Researchers conclude that Lianhua Qingwen Capsules improve the recovery rate from COVID-19 symptoms, shortens the time from initial symptoms to recovery, and improves morphological recovery from chest radiologic abnormalities. [1] The results from a multicenter randomized clinical trial indicate that Lianhua Qingwen Capsules are both safe and effective for use in patients with COVID-19. The researchers add that an extended study is needed to thoroughly explore the effects of Lianhua Qingwen Capsules on viral shedding.
The details of the study follow. First, it is important to note that approximately 92% of COVID-19 patients in China receive Chinese medicine and many studies support this integrative medicine approach to patient care. Improved patient outcomes are correlated with the integration of Chinese herbal medicine and acupuncture into in-patient and out-patient care. Lianhua Qingwen Capsules, covered in this research, is a class-A drug in China. This classification is based on results from multiple studies. As a result, COVID-19 patients in China have ubiquitous access to this herbal formula. Commonly, in the United States, patients are not supplied with evidence supported herbal medicine in usual care environments.
The study was divided into two arms. One group received usual care and another received usual care plus Lianhua Qingwen Capsules (4 pills, 3X daily) for a total of 14 days. Out of a total of 284 patients in the study (142 in each group), the group receiving Lianhua Qingwen Capsules had a greater recovery rate (91.5%) than the group receiving only usual care (82.4%).
The median time to symptomatic recovery was 7 days in the Lianhua Qingwen Capsules group and 10 days in the usual care monotherapy group. Symptom recovery times in the Lianhua Qingwen Capsules group were significantly better than the usual care only group. The Lianhua Qingwen Capsules group had the following symptom recovery rates: 57.7% day 5, 80.3% day 10, 91.5% day 14.
Similar results were found across several other parameters. The Lianhua Qingwen Capsules group had a shorter recovery time from “fever (2 vs. 3 days), fatigue (3 vs. 6 days) and coughing (7 vs. 10 days).” Importantly, chest computed tomographic (CT) improvements were significantly greater in the Lianhua Qingwen Capsules group (83.8% vs. 64.1%). This indicates less physical damage to patients from COVID-19 (coronavirus) for patients receiving Lianhua Qingwen Capsules. In addition, the total clinical recovery rate was better in the Lianhua Qingwen Capsules group (78.9% vs. 66.2%). [2]
Conversion to severe cases and viral assay findings did not differ between the groups. No serious adverse effects were reported and Lianhua Qingwen Capsules were found both safe and effective for the alleviation of COVID-19.
The research team notes important findings. Lianhua Qingwen Capsules suppress the cytopathic effects of SARS-CoV-2 in vitro and reduce the viral loads in cytoplasm and cellular membranes (Liu et al., 2020). Lianhua Qingwen Capsules suppress replication of SARS-CoV (Zhu et al., 2003), H3N2, H1N1, and H7N9 in vitro (Chinese Academy Of Military Hospital, 2009; Ding et al., 2017; Duan et al., 2011; Mo et al., 2007). The latter research results from investigations into the SARS-CoV outbreak of 2003.
The inflammatory cytokine storm is one of the dangers of COVID-19. Lianhua Qingwen Capsules were found effective in downregulating inflammatory mediators including TNF-α, IL-6, macrophage chemokine protein-1, and induced protein-10 (Li et al., 2020). In another study, Lianhua Qingwen Capsules abrogated expression of TNF-a, IL-6, IL-1β, IL-2, IL-4, and IL-14 (Mo et al., 2007).
Herbs
The research team notes that individual ingredients in Lianhua Qingwen Capsules have been tested for efficacy, including Jin Yin Hua (Lonicera japonica), Lian Qiao (Forsythia suspensa), Huo Xiang (Pogostemon cablin), Hong Jing Tian (Rhodiola rosea), and Da Huang (Rheum palmatum).
Jin Yin Hua (Lonicera japonica) and Lian Qiao (Forsythia suspensa) block binding of SARS-CoV-2 with angiotensin converting enzyme (Niu et al., 2020). These herbs have been paired for use against infectious diseases within the traditional Chinese medicine system for over a thousand years and have also received significant attention in modern laboratory and clinical research.
The researchers note that Huo Xiang “has been shown to ameliorate diarrhea and improve the defense of [the] gastrointestinal tract (Zhou, 2018).” They add that Da Huang “antagonize[s] the binding of spike protein and the angiotensin converting enzyme (Ho et al., 2007) and suppress[es] excessive release of inflammatory mediators, thus ameliorating lung injury (Dong et al., 2017).”
Licensed acupuncturists may find the inclusion of Hong Jing Tian (紅景天) within Lianhua Qingwen Capsules particularly interesting. This herb grows at altitudes of 3,500–5,000 meters. The greatest number of species of Hong Jing Tian grow in Tibet.
Tibetan monks use this herb and it is valued for improving concentration, physical endurance, memory, and absorbing oxygen. This herb is highly regarded for its ability to abate altitude sickness, reduce stress, and benefit shen-spirit. Many varieties also grow in Yunan, Sichuan, Heilongjiang, and other provinces. This is a clear heat and toxin category herb that is cold, sweet, bitter, and astringent. It enters the heart, liver, kidney, lung, and spleen channels.
Hong Jing Tian has several important functions. It tonifies spleen qi, clears lung heat, nourishes lung yin, and is especially useful for the treatment of coughing due to lung heat (including hemoptysis). In TCM clinics, it is used for the treatment of weakness after illness, hematemesis, bronchitis, and coughing due to pneumonia. This herb is an adaptogen and is valued for its ability to restore vital energy. Hong Jing Tian invigorates blood and transforms stasis and is used topically for burns and traumatic injuries. This herb promotes contractions and is used for the treatment of leukorrhea.
References:
1. Hu, Ke, Wei-jie Guan, Ying Bi, Wei Zhang, Lanjuan Li, Boli Zhang, Qingquan Liu et al. "Efficacy and Safety of Lianhuaqingwen Capsules, a repurposed Chinese Herb, in Patients with Coronavirus disease 2019: A multicenter, prospective, randomized controlled trial." Phytomedicine (2020): 153242.
2. Ibid.
3. Duan, Zhong-ping, Zhen-hua Jia, Jian Zhang, Liu Shuang, Chen Yu, Lian-chun Liang, Chang-qing Zhang et al. "Natural herbal medicine Lianhuaqingwen capsule anti-influenza A (H1N1) trial: a randomized, double blind, positive controlled clinical trial." Chinese Medical Journal 124, no. 18 (2011): 2925-2933.
4. Runfeng, Li, Hou Yunlong, Huang Jicheng, Pan Weiqi, Ma Qinhai, Shi Yongxia, Li Chufang et al. "Lianhuaqingwen exerts anti-viral and anti-inflammatory activity against novel coronavirus (SARS-CoV-2)." Pharmacological research (2020): 104761.
5. Ho, Tin-Yun, Shih-Lu Wu, Jaw-Chyun Chen, Chia-Cheng Li, and Chien-Yun Hsiang. "Emodin blocks the SARS coronavirus spike protein and angiotensin-converting enzyme 2 interaction." Antiviral research 74, no. 2 (2007): 92-101.
6. Hu, Ke, Wei-jie Guan, Ying Bi, Wei Zhang, Lanjuan Li, Boli Zhang, Qingquan Liu et al. "Efficacy and Safety of Lianhuaqingwen Capsules, a repurposed Chinese Herb, in Patients with Coronavirus disease 2019: A multicenter, prospective, randomized controlled trial." Phytomedicine (2020): 153242.
7. Dezhong, Cheng, Wang Wenju, Li Yi, Wu Xiaodong, Zhou Biao, and Sing Qiyong. "Effects of Chinese Traditional Medicine Lianhuaqingwen on 51 Patients with Novel Coronavirus-Infected Pneumonia: Multicenter Retrospective Research."
8. Ding, Yuewen, Lijuan Zeng, Runfeng Li, Qiaoyan Chen, Beixian Zhou, Qiaolian Chen, Pui leng Cheng et al. "The Chinese prescription lianhuaqingwen capsule exerts anti-influenza activity through the inhibition of viral propagation and impacts immune function." BMC complementary and alternative medicine 17, no. 1 (2017): 130.
9. Mo, H. Y., C. W. Ke, J. P. Zheng, and N. S. Zhong. "Antiviral effects of Lianhua Qingwen Capsule against influenza a virus in vitro." Traditional Chinese Drug Research & Clinical Pharmacology 18, no. 1 (2007): 5-9.
