Therapeutic Effects of Jing Si Herbal Tea for Chronic Obstructive Pulmonary Disease: A Comprehensive Investigation From Clinical to Basic Research
Phase: EARLY_PHASE1
Conditions: Airway Disease
Sponsor: Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation

 
 
Taipei Tzu Chi Hospital, Buddhist Tzu Chi 
Medical Foundation 
                
Title：  Comprehensive Research on Jing-Si-Herbal-Tea in Respiratory System 
Diseases      
Keywords：   Jing-Si-Herbal-Tea, Chronic Obstructive Pulmonary Disease                 
The study protocol was approved by the Ethics Committee of Taipei Tzu Chi Hospital (IRB number 
10-XD-132). 
Date: 20230101 
1. 
Purpose of study 
Jing-Si-Herbal-Tea (JSHT) is currently sold in Jingsi Hall. It contains eight kinds 
of traditional Chinese medicine ingredients, namely Ophiopogon japonicus, 
Houttuynia cordata, Platycodon grandiflorum, fish needle grass, licorice, mugwort 
leaf, perilla leaf, and chrysanthemum. Ophiopogon japonicus has the effect of 
moistening the lungs and relieving coughs, mainly targeting coughs, dry coughs, 
hemoptysis and other symptoms caused by yin deficiency and dryness of the lungs 
caused by insufficient lung yin. Houttuynia cordata has a significant inhibitory 
effect on a variety of pathogenic microorganisms, strengthens immune function, 
relaxes bronchial smooth muscle, and achieves antitussive and asthmatic effects. 
Platycodon has the effect of draining pus, relieving coughs and removing phlegm. 
It is often used for various coughs and phlegm syndromes. It is also very effective 
for those with sore throat and hoarseness. Fish needle grass is a commonly used 
medicinal herb, mainly used to treat colds and fever, vomiting and abdominal 
pain, gastric pain, skin eczema, etc. Licorice is a traditional Chinese medicinal 
material that has pharmacological effects such as relieving coughs and 
moisturizing the lungs. Mugwort can treat cold cough and asthma, and has the 
functions of relieving cough, eliminating phlegm and relieving asthma. Perilla is 
often used to treat colds, colds and coughs, and has a certain effect in treating 
allergies. Chrysanthemum has the effect of clearing away heat and detoxifying, 
which can help relieve the discomfort of throat inflammation and oral ulcers. It 
can also improve body fever, headache, thirst, cough with yellow phlegm, sore 
throat, yellow and thick nasal discharge, etc. These Chinese medicinal materials 
have anti-inflammatory effects. For example, Houttuynia Cordata can enhance the 
phagocytosis function of macrophages and has also been proven to have 
anti-inflammatory effects. Some studies have found that it can inhibit tumor 

 
necrosis factor-α (TNF-α) in sepsis, interleukin-1β (IL-1β) production and 
toll-like receptor 4 (TLR4) expression. In addition, Houttuynia cordata also has 
antioxidant effects and can relieve peroxidative stress. 
Research purposes: 
COPD is a disease caused by long-term inflammation of the respiratory tract or 
interstitium of the lungs, resulting in respiratory obstruction, which prevents gas 
from flowing in and out of the respiratory tract smoothly, or interstitial pulmonary 
fibrosis that prevents gas exchange. These patients suffer from poor pulmonary 
gas exchange function, symptoms of chest tightness, wheezing and coughing often 
occur. In addition, these patients are more likely to be accompanied by other 
comorbidities, such as cardiovascular disease, osteoporosis, diabetes, lung cancer, 
etc. These diseases have a huge impact on the patient's quality of life and life 
safety. Research is very important for the control of respiratory diseases. 
Although some drugs are currently used to treat these diseases, the therapeutic 
effect is limited. JSHT has anti-inflammatory and antioxidant effects, which can 
inhibit the inflammatory response of respiratory diseases. We aim to study the 
effect of JSHT in COPD. 
2. 
Study Design  
 The main inclusion and exclusion conditions of the study:   
Inclusion criteria: 
1. 
Outpatients: patients with chronic stable respiratory diseases (COPD, asthma, 
bronchiectasis, pulmonary fibrosis, interstitial pulmonary disease, sarcoidosis) 
2. 
Hospitalized patients: patients hospitalized due to acute attacks of respiratory 
diseases (COPD, asthma, bronchiectasis, pulmonary fibrosis, interstitial pulmonary 
disease, sarcoidosis) 
3. 
Severe patients: Respiratory failure due to acute attack of respiratory diseases 
(COPD, asthma, bronchiectasis, pulmonary fibrosis, interstitial lung disease, 
sarcoidosis) using invasive or non-invasive respirators and admitted to intensive 
care patients in ward 
 
Exclusion criteria: 
1. Under legal age 
2. Those who are unwilling to join 
3. Those with severe liver function abnormalities 

 
4. People with severe renal dysfunction 
5. Have a history of allergies to JSHT 
 
Research Methods and Procedures: 
This study comprises two parts, focusing on patients with COPD acute exacerbation 
(COPDAE). In the COPDAE part, the control group received standard treatment 
including intravenous steroids, inhaled butanyl and ipratropium, and parenteral 
antibiotics for secondary infections. Placebo mimics of JSHT were administered to the 
control group. The JSHT group received standard COPDAE treatment plus JSHT for one 
week. Baseline and post-treatment HRQL were assessed using the COPD assessment test 
(CAT), along with blood tests including white blood cells (WBCs), percentages of 
different types of WBCs (neutrophils, lymphocytes, monocytes, eosinophils, basophils), 
hemoglobin (Hb), hematocrit (Hct), platelets (PLT), blood urea nitrogen (BUN), 
creatinine (Cr), uric acid (UA), liver enzymes (aspartate aminotransferase, alanine 
aminotransferase), electrolytes (sodium, potassium), C-reactive protein (CRP), and 
pro-brain natriuretic peptide (pPro-BNP). For patients with stable COPD, the control 
group received standard inhaled medications according to the GOLD guidelines. 
Placebo mimics of JSHT were administered to the control group. The JSHT group 
additionally received JSHT daily for three months. Baseline and post-treatment HRQL 
assessments, blood tests, and pulmonary function tests (PFT). The study protocol was 
approved by the Ethics Committee of Taipei Tzu Chi Hospital (IRB number 
10-XD-132). Informed consent was obtained from all participants. 
HRQL 
The Taiwan Society of Pulmonary and Critical Care Medicine offers the Chinese version 
of the COPD Assessment Test (CAT) on the website. This test consists of eight items 
designed to evaluate COPD symptoms. These symptoms include cough, phlegm 
production, chest tightness, breathlessness, limitations in daily activities, confidence in 
leaving the house, sleep disturbances, and energy levels. Each symptom is rated on a 
scale from 0 to 5, culminating in a total CAT score ranging from 0 to 40. A higher score 
reflects more severe COPD symptoms. A score of 10 or higher is indicative of a 
significant symptom burden. The Modified Medical Research Council (mMRC) scale 
was used to evaluate dyspnea. This scale, comprising a 5-point grading system ranging 
from 0 to 4, measures dyspnea severity. A score of 0 indicates dyspnea only during 
intense exercise, while a sore of 4 represents breathlessness at rest. 
The 5-item Brief Symptom Rating Scale (BSRS-5) was used to assess psychological 

 
distress. It consists of five items: feeling tense, being easily angered, feeling depressed, 
feeling inferior to others, difficulty with sleep, and suicidal thoughts. The scale is a 
5-point scale ranging from 0 (not at all) to 4 (extremely), with higher scores indicating 
more severe symptoms. 
Pulmonary function tests 
PFT were conducted using a spirometer following the guidelines set by the American 
Thoracic Society. 
Cellular study for assessing the effects of JSHT on Inflammation 
In the cellular study conducted on A549 cells, five groups were analyzed to evaluate the 
effects of JSHT. The groups were: Control group: did not receive treatment; 
lipopolysaccharide (LPS) group: treated with LPS for 16 hours to induce inflammation; 
JSHT group: treated with JSHT for 12 hours; Pre-JSHT+LPS group: cells were 
pre-treated with JSHT for 1 hour, then LPS treatment for 16 hours; Post-JSHT+LPS 
group: cells were exposed to LPS for 16 hours followed by JSHT for 12 hours. 
Measurements were performed for DAMPs such as high mobility group box 1 
(HMGB1), formyl peptide receptor 1 (FPR1), and extracellular adenosine triphosphate 
(ATP); transcription factor nuclear factor kappa-light-chain-enhancer of activated B 
cells (NF-κB); phosphorylated mitogen-activated protein kinase (p-MAPK) and c-Jun 
N-terminal kinase (p-JNK); apoptotic marker cleaved Caspase 3 (cCaspase 3); and 
pro-inflammatory cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), 
interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α). 
Measurement of DAMPs 
A549 cells were cultured in a 6-well plate and incubated at 37°C for 24 h in a 
humidified incubator. Afterward, the cells were cultured under the conditions of the five 
experimental groups; the medium was collected and centrifuged, and then the 
supernatant was stored at -80°C. Commercial enzyme -linked immunosorbent assay 
(ELISA) kits were used to measure the expression levels of DAMP, including HMGB1, 
FPR1, and extracellular ATP, in the medium, following the manufacturer’s instructions. 
The absorbance was measured at a specified wavelength using an Infinite 200 PRO 
microplate reader. 
Measurement of cCaspase-3, NF-kB, p-MAPK, and p-JNK 
The cells were collected and lysed in cold Radioimmunoprecipitation Assay buffer 
containing protein and phosphatase inhibitors. Proteins were dispensed into each well 
and subjected to electrophoresis on a Sodium Dodecyl Sulfate-Polyacrylamide Gel 
Electrophoresis at 140 volts for one hour, followed by the transfer of proteins onto 

 
Polyvinylidene Difluoride (PVDF) membranes at 200 mA for two hours. The membranes 
were blocked with TOOLSpeed Blocking Reagent and incubated with cCaspase-3, 
NF-kB, p-MAPK, and p-JNK primary antibodies overnight at 4°C, then with  secondary 
antibodies for an additional hour. The protein bands were visualized using enhanced 
chemiluminescence reagents and radiographic films. The intensities of the reactive 
bands were analyzed using the Bio-Rad ChemiDoc XRS+ system. 
Cytokines ELISA 
A549 cells were cultured in a 6-well plate in a humidified incubator for 24 hours at 
37°C. Following culture, the cells were subjected to the conditions of the five 
experimental groups. The culture medium of each experimental treatment group was 
collected and stored at -80°C. The cytokines were quantified utilizing ELISA kits, 
following the protocols provided by the manufacturer. 
 
E6A0021975-F1