MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

“Today, scientists note that the glycyrrhizic acid contained in this plant prevents the development of a new coronavirus, which the whole world is fighting against. Moreover, even a small concentration of an aqueous extract of licorice root has a neutralizing effect.”

These are the words of President Gurbanguly Berdymukhamedov of Turkmenistan. The plant he referred to is licorice. With is the promotion of a herbal solution for the pandemic, he is in good company:

  • Thailand’s health ministry approved the use of Andrographis Paniculata, commonly known as green chiretta, to treat patients who are in the early stages of a Covid-19 infection.
  • The health authorities of Tamil Nadu distributed herbal medicine to the general public as a preventive measure against Coronavirus disease.
  • Madagascar claims to have a cure for Covid-19, the herbal tea named Covid-Organics has the plant artemisia as an ingredient.
  • China has been using TCM alongside conventional treatment methods to treat Covid-19 patients. Some of the herbal formulations used in the treatment are:
    • Jinhua Qinggan Granule
    • Sheganmahuang decoction
    • Lianhuaqingwen capsule
    • Maxingshigan decoction
    • Xuebijing Injection
  • Indonesia is testing two herbal medicines: Cordyceps militaris, a fungus common in the Himalayas, and a herbal formulation comprising Ginger, gripeweed, Ngai camphor, and Andrographis paniculata.

And what about some evidence? In 2020, Medline listed 302 articles on herbal medicine for COVID-19. Here I selected just 10 of them to give you a flavor:

1st article

COVID-19 is the most recently discovered coronavirus infectious disease and leads to pandemic all over the world. The clinical continuum of COVID-19 varies from mild illness with non-specific signs and symptoms of acute respiratory disease to extreme respiratory pneumonia and septic shock. It can transmit from animal to human in the form of touch, through the air, water, utensils, fomite and feco-oral route blood. The pathogenesis and clinical features of COVID-19 be the same as the clinical manifestation associated epidemic Fever. In Unani medicine, various herbal drugs are described under the caption of epidemic disease. Great Unani scholar also Avicenna (980-1037 AD) recommended that during epidemic condition movement should be restricted, self-isolation, fumigation around the habitant with perfumed herbs (Ood, Kafoor, Sumbuluttib, Saad Kofi, Loban, etc.), and use of appropriate antidotes (Tiryaqe Wabai) and vinegar (Sirka) as prophylaxis. Herbal approach is based on single (Unnab-Ziziphus jujuba, Sapistan-Cordia myxa, Bahidana-Cydonia oblonga, Khatmi-Althea officinalis, Khubazi-Malva sylvestris, Zafran-Crocus sativus, Sibr-Aloe barbedensis, Murmuki-Commiphora myrrha, Darchini-Cinnamomum zeylanicum, Qaranfal-Syzygium aromaticum, Rihan-Oscimum sanctum, Habtus Sauda-Nigella sativa, Aslus Sus-Glycyrrhiza glabra, Maghze Amaltas-Cassia fistula and Adusa-Adhatoda vasica) and compound drugs (Habbe Bukhar, Sharbat Khaksi, Sharbat Zanjabeel, Naqu Nazla, Majoon Chobchini, Jawrish Jalinus and Khamira Marvareed) most of them are claimed for anti-viral, anti-pyretic, blood purifier, cardioprotective and expectorant activities. Traditionally most of the herbal practitioners are using it.

2nd article

According to the World Health Organization (WHO), viral diseases continue to rise, and pose a significant public health problem. Novel coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. The pathogenesis and clinical manifestations of COVID-19 is close to Amraz-e-Wabai (epidemic diseases) which was described by Hippocrates, Galen, Aristotle, Razes, Haly Abbas, Avicenna, Jurjani etc. Presently, there is no specific or challenging treatment available for COVID-19. Renowned Unani Scholars recommended during epidemic situation to stay at home, and fumigate the shelters with aromatics herbs like Ood kham (Aquilaria agallocha Roxb.), Kundur (Boswellia serrata Roxb), Kafoor (Cinnamomum camphora L.), Sandal (Santalum album L), Hing (Ferula foetida L.) etc. Use of specific Unani formulations are claimed effective for the management of such epidemic or pandemic situation like antidotes (Tiryaqe Wabai, Tiryaqe Arba, Tiryaqe Azam, Gile Armani), Herbal Decoction (Joshandah), along with Sharbate Khaksi, Habbe Bukhar, Sharbate Zanjabeel, Khamira Marwareed, Jawarish Jalinus, and Sirka (vinegar). Such drugs are claimed for use as antioxidant, immunomodulatory, cardiotonic, and general tonic actions. The study enumerates the literature regarding management of epidemics in Unani medicine and attempts to look the same in the perspective of COVID-19 prevention and management.

3rd article

Unani system of medicine is based on the humoral theory postulated by Hippocrates, according to him the state of body health and disease are regulated by qualitative and quantitative equilibrium of four humours. Amraz-e-Waba is an umbrella term which is used in Unani medicine for all types of epidemics (smallpox, measles, plague, Hameer Saifi, influenza, Nipaha, Ebola, Zika, and 2019 novel coronavirus, etc.) mostly fatal in nature. The coronavirus disease 2019 (COVID-19) is a severe acute respiratory infection, and the pathogenesis and clinical features resemble with those of Nazla-e-Wabaiya (influenza) and Zatul Riya (pneumonia) which were well described many years ago in Unani text such as high-grade fever, headache, nausea and vomiting, running nose, dry cough, respiratory distress, alternate and small pulse, asthenia, foul smell from breath, insomnia, frothy stool, syncope, coldness in both upper and lower extremities, etc. The World Health Organization declared COVID-19 as a global emergency pandemic. Unani scholars like Hippocrates (370-460 BC), Galen (130-200 AD), Rhazes (865-925 AD), and Avicenna (980-1037 AD) had described four etiological factors for Amraz-e-Waba viz., change in quality of air, water, Earth, and celestial bodies, accordingly mentioned various preventive measures to be adopted during epidemics such as restriction of movement, isolation or “quarantena”, and fumigation with loban (Styrax benzoin W. G. Craib ex Hartwich.), sandalwood (Santalum album L.), Zafran (Crocus sativus L.), myrtle (Myrtus communis L.), and roses (Rosa damascena Mill.) and use of vinegar (sirka) and antidotes (Tiryaq) as prophylaxis, and avoiding consumption of milk, oil, sweet, meat, and alcohol. This review focuses and elaborates on the concept, prevention, and probable management of COVID-19 in the light of Amraz-e-Waba.

4th article

Background: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines.

Aims: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment.

Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positivepromisingnegative, and unknown.

Results: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativumAndrographis paniculataEchinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalisMikania glomerataPelargonium sidoidesPimpinella anisumSalix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine.

Conclusions: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.

5th article

Recently, the novel life-threatening coronavirus infection (COVID-19) was reported at the end of 2019 in Wuhan, China, and spread throughout the world in little time. The effective antiviral activities of natural products have been proved in different studies. In this review, regarding the effective herbal treatments on other coronavirus infections, promising natural products for COVID-19 treatment are suggested. An extensive search in Google Scholar, Science Direct, PubMed, ISI, and Scopus was done with search words include coronavirus, COVID-19, SARS, MERS, natural product, herb, plant, and extract. The consumption of herbal medicine such as Allium sativum, Camellia sinensis, Zingiber officinale, Nigella sativa, Echinacea spp. Hypericum perforatum, and Glycyrrhiza glabra, Scutellaria baicalensis can improve the immune response. It seems that different types of terpenoids have promising effects in viral replication inhibition and could be introduced for future studies. Additionally, some alkaloid structures such as homoharringtonine, lycorine, and emetine have strong anti-coronavirus effects. Natural products can inhibit different coronavirus targets such as S protein (emodin, baicalin) and viral enzymes replication such as 3CLpro (Iguesterin), PLpro (Cryptotanshinone), helicase (Silvestrol), and RdRp (Sotetsuflavone). Based on previous studies, natural products can be introduced as preventive and therapeutic agents in the fight against coronavirus.

6th article

Background: The aim of the present review is to provide basic knowledge about the treatment of Coronavirus via medicinal plants. Coronavirus (COVID-19, SARS-CoV, and MERS-CoV) as a viral pneumonia causative agent, infects thousands of people in China and worldwide. There is currently no specific medicine or vaccine available and it is considered a threat to develop effective novel drug or anti-coronavirus vaccine treatment. However, natural compounds to treat coronaviruses are the most alternative and complementary therapies due to their diverse range of biological and therapeutic properties.

Methods: We performed an open-ended, English restricted search of Scopus database, Web of Science, and Pubmed for all available literature from Jan-March, 2020, using terms related to phytochemical compounds, medicinal plants and coronavirus.

Results: The view on anti-coronavirus (anti-CoV) activity in the plant derived phytochemicals and medicinal plants give the strong base to develop a novel treatment of corona virus activity. Various phytochemicals and medicinal plant extracts have been revised and considered to be the potential anti-CoV agents for effective control and future drug development. We discuss some important plants (Scutellaria baicalensis, Psorothamnus arborescens, Glycyrrhiza radix, Glycyrrhiza uralensis , Lycoris radiate, Phyllanthus emblica, Camellia sinensis, Hyptis atrorubens Poit, Fraxinus sieboldiana, Erigeron breviscapus, Citri Reticulatae Pericarpium, Amaranthus tricolor, Phaseolus vulgaris, Rheum palmatum, Curcuma longa and Myrica cerifera) emerged to have broad spectrum antiviral activity.

Conclusion: Nigella sativa has potent anti-SARS-CoV activity and it might be useful souce for developing novel antiviral therapies for coronaviruses.

7th article

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 sinicaBupleurum chinensePogostemon cablinCinnamomum cassiaScutellaria 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.

8th article

In December 2019, a novel coronavirus SARS-CoV-2, causing the disease COVID-19, spread from Wuhan throughout China and has infected people over 200 countries. Thus far, more than 3,400,000 cases and 240,000 deaths have occurred worldwide, and the coronavirus pandemic continues to grip the globe. While numbers of cases in China have been steadying, the number of infections outside China is increasing at a worrying pace. We face an urgent need to control the spread of the COVID-19 epidemic, which is currently expanding to a global pandemic. Efforts have focused on testing antiviral drugs and vaccines, but there is currently no treatment specifically approved. Traditional Chinese medicine (TCM) is grounded in empirical observations and the Chinese people use TCM to overcome these sorts of plagues many times in thousands of years of history. Currently, the Chinese National Health Commission recommended a TCM prescription of Qing-Fei-Pai-Du-Tang (QFPDT) in the latest version of the “Diagnosis and Treatment guidelines of COVID-19” which has been reported to provide reliable effects for COVID-19. While doubts about TCM still exist today, this review paper will describe the rationalities that QFPDT is likely to bring a safe and effective treatment of COVID-19.

9th article

The fight against the novel coronavirus pneumonia (namely COVID-19) that seriously harms human health is a common task for all mankind. Currently, development of drugs against the novel coronavirus (namely SARS-CoV-2) is quite urgent. Chinese medical workers and scientific researchers have found some drugs to play potential therapeutic effects on COVID-19 at the cellular level or in preliminary clinical trials. However, more fundamental studies and large sample clinical trials need to be done to ensure the efficacy and safety of these drugs. The adoption of these drugs without further testing must be careful. The relevant articles, news, and government reports published on the official and Preprint websites, PubMed and China National Knowledge Infrastructure (CNKI) databases from December 2019 to April 2020 were searched and manually filtered. The general pharmacological characteristics, indications, adverse reactions, general usage, and especially current status of the treatment of COVID-19 of those potentially effective drugs, including chemical drugs, traditional Chinese medicines (TCMs), and biological products in China were summarized in this review to guide reasonable medication and the development of specific drugs for the treatment of COVID-19.

10th article

Objective: To analysis the medication characteristics of the prescriptions issued via open channel by the National and Provincial Health Committee and the State Administration of Traditional Chinese Medicine in treating coronavirus disease 2019 (COVID-19).

Methods: We collected the data of traditional Chinese medicine related to treatment plans published by the National and Provincial Health Committee and the State Administration of Traditional Chinese Medicine from the start of COVID-19 outbreak to February 19, 2020. The frequency analysis, cluster analysis and association analysis were performed.

Results: The study collected 4 national and 34 regional prevention and treatment plans, 578 items, 84 traditional Chinese formulations, 60 Chinese patent medicines, and 230 Chinese herbs. The high frequently used herbs were Liquorice, Scutellariabaicalensis, Semen armeniacaeamarae, and Gypsum. The commonly used traditional formulations included Maxing Shigan decoction, Yin Qiao powder, and Xuanbai Chengqi decoction. The Chinese patent drugs included Angong Niuhuang pill, Xuebijing injection, and Lianhua Qingwen capsule. The most common paired medications were Ephedra and Semen armeniacaeamarae, Fructusforsythiae and Liquorice. Two core combinations and one novel formula were discovered in the study.

Conclusions: Yin Qiao powder and Huopo Xialing decoction are the basic formulations for Weifen syndrome of COVID-19. In addition, Maxing Shigan decoction, Liang Ge powder, Qingwen Baidu decoction and Da Yuan decoction are the basic formulations for Qifen syndrome of COVID-19. The main medication characteristics are clearing heat, entilating lung, removing toxicity and removing turbidity. It shows that removing toxicity and eliminating evil are the prescription thought in treating epidemic disease of traditional Chinese medicine.

Confused?

Me too!

What seems to emerge is this:

  • ‘Herbalists and Co’ did not wait long to jump on the corona bandwagon.
  • They managed to confuse not just you and me, but even politicians, presidents, and their advisers.
  • They produced a plethora of articles implying that an endless array of herbs might be effective.
  • In doing so, no clear consensus emerged as to which herbs are the most promising.
  • Sound evidence seems to be not available.
  • Clinical trials are slow to start or not even planned.
  • Everything is based on more or less wild extrapolation.
  • Much of what is being published is borderline irresponsible.
  • YET, IT MUST BE GOOD FOR BUSINESS!

14 Responses to Herbal solutions to the COVID-19 pandemic?

  • COVID-19 is the most recently discovered coronavirus infectious disease and leads to pandemic all over the world. The clinical continuum of COVID-19 varies from mild illness with non-specific signs and symptoms of acute respiratory disease to extreme respiratory pneumonia and septic shock. It can transmit from animal to human in the form of touch, through the air, water, utensils, fomite and feco-oral route blood. The pathogenesis and clinical features of COVID-19 be the same as the clinical manifestation associated epidemic Fever.

    This is the first few sentences from the first article that you quoted. Almost all of it is factually incorrect. Not a good starting point for investigating treatment.

    By the way, liquorice is well known to have pharmacological effects. I can’t remember exactly which component it is, but there is something in it which both reduces stomach acid (and is therefore good for indigestion) and raises blood pressure by interfering with the renin-angiotensin system. One of my teachers at medical school used to tell the story of a lady that he had admitted to Westminster Hospital in order to try to get her blood pressure under control. Nothing seemed to work, until somebody noticed that she always bought a packet of Liquorice Allsorts from the sweet trolley every morning. Once she was banned from eating liquorice her blood pressure came down.

    The coronavirus spike protein binds to angiotensin converting enzyme receptors on the surface of cells in the lungs and heart, facilitating its entry, so I suppose it is plausible that this might be affected in some way by liquorice. That is a long way from deriving any sort of effective and safe treatment from it. I should also point out that for people with certain medical conditions (congestive cardiac failure, kidney failure etc.) even the quantities of liquorice in a normal-sized packet of sweets can be toxic. Though I used to love it when I was younger.

    • licorice has effects similar to corticosteroids

      • Edzard,

        licorice has effects similar to corticosteroids

        That is only partly true. Although the word corticosteroids strictly refers to hormones with a specific chemical structure which are secreted by the adrenal cortex, and by extension to synthetic analogues of these hormones, when most doctors use the word they generally mean glucocorticoids.

        The naturally-occurring glucocorticoid is cortisol, and drugs derived from it include hydrocortisone, prednisolone, dexamethasone etc. These are potent drugs with many effects, though they are most often used as immunosuppressants (e.g. dexamethasone can reduce Covid-19 mortality by suppressing an exaggerated immune response in very sick individuals with a specific stage of the disease).

        The other class of corticosteroids and mineralocorticoids, which are primarily concerned with sodium metabolism and the control of blood pressure. The naturally-occurring mineralocorticoid is aldosterone, and the mineralocorticoid drug usually prescribed is fludrocortisone.

        There is some overlap between them, which is why large doses of IV hydrocortisone are used to treat an Addisonian crisis, which is an acute steroid difficiency characterised, among other things, but a dangerously low blood pressure. However, the effect of liquorice is predominantly mineralocorticoid.

  • Tu YouYou (what a great name) shared a Nobel prize in 2015 for her part in discovering the value of a substance, Artemisenin, in Artemisia (Wormwood) that was effective in treating malaria.

    Years ago, friends of mine taped a documentary (who remembers VHS videotapes!) about this discovery, and showed it to me. The idea was to explore whether there was anything useful in Chinese Herbal medicine, because quinine compounds were becoming less effective.

    In the documentary (and I’ve just checked this on Wikipedia) the narrator explained that the team explored compounds from some TWO HUNDRED plants, (whittled down from a much longer list) used for malaria in Chinese Herbal medicine.

    It struck me at the time, that they could have chosen 200 plants growing in China quite independently of referring to any Herbal practitioner, and still come up with the same result. And it struck me that Chinese Herbal practitioers were using 199 uselsss plants for malaria.

  • I remain firmly committed to my preventative treatment of fresh cow dung and garlic. Five hundred grams fresh cow dung combined with 50 grams of crushed garlic applied externally plus 50 g of fresh garlic taken internally twice a day is a very effective treatment.

    A short note on the treatment will be at appearing in the Journal of Phantasmagorical Cures soon.

    • shaken or stirred?

    • You are wise. Take a pat on the back for your prophylactic methodology. Or lie under a cow and get a pat on the head….

    • Five hundred grams fresh cow dung combined with 50 grams of crushed garlic applied externally plus 50 g of fresh garlic taken internally twice a day is a very effective treatment.

      You may think you’re funny, but the Hindu nationalists already beat you to it.

    • @jrkrideau
      Let me guess … the mechanism behind your preventative treatment is its odiferous nature: anyone coming within an approximately 50 ft radius around you will be frantically scrambling to get out of your way.

      My compliments! You may just have stumbled upon the first real alternative to vaccination!

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