Since the pandemic began, Taiwan has developed several herbal formulas that traditional Chinese medicine doctors say are effective in treating COVID-19. The most prominent of these is Taiwan Chingguan Yihau (NRICM101), marketed under the name Respire Aid and developed by Taiwan’s National Research Institute of Chinese Medicine (NRICM).
The treatment is made up of ten ingredients that have long been used in TCM: chameleon plant, skullcap root, snake gourd, Japanese catnip, mulberry leaf, magnolia bark, mint, siler root, and baked licorice.
NRICM101 aims to suppress the progression of COVID-19 by achieving three targets: first, by blocking the binding of the SARS-CoV-2 spike protein to the ACE2 receptor on the surface of host cell membranes and reducing the virus’s ability to infect human cells; second, inhibiting the activity of 3CL proteases (enzymes involved in a wide variety of biological functions) in cells and stopping viral replication; and third, preventing fatal inflammatory responses by inhibiting the secretion of cytokines, a type of protein that affects the immune system. So-called cytokine storms, in which the body suddenly releases too many pro-inflammatory cytokines into the blood, can occur in severe COVID-19 cases.
Though NRICM101 received emergency use authorization (EUA) in Taiwan in May 2020, there was limited opportunity for domestic use for more than a year because of an effective zero-COVID policy. Taiwan simply had too few patients – roughly 1,000 total cases as of early May 2021, around 80% of which were imported, and very few severe cases. However, that changed with the first major domestic outbreak in May 2021.
At that time, an NRICM research group created a platform for clinical trials, held from May until early August 2021. The trials enrolled 524 patients, including 100 who were critically ill. NRICM found that patients who took NRICM101 were 80% less likely to progress to serious illness than those who did not. Further, researchers discovered that NRICM102, a variation on the original, lowered the critically ill’s mortality rate by more than 50%.
Added to NRICM102 are stronger substances that “help bolster health maintenance,” according to NRICM director Su Yi-chang. He adds that NRICM is assessing the new formula’s effectiveness in treating other diseases besides COVID-19, among them chronic obstructive pulmonary disease, cardiac and pulmonary arrest, and pulmonary embolism.
Use in Taiwan and overseas
In Taiwan, NRICM101 can be obtained after an examination and prescription from a TCM doctor. The cost is covered by Taiwan’s National Health Insurance (NHI) system. Overseas, it is marketed as a supplement and costs roughly US$60 per box. A 10-day treatment regimen requires about two boxes.
Some experts believe that the formula could be offered to elderly people in Taiwan who refuse to be vaccinated but are familiar with TCM. Taiwan’s vaccination rate has plateaued at around 80%, mostly due to hesitancy among seniors to get vaccinated. The Taiwanese government has tried to incentivize them with financial rewards of up to NT$500 per shot (for people 65 and older), but the efforts have had limited success thus far.
“Chinese medicine is not a substitute for a COVID-19 vaccine, but could potentially offer some protection,” says Johnsee Lin, chairman of the Taiwan Bio Industry Organization. “This has to be scientifically verified though.”
At an April news conference, Huang Yi-chia, a TCM practitioner from Tri-Service General Hospital, said that her hospital had prescribed NRICM101 to more than 200 COVID-19 patients aged three to 100 since it obtained EUA in Taiwan roughly two years ago. The patients showed significant improvement, she said.
In March, President Tsai Ing-wen said the government would promote the expansion of Taiwan’s TCM industry into international markets. Speaking at an event marking the 92nd anniversary of the NRICM’s founding, Tsai said Taiwan’s herbal formulas demonstrated success in “combating COVID-19 deaths.” Researchers at NRICM believe that the relative affordability of NRICM101 compared to Western pharmaceutical drugs used to treat COVID-19 could make the herbal formula a feasible treatment option in the developing world. While there is no doubt that NRICM101 is cheaper than Western antivirals, the fact that it has not undergone the same level of rigorous scientific review as those drugs could limit its international acceptance.