Discussion on the prevention and treatment of COVID-19 by Zhuang Medicine

Jue-Ying Chen ,Ji-Wei Qiu ,Jun-Lin Mo ,Wei Shi ,Yong-Xiang Xie＊

1First Clinical Medical College,Guangxi University of Traditional Chinese Medicine,Nanning,530023,China;

2Department of Nephrology,The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,530023,China.

Abstract The Corona Virus Disease 2019 (COVID-19) spreads rapidly and is highly infectious.Zhuang Medicine,as a unique ancient and emerging ethnic medicine in Guangxi region,is combined with the unique local climate,geography and population physique,summing up many prevention and control experiences for infectious diseases,such as taking orally and external treatment,focusing on prevention.What is more,the Zhuang Medicine shows its own unique advantages through coming up with the measures of wearing medicine therapy,pyrotechnic fumigation,characteristic medicine baths and taking prescriptions internally.This paper intends to explore the use of Zhuang Medicine to build a disease prevention and control system with characteristics of Zhuang Medicine,trying to make a contribution to the prevention and control and treatment in this region.

Keywords:The Corona Virus Disease 2019,Zhuang Medicine,Zhuang Medicine therapy,Prevention and control measures.

Background

Since December 2019,many have been infected with COVID-19 in WUHAN,HUBEI.With the rapid spread of the epidemic,it has brought a significant impact on people’ lives and the economy,and the country initiated a first-level response.Meanwhile,WHO also listed the outbreak as a public health emergency of international concern (PHEIC) [1].

As an important part of Traditional Chinese Medicine,Ethnic Medicine plays an indispensable role in the reproduction of the Chinese nation.After the occurrence of COVID-19,Zhuang Medicine,as a unique ethnic medicine in guangxi region,has played a guiding role in prevention and treatment.To Zhuang Medicine,Covid-19 is caused by "miasma",which can be classified as "miasma epidemic" category.Since ancient times,Guangxi has been known as the place of Lingnan with a harsh environment and many infectious diseases such as scarlet fever,epidemic gas infectious disease and miasma.It is recorded inthe Annual of Zhen'an County:“Tianbao County,with deep and dense jungle and harsh climate......Those who live here,are in poor health and easy to catch cold in four seasons......Namely disease epidemic current catch".Inthe Diary of Yu Heng in Guihai:The rivers and the soils there are not harmful to the local,and there is always malaria all the year around." All the year round there are "miasma"epidemic.Therefore,through years of struggle with this epidemic disease under such dangerous environment,the ancestors of Zhuang have accumulated a lot of prevention and treatment experience.

“Yin -Yang based and three qi synchronized" is Zhuang's idea on the correspondence of human and nature,"SanDao-LiangLu (SanDao consist of airway,waterway and the way of cereal; LiangLu consist of Dragon Road and Fire Road)” is the core theory of the Zhuang basic medicine.Through the coordination with the zang-fu viscera hub system,Zhuang Medicine tries to help the patient to achieve the synchronization of celestial,earth and human three qi.Pathogenesis of asthenia and toxin is the cause and pathogenesis of Zhuang Medicine;" Regulating qi,detoxifying and tonifying deficiency" are the treatment principles and methods of Zhuang Medicine,which together constitute the basic theoretical system of Zhuang Medicine [2].The theory of prevention and health preservation of Zhuang Medicine is a unique method for Zhuang people to constantly summarize experience to disease prevention in their daily practice and medical activities.It is also an important part of the basic theory of Zhuang Medicine.It is mainly Yin -Yang based and adjustmet body SanDao-LiangLu to achieve the boundary of the synchronization of celestial,earth and human qi,including the cultivation of body and spirit,regulation of diet,detoxification and tonify deficiency,and the compliance with the weather.The concrete practice is in drug recuperation,physical care,dietotherapy,customs,health massage,emotional adjustment and so on.Zhuang Medicine attaches great importance to the application of external treatment to prevent and treat diseases [3].Zhuang Medicine pays more attention to external treatment better than internal treatment in clinical treatment.Under the guidance of the basic theory of Zhuang Medicine,the external treatment method of Zhuang Medicine is application drugs or non-drug's methods in vitro treatment,directly acting on the dragon road and fire road in the body surface of the mesh,promoting blood circulation for removing blood stasis,out of exorcism,adjust the balance of qi and blood,restore the three qi synchronization to achieve the effect of disease prevention and treatment.

1 Wearing Medicine Therapy

Since ancient times people wearing sachet has been widely used as an effective method during the epidemic disease period,while wearing medicine therapy originated from the Zhuang Traditional Clothing "HUI FU" [4],Zhuang people like to hang dispel filth with aroma drugs such as the medicine bags made of Herba Eupatorii and Folium Artemisiae Argyi in their clothes and corners of the room,which has the functions of detoxification,repel foulness,anti-malaria,regulating the Fire-Road and Dragon-Road,unblocking the airway,balancing Qi and blood,etc.Through the aromatic smell of the medicine it can be inhaled through the nasal mucosa to encourage the healthy qi,expel evil spirits,unblock "SanDao-LiangLu",balance the Qi and blood to achieve the purpose of disease resistance and evil elimination.Modern research shows that the volatile oil contained in the dispel filth with aroma drugs can stimulate the body to improve immunity at the same time inhibit the vitality of viruses and bacteria to a certain extent.Wang LN et al combined with the geographical conditions and climatic characteristics of Guangxi used Zhuang Medicine anti-disease sachets made by authentic Zhuang Medicine to study the prevention of pediatric pneumonia [5].The results showed that the scent of the sachets could stimulate the respiratory tract and increase the content of sIgA and IgG in the respiratory tract,strengthen the immune barrier and reduce the symptoms of repeated respiratory tract infection in children.In view of the characteristics of COVID-19,it is recommended to wear resolving of dampness and aromatics sachet,which is composed of Shichangpu (Rhizoma A cori Tatarinowii) 6g,Aiye(Folium A rtemisiae A rgyi) 6g,Chenxiang (Lignum Aquilariae R esinatum)2g,Daye’an(Eucalyptus)6g,Cangzhu (Rhizoma Atractylodis)3g,Bohe(Menthahaplocalyx)3g,Qinghao (Herba A rtemisiae Annuae)3g,Rougui (Cortex Cinnamomi) 3g,Xiangmao(Citronella) 3g,after grinding into powder,the sachet is maked and hanged on the chest.It is recommended to replace it within 5-7 days.The sachet of dampness and aromatics is function of dispelling pathogenic wind and resolving of dampness,including Rhizoma Atractylodis has the function of “Dispelling the mountain and the river miasma".“This Sutra” is recorded that “grassleaf sweetflag rhizome is treatment to wind-cold and dampness...Warm malaria is epidemic of violent qi and also covered by phlegm-dampness,Acorus calamus can clear phlegm,repel foulness and strengthening resistance ...so it can be treated”.“Da Ming” means that grassleaf sweetflag rhizome has a strong sense of strengthening vital qi which can overcome evils and set the pain".Modern pharmacology research has proved that menthol polysaccharide in mint has a strong inhibitory effect on respiratory syncytial virus and oily volatile has a certain antibacterial effect [6];Artemisininhas direct or synergistic antibacterial effect on common pathogenic bacteria and drug-resistant bacteria [7].The essential oil of Eucalyptus grandis has the function of bacteriostasis and anti influenza virus,at the same time can also stimulate the respiratory tract mucosa,stop cough and eliminating phlegm [8].The extracts and decoctions from different parts of Chinese eaglewood have bacteriostatic effects,especially on Staphylococcus aureus and Klebsiella pneumoniae [9].Citronella volatile oil has antifungal activity in vitro.In addition,recent studies have shown that it can inhibit some Gram-positive and Gram-negative bacteria [10].The diameter of inhibition circle of essential oil extracted from cassia bark to Staphylococcus aureus and Escherichia coli was more than 20 mm [11].The combination of various drugs and the dispersing of nature and flavour pungent together play the effect of dispelling pathogenic wind,eliminating dampness and detoxification.

2 Pyrotechnic Fumigation Therapy

The Pyrotechnic fumigation therapy of Zhuang Medicine refers to a therapy that uses some medicines(argy wormwood leaf,sweet wormwood herb,Sulfur,etc.) after burning fireworks fumigated the house to achieve a therapy and prevent diseases [12].It is recorded in theHandbook of Preion for Emergencythat"febrile diseases cannot be affected by each other...Moxibustion on the four corners of the bed ...Well ";Compendium of M ateria M edicamentions that“(Atractylodes rhizome) combs all evils,burns smoke with Chizhu and pig's hoof armor,and Taoyinju also says that Atractylodes rhizome can eliminate evils and eliminate disasters.Therefore,people often burn it to eliminate the evil on epidemic disease and on the new year's day.” During epidemic can burn the medicine such as Atractylodes rhizome and Argy wormwood leaf in the room to disinfect and repel foulness.The results show that the smoke particles produced by the combustion of Argy wormwood leaf have the effect of sterilization [13].The removal rate of natural bacteria in the air reaches 90%adopt to moxa stick fumigation ward.COVID-19 was mainly spread by droplets and contact.Wang analyzed the Wuhan clinical characteristics of 138 patients in a hospital and found that about 43.1%of them may be transmitted by nosocomial infection[14].The people's Hospital of Tongxu County in Henan province carried out moxibustion fumigation in the outpatient and inpatient departments.All the patients recovered and were discharged from the hospital,and no medical staff were infected.Because the smoke particles formed after the combustion of wormwood leaf can absorb and agglomerate the small particles in the air,accelerate the sedimentation,reduce the time of droplets and bacteria dust in the air,and play the role of cutting off the transmission path [15].In addition to burning moxa sticks,it can also boil the traditional Chinese medicine fumigation room containing argy wormwood leaf,which has the same effect.Compared with moxa sticks fumigation,it reduces the dust particles in the air,improves the air humidity and air quality [16].Therefore,it is recommended to use 15g Aiye (Folium A rtemisiae A rgyi),Cangzhu (Rhizoma Atractylodis) and Daye’an(Eucalyptus),smash them into strips and light them,blow out the flame and fumigation.They are suitable for air disinfection in general wards with an area of 16m2 and a space of 45m3(about 1H) which can meet the requirements of class III air disinfection.Studies have shown that the eucalyptus oiland the volatile oil of Atractylodes macrophylla had a clear antibacterial effect on a variety of bacteria and fungi [17].While the Atractylodes rhizome was fumigatedby dosage 1g/m3 in the room for 2 hours,the sterilization rate of natural bacteria in the air was more than 90%and the sterilization effect lasted for 4 hours,which had no significant difference with the effect of ultraviolet air disinfection [18].This method can be used in relatively closed environment or places with mobility of people,such as families,individual shops,school classrooms,etc.compared with other disinfection methods such as spraying disinfectant and ultraviolet disinfection in different periods of time,it has the advantages of long duration of disinfection,convenient operation,effectiveness,easy promotion,and good feasibility.However,it is necessary to keep indoor ventilation and pay attention to fire prevention when burning.

Moxa-moxibustion therapy is one of the commonly used medical techniques of Zhuang Medicine.It can stimulate the Dragon Road and Fire Road on the body surface,regulate the body network,regulate qi and blood,coordinate Yin -Yang,eliminate toxin and cold,warm the channel,tonifying deficiency and ward off evil,treat diseases,improve the immunity of the body,and to a certain extent promote the blood circulation of the body and improve the body environment [19].The novel coronavirus pneumonia is located in the lung,belonging to the category of "Airway Disease" in

Zhuang Medicine."Mibo" qi is not fixed not solid,and when the evil spirit invaded,the Feishu (BL13),the Dazhui (DU14) and the Fengchi (GB20) can be adjusted to the airway,dispelling pathogenic wind and cold,and guarding the defensive qi."Mibo" is the metal,and"Milong" is the earth,reinforcing mother viscera for treating deficiency of child viscera,therefore,the method of reinforcing earth to generate metal,Zusanli(ST36),Guanyuan (RN4),Zhongwan (REN-RN12),Shenque (RN8) are taken to strengthen the spleen and stomach and fill the lung deficiency,Sandao-Lianglu are harmonised and synchronize the celestial qi,earth qi and human qi.In the moxibustion at the same time can also be fumigated through the way of fireworks for air disinfection,kill two birds with one stone.

3 Medicinal Fumigation and Wash Therapy

Zhuang medicinal bath has been widely used in Zhuang area for a long time,which is one of the important methods for people to prevent and treat diseases in Zhuang area.Zhuang medicinal bath can be divided into washing method and fumigating method according to different diseases and different medicine decocting for 30-40min to take medicine solution for soaking and bathing [20].The moist and hot gas produced during the fumigation and washing of drugs will heat the skin,expand the microvasculature,increase the permeability of the skin and accelerate the absorption of drugs; Warm stimulation can activate the function of reticuloendothelial system and accelerate the microcirculation of human body,so as to achieve the effects of dredging Sandao-Lianglu,regulating the qi movement of human body,dispelling pathogenic wind and cold,detoxifying and detumescence,sterilizing and antipruritic,strengthening vital qi to eliminate pathogenic factor,etc.According to the characteristics of COVID-19 cold-wet epidemic gas,Youye (Pomelo Leaf)100g,Hangpiye (the leaf of wampee) 100g,Aiye(Folium Artemisiae Argyi)100g,Shichangpu (Rhizoma Acori T atarinowii)100g,Qinghao (Herba A rtemisiae Annuae)100g; Daye’an (Eucalyptus)100g,Shengjiang(Rhizoma Z ingiberis R ecens)50g are used for fumigation and wash.The Eucalyptus robusta and the leaves of wampee in the prescription belong to the drugs for regulating airway [21],which it is recorded in the records of “Lingnan Medicine Collection” that" (The leaves of wampee are decocted and washed by water)can relieve the filth,eliminate the wind and swelling,treat scabies,clearing heat-toxicity".The leaves of wampee have the effects of regulating qi,removing wind-evil and are commonly used for treating airway diseases [22],and its extracts have obvious inhibitory effects on some Gram-positive bacteria [23].Eucalyptus robusta has the effects of ventilating airway and removing wind-evil,dispelling wind and arresting itching,clearing heat-toxicity,and has certain antibacterial effect; Ginger can unblock the airway and detoxify as so people go out in the morning often contain ginger to dispel the cold and repel foulness [24].The curcumin and volatile oil components in ginger have the effect of anti-Gram-positive bacteria in vitro also inhibit fungi and have strong toxicity to Salmonella[25].Guangxi Zhuang folk custom of prevention with the use of pomelo leaves prevention and cure disease for a long time because they think that pomelo leaves of the function of ventilating and dehumidification."The Herb Seeks the Original" also mentions that the leaves of pomelo can "eliminate swelling due to wind and repel foulness."The experiment shows that pomelo leaf has better antibacterial effect on Escherichia coli of chicken origin in vitro than traditional Chinese medicine such as Fangfeng and Qinghao but no experiment shows that it has inhibitory effect on other bacteria and fungi in human body which is worth discussing [26].This prescription combines grassleaf sweetflag rhizome to remove dampness and toxicity and strengthen the way of cereal according to the characteristics of dampness pathogen in Guangxi climate,at the same time its volatile oil component has certain antibacterial and bacteriostatic effects on broad-spectrum bacteria and fungi [27]; Sweet wormwood herb has the functions of clearing heat-toxicity,Sha detoxification and Zhang detoxification and inhibiting RNA virus (influenza virus)at the same time of antimicrobial activity [28].All kinds of drugs can be used together to prevent and control epidemics.

4 Isolation and Repel Foulness Therapy

In the Qiaonan Trivial Records,it is mentioned that in order to prevent the spread of infectious diseases,such as malignant malaria,epidemic infectious disease,etc,the ancestors of the Zhuang nationality isolated the infected persons from their homes in some places where the Zhuang nationality gathered,and hung signs to closed,and did not communicate with the villagers and neighboring villages [29]; When the epidemic is prevalent,go home and take a bath with herbal soup to clear up the repel foulness and detoxify [24]; Wash and sun clothes and utensils in hot water at home,and fumigate and disinfect the house with Zhuang Medicine,aiming at eliminating toxicity and avoiding pollution,and preventing cross-infection.This is basically consistent with the scheme of the Guidelines for the Prevention and Control of Infections in Home Isolation Medical Observation (Trial) proposed by the National Health Commission of China,in which the source of infection is controlled,the route of transmission is cut off and the susceptible population is protected [30].In addition to external treatment and prevention methods,Zhuang Medicine internal treatment also has a good advantage.Due to the unique geographical environment of Guangxi,the haze is dewy all the year round,so emphasis is placed on eliminating pathogens and detoxifying in the treatment.Oral medicines are mostly fresh medicines with high dose and less concerted application,pay attention to the strength and specialization,mostly for specially prescriptions for specially diseases.

The most important difference between Zhuang Medicine and TCM is that although there are syndrome differentiation concepts in Zhuang Medicine it emphasizes disease differentiation mainly and syndrome differentiation,while syndrome differentiation generally only distinguishes Yin syndrome and yang syndrome.The oral Decoction formulated by COVID-19,aimed at the Yang syndromes of fever or high fever,cough,thick phlegm,bitter taste,upset,red tongue,yellow or greasy fur,repid and slippery pulse.The Decoction of Shanzhima,Yiren(SemenCoicis),Shanyinhua (FlosLonicerae),Cangzhu(RhizomaAtractylodis),Tie baojin,Xiaoyejinhuacao was used for oral administration.Shanzhima is taste slightly bitter and spicy,cold in nature of drug,has the effects of Sha detoxicating,clearing heat-toxicity and removing dampness,combines with Xiaoyejinhuacao and Shanyinhua aim at Yang syndrome to clearing heat-toxicity,and also climate mixed with dampnessheat and supplemented by coix seed and Tiebaojin to enhance the power of clearing dampness-heat; For yin syndromes such as no fever or low fever,aversion to cold,heavy sensation of head and body,sore muscles,anorexia,loose stool,pink tongue,white and greasy fur,floating and rapid pulse,etc,Guizhi(RamulusCinnamomi),Yiyiren (SemenCoicis),Cangzhu (RhizomaAtractylodis),Zisuye(FoliumPerillae),Huoxiang (HerbaPogostemonis),Shengjinang (Rhizoma Z ingiberis R ecens),were selected for oral decoction.Cassia twig taste pungent and sweet，warm in nature have the effect of dispelling pathogenic wind-toxin and dispelling cold-toxicity.It is an essential drug for treating cold-toxicity.Yin syndromes often show the invasion of cold-dampness so compatible with fresh ginger and Perilla leaves to help it warming spleen and stomach for dispelling cold as well as coix seed,atractylodes rhizome,ageratum and hops to enhance the effect of removing dampnesstoxicity.Modern pharmacology shows that atractylone contained in Atractylodes Rhizomehas anti-influenza effect,and its content is positively correlated with antiinfluenza effect [31].A large number of Honeysuckle bud and flower has significant inhibitory effect on influenza virus in rat lung [32]; Ageratum can inhibit the expression of TNF-Q and high IL-10,IFN-γin serum,and improve the antiviral factors of mice infected with influenza virus [33].These traditional Chinese medicines have clear pharmacological mechanism,accurate efficacy and clear effect on anti-viral infection.However,with the evolution and increase of viruses,drug-resistant strains emerged.Although the mechanism of herbs such as Shanzhima,Tiebaojin and Xiaoyejinhuacao clover is not yet clear,they have great potential.At the same time,it cooperates with the characteristic external treatment method of the Zhuang Medicine to achieve the goal of treatment and prevention by combining both approaches and dredging the internal and external channels.

The Corona Virus Disease 2019 is dangerous and spread fast.Prevention and control are the key to control the epidemic.Under the guidance of the holism,TCM has provided many treatment schemes,therapies and prescriptions through treatment based on syndrome differentiation and adapting measures to local conditions.Ethnic Medicine based on their own medical thinking system puts forward different thinking theories,preventive measures and treatment methods.As an ancient and emerging ethnic medicine,Zhuang Medicine has been developed and perfected in the past 30 years and its basic system has been constructed and perfected，it can effectively guide clinical practice.As a unique ethnic medicine in Guangxi make full use of own advantages,excavates and constructs an epidemic prevention and control system with Zhuang Medicine characteristics makes sufficient preparations to contributing the prevention,control and treatment of the region.