Analysis on medication regularity and pharmacodynamic characteristics of traditional Chinese medicine treatment of 444 severe cases of COVID-19

WANG Chuan;MING Hao;JIA Wen;SU Wen;ZHAN Li-rui;LUO Dan;YANG Jia-yao

China Journal of Chinese Materia Medica,2020,Vol 45,No. 13

Coronavirus disease 2019 (COVID-19) is developing rapidly and posing a serious threat to public health. There is no effective intervention for the severe patients, and their prognosis is poor. It is worth noting that in the fight against COVID-19, China has always put equal emphasis on both traditional Chinese and western medicine. Traditional Chinese medicine (TCM) has played an important role in the whole process. It is of great significance to discuss the rules and characteristics of TCM prescriptions for COVID-19. In this study, information was collected from 444 severe COVID-19 patients who were admitted to a designated hospital in Wuhan before March 20, 2020. We collected the TCM prescriptions for them, referred to Chinese Pharmacopoeia ( Zhong Guo Yao Dian) to standardize the names of Chinese medicinals, and extracted the properties, flavors, and meridian tropism of them to analyze the medication regularity of the prescriptions. IBM SPSS Modeler 18.0 software was employed to conduct correlation analysis of Chinese medicinals and discover effective TCM prescriptions against COVID-19 by the TCMATCOV platform. In the end, 1 532 effective prescriptions were included. Among them, the high-frequency medicinals were Poria, Radix Astragali seu Hedysari, Herba Pogostemonis, Semen Armeniacae Amarum, Rhizoma Atractylodis Macrocephalae, Rhizoma Pinelliae, Radix Glycyrrhizae, Cortex Magnoliae Officinalis, Herba Ephedrae, and Ramulus Cinnamomi. Most of the medicinals have the functions of resolving dampness, replenishing deficiency, resolving phlegm, and relieving cough and asthma. The core combinations were Herba Pogostemonis–Poria, Radix Astragali seu Hedysari–Herba Pogostemonis–Poria, Fructus Amomi Villosi–Poria, Fructus Amomi Villosi–Herba Pogostemonis, and Fructus Amomi Villosi–Radix Astragali seu Hedysari. The medicinals cold and warm in property accounted for 41.03% and 38.46%, respectively, and those sweet and bitter in taste took up 34.71% and 30.58%, respectively. The medicinals showed meridian tropism in lung, stomach, and spleen, and those showing tropisim in lung accounted for 22.87%. According to the analysis result of high-frequency medicinals and core combinations, the main treatment principle for severe COVID-19 is to remove internal and external dampness, protect the spleen and stomach, eliminate pathogen, and reinforce healthy qi. TCMATCOV platform was used to calculate the network disturbances of the high-frequency medicinals involved. It was found that the Chinese medicinals with a high disturbance score accounted for a large proportion of the classic anti-COVID-19 prescriptions used by clinicians. Among them, the medicinals of top scores were Herba Ephedrae, Pericarpium Citri Reticulatae, Herba Eupatorii, Radix Platycodonis, Ramulus Cinnamomi, Radix Astragali seu Hedysari, Cortex Magnoliae Officinalis, Rhizoma Atractylodis Macrocephalae, Herba Pogostemonis, and Radix Scutellariae. After further exploring the action targets, we found that the COVID-19-specific factor TNF was the target of the ten medicinals, and Chinese medicinals can exert anti-inflammatory and immune-modulating effects at multiple targets and levels.