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Ongoing Clinical Studies into Chinese herbal medicine for coronavirus disease 2019

A new systematic review and meta-analysis was published in this month's issue of Pharmacological Research, including more clinical trials and ongoing research into the treatment of COVID-19 using Chinese herbal medicines alongside or in lieu of conventional Western Medicines (pharmaceuticals). Xiong et al. (2020) performed this updated systematic review and related current clinical results for SARS-CoV-2 to the 2003 SARS outbreak in China:

"According to the research reports of World Health Organization, compared to Conventional Western Medicine (CWM) group, TCM group has achieved remarkable therapeutic effect with 3 days for average fever reduction time, 10 days for average hospital stay, low medical costs, and no death, sequelae, transfer, and infection of nurses and doctors during the SARS epidemic in 2003. Among the 564 patients with COVID-19 admitted to Jiangxia Fangcang TCM Hospital, 482 were cured, and the rest 82 complicated with basic diseases were transferred to designated hospitals. During the treatment, no patients turned from mild to critical cases, and no nurses and doctors were infected by COVID-19. TCM has played an indispensable role and TCM therapeutic schedule was included in the guideline on diagnosis and treatment of COVID-19."

They note the value of the outcome measures looked at in all of this research, highlighting that this research relies on objective outcome measures, showing the results of the treatment on a variety of factors to determine effectiveness, going much further than subjective data:

"Secondly, large number of objective and subjective outcome measures including lung CT, death, clinical cure rate, ranging between mild and critical cases, length of hospital stay, clinical symptoms, TCM syndrome, viral nucleic acid testing, and inflammatory biomarkers were utilized to assess the efficacy of CHM comprehensively. This is different from the traditional evaluation of CHM that only focused on subjective indicators. The whole research findings from 18 trials involving 2275 patients showed that lung CT, clinical cure rate, ranging from mild to critical cases, length of hospital stay, total score of clinical symptoms, fever reduction time, symptom score of fever, number of cough reduction cases, symptom score of cough, number of fatigue reduction cases, symptom score of fatigue, disappearing time of fatigue, TCM syndrome, viral nucleic acid testing, and inflammatory biomarkers (CRP) were significantly improved by CHM."

They finalize their paper by concluding that the results are modest, more research is needed, and that considering the current results of this research and the challenges of this pandemic, we can take the modest evidence that Chinese herbal medicines help in the treatment of COVID-19 and it should be included in the ongoing fight against this virus:

"In general, this systematic review and meta-analysis suggested that CHM maybe beneficial for the treatment of COVID-19 in improving clinical symptoms, imaging, and laboratory indicators, shortening the course of disease, and reducing the number of severe cases."

One of the specific clinical trials included in the Xiong et al. study was focused on the patent herbal formula known as Lianhuaqingwen capsules, which has been repurposed as a supportive therapy to fight COVID-19 in China. Recognizing the urgency to apply effective, safe, and supportive treatment in the absence of any widely available drugs or vaccines for this novel coronavirus, this patented herbal formula has been widely used and research has been done to assess it's relative effectiveness.

This study was designed as a, "prospective, open-label, randomized controlled trial," with over 280 patients across 23 hospitals (Hu et al., 2020).

Of all the Chinese herbal medicines being used or recommended to treat prevention, and early-stage, or mild cases of COVID-19, the most commonly incorporated herbs in these formulas were, "were Jinyinhua (Lonicerae Japonicae Flos), Lianqiao (Forsythiae Fructus) and Gancao (Glycyrrrhizae Radix Et Rhizoma), and they all had therapeutic effects of clearing heat and detoxication [sic], which could bring potential for the prevention and treatment of 2019-nCoV. For instance, phillyrin, the natural lignan of Lianqiao, had antibacterial, anti-quorum sensing and anti-inflammatory activities for the control of infectious pathogens via the regulation the MyD88/IκBα/NF-κB signalling pathway, decrease the virus titers and IκBα, IL-1β, IL-6, TNF-α levels, reduction the expression of influenza hemagglutinin protein, and attenuation of lung tissue damage" (Zhang et al., 2020).

All these herbs are key herbs in our patented and custom herbal formulas and are available to our patients with appropriate consult. Due to the importance of having these herbs at earliest sign of symptoms, we will be making preparedness kits for the coming shift to heavier Autumn and Winter weather when the upper respiratory viruses more easily spread and a second wave of COVID-19 is expected. Keep an eye out for an email announcing these preparedness kits.

References: Hu, K., Guan, W., Bi, Y., Zhang, W., Li, L., Zhang, B., Liu, Q., Song, Y., Li, X., Duan, Z., Zheng, Q., Yang, Z., Liang, J., Han, M., Ruan, L., Wu, C., Zhang, Y., Jia, Z., & Zhong, N. (2020). Efficacy and safety of Lianhuaqingwen capsules, a repurposed Chinese herb, in patients with coronavirus disease 2019: A multicenter, prospective, randomized controlled trial. Phytomedicine, 153242.

Price, R. H. M., Graham, C., & Ramalingam, S. (2019). Association between viral seasonality and meteorological factors. Scientific reports, 9(1), 1-11.

Xiong, X., Wang, P., Su, K., Cho, W. C., & Xing, Y. (2020). Chinese herbal medicine for coronavirus disease 2019: A systematic review and meta-analysis. Pharmacological Research, 160, 105056.

Wise, J. (2020). Covid-19: Risk of second wave is very real, say researchers. BMJ: British Medical Journal (Online), 369.

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