Abstract:“Reinforcing Health Qi and Removing Pathogenic Factors” has an important historical position in the prevention and treatment of epidemic diseases, and modern pharmacological studies confirm that this treatment can significantly improve the immune status of the affected body. Patients with COVID-19 mainly rely on their own immune function to fight the virus, and in the prevention and treatment of COVID-19 using traditional Chinese medicine, “Reinforcing Health Qi and Removing Pathogenic Factors” runs through the entire process, and the role of traditional Chinese medicine in “supporting Health Qi” can regulate the body’s immune function, enhancing the body’s ability to fight the virus, that is, “the healthy Qi should be preserved and the internal evil should not be dried up.” The healthy Qi of the human body in TCM has similarities with the human immune function in modern medicine in resisting exogenous pathogens, therefore, in addition to TCM’s “dispelling evil” and modern antiviral treatments, it is particularly important to enhance the immune function of the body through the combination of traditional Chinese and Western medicine for the prevention and treatment of COVID-19.。
Keywords: COVID-19; Reinforcing Health Qi and Removing Pathogenic Factors; Immune Regulation
Classification Number: Ｒ563．1 Document Identification Code: A Article Number: 1000-1719( 2021) 08-0090-04
Funding Project: National Key Research and Development Program( 2018YFC1707200) ; Liaoning Provincial Natural Science Foundation( 20170540596) ; National Natural Science Foundation( 81803726)
Author Introduction: SONG Cheng( 1999－) , Male, from Dazhou, Sichuan, Bachelor,
Research Direction: Pharmaceutical Formulation. Corresponding Author: FENG Xiuzhi( 1986－) , Female, from Jining, Shandong, Lecturer, Doctoral Student,
Research Direction: Research on the Theory and Application of Chinese Medicine Properties. SHAN Guoshun( 1984－) , Male, from Yingkou, Liaoning, Associate Professor, Research Direction: Research on the Processing Technology and Quality Standards of Chinese Medicine.
Study on Preventive and Curative Effect of“Reinforcing Health Qi and Removing Pathogenic Factors” on COVID-19 from Perspective of Immune Regulation
SONG Cheng1，LI Jinyu1，SUN Mingyu1，FENG Xiuzhi2，SHAN Guoshun1
( 1．College of Pharmacy，Liaoning University of Traditional Chinese Medicine，Dalian 116600，Liaoning，China;
2．College of Traditional Chinese Medicine，Liaoning University of Traditional Chinese Medicine，Shenyang 110847，Liaoning，China)
Abstract: “Reinforcing Health Qi and Removing Pathogenic Factors” plays an important role in the prevention and treatment of pestilence. Modern pharmacological studies confirm that this treatment can obviously improve the immune state of the body. Patients with COVID-19 rely on autoimmunity to fight the virus. “Reinforcing Health Qi and Removing Pathogenic Factors” runs through the whole process in the prevention and treatment of COVID-19 using traditional Chinese medicine. The effect of traditional Chinese medicine in “supporting Health Qi” can regulate the body’s immune function and increase the body’s ability to fight off viruses. In other words, “the healthy Qi should be preserved and the internal evil should not be dried up.” The healthy Qi of the human body in TCM plays a similar role in the process of resisting exogenous pathogens as the human immune function in modern medicine. Therefore, in addition to “dispelling evil” in TCM and antiviral treatment in modern medicine, it is particularly important to enhance the immune function of the body through the combination of traditional Chinese and Western medicine for the prevention and treatment of COVID-19.Keywords: COVID-19; Reinforcing Health Qi and Removing Pathogenic Factors; Immune Regulation
As of late March 2020, the COVID-19 epidemic has been effectively controlled in our country, and the combination of traditional Chinese and Western medicine has achieved good results. However, COVID-19 has rapidly spread abroad, with the death toll continuously rising. The mechanism of COVID-19 is still unclear, and traditional Chinese medicine plays a role in the prevention and treatment of epidemics through multiple targets and pathways. Although the mechanism of the disease is complex, it can be highly summarized into two aspects: “healthy Qi” and “evil Qi”【1】. Currently, research on the prevention and treatment of COVID-19 using traditional Chinese medicine mainly focuses on anti-inflammatory and antiviral aspects, while 90% of cured COVID-19 patients rely on their own immunity【2】. Therefore, exploring the impact of TCM’s “Reinforcing Health Qi and Removing Pathogenic Factors” on the immune function of COVID-19 patients is of great significance. Through literature research, it has been found that “supporting Health Qi” has played a key role in the prevention and treatment of epidemic diseases throughout history, based on the synergistic effect of “Reinforcing Health Qi and Removing Pathogenic Factors” and the human immune function in combating viruses, exploring the immune regulatory role of “Reinforcing Health Qi and Removing Pathogenic Factors” in the prevention and treatment of COVID-19.
1“Reinforcing Health Qi and Removing Pathogenic Factors” in the Prevention and Treatment of Epidemics
1.1 Theoretical Origins of “Reinforcing Health Qi and Removing Pathogenic Factors”
“Reinforcing Health Qi and Removing Pathogenic Factors” originated from the Huangdi Neijing【3】, which states: “the healthy Qi should be preserved and the internal evil should not be dried up,” and “wherever evil gathers, its Qi must be deficient.” “Reinforcing Health Qi and Removing Pathogenic Factors” is a basic treatment principle formulated for the human body and pathogenic evil Qi, running through the principles, methods, formulas, and medicines of traditional Chinese medicine. Reinforcing refers to enhancing the body’s constitution through TCM methods, improving the body’s resistance to disease; removing evil refers to eliminating or weakening pathogenic evil through TCM methods【3】. The Suwen states: “I have heard that the five epidemics are all contagious, regardless of size, the symptoms are similar, and if no treatment is applied, how can they not transfer to each other? Those that do not transfer are those whose healthy Qi is preserved and the internal evil cannot invade, avoiding its toxic Qi”. Even for the same disease, the treatment cannot be generalized, therefore, in the process of preventing and treating COVID-19 with traditional Chinese medicine, it is necessary to always conduct syndrome differentiation and treatment, which essentially can be attributed to the interaction of evil and healthy Qi, the location of the disease, the cause of the disease, the mechanism of the disease, the nature of the disease, the transmission, the outcome, and the prognosis are all manifestations of the struggle between evil and healthy Qi【4】.The Shanghan Lun established the foundation of syndrome differentiation and treatment in traditional Chinese medicine, implementing the treatment principle of “Reinforcing Health Qi and Removing Pathogenic Factors,” becoming a model for later generations of physicians. Jiang Dan and others emphasize that in clinical practice, it is advisable to flexibly select prescriptions, and mastering “Reinforcing Health Qi and Removing Pathogenic Factors” is key.
1.2 The Role of “Reinforcing Health Qi” and “Removing Pathogenic Factors” in the Prevention and Treatment of Epidemics The Suwen states: “If it is not in its position, it is evil, if it is in its position, it is healthy, if it is evil, it will become severe, if it is healthy, it will be slight,” which clearly indicates the relationship between “Reinforcing Health Qi” and “Removing Pathogenic Factors” in the Neijing. The Suwen records: “Huangdi said: I have heard that the five epidemics are all contagious… how can they not transfer to each other?? Qibo said: Those that do not transfer are those whose healthy Qi is preserved and the internal evil cannot invade, avoiding its toxic Qi, and the heavens have come from the past, and they will return to their past.” Reinforcing and removing evil have thus become the two basic principles for the prevention and treatment of epidemics in later generations【5】. However, regarding which is more important, “Reinforcing Health Qi” or “Removing Pathogenic Factors, ancient physicians held different views. In the Tang Dynasty, Sun Simiao emphasized nourishing Yin to reinforce health, while during the Jin and Yuan dynasties, Li Gao used the Bu Zhong Yi Qi Decoction to treat epidemics, achieving the goal of removing evil by reinforcing health【6】. Zhu Zhenheng nourished Yin and reinforced health, which is beneficial for recovery in the later stages of epidemics【7】. In the Ming and Qing dynasties, physician Wu Yuxing proposed in the Wenyi Lun that “when the original Qi is full, evil does not easily enter, when the original Qi is deficient, during the breath, external evil takes advantage of it,” clearly stating that the deficiency of healthy Qi is the basis for the onset of epidemic diseases, emphasizing the importance of reinforcing health【8】.
Wu Jutong proposed in the Wenbing Tiaobian to clear and disperse warm and hot evils while protecting Yin fluids, removing evil and nourishing Yin to treat warm diseases【9】. Modern famous physician Pu Fuzhou also mentioned: “In the relationship between healthy and evil Qi, healthy Qi is the root, evil Qi is the branch, and the theory of disease in traditional Chinese medicine emphasizes the importance of healthy Qi”【10】. In modern research, physicians generally agree with the view that reinforcing healthy Qi is primary. “the healthy Qi should be preserved and the internal evil should not be dried up” also reveals that the cause of the disease lies in evil, but the foundation is in healthy Qi, emphasizing the importance of healthy Qi.
2 The Impact of “Reinforcing Health Qi and Removing Pathogenic Factors” on the Immune Function of the Human Body
2.1 The Relationship Between TCM Healthy Qi and Western Medicine Immune Function
“Reinforcing Health Qi and Removing Pathogenic Factors” plays a multifaceted role in the prevention and treatment of COVID-19, and from the perspective of its regulatory effect on the immune function of the human body, the healthy Qi described in TCM has commonalities with the immune function of modern medicine. The ability of healthy Qi to resist external evil and the treatment idea of reinforcing health to remove evil are consistent with the defensive and monitoring functions of the human immune system【11】. Guo Jing and others【12】 proposed that traditional Chinese medicine and modern immunology have similarities in basic theories, thinking methods, and other aspects. Healthy Qi consists of Wei Qi and Ying Qi, with Ying circulating in the meridians and Wei circulating outside the meridians. “Meridians” refers to the blood vessels of the human body, containing immune cells, and the lymphatic system is distributed outside the blood vessels and closely accompanies them, indicating that the network formed by lymphatic vessels is very similar to the meridians in TCM that circulate Ying and Wei Qi【13】. From the perspective of origin, distribution, time rhythm, and functional characteristics, the healthy Qi of the body and immune function have a high degree of consistency. The healthy Qi of the body and immune function have many similarities, but the differences between the two cannot be ignored. Xia Feifei and others【13】 believe that the two describe the body’s resistance to disease from completely different angles, and their research methods and approaches are also not entirely the same. Traditional Chinese medicine emphasizes a holistic view and syndrome differentiation, with conclusions drawn from practical experience and clinical summaries, which have scientific attributes and social philosophical attributes, but lack corresponding diagnostic and treatment standards, while modern immunology research focuses on structural lesions in the human body, which can be observed through modern scientific and technological means, providing quantifiable indicators for clinical diagnosis and treatment. Exploring the relationship and differences between healthy Qi and immune function can provide objective evidence for TCM’s “Reinforcing Health Qi and Removing Pathogenic Factors” in regulating the immune function of the body.
2.2 The Regulatory Effect of TCM on the Human Immune System
Liu Wei and others【14】 listed four potential Chinese medicines with immune-regulating effects against COVID-19: Ren Shen (Ginseng), Huang Qi (Astragalus), Gan Cao (Licorice), and Dong Chong Xia Cao (Cordyceps), all of which are tonifying Chinese medicines that can support the body’s healthy Qi. Research has found that many ginsenosides have strong immune activity【15】, and the polysaccharides, saponins, and flavonoids in Astragalus have significant effects on enhancing innate immunity, and Astragalus also regulates the respiratory, digestive, and gastric mucosal secretion functions【16】 and balances humoral and cellular immunity. Modern research has also confirmed that both Licorice and Cordyceps have immune activity. The effective components in compound Chinese medicines and single Chinese medicines can enhance T cell-mediated immune responses. Wu Xiaohong and others【17】 found that the active components in Chinese medicines have immune-regulating effects, such as polysaccharides and organic acids, which generally promote immunity, while glycosides and alkaloids have bidirectional regulatory effects, depending on their concentration and the interaction of multiple active components, which is influenced by the dosage and the combined effects of the prescriptions. Exploring the relationship between “Reinforcing Health Qi” and immune regulation can better understand the role of traditional Chinese medicine in the prevention and treatment of COVID-19.
3 Exploring the Significance of “Reinforcing Health Qi and Removing Pathogenic Factors” in the Prevention and Treatment of COVID-19 Based on the Human Immune System
3.1 Changes in the Immune System of COVID-19 Patients In the COVID-19 epidemic, severe patients have shown immune system disorders, with pulmonary immune cells in a state of overactivation, and a significant decrease in the total number of lymphocytes, such as the total number of T lymphocytes, CD4+ T lymphocytes, and CD8+ T lymphocytes in critically ill patients being lower than those in ordinary patients, while the number of neutrophils increases. In the serum of patients, inflammatory factors such as IL-1β, IFN-γ, MCP-1, CXCL-10, MCP-1, TNF-α, TNF-β, MIP-1, IL-2, IL-6, IL-7, and IL-10 are elevated, and these numerous cytokines lead to more immune cells infiltrating the infection site, subsequently blocking gas exchange between the alveoli and capillaries, leading to acute respiratory distress syndrome【19-21】. The immune response is originally a protective mechanism when the body is invaded by the virus, but when the response mechanism is disordered, leading to excessive abnormal levels of various cytokines, it is insufficient to combat the virus’s invasion, and instead brings a series of pathological changes to the body’s organs, worsening the condition.
3.2 The Impact of “Reinforcing Health Qi and Removing Pathogenic Factors” on the Immune Function of COVID-19 Patients The immune function of the body is the main manifestation of healthy Qi, and is the main body resisting viral infections. Therefore, patients with low immune function are very likely to develop COVID-19, which is consistent with TCM’s description of insufficient healthy Qi and the invasion of evil toxins【5】. “Reinforcing Health Qi” in a certain sense means improving the immune function of the human body. COVID-19 falls under the TCM category of “Wet and Turbid Evil Qi,” with the pathogenesis primarily involving “wetness, toxins, cold, heat, and stasis, with a complex and ever-changing pathogenesis, and in the later stages of the disease, obstruction and closure become the main pathological mechanisms, with “not being unblocked” being the key. Therefore, the initial treatment of COVID-19 focuses on “detoxifying and removing evil,” while the later stages focus on “supporting healthy Qi”【22】. It can be seen that even though “Reinforcing Health Qi” occupies an important position in the entire treatment process, it is not appropriate to solely focus on “Reinforcing Health Qi” or “Removing Pathogenic Factors,” and the specific application of “Reinforcing Health Qi and Removing Pathogenic Factors” throughout the treatment process must always be combined with TCM’s syndrome differentiation.
3.3 The Immune Regulatory Effects of “Reinforcing Health Qi” Formulas in the Prevention and Treatment of COVID-19
The General Office of the National Health Commission and the General Office of the National Administration of Traditional Chinese Medicine issued the latest revised “Diagnosis and Treatment Plan for COVID-19 ( Trial Version 6) ” on February 19, 2020, recommending different syndrome differentiation types and corresponding Chinese patent medicines and prescriptions, including: Huo Xiang Zheng Qi Capsules, Jinhua Qinggan Granules, Lianhua Qingwen Capsules ( Granules) , Shu Feng Jie Du Capsules ( Granules) , Qing Fei Pai Du Decoction. Comparing their functions and pharmacological effects (see Table 1), it can be found that the formulas for reinforcing health play a regulatory role in the immune system of the human body. Mice treated with Huo Xiang Zheng Qi Pills showed increased peripheral blood lymphocyte infiltration and 3H-TdR index【23】, indicating that Huo Xiang Zheng Qi Pills can enhance the immune function of mice. The extract of Honeysuckle has the effect of regulating the immune state, which is achieved by inhibiting pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6 to suppress or alleviate inflammatory responses【24】, while IL-6 is one of the key immune inflammatory factors that trigger the “cytokine storm” in patients【25】. Lianhua Qingwen Capsules can also downregulate the levels of inflammatory cytokines in the early stages of viral infection in the lungs of mice【26】, and have an inhibitory effect on bacterial biofilms associated with respiratory infections【27】, achieving the goal of enhancing the human immune defense system through its anti-inflammatory and antibacterial mechanisms. Shu Feng Jie Du Capsules can significantly reduce the proportion of peripheral blood B cells and CD8+ cells in model rats, lower serum levels of IL-1α, IL-1β, IL-2, IL-10, TNF-α, IFN-α, IFN-γ, IgM, and IgG, reduce the weight of the thymus, spleen, and lungs, and increase the peripheral blood CD4/CD8 ratio and NK cell proportion, indicating that Shu Feng Jie Du Capsules have significant immune regulatory effects【28】. The 6th edition of the “Diagnosis and Treatment Plan for COVID-19” provides five types of Chinese patent medicines and prescriptions, which should be reasonably selected based on the severity of the patient’s condition and symptoms through TCM’s syndrome differentiation. All five prescriptions have anti-inflammatory, antiviral, and immune-regulating effects, for example, the immune effects of Shu Feng Jie Du Capsules as described: “reducing the weight of the thymus, spleen, and lungs, and increasing the peripheral blood CD4/CD8 ratio and NK cell proportion.” The five prescriptions also use tonifying Chinese medicines such as Huang Qi and Shan Yao to “Reinforce Health Qi,” for example, the Shan Yao used in Qing Fei Pai Du Decoction can directly enhance immunity【29】, as recorded in the Shennong Bencao Jing: “Shan Yao is mainly for injury to the middle, replenishing deficiency, and removing cold and heat evil Qi,” indicating that Shan Yao can both tonify and dispel evil.
4 Conclusion and Outlook
In response to the current COVID-19 epidemic, many places have adopted a combination of traditional Chinese and Western medicine treatment methods and achieved results, and TCM’s “Reinforcing Health Qi” in regulating the immune function of the body is of great significance in the prevention and treatment of epidemic diseases. Whether it is “Reinforcing Health Qi” type Chinese medicines or compound prescriptions, their effective components have immune-regulating effects on COVID-19 patients, improving clinical symptoms, reducing the risk of mild cases turning into severe cases, and lowering mortality rates. The healthy Qi of the body and immune function explain the body’s response to disease from different disciplinary perspectives, and analyzing the relationship between the two can seek breakthroughs for the combined prevention and treatment of COVID-19 and other infectious diseases using both traditional Chinese and Western medicine。
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