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

Assessment of ecological and human health risks of heavy metals in soils and Polygonatum sibiricum plants from various cultivation areas in China

In this study, we collected 528 samples from 7 important Polygonatum sibiricum (P. sibiricum) planting areas in China. The P. sibiricum samples were classified into P. sibiricum Red., P. cyrtonema Hua. and P. kiugianum Col.et Hemsl. The content of the Cu, As, Zn, Cd, Pb, and Cr in P. sibiricum and soil were determined using inductively coupled plasma mass spectrometry, and the ecological and health risks were evaluated. The results showed that addition to Cu, the soil exhibits varying degrees of excessive pollution from Zn, As, Pb, Cd, and Cr exceeding permissible levels (GB15618 - 2018, Soil environmental quality-Risk control standard for soil contamination of agricultural land in China). Among them, 31.56% Zn, 22.43% As, and 22.05% Cd in soil exceeded the GB 15618 - 2018 standard. Additionally, three types of P. sibiricum soil have risks, with the risk level being P. cyrtonema Hua. > P. kiugianum Col.et Hemsl. > P. sibiricum Red. It was worth noting that the practice of artificial cultivation management may reduce the amount of As, Cd, and Cr in the soil while increasing the amount of Zn. The order of P. sibiricum bioaccumulating ability in different heavy metals was: Cd > Zn > Cu > Cr > As > Pb, and it had good tolerance to As, Pb, and Cr. In addition, the chronic daily intake, hazard quotient and hazard indexes indicate that the current Cu, Hg, As, Cd and Pb contents of P. sibiricum in China do not pose a health risk to humans. In summary, the impact of Cd in P. sibiricum should be given attention.

The methodological reporting quality in strictly randomized controlled trials for COVID-19 and precise reporting of Chinese herbal medicine formula intervention

Background

Chinese herbal medicine (CHM) formulas played an important role during the pandemic of coronavirus disease 2019 (COVID-19). Many randomized controlled trials (RCTs) on CHM for COVID-19 were quickly published. Concerns have been raised about their quality. In addition, inadequate detailed information on CHM formula intervention may arouse suspicion about their effectiveness. We aim to assess the most recent evidence of the methodological reporting quality of these RCTs with strict randomization, and the precise reporting of the CHM formula intervention.

Methods

RCTs on CHM formulas for COVID-19 were searched from nine databases. The CONSORT 2010, CONSORT-CHM Formulas 2017, and risk of bias were the guidelines used to assess the included RCTs. The checklist of sub-questions based on CONSORT-CHM Formulas 2017 was used to evaluate the precise reporting of CHM formula intervention. A comparison was made between RCTs that enrolled participants during and after the first wave of the pandemic (defined here as December 2019 to March 2020).

Results

The average score for 66 studies evaluated based on three guidelines, the CONSORT 2010, the CONSORT-CHM Formulas 2017, and the checklist of sub-questions based on the CONSORT-CHM Formulas 2017, is 16.4, 15.2, and 17.2, respectively. The reporting rate of sample size calculation, allocation concealment, and blinding is less than 30%. The checklist of sub-questions based on the CONSORT-CHM formulas 2017 can help report and assess CHM formula intervention more precisely. Most studies assessed an "unclear risk of bias" due to insufficient information. RCTs published in English and recruited subjects during the first wave of the pandemic have a higher risk of participant blinding bias than the studies recruited subjects after that (P < 0.05).

Conclusion

The methodological reporting quality in strictly randomized RCTs on CHM formulas for COVID-19 is inadequate-the reporting of sample size calculation, allocation concealment, and blinding need to improve especially. The checklist of sub-questions based on CONSORT-CHM formulas 2017 can help report and assess CHM formula intervention more precisely. The methodological reporting quality of RCTs published in English and enrolled participants during the first wave of the pandemic is worse than the studies that recruited subjects after the first wave of the pandemic.

Efficacy of Kegan Liyan oral liquid vs. Lianhuaqingwen capsules for patients with mild COVID-19: a double-blinded, randomized, controlled, non-inferiority trial

Background

Traditional Chinese medicine has been used for Coronavirus disease 2019 (COVID-19) as a therapeutic option. Lianhuaqingwen capsules (LHQW) are well-recognized for their efficacy, while Kegan Liyan oral liquid (KGLY), widely used for influenza treatment, has emerged as a promising candidate for COVID-19 therapy. This trial aims to assess whether KGLY is non-inferior to LHQW in treating mild COVID-19.

Methods

A total of 127 participants (63 in KGLY group and 64 in LHQW group) were randomly allocated to receive either KGLY therapy or LHQW therapy in a 1:1 ratio. The treatment was given for 7 days, and the follow-up period was 3 days.

Outcome measures

The primary outcome was symptom remission at day 10. Secondary outcomes included symptom recovery, time to symptom remission, recovery rates and time to recovery of selected symptoms, change in visual analog scale score for selected symptoms, area under the curve of the visual analog scale score for sore throat, negative conversion of the SARS-CoV-2 infection, having a positive test result after negative conversion, and incidence of pneumonia.

Results

Full analysis set analysis showed that the symptom remission rate at day 10 was 60.7% with KGLY and 58.3% in LHQW (difference + 2.3 p.p., lower limit of 95% confidence interval - 14.8 p.p.), indicating non-inferiority. There were no significant differences between the groups for any secondary outcome. The occurrence of adverse events did not differ between the groups and no severe adverse events were documented in either group.

Conclusion

Based on the study results, this trial proved that KGLY was non-inferior to LHQW for mild COVID-19, providing a promising option for COVID-19 treatment.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=166372, Identifier, [ChiCTR2200059105].

Detection of Total Aflatoxins in Herbal Medicines Based on Lateral Flow Assay with Contamination Ratio Model

In this study, we developed a colloidal gold immunochromatographic strip (CGIS) method that used the matrix-matched calibration curves of contamination ratio models to quantitatively determine the total aflatoxin in five herbal medicines. This approach addresses issues related to false results and poor accuracy associated with conventional methods. The CGIS was analyzed using a Vertu touch reader, and the matrix-matched calibration was established based on the absorbance ratios of the T and C lines, as well as the logarithmic values of the total aflatoxin concentrations. The total aflatoxins could be accurately and digitally detected from 2.5 to 40 μg/kg, and the LOD of total aflatoxins was 1 μg/kg in the five herbal medicines. The recovery rates from the spiked samples ranged from 65.1% to 98.6%, and the RSD was less than 16.9%. A total of 229 samples were analyzed by both CGIS and HPLC-FLD, with agreement ranging from 78.4% to 132.6% (Arecae semen), 82.6% to 133.0% (Nelumbinis semen), 79.9% to 117.9% (Coicis semen), 78.1% to 119.0% (Platycladi semen), and 76.1% to 123.0% (Ziziphi spinosae semen). This process for the discrimination of the CGIS results was established to assess if samples met the requirement of aflatoxin limits, which could save approximately 75% in time and reduce the workload of retesting by a designated confirmatory reference method to less than 10%. This study demonstrated that the application of matrix-matched calibration curves based on contamination ratio models to CGIS can effectively enhance the rapid quantitative determination capability of total aflatoxins in herbal medicine matrices.

Alliaceae-Derived Supplementation Improves the Severity of COVID-19 Symptoms among Elderly Nursing Home Residents

This study investigates the effect of daily consumption of a concentrated garlic and onion extract on COVID-19 symptoms among elderly nursing home residents. Volunteers consumed a daily capsule of the concentrated powder rich in organosulfur compounds over 36 weeks during lunch. The incidence and severity of COVID-19 symptoms between the treatment and control groups were compared, along with monitoring the safety of consumption, incidence of other diseases, and medicine usage. The treatment group showed a significant reduction in both the number and severity of COVID-19 symptoms compared to the control group, with no significant adverse effects observed. No significant reduction in symptom duration was detected. This study provides preliminary evidence that concentrated garlic and onion extract may aid in the treatment of COVID-19 among older adults. These findings suggest potential public health benefits, emphasizing the need for further research to explore the immunomodulatory properties of these natural compounds.

Efficacy of Shen Cao Gan Jiang Tang on Non-severe COVID-19 Patients: A Multicenter, Randomized, Open-Label Clinical Trial

Background In the face of the escalating COVID-19 pandemic amid shortages of medications and vaccines, a Vietnamese herbal formula known as Shen Cao Gan Jiang Tang (SCGJT) has been put into use for non-severe COVID-19 patients. This study aims to assess its efficacy and safety. Methods A multicenter, open-label, randomized controlled trial was conducted on 300 patients with non-severe COVID-19, randomly assigned into two groups: 150 receiving standard care (control group) and 150 receiving additional SCGJT for 10 days (SCGJT group). Time to resolution of symptoms, symptom severity, disease progression, time to discharge, the National Early Warning Score 2 (NEWS2) score, usage of Western drugs, time to viral clearance, and safety outcomes were continuously monitored. Results The SCGJT group exhibited faster symptom resolution (median: 9 vs. 13 days) and improved symptom severity, including cough, fatigue, hypogeusia, muscle aches, nasal congestion, runny nose, and sore throat, compared to the control group. Although there was a lower rate of severe progression in the SCGJT group (0.7% vs. 4.7%), the difference was not statistically significant. The time to discharge was significantly shorter in the SCGJT group (median: 7 vs. 8 days). Changes in the NEWS2 score did not show significant differences between groups. SCGJT has been demonstrated to reduce the need for symptomatic relief medications and hasten SARS-CoV-2 viral clearance. No adverse events were reported, and routine tests showed no significant differences. Conclusions SCGJT is safe and has potential clinical efficacy in non-severe COVID-19 patients. However, data regarding preventing severe progression remains inconclusive. Further studies should be conducted in light of the current state of the COVID-19 pandemic.

The efficacy of herbal medicines on the length of stay and negative conversion time/rate outcomes in patients with COVID-19: a systematic review

Introduction

In recent years, diverse initiatives have been carried out to control the COVID-19 pandemic, ranging from measures restricting social activities to analyzing drugs and vaccines. Studies on herbal medicines are also increasingly conducted in various countries as an adjuvant therapy or supplement. Therefore, this systematic review aimed to investigate the efficacy of herbal medicines analyzed from various countries through clinical trials with the randomized controlled trial method. The outcomes of Length of Stay (LOS), Negative Conversion Time (NCT), and Negative Conversion Rate (NCR) were the main focus.

Methods

An extensive review of literature spanning from 2019 to 2023 was carried out using well-known databases including PubMed, Scopus, and Cochrane. The search included relevant keywords such as "randomized controlled trial," "COVID-19," and "herbal medicine."

Results

A total of 8 articles were part of the inclusion criteria with outcomes of LOS, NCT, and NCR. In terms of LOS outcomes, all types of herbal medicines showed significant results, such as Persian Medicine Herbal (PM Herbal), Persian Barley Water (PBW), Jingyin Granules (JY granules), Reduning Injection, and Phyllanthus emblica (Amla). However, only JY granules showed significant results in NCR outcome, while JY granules and Reduning Injection showed significant results in reducing NCT.

Conclusion

These findings enrich our understanding of the potential benefits of herbal medicines in influencing LOS, NCR and NCT parameters in COVID-19 patients. Herbal medicines worked to treat COVID-19 through antiviral, anti-inflammatory, and immunomodulatory mechanisms.

Efficacy and safety of Link Natural Sudarshana, an Ayurvedic herbal preparation in COVID-19 patients: A phase II multicenter double-blind randomized placebo-controlled trial

ETHNOPHARMACOLOGICAL RELEVANCE

In vitro and in vivo studies have shown anti-viral and immunomodulatory actions in components of many traditional medicines. Various constituents of traditional medicines have been found to be effective against coronavirus disease (COVID-19) in several clinical trials and in-silico studies. Sudarshana cúrna, a polyherbal Ayurvedic medicine, has been used over thousands of years for a variety of infectious fevers.

AIMS OF THE STUDY

This study aimed to evaluate the efficacy and safety of Link Natural Sudarshana (LNS) tablets, in patients with COVID 19 disease. LNS is a polyherbal preparation comprising 49 medicinal plants included in the Sudarshana cúrna.

MATERIALS AND METHODS

A randomized parallel-group double-blind placebo-controlled multi-center phase II clinical trial was conducted in patients with mild to moderate COVID-19 disease. They were randomly allocated to intervention and control groups. The intervention group received LNS tablets whereas the control group received placebo tablets for 10 days or until the patient was discharged from the hospital. All patients received standard symptomatic treatment. The primary outcome, a reduction in mean log viral load was assessed at day 5 of treatment. The secondary outcomes, clinical progression and safety, were assessed by, monitoring changes in symptoms daily on a Likert scale ranging from 1 to 4 and laboratory tests respectively.

RESULTS

A total of 171 patients (treatment group 83, control group 88) completed the trial. There were no significant differences between the baseline status of the two groups except that body mass index was significantly higher in the placebo group. The mean log viral load reduction at day 5 was higher in the treatment group (2.20 ± 1.67) compared to the placebo group (1.93 ± 1.80), with a mean difference of -0.278. This difference was not statistically significant at the 5% significant level. Reduction of mean cumulative symptom score, which included 16 symptoms graded according to severity, was higher in the treatment group compared to the placebo group. This difference was not statistically significant. None of the study participants developed hypoxia. Among the 7 lymphopenia patients in the placebo group, 3 continued to have lymphopenia at day 10, whereas 9 lymphopenia patients in the treatment group, reverted to normal counts. C reactive proteins (CRP) showed a greater reduction in the treatment group. None reported adverse effects. No significant changes occurred in hematological and biochemical parameters that assessed safety.

CONCLUSIONS

LNS is safe to use in COVID-19 patients and accelerated the decline in viral load, relieved symptoms, reduced CRP levels and reversed lymphopenia earlier, when compared to the placebo.

Alternative therapies for viral infections caused by SARS-Cov-2

Abstract Introduction The relevance of the studied topic lies in the complexity of the treatment of infection caused by SARS-CoV-2. Objective To discuss the potential advantages and disadvantages of alternative treatments compared to conventional medical approaches, and to highlight the importance of collaborative communication between patients and healthcare providers in making informed decisions about alternative treatments of the SARS-CoV-2 virus. Methods The research methodology employed literature analysis methods, including bibliographic and bibliosemantic approaches. The study used theoretical, systematic, and statistical methods, including analysis, synthesis, generalization, interpretation, classification, and meta-analysis to explore alternative treatments for SARS-CoV-2 infections, their interrelationships, and statistical trends in incidence. Results The study identifies diverse alternative therapies for treating SARS-CoV-2 infections, highlighting herbal medicine, acupuncture, reflexology, biohacking, homoeopathy, and magnetotherapy. It underscores the potential benefits of herbal remedies like garlic, ginger, chamomile, and honeysuckle, as well as vitamins (C, D, B12) and minerals (zinc, selenium) in managing COVID-19 symptoms. Conclusion While of-fering holistic benefits, these therapies warrant cautious consideration due to limited scientific backing and potential interactions. Cultural understanding, patient-provider dialogue, and informed choices are key in harnessing the potential of alternative medicine along-side conventional approaches for managing COVID-19 challenges.

Antrodia cinnamomea May Interfere with the Interaction Between ACE2 and SARS-CoV-2 Spike Protein in vitro and Reduces Lung Inflammation in a Hamster Model of COVID-19

Purpose

Coronavirus disease 2019 (COVID-19) poses a global health challenge with widespread transmission. Growing concerns about vaccine side effects, diminishing efficacy, and religious-based hesitancy highlight the need for alternative pharmacological approaches. Our study investigates the impact of the ethanol extract of Antrodia cinnamomea (AC), a native medicinal fungus from Taiwan, on COVID-19 in both in vitro and in vivo contexts.

Methods

We measured the mRNA and protein levels of angiotensin-converting enzyme-2 (ACE2) in human lung cells using real-time reverse transcriptase-polymerase chain reaction and Western blotting, respectively. Additionally, we determined the enzymatic activity of ACE2 using the fluorogenic peptide substrate Mca-YVADAPK(Dnp)-OH. To assess the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we used SARS-CoV-2 pseudovirus infections in human embryonic kidney 293T cells expressing ACE2 to measure infection rates. Furthermore, we evaluated the in vivo efficacy of AC in mitigating COVID-19 by conducting experiments on hamsters infected with the Delta variant of SARS-CoV-2.

Results

AC effectively decreased ACE2 mRNA and protein levels, a critical host receptor for the SARS-CoV-2 spike protein, in human lung cells. It also prevented the spike protein from binding to human lung cells. Dehydrosulphurenic acid, an isolate from AC, directly inhibited ACE2 protease activity with an inhibitory constant of 1.53 µM. In vitro experiments showed that both AC and dehydrosulphurenic acid significantly reduced the infection rate of SARS-CoV-2 pseudovirus. In hamsters infected with the Delta variant of SARS-CoV-2, oral administration of AC reduced body weight loss and improved lung injury. Notably, AC also inhibited IL-1β expression in both macrophages and the lung tissues of SARS-CoV-2-infected hamsters.

Conclusion

AC shows potential as a nutraceutical for reducing the risk of SARS-CoV-2 infection by disrupting the interaction between ACE2 and the SARS-CoV-2 spike protein, and for preventing COVID-19-associated lung inflammation.

COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain

There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.

Xuanfei Baidu decoction in the treatment of coronavirus disease 2019 (COVID-19): Efficacy and potential mechanisms

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide and become a major global public health concern. Although novel investigational COVID-19 antiviral candidates such as the Pfizer agent PAXLOVID™, molnupiravir, baricitinib, remdesivir, and favipiravir are currently used to treat patients with COVID-19, there is still a critical need for the development of additional treatments, as the recommended therapeutic options are frequently ineffective against SARS-CoV-2. The efficacy and safety of vaccines remain uncertain, particularly with the emergence of several variants. All 10 versions of the National Health Commission's diagnosis and treatment guidelines for COVID-19 recommend using traditional Chinese medicine. Xuanfei Baidu Decoction (XFBD) is one of the "three Chinese medicines and three Chinese prescriptions" recommended for COVID-19. This review summarizes the clinical evidence and potential mechanisms of action of XFBD for COVID-19 treatment. With XFBD, patients with COVID-19 experience improved clinical symptoms, shorter hospital stay, prevention of the progression of their symptoms from mild to moderate and severe symptoms, and reduced mortality in critically ill patients. The mechanisms of action may be associated with its direct antiviral, anti-inflammatory, immunomodulatory, antioxidative, and antimicrobial properties. High-quality clinical and experimental studies are needed to further explore the clinical efficacy and underlying mechanisms of XFBD in COVID-19 treatment.

Herbal Medicine Nanocrystals: A Potential Novel Therapeutic Strategy

Herbal medicines have gained recognition among physicians and patients due to their lower adverse effects compared to modern medicines. They are extensively used to treat various diseases, including cancer, cardiovascular issues, chronic inflammation, microbial contamination, diabetes, obesity, and hepatic disorders, among others. Unfortunately, the clinical application of herbal medicines is limited by their low solubility and inadequate bioavailability. Utilizing herbal medicines in the form of nanocrystals (herbal medicine nanocrystals) has shown potential in enhancing solubility and bioavailability by reducing the particle size, increasing the specific surface area, and modifying the absorption mechanisms. Multiple studies have demonstrated that these nanocrystals significantly improve drug efficacy by reducing toxicity and increasing bioavailability. This review comprehensively examines therapeutic approaches based on herbal medicine nanocrystals. It covers the preparation principles, key factors influencing nucleation and polymorphism control, applications, and limitations. The review underscores the importance of optimizing delivery systems for successful herbal medicine nanocrystal therapeutics. Furthermore, it discusses the main challenges and opportunities in developing herbal medicine nanocrystals for the purpose of treating conditions such as cancer, inflammatory diseases, cardiovascular disorders, mental and nervous diseases, and antimicrobial infections. In conclusion, we have deliberated regarding the hurdles and forthcoming outlook in the realm of nanotoxicity, in vivo kinetics, herbal ingredients as stabilizers of nanocrystals, and the potential for surmounting drug resistance through the utilization of nanocrystalline formulations in herbal medicine. We anticipate that this review will offer innovative insights into the development of herbal medicine nanocrystals as a promising and novel therapeutic strategy.

The Efficacy of Herbs as Complementary and Alternative Therapy in Recovery and Clinical Outcome Among People with COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression

Background

The COVID-19 pandemic continues, and this condition has caused many cases in various countries around the world, resulting in more than 6 million deaths worldwide. Herbal medicines can act as immunomodulators, anti-inflammatories, antioxidants, antimicrobials, and others depending on the type and content of the herbs used. Previous studies have shown that several types of herbs, such as Echinacea purpurea, Curcumin or Turmeric, Nigella sativa, and Zingiber officinale, have proven their effectiveness as herbal plants for COVID-19.

Methods

We conducted a comprehensive literature search through five databases, namely, PubMed, Scopus, Embase, Wiley, and ProQuest to assess the efficacy of phytopharmaceuticals until July 12, 2022. We used the Cochrane RoB 2.0 for the quality assessment of the study.

Results

Phytopharmaceuticals significantly improved patients' recovery rate (OR = 3.54; p < 0.00001) and reduced deaths (OR = 0.24; p < 0.0001) compared to the control group. Phytopharmaceuticals also performed as a protective factor for COVID-19 clinical symptoms, such as dyspnea (OR = 0.42; p < 0.05) and myalgia (OR = 0.31; p = 0.02) compared to the control group. However, there is no statistically significant effect on cough (OR = 0.76; p = 0.61) and fever (OR = 0.60; p < 0.20). The results were not affected by patients' covariates [hypertension, diabetes mellitus, and cardiovascular diseases (meta-regression p > 0.05)].

Conclusion

Herbal medicine has the potential as an adjuvant therapy in the management of COVID-19.

Does the use of cysteine-rich whey protein supplements (Inmunocal®) improve the health well-being of COVID-19 patients? A qualitative study

<b>Introduction:</b> In the context of SARS-CoV-2 infection, it has been proposed that oxidative stress may contribute to the management of COVID-19 severity. The impact on the well-being of patients with COVID-19 using cysteine-providing supplements has not yet been evaluated and there is a need to understand the benefits and limitations they may offer.<br /> <b>Aim:</b> The aim of this study is to understand the experiences of improved well-being with cysteine-rich whey protein supplementation (Immunocal®) in patients with COVID-19.<br /> <b>Methods:</b> A qualitative study was conducted by conducting semi-structured interviews with four participants taking Immunocal® while they had COVID-19. Participants were randomly recruited through internet networking. Ethical approval was obtained from the University ethics committee. Participants were informed of the study objectives two days in advance and consent was obtained before interviews began. We used the 16-item “Use of Immunocal supplement for COVID-19” (USIC-19) questionnaire to inquire about COVID-19 behavior (time of illness, symptoms, and severity of illness) and the experience of using the supplement during illness. Confidentiality was maintained throughout this study.<br /> <b>Results:</b> All participants presented mild discomfort such as headache, weakness, and tiredness when they had COVID-19 impacting most of them emotionally. The use of Immunocal® produced a partial improvement in all patients as only two continued to experience fatigue. Immunocal® improved the mood (50%) and physical health of the participants. In addition, participants reported that the supplement was recommended and dosed primarily by a consultant and that they did not feel hesitant to use it because of previous experiences of friends and family. The daily dosage of half of the participants was two sachets and all felt the need to consume the supplement which resulted in daily use.<br /> <b>Conclusion:</b> Following the daily dosage indications of the consultants, the participants who have consumed Inmunocal® have presented a partial improvement of the symptoms related to COVID-19, however, they feel the need to consume the supplement daily to improve their quality of life.