Objective To explore the association between early treatment with Chinese herbal medicine and clinical outcomes in patients with severe coronavirus disease 2019（COVID-19） through retrospective analysis of the clinical data. Methods Seventy-two patients with severe COVID-19（severe cases and critical cases） who were admitted to Wuhan Hospital of Traditional Chinese Medicine from January 25 th to March 10 th

2020 were included

and were classified into early treatment group（treatment initiation time ≤ 3 days after onset） with 55 cases and late treatment group（treatment initiation time > 3 days after onset） with 17 cases. Patients in both groups were given Xuanqing Hehua Formula（宣清和化方）

Ganmao Tuire Formula（感冒退热方）

Xinguan No.2 Formula（新冠2号方） or named Xuanfei Baidu Formula（宣肺败毒方）

Lianhua Qingwen Capsules（连花清瘟胶囊）

Xiyanping Injection（喜炎平注射剂） and Xuebijing Injection（血必净注射剂） based on syndrome differentiation. The laboratory indicators

acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score

sequential organ failure assessment（SOFA） score

and lung CT status of the patients in both groups were measured at admission and at seven days after admission; the length of hospital stay was assessed; the results of the clinical outcomes were compared between groups. Results There were no statistically significant differences in general conditions and laboratory indicators at admission between groups（P>0.05）. The laboratory indicators measured at seven day after admission including white blood cells（WBC）

neutrophils（N）

creatine kinase isoenzyme MB（CK-MB）

lactate dehydrogenase（LDH）

aspartate aminotransferase（AST）

alanine aminotransferase（ALT） and D-dimer were not statistically different between groups（P>0.05）. Early treatment group had significantly lower levels of blood urea nitrogen（BUN）

C-reactive protein（CRP）

procalcitonin（PCT）

ApacheⅡ score and SOFA score（P<0.05）

as well as higher lymphocyte count（L

P<0.05） than those in the late treatment group. The median length of hospital stay in the early treatment group was 20 days while that of the late treatment group was 22 days

with no significant difference between groups（P>0.05）. The mortality rate in the early treatment group was 18.2%（10/55）

significantly lower than 52.9%（9/17） in the late treatment group（P<0.05）; the discharge rate was 78.2%（43/55） in the early treatment group

which was higher than 47.1%（8/17） in the late treatment group（P<0.05）. Conclusion Early treatment of Chinese herbal medicine can reduce the inflammatory response

regulate the immune function

promote the absorption of pulmonary inflammation

and reduce mortality in patients with severe COVID-19.