Chinese herbal medicine for COVID-19: Current evidence with systematic review and meta-analysis

Views of Hong Kong Chinese medicine practitioners on the application of the "Chinese Medicine Anti-epidemic Plans" prepared by the Chinese medicine expert group of central authorities: a focus group study

BACKGROUND

Drawing on the extensive utilization of traditional Chinese medicine (TCM) to combat COVID-19 in Mainland China, experts designed a series of TCM anti-epidemic strategies. This study aims to understand Hong Kong CM practitioners' application of and opinions on the "Chinese Medicine Anti-epidemic Plans."

METHODS

Online focus group interviews were conducted, and purposive sampling was employed to invite 22 CM practitioners to voluntarily participate in three interview sessions. The interviews were audio recorded, then transcribed verbatim. The transcripts were analyzed using template analysis.

RESULTS

Three themes were derived: (1) facilitators of the "Chinese Medicine Anti-epidemic Plans," (2) barriers of the "Chinese Medicine Anti-epidemic Plans," and (3) expectations on improving the "Chinese Medicine Anti-epidemic Plans." The participants could obtain relevant information from various sources, which highlights the value of the plans for TCM medicinal cuisine and non-pharmacologic therapies and guiding junior CM practitioners, supplementing Western medicine interventions, and managing Chinese herb reserves in clinics. However, the barriers included the lack of a specialized platform for timely information release, defective plan content, limited reference value to experienced CM practitioners, and lack of applicability to Hong Kong. The expectations of the CM practitioners for improving the plans were identified based on the barriers.

CONCLUSIONS

To enhance the implementation of the anti-epidemic plans, CM practitioners in Hong Kong expect to utilize a specific CM platform and refine the plans to ensure that they are realistic, focused, comprehensive, and tailored to the local context.

Advances in the application of traditional Chinese medicine during the COVID-19 recovery period: A review

Since the emergence of the Coronavirus Disease 2019 (COVID-19) outbreak, significant advancements has been made in research, from limited knowledge about the disease to the development of a vaccine. Although the severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) appears to be decreasing and the threat of COVID-19 is waning, there have been widespread concerns about persistent symptoms or sequelae experienced by some patients even after recovering from COVID-19. Traditional Chinese medicine (TCM) has shown favorable treatment outcomes during the onset of COVID-19, and extensive studies have been carried out to explore the efficacy of TCM interventions during the COVID-19 recovery period. The purpose of this review is to comprehensively analyze these studies and provide new insights for the prevention and treatment of the post-COVID-19 condition.

Combination of Chinese herbal medicine and conventional western medicine for coronavirus disease 2019: a systematic review and meta-analysis

Objective

This study aimed to assess the efficacy and safety of Chinese herbal medicine (CHM) plus conventional western medicine (CWM) in comparison with CWM against COVID-19.

Methods

We searched eight electronic databases and three trial registers spanning from January 1, 2020 to May 18, 2023. We included randomized controlled trials (RCTs) comparing the effectiveness and safety of CHM plus CWM and CWM against COVID-19 in our study. The Cochrane Risk of Bias tool 2.0 (RoB2) was applied to evaluate the methodological quality of the included RCTs. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was employed to assess the certainty of evidence. Statistical analysis was implemented in R version 4.1.2.

Results

Our study included 50 RCTs involving 11,624 patients. In comparison with sole CWM, CHM plus CWM against COVID-19 significantly enhanced clinical effective rate (RR = 1.18, 95% CI [1.13, 1.22]), improved chest image (RR = 1.19, 95% CI [1.11, 1.28]), inhibited clinical deterioration (RR = 0.45, 95% CI [0.33, 0.60]), lowered mortality (RR = 0.53, 95% CI [0.40, 0.70]), and reduced the total score of TCM syndrome (SMD = -1.24, 95% CI [-1.82, -0.66]). SARS-CoV-2 nucleic acid conversion time (MD = -2.66, 95% CI [-3.88, -1.44]), duration of hospitalization (MD = -2.36, 95% CI [-3.89, -0.82]), and clinical symptom (fever, cough, fatigue, and shortness of breath) recovery times were shorter in CHM plus CWM groups than in CWM groups. Further, CHM plus CWM treatment was more conducive for some laboratory indicators returning to normal levels. No statistical difference was found in the incidence of total adverse reactions between the two groups (RR = 0.97, 95% CI [0.88, 1.07]). We assessed the risk of bias for 246 outcomes, and categorized 55 into "low risk", 151 into "some concerns", and 40 into "high risk". Overall, the certainty of the evidence ranged from moderate to very low.

Conclusions

Potentially, CHM listed in this study, as an adjunctive therapy, combining with CWM is an effective and safe therapy mode for COVID-19. However, more high-quality RCTs are needed to draw more accurate conclusions.

Clinical trial registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=293963.

Reduced SARS-CoV-2 infection risk is associated with the use of Seven-Flavor Herb Tea: A multi-center observational study in Shanghai, China

OBJECTIVE

Omicron, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, is responsible for numerous infections in China. This study investigates the association between the use of Seven-Flavor Herb Tea (SFHT) and the risk of SARS-CoV-2 infection to develop precise and differentiated strategies for control of the coronavirus disease 2019 (COVID-19).

METHODS

This case-control study was conducted at shelter hospitals and quarantine hotels in China. A total of 5348 laboratory-confirmed COVID-19 patients were enrolled between April 1 and May 31, 2022, while 2190 uninfected individuals served as healthy controls. Structured questionnaires were used to collect data on demographics, underlying diseases, vaccination status, and use of SFHT. Patients were propensity-score-matched using 1:1 nearest-neighbor matching of the logit of the propensity score. Subsequently, a conditional logistic regression model was used for data analysis.

RESULTS

Overall, 7538 eligible subjects were recruited, with an average age of [45.54 ± 16.94] years. The age of COVID-19 patients was significantly higher than that of uninfected individuals ([48.25 ± 17.48] years vs [38.92 ± 13.41] years; t = 22.437, P < 0.001). A total of 2190 COVID-19 cases were matched with uninfected individuals at a 1:1 ratio. The use of SFHT (odds ratio = 0.753, 95% confidence interval: 0.692, 0.820) was associated with a lower risk of SARS-CoV-2 infection compared to untreated individuals.

CONCLUSION

Our findings suggest that taking SFHT reduces the risk of SARS-CoV-2 infection. This is a useful study in the larger picture of COVID-19 management, but data from large-sample multi-center, randomized clinical trial are warranted to confirm the finding. Please cite this article as: Zhang SX, Chen XX, Zheng Y, Cai BH, Shi W, Ru M, Li H, Zhang DD, Tian Y, Chen YL. Reduced SARS-CoV-2 infection risk is associated with the use of Seven-Flavor Herb Tea: a multi-center observational study in Shanghai, China. J Integr Med. 2023; Epub ahead of print.

A mathematic equation derived from host-pathogen interactions elucidates the significance of integrating modern medicine with traditional Chinese medicine to treat infectious diseases

The prognosis of infectious diseases is determined by host-pathogen interactions. Control of pathogens has been the central dogma of treating infectious diseases in modern medicine, but the pathogen-directed medicine is facing significant challenges, including a lack of effective antimicrobials for newly emerging pathogens, pathogen drug resistance, and drug side effects. Here, a mathematic equation (termed equation of host-pathogen interactions, HPI-Equation) is developed to dissect the key variables of host-pathogen interactions. It shows that control of pathogens does not necessarily lead to host recovery. Instead, a combination of promoting a host's power of self-healing and balancing immune responses provides the best benefit for host. Moreover, the HPI-Equation elucidates the scientific basis of traditional Chinese medicine (TCM), a host-based medicine that treats infectious diseases by promoting self-healing power and balancing immune responses. The importance of self-healing power elucidated in the HPI-Equation is confirmed by recent studies that the tolerance mechanism, which is discovered in plants and animals and conceptually similar to self-healing power, improves host survival without directly attacking pathogens. In summary, the HPI-Equation describes host-pathogen interactions with mathematical logic and precision; it translates the ancient wisdoms of TCM into apprehensible modern sciences and opens a new venue for integrating TCM and modern medicine for a future medicine.

Pharmaceutical approaches for COVID-19: An update on current therapeutic opportunities

SARS-CoV-2, a newly discovered coronavirus, has been linked to the COVID-19 pandemic and is currently an important public health issue. Despite all the work done to date around the world, there is still no viable treatment for COVID-19. This study examined the most recent evidence on the efficacy and safety of several therapeutic options available including natural substances, synthetic drugs and vaccines in the treatment of COVID-19. Various natural compounds such as sarsapogenin, lycorine, biscoclaurine, vitamin B₁₂, glycyrrhizic acid, riboflavin, resveratrol and kaempferol, various vaccines and drugs such as AZD1222, mRNA-1273, BNT162b2, Sputnik V, and remdesivir, lopinavir, favipiravir, darunavir, oseltamivir, and umifenovir, resp., have been discussed comprehensively. We attempted to provide exhaustive information regarding the various prospective therapeutic approaches available in order to assist researchers and physicians in treating COVID-19 patients.

Deciphering suppressive effects of Lianhua Qingwen Capsule on COVID-19 and synergistic effects of its major botanical drug pairs

The COVID-19 pandemic has resulted in excess deaths worldwide. Conventional antiviral medicines have been used to relieve the symptoms, with limited therapeutic effect. In contrast, Lianhua Qingwen Capsule is reported to exert remarkable anti-COVID-19 effect. The current review aims to: 1) uncover the main pharmacological actions of Lianhua Qingwen Capsule for managing COVID-19; 2) verify the bioactive ingredients and pharmacological actions of Lianhua Qingwen Capsule by network analysis; 3) investigate the compatibility effect of major botanical drug pairs in Lianhua Qingwen Capsule; and 4) clarify the clinical evidence and safety of the combined therapy of Lianhua Qingwen Capsule and conventional drugs. Numerous bioactive ingredients in Lianhu Qingwen, such as quercetin, naringenin, β-sitosterol, luteolin, and stigmasterol, were identified to target host cytokines, and to regulate the immune defence in response to COVID-19. Genes including androgen receptor (AR), myeloperoxidase (MPO), epidermal growth factor receptor (EGFR), insulin (INS), and aryl hydrocarbon receptor (AHR) were found to be significantly involved in the pharmacological actions of Lianhua Qingwen Capsule against COVID-19. Four botanical drug pairs in Lianhua Qingwen Capsule were shown to have synergistic effect for the treatment of COVID-19. Clinical studies demonstrated the medicinal effect of the combined use of Lianhua Qingwen Capsule and conventional drugs against COVID-19. In conclusion, the four main pharmacological mechanisms of Lianhua Qingwen Capsule for managing COVID-19 are revealed. Therapeutic effect has been noted against COVID-19 in Lianhua Qingwen Capsule.

Perspective Toward Complementary & Alternative Medicines in the Prevention of COVID-19 Infection

Background

Across the globe, people are seeking integrative and holistic measures to prevent coronavirus (COVID-19) infection in the form of complementary and alternative medicines (CAM) with or without conventional medicines. This study was done to know the extent of CAM use for COVID-19 prophylaxis and to know beliefs and attitudes of people related to CAM use in India.

Methodology

A pretested and prevalidated questionnaire was circulated on social media. Participants, who completed the online form and gave voluntary consent, were included. The questionnaire included demographic details and questions related to CAM use, preferences with reasons, preparations used, perceived role of CAM in prevention, immunity boosting and side effects, sources of information, etc.

Results

Out of 514 responses, 495 were analyzed. 47.07% of respondents were males and 52.93% were females. 66.9% were using CAM for COVID-19 prophylaxis. The association between age, gender, and profession with CAM use was statistically significant (P < 0.05). 41.1% reported CAM use in the past. 36.6% of CAM users were taking "Kadha" and 33% were using ayurvedic medicines. Other frequently used CAM preparations were chyavanprash, giloy, tulsi, ginger, pepper, cloves, honey, sudarshanghanvati, arsenic-30, lemon juice, cinnamon, steam inhalation, ashwagandha, swasarivati, coronil, and warm saline water gargles. 46.9% of the CAM users were on self-medication and 52.3% preferred CAM over allopathy.

Conclusion

Complementary and alternative medicine utilization for COVID-19 prophylaxis is widespread and self-medication is prevalent. As no specific cure is available in conventional systems, people believe in traditional medicines more than conventional, yet confusion exists. There is a need of increasing awareness regarding side effects, drug-drug interactions, and self-medication.

Contribution of Chinese herbal medicine in the treatment of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of randomized controlled trials

Coronavirus disease 2019 (COVID-19) has become a global epidemic, and there is no specific treatment for anti-COVID-19 drugs. However, treatment of COVID-19 using Chinese herbal medicine (CHM) has been widely practiced in China. PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases were searched to evaluate the efficacy and safety of CHM in the treatment of COVID-19. Twenty-six studies were included in this meta-analysis. The included cases were all patients diagnosed with COVID-19 according to the "New Coronary Virus Pneumonia Diagnosis and Treatment Program," with a total of 2,407 cases. Patients were treated with CHM, including 36 prescriptions, and 105 flavors of CHM were included. The results of the meta-analysis showed that the CHM group improved in lung CT, clinical cure rate, clinical symptom score and time to negative for viral nucleic acid. However, this study still has many limitations due to the limited number of included studies. Therefore, high-quality RCT studies are needed to provide more reliable evidence for CHM treatment of COVID-19. In conclusion, CHM may significantly improve the clinical manifestations and laboratory indicators of patients with COVID-19. In addition, no serious adverse reactions were found after CHM treatment. Therefore, CHM may be used as a potential candidate for COVID-19. HIGHLIGHTS: COVID-19 has become a global epidemic, and there is no specific treatment for anti-COVID-19 drugs. CHM has made a new breakthrough in the treatment of COVID-19. CHM may relieve lung CT images of COVID-19 patients. CHM may improve clinical symptoms of COVID-19 patients. CHM may inhibit the expression of inflammatory factors in patients with COVID-19.

Global Dietary and Herbal Supplement Use during COVID-19-A Scoping Review

During the first year of the COVID-19 pandemic, the lack of cure and the intensity of the global spread raised a common awareness of health. The aim of this scoping review is to summarize dietary supplement use globally during first two years of the COVID-19 pandemic. A systematic search was conducted in December 2021 following PRISMA guidelines. PubMed, ERIC, and Scopus databases were searched, and 956 results were screened for eligibility. Fourteen cross-sectional studies from 11 countries and 3 continents were examined. All studies were large population surveys investigating healthy eating and supplement use during COVID-19. Vitamin C, vitamin D, zinc and multivitamins were the most widely reported, as well as natural/herbal products such as ginger and honey. The most common reason cited for supplements use was to strengthen immune system and to prevent infection of COVID-19. These studies reported that populations are relying on healthcare providers, family, friends, and social media to learn about supplement use. Future studies on the treatment of COVID-19 should include more evidence for supplement use.

The relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk

Introduction

The perceived COVID-19 risk may lead to the use of various complementary and alternative medicine (CAM) modalities to reduce the potential risks of this disease. This study was conducted to investigate the relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk.

Methods

The study was conducted in Turkey between November 2021 and March 2022 and 1003 individuals voluntarily participated. The Personal Information Form, Attitude Towards Holistic Complementary and Alternative Medicine Scale (HCAMS), and Perceived COVID-19 Risk Scale (PCRS) were used for data collection. To evaluate the data descriptive statistics, Pearson's correlation, and Cronbach's alpha reliability analysis were used.

Results

In the study, 54.2% of the individuals were found to use CAM during the pandemic, and 56.2% believed that CAM practices were useful in preventing or recovering from COVID-19. It was revealed that 53.8% of the individuals drank herbal tea, 55.2% used religious and spiritual healing to manage, 6.6% used massage, and 10.1% applied aromatherapy. The mean total score of the HCAMS was 28.29 ± 4.99, and the mean total score of the perceived COVID-19 risk scale was 27.78 ± 6.35. A statistically significant positive correlation was identified between the CAM subscale and the emotional risk subscale (p < 0.05).

Conclusion

Individuals had a positive attitude towards using CAM during the pandemic period, the risk perception of COVID-19 was high and CAM methods were widely used.The literature should be supported by increasing the current and scientific studies in which CAM methods are questioned and their benefits are investigated during epidemic periods.

Traditional Chinese Medicine in Treatment of COVID-19 and Viral Disease: Efficacies and Clinical Evidence

Coronavirus disease 2019 (COVID-19) remains an uncontained, worldwide pandemic. While battling the disease in China, the Chinese government has actively promoted the use of traditional Chinese medicine, and many studies have been conducted to determine the efficacy of traditional Chinese medicine for treating COVID-19. The present review discusses the effectiveness and safety of traditional Chinese medicine in curing COVID-19 and provides clinical evidence from all confirmed cases in China. Applications of traditional Chinese medicine and specific recipes for treating other viral infections, such as those caused by severe acute respiratory syndrome coronavirus and influenza A viruses (including H1N1), are also discussed. Studies have reported that traditional Chinese medicine treatment plays a significant role in improving clinical symptoms. Therefore, further investigation may be of high translational value in revealing novel targeted therapies for COVID-19.

Ginseng as a Key Immune Response Modulator in Chinese Medicine: From Antipandemic History to COVID-19 Management

The cytokine storm plays an indispensable role in the severe and critical illness and death of the COVID-19 vulnerable population. Thus, suppressing the cytokine storm is of great significance. Ginseng is a traditional Chinese herb originally used for improving physiological conditions and ameliorating disease. Common throughout the history of ancient Chinese medicine is utilizing ginseng as a major ingredient to successfully fight various pandemics, and the most famous decoction is Renshen Baidu powder. In recent years, ginseng has been observed to provide preventive and therapeutic benefits in the treatment of various conditions by suppressing hyper-inflammation, inhibiting virus intrusion, and balancing the host's immunity. This paper summarizes the ancient Chinese medicine books' recordings of, the clinical practice of, and the laboratory exploration of ginseng for the treatment of pandemics and COVID-19. Ginseng and its active ingredients were found to downregulate inflammatory cytokines, upregulate anti-inflammatory cytokines, stimulate the secretion of the antiviral cytokine IFN-[Formula: see text], prevent viral entry and replication, and improve viral clearance. Furthermore, ginseng modulates both natural and acquired immunity during viral infection. Collectively, we propose that ginseng can act as a key immune response modulator against the cytokine storm of COVID-19. This paper may provide a new approach to discover specific medications using ginseng to combat COVID-19.

Phase III randomized clinical trial of BV ‐4051, an Ayurvedic polyherbal formulation in moderate SARS‐CoV ‐2 infections and its impact on inflammatory biomarkers

SARS-CoV-2 virus and its variants continue to be a challenge inspite of widespread vaccination and preventive measures. We hypothesized an oral, safe polyherbal formulation with antiinflammatory properties may improve the clinical outcome of this disease. BV-4051, a formulation from four Ayurvedic plants namely Ashwagandha, Boswellia, Ginger and Turmeric was used for the treatment of hospitalized moderate COVID-19 patients along with standard of care (SOC). Patients were randomly assigned to receive BV-4051 or placebo tablets for 14 days, at four sites in India during late 2020 to early 2021. Among 208 randomized subjects, 175 completed the study. In BV-4051 group the mean reduction in duration of illness (p = 0.036), alleviation and severity scores of several symptoms like fever, cough, smell, and taste disorders were statistically significant (p ≤ 0.05). A sub-set analysis of subjects treated with or without Remdesivir as SOC showed mean reduction in duration of illness in BV-4051 (p = 0.030), and severity scores (p ≤ 0.05). Mean difference in Interleukin-6 was statistically significant (p = 0.042) on BV-4051 without Remdesivir. BV-4051 may reduce duration of illness, symptoms severity, Interleukin-6, and prevent the incidence of COVID-19 complications. It may have an adjunctive effect with other SOC. Larger extensive clinical testing may give a better understanding of its effect.

Complementary and Alternative Medicines Used by Middle-Aged to Older Taiwanese Adults to Cope with Stress during the COVID-19 Pandemic: A Cross-Sectional Survey

Background: This study aimed to investigate the factors influencing the use of complementary and alternative medicines (CAMs) to manage stress during the COVID-19 pandemic in Taiwan. Methods: A cross-sectional survey was administered to community-dwelling adults between the ages of 46 and 75 years, and a total of 351 participants completed the questionnaire. Log-binominal regression analyses were fitted to explore the factors associated with the use of CAMs. Results: The mean age of the participants was 57.0 years, and 67.0% reported that they had used CAMs within the past three months. Middle-aged adults were more likely to use CAMs than late middle-aged adults and older adults (p < 0.001). Overall, the major CAMs utilized to relieve psychological stress were music therapies (37.6%), massage (31.1%), spinal manipulation (25.1%), relaxing therapies (24.2%), and reading scriptures or The Bible (23.9%). Religion and vegetarian diets were the most important factors influencing participants to use CAMs, especially music therapies, massage, and reading scriptures/The Bible. Conclusions: CAM use was very prevalent among middle-aged adults in Taiwan; in particular, music therapies were the most favored activities for reducing stress. Population-specific mental health interventions using music can be developed to improve stress management outcomes during public health emergencies.

Prevention and management of adverse events following COVID-19 vaccination using traditional Korean medicine: An online survey of public health doctors

BACKGROUND

Since February 2021, vaccination against coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has started in Korea.

AIM

To perform a questionnaire survey about the prevention and management of adverse events of COVID-19 vaccination among public health doctors of Korean Medicine (PHKMDs).

METHODS

An online questionnaire was developed, comprising categories about adverse events of vaccination (AEVs) and perception of using Korean medicine (KM) in managing vaccine adverse events (AEs) among PHKMDs. PHKMDs’ experience of AEVs, usage of Korean medicine for AEVs, and perception and attitude in using KM for AEVs were surveyed. The survey web-link was emailed to the association of PHKMDs. Online links were sent through Survey Monkey to all PHKMDs in Korea.

RESULTS

A total of 143 participants were recruited for this study; 65% of participants were vaccinated at the same of the survey (n = 93). Although most participants did not take any medication for prevention of the adverse events, 62% (n = 58) of participants had taken herbal medicine to treat the adverse events (n = 52). Approximately 35% of participants (n = 33) said that they would recommend taking herbal medicine to prevent any AEVs. From various KM interventions, the participants strongly recommended taking an herbal medicine (n = 69, 74.19%) to treat AEs, and the second-highest was acupuncture treatment (n = 19, 20.43%).

CONCLUSION

Overall, this research demonstrated a high prevalence of KM usage by the PHKMDs. Hence, this study's results may serve as fundamental evidence for health professionals to consider using KM treatments when treating or preventing AEVs in the near future.

Traditional Chinese medicine treatment for COVID-19: An overview of systematic reviews and meta-analyses

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused an extensive burden to the world. Consequently, a large number of clinical trials have examined the efficacy of traditional Chinese medicine (TCM) for treating and preventing COVID-19, with coinciding proliferation of reviews summarizing these studies.

OBJECTIVE

This study aimed to evaluate the methodological quality and evidence quality of systematic reviews and meta-analyses on the efficacy of TCM.

SEARCH STRATEGY

Seven electronic databases, including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chongqing VIP, Wanfang Data and SinoMed, were searched for systematic reviews and meta-analyses in October 2021. Search terms such as "Chinese medicine," "Lianhua Qingwen" and "COVID-19" were used.

INCLUSION CRITERIA

Systematic reviews and meta-analyses of randomized controlled trials that evaluated the efficacy of TCM treatment of COVID-19 were included.

DATA EXTRACTION AND ANALYSIS

A Measurement Tool to Assess Systematic Reviews Version 2.0 (AMSTAR 2) was used to evaluate the methodological quality. The quality of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Data extraction and analysis were performed by two reviewers independently.

RESULTS

There were 17 meta-analyses included in our overview. The intervention group was defined as TCM combined with Western medicine, while the control group was Western medicine alone. The methodological quality of all the included studies was moderate to poor. A total of 89 outcome indicators were evaluated, of which, 8 were rated as moderate quality, 39 as low quality, and 41 as very low quality. Only one outcome measure was graded as being of high quality. The moderate quality of evidence indicated that, for the treatment of COVID-19, the clinical efficacy of TCM in combination with Western medicine was better, in terms of lung recovery, rate of conversion to severe/critical cases, symptom scores, duration of symptoms, mortality, and length of hospital stay.

CONCLUSION

Evidence from the included studies shows that, compared with conventional Western medical therapy alone, the addition of TCM to COVID-19 treatment may improve clinical outcomes. Overall, the quality of evidence of TCM for COVID-19 was moderate to poor. Meta-analyses of the use of TCM in the treatment of COVID-19 can be used for clinical decision making by accounting for the experiences of clinical experts, medical policies, and other factors.

Therapeutic effects of herbal-medicine combined therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials

Background/Aim: Since 2019, the COVID-19 pandemic has been a devastating disease affecting global health to a great extent. Some countries have added on herbal medicines as a complementary treatment for combating COVID-19 due to the urgency of stopping the spread of this viral disease. However, whether these herbal medicines are effective is uncertain. This systematic review and meta-analysis aimed to evaluate the effects of herbal medicine combined therapy in the treatment of COVID-19. Methods: A literature search was performed following the PRISMA Statement and without language restrictions. Seven databases were searched from inception through December 2021. All selected studies were randomized clinical trials (RCTs). Comparing the effects of herbal medicine combined therapy with conventional western medicine, including improvement of clinical symptoms, chest CT images, viral conversion rate, C-reactive protein (CRP) and interleukin 6. Cochrane criteria were applied to examine the methodological quality of the enrolled trials; and meta-analysis software (RevMan 5.4.1) was used for data analysis. Results: In total, the data of 5,417 participants from 40 trials were included in this systematic review; and 28 trials were qualified for meta-analysis. The trials had medium-to-high quality based on GRADE system. Meta-analysis showed that combining herbal medicine vs conventional treatment in 1) coughing (1.43 95% CI:1.21, 1.71, p = 0.0001), 2) fever (1.09 95% CI:1.00, 1.19, p = 0.06), 3) fatigue (1.21 95% CI:1.10, 1.33, p = 0.0001); 4) CT images (1.26 95% CI:1.19, 1.34, P ≤ 0.00001), 5) viral conversion rates (1.22 95% CI:1.06, 1.40, p = 0.005) and 6) viral conversion times (-3.72 95% CI: -6.05, -1.40, p = 0.002), 7) IL6 change (1.97 95% CI: -0.72, 4.66, p = 0.15) and 8) CRP change (-7.92 95% CI: -11.30, -4.53, P ≤ 0.00001). Conclusion: Herbal medicine combined therapy significantly reduces COVID-19 clinical symptoms, improving CT images and viral conversion rates. Reported adverse events are mild. However, for certain biases in the included studies, and the need for further study on effective components of herbal medicine. Further large trials with better randomized design are warranted to definite a more definite role of herbal medicine.

Application of network pharmacology in the study of the mechanism of action of traditional chinese medicine in the treatment of COVID-19

Network pharmacology was rapidly developed based on multidisciplinary holistic analysis of biological systems, which has become a popular tool in traditional Chinese medicine (TCM) research in recent years. Its characteristics of integrity and systematization provide a new approach for the study on complex TCM systems, which has many similarities with the holistic concept of TCM. It has been widely used to explain the mechanism of TCM treatment of diseases, drug repositioning, and interpretation of compatibility of TCM prescriptions, to promote the modernization of TCM. The use of TCM have provided crucial support on prevention and treatment of diseases such as the famous “three medicines and three prescriptions”. Furthermore, TCM has become an important part of the treatment of COVID-19 and is one of the main contents of the “Chinese plan” to fight the epidemic. The current review demonstrated the role of TCM in treating diseases with multiple components, multiple targets, and multiple pathways, interprets the connotation of TCM treatment method selection based on pathogenesis and also discusses the application of network pharmacology in the study of COVID-19 treatment in TCM including single drug and prescription. However, there are still some shortcomings such as the lack of experimental verification and regular upgrading of the TCM pharmacology network. Therefore, we must pay attention to the characteristics of TCM and develop a network pharmacology method suitable for TCM system research when applying network pharmacology to TCM research.

Effect of Qingfei Paidu decoction combined with Western medicine treatments for COVID-19: A systematic review and meta-analysis

BACKGROUND

Qingfei Paidu decoction (QFPDD) showed to be beneficial for the treatment of coronavirus disease 2019 (COVID-19) in China.

PURPOSE

This study aimed to systematically assemble the evidence on the efficacy and safety of QFPDD combined with Western medicine treatments (WMT) for COVID-19.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, CNKI, CSTJ, CBM, Wanfang Data for clinical trials with a control arm until January 13, 2022. Studies matched the selection criteria were included. Data extraction and quality assessment of the included studies were independently conducted by two reviewers. Review Manager 5.4 was used for meta-analysis.

RESULTS

A total of 9 trials including 1108 COVID-19 patients met the selection criteria. Meta-analysis demonstrated that QFPDD combined with WMT reduced aggravation rate (AR) by 71% [risk ratio (RR) = 0.29, 95% confidence intervals (CI) (0.17, 0.51)], increased effective rate (ER) by 13% [RR = 1.13, 95%CI (1.04, 1.22)], shortened 4.78 days of viral shedding [95%CI (-5.79, -3.77)] and 4.45 days of hospital stay [95%CI (-6.05, -2.86)], also decreased the incidence of adverse events (AE) by 56% [RR = 0.44, 95%CI (0.22, 0.89)].

CONCLUSION

QFPDD combined with WMT might reduce the proportion of severe cases and the incidence of AE, shorten the duration of viral shedding and length of hospital stay. More randomized controlled trials (RCTs) are required to confirm our findings in the future.

Herbal medicine for COVID-19: An overview of systematic reviews and meta-analysis

BACKGROUND

As coronavirus disease 2019 (COVID-19) continues to spread throughout countries, researchers and scientific groups have published a large number of scientific papers examining effective treatments and prevention strategies for COVID-19, including herbal medicine. It has become difficult to navigate the increasing volume of scientific material on the pandemic, and critical appraisal of these outcomes is needed. This overview of systematic reviews (SRs) aims to synthesize evidence from SRs and summarize the effects of herbal medicine interventions in the treatment of COVID-19.

METHODS

Four databases were searched from inception up to October 20, 2021. SRs analyzing primary studies of the efficacy of herbal medications for treating COVID-19 were included. Two reviewers selected the studies and retrieved the data independently. The AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) was used to assess the methodological quality of the included SRs.

RESULTS

A total of 21 SRs on herbal medicine treatments for COVID-19 were included. All SRs were published between May 2020 and September 2021. Thirteen of the SRs included only randomized controlled trials (RCTs), whereas the remaining eight included evidence from nonrandomized trials in addition to RCTs, with a significant overlap identified across the RCTs. Twelve SRs concluded that existing evidence was insufficient to form a definite judgment, nine found that herbal therapy was useful, and none indicated that herbal medicine had no benefit. The AMSTAR 2 tool revealed that the methodological quality of the included SRs was generally low.

CONCLUSION

In this overview of SRs, we reviewed herbal medicine-related evidence from 21 SRs that were published after the outbreak of COVID-19. This study shows that while there is considerable evidence demonstrating the advantages of herbal medicine interventions, the quality of the evidence is inadequate to provide solid and accurate judgments about the effectiveness of herbal medicine therapies for COVID-19. Despite the crisis caused by the pandemic, clinical studies and SRs should comply with established methodological standards.

Investigation of Major Flavonoids from Artemisia argyi as a Potential COVID-19 Drug: Molecular Docking and DFT Calculations

Flavonoids from natural products are well-identified as potential antiviral agents in the treatment of SARS-CoV-2 (COVID-19) infection and related diseases. However, some major species of flavonoids from Chinese traditional folk medicine, such as of Artemisia argyi (A. argyi), have not been evaluated yet. Here, we choose five major flavonoids obtained from A. argyi, namely, Jaceosidin (1), Eupatilin (2), Apigenin (3), Eupafolin (4), and 5,6-Dihydroxy-7,3′,4′-trimethoxyflavone (5), compared to the well-studied Baicalein (6), as potential inhibitors analogs for COVID-19 by computational modeling strategies. The frontier molecular orbitals (FMOs), chemical reactivity descriptors, and electrostatic surface potential (ESP) were performed by density functional theory (DFT) calculations. Additionally, these flavonoids were docked on the main protease (PDB: 6LU7) of SARS-CoV-2 to evaluate the binding affinities. Computational analysis predicted that all of these compounds show a high affinity and might serve as potential inhibitors to SARS-CoV-2, among which compound (5) exhibits the least binding energy (−155.226 kcal/mol). The high binding affinity could be enhanced by increasing the electron repulsion due to the valence shell electron pair repulsion model (VSEPR). Consequently, the major flavonoids in Artemisia argyi have a significant ability to reduce the deterioration of COVID-19 in the terms of DFT calculations and molecular docking.

The efficacy and safety of combined chinese herbal medicine and western medicine therapy for COVID-19: a systematic review and meta-analysis

OBJECTIVE

To systematically review the clinical efficacy and safety of Chinese herbal medicine (CHM) with and without Western medicine (WM) for different severity of COVID-19.

METHODS

CNKI, PubMed, Wanfang Database, ClinicalTrails.gov, Embase, ChiCTR and ICTRP were searched from 01 Jan, 2020 to 30 Jun, 2021. Two authors independently assessed all the randomized clinical trials (RCTs) for trial inclusion, data extraction and quality assessment. Meta-analysis was conducted using Review Manager software (RevMan 5.4.1). Evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Primary outcomes included total effectiveness rate. Secondary outcomes included improvements in symptom improvement and total adverse event rate. Different severity of COVID-19 patients was assessed in subgroup analysis. This study was registered with INPLASY, INPLASY202210072.

RESULTS

22 high quality RCTs involving 1789 participants were included. There were no trial used CHM alone nor compare placebo or no treatment. Compared with WM, combined CHM and WM (CHM-WM) treatment showed higher total effectiveness rate, lower symptom scores of fever, cough, fatigue, dry throat and pharyngalgia, shorter mean time to viral conversion, better Computerized Tomography (CT) image and blood results, fewer total adverse events and worse conditions (P < 0.05). Subgroup analysis showed that the total effectiveness rate of combined CHM-WM group was significantly higher than WM group, especially for mild and moderate patients. No significant differences in mortality and adverse events were found between combined CHM-WM and WM treatment. No serious adverse events and long-term outcomes were reported.

CONCLUSION

Current evidence supported the therapeutic effects and safety of combined CHM-WM treatment on COVID-19, especially for patients with mild and moderate symptoms. Long-term effects of therapy are worthy in further study.

Herbal Medicine Intervention for the Treatment of COVID-19: A Living Systematic Review and Cumulative Meta-Analysis

Background: Integrative herbal medicine has been reported to have beneficial effects in the treatment of coronavirus disease 2019 (COVID-19).

Aim: To compile up-to-date evidence of the benefits and risks of herbal medicine for the treatment of COVID-19 symptoms.

Methods: Eleven databases, including PubMed, Cochrane Register of Controlled Trials (CENTRAL), Embase, Allied and Complementary Medicine Database (AMED), Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chinese Science and Technique Journals Database (VIP), Research Information Service System (RISS), Korean Medical database (KMBase), Korean Association of Medical Journal database (KoreaMed), and OASIS database, were searched from 15 June, 2020, until 28 March 2022. Randomized controlled trials (RCTs), published in any language, reporting the efficacy and safety outcomes of herbal medicine in patients of all ages with a PCR-confirmed diagnosis of COVID-19 were included in this analysis. Data extraction and quality assessments were performed independently.

Results: Random-effects meta-analyses showed evidence of favorable effects of treatment with herbal medicine when added to standard treatment, versus standard treatment alone, on the total effective rate (p = 0.0001), time to remission from fever (p < 0.00001), rate of remission from coughing (p < 0.0001), fatigue (p = 0.02), sputum production (p = 0.004), improvement of manifestations observed on chest computed tomography scans (p < 0.00001), incidence of progression to severe COVID-19 (p = 0.003), all-cause mortality (p = 0.003), time to a negative COVID-19 coronavirus test (p < 0.0001), and duration of hospital stay (p = 0.0003). There was no evidence of a difference between herbal medicine added to standard treatment, versus standard treatment alone, on the rate of remission from symptoms such as a fever, sore throat, nasal congestion and discharge, diarrhea, dry throat, chills, and the rate of conversion to a negative COVID-19 coronavirus test. Meta-analysis showed no evidence of a significant difference in adverse events between the two groups. There was an unclear risk of bias across the RCTs included in this analysis, indicating that most studies had methodological limitations.

Conclusion: Current evidence suggests that herbal medicine added to standard treatment has potential benefits in the treatment of COVID-19 symptoms but the certainty of evidence was low.

Efficacy of add-on Ayurveda and Yoga intervention in health care workers of tertiary care hospital during COVID-19: Randomized controlled trial

Background

The present study aimed to evaluate the safety and prophylactic efficacy of add-on Comprehensive Ayurveda and mindfulness-based Yoga (CAY) regimen to standard care among HealthCare Workers (HCWs) against COVID-19.

Materials and methods

This prospective single-blind (outcome assessor-blinded) RCT was conducted in tertiary care hospital in Delhi during July 2020–April 2021. HCWs of both sexes were randomized to add-on CAY intervention or control group. The primary outcomes were the incidence of confirmed COVID-19 positive cases and influenza-like illness events (ILI). Secondary outcomes were anxiety (GAD-7), depression (PHQ-9), and quality of life (SF-36) at the end of 12 weeks.

Results

Three hundred fifty-six participants (181 in intervention and 175 in the control group) were randomized. With the modified intention to treat approach, we analyzed 309 participants. The mean age for the intervention and control group was 39.3 ± 10.1 and 36.6 ± 10 years, respectively. Incidence of COVID-19 event was higher in control group compared to CAY group (16 of 164 [9.8%] vs. 11 of 145 [7.6%]; P = 0.50). The incidence of ILI events was also higher in the control group as compared to the CAY group (14 of 164 [8.5%] vs 9 of 145 [6.2%]). The health change domain of the SF-36 questionnaire showed statistically significant improvement in the CAY group as compared to the control group (P < 0.01).

Conclusion

Incidence of COVID-19 and ILI events was lower in the CAY group compared with the contr ol group, though the difference is not statistically significant.

Efficacy and Safety of Chinese Medicine for COVID-19: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of traditional Chinese medicine for COVID-19 treatment with a focus on the benefits of symptomatic relief and time-related indexes. Seven electronic databases (PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP, Wanfang Data, and Chinese Clinical Trial Registry) were systematically searched from their beginning to April 2021. Only randomized controlled trials (RCTs) comparing patients using Western therapy (WT) alone and those using additional Chinese medicine (WT [Formula: see text] CM) were included. Primary outcomes included overall efficacy, lung recovery, and time to viral assay conversion. Secondary outcomes included time and rate of individual symptom recovery, laboratory indicators, and adverse events. Overall, 15 RCTs, including 1469 participants, were included in this review. WT [Formula: see text] CM significantly improved overall efficacy (risk ratio, RR [Formula: see text] 1.21; 95% CI: 1.12 to 1.30; [Formula: see text] [Formula: see text] 0.01) and lung recovery (RR [Formula: see text] 1.30; 95% CI:1.19 to 1.42; [Formula: see text] [Formula: see text] 0.01) and shortened the time to viral assay conversion (weighted mean differences, WMD [Formula: see text]1.38; 95% CI: -1.98 to -0.78; [Formula: see text] [Formula: see text] 0.01) and duration of chest distress (WMD [Formula: see text] 2.41; 95% CI: -2.99 to -1.83; [Formula: see text] [Formula: see text] 0.01) compared to WT alone. There was no difference in safety between the WT [Formula: see text] CM and WT groups (RR [Formula: see text] 0.94; 95% CI: 0.64 to 1.39; [Formula: see text] 0.76). In conclusion, the synthesized evidence from 15 RCTs showed that additional Chinese medication may improve treatment efficacy, relieve symptoms, promote lung recovery, and reduce the inflammatory response against COVID-19, while not increasing the risk of adverse events compared with conventional Western medication alone.

Synergistic effect of Mahaenggamseok-tang in the treatment of pediatric patients with lower respiratory tract infections: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Infants are often hospitalized because of lower respiratory tract infections, and overuse of antibiotics to treat such infections has led to severe problems. Herbal medicines may be more effective and safer than antibiotics. Mahaenggamseok-tang is a common herbal medicine in Asia, but the evidence for its effectiveness in lower respiratory tract infection treatment is insufficient. This review assesses the efficacy of Mahaenggamseok-tang in treating lower respiratory tract infections.

METHODS

The study used Chinese, English, and Korean databases, as well as one Japanese database. All included studies were randomized controlled trials comparing Mahaenggamseok-tang with medication to treat lower respiratory tract infections. Studies using Mahaenggamseok-tang plus Western medicine were also included. Standardized mean difference (SMD), risk ratio (RR) with 95% confidence interval (CI), and risk of bias were analyzed using Review Manager 5.4 software. The GRADEpro website was used to assess the reviews.

RESULTS

Seventeen randomized controlled trials with a total of 1993 participants were included in the meta-analysis. All studies compared the Mahaenggamseok-tang plus Western medicine group to the Western medicine only group. Meta-analysis showed that Mahaenggamseok-tang affected total effective rate (risk ratio: 1.20, 95% confidence interval [CI]: 1.10-1.31, P < .001), cough disappearance time (SMD: -1.62, 95% CI: -2.30 to -0.95, P < .001), fever disappearance time (SMD: -2.04, 95% CI: -2.87 to -1.21, P < .001), abnormal lung sound disappearance time (SMD: -1.68, 95% CI: -2.43 to -0.93, P < .001), Creactive protein (SMD: -3.18, 95% CI: -4.36 to -1.99, P < .001), procalcitonin (SMD: -5.04, 95% CI: -9.20 to -0.88, P < .05), tumor necrosis factor-α (SMD: -0.84, 95% CI: -1.46 to -0.23, P < .01), IgE (SMD: -2.69, 95% CI: -2.91 to -2.47, P < .001), and adverse events (risk ratio: 0.44, 95% CI: 0.29-0.68, P < .001), but not interleukin-6 (SMD: -1.59, 95% CI: -3.48 to 0.30, P>.05).

DISCUSSION

Mahaenggamseok-tang plus Western medicine is more effective and safer than Western medicine alone for treating lower respiratory tract infections. However, the included randomized controlled trials were not randomized well; therefore, better randomized randomized controlled trials are needed to make significant recommendations.PROSPERO registration number: CRD42020165698.

Complementary and alternative medicine (CAM) interventions for COVID-19: An overview of systematic reviews

Background

Since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, various complementary and alternative medicines (CAMs) have been used in clinical practice. In this overview, we summarized the evidence for CAM interventions in the treatment of COVID-19 patients.

Methods

For this overview, PubMed, Embase and Cochrane Library were searched from inception to October 2021. Systematic reviews (SRs) on the effectiveness and safety of CAM interventions for COVID-19 patients were located, and the MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) was used to evaluate the reporting quality of the included SRs. Keywords including COVID-19 and CAM interventions were used for locating SRs. For evidence mapping, we created a two-dimensional bubble plot that included the width and strength of the evidence for each CAM intervention and specific outcome.

Results

In this overview, we identified 24 SRs (21 for Traditional Chinese Medicine (TCM) medications, two for vitamin D and one for home-based activity). From the included SRs, TCM herbal medications were reported to show good results in decreasing the rate of disease progression (relative risk (RR) 0.30, 95% confidence intervals (CI) [0.20, 0.44]), time to the resolution of fever (standard mean difference (SMD) -0.98, 95% CI [-1.78, -0.17]) and rate of progression to severe COVID-19 cases (RR 0.34, 95% CI [0.18, 0.65]), but the evidence for other interventions did not show effectiveness with certainty. Gastric disturbance was a major adverse event of TCM medications.

Conclusion

There is evidence that TCM medications are effective in the symptom management of COVID-19 patients. However, evidence for the effectiveness of most CAM interventions still needs evaluation.

Clinical Evidence on the Use of Chinese Herbal Medicine for Acute Infectious Diseases: An Overview of Systematic Reviews

Background: Acute infectious diseases constitute the most prevalent public health emergency (PHE) in China. Chinese herbal medicine (CHM) has long been used in the treatment of acute infections, but the overall evidence of its benefit and harm has not been comprehensively and systematically evaluated.

Methods: We searched CBM, CNKI, Wanfang, PubMed, Cochrane Library, embase and preprint platforms to retrieve systematic reviews (SRs) on CHM for acute infectious. Participants with COVID-19, SARS, H1N1, tuberculosis, bacillary dysentery, mumps, herpangina, hand-foot-and-mouth disease (HFMD), and other acute infectious diseases were included. Interventional group consisting of patients treated with CHM combined with Western medicine or CHM alone. The AMSTAR 2 tool was used to assess the methodological quality of the retrieved studies. Information on interventions, control measures and outcomes of the included studies was extracted, and meta-analyses were qualitatively synthesized.

Results: A total of 51 SRs and meta-analyses were eligible for this overview, including 19 for COVID-19, 11 for hand-foot-and-mouth disease, 8 for severe acute respiratory syndrome (SARS), 4 for tuberculosis, 3 for mumps, 2 for bacillary dysentery, 2 for H1N1 influenza and 2 for herpangina. Six systematic reviews were of high quality, all of which were on the use of CHM for COVID-19; 24 were of moderate quality; 10 were of low quality; and 11 were of very low quality. CHM appeared to have potential benefits in improving clinical symptoms and signs for most infections with an acceptable safety profile, and the clinical evidence of the benefits of CHM for acute respiratory infections such as COVID-19, SARS and H1N1 seems more sufficient than that for other acute infections.

Conclusion: Overall, CHM, both decoction and Chinese patent medicine, used alone or in combination with conventional medicine may offer potential benefits to relieving symptoms of people with acute respiratory infections. Full reporting of disease typing, staging, and severity, and intervention details is further required for a better evidence translation to the responses for PHE. Future CHM research should focus mainly on the specific aspects of respiratory infections such as its single use for mild infections, and the adjunct administration for sever infections, and individual CHM prescriptions for well-selected outcomes should be prioritized.

Evidence Mapping of 23 Systematic Reviews of Traditional Chinese Medicine Combined With Western Medicine Approaches for COVID-19

Background: Coronavirus disease 2019 (COVID-19) has already spread around the world. The modality of traditional Chinese medicine (TCM) combined with Western medicine (WM) approaches is being used to treat COVID-19 patients in China. Several systematic reviews (SRs) are available highlighting the efficacy and safety of TCM combined with WM approaches in COVID-19 patients. However, their evidence quality is not completely validated.

Purpose: We aimed to assess the methodological quality and the risk of bias of the included SRs, assess the evidence quality of outcomes, and present their trends and gaps using the evidence mapping method.

Methods: PubMed, Cochrane Library, Embase, CNKI, CBM, and Wanfang Data were searched from inception until March 2021 to identify SRs pertaining to the field of TCM combined with WM approaches for COVID-19. The methodological quality of the SRs was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), the risk of bias of the included SRs was assessed with the Risk of Bias in Systematic Review (ROBIS) tool, and the evidence quality of outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results: In total, 23 SRs were found eligible. Twenty-one were rated of moderate confidence by AMSTAR 2, while 12 were rated at low risk using the ROBIS tool. In addition, most outcomes were graded as having moderate quality using the GRADE system. We found that the combined use of TCM and WM approaches could improve the CT recovery rate, effective rate, viral nucleic acid negative conversion rate, and the disappearance rate of fever, cough, and shortness of breath. Also, these approaches could decrease the conversion rate from mild to critical, white blood cell counts, and lymphocyte counts and shorten the time to viral assay conversion and the length of hospital stay.

Conclusion: TCM combined with WM approaches had advantages in efficacy, laboratory, and clinical symptom outcomes of COVID-19, but the methodological deficiencies of SRs should be taken into consideration. Therefore, to better guide clinical practice in the future, the methodological quality of SRs should still be improved, and high-quality randomized controlled trials (RCTs) and observational studies should also be carried out.

Anticoronaviral Activity of the Natural Phloroglucinols, Dryocrassin ABBA and Filixic Acid ABA from the Rhizome of Dryopteris crassirhizoma by Targeting the Main Protease of SARS-CoV-2

The rhizome of Dryopteris crassirhizoma Nakai. (Dryopteridaceae) has been used in traditional medicine in East Asia and has recently been reported to have anticancer, anti-inflammation, and antibacterial activity as well as antiviral activity. Natural phloroglucinols from D. crassirhizoma, dryocrassin ABBA and filixic acid ABA were reported to inhibit influenza virus infection with an inhibitory activity on neuraminidase. In this study, we found that dryocrassin ABBA and filixic acid ABA have an inhibitory activity against the main protease of SARS-CoV-2. Therefore, dryocrassin ABBA and filixic acid ABA exhibited inhibitory activity against SARS-CoV-2 infection in Vero cells dose-dependently using the immunofluorescence-based antiviral assays. Moreover, these compounds inhibited SARS-CoV and MERS-CoV infection, suggesting their broad-spectrum anticoronaviral activity. In addition, a 5-day repeated-dose toxicity study of dryocrassin ABBA and filixic acid ABA suggested that an approximately lethal dose of these compounds in mice was >10 mg/kg. Pharmacokinetic studies of dryocrassin ABBA showed good microsomal stability, low hERG inhibition, and low CYP450 inhibition. In vivo pharmacokinetic properties of dryocrassin ABBA showed a long half-life (5.5–12.6 h) and high plasma exposure (AUC 19.3–65 μg·h/mL). Therefore, dryocrassin ABBA has therapeutic potential against emerging coronavirus infections, including COVID-19.

Chinese herbal medicine ("3 medicines and 3 formulations") for COVID-19: rapid systematic review and meta-analysis

BACKGROUND

To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically "three medicines and three formulations" (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu, and Xuanfei Baidu), is an effective treatment for COVID-19.

METHODS

We searched PubMed, MEDLINE and CNKI databases, preprint servers, clinical trial registries and supplementary sources for Chinese- or English-language randomized trials or non-randomized studies with comparator groups, which tested the constituents of 3M3F in the treatment of COVID-19 up to September 2020. Primary outcome was change in disease severity. Secondary outcomes included various symptoms. Meta-analysis (using generic inverse variance random effects model) was performed when there were two or more studies reporting on the same symptom.

RESULTS

Of 607 articles identified, 13 primary studies (6 RCTs and 7 retrospective non-randomized comparative studies) with 1467 participants met our final inclusion criteria. Studies were small and had significant methodological limitations, most notably potential bias in assessment of outcomes. No study convincingly demonstrated a statistically significant impact on change in disease severity. Eight studies reported sufficiently similar secondary outcomes to be included in a meta-analysis. Some statistically significant impacts on symptoms, chest CT manifestations, laboratory variables and length of stay were demonstrated, but such findings were sparse and many remain unreplicated.

CONCLUSIONS

These findings neither support nor refute the claim that 3M3F alters the severity of COVID-19 or alleviates symptoms. More rigorous studies are required to properly ascertain the potential role of Chinese Herbal Medicine in COVID-19.

COVID-19 Knowledge/Practices, Mental Status, and Return-To-Work Concerns Among Healthcare Workers in Huangzhou District, Huanggang City, China

Objective:

This study investigated the COVID-19-prevention knowledge and practices of healthcare workers (HCWs), their psychological states concerning the return to work, and their trust and requirements in using traditional Chinese medicine (TCM) to prevent and treat COVID-19. It is hoped that the study can serve as a reference for policy making during the resumption of work in other countries or regions experiencing similar situations.

Methods:

This study comprised a quantitative cross-sectional online survey design. Purposive sampling and Cluster sampling were used to recruit all HCWs working in public hospitals in Huangzhou District, Huanggang City, Hubei Province, China. From April 23 to May 14, 2020, surveys were sent electronically to all 13 public hospitals in this area.

Results:

In total, 2,079 responses were received and 2,050 completed forms were included. After analysis, 47.9 and 46.6% of HCWs indicated that they possessed very good knowledge or good knowledge of preventative measures, respectively. Multivariable log-binomial regression indicated that male, tertiary hospital, medical staff, and undergraduate/postgraduate qualification were associated with good knowledge. Good knowledge was also well-correlated with good practice (OR: 3.277; 95% CI: 2.734–3.928; P < 0.01). 59.8% of HCWs reported worries about resuming work; especially asymptomatic infections. The Self-Rating Anxiety Scale (SAS) indicated that 10.8% of participants had mild anxiety, 1.5% moderate anxiety, and 0.1% severe anxiety. Female, divorced/widowed, and working in a high risk hospital (the Huangzhou District People's Hospital was used for throat swab examinations of returning workers) were risk factors for concerns about resuming work and anxiety symptoms. However, good preventive knowledge was a protective factor for anxiety. HCWs' trust in using TCM to treat COVID-19 was significantly higher than their trust in using TCM for prevention (P < 0.001). Regarding preferences for preventative TCM products, oral TCM granules were the most preferred (62.4%). HCWs also indicated they wanted to know more about the clinical efficacy, applicable population, and adverse reactions of preventative TCM products (89.3, 81.1, and 81.4%, respectively).

Conclusion:

While HCWs had good knowledge of COVID-19 preventative measures, this did not eliminate the psychological impact of resumption of work. Promotion of COVID-19 prevention knowledge reduces the risk of infection, and alleviates the worries and anxiety symptoms of HCWs about resuming work (especially in administrative staff, those with low education, and those working in primary hospitals). Additional psychological support is required for female HCWs, divorced/widowed HCWs, and those working in high-risk hospitals. Finally, systematic trials of preventative TCM products are recommended.

Potential Benefits of Antiviral African Medicinal Plants in the Management of Viral Infections: Systematic Review

Background: Viruses cause various human diseases, some of which become pandemic outbreaks. This study synthesized evidence on antiviral medicinal plants in Africa which could potentially be further studied for viral infections including Coronavirus disease 2019 (COVID-19) treatment.

Methods: PUBMED, CINAHIL, Scopus, Google Scholar, and Google databases were searched through keywords; antiviral, plant, herb, and Africa were combined using “AND” and “OR”. In-vitro studies, in-vivo studies, or clinical trials on botanical medicine used for the treatment of viruses in Africa were included.

Results: Thirty-six studies were included in the evidence synthesis. Three hundred and twenty-eight plants were screened for antiviral activities of which 127 showed noteworthy activities against 25 viral species. These, were Poliovirus (42 plants), HSV (34 plants), Coxsackievirus (16 plants), Rhinovirus (14plants), Influenza (12 plants), Astrovirus (11 plants), SARS-CoV-2 (10 plants), HIV (10 plants), Echovirus (8 plants), Parvovirus (6 plants), Semiliki forest virus (5 plants), Measles virus (5 plants), Hepatitis virus (3 plants), Canine distemper virus (3 plants), Zika virus (2 plants), Vesicular stomatitis virus T2 (2 plants). Feline herpesvirus (FHV-1), Enterovirus, Dengue virus, Ebola virus, Chikungunya virus, Yellow fever virus, Respiratory syncytial virus, Rift Valley fever virus, Human cytomegalovirus each showed sensitivities to one plant.

Conclusion: The current study provided a list of African medicinal plants which demonstrated antiviral activities and could potentially be candidates for COVID-19 treatment. However, all studies were preliminary and in vitro screening. Further in vivo studies are required for plant-based management of viral diseases.

Role of herbal medicines in the management of patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials

Background and aim

The management of the worldwide spreading COVID-19 consists of amelioration of its symptoms but no cure is yet available. Herbal medicines supplemented with the Western medicine have been applied for COVID-19 treatment in India, China, Iran, and other countries. This systematic review and meta-analysis of RCTs evaluates the effect and safety of herbal intervention in the management of COVID-19.

Experimental procedure

RCTs from databases like PubMed, Cochrane Library, ScienceDirect, Google Scholar, Science Direct, CTRI, AYUSH Research Portal, India, were reviewed and the data were extracted for study sample demographics, intervention details, clinical effect, inflammatory markers and safety monitoring. Outcomes were expressed as Risk-ratio (RR) with 95% CI for dichotomous data, and Mean-Difference (MD) with 95% CI for continuous data.

Result and conclusion

From the 32 eligible studies, a total of 3177 COVID-19 patients were included in the review. Herbal intervention as an adjuvant to Western medicine causes significantly higher improvement compared to Western medicine alone [Fever (RR = 1.09 CI 1.03, 1.15), Cough (Risk-Ratio = 1.22 CI 1.08, 1.37), Fatigue (Risk-Ratio = 1.27 CI 1.11, 1.44), Chest CT Improvement (Risk-Ratio = 1.15 CI 1.08, 1.23)]. The laboratory parameters were also better in the herbal medicine group compared to standard care group only WBC (MD = 0.36 CI 0.16, 0.55), Lymphocyte percentage (MD = 5.48 CI 3.05, 7.92), Absolute lymphocyte count (MD = 0.23 CI 0.07, 0.39), CRP (MD = −5.66 CI -7.96, −3.37). However, duration of hospital stays (MD = −1.82 CI -3.84, 0.21); IL-6 (MD = −3.67 CI -8.76, 1.43), ESR Level (MD = −10.38 CI -25.96, 5.21) were statistically insignificant. No significant adverse events for herbal medications were noted in the included RCTs, during the time of the studies. (n = 665, RR 0.93; 95% CI 0.76, 1.14).

•

Herbal intervention along with Western medicine has better recovery for fever, cough, fatigue, chest CT Improvement, RT-PCR Negativity, sore-throat, and duration of hospital stay.

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The laboratory parameters (e.g., WBC, Lymphocyte percentage, Absolute Lymphocyte count, CRP, IL-6, ESR levels) were also better in the herbal medicine group compared to standard care group only.

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No significant adverse events for herbal medications were noted in the included RCTs.

A Systematic Review of Outcomes in COVID-19 Patients Treated with Western Medicine in Combination with Traditional Chinese Medicine versus Western Medicine Alone

Background

Since the outbreak of coronavirus disease 2019 (COVID-19) in late 2019, it has evolved into a global pandemic that has become a substantial public health concern. COVID-19 is still causing a large number of deaths in several countries around the world because of the lack of effective treatment.

Aim

To systematically compare the outcomes of COVID-19 patients treated with integrated Chinese with western (ICW) medicine versus western medicine (WM) alone by pooling the data of published literature, and to determine if ICW treatment of COVID-19 patients has better clinical outcomes.

Methods

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China Clinical Trial Registry, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Wanfang databases using keywords related to COVID-19, traditional Chinese medicine (TCM) and treatment effect. The search deadline was until 10 February 2021. All randomised controlled (RC) and non-randomised controlled (NRC) clinical trials of the ICW or WM treatment of COVID-19 patients were included. We analysed the effective rate, cure rate, exacerbation rate, turning negative rate of viral nucleic acid, remission rate and remission time of symptoms such as fever, cough, feebleness and chest computed tomography (CT) and the number of white blood cells (WBCs) and lymphocytes (LYM) of the COVID-19 patients. For qualitative and quantitative data, the ratio risk (RR) and weighted mean difference (WMD) were used as the indexes of the statistical analysis, respectively. RevMan 5.4 was used to perform meta-analyses and forest plots with the fixed-effects and random-effects models. Cochrane risk of bias tool (RoB 2.0) was used to assess the risk of bias in the included RC trials, whereas risk of bias in non-randomised studies of interventions was used to assess the risk of bias in NRC trials.

Results

This research includes 16 studies with 1645 valid confirmed COVID-19 patients, among which 895 patients of the experimental group received ICW treatment whereas 750 patients of the control group received WM treatment. The outcomes were assessed in three aspects, that is, overall indicator, symptoms indicator and blood indicator, respectively, and the results showed that the ICW group had better treatment outcomes compared with the WM. Among the overall indicators, the ICW group displayed a higher effective rate (RR = 1.24, 95% confidence interval (CI): 1.16–1.33), clinical cure rate (RR = 1.27, 95% CI: 1.03–1.56) and lower exacerbation rate (RR = 0.36, 95% CI: 0.25–0.52), but no statistical difference was observed in the turning negative rate of viral nucleic acid (RR = 1.20, 95% CI: 0.78–1.85). Among the symptom indicators, the ICW group had a higher fever remission rate (RR = 1.24, 95% CI: 1.09–1.42), less fever remission time (WMD = −1.49, 95% CI: −1.85 to −1.12), a higher cough remission rate (RR = 1.38, 95% CI: 1.10–1.73) and a feebleness remission rate (RR = 1.45, 95% CI: 1.18–1.77), less cough remission time (WMD = −1.61, 95% CI: −2.35 to −0.87) and feebleness remission time (WMD = −1.50, 95% CI: −2.38 to −0.61) and better improvement in chest CT (RR = 1.19, 95% CI: 1.11–1.28). For blood indicator, the number of WBCs in the blood of patients of ICW group rebounded significantly (WMD = 0.35, 95% CI: 0.16–0.54), and the recovery of LYM in the blood was more obvious (WMD = 0.23, 95% CI: 0.06–0.40).

Conclusion

The results of this study show that the outcomes in COVID-19 patients treated by the ICW is better than those treated by the WM treatment alone, suggesting that WM and TCM can be complementary in the treatment of COVID-19.

State-of-the-art evidence of traditional Chinese medicine for treating coronavirus disease 2019

Traditional Chinese medicine has widely been used internationally in the treatment of coronavirus disease 2019 (COVID-19) since January 2020. There has been great interest in initiating clinical studies testing different Chinese medicine therapies for COVID-19, but the majority of registered studies have yet to move forward due to a lack of COVID-19 patients in mainland China. The aim of this article was to systematically review the current clinical research evidence on Chinese medicine for treating COVID-19 from international and domestic bibliographic databases to reflect on the advances in this field.

Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?

Unexpected hepatic failure with liver necrosis is sometimes encountered during a forensic autopsy. Determining the etiology may sometimes be difficult, although increasingly herbal medicines are being implicated. To determine whether such effects might also be caused by foodstuffs, the following in vitro study was undertaken. Four formulations of traditional herbal soup advertised as bak kut teh were prepared and added to cultures of liver carcinoma cells (HepG2). Cell viability was assessed using an MTT colorimetric assay at 48 h demonstrating that all formulations had significant toxicity prior to dilution (p < 0.05). Formulation #1 showed 21% cell death (p = 0.023), Formulation #2 30% (p = 0.009), and Formulation #3 41% (p < 0.0001). Formulations #1-3 showed no significant toxicity once diluted (p > 0.05). Formulation 4 showed approximately 83% cell death before dilution (p < 0.0001) and persistent toxicity even with dilutions at 1:10 (15% ± 3.7, p = 0.023) and 1:1000 (14% ± 3.8, p = 0.024). This study has shown that herbal foodstuffs such as bak kut teh may be responsible for variable degrees of in vitro hepatotoxicity, thus extending the range of herbal products that may be potentially injurious to the liver. If unexpected liver damage is encountered at autopsy, information on possible recent ingestion of herbal food preparations should be sought, as routine toxicology screening will not identify the active components. Liver damage may therefore be caused not only by herbal medicines but possibly by herbal products contained in food.

Traditional Chinese Medicine for COVID-19: A Network Meta-Analysis and Systematic Review

To compare the efficacy of different traditional Chinese medicine (TCM) therapies for the treatment of coronavirus disease 2019 (COVID-19) and provide a higher level of evidence in the form of network meta-analysis (NMA) and systematic review. We searched the studies from the following databases: CNKI, VIP, WanFang, SinoMed, PubMed, Embase, and Web of Science from the establishment of the respective database until December 2021. Relevant studies were screened according to the pre-established inclusion criteria. The quality of the included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were assessed using the risk of bias (ROB) tool and the Methodological Index for Non-Randomized Studies (MINORS), respectively. R software 4.1.1 and Stata 13.1 were used for data analysis and mapping. A total of 34 studies were included in this network meta-analysis that tested 24 TCM interventions and included 3443 patients. Using cluster analysis of time to negative SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR), the length of hospital stay and composite events, we found that Jinyinhua oral liquid (JYH, 120 mL) + conventional Western medicine (CWM) has the highest SUCRA value at 88.64%, 85.61% and 84.24%. The traditional meta-analysis results revealed that Qingfei Paidu decoction + CWM were significantly different compared with CWM alone for the score of clinical symptoms (MD =-0.75, 95% CI [-1.04, -0.47]). Nine studies reported 57 adverse reactions (ADRs) and 3 adverse events (ADEs) in TCM + CWM groups, and eight studies reported 33 ADRs and 8 ADEs in CWM groups. In conclusion, the combination of TCM and CWM approaches may enhance the efficacy of CWM in COVID-19 patients. Based on the NMA result, JYH (120 mL) + CWM may be a more effective treatment and deserves further investigation. However, the differences in many comparisons between TCM interventions did not reach statistical significance; therefore, further high-quality studies are required to validate these findings.

Beneficial effects of herbal and natural remedies on the treatment of COVID -19

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The rationale behind the four major anti-coronavirus principles of Chinese herbal based on systems medicine

As the novel coronavirus disease 2019 (COVID-19) and its multi variants continue to rage into the second year of a global pandemic, many success stories of applying Chinese herbal medicine (CHM) to COVID-19 patients continue to emerge from China and other parts of the world. Herewith, the authors summarized those experiences from a systems medicine perspective and categorize the four major treatment principles: (1) focusing on eliminating toxins in the early stage of the disease, (2) tonifying the body against deficiency throughout the entire disease course, (3) treating affected lung and intestine simultaneously based on visceral interactions, and (4) and cooling the blood and removing blood stasis at the later stage. The rationale behind these principles is shown via a scientific interpretation. This is not only helpful in reducing the complexity of promoting the CHM applications to enhance anti-pandemic efficacy but also to ramp up the process of integrating traditional Chinese medicine with modern medical practices.

The Role of Herbal and Nutritional Treatments in the Fight against COVID-19 and Other Respiratory Tract Infections

With the growing spread of COVID-19 worldwide, the appeal to alternative and nutritional therapies in conjunction with medical therapies has been heightened. This article aims to review studies assessing the roles of Chinese traditional medicine and nutrition in upper respiratory infections, including COVID-19. Various Chinese herbal protocols have been shown to fight respiratory infections, with several having been tested on the novel coronavirus. Additionally, promising findings have been reported when medical treatments were complemented with nutritional interventions. Supplementation with vitamins C and D, Zinc and Selenium are discussed, in addition to certain phytochemicals and food that also possess immunoregulatory and antiviral properties. Further clinical studies are needed to establish these alternative treatments as part of the management of emerging respiratory infections.

Knowledge about, attitude and acceptance towards, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China: A cross-sectional survey

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic has had a serious impact on health all over the world. Cancer patient, whose immunity is often compromised, faces a huge challenge. Currently, some COVID-19 vaccines are being developed and applied on general population; however, whether cancer patients should take COVID-19 vaccine remains unknown. Our study aimed to explore the knowledge, attitude, acceptance, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China.

METHODS

A cross-sectional study was conducted in Eastern China from June 17th to September 3rd, 2021. Patients were selected using a convenience sampling method. A self-report questionnaire was developed to assess knowledge about the COVID-19 vaccine, attitude towards the vaccine and acceptance of the vaccine; following a review of similar studies previously published in the scientific literature, multivariate logistic regression analysis was used to determine the predictors associated with COVID-19 vaccine acceptance.

RESULTS

A total of 2158 cancer patients were enrolled in this study. The rate of vaccine hesitancy was 24.05% (519/2158); further, among the participants of vaccine acceptance, 767 had taken COVID-19 vaccine (35.54%), and 872 were willing to get vaccinated (40.01%). A total of 24 variables including demographic characteristics, clinical status of cancer, impact of COVID-19 pandemic on study participants, patients' knowledge about the COVID-19 vaccine, and attitude towards the vaccine, had significant differences between the "vaccine hesitancy" population and "vaccine acceptance" population. Multivariate logistic regression analysis indicated that parameters including alcohol consumption (odds ratio [OR] = 1.849; 95% confidence interval [CI]: 1.375-2.488; P-reference [P-Ref] < 0.001 vs non-drinkers), income impacted by COVID-19 pandemic (OR = 1.930, 2.037 and 2.688 for mild, moderate, and severe impact, respectively; all P-Ref < 0.01 vs no impact), knowledge of how the vaccine was developed (OR = 1.616; 95% CI: 1.126-2.318; P-Ref = 0.009 vs unknown), believing in the safety of the vaccine (OR = 1.502; 95% CI: 1.024-2.203; P-Ref = 0.038 vs denying the safety of vaccine), willingness to pay for the vaccine (OR = 3.042; 95% CI: 2.376-3.894; P-Ref < 0.001 vs unwilling), and willingness to recommend families and friends to get vaccinated (OR = 2.744; 95% CI: 1.759-4.280; P-Ref < 0.001 vs do not recommend) were contributors to vaccine acceptance. While such as being retired (OR = 0.586; 95% CI: 0.438-0.784; P-Ref < 0.001 vs unemployed), undergoing multiple therapies of cancer (OR = 0.408; 95% CI: 0.221-0.753; P-Ref = 0.004 vs no ongoing treatment), and worrying that the vaccine might deteriorate the prognosis of cancer (OR = 0.393; 95% CI: 0.307-0.504; P-Ref < 0.001 vs might not) were contributors to vaccine hesitancy.

CONCLUSION

This study provided preliminary estimates of the rates of vaccine acceptance and vaccine hesitancy among cancer patients in Eastern China. The intention to receive the COVID-19 vaccine was impacted by factors such as patient occupation, alcohol consumption, and some parts of knowledge about and attitude towards COVID-19 vaccine. It is recommended to develop individualized vaccination plans that meet the healthcare needs of cancer patients.

Prevention and Treatment of COVID-19 Using Traditional and Folk Medicine: A Content Analysis Study

Background

Coronavirus 2019 (COVID-19) is a respiratory disease with no specific and definitive drug treatment. With the COVID-19 outbreak, traditional and folk methods were used for its treatment. This study was conducted to explore people's experiences of using traditional and folk medicine for the prevention and treatment of COVID-19 in Iran.

Methods

This qualitative study was conducted on 37 people in Arak (Iran) from May to November 2020 using a conventional content analysis approach. The participants were selected using cluster sampling and interviewed using semistructured telephone interviews. After transcribing the interviews, they were analyzed using content analysis. Accordingly, semantic units were identified, related codes were extracted and placed in subcategories and categories based on similarities, and themes were formed. The interviews continued until data saturation.

Results

After analyzing the collected data, 116 different codes were extracted and classified into two subcategories of pharmacological and non-pharmacological methods. Then, each of the subcategories was classified into two categories: conventional medicine and traditional medicine. Finally, two main themes were obtained, including prevention methods and self-treatment methods for COVID-19.

Conclusion

People use various traditional and folk methods for COVID-19 prevention and treatment. Such methods can be either useful or lack the necessary effectiveness and have side effects. Thus, necessary training should be provided to the public about using these methods and avoiding unapproved treatments.

Evaluation of botanicals as potential COVID-19 symptoms terminator

Information about the coronavirus disease 2019 (COVID-19) pandemic is still evolving since its appearance in December 2019 and has affected the whole world. Particularly, a search for an effective and safe treatment for COVID-19 continues. Botanical mixtures contain secondary metabolites (such as flavonoids, phenolics, alkaloids, essential oils etc.) with many therapeutic effects. In this study, the use of herbal treatments against COVID-19 was evaluated. Medical synthetic drugs focus mainly on respiratory symptoms, however herbal therapy with plant extracts may be useful to relieve overall symptoms of COVID-19 due to the variety of bioactive ingredients. Since COVID-19 is a virus that affects the respiratory tract, the antiviral effects of botanicals/plants against respiratory viruses have been examined through clinical studies. Data about COVID-19 patients revealed that the virus not only affects the respiratory system but different organs including the gastrointestinal (GI) system. As GI symptoms seriously affect quality of life, herbal options that might eliminate these problems were also evaluated. Finally, computer modeling studies of plants and their active compounds on COVID-19 were included. In summary, herbal therapies were identified as potential options for both antiviral effects and control of COVID-19 symptoms. Further data will be needed to enlighten all aspects of COVID-19 pathogenesis, before determining the effects of plants on severe acute respiratory syndrome coronavirus 2.

Emergence of Ethnomedical COVID-19 Treatment: A Literature Review

The emergence of COVID-19 as a new pandemic in the modern era has led the public to a new perspective of health. In the earlier days of the COVID-19 pandemic, many factors made people go on their own ways in finding its supposed "cure". With conventional medicines' limited availability and access, traditional medicines become more appealing due to its widespread availability and increased perception of safety. Several herbal medicines are then believed to be able to alleviate or cure COVID-19 and its symptoms. Similarities and patterns in herbal medicines being used show local wisdom of the respective communities regarding their knowledge of diseases and its treatment, known as ethnomedicine. Despite not being approved yet by regulatory bodies as a definitive guideline in COVID-19 management, the application of ethnomedicine results in several herbal medicine candidates that show a promising result regarding its efficacy in managing COVID-19. This literature review aims to study how a society and its knowledge of medicine responds to a new and currently developing disease, and whether if that knowledge merits further study in search of a cure for the pandemic. Furthermore, the narrative aspect in this review also explores socio-politics and public health aspects and considerations of non-conventional COVID-19 treatment.