Interpretation of diagnosis and treatment scheme of COVID-19 in Hunan province (the third trial version) based on three factors and measures

Ying Fang, Ci-Ming Pan, Jian-Peng Hu

1. Graduate School of Anhui University of traditional Chinese medicine, Hefei, Anhui 230038 2. Anhui University of traditional Chinese medicine, Hefei, Anhui 230038

Keywords:Suiting measures to three factors COVID-19 Hunan province Diagnosis and treatment of TCM Damp-toxin mixed with dryness

ABSTRACT The similarities and differences between "Novel Coronavirus Infected pneumonia in Hunan province (trial second edition)" and "Novel Coronavirus Infected pneumonia (Trial seventh edition)" released by the National Health Commission and their ideas were interpreted based on “suiting measures to three factors”. ①In Hunan program, the third version of the trial adjustment more suitable for local characteristics of the disease; ②The prevention program population classification is clear, support, eliminate pathogenic factors of the primary and secondary distinct; ③ The cause of disease is prominent, damp and toxin are mixed with dryness, and the treatment is mainly to moisten the lung and clear away heat, and the prescription is mostly Xinliang light agent.

1. Introduction

More than 80,000 people have been confirmed in China between The onset of COVID-19 in December 2019 and its control in 2020, By March 2, 2020, more than 9,000 people have been confirmed on six continents and 136 people have died of the world . While other countries were on the rise, China was effectively contained. At present, western medicine has no specific medicine, so the prevention and treatment strategy of traditional Chinese medicine is effective and worth studying "Will be coronavirus pneumonia diagnosis and treatment scheme (third edition) began to increase the treatment of traditional Chinese medicine," will be coronavirus pneumonia diagnosis and treatment scheme (on a trial basis in the fourth edition) and improved, compared with the third edition deleted "disease in the lungs", the basic pathogenesis characteristics for "wet, heat, toxicity, silt", updated medical observation period and the corresponding treatment based on proprietary Chinese medicine before staging and clinical treatment, the will be coronavirus pneumonia diagnosis and treatment scheme (trial fifth edition) and the fifth edition correction (trial) and (on a trial basis in the fourth edition) no difference, Novel Coronavirus Pneumonia Diagnosis and Treatment Protocol (trial seventh edition) deleted during medical observation: Fangfengtongsheng Wan (particle); In the clinical treatment phase, "lung-clearing and detoxification decoction" was included, and treatment was based on the differentiation of symptoms and signs according to the light type, common type, severe type and critical type.

Issued by the national National Health Commission on March 3, 2020 "will be coronavirus pneumonia diagnosis and treatment plan 7 (trial edition), published on February 3, 2020 in Hunan province of Hunan province will be coronavirus pneumonia Chinese medicine diagnosis and treatment scheme (third edition), 2020 confirmed 1018 cases of Hunan province, on March 3, 885 cases cured, 4 cases died, so now the Hunan scheme with the national health committee, the similarities and differences between the first gas (trial edition) and its conception is interpreted as follows.

1. Features of COVID-19 in Hunan Province

“Four saints hanging hinge · Five epidemic diseases”: "Yu Qiuzi said: The heat of the epidemic disease is on the surface rather than in the surface, and the key point of clearing the heat is on the surface rather than in the surface. you need to clear the recipe until the heat into the interior; Cold pestilence’s cold, in the surface but not inside, we should warm dispersion surface cold rather than warm the interior. After the table cold into the dirty just need to warm up. But quack regardless of the etiology, all use strict strong drugs such as mirabilite and rhubarb diarrhea, it often leads to ten treatments have nine errors, that is absolutly complicit in torture." It is indeed necessary to reveal the evil, and not to misuse the method of attack without proof. Therefore, the COVID-19 should not be generalized. It is necessary to distinguish Yin and Yang for local and human reasons.

1.1.Adjust measures to local conditions ang time

In the past 110 years, the temperature in Hunan has been on the rise, increasing by 1 on average. In the first half of 2019, low temperature is rainy, high temperature is dry in the second half, and in the early winter, the sun is warm and the temperature is nearly 29 [1]. As “Suwen · Different methods of prescriptions” contains: "The cure of a disease, but the treatment of different, all healing, why? Qi Bo said: is the terrain, he pointed out that the five causes are different and the treatment is different, the key lies in the feeling of the disease and the adherence to the pathogenesis. Therefore, COVID-19 in Hunan province is not only caused by dampness, but also caused by dryness. In Hunan, COVID-19 is characterized by dampness, toxicity and dryness, which can be characterized as "dampness accompanied by dryness", in which "dampness" is the pathological basis and "dryness accompanied by pathogenic factors" is the pathological characteristic [2]. Fei Jinqing said, "Dryness is dryness to humidity." Zhang Congzheng said, "If you are trapped by moisture, then you can choose dried medicines such as orange peel, wood fragrance, rhizome atractylodis, and other dehumidification”. Therefore, dryness can be regarded as Yang [3]. However, wet belongs ti Yin and be removed only with the warm, so it is more difficult to treat. As "Su Wen" mentioned: " "Doctor who are good at diagnosis should first distinguish Yin and Yang ". Therefore, it’s of great importance to make a diagnosis according to the climatic characteristics of Hunan.

1.2. Adjust measures suited to each individual

The COVID-19 population is generally susceptible to infection, but the elderly are the main patients with severe coVID-19. Hunan version of the program highlighted the poor physique, the elderly and young adults of different programs. For the high-risk and vulnerable groups, the Hunan’s program added and reduced Guizhi soup, Yupingfeng soup and Shenshu powder. Yinqiao powder was added and subtracted for people with strong physique but a history of close contact with Wuhan. The two prevention programs have a clear direction, one is to strengthen the qi to strengthen the health, that is to say,” there is highly resistant, the pathogenicity cannot be invaded”, the other is to clear heat and to supplement and purge the method of interception torsion. In addition, we can also reference to use sachets, tea drinks, bath and other common "prevention of diseases " program, but also targeted to take the disease prevention before the first, the disease has become a step-by-step prevention program.

2. Interpretation of similarities and differences between the second edition and the third edition of Hunan’s scheme

The second trial version of Hunan’s plan issued on January 23, 2020 includes four syndrome types: dampness evil obstructing the lung, heat obstructing the lung, toxin obstructing the lung, internal closure and external detachment, as well as the prevention plan for high-risk and vulnerable groups, and the prescription of Guizhi Soup, Yupingfeng powder and Shenshu powder. The third version of the Hunan pilot program released on February 3 divided COVID-19 into four stages: initial heat stage, severe stage, critical stage and recovery stage. According to different clinical manifestations in each stage, COVID-19 was treated according to nine types of syndrome differentiation. In Hunan province, 9 cases were confirmed on January 23, 0 cases were cured and 0 cases died. By February 3, 521 cases were confirmed, 22 cases were cured and 0 cases died. By March 3, 1018 cases were confirmed, 892 cases were cured and 4 cases were dead. During the third version of Hunan pilot program, the average daily increase was 16.6, and the average daily cure was 29, so the later program adjustment was more suitable. Stage treatment patients can be separate, convenient management and treatment, further points card type evidence-based medicine can do one side, both to generalization, understand the patient's priorities, power dispatch physicians will also relatively appropriate, particularly in the doctor resource scarcity, patients with a spate of cases is more scientific and reasonable solution for the third edition of Hunan; This provides a new way of thinking for the later period, which is to systematize the whole first, and then to measure and treat the patient dialectically.

3. Interpretation of prevention programmes

The state "Novel Coronavirus pneumonia Diagnosis and treatment scheme (trial version 6)" proposed the medical observation period. According to different clinical manifestations, it is recommended to use Chinese patent medicine Huoxiang Zhengqi for patients with weakness and gastrointestinal discomfort, and to use Chinese patent medicine Lianhua Qingwen Capsule, Jinhua Qinggan particle and Shufeng Jiedu capsule for patients with weakness and fever. Hunan’s prevention program is also differentiated. Hunan prevention program is also differentiated. For high-risk groups and susceptible groups, Guizhi soup, Yufeng powder and Shenshu powder are used for treatment based on syndrome differentiation. People with a strong constitution and a history of close contact with Wuhan use Yinqiao powder. The two prevention programs have a clear direction, one is to replenish qi and prevent pathogenic factors to enhance health; The other is to clear heat and detoxification, dispelling pathogenic factors in order to supplement and purge. Therefore, the national version of the program focused on clearing away heat and detoxification, which is universal, and Hunan version of the plan emphasizes regionalism, in order to complement, reduce cent theory.

Ancient people used to wear perfume bag, medicinal bath, powder body and take medicine to achieve the purpose of prevention, such as Wu Shiji's "piercing plague bag" ; qiang huo (Taiyang), rhubarb (Yangming), Bupleurum (Shaoyang), Atractylodus atractyloides (Taiyin), Asarum (Shaoyin), Wuyu (Jueyin), medicine preparation method of six classics. According to Liu Songfeng's “Songfeng saying epidemic disease”: "after Guyu, take ligusticum chuanxiong, Atractylosus atractylosus, Angelica dahurica, lingxiang, etc. boil water and then bathe for three times to sweat. If the sweating person is not sick use ligusticum chuanxiong, Atractylosus atractylosus, Angelica dahurica and Lingxiang to bathe in decocted water for three times, so as to release the sweat, and the person who sweats is free from disease." Therefore, we can learn from the ancient sachet, tea, bath and other common "cure disease" program in practice, but also targeted to take prevention before the disease, the disease has been the prevention of step-by-step prevention program.

4. Formulation and medication research

Novel Coronavirus infected pneumonia (trial version 7) is included in the clinical treatment phase of "Lung cleansing and detoxification Soup" and Traditional Chinese medicine injection, and treatment is based on syndrome differentiation according to light, common, severe, critical and convalescence syndrome type 5 and 9. In the third version of the Hunan pilot program, COVID-19 was divided into four stages: initial heat stage, severe stage, critical stage and recovery stage. According to different clinical manifestations in each stage, COVID-19 was treated according to nine types of syndrome differentiation, as shown in Table 1.

The third version of Hunan’s pilot program did not focus on cold and dampness syndrome, but focused on the clinical manifestation of cough. If cough and asthma are prominent in the initial heat stage, it means different syndromes, that is, from the first stage of warm pathogen to the pulmonary syndrome of cough and micro-asthma, indicating that the disease is developing further. Secondly, the gastrointestinal syndrome of pathogenic factors is prominent, but this is a transitional or simultaneous syndrome, which can only be treated on the basis of the disease, instead of staying in the clearing of heat and turbidity for a long time, the main disease should be focused on, and the pathogenesis is still pulmonary loss of traction [4]. Due to the characteristics of climate, ephedra in particular should be used in a small amount to prevent excessive sweating. Instead of heavy agents, it should be used as "xin liang qingji" and "xinliang pingji", so as to allow pathogens to have a way out. This is a sharp contrast with Gansu's program [5]. The whole treatment plan shows the regional characteristics of Hunan province, which is warm and dry. There is no national cold and wet type, but the method of refreshing and moisturizing runs through the whole treatment.

As "Neijing" says: "Autumn injury in the wet, inverse cough. But Yu Jiayan pointed out that the autumn injury in driness, it can be seen that Yu's theory is a school of its own, as "YiMenFalv" says : From Neijing, cough more than out of the death of white blood, white blood is pale red, and flesh like lung, non-lung gold cut. Why? Try to see the fine grass, a gold gas, suddenly change tolerance, coke on the top, and dry gas first hurt on the canopy, I do not know. Refer to the pathogenesis of the disease All erectile dysfunction wheeze, all belong to on. Two clearly refers to dryness. "Suwen tongtian theory" point out that autumn injury in dryness, on the contrary and cough, hair for flacking. Dryness, a word and finally. It is consistent with the two principles of pathogenesis. Only to misunderstanding injury dryness for wet, the solution refers to dryness for wet disease, then to the purpose of unknown. Nowadays, the mechanism of dryness is meaningless." This in the second half of 2019 autumn drought injury in Hunan and dry, with COVID - 19 CT slice pairs of lung in patients with multiple patchy ground glass shadow, air bronchogram, double lung under article with fibers show in reports of similar, and anatomical aspects numerous sticky secretions from the alveoli overflow, and visible fiber cords, tip should be far end alveolar damage results agree [6]. Therefore, compared with the plan promulgated by the National Health Commission, dryness pathogenic factors are more prominent in the treatment, rather than cold pathogenic factors. Therefore, the prescription is to use the Sangju drink, sangxing soup, Sangbei powder and the convalescent period to emphasize such moistening lung and clearing heat as Shashen and radix ophioponae decoction.

5. Conclusion

In the face of COVID-19 this time, the combination of TCM and western medicine can jointly resist COVID-19, which is effective. Hunan’s program has been applied in practice, and practice is the litmus test to test the truth. In particular, Hunan province adheres to the principle of "one person, one policy, one party" in treatment, distinguishing and treating according to the evidence, highlighting dampness, toxin and dryness. The treatment focuses on moistening lung, relieving cough, clearing heat and dampness, invigorating qi and regulating spleen, with definite efficacy. There are also some shortcomings, such as in the prevention of Hunan program did not mention sachets, Chinese patent medicine and medicinal diet, It’s suggested to improve the popularity reference from Gansu’s practice; In the treatment period, there was no increase or decrease in a certain syndrome type. During the rehabilitation period, there is no discharge guidance, matters needing attention, recommendation of patent medicine, etc. It is hoped that it can be adjusted and given comprehensive scientific guidance.