Lianhua Qingwen

Lianhua Qingwen was developed by Shijiazhuang Yiling Pharmaceutical in 2003 as a treatment for severe acute respiratory syndrome (SARS) following the outbreak of the disease in 2002 and was listed by the National Health Commission of China in 2004 as a treatment for influenza and other respiratory disease.{{cite news |title=Traditional Chinese cures battle for acceptance in COVID-19 fight |url=https://asia.nikkei.com/Business/Pharmaceuticals/Traditional-Chinese-cures-battle-for-acceptance-in-COVID-19-fight |access-date=6 March 2021 |work=Nikkei Asia |date=8 May 2020}} Its formulation includes 13 herbs and minerals which are said to have been used in Chinese traditional medicine as early as the Han dynasty.{{cite web |title=Chinese traditional medicine for Covid-19 becomes money tree |url=https://www.scmp.com/business/china-business/article/3090536/wildly-popular-chinese-traditional-medicine-treatment-mcovid |website=South China Morning Post |language=en |date=29 June 2020}}

The medication is approved in China as a Chinese patent medicine. As a result, the package insert includes a list of herbs, but not their amounts.{{cite web |last1=石家庄以岭药业股份有限公司 |title=连花清瘟胶囊(以岭)说明书 |url=https://ypk.39.net/563759/manual |website=ypk.39.net |language=zh|trans-title=Package insert: Lianhua Qingwen capsules (Yiling)}} Sources of its formulation reportedly consist of:{{Cite journal |last1=Hu |first1=Caiyun |last2=Liang |first2=Mingming |last3=Gong |first3=Fengfeng |last4=He |first4=Bin |last5=Zhao |first5=Dongdong |last6=Zhang |first6=Guoliang |date=2020-09-17 |title=Efficacy of Lianhua Qingwen Compared with Conventional Drugs in the Treatment of Common Pneumonia and COVID-19 Pneumonia: A Meta-Analysis |journal=Evidence-Based Complementary and Alternative Medicine |volume=2020 |pages=5157089 |doi=10.1155/2020/5157089 |issn=1741-427X |pmc=7501551 |pmid=32963563|doi-access=free }}

• 北板蓝根 Isatis root
• 连翘 Weeping forsythia
• 金银花 Lonicera japonica
• 炙麻黄 Ephedra
• 甘草 Licorice root
• 绵马贯众 Male fern rhizome
• 石膏 Gypsum fibrosum
• 广藿香 Cablin patchouli herb
• 红景天 Herba rhodiolae
• 鱼腥草 Houttuynia cordata
• 大黄 Rhubarb root and rhizome
• 炒苦杏仁 Bitter apricot kernel
• 薄荷醇 menthol

The medicine is both in capsule and granular form.{{cite news | vauthors = Szeto W |title=Doctors warn against claims that Beijing-touted health supplement distributed in Canada treats COVID-19 |url=https://www.cbc.ca/news/canada/british-columbia/beijing-govt-health-supplement-1.5558583 |access-date=6 March 2021 |work=CBC News |date=8 May 2020}}

Being approved as a Chinese patent medicine, LHQW also needs to have information regarding its supposed function in the practice of TCM. The package insert text reads:{{Cite journal |last1=Jia |first1=Zhenhua |last2=Wu |first2=Yiling |date=2021-04-01 |title=Clinical applications and pharmacological research progress of Lianhua Qingwen capsules/granules |journal=Journal of Traditional Chinese Medical Sciences |language=en |volume=8 |issue=2 |pages=101–109 |doi=10.1016/j.jtcms.2021.05.001 |s2cid=236600045 |issn=2095-7548|doi-access=free }}

[Functions and Indications] Clears epidemics and removes toxins. Ventilates lung and discharges heat. Used to treat influenza of the heat-toxin invading lung pattern, with symptoms such as: fever or high fever, aversion to cold, muscle soreness and pain, nasal congestion and runny nose, coughing, headache, dry and sore throat, reddish tongue, yellow or greasy yellow tongue coating, etc. Addition approved in April 2020: In the routine treatment of novel coronavirus pneumonia, it can be used for fever, cough, and fatigue caused by mild and moderate types.{{cite web |last1=石家庄以岭药业股份有限公司 |title=关于连花清瘟胶囊（颗粒）新增适应症申请 获得批准的公告 |url=https://static.cninfo.com.cn/finalpage/2020-04-14/1207495806.PDF |language=zh|trans-title=Notice on the approval of new indication for Lianhua Qingwen Capsule (Granule)|date=April 4, 2020}}

Lianhua Qingwen should be avoided for patients with G6PD deficiency, since its active ingredient, Lonicera japonica, will lead to hemolysis to such patients.{{cn|date=August 2022}}

Due to the inclusion of Ephedra, people with high blood pressure, anxiety, history of seizures, irregular heart beats, or other heart conditions, should avoid taking Linhua Quingwen.

The official package insert of LHQW states that the adverse effects are "unclear".{{cite web |trans-title=Do not take LHQW for prevention of COVID-19|script-title=zh:不要吃连花清瘟预防新冠 |url=https://dxy.com/article/93712 |script-website=zh:丁香医生|trans-website=Dr. Clove |date=2022-04-17}} A January 2022 meta-analysis from China reports that it may cause GI discomfort, rashes and itches, dry mouth, and dizziness.{{cite journal |last1=Hu |first1=Caiyun |last2=He |first2=Bin |last3=Gong |first3=Fengfeng |last4=Liang |first4=Mingming |last5=Zhao |first5=Dongdong |last6=Zhang |first6=Guoliang |title=The Adverse Reactions of Lianhua Qingwen Capsule/Granule Compared With Conventional Drug in Clinical Application: A Meta-Analysis |journal=Frontiers in Pharmacology |date=27 January 2022 |volume=13 |pages=764774 |doi=10.3389/fphar.2022.764774|pmid=35153773 |pmc=8830515 |doi-access=free }}

During the COVID-19 pandemic, the government of the People's Republic of China (PRC) approved the use of Lianhua Qingwen for mild to moderate COVID-19 cases in January 2020, and promotes the use of the medicine abroad.{{cite news | vauthors = Mai J, Lo K |title=Beijing pushes traditional Chinese medicine as coronavirus treatment |url=https://www.scmp.com/news/china/society/article/3076500/beijing-pushes-traditional-chinese-medicine-coronavirus |access-date=6 March 2021 |work=South China Morning Post |date=23 March 2020 |language=en}}

In March 2022, during the Shanghai COVID-19 outbreak, the medication was distributed en masse to residents. Reports emerged indicating that this process consumed significant logistical capacity, drawing criticism about misuse of resources at a time when people were struggling with shortages of basic needs such as food and medication. An article on telemedicine and medical news platform Dr. Lilac pointed out that there was no scientific evidence available to indicate that LHQW was effective as prophylaxis to prevent infection, nor did there exist any official government recommendation for such usage; instead, taking the drug unnecessarily carried a risk of side effects. It argued that there was thus no reasonable basis for the mass distribution of the medication to healthy individuals to begin with, let alone doing so in a way that took up transportation capacity and resources that were urgently needed elsewhere.

Lianhua Qingwen has also been promoted and distributed by the government in Hong Kong (HK).{{cite news | vauthors = McGregor, G |title='More political than scientific': Beijing's peddling of traditional Chinese medicine may be undermining its COVID response |url=https://fortune.com/2022/04/22/china-covid-response-traditional-chinese-medicine-tcm-lianhua-qingwen-pill-vaccines/ |access-date=25 April 2022 |work=Fortune |date=23 April 2022 |language=en}} The pro-establishment DAB alliance was found to have distributed unregistered doses of LHQW, in breach of health regulations.{{cite news|title=衞生署打擊未註冊藥品「瘟膠囊」 民建聯曾於社區派發|url=https://www.inmediahk.net/node/政經/衞生署打擊未註冊藥品「瘟膠囊」-民建聯曾於社區派發|work=獨立媒體|date=2022-02-22|accessdate=2022-02-24|archive-date=2022-02-24|archive-url=https://web.archive.org/web/20220224070659/https://www.inmediahk.net/node/%E6%94%BF%E7%B6%93/%E8%A1%9E%E7%94%9F%E7%BD%B2%E6%89%93%E6%93%8A%E6%9C%AA%E8%A8%BB%E5%86%8A%E8%97%A5%E5%93%81%E3%80%8C%E7%98%9F%E8%86%A0%E5%9B%8A%E3%80%8D-%E6%B0%91%E5%BB%BA%E8%81%AF%E6%9B%BE%E6%96%BC%E7%A4%BE%E5%8D%80%E6%B4%BE%E7%99%BC}}

In April 2022, the Financial Times reported that the leading COVID-19 health official in the PRC, the famous epidemiologist and pulmonologist Zhong Nanshan - who has also been the most prominent scientific promoter of Lianhua Qingwen - had undisclosed prior investments in large stakeholdings in corporations producing Lianhua Qingwen and other treatments under question. As the Financial Times report showed, these appeared to be serious conflicts of interest as the investments benefited from the PRC and HK governments' rapid approval and then widespread national & international promotion of Lianhua Qingwen and other suspect treatments for purportedly helping COVID-19 sufferers.{{cite news | vauthors = Riordan, P, Li, G, Ho-him, C, Lockett, H |title=China Covid-19 tsar pushed treatments without revealing business ties |url=https://www.ft.com/content/fcac2cbc-4bff-44f5-81bf-66db32b99fca |access-date=25 April 2022 |work=Financial Times |date=25 April 2022 |language=en}}

A 2020 "randomized controlled trial" of LHQW involving Zhong was also found in April 2022 to have undisclosed funding from Yiling Pharmaceuticals, forcing an erratum.{{cite Q|Q95265290}} Retraction Watch also notes that author Jia Zheng-hua is the son-in-law of Wu Yi-ling, the founder of the company in question.{{Cite web|title=Prominent Chinese scientist failed to disclose company ties in COVID-19 clinical trial paper|url=https://retractionwatch.com/2021/05/04/prominent-chinese-scientist-failed-to-disclose-company-ties-in-clinical-trial-paper/|access-date=2022-04-12|date=2021-05-04|last=McCarty|first= Niko|work=Retraction Watch|language=en-US|archive-date=2022-06-12|archive-url=https://web.archive.org/web/20220612044802/https://retractionwatch.com/2021/05/04/prominent-chinese-scientist-failed-to-disclose-company-ties-in-clinical-trial-paper/}}

In the Philippines, its Food and Drug Administration approved Lianhua Qingwen on 7 August 2020 as a traditional herbal product that helps remove "heat-toxin invasion of the lungs, including symptoms such as fever, aversion to cold, muscle soreness, stuffy and runny nose". It is not registered as a COVID-19 medication, and a doctor's prescription is required for its use.{{cite web |title=DOH and FDA Clarify Claims on the Approval of Potential COVID-19 Treatments and Calls for Resignation of the SoH |url=https://doh.gov.ph/doh-press-release/DOH-AND-FDA-CLARIFY-CLAIMS-ON-THE-APPROVAL-OF-POTENTIAL-COVID-19-TREATMENTS-AND-CALLS-FOR-RESIGNATION-OF-THE-SOH |website=Republic of the Philippines Department of Health |access-date=17 February 2022 |date=5 April 2021}}{{cite news | vauthors = Montemayor T |title='Lianhua Qingwen' registered but not as Covid medication |url=https://www.pna.gov.ph/articles/1135819 |access-date=17 February 2022 |work=Philippine News Agency |date=April 5, 2021}} A Filipino TCM physician interviewed by ABS-CBN clarified that although the medicine can be used for symptomatic treatment of flu-like symptoms in COVID-19 patients, it is not an antibiotic nor anti-viral, and cannot cure the disease itself. It cannot be taken as prophylaxis or as a health supplement.{{cite news | vauthors = Nieva-Nishimori A |title=Lianhua Qingwen, the FDA-approved traditional Chinese med, only treats symptoms, not COVID |url=https://news.abs-cbn.com/news/08/18/20/lianhua-qingwen-the-fda-approved-traditional-chinese-med-only-treats-symptoms-not-covid |access-date=6 March 2021 |work=ABS-CBN News |date=18 August 2020 |language=en}}

In Singapore, the Health Sciences Authority has issued an advisory to clarify that although it has been approved for sale as a Chinese proprietary medicine for the relief of cold and flu symptoms, Lianhua Qingwen is not approved to treat or alleviate symptoms of COVID-19. It warned that sellers who make claims that it can prevent, protect against or treat COVID-19 may face prosecution.{{cite web |title=HSA Advisory on Lianhua Qingwen Products for Prevention or Treatment of COVID-19 |url=https://www.hsa.gov.sg/announcements/news/advisorycovid-lianhuaqingwen |website=Health Sciences Authority |date=17 November 2021 |access-date=17 February 2022}}

In Cambodia at least 50,000 boxes were handed over to the Ministry of Health around April 2021, but it remains unclear both who the sponsor of the donation was, exactly how many capsules were donated and where the products were to be put to clinical use. After local pharmaceutical distributor Argon, a subsidiary of Dynamic Group claimed exclusive rights to distribute the product,{{Cite web |last=Dua |first=PT Djembatan |date=2021-06-14 |title=Dynamic Argon Become Exclusive distributor for LIANHUA QINGWEN CAPSULES in Cambodia |url=https://www.dynamic-argon.com.kh/post/dynamic-argon-become-exclusive-distributor-for-lianhua-qingwen-capsules-in-cambodia |access-date=2024-08-15 |website=Dynamic Argon |language=en}} a number of private importers and online resellers were shut down.{{Cite news |title=Online sellers of Chinese medicine told to stop, or else |url=https://www.phnompenhpost.com/national/online-sellers-chinese-medicine-told-stop-or-else}}

Although the medicine has been allowed to be sold in Canada since 2012, Health Canada has cautioned against the use of the Chinese traditional medicine to prevent, treat, and cure COVID-19. In the United States, the FDA is advising consumers not to purchase or use Lianhua Qingwen, stating that it has not been approved or authorized by FDA and is being misleadingly represented as safe and/or effective for the treatment or prevention of COVID-19.{{cite web | author = Office of Regulatory Affairs |title=Fraudulent Coronavirus Disease 2019 (COVID-19) Products |url=https://www.fda.gov/consumers/health-fraud-scams/fraudulent-coronavirus-disease-2019-covid-19-products |website= U.S. Food and Drug Administration |language=en |date=22 July 2021}}

In Australia, the Therapeutic Goods Administration has not given approval to Lianhua Qingwen, as it contains ephedra, a key ingredient used to make the drug methamphetamine. Despite the ban, Lianhua Qingwen has been sold illegally in Australia as a COVID-19 treatment.{{cite news | vauthors = Gong N |title=Chinese medicine Lianhua Qingwen makes its way into community for COVID-19 treatment despite Australian ban |url=https://www.abc.net.au/news/2022-02-17/banned-chinese-medicine-lianhua-qingwen-in-australia-covid/100837934 |access-date=28 March 2022 |work=ABC News (Australia) |date=17 February 2022}}

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Category:Traditional Chinese medicine pills

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