Author: XUE Shasha; Editor in charge: CUI Xuan
Translator: COVID-19 Readings
The term “three medicines and three prescriptions” originated from a press conference held by the State Council Information Office on March 23, where “three medicines” refers to Lianhua Qingwen Capsules (Granules), Jinhua Qinggan Granules and Xuebijing Injection (drug components attached at the bottom of the article – COVID-19 Readings).
Recently, these three drugs have become the first batch of drugs to be approved for new indications for COVID-19 in China. The related announcements attracted public attention as soon as they were issued.
This is not the first time the three drugs have received attention. As early as in early February, they were all included in the “Novel Coronavirus Pneumonia Diagnosis and Treatment Program” (Trial Version 4). Since then, they have been included in multiple versions of the program and the clinical diagnosis and treatment of patients with COVID-19.
Lianhua Qingwen in the “Three Medicines” was developed for the treatment of “SARS”, and Jinhua Qinggan Granules were developed in response to the 2009 H1N1 influenza.
In the prevention and control of the COVID-19 epidemic, the “Three Medicines” played an important role, and as a result, they became highly sought-after, their sales increased significantly, and there were even shortages.
An expert in traditional Chinese medicine said in an interview with The Paper (www.thepaper.cn) on April 17 that although the three drugs can all treat COVID-19, they correspond to different symptoms and should be applied according to the specific symptoms. People who have no symptoms or are not infected with COVID-19 should not take these drugs, nor can they “prevent” COVID-19 by taking these three “treatment” drugs. The three drugs being approved for new indications for COVID-19 will provide a boost for Chinese medicine to go global. However, for Chinese medicine to be truly recognized internationally, there is still a long way to go.
Three Chinese Patent Medicines Approved for Adding Indication for COVID-19
“Given the important role played by the ‘Three Medicines’ in this epidemic and the favorable evidence obtained, the State Drug Administration has approved to add the treatment of COVID-19 into the indications of the three medicines.” Li Yu, director of the Science and Technology Department of the State Administration of Traditional Chinese Medicine, said so in the press conference on the afternoon of April 14.
The relevant approval documents issued by the State Drug Administration respectively state:
Approval of Lianhua Qingwen Capsules (Granules) Instructions [Functional Indications] item to add “Routine treatment of COVID-19, can be used for fever, cough, and fatigue caused by mild or regular COVID-19”; [Usage and Dosage] item to add “COVID-19 mild or regular case treatment course 7-10 days.”
Approval of Xuebijing Injection Instructions [Functional Indications] item to add “can be used for COVID-19 severe and critical case systemic inflammatory response syndrome or / and multiple organ failure”; [Usage and Dosage] item to add “for COVID-19: 100ml diluted with 0.9% sodium chloride injection 250ml, twice a day”.
Approval of Jinhua Qinggan Granules [Functional Indications] item to add “in routine treatment of COVID-19, can be used for fever, cough, and fatigue caused by mild or regular COVID-19” in addition to the original approved content; [Usage and Dosage] to add “COVID-19 mild or regular case: 1 to 2 bags at a time, 3 times a day. The course of treatment is 5 to 7 days” in addition to the original approved content.
The Paper looked into the instructions for the three Chinese patent medicines and noted that their functions all include “clearing heat and removing toxins”, which is suitable for fever symptoms. Among them, Lianhua Qingwen Capsules also treats “chills, muscle soreness, nasal congestion, runny nose, cough” etc.; Xuebijing Injection also treats wheezing, heart palpitations, infection-induced systemic inflammation etc.; the functions of Jinhua Qinggan Granules also include treating “red and sore throat, nasal congestion, runny nose, thirst” etc..
Information from the State Drug Administration shows that Lianhua Qingwen Capsules, Granules and Tablets are exclusive patent products from Shijiazhuang Yiling Pharmaceutical Co., Ltd. (hereinafter referred to as: Yiling Pharmaceutical) and its wholly-owned subsidiary Beijing Yiling Pharmaceutical Co., Ltd.; Xuebijing injection is produced by Tianjin Chase Sun Pharmaceutical Co., Ltd. (hereinafter: Chase Sun Pharmaceutical); Jinhua Qinggan Granules is an exclusive product from Juxiechang (Beijing) Pharmaceutical, a subsidiary of Beijing Yushengtang Sinopharm Holding Co., Ltd.
The Paper noted that since news of the approval was announced, as of April 17, Yiling Pharmaceutical and Chase Sun Pharmaceutical, as publicly listed companies, had reached the maximum daily trading limit for three consecutive days.
Lianhua Qingwen “Born for SARS”
Lianhua Qingwen was developed for the treatment of SARS.
A department head of Yiling Pharmaceutical told The Paper on April 15 that when the SARS epidemic broke out in 2003, Wu Yiling, an academician of the Chinese Academy of Engineering and founder of Yiling Pharmaceutical, started research and development of new drugs for the corresponding symptoms.
According to the department head, Lianhua Qingwen Capsules and Granules combined the prescriptions from three ancient dynasties, Zhang Zhongjing’s “Maxing Shigan Soup” from the Han Dynasty, Wu Youke’s “Rhubarb” for epidemic diseases from the Ming Dynasty, Wu Jutong’s “Yinqiao San” from the Qing Dynasty. It is developed by combining traditional Chinese medicines found to be effectively antiviral, anti-inflammatory, cough suppressing, phlegm loosening and immunity enhancing by modern scientific research. Related experiments confirmed that Lianhua Qingwen Capsules has an inhibitory effect on the SARS virus. Soon afterwards, Lianhua Qingwen Capsules entered the green channel for the rapid approval of new anti-SARS drugs.
After the SARS epidemic ended, Lianhua Qingwen turned to the battle against influenza.
The department head said that in the view of Chinese medicine, influenza and SARS both belong to the category of “external fever”, which is what the Chinese medicine called “the plague”. Experiments by the Chinese Academy of Chinese Medical Sciences have confirmed that Lianhua Qingwen can inhibit influenza virus H3N2, parainfluenza virus type I, respiratory syncytial virus, and adenovirus.
In May 2004, Lianhua Qingwen Capsules passed the review of the State Drug Administration and other departments, obtained the new drug certificate and production approval, and became a new member of China’s anti-influenza drugs.
The Paper found that Lianhua Qingwen Capsules (Granules) has been included in national diagnosis and treatment programs more than 20 times as a recommended drug, including “Novel Coronavirus Pneumonia Diagnosis and Treatment Program” (Trial Versions 4 to 7).
Similar to Lianhua Qingwen, Jinhua Qinggan Granules were also “born due to disease”.
According to Caixin.com, in April 2009, influenza A H1N1 which originated from North America became widespread. In June, the Beijing municipal government launched scientific research on using traditional Chinese medicine to treat this type of influenza. In December of that year, the Beijing Municipal Information Office announced “an effective method for the treatment of Influenza A H1N1 ‘Jinhua Qinggan Formula’”, which subsequently evolved into today’s “Jinhua Qinggan Granules”.
“Three Medicines” Sales May Yet Grow
Because of the extraordinary performance in the clinical treatment of COVID-19, coupled with the affirmation of experts that these three drugs are effective for treating COVID-19, they have become “sought-after drugs” this year.
Being “sought-after” directly brings sales.
“January to March 2020, the net profit increased by 50% to 60% over the same period of the previous year.” On March 31, Yiling Pharmaceutical disclosed in a performance preview for the first quarter of 2020 on the Shenzhen Stock Exchange’s official website that the net profit of Lianhua Qingwen products increased significantly compared with the same period last year.
The aforementioned department head of Yiling Pharmaceutical disclosed that in order to ensure supply, the company has urgently adjusted its production plan according to market demand since late January, and devoted all production lines to produce Lianhua Qingwen products around the clock, reaching a maximum daily production capacity of 50 million capsules and over 2 million bags of granules, while temporarily relying on the company’s finished product inventory and commercial channel inventory to meet the market demand for other products.
The department head said that after nearly 40 days of “production rush”, currently the shortage in the Lianhua Qingwen market has eased. Now the main bottleneck in production is the extraction capacity of medicinal materials. The company follow-up plan is to invest in a production base in Hengshui City, Hebei Province. The first phase will prioritize building an extraction workshop to alleviate the company’s current bottleneck in extraction capacity.
In addition to being approved for the addition of COVID-19 indication, the State Drug Administration issued an announcement on April 8 that in order to meet the needs of COVID-19 epidemic prevention and control, Jinhua Qinggan Granules will be converted from prescription only drugs to type A over-the-counter drugs.
This means that Jinhua Qinggan Granules can enter pharmacies for retail like Lianhua Qingwen Capsules; meanwhile Lianhua Qingwen Granules (Tablets) and Xuebijing are prescription drugs, which need to be purchased with a prescription or doctor’s order.
Hongri Pharmaceutical’s April 9 performance announcement for the 2020 first quarter also stated that the company’s main product, Xuebijing Injection, as an epidemic medicine, its sales volume increased significantly over the same period of the previous year.
The Paper noted that as of the market close on April 14, Yiling Pharmaceutical (stock code: 002603) had reached the daily limit, with a stock price of 31.32 yuan; as of the market close on the 15th, the price was 34.45 yuan, which also hit the daily limit. Yiling Pharmaceutical had managed to reach the daily limit on three consecutive days.
At the same time, on April 14, Chase Sun Pharmaceutical (stock code: 300026) was quoted for 5.40 yuan, with the stock price up 3.85%. This year, the stock’s cumulative increase has reached 53.85%, and by April 17, it had also achieved the maximum daily limit for three consecutive days.
Expert: There Is Still A Long Way to Go for Traditional Chinese Medicines to Be Recognized Internationally
Liu Baoyan, former executive vice president of the Chinese Academy of Chinese Medical Sciences and director of the Chinese Medicine Data Center, told the Paper on April 17 that during the epidemic, he and Wuhan front-line researchers collaborated on using COVID-19 patients in Wuchang District as the sample and relying on the Internet to understand the patients’ medication situation. The data showed that among the types of medicines taken by patients, Chinese patent medicines took the first place, accounting for 35.99%.
Liu Baoyan explained that the three drugs with newly added COVID-19 indications are all medicinally bitter and cold, suitable for “clearing heat and removing toxins”. Among them, Jinhua Qinggan Granules can treat patients with fever faster than other drugs, mainly suitable for early and mild patients; Lianhua Qingwen can also treat cough and relieve lung inflammation; Xuebijing Injection can also protect the patient’s organs from damage and can be used for severe and critically ill patients.
“‘All medicines are 30% poison’. Each medicine has its own indications. This is especially true of traditional Chinese medicine. Different people may have different reactions to the same medicine.” Liu Baoyan said that although all three medicines can treat COVID-19, they should be applied according to the specific symptoms as much as possible.
In previous interviews, The Paper reporters had learned that some residents, despite not having contracted COVID-19, thought that drugs such as Lianhua Qingwen could prevent infection, bought and took them on their own.
In this regard, Liu Baoyan particularly reminded residents who have no symptoms and are not infected with COVID-19 should not take these drugs, nor can they “prevent” COVID-19 by taking three “treatment” drugs.
“If you take these medicines without getting sick, it will damage the stomach and the body’s yang qi.” He suggested that if residents are worried about infection, they can take medicines that strengthen the body and strengthen their immunity according to their own physical characteristics, for example, for someone with bad spleen and stomach, it is necessary to use drugs to regulate the spleen and stomach. In addition, sleeping on time, eating regularly, and exercising regularly can all enhance the body’s immunity. “You don’t have to take medicines.”
COVID-19 is spreading in many countries around the world. These three drugs being approved for new indications for COVID-19 should provide a boost for Chinese medicine to go global. But in Liu Baoyan’s view, there is still a long way to go before Chinese medicine can be truly recognized internationally. He said frankly that some countries have strict approvals for medicines. If they want to enter the medicine shelves in other countries, they must first obtain approvals. At the same time, foreign medicines are mostly single-component medicines, while traditional Chinese medicines are mostly multi-component medicines. Foreigners generally tend to worry about the side effects of traditional Chinese medicines. In addition, people from some countries have fairly large biases in the understanding of traditional Chinese medicine, which also presents as an obstacle for traditional Chinese medicine to go global.
Lianhua Qingwen Capsules components:
连翘 Forsythia suspensa, 金银花 Lonicera japonica Thunb., 炙麻黄 Ephedra sinica Stapf, 炒苦杏仁 Fried bitter almonds, 石膏 Gypsum, 板蓝根 Isatis indigotica L. root, 绵马贯众 Dryopteris crassirhizoma Nakai, 鱼腥草 Houttuynia cordata, 广藿香 Patchouli, 大黄 Rhubarb, 红景天 Rhodiola rosea, 薄荷脑 Menthol, 甘草 Glycyrrhiza uralensis
Jinhua Qinggan Granules components:
金银花 Lonicera japonica Thunb., 浙贝母 Fritillaria thunbergii, 黄芩 Scutellaria baicalensis, 牛蒡子 Arctium lappa L., 青蒿 Artemisia annua, etc.
Xuebijing Injection components:
红花 Carthamus tinctorius L., 赤芍 Paeonia veitchii Lynch, 川芎 Ligusticum chuanxiong Hort, 丹参 Salvia miltiorrhiza, 当归 Angelica sinensis