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Traditional Chinese medicine (TCM) has thousands years history. It has unique basic theories and diagnostic methods. It is a very effective therapy in treating many chronic diseases and some acute diseases. If you are interested in TCM, welcome to pop in to this TCM forum, let's discuss on any topic about Chinese herbal medicine and acupuncture. If you have any health problem, you are welcome to visit my clinic Knowhow Acupuncture at 1 Harley street, London. If you are far away from London, you can pop in my online clinic to get some help. If you like this blog please share it to your friends.

Thursday, 5 March 2020

Systematic Review of Modified Yupingfeng San and its Potential Effects on Covid 19

Tiejun Tang

Yupingfeng San (YPF) is the most commonly used formula for prevent disease in the history of traditional Chinese medicine. It consists of three ingredients. They are Huangqi (Astmgali Radix), Baizhu ( Largehead Atractylodes Rh) and Fangfeng (Divaricate Saposhniovia Root.). It has been widely used in China since the Yuan dynasty (1217 AD). According to traditional Chinese medicine philosophy, this formula can build up healthy Qi and to prevent invasion of external evils. In Chinese “Yupingfeng mean jade screen and San mean powder. Is it possible to use YPF to prevent and treat Covid 19? Is there any scientific research evidence to support the clinical application of this classical formula? This paper aimed to answer these questions by systematic review.

Methods

Database includes PubMed, MEDLINE, CNKI, CSCD. Use Yupingfeng as key word.

Search time limit is from 2000-2020. All the Included articles were published in English.

Results

1.    Immunoregulatory and anti-inflammatory function

Inflammatory cytokine storm is very important pathological change of Covid 19.

To observe the Immunoregulatory and anti-inflammatory effects of YPF, Song J. applied YPF to treat a rat chronic bronchitis model. The results showed that the inflammation in the pulmonary tissue and the bronchus of rats was significantly reduced in the treatment groups.  In serum samples collected at different times from rats after administration of YPF, the result showed increased proliferation of splenic lymphocytes area. They use serum samples of YPF group to treat alveolar macrophages. The result found interleukin-8 (IL-8) in the cell culture media has been inhibited [1].

IL-8 plays an important role in the pathogenesis of bronchitis and cystic fibrosis. It also is a very important pathological factor in the cytokine storm of Covid 19 [2]. To investigate the immunomodulating mechanism of YPF, Sun H applied YPF polysaccharides to treat mice lymphocytes and macrophages. The results showed YPF polysaccharides effectively enhanced the proliferation of lymphocytes and promoted mRNA expression of inducible nitric oxide synthase (iNOS), IL-6, TNF-α, INF-γ, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and TLR-4 in lymphocytes and macrophages. Moreover, it can effectively normalized cell proliferation and down regulated mRNA expression levels of pro-inflammatory cytokines, NF-κB, TLR-4, and iNOs in chronic inflammation cells [3]. These cytokine factors all play important role in the chain reaction of Covid 19 cytokine storm [2].

2.    Anti-virus effect function

Coronavirus is the pathogen of Covid 19. The anti-virus effect of YPF was approved by some laboratory researches. To investigate the antivirus effect of YPF, Liu Q. applied real-time RT-PCR and western blotting technique to detect influenza virus (IFV) and the human respiratory syncytial virus (HRSV). The result showed YPF extract inhibited both IFV and HRSV in a dose-dependent manner when given before, during and after a viral infection. YPF was effective in blocking the entry of the virus. Furthermore, pre-treatment with YPF reduced the susceptibility of cells to the invasion of HRSV by inhibiting the expression of ICAM-1. YPF extract increased the survival rate of lethal influenza-infected mice, prolonged the survival time and alleviated the virus-induced lung lesions, which is comparable with the effects of ribavirin treatment [4]. To enhance the anti coronavirus function of YPF, I added Lizhihe (Litchi core) in my modified YPF formula, because of it can significantly inhibit protease activity of SARS coronavirus 3CL [5].

3.    Anti-asthma function

Difficulty breathing is one of the common symptoms of Covid 19. Previous studies showed YPF has a good function of anti-asthma.  Wang Z. reported that YPF could alleviate the inflammation in the lung tissue of mice, decrease the proportion of Th17 cells, and increase the proportion of Treg cells in bronchoalveolar lavage fluid, it could decrease IL-4 and TNF-α level and increase TGF-β level in blood [6]. Liu X applied network pharmacology to explore potential mechanism of YPF on asthma. In vitro experiments showed that YPF significantly decreased the production of TNF-α and IL-6, as well as both mRNA and protein levels of IL-1β, NLRP3, Caspase-1 and ASC. In vivo experiment showed YPF treatment not only reduce the clinical symptoms, but also reduced inflammatory cell infiltration, mucus secretion in lung of asthmatic mice. Moreover, YPF treatment remarkably decreased the mRNA and protein levels of IL-1β, NLRP3, Caspase-1 and ASC in lung of asthmatic mice [7].

4.    Anti pulmonary fibrosis

Pulmonary fibrosis is a major pathological change in Covid 19 patients. YPF showed an anti pulmonary fibrosis function in the previous studies. Li L applied total extract of YPF to treat bleomycin-induced pulmonary fibrosis in rats. The result showed YPF treatment can reduce the alveolitis and fibrosis, reduced the loss of body weight and increase of lung coefficient. YPF also significantly decreased the levels of hydroxyproline and type I collagen, and reduced the over-expression of high-mobility group box 1 (HMGB1), transforming growth factor-beta 1 (TGF-β1), Col-I and α-smooth muscle actin (α-SMA) .It can improve lung fibrosis by alleviating HMGB1 activity and TGF-β1 activation [8].

Cui W applied the total glycoside of Yupingfeng (YPF-G) to treat pulmonary fibrosis, the result found that both dose of YPF-G significantly reduced bleomycin-induced alveolitis and pulmonary fibrosis in rats. The levels of HMGB1, laminin, hyaluronic acid, and hydroxyproline were effectively reduced. The increased protein expression of HMGB1 was dramatically inhibited after YPF-G treatment [9].

5.    Clinical randomized controlled trials

Except laboratory research YPF also showed some good effects on clinical trials of some related diseases include SARS. A meta-analysis aimed to evaluate the immunomodulating function of YPF in children with recurrent respiratory tract infections. Twelve trials with 1236 patients were identified. YPF significantly increased serum levels of IgA, IgG, IgM and CD3 (+) T-lymphocytes. It also reduced the frequency of recurrent respiratory tract infections and increased total effective rates of symptom improvement [10]. A randomized, double-blind, parallel, placebo-controlled study analysed 240 patients from eight centres in China. Participants were eligible if they had mild to severe chronic obstructive pulmonary disease. They were randomly assigned to receive YPF or placebo. The result showed YPF group had a significantly lower exacerbation rate than placebo group and a significantly reduced risk of second exacerbation. The mean change in the COPD assessment test score in the YPF group were signifacantly lower than placebo group [11].

During the epidemic period of SARS in Hong Kong there were 2,601 medical staff administered with Kandu Bufei  Decoction which is a modified YPF It was confirmed that 1,063 people had taken it for a successive two weeks. They were regarded as the treatment groupThe control group consisted of 15,374 subjects who didn’t take Chinese herbal medicineThe result showed: No one in the herbal treatment group contracted the SARS infection while in the control group, 64(0.4%) were infected [12].

Discussion

The pandemic of Covid 19 is gradually getting under control in China. Chinese herbal medicine played a very important role in this battle against Covid 19 in China. More than 85% of patients received herbal medicine treatment. Because the involvement of Chinese herbal medicine the cure rate was significantly increased and mortality rate significantly decreased.

YPF is a natural immune enhancer. Its immunoregulatory function can prevent viral infection. The anti-inflammatory and antivirus function can block the cytokine storm reaction of Covid 19. The anti-asthma effect can release the shortness of breath. The anti pulmonary fibrosis effect can reduce the pulmonary fibrosis in the severe stages and recover stages.

Conclusions

Based on above research evidence we have reason to conclude YPF probably has the effects on prevention and treatment of Covid 19.

Reference

  1.  Song J. Anti-inflammatory and immunoregulatory effects of Yupingfeng powder on chronic bronchitis rats. Chin J Integr Med. 2013; 19(5):353-9.
  2.  Xuetao Cao. COVID-19: immunopathology and its implications for therapy. Nature Reviews Immunology . 2020; 20, 269-270.
  3.  Sun H. Bidirectional immunomodulating activity of fermented polysaccharides from Yupingfeng. Res Vet Sci. 2017; 110:22-28.
  4.  Liu Q. Jiawei-Yupingfeng-Tang, a Chinese herbal formula, inhibits respiratory viral infections in vitro and in vivo. J Ethnopharmacol. 2013; 150 (2):521-8.
  5. Shouji Gong.  A study on anti-SARS. CoV 3CL protein of flavonoids from litchichinem  sonn core. Chinese Pharmacological Bulletin 200824 (5): 699700.
  6. Wang Z. Yupingfeng Pulvis Regulates the Balance of T Cell Subsets in Asthma Mice. Evid Based Complement Alternat Med. 2016; 6916353.
  7.  Liu X. Yupingfeng San Inhibits NLRP3 Inflammasome to Attenuate the Inflammatory Response in Asthma Mice. Front Pharmacol. 2017; 8, 1-12.
  8.   Li L. Total extract of Yupingfeng attenuates bleomycin-induced pulmonary fibrosis in rats.Phytomedicine. 2015; 22 (1):111-9.
  9.  Cui W. Total glycosides of Yupingfeng protects against bleomycin-induced pulmonary fibrosis in rats associated with reduced high mobility group box 1 activation and epithelial-mesenchymal transition.Inflamm Res. 2015; 64(12):953-61.
  10. Song T. Adjuvant Treatment with Yupingfeng Formula for Recurrent Respiratory Tract Infections in Children: A Meta-analysis of Randomized Controlled Trials.Phytother Res. 2016; 30 (7):1095-103.
  11.  Ma J. Effects of YuPingFeng granules on acute exacerbations of COPD: a randomized, placebo-controlled study.Int J Chron Obstruct Pulmon Dis. 2018; 13, 3107-3114.
  12. Liu Dehui. Clinical Observation on the Preventive Effect of KangduBufei Decoction on AcuteSevere Respiratory Syndrome. Chinese Journal of Integrated Traditional and Western Medicine. 2004; 24(8): 685-688.

Tuesday, 4 February 2020

My ten year blogger journey

Tiejun Tang

Ten years ago, I opened my TCM blog Chinese Medicine Forum, during which I published over 80 posts. All the posts are related to Chinese medicine and acupuncture, and the topics range from clinical treatment to theoretical discussionand research review. I never expected this small blog could attract so many readers from all over the world. My readers include patients, TCM students & practitioners, doctors and researchers. Many readers received practical suggestion about their disease or health issues.
The pageviews of my blog have reached 318,253. 

The readers came from over 30 different countries.The top 10 countries are:



The following shows the posts concerning clinic treatment which received more pageviews.



The readers left 157 comments on my blog. Here are a few comments:

Williams wrote on Can acupuncture treat Parkinson’s disease?  "I wanted to thank you for this great Information and knowledge, I definitely loved every little bit of it. I have you bookmarked your web site to check out the latest stuff you post. Your blog is eye-catching. I get pleasure from it."

Alex wrote on How to treat Raynaud's Phenomenon with Chinese Medicine?  "It’s really nice and meanful. It’s really cool blog. Linking is very useful thing, you have really helped lots of people who visit blog and provide them useful information."

Leslie wrote on How to treat rheumatoid arthritis with Chinese medicine? I am really a big fan of Chinese medicine and I have been self studying about it. This article is very helpful. It gives total insight to the viewers when it comes to RA. It gives comparison and guide on how to deal with RA. "

Davy wrote on Acupuncture Pain Clinic in Whittington Hospital:  "Nice post. I read your article and found useful information regarding Acupuncture Pain Clinic. I would like to say thanks for sharing this. Keep sharing."

Anonymous wrote on Acupuncture Pain Clinic in Whittington Hospital: "This is a great posting of blog and thanks sharing, It was an one of the great treatment in acupuncture therapies, its useful for relaxation and infertility acupuncture etc."

Savannah wrote on Acupuncture Pain Clinic in Whittington Hospital:  "I have to say that the information here was the most complete that I found anywhere. I am definitely bookmarking this to come back and read later. Really impressed! "

Mendes wrote on Glandular fever and its TCM treatment: "This is a great article thanks for sharing this informative information. I will visit your blog regularly for some latest post. "

Williams wrote on How to treat urinary tract infection with Chinese herbal medicine?  "I have being researching about urinary tract infection and reading your blog, I found your post very helpful."

Greenjjade wrote on Hashimoto’s disease and its TCM treatment: "Hi Dr Tang, As a non-Chinese speaking student of TCM, I just wanted to express a very big thank you for freely sharing your clinical knowledge and expertise and writing about such interesting topics."

I am really appreciated all the comments.  Your feedback has encouraged me to keep on posting for the past 10years. I have been dedicated to TCM for more than 40 years, and deeply believe that Traditional Chinese medicine is a precious resource. The aim of this blog is to share my TCM knowledge and experience to English readers of the whole World. I will continue to post new articles in 2020, and readers are very welcome to leave their comments or share this blog with their friends. If this blog can make you and your family healthier, that is my best hope.

Thursday, 23 January 2020

How to prevent coronavirus infection?

Tiejun Tang


We are all aware of the new Coronavirus spreading from Wuhan across China and beyond.. This disease is very similar to the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 which originated in China and spread to 37 countries with 8098 cases and 774 fatalities. The pathogens are from a different subtype of coronavirus; Its incubation period is longer than SARS and its symptoms are slightly different.

SARS initially spread from Guangzhou in Southern China, and I was working in that city when SARS started to spread. Our hospital is one of the leading hospitals in Guangzhou, so we accepted and treated many patients. When patients were diagnosed with SARS they were isolated and treated with modern medicine. My PhD tutor, Professor Deng Tietao suggested to central government to use traditional Chinese medicine and after the Chinese herbal medicine was involved the mortality rate significantly reduced.
Chinese herbal medicine was widely used to prevent SARS infection. Many people took herbal decoction of Banlangen (Radix isatidis) which has proven to have an antiviral function.’[1] During the epidemic period of SARS in Hong Kong there were 2,601 medical staff administered with Kandu Bufei  DecoctionIt was confirmed that 1,063 people had taken it for a successive two weeks according to the request and had returned the questionnaire monitoring effectiveness They were regarded as the treatment groupThe control group consisted of 15,374 subjects who didn’t take Chinese herbal medicineResults: No one in the herbal treatment group contracted the SARS infection while in the control group, 64(0.4%) were infected.[2]
Extensive pharmacological research has shown that many Chinese herbal medicines have very good antiviral effects in their different ways.[3] Chinese herbal medicine could prevent the occurrence of coronavirus infection. It is possibly improving symptoms through enhancing the immunity of body. The ingredients of Kandu Bufei Decoction were based on the classical formula of Yupingfeng San, which is recorded from Yuan Dynasty in 1345 AD. Yupingfeng in Chinese means jade screen.  It means that like a jade screen this medicine can protect people from wind evils.  Modern research has shown that a modified Yupingfeng San formula can inhibit respiratory viral infections in vitro and in vivo.[4]
Coronavirus infection is preventable. Wearing a mask, washing hands and drinking plenty of water can help to prevent infection but the best way to prevent coronavirus infection is to take some Chinese herbal decoction. You can access your local Chinese herb clinic to get your jade screen. It will help you to stay safe from the risk of coronavirus.
Reference:
1. Zhou W Research progress of Chinese herbal medicineRadix isatidis (banlangen).
      Am J Chin Med. 2013;41(4):743-64.
2. Liu Dehui. Clinical Observation on the Preventive Effect of KangduBufei Decoction on AcuteSevere Respiratory Syndrome. Chinese Journal of Integrated Traditional and Western Medicine. 2004; 24(8): 685-688.
3.  Jun Huang. Antiviral Herbs -Present and Future. Infectious Disorders – Drug Targets, 2014, 14, 61-73.