Lianhua Qingwen Research Articles

Efficacy and safety of Lianhua Qingwen granule in the treatment of non-influenza viral pneumonia: a randomized, double-blind, placebo-controlled, multicenter clinical study.

To observe the effectiveness and safety of Lianhua Qingwen granule in the treatment of non-influenza viral pneumonia. This study was a multicenter, randomized, double-blind, placebo-controlled trial. Subjects who met the inclusion and exclusion criteria and were clinically diagnosed with viral pneumonia (negative for influenza virus) were randomly divided into the Lianhua Qingwen granule trial group and placebo control group. Patients in the trial group was given Lianhua Qingwen granule, 2 bags at a time, 3 times a day, and the controls were given placebo, with a treatment course of 7 days. Patients' clinical symptoms and signs, and treatment-associated adverse events were observed. Subjects should be included in the full analysis set (FAS) as long as they were all given the medication and had an effectiveness test performed after randomization. Subjects should be included in the Per Protocol Set (PPS),a subset of the total analysis set, which should contain those with strong compliance, no protocol violations, and complete baseline values for the primary indicators. A total of 169 subjects were enrolled in 12 subcenters, including 151 (76 in the trial group and 75 in the control group) in the FAS and 140 (68 in the trial group and 72 in the control group) in the PPS. After 7 days of treatment, the clinical symptom relief rates were 82.98% (FAS) and 87.12% (PPS) in the trial group, and 75.11% (FAS) and 76.02% (PPS) in the control group, respectively. The clinical symptom relief rates in the trial group were significantly higher than those in the control group (p < 0.001). Significant improvements in single symptoms of cough and expectoration in the trial group were observed compared with the control group (p < 0.05). There were no statistical differences in fever, sputum color change, chest pain, muscle pain, dyspnea, chills, and thirst between the two groups (p > 0.05). There were no significant differences in body weight, vital signs, blood routine, urine routine, stool routine, and blood biochemical indicators (CK, AST, ALT, Cr, and Bun) between the two groups before and after treatment (p > 0.05). During treatment, there were no significant differences in the incidence of adverse events and serious adverse events between the two groups (p > 0.05). Lianhua Qingwen granules improved the clinical symptoms of patients with non-influenza virus pneumonia, especially ameliorating cough and expectoration. Lianhua Qingwen granules were associated with good safety.

Efficacy and safety of Lianhua Qingwen granule combined with azithromycin for mycoplasma pneumoniae pneumonia in children: a systematic review with meta-analysis and trial sequential analysis.

Lianhua Qingwen (LHQW) granule, a botanical drug preparation, is frequently utilized as an adjuvant treatment for mycoplasma pneumoniae pneumonia (MPP). Nevertheless, the clinical efficacy and safety of this treatment remain uncertain. This study aims to evaluate the efficacy and safety of LHQW granule combined with azithromycin (AZM) in treating MPP in children. To identify all randomized controlled trials (RCTs) of LHQW granule plus AZM, a search was conducted in eight Chinese and English databases (CNKI, Wan Fang, VIP, Sinomed, PubMed, Embase, Web of Science, and Cochrane Library) from their inception until 25 December 2023. Meta-regression and subgroup analysis were employed to investigate heterogeneity. Sensitivity analysis and trial sequential analysis (TSA) were conducted to assess the robustness of the findings. Additionally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was utilized to evaluate the quality of evidence. A total of 15 RCTs involving 1909 participants were included in this study. The meta-analysis results indicated combination therapy of LHQW granule and AZM is significant different from AZM alone in both efficacy and safety, which are specifically observed in the following outcomes: response rate (RR = 1.17, 95% CI: 1.12 to 1.22, p < 0.01), antipyretic time (MD = -1.32, 95% CI: -1.66 to -0.98, p < 0.01), cough disappearance time (MD = -1.76, 95% CI: -2.47 to -1.05, p < 0.01), pulmonary rale disappearance time (MD = -1.54, 95% CI: -2.06 to -1.02, p < 0.01), c-reactive protein (CRP) (MD = -5.50, 95% CI: -6.92 to -4.07, p < 0.01), procalcitonin (PCT) (MD = -0.31, 95% CI: -0.38 to -0.24, p < 0.01), interleukin 6 (IL-6) (MD = -5.97, 95% CI: -7.39 to -4.54, p<0.01), tumor necrosis factor α (TNF-α) (MD = -5.74, 95% CI: -7.44 to -4.04, p < 0.01), forced vital capacity (FVC) (SMD = 0.48, 95% CI: 0.34 to 0.62, p < 0.01), forced expiratory volume in the first second (FEV1) (SMD = 0.55, 95% CI: 0.44 to 0.67, p < 0.01), FEV1/FVC (SMD = 0.49, 95% CI: 0.32 to 0.67, p < 0.01), CD4+ T lymphocyte (CD4+) (MD = 4.04, 95% CI: 3.09 to 4.98, p < 0.01), CD8+ T lymphocyte (CD8+) (MD = -3.32, 95% CI: 4.27 to 2.38, p < 0.01) and adverse events (RR = 0.65, 95% CI: 0.43 to 0.96, p < 0.01). The combination therapy of LHQW granule and AZM may be a better strategy to treat MPP in children. However, the clinical efficacy and safety of LHQW granule require further validation. https://www.crd.york.ac.uk/PROSPERO/.

Effects of Lianhuaqingwen Capsules in adults with mild-to-moderate coronavirus disease 2019: an international, multicenter, double-blind, randomized controlled trial

BackgroundIn a randomized trial, Lianhuaqingwen (LHQW) capsule was effective for accelerating symptom recovery among patients with coronavirus disease 2019 (COVID-19). However, the lack of blinding and limited sample sizes decreased the level of clinical evidence.ObjectivesTo evaluate the efficacy and safety of LHQW capsule in adults with mild-to-moderate COVID-19.MethodsWe conducted a double-blind randomized controlled trial in adults with mild-to-moderate COVID-19 (17 sites from China, Thailand, Philippine and Vietnam). Patients received standard-of-care alone or plus LHQW capsules (4 capsules, thrice daily) for 14 days. The primary endpoint was the median time to sustained clinical improvement or resolution of nine major symptoms.ResultsThe full-analysis set consisted of 410 patients in LHQW capsules and 405 in placebo group. LHQW significantly shortened the primary endpoint in the full-analysis set (4.0 vs. 6.7 days, hazards ratio: 1.63, 95% confidence interval: 1.39-1.90). LHQW capsules shortened the median time to sustained clinical improvement or resolution of stuffy or runny nose (2.8 vs. 3.7 days), sore throat (2.0 vs. 2.6 days), cough (3.2 vs. 4.9 days), feeling hot or feverish (1.0 vs. 1.3 days), low energy or tiredness (1.3 vs. 1.9 days), and myalgia (1.5 vs. 2.0 days). The duration to sustained clinical improvement or resolution of shortness of breath, headache, and chills or shivering did not differ significantly between the two groups. Safety was comparable between the two groups. No serious adverse events were reported.InterpretationLHQW capsules promote recovery of mild-to-moderate COVID-19 via accelerating symptom resolution and were well tolerated.Trial registrationChiCTR2200056727.

Lianhua Qingwen protects LPS-induced acute lung injury by promoting M2 macrophage infiltration

Ethnopharmacological relevanceTraditional Chinese medicine Lianhua Qingwen (LHQW) was used to treat regular seasonal influenza. In recent years, LHQW exerts significant therapeutic effects in treating influenza and Coronavirus Disease 2019 (COVID-19). However, the potential mechanisms are not yet understood and need further study. Aim of studyThis study aims to look into the influence of LHQW on lung inflammation and macrophage phenotype, and to clarify the connection between macrophage plasticity and LHQW. MethodsThe cell viability, marker expression, response to LPS stimulation, and phagocytosis of Raw264.7 were detected after LHQW treatment. In an LPS-induced acute lung injury (ALI) mouse model, the alleviating effect of LHQW on lung injury was investigated. The total macrophages and M2 macrophages in mice lungs and the peripheral blood monocytes after LHQW treatment were detected. The cell viability and polarization of peripheral blood macrophages treated with LHQW were detected. ResultsHere, we demonstrate that LHQW protects LPS-induced ALI by promoting M2 macrophage infiltration. LHQW treatment inhibited the inflammatory response and pro-inflammatory phenotype of Raw264.7 macrophages. High concentrations of LHQW promoted the phagocytic capacity of Raw264.7 macrophages. In an ALI mouse model, LHQW alleviated lung injury and no significant hepatotoxicity was observed. By Immunohistochemistry (IHC) analysis, LHQW increased the infiltration of macrophages, mainly M2 macrophages. Consistent with Raw264.7, LHQW also decreased the expression of M1 markers in peripheral blood macrophages. In addition, LHQW blood plasma promoted the M2-type polarization of peripheral blood macrophages. ConclusionsTaken together, our data demonstrate that LHQW reduces the inflammatory response and ameliorates acute lung injury by promoting anti-inflammatory polarization of macrophages.

A novel strategy for eliminating antibiotic resistance genes during fertilization of dewatered sludge by earthworms: Vermicomposting practice using Chinese herbal residues derived from Lianhua Qingwen as a bulking material

Vermicomposting is a sustainable sludge recycling technology that utilizes an eco-friendly composting using earthworms and microorganisms. However, a high abundance of antibiotic resistance genes (ARGs) remains in dewatered sludge that is not satisfactorily eliminated by vermicomposting. Chinese herbs have played a major role in curing many diseases in East Asia, leading to a large amount of Chinese herbal residues (CHRs) are difficult to dispose of. The present study investigated the feasibility of CHRs on the ARGs reduction in dewatered sludge during vermicomposting. The CHRs derived from Lianhua Qingwen were added separately to sludge with weight ratios of 0%, 10%, 30%, and 50%; sludge was then vermicomposted for 30 days. The results showed that co-vermicomposting of sludge and CHRs is a feasible strategy. The CHR treatments significantly (P < 0.05) decreased antibiotic concentration and bacterial population by 23.64%–49.68% and 42.58%–93.07%, respectively, compared to counterpart. Compared to the control, the CHR addition lowered the absolute abundances of macrolide, tetracycline, and sulfonamide ARGs by 42.69%–85.15%, 22.03%–75.24%, and 23.59%–90.66%, respectively. In addition, sludge containing 30% CHRs showed significant (P < 0.05) elimination of intⅠ-1 and tnpA-4 genes with abundance reductions of 71.40% and 52.33%, respectively, relative to the control. This study suggests that the CHRs can effectively reduce ARGs content in sludge by decreasing the bacterial population and horizontal gene transfer capacity during vermicomposting.

Ultrasound treatment of herbal extraction residue to enhance enzymatic saccharification

The utilization of herbal extraction residues (HERs) for production of valuable products has gained significant momentum in recent years. In this study, Lianhua Qingwen residue (LQR) was selected as a representative HER for enzymatic saccharification. By subjecting starch-containing raw unpretreated LQR to direct hydrolysis using a combination of cellulolytic and amylolytic enzyme, a glucan conversion of around 60 % was achieved within 48 h. To further enhance the hydrolysis rate and yield, ultrasound treatment of LQR samples was conducted. Investigation into the effect of ultrasound treatment on subsequent enzymatic saccharification revealed a noteworthy acceleration in the saccharification rate of LQR, exceeding 20 % within 10 h of hydrolysis time. Notably, this enhancement was achieved even when the substrate concentration was high at 10 % under optimized conditions of 5 min of sonication at a power intensity of 1.20 kW/cm2 and a temperature of 50 °C. The improvement in efficiency can be attributed to the disruptive effect of ultrasound treatment on the structure of LQR, leading to a reduction in particle size. Consequently, the LQR particles exhibited better contact with the enzyme, promoting a more efficient saccharification process. These findings suggest that ultrasound technology holds considerable potential for enhancing the enzymatic saccharification of HERs.

Stepwise co-fermented traditional Chinese medicine byproducts improve antioxidant and anti-inflammatory effects in a piglet model.

Lianhua Qingwen capsule is a traditional Chinese medicine (TCM) formula having antiviral and anti-inflammatory activities. During capsule production, a large amount of byproducts will be yielded and disposed of as waste by burying. Resourceful utilization of these kinds of TCM byproducts as feed additives through stage-based co-fermentation using enzyme and probiotics could reduce environmental stress and resource shortage. The in vitro characterization and the supplementary effects of fermented TCM byproducts (FTCM) for weaned piglets (initial body weight: 7.23 ± 0.33 kg; dose: basal diet + 300 mg kg-1 FTCM) were investigated. Higher reducing sugar content, total flavonoid content, flavonoid compounds (e.g. tectoridin, tricetin, flavone, apigenin, naringenin) and total antioxidant activity were determined in the FTCM compared to spontaneously fermented and unfermented materials. Supplementation of the FTCM to piglets did not significantly affect the feed intake, body weight gain and feed/gain ratio, but significantly decreased a proinflammatory cytokine, IL-8, and increased intestinal total antioxidant activity (TAC) and superoxide dismutase (SOD) activity. Moreover, FTCM supplementation increased α-diversity of the colonic microbiota accompanied with increased abundance of Prevotella genus and Treponema berlinense species. Correlation analysis indicates that T. berlinense is responsible for the decreased IL-8 level and enhanced intestinal TAC and SOD activities which might be mediated by a homoserine lactone molecule (3-oxo-C14). Overall, the stepwise co-fermentation enriched bioactive compounds within the TCM byproducts and their dietary supplementation did not generate any side effect on growth performance but displayed beneficial effects on enrichment of potential probiotic T. berlinense and relevant functions. © 2023 Society of Chemical Industry.

Traditional Chinese medicine (Lianhua Qingwen) as an add-on to Western medicine for mild to moderate COVID-19 patients: A meta-analysis

Abstract Background: Proprietary traditional Chinese medicine (TCM) such as Lianhua Qingwen (LQ) has been promoted to be an over-the-counter product for treating infectious diseases including COVID-19. This meta-analysis aimed to evaluate the efficacy of LQ in adults with mild or moderate COVID-19 diseases. Materials and Methods: The authors conducted the literature search using six electronic databases (Chinese and English) from the inception dates of the different database to October 31, 2022, using search for relevant keywords, that is, “severe acute respiratory syndrome coronavirus 2,” “COVID-19,” “Lianhuaqingwen,” and “Lianhua Qingwen” to identify randomized controlled trials (RCTs). Three reviewers independently identified studies, extracted the data, and assessed study quality. All analyses were conducted on RevMan 5.3. Results: A total of 6 RCT studies involving patients with COVID-19 were identified according to the inclusion and exclusion criteria. The quality of included studies was moderate. LQ was effective in improving overall clinical efficacy (RR = 1.25; 95% CI: 1.14–1.36; P &lt; 0.001), and relieved three features, that is, cough (WMD = –2.04; 95% CI: –3.92 to –0.17; P = 0.03), fatigue (WMD= –2.58; 95% CI: –3.45 to –1.71; P &lt; 0.001), and chest CT resolution (RR = 1.21; 95% CI: 1.02–1.43; P = 0.03) but not resolution of fever (WMD = –0.46; 95% CI: –1.54 to 0.62; P = 0.40) among adults with mild or moderate COVID-19. LQ was also effective in reducing the rate of conversion to severe cases (RR = 0.57; 95% CI: 0.37–0.86; P = 0.007). The adverse events rate (RR = 0.74; 95% CI: 0.40–1.37; P = 0.35) were similar between LQ group and the control group. Conclusion: This meta-analysis of six RCT shows that the Lianhua Qingwe (LQ) as an add-on to Western medicine achieves a higher overall clinical efficacy, faster resolution of cough, fatigue and chest CT changes than Western medicine alone in COVID patients. LQ is also effective in reducing the rate of conversion to severe cases. Further double-blinded placebo-controlled randomized studies are warranted for LQ as a stand-alone treatment for the “heat” subtype of mild to moderate COVID diseases.

Guideline on treating community-acquired pneumonia with Chinese patent medicines

Community-acquired pneumonia (CAP) is one of the most common infectious diseases, and its morbidity and mortality increase with age. Resistance and mutations development make the use of anti-infective therapy challenging. Chinese patent medicines (CPMs) are often used to treat CAP in China and well tolerable. However, currently there are no evidence-based guideline for the treatment of CAP with CPMs, and the misuse of CPMs is common. Therefore, we established a guideline panel to develop this guideline. We identified six clinical questions through two rounds of survey, and we then systematically searched relevant evidence and performed meta-analyses, evidence summaries and GRADE decision tables to draft recommendations, which were then voted on by a consensus panel using the Delphi method. Finally, we developed ten recommendations based on evidence synthesis and expert consensus. For the treatment of severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Xuebijing injection, Shenfu injection, and Shenmai injection respectively. For the treatment of non-severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Lianhua Qingwen capsule/granule, Qingfei Xiaoyan Pill and Shufeng Jiedu capsule respectively. CPMs have great potential to help in the fight against CAP worldwide, but more high-quality studies are still needed to strengthen the evidence.

Efficacy and safety of Lianhuaqingwen capsules in high-risk common type COVID-19 pneumonia: A multicenter retrospective study

Objective: To evaluate the clinical safety and efficacy of Lianhuaqingwen (LHQW) capsules in patients with high-risk common type COVID-19 pneumonia. Methods: A retrospective multicenter study on 383 high-risk common type COVID-19 pneumonia cases was conducted. Patients were categorized as the standard treatment (SDT) group (n=168) and the LHQW+SDT group (n=215). The primary endpoint was the rate of symptom (fever, fatigue, coughing) recovery and the secondary endpoints included the time to symptom recovery, the proportion of patients with improvement in chest CT images, the proportion of patients with clinical cure, the timing and rate of negative conversion of SARS-CoV-2 RNA assay. Results: The recovery rate was significantly higher in the LHQW+SDT group as compared with the SDT group (89.7% vs. 72.0%, P&lt;0.01). The combined use of LHQW+SDT also showed shorter time for symptom recovery, as well as shorter time for individual symptom of fever, fatigue and coughing recovery than use of SDT alone. A higher proportion of patients in the LHQW+SDT group with improvements in chest CT images and clinical cure (77.7% vs. 57.1%, P&lt;0.01) but the proportion of patients deteriorating to severe cases (1% vs. 25%, P&lt;0.01) in this group was significant lower than those in the SDT group. No significant difference in negative conversion rate of viral assay results was observed (76.8% vs. 75.0%, P&gt;0.05). No serious adverse events were reported. Conclusions: LHQW capsules could be recommended to ameliorate clinical symptoms and reduce the rate of deteriorating to severe cases for high-risk common type COVID-19 pneumonia.

Potential herb‒drug interactions between anti-COVID-19 drugs and traditional Chinese medicine.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide. Effective treatments against COVID-19 remain urgently in need although vaccination significantly reduces the incidence, hospitalization, and mortality. At present, antiviral drugs including Nirmatrelvir/Ritonavir (PaxlovidTM), Remdesivir, and Molnupiravir have been authorized to treat COVID-19 and become more globally available. On the other hand, traditional Chinese medicine (TCM) has been used for the treatment of epidemic diseases for a long history. Currently, various TCM formulae against COVID-19 such as Qingfei Paidu decoction, Xuanfei Baidu granule, Huashi Baidu granule, Jinhua Qinggan granule, Lianhua Qingwen capsule, and Xuebijing injection have been widely used in clinical practice in China, which may cause potential herb-drug interactions (HDIs) in patients under treatment with antiviral drugs and affect the efficacy and safety of medicines. However, information on potential HDIs between the above anti-COVID-19 drugs and TCM formulae is lacking, and thus this work seeks to summarize and highlight potential HDIs between antiviral drugs and TCM formulae against COVID-19, and especially pharmacokinetic HDIs mediated by metabolizing enzymes and/or transporters. These well-characterized HDIs could provide useful information on clinical concomitant medicine use to maximize clinical outcomes and minimize adverse and toxic effects.

Quality Evaluation of Bioactive Ingredients in Lianhua Qingwen Capsule Based on Quantitative Analysis of Multicomponent by the Single Marker Method and the Chemical Recognition Patterns Method

Based on high performance liquid chromatography with the diode array detector (HPLC-DAD), a new strategy for simultaneous determination of ten bioactive ingredients in Lianhua Qingwen capsule (LHQW) was developed for comprehensive quality assessment of LHQW. In this work, with rhein regarded as the internal reference substance (IRS), the relative correction factors (RCFs) of neochlorogenic acid, amygdalin, chlorogenic acid, forsythoside A, quercitrin, phillyin, glycyrrhizic acid, isoforsythiaside, and (+) pinoresinol-β-D-glucoside were calculated for simultaneous determination of ten bioactive ingredients. More importantly, compared to previous work, the simultaneous determination of the content of ten pharmacologically important active ingredients at one detection wavelength with only one reference substance has been achieved. Based on the contents of ten bioactive ingredients, the quality of the 20 batches of LHQW samples was further analyzed by chemical recognition patterns method. Ten bioactive ingredients showed a good linear relationship in their respective concentration ranges (r ≥ 0.999). The relative standard deviations (RSDs) of precision (≤4.62%), stability (≤4.04%), repeatability (≤3.87%), and the average recovery of ten bioactive components (99.8%∼104.1%) demonstrated the QAMS developed for LHQW which had good durability. The correlation coefficient ( P &gt; 0.05 ) showed that no significant difference existed in the results of QAMS and external standard method (ESM). Hierarchical clustering analysis (HCA) divided samples into three main groups. Radar plot analysis and principal component analysis (PCA) found some quality differences existed between the three groups of samples. Orthogonal partial least-squares discrimination analysis (OPLS-DA) showed that forsythoside A could be used as the primary marker responsible for the quality differences. In conclusion, the established QAMS method combined with chemometric analysis can simultaneously determine the content of 10 active components and comprehensively evaluate the quality of different batches of LHQW. It can provide scientific basis and reference of quality consistency evaluation for the formulation manufacturers and drug regulatory authorities.

Clinical characteristics of children with Omicron variant infection in Chengdu area, China

To investigate the clinical characteristics of children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Chengdu of China. A retrospective analysis was conducted for the clinical data of 226 children who were infected with the Omicron variant of SARS-Cov-2 and were isolated and treated in Chengdu Shelter Hospital from August 28 to September 21, 2022. According to the presence or absence of clinical symptoms, they were divided into two groups: asymptomatic group and mild symptomatic group. The two groups were compared in terms of clinical characteristics, diagnosis and treatment, and prognosis. Among the 226 children infected with the Omicron variant, 71 (31.4%) were asymptomatic and 155 (68.6%) had mild symptoms. Fever and cough were the most common clinical symptoms, with fever in 95 children (61.3%) and cough in 92 children (59.4%). Of all 226 children, 188 (83.2%) received coronavirus disease 2019 (COVID-19) vaccination. The time to nucleic acid clearance ranged from 6 to 26 days, with a nucleic acid clearance rate of 58.0% (131/226). There were no significant differences among different age groups in sex, early symptoms, clinical typing, nucleic acid re-positive rate, nucleic acid clearance rate, and length of hospital stay (P>0.05). There were no significant differences between the asymptomatic and mild symptomatic groups in age, sex, underlying diseases, COVID-19 vaccination, use of Lianhua Qingwen granules, nucleic acid clearance rate, nucleic acid re-positive rate, and length of hospital stay (P>0.05). Children infected with the Omicron variant of SARS-Cov-2 in Chengdu generally have mild clinical symptoms, mainly upper respiratory tract infection, which has little threat to the health of children of different ages, and children tend to have a good overall prognosis.

Three New Chemical Constituents of Dryopteris crassirhizoma Nakai in Lianhua Qingwen Capsule and Investigation on Their Antiviral Potential Based on 3CL Hydrolase of SARS-CoV-2

Three New Chemical Constituents of Dryopteris crassirhizoma Nakai in Lianhua Qingwen Capsule and Investigation on Their Antiviral Potential Based on 3CL Hydrolase of SARS-CoV-2

Similarity and Specificity of Lianhua Qingwen and Damp-Heat Plague Formula for the Management of Mild COVID-19

Lianhua Qingwen (LHQW) and damp-heat plague formula (DHPF) have positive therapeutic outcomes on coronavirus disease 2019 (COVID-19). This study aimed to clarify the mechanisms of LHQW and DHPF in COVID-19 treatment, and examined the differences between the 2 formulas in the treatment process. This study is based on systems biology and network pharmacology; the Traditional Chinese Medicine Systems Pharmacology database and Encyclopedia of Traditional Chinese Medicine were used to compare information on LHQW and DHPF; the STRING database was used to construct the “protein–protein interaction (PPI)” and protein module networks. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment were used to analyze the intersecting targets of LHQW and DHPF. Ingenuity Pathway Analysis was used to analyze the specific targets of the 2 formulas. Molecular docking and molecular dynamic simulation were used to validate the interactions of candidate active compounds and targets. The results show that both LHQW and DHPF alleviate mild COVID-19 by relieving inflammation, increasing immunity, apoptosis, and reducing oxidative stress. Furthermore, Machiline and Estrone in Armeniacae Semen Amarum (Kuxingren) in LHQW can target neurological disease-related genes (ADRA2B, ADRA2C, and DRD2). In contrast, Ellagic acid in Paeoniae Radix Rubra (Chi Shao) in DHPF can target immunity- and inflammation-related genes (GSTA1 and GSTA2). These findings suggest that when translated into clinical applications, LHQW would likely be more potent in treating patients with nervous disorders who experienced mild COVID-19, whereas DHPF would effectively perform antioxidant and anti-inflammatory activities.

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

: 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. : 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. : 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. : 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.

Efficacy and safety of Nirmatrelvir/Ritonavir for treating the Omicron variant of COVID-19.

To evaluate the efficacy and safety of Nirmatrelvir/Ritonavir in the treatment of the Omicron variant of coronavirus disease 2019 (COVID-19). Data from 58 patients who were infected with the Omicron variant of COVID-19 were retrospectively collected. The patients were divided into two groups according to the treatment regimen they received. Patients in both groups were given Lianhua Qingwen capsules orally, three times/day, 6 g/time. The study group was given Nirmatrelvir 300 mg/Ritonavir 100 mg orally, q12h, for 5 days, and the control group was not given any antiviral drugs. The two groups were compared in terms of the change in computed tomography (CT) values of COVID-19 nucleic acid, the negative conversion time of COVID-19 RNA, hospitalization time, adverse drug reactions and COVID-19 nucleic acid re-positive tests. The time to increase the CT values in the study group was faster than that in the control group, and the CT values in the study group were significantly larger than in the control group on days four and seven (p < 0.05); The negative conversion time in the study group was shorter than the control group (Z = -2.424, p = 0.015), and the hospitalization time was also shorter (Z = -2.603, p = 0.009). There were no statistically significant adverse drug reactions during hospitalization in both groups (χ2 = 2.747, p = 0.097). None of the study group tested re-positive for SARS-CoV-2 nucleic acid after discharge. The efficacy of Nirmatrelvir/Ritonavir in the treatment of the Omicron variant of COVID-19 was positive and had good tolerance in patients.

Effect of Nasal Irrigation in Children With Omicron Variant of COVID-19 Infection.

Objective: To explore the effect of nasal irrigation on the disappearance of symptoms and nucleic acid conversion in children with Omicron variant. Methods: This quasi-experimental study included children diagnosed with asymptomatic, mild, and moderate Omicron variant infection during the isolation observation period in the Shandong Public Health Clinical Center between April 1, 2022 and May 1, 2022. The children were divided into a routine group (received Lianhua Qingwen (LhQw) Granules), isotonic saline group (received LhQw Granules combined with isotonic saline nasal irrigation), and hypertonic saline group (received LhQw Granules combined with 3% hypertonic saline nasal irrigation), respectively. The primary outcomes were the time of symptom disappearance and nucleic acid conversion time. The secondary outcomes were peripheral white blood cell count (WBC), lymphocyte count (LYM), neutrophil count (NEU), and C-reactive protein (CRP) levels. Results: A total of 60 children (7.26 ± 3.15years old) were included (20 per group). The average time of nucleic acid conversion in the 2 saline nasal irrigation groups was significantly reduced compared with the routine group (all P < 0.001), while the fever time and cough duration among the 3 groups were comparable (all P > 0.05). LYM count in the 2 saline nasal irrigation groups was significantly increased after treatment compared to before treatment and was significantly higher than in the routine group (all P < 0.05). There was no significant difference in LYM count between the isotonic and hypertonic saline groups (P = 0.76). Additionally, all children in the saline group well tolerated the treatment, and no adverse events occurred in the isotonic saline group. Conclusions: Timely use of saline nasal irrigation may promote nucleic acid conversion in children with Omicron virus infection.

Anti-inflammatory effect and component analysis of Chaihu Qingwen granules

Ethnopharmacological relevanceAs prevalent acute respiratory condition in clinical practice, acute lung injury has a quick start and severe symptoms which can harm patients physically. Chaihu Qingwen granules (CHQW) is a classic formula for the treatment of respiratory diseases. Clinical observation shows that CHQW has good efficacy in treating colds, coughs, and fevers. Aim of the studyThe aim of this study was to investigate the anti-inflammatory effect of CHQW on lipopolysaccharide (LPS)-induced acute lung injury (ALI) model in rats and to explore its potential mechanism, as well as to clarify its substance composition. Materials and methodsMale SD rats were randomly divided into the blank group, the model group, the ibuprofen group, the Lianhua Qingwen capsule group and the CHQW group (2, 4 and 8 g/kg, respectively). The LPS-induced acute lung injury (ALI) model in rats was established after pre-administration. The histopathological changes in the lung and the levels of inflammatory factors in bronchoalveolar lavage fluid (BALF) and serum of ALI rats were observed. The inflammation-related proteins toll-like receptor 4 (TLR4), inhibitory kappa B alpha (IκBα), phospho-IκBα (p-IκBα), nuclear-factor-kappa B (NF-κB), and NLR family pyrin domain containing 3(NLRP3) expression levels were measured by western blotting analysis and immunohistochemical analysis. The chemical composition of CHQW was identified by liquid chromatography-quadrupole-time of flight-mass spectrometry (LC-Q-TOF-MS). ResultsCHQW significantly ameliorated lung tissue pathological injury in LPS-induced ALI rats and decreased the release of inflammatory cytokines (interleukin-1β, interleukin-17 and tumor necrosis factor-α) in BALF and serum. In addition, CHQW decreased the expression of TLR4, p-IκBα and NF-κB proteins, increased the level of IκBα, regulated the TLR4/NF-κB signaling pathway, and inhibited the activation of NLRP3. The chemical components of CHQW were analyzed by LC-Q-TOF-MS, and a total of 48 components were identified by combining information from the literature, mainly flavonoids, organic acids, lignans, iridoids and phenylethanoid glycosides. ConclusionThe results of this study showed that the pretreatment of CHQW had a strong protective effect on LPS-induced ALI in rats, reducing lung tissue lesions and decreasing inflammatory cytokines released in BALF and serum. The protective mechanism of CHQW may be related to the inhibition of the TLR4/NF-κB signaling pathway and NLRP3 activation. The main active ingredients of CHQW are flavonoids, organic acids, lignans, iridoids and phenylethanoid glycosides.

Network Meta-analysis of oral Chinese patent medicines in treatment of acute exacerbation of chronic obstructive pulmonary disease

This study aimed to evaluate the effectiveness and safety of eight oral Chinese patent medicines in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) by network Meta-analysis. Randomized controlled trial(RCT) on the treatment of AECOPD with eight oral Chinese patent medicines was retrieved from databases including CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, EMbase, and Cochrane Library from database inception to August 6, 2022. The information was extracted from the included literature and the quality of the included studies was evaluated using the Cochrane risk of bias assessment tool. The data were analyzed using Stata SE 15.1 and ADDIS 1.16.8 software. Finally, 53 RCTs were included, with 5 289 patients involved, including 2 652 patients in the experimental group and 2 637 patients in the control group. Network Meta-analysis showed that Lianhua Qingwen Capsules+conventional western medicine were optimal in improving clinical effective rate, Shufeng Jiedu Capsules+conventional western medicine in improving FEV1/FVC, Qingqi Huatan Pills+conventional western medicine in improving FEV1%pred, Feilike Mixture(Capsules)+conventional western medicine in improving PaO_2, Lianhua Qingwen Capsules+conventional western medicine in reducing PaCO_2, and Qingqi Huatan Pills+conventional western medicine in reducing C-reactive protein(CRP). In terms of safety, most of them were gastrointestinal symptoms, and no serious adverse reactions were reported. When the clinical effective rate was taken as the comprehensive index of efficacy evaluation, Lianhua Qingwen Capsules+conventional western medicine were the most likely to be the best treatment for AECOPD. There are some limitations in the conclusion of this study. It only provides references for clinical medication.