Chinese herbal medicine treatment in five mild COVID-19 cases:South African case studies
Complementary Medicine: Education and Research
Vol.1, No. 1, pp. 30-37, Feb 2024
Received Sep 12, 2023; Revised Jan 3, 2023; Accepted Jan 28, 2024
3006-273X / © 2024 by CMER
Published by Chinese Medicine and Acupuncture Association of Africa. This is an open access article under the CC BY-NC-ND license.
Chinese herbal medicine treatment in five mild COVID-19 cases: South African case studies
1. Department of Complementary Medicine, University of Johannesburg, South Africa
[1] Corresponding Author: PhD, Senior Lecturer, Department of Complementary Medicine, University of Johannesburg, South Africa. Email: zhu@uj.ac.za ORCID: 0000-0002-9752-4163
[2] PhD candidate, Nanjing University of Chinese Medicine, Nanjing, 210023, China; Confucius Institute of Chinese and Regenerative Medicine, University of Galway, Galway, Ireland. Email: 390186@njucm.edu.cn
To cite this article:
Hu, Z. & Zhang, J. (2024). Chinese herbal medicine treatment in five mild COVID-19 cases: South African case studies, Complementary Medicine: Education and Research, 1(1), 30-37. https://doi.org/10.62415/RFIX6198
ABSTRACT
In December 2019, the initial reports of a novel coronavirus epidemic emerged in China. Despite South Africa demonstrating determined political efforts to handle the outbreak within its borders, there is currently no established effective treatment for mild cases. The sharing of clinical experiences could prove beneficial in managing emerging infectious diseases. Given the successful management of COVID-19 in China, Traditional Chinese Medicine (TCM) might present a potential solution for mild cases in South Africa, potentially lowering the likelihood of mild cases progressing to severe stages and expediting the recovery process. Data were retrieved from an identified clinic in South Africa between 12 June 2020 to 26 June 2020. All cases were consulted under the regulation of telehealth and telemedicine by using online video consultation. It can be inferred that TCM is efficacious in hastening the recovery process and diminishing the instances of mild cases progressing to severe stages. The utilisation of Chinese herbal medicine proves applicable in treating mild cases of COVID-19, irrespective of variations in geography, climate, and racial factors. This study was constrained in its examination of patients from a single clinic, lacking a comparative aspect. It is advisable that future studies be conducted in more extensive settings to provide a broader perspective.
Keywords: COVID-19; Chinese medicine; herbal remedies; South Africa.
1. Introduction
Numerous diseases, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, are caused by coronaviruses, leading to respiratory tract infections with high infectivity, mortality, and significant public health implications (Gralinski & Menachery, 2020). In December 2019, the outbreak of a novel coronavirus epidemic was initially reported in Wuhan, China (Şencan & Kuzi, 2020). Initially named coronavirus 2019 (COVID-19), the International Virus Taxonomy group later designated this virus as SARS-CoV2. The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020, when over 100,000 confirmed cases were reported in more than 114 countries (Ghebreyesus, 2020). As of June 26, 2020, according to the National Institute for Communicable Diseases (NICD), South Africa recorded 124,590 cumulative confirmed COVID-19 cases with 2,340 cumulative deaths. The recovery rate was 51.5% as of June 26, 2020, with a mortality rate of 1.9% (NICD, 2020).
In SA, the confirmation of COVID-19 diagnosis relies on a positive laboratory test for SARS-CoV-2 (Adeloye, 2020). Despite SA demonstrating a strong political commitment to managing the epidemic, there is currently no established effective treatment for mild cases (NICD, 2020). Therefore, there is an urgent necessity to investigate alternative approaches that can contribute to the management of diseases and public health, such as TCM. The Allied Health Professions Act 63 of 1982 facilitated the registration of various Complementary Medicine (CM) modalities, including Chinese medicine and acupuncture. The practices of both Chinese medicine and acupuncture are subject to clear standards and requirements regulated by the Allied Health Professions Council of South Africa (AHPCSA) since the year 2001 (Hu & Venketsamy, 2022; SA, 2001). In an effort to safeguard the health of South Africans, a policy decision to implement telehealth and telemedicine was announced on March 25, 2020, with a revised version published on June 22, 2020 (AHPCSA, 2020).
Numerous instances of successful TCM treatments during various pandemics, such as the 2003 SARS outbreak, indicate a notable reduction in the course of the disease, mortality rates, and side effects associated with Western medicine when patients receive a combined treatment of TCM and Western Medicine (Li et al., 2020). However, the emergence of a new pathogen inevitably presents new challenges. Sharing clinical experiences can play a crucial role in controlling emerging infectious diseases and enhancing treatment protocols (Lai et al., 2020). Considering the effective management of COVID-19 in China, TCM emerges as a potential solution for mild cases in South Africa, offering the potential to decrease the progression of mild cases to severe stages and expedite the recovery process.
Understanding of COVID-19 according to TCM
Within TCM, historical records of pandemics extend back to the time of the publication of Huang Di Nei Jing, approximately 2,500 years ago. In Huang Di Nei Jing, it is documented that pestilent qi could give rise to pandemics, with patients exhibiting similar symptoms regardless of their age (Anonymous, 2016). COVID-19 displays a pronounced contagious nature, akin to the characteristics of the pestilent qi outlined in TCM theory (Bonilla-Aldana et al., 2020; Li, 2014). Common symptoms observed in most patients include muscle aches, chest tightness, poor appetite, and loose stools or diarrhoea, suggesting a close association between the cause of this pestilent qi and factors such as dampness, heat, and toxicity (Xiong, 2020).
COVID-19, often referred to as pestilent qi in TCM, impacts human health through the oral and nasal pathways, distinguishing it from the six exogenous pathogenic qi (wind, coldness, summer heat, dampness, dryness, and heat/fire). According to the Wen Ren Lun proposed by Ye Tianshi, the primary organ affected initially is the lung, followed by involvement of the spleen, stomach, liver, gallbladder, and others, aligning with these characteristics (National Health Commission, 2020). Various stages of COVID-19 infections manifest distinct meridian patterns as per the six-meridian differentiation method, and the role of anti-pathogenic qi holds significance in the disease's progression and treatment (Zhang & Zhu, 2020). The disease's evolution in diverse patients may exhibit varying patterns, as outlined in Table 1, which illustrates common manifestations in different phases of the illness.
Table 1. Common manifestations of the COVID-19 (Pang et al, 2020)
2. Cases
Five individuals with confirmed mild cases of COVID-19, comprising three males and two females, underwent treatment with Chinese herbal medicine. In terms of racial background, one individual identified as Coloured, two as Black, and two as South African Chinese (SAC). All patients were residents of Johannesburg and did not have any travel history. Among them, one patient has no apparent record of contact with confirmed cases, while the remaining four patients all exhibited clear evidence of confirmed contact. Common symptoms of these cases were fatigue (4 cases, 80%), cough (4 cases, 80%), runny nose (2 cases, 40%), dry throat/mouth (2 cases, 40%), diarrhoea (2 cases, 40%), chest tightness (2 cases, 40%) and nausea (1 case, 20%), mild fever (1 case, 20%). However, all cases presented with different tongue manifestations. Table 2 below illustrates the characteristics of patients.
Table 2. Characteristics of patients based on age, sex, duration of the disease before treatment (DDBT) and tongue manifestations
Each case received distinct prescriptions tailored to their specific manifestations and corresponding treatment principles. Remarkably, all clinical symptoms resolved within a week through the administration of the mentioned Chinese herbal medicine treatment. Table 3 illustrates the treatment principles and prescriptions for the patients.
Table 3. Treatment principles and prescriptions
3. Discussion
Traditional Chinese Medicine offers a comprehensive theoretical framework for understanding the pathological progression of diseases (Luo, 2020). Numerous datasets support the positive clinical efficacy of TCM treatment, indicating that early intervention with both TCM and Western medicine has favorable effects, reducing hospitalization duration and the progression from mild and moderate cases to severe cases (Zhao et al., 2021). As of April 1, 2020, a notable 92.44% of COVID-19 patients in China had successfully recovered (Luo, 2020). On March 23, the State Council Information Office of China reported that 74,187 confirmed COVID-19 patients, constituting 91.5% of total confirmed cases, underwent combined treatment with TCM and Western medicine (People’s Republic of China, 2020). The results demonstrated a total effective rate exceeding 90%.
Based on the observation of the progression and treatment of these five cases, we can deduce that mild COVID-19 instances typically exhibit mild flu-like symptoms, such as cough and fatigue. Notably, fever may not always manifest as a definitive symptom in mild cases. According to TCM theory, the pestilent qi invades the human body through the mouth and nose, specifically targeting the lung and defensive qi, potentially leading to fever and coughing (Anonymous, 2016). Despite experiencing the same viral infection within similar timeframes, patients displayed varying symptoms and tongue manifestations, even when residing in the same city (Johannesburg). This suggests that an individual's body constitution plays a significant role in the development and prognosis of COVID-19 infection (Hu, 2022). Consequently, these cases are characterised by yin deficiency pattern (case 1), cold-dampness pattern (case 3), damp-heat pattern (case 2), and qi & yin deficiency pattern (case 4).
In terms of treatment, we adhered to the principles outlined by Professor Xingyu Zheng, which can be summarised as ‘early tonifying and early phlegm alleviation’. The principle of early phlegm alleviation aims to expel the physical substance housing the pestilent qi, preventing the potential combination of pathogenic qi and phlegm, which might lead to a more severe or challenging disease pattern. 80% of the positive cases (4 out of 5) had a history of contact with a confirmed case, emphasising the continued importance of social distancing in prevention. Analysing the onset, progression, treatment, and prognosis of these cases, it becomes evident that COVID-19 infection does not discriminate based on races, and early diagnosis and treatment are highly recommended (Hu, 2022). The manifestations and treatment of these cases underscore the crucial role of syndrome/pattern differentiation in TCM treatment.
The experiences documented in the presented cases offer intriguing insights into the potential role of TCM in the management of mild cases of COVID-19. The alignment of observed manifestations, treatment principles, and prescriptions with TCM theories underscores the relevance of incorporating traditional practices in the comprehensive approach to infectious diseases. The positive outcomes, with all clinical symptoms resolving within a week, suggest that TCM, when integrated judiciously with Western medicine, could play a substantial role in expediting recovery and reducing the severity of mild COVID-19 cases. The emphasis on syndrome/pattern differentiation in TCM diagnosis and treatment becomes particularly evident in these cases. The recognition of individualized patterns such as yin deficiency, cold-dampness, damp-heat, and qi & yin deficiency reinforces the TCM principle that considers the uniqueness of each patient's constitution in guiding therapeutic interventions. This approach not only tailors the treatment to the specific needs of the patient but also reflects the holistic philosophy inherent in TCM (Hu & Venketsamy, 2022).
It is noteworthy that the successful outcomes were achieved within a week of treatment, providing a rapid resolution of symptoms. This raises intriguing possibilities for the integration of TCM into the broader spectrum of healthcare, particularly in cases where mild symptoms may progress to more severe conditions. The potential of TCM to mitigate the progression of mild cases to severe stages aligns with the overarching goal of reducing the burden on healthcare systems and improving overall public health outcomes. As we navigate through the global challenge posed by the COVID-19 pandemic, the presented cases prompt a reevaluation of the conventional boundaries between traditional and Western medicine. The recommendation for further research, particularly with larger sample sizes, aims to strengthen the evidence base for the efficacy of TCM. Collaborative efforts between traditional and Western medical practitioners can foster a synergistic approach that capitalizes on the strengths of both systems.
4. Conclusion
Public health awareness regarding the benefits of early intervention with TCM, coupled with an understanding of syndrome/pattern differentiation, is pivotal. Advocacy for continued policy support ensures that regulatory frameworks adapt to accommodate integrative healthcare practices. Additionally, global collaboration in research and knowledge-sharing can contribute to a more comprehensive understanding of the potential applications of TCM in managing infectious diseases. In conclusion, the experiences documented in these cases offer a glimpse into the promising intersection of TCM and conventional medicine. The positive outcomes underscore the need for a nuanced and integrated approach to healthcare that embraces the strengths of diverse medical traditions. The journey towards a more holistic and patient-centric healthcare system may well involve the thoughtful integration of time-tested practices like TCM alongside modern medical advancements.
5. Limitation
In the course of examining the potential efficacy of TCM in the treatment of mild COVID-19 cases, it is essential to acknowledge several limitations that temper the extent to which these findings can be applied to a broader context. First and foremost, this study's primary limitation lied in its small sample size, consisting of only five cases. While these cases provided valuable insights, the limited number of participants restricted the ability to draw definitive and universally applicable conclusions. Larger-scale studies involving more diverse cohorts are crucial to validating and generalising the observed outcomes. Furthermore, the study focused on patients from a single center, specifically in Johannesburg. The homogeneity of the sample, both in terms of geography and demographics, introduces a potential bias and limits the external validity of the results. Variation across different regions and populations must be considered for a more comprehensive and representative understanding. The absence of a control group receiving conventional medical treatment alone is another significant limitation. This absence hinders the ability to attribute the observed positive outcomes solely to the TCM intervention. Comparative studies, including control groups undergoing standard Western medical treatments, are essential to discern the specific contribution of TCM.
Acknowledgement
The author would like to express his sincere thanks to Prof Xingyu Zheng from the Fujian Provincial Hospital, Fuzhou, China, for his guidance in the analysis of treatments.
Author’s Disclosure Statement
The study wasn’t funded by any organization or institution. The author declared that she had no financial or personal relationships that might have inappropriately influenced her in writing this article.
Declaration
The author declared no conflicts of interest.
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