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To our knowledge, this is the first registered randomized,

controlled trial to investigate the efficacy and safety of oseltamivir,TCM, and no treatment in H1N1 influenza A. We

found that resolution of fever was faster with maxingshigan–yinqiaosan than no intervention, but the improvement in symptoms was not significantly more rapid. Compared with active treatments, the reduction in median time to fever resolution between oseltamivir plus maxingshigan–yinqiaosan and oseltamivir (20.0 hours [CI, 17.0 to 24.0 hours] vs. 16.0 hours [CI, 14.0 to 17.0]) was only 19% (CI, 34% to 0.3%); this reached borderline statistical significance, but the difference was less than the margin of 12 hours. Therefore, with regard to clinical implication, we could not conclude that maxingshigan–yinqiaosan was superior to oseltamivir. We did not find evidence for differences in reductions in viral shedding; however, viral outcomes were available only for a subgroup of patients who had fewer symptoms and longer time from illness onset to randomization.

The mechanism of TCM in the treatment of influenza

is complex. Zhao and colleagues (21) found that maxingshigan regulated the percentage of T-cell subpopulation in mice exposed to influenza virus A. Investigators also found that maxingshigan had inhibitory effects on influenza virus A by directly killing the virus, interfering with virus adsorption, inhibiting virus proliferation, and protecting the cells from being infected with virus. Except in terms of inhibiting virus proliferation, maxingshigan performed much better than ribavirin (22, 23). During the outbreak of the severe acute respiratory syndrome in Hong Kong,Poon and associates (24) showed that 2 herbal formulas had immunomodulating effects. In their study of healthy volunteers, they found that the CD4–CD8 ratio of T lymphocytes was significantly increased after participants received Chinese herbal medicine for 14 days (24). Administration of Chinese herbs may have beneficial immunomodulatory effects for rapid recovery of viral infections.More studies are needed to clarify the mechanisms of TCM.