After contracting COVID-19—whether during the initial infection, reinfection, or multiple infections—many individuals experience lingering sequelae. Manifestations vary by constitution, with common symptoms including fatigue, persistent cough, chest tightness, shortness of breath, phlegmatic wheezing, palpitations, insomnia, impaired gastrointestinal function, reduced physiological vitality, chronic throat discomfort, lymphadenopathy, and menstrual irregularities in women. These long-term effects pose significant threats to public health, with rare cases of severe complications or death due to improper management. Understanding and effectively treating post-COVID sequelae is now an urgent national priority.
Traditional Chinese Medicine (TCM) offers a holistic, pattern-differentiation-based approach to address chronic post-infectious conditions. For post-COVID recovery, TCM stands as the optimal modality. As descendants of Qi and Huang (Yellow Emperor and Qibo), we must not overlook ancestral wisdom in favor of fruitless pursuits. Mastery of self-care ("becoming one's own doctor through prolonged illness") and filial care ("Confucian familial duty") embodies TCM's greatest wisdom in pandemic response.
Below are evidence-informed TCM formulations for key sequelae patterns:
1. Acute/Subacute Phase Management
Presentation: High fever, sore throat, systemic pain.
Formula Strategy: Prioritize symptom-targeted prescriptions:
- Ephedra Decoction (Mahuang Tang)
- Kudzu Decoction (Gegen Tang)
- Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction (Maxing Shigan Tang)
- Minor Bupleurum Decoction (Xiao Chai Hu Tang)
- White Tiger Plus Ginseng Decoction (Baihu Jia Renshen Tang)
2. Chronic Fatigue & Immune Dysregulation
Core Pathogenesis: Spleen-Stomach deficiency impairing qi generation.
Formula Strategy:
- Ginseng and Poria Powder (Shenling Baizhu San):
- Key herbs: Ginseng/Dangshen (tonify qi), White Atractylodes/Poria (strengthen spleen, drain dampness), Licorice/Platycodon (detoxify, stabilize root)
- Four Gentlemen Decoction (Sijunzi Tang) or Six Gentlemen with Aucklandia and Amomum (Xiangsha Liujunzi Tang) for long-term use.
3. Chronic Cough & Phlegm Obstruction
Formula Strategy: Two Matured Substances Decoction (Er Chen Tang) modifications:
- Pinellia (Banxia), Citrus Peel (Chenpi) → Resolve phlegm
- Poria (Fuling) → Fortify spleen, drain dampness
- Dried Ginger (Ganjiang), Schisandra (Wuwei Zi) → Warm lungs, astringe qi
- Asarum (Xixin) added for severe cold-phlegm → Resolve "white lung" patterns
4. High-Risk Elderly with Cardiopulmonary Comorbidities
Critical Additions: Three Seeds Decoction (Sanzi Yangqin Tang):
- Perilla Seed (Suzi), Radish Seed (Laifuzi), Lepidium Seed (Tinglizi)
→ Descend qi, transform phlegm, reduce cardiopulmonary load
5. Lymphadenopathy & Sore Throat
Formula Strategy: Licorice (Gancao), Platycodon (Jiegeng), Patrinia (Baijiangcao), Coix Seed (Yiyiren) + Honeysuckle (Jinyinhua)/Forsythia (Lianqiao) if severe.
Caution: Cold-natured herbs may weaken spleen yang; reduce dosage in deficiency-cold constitutions.
6. Diarrhea & Spleen Deficiency
Formula Strategy: Six Gentlemen Decoction (Liujunzi Tang) or Regulate the Middle Decoction (Lizhong Tang) base:
- Stir-baked White Atractylodes, Poria, Stir-baked Lablab, Amomum (Sharen), Nutmeg (Doukou), Dried Ginger
→ Warm middle jiao, consolidate root
Lifestyle: Avoid raw/cold foods; moderate sexual activity.
7. Spontaneous Sweating & Low-Grade Fever
Pathogenesis: Lung qi deficiency, weakened exterior.
Herbs: Dangshen, Chinese Yam (Shanyao), Astragalus (Huangqi) → Tonify qi
- Cornus (Shanzhuyu) for refractory cases → Astringe liver yin
8. Olfactory/Gustatory/Auditory Dysfunction
Treatment Principle: Tonify vital qi (root) + Open orifices (branch):
- Root: Ginseng/Astragalus-based formulas
- Branch: Asarum (Xixin), Acorus (Shichangpu), Cinnamon Twig (Guizhi), Chuanxiong, Angelica Dahurica (Baizhi)
→ Short-term, low-dose use only
9. Severe Cases (e.g., "White Lung Syndrome")
Refer to specialized protocols (omitted per original text).
10. Complex Multimorbidity Management
TCM Advantage: Holistic pattern differentiation targeting the root pathogenesis over isolated symptoms. Requires advanced diagnostic insight.
