1. Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China 2. Beijing University of Chinese Medicine, Beijing 100029, China 3. National Center for Integrative Medicine, China-Japan Friendship Hospital, Beijing 100029, China 4. College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China 5. College of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Hefei 230012, China
Traditional Chinese medicine (TCM) has played an important role in the prevention and treatment of coronavirus disease 2019 (COVID-19) epidemic in China. The integration of Chinese and Western medicine is an important feature of Chinese COVID-19 prevention and treatment. According to a series of evidence-based studies, TCM can reduce the infection rate of severe acute respiratory syndrome coronavirus 2 in high-risk groups. For patients with mild and moderate forms of COVID-19, TCM can relieve the related signs and symptoms, shorten the period of nucleic-acid negative conversion, and reduce conversion rate to the severe form of the disease. For COVID-19 patients with severe and critical illnesses, TCM can improve inflammatory indicators and blood oxygen saturation, shorten the hospital stay, and reduce the mortality rate. During recovery, TCM can improve patients’ symptoms, promote organ function recovery, boost the quality of patients’ life, and reduce the nucleic-acid repositive conversion rate. A series of mechanism research studies revealed that capability of TCM to treat COVID-19 through antiviral and anti-inflammatory effects, immune regulation, and protection of organ function via a multicomponent, multitarget, and multipathway approach.
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Qimai Feiluoping decoction (QM), recovery using six types of proprietary Chinese medicine (Jinshuibao tablets, Shengmaiyin oral liquid, Shumian capsules, Xiaoyao capsules, Xiangsha Liujun pills, and Ludangshen oral liquid)
Tab.1
Study ID
Sample size
Intervention method
Duration of interventions
Primary outcome
Qiao et al. [3]
n = 22 975 (LHQW, n = 18 579; control arm, n = 6423)
Retrospective cohort study LHQW (oral, 4 capsules/time, 3 times/day)
The longest duration for taking the medication was 14 days
Reduced the positive rate of SARS-CoV-2 in close contacts of COVID-19 cases
Shah et al. [5]
n = 300 (JHQG, n = 150; control arm, n = 150)
RCTJHQG (oral, 5 g/sachet, 3 times/day)
10 days
Improved clinical symptoms and negative result in viral polymerase chain reaction (PCR)
Liu et al. [6]
n = 80 (treatment arm, n = 44; control arm, n = 36)
Real-world study Use of “Formula 1,” “Formula 2 (QFPD),” or “Formula 3” based on evidence and administration of one dose twice a day or the proprietary Chinese medicine recommended in the program
Median number of medication days: 8.0 (6.0–11.0) days
Severe/critical conversion rate during the observation period
Tian et al. [9]
n = 721 (treatment arm, n = 430; control arm, n = 291)
Retrospective cohort study SHHS (including decoction, granules, etc.)
Reduced proportion of mild and moderate COVID-19 patients who progressed to severe disease status
Zhang et al. [10]
n = 176
Retrospective cohort study SHHS (including decoction, granules, etc.)
Arrival or exceeding 7 days
Reduced proportion of mild to moderate COVID-19 patients who were converted to severe or death status
Pang et al. [11]
n = 180 (treatment arm, n = 120; control arm, n = 60)
Non-RCT XFBD (oral, 10 g/sachet, 2 times/day)
14 days
Reduced virus nucleic-acid negative-conversion time and length of hospital stay
Xiong et al. [12]
n = 2275
Meta-analysis18 RCTs were enrolled
5–15 days
Improving clinical symptoms, imaging, and laboratory indicators, shortening the course of disease, and reducing the number of severe cases
Tab.2
Study ID
Sample size
Intervention method
Duration of interventions
Primary outcome
Chen et al. [13]
n = 662 (CHM, n = 484; control arm, n = 178)
Retrospective cohort studyCHM (oral, 2 times/day)
The longest duration of taking medication was 14 days
Observation of changes in gastrointestinal and respiratory symptoms
He et al. [30]
n = 420 (treatment arm, n = 325; control arm, n = 95)
Observational study Comprehensive interventions (Baduanjin exercise, foot baths, moxibustion with acupoint application, Tongzhi granule, and Wuhan Kangyi decoction)
Reverse transcription-PCR results
Yan et al. [33]
n = 60 (treatment arm, n = 30; control arm, n = 30)
RCT Shugan Tiaoshen acupuncture (1 session/2 days, 3 times a week)
8 weeks
Depressed mood and quality of sleep
Xu et al. [35]
n = 2808 (treatment arm, n = 346; control arm, n = 346)
Retrospective cohort study Prescribed doses of LHQW granules were 3 g for children of 3–6 years old, 4.5 g for children of 7–9 years old, and 6 g for children of 10–17 years old, three times daily. LHQW capsule doses were 1 capsule for children of 3–6 years old, 2 capsules for children of 7–9 years old, and 4 capsules for children of 10–17 years old, three times daily. Children under 2 years of age received 1 g LHQW granules three times daily
Negative conversion time of nucleic acid
Feng et al. [36]
n = 108 (HSBD, n = 72; control arm, n = 36)
RCT Intervention group patients were given HSBD the day after randomization, with a dose of 2.5 g for children aged 3–6 years old, 5 g for children aged 7–12 years old, and 10 g for children aged 13–18 years old, twice daily for 5 consecutive days
5 days
Duration for SARS-CoV-2 nucleic-acid negative conversion after randomization
Tab.4
Study ID
Sample size
Intervention method
Duration of interventions
Primary outcome
An et al. [38]
n = 123 (JHQG, n = 92; control arm, n = 31)
RCTJHQG (oral, one sachet, three times/day)
14 days
Symptom improvement rate and symptom disappearance rate after 14 days of treatment
Duan et al. [38]
n = 123 (JHQG, n = 82; control arm, n = 41)
RCTJHQG (oral, 6 g/sachet, three times/day)
5 days
Symptom improvement rate and symptom disappearance rate
Wenguang et al. [39]
n = 108 (treatment arm, n = 73; control arm, n = 35)
RCT TCM decoction (1 total dose daily, 400 mL, twice in the morning/day)
Time to complete recovery and lung CT findings
Xiao et al. [40]
n = 124 (treatment arm, n = 61; control arm, n = 63)
Proportion of patients progressing to severe cases; lung CT improvement rate, disappearance time of fever, and disappearance time of cough
Sun et al. [44]
n = 57 (treatment arm, n = 32; control arm, n = 25)
RCTLianhua Qingke granules (1 bag, 3 times/day)
14 days
Proportion of patients progressing to severe cases; lung CT improvement rate, symptom disappearance rate
Yu et al. [45]
n = 295 (treatment arm, n = 147; control arm, n = 148)
RCTLianhua Qingwen granules (6 g, 3 times/day)
7 days
Proportion of patients progressing to severe cases; total effective rate and lung CT improvement rate
Li et al. [46]
n = 12 981
Meta-analysis of 21 studies (6 RCTs and 15 observational studies)
Kang et al. [47]
n = 15 520
Meta-analysis of 57 studies (28 RCTs and 29 retrospective studies)
Luo et al. [48]
n = 1474
Meta-analysis of 19 RCTs
Liu et al. [49]
n = 982
Meta-analysis of 11 studies (4 RCTs and 7 case-control studies)
Wang et al. [50]
n = 50
Retrospective cohort study
Efficacy and safety indicators
Huang et al. [51]
n = 53 (treatment arm, n = 31; control arm, n = 22)
A single-center, retrospective study
5 days
Clinical outcomes (i.e., discharge, mortality, and length of stay)
Tab.5
Fig.1
Herbal/compound
Active ingredients
Cells
Mechanisms of action
LHQW [55]
Vero E6 and Huh-7 cells
Inhibition of viral replication and reduction of cytokines released by host cells
QFPD [55]
Leupeptin
Vero cells
Inhibition of Mpro
XBJ [56]
Huh-7 cells
Blockage of virus proliferation
Honeysuckle [57]
BHK-21 cells
Inhibition of Mpro
Huangqi [57]
BHK-21 cells
Inhibition of Mpro
Perilla frutescens (L.) Britt [58]
Perilla leaf extract
Vero E6and Huh7 cells
Prevents SARS-CoV-2 from entering host cells
HSBD [59]
Glycyrrhisoflavone and licoisoflavone A
Inhibition of RdRp
HSBD [59]
Echinatin and quercetin
Inhibition of Mpro
Ephedra
Ephedrine [60]
ACE2(h) cells
Inhibition of SARS-CoV-2 spike pseudovirus entry into ACE2 (h) cells
Licorice
Glycyrrhizin [61,62]
Vero E6
Decreases ACE2 expression and inhibits the interaction between the S protein receptor binding domain (RBD) and ACE2/inhibition of spike proteins
Salvia miltiorrhiza
Salvianolic acid C [63]
Vero E6 and HEK85T cells
Inhibition of spike proteins
Magnolia officinalis
Honokiol derivatives [64]
HEK-293 T-ACE2h
Blocking the binding of SARS-CoV-2 to host ACE2 receptors
Radix Scutellariae
Baicalein [65]
Inhibition of Mpro
Tab.6
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