Characteristics of traditional Chinese medicine syndromes in patients with Chikungunya hemorrhagic fever: a cross-sectional study

To explore the traditional Chinese medicine (TCM) syndrome characteristics of patients with Chikungunya hemorrhagic fever and to provide empirical data to support the application of TCM in diagnosing and treating Chikungunya hemorrhagic fever.

A cross-sectional survey was conducted to collect clinical data (sex, age, days since onset, and comorbidity underlying disease conditions) and TCM with four-examination information (symptoms, tongue manifestations, and pulse manifestations) from 255 patients with Chikungunya hemorrhagic fever who visited Lecong Hospital of Shunde, Foshan, the Third People′s Hospital of Shunde District of Foshan, Shunde Hospital of Southern Medical University Affiliated Chencun Hospital between July 23 and July 29, 2025. Factor and cluster analyses were used to summarize TCM syndrome characteristics and analyze core pathogenesis in conjunction with clinical features.

Among the 255 patients with Chikungunya hemorrhagic fever, 131 were male and 124 were female, with a age of (49.05 ± 17.93) years and a disease duration of (3.26±1.78) days. Among the four types of examination information in TCM, 35 items exhibited a frequency exceeding 10%. The most prevalent symptoms were arthralgia (180 patients, 70.59%), exanthem (153 patients, 60.00%), fatigue (99 patients, 38.82%), anhidrosis (98 patients, 38.43%), pruritus (96 patients, 37.65%), and fever (92 patients, 36.08%). Tongue and pulse manifestations were primarily white fur (155 patients, 60.78%), pink tongue (111 patients, 43.53%), slippery pulse (143 patients, 56.08%), and greasy fur (134 patients, 52.53%). Patients with disease onset ≤3 d had a higher incidence of arthralgia, fatigue, fever, aversion to cold, generalized muscle pain, aversion to wind, insomnia, headache, sweating, low-grade fever, poor appetite, loose stool, hyperhidrosis, and red tongue than those with disease onset ≥ 4 d (P＜0.05). Patients with disease onset ≥ 4 d had a higher incidence of pink tongue and thick fur than those with disease onset ≤ 3 d (P＜0.05). The syndrome elements in patients with Chikungunya hemorrhagic fever predominantly manifested on the defensive exterior, with involvement of the sinew-bone joints, skin-muscle, and spleen. Pathogenic factors were primarily characterized by external winds, dampness, and heat. Factor and cluster analysis result indicated three TCM pathogenesis progression patterns: imbalance of the defensive exterior with wind-dampness conflict and heat transformation; dampness-heat flowing into muscles and meridians causing joint obstruction and qi blood stasis; and dampness-heat congelation resulting in qi mechanism obstruction, consumption of body fluids, and infiltration of the skin.

Patients with Chikungunya hemorrhagic fever primarily present with fever, joint pain, and rashes. In TCM, this condition falls under the category of "dampness-warmth" syndrome. Its etiology is attributed to pathogens, with transmission occurring through mosquito bites. The core pathogenesis of TCM is the invasion of the defensive exterior and dampness-toxic heat accumulation. The therapeutic principles focus on clearing heat pathogens, resolving dampness pathogens, dispersing wind pathogens, and promoting the resolution of rashes.