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In some areas the peak of pandemic of A H1N1 Flu 2009 has passed and emerged downward trend according to the report of WHO Dec. 11 2009. However, the seasonality of its epidemics seems to be not obvious with an unpredictable nature, so that no one can be sure whether it would set off another wave of the pandemic.

It is in this emergent situation, after careful investigation many researchers have questioned the efficacy of neuraminidase inhibitor drug – Tamiflu in preventing complications such as pneumonia in otherwise healthy people with seasonal flu, the drug manufacturer had failed to provide effective data to answer the question. [1][2][3]. And the World Health Organization has endorsed the findings. If the question comes true, it will undoubtedly destroy the hope and confidence of public in prevention and treatment of A H1N1 Flu 2009. It is bound to create massive panic.

The overuses of antibiotics have been significantly activating the activity of virus mutation. The viruses are able to develop resistant ability on new version antibiotics once they are being put in use shortly. I think that on the current medical technology, it seems very difficult to control the influenza virus effectively. Fortunately, in terms of A H1N1 Flu 2009, most of those infected had mild symptoms without heavy impairment and only fewer patients developed into critical or death, and British scientists studies have proven it is considerably less lethal than was feared in advance. Therefore, we should broaden our thinking way in combating against influenza, and turn to focus on the prevention and treatment of various complications by developing new effective drugs. Based on the current knowledge on natural drug’s researches, it would be feasible easily.

Now let discuss the feasibility of Chinese medicine (CM) on treatment of A/H1N1 2009 flu

1. The symptoms and complications of the A/H1N1 2009 flu infected

1.1. Lung cells can be infected deeper and cause more severe symptoms than seasonal flu can.

1.2. Many severe patients have pulmonary emboli that blocks the arteries in the lungs.

1.3. Patients was associated with severely low levels of blood oxygen, multi-system organ failure, needs for prolonged mechanical ventilation, and frequent use of rescue therapies.

1.4. China, the statistics of 1054 cases of domestic A H1N1 flu patients in July and August 2009, the results are as following.

1.4.1. The majority of patients’ symptoms’ was mild and has improved naturally within 72 hours. The mean fever temperature of patients is 37 degrees. Chinese medicine was effective for the mild patients.

1.4.2. Only a few patients are severe or critically ill and shows persistent high fever, severe cough, phlegm, chest tightness, even sanity changes. Such as restlessness, convulsions, some even have nausea, vomiting. There are clinical manifestations of pneumonia. Some patients had chronic diseases before is prone to complications. For the critically ill patients, mainly divided into two types, one is respiratory failure-type; one is shock-type, complicated by multiple organ failure.

1.4.3. Deaths were mostly due to the viral pneumonia, integrated with the respiratory failure and multiple organ dysfunctions. If the treatments focus on the specific symptomatic besides A H1N1 virus, the patient normally would not die.

2. The Advantages and Mechanism of CM on Treating Influenza

Chinese medicine has unique anti-viral role: 1. Able to kill the virus directly. 2. To prevent virus adsorption and penetration of host cells, inhibit viral replication in host cells, blocking the virus from infected cells into uninfected cells. 3. Inhibiting the transcription and replication of virus. 4. Can enhance the immunity of human body. 5. Inducing the the generation of interferon. 6. Eliminating the endotoxin. 7. Repair damaged body tissue. Chinese medicine can play a direct and indirect anti-viral defense role initiatively. Its unique advantages have aroused widespread concern.

2.1. Directly killing the virus

Some Chinese medicine can kill the virus before them into the cells.

Researches proved that anthraquinones, the alcohol extract of rhubarb, can directly kill the virus. Glycyrrhizin can directly kill Zoster virus. Banlangen can kill the Herpes virus directly.

2.2. Blocking the virus from infected cells into uninfected cells

Active ingredient in many Chinese medicines can inhibit the adsorption and penetration of virus on host cells to take the anti-viral effect, such as, flavonoids, polysaccharides and their derivatives, triterpenoids and their derivatives (such as glycyrrhizin derivatives), alkaloids, glycosides and so on.

Astragalus can inhibit the adsorption and penetration of the virus into the sensitive cells. Banlangen has a strong inhibitory effect on porcine reproductive and respiratory syndrome virus and influenza virus adsorption to host cells. In vitro, the combination preparation of Banlangen and Astragalus has a strong inhibitory effect on the proliferation of porcine reproductive and respiratory syndrome virus.

2.3. Inhibiting the transcription and replication of virus

A compounds extract from Rhubarb can inhibit the activity of 3CL protease that is major protease for virus life cycle, and thus block the SARS virus transcription and replication. Also, there are strong effect of anti-influenza virus and respiratory syncytial virus. Polyphenols can inhibit the synthesis of proteins and RN of influenza virus A.

2.4. Enhancing human immunity

2.4.1. Promoting the development of immune organs

Many anti-viral Chinese medicines are rich in nutrients that could well contribute to the enhancement of human immunity by increasing the weight of immune organs, including central immune organs, such as thymus, bursa of Fabricius and extrinsic peripheral immune organs, such as, spleen, lymph node.

2.4.2. Enhancing the number and phagocytic capacity of immune cells

Many anti-viral Chinese medicines can increase the number of macrophages and their phagocytic capacity. Such as, Coptis, Scutellaria, Phellodendron, Polyporus umbellatus, garlic and so on. Some can increase the phagocytosis of white blood cells, such as, Houttuynia, Berberine, Andrographis, Daqingye, wild chrysanthemum, paeonol, rhubarb and honeysuckle, etc. Some can increase the monocyte phagocytosis, such as, Acanthopanax, Astragalus, Codonopsis, Eucommia, Coptis chinensis, Phellodendron, licorice, Ganoderma lucidum, Poria, artemisinin, Danshen and so on.

2.4.3. Improving immune function by regulating endocrine, neurological and metabolic

Modern studies have shown that there are more than 200 kinds of Chinese medicine can regulate the human immune system, mainly through the following channels: The hypothalamus – pituitary – adrenal cortex and other endocrine system, regulation of Nerve – humoral, regulation of Autonomic nerves, regulation of cyclic nucleotide system, regulation of the nucleic acid metabolism and regulation of the quantity and quality of T lymphocytes.

2.5. Inducing the interferon

Interferon can make uninfected cells produce anti-viral protein, thus inhibiting the biosynthesis of viral macromolecule, and makes the cells acquire anti-virus capabilities. The interferon produced in the cells of invasion parts, can permeable to adjacent cells, thereby limiting the virus to spread around.

Modern research confirms that there are many Chinese medicines have a role of inducing endogenous IFN or procuring the inducing effect. Such as, the mushrooms element extracted from the mushroom, could induce serum IFN. The glycyrrhizin extracted from licorice and glycyrrhetinic acid preparations can induce type Ⅱ IFN, and enhancing the function of cellular immune. Some can induce interferon and immune globulin, which has anti-viral effect, such as, Astragalus, Salvia, Acanthopanax, gentian, etc.

2.6. Enhancing the activity of natural killer cells (NK)

Studies proved that Chinese medicine prescription of Xiao Chai Hu Tang and ginseng doctrine can markedly enhance the activity of Natural killer cell.

2.7. Eliminating the endotoxin.

2.8. Repair damaged body tissue.

3.. The researches of the constituents of anti-viral Chinese medicine

3.1. Polysaccharide

Polysaccharide is an important constituent of Chinese medicine, has many physiological functions. One of them is to activate immune cells. Such as, T lymphocytes, B lymphocytes, macrophages, natural killer cells (NK), cytotoxic cells (CTL) and so on.

3.1.1. Enhancing the function of T lymphocytes

The studies have shown that Lycium Bararum Polysaccharides (LBP), Ligustrum lucidum polysaccharide, epimedium polysaccharide, Astragalus polysaccharide and so on, can enhance the function of T lymphocytes with the immunomodulatory effect that is similar to Thymosin, the acting target is thymus. Mushroom polysaccharide is a typical T-lymphocyte enhancer, which can promote the generation of specific cytotoxic T lymphocyte (CTL) in vivo, and to enhance the killing activity of the CTL.

3.1.2. Improving the level of antibody

Evergreen polysaccharide can promote the phagocytic function of macrophages and enhance its ability in processing and delivering the antigen. Therefore raise the levels of antibody.

3.1.3. Affecting the complement system

In vivo and vitro, the Bupleurum polysaccharide, Artemsia argyi polysaccharides, Angelica polysaccharide, Pachymaran, Mushroom polysaccharide, Plantago polysaccharide and Jujube polysaccharide can activate complement.

3.1.4. Affecting interleukin (IL)

The vast majority of polysaccharide can promote the generation of IL-1 and IL-2. Mushroom polysaccharide can promote the release IL-3 of the spleen lymphocyte. Phytolacca polysaccharide can promote the T lymphocytes to produce IL-2.

3.1.5. Promoting the generation of interferon (IFN)

Versicolor Polysaccharide (PSK) can promote the Lymphocytes to generate interferon. That Astragalus polysaccharide, ginseng polysaccharides, Bupleurum polysaccharide, Acanthopanax polysaccharides, Tremella polysaccharides, angelica polysaccharide and so on, can induce interferon generation.

3.2. Volatile Oil

Volatile oil makes Chinese medicine has a flavor, mainly containing sulfide, terpenoids and aromatic compounds, etc.

3.2.1. Allicin, the volatile oil of garlic, has significant effect in immune enhancement. It can increase the content of serum lysozyme and activity of some enzyme.

3.2.2. Volatile oil of Patchouli leaf

In mice model pharmacology method of serum with volatile oil of Patchouli leaf, the results are as following:

3.2.2.1. Peripheral white blood cells: Showed very significant activating effect, after 3.0h and 4.0h P<0.01, after 6.0h P<0.05.

3.2.2.2. Peritoneal macrophages: Showed significant activating effect, after 3h P<0.05, after 4.0h and 6.0h P<0.01.

3.2.2.3. Spleen lymphocytes: Showed significant effect in proliferation, after 3.0h、4.0h and 6.0h P<0.05.

3.2.2.4. Antitussive and Expectorant

In ammonia induced cough and phenol red secretion mice model, Volatile oil of Patchouli leaf could significantly prolong the ammonia spray time of cause 50% mice cough (EDT50) and promote the phenol red excretion in mouse trachea.

3.3. Forsythia essential oil

Pharmacological experiments demonstrates that Forsythia essential oil has a protective effect on influenza virus infection in mice. In chick embryo it can inhibit the proliferation of Asian influenza and parainfluenza Sendai strain.

3.4. Organic acid

In recent years, the study found many of the organic acids in Chinese medicine possess biological activity.

3.4.1. Glycyrrhizic acid has been proven to enhance the immune function of animals.

3.4.2. In mice model, Folium Isatidis ( Isatis indigotica Fort ) acids can inhibit ear edema induced by P-xylene, significantly reduce the peritoneal Evans blue extravasation of mouse induced by acetic acid and significantly reduce the yeast-induced hyperthermia.

3.5. Saponin

3.5.1. Saponins of Bupleurum can reduce the tissue cells damage caused by inflammation through inhibiting the allergic reactions virus-induced.

3.5.2. Ginsenoside can inhibit stress-induced immunosuppressive effects by the hypothalamus – pituitary – adrenal axis, Neuropeptide Y-HPAA and NPY-sympathetic – immune regulation pathway.

3.6. Alkali

3.6.1. Matrine of Sophora can reduce the liver cell degeneration and necrosis that hepatitis B virus-induced, and promote the regeneration and repair of liver cell.