*3.1.7* Ginger *(the rhizome of Zingiber officinale)*

Ginger has been widely used for thousand years due to its numerous benefits. It was recorded in Chinese, Roman and Arabic medical literature [140]. It is mentioned in Holy Quran as one of Heaven's drinks [141]. Ginger contains many active ingredients, terpene and phenolic are mainly responsible for its pharmacological activities [142, 143]. Ginger has anti-inflammatory, antioxidative, immunomodulatory, antimicrobial, anti-fungal, anticancer, hepatoprotective, antidiabetic, cardiovascular protective, respiratory protective, anti-obesity, anti-nausea, and anti-emetic activities [144]. Ginger also exhibits a direct anti-viral potential [145–147]. A molecular docking study defined the inhibitory effect of 8-gingerol, 10-gingerol, 6-gingerol, and another class of the ginger's ingredients on SARS-CoV-2-related papain-like protease (PLpro) such protease is vital for viral survival and replication [148–150]. In addition, 6-gingerol showed interaction with some SARS-CoV-2 proteins which are crucial for replication, such as protease, SARS-CoV3C-like molecule, and cathepsin K [151] 6-gingerol binds with S protein as well [152]. Another docking study reported the affinity of gingerol, geraniol, shogaol, zingiberene, zingiberenol, and zingerone to the SARS-CoV-2 MPro [153]. A clinical study demonstrated that consumption of Echinacea tablet with *Zingiber officinalis* improved the clinical symptoms in COVID-19 outpatients. There was an alleviation of cough, dyspnea, and muscle pain without recorded side effects [154]. Consumption of ginger with other herbs improved the disease outcomes in COVID-19 patients [155–157].

### *3.1.8 Saussurea costus (S. costus)*

*S*. *costus,* is a perennial, aromatic plant that is native to the Himalayan region [158]. For centuries, S. *costus* was applied in folk medicine to treat numerous health disorders, mainly lung problems [159]. It is mentioned in Islamic literature. Prophet Muhammad (PBUH) said that "Treat with the Indian incense, for it has healing for seven diseases; it is to be sniffed by one having throat trouble and to be put into one side of the mouth of one suffering from pleurisy." [124] *S*. *costus* has a lot of

*Complementary and Alternative Medicine in COVID-19 Infection, an Old Weapon… DOI: http://dx.doi.org/10.5772/intechopen.106866*

ingredients the most effective are terpenes, anthraquinones, alkaloids, flavonoids, costunolide, and dehydrocostus lactone [160]. These compounds have a variety of pharmacological effects: antifungal activity anthelmintic, antidiabetic, antitumor, antimicrobial, immunostimulant, antiulcer, anti-inflammatory, and antihepatotoxic [161–167]. Moreover, the anti-viral activity recommended the use of *S*. *costus* to treat many viruses [160]. Silico with a molecular docking study reported that dehidrocostus lactone showed better binding potential with SARS-CoV-2 S protein than other compounds of *S.costus* [168]. An animal experiment showed that *S. costus* with *N. sativa* and honey induced a significant elevation of Th2, Th17 along with a rise in humoral immunity markers (TGF-β, sIgA,, IL-4, B-def, and IgG) in rat treated group versus placebo [169].

#### **3.2 Cupping therapy**

Cupping therapy (Al-Hijamah) is an ancient part of CAM that was widely practiced in the world and mentioned in every culture [170, 171]. It is mentioned in the book of medicine of Sahih Al-Bukhari where Prophet Muhammad (PBUH) stated that "If there is any healing in your medicines, then it is in cupping, a gulp of honey or branding with fire (cauterization), (one of three) according to that suits the ailment, but I do not like to be (cauterized) branded with fire." [124] Cupping therapy is a procedure where cups are placed on the skin and induce suction, hence, a negative pressure is created. This allows toxic substances to get out of the body [172]. There are a lot of types of cupping therapy, dry and wet cupping are the two main types [173]. Dry cupping is done without skin laceration, however, in wet cupping, the skin is scarified, so that blood is drawn into the cup [174]. Cupping therapy acts via many mechanisms, it elevates the level of endogenous opioids in the brain, hence, improves pain control with subsequent comfort and relaxation [175]. Other mechanism is to improve blood circulation and clear the blood from toxins substances [176]. This mechanism is mediated by the enhancement of microcirculation, angiogenesis, and capillary endothelial cell repair [172, 177]. Muscle relaxation and parasympathetic activity due to blood loss and vasodilation is other mechanisms [178]. A lot of studies reported the possible preventive and therapeutic advantages of cupping therapy in variable diseases, such as lung disorders, type 2 diabetes mellitus, autoimmune diseases, cardiac diseases, and chronic fatigue syndrome [179–183]. Cupping therapy is highly recommended in patients with COVID-19 infection for health improvement and to boost the sensation of well-being [184]**.** The Immunomodulation effect was recorded in 30 patients with rheumatoid arthritis when cupping therapy was combined with conventional therapy versus 20 patients who received conventional treatment only. NK-cell was significantly increased while soluble interleukin-2 receptor (SIL-2R) insignificantly lowered after combined treatment [181]. In a randomized controlled trial, cupping therapy increased the arterial O2 saturation when applied to smokers and enhanced breathing after 12 hours of application [185]. Cupping therapy and acupuncture helped in ameliorating the clinical severity in a case of COVID pneumonia and relieved the complications of respiratory disorders [186]. In a clinical study, warm cupping of the posterior thorax was applied with conventional treatments for 7 days in 8 patients who suffered from COVID-19 with acute respiratory destress syndrome (ARDS). Improvement of the symptoms severity scores was reported in all patients who were discharged without the need for mechanical ventilation [187].
