Zuobiao Yuan, Lic. Ac, Dipl. OM, PhD
This post was published in December 2020
Since the COVID-19 is a new viral infectious disease, there is definitely no specific drug in a short period of time. In addition to symptomatic and supportive therapies, the current treatment is Remedsivir, a medication with minor effectiveness, and dexamethasone. In China, more than 90% of patients have used traditional Chinese medicine. However, Chinese medicine is not currently used in regular hospitals in the United States for the treatment of the COVID-19, and even no clinical trials have been conducted. Why is that?
Here I will analyze the possible reasons I can think of.
1. Is the COVID-19 under well control? Obviously not
Our previous analysis of the pandemic data has clearly shown that the number of infections and deaths from the COVID-19 in the United States is far ahead in the world. According to the data I found, the total death toll in the United States in World War I was about 117,000, the death toll in the Korean War was about 54,000, the death toll in the Vietnam War was about 58,000, and the death toll in World War II was about 400,000. At present, the number of deaths in the United States due to the COVID-19 has exceeded the sum death toll of the First World War, the Korean War and the Vietnam War. In any case, this is a failed pandemic campaign.
2. Is it because of ideology? It should not be
Although Chinese medicine originated in China, the political systems between China and America are different. But if Chinese medicine is rejected only because of ideology, it should not be. The National Institutes of Health (NIH) data is still open to the world. For diseases that affect people's health, countries all over the world, including China and America, are still working together. Dr. Youyou Tu's artemisinin won the Nobel Prize, which is associated with the long-term and continuous nomination of several American scholars. The United States still produces and purchases medical-related products in China. Therefore, if it is related to the common health problem of all human being, possibility of no application or cooperation only because of ideology is very low.
3. Are the relevant departments not aware of Chinese medicine? No
NIH has a dedicated National Center for Complementary and Integrated Medicine (NCCIH), of which Chinese medicine is a very important part. Well-known American hospitals, including the Cleveland Clinic, which is ranked second in the world, provide Chinese medicine services other than acupuncture. The well-known Dr. Xiaoming Tian, whose TCM and Acupuncture Clinic is located near NIH, changed NIH's views on acupuncture and TCM, and promoted major changes in relevant regulations at the national level. He was also appointed by President Clinton as a member of the White House Complementary and Alternative Medicine Policy Committee. The title of this White House committee is one of the highest honors of an American medical doctor. Many senators and ministers seek help of acupuncture and Chinese medicine in his clinic.
4. Is Chinese medicine ineffective? No
According to reports of Chinese national media, the situation of China’s epidemic, as well as related papers published in English journals, Chinese medicine has a good effectiveness on the treatment of the COVID-19.
5. Is it that Chinese medicine has never undergone clinical trials in America? No
So far, in addition to the completion of phase III clinical trials of capsule T89 in America, a batch of Chinese medicines have obtained drug clinical trial licenses, and 5 Chinese patent medicines have completed phase II clinical trials. The results of some Chinese medicine clinical trials have also been officially published. For example, the doctors of Memorial Sloan-Kettering Cancer Center in New York City published results of a phase II clinical trial of Chinese medicine Xiao Chai Hu Tang for hepatitis C in 2011. The study was also praised by the journal Science.
6. Is it because of conflict of interest? Very unlikely
Is it possible that the American medical community, the pharmacy community has created all conditions to resist Chinese medicine because of conflicts of interest? I have no evidence for this and cannot mislead audiences. But if a technology or profession really benefits the country and the people, even if the industry resists for its own monopoly interests, it will not succeed. Since the legalization of acupuncture in Nevada in 1973, acupuncture and Chinese medicine practitioners have now become an official profession of the Department of Labor and Industry. The same situation occurs in the nursery community. Since the 1960s, due to the shortage of medical doctors, a new type of nurse, nurse practitioner, began to emerge. They can prescribe medication. Now there are even nurse practitioner specialists. This new profession effectively alleviated the shortage of medical doctors. At the same time, doctors in the United States have very high professional ethical standards and are not so narrow-minded. The clinical trials of Chinese medicines we mentioned earlier were all conducted under the work of American physicians. Therefore, I think the possibility of conflict of interest is very low.
7. Is the evidence weak? Possible
There are already some data published in traditional Chinese medicine. For example, the series of scientific research results of Dr. Xiaolin Tong, a traditional Chinese physician, academician of the Chinese Academy of Sciences (CAS), and professor at Peking University and Beijing University of Chinese Medicine, published in Pharmacological Research, Frontiers of Medicine, Frontiers in Pharmacology, showed that Chinese medicine is used to treat COVID-19. It can significantly reduce the aggravation rate of mild cases, reduce the mortality of severe patients, and reduce the reoccurrence of positive COVID-19 after the recovery, suggesting that traditional Chinese medicine can be used as an effective intervention in the whole process of prevention and treatment of COVID-19. But some would say that the number of cases in these clinical trials is only a few hundreds, which is relatively low. Moreover, the quality and reliability of clinical research conducted by Chinese using Chinese medicine and performed in China may not be as reliable as that of performed by Americans in the United States, and it is more credible to implement it with the American system. At the same time, ethnicity may also be different. This question is understandable, but why hasn’t America even had a clinical trial of Chinese medicine until now? This is actually a rejection, a question worthy of further discussion.
8. Is it because of laws and regulations? Possible
In order to protect the health of the American people, the National Food and Drug Administration (FDA) has formulated very stringent standards to ensure the safety and effectiveness of drugs. Even for emergency authorization, there are a series of procedures to ensure quality. Therefore, it is impossible to just take Chinese medicine prescription granules to form a prescription like that in China, and then start trying a large scale treatment. This is fine, but the question is why the COVID has been raging in America for almost a year, and there is no even one clinical trial of Chinese medicine is allowed? This is not what is supposed to be, right?
9. Is it because of finance crisis? No
A national-level economic stimulus package can cost several trillion dollars at every turn. An ordinary clinical trial, even if it costs tens of millions or hundreds of millions of dollars, is not a fraction of the previous one. But if it succeeds, the benefits will be tremendous.
10. Is it because of no ideal professional candidate? No
The TCM community in America has been proactive in providing advice and suggestions to this pandemic. There are Chinese medicine practitioners in California participating in the hospital setting of COVID-19. One brave Chinese medicine practitioner even actively infected with the SARS-CoV-2 virus, observed the development of the disease, and then cured with Chinese medicine by himself. I know there are many other colleagues who work hard to contain this pandemic. For me, I contacted U.S. Senator Tina Smith from Minnesota and submitted relevant documents on the NIH website.
On June 3, I heard that I could submit a COVID-19 treatment plan to NIH.
On August 5, I submitted my proposal to the foundation of NIH (FNIH).
After several rounds of communication and submitting additional data, I received a letter from FNIH indicating insufficient evidence on October 30.
Again, it is fine if I was told that my evidence is insufficient, but why there is even no a single clinical trial of Chinese medicine for COVID? This is really unreasonable.
11. Is it because of not fully understanding the theoretical system and application indications of TCM? Highly probable
The development a novel medication in the modern medical system generally follows this rule: firstly, a mechanism study discovered a target protein, and then a small/large molecule is found to regulate the protein target, its effectiveness is confirmed in vitro and in vivo, after that, phase I clinical trials is conducted to determine its safety and dosage, the phase II clinical trial will determine the therapeutic effect in a small population, and then the phase III clinical trial will determine the effect and safety on a large scale population, then it can be used in general population. The whole process is stringent, reliable and well regulated.
But the traditional Chinese medicine is different. When the practitioners see any disease, they always use theory of yin and yang, the five elements, the organs and meridians, or differentiation of symptoms and signs of Wei, Qi, Ying and blood, and so on. It does not require Phase I, II, and III clinical trials, which is in fundamental conflict with the FDA's procedures. At the same time, Chinese medicine theoretically seems to be able to help any disease, which makes ordinary people sound unbelievable. As for some single herbs or formulas, they often cover multiple diseases. For example, Banlangen can be used for hepatitis, pharyngitis, and this COVID-19; Lianhua Qingwen Capsules can be used for influenza, SARS and COVID-19. Maybe next time if there is another virus infection disease, they can also be applied. Does it give people a feeling of quack medicine?
In fact, this is not a counter instinct. The human being has only about 30,000 genes, whether they were tens of thousands of years ago, thousands of years ago, hundreds of years ago, or now, this fact is not changed. Then these genes encode proteins, and various inorganic small molecules transmit signals in the middle. These basic components have not changed. At the same time, the body's organ system and its functions have not changed. Influenza, SARS, or COVID-19, respectively caused by influenza virus, SARS virus and SARS-CoV-2 virus, will cause inflammation of the respiratory tract. Banlangen or Lianhua Qingwen capsule mainly work against this inflammation. Once the inflammation is controlled, the body's immunity can clear the remaining virus. Traditional Chinese medicine mainly promotes self-healing by regulating body functions. As long as these basic functions have not changed in thousands of years, it will work. Please note that I am only saying that they are helpful, not that they cure the disease every time. However, the ability to heal itself is sometimes not enough. For example, before development of the specific drug Sofosbuvir, traditional Chinese medicine was widely used in China for hepatitis C, and it can indeed improve symptoms and laboratory results more than conventional treatment only. Of course, this improvement is not good enough for a full recovery. Now sofosbuvir can cure 90% of hepatitis C cases, which almost solves this disease. The question is, decades or even longer before the development of Sofosbuvir, why cannot people seek help from Chinese medicine? Now that there is no specific medicine for the COVID-19, can't we try to combine other therapeutic approaches? Since the current data showed that Chinese medicine is very promising for the treatment of the COVID-19, why not try to start a clinical trial? Having said that, infectious diseases are single-factor diseases, and it is often relatively easy to find specific treatment medications, while a large number of non-infectious diseases have complex mechanisms and a simple specific medication is almost impossible to develop. For these disorders, the experience accumulated over thousands of years of practicing Chinese medicine can provide significant help. Once the effectiveness is confirmed, improvement of therapeutic effectiveness is next step. For example, from squeezing fresh Artemisia annua juice to treat malaria to the development of artemisinin is a good model of how Chinese medicine can be advanced. Giving up easily is not a responsible manner for good human health.
I believe that the associated administration departments may not well understand this, so more communication and dialogue are needed.
It does not matter if there is an issue, but it must be discovered and resolved. Since the 1990s, opioids have been abused in the United States, causing major health damage to the people. It was not until 2018 that HR6 became a law, which reversed the trend of abuse at the legal and administrative levels.
12. Action plan: Dialogue at the national organization level:
The National Acupuncture and Oriental Medicine Certificate Committee (NCCAOM), American Society of Acupuncturists (ASA) and the National Center for Complementary and Integrative Medicine (NCCIH) may organize dialogue with NIH and FDA. Understand what they need, and then maybe we can do something to avoid the same incident from happening again next time. If other colleagues have a better way, please also take actions. The key point is not to let the general public suffer major health damage again.
Postscript: The title picture records a TCM Chinese physician who is reading CT or MRI images of patients with COVID-19. He can also use western medicine directly, as well as treatment measures including a ventilator. This situation is unlikely to happen in the United States at present, but this model will not be beneficial to the patient's maximum health.