LIU Zi-ning (刘子宁), HAN Juan (韩 娟)

1. Secretariat of World Federation of Chinese Medicine Societies, Beijing 100101, China

2. Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China

ABSTRACT From a historical point of view, this paper studies the characteristics of traditional Chinese medicine (TCM) theories and methods of prevention and treatment of pestilence. By collecting information on the prevention and treatment of pestilence with TCM, we sorted out and studied the theories of pestilence prevention and treatment with TCM in the past dynasties and the clinical application methods of pestilence prevention. We explained the clinical application of TCM for the treatment of pestilence from 2 aspects, including internal treatment and external treatment, and discussed the clinical application of some famous prescriptions for the treatment of pestilence; and many external treatment methods, the clinical application of acupuncture and scraping are explained for modern epidemic prevention.

KEYWORDS Chinese medicine; Pestilence; Treatment method; Enlightenment

In the history of China, people have been suffered from pestilence. According to records, from the Western Han dynasty to the present, there have been more than 300 pestilence in China[1]. With the change and development of the environment, the types of pestilence are gradually increasing, and people are facing many challenges in the prevention and control of pestilence. In particular, the occurrence of acute infectious diseases does serious harm to the society, the country and the people. Based on the historical pestilence, traditional Chinese medicine(TCM) has carefully observed in long-term clinical practice and it is believed by TCM that pestilence is a kind of infectious disease caused by people feeling the pestilence Qi (气). Based on the clinical prevention and treatment of pestilence, TCM in past dynasties put forward different cognition of pestilence and applied different therapeutic prescriptions and methods.

TCM PRACTIONERS' UNDERSTANDING OF PESTILENCE IN PAST DYNASTIES

In the pre-Qin period, people had a certain understanding of pestilence and believed that pestilence was epidemic and infectious.

During the Eastern Han dynasty, ZHANG Zhong-jing attributed pestilence to "typhoid fever"and expounded the transmission and change rule of the pestilence disease to "Taiyang (太阳)-Yangming(阳明)-Shaoyang (少阳)-Taiyin (太阴)-Shaoyin (少阴)-Jueyin (厥阴)", which had an important influence on the treatment of pestilence by future generations of TCM practitioners.

During the Three Kingdoms period, there were also relevant records of pestilence in Treatise on the Origins and Manifestations of Various Diseases(《诸病源候论》). GE Hong believed that typhoid fever, seasonal epidemic and pestilence were all epidemic febrile diseases. CAO Zhi pointed out that the pestilence Qi (气) was due to "the dislocation of Yin and Yang and the wrong timing of cold and summer heat", which was line with "the Qi (气) that is not in season".

During the Sui dynasty, it was recorded in Treatise on the Origins and Manifestations of Various Diseases (《诸病源候论》) that pestilence was similar to heat, febrile and other diseases, and it was believed that if the disharmony of solar terms existed in a year, epidemic diseases would easily occur. CHAO Yuan-fang showed that the pestilence was caused by the dysfunction of warm and coolness, leading to pestilence Qi (气), which was easily infectious.

In Tang dynasty, it was recorded in Important Formulas Worth a Thousand Gold Pieces (《备急千金要方》), typhoid fever, seasonal epidemic and pestilence were different. However, the typhoid fever prescription in the book also had a number of"prescriptions for febrile disease", such as "prevention of febrile disease without infection" or "prescriptions for treating pestilence Qi (气)" and other prevention and treatment methods. In Basic Questions (《素问》), WANG Bing believed that there was a certain relationship between the pestilence and the abnormal changes of five circuits and six-Qi (气), so there were the terms "five pestilent Qi (气) or "five leprosy"[2].

During the Jin and Yuan dynasties, famous physician ZHU Dan-xi summarized 3 treatment methods for pestilence: appropriate supplement,appropriate dispersion and appropriate reduction. It was also believed that the transmission and change of epidemic diseases did not follow the transmission and change the six meridians.

During the Ming and Qing dynasties, TCM made great contributions to the pathogenic path,etiology and transmission of the epidemic. In Theory of On Pestilence (《温疫论》), WU You-ke clearly put forward the On Pestilence (《温疫论》) and broke through the understanding of the transmission and change of the six classics of the pestilence.He believed that the cause of the pestilence was material, location-specific, and contagious that entered from the nose and mouth. Since the founding of the People's Republic of China, modern TCM has inherited the doctrine of febrile disease,using pattern identification of Weifen (卫分)– Qifen(气分)– Yingfen (营分)- Xuefen (血分); assisted with six-channel pattern identification, Zang-fu (脏腑)identification, sanjiao (三焦) pattern identification,to treat the pestilence and its 5 overlapped or 10 syndromes, combined with modern medicine. It played its unique role in prevention and treatment[2].

METHODS OF PREVENTING AND CONTROLLING PESTILENCE IN PAST DYNASTIES

Internal Treatment Methods

TCM is a dialectical combination of treating epidemic febrile diseases, with internal treatment as the main treatment method. TCM practitioners of past dynasties have put forward many treatment prescriptions. Among them, there are many prescriptions for the treatment of pestilence in Qing Dynasty, such as Huanglian Jiedu Decoction (黄连解毒汤), Huangqin Decoction (黄芩饮), Huoxiang Zhengqi Powder (藿香正气散), Xijiao Daqing Decoction (犀角大青汤), Xijiao Dihuang Decoction(犀角地黄汤) and other prescriptions. The special prescription for the treatment of pestilence in Shuyi Yuebian (《鼠疫约编》) modified Jiedu Huoxue Decoction (解毒活血汤) is applied to clinical treatment and is mostly used[3-4].

Puji Xiaodu Decoction (普济消毒饮)

Adaptation symptom: dry throat disadvantage;upper panting; dry mouth and tongue; swollen-head cold. The usage of the formula: Rhizoma Coptidis(dry-fried wine) 15 g; Radix et Rhizoma Glycyrrhizae(raw); Radix Scutellariae (dry-fried with wine),Pericarpium Citri Reticulatae (scraping the external part), Radix Bupleuri; Radix Scrophulariae, Radix Platycodonis, 6 g each. Fructus Forsythiae, Fructus Arctii, Lasiosphaera seu Calvatia, Radix Isatidis,Herba Menthae, 3 g each. Bombyx Batryticatus,Rhizoma Cimicifugae, 2 g each. After grinding, half of it is mixed with decoction and served warmly; the other half is melted in the mouth with honey pills.After taking it, there were many living people and the effect was good[5].

Dayuan Decoction (达原饮)

In Chongzhen period, pestilence qi prevailed.In the Ming Dynasty, WU You-ke wrote On Pestilence (《温疫论》), which elaborated that Dayuan Decoction (达原饮) was used to treat pestilence during the period when foul, turbid and toxic pathogens were submerged in the membrane.The administration method of this prescription was as follows: Semen Arecae 6 g, Cortex Magnoliae Officinalis 3 g, Fructus Tsaoko 1.5 g, Rhizoma Anemarrhenae 3 g, Radix Paeoniae 3 g, Radix Scutellariae 3 g, Radix et Rhizoma Glycyrrhizae 1.5 g,decoction of the prescription for 8 min with 2 cups of water, and taking it very warm in the early 10 min in afternoon. In addition, WU You-ke recorded many prescriptions for strengthening the right qi and eliminating pathogenic factors in On Pestilence (《温疫论》), such as Qingzao Yangrong Decoction (清燥养荣汤) and Chengqi Yangrong Decoction (承气养荣汤), which were used for the treatment of pestilence[6].

Shengjiang Powder (升降散)

Shengjiang Powder (升降散): 1 Qian (钱)Periostracum Cicadae (to remove soil), 2 Qian (钱)white Bombyx Batryticatus (stir-fried wine ), 3 Qian(钱) Guang Rhizoma Curcumae Longae (peeled),4 Qian (钱) Chuan Radix et Rhizoma Rhei (raw), evenly ground. Patients with mild diseases take it 4 times, and the proportion of medication is: for every 1 Qian (钱)8 Fen (分) and 2 Li (厘) 5 Hao (毫) of the medicine,1 cup of cold yellow wine and 5 cents of honey were used, and the medicine was taken cold after being evenly mixed. For the seriously ill, it should be taken 3 times, and for the heaviest, it should be taken 2 times[7].

Qingwen Baidu Decoction (清瘟败毒饮)

Qingwen Baidu Decoction (清瘟败毒饮): raw Gypsum Fibrosum 180-240 g, Radix Rehmanniae 18-30 g, Cornu Rhinocerotis 18-24 g, Zhenchuanlian 12-18 g, Radix Platycodonis, raw Fructus Gardeniae,Radix Scutellariae, Radix Paeoniae Rubra, Fructus Forsythiae, Rhizoma Anemarrhenae, Radix Scrophulariae, Radix et Rhizoma Glycyrrhizae, fresh Folium Phyllostachydis Henonis, Cortex Moutan Radicis. The prescription is flexible in application,clearing away pestilence and toxic materials for 52 diseases, and is accompanied by the addition and subtraction of epidemic eruptive disease measles rash and death[8]. The curative rate of this prescription is as high as 94.9% when it is applied to clinical treatment of measles.

Modified Baihu Decoction and Renshen Decoction(白虎汤合人参加减)

In the prevention and treatment of SARS with TCM in 2003, modified Yinqiao Powder (银翘散) was used for initial treatment. Modified Baihu Decoction and Renshen Decoction (白虎汤合人参汤) were used for mid-term treatment. Then Zhuye Shigao Decoction (竹叶石膏汤) and Shengmai Decoction(生脉饮) were applied to the later clinical treatment[9].In addition, clinical literature recorded that ready-foruse TCM such as Qingkailing Injection (清开灵注射液), Banlangen Granules (板蓝根冲剂), Yuxingcao Injection (鱼腥草注射液) and Jinlian Qingre Granules(金莲清热颗粒) etc., which have obvious therapeutic effects in the clinical treatment of SARS[10]. The application method were as follows: Yuxingcao Injection (鱼腥草注射液) was dissolved in 500 ml 5% glucose solution, and the injection amount was 100 ml, per day, for 7-10 days.

Qingqi Decoction (清气饮)

In 2013, when the H7N9 avian influenza was spreading nationwide, the second prescription was used in clinical treatment, and the curative effect was good. This prescription can also be used to prevent influenza. The method of administration was as follows: 2-3 Qian (钱) Yinxingshuang, 2-3 Qian (钱)Radix Platycodonis (with head and feet removed),1-2 Qian (钱) Herba Pogostemonis, 2-3 Qian (钱)Caulis Lonicerae, 2-3 Qian (钱) Massa Medicata Fermentata, 2-3 Qian (钱) Massa Medicata Fermentata, 1 Qian (钱) Folium Perillae, 1 Qian (钱)Rhizoma Pinelliae, 3-4 Qian (钱) Fructus Setariae Germinatus, 5-7 Fen (分) Fenguangpi, 2-3 Qian (钱)Poria Rubra. Decoct 2 small bowls of water to 1 bowl,then take it warmly. If not noticed, go into 1 server. It's the experience to feel the air flow and comfort. The severe patients will be served 3 times[11].

External Treatment of Pestilence

In addition to internal medicines, TCM practitioners boldly explored treatments for the pestilence, and many external treatments were proven to be effective. Among them are:moxibustion, salt-vinegar rubbing, bloodletting,spot quenching, fili-acupuncture, scraping, sticking,scraping, etc., bloodletting, ironing, moxibustion,etc., and the scope of treatment of epidemic diseases is relatively widely. In addition, external treatment of pestilence also include scrubbing,rubbing and coating sticking[12,13].

Scraping method

In the TCM treatment of cholera in the late Qing dynasty, some TCM practitioners adopted acupuncture point bloodletting and scraping methods. When the course of cholera was in the first stage, purple blood was released from Louwan.In the second stage, it was better to stab sublingual,ten-digit, Chize (L5) and Weizhong (B40) urgently,and to bleed more. In addition, with the gradual development of the course of the disease, it was necessary to increase the intensity of scraping for patients. During the first stage, the entire back and flanks were scraped from the neck to the waist.In the second stage, the whole body was scraped until purple bubbles appeared. In the third stage,stop bloodletting and let the patient drink more ice water to make the patient vomit and wash the toxic pathogens in the stomach. At the same time,increased efforts to scrape the patient's whole body until purple bubbles appear. This method had a good effect in clinical treatment at that time[14].

Pricking blood method

In addition, according to the clinical experience of pestilence treatment, 10 commonly used pricking parts are summarized as follows: Xinbaihui acupoint on the top of the head, 2 Taiyang acupoints,Yintang, sublingual sides, throat sides, 2 hands and 10 fingers, 2 feet and 10 toes, 2 breasts, the crooked part of the 2 arms and 2 legs. According to the characteristics of the epidemic disease itself, the degree of occurrence and the mode of transmission,the acupuncture and moxibustion parts of different pestilences are different.

DISCUSSION

In ancient times in China, epidemic diseases occurred frequently. TCM has always played an important role in controlling epidemic diseases and protecting people's health. During the Shang dynasty, on the oracle bone inscriptions it was recorded: "Illness, death enters." (Compilation 22392) "Death, disease." (Compilation 22390). The previous article can be interpreted as not entering epidemic areas. And the latter one is interpreted as the patient's refusal to enter. This showed that even businessmen who believed in ghosts and gods had a real sense of protection against the epidemic and took measures to avoid infection to avoid infection. In the Qing Dynasty, WU Ju-tong wrote a book Differentiation of Febrile Diseases (《温病条辨》), which clearly stated that "febrile disease enters through the nose and mouth, the nose passes through the lungs, and the breath passes through the stomach. If the lung disease is reversed, it is the pericardium. In the middle-Jiao, the stomach and the spleen are also passed; if the middle Jiao disease is not cured, it will be passed down, and the liver and the kidneys are also passed. The disease starts from the upper Jiao and ends in the lower-Jiao (下焦)[15-17].

It can be seen from the understanding of the epidemic by the TCM practitioners of the past that the epidemic has the characteristics of sudden onset, strong contagion, rapid transmission, high fatality rate, and easy to cause social panic.The ancient ancestors actively responded to the epidemic in order to resist the epidemic, protect lives, and reduce injuries, having left a wealth of experience and profound lessons: ① Prevention is the first to strengthen the body; ② Early detection of the epidemic and isolation of patients; ③ In the face of new infectious diseases, you can boldly create new prescriptions and new methods; ④ Persist in disease identification -Combination of syndrome differentiation to treat infectious diseases; ⑤ Pay attention to summarizing the law of transmission,and determine the treatment method according to the law[16,17]. Therefore, we must fully understand and give full play to the unique role of Chinese medicine in the prevention and treatment of epidemics, while adhering to the correct policy of integrating Chinese and Western medicine, and carrying forward the ancient people's indomitable spirit of fighting against the epidemic.

General Secretary of CPC, XI Jin-ping once pointed out that "TCM contains thousands of years of health and wellness concepts and practical experience of the Chinese nation. It is a gem of Chinese civilization. It is necessary to follow the law of development of TCM, inherit the essence,maintain integrity, and accelerate the modernization of TCM industrialization". I think this sentence has clearly pointed out the future development of our Chinese medicine, and in the field of pestilence treatment, it is the touchstone for our Chinese medicine to start again.

Clinically, some prescriptions recorded in history can be treated according to syndrome differentiation, focusing on the connection between lung and other Zang-fu organs, highlighting the characteristics of the overall treatment of TCM,and further exerting its comprehensive role.Moreover, modern TCM practitioners have shown that acupuncture therapy has obvious effects on the treatment of inflammatory diseases. Combined with acupuncture methods of ancient doctors, it may be applied to the treatment of infectious disease to eliminate inflammation, remove blood stasis and dredge collaterals. Other external treatment methods, such as scraping, moxibustion, application,ironing, point burning, salt and vinegar wiping, etc.,may be applied to the prevention and control of different stages of infectious disease, or we can refer to the eight methods of pestilence rule, etc.

At present, Western countries are skeptical of TCM. We can strengthen the publicity of anti-epidemic prescriptions and external treatment methods in Chinese history, publicize scraping and moxibustion through the media and multilingual methods,strengthen international publicity of external treatment methods such as application method, ironing method,spot quenching method, salt-vinegar rubbing method,etc., and to promote the development of overseas communication of TCM.