The method of external use of Chinese medicine in prevention of epidemic disease and its application in COVID-19

Jia-Shuai Deng, Kai Li, Gui-Juan Pan, Yong Jiang✉

1. Chengdu University of Traditional Chinese Medicine, Chengdu 610075

2. Hainan Medical University, Haikou 571199

3. Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China

Keywords:Pestilence COVID-19 External use of Chinese medicine Medicine hanging Medicine smearing;Medicine fumigation Common Pathogenesis Individual Pathogenesis

ABSTRACT The ancient people of our country have accumulated rich experience in prevention of epidemic disease in the course of fighting the epidemic for thousands of years, and invented effective methods of external use of Chinese medicine for preventing epidemic, some of these methods have been still used today, in addition to ensuring the health and safety of ancient people in China. In the COVID-19 ravaged China today, all kinds of protective supplies for the general public is difficult to get, so the study of external use of Chinese medicine that preventing epidemic for modern society is still very significant and valuable. According to the characteristics of COVID-19 and the theory of combination of disease-syndrome, based on the applicability and feasibility for modern society, combed out three methods of external use of Chinese medicine, including medicine hanging, medicine smearing and medicine fumigation, and made corresponding application recommendations for hospitals, communities, families to prevent epidemic disease.

Traditional Chinese medicine has thousands of years of history in the prevention and treatment of epidemic diseases[1]. In the process of continuous struggle with epidemic diseases, the ancients accumulated extremely rich experience and invented mature and effective methods. The novel coronavirus pneumonia (as known as COVID-19) in December 2019 was first emerging in Wuhan, Hubei, and it was raging in the middle and late of January. The incubation period of the disease was long and the population was generally susceptible to this disease[2]. It belonged to the category of Yi disease (epidemic disease) in traditional Chinese medicine[3]. During this pandemic, the common people have the problem of weak protection awareness at the initial stage and are faced with the dilemma that protective equipment is hard to find. Therefore, it is urgent to use the theory of TCM to promote the effective, easy, inexpensive and convenient protection method of traditional Chinese medicine. According to the COVID-19 characteristics, based on the theory of combination of disease-syndrome, the paper reviews the source and method of external use of Chinese medicine to prevent epidemic diseases and puts forward relevant suggestions, so as to provide reference for hospitals, communities and families to prevent epidemic.

1.Analysis of Yi disease

1.1Concept definition of Yi disease

The ancients of our country realized the existence of infectious diseases very early. In the Zhou Dynasty, there were written records of infectious diseases such as "Yi, Yang, Ju, Feng, Jie "[4], but there was no unified disease name, and there were also differences in the names of diseases such as Yi, Li, WenYi (plague), WenYi (warm or hot epidemic disease) and Yi disease in later ages. Professor Jiang Yong of Chengdu University of Traditional Chinese Medicine pointed out clearly that, according to literature research[5], “Yi disease” is a general term for infectious and epidemic diseases caused by external pathogenic factors (Li Qi) invaded people from the mouth, nose and skin, in other words, regardless of its severity, all infectious diseases are called "Yi disease". And “Yi disease” can be further divided into two categories: warm nature and cold nature. The epidemic diseases with warm nature include WenYi (emphasizing warm nature), WenYi (plague, emphasizing severity) and ZaYi (emphasizing small epidemic scope and special main disease). Cold epidemic disease is Hanyi, and the concept is different. The specific figure is as follows.

Figure1 the concept of “Yi disease”

1.2The warm or cold nature of COVID-19

Undoubtedly, COVID-19 is “Yi disease”, but there is no final conclusion about its nature (warm or cold). For example, according to the clinical symptoms and the climate of Wuhan in January, academician Tong Xiaolin thought that the disease should be "cold dampness epidemic"[3]; the First Hospital of Hunan University of Chinese Medicine thought it is "dampness, toxin and dryness" based on the theory of Yun Qi and clinical symptoms[6]; Tianjin University of Traditional Chinese Medicine differentiated 88 cases of COVID-19 patients into "ShiWen" syndrome[7]; Dong Guoju[8] thought the nature is dampness and heat. The author think that reason for such a big difference in the judgment of disease nature is not the difference of disease, but the pathogenic factors have been changing based on time, space and the constitution of the patients. Professor Jiang Yong believes that every disease has Common Pathogenesis and Individual Pathogenesis[9], for this epidemic, the Li Qi (pathogenic factor) from external environment is the Common Pathogenesis. As long as we keep this point in prevention and treatment, and then add Chinese medicine for Individual Pathogenesis with time, space, and symptoms, we can get twice the result with half the effort.

2.Sources and methods of external use of Chinese medicine for epidemic prevention

The word “Yu Fang” (prevention) was first used in Zhou Yi, Xia Jing: “Jun zi yi si huan er yu fang zhi”, the meaning of this sentence is that we should prepare in advance and protect ourselves from disasters, traditional Chinese medicine also believes that “sheng ren bu zhi yi bing zhi wei bing, bu zhi yi luan zhi wei luan”. Inner Canon of the Yellow Emperor also puts forward the guiding principle of "keeping the health Qi will keep you from pathogenic Qi and you should avoid the pathogenic Qi". The sentence tells us that in addition to emphasizing the function of the health Qi, we also need to "avoid the pathogenic Qi ". Throughout the thousands of years of anti epidemic history in China, we can find that ancient Chinese people had accumulated rich experience in disease prevention[10], such as controlling the source of infection, cutting off the route of transmission, protecting susceptible people (including medical staff), etc. In the aspect of applying traditional Chinese medicine for epidemic prevention, in addition to taking tang, pill, powder and using acupuncture and moxibustion to strengthen the healthy Qi, we have also invented medicine epidemic prevention measures such as wearing, hanging, fumigating, bathing and water source disinfection to "avoid pathogenic Qi"[11]. Based on the literature, the feasibility and applicability of modern society, the author selected three methods of external use of Chinese medicine: hanging, daubing and fumigating and describe as follows.

2.1Medicine hanging

The method of hanging medicine is to select the fragrant and volatile Chinese medicine, which can continuously release the smell of medicine to prevent the invasion of epidemic disease. As early as the Qin and Han Dynasties, people began to wear or hang medicine to prevent disease and pathogenic factors. Feng Tu Ji recorded that wearing Evodia Rutaecarpa on your head on September 9 can prevent disease and cold; Xi Jing Za Ji also recorded that on September 9, wearing Evodia Rutaecarpa, eating peng'er and drinking chrysanthemum wine can make people live a long life[12], this is the origin of the habit of wearing Evodia Rutaecarpa on the Double Ninth Festival. The Handbook of Prescriptions for Emergencies in Jin Dynasty[13] first recorded hanging or wearing Tai Yi Liu Jin Fang and Hu Tou Sha Gui Fang can prevent epidemic disease. Tai Yi Liu Jin Fang is made of realgar, orpiment, alunite, podophyllum and antelope horn, and then "hangs them on the door" after grinding; Hu Tou Sha Gui Fang is made of the powder of cinnabar, realgar, orpiment, podophyllum, gleditsia sinensis, wuyi and other medicines by grinding and tie them to the forearm and the four corners of the house; Qian Jin Fang[14] recorded that people can put Realgar pill into bag and wear it to prevent the Han Dynasty’s great pestilence with high mortality; Song Feng Shuo Yi[15] recorded that taking Lao Jun Shen Ming San that is made of the powder of Atractylodes lancea, Platycodon Grandiflorum, asarum, monkshood can prevent pestilence.

2.2Medicine smearing

Medicine smearing is a way of smearing the medicine to a certain part of the body after grinding (or mixing with a certain liquid) to obtain disinfection or epidemic prevention effect. In ancient times, there were many records of external application of Chinese medicine to prevent epidemics, for example, Feng Su Tong Yi in the Eastern Han Dynasty[16] recorded the method of applying cinnabar to prevent epidemic: August 1st is six gods day, mixing cinnabar with dew and then “moxibustion” it can prevent disease; Ge Hong’s The Handbook of Prescriptions for Emergencies and Sun Simiao’s Qian Jin Yao Fang also recorded that takeing Realgar powder (grinding realgar, cinnabar, Acorus gramineus, and podophyllum) a little and smear it on five hearts(two palms , two feet and chest), upper forehead, philtrum and Er Men to "dispel the air of epidemic". Furthermore, the ancients also invented the method of applying medicine to the nasal cavity to prevent epidemic, for example, Treatise on Three Categories of Pathogenic Factors[17] recorded that people who mix grinding realgar with water evenly and smear them to the nasal cavity will not be infected even if they are in the same bed with the patient. Li Chan's Yi Xue Ru Men[18] in the Ming Dynasty also pointed out that "the best way to avoid epidemic disease is to eat with sesame oil, or dip the paper in sesame oil, then dip the paper in realgar cinnabar powder, and then smear it on the ear and nose". In addition, there are ways to sneeze by irritating nasal cavity. For example, Ji Yang Gang Mu recorded that before entering the house of a epidemic disease patients, you can smear the nostrils with sesame oil so that they will not be infected. After leaving the room, it is best to sneeze by irritating the nose by paper. In addition to realgar, doctors in the Qing Dynasty also found that applying wine, Sichuan peppers, Angelica dahurica, asarum, etc. to the nose also had a good effect of avoiding epidemic diseases, such as Tou Ding Qing Liang Yin (It is composed of Angelica dahurica, asarum, Angelica sinensis, realgar, etc) in Song Feng Shuo Yi and Sui Xi Ju Huo Luan Lun recorded that prevent external pathogenic factor by smearing nostril with Sichuan peppers[19].

2.3 Medicine fumigation

Medicine fumigation is the way of the method of igniting or boiling medicines and using its smell or smoke as epidemic prevention tools. Di Jing Sui Shi Ji Sheng recorded that as early as the Han Dynasty, people soaked realgar in wine and sprinkle the bed to avoid poisonous insects; The Handbook of Prescriptions for Emergencies first put forward air disinfection method, which requires to burn the Sha Gui Shao Yao Fang in front of the house in the morning and evening and in the middle of the night to prevent epidemic. In the year of the great epidemic, Tai Yi Liu Jin Fang and Hu Tou Sha Gui Fang should be burned in the atrium for air disinfection. This method did have clinical effective, so it was reprinted in Bei Ji Qian Jin Yao Fang and Wai Tai Mi Yao. In addition, Zhang Jiebin’s Complete Works of Zhang Jingyue, Wen Yi[20] recorded that burning Dalbergia odorifera can cure many disease and has definite curative effect; There are also many records in Compendium of Materia Medica[21] that during the great epidemic, medicine such as Atractylodes lancea, Artemisia argyi, Angelica dahurica, clove and sulfur can be burned in the room for air disinfection and decontamination. Zhou Yangjun’s Wen Re Shu Yi Quan Shu[19] also recorded that if people are afraid of being infected epidemic disease, they can burn Sichuan pepper, Peilan, Angelica dahurica and Atractylodes lancea and take their smell to prevent epidemic disease. The fourth chapter "sanitation and prevention" of He Lianchen and Chen Yueqiao’s Shi Wen Shi Yi Zhi Liao Fa emphasizes that when epidemic disease is prevalent, it is better to refresh the walls with lime, or sprinkle them with decontamination medicine at the same time, so as to avoid the disease of dampness and toxin.

To sum up, we can see the characteristics of ancient external Chinese medicine epidemic prevention are as follows: (1) In terms of usage: medicine hanging is mainly to put the powder of medicine into sachets, and then hang them on the chest, arms, bed curtains and doorways; medicine smearing is mainly applied local skin, in addition to medicine powder, the choice of solvents is to use alcohol or sesame oil to enhance its volatility; medicine fumigation is mainly used in crowded places (such as home, assembly place, etc. or places where patients gather; (2) In the selection of Chinese medicine, we mainly choose the medicines with strong flavor and pungent fragrance, such as realgar, Acorus gramineus, Angelica dahurica, alunite, cinnabar, Atractylodes lancea, Artemisia argyi, Sichuan pepper, sulfur, cinnamon, asarum, Ligusticum chuanxiong, etc. This kind of medicines is highly volatile and can prevent the invasion of external pathogenic factors, and the mianly function is “Pi Xie Qi”(disease prevention)[22]; (3) Before Wu Youke, the ancients had realized that "Li Qi" was a external thing. Although it was called "Qi", which was invisible to the eyes and inaccessible to the hands, it was a kind of substance, so it could effectively prevent the pathogenic Qi from entering the body through the barrier of aroma or smoke. Therefore, no matter how to hang, smear, fumigate or the medicine bath, water disinfection and other external medicine that had not been introduced, it could be used for epidemic prevention and the purpose of these methods is the same. Therefore, in real life, we can choose different epidemic prevention methods based on different application scenarios.

Up to now, the external use of Chinese medicine is still a convenient, inexpensive and effective[23] method for epidemic prevention in modern Chinese medicine doctors or folk. For example, the disinfection effect of fumigation with Chinese medicine in the SARS isolation area compared with the disinfection effect of ultraviolet radiation and chlorine containing disinfectant spray is satisfactory[24]. After the Wenchuan earthquake in Sichuan in 2008, the rescue team of Chengdu University of Traditional Chinese Medicine used the Ai Yexun formula, that is to ignite the ratio of Acorus gramineus and Artemisia argyi by 1:1, and fumigated in the shed area and indoor to prevent epidemic disease. Good curative effect was obtained[25]. In response to this COVID-19, Tongxu County People's Hospital[26], Zigong Hospital of TCM[27], Hunan University of Chinese Medicine Integrated Chinese and Western Medicine Affiliated Hospital[28] and many other hospitals take the fumigation and scent of Chinese medicine to disinfect the air to prevent epidemic disease[29] and achieve good results.

3.The application of external use of Chinese Medicine for epidemic prevention based on the characteristics of COVID-19

Professor Jiang Yong believes that every disease has Common Pathogenesis and Individual Pathogenesis, and the epidemic disease’s Common Pathogenesis is “Li Qi” from external environment. Based on the clinical observation and tongue diagnosis[30] of COVID-19, Professor Jiang Yong thinks that the Common Pathogenesis of this disease is dampness encumber Yang Qi. Dampness is Yin pathogen, it can cause long course of disease and has many changes. Dampness invading human body would encumber Yang Qi, so it makes people weakness, obstructed Yang Qi would make people feel fever. If dampness invades lung, people would have cough, stuffy and runny nose; if it encumbers spleen and stomach, it would induce diarrhea; or it would turn to cold-dampness when dampness combines with external cold pathogen; or obstructed Yang Qi turns to pathogenic heat; or skin becomes dry because dampness encumbers body fluid, many symptoms are caused by dampness changing. Therefore, on the basis of the principle of dehumidification and eliminate the pathogenic factors , it is most appropriate to choose different medicines for different epidemic diseases (that is Individual Pathogenesis) according to different regions and syndromes. In addition, although the ancients mostly chose realgar, cinnabar and other minerals, and modern researchs have confirmed that they are very effective on anti-virus and bacteriostasis[31,32], in consideration of safety, applicability and accessibility, we can only give up. So in the aspect of medicine hanging, according to the Common Pathogenesis, it is suggested to select 15g Atractylodes lancea, 10g Cimicifuga, 10g Radix Aucklamdias and 10g Artemisia argyi and then crush and bag them. Atractylodes lancea is pungent and bitter, it can “eliminating pathogenic factors”, Compendium of Materia Medica also said that it can eliminate miasma and pathogen; Radix Aucklamdias is pungent and bitter, Shen Nong’s Herbal Classic said that it can prevent epidemic disease; Cimicifuga and Artemisia argyi’s Qi are strong and have high volatility and a long history of epidemic disease prevention, so they are auxiliary medicines. The four medicines have strong Qi, flavor and volatility, and they all have the function of drying dampness, they can not only eliminate pathogenic factors, but also keep health Qi, so they are the best medicines for the Li Qi with dampness. And then, add medicines for different regions or syndromes, that is, for Individual Pathogenesis. For example, for dampness-hot areas or syndromes, you can add borneol, honeysuckle, patchouli leaf, Peilan, gentian, etc. to eliminate dampness and heat; for cold-dampness areas or syndromes, you can add pummelo peel, almond, ephedra, rhizoma gastrodiae and ginger, etc. to eliminate cold and dampness. In the aspect of medicine fumigation, we suggest to mainly burn Artemisia argyi and Atractylodes lancea. Modern research shows that the disinfection effect of Artemisia argyi ' smog after burning is equivalent to ultraviolet, even better than that of ultraviolet disinfection[33,34]; Atractylodes lancea also has obvious and satisfactory disinfection effect[35,36].

4. Conclusion

Qian Jin Yao Fang contains 25 epidemic prevention prescriptions, Tai Ping Sheng Hui Fang contains 26 prescriptions and Song Feng Shuo Yi contains 65 prescriptions, most of which are for external use, so this situation also reflects the long history, clear structure and good effect of external use of Chinese medicine for epidemic disease prevention. In addition to its effect of effective disinfection, it has the advantages of simple use, no stimulation, low price and easy access. Based on the literature, the author combed out the methods of external use of Chinese medicine for epidemic prevention, and puts forward effective protection suggestions according to the characteristics of COVID-19, and based on the combination of disease-syndrome’s Common Pathogenesis and Individual Pathogenesis theory. Under the condition that all kinds of protective products are hard to find, the external use of Chinese medicine for epidemic prevention is another effective choice for hospitals, squares or homes.