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Thursday, 30 July 2020

Post-viral syndrome after COVID 19 and its TCM treatment

Tiejun Tang

The peak of the Covid 19 pandemic has passed in the UK and most Europe countries. Many Covid 19 patients showed some sequel symptoms after their body temperature returned to normal: the cough disappeared, virus turned negative and they were discharged from hospital. Some people called these symptoms Covid 19 sequelae. The formal name of this condition should be called “Post Viral Syndrome after COVID 19.” At this stage, patients showed different symptoms to different degrees. Western medicine usually gives a basic symptomatic treatment. The effects are usually not satisfactory. Traditional Chinese medicine (TCM) already shows a particularly good effect in the acute phase of Covid 19. Additionally, in the post virus era it can also play an important role on the Post-Viral syndrome of Covid 19. My opinion about this syndrome and personal clinical experienceis as follows.

The incidences of post-viral syndrome are various.Not every Covid-19 patient will develop squeal symptoms. Most young patients or basically healthy individuals can fully recover after the virus disappear - no squeal symptoms remain. As Huangdi Neijing said: "The healthy qi strong person will not get the illness, only qi deficiency person will become sick." However, for elderly and weak patients, the incidence of squeal symptoms is quite high and in some cases the symptoms may be severe and even life-threatening. The incidence of different squeal symptoms varies. Common squeal symptoms mainly include:

1. Fatigue:

Fatigue is the most common and mildest sequel symptom of Covid-19. More than half of Covid-19 patients have varying degrees of fatigue. TCM theory believes that the main causes of fatigue are qi and blood deficiency. Covid 19 patients have experienced high fever for up to 2-3 weeks. They have taking a variety of western medicines, and a large number of bitter and coldness herbs which might injury healthy qi. Huangdi Neijing said: “Normal body temperature produce healthy qi, but high fever will consume healthy qi”. The healthy qi of patient is exhausted by the “pathogenic heat” caused by coronavirus. This is the reason for fatigue. Modern medicine calls it "Post-Viral fatigue syndrome"[1]. Some patients may develop to a chronic fatigue syndrome (CFS).

2. Depression:

After few months of lockdown, almost everyone has a certain degree of negative psychological impact. For patients with Covid 19, they have gone through several weeks of isolated treatment and some severe cases have experienced it in ICU. They have experienced the life and death test. The horrible memory about the ventilator and the witnessing the death of other patients became a negative psychological stimulation to patients. After being discharged from hospital some patients showed many psychological or physical symptoms such as depression, panic attack, restlessness, insomnia and worry about virus recurrence. These symptoms are called "Post-traumatic Stress Disorder" (PTSD) in western medicine. Although some people who are not infected by Covid 19 also experienced depression due to the scare about the pandemic and the changes in their life and work, this kind of post-viral depression is common.

 3. Pulmonary Fibrosis:

According to the report 21.5% of SARA patients had showed the imaging of pulmonary fibrosis during the recovery period. [2] The main symptoms were dry cough and progressive dyspnea. Imaging of the lungs showed characteristic changes in pulmonary fibrosis. The proportion of pulmonary fibrosis in Covid 19 should be very familiar with SARA.[3] It has been reported that the average survival time after diagnosis of pulmonary fibrosis is only 2.-3 years, and the mortality rate is higher than most of cancer. Pulmonary fibrosis is called "chronic cancer." Western medicine treats pulmonary fibrosis using two newly developed drugs, pirfenidone and nintedanib, but both have strong gastrointestinal side effects. Research on the treatment of pulmonary fibrosis with Chinese herbal medicine has showed satisfactory results.[4]

4. Fibromyalgia:

Some patients experienced body ache after Covid 19, and the pain is wandering. The position is mainly in the muscles and bones of the limbs and back. The pain is usually combined with fatigue and depression. Western medicine diagnoses it as "fibromyalgia" (FM). The etiology of this disease is not clear, but it is believed to be related to traumatic stress, immune disorders, Epstein-Barr virus infection and other factors. The cytokine storm caused by Covid 19 virus is very likely to be a new cause of fibromyalgia.

5. Heart failure:

Heart and lungs all located in the chest (upper Jiao). According to the Zang-fu theory of TCM, heart is the "officer of the monarch", it dominates blood circulation; Lung is the "officer of prime minister", it dominates the qi. The heart and lungs are extremely closely related in their physiological functions, and they also influence each other in pathology. When lungs get ill heart must be affected. Western medical research shows that Covid 19 first invaded the human body through the angiotensin-converting enzyme 2 (ACE2) receptor located on the cell surface. Many patients develop viral myocarditis and pericarditis after Covid 19, which leads to heart failure. For some elderly people who have history of coronary heart disease, after the Covid 19, the patients can still be aggravated by heart failure or arrhythmia. This became the main reason of death for elderly Covid 19 patients.

6. Lost the sensation of smell and taste:

The Huangdi Neijing states that “The lung qi flows through the nose, the smell function depend on the normal function of lungs.” In Covid 19 patients, their lung qi was injured by the virus. Patients lost smell sensation. In some cases patient also loss of taste. This condition is very common, and it has even become one of the characteristic symptoms for the diagnosis of covid 19. After the virus, the recovery of smell and taste is often an extremely slow process, and it is still uncertain whether it can be completely recovered.

7. Impaired reproductive function:

Studies have shown that Covid19 destroys lung cells and/or ACE2 protective pathways. The expression of .ACE2 in the ovaries and testis indicates that this enzyme affects germ cells and fertility function. Therefore, theoretically, Covid 19 may cause male or female infertility. The impact of the virus on the fertility function will be gradually revealedin the future.

The above seven points are the main manifestations of the post-viral syndrome of Covid 19. In addition, there are other diseases such as acute and chronic kidney damage, proteinuria, and stroke which are induced by Covid 19.

Chinese medicine treatment:  

TCM has shown an excellent effect in the treatment and prevention of Covid 19. The three formulas and three remedies recommended by China's National Health Commission are widely used in China during the pandemic. For treatment of chronic diseases TCM may show more advantages. I treated some patients with post-viral syndrome in the past few months. I would like to share my personal experience on the treatment of this syndrome.

 1) Post-viral fatigue syndrome: The main pathogenesis of this syndrome is deficiency of qi and blood. TCM theory believes “If there is deficiency, supplement it”. TCM usually use Sijunzi decoction for replenishing qi and Siwu decoction for nourishing blood. For the patient with more digestive system disorders, we should benefit lung by tonifying spleen. Guipi Wan, or ChenXia Liujunzi Decoction can be selected. Spleen and stomach are the source of qi and blood. If spleen is strong, the qi and blood are sufficient, and the fatigue will be improved. The food therapy can be applied. Add some Huangqi, Dangshen, Danggui, Longyan, Gouqizi while cooking soups. Wuzhualong is the most favourite herb of my tutor, Professor Deng Tietao. It can not only invigorate qi, but also has the effect of reducing phlegm and relieving cough. It is a very good choice for the Post-viral fatigue after Covid 19.

2) Post-viral depression and PTSD: The depression after Covid 19 is mostly due to liver-qi stagnation, and Xiaoyaosan and Chaihu Shugan San can be used to relieve liver depression; PTSD symptoms are mostly due to heart shen disturbed. Chinese medicine Baizi Yangxin Wan, Tianwang Buxin Wan and Ganmai Dazao decoction can be selected.  I recommend adding Baihe, Meiguihua, Suxinhua, Yujin etc. to release the depression. Appropriate psychological treatment can help, but it is not recommended to use antidepressantsif not very necessary. Chinese herbal medicine is a natural way of anti-depression.

3) Post-coronary pulmonary fibrosis: For the treatment of pulmonary fibrosis, Chinese medicine adopts the treatment principles of clearing dryness and moisturizing the lungs, lowering qi and relieving asthma, promoting blood circulation and removing blood stasis. The prescriptions are mostly Qingzao Jiufei Decoction, Suzi Jiangqi Decoction, Sanzi Yangqin Decoction, plus Danshen, Chishaoyao, Sanqi and other herbs for promoting blood circulation and removing blood stasis. There are many research reports showing that single or compound Chinese medicine can significantly improve pulmonary fibrosis in rats caused by bleomycin[5]. Among them, the classic ancient prescription Yupingfeng San has shown good effect in anti-pulmonary fibrosis. I also have an English article devoted to discussing the mechanism of Yupingfeng on the prevention and treatment of Covid 19.

 4) Fibromyalgia caused by the virus: Acupuncture has a very good effect on the treatment of fibromyalgia. Acupuncture should be the first choice for muscle and joint pain after Covid 19.There are many research reports on the mechanism of acupuncture analgesia. Not only relieving pain, acupuncture is also a comprehensive treatment measure, which can also alleviate related symptoms such as, depression, and sleep disorders.

5) Heart failure: Heart failure is more common in severe case of Covid 19. In some mild cases tachycardia and arrhythmia can be found after the virus. TCM usually chooses Xuefu Zhuyu Decoction and Shengmai San to treat the heart failure. Studies have confirmed that these prescriptions can improve myocardial blood supply, reduce myocardial oxygen consumption, improve microcirculation and many other effects, thereby gradually improving heart failure.

6) Loss of smell and taste after the Covid 19: Acupuncture at Yingxiang (LI 20) and Bitong points beside the nose, and certain specific areas of the scalp acupuncture, to help restore the sense of smell; Acupuncture on the face, cheeks, and neck acupoints such as Dichang (ST4), Jiache (ST6) and Lianquan (RN23) and combined with strengthening spleen herbs, can help restore the sense of taste.

7) Infertility after Covid 19: Wuzi Yanzong Wan can improve sperm quantity and quality, improve sperm motility, improve semen liquefaction time, and increase reproductive ability. It is used for the treatment of male infertility[6]. For female infertility Nuangong Yunzi Wan, Zishen Yutai Wan, or Fuke Bazhen Wan can be selected according to the syndrome differentiation.

After the peak of the pandemic passed, it can be predicted that the peak of post-viral syndrome will follow. Ray[1] suggests that prevalence of fatigue-related symptoms after Covid 19 infection should be studied first, and pragmatic, relatively low-cost techniques should be explored to treat post-viral fatigue. Relieve symptoms and improve the quality of life of people affected by the long-term sequelae of Covid 19. I think Chinese medicine should be the best option. Patients and doctors must be aware of the post-viral syndrome, and apply suitable treatment,ensuring a complete recovery and to prevent it from recurring.

If the patient's virus test has turned negative, it is better co


mbine acupuncture and herbs treatment together because the effects can enhance each other. If the virus still positive, patient can get the herbal medicine treatment or diet advice through the online consultation. It is my wishing patients emerge from the shadow of Covid 19 as soon as possible and return to their normal and healthy life.

Reference:

1.      Ray Perrin. Into the looking glass: Post-viral syndrome post COVID-19. Med Hypotheses. 2020 Nov; 144: Published online 2020 Jun 27.

2.      Xie L Dynamic changes of serum SARS-coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge[J]. Respir Res, 2005,6:5. DOI: 10.1186/1465-9921-6-5.

3.      Peter M. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. The Lancet Respiratory Medicine. May 15, 2020

4.      Yunping Bai. A Chinese Herbal Formula Ameliorates Pulmonary Fibrosis by Inhibiting Oxidative Stress via Upregulating Nrf2. Front Pharmacol. 2018; 9: 628.

5.       Jiepeng Wang. Danggui Buxue Tang ameliorates bleomycin-induced pulmonary fibrosis in rats through inhibiting transforming growth factor-β1/Smad3/ plasminogen activator inhibitor-1 signaling pathway. J Tradit Chin Med. 2020 Apr;40(2):236-244.

6.      Dixin Zou. Analysis of pharmacological mechanisms and targets mining of Wuzi-Yanzong-Wan for treating non-obstructive oligoasthenospermia.   Biomed Pharmacother. 2019 Jul; 115:108898.


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