Study on COVID-19 based on nourishing yin and resolving phlegm

Wei-Dong Lai, Jie-Yi Wang, Xiao-Gu Liu

1First Clinical Medical College of Zhejiang University of Traditional Chinese Medicine , Hangzhou, China;2School of Basic Medicine,Zhejiang University of Traditional Chinese Medicine, Hangzhou, China.

Abstract

Keywords:COVID-19, Nourishing yin, Resolving phlegm

Background

Since the outbreak of corona virus disease 2019(COVID-19) in Hubei in December 2019, the epidemic has gradually spread, seriously endangering people's health.We made a clear request to adhere to the integration of traditional Chinese and western medicine,constantly improve the diagnosis and treatment program, and make Chinese medicine enter the main battlefield of prevention and control of the epidemic situation.Then, traditional Chinese medicine(TCM)was included in the nationalCOVID-19 diagnosis and treatment program (trial version 3 to 6), emphasizing the active role of TCM.As of February 17, the total number of confirmed cases of Chinese medicine participating in treatment in China was 60107, the number of confirmed cases of Chinese medicine participating in treatment in China accounted for 85.20%, and the number of cured and discharged cases and symptoms improvement of TCM participating in treatment accounted for 87% [1].

In summing up the experience in the diagnosis and treatment of new crown pneumonia using traditional Chinese medicine, we found that the core pathogenesis of this disease is "wet"[2], so the prescription of TCM is mostly treated from "wet".Therefore, how to clear the sputum in the alveoli is the key [3].And TCM is very good at treating phlegm and various means,combined with the COVID-19 guidelines related to the diagnosis and treatment of TCM, many places can be seen in removing dampness and resolving phlegm at the same time using moisturizing drugs.Such asCOVID-19 diagnosis and treatment program(trial version 3 to 6), such as Xuanshen(Radix Scrophulariae), Zhimu(Rhizoma Anemarrhenae),Dihuang(Radix Rehmanniae)moisturizing drugs[4].This paper based on this view, try to explore the theoretical basis of yin and phlegm treatment theory.

1 Traceability of phlegm

"Phlegm" as a medical proper noun, its history can be traced back to the Qin and Han dynasties."Synopsis of Prescriptions of the Golden Chamberformally put forward the "phlegm drink" statement.Three Causes and One Disease Syndrome Prescriptionholds that the abnormal operation of qi, blood and body fluid in the body and the dysfunction of viscera function will lead to phlegm, and the causes of phlegm are various.

Phlegm and drink are separated byGeneral Treatise on the Cause and Symptoms of Diseases.Phlegm is also divided into cold and hot phlegm according to the disease.Phlegm is not only related to abnormal body fluid, Qi unobstructed is also its key cause.Key to Diagnosis and Treatmentsays that treatment of Qi and phlegm, Qi smooth and phlegm elimination.It can be seen that the cause of phlegm is mainly related to the rise and fall of Qi machine and abnormal metabolism of body fluid [5].

2 Cause and effect of phlegm dampness and yin injury

According to Yin and Yang two points method, we can divide the essence into Yin essence and Yang essence.the TCM "Yigui homology" is about the relationship between Yin essence and blood.Yin essence can be transformed with blood.And Yin essence, blood, body fluid can be transformed into each other.It can be seen that the category of Yin mainly refers to essence,blood, body fluid and other liquid essence substances.So the three Yin essence, Yin blood, Yin Jin in the body form an organic whole, the same belong to the category of "Yin ".

The formation and distribution of body fluid are closely related to the three organs of lung, spleen and kidney.That is, after the water valley into the stomach,body fluid on the spleen, through the spleen transport effect of dispersing the whole body.A part of body fluid is transported to the lung, through the function of lung qi, combined with the function of kidney gasification and Sanjiao waterway regulation.The body fluid is transported to the bladder under the body fluid, and the clear water is proficient in filling the meridians of the five viscera, and the turbid liquid in the water is turned into urine and discharged out of the body.If the lung is lost, it is difficult to regulate the waterway and can not transport water, dampness and phlegm.Spleen deficiency can not remove qi and water, so that the body fluid running slowly, so that phlegm into drink;kidney deficiency qi loss, water fluid must not be normal steam, so that water fluid stop gathering,brewing phlegm turbid.Three viscera deficiency damage, water and liquid must not biochemical and wet into phlegm.It can be seen that phlegm is the pathological product of human body fluid delivery disorder.It can be seen that phlegm and body fluid are homologous.Although phlegm, drink, water, dampness although the name is different, but the same Yin evil,that is, Yin essence, blood, body fluid, phlegm, drink,water, dampness should belong to the broad sense of"Yin" category.

Jingyue Quanshuindicates that sputum will consume body fluid, so that the viscera qi and blood fluid decline and it is one of the important causes of Yin-jin consumption.As a pathological product, it can be used as a cause of disease, blocking the tri-coke, affecting the rise and fall of qi and body fluid.Synopsis ofPrescriptions of the Golden Chambersays that phlegm dampness not only affects the formation of body fluid,but also affects the transport and transformation of body fluid.

The main component of the body is water, accounting for about 60% of the body weight, so the total amount of their own yin is the minimum requirements to meet their own nourishing needs.If their people do not drink water for a long time, the blood tends to thicken, blood viscosity increased, resulting in high intravascular osmotic pressure, then tissue fluid infiltration into the veins to maintain normal balance of body fluid.Synopsis of Prescriptions of the Golden ChambershowsthatYin damage will lead to phlegm dampness fill and it is the internal and external inspiration, so this situation caused by the external dampness inside should be called "external dampness seepage body".the meaning of these two completely different.If the body fluid sufficient, smooth, yang qi along the smooth,although there is external dampness, not harmful.It can be seen that Yin injury people phlegm dampness fill, can be responsible for the same Qi, internal and external call physiological compensation, that is, a point Yin damage is a point Yin fill.

In addition, Yin injury can also cause Yang damage,which leads to lung loss depression, spleen loss of health, life gate not warm, kidney loss gasification,Qi machine rise and fall, waterway regulation lost division, can be stagnation and phlegm drink.Yin and Yang serve each other, if Yin essence damage, Yang Qi biochemical deficiency, resulting in adverse body fluid distribution, such as phlegm dampness pathological products.

Deficiency and phlegm are not isolated, it is an interactive, interactive pathological process.Sputum accumulation can damage the body Yin fluid, but Yin fluid injury and aggravate the formation of phlegm.Whether it is lung and stomach yin deficiency, or heart,spleen and blood deficiency, or liver and kidney yin deficiency, can lead to deficiency of fire in the body,burn body fluid, Sanjiao body fluid operation disorder,Jin coagulation for phlegm, deficiency and reality mixed.So repeated, evil accumulation is difficult to go, even blood stagnation for blood stasis, phlegm and blood stasis knot each other, the disease is prolonged.Modern studies have also found that yin deficiency can affect water-liquid metabolism to produce phlegm [6].

3 Characteristics of Drug Use

Many doctors in clinical practice often stick to the viewpoint of "warm away it".The use of warm dryness too, but lead to phlegm evil cementation which is difficult to go.Therefore, the treatment of phlegm should not stick to fearing of nourishing yin medicine multi-sex stagnation, but ignore the examination of syndrome seeking cause, syndrome differentiation and treatment.Once phlegm turbid block Sanjiao, injury body fluid, then give nourishing yin medicine to make body fluid abundant, water dampness can be slowly discharged from the body in the form of sweat and so on, in order to achieve the effect of auxiliary dispelling dampness and resolving phlegm.If not treated at that time, the disease is prolonged, phlegm turbid diffuse Sanjiao, blocking the meridian.Not only affect the whole body qi and blood body fluid delivery, but also affect the formation of body fluid, forming a vicious circle, eventually see phlegm turbid block, pulp withered injury.

Generally speaking, according to the degree of Yin injury and phlegm obstruction, need to be treated in stages.

3.1 Nourish yin and promot body fluid

Body fluid loss at early, aromatic herbal like Shichangpu (Rhizoma Acori Tatarinowii),Huoxiang(Herba Pogostemonis),Peilan (Herba Eupatorii),Sharen (Fructus Amomi),Doukou (Semen Alpiniae Katsumadai)can be uesd to nourish Yin nutmeg with the quality of juicy fresh products, such as sugar cane juice, Wusheng decoction, Shaoyao Gancao soup.Wuyelugen decoction including Huoxiang (Herba Pogostemonis), Bohe (Herba Menthae), Heye (Folium Nelumbines), Dongguazi (Exocarpium Benincasae)Peilan (Herba Eupatorii),Lugen (Rhizoma Phragmitis)arrhena, which is mainly used for Qi and yin deficiency and late stage of damp heat disease [7].

3.2 Blood-nourishing and eliminat stagnation

Nourishing blood is filling essence.Essence and blood deficiency, light sent to Dazao (Fructus Jujubae),Suanzaoren(Semen Ziziphi Spinosae),Shaoyao (Radix Paeoniae Alba), Jixueteng (Caulis Spatholobi), Danggui (Radix Angelicxcae Sinensis),slightly heavy need Shudihaung (Radix Rehmanniae Preparata), Huangjing (Rhizoma Polygonati) and so on, but also elected flesh and blood sentimental products, such as Ejiao (Colla Corii Asini).On this basis, then used with qi regulating products such as Sharen (Fructus Amomi) and Chenpi (Pericarpium Citri Reticulatae), which can also reduce the greasiness of the medicine.Decreased white blood count is the prominent clinical symptom of new coronary pneumonia, and Chen HT, et al [8] found that the blood filling can enhance the body's white blood count,enhance immunity, in addition, body fluid loss is prone to increase blood viscosity, and inflammatory exudation is a blood adverse water an important embodiment,which means to regulate qi and blood circulation or lung inflammation caused by increased airway secretion and hypoxemia has a certain role [9].

3.3 Open the body to awaken the mind

At this time, it is often seen in the critical syndrome of turbid phlegm blinding pericardium or late stage of Yin exhaustion and Yang detachment.The first thing to do is to awaken the mind and return to Yang and gutuo.According to the cold and heat of the patients,the resuscitation agents such as Angong Niuhuang Wan, Purple snow elixir, Treasured Bolus or Suhexiang pills can be taken.If the symptoms are deficient, mint and ginseng soup will be taken, while those with real Yin and Yang will be taken by Shenfu decoction and Shengmai powder.Novel coronavirus pneumonia in Wuhan area, Rui Chen et al [10] were summarized based on the analysis of 52 cases of TCM treatment of new crown pneumonia in the area.It is considered that the disease is characterized by the appearance of delirium, high fever, asthma, pulmonary inflammatory infiltration and blood oxygen saturation.The disease is divided into internal and external categories.When it is used for eliminating the toxin, opening and closing the body, removing the Yang and eliminating the adverse effects, the Shenfu Sini decoction is added orAngong Niuhuang Wan, Purple snow elixir, Treasured Bolus,Suhexiang pill.

Discussion

In a word, body fluid, blood, yin essence and phlegm belong to the category of "yin".The total amount of body yin has the minimum requirement to meet its own nourishing needs.By virtue of the characteristics of the body's Yin and Yang, it can maintain dynamic balance in the human body.Once the Yin injury occurs in the body, it can not meet the needs of maintaining the basic physiological function of the body.It will fill the negative substances to expand the total amount of Yin.The negative substances can be physiological body fluid, blood, Yin essence, but more are the negative pathological products such as phlegm, drink, water,dampness and so on, which can cause dysfunction of lung and spleen.Accordingly, phlegm dampness as a pathological product can be used as a cause to hinder the formation and transport of body fluid, and phlegm dampness and body fluid homology, phlegm dampness is the body fluid, so the formation of phlegm dampness will also consume body fluid, this phlegm dampness can cause Yin injury.Phlegm dampness, Yin injury both cause and effect.

The main cause of this new-crown pneumonia epidemic is dampness evil, which is glue adhesion and often along with yin injury, the two cause and effect.It can cause great challenges for clinical diagnosis and treatment.Clinical diagnosis and treatment of phlegm and drink disease referred to a variety of means, including pure to nourish yin, pure phlegm,no lack of nourishing yin and phlegm.We should not only focus on defilement and turbid, but also look at nourishing yin solid, phlegm does not nourish yin,this is not its treatment, nourishing yin and phlegm method is reasonable.Based on the different severity of yin injury and phlegm obstruction, we should choose three methods of nourishing yin and nourishing body,removing filth and turbid, nourishing blood and filling essence, eliminating stagnation and opening orifices to awaken mind and returning yang and removing dampness, in order to provide new ideas for clinical doctors to treat phlegm and drink and Yin injury diseases.