Prevention and treatment of COVID-19 using Traditional Chinese Medicine: A review

Pharmacokinetic analysis of antiviral drug ritonavir across the blood-brain barrier and its interaction with Scutellaria baicalensis using multisite microdialysis in rats

Ritonavir, an excellent inhibitor of CYP3A4, has recently been combined with nirmatrelvir to form Paxlovid for the treatment of severe acute respiratory syndrome coronavirus 2 infections. The root of Scutellaria baicalensis Georgi (S. baicalensis), a traditional Chinese medicinal (TCM) herb commonly used to treat heat/inflammation in the lung and digestive tracts, which are major organs targeted by viral infections, contains flavones that can influence the CYP3A metabolism pathway. To investigate the ability of ritonavir to cross the bloodbrain barrier (BBB) and its potential herb-drug interactions with an equivalent TCM clinical dose of S. baicalensis, multisite microdialysis coupled with an LCMS/MS system was developed using rat model. Pretreatment with S. baicalensis extract for 5 days, which contains less flavones than those used in previous studies, had a significant influence on ritonavir, resulting in a 2-fold increase in the total concentration of flavones in the blood and brain. Treatment also boosted the maximum blood concentration of flavones by 1.5-fold and the maximum brain concentration of flavones by 2-fold, all the while exerting no noticeable influence on the transfer ratio across the bloodbrain barrier. These experimental results demonstrated that the use of a typical traditional Chinese medicinal dose of S. baicalensis is sufficient to influence the metabolic pathway and synergistically increase the concentration of ritonavir in rats.

Effects of geographical, soil and climatic factors on the two marker secondary metabolites contents in the roots of Rubia cordifolia L

The growth and quality of medicinal plants depend heavily on environmental variables. The quality of Rubia cordifolia, an important medicinal plant, is determined by the two main secondary metabolites of the root, purpurin and mollugin. However, their relationship with environmental factors has not been studied. In this study, the purpurin and mollugin contents of R. cordifolia roots from different sampling sites in China were measured using ultra-high-performance liquid chromatography, and the correlations between the two secondary metabolites and environmental variables were analyzed. The results showed that there were significant differences in the contents of purpurin and mollugin in the roots of R. cordifolia at different sampling points. The content of purpurin ranged from 0.00 to 3.03 mg g-1, while the content of mollugin ranged from 0.03 to 10.09 mg g-1. The quality of R. cordifolia in Shanxi, Shaanxi and Henan border areas and southeastern Liaoning was higher. Liaoning is expected to become a R. cordifolia planting area in Northeast China. Correlation and regression analysis revealed that the two secondary metabolites were affected by different environmental factors, the two secondary metabolites contents were positively correlated with longitude and latitude, and negatively correlated with soil nutrients. In addition, higher temperature and shorter sunshine duration facilitated the synthesis of purpurin. Annual precipitation might be the main factor limiting the quality of R. cordifolia because it had opposite effects on the synthesis of two major secondary metabolites. Therefore, this study is of great significance for the selection of R. cordifolia planting areas and the improvement of field planting quality.

Characteristics analysis of Internet pharmacy consultation services for children in southwest China during the post-epidemic era: A cross-sectional study

AIM

This study aims to examine the features of online pediatric pharmacy consultations in Southwest China, an area with limited medical resources during the post-epidemic era and to explore the factors affecting the dialogue volume in online consultations.

METHODS

A cross-sectional study was conducted in southwest China from April 2022 to March 2023. The study encompassed a cohort of 2,526 children, ranging from 0 to 18 years old. The collected data encompassed patient gender, age, weight, department, drugs involved in consultation services, types of questions consulted, consultation start time, and the dialogue volume in online consultations. Descriptive statistics and an ordered multicategorical logistic regression analysis were performed. SPSS 26.0 software was used for data analysis.

RESULTS

Among the total Internet pharmacy consultation services offered, the infant group constituted the largest portion (n = 1021). Children with internal medicine concerns have greater online consultation needs (n = 455). The peak usage of Internet pharmacy consultation occurred in the fall at 11:00 a.m. (n = 73). Factors influencing the dialogue volume in online consultations include the non-availability of Chinese medications [P = 0.033, OR = 0.81, 95 % CI (0.67-0.98)], consultation initiation during the spring [P = 0.002, OR = 1.52, 95 % CI(1.17-1.97)] or afternoon [P = 0.012, OR = 1.36, 95 % CI (1.07-1.72)] and weight＜15 kg group [P = 0.038, OR = 2.19, 95 % CI (1.04-4.58)].

CONCLUSION

Our findings provide important information for peers to carry out their work. In the post-epidemic era, emphasis should be placed on addressing concerns related to children's internal medicine and otolaryngology. Optimizing healthcare resource allocation should take into account the time-seasonal variability of children's consultation behaviors. Furthermore, it is recommended to focus on weight＜15 kg children in inquiries, absorb sufficient knowledge about Chinese medicines, and schedule more pharmacists to participate in consultation services during the spring or in every afternoon. These findings help the authorities of online platforms and the National Health Commission to rationalize the allocation of healthcare resources, optimize the quality of service delivery, and develop new policies.

Effect of Chinese Medicine in Patients with COVID-19: A Multi-center Retrospective Cohort Study

OBJECTIVE

To evaluate the effectiveness and safety of Chinese medicine (CM) in the treatment of coronavirus disease 2019 (COVID-19) in China.

METHODS

A multi-center retrospective cohort study was carried out, with cumulative CM treatment period of ⩾3 days during hospitalization as exposure. Data came from consecutive inpatients from December 19, 2019 to May 16, 2020 in 4 medical centers in Wuhan, China. After data extraction, verification and cleaning, confounding factors were adjusted by inverse probability of treatment weighting (IPTW), and the Cox proportional hazards regression model was used for statistical analysis.

RESULTS

A total of 2,272 COVID-19 patients were included. There were 1,684 patients in the CM group and 588 patients in the control group. Compared with the control group, the hazard ratio (HR) for the deterioration rate in the CM group was 0.52 [95% confidence interval (CI): 0.41 to 0.64, P<0.001]. The results were consistent across patients of varying severity at admission, and the robustness of the results were confirmed by 3 sensitivity analyses. In addition, the HR for all-cause mortality in the CM group was 0.29 (95% CI: 0.19 to 0.44, P<0.001). Regarding of safety, the proportion of patients with abnormal liver function or renal function in the CM group was smaller.

CONCLUSION

This real-world study indicates that the combination of a full-course CM therapy on the basic conventional treatment, may safely reduce the deterioration rate and all-cause mortality of COVID-19 patients. This result can provide the new evidence to support the current treatment of COVID-19. Additional prospective clinical trial is needed to evaluate the efficacy and safety of specific CM interventions. (Registration No. ChiCTR2200062917).

A new method to comprehensively evaluate the quality of Tianma Toutong tablets by multiple fingerprints combined with quantitative analysis and prescription analysis

Tianma Toutong Tablets (TMTTTs) are composed of six traditional Chinese medicines (TCMs), and there is currently no comprehensive method to evaluate the quality of TMTTT. To ensure its quality, it is necessary to propose methods for evaluation and control. To address the issue, we established an HPLC and electrochemical fingerprint of TMTTT and quantify eight components-Gastrodin, p-hydroxybenzyl alcohol, chlorogenic acid, parishin A, ferulic acid, hesperidin, imperatorin, and isoimperatorin. We used the Sub-quantified profiling method (SQPM) to calculate the actual contribution value of each individual herb and evaluated and predicted the quality of the compound medication. In addition, electrochemical fingerprinting (ECFP) was established using a Belousov-Zhabotinsky (B-Z) oscillation system in which six characteristic electrochemical parameters were recorded to compare the differences between batches. Finally, a compound synthesizing fingerprint (CSF) of TMTTT was developed by fitting the compounds of the six herbs, the contribution of individual herbs to the prescription was evaluated. Principal component analysis (PCA) was used to downscale the data of different fingerprint profiles to assist the analysis process. The rational combination of multidimensional fingerprinting and PCA provided a comprehensive and reliable method for the evaluation of TMTTT and other TCM compound preparations, SQPM could effectively link single herbs to compound preparations, avoiding the use of non-compliant TCMs at source and improving the quality of compound preparations.

Time-/dose- series transcriptome data analysis and traditional Chinese medicine treatment of pneumoconiosis

Pneumoconiosis' pathogenesis is still unclear and specific drugs for its treatment are lacking. Analysis of series transcriptome data often uses a single comparison method, and there are few reports on using such data to predict the treatment of pneumoconiosis with traditional Chinese medicine (TCM). Here, we proposed a new method for analyzing series transcriptomic data, series difference analysis (SDA), and applied it to pneumoconiosis. By comparison with 5 gene sets including existing pneumoconiosis-related genes and gene set functional enrichment analysis, we demonstrated that the new method was not inferior to two existing traditional analysis methods. Furthermore, based on the TCM-drug target interaction network, we predicted the TCM corresponding to the common pneumoconiosis-related genes obtained by multiple methods, and combined them with the high-frequency TCM for its treatment obtained through literature mining to form a new TCM formula for it. After feeding it to pneumoconiosis modeling mice for two months, compared with the untreated group, the coat color, mental state and tissue sections of the mice in the treated group were markedly improved, indicating that the new TCM formula has a certain efficacy. Our study provides new insights into method development for series transcriptomic data analysis and treatment of pneumoconiosis.

Enhancing quality evaluation in traditional Chinese medicine: Utilizing dual wavelength fusion fingerprint, electrochemical fingerprint, and DSC fingerprint

Developing a reliable and effective quality evaluation system for traditional Chinese medicine (TCM) is both challenging and crucial for its advancement. This study employs fingerprinting techniques to establish precise and comprehensive quality control for TCM, taking Xuezhikang capsules as an example and aiming to facilitate the internationalization of TCM. The "double wavelength absorption coefficient ratio fingerprint" and "Reliability theory" are developed to determine the fingerprint peak purity and fingerprint reliability respectively. Subsequently, the dual-wavelength fusion fingerprint was obtained to avoid the limitations of a single wavelength. In addition, an electrochemical fingerprint (ECFP) was obtained to assess the similarity of electroactive components in the sample, and the Differential Scanning Calorimetry quantized fingerprint (DSC QFP) was introduced for thermal analysis. Fingerprint-efficacy correlations between PL-EC* and dual-wavelength fusion fingerprint (DWFFP) provided valuable insights that there are 76.6 % of the fingerprint compounds exhibited electroactivity. Finally, samples were classified into grades 1∼3 by combining DWFFP, ECFP and DSC QFP through the mean method, meeting the evaluation standard (SL-M > 0.9, PL-M between 80 % and 120 %). This study provides valuable information for ensuring the quality of TCM products, which represents a significant step forward in enhancing the reliability and authenticity of TCM products.

Advances in the application of traditional Chinese medicine during the COVID-19 recovery period: A review

Since the emergence of the Coronavirus Disease 2019 (COVID-19) outbreak, significant advancements has been made in research, from limited knowledge about the disease to the development of a vaccine. Although the severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) appears to be decreasing and the threat of COVID-19 is waning, there have been widespread concerns about persistent symptoms or sequelae experienced by some patients even after recovering from COVID-19. Traditional Chinese medicine (TCM) has shown favorable treatment outcomes during the onset of COVID-19, and extensive studies have been carried out to explore the efficacy of TCM interventions during the COVID-19 recovery period. The purpose of this review is to comprehensively analyze these studies and provide new insights for the prevention and treatment of the post-COVID-19 condition.

Bibliometric analysis and key messages of integrating Chinese and Western Medicine for COVID-19

Background

The coronavirus disease 2019 (COVID-19) has been a global pandemic since it broke out, and integrated Chinese and Western medicine (ICWM) has played an important role in the prevention and treatment of COVID-19. We aimed to analyze the published literature on ICWM for COVID-19 at home and abroad, and compare their differences on hotspots and research fronts.

Methods

Publications before Oct 31, 2022 were retrieved from the Web of Science core database (WOS), PubMed, China National Knowledge Infrastructure database (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), China Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM), CiteSpace and VOSviewer to summarize the basic characteristics of publications, countries, institutions, keywords, and citations.

Results

We included 580 English papers and 1727 Chinese papers in this study. The development trends in China and other countries are relatively asynchronous and show a smooth growth trend for the future. The most productive countries were China, India, and the United States, while the most productive domestic research institution was the Beijing University of Chinese Medicine. The clustering analysis of high-frequency keywords showed that Chinese literature focused on clinical studies of ICWM for COVID-19, such as retrospective studies, clinical features, and traditional Chinese medicine syndrome analysis, while English literature focused on therapeutic mechanism studies and evidence-based medicine studies, such as systematic reviews and meta-analysis, and both of them paid attention to network pharmacological research and Qingfei Paidu Decoction. Sorting out the top 10 highly cited articles, Huang CL's article published in Lancet in 2020 was regarded as a cornerstone in the field.

Conclusion

The treatment of COVID-19 by ICWM has become a worldwide research hotspot. Although there are differences in the specific contents among countries, the development trend of research types to the mechanism of action, and the development trend of research contents to the recovery period treatment and the prevention of COVID-19 by ICWM are consistent.

Inconsistency between physicians' attitudes and behaviors toward TCM: A questionnaire survey in Chengdu

Although Western Medicine is considered as the mainstream medicine in China, Traditional Chinese Medicine (TCM) still has its own advantages and characteristics. The attitudes and behaviors to TCM are divided, some West Medicine Doctors prefer TCM during treatment, while others consider it not effective. The objective of this study is to find out the attitudes and treatment behaviors of Chengdu physicians toward TCM, and identify factors associated with their attitude and behaviors. A representative sample of 2049 Chengdu physicians were recruited online to investigate their attitudes and behaviors toward TCM. During this research, previous Integrative Medicine Attitude Questionnaire were referred and modified, and adjusted questionnaire was made based on the actual situation of TCM in Chengdu. This questionnaire contains 3 distinct parts. The first part aimed at the attitudes of respondents toward TCM, and contains 15 questions in 3 sections, Holism, Knowledge, and Evidence. The second part tried to determine the behaviors toward TCM in terms of self-use, recommendations, as well as prescriptions. In addition, 6 modalities including Chinese Patent Medicine, Chinese Herbal Medicine, Acupuncture, Massage & Bone Setting, Qigong, and TCM diet were introduced in the behavioral part. In the third part, we aimed to collect personal, professional, and structural factors that may significantly influence TCM attitudes and behaviors. Physicians hold positive attitudes toward TCM in general, all the mean/highest possible subscales scores value of Holism (90.53%), Knowledge (63.77%), and Evidence (62.73%) domain were over 60%. On the other hand, physicians were more positive on self-use (49.40%) and recommendation (55.98%) of TCM than giving TCM prescriptions (36.60%) to patients. The attitudes and behaviors toward may not be consistent, which means physicians may not give prescriptions to patients even they have good attitudes to TCM. Education and self-use of TCM are important positive factors that influence the behaviors of physicians.

Inhibitory Efficacy of Main Components of Scutellaria baicalensis on the Interaction between Spike Protein of SARS-CoV-2 and Human Angiotensin-Converting Enzyme II

Blocking the interaction between the SARS-CoV-2 spike protein and the human angiotensin-converting enzyme II (hACE2) protein serves as a therapeutic strategy for treating COVID-19. Traditional Chinese medicine (TCM) treatments containing bioactive products could alleviate the symptoms of severe COVID-19. However, the emergence of SARS-CoV-2 variants has complicated the process of developing broad-spectrum drugs. As such, the aim of this study was to explore the efficacy of TCM treatments against SARS-CoV-2 variants through targeting the interaction of the viral spike protein with the hACE2 receptor. Antiviral activity was systematically evaluated using a pseudovirus system. Scutellaria baicalensis (S. baicalensis) was found to be effective against SARS-CoV-2 infection, as it mediated the interaction between the viral spike protein and the hACE2 protein. Moreover, the active molecules of S. baicalensis were identified and analyzed. Baicalein and baicalin, a flavone and a flavone glycoside found in S. baicalensis, respectively, exhibited strong inhibitory activities targeting the viral spike protein and the hACE2 protein, respectively. Under optimized conditions, virus infection was inhibited by 98% via baicalein-treated pseudovirus and baicalin-treated hACE2. In summary, we identified the potential SARS-CoV-2 inhibitors from S. baicalensis that mediate the interaction between the Omicron spike protein and the hACE2 receptor. Future studies on the therapeutic application of baicalein and baicalin against SARS-CoV-2 variants are needed.

Bioactive Components of Areca Nut: An Overview of Their Positive Impacts Targeting Different Organs

Areca catechu L. is a widely cultivated tropical crop in Southeast Asia, and its fruit, areca nut, has been consumed as a traditional Chinese medicinal material for more than 10,000 years, although it has recently attracted widespread attention due to potential hazards. Areca nut holds a significant position in traditional medicine in many areas and ranks first among the four southern medicines in China. Numerous bioactive compounds have been identified in areca nuts, including alkaloids, polyphenols, polysaccharides, and fatty acids, which exhibit diverse bioactive functions, such as anti-bacterial, deworming, anti-viral, anti-oxidant, anti-inflammatory, and anti-tumor effects. Furthermore, they also display beneficial impacts targeting the nervous, digestive, and endocrine systems. This review summarizes the pharmacological functions and underlying mechanisms of the bioactive ingredients in areca nut. This helps to ascertain the beneficial components of areca nut, discover its medicinal potential, and guide the utilization of the areca nut.

Nigella sativa and its chemical constituents: pre-clinical and clinical evidence for their potential anti-SARS-CoV-2 effects

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused over 500 million reported cases of COVID-19 worldwide with relatively high morbidity and mortality. Although global vaccination drive has helped control the pandemic, the newer variant of the virus still holds the world in ransom. Several medicinal herbs with antiviral properties have been reported, and one such promising herb is Nigella sativa (NS). Recent molecular docking, pre-clinical, and clinical studies have shown that NS extracts may have the potential to prevent the entry of coronaviruses into the host cell as well as to treat and manage COVID-19 symptoms. Several active compounds from NS, such as nigelledine, α-hederin, dithymoquinone (DTQ), and thymoquinone (TQ), have been proposed as excellent ligands to target angiotensin-converting enzyme 2 (ACE2 receptors) and other targets on host cells as well as the spike protein (S protein) on SARS-CoV-2. By binding to these target proteins, these ligands could potentially prevent the binding between ACE2 and S protein. Though several articles have been published on the promising therapeutic role of NS and its constituents against SARS-CoV-2 infection, in this review, we consolidate the published information on NS and SARS-CoV-2, focusing on pre-clinical in silico studies as well as clinical trials reported between 2012 and 2023.

Comparison of different extraction methods of active ingredients of Chinese medicine and natural products

Like other traditional medicine in the world, Chinese traditional medicine (CTM) has a long history, which is a treasure of the combination of medicine and Chinese classical culture even more than 5000 years. For thousands of years, CTM has made great contributions to the reproduction and health of the Chinese people. It was an efficient therapeutic tool under the guidance of Chinese traditional medical theory, its source is generally natural products, but there are also a small number of it are natural products after some processing methods. In fact, the definition of Chinese medicine (CM) includes both traditional and new CM developed by modern technology. It is well known that the chemical composition of most CM and natural products is very complex, for example, a single herb may contain hundreds of different chemicals, including active ingredients, side effects, and even toxic ingredients. Therefore, the extraction process is particularly crucial for the quality and clinical efficacy of CM and natural products. In this work, a new classification method was proposed to divide the extraction technologies of CM and natural products into 21 kinds in recent years and analyze their status, advantages, and disadvantages. Then put forward a new technical route based on ultra-high-pressure extraction technology for rapid extraction else while removing harmful impurities and making higher utilization of CM and natural products. It is a useful exploration for the extraction industry of medicinal materials and natural products in the world.

An online questionnaire survey on the sexual function of Chinese male adults in the COVID-19 pandemic with loosened controls

The coronavirus disease 2019 (COVID-19) may have a negative impact on the sexual health of male adults. An online questionnaire survey was conducted among male adults from February 04, 2023 to March 15, 2023 to analyze the impact of COVID-19 on the sexual health of male adults in China. Participants provided about their medical, social, lifestyle, and family situations information through questionnaires including the Brief Sexual Function Inventory (BSFI). Sexual function problems were defined based on predetermined cutoff values of the BSFI domain scores. A total of 1,250 male adults were included with median age as 32 years. According to the analysis of statistical results, sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 14.8 % and 11.1 % of COVID-19 survivors, respectively. Compared with uninfected persons, COVID-19 survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erectile. In multivariate models of COVID-19 survivors, age ≥30 years, rural resident, lower education level, manual worker, lower income, and shorter duration from recovery to survey date were significantly associated with poorer overall sexual function. In this study, COVID-19 survivors was reported to have significantly poorer sexual function than uninfected persons. The COVID-19 may have had a significant impact on the sexual health of Chinese male adults. We need to focus on sexual dysfunction in COVID-19 survivors, and proactively provide effective interventions.

Phenome-wide association study and precision medicine of cardiovascular diseases in the post-COVID-19 era

SARS-CoV-2 infection causes injuries of not only the lungs but also the heart and endothelial cells in vasculature of multiple organs, and induces systemic inflammation and immune over-reactions, which makes COVID-19 a disease phenome that simultaneously affects multiple systems. Cardiovascular diseases (CVD) are intrinsic risk and causative factors for severe COVID-19 comorbidities and death. The wide-spread infection and reinfection of SARS-CoV-2 variants and the long-COVID may become a new common threat to human health and propose unprecedented impact on the risk factors, pathophysiology, and pharmacology of many diseases including CVD for a long time. COVID-19 has highlighted the urgent demand for precision medicine which needs new knowledge network to innovate disease taxonomy for more precise diagnosis, therapy, and prevention of disease. A deeper understanding of CVD in the setting of COVID-19 phenome requires a paradigm shift from the current phenotypic study that focuses on the virus or individual symptoms to phenomics of COVID-19 that addresses the inter-connectedness of clinical phenotypes, i.e., clinical phenome. Here, we summarize the CVD manifestations in the full clinical spectrum of COVID-19, and the phenome-wide association study of CVD interrelated to COVID-19. We discuss the underlying biology for CVD in the COVID-19 phenome and the concept of precision medicine with new phenomic taxonomy that addresses the overall pathophysiological responses of the body to the SARS-CoV-2 infection. We also briefly discuss the unique taxonomy of disease as Zheng-hou patterns in traditional Chinese medicine, and their potential implications in precision medicine of CVD in the post-COVID-19 era.

Danggui Shaoyao San ameliorates the lipid metabolism via the PPAR signaling pathway in a Danio rerio (zebrafish) model of hyperlipidemia

The escalating prevalence of hyperlipidemia has a profound impact on individuals' daily physiological well-being. The traditional Chinese medicine (TCM) prescription Danggui Shaoyao San (DSS) has demonstrated significant clinical efficacy and promising prospects for clinical application. Leveraging network pharmacology and bioinformatics, we hypothesize that DSS can ameliorate lipid metabolic disorders in hyperlipidemia by modulating the PPAR signaling pathway. In this study, we employed a zebrafish model to investigate the impact of DSS on lipid metabolism in hyperlipidemia. Body weight alterations were monitored by pre- and postmodeling weight measurements. Behavioral assessments and quantification of liver biochemical markers were conducted using relevant assay kits. Pathways associated with lipid metabolism were identified through network pharmacology and GEO analysis, while PCR was utilized to assess genes linked to lipid metabolism. Western blotting was employed to analyze protein expression levels, and liver tissue underwent Oil Red O and immunofluorescence staining to evaluate liver lipid deposition. Our findings demonstrate that DSS effectively impedes weight gain and reduces liver lipid accumulation in zebrafish models with elevated lipid levels. The therapeutic effects of DSS on lipid metabolism are mediated through its modulation of the PPAR signaling pathway, resulting in a significant reduction in lipid accumulation within the body and alleviation of certain hyperlipidemia-associated symptoms.

The role and mechanism of TCM in the prevention and treatment of infectious diseases

The constant presence of infectious diseases poses an everlasting threat to the entire world. In recent years, there has been an increased attention toward the application of traditional Chinese medicine (TCM) in the treatment of emerging infectious diseases, as it has played a significant role. The aim of this article is to provide a concise overview of the roles and mechanisms of TCM in treating infectious diseases. TCM possesses the ability to modulate relevant factors, impede signaling pathways, and inhibit microbial growth, thereby exhibiting potent antiviral, antibacterial, and anti-inflammatory effects that demonstrate remarkable efficacy against viral and bacterial infections. This article concludes that the comprehensive regulatory features of Chinese herbal medicines, with their various components, targets, and pathways, result in synergistic effects. The significance of Chinese herbal medicines in the context of infectious diseases should not be underestimated; however, it is crucial to also acknowledge their underutilization. This paper presents constructive suggestions regarding the challenges and opportunities faced by Chinese medicines. Particularly, it emphasizes the effectiveness and characteristics of Chinese medicines in the treatment of infectious diseases, specifying how these medicines' active substances can be utilized to target infectious diseases. This perspective is advantageous in facilitating researchers' pharmacological studies on Chinese medicines, focusing on the specific points of action. The mechanism of action of Chinese herbal medicines in the treatment of infectious diseases is comprehensively elucidated in this paper, providing compelling evidence for the superior treatment of infectious diseases through Chinese medicine. This information is favorable for advancing the development of TCM and its potential applications in the field of infectious diseases.

An updated meta-analysis of Chinese herbal medicine for the prevention of COVID-19 based on Western-Eastern medicine

Background and aims: Chinese herbal medicine (CHM) was used to prevent and treat coronavirus disease 2019 (COVID-19) in clinical practices. Many studies have demonstrated that the combination of CHM and Western medicine can be more effective in treating COVID-19 compared to Western medicine alone. However, evidence-based studies on the prevention in undiagnosed or suspected cases remain scarce. This systematic review and meta-analysis aimed to investigate the effectiveness of CHM in preventing recurrent, new, or suspected COVID-19 diseases. Methods: We conducted a comprehensive search using ten databases including articles published between December 2019 and September 2023. This search aimed to identify studies investigating the use of CHM to prevent COVID-19. Heterogeneity was assessed by a random-effects model. The relative risk (RR) and mean differences were calculated using 95% confidence intervals (CI). The modified Jadad Scale and the Newcastle-Ottawa Scale (NOS) were employed to evaluate the quality of randomized controlled trials and cohort studies, respectively. Results: Seventeen studies with a total of 47,351 patients were included. Results revealed that CHM significantly reduced the incidence of COVID-19 (RR = 0.24, 95% CI = 0.11-0.53, p = 0.0004), influenza (RR = 0.37, 95% CI = 0.18-0.76, p = 0.007), and severe pneumonia exacerbation rate (RR = 0.17, 95% CI = 0.05-0.64, p = 0.009) compared to non-treatment or conventional control group. Evidence evaluation indicated moderate quality evidence for COVID-19 incidence and serum complement components C3 and C4 in randomized controlled trials. For the incidence of influenza and severe pneumonia in RCTs as well as the ratio of CD4+/CD8+ lymphocytes, the evidence quality was low. The remaining outcomes including the disappearance rate of symptoms and adverse reactions were deemed to be of very low quality. Conclusion: CHM presents a promising therapeutic option for the prevention of COVID-19. However, additional high-quality clinical trials are needed to further strengthen evidential integrity.

Baicalin inhibits the replication of the hepatitis B virus by targeting TRIM25

Objective

Baicalin, which is a key bioactive constituent obtained from Scutellaria baicalensis, has been utilized in traditional Chinese medicine for many centuries. Although it has been reported that Baicalin (BA) can inhibit the replication of the Hepatitis B virus (HBV), the exact mechanism behind this process remains unclear. Interferon-stimulated genes (ISGs) are crucial in the process of antiviral defense. We aim to investigate whether BA can regulate the expression of ISGs, and thereby potentially modulate the replication of HBV.

Methods

The study involved the use of CRISPR/Cas9 technology to perform knockout experiments on TRIM25 and IFIT3 genes. The expression of these genes was confirmed through techniques such as immunoblotting or Q-PCR. The levels of HBsAg and HBeAg were measured using ELISA, and the expression of interferon-stimulated genes was detected using a luciferase assay.

Results

It is interesting to note that several ISGs belonging to the TRIM family, including TRIM5, TRIM25, and TRIM14, were induced after BA treatment. On the other hand, members of the IFIT family were reduced by BA stimulation. Additionally, BA-mediated HBV inhibition was found to be significantly restored in HepG2 cells where TRIM25 was knocked out. Additional research into the mechanism of action of BA found that prolonged treatment with BA activated the JAK/STAT signaling pathway while simultaneously inhibiting the NF-kB pathway.

Conclusion

The findings of our study indicate that TRIM25 has a significant impact on the regulation of HBV replication following BA treatment, providing additional insight into the mechanisms by which BA exerts its antiviral effects.

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

Purpose

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

Methods

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

Results

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

Conclusion

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

Jingfang Granule alleviates bleomycin-induced acute lung injury via CD200-CD200R immunoregulatory pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Jingfang granules (JF), one famous traditional Chinese formula in "She Sheng Zhong Miao Fang" written by Shi-Che Zhang during the Ming Dynasty era, has been widely used to prevent epidemic diseases in history and now was recommended for the treatment of coronavirus disease 2019 (COVID-19) in China. However, the roles of JF against acute lung injury and its mechanisms remain unclear.

AIM OF THE STUDY

Acute lung injury (ALI) and its progressive acute respiratory distress syndrome (ARDS) are a continuum of lung inflammatory disease with high morbidity and mortality in clinic, especially in COVID-19 patients. The present study aims to investigate the effect of JF on ALI and clarify its underlying mechanisms for clinical application in COVID-19 control.

METHODS

Bleomycin-induced ALI mice were given oral gavage daily for seven days with or without Jingfang granules (2, 4 g/kg). The body weight, lung wet/dry weight ratios, lung appearance and tissue histopathology were evaluated. Quantitative real-time PCR, biochemical bronchoalveolar lavage fluids analysis was used to determine the gene expression of proinflammation factor and infiltrated inflammatory cells in lung. Immunofluorescence image and western blot were used to detect the markers of alveolar macrophages (AMs), endothelial cell apoptosis and changes of CD200-CD200R pathway.

RESULTS

Firstly, histopathological analysis showed that JF significantly attenuated pulmonary injury and inflammatory response in ALI mice. Then, cytokine detection, inflammatory cells assay, and JNKs and p38 pathway analysis indicated that the recruitment and activation of alveolar macrophages was the main reason to cause ALI and JF could reverse this variation. Next, immunofluorescence staining and TUNEL assay showed that JF upregulated the expression of CD200 and suppressed the apoptosis of alveolar endothelial cells. Finally, double immunofluorescence staining of CD200 and CD11c indicated that the seriously damaged tissue had the lower CD200 while more AMs infiltration, which was confirmed by RT-PCR analysis of CD200/CD200R.

CONCLUSIONS

Jingfang granules can protect lung from acu te injury and mitigate the recruitment and overactive AMs-induced inflammation via CD200-CD200R immunoregulatory signal axis, which will provide an experimental basis for Jingfang granules clinical applications in COVID-19.

Umbelliferone and eriodictyol suppress the cellular entry of SARS-CoV-2

BACKGROUND

Artemisia argyi (A. argyi), also called Chinese mugwort, has been widely used to control pandemic diseases for thousands of years since ancient China due to its anti-microbial infection, anti-allergy, and anti-inflammation activities. Therefore, the potential of A. argyi and its constituents in reducing the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was investigated in this study.

RESULTS

Among the phytochemicals in A. argyi, eriodictyol and umbelliferone were identified to target transmembrane serine protease 2 (TMPRSS2) and angiotensin-converting enzyme 2 (ACE2) proteins, the essential factors for the cellular entry of SARS-CoV-2, in both FRET-based enzymatic assays and molecular docking analyses. These two ingredients of A. argyi suppressed the infection of ACE2-expressed HEK-293 T cells with lentiviral-based pseudo-particles (Vpp) expressing wild-type and variants of SARS-CoV-2 spike (S) protein (SARS-CoV-2 S-Vpp) via interrupting the interaction between S protein and cellular receptor ACE2 and reducing the expressions of ACE2 and TMPRSS2. Oral administration with umbelliferone efficiently prevented the SARS-CoV-2 S-Vpp-induced inflammation in the lung tissues of BALB/c mice.

CONCLUSIONS

Eriodictyol and umbelliferone, the phytochemicals of Artemisia argyi, potentially suppress the cellular entry of SARS-CoV-2 by preventing the protein binding activity of the S protein to ACE2.

Traditional Chinese medicine for the COVID-19 pandemic: An online cross-sectional survey among health care workers

Background

: During the coronavirus disease (COVID-19) pandemic, health care workers (HCWs) have faced a heightened risk of infection. Preventative measures are critical to mitigate the spread of COVID-19 and protect HCWs. Traditional Chinese medicine (TCM) has been recommended to prevent and treat COVID-19 in China. We conducted this survey to investigate the use of infection control behaviors, preventative and therapeutic interventions, and outcomes among HCWs during the surge of Omicron variant infections to explore the association of preventative measures with outcomes and to investigate the factors influencing the adoption of TCM as a preventative measure.

Methods

: The questionnaire consisted of 23 sections with 154 questions intended for HCWs. The targeted respondents comprised all HCWs from Xiamen Hospital Affiliated of Beijing University of Chinese Medicine. The recruitment process was open between March 17 and June 1, 2022. Chi-square test was used to estimate the relationship between prevention and outcomes. Multivariable logistic regression was used to investigate factors influencing the use of TCM as a preventative measure.

Results

: Among the 1122 participants who completed the questionnaire, 79.71% took preventative measures, including TCM (56.21%), physical activities (52.37%) and food supplements (26.99%). Xiamen preventative formula (a government-approved fixed prescription) (45.22%) and Lianhua Qingwen preparations (18.95%) were the most commonly used Chinese medicines. Thirty-six participants reported flu-like symptoms and three were diagnosed with COVID-19. Flu-like symptoms were not associated with prevention, vaccination, or TCM. Frontline working experience (OR = 0.61, 95% CI: 0.46-0.80), good knowledge of post-COVID-19 syndrome (OR = 0.57, 95% CI: 0.39-0.84), Western medicine qualifications (OR = 2.41, 95% CI: 1.51-3.86), nurses (OR = 1.70, 95% CI: 1.21-2.40), and medical technicians (OR = 2.27, 95% CI: 1.25-4.10) were associated with the willingness of using TCM as a preventative measure.

Conclusion

: Complementary medicine, especially TCM, could be used for COVID-19 prevention. Knowledge of COVID-19 may prompt people to use TCM to prevent COVID-19. Multicenter studies and prospective cohort follow-up studies are needed to provide further insights into the use of TCM for COVID-19 management.

Intelligent Chinese Medicine: A New Direction Approach for Integrative Medicine in Diagnosis and Treatment of Cardiovascular Diseases

High mortality rates from cardiovascular diseases (CVDs) persist worldwide. Older people are at a higher risk of developing these diseases. Given the current high treatment cost for CVDs, there is a need to prevent CVDs and or develop treatment alternatives. Western and Chinese medicines have been used to treat CVDs. However, several factors, such as inaccurate diagnoses, non-standard prescriptions, and poor adherence behavior, lower the benefits of the treatments by Chinese medicine (CM). Artificial intelligence (AI) is increasingly used in clinical diagnosis and treatment, especially in assessing efficacy of CM in clinical decision support systems, health management, new drug research and development, and drug efficacy evaluation. In this study, we explored the role of AI in CM in the diagnosis and treatment of CVDs, and discussed application of AI in assessing the effect of CM on CVDs.

Bioinformatic assay reveal the potential mechanism of Guizhi-Shaoyao-Zhimu decoction against rheumatoid arthritis and mild-to-moderate COVID-19

BACKGROUND AND OBJECTIVE

Patients with rheumatoid arthritis (RA) are more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than healthy population, but there is still no therapeutic strategy available for RA patients with corona virus disease 2019 (COVID-19). Guizhi-Shaoyao-Zhimu decoction (GSZD), Chinese ancient experience decoction, has a significant effect on the treatment of Rheumatism and gout. To prevent RA patients with mild-to-moderate COVID-19 from developing into severe COVID-19, this study explored the potential possibility and mechanism of GSZD in the treatment of this population.

METHODS

In this study, we used bioinformatic approaches to explore common pharmacological targets and signaling pathways between RA and mild-to-moderate COVID-19, and to assess the potential mechanisms of in the treatment of patients with both diseases. Beside, molecular docking was used to explore the molecular interactions between GSZD and SARS-CoV-2 related proteins.

RESULTS

Results showed that 1183 common targets were found in mild-to-moderate COVID-19 and RA, of which TNF was the most critical target. The crosstalk signaling pathways of the two diseases focused on innate immunity and T cells pathways. In addition, GSZD intervened in RA and mild-to-moderate COVID-19 mainly by regulating inflammation-related signaling pathways and oxidative stress. Twenty hub compounds in GSZD exhibited good binding potential to SARS-CoV-2 spike (S) protein, 3C-like protease (3CLpro), RNA-dependent RNA polymerase (RdRp), papain-like protease (PLpro) and human angiotensin-converting enzyme 2 (ACE2), thereby intervening in viral infection, replication and transcription.

CONCLUSIONS

This finding provides a therapeutic option for RA patients against mild-to-moderate COVID-19, but further clinical validation is still needed.

What can we learn from the Baduanjin rehabilitation as COVID-19 treatment?: A narrative review

AIM

To understand Baduanjin rehabilitation therapy in mild COVID-19 patients.

DESIGN

A narrative review.

METHODS

A literature search for COVID-19 and Baduanjin treatments was conducted on Chinese and English electronic databases: China National Knowledge Infrastructure, Wanfang Data, Embase, PubMed, Scopus, Science Direct, Ebscohost, SPORTDiscus and ProQuest.

RESULTS

Twelve studies on the Baduanjin rehabilitation for COVID-19 patients have been included. We acknowledged the considerable published research and current clinical practice using Baduanjin for COVID-19 treatment in the following areas: anxiety, depression, insomnia, lung function rehabilitation, immunity and activity endurance.

CONCLUSION

The use of Baduanjin as adjuvant therapy for COVID-19 patients' rehabilitation is still limited, therefore, more clinical studies are needed to confirm its efficacy.

Systems pharmacology reveals the mechanism of Astragaloside IV in improving immune activity on cyclophosphamide-induced immunosuppressed mice

ETHNOPHARMACOLOGICAL RELEVANCE

Myelosuppression, also known as bone marrow suppression (BMS), is a pathological phenomenon of the decrease in the production of blood cells and further lead to immune homeostasis disorder. Astragalus mongholicus Bunge (AM, checked with The World Flora Online, http://www.worldfloraonline.org, updated on January 30, 2023) is a traditional Chinese medicine with efficacy of tonifying Qi and strengthening body immunity in thousands of years of clinical practice in China. Astragaloside IV (AS-IV) is a major active ingredient of AM, which plays an important role in regulating immune system through different ways.

AIM OF THE STUDY

This study was aimed to investigate the protective effect and mechanism of AS-IV on macrophages in vitro and cyclophosphamide (CTX)-induced immunosuppressive mice in vivo, and to provide experimental basis for the prevention and treatment of AS-IV in myelosuppression.

MATERIALS AND METHODS

Based on network pharmacology and molecular docking technology, the core targets and signaling pathways of saponins of AM against myelosuppression were screened. And then, the immunoregulatory effect of AS-IV on RAW264.7 cells was investigated by cellular immune activity and cellular secretion analysis in vitro. In this way, the effects of AS-IV on the main potential targets of HIF-1α/NF-κB signaling pathway were analyzed by qRT-PCR and Western blot methods. Furthermore, comprehensive analysis of the effects of AS-IV against CTX-induced mice were conducted on the basis of immune organs indices analysis, histopathological analysis, hematological analysis, natural killer cell activity analysis and spleen lymphocyte transformation activity analysis. In order to further verify the relationship between active ingredients and action targets, drug inhibitor experiments were finally conducted.

RESULTS

AS-IV, as a potential anti-myelosuppressive compound, was screened by systematic pharmacological methods to act on target genes including HIF1A and RELA together with the HIF-1α/NF-κB signaling pathway. Further studies by molecular docking technology showed that AS-IV had good binding activity with HIF1A, RELA, TNF, IL6, IL1B and other core targets. Besides, cellular and animal experiments validation results showed that AS-IV could enhance the migration and phagocytosis of RAW264.7 cells, and protect the immune organs such as spleen and thymus together with bone tissues from damage. By this means, immune cell function including spleen natural killer cell and lymphocyte transformation activity were also enhanced. In addition, white blood cells, red blood cells, hemoglobin, platelets and bone marrow cells were also significantly improved in the suppressed bone marrow microenvironment (BMM). In kinetic experiments, the secretion of cytokines such as TNF-α, IL-6 and IL-1β were increased, and IL-10, TGF-β1 were decreased. The key regulatory proteins such as HIF-1α, NF-κB, PHD3 in HIF-1α/NF-κB signaling pathway were also regulated in the results of upregulated expression of HIF-1α, p-NF-κB p65 and PHD3 at the protein or mRNA level. Finally, the inhibition experiment results suggested that AS-IV could significantly improve protein response in immunity and inflammation such as HIF-1α, NF-κB and PHD3.

CONCLUSION

AS-IV could significantly relieve CTX-induced immunosuppressive and might improve the immune activity of macrophages by activating HIF-1α/NF-κB signaling pathway, and provide a reliable basis for the clinical application of AS-IV as a potentially valuable regulator of BMM.

Two new guaianolide-type sesquiterpenoids with NO inhibitory activity from Chrysanthemum indicum

Two new guaianolide-type sesquiterpenoids chrysanthemulides K and L (1 and 2), together with six known analogues (3-8), were isolated from an CH₂Cl₂ extract of the aerial parts of Chrysanthemum indicum. The structures of new compounds 1 and 2 were established by extensive spectroscopic analysis, including UV, IR, MS, NMR and computational electronic circular dichroism (ECD) methods. Inhibitory effects of all compounds on nitric oxide production were investigated in lipopolysaccharide (LPS)-induced RAW 264.7 cells. Results showed that compounds 1-8 displayed NO production inhibitory activity with IC50 values ranged from 3.5 to 34.3 µM.

Based on network pharmacology and bioinformatics to analyze the mechanism of action of Astragalus membranaceus in the treatment of vitiligo and COVID-19

Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. However, the treatment of vitiligo combined with COVID-19 has not been reported. Astragalus membranaceus (AM) has a therapeutic effect on patients with vitiligo and COVID-19. This study aims to discover its possible therapeutic mechanisms and provide potential drug targets. Using the Chinese Medicine System Pharmacological Database (TCMSP), GEO database and Genecards websites and other databases, AM target, vitiligo disease target, and COVID-19 related gene set were established. Then find the crossover genes by taking the intersection. Then use GO, KEGG enrichment analysis, and PPI network to discover its underlying mechanism. Finally, by importing drugs, active ingredients, crossover genes, and enriched signal pathways into Cytoscape software, a "drug-active ingredient-target signal pathway-" network is constructed. TCMSP screened and obtained 33 active ingredients including baicalein (MOL002714), NEOBAICALEIN (MOL002934), Skullcapflavone II (MOL002927), and wogonin (MOL000173), which acted on 448 potential targets. 1166 differentially expressed genes for vitiligo were screened by GEO. CIVID-19 related genes were screened by Genecards. Then by taking the intersection, a total of 10 crossover genes (PTGS2, CDK1, STAT1, BCL2L1, SCARB1, HIF1A, NAE1, PLA2G4A, HSP90AA1, and HSP90B1) were obtained. KEGG analysis found that it was mainly enriched in signaling pathways such as IL-17 signaling pathway, Th17 cell differentiation, Necroptosis, NOD-like receptor signaling pathway. Five core targets (PTGS2, STAT1, BCL2L1, HIF1A, and HSP90AA1) were obtained by analyzing the PPI network. The network of "active ingredients-crossover genes" was constructed by Cytoscape, and the 5 main active ingredients acting on the 5 core crossover genes acacetin, wogonin, baicalein, bis2S)-2-ethylhexyl) benzene-1,2-dicarboxylate and 5,2'-Dihydroxy-6,7,8-trimethoxyflavone. The core crossover genes obtained by PPI and the core crossover genes obtained by the "active ingredient-crossover gene" network are intersected to obtain the three most important core genes (PTGS2, STAT1, HSP90AA1). AM may act on PTGS2, STAT1, HSP90AA1, etc. through active components such as acacetin, wogonin, baicalein, bis2S)-2-ethylhexyl) benzene-1,2-dicarboxylate and 5,2'-Dihydroxy-6,7,8-trimethoxyflavone to activate IL-17 signaling pathway, Th17 cell differentiation, Necroptosis, NOD-like receptor signaling pathway, Kaposi sarcoma-associated herpesvirus infection, and VEGF signaling pathway and other signaling pathways to achieve the effect of treating vitiligo and COVID-19.

Inhibitory Effects and Related Molecular Mechanisms of Huanglian-Ganjiang Combination Against H1N1 Influenza Virus

Influenza is an infectious acute respiratory disease with complications and a high mortality rate; the effective medicines for influenza therapy are limited. "Huanglian" or Coptidis Rhizoma, Coptis chinensis Franch., Ranunculaceae, and "ganjiang" or Zingiberis Rhizoma, Zingiber officinale Roscoe, Zingiberaceae, combination is clinically used for treating respiratory diseases. HPLC was applied for the quantification of berberine hydrochloride (1.101 mg/ml) and 6-gingerol (38.41 μg/ml) in the H₂O-soluble extract of the herbal formulation. In this study, the effect of "huanglian"- "ganjiang" extract on influenza virus H1N1-induced acute pulmonary inflammation was evaluated, in addition to the investigation of its anti-influenza mechanism in a mouse model. The analyzed herbal combination inhibited the expression of cytokine IL-6 and stimulated the expression of IL-2 in the serum of influenza virus-infected mice. Meanwhile, the herbal combination downregulated the gene and protein expression levels of TLR3, TLR7, MyD88, RIG-I, MAVS, TRAF3, and NF-κB p65, which are key targets of toll-like and RIG-I-like receptor signaling pathways in mice. In addition, the herbal combination could also promote the combination of intracellular autophagosomes and lysosomes in autophagosome-lysosome formation and improve impaired fusion of autophagosomes and lysosomes by influenza virus. This study suggested that the "huanglian"- "ganjiang" extract may be a candidate therapeutic strategy for the treatment of H1N1 influenza.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s43450-023-00372-z.

Complementary and alternative medicine use during the COVID-19 pandemic: Community pharmacists' knowledge, attitudes, and practices

BACKGROUND

The challenges in COVID-19 treatment have driven patients to seek Complementary and Alternative Medicine (CAM) for the prevention and/or treatment of the disease. Pharmacists are uniquely positioned to promote the effective and safe use of CAM.

OBJECTIVE

Assess the beliefs, practices, and knowledge of community pharmacists in Lebanon about existing evidence for the use of CAM for the prevention and/or treatment of COVID-19.

METHODS

A national cross-sectional survey was conducted among community pharmacists during the COVID-19 pandemic in Lebanon (n = 310 respondents). Participants completed an online questionnaire addressing, in addition to the socio-demographic characteristics; the beliefs, practices, and knowledge of pharmacists regarding the existing evidence of CAM use for COVID-19 prevention and/or treatment.

RESULTS

Pharmacists (70%) received frequent inquiries about CAM for COVID-19 prevention or treatment. Only 25.5% of the pharmacists reported having enough time to get information about CAM and COVID-19. Almost all participants believed that pharmacists have a major role in the fight against COVID-19 (98%) and that they have enough information to counsel patients in that regard (75%). For practices, the majority of pharmacists reported counseling their patients on proper use (98%) and possible adverse reactions (93%) of CAM, but only 51% reported toxic or undesirable effects. Regarding knowledge, although most pharmacists answered correctly the questions on the role of CAM in preventing COVID-19, few knew about its role in treating the infection. Pharmacists who trust the WHO website as a credible source had a higher knowledge score (β = 0.52, 95%CI: 0.05-0.986).

CONCLUSIONS

The positive beliefs and practices of pharmacists towards CAM during the pandemic were coupled with a few gaps, especially in their knowledge about existing evidence for CAM use. Concerted efforts ought to be dedicated to supporting pharmacists in playing a more prominent role during health crises such as the COVID-19 pandemic.

A multi-target protective effect of Danggui-Shaoyao-San on the vascular endothelium of atherosclerotic mice

BACKGROUND

Atherosclerosis (AS) is a chronic disease characterized by abnormal blood lipid metabolism, inflammation and vascular endothelial injury. Vascular endothelial injury is the initial stage during the occurrence of AS. However, the function and mechanism of anti-AS are not well characterized. Danggui-Shaoyao-San (DGSY) is a classic Traditional Chinese Medicine (TCM) prescription for the treatment of gynecological diseases, and has been widely used in the treatment of AS in recent years.

METHODS

ApoE^-/- atherosclerosis male mice were established by feeding with high-fat diet, and then randomly divided into three groups: Atherosclerosis group (AS), Danggui-Shaoyao-San group (DGSY), and Atorvastatin calcium group (X). The mice were administered with the drugs for 16 weeks. Pathological changes in aortic vessels were examined by staining with Oil red O, Masson and hematoxylin-eosin. In addition, blood lipids were analyzed. The level of IL-6 and IL-8 in aortic vessels were detected by ELISA and the expression of ICAM-1 and VCAM-1 in the aortic vascular endothelium were measured by Immunohistochemical. The mRNA expression of interα5β1/c-Abl/YAP in the aortic vessels were measured by Real-time quantitative PCR and location of expression was assessed by immunofluorescence.

RESULTS

DGSY can significantly reduce the content of TC,TG and LDL-C and increase the level of HDL-C in the serum, reduce the plaque area and inhibit the concentration of IL-6 and IL-8, down-regulate the expression of IVAM-1,VCAM-1 and interα5β1/ c-Abl/YAP in the aortic vessels.

CONCLUSIONS

Collectively, DGSY can alleviate vascular endothelium damage and delay the occurrence of AS, and the underlying mechanism may be related to the multi-target protective of DGSY.

The efficacy of traditional Chinese medicine in the treatment of the COVID-19 pandemic in Henan Province: a retrospective study

BACKGROUND

Since 2020, novel coronavirus disease (COVID-19) has posed serious threats to health systems and led to tremendous economic decline worldwide. Traditional Chinese medicine (TCM) is considered a promising treatment strategy for COVID-19 in China and is increasingly recognized as a key participant in the battle against COVID-19. Clinicians also need accurate evidence regarding the effectiveness of TCM treatments for COVID-19.

METHODS

We retrospectively analyzed patients diagnosed with COVID-19 by collected from the electronic medical records of the hospitals in Henan Province from January 19, 2020, to March 2, 2020. Demographic characteristics, clinical data, frequency analysis of Chinese patent medicines (CPMs), Chinese medicine injections (CMIs), evaluation of baseline symptom scores, nucleic acid negative conversion, length of hospitalization, and mortality rates were studied.

RESULTS

Between 15 January 2020 and 2 March 2020, 131 hospitals with 1245 patients were included. Survey response Chinese herbal decoction, CPMs, and CMIs combined with conventional Western medicine (CWM) used for the treatment of COVID-19. The top 8 CPMs were Lianhua Qingwen capsules, Shuanghuanglian oral liquid, Pudilan Xiaoyan oral liquid, Banlangen granules, Lanqin oral liquid, compound licorice tablets, Bailing capsules, montmorillonite powder. The most frequently used CMIs were Xuebijing, Tanreqing, Reduning, Xiyanping and Yanhuning. TCM combined with CWM improved the patients' symptom scores for fever, cough, chest tightness, shortness of breath, and fatigue. Nucleic acid negative conversion occurred at11.55 ± 5.91 d and the average length of hospitalization was 14.92 ± 6.15 d. The mortality rate was approximately 1.76%, which is a reduction in patient mortality.

CONCLUSIONS

TCM combined with CWM improved clinical symptoms and reduced hospitalization and mortality rates.

Herbal small RNAs in patients with COVID-19 linked to reduced DEG expression

In China, more than 80% of patients with coronavirus disease 2019 (COVID-19) received traditional Chinese medicine (TCM) as a treatment and their clinical efficacy have been reported. However, the underlying molecular mechanism remains unclear. Previous studies have identified herbal small RNAs (sRNAs) as novel functional components. In this study, a cohort of 22 patients with COVID-19 treated with Toujie Quwen (TQ) granules was analyzed. We observed thousands of herbal small RNAs that entered the blood cells of patients after the consumption of TQ granules. In response to this treatment, the reduced differentially expressed genes (DEGs) were highly correlated with the predicted target genes of the most prevalent herbal sRNAs detected in the blood. Moreover, the predicted target genes of the top 30 sRNAs from each of the 245 TCMs in the Bencao sRNA Atlas overlapped with 337 upregulated DEGs in patients with mild COVID-19, and 33 TCMs, with more than 50% overlapping genes were identified as effective TCMs. These predicted target genes of top 30 sRNAs from Juhong, Gualoupi and Foshou were confirmed experimentally. Our results not only elucidated a novel molecular mechanism of TCM potential clinical efficacy for COVID-19 patients, but also provided 33 effective COVID-19 TCMs for prescription optimization.

Network pharmacology study of the mechanism underlying the therapeutic effect of Zhujing pill and its main component oleanolic acid against diabetic retinopathy

Diabetic retinopathy (DR) is the leading cause of blindness in the working population worldwide, with few effective drugs available for its treatment in the early stages. The Zhujing pill (ZJP) is well-established to enhance the early symptoms of DR, but the mechanism underlying its therapeutic effect remains unclear. In the present study, we used systems biology and multidirectional pharmacology to screen the main active ingredients of ZJP and retrieved DrugBank and Genecards databases to obtain 'drug-disease' common targets. Using bioinformatics analysis, we obtained the core targets, and potential mechanisms of action of ZJP and its main components for the treatment of DR. Molecular docking was used to predict the binding sites and the binding affinity of the main active ingredients to the core targets. The predicted mechanism was verified in animal experiments. We found that the main active ingredient of ZJP was oleanolic acid, and 63 common 'drug-disease' targets were identified. Topological analysis and cluster analysis based on the protein-protein interaction network of the Metascape database screened the core targets as PRKCA, etc. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that these core targets were significantly enriched in the pro-angiogenic pathway of the VEGF signaling pathway. Molecular docking and surface plasmon resonance revealed that ZJP and its main active component, oleanolic acid had the highest binding affinity with PKC-α, the core target of the VEGF signaling pathway. Animal experiments validated that ZJP and oleanolic acid could improve DR.

Diversity of Citrullus colocynthis (L.) Schrad Seeds Extracts: Detailed Chemical Profiling and Evaluation of Their Medicinal Properties

Seeds and fruits of Citrullus colocynthis have been reported to possess huge potential for the development of phytopharmaceuticals with a wide range of biological activities. Thus, in the current study, we are reporting the potential antimicrobial and anticancer properties of C. colocynthis seeds extracted with solvents of different polarities, including methanol (M.E.), hexane (H.E.), and chloroform (C.E.). Antimicrobial properties of C. colocynthis seeds extracts were evaluated on Gram-positive and Gram-negative bacteria, whereas, anticancer properties were tested on four different cell lines, including HepG2, DU145, Hela, and A549. All the extracts have demonstrated noteworthy antimicrobial activities with a minimum inhibitory concentration (MIC) ranging from 0.9-62.5 µg/mL against Klebsiella planticola and Staphylococcus aureus; meanwhile, they were found to be moderately active (MIC 62.5-250 µg/mL) against Escherichia coli and Micrococcus luteus strains. Hexane extracts have demonstrated the highest antimicrobial activity against K. planticola with an MIC value of 0.9 µg/mL, equivalent to that of the standard drug ciprofloxacin used as positive control in this study. For anticancer activity, all the extracts of C. colocynthis seeds were found to be active against all the tested cell lines (IC₅₀ 48.49-197.96 µg/mL) except for the chloroform extracts, which were found to be inactive against the HepG2 cell line. The hexane extract was found to possess the most prominent anticancer activity when compared to other extracts and has demonstrated the highest anticancer activity against the DU145 cell line with an IC₅₀ value of 48.49 µg/mL. Furthermore, a detailed phytoconstituents analysis of all the extracts of C. colocynthis seeds were performed using GC-MS and GC-FID techniques. Altogether, 43 phytoconstituents were identified from the extracts of C. colocynthis seeds, among which 21, 12, and 16 components were identified from the H.E., C.E., and M.E. extracts, respectively. Monoterpenes (40.4%) and oxygenated monoterpenes (41.1%) were the most dominating chemical class of compounds from the hexane and chloroform extracts, respectively; whereas, in the methanolic extract, oxygenated aliphatic hydrocarbons (77.2%) were found to be the most dominating chemical class of compounds. To the best of our knowledge, all the phytoconstituents identified in this study are being reported for the first time from the C. colocynthis.

Analysis of Metabolic Differences in the Water Extract of Shenheling Fermented by Lactobacillus fermentum Based on Nontargeted Metabolomics

Objective: To explore the characteristics of metabolites in Shenheling (SHL) fermented by Lactobacillus fermentum. Methods: In this study, ultrahigh-performance liquid chromatography-quadrupole electrostatic field orbit trap mass spectrometry (UHPLC-QE-MS) was used to qualitatively, quantitatively, and differentially analyze the metabolites of SHL before and after fermentation. Results: A total of 102 significant differential metabolites in nine categories were analyzed before and after fermentation. It mainly includes 29 terpenoids, 17 alkaloids, 14 organic acids and derivatives, 10 flavonoids, 9 phenylpropanoids, 6 phenols, 3 aromaticity, and 3 amino acid derivatives. Further screening found that the content of most active substances, such as alkaloids, organic acids, and flavonoids, increased significantly. These metabolites play an important role in improving the taste and efficacy of SHL. After fermentation, the contents of differential metabolites, such as panaquinquecol 2, ginsenoside Rh3, ginsenoside Rg3, dehydronuciferin, nicotinic acid, 5-hydroxytryptophan, azelaic acid, dihydrokaempferol, and chrysin, were increased, which increased the effects of antioxidation, anti-obesity, hypoglycemic, antibacterial, and improved immunity compared with those before fermentation. KEGG pathway analysis identified 10 metabolic pathways. Isoquinoline alkaloid biosynthesis, vitamin B6 metabolism, beta-alanine metabolism, nicotinate, and nicotinamide metabolism, purine metabolism, pantothenate and CoA biosynthesis, glyoxylate and dicarboxylate metabolism, tyrosine metabolism, citrate cycle (TCA cycle), phenylpropanoid biosynthesis, etc. Conclusions: Fermentation significantly changed the metabolites in SHL and played an important role in improving its taste, aroma quality, antioxidant, anti-obesity, and other health care functional components.

TCM Prescription Generation via Knowledge Source Guidance Network Combined with Herbal Candidate Mechanism

Traditional Chinese medicine (TCM) prescriptions have made great contributions to the treatment of diseases and health preservation. To alleviate the shortage of TCM resources and improve the professionalism of automatically generated prescriptions, this paper deeply explores the connection between symptoms and herbs through deep learning technology, and realizes the automatic generation of TCM prescriptions. Particularly, this paper considers the significance of referring to similar underlying prescriptions as herbal candidates in the TCM prescribing process. Moreover, this paper incorporates the idea of referring to the potential guidance information of corresponding prescriptions when model extracts symptoms representations. To provide a reference for inexperienced young TCM doctors when they prescribe, this paper proposes a dual-branch guidance strategy combined with candidate attention model (DGSCAM) to automatically generate TCM prescriptions based on symptoms text. The format of the data used this paper is the "symptoms-prescription" data pair. The specific method is as follows. First, DGSCAM realizes the extraction of key information of prescription-guided symptoms through a dual-branch network. Then, herbal candidates in the form of prescriptions that can treat symptoms are proposed in view of the compatibility knowledge of TCM prescriptions. To our knowledge, this is the first attempt to use prescriptions as herbal candidates in the prescription generation process. We conduct extensive experiments on a mixed public and clinical dataset, achieving 37.39% precision, 25.04% recall, and 29.99% F1 score, with an average doctor score of 7.7 out of 10. The experimental results show that our proposed model is valid and can generate more specialized TCM prescriptions than the baseline models. The DGSCAM developed by us has broad application scenarios and greatly promotes the research on intelligent TCM prescribing.

(±)-Gentiovarisin A and gentiovarisin B, unusual secoiridoid dimer skeletons from gentiopicroside

Gentiana scabra, a famous traditional Chinese medicine (TCM), has been documented in Chinese Pharmacopoeia for the treatment of hepatitis. Its index component gentiopicroside could not be detected in the decoction, which suggested that the quality control of the TCM with this ingredient needs attention. The transformed products were obtained from gentiopicroside, mimicking the traditional process of G. scabra. Further investigation of the heat-transformed products yielded two secoiridoid dimers, gentiovarisin A (1) and B (2), with an unprecedented 6/6/6/6/6-fused pentacyclic skeletons. Their structures were elucidated by extensive spectroscopic analyses and single-crystal X-ray diffraction analysis, and the absolute configurations of 1 were confirmed as (+)-1 and (-)-1 by ECD method. Plausible transformation pathways of the isolates were also proposed. Compounds 1 and 2 exhibited in vitro hepatoprotective activity similar to gentiopicroside, while (+)-1 displayed a more potent hepatoprotective activity than N-Acetyl-L-cysteine.

Chemical composition and therapeutic mechanism of Xuanbai Chengqi Decoction in the treatment of COVID-19 by network pharmacology, molecular docking and molecular dynamic analysis

Xuanbai Chengqi Decoction (XBCQD), a classic traditional Chinese medicine, has been widely used to treat COVID-19 in China with remarkable curative effect. However, the chemical composition and potential therapeutic mechanism is still unknown. Here, we used multiple open-source databases and literature mining to select compounds and potential targets for XBCQD. The COVID-19 related targets were collected from GeneCards and NCBI gene databases. After identifying putative targets of XBCQD for the treatment of COVID-19, PPI network was constructed by STRING database. The hub targets were extracted by Cytoscape 3.7.2 and MCODE analysis was carried out to extract modules in the PPI network. R 3.6.3 was used for GO enrichment and KEGG pathway analysis. The effective compounds were obtained via network pharmacology and bioinformatics analysis. Drug-likeness analysis and ADMET assessments were performed to select core compounds. Moreover, interactions between core compounds and hub targets were investigated through molecular docking, molecular dynamic (MD) simulations and MM-PBSA calculations. As a result, we collected 638 targets from 61 compounds of XBCQD and 845 COVID-19 related targets, of which 79 were putative targets. Based on the bioinformatics analysis, 10 core compounds and 34 hub targets of XBCQD for the treatment of COVID-19 were successfully screened. The enrichment analysis of GO and KEGG indicated that XBCQD mainly exerted therapeutic effects on COVID-19 by regulating signal pathways related to viral infection and inflammatory response. Meanwhile, the results of molecular docking showed that there was a stable binding between the core compounds and hub targets. Moreover, MD simulations and MM-PBSA analyses revealed that these compounds exhibited stable conformations and interacted well with hub targets during the simulations. In conclusion, our research comprehensively explained the multi-component, multi-target, and multi-pathway intervention mechanism of XBCQD in the treatment of COVID-19, which provided evidence and new insights for further research.

Oral Liushen pill for patients with COVID-19: A prospective randomized controlled trial

We examined the efficacy and safety of Liushen pill combined with basic treatment for patients with COVID-19. In total, 181 patients hospitalized with COVID-19, classified as asymptomatic mild type, were randomly divided into the experimental (n = 91) and control (n = 90) groups and were administered placebo (Maizao decoction) and Maizao decoction and Liushen pill, in addition to standard care, respectively. The negative conversion rate of nucleic acid (Day 7), hospital discharge rate (Days 8, 10, and 14), symptom disappearance rate (Days 3, 5, and 7), inflammatory cytokine levels, and adverse events were compared between the groups. The negative viral conversion rate was significantly higher in the experimental than in the control group (48.35 vs. 31.11%, p < 0.05). Subgroup analysis showed a similar significant trend when the Ct value was ≤30 at baseline. After 10 days, the hospital discharge rate was significantly higher in the experimental than in the control group (69.23 vs. 53.33%, p < 0.05). After 3-day medication, the headache symptoms significantly disappeared in the experimental (88.57%) compared to the control group (63.33%) (p < 0.05). After 5 days, the symptom disappearance rates of headache and cough were significantly higher in the experimental (97.14%) than in the control group (97.14 vs. 80.00, p < 0.05; 82.65 vs. 58.93%, p < 0.01, respectively). Posttreatment, the procalcitonin level was significantly lower in the experimental than in the control group (0.09 ± 0.00 vs. 0.14 ± 0.05 ng/L; p < 0.05). There were no significant between-group differences in clinical safety test indices. Early intervention with Liushen pill improved cough and headache and increased negative viral conversion and discharge rate.

Inhibitory activity of dry ethanol extracts of <i>Artemisia</i> spp. on SARS‐CoV‐2 replication <i>in vitro</i>

Aim. In vitro analysis of the inhibitory activity of dry ethanol extracts of some Artemisia spp. growing in the Novosibirsk region for SARS‐CoV‐2 replication.

Materials and Methods. The laboratory strain SARS‐CoV‐2/human/RUS/Nsk‐FRCFTM‐1/2020 was passed on Vero cell culture. Dry ethanol extracts of plant parts (stems, flowers, leaves) of six types of Artemisia were prepared. The types used were: A. vulgaris L.; A. glauca (Pall. Ex Willd.); A. dracunculus L. (from three growth locations); A. absinthium L.; A. frigida Willd.; and A. sieversiana Ehrh. ex Willd. Dry extracts were dissolved in DMSO. In vitro analysis of the inhibitory activity of extracts against SARS‐CoV‐2 (an infectious titer of 103 TCID50/ml) replication was performed in a Vero E6 cell culture. To do this, the method of direct inactivation (neutralization) of virions, as well as schemes of “preventive” and “therapeutic” of cells, were used. Comparison samples were dry ethanol extracts of Inonotus obliquus, Syzygium aromaticum L. and Camellia sinensis L.

Results. Extracts of leaves of Artemisia spp. proved to be most effective in direct inactivation of virions. By equal and decreasing activity these are the species: A. vulgaris; A. dracunculus*; A. absinthium; A. dracunculus***; A. dracunculus**; A. frigidа; A. glauca; and A. sieversiana with a 50% effective concentration of range 1.10±0.24 – 11.72±2.89 μg/ml. Extracts of flowers of A. vulgaris, A.glauca, A. dracunculus*, A. dracunculus**, A. dracunculus***, A. frigida and A. sieversiana also contain biologically active substances which act both destructively on virions and after the virus has entered cells. For extracts of stems consistently high values of EC50 were found for A. glauca (6.84±1.35; 7.81±2.00 and 14.06±3.06 μg/ml) according to the results of three experimental schemes.

Conclusion. The results obtained can become the basis for the development of inexpensive domestic drugs for the treatment and/or prevention of COVID‐19.

GlPS1 overexpression accumulates coumarin secondary metabolites in transgenic Arabidopsis

The dried root of Glehnia littoralis is a traditional Chinese herbal medicine mainly used to treat lung diseases and plays an important role in fighting coronavirus disease 2019 pneumonia in China. This study focused on the key enzyme gene GlPS1 for furanocoumarin synthesis in G. littoralis. In the 35S:GlPS1 transgenic Arabidopsis study, the Arabidopsis thaliana-overexpressing GlPS1 gene was more salt-tolerant than Arabidopsis in the blank group. Metabolomics analysis showed 30 differential metabolites in Arabidopsis, which overexpressed the GlPS1 gene. Twelve coumarin compounds were significantly upregulated, and six of these coumarin compounds were not detected in the blank group. Among these differential coumarin metabolites, isopimpinellin and aesculetin have been annotated by the Kyoto Encyclopedia of Genes and Genomes and isopimpinellin was not detected in the blank group. Through structural comparison, imperatorin was formed by dehydration and condensation of zanthotoxol and a molecule of isoprenol, and the difference between them was only one isoprene. Results showed that the GlPS1 gene positively regulated the synthesis of coumarin metabolites in A. thaliana and at the same time improved the salt tolerance of A. thaliana.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11240-022-02427-w.

Mild shading promotes sesquiterpenoid synthesis and accumulation in Atractylodes lancea by regulating photosynthesis and phytohormones

Atractylodes lancea rhizome (AR) has high medicinal and economic value. A previous study has reported that the accumulation of sesquiterpenoids in AR has obvious advantages under bamboo canopy. A concrete shade value to promote the cultivation of high-quality AR has not been established. In this study, 80% shading was screened at six different light intensities (100%, 80%, 60%, 40%, 20%, 7%), and the mechanism was explored in terms of photosynthetic efficiency and phytohormones levels. The results indicated that the total sesquiterpenoid content of 80% mild shading increased by 58%, 52%, and 35%, respectively, compared to 100% strong light in seedling, expansion, and harvest stages and increased by 144%, 178%, and 94%, respectively, compared with 7% low light. The sesquiterpenoids hinesol and β-eudesmol contributed approximately 70% to the differential contribution ratio between mild shading and strong light (100%) or between mild shading and low light (7%). Furthermore, HMGR, DXR, and FPPS genes, which regulate sesquiterpenoid synthesis, were significantly upregulated in 80% mild shading. Transpiration rate; the intercellular CO₂ concentration; net photosynthetic rate; and levels of jasmonic acid, abscisic acid, and gibberellin were strongly correlated (r > 0.85) with sesquiterpenoid accumulation. Cis-acting elements responding to light and phytohormones were present within the promoter regions of HMGR, DXR, and FPPS. Therefore, 80% shading promotes the synthesis and accumulation of sesquiterpenoids in AR by regulating photosynthetic efficiency and phytohormone production, thereby promoting transcriptional expression.

Effect of the Announcement of Human-to-Human Transmission on Telemedicine Services in China During COVID-19

OBJECTIVES

Telemedicine enables patients to communicate with physicians effectively, especially during the coronavirus disease (COVID-19) pandemic. However, few studies have explored the use of online health care platforms for a comprehensive range of specialties during the COVID-19 pandemic. This study aimed to investigate how telemedicine services were affected by the announcement of human-to-human transmission in China.

METHODS

Telemedicine data from haodf.com in China were collected. A difference-in-differences analysis compared the number of telemedicine use and the number of active online physicians for different specialties in 2020 with the numbers in 2019, before and after the announcement of human-to-human transmission.

RESULTS

Data from 2 473 734 telemedicine use during the same calendar time in 2020 and 2019 were collected. Telemedicine use in 2020 increased by 349.9% after the announcement of human-to-human transmission in China, and the number of active online physicians increased by 23.2%. The difference-in-differences analysis indicated that the announcement had statistically significant positive effects on the numbers of telemedicine use for almost all specialties, except cosmetic dermatology, pathology, occupational diseases, sports medicine, burn, medical imaging, and interventional medicine.

CONCLUSION

Telemedicine services increased significantly after the announcement of human-to-human transmission of COVID-19. Online activities of most specialties increased, except where providers had to conduct in-person testing and provide bedside therapies.

A cross-sectional survey of self-medication with Traditional Chinese Medicine for treatment and prevention of COVID-19

OBJECTIVE

To investigate user behavioural profiles and the prevalence of self-medication with traditional Chinese medicine (TCM) for COVID-19 among the general public in China.

DESIGN

Cross-sectional study.

SETTING

Self-administered online survey was carried out between January and June 2021 in China.

RESULTS

A total of 1132 complete responses were received from a nationwide sample. A considerable proportion viewed TCM to be more effective than Western medicine for treating COVID-19 (67.1 %) and stated that it is safer to use TCM (63.5 %) and easier to access TCM for treating COVID-19 (63.5 %). A total of 16.4 % (95 %CI 14.3-18.7) reported ever self-medicating with TCM to resolve COVID-19 symptoms and 12.2 % (95 % CI 10.3-14.2) ever using TCM to prevent SARS-CoV-2 infection. Lianhua Qingwen capsule/granule (53.2 %), Ganmao granule (50.5 %) and Banlangen granule (44.6 %) were most commonly used to resolve COVID-19 symptoms whereas Banlangen granule (60.1 %) was commonly used for the prevention of SARS-CoV-2 infection. Older age participants, from rural areas, with chronic diseases, higher socioeconomic status, and a positive attitude towards TCM were more likely to self-medicate using TCM to resolve COVID-19 symptoms.

CONCLUSION

Self-medication with TCM during the COVID-19 pandemic for symptom control or prevention is prevalent. The findings of the user behavioural profile and types of TMCs commonly used in this study provide beneficial information for the development of strategies to improve public health-seeking behaviour and the performance of the country's healthcare system in the era of the COVID-19 pandemic.

Danggui Sini decoction treatment of refractory allergic cutaneous vasculitis: A case report

BACKGROUND

Allergic cutaneous vasculitis (ACV) is a difficult disease to treat. At present, there is no effective treatment for this condition. Traditionally, immunosuppressants and hormones have been primarily used in its management, but the treatment effect is suboptimal, and it has several side effects.

CASE SUMMARY

We present the case of a 19-year-old woman who presented at our hospital with a four-year history of symmetric skin lesions mainly affecting her lower extremities. She had previously undergone treatment with prednisolone acetate, cetirizine hydrochloride, and loratadine tablets but had not experienced any relief in her condition. Thereafter, she was treated with oral traditional Chinese medicine. Her skin damage gradually improved within two months of treatment initiation. After six months, the skin ulcers had completely subsided. No evidence of skin ulcer recurrence was observed during the subsequent follow-up. This report presents the first case of a female patient who received oral Danggui Sini decoction for the treatment of ACV.

CONCLUSION

Danggui Sini decoction may be a promising oral treatment for ACV patients.

Quantitative evaluation of traditional Chinese medicine development policy: A PMC index model approach

Background

Traditional Chinese medicine development policies (TCMDPs) are essential in improving the sustainable development of TCM undertakings, of which transmissions of policy information are closely related to the actual policy effectiveness. However, the inherent components of TCMDPs had not been explored from the structural dimension of policy design.

Methods

Based on the policy modeling consistency (PMC) index model, we constructed a comprehensive evaluation system, including ten first-level and 40 second-level indicators, and focused on the TCMDPs released by the Chinese central government in the past 42 years (1980-2022) to conduct multi-dimensional inspections to TCMDPs by analyzing the overall policy quality, individual scoring performance, and indicators distribution characteristics.

Results

This study pointed out that four policies were rated as "perfect," 35 were rated as "superb," 50 were rated as "excellent," 28 were rated as "good," and four were rated as "acceptable," with total mean values of the PMC index being 7.530 ± 0.835. Although most TCMDPs had appropriate policy structure and consistency, the potential weaknesses in the design of TCMDPs also needed our attention through careful checks on the outlier policy samples. Besides, the existing TCMDPs had room for improvement regarding policy areas, guarantees and incentives, objects included, and issuing agencies.

Conclusions

We emphasized that the policy evaluation method used in this current study, the PMC index model, is scarce in the TCMDPs. These findings are helpful for fully understanding the strengths and weaknesses of TCMDPs and provide theoretical references for further studies optimizing TCMDPs.