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   Table of Contents - Current issue
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April-June 2020
Volume 6 | Issue 2
Page Nos. 121-227

Online since Saturday, May 30, 2020

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PROTOCOL  

Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7) Traditional Chinese medicine (TCM) treatment p. 121

DOI:10.4103/2311-8571.281609  
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REVIEW ARTICLES Top

Comprehensive comparison and analysis of the prevention and treatment of coronavirus disease 2019 and severe acute respiratory syndrome with traditional chinese medicine Highly accessed article p. 124
Ying Chen, Jing-Jing Zhang, Yan Liu, Hong-Cai Shang
DOI:10.4103/wjtcm.wjtcm_13_20  
Since December 2019 the Coronavirus Disease 2019 (COVID-19) has erupted in many places around the world, which is strong infectious and highly epidemic. After the outbreak of COVID-19 in China, traditional Chinese medicine (TCM) has been in the front line of the fight against the epidemic. It has shown characteristics and advantages in the prevention and treatment of COVID-19. TCM also played an important role in the winter of 2002 and in the spring of 2003 during the outbreak of severe acute respiratory syndrome (SARS). This article compares the strategies, programs, measures, resource investments, and effects of TCM for the prevention and treatment of COVID-19 with those for SARS. At present, the involvement of TCM has been earlier, faster, and more comprehensive in the fight against the epidemic and has shown good clinical efficacy and treatment prospects.
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Antiviral properties of traditional chinese medicine against coronavirus: Research clues for coronavirus disease-2019 p. 132
Xu-Jie Wang, Jia-Xi Li, Miao-Ran Wang, Zhong-Yang Zhou, Bao-Chen Zhu, Xue-Xue Zhang, Rui Zhang, Wei Tang, Yu-Fei Wu, Wan-Tong Zhang, Qiu-Yan Li
DOI:10.4103/wjtcm.wjtcm_15_20  
The objective of this study was to provide research clues for the prevention and treatment of coronavirus disease-2019 (COVID-19) and coronavirus (CoV) infection using Traditional Chinese Medicine (TCM). A review on research and clinical trials that using TCM extracts and active ingredients against CoV was performed, and a table of TCM agents and their effects on CoV were summarized. Relevant analysis was performed and visual expression of the data included summarizing the types of TCM and treatment methods for COVID-19. TCM fighting against CoV is mainly used in the lung and heart channels, and its medicinal properties are mainly cold and mild, while its taste is mainly bitter and sweet. The majority of research focused on treatments that clear away heat and toxic materials and those that strengthen body resistance and tonify deficiencies. TCM has unique advantages to fight against CoV. The development of new anti-CoV therapy using TCM is of great significance for the prevention and treatment of COVID-19 pneumonia and various viral infectious diseases.
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Analysis of interventional clinical research protocols related to coronavirus disease 2019 and future expectations p. 139
Ya-Feng Wang, Min Du, Rui Su
DOI:10.4103/wjtcm.wjtcm_11_20  
Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease. After its outbreak, researchers started a large number of clinical interventional studies, using a variety of interventions to study the different types of COVID-19 cases. In this article, we searched the websites of Chinese Clinical Trial Registry, ClinicalTrials.gov, etc., to study the publicly registered research information. Through the classification and summary of interventional methods, evaluation indicators, research design, etc., this article provided readers with the outline of clinical research about COVID-19, and looked forward to the scientificity, feasibility, and future evidence of the clinical researches.
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Analysis of similarities and differences between coronavirus disease 2019 and severe acute respiratory syndrome p. 145
Li-Ting Liu, Jie Li, Gui-Ying Peng, Jing Li, Tong Wu, Zi-Yang Yu, Ming-Ming Huang, Cui-Yun Zhao
DOI:10.4103/wjtcm.wjtcm_21_20  
Both coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) are epidemic, contagious, sudden, and publicly harmful diseases. The whole-genome nucleotide identity of the pathogens causing the two diseases reached 79.5%. The mechanism and treatment of COVID-19 are still under investigation. Combining the experiences of SARS prevention and treatment in 2003, and the case data and literature of COVID-19, the similarities and differences between the two diseases in terms of causes, susceptible people, characteristics, dialectical mode, and treatment were analyzed. The two diseases are both plagues in terms of Chinese medicine. The cause of SARS was “heat poison,” and its pathogenesis was “heat poison, stasis, and qi and yin deficiency.” Therefore the treatment regimen was mainly to clear away heat, detoxicate, and expel evil. While the cause of COVID-19 was “wet poison,” and its pathogenesis was “wet, poison, heat, stasis, close, syncope, and yang collapse.” Hence the basic treatment strategy was to declare lung and remove dampness. Treatment of COVID-19 was clearing away evil qi as soon as possible, with the basic treatment regimen, which was declaring lung, removing dampness, and dispelling the evil. Combined with Traditional Chinese medicine's (TCM's) understanding and experience in SARS prevention and treatment, and Chinese clinical cured cases, we try to provide strategies for people all over the world to understand and respond to COVID-19, through the analysis and comparison. To improve COVID-19 prevention and treatment regimen and give full play to the advantages of TCM.
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Xihuang pills, a traditional chinese preparation used as a complementary medicine to treat cancer: An updated review p. 152
Christian Bailly
DOI:10.4103/wjtcm.wjtcm_6_20  
The traditional Chinese medicine, Xihuang pills (XHP), has long been used for the management of cancers, both to limit tumor cells proliferation and dissemination, and to protect nontumor cells from damages induced by conventional therapeutic agents. XHP is made from two plant extracts (from Boswellia carteri and Commiphora myrrha) and two animal-derived products (from Moschus moschiferus and Calculus bovis). Recent advances into the mechanism of action of XHP and its clinical efficacy are reviewed here to highlight its potential to treat breast and colon cancers in particular. The immunoregulatory effects of XHP are underlined. Similar traditional medicinal preparations containing Boswellia and Commiphora are discussed, as well as the activities of the major natural products found in XHP including abietic acid, acetyl-keto-boswellic acid, and muscone. Pharmacological and clinical studies of XHP and similar medicinal preparations, such as the Korean medicine HangAmDan-B, are encouraged.
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The Potential effects and use of chinese herbal medicine pine pollen (Pinus pollen): A bibliometric analysis of pharmacological and clinical studies p. 163
Shi-Bing Liang, Ning Liang, Fan-Long Bu, Bao-Yong Lai, Ya-Peng Zhang, Hui-Juan Cao, Yu-Tong Fei, Nicola Robinson, Jian-Ping Liu
DOI:10.4103/wjtcm.wjtcm_4_20  
The objectives of this study are to conduct a comprehensive literature search and bibliometric analysis to identify the breadth and volume of pharmacological and clinical studies on pine pollen (Pinus pollen) and to identify the potential effects and the use of pine pollen. Three Chinese electronic databases and two English electronic databases were searched for pharmacological and clinical studies on pine pollen. Data were extracted and analyzed and included publication year, authors, study type, pharmacological research topics or clinical diseases/conditions, usage and type of preparation, authors' conclusions, and adverse effects. Of 239 publications identified, 180 were pharmacological studies, 37 were clinical trials, and 22 were reviews. Numbers of publications increased particularly from 2004 onward. The top 10 most frequent topics in pharmacological studies were immune regulation, antisenility, antioxidation, liver protection, inhibiting prostate hyperplasia, inhibiting tumor cell proliferation, lowering blood glucose, lowering blood lipids, antifatigue, and improving intestinal function. The top 10 most frequent clinical diseases treated or where pine pollen was used as an adjuvant were bedsores, diaper dermatitis, hyperlipidemia, oral mucositis, eczema, hyperplasia of prostate, hypertension, prostatitis, type 2 diabetes mellitus, and radiodermatitis. Eight trials reported no adverse events associated with pine pollen, one reported mild gastrointestinal reactions, but symptoms disappeared without special management. There have been an increasing number of publications on pine pollen during the past 20 years. Pharmacological studies have shown many potential benefits, and clinical studies have indicated some positive effects when it is either used as a single herb or as an adjuvant to treat disease. Its use as a topical agent, especially for skin diseases, was notable.
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Research progress on antidepressant therapeutic biomarkers of Xiaoyaosan p. 171
Yao Gao, Ying-Xia Zhao, Teng Xu, Jun-Sheng Tian, Xue-Mei Qin
DOI:10.4103/wjtcm.wjtcm_16_20  
Depression is one of the most prevalent and serious mental disorders with a significant burden of disease. Xiaoyaosan (XYS), a well-known Chinese formula, has been widely used in the treatment of depression. Both clinical studies and animal experiments have indicated that XYS has an obvious antidepressant activity. How to select objective pharmacodynamic markers for traditional Chinese medicine (TCM) treatments based on clinical metabolites, linking pathogenic genes, and drug targets, is a bottleneck problem in the modernization of TCM. To address this issue, we sorted out clinical metabonomics experiments of XYS in treating depression, constructed a metabolic profile of therapeutic biomarkers, and deduced metabolic biomarker-protein interactions networks. The therapeutic biomarkers found for XYS were involved in neurotransmitter synthesis, energy metabolism, and gut microbial metabolism. This study aims to provide a scientific basis for the clinical diagnosis of depression and evaluate the efficacy of XYS in its treatment.
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ORIGINAL ARTICLES Top

A network pharmacology study of reduning injection for the treatment of coronavirus disease-19 p. 180
Jian Wu, Dong-Dong Ruan, Tong-Fei Fu, Jun Yuan
DOI:10.4103/wjtcm.wjtcm_19_20  
Objective: The 2019 novel coronavirus (2019-nCoV) outbreak has escalated into a global pandemic. According to Chinese guidance for coronavirus disease-19 (COVID-19): Prevention, control, diagnosis, and management, Reduning injection can effectively treat, the disease caused by the virus. To identify the active ingredients of Reduning injection and COVID-19 disease-related pathways, we conducted a network pharmacology study. Methods: The Traditional Chinese Medicine Systems Pharmacology database was used to screen the chemical constituents and potential targets of Reduning injection. The gene names were converted to the corresponding protein names using UniProt. GeneCards and OMIM databases were used to select targets related to 2019-nCoV. Using Cytoscape 3.7.2 software platform and STRING database, we constructed drug-common target and target protein protein-protein interaction network diagrams. Rx64 3.6.2 software and Bioconductor biological information software package were used for Gene Ontology (GO) functional enrichment and KEGG pathway analyses. Results: In Reduning injection, a total of 33 effective chemical components were obtained that were involved in 151 signaling pathways, of which 44 targets were considered therapeutically relevant. Conclusion: Reduning injection can be potentially applied for the treatment of COVID-19 based on the results of our network pharmacology study.
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Advantages of anti-inflammatory acupuncture in treating sepsis of coronavirus disease 2019 Highly accessed article p. 188
Guan-Yuan Jin, Louis Lei Jin, Jin Zheng, Belinda Jie He
DOI:10.4103/wjtcm.wjtcm_12_20  
Background: Sepsis is one of the most serious complications and a leading cause of death in patients with coronavirus disease 2019 (COVID-19). In general, it is the result of an unregulated inflammatory cascade such as a postinfection “cytokine storm.” The conventional treatment mainly relies on glucocorticoids, of which curative effects are not ideal, as they come with significant side effects. It is critical to seek or develop other effective therapeutics in dealing cytokine storm to fight COVID-19 with sepsis. Aims and Objectives: Raise awareness of the significance applying anti-inflammatory acupuncture in dealing COVID-19 patients with sepsis and provide an appropriate acupuncture protocol that can be easily integrated into existing medical guideline. Materials and Methods: Current evidences from animal experiments and clinical trials about acupuncture in treating infectious sepsis are reviewed, and a detailed discussion on advantages of anti-inflammatory acupuncture is followed, then the rationality on the point selection and stimulation parameters of acupuncture is analyzed to propose an appropriate acupuncture protocol. Results: Current experiments have shown that acupuncture can play a significant role to improve inflammation reaction and reduce mortality in infectious animal and patients with sepsis and its mechanisms are mainly achieved by stimulating the vagus-cholinergic anti-inflammatory pathways. Applying acupuncture in treating COVID-19 patients with sepsis has four aspects of advantages. Moreover, a simple and convenient clinical acupuncture protocol including point selection and appropriate stimulation parameters is proposed. Conclusion: Acupuncture, especially electroacupuncture, has shown potentials in effectively treating infectious sepsis of animal models and critically ill patients in small sample studies by stimulating the nervous system, but has been largely overlooked in the clinic so far. It is advised that acupuncture should be integrated into the existing medical guidelines in dealing with COVID-19 complicated with sepsis.
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The experience of treating patients with pneumonia secondary to the coronavirus disease 2019 using the Guizhi method of traditional Chinese medicine p. 196
Yu-Ting Ma, Qiu-Yun Wu, Sheng-Bo Lu, Wen-Mei Qiu, Pan Pan, Min Xu, Nong Tang
DOI:10.4103/wjtcm.wjtcm_14_20  
This paper is a discussion of Professor Tang Nong's approach to the diagnosis and treatment of the coronavirus disease 2019 (COVID-19) while providing a case report at the end. Professor Tang Nong considered that the main etiologies of the disease are “cold, wet, and poisonous.” He suggested resolving the body's dampness by balancing internal organ functions, detoxifying the lungs, and providing heat. However, the treatment of cold with herbs and cleansing heat must not be performed too early to prevent the spread of the disease. Using principles from the basic theory of Fuyang Pai from traditional Chinese medicine (TCM), this project used the Huashi Qingfei immune formula (modified Guizhi Erchen decoction), which has been shown to be effective, to treat patients diagnosed with COVID-19. At present, the participation of TCM in our hospital is over 96% with a cure rate of approximately 90%.
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Molecular insight into the therapeutic promise of xuebijing injection against coronavirus disease 2019 p. 203
Dan Zhang, Jin-Tao Lv, Bing Zhang, Ri-Na Sa, Bing-Bing Ma, Xiao-Meng Zhang, Zhi-Jian Lin
DOI:10.4103/wjtcm.wjtcm_22_20  
Background: The potential human-to-human transmission of the coronavirus pneumonia (coronavirus disease 2019 [COVID-19]) has caused an outbreak of acute respiratory illness. Xuebijing injection is recommended as first-line treatment for the severe and critical patients with COVID-19. The aim of present study is to interpret the pharmacological mechanisms and molecular connections of Xuebijing injection against COVID-19 by utilizing the approaches of network pharmacology and molecular docking. Materials and Methods: Active ingredients of Xuebijing injection were collected by Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, and putative therapeutic targets were screened from TCMSP, SwissTargetPrediction, and STITCH databases. Moreover, the protein–protein interactions, topological analysis, and pathway enrichment were established to distinguish the hub targets and pathways by employing STRING database, Cytoscape software, DAVID database, respectively. In addition, the potential interaction and binding activity of candidate ingredients in Xuebijing injection with core targets were revealed by molecular docking simulation (AutoDock software). Results: A total of 115 bioactive components in Xuebijing injection were collected, and416 targets including AKT1, TP53, VEGFA, ALB, TNF and so on were responsible for treating COVID-19. Bioinformatics analysis revealed that matching core targets were closely associated with the inhibition of cytokine storm for its clinical beneficial effects in severe cases. The results of enrichment analysis indicated that PI3K-Akt signaling pathway, human T-cell leukemia virus type 1 infection, mitogen-activated protein kinase signaling pathway, tuberculosis, focal adhesion, TNF signaling pathway, and small-cell lung cancer were represented pathways of Xuebijing injection against COVID-19 in terms of lung inflammation, virus infection, and lung injury. Meanwhile, the active ingredients of Xuebijing injection exerted superior binding activities with 3CLpro and angiotensin-converting enzyme 2 as observed via molecular docking simulation. Conclusions: Through the comprehensive analysis of network pharmacology, the current research preliminarily elaborated the molecular regulation of therapeutic mechanisms for Xuebijing injection against COVID-19 and binding activity between active components and core targets, which provided scientific evidence to facilitate the development of Xuebijing injection and clinical treatment for COVID-19.
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Effect of Yangxinshi tablets on the phenotype and function of monocytes in patients with unstable angina pectoris of coronary heart disease p. 216
Li-Na Yang, Ming-Yu Wang, Ya-Qi Tong, Shu-Nan Zhang, Wei-Xia Wu, Yan-Chun Ding
DOI:10.4103/wjtcm.wjtcm_39_19  
Objective: The objective of this study was to observe the effect of Yangxinshi tablets on the phenotype and function of peripheral blood monocytes in patients with unstable angina of coronary heart disease (CHD) and to explore the possible mechanism of Yangxinshi tablets in the treatment of CHD. Methods: A total of 100 patients with unstable angina of CHD were randomly divided into two groups: Group A – treatment group and Group B – control group. The phenotypic and functional changes in blood monocytes and the changes in serum inflammatory factors before and after treatment were compared in the two groups. Results: The expression of CD14+CD163+ interleukin (IL)-10+ was significantly higher in the control group than in the patients with unstable angina of CHD, whereas the expression of CD14+CD163IL-12+ was lower. The concentration of IL-10 was higher in the control group than in the patients with unstable angina, whereas the concentration of tumor necrosis factor-α (TNF-α) and IL-12 was significantly lower. In Group A, the expression of CD14+CD163+, CD14+CD206+, and CD14+CD163+CD206+ in peripheral blood monocytes increased after treatment than before treatment, whereas the expression of CD14+CD163CD206 decreased. The expression of CD14+CD163IL-12+ decreased after treatment than before, whereas CD14+CD163+IL-10+ expression increased. The serum concentration of IL-10 in Group A was higher after treatment than before, whereas that of IL-12 and TNF-α was lower. In Group B, the phenotype and function of the peripheral blood monocytes remained unchanged. Conclusion: Yangxinshi tablet therapy can change the phenotype of the peripheral blood monocytes in patients with unstable angina of CHD. Yangxinshi tablet therapy changes the inflammatory state in patients with an increase in the expression of anti-inflammatory factors and a decrease in the expression of inflammatory factors.
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ERRATUM Top

Erratum: Academician Kai-Xian Chen talks about the development of traditional Chinese medicine and global medicine p. 227

DOI:10.4103/2311-8571.285416  
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