Eine Einordnung der medizinischen Leitlinien aus China
Der folgende Artikel war ein Teil einer Hausarbeit für das Studium an an der NJUCM. Die Hausarbeit hatte das Thema „Research Methodology“ und ging näher auf die Coronavirus Infektion ein.
In China wurde von der National Health Commission & State Administration of Traditional Chinese Medicine das Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7) Traditional Chinese medicine (TCM) treatment heraus gegeben.
In diesem Protokoll werden Leitlinien für die Behandlung von an Covid-19 Erkrankten beschrieben. Die Behandlung umfasste sowohl die „standard“ Behandlung als auch die Behandlung mit Rezepturen aus der chinesischen Medizin. Nach Yang et al. (2020) wurden in China mehr als 85% der Erkrankten mit beiden Verfahren behandelt.
Die Hausarbeit beschäftigte sich mit dem folgenden Abschnitt aus dem Treatment Protocol und beantwortet die Frage, wie sinnvoll die folgende Behandlung ist:
The patients in clinical treatment period (confirmed cases), should take Qingfei Paidu Decoction. However, the patients in medical observation period, whether confirmed COVID-19 or not, should take Chinese patent medicines.
Chinese patent medicines during the medical observation:
Clinical manifestation: fatigue with gastrointestinal discomfort
Huoxiang Zhengqi Capsule (Pill, Liquid, Oral liquid)
Clinical manifestation: fatigue with fever
Jinhua Qinggan Granule
Lianhua Qingwen Capsule (Granule)
Shufeng Jiedu Capsule (Granule)
Is it reasonable?
This question can just be answered by looking if those Chinese patent medicines can cure virus infections or have a potential anti-viral effect on all virus in the mentioned differential diagnosis from the Treatment Protocol.
The main symptoms of the coronavirus infections are fatigue, fever and dry cough. Symptoms like nasal congestion, runny nose, sore throat, myalgia and diarrhea are possible but rare (Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia, 2020, p. 3). Further symptoms are chest tightness and headache (Chen et al, 2020).
Those symptoms can be caused by many other different virus or bacteries infections. Therefore laboratory test are necessary to have a clear differential diagnosis. This will need time. In Germany the usual time for a corona virus infection will take one or two days (Antworten auf häufig gestellte Fragen zum Coronavirus SARS-CoV-2., 2020). During this time the patient is suffering and is treated with oxygen therapy and antiviral therapy. The effect and the efficacy of the antiviral therapy like Alpha-interferon, Lopinavir/ritanovir, Ribavirin or Chloroquine is still beeing evaluatetd. Antiobiotics are not recommended (Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia, 2020, p. 9).
Therefore additional treatments are needed. Tao et al. (2013) argued that the chinese goverment supported the research for treating Influenza A virus infections like H5N1, H1N1, and H7N9 with herbal stockpiled formulars like Shufeng Jiedu capsules, Lianhua Qingwen capsules, Maxing Shigan decoction, Yinqiao powder, and Jinhua Qinggan granules.
Li et al. (2013) evaluated that a low dose therapy with Jinhua Qinggan granule is effective and safe for treating Influenza. In this study Jinhua Qinggan was more effective than a placebo.
The efficacy and safety of Lianhua Qingwen capsules were investigated in a systematic review by Niu et al. (2017). The comparison with Ribavirin showed that Lianhua Qingwen capsules are more effective and safer than Ribavirin and other antivral medications like Oseltamivir and Ankahuangmin capsules. This result should be taken carefully, the systematic review from Wang et al. (2019) showed that the incidence of adverse reactions during the treatment with Lianhua Qingwen capsules is high. The author argued that more high-quality clinical studies are needed to confirm this statement.
Shufeng Jiedu Capsules are effective in treating bacterial infections from Streptococcus or Staphylococcus aureus infection in mice, which was investigated by Bao et al. (2016). The effect was superior to Lianhua Qingwen capsules as a broad-spectrum antibacterial.
The prognosis in the corona infection is poorer in elderly (Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia, 2020, p. 4) and in patients with a chronic underlying diseases like hypertension, diabetes and chronic lung issues (Chen et al., 2020, Xu et al.,2020). Ji et al. (2020) reseached the synergistic effect of Shufeng Jiedu Capsule and Oseltamivir in treating Influenza A virus infection in rats with chronicobstructive pulmonary disease (COPD) in vivo. Additional research was done in vitro with human bronchial epithelial cells to compare the therapeutic effects of Shufeng Jiedu Capsule and Oseltamivir as a monotherapy and with both medication together. In the conclusion the authors suggested that both medications together may be a novel treatment strategy for Influenza A infections in COPD patients.
The Huoxiang Zhengqi Capsules were researched by Zhao et al. (2017). In this systematic review and in the additional meta-analysis Huoxiang Zhengqi Capsules showed a better effect than the usual western medicine routine treatment group from clinical efficacy for gastrointestinal type cold but larger sample sizes are needed in rigorously designed randomised controlled trails.
Huoxiang Zhengqi Capsules combined with Chaihu droplet pill in the early stages of SARS seems to lower the dosage of the needed glucocorticoid and could alleviate the injury in lung and reduce the inflammatory reaction (Li et al., 2004).
The SARS (severe acute respiratory syndrome) pandemie in the year 2003 is related to the same virus family like the current Corona virus and had similar symptoms.
In reference to the question if this Treatment Protocol seems reasonable it is possible to broaden the focus and look at different Treatment Protocols. This work was done by Fan et al. (2020). 4 national and 34 regional prevention and treatment plans were collected and summarised. The most commonly used traditional formulars included Maxing Shigan Decoction, Yin Qiao Powder, and Xuanbai Chengqi Decoction. The most frequent used Chinese patent pill included Angong Niuhuang Pill, Xuebijing Injection, and Lianhua Qingwen capsule.
Wang and Jin et al. (2020) analysed further clinical study protocols. They found additionally to the above mentioned many further Chinese patent medicine like Jinye Baidu Granules or Shuanghuanglian Oral Liquid for example.
One might ask why so many different chinese patent medicine were used. The answer is given by the Treatment Protocol (2020) itself “According to the different local climate characteristic and individual state of illness and physical conditions, the following treatment Protocol may vary” (p. 11).
To give an answer if those patent based Treatment Protocols are reasonable the answers is yes but some further discussions are necessary. There are many studies which showed the anti-viral effect of the recommended patent medicine, especially in treating Influenza. Therefore as long as the differential diagnosis is in progress giving patent medicine is reasonable. If the differential diagnosis is clear other chinese patent medicine could be better in treating the corona virus. According to Publicity Department of the People’s Republic of China (2020, as cited in Ren et al, 2020) the effective cure rate of the Qingfei Paidu Decotion is over 90 %. A similar effective cure rate is shown in a clinical pilot study from the State Administration of Traditional Chinese Medicine done in four provincial hospitals in Shanxi, Hebei and Heilongjiang (2020, as cited from Zhang, 2020). Therefore Qingfei Paidu Decotion seems to be very effective in the cure of the corona virus infection but further RCTs will be necessary to verify the effectiveness.
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