Shanghai needs food, not TCM Covid-19 medicine Lianhua Qingwen: medical experts

A leading neurologist in China has called for authorities to make it “very clear” whether traditional Chinese medicine (TCM) Lianhua Qingwen is effective against COVID-19 before giving it precedence over food and other essential deliveries to people in lockdown.

At least 8 million boxes of Lianhua Qingwen capsules have been sent to Shanghai in its battle against the Omicron variant, at the same time as many of its 25 million people are struggling to find fresh vegetables, rice and masks.

“Dispatching of Covid medicines should follow rigorous tests and examinations. No fake and shoddy products should be given to the public, ”Rao Yi, president of Capital Medical University in Beijing, said in a post on social media platform WeChat.

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“If the efficacy of Lianhua Qingwen has never been strictly proven, the mandatory dispatch would hurt the interests of people in shortage of food and drug necessities,” he posted to his Rao Yi Science account on Sunday.

According to a bourse filing on April 8, makers Shijiazhuang Yiling Pharmaceutical donated 61 million yuan (US $ 9.5 million) worth of Lianhua Qingwen to Shanghai – at least 8 million boxes.

The delivery priority given to the donation generated widespread outrage on social media platforms when a volunteer driver in Shanghai said last week he was part of a motorcade that devoted a third of its capacity to the remedy, instead of desperately needed vegetables, rice and masks.

Three medical experts led by Jinan University’s Xie Wangshi also expressed dismay at the prioritizing of Lianhua Qingwen in supplies to Shanghai, in an article on Sunday at Chinese health platform DXY.

“It should not have happened that a medication with no effect to prevent Covid-19 was sent to healthy people. It’s even more inappropriate to squeeze the logistics capacity for lifeline products, ”they wrote.

The distribution of Lianhua Qingwen to healthy people has prompted doctors around the country to warn against taking it unless they are feeling unwell, as it could lead to stomach or kidney dysfunction, according to reports in Shanghai-based state media Jiefang Daily and the Wuhan-based provincial mouthpiece Hubei Daily.

Lianhua Qingwen made its way into China’s national Covid-19 guidelines in April 2020 as a recommended treatment for fever, cough and fatigue in mild-to-moderate cases. In Hong Kong, it is included in anti-epidemic kits distributed citywide.

It is not the only treatment for Covid-19 available in China, but it is cheaper than alternatives. An antibody treatment developed by Brii Biosciences was given Chinese approval in December, but it needs to be administered intravenously.

Giveaway kits distributed in Hong Kong include the traditional Chinese medicine (TCM) Lianhua Qingwen.  Photo: Jelly Tse

China’s regulator also approved Pfizer’s oral pills Paxlovid in February. About a dozen oral pill candidates, developed domestically, are still in preclinical or clinical stages.

One front runner – an antiviral pill by Kintor Pharma – was found to reduce the risk of hospitalization or death by 50 to 100 per cent in late stage trials. Another candidate, VV116 by Junshi Biosciences, started a phase 3 trial last month.

According to its manufacturer, Lianhua Qingwen is based on a formula dating back to the Han dynasty (202BC-220AD). The modern treatment was developed in 2003 for severe acute respiratory syndrome (Sars).

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Some of China’s best-known medical experts, including Zhong Nanshan, Li Lanjuan and Zhang Boli – as well as Jia Zhenhua, son-in-law of the company’s founder Wu Yiling – were among 19 authors to back Lianhua Qingwen in a paper published by the journal Phytomedicine in May last year.

Speaking to Hong Kong residents in their fifth wave of Covid-19 in February in a video posting, Zhong suggested the elderly get vaccinated and recommended Paxlovid, the mainland-developed BRII 196-198 antibody treatment and “some TCMs with verified effects”. He did not mention Lianhua Qingwen specifically.

According to the paper, the treatment’s efficacy and safety were proven in a trial involving 284 patients. Half were given the capsules and recovered from their symptoms more quickly than those who did not receive the TCM intervention.

The study’s validity has been questioned because of its small sample size and its lack of a double blind trial, in which neither participants nor researchers know who is receiving a placebo until it is over, making results less likely to be affected by bias.

Early last month the World Health Organization held a virtual meeting of experts to evaluate the role of TCM in Covid-19 treatments.

Rudi Eggers, director of the WHO’s integrated health services department, said the agency considered traditional and complementary medicines essential. He suggested further analysis and trials, with the results to be shared with member states.

The WHO discussion followed a high-level dialogue between WHO director general Tedros Adhanom Ghebreyesus and China’s National Administration of Traditional Chinese Medicine (NATCM) in Geneva in January.

NATCM commissioner Yu Wenming said the use of TCM, including Lianhua Qingwen, was key to “keeping the extent of disease low in China”.

WHO panel sees potential benefits of TCM in Covid-19 treatment

Shijiazhuang Yiling Pharmaceutical’s stock price fell 10 per cent on Friday and Monday – hitting the daily floor limit – after Wang Sicong, the son of Dalian Wanda Group chairman Wang Jianlin, raised doubts about the WHO’s support for Lianhua Qingwen.

Wang posted to his more than 40 million followers on social media platform Weibo questioning whether the WHO had ever recommended Lianhua Qingwen as a treatment for Covid-19. His account of him was suspended on Tuesday, with the platform citing “violations of relevant laws and regulations” as the reason.

In response to investors’ inquiries, the company said on Monday it would take legal action to protect its legitimate rights and interests when necessary.

Thanks in large part to Lianhua Qingwen, the company reported a 150 per cent increase in sales revenue in 2020 on the year before. According to Shijiazhuang Yiling Pharmaceutical, last year its total revenues from overseas markets – including Indonesia, Mozambique and Thailand – doubled from the previous year.

How traditional Chinese medicine – TCM – is used to treat Covid-19

The US National Institutes of Health has said that while it may help with symptom relief, its overall effectiveness against Covid-19 is inconclusive.

In Singapore, it is registered as an auxiliary healthcare product, not as a Covid-19 medication.

In November, Singaporean health authorities issued an advisory against misleading claims about its efficacy in treating or preventing the coronavirus.

“There is no scientific evidence from randomized clinical trials to show that any herbal product, including Lianhua Qingwen products, can be used to prevent or treat Covid-19,” the advisory said.

The treatment, which is claimed to detoxify the lungs and clear heat, lists 13 ingredients, including apricot kernel, rhubarb, honeysuckle and forsythia powder. According to Australian authorities, it also contains ephedra, which can be used to make menthol.

In May 2020, Swedish customs disallowed the imports of Lianhua Qingwen as the authorities said they tested samples and found they only contained menthol.

Ephedra is also a key ingredient in the drug methamphetamine – commonly known as meth. Also in 2020, the Australian Border Force said it seized around 1.3 million Lianhua Qingwen capsules. US Customs has also seized shipments of the remedy.

In Hong Kong, the special administrative region’s government in February distributed the first batch of Chinese medicines for Covid-19, including Lianhua Qingwen donated by the mainland to people under isolation.

Additional reporting by Zhuang Pinghui

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