News Letter, Vol. 9 (1)
June 26, 2022, © Copyright
Jun Xu, M.D., Acupuncturist, Hong Su, C.M.D., Acupuncturist., Po Xu, M.D., Acupuncturist,
www.drxuacupuncture.co
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
203-637-7720
Acupuncture may help you with Long Covid or Post Covid Conditions
https://m.ofweek.com
Mark S is a 25-year–old man who complained of brain fog, depression and anxiety, whole body achy, joint pain, poor memory and concentration, asleep, headache and dizzy after he recovered from Covid-19 for two months. He went to many doctors, all the tests including Rheumatic factor, ANA, x-ray of his neck, low back and MRI of his brain were negative. He was given antidepressant, and pain medicine for one month without success. He was told he had Long Covid, therefore, he might need take these medicines for a long time. Therefore, he came to us for evaluation and treatment.
Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as post-COVID conditions (PCC) or long COVID. Long Covid is a wide range of new, returning, or ongoing health problems. The extensive distribution of the SARS-CoV-2 host cell entry factors in the human body indicates that the virus can potentially infect most of the organs and tissue types. Most patients get better within a few days to a few weeks after infection, so at least four weeks after infection is the start of Long Covid symptoms. Anyone who was infected can experience post-COVID conditions. The most common symptoms are: (https://www.cdc.gov)
General symptoms
⦁ Tiredness or fatigue that interferes with daily life
⦁ Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
⦁ Fever
Respiratory and heart symptoms
⦁ Difficulty breathing or shortness of breath
⦁ Cough
⦁ Chest pain
⦁ Fast-beating or pounding heart (also known as heart palpitations)
Neurological symptoms
⦁ Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
⦁ Headache
⦁ Sleep problems
⦁ Dizziness when you stand up (lightheadedness)
⦁ Pins-and-needles feelings
⦁ Change in smell or taste
⦁ Depression or anxiety
⦁ Hearing loss
⦁ Facial Paralysis
Digestive symptoms
⦁ Diarrhea
⦁ Stomach pain
Other symptoms
⦁ Joint or muscle pain
⦁ Rash
⦁ Changes in menstrual cycles
Am J Physiol Cell Physiol. 2022 Jan 1; 322(1): C1–C11.
Medical Society has studied intensively about Post Covid Conditions, one of the reviews from British Medical Journal reported on 10,951 people (48% female) in 12 countries, most included previously hospitalized people (78%, 8,520/10,951), the longest mean follow-up time was 221.7 (SD: 10.9) days post COVID-19 onset, that over 60 physical and psychological signs and symptoms with wide prevalence were reported, most commonly weakness (41%), general malaise (33%), fatigue (31%), concentration impairment (26%) and breathlessness (25%), 37% of patients reported reduced quality of life; 26% of studies presented evidence of reduced pulmonary function. (BMJ Glob Health. 2021 Sep;6(9):e005427)
Mechanism of Brain Injury by Covid-19
Neurocrit Care. 2020 Jul 13 : 1–10.
Infection with the SARS-CoV-2 virus may lead to brain pathology through potential direct and indirect mechanisms. SARS-CoV-2 infection leads to cytokine storms, which can damage an intact blood–brain barrier and disrupt normal functioning in the Central Nervous System (CNS) without the virus crossing the blood–brain barrier from the systemic circulation. In addition, COVID-19 has been associated with a pro-thrombotic state, which may lead to occlusion of cerebral vessels and lead to brain injury. Finally, ACE2, a functional receptor of SARS-CoV-2, may facilitate direct invasion of neurons and cerebrovascular endothelial cells, leading to apoptosis and necrosis of neurons and neighboring cells
Western Medicine Treatment for Long Covid
⦁ Prevention
Research suggests that people who are vaccinated but experience a breakthrough infection are less likely to report post-COVID conditions, compared to people who are unvaccinated.
⦁ Symptomatic patients should be treated with Antivirus immediately after they are infected.
PAXLOVID™ is the first choice now, it was found to reduce the risk of hospitalization or death by 89% compared to placebo in non-hospitalized high-risk adults with COVID-19.
In the overall study population through Day 28, no deaths were reported in patients who received PAXLOVID™ as compared to 10 deaths in patients who received placebo. (https://www.paxlovid.com)
Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease. There is currently no evidence that additional treatment is needed with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected.
(https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_467.pdf)
⦁ Post Covid Symptomatic Treatment
Western Medicine uses symptomatic treatment for each system, if you feel your symptoms are getting worse, we suggested you to visit each specialty physician, such as cardiology, neurology, pulmonology, etc.
Eastern Medicine Treatment for Long Covid
Recently some studies revealed promising results, of the 1,137 studies searched, 14 studies performed on 972 COVID-19 patients entered the systematic review final stage. The results showed that different Eastern Medicine interventions (acupuncture, Traditional Chinese medicine [TCM], relaxation, Qigong) significantly improved various psychological symptoms (depression, anxiety, stress, sleep quality, negative emotions, quality of life) and physical symptoms (inflammatory factors, physical activity, chest pain, and respiratory function) in COVID-19 patients. The results showed that various Eastern Medicine interventions have a positive effect on improving the various dimensions of coronavirus disease. (Rev Environ Health. 2021 Apr 12;36(3):443-450)
Acupuncture Treatment for Long Covid
We have been treating the Long Covid patients with acupuncture since the pandemic in May, 2000. Here is what we learnt from our experience. Bilateral LI4 He gu, LI11 Qu Chi, LIV3 Tai Chong, SP6 San Yin Jiao, ST36 Zu San Li are essential points, which should be used to each Long Covid Patients, then the following points should be added accordingly,
⦁ Neurological symptoms:
Difficulty thinking or concentrating (brain fog), Headache, Dizziness, lightheadedness, Depression, Anxiety and Sleep Problems, GV20 Bai Hui, EX-HN 1 Si Sheng Chong, GB20 Feng Chi, Du16 Feng Fu, GB8 Shuai Gu, EX-HN5 Tai Yang, Du14 Da Zhui, Ht7 Sheng Men.
Pins-and-needles feelings, P6 Nei Guan, Du3 Yang Gu, KI04 Da Zhong, BL60 Kun Lun
Change in smell or taste, Bilateral BL1 Ying Xiang, and Ren23 Lian Quan
Facial Paralysis: GB8 Shuai Gu, Tai Yang, GB1 Jing Ming, GB14 Yang Bai, St2 Cheng Qi, LI20 Ying Xiang, Ren24 Ren Zhong, etc.
Hearing Loss: SI19 Ting Gong, GB2 Ting Hui, SJ21 Er Meng, SJ17 Yi Feng
⦁ General symptoms:
Tiredness or fatigue that interferes with daily life, and symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”): BL23 Shen Shu, BL13 Fei Shu, BL21 Wei Shu, BL20 Pi Shu, ST36 Zu San Li.
⦁ Respiratory and heart symptoms:
Difficulty breathing or shortness of breath, cough: BL13 Fei Shu, Lu1 Zhong Fu, Lu2 Yun Men, Ren17 Tang Zhong.
Chest pain, fast-beating or pounding heart (also known as heart palpitations): P6 Nei Guang, BL15 Xin Shu, Ht7 Shen Men.
⦁ Digestive symptoms
Diarrhea, Stomach pain: Ren13 Shang Wan, Ren12 Zhong Wan, Ren11 Xia Wan.
⦁ Other symptoms
Joint or muscle pain: Arshi points at related joints or muscles
Rash: Chinese herb and Lung Meridian Points
Changes in menstrual cycles: SP6 San Yin Jiao, SP10 Xue Hai, ST29 Gui Lai, ST30 Qi Chong, Ren6 Qi Hai, Ren4 Guan Yuan, etc.
Mark’s Treatment
Mark underwent our treatment two times per week, after six-week treatment, he reported his brain fog was getting better, he had less depression and anxiety. He felt the most important improvement was his sleep, he could sleep soundly about 8 to 9 hours per night. He still feels some pain at his neck and midback, but his memory is slowly getting better, he has had fewer headaches and dizzy.
We advised him to gradually reduce the dosage of antidepressant and pain medicine, and continue to have acupuncture treatment with us once a week for 4 to 6 weeks.
Tips to acupuncturists and patients:
The most common symptoms we ever encounter are BRAIN FOG, POOR SLEEP, FATIGUE, BODY ACHY, HEARING LOSS and FACIAL PARALYSES. The Symptoms of Post Covid Conditions vary; most Covid patients have no Long Covid symptoms. However, if the patients seek for acupuncture treatment, they usually tried everything else without success, therefore, it is a challenge for both the patients and acupuncturists.
⦁ The Covid-19 virus invades central nervous system, and damages the neurons, BRAIN FOG, POOR SLEEP, FATIGUE, are most common, therefore, treatment should focus the brain, the following acupuncture points are most important, GV20 Bai Hui, EX-HN1 Si Sheng Chong, GB20 Feng Chi, Du16 Feng Fu, GB8 Shuai Gu, EX-HN5 Tai Yang, Du 14Da Zhui, Ht7 Shen Men. The patients should be aware that the symptoms might last a long time.
⦁ Body Achy is very common at the trunk, i.e., the neck, mid back and low back, heating pad, massage, guasha, exercise plus acupuncture are very helpful.
⦁ Facial Paralyses in Long Covid are different from Bell’s Palsy, hearing loss in Long Covid is not the same as regular hearing loss. The most difficult obstacle is its long lasting, as we mention earlier, the Covid-19 virus invades neurons, therefore, the patients should be patient, and it may take two-month treatment without any effects in severe cases. However, there is a chance to recover if they patients are young and receive early treatment.
⦁ Smell and taste loss is possibly recoverable. For some reason, many patients with the smell and taste loss are treated with acupuncture and gained reasonable good results.