Author: Yili Hu, Huyun Dong
Viral respiratory diseases are highly infectious diseases that seriously endanger human health. According to incomplete statistics, approximately 70-80% of epidemic diseases are caused by viral infections (1). In recent years, viral genome mutations and the emergence of new virus strains, such as SARS in China in 2003, H1N1 in 2009, H7N9 in 2013, and COVID-19 in many countries in the world since 2019, have caused great damage and death to human beings. Furthermore, the emergence of new viral strains and virus mutations, combined with the lagging behind of the research on effective medicines and vaccines, have posed huge challenges to human prevention and treatment. It is of great significance both for human health and the development of the social economy to study on how to improve immunity, prevent infections by such infectious diseases, and protect the susceptible population.
In order to effectively investigate the broad-spectrum Chinese herb-medicine preparations for the prevention of viral respiratory diseases, we collected cases from Dr. XiangqiuLiu who prevented 230 subjects from a school in March 2018 and 68 subjects from a senior care institution in November 2018 from contracting influenza A (H1N1) and prevented COVID-19 infections in 49 subjects who had been exposed to patients with COVID-19 in February 2020. Moreover, we set up contrast groups. According to the results, the addition/reduction of “Hezhengquwen” Granules according to the basic prescription had a favorable effect on the prevention of viral respiratory infectious diseases.
1. Data
1.1 General Data
There were 230 subjects (92males and 138 females)in the influenza A (H1N1)prevention observation group of the school, whose ages ranged from 15 years old to 59 years old, with an average age of 18.6 years old. There were 89 subjects (36 males and 53 females) in the control group (Youth Sports School in the same city), whose ages ranged from 13 years old to 58 years old, with an average age of 16.9 years old.
There were 68 subjects (27 males and 41 females) in the influenza A (H1N1)prevention observation group in the institution for the aged, whose ages ranged from 60 years old to 91 years old, with an average age of 81.4 years old. There were 55 subjects (22 males and 33 females) in the control group (another institution for the aged in the same city), whose ages ranged from 57 years old to 89 years old, with an average age of 80.3 years old.
There were a total of 49 subjects (31 males and 18 females) in COVID-19 prevention observation group in the designated medical institution, whose ages ranged from 9 years old to 60 years old, with an average age of 35.6 years old. There were 63 subjects (35 males and 28 females) in the control group (another designated medical institution in the same city), whose ages ranged from 12 years old to 65 years old, with an average age of 37.7 years old.
The data of the above observation and the control groups were comparable, with no significant difference.
1.2 Selection Criteria
The selection criteria for influenza A (H1N1)prevention subjects of the schools is that the local disease control and prevention center confirmed that there was H1N1 epidemic in the local area, and local outbreaks of influenza A (H1N1) had been seen in some schools and kindergartens. Subjects of the observation and the control groups were all resident teachers and students of the schools in the same city.
The selection criteria of influenza A (H1N1) prevention subjects in the institutions for the aged were that the institutions of both the observation and the control groups had H1N1 outbreaks. Meanwhile, there were death cases with complicated underlying diseases. All the subjects were the cared and working staff in the same city.
The selection criteria of subjects who were prevented from infections after exposure to patients with COVID-19 were subjects who had been in contact with COVID-19 patients or who had returned from trips to heavily affected cities as shown by the epidemiological investigations. They were two government-designated observation points in the same city.
2. Prevention Methods
The Observation group: Independently-made “Hezhengquwen” Granules were taken as the basic prescription for addition/reduction. The basic prescription consisted of the following Chinese herbal medicinal ingredients: Astragali Radix of 15g, Ganoderma Spore Powder of 3g, Siberian Ginseng of 10g, Underleaf Pearl of 10g, LoniceraeFlos of 12g, Trollius Chinensis Bunge of 10g, Isatis Leaf of 10g, Woad Root of 10g, Patchouli of 10g, Forsythia Fruit of 10g, Centellae Herba of 10g, Aged Tangerine Peel of 10g, Giant Knotweed of 15g, Reed Rhizome of 15g, Licorice Root of 3g, and Zingiberis Rhizoma Recens of 3g.
Addition/reduction: Reduction of Trollius Chinensis Bunge of 10g, Isatis Leaf of 10g, Centellae Herba of 10g, and Giant Knotweed of 15g from the basic prescription should be taken for subjects over 60 years old with underlying diseases. Reduction of Ganoderma Spore Powder of 3g, Siberian Ginseng of 10g, Underleaf Pearl of 10g, Trollius Chinensis Bunge of 10g, Centellae Herba of 10g, Giant Knotweed of 15g and Zingiberis Rhizoma Recens of 3g from the basic prescription should be carried out for subjects below 16 years old. The above dose was a daily dose, taken half an hour after meals in the morning and evening. The duration of the medication was 10 days.
The control group: Subjects received the Woad Root Granules a pack once, three times per day taken half an hour after meals. The duration of the medication was 10 days. Or subjects didn’t receive any medicine.
The observation periods of both groups were 14 days.
3. Observation Result
3.1. Among 230 subjects in influenza A (H1N1) prevention observation group in the school, 2 subjects had influenza A (H1N1) infections, with an Uninfected prevention rate of 99.1% and an Infected rate of 0.87%. There were 89 subjects in the control group, 12 of whom infected by influenza A (H1N1). The Uninfected rate of prevention was 86.5% and the Infected rate was 13.48%. The results were shown as follows in Table 1.
3.2. There were a total of 68 subjects in the influenza A (H1N1) observation group of the institution for the aged(Since one subject died of sudden severe arrhythmia and was excluded from the observation group, there were actually 68 subjects), two of whom had a fever and were diagnosed with influenza A. The Uninfected rate of prevention was 97% and the incidence rate of influenza was 2.94%. There were 55 subjects in the control group, 7 of whom were infected by influenza A (H1N1). The effective rate of Uninfected was 87.27% and the incidence rate was 12.72%. The results were shown as follows in Table 2.
3.3. In a total of 49 subjects who were prevented from infections after exposed to patients with COVID-19 in the observation group, none was infected, with the effective prevention rate of 100%. Of the 44 subjects in the control group, one subject was attacked and confirmed as infection by COVID-19, with the Uninfected prevention rate of 97.72% and the incidence rate of 2.27%. The results were shown as follows in Table 3.
No adverse reactions were observed in the above observation groups for prevention.
4. Discussions
Viral respiratory diseases are multiple organ lesions taking the respiratory tract as a portal to invade, which are viral infectious diseases transmitted primarily by respiratory droplets. In particular, the elderly, the adults with decreased resistance, or having no virus immunity are at a high risk of infections. A large number of people from all sectors of society may be attacked by such diseases which are with great damage. Currently, there is no effective method for the treatment of viral respiratory infections through western medicine treatment, especially for the new onset of viral respiratory infections. However, valuable experience has been accumulated for Traditional Chinese Medicine (TCM) in the prevention of such infectious diseases since ancient times. The idea of “prevention before the onset of diseases” in TCM has long been established. Viral respiratory diseases, such as H1N1, SARS, and COVID-19, fall under the category of “plagues” and “epidemic diseases” in TCM. The deficiency of vital qi and weakness of spleen and stomach are the main internal causes of the diseases. Active and effective preventive measures should be taken to prevent epidemic diseases. Not only should we pay attention to the infections of the epidemic diseases, but also we should attach importance to the internal factors of vital qi of the human body. It is definitely effective to prevent viral respiratory infections with TCM(1), the main function of which is not to target the corresponding pathogens, but to improve the overall state of the body and reduce the pathological damage, thus playing the role of non-specific treatment (2). Meanwhile, TCM acts on multiple targets, which is not easy to produce drug resistance, and has no or few adverse reactions. In the “Hezhengquwen prescription, Astragali Radix is used for invigorating qi for strengthening superficies (4), Ganoderma Spore Powder for invigorating the deficiency of the five internal organs (heart, liver, spleen, lungs, and kidneys) (5), Siberian Ginseng for boosting essence and strengthening the spleen (6), and Aged Tangerine Peel for strengthening the spleen and moistening the lungs, and promoting the circulation of qi and resolving phlegm (7). Modern pharmacology research shows that all the above Chinese herbs are provided with a favorable effect on multiple immune system links, enhancing the immune function of the body (4) (5) (6) (7). LoniceraeFlos, Trollius Chinensis Bunge, Isatis Leaf, and Woad Root have the effect of clearing away heat and toxic materials (8) (9) (10) (11); Patchouli, Forsythia Fruit and Zingiberis Rhizoma Recens are provided with the effect of relieving exterior syndrome and resolving dampness (12) (13) (14); Giant Knotweedhas the effect of clearing heat and promoting dieresis, and relieving cough and reducing sputum(15). Moreover, Centellae Herba and Underleaf Pearl are provided with the effect of clearing heat and promoting dieresis, and removing toxicity for detumescence(16) (17); Reed Rhizome has the effect of removing heat to promote salivation(18), and GlycyrrhizaeRadix Et Rhizoma is provided with the effect of coordinating the drug actions of the prescription. Pharmacological studies have shown that the above Chinese herbal medicinal ingredients have broad-spectrum bidirectional functions of antiviral or viral inhibition and regulation of immune functions (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18). The prescription on the whole plays the function of strengthening healthy energy and the exterior, invigorating the spleen to promote the secretion of saliva or body fluid, clearing away heat and toxic materials, and inducing mild diaphoresis and reducing the dampness. Not only can it be used to improve body immunity, protect the lung, heart, liver, and other important organ functions, but also it can be utilized to inhibit or resist the invasion of the virus. Worn out with age and gradually weak in Yang, the aged over 60 years old should be treated with the basic prescription with the reduction of the cold and cool ingredients including Trollius Chinensis Bunge, Isatis Leaf, Centellae Herba, and Giant Knotweed. At the early stage of Yin and of Pure Yang, subjects below 16 years old should receive the basic prescription with the reduction of Ganoderma Spore Powder of 3g, Siberian Ginseng of 10g, Underleaf Pearl of 10g, Trollius Chinensis Bunge of 10g, Centellae Herba of 10g, Giant Knotweed of 15g and Zingiberis Rhizoma Recens of 3g, so as to simplify the medicines and seek for the maximum treatment effect. This study shows that the addition and reduction of “Hezhengquwen” Granulesis provided with a significant effect on the prevention of the representative viral respiratory infectious diseases including influenza A (H1N1) and COVID-19, and is worthy of further promotion.
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