Review of the "International Alliance of Prevention and Treatment of Major Infectious Diseases with Traditional Medicine "Founding Conference

ZHANG Zi-jun (張子雋), SONG Ping (宋 坪)

Department of International Cooperation, China Academy of Chinese Medical Sciences, Beijing 100700, China

Correspondence to: SONG Ping, E-mail: songping@vip.126.com

From Dec 21stto 22nd, 2020, the "International Alliance of Prevention and Treatment of Major Infectious Diseases with Traditional Medicine" was officially founded by China Academy of Chinese Medical Sciences as the leading unit, united with World Federation of Chinese Medicine Societies, the World Federation of Acupuncture and Moxibustion Societies, China Association of Chinese Medicine,China Association of Traditional Chinese Medicine.Nearly 300 officials of traditional medicine authorities and traditional medicine experts from more than 30 countries and regions including China, Thailand,Cambodia, Pakistan, the United Kingdom, and Austria attended the ceremony and the seminar.

With the theme of "Learn from each other, Consult with each other with shared benefits", the major events including three parts: alliance establishment ceremony,keynote speeches and experience sharing.

Opening Ceremony of Founding Conference of International Alliance of Prevention and Treatment of Major Infectious Diseases with Traditional Medicine

During the founding ceremony, the Nobel Prise Winner, Lifetime Researcher of Chinese Academy of Chinese Medical Sciences, professor Tu Youyou delivered a "Video Speech"; Dr. Zhang Qi, Head of Traditional, Complementary and Integrative Medicine from WHO; and Ambassadors from foreign embassies in China and Chinese Ambassadors abroad; Directors from the Ministry of Health of the Philippines and Thailand, and leaders from Chinese People's Association for Friendship, the China Association for Science and Technology, National Administration of TCM, the "Belt and Road" Alliance of International Scientific Organizations attended the ceremony, and they all congratulated to the founding of this Alliance.

Professor Tu Youyou, the Nobel Prise Winner,Lifetime Researcher of Chinese Academy of Chinese Medical Sciences, delivered a "Video Speech"

Mr. Rolf Almklov,Commercial Counsellor of Embassy of Kingdom of Norway attended the ceremony

Dr. Zhang Qi, Head of Traditional,Complementary and Integrative Medicine from WHO attended the ceremony

Mr. Lei Fengyun,Counselor for Scientific and Technological Affairs of Embassy of the PRC in the Republic of Austriaattended the ceremony

This alliance is the first of this kind in the world,which will work with the global high-level research institutes, universities and enterprises to do the following work:

I. Taking active action to jointly combat the severe infectious diseases.

II. Deepening international cooperation in traditional medicine and promote exchanges and mutual learning regarding education, technology and people-to-people exchanges.

III. Summarizing the experience in the prevention and treatment of severe infectious diseases with traditional medicine and share corresponding research outcomes.

During the keynote speech section after the founding ceremony, Academician Huang Luqi, president of China Academy of Chinese Medical Sciences(the main initiator of the alliance), Prof Bauer from the Austria University of Graz, Prof Tariq Mahmood from Faculty of Plant Sciences of Jinnah University in Pakistan, and Prof Sanjeev Krishna from the Institute of Infection and Immunity, St. George's University of London delivered speeches focusing on the research of the prevention and treatment of COVID-19.

Academician Huang Luqi, president of China Academy of Chinese Medical Sciences delivered speech

Huang Luqi's report is entitled "The Advantages and Functions of Traditional Chinese Medicine in Fighting the COVID-19 Epidemics", told the story of how did Traditional Chinese Medicine ( TCM)team fight against the COVID-19 in Wuhan and how difficult it was throughout the whole process. He said that under the unified leadership of the National Administration of Traditional Chinese Medicine, China sent five groups of TCM teams with all together 773 members to Wuhan, including academicians,chief scientists, as well as specialists in emergency,severe, respiratory and other departments. Among them, China Academy of Chinese Medical Sciences,as the first Chinese Medical team of China arriving in Wuhan, took over the south bed-ward of Jinyintan Hospital with whole system and participated in the treatment of severe and critical patients. At the same time, TCM participated in the national diagnosis and treatment plan from the third to the eighth edition.

Chinese medicine plays an important role in fighting against COVID-19 in five aspects. The first role of TCM is to intervene in different stages and could be used in the observation period and clinical treatment; also, the patients with cold and flu were distinguished. Then with group consultation of the TCM expert, the TCM team screened out the “Three Prescriptions and Three Drugs”. Second, TCM has played the major role in treating the mild and ordinary patients and by combining with the Western medicine,TCM could cure the severely and critically ill patients.By using traditional Chinese medicine to treat severe patients can shorten the length of stay in hospital,reduce the use of antibiotics, hormones, as well as the deterioration rate. Third, TCM could play the overall regulatory effect in the process of rehabilitation. As for those whose symptoms has not been improved,especially the pulmonary inflammation, TCM could reduce the pulmonary fibrosis and play an overall regulatory role. The fourth role of TCM is its unique role in prevention. TCM emphasizes the homo-logy of medicine and food. At the invitation of the Wuhan Municipal Health Commission, the TCM medical team prescribed Chinese herbs which could be made as food to the patients which gained trust by Wuhan people and brought confidence to them. The fifth role is TCM could meet the needs of Chinese people. The clinical survey shows that more than 80% severely ill patients would choose to be treated by the combination of TCM and western medicine, and more than 90% of mildly ill patients would choose TCM intervention.

Based on the TCM's understanding of COVID-19,it belongs to a kind of plague with dampness and toxicity, with the difference of constituents of the body and regions, such plague could add cold, heat, dryness,with the symptoms of cold and dampness, dampness and heat and blood stasis. The disease is located in the lungs and spleen. With the development of the diseases,different organs will be damaged. The Etiology and pathogenesis of the mild and ordinary type is dampness and toxicity affecting the lung and for the sever and critical type is Qi deficiency and blood stasis. TCM could treat different types with syndrome differentiation.

The TCM medical team saved life, as well as did research and made conclusion, developed Huashi Baidu Granule (化濕敗毒顆粒) as the new herbal medicine treating COVID-19. It serves as a demonstration of theory, and shows clinical efficacy as well as science, it could be promoted, replicated and used by many people. Thus, this prescription first was produced inside the academy, with controllable quality and stable efficacy, and regime RCT experiment. The Huashi Baidu Granule contains 14 herbs, according to the basic theory of Chinese herbs formula (which contains principal, assistant, adjuvant and dispatcher herbs), and after the research of Network Pharmacology and bioinformatics, these herbs could play the majoir role in fighting against the virus and Annie-inflammation.He explained the mechanism of this formula by using a metaphor of playing football.

Take the medicine of Maxing Shigan Decoction(麻杏石甘湯) and Xuanbai Chengqi Decoction (宣白承氣湯) for the upper jiao to clear the middle Jiao and evacuate the upper Jiao, take the medicine of Huoxiang Zhengqi Poder (藿香正氣散) and Da Yuan Drink (達(dá)原飲) to reduce dampness, harmonizing stomach and mediate middle jiao; Take the medicine of Taoren Chengqi Decoction (桃仁承氣湯) and Tingli Dazao Xiefei Decoction (葶藶大棗瀉肺湯), invigorate the circulation of detoxification, and reaches xiao jiao.There are all together 14 players ( including 3 benchwarmers), just like the 14 herbs. Some herbs treat the disease in the upper Jiao, same treat the middle Jiao, and some treat the lower Jiao. He named this medicine (Q-14). It mesns "cure for all".

The animal experiments results of Huashi Baidu Granules showed that the transgene significantly reduced the viral load (30%), which was statistically significant; The toxicology tests were safe and good;The results of clinical trials were very good, which can block the transition from light type/ormal type to severe type/critical type, and has a tendency to improve the CT images of patients with lung, with good safety. It was on the basis of the experiment evidence that the Chinese Academy of Chinese Medical Sciences (CACMS) sent an international team of TCM expert to the United Arab Emirates to provide prevention and control guidance, and the drug was urgently registered and listed in the United Arab Emirates after being evaluated by local experts.This marked the recognition of the power of TCM in the global fight against the disease.

Rudolf Bauer, a professor at the University of Graz delivered speech

Rudolf Bauer, a professor at the University of Graz,Austria, gave a report on "Prevention and Treatment of New Coronavirus Pneumonia with Traditional Chinese Medicine—What Needs to Be Accepted for Western Medicine Treatment System". He pointed out that the current global situation of the COVID-19 epidemic is not optimistic, but China's infection cases have been controlled, which shows that its disease prevention and control methods are very effective and very successful.Since 90% of patients were treated or prevented by TCM, TCM should be considered to help other countries cope with the new pandemic.

He analyzed 173 prescriptions frequently mentioned in ancient Chinese books for the prevention and treatment of pneumonia and plague, and analyzed the mechanism of action of Gancao (Radix Glycyrrhizae),Huangqin (Radix Scutellariae), Jiegeng (Radix Platycodonis) and several other drugs commonly used to treat COVID-19 and how to find targets for action. TCM has a wealth of experience in dealing with infectious diseases, but it requires more scientific evidence to make the West accept Chinese medicine better. More scientific evidence is needed to further prove the effectiveness, safety and quality control of the medicine,to ensure uniform medicine activity and consistency between batches, and to explain the active ingredients of the medicine and the mechanism of action. We need to conduct randomized controlled experiments, conduct clinical studies, provide evidence-based science.

China has carried out a lot of clinical studies during the period of the epidemic, especially when the epidemic was severe, and the relevant clinical trials were carried out as early as January 2020. There are still a lot of clinical trials going on, including 163 clinical trials of western medicine and 110 clinical trials of TCM.This data is very remarkable and provides us with a lot of clinical evidence. There are a number of trials that have been evaluated and have even been published,and we can look at Lianhua Qingwen (連花清瘟), which was tested in randomized controlled experiment, and the article has been published. This is a direction that we can continue to develop in the future. We also need to look at other related studies. We hope that other related TCM studies will be published as soon as possible.

The Chinese prescription that uses this method is Huangqi Jianzhong Decoction (黃芪建中湯). Of course, there are other studies that have analyzed a variety of Chinese plants, such as Gancao (Radix Glycyrrhizae). Pharmacological analysis has also been carried out on some ingredients, such as baicalein Huangqinsu (Baicalein), which we know has very good pharmacological action, which is related to the entry of virus and the replication of COVID-19. This is a more promising approach, and it can also povide us with some evidence-based persuasion that these pharmaceutical ingredients in Western countries are not only placebos, but real active ingredients. When we look at some TCM ingredients most commonly used by COVID-19 patients, we can find that 8 of the 10 most commonly used TCM ingredients have been included in the European Pharmacopoeia monograph or are in the process of drafting.

The immune system played a major role in the development of COVID-19. If enough interferon is not produced, patients are more likely to develop severe symptoms. Healthy people with strong immune systems that can respond to the virus are safer by producing large amounts of interferon. This means that we can consider the use of immunomodulatory drugs for prevention and treatment, there are many Chinese herbal medicine also have such a mechanism, we should pay attention to the field.

He advocated building international coalitions that would allow countries to work together on research to tackle the world's major infectious diseases.

Academician Talk-Tariq Mahmood from the Faculty of Plant Sciences of Jinnah University delivered speech

Academician Talk-Tariq Mahmood from the Faculty of Plant Sciences of Jinnah University in Pakistan, titled "The Therapeutic Potential of Medicinal Plants," reports that natural medicinal products have the same long history as human civilization.Therapeutic properties of biological or rare compounds derived from nature are the source of ancient medicines. Most of the ingredients are obtained from wild concentrations, and billions of people around the world still use traditional botanical medicines.The compounds of traditional medicines are readily obtained from natural medicines, and the structural adjustment of these compounds can lead to more promising, safer active drugs, which also have an economic effect. There are widely used and extracts,botanical medicines in the industry, and their use is becoming more and more widespread. They come from nature, and people tend to use drugs that come from nature rather than modern synthetic chemical drugs. The large-scale development and production of chemically synthesized drugs has transformed our healthcare systems, and large numbers of people in developing countries still rely on traditional medicines and herbal medicines as a source of basic health care.

Currently, there are more than 72,000 species of botanical medicines in global/regional/domestic trade. The present situation, source, classification and application of traditional botanical drugs in different countries were introduced. He suggested some natural medicines that might be effective in treating the disease.According to the study, these botanical ingredients,including cinchona tree (金雞納樹),Rhizoma Curcumae Longae(姜黃)and other drugs are considered to be promising drug options for treating COVID-19.

He analyzed the economic and technical difficulties faced by plant medicines, focusing on the problem of over-exploitation of medicinal plants,as well as the problems of raw material supply,complex extraction technology and high extraction cost faced by the extraction of medicinal ingredients from plants, and put forward a series of practical solutions to increase the production of secondary metabolites and medicinal plants.

As COVID-19 continues to devolve, it will require a re-examination of the medical system,and the mechanisms of infection and treatment will help us better understand what treatment should be adopted. We need to identify which ingredients in the current infectious diseases are very deadly and which treatments are being used, and we need to build a network of pharmacological technologies using alternative complementary medicine methods (natural plant methods), and learn to use different medicinal ingredients and integrate them for different targets.There should also be the use of integrative aspects of multi-omics, including methods such as genomics,transcriptomics, proteomics, and metabolomics, as well as physical, chemical, biological and so on.

In order to ensure the safety and effectiveness of botanical drugs, quality control is very important.The need to find better quality control markers is an important area for future herbal research.Nanoparticles usually have very good physical,chemical and biological properties, and we can use them in plant medicine to play more roles.

Finally, he proposed that they should cooperate with each other and carry out research cooperation to deal with common problems, such as the field of drug resistance, which is a problem faced by the entire international community and the entire human race.

Professor Sanjeev Krishna from the School of Infection and Immunity of St. George's University delivered speech

Professor Sanjeev Krishna from the School of Infection and Immunity of St. George's University,London, presented the relevant research on artemisinin against SARS-CoV-2 virus with the title of "Repurposing Antimalarials for COVID-19". Why is reusing antimalarial drugs such an effective tool in the response to COVID-19. Taking a drug that has been applied to a certain indication and testing it for other indications can reduce a lot of early research time, which means going straight to the effectiveness studies. The development process of conventional new drugs needs to consume a lot of time and economic costs. Using known drugs, we can skip the early safety studies and directly enter the late-stage clinical trials. It can speed things up and reduce costs.

Reuse existing medications, such as quinine.Quinine was discovered in the 17th century as a treatment for fevers. When a cardiologist in the Netherlands used quinine to prevent malaria, he was surprised to find that atrial fibrillation was well controlled. In 1918, another scientist showed that quininine, which is chemically related to quinine,was more effective at controlling atrial fibrillation.Then, during World War II, medical workers discovered that a drug called Mepaclin that could treat lupus erythematosus. Since then, related drugs including hydroxychloroquine have been approved by the FDA for the treatment and control of lupus erythematosus. Hydroxychloroquine was tested extensively in the early stages of the epidemic,which was quite controversial. Due to imperfect experimental design, insufficient sample size and other reasons, the experimental results are not ideal.

There are drugs that have been used very successfully to treat COVID-19, saving many lives.The most famous example is the large-scale clinical trial of dexamethasone in the UK. Dexamethasone is used mainly for its anti-inflammatory effects in patients with mild symptoms. Tocilizumab is an antibody that has also been proven to have very good clinical effects and is very effective in patients with severe illness. There are also data from the effects of barictinib and remdesivir, successfully saving patients with severe illness.

It is pointed out that artemisinin, as an antimalarial drug used for a long time, has the potential to fight against SARS-CoV-2 virus, and the research and development of these used drugs will shorten the clinical trial time and have the advantage of low cost. He analysed the mechanism of artesunate's antiinflammatory effect and recommended the use of existing drugs to treat COVID-19.

Finally, he introduced the effects of artemisinin.Artemisinin is a drug discovered by a team led by Professor Tu Youyou. It won the Nobel Prize in Medicine in 2015 and is now widely used in the process of anti-malaria. Artesunic acid is a very useful ingredient, and it will play a better role in the later stages of the disease (in the third and fourth stages). Artesunate has anti-inflammatory properties,and a lot of research has been done, which means that it has anti-interleukin-6 properties. We have talked about some examples before, the use of artesunate can be a good intervention, especially for the intervention of interleukin 6, because interleukin 6 is still a very important substance in some major diseases. We have carried out relatively good treatments, and some serious diseases are treated,especially in the later stages of infection. Currently,there is a lack of cheap, safe, and early drug interventions, which can help us prevent the disease from reaching a serious stage. Finally, he suggested the combination of drugs to support the treatment during the course of COVID-19 infection.

Conference scene

On Dec 22nd, 9 experts from "NEJM Frontiers in Medicine" magazine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Capital Medical University. Beijing Hospital of Traditional Chinese Medicine, Guang'an Men Hospital, Ontario College of Traditional Chinese Medicine from Canada, Tehran Medical University from Iran,Traditional Chinese Medicine Center from Philippine,Sabinesa University School of Medicine from Italy,China-Swiss Traditional Chinese Medicine Center all introduced the clinical and scientific experience of fighting against COVID-19 in there own countries.

Deputy Director Zhao Jianfei from "NEJM Frontiers in Medicine" magazine, with "Review of Important COVID-19 Research Published in New England Journal", introduced the publication of new coronary pneumonia papers in the "New England Journal" in 2020, especially the publication of Chinese papers and hot spot fields, and introduced the study on COVID-19 in different angels and stages.

President Li Hao from Wangjing Hospital,based on the experience of treating COVID-19 patients both at home and abroad, with the title of "Retrospective Study of Synergistic Treatment of Chinese and Western Medicine for Severe Patients with COVID-19", introduced a retrospective cohort study of treating 100 severely ill patients in Wuhan. The focus is on the role of Huashi Baidu Granules developed by the China Academy of Chinese Medical Sciences during the epidemic in the treatment of critically ill patients. His conclusion is that the antibiotics, hormones, antiviral drugs,and immunomodulatory drugs in the integrated Traditional Chinese and Western medicine treatment group have obvious advantages in terms of the use of time, number of cases, and total number; in addition, there are obvious advantages in improving,symptoms, time and number of cases of nucleic acid conversion. The number of hospitalization days has been significantly reduced; there are also obvious advantages in the rate of decline of inflammation indicators and the time to improve; and there are fewer adverse reactions.

President Liu Qingquan of the Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, with the title of "The role of Fangcang Shelter Hospitals in response to the COVID-19", introduced the source, connotation,characteristics and functions of Shelter Hospital,the renovation of Jiangxia Shelter Hospital and the background of using Shelter Hospital in Wuhan, as well as the comprehensive syndrome differentiation and external treatments of COVID-19 patients.

Chief Physician Li Guangxi from the Respiratory Department of Guang'an Men Hospital, CACMS, with the name of "Protecting the Vulnerable Population—The Key Rold of TCM in Treating COVID-19",introduced the main symptoms and the patients, the character of the vulnerable population, and how to divide the patients with TCM theory. Then he analyzed how to avoid the infection of the vulnerable population,and the development stages of COVID-19 as well as the treating prescriptions for Acute Lung Injury.

Dr. Wu Binjiang, President of Ontario College of Traditional Chinese Medicine, Canada, with the name of "Anti-Epidemic Work Report and Sharing of Ontario College of TCM & Reflections on the Oversea Development of Chinese Medicine", introduced the anti-epidemic assistance provided by his college to mainland China and Chinese community in Canada,including donation, distribution of anti-pandemic TCM packages, translating relevant Chinese experience and hold on-line lectures. Besides, he analyzed the the obstacles of TCM used overseas fighting against COVID-19, and the intervention and treatment effect of TCM in the recovery period, and the development trend of overseas TCM in the post-epidemic era.

Prof. Amir Hooman Kazemi from Tehran University of Medical Sciences of Iran,with the name of "Efficacy of herbal formulations (capsule&decoction) in Patients with COVID-19", introduced an open-label, randomized, controlled, multi-center clinical trial conducted by his university on 364 COVID-19 patients in 5 centers, which showed that the hospitalization time and symptoms of the herbal medicine group have obvious advantages.After that he introduced the composition of natural medicine.

Chairman & Chief Consultant Zheng Qiming of Philippine Traditional Chinese Medicine Center, with the name of "Role of TCM on Fighting against the COVID-19 Pandemic in Philippines", introduced how did the center share China's experience of fighting against COVID-19 and the prevention method, and how to integrate TCM theory to Philippine condition and proved TCM prescription to Philippine people,as well as how to use Acupuncture and moxbustion at home.

Prof. Aldo Liguori from Medical Faculty of Sapienza University in Italy, with the name of"COVID-19 condition in Italy and Contribution of Prevention with TCM", introduced the pandemic condition in Italy, vaccine development and distribution,the clinical practice of treatment of patients with COVID-19 in different stages, and the use of Chinese medicine and acupuncture on Italian patients.

Director Dong Hongguang of China-Swiss TCM Center, with the name of "Experience Sharing of TCM on Treatment of Infectious Diseases with the "Combination of Western and Chinese Medicine in China-Swiss Center, introduced the medical system the use of TCM in Switzerland,the key tasks of the China-Swiss TCM Center",and the work done by the center in the prevention and treatment of COVID-19 and providing TCM guidance to the pandemic.

At present, the alliance has more than 70 experts from more than 60 institutions in more than 30 countries. It will integrate the wisdom and superior resources of experts and scholars from various countries to jointly contribute to the scientific research on the prevention and treatment of major infectious diseases in traditional medicine.