The three formulas – Lianhua Qingwen Capsule, Jinhua Qinggan Granule, and Xuebijing Injection – are patented products that are already commercially available and have been tested on COVID-19 patients in clinical settings.
The first two are herbal products featuring ingredients such as honeysuckle and weet wormwood.
They are now recognised as part of China’s Standard Therapy for Novel Coronavirus Pneumonia (Tentative, version VII), the National Administration of Traditional Chinese Medicine announced last Wed (Apr 15).
Zhang Boli, an academician of the Chinese Academy of Engineering and president of Tianjin University of Traditional Chinese Medicine, said that the three formula were previously used as anti-viral drugs for treating SARS and influenza.
"That means these three drugs have passed strict reviews by the administration and can be commonly and widely used in China. Their effects are exact and backed with ample evidence. So people may have a new choice if there's a similar epidemic in the future,” he said during a press conference.
Lianhua Qingwen capsule
A randomised, open-label, and blank-controlled trial on the product was first registered on Feb 1 on the Chinese Clinical Trial Registry.
The study leaders included Zhang himself and the renowned virologist Zhong Nanshan and Li Lanjuan.
A total of 284 COVID-19 patients from 23 hospitals were involved in the trial.
According to the study design, the intervention given include routine treatment and four capsules of Lianhua Qingwen each time or one bag of Lianhua Qingwen granules thrice per day. The control group took conventional treatment.
Zhang said that about 83.8% of the patients in the treatment group saw an improvement in their lung scan images, and 78.9% recovered, while the figures for the control group were respectively 64.1% and 66.2%.
He added that China has donated 100,000 boxes of the product to Italy.
The formula is a key product of Chinese firm Shijiazhuang Yiling Pharmaceutical. The company’s product, which first entered the market 16 years ago, was also the exact product used in the aforementioned clinical trial.
The company said last week that it had received approval from the State Drug Administration to add new functional claims to the product.
“In the conventional treatment of novel coronavirus pneumonia, it can be used for a light, common type of fever, cough, and fatigue,” the company said in a statement, adding that it could be used for seven to 10 days on treatment of mild cases.
The product is also said to be anti-H1N1, H3N2, H5N1, H9N2, SARS and EV71, according to the specifications on the company’s website.
Containing ingredients such as apricot kernel, rhubarb, honeysuckle and forsythia powder, it was shown in a recent study published in March on Pharmacological Research to have inhibited COVID-19 replication in Vero E6 cells.
It has also shown to reduce pro-inflammatory cytokines production at the mRNA level.
Jinhua Qinggan Granule
On the other hand, Jinhua Qinggan Granule was developed at a later time during 2009’s H1N1.
It contains ingredients such as honeysuckle, baical skullcap root, sweet wormwood herb and Juxiechang (Beijing) Pharmaceutical is a manufacturer of the product.
It can also make the same health claim as Lianhua Qingwen capsule, as for the dosage, it is one to two granular bags three times per day for five to seven days.
Zhang said that a RCT study involving 102 patients were conducted in Wuhan and Beijing You An Hospital.
According to the trial in Wuhan, in mild and moderate COVID-19 patients, the intake of Jinhua Qinggan Granule can reduce their chance of worsening by about 66%.
White blood cell, neutrophil and lymphocyte counts reflecting immune function also improved.
A randomised trial study published in the Annals of Internal Medicine in 2011 also showed that the formula, when administered on its own or combined with oseltamivir (Tamiflu), can reduce the time to fever resolution in H1N1 patients.
The Xuebijing injection was trialled on 156 severely and critically ill patients in 32 hospitals.
The product can now claim to be used on critically and severely ill patients with inflammatory response in the entire body and/or multiple organ failures.
An earlier study published on Critical Care Medicine last year shown that the product, when used on critically ill patients with severe community-acquired pneumonia, can reduce their duration of ICU stay.
China has stepped up the production of TCM to meet rising demand.
According to Cao Xuejun, an official with the Ministry of Industry and Information Technology, the daily production of Lianhua Qingwen capsule and Jinhua Qinggan are two million boxes and 26k boxes respectively.