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NEWS The prevention and treatment of COVID-19 with Qingfei Paidu decoction in shanxi, China

Ning Liu1, Shuangquan Li1, Kaili Fan1, Tian Lu1, Tingquan Li1*

1 The Affiliated Hospital of Shanxi University of Chinese Medicine, Taiyuan City, Shanxi 030024, China.

*Correspondence to: Tingquan Li, The Affiliated Hospital of Shanxi University of Chinese Medicine, Taiyuan City, Shanxi 030024, China. Email: [email protected], Tel: +86 0351 8618635.

Submit a manuscript: https://www.tmrjournals.com/mhm TMRmhm | Aug 2020 | Vol.3 | No.3 | 1 doi:10.12032/TMRmhm202003066 NEWS were 132 confirmed cases (among which were 129 Background moderate cases, 2 sever cases and 1 critical cases), 11 suspected cases and 314 medical observation cases, In December 2019, Corona Virus Disease totally 457 cases and 76 cured cases[4]. The data 2019(COVID-19) burst in Wuhan, China, and above come from the dynamic distribution of the wreaked havoc over the country. On January 27, 2020, epidemic cases on the official website of Health the National Administration of Traditional Chinese Commission of Shanxi Province, combined with the Medicine urgently launched the special project, data from prefecture-level cities of Shanxi Province. “research on screening effective prescriptions of traditional Chinese medicine (TCM) for prevention General status of TCM in treating and treatment of COVID-19”. As the first pilot areas, COVID-19 Shanxi Province, Hebei Province, Heilongjiang Province and Shaanxi Province carried out clinical The main forms of TCM intervention in COVID-19 observation of Qingfei Paidu decoction in preventing are TCM decoction, Chinese patent medicine and the and treating COVID-19. The basic formula of Qingfei combined use of both. The TCM decoction is mainly Paidu decoction: Mahuang (Herba Ephedrae) 9g, Qingfei Paidu decoction modified by syndrome Zhigancao (Radix Glycyrrhizae) 6g, Xingren (Semen differentiation. Chinese patent medicines were also Armeniacae Amarum) 9g, Shengshigao (Gypsum selected by syndrome differentiation, including Fibrosum) 15g, Guizhi (Ramulus Cinnamomi) 9g, Lianhua Qingwen Capsule, Shexiang Niuhuang Pill, Zexie (Rhizoma Alismatis) 9g, Zhuling (Polyporus Shenfu Injection etc. Up to 24:00 on February 20, Umbellatus) 9g, Baizhu (Rhizoma Atractylodis 2020, there were 347(75.93%) people, of the whole Macrocephalae) 9g, Fuling (Poria) 15g, Chaihu 457 people, were applied with TCM interventions (Radix Bupleuri) 16g, Huangqin (Radix Scutellariae) intervention or treatment, which consists of 6g, Jiangbanxia (Rhizome Pinelliae Preparata) 9g, 130(98.48%) of 132 confirmed cases, 8(72.73%) of 11 Shengjiang (Rhizoma Zingiberis Recens) 9g , Ziyuan suspected cases and 209(66.56%) of 314 medical (Radix Asteris) 9g, Kuandonghua (Flos Farfarae) 9g, observation cases (Figure 1). From February 9 to Shegan (Rhizoma Belamcandae) 9g, Xixin (Herba February 20, in the confirmed cases, the number of Asari) 6g, Shanyao (Rhizoma Dioscoreae) 12g, Zhishi patients receiving the treatment of integrated (Fructus Aurantii Immaturus) 6g, Chenpi traditional Chinese and Western medicine gradually (Pericarpium Citri Reticulatae) 6g, Huoxiang (Herba increased, and the utilization rate of traditional Pogostemonis) 9g [1]. Chinese medicine also gradually increased (Figure 2). We made a statistical analysis on the data of TCM TCM treating status in 11 cities, including Taiyuan intervened cases up to 24: 00 on February 20, 2020. City, Datong City, Yangquan City, Changzhi City, According to the COVID-19's diagnosis and treatment Jincheng City, Shuozhou City, Xinzhou City, Luliang plan (the trial fifth, sixth Edition) (Abbreviated as City, Jinzhong City, Linfen City, Yuncheng City, is “diagnosis and treatment plan” below) [2, 3], there shown in Table 1.

Figure 1 COVID-19 's participation rate of TCM in confirmed, suspected and medical observation cases (Integrative Medicine Group, the cases were treated with TCM and western medicine; non-Integrative Medicine Group, the cases were treated with western medicine or medical observaion.) TMRmhm | Aug 2020 | Vol.3 | No.3 | 2 Submit a manuscript: https://www.tmrjournals.com/mhm NEWS doi: 10.12032/TMRmhm202003066

Figure 2 The trend of the combination of traditional Chinese and Western medicine in the treatment of confirmed cases (Integrative Medicine Group, the cases were treated with TCM and western medicine; non-Integrative Medicine Group, the cases were treated with western medicine or medical observaion.) Table 1 Statistics of different TCM participation form in COVID-19 treating in Shanxi Province (up to 24:00 on February 20, 2020) Medical Confirmed cases Suspected cases observation cases * District TCM intervened cases TCM intervened cases Total Total Total A&B cases A B A&B cases A B A&B Taiyuan City 20 20 0 15 5 9 7 0 6 1 44 44 Datong City 12 11 3 2 6 2 1 0 1 0 39 8 Yangquan City# 4 4 0 0 4 0 0 0 0 0 1 0 Changzhi City# 8 8 4 1 3 0 0 0 0 0 13 0 Jincheng City# 10 10 3 0 7 0 0 0 0 0 1 0 Shuozhou City# 8 8 0 0 8 0 0 0 0 0 39 37 Xinzhou City# 7 7 0 0 7 0 0 0 0 0 22 16 Luliang City 6 6 6 0 0 0 0 0 0 0 0 0 Jinzhong City# 36 35 30 2 3 0 0 0 0 0 147 96 Linfen City 2 2 2 0 0 0 0 0 0 0 0 0 Yuncheng City# 19 19 13 1 5 0 0 0 0 0 8 8 Total 132 130 61 21 48 11 8 0 7 1 314 209 Note: #, There were cases of regional transfer to provincial designated hospitals, including 1 case in Yangquan, 3 cases in Changzhi City, 3 cases in Jincheng City, 2 cases in Shuozhou City, 3 cases in Xinzhou City, 5 cases in Jinzhong City and 2 cases in Yuncheng City. *, The medical observation cases only have a history of contact and have no specific clinical symptoms, there is no detailed statistics on the specific intervention form of TCM. A, the cases treated with TCM decoction only; B, the cases treated with Chinese patent medicine only; A&B, the cases treated with TCM decoction and Chinese patent medicine.

Submit a manuscript: https://www.tmrjournals.com/mhm TMRmhm | Aug 2020 | Vol.3 | No.3 | 3 doi:10.12032/TMRmhm202003066 NEWS Among the 138 confirmed or suspected cases, 103 Utilization status and the effectiveness of (79.23% of 138) patients were applied with Qingfei Qingfei Paidu decoction Paidu decoction, including 102(99.02% of 103) confirmed cases and 1 (0.97% of 103) suspected cases Utilization status of Qingfei Paidu decoction (Table 2). Table 2 Statistics of utilization status of Qingfei Paidu decoction in the prefecture-level cities of Shanxi Province Confirmed Cases Suspected Cases Qingfei Paidu Qingfei Paidu District Integrated Integrated decoction TCM only a decoction TCM only medicine b medicine treated cases treated cases Taiyuan City 5 0 5 1 1 0 Datong City 9 0 9 0 0 0 Yangquan City 4 0 4 0 0 0 Changzhi City 6 0 6 0 0 0 Jincheng City 9 0 9 0 0 0 Shuozhou City 5 0 5 0 0 0 Xinzhou City 7 0 7 0 0 0 Luliang City 5 0 5 0 0 0 Jinzhong City 32 0 32 0 0 0 Linfen City 2 0 2 0 0 0 Yuncheng City 18 0 18 0 0 0 Total 102 0 102 1 1 0 Note: a, TCM only, merely use Qingfei Paidu decoction to treat COVID-19; b, Integrated medicine, use Qingfei Paidu decoction combined with western medicine treating, such as antiviral drugs, antibiotic drugs, atomization treating etc. individually based on the change of the patient's Effectiveness of Qingfei Paidu decoction in condition. COVID-19 Efficacy of Qingfei Paidu decoction in cured Clinical symptoms of COVID-19 patients, such as COVID-19 patients fever, fatigue and cough etc., were recorded by the Among the 76 discharged patients, 59 cases were Novel Coronavirus Pneumonia Symptom Collection treated with Qingfei Paidu decoction, and the mean and Evaluation Form, which was disigned by the State hospitalization time was 11.3±4.2 days. The effect Administration of Traditional Chinese Medicine, and observation showed that the mean hospitalization time every symptom was divided into four grades: None, of moderate patients was 6±3.5days, and the mean Light, Medium, Heavy. The outcomes of the 102 time of symptom relief after taking TCM was 4±1.6 confirmed cases, treated integrative midicne on the days, of which chest CT shows significant absorption basis of Qingfei Paidu decoction, were assessed by 2 of inflammatory lesions. In a few patients with chief physician, majored in TCM and western positive nucleic acid, the nucleic acids could turn medicine respectively. The symptoms were stable in 5 negative within a week, and the time of nucleic acid cases, partial relieved in 31 cases, complete relieved negative conversion was between 7 to 10 days for in 64 cases, aggravated in 2 cases, and the total most patients. The time of severe and critical cases symptom relief rate accounted for 93.14%. was longer than that of moderate cases.

Efficacy of TCM interventions in critical Conclusion and Prospect COVID-19 cases. Qingfei Paidu decoction, as the official recommended In the hospital cases, there were 2 severe cases and 1 emergency epidemic prevention prescription, has a critical case.On the basis of western medicine therapy, high degree of participation in the prevention and TCM therapy mostly adopted Chinese patent medicine treatment of patients with COVID-19 in Shanxi of restoring yang to save from collapse, such as Province, and has better clinical efficacy in improving Xuebijing injection, Shexiangniuhuang pill, Shenfu clinical symptoms and alleviating disease progression. injection etc., since the condition of the patients was According to the official report, the total effective rate critical. The utilization of TCM decoction was of clinical treatment for 214 patients is more than 90% TMRmhm | Aug 2020 | Vol.3 | No.3 | 4 Submit a manuscript: https://www.tmrjournals.com/mhm NEWS doi: 10.12032/TMRmhm202003066 [5], Qingfei Paidu decoction has definite curative 4. Health Commission of Shanxi Province. [Internet]. effect in preventing and improving the clinical Dynamic distribution of the epidemic cases on the symptoms of patients [6]. For new diseases, when official website of Health Commission of Shanxi both TCM and Western medicine are lack of effective Province, combined with the data from cities of understanding, the syndrome differentiation and Shanxi Province.[cited 2020 February 14]. (Chinese). Available from: individualized treatment of TCM has certain http://wjw.shanxi.gov.cn/fyfb/html/feiyan/index.ht advantages compared with the symptomatic support ml. treatment of Western medicine. However, during the 5. State Administration of Traditional Chinese application of Qingfei Paidu decoction, when there are Medicine. [Internet].Qingfei Paidu decoction has a some uncomfortable symptoms such as diarrhea, it is good effect in treating COVID-19. [cited 2020 difficult to distinguish whether it is due to the use of February 23]. (Chinese) Available from: antiviral drugs or hormones or TCM, which often http://yzs.satcm.gov.cn/zhengcewenjian/2020-02-07 affects the confidence of attending physician and /12876.html. patient. It is an effective and convenient way of 6. Liu QQ, Xia WG, An HQ et al.Thoughts on the internet remote consultation, but it is difficult for effect of integrated traditional and western remote consultation experts of TCM to reach a medicine in the treatment of COVID-19. Journal of consensus and get the recognition of local experts in a Traditional Chinese Medicine 2020, online. (Chinese) short of time, it may needs more time to explore a 7. Zhao J, Tian SS, Yang JS, et al. Network feasible mode of remote consultation of TCM. Qingfei Pharmacology of Qingfei Paidu decoction in the Paidu decoction can be regulated by multiple Treatment of COVID-19. Chinese Traditional & components and targets in a network pharmacological Herbal Drugs 2020, online. (Chinese) study of the mechanism of treating COVID-19 [7]. The clinical efficacy of Qingfei Paidu decoction needs to be further studied and verified in the future.

Executive Editor: Chaoyong Wu Submitted: 18 February 2020, Accepted: 23 February 2020, Online: 25 February 2020

References

1. General Office of National Health Commission, Office of State Administration of Traditional Chinese Medicine. [Internet]. Notice on recommending the use of “Qingfei Paidu decoction” in the treatment of pneumonitis infected by COVID-19 with integrated Chinese and Western medicine [cited 2020 February 7]. (Chinese) Available from: http://yzs.satcm.gov.cn/zhengcewenjian/2020-02-07 /12876.html. 2. General Office of National Health Commission, Office of State Administration of Traditional Chinese Medicine. [Internet]. Notice on printing and distributing COVID-19 's diagnosis and treatment plan (trial fifth edition) [cited 2020 February 9]. (Chinese) Available from: http://bgs.satcm.gov.cn/zhengcewenjian/2020-02-0 9/12929.html. 3. General Office of National Health Commission, Office of State Administration of Traditional Chinese Medicine. [Internet]. Notice on printing and distributing COVID-19 's diagnosis and treatment plan (trial sixth edition) [cited 2020 February 19]. (Chinese) Available from: http://yzs.satcm.gov.cn/zhengcewenjian/2020-02-19 /13221.html. Submit a manuscript: https://www.tmrjournals.com/mhm TMRmhm | Aug 2020 | Vol.3 | No.3 | 5