Skip to main content
NCBI home page
Journal of Translational Medicine logoLink to Journal of Translational Medicine
. 2025 Jul 16;23:801. doi: 10.1186/s12967-025-06830-7

Efficacy and safety of traditional Chinese medicine for post-COVID-19 syndrome: a systematic review and meta-analysis

Yiting Wang 1,#, Xiao Li 1,#, Huaizheng Hui 2,✉, Dianxing Yang 1,✉
PMCID: PMC12269130  PMID: 40671020

Abstract

Background

Post-COVID-19 syndrome, characterized by persistent symptoms such as fatigue, dyspnea, cough, insomnia, and exercise intolerance, poses a significant challenge to global healthcare systems. Traditional Chinese Medicine (TCM) has been used to manage post-viral syndromes, but high-quality evidence for its effectiveness in post-COVID-19 recovery is limited. This study aimed to evaluate the clinical efficacy and safety of Chinese herbal medicine (CHM) in treating post-COVID-19 syndrome through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods

Five electronic databases (PubMed, Embase, Web of Science, Cochrane Library and CNKI) were systematically searched up to March 15, 2025. RCTs comparing CHM with placebo or usual care in patients with confirmed post-COVID-19 syndrome were included. Primary outcomes were symptom severity measured by the Visual Analogue Scale (VAS); secondary outcomes included relief rates of cough, fatigue, chest tightness, dyspnea, insomnia, and exercise intolerance. Data were pooled using a random-effects model, and heterogeneity was assessed using I2 statistics.

Results

Ten RCTs involving 2401 patients were included. CHM showed a greater reduction in VAS scores compared to controls (MD = −1.03; 95% CI −2.10 to 0.03; P = 0.0577), with higher heterogeneity (I2 = 92%). Although this result did not reach conventional statistical significance, it suggests a potentially meaningful clinical trend favoring CHM. Subgroup analysis indicated both short-term and long-term CHM treatments improved VAS scores, with a stronger effect in long-term treatment. CHM significantly improved chest tightness (RR = 1.40; 95% CI 1.21–1.61; P < 0.0001; I2 = 0%) and insomnia (RR = 1.23; 95% CI 1.03–1.47; P = 0.0216; I2 = 0%). A trend toward improvement was observed in fatigue (RR = 1.58, 95% CI 0.95–2.64; P = 0.0781) and dyspnea (RR = 1.39, 95% CI 0.99–1.95; P = 0.0554), although these results did not reach statistical significance. No significant difference was observed in terms of 6-min walking distance (MD = 13.95 m, 95% CI −11.64 to 39.55; P = 0.2853). Adverse event rates were comparable between the herbal and control groups (RR = 0.72, 95% CI 0.49–1.07; P = 0.1052).

Conclusions

This meta-analysis indicates that Traditional Chinese Medicine (TCM) may help relieve certain post-COVID-19 symptoms, especially chest tightness and insomnia. Trends toward benefit were also noted for fatigue and dyspnea, though without statistical significance. Given the non-significant VAS results and high heterogeneity, these findings should be interpreted cautiously. Further large-scale, high-quality trials are needed to validate these outcomes and optimize treatment strategies.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/home, CRD420251016442.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-025-06830-7.

Keywords: Post-COVID-19 syndrome, Long COVID, Traditional Chinese Medicine, Effectiveness, Safety

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has triggered a global public health crisis since its emergence. Although most patients recover from the acute phase, a significant proportion continue to experience persistent symptoms lasting for weeks or even months post-infection, a condition known as post-COVID-19 symptoms or long COVID. The UK National Institute for Health and Clinical Excellence (NICE) defines it as symptoms that persist for more than 12 weeks after acute infection and cannot be explained by an alternative diagnosis [1]. The clinical manifestations of post-COVID-19 syndrome are complex and often involve multiple organ systems. The most frequently reported symptoms include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, post-traumatic stress symptoms, and myalgia, with symptom duration varying from several weeks to months [2, 3]. These persistent post-viral manifestations impose a considerable burden on healthcare systems worldwide. A growing body of clinical and observational research suggests that post-COVID-19 syndrome is a multifactorial condition, potentially involving long-term residual viral presence, dysregulated immune responses, endothelial dysfunction and microvascular injury, as well as disturbances in the gut microbiota [4–6]. However, there is currently no widely recognized effective treatment for post COVID-19 syndrome. Current management strategies rely on multidisciplinary approaches, including physiotherapy, psychological support and non-pharmacological interventions [7]. Pharmacological treatments have been used to target specific symptoms such as insomnia, mood disturbances, and fatigue, but the overall efficacy remains uncertain [8]. In this context, there is an urgent need to explore complementary and alternative therapies that are safe, effective, and widely accessible.

Traditional Chinese Medicine (TCM) has been extensively used in the treatment of COVID-19, other viral infections, and various chronic conditions [9–12]. In recent years, several randomized controlled trials (RCTs) have investigated the clinical effectiveness of Chinese herbal medicine in managing long COVID symptoms. These interventions include Chinese herbal tonics, patented formulations, patented formulations, and granule-based preparations. Findings from these studies suggest that TCM may alleviate fatigue, improve respiratory symptoms, and regulate emotional disturbances [13–15]. Additionally, some evidence points to TCM’s potential in modulating inflammatory markers, enhancing cardiopulmonary function, and reducing psychological stress [16].

Nevertheless, the current literature exhibits significant heterogeneity in terms of study design, sample sizes, intervention protocols, and outcome measures, resulting in inconsistent conclusions regarding efficacy. To date, no comprehensive systematic review and meta-analysis has been conducted to evaluate the efficacy and safety of TCM in treating post-COVID-19 syndrome. Therefore, it is essential to integrate existing evidence through systematic evaluation and meta-analytic techniques to provide a comprehensive assessment of the clinical efficacy and safety of TCM in the treatment of post-COVID-19 syndrome, and to offer evidence-based guidance for the long-term management of COVID-19 survivors.

Materials and methods

This study is a systematic review and meta-analysis of randomized controlled trials, conducted according to PRISMA guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the identifier CRD420251016442.

Literature search strategy

We systematically searched 5 databases including PubMed、Web of science、Embase、Cochrane Library and CNKI (China National Knowledge Infrastructure) from their inception to March 15, 2025. Both Medical Subject Headings (MeSH) and free-text terms were used to ensure comprehensive coverage. The MeSH terms included: “Traditional Chinese medicine,” “Medicine, Chinese Traditional,” “Post-COVID-19 Condition,” “Post-COVID-19 Syndrome,” “COVID-19,” “Coronavirus Disease-19,” “2019-nCoV Infection,” “SARS-CoV-2 Infection.” The complete search strategies for all six databases are provided in Supplementary Material.

Inclusion and exclusion criteria

Inclusion criteria: (1) Population: Adults with a confirmed history of SARS-CoV-2 infection and persistent symptoms consistent with long COVID. (2) Intervention: Treatment with Chinese herbal compound formulations or Chinese patent medicines. (3) Comparison: Placebo or usual care. (4) Outcomes: The primary outcome was the visual analogue scale (VAS). Secondary outcome included clinical symptoms (cough, fatigue, dyspnea, chest tightness, insomnia), 6-min walk distance (6MWD), and adverse events. (5) Study design: Randomized controlled trials (RCTs).

Exclusion criteria: (1) Duplicate data. (2) Studies without full text or complete data. (3) Reviews, abstracts, letters, case reports, case series and animal studies. (4) Duplicate publications reporting identical results.

Data extraction

Two researchers (YW and HH) independently screened the literature and extracted data based on the eligibility criteria. Discrepancies were resolved by consultation with a third reviewer (XL). Extracted data included: first author's name, journal, year of publication, participant characteristics, intervention and control protocols, outcome measures, and results.

Risk of bias assessment

The risk of bias in the included studies was assessed using the Cochrane Handbook of Systematic Reviews of Interventions [17]. The following domains were evaluated: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other sources of bias. Each domain was rated as “low risk,” “high risk,” or “unclear risk.”

Data synthesis and statistical analysis

In this meta-analysis, the VAS was designated as the primary outcome, while cough, fatigue, dyspnea, chest tightness, insomnia, and exercise intolerance were analyzed as secondary outcomes. Furthermore, to investigate the impact of treatment duration on outcomes, subgroup analyses were conducted.

Heterogeneity across studies was assessed using the chi-square (χ2) test (with a significance threshold of P < 0.10) and the I2 statistic (with I2 > 50% indicating substantial heterogeneity). When both P < 0.10 and I2 > 50% were present, a random-effects model was applied to account for between-study variability. For continuous outcomes, means and standard deviations (SD) were used to calculate the effect size, expressed as mean difference (MD) with corresponding 95% confidence intervals (CI), provided that the same measurement tools were used across studies. All analyses were conducted using Comprehensive Meta-Analysis software (version 4), and dose–response meta-analysis were performed using the ‘dosresmeta’ package in R software (version 2.0.1). A two-sided P value of < 0.05 was considered statistically significant.

Results

Search results

The initial database search yielded 1,286 records. After removing duplicates, 912 unique records remained for title and abstract screening. Based on this screening, 94 studies were selected for full-text review. Following detailed eligibility assessment, 10 RCTs met the inclusion criteria and were ultimately included in this meta-analysis. The study selection process is illustrated in the PRISMA 2020 flow diagram (Fig. 1).

Fig. 1.

Fig. 1

Open in a new tab

Literature screening process

Characteristics of included studies

A total of 10 RCTs comprising 2,401 participants were included in the analysis. Sample sizes ranged from 131 to 482, and treatment durations varied between 14 and 90 days. All studies were conducted in China and published in English. A summary of the key characteristics of the included RCTs is presented in Table 1 (additional file).

Table 1.

Characteristics of Randomized Controlled Trials (RCTs) on CHM for post-COVID-19 syndrome

Source Participants CHM group Control group Sample size (I/C), drop out (I/C) Age (I/C) Outcome measures
Pang et al. [11] Discharged patients Oral Qing Jin Yi Qi granules, 10 g twice daily for 14 days + standard rehabilitation Standard rehabilitation 388 (194/194), 4 (1/3) 47.96 ± 1.36/44.82 ± 1.17 mMRC scale, Borg scale, Symptoms score, 6MWD
Chen et al. [12] Discharged patients with lung and spleen qi deficiency Oral Bufei Huoxue capsule (BFHX), 1.4 g (4 capsules) 3 times daily for 90 days Matching placebo, same dose and duration 131 (64/65), 14 (7/7) 54.16 ± 12.11/52.51 ± 12.31 lung lesion volume, ground-glass opacity volume, consolidation volume, 6MWD, FAI, SGRQ, Borg Dyspnea score, TCM symptom score
Xu et al. [18] Patients aged 18–65 years with post-infectious cough onset 3–8 weeks post-infection, VAS ≥ 40 mm Oral Lianhua Qingke tablets, 1.84 g (4 tablets) 3 times daily for 14 days Placebo, same dose and duration 482 (241/241), 2 (2/0) 42.05 ± 13.68/40.03 ± 13.18 Symptom resolution time, Symptom improvement rate, Symptom disappearance rate
An et al. [21] Discharged 2–4 weeks ago, aged 18–70 years, lung and spleen qi deficiency, with ≥ 2 TCM symptoms or VAS > 4 Oral Ludangshen oral liquid, 10 ml twice daily for 14 days Placebo, same dose and duration 200 (100/100), 8 (3/5) Unknown VAS, Symptom improvement rate, Symptom disappearance rate
Zhang et al. [22] Discharged > 2 weeks, aged 18–70 years, with digestive symptoms or single VAS score > 4 Oral Xiangsha Liujun Pills, 12 tablets, 3 times daily for 14 days Placebo, one packet, 3 times daily for 14 days 200 (100/100), 7 (2/5) Unknown Symptom improvement rate, Symptom disappearance rate, VAS
Zhang et al. [19] Discharged 2–4 weeks ago, aged 18–70 years, with ≥ 3 symptoms (e.g. cough, chest tightness, shortness of breath, sweating and palpitations) or VAS > 4 Oral Jinshuibao capsules, 4 capsules 3 times daily for 14 days Placebo, same dose and duration 200 (100/100), 8 (3/5) 55.04 ± 10.51/53.27 ± 10.64 VAS, Symptom improvement rate, Symptom disappearance rate
An et al. [20] Discharged 2–4 weeks ago, aged 18–70 years, with cardiopulmonary symptoms Oral Shengmai Yin, 10 ml 3 times daily for 14 days Placebo, same dose and duration 200 (100/100), 8 (2/6) Unknown VAS, Symptom improvement rate, Symptom disappearance rate
An et al. [37] Rehabilitation-phase COVID-19 patients aged 18–70 years, with sleep/emotional symptoms, HAMD-17: 17–24, PHQ-15 ≥ 5 Oral Shugan Jieyu capsules, 2 capsules twice daily for 6 weeks Placebo, same dose and duration 200 (100/100), 4 (1/3) 54.5 ± 10.8/55.0 ± 9.4 HAMD-17, HAMA, PHQ-15, ISI
Li et al. [23] Discharged 2 weeks ago with mood/sleep disturbances such as irritability, anxiety, poor sleep, or both, VAS ≥ 4, aged 18–70 years Oral Shumian capsules, 3 capsules twice daily for 2 weeks Placebo, same dose and duration 200 (100/100), 3 (2/1) Unknown VAS, Symptom improvement rate, Symptom disappearance rate, Efficacy evaluation
Yang et al. [14, 34] Discharged 2 weeks ago, aged 18–70 years, with 2–3 symptoms of sleep/mood disorder or VAS > 4 Oral Xiaoyao capsules, 4 capsules twice daily for 14 days Placebo, same dose and duration 200 (100/100), 5 (0/5) Unknown VAS, overall effectiveness rate,
Open in a new tab

Chinese Herbal Medicine (CHM), Visual Analogue Scale (VAS), Six-minute walking distance (6MWD), Modified Medical Research Council (mMRC), Fatigue Assessment Inventory (FAI), St.George's Respiratory Questionnaire (SGRQ), Hamilton Depression Scale-17 (HAMD-17), Hamilton Anxiety Scale (HAMA), Patient Health Questionnaire-15 (PHQ-15), Insomnia Severity Index (ISI)

Among these studies, nine (90%) were registered with the Chinese Clinical Trial Registry, while one study (10%) did not report its registration status. Nine studies (90%) employed a multicenter, center-randomized, double-blind, controlled trial design, whereas one study (10%) was randomized, open-label trial. In nine trials, Chinese herbal medicine (CHM) was used as the sole intervention; in the remaining study, both groups received adjunctive rehabilitation therapies, such as breathing exercises and Baduanjin (a traditional Chinese qigong practice). The CHM formulas varied across all included trials, reflecting the diversity of herbal combinations used.

Risk of bias in included studies

Risk of bias was evaluated for all ten included RCTs (Fig. 2). Several studies were judged to have an unclear risk of bias across multiple domains due to limited methodological reporting.

Fig. 2.

Fig. 2

Open in a new tab

Results of the risk of bias evaluation

With regard to selection bias, six trials reported adequate randomization procedures and were considered at low risk. The remaining four were rated as unclear risk due to insufficient detail on random sequence generation. In terms of allocation concealment, Seven trials were assessed as low risk, two as unclear, and one as high risk, the latter being an open-label study and thus more prone to selection bias. For performance bias, s seven trials clearly reported blinding of participants and personnel and were considered at low risk. One study was judged at high risk due to the absence of blinding, while two lacked sufficient detail and were classified as unclear risk. Regarding detection bias, three trials described appropriate blinding of outcome assessors, leading to a low risk rating. Six trials were rated as unclear due to insufficient methodological detail, and one was judged high risk due to the lack of blinding, which could affect the objectivity of outcome assessment. For attrition bias, only one trial clearly reported a low dropout rate and appropriate handling of missing data and was assessed as low risk. The remaining nine did not adequately address missing data and were thus rated as unclear risk. Regarding reporting bias, seven trials had accessible pre-registered protocols, supporting a low risk of selective reporting. The other three lacked protocol registration or accessibility, resulting in an unclear risk rating. In the domain of other sources of bias, six trials were considered to be at low risk of other potential biases. The remaining four were rated as unclear risk due to insufficient information to determine whether other sources of bias were present.

Primary outcome: VAS score

Three studies [19, 20, 24] used VAS scores as an outcome measure, with higher values indicating more severe symptoms. The results of the meta-analysis demonstrated a mean reduction in VAS scores in the CHM group compared to the control group (MD =  − 1.03; 95% CI  − 2.10 to 0.03; Z = −1.90; 529 participants; Fig. 3), but this difference did not reach statistical significance (Z =  − 1.90, P = 0.0577). Due to the presence of high heterogeneity (I2 = 92%, P < 0.0001), a random-effects model was employed to estimate the pooled effect size.

Fig. 3.

Fig. 3

Open in a new tab

Forest plot of VAS scores at the end of treatment in the CHM and control

Cough relief rate

Three studies [18–20] reported the rates of cough relief, and the meta-analysis demonstrated a non-significant trend favoring the CHM group compared to the control group (RR = 1.17; 95% CI 0.86–1.57; Z = 1.00; P = 0.3156; 768 participants; Fig. 4), indicating that patients receiving CHM were more likely to experience relief from their cough, although this difference did not reach statistical significance. There was significant heterogeneity among the included studies (I2 = 74%, P = 0.0200), suggesting variability in treatment effects.

Fig. 4.

Fig. 4

Open in a new tab

Forest plot of the rate of cough relief at the end of treatment in the CHM and control

Fatigue relief rate

Two studies [21, 22] reported fatigue remission rates, and the meta-analysis revealed a non-significant trend in favor of the CHM group over the control group (RR = 1.58; 95% CI 0.95–2.64; Z = 1.76; P = 0.0781; 347 participants; Fig. 5). This suggests that patients receiving CHM treatment may experience a trend toward fatigue relief, although the difference did not achieve statistical significance. Significant heterogeneity was found across the studies (I2 = 91%, P = 0.0007), indicating substantial variability in the treatment effects.

Fig. 5.

Fig. 5

Open in a new tab

Forest plot of the rate of fatigue relief at the end of treatment in the CHM and control

Insomnia relief rate

Two studies [23, 24] reported the remission rate of insomnia. The meta-analysis demonstrated a statistically significant improvement in the CHM group compared to the control group (RR = 1.23; 95% CI 1.03–1.47; Z = 2.30; P = 0.0216; 376 participants; Fig. 6), suggesting that patients receiving Chinese herbal medicine were significantly more likely to experience remission of insomnia than those treated with placebo. No significant heterogeneity was observed across the included studies (I2 = 0%, P = 0.3394), indicating a high level of consistency in treatment effects.

Fig. 6.

Fig. 6

Open in a new tab

Forest plot of the rate of insomnia relief at the end of treatment in the CHM and control

Dyspnea relief rate

Three studies [19–21] assessed the relief rates of dyspnea, and the meta-analysis demonstrated a non-significant trend favoring the CHM group compared to the control group (RR = 1.39; 95% CI 0.99–1.95; Z = 1.92; P = 0.0554; 478 participants; Fig. 7), suggesting that patients receiving CHM may experience a trend toward dyspnea relief, although the results did not reach statistical significance. Substantial heterogeneity was observed across the included studies (I2 = 85%, P = 0.0015).

Fig. 7.

Fig. 7

Open in a new tab

Forest plot of the rate of dyspnea relief at the end of treatment in the CHM and control

Chest tightness relief rate

Two studies [19, 20] assessed the relief rate of chest tightness. Meta-analysis revealed a statistically significant benefit in the CHM group compared with the control group (RR = 1.40; 95% CI 1.21–1.61; Z = 4.62; P < 0.0001; 363 participants; Fig. 8, suggesting that patients treated with Chinese herbal medicine were more likely to have chest tightness relief compared with patients receiving placebo. Heterogeneity between studies was minimal (I2 = 0%, P = 0.6448) demonstrating a high degree of consistency across trials.

Fig. 8.

Fig. 8

Open in a new tab

Forest plot of the rate of chest tightness relief at the end of treatment in the CHM and control

6MWD

Two studies [11, 12] reported data on six-minute walking distance (6MWD), with higher values indicating better exercise tolerance and cardiorespiratory recovery. The meta-analysis revealed no significant increase in 6MWD in the CHM group compared to the control group (MD = 13.95; 95% CI −11.64 to 39.55; Z = 1.07; P = 0.2853; 506 participants; Fig. 9). There was significant heterogeneity across the studies (I2 = 79%, P = 0.0292).

Fig. 9.

Fig. 9

Open in a new tab

Forest plot of the rate of 6MWD relief at the end of treatment in the CHM and control

Subgroup analyses

The subgroup analysis revealed that both short-term treatment (≤ 7 days) and long-term treatment (≥ 14 days) significantly improved VAS scores (Fig. 10). The mean difference for short-term treatment was −0.62 (95% CI −1.12 to −0.11), while for long-term treatment, it was −1.03 (95% CI −2.10 to 0.03). Although long-term treatment showed a stronger effect, the high heterogeneity in both subgroups (I2 = 70% for short-term and I2 = 92% for long-term) suggests the presence of other influencing factors. Overall, Chinese herbal medicine demonstrated beneficial effects on VAS scores in both short-term and long-term treatments.

Fig. 10.

Fig. 10

Open in a new tab

Forest plot of mean difference in VAS scores by treatment duration (short-term vs long-term) in CHM and control groups

Adverse events

The meta-analysis showed no significant difference in the risk of adverse events between the CHM and control groups (RR = 0.72; 95% CI 0.49–1.07; Z = −1.62; P = 0.1052; 1966 participants; Fig. 11), indicating that CHM did not significantly increase the risk of adverse events compared with placebo. There was no heterogeneity among the included studies (I2 = 0%, P = 0.5196). These findings suggest that CHM was generally well tolerated, with no significant difference in the incidence of adverse events compared with placebo.

Fig. 11.

Fig. 11

Open in a new tab

Adverse events

Discussion

Interpretation of results and mechanistic insights

Post-COVID-19 syndrome is a complex, multisystem disorder that can affect nearly every organ system, with no currently established definitive cure. Multidisciplinary therapeutic approaches have therefore become a cornerstone in the management of post-COVID-19 conditions. In this systematic review and meta-analysis, we comprehensively evaluated the efficacy and safety of TCM in managing post-COVID-19 syndrome. A total of 10 RCTs involving 2,401 patients were included, covering a wide range of Chinese herbal interventions can improve major recovery-phase symptoms, including fatigue, dyspnea, chest tightness, cough, insomnia, and exercise intolerance, while demonstrating a favorable safety profile with no serious adverse events reported. These results provide important evidence supporting the incorporation of TCM into the multidisciplinary management of post-COVID-19 syndrome and open new avenues for addressing chronic multisystem symptoms associated with long COVID.

Cough is one of the most prevalent residual symptoms during COVID-19 recovery, often related to persistent airway inflammation and hyperresponsiveness [25]. Lianhua Qingwen formula, containing Ephedra (Mahuang), Forsythia (Lianqiao), Scutellaria (Huangqin), Platycodon (Jiegeng), and Gypsum (Shigao), has demonstrated potent anti-inflammatory effects [18]. Ephedra, in particular, has been shown to inhibit pro-inflammatory cytokines and improve hypothalamic homeostasis when combined with Gypsum [26]. Platycodon promotes salivary and bronchial secretions and suppresses airway hyperreactivity [27]. Forsythia, honeysuckle, and scutellaria possess both antiviral and anti-inflammatory activities, aligning with modern medical strategies targeting airway remodeling and post-infectious inflammation [28, 29].

Fatigue and exercise intolerance are central manifestations of post-viral syndromes. Formulations such as Qingjin Yiqi Granules, Bufei Huoxue Capsules, Ludangshen Granules, and Shengmai Yin contain classic tonifying herbs like Ginseng (Renshen), Codonopsis (Dangshen), and Astragalus (Huangqi) [11, 12, 20, 21]. These herbs have been shown to enhance mitochondrial function, promote ATP production, and boost immune resilience [30–33]. Additionally, ginseng may alleviate central fatigue by modulating the hypothalamic–pituitary–adrenal (HPA) axis hyperactivity, thus improving overall physical endurance [34, 35].

Chest tightness and dyspnea reflect incomplete cardiopulmonary recovery. Bufei Huoxue, Shengmai Yin, and Jinshuibao Capsules contain herbs such as Ophiopogon (Maidong), Schisandra (Wuweizi), and Red Ginseng (Hongshen), which are known to nourish Yin, promote fluid production, and improve mucosal hydration of the respiratory tract, thereby ameliorating respiratory symptoms [12, 19, 20, 36].

Notably, psychological symptoms such as anxiety, depression, and sleep disturbances are highly prevalent among post-COVID-19 patients, significantly impairing their quality of life and social functioning. Several included studies utilized formulations such as Shumian Capsules and Shuganjieyu Capsules, which contain Semen Ziziphi Spinosae (Suanzaoren), Albizia flower (Hehuanhua), Bupleurum (Chaihu), and Acanthopanax (Ciwujia) [23, 37]. Suanzaoren enhances sleep quality through modulation of GABAergic and serotonergic pathways, while Acanthopanax exerts sedative and anti-fatigue effects, contributing to the restoration of normal sleep–wake cycles [37–39]. These findings provide new evidence supporting the role of TCM in integrative psychological rehabilitation for long COVID.

Regarding safety, no significant adverse events were identified across the included trials, suggesting that TCM is generally well tolerated in post-COVID-19 populations. However, limitations remain due to the lack of long-term safety data and insufficient exploration of herb-drug interactions and pharmacokinetic profiles. Future studies should incorporate systematic monitoring of adverse events and robust pharmacological assessments to ensure comprehensive safety evaluation.

Strengths and limitations of the study

First, all included studies were randomized controlled trials (RCTs), and most were registered in the Chinese Clinical Trial Registry, suggesting a certain level of methodological rigor. Second, this analysis specifically focused on the recovery phase (i.e., long COVID stage) rather than the acute infection phase, ensuring a clearly defined target population and a uniform intervention window, which enhances the relevance and clinical applicability of the findings.

However, several limitations must be acknowledged. First, variability in the methodological quality of the included studies was observed; in particular, some trials did not clearly describe randomization procedures or the implementation of blinding, raising concerns about potential selection and detection bias. Second, considerable heterogeneity existed regarding the herbal formulations, dosages, treatment durations, and adjunctive interventions (e.g., breathing exercises, Baduanjin) employed across studies, potentially affecting the clarity of efficacy attribution. Third, all studies were conducted in mainland China, and the study populations were largely homogeneous (e.g., predominantly Han ethnicity, middle-aged adults), which may limit the generalizability of the findings to broader, more diverse populations and different cultural settings. Therefore, we should further validate the efficacy through larger samples and more rigorous RCT designs.

Implications for clinical practice

Against the backdrop of a growing global population affected by long COVID, developing effective, safe, and individualized rehabilitation strategies to alleviate persistent symptoms and improve quality of life has become an urgent challenge for public health systems and clinicians. Current international guidelines primarily recommend multidisciplinary rehabilitation approaches, including respiratory training, exercise therapy, and psychological support, but lack specific pharmacological interventions [40].

The results of this meta-analysis suggest that Chinese herbal medicine offers advantages in managing common symptoms of post-COVID-19 syndrome, with minimal adverse effects and good clinical feasibility. Therefore, TCM may serve as an important component of rehabilitation management, particularly for patients with persistent symptoms who respond poorly to conventional interventions. Furthermore, the principles of syndrome differentiation and individualized treatment central to TCM philosophy complement the modern concept of precision medicine, offering promising opportunities for constructing personalized rehabilitation models for long COVID patients.

Conclusion

This meta-analysis provides preliminary evidence that Traditional Chinese Medicine (TCM) may effectively improve major symptoms associated with post-COVID-19 syndrome, particularly chest tightness and insomnia, while also demonstrating a favorable trend toward alleviating fatigue and dyspnea. These findings suggest that TCM represents a safe and potentially effective therapeutic option for patients recovering from COVID-19. However, given the limitations in current evidence, including variability in intervention protocols and study quality, further well-designed, large-scale randomized controlled trials are warranted to validate these results. Future research should aim to identify optimal herbal formulations and to delineate specific patient subgroups most likely to benefit from TCM interventions, thereby advancing the integration of TCM into comprehensive rehabilitation strategies for post-COVID-19 management.

Supplementary Information

Additional file 1. (20KB, docx)

Acknowledgements

We would like to thank the researchers and participants of the studies included in this meta-analysis on COVID recovery syndrome.

Author contributions

YW and HH performed the literature search and data extraction, and drafted the manuscript. XL and YG was responsible for the quality assessment. DY, HH, and YW conducted the statistical analysis. DY was responsible for the design and conceived the original idea. All authors contributed to the article and approved the submitted version.

Funding

We did not receive any funding or financial support for this study.

Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent for publication was obtained from all participants in this study.

Competing interests

The authors declare that they have no competing interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yiting Wang and Xiao Li have contributed equally to this work and share first authorship.

Contributor Information

Huaizheng Hui, Email: FzmdrH@163.com.

Dianxing Yang, Email: ydianxing@126.com.

References

  • 1.National Institute for Health and Care Excellence: Clinical Guidelines. COVID-19 rapid guideline: managing the long-term effects of COVID-19. London: National Institute for Health and Care Excellence (NICE) Copyright © NICE 2020. 2024. [PubMed]
  • 2.Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. BMJ. 2021;374:n1648. [DOI] [PubMed] [Google Scholar]
  • 3.Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022;23(2):194–202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Chen B, Julg B, Mohandas S, Bradfute SB. Viral persistence, reactivation, and mechanisms of long COVID. Elife. 2023;12:e86015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Santoro L, Zaccone V, Falsetti L, Ruggieri V, Danese M, Miro C, et al. Role of endothelium in cardiovascular sequelae of long COVID. Biomedicines. 2023;11(8):2239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.He ST, Wu K, Cheng Z, He M, Hu R, Fan N, et al. Long COVID: the latest manifestations, mechanisms, and potential therapeutic interventions. MedComm (2020). 2022;3(4):e196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021;114(9):428–42. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Nakamura K, Kondo K, Oka N, Yamakawa K, Ie K, Goto T, et al. Donepezil for fatigue and psychological symptoms in post-COVID-19 condition: a randomized clinical trial. JAMA Netw Open. 2025;8(3):e250728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Huang K, Zhang P, Zhang Z, Youn JY, Wang C, Zhang H, et al. Traditional Chinese Medicine (TCM) in the treatment of COVID-19 and other viral infections: efficacies and mechanisms. Pharmacol Ther. 2021;225:107843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Zhang Y, Jin F, Wei X, Jin Q, Xie J, Pan Y, et al. Chinese herbal medicine for the treatment of chronic fatigue syndrome: a systematic review and meta-analysis. Front Pharmacol. 2022;13:958005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Pang W, Yang F, Zhao Y, Dai E, Feng J, Huang Y, et al. Qingjin Yiqi granules for post-COVID-19 condition: a randomized clinical trial. J Evid Based Med. 2022;15(1):30–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Chen Y, Liu C, Wang T, Qi J, Jia X, Zeng X, et al. Efficacy and safety of Bufei Huoxue capsules in the management of convalescent patients with COVID-19 infection: a multicentre, double-blind, and randomised controlled trial. J Ethnopharmacol. 2022;284:114830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Wang Y, Chen YJ, Xiang C, Jiang GW, Xu YD, Yin LM, et al. Discovery of potential asthma targets based on the clinical efficacy of Traditional Chinese Medicine formulas. J Ethnopharmacol. 2020;252:112635. [DOI] [PubMed] [Google Scholar]
  • 14.Yang J, Li Y, Chau CI, Shi J, Chen X, Hu H, et al. Efficacy and safety of traditional Chinese medicine for cancer-related fatigue: a systematic literature review of randomized controlled trials. Chin Med. 2023;18(1):142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Yang Y, Zhong Z, Wang B, Wang Y. Xiaoyao San ameliorates high-fat diet-induced anxiety and depression via regulating gut microbiota in mice. Biomed Pharmacother. 2022;156:113902. [DOI] [PubMed] [Google Scholar]
  • 16.Chiang CY, Lin YJ, Weng WT, Lin HD, Lu CY, Chen WJ, et al. Recuperative herbal formula Jing Si maintains vasculature permeability balance, regulates inflammation and assuages concomitants of “Long-Covid.” Biomed Pharmacother. 2023;163:114752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Xu X, Ying J, Tian T, Liu T, Chi C, Gong Z, et al. Efficacy and safety of Lianhua Qingke tablets in the treatment of long coronavirus disease (COVID) cough: a randomized, double-blind, placebo-controlled. Multicenter Clin Study Eng. 2024;40:61–9. [Google Scholar]
  • 19.Yuehong Z, Dandan D, Youqin Y, Hao Z, Guangli W, Wei Z, et al. Effectiveness and safety of Jinshuibao capsules in treatment of residual cardiopulmonary symptoms in convalescent patients of coronavirus disease 2019: a pilot randomized, double-blind, placebo-controlled clinical trial. J Tradit Chin Med. 2023;43(1):134–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Xuedong AN, Lina M, Ping X, Wen SU, Beibei W, Leiya K, et al. Effects of Shengmai Yin on pulmonary and cardiac function in coronavirus disease 2019 convalescent patients with cardiopulmonary symptoms: a randomized, double blind, multicenter control trial. J Tradit Chin Med. 2023;43(1):140–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.An X, Peng B, Huang X, Jiang H, Xiong Z, Zhang H, et al. Ludangshen oral liquid for treatment of convalescent COVID-19 patients: a randomized, double-blind, placebo-controlled multicenter trial. Chin Med. 2022;17(1):42. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Yuehong Z, Xianzhi S, Qianlong Z, Hualong Z, Jianhua Z, Sisi DU, et al. Effectiveness of Xiangsha Liujun pills on decreased digestive function in convalescent patients of coronavirus disease 2019: a randomized, double blind, placebo controlled clinical trial. J Tradit Chin Med. 2023;43(3):552–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Li L, Xuedong A, Qing Z, Junxiu T, Jing H, Yun C, et al. Shumian capsule(舒眠胶囊) improves symptoms of sleep mood disorder in convalescent patients of Corona Virus Disease 2019. J Tradit Chin Med. 2021;41(06):974–81. [DOI] [PubMed] [Google Scholar]
  • 24.Cunqing Y, Fengmei L, Guiping Y, Yufeng H, Shuangbin Z, Jianghua W, et al. Effectiveness of Xiaoyao capsule on sleep disorders and mood disturbance in patients in recovery from coronavirus disease 2019: a randomized controlled trial. J Tradit Chin Med. 2023;43(2):343–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, et al. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers. 2022;8(1):45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Huang XF, Cheng WB, Jiang Y, Liu Q, Liu XH, Xu WF, et al. A network pharmacology-based strategy for predicting anti-inflammatory targets of ephedra in treating asthma. Int Immunopharmacol. 2020;83:106423. [DOI] [PubMed] [Google Scholar]
  • 27.Zhang L, Wang Y, Yang D, Zhang C, Zhang N, Li M, et al. Platycodon grandiflorus - an ethnopharmacological, phytochemical and pharmacological review. J Ethnopharmacol. 2015;164:147–61. [DOI] [PubMed] [Google Scholar]
  • 28.Xu Z, Li K, Pan T, Liu J, Li B, Li C, et al. Lonicerin, an anti-algE flavonoid against Pseudomonas aeruginosa virulence screened from Shuanghuanglian formula by molecule docking based strategy. J Ethnopharmacol. 2019;239:111909. [DOI] [PubMed] [Google Scholar]
  • 29.Fehrenbach H, Wagner C, Wegmann M. Airway remodeling in asthma: what really matters. Cell Tissue Res. 2017;367(3):551–69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Li XT, Chen R, Jin LM, Chen HY. Regulation on energy metabolism and protection on mitochondria of Panax ginseng polysaccharide. Am J Chin Med. 2009;37(6):1139–52. [DOI] [PubMed] [Google Scholar]
  • 31.Shen Q, Fang J, Guo H, Su X, Zhu B, Yao X, et al. Astragaloside IV attenuates podocyte apoptosis through ameliorating mitochondrial dysfunction by up-regulated Nrf2-ARE/TFAM signaling in diabetic kidney disease. Free Radic Biol Med. 2023;203:45–57. [DOI] [PubMed] [Google Scholar]
  • 32.Huang Q, Lou T, Lu J, Wang M, Chen X, Xue L, et al. Major ginsenosides from Panax ginseng promote aerobic cellular respiration and SIRT1-mediated mitochondrial biosynthesis in cardiomyocytes and neurons. J Ginseng Res. 2022;46(6):759–70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Dong J, Na Y, Hou A, Zhang S, Yu H, Zheng S, et al. A review of the botany, ethnopharmacology, phytochemistry, analysis method and quality control, processing methods, pharmacological effects, pharmacokinetics and toxicity of codonopsis radix. Front Pharmacol. 2023;14:1162036. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Yang SJ, Wang JJ, Cheng P, Chen LX, Hu JM, Zhu GQ. Ginsenoside Rg1 in neurological diseases: From bench to bedside. Acta Pharmacol Sin. 2023;44(5):913–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Yang S, Chu S, Gao Y, Ai Q, Liu Y, Li X, et al. A narrative review of cancer-related fatigue (CRF) and its possible pathogenesis. Cells. 2019;8(7):738. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Chen MH, Chen XJ, Wang M, Lin LG, Wang YT. Ophiopogon japonicus–a phytochemical, ethnomedicinal and pharmacological review. J Ethnopharmacol. 2016;181:193–213. [DOI] [PubMed] [Google Scholar]
  • 37.Xuedong AN, Qing Z, Junxiu T, Li LI, Yun C, Kejian LI, et al. Shugan Jieyu capsule improve sleep and emotional disorder in coronavirus disease 2019 convalescence patients: a randomized, double-blind, placebo-controlled trial. J Tradit Chin Med. 2022;42(5):803–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Yeung WF, Chung KF, Poon MM, Ho FY, Zhang SP, Zhang ZJ, et al. Chinese herbal medicine for insomnia: a systematic review of randomized controlled trials. Sleep Med Rev. 2012;16(6):497–507. [DOI] [PubMed] [Google Scholar]
  • 39.Zhou QH, Zhou XL, Xu MB, Jin TY, Rong PQ, Zheng GQ, et al. Suanzaoren formulae for insomnia: updated clinical evidence and possible mechanisms. Front Pharmacol. 2018;9:76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.World Health Organization. Clinical management of COVID-19: living guideline. 2023. https://iris.who.int/bitstream/handle/10665/365580/WHO-2019-nCoV-clinical-2023.1-eng.pdf. [PubMed]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Additional file 1. (20KB, docx)

Data Availability Statement

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Articles from Journal of Translational Medicine are provided here courtesy of BMC

RESOURCES