Review
Chinese herbal medicine: Fighting SARS-CoV-2 infection on all fronts

https://doi.org/10.1016/j.jep.2021.113869Get rights and content

Abstract

Ethnopharmacological relevance

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (COVID-19), a highly pathogenic virus that has spread rapidly across the entire world. There is a critical need to develop safe and effective drugs, especially broad-spectrum antiviral and organ protection agents in order to treat and prevent this dangerous disease. It is possible that Chinese herbal medicine may play an essential role in the treatment of patients with SARS-CoV-2 infection.

Aim of the review: We aim to review the use of Chinese herbal medicine in the treatment of COVID-19 both in vitro and in clinical practice. Our goal was to provide a better understanding of the potential therapeutic effects of Chinese herbal medicine and to establish a “Chinese protocol” for the treatment of COVID-19.

Materials and methods

We systematically reviewed published research relating to traditional Chinese herbal medicines and the treatment of SARS-CoV-2 from inception to the 6th January 2021 by screening a range of digital databases (Web of Science, bioRxiv, medRxiv, China National Knowledge Infrastructure, X-MOL, Wanfang Data, Google Scholar, PubMed, Elsevier, and other resources) and public platforms relating to the management of clinical trials. We included the active ingredients of Chinese herbal medicines, monomer preparations, crude extracts, and formulas for the treatment of COVID-19.

Results

In mainland China, a range of Chinese herbal medicines have been recognized as very promising anti-SARS-CoV-2 agents, including active ingredients (quercetagetin, osajin, tetrandrine, proscillaridin A, and dihydromyricetin), monomer preparations (xiyanping injection, matrine-sodium chloride injection, diammonium glycyrrhizinate enteric-coated capsules, and sodium aescinate injection), crude extracts (Scutellariae Radix extract and garlic essential oil), and formulas (Qingfei Paidu decoction, Lianhuaqingwen capsules, and Pudilan Xiaoyan oral liquid). All these agents have potential activity against SARS-CoV-2 and have attracted significant attention due to their activities both in vitro and in clinical practice.

Conclusions

As a key component of the COVID-19 treatment regimen, Chinese herbal medicines have played an irreplaceable role in the treatment of SARS-CoV-2 infection. The “Chinese protocol” has already demonstrated clear clinical importance. The use of Chinese herbal medicines that are capable of inhibiting SARS-Cov-2 infection may help to address this immediate unmet clinical need and may be attractive to other countries that are also seeking new options for effective COVID-19 treatment. Our analyses suggest that countries outside of China should also consider protocols involving Chinese herbal medicines combat this fast-spreading viral infection.

Keywords

SARS-Cov-2
Chinese herbal medicine
Active ingredients
Broad-spectrum antiviral
Organ protection

Abbreviations

ACE2
angiotensin-converting enzyme 2
andro
andrographolide
CHIKV
Chikungunya virus
3CLpro
3C-Like protease
COVID-19
coronavirus disease 2019
EBOV
Ebola virus
EC50
half maximal effective concentration
FCV
feline calicivirus
GA
glycyrrhizic acid
HBV
Hepatitis B virus
HCV
hepatitis C virus
HIV
human immunodeficiency virus
GRP78
glucose regulating protein 78
H1N1
influenza A
HSV-1
herpes simplex virus type 1
IC50
half maximal inhibitory concentration
IL-10
interleukin-10
JHQG
Jinhua Qinggan granules
LHQW
Lianhuaqingwen capsules
MERS
Middle East respiratory syndrome coronavirus
MLAV
Mengla virus
Mpro
main protease
NHC PRC
National Health Commission of the People's Republic of China
nsp
nonstructural protein
PDL
Pudilan Xiaoyan oral liquid
PHEIC
public health emergency of international concern
PLpro
papain-like protease
RdRp
RNA-dependent RNA polymerase
SARS-CoV
severe acute respiratory syndrome coronavirus
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
SI
selectivity index
TMPRSS2
transmembrane protease serine 2
TNF-α
tumor necrosis factor-α
WHO
World Health Organization
XYP
Xiyanping injection

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