Effects of Iranian Polyherbal Syrup (Zufa syrup) on oxygen saturation and clinical symptoms in suspected patients with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has caused an urgent need for investigating potential treatments. Traditional medicine offers many potential remedies that have been historically used and have the advantage of bypassing the cultural obstacles in the practice of medicine. We aimed to investigate the efficacy of Zufa syrup in the treatment of suspected patients with mild to moderate symptoms of COVID-19. This triple-blind randomized controlled trial recruited patients with evidence of COVID-19 on chest computed tomography without an indication of hospital admission from March 2020 until April 2020. Participants were assessed by a physician and completed a pre-specified form to assess the duration and severity of symptoms. Patients were randomized to receive Zufa syrup (a combination of herbal medicines: Nepetabracteata, Ziziphus jujube, Glycyrrhizaglabra, Ficuscarica, Cordia myxa, Papaver somniferum, Fennel, Adiantumcapillusveneris, Viola, Viper‘s-buglosses, Lavender, Iris, and sugar) or identical-looking placebo syrup at a dose of 7.5 mL (one tablespoon) every 4 hours for 10 days. After applying the eligibility criteria, 116 patients (49.1% male) were randomized to trial arms with a mean age of 44.3. During the follow-up, Cough, dyspnea, headache, myalgia, anorexia, anxiety, and insomnia improved gradually in both groups, and showed no difference between Zufa syrup and placebo. Oxygen saturation and pulse rate had stable trends throughout the follow-up and were similar between study arms. No patient required hospital admission or supplemental oxygen therapy during the study period. To conclude, in patients with mild to moderate symptoms of COVID-19, Zufa syrup did not show any difference in symptomatology over a 10 days’ period when compared with placebo. Due to potential effects of medicinal plants in the treatment of respiratory infections, further studies are warranted to clarify their role in COVID-19. The study was approved by the Ethics Committee of the Qom University of Medical Science (Ethics committee reference number IR.MUQ.REC.1398.165) on March 10, 2020 and was registered in Iranian Clinical Trial Center (approval ID: IRCT20200404046934N1) on April 13, 2020.

Exploring the Impact of Herbal Therapies on COVID-19 and Influenza: Investigating Novel Delivery Mechanisms for Emerging Interventions

“…One study used Viola odorata L. aqueous extract (violet syrup) [36]; one study used pomegranate juice added to SUMAC (a composition of tannins, flavonoids, anthocyanins, isoflavones, terpenoids, and diterpenes) [37]; one study used Covexir (Ferula foetida oleogum) [38]; one study used Zufa syrup (a composition of Nepeta bracteata, Ziziphus jujube, Glycyrrhizaglabra, Ficuscarica, Cordia myxa, Papaver somniferum, Fennel, Adiantumcapillus veneris, Viola, Viper's-buglosses, Lavender, and Iris) [39]; one study used sachets of Matricaria chamomilla L., Zataria multiflora Boiss., Glycyrrhiza glabra L., Ziziphus jujuba Mill., Ficus carica L., Urtica dioica L., Althaea officinalis L., Nepeta bracteata Benth, and capsules of Rheum palmatum L. rizhome, Glycyrrhiza glabra root, Punica granatum L. fruit peel, Rheum palmatum, and Nigella sativa L. [40]; one study used giloy, swasari ras, ashwagandha, and tulsi ghanvati [41]; one used a multicomponent over-the-counter formulation [42]; one used lacto-wolfberry [43]; one used aged garlic extract powder [44]; one used ephedra herb, apricot kernel, cinnamon bark and glycyrrhiza root [45]; one used ginseng [46]; two used broccoli sprout decoction [47,48]; one used a Chima qingwen decoction [49]; one used elderberry extract orally [50]; and one use posaconazole [51]. The administered doses ranged from 300 mg to 200 g per day, and the intervention period ranged from 4 days to 20 weeks.…”

“…Borujerdi et al [39] conducted a placebo-controlled, randomized, triple-blind clinical trial to evaluate the effects of Zufa syrup (Nepeta bracteata, Ziziphus jujube, Glycyr-rhizaglabra, Ficuscarica, Cordia myxa, Papaver somniferum, Fennel, Adiantumcapillus ven-eris, Viola, Viper'sbuglosses, Lavender, and Iris) in reducing COVID-19 symptomatology. The results showed that the intervention was not significantly different from the placebo and did not exert treatment effects.…”

A polyherbal remedy of Chamomile, Cinnamon, Oregano, Ginger, and Anise (CCOGA) combined with physician-prescribed medication is a promising COVID-19 therapy.

“…This may be owing to the expectorant action of Pimpinella anisum, a CCOGA ingredient [10]. Other research on a polyherbal remedy did not nd any differences in SpO2 between the treatment group and the control group, so the CCOGA may be more effective [39].…”

“…CRP is a key pro-in ammatory marker that rises dramatically in severe COVID-19 patients and falls as the patient heals [38][39][40][41]. The use of CCOGA decreased the CRP level in the treatment arm as compared to the control arm.…”