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2020-03-10 12:17:02 Voices

On Jan. 31, the Chinese Academy of Sciences reported an important discovery in the battle against COVID-19: Preliminary research by the Shanghai Institute of Materia Medica and the Wuhan Institute of Virology had found that Shuanghuanglian, a traditional Chinese medicine, could “inhibit” the novel coronavirus. The apparent breakthrough, which was quickly hailed by the state-run Xinhua News Agency, sent people around the country dashing off to their local pharmacies for a chance to stock up on the drug.

Only, there was — and still is — no conclusive evidence Shuanghuanglian can actually inhibit COVID-19 infections. The next day, experts and some state media outlets tried to dial back the report, warning that Shuanghuanglian’s effectiveness against COVID-19 had yet to be substantiated. Their fact checks didn’t reach everyone in time, however. On Feb. 14, a patient in the central city of Zhengzhou was diagnosed with the disease. They had left their home only once in the 10 days prior to falling sick — to visit the pharmacy to buy Shuanghuanglian.

TCM is widely accepted by the Chinese public and enjoys a strong social and official cachet, so it’s no surprise that it’d be used heavily during the current epidemic. Last week the World Health Organization took “traditional herbal remedies” off its list of ineffective and potentially harmful treatment measures, explaining that many people may turn to herbal drugs “to alleviate some of the milder symptoms of COVID-19.” Yet it’s worth asking why, in a modern country with access to advanced medicine and equipment, so many people would put their faith in a drug primarily composed of honeysuckle, Chinese skullcap, and forsythia.

Left: Shuanghuanglian oral solution; Right: Tea brewed with Banlangen. IC

Left: Shuanghuanglian oral solution; Right: Tea brewed with Banlangen. IC

TCM has long been promoted for epidemic control in China. In 1988, Shanghai experienced an outbreak of hepatitis A that eventually infected around 300,000 residents. Growing up in a small nearby city, I still remember people rushing out to buy Banlangen, a traditional cold remedy that the Shanghai health authorities said could prevent and treat the disease. In Shanghai, it briefly became fashionable to serve a cup of hot Banlangen to guests.

Banlangen experienced a renewed burst of popularity in 2003, when an epidemic of severe acute respiratory syndrome swept the country, and again in 2013 — this time along with Shuanghuanglian — during a bird flu outbreak. Even as early as Jan. 1 this year, when the novel coronavirus was still largely being treated as a rumor, my friends and family were already musing about stocking up on Banlangen again.

The continued widespread prescription of herbal remedies by medical professionals in China is to an extent a legacy of the nascent years of the People’s Republic of China. In the early 1950s, the country promoted the so-called integration of Chinese and Western medicine as a way to supplement its scarce medical resources.

The movement gained steam in the 1960s, when the country began training “barefoot doctors” to provide basic medical services to rural areas. This group was given a crash course in modern diagnostics, including theories of internal medicine, gynecology, and pediatrics, but they were also schooled in the “one needle, one herb” theory of TCM, which was viewed as an important complement to modern medicine.

A doctor checks a patient during an outbreak of Hepatitis A in Shanghai, 1988. From @潜龙在渊围脖 on Weibo

A doctor checks a patient during an outbreak of Hepatitis A in Shanghai, 1988. From @潜龙在渊围脖 on Weibo

A manual for barefoot doctors, published in Shanghai in 1970, recommended Banlangen and the main ingredients of Shuanghuanglian as effective “heat-clearing” drugs and listed them as potential prophylactics for common infectious diseases, including influenza and Japanese encephalitis. Widely cultivated and easily manufactured at a time of economic scarcity, these herbs helped compensate for a lack of access to modern alternatives.

As for their popularity today, this can be partly attributed to culturally ingrained beliefs about the nature of herbal medicines. Historically, the line between TCM and diets has been blurred, and it remains common for people to view TCM remedies as something that can be consumed safely on a daily basis. The underlying idea is simple: By regulating the body’s balance before falling ill, one can improve one’s natural resistance — it’s a sort of folk version of medical immunity.

Although some traditional remedies, such as malaria treatment artemisinin, have been adapted for use by the broader medical community, most Chinese herbal therapies have yet to be tested or proven in a laboratory or clinical setting. Their toxicity and potential side effects are often unclear, and a number of manufacturers have been accused of using poisonous or even carcinogenic materials. Yet many Chinese continue to believe that, because they are made from natural ingredients, they pose no risk.

Setting aside its physical properties, the popularity and widespread acceptance of TCM can sometimes endow it with unforeseen value in epidemic situations. In 1988, Shanghai experienced an outbreak of hepatitis A. As a “self-limited” disease, there is no effective medication for hepatitis A, meaning doctors can only care for patients and make them as comfortable as possible while their bodies fight off the infection.

Nevertheless, we must be careful not to go overboard.

Xie Lijuan, a former doctor who was then serving as Shanghai’s vice mayor, knew this, but she still believed TCM could help. In a recent interview, she recalled how the city developed and issued a heat clearing TCM concoction: “The patients would feel that they were receiving treatment and be reassured and comforted.”

The choice of medicine wasn’t random. “According to TCM theory, heat clearing drugs are to a certain extent beneficial in treating hepatitis A,” she noted.

COVID-19 also has no known cure or proven treatment regimen. On Feb. 14, Huang Luqi, a medical expert with the National Administration of Traditional Chinese Medicine, stated: “The common people have an urgent need for TCM, and their anxiety has been relieved to some extent after taking it.”

Nevertheless, we must be careful not to go overboard. In addition to the above-mentioned Shuanghuanlian incident, earlier this month, students in the southwestern city of Lincang complained they were being required to consume a supposedly medicinal soup before they were allowed back on campus, though city officials quickly backed down.

Given the stakes, it’s important to be cautious, hold all prospective treatments to strict scientific and clinical standards, and put the protection of human life above all else.

Translator: Matt Turner; editor: Zhang Bo.

(Header image: A TCM pharmacy in Suzhou, Jiangsu province, Dec. 22, 2019. Wang Jiankang/VCG)