Yonggang Han
Abstract: At the end of 2022, the number of COVID-19 positive patients increased significantly after cautionary measures were relaxed. The combination of the classic TCM texts Shanghan Zabing Lun ［On Cold Damage and Miscellaneous Diseases］ and Fu Xing Jue ［Extraneous Secrets］ with the theory of 5 movements and 6 qi provides powerful guidance in the prevention and treatment of epidemics. According to the minor method of 5 movements and 6 qi, it is recommended to use Major Spleen-Supplementing Decoction (dà bǔ pí tāng) and Major Spleen-Supplementing Acupuncture (dà bǔ pí zhēn) from Fu Xing Jue as a preventive method. According to the intermediate and major methods of 5 movements and 6 qi, it is recommended to use Cinnamon Twig Decoction (guì zhī tāng) from Shanghan Lun ［On Cold Damage］ or Minor Yang Dawn Decoction (xiǎo yáng dàn tāng) from Fu Xing Jue as a preventive prescription. In addition, it is recommended to use food therapy for prevention, such as hot-and-sour soup and ginger-and-scallion soup. For patients with fever, the recommended prescription is Major Yin Dawn Decoction (dà yīn dàn tāng) from Fu Xing Jue, which is the same as Minor Bupleurum Decoction (xiǎo chái hú tāng) from Shanghan Lun plus red peony root (chì sháo).
Keywords:COVID-19; Shanghan Lun; Fu Xing Jue; five movements and six qi.
The COVID-19 Epidemic in Late 2022
In late 2022, cautionary measures against COVID-19 were gradually relaxed in mainland China. According to a report from Xinhua News on December 2nd, Beijing’s Chaoyang District announced that restrictions would be removed from 363 high-risk zones that met the necessary criteria. Guangzhou and Kunming also released announcements that removed temporary restrictions in some areas. However, after these restrictions were lifted, the number of COVID-19 positive patients increased dramatically. On December 12th, Beijing’s 431st COVID-19 Epidemic Prevention Press Conference reported that on the 11th, there were over 22,000 patient visits to fever clinics in Beijing and the number of fever clinic patients was 16 times that of the previous week. On December 19th, China News Service reported that Beijing was adjusting its medical resources in a timely manner based on current trends and was working quickly to open more fever clinics. The total number of fever clinics increased rapidly from 94 to 1263 locations.
The author of this paper is based in London, United Kingdom. According to a December 15th report by the UK Health Security Agency (UKHSA), there were a total of 74 deaths caused by streptococcal infection across all age groups in the UK from September 12th to December 11th, including 19 children.
Shanghan Zabing Lun and Fu Xing Jue
Shanghan Zabing Lun［On Cold Damage and Miscellaneous Diseases］was written by late Eastern Han dynasty master, Zhang Zhongjing. Many years after its compilation, it was divided into 2 parts, Shanghan Lun ［On Cold Damage］and Jingui Yaolüe ［Essential Prescriptions from the Golden Coffer］. In terms of diagnosis and treatment, Shanghan Lun uses the 6 channels to diagnose cold damage, while the Jingui Yaolüe uses the viscera and bowels to diagnose miscellaneous diseases.
Southern Qi and Liang dynasty TCM master Tao Hongjing’s famous work Fu Xing Jue ［Extraneous Secrets］ also includes 2 main parts, “Bowel and Viscera Supplementation and Drainage Prescriptions” and “2 Dawns and 4 Spirits Prescriptions”. “Bowel and Viscera Supplementation and Drainage Prescriptions” uses the 5 elements to diagnose miscellaneous diseases. Based on the core 5 elements, diseases are diagnosed using the viscera instead of the bowels. This part does not clearly distinguish the viscera from the bowels, but rather uses the former in place of the latter, treating the bowels without mentioning them. “Two Dawns and 4 Spirits Prescriptions” uses the 6 directions to diagnose epidemics and plagues; the 6 directions are used to diagnose and treat highly contagious epidemic and plague diseases caused by abnormal qi of heaven and earth. In using the 5 elements to diagnose miscellaneous diseases, the number 5 corresponds to the 5 movements, the 5 elements, and the 5 viscera. In using the 6 directions to diagnose epidemics and plagues, the number 6 corresponds to the 6 directions, the 6 qi, and the 6 channels. This fully embodies the classical TCM system of Daoist practice, in which “the number belonging to heaven is 5 and that belonging to earth is 6” and “the number belonging to heaven is 6 and that belonging to earth is 5”. In this system, the Dao ［way］ serves as a basis for practice, as the one principle unifying everything.
Analysis of Prevention and Treatment Based on the Theory of Five Movements and Six Qi
According to the TCM theory of 5 movements and 6 qi, there are 7 main movement and qi factors: major movement, host movement, guest movement, host qi, guest qi, celestial manager ［or celestial controlling］, and at-the-spring ［or terrestrial controlling］. The minor, intermediate, and major movement and qi methods can be used to prevent and treat virulent contagious diseases.
This paper was written on December 19th, 2022 in the Gregorian calendar. In the Chinese calendar, this is the 26th day of the winter month in the Yang Water (rén yín) Year of the Tiger, in the solar term of Heavy Snow (21st solar term), just before the winter solstice.
(1) The Minor Movement and Qi Method
Chapter 69 of the Huangdi Neijing Su Wen ［Yellow Emperor’s Classic of Internal Medicine: Elementary Questions］, entitled “On the Major Theory of Qi Interchange and Transformation”, states: “If in a given year, the wood element is in excess, the wind qi will flow and spread, and spleen earth will be invaded. The people will become ill with indigestion, diarrhea, loss of appetite, heavy limbs, vexation, repressed negative emotions, borborygmus, and propping abdominal fullness. This is in response to the strong influence of Jupiter. In extreme cases, there may be sudden anger, dizziness, vertigo, and diseases of the head. The transformation qi ［of earth］ does not govern properly; the vital qi ［of wood］ rules alone. Clouds fly through the air, and plants and trees are unsettled, and may even shake and fall. People may have rib-side pain and severe vomiting. Those whose Chongyang ［ST-42］ pulse expires are untreatable and will die. This is in response to the strong influence of Venus.”
Jupiter is the wood planet, while Venus is the metal planet. In the 2022, the Yang Water (rén yín) Year of the Tiger, wood is excess in the major movement. The functions of the wood element systems of the liver and gallbladder are excessively effulgent and exuberant, thereby causing illness. Wood exploits earth; the earth element systems of the spleen and stomach are oppressed by the wood qi 〖JP2〗and are most deeply injured by it. Therefore, using the minor movement and qi method, which only takes into account the single movement and qi factor of the major movement (the year movement), the optimal movement and qi prescription for this year is the Major Spleen-Supplementing Decoction (dà bǔ pí tāng) from Fu Xing Jue.
The full manuscript of Fu Xing Jue Wuzang Yongyao Fayao ［Extraneous Secrets: Essential Methods of Using Herbal Medicine to Treat the Five Viscera］ states: “Major Spleen-Supplementing Decoction or Powder (dà bǔ pí tāng sǎn) treats abdominal distention and swelling, inability to transform food and drink, and occasional spontaneous vomiting and diarrhea. These patients are desiccated and thin like twigs, and when standing they cannot move or turn. They have dryness, thirst, sweating, and hasty breathing. The pulse is faint and, at times, bound. The prescription consists of 3 liang* each of ginseng (rén shēn), mix-fried licorice (gān cǎo, zhì), dried ginger (gān jiāng), and ophiopogon (mài mén dōng), and 1 liang each of ovate atractylodes (bái zhú), schisandra (wǔ wèi zǐ), and inula flower (xuán fù huā). Gather these 7 ingredients and add 1 dou* of water. Boil until the volume of water is reduced to 4 sheng*. While the decoction is warm, take 1 sheng. Take 3 times during the day and 1 time at night.”
Major Spleen-Supplementing Decoction (dà bǔ pí tāng) cultivates earth so that it can engender metal, supplementing the element and its child at the same time; it supplements spleen earth and lung metal simultaneously. Supplementing spleen earth can prevent and treat injury to the spleen earth caused by excessive wood, so it is a defensive tactic. Because metal restrains wood, supplementing lung metal is a counterattack against wood, so this can reduce the excessive wood qi. Major Spleen-Supplementing Decoction (dà bǔ pí tāng) is a movement and qi prescription designed for year movements with excess wood using a mix of defensive and offensive tactics. Clinically, one could also use a combination of Minor Spleen-Supplementing Decoction (xiǎo bǔ pí tāng) and Minor Lung-Supplementing Decoction (xiǎo bǔ fèi tāng). The preventive effect of this prescription is more reliable than a vaccine; it can greatly strengthen the human body’s resistance, thereby preventing invasion by pathogenic microorganisms
Aside from Chinese herbal medicine, one can use Major Spleen-Supplementing Acupuncture (dà bǔ pí zhēn) from the“Fu Xing Jue Viscera and Bowel Supplementation and Drainage Acupuncture Technique” that the author of this paper has explored and summarized. Points to be supplemented are Taibai ［SP-3］, Dadu ［SP-2］, Jingqu ［LU-8］, and Taiyuan ［LU-9］. Points to be drained are Ququan ［LV-8］, Taixi ［KD-3］, and Zhongchong ［PC-9］.
(2)The Intermediate and Major Movement and Qi Methods
In the intermediate movement and qi method, one must take 2 to 3 movement and qi factors into account. In the major movement and qi method, one must take 5 to 7 of these factors into account.
In 2022, the Yang Water (rén yín) Year of the Tiger, there is excess wood in the major movement. In the latter half of the year, jue yin ［reverting yin］ wind wood is at-the-spring ［or terrestrial controlling］, so wood from the 5 movements and wind from the 6 qi are the determining factors that must be prioritized. Finally, shrinking the time frame down to the time of writing, the northern hemisphere is currently in the fifth movement, with both host and guest movements in tai yang ［greater yang］ cold water. It is in the sixth qi, with the host qi of tai yang cold water and guest qi of jue yin wind wood. Among the 7 movement and qi factors, 3 are cold water and 3 are wind wood. The larger environment consisting of the 2 qi of heaven and earth is wind cold; among the 6 excesses ［or kinds of weather］, the main disease-causing factors are wind and cold. Therefore, the major method for prevention and treatment is to dispel wind and dissipate cold. In terms of prevention, the author primarily recommends Cinnamon Twig Decoction (guì zhī tāng) from Shanghan Lun. The name of this prescription in Fu Xing Jue is Minor Yang Dawn Decoction (xiǎo yáng dàn tāng).
The chapter of Shanghan Lun entitled “Diagnosing Tai Yang Disease Pulse and Symptoms with Treatment Methods” states, “In tai yang ［greater yang］ wind strike, yang is floating and yin is weak; those with floating yang have spontaneous heat effusion and those with weak yin have spontaneous sweating. If there is shivering with aversion to cold, aversion to wind and drafts, mild heat effusion, noisy breathing, and dry retching, Cinnamon Twig Decoction (guì zhī tāng) governs. Cinnamon Twig Decoction (guì zhī tāng) prescription: cinnamon twig (guì zhī), 3 liang, bark removed, acrid and hot; peony root (sháo yào), 3 liang, bitter and sour, slightly cold; licorice (gān cǎo), 2 liang, mix-fried, sweet and neutral; fresh ginger (shēng jiāng), 3 liang, sliced, acrid and warm; and jujube (dà zǎo), 12 pieces, split, sweet and warm. Gather these 5 ingredients and crush them, then add 7 sheng of water. Boil on low heat until the volume of water is reduced to 3 sheng. Strain the decoction and wait for it to reach a suitable temperature, then take 1 sheng. After taking the decoction, drink more than 1 sheng of hot diluted porridge to strengthen the effect of the herbs. Cover up and keep warm for about 1 hour. If the whole body becomes slightly moist with sweat, this is a good sign. One must not cause the patient to be dripping wet or else the disease will not be eliminated.”
The full manuscript of Fu Xing Jue Wuzang Yongyao Fayao states, “Minor Yang Dawn Decoction (xiǎo yáng dàn tāng) treats contagious heat effusion, spontaneous sweating with aversion to wind, noisy breathing, and dry retching. It consists of 3 liang of cinnamon twig (guì zhī), 3 liang of peony root (sháo yào), 2 liang of sliced fresh ginger (shēng jiāng), 2 liang of mix-fried licorice (gān cǎo, zhì), and 12 pieces of jujube (dà zǎo). Gather these 5 ingredients and add 7 sheng of water. Boil until the volume of water is reduced to 3 sheng. While the decoction is warm, take 1 sheng. After taking it, immediately drink 1 vessel of hot rice porridge to strengthen the effect of the herbs. One should cause slight sweating, but the patient must not sweat heavily as if dripping wet. If there is such sweating, the disease will not be eliminated. If there is no sweating, continue to take the decoction and stop upon recovery. Take it 3 times daily. If 1 sheng of malt sugar (yí táng) is added, this becomes Upright Yang Dawn Decoction (zhèng yáng dàn tāng).”
During the COVID-19 epidemic, many Chinese medicinals dramatically increased in price, and some were not even available at all. In light of this, the author of this paper suggests 2 food therapy prescriptions for prevention: hot-and-sour soup and ginger-scallion soup. Food and medicine come from the same source, therefore, the same medical principles also apply here.
In terms of treating patients with heat effusion after contracting the virus, from the movement and qi perspective, the author primarily recommends Major Yin Dawn Decoction (dà yīn dàn tāng) from Fu Xing Jue, which is equivalent to Minor Bupleurum Decoction (xiǎo chái hú tāng) from Shanghan Lun plus peony root (sháo yào). For peony root (sháo yào) in this prescription, the author suggests using red peony root (chì sháo).
The chapter of Shanghan Lun entitled “Diagnosing Tai Yang Disease Pulse and Symptoms with Treatment Methods” states, “After 5 or 6 days of cold damage with wind strike, if there is alternating heat effusion and aversion to cold, fullness in the chest and rib-side, silence with no desire to eat or drink, heart vexation, desire to vomit, or vexation in the chest without vomiting, or thirst, or abdominal pain, or hard glomus under the rib-side, or palpitations below the heart with urinary difficulty, or lack of thirst with slight body heat, or cough, then Minor Bupleurum Decoction (xiǎo chái hú tāng) governs. Minor Bupleurum Decoction (xiǎo chái hú tāng) prescription: bupleurum (chái hú), ? jin*, bitter and slightly cold; scutellaria (huáng qín), 3 liang, bitter and cold; ginseng (rén shēn), 3 liang, sweet and warm; licorice (gān cǎo), 3 liang, sweet and neutral; pinellia (bàn xià), ? sheng, washed, acrid and warm; fresh ginger (shēng jiāng), 3 liang, sliced, acrid and warm; and jujube (dà zǎo), 13 pieces, split, sweet and warm.”
Fu Xing Jue states, “Major Yin Dawn Decoction (dà yīn dàn tāng) treats all diseases of the head and eyes with vertigo and dizziness, dryness in the throat, desire to dry-retch, inability to keep food down, vexation and fullness in the heart, chest and rib-side propping pain, and alternating aversion to cold and heat effusion. It consists of 8 liang of bupleurum (chái hú); 3 liang each of ginseng (rén shēn), scutellaria (huáng qín), and sliced fresh ginger (shēng jiāng); 2 liang of licorice (gān cǎo), mix-fried; 4 liang of peony root (sháo yào); 12 pieces of jujube (dà zǎo); and 1 sheng of pinellia (bàn xià), washed. Gather these 8 ingredients, and add 1 dou 2 sheng of water. Boil until the water is reduced to 6 sheng, strain the decoction, and continue cooking, slowly simmering it until it is reduced to 3 sheng. While the decoction is warm, take 1 sheng. Take it 3 times daily.”
The aforementioned recommendations can be used until the Start of Spring (1st solar term) on February 4th, 2023.
Note: It is currently summer in the southern hemisphere; the solar term is Grain in Ear (9th solar term) and the summer solstice is approaching. Therefore, the aforementioned recommendations based on the intermediate and major movement and qi methods are not applicable to people in Australia and New Zealand.
The starting point for a movement and qi prescription is the group; it is targeted to an entire population in a specific time and place, with “1 prescription for 10,000 people” that can be applied to the majority of cases. Another feature of TCM is that it is an individualized medicine that relies on pattern diagnosis and a model of’1 prescription for 1 person. By combining the individualized examination procedures of inspection, listening and smelling, asking, and palpation with general movement and qi calculations, this close integration of generalization and individualization can significantly improve the preventive and therapeutic effects of TCM treatment.
*Translator’s Note: The terms “liang”, “jin”, “dou”, and “sheng” are traditional Chinese units of weight or volume. The historical definition of these units has varied over time, so no conversions have been provided here. Interested readers may consult page 719 of A Practical Dictionary of Chinese Medicine (Second Edition, Second Printing) by Nigel Wiseman and Feng Ye.
About the Author:
Han Yonggang earned his doctoral degree from the Institute of Basic Research in Clinical Medicine at the China Academy of Chinese Medical Sciences. He studied under Wang Yongyan, a member of the Chinese Academy of Engineering, and Professor Gao Sihua, former president of Beijing University of Chinese Medicine. He has worked in the UK since 2009, where he is currently employed at Chelsea Natural Health Clinic and the London Academy of Chinese Acupuncture. He is a member of the World Classic Chinese Medicine Association Expert Committee, a standing member of the World Federation of Chinese Medical Societies Expert Committee on Prescription-Dose Effects, and a council member of the World Federation of Chinese Medicine Yunqi Societies.
