Acupuncture, post-COVID condition and long COVID

Since January 2022, in our Geelong clinic we have seen more and more patients who have had COVID-19. Some patients came to us within a few weeks of diagnosis, presenting with fatigue, brain fog, loss of smell, feeling cold and / or short of breath. Let us call this post-COVID condition. Others came to us weeks or months after the diagnosis, which fits in with in the diagnosis of long COVID. In the last blog, we talked about long COVID and its diagnosis. In this blog we will explain ours and others’ experience of treating post-COVID condition and long COVID with acupuncture.

How does Chinese medicine understand long-COVID?

Chinese medicine diagnoses health conditions based on detailed analysis of individual’s symptoms, with minimal reliance on laboratory tests. Using data from those who contracted the initial variance of SAR-CoV-2 virus (COVID-19 virus), Chinese medicine practitioners in China identified 10 common types of patterns based on different signs and symptoms presented. Even with the same variance of the virus, there are different patterns of presentations. This is because of individual differences in our constitution and body system, and in geographic locations.

Similarly, there are a few different patterns associated with long COVID based on our experience. The most common one is called Cold dampness, which suppresses the Yang or fire of our body.  Our vitality, mental alertness and strength is the result of a balanced Yin and Yang. When the Yang is suppressed, Yin will be dominate, leading to a state of fatigue and inactivity. The presentation of cold dampness associated with long COVID is feeling cold easily, in particular in the upper body, tightness in the neck and / or chest, fatigue, heaviness in the body, feeling like having to drag oneself every day, mental fog, feeling fullness in the head or headache, body aching and tightness, either waking up un-refreshed or unsettled sleep. Some people also experience short of breath, cough or heart palpitation. Some people may have blocked nose or sinuses, loss of change of smell and taste, diarrhoea and / or abdominal bloating. Anxiety and depression, either new onset after COVID-19 or exacerbation of previous mental health issues, are very common.  Chinese medicine sees emotional and physical health as one. So the combination of those symptoms is labelled as Cold dampness. This diagnosis helps Chinese medicine practitioners develop appropriate treatment strategies.

Some people might have fatigue, mental fog, but feeling hot. Then this will be a different pattern, with different treatment strategies.

How does acupuncture help long-COVID?

Acupuncture is used to strengthen the body, move the dampness out and unblock the meridians, or energy pathways. It is also used to calm the system, improve sleep and reduce pain.  Moxibustion, a modality of acupuncture involving using a medicinal herb (Artemisia) to warm certain body parts, is used to expel the coldness and to activate Yang Qi. Together the two modalities are to rekindle the fire in the body and restore the meridian flow, consequently to address a number of symptoms associated with long COVID. So far two case reports have been published, and three clinical trials, one in the United Kingdom, one in the United States of America and one in Germany, are recruiting participants.

 

From modern science point of view, how might acupuncture help long COVID? To answer this question, we need to look at the current understanding of the pathology underlying long COVID. The knowledge in the field is developing as we speak. A 2021 paper published in the leading medical journal BMJ  explains that inflammation status alone could not explain the presence of fatigue. The authors think that fatigue is likely to be the results of multiple factors involving the central nervous system, peripheral muscles, and psychology. Inflammation induced by SAR-CoV-2 virus could produce neural toxin and neuro-inflammation in the brain, direct viral infection of the skeleton muscles can cause damage to and weakness of the muscle fibres, and anxiety / depression itself often leads to fatigue. The review also points it that short of breath in some could be due to lung scarring after COVID-19, but many people with short of breath do not have evidence of lung damage.  Another review states that short of breath, post-exercise fatigue, palpitation, chest pain and exercise intolerance could be due to autonomic nervous system changes or injury and persistent inflammation in the lungs. Un-refreshed sleep and sleep disturbance are so commonly seen among those with COVID and long COVID, the term “Coronasomnia” is proposed.  Poor sleep quality could also contribute to the brain fog and fatigue. Overall multiple systems and mechanisms are involved in long COVID.

A recent systematic review outlines ample evidence supporting that acupuncture reduces neuro-inflammation, facilitates repairment of the nervous system, reduces pain and regulates the functions of multiple systems. A group of scientists from the Harvard University published a paper in the top science journal Nature in 2021 and discovered the specific mechanisms through which acupuncture reduces inflammation. Our recent systematic review in one of the top sleep journals has also shown that acupuncture changes the objective sleep index and has the potential to restore the sleep architecture among those with primary insomnia.  It is important to know none of the research is specific to COVID or long COVID. However those proven mechanisms of acupuncture action provide some evidence base to our clinical practice.

How do we help people with long COVID?

For us it essential to work with your GP to help you with various symptoms associated with long COVID. It is important to exclude major health issues associated or not associated with COVID-19, such as pulmonary scarring, myocarditis, and cardia arrhythmia. A collaborative approach is likely to bring out the best result.

We will make a Chinese medicine assessment of individuals with long COVID.  It is our opinion that fatigue and mental fog are closely related to the coldness in the body, anxiety, poor sleep or un-refreshed sleep, short of breath and blocked nose and head.  We utilise the strengths of acupuncture and moxibustion to reduce anxiety, improve sleep, reduce pain, warm the body, and address other symptoms.

We have found for those who came to us early, soon after they were out of isolation, acupuncture can help alleviate symptoms faster and more effectively. For those who have developed long COVID for months, acupuncture help with alleviation of symptoms and improve functions at a slower pace. For those who have chronic fatigue prior to COVID-19, the changes are even slower. So early intervention is the key.

For some, it will be a relatively long journey to recover from long COVID. We will work with your GP and guide you to some self-care approaches, such as sleep hygiene, diet advice, self-acupressure (to unblock meridians), pacing  and Qi Gong (for breathing and relaxation), so as to empower you on this journey.

Next time we will talk about some self-care strategies for post-COVID conditions and long COVID.