Chikungunya fever, caused by Chikungunya virus (CHIKV), has re\u2011emerged as a major global health threat. The 2025 outbreak in Guangdong, China \u2013 the largest local epidemic ever recorded \u2013 marks a critical epidemiological turning point. While conventional care remains supportive, traditional Chinese medicine (TCM) offers complementary strategies for acute symptoms and chronic polyarthralgia. This review synthesizes current knowledge on etiology, pathogenesis, clinical features, and management, with emphasis on evidence\u2011based TCM integration. It concludes that a multipronged public health approach, combining standard measures with validated TCM therapies, is essential, and calls for rigorous clinical trials to globalize these integrative treatments.<\/p>\n
Introduction<\/p>\n
CHIKV is an alphavirus transmitted by\u00a0Aedes\u00a0mosquitoes. First identified in Tanzania in 1952, it has now spread to over 119 countries. Viral adaptations have expanded vector competence, enabling temperate\u2011zone transmission. The July 2025 Foshan outbreak \u2013 over 4,000 confirmed cases \u2013 signifies a shift from sporadic imported cases to sustained local transmission in China, highlighting vulnerabilities in naive populations. Conventional management is symptomatic, but TCM integration shows promise, forming the focus of this review.<\/p>\n
Etiology and viral replication<\/p>\n
CHIKV is an enveloped, positive\u2011sense RNA virus with an ~11.8\u2011kb genome. Two ORFs encode non\u2011structural (Nsp1\u20114) and structural (C, E1, E2) proteins. Four genotypes exist; the East\/Central\/South African (ECSA) genotype drives current outbreaks, with mutations potentially linked to chronic arthritis. Viral entry involves E2 binding to receptors like MXRA8, endocytosis, pH\u2011dependent fusion, and cytoplasmic replication. New virions bud from the host cell surface, completing the cycle.<\/p>\n
Pathogenesis<\/p>\n
Pathogenesis involves direct cytopathic effects and a dysregulated immune response. After skin replication, the virus disseminates to joints, muscles, and other organs. Strong innate immunity \u2013 type I interferons and pro\u2011inflammatory cytokines (IL\u20111\u03b2, IL\u20116) \u2013 controls virus but also recruits immune cells, causing tissue damage and arthralgia. CD8\u207a T cells<\/a> may become exhausted. Chronic polyarthralgia arises from persistent viral RNA\/antigens in tissue reservoirs and\/or a virus\u2011triggered autoimmune\u2011like reaction. IL\u20116\u2011driven osteoclastogenesis further contributes to bone erosion.<\/p>\n Clinical manifestations<\/p>\n The disease has three phases:\u00a0acute\u00a0(14\u201321 days) with sudden high fever, rash, and severe symmetric polyarthralgia (distal joints);\u00a0subacute\u00a0(up to 3 months) with persisting joint symptoms; and\u00a0chronic\u00a0(>3 months) in 40\u201380% of patients, causing long\u2011term morbidity. Mortality is low, but severe complications (neurological, cardiac, ocular) can occur in neonates, elderly, and comorbid individuals. Differential diagnosis from dengue and Zika relies on features like thrombocytopenia (dengue), severe arthralgia (chikungunya), and pruritus (Zika).<\/p>\n Therapeutic and preventive strategies<\/p>\n No specific antivirals exist.\u00a0Acute phase\u00a0management includes rest, hydration, and acetaminophen; severe pain may need opioids, but corticosteroids are avoided.\u00a0Chronic phase\u00a0uses NSAIDs, low\u2011dose corticosteroids, or DMARDs (methotrexate, hydroxychloroquine), plus physiotherapy.<\/p>\n TCM integration\u00a0is officially recommended in China’s 2025 national protocol. Based on “dampness\u2011heat” theory: (1) Acute phase \u2013 “clearing heat, resolving dampness” with herbs like\u00a0Guanghuoxiang,\u00a0Gegen,\u00a0Lianqiao; (2) Recovery phase \u2013 “dispelling cold and removing dampness” for persistent arthralgia using\u00a0Qianghuo,\u00a0Duhuo,\u00a0Qinjiao; (3) External therapies \u2013 bloodletting at acupoints or joints, and cold herbal compresses (Rendongteng) for local relief. However, high\u2011quality international evidence is limited, demanding rigorous trials.<\/p>\n Prevention\u00a0benefits from two newly approved vaccines (Ixchiq for \u226518 years; Vimkunya for \u226512 years), though safety, cost, and equitable access remain challenges. Integrated vector control (source reduction, insecticides,\u00a0Wolbachia\u2011infected mosquitoes) remains fundamental.<\/p>\n Outlook and challenges<\/p>\n Future priorities include: (1) unraveling chronic arthralgia mechanisms and developing predictive biomarkers; (2) ensuring vaccine equity, regional reserves, and post\u2011licensure surveillance; (3) advancing affordable therapies, including TCM with molecular target studies. Current research gaps include insufficient TCM mechanistic data, lack of vaccine trials in low\u2011income countries, and small sample sizes in long\u2011term follow\u2011up studies.<\/p>\n Conclusion<\/p>\n A holistic response to CHIKV requires combining clinical surveillance, environmental monitoring, cross\u2011border collaboration, and community engagement, alongside standard care and evidence\u2011based TCM. Strengthened global cooperation and research investment will enhance preparedness and reduce the impact of this growing arboviral threat.<\/p>\n Source:<\/p>\n Journal reference:<\/p>\n Ding, M., et al. (2026) Chikungunya Fever: Etiology, Pathogenesis, and Management, with a Particular Focus on Evidence-based Application of Traditional Chinese Medicine. Future Integrative Medicine. DOI:\u00a010.14218\/FIM.2025.00046.\u00a0https:\/\/www.xiahepublishing.com\/2835-6357\/FIM-2025-00046<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Chikungunya fever, caused by Chikungunya virus (CHIKV), has re\u2011emerged as a major global health threat. 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