Discussion on the Prevention and Treatment of COVID-19 Causing Lung Disease and Heart Damage Based on Lei Zhongyi’s Theory of Intermingled Phlegm, Blood Stasis and Toxin

Jinfeng CHEN, Zhongyi LEI, Chaofeng LIU, Hong FAN, Peng LEI, Xueping WU, Xiaoyong YU, Yanfen ZHOU, Jiejun HOU

1. Institute of Traditional Chinese Medicine Master, Shaanxi Traditional Chinese Medicine Hospital, Xi’an 710003, China; 2. Shaanxi Provincial People’s Hospital, Xi’an 710062, China; 3. Shaanxi University of Chinese Medicine, Xianyang 712000, China

Abstract Novel coronavirus infection not only damages lung function, but also causes myocardial injury, elevated myocardial enzymes and heart failure, especially for patients with basic heart diseases who develop COVID-19, the first consideration should be the protection of cardiac function. Based on the theory of intermingled phlegm, blood stasis and toxin of heart disease put forward by Master Lei Zhongyi, the dialectical treatment thinking of COVID-19 patients from the concept of damage of phlegm, blood stasis and toxin to the heart were discussed. During the diagnosis, critical stage and recovery period of COVID-19, expectorant and blood-activating agents, heat and detoxification agents can be added to promote lung and asthma, free Bizheng and remove blood stasis, calm the heart and calm the mind, and promote the recovery of cardiopulmonary functions.

Key words COVID-19, Intermingled phlegm, Blood stasis and toxin, Lei Zhongyi, Lung disease and heart damage, Blood stasis caused by epidemic toxin

1 Introduction

In December 2019, a viral pneumonia of unknown cause appeared in Wuhan City of Hubei Province, and spread rapidly across the country. Thanks to the decisions and plans of Central Committee of the Communist Party of China with General Secretary Xi Jinping as the core and the concerted efforts of the health care workers of National Health Commission of the People’s Republic of China and national health care system, the epidemic has been well controlled in China. At the beginning of the epidemic, Lei Zhongyi, a master of traditional Chinese medicine, told us that Ye Tianshi had said that if you suffer from warm pathogenic bacteria, it will first attack the lungs, and then reverse and invaginate pericardium; the author has been following the latest reports of people’s resistance to COVID-19 across the country, and found that it is indeed true that COVID-19 has damaged the heart.

Lei Zhongyi, a master of traditional Chinese medicine, was one of the first to put forward the theory of phlegm stagnation intermingled with blood stasis in heart disease. After more than 60 years of clinical practice, the theory of phlegm and blood stasis has been developed into the theory of intermingled phlegm, blood stasis, toxin and wind. In the past ten years, Lei Zhongyi has accumulated more experience in clinical and scientific research on the theory of phlegm, blood stasis and toxin in chest pain. Since the spread of the COVID-19 epidemic, Master Lei Zhongyi has been following developments, looking up information and proposing many strategies to prevent and cure COVID-19.

2 COVID-19 can cause lung disease and heart damage

2.1 Pathological changes of COVID-19 can lead to heart damageNational Health Commission of the People’s Republic of China and National Administration of Traditional Chinese Medicine recently issued a revisedCircularontheIssuanceofCOVID-19DiagnosisandTreatmentProtocol(TrialSeventhEdition), stating that pathological changes of COVID-19 can lead to heart damage. For example, in COVID-19 patients, degeneration and necrosis of myocardial cells can be seen on examination, and infiltration of a few monocytes, lymphocytes and/or neutrophils can be seen in the stroma, partial vascular endothelium detachment, intimal inflammation and thrombosis can be seen[1].

2.2 The elevation of myocardial injury markers and myocardial enzyme profiles in COVID-19 patientsThe earliest COVID-19 patients diagnosed in Wuhan showed elevated levels of high-sensitivity troponin (hs-cTnI) and myocardial enzymes during treatment, especially the elevated levels of cardiac kinase (CK) and cardiac kinase isoenzyme (CKMB), indicating that the patient’s condition was serious and indicating that the patient’s condition was likely to worsen[2-3].

2.3 Effects of COVID-19 on the conduction systemFrom the previous studies on SARS, it has been found that the heart damage caused by SARS is also diverse, which affects the conduction system, endocardium, myocardium and epicardium; the manifestations include arrhythmia (atrioventricular block), decreased exercise tolerance, changes after myocarditis, endocardial lesions, segmental dyskinesia of left ventricle, decrease of left ventricular ejection fraction, enlargement of left atrium and pericardial effusion,etc.[4-5].

2.4 The overexpression of ACE2 in COVID-19 plays a messenger role in myocardial damage and transmission promotionRecent studies have shown that the pathway of SARS-CoV-2 entering the body cells is very similar to that of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MARS) coronavirus; through the binding of spike protein(S-protein) on the surface of viral envelope with a cell membrane receptor angiotensin-converting enzyme 2 (ACE2), it makes a large number of copies in human cells, leading to the death of the invaded cells, inducing the inflammatory response in the body, causing tissue and organ damage and dysfunction, and in severe cases, the clinical manifestations of the affected organ failure. The causes of myocardial damage in patients with COVID-19 are firstly related to the high expression of ACE2 in cardiac vascular endothelial cells and cardiac myocytes, the heart may be an important harrowing organ for extra pulmonary damage caused by novel coronavirus; secondly, myocardium is extremely sensitive to acute severe hypoxia, which directly leads to energy metabolism crisis of myocardium, in severe cases, severe myocardial damage, even extensive myocardial cell necrosis, and acute ischemic myocarditis may occur; moreover, novel coronavirus infection induced by inflammatory factor storm can also directly damage the myocardium. If COVID-19 patients with chronic cardiovascular disease, especially elderly patients, have poor cardiac reserve function, and even mild myocardial damage is likely to develop into severe heart failure, aggravating the disease. Studies have shown that the expression level of ACE2 in peripheral blood mononuclear cells of patients with hypertension and diabetes mellitus is increased, the patients who take ACE inhibitors for a long time also have a similar trend[6-8]. From above, novel coronavirus pneumonia should also be considered in the treatment of pulmonary diseases.

In ancient times, there was a saying that if you suffer from warm pathogenic bacteria, it will first attack the lungs, and then reverse and invaginate pericardium. Ye Tianshi wrote inCommentsonWarmHeatfromExogenousContractionthat if you suffer from warm pathogenic bacteria, it will first attack the lungs, and then reverse and invaginate pericardium[9]. That is to say, if the warm pathogen attacks the upper part, the lung, as a delicate organ, is most vulnerable to the invasion of warm pathogen. At this time, the collateral of lung meridian suffers from disease first, loses treatment and mistreatment, and the invasion of warm pathogen will enter the envelope of pericardium channel of hand Jueyin, and blood tier will also be injured. That is to say, the popular wind-warm disorder and damp warm are from the outside, first of all, it offends the lung, the lung guard fence is out of control, and the function of lung governing diffusion is maladjusted, it is inevitably lead to cough, expectoration, aversion to cold and fever, do not follow the six meridians, but reversely spreads to the pericardium, resulting in mental disorders such as restlessness, dizziness, delirium and so on.

3 COVID-19 phlegm disturbs the mind

Patients with COVID-19 suffer from impairment of purifying function of the lung, ascending and descending disorder, large amount of sputum storage in the lung, adverse Qi, turbidity inside phlegm, blockage of the cardiac vessels, disorder of vital energy and blood, general pain, and chest obstruction. InSuwen·ZhiZhenYaoDaLun, it was recorded that Taiyin Sitian produces water and moisture, and Zaiquan produces sugar, …Exogenous dampness causes symptoms, and overdrinking causes heartache[10]. InGeneralTreatiseonCausesandManifestationsofAllDiseases·ZhuTanHou, it was recorded that all patients with phlegm are blocked by blood vessels, retained fluid accumulates but does not dissipate, as time goes by, it becomes phlegm. InGeneralTreatiseonCausesandManifestationsofAllDiseases·RenShenXin, it was recorded that pain symptoms are that if the heart is painful, it is mostly wind-evil and phlegm and retained fluid, through the meridians of the heart, the evil Qi is rich in the healthy Qi, and the pain is caused by the knot. In Ye Tianshi’sTreatiseonWarmandHeatPathogens, it was recorded that for people with palpitations, shortness of breath, Qi deficiency, and phlegm, when there is external heat and invagination of the pericardium, the internal vein will be blocked. The second is the retention of Qi Fen and the difficulty of dispersing; the third is the stagnation of fluid, the excess fluid can not be discharged from the body, and the fluid is stagnant, the liquid in the human body can not flow away normally and accumulate into phlegm. After being invaded by the warm evil, the heat evil accumulates inside, and gradually boils into the fluid and becomes phlegm. In doctrine of epidemic febrile disease, the treatment of febrile diseases to treat phlegm was proposed; according to the different etiology and clinical manifestations, it can be divided into hot phlegm, dry phlegm, wind phlegm, wet phlegm,etc., but the phlegm syndrome of warm disease is not mainly phlegm, and often is the combination of other syndromes[11]. The onset of COVID-19 is caused by dampness, with lung as the main disease site, and the pathogenesis of COVID-19 includes dampness, dampness obstructing the lung, phlegm and blood stasis obstructing the lung, and decay of vitality,etc. The lung controls Qi, and is at the top and regulates the water channel; although water dampness is born in the spleen and stomach, it is governed by the diffusion & purification and descending of lung. Due to the combination of heat and dampness and phlegm dampness, the Qi of the triple energizer is blocked, and a large amount of phlegm and dampness is blocked in the lung, and the lung Qi is closed and unfavorable, and finally, it leads to the extinction of the source of lung transformation and falls into critical illness and even death[12]. The lung is like the official of Xiangfu, lung is like Huafu, and lung is delicate, if the function of the lung is maladjusted, Qi movement will be disordered, ascending and descending will be disordered; Qi and blood are of the same origin, blood flow is unfavorable, heart and lung live together on the upper Jiao, phlegm heat can burn the lung and disturb the heart, the heart does not master the mind, the blood vessels are unfavorable, the blood vessels are blocked, phlegm fire can disturb the heart, and the mind is restless.

4 COVID-19 stasis can upset the heart

4.1 Long cough can cause blood stasisIn Ye Tianshi’sGuidetoClinicalPracticewithMedicalRecords·Cough, it believed that if you cough for a long time, you will be injured due to fatigue, and the collaterals and blood are easy to be stasis. If cough for a long time, it is easy to overwork and easy to damage the body essence. If Qi deficiency is unable to promote blood flow, slow blood flow will lead to blood stasis, or blood can not be warm, blood cold and stagnation lead to blood stasis[13].

4.2 Exogenous pathogens invade and form blood stasisInGuidetoClinicalPracticewithMedicalRecords·Rheumatism, it was recorded that if external pathogenic factors remain over the years, Qi and blood will be injured, which turns into blood stasis and phlegm, and mixed with meridians. If the pulse is blocked, the blood will coagulate. Cold coagulation or heat accumulation promotes or aggravates blood stasis.

4.3 The plague caused by blood stasisPestilence is an infectious disease caused by the evil spirit of pestilence. Wang Qingren thought that the disease toxin and blood stasis should be paid attention to in the differentiation of pestilence. At the same time of detoxification, Qi and blood circulation should be replenished to remove blood stasis. InCorrectiononErrorsinMedicalClassics·WenDuTuXieZhuanJinShuo, it pointed out that the pestilent toxicity enters the trachea from the mouth and nose, reaches the blood vessels from the trachea, and coagulates the Qi and blood[14]. InCorrectiononErrorsinMedicalClassics·LunDouFeiTaiDu, it also pointed out that the pestilent toxicity can’t come out from the skin outside, but it will attack the viscera inside, the viscera will suffer from toxicity and fire, which will lead to various visceral diseases. Even if you know how to cure the pestilent toxicity, you don’t know that its lair is in blood. Thus the novel coronavirus pneumonia will inevitably form stasis, blood stasis, blood obstruction, and restlessness, which will inevitably involve the heart.

5 COVID-19 fever can strike at the heart

Zhang Xuewen who is a master of traditional Chinese medicine believed that most diseases caused by toxin are exogenous, such as direct invasion of warm heat and toxin, or indirect transformation from wind, cold, dampness, dryness and other pathogens; the second is that the body is full of Yang or Yin deficiency, and is also caused by Qi imbalance, excess Qi is fire, which is generated from the inside and forms poison by dampness[15]. InPlainQuestions·CiRe, it was recorded that if the heart suffers from the heat, the heart will ache, the symptoms are irritated and vomiting, headache, red face and no sweat. It was pointed out that heartache is related to thermal evil. InGeneralTreatiseonCausesandManifestationsofAllDiseases·XinTongDuoTuoHou, it was said that those who suffer from heartache and have profuse spittle, the reason is stagnant fluid retention in the collaterals of the heart. In Qin Jingming’sZhengYinMaiZhi, it was said that the cause of internal injury chest pain is the seven emotions and six sensory pleasures, if you have the emotions, you will have heartfire, hurt the lung, or may feel angry and stuffy, and reverse Qi. If you hurt the lung, you will get phlegm and Qi stagnation. If phlegm-fluid retention transforms into heat, it will hurt the upper Jiao, blood will accumulate inside, and chest pain will occur. It was pointed out that blood stasis and phlegm-fluid retention transforming into heat are the causes of chest pain. InGeneralTreatiseonCausesandManifestationsofAllDiseases·XinXuanJiAoTongHou, it was recorded that the evil forces Yang Qi not to be unblocked, the blood stasis generates heat, so the heart has a sense of suspension and anxiety, feeling upset and pain. The pathogenesis of blood stasis causing heat was put forward. Ding Shuwen, the first national famous traditional Chinese medicine, also put forward the theory of heat toxin in heart diseases[16]. In recent years, many scholars have proposed that pathogenic toxin is an important factor in the pathogenesis of coronary heart disease, and phlegm and blood stasis toxin runs through the pathogenesis of coronary heart disease.

6 The manifestation of Reye’s chest stuffiness and pains of intermingled phlegm, blood stasis and toxin in COVID-19 causing lung disease and heart damage

Lei Zhongyi, a master of traditional Chinese medicine, proposed chest stuffiness and pains of intermingled phlegm, blood stasis and toxin. It is believed that the deficiency of the five internal organs can lead to maladjustment of metabolism of Qi, blood and body fluid, adverse Qi, turbid phlegm and blood stasis, mutual accumulation of phlegm and blood stasis, accumulation of heat and toxin over time. For example, deficiency of lung Qi and Yin, dryness of lung, lung Qi obstruction and elimination of lung, unfavourable water channel, obstruction of blood stasis, inflammation of heart fire, restlessness of mind, loss of spleen transportation and water dampness, stagnation of spleen Qi, hyperactivity of liver fire, loss of catharsis, disorder of emotion, weakness of kidney Qi, deficiency of kidney water, disharmony of heart and kidney, accumulation of heat in Sanjiao, and unfavorable Qi passage will affect the distribution of Qi, blood and body fluid. Thus, phlegm and blood stasis are endogenous, phlegm and blood stasis are both pathological products and pathogenic factors, they are often associated with diseases, obstruction of Qi, stagnation of Yang in the chest and restlessness of mind. As a result, they cause chest pain and palpitation[17]. Moreover, phlegm and blood stasis are intermingled for a long time, heat generating and toxin transforming, stagnant heat and toxin and latent heat stasis and flesh rot result in blocked pulse channels, disharmony between Ying and Wei, and deficiency of Qi and blood, forming phlegm blood stasis and heat toxin binding each other, which promotes the deterioration of chest obstruction and heartache[18]. The novel coronavirus pneumonia arises from the lung, transmits and changes in the pericardium, and it manifests the pathogenesis of intermingled phlegm, blood stasis and toxin. From the above analysis, it is not difficult to see that COVID-19 also has the pathogenesis changes of intermingled phlegm, blood stasis and toxin, and is also an important pathway of lung disease and heart disease.

7 Pathogenesis of harassing the heart caused by intermingled phlegm, blood stasis and toxin of COVID-19

InPlainQuestions·KeLun, it was recorded that disease of all the viscera could cause cough, not only lung[19]. COVID-19 lung disease, an epidemic disease of unfavourable climate injuring to the lung surface, causes the loss of lung function, disorder of body fluid metabolism, stagnation of spleen, endogenesis of phlegm and dampness, obstruction of airway, disorder of qi movement and weak blood supply, endogenous blood stasis, liver failure, liver stagnation into fire, kidney qi damage, congenital foundation deficiency, heart and kidney disharmony, fire on the heart, phlegm and blood stasis, stagnation of Qi, phlegm stagnation accelerating fire, accumulation of fire toxin, phlegm, blood stasis and toxin in the body, lung losing control of Qi, heart losing control of blood, kidney losing control of water, obstruction in liver and spleen lifting hub, obstructed triple energizer, phlegm and stasis toxin closing lung, heart impediment, and five viscera failure. In Lizhongzi’sComplementaryTreatmentofSyndromeDifferentiationandTreatment·PhlegmSyndrome, it was said that the lung is the organ of storing phlegm, and the spleen is the source of producing phlegm[20]. InGeneralTreatiseonCausesandManifestationsofAllDiseases·XinXuanAoTongHou, it was recorded that evil forces lung qi, makes it not free, stasis causing fever, so the heart was urgent as hanging, vexed and painful. InSynopsisofPreionsoftheGoldenChamber·FeiWeiYongKeSouShangQiBingMaiZhengZhiHou, it was said that fever causing blood stagnation, accumulation of carbuncle pus, vomiting such as rice porridge, and it could be cured early, and the pus lead to death[21]. InCorrectiononErrorsinMedicalClassics·WenDuTuXieZhuanJinShuo, it was recorded that the pestilence enters the trachea from the mouth and nose, reaches the blood vessels from the trachea and coagulates the Qi and blood. InCorrectiononErrorsinMedicalClassics·LunDouFeiTaiDu, it was also recorded that the poison of pestilence could not come out from the skin, but it will attack the viscera inside, and the viscera would suffer from poison and fire, which will lead to various visceral diseases. Even if you know how to cure the pestilence, you did not know that its lair is in blood[22]. In summary, COVID-19 lung disease caused all the viscera mixed infection, serious lung disease, phlegm and stasis toxin, and it would inevitably damage all the viscera including the heart.

8 Treatment and rehabilitation of COVID-19 from phlegm, blood stasis and poison

8.1 A preliminary study on the treatment of phlegm and blood stasis in classical medical booksInSynopsisofPreionsoftheGoldenChamber·XiongBiXinTongDuanQiBingMaiZhengZhi, it recorded a series of well-known prescriptions for the treatment of chest obstruction and heartache by dissipating phlegm and resolving masses, diffusing impediment and activating Yang, such as Gualou Xiebai Baijiu decoction, Gulou Xiebai Banxia decoction, Zhishi Xiebai Guizhi Decoction, Renshen decoction, Fuling Xingren Gancao Decoction, Juzhijiang decoction, Yiyi Fuzi powder, Guizhi Shengjiang Zhishi decoction, Wutou Chishizhi pill, Jiutong pill,etc.[23]. InSynopsisofPreionsoftheGoldenChamber·FeiWeiYongKeSouShangQiBingMaiZhengZhiHou, it was said that heat can hurt blood vessel…heat is the crux of the disease, blood because of this will be stagnant, pathogens accumulate and form abscess. It was pointed out that heat pathogen causes blood stasis, so later generations use Qianjin Weigan decoction to activate blood circulation, eliminate carbuncle, clear lung and expel pus. InSynopsisofPreionsoftheGoldenChamber·XueBiXuLaoBingMaiZhengBingZhi, it was recorded that for blood stasis, Yin and Yang are weak, Cunkou and Guanshang are weak…it is like wind arthralgia, the main treatment is Huangqi Guizhi Wuwu decoction. InSynopsisofPreionsoftheGoldenChamber·XueBiXuLaoBingMaiZhengBingZhi, it was also recorded that for those who suffer from lumbago due to consumptive disease, cramping sensation of the lower abdomen, and difficult urination, Bawei Shenqi pills can be used[24]. Wang Qingren thought that the epidemic toxin and blood stasis should be paid attention to in the differentiation of pestilence, at the same time of detoxification, Qi and blood circulation should be replenished to remove blood stasis[25]. InCorrectiononErrorsinMedicalClassics, Wang Qingren pointed out that those with blood stasis in the chest should use Xuefu Zhuyu decoction; those with blood stasis in the head, face, limbs, blood vessels all over the body should use Tongqiao Huoxue decoction; those with blood stasis in the belly should use Gexia Zhuyu decoction, those with blood stasis in the lower abdominal uterine should use Shaofu Zhuyu decoction, those with blood stasis in the shoulder, arms, waist and leg combined with rheumatism should use Shentong Zhuyu decoction, those with acne and blood stasis in the blood vessels should use Tongjing Zhuyu decoction, those with blood stasis in the epiglottis and choke when drinking should use Huiyan Zhuyu decoction, those with blood stasis in the abdomen below diaphragm should use Gexia Zhuyu decoction, those with blood stasis in the Jinmen and pestilent toxicity causing muscular, spasm and muscular spasm in the initial stage should use Jiedu Huoxue decoction, adults and children with hemiplegia should use Buyang Huanwu decoction, those with leg paralysis and various sores should use Buyang Huanwu decoction, those with blood stasis blocked in the blood vessels of retching, irritable, sleepless symptoms should use Tongjing Zhuyu decoction[26]. It was also pointed out inCorrectiononErrorsinMedicalClassicsthat those with cough, excessive panting, shortness of diet, weakness of limbs, fever in the afternoon and especially at night should use Tongqiao Huoxue decoction[27]. According to Wang Qingren’sWenDuTuXieZhuanJinShuo, vomiting and diarrhea are caused by the fact that the pestilence toxin enters the trachea from the mouth and nose, reaches the blood vessels from the trachea, coagulates the Qi and blood, chokes up the Jinmen, and the water cannot be obtained, which are treated by activating the blood and detoxifying the toxin, the Jiedu Huoxue decoction is created by combining the two methods of detoxification and promoting blood circulation. It was also like the book ofLunDouFeiTaiDuthat when the plague is very severe, the pestilent toxicity will burn its blood inside, and if the blood is burned, the blood will coagulate…. At the same time, it was proposed to use both the method of detoxifying and promoting blood circulation to drive blood stasis and the method of invigorating Qi, Tongjing Zhuyu decoction and Huiyan Zhuyu decoction should be used. The simultaneous use of detoxification and blood circulation has been clinically used to date for the treatment of febrile diseases such as septicopyemia, pneumonia, erysipelas, herpes zoster and other fire-toxicity syndromes[28].

8.2 Syndrome differentiation of COVID-19 with integrated Chinese and Western medicineReferring to COVID-19 combined with integrated traditional Chinese and Western medicine recommended inCircularontheIssuanceofCOVID-19DiagnosisandTreatmentProtocol(TrialSeventhEdition) issued recently by National Health Commission of the People’s Republic of China and National Administration of Traditional Chinese Medicine[1], COVID-19 can be mainly divided into: mild case: Cold-damp constraint in the lung pattern, damp-heat accumulation in the lung pattern; moderate case: Damp-toxin constraint in the lung pattern, cold-damp obstructing the lung pattern; severe case: Epidemic toxin blocking the lung pattern, blazing of both Qi and Ying pattern; critical case: Internal blockage and external desertion pattern; convalescence: Lung-spleen Qi deficiency pattern, deficiency of both qi and yin pattern. Chinese patent medicines as follows are recommended, such as Qingfei Paidu Decoction, Huoxiang Zhengqi Capsule, Jinhua Qinggan Granule, Lianhua Qingwen Capsule and Shufeng Jiedu Capsule. Injection fluid as follows are recommended, such as Xuebijing injection, Reduning injection, Tanreqing injection, Xingnaojing injection, Shenfu injection, Shengmai injection, Shenmai injection,etc.

8.3 At the same time of clearing lung, detoxification and phlegm, the drugs of clearing heat and resolving phlegm, promoting blood circulation and removing blood stasis should be added appropriatelyBased on our long-term experience in treating chest stuffiness and pains caused by intermingled phlegm and blood stasis, and intermingled phlegm, blood stasis and toxin, it was suggested that when COVID-19 lung disease damage the heart, it is advisable to start with the syndrome of mutual accumulation of phlegm, blood stasis and poison, in addition to clearing away the lung-heat, detoxifying and eliminating phlegm, the drugs of clearing heat and resolving phlegm, promoting blood circulation and removing blood stasis can be added appropriately. In the treatment and rehabilitation periods, the above classic prescriptions can be used dialectically in clinical and rehabilitation treatment for patients with chest stuffiness and pains, such as Qingfei Paidu decoction, Gualou Xiebai Banxia decoction, Xuefu Zhuyu decoction, Tongqiao Huoxue decoction, Jiedu Huoxue decoction, Tongjing Zhuyu decoction, Huiyan Zhuyu decoction, Qianjin Weijing decoction, Huangqi Chifeng decoction, Huangqi Guizhi Wuwu decoction,etc. Danlou tablets, a state-level new drug developed by us for the treatment of chest stuffiness and pain, and Danqu capsules for the treatment of the mutual junction of phlegm and blood stasis are also reasonable choices. Danlou tablet can not only be used in the treatment of coronary heart disease angina pectoris with phlegm and blood stasis syndrome, but also has the advantages of anti-thrombosis, improving vascular endothelial damage, reducing blood lipid, stabilizing plaque and improving cardiac function[29]. Studies have confirmed that treatment of acute episodes of chronic obstructive pulmonary disease combined with Danilou tablets is helpful to improve airway ventilation function and increase vital capacity[30]. "Danqu capsule" as a hospital preparation in Shaanxi Provincial Hospitals of Traditional Chinese Medicine has been in clinical application for many years; after years of clinical and basic research, Danqu capsule can treat angina pectoris of coronary heart disease and heart failure with mutual syndrome of phlegm, blood stasis and toxin[31], alleviate myocardial damage, reduce arterial systolic pressure and diastolic pressure, and affect the time index of myocardial tension[32]. For patients with COVID-19, coronary heart disease and high blood pressure, and patients who take antihypertensive drugs of ACI class and ARB class orally, according to the advice of Professor Liu Lisheng, a hypertension expert, COVID-19 patients with mild hypertension should stop taking antihypertensive drugs of ACI class and ARB class, in severe cases, drug withdrawal should be stopped immediately, diuretics, dipine antihypertensive drugs, and pipe-expanding antihypertensive drugs can be used for treatment[33]. Danqu capsule can also be used as a choice of traditional Chinese medicine to fight intermingled phlegm, blood stasis and toxin and reduce blood pressure.

To sum up, it is not unreasonable for Ye Tianshi to say that if you suffer from warm pathogenic bacteria, it will first attack the lungs, and then reverse and invaginate pericardium. COVID-19 is the first to infect the lungs, the heart is a main important harrowing organ for extra pulmonary damage caused by novel coronavirus, ACE2 mediated by ACE2 causes damage to the RAS system; secondly, myocardium is extremely sensitive to acute severe hypoxia, which directly leads to energy metabolism crisis of myocardium, in severe cases, severe myocardial damage, even extensive myocardial cell necrosis, and acute ischemic myocarditis may occur; moreover, inflammatory factor storm induced by novel coronavirus infection can also directly damage the myocardium. So, COVID-19 is bound to be transmitted back to the heart. COVID-19 has a comprehensive manifestation of phlegm, blood stasis and toxin, in clinical and rehabilitation treatment, it is also worth further investigation and discussion to demonstrate the interaction among phlegm, blood stasis and toxin.