Study of Traditional Chinese Medicine Syndrome Differentiation in post-COVID patients  with Respiratory Symptoms in Thailand

Wachiraporn Padungkiettiwong; Watjanarat Panwong; Siraprapa Veerapattananon; Peeradone Srichan; Chatchada Sutalangka; Wilawan Chaiut; Ekalak Sitthipornvorakul; Raksuda Taniguchi

doi:10.59796/jcst.V15N2.2025.95

Authors

Wachiraporn Padungkiettiwong School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand & School of Chinese Medicine, Hong Kong Baptist University, Kowloon, Hong Kong
Watjanarat Panwong School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand
Siraprapa Veerapattananon School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand
Peeradone Srichan School of Health Science, Mae Fah Luang University, Chiang-Rai 57100, Thailand
Chatchada Sutalangka School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand
Wilawan Chaiut School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand
Ekalak Sitthipornvorakul School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand
Raksuda Taniguchi School of Integrative Medicine, Mae Fah Luang University, Chiang-Rai 57100, Thailand

DOI:

https://doi.org/10.59796/jcst.V15N2.2025.95

Keywords:

TCM syndrome, zheng, fatigue, FSS, neurology

Abstract

Post-COVID-19 has a significant impact on recovered individuals. Traditional Chinese Medicine (TCM) offers a framework for understanding and treatment, but its utility in post-COVID cases remains under investigation. This study aimed to investigate the TCM syndromes in patients experiencing post-COVID with respiratory symptoms and explore alternative clinically practical assessment tools (spirometry and Fatigue Severity Scale [FSS]) for differentiating TCM patterns. A cross-sectional study was conducted involving 150 subjects with post-COVID respiratory symptoms in Thailand. TCM differentiation was diagnosed by three certified TCM practitioners, and spirometry was conducted by a physical therapist who holds a spirometry certification. Both spirometry and FSS were used for evaluation. Lung and Spleen Qi Deficiency Syndrome (FPQX) was the dominant TCM pattern (72%), followed by Deficiency of Both Qi and Yin Syndrome (QYLX) (28%). Spirometry revealed a statistically significant, but small decrease in lung function (FEV₁/FVC) within the FPQX group compared to the QYLX group. However, both groups remained within the normal range. FSS scores did not differ significantly between the groups. This study suggests that FPQX is prevalent in post-COVID patients in Thailand. It also indicates that spirometry might not be sensitive enough to capture the full extent of lung dysfunction in post-COVID respiratory symptoms. While the FSS confirmed the presence of fatigue in both groups, it may not be the best tool for differentiating between specific TCM syndromes. Future research should explore more sensitive biomarkers for TCM diagnosis and consider potential neurological contributions to post-COVID respiratory symptoms.

References

Ai, J., Wu, L., Wang, T., Deng, W., & Zhang, X. (2020). Prevention and treatment of “Epidemic toxin, pathogenic dampness, and lung deficiency” after COVID-19 recovery based on the theory of “Preventive treatment of diseases” in traditional Chinese medicine. Chinese Medicine and Culture, 3(3), 181-188. https://doi.org/10.4103/CMAC.CMAC_29_20

Aronson, K. I., Martin-Schwarze, A. M., Swigris, J. J., Kolenic, G., Krishnan, J. K., Podolanczuk, A. J., ... & Pulmonary Fibrosis Foundation. (2023). Validity and reliability of the fatigue severity scale in a real-world interstitial lung disease cohort. American Journal of Respiratory and Critical Care Medicine, 208(2), 188-195. https://doi.org/10.1164/rccm.202208-1504OC

Chiang, H. C., Yang, S. T., Lee, K. C., Huang, P. Y., Hsu, M., & Chang, H. H. (2012). From theory to clinic: key components of qi deficiency in traditional Chinese medicine. Alternative Therapies in Health & Medicine, 18(6), 28–36.

Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Teague, W. G. (2014). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, 43(2), 343-373. https://doi.org/10.1183/09031936.00202013

Conroy, S. F., Hastings-Tolsma, M., Voreis, K., & Deboskey, H. (2020). Traditional Chinese medicine: a qualitative study for reconsidering nursing care in the United States. Journal of Holistic Nursing, 38(4), 336-349. https://doi.org/10.1177/0898010120903167

Cooper, B. G., Stocks, J., Hall, G. L., Culver, B., Steenbruggen, I., Carter, K. W., ... & Stanojevic, S. (2017). The Global Lung Function Initiative (GLI) Network: bringing the world’s respiratory reference values together. Breathe, 13(3), e56-e64. https://doi.org/10.1183/20734735.012717

De Azevedo Vieira, J. E., Mafort, T. T., Monnerat, L. B., da Cal, M. S., Ghetti, A. T. A., & Lopes, A. J. (2023). Assessment of short-and long-term functionality and quality of life in patients with post-acute COVID-19 syndrome. Journal of Back and Musculoskeletal Rehabilitation, 36(3), 541-550. https://doi.org/10.3233/BMR-220308

Fernández-de-Las-Peñas, C., Palacios-Ceña, D., Gómez-Mayordomo, V., Florencio, L. L., Cuadrado, M. L., Plaza-Manzano, G., & Navarro-Santana, M. (2021). Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. European Journal of Internal Medicine, 92, 55-70. https://doi.org/10.1016/j.ejim.2021.06.009

Graham, B. L., Steenbruggen, I., Miller, M. R., Barjaktarevic, I. Z., Cooper, B. G., Hall, G. L., ... & Thompson, B. R. (2019). Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. American Journal of Respiratory and Critical Care Medicine, 200(8), e70-e88. https://doi.org/10.1164/rccm.201908-1590ST

Han, Q., Zheng, B., Daines, L., & Sheikh, A. (2022). Long-term sequelae of COVID-19: a systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms. Pathogens, 11(2), Article 269. https://doi.org/10.3390/pathogens11020269

Jiang, M., Lu, C., Zhang, C., Yang, J., Tan, Y., Lu, A., & Chan, K. (2012). Syndrome differentiation in modern research of traditional Chinese medicine. Journal of Ethnopharmacology, 140(3), 634-642. https://doi.org/10.1016/j.jep.2012.01.033

Joli, J., Buck, P., Zipfel, S., & Stengel, A. (2022). Post-COVID-19 fatigue: A systematic review. Frontiers in Psychiatry, 13, Article 947973. https://doi.org/10.3389/fpsyt.2022.947973

Kang, X., Fu, J., & Gao, N. (2022). Relationship between Traditional Chinese Medicine Dialectical Classification and Pulmonary Function and Inflammatory Indexes in Patients with Stable COPD. Journal of Sichuan of Traditional Chinese Medicine, 12, 48–52.

Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46(10), 1121-1123. https://doi.org/10.1001/archneur.1989.00520460115022

Lenz, C., Slack, M. P., Shea, K. M., Reinert, R. R., Taysi, B. N., & Swerdlow, D. L. (2024). Long-Term effects of COVID-19: A review of current perspectives and mechanistic insights. Critical Reviews in Microbiology, 50(3), 315-328. https://doi.org/10.1080/1040841X.2023.2190405

Li, Y., Shi, S., Yao, Y., Chen, A., Cao, X., & Li, L. (2020). Clinical Characteristics of 86 Cases COVID-19 Convalescent Patients. Journal of Liaoning University of Traditional Chinese Medicine, 9, 122–125. https://doi.org/10.13194/j.issn.1673-842x.2020.09.029

Li, Z. Y., Xie, Z. J., Li, H. C., Wang, J. J., Wen, X. H., Wu, S. Y., ... & Wen, C. P. (2021). Guidelines on the treatment with integrated traditional Chinese medicine and western medicine for severe coronavirus disease 2019. Pharmacological Research, 174, Article 105955. https://doi.org/10.1016/j.phrs.2021.105955

Lin, H. Y., Zhao, Y. P., Xu, G. P., Li, Y. S., Xie, W. Y., Bai, L. H., & Jin, H. (2017). Weaker cognitive control abilities of Pi (Spleen) qi-deficient individuals supported Chinese medicine diagnosis. Chinese Journal of Integrative Medicine, 1-8. https://doi.org/10.1007/s11655-017-2967-x

National Institute for Health and Care Excellence (NICE). (2003). National Institute for Health and Care Excellence: Guidelines. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11822/

Niu, X., Li, X., Liu, Y., Ju, W., & Yao, W. (2021). Clinical Characteristics of Traditional Chinese Medicine in 28 Cases of COVID-19 Convalescent Patients. Journal of Practical Traditional Chinese Internal Medicine, 12, 11–13. https://doi.org/10.13729/j.issn.1671-7813.Z20201294

Ortelli, P., Ferrazzoli, D., Sebastianelli, L., Engl, M., Romanello, R., Nardone, R., ... & Versace, V. (2021). Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom. Journal of The Neurological Sciences, 420, 117271. https://doi.org/10.1016/j.jns.2020.117271

Ren, W., Liang, P., Ma, Y., Sun, Q., Pu, Q., Dong, L., ... & Yang, S. (2021a). Research progress of traditional Chinese medicine against COVID-19. Biomedicine & Pharmacotherapy, 137, Article 111310. https://doi.org/10.1016/j.biopha.2021.111310

Ren, Y., Wang, Y., Liu, H., Mou, F., Yan, X., Tang, L., ... & Zuo, G. (2021b). The effects of a comprehensive rehabilitation program involving traditional Chinese medicine in severe and critical COVID-19 patients: A clinical study. Advance Online Publication. https://doi.org/10.21203/rs.3.rs-541774/v1

Salem, A. M., Al Khathlan, N., Alharbi, A. F., Alghamdi, T., AlDuilej, S., Alghamdi, M., ... & Sabit, H. (2021). The long-term impact of COVID-19 pneumonia on the pulmonary function of survivors. International Journal of General Medicine, 14, 3271-3280. https://doi.org/10.2147/IJGM.S319436

Sawasdee, A., Preechawong, S., & Jitpanya, C. (2014). Factors associated with fatigue in post-stroke patients [Unpublished Master thesis], Chulalongkorn University, Bangkok, Thailand.

Sousa, P. H. B., Targino, H. A. S., de Lima Júnior, F. A. S., de Oliveira Costa, C. M., de Sousa, T. L. F., & de Araújo Braga, I. G. (2023). Analysis of pulmonary function in post-Covid-19 patients at a university hospital. Medicina (Ribeirão Preto), 56(3), Article 206263. https://doi.org/10.11606/issn.2176-7262.rmrp.2023.206263

Stefanou, M. I., Palaiodimou, L., Bakola, E., Smyrnis, N., Papadopoulou, M., Paraskevas, G. P., ... & Tsivgoulis, G. (2022). Neurological manifestations of long-COVID syndrome: a narrative review. Therapeutic Advances in Chronic Disease, 13, 1-21. https://doi.org/10.1177/20406223221076890

Sun, X. H., Shi, S. F., Wang, B. H., Tang, L., Ju, W., Xu, Y., ... & Shi, X. (2022). Clinical study on comprehensive rehabilitation program of traditional Chinese medicine for patients with different syndrome types in Corona virus disease 2019 recovery period. China Journal of Traditional Chinese Medicine and Pharmacy, 37, 4181-4185.

Tian, F., Ke, J., Chen, J., Lin, H., Yang, L., Zheng, M., Liu, Y., Zeng, X., Zhou, Y., & Yang, Y. (2020). Investigation and Analysis of Traditional Chinese Medicine Symptoms During Recovery Period in Patients with COVID-19. Herald of Medicine, 05, 637–639.

Torres-Castro, R., Vasconcello-Castillo, L., Alsina-Restoy, X., Solis-Navarro, L., Burgos, F., Puppo, H., & Vilaró, J. (2021). Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis. Pulmonology, 27(4), 328-337. https://doi.org/10.1016/j.pulmoe.2020.10.013

Vishnu, N. S., Sodhi, M. K., Aggarwal, D., Puri, S., & Saini, V. (2023). Persistent respiratory symptoms and lung function abnormalities in recovered patients of COVID-19. Lung India: official organ of Indian Chest Society, 40(6), 507–513. https://doi.org/10.4103/lungindia.lungindia_166_23

Wang, Q., Ren, X. J., Yao, S. L., & Wu, H. D. (2010). Clinical observation on the endocrinal and immune functions in subjects with yin-deficiency constitution. Chinese Journal of Integrative Medicine, 16, 28-32. https://doi.org/10.1007/s11655-010-0028-9

Wei, P. F. (2020). Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). Chinese Medical Journal, 133(9), 1087-1095. https://doi.org/10.1097/CM9.0000000000000819

Yang, S., Chen, H., Lin, Y., & Chen, Y. (2012). The exploration of disease pattern, zheng, for differentiation of allergic rhinitis in traditional Chinese medicine practice. Evidence‐Based Complementary and Alternative Medicine, 2012(1), Article 521780. https://doi.org/10.1155/2012/521780

Ying, Z., & Yuan, W. (2023). Clinical Speculation for Treatment of Dementia Based on the Perspective of Spleen and Kidney Harmony. Clausius Scientific Press, 5(1), 69–76.

Zhang, Z., Zhou, J., Conroy, T. B., Chung, S., Choi, J., Chau, P., ... & Kan, E. C. (2023). Deduced respiratory scores on COVID-19 patients learning from exertion-induced dyspnea. Sensors, 23(10), Article 4733. https://doi.org/10.3390/s23104733