世界针灸学会联合会

Q & A of Experts at the State Council Information Office of PRC

author:WFAS source:WFAS Click:525 update:2020-03-28
  

CGTN reporter: During the fight against the epidemic in Wuhan, TCM has been widely and effectively used in treatment. I would like to ask Prof. Zhang Boli, an academician, what are your important experiences in the 50-day treatment practice in Wuhan to share with the international colleagues? Thank you.

Zhang Boli: Thank you for your question. I arrived in Wuhan on January 27, and it's been almost two months now. When I first arrived in Wuhan, the epidemic situation was very serious. The hospital beds were fully occupied. Hundreds of people had to line up for registration for a few hours, and even so many cannot get treatment. In particular, the patients and their companions often stayed together, which caused great concern. But the current situation in Wuhan after two months now has been better. The number of patients in the hospital has decreased from more than 60,000 to about 5,000, and the number of critically ill patients has decreased from 12,000 to about 1,800. In particular, in the past 5 consecutive days, zero confirmed case and zero suspected case was reported, and the total suspected case remains zero. The situation is improving. As the Italian poet Dante said, "Stars can be seen only in the dark night."

However, seeing the epidemic situation in Europe and US, I was very worried and sympathetic, and I am very willing to exchange some of our experience with international colleagues. 

First, facing the chaotic situation in Wuhan, it was the central steering group that made decisive decisions of collective isolation and classifying management, which meant strict isolation among the febrile cases, those in medical observation, the suspected cases and the close contacts. The grass-root organizations in communities and the citizens in Wuhan were very supportive, and they isolated the patients in a few days. However, it was only half way to the success to isolate without medication. Without therapeutics or vaccines, we have TCM, so we use TCM decoctions and drugs in treatment. It didn’t start well at first. In the 13 districts of Wuhan, only 3000 dosages were distributed on the first day. But after two or three days, when the efficacy was seen with reducing body temperature and coughing, the patients asked for TCM medication. The number of decoctions came up to 10,000, and then to 600,000 in total. What about the effect? The epidemic is in control, and I will explain it with some data. Till the middle of February, the proportion of patients diagnosed with COVID-19 from the four mentioned categories dropped from 80% to 30% compared with the early February; and till the end of February, to less than 10%. Therefore, we say that collective isolation and TCM medication helped to mitigate the epidemic, which laid a foundation for the ultimate victory.

Second, the central government decided that each patient should has access to the hospital bed and treatment. With shortage of beds, the central steering group decided to categorized management and scientific-based treatment. Severe cases were sent to designated hospitals for treatment, and mild cases to makeshift hospitals, according to the newly developed treatment guideline for mild and moderate cases. However, the makeshift hospital is different from real hospitals. With hundreds or thousands of patients were gathered in the huge makeshift hospital, it was a big problem to manage the whole. Such being the case, Prof. Liu Qingquan and I made a joint proposal to the command center that TCM be used in the makeshift hospital. We set up a TCM makeshift hospital, namely Jiangxia Makeshift Hospital, where put service before treatment. What kind service? The makeshift hospital was very large and the temperature inside was relatively low. We guaranteed the supply of warm beds, hot water, hot meals, and good service. At the same time, we took good the patients and communicated frequently with them. For example, we organized special birthday parties and practiced health exercises with them. In addition, we organized activities such as selecting the role models from patients. With caring treatment, our doctor-patient relationship was very close. After a few days, everyone felt that the makeshift is not like a hospital but a large community, a large family, which was of benefit to the treatment of patients.

In the makeshift hospital, all patients were with mild and moderate disease. According to the World Health Organization report, severe cases account for 13% of all patients with COVID-19, and critical cases accounts for about 7%. So our goal was to prevent the mild cases from progressing to severe ones. Therefore, we have adopted integrated treatment of TCM and western medicine, while TCM played a bigger role. In addition to oral medication of TCM decoctions and drugs, we also gave our patients such comprehensive therapies as massage, cutaneous scraping and plasters. How about the effect? Taking Jiangxia's Makeshift Hospital as an example, none of the 564 patients turned to severe cases. Experience gained, we also introduced it to the other makeshift hospitals, where more than 10,000 patients used TCM, and the deterioration to severe cases only accounted for about 2% to 5%. It should be said that the comprehensive treatment of TCM used in the makeshift hospitals significantly reduced the progression proportion from mild cases to severe ones, which is the key to our victory.

In addition, the treatment for severe cases was the top priority. For severe cases, we put western medicine before TCM in the integrated treatment of TCM and western medicine. However, sometimes with TCM, the treatment is more effective. In Jinyintan Hospital, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, and Leishenshan Hospital, TCM was given to the severe cases and got very good outcomes. Our experience is that TCM injections should be used early and in an aggressive way. For example, Shengmai Injection and Shenmai Injection, both helped to stabilize blood oxygen saturation and improve oxygenation level. Tanreqing Injection and Reduning Injection, they could help to amplify the strength of antibiotics. Xuebijing Injection helps to inhibit the cytokine storm and the progression of the disease. It is the core of our victory to treat severe cases, to integrate TCM and western medicine, and to reduce case fatality rate.

Last, after negative test and discharge from the hospital, the patients were sent to the isolation places for rehabilitation. During the convalescent period, sometimes they still showed symptoms of fatigue, cough and minor psychological problems. The lesions of the lungs were not completely recovered, and their immune functions, neither. In this case, we adopted the integrated TCM and western medicine treatment, such as breathing exercises, acupuncture, moxibustion, massage. These comprehensive therapies could improve the symptoms, promote lung inflammation resolution, protect organs, and repair immune functions. Therefore, we used the integration of TCM and western medicine in rehabilitation of the convalescent period and took the respective advantages of both, with which we will strive to an ultimate victory.

It is said that the early and whole-process intervention TCM have played an important role in the treatment of COVID-19. If we say the course of COVID-19 is a parabolic curve, TCM plays a better role at both ends. Although we do not have a therapeutic for the disease, we have an effective TCM treatment. The integrated treatment of TCM and western medicine is a highlight in Chinese story fighting the disease. The pandemic situation is worsening. The virus respects no borders, while TCM could also be brought beyond borders. My colleagues here and I would like to share the above experience with those in need. Thank you.

Reuters reporter: Prof. Du Bin, member of the National Health Commission high-level expert group, said at a briefing last week that he hoped that western medicine evaluation methods would be used to prove the effectiveness of TCM in the treatment of COVID-19. What methods of TCM are recommended by the Chinese government to treat COVID-19? Is there any evidence that they are effective? Thank you

Prof. Qiu Haibo: Prof. Du Bin is my colleague. We both treat severe and critical patients, and we often discuss the issues of diagnosis and treatment, as well as the integration TCM and western medicine.

I am a doctor of western medicine, specialized in ICU. As for how to evaluate the effect of TCM drugs, more and more internationally accepted evidence-based medicine methods have been adopted for evaluation. Now, we can also see that the efficacy of more and more TCM products, TCM drugs, and injections is evaluated with internationally accepted methods used in randomized controlled studies. As you know, Prof. Wang Chen and Gao Runlin led a rigorous randomized controlled study to evaluate the efficacy of Jinhua Qinggan Capsule and Qili Qiangxin Capsule for flu H1N1 and chronic heart failure, with the sample size of 410 to 526 cases. In the study, with the randomized controlled method, we observed that with the medication added, Jinhua Qinggan Capsule can significantly reduce the febrile period of flu patients, and Qizhi Qiangxin Capsule can significantly improve the heart function of chronic heart failure patients, compared with the control group of ordinary treatment. These studies have also been published in international journals.

In addition, I would like to say more about Xuebijing Injection, a kind of TCM injection. Several academicians and professors here today are also doing some clinical studies, with internationally accepted evidence-based methods. Regarding the evaluation of the efficacy of TCM, in fact, we know that TCM put emphasizes on dialectical, personalized treatment, but we also realize that we depend more and more on internationally accepted evidence-based medicine methods for evulation.

TCM has been involved in the treatment of COVID-19 at the beginning of the outbreak, especially in the treatment of severe and critical cases. From the current clinical observations, there are several aspects of the treatment of severe and critical cases: the first is to reduce the progression of mild and moderate cases to severe; the second is to reduce the progression of severe cases to critical; and the third is to treat severe and critical cases; and the fourth is to help the rehabilitation of severe and critical cases. In all these aspects, TCM has played a very important role. I should say that, we have seen the effectiveness of TCM in the inhibition of moderate case progressing to severe. It played a certain role in the treatment of severe cases, and a very important role in rehabilitation.

In fact, TCM and western medicine are obviously different in their treatment modes. From the angle of western medicine, most chemical drugs are single-targeted, while TCM are more multi-targeted. In other words, TCM works more like a team. In this sense, the treatment modes are different. But as far as the disease is concerned, there are a few points that can be intervened in. Taking COVID-19 as an example, the virus causes inflammation and immunity disorders, further doing hard to organ functions and lesions in lung, heart and other organs. That is to say, organ lesions caused by virus, inflammation and immunity dysfunction are all targets for drugs. A western medicine is a chemical, which is often targeted at a certain target, while a TCM drug may be a multi-targeted treatment, such as to virus replication, balancing between inflammation and immunity, subsequent organ lesions, blood coagulation. Here I will take Xuebijing Injection as an example. Xuebijing Injection is a TCM injection that has been relatively well studied in recent years. In a study of its chemical composition by Shanghai Institute of Materia Medica, Chinese Academy of Sciences, at least six active ingredients have been proven. Moreover, in vitro experiments have also demonstrated that Xuebijing Injection can actually inhibit the replication of the novel coronavirus. In related animal experiments, it has also been noticed that Xuebijing Injection has an inhibiting effect on cytokine storm, as well as on coagulation dysfunction. Therefore, this time we chose TCM injection to treat severe and critical patients, because Xuebijing Injection proved quite effective for severe cases in the earlier clinical trials. We know that there is no therapeutics for COVID-19, so is it possible that these TCM drugs will be effective for COVID-19? We first saw that it has achieved well-recognized results in the previous treatment of severe pneumonia and sepsis. For example, the study by Prof. Bai Chunxue of Fudan University, and the randomized controlled trials of "Xuebijing and placebo for severe pneumonia" by 33 hospitals, show that Xuebijing, combined with conventional treatment, can significantly reduce the fatality of patients with severe pneumonia in 28 days, by 8.8%. It can also significantly fasten the inflammation resolution, shorten mechanical ventilation, and shorten hospital stay. In our newly unblinding research on sepsis, Xuebijing Injection has also proven to reduce the case fatality rate. It was because Xuebijing had been seen efficacy in the early study of severe pneumonia and sepsis. Therefore, in the treatment of severe and critical patients with COVID-19, we are also observing whether it is effective. We have noticed that as a multi-targeted treatment drug, Xuebijing is used in the treatment of severe and critical cases of COVID-19. We also noticed that in the study of 156 severe and critical cases in 32 hospitals, Xuebijing, combining with basic treatment, the effective rate is relatively high. Of course, it needs more to do before the confirmed results. At least for now, Xuebijing Injection may be a very important therapeutic drug for COVID-19, especially for severe and critical cases.

Of course, everyone is also very concerned about safety. In fact, in the safety study after Xuebijing Injection came in the market, it was noted that the adverse effect rate was no higher than 1% in the clinical use. So it is safe, generally speaking. I believe that TCM, as a multi-targeted treatment for COVID-19, combined with the conventional treatment, will definitely save more lives of severe and critical patients. Thank you.

Xinhua News reporter: According to the current research results, what TCM products are effective for COVID-19? How is the efficacy identified? Thank you.

Zhang Boli: Thank you for your question. With some medicine in hand, we don’t panic. After each epidemic, good therapeutics will emerge. So there is a saying, “A great drug comes out of a great epidemic.” After a big epidemic, a batch of good therapeutics will emerge. Without therapeutics and vaccines, we give attention to repurposing existing drugs as our west medicine colleagues do. We have also developed several new drugs and formulas, which Yu Yanhong mentioned as “three drugs and three formulas." I will focus on Jinhua Qinggan Granule and Lianhua Qingwen Capsule. And Xuebijing Injection has just been well introduced by Prof. Qiu.

Jinhua Qinggan Granule is a new drug for influenza developed during the H1N1 epidemic in 2009, and was put into the market then. The formula of the Granule is the combination of Maxing Shigan Decoction in Treatise on Cold Damage and Miscellaneous Diseases and Yinqiao San Decoction in Systematized Identification of Warm Diseases. Maxing Shigan Decoction has a history of 1800 years, and Systematized Identification of Warm Diseases also has a history of nearly 300 years. The two formulas have stood the test of long history and are effective. The main effect of the Granule is to relieve wind, to diffuse the lung, to clear heat and to detoxify. During the development, Wang Chen, an academician, did a RCT study, and published the result in Annals of Internal Medicine of US. It proves similar efficacy as Tamiflu for flu H1N1, but with less adverse effects and lower cost.

We also conducted a clinical control study of 102 cases in the first-line of Wuhan this time. The results showed that compared with the control group, Jinhua Qinggan Granule reduced the proportion of progression from mild and moderate cases to severe by 2/3 and shorten the febrile period by 1.5 days. And the counts of leukocyte, neutrophil granulocyte and lymphocyte, reflecting immune functions, were significantly improved. The results show that Jinhua Qinggan Granule is effective. Besides improving clinical symptoms, especially reducing the rate of progression to severe cases, it is also effective to immunological indicators.

Beijing YouAn Hospital also conducted a clinical observation of 80 cases with it. The results showed that the period for the nucleic acid test to turn negative was shortened by 2.5 days, which made the pulmonary inflammation resolution shortened by two to three days compared with the control group. The counts of leukocyte and lymphocyte also increased significantly. So the Granule is an effective for COVID-19, and is widely used in clinical treatment.

The second is Lianhua Qingwen Capsule, based on a formula developed during the SARS epidemic by Wu Yiling, an academician. Its main effect is also to clear pestilence, to detoxify, to diffuse the lung and to reduce fever. It is effective for mild and moderate cases of COVID-19. 100,000 packages of the Capsules have been donated to Italy. I heard that Italy hoped to get another 100,000 packages.

A RCT study jointly led by Zhong Nanshan, Li Lanjuan, and I, three academicians, in 23 hospitals of 9 provinces and cities across the country, included a total of 284 COVID-19 patients. The results showed that the main clinical symptoms disappeared in more patients in the treatment group than the control group, and symptom duration were shorter. The improved pulmonary imaging was observed by 83.8%, compared with 64.1% in the control group. The Capsule offered a cure for COVID-19 in 78.9% of cases, compared with 66.2% in the control group. The outcome of the treatment group was obviously better. In terms of mild cases, the rate progressing to severe cases was 50% lower than compared with the control group

At the same time, an in vitro experiment just finished showed that Lianhua Qingwen Capsule has an inhibiting effect on COVID-19. 

Both drugs are effective for COVID-19, and which should we choose in clinical treatment? We choose Jinhua Qinggan Granule for the cases with low-grade fever and severe headaches. We choose Lianhua Qingwen Capsule for the cases with higher temperature and dry stools. This is how we choose between them in clinical treatment. Thank you all.

NBC reporter: It is reported that China has shipped medical supplies to Italy and sent a medical team including TCM doctors. Many people believe that TCM is not scientific. Are you worried that the patients in western countries are not ready yet to accept TCM? Thank you.

Huang Luqi: Thank you for your question. I'm not worried. The reason comes from confidence and practice. Although TCM and western medicine belong to two different medical systems and take different perspectives on health and disease, they are both based on the fact of clinical efficacy. It is based on the fact of clinical efficacy that Yu Yanhong just gave an example of Tu Youyou in her opening remarks. Tu Youyou, a Chinese scientist, and other Chinese scientists discovered artemisinin, a drug for malaria, and it is widely used for this purpose. Prof. Tu was awarded the Nobel Prize in Physiology or Medicine in 2015. Based on the fact of its clinical efficacy, TCM has already spread to 183 countries and regions. According to World Health Organization statistics, 103 Member States have recognized and used TCM acupuncture. Such being the case, in the 72nd World Health Assembly, most member states adopted the eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), which for the first time includes a chapter on traditional medicine originating from TCM.

I think it is based on the fact of clinical efficacy of TCM, Yu Yanghong mentioned the "three drugs and three formulas", and Dr. Qiu Haibo and Prof. Zhang Boli introduced the three drugs. Based on the fact of clinical efficacy of TCM, I would like to introduce "the three formulas” to you.

First, the formula of Lung Cleansing and Detoxifying Decoction. It came from the combination of Maxing Shigan Decoction, Shegan Mahuang Decoction, Xiaochaihu Decoction and Wuling San Decoction. It is generally suitable for mild, moderate, severe and critical cases.

In the observation of 1,263 cases in 66 designated hospitals of 10 provinces (without Hubei), 1,214 cases, 96.12% of the total, were cured and discharged. In the clinical observation of 57 severe cases treated with integrated TCM and western medicine and given Lung Cleansing and Detoxifying Decoction, 42 cases, 73.7%, were cured and discharged. The lung imaging results showed that after two courses (6 days) of Lung Cleansing and Detoxifying Decoction, the lung lesions of 53 patients (93%) showed reduction and resolution in different degrees..

According to data from clinical studies, Lung Cleansing and Detoxifying Decoction has played an positive role in preventing mild and moderate cases progressing to severe and critical. It blocked the deterioration of the disease, reduced the case fatality rate, hence mitigate the damage caused by the epidemic.

Second, the formula of Lung Diffusing and Detoxifying Decoction. It came from the combination and selection of the classical formulas, including Maxing Shigan Decoction, Maxing Yigan Decoction, Tingli Dazao Xiefei Decoction, Qianjin Weijing Decoction. A control study on Lung Diffusing and Detoxifying Decoction group (70 cases) and the control group (50 cases) was conducted in Wuhan TCM Hospital and Hubei Provincial Hospital of Integrated Chinese and Western Medicine. The results showed that Lung Diffusing and Detoxifying Decoction is effective in inflammation control and lymphocyte count increase. Compared with the control group, recovery of lymphocyte was increased by 17%, and the clinical cure rate was increased by 22%.

The First Hospital of Henan University of Chinese Medicine adopted the formula, and 40 mild and moderate cases were given the Decoction. It took a median of 9.66 days for the cases to turn to negative with the virus. No one progressed to severe or critical case. The CT scans of 85% cases showed improvement.

A cohort study of 500 patients was conducted in Wuhan TCM Hospital, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, and Jiangxia Makeshift Hospital. All the patients were given the Decoction. The observation showed that the symptoms of mild and moderated cases, such as fever, cough, and fatigue were significantly relieved. The CT scan also showed a significant improvement, and no one progressed to severe case.

Third, the formula of Dampness Resolving and Detoxifying Decoction. The formula was modified by the medical team of the Chinese Academy of Chinese Medical Sciences in Jinyintan Hospital, on the basis of the local context and the relative formula recommended in the Diagnosis and Treatment Protocol for COVID-19..

The clinical observations were conducted with the severe, moderate and mild cases in in Jinyintan Hospital, Dongxihu Makeshift Hospital and Jiangjunlu Street Hospital. In the clinical controlled trial conducted in Jinyintan Hospital, the pulmonary inflammation in CT imaging and clinical symptoms of all the 75 severe cases were significantly improved. The time for the patients to turn to negative with the virus and the hospital stay were shortened by 3 days on average. We observed 124 moderate cases in Jiangjunlu Street Hospital, and 894 mild and moderate cases in a randomized controlled way (among them, 452 given the Decoction) in Dongxihu Makeshift Hospital. It proved the effectiveness of the formula. In the follow-up test for the liver and kidney functions, no adverse effect was reported. In terms of experiments, the virus load of a 30% reduction was found in a mouse model of evaluation for its effectiveness on the novel coronavirus.

To this end, on March 18, Dampness Resolving and Detoxifying Granule was approved by the National Medical Products Administration for clinical trials. The research and development process of a TCM drug is different from that of a chemical drug or a bio-medicine. Dampness Resolving and Detoxifying Decoction originated from the clinical practice, so the significance of the clinical trial lies in the fact that TCM has a materialized carrier for its theories of the epidemics and clinical efficacy, and that the clinical trial provides an effective translation from TCM research data into a high-level clinical evidence.

The clinical trial approved, many foreign friends asked us for the Granule. When we gave it to foreign friends, the Granule was affectionately called "Q-14". Q took the pronunciation of the English word CURE and "14" means that the Granule is composed of 14 components. Here, I would like to quote a saying, "One for all, all for one." We are willing to fight alongside the people of all countries to beat the epidemic and share our experience and TCM drugs. Thank you.

The Kyunghyang Shinmun reporter: It is known that TCM was also included in the diagnosis and treatment protocol for SARS, MERS. Is the TCM part of the Diagnosis and Treatment Protocol for COVID-19 different from the protocol for SARS. If different, why? Thank you.

Liu Qingquan: Thank you. As for this question, I think it has been answered to some extent by Yu Yanhong, Zhang Boli, and Huang Luqi. TCM has been dealing with infectious diseases for thousands of years. In the process, relatively improved scientific theories have been formed. The treatment of infectious diseases mainly relies on three methods, clearing heat, resolving dampness, and detoxifying. Each method has its targeted infectious diseases according to the pathogeny. In the long process, a few well-known classic formulas were developed, which Zhang Boli and Huang Luqi gave a good illustration. For example, Zhang Zhongjing in the Han Dynasty developed Maxing Shigan Decoction and Daqinglong Decoction; Sun Simiao in the Tang Dynasty developed Qianjin Jingwei Decoction; Wen Youke in the Ming Dynasty developed Dayuan Decoction, and Wu Jutong in the Qing Dynasty developed Yinqiao San and Zheng Qi San. If used early, these formulas could help to eliminate the pathogenic factors and to reinforce the healthy qi, hence protecting the health. Using TCM is like mobilizing the military defense system in a country, in which enemies (viruses) are expelled to protect the country from major damage. I would like to explain it with an example. Resolving dampness is to improve the immune system, like boosting the morale of the military and civilians. Mian Yi (Immunity), the two Chinese characters are vivid in TCM, meaning avoiding a disease. The method of detoxification is like giving the enemy a good blow, and here giving a good blow to the virus. The method of clearing heat can change the human internal environment so that the virus has not place to hide in or escape from. In the fight against the epidemic, all the treatment methods were used with their advantages and in good coordination for the victory.

In the past 20 years, in the response to the newly emerging infectious diseases and on the basis of the ancient classis formulas, a few formulas were developed. For example, as mentioned by Prof. Zhang Boli, Lianhua Qingwen Capsule was developed to treat viral infections during the SARS epidemic in 2003. Jinhua Qinggan Granule was jointly developed by Prof. Wang Chen, Prof. Huang Luqi and some other academicians during the flu H1N1 pandemic. All of these examples help to illustrate the efficacy of TCM and its role in the response to emerging infectious diseases.

In response to COVID-19 this year, we tried to repurpose the existing drugs. Clinical studies show that Jinhua Qinggan Granule and Lianhua Qingwen Capsule are effective on mild and moderate COVID-19 cases. Especially, both of them played a very good role in the treatment of COVID-19 in Wuhan. Xuebijing Injection has a good effect in the treatment of cytokine storm and Coagulopathy. Dr. Qiu Haibo has just given a good introduction to Xuebijing Injection, so I won't go into details again.

In the fight against the epidemic in Wuhan, on the basis of the above mentioned three methods and the ancient classic formulas, the “three formulas” were developed, and they are Lung Cleansing and Detoxifying Decoction, Dampness Resolving and Detoxifying Decoction and Lung Diffusing and Detoxifying Decoction. During this process, we made innovations while keeping the tradition, and treat the disease according to the new context. Thank you.

The Star reporter: From the perspective of TCM, are there any health diets or dietary methods that can help people improve their immunity and strengthen the heart and lung function to fight the virus? Thank you.

Huang Luqi: Thank you for your question. As far as I know, TCM is very popular in Malaysia and is also what you are familiar with. Therefore, I would like to quote two sentences from the classic Huangdi’s Internal Classis to answer your question:

The first sentence is that, best doctors prepare their patients for disease. TCM emphasizes a lot the role of prevention, and prevention plays an important role in the response to the epidemic. For example, in the makeshift hospitals, at the request of the Hubei Health Committee, preventive TCM decoctions were provided to the medical workers in the makeshift hospitals. Till now, there is no medical worker infected in the makeshift hospital.

The second sentence is that, those who have not infected have vital qi in their bodies, and they should stay away from the pathogen to keep healthy. It is emphasized to improve the vital qi, which could be done by TCM exercises like Tai-chi and Baduanjin. You can use some TCM materials, which are also used as food materials, to enhance the vital qi. You are advised to use them in line with the TCM theories, to keep the vital qi and keep from the disease. It is also emphasized to stay away the pathogen. Home isolation is an effective method, as well as necessary disinfection of the living environment.

In addition, TCM also emphasizes the role of emotions in improving the vital qi. Therefore, during the epidemic, we must give more attention to the balance between work and rest, between the physical and mental situation. With the emotional health, it is difficult for the pathogen come in. Thank you.

China News Agency reporter: At present, the number of COVID-19 cases in Hubei and Wuhan decreased obviously, and a considerable part of them are severe and critical cases. For these patients, how will you make a better use of TCM? Thank you.

Liu Qingquan: Thank you for your question. I should say that it is a topic of great significance and great importance. The treatment of critical cases is to further reduce the case fatality rate. I am a doctor of ICU and ER, but I study ICU medicine from the perspective of TCM. In the practice of COVID-19 clinical treatment for more than two months, I often communicate with Dr. Qiu Haibo and Dr. Du Bin. I should say that in the past two months, the experience of how to integrate TCM and western medicine, how to reduce the case fatality rate, has been accumulated. Especially an expert group was set up jointly by the National Health Commission and the National Administration of Traditional Chinese Medicine, to use the integrated treatment for severe cases. The life support techniques of western medicine, such as the use of ventilator, hemofiltration, ECMO and water-electrolyte balance, are very important to critical patients. In the process, for example, the use of fu unblocking materials, such as Dahuang (rhubarb), which can solve the Patient-ventilator asynchrony, reduce the dose and time of sedative, analgesic, and muscle relaxant medication. Shenmai Injection, Shengmai Injection and Dushen Decoction can help to stabilize circulation and blood oxygen saturation. Xuebijing Injection can help in the intervention with cytokine storm. With good coordination, they could play a very good part together.

In the process of integrated TCM and western medicine inspection, the western medicine experts focus on performing standardized treatment, such as the use of mechanical ventilation, the use of hemofiltration, the best timing for intubation.  TCM doctors focus on the use of TCM in the different treatment procedures for severe and critical patients. The complementary integration of TCM and western medicine can reduce the case fatality rate, by making good use of their respective advantages. These are indispensable for the Chinese experience in treating critical patients of COVID-19 and reducing the case fatality rate. It can say that in global response to the epidemic, it can be used in the other countries around the world, and ultimately reduce the fatality rate of critical cases and improve their medical conditions. Thank you.