Potential Targets for Treatment of Coronavirus Disease 2019 (COVID-19): A Review of Qing-Fei-Pai-Du-Tang and Its Major Herbs

Abstract

COVID-19 has been declared a pandemic by WHO on March 11, 2020. No specific treatment and vaccine with documented safety and efficacy for the disease have been established. Hence it is of utmost importance to identify more therapeutics such as Chinese medicine formulae to meet the urgent need. Qing Fei Pai Du Tang (QFPDT), a Chinese medicine formula consisting of 21 herbs from five classical formulae has been reported to be efficacious on COVID-19 in 10 provinces in mainland China. QFPDT could prevent the progression from mild cases and shorten the average duration of symptoms and hospital stay. It has been recommended in the 6th and 7th versions of Clinical Practice Guideline on COVID-19 in China. The basic scientific studies, supported by network pharmacology, on the possible therapeutic targets of QFPDT and its constituent herbs including Ephedra sinica, Bupleurum chinense, Pogostemon cablin, Cinnamomum cassia, Scutellaria baicalensis were reviewed. The anti-oxidation, immuno-modulation and antiviral mechanisms through different pathways were collated. Two clusters of actions identified were cytokine storm prevention and angiotensin converting enzyme 2 (ACE2) receptor binding regulation. The multi-target mechanisms of QFPDT for treating viral infection in general and COVID-19 in particular were validated. While large scale clinical studies on QFPDT are being conducted in China, one should use real world data for exploration of integrative treatment with inclusion of pharmacokinetic, pharmacodynamic and herb-drug interaction studies.

SARS-CoV-2: Structure, Biology, and Structure-Based Therapeutics Development

“…New and unconventional ideas and routes of antiviral drug design and development are needed to overcome the shortcomings of the present reductionism-based drug research. In this aspect, the holism-based traditional Chinese medicine especially the Chinese medical herb formulae could be considered which are proved effective in the fight against COVID-19 in China (Ang et al, 2020;Luo et al, 2020;Ren et al, 2020;Zhang et al, 2020a;Zhong et al, 2020), although further mechanistic studies and large-scale clinical trials are warranted.…”

Qingfei Paidu decoction, a Chinese herbal medicine against COVID‑19, elevates the blood levels of pro‑inflammatory cytokines: An open‑label, single‑arm pilot study

“…One of these is Qingfei Paidu decoction (QFPD, the Chinese word for 'lung cleansing and detoxifying decoction'). QFPD was formulated specifically for the treatment of patients with COVID-19 and has exhibited satisfactory therapeutic efficacy (6)(7)(8)(9)(10). QFPD administration combined with the standard of care has been shown to significantly enhance the cure rates and to prevent disease progression in mild to critical cases (6)(7)(8).…”

“…QFPD was formulated specifically for the treatment of patients with COVID-19 and has exhibited satisfactory therapeutic efficacy (6)(7)(8)(9)(10). QFPD administration combined with the standard of care has been shown to significantly enhance the cure rates and to prevent disease progression in mild to critical cases (6)(7)(8). The concomitant administration of QFPD and Western medicine to patients with mild to moderate disease has been shown to achieve greater improvements in blood outcome indicators, such as C-reactive protein, creatine kinase and lactate dehydrogenase (9).…”

Potential Mechanisms for Traditional Chinese Medicine in Treating Airway Mucus Hypersecretion Associated With Coronavirus Disease 2019

“…The QFPD was specifically designed to treat major symptoms from COVID-19, including expectorant. However, other functions of QFPD, e.g., anti-inflammation, antiviral, immunity-boosting, etc., have been mechanistically investigated (Zhong et al, 2020), except for expectorant. In this study, we provided molecular mechanisms for expectorant of these top herbs, focusing on their regulatory mechanisms on mucin related pathways, such as HIF-1/MAPK and interleukin, aiming to confer further insight for TCM attribution to the remission of COVID-19 infection.…”