Abstract
During the outbreak of the novel coronavirus disease (COVID-19), the Chinese government took a series of public health measures to tackle the outbreak and recommended six traditional Chinese medicine (TCM) evolved formulas, collectively referred to as “3-drugs-3-formulas”, for the treatment. In this prospective article, we will discuss how these six formulas evolved from TCM and what their underlying mechanisms of actions may be by evaluating the historical usage of the component formulas, the potential targeted pathways for the individual herbs used by STAR (signal transduction activity response) database from our laboratory, and the pathogenesis of COVID-19. Five of the six recommended formulas are administered orally, while the sixth is taken as an injection. Five classic categories of herbs in the six formulas including “Qing-Re”, “Qu-Shi”, “Huo-Xue”, “Bu-Yi” and “Xing-Qi” herbs are used based on different stages of disease. All five oral formulas build upon the core formula Maxingshigan Decoction (MD) which has anti-inflammatory and perhaps antiviral actions. While MD can have some desired effects, it may not be sufficient to treat COVID-19 on its own; consequently, complementary classic formulas and/or herbs have been added to potentiate each recommended formula’s anti-inflammatory, and perhaps anti-renin-angiotensin system (RAS)-mediated bradykinin storm (RBS) and antiviral effects to address the unique medical needs for different stages of COVID-19. The key actions of these formulas are likely to control systemic inflammation and/or RBS. The usage of Chinese medicine in the six formulas is consistent with the pathogenesis of COVID-19. Thus, an integrative systems biology approach—combining botanical treatments of conventional antiviral, anti-inflammatory or anti-RBS drugs to treat COVID-19 and its complications – should be explored.
Highlights
In late December 2019, pneumonia clusters from unknown causes were reported in Wuhan, China
It is highly likely that traditional Chinese medicine (TCM) played a pivotal role in treating COVID-19 patients and in containing the outbreak
The 3-drugs (JQC, Lianhua Qingwen Capsule (LQC) and Xuebijing Injection (XI)) are established formula drugs in China that have been used for the treatment of respiratory diseases; the 3formulas (LCDD, Huashibaidu Decoction (HD) and Xuanfeibaidu Decoction (XD)) are new formulas that evolved by the combining different formulas to treat different stages of COVID-19
Summary
In late December 2019, pneumonia clusters from unknown causes were reported in Wuhan, China. MD is the core formula of HD, Huopoxialing Decoction is included to “resolve dampness”, and additional herbs eliminate or relieve symptoms of cough with sputum secretion, airway obstruction, short of breath, and fatigue in severe COVID-19 cases. Wuling Powder may improve lung tissue edema, protect gastrointestinal function, and have anti-oxidation and antiinflammatory effects, reducing COVID-19 damage to target tissues, and regulating immunity to improve the body’s antiviral ability to facilitate disease recovery In another component formula, Juzhijiang Decoction, Citrus × aurantium L., peel has antithrombotic and anti-inflammatory actions; Citrus trifoliata L. fruit may improve myocardial metabolism and has anti-inflammatory activity (Yao et al, 2020). The capabilities of the XI formula could include its potential anti-viral, anti-inflammatory, and anti-RBS properties
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