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