Ancient cures to the fore

The stupidest thing the United States ever did, said former US Navy Secretary Dan Kimball, was to accuse Qian Xuesen of being a Communist spy. Later the US swapped the rocket scientist for American pilots captured in the Korean War. Qian was then instrumental in helping China join the nuclear club. He’s also widely regarded as the father of China’s space programme.

In his later years the MIT-educated scientist started to explore disciplines that are often deemed to be pseudoscience in the West. Qian began advocating that researchers accumulate more data on traditional Chinese medicine (TCM), qigong and even “paranormal human body functions” (see WiC236). The future of medical science, he believed, would be a combination of the best of TCM used alongside techniques from conventional Western medicine (CWM).

The Covid-19 pandemic has brought a new focus to TCM, where practitioners claim the backing of more than 5,000 years of clinical experience. But has it demonstrated more of the potential that one of China’s most respected scientists once professed – or do doctors around the world still need more proof of its efficacy?

How have the Chinese applied TCM in combating Covid-19?

According to a Xinhua report last month, a total of 74,187 patients, or 91.5% of the confirmed cases in the country received some form of TCM treatment. More than 4,900 medics from TCM clinics nationwide were sent to Hubei at one point, or about 13% of the medical staff dispatched to the province hardest hit by the outbreak.

At a time when medical resources were being stretched to the limit, TCM played an important role in providing relief to the mounting number of patients. In a press conference in March, when the outbreak was beginning to come under control in other Chinese cities, Yu Yanhong, Party boss of the State Administration of Traditional Chinese Medicine (SATCM) said the majority of more than 50,000 patients who had recovered from the virus in local hospitals were treated with TCM.

Patients with mild symptoms were prescribed traditional remedies to aid their recuperation. People with more severe symptoms were treated with both TCM and CWM. In addition to prescribed herbal formulas, patients were given acupuncture and acupressure. In some hospitals foot massages were available.

In Wuhan, there were designated hospitals to house patients who were over the worst of the infection, or were suffering only milder strains. Photos from these hospitals show instructors in hazmat suits and goggles leading the patients in taichi practice, as well as pharmacists standing next to centrifuges making herbal remedies.

Has TCM been effective in taming the coronavirus?

Confidence in TCM seems to be confined to China for the time being. Apart from holding a better understanding of their medicinal traditions, the Chinese have also amassed a bigger pool of clinical data on TCM’s remedial effect on the coronavirus.

In a comparative study of 452 Covid-19 patients, the SATCM’s Yu said the group of patients receiving the combined treatment showed a higher rate of improvement than the group treated with Western medicine (CWM) alone.

Another clinical test of 500 patients demonstrated that no patients showing milder symptoms had seen their conditions worsen after treatment with TCM remedies, she said.

According to another piece of research on 102 patients with mild symptoms, Yu said TCM treatments could shorten the average length of a patient’s stay in hospital by 2.2 days. The ‘transfer rate’ from mild symptoms to severe cases also dropped by 27 percentage points. (Yu added that experts had conducted other studies on nearly 100 patients who had been critically ill and seemed to be cured with TCM alone, although Yu admitted that the research was “in progress” and that the results won’t be made public in the near future.)

All in all, the authorities haven’t tried to position TCM as a cure for Covid-19, but more as something that works as a supplementary treatment to CWM. The “Chinese plan” has been to combine TCM with CWM to cure patients with Covid-19, Xinhua has observed. Patients in critical condition are still relying on modern equipment such as respirators, but TCM has been applied more broadly to assist those in less critical condition.

TCM remedies, mostly in the form of herbal drinks, are much cheaper than their CWM counterparts, the newspaper adds, so the government’s dual approach may have helped to relieve the pressure on the public healthcare system and concentrate resources for critical cases.

Which remedies are being talked about most?

TCM prescriptions translated into English can sound unwieldy (do take this “lung cleansing and detoxifying decoction” three times a day, Mr Smith). But for the Chinese this is just part of TCM culture. Remedies like Lianhua Qingwen, one of three patented medicines approved by the National Drug Administration (China’s equivalent to America’s FDA) to treat Covid-19, have even become a ‘superstar drug’ for overseas Chinese as well.

Lianhua means ‘lotus flower’ and Qingwen translates literally as ‘cleansing the epidemic’.

During the H1N1 pandemic in 2009, which killed up to 575,400 people worldwide in the first year that the virus was circulating, China’s national health authorities began to support the development of TCM vaccines and prescriptions such as Lianhua Qingwen.

The drug had originally been developed by Wu Yiling, chairman of Yiling Pharmaceutical, to fight the SARS outbreak. Wu is said to have invented his formulation after consulting scrolls of ancient literature. Yet when the flu-fighting drug finally got the nod from the NDA in 2004, the SARS coronavirus had already vanished. As a common drug to treat flu, the TCM product was then submitted to the American FDA for approval in 2005. It still has not been given the green light, although Chinese media have suggested that Lianhua Qingwen is the first TCM to start clinical trials in the US.

Lianhua Qingwen has become a common treatment for colds and flu among Chinese. Composed of 13 herbal components, it is thought to be effective in relieving fever, coughs and fatigue. But the drug shot to wider stardom in Chinese communities around the world earlier this year thanks to the backing it received from the Chinese foreign ministry.

There are about 1.6 million Chinese students studying abroad and as Covid-19 escalated into a pandemic, the large majority opted against returning to China (as of the end of March). In what appears to be an attempt to encourage them to stay put (to limit the number of imported cases of Covid-19 back into China), Chinese embassies around the world distributed “healthcare packages”. Typically, they consisted of a few face masks, a handbook on how best to avoid catching Covid-19, and a box of Lianhua Qingwen capsules.

This created a halo effect for the remedy as the only drug sent by the Chinese government to students abroad. And as its fame grew, the standard retail price of Lianhua Qingwen (usually Rmb15 a box in China, or $2.12) surged multiple times. Supply started to thin out as well, with the remedy still sold-out on most e-commerce platforms, Phoenix News noted.

Is TCM well-received in foreign countries?

Xinhua said earlier this month that Lianhua Qingwen had won approvals for sale in the Thai market, while French researchers are planning to conduct clinical research on the treatment too.

By the end of last month, the Chinese had also donated at least 100,000 boxes of Lianhua Qingwen to Italy, the European country worst hit by Covid-19.

State media was quieter on how the product has been received in other countries, hinting at the potential limits of its appeal outside China.

The National Health Commission also said this month that China had dispatched a number of medical teams, including TCM experts, to countries including Italy, Serbia, Pakistan and Venezuela to help fight the pandemic.

Italy was the only country in the G7 that actively sought aid from TCM in efforts to treat the virus, the Chinese media acknowledged, underscoring that faith in TCM is still pretty thin in most countries. (Italy is also the only G7 nation to have embraced China’s Belt and Road Initiative, see WiC445).

China’s willingness to assist other countries in the fight against Covid-19 has also been tainted by reports that some of its medical gear has turned out to be substandard. For instance, the Chinese embassy in Canada said this week that it was investigating claims that a million masks purchased from China claiming efficacy similar to the FDA’s N95 had failed to meet the Canadian standard.

If cases like these weaken international confidence in relatively simple medical gear, it might be far-fetched to expect overseas patients to embrace herbal prescriptions such as the “lung cleansing and detoxifying decoction”.

Who are the sceptics on TCM?

Chinese President Xi Jinping is a big fan of TCM, talking about the need to further develop what he calls a “treasure” of Chinese civilisation.

Critics think otherwise, seeing the government’s support for TCM – particularly as a potential remedy for Covid-19 – as more of an effort to support a sector where Chinese firms are inevitably the leaders. According to government figures TCM generates revenues of Rmb3 trillion annually, a total that includes the sale of medicines overseas, as well as fees from other related remedies such as acupuncture.

Opponents say that Beijing’s backing for traditional medicine is downright dangerous for patients. As The Economist wrote last month “some people prefer it to conventional treatments that, unlike TCM, are proven to save lives”. As the magazine further noted, some natural remedies also rely on animal products as ingredients – including items such as bat faeces or pangolin skin. Both of these animals have been cited as potential harbourers of the coronavirus in the wild and the National People’s Congress made another effort to stamp out their trade at a meeting in Beijing last month. (The pangolin is also an endangered species.)

Part of the problem is that TCM encapsulates a pantheon of different practices and schools of medical thought. Speaking of it as a whole, as the government often does, can be misleading. But TCM practitioners believe – not always without reason – that some remedies genuinely do good and that their methods are backed by 5,000 years of clinical experience.

The challenge is that many of these ancient medical theories and techniques have not been well-documented – much less tested in the systematic and scientific way that CWM has been over the past two centuries.

Fundamental misunderstandings also abound, including the overseas view that TCM rests on “pseudoscientific ideas” such as yin-yang or the so-called ‘five elements’.

The profession would benefit from a more coordinated effort to explain its core principles. Along similar lines, the Beijing municipal government recently launched a WeChat-based platform to help overseas Chinese understand TCM better, as well as its claims to tackling the effects of Covid-19. Interested readers can take a look: http://epidemic.tcmlive.com/en/common/home)

Will the Chinese look at TCM differently after Covid-19?

As regular WiC readers will know, TCM has attracted its fair share of sceptics in China too (see WiC263 for a famous debate over whether TCM doctors can detect pregnancies by checking female pulses).

The government’s subsequent promotion of TCM in responding to Covid-19 has stoked a lot of debate. Naysayers believe it was at best a placebo for coronavirus sufferers. However, throughout the millennia the Chinese have survived countless plagues and epidemics. Proponents of TCM argue that this history, plus China’s very existence as the world’s most populated country, is evidence that TCM can’t be simply discounted as ineffective.

The mixed reception points to a cautious approach to TCM’s development as a more modern medical sector.

“If we hurriedly introduce TCM treatments which have not been rigorously tested, no matter how noble and urgent the starting point of this approach, it may lead to unbearable health costs,” 21CN Business Herald warned in March. 

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