Trial of Chinese Herbal Medicine in the Treatment of Upper Respiratory Tract Infections (URTIs)
Trial of Chinese Herbal Medicine in the Treatment of Upper Respiratory Tract Infections (URTIs)
Upper respiratory tract infections (URTIs) are the most common illnesses in primary medical
 services but there is no established cure for these conditions in Western medicine. In Hong
 Kong, many patients use Chinese herbal medicine (CHM) for the treatment of URTIs but there is
 little research evidence on their effectiveness or side effects. The aim of this study is to
 test whether two commonly used Chinese herbal medicine (CHM) formulae guided by Traditional
 Chinese medicine (TCM) diagnosis will significantly increase recovery rate, and reduce the
 duration and/or severity of symptoms, and improve the quality of life of patients with URTIs
 in primary care.

 If a patient consents to take part in the study and is found eligible, he/she will be invited
 by the consulting doctor, and then be assessed by a registered Chinese medicine practitioner
 for whether the illness satisfies the TCM diagnosis of the two major TCM types of URTIs:
 Group A (Wind-cold syndrome) and Group B (Wind-heat syndrome). Subjects in Group A (Wind-cold
 syndrome) will be randomised to receive the Jing Fan Bai Du san or placebo. Subjects in Group
 B (Wind-heat syndrome) will be randomised to receive Ying Qiao san or placebo. Both group A
 and B treatments and placebo will be given in sachets of granules that are identical in
 appearance. Neither the Chinese medicine practitioner, the recruiting doctors, nor patient
 know whether a subject is taking CHM or placebo.

 328 subjects (164 in each diagnosis group) will be recruited from patients consulting the Ap
 Lei Chau Government General Outpatient clinic for URTIs. Each subject is required to return
 to the clinic for follow-up assessment by the Chinese medicine practitioner on day 7
 post-treatment and all subjects will be contacted by telephone on Day 2, 3, 5, 9, 11, 13,15
 and 20 after treatment to assess their symptoms and to find out if they have developed any
 side effects or adverse reactions.

 The main outcome measure is any difference in the proportion of subjects who have resolution
 of the URTI on Day 7 between the treatment and placebo groups. The secondary outcome measures
 are the reduction in the duration and severity of symptoms, quality of life during the
 illness and side effects.

 This study will provide scientific evidence to support or refute the effectiveness of two
 commonly used CHM formulae in the treatment of URTIs.
Acute upper respiratory tract infections (URTIs) are the most common diagnoses made in the
 primary medical services, which consisted of 34.6% of all diagnoses in Hong Kong. It accounts
 for approximately 100 million visits per year in the US. It was estimated that an adult has
 an average of 3 to 4 times while children has an average of 6 to 8 times each year. WHO has
 pointed out that URTIs have a great impact on personal and economical aspects although they
 are rarely lethal It was estimated that 60% of the working class has contracted URTIs each
 year, and a loss of 8.8 days of perfect health for each worker on average each year, and a
 loss of up to HK$ 31.3 billion of economic output each year.

 There is no established curative treatment in Western medicine for URTIs except for selected
 cases of influenza. Studies have shown that the average duration of illness of an URTI is
 around 7 days, and most URTIs resolve by the 10th day. Traditional Chinese medicine (TCM) is
 commonly used by people in Hong Kong on its own or along side with Western medicine for the
 treatment of URTIs. The Chinese Medicine Council of Hong Kong was established in September
 1999, the use of Chinese herbal medicine (CHM) is expected to increase and there is an urgent
 need for research evidence on their effectiveness and side effects. TCM follows a theoretical
 and methodological pathway, which leads to its diagnosis and treatment. Most URTIs can be
 differentiated into two types according to the theory of TCM: Wind-cold syndrome and
 Wind-heat syndrome. The theory leads to two classical herbal formulae that are very popular
 in Hong Kong: the Jing Fang Bai Du san for treating the Wind-cold syndrome whiles the Ying
 Qiao san for treating Wind-heat syndrome.

 The Jing Fang Bai Du san can relieve external symptoms and effectively clear up the
 pathogenic cold. It contains 13 herbs including, Radix Angelicae Pubescentis, Radix
 Peucedani, Radix Ginseng, Smilacis Glabrae Rhizoma, Rhizoma Chuanxiong, Fructus Aurantii,
 Radix Platycodi, GlycyrrhizaeRadix, Herba Schizonepetae, Fructus Arctii, MenthaeFolium, Radix
 Saposhnikoviae, Rhizoma et Radix Notopterygii. Previous clinical studies conducted in China
 showed mixed results on the effectiveness of Jing Fang Bai Du san on Wind-cold syndrome. One
 study showed that it was no better than no treatment while another study showed that
 concentrated granules of Jing Fang Bai Du san was more effective (80%) than Western medicine
 (10%) in improving and resolving symptoms of Wind-cold syndrome within 7 days.

 The Ying Qiao san can relieve external symptoms and effectively clear up the pathogenic heat.
 It contains 10 herbs: Fructus Forsythiae, LoniceraeFlos, Radix Platycodi, MenthaeFolium,
 GlycyrrhizaeRadix, Herba Schizonepetae, Sojae Semen praeparatum, Fructus Arctii,
 PhragmitisRhizoma and LophatheriHerba. From pharmacological studies, it showed
 anti-inflammatory, antipyretic, analgesic, anti-bacterial and antiviral actions. A clinical
 trial also showed the concentrated granules of Ying Qiao san was more effective (66.13%) than
 Western medicine (40%) in resolving the symptoms of Wind-heat syndrome within 1 week. These
 two CHM formulae have been used for many years and have not been associated with any serious
 adverse reactions. The common side effects are mild diarrhoea and headache.

 Although there are some data from Mainland China suggesting the effectiveness of these two
 formulae for URTIs but most of these previous studies were observational and the few clinical
 trials were not placebo-controlled and of poor quality. Furthermore, results of trials from
 Mainland China may not be generalisable to the people in Hong Kong. Most previous studies on
 CHM focused on individual herbs, which is against the TCM principles as pointed out by the
 WHO. The WHO recommends that future clinical studies should attempt to integrate TCM
 diagnosis pattern with traditional CHM treatments. In this proposed study, the integrated TCM
 approach of using traditional formulae of multiple herbs, guided by the TCM diagnosis, will
 be used in a double-blind randomized placebo-controlled trial.
Inclusion Criteria:

 -  Patients will be included if they have all the following:

 -  Age ≥18 years old

 -  Patient has developed URTIs symptoms for 48 hours or less.

 -  At least one from each of the following groups of URTIs symptoms:

 -  Symptoms of infection: headache, chills, muscle ache, or an oral temperature greater
 than 37.5 degrees Celsius.

 -  Symptoms from the upper respiratory tract: cough, hoarseness, running nose, nasal
 obstruction, itchy throat, sore throat or sneezing.

 Exclusion Criteria:

 -  Patients will be excluded from the study if they have one or more of the following:

 -  Have symptoms of URTIs for more than 48 hours.

 -  Pregnancy or breast-feeding

 -  Liver disease

 -  Known immune deficiency

 -  Alcohol (>30 units/wk) or drug abuse

 -  Medical history of asthma, allergic rhinitis, cystic fibrosis and chronic
 bronchopulmonary diseases

 -  Known allergies to food additives or study medications

 -  Taking chronic medications that contain any kind of herbs, mineral, or specific
 vitamin supplements

 -  Diabetes mellitus

 -  Cancer

 -  Any other serious disease