To evaluate the clinical efficacy and safety of traditional Chinese medicine (TCM) prescriptions in improving the early outcomes and prognosis of severe pneumonia when used in combination with comprehensive treatments such as anti-infection therapy, glucocorticoids, and Xuebijing, and to explore the optimal TCM prescription for early integrated TCM-Western medicine therapy in severe pneumonia to enhance treatment efficacy and prognosis.

A total of 89 patients with early-stage severe pneumonia who met the inclusion criteria were selected and divided into a control group (antibiotic, glucocorticoid, and Xuebijing group, 46 cases) and an observation group (antibiotic, glucocorticoid, Xuebijing, and TCM group, 43 cases) based on their willingness to take TCM. The control group received treatment with levofloxacin, hydrocortisone, and Xuebijing. The observation group received additional TCM prescriptions tailored to their syndrome differentiation on the basis of the control group′s treatment. The serum infection markers [white blood cell count (WBC), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), amyloid A (SAA), interleukin-6 (IL-6)], oxygenation indicators, treatment efficacy, and incidence of adverse reactions were compared between the two groups.

After treatment, serum infection markers (WBC, hs-CRP, PCT, SAA, IL-6) in both groups showed significant improvement compared to pre-treatment levels. The observation group exhibited lower levels of WBC(9.78±0.85)×10⁹/L、hs-CRP(7.23±0.15) mg/L、PCT (0.09±0.00)pg/ml、SAA (10.27±0.25)mg/L、IL-6 9.35 (7.48, 13.32) pg/ml than those of the control group(11.15±0.76)×10⁹/L, (12.73 ± 0.89) mg/L, (0.15±0.00) pg/ml, (24.20±1.32) mg/L, 18.34 (13.54, 21.51) pg/ml. The observation group significantly outperformed the control group in reducing serum inflammatory markers, with statistically significant differences (P<0.05). Notably, IL-6 levels decreased markedly, approaching the normal reference range. After, arterial blood gas oxygenation indicators (PaO₂, SaO₂, oxygenation index PaO₂/FiO₂) in both groups improved significantly compared to pre-treatment levels. The observation group showed higher PaO₂(95.64±8.25) mmHg, SaO₂(98.58±4.41)%、PaO₂/FiO₂(333.27±10.89)mmHg than those of the control group(84.74±5.90) mmHg, (94.63±7.39)%, (240.50±12.01) mmHg. The observation group significantly outperformed the control group in improving arterial oxygenation indicators, with statistically significant differences (P<0.05). The observation group had shorter durations for fever resolution (2.38 days), cough and sputum relief (6.32 days), mechanical ventilation (75.38 hours), chest CT inflammation absorption (8.46 days), and average hospitalization (10.74 days) compared to the control group (5.31 days, 11.88 days, 128.53 hours, 13.25 days, 13.34 days, respectively). The observation group significantly outperformed the control group in reducing these indicators, with statistically significant differences (P<0.05). Both groups showed reduced CPIS scores at D14 compared. The observation group achieved a CPIS score of 4.15, which was significantly lower than the control group′s 6.57. The effective rate in the observation group (79.07%) was slightly higher than that in the control group (76.40%), but the difference was not statistically significant; The mortality rate in the observation group (16.28%) was comparable to that in the control group (17.39%), with no statistically significant difference. The overall incidence of adverse reactions in the observation group (27.91%) was similar to that in the control group (28.26%), showing no statistically significant difference between the two groups. Most adverse reactions were mild, including rashes, slight dizziness, and gastrointestinal symptoms (nausea, vomiting, bloating), with no severe myocardial damage or liver and kidney function impairment observed.

The combined treatment of traditional Chinese and Western medicine (anti infection+ hydrocortisone+ Xuebijing+ Chinese herbal formula) can significantly improve various inflammatory indicators, improve oxygenation, shorten the course of disease, achieve ideal therapeutic effects, and have mild adverse reactions and good safety. It can be used as the preferred early treatment plan for severe pneumonia. (2) Traditional Chinese medicine formulas have certain adjuvant therapeutic value for severe pneumonia, but there is no definite advantage in improving overall efficacy and reducing mortality.