How Traditional Chinese Medicine Is Studied for COVID-19
When COVID-19 swept across the globe in early 2020, the world faced a terrifying new illness without known treatments. As scientists scrambled to develop new therapeutics, researchers in China turned to an ancient medical tradition—Traditional Chinese Medicine (TCM)—and launched an unprecedented research effort to study its potential benefits. The race to evaluate TCM remedies for COVID-19 has generated hundreds of clinical studies, creating both excitement and skepticism within the scientific community.
The significance of this research extends beyond immediate COVID-19 treatment. TCM represents a fundamentally different approach to health and healing compared to Western medicine, emphasizing balance, prevention, and holistic care rather than targeted attacks on pathogens. As the World Health Organization works to integrate traditional medicines into global healthcare systems, understanding how to properly study these complex interventions becomes increasingly important . The COVID-19 pandemic has provided an unexpected opportunity to advance these research methodologies while addressing an urgent public health need.
Epidemics experienced throughout Chinese history
Traditional Chinese Medicine is not merely a collection of herbal remedies but a comprehensive medical system with a theoretical framework developed over millennia. Its two core philosophical concepts are homeostasis (emphasizing the integrity of the human body and its relationship with the social and natural environment) and dynamic balance (prioritizing movement within integrity) 4 .
Unlike Western medicine's focus on specific pathogens, TCM approaches disease as an imbalance in the body's systems, treating the whole person rather than just the disease.
Modern scientific investigation has begun to uncover the mechanisms through which TCM formulations may combat viral infections like COVID-19. Network pharmacology analyses have identified active ingredients in TCM that target key proteins involved in SARS-CoV-2 infection, including:
TCM formulations are known to possess anti-inflammatory, antiviral, and immunoregulatory properties 4 .
Systematic review protocols registered in PROSPERO by August 2020 3
Different organizations involved in TCM COVID-19 research 3
Countries contributing to TCM COVID-19 research (China, Australia, Singapore, Canada, England) 3
The research response to COVID-19 has been unprecedented in scale and speed. By August 2020, at least 80 systematic review protocols related to TCM for COVID-19 had been registered in PROSPERO (the International Prospective Register of Systematic Reviews), with 71 ultimately meeting inclusion criteria for analysis 3 .
This research effort was overwhelmingly based in China (66 protocols), but also included contributions from Australia, Singapore, Canada, and England 3 . The rapid mobilization of research institutions demonstrates the high level of interest in studying TCM for COVID-19, though it also raised concerns about potential duplication of effort and waste of research resources without proper coordination.
Recognizing the problem of heterogeneous outcome measures across COVID-19 trials, a group of Chinese researchers developed a Core Outcome Set for COVID-19 clinical trials (COS-COVID) to standardize measurements and ensure that studies capture the most clinically important information 5 .
The project followed the Core Outcome Measures in Effectiveness Trials (COMET) Handbook guidelines and involved experts in respiratory medicine, critical care, TCM, evidence-based medicine, clinical pharmacology, statistics, and medical journal editing 5 .
The researchers examined 78 COVID-19 clinical trial protocols, collecting 259 outcomes which were consolidated into 132 outcomes across 7 domains 5 . After a rigorous selection process including two Delphi surveys and a consensus meeting, they established a core set of outcomes tailored to different clinical classifications of COVID-19 5 .
| Disease Severity | Core Outcomes |
|---|---|
| Mild | Time to 2019-nCoV RT-PCR negativity |
| Ordinary | Length of hospital stay, Composite events, Score of clinical symptoms, Time to 2019-nCoV RT-PCR negativity |
| Severe | Composite events, Length of hospital stay, PaO2/FiO2, Duration of mechanical ventilation, Time to 2019-nCoV RT-PCR negativity |
| Critical | All-cause mortality |
| Rehabilitation | Pulmonary function |
Table 1: COS-COVID Core Outcome Measures by Disease Severity 5
A comprehensive meta-analysis published in 2025 analyzed 22 randomized clinical trials investigating TCM for COVID-19 4 .
The researchers conducted a comprehensive search of electronic databases, initially identifying 4340 articles 4 . After removing duplicates and excluding ineligible study types, they ultimately included 22 RCTs in their analysis 4 . Most studies were conducted in China, with one from Iran 4 .
The included trials involved patients with varying severity of COVID-19, from mild to severe cases. Most studies compared standard care plus TCM against standard care alone, while three studies included placebo controls, and one used a compound pholcodine oral solution as control 4 .
Two studies focused specifically on pediatric patients 4 .
TCM interventions varied across studies and included 4 :
| Study | Design | Intervention |
|---|---|---|
| Zhao et al., 2021 | Prospective, cluster-randomized | Huashi Baidu granule + conventional treatment |
| Liu J et al., 2021 | Single-center, open-label RCT | Huashi Baidu granule + standard care |
| Ni et al., 2021 | Randomized, open-label, multicenter | Shuanghuanglian (various doses) + standard therapy |
| Alipour et al., 2022 | Randomized, three-arm trial | Acupuncture + conventional treatment |
Table 2: Characteristics of Selected Studies from the Meta-Analysis 4
The meta-analysis found that TCM had a positive effect on various COVID-19 symptoms and outcomes 4 . Specifically, TCM influenced:
Notably, TCM significantly affected SARS-CoV-2 test conversion rates on particular days (RR = 1.21; 95% CI [1.10; 1.32]; p < 0.0001) 4 .
Despite these encouraging findings, the researchers noted the necessity for further randomized trials with larger participant numbers and in more countries 4 . The high heterogeneity (I² = 84%) in some analyses indicates substantial variation between studies, possibly due to different TCM formulations, patient populations, or standard care practices.
| Outcome Measure | Effect Size | Heterogeneity (I²) |
|---|---|---|
| SARS-CoV-2 test conversion rate | RR = 1.21; 95% CI [1.10; 1.32] | 84% |
| Time to fever recovery | Significant improvement | Not reported |
| Time to cough recovery | Significant improvement | Not reported |
| Mortality reduction | Positive trend | Not reported |
Table 3: Key Efficacy Outcomes from TCM Meta-Analysis 4
| Reagent/Material | Function in Research | Examples in TCM COVID-19 Studies |
|---|---|---|
| Standardized TCM formulations | Ensure consistency of interventions across study sites | Huashi Baidu granule, Lianhua Qingwen capsule, Shuanghuanglian oral liquid |
| Placebo controls | Blind participants and researchers to treatment assignment | Matching placebo capsules or granules identical to active TCM but without herbal components |
| Laboratory reagents | Measure biological outcomes and potential mechanisms | PCR tests for SARS-CoV-2, cytokine measurement kits, inflammatory markers |
| Quality control assays | Standardize herbal components and ensure batch consistency | High-performance liquid chromatography (HPLC) for marker compounds, mass spectrometry |
| Data collection tools | Standardize outcome measurement across sites | COS-COVID case report forms, symptom diaries, quality of life questionnaires |
Table 4: Key Research Reagent Solutions in TCM COVID-19 Studies
The extensive research on Traditional Chinese Medicine for COVID-19 represents a significant advancement in the scientific study of traditional medicines. While results so far suggest potential benefits, particularly for symptom improvement and viral clearance, the evidence base remains limited by methodological weaknesses and geographic concentration of studies in China.
The development of core outcome sets like COS-COVID represents important progress toward standardizing TCM research 5 . Similarly, the registration of systematic review protocols in PROSPERO helps prevent duplication and increase transparency in evidence synthesis 3 . However, challenges remain in ensuring that future studies are sufficiently innovative and methodologically rigorous 3 .
Looking ahead, the integration of real-world evidence (RWE) may offer new opportunities for TCM research. China's National Medical Products Administration has issued guidelines on using RWE to support drug development and evaluation, potentially streamlining the path from traditional formulas to approved medicines 6 .
As the world continues to face new infectious disease threats, the careful, rigorous study of traditional medical systems like TCM will remain an important component of the global response. By applying modern research methods to ancient healing traditions, scientists can help ensure that valuable knowledge from the past informs healthcare solutions for the future.
The story of TCM and COVID-19 research demonstrates both the challenges and opportunities of integrating traditional medicine into modern healthcare systems. While much work remains to be done, the systematic evaluation of TCM for COVID-19 has established important methodological frameworks that will benefit traditional medicine research long after the current pandemic has faded.
Distribution of TCM COVID-19 research by country