Abstract
Post-COVID syndrome affects at least 10% of individuals recovering from COVID-19. Currently, there is no causal treatment. This retrospective cohort study aimed to evaluate the potential of traditional Chinese medicine (TCM) in treating post-COVID symptoms. TCM physicians in Germany and Austria completed online questionnaires to retrospectively record symptoms, treatment approaches, and outcomes for patients diagnosed with post-COVID. Nine physicians collected data from 79 patients (65% female, 47 ± 16 SD). The most common TCM treatments for post-COVID were acupuncture (n = 66; 85%), Chinese pharmacological therapy (n = 61; 77%), and Chinese dietary counseling (n = 32; 41%). After an average of 7 ± 4 TCM consultations, physicians rated global symptom improvement as 62% ± 29%. Significant alleviation from the start of TCM treatment was observed in major symptoms, such as fatigue (P < .001), impaired physical performance (P < .001), and exertional dyspnea (P < .001). TCM treatment was associated with significant improvements in post-COVID symptoms, warranting further evaluation through randomized controlled studies.
Keywords: acupuncture, chinese drugs, complementary therapies, coronavirus disease-19, fatigue, long COVID
1. Introduction
As evidenced by many studies, survivors of coronavirus disease 2019 (COVID-19) frequently experience persistent symptoms after recovery.[1,2] Based on a conservative estimated incidence of a minimum of 10% among infected people, it can be assumed that long-term symptoms affect at least 65 million people world-wide.[3] Although COVID-19 was initially recognized as a respiratory illness, a range of symptoms affecting multiple organ systems have been described as long-term sequelae. Common symptoms include fatigue and impaired physical performance, shortness of breath, cognitive impairment, mental health issues, and insomnia and are referred to as post-COVID syndrome, or Long-COVID.[1,2,4,5]
Despite the growing body of research, many questions remain regarding the risk factors and pathophysiology of the long-term complications of COVID-19. These symptoms have multiple causes, including virus-specific and immune-mediated damage to cells and tissues, immune dysregulation, and coagulation system.[3,6,7] Several pharmacological and nonpharmacological therapeutic approaches have been proposed, such as antivirals, anticoagulants, intravenous immunoglobulin, and dietary supplements.[3,8] Due to the pathological and symptomatic similarities of post-COVID conditions and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), treatment options for a number of components of post-COVID have been extrapolated from research on ME/CFS.[3] However, to date, there are no validated effective treatments. Given the broad spectrum of pathomechanisms and symptoms and the increasing popularity of Traditional Complementary and Integrated Health (TCIH), an individualized, holistic, and integrated approach is recommended.[3,8,9]
One promising TCIH approach for the treatment of post-COVID conditions involves the application of traditional Chinese medicine (TCM). Epidemic diseases significantly influence the evolution of TCM in terms of theory and practices.[10] Furthermore, TCM holds the promise of not only alleviating symptoms but also influencing intricate pathogenic mechanisms, for example, by modulating inflammation and enhancing immune and coagulation functions.[6,11–13] Various types of TCM therapies, including acupuncture and moxibustion,[14,15] Chinese pharmacological medicine[16] and qigong,[17] have been shown to represent safe and efficient treatment options for ME/CFS.[18] Hence, TCM may also be a reasonable treatment option for post-COVID symptoms.
The aim of this study was to evaluate the effectiveness of TCM approaches for the treatment of post-COVID conditions. To achieve this, a retrospective cohort study was conducted among TCM physicians to gain insight into their firsthand experience in treating patients suffering from the long-term sequelae of COVID-19. We were especially interested in assessing the symptoms of post-COVID before TCM treatment, the various types of TCM treatments used, and the subsequent changes in symptoms from the physicians’ perspective.
2. Methods
This retrospective cohort study was conducted and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.[19] The study protocol was approved by the Ethics Committee of Coburg University (approval number: HC-Meißner-20220721).
TCM physicians experienced in treating post-COVID patients were recruited from German-speaking countries through the authors’ network, between October 2022 and February 2023. TCM physicians who expressed interest received written information regarding the study procedure by one of the authors (JK). They were then screened for the following inclusion criteria via an online questionnaire sent by JK: possession of a valid and completed qualification in TCM, a minimum of 5 years of practical experience in TCM, and TCM treatment of at least 5 patients diagnosed with post-COVID.
The survey aimed to encompass between 5 and 10 patient cases per physician, targeting a total of 100 patient cases, with TCM treatment either terminated or ongoing and a minimum of 2 appointments per patient. To be included in the data entry, patients had to meet the following inclusion criteria, as verified by the physician: post-COVID diagnosis according to the S1 guideline,[20] absence of CFS/MS prior to COVID-19 infection, absence of severe psychiatric illness prior to COVID-19 infection, and absence of severe comorbid diseases necessitating treatment (e.g., cancer).
TCM physicians who met all the inclusion criteria and provided written informed consent were assigned pseudonyms by one of the authors (JK) and received a link via email to access the online questionnaires. Physicians were asked to enter their pseudonym in the online form and to complete one anonymous online-questionnaire per post-COVID patient treated with TCM, with a minimum of 5 and a maximum of 10 patients. In case of more than 10 eligible patients per physician, they assigned consecutive numbers to all patients meeting the inclusion criteria and sent the list of numbers (without names) to JK, who then randomly selected 10 patients using the random number function implemented in Excel and provided the physician with the selected numbers of patients to be included in the data entry. The survey was conducted using QuestorPro 5.0.7 software, though physicians had the option to complete the questionnaire in analog format if preferred. Data collection began in October 2022, with data entry concluded in March 2023.
The patient questionnaire, to be completed by the physicians, covered the following aspects: 1) sociodemographic data (year of birth and sex); 2) history of acute COVID-19 infection (date of infection, prior vaccination(s), and severity according to Rommel et al[21]; 3) previous medical conditions, risk factors, and medication usage; 4) onset times of post-COVID and TCM therapy; 5) severity of a range of common post-COVID symptoms[21] at the start and end of TCM treatment or at the time of assessment; 6) TCM diagnoses according to the 11th revision of the International Classification of Diseases (ICD-11) at the start and end of TCM treatment or at the time of assessment; 7) TCM therapy procedures and any potential side effects; 8) prescriptions of Chinese pharmacological therapy; 9) TCM treatment status (ended or ongoing), along with the number of treatment sessions and duration; 10) accompanying conventional therapies, such as psychotherapy and rehabilitation; 11) physicians’ assessment of global improvement, adapted from the clinical global impression-improvement scale (CGI-I).[22]
Predefined response options were provided to indicate risk factors, current medication, specific TCM therapy techniques applied, Chinese pharmacological formulations, and (if applicable) reasons for discontinuation of treatment. Symptoms of the initial COVID-19 infection and post-COVID symptoms[23] were assessed using ordinal severity Likert scales, with the answer options “none‘, ’mild,” “moderate,” and ’severe.’ All questions required an answer and included the option ’unknown.’ Additionally, most medical questions included options for free text responses.
Statistical analyses were performed using SPSS (IBM, version 29) and included appropriate descriptive statistics and nonparametric Wilcoxon tests to assess prepost changes in symptom severity on ordinal Likert scales. Responses labeled “unknown” were excluded from the respective analyses. The level of significance (2-sided) was set at 5%.
3. Results
3.1. Recruitment process
A total of 575 practicing TCM physicians from Germany, Austria, and Switzerland were informed of the survey via email (Fig. 1). Of the contacted physicians, 33 expressed an interest in participating and were subsequently provided with detailed written information. Among them, 11 physicians completed informed consent forms and 9 finally completed the survey for their patient cases. Data were obtained from 81 patients, with an average of 9 patient cases per physician. Two cases were excluded owing to unplausible data, resulting in a total of 79 patients included in the analysis.
Figure 1.
Flow diagram of recruited physicians and included cases.
3.2. Physicians’ and patients’ characteristics
Nine physicians (89% female) participated in the survey. The patients were from Germany (56%) and Austria (44%), with a mean age of 51 ± 11 standard deviation (SD) years. They had been practicing TCM for an average of 16 ± 8 years, with approximately 54 ± 31 patient contacts per week. The physicians reported having treated an average of 23 ± 19 (range, 5–50) patients diagnosed with post-COVID.
The study sample comprised 79 patients (65% female), with an average age of 47 ± 16 years. The majority (68%) of patients had been vaccinated against COVID-19 at the time of infection. The course of acute COVID-19 infection was predominantly mild (28%) to moderate (59%). At the time of infection, most patients showed neither preexisting diseases (44%) nor risk factors for a severe course of COVID-19 (59%), and the majority were not taking any medication (58%) (Table 1).
Table 1.
Characteristics of the 79 patients.
| Variables | ||
|---|---|---|
| Age in years, mean (SD) | 47 | (16) |
| Sex, n (%) | ||
| Male | 28 | (35) |
| Female | 51 | (65) |
| COVID-19 vaccinations, n (%) | ||
| 0 | 25 | (32) |
| 1 | 3 | (4) |
| 2 | 9 | (11) |
| 3 | 41 | (52) |
| 4 | 1 | (1) |
| COVID-19 infections, n (%) | ||
| 1 | 64 | (81) |
| 2 | 14 | (18) |
| 3 | 1 | (1) |
| Severity of acute COVID-19 infection (according to[21]), n (%) | ||
| Asymptomatic | 3 | (4) |
| Mild | 22 | (28) |
| Moderate | 47 | (59) |
| Severe | 7 | (9) |
| Critical | 0 | (0) |
| Preexisting diseases, n (%) | ||
| None | 35 | (44) |
| Cardiovascular disease | 14 | (18) |
| Autoimmune disease | 12 | (15) |
| Allergy | 8 | (10) |
| Anxiety disorder | 8 | (10) |
| Metabolic disorder | 6 | (8) |
| Preexisting medication, n (%) | ||
| None | 46 | (58) |
| Antihypertensives | 12 | (15) |
| Hormonal drugs | 8 | (10) |
| Miscellaneous | 24 | (30) |
COVID-19 = coronavirus disease 2019, SD = standard deviation.
3.3. Post-COVID symptoms
Post-COVID symptoms started a median of 4 (interquartile range (IQR), 4–8) weeks after acute infection (n = 78) and led to significant limitations or temporary occupational disability in 46% of the patients. TCM treatment began 4 (median; IQR, 0–11) weeks after the onset of post-COVID symptoms, which was 10 (median; IQR, 6–21) weeks after acute infection. The most common post-COVID complaints at treatment onset were fatigue (86%), limited performance (78%), exertional dyspnea (61%), memory/concentration impairment (53%), headache (51%), and depressed mood (49%) (Table 2).
Table 2.
Frequency and severity of post-COVID symptoms at onset and at the end of treatment, or time of assessment (n = 79).
| Post-COVID symptom | Onset of treatment | End of treatment or time of assessment | P-value* | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Frequency, n (%) | Frequency, n (%) | ||||||||||||||||||||
| None | Mild | Moderate | Severe | Unknown | None | Mild | Moderate | Severe | Unknown | ||||||||||||
| Fatigue | 11 | (14) | 15 | (19) | 38 | (48) | 15 | (19) | 0 | (0) | 42 | (54) | 28 | (35) | 8 | (10) | 0 | (0) | 0 | (0) | <.001 |
| Impaired performance | 17 | (22) | 16 | (20) | 32 | (41) | 14 | (18) | 0 | (0) | 38 | (48) | 30 | (38) | 8 | (10) | 3 | (4) | 0 | (0) | <.001 |
| Exertional dyspnea | 31 | (39) | 22 | (38) | 22 | (28) | 4 | (5) | 0 | (0) | 60 | (76) | 12 | (15) | 3 | (4) | 2 | (3) | 2 | (3) | <.001 |
| Memory/concentration impairment | 36 | (46) | 17 | (22) | 21 | (27) | 4 | (5) | 1 | (1) | 59 | (75) | 15 | (19) | 5 | (6) | 0 | (0) | 0 | (0) | <.001 |
| Headache | 39 | (49) | 20 | (25) | 16 | (20) | 4 | (5) | 0 | (0) | 66 | (84) | 10 | (13) | 2 | (3) | 0 | (0) | 1 | (1) | <.001 |
| Depressed mood | 40 | (51) | 16 | (20) | 21 | (27) | 2 | (3) | 0 | (0) | 55 | (70) | 18 | (23) | 5 | (6) | 1 | (1) | 0 | (0) | <.001 |
| Sleep difficulties | 46 | (58) | 15 | (19) | 14 | (18) | 4 | (5) | 0 | (0) | 60 | (76) | 16 | (20) | 3 | (4) | 0 | (0) | 0 | (0) | <.001 |
| Vertigo/ circulatory disturbances | 48 | (61) | 18 | (23) | 11 | (14) | 2 | (3) | 0 | (0) | 70 | (89) | 8 | (10) | 0 | (0) | 1 | (1) | 0 | (0) | <.001 |
| Chest pain (tightness, stinging) | 50 | (63) | 20 | (25) | 7 | (9) | 2 | (3) | 0 | (0) | 65 | (82) | 13 | (17) | 1 | (1) | 0 | (0) | 0 | (0) | <.001 |
| Palpitations | 51 | (65) | 11 | (14) | 13 | (17) | 3 | (4) | 1 | (1) | 66 | (84) | 11 | (14) | 1 | (1) | 1 | (1) | 0 | (0) | <.001 |
| Distress | 52 | (66) | 11 | (14) | 15 | (19) | 1 | (1) | 0 | (0) | 62 | (79) | 14 | (18) | 3 | (4) | 0 | (0) | 0 | (0) | <.001 |
| Resting dyspnea | 53 | (67) | 22 | (28) | 3 | (4) | 1 | (1) | 0 | (0) | 70 | (89) | 7 | (9) | 1 | (1) | 0 | (0) | 1 | (1) | <.001 |
| Anxiety | 54 | (68) | 9 | (11) | 12 | (15) | 4 | (5) | 0 | (0) | 61 | (77) | 15 | (19) | 2 | (3) | 1 | (1) | 0 | (0) | .001 |
| Cough | 55 | (70) | 14 | (18) | 10 | (13) | 0 | (0) | 0 | (0) | 73 | (92) | 5 | (6) | 1 | (1) | 0 | (0) | 0 | (0) | <.001 |
| Olfactory/gustatory disturbance | 58 | (73) | 13 | (17) | 6 | (8) | 2 | (3) | 0 | (0) | 73 | (92) | 6 | (8) | 0 | (0) | 0 | (0) | 0 | (0) | <.001 |
| Muscular pain | 57 | (72) | 11 | (14) | 10 | (13) | 0 | (0) | 1 | (1) | 75 | (95) | 1 | (1) | 3 | (4) | 0 | (0) | 0 | (0) | <.001 |
| Tachycardia | 59 | (75) | 10 | (13) | 6 | (8) | 3 | (4) | 1 | (1) | 71 | (90) | 6 | (8) | 2 | (3) | 0 | (0) | 0 | (0) | <.001 |
| Loss of appetite | 62 | (79) | 12 | (15) | 3 | (4) | 2 | (3) | 0 | (0) | 77 | (98) | 2 | (3) | 0 | (0) | 0 | (0) | 0 | (0) | <.001 |
| General pain | 63 | (80) | 6 | (8) | 8 | (10) | 2 | (3) | 0 | (0) | 70 | (89) | 4 | (5) | 3 | (4) | 1 | (1) | 1 | (1) | .004 |
| Joint pain | 63 | (80) | 10 | (13) | 5 | (6) | 0 | (0) | 1 | (1) | 76 | (96) | 3 | (4) | 0 | (0) | 0 | (0) | 0 | (0) | <.001 |
| Nausea | 66 | (84) | 6 | (8) | 5 | (6) | 2 | (3) | 0 | (0) | 74 | (94) | 4 | (5) | 0 | (0) | 0 | (0) | 1 | (1) | .003 |
| Symptoms of PTSD | 67 | (85) | 5 | (6) | 5 | (6) | 0 | (0) | 2 | (3) | 75 | (94) | 2 | (3) | 1 | (1) | 1 | (1) | 1 | (1) | n.s. |
| Hair loss | 68 | (86) | 3 | (4) | 5 | (6) | 2 | (3) | 1 | (1) | 74 | (94) | 4 | (5) | 0 | (0) | 0 | (0) | 1 | (1) | .006 |
| Diarrhea | 69 | (87) | 3 | (4) | 6 | (8) | 1 | (1) | 0 | (0) | 77 | (97) | 2 | (3) | 0 | (0) | 0 | (0) | 0 | (0) | .004 |
| Fever episodes | 70 | (89) | 6 | (8) | 3 | (4) | 0 | (0) | 0 | (0) | 79 | (100) | 0 | (0) | 0 | (0) | 0 | (0) | 0 | (0) | .006 |
| Tinnitus | 72 | (91) | 6 | (8) | 1 | (1) | 0 | (0) | 0 | (0) | 75 | (95) | 4 | (5) | 0 | (0) | 0 | (0) | 0 | (0) | .046 |
| Paralysis/sensory disturbance | 73 | (92) | 2 | (3) | 3 | (4) | 1 | (1) | 0 | (0) | 75 | (95) | 3 | (4) | 1 | (1) | 0 | (0) | 0 | (0) | .034 |
| Skin rash | 75 | (95) | 3 | (4) | 1 | (1) | 0 | (0) | 0 | (0) | 76 | (96) | 3 | (4) | 0 | (0) | 0 | (0) | 0 | (0) | n.s. |
| Ear ache | 77 | (98) | 1 | (1) | 0 | (0) | 1 | (1) | 0 | (0) | 78 | (99) | 1 | (1) | 0 | (0) | 0 | (0) | 0 | (0) | n.s. |
| Voice loss | 77 | (98) | 2 | (3) | 0 | (0) | 0 | (0) | 0 | (0) | 79 | (100) | 0 | (0) | 0 | (0) | 0 | (0) | 0 | (0) | n.s. |
| Emerging metabolic diseases | 78 | (99) | 1 | (1) | 0 | (0) | 0 | (0) | 0 | (0) | 79 | (100) | 0 | (0) | 0 | (0) | 0 | (0) | 0 | (0) | n.s. |
| Thromboembolism | 78 | (99) | 0 | (0) | 0 | (0) | 1 | (1) | 0 | (0) | 79 | (100) | 0 | (0) | 0 | (0) | 0 | (0) | 0 | (0) | n.s. |
COVID = coronavirus disease, n.s. = not significant, PTSD = post-traumatic stress disorder.
Wilcoxon-test (“unknown” cases excluded).
3.4. TCM treatments
At the time of the survey, the patients attended an average of 7 ± 4 TCM consultations. TCM treatment was still ongoing for 37 patients, whereas for the remaining 42 patients, treatment was concluded after an average of 6 ± 3 consultations within 16 ± 16 weeks. Among these, 32 patients (76%) discontinued treatment because of significant symptom reduction exceeding 50% and/or restoration of their performance and work capabilities. Six patients (14%) discontinued treatment because of a lack of success.
Most patients received acupuncture (n = 66; 84%) and Chinese pharmacological treatment (n = 61; 77%). Additionally, nutritional counseling (n = 32; 41%), indirect moxibustion (n = 22; 28%), ear acupuncture (n = 14; 18%), western herbs according to TCM principles (n = 8; 10%), tuina massage (n = 7; 9%), qigong (n = 4; 5%), and acupressure (n = 3; 4%) were administered. Side effects were reported in one case (nightmares after acupuncture treatment).
Most patients received TCM pharmacological formulas (n = 67; 85%), which were frequently further modified (n = 46; 58%). The most commonly used formulas were Xiao Chai Hu Tang (n = 8, 10%), Gui Zhi Tang (n = 8, 10%), Liu Jun Zi Tang (n = 7, 9%), Ban Xia Xie Xin Tang (n = 7, 9%), and Gua Lou Gui Zhi Tang (n = 7, 9%). Individualized TCM formulas were prescribed in 30% of the cases.
Alongside TCM therapy, 42% of the patients underwent conventional therapies (primarily psychotherapy, rehabilitation, physiotherapy, and drug therapy). Furthermore, 15% of patients were taking dietary supplements during TCM therapy.
3.5. Symptom changes
At the time of assessment, physicians rated global improvement on average at 62% ± 29%, with 53 of 79 patients (67%) showing ≥ 50% improvement. For patients who had already completed treatment, there was a global symptom reduction of 71% ± 29%, with 32 out of 42 patients (76%) showing ≥ 50% improvement. Global symptom improvement for patients with ongoing treatments was rated significantly at 52% ± 25% (P < .001).
Following TCM treatment, most of the reported post-COVID complaints significantly decreased (Table 2). Figure 2 illustrates the changes in the severity of the 10 most prevalent symptoms at the start and end of treatment or at the time of assessment. For instance, fatigue as the most common complaint was initially reported in 68 (86%) patients, but only in 36 (45%) patients at the end of treatment or at the time of assessment, respectively. Although fatigue was mostly classified as moderate (48%) at the start of TCM treatment, it typically improved to mild (35%) symptoms during the course of therapy, and severe cases of fatigue were no longer prevalent. Further symptoms with marked relief included, but were not limited to, exertional dyspnea, memory and concentration impairment, headache, depressed mood, sleep difficulties, vertigo, circulatory disturbances, and chest pain (Fig. 2; for all symptoms, see Table 2).
Figure 2.
Retrospectively assessed changes of the 10 most prevalent symptoms at start of TCM treatment. MCI = memory/concentration impairment, TCM = traditional Chinese medicine.
4. Discussion
This study aimed to assess the suitability of TCM approaches for the treatment of post-COVID symptoms. After an average of 7 ± 4 TCM consultations, physicians assessed patients’ global improvement at 62% ± 29%, with 67% of patients showing a significant improvement of at least 50%. Among the 42 patients who completed their treatment, global improvement was estimated at 71% ± 29% after an average of 6 ± 3 consultations, with 76% of patients showing ≥ 50% improvement. The most common post-COVID complaints such as fatigue, impaired performance, exertional dyspnea, and memory and concentration impairment, were reported less frequently and with reduced severity following TCM treatment.
In the present sample, acute COVID-19 infections were generally mild-to-moderate in the majority of cases (87%). Despite the higher risk of post-COVID after a severe acute course of the disease, many individuals with milder courses are affected by long-term sequelae, as well.[24] The most prevalent symptoms that led patients to consult a TCM physician were fatigue, impaired performance, exertional dyspnea, loss of memory and/or concentration, and sleep difficulties. These complaints align with those reported in the literature for 3 to 9 months following acute infection.[4] Consistent with previous findings that women are more frequently and severely affected by the long-term sequelae of COVID-19,[8,23,24] a majority (65%) of the study patients were female. Additionally, the gender difference might be attributed[6] to the higher likelihood of women using TCIH methods compared to men.[25]
Fatigue and cognitive impairment are 2 of the most important symptoms for both impaired health recovery and reduced work capacity in post-COVID patients.[24] These symptoms were highly prevalent among the patients of this survey, with 68% experiencing fatigue and 42% reporting cognitive impairments. Accordingly, ability to work was affected by post-COVID symptoms in nearly half of the sample (46%). The results of this study highlight that TCM treatment was associated with significant improvements (P < .0001 and P = .003, respectively) in fatigue and cognitive impairment among the subgroup of patients initially unable to work due to these symptoms. This suggests that TCM approaches could be helpful in alleviating the socioeconomic burden of sick leave caused by post-COVID syndrome.
Among the participating TCM practitioners, acupuncture and Chinese pharmacological remedies were the 2 most commonly used therapies, with only one of the 79 patients receiving none. However, the use of these treatments to addressing post-COVID symptoms remains relatively limited in German-speaking countries. In a survey of 499 respondents, only 22 (4%) and 13 (3%) reported using acupuncture and/or Chinese pharmacological treatment, respectively, to manage their symptoms.[26] This is somewhat surprising given that acupuncture is renowned for its positive effects on common post-COVID symptoms such as fatigue and pain.[11,13,27] Randomized controlled trials on the efficacy of acupuncture and TCM pharmacological therapy for post-COVID symptoms are important in this regard.
Interpreting the results of this study requires careful consideration of the following limitations: First, the absence of a controlled study design means that the extent to which other factors, such as regression to the mean, concurrent treatments, or the natural recovery process may have influenced symptom improvement, cannot be ascertained. For example, 42% of patients pursued other therapies during the TCM treatment period, including psychotherapy, rehabilitation measures, physiotherapy, and medication. Consequently, changes in the symptoms cannot be attributed to TCM treatment. Second, the retrospective study design may have introduced a recall bias among practitioners, potentially influencing the results. Third, the assessment of symptom improvement relied on the evaluation by TCM physicians rather than the perspective of the patients themselves. Future research should prioritize patient experiences. Fourth, validated grading scales, such as the post-COVID-19 Functional Status scale[28] should be used in future studies. Fifth, the results were based on information provided by 9 physicians, representing a limited range of experience. This might have introduced a nonresponse bias, implying that physicians who observed higher treatment success or held more positive views on TCM were more likely to participate in the survey. Finally, the data were based on a limited number of cases (n = 79). This prevented more detailed analyses. Future studies should aim for larger patient cohorts and consider subgroup analyses to evaluate possible sex-specific differences in treatment outcomes, variations in the efficacy of specific TCM treatment approaches for different symptom clusters, and predictors of a positive response.
In conclusion, the present study results suggest that TCM treatments focusing on acupuncture and Chinese pharmacotherapy could be helpful for a wide range of post-COVID symptoms, including mental, neurological, cardiovascular, and musculoskeletal conditions. However, the findings must be considered within the context of methodological limitations, such as the absence of a controlled study design and the possibility of recall and nonresponse biases. Further research, especially well-designed randomized controlled trials with large patient samples, is warranted to further evaluate the potential value of TCM approaches in the treatment of post-COVID symptoms.
Acknowledgments
We gratefully acknowledge the physicians who entered the data.
Author contributions
Conceptualization: Anne Hardy, Verena Baustädter, Martina Bögel-Witt, Katharina Krassnig, Birgit Ziegler, Karin Meissner.
Formal analysis: Jana Kraft, Karin Meissner.
Investigation: Jana Kraft, Paula J. Waibl.
Methodology: Jana Kraft, Anne Hardy, Verena Baustädter, Martina Bögel-Witt, Katharina Krassnig, Birgit Ziegler, Paula J. Waibl, Karin Meissner.
Project administration: Jana Kraft, Paula J. Waibl.
Supervision: Anne Hardy, Verena Baustädter, Martina Bögel-Witt, Katharina Krassnig, Birgit Ziegler, Karin Meissner.
Visualization: Jana Kraft, Karin Meissner.
Writing – original draft: Jana Kraft, Karin Meissner.
Writing – review & editing: Anne Hardy, Verena Baustädter, Martina Bögel-Witt, Katharina Krassnig, Birgit Ziegler, Paula J. Waibl.
Abbreviations:
- CGI-I
- clinical global impression—improvement scale
- COVID
- coronavirus disease
- COVID-19
- coronavirus disease 2019
- ICD-11
- Eleventh Revision of the International Classification of Diseases (ICD)
- IQR
- interquartile range
- ME/CFS
- myalgic encephalomyelitis/chronic fatigue syndrome
- SD
- standard deviation
- SPSS
- statistical package for social sciences
- STROBE
- reporting of observational studies in epidemiology
- TCIH
- traditional complementary and integrated health
- TCM
- traditional Chinese medicine
AH, MB-W, and BZ are members of the board of AGTCM, a professional association for TCM therapists in Germany. KK and VB head the Vienna School of TCM in Austria (WSTCM). Both organizations have financially supported the conduct and publication of the study.
The authors have no conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Kraft J, Hardy A, Baustädter V, Bögel-Witt M, Krassnig K, Ziegler B, Waibl PJ, Meissner K. Traditional Chinese medicine for post-COVID: A retrospective cohort study. Medicine 2025;104:18(e42275).
Contributor Information
Jana Kraft, Email: jkraft-laurentius@web.de.
Paula J. Waibl, Email: paula.waibl@web.de.
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