“Three medicines and three formulas” in COVID-19: from bench to bedside

Abstract

Chinese guideline has proven effective in the fight against coronavirus disease 2019 (COVID-19) during the global spread of the epidemic. Traditional Chinese medicine (TCM) is widely recognized for its effectiveness in alleviating symptoms, inhibiting disease progress, reducing mortality, and improving the cure rate of patients with COVID-19. During the pandemic, “three medicines and three formulas” (TMTFs) stood out from hundreds of others in registered clinical studies, which became highly recommended as TCM for COVID-19 treatment. The TMTFs not only effectively relieve the clinical symptoms of fever, cough, fatigue, and phlegm, but also substantially shorten the time of nucleic acid negative conversion, improve lung computed tomography imaging features and inflammation, ameliorate clinical biochemical indicators, and reduce sequelae. Their potential pharmacological mechanisms are mainly related to the crosstalk between viral toxicity, endothelial damage, cytokine storm, immune response, and microthrombus. In brief, the clinical effects and the potential mechanisms of TMTFs on COVID-19 were systematically analyzed and summarized covering the entirety of disease development, including virus invasion and replication, immune response and cytokine storm, and acute respiratory distress syndrome and multiple organ dysfunction syndrome. This review provides a theoretical basis and reference for the in-depth understanding of the positive role of TMTFs in COVID-19 treatment.