Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS)

Background Severe acute respiratory syndrome (SARS) is an acute respiratory disease, which first appeared in Foshan City, China on 22 December 2002. It was reported by some that Chinese herbs played an important role in the treatment of SARS patients. Objectives To evaluate the possible effectiveness and safety of Chinese herbs combined with Western medicines versus Western medicines alone for SARS patients. Search strategy We searched the following electronic databases for reports of randomised controlled trials: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005); MEDLINE (1966 to September 2005); EMBASE (1990 to December 2004); and Chinese Biomedical Literature (Issue 2, 2005). Selection criteria Randomized and quasi-randomized controlled trials of Chinese herbs combined with Western medicines versus Western medicines alone for diagnosed SARS patients were included. Data collection and analysis Two authors independently extracted the data from each trial. We extracted dichotomous and continuous data with 95% confidence intervals (CI). For dichotomous data, relative risk (RR) was used. For continuous data, we calculated weighted mean differences (WMD). Overall results were calculated based on the random effects model if heterogeneity existed between studies. If no heterogeneity was detected between the studies, we used the fixed effects model. Using the Z score and the chi square statistic with significance being set at p < 0.05 tested heterogeneity. Main results We finally included twelve randomized controlled trials and one quasi-randomized controlled trial. A total of 654 SARS patients and 12 Chinese herbs were identified. We did not find Chinese herbs combined with Western medicines decreased morbidity versus Western medicines alone. Two herbs may improve symptoms. Five herbs may improve lung in filtrate absorption. Four herbs may decrease the dosage of corticosteroids. Three herbs may improve the quality of life of SARS patients. One herb may shorten the length of stay in hospital. Only two trials reported adverse events. Authors' conclusions Chinese herbs combined with Western medicines made no difference in decreasing morbidity versus Western medicines alone. It is possible that Chinese herbs combined with Western medicines may improve symptoms, quality of life, and lung in filtrate absorption and decrease the corticosteroid dosage for SARS patients. The evidence is weak because of the poor quality of the included trials. Longterm of follow up of these included trials is needed.