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Covid-19: four fifths of cases are asymptomatic, China figures indicate

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1375 (Published 02 April 2020) Cite this as: BMJ 2020;369:m1375

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Traditional Chinese Medicine Is being Abandoned Regardless of Government’s Support

Dear Editor

An interesting thing happened on the English website of the World Health Organization(WHO)between March 7th and 8th, 2020:among the measures that are ineffective and potentially harmful to the treatment of COVID-19, they included "Taking traditional herbal remedies", but this content has been deleted from the website on March 8. (1)However, on the WHO Chinese website, there has never been any content that traditional herbs are “ineffective and potentially harmful”. (2)

The use of herbal medicine is exactly the representative part of the core value of traditional Chinese medicine(TCM), which is not displayed on the Chinese website to indicate that WHO does not want to offend Beijing in this case, who has long regarded TCM as a symbol of China's traditional values that are different from those of the West. China's propaganda of TCM was unprecedented in this battle against the outbreak.

Zhang Boli, a member of the Chinese Academy of Engineering, said that his team compared the clinical data of 34 cases of COVID-19 in the integrated Chinese and Western medicine treatment group with 18 cases in the Western medicine group, and the overall efficacy of the former was significantly better than that of pure Western medicine treatment under the measurement of various inspection indicators. (3)
However, judging from the number of confirmed cases in China that have exceeded 80,000, the conclusion that Academician Zhang Boli relied on dozens of cases does not seem to give any confidence that TCM plays an active role in the treatment of COVID-19.

TCM has a long history, and the early basic theories came from an ancient book called “The Inner Canon of the Yellow Emperor” two thousand years ago. The treatment methods of TCM preached in the book were based on the Yin-yang and Five-element Thought, which has not changed for thousands of years, and is still the core part of the current theory of TCM. Its principle cannot be demonstrated experimentally to prove its correctness, nor can it restore the treatment process and evidence in an evidence-based way.

The medicine used by traditional Chinese pharmacy is very extensive, and a variety of naturally occurring substances can be included in the scope. In the current COVID-19 spreading around the world, there is evidence to show a close relationship with the use of Chinese medicine. The scholars from the South China Agricultural University have found that the virus strains isolated in pangolins are 99% similar to covid-19 virus strain in the infected. (4)TCM treats a large number of animal organs as medicine raw materials. For pangolins, TCM thinks that eating pangolins can make breastfeeding women lactate smoothly, which is based on the fact that the pangolin's hard shell can penetrate hard objects to gain access. According to statistics, China consumes 300,000 pangolins each year.

The major drawback of TCM is the use of untested prescriptions to prescribe medicines for patients. The toxic side effects, contraindications, and adverse reactions of these medicines have not been proven through clinical trials. On October 27, 2017, in the list of carcinogens released by the WHO's International Cancer Research Agency, aristolochic acid and plants containing aristolochic acid belonged to the first class of carcinogens; (5)however, there are six types of Chinese medicinal materials that have clearly contained aristolochic acid in the 2000 Chinese Pharmacopoeia.

China's economy has developed rapidly in the past three decades, and its GDP has become the world's second-largest country after the United States. Compared with the tragic situation of poverty and persistent insults in the country more than 100 years ago, China is now becoming stronger and more confident than ever before, and it is very urgent to publicize and project this strength and confidence. High-speed railways, communication networks, and manufacturing capabilities are typical examples of China's external display of its economic strength, a sign of hard power. In addition, China has also promoted the superiority of its soft power to the world, that is, traditional culture, but there are not many choices worthy of external publicity. And TCM that has been widely used in China for thousands of years has been selected as a typical representative.

Although TCM has various problems that contradict modern medicine, it has survived and developed stubbornly in China, which has a huge relationship with the government's vigorous efforts to support it. In the composition of all levels of government in China, there are government agencies such as the Administration of Traditional Chinese Medicine to support TCM, and every year a large amount of scientific research funds are used to study how to promote the development of TCM.

The result now is that not only has TCM failed to develop abroad, it has also been increasingly controversial and questioned at home, and the Chinese are increasingly rejecting TCM as the primary treatment option.

In 2010, the number of Chinese people receiving medical services about was 2.396 billion, of which 613 million were TCM services, accounting for about 30.04%; however, in 2018, the number of medical services was 8.308 billion, of which 108 million were TCM services, accounting for 12.90%, a decrease of 17.14 percentage points. (6) It can be seen from the trend of the change in numbers that the efficacy of traditional Chinese medicine is unsatisfactory. More and more Chinese accept Western medicine services and give up TCM services, the number of patients receiving TCM services only a small proportion.

According to the current trend, if TCM still cannot solve the pathological and pharmacological problems through experimental and evidence-based methods, and continue to use similar methods of witch doctors such as "Heaven and Man Unity" and " Yin-yang and Five-element Thought " without scientific explanation to prove to the world the rationality of TCM, and the therapeutic effect of TCM cannot be fully recognized by patients, TCM will be abandoned by everyone sooner or later, regardless of whether the government is still willing to spend huge amounts of money to support it.

References:
(1)Q&A on coronaviruses (COVID-19), https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
(2)https://www.who.int/zh/news-room/q-a-detail/q-a-coronaviruses
(3)http://dz.jjckb.cn/www/pages/webpage2009/html/2020-02/26/content_61837.htm
(4)http://finance.chinanews.com/sh/2020/02-07/9082215.shtml
(5)Zhao Chong, Liu Zhongyang. Research progress on the influence of benzene series in the paint coatings on the health status of the exposed personnel, Occupation and Health, May 2019, 1286-1289. DOI:10.13329/j.cnki.zyyjk.2019.0339
(6)Data from the 2019 China Health Statistics Yearbook, Page3,119 and 195.

Competing interests: No competing interests

20 April 2020
Shuping Dai
college teacher & practising attorney
Youli Hu
Shandong Women’s University, 2399 University Road, Changqing Science and Technology Park, Jinan, Shandong Province, China