Objective To explore the clinical characteristics of traditional Chinese medicine（TCM） in severe patients with coronavirus disease 2019（COVID-19）. Methods The Clinical Survey Form of Traditional Chinese Medicine Syndromes for Severe Patients with COVID-19 was compiled

and the general data and four diagnosis data of 181 severe patients with COVID-19 in the Union Hospital affiliated to Tongji Medical College

Huazhong University of Science and Technology were collected. Chi-square test

factor analysis

cluster analysis were used and Pearson correlation test were used to analyze the relationship between the characteristics of TCM syndromes

the pattern of syndromes and the symptoms of the lung and spleen system. Results A total of 181 patients were enrolled. The male to female ratio was 1.6 ∶1 and the average age was（61.32±10.46） years. Syndrome elements in descending order were chest tightness（75.14%）

shortness of breath（69.61%）

dry mouth（62.89%）

bitter mouth（56.91%）

dry cough（55.80%）. The elements of tongue and pulse in decending order were pale red tongue

white turbid coating（80.66%）

and thin pulse（76.80%）. There were statistically significant differences in the distribution of shortness of breath

bitter mouth

poor appetite

pale red tongue

and white turbid coating（P<0.05）. Fever

shortness of breath

chest tightness

anorexia

pale red tongue

white turbid coating

and narrow pulse have statistically significant differences among different age groups（P<0.05）. The pulmonary symptoms of severe patients with COVID-2019 were significantly related to the symptoms of the spleen and stomach system（r=0.42）. The 12 common factors extracted by cluster analysis formed two main syndrome types

Shaoyang phlegm dampness syndrome and deficiency syndrome of both qi and fluid. Conclusion The pulmonary system symptoms of severe patients with COVID-19 are significantly related to the symptoms of the spleen and stomach system

and the syndrome of Shaoyang phlegm dampness and deficiency syndrome of both qi and fluid are the main syndrome types.