Preventive Effect of Xiangsha Yangwei Pills on the Novel Coronavirus Pneumonia from "Genuine Qi Exists, Illness Never"

Rong LI, Yongqiang KANG*, Yuxin JIA, Maosheng RAN, Xiujuan ZHAO, Yeping YANG, Caiyun MI

1. The Second People’s Hospital of Lanzhou City, Lanzhou 730030, China; 2. Gansu University of Chinese Medicine, Lanzhou 730030, China

Abstract The preventive effect of traditional Chinese medicine on the novel coronavirus(COVID-19) pneumonia is embodied in the "prevention before disease onset" of "treatment of disease" theory of thought, and it is considered that the key to the success or failure of prevention is whether the healthy qi is abundant or not. This article discusses and understands the "genuine qi" from the The Medical Classic of the Yellow Emperor, and describes its meaning comprehensively and systematically, combining with the expansion and supplement of many doctors in later generations. The "genuine qi" includes healthy qi, pulse qi, congenital qi, personal qi, Jing qi primordial qi and food energy, all of which are closely related to spleen-stomach. The function of spleen-stomach is normal, water and grain are transported properly, and the rise and fall of qi is appropriate, then the human body’s qi is abundant, the anti-evil force is strong, and people are not easy to cause disease; even if the disease, the prognosis is better. This the novel coronavirus pneumonia comprehensive analysis, belongs to the traditional Chinese medicine science "damp-toxin epidemic", therefore the prevention should pay more attention to strengthen spleen and stomach, eliminate dampness, and Xiangsha Yangwei Pills is the appropriate choice.

Key words Treatment of disease, Genuine qi, Prevention, Xiangsha Yangwei Pills, Novel Coronavirus Pneumonia, Damp-toxin epidemic

1 Introduction

In traditional Chinese medicine, the word "genuine qi" first appeared inTheMedicalClassicoftheYellowEmperor, which is the core content of its thoughts on qi, there are 23 references to "genuine qi" and more than 100 references to "Zhen" in the book, it also expressed its meaning in detail in such chapters asSuWen·ShangGuTianZhenLun,SuWen·YuJiZhenCangLun,LingShu·CiJieZhenXie,LingShu·XieKe,etc., specifically, it can be roughly divided into four categories, that is, the healthy qi of human body, the qi of meridians, the congenital qi, and the qi of Zang Zhen. On the basis of inheriting the theory of "genuine qi" inTheMedicalClassicoftheYellowEmperor, the later physicians have developed and supplemented it in varying degrees, such as qi of the whole body, essential qi, the primordial qi, and essence derived from food,etc.

2 Understanding of "genuine qi" in The Medical Classic of the Yellow Emperor

2.1 Healthy qi of human bodyAs opposed to evil qi, the healthy qi of human body refers to body’s ability to resist evil or the recovery of the body. InSuWen·ShangGuTianZhenLun, it was recorded that if people’s desires such as fame and wealth are removed, we will naturally have less troubles, don’t stick to them for a long time, when appropriate, they should be put down, subtracted and emptied, so that we can have a leisurely and comfortable heart. Don’t deliberately yearn for or pursue all kinds of physical touch, but keep the spirit inside and observe it with a calm heart, so that the spirit will naturally yearn for and harmonize with each other in the body. Because it is subtle and ubiquitous, it will sweep away all the haze obstacles like sunlight. At this time, the meridians and joints of the whole body will become smooth and clear, even if there are hidden diseases, they will be removed unconsciously, so that diseases will not happen. Depriving the patient of healthy qi, turning the favorable disease into the adverse disease, dispersing the patient’s Yingfen and Weifen, dispersing the true qi, and keeping the evil qi in the patient’s body, will destroy the patient’s life and bring great disaster to others. InLingShu·XieKe, it was recorded that in this way, the evil qi can be removed and the true qi can be strengthened. InLingShu·CiJieZhenXie, it was recorded that if the true qi leaves and the evil qi stays alone, it will become hemiplegia.

2.2 Qi of meridiansInSuWen·LiHeZhenXieLun, it was recorded that genuine qi is meridians qi. InLingShu·ZhouBi, it was recorded that this kind of disease is that the pathogenic factors have not penetrated into the internal organs, and the external attack has not been shown on the skin, but just stay between the meat, so that the genuine qi can not circulate around the whole body. It was pointed out that the pulse qi in the meridians is a kind of genuine qi.

2.3 Congenital qiInLingShu·CiJieZhenXie, it was recorded that genuine qi is the life energy which is derived from the combination of natural clear qi (oxygen) and grain essence (nutrient) ingested by diet, it is the material basis and power source of human life activities. It showed that the genuine qi is a kind of innate qi inherited from heaven, which combines with the qi of water and valley to nourish the body together.

2.4 Qi of Zang ZhenThe qi of Zang Zhen refers to the qi of the five internal organs of human body, namely liver qi, heart qi, spleen qi, lung qi and kidney qi, its essence is the distribution of the qi of human body in each Zang and Fu. InSuWen·PingRenqiXiangLun, it was recorded that the liver is vigorous in spring, and the qi of Zang Zhen is scattered in the liver, which is to nourish the qi of fascia; the heart is vigorous in summer, and the heart controls the blood vessels; the spleen is vigorous in long summer, and the visceral qi of long summer moistens the spleen, and the spleen controls the muscles, and the spleen stores the muscle qi; in autumn, the visceral qi is stored in the lung, and the lung controls the qi toward the pulse, which is the disease-free flat pulse; the kidney is vigorous in winter and lives in the lower Jiao of human body, and the visceral qi is stored in the kidney in winter. InSuWen·PingReBingLun, there was also a discussion that water belongs to Yin, and the part under the eyes belongs to Yin, and the abdomen is also the place where Yin is, therefore, if there is water in the abdomen, it will make the part under the eyes swollen. The qi of water evil attacks the heart, forcing the qi of Zang Zhen’s heart fire to go against, so the mouth is bitter and the throat is dry.ShangGuTianZhenLunis the opening work ofHuangDiNeiJing·SuWen, which is named after "Tian Zhen". It mainly discusses the gap between "ancient people" and "modern people" in life span, spirit and action (life activities, disease occurrence, health preservation),etc., and points out that the reason why people in ancient times could live a hundred years and keep their actions is that people in ancient times understood the principle of the operation between heaven and earth, that is, the harmony between Yin and Yang, and that everyone’s fate had a fixed number, so they did not act against the principle of the normal operation of heaven and earth, then in daily life, they had a moderate diet, regular work and rest, paid attention to spiritual care, and combined work with rest. In this way, the body and spirit can be in harmony, and they can live a long and good life. Modern people, however, don’t like this, they take wine as a drink and lead an abnormal life style, they are also used to having sex day and night upside down. After getting drunk, they discharge their essence for pleasure, as a result, they dissipate qi, they don’t know how to keep the spirit full and are not good at recuperating qi. In the end, they are greedy for a moment’s happiness and go against the pleasure of health preservation, because "contrary to the normal law of life, there is no principle of life", so they have been almost 50 years old from the beginning of the unhealthy, movement is not good. Therefore, the sage taught that if people want to get rid of illness and prolong their life and maintain health, they must maintain the true qi, that is, if people’s desires such as fame and wealth are removed, we will naturally have less troubles, don’t stick to them for a long time, when appropriate, they should be put down, subtracted and emptied, so that we can have a leisurely and comfortable heart. Don’t deliberately yearn for or pursue all kinds of physical touch, but keep the spirit inside and observe it with a calm heart, so that the spirit will naturally yearn for and harmonize with each other in the body. Because it is subtle and ubiquitous, it will sweep away all the haze obstacles like sunlight. At this time, the meridians and joints of the whole body will become smooth and clear, even if there are hidden diseases, they will be removed unconsciously, so that diseases will not happen.

3 The expansion and supplement of "genuine qi" by later physicians

3.1 Personal QiYang Shangshan annotatedLingShu·JueqiinHuangDiNeiJingTaiSu, the Yellow Emperor said: "I have heard that human beings have the essence, qi, jin, fluid, blood and pulse, I thought they were all one qi, but now they are divided into six names. I don’t know the truth". It was believed that true qi is the general term of human body qi (essence, qi, Jin, fluid, blood and pulse), it said that true qi is the qi of human body, which has six names, it was pointed out that the personal qi is opposed to the evil qi, that is, true qi is healthy qi. This is the same as the following doctor’s judgment, for example, Ma Shi said that "the true qi is healthy qi", and Yu Jiayan said that "the true qi lies in three aspects, namely, upper, middle and lower…", "If qi is harmonious, it is healthy qi and also true qi". Pulse qi is the qi of the meridians in the circulation of the pulse, it is one of the six parts of the true qi, it is the division of human body qi in the pulse, pulse qi also contains the essence of qi, blood, Jin and fluid in the blood.

3.2 Vital essenceThe acquired qi will generate essence. Li zhongzi held inNeijingZhiYaothat the essence qi is the healthy qi, is the essence material transformed by cereals. The essence of innate qi is transformed into essence qi. Ma Yuantai believed that the genuine qi is born with nature and received it from heaven; Zhang Zhicong believed that the essence is innate. However, the innate essence receives a large amount, and after birth, it is consumed all the time in the process of growing, strengthening and aging. Therefore, it must be combined with the essence derived from food to fill the body, and rely on the nourishment of the acquired water and essence derived from food to make it grow stronger.

3.3 Promordial QiIn Miao Xiyong’sShenNongBenCaoJingShu, it was said that stomach qi is the acquired vital energy, which is based on the essence derived from food; Li Dongyuan said that genuine qi is also called primordial qi; Li Yongcui showed inZhengZhiHuiButhat the promordial qi of human beings is strong, nutrient qi and defensive qi are harmonious, and the striae and interstitial space is dense, how can external evil do harm to human beings. These showed that the primordial qi can resist the evil and make the body less susceptible to disease. InTreatiseontheSpleenandStomach, Li Dongyuan systematically discussed the close relationship among innate genuine qi, qi of spleen and stomach and organism from the aspects of physiology and pathology, it was considered that physiologically, the spleen and stomach are well received and decomposed, and the function of transporting water and grain is normal, if the water and grain are properly transported and the rise and fall are appropriate, the qi of water and grain is sufficient, which can nourish the innate qi, make the qi abundant, and maintain the health of the body; on the contrary, if the qi of the spleen and stomach is deficient or the food is damaged carelessly, then the innate qi can not be nourished, if the qi of the spleen and stomach is deficient, it can not fill the body, then the evil and evil wind will invade the body, and all kinds of diseases will arise. Therefore, promordial qi is the essence of the body, not the stomach qi.

3.4 Essence derived from foodInRenZhaiZhiZhiFangLun, Yang Shiying stated that people’s true qi is exuberant when they eat and drink into the stomach, if the stomach is harmonious, the essence derived from food will rise; according to Yu Jiayan’sYiMenFaLu, it was said that the essence of water and food in the stomach and the fierce qi of water and food are both healthy qi. It showed that the healthy qi comes from the qi of water and food, which is closely related to the function of spleen and stomach.

4 Xiangsha Yangwei Pill

4.1 Origin, composition and efficacyXiangsha Yangwei Pill has many sources, it was recorded in Zhang Shiche’sSheShengZhongMiaoFang, Wu Zhiwang’sJiYinGangMu, Nian Xiyao’sJiYanLiangFangand Fang Gu’sYiLinShenMoDaQuan. Although the name of the prescription is the same, its drug composition and efficacy have their own characteristics. At present, Xiangsha Yangwei Pill produced by pharmaceutical factories in circulation are based on thePharmacopoeiaofthePeople’sRepublicofChina(2005 Edition), this prescription came fromZaBingYuanLiuXiZhuby Shen Jin’ao, a doctor in qing Dynasty, the whole prescription consists such 14 kinds of traditional Chinese medicine as Radix Aucklandiae, Fructus Amomi Villosi, Atractylodes Macrocephala, Pericarpium Citri Reticulatae, Poria, Rhizoma Pinelliae, prepared Rhizoma Cyperi with vinegar, roasted Fructus aurantii immaturus, Fructus Amomi Rotundus(peeled), ginger-processed officinal magnolia bark,Pogostemoncablin, liquorice, ginger, Fructus Ziziphi Jujubae, which has the effects of supplementing qi and strengthening spleen, warming the middle and harmonizing the stomach, regulating qi and resolving phlegm, and highlights the functions of warming the middle, promoting qi and resolving dampness. This prescription is based on Xiangsha Liujunzi Decoction, ginseng is removed, cyperus rotundus, Fructus Aurantii Immaturus andMangnoliaofficinalisare added to enhance the power of qi circulation and broadening,Agastacherugosus, Fructus Amomi Rotundus, ginger and Fructus Ziziphi Jujubae are added to enhance the power of invigorating the spleen, removing dampness and warming the middle.

4.2 Scope of applicationThis prescription is suitable for pattern of spleen-stomach vacuity cold, syndrome of blockade of dampness due to qi stagnation, spleen disorder due to cold and dampness, syndrome of dampness invading spleen,etc., the symptoms include dull stomach pain, vomiting, clear phlegm and saliva, abdominal distension, noisy discomfort, no appetite, sallow complexion, lack of qi and lazy speech, mental fatigue, bowel sounds and diarrhea,etc. Modern pharmacological research showed that Xiangsha Yangwei Pill can regulate gastrointestinal function by regulating the secretion of digestive juice, and play the role of inhibiting ulcer, bacteriostasis and cholagogic[1]; some studies have also proved that according to the treatment principles of traditional Chinese medicine "supplementing spleen to nourish lung" and "reinforcing the mother-organ to treat deficiency", additional oral Xiangsha Yangwei Pill can significantly improve the anti-infection treatment effect, shorten the course of treatment, and promote the recovery of body function in patients with respiratory tract infection of spleen deficiency and dampness stagnation type[2].

5 TCM knowledge of new coronavirus pneumonia (COVID-19)

The novel coronavirus pneumonia(COVID-19) occured at the turn of winter and early spring, and the luck was characterized by the end of 2019, and the influence of ministerial fire, and the phenomenon of winter warming. InTheMedicalClassicoftheYellowEmperor, it was said that at this time, the climate is not too cold, yang is leaked, people will be more comfortable, but are prone to winter temperature diseases, such as fear of cold and fever, a series of symptoms such as sore throat, fever, yellow phlegm, and even epidemic febrile[3]. At this time, the human body is most vulnerable to the evil of perverseness. The disease has obvious seasonal characteristics, and has a very strong infectious, large-scale onset, rapid onset, serious disease, transmission, rapid development, the patient’s symptoms have many similarities[4]: (i) Fever, most of the patients have no body heat, sore throat, dry cough, less sputum and other respiratory symptoms; (ii) The patients have the symptoms of tiredness, fatigue and other spleen qi deficiency; (iii) Most of the patients are accompanied by the symptoms of stomach and intestines, such as inappetence, nausea, sparse and unformed excrement; (iv) The patients have the symptoms of qi deficiency and dampness stagnation, such as bitter taste, dry mouth and no desire to drink,etc. (v) The patients also have the symptoms of internal resistance of dampness, such as dark tongue, slightly red tongue sharp edge, thick and greasy tongue coating.

To sum up, the pneumonia has the characteristics of seasonality, infectivity, epidemic, similar symptoms, rapid onset and rapid development, and so on. It is an acute infectious disease, which belongs to the category of "typhoid", "febrile disease", "pestilence" and "epidemic toxin" of traditional Chinese medicine. As Chao Yuanfang said inZhuBingYuanHouLun·WenBingZhuHou, this disease is caused by the bad season, lack of integrity between the warm and the cold, and people’s feeling of grumpiness. If people get sick, then the disease and qi will change and infect each other easily, and even destroy the family, extending to outsiders[5].

According to the characteristics of five movements and six dlimates at the time of onset, combined with the comprehensive analysis of the above clinical symptoms, the epidemic virus disease was caused by dampness evil, and it was "dampness toxin", namely "dampness toxin epidemic"; the disease is located in the lung, which is closely related to the spleen and kidney; the basic pathogenesis is dampness toxin stasis and qi stagnation. Dampness is yin evil, vulnerable to yang qi; the spleen is in charge of transportation and transformation, and likes dryness and hates dampness, so exogenous dampness evil is the most likely to trap the spleen, resulting in deficiency of spleen Yang, transportation and transformation is not enough, making water and dampness endogenous, then internal and external dampness evil is trapped. Dampness is the pathogenic factor of heavy turbidity, it is easy to suppress qi mechanism, make viscera qi abnormal, and obstruct meridian qi. The spleen and stomach are located in the middle Jiao, and belong to the earth of the five elements, the dampness pathogen is the most likely to invade the middle Jiao, resulting in abnormal qi movement, the clear Yang should not rise, and the turbid Yin should not fall, it is difficult to distinguish between the clear and the turbid. If the clear qi is in the lower part, it will produce dinner discharge, and if the turbid qi is in the upper part, it will produce distension, the symptoms include fullness of chest cavity, no appetite, nausea and loose stool, and so on. The lung is the main body of qi, but it is blocked by dampness, and the qi mechanism is abnormal, therefore, cough, bad throat and other lung diseases can be seen. Dampness evil is blocked inside, which affects the gallbladder qi and makes the gallbladder qi unfavourable, the excretion of essence is not smooth, and the gallbladder qi is disturbed, so the mouth is bitter. The dampness is heavy, and Yang qi is trapped, the deficiency of Yang qi in the human body leads to the feeling of dampness, which hinders Yang qi and prevents it from rising to the head, the head is heavy and bulging or even fainted, such as wrapped in the shape of things, these are recorded inSuWen·ShengqiTongTianLun. It is also characterized by turbid nature, face dirt, excessive diarrhea, loose stools, turbid urine, wet sticky, then feces and secretions sticky, thick and greasy tongue coating.

6 Mechanism of Xiangsha Yangwei Pill in the prevention of COVID-19

There is a direct discussion about "epidemic disease" inSuWenCiFaLun, the Yellow Emperor said, "I’ve heard that the five epidemic diseases can infect each other. The symptoms of both adults and children are the same. How can we prevent them from infecting each other if we don’t treat?" qi Bo said, "The reason why the disease is not infected is that the healthy qi is enriched in the body. The evil qi can not be violated, and the poisonous qi must be avoided. The evil qi enters from the nostril and comes out from the nostril. If the healthy qi comes from the brain, the evil qi can not be committed…"[6]. It shows that the basis of prevention of epidemic infection is "keeping healthy qi inside", it can be seen that the filling of human positive qi is the key to prevent success, just as "if the reason why the disease is not infected is that the healthy qi is enriched in the body. The evil qi can not be violated, and the poisonous qi must be avoided". Treatment based on syndrome differentiation is the essence of traditional Chinese medicine, and seeking the cause of disease is not only the basis of traditional Chinese medicine treatment, but also the theoretical basis of disease prevention. The qi of pestilence and toxin is the external cause, and the deficiency of true qi is the internal cause. If the external cause is combined with the internal cause, the disease will occur. If the true qi is stored in the body, the healthy qi is full, the body has strong anti-evil force, and the external evil qi attacks, it can resist the evil and prevent the disease from happening; even if it is pathogenic, it is easy to recover, avoid the invading of evil and poison, and cut off the vitality. FromTheMedicalClassicoftheYellowEmperorto the later physicians’ understanding and discussion of "true qi", on the whole, it is inseparable from the spleen and stomach function of zhongjiao, "the middle jiao is vigorous, the valley qi is abundant, the spleen and stomach qi is sufficient, the congenital essence qi is fully raised, and the true qi is stored", and vice versa. Xiangsha Yangwei Pill is a good prescription for the treatment of spleen and stomach weakness, dampness stagnation and qi stagnation. In this case, the novel coronavirus pneumonia(COVID-19) was caused by dampness, and the dampness was toxic, the evil of dampness was intrinsically committed, which was most likely to trap middle Jiao and cause disease. In case of spleen deficiency and dampness, the disease was inevitable. Therefore, the novel coronavirus pneumonia(COVID-19) is currently being treated by regulating spleen and stomach, tonifying spleen, harmonizing stomach and resolving dampness, and Xiangsha Yangwei Pill is the appropriate choice of Chinese patent medicine.

7 Conclusions

The main academic thought of the theory of "preventive treatment of disease" in traditional Chinese medicine includes three stages: prevention before disease, prevention of disease and rehabilitation. In this study, "true qi" was taken as the breakthrough point, from the perspectives of "if the true qi exists, the disease will never be safe" and "if healthy qi is enriched inside, evil qi cannot be violated", Xiangsha Yangwei Pill has been deeply discussed on the TCM prevention theory of COVID-19. It is hoped that this study can benefit the national health and make a modest contribution to the cause of TCM epidemic prevention.