Acupuncture Continuing Education

Chinese Herbal Medicine & Antivirals COVID-19 (Coronavirus) Results

bailiangcao lianqiao

Acupuncturists providing herbal medicine play an integral role in the treatment of COVID-19 (coronavirus). A study published by Shanghai University of Traditional Chinese Medicine and Shanghai Public Health Clinical Center researchers indicates that an integrative medicine approach to patient care produces significant positive patient outcomes. Based on Chinese medicine principles and modern scientific investigations, Shufeng Jiedu capsules, antiviral medications, and antibiotics were combined in a rigorous treatment regimen. 

Four patients with mild to severe COVID-19 related pneumonia were the subjects of an investigation by Wang et al. All patients received a combination of medications and Chinese herbal medicine. All patients were either cured or demonstrated significant improvements. [1] The positive patient outcomes produced in this limited sample size study indicate that a larger investigation is warranted into integrative medicine for COVID-19 related treatments.

Two patients with mild pneumonia and one with severe pneumonia had significant improvements within approximately 1–2 weeks. The fourth patient also demonstrated significant improvements, but not at the level of the others. The start of the investigation was on January 21, 2020 and it ended on February 5, 2020. Two of the patients were discharged by the end of the investigation and two remained in the hospital.

All patients admitted to the study were diagnosed with COVID-19. Confirmation with laboratory tests included throat-swab specimens, chest computed tomography (CT), and chest radiography. Two patients were under 35 years of age and two were over 60. Two patients had recently travelled to Wuhan, one was a student in Wuhan that had left for winter break, and another contracted COVID-19 from their spouse. All were treated at the Shanghai Public Health Clinical Center.

All patients presented with fevers and received oxygen therapy, antibiotics, antiviral medications, and Chinese herbal medicine. The herbal medicine was a Chinese patent medicine: Shufeng Jiedu Capsule. The main ingredients Shufeng Jiedu Capsule are the following:

  • Hu Zhang (Rhizoma Polygoni Cuspidati, 虎杖)
  • Lian Qiao (Fructus Forsythiae, 连翘)
  • Ban Lan Gen (Radix Isatidis, 板蓝根)
  • Chai Hu (Radix Bupleuri, 柴胡)
  • Bai Jiang Cao (Herba Patriniae, 败酱草)
  • Ma Bian Cao (Herba Verbenae, 马鞭草)
  • Lu Gen (Rhizoma Phragmitis, 芦根)
  • Gan Cao Radix (Glycyrrhizae, 甘草)

This formula had been the subject of prior research (Song et al.) at the Chinese Academy of Sciences (Beijing) on the effects of Shufeng Jiedu Capsule on influenza. The team managed to collect 243 nonredundant chemicals present in the herbal formula, including quercetin, resveratrol, kaempferol, and eugenol. They noted that quercetin produces prooxidant effects in healthy animals but exhibits antioxidant activity in animals infected with influenza.They added that quercetin produced antiviral effects on “Toll-like receptor 7 (TLR7) signaling pathway when dendritic cells and macrophages were infected with H1N1.” [3] In addition, they add that resveratrol inhibits influenza virus replication in Madin-Darby Canine Kidney (MDCK) cells, kaempferol inhibits “influenza A nucleoprotein production in human lung epithelial (A549) cells infected with the H5N1 virus strain,” and eugenol inhibits influenza replication. [4]

This background gives us insight as to why Wang et al. chose this herbal formula for the COVID-19 investigation. The herbal ingredients of the formula are supported for this treatment protocol by Chinese medicine historical and traditional usages and by modern scientific investigations. All patients also received administration of lopinavir/ritonavir (brand name: Kaletra) and arbidol. Kaletra is an HIV protease inhibitor used in antiretroviral therapy. The common use of this medication is to prevent HIV from multiplying. Arbidol “is a Russian-made potent broad-spectrum antiviral” that is in common use in Russia and China and arbidol “has an established molecular mechanism of action against influenza A and B viruses.” [5]

On admission to the hospital, common symptoms were fever, coughing, fatigue, nasal congestion, rhinorrhea, and dizziness. Two patients had diarrhea and two were constipated. Three of the patients had an increased respiratory rate and one of the patients had tachypnea (abnormally rapid breathing). Three patients presented with rhonchi, which are low-pitched wheezes or snoring-like sounds heard through a stethoscope. This is often indicative of lung obstructions or increased secretions of the airways.

All patients had chest radiography abnormalities. Ground-glass opacities were the most common finding. Patients 1–2 had mild pneumonia and patients 3–4 had severe pneumonia and low oxygen pressures (7.60 and 5.45 kPa respectively). All patients received supplemental oxygen therapy via nasal cannula in addition to antiviral, antibiotic, and Chinese herbal medicine therapy.

  • Patient #1 received the aforementioned care starting January 21 and by January 27, leucocytes and lymphocytes increased, indicating a restoration of the immune system. By January 29, the patient was discharged from the hospital because chest CT revealed significant improvements and the following symptoms and signs resolved completely: coughing, fever, shortness of breath, diarrhea, abdominal pain, dyspnea.
  • Patient #2 was admitted to the hospital on January 24 and received the same treatment regimen. By January 28, leucocytes and lymphocytes increased and by January 29, CT showed improvements in pneumonia. Two COVID-19 tests were performed with throat-swabs, and the patient was cleared; both tests came back negative. The patient was discharged from the hospital on January 30.
  • Patient #3 (63 years of age) and was admitted to the hospital on January 24. After one day of the treatment regimen, the fever disappeared completely. On February 1, the pneumonia CT imaging revealed significant improvements and by February 3, oxygen pressure improved significantly (blood gas analysis confirmed). At this time, the patient had a mild cough with white phlegm but the following had resolved completely: fever, diarrhea, abdominal pain, dyspnea, shortness of breath. On February 4, the patient was tested for COVID-19 and the results came back negative. The patient was kept at the hospital to receive another test to confirm the results.
  • Patient #4 was also 63 years of age. This patient was admitted to the hospital on January 22, 2020. This patient received the same treatment regimen as the others but also received seralbumin (the principal protein in plasma) and γ-immunoglobulin (plasma containing antibodies). Starting January 31, the patient was provided “intubated ventilator-assisted breathing therapy because of refractory low blood oxygen pressure.” [6] By February 1, chest radiographs improved and by the next day, radiographs confirm continued improvements. By February 5 (the last day of the study), pneumonia radiographs improved significantly; however, the patient was using ventilators.

In the Diagnosis and Treatment of Pneumonia Caused By 2019-nCoV issued by the National Health Commission (China), Shufeng Jiedu Capsule and lopinavir/ritonavir (Kaletra) are formally recommended COVID-19 treatment modalities and a randomized controlled trial is underway investigating arbidol for the treatment of COVID-19. Given the outcomes of this limited sample size study, a larger investigation is warranted.

In an independent investigation, researchers (Hong-Zhi et al.) confirm that Qing Fei Pai Du Tang (a Chinese herbal formulae) had a 90% response rate for 214 COVID-19 (coronavirus) patients with pneumonia. [7] Out of the 90%, symptoms markedly improved in ≥60% and the remaining 30% stabilized. In addition, Prof. Jeffrey Pang, L.Ac. (Department Chair at Five Branches University and HealthCMi author and presenter) notes that an herbal formula often used for the treatment of influenza is an effective approach in COVID-19 herbal medicine strategies. This herbal formula is featured in the acupuncture CEU/PDA course: Influenza, Asthma, Bronchitis.

 

References:
1. Wang, Zhenwei, Xiaorong Chen, Yunfei Lu, Feifei Chen, and Wei Zhang. "Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment." Bioscience trends (2020).
2. Song, Jianglong, Fangbo Zhang, Shihuan Tang, Xi Liu, Yibo Gao, Peng Lu, Yanping Wang, and Hongjun Yang. "A module analysis approach to investigate molecular mechanism of TCM formula: a trial on shu-feng-jie-du formula." Evidence-Based Complementary and Alternative Medicine 2013 (2013).
3. Ibid.
4. Ibid.
5. Boriskin, Y. S., I. A. Leneva, E-I. Pecheur, and S. J. Polyak. "Arbidol: a broad-spectrum antiviral compound that blocks viral fusion." Current medicinal chemistry 15, no. 10 (2008): 997-1005.
6. Wang, Zhenwei, Xiaorong Chen, Yunfei Lu, Feifei Chen, and Wei Zhang. "Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment." Bioscience trends (2020).
7. Hong-Zhi, D. U., H. O. U. Xiao-Ying, M. I. A. O. Yu-Huan, H. U. A. N. G. Bi-Sheng, and L. I. U. Da-Hui. "Traditional Chinese Medicine: an effective treatment for 2019 novel coronavirus pneumonia (NCP)." Chinese Journal of Natural Medicines 18, no. 3 (2020): 1-5.

 

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