1. Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China 2. Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061, China 3. Institute of Liver Diseases, Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan 430061, China 4. School of Computer Science, The University of Sydney, Sydney, New 2006, Australia 5. Analytic and Clinical Cooperative Laboratory for Integrative Medicine, USYD & CUHK, Sydney, NSW 2006, Australia 6. China Academy of Chinese Medical Sciences, Beijing 100700, China
Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273= 6.2% vs. 7/20= 35%, P = 0.0004 for all cases; 17/77= 22% vs. 7/9= 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.
Disease conditions (Number of patients treated with herb prescriptions/number of patients)
Moderate (N = 207)
Severe (N = 86)
Total (N = 293)
Discharged (n = 238)
187/198 (94%)
39/40 (98%)
226/238 (95%)
Transferred (n = 31)
9/9 (100%)
21/22 (95%)
30/31 (97%)
Died (n = 24)
0/0
17/24 (71%)
17/24 (71%)
Total (n = 293)
196/207 (95%)
77/86 (90%)
273/293 (93%)
Tab.7
Herb
Total (n = 293)
Moderate (n = 207)
Severe (n = 86)
P values
Radix Glycyrrhizae
200 (68%)
143 (69%)
57 (66%)
6.80E−01
Rhizoma Pinellia
184 (63%)
137 (66%)
47 (55%)
8.41E−02
Poria
177 (60%)
129 (62%)
48 (56%)
3.59E−01
Pericarpium Citri Reticulatae
176 (60%)
130 (63%)
46 (53%)
1.51E−01
Radix Scutellariae
175 (60%)
117 (57%)
58 (67%)
9.02E−02
Pericarpium Trichosanthis
172 (59%)
124 (60%)
48 (56%)
5.18E−01
Radix Codonopsis
164 (56%)
127 (61%)
37 (43%)
4.54E−03**
Cortex Magnoliae Officinalis
162 (55%)
115 (56%)
47 (55%)
8.98E−01
Radix Platycodonis
155 (53%)
121 (58%)
34 (40%)
4.54E−03**
Semen Armeniacae Amarum
143 (49%)
100 (48%)
43 (50%)
7.99E−01
Rhizoma Anemarrhenae
99 (34%)
62 (30%)
37 (43%)
4.15E−02*
Fructus Schisandrae Chinensis
75 (26%)
62 (30%)
13 (15%)
8.11E−03**
Fructus Forsythiae
68 (23%)
41 (20%)
27 (31%)
4.75E−02*
Radix Notoginseng
55 (19%)
46 (22%)
9 (10%)
2.11E−02*
Semen Coicis
47 (16%)
27 (13%)
20 (23%)
3.62E−02*
Tab.8
Herb
Discharged (n = 40)
Transferred (n = 22)
Died (n = 24)
P values
Radix Scutellariae
29 (73%)
16 (73%)
13 (54%)
1.77E−01
Radix Glycyrrhizae
30 (75%)
15 (68%)
12 (50%)
5.81E−02
Pericarpium Trichosanthis
29 (73%)
8 (36%)
11 (46%)
6.06E−02
Poria
30 (75%)
10 (45%)
8 (33%)
1.54E−03**
Rhizoma Pinellia
31 (78%)
6 (27%)
10 (42%)
6.61E−03**
Cortex Magnoliae Officinalis
23 (58%)
11 (50%)
13 (54%)
8.01E−01
Pericarpium Citri Reticulatae
24 (60%)
15 (68%)
7 (29%)
2.15E−02*
Semen Armeniacae Amarum
26 (65%)
10 (45%)
7 (29%)
9.26E−03**
Rhizoma Anemarrhenae
21 (53%)
10 (45%)
6 (25%)
3.89E−02*
Rhizoma Atractylodis Macrocephalae
22 (55%)
10 (45%)
5 (21%)
9.37E−03**
Radix Codonopsis
21 (53%)
10 (45%)
6 (25%)
3.89E−02*
Radix Bupleuri
19 (48%)
10 (45%)
7 (29%)
1.92E−01
Fructus Tsaoko
18 (45%)
7 (32%)
10 (42%)
1.00E+00
Radix Ophiopogonis
21 (53%)
10 (45%)
4 (17%)
7.45E−03**
Herba Pogostemonis
18 (45%)
9 (41%)
7 (29%)
2.91E−01
Tab.9
Herb name
Herb name
Confidence
Frequency
Poria
Semen Trichosanthis
0.74
434
Semen Trichosanthis
Poria
0.95
434
Pericarpium Trichosanthis
Rhizoma Pinellia
0.78
398
Pericarpium Citri Reticulatae
Radix Glycyrrhizae
0.71
398
Radix Codonopsis
Pericarpium Citri Reticulatae
0.82
393
Pericarpium Citri Reticulatae
Radix Codonopsis
0.71
393
Radix Scutellariae
Radix Glycyrrhizae
0.79
388
Radix Codonopsis
Radix Glycyrrhizae
0.76
363
Pericarpium Trichosanthis
Semen Trichosanthis
0.70
358
Semen Trichosanthis
Pericarpium Trichosanthis
0.96
358
Tab.10
Fig.3
Medicine
Patient number
Percentage (n = 293)
Antibiotics
138
47%
Moxifloxacin
101
34%
Cephalosporin
48
16%
Levofloxacin
16
5%
Amoxicillin
12
4%
Antivirals
122
42%
Oseltamivir
79
27%
Arbidol
61
21%
Chinese patent medicine
89
30%
Lianhuaqingwen capsule
69
24%
Biological products
14
5%
Immunoglobulin
13
4%
Tab.11
Medicine and symptom
Patient number
Patient number (relieved)
Partial relief rate
Moxifloxacin
Fever
63
27
43%
Coughing
36
7
19%
Chest tightness
25
1
4%
Wheezing
25
2
8%
Dry cough
10
2
20%
Fatigue
9
4
44%
Diarrhea
9
2
22%
Palpitation
4
0
0%
Dry mouth
4
0
0%
Throat discomfort
2
0
0%
Oseltamivir
Fever
44
13
30%
Coughing
29
3
10%
Wheezing
19
0
0%
Chest tightness
17
0
0%
Diarrhea
8
0
0%
Dry cough
7
0
0%
Fatigue
7
2
29%
Palpitation
5
0
0%
Throat discomfort
3
0
0%
Dry mouth
2
0
0%
Arbidol
Fever
30
12
40%
Coughing
21
4
19%
Chest tightness
17
3
18%
Wheezing
17
4
24%
Diarrhea
7
1
14%
Dry cough
7
3
43%
Fatigue
7
3
43%
Palpitation
3
0
0%
Throat discomfort
2
0
0%
Dry mouth
2
0
0%
Lianhuaqingwen capsule
Fever
39
15
39%
Coughing
25
5
20%
Chest tightness
18
2
11%
Wheezing
17
3
18%
Dry cough
12
3
25%
Diarrhea
7
0
0%
Fatigue
7
3
43%
Palpitation
4
0
0%
Dry mouth
2
0
0%
Throat discomfort
1
0
0%
Tab.12
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