by M. Ann Phillips, PhD and Queenie Zhang, CMD

Severe Acute Respiratory Syndrome (SARS) was identified by the World Health Organization (WHO) as a threat to health worldwide little over a month ago. According to the WHO, as of May 5, there have been 6,583 cases of SARS reported from 27 countries. Of the more than sixty five hundred cases, the majority have recovered though SARS has resulted in the death of 461 people. Different studies place the death rate worldwide at between 6 and 20%. One Hong Kong study suggests that the death rate in older patients may be closer to 50%. In Canada many of those affected have been health care workers and their close contacts and the majority of deaths have been in elderly people or people with pre-existing health conditions.

Despite the April sequencing of the genome of the carona virus identified by the WHO as the causative agent for SARS, and the availability of a PCR rapid diagnostic test, there is a lot that still is unknown about SARS. Western medicinal approaches, with its' knowledge of infectious agents, have allowed the development of protocols for containing SARS, but relatively little is still known about how SARS is spread or about preventing or treating SARS. Traditional Chinese Medicine (TCM), which has been around for 5,000 years, approaches disease from a very different perspective than conventional Western medicine. TCM may offer some insights into the features, treatment and prevention of SARS which fill in gaps so far undetermined in conventional Western medicine.

Traditional Chinese Medical does not look for precise agents or causes of diseases but tries to identify an overall picture for each individual/condition. Chinese Medicine treatment is based on differentiating of the imbalances or "patterns of disharmony" that are thought to underlie all clinical problems. Although in ancient China, the name SARS was not known, a similar condition known as "Yi Li" or "Wen Yi" is discussed in some old TCM texts. While SARS may be a new disease in our times, it or something very similar to it, may well have existed thousands of years ago. If the virus that causes SARS mutated from one that infects animal hosts to one infecting human, as many scientists suspect, this may indeed have happened at another period in human history.

Not much is known about this ancient condition, but in Chinese Medicine, "Yi Li" or "Wen Yi" is thought to be a virulent "disease causing factor" from outside the body -- an "exogenous pathogenic factor" also known as a "pestilent factor". According to Chinese medicine theory, some conditions are due to external pathogens while others are caused by internal pathogens. In TCM thinking SARS is similar in nature to a milder pathogenic factor known as 'febrile disease'. Patients with this condition have a high fever. The condition usually affects the upper body, eg lungs, first and gradually progresses to the lower body as the disease develops. However, in certain cases the transmission of the disease goes directly from the lung to the energy pathway, or the meridian, responsible for consciousness - the pericardium meridian -causing sudden loss of consciousness or even death - a similar picture to that of SARS.

Pestilent factors are known to be more pernicious and are fiercer types of pathogens. The diseases caused by pestilent factors are epidemical and dangerous, with rapid drastic changes and most acute contagious diseases. In Chinese medicine thinking, these diseases are thought to relate to external weather patterns such as heat and dampness. From the TCM point of view it is not surprising that a condition with the symptoms associated with SARS could have arisen, as seems to be the case, in Guang Dong province, one of the warm, damp Southern provinces in China. The relationship between external weather conditions and disease causing agents is an area that does not really feature into western medical thinking. With global warming creating more erratic weather patterns around the world, scientists/research physicians could draw from TCM ideas of the mechanisms by which environment influences human disease when trying to understand new and emerging diseases.

Western medicine to date has no effective treatment for SARS. It is known that most antibiotics are ineffective and current treatment has involved antiviral agents either with or without steroids. However it is still not known how effective this therapy is. As SARS is an acute and contagious condition most TCM practitioners prefer to leave such conditions in the hands of western medicine. However, this may be a case where it is worth while to investigate whether a Chinese herbal medical approach might be effective. According to TCM to get rid of these fierce external pathogens one must use an herbal formula to expel the pathogen from the body, and at the same time to clear and eliminate Heat-Damp from the body. Certain herbal formulas are particularly effective at expelling external pathogens. In these kind of highly infectious conditions, acupuncture, which works mainly by regulating the energy flow in the body, is not thought to be the first course of treatment.

TCM theory and practice offers both treatment and prevention for SARS which would be worth further study by scientists interested SARS and by Western medical practitioners. According to TCM theory, the specific type of herbal formula for each person's condition must be determined by assessing the individual symptoms. However, there are several basic formulas recommended by TCM experts including Wei Jing Tang> (Reed Decoction), Qing Qi Hua Tan Tang> (Clearing Heat-Resolving Phlegm Decoction), and <An Gong Niu Huan Wan> (Calm the Palace Pill with Cattle Gallstone). <Wei Jing Tang> is a famous and classical formula which is commonly used for treating Lung abscess. It targets the Lung system to clear Heat, eliminate toxicity and resolve phlegm. While it is not recommended that people who suspect they have SARS turn to their TCM practitioner for treatment, now might be the time for western doctors to put aside their skepticism of other medical systems and investigate whether these well-known Chinese herbal remedies might prove effective in treating the more severe case.

Western medical practitioners are not likely to eagerly embrace traditional Chinese medical treatments. However, they may be more open to considering the use of TCM herbal formulas for prevention of SARS. There are also several herbal formulas or teas that are recommended to help prevent SARS by TCM experts. These include <San Ju Yin> (Mulberry Leaf and Chrysanthemum), <Yin Qiao San> (Honeysuckle and Forsythia Powder), <Sang Xing Tang> (Mulberry Leaf and Apricot Kernel Decoction), and <Yu Ping Feng San> (Jade Windscreen Powder). As well, there are several traditional Chinese herbs that can be used to boost the immune system [in Western medicine terms] and may serve the decrease the likelihood of contracting diseases like SARS, including Ban Lan Gen (Radix Isatidis), Lian Qiao (Fructus Forsythiae) and Jin Yin Hua (Flos Lonicerae). Again any TCM herbal formula needs to be prescribed by an experienced TCM practitioner as the same herbs can also make the body weaker and more susceptible to infections. A few months ago herbs like Ban Lan Gan were relatively cheap in Toronto's chinatown, but since the SARS outbreak the price of several herbs has jumped as many Chinese people have been buying this well known herb to help protect them from the current outbreak.

As it looks like SARS is likely to be around for while, integrative approaches to preventing, treating and understanding SARS are needed. Traditional Chinese medicine has proven to be a very powerful medical system for dealing with many illnesses, particularly chronic difficult conditions, which conventional western medicine is not able to deal with effectively. There is definitely a need for more discussion and collaboration between western trained MDs and TCM practitioners, who have a wealth of skills and knowledge, in an effort to develop a more integrative approach to prevention and treatment of diseases like SARS.

As TCM gains popularity in the US, Canada, Australia and Europe, the time is right for such collaboration. In Canada, organizations like the Ontario Association of Acupuncture and Traditional Chinese Medicine and Traditional Chinese Medicine Physicians Association of Canada are open to discussion with scientists and western doctors about collaborative research and integrative approaches. It is truly a shame that one of the few, maybe the only centre for integrative TCM and western medicine in Canada - the Tzu Chi Insititue in Vancouver --recently had to close after almost 7 years of operation, because of lack of funding. At crucial times when new diseases like SARS emerge, it becomes clearer that an ongoing collaboration between TCM and conventional western medicine is needed now more than ever. This type of collaboration may shed light on novel ways of preventing and treating diseases which baffle western medical practitioners.