As President of the China Academy of Chinese Medical Sciences, you know that Chinese medicine is NOT regulated in most western countries and that, in those countries where it is regulated, such as Australia, Portugal, Chile, USA, etc., and even in China, the efficacy of Chinese medicine is questioned, by defenders of Western medicine, based on its alleged "lack of scientific evidence." We also know that, in most Western countries, Chinese medicine is accepted and highly valued by citizens and that, in these countries, the majority of professionals who practice Chinese medicine (more than 90%) are NOT Western doctors. In most western countries, where Chinese medicine (and Chinese herbal medicine) are not regulated, it is NOT possible to use Chinese medicine formulas and patent medicines for the treatment of COVID-19, because the governments of these countries do not allow imports, since Chinese herbal medicine products are not registered, even though they are donations and at times as exceptional as those we are going through.
Q1: From your explanations, it is evident that, in the R.P. China, Chinese medicine has made great contributions, in combination with Western medicine techniques, in the prevention, treatment and cure of COVID-19.
My question is whether this reality, which you have explained to us is sufficiently recognized by the Chinese Government authorities themselves?
Prof. Huang Luqi: All the diagnosis and treatment plans and various treatment measures in the fight against the COVID-19 epidemic in Wuhan this time are organized and implemented by the Chinese government. It is the public health policy of the Chinese government to attach equal importance to TCM and Western medicine. The diagnosis and treatment experience and scientific research results introduced in my report just now are fully recognized by the Chinese government and recommended nationwide.
Q2: If the documentation of this reality, based on criteria acceptable to the scientific community, can help Western countries, following the recommendations of the document of "WHO 2014-2023 Strategy", decide to regulate Chinese medicine and integrate it in their National Health Systems, as advised by the WHO?
Prof. Huang Luqi: In my report just now, I have introduced our relevant experience in the clinical observation of the treatment of COVID-19, which are all based on standards acceptable to the scientific community to study and design how to obtain high-level and high-quality clinical evidence. I think what we are doing now should be recognized by the scientific community and can promote “the potential contribution of mastering the use of traditional and complementary medicine to health, well-being and people-oriented health care” as proposed in the document "WHO 2014-2023 Strategy ”. Therefore, in the face of such a global outbreak, based on the clinical efficacy of traditional Chinese medicine, we can definitely help western countries to achieve a better understanding of TCM, thus promoting the legislation of TCM in the host country. At the same time, we also hope that TCM experts and colleagues like Professor Ramon can actively promote and recommend TCM in western countries and even make good use of TCM in clinical practice.
The research on the COVID-19 epidemic is centered on clinical research. Throughout the clinical process, we have made full use of internationally recognized modern scientific research methods and carried out various researches including clinical research, disease mechanism and new drug research and development. We have proposed and provided these research results to WHO, hoping that WHO can organize international experts to take further evaluation of these researches. At the same time, I also hope that through WHO, we can spread our mature experience to all countries or regions in the world and make greater contributions to the global fight against the COVID-19 epidemic.
Q3: What can you suggest to European organizations and those of the rest of the world, that we take care of promoting education, clinical practice and research in Chinese medicine, for the benefit of the citizens of our countries?
Prof. Huang Luqi: To give advice to European organizations of Chinese medicine education, clinical practice and scientific research, I think the education of Chinese medicine is the foundation, through which the public can have a better understanding of Chinese medicine so as to have a better understanding of diseases or health. With such a foundation of Chinese medicine education, combined with clinical practice and scientific research, especially in the COVID-19 epidemic, if Chinese medicine can be applied locally and the advantages and characteristics of clinical efficacy of Chinese medicine can be reflected, then Chinese medicine therapy will definitely be better accepted in Europe, thus promoting the local legislation of Chinese medicine and providing legal protection for the local use of TCM.
苏叶50g, 炙甘草10g, 杏仁10g, 生石膏15g, 桂枝10g, 泽泻10g，猪苓10g, 炒白术15g, 茯苓15g, 柴胡15g, 黄芩10g, 姜半夏10g,
紫苑10g, 冬花10g, 炒枳壳 5g, 陈皮 10g, 生姜25g
Q4: Because of the Italian situation, only a limited number of herbs is available because of the European regulations (there are many herbs, minerals and animals not allowed to be imported into the European territory) and there is a shortage of products on the market.
For the above reasons some TCM doctors in Italy are prescribing the below formula (derived from the QingFei PaiDu Formula, modified).
What is your opinion? Is it still effective, even if modified?
Prof. Huang Luqi: This prescription is a modified formula based on QingFei PaiDu Decoction, and the new formula subtracts the five herbs which are Herba Ephedrae(Ma Huang), Rhizoma Belamcandae(She Gan), Herba Asari(Xi Xin), Rhizoma Dioscoreae(Shan Yao), and Herba Agastaches(Huo Xiang). The deduction of Ephedra (Ma Huang) is very understandable, because it is controlled in Europe and is worried that ephedrine in Ephedra excites sympathetic nerve, thus increasing the risk of heart rate acceleration. Therefore, Ephedra is removed and replaced by Folium Perillae(Su Ye) in the new prescription. However, I want to explain at this point that the acceleration of heart rate in COVID-19 patients is sympathetic nerve excitation caused by hypoxia (thus accelerating heart rate), so the key to treatment is to improve the anoxic state of patients. Ephedra is the most effective herb in Chinese medicine for "dispersing lung qi and relieving asthma". Although folium perillae(Su Ye) has the function of "clearing lung heat and relieving exterior syndrome", it is not capable (like ephedra). Therefore, the treatment effect of the new prescription is definitely not as good as that of the original one by replacing ephedra with folium perillae(Su Ye). In addition, Pogostemon rugose (Huo Xiang) is removed from the new prescription. It is well-known that it has the effect of aromatizing and dampening. It is the main medicine for removing dampness in the treatment. It is also used in the prescription of HuaShi BaiDu Formula.
Therefore, judging from the two herbs of ephedra (Ma Huang) and Pogostemon rugose (Huo Xiang), I think the new prescription is definitely not as good as the original one (QingFei PaiDu Decoction).
Q5: With the help of TCM diagnosis, is it possible to understand in advance if a severe patient is going to develop coagulopathy?
Prof. Huang Luqi: Coagulation DIC is a western medical diagnostic concept. It refers to the pathological syndrome characterized by coagulation dysfunction, which is common in the development process of severe patients. It corresponds to the category of blood stasis in Chinese medicine. The common clinical features are mainly needle pricking like pain, such as chest pain, abdominal pain, lower extremity pain, etc., and facial symptoms such as dark purple lips and tongue, etc. Whether there is blood stasis in patients can be identified through combination of four TCM diagnostic methods: observation, auscultation and olfaction, interrogation, and palpation and pulse feeling. In clinical practice, it is found this time that symptoms such as dark tongue and purple lips generally occurs to severe and critical COVID-19 patients. Some patients have abnormal coagulation indexes, and this type of patients have a high risk of coagulation DIC. However, there are also some patients who do not have abnormalities of laboratory indexes, and the risk of coagulation DIC is not high or very low for such patients. Therefore, it can be said that blood stasis syndrome in Chinese medicine is more extensive than coagulation DIC in western medicine. In general, COVID-19 patients who are differentiated as blood stasis syndrome do not necessarily have coagulation DIC and its corresponding clinical interventions. In clinical practice, we suggest to further clarify the diagnosis with the help of laboratory indicators so as not to delay the patient's condition.
Q6：Can you please tell us if there are researches from CACMS about Chinese Medicine treatment of Covid-19?
Prof. Huang Luqi: The CACMS has been doing clinical to laboratory research on TCM treatment of COVID-19 diseases. The work described in my report is the clinical research we did in Wuhan Jinyintan Hospital, Dongxihu makeshift hospital and Jiangjun Street Community Hospital. At the same time, we have also done a lot of laboratory research that matches the clinical research. Related work done by laboratory animals in the Academy of Medical Sciences. For example, our Chinese Herb Institute of the CACMS has done research on animal models, and Laboratory Animal Institute of the CACMS has also done related work.
Q7: In Brazil the numbers are increasing daily. What could you suggest for prevention? I mean to improve our 正气 in order to be more prepared for a possible infection
Prof. Huang Luqi: Regarding prevention, I think to draw on the sentence in the classic Yellow Emperor's Internal Classics of Chinese Medicine, "People won’t get infected during pandemic is because their righteous Qi is strong inside, pathogenic influences cannot invade from the outside, and stay away from toxic Qi". That means people need to improve their immunity. But how? We can use some fitness methods, such as Tai Chi, Ba Duan Jin, and can also use cook some herbal food. In addition, Chinese medicine also emphasizes the role of emotion regulation, so we should pay attention to the combination of work and rest, Co-feeding of physical body and spirit to improve the body's righteous Qi and prevents infection.
美国 纽约斯隆肿瘤中心整合医学中心医务主任 Gary邓教授：
Q8: In many countries, people have the demand for Chinese medicine, but the supply and the quality of medicines are not always guaranteed. Does the country have any overall plans and measures for increasing the quantity and quality of Chinese herbal medicines for export?
Prof. Huang Luqi: In our country, the quality of traditional Chinese herbs is mainly regulated by the National Pharmacopoeia. If they go through formal channels or manufacturers (for procurement), they are guaranteed by corresponding laws and regulations. In terms of international cooperation, I mentioned in the proposal that I plan to establish a corresponding international anti-epidemic alliance, which mainly composed of Chinese medicine research institutions, medical institutions and enterprises. The quality and supply chain of traditional Chinese medicines can be guaranteed through such alliance. If there is a demand from various countries, our CACMS can further promote and carry out related work in this regard.
Q9: At present, China has published real-time data on asymptomatic patients. Do they need to be treated? Please introduce the relevant experience in the prevention or treatment of traditional Chinese medicine for such asymptomatic infections.
Prof. Huang Luqi: Chinese medicine believes that asymptomatic infections should fall into the category of "Pathogen hides inside and susceptible to be sick". Such people already have evidence of viral infections, such as nucleic acid test positive, Ig M antibody positive in serum, but no obvious clinical symptoms. For such asymptomatic patients, there are generally two possibilities: (1) Righteous Qi wins and Evil Qi goes away, the body is in a state of eliminating pathogens, so the symptoms are not obvious, and these patients may gradually heal themselves; (2) Righteous Qi and Evil Qi are fighting, the disease is on the edge to break out. There are three situations of this kind of patient. The first one is the victory of Righteous Qi and proceed to self-healing. The second one is Righteous Qi and Evil Qi are continuously fighting, pathogen remains hidden state, and the patient become a chronic virus carrier. The third one is Righteous Qi and Evil Qi fight each other, and the patient get induced by internal or external causes and show up symptoms. Such patients should be treated early. When we were in Wuhan, we drafted a herb and food homologue for asymptomatic infected patients, and processed it into herbal tea, so that the body can support Righteous Qi and drive out evil pathogen.
金银花2g 藿香2g 百合3g 茯苓5g 薄荷1g 桑叶1g 赤小豆5g 人参3g
“Yi Xiaofang”——Homology of medicine and food：
Flos Lonicerae Japonicae 2g，Herba PogoStemonis 2g，Bulbus Lilii 3g， Poria 5g， Herba Menthae 1g， Folium Mori 1g， Semen Phaseoli 5g， Radix Ginseng 3g