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J Tradit Chin Med 2021 December 15; 41(6): 982-984
ISSN 0255-2922
© 2021 JTCM. All rights reserved.

RESEARCH ARTICLE
TOPIC

Traditional Chinese Medicine enhances absorption of lung lesions
in corona virus disease 2019 patients

BAO Chunmiao, LI Binbin
aa
BAO Chunmiao, Department of Respiratory, Yuyao People's
Hospital of Zhejiang Province (the Affiliated Yangming Hospital of Ningbo University), Ningbo 315000, China
LI Binbin, Department of Respiratory, YongJia County People's Hospital, Wenzhou 325000, China
Correspondence to: BAO Chunmiao, Department of Respiratory, Yuyao People's Hospital of Zhejiang Province (the Affiliated Yangming Hospital of Ningbo University), Ningbo
315000, China.
Telephone: +86-15968459836
Doi: 10.19852/j.cnki.jtcm.2021.06.016
Accepted: February 8, 2021

with WM plus TCM and cases only received WM.
Multivariate cox regression model showed that cases receiving extra TCM had lower risk of delayed absorption of lung lesions [Hazard ratio = 0.24, 95%
confidence Interval (0.06, 0.96), P = 0.043].
CONCLUSION: Compared to WM, the treatment of
WM plus TCM facilitates the recovery of pulmonary
infiltration on COVID-19 cases without significantly
increasing medical expense.

© 2021 JTCM. All rights reserved.
Keywords: COVID-19; Traditional Chinese Medicine; Western Medicine; Epidemiology; Computed
tomography

Abstract
OBJECTIVE: To study the possible role of traditional Chinese medicine (TCM) of Huangqi (Radix Astragali Mongolici), Gancao (Radix Glycyrrhizae), Jinyinhua (Flos Lonicerae), and Lianqiao (Fructus Forsythiae Suspensae) in absorption of lung lesions in Corona Virus Disease 2019 (COVID-19) patients.

INTRODUCTION
Chest computed tomographic (CT) scan was extensively applied in the diagnosis and management of COVID-19 cases.1 Conversion to negative test result of real
time polymerase chain reaction (RT-PCR) and improvement on chest CT scan predict a recovery from
COVID-19.2 Previous study reported that over half
COVID-19 patients present with typical chest CT development that parallel to the change of RT-PCR test
whereas the rest showed a delayed improvement in
lung lesions as compared with viral load shedding.3 Traditional Chinese medicine (TCM) functioned as an adjunctive option in the management of COVID-19.4
The therapeutic role of TCM in this refractory pulmonary infiltration remained unclear. This study was
aimed to identify the possible effect of TCM in recovery of COVID-19 in terms of absorption of lung
lesions.

METHODS: A cohort of COVID-19 cases was recruited. During hospitalization, chest computed tomographic (CT) scan and real time polymerase chain
reaction (RT-PCR) test were performed every three
days. Comparison was held (Western Medicine, WM
vs WM plus TCM) on absorption of lung lesions,
time interval from admission to negative test result
of RT-PCR (ATN), and medical expense. Multivariate
cox regression models were built to identify the
possible prognostic factor of delayed absorption of
lung lesion.
RESULTS: The medical expenditure (1163 ± 379 vs
1137 ± 498, P = 0.863) and ATN (13 ± 4 vs 10 ± 4, P =
0.055) were comparable between cases treated

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METHODS
A cohort of individuals with diagnosis of COVID-19
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confirmed by RT-PCR was consecutively recruited.
Clinical characteristics of age, gender, comorbidity,
smoking status, and time interval from symptom onset
to admission (STA) were collected during epidemiological investigation. Diabetes and hypertension were reported as comorbidity while no other disease was
found in this study population. STA was used to measure the timing of medical intervention (longer STA indicates a delayed medical intervention). During the
hospitalization, chest CT scan and RT-PCR test were
performed every three days. Initial CT scan of each patient showed bilateral pulmonary infiltration. Patients
with a negative RT-PCR test while CT scan showed
nodular or patchy ground glass opacity lesions in multiple areas, with thickening of interlobular and intralobular septa, and halo signs around the nodules were defined as cases with delayed absorption. No medical
treatment was provided pre-hospitalisation whereas a
combination of IFN α-2b, lopinavir, and umifenovir
(western medicine, WM) was initiated on each patient
after admission. In addition to WM, computer-aided
random selection of patients (n = 29) received an extra
of TCM (Radix astragali, Radix Glycyrrhizae, Lonicerae
Japonicae Flos, and Fructus Forsythia). Baseline laborato-

ry tests (white blood cell, WBC, platelet, Plt, and c-react protein, CRP), time interval from admission to negative RT-PCR (ATN), and medical expense were collected. ATN was used to measure the change of viral
load (longer ATN indicated a prolonged coronavirus

shedding). The conversion of medical expenditure in
Chinese yuan to United States dollars (USD) was
made basing on March 18th 2020 (last patient discharged) exchange rate (1 USD = 7.03 CNY). This
study was approved by the Research Ethics Committee
of Yongjia County People's Hospital (approval number: 2020-L01), with a waiver of informed consent.
Statistical analysis
Difference between groups (WM vs WM plus TCM)
were assessed with independent sample t test, wilcoxon
signed rank tests, or Chi-square test, depending on the
distribution. Survival analyses for time to negative
RT-PCR was conducted using two multivariate cox regression models. Age, gender, comorbidity, smoking
status, STA were adjusted in the first cox model. In addition to these potential confounders, baseline laboratory test (mean ± standard deviation) was added as a covarite in the second cox model. All analysis was per-

Table 1 Comparison between WM and WM plus TCM [n (%)]
Items

Total
(n = 43)

WM plus TCM
(n = 29)

WM
(n = 14)

P value

Agea

43.6 (14.6)

44.1 (14.7)

42.6 (15.0)

0.768

Maleb

21 (48.8)

13 (44.8)

8 (57.1)

0.449

Delayed absorption of lung lesions

35 (81.4)

23 (79.3)

12 (85.7)

0.613

Comorbidityb

8 (18.6)

7 (24.1)

1 (7.1)

0.240

b

Smoker

6 (14.0)

5 (17.2)

1 (7.1)

0.645

WBCa

6.4 (2.5)

7.1 (2.7)

5.0 (1.1)

0.014

212.4 (60.5)

217.5 (56.6)

202.5 (68.9)

0.494

32.0 (35.2)

38.6 (34.6)

29.5 (42.2)

0.878

3.0 (4.0)

3.0 (5.0)

3.0 (3.0)

0.469

12.0 (4.3)

12.8 (4.1)

10.1 (4.4)

0.055

b

Plt

a

CRP

c

STA (days)c
ATN (days)

a

Medical expense (USD)a
1154.3 (414.2)
1162.6 (378.8)
1137.0 (497.9)
0.863
Notes: WM: western medicine; TCM: traditional Chinese medicine; STA: symptom to admission; ATN: admission to negative real time
polymerase chain reaction; USD: United States dollars; WBC: white blood cell; Plt, platelet; CRP: c-react protein. a: Mean (standard deviaton); b: n (%); c: Median (IQR).
Table 2 Multivariate cox regression model
HR

P value

95% CI

HR

P value

95% CI

WM plus TCM

0.47

0.059

0.21, 1.03

0.24

0.043

0.06, 0.96

Age

1.02

0.761

0.89, 1.16

0.93

0.026

0.87, 0.99

Male

0.97

0.053

0.93, 1.00

0.61

0.412

0.18, 2.01

Smoker

1.04

0.927

0.48, 2.25

0.86

0.800

0.26, 2.80

Comorbidity

0.84

0.757

0.28, 2.51

3.28

0.206

0.52, 20.77

STA

0.74

0.610

0.23 2.40

1.00

0.965

0.83, 1.20

WBC

1.02

0.916

0.74, 1.39

Plt

1.00

0.742

0.99, 1.01

CRP
0.98
0.082
0.95, 1.00
Notes: WM: Western Medicine; TCM: Traditional Chinese Medicine; STA: symptom to admission; HR: hazard ratio; CI: confidence interval; WBC: white blood cell; Plt: platelet; CRP: c-react protein.
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formed with STATA 16.0 (Stata Corp, College Station,
TX, USA), P-value < 0.05 was defined as statistically
significant.

reported to be useful in a family case of COVID-19.9
Systematic review and Meta-analysis showed that patients with integrated therapy had better outcome without inducing severe adverse drug reactions.10 In addition to these studies, we provided radiographic evidence for a trend of disease fades while a combination
of TCM and WM was used. For cases only received
WM, repeated CT scan may be necessary to identify
and evaluate the delayed absorption of lung lesions.
Our study has several limitations. First, only moderate
COVID-19 patients (positive RT-PCR and pneumonia) were recruited in this study. So our founding may
not apply to severe cases. Another limitation was that
we only focused on radiographic outcome in this
study. Functional prognosis such as lung capacity test
was not performed in the follow up.

RESULTS
Without ventilation support, all patients (n = 43) were
fully recovered from COVID-19 with a mean medical
expense of 1154.29 USD. Medical intervention was
initiated in early stage of disease (median STA was
three days). Mean ATN of our study population was
11.95 d (standard deviation = 4.31). Most clinical characteristics had a similar distribution between two
groups (29 in WM plus TCM, 14 in WM). Baseline
laboratory tests found higher level of WBC in WM
plus TCM group, as compared with WM only group
(7.1 ± 2.7 vs 5.0 ± 1.1, P = 0.014, Table 1). After adjusted for age, gender, comorbidity, smoking status,
and STA, multivariate cox regression model presented
a pattern of lower risk of delayed absorption of lung lesion in patients treated with WM plus TCM [Hazard
ratio = 0.47, 95% confidence interval (0.21, 1.03), P =

0.059, Table 2]. While adding the laboratory tests in
the model, extra TCM in treatment was identified as
the prognostic factor of less refractory lung damage
[Hazard ratio = 0.24, 95% confidence interval (0.06,
0.96), P = 0.043, Table 2].

REFERENCES
1

2

3

DISCUSSION

4

Chest CT scan plays an important role in early detection of COVID-19, which shows various degrees of
pulmonary abnormalities.5 Unparalleled progress on
CT image and viral load has been reported.6 In our
study, the combination therapy of WM and TCM was
associated with lower risk of delayed absorption of
lung lesions, as compared with WM only treatment,
without dramatically increasing the medical expenditure. National policy in China rules in full coverage of
medical expense by healthcare insurance in treating
COVID-19, removing the effect of social-economic status in patients' outcomes. As a measurement for conversion of RT-PCR, ATN was found marginally significant prolongation in WM plus TCM group, suggesting
that the disparity in chest CT scan is not only a reflection of presumable later phase of lung tissue repair 7
but also an indication of different process of viral load
shedding.
Better recovery from pulmonary infiltration was found

in patients who received treatment of WM plus TCM,
which supports a stratified management of COVID-19
patients. There were several studies supported the use
of TCM on COVID-19 cases. The empirical use of
TCM has been widely applied in treating COVID-19,
which was proved to be effective in reducing severe
symptoms.8 The combination of WM and TCM was
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5

6

7

8

9

10

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