Treatment of Influenza
Treatment Principles
Flu patients should rest in bed early, drink plenty of fluids, and prevent secondary infections. For mild cases, choose one or two traditional Chinese patent medicines or compound preparations of Chinese and Western medicine, or use simple proven formulas. For severe cases, take decoctions based on syndrome differentiation, plus antiviral drugs; for high fever with convulsions, add antipyretic and sedative agents; for severe throat inflammation, use nebulization inhalation. For bacterial pharyngitis or pneumonia complicating flu, select antibiotics targeting the causative bacteria.
Modern Medical Treatment:
Mainly symptomatic treatment, including antipyretic analgesics and prevention of secondary bacterial infections. For severe fever and body aches, use analgesic and antipyretic drugs, but prevent excessive sweating leading to collapse. Aspirin is contraindicated in children to prevent Reye's syndrome. For dry cough, use benproperine, brown mixture, or codeine. For severe fever and toxic symptoms, administer intravenous fluids and physical cooling, closely monitor the condition, promptly manage complications. If secondary bacterial infection occurs, use appropriate antibiotics early based on pathogen.
For elderly flu patients or residents in nursing homes, administer amantadine hydrochloride or rimantadine within the first 1–2 days of onset to alleviate symptoms and shorten the course. Amantadine and rimantadine block viral replication, effective for both prevention and treatment of type A influenza. Adult dosage: 100–200 mg daily, divided into two doses, which shortens the course and reduces viral release. Must start on the first day after onset, treatment duration 3–5 days. Children: 4.4–8.8 mg/kg daily, divided into two doses, treatment duration 5–7 days. Generally no side effects, but watch for gastrointestinal and neurological reactions such as excessive excitement, slurred speech, tremors, insomnia, dizziness, fatigue, mood disorders, ataxia. Rimantadine has fewer side effects than amantadine. After an outbreak of type A influenza, consider prophylactic use for susceptible individuals. Renal impairment or interaction with anion drugs (e.g., Triameterin) inhibits renal tubular secretion of amantadine, so elderly patients over 65 with renal impairment should reduce dosage and monitor side effects. About 30% of patients treated with amantadine or rimantadine can isolate drug-resistant strains, fewer in close contacts receiving prophylaxis. These resistant strains can appear as early as 2–3 days into treatment, and remain stable genetically after multiple laboratory passages. These resistant strains can spread among patients during family and nursing home outbreaks, and even prophylactically treated contacts may still develop typical flu symptoms—worth noting.
TCM Syndrome Differentiation and Treatment:
TCM mainly divides flu into wind-heat and wind-cold types.
For wind-heat flu with prominent fever, mild chills, headache, sweating, thirst, dry and sore throat, short red urine, thin yellow tongue coating, floating-rapid pulse, treatment should aim to release exterior and clear heat, disperse lung heat. Often use modified Yinqiao San (Honeysuckle, Forsythia, Polygonum, Light Bamboo Leaf, Great Burdock Seed, Fresh Reed Rhizome, Platycodon Root, Perilla Seed, Mint, Licorice).
For wind-cold flu with strong chills, mild fever, severe body pain, headache, no sweating, nasal congestion, runny nose, itchy throat, cough with thin phlegm, limb soreness, thin white and moist tongue coating, floating pulse, treatment should aim to release exterior with warmth, disperse lung cold. Often use modified Jingfang Baidu San (Schizonepeta, Saposhnikovia, Bupleurum, Peucedanum, Notopterygium, Platycodon, Ligusticum, Angelica, Kudzu).
When flu is complicated with summer-dampness, presenting with fever without obvious rise, sweating without relief, irritability, red urine, greasy yellow tongue coating, or dizziness, eye swelling, heavy limbs, joint pain, white greasy coating, wiry slippery or soft rapid pulse, treatment should aim to disperse wind, clear summer heat, and resolve dampness. Use Huoxiang Zhengqi San (Agastache, Perilla, Angelica, Platycodon, Pinellia, Poria, White Atractylodes, Tangerine Peel, Ginger) or Xiangru Yin (Honeysuckle, Forsythia, Agastache, Broad Bean Flower, Eupatorium, Agastache, Magnolia Bark, Liu Yi San).
When flu is complicated with dryness, besides wind-heat symptoms, also presents with dry nose, cracked lips, oral ulcers, or dry cough without phlegm, red tongue with little moisture, fine rapid pulse. At this stage, treatment should aim to disperse wind, clear lung, and moisten dryness. Use modified Sangxing Tang (Mulberry Leaf, Apricot Kernel, Adenosma, Fritillaria, Fermented Soybean, Gardenia, Mint, Mountain Bean Root).
Commonly Used Patent Medicines:
Wind-cold flu: Use Jingfang Baidu San, Ganmao Qingre Granules, Zhengchaihu Yin Granules;
Wind-heat flu: Use Yinqiao Jiedu Granules, Sangju Cold Tablets, Shuanghuanglian Oral Liquid, Antiviral Oral Liquid.
Medicines like cold granules and Banlangen granules, if used within the first 1–2 days of onset, can alleviate symptoms but have no antiviral effect.
Efficacy and Prognosis:
Simple flu has a good prognosis. Influenza pneumonia or (and) secondary bacterial pneumonia mostly affects infants and pregnant women. Those with pre-existing chronic heart or lung disease and elderly patients have poorer prognosis, possibly dying from heart failure and respiratory failure. Reye's syndrome associated with flu has high mortality.
Additionally, flu virus can cause meningitis and encephalitis; Reye's syndrome is also linked to flu; it can also lead to myocarditis, pericarditis, acute myositis, hemorrhagic cystitis, nephritis, etc.
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