Chinese herbal medicine for coronavirus disease 2019: A systematic review and meta-analysis.

Xingjiang Xiong, Pengqian Wang, Kelei Su, William C Cho, Yanwei Xing

Journal: Pharmacological research 2020;160():105056

PMID: 32622723

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Plain Language Summary

Coronavirus- 2019 (COVID-19) infection, the cause of a global pandemic, can lead to respiratory failure and death. Whilst no specific antiviral drugs or vaccines were available in the early stages of the outbreak, in China Chinese Herbal Medicine (CHM) had been widely used since the beginning. This systematic review and meta-analysis compared the efficacy of CHM to conventional Western medicine treatments for COVID-19 infections, involving 2275 patients from 18 trials. The outcome suggested that the use of CHM exhibited many positive effects on the course of the disease, including fever severity, length of hospital stay, cough, fatigue, anti-inflammatory markers and lung imaging, therefore presenting a promising treatment for reducing the severity and duration of the disease, whilst having little to no side effects. The trials included various formulations predominantly based on traditional Chinese herbal medicine, with the therapeutic principles of ‘dispelling cold’, ‘relieving exterior’, ‘dissipating phlegm’, ‘clearing away heat’, ‘invigorating spleen’, and ‘replenishing qi’. In the included trials a total of 100 different herbs were identified. The five most frequently used herbs being Liquorice Root (Glycyrrhiza spp.), Baikal Skullcap Root (Scutellaria baicalensis), Pinellia Rhizome (Pinelliae tematae), Forsythia Fruit (Forsythia suspensa), and Bitter Apricot Seed (Armeniacae amarum). The treatment course ranged from 5 to 15 days and the most common dosage were tea preparations. The authors describe the meta-analysis as one of the larger ones conducted so far and briefly discuss some of the therapeutic effects and mechanisms of the herbs most used. This meta-analysis yields evidence for alternative strategies in the support and management of COVID-19 infections.

Abstract

Currently, coronavirus disease 2019 (COVID-19), which can lead to severe respiratory failure and death, is now a global pandemic with no specific anti-viral drugs or vaccines. However, It is worth noting that traditional Chinese medicine (TCM), especially Chinese herbal medicine (CHM), has been widely applied in mainland China since outbreak, bringing new hope for the prevention and control of COVID-19. A comprehensive literature searching was conducted in 7 electronic databases from their inception up to June 21, 2020 to evaluate the efficacy and safety of CHM for COVID-19. Eighteen randomized controlled trials (RCTs) involving 2275 patients were enrolled. Most of CHMs were originated from classical Chinese herbal formulas. Liquoric Root (Gancao, Radix Glycyrrhizae), Baical Skullcap Root (Huangqin, Radix Scutellariae Baicalensis), Pinellia Rhizome (Banxia, Rhizoma Pinelliae Tematae), Forsythia Fruit (Lianqiao, Fructus Forsythiae Suspensae), and Bitter Apricot Seed (Kuxingren, Semen Armeniacae Amarum) were most frequently used Chinese herbs. The most commonly used dosage formulation was decoction. Our meta-analyses found that comparing CHM group and conventional western medicine group, CHM group has improvements in several clinical parameters including lung CT, clinical cure rate, ranging from mild to critical cases, length of hospital stay, total score of clinical symptoms, fever reduction time, symptom score of fever, number of cough reduction cases, symptom score of cough, number of fatigue reduction cases, symptom score of fatigue, disappearing time of fatigue, TCM syndrome, viral nucleic acid testing, and inflammatory biomarkers (C-reactive protein). Besides, no severe adverse effects was identified by CHM. CHM, especially classical Chinese herbal formulas, could be used as potential candidates for COVID-19 in this battle.

Address: Department of Cardiovascular Care Unit, Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. Electronic address: [email protected].; Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, South Small Street 16#, Dongzhimen Inside, Dongcheng District, Beijing, China; Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, South Small Street 16#, Dongzhimen Inside, Dongcheng District, Beijing, China. Electronic address: [email protected].; Department of Respiration, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China; Department of Respiration, Jiangsu Branch of China Academy of Chinese Medical Sciences, Jiangsu, China.; Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong. Electronic address: [email protected].; Department of Cardiovascular Care Unit, Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. Electronic address: [email protected].

DOI: 10.1016/j.phrs.2020.105056