1Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong
2State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Hong Kong
Received Date: 01 Jun, 2020 ; Accepted Date: 18 Jun, 2020 ; Published Date: 24 Jun, 2020
Classics in Chinese Medicine contain rich descriptions on Infections and diseases with febrile symptoms resembling respiratory pathology. From early 3000 BC down to recent Qing Dynasty, great masters devoted a lot of energy on infections and epidemics. This paper attempts to give a brief description of the historical records, followed by an exploratory study on the clinical applications of Chinese Medicine in the recent decades. Although current epidemics of viral origin have initiated further endorsement of Chinese Medicine as treatment options, little has been said about the preventive value. It is time to work out the immunological supportive value of the classical formulae in the expectation of developing evidence-based preventive supplements against viral infections.
Chinese Medicine; Epidemic Diseases; Infections; Preventive Supplements
Infectious diseases first affect the individual; then according to the causative agent’s aggressiveness, will affect the individual’s close circle, then later, possibly spread to the community. Presumably, ever since human history begins, infective agents attack vulnerable individuals, commonly presenting with symptoms of the upper respiratory tract or gastrointestinal problems. The infective agent may be carried by insects or other vectors to the nearby community and beyond, resulting in wide-spread involvements - an epidemic. This is a simple story of how the sick individual carries the disease home and later transmits it to the community. Descriptions of Epidemics are plenty in the historical records of China. Not only are the socio-economic-political implications well documented, but the whole processes of combat against the causative agents have created interventional experiences of great value. Experts involved in specific epidemics have not only learned a lot throughout the process but are able to develop innovations and new ideas related to the control of the disease. The innovations are not limited to the epidemic alone, but should have much wider implications. Today, when the classics of the legendary Chinese Medicine Masters are studied, leading chapters of special importance are found related to episodes of infections and epidemics.
Excavation of tortoise shell scriptures revealed records of disease affections that killed hundreds of people, as early as 3,000 more years ago. This could be the earliest record of epidemics in China. The oldest classic related to medical treatment in China is “Neijing” of the “Warring Period” (770BC - 221BC). A vivid description on infection and epidemic is given as follows:
“Be aware of infections with variable but similar symptoms of different severities. They are all contagious; they need appropriate treatment otherwise they spread. Only those in possession of anti-infection power (Qi) can effectively resist the attack and help preventing spread”. The instructions include advice during an epidemic: “Within the wicked period, avoid panic, keep up with the spirit, have good physical training and choose the appropriate treatment” .
The legendary ancient ‘Saints’ of Chinese Medicine have set clear guidelines for the Management of the Individuals as well as the Community . Han Dynasty (220BC - 202AD) is noted for Zhang Zhong Jiang, the great Physician and Huatoa, the physician-surgeon. Zhang develop a comprehensive system of managing “Febrile Illnesses due to External Invasions” basing on Health Philosophy . His great volume Book of Febrile Illnesses “Treatise on Febrile Diseases caused by Cold” set the basic rules on the management of syndromes resembling infection with fever, sweating, abdominal problems and diarrhea. Instructions included: “check the cause; determine the main challenge; maintain a physiological balance; differentiate acute from chronic symptoms; and persist on the maintenance of harmony”.
Hautao had a wide range of expertise. With regard to syndromes of febrile illnesses resembling infection, he stressed the importance of “Careful scrutinisation of superficial affections in contrast to deep, internal involvements” . Great healers in the following decades include Guhong, Wang Suhe and Tao Hungjing all three of them followed their predecessors and further developed the individual care for the infected . The Tang Dynasty (618 - 907) is marked by another great physician Suen Si Miao. Suen analyzed the different descriptions in the previous generations and matched them with different presentations of specific infections or infectionlike syndromes, concluding that “Different herbal combinations could be safely and effectively used for specific purposes” . The long period of early Chinese History spreading over 1,000 years has lay down the principles of diagnosis, management and choice of herbal and other treatments of diseases. The basic principles and details are divergent but significantly related to infections of different nature, described as “Febrile illness”.
Firstly, infections must be very common causes of ailment. Secondly, non-infectious diseases could also give symptoms of fever, cold and frailness. Early physicians and their teachings naturally considered the different diseases with the same presenting symptoms and syndrome as belonging to the same category. This practice did not help to delineate infection from other diseases and has tremendous influences over the subsequent era. The period of Sung-Jin-Yuen dynasties (960 - 1368) have experienced over 100 epidemics in different regions in China. These natural disasters could have initiated a better awareness of infectious diseases. The establishment of a unique section of Chinese Medicine related to infection: “Wan-beng” was the outcome. Medical experts pointed out the unique symptom features of infection in contrast to the general syndrome of “febrile illness” and that “Wan-beng” had seasonal attachments .
Li Dang Wuen was the most influential expert of this period. He gave the details of the epidemic in year 1232, victims of which presented with high fevers, unbearable thirst, throat swelling and pain together with upper respiratory symptoms. He invented a special formula which remains popular to-date . The establishment of the epidemic infection concept led the way to an important branch of Chinese Medicine specified “Wa-beng” in the Ming Dynasty (1368 - 1644) . Again in year 1641 towards the end of the Ming Dynasty, a serious epidemic in Central China killed thousands of people. Wu Juke, a distinguished physician lived within the most affected area. His “Treaty of Epidemic” (Wenyi Lun) was completed in this period. He emphasized on the need for early exclusion of the causative agent, and the need to differentiate respiratory from other involvements. He observed that infections of domestic animals could be related and yet could have different vectors of infection spread. Those were really scholastic observations of great value.
In this period, again arising from within an epidemic era, the earliest practice of vaccination was invented. Using the nasal secretion of children suffering from smallpox, or their worn garments to be closely applied to the uninfected people was found to result in a low grade affection causing little harm leading to rapid recovery . This primitive vaccination invented by Zhang in 1562, was well ahead of Edward Jenner’s smallpox vaccination in England in 1790 – 1810 . Reaching the Qing Dynasty, epidemics remained frequent health challenges: 80 episodes were recorded in 228 years. The advancing knowledge of medical pathology started to offer explanations to the origins of the epidemics, which has been described as cholera. malaria, smallpox, measles, scarlet fever, respiratory infection and plaque. There should be good reasons for further advances in the management of epidemics in China. Indeed, Ye Tien Shi was the most prominent contributor. He wrote the “Treaty of Epidemics” . A more modern concept was followed with more explanations to the sequence of events, so that “The heat enemy first attacks the lungs before the heart. Later, other internal organs will be the targets. Treatment requires a clear judgement on the stages of disease progress, from the gradual commencement towards the advanced un-redeemable”.
Another influential figure Wu Ju Tong who lived through the early stage of Modern Medicine (1758 - 1836) applied Ye’s recommendations during the Central China epidemic of 1793 and was well known for the enlightening wisdom. He was able to simplify the management of complicated upper respiratory infectious diseases into three practical stages: “Firstly, the lung and heart; thence, the stomach and spleen; lastly, the intestines, liver and kidneys” . It might be true to say that Traditional Chinese Medicine grew and matured with epidemics. The continuous development of Infection Concepts and Treatment principles: from ancient times to before the Republic of China has given us a clear picture of the medical advancement with time, which was not only related to infections and epidemics alone but had reflected the overall picture of Chinese Medicine throughout history. The closeknitted relationship between the infection symptoms and other disease presentations has influenced a joint development involving both. Yet the gradual separation of the two streams started in the Qing Dynasty (1636 - 1911). Separate developments of the two streams would need to be considered together with the speedy introduction of Modern Medicine to China.
Reaching the period of the National Republic (since 1911), the biological science based modern medicine was brought to China by the missionaries from Europe and America. Hospitals were built and hospital practice with the introduction of new diagnostic principles and techniques, together with target orientated pharmaceuticals provided new options for disease treatment and great challenges to traditional practices. The shift from traditional to modern had been a very gradual process very much supported by the upper class intellectuals while traditional practice remained popular under normal circumstances. Given its quick responses, modern infection management should be preferred by all people on the individual level. However, when facing an epidemic, difficulties and insufficiencies are met, and unfavorable gaps in the management would become obvious. With the strong cultural heritage of Traditional Chinese Medicine, popular traditional practices to combat infection would nationally come up for rescue .
Since 1911, 7 epidemics of influenza infection occurred in China: 4 of which (1918, 1957, 1968, 1977) affected China and other countries, while 3 others affected China alone (1997, 1999 and 2003). The 1918 pandemic was the most damaging epidemic ever reported of the influenza virus. China apparently was not as severely hit and the mortality was lower. One reason given was that modern medicine was not well developed, no vaccine was available but Chinese Medicine contributed a lot to the control of the infection . Since 1949, during the influenza epidemics in China, strong national encouragements for the use of Traditional Chinese Medicine at different stages of the disease were observed. Since influenza has a universal (global) low rate of mortality, the value of Chinese Medicine presumably could be related to symptom control and prevention of complications . Mild cases could be receiving herbal treatment alone, moderately severe cases could be supplemented with modern therapy while severe cases with respiratory complications would be hospitalized .
We have seen how epidemics in ancient China have enriched the management of the infections and the control of their spread ever since 3,000 years ago. In the most recent influenza epidemics, amidst fear and concern of disease contraction, Chinese people resorted to traditional medicine, voluntarily and very much acted according to the National Policy. Are there other innovative ways to better use the popular traditional practice for the need of infection control? Pharmacologists would not consider herbal formulations suitable for drug development [18, 19]. The use of Herbal medicine formulations in the treatment of infections has no simple target orientation. Instead they aim to provide the maintenance of a physiologically balanced state i.e. when “Yin and Yang” exist in harmony. In modern terms it might mean an immunological harmony that would not allow disturbances from an outside invader. This effect could be considered a situation resembling a post vaccination immunological state of defence .
This could be the challenge for Traditional Chinese Medicine experts. One of the most important teachings on Chinese Medicine given in Neijing is “Treat the undiseased”. This concept emphasises the individual’s responsibility to fight against disease. It should also carry the message of Prevention against infection. However, a careful study of the rich collection of herbal formulae advocated for infections and epidemics fail to reveal specific categories advocated for “Preventive use”. Nevertheless, if treatment were given at an early stage, the purpose could relate to the prevention of deterioration. Since the individual is responsible for his/her own health, when facing the challenge of infection, early treatment is the next move when prevention fails. Whatever is the background behind the absence of Preventive specification among formulations advocated for epidemics, those recommended for early treatment of mild clinical presentations could be considered as appropriate for Prevention . Prevention is particularly important for patient care-givers in the family circle and clinical settings.
During the SARS epidemic in Hong Kong in 2003, a clinical trial using herbal medicine for prevention was conducted. Details of the trial is given as follows:
As a means to protect the at-risk hospital workers, an innovative herbal formula was created and given to 3,160 of them for two weeks’ consumption. During the two weeks, infection symptoms and adverse effects were closely monitored. The herbal formula was the combination of two classical formulae popular for the treatment of cold and influenza like infections. One month later, it was shown that none of the herbal consumers contracted the infection whereas 0.4% of the non-consumer controls were infected . The immunological states of 37 of the herbal consumers were studied serologically before and after the herbal consumption. Boosting of the innate immunological state of the consumers was confirmed, and the adverse effects were found to be insignificant .
Follow-up, immunological studies on the same formula have given further evidences of its immunological boosting effects [24, 20]. In any epidemic of respiratory disease, it is not easy to organize proper clinical trials. The Hong Kong study during the SARS crisis in 2003 succeeded in giving early objective indications that classical anti-febrile illness herbal formulae could be useful in an epidemic to provide personal protection against the contraction of the highly contagious disease. Further research would be very much needed. After the SARS crisis, since 2005 some Chinese Medicine experts in China have carried out clinical trials using herbal formulations for preventive purposes. The target populations included medical staff; people in close contact and students. Four such reports are available. Unfortunately, they are of very poor qualities: reports were short, client numbers varied from over 10,000 to just a few; and only general impressions like “lower infection rates” were given .
This paper was prepared during the Pandemic of COVID-19. China once more, has been advocating the use of Chinese Medicine for the treatment of the infection on a national level, and has proposed many optional choices of herbal formulae. Once more the treatment and prevention aspects are vaguely defined. Now that genuine explorations on the immunological protection of the at-risk groups have started, it is very much wished that further research commitments could be made on the creation of evidencebased supplements for the boosting of innate immunological defense abilities, since an effective vaccine is yet to be expected .
The authors state no conflict of interest.
This work was supported by the State Key Laboratory Fund provided by the Innovation and Technology Commission of Hong Kong.
Citation: Ping-chung L (2020) Epidemic Diseases and Chinese Medicine - From Ancient to Current Time. J Trop Med Infect Dis 1: 001. 10.29011/ JTMID-101.100001