Integrating Chinese and western medicine for COVID‐19: A living evidence‐based guideline (version 1)

Abstract

Background:The coronavirus disease 2019 has turned into a pandemic and resulted in huge death tolls and burdens. Integrating Chinese and western medicine has played an important role in the fight against the COVID-19 pandemic. Purpose:We aimed to develop a living evidence-based guideline of integrating Chinese and western medicine for COVID-19. Study design: Living evidence-based guideline.Methods: This living guideline was developed using internationally recognized and accepted guideline standards, dynamically monitoring the release of new clinical evidence, and quickly updating the linked living systematic review, evidence summary tables, and recommendations. Modified Delphi method was used to reach consensus for all recommendations. The certainty of the evidence, resources, and other factors were fully considered, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of evidence and the strength of recommendations. Results:The first version of this living guidance focuses on patients who are mild or moderate COVID-19. A multidisciplinary guideline development panel was established. Ten clinical questions were identified based on the status of evidence and a face-to-face experts' consensus. Finally, nine recommendations were reached consensus, and were formulated from systematic reviews of the benefits and harms, certainty of evidence, public accessibility, policy supports, feedback on proposed recommendations from multidisciplinary experts, and consensus meetings. Conclusion:This guideline panel made nine recommendations, which covered five traditional Chinese medicine (TCM) prescription granules/decoction (MXXFJD, QFPD, XFBD, TJQW, and JWDY), three Chinese patent medicines (LHQW granules/capsule, JHQG granules, and LHQK granules), and one Chinese herbal injection (XBJ injection).Of them, two were strongly recommended (LHQW granules/capsule and QFPD decoction), and five were weakly recommended (MXXFJD decoction, XFBD decoction, JHQG granules, TJQW granules, and JWDY decoction) for the treatment of mild and moderate COVID-19; two were weakly recommended against (XBJ injection and LHQK granules) the treatment of mild and moderate COVID-19. The users of this living guideline

Use of Traditional, Complementary and Integrative Medicine During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…During the COVID-19 pandemic when some underdeveloped countries experienced shortage of medical resources and restricted access to medical institutions, TCIM interventions tended to be accepted as a panacea, and this kind of attitude is based on health-related beliefs and the desire for self-care to improve immunity from the viral infection with a holistic approach ( 26 , 80 , 81 ). China published TCM guidelines for COVID-19, which might be related to the high usage rate of TCM interventions for therapeutic purposes during the pandemic period ( 7 , 82 – 84 ). Meanwhile, the prevalence of TCIM usage in Western countries, such as the United States, was as high as that in underdeveloped countries.…”

“…Since the outbreak of COVID, Traditional, Complementary and Alternative Medicine (TCIM) has been adopted as an alternative strategy for the prevention and treatment of COVID-19 as the entire medical capacity of a country is mobilized at a national level to promote immunity and to protect against viral infection at both the national and individual levels. Clinical practice guidelines (CPGs) or therapeutic protocols for the management of COVID-19 have been published in various fields of TCIM, such as Traditional Chinese Medicine (TCM) ( 6 , 7 ), Korean Medicine ( 8 ), and Ayurveda ( 9 ). In addition, according to a survey conducted on patients in quarantine in India, 25% of patients responded that they had experiences with TCIM-related products or home remedies ( 10 ).…”

Dissemination of Acupuncture-Moxibustion Clinical Practice Guidelines among Clinical Practitioners: A Systematic Review of Quality Assessment Studies

“…Guideline methodology recommendations are to further standardize the method and process of guideline formulation [ 30 ]. Close multidisciplinary collaboration, especially between methodologists and clinical experts, is needed.…”

GRADE Methods in traditional medicine

“… 14 On the other hand, integrative Chinese-Western medicine and Chinese herbal medicine were recommended for the management of Covid-19 based on current research evidence but without evidence grading and quality assessment. 15 , 16 , 17 , 18 Similar guidelines for traditional Chinese medicine for Covid-19 adopted GRADE methods to grade evidence and make recommendation. 19 Facing the unique features of traditional and integrative medicine, some experts advised to adapt consensus statements to develop clinical guidelines.…”