“In 2020, at the start of the pandemic, Chinese clinics encouraged the use of traditional Chinese medicine as early intervention in mild coronavirus illness.”

*Chinese herbal medicine continues to play a role in COVID-19 treatment.*

At the start of the pandemic, Chinese clinics used traditional herbal medicine as early intervention in mild coronavirus illness. Today, in 2025, China’s official COVID-19 treatment guidelines still emphasize traditional Chinese medicine (TCM) to relieve symptoms, differentiate syndromes, and support recovery.

3000-YEAR HISTORY

In traditional Chinese medicine, the physician observes patterns in clinical events to visualize a bodily landscape. Aspects of activity or illness in the body are compared to elements in nature and individual disharmonies are noted. A system of pre-technological medical thought, TCM has its own body systems and parallel notions of reharmonizing opposites. Diagnosis is based on precisely describing patterns of disharmony and then reconciling hostile elements in the body. Extremes are balanced. The highly personalized diagnostic process attempts to capture the essence of the individual patient.

DISEASE THEORIES

Historically, TCM has categorized infectious disease as Shanghan (cold damage) and Wenbing (seasonal febrile disease). In Shanghan (伤寒) theory, which dates back to the Han Dynasty (206 BCE-220 CE), all heat diseases are of the cold damage kind. Stage 1 starts at the exterior, the respiratory tract, with chills and sniffles. Stage 2 progresses inward to the lungs and the digestive tract, as cough and gastrointestinal symptoms. Stage 3 moves deeper into the digestive tract and the kidneys.

Wenbing (温病) theory from the Ming Dynasty (1368-1644 CE) is defined as any of various heat diseases from exogenous pathogenic warmth or heat, characterized by rapid onset and shifts, pronounced heat signs, a tendency to dryness, and yin damage. It is infectious and seasonal in nature. Wenbing theory builds on earlier Shanghan concepts to elucidate how pathogens spread from person to person.

TCM views COVID-19 from the perspective of both Shanghan and Wenbing; the disease progresses from the exterior to the interior. When COVID-19 illness progresses to pneumonia, it is categorized as Wenbing. The main cause is damp heat with pestilent toxin, and the pathological features are “dampness, heat, stasis, toxin, and vacuity.” In clinical practice, the patient may present with fever, fatigue, sore muscles, sensation of heaviness in the body, poor appetite, and greasy tongue coating – indicating that the pathogen is in the exterior. Most patients have cough, chest oppression, and shortness of breath. The fundamental pathogenic factors are dampness and heat.

*Traditional Chinese medicine is based on empirical observation and practical medical knowledge.*

PATTERNS ASSOCIATED WITH COVID-19 DISEASE

The TCM practitioner performs a thorough review of the patient’s symptoms and selects the pattern that best describes the individual patient. Patterns associated with COVID-19 include:

Pathogenic Damp Stagnation in the Lungs 邪湿郁肺型 Stagnation interferes with the qi dynamic of the lungs. Early symptoms include low-grade fever, sensation of heaviness and stuffiness in the head and body, muscle pain and soreness. Tongue is pale red with a greasy white coating. Pulse is floating and slightly rapid.

Pathogenic Heat Obstructing the Lungs 邪热阻肺型 In this pattern, the lungs lose the ability to diffuse and descend. Symptoms include high-grade fever, cough, yellow or thick phlegm, fatigue, headache, pain and soreness throughout the body. Tongue: red with a greasy yellow coating. Pulse: slippery and rapid.

Damp-Warm Stagnation in the Lungs 湿温郁肺型 Symptoms include fever, strong or abnormal heat sensation, slight aversion to cold, cough, chest oppression, and abdominal distension. Tongue: pale red with thin yellow greasy coating. Pulse: slippery and rapid.

Pestilent Dampness Damaging the Lungs 疫湿伤肺型 Normal body temperature. Symptoms include cough with little or no phlegm, chest oppression or shortness of breath after exertion, and lethargy. Tongue: pale red with a white coating or slightly greasy.

PRIMARY TCM TREATMENT STRATEGIES IN COVID-19

Primary strategies target latent heat and damage to qi and yin. The main cause of disease is dampness, which obstructs the spleen and blocks the lungs (湿困脾闭肺) and disrupts the rising and falling of the qi dynamic (⽓机升降失司). Damp toxins are converted into heat, bowel repletion develops, damp toxins and stagnating heat are locked in, and the increasing heat leads to severe qi reversal and imbalance.

TCM employs herbs that transform dampness and release toxins, as well as herbs that clear heat and resolve toxins. The goal is to diffuse the lungs to vent pathogens. Herbal formulas, acupuncture, and other therapies are combined, because the approaches act synergistically to improve symptoms. Treatment is tailored to the patient’s symptoms and based on the practitioner’s knowledge about local manifestations of the virus.

HERBAL FORMULAS IN COVID-19 TREATMENT

Herbs in the Hua Shi Bai Du (化湿败毒) formula for the treatment of severe COVID-19 include baishao (白芍), mahuang (麻黄), xingren (杏仁), gancao (甘草), huoxiang (藿香), houpo (厚朴), banxia (半夏), and fuling (茯苓).

The Xuan Fei Bai Du (宣肺败毒) formula, used to treat moderate cases, combines herbs with expectorant, antipyretic, anti-inflammatory, and immunomodulatory actions that work synergistically to clear heat, resolve dampness, relieve respiratory symptoms, and regulate the immune response. Research suggests that this formula acts by modulating inflammatory cytokines (IL-6, CXCL8) and immune cell pathways (Th1, Th2, Th17), to suppress cytokine storms and promote immune balance in COVID-19 infection. The formula includes mahuang (麻黄), xingren (杏仁), shengshigao (生石膏), yiyiren (薏苡仁), huoxiang (藿香), qinghao (青蒿), huzhang (虎杖), and gancao (甘草).

The State Administration of Traditional Chinese Medicine and the National Health Commission of China endorse the use of the Qing Fei Pai Du (清肺排毒) formula for mild, moderate, and severe cases. It contains 21 herbs: mahuang (麻黄), gancao (甘草), xingren (杏仁), shengshigao (生石膏), guizhi (桂枝), zexie (泽泻), zhuling (猪苓), baizhu (白术), fuling (茯苓), chaihu (柴胡), huangqin (黄芩), banxia (半夏), shengjiang (生姜), ziwan (紫菀), donghua (冬花), sheqian (射千), xixin (细辛), shanyao (山药), zhishi (枳实), chenpi (陈皮), and huoxiang (藿香).

PROPERTIES OF INDIVIDUAL HERBS

Baishao (白芍 or Paeonia lactiflora) is an antipyretic, hemostatic, and antiseptic. It has affinity for the liver and is indicated for all symptoms of heat excess, blood deficiency syndrome, and sweating. Baishao tonifies the blood and yin and alleviates pain (muscle spasms, abdominal pain). It is combined with guizhi for cold damage and with gancao for gastric pain. May cause drowsiness. Contraindicated for concurrent diarrhea.
Baizhu (⽩术 or Atractylodes macrocephala) tonifies the spleen and the qi, dries dampness, and stabilizes the exterior. Indicated for fatigue, diarrhea, phlegm, and swelling due to damp-excess. Protects the liver, promotes urination, and reduces blood sugar. May interact with the anticoagulants heparin and warfarin. Concurrent use with diuretics may lead to increased elimination of water and/or electrolytes.
Banxia (半夏 or Pinellia ternata) dries dampness, transforms phlegm, reduces stagnation, and harmonizes the stomach. It is indicated for nausea and vomiting, chronic cough, excess phlegm, and gastritis. Avoid use in pregnancy. Use the prepared herb because the fresh herb is toxic.
Gancao (甘草 or Glycyrrhizae radix) tonifies the spleen and qi, moderates and harmonizes the properties of other herbs, generates fluids, alleviates thirst, moistens the lungs, resolves phlegm, stops cough, and clears heat. Indicated for sore throat, coughs, and asthma. Anti-inflammatory, demulcent to the lungs, and expectorant. Gancao is used for the respiratory tract because it dilates the bronchi, and it is combined with mahuang and xingren for cough or wheezing due to wind-cold attacking the lungs. Avoid in hypertension, hypokalemia, and heart disease. Avoid use in pregnancy. Possible choleretic effects. Avoid in type I diabetes. Avoid prolonged use.

Houpo (厚朴 or Magnolia officinalis) is indicated for ailments of damp excess in the spleen and stomach, oppression in the chest, excess phlegm in the respiratory tract, and shortness of breath. Transforms dampness, promotes qi movement, warms and invigorates the spleen, and tamps down rebellious qi. Combined with banxia and fuling for phlegm that obstructs the qi. Increases the effects of benzodiazepines.
Huangqin (黄芩 or Scutellaria baicalensis) clears heat and dries dampness. Huangqin is an antispasmodic, nerve tonic, sedative, and restorative for the nerves. It is used to support the nervous system. Contraindicated with antidepressant medications. Affects absorption of cyclosporine.
Huoxiang (藿香 or Agastache rugosa) transforms dampness in the body, harmonizes the stomach, inhibits influenza, and relieves vomiting. Huoxiang is indicated for damp excess in the stomach and spleen, oppression in the chest, sluggishness due to summer colds, and external injuries of wind-cold. Combined with houpo for fever and chills, stifling sensation in the chest, and cough and nausea due to wind-cold with dampness. Combined with banxia, fuling, and houpo for early stages of damp-warmth when dampness predominates with fever.
Mahuang (麻黃 or Ephedra sinica) induces sweating, releases the exterior, disseminates and facilitates lung qi, calms wheezing, stops coughing, promotes urination, and reduces edema. Affinity for the lungs and bladder. Dilates the bronchi. Indicated for wind-cold chills and fever. Overuse may cause excess sweating. Use with cardiac glycosides may lead to cardiac arrhythmia. Do not combine with sympathomimetic drugs, may reduce the effects of beta-blockers. Use with diuretics may lead to increased elimination of water. Hypertension noted with high doses of mahuang. Avoid prolonged use.
Xingren (杏仁 or Prunus armeniaca) stops cough and calms wheezing, moistens the intestines, and unblocks the bowels. Indicated for constipation. Indicated for cough due to heat or cold and for wind-dry cough. Contraindicated in children.
Yiyiren (薏苡仁 or Coix lacryma-jobi) promotes urination, decongests the lungs, clears heat, strengthens the spleen, and dispels dampness. Indicated for dark and scanty urine, swelling, and painful joints due to damp excess. Indicated for any damp-heat condition. Avoid use in pregnancy.

This blog introduces theories from traditional Chinese medicine. It is provided for educational purposes only. If you have COVID-19 symptoms, please contact your healthcare provider. Seek the advice of a qualified healthcare practitioner before taking any herbal medicine, dietary supplement, or pharmaceutical remedy.

Chinese Herbal Medicine in the Fight Against COVID-19