PMC:7104236 / 64233-70121 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7104236","sourcedb":"PMC","sourceid":"7104236","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7104236","text":"4 Discussion\nIn this review, we systematically summarized and analyzed all the herbal formulae provided by the guidelines according to their pattern identification and herbal compositions. The Chinese medicine herbs used for the prevention of COVID-19 based on 23 provincial guidelines issued in mainland China were reviewed and analyzed in a recent publication.5 With reference to it, but in contrast, our review focused on the traditional medicine treatment measures recommended by all available guidelines. We extended our search of guidelines to nearby countries and reviewed guidelines issued by mainland China (25 provincial guidelines and 1 national guideline) and South Korea to conduct a more comprehensive review.\nFor the frequency analysis of herbs used in every Chinese guideline for COVID-19, each stage has several herbs that were not shown in the list of top 10 frequently used herbs for other stages. For instance, Magnoliae Officinalis Cortex and Platycodonis Radix could only be seen for the mild stage. Magnoliae Officinalis Cortex is often prescribed for the treatment of various gastrointestinal problems, such as fullness in the stomach, vomiting, and diarrhea from dampness. Platycodonis Radix is usually prescribed for coughs with excessive phlegm and sore throat due to exogenous pathogens.16 It could be inferred that gastrointestinal symptoms due to dampness and sore throat as well as coughing with sputum are the primary clinical manifestation in the mild stage of COVID-19. The active components contained in these 2 herbs also showed anti-inflammatory benefits in the in vivo studies of the acute lung injury model.17, 18\nIn the severe stage, Aconiti Lateralis Radix Praeparata and Rhei Radix et Rhizoma were identified to be frequently used but not in other stages. This could be due to the extreme PIs and clinical manifestations that are only found in severe patients. Aconiti Lateralis Radix Praeparata is known to treat heart failure and has anti-asthmatic and anti-epileptic properties.19, 20 The combination of Aconiti Lateralis Radix Praeparata and Rhei Radix et Rhizoma is also highly compatible, and this combination is often used in various herbal formulae. As these herbs have a certain degree of toxicity, they have to be used in caution and preferably are reserved for extreme cases.21\nMoreover, there are 4 herbal medicines available only in the severe stage. Angong Niuhuang Pill, Zhi Bao Dan, Zi Xue San, and Su He Xiang Pill played a significant role in the severe stage treatment. Angong Niuhuang Pill, Zhi Bao Dan, Zi Xue San belongs to the First Aid Three Treasures of Chinese Medicine22, which is cold in nature and is used when the patient loses consciousness due to infectious disease-induced heat. In contrast, Su He Xiang Pill is an aromatic warm-natured medicine and is used when the patient loses consciousness due to a cold pathogen. All 4 herbal medicines were prescribed in different conditions of extremely severe or critical stages based on the patients’ clinical manifestation, and they shared the same therapeutic principle to clear the orifices.\nPinelliae Praeparatum cum Zingiberis and Citri Reticulatae Pericarpium were only identified in the list of frequently used herbs in the recovery stage where patients may suffer from white and thin phlegm after their recovery. Pinelliae Praeparatum cum Zingiberis and Citri Reticulatae Pericarpium are major components of the herbal formula Er Chen Tang, which is usually prescribed to clear phlegm and dampness.16 Another herb, Ophiopogonis Radix, is conventionally used for nourishing yin and promoting fluid production. This herb is prescribed for dry cough caused by yin deficiency and is especially suitable for patients in the recovered stage.16\nGlycyrrhizae Radix et Rhizoma is the herb with the highest frequency use overall regardless of disease stage. It is one of the antiviral herbal medicine which is approved by the China Food and Drug Administration (CFDA). Many studies have reported that this herb inhibits viral attachment, entry and replication, which is previously used in combating SARS.23, 24 Moreover, Glycyrrhizae Radix et Rhizoma also has an anti-inflammatory quality which is suitable for the treatment of inflammatory lung condition in COVID-19.25\nThe herbal formula Qingfei Paidu Tang was recommended by both Chinese and Korean guidelines. In the Chinese guidelines, this formula is recommended for all stages. According to a recent publication,26 this herbal formula increases immunology and reduces inflammation by targeting the lung and spleen, which are the disease pathways of COVID-19. However, the herb Farfarae Flos was removed in the Korean guidelines due to its safety and toxicity.27\nThis review has several limitations. First, the results of this review were obtained after standardizing the terms of the PIs and herbal formulae. Therefore, there might be a difference in the terms used in the provided guidelines. Second, this review does not include any direct evidence on the efficacy of traditional medicine in the clinical treatment of COVID-19. The results provided by this review are a summary of the traditional medicine guidelines, which can only be considered as guidance, and clinical verification is still required. Third, although this review summarized the most recent version of the national and provincial guidelines available up to March 6, 2020, the guidelines issued on COVID-19 by the Chinese government are constantly and frequently updated.\nIn conclusion, this review can be used as a reference in the traditional medicine treatment of COVID-19. Clinical studies are required to evaluate the efficacy and safety of traditional medicine and to provide clinical evidence. The integration of traditional medicine into conventional treatment may be an alternative approach for the treatment of COVID-19 in the 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