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THE year 2020 saw the outbreak and rapid spread of the COVID-19 pandemic across the world. In response to the international health crisis， Traditional Chinese Medicine （TCM） physicians extended their expertise and efforts to help overseas Chinese and local residents in various countries in the fight against the pandemic， providing them with prescriptions and other helpful Chinese herbal remedies.
The recent daily work routine of many TCM physicians in the U. K. consists of opening up their online chat software， providing consultation to patients after analyzing the coloring and texture coating of their tongues and complexion of their face through videos or pictures， and asking them about their symptoms. After that， they prescribe treatments for patients and ship off the medicine.
“We’ve rarely been as busy as this before. The questions regarding methods of treating COVID-19 and inquiries for prescriptions since the beginning of the outbreak have increased from a few dozen to nearly a hundred every day. The present demand for Chinese medicine is 5-10 times the normal amount，” said Wang Tianjun， chairman of the Chinese Medicine Forum in Great Britain and founder of the Great Britain Chinese Medicine Alliance network.
After the novel coronavirus began to spread in the U.K.， several qualified TCM doctors of the Great Britain Chinese Medicine Alliance network launched anti-epidemic Chinese medicine assistance program. In the beginning， the activities focused on serving overseas Chinese residents， but as the pandemic escalated on a daily basis， an increasing number of local British people chose to use Chinese medicine for treatment as well. As a result， local TCM doctors became inundated with work stemming from online medical consultation and shipping off Chinese medicine.
Li Lihua is a TCM doctor living in the U.K. who has run a TCM pharmacy there for nearly 20 years. Within two weeks beginning on March 9， 2020， the number of visits to her TCM pharmacy Facebook page regarding TCM consultation increased by around 70，000.
An interview with a local doctor revealed that there are a number of factors as to why enthusiasm around using TCM for COVID-19 is peaking， ranging from effective results witnessed in treatment of COVID-19 in China and other countries， in addition to the British government-funded health system becoming overwhelmed due to demands put on it by the crisis and being unable to provide assistance to large numbers of infected patients self-isolating at home. Consequently， many local British patients chose to use Chinese medicine because of its ability to boost their immune system. In addition to providing physical medical consultation， the “cloud consulting office” of TCM doctors have also shared with foreign countries the wisdom of Chinese medicine in fighting COVID-19.
“British people have the habit of drinking cold water. We suggest they drink lukewarm water instead，” and “In accordance with relevant temperatures and environments， we suggest that relevant local medicinal materials be used to treat the symptoms of patients taking into consideration their own physical condition，” said a TCM doctor recently from Jiangsu Province Hospital of Chinese Medicine during an online video meeting with TCM experts at the Victory University of Manchester， in which they discussed ways of using TCM to prevent and treat disease.
The international cooperation plat- form for long-distance TCM education of the Jiangsu hospital carries out operations in more than a dozen countries and regions across the world including the U.S.， Canada， the U.K.， Australia， Switzerland， Brazil， Ireland， and Singapore.
There are nearly 20 countries throughout Europe and the Americas that presently recognize TCM. In the U.S. alone， more than 40 states have implemented management regulations for TCM， and half of those states have a TCM medical insurance system.
In addition to this， since January 1 of this year， acupuncture services have been included in the medical services covered by the Blue Cross Blue Shield Association （BCBS） in the U.S. The BCBS is an alliance of 36 independent medical insurance organizations and companies in the U.S. that provide health insurance for over 106 million citizens. It was also one of the first organizations to include acupuncture in its health insurance.
According to the U.S. National Institute of Health （NIH）， around one in five Americans use herbal medicine in their daily lives.
At a press conference on the important role of TCM and effective TCM drugs for the prevention and treatment of COVID-19 held by the State Council Information Office， several TCM prescriptions that have shown results in treating COVID-19， including Jinhua Qinggan Granules， Lianhua Qingwen Capsules， Xuebijing Injection， Lung Cleansing & Detoxifying Preparation， Dampness Resolving and Detoxifying Preparation， and Lung Diffusing and Detoxifying Preparation， referred to as“three drugs and three treatments，” were introduced. Clinical therapeutic effect observation shows that TCM has a total effectiveness rate of over 90 percent， being able to effectively alleviate symptoms， reduce mild illnesses from progressing into severe conditions， improve recovery rates， reduce death rates， and promote the physical health of patients who are recovering. During the online meeting Fighting COVID-19 in China and Europe held on March 25， Dr. Zhong Nanshan presented to European experts at the meeting China’s experience in treating and preventing the spread of COVID-19. During his speech， he indicated that the recovery rate of 284 patients that were treated with Lianhua Qingwen Capsules was over 91.5 percent. This medicine has been included in the epidemic prevention products shipped to overseas Chinese students from Chinese embassies around the world. China also sent Italy 100，000 boxes of Lianhua Qingwen to help in its fight against COVID-19.This resulted in an increase of sales of Chinese medicine in many TCM pharmacies in Italy who followed the formulas given by the TCM experts in China. In addition to overseas Chinese people， many local Italians also began purchasing Chinese medicine and consulting TCM doctors.
Beginning on February 27， the European Plaza Trade Center in the eighth district and China Town trade center in the 10th district of Budapest， Hungary， began to prepare and pass out free Chinese herbal drinks. According to local sources， due to the high demand， several employees from Chinese restaurants were invited to help cook the Chinese medicine. People who drank the Chinese herbal drinks included both overseas Chinese and non-Chinese locals.
Demand for Chinese herbal remedies in treating flu-like symptoms has doubled since COVID-19 began spreading across the U.S. at the end of February， Reuters reported on March 9， citing a Chinese medicine company. On March 18， China Daily reported that a Dutch pharmaceutical trading company said that the 750 boxes of TCM medicines imported from China the previous week had sold out and an emergency order of an additional 15，150 boxes had been placed.
In a short time， Lianhua Qingwen Capsules became a highly sought-after medicine in foreign countries. On many e-commerce platforms， they have sold out. Demand has been so high that the price per box of Lianhua Qingwen on some supplier platforms went from the average price in China of around RMB 15 to over RMB 100， and yet the supply was still not able to satisfy the demand. In addition to that， it took over a month for the medicine to reach customers by postal services.
The surprising rise in popularity of Lianhua Qingwen ignited skyrocketing demand for Chinese herbal medicines by overseas netizens. According to a Reuters report， while visiting a TCM pharmacy in New York City in the U.S， reporters witnessed bustling customers and busy workers using traditional Chinese scales to measure out herbal ingredients including Lonicera japonica Thunb， cassia twig， and medicinal Paeonia suffruticosa Andr. “In Germany， antiviral Chinese herbs and Chinese herbs thought to boost immunity， such as folium insatidis， insatis root， wild honeysuckle flower， and astragalus root are hard to find these days，”said Dr. Du Xudian， a longtime TCM practitioner in Darmstadt， Germany. A similar situation occurred at another Chinatown pharmacy， where the owner said 40 pounds of herbs which would have sold in about two or three weeks under normal circumstances sold out in a matter of days. The most popular herbs were preparations made of honeysuckle and insatis root. With the supply already running out， prices also began to rise.
Even before the government of California ordered the closing of all nonessential businesses， sales of Chinese herbal medicine had been booming throughout the state， where the market for some of China’s recommended antiepidemic remedies， such as Houttuynia cordata， honeysuckle， and asarum， had been hard to come by， said Liu Yuankai， President of the American Chamber of Commerce for Traditional Chinese Medicine. “Urgent orders for our company’s honeysuckle herbal medicine are being sent by air from China，” Liu said. Before the local lockdown， the chamber of commerce made 12，000 Chinese medicine sachets for epidemic prevention and distributed them to local people free of charge， and another 20，000 sachets are being assembled presently.
At the rapid pace with which Chinese medicine has “gone abroad，” the prospects of a number of TCM enterprises look bright. Ma Shuai， chief analyst of the pharmaceutical industry of Essence Securities， said that traditional Chinese herbal medicine has had an obvious effect in fighting COVID-19. If relevant treatment solutions can be promoted globally， this will have a certain boost on the entire TCM industry， especially the Chinese medicines with proven antiviral effects. At present， some listed companies have already begun to expand their production and export overseas.
China is the major source of traditional Chinese medicine. But due to the lack of unified scientific standards which are accepted by Western countries， the total export volume of Chinese medicine is still relatively low. According to statistics， China’s export volume of traditional medicine during the year 2018 was just over US $3.9 billion. Seventeen years ago， Chinese medicine played an active role in the fight against SARS and received much international fame as a result. However， after SARS passed， international attention towards TCM waned. Chinese medicine needs time to show an impact in patients and thus requires a longer treatment process. Western medicine on the other hand pursues the quick effect of “immediate relief.”Since Chinese medicine mainly consists of natural herbal materials， they are prepared by cooking， while Western medicine utilizes chemical agents and are delivered to patients by injections or consumed orally. TCM focuses on curing the “root of the problem，” while Western medicine focuses on curing the“symptoms of the problem” all of which create stark ideological differences between the two schools of medicine.
As there have been no major breakthroughs in the area of TCM invention patents， and the fact that it is difficult to scientifically define the composition and function of TCM herbal medicine according to Western medicinal standards， the threshold for traditional Chinese medicines entering the foreign market is very high. In the words of Zou Zengqiang， deputy general manager of China National Pharmaceutical Group（Sinopharm）， “The challenges Chinese herbal medicine presently faces in the international market are the laws and regulations and the ideologies of dif- ferent countries. Therefore， despite the thousands of years of history for which TCM has been around， it has not entered the mainstream market in the West.” This is a real challenge and hurdle that Chinese medicine has to overcome.
For a long time， it has not been easy for patented Chinese medicines to get registered and listed overseas. As a pharmaceutical drug， it should have a clear chemical composition， as well as list the pharmacodynamic effect of each chemical composition， including the effect of the interaction between each chemical composition on the efficacy and toxicity. However， Traditional Chinese medicine is usually a mixture of multiple components， whose chemical composition is not completely clear， and the pharmacodynamic effect cannot be completely determined. As a result， traditional Chinese medicine cannot be tested for its pharmacology and toxicology based on existing Western medicine theories. In the end， TCM has had great difficulty in gaining recognition in the international registered pharmaceutical market.
According to the standards for certifying Western medicine， it is very difficult for finished TCM drugs to gain certification and enter the pharmaceutical market. Perhaps the development of finished TCM drugs is not suitable for the international development of TCM. During the COVID-19 pandemic we have realized that TCM must follow its own unique path of development，”Wang Yonghui， CEO of Xiangxue Pharmaceutical Co.， Ltd. told reporters in an interview.
“In recent years， our company has built a system based on the ancient wisdom of TCM using big data， artificial intelligence， and the Internet of Things， including combining three modules of TCM of individualized diagnosis， personalized therapy， and personalized prescriptions. This enables people to automatically receive realtime electronic prescriptions， have a tailored herbal prescription created for them in record time， which is then sent out to them. In Wuhan， for example， we provided 60，000 doses of a certain Chinese medicinal broth to patients every day， one prescription for each patient. We can also share our service experience overseas， for example， in overseas TCM clinics， we can provide TCM treatment and help them assemble TCM herbal formulas. It is our belief that the pathway TCM should follow overseas is that of personalized medicine treatment.”
TCM Finds New Ways of Fighting the Pandemic
The recent daily work routine of many TCM physicians in the U. K. consists of opening up their online chat software， providing consultation to patients after analyzing the coloring and texture coating of their tongues and complexion of their face through videos or pictures， and asking them about their symptoms. After that， they prescribe treatments for patients and ship off the medicine.
“We’ve rarely been as busy as this before. The questions regarding methods of treating COVID-19 and inquiries for prescriptions since the beginning of the outbreak have increased from a few dozen to nearly a hundred every day. The present demand for Chinese medicine is 5-10 times the normal amount，” said Wang Tianjun， chairman of the Chinese Medicine Forum in Great Britain and founder of the Great Britain Chinese Medicine Alliance network.
After the novel coronavirus began to spread in the U.K.， several qualified TCM doctors of the Great Britain Chinese Medicine Alliance network launched anti-epidemic Chinese medicine assistance program. In the beginning， the activities focused on serving overseas Chinese residents， but as the pandemic escalated on a daily basis， an increasing number of local British people chose to use Chinese medicine for treatment as well. As a result， local TCM doctors became inundated with work stemming from online medical consultation and shipping off Chinese medicine.
Li Lihua is a TCM doctor living in the U.K. who has run a TCM pharmacy there for nearly 20 years. Within two weeks beginning on March 9， 2020， the number of visits to her TCM pharmacy Facebook page regarding TCM consultation increased by around 70，000.
An interview with a local doctor revealed that there are a number of factors as to why enthusiasm around using TCM for COVID-19 is peaking， ranging from effective results witnessed in treatment of COVID-19 in China and other countries， in addition to the British government-funded health system becoming overwhelmed due to demands put on it by the crisis and being unable to provide assistance to large numbers of infected patients self-isolating at home. Consequently， many local British patients chose to use Chinese medicine because of its ability to boost their immune system. In addition to providing physical medical consultation， the “cloud consulting office” of TCM doctors have also shared with foreign countries the wisdom of Chinese medicine in fighting COVID-19.
“British people have the habit of drinking cold water. We suggest they drink lukewarm water instead，” and “In accordance with relevant temperatures and environments， we suggest that relevant local medicinal materials be used to treat the symptoms of patients taking into consideration their own physical condition，” said a TCM doctor recently from Jiangsu Province Hospital of Chinese Medicine during an online video meeting with TCM experts at the Victory University of Manchester， in which they discussed ways of using TCM to prevent and treat disease.
The international cooperation plat- form for long-distance TCM education of the Jiangsu hospital carries out operations in more than a dozen countries and regions across the world including the U.S.， Canada， the U.K.， Australia， Switzerland， Brazil， Ireland， and Singapore.
There are nearly 20 countries throughout Europe and the Americas that presently recognize TCM. In the U.S. alone， more than 40 states have implemented management regulations for TCM， and half of those states have a TCM medical insurance system.
In addition to this， since January 1 of this year， acupuncture services have been included in the medical services covered by the Blue Cross Blue Shield Association （BCBS） in the U.S. The BCBS is an alliance of 36 independent medical insurance organizations and companies in the U.S. that provide health insurance for over 106 million citizens. It was also one of the first organizations to include acupuncture in its health insurance.
According to the U.S. National Institute of Health （NIH）， around one in five Americans use herbal medicine in their daily lives.
TCM Prescriptions Go Viral
At a press conference on the important role of TCM and effective TCM drugs for the prevention and treatment of COVID-19 held by the State Council Information Office， several TCM prescriptions that have shown results in treating COVID-19， including Jinhua Qinggan Granules， Lianhua Qingwen Capsules， Xuebijing Injection， Lung Cleansing & Detoxifying Preparation， Dampness Resolving and Detoxifying Preparation， and Lung Diffusing and Detoxifying Preparation， referred to as“three drugs and three treatments，” were introduced. Clinical therapeutic effect observation shows that TCM has a total effectiveness rate of over 90 percent， being able to effectively alleviate symptoms， reduce mild illnesses from progressing into severe conditions， improve recovery rates， reduce death rates， and promote the physical health of patients who are recovering. During the online meeting Fighting COVID-19 in China and Europe held on March 25， Dr. Zhong Nanshan presented to European experts at the meeting China’s experience in treating and preventing the spread of COVID-19. During his speech， he indicated that the recovery rate of 284 patients that were treated with Lianhua Qingwen Capsules was over 91.5 percent. This medicine has been included in the epidemic prevention products shipped to overseas Chinese students from Chinese embassies around the world. China also sent Italy 100，000 boxes of Lianhua Qingwen to help in its fight against COVID-19.This resulted in an increase of sales of Chinese medicine in many TCM pharmacies in Italy who followed the formulas given by the TCM experts in China. In addition to overseas Chinese people， many local Italians also began purchasing Chinese medicine and consulting TCM doctors.
Beginning on February 27， the European Plaza Trade Center in the eighth district and China Town trade center in the 10th district of Budapest， Hungary， began to prepare and pass out free Chinese herbal drinks. According to local sources， due to the high demand， several employees from Chinese restaurants were invited to help cook the Chinese medicine. People who drank the Chinese herbal drinks included both overseas Chinese and non-Chinese locals.
Demand for Chinese herbal remedies in treating flu-like symptoms has doubled since COVID-19 began spreading across the U.S. at the end of February， Reuters reported on March 9， citing a Chinese medicine company. On March 18， China Daily reported that a Dutch pharmaceutical trading company said that the 750 boxes of TCM medicines imported from China the previous week had sold out and an emergency order of an additional 15，150 boxes had been placed.
Demand for TCM Rises in Overseas Markets
In a short time， Lianhua Qingwen Capsules became a highly sought-after medicine in foreign countries. On many e-commerce platforms， they have sold out. Demand has been so high that the price per box of Lianhua Qingwen on some supplier platforms went from the average price in China of around RMB 15 to over RMB 100， and yet the supply was still not able to satisfy the demand. In addition to that， it took over a month for the medicine to reach customers by postal services.
The surprising rise in popularity of Lianhua Qingwen ignited skyrocketing demand for Chinese herbal medicines by overseas netizens. According to a Reuters report， while visiting a TCM pharmacy in New York City in the U.S， reporters witnessed bustling customers and busy workers using traditional Chinese scales to measure out herbal ingredients including Lonicera japonica Thunb， cassia twig， and medicinal Paeonia suffruticosa Andr. “In Germany， antiviral Chinese herbs and Chinese herbs thought to boost immunity， such as folium insatidis， insatis root， wild honeysuckle flower， and astragalus root are hard to find these days，”said Dr. Du Xudian， a longtime TCM practitioner in Darmstadt， Germany. A similar situation occurred at another Chinatown pharmacy， where the owner said 40 pounds of herbs which would have sold in about two or three weeks under normal circumstances sold out in a matter of days. The most popular herbs were preparations made of honeysuckle and insatis root. With the supply already running out， prices also began to rise.
Even before the government of California ordered the closing of all nonessential businesses， sales of Chinese herbal medicine had been booming throughout the state， where the market for some of China’s recommended antiepidemic remedies， such as Houttuynia cordata， honeysuckle， and asarum， had been hard to come by， said Liu Yuankai， President of the American Chamber of Commerce for Traditional Chinese Medicine. “Urgent orders for our company’s honeysuckle herbal medicine are being sent by air from China，” Liu said. Before the local lockdown， the chamber of commerce made 12，000 Chinese medicine sachets for epidemic prevention and distributed them to local people free of charge， and another 20，000 sachets are being assembled presently.
At the rapid pace with which Chinese medicine has “gone abroad，” the prospects of a number of TCM enterprises look bright. Ma Shuai， chief analyst of the pharmaceutical industry of Essence Securities， said that traditional Chinese herbal medicine has had an obvious effect in fighting COVID-19. If relevant treatment solutions can be promoted globally， this will have a certain boost on the entire TCM industry， especially the Chinese medicines with proven antiviral effects. At present， some listed companies have already begun to expand their production and export overseas.
Future Development Path
China is the major source of traditional Chinese medicine. But due to the lack of unified scientific standards which are accepted by Western countries， the total export volume of Chinese medicine is still relatively low. According to statistics， China’s export volume of traditional medicine during the year 2018 was just over US $3.9 billion. Seventeen years ago， Chinese medicine played an active role in the fight against SARS and received much international fame as a result. However， after SARS passed， international attention towards TCM waned. Chinese medicine needs time to show an impact in patients and thus requires a longer treatment process. Western medicine on the other hand pursues the quick effect of “immediate relief.”Since Chinese medicine mainly consists of natural herbal materials， they are prepared by cooking， while Western medicine utilizes chemical agents and are delivered to patients by injections or consumed orally. TCM focuses on curing the “root of the problem，” while Western medicine focuses on curing the“symptoms of the problem” all of which create stark ideological differences between the two schools of medicine.
As there have been no major breakthroughs in the area of TCM invention patents， and the fact that it is difficult to scientifically define the composition and function of TCM herbal medicine according to Western medicinal standards， the threshold for traditional Chinese medicines entering the foreign market is very high. In the words of Zou Zengqiang， deputy general manager of China National Pharmaceutical Group（Sinopharm）， “The challenges Chinese herbal medicine presently faces in the international market are the laws and regulations and the ideologies of dif- ferent countries. Therefore， despite the thousands of years of history for which TCM has been around， it has not entered the mainstream market in the West.” This is a real challenge and hurdle that Chinese medicine has to overcome.
For a long time， it has not been easy for patented Chinese medicines to get registered and listed overseas. As a pharmaceutical drug， it should have a clear chemical composition， as well as list the pharmacodynamic effect of each chemical composition， including the effect of the interaction between each chemical composition on the efficacy and toxicity. However， Traditional Chinese medicine is usually a mixture of multiple components， whose chemical composition is not completely clear， and the pharmacodynamic effect cannot be completely determined. As a result， traditional Chinese medicine cannot be tested for its pharmacology and toxicology based on existing Western medicine theories. In the end， TCM has had great difficulty in gaining recognition in the international registered pharmaceutical market.
According to the standards for certifying Western medicine， it is very difficult for finished TCM drugs to gain certification and enter the pharmaceutical market. Perhaps the development of finished TCM drugs is not suitable for the international development of TCM. During the COVID-19 pandemic we have realized that TCM must follow its own unique path of development，”Wang Yonghui， CEO of Xiangxue Pharmaceutical Co.， Ltd. told reporters in an interview.
“In recent years， our company has built a system based on the ancient wisdom of TCM using big data， artificial intelligence， and the Internet of Things， including combining three modules of TCM of individualized diagnosis， personalized therapy， and personalized prescriptions. This enables people to automatically receive realtime electronic prescriptions， have a tailored herbal prescription created for them in record time， which is then sent out to them. In Wuhan， for example， we provided 60，000 doses of a certain Chinese medicinal broth to patients every day， one prescription for each patient. We can also share our service experience overseas， for example， in overseas TCM clinics， we can provide TCM treatment and help them assemble TCM herbal formulas. It is our belief that the pathway TCM should follow overseas is that of personalized medicine treatment.”