COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Ang L, Song E, Lee HW, et al. Herbal Medicine for the Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2020 May 23;9(5):1583. doi: 10.3390/jcm9051583.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has caused a worldwide outbreak of respiratory illness. This review aims to evaluate the effectiveness and adverse events of herbal medicines for the treatment of COVID-19.

METHODS: Twelve databases were searched through 12 May 2020. Randomized controlled trials (RCTs) and quasi-RCTs assessing the effects of herbal medicines for the treatment of COVID-19 were eligible. The study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias tool was used for the assessment of the risk of bias in all included RCTs. Mean differences (MDs), risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and the effect sizes of the studies were pooled.

RESULTS: Seven RCTs with a total of 855 patients were included. All included trials compared the combined therapy of herbal medicine with Western medicine to Western medicine alone. The combined therapy significantly improved the total effective rate (RR 1.23, 95% CI 1.13 to 1.34, p < 0.001), cough symptom disappearance rate (RR 1.45, 95% CI 1.12 to 1.89, p = 0.005), and sputum production symptom disappearance rate (RR 1.73, 95% CI 1.19 to 2.50, p = 0.004). Beneficial effects of the combined therapy were also seen in TCM syndrome score of cough (MD -1.18, 95% CI -1.34 to -1.03, p < 0.001), fever (MD -0.62, 95% CI -0.79 to -0.45, p < 0.001), dry and sore throat (MD -0.83, 95% CI -1.45 to -0.20, p = 0.009), and fatigue (MD -0.60, 95% CI -1.04 to -0.17, p = 0.007). The overall risk of bias of the included studies was unclear. No serious adverse events were reported.

CONCLUSION: Significant effects of the combined therapy of herbal medicine with Western medicine were found, and revealed the potential role of herbal medicine in treating COVID-19. More high-quality RCTs are needed to further validate the effectiveness and adverse events of herbal medicine in the treatment of COVID-19.

Discipline / Specialty Area Score
Public Health
Infectious Disease
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater


Infectious Disease rater

I do not think this article will change clinical practice.

Infectious Disease rater

I have concerns about the outcome of "total effective rate". The summary of ongoing trials may be a helpful reference. It's unclear if the HM interventions tested are available across diverse populations/settings.

Public Health rater

Great attempt! However, the findings should be taken with great caution in view of the limited study size, lack of clarity on study design, unavailable important information, and limited follow up period. As clearly recommended by the authors, this is an eye opener for further well designed similar studies that would produce a high quality evidence base.

Public Health rater

Multiple treatment strategies have been tried for Covid 19. The use of herbal non conventional medicine has been proposed by several clinical and research groups. The current study provides more relevant evidence in this regard and systematically concludes a trend towards benefits. This is important as it paves the way for multiple lines and readily available therapies that may have better efficiency- risk ratio.