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Understanding how COVID-19 is a plague

Infectious diseases are often associated with viruses, such as in the cases of Severe Acute Respiratory Syndrome (SARS) in 2003, Middle East respiratory syndrome (MERS) in 2012, and COVID-19 in 2019. The pathogens associated with these diseases are all coronaviruses. But, TCM does not consider viruses to be the main cause of infectious diseases. As long as the disease is cured, the virus will die out naturally. Further, a negative virus test does not indicate recovery. COVID-19 belongs to the category of 'epidemic' disease in TCM (Wang et al., 2020). Plagues have their own properties, and a plague corresponds to a nature (Yang et al., 2020).

COVID-19 was categorized as a cold and dampness epidemic (Sun et al., 2020), and the pathogenic factors are found in the body's mucous membranes (Han et al., 2020). Dampness should be paid more attention to in this epidemic (Li et al., 2020; Zheng et al., 2020). The complexity of COVID-19 lies in the fact that damp evil is dominant and dryness evil is contained (Fan et al., 2020).

In addition, some patients have been infected with the disease without obvious symptoms, which makes the prevention and control of the epidemic more difficult. TCM also has a treatment plan for patients who have been infected with the disease without symptoms (Liu et al., 2020).

Focus on organs other than lungs

Treating patients as an organic whole is the prerequisite for TCM to treat all diseases. COVID-19 is primarily located in the lungs, but there are exterior and interior relationships between the lungs and the large intestine (Xia and Huang, 2020).

The connection between the spleen, stomach, and lungs is extremely strong and should be attended to during treatment (Ding et al., 2020; Wen and Zhang, 2020). More importantly, TCM also attaches great importance to liver damage caused by COVID-19 (Chai et al., 2020; Liu, 2003). During the SARS epidemic, it was recognized that the receptor angiotensin converting enzyme II (ACE2) was activated during the viral infection and subsequently caused a dysfunction in blood clotting. This finding suggested that we should also pay attention to the relationship between the heart and the lungs (Xian et al., 2020).

TCM treatment strategy for COVID-19

TCM divides the disease into four stages according to the law of disease transmission: early stage, advanced stage, critical stage, and recovery stage (Table 1 ). In the early stage, the common syndromes of COVID-19 were the syndrome of dampness repressing the defensive qi of the lungs or of wind heat attacking the lungs. The primary treatment is dredging the exterior and penetrating the pathogen, ventilating the lung qi for lowering adverse qi, and treatment against the cold in the Taiyang meridian (Wang et al., 2020; Xiao et al., 2020). In the advanced stage, the common syndromes were the syndrome of dampness blocking the lungs and stomach or pathogenic heat accumulating in the lungs. The main treatment is increasing clear qi and lowering adverse qi (Shao et al., 2020; Xue et al., 2020). Then, in the critical stage, the common syndromes were the syndrome of epidemic virus closing the lungs, or internal block and outward desertion. The treatment should allow the Yang to recover and open the orifices to induce resuscitation (Bai et al., 2020; Ma et al., 2020; Xiao et al., 2020). Finally, the common syndromes in the recovery stage were the syndromes of qi deficiency of the lungs and spleen. Attention should be paid to qi and yin in the later period (Xie et al., 2020). In addition, in the treatment of plague, both evil and positive are emphasized by TCM (Shao et al., 2020).

TCM prevention of COVID-19

Prediction based on five movements and six qi

Based on the theory of "five movements and six qi," the science of disaster prediction in ancient China can be used to predict the effect of natural climate change on human organ function based on the combination of the five movements of the sky and the six qi of the earth. Further, based on the theory of "3-year epidemic formation," it is proposed that if the migration and operation of the climate is abnormal, an epidemic will occur in approximately 3 years (Liu et al., 2013). The Spring Festival of 2020 was affected by excessive jinyun, the minister fire of shaoyin being the celestial manager and the influence of zhuqi and keqi, the lungs (the five element is gold) and liver (the five element is wood) are easily out of balance, and the functions of the spleen are gradually recovering (Li and Du, 2020; Yang and Yu, 2020). In other words, TCM can make relatively accurate predictions before the outbreak of the disease, allowing the hospitals to make emergency plans.

Prevention using TCM decoction

For people who are isolated at home in the community, a TCM decoction can be used for prevention. The composition of the prescription is mainly aromatic and is used to avoid filth and improve autoimmunity (Ali et al., 2013; Angenent et al., 1986; Hosain et al., 1969). COVID-19 prevention prescriptions based on the theory of "Natural Factor" were used to maintain vital qi (Li and Qiu, 2020). Modern pharmacological studies have shown that TCM ingredients are effective in clearing away heat and detoxifying, as well as in relieving surface dampness, thereby inhibiting the virus. As early as the 1970s, the study of TCM against the influenza virus has been undertaken in China. There are two ways that TCM acts as an antiviral. The first is by directly inhibiting the virus, primarily by heat clearing and detoxifying. Lonicera, Folium Isatidis, and Scutellaria are used for inhibition. The second is to indirectly play an antiviral role or inhibit the virus-mediated inflammatory response by regulating the immune function of the body. Astragalus, Salvia, Acanthopanax senticosus, and Gentiana are used as antivirals and induce interferon and immunoglobulin. TCM focuses on the overall regulation of the body. Thus, TCM can play a multi-target role in the regulation of the body's systems (Gao and Wang, 2018).

Prevention of disease with herbal incense

Sachets are made of aromatic herbs. For those who have not been infected with the virus but have been exposed, the most simple and effective method of TCM prevention is by the traditional aromatherapy method with herbs such as Atractylodes lanceolata, Phellodendron amurense, and Artemisia argyi, which have a significant preventive effect (Liang et al., 2003). In addition, the herbs can be made into a sachet to "avoid poisonous gas" (Zhang et al., 2020; Zhang et al., 2003), which is an important principle in TCM (Liu, 2003).

Prevention of infection among medical staff

Insufficient protection increases the risk of COVID-19 in frontline medical staff (Fu et al., 2020). Moreover, once masks, goggles, and protective clothing are contaminated, they cannot be used again.

In TCM hospitals, or hospitals based on TCM treatment methods, medical staff take one or two decoctions every day and burn Artemisia argyi or Atractylodes lanceolata in the hospital to cut off the transmission route.

As reported by CCTV4, 1250 medical staff in Tongxu County Hospital (Henan province) drank Chinese medicine decoctions and burned Artemisia argyi in the hospital corridor. With regard to masks, disposable masks were used for medical personnel, and N95 masks were not used (Hao et al., 2012). In Jingzhou (Hubei province), the worst-hit area of the epidemic, 580 medical staff came from Jingzhou TCM Hospital, and none of them were infected by the disease. In addition, the hospital produces 25,000 preventive Chinese patented medicines for distribution to other hospitals every day (Zhang et al., 2017). In Wuhan, where the epidemic was most severe, Jiangxia Fangcai Hospital also achieved zero infections among medical staff (Seah et al., 1973). Moreover, in Huanggang, Huangshi (Hubei province), and Guangzhou (Guangdong province), TCM methods were used to prevent the epidemic, and there was zero infection among the medical staff there as well. However, more than 3000 medical staff without TCM prevention were infected. Considering the similarity between the COVID-19 epidemic and the SARS epidemic in 2003, it is pertinent to compare the outcomes among medical personnel in China. Three studies were identified including one controlled study (Lau et al., 2005) and two single cohort studies (Luo et al., 2020) conducted during the SARS epidemic. Lau et al designed a controlled study to evaluate an herbal formula for prevention of SARS (no herbal intervention in the control group) and conducted it in Hong Kong, China. The sample size was 16,437 (1063 in the herbal group and 15,374 in the control group), and all participants were hospital care workers including doctors, nurses, and other staff. The results showed that none of the participants who took a modified formula of Yupingfeng Powder and Sangju Decoction contracted SARS, whereas 64 of 15,347 (0.4%) in the control group were infected with SARS (P=0.035). There were 19 cases (1.8%) of minor adverse effects after 14 days of taking the herbal medicine, including diarrhea, sore throat, dizziness, and nausea. Both single cohort studies were conducted in Beijing, China, with sample sizes of 3561 and 163, respectively. All participants were medical staff from two hospitals in which SARS patients were recruited and treated during the study period (Luo et al., 2020). One of the studies included only first-line medical staff treating SARS. The courses of taking the herbal formulae for prevention were 6 days and 12 to 25 days for the two cohort studies, respectively. The decoctions used in these studies were both a classic formula of Yupingfeng Powder and some heat-clearing and detoxifying herbs. The results of the two studies showed that none of the participants who took the preventive herbal medicine contracted SARS.

TCM treatment of COVID-19

TCM has achieved good results in the treatment of COVID-19. Thus far, no exacerbations and no cases of recovery yang have been reported. In terms of treatment methods, TCM decoction, acupuncture, and external treatments, even Tui Na have been used, among others.