File Name: chinese herbal formulas and applications pharmacological effects and clinical research .zip
Efficacy, safety, quality control, marketing and regulatory guidelines for herbal medicines phytotherapeutic agents. This review highlights the current advances in knowledge about the safety, efficacy, quality control, marketing and regulatory aspects of botanical medicines. Phytotherapeutic agents are standardized herbal preparations consisting of complex mixtures of one or more plants which contain as active ingredients plant parts or plant material in the crude or processed state. A marked growth in the worldwide phytotherapeutic market has occurred over the last 15 years.
China has achieved rapid containment of this highly infectious disease following the principles of early detection, early quarantine and early treatment with integrated traditional Chinese and Western medicine.
The inclusion of traditional Chinese medicine TCM in the Chinese protocol is based on its successful historic experience in fighting against pestilence. Current findings have shown that the Chinese medicine can reduce the incidence of severe or critical events, improve clinical recovery and help alleviate symptoms such as cough or fever. The pharmacological studies have suggested that Chinese medicine is effective for COVID probably through its host-directed regulation and certain antiviral effects.
It could reduce the incidence of severe or critical events and help alleviate symptoms. The possible mechanisms might be related with its host-directed regulation and certain antiviral effects. People with COVID have had a wide range of symptoms from mild symptoms such as fever, cough and fatigue, to severe illness such as acute respiratory distress syndrome ARDS likely precipitated by a cytokine storm 1 , 2.
Since the outbreak, China has taken unprecedented public health interventions to contain the spread of the virus within China 5 , and has achieved rapid containment of COVID infection following the principles of early detection, early quarantine and early treatment. China's treatment protocol using integrated traditional Chinese and Western medicine attracted increasing attention of the international community.
Traditional Chinese medicine treatment was included in the third version of integrative treatment protocol officially released on January 22, A body of evidence from clinical practice and research has shown that integrated traditional Chinese and Western medicine played an important role for China's successful battle with COVID The National Administration of traditional Chinese medicine recommended traditional Chinese medicine based on pattern identification from the TCM perspective.
So far, the protocol has been updated seven times. There is no specific antiviral medicine yet to prevent or treat this condition. Right after the COVID outbreak, traditional Chinese medicine doctors rushed to the frontline of the epidemic to work with doctors of modern medicine to control the disease and collect clinical data from the TCM perspective.
This firsthand information is essential to pattern identification, treatment recommendations, and national prevention and treatment protocol. Their research paper was published online on January 29, In Trial Version 3, there were no disease stages; just four patterns and four recommended formulas for clinical reference.
In Trial Version 4, there were two periods: medical observation for suspected cases and clinical treatment for confirmed cases. The protocol recommended five types of Chinese patent medicine for patients during medical observation. Besides individualized traditional Chinese medicine decoction, the protocol also recommended four Chinese medicine injections for patients during clinical treatment, including Xiyanping Injection , Xuebijing Injection , Shenfu Injection and Shengmai Injection.
In addition, Fangfeng Tongsheng Zhiji was removed from the recommended lists of Chinese patent medicine and four Chinese medicine injections were added Table 2 , including Reduning Injection , Tanreqing Injection , Xingnaojing Injection major ingredients: moschus, borneol, Gardeniae Fructus, etc. The three Chinese patent medicines, i. Among the three herbal formulas, i. The understanding of pestilence has been documented throughout the history of traditional Chinese medicine TCM.
These theories have evolved over time and played a significant role in epidemic control. Some examples of great creativity became the inspiration of modern medical breakthroughs, such as variolation for the eradication of smallpox, and the discovery of artemisinin for malaria.
From before common era BCE to , China suffered at least devastating epidemic diseases. Unlike the Antonine Plaque — BCE and Spanish flu pandemic in that killed millions of lives, epidemic disease in the history of China had been contained soon after the outbreaks. Over time, these successful experiences contributed to an established system to infectious diseases intervention using herbal medicine, non-drug therapies, and numerous single or compound formulas or techniques, such as the well-known Artemisiae Annuae for malaria and the use of variolation for smallpox Traditional Chinese medicine shares similar understandings of infectious diseases with modern medicine.
It believes that the emergence, outbreak and threat of infectious diseases are closely associated with three interactive factors—epidemic pathogens pathogenic microorganism , living environment and host human being, Fig. A diagrammatic illustration: essential TCM theory on pestilence prevention and treatment. This includes prevention and treatment strategies. Prevention strategy: to stop pathogens from attacking the host, change the existing environment of pathogens, and make the host stay away from pathogens.
Treatment strategy: to reinforce healthy qi to boost the host's ability to defend against diseases, and to remove pathogenic factors, i. After disease occurrence, active measures need to be taken to prevent mild conditions from developing into severe or critical ones. It is also important to take precautions to prevent recurrence upon recovery.
To reinforce healthy qi requires regulating the body functions, achieving homeostasis, and maximizing the body's self-defending ability. In addition to Chinese medicine decoction or patent medicine, nondrug intervention methods include acupuncture, tuina Chinese therapeutic massage , qigong, mental adjustment and nutrition. To treat disease by three categories of three etiological factors requires the physician to conduct individualized precision intervention according to different timing, geographic region and population groups.
The Shang Han Lun Treatise on Cold Damage written in the 2nd century is another classic text of traditional Chinese medicine, which preliminarily established the system of Chinese herbal medicine. This text recorded a total of compound formulas and usage for infectious diseases. Like precision medicine, these formulas are modified according to individual conditions.
As most of these formulas are directed at regulating the body functions, they have also been widely used for noncommunicable diseases in China and Japan. They have survived the passage of time and are still regarded as having great relevance in today's environment. The recommended formulas Fig.
A brief history timeline: traditional Chinese medicine for pestilence prevention and treatment of infectious diseases. Unlike evidence-based modern medicine, traditional Chinese medicine is an empirical medicine developed on accumulated clinical observations gathered over centuries of practice.
It not only deals with the etiological factor to eradicate the pathogenic microbial, but also supports the body's immune function to help fight the disease and ameliorate its consequences. In ancient times, when facing infectious disease, specific pathogens could not be identified; however, doctors could observe the patient's sign and symptoms, assess the condition and develop strategies and formulas for the different stages of the illness.
The results of 16 published papers on this topic not including case reports and a systematic review on 8 clinical trials cases have suggested that integrated traditional Chinese and Western medicine can reduce the incidence of severe or critical events, improve clinical recovery and help alleviate symptoms such as cough or fever Two papers 17 , 18 reported the detailed information of its adverse reactions during the treatment for COVID A search was performed on clinical trial registries of privately and publicly funded clinical trials worldwide.
We selected Chinese clinical trial registries www. Our search strategy was designed to identify all the clinical trials that were registered for COVID The research subjects of the trials include confirmed cases mild, moderate, and convalescent , suspected cases and those who had been in close contact with a confirmed case.
The planned sample size was 52, cases. The smallest sample size was 16 cases case-control study, Guangzhou. The largest sample size was 20, cases Health Service Research, Chengdu. Conventional Western medicine was used as control symptomatic treatment or standard treatment. These trials measured outcomes, including primary outcomes such as time to defervescence, routine blood test, pulmonary functions, chest CT scan, St.
Ever since the outbreak of COVID epidemic, ethical reviews have been performed on all related clinical studies to protect research participants. On February 13, , the operation instructions on using teleconference for ethical review were published on Chinese Medical Ethics online On March 23, , Chinese scholars published a paper on ethical review online in JAMA 25 , which summarized ethical committee reviews and found that the ethical approval during an epidemic outbreak was more quickly; however, the review standards were not lowered.
According to a retrospective study on COVID cases treated in Wuhan University Tongren Hospital, patients who took Chinese medicine preparations had a smaller death risk than those who did not 0. Preliminary study findings have shown that integrated traditional Chinese and Western medicine had a shorter time to defervescence than standard Western medicine treatment alone. Compared with control group, the recovery rate In terms of adverse reactions, Jinhua Qinggan Granules caused diarrhea in The author advised modification for individual patients, for example, Qingfei Paidu Decoction is not indicated for patients with a red tongue with scanty coating due to stomach yin deficiency.
It is also worth noting some adverse reactions are associated with the combination of Western medication, for example, the serum transaminase can be restored normal after discontinuation of arbidol alone or discontinuation of both arbidol and Qingfei Paidu Decoction. Their study underlines the need to register as much details as possible on clinical trials registries during outbreaks in order to inform the development of future trials.
And they believe reporting as much details as possible is key to have consistent clinical trials and to enhance the reproducibility of the results, especially as studies are more often associated with a low number of planned inclusions and composite or weak outcomes that can limit the efficacy assessment of the treatments. Our study data found similar limitations in registered TCM clinical trials. As shown in Table 4 , except for three randomized controlled trials, the rest of the published clinical studies are observational, whose overall evidence is relatively low.
Due to insufficient studies and a large heterogeneity in outcome measures, it is too soon to conduct a systematic review. Higher levels of evidence are further needed to justify the efficacy of traditional Chinese medicine treatment for COVID It is worth noting that it is challenging to conduct large-scale randomized controlled trials RCT during an ongoing pandemic, especially the ethical issue of RCTS with a double-blind design.
Chinese medicine formulas recommended in the Chinese protocol are composed of multiple ingredients. The roles of these ingredients are categorized into monarch, minister, assistant and guide according to their roles. This categorization is based on the two characteristics of traditional Chinese medicine: a holistic concept and treatment based on pattern identification. With multiple components, multiple targets and multiple links, compound Chinese medicine formulas produce an overall regulation of the body.
Studies have shown that some Chinese medicine indirectly inhibit virus growth via host-directed regulation to boost the immune function of the host or inhibit virus-mediated inflammatory response, and some Chinese medicine can directly exhibit broad-spectrum antiviral effects, such as Jin Yin Hua Flos Lonicerae Japonicae , Huang Qin Radix Scutellariae and Da Qing Ye Folium Isatidis In the past decade, scientists have confirmed multiple components in TCM with immune regulatory and antiviral activity.
Consequently, Lianhua Qingwen Capsules have antiviral effect as well as anti-inflammatory and immune mechanism of action. Network pharmacological study 52 has suggested that the compound formula Qingfei Paidu Decoction contains chemical components, which act via modulation of potential target proteins.
The protein—protein interactions may form a molecular network. As modulations of these targets may regulate immunity- and cytokine-related pathways, inhibit the activation of cytokines, and thus mediate overactive immune response and reduce inflammation, multiple active components of Chinese medicine have been found to protect organ damage from virus infection, virus replication and secondary inflammatory factors.
They identified 39 chemical components, among which 9 can be rapidly absorbed and distributed over multiple tissues. These findings provided pharmacokinetic information for its further efficacy study and clinical use.
Previous studies have suggested that ephedrine, pseudoephedrine and amygdalin have notable anti-inflammatory 54 and immunomodulatory actions 55 , and therefore, are main components in therapeutic drugs for respiratory disorders. Network pharmacology and molecular docking have also been used in potential targets and action mechanism of recommended formulas in the Diagnosis and Treatment Protocol for COVID 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , They found that some natural flavanoids, licoflavonol from Glycyrrhiza uralensis , cosmosiin from Scutellaria baicalensis , neohesperidin from Citrus aurantium , mangostin from Garcinia mangostana , kouitchenside D from Swertia kouitchensis , excoecariatoxin from Excoecaria agallocha , phyllaemblicin G7 from Phyllanthus emblica , and piceatannol from Vitis vinifera , exhibited high binding affinity.
The only compound that could target the binding interface between Spike and ACE2 was hesperidin. Its active antiviral components include chlorogenic acid 75 , flavonoids and triterpene saponins Huang Qin Radix Scutellariae can inhibit respiratory syncytial virus, influenza virus and Coxsackie virus 78 , 79 , Its chemical components include flavonoids, flavonols baicalin, baicalein, wogonoside, wogonin, dihydrobaicalin, etc.
Rao and his team 82 screened baicalein, a SARS-CoV 3CL protease inhibitor, and assumed that flavonoids have the similar activity as they share the similar structure. Recent studies reported the first family case of COVID achieved rapid recovery to combined Western medicine and Shuanghuanglian Oral Liquid without obvious adverse reactions; however, sufficient evidence is needed for recommended clinical use
Human diseases, especially infectious ones, have been evolving constantly. However, their treatment strategies are not developing quickly. Some diseases are caused by a variety of factors with very complex pathologies, and the use of a single drug cannot solve these problems. TCM formulae contain multiple herbs with multitarget, multichannel, and multilink characteristics. In recent years, with the flourishing development of network pharmacology, a new method for searching therapeutic drugs has emerged. The multitarget action in network pharmacology is consistent with the complex mechanisms of disease and drug action. Using network pharmacology to understand TCM is an emerging trend.
However, few researchers have analyzed and summarized the rapid growth of academic articles of TCMF published in English. The primary aim of this work was to assess the outcome of these research outputs in the TCMF field from to and to evaluate the situation and tendency. Moreover, visualization software CiteSpace V was used to analyze and generate visualization knowledge maps. In total, 26, articles appeared in the Web of Science database, and only 2, publications met requirement based on reading the abstract or full text.
Chinese herbal medicines CHMs have been widely used to promote health and treat illnesses in daily medical care throughout Asia while mostly accepted as an alternative medical method in many nations of the western world. CHM has a unique therapeutic effect to reduce adverse effects on cancer patients caused by chemotherapy and surgery; however, we did not find any high-quality review for the claimed effects. In this review, we will summarize the history, basic theories and principles, and clinical applications of CHM for disorders, especially female cancers.
John Chen and Tina Chen. Chinese Herbal Formulas and Applications takes the next step in presenting not only the traditional usage of Chinese herbal formulas, but also a combined perspective of the pharmacological effects of formulas themselves with clinically relevant research evidence. To see sample pages of this book, click here. John K.
China has achieved rapid containment of this highly infectious disease following the principles of early detection, early quarantine and early treatment with integrated traditional Chinese and Western medicine. The inclusion of traditional Chinese medicine TCM in the Chinese protocol is based on its successful historic experience in fighting against pestilence. Current findings have shown that the Chinese medicine can reduce the incidence of severe or critical events, improve clinical recovery and help alleviate symptoms such as cough or fever. The pharmacological studies have suggested that Chinese medicine is effective for COVID probably through its host-directed regulation and certain antiviral effects. It could reduce the incidence of severe or critical events and help alleviate symptoms.
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An article collection in Chinese Medicine. Modern studies have shown that adaptogens can non-specifically enhance the resistance of human body under a wide range of external stress conditions with a multi-targeted and multi-channel network-like manner, Citation: Chinese Medicine 13
Since ancient times, plants have been used as a prime natural source of alternative medicines and have played an important role in our lives. The old tradition of medicinal plant application has turned into a highly profitable business in the global market, resulting in the release of a large number of herbal products. People have tried to find different sources of medicines to alleviate pain and cure different illnesses. Due to severe constraints of synthetic drugs and the increasing contraindications of their usage, there is a growing interest world over in the usage of natural products based on medicinal herbs, hence, there is an ever expanding market of herbs and herbal based medicinal preparations all over the world. This has culminated into an exponential increase in number of research groups in different geographical locations and generation of volume of research data in the field in a short span of time. The path breaking advancement in research methods and interdisciplinary approaches is giving birth to newer perspectives.
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