related lung injury. When the airway plateau pressure is equal to 35cmH2O or less, high PEEP can be appropriately adopted to keep the airway warm and humidified. Long-term sedation should be avoided. Medical staff should wake up patients early and carry out lung rehabilitation treatment. Some patients have man-machine asynchrony, and sedation and muscle relaxants should be used in time. According to the situation of airway secretions, closed sputum suction is selected,and bronchoscopy is performed if necessary.

④ Rescue treatment: For patients with severe ARDS, lung dilation is recommended. Under the condition of sufficient human resources, prone position ventilation should be carried out for more than 12 hours every day. For those with poor ventilation effect in prone position, extracorporeal membrane oxygenat ion (ECMO) should be considered as soon as possible if conditions permit.Relevant indicators: 1) when FiO2> 90% and the oxygenation index is less than 80mmHg, the treatment should last for more than 3-4 hours; 2)when the airway plateau pressure is35 cmH2O,VV-ECMO mode is preferred to treat patients with simple respiratory failure. If circulation support is needed, VA-ECMO mode is selected. Withdrawal test can be started when the basic disease is under control and the cardiopulmonary function shows signs of recovery.

(2) Cycle support: On the basis of sufficient fluid resuscitation, improve microcirculation, use vasoactive drugs, closely monitor the changes of blood pressure, heart rate and urine volume of patients, as well as lactic acid and alkali surplus in arterial blood gas analysis, and carry out noninvasive or invasive hemodynamic monitoring when necessary, such as ultrasonic Doppler method,echocardiography, invasive blood pressure or continuous cardiac output (PiCCO) monitoring.In the process of treatment, pay attention to the liquid balance strategy to avoid excessiveness and insuf ficiency. If it is found that the sudden increase of heart rate of the patient is more than 20% of the basic index or the blood pressure drops by more than 20% of the basic index, and if accompanied by skin perfusion insufficiency and urine volume reduction, the patient should be closely observed for septic shock, gastrointestinal hemorrhage or heart failure.

(3) Renal failure and renal replacement therapy. The causes of renal injury and dysfunction in severe patients should be monitored and figured out, such as hypoperfusion and drugs. The treatment of renal failure patients should focus on body fluid balance, acid-base balance and electrolyte balance. For nutrition supportive treatment, pay more attention to the supplement of nitrogen as well as intake of calory and trace elements. Continuous renal replacement therapy (CRRT) can be selected for severe patients. The indications include: ①hyperkalemia; ② acidosis; ③ Pulmonary edema or overload of water; ④ Fluid management during multiple organ insuf ficiency.

(4) Therapy using the plasma of recovered patients: suitable for severe and critical patients or those whose conditions progress rapidly. The usage and dosage can refer toClinical Treatment Plan of COVID-19 by Plasma of Recovered Patients(Trial Version II).

(5) Blood purification treatment: The blood purification system includes plasma exchange,adsorption, perfusion, blood/plasma filtration, etc. It can remove in flammatory factors and block "cytokine storm", thus reducing the damage of inflammatory reaction to the body. The method can be used to treat severe and critical patients in the early and middle stages of cytokine storm.

(6) Immunotherapy: Tozumab can be used for patients with extensive diseases of bilateral lung and severe patients, and for patients with elevated IL-6 level. The first dose is 4-8mg/kg, while the recommended dose is 400mg, diluted with 0.9%normal saline to 100ml, and the infusion time should be longer than 1 hour. If the effect of the first medication is not good, another infusion can be added after 12 hours (Same dosage as before).The infusion can be used up to twice, and the maximum single dose should not exceed 800 mg.Pay attention to anaphylaxis. It is forbidden for those with active infection such as tuberculosis.

(7) Other Treatment Measures

① For patients with progressive deterioration of oxygenation index, rapid imaging progress and over-activation of inflammatory reaction,glucocorticoid should be used in a short period of time (3-5 days), and the recommended dose should not exceed 1-2mg/kg/day equivalent to the dosage of methylprednisolone. It should be noted that relatively large doses of glucocorticoid will delay the clearance of coronavirus due to immunosuppression. Patients can be treated with large dose of vitamin C (3-6g) to treat oxidative stress and inflammation. Patients can be given Xuebijing 100ml/time through intravenous injection,twice per day; intestinal microecological regulators can be used to maintain intestinal microecological balance and prevent secondary bacterial infection.For severe patients with high in flammatory reaction,in vitro blood purification technologies such as plasma exchange, adsorption, perfusion, blood/plasma filtration, etc. can be considered when conditions permit.

② Children in severe and critical cases can be given intravenous drip of gamma globulin. Pregnant patients in severe or critical COVID-19 cases should actively terminate pregnancy, with caesarean as the first choice.

③ Psychological counseling should be provided for patients with anxiety and fear.

(8) TCM treatment based on syndrome differentiation

① Syndrome of epidemic pathogen blocking the lung

Clinical manifestations: lasting body heat or low-grade fever, mild in the morning and severe in the evening, or no fever, shortness of breath,dyspnea, oppression in the chest and agitation,cough, little phlegm, thirst with no desire to drink,accompanied by poor appetite, limb tiredness,yellow and reddish urine, dry stool, red tongue,yellow and slimy fur, and slippery and rapid pulse.

Treatment: regulate bowel and discharge heat,purging the lung to calm panting

Prescription: Maxing Shigan Decoction and Xuanbai Chengqi Decoction

Ephedrae Herba(processed with honey) (Zhi Ma Huang) 10 g,Armeniacae Semen Amarum(Ku Xing Ren) 15 g,Gypsum Fibrosum(Sheng Shi Gao)30 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 5 g,Rhei Radix Et Rhizoma(Sheng Da Huang)10 g,Trichosanthis Fructus(Quan Gua Lou) 15 g,Mori Cortex(Sang Bai Pi) 10 g,Scutellariae Radix(Huang Qin) 15 g,Scrophulariae Radix(Xuan Shen)10 g,Magnoliae OfficinalisCortex (Hou Po) 15 g,Aurantii Fructus(Zhi Qiao) 10 g,Citri Sarcodactylis Fructus(Fo Shou) 10 g,Arecae Semen(Bing Lang)20 g,Descurainiae Semenlepidii Semen(Ting Li Zi)10 g,Salviae Miltiorrhizae Radix Et Rhizoma(Dan Shen) 15 g,Artemisiae Annuae Herba(Qing Hao)10 g (put in later).

Usage: 1 dose per day, boiled with 400ml water, 100-200ml each time, 2-4 times per day, oral or nasal feeding.

② Syndrome of blazing of both qi and nutrient Clinical manifestations: hot, agitation, dyspnea,mental confusion or loss of consciousness and delirious speech, macula, hematemesis, epistaxis,limb convulsions, crimson tongue with little or no fur, deep and thin pulse, or floating, large and rapid pulse.

Treatment: heat-clearing and purging fire,cooling blood to detoxify

Prescription: Qingwen Baidu Decoction

Gypsum Fibrosum(Sheng Shi Gao) 30 g,Anemarrhenae Rhizoma(Zhi Mu) 30 g,Rehmanniae Radix(Sheng Di) 30 g,Bubali Cornu(Shui Niu Jiao)30 g (stir-fried beforehand),Paeoniae Radix Rubra(Chi Shao) 30 g,Scrophulariae Radix(Xuan Shen)30 g,Forsythiae Fructus(Lian Qiao) 15 g,Moutan Cortex(Dan Pi) 15 g,Coptidis Rhizoma(Huang Lian)6 g,Lophatheri Herba(Zhu Ye) 12 g,Descurainiae Semenlepidii Semen(Ting Li Zi) 15 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 6 g,Callicarpae Caulis et Folium(Zi Zhu Cao) 15g.

Usage: 1 dose per day, boiled with 400ml water, 100-200ml each time, 2-4 times per day, oral or nasal feeding.

③ Syndrome of internal block and external collapse

Clinical manifestations: dyspnea, frequent panting or requiring mechanical ventilation,accompanied by dizziness, agitation, cold limbs with sweating, purple and dark tongue, thick and slimy or dry fur, floating pulse without roots.

Treatment: Open and close, fix and remove,detoxifying and rescuing patient from collapse.

Prescription:Ginseng Radix Et Rhizoma(Ren Shen) 15 g,Radix Aconiti Lateralis Radix Preparata(Hei Shun Pian) 10 g (roasted first),Corni Fructus(Shan Zhu Yu) 15 g, accompanied with Suhe Xiang Pills or Angong Niuhuang Pills.

Usage: 1 dose per day, boiled with 400ml water, 100-200ml each time, 2-4 times per day, oral or nasal feeding.

11.3.4 Recovery period

After treatment, as the symptoms of patients are improved, gradually reduce the treatment of invasive ventilator, non-invasive ventilator, high flow oxygen therapy, mask oxygen inhalation, nasal catheter oxygen inhalation as well as the antiviral drugs and other supportive treatments. Meanwhile strengthen TCM treatment, as follows:

① Syndrome of qi de ficiency of the lung-spleen

Clinical manifestations: shortness of breath,lack of strength and fatigue, body heat has subsided,or low-grade fever, oppression in the chest,abdominal distension, anorexia, weak or sticky stool,pale and dark tongue, white and slimy fur, and thin and rapid pulse.

Treatment: reinforce the healthy qi and eliminate the pathogenic factors, replenish qi and fortify the spleen

Prescription: Shenling Baizhu Powder

Pseudostellaria Radix(Tai Zi Shen) 30 g,Fici Simplicissimae Radix(Wu Zhi Mao Tao) 30 g,Poria(Fu Ling) 15 g,Atractylodis Macrocephalae Rhizoma(stir-baked) (Chao Bai Zhu) 20 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao)5 g,Citri Reticulatae Pericarpium(Chen Pi) 10 g,Amomi Fructus(Sha Ren) 10 g (put in later),Coicis Semen(Yi Yi Ren) 30 g,Phragmitis Rhizoma(Wei Jing) 15 g,Hedyotidis Diffusae Herba(Bai Hua She She Cao) 10 g,Artemisiae Scopariae Herba(Yin Chen) 10 g,Massa Medicata Fermentata(Shen Qu) 10 g,Salviae Miltiorrhizae Radix Et Rhizoma(Dan Shen) 15 g,Ganoderma(Bao Gai Ling Zhi)15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

② Syndrome of lung heat and fluid depletion

Clinical manifestations: lack of strength,shortness of breath, body heat has subsided, or lowg-rade fever, dry and bitter mouth, dry cough,little phlegm, torpid intake, red tongue and little fur,and thin and rapid pulse.

Treatment: reinforce the healthy qi and eliminate the pathogenic factors and invigorating lung-stomach

Prescription: Shengmai Decoction, Shashen Maidong Decoction and Yupingfeng Powder

Glehniae Radix(Sha Shen) 15 g,Polygonati Odorati Rhizoma(Yu Zhu) 10 g,Glycyrrhizae Radix Et Rhizoma(Sheng Gan Cao) 5 g,Mori Folium(Sang Ye) 10 g,Ophiopogonis Radix(Mai Dong)15 g,Lablab Semen Album(Bai Bian Dou) 10 g,Atractylodis Macrocephalae Rhizoma(stir-baked)(Chao Bai Zhu) 10 g,Rehmanniae Radix(Sheng Di) 20 g,Panacis Quinquefolii Radix(Xi Yang Shen) 10 g,Fici Simplicissimae Radix(Wu Zhi Mao Tao) 30 g,Dendrobii Caulis(Shi Hu) 20 g,Ganoderma(Bao Gai Ling Zhi) 15 g.

Usage: 1 dose per day, boiled with 400ml water, and take twice a day, in the morning and in the evening, respectively.

11.3.5 Rehabilitation

(1) Carry out early intervention of pulmonary function recovery during the rehabilitation of patients, exercise their respiratory function and properly exercise their physical fitness, such as Taijiquan, Baduanjin and physical exercise.

① respiratory function exercise: including the adjustment of breathing rhythm (inspiration:exhalation=1:2), abdominal breathing training,pursed-lip breathing training and so on. According to the patient's physical condition, the patient can also perform neck flexion and extension, chest expansion, turning, waist rotation, side quarters,squatting, leg lifting, leg opening, ankle pump and other respiratory rehabilitation exercises.

② Tai chi: once per day; 30 to 50 minutes each time. (recommended)

③ Baduanjin: 10-15 minutes each time, 1-2 times per day. Patients should exercise according to individual physical conditions and bearing capacities.(recommended)

④ sports: patient can step, fast walk, jog, swim,etc., 20-30 min/time, 3-5 times/week. Use sandbags,dumbbells, elastic bands or bottled water for progressive resistance training, 15-20 movements in each group, 1-2 groups/day, 3-5 days /week.

⑤ The above activities should be tried step by step from low intensity. The intensity of exercise should not make people fatigue on the second day after exercise. For patients who are prone to fatigue,intermittent exercise can be used, and combine exercise with rest. The above activities should start from low intensity, step by step, and take the exercise intensity that does not appear fatigue on the second day after exercise as appropriate.For patients who are prone to fatigue, intermittent exercise can be used. Remember to strike a balance between work and rest always.

(2) According to the actual situation, patients can continue to take convalescent TCM prescriptions or take preventive prescriptions.

(3) Perform medicated diet therapy, and recommended herbs are:Dioscoreae Rhizoma(Shan Yao),Citri Reticulatae Pericarpium(Chen Pi),Astragali Radix(Huang Qi),Poria(Fu Ling),Lablab Semen Album(Bai Bian Dou),Codonopsis Radix(Dang Shen),Pseudostellaria Radix(Tai Zi Shen),Fici Simplicissimae Radix(Wu Zhi Mao Tao),Coicis Semen(Yi Yi Ren),Lilii Bulbus(Bai He),Ganoderma(Bao Gai Ling Zhi ) etc.

(4) Appropriate techniques of TCM: patients can resort to moxibustion at acupoints such as Dazhui (DU14), Feishu (BL13) and Zusanli (ST36),and massage acupoints such as Taiyuan (LU9),Shanzhong (RN17), Zhongfu (LU1) and Feishu(BL13), or massage channels such as lung meridian,large intestine meridian, stomach meridian, as well as acupuncture, ear point bean pressing, scraping,cupping, etc.

11.3.6 Criteria of Discharge and Notes after Discharge

(1) Discharge Criteria

① Body temperature returns to normal for more than 3 days; ② Respiratory symptoms get improved obviously; ③ Pulmonary imaging shows that acute exudative lesions are significantly improved. ④Nucleic acid tests of respiratory tract specimens such as sputum and nasopharyngeal swabs are negative for 2 consecutive times (sampling time interval is at least 24 hours). Nucleic acid tests of anal swab are negative (if condition permits).

Those who meet all of the above criteria can be discharged from hospital.

(2) Notes after discharge

① Designated hospitals should make good contact with the primary medical institutions in the patient's residence, share medical records, and timely pass the information of the discharged patient to the patient's residence authority or committee and primary medical and health institutions.

② After the patient is discharged from hospital,it is suggested that he/she should continue to carry out 14-day quarantine and self-monitoring,wear masks, live in a well-ventilated single room if conditions permit, and reduce close contact with family members. Eat separately Keep the hands clean, and avoid going out.

③ It is suggested for discharged personnel to return to the hospital to have follow up visit and consultation at the 2nd and 4th weeks after discharge.