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Traditional Chinese Medicine
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How is the Traditional Chinese Medicine, Qingfei Detoxication Decoction, used in China to prevent and treat COVID19?

 

Authors: Tingyi Yang MPH candidate, Vojislav Maric MS1; UC San Diego

Completed on:  March 28, 2020

Last updated on: May 1, 2020

Reviewed by: Marsha-Gail Davis MD

Reviewed on: April 30, 2020

This summary was written as part of the CoRESPOND Earth 2.0 COVID-19 Rapid Response at UC San Diego.  For more information about the project, please visit http://earth2-covid.ucsd.edu

Key findings:

Related topics: None

Summary of information:

Traditional Chinese Medicine (TCM) has been used to provide complementary and alternative treatments to patients in China for centuries.1 Due to the prior use of TCM during the SARS epidemic response in China in 2002, patients infected by the COVID19 have been treated with various TCM along with conventional medicine.

In China, a particular form of TCM, Qingfei Detoxication Decoction (QFPDT), which literally means cleaning the lung in Chinese, has been positively correlated with a lower case fatality rate and lower infection rate in volunteers and workers in the hospital when compared with a control group in SARS epidemic.5 However, this was not a high quality, randomized control trial.  According to Xiaolin Tong, the specialist group leader of the Chinese National Administration of Traditional Medicine, the effective rate of the Qingfei Detoxication Decoction is 97.78%.2 Along with TCM, more than 90% of patients have received anti-viral treatment and symptomatic treatment which includes respiratory support, circulatory support, and immunity support to speed up the recovery.8

Components of QFPDT and its targets

The formula of Qingfei Paidu Decoction consists of Ephedrae Herba, Glycyrrhizae Radix et Rhizoma Praeprata cum Melle, Armeniacae Semen Amarum, Gypsum Fibrosum, Cinnamomi Ramulus, Alismatis Rhizoma, Polyporus, Atractylodis Macrocephalae Rhizoma, Poria, Bupleuri Radix, Scutellariae Radix, Pinelliae Rhizoma Praepratum cum Zingibere et Alumine, Zingiberis Rhizoma Recens, Asteris Radix et Rhizoma, Farfarae Flos, Belamcandae Rhizoma, Asari Radix et Rhizoma, Dioscoreae Rhizoma, Aurantii Fructus Immaturus, Citri Reticulatae Pericarpium, and Pogostemonis Herba.11 The variety of herbs contain 948 compounds which correspond to 790 potential targets, in which 232 of them were co-expressed with the receptor of SARS-COV-2 --- ACE2.4  Since COVID19 symptoms can be caused by the disordered expression of ACE, TCM containing such targets could potentially have a positive impact of COVID-19 virology and symptomatology.4   The decoction also primarily focuses on the lung since 16 herbs target the lung site, the organ mostly impacted by COVID19.7 Additionally, QFPDT contains adenosine and vernine which inhibit the replication of virus via manipulating ribosomal proteins in the host.4 The potential antiviral effect of QFPDT is further supported by the interaction of 48 molecular targets of QFPDT with six HIV viral proteins.4

A study investigating the effect of various herbs used in Chinese Medicine looked at the biological evidence of the anti-COVID19 components and oral bio-availability in the herbs.13 Herbs that were verified in PubMed and shown to be effective in treating SARS and MERS were selected.13 Using molecular docking technology, the compounds of the herbs were shown to bind to the COVID19 protein model.13 Twenty six herbs were found to attenuate viral infection, immune and inflammatory response, and hypoxia response.13 Among the 26 herbs noted in the study, Farfarae Flos, Licorice (Glycyrrhiza uralensis), and Asteris radix et rhizoma were used in Qingfei Paidu Decoction. Additionally, there were seven natural antiviral compounds that were found to be present in the herbs.13 

Effect of TCM on CT scan findings

Abnormal findings on chest CT scans can be a helpful sign to support the diagnosis and management of COVID19. Patchy shadows of the bilateral lungs and ground‐glass opacities have been identified as typical radiographic signs of COVID‐19.6  While ICU patients show bilateral multiple lobular and subsegmental areas of consolidation, non-ICU patients present more with bilateral ground glass opacities in addition to subsegmental areas of consolidation.9 Research may support that TCM treatment reduces inflammation and improves chest CT results.   Under TCM treatments, the tracheobronchial shadow becomes normal and the ground-glass shadow decreases after 6 days.7 

Cytokine storm/inflammation

Wan et al. points out that the COVID-19 virus (SARS Cov-2) attacks the immune system due to the decreased count of lymphocytes in patients, and that lymphocytopenia is associated with the cytokine storm.6 Another study that observed cytokine storm in COVID19 patients suggests that the severity of the disease is associated with cytokine storm.9 Using network pharmacology, a network analysis which investigates the biological and pharmacological mechanism of multiple TCM compounds in the body,  Zhao et al. found that the components in QFPDT have immunosuppressive effects by regulating immune pathways and inhibiting cytokine-related pathways to reduce inflammation due to excessive immune response.4 Furthermore, molecular docking predicts that QFPDT is effective in targeting parts of the anti-inflammatory/inflammatory pathway including AKT1, IL6, MAPK8, MAPK1, and JUN network10.   In addition, a function enrichment analysis shows the effect of QFPDT in the HIF-1 and TLRs signaling pathways.10 Similarly, another form of TCM named Lianhua Qingwen (LH) has been shown to inhibit the elevated expressions of cytokines TNF-α, IL-6, CCL-2/MCP-1, and CXCL-10/IP-10, which suggests that LH could be effective in inhibiting cytokine storms induced by SARS-COV-2, though this has not yet been confirmed in vivo.12

 

The Qingfei Detoxication Decoction treatment is now recommended to the whole country by the National Health Administration and National Administration of Traditional Medicine. 2 Along with Qingfei Paidu Decoction, other TCMs that are under clinical trials include Xue Bi Jing Injection, Re Du Ning Injection, Tan Re Qing Injection, Shen Fu Injection, Sheng Mai Injection, Shen Mai Injection, Su He Xiang Pill, An Gong Niu Huang Pill.1

Additional information:

The Qingfei Detox Decoction is registered on the Chinese Clinical Trial Registry. The measured outcomes include body temperature, systemic symptoms, respiratory symptoms, chest image changes, “Detection of novel coronavirus nucleic acid two consecutive negative time”, and TCM syndrome changes.3 More details please see the website: [http://www.chictr.org.cn/showproj.aspx?proj=50960]

Gaps in knowledge:

There remains a lack of robust RCTs to further characterize the true effect of TCM on COVID-19.

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References

1.         Yang Y, Islam MS, Wang J, Li Y, Chen X. Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective. Int J Biol Sci 2020; 16(10):1708-1717. doi:10.7150/ijbs.45538. Available from http://www.ijbs.com/v16p1708.htm

2.         Academician Tong Xiaolin: The total effective rate of QIngfei Paidu Decoction was 97%, and no patient’s disease status changed from light to heavy   http://www.xinhuanet.com/politics/2020-03/17/c_1125724822.htm

3.         Chinese Clinical Trial Registry: http://www.chictr.org.cn/showproj.aspx?proj=50960

4.         Zhao, J., S. Tian, J. Yang, J. Liu and W. Zhang. Investigating the mechanism of Qing-Fei-Pai-DuTang for the treatment of novel coronavirus pneumonia by network pharmacology. Chin. Tradit. Herb. Drugs, 2020, http://jtp.cnki.net/bilingual/detail/html/ZCYO20200216002#5

5.         T.F. Lau, Leung PC, Wong ELY, Fong C, Cheng KF, Zhang SC, et al. Using Herbal Medicine as a Means of Prevention Experience During the SARS Crisis. Am J Chin Med. 2005;33:345-56

6.        Wan, S., Xiang, Y., Fang, W., Zheng, Y., Li, B., Hu, Y., Lang, C., Huang, D., Sun, Q., Xiong, Y., Huang, X., Lv, J., Luo, Y., Li, S., Yang, H., Huang, G., Yang, R. Clinical Features and Treatment of COVID19 Patients in Northeast Chongqing. J. Med. Virol. https://doi.org/10.1002/jmv.25783

7.        Ren, J., Zhang, A., Wang, X. Traditional Chinese Medicine for COVID19 Treatment. Pharmacol Res. 2020 Mar 4;155:104743. doi: 10.1016/j.phrs.2020.104743.

8.        Publicity Department of the People’s Republic of China. Press conference of the joint prevention and control mechanism of state council on Feb 17, 2020. http://www.nhc.gov.cn/xcs/fkdt/202002/f12a62d10c2a48c6895cedf2faea6e1f.shtml

9.        Huang C. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020

10.        H. Wu, J.Q. Wang, Y.W. Yang, T.Y. Li, Y.J. Cao, Y.X. Qu, Y.J. Jin, C.N. Zhang, Y.K. Sun, Preliminary exploration of the mechanism of Qingfei Paidu decoction against novel coronavirus pneumonia based on network pharmacology and molecular docking technology, Acta Pharmaceutica Sinica. DOI: 10.16438/j.0513-4870.2020-0136.

11.        National Health Commission of the People’s Republic of China. Guideline on diagnosis and treatment of COVID-19 (Trial 6th edition). http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml

12.        Runfeng L, Yunlong H, Jicheng H, et al. Lianhuaqingwen exerts anti-viral and anti-inflammatory activity against novel coronavirus (SARS-CoV-2) [published online ahead of print, 2020 Mar 20]. Pharmacol Res. 2020;104761. doi:10.1016/j.phrs.2020.104761

13.        Zhang, D. H., Wu, K. L., Zhang, X., Deng, S. Q., & Peng, B. (2020). In silico screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus. Journal of integrative medicine, 18(2), 152–158. https://doi.org/10.1016/j.joim.2020.02.005