Common Cold & Flu

2020 Frontiers in Pharmacology

Traditional Chinese medicine impacts on the prevention and treatment of influenza with potential value in shorting fever durations and alleviating influenza symptoms among children and pregnant women.

Influenza infection is a highly contagious, acute febrile respiratory disease caused by the influenza virus. Traditional Chinese Medicine (TCM) has dominated plenty of theoretical and practical approaches in the treatment of influenza. It is, therefore, important to highlight the effects of TCM in the clinical treatment of influenza and their impact on inhibiting the growth of this virus in laboratory experiments. We scrutinized existing evidence on whether TCM is effective in clinical applications. Moreover, we described the potential mechanisms of TCM against the influenza virus. Our findings provide analytical evidence that supports the effectiveness of TCM in treating influenza infections as well as their mechanisms against this virus.

Traditional Chinese Medicine in Treating Influenza: From Basic Science to Clinical Applications Xiong Y, Li NX, Duan N, Liu B, Zhu H, Zhang C, Li L, Lu C, Huang L

2020 Frontiers in Pharmacology

Traditional Chinese medicine has unique advantages in relieving symptoms, shortening treatment time and reducing the development of severe viral pneumonia.

In the treatment of viral pneumonia through syndrome differentiation, traditional Chinese medicine (TCM) plays a variety of roles in inhibiting the proliferation, replication, adsorption and membrane penetration of the virus, promoting the expression of interferon in vivo, inhibiting inflammatory reaction, enhancing immunity, etc., which is one of the theoretical bases for the clinical application of TCM in the prevention and treatment of viral pneumonia.

Traditional Chinese herbal medicine and compound medicinals are characterized by multi-component, multi-pathway and multi-pathway complex networks. Therefore, drug resistance is relatively rare in the clinical practice of TCM. Moreover, in the process of diagnosis and treatment of TCM, treatment based on differentiation of symptoms and signs, especially treatment based on classification of symptoms and signs, can best reflect the overall concept of TCM. TCM has precise therapeutic activity and less adverse reactions. Accumulating evidence has demonstrated the competent therapeutic effects of TCM against viral pneumonia with a prominent safety profile.

Role of Traditional Chinese Medicine in the Management of Viral Pneumonia Xi S, Li Y, Yue L, Gong Y, Qian L, Liang T, Ye Y

2019 APMIS

Traditional Chinese medicine can restrain some infections induced by various drug-resistant bacteria.

A large number of studies have shown that multiple traditional Chinese medicine (TCM) compounds, single herbs, and monomers have effects on inhibiting drug-resistant bacteria in both in vitro and in vivo studies such as MRSA, Acinetobacter baumannii, and Pseudomonas aeruginosa.

The mechanism of treating drug-resistant bacteria in TCM mainly includes the following two aspects: eliminating plasmid and inhibition of the active efflux pump system. Forsythia decoction can inhibit the active efflux pump of A. baumannii, resulting in the variation of an adeB sequence of efflux pump coding gene.

In addition, TCM has a large impact on the production of the inactivating enzyme of antimicrobials to reverse the drug resistance. To inhibit the growth and reproduction of bacteria, Chinese medicinal herbs can alter the structure of bacterial cell wall to affect permeability. Some herbs such as rhubarb and berberine can restrain the formation of biofilms to inhibit the MRSA.

Notably, the antibacterial activity of TCM with little side effects is equivalent to that of antibiotics. A study showed that Chinese medicine, Mayushihuang decoction, has the same efficiency with teicoplanin for clearing MRSA; however, distinct adverse effects were not detected in the TCM group as compared to abnormal hepatorenal function in the teicoplanin group.

Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary Yuexia Ma, Ming Chen, Yali Guo, Jian Liu, Weitao Chen, Mengyue Guan, Yue Wang, Xuehui Zhao, Xu Wang, Haoyuan Li, Lingxin Meng, Yulong Wen, Yuguang Wang

2019 APMIS

Clinical efficacy can be improved by the combination of Chinese and Western medicine in the treatment of bacterial infectious diseases.

The combination of traditional Chinese medicine (TCM) intravenous preparations with conventional antibiotics can effectively improve the clinical efficacy of community-acquired pneumonia (CAP) and promote the early rehabilitation of patients, thereby reducing the rate of mortality of the patients. Previous studies showed that Xiyanping injection (TCM injections are approved by the China Food and Drug Administration for the treatment of respiratory infection; the main ingredient is andrographolide sulfonate) combined with piperacillin and sulbactam significantly improved the clinical efficacy of pulmonary infection in the elderly.

Pulmonary infection is the most common complication and cause of death in stroke patients. Compared to simple symptomatic support treatment, the recovery rate and efficiency of Qingjin huatan decoction (famous TCM recipe composed of Scutellaria baicalensis, Fructus gardeniae, Fritillaria thun-bergli, for clearing heat and reducing phlegm) combined with Xiaochengqi decoction (purgative prescription) in the treatment of apoplexy-related lung infection is greatly improved. The symptoms of patients with pulmonary infection complicated with sepsis were significantly improved after treatment with the addition of Shengjiang powder combined with basic Western medical treatment including antibiotics and expectorant application. Consequently, the APACHE2 score was significantly reduced, and the levels of inflammatory cytokines, such as CRP, TNF-α, and IL-6 were also significantly reduced.

Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary Yuexia Ma, Ming Chen, Yali Guo, Jian Liu, Weitao Chen, Mengyue Guan, Yue Wang, Xuehui Zhao, Xu Wang, Haoyuan Li, Lingxin Meng, Yulong Wen, Yuguang Wang

2019 APMIS

Traditional Chinese medicine has a generalized antiviral effect indicating the regulation on the direct inhibition of virus, body immunity, and inflammatory response control.

Present, several studies on the anti-virus activity of single Chinese medicinal herb, such as Fructus forsythiae, Radix isatidis, and Scutellaria baicalensis, using modern technology confirmed the effective constituent and materials, as well as the functional mechanism of the relevant parts. A systematic analysis found that TCM decoction and Ganmao capsule (a non-prescription Chinese patent medicine composed of some herbs for clearing heat and toxicity is commonly used in treating cold and flu) had better effects on the treatment of H3N2 and influenza B, respectively, than amantadine and ribavirin.

In terms of anti-inflammation, TCM can alleviate the damage caused by excess inflammatory reactions initiated by a virus. The single and compound Chinese medicinal herbs which can cause clearing heat and toxicity could decrease the cytokine storm resulting from the production of several species of pro-inflammatory cytokines and anti-inflammatory cytokines aim to improve the injury of tissue and organs. In turn, this phenomenon promotes blood circulation and removes stasis, thereby confining the inflammation and promoting its absorption. In the case of SARS, a rapidly spreading infectious disease, TCM combined with corticosteroids during the early stage of the outbreak could decrease the mortality by promoting innate immunity to relieve inflammation.

Subsequently, the TCM compounds of Chinese herbs analyzed based on the theory of strengthening healthy Qi and clearing pathogenic factors with the feature of multicomponent, multi-channel, and multiple targets exerted a synergistic effect on inhibiting the virus directly, relieving the immunopathological injury, and controlling the inflammatory reaction caused by virus infection.

Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary Yuexia Ma, Ming Chen, Yali Guo, Jian Liu, Weitao Chen, Mengyue Guan, Yue Wang, Xuehui Zhao, Xu Wang, Haoyuan Li, Lingxin Meng, Yulong Wen, Yuguang Wang

2019 APMIS

Traditional Chinese medicine rapidly relieves the clinical symptoms caused by viral infection with a remarkable antifebrile effect.

The overall characteristics of TCM in treating viral infectious diseases are that it can significantly lighten the symptoms and bring down the fever quickly; however, the time of viral nucleic acid to be negative in TCM is slower as compared to the chemical antiviral drugs.

Some randomized controlled trials showed that Maxingshigan decoction (a classical TCM recipe that is commonly used for pneumonia composed of Chinese ephedra, apricot kernel, gypsum, licorice), Yinqiaosan decoction (a famous TCM recipe mainly composed by Lonicera japonica and Fructus forsythiae is commonly used for cough and sore throat caused by virus infection), and modern Chinese patent medicine Lianhua qingwen capsules (a TCM capsule, which is approved by the China Food and Drug Administration for the treatment of flu) relieve the clinical symptoms of influenza patients and shorten the time of disease progression.

Prevention and treatment of infectious diseases by traditional Chinese medicine: a commentary Yuexia Ma, Ming Chen, Yali Guo, Jian Liu, Weitao Chen, Mengyue Guan, Yue Wang, Xuehui Zhao, Xu Wang, Haoyuan Li, Lingxin Meng, Yulong Wen, Yuguang Wang

2018 PLOS One

Andrographis Paniculata (Chuan Xin Lian) appears beneficial and safe for relieving acute respiratory tract infection symptoms and shortening time to symptom resolution.

Thirty-three RCTs (7175 patients) were included. Most trials evaluated A. Paniculata (as a monotherapy and as a herbal mixture) provided commercially but seldom reported manufacturing or quality control details.

A. Paniculata improved cough and sore throat when compared with placebo. A. Paniculata (alone or plus usual care) has a statistically significant effect in improving overall symptoms of acute respiratory tract infections when compared to placebo, usual care, and other herbal therapies. Evidence also suggested that A. Paniculata (alone or plus usual care) shortened the duration of cough, sore throat and sick leave/time to resolution when compared versus usual care. No major adverse events were reported and minor adverse events were mainly gastrointestinal. The methodological quality of included trials was overall poor.

Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis Hu XY, Wu RH, Logue M, Blondel C, Lai LYW, et al.

2018 BMC Complementary Medicine and Therapies

Ma Huang Tang may lower the duration of fever when it is used alone or in combination with neuraminidase inhibitors and may be a well-tolerated treatment.

Twelve relevant studies were identified, including two randomised controlled trials (RCTs, N = 60) and ten non-randomised studies (NRSs, N = 1110). We found that maoto plus NAIs was superior to NAIs alone in terms of the duration of fever in one RCT and four NRSs. The duration of symptoms or virus isolation did not differ between maoto and NAIs. No severe side effects or adverse reactions were reported related to maoto or NAIs.

Although we could not reach a definitive conclusion because of the small sample sizes and high risk of bias in the analysed studies, maoto may lower the duration of fever when it is used alone or in combination with NAIs and may be a well-tolerated treatment. More RCTs are needed to determine the efficacy and safety of maoto.

The use of maoto (Ma-Huang-Tang), a traditional Japanese Kampo medicine, to alleviate flu symptoms: a systematic review and meta-analysis Yoshino, T., Arita, R., Horiba, Y. et al

2016 Journal of the Chinese Medical Association

Compared with oseltamivir, Chinese herbs might have superior potential effects on fever resolution and similar effects on viral shedding.

In this review, several Chinese herbal medicines demonstrated a potentially positive effect on the influenza A (H1N1) strain, especially on its time to defervescence, as in the studies analyzed, the mean time to defervescence in the TCM treatment group was less than that noted in the control group. Furthermore, the duration of influenza A (H1N1) shedding in the integrated Chinese and Western medicine subgroup was less than that noted in the control group, although existing evidence indicated that the difference in duration of viral shedding and effective rate between the two groups was statistically similar. The applicability of the included studies was limited, however, because their inclusion criteria, interventions, durations, and outcome measures were different. Consequently, more well-designed trials are required.

Efficacy and safety of traditional Chinese medicine for the treatment of influenza A (H1N1): A meta-analysis Li, Jiang-Honga,; Wang, Re-Qina; Guo, Wen-Jieb; Li, Juan-Shengc

2015 Alternative Therapies in Health and Medicine

Compound formulas of traditional Chinese medicine, compared with placebo, can provide benefits to patients with the common cold, with no serious side effects having been identified in the included trials.

A total of 6 randomized, double-blind, placebo-controlled trials involving 1502 participants were included. Most trials had a low risk of bias. Five were conducted in mainland China and 1 in Hong Kong; 5 were multicenter clinical trials and 1 was a single-center trial; 4 were published in Chinese and 2 were published in English. Compound formulas of TCM were superior to placebos in reducing disease symptoms, inducing recovery from a TCM syndrome, and increasing quality of life. In addition, the formulas were superior in shortening the duration of the main symptoms, the amount of time for a decline in temperature of at least 0.5°C to occur, and the duration of any fever. The team did not perform a summary meta-analysis due to clinical heterogeneity. No serious adverse event (AE) occurred in either the treatment or the control groups.

This systematic review indicated that compound formulas of TCM, compared with placebo, can provide benefits to patients with the common cold, with no serious side effects having been identified in the included trials. However, due to the small number of included studies and of participants and the unclear risk of some biases in the included studies, more high-quality, large-scale RCTs are still warranted to clarify fully the effectiveness and safety of compound formulas of TCM in treating the common cold.

Compound Formulas of Traditional Chinese Medicine for the Common Cold: Systematic Review of Randomized, Placebo-controlled Trials Li G, Cai L, Jiang H, Dong S, Fan T, Liu W, Xie L, Mao B.

2015 Complementary Medicine Research

There is strong evidence for Andrographis paniculata (Chuan Xin Lian) being significantly superior to placebo in alleviating the frequency and severity of cough symptoms.

Most studies showed significant improvements in active treatment group patients with cough-related symptoms. The study by Narimanian et al. showed particularly good results for mucociliary clearance. The sole exception was the trial conducted by Melchior et al.; a pilot study with relatively few patients. All studies reported small numbers of mild adverse effects, including nausea, emesis, vertigo, skin rash and diarrhea, but none required further treatment.

Four trials were assessed quantitatively with regard to changes in the frequency of patients' cough symptoms. In these studies, meta-analysis showed strong evidence that A. paniculata reduced this frequency, although significant heterogeneity was found in the original study results. These 5 trials were also compared with regard to changes in the severity of patients' cough symptoms. The results showed strong evidence for the benefit of phytotherapeutics in this area, although significant heterogeneity was found here, too. These analyses show that A. paniculata is effective in reducing the frequency and severity of patients' cough symptoms.

Herbal Medicine for Cough: a Systematic Review and Meta-Analysis Wagner L., Cramer H., Klose P., Lauche R., Gass F., Dobos G, Langhorst J.

2013 Cochrane Database of Systematic Reviews

Most Chinese medical herbs in the included studies showed similar effects to antiviral drugs in preventing or treating influenza.

This updated review assessed the therapeutic effects and safety of Chinese medicinal herbs as an alternative and adjunctive therapy to other commonly used drugs for influenza. Eighteen studies involving 2521 participants were included in the review. 'Ganmao' capsules were found to be more effective than amantadine in decreasing influenza symptoms and aiding recovery in one study (in which adverse reactions were mentioned in the amantadine group although no data were reported). There were no significant differences between 'E Shu You' and ribavirin in treating influenza, nor in the occurrence of adverse reactions. The remaining 17 Chinese herbal trials showed a similar effect to antiviral drugs in preventing or treating influenza. However, since these included studies were of poor quality, the evidence does not support or reject the use of any Chinese herbal preparations for influenza. High‐quality trials are required.

Chinese medicinal herbs for influenza Jiang L, Deng L, Wu T.