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SARS: Clinical Trials on Treatment Using a Combination of Traditional Chinese Medicine and Western Medicine
(2004; 194 pages) View the PDF document
Table of Contents
View the documentAcknowledgements
View the documentIntroduction
View the documentReport of the International Expert Meeting to review and analyse clinical reports on combination treatment for SARS
View the documentReport 1: Clinical research on treatment of SARS with integrated Traditional Chinese medicine and Western Medicine
View the documentReport 2: Clinical efficacy of the treatment of SARS with integrated Traditional Chinese medicine and Western medicine: an analysis of 524 cases
View the documentReport 3: Manifestation of symptoms in patients with SARS and analysis of the curative effect of treatment with integrated Traditional Chinese medicine and Western medicine
View the documentReport 4: Clinical study on 103 inpatients undergoing therapy with integrated Traditional Chinese medicine and Western medicine
View the documentReport 5: Clinical observations of 11 patients with SARS treated with Traditional Chinese medicine
View the documentReport 6: Effects of applying integrated therapy with Traditional Chinese medicine and Western medicine on liver and kidney functions in patients with SARS
View the documentReport 7: Clinical research on 63 patients with SARS treated with integrated Traditional Chinese medicine and Western medicine
View the documentReport 8: Influence of integrated therapy with Traditional Chinese medicine and Western medicine on lymphocytes and T-lymphocyte subpopulations of patients with SARS
View the documentReport 9: Analysis of the clinical curative effects on patients with SARS of treatment with Traditional Chinese medicine and Western medicine
View the documentReport 10: Evaluation of clinical curative effects of Traditional Chinese medicine in treatment of patients convalescing from SARS
View the documentReport A: A herbal formula for the prevention of transmission of SARS during the SARS epidemic in Hong Kong Special Administrative Region - a prospective cohort study
View the documentReport B: Effects of Chinese medicine on patients convalescing from SARS in Hong Kong special administrative region - a prospective non-randomized controlled trial
View the documentReport C: Traditional Chinese medicine in the management of patients with SARS in Hong Kong Special Administrative Region - a case-control study of 24 patients
View the documentAnnex
 

Report 5: Clinical observations of 11 patients with SARS treated with Traditional Chinese medicine

Tong Xiaolin23, Li Aiguo23, Zhang Zhiyuan23, Chen Xiaoguang23, Li Ping23, Duan Jun23, Hua Chuanjin23, Zhao Dong23, Xu Yuan23, Shi Xiaoping23, Tian Xin23, Lin Fan23, Cao Yongtong23, Lu Jin23, Chang Ming23 and Wang Yunting23

23 Ministry of Health China-Japan Friendship Hospital, Beijing 100029, People's Republic of China


Abstract Through clinical observation of 11 patients with severe acute respiratory syndrome (SARS) admitted to the Ministry of Health China-Japan Friendship Hospital and treated with Traditional Chinese medicine (TCM), this study examined the feasibility and effectiveness of treating SARS with TCM. TCM prescriptions and TCM preparations for intravenous drips were used to treat 11 patients with SARS, instead of treating them with glucocorticoid, antiviral drugs, immunomodulator and other conventional Western medicines. Antibiotics were not used unless there was clear evidence of bacterial infection. The curative effects were evaluated by measuring factors such as fever-abatement time, time taken for changes to be seen on the chest X-ray, length of hospitalization period and cost of hospitalization. The fever-abatement time was between 2 and 7 days; chest radiographs showed that the shadow in the lungs of nine patients was almost absorbed, with an average absorption time of 14.56 ± 6.71 days; two of the patients showed less improvement. The average duration of hospitalization was 20.45 ± 6.04 days; the per capita cost of hospitalization was 7024.41 yuan and the per capita cost of medications was 3874.83 yuan. None of the cases included in this study was severe. Patients with normal SARS can be treated successfully by TCM alone.

Introduction

SARS is a new and highly infectious respiratory disease on which knowledge is still being gathered. In the past, TCM has been used effectively to treat influenza, viral pneumonia, encephalitis B, epidemic haemorrhagic fever, measles, epidemic parotiditis and other viral infections. Based on these successful experiences together with observations on approximately 60 patients with SARS admitted to the China-Japan Friendship Hospital (under the Ministry of Health) in early April 2003, we developed a therapeutic regimen, by using the TCM theory on pestilence, which was administered to 11 patients with SARS admitted to the same hospital. The following is a preliminary clinical treatment report, which is expected to provide the basis for an effective approach to the clinical treatment of SARS with TCM.

Research subjects and method

Research subjects

Source of cases: SARS patients admitted to China-Japan Friendship Hospital (under the Ministry of Health) after 8 May 2003.

• The diagnostic criteria were those formulated by the Ministry of Health of the People's Republic of China in the document entitled Clinical diagnosis criteria for infectious SARS (proposed) (amended on 3 May 2003).


All the patients who participated in this study were referred to the hospital after the diagnosis of SARS had been confirmed by the Beijing Centre for Disease Control (CDC).

Case inclusion criteria

Patients included in the study were:

• those that complied with the criteria for diagnosis of SARS;
• those infected by SARS not more than 10 days before admission to hospital; and
• those who had not systematically been treated with hormones and antiviral drugs before being hospitalized.


Exclusion criteria

Patients excluded from the study were:

• those with severe SARS;
• those infected by SARS more than 10 days before admission to hospital; and
• those who had been systematically treated with hormones and antiviral drugs before being hospitalized.


General information

Gender distribution: of the 11 patients, nine were male and two were female.

Age distribution: the youngest patient was 22 years old and the eldest 52 years old. The average age was 34.91 ± 11.67 years.

Underlying disease: two of the patients suffered concurrently from underlying disease; one had hypertension and one type 2 diabetes.

Main clinical symptoms

The main clinical symptoms are summarized in Table 1.

Table 1. Main clinical symptoms manifested in patients

Symptoms

Initial diagnosis
No of cases

At the time of hospitalization
No of cases

Cough

7

6

Fever

11

4

Headache

1

3

Inertia

1

3

Shortness of breath

0

3

Aversion to cold

3

2

Dyspnoea

0

2

Feeling of oppression in chest

3

2

Diarrhoea

1

1

Myalgia

1

1

Therapeutic regimen

The development process of SARS was divided into five stages, namely:

• incubation;
• pyretogenic;
• cough and gasp;
• collapse; and
• convalescent.


The pyretogenic stage is subdivided into three substages: onset, strong fever and toxic heat. Overlap of two or even three stages was possible in patients with severe SARS. Based on the above divisions, 12 TCM prescriptions for oral administration were developed (for the purposes of this paper the prescriptions are referred to as SARS prescriptions 1-12). Prescription 4 was developed specifically for treating patients who had received glucocorticoid. Thus none of the participants in this study were treated with SARS prescription 4. These preparations were used in combination with an intravenous drip of TCM. All the Chinese patent medicines were prescription drugs approved by State Drug Administration and are available commercially, and all the decoction pieces conformed to the Chinese Pharmacopoeia (2000 Edition).

Pyretogenic stage

Onset substage

The onset substage is characterized by retention of pathogenic factor in the superficial defensive system. The onset of fever was 1-3 days previously; symptoms manifested include fever, cough, headache, muscular stiffness, reddened tongue with white or greasy fur, and slippery pulse. The principles of treatment are to dispel the wind and heat, and remove toxins and dampness.

The herbal decoction for oral administration is SARS prescription 1 (Rhizoma Phragmitis 30 g, Lonicera japonica 30 g, periostracum cicadae (cicada slough) 6 g, bombyx batryticatus (stiff silkworm) 6 g, almond 10 g, unprepared Semen Coicis 30 g, and Herba Eupatorii 6 g). This prescription is used in combination with an intravenous drip containing shuanghuanglian powder for injection and houttuynia injection.

Strong fever substage (retention of pathogenic heat in lung)

The onset of fever was 3-5 days previously; symptoms include high fever, cough, thirst, hyperhidrosis, reddened tongue with thick or greasy and yellowish fur, and slippery pulse. The principles of treatment are to clear away heat to ventilate the lung and remove toxins to promote blood circulation. The herbal decoction for oral administration is SARS prescription 2 (including stir-fried ephedra 6 g, unprepared gypsum 30 g, almond 10 g, Lonicera japonica 30 g, Rhizoma Phragmitis 30 g, Radices Scutellariae 10 g, Cortex Mori Radicis 30 g and Radices Paeoniae Rubra 30 g), which is used in combination with an intravenous drip of qingkailing injection, houttuynia injection, and Salvia miltiorrhiza injection.

Toxic heat substage

The toxic heat substage is characterized by intense heat in both qi and ying systems; accumulation of toxins and stagnant heat in lung). Fever has lasted for more than 5 days; symptoms include persistent high fever, flushed face, cough, shortness of breath, dark reddened or deep red tongue, yellow thick dry or dark fur, with slippery or deep pulse. The principles of treatment are to clear qi and remove heat from ying, and remove toxins to promote blood circulation.

The herbal decoction for oral administration is SARS prescription 3 (unprepared gypsum 60 g, Rhizoma Phragmitis 60 g, Radices Scutellariae 15 g, dried rehmannia root 30 g, buffalo horn (to be decocted first) 60 g, unprepared Radices Rhei 6 g, Radices Paeoniae Rubra 30 g and Flores Carthami 10 g used in combination with an intravenous drip of xingnaojing injection, houttuynia injection and Salvia miltiorrhiza injection.

Cough and gasp stage

For patients who have been treated with hormones (deficiency in yin induces vigorous fire, stagnation of water and pathogenic heat).

Symptoms manifested include gasping and dyspnoea, cough, shortness of breath, feverish sensation in the palms and soles, hyperhidrosis, dry mouth and tongue, reddened tongue with little fur, and slippery pulse. The principles of treatment are to nourish yin to clear away the fire; activate blood circulation and promote the circulation of water.

The herbal decoction for oral administration is SARS prescription 4 (unprepared Radices Rehmanniae 30 g, Cortex Phellodendri 15 g, Rhizoma Anemarrhenae 15 g, unprepared licorice 10 g, pberetima 10 g, Radices Paeoniae Rubra 30 g, Herba Lycopi 30 g, and pseudostellaria root 15 g). The prescription is used in combination with an intravenous drip containing Salvia miltiorrhiza injection.

For patients who have not been treated with hormones (excessive heat in the lung, stagnation of pathogenic phlegm).

Symptoms manifested include the fever that has been allayed or not yet completely allayed, dyspnoea, cough, breathlessness, shortness of breath, reddened tongue with white or yellowish and sticky fur, and strong pulse. The principles of treatment are to remove heat from the lungs to relieve asthma, and clear the hollow viscera to promote blood circulation.

The herbal decoction for oral administration is SARS prescription 5 (including Radices Scutellariae 15 g, Cortex Mori Radicis 30 g, whole Mongolian snakegourd 30 g, Semen Lepidii 15 g, almond 15 g, pberetima 10 g, Radices Paeoniae 30 g and unprepared rhubarb 6 g). This prescription is used in combination with an intravenous drip of Salvia miltiorrhiza injection.

Collapse stage

Consumption of pectoral qi: symptoms manifested include rapid breathing, increased heart rate, profuse perspiration, mental weariness, reddened or reddish tongue, thin and white fur, with thready and weak pulse. The principles of treatment are to nourish qi and stop collapse, and to promote blood circulation by removing blood stasis.

The herbal decoction for oral administration is SARS prescription 6 (pseudostellaria root 30 g, Radix Astragali 30 g, pulp of dogwood fruit 15 g, Radix Ophiopogonis 30 g, pberetima 10 g and safflower 10 g). The prescription is used in combination with an intravenous drip of Salvia miltiorrhiza injection and shenmai injection.

Consumption of primordial qi: symptoms manifested include shortness of breath, increased heart rate, hidrorrhoea, coldness in the four limbs, reddish or light purple tongue, with rapid and weak pulse. The principles of treatment are to warm yang and stop depletion and to promote blood circulation by removing blood stasis.

The herbal decoction for oral administration is SARS prescription 7 (Jilin Radix Ginseng 15 g, danfu pian 10 g, Radix Astragali 30 g, pulp of dogwood fruit 30 g, Semen Persicae 10 g and safflower 10 g). This prescription is used in combination with an intravenous drip of Salvia miltiorrhiza injection and shenfu injection.

Convalescence stage

Deficiency of qi and blood in the heart and spleen: symptoms manifested include palpitations, mental confusion, shortness of breath, inertia, excessive sweating, mental weariness, poor appetite, reddish tongue with thin and white fur, and weak pulse. The principles of treatment are to replenish qi to invigorate the spleen, and nourish the heart to calm the mind.

The herbal decoction for oral administration is SARS prescription 8 (Radix Astragali 30 g, pseudostellaria root 15 g, tuckahoe 15 g, parched Atractylodes macrocephala 10 g, Radices Polygalae 10 g, lilyturf root 30 g, dried rehmannia root 15 g, amethyst (to be decocted first) 30 g, Fructus Schizandrae 10 g and Radices Salviae Miltiorrhizae 15 g). This prescription is used in combination with an intravenous drip of Salvia miltiorrhiza injection and Shenmai injection.

Disharmony between the heart and kidney: symptoms manifested include insomnia, hypochondriac discomfort, restlessness, irascibility, palpitations and inquietude, feverish sensation in palms and soles, dry mouth (more obvious at night), hidrosis, reddened tongue, white and dry fur, with weak pulse. The principles of treatment are to keep the heart fire and the kidney yin in balance; nourish the blood and soothe the nerves.

The herbal decoction for oral administration is SARS prescription 9 (rhizoma coptidis 3 g, donkey-hide gelatine (to be melted by heating) 10 g, Radices Scutellariae 10 g, Radices Paeoniae Alba 30 g, unprepared lily 30 g, dried rehmannia root 20 g, parched date kernel 30 g, and Fructus Schizandrae 10 g). The prescription is used in combination with an intravenous drip of Salvia miltiorrhiza injection and shenmai injection.

Dampness and heat in the liver channel: symptoms manifested include fullness in both costal regions, distension and fullness in gastric cavity, poor appetite, lassitude and listlessness, sticky and greasy perspiration, reddish tongue, yellow thick and greasy fur, with deep and slippery pulse. The principles of treatment are to remove heat from the liver, and remove toxins and dampness.

The herbal decoction for oral administration is SARS prescription 10 (Paris polyphylla Sm. Rhizoma Bistortae 20 g, Rhizoma Smilacis Glabrae 30 g, Herba Hedyotidis 15 g, herba of stringy stonecrop 15 g, Herba Artemisiae 15 g, Fructus Schizandrae 10 g, parched Atractylodes macrocephala 10 g, and three scorched herbs (scorched germinating barley, hawthorn fruit and medicated leaven) 30g) used in combination with intravenous drip of kuhuang injection or yinzhihuang injection.

Deficiency of yin due to excess fire and toxic substances: symptoms manifested include flushed face and red eyes, feverish sensation in palms and soles, hypochondriac discomfort and uneasiness, dry throat and thirst, constipation and yellow urine, dark red tongue, little fur or white, thick and dry fur, with weak pulse. The principles of treatment are to clear away pathogenic heat and remove the toxin, and nourish yin to reduce pathogenic fire.

The herbal decoction for oral administration is SARS prescription 11 (Cortex Phellodendri 10 g, Rhizoma Anemarrhenae 10 g, dried rehmannia root 20 g, unprepared licorice 10 g, Rhizoma Coptidis 3 g, Radices Trichosanthis 20 g, adenophora root 30 g, and Cortex Granati 20 g).

Accumulation of phlegm in pulmonary vessels: symptoms manifested include cough and asthma that is especially obvious after movement, chest distress, lassitude and listlessness, dark red tongue, white fur, deep and weak pulse. The principles of treatment are to nourish qi and moisten the lung; disperse phlegm and activate the channels.

The herbal decoction for oral administration is SARS prescription 12 (pseudostellaria root 20 g, Radices Glehniae 30 g, Fructus Schizandrae 10 g, Thunberg fritillary bulb 10 g, earthworm 10 g, leech 30 g, Radices Pseudoginseng 3 g, and tabasheer 10 g).

Observations

Types of observation

Observations on the following aspects of illness were recorded: clinical symptoms, change in physical signs, routine blood and biochemical assays, chest X-ray, duration and cost of hospitalization.

Period of observation

The period of observation started from the time when the patient was admitted to the hospital and ended at the time when he or she was discharged from hospital or died.

The criteria for discharging a patient from hospital were based on the Reference standard for the discharge of cases of infectious SARS issued by the Ministry of Health of the People's Republic of China and on meeting the following requirements:

• Body temperature had returned to normal for at least 7 days.
• Respiratory symptoms had been obviously improved.
• X-ray showed clearly that the lung shadow had been absorbed.
• Course of the illness had lasted up to 21 days.


Results

None of the 11 SARS patients treated with Traditional Chinese medicines became severely ill.

In four of the patients (those who had fever when they were admitted to hospital; Nos 4, 5, 8 and 11), the fever abated on days 3, 6, 7 and 2, respectively. Continuous observations were made and there was no recurrence of fever before these patients were discharged (Table 2 and Fig. 1).


Fig. 1. Change of body temperature

Table 2. Characteristics of fever in 11 study subjectsa

a The average time for between onset of SARS and admission to the hospital was 5.5 ± 2.6 days (ranging from 2 days at the shortest to 10 days at the longest).


Patient
No

Date of onset

Date of admission to hospital

Highest body temperature before admission (°C)

Body temperature at time of admission (°C)

Highest body temperature after admission

Date on which fever abated

1

8 May

13 May

39.0

<37.0

<37.0

-

2

8 May

12 May

40.0

<37.0

<37.0

-

3

13 May

16 May

39.0

37.3

37.3

-

4

3 May

13 May

39.7

37.7

38.5

May 16

5

3 May

9 May

38.6

37.0

39.4

May 15

6

7 May

12 May

39.4

<37.0

<37.0

-

7

6 May

13 May

38.4

<37.0

<37.0

-

8

5 May

9 May

39.0

38.2

40.0

May 16

9

7 May

12 May

39.0

<37.0

<37.0

-

10

28 April

8 May

38.3

<37.0

<37.0

-

11

11 Ma

13 Ma

39.3

37.8

37.8

Ma 15

The lymphocyte counts of three of the patients at the time of hospitalization were lower than 1.0 × 109/l, and those of the remaining eight patients were all lower than 1.5 × 109/l. After the treatment, nine patients had a lymphocyte count higher than 1.5 × 109/l, and the other two had counts higher than 1.0 × 109/l, but lower than 1.5 × 109/l. The total white blood cell counts (lymphocyte percentage and neutrophil granulocyte percentage) after treatment were all within the normal range (Figs 2-7 and Table 3).


Fig. 2. Change in lymphocyte count before and after treatment

Table 3. Results of routine blood tests before and after the treatment

 

WBC (× 109/l)

GRAN %

LYM (× 109/l)

LYM (%)

PLT

 

Before

After

Before

After

Before

After

Before

After

Before

After

1

2.9

4.9

52.9

68.8

0.9

1.2

33.0

23.7

141.0

165.0

2

4.2

6.3

59.8

64.8

0.9

1.6

22.0

25.5

151.0

179.0

3

4.4

5.6

63.7

66.2

1.2

1.5

26.5

25.8

117.0

186.0

4

8.0

5.6

72.3

49.6

1.1

2.3

14.3

41.1

279.0

224.0

5

3.7

4.8

61.8

48.5

1.0

1.9

28.1

40.1

108.0

359.0

6

4.7

5.9

61.7

44.5

1.3

2.9

28.2

49.4

182.0

260.0

7

7.5

5.3

78.6

57.7

1.4

2.0

18.4

37.5

248.0

183.0

8

4.3

5.7

77.1

48.7

0.6

2.2

14.8

38.5

159.0

234.0

9

3.6

5.6

47.7

46.5

1.1

1.9

28.9

34.0

193.0

215.0

11

5.9

8.3

73.9

50.8

1.3

3.1

21.3

37.3

194.0

305.0

Average

4.9

5.8

65.0

54.6

1.1

2.1

23.6

35.3

177.2

231.0

 

WBC, White blood cell count; GRAN, granulocyte count; LYM, lymphocyte count; PLT, platelet count.


Fig. 3. Change of lymphocyte count


Fig. 4. Change of total white blood cell count


Fig. 5. Change of neutrophil granulocyte percentage


Fig. 6. Change of lymphocyte percentage


Fig. 7. Change of platelet count

From the chest radiographs of the 11 patients, it could be seen that the lung shadow in nine of them had almost been absorbed after a mean of 14.56 ± 6.71 days, and the two remaining patients had shown an improvement. (Note: The basic absorption criterion was that no abnormality was visible on the chest radiograph. The criterion for improvement was that the chest radiograph showed that the infiltration range had been reduced by over 50%, or from bilateral pathological change to unilateral pathological change, or from unilateral multilobular lesions to single-lobular or local lesions.)

Three patients were found to have increased alanine aminotransferase (ALT) when they were admitted to the hospital, but they improved to a varying extent after treatment (Table 4, Fig. 8). The ALT of four other patients started to rise on days 7, 11, 8 and 9, respectively, after being hospitalized (i.e. days 10, 16, 12 and 11 after being attacked by SARS). One patient had a normal level of ALT when he left the hospital. None of the 11 patients showed abnormalities of renal function after the treatment. Two patients had a high blood sugar level when they were admitted to the hospital but it returned to normal after the treatment, whereas the remaining nine patients showed no increase in blood sugar level. The changes in concentration of aspartate transaminase, blood urea nitrogen, creatinine and glutamic acid are shown in Figs 9-12.

Table 4. Liver and renal function before and after treatment

Patient no

ALT

AST

BUN

CRE

GLU

 

Before

After

Before

After

Before

After

Before

After

Before

After

1

24

35

22

28

9.8

 

0.5

 

71

 

2

95

89

44

37

12.0

11.8

1.1

1.1

85

83

3

35

88

26

33

10.8

14.4

1.1

1.3

102

86

4

141

70

126

37

32.6

21.2

1.2

1.2

164

74

5

14

 

16

 

6.2

 

0.9

     

6

41

19

49

20

8.1

8.0

1.1

0.9

99

81

7

20

26

16

19

14.9

11.6

1.2

1.0

92

73

8

26

179

33

80

8.2

11.8

0.9

1.1

134

88

9

65

35

37

21

11.0

10.1

1.3

1.3

98

83

11

44

116

44

45

9.4

13.6

1.2

1.2

105

96

Average

51

73

41

36

12.3

12.8

1.1

1.1

106

83

 

ALT, Alanine aminotransferase; AST, aspartate transaminase; BUN, blood urea nitrogen; CRE, creatinine; GLU, glutamic acid


Fig. 8. Change in concentration of alanine aminotransferase


Fig. 9. Change in concentration of aspartate transaminase


Fig. 10. Change in concentration of blood urea nitrogen


Fig. 11. Change in concentration of creatinine


Fig. 12. Change of concentration of glutamic acid

Duration of hospitalization and costs

The average length of stay in hospital was 20.45 ± 6.04 days. The per capita cost of hospitalization was 7024.41 yuan, and the per capita medication expenses were 3874.83 yuan. The per capita cost of hospitalization for the control group was 18 867.36 yuan (Fig. 13). The control group consisted of 11 patients with normal SARS with a similar distribution of age, sex and state of illness, who were treated with Western medicine alone.


Fig. 13. Composition of the medical expenses

Discussion

Fever

All the 11 SARS patients had fever, and had received various treatments before being hospitalized. The body temperature of the four patients who still had a fever after being hospitalized returned to normal after 2, 3, 6 and 7 days, respectively, and none had a relapse, which indicates that TCMs have certain curative effects in terms of allaying fever.

Liver function

Three patients had abnormal liver function at the time of their admission to hospital, which had returned to normal by the time they left hospital. However, four other patients showed abnormal liver function only after being hospitalized. To find out whether this finding was related to the treatment with TCM or not, we looked at the liver functions of another 198 patients who had been hospitalized during the same period, and found that 104 of them had abnormal liver functions (52.5% of the total). The period from the ninth to the twelfth day after the onset of SARS was the peak time for signs of abnormal liver function; this period of time coincided with duplication of the SARS virus and the peak concentration of live virus. Therefore there is support for suggesting that the abnormal liver functions observed in four patients during the treatment may not have been directly related to the TCMs used.

Avoidance of harmful side-effects

As can be seen from the clinical observations, the use of TCM for the treatment of the 11 patients in this study is likely to have avoided the toxic effects and side-effects that may be caused by using large amounts of glucocorticoid, antiviral drugs and other Western medicines.

Absorption of shadow on lung

Chest radiographs showed that in nine out of the 11 patients with middle lung shadow, the shadow had been almost absorbed after a mean of 14.56 ± 6.71 days, and the remaining two cases showed improvement.

Conclusions

• Patients with normal SARS can be treated successfully with TCM alone.

• TCMs have good curative effects in allaying fever, restoring lymphocyte levels and improving absorption of inflammation.

• In terms of liver functions, renal functions and routine blood tests, the TCMs showed no obvious toxic effects or side-effects.

• Treatment with TCMs can avoid the toxic effects and side-effects that may be associated with the use of large amounts of glucocorticoid and antiviral drugs.

• Treatment with TCM can significantly reduce the cost of hospital treatment and shorten the number of days of hospitalization needed.

Acknowledgements

We would like to express our appreciation to the State Administration of Traditional Chinese Medicine of the People’s Republic of China, which earmarked funds for this project. Our grateful thanks also go to the directors and medical staff of the China-Japan Friendship Hospital (under the Ministry of Health) who fought with us against SARS, and also to the leaders of the hospital and those working in the Department of Medical Affairs, Department of Science and Education, Department of Radiation, the laboratories and the Office of Medical Cases of the hospital, who gave us their full support with the collection of clinical data.

 

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