Effectiveness of Five-Element Regulatory Therapy for post-COVID syndrome: a retrospective cohort study, 2025, Ding et al.

[Chandelier]

Effectiveness of Five-Element Regulatory Therapy for post-COVID syndrome: a retrospective cohort study

Spoiler: Authors

Ding, Ning; Zhou, Yunqiao; Zhang, Haolin; Xin, Xiyan; Ye, Yang; Li, Dong

Abstract
Introduction: Post-COVID syndrome is characterized by persistent, unexplained symptoms including chronic cough, palpitations, insomnia, and fatigue that develop following SARS-CoV-2 infection without identifiable causes. Current treatments show limited efficacy, requiring alternative options. This study aims to observe the effectiveness of Five-Element Regulation Therapy (FERT), a Traditional Chinese medicine (TCM) intervention, in managing post-COVID syndrome.

Methods: A retrospective cohort study was conducted using clinical records of 127 post-COVID syndrome patients from the TCM outpatient department of Peking University Third Hospital. The participants were divided into two groups: 81 cases receiving FERT treatment were assigned to the exposure group, while 46 cases undergoing conventional TCM therapy served as the control group. The treatment duration was 2 weeks for both groups, followed by immediate follow-up. The outcomes included the clinical cure rate and clinical response rate at 2 weeks after the treatment initiation.

Results: The FERT group demonstrated superior clinical outcomes, achieving a 61.7% cure rate and 88.9% response rate, significantly higher than the control group’s 21.7% (p < 0.001) and 67.4% (p < 0.01), respectively.

Conclusion: This study provides preliminary evidence that FERT may be superior to conventional TCM therapy in managing post-COVID syndrome. Results should be interpreted with heightened caution due to the study’s inherent limitations.

Funding​

The author(s) declare financial support was received for the research and/or publication of this article. This study was supported by the National Natural Science Foundation of China (No. 82074193) and Clinical Key Project of Peking University Third Hospital (No. BYSY2023049).


Web | DOI | PMC | PDF | Frontiers in Medicine

 

[Eleanor]

The inclusion criteria included: (1) Patients with a confirmed history of COVID-19 diagnosis verified by either PCR testing or SARS-CoV-2 antibody detection. (2) The interval between COVID-19 diagnosis and the current visit must be at least 1 month.

and the treatment lasted two weeks. So one thing they've confirmed is that lots of post-acute Covid symptoms clear up within a short time.

The Five Elements are supposedly the stages of disease, and the patients in the treatment group received different herbal medicines according to which stage they presented at. So while some research in the west now seems to be focusing on separating out different problems that are currently all defined as "Long Covid", these researchers are seeing it as one syndrome that progresses in different phases (chronic fatigue being the last).

In the earliest stage of diseases, they are classified as Metal Disease in FERT therapy, characterized primarily by fever with accompanying symptoms including cough, headache, fatigue and decreased appetite. Respiratory symptoms, including chronic cough, viscous sputum production, and dyspnea, were classified as Earth Disease. Cardiac symptoms such as palpitations, precordial discomfort, and anxiety attacks were categorized as Fire Disease. The Wood Disease classification encompassed sleep disturbances, anxiety disorders, and depressive symptoms, while Water Disease included chronic fatigue syndrome along with lumbar and knee joint pain.

The therapy precisely categorizes symptom progression into five sequential syndrome patterns according to the generative cycle of the Five Phases: Early-stage pulmonary symptoms (Metal Disease, mean 38 days), Persistent respiratory impairment (Earth Disease, mean 38 days), Cardiovascular disturbances (Fire Disease, mean 56 days), Emotional dysregulation (Wood Disease, mean 73 days), Systemic exhaustion in advanced stages (Water Disease, mean 114 days). FERT employs tailored prescriptions targeting the core pathogenesis of each stage, with individualized modifications based on specific symptoms. This temporally stratified intervention strategy effectively aligns with the characteristic sequential multi-system damage observed in post-COVID sequelae. In contrast, conventional TCM’s static pattern differentiation fails to capture this dynamic progression.

The control group also received different medicines "guided by syndrome differentiation. For instance, Xiao Qing Long Tang was prescribed for cough, while Jiao Tai Wan was utilized for insomnia."

There's a lot of description of the 'response rates' and 'cure rates' in the treatment group being so much better than in the control group - it looks as if the cardiovascular and respiratory issues were more amenable to treatment than the dysregulation and fatigue subgroups, which is probably what you'd expect?

But also this little line is slipped in:

In terms of clinical response rates, only the improvement in the Fire Disease group is statistically significant

"Future high-quality studies are warranted", naturally.

 

[rvallee]

The title didn't give away that this is about TCM and I assumed it was just yet another BS biopsychosocial rehab at first, and that just says everything because if you simply remove the cultural element, it's the same thing. Just compare it to mindfulness or whatever. Same thing.

We may frankly call the traditional rehab model Traditional Western Medicine and it wouldn't make any difference about what it is, what it aims to do, and how utterly worthless it all is.

 

[Trish]

The title didn't give away that this is about TCM and I assumed it was just yet another BS biopsychosocial rehab at first,

So did I.

 

[rvallee]

So did I.

I had a further thought on this yesterday, and realized that by removing identifiers about which year a study was published and other bits that could serve to identify, such as authors and references, it would be impossible to tell whether anything biopsychosocial or "evidence-based" was published yesterday, 50 years ago, or any point in-between from the facts alone and what is discussed in about 95-99% of papers.

Because there has been zero actual movement in its substance, the whole field is a stuck needle on a record. The words change a bit but it's the same ideas, the same questions, even the same answers. I'm fairly sure even theology sees more movement in its ideas.