David Y.W. Lee,a Qing Y. Li,a,b Jing Liu,a and Thomas Efferthc,⁎

Abstract
Background

: Throughout the 5000-year history of China, more than 300 epidemics were recorded. Traditional Chinese herbal medicine (TCM) has been used effectively to combat each of these epidemics’ infections, and saved many lives. To date, there are hundreds of herbal TCM formulae developed for the purpose of prevention and treatment during epidemic infections. When COVID-19 ravaged the Wuhan district in China in early January 2020, without a deep understanding about the nature of COVID-19, patients admitted to the TCM Hospital in Wuhan were immediately treated with TCM and reported later with >90% efficacy.

Approach

: We conducted conduct a systematic survey of various TCM herbal preparations used in Wuhan and to review their efficacy, according to the published clinical data; and, secondly, to find the most popular herbs used in these preparations and look into the opportunity of future research in the isolation and identification of bioactive natural products for fighting COVID-19.

Results

: Although bioactive natural products in these herbal preparations may have direct antiviral activities, TCM employed for fighting epidemic infections was primarily based on the TCM theory of restoring the balance of the human immune system, thereby defeating the viral infection indirectly. In addition, certain TCM teachings relevant to the meridian system deserve better attention. For instance, many TCM herbal preparations target the lung meridian, which connects the lung and large intestine. This interconnection between the lung, including the upper respiratory system, and the intestine, may explain why certain TCM formulae showed excellent relief of lung congestion and diarrhea, two characteristics of COVID-19 infection.

Conclusion

: There is good reason for us to learn from ancient wisdom and accumulated clinical experience, in combination with cutting edge science and technologies, to fight with the devastating COVID-19 pandemic now and emerging new coronaviruses in the future.

Keywords: Medicinal herb, Phytotherapy, SARS-CoV-2, Viral infection
Keywords: Abbreviations: ACE2, angiotensin-converting enzyme II; AIV, avian influenza virus; ALI, acute lung injuries; AVP, arginine vasopressin; c-AMP, cyclic adenosine phosphate; CASP3, caspase 3; CCL2, CC chemokine ligand 2; CDC, Center for Disease Control and Prevention; CoV, coronavirus; COVID-19, coronavirus disease 2019; COX-2, cyclooxygenase-2; CXCL, C-X-C- motif chemokine; ECMO, extracorporeal membrane oxygenation; FM1, FM1 coronavirus; GCGJ, Gancao ganjiang decoction; HIV, human immunodeficiency virus; HSV-1, herpes simplex virus 1; ICU, intensive care unit; IEC-6, rat intestinal epithelial cell line 6; IL, Interleukin; iNOS, nitric oxide synthase; JEV, Japanese encephalitis virus; LH, Lianhuaqingwen capsule; LPS, lipopolysaccharides; MAPK, mitogen-activated protein kinase; MDA, malondialdehyde; MDCK, Madin-Darby Canine Kidney cells; MXSG, Ma xing shi gan decoction; NF-κB, nuclear factor kappa B cells; NO, nitric oxide; PA, patchouli alcohol; PGE2, prostaglandin E2; PTGS2, Prostaglandin-endoperoxide synthase 2; QFPD, Qingfeipaidu decoction; RSV, respiratory syncytial virus; SARS, Severe Acute Respiratory Syndrome; SMD, Sheganmahuang decoction; SOD, superoxide dismutase; TCM, traditional Chinese medicine; TLR-4, Toll-like receptor-4; TNF, tumor necrosis factor; WHO, World Health Organization