COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Fan AY, Gu S, Alemi SF Chinese herbal medicine for COVID-19: Current evidence with systematic review and meta-analysis. J Integr Med. 2020 Sep;18(5):385-394. doi: 10.1016/j.joim.2020.07.008. Epub 2020 Jul 31.

BACKGROUND: There is currently no drug or therapy that cures COVID-19, a highly contagious and life-threatening disease.

OBJECTIVE: This systematic review and meta-analysis summarized contemporary studies that report the use of Chinese herbal medicine (CHM) to treat COVID-19.

SEARCH STRATEGY: Six electronic databases (PubMed/MEDLINE, Cochrane Library, ScienceDirect, Google Scholar, Wanfang Data and China National Knowledge Infrastructure) were searched from their beginning to May 15, 2020 with the following search terms: traditional Chinese medicine, Chinese medicine, Chinese herbal medicine, COVID-19, new coronavirus pneumonia, SARS-CoV-2, and randomized controlled trial.

INCLUSION CRITERIA: Randomized controlled trials (RCTs) from peer-reviewed journals and non-reviewed publications were included. Further, included RCTs had a control group that was given standard care (SC; such as conventional Western medicine treatments or routine medical care), and a treatment group that was given SC plus CHM.

DATA EXTRACTION AND ANALYSIS: Two evaluators screened and collected literature independently; information on participants, study design, interventions, follow-up and adverse events were extracted, and risk of bias was assessed. The primary outcomes included scores that represented changes in symptoms and signs over the course of treatment. Secondary outcomes included the level of inflammatory markers, improvement of pneumonia confirmed by computed tomography (CT), and adverse events. Dichotomous data were expressed as risk ratio or hazard ratio with 95% confidence interval (CI); where time-to-event analysis was used, outcomes were expressed as odds ratio with 95% CI. Continuous data were expressed as difference in means (MD) with 95% CI, and standardized mean difference (SMD) was used when different outcome scales were pooled.

RESULTS: Seven original studies, comprising a total of 732 adults, were included in this meta-analysis. Compared to SC alone, CHM plus SC had a superior effect on the change of symptom and sign score (-1.30 by SMD, 95% CI [-2.43, -0.16]; 3 studies; n = 261, P = 0.03), on inflammatory marker C-reactive protein (CRP, mg/L; -11.82 by MD, 95% CI [-17.95, -5.69]; 5 studies; n = 325, P = 0.0002), on number of patients with improved lung CT scans (1.34 by risk ratio, 95% CI [1.19, 1.51]; 4 studies; n = 489, P < 0.00001). No significant adverse events were recorded in the included RCTs.

CONCLUSION: Current evidence shows that CHM, as an adjunct treatment with standard care, helps to improve treatment outcomes in COVID-19 cases.

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

Family Medicine (FM)/General Practice (GP) rater

The study methodology appears to be rigorous and the efficacy of Chinese herbal medicine as a generic treament appears to have been demonstrated. It is not possible to draw conclusions from this study about the efficacy of specific chinese herbal medicines and it would certainly be of importance to do that in future research. In Primary Care, clinicians are often asked by patients about the efficacy of such treatments and it is important to know that there is some value in Traditional Chinese medicine.

General Internal Medicine-Primary Care(US) rater

This is an SR and MA comparing Chinese herbal medicine for COVID-19 vs. standard care from 7 small size RCTs. The trials were not blind. There was scarce information about caracteristics and conditions of the recruited participants. The primary outcome were score measured by the summary of changes in the main symptoms and signs of the condition (many of them not validated); secondary outcomes included the level of inflammatory markers, with marked heterogeneity. Finally, the intervention in each RCR were different herbal formula (groups of CHMs).

Infectious Disease rater

It's very hard to evaluate what is included in the category of Chinese Herbal Medicines and whether they were standardized in how they were taken, made and dosed. So, I am not sure what to really make of the findings.

Infectious Disease rater

The conclusion of this systematic review and meta-analysis that CHM, as an adjunct treatment with standard care, helps to improve treatment outcomes in COVID-19 cases is very important. The benefit of this article to me is that it provides evidence that CHM may as a therapeutic adjunct when treating COVID-19 patients.

Intensivist/Critical Care rater

There is low clinical relevance of evaluated outcomes.

Intensivist/Critical Care rater

Interesting. The real problem worldwide is the external validity of these findings.

Public Health rater

The use of Chinese herbal medicine is limited to other regions of the world.