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Traditional Chinese medicine (TCM) has thousands years history. It has unique basic theories and diagnostic methods. It is a very effective therapy in treating many chronic diseases and some acute diseases. If you are interested in TCM, welcome to pop in to this TCM forum, let's discuss on any topic about Chinese herbal medicine and acupuncture. You are welcome to visit my clinic Knowhow Acupuncture at 1 Harley street, London.

Sunday, 17 April 2022

How to treat brain fog post COVID 19?

 Tiejun Tang, Ying Zhang 

"Brain fog" is not a medical terminology, but a colloquial term used to describe slow or fuzzy thinking and slowed-down cognitive response. The symptoms are various depending on different body constitution, such as confusion, memory loss, difficult recalling words, slow thinking, difficulty concentrating, and being easily distracted. Symptoms of brain fog can appear during the recovery period after many viral infections. Serena Spudich, a professor of neurology at Yale University, reported that a person seems to experience more cognitive slowing and emotional problems after contracting the coronavirus than most of other viral infections.Neurological symptoms occurred in 80% of hospitalized patients with COVID-19 investigated in one study.[1].A survey study published in Eclinical Medicine, The Lancet showed that in 3,762 people with confirmed or suspected COVID-19, 85% reported brain fog [2]. A cohort study based on linked electronic health records data from 81 million patients including 273,618 COVID-19 survivors, 36.55% of people have sequelae during the 3-6 months.[3]  This condition, often referred to as long COVID, a common and particularly difficult problem with long COVID is brain fog. Why does brain fog occur? How to diagnose and treat brain fog in traditional Chinese medicine and western medicine? These questions are important in the long-term treatment of COVID-19 and significant to a nation’s medical system. In this work, we aim to provide an alternative view (TCM) in treating brain fog.

The Mechanism of Brain Fog and the Pathogenesis of TCM

The reason of brain fog is not very clear in modern medicine, but Dr. Spudich believes the most likely cause was inflammation caused by the body's immune response, rather than the virus itself. A study issued in the March 2021 found autoantibodies in the cerebrospinal fluid of COVID-19 patients with neurological symptoms [4]. This result suggests that the generation of brain fog may have its pathological material basis, and it is not entirely a psychological problem. It's also possible that the virus itself has somehow entered the brain, possibly by spreading through the top of the nose or by infecting cells known to cross the blood-brain barrier. But in a study by Columbia University published in September 2021, no evidence of coronavirus RNA or protein was found in brain cell samples from 41 people who died of COVID-19 [5]but a recent study published in Nature shows strong evidence for brain-related abnormalities in COVID-19. In this study, researchers investigated brain changes in 785 UK-based participants (aged 51-81 years) who underwent imaging twice and found reduced grey matter thickness and tissue contrast in the orbitofrontal cortex and para hippocampal gyrus, which is correlated with changes in functionally relevant regional tissue damage markers, and overall causing brain-capacity reduction. This explains why infected participants also exhibited greater cognitive decline on average between the two time points.

However, whether such deleterious effects can be partially reversed or whether these effects will persist in the long term remains to be further investigated.[6].

Traditional Chinese Medicine Theory believes that people's spiritual consciousness activities are dominated by the heart. "Huangdi Neijing" (Inner Canon of the Yellow Emperor) recorded: "The heart is the official of the monarch, whom in charge of the consciousness." ZHANG Jiebin (a Chinese Physician, 1563-1640) explained: "The heart is the king of a body, with a vain spirit and it has the ability to cope with many changes. All the internal organs and the whole body are controlled by heart, thus, wisdom and spiritual comes from the heart. And the consciousness comes from heart". In the words of Traditional Chinese Medicine, the brain belongs to the "extraordinary Fu-organ ", with a function in regulating mental activities. JIN Zhengxi (1598-1645) of the China’s Yuan Dynasty said: "The memory and people's inspirations lie in the brain. Children's brains are not full but with gradual growing. Old people’s brainis gradually empty, therefore with memory declining."

There have been some debates in the field of Chinese medicine about whether the heart dominatesmind or the brain dominates mind. Professor DENG Tietao (the author’s supervisor) published "The scientific evidence of the Theory of Heart Dominates the Mind" in the journal of New Chinese Medicine[7]with an opinion that “the theory of heart dominating the mind comes from practice, which in turn can guide clinical practice. Practice is the criterion for testing the truth. Therefore, this theory is scientific”.One of my articles "A Joined Discussion about the Heart and Brain Dominating the Mind" extended Deng’s work by arguing the mechanism of heart dominating mind as the root, and the brain dominating the mind as the branch [8]. In my opinion, although western medicine believes that the brain fog comes from the brain, its origin does come from the heart. According to the principle that treatment must be based on the origin of the pathology, the treatment of brain fog should therefore focus on nourishing the heart and calm the mind at the same time, while taking the opening of the orifices of brain into account.

In addition, according to the TCM,(1) the kidneys govern the bones, and the bones generate marrow, while the marrow nourishes the brain, so nourishing the kidneys and filling essence is to nourish the brain; (2) the liver controls stagnation, regulates qi, thus, relieving the stagnation of liver qi helps relieving depression; (3) spleen is the source of qi and blood, meanwhile related to thinking . Strengthening the spleen and nourishing qi can also indirectly nourish the heart and calm the nerves. Although brain fog is in the brain, to regulate the function of five Zang organs can achieve the purpose of treatment. In particular, nourishing the heart and calming the nerves should be the focus.

Chinese and Western Medicine in Treatment of Brain Fog

Western Medicine Treatment

Western medicine believes that cognitive rehabilitation seems to be the best way to treat brain fog. Cognitive rehabilitation is like physical therapy, but it targets the brain. Usually performed by a neuropsychologist, and the treatment consists of written and oral exams and focuses on strategies to improve certain functions, such as attention or memory. Many hospitals in the U.S. currently have cognitive rehabilitation programs, and many long COVID clinics also offer brain fog treatment. There is some evidence that playing games like CogMed, Lumosity, etc. on a computer or mobile phone can also improve cognitive performance. It can be a great addition to cognitive rehabilitation therapy.

In terms of drug therapy, the United Kingdom has recently launched a combination preparation for the treatment of brain fog called Brainzyme, which includes EMT mixture (theanine, EGCG and polyphenols), guarana seeds, choline, ginkgo biloba, L-Tyrosine, Piperine, Bromelain, Maca Root, Vitamins and Minerals. Among them, ginkgo biloba and pepper are the ingredients of traditional Chinese medicine, and the others are mostly nutritional additives, which are also contained in many traditional Chinese medicines. The efficacy of Brainzyme in the treatment of brain fog has not been reported.

Traditional Chinese Medicine Treatment

Herbal Medicine

Traditional Chinese Medicine treats brain fog according to the principle of syndrome differentiation and treatment. In clinical treatment, I found that there are mainly four common syndromes.

(1) Heart-blood deficiency and heart-yin deficiency:

Main symptoms: Memory loss, lack of concentration, insomnia and dreaminess, dizziness and fatigue, pale complexion or red cheeks, or night sweats or spontaneously sweat, pale tongue or red tongue with little coating, deep and thin pulse.

Treatment principles: Nourishing yin and nourishing blood, calming the mind and the nerves.

Formula selection: Modified BaiziZixinWan.

Herbs selection:Baiziren, Xuanshen, Shudihuang, Gouqizi, Zhigancao, Danggui, Shichangpu, Maimendong, Fuling.

For those with more blood deficiency, add Jixueteng.Heshouwu;

For those with more Yin deficiency, add Baihe, Tianmendong;

For those with sleep disorders, add Suanzaoren, Yejiaoteng.

(2) Disharmony between the heart and kidney:

Main symptoms: Forgetfulness, insomnia, trance, dizziness, palpitations, soreness and weakness of waist and knees, hot flashes and night sweats, tinnitus, red tongue with little or no coating, rapid pulse.

Treatment principles: Nourish yin and calm the mind, regulate heart and kidney.

Formula Selection: Tianwang Buxin Dan

Herbs selection: Baiziren, Suanzaoren, Maimendong, Tianmendong, Shengdihuang, Xuanshen, Taizishen, Wuweizi, Danggui, Yuanzhi, Hehuanpi, Yizhiren.

If the kidney deficiency is the main reason, add Xuduan, Duzhong;

If the heart fire is inflamed, add Zhizi, Huanglian.

(3) Liver qi stagnation:

Main symptoms: Depression, restlessness, irritability, forgetfulness, dreaminess, dizziness, hypochondriac distension, red eyes and bitter mouth, thin white or yellow tongue coating, wiry pulse.

Treatment principles: Soothe the liver and relieve depression, calm the heart and mind.

Formula Selection: Modified XiaoyaoWan

Herbs selection: Chaihu, Danggui, Baishao, Fushen, Baizhu, Xiangfu, Qingpi, Yujin, Zhigancao.

For the cases of live fire excess, add Mudanpi, Zhizi;

For cases with severe emotional depression, add Suxinhua, Meiguihua,Jianghuang;

For the cases of bitter taste in the mouth add Longdancao, Xiakucao.

4Heart and spleen deficiency:

Main symptoms: Forgetfulness, anxiety, lack of concentration, fatigue, palpitations, insomnia, loose stools, or abdominal distention, pale tongue, fat tongue with tooth marks, white and slippery coating, slow pulse.

Treatment principle: Nourish the heart and spleen, soothe the nerves.

Formula Selection:  Modified Guipi Wan.

Herbs selection: Renshen, Huangqi, Baizhu, Danggui, Fushen, Yuanzhi, Suanzaoren, Longyanrou, Wuweizi, Zhigancao.

For those with spleen deficiency and loose stools; add Yiyiren, Cheqianzi;

For those with abdominal distension, add Muxiang, Sharen;

For those with poor appetite add Maiya, Guya;

For those with severe memory loss, add Yizhiren and Shichangpu.

Acupuncture

In addition to herbal treatment, acupuncture is also an effective means of treating post-COVID-19 brain fog. Mainly select the points on the Heart Meridian of Hand Shaoyin, the Pericardial Meridian of Hand Jueyin, the Liver Meridian of Foot Jueyin, the Kidney Meridian of Foot Shaoyin, the Du meridian, and local acupuncture points on the head. Scalp acupuncture can also be used entirely, or electro-acupuncture can be added.

Dietary

Healthy dietary can also help brain fog recovery. A healthy diet (including olive oil, fruits and vegetables, nuts and legumes, and whole grains) has been shown to improve thinking and memory. Avoid alcohol and drugs. Getting enough sleep, listening to music, regular aerobic exercise, and participating in social activities can also help eliminatethe symptoms of brain fog.

Conclusion

Brain fog is very common in the duration of COVID 19 infection and its aftermath. Western Medicine usually applies cognitive rehabilitation therapy to treat Brain Fog, while Traditional Chinese Medicine apply herbals to treat based on a TCM theory that many organs (liver, kidneys, spleen) can affect on brain capacity, however, the brain is mainly charged by the heart. This paper suggests that Chinese herbal medicine can be a very effective alternative or/and supplement treatment to eliminate Brain Fog, with the principle of combining heart and brain in the treatment, by nourishing the heart, tranquilizing the mind, clearing the orifices, and refreshing the brain.

Reference

1. Chou, S. H.-Y. Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19-A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium. JAMA Netw. Open 2021; 4, e2112131.

2.  Hannah E. Davisa.Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. Lancet. e Clinical Medicine.2021; (38): 101019.

3.  Maxime Taquet. Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLOS Medicine 28 Sep 2021.

4.  Christiana Franke. High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms. Brain Behav Immun. 2021 Mar; 93: 415–419.

5. Kiran T Thakur.COVID-19 neuropathology at Columbia University Irving Medical Center/New York Presbyterian Hospital. Brain. 2021; 144 (9): 2696–2708.

6. GwenaëlleDouaud. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature.Published: 07 March 2022.

7.  邓铁涛. 心主神明论的科学性[J].新中医,2003,35(3):15-16.

8.  唐铁军.也谈心主神明与脑主神明[J].中华现代中西医杂志,2004,2(5):443-444.

Monday, 21 February 2022

A natural way of anti depression

 Tiejun Tang     

Do you suffer from depression? 

We all have times when we feel down, but for most of us it is short lived, perhaps lasting for a few days. However, for those with depression the feeling of sadness and anxiety will often persist for weeks, months or even years. 

Depression is one of the leading psychological disorder’s in the West. About 20-30 % of people experience symptoms of depression and it is continuing to affect people of all age groups.

Depression does not discriminate. Regardless of social status, wealth, employment, age, gender, it can affect anyone in society.

Statistics showed that 1 in 4 Britons suffer from a mental health problem within a given year, with anxiety and depression being the most common combination of mental health disorders in the UK.

It has become common practice for Psychiatrists and Psychologists to prescribe antidepressants as the first line of treatment for many mental health disorders. However, this is not without side effects; certain antidepressants have shown to cause sexual dysfunction in men (Jeffrey H. 1995), and cardiovascular toxicity in both sexes. (Pal Pacher, 2004). Although antidepressants have proven to be effective in reducing suicidal rates amongst patients, most people still prefer not to take them because of the side effects and instead opt for conventional or alternative treatment.

Remember, you are not alone in your battle against depression. No matter the duration of your symptoms, help and support is available and recovery is possible. There is no one treatment that fixes all. Everyone responds differently to different treatments. As a TCM Practitioner, I would like to offer my insight on how depression can and have been successfully treated through Chinese medicine.

In traditional Chinese medicine, depression falls within the category of Yu Zheng (郁证) and Zang Zao (脏躁). Chinese medicine believes that low mood, anxiety and irritability are caused by liver qi stagnation; insomnia, dream disturbed sleep, memory loss and palpitation are due to heart shen disorder;  poor appetite and low energy and other indigestion symptoms are due to spleen deficiency; hot flush, night sweat and dry mouth are due to yin deficiency; cold extremities, pale complexion and low libido are due to kidney yang deficiency.

There are many advantages in choosing TCM for the treatment of mental health disorders. According to the symptoms of different cases, we can remove the stagnated qi, regulate the function of Zang Fu (internal) organs, and balance yin and yang energies in the body. We can select herbal pills, such as Xiaoyao Wan, Chaihu Shugan Wan or Guipi Wan. Alternatively, we can prescribe decoction based on Xiaoyao San, Ganmai Dazao Tang and Suanzaoren Tang. Symptoms vary in different cases of depression, therefore, we must modify our prescription according to individual conditions.

My  colleagues in China use molecular biology techniques investigated the anti depression  mechanism of Xiaoyao San. Their research found  that Xiaoyao San  can improve depressive-like behaviors by triggering autophagy to alleviate neuronal apoptosis.  It is an effective supplement for depression treatment, and can be harnessed to enhance autophagy and synergize with antidepressant action.(Wang M 2019)

The selection of acupuncture points should focus on the liver and heart meridians, combining with specific points on the Du meridian and extra points on the head. The points that are commonly used include, Taicong (LV3), Ligou (LV5), Zhangmen (LV13), Qimen (LV14), Shenmen (HT7), Shaohai (HT3), Neiguan (PC6), Baihui (DU20), Shenting (DU24), Yintang (EX-HN3), Taiyang (EX-HN5).

Apart from needling, Tuina massage techniques (especially on the head points as mentioned above) will also help relieve symptoms. Many clinical trials have shown that acupuncture can effectively treat depression. Treatment methods included manual acupuncture (John J 1998), electric acupuncture (Huan Cui 2004), and laser acupuncture (Joo Smith 2005). These research reports showed acupuncture could significantly relieve depression.

Lastly, enjoy your Christmas, enjoy your life. To be depression-free is the first step
to a healthier and happier new year!

Reference:

  1. Jeffrey H. Hsu (1995). Male Sexual Side Effects Associated with Antidepressants: A Descriptive Clinical Study of 32 Patients. The International Journal of Psychiatry in Medicine. 25(2): 191-201.
  2. Pal Pacher, Valeria Kecskemeti. (2004). Cardiovascular Side Effects of New Antidepressants and Antipsychotics: New Drugs, old Concerns? Curr Pharm 10(20): 2463–2475.
  3. Wang M.(2019). Modified Xiaoyao San ameliorates depressive-like behaviors by triggering autophagosome formation to alleviate neuronal apoptosis. Biomed Pharmacother.  Mar;111:1057-1065
  4. John JB et al. (1998). The Efficacy of Acupuncture in the Treatment of Major depression in Women. Psychological Science. 9(5): 397-401.
  5. Han Cui, Li Xiaohong, Luo Hechun.(2004) Clinical study on Electro-acupuncture treatment for 30 cases of mental depression. Journal of Traditional Chinese Medicine. 24 (3): 172-176.
  6. Joo Im Quah-Smith, Wai Mun Tang (2005). Laser acupuncture for mild to moderate depression in a primary care setting – a randomised controlled trial Acupunct Med 23(3):103-111.
Note: * First version published in 24th December 2010, updated version at 21st February 2022. 
         

Thursday, 8 July 2021

How to prevent delta variant?

 Tiejun Tang

The Covid pandemic has spread globally for one and a half years, and many European countries have experienced three peaks. Why does this pandemic seem to be endless? The main reason is the mutation of the virus. First, the Alpha variant appeared in the UK, and then the Beta variant appeared in South Africa, the Gamma variant appeared in Brazil, and then the Delta variant appeared in India.

Genetic mutation is the natural to a virus. As you know many people have been vaccinated for influenza in the past, but they still have the flu. That is because the influenza virus is constantly mutating. So does the Coronavirus.

Currently, there is no effective treatment drug for the Covid virus. Doctors mainly rely on vaccines to control the pandemic, but the speed of vaccine research and development cannot keep up with the speed of virus mutation. Therefore, human beings are in a passive situation in the battle against the virus.

Virologist Shahid Jameel, director of the Trivedi School of Biosciences at Ashoka University, said "we don't yet know whether further mutations would make current vaccines useless, this is unlikely. However, the efficacy of vaccines may be reduced due to mutations."

A Public Health England study published on 22 May found that a single dose of either AstraZeneca's or Pfizer's vaccine reduced a person’s risk of developing COVID-19 symptoms caused by the Delta variant by 33%, compared to 50% for the Alpha variant. A second dose of the AstraZeneca vaccine boosted protection against Delta to 60% (compared to 66% against Alpha), while two doses of Pfizer’s jab were 88% effective (compared to 93% against Alpha).

The third wave of pandemic was caused by Delta variant. How to prevent the Delta variant? We can’t just pin our hopes on vaccines, we need some new ideas.

My PhD tutor professor Deng Tietao used to be the leader of the Chinese Medicine Expert Group on SARS in the State Administration of Traditional Chinese Medicine in 2003. I found his calligraphy last year while I studied his clinical experience on anti SARS. I translated it in English. He said: "The prevention and treatment of influenza is the advantage of traditional Chinese medicine. No matter how virus changes, it couldn’t escape the palm of traditional Chinese medicine. The curative effect of Chinese medicine on SARA and swine flu is the evidence. Researching on Chinese medicine to prevent viral infectious diseases, to replace immune injection, it will benefit the whole world." His exposition ten years ago still gives us a lot of inspiration for today’s pandemic.   

Different from the mechanism of vaccines, Chinese herbal medicine anti the viral infectious diseases by enhancing the body’s own immunity. Studies have shown that Chinese herbal compound has a multi-target action. It not only acts on the cellular immune system, but also on humoral immune system. Chinese herbal medicine preparation likes a great sky net for viruses. That is why Professor Deng Tietao can confidently say: "No matter how the virus changes, it cannot escape the palm of Chinese medicine."

Based on Professor Deng’s clinical experience, combined with the latest research results of modern pharmacology, I developed Modified Yupingfeng San for the prevention of Covid 19.

It showed a satisfactory prevention effect on the subject groups in UK, North America and Taiwan. 

Due to the mutation of the virus, the pandemic is difficult to control. I suggest that in addition to vaccines, traditional alternative medicine therapies should be selected as a complementary preventive method.

Tuesday, 1 June 2021

Anti Covid 19 pandemic under the guidance of Professor Deng Tietao's aca...

The 3rd Traditional Medicine Forum was a international online conference hosted by WTMF and co-sponsored by the World Health Organization. I am honored to be invited to speak at this international conference as the only speaker from UK.
Professor Deng Tietao has over 80 years clinical experience. In 2003 under his supervision China conquered SARS in about 3-4 month. Covid 19 also called SARS-CoV-2. I hope Prof. Deng’s clinical experience on anti SARS can help to anti the pandemic today.  

Wednesday, 19 August 2020

The use of Traditional Chinese Medicines to treat COVID 19 may cause more good than harm

Tiejun Tang

This morning I read an article from the website of Professor Edzard Ernst. The article title is “The use of Traditional Chinese Medicines to treat SARS-CoV-2 may cause more harm than good”. I totally disagree with this opinion and after some investigation, I would like to change a few words in the title of his paper -- "The use of Traditional Chinese Medicines to treat COVID 19 may cause more good than harm."

Actually Mr Ernst is not the author of this article. This paper was originally published by two Australian doctors two month ago [1]. Their conclusion was mainly based on an article which was published by a group of Japanese doctors in 2017. It was a Meta-Analysis paper. The author using PubMed and Ichushi-Web-the database of the Japan Medical Abstracts Society to identify articles published between 1996 and 2015 describing patients with Japanese herbal medicine induced pneumonia. They found that 73 patients have been diagnosed with pneumonia after taking Japanese herbal medicine[2] . The mean age at pneumonia diagnosis was 63.2 ± 15.5 years. The herbal formulas they used were sho-saiko-to (小柴胡汤26%, sairei-to (柴苓汤)(16%, seishin-renshi-in (清心莲子饮) (8%and bofu-tsusyo-san (防风通圣散8%.These formulas all are traditional Chinese medicine formulas which were widely used for hundreds or thousands of years in China, but not for early stage common cold or flu complaints.  Chinese medicine diagnosis for early stage common cold or flu is Taiyang syndrome and the treatment principle should be expelling wind cold or wind heat. The indication of sho-saiko-to is Shaoyang syndrome and of course it is not suitable for Taiyang syndrome. The other 3 formulas are all not suitable for this stage of Taiyang syndrome. If the treatment missed the target of diagnosis, it will not work at all.

In addition to the diagnosis problem, I noticed that the mean age at pneumonia diagnosis was over 60. Elderly people are easier to develop into pneumonia when they catch cold, that is common sense. The conclusion of Mr Enomoto’s article was against the basic principle of statistics -- age group differentiation.

Mr.Gray the author of that article believes that the Chinese herb Scutellariae Radix (Huangqin) is the cause of ARDS. Many of the Chinese medicine formulas which are used in Covid 19 treatment contain Huangqin. That is why he gets his opinion of more harm than good. His evidence for this also came from a Japanese report [3]. In this report only 5 patients have got ARDS after receiving the herbal treatment. He uses this very small sample report to against the report from Dr Ren[4]  which includes 701 cases of Covid 19 with a positive result. From Mr Gray’s article I cannot find any evidence based on a large sample RCT research or laboratory research.

Mr Edzard Ernst is a very famous retired professor and critic of Chinese medicine. We all benefit greatly from constructive logically based criticism but this becomes wasteful and distracting if the criticism is not based on the principles of medical statistics, and is selective in it’s use of research results to support a personal agenda. I would like to be able to say that this paper made a useful addition to the discussion on the efficacy of Traditional Chinese Medicines in the modern world, but unfortunately I cannot.

Just a few days ago, we received some positive news from the US National Centre for Biotechnology Information (NCBI) who stated that “overall,” treatment with the Chinese herbal medicine Lianhua Qingwen for 14 days resulted in a “significantly higher rate of, and a shorter time to, symptom recovery.” Their conclusion is  "Traditional Chinese medicine can help COVID 19 patients recover faster” [5]

I hope that every reader can have a second thought about this topic. Always follow the science.

Reference:

  1. Paul E. Gray. The use of Traditional Chinese Medicines to treat SARS-CoV-2 may cause more harm than good. Pharmacol Res. 2020 Jun; 156: 104776.
  2. Enomoto Y. Japanese herbal medicine-induced pneumonitis: a review of 73 patients. Respir. Investig. 2017; 55:138–144.
  3. Osamu Sakamoto. Clinical and CT characteristics of Chinese medicineinduced acute respiratory distress syndrome.  Respirology 2003; 8(3):344-50. doi: 10.1046.
  4. Ren J.L. Traditional Chinese medicine for COVID-19 treatment. Pharmacol. Res. 2020:104743.
  5. https://www.onenews.ph/us-health-agency-says-traditional-chinese-medicine-can-help-covid-19-patients-recover-faster

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-viral 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.