| BackgroundAs a traditional Chinese medicine health-preserving regime,Bigu has a long history and has been described in the pre-Qin period.Its literal meaning is not eating whole grains,or replacing food with Chinese medicinals,or completely fasting for a period of time,which is often associated with qigong exercise.Although the contemporary understanding of Bigu is controversial,it is still regarded as a health care method that is beneficial to physical and mental health.Fasting similar to Bigu has been prevalent in Western countries for a long time and is considered to be an effective health care therapy,and a consensus guideline on fasting has been formed.However,fasting has certain health risks,such as irritability and fatigue caused by hunger.Some studies have found that fasting combined with exercise,or adopting a groupbased comprehensive fasting method can effectively control the adverse risks.This comprehensive fasting program is similar to the current Bigu in China.Then,the safety of Bigu,with distinctive and original Chinese characteristics,and its effects on health status are scientific problems that need to be solved urgently.In recent years,Infrared thermography(IRT)is regarded as an extension of TCM inspection because it can diagnose human health status from an overall perspective,and is known as"Traditional Chinese Medicine CT".Since it is not appropriate to use invasive operations to explore its effects on health status during Bigu,it is of great practical significance to explore the value of IRT in the identification of the health status of people who are inedible from the perspective of inspection.In addition,modern research has shown that many physical and mental diseases are related to gut microbiota,and Bigu/fasting has an effect on the gut microbiota.Therefore,observing the effect of Bigu on the gut microbiota can help to explore the effects of Bigu on health status and help to provide a basis for the prevention and treatment of diseases.Objectives1.Sort out the ancient literature of Bigu,summarize the connotation,form and characteristics of conventional Bigu,to provide the basis for the study of modern Bigu.2.To explore the effects of Bigu and re-feeding on the human health status with different health conditions in the real world,and to explore the feasibility of infrared thermal imaging as an extension of inspection in identifying health status changes before and after Bigu.3.To explore the difference in the effects of Bigu and fasting on health status and the effect of re-feeding on the long-term effects of them.Methods1.Literature research:a total of 14 search terms related to Bigu were retrieved and sorted from 16 traditional medical treatises and 8 Taoist treatises,and the connotation,form and characteristics of ancient Bigu were summarized.2.Clinical studyⅠ Observational study:The general data,objective data,subjective feelings and infrared thermal images of 154 subjects before,after and during the 7-day Bigu organized by Beijing Taoist Medical Research Institute nationwide from January 2019 to December 2020 were observed and analyzed.Questionnaires was used to collect general information,Body fat meter used to measure weight,BMI,basal metabolic rate,visceral fat index,body age and fat rate.Omron sphygmomanometer and glucometer were applied to measure heart rate,blood pressure and blood sugar.Infrared thermal imaging was observed by Shenzhen Enpeng Medical Infrared thermal imager.Daily subjective feelings were collected by the VAS self-rating scale.Ⅱ Qualitative research:The subjects in the observational study were recruited by purposeful sampling,and semi-structured interviews were conducted in the form of one-to-one interviews.The interview data were analyzed thematically.3.Animal experimentTwo experiments were carried out simultaneously under the same conditions.Experiment Ⅰ:Thirty-four healthy male rats were randomly divided into blank group(n=10),fasting group(n=12),and Bigu group(n=12).The blank group was taken as control.The fasting group rats was completely deprived of food for 3 days,during which water was freely consumed.The Bigu group was combined with low-intensity exercise every day on the basis of fasting group.Experiment Ⅱ:Another thirty-four healthy male rats were randomly divided into blank group(n=10),fasting group(n=12),and Bigu group(n=12).The blank group was taken as control.The fasting group rats gradually re-fed for 9 days after 3 days of fasting,during which water was freely consumed.The Bigu group was combined with low-intensity exercise every day on the basis of fasting group.Every rat in the three groups were reared in one cage.After the experiment,the general data,animal behavior,tongue and paw manifestation,hematological indicators,pathological changes of gastrointestinal mucosa,and gut microbiota in rat cecal feces detected through 16S rRNA high-throughput sequencing technology were collected and analyzed.ResultsPart Ⅰ Literature ResearchBigu originated from the pre-Qin period,and followed the principle of fasting with desire for nothing.The ancient health-preserving Bigu is not just fasting,but a comprehensive healthpreserving method that fasts for a certain period of time,and combines with qigong exercises or taking medicinal bait to achieve the effects of health care,disease-removing and longevity.Part Ⅱ:Clinical ResearchStudy 1:Observational study on effects of Bigu on human health status in the real world 1.General information:154 subjects(97 males 67 females),aged 50.03±11.06 years;64(41.56%)with metabolic diseases,28(18.18%)with cardiovascular and cerebrovascular diseases,and 21 with digestive system diseases(13.64%)and 7 with health condition(4.55%).68.8%of the subjects had undergraduate education level or above;the main purpose of Bigu is to regulate the body,improve sub-health status(65.58%)and improve disease status(53.90%).2.Objective indicators(1)After fasting,the body weight of each subject decreased by 7.41%,BMI decreased by 7.52%,basal metabolic rate decreased by 5.97%,visceral fat index decreased by 1.79±1.14 units,and body age decreased by 2.5 ± 1.45 years,all the difference were significant(P<0.001).(2)The overall blood pressure and blood sugar decreased after fasting(P<0.01),and there was basically no abnormal high or low phenomenon within 7 days.The systolic blood pressure decreased in the following order:hypertensive subjects>normal blood pressure subjects>hypotensive subjects(P<0.001).The diastolic blood pressure in the hypertensive subjects decreased;the diastolic blood pressure in the hypotensive and normotensive subjects increased,and the increase order was:hypotension>normal high value(P<0.001).The blood sugar of the hypoglycemic subjects increased;the blood sugar of the normoglycemic and hyperglycemic subjects decreased,and the decrease order was:hyperglycemia>normal blood sugar(P<0.001).Compared with before Bigu,the overall heart rate increased significantly within 7 days(average 84.95±12.29 bpm).Subjects’ BMI decline order was as follows:obese>overweight>normal weight(P<0.001).(3)Comparison of infrared thermal imagesBefore fasting,the overall body surface infrared temperature has different degrees of cold and heat deviation,unevenness and asymmetry.After fasting,86.11%of the subjects’ metabolic heat of the head and face decreased,86.11%of the chest and abdomen increased,88.89%of the waist and back increased,75.00%of the limbs decreased,and 91.67%of the limbs decreased.The overall metabolic heat distribution is gradual,uniform and symmetrical;the metabolic heat in the Governer vessel region is relatively continuous,and the metabolic heat contour can be seen.The infrared temperature of Conception vessel,Governer vessel,Danzhong,Shenque,Dazhui and Mingmen all increased after Bigu(P<0.001),and the infrared temperature ranges of meridians and acupoints were more concentrated.Comparison between different groups:After Bigu,compared with males,the infrared temperature of Conception vessel(P<0.05),Danzhong(P<0.001)and Shenque(P<0.01)in females increased;The infrared temperature of the Canception vessel,Governer vessel,Shenque and Dazhui points of the subjects were as follows:normal weight>overweight>obesity(P<0.05).3.Subjective feelings:(1)The scores of headache,dizziness,fatigue,hunger and heartburn on the 4th and 5th days of Bigu were the highest,but all below 4 points(total 10 points);on the 3rd and 4th days,the percentages of palpitation and sweating were the highest,but all below 45%.(2)The overall difficulty of the subjects’ evaluation of 7 d Bigu was:5 d>4 d>2 d>3 d>6 d>7d>1d(P<0.001).(3)Within 7 days of Bigu,the daily mood swings level of the subjects was below 3 points(total 10 points).71.53%of the subjects were emotionally stable,16.28%were depressed,and 7.97%were anxious.Study 1:Qualitative study of re-feeding and long-term effects based on interviews with Bigu subjectsA total of 14 subjects participated in the 2 interviews.The study found that the condition of re-feeding has an impact on the health status.The score of Bigu goal achievement was significantly positively correlated with the score of qigong exercise(R=0.80,P<0.001).After 2 months of fasting,the physical and mental state has been greatly improved,especially the mental state has improved significantly.Part Ⅲ:animal experimentExperiment 1:Effects of 3-day Bigu on the health status of rats1.Animal behavior:There was no difference in total movement distance,total time to enter the central area,OE%and OT%between control group,fasting group and Bigu group(P>0.05).2.The tongues of the three groups were all prosperous,moist and fresh.Compared with control group,fasting group and Bigu group had darker tongue color and less tongue coating,fasting group had slightly smaller and less fluid tongues,and Bigu group had slightly fatter tongues.Tongue r values in both fasting group and Bigu group were greater than those in control group(P<0.01),and there was no difference between fasting group and Bigu group(P>0.05).The claws and the tongue are the same in manifestation and r value.3.Hematological index:The WBC,RBC,HGB,PLT and ALB,ALT,AST,BUN,CRE and GLU of the three groups were all within the normal reference range.RBC and HGB in fasting group and Bigu group were higher than those in control group(P<0.01),ALB in fasting group was higher than that in control group(P<0.01);GLU in fasting group and Bigu group were lower than those in control group(P<0.01);There was no difference between the other two groups(P>0.05).4.There were no abnormal pathological phenomena in the gastric and duodenal mucosa of control group,fasting group and Bigu group.5.Gut microbiota(1)The Alpha index of fasting group was greater than that of control group(P<0.01),and there was no difference between the other two groups(P>0.05).The Beta index of both fasting group and Bigu group was greater than that of control group(P<0.05),and there was no difference between the other two groups(P>0.05).(2)The species composition at the phylum,order and genus levels in Bigu group and fasting group changed significantly,and the degree of change in Bigu group was less than that in fasting group.(3)The F/B ratio(Firmicutes/Bacteroidetes)in fasting group was higher than that in control group(P<0.01),and there was no difference between the other two groups(P>0.05).Experiment 2:Effects of 3-day Bigu combined 9-day refeeding on health status of rats1.Animal behavior:The control group,fasting group and Bigu group had no difference in the total time to enter the central area,OE%and OT%(P>0.05);fasting group and Bigu group were all greater than control group in total movement distance(P<0.01),There was no difference between other groups(P>0.05).2.The tongue manifestation of the three groups were all prosperous,moist and fresh.Compared with control group,the tongue coating of fasting group and Bigu group was similar,but the tongue body of fasting group was slightly fatter than Bigu group.There was no difference in the tongue r value between control group,fasting group and Bigu group(P>0.05).The claws and the tongue are the same in manifestation and r value.3.Hematological index:The WBC,RBC,HGB,PLT and ALB,ALT,AST,BUN,CRE and GLU of the three groups were all within the normal reference range.The RBC and HGB of fasting group and Bigu group were lower than those of control group(P<0.01),and the RBC and HGB of Bigu group were greater than those of fasting group(P>0.05).There was no difference in ALB among the three groups(P>0.05).The GLU of Bigu group was greater than that of control group and fasting group(P<0.05),and there was no difference between the other two groups(P>0.05).4.There were no abnormal pathological phenomena in the gastric and duodenal mucosa of control group,fasting group and Bigu group.5.Gut microbiota(1)There was no difference in the Alpha index among control group,fasting group and Bigu group(P>0.05),only in Shannon index,fasting group was smaller than control group(P<0.05);there was no difference between the other two groups(P>0.05).In the Beta index,the Bray Curtis index of control group,fasting group and Bigu group were significantly different(P<0.01),the Weighted Unifrac index of the control group,Bigu group and fasting group were significantly different(P<0.01),and the fasting group and Bigu group were significantly different(P<0.01).The Unweighted Unifrac index was significantly different(P<0.01),and there was no difference between the other two groups(P>0.05).(2)Compared with control group,the species composition of fasting group at the phylum,order and genus levels was still significantly different,while that of Bigu group was basically not different.(3)The abundance of Prevotella in fasting group and Bigu group was significantly lower than that in control group(P<0.0001),and the abundance of Lactobacillus in fasting group was significantly greater than that in control group and Bigu group.The F/B ratios of fasting group and Bigu group increased compared to control group.Conclusions1.The Bigu in this study follows the ancient Chinese conventional Bigu,which is a comprehensive fasting method that includes fasting,qigong exercise and other health care methods,and follows the principle of gradual re-feeding.Therefore,it is different from simple fasting.2.In the real world,7-day fasting has a certain effect on health status,mainly manifested in rapid weight loss,visceral fat reduction,psychological adjustment,and bidirectional regulation of blood pressure and blood sugar.There were no obvious adverse reactions except slight unwell reaction and mood swings on the 3 rd to 5th days.3.Infrared thermal images can objectively reflect the changes of metabolic heat on the body surface before and after Bigu.This change may be related to the changes in Zang and Fu organs and qi and blood functions.Infrared thermal images can be used as an objective indicator to identify changes in health status and evaluate the effect of Bigu.4.The gradual re-feeding method helps to maintain and promote the effect of Bigu.The subjective health status was improved after 2 months of Bigu.Qigong exercise plays an important role in Bigu and re-feeding,and it is significantly positively correlated with the effect of Bigu.The objective evidence of qigong exercise needs further control experiments to verify.5.The 3-day Bigu and fasting,and 9-day refeeding have no adverse effects on the behaviors,blood routine,blood biochemistry,gastrointestinal pathological changes and other indicators of the healthy rats,suggesting that Bigu and fasting are relatively safe.Bigu is more likely to cause spleen deficiency than fasting in rats,but compared with fasting rats,the Bigu rats’ spleen and stomach qi recover faster and the blood circulation run more smoothly after re-feeding.6.Both Bigu and fasting can increase the abundance and diversity of gut microbiota species in rats,reduce the abundance of pro-inflammatory bacteria(such as Prevotella),and increase antiinflammatory probiotics(such as Lactobacillus).However,after re-feeding,the gut microbiota of Bigu rats returned to steady state faster than the fasting rats.Exercise during fasting played an important role in maintaining the stability of intestinal microflora structure.7.Based on clinical research and animal experiment,it preliminarily shows that Bigu is relatively safe and has a positive effect on health-related indicators,which is equivalent to that of simple fasting in promoting body health.And the positive effect of Bigu after re-feeding is more obvious. |
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