Li Ling , Xin Tian, Jin-Hua Liao, Jian-Guang Wu, Liang-Ji Liu, Lin Li,?

1.Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China

2.Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China

Keywords:

ABSTRACT

1. The COVID-19 cold and warm debate

Since December 2019, many cases of COVID-19 have been found in Wuhan, Hubei Province. With the spread of the epidemic, such cases have also been found in other parts of China and overseas.This epidemic situation belongs to the category of epidemic disease in Traditional Chinese medicine. The disease comes on because the rage of epidemic disease encroaches on the human body through the mouth and nose and causes the human body to become infected with pathogenic factors. Treatment can be based on the syndrome differentiation according to the conditions in different regions, climate characteristics and different physical conditions, and by referring to the novel Coronavirus diagnosis and treatment plan (trial version 6) [1]. Since the outbreak of COVID-19, many famous TCM practitioners have expressed their views on COVID-19. There are two schools of thought on the issue of cold temperature.

First of all, there are medical experts think that belongs to "cold and wet epidemic", Bi Mingda, Feng Jihong[2]It is believed that COVID-19 belongs to the category of "epidemic disease" in Chinese medicine. Its etiology is mainly the sensation of qi and spleen caused by the cold and dampness epidemic, and its pathogenesis mainly involves the closure of the lungs and the obstruction of the spleen and qi, and the location of the disease mainly involves the lungs, spleen and stomach.Shi Yan, Gao He and others[3]COVID-19 is considered to be an epidemic of wind, cold and dampness, and the cause of COVID-19 is believed to be a mixture of wind, cold and dampness, and three gases, which is what Wang Haogu called "fog dew".Fog and dew for cold and wet qi, can hurt the lung and spleen at the same time, lung injury cough, spleen injury is cold and wet syndrome.

Some doctors regard it as a "damp-heat epidemic". Xu Jiasong believes that the onset time of COVID-19 is related to the abnormal climate, which is in line with the prediction of "mild and severe disease" by the "theory of luck" in Su Wen.COVID-19 is considered "warm"[4]. Yu-guang wang etc.[5]In the article "Novel Coronavirus and Pneumonia: A Preliminary Study on The Clinical Characteristics and Syndrome Differentiation of Pneumonia", it is pointed out that the plague is caused by the "wet-poison" and is mainly "wet-poison fever".

The two completely different viewpoints are both correct. From the analysis of etiology, exogenous evil can be felt, both cold evil and heat evil. According to the overall view of constant movement, even the cold evil can quickly enter into the heat, and disease is a changing process. Therefore, in the face of the complex relationship between cold and temperature, we usually cannot quickly judge whether it is a simple febrile disease or a simple typhoid disease. Therefore, we cannot quickly choose the best method of syndrome differentiation on the basis of syndrome differentiation of nourishing qi and nourishing blood and six meridians. Therefore, how to unify the cold and temperature is particularly important, which is helpful to make accurate judgment on the complex cold-temperature relationship.

2. The ancient origin and development of the unified thought of cold and temperature

In the Qin and Han Dynasties, The Su-Wen heat Treatise put forward that "all fevers of today are typhoid fever and the like", and all exogenous fevers at that time were collectively called "typhoid fever", that is, the current category of "generalized typhoid fever".In the Nanjing, "Typhoid fever has five kinds, including stroke, typhoid fever, humidity and temperature, fever and febrile diseases", among which "typhoid fever" belongs to the narrow sense of typhoid fever, which refers to a kind of diseases caused by exogenous cold.The name of the disease first appeared in the book Of Simple Questions. "Qi is the great temperature, grass is the early glory, the people is the severe disease, and the disease of mild fever is the action", according to the Great Treatise on the Six Yuan Dynasty.From the Warring States period to the Jin and Tang Dynasties, in the embryonic stage of the development of the disease, the concept of the disease is classified as a generalized typhoid.In the Eastern Han Dynasty, zhang Zhongjing, a famous physician, wrote a treatise on Typhoid fever and Miscellaneous Diseases and established the theoretical system of syndrome differentiation of the six classics. Although exogenous fever discussed by Zhongjing included part of the prevention and treatment of febrill, on the whole, He was more detailed about cold than warm, and his theoretical and practical understanding of febrill was still shallow.During the Song, Jin and Yuan dynasties, Liu Wancu developed a new idea, emphasizing that heat should not be used as an agent in the early days of fever, and advocating that cold should be the main treatment. Liu Hejian's theory laid a foundation for the treatment of heat disease in later generations.Wang Andao, a doctor at the end of Yuan Dynasty, in "Hui Hui Ji" said, "Zhongjing is specially designed for the typhoid fever of soon-to-be disease, and it is also designed for the heat and heat of soon-to-be disease.From then on, the epidemic began to separate from the typhoid system.In the Qing Dynasty, the theory of heat disease gradually became mature. Ye Tianshi, Xue Shengbai, Wu Jutong and Wang Mengying, four masters of heat disease, established the treatment program of nourishing qi, nourishing blood and differentiating three focal points.At the same time, a group of doctors such as Yu Genchu, Wu Kunan, Yang Lishan and Lei Feng, based on their own clinical practice, made a profound discussion and display of the theory of external sensationalism, and made an important contribution to the formation of an independent system of external sensationalism[6].

3. "Unity of cold and Temperature" with jiangxi COVID-19 prevention and control

In 1957, Mr. Wan Yousheng, a famous old Doctor of Traditional Chinese medicine, published "Cold temperature and vertical and horizontal Theory" in The journal of Jiangxi Traditional Chinese Medicine, and successively published "Unified Theory of Cold temperature", "Thermal epidemiology" and other works, advocating the unification of cold temperature[7].Warm disease school of thought in the treatment of warm disease on the formulas have an unprecedented development, the article warm disease cause more widely quoted party of treatise on febrile disease, or change it to reform the system, or from its method and differ or has not prepared for its innovative, greatly make up for the zhang zhongjing in the treatment of warm disease deficiency, cold temperature separation is not conducive to the development of traditional Chinese medicine, and complicate the TCM syndrome differentiation system, only cold temperature is unified, make full use of the science of seasonal febrile diseases, the formulas of future generations to make TCM developing smoothly[8]. Mr Yao medical charge in jiangxi famous TCM family background, study on li & fung, says Mr Yao lotus born syndrome classification to one, the first thing to break the disease boundary constraints, to know the syndrome differentiation method and the adaptability of diseases is relative, so Mr Yao trouble is proposed according to disease, illness, and pathogenesis of substantial basis points, in images combined with eight principles for abstract Outlines, with zang-fu organs, meridian, obsessed with the body combined with the spirit of wei qi camp blood fluid for the breakdown, integrates the cause of dialectical content the basic framework of ideas[9]", just as Ke Yunbo advocated, "But we should seek the root in the six Sutras, not seek the branches in the name of the disease".

Professor Wu Bingcai, a master of Chinese medicine, learned from Mr. Yao Hesheng. Academically, he inherited the idea of unified differentiation of cold and temperature inside and outside. In clinical practice, he often used the prescription of febricity and typhoid fever.According to the characteristics of humid climate in Jiangxi province, Professor Wu Bingcai, with the unified idea of cold and temperature, created anti-toxin prescription for dispelling cold and desiccating dampness and anti-toxin prescription for TCM prevention and treatment of COVID-19 in Jiangxi province, aiming at the two syndrome types of cold and dampness stagnation and damp-heat accumulation of lung respectively[10].

(1) Powder cold dehumidification anti-toxin formula

This recipe is composed of typhoid - ephedra decoction and warm - disease - Xingsu powder.Ephedra plus art soup from the Golden Chamber Synopsis, the body wet sheng people, the external feeling of cold and damp evil in the table, the most appropriate ephedra plus art soup.Xingsu powder comes from the "Wen Bing Bian", this prescription is originally bitter, mild and gan Xin method, can be lightly publicised outside and solve the dryness, can manage the lung phlegm and stop coughing.Lung main gas department respiration belongs to wei, cold and wet bundle table, Weiyang is suppressed, evil orthogonal dispute, so see fever;Wet heavy, qi and blood running not free, so weak, body pain;Cold and dampness depressed lung, lung loss, body fluid gathering but not cloth, phlegm and dampness filled, so cough, cough sputum, chest tightness and suffocation;The spleen likes dryness and hates dampness; dampness and evil affect the spleen; spleen loses transport and changes; spleen and stomach lose harmony; therefore, the spleen becomes numb; nausea, vomiting, and bowels become sticky;Tongue light fat tooth mark, moss white thick greasy, pulse moisten the signs.Therefore, it is necessary to spread cold clearing damp, regulate lung and reduce phlegm legislation.In ephedrine open-Cou rationale, transparent hair barrier, sweating remove the surface of the cold evil, xuanfan lung chi occlusie and asthma, for your medicine.Cassia twigg, lysis of muscle published, help you drug ephedra table powder cold;Atractylodes atractylodes is good at strengthening spleen clearing damp, and combined with ephedra has the effect of sweating table clearing damp.Almond and Perilla seed can reduce lung gas and relieve cough and asthma.Aprict, Su and ephedra with five, a xuanyi fall, to restore lung gas xuansheng, the common minister medicine.The former hu reduces qi and reduces phlegm, the radix platycodonis and fructus aurantii xuanqi reduces lung qi, poria cofuling water infiltration and dampness, which makes qi regulating and body fluid transportation normal.Dried tangerine peel and Pinellia ternata from "two Chen" meaning of dampness and phlegm;Ginger, jujube harmonized spleen and stomach, for the minister.Radix glycyrrhizae palliatives are used for adjuvant purposes.All drugs are used together to play the effects of dispelling cold and desiccant, dispelling lung qi, regulating lung and resolving phlegm, which are the anti-toxin prescription for dispelling cold and desiccant.

(2) Heat and moisture anti - poison prescription

This recipe is composed of typhoid - Maxing - Gan Tang and warm - sickness - square almond soup.Ma Xing Gan Tang from The Synopsis of the Golden Chamber, the indications of cold and dampness exogenous pathogenic factors, yu in the muscle surface.Almond soup is from The Book "Differentiation of Heat and Disease", which is mainly used to treat dampness and heat to bring lung and consume lung jin. Professor Wu Bingcai believes that clinically, almond soup is suitable for dampness and heat diffusing three-coke, while the above coke is mainly used.Lung main gas belongs to Wei, Weiyang for dampness repression, so now slightly hate cold;Damp repress heat volt, therefore low heat or not calorific, have no sweat or sweat out not free;Dampness is Yin evil, and it is viscous. Wet yu Wei table prevents Qingyang, so it is weak, heavy head and body, and muscle soreness.Damp and hot accumulate lung, damp and hot injure jin, lung gas is adverse, dry cough phlegm is little;Damp and hot accumulate and change poison, reason see pharynx is painful;Wet turbidity in the resistance, jin does not bear, so dry mouth do not want to drink more;Damp repress qi, the spleen and stomach rise and fall transport changes the disorder, therefore the chest frowsty Wan PI, or see vomits disgusting na stay, loose stool or stool sticky uncomfortable.The tongue is light red, the moss yellow and greasy, the pulse slippery number is the image of damp heat.The evil of dampness and heat injures people, often affected by the three coke, so the treatment to Xuanchang qi machine, heat detoxification, detoxification for the method.The almond in the square xuan reduces lung gas, can reduce phlegm to stop cough;Ephedra permeates and dispels pathogenic factors, opens and spreads lung qi. The second medicine is mainly Xuanchang lung Qi, which is your medicine.Cardamom, wet gas, xingspleen and stomach;Raw coix seed to remove dampness and heat, relieve damp and heat from urination;Two drugs with apricot, hemp, xuanhair lung gas to open the source, aromatization to help the spleen transport, light permeability to the water channel, a total of minister medicine. Therefore, it is compatible with Scutellaria and Forsythia to clear heat, dry moisture and detoxify;Dampness and heat accumulate lung, heat injury lung jin, so mulberry leaves qingfei moisten dry;Dampness and heat internal resistance, to the evil out of the way, so with poria cocos, talc infiltration of dampness evil, two drugs and coix seed to make the heat and moisture from the urine, a total of adjuvant medicine.Raw licorice mixed with various drugs, with adjuvant.All drugs are used together to play Xuanchang qi, heat dehumidification, detoxification, for heat dehumidification antitoxic prescription.

4. Medical Records

Liu Mou, male, 46 years old.After COVID-19 was diagnosed in another hospital and treated by western medicine for 10 days, the patient was transferred to the designated hospital for COVID-19 for TCM treatment.

First diagnosis on February 20, 2020: the patient had a slight cough, slight aversion to cold, no fever, fatigue, heavy head and body, chest tightness, no chest pain, dry mouth and bitter mouth, sticky mouth, no coughing sputum, no headache and dizziness, no forehead pain, neck pain, no pharynx or itch, no stool, yellow urine, frequent but not short.Tongue red, moss yellow greasy, pulse slippery number.Many nucleic acid tests were positive during the treatment in other hospitals.TCM diagnosed phytophthora blight, syndrome differentiation as cold evil, dampness and heat poison in the lung, treatment should be spread outside to show cold, and inside to clear heat and detoxify, the prescription should be clear heat and dampness and anti-poison soup added flavor: bitter almond 10g pachyrhizus 10g baicalin 10g white cardamom 6g talcum powder 6g forsythia 10g mulberry leaves 10g ephedrine 6g coix seed 10g prepared liquorice 6g×3, orally taken twice.

2020-02-23 The second diagnosis: the patient's cough was improved, mainly at night, no obvious cough in the day, slightly sputum, white.Slight chest tightness without chest pain, mouth dry mouth not bitter, mouth not sticky, nose slightly dry, no headache, dizziness, forehead not pain, neck not pain, no aversion to cold and fever, pharynx not scratchy, soft stool, urine clear long. Tongue red, greasy yellow, pulse slippery. All the symptoms have been reduced, indicating that the drug has been proved to be the right one, and the Shushu anti-toxin prescription has been added and reduced: bitter almond (10g), poria cocos (10g), baicalin (10g), white cardamom (6g), talc (6g), forsythia (10g), mulberry leaves (10g), peach roots (10g), rhizome (12g), winter melon seeds (10g), turpentine (6g), loquat leaves (6g×7), taken orally in two times.

Third diagnosis: no cough, sputum, fever, cold, sweat, headache, dizziness, chest pain, chest tightness, dry mouth, sticky mouth, slightly dry nose, stuffy nose, sneezing, dry throat, dry stool and yellow urine.Red tongue, white coating, smooth pulse.If the nucleic acid test was negative, and the patient met the discharge standards stipulated in the COVID-19 Diagnosis and Treatment Protocol (trial version 6), the patient was ordered to independently isolate at home, followed by 10 additional doses of heat and humidity anti-toxin prescription to consolidate the curative effect and follow up with discomfort.

According to: According to the initial diagnosis, the patient had slight aversion to cold, fatigue, and heavy head and body. It was believed that there was cold and dampness outside, and qingyang was blocked.The mouth is dry, the mouth is bitter, the mouth is sticky, and the chest is stuffy. It is believed that the evil of feeling dampness and poison accumulate in the lung, and will melt into heat for a long time.Wet heat bet, see urine yellow;The patient's tongue is red, the coating on the tongue is yellow and greasy, and the pulse is smooth. Therefore, it is appropriate to treat the cold pathogen outside the surface. The method of clearing away heat and detoxifying dampness is to select cold temperature and use the method of clearing away heat and detoxifying dampness to add flavor of anti-toxic soup.After 3 doses, the symptoms of the patients were significantly improved, including slight aversion to cold, slight aversion to cold, fatigue, head and body weight had been removed, indicating that the surface cold had been solved.But still more than night cough, soft stool, red tongue, moss greasy yellow, veins smooth, evil legacy of the hot and humid, so remove MaXingYi sweet soup, or the daughter of clearing lung heat lishi reed stems soup, with clear non-digestion in hot and humid in turmeric, loquat leaf, interesting, curative effect is accurate, after 7 doses of patients with the disease are in addition to, the review of the nucleic acid detection overcast, conforms to the COVID - 19 medical 6 (trial version) "prescribed discharge standards, to consolidate curative effect, tell her to continue 10 doses of clear heat, wet resistance to poison, and make home quarantine, discomfort follow-up.

5. Summary

The unification of cold and temperature has gone through a long process from the historical debate to the gradual consensus of modern research. How to accurately communicate the syndrome differentiation of cold and warm has puzzled many TCM scholars and clinicians.Professor Wu Bingcai, a master of Chinese medicine, inherited The academic thoughts of Mr. Yao Hesheng and advocated unified syndrome differentiation of cold and temperature in clinical practice.Yao Hesheng's assumption of the framework of cold and warm syndrome differentiation is based on the unified physiological and pathological basis of the human body, which achieves the integrity of syndrome differentiation, the inclusiveness of disease species and the systematization of the framework. Therefore, after the outbreak of COVID-19 in Jiangxi province, Professor Wu Bingcai created anti-toxin prescription for dispelling cold and desiccating dampness and anti-toxin prescription for clearing heat and reducing dampness. The ingenious idea of combining cold and temperature and unifying inside and outside is reflected in the prescription everywhere, ignoring the limitation of disease species and seeking for the root of syndrome differentiation only.Under the guidance of the unified theory of cold and temperature, TCM clinical practice was tested in the designated hospital of Jiangxi Province with the combination of Traditional Chinese and Western medicine to combat the epidemic, and TCM was used to make the nucleic acid test of all the patients two consecutive negative results[11], and achieved satisfactory curative effect.