The COVID-19 pandemic was a threat to public safety and health around the world. The outbreak and spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) inflicted loss of human life all over the globe.
Long COVID is a term used to describe post-COVID symptoms which may remain present despite having recovered from COVID-19 infection. These symptoms vary from person to person and include but are not limited to: anxiety and depression, extreme fatigue, chest pain and tightness, memory and concentration problems, sleep difficulty, dizziness, joint pain, and others.
It is estimated that over 20 million American adults are living with long COVID, while about 7 million are experiencing disabling long COVID.
As of January 2022, it was estimated that long COVID has caused a cumulative loss of about $400 billion. This estimate includes medical expenses, lost wages, and lost savings incurred by individuals. It does not include costs suffered by government agencies or businesses.
These alarming figures buttress the need for urgent holistic approach to the treatment of COVID-19 infection and long COVID.
The causes of long COVID are not easily explained by Western medicine. Theories include excessive inflammation mediated by mast cell activation. However, in Chinese medicine, long COVID is seen to be caused by exhaustion of the body resulting from fighting off the initial infection and in some cases, the COVID pathogen still being present in the body.
The Role of Acupuncture in the Treatment of Long COVID
Several studies have shown that acupuncture can improve symptoms of long COVID such as breathlessness, nausea, insomnia, fatigue, and more. Some of these studies demonstrated that acupuncture increases nitric oxide production which in turn inhibits the replication cycle of the first severe acute respiratory syndrome (SARS) virus which is similar to SARS-COV2. Clinical features and pathophysiology have also shown that endothelial dysfunction and nitric oxide deficiency contributes to the development of COVID-19. It is suggested that nitric oxide plays an important role in protective effects against inflammation and acute lung injury.
In Chinese medicine, it is understood that when the body encounters a pathogen, the body engages its defensive layer of energy or Wei Qi in response to the pathogen. This helps to push the pathogen out of the body. This defensive response can manifest as fever, sweating, coughing, sneezing, and a runny nose.
With a strong immune system, a person may not even notice that a pathogen has been encountered and brushed off beyond a few sneezes or a small sweat. Alternatively, the patient’s Wei Qi may battle with the pathogen for some time before finally eradicating it from the body. This may make the patient feel awful for an extended period of time.
When a pathogen is particularly virulent, like COVID-19, it is able to move past these defenses and penetrate the body more deeply. Here, certain acupuncture channels will come into action to prevent the pathogen from reaching the most critical areas of the body ie, the internal organs.
These channels, called Luo and Divergent channels, use the medium of blood and body fluids as a buffer that wraps around the pathogen to hold it in check. At this point, the virus is no longer circulating around the body therefore tests may come back negative. If the person is relaxed, well-rested, and nourished, the buffering capacity will be plentiful, the pathogen can be held successfully held in check and no symptoms will manifest.
In cases where the body is strong enough, it will mount what is often referred to as a “healing crisis” which is an attempt to eject the pathogen back toward the exterior of the body. Symptoms such as a strong fever with sweating or vomiting and diarrhea are seen as the pathogen is ejected from the body.
When treating long COVID with acupuncture it is important to determine which of the body’s resources are deficient and nourish them accordingly. This diagnosis can be made based on an analysis of the patient’s signs, symptoms, and case history. Two indispensable diagnostic tools in Chinese medicine are tongue diagnosis and palpation of the pulse. After proper diagnosis, acupuncture treatment can then nourish these overtaxed resources.
Chinese Herbal Medicine and Long COVID
Traditional Chinese medicine has been widely used in the treatment of COVID-19 since January 2020. Chinese medicine has a long history in the prevention and control of infectious diseases, such as COVID-19.
There are many herbs that can easily be sourced and taken regularly to prevent infection from COVID and even improve immunity. Some of them include ginseng (Ren Shen), astragalus (Huang Qi), Chinese red dates (Jujube), brown sugar, and ginger (Sheng Jiang), amongst others.
In the early stage of COVID-19, there is the manifestation of heat, cold, or dampness of the lungs which causes most patients to have symptoms such as fever, cough, sore throat, and chills. Baidoukou (Amomum kravanh), Kuxingren (Semen Armeniacae Amarum), and Houpo (Magnolia Officinalis Cortex) are the three main Chinese herbs used in this stage.
In the middle stage, most patients will have traditional Chinese medicine syndrome of plague poison that obstructs the lungs. Kuxingren (Semen Armeniacae Amarum), Shigao (Gypsum Fibrosum), and Tinglizi (Descurainiae Semen) are the commonest Chinese herbs used at this stage.
In the severe stage, the most common presenting symptoms are dyspnea and coma. Mechanical ventilator and ECMO (extracorporeal membrane oxygenation), are often employed. Renshen (Ginseng Radix and Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), and Shanyurou (Fructus Corni) are the three most used Chinese herbs in this stage.
One herb, Fuzi, has the effects of decreasing heart failure, however, according to some studies, it also has neurotoxicity and cardiac toxicity. Fortunately, combination with Gancao and Ganjiang can regulate the herb’s efficacy and toxicity.
During the recovery stage, patients often have traditional Chinese medicine syndromes of lung-spleen Qi deficiency and Qi-yin deficiency. Fuling (Poria), Fabanxia (Pinelliae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium) are the most commonly used Chinese herbs at this stage.
Lifestyle Modifications in the Treatment of Long COVID
In addition to treating long COVID with acupuncture and Chinese herbal medications, there are lifestyle changes that patients are advised to make. These are usually tailored to individual cases but there is some general advice that will benefit most patients. These include:
- Diet: food and drinks should be taken at warm temperatures. This is to aid proper digestion. Cold and raw foods should be avoided for people with long COVID. Also, certain foods and drinks are particularly inflammatory and should be avoided. They include alcohol, caffeine, and sugary foods. Foods like chilies, garlic, and onions, should be used cautiously. Although they trigger immune response and may be useful initially, continued use strains the immune system and may cause subsequent depletion of vital energy.
- Hydration: this is essential as it forms the basis of the blood and fluids that the body needs. Bodily fluids serves both as a vehicle to carry a pathogen out of the body and help to create the buffer that holds a pathogen in check. Hydration should go beyond just drinking water. This is because there is need to consume water in a slower moving form which gives the body the chance to absorb it better. Therefore, consumption of wet foods like porridges, broths, soups, and stews are encouraged.
- Sleep: the need for adequate sleep cannot be overemphasized. Immunity is usually built during sleep. Going to bed before 11 pm is advisable especially in cases where the body’s resources are already quite depleted.
Keng-Chang Tsai, et al. A traditional Chinese medicine formula NRICM101 to target COVID-19 through multiple pathways: A bedside-to-bench study, Biomedicine & Pharmacotherapy, Volume 133, 2021, 111037, ISSN 0753-3322, https://doi.org/10.1016/j .biopha.2020.111037. (https://www.sciencedirect.com/science/article/pii/S0753332220312294)
SA Azer, COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics, New Microbes and New Infections, Volume 37, 2020, 100738, ISSN 2052-2975, https://doi.org/10.1016/j.nmni.2020.100738. (https://www.sciencedirect.com/science/article/pii/S2052297520300901)
Luo, Wenjun MSa; Zhai, Yan MSb,∗; Sun, Mi MDa; Guo, Dong MDa; Xie, Fang MSa; Yu, Zhou MSa; Tang, Zunhao MSa Clinical study on acupuncture treatment of COVID-19, Medicine: January 14, 2022 – Volume 101 – Issue 2 – p e28296. doi: 10.1097/MD.0000000000028296
Xin Yin, Shu-bin Cai, Lan-ting Tao, Lu-ming Chen, Zhong-de Zhang, Su-hong Xiao, Arthur Yin Fan, Xu Zou, Recovery of a patient with severe COVID-19 by acupuncture and Chinese herbal medicine adjuvant to standard care, Journal of Integrative Medicine, Volume 19, Issue 5, 2021, Pages 460-466, ISSN 2095-4964, https://doi.org/10.1016/j.joim.2021.06.001. (https://www.sciencedirect.com/science/article/pii/S2095496421000601)
Jianping Liu, Fei Dong, Nicola Robinson, State-of-the-art evidence of traditional Chinese medicine for treating coronavirus disease 2019, Journal of Traditional Chinese Medical Sciences, Volume 9, Issue 1, 2022, Pages 2-6, ISSN 2095- 7548, https://doi.org/10.1016/j.jtcms.2022.01.005. (https://www.sciencedirect.com/science/article/pii/S2095754822000059)