Details Of The New Research Findings
City People has found out how the Chinese promptly treated the Coronavirus pandemic that hit China a few months back with what it calls Traditional Chinese Medicine. And a new Research has revealed what has been titled The Treatment Efficacy Analysis of Traditional Chinese Medicine for Novel Coronavirus Pneumonia (COVID-19): An Empirical Study From WUHAN, Hubei Province, China.
The Research finding released by 8 researchers Erdan Luo, Daiyan Zhang, HuaLuo, Bowen Liu, Keming Zhao, Yonghua Zhao, Ying Bian, and Yitao Wang, reveals the following:
A novel Coronavirus was identified in December 2019 in Wuhan, China, and Traditional Chinese Medicine (TCM) played an active role in combating the novel Coronavirus pneumonia (NCP) caused by this fast-spreading virus COVID-19. Thus, we aimed to explore TCM characteristics of clinical efficacy to NCP, as well as to optimise Qingfei Paidu decoction (QFPDD) and the recommended formulas to NCP by the National Health Commission (NHC).
What was the method used? Chinese medical sciences theory and clinical application of TCM were analyzed. A total of 54 NCP patients were observed in a hospital in Wuhan, whose clinical characteristics and utilisation of Chinese Medicines (CMs) were described. The paired test was used to measure the change of patients’ hemogram during the hospitalisation period, indicating the effect of CMs. Multiple linear regression analysis was applied to explore the factors affecting the length of hospital stay. Network pharmacology analysis were applied to figure out the performance of NHC-recommended formulas of five disease stages at levels of compounds, targets and pathways.
What was the result? The average length of hospital stay was 8.96 days. Patients over 45 stayed 9.79 days in hospital on average, longer than 7.64 days of patients under 45. Comparing the hemograms between admission and discharge of hospital, the number of leukocytes, neutrophil, lymphocyte and platelet increased, while the numbers of erythrocytes, haemoglobin concentration and hematocrit decreased. According to the standard coefficients of regression, the factor affecting the length of stay for the most was CMs in the category of Invigorating Spleen And Removing Dampness (lSRD), followed by administrating CMs, male, and cough. Thirty-two CMs were screened after deleting duplication from QFPDD and NHC-recommended formulas. Compound quercetin, luteolin, kaempferol, acacetin etc., were all involved in the treatment of various disease stages on the compound level both in generality and individuality.
What were the conclusions? TCM has a systemic theoretical understanding on the pathological evolution and a positive clinical efficacy on NCP The CMs of ISRD improved patients’ recovery, suggesting the importance of regulating intestinal function and keeping microenvironmental balance in TCM treatment of NCP. The active compounds from QFPDD and NHC -recommended formulas contribute to the recovery of the varied disease progresses during TCM treating NCP.
THE BACKGROUND
COVID-19 was identified in December 2019 in Wuhan, China, which caused infectious pneumonia and spread rapidly. However, there has been no consensus on the nomenclature of novel coronavirus pneumonia (NCP) from the perspective of traditional Chines Medicine (TCM) so far. Academician Tong Xiaolin suggested that the disease should be named as cold-dampness pestilence, and academician Wang Qi called the disease pulmonary pestilence in the Manual for Traditional Chinese Medicine diagnosis and treatment of NCP. In general, there is an agreement on the opinion that CP belongs to the category of epidemic disease in TCM. As the special climate of Wuhan, where the local temperature in last winter was higher than that in previous winter, and the rainfall was more frequent than snowfall, the syndromes of NCP patients often presented the characteristics of dampness pathogen in TCM. Integrating the analysis resulted from
Professor Liu Qingquan and Dr. Xiang Qiong, we consider that NCP (COVID-19) should be defined as dampness toxin pestilence Dampness toxin runs through the comprehensive pathology of NCP. Even in Gansu, a region with a dry climate, the researchers found that the characteristics of dampness pathogen from NCP patients were similar to those in Wuhan.
Chinese Medicine (CM) has accumulated abundant clinical experiences and effective formulas on the prevention and treatment of epidemic diseases. In Ming dynasty, Wu Youke, a famous Chinese medicine doctor, believed that the pathogen of epidemic disease was different from the six excesses, but was a kind of pestilent Qi that had high contagious and powerful toxic features. Pestilent Qi is prone to encroaching specific organs and involving multiple organs failure and commonly breaks out in populated large cities. In 2004, a clinical study including 524 patients with the severe acute respiratory syndrome (SARS) showed that the duration of major symptoms in the group of patients treated by integrated Chinese and Western medicines was significantly shorter than those in the group treated by Western medicine alone. The satisfied therapeutic effects of TCM in preventing and treating SARS suggested the superiority of TCM on severe infectious diseases.
In March 2020, the Diagnosis and Treatment Guideline of Novel Coronavirus Pneumonia (Edition 7) was released by the National Health Commission (NHC) of People’s Republic of China, in which Qingfei Paidu decoction (QFPDD) and other TCM formulas were recommended to treat NCP. Although it is necessary to consider the real pathological evolutions of patients based on local climatic features and individual physical characteristics of patients, the inconsistency of syndrome types is prone to producing cluttered Chinese medicine formulas. In view of this, the TCM symptom types in this study complied with those in the guideline from treatment to recovery period. Therefore, this study aimed to figure out efficacy of TCM in treating NCP, to explore the relationship of the TCM’s influence factors with patient’s individual characteristics, and to optimize QFPDD and NHC-recommended formulas corresponding to the treatment and recovery period of NCP. By using both statistical analysis and network pharmacological technology, this study can not only partially reveal the therapeutic mechanisms of TCM through the corresponding relationships among formula, medicine, and syndrome, but also provide scientific evidence for screening and optimising TCM formulas for the treat- mentof NCP.
METHODS: STUDY POPULATION
Data of 54 patients with NCP, namely SARS-CoV-2 pneumonia (COVID-19) undergoing CMs treatment originated from the department of infectious disease in The Hospital from Wuhan from January 24 to February 17. The information about patients’ age, gender, symptoms, temperature, use of TCMs and results of laboratory examinations during hospitalisation were collected through the hospital information system (HIS).
As for the Statistical Analysis, the clinical characteristics of patients and the frequency of CMs use were described. Independent test was used to measure the differences of clinical characteristics among patients in varied demographic groups, and paired to test was used to measure the differences of patients’ blood test results between admission and discharge of hospital, which could indicate the effect of CMs. Correlation analysis was applied to investigate the relevance among various symptoms and TCM clinical features. Multiple linear regression analysis was applied to explore the factors affecting the length of hospital stay.
NETWORK PHARMACOLOGY ANALYSIS
As for Network Pharmacology Analysis, the compound information of all the 21 Chinese medicines in QFPDD were collected. There were one to three herbs selected as the sovereign medicinal to represent the main effect of the recommended formulas of five disease stages: mild, moderate, severe, critical and recovery stages.
For target prediction and active compound (C)-target (T) network construction, we input the SMILES of the compounds into online tools Similarity Ensemble Approach (SEA) to predict the putative targets. The software Cytoscape (version: 3.7.0) was used to construct an active compounds-targets network, and the network parameters of each element were analysed based on the plug-in Network Analyzer for further analysis. A web-based gene set analysis toolkit was applied for the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of putative targets. Parameter settings were as follows: Homo sapiens in Organism of Interest, Over-Representation Analysis (ORA) in Method of Interest and KEGG in Functional Database.
RESULTS
TCM comprehension on pathological evolution of NCP and medication paradigm were analyzed based on syndrome differentiation. As NCP belongs to the category of epidemic disease, the pathogen is generally attributed to dampness toxin according to the main symptom characteristics of this disease. TCM believes that NCP locates in lungs, and is closely related to spleen and stomach, and its pathological changes involve in heart, liver and kidney in the later stages. Dampness pathogen can change into cold-dampness pathogen following the Yin body constitution, and also become the dampness-heat pathogen following the Yang body constitution. Clinical observation shows that dampness toxin can directly invade into middle energizer in partly NCP patients, and leads to the dysfunction of Qi movement. If the treatment method is appropriate and sufficient healthy Qi gradually recovers, the pathogen will be driven out, consequently, the patient will enter into the recovery period. At the same time, clinical manifestations appear some symptoms of Qi and Yin deficiency. Thus, the pathological evolution of NCP in TCM can be summarised as dampness toxin invading defense exterior in early stage, and then enters the lungs and influences spleen function, eventually involves heart, liver and kidney, which causes Yang Qi collapse by excess pathogen and Yin and Yang separates from each other. If the treatment is timely and suitable, sufficient healthy Qi can eliminate the pathogen, syndromes with deficiency of Qi and Yin in lung and spleen will be manifested.
