Traditional Chinese medicine in treating pox: Insights for basic and clinical research of Mpox

• Through Chinese history, Traditional Chinese Medicine (TCM) has played a vital role in preventing and treating infectious diseases, especially poxvirus infection. • Extensive clinical and pharmacological studies have shown that TCM can effectively alleviate clinical symptoms, shorten the illness duration, and enhance the immune response in individuals infected with poxvirues. • TCMs have the benefit of being multi-target, multi-pathway, and multi-component in the treatment of poxvirus. • Considering the proven efficacy of TCM in treating poxvirus infections, along with the fact that monkeypox virus exhibits a high degree of genetic similarity and shares similar pathogenic mechanisms with other poxviruses, utilizing TCM for the treatment of monkeypox holds tremendous potential. • Monkeypox therapy with TCM will be a promising direction, and pharmacological and clinical studies on this topic possess important scientific significance and application value. Mpox is rapidly spreading, posing a significant threat to public health. However, we were not prepared to deal with this re-emerging infectious disease. Traditional Chinese medicine (TCM) has long been used to treat emerging infectious diseases in China. It is worth investigating and debating whether TCM is a viable therapy option for mpox. This review aims to primarily describe the clinical evidence of TCM in the treatment of the pox virus, as well as the related antiviral mechanisms, to explore the potential of TCM in the treatment of mpox. A comprehensive literature search was conducted to identify relevant studies on the use of TCM in treating poxvirus infections. Clinical trials, case reports, and mechanistic studies were included. Data on the effectiveness of TCM treatments, as well as the molecular and cellular mechanisms of action, were extracted and analyzed. Clinical evidence shows that TCM has considerable clinical effectiveness against poxvirus. TCM-derived medicinal compounds such as mimosine, quercetin, and miRNAs could inhibit viral replication by targeting viral genes or enzymes. TCMs have the benefit of being multitarget, multipathway, and multicomponent in the treatment of poxvirus. Furthermore, a number of TCM-prospective medications for the treatment of mpox were disclosed. The results suggest that TCM has enormous potential in the treatment of mpox. The multitarget and multipathway nature of TCM offers a unique advantage in combating complex viral infections. However, there are existing problems such as the lack of standardized TCM preparations and the need for more rigorous clinical trials. Initiatives for improved drug development should focus on standardization and validation of TCM treatments. Overall, this review provides theoretical guidance for future TCM research on mpox therapy, and it is likely to inspire research on a potential avenue of drug discovery for mpox treatment. Further studies are needed to fully realize the potential of TCM in the treatment of mpox.