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A Closer Look at the “Chinese Plan” of Combining Conventional Medicine with Traditional Chinese Medicine in Treating COVID-19

[avatar user=”Sanjoy” size=”thumbnail” align=”left” link=”file” target=”_blank”]SANJOY SINGH NINGTHOUJAM[/avatar]

The COVID-19 pandemic has put nearly one-third of humanity under lockdown. It may snowball and lead to a global economic crash with large-scale humanitarian crises throughout the world. As of now, there is no known cure or vaccine for Novel Coronavirus which leads to a medical condition now referred to as COVID-19. Scientific communities all over the world are racing to discover drugs for its treatment. While the disease is accelerating in other parts of the world, COVID-19 is slowing down its infection rate in Wuhan, the first epicentre of this disease. This has been achieved through extreme measures including restrictions on human mobility combined with extensive surveillance system? Conventional and Social Media are rife with speculations on suppression of real statistics, secret antidotes, bio-weapons, and the limits of these speculations span as wide as the boundless territory human imagination can reach. Despite all these speculations, the fact remains. Cases of COVID-19 in Wuhan have steadily declined from mid-February. During the peak of infection, the actual strategy of fighting COVID-19 remains an enigma.

Recently, the Chinese government officially open up its strategy of combating COVID-19. According to a report in Xinhua on March 23, Yu Yanhong, Party Chief of the National Administration of TCM revealed that China had worked out a unique “Chinese Plan” to combat TCM with western medicine (allopathy) for treating COVID-19. He reported that a total of 74,187 patients (91.5% of the confirmed cases) received TCM treatment. TCM medics constituted about 13% of all medics dispatched to the Hubei Province. The plan is reflected in the Clinical Guidance for Covid-19 Pneumonia Diagnosis and Treatment published by the Chinese National Health Commission. Since the 4thedition, the publication recommended the use of TCM based on stages and symptoms differentiation. The 7th version of the document was published on 4 March 2020. English translation of the document by the Chinese Society of Cardiology gives a reflection of experience in diagnosis and treatment methods. Treatment strategies include determination of place, general treatment, specialized treatment for severe and critically severe cases and treatment with TCM. The TCM treatment includes Huoxiang Zengqi for asthenia and gastrointestinal discomfort and Jinhua Qinggan granules, Lianhua Qingwen capsule and Shufeng Jiedu capsules for asthenia and fever respectively.

Table 1: Conventional Treatment for COVID-19 in China

Type of Treatment Therapeutic Agent or Device
Oxygen Therapy Nasal canella

Non-invasive mechanical ventilation

Invasive mechanical ventilation

ECMO (extracorporeal membrane oxygenation)

Antibiotics Combination Amoxicillin

Azithromycin

Fluoroquinolones

Antivirals Lopinavir/ ritonavir

Ribavirin

Alpha-interferon

Chloroquine Phosphate

Arbidol

Corticosteroids Methylprednisolone
Plasma Therapy Convalescent plasma

 

With the continuous fatal spread of COVID-19, the search for effective pharmaceutical drugs continued worldwide. At the moment, at least 12 potential COVID-19 treatments are undergoing clinical trials. The trials include drugs used in the treatment of HIV, malaria, antiviral compounds from animal experiments and antibody-rich plasma collected from recovered patients. The WHO on 20 March 2020, announced the launch of SOLIDARITY, a coordinated push to share coordinated scientific data. This effort is to overcome challenges faced by the limitation of data. For instance, the WHO noted that China has not shared any data for more than 20 COVID-19 studies involving chloroquine or hydroxychloroquine. Not only in data on pharmaceutical drugs, there is limited data on the tests of TCM in COVID-19 also.

According to Nature (journal), traditional therapies are included among many clinical trials that are running or pending in China for fighting COVID-19. While writing this article, more than three hundred TCM formulations are registered for clinical trials according to the Chinese Clinical Trial Registry. Some of these trials are in Phase 4 stage or so-called post-marketing surveillance stage. Phase 4 stage begins only after a drug has been approved for use in the general population following Phase 1, 2 and 3 to rigorously test its efficacy, risks, and side effects.

Table 2: Some of the Clinical Trials registered for the treatment of Covid-19 registered in China (Source: Chinese Clinical Trial Registry)

Registration No Scientific Title Drug Name Date of Registration Phase
ChiCTR2000030988 A RCT for Hua-Shi Bai-Du granules in patients with novel corona virus pneumonia (COVID-19) Hua-Shi Bai-Du 2020-03-20 N/A
ChiCTR2000030940 Study for ”Bai-Du Duan Fang” application on the acupoint in the treatment of general type novel corona virus pneumonia (COVID-19) Bai-Du Duan Fang 2020-03-18 N/A
ChiCTR2000030937 A randomized, open-label, controlled trial for Gu-Shen Ding-Chuan-Wan in the treatment of patients with novel corona virus pneumonia (COVID-19) at recovery phase with Fei-Pi-Qi-Xu Zhen Gu-Shen Ding-Chuan-Wan 2020-03-18 4
ChiCTR2000030936 A real-world study for the Chinese medicines ”Xinguan 2” and ”Xinguan 3” in the treatment of novel corona virus pneumonia (COVID-19) Xinguan 2 and 3 2020-03-18 N/A
ChiCTR2000030933 Effectiveness of ”Liu-Zi-Jue” combined with respiratory muscle training for respiratory function in novel corona virus pneumonia (COVID-19) patients: a randomized controlled trial Liu-Zi-Jue 2020-03-18 0
ChiCTR2000029605 A randomized, open-label, blank-controlled, multicenter trial for Shuang-Huang-Lian oral

solution in the treatment of 2019-nCoV pneumonia

Shuang-Huang-Lian 2020-02-07 4
ChiCTR2000029487 Clinical Study for Gu-Biao Jie-Du-Ling in Preventing of 2019-nCoV Pneumonia (Novel Corona virus Pneumonia, NCP) in Children Gu-Biao Jie-Du-Ling 2020-02-02 0
ChiCTR2000029434 A randomized, open-label, blank controlled trial for Lian-Hua Qing-Wen Capsule/Granulein the treatment of 2019-nCoV pneumonia Lian-Hua Qing-Wen 2020-02-01 4
ChiCTR2000029432 A Real World Study For the Efficacy and Safety of Large Dose Tanreqing Injection in the Treatment of Patients with 2019nCoV Pneumonia Tanreqing 2020-02-01 4

 

Some of the recommended TCM formulations raised eyebrows not from medical fraternity but wildlife advocates. The Tanreqing injection recommended in the 6th publication of the Chinese guideline includes bear bile as one of the constituents. Angong Niuhuang Wan, another pill recommended for COVID-19, contains rhino-horn. The Wildlife Watch, an investigative reporting agency for National Geographic expressed concerns that recommendations of such formulations may increase the trade in illegal wildlife products. Their concern is not without reason. For instance, Clinical Trial registry no. ChiCTR2000030920 advocates the use of Dendrobium moniliforme and Cannabis sativa (Ganja). North East India is bearing the brunt of illegal trade of orchids in the past. Dendrobium moniliforme is now rarely seen in the wild though it was first reported from Manipur in 1953, a grim reminder of orchid hunting. When it comes to COVID-19, some of the experts sent out mixed messages. For instance, a Professor of University of Minnesota makes his stand clear that the world just need to develop a cure against this disease “to protect the people”. Incidentally, the 7th edition of the Guidance did not include the recommendations of these controversial formulations.

Though TMs are the outcome of the age-old knowledge, these systems remain in a marginal position in the health care systems of many countries, even in China and India where TCM and AYUSH have solid foundations respectively. For incorporation to healthcare system, people’s perception towards TMs should be changed from superstition and cultural loyalty towards scientific principles. Instead of arraying traditional uses of Toningkok (Houttuynia cordata) repeatedly, it is more acceptable to describe that its water extract could inhibit SARS corona virus multiplication by inhibiting 3CLpro protease and RNA polymerase enzymes. Randomized, double-blind and placebo-controlled studies of traditional medicine might provide scientific evidences for these therapies. For the first time on 22 March 2020, the National Medical Products Association of China approved the clinical trial for a TCM medicine for treating COVID-19.Chinese President Xi Jinping announced during the G-20 summit on 26 March 2020 that China has set up an online COVID-19 knowledge centre that is open to all countries. These efforts may provide a chance to share the knowledge and understanding on the efficacies and risks of both pharmaceutical drugs and TCM formulations in treating COVID-19.

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