Navigating Herbal and Pharmaceutical Interactions: My Experience with Xiao Chai Hu Tang and Prednisolone in COVID-19 Care

In my journey as a Traditional Chinese Medicine (TCM) practitioner, particularly amidst the ongoing challenge of COVID-19, I've been constantly reminded of the delicate dance between the ancient wisdom of herbal treatments and the advancements of modern pharmaceuticals. The integration of TCM into the broader spectrum of COVID-19 management has been both a privilege and a complex responsibility, especially when it comes to combining herbal formulas like Xiao Chai Hu Tang with conventional medications such as prednisolone.

From the onset of the pandemic in 2021, I've embraced the role of Xiao Chai Hu Tang, often in combination with Bai Hu Tang or other formulae as proposed by Huang, H. (2020), to address the multifaceted symptoms of COVID-19 in patients preferring a holistic approach. These formulas, with their rich history and balanced properties, have shown promising results in alleviating "heat" symptoms and restoring equilibrium within the body's systems. However, an area of particular concern and professional vigilance has been the potential interaction between these herbal formulas and prednisolone, a corticosteroid frequently prescribed to manage the severe inflammatory responses seen in COVID-19.

My caution stems from a foundational understanding of pharmacokinetics and the influence of herbal constituents on drug metabolism. A study that has significantly shaped my practice is by Homma et al. (1995), which highlights how ingredients like glycyrrhizin in Glycyrrhiza (found in Xiao Chai Hu Tang) can modify the pharmacokinetics of prednisolone, impacting its effectiveness and safety profile. However, according to the same paper, glycyrrhizin couldn’t explain the interaction alone and other bioactive are to be investigated as well.

A defining moment in my practice emerged with a case where a patient, already prescribed prednisolone by her physician, was undergoing a TCM treatment I had tailored for her, featuring a combination of Xiao Chai Hu Tang and Bai Hu Tang. Upon learning about the prednisolone prescription, I ceased the TCM regimen. This experience highlighted the critical need for a cohesive approach and transparent communication between TCM practitioners and conventional medical doctors. It served as a compelling illustration of the necessity to acknowledge and navigate the complexities inherent in merging diverse therapeutic traditions.

This experience propelled me to delve deeper into the mechanisms of such interactions and reinforced the imperative to conduct thorough assessments and foster dialogue with patients about their comprehensive treatment plans. It also highlighted the need for practitioners on both sides to collaborate closely, ensuring that treatments complement rather than counteract each other.

Reflecting on these challenges and lessons, I'm reminded of the responsibility that comes with the privilege of caring for others. It's a journey of continuous learning, adaptation, and collaboration. As we navigate the complexities of integrating TCM with modern pharmaceuticals, our priority remains the safety and well-being of our patients, guiding them through their recovery with both wisdom and caution.

References:

Homma, M., Oka, K., Ikeshima, K., & Takahashi, N. (1995). Different Effects of Traditional Chinese Medicines Containing Similar Herbal Constituents on Prednisolone Pharmacokinetics. Journal of Pharmacy and Pharmacology, 47(8), 687-692.

Huang, H. (2020). Pondering over the outbreak of COVID-19 from the perspective of Jingfang Medicine. Journal of Nanjing University of Traditional Chinese Medicine. Retrieved from https://kns.cnki.net/kcms/detail/32.1247.R.20200216.2006.002.html