COVID-19 came from China; Can We Use Chinese Herbal Medicines to Treat COVID-19?

An interesting correspondence from The Lancet expands further on this. 

Chinese officials announced at a press conference on April 14, 2020 that three patent herbal drugs had been approved to treat COVID-19 symptoms – these included Lianhuaqingwen capsules, Jinhuaqinggan granules for mild conditions and Xuebijing injectable for severe conditions.

These drugs are widely used within China to treat COVID-19.  At this press conference it was claimed that the drugs can effectively relieve symptoms including fever, cough and fatigue.  They also claimed that it reduced the probability of patients developing severe conditions but there was no data provided to confirm this. 

There has been no rigorously peer reviewed clinical trial of herbal drugs in any international recognised journal.  These approvals were based on in-vitro investigations and anecdotal clinical data.  It is worrying that the approval may lead to severe worrisome consequences.

  1. Safety

This must be the top priority. Herbal practitioners argue that herbal medications are widely used and safe, but is this actually true?  All drugs carry risks.  It should be remembered that in 1990 it was reported that women who followed a slimming herbal remedy developed rapidly progressive renal failure and urothelial cancer.  Investigation showed that aristolochic acid, found in many traditional herbs was contributory.

An injectable herbal drug called Xiyanping which had been recommended by the Chinese diagnosis and treatment protocol for COVID-19 has already been recalled after reports of adverse effects.  Many patent herbal drugs have been used clinically for many years.

However, when used as a treatment for a novel disease like COVID-19 and especially in combination with antivirals, antibiotics and immune suppressants, it is so important that their safety is evaluated.

  • Evidence

Where is the evidence from clinical trials to support the efficacy of these herbal medications?  Traditional medical practitioners argue that herbal remedies cannot be tested because they are tailored to each individual’s symptoms and syndromes.  This argument is a fallacy.  Many patent herbal drugs are produced in advance of any treatment and their composition is actually fixed.  Clinical endpoints such as mortality, time to clinical improvement and number of days in an intensive care unit could be used to evaluate the efficacy of herbal drugs used in treatment for COVID-19. 

Clearly standardised double-blind trials have methodological challenges, take time, effort and have financial considerations but this should not be a reason for lowering safety and efficacy standards in order to allow traditional herbal medications to be used.  The argument that thousands of years of usage and faith cannot be taken as evidence for the efficacy of these traditional herbs.

  • Composition

Their actual basic molecular mechanism is unclear.  Lianhuaqingwen capsules have been shown to have a wide-spectrum antiviral and anti-inflammatory effect.  Unfortunately, their active ingredients and the underlying mechanism of action are unknown.  Traditional herbal drugs usually contain many active ingredients and these need to be better understood and in particular, which ingredient is the functional one.  Limited experimental cell cultures and animal studies do not guarantee safety and efficacy.

  • Dispensing

Finally, it is possible to purchase these herbal medications without a doctor’s prescription.  They claim to treat effectively COVID-19 and some patients with flu like symptoms self-medicate.  This avoids these patients from seeking medical help and may delay the proper diagnosis and treatment of their symptoms and disease.  This will inevitably hamper the government’s testing, tracing and quarantining efforts. 

At the end of January rumours circulating on social media suggested that a patent herbal drug called Shuanghuanglian containing honeysuckle and forsythia, used routinely in traditional medicine to treat influenza and the common cold, was considered as a treatment for COVID-19. Millions of people bought this herbal drug as a just-in-case remedy. 

Clearly, the current COVID-19 pandemic is an unprecedented challenge for all governments and public.  It is argued that screening potential active components from traditional herbal medicines is a viable strategy that should not be dismissed.  However, this should not be rushed without sufficient scientific evidence.

With the increased morbidity and mortality of COVID-19, it is understandable why the emergency use of unproven drugs is considered, but this must be based on evidence.  The Chinese Government has invested huge sums of money to promote the modernisation and standardisation of traditional medicine.  They have carried out sustainable basic and clinical research to get international recognition, but the rushed approval of these herbal medications to treat COVID-19 is a backward step.  Any attempt to find a cure or treatment should include rigorous testing and trials. 

The London General Practice has kept abreast of all available treatments, whether novel or approved and provides a COVID safety net approach when looking after its patients with COVID.  It has sought advice from leading experts and continues to help any patient whether at home or admitted to hospital.

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