Three traditional formulas improve chest symptoms, fatigue, and cough duration in COVID-19 patients
In 57 clinical trials, traditional Chinese medicine (TCM) reduced fever duration by up to 2.2 days, accelerated viral clearance, and improved lung recovery on chest CT scans. Patients treated with these formulas were also less likely to progress to severe illness. The review grouped treatments into three strategies: detoxification alone; detoxification with dampness elimination; and a full combination that includes qi activation. Each aligns with a distinct symptom profile. One formula resolved sore throat more rapidly, while others reduced fatigue, cough, and chest tightness by targeting fluid retention and blocked qi. This reflects TCM’s clinical model of addressing lung closure, fluid stagnation, and heat patterns seen in viral infections. These findings offer evidence-based tools for respiratory care.
Traditional Chinese medicine is a clinical system developed over thousands of years to treat disease by regulating the body’s internal balance and vital functions. It uses a diagnostic framework that identifies pathologic patterns such as internal heat, dampness accumulation, qi stagnation, or deficiency of organ systems. Treatment involves selecting specific herbal formulas that match the patient’s symptom pattern to restore physiological function. In the context of infectious diseases like COVID-19, TCM approaches use principles established for treating epidemic diseases, often involving toxin clearance, dampness resolution, and restoration of lung function.
Fever Duration, Viral Clearance, and Chest CT Recovery All Improved
All three TCM formula types led to measurable improvements in COVID-19 patients. Fever duration decreased by 1.25 to 2.23 days, depending on the formula used. Importantly, patients treated with TCM converted to a negative PCR test more quickly, indicating earlier viral clearance. Lung recovery on chest CT was faster, with reduced inflammation and congestion compared to control groups. These are objective clinical endpoints that go beyond subjective symptom relief.
The most pronounced effects were seen in formulas that activated qi and cleared dampness. Patients with fatigue and chest tightness—often linked to fluid stagnation—benefited most. These formulas not only eased symptoms but also lowered the chance of severe illness. Matching herbal formulas to symptom patterns allowed for earlier and more effective treatment.
Targeted Formula for Sore Throat, Fatigue, or Dampness-Driven Symptoms
Detoxification Formulas for Sore Throat and Heat
Each TCM formula addressed a specific symptom pattern seen in COVID-19. Patients with sore throat and fever, which signal internal heat in TCM, responded best to detoxification formulas. Maxing Shigan decoction combines Ephedra (Ma Huang), Gypsum (Shi Gao), Almond (Xing Ren), and Licorice (Gan Cao) to clear heat, reduce fever, and calm cough. Yinqiao San uses Forsythia and Honeysuckle to treat early-stage sore throat and inflammation.
Dampness-Resolving Formulas for Fatigue and Chest Tightness
For fatigue, chest tightness, or digestive sluggishness, formulas like Xuanfei Badu granules were more effective. These target dampness—a pattern associated with fluid buildup, sluggish digestion, and low energy. Ingredients like Poria, Agastache, Atractylodis, and Imperatae help clear this internal congestion and support qi circulation.
Qi-Activating Formulas for Lingering Cough and Stagnation
In cases of persistent cough, low appetite, or stagnation, Qingfei Paidu decoction was used. It combines formulas like Maxing Shigan and Xiao Chaihu Tang with herbs such as Bupleurum, Magnolia bark, and Semen Arecae. This combination helps open the lungs, move stuck qi, and resolve internal blockage.
These three treatment categories—detoxification; detoxification with dampness resolution; and detoxification with added qi activation—give practitioners a practical structure to match herbal protocols to each patient’s symptom profile.
TCM Formulas Match Core COVID-19 Pathogenesis: Damp-Toxin and Qi Stagnation
The lingering symptoms of COVID-19, including fatigue, chest tightness, and cough, match a classical TCM epidemic pattern called “damp-toxin invasion.” In this model, dampness is a heavy, Yin pathogen that blocks the flow of Yang qi, which supports circulation, metabolism, and respiratory function. When dampness stagnates in the lungs, patients develop a sense of oppression and slow recovery. COVID-19’s pattern of fatigue, lingering phlegm, and poor lung clearance closely aligns with this concept.
TCM treatment aims to clear the lungs, resolve dampness, and restore qi circulation. The addition of qi-moving herbs helps restore flow by releasing stagnation rather than suppressing it. This approach draws from epidemic-era principles like the Tongzhi method, which treats both the cause and symptom simultaneously. This is especially important during outbreaks with high case volume and limited access to individualized care.
Regional, climatic, and constitutional differences affect how patients respond to treatment. Those with a heat-dominant profile respond better to detoxification-only formulas. Individuals in humid environments or with signs of qi stagnation benefit from formulas that activate movement and transform dampness. Biological sex may also influence therapeutic response, particularly in those with underlying Yang deficiency. During widespread outbreaks, selecting the treatment category based on dominant symptom clusters can guide faster, pattern-based decisions when full syndrome differentiation is not feasible in high-volume clinical settings.
Practitioners may also support treatment with dietary adjustments to reduce internal dampness. Avoiding cold, greasy foods and encouraging breathing or movement practices that stimulate qi flow can improve outcomes. These measures support metabolic function and may improve recovery when used alongside herbs or medications.
Formula Selection by Symptom Pattern
- Use Yinqiao San when patients present with fever, sore throat, and other signs of internal heat. This formula clears lung heat and may reduce fever duration.
- For symptoms like fatigue, chest tightness, or sluggish digestion, select Xuanfei Badu granules. Ingredients such as Poria and Agastache help eliminate dampness and support energy metabolism.
- If the patient has lingering cough, low appetite, or signs of qi stagnation, prescribe Qingfei Paidu decoction. Herbs like Bupleurum and Magnolia bark restore qi flow and improve lung function.
- Monitor treatment progress using objective clinical markers such as fever resolution, PCR negativity, CT imaging improvement, and energy levels.
- Select the formula type based on the dominant symptom pattern. This is especially helpful when full syndrome differentiation is not feasible in high-volume or urgent care settings.
TCM formulas evaluated in this review improved fever duration, viral clearance, and lung recovery. These outcomes reflect the specific actions of clearing heat, draining dampness, and restoring qi flow. Fatigue, cough, poor appetite, and chest discomfort often persist after infection and align with the same patterns addressed in acute care. These formula categories can guide treatment based on the patient’s dominant symptoms.
In cases where antivirals are not tolerated or not indicated, these formulas offer a structured, evidence-informed option. Rather than providing general support, they have shown measurable impact on inflammation, recovery of respiratory function, and symptom resolution.
