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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

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Front. Med.    2023, Vol. 17 Issue (6) : 1014-1029    https://doi.org/10.1007/s11684-023-1040-8
Practice and principle of traditional Chinese medicine for the prevention and treatment of COVID-19
Linhua Zhao1, Chuanxi Tian1,2, Yingying Yang3, Huifang Guan4, Yu Wei1,2, Yuxin Zhang1, Xiaomin Kang1,2, Ling Zhou1, Qingwei Li1, Jing Ma4, Li Wan1,2, Yujiao Zheng5, Xiaolin Tong1()
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
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Abstract

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.
Keywords traditional Chinese medicine      COVID-19      SARS-CoV-2      clinical evidence-based study      mechanism      integrated traditional Chinese and Western medicine     
Corresponding Author(s): Xiaolin Tong   
Just Accepted Date: 21 November 2023   Online First Date: 25 December 2023    Issue Date: 06 February 2024
 Cite this article:   
Linhua Zhao,Chuanxi Tian,Yingying Yang, et al. Practice and principle of traditional Chinese medicine for the prevention and treatment of COVID-19[J]. Front. Med., 2023, 17(6): 1014-1029.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-023-1040-8
https://academic.hep.com.cn/fmd/EN/Y2023/V17/I6/1014
Staging treatmentRepresentative TCM decoction and Chinese patent medicine
Mild and moderateLianhua Qingwen capsules (LHQW), Jinhua Qinggan granules (JHQG), Qingfei Paidu decoction/granule (QFPD), Sanhan Huashi granules (SHHS) decoction/granules (also known as HSY Formula), Huashi Baidu decoction/granules (HSBD), Xuanfei Baidu decoction/granules (XFBD)
Severe and criticalQFPD, HSBD, Xiyanping (XYP) injection, Xuebijing (XBJ) injection, Shenhuang granules
Recovery periodQimai 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  Research results on the staging treatment of COVID-19 with TCM
Study IDSample sizeIntervention methodDuration of interventionsPrimary 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 daysReduced 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 daysImproved 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)Retrospective cohort studyJHQG (oral, 6 g/sachet, 2 times/day)7 daysViral nucleic-acid testing and duration of improvement of pneumonia
Lin et al. [7]n = 78Retrospective cohort studyJHQG (oral, 5 g/sachet, 3 times/day)
Li et al. [8]n = 749 (CHM arm, n = 509; control arm, n = 240)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) daysSevere/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 = 176Retrospective cohort study
SHHS (including decoction, granules, etc.)		Arrival or exceeding 7 daysReduced 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 daysReduced virus nucleic-acid negative-conversion time and length of hospital stay
Xiong et al. [12]n = 2275Meta-analysis18 RCTs were enrolled5–15 daysImproving clinical symptoms, imaging, and laboratory indicators, shortening the course of disease, and reducing the number of severe cases
Tab.2  Application of TCM in the treatment of mild and moderate forms of COVID-19
Study IDSample sizeIntervention methodDuration of interventionsPrimary 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 daysAll-cause mortality
Sun et al. [14]n = 282 (TCMD, n = 186; control arm, n = 96)Retrospective cohort studyTCMD (oral, 2 times/day)10 daysAll-cause mortality
Liu et al. [15]n = 50 (treatment arm, n = 25; control arm, n = 25)HSBD (1–2 doses were taken daily with water decoction, 100–200 mL each time, by oral or nasal feeding, 2–4 times/day)1 monthClinical outcome, blood count, inflammatory factor levels, and occurrence of adverse reactions
Shi et al. [16]n = 60 (A = 20, B = 20, C = 20)Non-RCTGroup C:
HSBD (137 g twice daily, orally), Shenmai injection (60 mL once daily, intravenously), XYP injection (100 mg twice daily, intravenously), and XBJ injection (100 mL twice daily, intravenously)		Clinical remission time and clinical remission rate
Zhou et al. [20]n = 111 (SHG arm, n = 57; control arm, n = 54)RCT
Shenhuang granule (oral, 1 sachet, twice daily)		14 daysClinical improvement and mortality rate
Tab.3  Application of TCM in the treatment of severe and critical forms of COVID-19
Study IDSample sizeIntervention methodDuration of interventionsPrimary outcome
An et al. [26]n = 1200 (100 individuals in each control and experimental groups for six Chinese patent medicines)RCT
An et al. [27]n = 200 (treatment arm, n = 100; control arm, n = 100)RCTLudangshen oral liquid (10 mL/time, twice daily)14 daysObservation 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 weeksDepressed 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 daysDuration for SARS-CoV-2 nucleic-acid negative conversion after randomization
Tab.4  Application of TCM in the recovery period and treatment of children with COVID-19
Study IDSample sizeIntervention methodDuration of interventionsPrimary outcome
An et al. [38]n = 123 (JHQG, n = 92; control arm, n = 31)RCTJHQG (oral, one sachet, three times/day)14 daysSymptom 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 daysSymptom 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)RCT
Huoxiang Zhengqi dropping pills (one bag, 2 times/day) and Lianhua Qingwen granules (one bag, 3 times/day)		14 daysClinical symptom improvement and disappearance rates after 14 days of treatment
Zhang et al. [41]n = 130Multicenter, prospective, open-label RCT
XYP injection (10 mg/kg once per day, maximum daily dosage 500 mg)		7–14 daysTime from the start of studying medicine to complete symptom resolution, including fever resolution and cough recovery
Fu et al. [42]n = 73 (treatment arm, n = 37; control arm, n = 36)RCTToujie Quwen granules (one bag, 2 times/day)15 daysProportion of patients progressing to severe cases, total effective rate, and discharge rate
Qiu et al. [43]n = 50RCT
Maxing Xuanfei Jiedu decoction (150 mL, 3 times/day)		10 daysProportion 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 daysProportion 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 daysProportion of patients progressing to severe cases; total effective rate and lung CT improvement rate
Li et al. [46]n = 12 981Meta-analysis of 21 studies (6 RCTs and 15 observational studies)
Kang et al. [47]n = 15 520Meta-analysis of 57 studies (28 RCTs and 29 retrospective studies)
Luo et al. [48]n = 1474Meta-analysis of 19 RCTs
Liu et al. [49]n = 982Meta-analysis of 11 studies (4 RCTs and 7 case-control studies)
Wang et al. [50]n = 50Retrospective cohort studyEfficacy and safety indicators
Huang et al. [51]n = 53 (treatment arm, n = 31; control arm, n = 22)A single-center, retrospective study5 daysClinical outcomes (i.e., discharge, mortality, and length of stay)
Tab.5  Integration of TCM and Western medicine
Fig.1  Potential mechanism of TCM in the treatment of COVID-19.
Herbal/compoundActive ingredientsCellsMechanisms of action
LHQW [55]Vero E6 and Huh-7 cellsInhibition of viral replication and reduction of cytokines released by host cells
QFPD [55]LeupeptinVero cellsInhibition of Mpro
XBJ [56]Huh-7 cellsBlockage of virus proliferation
Honeysuckle [57]BHK-21 cellsInhibition of Mpro
Huangqi [57]BHK-21 cellsInhibition of Mpro
Perilla frutescens (L.) Britt [58]Perilla leaf extractVero E6and Huh7 cellsPrevents SARS-CoV-2 from entering host cells
HSBD [59]Glycyrrhisoflavone and licoisoflavone AInhibition of RdRp
HSBD [59]Echinatin and quercetinInhibition of Mpro
EphedraEphedrine [60]ACE2(h) cellsInhibition of SARS-CoV-2 spike pseudovirus entry into ACE2 (h) cells
LicoriceGlycyrrhizin [61,62]Vero E6Decreases ACE2 expression and inhibits the interaction between the S protein receptor binding domain (RBD) and ACE2/inhibition of spike proteins
Salvia miltiorrhizaSalvianolic acid C [63]Vero E6 and HEK85T cellsInhibition of spike proteins
Magnolia officinalisHonokiol derivatives [64]HEK-293 T-ACE2hBlocking the binding of SARS-CoV-2 to host ACE2 receptors
Radix ScutellariaeBaicalein [65]Inhibition of Mpro
Tab.6  Antiviral targets of TCM
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