麻杏甘石湯痰的八卦，PTT、FACTPEDIA、YOUTUBE和Yahoo名人娛樂都在討論

#食況轉播 #RAW的秋季漢方

第一道讓我腦袋亮燈的菜色，是這碗湯。

裝在天青色的蓋碗裡，膚金透亮，雅香冉冉，舀一勺入口，純粹的動物鮮味像是熨斗一樣從舌面至喉頭烙貼著前進，暖到胃底。這是一碗滴雞精，清蒸全雞再以西式手法過濾而來的精華， RAW 廚房每日特製。

喝湯之前，還得先含一枚「干貝片」。那是江振誠主廚的童年回憶，爸爸總是叮嚀他在上學途中要含一枚參片，到了學校再嚼碎，他於是把這概念延伸為干貝片，有如把燉湯的材料獨立出來，改換型態、增添趣味；味道上也有道理，當干貝片還在舌尖未完全消融時，飲一口湯，加乘的鮮味餘韻綿長。

再一鮮味，是伊比利火腿。作為湯料，與蝦夷蔥、枸杞一起捲在蕪菁薄片裡，媲美金華火腿的鮮鹹，卻更甘甜適口，融入滴雞精中，鮮美峰峰相連。

#漢方是我們的生活方式

花這麼多篇幅寫一碗湯，是因為我覺得這碗湯在開頭就為RAW本季菜單定了調。

漢方。

「漢方可以是我們吃飯的行為模式，我們飲食的特有組合，用法國菜的觀點來看，特別有趣。」

江振誠主廚娓娓道來RAW秋季菜單的概念，「漢方」是他的點子，所有菜色從頭到尾，都來自他的腦海。RAW即將屆滿六週年，從開業起引領「台灣味」的論述至今，RAW仍在尋求突破，在地食材講過了，台灣小吃玩過了，下一步可以怎麼走？江振誠心中所想，是將台灣味的概念再往形而上的方向提升。

「台灣味是什麼樣的行為、文化、知識，是我們什麼樣的生活方式？」

於是，RAW主張的漢方，不是中藥入菜。江振誠舉出他看過的一本書《宋宴》，其中提到的宋朝美食，有好多食材或風味的組合是現代人耳目一新的。他於是開始聯想，關於秋天，RAW的新菜單還能怎麼設計？為什麼我們有「秋補」的理論？為什麼我們在秋天要吃這些東西？他靈光乍現：這些當令養生的飲食，是我們特有的組合方式，法國菜裡沒有的觀點。

就像那一碗滴雞精，溫潤舒心，在用餐開端喝上一碗，整個人都妥貼了。

#前所未見的湯佐餐 #SoupPairing

我們就喜歡喝湯，不是嗎？尤其在涼涼的天，鍋物大出，想喝湯的心蠢蠢欲動。先別說秋冬，就連盛夏我們都能大啖火鍋。

RAW本季一項嶄新的創意是「湯佐餐」，soup pairing。沒聽過吧？酒搭餐、茶搭餐、咖啡搭餐、果汁搭餐，我們總把搭餐的液體視為飲料，把湯視為料理，怎麼就沒想到湯也能作為「飲料」呢？明明台灣人如此愛喝湯，湯是如此明顯的題目！

湯在秋冬的溫補形象，也完全貼合RAW「漢方」的概念。RAW廚房每天要備製五種湯，江振誠笑稱副主廚Ben是湯王！他也解釋，廚房作業就像把製湯當作醬汁來照顧，一點也不難倒人。

藉由湯佐餐，江振誠想補強一道菜欠缺的滋味或香氣，或者加深一道菜的風味共鳴。譬如一道石蟳、海膽、烏魚子，三款秋天的橘色可比楓紅，石蟳由宜蘭直送，從四個漁港搜羅貨色，細緻的肉被拆出來，與新鮮的台東馬糞海膽、海膽烏魚子蒸蛋送作夥，一匙挖到底，滑滑嫩嫩中交織著醇美與鮮甜，搭配一旁薄如落葉、手切烤乾的梅爾巴土司（Melba toast），結構完整。咀嚼之間，石蟳肉蘊含柑橘清香，原來拌進了檸檬皮，正是這飄渺的清香連回了佐餐的湯— 檸檬燉陳皮。好搭！甜甜熱熱地喝，有點似大閘蟹配薑茶般地互補，清新的檸檬串連成熟的檸檬，菜與湯的風味也十分匹配。

堅挺好似金磚的法式吐司（Pain Perdu），有花瓣般的蘑菇薄片盛開其上，紮根的土壤是松茸、姬松茸與羊肚菌製成的菇醬。狠心從中掰斷，大口一咬，潮濕土壤的氣息與菇的鮮味，伴著酥脆擴散開來。吐司磚四面金黃，表層有糖，口感與風味俱足；吐司內裡還蘊藏秘密：表面煎炸完成後，另以針筒注入蛋液！不僅外酥還要內嫩！與此相搭的湯，則是松茸、羊肚菌、香菇等等菇類熬成的野菇湯，以菇搭菇言之成理，只是菇湯也開了個小玩笑：黝黑湯面漂浮著「薑片」，乍看以為是薑茶，其實那是一片杏鮑菇啦。

野菇湯可以繼續搭下一道「鴨肝麵茶」。傳統上，麵茶以麵粉、豬油、堅果（花生、芝麻最常見）炒製而成，法國也有法棍麵包製成的濃湯baguette soup，江振誠就結合二者，將麵茶做成濃稠的醬汁，baguette soup做成輕盈的泡泡，用以襯托煎香的鴨肝，另點綴以板栗與印加果。麵茶甜口，法棍泡泡鮮鹹，鴨肝的油脂居中連結，鴨肝本身也煎得好，表面的鹽粒與印加果碎屑增添酥脆與鹹香，每一口都吃進溫暖的、烘烤過的堅果味，秋意盎然。

#精彩的新創作

又一蓋碗上桌，揭蓋見橙黃，啜一口，甘鮮滿盈繼而尾韻微苦。它有個非常中式的名字：川貝鷓鴣湯，據說可以止咳化痰、潤肺養顏。我沒想到初嚐此湯會是在RAW。

還有另一項第一次，是品嚐如此纖細嬌小的「肋排」。肯定不是羊排，見那骨架與肉相就不是，江主廚一臉淘氣說「貓排」也騙不了人。謎底揭曉：這是黃鰭鮪魚，中型尺寸，一條魚就七到八根骨頭，先用鹽昆布與明太子等「自然鹽」醃過，再燒烤，切開大約三分熟，入口仍有鮪魚赤身的酸味與鐵味，醃料則散發炭烤燻味與沙茶醬般的複雜鹹香，這等來自海洋的鮮，與川貝鷓鴣湯的陸地鮮味互相呼應。一旁搭佐的「八寶飯」，則是以炸青豆、薏仁等等綜合豆類、穀物製成的義式燉飯，上頭的泰國青檸（kaffir lime）泡泡清香明亮，為整道菜畫龍點睛。

整份菜單強度高昂至今，主菜才不甘於平淡。有時候，一份tasting menu吃到主菜已經反高潮，這道戰斧豬排則完全不會，吃可可與酒粕長大的宜蘭葛瑪蘭黑豬，直火炭烤後澆淋上焦化奶油、蒜末與巴西里，由法式meunière延伸而來的做法，噴香至極，上桌的芬芳簡直勾魂；卻還有另一種香味與之共舞，那是調入了埔里香草的肉汁！「我超愛這個香草醬汁」，江振誠一邊淋一邊說，我已經等不及動刀，豬肉之香甜與鮮美，我幾乎懷疑是否有用鹽麴醃過，但沒有，那就是豬本身的魅力。

與主菜相搭的湯，則是甘草黑豆，不再需要海洋或動物的鮮，單純以黑豆的麥茶、咖啡、可可風味去連結香草的甜香與焦化奶油的堅果氣息，勾勒出溫暖、深邃的醇厚印象，若以巧克力的風味象限來比喻，是偏向dark sweet的濃郁風格，非常秋冬應景。

還值得一提的是主菜刀。由法國職人Roland Lannier手工打造，以水泥、黑膠唱片等嶄新素材表現龐克精神，這些精美的刀子RAW進了一套，全以主廚命名，除有為江振誠主廚量身定制、磨石子刀柄與台灣地圖的款式，還有現行世界第一主廚Mauro Colagreco，法國料理教父Alain Ducasse，法國三星女主廚Anne Sophie Pic，西班牙傳奇山中燒烤店Asador Etxebarri，全都任君挑選。下次去RAW吃飯不妨試試手氣。

#科學思維的茶佐餐 #TeaPairing

除了湯佐餐，RAW本季的茶佐餐（tea pairing）也別有看頭。與南投鹿谷的「開蘭茶 KALON TEA」合作，江振誠與開蘭茶共同探索，同一款茶葉如何在特定的溫度與萃取方式下展現不同的風味。例如一款輕發酵、輕烘焙的金萱烏龍茶，冷泡八小時並調高茶葉比例後，能夠凸顯其野薑花香氣，甚至散發綠茶般的海苔鮮味，用以搭配菜單開頭的竹莢魚與茄子小塔、藥燉黑鮑；同一款輕發酵、輕烘焙的金萱烏龍茶，改為熱泡，鮮味減低並殿後了，野薑花香則轉為淡淡奶香，用以搭配石蟳、海膽、烏魚子。

一款重發酵重烘焙的烏龍茶特別有趣。江振誠解釋，這款茶是以咖啡烘焙曲線焙成，「茶會以為自己是咖啡」，冷泡久浸十六小時後，搭配-196℃液態氮潤過降溫的玻璃空杯，竟冷萃出明顯的可可風味！激似可可果殼茶或咖啡果葉茶，這款冷泡烏龍茶散發的堅果、香料風味，和葛瑪蘭豬的主菜搭極了！（尤其那香草肉汁！）

#直到甜點毫無冷場

高強度的菜單，直到最後都不放過人。甜點太精彩了，我無法跳過不寫，更惱人的是甜點還有三道。

彷彿鑲了金箔的羊羹，這道優雅的「木瓜凝」，做法很有意思。木瓜連籽打成汁，放置隔夜，殘渣會自動浮起凝結，因此誕生的木瓜凝，濃縮了木瓜的清潤甜味與草木芬芳，可謂「木瓜中的木瓜」；表面撒上桂花粉增香添雅，襯底的柑橘醬汁，則集結了柚子、檸檬、葡萄柚、萊姆等等柑橘水果，就像吃木瓜要擠上檸檬汁一樣，明媚的酸香更襯托木瓜的清甜，二者相加，氣質出眾。

接著的「蜜酥煎」，江振誠自陳是他最愛。如果你和我一樣沒聽過蜜酥煎，那是中醫裡一帖降氣止咳、潤肺補虛的良方，以杏仁、蜂蜜、牛酥煎製而成，江振誠在試做的過程中發現，這根本是美國的奶油軟糖（fudge）！牛酥的部分，他採用自製澄清奶油與印度酥油（ghee），同樣試岀洋溢焦糖香與奶甜的配方，配上一球葛瑪蘭威士忌冰淇淋，就模擬了傳統上蜜酥煎配暖酒服用的吃法，馬鈴薯泥居間協調冰淇淋與蜜酥煎，最後刨上黑松露、撒上海鹽粒與橄欖油，只消一匙，各種馨香奔騰而來，酒香與焦糖香，蕈香與草香，還有鮮明的鹹味點亮味蕾，交織出複雜的美麗風味。

最後是「凍梨」，中國東北冬季特產，梨子因為反覆結凍而形成冰沙般的軟綿質地，RAW廚房如法炮製，將水梨反覆結凍解凍後挖出果肉，佐以川貝煮桃膠與烤杏仁，綴以新鮮水梨片與杏仁粉，水梨的脆與軟、輕甜與濃甜都給我們嚐到了。

還沒完。佐茶與咖啡的petit four，法文意指「小烤箱」，什麼樣烤的點心能符合「漢方」的主題？江振誠想到了漢餅，紅豆粉粿口味，皮薄餡美，再飽也要嚐嚐。

服氣，服氣，這季菜單毫無冷場。嚴密的概念，新穎的創意，精準的執行，菜色味道也沒有以往有時會因暴衝而紊亂失衡。自我突破是非常困難的，只有RAW能超越RAW，我願意下如此俗氣的結論。

從非典到新冠肺炎

From SARS to Novel Coronavirus (COVID-19) - English version is in the second half

新冠肺炎，Novel coronavirus (2019-nCoV) 新型冠状病毒肺炎，疫情越來越嚴重，被證實可以人傳人，也在武漢以外的許多地方發現病例，造成世界各國及世界衛生組織（WHO）高度關切，當然也讓很多住在中國大陸及附近區域的華人非常緊張，就好像當年的非典肺炎疫情即將再一次大爆發一樣。

目前，現代醫學還沒有找到治療新冠肺炎的方法，只能針對某些症狀來處理，疫苗的研發更是遙遙無期。怎麼辦？每次遇到這種情況，中醫就會被搬出來，這次也不例外。新冠肺炎爆發後，網上馬上有許多中醫對付新冠肺炎的文章。當然，除非哪位中醫師看過、治好過大量的新冠肺炎病例，所有的討論都是猜想、假設。然而，有些猜想及假設值得參考，有些猜想及假設卻明顯在誤導大眾。

我還沒有治療過新冠肺炎，不能大肆評論。不過，我治好過很多禽流感、豬流感、及每年流感導致的嚴重肺炎及其它病變的病人。其中許多病人是被美國大型西醫院證實為嚴重肺炎，被要求醫院或居家隔離，偷偷溜出來找中醫看診的。也因此許多病人及討論中醫的網站，希望我能針對新冠肺炎發表一些意見。

我們以前就討論過，這些彪悍的流感病毒，經過那麼多年、那麼多次的變種（mutation），每年都不一樣，東漢時期傳下來的經典中醫，根本沒有遇到過現在的病毒，怎麼可能治療如此嚴重的肺炎呢？

中醫從來就不認識病毒，也不從病毒種類的角度來思考。中醫是探討人體受到外界因素破壞，失去平衡後，身體會有哪些現象、哪些反應，根據那些現象、那些反應來調整身體狀況，期待身體能恢復到平衡狀態，把外界因素帶來的破壞減到最小。我打個半開玩笑的比方，警匪槍戰時，我們注意到壞人哪個方向來的火力強大，造成我們部署在哪個位置的警員傷亡，這時我們會趕緊重新部署人員，或者想辦法增派警力，我們大概無暇去管壞人是用哪個牌子的槍、哪個工廠做的子彈！

雖然幾百年幾千年下來，病毒變種等等的外界因素改變了非常多，人體演化的改變卻非常有限。人體的功能，無論是怎麼被破壞的，某項功能被破壞而導致的症狀、反應、後續演變，卻依然有明顯的脈絡可循。也因為如此，在很多情況下，中醫以專注人體本身平衡狀態的治療方式，反而比西醫專注在外來敵人的治療方式來得有效許多。

依據多年累積大量的臨床病例觀察，無論是禽流感、豬流感、還是每年的流感，人體敗壞的進程依然如同傷寒雜病論探討的一樣，非常簡化的說，從一般桂枝湯證、葛根湯證等的表寒，轉變到小青龍湯證等的裡寒，津液不足、水道運化失調而化熱，變成比較嚴重的大青龍湯證，或者更嚴重肺臟的寒熱夾雜，金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇中的射干麻黃證、葶藶大棗瀉肺湯證、澤漆湯證、小青龍加石膏湯證等等混雜出現，搞得亂七八糟，也不再是什麼簡單方劑可以對應的。

然而，雖然進程很像，不同於一般外感的是，這些嚴重流感肺炎病情加重的改變速度快非常多，也來得猛烈頑強很多。一般的外感從桂枝湯證、葛根湯證等轉變到大青龍湯證或更複雜的病情，通常需要一兩週的時間。同時，還得病人自己非常不注意，或者醫生治療錯誤，一般感冒才會沒辦法自己好，反而變成嚴重的病症。這幾年的流感，從一開始覺得不太對勁，到嚴重複雜的病情，只需要三四天，而且有越來越快的趨勢。這大幅提高中醫師治療流感時，判斷功力及敏感度的要求，中醫師必須在許多症狀還沒有出現時，就得抓緊時間，趕緊行動，卻又不能預防過度，反而讓病情加重。換句話說，時機、劑量、藥材比例變得非常重要，稍有不慎，就無法反轉病情。

舉個例子，有些病人得了流感，咳嗽非常嚴重，痰非常多，呼吸困難。依照中醫的辨證，假如一致都是寒，舌苔白、小便清、怕冷等等，本來依照辨證論治，我們可能會開射干麻黃湯加減給病人。然而，因為流感的進程非常快速，中醫師得非常敏感，譬如看到舌苔白卻帶有一絲絲乾的感覺，就很可能得加上大寒的石膏來避免肺喪失津液，卻又不能加太多石膏，以免肺寒加重。又譬如聽到咳嗽聲音非常深沈，從肺的底部發出，又帶有膿痰的濁音，就很可能得加上瀉肺的葶藶來避免肺中水飲、痰飲大幅增加，卻又不能加太多葶藶，以免肺變得太虛弱。

我們回頭來看這次的新冠肺炎。根據有限的資訊，我們知道感染後有大約兩週的潛伏期，這段時間沒有什麼症狀，病人可能只會感到有些疲憊。剛開始發病時，很像一般的感冒，病人會發熱、乏力，並不嚴重，沒有什麼流鼻涕等上呼吸道的症狀，有的甚至沒有發熱。約一半的病人一週多後恢復，另一半的病人卻在一週後出現呼吸困難，有些病人會快速進展為急性呼吸窘迫綜合征、膿毒症休克、代謝性酸中毒、凝血功能障礙等等嚴重的問題，可能導致死亡。

從上面的敘述，我們不難發現，一開始很像一般中醫外感的桂枝湯證、葛根湯證，一半的病人也就自己恢復了，另一半的病人卻出現快速的入裡化熱現象，肺津液迅速流失，非常濃稠的痰飲沈積在肺部下方。同時，中醫認為肺為人體調節津液的源頭，肺金生水，好比天空下雨一般，而當肺的功能及津液調節出現嚴重障礙，很快就會拖累三焦水道、腎臟等的功能，導致上面提到的幾種嚴重病情。換句話說，新冠肺炎可以讓輕微的太陽證外感，迅速發展成嚴重的肺痿肺癰，再進一步瓦解人體其它功能的運作。

怎麼治療？在沒有直接治療武漢肺炎病人的情況下，我們也只能根據有限的資訊來推論，不過，以前大量的流感肺炎治療病例，可以讓我們比較有信心的面對新冠肺炎。當病人已經出現明顯新冠肺炎症狀時，大多已經入裡化熱，嚴重的肺痿肺癰。這個時候，得用大劑量的石膏清肺熱、加強肺津液運作。也得靠葶藶、大戟等把肺下方濃稠的痰飲及胸腔可能的積液去掉，痰飲積液不去，是無法修復肺家津液運作的。同時，肺氣不宣，就好像吸管上頭堵住了，吸管內的水無法上下，我們還得使用麻黃等宣肺、發陽的中藥來配合。另外，肺已經受損了，除了大動作急救外，比較穩定後，還得靠一些潤肺的藥來收尾，讓肺完全恢復。如果我們列一個可能加入的中藥單，大致有石膏、葶藶子、大戟、生半夏、麻黃、射干、紫菀 、款冬花、 生薑、炙甘草、紅棗、麥門冬、杏仁等等。當然，如前面所言，用藥的時機、劑量、藥材比例非常重要，每一個病人的差異也很大，嚴格考驗中醫師的功力與膽識，一旦判斷錯誤，不但沒有效果，反而可能會加重病情。

網上有些中醫師，說新冠肺炎或其它流感肺炎可以用板藍根清熱解毒來治好。也有些中醫師說可以用麥門冬湯等等的輕劑治好嚴重的肺炎。甚至還有些中醫師說多喝綠豆湯可以預防新冠肺炎！其實，真的遇過、治好過禽流感、豬流感等嚴重流感肺炎的中醫師，一看這些文章，就幾乎可以確定這些人根本沒有治療過嚴重肺炎的經驗，充其量只是在西醫治療下，在旁邊幫幫病人一些小忙而已。這樣的情況下，難怪中國政府平時大力推展中醫，真的有如同新冠肺炎這樣重大疫情爆發時，卻看不到中國政府大量使用中醫方法來治療病人、控制疫情。醫學是實戰的學問，沒有大量臨床病例，講得再好聽都是沒有用的，如果希望中醫真的在主流醫學裡站立起來，希望中醫真的能面對大規模的疫情，回歸最基本的臨床療效，才是最重要的，其它都只像是武術表演，而非實際作戰。

From SARS to Novel Coronavirus (COVID-19)

Written in Chinese by Dr. Andy Lee, January 21, 2020
Translated to English by Dr. James Yeh and Dr. Andy Lee, March 28, 2020

The epidemic from Novel Coronavirus is becoming much more serious. Transmissivity among people has been proven. (Note: It's now named COVID–19. The term “Coronavirus” will be used here.) Cases were found in areas beyond Wuhan. It has caused serious attentions from the WHO (World Health Organization) and many countries around the world. The residents in China and the surrounding regions are quite worried and wonder whether it will break out like SARS (2003). (Note: The article was written on January 21, 2020, before Coronavirus became a global pandemic.)

So far, the modern medical field has not found a cure for Coronavirus, but resorts to treating patients’ symptoms only. Any vaccine to treat Coronavirus is still no way in the sight. What do we do? Every time such a situation happens, the topic of using Traditional Chinese Medicine (TCM) is raised (at least among the Chinese communities). There is no exception this time. Many articles related to using TCM on Coronavirus have been popping up on the web. However, unless some TCM doctors who have actually treated many Coronavirus cases, all the discussion would be hypotheses or assumptions. Some hypotheses are worth considering while many others could be quite misleading.

Personally I have not treated patients cases related to Coronavirus. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully, and has published other later blogs which included his involvement in treating those patients. Please refer to his medical blog http://www.DrLee.us.) However, I did treat and cure patients inflicted by other viruses in the past, such as the Bird Flu, Swine Flu, and other influenza. A good amount of those patients were diagnosed as severe pneumonia by large hospitals and were required for isolation or self-quarantine. Hence many of patients and online medical forums online are asking for my opinions about Coronavirus.

As we discussed before, all these viruses from the outbreaks are either newly found or mutated from previous strands. The strand can be different every year. Therefore, people always ask how one can say that the TCM knowledge developed in East Han Dynasty (25-220 AD) would be any useful for treating the modern diseases, let alone the severe ones.

It turns out that TCM does not recognize any virus and does not deal with the concept of which type of virus is microscopically at work. TCM looks at how human bodies would become out-of-balance and react to external stimuli. Once the body is out of balance, what symptoms will exhibit and what reactions will be to adjust the body conditions to regain the balance, hence to reduce the damage to the body to the minimum. Let me take an example to illustrate: when there is a gunfight between the police and bandits, we want to see which direction the shots are coming from, causing casualties of the police force, so that we are able to adjust or reinforce the police power. We have no time to think about which brand of the guns or bullets the bandits use.

Over thousands of years, the external viruses have changed and evolved quite a bit, but the evolution of human beings was quite limited. The human body function, no matter how it was damaged, the symptoms due to the damage of the function, the reactions, and the following progression of the disease still follow certain paths. For this very reason, TCM’s focus on the balance of the human body often surpasses the effectiveness of Western medicine, which focuses more on external treats and the microscopic aspect of how human body’s cells are impacted by the external treats.

From the accumulation of many years of clinical treatment and observations, no matter it is Bird Flu, Swine Flu or other influenza, the bodily ‘damage’ and its progression by the viral attack still follow the description of the classic TCM literature “Treatise on Cold Damage on Miscellaneous Disease” (傷寒雜病論). In short summary, the disease usually starts with “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒), for which is matched to one of the several syndromes named with the corresponding herbal remedies such as “Gui Zhi Tang” (桂枝湯) and “Ge Geng Tang” (葛根湯). Then, the disease moves onto the next stage “Interior Coldness” (裡寒) or “Lung Coldness” (肺寒), which shows the syndromes named as “Xiao Qing Long Tang” (小青龍湯), etc. When the respiratory system is “affected by the coldness”, the body fluid function of the respiratory system gets affected. The circulation function of the lung becomes “Dry and Overheated” (燥热). This would lead to a more serious stage “Heated Interior” (入裡化熱) and would often be matched to its herbal remedy “Da Qing Long Tang” (大青龍湯). Or, even worse, it becomes so-called “mixed coldness and heat” (寒熱夾雜) in the lung. Such a complex situation was extensively discussed in Chapter 7 of the classic literature “Synopsis of Prescriptions of the Golden Chamber” (金匮要略肺痿肺癰咳嗽上氣病脈證治第七篇). At this complex stage, the illness development varies significantly among patients of different preconditions and other variants. It is no longer the situation that a simple herbal remedy can be applied to all the situations. The TCM theory illustrates various treatments by those herbal remedies such as “She Gan Ma Hung Tang” (射干麻黃湯), “Ting Li Da Zao Xie Fei Tang” (葶藶大棗瀉肺湯), ”Ze Qi Tang” (澤漆湯), “Xiao Qing Long Jia Shi Gao Tang” (小青龍加石膏湯), and others.

However, even the disease progressions are similar, the more serious viral attacks like Coronavirus can and often do progress much faster with more severe consequences than the common flu. As described in the previous paragraph, normally the disease progression of the “External Coldness” stage to the more serious “Heated Interior” stage usually takes one to two weeks. It is also often due to the ignorance of the patient or misdiagnosis and treatment of the doctor, which prevents the patient from recovering from this “catching a cold”. In the recent several years though, the time period between the time that the patient did not feel well and the time that the patient is in a serious and complex situation can be as short as 3 to 4 days. We also see the trend that this period gets shorter and shorter. In other words, the disease progression is getting much faster. This phenomenon poses a much higher demand on TCM doctors’ ability to make a quick and proper judgment and sensitivity to the subject matter. TCM doctors must intercept the disease progression before it reaches to a more serious stage, even without obvious symptoms of the next stage. TCM doctors have to timely prescribe the proper herbal remedy in terms of the type of herbs and relative dosages of herbs. Too weak a dosage could not stop the progression while too strong a dosage could worsen the condition also. A misjudgment would not be able the turn the conditions around, but hurt the patient more.

The above can be illustrated by a simple example. A patient caught flu and has symptoms such as heavy coughing, lots of sputum, and difficulty in breathing. From the TCM dialectics, with observations of white tongue coating, clear urine, and feeling chilly, etc., it is clearly caused by “Coldness”. Such a patient typically should be prescribed with “She Gan Ma Hung Tang” (射干麻黃湯) or its variations. However, due to the fast progression of the modern flu, the TCM doctor would need to pay attention to much subtle details such as the dryness of the tongue although it still shows the white coating. In this case, Sheng Shi Gao (Gypsum, 生石膏) might need to be added to the herbal remedy to make sure that the lung would not suffer dryness. Given that Sheng Shi Gao (Gypsum, 生石膏) itself is an ingredicient that is “very cold” in nature, the dosage could not be too strong to make the lung too chilly. At the opposite end of the spectrum, if the sound of the coughing is very ‘deep’, like dense sputum coming from the bottom of the lung, the herbal remedy might need to add Ting Li (Sisymbrium indicum, 葶藶) to clear up the lung to avoid too much mucus in the lung. And again, the dosage of葶藶 could not be too much to weaken the lung. (Note: Handling the proper timing and proper remedy can be a real test to the ability and experience of the TCM doctor.)

Let’s go back to the discussion on Coronavirus. From the limited information available so far, we know that there are about two weeks of incubation period after the infection. There are little symptoms during this period and the patient may just feel more tired than usual. More obvious symptoms will start like those of common flu with fever, fatigue but not too serious. Upper respiratory symptoms like running nose are less common. Some patients may not even exhibit fever. About half of the patients infected will recover over a week or so. The other half of the patients will experience difficulty in breathing, or rapid progression to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulopathy, etc. Some patients had died due to these severe conditions.

From the above description, this Coronavirus, in the beginning, is very much like the common flu and will stay in stages of “Exterior Deficiency or Weakness” (表虛) or “External Coldness” (表寒). Half of the patients infected will recover by themselves as in common cold. The other half of the patients may exhibit situations of rapid penetration into inner organs and excess ‘heat’, which causes loss of fluidity of respiratory system and accumulation of dense sputum at the lower part of the lung. In the TCM theory, the lung serves as the initial “gating factor” of body fluids. When the lung fails to serve the proper function, other organs like the kidney will be adversely affected also. In other words, Coronavirus can turn a light “External Coldness” to extremely severe “Lung Atrophy” (肺痿) and “Lung Abscess” (肺癰), which in turn will impair the function of other organs.

How to treat? Without direct experience of treating Coronavirus patients, we can only postulate from our limited information available in hand. (Note: Shortly after this writing, the author has directly and indirectly participated in treating patients of Coronavirus successfully. The treatments were exactly as outlined in this article.) From the ample experience of dealing pneumonia cases caused by flu, we are confident that we can also treat Coronavirus successfully. When patients are showing the obvious Coronavirus symptoms, most of them would have entered the stage of “Heated Interior” (入裡化熱) with “Lung Atrophy” (肺痿) or “Lung Abscess” (肺癰) to a certain degree. At this stage, we will need large dosages of Sheng Shi Gao (Gypsum, 生石膏) to clear the heat to ensure the proper fluidity function of the lung. Also, we will rely on Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), etc. to clear up the dense mucus at the lower part of the lung and to remove the edema of the chest chamber. Without getting rid of the excess mucus and fluid, the lung cannot properly function. We need to use Ma Huang (Ephedra sinica Stapf., 麻黃), etc. to enhance the lung function (宣肺、發陽) and restore proper breathing. When the lung is damaged as in fibrosis, after the conditions stabilize, we need to “moisturize” the lung (润肺) to help the lung to recover fully. In other words, we will most likely use the herbal ingredients such as Sheng Shi Gao (Gypsum, 生石膏), Ting Li (Sisymbrium indicum, 葶藶), Da Ji (Euphorbia pekinensis Rupr., 大戟), Sheng Ban Xia (Pinellia ternate, 生半夏), Ma Huang (Ephedra sinica Stapf., 麻黃), She Gan (Belamcanda chinensis, 射干), Zi Wan (Aster tataricus, 紫菀), Kuan Dong Hua (Tussilago farfara flower, 款冬花), Sheng Jiang (Ginger, 生薑), Zhi Gan Cao (processed Glycyrrhiza uralensis Fisch., 炙甘草), Hong Zao (Ziziphus jujube, 紅棗), Mai Men Dong (Ophiopogon japonicas, 麥門冬), Xing Ren (Prunus armeniaca, 杏仁), and others. As we discussed in previous paragraphs, the timing, dosage, the relative ratios of different herbal ingredients are very critical. Given that there are quite some variations in patient conditions, the challenges on TCM doctors’ comprehensive knowledge, judgment and courage are unprecedented.

In those articles online, some TCM doctors claimed that Coronavirus can be cured by Ban Lan Gen (Isatis tinctoria root, 板藍根), which is believed to have natural antibiotic chemicals to “clear up the heat and toxics”. Some TCM doctors suggested using a simple mild herbal remedy “Mai Men Dong Tang” (麥門冬湯), which mainly relies on the ingredient Mai Men Dong (Ophiopogon japonicas, 麥門冬). Some people even suggested that having the green bean soup could prevent Coronavirus. In fact, those TCM doctors who have good experience of treating Bird Flu, Swine Flu, and pneumonia caused by other influenza would know that the people making those claims never had the real experience of treating severe pneumonia. They at most helped in a minor way the patients under Western medicine treatments. Under such conditions, it is not a surprise that the China government has not used TCM as the primary method of treating Coronavirus, despite its big promotion of TCM in the recent years. (Note: After this writing, Coronavirus epidemic became so severe in China that the China government changed its strategy and started to use TCM extensively in treating many mild Coronaviurs cases.)

Medicine is the science based on real treatment results. Without a good amount of successful cases in clinical treatments, it is useless to promote any fancy idea of treating patients. If we would like TCM to be respected in the mainstream medicine and to be meaningfully used in a severe epidemic like Coronavirus, it is critical to focus on the most fundamental. That’s the clinical results. Like the martial arts, unless you can fight off the bad guys, it’s just a show of fancy movements.

（http://andylee.pro/wp/?p=7169）
#當張仲景遇上史丹佛

「連花清瘟」抗新冠病毒？

前幾天，中國領頭抗疫的鍾南山院士發表他團隊的中藥研究，體外實驗顯示「連花清瘟」能抑制新冠病毒複製，發揮抗炎作用。這個消息被很多中文媒體大幅報導，很多華人也覺得總算找到證據說明中藥可以對抗新冠肺炎。

鍾南山院士團隊的辛苦研究，固然值得大家敬重。然而，這樣真的代表中醫可以治療新冠肺炎嗎？真的解釋了為什麼中醫可以治療新冠肺炎嗎？其實，說句大家不想聽的話，這樣的研究是本末倒置，「廢中醫存中藥」的西醫研究中醫方式，短期內好像在推展中醫，長期卻害了中醫。

中醫的理論及臨床療效，是建立在望聞問切蒐集病人身體資訊後，藉由中醫的生理及病理學反推病人身體內部的問題，利用中藥、針灸、或其它方法，把病人體內的偏差，推回到比較平衡及正常的狀態。換句話說，中醫很大的一部分是基於改變身體內部環境，而非直接基於細菌、病毒的生物化學反應。許多的中藥方劑，在實驗室體外研究中，找不出什麼確切的證據，臨床效果卻非常良好。

如果以西藥研究的方式來找尋中藥材中的「有效化學成分」，那不是中醫，西藥廠早在二十幾年前就開始大量研究上千種中藥材內的化學成分，到目前為止，成功製藥的比例仍非常低。而這次對抗新冠肺炎疫情，「體外實驗」顯示有多樣西藥能抑制新冠病毒複製，譬如干擾素、抗伊波拉藥物、抗瘧疾藥物、抗流感藥物等等，在實驗室的環境下，這些西藥大多都比各種中藥方劑更能「抑制新冠病毒複製」，但拿來用在實際臨床治療時，效果卻非常有限，不然疫情也不會如此嚴重。既然連那些「體外實驗」更有效果的西藥在臨床治療上都遇到了瓶頸，那麼「連花清瘟」又怎麼能代表中醫治療新冠肺炎的有效性？

真的想要研究及推廣中醫對抗新冠肺炎疫情，必須從臨床中醫成功治癒的病例開始，特別是從那些重症、西藥治療效果非常有限的病例來著手，聽從有成功病例中醫師們的思路及治療方法，大幅推廣到更多的確診病人，從大量的臨床病例來驗證中醫的療效，事後再做各種研究來「解釋」中醫療效背後的機制。而不是反向的在實驗室內做許多的「體外實驗」，找尋什麼中藥方劑有「抑制病毒複製的化學成分」，那樣是枉費了中醫的智慧，也無視實際上已經有很多純中醫治癒的病例，這樣的閉門造車，留給西藥廠去慢慢研究，不要耽誤了中醫抗疫的推展，更不要把中醫誤導進入了「廢中醫存中藥」的死胡同。

或許有讀者會說，既然「連花清瘟」有「體外抑制新冠病毒複製的實驗證明」，那麼先服用了也無妨，大不了沒有效果。真的「無妨」嗎？「連花清瘟」的成分為：連翹、金銀花、炙麻黃、炒苦杏仁、石膏、板藍根、綿馬貫眾、魚腥草、廣藿香、大黃、紅景天、薄荷腦、甘草，以清熱解毒為治療方向。這次新冠肺炎輕症病人，很多表現出「葛根湯證」、「小青龍湯證」的表寒裡寒症狀，服用這樣清熱解毒藥材的組合，反而有可能讓病情加重。對肺家輕微發熱的病人，這樣清熱解毒藥材的組合或許有些幫助，然而，這次新冠肺炎和SARS非典肺炎很不一樣，很多病人並沒有像非典肺炎那樣導致肺痿、肺纖維化，反而是肺家積聚了大量的濃稠液體、痰飲，偏向中醫的「射干麻黃湯證」、「葶藶大棗瀉肺湯證」等，如果病情發展到這樣的中重症階段，「連花清瘟」不但沒有效果，反而可能會導致更多的問題。

我們並不是說「連花清瘟」沒有道理、沒有效果，而是強調這樣的方劑只適合某一部分的病人，不能因為「體外實驗顯示抑制新冠病毒複製」，就以為找到了答案，大量給各種不同症狀表現的病人。而這樣的實驗室研究，是以西藥的方法來研究中藥，「廢中醫存中藥」的思維不但不會幫助中醫推廣，反而會導致中醫的滅亡，更不用說能治癒中重症新冠肺炎病例。

(http://andylee.pro/wp/?p=7775)
#當張仲景遇上史丹佛