Chinese Herbal Remedy for H1N1

By Carol A. Kemper, MD, FACP, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center. Dr. Kemper does research for the National Institutes of Health, Abbott Laboratories, and Merck.

This article originally appeared in the October 2011 issue of Infectious Disease Alert. At that time, it was peer reviewed by Timothy Jenkins, MD, Assistant Professor of Medicine, University of Colorado, Denver Health Medical Center. Dr. Jenkins reports no financial relationship to this field of study.

Source: Wang C, et al. Oseltamivir compared with the Chinese Traditional Therapy Maxingshigan-Yinqiaosan in the treatment of H1N1 Influenza. Ann Intern Med 2011;15:217-225.

Thousands of Chinese used a compound called maxingshigan-yinqiaosan (MY) for treatment of flu symptoms during the 2009 H1N1 epidemic. MY is a concoction of 12 different herbs, including toasted Herba ephedra, as well as qinghao, gypsum fibrosum, and rhizoma.

To test the efficacy of this herbal remedy for influenza, the authors conducted an unblinded, randomized study of 410 adults (ages 15-59; average age, 19 years) with laboratory-confirmed influenza H1N1. Patients were randomly assigned in a 1:1 fashion to receive 5 days of either oseltamivir (OS), OS plus MY, MY alone, or nothing. Patients were excluded from study if they had pneumonia or abnormal chest radiographs, other significant underlying illness or HIV infection, or had received influenza vaccination in the past year. All of the participants were hospitalized for quarantine and close monitoring. Serial real-time PCR for viral RNA titers were conducted daily in a subset of 148 randomly selected patients.

The MY compound met Chinese safety standards and was tested for heavy metals, bacterial contamination, and pesticides, and was centrally distributed to the study sites. Antibiotics could be used at the discretion of the treating physician.

The median time from onset of illness to randomization was 35 hours (range, 18-48 hours), and was similar between the three active treatment groups and controls. The use of concomitant antibacterials was similar in the four groups prior to randomization. Following randomization, the control group received significantly more antibiotics than the three active treatment groups (34% vs. 15.7% for OS, 9.7% for MY, and 7.8% for OS + MY; P < 0.001). Time to resolution of fever was significantly less for all three treatment groups compared with the control group (median time, 15 hours for OS + MY, 16 hours for MY, 20 hours for OS, and 26 hours for the control group; P < 0.001). A borderline statistically significant difference in favor of the combined treatment group compared with the OS group was observed for time to resolution of fever. No difference in the reduction of other symptoms (cough, headache, fatigue) between the groups was observed. Only two patients developed nausea and vomiting with MY, and none reported side effects to OS.

Throat swabs demonstrated a rapid reduction in H1N1 viral shedding between baseline and day 5, although no significant difference between the treatment groups and controls was detected. By day 5 of illness, viral shedding was still detectable by PCR in 40% of the control group, 30% of the MY group, and 16-18% of the groups receiving OS. Further analysis revealed that this subgroup of patients had a lower symptom score compared with the other study patients.

The combination of this Chinese herbal remedy plus oseltamivir for influenza H1N1 appeared more effective than OS alone in the reduction of fever, and was well-tolerated.