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      Analysis on the medication rule of traditional Chinese medicine in the treatment of COVID-19 patients

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          Abstract

          Objective:

          To describe patterns of utilization of traditional Chinese medicine (TCM) in the treatment of patients with coronavirus disease 2019 (COVID-19).

          Methods:

          Adult patients with COVID-19 who received TCM treatment were divided into a non-serious group (mild and moderate types) and a serious group (severe and critical types) according to their admission conditions. The medical records and prescriptions of these patients were investigated to determine their TCM utilization patterns.

          Results:

          In all, 3,872 COVID-19 patients were included. Oral Chinese traditional patent medicine (CPM) was the most commonly used type of TCM, followed by decoction. The proportion of multi-drug combinations was higher than single drug use (55.0% vs. 45.0%). Decoction combined with oral CPM was the most common combination (39.1%, 1,514/3,872). Orally administered, injected, and externally applied CPM were significantly more common in the serious group than in the non-serious, while decoction and non-drug TCM treatments were more common in the non-serious than in the serious group. Multi-drug combinations were used for the majority of patients in both groups, mainly in the form of decoctions combined with oral CPM. Among the serious patients, injected CPM was more often used in patients who died during treatment (35.0%, 36/103). The two most common medication patterns were decoction combined with oral CPM and oral CPM alone in the two finally discharged groups. Oral CPM alone or used in combination with injected CPM were seen most commonly in the death group. Significant differences were established in TCM utilization and medication patterns among patients in three groups who had different prognoses and outcomes.

          Conclusions:

          The treatment measures and medication patterns of TCM commonly used in COVID-19 patients with the range of conditions found in this study should be further explored in the future to provide a more complete reference for COVID-19 treatment.

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          Most cited references39

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          Lianhuaqingwen exerts anti-viral and anti-inflammatory activity against novel coronavirus (SARS-CoV-2)

          Li Runfeng, Hou Yunlong, Huang Jicheng … (2020)
          Purpose Lianhuaqingwen (LH) as traditional Chinese medicine (TCM) formula has been used to treat influenza and exerted broad-spectrum antiviral effects on a series of influenza viruses and immune regulatory effects [1]. The goal of this study is to demonstrate the antiviral activity of LH against the novel SARS-CoV-2 virus and its potential effect in regulating host immune response. Methods The antiviral activity of LH against SARS-CoV-2 was assessed in Vero E6 cells using CPE and plaque reduction assay. The effect of LH on virion morphology was visualized under transmission electron microscope. Pro-inflammatory cytokine expression levels upon SARS-CoV-2 infection in Huh-7 cells were measured by real-time quantitative PCR assays. Results LH significantly inhibited SARS-CoV-2 replication in Vero E6 cells and markedly reduced pro-inflammatory cytokines (TNF-α, IL-6, CCL-2/MCP-1 and CXCL-10/IP-10) production at the mRNA levels. Furthermore, LH treatment resulted in abnormal particle morphology of virion in cells. Conclusions LH significantly inhibits the SARS-COV-2 replication, affects virus morphology and exerts anti-inflammatory activity in vitro. These findings indicate that LH protects against the virus attack, making its use a novel strategy for controlling the COVID-19 disease.
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            Can Chinese Medicine Be Used for Prevention of Corona Virus Disease 2019 (COVID-19)? A Review of Historical Classics, Research Evidence and Current Prevention Programs

            Hui Luo, Qiao-ling Tang, Ya-xi Shang … (2020)
            Objective Since December 2019, an outbreak of corona virus disease 2019 (COVID-19) occurred in Wuhan, and rapidly spread to almost all parts of China. This was followed by prevention programs recommending Chinese medicine (CM) for the prevention. In order to provide evidence for CM recommendations, we reviewed ancient classics and human studies. Methods Historical records on prevention and treatment of infections in CM classics, clinical evidence of CM on the prevention of severe acute respiratory syndrome (SARS) and H1N1 influenza, and CM prevention programs issued by health authorities in China since the COVID-19 outbreak were retrieved from different databases and websites till 12 February, 2020. Research evidence included data from clinical trials, cohort or other population studies using CM for preventing contagious respiratory virus diseases. Results The use of CM to prevent epidemics of infectious diseases was traced back to ancient Chinese practice cited in Huangdi’s Internal Classic (Huang Di Nei Jing) where preventive effects were recorded. There were 3 studies using CM for prevention of SARS and 4 studies for H1N1 influenza. None of the participants who took CM contracted SARS in the 3 studies. The infection rate of H1N1 influenza in the CM group was significantly lower than the non-CM group (relative risk 0.36, 95% confidence interval 0.24–0.52; n=4). For prevention of COVID-19, 23 provinces in China issued CM programs. The main principles of CM use were to tonify qi to protect from external pathogens, disperse wind and discharge heat, and resolve dampness. The most frequently used herbs included Radix astragali (Huangqi), Radix glycyrrhizae (Gancao), Radix saposhnikoviae (Fangfeng), Rhizoma Atractylodis Macrocephalae (Baizhu), Lonicerae Japonicae Flos (Jinyinhua), and Fructus forsythia (Lianqiao). Conclusions Based on historical records and human evidence of SARS and H1N1 influenza prevention, Chinese herbal formula could be an alternative approach for prevention of COVID-19 in high-risk population. Prospective, rigorous population studies are warranted to confirm the potential preventive effect of CM. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s11655-020-3192-6.
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              Efficacy and Safety of Lianhuaqingwen Capsules, a repurposed Chinese Herb, in Patients with Coronavirus disease 2019: A multicenter, prospective, randomized controlled trial

              Ke Hu, Wei-jie Guan, Ying Bi … (2020)
              Background Coronavirus disease 2019 (Covid-19) has resulted in a global outbreak. Few existing targeted medications are available. Lianhuaqingwen (LH) capsule, a repurposed marketed Chinese herb product, has been proven effective for influenza. Purpose To determine the safety and efficacy of LH capsule in patients with Covid-19. Methods We did a prospective multicenter open-label randomized controlled trial on LH capsule in confirmed cases with Covid-19. Patients were randomized to receive usual treatment alone or in combination with LH capsules (4 capsules, thrice daily) for 14 days. The primary endpoint was the rate of symptom (fever, fatigue, coughing) recovery. Results We included 284 patients (142 each in treatment and control group) in the full-analysis set. The recovery rate was significantly higher in treatment group as compared with control group (91.5% vs. 82.4%, P=0.022). The median time to symptom recovery was markedly shorter in treatment group (median: 7 vs. 10 days, P 0.05). No serious adverse events were reported. Conclusion In light of the safety and effectiveness profiles, LH capsules could be considered to ameliorate clinical symptoms of Covid-19.
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                Author and article information

                Journal
                Journal ID (publisher-id): HM9
                Title: Acupuncture and Herbal Medicine
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 2097-0226
                ISSN (Electronic): 2765-8619
                Publication date (Print): June 2022
                Publication date (Electronic): 17 June 2022
                Publication date PMC-release: 17 June 2022
                Volume: 2
                Issue: 2
                Pages: 91-98
                Affiliations
                [1 ]School of Public Health, Peking University, Beijing, China
                [2 ]Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
                [3 ]Department of Pharmacy, Zhongnan Hospital, Wuhan University, Wuhan, China
                [4 ]Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
                [5 ]Shijiazhuang People's Hospital, Shijiazhuang, China
                [6 ]National Center for ADR Monitoring, Beijing, China
                [7 ]NMPA Key Laboratory for Research and Evaluation of Pharmacovigilance, Beijing, China.
                Author notes
                [∗ ]Corresponding author. Feng Sun, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China, E-mail: sunfeng@ 123456bjmu.edu.cn , Haibo Song, National Center for ADR Monitoring, China, No. 128, Jianguo Road, Chaoyang District, Beijing, 100022, China, E-mail: jinanshb@ 123456126.com , Hong Cheng, Department of Pharmacy, Zhongnan Hospital, Wuhan University, Wuhan 430071, China, E-mail: chenghong@ 123456znhospital.cn .

                How to cite this article: Tan XY, Yang QQ, Cai XM, Tao YM, Gao SY, He LX, Zhao YB, Zhan SY, Cheng H, Song HB, Sun F. Analysis on the medication rule of traditional Chinese medicine in the treatment of COVID-19 patients. Acupunct Herb Med. 2022;2(2):91–98. doi: 10.1097/HM9.0000000000000030

                Xiaoyu Tan and Qingqing Yang contributed equally to this work.

                Article
                Publisher ID: AHM-21-064 Accession ID: 00004
                DOI: 10.1097/HM9.0000000000000030
                PMC ID: 9407178
                PubMed ID: 37808251
                SO-VID: 4ef28412-9096-417a-a861-fa6eef6b6c1f
                Copyright © Copyright © 2022 Tianjin University of Traditional Chinese Medicine.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 8 December 2021
                Date accepted : 19 April 2022
                Categories
                Subject: Original Articles
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: covid-19,descriptive analysis,drug utilization,medication pattern,traditional chinese medicine (tcm)
                Data availability:
                Keywords: covid-19, descriptive analysis, drug utilization, medication pattern, traditional chinese medicine (tcm)

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