Traditional Chinese Medicine for Cough Variant Asthma: Bridging TCM Syndrome Differentiation with Modern Immunological Mechanisms and Clinical Translation — A Narrative Review

Dan Luo,1 Yingling Yang,1 Jinna Tian,2 Jianbao Li21Clinical Medical College, Chengdu University of TCM, Chengdu, Sichuan, 611137, People’s Republic of China; 2Department of Pediatrics, Hospital of Chengdu University of TCM, Chengdu, Sichuan, 610075, People’s Republic of ChinaCorrespondence: Jinna Tian, Department of Pediatrics, Hospital of Chengdu University of TCM, No. 39, Shi-Er-Qiao Road, Jinniu District, Chengdu, Sichuan, 610075, People’s Republic of China, Email tianjinna@cdutcm.edu.cn Jianbao Li, Department of Pediatrics, Hospital of Chengdu University of TCM, No. 39, Shi-Er-Qiao Road, Jinniu District, Chengdu, Sichuan, 610075, People’s Republic of China, Email lijianbao@cdutcm.edu.cnBackground: Cough variant asthma (CVA) constitutes a diagnostically challenging phenotype of asthma, predominantly characterized by chronic cough without overt wheezing. Its pathogenesis involves airway inflammation, immune dysregulation, airway hyperresponsiveness, and cough hypersensitivity, yet therapeutic optimization remains an unmet need.Objective: This review aims to systematically synthesize current evidence on the role of traditional Chinese medicine (TCM) in CVA, bridging TCM syndrome-differentiation theory, molecular immunological mechanisms, and real-world clinical applications.Findings: In TCM theory, CVA is conceptualized as a disorder arising from external triggers (notably wind), internal viscera dysfunction (lung, spleen, kidney), phlegm retention, and blood stasis. Syndrome differentiation guides individualized treatment. Experimentally, TCM interventions modulate Th1/Th2 and Th17/Treg immune axes, inhibit key inflammatory pathways (TLR4/NF-κB, IL-6/STAT3), attenuate airway remodeling, and regulate gut microbiota. Clinically, meta-analyses and randomized trials indicate that TCM, alone or as adjunctive therapy, may improve cough control, reduce recurrence, and enhance quality of life. Nevertheless, substantial heterogeneity across study designs, TCM syndrome classification criteria, and selected outcome measures fundamentally restricts the generalizability and robustness of existing clinical evidence.Future Directions: Advancing the field requires phenotype-stratified trials, integration of biomarkers and TCM syndromes, exploration of the gut–lung axis, and application of AI-driven compound screening and microfluidic models. International standardization and inclusion in global guidelines are essential for translational impact.Conclusion: TCM offers a mechanistically plausible and clinically relevant integrative approach to CVA. Rigorous, multicenter, and mechanism-based research is urgently needed to establish its definitive role in global respiratory medicine.Keywords: cough variant asthma, traditional Chinese medicine, pathophysiological mechanisms, clinical practice, immune regulation, airway inflammation, syndrome differentiation, integrative treatment