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Frontiers of Medicine

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Front. Med.    2020, Vol. 14 Issue (6) : 760-775    https://doi.org/10.1007/s11684-020-0803-8
RESEARCH ARTICLE
Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases
Zixin Shu1, Yana Zhou2, Kai Chang1, Jifen Liu2, Xiaojun Min2, Qing Zhang2, Jing Sun2, Yajuan Xiong2, Qunsheng Zou1, Qiguang Zheng1, Jinghui Ji1, Josiah Poon4,5(), Baoyan Liu6(), Xuezhong Zhou1(), Xiaodong Li2,3()
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
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Abstract

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.
Keywords COVID-19      traditional Chinese medicine      clinical features     
Corresponding Author(s): Josiah Poon,Baoyan Liu,Xuezhong Zhou,Xiaodong Li   
Just Accepted Date: 30 July 2020   Online First Date: 14 September 2020    Issue Date: 24 December 2020
 Cite this article:   
Zixin Shu,Yana Zhou,Kai Chang, et al. Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases[J]. Front. Med., 2020, 14(6): 760-775.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-020-0803-8
https://academic.hep.com.cn/fmd/EN/Y2020/V14/I6/760
Fig.1  Data filtering and grouping flow chart. COVID-19, coronavirus disease 2019; TCM, traditional Chinese medicine.
Demographics and clinical characteristics Total
(n = 293)		 Moderate
(n = 207)		 Severe
(n = 86)		 P values
Age (year) 57.1±15.6 54.0±15.0 64.6±14.5 1.25E−07**
Sex 　 　 　 2.50E−05**
Female 158 (54%) 128 (62%) 30 (35%) 　
Male 135 (46%) 79 (38%) 56 (65%)
Hospital stay duration (day) 14.5±6.1 14.0±5.1 15.5±7.9 5.14E−02
Onset time (day) 10.8±7.2 11.5±7.5 9.1±6.3 1.58E−02*
Any comorbidity 178 (61%) 108 (52%) 70 (81%) 3.09E−06**
Endocrine and metabolic diseases 101 (34%) 58 (28%) 43 (50%) 3.12E−04**
Diabetes mellitus 47 (16%) 25 (12%) 22 (26%) 4.13E−03**
Circulatory system diseases 91 (31%) 47 (23%) 44 (51%) 1.64E−06**
Hypertension 69 (24%) 40 (19%) 29 (34%) 8.17E−03**
Coronary heart disease 19 (6%) 8 (4%) 11 (13%) 4.72E−03**
Cerebral infarction 11 (4%) 2 (1%) 9 (10%) 3.73E−04**
Digestive system diseases 39 (13%) 13 (6%) 26 (30%) 3.88E−08**
Chronic gastritis 5 (2%) 1 (0.5%) 4 (5%) 4.41E−02*
Genital system diseases 22 (8%) 11 (5%) 11 (13%) 2.70E−02*
Chronic kidney disease 4 (1%) 0 (0%) 4 (5%) 1.01E−02*
Signs and symptoms 　 　 　 　
Respiratory system symptoms 243 (83%) 171 (83%) 72 (84%) 8.18E−01
Coughing 148 (51%) 101 (49%) 47 (55%) 3.61E−01
Chest tightness 104 (35%) 61 (29%) 43 (50%) 8.24E−04**
Wheezing 104 (35%) 59 (29%) 45 (52%) 1.04E−04**
Respiratory difficulty 34 (12%) 14 (7%) 20 (23%) 5.97E−05**
General symptoms 181 (62%) 121 (58%) 60 (70%) 8.18E−01
Fever 102 (35%) 57 (28%) 45 (52%) 4.99E−05**
Digestive system symptoms 138 (47%) 86 (42%) 52 (60%) 3.13E−03**
Reduced appetite 87 (30%) 52 (25%) 35 (41%) 7.87E−03**
Nervous system symptoms 120 (41%) 75 (36%) 45 (52%) 1.07E−02*
Insomnia 96 (33%) 56 (27%) 40 (47%) 7.87E−03**
Circulatory system symptoms 24 (8%) 12 (6%) 12 (14%) 2.04E−02*
Palpitations 24 (8%) 12 (6%) 12 (14%) 2.04E−02*
Temperature (°C) 36.9±0.7 36.8±0.7 37.0±0.8 1.03E−01
Breathing 20.9±4.1 20.3±2.7 22.2±5.9 9.25E−04**
Blood pressure 　 　 　 　
Systolic pressure (mmHG) 126.3±16.4 123.0±13.7 132.9±19.2 1.99E−06**
Diastolic pressure (mmHG) 75.9±10.3 75.0±9.3 77.7±11.9 2.05E−02*
Tongue fur and pulse manifestations 　 　 　 　
Reddish tongue 155 (53%) 112 (54%) 43 (50%) 5.21E−01
Dull tongue 12 (4%) 5 (2%) 7 (8%) 2.44E−02*
Yellow fur 167 (57%) 125 (60%) 42 (49%) 6.90E−02
Greasy fur 73 (25%) 52 (25%) 21 (24%) 8.99E−01
Rapid pulse 42 (14%) 22 (11%) 20 (23%) 4.97E−03**
TCM syndromes
Syndrome of pathogenic qi lung invasion 91 (31%) 56 (27%) 35 (41%) 2.15E−02*
Syndrome of phlegm-heat lung obstruction 84 (29%) 62 (30%) 22 (26%) 4.51E−01
Syndrome of stagnant and jamming wind-heat 33 (11%) 26 (13%) 7 (8%) 2.76E−01
Syndrome of wind-heat weifen invasion 18 (6%) 13 (6%) 5 (6%) 8.80E−01
Syndrome of phlegm-dampness lung obstruction 14 (5%) 10 (5%) 4 (5%) 8.14E−01
Laboratory findings 　 　 　 　
WBC ((3.5–9.5) ´ 109/L) 5.0 (3.9–7.0) 4.9 (3.9–6.2) 5.8 (3.9–8.0) 7.14E−02
Neutrophil count ((1.8–6.3) ´ 109/L) 3.5 (2.6–5.3) 3.4 (2.5–4.2) 4.6 (3.1–6.6) 1.55E−03**
Lymphocyte count ((1.1–3.2) ´109/L) 1.0 (0.7–1.4) 1.2 (0.9–1.6) 0.7 (0.5–1.0) 6.76E−09**
C-reactive protein (<3 mg/L) 18.2 (4.2–63.5) 8.1 (2.3–25.4) 58.3 (22–117.5) 1.89E−12**
Triglycerides (<1.7 mmol/L) 1.6 (1.1–2.0) 1.6 (1.2–2.1) 1.4 (1.1–1.79) 3.71E−02*
Myoglobin (<100 ng/mL) 54.0 (35.3–91.5) 43.6 (35.3–58.4) 76 (45.7–147.1) 4.88E−03**
Total bilirubin (<21 μmol/L) 8.0 (6.2–11.6) 7.2 (5.8–9.7) 10.3 (7.2–13.6) 6.97E−05**
Total cholesterol (<5.17 mmol/L) 4.2 (3.5–4.9) 4.4 (3.9–5.0) 3.8 (3.4–4.4) 2.17E−03**
LDL (<3.4 mmol/L) 2.2 (1.8–2.6) 2.3 (1.9–2.8) 2.0 (1.7–2.5) 1.47E−02*
HDL (1.29–1.55 mmol/L) 1.1 (0.9–1.2) 1.1 (0.9–1.2) 1.0 (0.9–1.2) 5.38E−02
ALT (13–40 U/L) 22.0 (18.0–34.0) 20.0 (17.0–27.0) 33.0 (22.0–49.0) 8.18E−07*
γ-GT (7–45 U/L) 23.0 (15.0–40.0) 22.0 (14.3–35.8) 26.5 (17.0–47.5) 5.54E−02
Uric acid (155–357 μmol/L) 300 (234.5–369) 315 (241–364.5) 285 (231.5–396) 7.66E−01
Platelet count ((125–350) ´ 109/L) 210 (163.3–253) 228 (171–267) 190 (140–240) 8.96E−03**
Prothrombin time (9.9–12.9 s) 12.1 (11.5–12.6) 11.9 (11.4–12.4) 12.5 (11.9–13.6) 1.33E−04**
Oxygen saturation (96%–98%) 97.1 (94.9–98.7) 97.8 (97.0–99.0) 96.1 (93.3–98.7) 4.39E−03**
Interleukin-6 (<7 pg/mL) 14.6 (4.4–39.5) 9.8 (2.5–18.7) 34.2 (13.7–87.9) 9.95E−05**
Tab.1  Characteristics of moderate and severe COVID-19 cases
Demographics and clinical characteristics Discharged
(n = 40)		 Transferred
(n = 22)		 Died
(n = 24)		 P values
Age (year) 58.3±13.5 66.3±13.8 73.6±11.8 1.02E−04**
Sex 　 　 　 1.25E−02*
Female 21 (53%) 4 (18%) 5 (21%) 　
Male 19 (48%) 18 (82%) 19 (79%)
Hospital stay duration (day) 17.7±5.3 15.5±9.8 11.9±8.6 2.03E−03**
Onset time (day) 10.9±6.3 7.6±5.8 7.7±6.5 8.91E−02
Any comorbidity 33 (83%) 16 (73%) 21 (88%) 8.59E−01
Hypertension 13 (33%) 8 (37%) 8 (33%) 9.45E−01
Diabetes mellitus 11 (28%) 4 (18%) 7 (29%) 8.86E−01
Coronary heart disease 4 (10%) 3 (14%) 4 (17%) 6.96E−01
Acute coronary syndrome 0 (0%) 0 (0%) 3 (13%) 9.30E−02
Cerebral infarction 3 (8%) 1 (5%) 5 (21%) 2.42E−01
Complications 　 　 　 　
Respiratory failure 6 (15%) 3 (14%) 11 (46%) 6.86E−03**
Signs and symptoms 　 　 　 　
Coughing 22 (55%) 12 (55%) 13 (54%) 9.48E−01
Wheezing 27 (68%) 6 (27%) 12 (50%) 1.65E−01
Fever 24 (60%) 11 (50%) 10 (42%) 1.55E−01
Chest tightness 21 (53%) 10 (45%) 12 (50%) 8.46E−01
Insomnia 19 (48%) 10 (45%) 11 (46%) 8.97E−01
Reduced appetite 19 (48%) 9 (41%) 7 (29%) 1.48E−01
Respiratory difficulty 8 (20%) 7 (32%) 5 (21%) 9.36E−01
Temperature (°C) 37.0±0.8 37.1±0.8 37.0±0.8 8.84E−01
Breathing 21.0±5.3 22.8±4.9 23.3±7.5 9.83E−02
Blood pressure 　 　 　 　
Systolic pressure (mmHG) 129.0±18.3 129.5±14.8 142.0±22.4 5.56E−02
Diastolic pressure (mmHG) 76.0±11.9 78.6±10.1 79.4±13.5 1.89E−01
Tongue fur and pulse manifestations 　 　 　 　
Reddish tongue 22 (55%) 12 (55%) 9 (38%) 1.75E−01
Yellow fur 22 (55%) 13 (59%) 7 (29%) 4.44E−02*
Stringy pulse 12 (30%) 6 (27%) 4 (17%) 3.71E−01
Greasy fur 13 (33%) 6 (27%) 2 (8%) 5.68E−02
TCM syndromes
Syndrome of pathogenic qi lung invasion 16 (40%) 13 (59%) 6 (25%) 2.21E−01
Syndrome of phlegm-heat lung obstruction 15 (38%) 2 (9%) 5 (21%) 1.64E−01
Tab.2  Characteristics based on the prognosis of severe cases
Laboratory findings Test time Discharged
(n = 40)		 Transferred
(n = 22)		 Died
(n = 24)
WBC ((3.5–9.5) ´ 109/L) First 5.5 (4.5–7.7) 6.5 (3.8–7.6) 6.3 (3.4–8.8)
Last 7.6 (4.4–8.8) 8.1 (5.0–12.7) 11.9 (6.9–12.7)
P values 2.98E−01 3.96E−01 4.60E−02
Neutrophil count ((1.8–6.3) ´ 109/L) First 4.1 (3.2–6.4) 5.4 (3.2–6.1) 4.4 (2.6–8.5)
Last 5.4 (3.1–6.9) 6.1 (3.7–11.3) 10.3 (4.9–12.1)
P values 6.50E−01 5.27E−01 6.43E−02
C-reactive protein (<3 mg/L) First 45.1 (19.8–87.2) 37.5 (16.2–115.8) 81.6 (51–152.9)
Last 3.1 (1.1–12.4) 34.60 (12.15–99.2) 72.3 (33–144.3)
P values 2.99E−04** 6.64E−01 6.88E−01
Total cholesterol (<5.17 mmol/L) First 4.1 (3.4–4.4) 3.5 (3.4–4.0) 4.0 (3.5–4.9)
Last 5.6 (3.1–5.8) 3.7 (3.3–4.4) 3.4 (3.0–4.1)
P values 3.89E−01 9.50E−01 5.12E−02
HDL (1.29–1.55 mmol/L) First 0.99 (0.93–1.15) 0.95 (0.79–1.17) 1.01 (0.91–1.10)
Last 0.95 (0.94–0.96) 0.90 (0.89–0.91) 0.77 (0.56–0.94)
P values 4.81E−01 9.41E−01 4.00E−02*
Tab.3  Laboratory findings based on the prognosis of severe cases before and after hospitalization treatment
Variable Coefficient P values LL UL
Baseline variables
Age (year) 0.753 0.002** 0.286 1.221
Gender (female/male) 0.173 0.042* 0.006 0.341
Clinical classification (moderate/severe) 0.856 <0.0001** 0.647 1.066
Clinical variables (yes/no)
Cough -0.14 0.115 -0.335 0.036
Chest tightness 0.013 0.894 -0.184 0.21
Wheezing -0.06 0.525 -0.266 0.136
Fever -0.08 0.354 -0.277 0.099
Fatigue -0.23 0.01* -0.413 -0.056
Insomnia 0.038 0.718 -0.173 0.251
Reduced appetite -0.19 0.066 -0.405 0.013
Coughing of phlegm 0.329 0.006** 0.094 0.564
Dry cough -0.07 0.47 -0.289 0.134
Respiratory difficulty -0.02 0.873 -0.294 0.25
Throat discomfort -0.10 0.487 -0.401 0.191
White sputum 0.276 0.111 -0.064 0.616
Headache -0.13 0.429 -0.463 0.197
Palpitation -0.11 0.456 -0.431 0.194
Diarrhea 0.066 0.68 -0.252 0.386
Loose stool 0.053 0.765 -0.296 0.402
Bitter taste in mouth -0.24 0.303 -0.698 0.218
Vertigo -0.36 0.061 -0.74 0.017
Dry mouth 0.162 0.514 -0.327 0.652
Limb pain 0.222 0.283 -0.185 0.631
Hypertension -0.09 0.3 -0.161 0.52
Diabetes mellitus -0.06 0.393 -0.309 0.122
Coronary heart disease 0.179 0.584 -0.301 0.17
Cerebral infarction 0.758 0.001** 0.308 1.209
Reddish tongue -0.09 0.221 -0.352 0.082
Pink tongue -0.10 0.701 -0.566 0.381
Deep red tongue -0.04 0.608 -0.252 0.43
Pale tongue -0.09 0.929 -0.263 0.24
Dull tongue -0.11 0.619 -0.446 0.266
Yellow fur -0.31 0.042** -0.616 -0.011
Greasy fur -0.13 0.29 -0.113 0.376
Thin fur -0.01 0.605 -0.517 0.302
White fur -0.26 0.529 -0.301 0.155
Thick fur -0.01 0.652 -0.618 0.388
Wiry pulse -0.07 0.087 -0.573 0.039
Slippery pulse 0.131 0.913 -0.283 0.253
Rapid pulse 0.155 0.248 -0.109 0.42
Floating pulse 0.088 0.093 -0.046 0.592
Thready pulse 0.273 0.841 -0.517 0.421
Syndrome of pathogenic qi lung invasion -0.26 0.946 -0.415 0.444
Syndrome of phlegm-heat lung obstruction -0.02 0.033* -0.501 -0.021
Syndrome of stagnant and jamming wind-heat -0.07 0.864 -0.266 0.223
Syndrome of wind-heat weifen invasion 0.014 0.925 -0.445 0.405
Tab.4  Associated clinical features for the prognosis of COVID-19
Medicine Total (n = 293) Moderate
(n = 207)		 Severe
(n = 86)		 P values
Antibiotics 258 (88%) 175 (85%) 83 (97%) 7.83E−03**
Moxifloxacin 232 (79%) 152 (73%) 80 (93%) 1.69E−04**
Cefoperazone 91 (31%) 42 (20%) 49 (57%) 2.19E−09**
Imipenem and cilastatin sodium 49 (17%) 7 (3%) 42 (49%) 1.12E−19**
Antivira 247 (84%) 171 (83%) 76 (88%) 2.17E−01
Arbidol 199 (68%) 143 (69%) 56 (65%) 5.83E−01
Ribavirin 56 (19%) 38 (18%) 18 (21%) 6.27E−01
Interferon 52 (18%) 33 (16%) 19 (22%) 2.40E−01
Digestive system drugs 190 (65%) 117 (57%) 73 (85%) 3.65E−06**
Omeprazole 79 (27%) 42 (20%) 37 (43%) 1.42E−04**
Pantoprazole 78 (27%) 45 (22%) 33 (38%) 5.52E−03**
TCM patent prescription 184 (63%) 112 (54%) 72 (84%) 1.79E−06**
Baicalin 52 (18%) 19 (9%) 33 (38%) 1.59E−08**
Xue Bi Jing injection 46 (16%) 13 (6%) 33 (38%) 7.81E−11**
Glucocorticoids 135 (46%) 68 (33%) 67 (78%) 1.84E−12**
Methylprednisolone 116 (40%) 51 (25%) 65 (76%) 7.00E−16**
Nutrition support 134 (46%) 69 (33%) 65 (76%) 3.83E−11**
Potassium chloride 61 (21%) 28 (14%) 33 (38%) 5.79E−06**
Biological products 127 (43%) 64 (31%) 63 (73%) 2.75E−11**
Human albumin 61 (21%) 20 (10%) 41 (48%) 3.19E−12**
Antitussive and antiasthmatic 126 (43%) 74 (36%) 52 (60%) 9.97E−05**
Ambroxol 52 (18%) 23 (11%) 29 (34%) 1.55E−05**
Vitamins 111 (38%) 61 (29%) 50 (58%) 4.09E−06**
Vitamin C 68 (23%) 35 (17%) 33 (38%) 1.30E−04**
Antipyretic analgesic 84 (29%) 44 (21%) 40 (47%) 1.34E−05**
Diclofenac sodium 44 (15%) 24 (12%) 20 (23%) 1.85E−02*
Anticoagulant 76 (26%) 35 (17%) 41 (48%) 4.46E−08**
Heparin 69 (24%) 32 (15%) 37 (43%) 1.54E−06**
Antihypertensive agent 67 (23%) 36 (17%) 31 (36%) 5.35E−04**
Amlodipine 31 (11%) 14 (7%) 17 (20%) 2.77E−03**
Immunomodulator 62 (21%) 28 (14%) 34 (40%) 6.93E−07**
Thymosin 57 (19%) 24 (12%) 33 (38%) 5.18E−07**
Antidiabetic 51 (17%) 21 (10%) 30 (35%) 3.66E−07**
Acarbose 29 (10%) 15 (7%) 14 (16%) 2.97E−02*
Insulin 28 (10%) 5 (2%) 23 (27%) 1.49E−09**
Antishock 22 (8%) 0 (0%) 22 (26%) 2.30E−13**
Epinephrine 19 (6%) 0 (0%) 19 (22%) 1.62E−11**
Lobeline hydrochloride 12 (4%) 0 (0%) 12 (14%) 2.30E−07**
Prognosis
Discharged 238 (81%) 198 (96%) 40 (47%)
Transferred 31 (11%) 9 (4%) 22 (26%)
Died 24 (8%) 0 (0%) 24 (28%)
Tab.5  Clinical therapies for moderate and severe COVID-19 cases
Medicine Discharged (n = 40) Transferred
(n = 22)		 Died (n = 24) P values
Antibiotics 38 (95%) 22 (100%) 23 (96%) 6.47E−01
Moxifloxacin 37 (93%) 21 (95%) 22 (92%) 7.18E−01
Cefoperazone 19 (48%) 15 (68%) 15 (63%) 2.44E−01
Imipenem and cilastatin sodium 14 (35%) 13 (59%) 15 (63%) 3.24E−02*
Antivira 34 (85%) 21 (95%) 21 (88%) 9.26E−01
Arbidol 24 (60%) 14 (64%) 18 (75%) 2.21E−01
Glucocorticoids 30 (75%) 18 (82%) 19 (79%) 7.03E−01
Methylprednisolone 28 (70%) 18 (82%) 19 (79%) 4.21E−01
TCM patent prescription 29 (73%) 20 (91%) 23 (96%) 2.30E−02*
Xue Bi Jing injection 12 (30%) 7 (32%) 14 (58%) 2.55E−02*
Antihypertensive agent 15 (38%) 7 (32%) 9 (38%) 1.00E+00
Antishock 0 (0%) 1 (5%) 21 (86%) 3.85E−12**
Epinephrine 0 (0%) 0 (0%) 19 (79%) 4.87E−12**
Tab.6  Clinical therapies sorted by the prognosis of severe cases
Fig.2  Therapeutic characteristics of TCM herbal prescriptions. (A) Distributions of 1176 prescription-related herbs for 273 patients; (B) top 10 herbs and related features sorted by the number of patients. RAG, Radix Glycyrrhizae; RHP, Rhizoma Pinellia; PCR, Pericarpium Citri Reticulatae; RAS, Radix Scutellariae; PET, Pericarpium Trichosanthis; RAC, Radix Codonopsis; CMO, Cortex Magnoliae Officinalis; RAP, Radix Platycodonis; SAA, Semen Armeniacae Amarum.
Prognosis 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  Prognosis of patients treated with herbal prescriptions
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  Differences between the herb therapies received by moderate and severe cases of COVID-19
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 therapies sorted on the basis of the prognosis of patients with severe COVID-19
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  Top 10 herb combinations in COVID-19 TCM herbal prescriptions
Fig.3  Core herbs for COVID-19 treatment and their characteristics. This network shows the core herb combinations in TCM prescriptions. It is organized into four different types of nodes: the green nodes represent TCM herbs, and the pinkish blue and orange nodes correspond to the core pharmacological effects, channel tropisms, and flavor of the herbs. Node size reflects the degree value (a high degree is represented by a large node). PCR, Pericarpium Citri Reticulatae; CMO, Cortex Magnoliae Officinalis; SAA, Semen Armeniacae Amarum; RQF, Regulating qi flow; PFP, Rhizoma Atractylodis Macrocephalae; RAM, Rhizoma Atractylodis Macrocephalae.
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  Therapeutic characteristics of preadmission therapies
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  Symptoms of preadmission medication cases with improvement
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