Skip to main content
PMC home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2020 Sep 14;14(6):760–775. doi: 10.1007/s11684-020-0803-8

Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases

Zixin Shu 1,#, Yana Zhou 2,#, Kai Chang 1,#, Jifen Liu 2, Xiaojun Min 2, Qing Zhang 2, Jing Sun 2, Yajuan Xiong 2, Qunsheng Zou 1, Qiguang Zheng 1, Jinghui Ji 1, Josiah Poon 4,5,✉, Baoyan Liu 6,✉, Xuezhong Zhou 1,✉, Xiaodong Li 2,3,✉
PMCID: PMC7488634  PMID: 32926319

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

Acknowledgements

This work is partially supported by the National Key Research and Development Program (Nos. 2017YFC1703506, 2017YFC1703505, 2017YFC1703502, and 2020YFC0841600), the Special Programs of Traditional Chinese Medicine (Nos. JDZX2015168, JDZX2015171, and JDZX2015170) and the Fundamental Research Funds for the Central public welfare research institutes (Nos. ZZ10-005 and 2018JBZ006).

Compliance with ethics guidelines

Zixin Shu, Yana Zhou, Kai Chang, Jifen Liu, Xiaojun Min, Qing Zhang, Jing Sun, Yajuan Xiong, Qunsheng Zou, Qiguang Zheng, Jinghui Ji, Josiah Poon, Baoyan Liu, Xuezhong Zhou, and Xiaodong Li declare that they have no conflict of interest. This study was approved by the ethics review board of Hubei Provincial Hospital of Traditional Chinese Medicine (HBZY2020-C01-01). Written consent was waived due to the retrospective nature. This study was reported according to STROBE (The Strengthening the Reporting of Observational Studies in Epidemiology).

Footnotes

These authors contributed equally to this work.

Contributor Information

Josiah Poon, Email: josiah.poon@sydney.edu.au.

Baoyan Liu, Email: liuby5505@139.com.

Xuezhong Zhou, Email: xzzhou@bjtu.edu.cn.

Xiaodong Li, Email: lixiaodong555@126.com.

References

  • 1.Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19) J Gen Intern Med. 2020;35(5):1545–1549. doi: 10.1007/s11606-020-05762-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features ofpatients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW, Tsoi HW, Lo SK, Chan KH, Poon VK, Chan WM, Ip JD, Cai JP, Cheng VC, Chen H, Hui CK, Yuen KY. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514–523. doi: 10.1016/S0140-6736(20)30154-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.The Lancet Emerging understandings of 2019-nCoV. Lancet. 2020;395(10221):311. doi: 10.1016/S0140-6736(20)30186-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Chan KW, Wong VT, Tang SCW. COVID-19: an update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese-Western medicine for the management of 2019 novel coronavirus disease. Am J Chin Med. 2020;48(3):737–762. doi: 10.1142/S0192415X20500378. [DOI] [PubMed] [Google Scholar]
  • 6.Lu YF, Yang ZG, Wang M, Shi J, Wang ZW, LYU Y, Tang BZ, Ye C, Xu QN, Yin KS, Chen XR. Analysis on Chinese medical clinical characteristics of 50 patients with 2019-nCoV-infected pneumonia. J Shanghai Univ Tradit Chin Med (Shanghai Zhong Yi Yao Da Xue Xue Bao) 2020; (2): 17–21 (in Chinese)
  • 7.Zheng WK, Zhang JH, Yang FW, Wang YG, Liu QQ, Zhang BL. Comprehensive analysis of diagnosis and treatment schemes for prevention and treatment of novel coronavirus pneumonia by traditional Chinese medicine. J Tradit Chin Med (Zhong Yi Za Zhi) 2020;61(4):277–280. [Google Scholar]
  • 8.Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y, Hu B, Hu F, Li BH, Li YR, Liang K, Lin LK, Luo LS, Ma J, Ma LL, Peng ZY, Pan YB, Pan ZY, Ren XQ, Sun HM, Wang Y, Wang YY, Weng H, Wei CJ, Wu DF, Xia J, Xiong Y, Xu HB, Yao XM, Yuan YF, Ye TS, Zhang XC, Zhang YW, Zhang YG, Zhang HM, Zhao Y, Zhao MJ, Zi H, Zeng XT, Wang YY, Wang XH, the Zhongnan Hospital of Wuhan University Novel Coronavirus ManagementResearch Team, Evidence-Based Medicine Chapter of China International ExchangePromotive Association for MedicalHealth Care CPAM A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Mil Med Res. 2020;7(1):4. doi: 10.1186/s40779-020-0233-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Liang TB. Handbook of COVID-19 prevention and treatment. The First Affiliated Hospital, Zhejiang University School of Medicine. Compiled According to Clinical Experience. 2020. http://che.zju.edu.cn/cheen/2020/0401/c27758a2021088/page.htm (accessed March 20, 2020)
  • 10.Wang Y, Wang L, Rastegar-Mojarad M, Moon S, Shen F, Afzal N, Liu S, Zeng Y, Mehrabi S, Sohn S, Liu H. Clinical information extraction applications: a literature review. J Biomed Inform. 2018;77:34–49. doi: 10.1016/j.jbi.2017.11.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Reed GM. Toward ICD-11: improving the clinical utility of WHO’s International Classification of mental disorders. Prof Psychol Res Pr. 2010;41(6):457–464. [Google Scholar]
  • 12.Baclawski K, Matheus CJ, Kokar MM, Letkowski J, Kogut PA. Towards a symptom ontology for semantic web applications. In: Proceedings of Third International Semantic Web Conference. Hiroshima, Japan. 2004. 650–667
  • 13.Zhang Y, Xie YM, Li YN, Zhang C, Chen C, Zhuang Y. Association rules analysis for exploring combined medication characteristics of Fufang Kushen injection: real-world study based on 49 597 cases. China J Chin Mater Medica (Zhongguo Zhong Yao Za Zhi) 2017;42(15):2900–2904. doi: 10.19540/j.cnki.cjcmm.20170705.009. [DOI] [PubMed] [Google Scholar]
  • 14.Müller B, Reinhardt J, Strickland MT. Neural Networks: An Introduction. Berlin/Heidelberg, Germany: Springer; 2012. [Google Scholar]
  • 15.Yang Y, Yang K, Hao T, Zhu G, Ling R, Zhou X, Li P. Prediction of molecular mechanisms for Lianxia Ningxin Formula: a network pharmacology study. Front Physiol. 2018;9:489. doi: 10.3389/fphys.2018.00489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.FitzGerald GA. Misguided drug advice for COVID-19. Science. 2020;367(6485):1434. doi: 10.1126/science.abb8034. [DOI] [PubMed] [Google Scholar]
  • 17.Russell B, Moss C, George G, Santaolalla A, Cope A, Papa S, Van Hemelrijck M. Associations between immune-suppressive and stimulating drugs and novel COVID-19—a systematic review of current evidence. Ecancermedicalscience. 2020;14:1022. doi: 10.3332/ecancer.2020.1022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Md Insiat Islam Rabby Current drugs with potential for treatment of COVID-19: a literature review. J Pharm Pharm Sci. 2020;23(1):58–64. doi: 10.18433/jpps31002. [DOI] [PubMed] [Google Scholar]
  • 19.Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z, Wang J, Qin Y, Zhang X, Yan X, Zeng X, Zhang S. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): the perspectives of clinical immunologists from China. Clin Immunol. 2020;214:108393. doi: 10.1016/j.clim.2020.108393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Zeng SP. Study of integrated traditional Chinese and western medicine treatment for severe COVID-19. Classical Chin Med Res (Jing Dian Zhong Yi Yan Jiu) 2020;3(2):36–45. [Google Scholar]
  • 21.He LL, Gong PY, Feng Y, Zou W, Wang EL, Gu J. Analysis on application of Chinese materia medica in treatment of COVID-19 by suppressing cytokine storm. Chin Tradit Herbal Drugs (Zhong Cao Yao) 2020;51(6):1375–1385. [Google Scholar]
  • 22.Ling CQ. Traditional Chinese medicine is a resource for drug discovery against 2019 novel coronavirus (SARS-CoV-2) J Integr Med. 2020;18(2):87–88. doi: 10.1016/j.joim.2020.02.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Li SY, Chen C, Zhang HQ, Guo HY, Wang H, Wang L, Zhang X, Hua SN, Yu J, Xiao PG, Li RS, Tan X. Identification of natural compounds with antiviral activities against SARS-associated coronavirus. Antiviral Res. 2005;67(1):18–23. doi: 10.1016/j.antiviral.2005.02.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Ran J, Li YP, Li QT, Liu HB, Zeng CF, Ren Y, Wan P, Wei DR, Li XH, Yang MG, Wu MS, Zuo GQ, He LF, Wang HW, Li PF, Luo L. Study of TCM syndrome in 209 novel coronavirus pneumonia cases of Chongqing in 2020. J Emerg Tradit Chin Med (Zhongguo Zhong Yi Ji Zheng) 2020;29(5):753–755. [Google Scholar]
  • 25.Yang JY, Sun W, Qiao J, Cai R, Liu X, Wei L. Analysis on traditional Chinese medicine syndromes and constitutions of 90 patients with common COVID-19. J Tradit Chin Med (Zhong Yi Za Zhi) 2020;61(8):645–649. [Google Scholar]
  • 26.Sun HY, Bi YF, Zhu ZG, Liu M, Liu XQ, Ma ZR, Wang XL, Zhao GY, Su Q, Mao JY, Zhang BL. Characteristics of traditional Chinese medicine syndromes in 88 patients with coronavirus diseases 2019 in Tianjin. J Tradit Chin Med (Zhong Yi Za Zhi) 2020;61(10):837–841. [Google Scholar]
  • 27.Li JS, Li SY, Xie X, Zhao HL, Feng ZZ, Chun L, Wang JJ, Sun BQ. Clinical characteristics and TCM syndrome distribution of 524 COVID-19 patients in Henan province. J Tradit Chin Med (Zhong Yi Za Zhi) 2020; [Epub ahead of print] (in Chinese) http://kns.cnki.net/kcms/detail/11.2166.R.20200311.1508.002.html
  • 28.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–481. doi: 10.1016/S2213-2600(20)30079-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Cao WJ, Wang TT, Gao YF, Wang YQ, Bao T, Zou GZ. Serum lipid metabolic derangement is associated with disease progression during chronic HBV infection. Clin Lab. 2019;65(12):2377–2386. doi: 10.7754/Clin.Lab.2019.190525. [DOI] [PubMed] [Google Scholar]
  • 31.Schroeder C. Cholesterol-binding viral proteins in virus entry and morphogenesis. Subcell Biochem. 2010;51:77–108. doi: 10.1007/978-90-481-8622-8_3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Takano T, Endoh M, Fukatsu H, Sakurada H, Doki T, Hohdatsu T. The cholesterol transport inhibitor U18666A inhibits type I feline coronavirus infection. Antiviral Res. 2017;145:96–102. doi: 10.1016/j.antiviral.2017.07.022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.National Health Commission. The Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version Seven). 2020. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml (in Chinese) (accessed March 9, 2020)
  • 34.Zhang DH, Wu KL, Zhang X, Deng SQ, Peng B. In silico screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus. J Integr Med. 2020;18(2):152–158. doi: 10.1016/j.joim.2020.02.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Chakrabarty B, Das D, Bulusu G. Network-based analysis of fatal comorbidities of COVID-19 and potential therapeutics. ChemRxiv 2020; doi: 10.26434/chemrxiv.12136470.v1 [DOI] [PMC free article] [PubMed]
  • 36.Maddaloni E, Buzzetti R. COVID-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev 2020; [Epub ahead of print] doi: 10.1002/dmrr.3321 [DOI] [PMC free article] [PubMed]
  • 37.Zhou X, Li Y, Peng Y, Hu J, Zhang R, He L, Wang Y, Jiang L, Yan S, Li P, Xie Q, Liu B. Clinical phenotype network: the underlying mechanism for personalized diagnosis and treatment of traditional Chinese medicine. Front Med. 2014;8(3):337–346. doi: 10.1007/s11684-014-0349-8. [DOI] [PubMed] [Google Scholar]
  • 38.Huang M, Wang J, Zhang R, Ni Z, Liu X, Liu W, Kong W, Chen Y, Huang T, Li G, Wei D, Liu J, Zhou X. Symptom network topological features predict the effectiveness of herbal treatment for pediatric cough. Front Med. 2020;14(3):357–367. doi: 10.1007/s11684-019-0699-3. [DOI] [PubMed] [Google Scholar]
  • 39.Barabási AL, Gulbahce N, Loscalzo J. Network medicine: a network-based approach to human disease. Nat Rev Genet. 2011;12(1):56–68. doi: 10.1038/nrg2918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Zhou X, Lei L, Liu J, Halu A, Zhang Y, Li B, Guo Z, Liu G, Sun C, Loscalzo J, Sharma A, Wang Z. A systems approach to refine disease taxonomy by integrating phenotypic and molecular networks. EBioMedicine. 2018;31:79–91. doi: 10.1016/j.ebiom.2018.04.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Shu Z, Liu W, Wu H, Xiao M, Wu D, Cao T, Ren M, Tao J, Zhang C, He T, Li X, Zhang R, Zhou X. Symptom-based network classification identifies distinct clinical subgroups of liver diseases with common molecular pathways. Comput Methods Programs Biomed. 2019;174:41–50. doi: 10.1016/j.cmpb.2018.02.014. [DOI] [PubMed] [Google Scholar]

Articles from Frontiers of Medicine are provided here courtesy of Nature Publishing Group

RESOURCES