TCM helps reduce the possibility of mild disease progressing to severe disease and recover with less sequelae; TCM medication significantly shortens the time of turning to negative test with severe cases, and reduces life risk of severe and critical cases by over 80%.
Image of the 4th national TCM team (Shanghai) assisting Wuhan during its outbreak at the very beginning of 2020 The long history of TCM treating the epidemics TCM is a holistic medicine that integrates prevention, treatment and rehabilitation.
Such TCM classics as Sun Simiao’s Qian Jinfang, Zhang Zhongjing’s Treatise on Febrile and Miscellaneous Diseases, Wu Youke’s Treatise on Pestilence and Wu Jutong’s Item Differentiation of Warm Febrile Diseases systematically summarized the basic theories, clinical practice, classical formulas and technical methods of TCM in the prevention and treatment of infectious diseases.
Those classics are the united wisdom of ancient Chinese in continuously exploring, cogitating and summarizing the laws of preventing and treating epidemic diseases. Researcher Tu Youyou wasinspired by Ge Hong's Handbook of Prescriptions for Emergencies and discovered artemisinin, which has saved millions of lives worldwide, and she thus was awardedthe Nobel Prize in Physiology or Medicine.
TCM has also been effective in treating viral infections. In recent years, viral respiratory infections have been prevalent. TCM has also achieved significant results in the treatment of SARS, H1N1 and other diseases, and has accumulated rich experience in treating newly emerging infectious diseases. Studies have confirmed that TCM can improve the overall balance and immunity of the human body, while also inhibiting and killing viruses.
Treatment experience of TCM for COVID-19 When looking back at the chaotic situation in Wuhan at the beginning of 2020, there are much experience that can be referred to. What needs to be put first is that TCM and Western medicine are obviously different in their treatment modes.
From the angle of Western medicine, most chemical drugs are single-targeted, while TCM are more multi-targeted. In other words, TCM works more like a team. In this sense, the treatment modes are different.
But as far as the disease is concerned, there are a few points that can be intervened in. Taking COVID-19 as an example, the virus causes inflammation and immunity disorders, further doing hard to organ functions and lesions in lung, heart and other organs. That is to say, organ lesions caused by virus, inflammation and immunity dysfunction are all targets for drugs.
A Western medicine is a chemical, which is often targeted at a certain target, while a TCM drug may be a multi-targeted treatment, such as to virus replication, balancing between inflammation and immunity, subsequent organ lesions, blood coagulation.
In order to promote the technological research and treatment of COVID-19, observations on the clinical efficacy of TCM drugs and formulas included in the 5 th , 6 th and 7 th Diagnosis and Treatment Protocol were carried out. Three drugs and three formulas proved effective, i.e. Jinhua Qinggan Granule, Lianhua Qingwen Capsule, Xuebijing Injection, Lung Cleansing and Detoxifying Decoction, Dampness Resolving and Detoxifying Decoction, and Lung Ventilatingand Detoxifying Decoction.
They are recommended by the academicians and experts. In the updated Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7), Lung Cleansing and Detoxifying Decoction is included as best in TCM therapies.
1. Xubijing Injection Xuebijing Injection is a TCM injection that has been relatively well studied inrecent years. In a study of its chemical composition by Shanghai Institute of Materia Medica, Chinese Academy of Sciences, at least six active ingredients have been proven.
Moreover, in vitro experiments have also demonstrated that Xuebijing Injection can actually inhibit the replication of the novel coronavirus. In related animal experiments, it has also been noticed that Xuebijing Injection has an inhibiting effect on cytokine storm, as well as on coagulation dysfunction.
Therefore, TCM injection was selected to treat severe and critical COVID-19 patients, because Xuebijing Injection proved quite effective for severe cases in the earlier clinical trials. Before COVID-19, the injection has achieved well-recognized results in the previous treatment of severe pneumonia and sepsis.
For example, the study by Prof. Bai Chunxue of Fudan University, and the randomized controlled trials of "Xuebijing and placebo for severe pneumonia" by 33 hospitals, show that Xuebijing, combined with conventional treatment, can significantly reduce the fatality of patients with severe pneumonia in 28 days, by 8.8%.
It can also significantly fasten the inflammation resolution, shorten mechanical ventilation, and shorten hospital stay. In an unblinding research on sepsis, Xuebijing Injection has also proven to reduce the case fatality rate. It was because Xuebijing had been seen efficacy in the early studyof severe pneumonia and sepsis.
As a multi-targeted treatment drug, Xuebijing is used in the treatment of severe and critical cases of COVID-19. As to its safety, in fact, in the safety study after Xuebijing Injection came in the market, it was noted that the adverse effect rate was no higher than 1% in the clinicaluse.
So it is safe, generally speaking. 2. Jinhua Qinggan Capsule Jinhua Qinggan Granule is a new drug for influenza developed during the H1N1 epidemic in 2009, and was put into the market then. The formula of the Granule is the combination of Maxing Shigan Decoction in Treatise on Cold Damage and Miscellaneous Diseases and Yinqiao San Decoction in Systematized Identification ofWarm Diseases.
Maxing Shigan Decoction has a history of 1800 years, and Systematized Identification of Warm Diseases also has a history of nearly 300 years. The two formulas have stood the test of long history and are effective. The main effect of the Granule is to relieve wind, to diffuse the Lung, to clear heat and to detoxify.
During the development, Wang Chen, an academician, did a RCT study, and published the result in Annals of Internal Medicine of US. It proves similar efficacy as Tamiflu for flu H1N1, but with less adverse effects and lower cost. Another clinical control study of 102 cases was carried out in the first-line of Wuhan. The results showed that compared with the control group, Jinhua QingganGranule reduced the proportion of progression from mild and moderate cases tosevere by 2/3 and shorten the febrile period by 1.5 days.
And the counts of leukocyte, neutrophil granulocyte and lymphocyte, reflecting immune functions, were significantly improved. The results show that Jinhua Qinggan Granule is effective. Besides improving clinical symptoms, especially reducing the rate of progression to severe cases, it is also effective to immunological indicators. 3. Lianhua Qingwen Capsule
Lianhua Qingwen Capsule Lianhua Qingwen Capsule is a formula developed during the SARS epidemic by Wu Yiling, an academician. Its main effect is also to clear pestilence, to detoxify, todiffuse the Lung and to reduce fever. It is effective for mild and moderate cases of COVID-19.
A RCT study jointly led by Zhong Nanshan, Li Lanjuan, and Zhang Boli, three academicians, in 23 hospitals of 9 provinces and cities across the country, included a total of 284 COVID-19 patients. The results showed that the main clinical symptoms disappeared in more patients in the treatment group than the control group, and symptom duration were shorter.
The improved pulmonary imaging was observed by 83.8%, compared with 64.1% in the control group. The Capsule offered a cure for COVID-19 in 78.9% of cases, compared with 66.2% in the control group. The outcome of the treatment group was obviously better. In terms of mild cases, the rate progressing to severe cases was 50% lower than compared with the control group.
At the same time, an in vitro experiment showed that Lianhua Qingwen Capsule has an inhibiting effect on COVID-19. 4. Lung Cleansing and Detoxifying Decoction It came from the combination of Maxing Shigan Decoction, Shegan Mahuang Decoction, Xiaochaihu Decoction and Wuling San Decoction. It is generally suitable for mild, moderate, severe and critical cases.
In the observation of 1,263 cases in 66 designated hospitals of 10 provinces (without Hubei) in China, 1,214 cases, 96.12% of the total, were cured and discharged. In the clinical observation of 57 severe cases treated with integrated TCM and western medicine and given Lung Cleansing and Detoxifying Decoction, 42 cases, 73.7%, were cured and discharged.
The lung imaging results showed that after two courses (6 days) of Lung Cleansing and Detoxifying Decoction, the lung lesions of 53 patients (93%) showed reduction and resolution in different degrees. According to data from clinical studies, Lung Cleansing and Detoxifying Decoction has played a positive role in preventing mild and moderate cases progressing to severeand critical.
It blocked the deterioration of the disease, reduced the case fatality rate, hence mitigate the damage caused by the epidemic. 5. Lung Diffusing and Detoxifying Decoction It came from the combination and selection of the classical formulas, including Maxing Shigan Decoction, Maxing Yigan Decoction, Tingli Dazao Xiefei Decoction, Qianjin Weijing Decoction.
A control study on Lung Diffusing and Detoxifying Decoction group (70 cases) and the control group (50 cases) was conducted in Wuhan TCM Hospital and Hubei Provincial Hospital of Integrated Chinese and Western Medicine. The results showed that Lung Diffusing and Detoxifying Decoction is effective in inflammation control and lymphocyte count increase.
Compared with the control group, recovery of lymphocyte was increased by 17%, and the clinical cure rate was increased by 22%. The First Hospital of Henan University of Chinese Medicine adopted the formula during the treatment of COVID-19, and 40 mild and moderate cases were given the Decoction.
It took a median of 9.66 days for the cases to turn to negative with the virus. No one progressed to severe or critical case. The CT scans of 85% cases showed improvement. A cohort study of 500 patients was conducted in Wuhan TCM Hospital, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, and Jiangxia Makeshift Hospital.
All the patients were given the Decoction. The observation showed that the symptoms of mild and moderated cases, such as fever, cough, and fatigue were significantly relieved. The CT scan also showed a significant improvement, and no one progressed to severe case.
6. Dampness Resolving and Detoxifying Decoction The formula was modified by the medical team of the Chinese Academy of Chinese Medical Sciences in Jinyintan Hospital, on the basis of the local context and the relative formula recommended in the Diagnosis and Treatment Protocol forCOVID-19.
The clinical observations were conducted with the severe, moderate and mild cases in Jinyintan Hospital, Dongxihu Makeshift Hospital and Jiangjunlu Street Hospital. In the clinical controlled trial conducted in Jinyintan Hospital, the pulmonary inflammation in CT imaging and clinical symptoms of all the 75 severe cases were significantly improved.
The time for the patients to turn to negative with the virus and the hospital stay were shortened by 3 days on average. 124 moderate cases were observed in Jiangjunlu Street Hospital, and 894 mild and moderate cases in a randomized controlled way (among them, 452 given the Decoction) in Dongxihu Makeshift Hospital.
It proved the effectiveness of the formula. In the follow-up test for the liver and kidney functions, no adverse effect was reported. In terms of experiments, the virus load of a 30% reduction was found in a mouse model of evaluation for its effectiveness on the novel coronavirus.
Aromatic Chinese herbs in preventing and treating epidemics Among various TCM therapies (for instance, moxibustion, Chinese herbs and traditional Chinese exercises) used in daily life in prevention and clinical treatment for COVID-19, a special therapy has attracted the attention and been welcomed by the public-- the aromatic Chinese herbs, a group of Chinese herbs with strong aroma.
They have been used with a large range in both aromatherapy and sachet-wearing for prevention and oral-taking herbal formulas prescribed by TCM experts who worked in the first line of the epidemic. These practices have made aromatic Chinese herbs stressed by the public gradually. Because of strong fragrant aroma, aromatic Chinese herbs are also called “fragrantmedicinals”.
Since ancient time, this kind of medicinals has been used in treating and preventing the pestilence. History of Epidemic Disease in China recorded that, there were about 320 large epidemics happened over the past 2000 years in China, from the period of the Western Han Dynasty. In pestilence spreading process, aromatic Chinese herbs were commonly used in preventing its transmission by lighting the incense or wearing sachet.
Wearing a sachet made with aromatic Chinese herbs People started to use aromatic Chinese herbs since Han Dynasty. Till the Ming and Qing dynasties, theories guiding the use of aromatic herbs in preventing pestilence were already well developed, and more using methods could be selected, such as incense lighting, sachet wearing, bathing with flavoring medicinals and medicine in-taking.
These methods were widely applied and many are stilled used nowadays. Here are introductions of some methods applied in family to prevent the epidemic. Wearing a sachet made with aromatic Chinese herbs Since ancient time, Chinese people have the habit of wearing aromatic sachets.Because of the convenience, they are widely used during the outbreak of the epidemics, and also taken as a beautiful personal decoration.
In modern time, it is also recommended to hang the aromatic medicinal decorations such as aromatic sachet, mixed herbal tablet, mixed herbal bracelet and Chinese pills at home, in car orcarrying them all the time. These articles not only act as a decoration, but most importantly, can clean the air in the indoor environment and improve the air quality in the surroundings of the body, thus, reaching the aim of keeping the pestilence away.
The first Chinese formula recorded in Elaborating the Pestilence by Songfeng was Chuhui Jingwen Pill (Filth Removing and Pestilence Expelling Pill) created by the writer Liu Songfeng. This formula contains 35 kinds of Chinese material medicines, including Cangzhu (Atractylodis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma) and Dahuang (Rhei Rhizoma et Radix), etc.
After grinding the medicine into powder and enclosed in a small sachet, people can wear it with its smell preventing infection of pestilence.Igniting incense made of aromatic Chinese herbs When talking about incense, many people may think about those used in the temple or in sacrifice activity.
However, after the outbreak of COVID-19, people are now realizing that there is special incense made of aromatic Chinese herbs used by many hospitals in China. Burning the incense can prevent the spread of COVID-19. The use of moxibustion is just one case. The Mugwort leaf, or the moxa, is often used for indoor fumigation with its warm property to prevent pestilence and common cold,expel cold and remove dampness, warm and sooth meridians and collaterals, harmonize qi and blood.
Mugwort Leaf Igniting incense--moxibustion In Elaborating the Pestilence by Songfeng, it also collected many formulas used for epidemics by incense burning, such as Cangzhu and Jiangxiang Resuscitating Incense.
It is worth mentioning that Cangzhu (Atractylodis Rhizoma) is the most commonly used medicinal in a total of 65 formulas for the prevention of the epidemics recorded in this book. Modern pharmacological research indicates that Cangzhu (Atractylodis Rhizoma) is an effective air disinfectant with the main component of volatile oil and has the antiviral function and the effect of sterilization.
Many patients with COVID- 19 have gastrointestinal symptoms, including nausea, vomiting and poor appetite, and Cangzhu (Atractylodis Rhizoma) can deal with these problems by invigorating the Spleen (Note: the organs mentioned in this article are concepts all different from thosein Western medicine.
For example, the Spleen here is one of the zang-fu organs in TCM, the function and location of which differ from those of the spleen in Western medicine), harmonizing the Stomach and eliminating dampness.
Bathing with aromatic Chinese herbs During the Warring States period (475- 221 BC), “Mulan Bathing water” was recorded in a lyric poem, Li Sao, written by Chinese poet Qu Yuan. In the Ming dynasty, herbal monumental work, Compendium of Materia Medica, also recorded that, boiling bathing water with Baimaocao, Maocao, Lancao together had the effectof keeping away from the epidemics”.
Elaborating the Pestilence by Songfeng also has the records on epidemic prevention methods with medicinal bathing. Bathing with the aromatic medicine water can keep people away from the epidemics by eliminating pathogens.