Theoretical discussion on TCM intervention of COVID-19

Yi-Bing Xu

1College of Traditional Chinese Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250300,China.

Abstract Chinese medicine has played an important role in the treatment of COVID-19.The pneumonia caused by the COVID-19 belongs to the category of"epidemic disease" in the theoretical system of Chinese medicine, therefore, the mechanism of action of COVID-19 and its mutated strains is used to analyze the principle of the disease and its treatment.The treatment rules and methods are based on the characteristics of the TCM theoretical system—the discriminatory treatment; the characteristics of the prescription of drugs for special constitutions (infants,children and the elderly)emphasizing the differences in the use of drugs for different groups of people and tailoring the treatment to the individual; and then summarizing the current situation and future development directions of COVID-19 treatment.This is followed by a summary of the current status and future directions of COVID-19 treatment and how to improve experimental studies and finally a brief summary of the prescriptions used in Chinese medicine since ancient times in dealing with major epidemics.

Keywords: COVID-19; New Coronary Pneumonia; Chinese medicine; cold-dampness epidemic;identification and treatment

Background

Around Chinese New Year 2019, an outbreak in the city of Wuhan quickly struck the world.The epidemic, known as COVID-19, has plunged the world into a crisis with a very high rate of transmission and a very high probability of mutation—China, as a flourishing socialist country, has demonstrated its reverence and respect for life by adopting a"people-centred"attitude and ideology.

As a treasure of Chinese medicine with a thousand years of history,China was the first to analyse COVID-19, formulate epidemic prevention plans, actively combat the epidemic, prepare epidemic prevention supplies and increase medical resources......It was a leading and guiding force in the world's epidemic prevention process.It is worth mentioning that Chinese medicine, the treasure of China, has played an important role in this "war against the epidemic".Because of its unique theoretical thinking, Chinese medicine looks at epidemics from a different perspective, and its treatment methods are instructive and thought-provoking.

Different measures in Chinese medicine for the"old"and "new" versions of the COVID-19

Analysis of New Coronary Pneumonia (NCP) changes according to the"Liu Qi"theory of Chinese medicine

The so-called"Liu Qi"are"the wind","the cold","the heat","the humidity","the dry" and "the fire".This is a collective term for six types of external illnesses.They are all subject to a certain amount of change.There are certain limits to climate change.There are three main reasons for the transformation of the "Liu Qi" of nature into the "Liu Qi": firstly, the "Liu Qi"(or climate)change beyond the normal limits of the human body,making the body unable to adapt; secondly, the "Liu Qi" changes abnormally, not at the right time but at the right time, and the climate change is too rapid.The third is that the body's ability to adapt to changes in the external environment has gradually weakened over the course of human evolution, or that the body's ability to resist external evil has weakened during special periods such as the elderly, or that women are vulnerable to external evil during their physiological periods.In short, it means that changes in the "Liu Qi" of nature or changes in the human body itself that make the organism unable to adapt to the "Liu Qi" will lead to illness,thus leading to the"Liu Qi",which are "Liu Qi" transformed from being harmless to the human body to being harmful to the process, which is also an important factor in the pathogenesis of infectious diseases.

Since ancient times, in Chinese medical theory, both SARS and Neoplasm are caused by external evil.From the results of the dialectical examination, the initial COVID-19 showed evidence of "cold and dampness", which is also related to the natural environment at the end of 2019, and I believe that the widespread spread of the virus and such an environment have the meaning of "the same qi seeking each other", which also reflects the "holistic concept" of traditional Chinese medicine thinking.This also reflects the"holistic concept"of traditional Chinese medicine.

The initial stage of the COVID-19 has the evil of"cold and dampness",which is a combination of"cold" and"dampness"."Cold is a"Yin"(Yin and Yang are a pair of categories in ancient Chinese philosophy.The original meaning refers to the back of the sun,the sun is Yang,the back of the sun is Yin.From this extension, it is the cold and warm climate, the up and down,around,inside and outside of the azimuth,and the restlessness and tranquility of the movement state.It is used to represent the positive and negative aspects of opposites and mutual fluctuations of things,and then expounds the rules of occurrence, development and change of things.) evil, easily injuring"Yang" (Yin and Yang are a pair of categories in ancient Chinese philosophy.The original meaning refers to the back of the sun, the sun is Yang,the back of the sun is Yin.From this extension,it is the cold and warm climate, the up and down, around,inside and outside of the azimuth, and the restlessness and tranquility of the movement state.It is used to represent the positive and negative aspects of opposites and mutual fluctuations of things,and then expounds the rules of occurrence, development and change of things.) energy", it is easy to injure the surface of the body, and the cold nature of the collection and attraction is easy to make the sweat hole contract,blocking the dissemination of"Wei Qi"(Wei Qi is a physiological term.It is a kind of Yang Qi.), so that people's resistance to external evil function is weakened;and the damp evil is also a yin evil,blocking the"Qi Mechanism"(the normal operation mechanism of Qi in human body includes the functional activities of zang-fu organs and meridians.).The compound of the two evils of cold and damp makes the COVID-19 grow at the end of 2019 in accordance with the climate and is not easy to prevent.

In 2020,a COVID-19 mutant strain,"Delta virus", began to tighten the newly relieved heartstrings.The Delta mutant strain was first discovered in India in October 2020; in May 2021, WHO named the new crown mutant strain B.1.617.2 "Delta" [11].Delta virus is an mRNA virus, highly susceptible to genetic mutations, and belongs to the selective evolution of COVID-19.Compared with COVID-19, it is characterized by faster transmission,shorter pathogenicity incubation period, slower transmigration,more severe symptoms, longer treatment period, and atypical early onset symptoms [12].According to the World Health Organization, as of November 12, 2021, the mutant strain has spread to 132 countries and territories,causing more than 100 million infections[10].

As the climate changes and the weather becomes hotter, the early COVID-19 gradually loses its activity, while Delta is rampant at this time.According to the ancient book of Chinese medicine "Huangdi Neijing"(Yellow Emperor’s Inner Classic; 221B.C.E.–220C.E.), the natural environmental property of the summer of XinChou is "Damp-Heat"(Damp-Heat is an etiological noun.It's refers to a disease—A combination of heat and humidity.),and from the "holistic concept" of Chinese medicine,Delta was born at this time because its property is the same as that of the climate, which is "hot and humid".This explains why such a hot climate makes delta flourish[1].

Dialectical treatment-measures to treat"old"and"new"NCP

According to the climate at the end of 2019,Wuhan experienced high rainfall and a cold winter, creating favourable external conditions for the development of the "cold and wet disease".For example, the half-life of the virus decreased from 6.3 to 18.6 hours to 1.0 to 8.9 hours when the temperature increased from 24°C to 35°C under constant relative humidity conditions.Taken together, NCP does prefer a cold and humid environment[8].

The early clinical manifestations of NCP are vicious chills and fever,body aches and pains,chest tightness and breathlessness,shortness of breath,weakness, dry cough with little sputum, poor spleen and stomach, mucousy stools, pale and fat tongue with teeth marks, white thick and greasy or thick and rotten tongue coating (or a dark, greenish-purple tongue with yellow coating),and a slippery or moist[7]pulse.The key to this is to"promote the lung and dispel dampness".It is based on the four-pronged formula of decoction of Mahuang (Ephedrae Herba), Xingren (Almond), Shigao(Gypsum Fibrosum) and Gancao (Glycyrrhizae Radix Et Rhizoma),Xiaochaihu decoction, Wuling powder and Yegan Mahuang decoction,which is composed of 21 herbs, includingEphedrae Herba, Zhigancao(Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle),Almond,Shengshigao (Gypsum Fibrosum), Guizhi (Cinnamomi Ramulus), Zexie(Alismatis Rhizoma), Zhuling (Polyporus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chaihu (Bupleuri Radix),Huangqin (Scutellariae Radix), Jiangbanxia (Pinelliae Rhizoma Praeparatum Cum Zingibere Et Alumine), Shengjiang (Zingiberis Rhizoma Recens) and Yegan (Belamcandae Rhizoma).It is suitable for the treatment[4] of all stages of COVID-19.It is effective in clearing the lung and relieving asthma, as well as pungent and cooling the exterior of the lung.It also promotes the lung without aiding heat, and clears the lung without cooling the body.The combination of all these formulae is effective in promoting unification of the"Sanjiao"(Sanjiao is one of the six Fu organs.It has the function of presiding over various Qi and dredging waterways.) and expelling evil from the body.

For the"Damp-Heat"property of the new strain of Delta virus, Chinese medicine practitioners use "Jin Hua Qing Gan Granules" (SFDA:Z20160001), which is based on the addition and subtraction of Maxing Shigan decoction and Yinqiao power.This formula is made up of 12 herbs,including Jinyinhua(Lonicerae Japonicae Flos),Gypsum Fibrosum,Roasted Ephedrae Herba, Zhimu (Anemarrhe Naerhizoma), Lianqiao (Forsythiae Fructus),Kuxingren(Armeniacae Semen Amarum),Scutellariae Radix,Bohe(Menthae Haplocalycis Herba), Aiye (Artemisiae Argyi Folium) andGlycyrrhizae Radix Et Rhizoma, which are effective in clearing heat and detoxifying toxins, dispelling wind and relieving symptoms, and relieving irritation and heat[4].

Traditional Chinese medicine treatment in different disease stages

Prevention

During the prevention phase of NCP, universities around the world have introduced "anti-epidemic decoction" to strengthen the body's resistance."One of the causes of plague is the lack of the body's own vital energy.One of the causes of plague is the "deficiency of the body's own vital energy", so the focus of "anti-epidemic decoction" or other anti-epidemic medicines is to protect the body's vital energy.Chinese medicine suggests the use of Huangqi (Astragali Radix), which can defend against external evil and solidify"Wei Qi".Zhang Yuansu(1131–1234)has said that"Astragali Radixis sweet, warm and pure Yang, and has five functions......The Chinese medicine practitioner has said that "Astragali Radixis sweet,warm and pure"Yang", and has five functions: to benefit the vital energy", while Li Gao(1180–1251) also said that "Fangfeng (Saposhnikoviae Radix) can controlAstragali Radix, and ifAstragali RadixandSaposhnikoviae Radixare used together, the more effective they are, this is a pairing that is fearful of each other but makes each other.This is a combination of mutual fear and mutual ambition.The pairing of the two can both consolidate righteousness and dispel the symptoms and expel the evil.In the case of the Delta virus,Chinese medicine practitioners suggest the use of medicines such as Guanghuoxiang(Pogostemonis Herba)to clear heat and detoxify the body in view of the hot summer conditions.

In the prevention phase, doctors should develop a programme based on the variability of the human constitution, for example, children should not receive medicines that are too stimulating, as well as avoiding food according to their constitution.

Initial

As the invasion of cold and dampness in the six evil spirits enters from the surface, the disease felt by the mildly ill patient has not yet passed on and stays at the initial evidence of the disease.If the cold and damp attack reaches the lung,Xiao Qinglong decoction can be used to remove water from the surface and resolve phlegm in the lung; if the cold and damp attack reaches the spleen, the dampness is heavy and sticky,and dampness tends to trap the spleen and prevent it from being transported and transformed,Huoxiang Zhengqi powder [3] can be used to treat the evidence of external wind and cold and internal dampness and stagnation.

Mid-term

The cold and damp "Qi"(one is a physiological term.It refers to the flow of nutrient-rich fine matter in the body, such as the Qi of water and grain, and the Qi of breathing.Second,it refers to the function of organs,such as the Qi of the five viscera, the Qi of the six Fu organs.) penetrates deeply from the surface into the interior and is affected by the body's subtlety and the external environment to manifest different evidence of cold and heat.

If the cold and dampness are obstructed by cold and dampness,it is easy to trap the spleen, lung and other organs, causing phlegm and dampness,stasis of blood and other symptoms,so we can use Maxing Shigan decoction and Xuefu Zhuyu decoction with addition and subtraction to cool and ventilate, clear the lung and calm asthma [4]; if the cold and dampness lead to "Yang" deficiency in the body, we can use Maxin Fuzi decoction,Ephedrae Herbato release sweat and relieve the surface, but also with Fuzi(Aconiti Lateralis Radix Praeparaia) to protect the kidney Qi, so as not to disperse too much,both hair and tonic.

Influenced by the body's subordination and the external environment,the delta virus, for example, manifests itself as an epidemic of heat transformation.If cold and damp evils are heat-forming and most likely to injure the lung, Xiaochaihu decoction is used to clear the evil and penetrate the surface,to expel "Lung Qi"(Qi is considered to be the force that informs and animates all things in Daoism, which is believed to flow through the body along routes known as meridians; illness is attributed to changes in the flow of Qi according to the construct of Chinese medicine.Lung Qi refers to the functional activity of the lungs and also includes breathing gases.)and to conciliate "Shao Yang" (One of the meridians.It has the meaning of weakening Yang Qi.).If the lung is congested and the internal organs are solid, use Da Cheng Qi decoction to moisten the lung and remove dryness,and diarrhea heat to nourish"Yin".

Critical phase

Patients in the critical stage generally have weak vital energy and their"Yang" energy is lost.At this time they should use medicines to return the"Yang" energy, such as Shenfu decoction, which actively mobilizes the"Yang" energy in the body to return the "Yang" energy and tonify it; Fuzi(Aconiti Lateralis Radix Praeparaia),which is pungent and sweet,is hot and warms the"Yang" energy.If the "Qi"and "Yin" are burnt, clear the heat and detoxify the toxin.

Recovery period

If there is a deficiency of "Yang" energy during the rehabilitation period, if the positive energy is deficient and the positive is not in harmony with the evil, Chaihu Guizhi decoction should be used to reconcile "Shao Yang",warm the Ying and Wei and clear the "Qi"; if the "Qi" is weak and the lung and spleen are both deficient, the "Qi" should be mobilized, then Six Jun Zi decoction should be used to regulate the spleen and stomach and clear the"Qi".

Chinese medicine selects different prescriptions for specific body types to treat the COVID-19

Infants and toddlers

For infants and young children, their internal organs are"formed but not yet complete, complete but not yet solid", and they are"pure Yang bodies".It is also slightly sweet in the mouth, making it more palatable to children.Another characteristic of children is that their spleen and stomach are underdeveloped and they are prone to indigestion.Therefore, the expert group has added Zisuye (Perillae Folium) to the formula, which can both relieve the symptoms and aid digestion.In addition, to address the deficiencies of the spleen and stomach,Atractylodis Macrocephalae Rhizomaand Yiyiren (Coicis Semen) are added to strengthen the spleen and dispel dampness[5].

Elderly

With the increase of age, the essence of the viscera gradually weakens, or because of other reasons of old age diseases,the viscera are damaged in form and quality.The physical characteristics are as follows: First, the immune function decreases,the resistance to external disease sources decreases,and it is easy to contract diseases.Second,self-regulation and rehabilitation ability is reduced, if encountered with disease, the body function is difficult to restore to the original state.Third, there are many underlying diseases, and due to their age,all metabolic capacities decline,and they often suffer from a variety of underlying diseases, which will endanger their lives once they are infected with the virus [13].As of 24:00 on February 3, there were 425 cumulative deaths of NCP patients nationwide, and more than 80% of them were elderly people over 60 years old[13].

In the basic theory of traditional Chinese medicine,there are five stages:"birth, growth, strength, old age, and already", and the elderly have the characteristics of imbalance of yin and yang, gradual deficiency of the five organs, and deficiency of "Qi" and blood biochemistry [14], while the deficiency of essence and "Qi" of the internal organs is the focus.The disease starts in the liver,goes through the heart,spleen,lungs and finally the kidneys.With age, the deficiency of the internal organs is the main physiopathological basis of the elderly[14].Because of the reduced function of the internal organs, the deficiency of essence, blood and "Qi", and the weakness of positive "Qi", it is easy to feel evil after the fight between positive and evil,and various diseases arise.

Because of the weak constitution of Qi in the elderly, some scholars recommend the following combination:Astragali Radix,Atractylodis Macrocephalae Rhizoma,Saposhnikoviae Radix, Qianghuo (Notopterygll Rhizoma Et Radix)Zingiberis Rhizoma Recens,and Peilan(Eupatorii Herba)[14], and the formula contains Yupingfeng powder, which focuses on supporting the righteous and dispelling evil, benefiting "Qi" and strengthening the surface, and supporting Yang Qi.The ancient book of Chinese medicine"Gujin Mingyifang"(Ancient and Modern FamousDoctor's Formulasuggests;1675C.E.)that"Saposhnikoviae Radixis good at expelling wind, and if you getAstragali Radixto fix the surface, you will have something to defend the outside, and if you getAtractylodis Macrocephalae Rhizomato fix the inside, you will have something to base the inside,so that the wind evil will go and not come back".This can support the positive energy of the elderly and improve their resistance to external evil.

Current status and development of Chinese medicine in the treatment of COVID-19 in recent years

On March 12, WHO officially announced that the outbreak of NCP has constituted a global "Pandemic" [15].After the outbreak, Chinese medicine used its centuries of experience in fighting epidemics and warm diseases to make timely and accurate countermeasures, using oral antiviral Chinese medicines such as "Lianhua Qingfei capsules" (SFDA: Z20040063), herbal tonics such as "Qingfei Jiedu decoction", and herbal injections such as The use of oral antiviral Chinese medicine such as "Lianhua Qingfei capsules",Chinese medicine soup such as "Qingfei Jiedu decoction", and Chinese medicine injection such as "Xiyanping injection" [15].In recent years,Chinese medicine has played a stable role in the fight against the epidemic,and has been steadily and orderly for the prevention of the general population and the treatment of patients with mild diseases.And in the future fight against COVID-19,TCM should borrow more digital technology to analyze the effect and efficacy of TCM on the virulent strain,and conduct simulation experiments to further validate and promote it,and improve the shortcomings of insufficient animal experiments and less data.

It is worth mentioning that the combination of Chinese and Western medicine has also played a great role in the fight against the epidemic.As a rapidly developing field in recent years, the combination of Chinese and Western medicine has also demonstrated its"Chinese body and Western use"in the fight against the epidemic.By drawing on the evidence-based and pharmacological analysis of Western medicine, TCM can speed up the screening of Chinese medicines with significant efficacy through scientific analysis and data screening,and develop proprietary Chinese medicines with strong directivity, and enrich the drug delivery channels to provide multi-faceted, comprehensive and multi-angle treatment.As soon as possible, we should establish a clinical drug use and quality assurance system with"full coverage"and"full process"of Chinese medicine treatment[15].

Summary of the development and unique experience in the treatment of epidemic diseases

Since ancient times,epidemics have often afflicted people all over the world.Plague"and"epidemic",which were first mentioned in theYellow Emperor’s Inner Classic, are highly contagious, and "plague" causes disease with"strong contagiousness and easy prevalence.The characteristics of "plague"are "highly contagious and easy to spread", "rapid onset and critical condition", and "one disease with similar symptoms", so its prevention and treatment are very important.Later,after the development of the elaboration of the four great masters of warm diseases, including Wu Youke(1582–1652), the treatment of epidemic diseases finally had a more complete system.

In the struggle against epidemics, medical practitioners of all generations were courageous in research and innovation, forming new medical theories and methods.At the end of the Eastern Han Dynasty(25C.E.–220C.E.), when epidemics were prevalent, Zhang Zhongjing(About 150–154C.E.–about 215–219C.E.) wrote"Shanghanlun"(Treatise on Typhoid Fever; 200C.E.–210C.E.), which laid the foundation of"Discriminatory Treatment"; at the end of the Jin Dynasty (1115–1234),when epidemics were prevalent in Bianjing, Li Gao wrote"NeiWaiShangBianHuoLun" (Distinguishing the Confusion of Internal and External Injury; 1231C.E.–1247C.E.), which created the doctrine of"internal injuries" and the idea of "sweet warmth and heat removal".In the late Ming Dynasty(1567–1661),when epidemics were rampant,Wu created"Wenyi Lun"(the theory of the plague; 1642C.E.), which pioneered the theory of warming and epidemics.For example, Ge Hong(284C.E.–364C.E.) used Bozhi powder to prevent epidemics; Sun Simiao(581C.E.–682C.E.) developed Xionghuang Wan to avoid epidemics; Liu Wan Su's(About 1120C.E.–1200C.E.)Huanglian Jiedu powder and Li Gao's Buzhong Yiqi decoction in the Jin Dynasty [6], Wu Youke's Dayuan Yin,Sanxiao Yin, and Juban decoction in the Ming Dynasty (1368–1644), and Wu Ju Tong's (1758–1836) Sangju Yin and Yinqiao powder in the Qing Dynasty(1636–1912),all of which were effective in preventing and treating epidemics[9].

In the earlier fight against SARS in Chinese medicine, in addition to treatment with Chinese herbal remedies,from the perspective of"treating the disease before it happens", it was also emphasized that people should strengthen the body's positive energy to defend against external evil; avoid contact with the evil to cut off the transmission pathway.The prevention of SARS is based on spiritual adjustment,dietary regimen,appropriate exercise,and drug prevention.

And this COVID-19, in either aspect, Chinese medicine has played a major role, providing new ideas for the treatment of NCP in China and the world, carrying forward the innovation of traditional thinking in Chinese medicine, enhancing China's cultural self-confidence, improving China's international status, and giving an example, guidance and help, and support to the epidemic prevention work of countries around the world.