Qi Field Effect of Acupuncture Time-Acupoints-Space in the Treatment of Long Coronavirus Disease and Coronavirus Disease 2019 Vaccine Adverse Reactions

Abstract Corona Virus disease 2019 (COVID-19) has become a serious challenge. On the one hand, there is not a single explanation of its pathological mechanism, which directly affects the treatment efficacy. On the other hand, the complicated symptoms of long COVID and COVID-19 vaccine adverse reactions involve multiple systems and the number of affected patients is large, which have attracted great attention. Acupuncture time-acupoints-space (ATAS) is a new acupuncture technique developed on the basis of four methods of day-prescription of acupoints (Na Jia method), hour-prescription of acupoints (Na Zi Method), eightfold methods of the sacred tortoise (Ling Gui Eight Methods), and eight methods of swift puncturing of needles (Fei Teng Eight Methods) in midnight-noon and ebb-flow doctrine (Zi Wu Liu Zhu). The main idea of ATAS is to use the orderly combination of time acupoints and space acupoints to construct a field to regulate qi movement and treat diseases through the qi field effect. In France, although traditional Chinese medicine cannot be directly used to treat COVID-19, hundreds of patients with long COVID and COVID-19 vaccine adverse reactions have been treated using the four methods of ATAS. With reference to the microcirculatory lesions in the pathological mechanism of COVID-19 in Western medicine, hour prescription of acupoints (Na Zi Method) of ATAS showed specific efficacy for long COVID.

The space acupoints are the isomorphic acupoints of the time acupoints and play a supporting and augmenting role for the time acupoints, such as the acupoints to remove obstruction in meridian/channel and strengthen nutrient qi pillar-plate acupoints by hour-prescription of acupoints (Na Zi Method); acupoints to receive qi and distinguish areas and to regulate the original qi pillar-plate acupoints by day-prescription of acupoints (Na Jia method); the nine palaces acupoints of eightfold methods of the sacred tortoise (Ling Gui Eight Methods) and the eight trigrams acupoints of eight methods of swift puncturing of needles (Fei Teng Eight Methods), etc. The orderly combination of time acupoints and space acupoints elevates the ancient time-prescription points selection method to the space-time integration, which becomes a carrier with the function of regulating the qi field. 1

Discussion on the Mechanism
The mechanism of long COVID is still being investigated. Some Western medicine experts have proposed that novel coronavirus mainly enters multiple human organs through angiotensin-converting enzyme 2 as a target, which is highly expressed not only in alveolar cells and cardiomyocytes but also in vascular endothelial cells, causing extensive vascular or microvascular lesions. [2][3][4][5][6][7][8][9][10] Common lesions include disseminated intravascular coagulation and venous thromboembolism, etc., which impair the barrier between blood vessels and organ tissues, as well as the basis for transporting blood, oxygen, and nutrients to various tissues, causing diseases in a wide range. Even when patients are negative for COVID test, these injuries are not easy to be repaired quickly, resulting in complex and diverse long COVID. 11 Clinically, long COVID patients often have blood stasis symptoms such as multiple viscera injury, ecchymosis and petechial on tongue tip and edge, and sublingual venous plexus varices, so it is believed that microangiopathy developing into long COVID may become one of the common pathogenesis of the complex symptoms.
The ancient hour-prescription of acupoints (Na Zi Method) is based on the principles of the 28 meridians for nutrient qi in The Spiritual Pivot (Ling Shu) and the mothersupplementing child-draining method in TCM. The 28 meridians for nutrient qi consist of 12 regular meridians, and conception vessel, governor vessel, female yin heel vessel, and male yang heel vessel belonging to eight extra meridians. In this network with the 12 meridians as the dominant system and the four vessels as the hidden system, there is not only deep and ubiquitous running of nutrient qi but also original qi and defense qi, which has become an important carrier and network of the theory of sufficient healthy qi inside preventing the invasion of pathogenic factors in TCM. In the three major cycles of using Five Shu acupoints to form a day-on-time sensitivity, the hour-prescription of acupoints (Na Zi Method) runs through the principle of reinforcing and reducing by puncturing along and against the direction of meridians, respectively, and mother-supplementing childdraining. That is to say, in the process of flowing the meridians according to the time sensitivity, the mechanism of reinforcement and restraint of the Five Shu acupoints to distinguish the deficiency and excess diseases is applied, and the method of treating deficiency by tonification and treating excess by purgation is performed based on acupoints combination and therapeutic manipulation. Using time acupoints, hour-prescription of acupoints (Na Zi Method) creates major meridian-unblocking involving 12 acupoints to clear the qi stagnation and blood stasis, supplement the deficiency of nutrient qi and original qi, and deeply participate in promoting blood circulation and removing blood stasis in nutrient qi running to assist healthy qi. The structure of the close combination of time acupoints and space acupoints makes hour-prescription of acupoints (Na Zi Method) play a specific role in the treatment of long COVID.

Typical Cases
Case 1 was 51-year old male. Date of first visit was at 18:30 on February 22, 2021 (Xin Chou Day 38, Ding You Hour 34). Complaints were on January 2021, the patient received first aid for one and a half months during hospitalization due to an infection resulting from the installation of cardiac first aid equipment and was discharged following multiple negative nucleic acid tests. Underlying condition was type 2 diabetes. Current symptoms were weight loss of 20 kg, fatigue, gasping for breath, and unable to move after 10-m walk in need of support, with joint and muscle aches all over the body, insomnia, blank mind, and complete shutdown of life and work. The painkillers caused stomach pain, which was reduced to the minimum dosage and was almost ineffective, so they were stopped. Pulse was deep, thready, and weak especially at the two chi parts of the wrist, the tongue was fat and teeth marked with the bottom covered with bloodshot, and the coating was white and thick. Western medicine diagnosis was long COVID. TCM diagnosis was the deficiency of spleen and kidney, dampness, and blood stasis blocking meridians and channels. Treatment principle was tonifying spleen and kidney, promoting blood circulation and removing blood stasis, removing dampness, and relieving pain. Therapy included major meridian-unblocking method by hour-prescription of acupoints (Na Zi Method) of ATAS with Taixi  Complaints were in March 2021, the patient and his wife were simultaneously infected with COVID-19, receiving home isolation treatment for a month, and the multiple nucleic acid tests were negative before the visit. Current symptoms were fatigue, chest tightness, expectoration, pharynx blockage, nasal obstruction, decreased memory and reaction ability, and unable to work properly. With the history of severe attacks of low back pain radiating to the lower extremities, insomnia, and hyperosteogeny of lumbar vertebrae 4 and 5. Pulse was deep and thready, especially at two chi parts of the wrist. The tongue was fat and teeth-marked with bloodshot at the bottom of tongue, and the coating was white, thick, and greasy. Western medicine diagnosis was long COVID. TCM diagnosis was the deficiency of spleen and kidney, dampness, and blood stasis blocking meridians and channels. Treatment principle was tonifying the spleen and kidney, promoting blood circulation, removing dampness, and relieving pain. Therapy included major meridian-unblocking method in hour-prescription of acupoints (Na Zi Method) of ATAS. Time acupoints adopted Tonggu (BL 66) for even reinforcing and reducing, from left to right; space acupoints were from left to right, first Shenmai (BL Targeting acupoints were Weizhong (BL 40) and Fenglong (ST 40). The needle was retained for 40 minutes. During the needle retention, the patient fell asleep deeply. The patient felt relaxed and lumbosacral pain disappeared when the needle was taken out. After treatment once every 2 weeks for four times, all the symptoms disappeared and returned to normal work. Then, the therapy was performed to strengthen the curative effect once a month.
Note: The specificity of ATAS in the treatment of long COVID lies in that it can not only directly act on nutrient qi flow in meridians to regulate and tonify nutrient qi, defense qi, and original qi but also has effects of unblocking the meridian and blood activating in a wide range. ATAS has become a highly targeted treatment for microcirculation lesions in long COVID. In addition, the combination of targeting acupoints and empirical acupoints is of extensive adaptability, so it has achieved satisfactory results in the clinic.

Discussion on the Mechanism
People having COVID-19 vaccine adverse reactions are mainly concentrated in the population with underlying conditions such as cancer, heart disease, hypertension, diabetes, arthropathy, asthma, allergic diseases, anxiety, depression, and uncured long COVID patients. The occurrence of adverse reactions is closely related to the patient's constitutions, that is, the original qi state in TCM.
ATAS combined with triple energizer pericardium to connect the original qi in the cycle in the twelve meridians (Na Jia Method), to stimulate the vitality of the original qi in the combination of acquired eight trigrams and nine palaces (Ling Gui Eight Methods), or to use congenital eight trigrams to regulate the original qi (Fei Teng Eight Methods), which are with different qi channels, but their goals are the same to enhance and regulate the original qi. 1

Typical Cases
Case 3 was 48-year-old male. The date of first visit was at 13:15 on November 22, 2021 (Jia Xu Day 11, Geng Wu Hour 7). Complaints were long-term depression with anxiety, alternate use of antidepressant and antianxiety drugs, and intractable low back pain without abnormal imaging findings. Medical history included total prostatectomy in 2018 because of prostate cancer. Current symptoms were the patient was infected with COVID-19 in March 2020, was negative for the nucleic acid test after 3 weeks of treatment at home, and was diagnosed and cured by Western medicine. The second shot of the vaccine was given at 10:00 on July 7, 2021. Three weeks later, wandering click-like pain accompanied by a sense of burning occurred in the nerve ending, which was called wandering electric sense according to the patient. It usually started at the fingertip of the left hand and radiated to the palm, arm, and shoulder, then to the right shoulder, along the right arm, and palm to the fingertip, and then to the lower extremities, accompanied by muscle flicker pain and contracture, worse in the right lower extremities. Similar symptoms often occurred around the lips. All the examinations results were normal in the department of Internal Medicine and Neurology of Bikier Hospital, Paris Public Hospital, and the adverse reaction of COVID-19 vaccine was diagnosed by multidepartment consultation. The patient's physical fitness decreased significantly, fatigued easily, with muscle weakness all over the body, poorly slept, and easily woke up with normal urination and defecation. Pulse was deep, thready, and hesitant. The tongue was pale, fat, tooth-marked with little coating, and there were blood stasis nodules at the bottom of the tongue. Western medicine diagnosis was adverse reaction of COVID-19 vaccine. TCM diagnosis was the deficiency of kidney qi, meridian blocking. Treatment principle was tonifying kidney qi, dredging channels, and activating collaterals. Therapy included major meridian-unblocking method in hour-prescription of acupoints (Na Zi Method) of ATAS. Time acupoints were Shaochong (HT 9). Because the patient's symptoms started from left body, contralateral meridian needling from right to left was applied. Space acupoints: due to the main symptoms of pain and burning, 12 acupoints of meridian-unblocking should be punctured first, that is, Dabao (SP 21), Shaofu (HT  Taichong (LR 3). The time-acupoints were replenished by the centripetal oblique insertion reinforcing method of hour-prescription of acupoints (Na Zi Method). Major meridian-unblocking acupoints, nutrient qi pillar-plate acupoints, and targeting acupoints were needled by oblique insertion of the 12 regular meridians, and the reinforcing method of time acupoints was applied in all acupoints from right to left. The needle was retained for 40 minutes and was taken out the needle according to the order of insertion.
Second visit was at 13:10 on November 29, 2021 (Xin Si Day 18, Jia Wu Hour 13). Complaints were after acupuncture, the body relaxed and the symptoms of anxiety improved, but the symptoms of limbs did not improve significantly. Pulse was deep, thready, and uneven pulse. The tongue was pale, fat, and tooth-marked with little coating. There were dark nodules at the bottom of the tongue. TCM diagnosis was kidney deficiency and liver depression, meridian block. Treatment principle included tonifying kidney and regulating liver, dredging channels, and activating collaterals. Therapy included eight methods of swift puncturing of needles (Fei Teng Eight Methods) of ATAS. Time-acupoints were Gongsun (SP 4) and Neiguan (PC 6) in adherence to the custom of male left body female right from left to right. Starting from the first trigram where Gongsun (SP 4) is located; the space acupoints were divided into three groups of Bagua acupoints, that is, neck-back Bagua acupoints, headupper limbs Bagua acupoints, as well as chest-abdomenlower limbs Bagua acupoints, shown in ►Fig. 1. Weizhong (BL 40) was the targeting acupoint. The needle was retained for 40 minutes and was taken out the needle according to the sequence of needle insertion.
Third visit was at 12:20 on December 6, 2021 (Wu Zi Day 25, Wu Wu Hour 55). Complaints were the patient accidentally fell on December 5 and the injury of the left gastrocnemius muscle caused severe low back pain. Pulse was deep, thready, and uneven. The tongue was pale, fat, tooth-marked with little coating and bloodshot on the bottom of the tongue. TCM diagnosis and treatment principles were the same as above. Therapy included eightfold methods of the sacred tortoise (Ling Gui Eight Methods) of ATAS. Time acupoints were Shenmai (BL 62) and Houxi (SI 3). Contralateral meridian needling was used first for the left gastrocnemius muscle injury, from right to left; space-acupoints: starting from the first palace where Shenmai (BL 62) is located, the three groups of acupoints were respectively needled as shown in ►Fig. 2, with Weizhong (BL 40), Zulinqi (GB 41), and Zusanli (ST 36) as targeting acupoints. The needle was retained for 40 minutes and was taken out the needle according to the order of insertion. Treatment was performed every 3 days and after 2 months of treatment, the patient's physical and mental symptoms gradually improved, and the wandering electric sense of the limbs was reduced by 80%.
Note: The patient in this case had kidney deficiency and liver depression for a long time. When COVID-19 infection and vaccine adverse reactions occurred simultaneously, not only the deficiency of kidney was aggravated but also the function of liver and blood to nourish meridian tendons was damaged. During the first visit, hour-prescription of acupoints (Na Zi Method) of ATAS was used to unblock meridians, relieve pain, and tonify kidney qi so that the anxiety and nervousness of patients could be relieved. During the second and third visit, eight methods of swift puncturing of needles (Fei Teng Eight Methods) and eightfold methods of the sacred tortoise (Ling Gui Eight Methods) of ATAS were applied. Time acupoints: Gongsun (SP 4) in combination with Neiguan (PC 6) and thoroughfare vessel in combination with yin link vessel were selected to dredge heart and chest depression; Shenmai (BL 62) in combination with Houxi (SI 3) and yang heel vessel in combination with governor vessel were selected to invigorate kidney and yang qi. The two groups of time-acupoints were the keys to enter the congenital and acquired eight trigrams and qi field.  Taichong (LR 3), and Yanglingquan (GB 34) on the left and right body not only had the function of curing root causes from liver and kidney but also has the effect of tranquillizing and relieving pain and unblocking meridians. On the basis of constructing qi field, the targeting acupoints play the role of keeping waist-back healthy through Weizhong (BL 40) and belly and abdomen through Zusanli (ST 36). This case was a mixed disease of the new and refractory, kidney injury, which could not be cured in a short time, so with the purpose of regulating individual qi field, it was flexible to choose from the hour-prescription of acupoints (Na Zi Method), eightfold methods of the sacred tortoise (Ling Gui Eight Methods) and eight methods of swift puncturing of needles (Fei Teng Eight Methods) of ATAS, and a good effect was obtained.
Case 4 was 43-year-old female. Date of first visit was at 18:00 on January 31, 2022 (Jia Shen Day 21, Gui You Hour 10). The patient had underlying asthma and the third dose of the COVID-19 vaccine was injected on January 22, 2022. On January 23, the trachea tightened and ached, cough appeared. On the night of January 23, severe pain appeared in the ovary, radiating to the sacral pelvis and back, and the patient was unable to sleep with a continuous secretion of a large amount of white, sticky, and smelly leucorrhea. The lower limbs were covered with a crimson rash, unbearable itching, and the palms of the hands had felt burning to pain. The patient was sent to the hospital for emergency treatment and was diagnosed as vaccine adverse reactions. After hospitalization for 3 days, abdominal lumbosacral pain was alleviated and the appearance and smell of leucorrhea was slightly improved. TCM diagnosis: lung, spleen and kidney damage, phlegm dampness, and blood stasis blocking meridians. Treatment principle was invigorating the spleen, tonifying the kidney and regulating the lung, removing dampness, and removing blood stasis to relieve pain. Therapy included eightfold methods of the sacred tortoise (Ling Gui Eight Methods) of ATAS. Time acupoints: Waiguan (SJ 5) and Linqi (GB 41) were selected because of serious gynecological adverse reactions from right to left according to the custom of male left female right; space acupoints: the three groups of nine palaces acupoints of neck-back-waist, head-shoulderupper limbs, and chest-abdomen-lower extremities were used, all started from the third house where Linqi (GB 41) is located; the targeting acupoints were Weizhong (BL 40) and Fenglong (ST 40), needling from right to left. The needle was retained for 40 minutes and was taken out the needle according to the insertion order.
Second visit was at 17:00 on February 7, 2022 (Xin Mao Day 28, Bing Shen Hour 33). Complaints were the lumbosacral pain in the lower abdomen was reduced by 80%, and the patients could sleep soundly. The rash basically disappeared and the leucorrhea returned to normal. Therapy was eightfold methods of the sacred tortoise (Ling Gui Eight Methods) of ATAS . Time acupoints were Zhaohai (KI 6) and Lieque (LU 7) from right to left; space acupoints were the same three groups as the first visit, needling from the fifth house where Zhaohai (KI 6) is located; targeting acupoints were Zusanli (ST 36) and Sanyinjiao (SP 6). The needle was retained for 40 minutes and was taken out the needle according to the insertion order.
Third visit was at 13:00 on March 11, 2022 (Gui Hai Day 60, Wu Wu Hour 55). Complaints were symptoms at the first visit basically disappeared, and the patient hoped to consolidate the curative effect. Treatment method: eight methods of swift puncturing of needles (Fei Teng Eight Methods) of ATAS. Time acupoints were Zulinqi (GB 41) and Waiguan (SJ 5), needling from right to left; space acupoints were three groups of Bagua acupoints on neck-back, head-hand, chestabdomen-lower, needling from the sixth Gua where Zulinqi (GB 41) is located, targeting acupoints were Zusanli (ST 36) and Sanyinjiao (SP 6), needling from right to left. The needle was retained for 40 minutes and was taken out the needle according to the insertion order.
Note: because this patient had underlying asthma, the vaccine not only caused serious adverse reactions to the lungs but also involved gynecology and dermatology. Among the four methods of ATAS, the application of eightfold methods of the sacred tortoise (Ling Gui Eight Methods) was based on two aspects. First, the time acupoints Waiguan (SJ 5) and Zulinqi (GB 41) combined with yang link vessel and belt vessel in the treatment of gynecological emergency was the key to entering the treatment qi field. Second, the three groups of acupoints of eightfold methods of the sacred tortoise (Ling Gui Eight Methods) could comprehensively cover a variety of side effects of patients, such as Feishu (BL Quchi (LI 11) in nine palaces acupoints cooperated to clear dampness and heat. This construction of qi field obtained a rapid and immediate effects in the first visit. The second visit continued to use eightfold methods of the sacred tortoise (Ling Gui Eight Methods) of ATAS, but the time acupoints were changed to Zhaohai (KI 6) and Lieque (LU 7) in combination with yin heel vessel and conception vessel directly solved gynecological adverse reactions. Eight methods of swift puncturing of needles (Fei Teng Eight Methods) for the third visit with Zulinqi (GB 41) and Waiguan (SJ 5) time acupoints had the same role as Waiguan (SJ 5) and Zulinqi (GB 41) for the first visit. For the eight trigrams acupoints, Shenshu (BL 23) was changed to Pishu (BL 20), Danzhong (RN 17) to Zhongwan (RN 12) for cooperating with the targeting acupoint Zusanli (RN 17) in order to tonify the spleen and stomach and consolidate the curative effect. regulating gynecology with Sanyinjiao (SP 6).Sanyinjiao (SP 6) was continuously used to regulate gynecological diseases. After three times of treatment, the complex symptoms of the vaccine adverse reactions were basically relieved and satisfactory results were obtained.

Conclusion
The microvascular lesion is an important part of COVID-19 pathology, which can be used as a reference for the pathological mechanism of long COVID. On the basis of tonifying nutrient qi, hour-prescription of acupoints (Na Zi Method) of ATAS has made great efforts and obtained good efficacy in removing the stagnation in nutrient qi flow in 28 meridians, tonifying deficiency and dredging depression as well as treating both symptoms and root causes and suggesting that paying attention to and dealing with the relationship between healthy qi and blood stasis is a key avenue of TCM in the treatment of COVID-19. The COVID-19 vaccine adverse reactions are closely related to the constitutions associated with the underlying diseases, that is, the state of original qi in TCM, so the treatment of vaccine adverse reactions is mainly based on the three methods of ATAS, Ziwu Liuzhu Na Jia Method, eightfold methods of the sacred tortoise (Ling Gui Eight Methods) and eight methods of swift puncturing of needles (Fei Teng Eight Methods), and the hour-prescription of acupoints (Na Zi Method) of ATAS can also be used. In a word, ATAS aims to construct and adjust the exteriorly interiorly connected qi field, which leads nutrient qi and original qi to the focus with the guidance of targeting acupoints, and the normal pulse can be achieved with a needle without consultation. Although the long COVID and COVID-19 vaccine adverse reaction are major issues never seen before, we have made a rapid response in the clinic with curative effects. 12 The mechanism of ATAS through constructed qi field is worthy of further investigation.
CRediT Authorship Contribution Statement M.Z. was responsible for conceptualization, investigation, methodology, validation, writing, and writing-review and editing.

Funding
None.