Table 4.
Essential points of the recommendations.
| Clinical Question 1 | How to reduce the severe conversion rate of COVID-19 patients with integrated TCM and western medicine? |
| Recommendation 1 | Supportive and symptomatic therapy (consensus recommendation) |
| Triple therapy with IFN β-1b, Lpv/R, and ribavirin (weak recommendation, low evidence quality) | |
| For elderly patients with mild COVID-19: Early treatment with high-titer convalescent plasma (weak recommendation, high evidence quality) | |
| Recommendation 2 | TCM decoctions / CPMs based on syndrome differentiation (strong recommendation, high evidence quality) |
| Clinical Question 2 | How to treat severe COVID-19 with integrated TCM and western medicine? |
| Recommendation 3 | Close monitoring for signs of clinical deterioration, aggressive management of complications and secondary infections, and timely supportive treatment; Immediately respiratory support. (consensus recommendation) |
| For patients HFNC or NIV: Concurrent awake prone ventilation (weak recommendation, low evidence quality) | |
| Recommendation 4 | Corticosteroids (strong recommendation, moderate evidence quality) |
| For adult patients with high inflammatory markers: TCZ (strong recommendation, moderate evidence quality) | |
| For patients receiving oxygen therapy but not on IMV: 5 days of remdesivir treatment (weak recommendation, moderate evidence quality) | |
| For patients who fail to respond to initial therapy: IVIg (strong recommendation, moderate evidence quality) | |
| Recommendation 5 | Severe COVID-19 belongs to the “damp toxin epidemic” in TCM theory, and its main TCM pathogenesis is “epidemic toxin blocking lung” (consensus recommendation) |
| TCM medications based on syndrome differentiation that has the effect of “releasing pulmonary Qi and detoxicating”. (strong recommendation, low evidence quality) | |
| TCM medications that has the effect of “nourishing the spleen and dissipating dampness”. (strong recommendation, moderate evidence quality) | |
| Clinical Question 3 | How to treat elderly patients with severe COVID-19 with integrated TCM and western medicine? |
| Recommendation 6 | Reduce polypharmacy; adjusted drug dose according to the condition, organ function, and drug interactions; prevent adverse events. (consensus recommendation) |
| Recommendation 7 | Potential complications should be monitored and prevented; treatments should focus on supportive, symptomatic treatment and TCM treatment with syndrome differentiation. (consensus recommendation) |
| Recommendation 8 | TCM therapeutic method of “strengthening healthy energy and removing blood stasis” (consensus recommendation) |
| Clinical Question 4 | How to mitigate the adverse effects of medications with integrated TCM and western medicine in the treatment of severe COVID-19? |
| Recommendation 9 | Use the medications that carries the lowest risk of drug-drug interactions with other medications that the patient may be receiving; for medications with dose-dependent negative effects, minimum effective doses should be used for the shortest duration (consensus recommendation) |
| Recommendation 10 | Symptomatic treatment combined with TCM treatment based on syndrome differentiation (consensus recommendation) |
| For liver damage: The combination of symptomatic treatment with TCM decoction based on the therapeutic strategy of “strengthening primordial energy, releasing pulmonary qi, nourishing spleen, and detoxification” (weak recommendation, low evidence quality) | |
| Recommendation 11 | TCM treatment for severe COVID-19 based on syndrome differentiation could reduce adverse events by shortening the application time and total dose of other medications. (strong recommendation, low evidence quality) |
| Clinical Question 5 | How to treat the complications of severe COVID-19 with integrated TCM and western medicine? |
| Recommendation 12 | Active monitoring and evaluation according to the TCM theory of “treating the disease before it occurs (preventive treatment of disease)” (consensus recommendation) |
| Recommendation 13 | For fatigue, chest distress, shortness of breath, loss of appetite, limb pain, and other complications: HXZQ capsule/dropping pill combined with LHQW capsule/granule based on syndrome differentiation (strong recommendation, moderate evidence quality) |
| For digestive system complications, including anorexia, diarrhea, and constipation: TCM decoctions based on syndrome differentiation may be more effective than CPMs (strong recommendation, moderate evidence quality) | |
| For abdominal fullness, anorexia, and nausea: TCM herbs that have the effect of “regulating stomach and dissipating dampness” or “tonifying spleen and appetizing” (consensus recommendation) | |
| For constipation, dry stool, and abdominal distension: Chengqi decoction series based on syndrome differentiation (consensus recommendation) | |
| For pulmonary function damage including pulmonary fibrosis: TCM herbs that have the effects of “dispelling wind, dredging collaterals, and resolving hard lumps” or Guizhi Fuling decoction/pill (for those who do not have high fever) (consensus recommendation) | |
| Clinical Question 6 | How to carry out integrated TCM and western medicine treatment for patients recovering from severe COVID-19? |
| Recommendation 14 | All patients before hospital discharge or those experienced persistent symptoms and/or functional limitations after hospital discharge should be screened for rehabilitation needs in terms of physical, cognitive, and mental disorders, to facilitate onward referral and/or be managed timely (consensus recommendation) |
| Recommendation 15 | Provide education and support for self-management of breathlessness and resumption of activities. (consensus recommendation) |
| Recommendation 16 | The general TCM pathogenesis of patients recovering from severe COVID-19 is “unexhausted evil Qi and unrecovered healthy Qi”, and the specific pathogenesis is mainly characterized by “deficiency, stasis, and dampness”. (consensus recommendation) |
| The basic TCM syndromes are “Qi deficiency of the lung and spleen, and Qi and Yin deficiency”, which are conditionally combined with “uncleared toxin and phlegm-stasis blocking collaterals” (consensus recommendation) | |
| Recommendation 17 | TCM decoctions and CPMs with syndrome differentiation (strong recommendation, low evidence quality) |
| TCM therapy such as acupuncture and moxibustion, manipulation, auricular points therapy, skin-scraping therapy, cupping, foot bath, diet therapy, and emotional therapy; traditional Chinese excises such as Baduanjin and Tai-chi (strong recommendation, moderate evidence quality) | |
| Clinical Question 7 | How to improve the mental health of patients recovering from severe COVID-19 with integrated TCM and western medicine? |
| Recommendation 18 | Establish prompt identification and assessment as well as early warning mechanism; initiate psychosocial support strategies and first-line intervention (consensus recommendation) |
| Recommendation 19 | Provide basic mental health and psychosocial support by asking and addressing their needs and concerns (consensus recommendation) |
| Recommendation 20 | For anxiety, fear, depression, somatization symptoms, and other adverse mental states:Psychological counseling, mental health education, and non-drug treatment such as Tai Chi, breathing relaxation training, mindfulness training, cognitive behavioral therapy, and group intervention (strong recommendation, low evidence quality)Symptomatic treatment combined with TCM decoctions based on syndrome differentiation, which follows the therapeutic method of “soothing the liver and relieve depression, reinforcing earth (spleen) to strengthen metal (lung)” and “eliminating the remaining evil Qi” (weak recommendation, low evidence quality) |
| Clinical Question 8 | How to help rehabilitate pulmonary function in patients with severe COVID-19 with integrated TCM and western medicine? |
| Recommendation 21 | Rehabilitation care should be implemented as soon as possible (could be carried out in parallel with the treatment of the disease according to the correct assessment) (consensus recommendation) |
| Recommendation 22 | For potential impaired pulmonary function and pulmonary fibrosis:Pulmonary rehabilitation training and TCM decoction according to syndrome differentiation, which follows the therapy method of “reinforcing earth (spleen) to strengthen metal (lung), eliminating phlegm to dredging collaterals” and “eliminating the remaining evil Qi (epidemic toxin)” (weak recommendation, low evidence quality)Non-drug treatments such as the Baduanjin, Tai-chi, 6-character breathing exercise, posture management, and breathing exercise management (strong recommendation, low evidence quality) |
IFN: interferon; Lpv/R: lopinavir/ritonavir; TCM: traditional Chinese medicine; CPM: Chinese patent medicine; HFNC: high flow nasal cannula; NIV: noninvasive ventilation; TCZ: tocilizumab; IVIg: intravenous immunoglobulin; HXZQ, Huoxiang Zhengqi; LHQW, Lianhua Qinwen