5 Tips for Long Covid: An East-West Point of View

There's a fascinating historical anecdote about Mozart getting sick and never fully recovering that is very relevant to COVID and long COVID. Now at one point in his life Mozart was said to have been strucken down with a strong fever where he was constantly dancing between life and death and his parents weren't sure if he was actually going to recover and get well again. Now miraculously he survived and I don't know off the top of my head what that infection was or what that fever was from but I do know after that period of time Mozart was said to have had this constant feeling of sickness like a foreboding that he would not live a long time and that he would die young. Now for so many of my patients that I've seen get long COVID from COVID there's a very similar scenario where after this powerful viral infection they have never felt the same since. Now in this video let's jump in east and west and look at long COVID what it looks like and how we treat it with traditional Chinese medicine as well. Hey guys I'm Dr. Alex Hein, doctor of acupuncture and traditional Chinese medicine and author of the health book Master of the Day. So let's jump in walk over to the whiteboard and look at this a little bit closer. All right guys so we're here at this incredibly impressive work of art that I spent weeks of my life creating. When we talk about long COVID specifically you know we're going to talk about east and west and one of the reasons we want to share this east and west is because traditional Chinese medicine for thousands of years has had a very interesting opinion on really viral infections. These febrile events where afterwards people are left in a weakened state so to speak. When you look at the literature the acute phase of COVID is generally accepted to be about four weeks, this is weeks here and then long COVID begins where after 12 weeks which is a long time, three months, you're still not really doing any better and those symptoms are lingering. Obviously if you get a cold or flu and three months later you're still feeling the same symptoms that's more than a little bit worrying. But when we look not only in my clinical practice and what I see day to day but also in the literature there may be about a half dozen buckets of symptoms that you see people having regarding long COVID and we'll talk about these you know east versus west as we move towards this this little journey here. So the first thing is we tend to see neurological issues. Now those can range from things like headaches to obviously even strokes. We talk about CFS chronic fatigue syndrome. Now it's interesting chronic fatigue syndrome is now a documented post-viral stage of illness for some viruses. Now initially when this was being observed these patients were initially considered to be hypochondriacs or just to have depression or anxiety. They were just given antidepressants and sent on their way and told it was all in their head. Now this is going back maybe 40 or 50 years or so but long COVID is another example of a post-viral stage of illness that can lead to something like chronic fatigue syndrome. One of the things I see in my patients with this is that they will say I used to exercise no problem but now specifically when I exercise the next day or two I am like catatonic. I have no energy. I feel depressed. So it is a very distinct feeling that is not just I feel tired because I just did a heart workout yesterday right they're really dipping into the negative in terms of their battery reserves so to speak. The third is obviously respiratory issues right. One of the main issues people come in with for long COVID to my practice is either they have chronic respiratory issues, chronic neurological or nervous system inflammation issues or nervous system in general, respiratory or GI issues. I would say those make up the four main buckets that make up about 90% of the patients that come in to see me. So in terms of respiratory issues we see shortness of breath, we see chronic sputum production, people are coughing or they're still wheezing or they're still clearing the throat for months and months and months after. Mostly what I see is that they're coming in because of issues with chronic phlegm production and again we're going to talk about damp toxin you can see over there. One of the most common TCM diagnoses for long COVID. The fourth is digestive symptoms. I see people coming in with wandering body pains. Maybe we can put that more in the nervous system bucket. They come in with altered bowels in general. They're having upper GI issues, they're having lower GI issues, they're still having diarrhea or severe bloating or wandering abdominal pains I've seen. And the fifth would be issues related to the nervous system. So common ones that I see are wandering aches and pains, chest pain and wandering chest pains. Basically the whole trunk I'm seeing pain. I'm also seeing issues with mental health if you want to call it that, anxiety and depression and sleep issues. I lump these all in the category of nervous system in this regard and overall I would say sleep anxiety and depression would be this massive resurgence or after COVID now my son or my daughter or my wife has insomnia every single night. So I'm seeing that as well. So these five buckets are the most common ones that I'm seeing on a day-to-day basis and when you look in the literature you know certainly outside of for example having strokes and heart attacks, cardiovascular events from it, this is a lot of what makes up the chronic long COVID patients that I see. Let's jump over here. There's a concept in TCM and the reason I wanted to shoot this video is traditional Chinese medicine is about healing and one thing I'm seeing in conventional medicine is that this has been a real struggle for medicine to try to treat and even for long COVID there's really not much that they can offer besides medications. So within TCM there's a saying fu zheng qi xie and this expression means tonify or strengthen let's just call it your resources and remove what is pathogenic right. So check this out here. When we're talking about before this is when you have let's say long COVID, z is going to be zheng qi which means let's just say your resources, your immune system strength right. They're not one-to-one correlates but we're just going to use that as a metaphor or analogy. So when you have long COVID what's happening is that your resources let's just say are 50% of the pathogenic right the viral load whatever's going on here in the acute infection phase or in this case chronic but here what happens is your resources have been deregulated or more commonly they were this case beforehand which is why you got so sick in the first place. Not every case but most of the time I'm seeing this is true even if you weren't aware of it your battery charge is at 50%. Now you get a strong pathogen comes in and it just wipes out anybody that is susceptible. It may wipe them out in terms of they might die, it may wipe them out in terms of they may get very sick for a short period of time but then they're okay, or it may wipe them out in the case that they get very sick or maybe kind of sick but then it lingered because there's still a strong fight basically going on within your body. Now ancient doctors within traditional Chinese medicine had noted that the strength of the patient's zheng qi right this upright qi let's just call it your reserves determines how hard you're hit depending on the strength of the infection how sick you get and how sick you stay and if you are able to recover. So obviously we're seeing a lot of this with long COVID right a lot of people who get very very sick and the ones who had died we're looking at this sort of scenario. So if you're older if you're immunocompromised if you're not in good health currently you have weaker zheng qi a weaker battery charge than someone who is the opposite of that. That will determine number one how sick you get and how chronic it stays. So now what we're looking to do after treatment in my clinic is we boost the reserves and we get rid of what's pathogenic. So this expression in China is support the resources and get rid of this pathogenic and that is what these treatment strategies involve from an acupuncture and an internal medicine and herbal medicine point of view. This is the ultimate philosophy because this is the thing that determines why people get sick in the first place and how they get sick. So I could treat it symptomatically and yet they will end up in this scenario yet again for the next flu pandemic which will eventually happen again. This is what is most essential. So let's come on over to here and we'll talk about the organ networks that are primarily involved. So number one we see the tie-in lung and spleen organ network. So the tie-in organ networks are very very important here because the lung is obviously your lung and the spleen and TCM governs a lot of digestive functions. It is most likely the spleen pancreas so it deals a lot with digestive enzymes, bloating, food allergies, low immunity, that kind of thing. We are saying that is the number one organ network commonly affected because do you remember the initial news on long COVID? Do you remember these reports coming out of China of people taking pictures of this thick glue-like phlegm that they were coughing up and they were literally basically suffocating to death on this kind of mucus and this chunky phlegm. Tie-in the lung and spleen govern what we call the mucus membranes and so they're very susceptible to dampness like mucus and conditions that affect those mucus membranes. Obviously when you catch an upper respiratory infection the lung is one of those things that's affected right because you're coughing and you're sneezing and all of this and you know you may feel a little bit of pressure in the chest. The spleen deals with we say the spleen generates dampness aka mucus and the lung is the container of it. So lots of my patients that come in that are more prone to mucus and phlegm, some it's coming up from the digestive system, the stomach, others it's they have chronic drainage like post nasal drip. The Shaoyang organ networks are the gallbladder and the triple warmer. Now a way to conceptualize these is that these organ networks in TCM are in charge of inflammatory conditions. So when someone comes in and we are treating let's say their acid reflux or we're treating their bronchitis or we're treating their covid where you know what they're having a dry cough, they're having a sore throat, they're having ear aches, ear nose and throat issues and they're having brain fog, we're often treating these organ networks with the Taiyan organ networks. And finally the Shaoyang organ network, the heart and the kidney, one way you can conceptually think of these is that yes that is the axis of the cardiovascular system because the other one where we haven't showed here is Jain which is the pericardium and liver but some of the cardiovascular events here that happen from long covid right like strokes are in this pattern and some of the cardiovascular and nervous system symptoms are in this. So the people who are coming out with a crazy anxiety with heart palpitations is one thing we didn't mention, with a very very elevated resting heart rate, with depression, with sleep issues, that is this organ network that's been deregulated. Maybe people think of it as adrenals but this is really what it is and it's more nervous system in nature. So let's get into how we actually approach this from a TCM herbal point of view. Let's take a look here at how I treat this herbally because the TCM herbal point of view, one there's a lot of evidence about how well these formulas work clinically to treat long covid and I'm seeing this often in my practice and it's very effective. So we've talked about some of the neurological aspects, headaches, brain fog, dizziness, right? To me a lot of these are lymphatic issues and neurological issues. We talked about respiratory issues, shortness of breath, chest symptoms, we talked about nervous system issues, body aches, wandering body pains, that kind of thing, GI issues, etc. Now when we talk about the herbal treatments for long covid, first thing we're talking about damp toxin. So when we talk about dampness, we are talking about not only dampness as in mucus, issues involving the mucus membranes like having to clear your throat or cough up mucus and phlegm, those are the most obvious, but dampness also shows up in the gut. In terms of the gut it can be candida or yeast issues, bloating, food allergies, that kind of thing, thick white tongue coat. If you looked at your tongue while you had covid, I know a lot of you had a disgusting thick white tongue coat. That is damp toxin according to TCM. Now to treat dampness, signs and symptoms of dampness are, for example, can be bloating and GI issues, loose stools and diarrhea was also and cramping was another covid symptom. Headaches, brain fog and dizziness can often be signs of dampness. Now we treat this not only from a nervous system and a dampness point of view and we typically use herbs like gui zhi, which is cinnamon twig or rou gui, cinnamon bark, an herb called bai ju, fuling, and another one called ban xia, which is penelia. Penelia is one of the strongest for these lymphatic issues. People who have chronic lymphatic issues, who are chronically exposed and prone to brain fog and that kind of thing. So we ended up using herbs that we say dry dampness and help with mucus and phlegm. But one of the most common ones I'm using for this, fuling is also poria, ban xia is penelia. Penelia one of the strongest if people have brain fog in particular or pressure sensations in the head. It's also one of the best for mucus and phlegm in the chest. So lots of acid reflux, people are getting mucus and they're coughing a lot, penelia, ban xia is one of the most important. The second pattern is what we call let's say residual damp heat. So sometimes what shows up for this is sometimes people are having skin rashes from COVID, sometimes people are having even hot flashes, they're having what look like fungal or bacterial conditions, you know what look sometimes people have issues like jock itch where it's red and it's raised. These kind of issues that are inflammatory or fungal in nature are called damp heat. So the herbs we use for a damp heat very frequently include herbs like chai hu, bupleurum, as well as huang qin which is scutellaria. The other one being coptis or coptidis rhizoma which is huang lian, very very effective antibacterial agents and antifungals as well. They're also really well studied for treating candida and yeast issues, that kind of thing. When we talk about qi and blood stasis, a lot of the time this involves symptoms like fixed pain. So obviously one of the scarier symptoms we saw of COVID was these cardiovascular events like strokes and even for some people heart attacks, right? So these clotting events are often viewed as blood stagnation. Now in an ordinary person that develops let's say a clot or a stroke, there's some kind of chronic cardiovascular impairment, right? There's an issue in the flow of that river that is not working and now you're leading to clotting elsewhere in the body. Due to the unique aspects of COVID we're seeing this also. So the herbs that we use are herbs like tauren and hong hua and these herbs help what we call say move blood stagnation. A lot of these same herbs are herbs that we use for blood stasis elsewhere in the body. You can use them to assist let's say for example leiomyomas, ovarian cysts it can be used for as well or fixed abdominal pain due to other gynecological conditions like endometriosis for example. Talk about lung and spleen qi deficiency. What we're seeing here is most often respiratory and digestive symptoms that linger. Respiratory being like chronic shortness of breath, chronic wheezing, chronic sputum production, mucus and on the GI side we're typically seeing very low appetite, we're seeing bloating, we're seeing loose stools, food allergies and sometimes for women discharge that kind of thing. So remember lung and spleen often govern issues with the mucus membranes and with dampness. Basically the mucosa, right? Not only lung but it can be the nose, the sinuses, it can be the stomach, it can be the intestines. So for this we often use a combination of herbs. Some are again rou gui, cinnamon bark, some are ren qian, ginseng, bai ju, attractalodes, dries a lot of the dampness and fuling poria is like a mild diuretic basically that flushes some of this residual congestion people have. So we use these for lots of other general internal medicine conditions but that one in particular we end up using for these residual that kind of pattern. And then when we say yin deficiency generally we're talking about for some people they have sensations of hot flashes after. Sometimes we treat that as yin deficiency is almost like your engine oil has run out on your car now the car is running hot and that heat is just smoking and rising out of the car. In this case it's usually the head that people say they feel hot. So those are some of the main herbal patterns that I'm seeing clinically day to day and let's talk about a case so I can describe exactly what she was experiencing and what that looked like and how we treated it. So this particular woman came in who was 34 years old and she came in with a few symptoms of different organ networks here in TCM. First was the xiaoyang organ network because her primary symptom she was complaining of was you know when she was young she had a history of headaches and migraines but now that she's had COVID they've just gone to crisis mode every single day. She'll have a migraine for three days straight and that was not something she normally had before. So headaches and migraines are often the signs of what we call either constraint or floating yang right it's almost like there's this heat in the system the heat heat heat is just packed and then it just starts rising and it causes havoc. So for this pattern headaches and migraines it was almost like COVID had brought up a constitutional genetic susceptibility that she had prior. For her migraines we used a formula that is called xiao chai hu tang. Now xiao chai hu tang that modification is basically something we use to unblock the gallbladder and the triple warmer and the lymphatic system in particular. So chai hu is often used for issues involving you know the submandibular lymph nodes for example where people will say all my glands are swollen right because I have a sore throat and I'm getting sick. The second one she came in with dizziness brain fog and shortness of breath. Now these conditions are typically involving dampness or lung and spleen qi deficiency. So the dizziness the brain fog and the shortness of breath were associated with these POTS symptoms right she was having pretty significant dizziness and vertigo. Dizziness and vertigo we often utilize formulas that one treat the nervous system we call this weak yang or yang heart yang deficiency because they often have issues with heart rate variability palpitations that kind of thing. And we combine them with herbs that we say move the lymphatic system and drain dampness. So herbs like penelia, bansha, atractylodes, baiju, fuling, poria, rou gui, cinnamon bark. All of these really really effectively move the lymphatic system and improve the circulation to these zones. And then when we talk about the chai and organ network the heart and the kidney we're really treating her nervous system at that point the adrenals if you want to call it that. A lot of these symptoms present with what the lay person calls adrenal issues, heart rate variability, elevated heart rate, anxiety, chronic fatigue, exhaustion that sort of thing. She was having POTS so a lot of dizziness a chronic fatigue like pattern where for example she couldn't exercise anymore and actually she couldn't even work when she came to me so she's quite fatigued. General body aches and also insomnia. So for this we use the combination of a high dose of this cinnamon twig guajir and cinnamon bark rou gui and what those herbs are very effective for is for taking the nervous system down a couple notches and with conditions that also involve palpitations, elevated heart rate, anxiety. Guajir is the king of anything on the planet for treating that kind of thing. So that is a sample case and for her within about three weeks the migraines had decreased by 50% and within about three months she was 95% back to normal after two years of not being able to work. So this was a very interesting sort of overview of long COVID what it is east versus west and how we treat it. Now also if you guys are interested in healing with traditional Chinese medicine in particular I have a free guide on my website. It's the first link right below this video. Four daily rituals that could potentially help you add years to your life with traditional Chinese medicine. Also I do see patients like this in my private practice in Los Angeles or virtually via telemedicine so you can reach out. The link to reach out to my clinic and private practice is below this video if you ever want to discuss more. And before we go I also have a related video for you right there.