Highlights of traditional Chinese medicine frontline expert advice in the China national guideline for COVID-19

Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare

Poland has a unique history of traditional Chinese medicine (TCM) dating back to the 17th century when Polish missionary Michael (Michał) Boym was a pioneer in the field. In the 20th century, his successor, Professor Zbigniew Garnuszewski, reintroduced acupuncture to medical practice in Poland. However, other methods of TCM and its holistic approach to patient care have not found their place in modern medicine in Poland. At present, the legal status of TCM in Poland remains unregulated, with TCM included in the broad spectrum of complementary and alternative medicine (CAM) practices. Few reports are available on the use of TCM methods among the Polish population. Integrative medicine combines conventional medicine with evidence-based CAM interventions and considers all aspects of a patient's health, including physical, emotional, mental, social, and environmental factors. An integrative healthcare model that incorporates TCM modalities and lifestyle recommendations as well as a whole person approach may provide a more sustainable solution for the constantly underfinanced Polish healthcare system, which faces challenges of multimorbidity in an aging society and limited access to care. The coronavirus disease 2019 pandemic, war in Ukraine, and ongoing climate crisis have underscored the need to strengthen the resilience of the Polish healthcare system and search for new solutions. A model of care that blends the best of biomedicine and TCM healing approaches may be a better option for both patients and the healthcare system in Poland. Please cite this article as: Rybicka M, Zhao J, Piotrowicz K, Ptasnik S, Mitka K, Kocot-Kępska M, Hui KK. Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare. J Integr Med. 2023; 21(6): 509-517.

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.

Effectiveness and Safety of Lianhua Qingwen Capsules for COVID-19: A Propensity-Score Matched Cohort Study

As a traditional Chinese medicine, Lianhua Qingwen capsules have been widely used to treat Coronavirus Disease 2019 (COVID-19). This study was aimed to demonstrate the association between treatment with Lianhua Qingwen capsules and the clinical outcomes of hospitalized patients with COVID-19. This retrospective study was conducted at four hospitals in Central China. Data of hospitalized COVID-19 patients were collected between December 19, 2019 and April 26, 2020. Based on whether Lianhua Qingwen capsules were used, patients were classified into Lianhua Qingwen and non-Lianhua Qingwen (control) groups. To control for confounding factors, we used conditional logistic regression in a propensity-score matched (PSM) cohort (1 : 1 balanced), as well as logistic regression without matching as sensitivity analysis. A total of 4918 patients were included, 2760 of whom received Lianhua Qingwen capsules and 2158 of whom did not. In the PSM model, after adjusting for confounders, the in-hospital mortality was similar between the Lianhua Qingwen group and the control group (6.8% vs. 3.3%, adjusted OR, 0.66 [95% CI, 0.38-1.15], p = 0.138). The negative conversion rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection was higher in the Lianhua Qingwen group (88.3% vs. 96.1%, adjusted OR, 4.02 [95% CI, 2.58-6.25], p < 0.001). The incidence of acute liver injury was comparable between the two groups (14.0% vs. 11.5%, adjusted OR: 0.85 [95% CI, 0.71-1.02], p = 0.083), and the incidence of acute kidney injury was lower in the Lianhua Qingwen group (5.3% vs. 3.0%, adjusted OR: 0.71 [95% CI, 0.50-1.00], p = 0.048). Treatment with Lianhua Qingwen capsules was not significantly associated with in-hospital mortality in COVID-19 patients. In the Lianhua Qingwen group, the negative conversion rate of SARS-CoV-2 infection was higher and the incidence of acute kidney injury was lower than in the control group.

Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States

BACKGROUND

The introduction of traditional, complementary and integrative medicine (TCIM) services into health systems has been advocated by the World Health Organization, but there is a paucity of reviews synthesising the experiences of (i) implementing TCIM services in conventional healthcare settings and (ii) introducing evidence-based practice in TCIM. Knowledge of the first issue will assist policymakers to innovate implementation interventions in their own health system contexts. Addressing the second issue will facilitate the closure of the evidence-practice gap in TCIM and improve the translation of research evidence into health outcome benefits.

PURPOSE

The aim of this study was to identify, describe and analyse publications on these two key TCIM policy issues via an overview from an implementation science perspective.

METHODS

Publications describing international experiences of implementing TCIM services or evidence for TCIM practices were identified by searching MEDLINE, EMBASE and Global Health databases in November 2021. The findings were summarised using a narrative synthesis approach.

RESULTS

Sixty-three relevant publications were included in the analysis. Current experiences in China and the United Sates (US) reflect varying policy priorities at different stages of implementing TCIM services. In the US, where TCIM have yet to be introduced into mainstream healthcare settings, implementation interventions were designed to facilitate the provision of specific, evidence-based TCIM modalities via referrals from conventional clinicians. The application of these strategies at the health system, regulatory, financial, community, provider and patient levels provided a comprehensive picture of how TCIM implementation may be facilitated via multi-level interventions. In China, the major form of TCIM is traditional Chinese medicine (TCM), for which service provision has already been adopted at all levels of healthcare. With the high volume of clinical research that has been generated in the past several decades, a key policy question at this stage is how to translate TCM-related clinical evidence into practice. The development of clinical practice guidelines (CPGs) is the main implementation intervention, but adherence by TCM clinicians has been poor, due to the conflict between classical individualised practice and CPG standardisation. While tailoring interventions to facilitate CPG uptake is indicated, concurrent innovations in TCM clinical research methods would improve the compatibility between classical and CPG-based practice.

CONCLUSION

Policymakers managing different stages of TCIM implementation will benefit from the experiences of practitioners in the US and China. Multi-level implementation interventions launched in the US provide ideas for the initial introduction of TCIM into a conventional medicine-dominated health system. As TCIM service provision and related clinical research become more common, China's experience will inform how clinical evidence related to TCIM may be disseminated and implemented to improve service quality.

In vitro testing and computational analysis of specific phytochemicals with antiviral activities considering their possible applications against COVID-19

The purpose of this study was to investigate the reservoir of natural products against the SARS-CoV-2 virus and to identify suitable candidates in order to recommend appropriate phytotherapy. Adequately prepared 65 molecules from traditional Chinese medicine with proven antiviral properties were subjected to docking analysis using AutoDock Vina 4 software with the aim to investigate binding affinity and interactions of compounds with Mpro from the SARS-CoV-2 virus. Biflavonoids and tannins show best docking scores with -9,80 kcal/mol for biflavonoids and -9,00 kcal/mol for tannins. Biflavonoids: amentoflavone, agathistaflavone, robustaflavone, hinokiflavone and rhusflavanone were tested for their radical scavenging activity. Partition coefficients were examined by RP-HPLC. Evaluation of drug-likeness properties of investigated biflavonoids suggested rhusflavanone as a molecule with the best ADMET characteristics. Anti-inflammatory activity of rhusflavanone was investigated in LPS stimulated RAW264.7 macrophages. Tested biflavonoids exibit beneficial effects against inflammation by scavenging free radicals and by suppressing the production of proinflammatory mediators by macrophages. Both predictions of affinity spectra for substances (PASS) and in vitro testing showed promising biological activity of investigated biflavonoids. A Quantum chemical study was performed in order to calculate the thermodynamic, molecular orbital, and electrostatic potential of selected molecules and to compare their biological and chemical features. Our results highlighted antioxidant, anti-inflammatory and antiviral properties of investigated compounds, emphasizing the significance of biflavonoid moiety to selected characteristics, which encourage further investigational strategies against COVID-19.

Therapeutic Plants with Immunoregulatory Activity and Their Applications: A Scientific Vision of Traditional Medicine in Times of COVID-19

The progression of SARS-CoV-2 (COVID-19) in humans heavily depends on the patient's overall health status, especially on its immunoregulatory capacity. Different plants and plant-derived preparations (infusions, encapsulated, etc.) have been used as immunoregulators, several of them with scientific support. Nevertheless, due to the composition complexity of such plant-derived preparations, the molecular and physiological mechanisms involved in their beneficial effects remain, in some cases, unclear. In this review article, the most reported plants used in traditional medicine to enhance immunoregulatory capacity are presented, and their effect on the innate immune response is discussed and correlated with their respective phytochemical profile. Understanding how the plant phytochemical profile relates to the observed impact on the innate and adaptative immune response is fundamental to designing plant-derived co-treatments to lessen the symptoms and favor the recovery of COVID-19 patients. In this regard, we propose a prospective guideline for using plants and plant-derived preparations as co-treatments for COVID-19 (and similar viral infections), which could be helpful in the context of the worldwide effort to end the current SARS-CoV-2 pandemic.

Clinical features and effectiveness of Chinese medicine in patients with COVID-19 from overseas: A retrospective study in Xiamen, China

COVID-19, referred to as new coronary pneumonia, is an acute infectious disease caused by a new type of coronavirus SARS-CoV-2. To evaluate the effect of integrated Chinese medicine and Western medicine in patients with COVID-19 from overseas. Data were collected from 178 COVID-19 patients overseas at First Affiliated Hospital of Xiamen University from April 1, 2021 to July 31, 2021. These patients received therapy of integrated Chinese medicine and western medicine. Demographic data and clinical characteristics were extracted and analyzed. In addition, the prescription which induced less length of PCR positive days and hospitalization days than the median value was obtained. The top 4 frequently used Chinese medicine and virus-related genes were analyzed by network pharmacology and bioinformatics analysis. According to the chest computed tomography (CT) measurement, abnormal lung findings were observed in 145 subjects. The median length of positive PCR/hospitalization days was 7/7 days for asymptomatic subjects, 14/24 days for mild subjects, 10/15 days for moderate subjects, and 14/20 days for severe subjects. The most frequently used Chinese medicine were Scutellaria baicalensis (Huangqin), Glycyrrhiza uralensis (Gancao), Bupleurum chinense (Chaihu), and Pinellia ternata (Banxia). The putative active ingredients were baicalin, stigmasterol, sigmoidin-B, cubebin, and troxerutin. ACE, SARS-CoV-2 3CL, SARS-CoV-2 Spike, SARS-CoV-2 ORF7a, and caspase-6 showed good binding properties to active ingredients. In conclusion, the clinical results showed that integrated Chinese medicine and Western medicine are effective in treating COVID-19 patients from overseas. Based on the clinical outcomes, the putative ingredients from Chinese medicine and the potential targets of SARS-CoV-2 were provided, which could provide a reference for the clinical application of Chinese medicine in treating COVID-19 worldwide.

Phenolic compounds versus SARS-CoV-2: An update on the main findings against COVID-19

The COVID-19 pandemic caused by SARS-CoV-2 remains an international concern. Although there are drugs to fight it, new natural alternatives such as polyphenols are essential due to their antioxidant activity and high antiviral potential. In this context, this review reports the main findings on the effect of phenolic compounds (PCs) against SARS-CoV-2 virus. First, the proven activity of PCs against different human viruses is briefly detailed, which serves as a starting point to study their anti-COVID-19 potential. SARS-CoV-2 targets (its proteins) are defined. Findings from in silico, in vitro and in vivo studies of a wide variety of phenolic compounds are shown, emphasizing their mechanism of action, which is fundamental for drug design. Furthermore, clinical trials have demonstrated the effectiveness of PCs in the prevention and as a possible therapeutic management against COVID-19. The results were complemented with information on the influence of polyphenols in strengthening/modulating the immune system. It is recommended to investigate compounds such as vitamins, minerals, alkaloids, triterpenes and fatty acids, and their synergistic use with PCs, many of which have been successful against SARS-CoV-2. Based on findings on other viruses, synergistic evaluation of PCs with accepted drugs against COVID-19 is also suggested. Other recommendations and limitations are also shown, which is useful for professionals involved in the development of efficient, safe and low-cost therapeutic strategies based on plant matrices rich in PCs. To the authors' knowledge, this manuscript is the first to evaluate the relationship between the antiviral and immunomodulatory (including anti-inflammatory and antioxidant effects) activity of PCs and their underlying mechanisms in relation to the fight against COVID-19. It is also of interest for the general population to be informed about the importance of consuming foods rich in bioactive compounds for their health benefits.

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Phenolic compounds are known for their high potential against various human viruses.

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Phenolic compounds also have anti-inflammatory and immunomodulatory activity.

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Medicinal plants used against COVID-19 are rich in phenolic compounds.

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Phenolic compounds interfere with the activity of SARS-CoV-2 proteins.

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A wide variety of food products with high polyphenolic content are presented.

Effects of Chinese medicine for COVID-19 rehabilitation: a multicenter observational study

Objectives

This study aimed to evaluate the effects of Chinese Medicine (CM) on the health condition of the post-COVID-19 patients, particularly with the CM Syndrome diagnosis and Body Constitutions (BC), as well as related clinical characteristics.

Methods

150 participants who had COVID-19 and discharged from Hong Kong public hospitals were recruited. They were provided with three to six months of CM treatments, during which assessments were made per month and at follow-up on their CM syndromes, BC, lung functions, and other medical conditions. This study was divided into two parts: (1) Retrospective survey: medical history of participants during COVID-19 hospitalization was collected during the baseline visit; (2) Prospective observation and assessments: clinical symptoms, lung functions, and BC status were evaluated in participants receiving CM treatment based on syndrome differentiation and clinical symptoms.

Results

The median hospitalization period was 16 days. Symptoms were presented in 145 (96.6%) patients at the day they were diagnosed with COVID-19. Fever, fatigue, and dry cough were the most common symptoms, exhibiting in 59.3% (89 of 150), 55.3% (83 of 150), and 46% (70 of 150) participants, respectively. Among the 150 post-COVID patients, majority (71.3%) were of the two particular post-COVID CM Syndromes (Qi Deficiency of Lung and Spleen, and Qi and Yin Deficiency). Upon CM treatment, there was an observable increase in participants reaching a balanced BC (i.e. healthy body conditions). The increase was observed to be more prominent in those without the particular CM Syndromes compared to those with the CM Syndromes. Main clinical symptoms in participants with the CM Syndromes decreased upon CM treatment. Occurrence of fatigue also dropped after CM treatment though not all accompanied clinical symptoms were resolved fully. Further to the improvement in terms of CM assessments, lung functions of the participants were found to show improvement after treatment. Both the performance in 6MWT and scores in the LFQ improved upon CM treatments (P < 0.05).

Conclusion

This study provided evidence for individualized CM treatment on COVID-19 rehabilitation concerning the clinical symptoms improvements, lung functions improvement, and achieving a balanced BC. It is believed that CM may be a key to further promote rehabilitation and resolution of residual symptoms. Long-term large scale follow-up studies on sub-categorising post-COVID patients according to different CM syndromes would be required to further elucidate treatment of persistent symptoms that may be associated with long-COVID.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13020-022-00654-z.

Factors influencing physician's behavioral intention to use Traditional Chinese Medicine to treat coronavirus disease 2019 based on the theory of planned behavior

OBJECTIVE

To explore the factors influencing physicians' intentions to use Traditional Chinese Medicine (TCM) to treat coronavirus disease 2019 (COVID-19).

METHODS

A cross-sectional, self-report online survey was conducted from March 16, 2020, to April 2, 2020, in China. Participants were recruited through convenience and snowball sampling. Data were collected by using a self-designed questionnaire based on the Theory of Planned Behavior. Structural equation modeling was used for data analysis.

RESULTS

A total of 494 physicians were enrolled in this study. Overall, the model explained 75.4% and 75.5% of the total variance in intention and attitude, respectively. Specifically, attitudes (β = 0.467, P < 0.001), past behavior (β = 0.384, P < 0.05), subjective norms (SN) (β = 0.177, P < 0.001), and perceived behavioral control (PBC) (β = 0.133, P < 0.05) significantly affected physicians' intention to use TCM. Cognition (β = 0.606, P < 0.001) and PBC (β = 0.569, P < 0.01) significantly influenced physicians' attitudes toward using TCM. SN (β = 0.064, P = 0.263) was not a factor affecting attitude.

CONCLUSION

Physicians' intention to use TCM was significantly associated with attitude, past behavior, PBC, and SN. The findings may not only be useful for understanding the influencing factors and paths of physicians' intention to use TCM to treat COVID-19 but also provide a reference for health authorities and policymakers to promote physicians to utilize TCM.

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.

Chinese Medicine Meets Conventional Medicine in Targeting COVID-19 Pathophysiology, Complications and Comorbidities

OBJECTIVE

To investigate how the National Health Commission of China (NHCC)-recommended Chinese medicines (CMs) modulate the major maladjustments of coronavirus disease 2019 (COVID-19), particularly the clinically observed complications and comorbidities.

METHODS

By focusing on the potent targets in common with the conventional medicines, we investigated the mechanisms of 11 NHCC-recommended CMs in the modulation of the major COVID-19 pathophysiology (hyperinflammations, viral replication), complications (pain, headache) and comorbidities (hypertension, obesity, diabetes). The constituent herbs of these CMs and their chemical ingredients were from the Traditional Chinese Medicine Information Database. The experimentally-determined targets and the activity values of the chemical ingredients of these CMs were from the Natural Product Activity and Species Source Database. The approved and clinical trial drugs against these targets were searched from the Therapeutic Target Database and DrugBank Database. Pathways of the targets was obtained from Kyoto Encyclopedia of Genes and Genomes and additional literature search.

RESULTS

Overall, 9 CMs modulated 6 targets discovered by the COVID-19 target discovery studies, 8 and 11 CMs modulated 8 and 6 targets of the approved or clinical trial drugs for the treatment of the major COVID-19 complications and comorbidities, respectively.

CONCLUSION

The coordinated actions of each NHCC-recommended CM against a few targets of the major COVID-19 pathophysiology, complications and comorbidities, partly have common mechanisms with the conventional medicines.

Traditional Chinese medicine in COVID-19

COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the globe, posing an enormous threat to public health and safety. Traditional Chinese medicine (TCM), in combination with Western medicine (WM), has made important and lasting contributions in the battle against COVID-19. In this review, updated clinical effects and potential mechanisms of TCM, presented in newly recognized three distinct phases of the disease, are summarized and discussed. By integrating the available clinical and preclinical evidence, the efficacies and underlying mechanisms of TCM on COVID-19, including the highly recommended three Chinese patent medicines and three Chinese medicine formulas, are described in a panorama. We hope that this comprehensive review not only provides a reference for health care professionals and the public to recognize the significant contributions of TCM for COVID-19, but also serves as an evidence-based in-depth summary and analysis to facilitate understanding the true scientific value of TCM.

Nitric Oxide on Pathophysiology of SARS-CoV 19: Toward Possible Role of Acupuncture Treatment

The ongoing outbreak of COVID-19 has quickly become a daunting challenge to global health. In the absence of satisfied therapy, effective treatment interventions are urgently needed. Previous studies have demonstrated that acupuncture is effective at relieving common symptoms of COVID-19 including breathlessness, nausea, insomnia, leukopenia, fatigue, vomiting, and abdominal pain. Experiments have shown that nitric oxide (NO) inhibits the replication cycle of severe acute respiratory syndrome (SARS) coronavirus with similar structures of COVID-19. Increase in level of NO by using NO gas inhalation has been shown to restore lung function by reducing airway resistance and improving virus-induced lung infections in SARS patients. Recent case report showed that a medical acupuncturist with symptoms consistent with severe COVID pneumonia achieved full recovery by self-administered medical acupuncture and cupping therapy at home. Clinical features and pathophysiology demonstrated that NO deficiency and endothelial dysfunction contribute to the development of COVID-19. Several studies from different groups consistently demonstrated that acupuncture increases NO synthase expression and induces an elevation of NO production and release in plasma and the local skin regions in both animals and humans. It is suggested that exogenous NO supplies or interventions that induce increasing levels of NO can play an important role in protective effects against inflammation and acute lung injury. This article reviews the rationale for mechanisms of NO induction induced by acupuncture in the possible treatment of COVID-19 and highlights its potential for contributing to better clinical outcomes and improving future clinical studies of acupuncture on treatment of COVID-19.

The Promising Enzymes for Inhibitors Development against COVID-19

Since the outbreak of COVID-19, it has been an epidemic for nearly a year. COVID-19 has brought painful disasters to people all over the world. It not only threatens lives and health, but also induces economic crises. At present, promising methods to eradicate COVID-19 mainly include drugs and vaccines. Enzyme inhibitors have always been a reliable strategy for the treatment of related diseases. Scientists worldwide have worked together to study COVID-19, have obtained the structure of key SARS-CoV-2 associated enzymes, and reported the research of inhibitors of these enzymes. This article summarizes COVID-19-related enzyme inhibitors' recent development, mainly including 3CLpro, PLpro, TMPRSS2, and RdRp inhibitors, hoping to provide valuable weapons in the ensuing battle against COVID-19.

Integrative management of critical case of Covid 19 with Ayurveda and Modern medicine: A case report

Covid 19 pandemic has placed challenges in front of medical health fraternity in terms of management, prevention and immunity building. Effectiveness of any medication has not conclusively proven; hence there is need for integrative management of Covid 19. We have managed a critical case of Covid-19 having history of thalassemia, hypothyroidism with integrative management of Ayurveda and modern medicine. A male patient (59 years of age) with history of thalassemia had complaints of cough and breathlessness since 4 days. He performed RT PCR because of his exposure to a Covid positive cases in immediate family. He was treated with Favipiravir at home for 5 days. He deteriorated on 6th day with SPO₂ dropped to 75%, temp raised to 101 F and respiratory rate (RR) raised to 45/min. He was admitted in Yogeshwari Hospital Daund, Maharashtra; treated with oxygen inhalation, Remdesvir and Ayurveda medicines in intensive care unit (ICU). Ayurveda treatment protocol was advised through telemedicine. Significant improvement in clinical symptoms and normal HRCT was observed at completion of treatment. This case report provides further directions for integrative management in cases of Covid 19. Further clinical research studies in this direction are warranted.

A public survey of traditional, complementary and integrative medicine use during the COVID-19 outbreak in Hong Kong

Background

During COVID-19, the public actively sought non-pharmacological and self-management approaches to prevent infection. Little is known on the use of traditional, complementary and integrative medicine (TCIM) by the public as preventive measures. This study investigated the prevalence and patterns of TCIM use during the pandemic, and identified factors associated with its use among the general population in Hong Kong.

Methods

An online cross-sectional survey was conducted from November to December 2020. The survey solicited information on the respondents’ sociodemographic characteristics, risk perception of the pandemic, and use of TCIM before and during the pandemic. Logistic regression analysis was conducted to determine predictors of TCIM use.

Results

In total, 632 responses (completion rate = 88.1%) were analyzed. TCIM was used by 44.0% of respondents during the pandemic. The most popular forms of TCIM were vitamins or other dietary supplements (n = 160, 25.3%) and Chinese herbal medicine (n = 122, 19.3%) during the pandemic. The most frequently reported indication was strengthening the immune system, especially for vitamins or other dietary supplements (n = 142/160, 88.8%). Respondents who reported using TCIM were more likely to be female (adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.29–2.59), had higher education attainment (aOR = 2.21, 95% CI = 1.39–3.59), and older-aged (age >55 years: aOR = 1.77, 95% CI = 1.04–3.02). Respondents who resided in districts with moderate to high number of confirmed COVID-19 cases (aOR = 1.60, 95% CI = 1.07–2.42) and had a higher level of risk perception (aOR = 1.04, 95% CI = 1.01–1.07) were also more likely to use TCIM.

Conclusion

TCIM was used commonly in Hong Kong during the COVID-19 pandemic. While vaccination and social distancing remain the mainstay of controlling the pandemic, professional bodies should proactively consider public preferences and provide information regarding the effectiveness and safety of TCIM for COVID-19 prevention and treatment.

Use of Natural Compounds as a Potential Therapeutic Agent Against COVID-19

The current 2019-nCoV outbreak is becoming extremely harmful and has affected the whole world. Its control is challenging because there is no effective vaccine or drug available for coronavirus disease. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), previously named as 2019 novel coronavirus (2019-nCoV), primarily targets the human respiratory system to lung lesions and lethal pneumonia. Natural products have always shown a crucial role in the process of drug development against various diseases. They may serve as leads for further drug development to combat emergent mutants of the coronavirus. In this review, the current status of natural compounds and their derivatives acting against different species of CoV are discussed.

Therapeutic Development in COVID-19

Since the outbreak of coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2, the disease has spread rapidly worldwide and developed into a global pandemic, causing a significant impact on the global health system and economic development. Scientists have been racing to find effective drugs and vaccines for the treatment and prevention of COVID-19. However, due to the diversity of clinical manifestations caused by COVID-19, no standard antiviral regimen beyond supportive therapy has been established. Ongoing clinical trials are underway to evaluate the efficacy of drugs that primarily act on the viral replication cycle or enhanced immunity of patients. This chapter will summarize the currently used antiviral and adjuvant therapies in clinical practice and provide a theoretical basis for the future treatment of COVID-19.

The add-on effect of Chinese herbal medicine on COVID-19: A systematic review and meta-analysis

BACKGROUND

Chinese herbal medicine (CHM) is thought to be a potential intervention in the treatment of coronavirus disease (COVID-19).

PURPOSE

This study aimed to investigate the efficacy and safety of CHM or CHM combination therapy for COVID-19.

STUDY DESIGN

Systematic review and meta-analysis METHODS: We searched for relevant studies in the CNKI, CBM, Wanfang Data, PubMed, Cochrane Library, Embase, and other resources from their inception to April 15, 2020. Randomized controlled trials, cohort studies, and case-control studies on CHM or CHM combination therapy for COVID-19 were included. Meta-analysis was performed according to the Cochrane Handbook.

RESULTS

Overall, 19 studies with 1474 patients were included. Meta-analysis showed that the overall clinical effectiveness (OR = 2.67, 95% CI 1.83-3.89, I2 = 0%), improvement in the CT scan (OR = 2.43, 95% CI 1.80-3.29, I2 = 0%), percentage of cases turning to severe/critical (OR = 0.40, 95% CI 0.24-0.67, I2 = 17.1%), reverse transcription-polymerase chain reaction (RT-PCR) negativity rate (OR = 2.55, 95% CI 1.06-6.17, I2 = 56.4%) and disappearance rate of symptoms (fever, cough, and fatigue) were superior by combined CHM treatment of COVID-19. However, there was no statistical difference between the two groups in terms of length of hospital stay (WMD = -0.46, 95% CI -3.87 - 2.95, I2 = 99.5%), and rate of adverse effects (OR = 1.21, 95% CI 0.48-3.07, I2 = 43.5%). The quality of evidence was very low to low.

CONCLUSION

The combined treatment of COVID-19 with Chinese and Western medicine may be effective in controlling symptoms and reducing the rate of disease progression due to low quality evidence.

Edible and Herbal Plants for the Prevention and Management of COVID-19

Background: The outbreak of the pandemic coronavirus disease 2019 (COVID-19) has now become a global pandemic spreading throughout the world. Unfortunately, due to the high infectiousness of the novel β-coronavirus, it is very likely to become an ordinary epidemic. The development of dietary supplements and functional foods might provide a strategy for the prevention and management of COVID-19.

Scope and Approach: A great diversity of potential edible and medicinal plants and/or natural compounds showed potential benefits in managing SARS, which may also combat COVID-19. Moreover, many plants and compounds have currently been proposed to be protective against COVID-19. This information is based on data-driven approaches and computational chemical biology techniques. In this study, we review promising candidates of edible and medicinal plants for the prevention and management of COVID-19. We primarily focus on analyzing their underlying mechanisms. We aim to identify dietary supplements and functional foods that assist in managing this epidemic.

Key findings and Conclusion: We infer that acetoside, glyasperin, isorhamnetin, and several flavonoid compounds may prevent and/or be effective in managing COVID-19 by targeting the viral infection, reducing the host cytokine storm, regulating the immune response, and providing organ protection. These bioactive dietary components (used either alone or in combination) might assist in the development of dietary supplements or functional foods for managing COVID-19.

[Salvianolic acid B and its magnesium salt inhibit SARS-CoV-2 infection of Vero-E6 cells by blocking spike protein-mediated membrane fusion]

OBJECTIVE

The investigate the inhibitory effects of the traditional Chinese medicine (TCM) monomer salvianolic acid B (Sal-B) and its magnesium salt Salvia Miltiorrhiza Polyphenolate Injection (ZDDY) against SARS-CoV-2 infection in vitro and explore the molecular mechanism.

OBJECTIVE

The anti-SARS-CoV-2 activity of Sal-B and ZDDY was assessed using the authentic and pseudotyped SARS-CoV-2 infection assay. The antiviral targets of Sal-B were identified by molecular docking and molecular dynamics simulation. Circular dichroism spectroscopy was used to examine the structural characteristics of HR1 and HR2 regions of SARS-CoV-2 S protein, and the S protein-mediated cell-cell fusion assay was used to evaluate the effect of Sal-B on virus-cell membrane fusion. Flow cytometry was carried out to analyze the effect of Sal-B on the binding of SARS-CoV-2 RBD to hACE2 receptor.

OBJECTIVE

The median effective concentrations (EC50) of Sal-B and ZDDY against SARSCoV-2 infection in Vero-E6 cells were 55.47 μmol/L and 36.07 μg/mL, respectively. Both Sal-B and ZDDY successfully inhibited the entry of SARS-CoV-2 pseudovirus into the cells that stably expressed human ACE2 (ACE2/293T), with half maximal inhibitory concentrations (IC50) of 1.69 μmol/L and 24.81 μg/mL, respectively. Sal-B showed a binding affinity of -8.2 kcal/mol to the 6-helix bundle (6-HB) of SARS-CoV-2 S protein. Molecular dynamics simulation showed stable binding between Sal-B and the 6-HB of SARS-CoV-2 S protein at the predicted binding site. Sal-B disturbed the formation of the secondary structure of 6-HB in HR1P/HR2P mixture, resulting in a significantly lowered α-helicity (P < 0.05). Sal-B dose-dependently inhibited SARS-CoV-2 S protein-mediated cell-cell fusion, with an IC50 of 3.33 μmol/L. Sal-B showed no effect on RBD-Fc protein binding to the ACE2 receptor.

OBJECTIVE

Sal-B and its magnesium salt ZDDY can inhibit the entry of SARS-CoV-2 in Vero-E6 cells in vitro by blocking SARS-CoV-2 spike protein-mediated virus-cell membrane fusion.

Evaluating traditional and complementary medicines: Where do we go from here?

Traditional and complementary medicines are increasingly considered possible options for prevention and symptomatic treatment of the novel coronavirus, COVID-19. With renewed attention on these therapies from researchers and policy makers alike, the well-documented challenges of evaluating their safety and efficacy are once again of global concern. Between 2005 and 2018, the World Health Organization conducted a series of surveys, in which 88 percent of responding member states confirmed that their biggest challenge in traditional medicine was the need for technical guidance on research and evaluation. As a first step in pursuing this need, our commentary summarizes thirteen international and regional guidance documents by three broad categories on evaluating safety, efficacy, and product quality for market-based approval and distribution of these treatments. We highlight the paucity of updated international recommendations on these subjects and identify gaps that could inform the current evidence base. All available guidance note the need for evidence surrounding the efficacy of these treatments and practices but are also quick to caution against methodological difficulties in the conduct of such evaluations. Evidence suggests that improved evaluation methods on efficacy and effectiveness are crucial toward expanding future research into establishing the cost-effectiveness of these therapies, in the context of shifting acceptance, interest, and integration of traditional medicines into health systems, and as another step toward Universal Health Coverage.

A study on nursing effect of integrated traditional Chinese and Western medicine management mode on COVID-19

AIM

This study aims to explore the effect of integrated traditional Chinese and Western medicine management mode on nursing care of patients with coronavirus disease 2019 (COVID-19).

METHODS

The study included 142 COVID-19 patients hospitalized in Huoshenshan Hospital from February to March 2020. Nursing measures in the treatment (n = 111) and control (n = 31) groups included integrated management care and usual care. The integrated management model had eight components: WeChat group management, early Traditional Chinese Medicine (TCM) treatment, emotional nursing, music therapy, observation of tongue coating and pulse, vital Qi strengthening, preventing recurrence after recovery, and an individualized follow-up scheme. The endpoints included clinical outcome, recovery time of clinical symptoms and signs, days of hospital stay, and survival without intensive care unit (ICU) admission.

RESULTS

Recovery time from clinical symptoms such as fever, cough, shortness of breath, muscle aches, and fatigue in the treatment group was shorter than that in the control group. Less time was required to show negative chest computed tomography findings in the treatment group than in the control group (13.0 ± 2.8 vs. 16.7 ± 3.9, p < .025). The lengths of hospital stay in the two groups were 16.4 ± 7.3 days (treatment group) and 24.4 ± 4.8 days (control group) (p < .001). Kaplan-Meier curves for survival without ICU transfer showed statistical difference between the two groups (χ2 = 5.427, p = .020).

CONCLUSIONS

Our study shows that the integrated management mode can relieve the symptoms of patients faster, shorten hospital stay and disease course, and reduce the rate of ICU transfers.

Medical Acupuncture as a Treatment for Novel COVID-19-Related Respiratory Distress: Personal Experience from a Frontline Anesthesiologist

Background: COVID-19 leads to significant respiratory distress among many other multiorgan dysfunctions. Depending on severity of symptoms, current treatment in the United States for COVID-19 consists of supportive care, including, but not limited to, supplemental oxygen, antipyretic drugs, pain killers, and mechanical ventilation. Case Description: This case reports a previously healthy anesthesiologist and medical acupuncturist working in a New York City COVID intensive care unit who contracted and was diagnosed with COVID-19 virus. She subsequently developed self-diagnosed acutely symptomatic COVID pneumonia, including symptoms of pleuritic chest pain, hypoxia with shortness of breath, increased respiratory rate, dry cough, orthostatic hypotension, and headache. She self-treated with cupping therapy at the onset of symptoms and medical acupuncture at the onset of pulmonary symptoms to full recovery. Conclusions: Acupuncture should be considered as a viable adjunct in supportive care for patients with symptomatic COVID-19 pneumonia.

Herbal Medications Used to Treat Fever

Fever is a natural body defense and a common symptom of disease. Herbs have been used for thousands of years to treat fever. Many herbs have anti-inflammatory properties. Some are useful in reducing the release of cytokines and mediators of inflammation, whereas others work as natural aspirins to inhibit cyclooxygenase. In addition, herbs have known antipathogenic properties and can be effective in the treatment of infection from numerous microorganisms. Last, in traditional Chinese medicine, herbs are used to restore imbalances between the nonpathogenic and the pathogenic clearing interior heat and treating heat patterns in a variety of ways.

Impact of the COVID-19 pandemic on intention to use traditional Chinese medicine: A cross-sectional study based on the theory of planned behavior

Objective

Coronavirus disease 2019 (COVID-19) has become an increasingly severe public health emergency. Although traditional Chinese medicine (TCM) has helped to combat COVID-19, public perception of TCM remains controversial. We used the theory of planned behavior (TPB) to identify factors that affect the intention to use TCM.

Methods

A cross-sectional web-based survey of 10,824 individuals from the general public was conducted between March 16 and April 2, 2020. The participants were recruited using a snowball sampling method. Data were collected using a self-administered questionnaire, based on the TPB. The questionnaire consisted of demographic characteristics and TPB structures. Structural equation modeling was used to identify predictors of intention.

Results

The results indicated the model explained 77.5% and 71.9% of intention and attitude variance. Intention to use TCM had the strongest relationship with attitude (P < 0.001), followed by past behavior (P < 0.001), subjective norms (P < 0.001) and perceived behavioral control (P < 0.001). Attitudes toward TCM were significantly affected by perceived behavioral control (P < 0.001), subjective norms (P < 0.001) and cognition of TCM (P < 0.001).

Conclusion

Attitude is a key factor in determining the intention to use TCM, followed by past behaviors, subjective norms and perceived behavioral control. Our results offer important implications for health policy makers to promote the use of TCM.

Clinical characteristics and impacts of traditional Chinese medicine treatment on the convalescents of COVID-19

Objectives: A significant proportion of discharged COVID-19 patients still have some symptoms. Traditional Chinese medicine (TCM) has played an important role in the treatment of COVID-19, but whether it is helpful for discharged patients is still unknown. The aim of this study was to retrospectively analyze the impacts of TCM treatment on the convalescents of COVID-19. Methods: A total of 372 COVID-19 convalescents from February 21 to May 3 in Shenzhen, China were retrospectively analyzed, 291 of them accepted clinically examined at least once and 191 convalescents accepted TCM. Results: After retrospective analysis of the clinical data of convalescents accepted TCM treatment or not, we found that the white blood cell count, as well as serum interleukin-6 and procalcitonin decreased in TCM group. Serum γ-glutamyl transpeptidase was significantly decreased, while prealbumin and albumin increased in TCM group. Red blood cell, hemoglobin, and platelet count increased in TCM group. The mechanisms of TCM treatment might be the overall regulations, including balanced immune response, improved hematopoiesis and coagulation systems, enhanced functions of liver and heart, increased nutrient intake and lipid metabolism. Conclusions: This study suggested that TCM treatment would be beneficial for discharged COVID-19 patients. However, long-term medical observation and further study with randomized trial should be done to confirm this result. Besides, the potential molecular mechanisms of TCM treatment should be further revealed.

Approaches towards fighting the COVID‑19 pandemic (Review)

The coronavirus disease 2019 (COVID‑19) outbreak, which has caused >46 millions confirmed infections and >1.2 million coronavirus related deaths, is one of the most devastating worldwide crises in recent years. Infection with COVID‑19 results in a fever, dry cough, general fatigue, respiratory symptoms, diarrhoea and a sore throat, similar to those of acute respiratory distress syndrome. The causative agent of COVID‑19, SARS‑CoV‑2, is a novel coronavirus strain. To date, remdesivir has been granted emergency use authorization for use in the management of infection. Additionally, several efficient diagnostic tools are being actively developed, and novel drugs and vaccines are being evaluated for their efficacy as therapeutic agents against COVID‑19, or in the prevention of infection. The present review highlights the prevalent clinical manifestations of COVID‑19, characterizes the SARS‑CoV‑2 viral genome sequence and life cycle, highlights the optimal methods for preventing viral transmission, and discusses possible molecular pharmacological mechanisms and approaches in the development of anti‑SARS‑CoV‑2 therapeutic agents. In addition, the use of traditional Chinese medicines for management of COVID‑19 is discussed. It is expected that novel anti‑viral agents, vaccines or an effective combination therapy for treatment/management of SARS‑CoV‑2 infection and spread therapy will be developed and implemented in 2021, and we would like to extend our best regards to the frontline health workers across the world in their fight against COVID‑19.

Complementary and alternative medicine

Complementary and alternative medicine is used worldwide. The use of plant-based medicines for the prevention or treatment of disease is prevalent but not regulated or studied. Multiple countries are implementing pharmacovigilance systems to monitor the use and safety of dietary supplements. Reporting mechanisms continue to be sporadic and inconsistent, based mainly on consumer or healthcare provider reports outlining individual adverse effects (AEs) from dietary supplements. Supplement product ingredient lists may be inaccurate, claims biased, and Evidence-Based information regarding risks and benefits lacking. Healthcare providers should familiarize themselves with complementary medicine practices, the benefits and associated risks to best care for their patient populations.

A global pandemic marked 2020 with the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A short review of vitamin and plant-based prevention, treatment, and associated ramifications with use of these products for coronavirus disease 2019 (COVID-19) is provided. Another world-wide dilemma is food security. Nutrieconomics and the socioeconomic ramifications of food are reviewed from a wider timeframe.

Reports and reviews from 2020 describe AEs of complementary and alternative medicine and herbal dietary supplements. These are listed alphabetically by plant or supplement name.

Traditional Chinese medicine network pharmacology study on exploring the mechanism of Xuebijing Injection in the treatment of coronavirus disease 2019

As a representative drug for the treatment of severe community-acquired pneumonia and sepsis, Xuebijing (XBJ) injection is also one of the recommended drugs for the prevention and treatment of coronavirus disease 2019 (COVID-19), but its treatment mechanism for COVID-19 is still unclear. Therefore, this study aims to explore the potential mechanism of XBJ injection in the treatment of COVID-19 employing network pharmacology and molecular docking methods. The corresponding target genes of 45 main active ingredients in XBJ injection and COVID-19 were obtained by using multiple database retrieval and literature mining. 102 overlapping targets of them were screened as the core targets for analysis. Then built the PPI network, TCM-compound-target-disease, and disease-target-pathway networks with the help of Cytoscape 3.6.1 software. After that, utilized DAVID to perform gene ontology (GO) function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis to predict the action mechanism of overlapping targets. Finally, by applying molecular docking technology, all compounds were docked with COVID-19 3 CL protease(3CLpro), spike protein (S protein), and angiotensin-converting enzyme II (ACE2). The results indicated that quercetin, luteolin, apigenin and other compounds in XBJ injection could affect TNF, MAPK1, IL6 and other overlapping targets. Meanwhile, anhydrosafflor yellow B (AHSYB), salvianolic acid B (SAB), and rutin could combine with COVID-19 crucial proteins, and then played the role of anti-inflammatory, antiviral and immune response to treat COVID-19. This study revealed the multiple active components, multiple targets, and multiple pathways of XBJ injection in the treatment of COVID-19, which provided a new perspective for the study of the mechanism of traditional Chinese medicine (TCM) in the treatment of COVID-19.

Network Pharmacology Integrated Molecular Docking Reveals the Anti-COVID-19 Mechanism of Xingnaojing Injection

In the process of fighting against COVID-19 in China, Xingnaojing injection has been recommended for its clinical treatment, but the information about its active components and mechanism is still lacking. Therefore, in this work, using network pharmacology and molecular docking, we studied the active components of Xingnaojing injection having anti-COVID-19 properties. Using the DL parameter, TCMSP and CNKI databases were used to screen the active components of the Xingnaojing injection. Then, the SwissTargetPrediction webserver was used to collect the corresponding gene targets, and the gene targets related to COVID-19 were searched in the Genecards database. The DAVID database was used to enrich the function of gene targets, and the KOBAS3.0 database for the annotation of related KEGG pathways. The “components–targets–pathways” network of Xingnaojing injection was constructed with Cytoscape 3.6.1 software. The protein–protein interaction networks were analyzed using the String database. Specific proteins, SARS-COV-2 3 Cl, ACE2, and the active components were imported into Discovery Studio 2016 Client for molecular docking studies. From the Xingnaojing injection, a total of 58 active components, including Divanillalaceton and Q27139023, were screened. These were linked to 53 gene targets including mitogen-activated protein kinase 1 (MAPK1), tumor necrosis factorTNF, epidermal growth factor receptor, MAPK3, and 196 signaling pathways related to COVID-19, such as apoptosis, C-type lectin receptor signaling pathway, and hypoxia-inducible factor 1 signaling pathway. Furthermore, molecular docking studies were performed to study potential binding between the key targets and selected active components. Xingnaojing injection exhibits anti-COVID-19 effects via multiple components, multiple targets, and multiple pathways. These results set a scientific basis for further elucidation of the anti-COVID-19 mechanism of Xingnaojing injection.

Traditional Chinese Medicine as a complementary therapy in combat with COVID-19-A review of evidence-based research and clinical practice

AIM

To examine the literature on Traditional Chinese Medicine (TCM) used in the treatment, prevention and supportive care in patients with COVID-19.

DESIGN

A narrative review was performed.

DATA SOURCES

A systematic and comprehensive search was conducted on both Chinese and English electronic databases: China National Knowledge Infrastructure, Wanfang Data, CINAHL, Embase, Cochrane, PubMed, PsycINFO. Articles published from 1 December 2019 -1 April 2020 were included in this review.

REVIEW METHODS

Studies reporting on the treatment and prevention of COVID-19 using TCM regardless of study designs were included. In addition, grey literatures, including media reports on Chinese government websites or official media websites and treatment guidelines were searched for TCM treatment and prevention on COVID-19.

RESULTS

Limited research has been published on the use of TCM for COVID-19. We qualitatively described and synthesized the published research and current clinical practice on the use of TCM for COVID-19, and focused on the following areas: TCM treatment used in SARS, MERS, H1N1; TCM treatment plan for COVID-19; TCM in Prevention and Treatment at Early Stage of COVID-19; TCM emotional therapy; and personalized TCM treatment plan.

CONCLUSION

The combination of western medicine and TCM in treatment, and treatment based on the local condition, isolation, personal protective measures are of great significance for the prevention and treatment of COVID-19. Relevant laboratory research and clinical evaluation should be continued to collect scientific evidences on the efficacy of TCM.

IMPACT

TCM has been used in the treatment and prevention of COVID-19 in China, and the clinical evidences indicated that TCM regulates immunity and exerts anti-viral effect simultaneously. This review provides practical recommendation for the policymakers in the selection process of the treatment and preventive measures for the global pandemic of COVID-19.

Potential Therapeutic Effect of Traditional Chinese Medicine on Coronavirus Disease 2019: A Review

The Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has been rapidly spreading globally and has caused worldwide social and economic disruption. Currently, no specific antiviral drugs or clinically effective vaccines are available to prevent and treat COVID-19. Traditional Chinese medicine (TCM) can facilitate syndrome differentiation and treatment according to the clinical manifestations of patients and has demonstrated effectiveness in epidemic prevention and control. In China, TCM intervention has helped to control the epidemic; however, TCM has not been fully recognized worldwide. In this review, we summarize the epidemiology and etiological characteristics of severe acute respiratory syndrome coronavirus 2 and the prevention and treatment measures of COVID-19. Additionally, we describe the application of TCM in the treatment of COVID-19 and the identification of small molecules of TCM that demonstrate anti-coronavirus activity. We also analyze the current problems associated with the recognition of TCM. We hope that, through the contribution of TCM, combined with modern technological research and the support of our international counterparts, COVID-19 can be effectively controlled and treated.

Network Pharmacology Analysis to Identify Phytochemicals in Traditional Chinese Medicines That May Regulate ACE2 for the Treatment of COVID-19

“Three formulas and three medicines,” which include Jinhua Qinggan granule, Lianhua Qingwen capsule/granule, Xuebijing injection, Qingfei Paidu decoction, HuaShiBaiDu formula, and XuanFeiBaiDu granule, have been proven to be effective in curbing coronavirus disease 2019 (COVID-19), according to the State Administration of Traditional Chinese Medicine. The aims of this study were to identify the active components of “Three formulas and three medicines” that can be used to treat COVID-19, determine their mechanism of action via angiotensin-converting enzyme 2 (ACE2) by integrating network pharmacological approaches, and confirm the most effective components for COVID-19 treatment or prevention. We investigated all the compounds present in the aforementioned herbal ingredients. Compounds that could downregulate the transcription factors (TFs) of ACE2 and upregulate miRNAs of ACE2 were screened via a network pharmacology approach. Hepatocyte nuclear factor 4 alpha (HNF4A), peroxisome proliferator-activated receptor gamma (PPARG), hsa-miR-2113, and hsa-miR-421 were found to regulate ACE2. Several compounds, such as quercetin, decreased ACE2 expression by regulating the aforementioned TFs or miRNAs. After comparison with the compounds present in Glycyrrhiza Radix et Rhizoma, quercetin, glabridin, and gallic acid present in the herbal formulas and medicines were found to alter ACE2 expression. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were used to search for possible molecular mechanisms of these compounds. In conclusion, traditional Chinese medicine (TCM) plays a pivotal role in the prevention and treatment of COVID-19. Quercetin, glabridin, and gallic acid, the active components of recommended TCM formulas and medicines, can inhibit COVID-19 by downregulating ACE2.

Analysis of the mechanism of Shufeng Jiedu capsule prevention and treatment for COVID-19 by network pharmacology tools

Introduction

The novel coronavirus pneumonia that broke out in 2019 has become a global epidemic. According to the diagnosis and treatment plan issued in China and the existing clinical data, Shufeng Jiedu (SFJD) Capsule can be effectively used in the treatment of COVID-19 patients. This study aimed to explore its mechanism of action by network pharmacology and molecular docking technology.

Methods

The Chinese Medicine System Pharmacology Analysis Platform (TCMSP), a Bioinformatics Analysis Tool for Molecular mechANism of Traditional Chinese Medicine (BATMAN-TCM), the Encyclopedia of Traditional Chinese Medicine (ETCM) and related literature records were used to search the composition and main active compounds of SFJD, and to screen out the targets of drug components. Disease-associated genes were obtained by the Human Gene Database (GeneCards), the Human Online Mendelian Inheritance Platform (OMIM) and the DisGeNET database, and the co-targeted genes/proteins as targets of both SFJD and COVID-19 were selected by the Comparative Toxicogenomics Database (CTD). Co-targeted genes/proteins were analyzed by STRING, the Database for Annotation, Visualization and Integrated Discovery (DAVID) and Reactome for proteins to protein interaction (PPI), pathway and GO (gene ontology) enrichment, and predicted by AutoDock for their high-precision docking simulation. In addition, the therapeutic effect for SFJD treatment on COVID-19 was validated by the Chinese medicine anti-novel coronavirus pneumonia drug effect prediction and analysis platform (TCMCOVID).

Results

Screening resulted in 163 compounds and 463 targeted genes. The PPI core network contains 76 co-targeted proteins. The Reactome pathways were enriched in signaling by interleukins, immune system, etc. Finally, 6 key proteins of TNF, IL-10, IL-2, IL-6, STAT1 and CCL2 were selected and successfully docked with 4 active ingredients of quercetin, luteolin, wogonin and kaempferol.

Conclusion

SFJD may play a role in the prevention and treatment of COVID-19 through multiple active compounds acting on multiple targets and then multiple pathways.

Epidemiological Situation and Efficacy of Dexamethasone for the treatment planning of COVID-19: A perspective review

The current COVID-19 pandemic has prompted the urgent requirement for searching effective treatments since the implications are so huge globally as compared to the earlier pandemics. Momentarily, there has been no effective medicine for SARS-CoV-2 infection, and supportive care tends to be the most effective approach to treat COVID-19 patients. The rapidly growing awareness of SARS-CoV-2 virology offers a large number of possible drug targets. The World Health Organisation (WHO) is steadily updating the treatment protocol for COVID-19 based on the recent clinical trials. In the present review, we have summarised the possible mode of action, clinical evidence, consequences of the dexamethasone as a therapeutic agent against Covid-19. Currently, there are many corticosteroids tested in ongoing randomised trials. Dexamethasone could come as a lifesaving drug. Dexamethasone drug looks useful only in those patients who are already in a critical state. We might allow dexamethasone as a fascinating shot if the long-term health effects of Covid-19 recovered patients safeguard favourable clinical meanings. It is commonly accepted to reinforce approved drugs in the fight against newly emerging diseases such as COVID-19 as these drugs have established pharmacokinetic profiles and protection. The current focus should be on the development of novel proven therapeutics along with vaccines. High-quality, more extensive, rapid and collaborative randomised controlled trials, with more control groups, would be required to include conclusive evidence to ensure and evaluate what works.

Phytochemicals containing biologically active polyphenols as an effective agent against Covid-19-inducing coronavirus

The outbreak of Covid-19 disease caused by SARS-CoV-19, along with the lack of targeted medicaments and vaccines, forced the scientific world to search for new antiviral formulations. In this review, we describe the current knowledge about plant extracts containing polyphenols that inhibit Covid-19. Many plant-derived natural compounds (polyphenols) might provide a starting point for the research on the use of plant extracts in coronavirus treatment and prevention. Antivirus polyphenolic drugs can inhibit coronavirus enzymes, which are essential for virus replication and infection. This group of natural substances (betulinic acid, indigo, aloeemodine, luteolin, and quinomethyl triterpenoids, quercitin or gallates) is a potential key to designing antiviral therapies for inhibiting viral proteases. The known pharmacophore structures of bioactive substances can be useful in the elaboration of new anti-Covid-19 formulations. The benefit of using preparations containing phytochemicals is their high safety for patients and no side effects.

The increasing importance of the novel Coronavirus

Coronavirus disease 2019 (COVID-19) instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected more`` than 20 million people, with more than more than 700000 deaths globally; and has been declared a pandemic. SARS-CoV-2 is recognized as the seventh coronavirus affecting Homo sapiens. The symptoms of COVID-19 consist of an elevated temperature, cough, diarrhea, and vomiting amongst others, whereas the transmission of SARS-CoV-2 is believed to arise via release of respiratory secretions; through sneezing and coughing. COVID-19 is identified via X-ray or computed tomography scans and further corroborated with molecular diagnostics techniques, including polymerase chain reaction. At present there are no successful therapeutics against SARS-CoV-2; existing antiviral therapies have been utilized to hinder manifestation of respiratory difficulties by diminishing viral load. Herein, we depict an extensive update on the clinical aspects of COVID-19, including strategies for the regulation of the transmission, diagnosis, treatment, and pathogenesis of SARS-CoV-2 infections.

The therapeutic efficacy of Chinese patent medicine combined with routine western medicine in the treatment of coronavirus disease 2019 (COVID-19): A protocol for systematic review and meta-analysis

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a potentially fatal disease. clinical practice shows that Chinese Patent Medicine (CPM) has played an important role in the outbreak, Among them, Jinhua Qinggan granules, Lianhua Qingwen capsule, and Xuebiqing injection have an effect in treating COVID-19 patients, but it has not been systematically evaluated for efficacy and safety. We provide a protocol for systematic review and meta-analysis.

MATERIALS AND METHODS

Retrieved the database, including the China National Knowledge Infrastructure, Chinese Biomedical Database, Wan Fang database, and PubMed. The quality of each study is assessed according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Using Manager 5.3 software and STATA 16.0 software were used to perform the meta-analysis.

RESULTS

The systematic review and meta-analysis aims to review and pool current clinical outcomes of CPM combined with routine western medicine (RWM) for the treatment of COVID-19.

CONCLUSION

This study will provide evidence of CPM (including Jinhua Qinggan granule, Lianhua Qingwen capsule, and Xuebiqing injection) for the treatment on COVID-19 patients.INPLASY Registration number: INPLASY202050050.

Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study

BACKGROUND

Traditional Chinese medicine (TCM) has been widely used in the treatment of coronavirus disease 2019 (COVID-19). Tongue features should be referred for diagnosis and treatment of diseases in TCM. Therefore, it is necessary to analyze the tongue features of the patients suffered from COVID-19.

METHODS

COVID-19 Symptom Database (established by Evidence-based Medicine Center of Tianjin University of TCM) was searched for eligible tongue pictures. The tongue pictures were assessed by TCM experts to extract the data of tongue color, coating color, tongue body shape and coating proper feature. The relationship between tongue features and patient's condition was analyzed.

RESULTS

Patients diagnosed as mild and moderate COVID-19 commonly had light red tongue and white coating. Severe patients had purple tongue and yellow coating. The proportion of critical patients with tender tongue increased to 75%. Greasy coating was a significant characteristic of patients with COVID-19. The proportions of greasy coating were 53.33%, 73.30%, 83.67 and 87.5% in disease category of mild, moderate, severe and critical. In addition, the thick coating proportion increased from mild (24.89%) to critical (50.00%).

CONCLUSIONS

Tongue features have certain relationship with the category of COVID-19. Tongue features can serve as potential indicators for the evaluation of patient's condition and prognosis. Further studies are needed to enhance the quantification of tongue features and develop standards.

Traditional Herbal Medicine for the Prevention and Treatment of Cold and Flu in the Autumn of 2020, Overlapped With COVID-19

Many herbs and plants included in several traditional systems have promising bioactive compounds for modern drug therapy. The second round of COVID-19 cases will be accompanied by the spread of seasonal influenza in the fall. The combination of the influenza season and the second wave of COVID-19 may lead to more confusion and put more pressure on public health systems. A literature survey was accomplished using multiple databases including PubMed, Science Direct, ISI web of knowledge, and Google Scholar. The most important antiviral herbs for cold and flu are Thymus vulgaris, honeysuckle flowers, Andrographis, yarrow, peppermint leaf and oil, and Calendula. The most important expectorant herbs for flu and cold are tulsi, snake root, licorice root, clove, slippery elm root, marshmallow osha root, and sage leaf. Immunostimulant herbs for these 2 diseases are Echinacea root, Eucalyptus, garlic, ginseng, marshmallow, slippery elm, Isatisroot, Usnea lichen, myrrh resin, and ginger root. In this mini-review, we mention the key role of some of the most important herbal plants and prescriptions against influenza and cold on the basis of traditional Asian medicine.

The Significance of Natural Product Derivatives and Traditional Medicine for COVID-19

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, there have been more than 10 million reported cases, more than 517,000 deaths in 215 countries, areas or territories. There is no effective antiviral medicine to prevent or treat COVID-19. Natural products and traditional medicine products with known safety profiles are a promising source for the discovery of new drug leads. There is increasing number of publications reporting the effect of natural products and traditional medicine products on COVID-19. In our review, we provide an overview of natural products and their derivatives or mimics, as well as traditional medicine products, which were reported to exhibit potential to inhibit SARS-CoV-2 infection in vitro, and to manage COVID-19 in vivo, or in clinical reports or trials. These natural products and traditional medicine products are categorized in several classes: (1) anti-malaria drugs including chloroquine and hydroxychloroquine, (2) antivirals including nucleoside analogs (remdesivir, favipiravir, β-D-N4-hydroxycytidine, ribavirin and among others), lopinavir/ritonavir and arbidol, (3) antibiotics including azithromycin, ivermectin and teicoplanin, (4) anti-protozoal drug, emetine, anti-cancer drug, homoharringtonine, and others, as well as (5) traditional medicine (Lian Hua Qing Wen Capsule, Shuang Huang Lian Oral Liquid, Qingfei Paidu Decoction and Scutellariae Radix). Randomized, double-blind and placebo-controlled large clinical trials are needed to provide solid evidence for the potential effective treatment. Currently, drug repurposing is a promising strategy to quickly find an effective treatment for COVID-19. In addition, carefully combined cocktails need to be examined for preventing a COVID-19 pandemic and the resulting global health concerns.

Clinical practice guidelines and experts' consensuses of traditional Chinese herbal medicine for novel coronavirus (COVID-19): protocol of a systematic review

BACKGROUND

The World Health Organization declared on March 11, 2020, that the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has escalated from epidemic into pandemic. As the initial outbreak area, China has taken multiple active measures to deal with the epidemic. Updated versions of diagnosis and treatment guideline for novel coronavirus (COVID-19) patients have been issued, and traditional Chinese herbal medicine has been recommended as a treatment. The objective of this study will be to summarize the recommendations in current clinical practice guidelines about the use of traditional Chinese herbal medicine for COVID-19 patients. We will also evaluate and report on the methodological and reporting quality of these guidelines.

METHODS

In this systematic review, we will search for guidelines, expert consensuses, and policy documents published since December 2019 in electronic databases (e.g., PubMed, EMBASE, and Chinese databases) and on websites of governments or organizations (e.g., The National Guideline Clearinghouse [NGC], Guidelines International Network [GIN], National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network [SIGN], and WHO). Eligible documents will be independently selected, and relevant data will be independently extracted by two reviewers. We will also independently evaluate the methodological quality and reporting quality of the included guidelines, using the Appraisal of Guidelines for REsearch & Evaluation (AGREE) II tool and Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement, respectively. Any discrepancies will be discussed and resolved through discussion among the reviewers. We will use the extracted information to summarize their recommendations for traditional Chinese herbal formulae and Chinese patent medicine for COVID-19 patients and to summarize the strength and quality of these recommendations with reference to the results of AGREE II and RIGHT tools.

DISCUSSION

This review will summarize the recommendations in current clinical practice guidelines and provide insight into the implementation strategies for traditional Chinese herbal medicine in COVID-19 patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020179205.

Telemedicine Center of Korean Medicine for treating patients with COVID-19: a retrospective analysis

Background

Since January 2020, novel coronavirus (SARS-Cov-2) - infected pneumonia (COVID-19) rapidly spread in Korea. This study aimed to introduce the Korean Medicine (KM) telemedicine center for treatment of COVID patients in Korea.

Methods

This work was a retrospective review of medical records on patients who received at least one telemedicine session from March 9, 2020 to April 12, 2020 provided by the COVID-19 telemedicine center of Korean Medicine. Data on demographic characteristics, treatment frequency, number of consultation were collected. A descriptive statistical analysis was conducted to report characteristics of patients.

Results

A total of 1742 patients underwent consultation through KM telemedicine centers. Despite the rapid increase in the number of patients, the telemedicine center provided treatments to an average of 192 patients per day by about an average of 15 doctors. Furthermore, 4552 herbal medicines were prescribed through telemedicine center, among which 1366 cases (30%) being Qing-Fei-Pai-Du-tang. Telemedicine care also has shown that even with patient's residence transition, medical care can be continued without pause.

Conclusion

These results show some advantages of the telemedicine center's implementation in terms of the effective use of medical resources and continuous treatment for patients.

In silico ADMET and molecular docking study on searching potential inhibitors from limonoids and triterpenoids for COVID-19

Virtual screening of phytochemicals was performed through molecular docking, simulations, in silico ADMET and drug-likeness prediction to identify the potential hits that can inhibit the effects of SARS-CoV-2. Considering the published literature on medicinal importance, 154 phytochemicals with analogous structure from limonoids and triterpenoids were selected to search potential inhibitors for the five therapeutic protein targets of SARS-CoV-2, i.e., 3CLpro (main protease), PLpro (papain-like protease), SGp-RBD (spike glycoprotein-receptor binding domain), RdRp (RNA dependent RNA polymerase) and ACE2 (angiotensin-converting enzyme 2). The in silico computational results revealed that the phytochemicals such as glycyrrhizic acid, limonin, 7-deacetyl-7-benzoylgedunin, maslinic acid, corosolic acid, obacunone and ursolic acid were found to be effective against the target proteins of SARS-CoV-2. The protein-ligand interaction study revealed that these phytochemicals bind with the amino acid residues at the active site of the target proteins. Therefore, the core structure of these potential hits can be used for further lead optimization to design drugs for SARS-CoV-2. Also, the medicinal plants containing these phytochemicals like licorice, neem, tulsi, citrus and olives can be used to formulate suitable therapeutic approaches in traditional medicines.

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154 limonoids and triterpenoids were screened computationally to search potential inhibitors for COVID-19.

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Phytochemicals were screened by molecular docking, in silico ADMET and drug-likeness prediction.

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Docking studies of phytochemicals were performed with five therapeutic protein targets of SARS-CoV-2.

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7 potential phytochemicals were proposed as potential hits against the SARS-CoV-2.

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Proposed phytochemicals are found mainly in neem, tulsi, citrus, licorice and olives.

Ayurvedic treatment of COVID-19/SARS-CoV-2: A case report

This is the first known case of a Coronavirus disease (COVID-19) positive patient treated entirely with Ayurveda. So far in Modern Western Medicine (MWM), no cure has been found which is specific to COVID-19. The only literature relevant to the treatment of Coronavirus disease has surfaced from Traditional Chinese Medicine (TCM). TCM which was extensively used to control the epidemic in China, also consists of herbal medicines similar to Ayurveda. In this case, the patient, who was familiar with the use of Ayurvedic medicines, fully aware that no proven cure exists in MWM, decided to entirely rely on the limited Ayurvedic medicines that he had in his possession at the time of falling ill. Despite the patient presenting with symptoms, namely high fever, severe body pain and severe cough, along with many of the other associated symptoms of COVID-19, the progress of the disease could be arrested within a short period by being exclusively on Ayurvedic medicines. This illustrates that there is a wide scope to explore the variety of pertinent medicines present in Ayurvedic pharmacopoeia which can be used more rationally to suit every stage of the disease. Being the first-of-its-kind it is a valuable contribution to scientific literature from the world of Ayurveda. This should encourage the healthcare policy makers to quickly use Ayurveda to bring the COVID-19 pandemic under control in India, as they seemed to have demonstrated it in China with TCM.