In the Spirit of Benevolence: Taking Action to Fight Against the COVID-19 Pandemic : Chinese Medicine and Culture

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In the Spirit of Benevolence: Taking Action to Fight Against the COVID-19 Pandemic

Wang, Xu-Jie1,2; Zhang, Wan-Tong1; Zhang, Xue-Xue1,2; Li, Jia-Xi3; Li, Qiu-Yan1,✉; Weng, Wei-Liang1,✉

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doi: 10.1097/MC9.0000000000000028
  • Open

Abstract

1 Introduction

In 1918, a global influenza pandemic broke out. Just over a 100 years later, the coronavirus disease 2019 (COVID-19) pandemic imposed huge challenges on the global society.1 The COVID-19 pandemic required society to focus on supporting medical workers, public health, and the pharmaceutical industry.2 Following the explosive development of modern science and technologies in the medical field, new methods are emerging for relieving pain or completely curing diseases. Thus, new and evolving treatment options have benefited many peoples’ health and wellness. Following the outbreak of the COVID-19 pandemic, however, people have realized that, in addition to advanced medical technologies, humanistic medical care is also very important for patients’ physical and mental health.3 Along with the rapid development of medical technology, researchers are increasingly focusing on humanistic medical care as the foundation and gold-standard of medical practice. The establishment of the biopsychosocial model bringing people-centered attention to modern medical diagnosis and treatment shows that humanistic care plays a pivotal role in medical practice.4

Traditional Chinese medicine (TCM) has always emphasized that “medicine is the art of benevolence” and valued doctors’ virtues throughout its long history.5 TCM and Confucianism are each traditions that stretch back over a millenium further, but the idea of Confucian social & moral philosophy contributing, as an overarching guiding paridigm, to the practice of medicine, emerged during China’s Song Dynasty, circa the 12th century.6–8 In ancient China, the social status of doctors was generally low, so it was not the primary choice for Confucians.9 However, in today’s Chinese society, the social status of doctors continues to improve, and becoming a doctor is the pursuit of many young people. As an outstanding representative of TCM doctors, Confucian doctor (儒医) has a broader significance in the modern times and has become a role model for many people to learn.10 Although Confucian doctors may come from different medical schools, their professional ethics and broad-mindedness in saving lives and healing illnesses are common distinctive features in their medical practices.

2 Important implications for Confucian doctors

“Confucian doctor” is a collective term for a class of doctors and a cultural phenomenon.11 However, Confucian doctors are not hidden in the depths of ancient documents but are a living inspiration for professional medical personnel today. Culture is a sociohistorical phenomenon formed through long-term societal practices and it symbolizes human wisdom based on peoples’ spiritual independence.

Confucian culture originated from the Spring and Autumn Period and developed gradually to form into a cultural system emphasizing benevolence, courtesy, and moderation as its essence. Its influence is so impactful that it is still used as a guide in the development of contemporary China. Confucian culture first became the dominant factor in Chinese culture during the Han dynasty. Dong Zhongshu’s (董仲舒) proposal to “banish other schools of thought and revere Confucianism alone” was adopted by Liu Che (刘彻), better known as Emperor Wu of the Han dynasty. Confucianism then became the orthodox philosophy of Chinese society, and Confucian culture has since become a decisive factor in the inheritance and development of Chinese culture.

Between 13th and 14th centuries, Zhu Zhenheng (朱震亨) advocated for the application of Confucian philosophy into TCM.7 Thereafter, the concepts of Chinese medicine have become deeply imprinted with Confucianism.

2.1 The origin of Confucian doctors

Confucian culture deeply influences TCM.12Song Hui Yao Ji Gao (《宋会要辑稿》 The Collation and Research of the Compilation of Song Regulations) states that:

“The imperial court established medical disciplines to educate scholars, so that Confucian scholars could master the Basic Questions in The Yellow Emperor’s Inner Canon, learn how to diagnose and treat diseases, and help those who were ill. Such people were called the Confucian doctors.”13

“Confucian doctor” refers to people who understand TCM and have mastered Confucianism, those who learned about TCM through Confucianism, or those who are familiar with both Confucianism and TCM. Confucian doctors intend to use Confucianism to improve the overall knowledge of medical practitioners.14 Fan Zhongyan (范仲淹), a famous official and litterateur during the Song Dynasty, once said, “If you cannot become a governing official (to save the country and the people), you should strive to become a good doctor.” Therefore, Confucian scholars’ determination to practice medicine is one of their choices in realizing a Confucian lifestyle and social values. In the Confucian Doctor chapter of the Gu Jin Yi Tong Da Quan (《古今医统大全》 Ancient and Modern Medicine Complete Book), a physician of the Ming dynasty, Xu Chunfu (徐春甫) is quoted thusly:

“Confucian students must understand social etiquette and justice, while doctors need to learn the essentials of diagnosis. Failure to practice social etiquette and justice shows ignorance of the teachings of Confucius and Mencius. Failure to learn the essentials of diagnosis will endanger the lives of people. Both Confucianism and medical knowledge are very important.”15

Some scholars in the Southern Song period regarded that possessing general knowledge of Confucianism was an important foundation of becoming an excellent physician.

2.2 Confucian doctors’ practice

In addition to deeply understand the importance of medicine to human life and health, Confucian doctors must perform in-depth studies on the essence of medical technologies and clinical diagnoses.10 They must go beyond the theoretical understanding of medicine to extract, master, condense, and integrate their scholarly medical knowledge with philosophy, humanities, ethics, and other aspects of human inquiry to truly comprehend the essence of medicine and its deep connotations for humanity.

3 Spiritual connotations of Confucian doctors

In today’s society, the meaning of Confucian doctor’s connotation is expanding, and they represents those TCM medical staff who have noble virtues and can make important contributions to society.10 Professional ethics is still the basic quality of Confucian doctors. They must follow this professional spirit in their scientific research, clinical diagnosis & treatment, and scholarship pursuit. Thus, professional ethics is an essential aspect of TCM culture.

3.1 Fighting the pandemic at the front line

TCM is rooted in traditional Chinese culture, which attaches immense importance to life, it has been gradually appreciated by the international community. Becoming a TCM practitioner is an important choice for today’s youth. At the same time, more and more TCM medical staff are contributing to all mankind and striving to become an excellent Confucian doctor. During the onset of COVID-19 pandemic, thousands of TCM professionals across China were sent to form TCM teams to support medical institutions in Hubei Province to fight against the disease.16 These TCM teams were TCM scholars and experts of young and middle-aged. These TCM professionals devoted themselves to the prevention and control of the COVID-19 pandemic without thinking twice of their own personal safety. During the pandemic, the intense participation and widespread use of TCM in diagnosis and treatment was unprecedented. TCM practitioners played a key role in anti-pandemic activities since the beginning of the outbreak. Good curative effects have been observed in using TCM to treat mild and common COVID-19 patients. Subsequently, a variety of TCM products and pharmaceutical extracts have been discovered to show potential in preventing COVID-19.17–20 TCM therapies have effectively alleviated patients’ symptoms, significantly reduced the rate of mild-to-severe cases, improved patients’ recovery period, and showed better performance as auxiliary treatment for severe conditions.21

Professor Zhang Boli (张伯礼), a Fellow from the Chinese Academy of Engineering, observed that: “TCM researchers have also carried out a large number of emergency research projects after the outbreak of the COVID-19 epidemic, and completed the screening and evaluation of anti-viral, anti-cytokine storm, and anti-pulmonary fibrosis effects of Chinese medicine preparations, and other works through basic scientific research, supporting TCM against the COVID-19 epidemic with science and technology.”22

Through their selfless dedications during the pandemic, TCM researchers have demonstrated the professional qualities of contemporary Confucian doctors.

3.2 Humanitarian spirit

The concept of “benevolence” is at the core of Confucian philosophy. Thus, Confucian doctors must not only study academic disciplines, develop good scientific research skills and medical skills for their clinical practice, but also cultivate kindness to become a caring doctor. At the anti-pandemic front line, Confucian doctors compassionately cared for the sick and simultaneously provided humanistic medical care to patients who were in desperate. By relating patients as if they were their own parents, Confucian doctors comforted both the mind and body of elderly patients injured by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Likewise, they treated young patients as if they were their own children. In this way, Confucian doctors cared for every patient and person affected by the pandemic from their heart, which embodies the noble Confucian exhortation to

“Expending the respect of the aged in one’s family to that of other families, and expending the love of the young ones in one’s family to that of other families.”23

Although experienced a heavy workload, many TCM professionals tirelessly provided their patients with acupuncture, moxibustion, and other treatments. They also instructed them to learn traditional Chinese exercise methods, such as Tai Chi (太极) and Ba Duan Jin (八段锦). In this way, Confucian doctors helped their patients to reduce various adverse symptoms during the post-COVID-19 recovery period, enhance their resistance, and promote the complete recovery of their body functions. Confucian doctors’ kind and care-giving practices have effectively alleviated the nervousness of patients caused by the infection and made them deeply aware of TCM’s understanding of good health:

“More important than medical technology is morality and a benevolent heart. Doctors resolve illnesses, save souls, write prescriptions, and give humane solicitude.”

Confucian TCM practices may also convince newly graduated medical students to confront the current tensions between doctor and patient. It helps them realize that a harmonious doctor–patient relationship is not just a formal slogan, but requires every doctor to actively practice these principles.

4 The enduring spirit of Confucian doctors

Confucian doctors’ kindness in clinical practices helps people to realize that Confucian doctors are noble as they uphold medical ethics equally as important as superb medical skills. Medical ethics is part of the professionalism doctors should abide; humanities are part of the art of healing; when combined, humanities and medical ethics itself can be a cure for diseases. Thus, scientific knowledge and humanities are inseparable and complementary. While medicine belongs to the natural sciences, it is also a humanities subject. Scientific and humanistic pursuits can be mutually enlightening in concepts, methodologies, and construction of application.24 They are essentially integrated in philosophical level. Thus, Confucian doctors typically practice both the spirit of science and humanism. Not only have they inherit the time-honored humanistic spirit, but they are also erudite in their interdisciplinary knowledge. Their pursuit of health, treating and preventing illness is unified by humanism and science, just as the balance between Yin and Yang in TCM.25

4.1 Role model for new generations

Even during the pandemic, Confucian doctors have always adhered to their original responsibility of care, that is, “helping sick people to regain their lives; rescuing the weak and disabled to restore their health.”26

Thus, Confucian doctors impact their devotions to patients to medical students. In addition to improving students’ academic performance, Confucian doctors set a role model for students. The Chinese version of the Hippocratic Oath, the “Virtues of A Great Physician (大医精诚)” states,

“When great doctors treat patients, they must quiet the spirit and settle the will, they must be free of wants and desires, and they must first develop a heart of great compassion and empathy. The must pledge to devote themselves completely to relieving the suffering of all sentient beings. If the patients come ask for help, they would not treat them differently whether they are rich or poor, old or young, beautiful or ugly, enemy or friends, Chinese or foreigners and foolish or intelligent. They would treat all patients like their close relatives.”27

This professional ethics of Confucian doctors have inspired new generations of TCM practitioners. The practice of medical ethics based on benevolence has not only set a model for contemporary medical education, but also effectively cultivates the humanistic spirit of reverence and caring in medical students.

4.2 Benefit the entire world

Following the global COVID-19 outbreak, TCM is gradually being used to help fight the pandemic internationally, a large number of Confucian doctors are also making important contributions.28 As an important part of China’s pandemic prevention and control measures, the efficacy of TCM treatments for COVID-19 is now well known. The “Diagnosis and Treatment Protocol for COVID-19” (新型冠状病毒肺炎防控方案) series issued by the National Health Commission of the People’s Republic of China contains TCM diagnosis and treatment contents, which demand the integration of TCM with Western medicine to be strengthened and promotes the role of TCM.29 Following a large number of clinical studies, according to changes in the disease, clinical, and scientific TCM researchers identified four treatment stages of COVID-19 infections: early, advanced, critical, and recovery. Many TCM preparations, including Qing Fei Pai Du Decoction (清肺排毒汤), Hua Shi Bai Du Decoction (化湿败毒汤), Xuan Fei Bai Du Decoction (宣肺败毒汤), Jin Hua Qing Gan Granule (金花清感颗粒), Lian Hua Qing Wen Capsule (连花清瘟胶囊), and Xue Bi Jing Injection (血必净注射液), have demonstrated good clinical efficacy for COVID-19.30 TCM treatments can relieve the symptoms and shorten the course of disease for general patients, prevent the deterioration of the disease for severe and critically ill patients, and promote the rehabilitation process for patients convalescing from COVID-19.31 The advantages of integrating TCM with Western medicine can produce a synergistic effect through their complementary advantages, which is reflected in medical treatments during the pandemic. Respiratory and circulatory support are important treatment methods in Western medicine, while TCM has a better effect in relieving symptoms and regulating physical status through its rehabilitation treatment during the recovery period. In addition, TCM has significant advantages in restoring physical fitness and promoting the absorption of residual pulmonary inflammation.32

Global attention to the use of TCM in COVID-19 treatment is increasing; hence, visits to TCM clinics in European countries and America have soared.33 In addition, Chinese pharmaceutical companies’ overseas orders for TCM products are increasing rapidly. Scientific research institutions in Italy, Japan, and South Korea also hope that Chinese experts will share their TCM diagnosis and treatment experiences. China has sent many TCM experts with rich anti-pandemic experience to Italy, Cambodia, Sierra Leone, Zimbabwe, and Equatorial Guinea, among others.34,35 China is working with other countries to fight against the pandemic, and Confucian doctors globally are ceaselessly working to protect society using various kinds of TCM therapies.36

When China entered the most difficult period of fighting against the pandemic in February 2020, TCM experts from multiple countries jointly issued a “Traditional Chinese Medicine for International Anti-Pandemic Proposal.” This proposal suggested that global TCM scholars take advantage of Internet to disseminate their experiences of using TCM in the prevention and treatment of infectious diseases. In addition, TCM practitioners also use the “Overseas Traditional Chinese Medicine Prevention and Control Internet Public Service Platform for COVID-19” to provide people with free online TCM consultations and methods for preventing COVID-19. More than 20 TCM experts from China, Italy, France, the United Kingdom, Spain, the United States, Australia, Canada, New Zealand, Thailand, Austria, Belgium, and Japan delivered tele-health consultation using the platform.37 The platform is an important force in using TCM to prevent and control the COVID-19 pandemic. It has provided strong support for TCM’s anti-pandemic activities internationally and has attracted attention from the international medical communities. Many countries have expressed their trusts in TCM, for example, netizens from India, the United States, Tanzania, and other countries have all expressed great interest in using TCM to treat COVID-19. The US Cable News Network also cited data from relevant Chinese medical institutions that the combination of TCM and Western medicine quickly alleviates the symptoms of COVID-19 patients, increases the cure rate, and reduces the mortality rate.38

Sponsored by the World Federation of Chinese Medicine Societies (WFCMS) and Beijing University of Chinese Medicine, the “Global Live Broadcast of Frontline Experiences of Traditional Chinese Medicine in Fighting against COVID-19” was held online in April 2020. Dozens of medical experts shared their TCM experiences in China’s fight against the pandemic online. More than 1 million viewers from over 20 countries worldwide were recorded during the broadcast. Medical experts from Germany, Australia, Hungary, the United Kingdom, and other countries subsequently discussed how to combine their clinical research to timely and effectively introduce TCM prevention and treatment in their home countries, including replacing banned drugs in effective TCM prescriptions using traditional Chinese patent medicines.39

In addition, the WFCMS also held three global live broadcasts presenting TCM experts’ experiences in fighting against the global COVID-19 pandemic. Members and representatives from more than 30 countries participated in the online broadcasts. Among the TCM experts, Professor Zhang Boli, Huang Luqi (黄璐琦), and Tong Xiaolin (仝小林) shared their experiences in using TCM to prevent and control the COVID-19 pandemic. Many news media simultaneously promoted the live broadcasts and has helped attracted participants from more than 40 countries.40–42

5 Conclusion

The unique advantages of TCM in the prevention and treatment of infectious diseases are based on the complex composition of TCM compounds, a wide range of treatments, as well as in addition to their multiple approaches and targets.43 TCM has been used during major epidemic outbreaks throughout the long history in China. Thus, under the guidance of TCM concepts and theories of syndrome differentiation, there is a long list of TCM prescriptions to combat infections.44,45 Nobel laureate Madame. Tu Youyou (屠呦呦), representative figure of Confucian doctor, from the China Academy of Chinese Medical Sciences said,

“It is my dream that Chinese medicine will help us conquer life-threatening diseases worldwide, and that people across the globe will enjoy its benefits for health promotion.”46

TCM has once again justified itself during the COVID-19 pandemic. It has simultaneously demonstrated its important value to humanity. The TCM industry will work hard to cooperate with the WFCMS to promote the continuous development and growth of TCM, cultivate more outstanding Confucian doctors, and adhere to professional TCM ethics. TCM’s cultural soft power can be improved continuously to make greater contributions to global health care of all humankind.

The COVID-19 pandemic recognizes no borders and the SARS-CoV-2 virus is the common enemy for all humankind. Therefore, all countries need to work together to end the COVID-19 pandemic globally. After extensive clinical trials, the integration of TCM with Western medicine is now understood to be a better treatment for COVID-19 than stand alone Western medicine.47 Integrated TCM and Western medicine is a major feature of China’s COVID-19 prevention and control strategy. In particular, the unique advantages of TCM played a significant role in the fight against COVID-19.48 Considering the significant results achieved, the WFCMS recommended that the World Health Organization should recommend the inclusion of TCM in COVID-19 treatments to inhibit the rapid spread and to protect human lives.49 Distinguished TCM practitioners like “Confucian doctor” will simultaneously be making great efforts to identify the active ingredients and therapeutic mechanisms of medicinal substances that combat SARS-CoV-2 virus in TCM. TCM is a powerful weapon for humans in conquering various diseases.

Funding

This study was financed by the grant from the third National TCM Master’s Inheritance Studio Construction Project of the State Administration of Traditional Chinese Medicine (Weng Wei-liang Academic Succession Studio) and Beijing Traditional Chinese Medicine’s Succession “3 + 3” Project (Weng Wei-liang Academic Succession Workstation).

Ethical approval

This study does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

Qiu-Yan Li, Wei-Liang Weng, and Xu-Jie Wang conceived and designed the study. Xu-Jie Wang drafted the article. Qiu-Yan Li and Wei-Liang Weng supervised the study. All authors contributed to data collection, analysis, and interpretation. All authors revised the manuscript and approved the final version before submission.

Conflicts of interest

The authors declare no financial or other conflicts of interest.

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Keywords:

Benevolence; Confucian doctor; COVID-19; Chinese medicine; Integrated Chinese and Western medicine; Medical ethics

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