Chikungunya fever, caused by the chikungunya virus (CHIKV), has re-emerged as a major global health threat. The 2025 outbreak in Guangdong, China — the largest local epidemic ever recorded — marks a critical epidemiological turning point. A new review synthesizes current knowledge on the disease’s biology, symptoms, and management, with particular emphasis on evidence-based integration of traditional Chinese medicine (TCM), and calls for rigorous clinical trials to bring these integrative treatments to a global audience.

An Old Virus in New Territory

CHIKV is an alphavirus transmitted by Aedes mosquitoes. First identified in Tanzania in 1952, it has now spread to more than 119 countries, and viral adaptations have expanded the range of mosquitoes that can carry it, enabling transmission in temperate zones. The July 2025 Foshan outbreak, with more than 4,000 confirmed cases, signified a shift from sporadic imported cases to sustained local transmission in China, highlighting vulnerabilities in populations with no prior exposure.

The virus causes disease through both direct cell damage and a dysregulated immune response. After replicating in the skin, it spreads to joints, muscles, and other organs; a strong innate immune response helps control the virus but also recruits immune cells that cause tissue damage and joint pain. The disease unfolds in three phases: an acute phase lasting two to three weeks with sudden high fever, rash, and severe joint pain; a subacute phase lasting up to three months with persisting joint symptoms; and, in 40 to 80 percent of patients, a chronic phase lasting more than three months that causes long-term illness. Mortality is low, but severe complications can occur in newborns, the elderly, and people with other health conditions.

Where Traditional Chinese Medicine Fits In

No specific antiviral treatment exists for chikungunya. Acute-phase management centers on rest, hydration, and acetaminophen, with opioids reserved for severe pain and corticosteroids generally avoided. Chronic-phase treatment uses NSAIDs, low-dose corticosteroids, or disease-modifying drugs such as methotrexate and hydroxychloroquine, along with physiotherapy.

Traditional Chinese medicine integration is officially recommended in China’s 2025 national treatment protocol, based on “dampness-heat” theory. In the acute phase, the approach centers on “clearing heat, resolving dampness” using herbs including Guanghuoxiang, Gegen, and Lianqiao; in the recovery phase, on “dispelling cold and removing dampness” for persistent joint pain using Qianghuo, Duhuo, and Qinjiao; and external therapies include bloodletting at acupoints or joints and cold herbal compresses using Rendongteng for local relief. The review notes that high-quality international evidence for these approaches remains limited, and calls for rigorous clinical trials.

On the prevention side, two vaccines have recently been approved — Ixchiq for people 18 and older, and Vimkunya for those 12 and older — though questions about safety, cost, and equitable access remain. Integrated vector control, including source reduction, insecticides, and Wolbachia-infected mosquitoes, remains a fundamental part of prevention. The review concludes that a comprehensive response to chikungunya requires combining clinical surveillance, environmental monitoring, cross-border collaboration, and community engagement alongside standard care and evidence-based traditional medicine, with continued research investment to reduce the impact of this growing viral threat.

The review was published in Future Integrative Medicine (DOI: 10.14218/FIM.2025.00046), published by Xia & He Publishing Inc.