Lianhua Qingwen

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Lianhua Qingwen
Alternative medicine
ClassificationTraditional Chinese medicine (TCM)
ModalityCapsule and granular
ClaimsTreatment against various respiratory diseases including influenza, severe acute respiratory syndrome, and COVID-19
Year proposed2003
Original proponentsShijiazhuang Yiling Pharmaceutical

Lianhua Qingwen (连花清瘟, LHQW) is a traditional Chinese medicine (TCM) formulation used for the treatment of influenza.[1] In the practice of TCM, LHQW is considered to have the effects of clearing excessive heat, removing toxins, improving lung ventilation, and discharging heat.[2]

Background[edit]

Lianhua Qingwen was developed by Shijiazhuang Yiling Pharmaceutical in 2003 as a treatment for severe acute respiratory syndrome (SARS) following the outbreak of the disease in 2002 and was listed by the National Health Commission of China in 2004 as a treatment for influenza and other respiratory disease.[3] Its formulation includes 13 herbs which is said to have been used for medical purposes as early as the Han dynasty.[4]

Sources of its formulation reportedly consist of:[5]

The medicine is both in capsule and granular form.[3][6]

Contraindication[edit]

Lianhua Qingwen should be avoided for patients with G6PD deficiency, since its active ingredient, Lonicera japonica, will lead to hemolysis to such patients.

Adverse effects[edit]

The official monograph of LHQW states that the adverse effects are "unclear".[7] A January 2022 meta-analysis from China reports that it may cause GI discomfort, rashes and itches, dry mouth, and dizziness, but emphasizes that the effects are more common with "conventional treatment".[8]

Uses and controversies of Lianhua Qingwen in relation to COVID-19, by region[edit]

In China[edit]

During the COVID-19 pandemic, the government of the People's Republic of China (PRC) approved the use of Lianhua Qingwen for mild to moderate COVID-19 cases in January 2020, and promotes the use of the medicine abroad.[3][9]

In March 2022, during the Shanghai COVID-19 outbreak, the medication was distributed en masse to residents. Reports emerged indicating that this process consumed significant logistical capacity, drawing criticism about misuse of resources at a time when people were struggling with shortages of basic needs such as food and medication. An article on telemedicine and medical news platform Dr. Clove pointed out that there was no scientific evidence available to indicate that LHQW was effective as prophylaxis to prevent infection, nor did there exist any official government recommendation for such usage; instead, taking the drug unnecessarily carried a risk of side effects. It argued that there was thus no reasonable basis for the mass distribution of the medication to healthy individuals to begin with, let alone doing so in a way that took up transportation capacity and resources that were urgently needed elsewhere.[7]

Lianhua Qingwen has also been promoted and distributed by the government in Hong Kong (HK).[10]

Conflict of Interest Controversy[edit]

In April 2022, the Financial Times reported that the leading COVID-19 health official in the PRC, the famous epidemiologist and pulmonologist Zhong Nanshan - who has also been the most prominent scientific promoter of Lianhua Qingwen - had undisclosed prior investments in large stakeholdings in corporations producing Lianhua Qingwen and other treatments under question. As the Financial Times report showed, these appeared to be serious conflicts of interest as the investments benefited from the PRC and HK governments' rapid approval and then widespread national & international promotion of Lianhua Qingwen and other suspect treatments for purportedly helping COVID-19 sufferers.[11]

Elsewhere in Asia[edit]

In the Philippines, its Food and Drug Administration approved Lianhua Qingwen on 7 August 2020 as a traditional herbal product that helps remove "heat-toxin invasion of the lungs, including symptoms such as fever, aversion to cold, muscle soreness, stuffy and runny nose". It is not registered as a COVID-19 medication, and a doctor's prescription is required for its use.[12][13] A Filipino TCM physician interviewed by ABS-CBN clarified that although the medicine can be used for symptomatic treatment of flu-like symptoms in COVID-19 patients, it is not an antibiotic nor anti-viral, and cannot cure the disease itself. It cannot be taken as prophylaxis or as a health supplement.[14]

In Singapore, the Health Sciences Authority has issued an advisory to clarify that although it has been approved for sale as a Chinese proprietary medicine for the relief of cold and flu symptoms, Lianhua Qingwen is not approved to treat or alleviate symptoms of COVID-19. It warned that sellers who make claims that it can prevent, protect against or treat COVID-19 may face prosecution.[15]

North America[edit]

Although the medicine has been allowed to be sold in Canada since 2012, Health Canada has cautioned against the use of the Chinese traditional medicine to prevent, treat, and cure COVID-19.[6] In the United States, the FDA is advising consumers not to purchase or use Lianhua Qingwen, stating that it has not been approved or authorized by FDA and is being misleadingly represented as safe and/or effective for the treatment or prevention of COVID-19.[16]

Australia[edit]

In Australia, the Therapeutic Goods Administration has not given approval to Lianhua Qingwen, as it contains ephedra, a key ingredient used to make the drug methamphetamine. Despite the ban, Lianhua Qingwen has been sold illegally in Australia as a COVID-19 treatment.[17]

References[edit]

  1. ^ Shen X, Yin F (October 2021). "The mechanisms and clinical application of Traditional Chinese Medicine Lianhua-Qingwen capsule". Biomedicine & Pharmacotherapy. 142: 111998. doi:10.1016/j.biopha.2021.111998. PMC 8352581. PMID 34385103.
  2. ^ Jia, Zhenhua; Wu, Yiling (2021-04-01). "Clinical applications and pharmacological research progress of Lianhua Qingwen capsules/granules". Journal of Traditional Chinese Medical Sciences. 8 (2): 101–109. doi:10.1016/j.jtcms.2021.05.001. ISSN 2095-7548. S2CID 236600045.
  3. ^ a b c "Traditional Chinese cures battle for acceptance in COVID-19 fight". Nikkei Asia. 8 May 2020. Retrieved 6 March 2021.
  4. ^ "Chinese traditional medicine for Covid-19 becomes money tree". South China Morning Post. 29 June 2020.
  5. ^ Hu, Caiyun; Liang, Mingming; Gong, Fengfeng; He, Bin; Zhao, Dongdong; Zhang, Guoliang (2020-09-17). "Efficacy of Lianhua Qingwen Compared with Conventional Drugs in the Treatment of Common Pneumonia and COVID-19 Pneumonia: A Meta-Analysis". Evidence-Based Complementary and Alternative Medicine. 2020: 5157089. doi:10.1155/2020/5157089. ISSN 1741-427X. PMC 7501551. PMID 32963563.
  6. ^ a b Szeto W (8 May 2020). "Doctors warn against claims that Beijing-touted health supplement distributed in Canada treats COVID-19". CBC News. Retrieved 6 March 2021.
  7. ^ a b 不要吃连花清瘟预防新冠 [Do not take LHQW for prevention of COVID-19]. 丁香医生 [Dr. Clove]. 2022-04-17.
  8. ^ Hu, Caiyun; He, Bin; Gong, Fengfeng; Liang, Mingming; Zhao, Dongdong; Zhang, Guoliang (27 January 2022). "The Adverse Reactions of Lianhua Qingwen Capsule/Granule Compared With Conventional Drug in Clinical Application: A Meta-Analysis". Frontiers in Pharmacology. 13: 764774. doi:10.3389/fphar.2022.764774. PMC 8830515. PMID 35153773.
  9. ^ Mai J, Lo K (23 March 2020). "Beijing pushes traditional Chinese medicine as coronavirus treatment". South China Morning Post. Retrieved 6 March 2021.
  10. ^ McGregor, G (23 April 2022). "'More political than scientific': Beijing's peddling of traditional Chinese medicine may be undermining its COVID response". Fortune. Retrieved 25 April 2022.
  11. ^ Riordan, P, Li, G, Ho-him, C, Lockett, H (25 April 2022). "China Covid-19 tsar pushed treatments without revealing business ties". Financial Times. Retrieved 25 April 2022.
  12. ^ "DOH and FDA Clarify Claims on the Approval of Potential COVID-19 Treatments and Calls for Resignation of the SoH". Republic of the Philippines Department of Health. 5 April 2021. Retrieved 17 February 2022.
  13. ^ Montemayor T (April 5, 2021). "'Lianhua Qingwen' registered but not as Covid medication". Philippine News Agency. Retrieved 17 February 2022.
  14. ^ Nieva-Nishimori A (18 August 2020). "Lianhua Qingwen, the FDA-approved traditional Chinese med, only treats symptoms, not COVID". ABS-CBN News. Retrieved 6 March 2021.
  15. ^ "HSA Advisory on Lianhua Qingwen Products for Prevention or Treatment of COVID-19". Health Sciences Authority. 17 November 2021. Retrieved 17 February 2022.
  16. ^ Office of Regulatory Affairs (22 July 2021). "Fraudulent Coronavirus Disease 2019 (COVID-19) Products". U.S Food and Drug Administration.
  17. ^ Gong N (17 February 2022). "Chinese medicine Lianhua Qingwen makes its way into community for COVID-19 treatment despite Australian ban". ABC News (Australia). Retrieved 28 March 2022.