Chinese herbal medicine and COVID-19: quality evaluation of clinical guidelines and expert consensus and analysis of key recommendations

Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.

What Has Been Overlooked on Study of Chinese Materia Medica in the West?

Chinese materia medica （CMM）, including Chinese herbal, animal, and mineral medicine, has been widely researched in the past century for their biological and pharmacological activities. However, their mechanism and clinical efficacy studies did not always give expected results. For example, the most commonly used Chinese herb for menstrual disorders, Radix Angelicae sinensis, showed neither estrogenic nor progesteronic activity in laboratory and clinical studies. Its efficacy should not be denied simply based on such results, because it is mostly used together with other herbs in formulae. Moreover, its regulation on menstruation may take effect through other mechanisms, such as regulation of blood circulation. The key difference of Chinese medicine （CM） from conventional medicine is its unique holistic view on human body and diseases. CMM is mostly applied in clinic in the form of formulae. Study on individual CMM, simply using methods for development of conventional drugs, is unable to thoroughly reveal the power of CMM formulae. The reason may partly result from improper design due to the lack understanding about application principle of CMMs in CM, and/or to current lack of knowledge about the causes of some symptoms and diseases. This paper will introduce the importance of qi and blood in CM etiology and pathology, Zheng differentiation, formulation of CMMs, and explain why one formula can treat different diseases and one disease can be treated with different formulae. Examples in the paper will demonstrate that proper studies on Zheng and its corresponding clinically proven formulae could help scientists find new direction to explain and treat symptoms and diseases that so far modern medicine has been unable to, provided that the designer properly understands CM theories, etiology and pathology of CM, as well as modern medicine. Strategy suggestions about research methods for CMM and its formulae will be given at the end.