New Progress in theTreatment of Novel Coronavirus with Traditional Chinese Medicine

LI Xiang-ming

(Fever Clinic of the Department of Infectious Diseases, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250001)

ABSTRACT: The outbreak ofnovel coronavirus pneumonia (COVID-19) in Wuhan since December 2019 has become a public health emergency of international concern because of its strong infectivity. Traditional Chinese medicine has accumulated thousands of years of experience in the prevention and treatment of infectious diseases. In the treatment of novel coronavirus pneumonia, traditional Chinese medicine fully demonstrates its characteristics and advantages, and can play a role in the whole process. At present, TCM prevention and treatment of COVID-19 has become the main force from a participant. The review is to discuss the etiology of disease from traditional Chinese medicine, analyze the etiology, pathogenesis, treatment and thinking of the disease, and summarize the current situation of traditional Chinese medicine in treating new crown pneumonia in terms of etiology, pathogenesis, treatment and syndrome differentiation. The classic famousprescription, Qingfei detoxification decoction, is summarized and analyzed, and the advantages and prospects of TCM in treating new crown pneumonia were also elaborated.

KEY WORDS: novel coronavirus pneumonia; traditional Chinese medicine; review

0 Introduction

Since December 2019，the novel coronavirus has caused rapid development of pneumonia. The provinces and cities have launched a major public health emergency response on January 30，2020. The novel coronavirus pneumonia (NCP) was named temporarily by the National Health Protection Committee in February 7，and it was named COVID-19 by the World Health Organization (WHO) in February 11. WHO formally announced it in Geneva on February 7. The novel coronavirus pneumonia is more spread and more infected than the 2015 Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) in 2003. China's novel coronavirus pneumonia was diagnosed in 80270 cases at 24 O'clock on March 3，2020，and 520 suspected cases were present. 49856 cases were cured and 2981 cases died. Traditional Chinese medicine has accumulated thousands of years of experience in the prevention and treatment of infectious diseases. The traditional Chinese medicine in treating the novel coronavirus has increasingly demonstrated its advantages and characteristics. At present，the National Health and Health Council jointly issued the 6th version of the new diagnostic and therapeutic plan for pneumonia caused by coronavirus，which has been added to the third edition of the Chinese medicine authority. Local TCM intervention programs have been formulated in different regions according to the local actual situation. As of February 22，2020，novel coronavirus pneumonia cases involving over 60 thousand cases were diagnosed by the State Administration of Traditional Chinese Medicine. Novel coronavirus pneumonia has been in the critical stage，and the current status of the treatment of novel coronavirus pneumonia is reviewed.

1 Name ofnovel coronavirus pneumonia

Suwen · on Needling Method said："the five diseases，are easy to infect，no question of size，with similar symptoms." The characteristics of the outbreak of infectious diseases are strong infectivity and similar symptoms. In traditional Chinese medicine，this kind of disease is called "epidemic disease".Undoubtedly novel coronavirus pneumonia belongs to the category of "epidemic disease" in traditional Chinese medicine. Tong Xiaolin and other experts of novel coronavirus pneumonia found that after the tongue coating was thick and greasy fur，wet turbidity was very heavy，the climate in Wuhan was humid，and the overall appearance of external wet and internal wet was consistent. There are also relevant descriptions in Wenre Jingwei Volume 3and Ye Xiangyan's Chapter on Exogenous Warmth："the white moss of pestilence is as thick as powder，and its filthy and turbid weight is heavy.”

Also the dampness disease is one of the five diseases.Combined with clinical symptoms，regional characteristics and other comprehensive analysis，Most experts think it is more accurate to classify the disease as "wet".

It is more accurate to classify "epidemic disease" as "wet epidemic disease". At present，novel coronavirus pneumonia is recognized as "epidemic disease" and "damp epidemic disease"，but there are different understanding of cold damp epidemic disease，damp toxin epidemic，damp heat epidemic. Wang Yuguang and Miao Qing believed thatnovel coronavirus pneumonia belonged to the category of "damp toxin epidemic". It is pointed out that the disease is the disease of the disease. The basic pathogenesis is "damp，poison，stasis，and closure". Novel coronavirus pneumonia is considered to be "cold damp epidemic" by Tong Xiaolin，Wang Yongyan and Xue Boshou. It is believed that the disease is caused by cold，damp and epidemic diseases.Dong Guoju thought that the epidemic was damp heat epidemic. He pointed out that winter was Yin，cold was also Yin，and heavy Yin was bound to be Yang. Moreover，the symptoms of fever，thick and greasy tongue coating，dry and bitter mouth，diarrhea，and sticky stool were also consistent with the symptoms of damp heat disease.

2 Analysis of the etiology from the perspective of three factors

Novel coronavirus pneumonia is the cause of invasion of the human body by "epidemic resistance". Wu Youke said in his Treatise on Epidemic Febrile Diseases that "those who are infected with pestilence will feel the evil Qi of heaven." In the book，there is a kind of cold disease，which is not a kind of heat disease. It can be seen that pestilence is a kind of evil Qi with strong infectivity，multiple transmission forms and rapid pathological changes. Novel coronavirus pneumonia is analyzed from three aspects of the etiology.

2.1 Timing -- Analysis from the theory of five movements and six Qi

Unseasonality is an important factor in the outbreak. "Spring should be warm and anti-cold，summer should be hot and anti-cold，autumn should be cool and anti-hot，winter should be cold and anti-temperature，this is not its time has its own gas. In one year of age，the disease of old and young are all similar，called plague disease also." It is pointed out that the disease is easy to break out at different times. 2019 is the year of Jihai，the earth transport is not good，the wind is in the sky，the fire is in the spring of Shaoyang，and the overall climate is hot and windy. The year of Jihai was the peak year of stroke fever in sixty years. The COVID-19 outbreak began at the end of Jihai. The weather was cold at the end of Jihai，the sun was cold and the water was cold. The climate should have been cold，but there was a situation of "wind and heat being more abundant". The year 2020 is the year of Gengzi，the year of Gengzi，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng，the year of Geng. Gu Zhi mountain comprehensive luck factor was that the outbreak is complex，the six evils of the Chen miscellaneous，dry，wet，fire，cold，wind，and from five to six qi theory points out that the outbreak either hot or cold dampness，"v dry" and "wood Li" is the pathogenesis，and throughout，the standard of fire is the pathogenesis，wet，cold，etc，to change at any time.

2.2 Analysis on regional climate characteristics of Wuhan

The regional climate of Wuhan is the external factor of the outbreak. Wuhan is located in the center of China's hinterland and at the intersection of the Yangtze River and Hanjiang River. It is one of the largest cities with the richest water resources in the world. Wuhan belongs to subtropical humid monsoon climate，with abundant rainfall，sufficient sunshine，concentrated precipitation and humid climate.Wuhan's special geographical location and humid climate characteristics are the external conditions of the disease.Therefore，the 2019 novel coronavirus pneumonia is mainly "wet". Wuhan is the largest inland water，land and air transportation hub in China，known as the "thoroughfare of nine provinces"，and has great population mobility，which is also the key factor leading to the rapid spread of the epidemic in China and even the world.

2.3 Analysis of individual physical factors

The novel coronavirus pneumonia is the intrinsic factor of deficiency of the body and heavy humidity. Suwen · on Needling Method says："healthy Qi is stored inside，and evil cannot be done." Lingshu · the Beginning of All Diseases said："wind，rain，cold，heat can not be empty，and evil can not only hurt people." Deficiency of healthy Qi is the decisive factor leading to the invasion of pathogenic Qi into human body. Although the population is generally susceptible to the epidemic，the death rate of the elderly with deficiency of basic diseases is the highest. The local people's diet is not festival，and they like to eat fat，sweet and thick taste food，hindering the spleen to transport dampness，generally with more heavy internal humidity. Yang Jiayao et al. analyzed the TCM syndromes and constitutions of 90 patients with common COVID-19，and found that the main TCM syndromes were moderate Jiao with dampness obstruction and cold and dampness attack on the lung，while phlegm and dampness，Qi deficiency，blood stasis and dampness and heat were the main constitutions. It can be seen that COVID-19 patients were mostly heavy with dampness，resulting in the combination of internal and external dampness and the onset of the disease.

3 Pathogenesis analysis

The evil Qi，coming from the nose，first attacks the lung. The pathogenesis of the epidemic is mainly characterized by dampness，and the disease location is mainly in the lung. Most traditional Chinese medicine scholars have no doubt about this，but there are still some differences in other pathogenesis characteristics and disease location.

3.1 Pathogenesis characteristics

The novel coronavirus pneumonia diagnosis and treatment plan (trial version third) indicates that the basic pathogenesis of the novel coronavirus pneumonia is "wet，hot，toxic，and stasis"，and the relevant contents of the disease location and basic pathogenesis characteristics are deleted from the fourth，fifth，sixth editions. Zheng Wenke and others analyzed the "plan" of each region，and "cold" is not obvious in the "plan" of each region. The epidemic disease is mainly characterized by "dampness，heat，toxin，blood stasis and deficiency". Although there are differences in the expression of the scheme，it basically conforms to the pathogenesis characteristics of "dampness，heat，toxin and blood stasis". In addition to "dampness，heat，toxin，stasis" pathogenesis characteristics，some scholars think there are other pathogenesis characteristics. Professor liang-duo jiang "gas is not taken for jin is the key pathogenesis，points out the current treatment did not attach enough importance to" gas is not taken for jin，don'tthink gas is taken not only appeared deficiency syndrome，tianjin，can appear more phlegm dampness，phlegm heat bizu jet card，its emphasis on COVID - 19 treatment cannot be mud in the training of the ancients "cure energizer feather"，should be used for the deficiency of lung closed heavy dose of astragalus membranaceus can pick up the slack.

3.2 Understanding of disease location

① From the point of view of determining the disease location of the five zang organs，it has been agreed that the disease location is mainly in the lung and spleen. The lung is delicate，and it is easy to be injured by the dry and cold nature of pestilence pathogen. The dry nature of the lung Qi is often manifested as dry cough；the spleen is evil，and is easy to be committed by the nature of pestilence and dampness. The spleen is dampness，and the ascending and descending of the spleen and stomach are maladjusted，with poor appetite and loose stools. Severe patients with damp heat disease with phlegm can sink into the pericardium，the location of the disease is from the lung and heart，and the spirit is lost. Some scholars believe that the disease location is in the lung，spleen，liver and gallbladder，and that the epidemic is mainly damp heat，while liver and gallbladder damp heat has dry mouth and bitter mouth. ② According to the location of the six meridians，the most common diseases were Taiyang or taishaohe，and the critical patients were more sick，Shaoyin and Jueyin. ③ According to the location of Wei Qi Ying Xue，epidemic pathogens mainly stay in Qi Fen，while critical patients are more sick and Ying Xue Fen. ④ some scholars think that the initial stage of disease is in the upper Jiao membrane.

4 Thinking of differentiation and treatment

The existence of a variety of syndrome differentiation theory systems，such as the syndrome differentiation of six channels，the syndrome differentiation of Wei Qi and Ying Blood，the syndrome differentiation of Three Jiao，and the syndrome differentiation of Zang Fu organs，has better guided the differentiation and treatment of the epidemic. Xue Boshou pointed out that this epidemic should follow Zhang Zhongjing's six meridian syndrome differentiation. He believed that this epidemic was a cold and dampness epidemic in Zhang Zhongjing's time，and stressed that ephedra should be used for cold and dampness epidemic. Yang Jiezhuo believed that solar typhoid syndrome was the initial stage of most COVID-19，and emphasized the use of micro-perspiration solution，such as Guizhi decoction，Ephedra decoction，Huoxiang Zhengqi powder，etc.，together with sipping hot porridge. Cold and cold drugs were forbidden to prevent the entraption of epidemic virus at this time. Lin Ju choose to analyze guangdong confirmed cases，such as that the outbreak follow the change law of wei qi camp blood，formed the camp who gas blood syndrome differentiation and visceral syndrome differentiation with the combination of traditional Chinese medicine diagnosis and treatment plan，it considers the disease spread throughout the rules as follows：1) the early lung heat attack who see epidemic more point card，spleen and stomach syndrome epidemic hot attack who points，spleen and stomach syndrome epidemic hot gas straight points；2) In the middle stage，the syndrome of epidemic fever obstructing gas in the lung，the syndrome of epidemic fever closing camp in the lung，and the syndrome of epidemic heat encamping in two burnt；3) In the later period，the symptoms were mainly infectious fever burning camp liver syndrome and infectious fever bleeding distraction and envelop syndrome；4) The convalescence stage is mostly lung and spleen qi deficiency syndrome and Qi and Yin deficiency syndrome. Zhang Zailiang made a detailed analysis of the understanding of "epidemics" by doctors in successive dynasties，and believed that the Six Classics made laws for all kinds of diseases，which could not be doubted. The Six Classics included not only the methods of Wen and Disease，Qi，Ying and Blood，but also the methods of Jin Yuan doctors and Wu Youke. He believed that it was difficult to separate the six channels from the epidemic fever in clinical practice，and pointed out that Liu Hejian's Fangfeng Tongsheng San，Wu Youke's Dayuan Yin，Yang Lishan's lifting and lowering powder，and Wang Qingren's Detoxification and Huoxue Decoction were all the variants of the prescriptions of the six channels. Yang Jin believes that COVID-19 can be differentiated and treated according to the syndrome differentiation theory of Weiqi and Ying and Blood and the syndrome differentiation theory of Three Jiao，and the development law can be analyzed by using the syndrome differentiation theory of Six meridian. In addition，there are many established syndromes in Chinese medicine，and the treatment can be done by referring to the traditional principles and formulas.

5 Common prescriptions

The novel coronavirus pneumonia diagnosis and treatment plan (trial version Eighth) divides diseases into medical observation period and clinical treatment period. Chinese patent medicine is recommended in the period of medical observation；the general prescription "Qingfei Paidu Decoction" is recommended in the clinical treatment period，and the clinical treatment period is divided into light，common，severe，critical and recovery periods.

5.1 General prescription Qingfei Paidu Decoction

The composition of Qingfei detoxification soup is：Ephedra 9g，Zhi Glycyrrhizae 6g，Almond 9g，Gypsum 15-30g (decocted first)，Guizhi 9g，Alisma alissima G，Zhuling 9，Atractylodonia 9g，Poria 15g，Bupleurum 16g，Radix Sutellaria 6g，Pinellia ginger 9g，Ginger 9g，Aster G，Donghua 9g，Shegan 9g，Asarum 9g，Yam 12g，Zhishi 6g，Tangerine peel 6g，Huoxiang 9g. It is recommended to add half a bowl of rice soup after taking each medicine，and one bowl more for those with dry tongue and body fluid deficiency. Qing-hu he thought such as clearing lung detoxification soup all party is by MaXingShi sweet soup，five three scattered，small bupleurum soup，shoot dry ephedra soup four by the party，the whole policy of cold，hot，wet，poison，the evil，medication XinWen and cool，pale and aromatic，with many method，fully focused on thin is not blocked，highlights to the pathogens to way of thinking，the whole party altogether plays xuan lung cough，wet，the effect of jiedu eliminate pathogenic heat. Xue Boshou believed that "lung-clearing and detoxification soup" was an innovative compound based on the fusion of Jingfang Ephedra Decoction and Wuling San. Zhao Jing et al. confirmed that Qingfei Detu Decoction can balance immunity and eliminate inflammation by regulating the protein co-expressed with angiotensin converting enzyme 2 (ACE2) and a series of signal pathways. And can target ribosomal protein and play an antiviral role. ACE2 is an important target of SARS-Co V-2 infection，which is consistent with the target of SARS-Co V infection in the organism. The sequence of SARSCo V-2 is highly similar to that of SARS-Co V.

5.2 Classic prescriptions

A comprehensive analysis of novel coronavirus pneumonia diagnosis and treatment plan (trial version third) and regional diagnosis and treatment plan was made. The commonly used classic names include Ma Xing Yi Gan Tang，Sheng San，Da Yuan Yin，Yinqiao San，Xuan Bai Chengqi Decoction，Huanglian Jiedu Decoction，Jiedu Huoxue Decoction，F(xiàn)our Inverse Plus Ginseng Decoction，Angong Niuhuang Pill，and Purple Snow Powder.

5.3 Chinese patent medicine

The novel coronavirus pneumonia diagnosis and treatment plan (trial version Eighth). The recommended Chinese medicines used in the medical observation period are："Xiang Xiang Zheng Qi Capsule" (pills，water，oral liquid)，Jinhua Qinggan Granule，Lianhua Qingwen Capsule (granule)，Shu Feng Jiedu Capsule (granule)；during the clinical treatment period，the recommended severe Yanyanping Injection，Xuebijing Injection，Reuonning Injection and Tanreqing Injection are recommended. Xingnaojing Injection；Xuebijing Injection，Reduning Injection，Tanreqing Injection，Xingnaojing Injection，Shenfu Injection，Shengmai Injection and Shenmai Injection are recommended for critical patients. Among the diagnosis and treatment programs in different regions，Angong Niuhuang Pill was the most frequently used，followed by Xuebijing Injection and Lianhua Qingwen Capsule (granules). Traditional Chinese medicine injections such as Xuebijing Injection，Shenfu Injection，Shengmai Injection and Xiyanping Injection have significant curative effect on critical illness，and have been adopted by many local diagnosis and treatment programs.

5.4 Traditional Chinese medicine decoction

The novel coronavirus pneumonia diagnosis and treatment plan(trial version Eighth) will be divided into light，general，heavy，critical and recovery stages. In addition to the general prescription "Qingfei Paidu Decoction"，the prescriptions for each syndrome type were recommended respectively. ① Light：recommended prescription for cold dampness stagnation lung syndrome：Raw Ephedra 6g，Gypsum 15g，Almond 9g，Notopterygium 15g，Tinglizi 15g，Guanzhong 9g，Dilong 15g，Xuchangqing 15g，Huoxiang 15g，Peilan 9g，Atractylodes Lancea 15g，Yunling 45g，Shengbaizhu 30g，Jiaosanxian 9g，Magnolia 15g，Jiaoareca 9g，Simmered Caoguo 9g，Ginger 15g；recommended prescription for dampness heat accumulation lung syndrome：Areca 10g，Caoguo 10g，Magnolia Officinalis 10g，Anemarrhena 10g，Scutellaria Baicalensis 10g，Bupleurum 10g，Radix Paeoniae Rubra 10g，F(xiàn)orsythia Suspensa 15g，Artemisia Annua 10g (lower back)，Atractylodes Lancea 10g，F(xiàn)olium Isatidis 10g，Glycyrrhiza Uralensis 5g. ② Common type：recommended prescription for dampness toxin stagnation lung syndrome：Raw Ephedra 6g，Bitter Almond 15g，Raw Gypsum 30g，Raw CoixSeed 30g，Atractylodes Lancea 10g，Pogostemon Cablin 15g，Artemisia Annua 12g，Polygonum Cuspidatum 20g，Verbena 30g，Dried Reed Root 30g，Tinglizi 15g，Huajuhong 15g，Raw Licorice 10g；recommended prescription for cold dampness obstructing lung syndrome：Atractylodes Lancea 15g，Tangerine Peel 10g，Magnolia Officinalis 10g，Huoxiang 10g，Cao Guo 6g，Raw Ephedra 6g，Notopterygium 10g，Ginger 10g，Areca 10g. ③ The recommended prescriptions for the syndrome of Qi Ying two burnt diseases are as follows：Raw Ephedra 6g，Yaoren 9g，Gypsum 15g，Liquorice 3g，Huoxiang 10g，Magnolia Officinalis 10g，Atractylodes Macrocephala 15g，Caocao Fruit 10g，Rhizoma Pinelliae 9g，Poria Cocos 15g，Rhubarb 5g (lower part)，Astragalus Membranaceus 10g，Tinglizi Seed 10g，Chishao 10g；Qiying Liangshao recipe：Shenggypsum 30 ～ 60g (first decoction)，Anemarrhena 30g，Shengdi 30 ～ 60g，Buffalo Horn 30g (first fried)，Red Peony 30g，Scrophularia 30g，F(xiàn)orsythia Suspense 15g，Cortex Moutan 15g，Coptis Chinensis 6g，Bamboo Leaves 12g，Tinglizi 15g，Raw Licorice 6g. ④ The recommended prescription for critical illness (internal closure and external debonding)：Ginseng 15g，Heishun Tablet 10g (first fried)，Cornus Officinalis 15g，Suhexiang Pill or Angong Niuhuang Pill.

6 Novel coronavirus pneumonia: advantages and prospects

The academic contentions of doctors greatly promoted the development of TCM disease theory. The inclusion of lungclearing and detoxifying decoction as a universal prescription in the national diagnosis and treatment scheme means that TCM is showing its sharp sword to COVID-19. Academician Zhang Boli pointed out that traditional Chinese medicine can play a role in the whole process of COVID-19 treatment，fully highlighting the characteristics and advantages of traditional Chinese medicine. At present，the advantages of traditional Chinese medicine are mainly reflected in the following aspects：(1) For light and common patients，it can not only improve symptoms，shorten the course of disease，but also reduce the possibility of light and common patients transforming into heavy or critical type；(2) for patients with severe and critical diseases：Chinese medicine plays a role in reducing lung exudation，inhibiting the release of inflammatory factors，stabilizing blood oxygen saturation，reducing the intensity of respiratory support and the use of antibiotics；(3) for patients in the convalescent period：although the virus nucleic acid test is negative，but lung inflammation is not completely absorbed，there are residual evil，Qi and Yin deficiency，the use of Chinese medicine to help qi，remove residual evil，dredg-up collateral and remove blood stasis，can reduce adhesion，promote inflammation absorption，speed up the recovery process. (4) Traditional Chinese medicine has a significant advantage in improving human immunity，which can stimulate the body's ability to resist disease and recover as soon as possible. Academician Zhang Boli pointed out that TCM prevention and treatment of COVID-19 has changed from a participant to a major force. The participation of traditional Chinese medicine helps to shorten the length of hospital stay，improve symptoms such as fever，cough，fatigue，dry throat and loss of appetite，improve immunity and reduce mortality，etc. Therefore，early and whole-course intervention should be taken in the treatment of COVID-19 with traditional Chinese medicine. At present，a large number of clinical studies on the prevention and treatment of COVID-19 with traditional Chinese medicine are also under way. Most of the research designs are based on interventional experimental studies. Intervention measures include Chinese patent medicine (more than 10 kinds of Lianhua Qingwen Capsule，Huoxiang Zhengqi Drop Pillue，etc.)，decoction and Taijiquan therapy. I believe that with the further publication of the research results，the advantages of TCM in the prevention and treatment of infectious diseases will be more and more recognized. In addition，due to the multicomponent and multi-target characteristics of traditional Chinese medicine，the combination of network pharmacological analysis，experimental verification and multi-omics can be used to further clarify the specific mechanism of action of traditional Chinese medicine.