Peilin Sun - The Pathogenesis and Treatment of Covid-19 and Long Covid With Traditional Chinese Medicine-World Scientific (2023)
Peilin Sun - The Pathogenesis and Treatment of Covid-19 and Long Covid With Traditional Chinese Medicine-World Scientific (2023)
Peilin Sun - The Pathogenesis and Treatment of Covid-19 and Long Covid With Traditional Chinese Medicine-World Scientific (2023)
com
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COVID-19--etiology | COVID-19--complications
Classification: LCC RA644.C67 | NLM WC 506.2 | DDC 616.2/414--dc23/eng/20220314
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Printed in Singapore
Foreword
the extent of the suffering caused by the pandemic around the world,
it is greatly welcome.
The author, Peilin Sun, has been a prolific contributor to the
Chinese medicine profession for many years. He has shared his
knowledge generously via the Journal of Chinese Medicine since the
1990s, and as editor I have been fortunate to work with him to bring
his articles to publication. More recently, Professor Sun responded to
the coronavirus pandemic with urgency and an admirable commit-
ment to be of assistance to his colleagues around the world. He
swiftly set about researching to understand the nature of the disease
the world was faced with and how it might best be treated with tra-
ditional Chinese medicine, and has since shared his findings gener-
ously. Initially, this material was based on clinical reports from the
frontline of care in China, and as the pandemic has progressed and
he has built up a significant body of clinical experience in treating
this disease, he has shared his valuable insights into the treatment of
side-effects of the vaccines and how to intervene in the crucial con-
valescent phase of COVID-19 to prevent patients’ lives being blighted
by Long COVID.
Professor Sun’s work is characterized by great clarity in clinical
thinking and a broadness of perspective that encompasses both the
extreme complexity of detail characteristic of Western biomedicine
v
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
vi
Preface
vii
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
more. We believe that the stronger the immunity, the more ammuni-
tion for the battle, which means more power to resist the attack of the
virus and protect human health.
Globally, there is a lot of knowledge about the virus but the
knowledge of how to eradicate it or make it harmless is still in its
infancy. There is no effective treatment plan for it at this stage. At the
start of the outbreak last March, vaccine options were being tested,
the human population had not received any vaccine, and there
was little or no immunity against COVID-19. At the point of writing
this book, vaccination rates in most developed countries has
achieved a relative high level, although people still feel frustrated
because of the phenomena, i.e., while observing the high efficacy of
COVID-19 vaccines in the prevention of severe and critical cases,
and new confirmed COVID-19 numbers increasing sharply over the
past few weeks up to November 2021 even among those who have
been fully vaccinated. This is because the natural immunity is still
low to COVID-19. Even when fully vaccinated, people are still at risk
of getting infected. Some new variants are emerging and among
them, the Delta variant is highly infectious, and has spread all over
the world. Many have found it difficult to keep up with new policies
and changes to measures. “Zero COVID” by means of isolation, guar-
antee, and lockdown measures does not seem to be a realistic option
viii
Preface
anymore, because not every country can stay locked down and
closed off indefinitely. Thus, almost all the countries over the world
have accepted the strategy of “Living with COVID-19”, encouraging
people to take personal and social responsibilities properly.
To achieve the goal of “Living with COVID-19” successfully dur-
ing the battle against this epidemic/pandemic event including Long
COVID, TCM stresses the great importance of zheng-qi instead of
passive home isolation or a symptomatic treatment. TCM health sup-
port and care is to offer a holistic approach and treat each case dif-
ferently to speed up the recovery, prevent aggravation of illness, and
diminish Long COVID complaints as much as possible. At the start of
compiling this book, our aim was to introduce the valuable knowl-
edge of TCM in managing Long COVID, but we quickly realized that
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ix
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Ms. Shi Ying Koe and Dr. Natalie K. Watson from the publishing
house, for their patience, kindness and great assistance. Without their
efforts and guidance, it could be impossible for this team to reach the
point of publication.
I am also thankful for all the public websites. Through them I
could surf, search, study and improve my knowledge. All English
names of herbal formulas in this book are obtained from https://
www.americandragon.com/.
COVID-19 will eventually become a minor virus, but the infor-
mation included in this book should not cease to apply at that stage,
as it is a guide to the treatment of all viruses and can become part of
the future treatments in TCM as a whole.
Peilin Sun
December 2021, Belgium
x
About the Author
xi
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
xii
List of Contributors
xiii
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
xiv
List of Contributors
Ohio University, and Chair Professor of the US-China Joint Institute for
Acupuncture & Rehabilitation Medicine at Wenzhou Medical
University. Dr. Yang also have served as director for the SHI acupunc-
ture school, vice president at American TCM Association few years
ago, and supervised the doctoral program at American Academy of
Acupuncture & Oriental Medicine and other 10 medical university in
the World. He is president of Chinese Medicine Luobing Society of
American. During his career, Dr. Yang published 10 books and over 70
research articles on basic biology and traditional Chinese medicine,
and work as editor and reviewer for numerous renowned SCI journals.
Dr. Yang also is associate editor for International Journal of Clinical
Acupuncture. He also is vice president of the World Federation of
Chinese Medicine Digestion Committee and Endocrine Committee.
xv
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
xvi
List of Contributors
xvii
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Foreword v
Preface vii
About the Author xi
List of Contributors xiii
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xix
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
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Contents
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1
World Health Organization (WHO). Director-General’s opening remarks at the
media briefing on COVID-19–19 April 2021. (Press Release) 19 April 2021. https://
www.who.int/director-general/speeches/detail/director-generals-opening-remarks-
at-the-media-briefing-on-covid-19-19-april-2021.
1
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
2
General Procedures of Treatment of COVID-19
2
Xi Vivien Wu, et al. Traditional Chinese Medicine as a complementary therapy in
combat with COVID-19—A review of evidence-based research and clinical practice.
Journal of Advanced Nursing. 2021, 77: 1635–1644. https://doi.org/10.1111/
jan.14673.
3
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
3
Wei Ren, et al. Research advance on Qingfei Paidu Decoction in prescription
principle, mechanism analysis and clinical application. Frontiers in Pharmacology.
2021, 11: 589714. https://doi.org/10.3389/fphar.2020.589714.
4
General Procedures of Treatment of COVID-19
4
Zhenyu Zhao, et al. Prevention and treatment of COVID-19 using Traditional
Chinese Medicine: A review. Phytomedicine. 2021, 85: 153308. doi: 10.1016/j.
phymed.2020.153308.
5
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
5
Ibid.
6
General Procedures of Treatment of COVID-19
6
Xiaoming Li, et al. CT imaging changes of corona virus disease 2019 (COVID-19):
A multi-center study in Southwest China. Journal of Translational Medicine. 2020,
18: 154. https://doi.org/10.1186/s12967-020-02324-w.
7
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
1.1.2 In TCM
Diagnosis of COVID-19 in TCM could be obtained or confirmed by
the following procedures.
Since there is no term for “virus” in TCM, the diagnosis of
COVID-19 in TCM is completely different from those in modern
medicine. Common symptoms and signs of COVID-19 include:
• fever
• dry cough
• fatigue
• shortness of breath or breathing difficulties
• loss of smell or taste
• muscle pain or headache
• joint pain
• chest pain
• depression or anxiety
• memory, concentration, or sleep problems
8
General Procedures of Treatment of COVID-19
• dizziness
• worsened symptoms after physical or mental activities
9
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
10
General Procedures of Treatment of COVID-19
• The pair of yin and yang is the most general classification for pat-
tern diagnosis and description of the relationship between the
other three pairs of the principles.
• The pair of interior and exterior differentiation is not made based
on etiology of disease but location, which could give an indication
of the direction the illness is becoming—more external or migrat-
ing deeper into the body.
• The pair of cold and heat describes the nature of a pattern and
clinical manifestations.
• The pair of deficiency and excess is made according to the pres-
ence or absence of a pathogenic factor and the strength of the
body’s energetic substances.
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11
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
12
General Procedures of Treatment of COVID-19
7
Yuguo Li, et al. Role of air distribution in SARS transmission during the largest noso-
comial outbreak in Hong Kong. Wiley online library. Indoor Air. 2004, 15(2): 83–95.
https://doi.org/10.1111/j.1600-0668.2004.00317.x.
8
Hongchao Qi, et al. COVID-19 transmission in Mainland China is associated with
temperature and humidity: A time-series analysis. Science of the Total Environment.
2020, 728: 138778. https://doi.org/10.1016/j.scitotenv.2020.138778.
9
Benjamin D. Dalziel, et al. Urbanization and humidity shape the intensity of
influenza epidemics in U.S. cities. Science. 2018, 362(6410): 75–79. doi: 10.1126/
science.aat6030.
10
Muhammad Farhan Bashir, et al. Correlation between climate indicators and
COVID-19 pandemic in New York, USA. Science of the Total Environment. 2020,
728: 138835. https://doi.org/10.1016/j.scitotenv.2020.138835.
11
David N. Prata, et al. Temperature significantly changes COVID-19 transmission in
(sub)tropical cities of Brazil. Science of the Total Environment. 2020, 729: 138862.
https://doi.org/10.1016/j.scitotenv.2020.138862.
12
Peng Shi, et al. Impact of temperature on the dynamics of the COVID-19 outbreak
in China. Science of the Total Environment. 2020, 728: 138890. https://doi.
org/10.1016/j.scitotenv.2020.138890.
13
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
13
Muhammad Farhan Bashir, et al. op. cit.
14
Peng Shi, et al. op. cit.
15
David N. Prata, et al. op. cit.
16
Amitesh Gupta, et al. Significance of geographical factors to the COVID-19 out-
break in India. Modeling Earth Systems and Environment. 2020, 6: 2645–2653.
https://doi.org/10.1007/s40808-020-00838.
14
General Procedures of Treatment of COVID-19
the “outer reflects the inner” principle, which means external struc-
tures reflect the conditions of the internal structures. Besides, by
observing the various regions of the tongue, we can identify the
organs or tissues affected by COVID-19.
The aspects of the tongue considered in diagnosis in COVID-19
include:
• tongue characteristics
• body color
• body shape
• tongue coating
• tongue moisture
15
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
16
General Procedures of Treatment of COVID-19
principles.
17
Sheng-Teng Huang, et al. Principles and treatment strategies for the use of Chinese
herbal medicine in patients at different stages of coronavirus infection. American
Journal of Cancer Research. 2020, 10(7): 2010–2031. eCollection 2020.
17
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
18
General Procedures of Treatment of COVID-19
the critical stage of COVID-19. This is due to the failure of the lung
in descending the qi, resulting from deterioration of the situations
from various kinds of causative factors. The main clinical manifesta-
tions are severe cough, dyspnea or even asthma, chest tightness,
excitation of profuse foamy or diluted phlegm, edema, scanty urina-
tion, greasy tongue coating and a slippery pulse.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
organs, leading to high fever, cough with yellow phlegm, chest pain,
dyspnea, insomnia, restlessness, thirst, severe constipation for a few
days, abdominal pain with distension, headache, red tongue, yellow
and dry tongue coating, and a deep, wiry and rapid pulse.
20
General Procedures of Treatment of COVID-19
18
Joan Loo, et al. COVID-19, immunothrombosis and venous thromboembolism:
Biological mechanisms. Thorax. 2021, 76(4): 412–420. http://dx.doi.org/10.1136/
thoraxjnl-2020-216243.
21
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
weak pulse.
22
General Procedures of Treatment of COVID-19
19
Lihua Zhang, et al. Association between use of Qingfei Paidu Tang and mortality
in hospitalized patients with COVID-19: A national retrospective registry study.
Phytomedicine. 2021, 85: 153531. doi: 10.1016/j.phymed.2021.153531.
23
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
24
General Procedures of Treatment of COVID-19
20
Ibid.
25
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Qiang Huo Sheng Shi Tang—Notopterygium Decoction to Overcome
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Dampness.
Herbal Treatment:
Huo Xiang Zheng Qi San—Agastache Powder to Rectify the Qi.
26
General Procedures of Treatment of COVID-19
27
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Ma Xing Gan Shi Tang—Ephedra, Apricot Kernel, Gypsum and
Licorice Decoction.
Herbal Treatment:
Xiao Qing Long Tang—Minor Blue Green Dragon Decoction.
28
General Procedures of Treatment of COVID-19
• When it attacks the wei system in the body, it may bring about
aversion to cold, slight sweating with difficulty in lowering down
the fever, fever, slight cough, headache and body pain with heavy
sensation, red tip of the tongue, and a superficial and rapid pulse.
• While the invasion of damp-heat to the middle Jiao could cause
fever, aversion to cold, slight cough, nausea, poor appetite, vomit-
ing, stomach pain or abdominal pain, loose stool, heaviness of the
body, red tongue, yellow and greasy tongue coating, and a super-
ficial and slippery pulse.
• If there is an invasion of damp-heat to the lower burner, it could
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Herbal Treatment:
Lian Po Yin—Coptis and Magnolia Bark Drink
or
San Ren Tang—Three Seed (Nut) Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
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Herbal Treatment:
Yin Qiao San—Honeysuckle and Forsythia Powder.
30
General Procedures of Treatment of COVID-19
Herbal Treatment:
Qing Ying Tang—Clear the Nutritive Level Decoction.
Herbal Treatment:
Tiao Wei Cheng Qi Tang—Regulate the Stomach and Order the Qi
Decoction
or
Da Cheng Qi Tang—Major Order the Qi Decoction.
31
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Dan Shen Yin—Salvia Drink
or
Tao Hong Si Wu Tang—Four Substance (Things) Decoction with
Safflower and Peach Pit.
21
Xi Zhan, et al. Postinflammatory pulmonary fibrosis of COVID-19: The current
status and perspective.Chinese Journal of Tuberculosis and Respiratory Diseases
(中华结核和呼吸杂志). 2020, 43(9): 728–732. doi: 10.3760/cma.j.cn112147-
20200317-00359.
32
General Procedures of Treatment of COVID-19
Herbal Treatment:
Si Ni Tang—Frigid Extremities Decoction.
33
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Si Jun Zi Tang—Four Gentlemen Decoction.
Herbal Treatment:
Shi Quan Da Bu Tang—All-Inclusive Great Tonifying Decoction
or
Li Zhong Tang—Decoction (Pill) to Regulate the Middle.
34
General Procedures of Treatment of COVID-19
Herbal Treatment:
Sha Shen Mai Men Dong Tang—Glehnia and Ophiopogonis
Decoction.
35
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
22
Carlos del Rio, et al. COVID-19–New insights on a rapidly changing epidemic.
JAMA. 2020, 323(14): 1339–1340. doi: 10.1001/jama.2020.3072.
23
Stephanie I. Cheng. Medical acupuncture as a treatment for novel COVID-19-
related respiratory distress: Personal experience from a frontline anesthesiologist.
Medical Acupuncture. 2021, 33(1): 83–85. http://doi.org/10.1089/acu.2020.1467.
36
General Procedures of Treatment of COVID-19
24
Zhenzhen Han, et al. Is acupuncture effective in the treatment of COVID-19
related symptoms? Based on bioinformatics/network topology strategy. Brief
Bioinform. 2021, 22(5). https://doi.org/10.1093/bib/bbab110.
37
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
25
Chen Yong, et al. Acupuncture for corona virus disease 2019 A protocol for system-
atic review and meta analysis. Medicine. 2020, 99(40): p. e22231. doi: 10.1097/
MD.0000000000022231.
26
Meaghan Elizabeth Coyle, et al. Acupuncture therapies for chronic obstructive
pulmonary disease: A systematic review of randomized, controlled trials. Alternative
Therapies in Health Medicine. 2014, 20(6): 10–23. https://pubmed.ncbi.nlm.nih.
gov/25478799/.
38
General Procedures of Treatment of COVID-19
39
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Wind-cold
Hegu L.I.-4, Waiguan SJ-5, Lieque LU-7, Fengchi GB-20, and Fengmen
BL-12, etc. A reducing method is applied on these points. Moxibustion
is suggested to be applied on the first three points.
Wind-heat
Erjian L.I.-2, Hegu L.I.-4, Waiguan SJ-5, Yuji LU-10, Fengchi GB-20,
and Fengmen BL-12, etc. A reducing method is applied on these
points.
40
General Procedures of Treatment of COVID-19
41
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
42
General Procedures of Treatment of COVID-19
1.5 Precautions
COVID-19 is a highly contagious disease that could transmit from
person-to-person directly. During the TCM treatment, especially acu-
puncture treatment, preventive measures should be taken to prevent
being infected. The infectious period is 10 days from the onset of the
43
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
44
General Procedures of Treatment of COVID-19
But when it enters the severe or critical stage, herbs to descend the
lung-qi should be applied, including:
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The fullness of the chest with tightness is the most urgent problem to
be solved. Extra herbs should be added, such as:
45
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1
World Health Organization (WHO). Coronavirus disease (COVID-19). 15 April
2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
2
World Health Organization (WHO). Clinical management of severe acute respira-
tory infection (SARI) when COVID-19 disease is suspected. 2020. https://www.who.
int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-
when-novel-coronavirus-(ncov)-infection-is-suspected.
3
World Health Organization (WHO). Coronavirus disease (COVID-19). Weekly epi-
demiological update and weekly operational update. 2020. https://www.who.int/
emergencies/diseases/novel-coronavirus-2019/situation-reports.
47
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
4
National Health Commission of People’s Republic of China. Diagnostic and treat-
ment plan of coronavirus disease 2019. 7th edn. 2020. http://www.nhc.gov.cn/yzygj/
s7653p/202003/46c9294%20a7dfe4cef80dc7f5912eb1989.shtml.
5
Zhiru Gao, et al. A systematic review of asymptomatic infections with COVID-19.
Journal of Microbiology, Immunology and Infection. 2021, 54(1): 12–16. doi:
10.1016/j.jmii.2020.05.001.
6
Jasper Fuk-Woo Chan, et al. A familial cluster of pneumonia associated with the 2019
novel coronavirus indicating person-to-person transmission: A study of a family cluster.
The Lancet. 2020, 15, 395(10223): 514–523. doi: 10.1016/S0140-6736(20)30154-9.
7
Zhiliang Hu, et al. Clinical characteristics of 24 asymptomatic infections with
COVID-19 screened among close contacts in Nanjing, China. Science China Life
Sciences. 2020, 63(5): 706–711. https://doi.org/10.1007/s11427-020-1661-4.
48
TCM Treatment of Asymptomatic Infections of COVID-19
8
Gao Wenjing, et al. Advances on presymptomatic or asymptomatic carrier transmis-
sion of COVID-19. Chinese Journal of Epidemiology. 2020, 41(0): 485–488. doi:
10.3760/cma.j.cn112338-20200228-00207.e.
9
Lirong Zou, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected
patients. The New England Journal of Medicine. 2020, 382: 1177–1179. doi:
10.1056/NEJMc2001737.
10
Yi Chen, et al. Epidemiological characteristics of infection in COVID-19 close
contacts in Ningbo city. Chinese Journal of Epidemiology. 2020, 10, 41(5): 667–671.
doi: 10.3760/cma.j.cn112338-20200304-00251.
11
Anne Gulland. (2020, 2011). Could you be a coronavirus super spreader? The
Telegraph: [1] https://www.telegraph.co.uk/health-fitness/body/could-coronavirus-
super-spreader/.
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Yan Bai, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA.
2020, 323(14): 1406–1407. doi:10.1001/jama.2020.2565.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
13
Manzi Zhang, et al. The initial 52 cases of asymptomatic infections in the new
outbreak cluster 21 cases were referred to confirmed. Xinhua Net (新华网). 9 July
2020. http://www.xinhuanet.com/politics/2020-07/09/c_1126217493.htm.
14
Yunshuang Yang, et al. Discussion on TCM treatment strategies for asymptomatic
patients with new coronary pneumonia. Basic Medical Theory Research (基础医学
理论研究). 2020, 2(2): 5–6.
15
Annelies Wilder-Smith, et al. Asymptomatic SARS coronavirus infection
among healthcare workers, Singapore. Emerging Infectious Diseases. 2005, 11(7):
1142–1145. doi: 10.3201/eid1107.041165.
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CoV-2 (COVID-19). Travel medicine and infectious disease. 2020, 35: 101608.
doi: 10.1016/j.tmaid.2020.101608.
50
TCM Treatment of Asymptomatic Infections of COVID-19
infections.
It is difficult to detect asymptomatic infected persons and keep
them quarantined in time. The asymptomatic infection could easily
cause an accumulation of infection sources, posing a major chal-
lenge to the prevention and control of the epidemic. The study has
shown that the presence or absence of clinical symptoms is not sig-
nificantly related to the severity of COVID-19 patients. There is no
difference between the pathophysiological changes caused by 2019-
nCoV infection to asymptomatic patients and symptomatic patients.
For instance, in a study, 21 patients in the asymptomatic group
underwent chest CT examination, of which 12 cases showed bilateral
pneumonia, two cases showed unilateral pneumonia, and the
remaining seven cases underwent CT examination in a third-party
17
Zhonghua Liu, et al. The epidemiological characteristics of an outbreak of 2019
novel coronavirus diseases (COVID-19) in China. Chinese Journal of Epidemiology.
2020, 41(2): 145–151. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003.
18
Sijia Tian, et al. Characteristics of COVID-19 infection in Beijing. Journal
of Infection. 2020, 80(4): 401–406. doi: 10.1016/j.jinf.2020.02.018.
19
COVID-19 National Emergency Response Center, Epidemiology and Case
Management Team, Korea Centers for Disease Control and Prevention. Early
epidemiological and clinical characteristics of 28 cases of coronavirus disease in
South Korea. Osong Public Health and Research Perspectives. 2020, 11(1): 8–14.
doi: 10.24171/j.phrp.2020.11.1.03.
51
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20
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novel coronavirus. Chinese Journal of Infectious Diseases (中华传染病杂志). 2020,
38(12): 772–776. doi: 10.3760/ca.j.cn311365-20200319-00356.
21
Zhibin Hu, et al. Discovery and management of latent infections of the new coro-
navirus. Chinese Journal of Preventive Medicine (中华预防医学杂志). 2020, 54(5):
484–485. doi: 10.3760/cma.j.cn112150-20200229-00220.
22
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Chinese Medical Journal (Engl). 2020, 133(9): 1123–1125. doi: 10.1097/
CM9.0000000000000798.
52
TCM Treatment of Asymptomatic Infections of COVID-19
23
Fei Zhou, et al. Clinical course and risk factors for mortality of adult inpatients with
COVID-19 in Wuhan, China: A retrospective cohort study. The Lancet. 2020,
395(10229): 1054–1062. doi: 10.1016/S0140-6736(20)30566-3.
24
Kin Wing Choi, et al. Outcomes and prognostic factors in 267 patients with severe
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139(9): 715–723. doi: 10.7326/0003-4819-139-9-200311040-00005.
25
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(MERS). Thorax. 2018, 73(3): 286–289. doi: 10.1136/thoraxjnl-2016-209313.
26
Xiaoxia Lu, et al. SARS-CoV-2 infection in children. The New England Journal of
Medicine. 2020, 382(17): 1663–1665. doi: 10.1056/NEJMc2005073.
27
Jieliang Chen. Pathogenicity and transmissibility of 2019-nCoV-A quick overview
and comparison with other emerging viruses. Microbes and Infection. 2020, 22(2):
69–71. doi: 10.1016/j.micinf.2020.01.004.
28
Wenhao Su, et al. Analysis of clinical characteristics of asymptomatic infection of
novel coronavirus. Chinese Journal of Infectious Diseases (中华传染病杂志). 2020,
38(12): 772–776. doi: 10.3760/cma.j.cn311365-20200319-00356.
53
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29
Saskia L. Smits, et al. Exacerbated innate host response to SARS-CoV in aged non-
human primates. PLOS Pathogens. 2010, 6(2): e1000756. doi: 10.1371/journal.
ppat.1000756.
30
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Clinical Infectious Diseases. 2005, 41(Suppl 7): S504–512. doi: 10.1086/432007.
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Zhibin Hu, et al. op. cit.
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TCM Treatment of Asymptomatic Infections of COVID-19
• Although the PCR test is positive, its pathogenic qi is still mild and
the zheng-qi of the patient is sufficient. The patient is considered
asymptomatic when he is able to fight against, control, and dispel
the pathogenic qi.
• Zheng qi is insufficient, and the pathogens are relatively strong,
in which xie-qi is able to enter deeply into the body and hide in
the Mo Yuan. In this situation, the battle between zheng-qi and
xie-qi is not violent and obvious. Although the disease will not
occur temporarily, it could start at any time when xie-qi grows
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Wang YF, et al. (2020). CT image features of asymptomatic patients with novel
32
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
33
Qi Wang. The classification of 9 basic TCM constitution types and the basis
for their diagnosis. Journal of Beijing University of Traditional Chinese Medicine
(北京中医药大学学报). 2005, 28(4): 1–8.
58
TCM Treatment of Asymptomatic Infections of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
60
TCM Treatment of Asymptomatic Infections of COVID-19
Depending upon the location and mixture of this damp with some
other pathogenic factors, some herbs should be combined, including
the following.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
62
TCM Treatment of Asymptomatic Infections of COVID-19
Following herbs are used to protect and restore the lung in dispersing
the qi:
Ma Huang Herba Ephedrae 10 g
Gui Zhi Ramulus Cinnamomi Cassiae 10 g
Jie Geng Radix Platycodi Grandiflori 10 g
Xing Ren Semen Pruni Armeniacae 10 g
Zi Su Ye Folium Perillae Frutescentis 10 g
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Following herbs are used to protect and restore the lung in descend-
ing the qi:
Ma Huang Herba Ephedrae 10 g
Gui Zhi Ramulus Cinnamomi Cassiae 10 g
Xing Ren Semen Pruni Armeniacae 10 g
Zi Su Zi Fructus Perillae Frutescentis 10 g
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
64
TCM Treatment of Asymptomatic Infections of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
66
TCM Treatment of Asymptomatic Infections of COVID-19
Principles of Treatment:
Dispel wind-heat and disperse the lung-qi.
Herbal Treatment:
Sang Ju Yin-Mulberry Leaf and Chrysanthemum Decoction.
nucleic acid to turn negative, which is the first in the country. Taiyuan Evening
News (太原晚报). 1 March 2020. http://www.tynews.com.cn/system/2020/03/01/
030187933.shtml.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanation:
• Sang Ye and Ju Hua promote sweating to dispel wind-heat and
relieve external symptoms. They could prevent further invasion of
wind-heat into the deep layer of the body.
• Huang Qin and Lian Qiao clear the heat in the upper Jiao and
remove the toxins.
• Jie Geng disperses and protects the lung-qi. Meanwhile, it resolves
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the phlegm in the lung and relieves possible coughing. Xing Ren
disperses and descends the lung-qi at the same time, and could
prevent the failure of lung-qi in descending. In this way, the lung
is well protected.
• Zhe Bei Mu is applied here to resolve the heat-phlegm because it
works in combination with Jie Geng to eliminate potential cough
due to heat-phlegm.
Modifications:
• In the case of an obvious sore throat, add Niu Bang Zi Fructus
Arctii Lappae 10 g and Bo He Herba Menthae Haplocalycis 5 g to
improve throat condition and relieve the sore throat.
• In the case of too much cough, add Zhi Ban Xia Rhizoma Pinelliae
Ternatae Preparata 10 g and Gua Lou Pi Pericarpium Trichosanthis
10 g to eliminate phlegm and relieve the cough.
• In the case of strong loss of smell, add Cang Er Zi Fructus Xanthii
Sibirici 10 g and Xin Yi Hua Flos Magnoliae 10 g to open the nasal
orifice and relieve the loss of smell.
• In the case of obvious loss of taste, add Sha Ren Fructus Amomi
5 g and Shi Chang Pu Rhizoma Acori Graminei 10 g to benefit the
orifice and improve the tastebuds.
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TCM Treatment of Asymptomatic Infections of COVID-19
Principles of Treatment:
Dispel wind-cold and disperse the lung-qi.
Herbal Treatment:
Jing Fang Bai Du San-Schizonepeta and Saposhnikoviae Powder to
Overcome Pathogenic Influences.
Explanation:
• Jing Jie, Fang Feng and Zi Su Ye are used to dispel wind-cold and
relieve external symptoms.
• Du Huo and Qiang Huo promote sweating to dispel wind-cold
and relieve muscle pain.
• Jie Geng, Xing Ren and Zi Su Zi disperse the qi of the lung and
protect the lung in its descending qi.
• Fu Ling tonifies the zheng-qi and resolves phlegm.
Modifications:
• In the case of an obvious sore throat, add Niu Bang Zi Fructus
Arctii Lappae 10 g and She Gan Rhizoma Belamcandae Chinensis
10 g to improve throat condition and relieve the sore throat.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• In the case of too much cough, add Zhi Ban Xia Rhizoma Pinelliae
Ternatae Preparata 10 g to eliminate phlegm and relieve the cough.
• In the case of strong loss of smell, add Cang Er Zi Fructus Xanthii
Sibirici 10 g and Xin Yi Hua Flos Magnoliae 10 g to open the nasal
orifice and relieve the loss of smell.
• In the case of an obvious loss of taste, add Sha Ren Fructus Amomi
5 g and Shi Chang Pu Rhizoma Acori Graminei 10 g to benefit the
orifice and improve the tastebuds.
Principles of Treatment:
Resolve cold-damp and harmonize the middle Jiao.
Herbal Treatment:
Huo Xiang Zheng Qi San-Agastache Powder to Rectify the Qi.
Explanation:
• Huo Xiang and Pei Lan dispel cold-damp and resolve damp in the
middle Jiao.
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TCM Treatment of Asymptomatic Infections of COVID-19
• Cang Zhu, Zhi Ban Xia and Chen Pi resolve damp in the middle
Jiao and harmonize the spleen and stomach.
• Jie Geng and Zhi Ban Xia could eliminate phlegm in the lung and
prevent coughing.
• Hou Po eliminates damp in the middle Jiao and resolves fullness
in the abdomen and stomach.
• Fu Ling promotes urination to eliminate damp in the body and
strengthens the zheng-qi.
• Sha Ren and Bai Dou Kou regulate the qi and eliminate the damp
in the middle Jiao.
Modifications:
• In the case of an obvious heaviness of the body or body pain, add
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Principles of Treatment:
Clear heat, dispel damp, and harmonize the middle Jiao.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Lian Po Yin-Coptis and Magnolia Bark Drink.
Explanation:
• Huang Lian, Dan Dou Chi, and Zhi Zi clear heat and resolve
damp.
• Xing Ren, Zhe Bei Mu and Zhi Ban Xia protect the lung, eliminate
phlegm in the lung and relieve the disturbance to the lung.
• Hou Po, Chen Pi and Chang Pu resolve the damp in the middle
Jiao and relieve the fullness of the abdomen and stomach.
• Fu Ling promotes urination to eliminate damp in the damp and
strengthens the zheng-qi.
Modifications:
• In the case of constant high fever, add Zhi Mu Radix Anemarrhenae
Asphodeloidis 10 g to clear the heat and reduce the fever.
• In the case of excessive cough with yellow phlegm, add Huang
Qin Radix Scutellariae Baicalensis 10 g to clear the heat, eliminate
phlegm and relieve the cough.
• In the case of excessive white phlegm, add Zi Su Zi Fructus Perillae
Frutescentis 10 g and Ting Li Zi Semen Descurainiae seu Lepidii
10 g to eliminate phlegm and stop the cough.
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TCM Treatment of Asymptomatic Infections of COVID-19
2.2.2.5 Deficiency of qi
Slight tiredness, sweating easily, slightly poor appetite and sleepiness,
possible lightness in the head or weakness of muscle, slight loose
stool, thin and white tongue coating, with or without weak pulse.
Principles of Treatment:
Tonify the qi and strengthen the body.
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Herbal Treatment:
Yu Ping Feng San-Jade Windscreen Powder and Si Jun Zi Tang-Four
Gentlemen Decoction.
Explanation:
• Zhi Huang Qi, Fang Feng and Jiao Bai Zhu, the complete compo-
sitions of Yu Ping Feng San, are used to tonify the wei qi and
strengthen the skin pores.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Dang Shen, Fu Ling, and Zhi Gan Cao, together with Jiao Bai Zhu,
the complete composition of Si Jun Zi Tang, tonify the qi of the
spleen and stomach in general to improve the resistance to the
pathogenic factors.
• Jing Jie, Zi Su Ye, together with Fang Feng are used to dispel wind
and relieve any external symptoms.
• Jie Geng, Xing Ren and Zhi Ban Xia are used to dispel the lung-qi
and eliminate phlegm in the lung, consequently protecting the
physiological function of the lung.
Modifications:
• In the case of excessive white phlegm, add Zi Su Zi Fructus Perillae
Frutescentis 10 g and Ting Li Zi Semen Descurainiae seu Lepidii
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• a strong physique
• a moderate body posture
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TCM Treatment of Asymptomatic Infections of COVID-19
• good complexion
• energetic state
• well-proportioned body
• moisturized complexion, skin and lips
• shiny hair
• bright eyes
• able to smell and taste normally
• low fatigue levels
• good tolerance to cold and heat
• sleep well
• good appetite
• easy-going and cheerful personality
• strong ability to adapt to the natural and social environment
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Principles of Treatment:
Strengthen the body and tonify the wei qi.
Herbal Treatment:
Yu Ping Feng San-Jade Windscreen Powder.
Explanation:
• Zhi Huang Qi, Fang Feng and Jiao Bai Zhu, the complete compo-
sitions of Yu Ping Feng San, are used to tonify the wei qi and
strengthen the skin pores.
• Zi Su Ye and Jing Jie, together with Fang Feng are used to dispel
wind and relieve external invasion.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Jie Geng and Xing Ren are used to dispel the lung-qi and eliminate
phlegm in the lung so as to protect the physiological functions of
the lung.
• general weakness
• thin or softness of the muscles
• myalgia
• weakness of limbs
• fatigue
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• dyspnea
• no desire to talk or have a low voice
• spontaneous sweating or easy sweating
• catches the common cold frequently
• pale complexion
• poor vision
• pale lips
• thin or brittle hair
• dizziness
• forgetfulness
• normal or loose stool, or prolapse of rectum and internal organs
• normal or frequent urination
• introverted personality
• emotional instability or emotional exhaustion
• mental fog, timid and not adventurous
• intolerance of cold
• cold hands and feet
• pale and swollen tongue with teeth marks on the sides
• weak pulse
Principles of Treatment:
Activate the spleen and kidney and tonify qi.
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TCM Treatment of Asymptomatic Infections of COVID-19
Herbal Treatment:
Si Jun Zi Tang-Four Gentlemen Decoction.
Explanation:
• Ren Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, the complete com-
position of Si Jun Zi Tang, are used to activate the spleen and
stomach and to promote the production of qi.
• Huang Qi raises the qi and tonify the qi of the middle Jiao and
relieves the tiredness. When Huang Qi, Bai Zhu and Fang Feng are
used together, they can also strengthen the skin and improve the
wei qi, which is very important to improve the resistance to fight
against a common cold.
• Shan Yao tonifies the qi, benefits the kidney and reinforces the
jing.
• Since qi and blood share a good relationship between each other
and when there is a deficiency of qi, there would be a deficiency
of blood to a certain degree. Thus, Dang Gui is used to benefit the
jing and tonify the blood.
• Zi Su Ye, Jing Jie and Fang Feng, are used to dispel wind and
relieve external invasion.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Jie Geng and Xing Ren are used to dispel the lung-qi and eliminate
phlegm in the lung, in order to protect the physiological function
of the lung.
• aversion to cold
• sensitivity to cold weather
• cold hands and feet
• preference for warm food and drinks
• lack of energy
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• excessive sleep
• pale complexion and lips
• darkness of lower eyelid
• hair loss
• easy sweating
• loose stool
• clear and profuse urine
• nycturia
• impotence
• frigidity
• water retention
• edema
• pale tongue, thin and white coating
• thready, deep, and slow pulse
Principles of Treatment:
Tonify the yang and dispel the cold.
Herbal Treatment:
Da Bu Yuan Jian-Great Tonify the Primal Decoction.
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TCM Treatment of Asymptomatic Infections of COVID-19
Explanation:
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• Shu Di Huang, Shan Yao, Shan Zhu Yu and Gou Qi Zi are used to
tonify the kidney-qi and benefit the jing.
• Du Zhong reinforces the yang of the kidney and dispels the cold.
It can also strengthen the lower back to relieve lower back pain
and weakness.
• Ren Shen and Dang Gui tonify the qi and blood, so as to improve
the zheng-qi in general.
• Zi Su Ye, Jing Jie and Fang Feng are used to dispel wind and relieve
external invasion.
• Jie Geng and Xing Ren are used to dispel the lung-qi and eliminate
phlegm in the lung, so as to protect the physiological function of
the lung.
• Zhi Gan Cao regulates the formula and tonifies the qi of the
body.
• thin body
• warm or hot hands and feet
• restlessness
• dry mouth, throat and lips
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principles of Treatment:
Nourish the yin, clear the deficient heat, and benefit the kidney.
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Herbal Treatment:
Liu Wei Di Huang Wan-Six-Ingredient Pill with Rehmannia.
Explanation:
• Shu Di Huang, Shan Yao, and Shan Zhu Yu are used to tonify the
kidney and benefit the jing.
• Gou Qi Zi, Mai Men Dong and Wu Wei Zi tonify the Yin and ben-
efit the body fluid.
• Zi Su Ye, Jing Jie and Fang Feng are used to dispel wind and relieve
external invasion.
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TCM Treatment of Asymptomatic Infections of COVID-19
• Jie Geng and Xing Ren are used to dispel the lung-qi and eliminate
phlegm in the lung so as to protect the physiological function of
the lung.
• obesity
• swollen abdomen
• fullness in the stomach
• greasy skin
• often cough with expectoration of phlegm
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Principles of Treatment:
Activate the spleen and stomach and resolve the damp.
Herbal Treatment:
Ping Wei San-Calm the Stomach Powder, plus
Er Chen Tang-Decoction of Two Old (Cured) Drugs.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanation:
• Cang Zhu, Hou Po and Zhi Ban Xia eliminate damp and resolve
phlegm.
• Qing Pi, Chen Pi and Zhi Ke eliminate damp and promote the qi
circulation and relieve the fullness of the abdomen caused by
damp accumulation.
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TCM Treatment of Asymptomatic Infections of COVID-19
Principles of Treatment:
Clear the heat, eliminate damp, and remove the toxins.
Herbal Treatment:
Lian Po Yin-Coptis and Magnolia Bark Drink.
Explanation:
• Lian Po Yin is applied to clear the heat, eliminate damp, resolve
disharmony in the middle Jiao and benefit the stomach. This for-
mula is good to eliminate damp-heat in the middle Jiao and of
course, it has a weak function to dispel external invasion.
• Huang Qin and Lian Qiao are added into the prescription to dispel
wind-heat and relieve toxins.
• Jie Geng and Xing Ren are used to disperse the lung-qi and descend
the lung-qi so as to protect the physiological function of the lung.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• depression
• headache
• fullness of the chest and abdomen
• belching
• poor appetite
• hypochondriac pain and distention
• insomnia
• cyst in the breast
• painful and irregular menstruation
• a thin and white coating
• a wiry pulse
Principles of Treatment:
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Herbal Treatment:
Xiao Yao San-Rambling Powder.
Explanation:
• Chai Hu and Bao Shao Yao smooth the liver and regulate the qi in
the liver.
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TCM Treatment of Asymptomatic Infections of COVID-19
• The liver is the organ, which is called a yin organ with a yang activ-
ity. Dang Gui benefits the liver blood and promotes blood circulation
so as to relieve the spasm in the liver due to liver-qi stagnation.
• Zhi Ke and Xiang Fu promote the qi circulation and relieve the
fullness in the abdomen.
• Chen Pi and Qing Pi are used to promote the qi circulation and
eliminate damp due to the stagnation of qi.
• Jing Jie and Fang Feng are used to dispel wind and relieve external
invasion.
• Jie Geng and Xing Ren are used to dispel the lung-qi and eliminate
phlegm in the lung so as to protect the physiological function of
the lung.
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Principles of Treatment:
Promote the qi and blood circulation, eliminate blood stasis, and
relieve the pain.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Tao Hong Si Wu Tang-Four Substance (Things) Decoction with
Safflower and Peach Pit.
Explanation:
• Tao Hong Si Wu Tang is a typical herbal formula to promote blood
circulation and eliminate blood stasis without harming the blood.
• However, this formula is not so strong to eliminate blood stasis. Pu
Huang and Yu Jin are added to promote blood circulation, elimi-
nate blood stasis, and relieve the pain.
• Jing Jie and Fang Feng are used to dispel wind and relieve external
invasion.
• Jie Geng and Xing Ren are used to dispel the lung-qi and eliminate
phlegm in the lung, in order to protect the physiological function
of the lung.
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TCM Treatment of Asymptomatic Infections of COVID-19
Principles of Treatment:
Strengthen the constitution, eliminate pathological changes, and
restore physiological functions.
Since there are various kind of patterns related to this type, treat-
ment and herbal formulas should be given accordingly by adding cer-
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tain herbs to relieve the external invasion and protect the physiological
functions of the lung. These herbs can be the same as the herbs used
above, including Jing Jie Herba seu Flos Schizonepetae Tenuifoliae,
Fang Feng Radix Ledebouriellae Divaricatae, Jie Geng Radix Platycodi
Grandiflori, and Xing Ren Semen Pruni Armeniacae, etc.
87
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1
World Health Organization (WHO). WHO Director-General’s opening remarks at
the media briefing on COVID-19—11 March 2020. (Press Release) 11 March 2020.
Archived from the original on 11 March 2020. Retrieved 12 March 2020.
2
Sui-Lee Wee, et al. WHO declares global emergency as Wuhan coronavirus spreads.
The New York Times. 30 January 2020. https://www.nytimes.com/2020/01/30/health/
coronavirus-world-health-organization.html.
3
Jasper Fuk-Woo Chan, et al. op. cit.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
4
Roman Wölfel. Virological assessment of hospitalized patients with COVID-2019.
Nature. 2020, 581: 465–469.
5
Kelly McLaughlin. Iceland is allowing everyone in the country to be tested for the
coronavirus. The government says it spent years perfecting its approach. Insider. 2 April
2020. https://www.businessinsider.com/iceland-coronavirus-pandemic-approach-
could-help-other-countries-2020-4?r=US&IR=T.
90
TCM Treatment of Early Symptoms of COVID-19
that the relevant symptoms include not only the commonly recog-
nized ones, like fever and respiratory manifestations or the major
flu-related symptoms, but also some digestive, urological, physical,
mental and musculoskeletal issues. On top of that, other less iden-
tifiable symptoms like anosmia, ageusia, skin rash, chilblain-like
wound, eye irritations and different levels of nervous system impair-
ments may be involved too. Although there is a lack of inner logic
connection between each individual symptom in the western con-
text, these clinical manifestations have various underlying mecha-
nisms in TCM.
Regarding the early symptoms, different countries take a different
approach towards it. In the UK, the NHS still insists on its website
that only fever, cough and difficulty breathing are the key symptoms
of COVID-19 infection. Only if a patient presents the above symp-
toms will NHS medical professionals consider admitting the patient
for COVID-19 test and hospital treatments. This method has com-
pletely excluded all other mild symptoms on the early stage of the
infection, which in our opinion, may greatly contribute to the conse-
quence that the UK is among those holding the highest COVID-19
casualty alongside the US as of 24 April 2020, with 18,738 deaths,
reaching the fifth highest in the world.6
6
Worldometer COVID-19 data. https://www.worldometers.info/coronavirus/about.
91
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
7
Centers for Disease Control and Prevention (CDC). Symptoms of COVID-19.
Updated 22 February 2021. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-
testing/symptoms.html.
8
Hussin A. Rothan, et al. The epidemiology and pathogenesis of coronavirus disease
(COVID-19) outbreak. Journal of Autoimmunity. May 2020, 109: 102433. Published
online 26 February 2020. doi: 10.1016/j.jaut.2020.102433.
92
TCM Treatment of Early Symptoms of COVID-19
9
Roni Caryn Rabin. Lost sense of smell may be peculiar clue to coronavirus infec-
tion. The New York Times. 22 March 2020. https://www.nytimes.com/2020/03/22/
health/coronavirus-symptoms-smell-taste.html?_ga=2.188496424.1813510712.
1587638610-1648265835.1587638610.
10
Cristina Menni, et al. Loss of smell and taste in combination with other symptoms
is a strong predictor of COVID-19 infection. MedRxiv. 2020. https://doi.org/10.1101/
2020.04.05.20048421.
11
Luigi A. Vaira, et al. Anosmia and ageusia: Common findings in COVID-19 patients.
Laryngoscope. 2020, 130(7): 1787. doi: 10.1002/lary.28692.
12
Enrique D Fernandez-Nieto, et al. Comment on: Cutaneous manifestations in
COVID-19: A first perspective. Safety concerns of clinical images and skin biopsies.
Journal of the European Academy of Dermatology and Venereology. 2020, 34(6):
e252–e254. doi: 10.1111/jdv.16470.
13
Anwaar Alramthan, et al. A case of COVID-19 presenting in clinical picture resem-
bling chilblains disease. First report from the Middle East. Clinical and Experimental
Dermatology. 2020, 45(6). doi: 10.1111/ced.14243.
14
Antoine Mahe, et al. A distinctive skin rash associated with coronavirus disease
2019. Journal of the European Academy of Dermatology and Venereology. 2020, 34,
e241–290. doi: 10.1111/jdv.16471.
93
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
15
Cynthia Magro, et al. Complement associated microvascular injury and thrombosis
in the pathogenesis of severe COVID-19 infection: A report of five cases. Translational
Research: The Journal of Laboratory and Clinical Medicine. 2020, 220: 1–13. doi:
10.1016/j.trsl.2020.04.007.
16
Marvi Cheema, et al. Keratoconjunctivitis as the initial medical presentation of the
novel coronavirus disease 2019 (COVID-19). Canadian Journal of Ophthalmology.
2020, 55(4): E125–E129. doi: 10.1016/j.jcjo.2020.03.003.
17
Ali A. Asadi-Pooya, et al. Central nervous system manifestations of COVID-19:
A systematic review. Journal of the Neurological Sciences. 2020, 413: 116832.
doi: 10.1016/j.jns.2020.116832.
18
Kevin Roe. Explanation for COVID-19 infection neurological damage and reactiva-
tions. Transboundary and Emerging Diseases. 2020, 67: 1414–1415. doi: 10.1111/
tbed.13594.
94
TCM Treatment of Early Symptoms of COVID-19
19
Damian McNamara. COVID-19 linked to large vessel stroke in young adults.
Medscape. 24 April 2020. https://www.medscape.com/viewarticle/929345.
20
Libin. We have a deeper understanding of response strategies—Academician Tong
Xiaolin “interprets” the TCM treatment plan in the “New Coronavirus Pneumonia
Diagnosis and Treatment Plan” (Trial Fourth Edition). Xinhua Net (新华网).
28 January 2020. http://www.xinhuanet.com/2020-01/28/c_1125508711.htm.
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21
Cristina Menni, et al. op. cit.
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TCM Treatment of Early Symptoms of COVID-19
spreads into the Intestines and the stomach. With both the yin and
the yang (regions/channels) being affected, the five depots (wu zang,
internal yin organs) will be harmed”.
This chapter provides a clear clue of the mechanisms of evil EPF’s
invasion into the body:
• EPF first enters the body on stage one via skin and the cutaneous
section to disturb the wei-qi level.
• EPF then lodges into the channel and collateral vessel level in
stage two. Because the cutaneous section belongs to the jing-luo
complex system, it is clear that stage one and two are both the
disorders on the channel system—a superficial level of disorder.
Regarding invasion on these two early stages, if a tailored treat-
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ment to dispel and eliminate the EPF from the channel system can
be applied promptly, it will cease or at least slow down the further
development of the invasion, and this is the importance of our
emphasis on the early intervention on COVID-19 infections.
• The invasion ends in stage three, after affecting the stomach and
Intestines. The invasion settles finally in the five yin organs (wu
zang) and damage of five yin organs, leading to more severe sys-
tematic illness.
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• The symptoms on body parts and areas along with the distribution
of the relevant channels.
• The malfunction symptoms of the relevant yang organs.
• The three-yang-channel system clearly draws a line on the process
of external invasion between stages one, two and three in which
the internal yin organs are affected and harmed. In other words,
stage three represents the three-yin-channel system that is stated in
Shang Han Lun.
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TCM Treatment of Early Symptoms of COVID-19
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100
TCM Treatment of Early Symptoms of COVID-19
ment of toxic heat can damage the Shaoyin channel and cause yin
depletion, featuring deep red skin rash or bleeding complications,
although this is usually a later stage condition not covered com-
pletely in this article. At this complex state, it could manifest into a
critical condition soon. Therefore, urgent attention is needed once
this complex pattern is identified.
In addition to the six-channel differentiation by Shang Han Lun,
zang-fu differentiation may give a more detailed analysis of stage
three development. It mainly involves the three organs: lung, spleen
and San Jiao, at the beginning of COVID-19 infection.
The functions of the lung are to maintain respiration, disperse
and descend the lung-qi, provide an opening into the nose, domi-
nate the skin, and regulate the water passage. On the other hand,
the spleen has physiological functions in producing qi and blood,
transporting and transforming food and fluid, dominating the mus-
cles and four limbs, providing an opening to the mouth, harmoniz-
ing with the stomach, and controlling the blood circulation within
the vessels. San Jiao functions in harmonizing the San Jiao, regulat-
ing the corridor of yuan-qi and water, distributing the qi to all
parts of the body. If the qi distribution and water metabolism of
the San Jiao become disturbed or blocked, water retention could
happen, which leads to various dysfunctions throughout the whole
101
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Blockage of wei qi
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TCM Treatment of Early Symptoms of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
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TCM Treatment of Early Symptoms of COVID-19
Herbal Treatment:
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
Dampness.
Herbal Modifications:
• Cang Zhu Rhizoma Atractylodis 10 g, Huo Xiang Herba Agastaches
seu Pogostemi 10 g, Qing Hao Herba Artemisiae Annuae 10 g
and Jin Yin Hua Flos Lonicerae Japonicae 10 g could be added into
the formula to strengthen the effect of eliminating cold-damp and
toxins.
• In the case of obvious dry cough, add Tian Hua Fen Radix
Trichosanthis Kirilowii 5 g and Mai Men Dong Tuber Ophiopogonis
Japonici 10 g to moisten the lung and reduce the dry cough.
• In the case of severe anhidrosis, add Ma Huang Herba Ephedrae
10 g and Gui Zhi Ramulus Cinnamomi Cassiae 10 g to promote
sweating and relieve the external symptoms.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Points:
• Ghost points: Shaoshang LU-11 and Yinbai SP-1, puncturing
superficially.
• Lieque LU-7 + Zhaohai KID-6, Waiguan SJ-5 + Zulinqi GB-41 with
even methods.
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Points Modifications:
• In the case of an obvious dry cough, add Jingqu LU-8 to moisten
the lung and reduce the dry cough.
• In the case of severe anhidrosis, add moxa on Hegu L.I.-4, Feishu
BL-13, and Zusanli ST-36 to promote sweating and relieve the
external symptoms.
• In the case of muscle pain, add Feiyang BL-58 and Kunlun BL-60
to harmonize the collaterals and relieve the muscle pain.
• In the case of severe sore throat, add Lianquan REN-23 to relieve
the throat pain.
• In the case of loss of smell, add Yingxiang L.I.-20 and Juliao ST-3
to open the nasal orifice and improve the nose function.
Herbal Treatment:
Da Qing Long Tang-Major Green Dragon Decoction.
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TCM Treatment of Early Symptoms of COVID-19
Herbal Modifications:
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Acupuncture Points:
• Ghost points: Shaoshang LU-11 and Yinbai SP-1, puncturing
superficially.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Points Modifications:
• In the case of high fever, add Dazhui Du-14 to clear the heat and
reduce fever.
• In the case of a blocked nose and nasal bleeding, add Yingxiang
L.I.-20 to open the nasal orifice and stop the bleeding.
• In the case of loss of taste, add Dicang ST-4 to regulate the channel
and harmonize the collateral to improve the tastebuds.
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Herbal Treatment:
Chai Hu Gui Zhi Tang-Bupleuri and Ramuli Cinnamomi Decoction.
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TCM Treatment of Early Symptoms of COVID-19
Herbal Modifications:
• Cang Zhu Rhizoma Atractylodis 10 g, Huo Xiang Herba Agastaches
seu Pogostemi 10 g, Qing Hao Herba Artemisiae Annuae 10 and
Jin Yin Hua Flos Lonicerae Japonicae 10 g could be added into the
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Acupuncture Points:
• Ghost points: Shaoshang LU-11 and Yinbai SP-1, puncturing
superficially.
• Lieque LU-7 + Zhaohai KID-6, Waiguan SJ-5 + Zulinqi GB-41,
Neiguan P-6 + Gongsun SP-4 with an even method.
• Chize LU-5, Feishu BL-13, Yuji LU-10, Yanglingquan GB-34, Xiaxi
GB-43, and Sanyinjiao SP-6 with reducing methods.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Points Modifications:
• In the case of much dry cough, add Jingqu LU-8 to moisten the
lung, disperse the lung-qi and relieve the dry cough.
• In the case of redness in the eyes or eye irritation, add Guanchong
SJ-1 and Xingjian LIV-2 to clear the heat in the liver and relieve the
eye complaints.
• In the case of severe vomiting and a bitter taste in the mouth, add
Qiuxu GB-40 and Zhongwan REN-12 to descend the stomach-qi
and relieve the vomiting.
• In the case of emotional depression, add Qimen LIV-14 and
Shaohai HE-3 to smooth the qi circulation, and tranquillize the shen.
• In the case of chest tightness or pressure over the chest, add
Tanzhong REN-17 and Ximen P-4 to descend the qi, regulate the
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Herbal Treatment:
Chai Ge Jie Ji Tang-Bupleurum and Kudzu Decoction to Release the
Muscle Layer.
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TCM Treatment of Early Symptoms of COVID-19
Directions:
• Decoct one package of crude herbs each day and take the decoc-
tion once in the morning and once in the evening (40 minutes after
a meal). If conditions permit, take half a bowl of rice soup after
drinking the decoction.
• Three days of treatment constitutes one course. Usually, only one
or two courses of treatment are required.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• If the patient does not have a high fever, the amount of Shi
Gao Gypsum Fibrosum can be reduced. Conversely, if the fever is
high, the amount of Shi Gao Gypsum Fibrosum should be
increased.
Acupuncture Points:
• Ghost points: Shaoshang LU-11 and Yinbai SP-1, puncturing
superficially.
• Lieque LU-7 + Zhaohai KID-6, Neiguan P-6 + Gongsun SP-4 with
even method.
• Chize LU-5, Feishu BL-13, Yuji LU-10, Hegu L.I.-4, Quchi L.I.-11,
Fengchi GB-20, Yanglingquan GB-34, and Neiting ST-44 with
reducing methods.
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Points Modifications:
Selections are as above patterns.
Herbal Treatment:
Huo Xiang Zheng Qi Tang-Agastache Decoction to Rectify the Qi.
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TCM Treatment of Early Symptoms of COVID-19
Herbal Modifications:
• Qing Hao Herba Artemisiae Annuae 10 g and Jin Yin Hua Flos
Lonicerae Japonicae 10 g could be added into the formula to
strengthen the effect of eliminating cold-damp and toxins.
• In the case of loss of taste, add Sha Ren Fructus Amomi 5 g to
eliminate cold-damp and improve the tastebuds.
• In the case of severe diarrhea, add Ge Gen Radix Puerariae 10 g
to ascend the clear-qi and descend the turbid-qi.
• In the case of severe tiredness, add Shan Yao Radix Dioscoreae
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Acupuncture Points:
• Ghost points: Shaoshang LU-11, Yinbai SP-1, puncturing
superficially.
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4 with
even method.
• Zhigou SJ-6, Feishu BL-13, Yanglingquan GB-34, Zhongwan Ren-
12, Fenglong ST-40, Tianshu ST-25, Yinlingquan SP-9, Zusanli
ST-36 with even method. Moxa on ST-36.
Points Modifications:
• In the case of severe fatigue, add Pishu BL-20 and Qihai Ren-6
with moxa to activate the spleen and tonify spleen-qi to improve
the energy.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• In the case of loss of taste, add Dicang ST-4 and Chongyang ST-42
to regulate the channel and harmonize the collateral to improve
the tastebuds.
• In the case of severe diarrhea, add Shangjuxu ST-37 to stop
diarrhea.
• In the case of loss of appetite, add Taibai SP-3 to activate the
spleen and improve appetite.
• In the case of excessive mucus in the mouth, add Tiantu REN-22
to descend the qi and relieve the mucus.
• In the case of frostbite/chilblain (cold-oriented), moxa on jing Well
points of nearest relevant meridians or on the tip of the nearest toe.
• In the case of skin blisters, add Taiyuan LU-9 and Taibai SP-3 to
eliminate cold-damp in the skin and muscle and relieve the skin
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blisters.
Herbal Treatment:
Ma Huang Fu Zi Xi Xin Tang-Ephedra, Prepared Aconite and Asarum
Decoction, or
Ma Huang Fu Zi Gan Jiang Tang-Ephedra, Prepared Aconite and Dry
Ginger Decoction.
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TCM Treatment of Early Symptoms of COVID-19
Herbal Modifications:
• Cang Zhu Rhizoma Atractylodis 10 g, Huo Xiang Herba Agastaches
seu Pogostemi 10 g and Qing Hao Herba Artemisiae Annuae 10 g
could be added into the formulas to strengthen the effect of elimi-
nating cold-damp and relieve the external symptoms.
• In the case of a weak heartbeat, add Gui Zhi Ramulus Cinnamomi
Cassiae 10 g and Zhi Gan Cao Radix Glycyrrhizae Preparata 10 g
to warm the heart and strengthen the heartbeat.
• In the case of scanty urination or edema on the lower limbs, add
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Acupuncture Points:
• Ghost points: Shaoshang LU-11, Yinbai SP-1, puncturing
superficially.
• Lieque LU-7 + Zhaohai KID-6, Neiguan P-6 + Gongsun SP-4 with
even method.
• Hegu L.I.-4 and Feishu BL-13 with reducing method.
• Xinshu BL-15, Shenshu BL-23, Qihai REN-6, Guanyuan REN-4,
Taixi KID-3 and Zusanli ST-36 with a tonifying method with moxa
on KID-3, REN-4 and REN-6.
Points Modifications:
• In the case of a weak heartbeat, add Xinshu BL-15 with moxa to
warm the heart and strengthen the heartbeat.
• In the case of scanty urination, or edema on the lower limbs, add
Shuidao ST-29 and Yinlingquan SP-9 to promote urination and
relieve edema.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
116
4
TCM Treatment of Ordinary Syndromes
of COVID-19
1
Diagnosis and treatment plan for pneumonia of new coronavirus infection (trial
version 4) (新型冠状病毒感染的肺炎诊疗方案(试行第四版)). https://www.gov.cn/
zhengce/zhengceku/2020-01/28/5472673/files/0f96c10cc09d4d36a6f9a9f0b42d9
72b.pdf.
117
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
118
TCM Treatment of Ordinary Syndromes of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
120
TCM Treatment of Ordinary Syndromes of COVID-19
Principle of Treatment:
Dispel wind-cold, eliminate damp and toxins, disperse the lung-qi
and relieve the cough.
Herbal Treatment:
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
Dampness, plus
Xing Su San-Apricot Kernel and Perilla Leaf Powder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Qiang Huo, Du Huo and Gao Ben dispel wind-cold, resolve
damp, and relieve external symptoms.
• Cang Zhu assists the above herbs to resolve damp and relieve
muscle pain and heaviness.
• Zi Su Ye promotes sweating and relieves external symptoms.
• Jie Geng, Xing Ren, Bai Jie Zi, Zhi Ban Xia, Chen Pi and Fu Ling
eliminate damp-phlegm and relieve cough.
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Acupuncture treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Waiguan SJ-5, Zhigou SJ-6, Lieque LU-7, Feishu
BL-13, Chize LU-5, Fenglong ST-40, Yanglingquan GB-34, and
Sanyinjiao SP-6 with a reducing method.
Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve the cough.
• Hegu L.I.-4, the yuan-source point of the large intestine channel,
SJ-5, the luo-connecting point of the San Jiao channel, and LU-7,
the luo-connecting point of the lung channel respectively, are used
to promote sweating and dispel external pathogenic factors.
• SJ-6, jing-river point of the San Jiao channel, is used to dispel
external pathogenic factors, promote the discharge of damp in the
body.
• BL-13, the back-shu point of the lung, together with LU-5, the he-
sea point of the lung channel, is used to disperse the lung-qi and
restore the physiological functions of the lung.
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TCM Treatment of Ordinary Syndromes of COVID-19
Principle of Treatment:
Dispel wind, clear heat, eliminate damp and toxins, disperse the
lung-qi, and relieve the cough.
Herbal Treatment:
Sang Ju Yin-Mulberry Leaf and Chrysanthemum Decoction, plus
Zhi Sou San-Stop Coughing Powder.
Explanations:
• Sang Ye and Ju Hua clear heat, dispel wind, and relieve external
symptoms.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Erjian L.I.-2, Hegu L.I.-4, Waiguan SJ-5, Lieque LU-7, Yuji LU-10,
Feishu BL-13, Chize LU-5, Yanglingquan GB-34, and Fenglong
ST-40 with a reducing method.
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Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve the cough.
• L.I.-4, the yuan-source point of the large intestine channel, LU-7
and SJ-5, the luo-connecting point of the lung channel and San
Jiao channel respectively, are used to promote sweating to dispel
external pathogenic factors.
• BL-13 and LU-5, the back-shu point and the he-sea point of the
lung channel respectively, are the chief points to descend the
lung-qi and relieve difficulty to expectorate the phlegm, shortness
of breath, and chest tightness.
• LU-10 and L.I.-2, the ying-stream point of the lung channel and
large intestine channel respectively, are used to clear the heat and
reduce fever in the lung and relieve the cough.
• GB-34, the he-sea point of the Gallbladder channel, and ST-40,
the luo-connecting point of the stomach channel, are used to
eliminate external damp, regulate the middle Jiao, and relieve
myalgia and arthralgia.
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TCM Treatment of Ordinary Syndromes of COVID-19
in the limbs and joints, sore throat and tightness, headache, heavi-
ness of the body, ageusia, lack of thirst, nausea, vomiting, loose
stool or diarrhea, abdominal pain and distension, thin, white, and
greasy coating on the tongue, and a superficial and slippery pulse.
Principle of Treatment:
Eliminate cold, resolve damp, release the external symptoms, and
stop coughing.
Herbal Treatment:
Jiu Wei Qiang Huo Tang-Nine-Herb Decoction with Notopterygium.
Explanations:
• Qiang Huo, Fang Feng and Zi Su Ye dispel wind, promote sweat-
ing, and eliminate external cold-damp.
• Cang Zhu eliminates cold-damp and relieves diarrhea.
• Bai Zhi, Xi Xin and Chuan Xiong promote sweating, warm the
meridians, and relieve pain due to invasion of cold-damp.
• Bai Shao Yao and Huang Qin regulate Shaoyang and eliminate
toxins in the body.
• Ge Gen and Sheng Ma harmonize the middle Jiao, descend tur-
bid-qi and relieve vomiting and diarrhea.
• Gan Cao harmonizes the herbs in the prescription.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Yangchi SJ-4, Waiguan SJ-5, Zhigou SJ-6, Lieque LU-7,
Feishu BL-13, Chize LU-5, Fenglong ST-40, and Yanglingquan
GB-34 with a reducing method.
Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve the cough.
• L.I.-4, the yuan-source point of the large intestine channel, SJ-5,
the luo-connecting point of the San Jiao channel, and LU-7, the
luo-connecting point of the lung channel respectively, are used to
promote sweating, dispel external pathogenic factors and relieve
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external symptoms.
• SJ-4 and SJ-6, the yuan-source point and jing-river point of the San
Jiao channel respectively, are used to dispel external pathogenic
factors and promote the discharge of damp in the body.
• BL-13, the back-shu point of the lung, together with LU-5, the he-
sea point of the lung channel, together with LU-7, is used to
disperse the lung-qi and restore the physiological functions of the
lung.
• ST-40, the luo-connecting point of the stomach channel, GB-34,
the he-sea point of the gallbladder channel, are used to dispel
external damp and benefit the joints.
Principle of Treatment:
Dispel heat, reduce fever, disperse the lung-qi and relieve cough.
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TCM Treatment of Ordinary Syndromes of COVID-19
Herbal Treatment:
Yin Qiao San-Honeysuckle and Forsythia Powder, plus
Zhi Zi Chi Tang-Gardenia and Prepared Soybean Decoction.
Explanations:
• Jin Yin Hua, Lian Qiao and Zhi Zi dispel heat, reduce fever, and
remove toxins.
• Jie Geng, Sang Ye, Bo He, Niu Bang Zi and Huang Qin clear heat
in the lung, benefit the throat and relieve cough.
• Dan Dou Chi promotes sweating and reduces fever.
• Lu Gen and Sheng Di Huang clear heat and benefit the body fluid
to relieve thirst.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Erjian L.I.-2, Hegu L.I.-4, Quchi L.I.-11, Dazhui DU-14, Chize
LU-5, Feishu BL-13, Yuji LU-10, Neiting ST-44, and Sanyinjiao
SP-6 with a reducing method.
Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve the cough.
• L.I.-2, L.I.-4 and L.I.-11, the ying-stream point, the yuan-source
point and the he-sea point of the large intestine channel respec-
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
tively, together with DU-14, the meeting point of all the yang
channels in the body, are used to clear heat, remove toxins and
reduce fever.
• LU-5 and BL-13, the he-sea point of the lung channel and the
back-shu point of the lung respectively, together with LU-10, the
ying-stream point of the lung channel, are used to clear heat in
the lung and disperse the lung-qi.
• ST-44 and SP-6, the ying-stream point of the stomach channel and
the crossing point of three yin channels of the foot, are used to
clear heat, remove the toxins, and reduce fever.
Principle of Treatments:
Clear heat, resolve damp, harmonize the middle Jiao, and relieve
cough.
Herbal Treatment:
Gan Lu Xiao Du Yin-Sweet Dew Special Pill to Eliminate Toxins, plus
Lian Po Yin-Coptis and Magnolia Bark Drink.
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TCM Treatment of Ordinary Syndromes of COVID-19
Explanations:
• Hua Shi, Hou Po, Huag Qin, Lian Qiao, Zhi Mu and Yin Chen Hao
clear heat, eliminate damp, reduce fever, and remove toxins.
• Bo He clears heat and benefits the throat.
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• She Gan and Jie Geng eliminate phlegm and relieve cough.
• Huo Xiang, Bai Bian Dou, Bing Lang harmonize the middle Jiao
and relieve diarrhea.
• Shi Chang Pu relieves damp in the middle Jiao and relieves pos-
sible dizziness due to damp invasion.
• Gan Cao eliminates toxins and harmonizes the herbs in the
prescription.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Quchi L.I.-11, Waiguan SJ-5, Zhigou SJ-6, Chize
LU-5, Feishu BL-13, Zhongwan REN-12, Tianshu ST-25, Fenglong
ST-40, Yanglingquan GB-34, and Yinlingquan SP-9 with reducing
methods.
Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve the cough.
• L.I.-4, the yuan-source point of the large intestine channel, SJ-5,
the luo-connecting point of the San Jiao channel, and SJ-6, jing-
river point of the San Jiao channel, are used to clear heat, eliminate
damp, and relieve the external symptoms.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatments:
Clear heat, reduce fever, disperse the lung-qi, and relieve cough.
Herbal Treatment:
Ma Xing Shi Gan Tang-Ephedra, Apricot Kernel, Gypsum and Licorice
Decoction.
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TCM Treatment of Ordinary Syndromes of COVID-19
Explanations:
• Ma Huang and Xing Ren descend the lung-qi and relieve cough.
• Sheng Shi Gao, Huang Qin and Zhi Mu clear heat in the lung,
remove toxins and reduce fever.
• Zhe Bei Mu and Zhi Ban Xia eliminate heat-phlegm in the lung
and relieve cough.
• Sheng Di Huang clears heat, reduces fever, and removes toxins.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Quchi L.I.-11, Dazhui DU-14, Feishu BL-13, Chize
LU-5, Yuji LU-10, Fenglong ST-40, and Sanyinjiao SP-6 with a
reducing method.
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Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve cough.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, together with Dazhui
DU-14, the meeting point of all the yang channels of the body, are
used to clear heat and reduce fever.
• BL-13 and LU-5, the back-shu point of the lung and the he-sea
point of the lung channel respectively, are used to clear heat in the
lung and relieve the cough.
• ST-40 and SP-6, the luo-connecting point of the stomach channel
and the crossing point of the three yin channels of the foot
respectively, are used to clear heat and eliminate phlegm in the
lung.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatments:
Clear heat, eliminate phlegm, disperse the lung-qi, and relieve
cough.
Herbal Treatment:
Qing Qi Hua Tan Tang-Clear the Qi and Transform Phlegm
Decoction.
Explanations:
• Dan Nan Xing, Quan Gua Lou and Zhe Bei Mu clear heat, elimi-
nate phlegm and relieve cough.
• Huang Qin and Zhi Zi clear heat in the lung and reduce fever.
• Xing Ren descends the lung-qi and relieve cough.
• Hou Po relaxes the chest and relieves slight pressure over the
chest.
• Zhi Ban Xia, Chen Pi and Fu Ling eliminate damp, resolve phlegm,
and relieve cough.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Quchi L.I.-11, Dazhui DU-14, Chize LU-5, Yuji
LU-10, Feishu BL-13, Tianshu ST-25, Fenglong ST-40, and
Sanyinjiao SP-6 with a reducing method.
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TCM Treatment of Ordinary Syndromes of COVID-19
Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest, assist
respiration and relieve cough.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, together with DU-14, the
meeting point of all the yang channels of the body, are used to
clear heat in the body and reduce fever.
• LU-5, BL-13 and LU-10, the he-sea point of the lung channel and
the back-shu point, and the ying-stream point of the lung channel
respectively, are used to clear heat in the lung, disperse the lung-qi
and relieve cough.
• ST-25, the front-mu point of the large intestine, ST-40 and SP-6, the
luo-connecting point of the stomach channel, and the crossing
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point of the three yin channels of the foot respectively, are used to
clear heat, reduce fever, and eliminate phlegm in the lung.
Principle of Treatments:
Eliminate cold, resolve phlegm, disperse the lung-qi and relieve cough.
Herbal Treatment:
San Zi Yang Qin Tang-Three Seed Decoction to Nourish One’s Parents.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Bai Jie Zi, Zi Su Zi and Ting Li Zi eliminate cold-phlegm, descend
the lung-qi and relieve cough.
• Jie Geng and Xing Ren eliminate phlegm in the lung, restore the
physiological functions of the lung and relieve cough.
• Zhi Shi and Hou Po eliminate phlegm in the lung, promote qi cir-
culation and relieve the heaviness in the chest.
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• Zhi Ban Xia, Chen Pi and Fu Ling eliminate damp in the body and
resolve phlegm.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Lieque LU-7, Chize LU-5, Taiyuan LU-9, Feishu BL-13, Zhongwan
REN-12, Zusanli ST-36, Fenglong ST-40, Sanyinjiao SP-6, and
Yinlingquan SP-9 with a reducing method. Moxibustion could be
applied on BL-13, ST-36 and ST-40.
Explanations:
• P-6 + SP-4 are used to regulate the qi circulation in the chest and
assist respiration and relieve cough.
• LU-7 and LU-5, the luo-connecting point and he-sea point of
the lung channel respectively, and BL-13, the back-shu point of the
lung, are used to disperse the lung-qi, eliminate phlegm in the
lung and relieve cough.
• REN-12, the gathering point of the fu organs, ST-36 and ST-40, the
he-sea point and the luo-connecting point of the stomach channel
respectively, together with SP-6, the crossing point of three yin
channels of the foot, and SP-9, the he-sea point of the spleen chan-
nel, are applied to eliminate damp-phlegm in the body, harmonize
the middle Jiao and relieve cough.
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TCM Treatment of Ordinary Syndromes of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Although TCM has some strong herbs that can be used to reduce
fever symptomatically, such as Shi Gao Gypsum Fibrosum and Zhi
Mu Radix Anemarrhenae Asphodeloidis, etc., or L.I.-4, L.I.-11 and
DU-14, it is never practiced in that way. Clinically, the individual
symptom is always treated in combination with a group of symptoms
during a syndrome differentiation. It can be seen from above that
symptomatic treatment will only reduce fever for a short period,
which is not recommended in TCM.
It has also been noticed recently since the appearance of COVID-
19 variants that clinical symptoms of COVID-19, especially the initia-
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TCM Treatment of Ordinary Syndromes of COVID-19
LU-9, Sanyinjiao SP-6 and Zhaohai KID-6, etc., are also not
necessary.
Bloodspots with cough are caused by damage of the external
pathogenic factors, and it could be due to wind-cold, wind-heat or
other factors invading the blood vessels. Clinically, blood cooling
herbs or bleeding-stopping herbs should not be applied in this case,
including Sheng Di Huang Radix Rehmanniae Glutinosae Recens,
Xuan Shen Radix Scrophulariae Ningpoensis, Mu Dan Pi Cortex
Moutan Radicis, Bai Ji Rhizoma Bletillae Striatae, Ce Bai Ye Cacumen
Biotae Orientalis and Xue Yu Tan Crinis Carbonisatus, etc. When
these external pathogenic factors are expelled and the lung functions
are restored, bloodspots will be under control. Of course, if there is
severe bleeding, which is usually not the case, it is something else.
TCM never gives an over-treatment.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
4.2.9.4 Fatigue
Fatigue could be one of the chief symptoms in the early stage of
COVID-19. However, it may remain during ordinary syndromes.
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similar to the treatment in the early stage, TCM will not offer any qi
or blood tonics to the patients for their tiredness because this com-
plaint is not caused by deficiency of qi or blood, but by disturbance
to the physiological functions of the lung and spleen, especially the
function of the lung in dispersing the qi in the body. When the lung
functions recover after treatment, the patient will gradually feel less
tired. This explains why in the therapeutic prescription, there is no qi
or blood tonic being used. If these tonics are prescribed too early,
they could aggravate the situation and slow down the healing process
of treatment.
138
TCM Treatment of Ordinary Syndromes of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
140
5
TCM Treatment of Severe Syndromes
of COVID-19
141
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
1
COVID-19 infections rise, Delta variant spreads to 132 countries. United Nation
News. 28 July 2021. https://news.un.org/en/story/2021/07/1096572.
2
Izumi Kimura, et al. SARS-CoV-2 Lambda variant exhibits higher infectivity and
immune resistance. bioRxiv. 28 July 2021. https://doi.org/10.1101/2021.07.28.454085.
3
Luke Hurst. Lambda: What do we know about the latest COVID variant flagged by
the WHO? Updated: 7 July 2021. https://www.euronews.com/2021/07/06/lambda-
what-do-we-know-about-the-latest-covid-variant-flagged-by-the-who.
4
Clive Cookson. Lambda Covid variant’s “unusual” mutations puzzle scientists.
Financial Times. 2 July 2021. https://www.ft.com/content/b3ea5177-9312-418b-
acb7-af16a3bdcd22.
142
TCM Treatment of Severe Syndromes of COVID-19
5
UK scientists: Future COVID-19 variants could have 35% fatality rates. Arab News.
31 July 2021. https://www.arabnews.com/node/1903196/world.
143
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
up to 1260 times higher than those in people infected with the origi-
nal strain.
The combination of a high number of viruses and a short incuba-
tion period makes sense as an explanation for Delta’s heightened
transmissibility, which is more than twice of the original strain of
SARS-CoV-2. The short incubation makes contact tracing more diffi-
cult in countries such as China, which systematically tracks each
infected person’s contacts and requires them to go under quarantine.
Meanwhile, a number of other questions about the Delta variant
remain unanswered. Is it more likely to cause severe disease than the
original strain? How good is it at evading the immune system? Some
of this information will emerge as researchers look more closely at
broader and more diverse populations of people infected with Delta
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6
Sara Reardon. How the Delta variant achieves its ultrafast spread. Nature. 21 July
2021. https://doi.org/10.1038/d41586-021-01986-w.
144
TCM Treatment of Severe Syndromes of COVID-19
two doses of the ChAdOx1 nCoV-19 vaccine was lower than with
the BNT162b2 vaccine. However, with the ChAdOx1 nCoV-19
vaccine, the difference in effectiveness between the Alpha and
Delta variants was small (74.5% and 67.0% respectively).7 However,
according to Israel’s Health Ministry, the vaccine protected 64% of
inoculated people from infection during an outbreak of the Delta
variant, down from 94% before. It was 94% effective at preventing
severe illness in the same period, compared with 97% before.8
Nevertheless, the effectiveness at preventing severe illness is still
quite high.
7
Jamie Lopez Bernal, et al. Effectiveness of Covid-19 vaccines against the B.1.617.2
(Delta) variant. 2021. N Engl J Med. 2021, 385: 585–594. doi: 10.1056/
NEJMoa2108891.
8
Dov Lieber. Pfizer vaccine less effective against delta infections but prevents severe
illness, Israeli data show. The Wall Street Journal. 6 July 2021. https://www.wsj.com/
articles/pfizers-covid-19-vaccine-is-less-effective-against-delta-variant-israeli-data-
show-11625572796.
145
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
146
TCM Treatment of Severe Syndromes of COVID-19
9
Yang Wang. The information office of the state council held a press conference on
the important role of traditional Chinese medicine in the prevention and treatment
of new coronary pneumonia and effective drugs. 23 March 2020. Central People’s
Government of the People’s Republic of China. http://www.gov.cn/xinwen/
2020-03/23/content_5494694.htm.
10
These Chinese medicine prescriptions are effective in the treatment of new coro-
nary pneumonia. The “three medicines and three prescriptions” write a Chinese
medicine anti-epidemic plan. China Daily (中国日报). 18 March 2020. http://www.
xinhuanet.com/2020-03/18/c_1125729859.htm.
147
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Yulong Qin. Traditional Chinese medicine has a good effect on new coronary
11
148
TCM Treatment of Severe Syndromes of COVID-19
Boli Zhang, et al. Experience of Chinese medicine in the treatment of new coro-
12
149
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
5.1.2.1 Complexity
Compared with China, Europe is not the same in terms of regional
environment, climate change, lifestyle and personal diet, or physical
fitness and emotional state. These obvious differences are important
for patients in terms of invasion of pathogens and changes in patho-
genesis. The causative factors of patients with severe and critical
syndromes are complex, and are often caused by the combination of
internal and external factors. The combination of new and old ill-
nesses also makes the pathogenesis very complicated. It is rare to see
patients with severe and critical syndromes with a single cause, or
involvement of only one organ. Failure of the lung in its descending,
150
TCM Treatment of Severe Syndromes of COVID-19
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
5.1.2.2 Changeability
Once highly suspected or positive PCR is confirmed, the patients
usually start following procedures in Europe, including quarantine,
self-isolation, and self-administration of antipyretic to fight against
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TCM Treatment of Severe Syndromes of COVID-19
5.1.2.3 Severity
Due to the sudden occurrence of the COVID-19 pandemic, even in
economically and technologically advanced Europe, there are still
limited medicine available in the treatments, and most of these are
based upon symptomatic support. In addition, most patients with
self-isolation lack modern tracking methods and technology, which
implies that its treatment is somehow left behind social and medical
needs.
153
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
13
Robert Booth. Half of coronavirus deaths happen in care homes, data from EU
suggests. The Guardian. 13 April 2020. https://www.theguardian.com/
world/2020/apr/13/half-of-coronavirus-deaths-happen-in-care-homes-data-from-
eu-suggests.
154
TCM Treatment of Severe Syndromes of COVID-19
14
Kuan-Yu Pan, et al. The mental health impact of the COVID-19 pandemic
on people with and without depressive, anxiety, or obsessive-compulsive
disorders: A longitudinal study of three Dutch case-control cohorts. The Lancet
Psychiatry. 2021, 8(2), 121–129. https://doi.org/10.1016/S2215-0366(20)30491-0.
155
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156
TCM Treatment of Severe Syndromes of COVID-19
157
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
The fullness of the chest with tightness is the most urgent problem to
be solved, extra herbs should be added, such as:
Hou Po Cortex Magnoliae Officinalis
Zhi Shi Fructus Immaturus Citri Aurantii
15
Xikui Zhang, et al. Analysis of the six channels syndrome for differentiation
and treatment of novel coronavirus pneumonia. Fujian Traditional Chinese Medicine
(福建中医药). 2020, 51(2): 1–3. http://subject.med.wanfangdata.com.cn/UpLoad/Fil
es/202002/9bee4dfbc2cd41f29e7a941a419198f4.pdf.
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TCM Treatment of Severe Syndromes of COVID-19
the wei, qi, ying and xue systems,16 and some follow the syndrome
differentiation based upon the perspective of San Jiao system.17
However, when COVID-19 develops into severe or critical syn-
drome, its pathological changes are more complicated and serious.
There may be a syndrome with a combination of two different chan-
nels simultaneously, or the syndrome with one channel is not yet
healed, but another channel starts to be involved. There is the pos-
sibility of a mixture of three yang channels with involvement of
Shaoyin channel at the same time, or involvement of Taiyang channel
with an accumulation of damp-heat in the lower Jiao, or syndrome
of Shaoyang channel with an accumulation of damp-heat in the
middle Jiao, etc.
In the contents and descriptions of Shang Han Lun—Treatise on
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Febrile Diseases, lung failure and damage to the relation between the
lung and other related organs are not the main pathogenesis to be
discussed and treated. Therefore, it is necessary to point out that syn-
drome differentiation and treatment that is based solely upon a six-
channel system could not be completely applied in the TCM
management of COVID-19. The theory of differentiation based upon
the zang-fu organ systems should also be combined. Meanwhile, due
to the constant high fever with hyperactivity of qi and ying, and the
predominance of damp with blockage of the functions of the qi at
various levels, it is also necessary to combine the differentiation
based upon wei, qi, ying, and xue system or the San Jiao system. It
can be seen clearly that differentiations based upon a single system—
no matter what kind of system—in severe and critical syndrome is
16
Juze Lin, et al. Based on the combination of Weiqiyingxue syndrome differentia-
tion and visceral syndrome differentiation for the treatment of novel coronavirus
pneumonia. Tianjin Traditional Chinese Medicine (天津中医药). 2020, 37(3): 251–
254. http://www.tjzhongyiyao.com/html/tjzyy/2020/3/20200304.htm.
17
Yuhao Wang, et al. Discussion on the transmission rule of COVID-19 based on
damp-heat tri-Jiao syndrome differentiation by XUE Xue. Journal of Zhejiang
University of Traditional Chinese Medicine (浙江中医药大学学报). 2020, 7: 599–
604. https://xuebao.zcmu.edu.cn/ch/reader/view_abstract.aspx?file_no=20200701&
flag=1.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Dispel cold, clear heat, descend the lung-qi, and relieve cough.
160
TCM Treatment of Severe Syndromes of COVID-19
Herbal Treatment:
Da Qing Long Tang-Major Blue Green Dragon Decoction.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Wai guan SJ-5, Lieque LU-7, Feishu BL-13, Zhongfu
LU-1, Chize LU-5, Quchi L.I.-11, Fenglong ST-40, Sanyinjiao SP-6,
and Neiting ST-44 with a reducing method.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest tightness,
while regulating digestion and eliminating excess water in the body.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Dispel cold, eliminate damp, clear heat, descend the lung-qi, and
relieve cough.
Herbal Treatment:
Jiu Wei Qiang Huo Tang-Nine-Herb Decoction with Notopterygium.
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TCM Treatment of Severe Syndromes of COVID-19
Acupuncture Treatment:
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Principle of Treatment:
Dispel cold, clear heat, descend the lung-qi, and relieve shortness of
breath.
Herbal Treatment:
Chai Ge Jie Ji Tang-Bupleurum and Kudzu Decoction to Release the
Muscle Layer.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Lieque LU-7, Feishu BL-13, Zhongfu LU-1, Chize
LU-5, Yuji LU-10, Quchi L.I.-11, Fenglong ST-40, Yanglingquan
GB-34, and Xiaxi GB-43 with a reducing method.
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TCM Treatment of Severe Syndromes of COVID-19
Explanations:
• P-6 + SP-4 are used to descend the lung-qi, relieve fullness of the
chest and shortness of breath. They can also regulate digestion and
eliminate excess water in the body.
• L.I.-4 and LU-7, the yuan-source point of the large intestine chan-
nel and the luo-connecting point of the lung channel respectively
are used to promote sweating to dispel external pathogenic factors.
• BL-13 and LU-1, the back-shu point of the lung and the front-mu
point of the lung channel, together with LU-5, the he-sea point of
the lung channel, which are all the chief points to descend the
lung-qi and relieve the fullness of the chest.
• LU-10, the ying-spring point of the lung channel, L.I.-11, the he-
sea point of the large intestine channel, GB-34 and GB-43, the
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Principle of Treatment:
Dispel cold, nourish yin, clear heat, and descend the lung-qi.
Herbal Treatment:
Jia Jian Wei Rui Tang-Modified Solomon’s Seal Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
These patients usually don’t have a very high fever, but sometimes it
could be very dangerous because most of those patients have some
basic diseases, as well as obvious yin deficiency in TCM. Their blood
saturation is usually very low, and remains low, often around 90% to
92% or even lower, and does not rise quickly. When the blood satu-
ration drops under 90% suddenly, it is considered a mixture of cold
and heat, failure of zheng-qi to prevail over xie-qi, formation of
blood stasis in the blood vessels, and restlessness of the heart and
shen. The patients should be taken into the hospital to receive a com-
bination of modern medicine and TCM. Any delayed or improper
treatment could lead to fatal consequences. In this case, some herbs
to promote blood circulation and resolve blood stasis should be
applied in the herbal prescription, including:
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TCM Treatment of Severe Syndromes of COVID-19
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Hegu L.I.-4, Lieque LU-7, Feishu BL-13, Zhongfu LU-1, Chize
LU-5, and Fenglong ST-40 with a reducing method.
• Jingqu LU-8, Sanyinjiao SP-6, Taixi KID-3, Zhaohai KID-6, KID-7,
and REN-6 with tonifying methods.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve shortness
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Principle of Treatment:
Clear heat, warm the interior, tonify yang of the heart and kidney, and
descend the lung-qi.
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Herbal Treatment:
Ma Xing Shi Gan Tang-Ephedra, Apricot Kernel, Gypsum and Licorice
Decoction.
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TCM Treatment of Severe Syndromes of COVID-19
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Erjian L.I.-2, Hegu L.I.-4, Lieque LU-7, Yuji LU-10, Feishu BL-13,
Chize LU-5, and Fenglong ST-40 with a reducing method.
• Zusanli ST-36, Shaofu HE-8, KID-3, and REN-6 with a tonifying
method.
• Moxibustion should be applied on ST-36, KID-3, and REN-6.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
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• L.I.-4 and LU-7, the yuan-source point of the large intestine chan-
nel and the luo-connecting point of the lung channel respectively,
are used to promote sweating to dispel external pathogenic factors.
• BL-13 and LU-5, the back-shu point and the he-sea point of the
lung channel respectively, LU-10 and L.I.-2, the spring point of
lung channel and large intestine channel repsectively, are the chief
points to descend lung-qi, clear heat and relieve difficulty in
expectorating the phlegm, shortness of breath and chest tightness.
• ST-40, the luo-connecting point of the stomach channel, is used to
eliminate phlegm in the lung.
• ST-36, the he-sea point of the stomach channel, and REN-6 are
used in combination with HE-8, the ying-spring point of the heart
channel, and KID-3, the yuan-source point of the kidney channel,
to tonify the yang of the heart and kidney and eliminate interior
cold. Moxibustion strengthens the effect of tonifying points and
dispels the interior cold.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Dispel external cold, resolve phlegm, eliminate cold fluid, and
descend lung-qi.
Herbal Treatment:
Xiao Qing Long Tang-Minor Blue Green Dragon Decoction, plus
San Zi Yang Qin Tang-Three Seed Decoction to Nourish One’s
Parents.
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TCM Treatment of Severe Syndromes of COVID-19
No matter if Xiao Qing Long Tang descends the lung-qi and relieves
asthma, or San Zi Yang Qin Tang resolves phlegm, both herbal treat-
ments cannot control the complicated situations from this syndrome.
Therefore, Xing Ren and Ting Li Zi are added to descend the lung and
eliminate phlegm. Hou Po and Gua Lou Pi are used to relax the chest
and regulate the qi in the lung. Che Qian Zi, Ze Xie, and Qian Niu
Zi are used to promote urination and relieve edema. Long Chi and
Zhen Zhu Mu are used to calm the shen and relieve palpitations.
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Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6 with
even methods.
• Hegu L.I.-4, Wai guan SJ-5, Feishu BL-13, Chize LU-5, Fenglong
ST-40, Tanzhong REN-17, Sanyinjiao SP-6, and Yinlingquan SP-9
with a reducing method.
• REN-6 and Zusanli ST-36 with a tonifying method.
Explanations:
• P-6 + SP-4, LU-7 + KID-6 are used to descend the lung-qi, reduce
fluid in the chest and relieve chest tightness.
• L.I.-4 and SJ-5, the yuan-source point of the large intestine chan-
nel and the luo-connecting point of the San Jiao channel
respectively are used to promote sweating to dispel external
pathogenic cold.
• BL-13, LU-5, and REN-17, the back-shu point and the he-sea point
of lung channel respectively, together with REN-17, the gathering
point of the qi in the body, are the chief points to descend the
lung-qi, eliminate fluid in the chest and relieve difficulty to expec-
torate the phlegm, shortness of breath and chest tightness.
• ST-40, the luo-connecting point of the stomach channel, is used to
eliminate phlegm in the lung.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• SP-6, the crossing point of the three yin channels of the foot, and
SP-9, the he-sea point of the spleen channel, are used to eliminate
fluid and excessive water in the body.
• REN-6, an essential point for qi in the body, and ST-36, the he-sea
point of the stomach channel, are used to tonify the qi and yang in
the body and eliminate cold.
Principle of Treatment:
Harmonize the Shaoyang and San Jiao, eliminate damp-heat, and
descend lung-qi.
Herbal Treatment:
Xiao Chai Hu Tang-Minor Bupleurum Decoction, plus
San Ren Tang-Three Seed (Nut) Decoction.
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TCM Treatment of Severe Syndromes of COVID-19
Xiao Chai Hu Tang harmonizes the Shaoyang, and San Ren Tang
eliminates damp-heat in the San Jiao. They do not regulate and cor-
rect the situations of failure of the lung in descending the qi. Therefore
Ma Huang, Xing Ren, Sang Bai Pi, Zhe Bei Mu, Huang Qin, and Gua
Lou Pi are added into the prescription as the chief herbs to deal with
the main pathogenic results. If Yangming excess is also present, mani-
festing as constipation and abdominal distention, Da Huang and
Mang Xiao could be added to promote defecation and relieve
constipation.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4 with
even methods.
• Hegu L.I.-4, Lieque LU-7, Feishu BL-13, Chize LU-5, Fenglong ST-40,
Tanzhong REN-17, Taichong LIV-3, Qimen LIV-14, Yanglingquan
GB-34, Qiuxu GB-40, Sanyinjiao SP-6, and Yinlingquan SP-9 with a
reducing method.
Explanations:
• SJ-5 + GB-41 is used to harmonize the Shaoyang and relieve
the disturbance of external pathogenic factors to the liver and
gallbladder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• L.I.-4 and LU-7, the yuan-source point of the large intestine channel,
and the luo-connecting point of the lung channel respectively are
used to promote the sweating to dispel external pathogenic factors.
• BL-13, LU-5 and REN-17, the back-shu point and the he-sea point
of lung channel respectively, together with REN-17, the gathering
point of the qi in the body, are the chief points to descend the
lung-qi, eliminate fluid in the chest and relieve difficulty to expec-
torate the phlegm, shortness of breath and chest tightness.
• ST-40, the luo-connecting point of the stomach channel, is used to
eliminate phlegm in the lung.
• LIV-3 and LIV-14, the yuan-source point from the liver channel
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and the front-mu point the liver respectively, together with GB-34
and GB-40, the he-sea point and yuan-source point of the
gallbladder channel respectively are used to promote the qi circu-
lation, harmonize the liver and gallbladder, and restore the
physiological functions of the liver and gallbladder.
• SP-6 and SP-9, the crossing point and the he-sea point of the
spleen channel respectively, are used to promote digestion and
relieve nausea and diarrhea.
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TCM Treatment of Severe Syndromes of COVID-19
Principle of Treatment:
Clear heat in the lung and stomach, resolve phlegm, and descend the
lung-qi.
Herbal Treatment:
Ma Xing Gan Shi Tang-Ephedra, Apricot Kernel, Gypsum and Licorice
Decoction.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6 with
even methods.
• Hegu L.I.-4, Zhongfu LU-1, Feishu BL-13, Chize LU-5, Tanzhong
REN-17, Quchi L.I.-11, Zhongwan REN-12, Tianshu ST-25,
Fenglong ST-40, ST42, Neiting ST-44, and Sanyinjiao SP-6 with a
reducing method.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest tightness.
• LU-7 + KID-6 are used to relax the chest and benefit the lung.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, are used to clear heat and
reduce fever.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• LU-1, LU-5, and BL-13, the front-mu point and the he-sea point of
the lung channel respectively, the back-shu point of the lung, are
used to clear heat in the lung and descend the lung-qi.
• REN-12, the gathering point of the fu organs and the front-mu
point of the stomach, ST-25, ST42, and ST-44, the front-mu point
of the large intestine, the yuan-source point of the stomach chan-
nel, and the ying-spring point of the stomach channel, are used to
clear heat in the stomach and large intestine.
• ST-40 and SP-6, the luo-connecting point of the stomach channel
and the crossing point of the three yin channels of the foot respec-
tively are used to clear heat and eliminate phlegm in the lung.
Constant high fever, severe cough with profuse yellow and sticky
phlegm (that is difficult to be expectorated), the fullness of chest with
pain and tightness, shortness breath, restlessness, and a red tongue
with a yellow and greasy coating.
It frequently occurs on patients who have always been suffering
from obesity with retention of damp and phlegm in the body, often
have cough with yellow phlegm, bitter taste in the mouth, dryness,
and an uncomfortable feeling in the throat. When there is an invasion
of wind-heat or damp-heat, it could cause aggravation of the situa-
tions with the quick transformation of external heat into the internal
heat, leading to failure of the lung in descending the lung-qi and
accumulation of phlegm-heat in the lung.
Principle of Treatment:
Clear heat in the lung, resolve phlegm, descend the lung-qi and
relieve shortness of breath.
Herbal Treatment:
Ding Chuan Tang-Arrest Wheezing Decoction.
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TCM Treatment of Severe Syndromes of COVID-19
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6 with
even methods.
• Hegu L.I.-4, Quchi L.I.-11, Zhongfu LU-1, Chize LU-5, Yuji LU-10,
Feishu BL-13, Tanzhong REN-17, Tianshu ST-25, Fenglong ST-40,
and Sanyinjiao SP-6 with a reducing method.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• LU-7 + KID-6 are used to relax the chest and benefit the lung.
• L.I.-4, L.I.-11, and ST-25, the yuan-source point and the he-sea
point of the large intestine channel, and front-mu point of the large
intestine, are used to clear heat, promote defecation, and reduce
fever.
• LU-1, LU-5, and BL-13, the front-mu point, the he-sea point of the
lung channel, the back-shu point of the lung respectively, are used
to clear heat in the lung and descend the lung-qi.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
178
TCM Treatment of Severe Syndromes of COVID-19
Principle of Treatment:
Resolve damp, eliminate phlegm, descend the lung-qi, and relieve
shortness of breath.
Herbal Treatment:
Huo Po Xia Ling Tang-Agastaches, Magnolia Bark, Pinellia and Poria
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Decoction, plus
San Zi Yang Qin Tang-Three Seed Decoction to Nourish One’s Parents.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6 with
even methods.
• Zhongfu LU-1, Chize LU-5, Taiyuan LU-9, Feishu BL-13, Zhongwan
REN-12, Tanzhong REN-17, Tianshu ST-25, Fenglong ST-40,
Taichong LIV-3, Sanyinjiao SP-6, and Yinlingquan SP-9 with a
reducing method.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• LU-7 + KID-6 are used to relax the chest and benefit the lung.
• LU-1, LU-5, LU-9 and BL-13, the front-mu point, the he-sea point,
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TCM Treatment of Severe Syndromes of COVID-19
Principle of Treatment:
Clear heat, resolve damp, harmonize the middle Jiao, descend the
lung-qi, and relieve shortness of breath.
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Herbal Treatment:
Lian Po Yin-Coptis and Magnolia Bark Drink.
Lian Po Yin is only good at clearing the heat and resolving damp in
the middle Jiao, it has no effect to descend the lung-qi in COVID-19.
Therefore, some extra herbs should be added to the prescription to
clear the heat, eliminate phlegm in the lung and descend the lung-qi.
Otherwise, shortness of breath, tightness of the chest, and severe
cough with yellow phlegm will not improve.
It is possible that sometimes there is some confusion between
using Bai Hu Tang or Lian Po Yin. In fact, there is an obvious big
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Chize LU-5, Feishu BL-13, Zhongwan REN-12, Tanzhong REN-17,
Quchi L.I.-11, Tianshu ST-25, Fenglong ST-40, Yanglingquan
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Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• LU-5 and BL-13, the he-sea point of the lung channel, and the
back-shu point of the lung respectively are used to descend the
lung-qi, resolve damp-phlegm in the lung and relieve cough.
• REN-17, the gathering point of the qi, is used to descend the
lung-qi and relax the chest to relieve chest tightness.
• L.I.-11, REN-12, ST-25, ST-40, the he-sea point of the large intes-
tine channel, the gathering point of the fu organs and the front-mu
point of the stomach, the front-mu point of the large intestine, and
the luo-connecting point of the stomach channel respectively,
together with SP-6 and SP-9, the crossing point of the three yin
channels of the foot and the he-sea point of the spleen channel
respectively, are used to eliminate damp-heat in the middle Jiao
and relieve the vomiting and diarrhea.
• GB-34 and GB-40, the he-sea point and yuan-source point of the
gallbladder channel respectively, are used to eliminate damp-heat
in the body and promote digestion.
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TCM Treatment of Severe Syndromes of COVID-19
heat quickly, starting to mix with the interior heat in the Yangming.
However, it is lucky that there is not yet the formation of excessive
heat with the stool in the large intestine. Otherwise, this situation
could cause another syndrome discussed below, i.e., formation of
Yangming fu excess.
Principle of Treatment:
Clear heat, reduce fever, descend the lung-qi, and relieve shortness
of breath.
Herbal Treatment:
Bai Hu Tang-White Tiger Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
It is quite clear that the herbal formula Bai Hu Tang is for sure a good
prescription to clear the heat and reduce fever. However, it will not
be able to descend the lung-qi and relieve severe cough. Besides, it
could resolve phlegm in the lung. Therefore, some extra herbs to
clear heat and eliminate phlegm in the lung should be added to the
prescription. Otherwise, fever is reduced, but the lung situation
deteriorates.
Acupuncture Treatment:
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Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• LU-5 and BL-13, the he-sea point of the lung channel and the
back-shu point of the lung respectively, are used to descend the
lung-qi and relieve cough.
• REN-17, the gathering point of the qi, is used to descend the
lung-qi and relax the chest to relieve chest tightness.
• L.I.-4, L.I.-11, and REN-12, the yuan-source point and the he-sea
point of the large intestine channel, the gathering point of the fu
organs, and the front-mu point of the stomach respectively, are
used to clear heat in the stomach, reduce fever and promote
defecation.
• DU-14, the meeting of all the yang channels in the body, is used
to clear heat and reduce fever.
• ST-40, the luo-connecting point of the stomach channel, is used to
resolve phlegm in the lung and stop coughing.
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TCM Treatment of Severe Syndromes of COVID-19
• ST-44 and SP-6, the ying-stream point of the stomach channel, and
the crossing point of three yin channels of the foot are used to
clear heat in the stomach and reduce fever.
Principle of Treatment:
Promote defecation, clear heat, descend the lung-qi, and relieve
shortness of breath.
Herbal Treatment:
Da Cheng Qi Tang-Major Order the Qi Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4 with even methods.
• Chize LU-5, Feishu BL-13, Tanzhong REN-17, Hegu L.I.-4, Quchi
L.I.-11, Tianshu ST-25, Shangjuxu ST-37, Fenglong ST-40, Neiting
ST-44, Dazhui DU-14, and Sanyinjiao SP-6 with a reducing
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method.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• LU-5 and BL-13, the he-sea point of the lung channel and the
back-shu point of the lung respectively, are used to descend the
lung-qi and relieve cough.
• REN-17, the gathering point of the qi, is used to descend the
lung-qi and relax the chest to relieve chest tightness.
• L.I.-4, L.I.-11, and REN-12, the yuan-source point and the he-sea
point of the large intestine channel, the gathering point of the fu
organs, and the front-mu point of the stomach respectively, are
used to clear heat in the stomach, reduce fever and promote
defecation.
• DU-14, the meeting of all the yang channels in the body, is used
to clear heat and reduce fever.
• ST-40, the luo-connecting point of the stomach channel, is used to
resolve phlegm in the lung and stop coughing.
• ST-25, the front-mu point of the large intestine, ST-37, the lower
sea point of the large intestine, ST-44, the ying-spring point of the
stomach, and SP-6, the crossing point of the three yin channels of
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TCM Treatment of Severe Syndromes of COVID-19
the foot, are used to clear heat in the stomach, promote defecation
and reduce fever.
Principle of Treatment:
Greatly tonify yang of the heart and kidney, descend the lung-qi, and
resolve the phlegm.
Herbal Treatment:
Si Ni Tang-Frigid Extremities Decoction, plus
Ma Huang Fu Zi Xi Xin Tang-Ephedra, Prepared Aconite and Asarum
Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6 with
even methods.
• Chize LU-5, Feishu BL-13, Tanzhong REN-17, and Fenglong ST-40
with a reducing method.
• Zusanli ST-36, Shaofu HE-8, Laogong P-8, Taixi KID-3, Guanyuan
REN-4, and Qihai REN-6 with a tonifying method.
• Moxibustion should be applied on ST-36, Taixi KID-3, REN-4, and
REN-6.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve chest
tightness.
• LU-7 + KID-6 are used to benefit the lung and relieve shortness of
breath.
• LU-5, BL-13 and REN-17, the he-sea point of the lung channel, the
back-shu point of the lung, and the gathering point of the qi
respectively, are the chief points to descend the lung-qi and relieve
shortness of breath and chest tightness.
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TCM Treatment of Severe Syndromes of COVID-19
189
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1
Hui Zhu, et al. Clinical features of COVID-19 convalescent patients with re-positive
nucleic acid detection. J Clin Lab Anal. 2020, 34: e23392. https://doi.org/10.1002/
jcla.23392.
191
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
memory, loss of taste and smell (iii) damage to the kidney function,
which causes edema and (iv) reduce the number of sperm cells in
men, which affects fertility. A number of investigations and research
findings in recent days have found that patients who have recovered
from new coronary pneumonia still show various symptoms, which
might retain for six months or more after convalescence.
Convalescence, synonyms for recovery and recuperation, means
the same as the Latin convale-scere, meaning “to regain health”,
gradual healing after sickness or injury. Convalescence for an illness
is often accompanied by various medicines, sufficient rest, proper
diet, an emotional coach, and some physical exercise.
The patients during the convalescence period are required to visit
the doctor for regular check-ups. A negative COVID-19 test does not
mean convalescence or recovery.
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TCM Treatment of COVID-19 at Convalescent Stage
phase refers to the period of the first 4–5 weeks immediately after
the onset of the symptoms of COVID-19. Acute post-COVID
symptoms last from week 5 to week 12, long post-COVID symp-
toms last from week 12 to week 24, and persistent post-COVID
symptoms last more than 24 weeks. From the above, it could be
concluded that convalescence of COVID-19 refers to the period
from week five to week 12 from the onset of the first symptom.
However, it could also be up to 6 months, or even longer. “With
other common viral illnesses, such as flu, we would expect recovery
to mean going back to pre-infection levels of functionality and qual-
ity of life. This means we must follow up on all patients with con-
firmed (by test) or highly probable (by symptoms) COVID-19 and
find out whether they have returned to their previous “normal”
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2
Nisreen A. Alwan. A negative COVID-19 test does not mean recovery. Nature.
2020, 584: 170. https://doi.org/10.1038/d41586-020-02335-z.
193
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
3
Yang Wang. op. cit.
194
TCM Treatment of COVID-19 at Convalescent Stage
195
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
yet known with certainty. Several studies have shown that most trans-
mission happens around the onset of symptoms and that SARS-CoV-2
can initially be detected in upper respiratory samples around two
days before the onset of symptoms. In studies of non-severe cases,
the virus was successfully isolated for ten days from the onset of
symptoms. In an analysis of 72 infector-infected pairs in South Korea,
the estimated median transmission onset was 1.31 days (standard
deviation (SD) 2.64 days), following the onset of initial symptoms
with a peak of 0.72 days. Among hospitalized/severe COVID-19
patients, isolation of SARS-CoV-2 was possible until day 20 after the
onset of symptoms, with a median of 8 days (interquartile range (IQR)
5–11 days). The probability of detecting infectious SARS-CoV-2
dropped below 5% after 15.2 days after the onset of symptoms (95%
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4
European Centre for Disease Prevention and Control. Guidance for discharge and
ending of isolation of people with COVID-19. 16 October 2020. Stockholm: ECDC,
2020. https://www.ecdc.europa.eu/sites/default/files/documents/Guidance-for-
discharge-and-ending-of-isolation-of-people-with-COVID-19.pdf.
5
Shaobin He et al. Positive RT-PCR test results in 420 patients recovered from
COVID-19 in Wuhan: An observational study. Front. Pharmacol. 7 October 2020.
https://doi.org/10.3389/fphar.2020.549117.
196
TCM Treatment of COVID-19 at Convalescent Stage
6
The Centre for Evidence-Based Medicine. PCR positives: What do they mean?
17 September 2020. https://www.cebm.net/covid-19/pcr-positives-what-do-they-
mean/.
197
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
than 20 days after symptom onset. However, there have been several
reports of people shedding replication-competent virus beyond 20
days due to severe immunocompromise.7 There could be exceptions.
After almost 10 months, 43 positive RT-PCR tests, and several near-
death experiences, a man in UK, Bristol has tested negative for
COVID-19. With this, he came to hold an unfortunate record of
being an active COVID-19 patient for the longest duration.8
During the pandemic, some hospitals require their staff to con-
tinue to work when their PCR tests are positive. For instance—a
hospital in Liege, which is situated in the east near the border with
the Netherlands and at the center of a coronavirus hotspot with the
highest coronavirus incidence rate in Belgium—was asking its nurses
to carry on working as long as they are not displaying symptoms even
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7
Centers for Disease Control and Prevention (CDC). Ending isolation and precau-
tions for people with COVID-19: Interim guidance. 14 September 2021. https://
www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html.
8
10 months. That’s how long this UK man tested positive for Covid. India Today
24 June 2021. https://www.indiatoday.in/world/story/10-months-that-s-how-long-
this-uk-man-tested-positive-for-covid-read-his-story-1818967-2021-06-24.
9
Shona Murray, Joanna Gill. Nurses with COVID-19 asked to carry on working at
under pressure hospital in Belgium. Euronews. 28 October 2020. https://www.
euronews.com/2020/10/28/coronavirus-nurses-with-covid-19-asked-to-carry-on-
working-at-under-pressure-hospital-in-b.
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TCM Treatment of COVID-19 at Convalescent Stage
antigen test that is less than 48 hours old or proof that they have
recovered from COVID-19 in the last six months. According to the
government’s draft bill, restaurants could be fined up to €45,000 and
proprietors face up to a year in prison if they fail to comply.10
10
Grégoire Sauvage. France prepares to introduce COVID-19 “health pass” for access to
cultural venues. France24. 16 July 2021. https://www.france24.com/en/europe/20210716-
as-france-extends-use-of-covid-health-pass-what-are-its-eu-neighbours-doing.
11
Bingman Liu et al. Epidemiological characteristics of COVID-19 patients in
convalescence period. Epidemiol Infect. 2020, 148: e108. doi: 10.1017/S0950268
820001181.
199
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
12
Hui Zhu, et al. op. cit.
200
TCM Treatment of COVID-19 at Convalescent Stage
13
Bingman Liu, et al. op. cit.
201
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
ferences were observed in the positive rate of IgM and/or IgG anti-
bodies between severe and non-severe patients. Their conclusions
are that leukopenia, lymphopenia, ground-glass opacity, and fibrosis
are common in discharged severe COVID-19 patients, and liver
injury is common in discharged adult patients.14
14
Siqin Zhang, et al. Clinical characteristics of 134 convalescent patients with
COVID-19 in Guizhou, China. Respir Res. 2020, 21: 314. https://doi.org/10.1186/
s12931-020-01580-0.
202
TCM Treatment of COVID-19 at Convalescent Stage
203
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
15
Ke Hu, et al. Efficacy and safety of Lianhua Qingwen capsules, a repurposed
Chinese herb, in patients with Coronavirus disease 2019: A multicenter, prospective,
randomized controlled trial. Phytomedicine. 2021, 85: 153242. https://doi.org/10.
1016/j.phymed.2020.153242.
204
TCM Treatment of COVID-19 at Convalescent Stage
2021. https://www.news-medical.net/health/What-is-Convalescent-Plasma.aspx.
205
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
17
Kai Duan, et al. Effectiveness of convalescent plasma therapy in severe COVID-19
patients. PNAS. 2020, 117(17): 9490–9496. https://doi.org/10.1073/
pnas.2004168117.
18
Romina Libster, et al. Early high-titer plasma therapy to prevent severe COVID-
19 in older adults. N Engl J Med. 2021, 384: 6106–6118. doi: 10.1056/
NEJMoa2033700.
206
TCM Treatment of COVID-19 at Convalescent Stage
207
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
208
TCM Treatment of COVID-19 at Convalescent Stage
hand, when methods to strongly attack the pathogens are still mainly
applied instead of using treatment to tonify the zheng-qi for those
who has almost no pathogens and are suffering from zheng-qi defi-
ciency, this treatment could cause further damage to the patient.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Clear heat, disperse the lung-qi, resolve damp, and harmonize the
middle Jiao.
Herbal Treatment:
Cang Fu Dao Tan Tang-Atractylodes-Poria Phlegm-Dissipating
Decoction.
Explanations:
• Cang Zhu, Xiang Fu, Zhi Ke and Hou Po are used to eliminate
damp, promote the qi circulation in the chest, and harmonize the
middle Jiao.
• Zhi Ban Xia, Xing Ren and Jie Geng eliminate damp-phlegm and
regulate the functions of the lung to relieve cough and slight tight-
ness of the chest.
• Fu Ling and Chen Pi are used to activate the spleen, eliminate
damp in the body and resolve phlegm in the lung.
• Yu Jin and Hong Hua harmonize the collaterals in the lung and the
collaterals connected by the lung so as to promote the qi and
blood circulation and prevent blood stagnation.
• Ge Gen ascends clear yang and descends the turbid yin so as to
eliminate damp in the spleen and resolve phlegm in the body.
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TCM Treatment of COVID-19 at Convalescent Stage
Modifications:
• If there is a headache, add Bai Zhi Radix Angelicae Dahuricae
10 g to relieve the headache.
• If there is much emotional disorder, add Chang Pu Rhizoma
Anemonis Altaicae 10 g and Yuan Zhi Radix Polygalae Tenuifoliae
10 g to benefit the heart orifice and regulate the emotions.
• If there is muscle pain, add Qiang Huo Rhizoma et Radix
Notopterygii 10 g and Sang Zhi Ramulus Mori Albae 10 g to
relieve the muscle pain.
• If there is much expectoration of white phlegm, add Bai Jie
Zi Semen Sinapis Albae 10 g and Zhi Ban Xia Rhizoma Pinelliae
Ternatae Preparata 10 g to eliminate phlegm and relieve cough.
• If there is cough with much diluted phlegm, add Ting Li Zi Semen
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Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Chize LU-5, Feishu BL-13, Zusanli
ST-36, Fenglong ST-40, Sanyinjiao SP-6, Yinlingquan SP-9,
Yanglingquan GB-34, and Tanzhong Ren-17.
• An even method is used on Neiguan P-6 + Gongsun SP-4, and a
reducing method is used on LU-5, BL-13, ST-40, SP-6, SP-9, and
GB-34. An even method is used on Ren-17. A tonifying method is
used on ST-36.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve remaining
cough.
• LU-5 and BL-13, the he-sea point of the lung channel and the
back-shu point of the lung respectively, eliminate remaining path-
ogens in the lung and relieve cough and sore throat.
• SP-6 and SP-9, the crossing point of the three yin channels of the
foot, and the he-sea point of the spleen channel respectively, ST-40,
the luo-connecting point of the stomach channel, and GB-34, the
he-sea point of the gallbladder channel, are used to remove toxins,
eliminate damp in the body and relieve the body pain.
• Ren-17, the gathering point of the qi, is used with an even method
to promote the qi circulation in the chest and restore the physio-
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Modifications:
• If there is much headache, add Shenting DU-24 to relieve the
headache.
• If there is much emotional disorder or insomnia, add the Extra
Anmian and Extra Sishencong to calm the shen, regulate the emo-
tions and improve sleeping.
• If there is muscle pain, add Waiguan SJ-5 and Zulinqi GB-41 to
harmonize the yangwei channel, regulate the Shaoyang channel
and relieve the muscle pain.
• If there is much expectoration of white phlegm, add Zhongfu
LU-1, the front-mu point of the lung, to eliminate phlegm and
relieve cough.
• If there is cough with much diluted phlegm, add Taiyuan LU-9 to
descend the lung-qi and eliminate cold-phlegm.
• If there is obvious loss of smell and taste, add Yingxiang L.I.-20 and
Juliao ST-3 to open the nasal orifice and improve smell and taste.
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TCM Treatment of COVID-19 at Convalescent Stage
Principle of Treatment:
Activate the spleen, benefit qi, clear heat, remove toxins, and elimi-
nate damp.
Herbal Treatment:
Lian Po Yin-Coptis and Magnolia Bark Drink.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Huang Lian, Huang Qin and Hou Po are used to clear heat,
remove toxins, eliminate damp and harmonize the middle Jiao.
Hou Po could also open the chest and relieve the pressure over the
chest.
• Zhi Mu and Zhi Zi are used together to support the above herbs to
clear remaining damp-heat and reduce feverish feeling.
• Sang Ye and Xing Ren are used to clear heat in the lung and relieve
the cough.
• Cao Guo eliminates damp and removes toxins.
• Dang Shen, Bai Zhu, and Fu Ling are used to activate the spleen,
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Modifications:
• If there is a headache, add Bai Zhi Radix Angelicae Dahuricae
10 g to relieve the headache.
• If there is much emotional disorder, add He Huan Pi Cortex
Albizziae Julibrissin 10 g and Fu Shen Sclerotium Poriae Cocos
Paradicis 10 g to calm the shen and regulate the emotions.
• If there is obvious loss of smell and taste, add Cang Er Zi Fructus
Xanthii Sibirici 10 g and Xin Yi Hua Flos Magnoliae 10 g to open
the nasal orifice and improve the smell and taste.
• If there is much expectoration of yellow phlegm, add Zhe Bei
Mu Bulbus Fritillariae Thunbergii 10 g and Sang Bai Pi Cortex
Mori Albae Radicis 10 g to eliminate phlegm-heat and relieve
cough.
• If there is very poor appetite and much nausea, add Jiao Mai
Ya Fructus Hordei Vulgaris Germinantus 10 g and Sha Ren
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TCM Treatment of COVID-19 at Convalescent Stage
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Chize LU-5, Feishu BL-13, Quchi
L.I.-11, Zhongwan REN-12, Fenglong ST-40, Neiting ST-44,
Sanyinjiao SP-6, Yinlingquan SP-9, Yanglingquan GB-34, and
Zusanli ST-36.
• An even method is applied on P-6 + SP-4, a reducing method is
used on LU-5, BL-13, L.I.-11, REN-12, ST-40, ST-44, SP-6, SP-9,
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Explanations:
• P-6 + SP-4 are used to descend the qi of the lung and stomach,
relieve remaining cough and nausea.
• LU-5 and BL-13, the he-sea point of the lung channel and the
back-shu point of the lung respectively, eliminate remaining
pathogens in the lung and relieve cough and pressure over the
chest.
• L.I.-11, the he-sea point of the large intestine channel, ST-44, the
ying-spring point of the stomach channel, and SP-6, the crossing
point of the three yin channels of the foot, clear heat, reduce fever
and remove toxins in the body.
• REN-12, the gathering point of the fu organs and the front-mu
point of the stomach, SP-9, the he-sea point of the spleen channel,
and GB-34, the he-sea point of the gallbladder channel, are used
to eliminate damp in the body, harmonize the middle Jiao and
promote digestion.
• ST-36, the he-sea point of the stomach channel, is used to tonify
the zheng-qi, and activate the spleen and stomach so as to improve
strength of the body.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Modifications:
• If there is much headache, add Extra Yintang or Extra Taiyang to
relieve the headache.
• If there is much emotional disorder, add Shaohai HE-3, and
Shenmen HE-7 to calm the shen and regulate the emotions.
• If there is obvious loss of smell and taste, add Yingxiang L.I.-20 and
Juliao ST-3 to open the nasal orifice and improve the smell and taste.
• If there is much expectoration of yellow phlegm, add Yuji LU-10,
the ying-stream point of the lung channel, to eliminate phlegm-
heat and relieve cough.
• If there is very poor appetite and much nausea, add Zusanli ST-36,
the he-sea point of the stomach channel, to promote digestion and
improve appetite.
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Principle of Treatment:
Promote the qi and blood circulation, eliminate damp, and remove
toxins.
Herbal Treatment:
Xue Fu Zhu Yu Tang-Drive out Stasis in the Mansion of Blood
Decoction.
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TCM Treatment of COVID-19 at Convalescent Stage
Explanations:
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• Tao Ren, Hong Hua, Yu Jin, Chi Shao Yao and Pu Huang are
used to strongly promote the blood circulation, eliminate blood
stasis and relieve the stabbing pain in the chest and muscle
pain.
• Zhi Ke and Hou Po promote the qi circulation so as to promote the
blood circulation.
• Hou Po and Xing Ren are used in combination to eliminate damp
and phlegm, regulate the qi in the lung, and descend the lung-qi
to relieve the cough and asthma.
• Fu Shen calms shen and improves sleep.
• Huang Qin clears remaining heat in the lung.
• Tong Cao and Zhu Ling are used to promote urination and relieve
weak urination.
• Da Fu Pi promotes the qi circulation in the abdomen and relieves
weak defecation.
• Chuan Niu Xi promotes blood circulation and induces the blood
to move downwards.
Modifications:
• If there is much headache, add Chuan Xiong Radix Ligustici
Wallichii 10 g to relieve the headache.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Chize LU-5, Taiyuan LU-9, Feishu
BL-13, Geshu BL-17, Shaohai HE-3, Fenglong ST-40, Sanyinjiao
SP-6, Yinlingquan SP-9, Xuehai SP-10, Yanglingquan GB-34,
Tanzhong Ren-17 and Zusanli ST-36.
• An even method is applied on Neiguan P-6 + Gongsun SP-4, a
reducing method is applied on LU-5, LU-9, BL-13, BL-17, HE-3,
ST-40, SP-6, SP-9, SP-10, GB-34, and Ren-17, and a tonifying
method is used on ST-36.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve remaining
cough and asthma. Meanwhile they could promote the qi circula-
tion in the body.
• LU-5 and BL-13, the he-sea point of the lung channel and the
back-shu point of the lung respectively, together with Ren-17,
the gathering point of the qi, eliminate remaining pathogens in the
lung and relieve cough and asthma. Ren-17 also promotes and
regulates the qi circulation in the body.
• LU-9, the gathering point of the vessels in the body, SP-6, the
crossing point of three yin channels of the foot, together with
BL-17, the gathering point of the blood, and SP-10, are used to
promote the blood circulation and eliminate blood stasis.
218
TCM Treatment of COVID-19 at Convalescent Stage
Modifications:
• If there is much headache, add Fengchi GB-20 and extra Yintang
to relieve the headache.
• If there is an obvious emotional situation, add Xinshu BL-15 and
Shenmen HE-7, the back-shu point of the heart and the yuan-
source point of the heart channel respectively, to calm the shen
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Principle of Treatment:
Tonify the qi, activate the spleen and reinforce the lung and relieve
damp-phlegm.
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• The first six herbs, which are the complete ingredients of Bu Fei
Tang, are used to tonify lung-qi and relieve cough.
• Ren Shen, Fu Ling, Bai Zhu and Zhi Gan Cao, which are the com-
plete ingredients of Si Jun Zi Tang, are used to tonify the qi of the
general body and relieve tiredness.
• Sha Ren promotes digestion and eliminates damp in the middle Jiao.
• Zhi Ban Xia and Chen Pi are used to eliminate remaining phlegm
in the lung and damp in the body.
• Zhi Ke promotes the qi circulation and prevents qi stagnation.
• Yu Jin and Hong Hua are used to promote the blood circulation,
regulate the collaterals, and relieve the pain.
Modifications:
• If there is severe fatigue, add Dong Chong Xia Cao clerotium Cor-
dyceps Sinensis 1 g for infusion and Sheng Ma Rhizoma Cimicifugae
6 g to ascend qi and relieve the fatigue.
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TCM Treatment of COVID-19 at Convalescent Stage
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6 with
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even methods.
• Chize LU-5, Taiyuan LU-9, Feishu BL-13, Geshu BL-17, Pishu
BL-20, Zusanli ST-36, Qihai REN-6, Taixi KID-3, Yinlingquan SP-9,
and Tanzhong Ren-17.
• A tonifying method is applied on LU-5, LU-9, BL-13, BL-20, ST-36,
REN-6, KID-3, SP-9, and Ren-17. An even method is used on Ren-
17 and BL-17, a reducing method is applied on SP-9. Moxibustion
is used on ST-36 and REN-6.
Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve remaining
cough.
• LU-7 and KID-6 are used to nourish the qi of the body and relax
the chest.
• LU-5, LU-9, and BL-13, the he-sea point, the yuan-source point of
the lung channel, and the back-shu point of the lung respectively,
together with ST-36, the he-sea point of the stomach channel, in
combination with BL-20, the back-shu point of the spleen, and
KID-3, the yuan-source point of the kidney channel, and REN-6,
the important point to reinforce the body, are all applied in groups
to tonify the qi of the body, improve yuan-source qi and the
strength of the body and relieve fatigue.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Ren-17, the gathering point of the qi, and BL-17, the gathering
point of the blood, together with SP-9, the he-se point of the
spleen channel, are used to promote elimination of qi stagnation,
toxins accumulation and damp obstruction in the body.
Modifications:
• If there is severe fatigue, add Sanyinjiao SP-6 and Baihui DU-20 to
tonify the qi, ascend the qi and relieve the fatigue.
• If there is an obvious emotional situation, add Xinshu BL-15 and
Ganshu BL-18, the back-shu point of the heart and liver respec-
tively, to benefit the heart and liver, regulate the emotions and
calm the shen.
• If there is obvious aversion to cold with cold hands and feet, add
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Principle of Treatment:
Tonify qi, nourish yin, benefit the lung, and relieve dry cough.
Herbal Treatment:
Sha Shen Mai Men Dong Tang-Glehnia and Ophiopogonis Decoction.
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TCM Treatment of COVID-19 at Convalescent Stage
Explanations:
• Nan Sha Shen, Bei Sha Shen, and Mai Men Dong are used
to nourish the yin of the lung and kidney, and clear the deficient
heat, promote the secretion of body fluid, and relieve the thirst.
• Xi Yang Shen nourishes the qi and yin of the general body,
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Modifications:
• If there is severe fatigue, add Huang Qi Radix Astragali Membranacei
10 g to tonify the qi and relieve the fatigue.
• If there is obvious emotion, add He Huan Pi Cortex Albizziae
Julibrissin 10 g and Bai Zi Ren Semen Biotae Orientalis 10 g to
smooth the emotions and calm the Shen.
• If there is much dry cough, add Chuan Bei Mu Bulbus Fritillariae
Cirrhosae 10 g and Bai Bu Radix Stemonae 10 g to nourish the
lung and stop the cough.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6,
Chize LU-5, Jingqu LU-8, Shenshu BL-23, Taiyuan LU-9, Feishu
BL-13, Zusanli ST-36, Qihai REN-6, Taixi KID-3, Fuliu KID-7,
Sanyinjiao SP-6 and Tanzhong Ren-17.
• An even method is applied on P-6 + SP-4, LU-7 + KID-6 and
Ren-17.
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Explanations:
• P-6 + SP-4 are used to descend the lung-qi and relieve remaining
cough.
• LU-7 and KID-6 are used to nourish the qi of the body and relax
the chest.
• LU-5, LU-9, and BL-13, the he-sea point, the yuan-source point of
the lung channel, and the back-shu point of the lung respectively,
together with ST-36, the he-sea point of the stomach channel, KID-
3, the yuan-source point of the kidney channel, in combination
with BL-20, the back-shu point of the spleen, are all applied in
group to tonify the qi of the body, improve yuan-source qi and the
strength of the body and relieve fatigue.
• LU-8, the jing-metal point of the lung channel, BL-23, the back-
shu point of the kidney, KID-7, the jing-metal point of the kidney
channel, SP-6, the crossing point of three yin channels of the foot,
KID-3, the yuan-source point of the kidney channel, together with
REN-6, are used to nourish the yin of the lung and kidney and
clear the deficient heat in the body.
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TCM Treatment of COVID-19 at Convalescent Stage
Modifications:
• If there is severe fatigue, add Baihui DU-20 to lift the qi and relieve
the fatigue.
• If there is an obvious emotional situation, add Qimen LIV-14 and
Shenmen HE-7 to smooth the emotions and calm the shen.
• If there is much dry cough, add Shenfeng KID-23 to nourish the
yin of the lung and kidney and stop the cough.
• If there is too much night sweating, add Tongli HE-5 and Yinxi
HE-6 to nourish the yin and stop night sweating.
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225
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1
World Health Organization (WHO). WHO coronavirus (COVID-19) dashboard.
2021. https://covid19.who.int/?gclid=Cj0KCQiA0rSABhDlARIsAJtjfCcog4ziUoRhw7F
Mc63Sbm5sf_y6uSbwc14d7D0EICut7WB9Z91IFzMaAnpeEALw_wcB.
2
Pfizer and BioNTech conclude phase 3 study of COVID-19 vaccine candidate,
meeting all primary efficacy endpoints. Pfizer.com (Press Release) 18 November
2020. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-
biontech-conclude-phase-3-study-covid-19-vaccine.
3
Peter Doshi. Pfizer and Moderna’s “95% effective” vaccines—we need more details
and the raw data. BMJ. (Press Release) 5 February 2021. https://blogs.bmj.com/
bmj/2021/01/04/peter-doshi-pfizer-and-modernas-95-effective-vaccines-we-need-
more-details-and-the-raw-data/.
227
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
side-effects other than a sore arm. Unfortunately, this is not the case
for the Pfizer and Moderna COVID-19 vaccines, at least not yet.4
Fevers and aches following these jabs are not dangerous but can be
intense for some.5 Short-term pain at the injection site is widespread
with both vaccines—roughly 90% of those who received the
Moderna vaccine reported pain,6 as did roughly 80% of those who
received the Pfizer vaccine.7 In both trials, injection-site pain was
infrequent in people who received a placebo. In research in the US,
FDA analysis showed that neither the Pfizer or Moderna vaccines
caused problems that would make emergency use unwarranted.8
Fewer than 2% of Pfizer and Moderna vaccine recipients devel-
oped severe fevers with a temperature of 39°C to 40°C. However, if
the companies win regulatory approval, they aim to supply vaccines
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4
Helen Branswell. Comparing the COVID-19 vaccines developed by Pfizer, Moderna,
and Johnson & Johnson, Stat. 2 February 2021. https://www.statnews.com/2020/12/19/
a-side-by-side-comparison-of-the-pfizer-biontech-and-moderna-vaccines/.
5
Meredith Wadman. Fever, aches from Pfizer, Moderna jabs aren’t dangerous but
may be intense for some, Science. 18 November 2022. https://www.sciencemag.org/
news/2020/11/fever-aches-pfizer-moderna-jabs-aren-t-dangerous-may-be-intense-
some.
6
FDA. FDA briefing document moderna COVID-19 vaccine. 17 December 2020.
https://www.fda.gov/media/144434/download.
7
Karen Kaplan. How the COVID-19 vaccines from Moderna and Pfizer compare head
to head, Los Angeles Times. 15 December 2020. https://www.latimes.com/science/
story/2020-12-15/how-the-covid-19-vaccines-from-moderna-and-pfizer-compare-
head-to-head.
8
Ibid.
9
Meredith Wadman. Public needs to prep for vaccine side effects, Science. 27 November
2020, 370(6520): 1022. https://science.sciencemag.org/content/370/6520/1022.
10
Ibid.
228
TCM Treatment of Side Effects of COVID-19 Vaccines
11
Meredith Wadman. 18 November 2022. op. cit.
12
Ten people die after getting Pfizer vaccine in Germany. NEWS.ru. https://news.ru/
en/europe/ten-people-die-after-getting-pfizer-vaccine-in-germany/.
13
Karen Kaplan, op. cit.
14
Meredith Wadman. 27 November 2022. op. cit.
15
Meredith Wadman. 18 November 2022. op. cit.
16
Ibid.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• The vaccines enter the body through the skin in the same way as
other external pathogenic factors.
• Patients develop flu-like symptoms.
• Symptoms start suddenly.
• Symptoms could occur at different stages, not always at Taiyang
stage.
• The symptoms are due to the conflict between zheng-qi and
xie-qi.
• Symptoms are mostly temporary.
17
Coronavirus vaccine — summary of Yellow Card reporting. https://www.gov.uk/
government/publications/coronavirus-covid-19-vaccine-adverse-reactions/corona
virus-vaccine-summary-of-yellow-card-reporting.
230
TCM Treatment of Side Effects of COVID-19 Vaccines
231
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
232
TCM Treatment of Side Effects of COVID-19 Vaccines
ing that the invading pathogens have been cleared. Any pathogens
remaining in the body can bring about long-term illness. When the
immediate side-effects of vaccines occur, they usually present as
pathology involving Taiyang (invasion of wind-cold), Shaoyang or
Yangming (invasion of toxic heat). However, in some cases more
severe consequences can occur. The MHRA has undertaken a thor-
ough review into UK reports of an extremely rare specific type of
blood clot in the brain, known as cerebral venous sinus thrombosis
(REN-ST) occurring together with low levels of platelets (thrombocyto-
penia) following vaccination with the COVID-19 Vaccine AstraZeneca.
It is also considering other blood clotting cases (thromboembolic
events) alongside low platelet levels. This ongoing scientific review
has concluded that the evidence of a link with COVID-19 Vaccine
AstraZeneca is stronger.20 An anaphylactic reaction or even death is
18
Karen Kaplan. op. cit.
19
Ibid.
20
Medicines and Healthcare Products Regulatory Agency. MHRA issues new advice,
concluding a possible link between COVID-19 vaccine AstraZeneca and extremely
rare, unlikely to occur blood clots. (Press Release) 7 April 2021. https://www.gov.uk/
government/news/mhra-issues-new-advice-concluding-a-possible-link-between-
covid-19-vaccine-astrazeneca-and-extremely-rare-unlikely-to-occur-blood-clots.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
another severe case. For example, Norwegian health officials say that
23 deaths among the frail and elderly were associated with recent
COVID-19 vaccinations.21 More than half of those who died have
been assessed, and the agency involved has stated that those fatalities
may be linked to common adverse reactions from the vaccine. Note
that these life-threatening situations would involve much more com-
plicated pathology than the patterns presented in this chapter.
Herbal Treatment:
Jing Fang Bai Du San-Schizonepeta and Saposhnikovia Powder to
Overcome Pathogenic Influences.22
21
Adam Smith. 23 died after getting covid shot in Norway. Here’s the rest of the story,
The Street, 17 January 2021. https://www.thestreet.com/latest-news/23-died-after-
covid-shot-in-norway-heres-the-rest-of-the-story.
22
There are of course other herbal formulas which might be used to deal with inva-
sion of wind-cold, such as Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang
Cinnamon Twig Decoction) and Qiang Huo Sheng Shi Tang (Notoptergium
Decoction to Overcome Damp) Ma Huang Tang is suitable to treat severe symptoms
of wind-cold invasion following vaccination, in which there is no sweating, obvious
aversion to cold, muscle pain, headache and joint pain, thin and white coating and
a tight pulse. Qiang Huo Sheng Shi Tang is used when there is severe sensation of
heaviness with pain in the head, muscles and joints, a white and greasy tongue coat-
ing and a slippery pulse.
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TCM Treatment of Side Effects of COVID-19 Vaccines
Explanations:
• Jing Jie and Fang Feng dispel wind-cold and relieve the exterior
symptoms.
• Qiang Huo, Gao Ben and Bai Zhi dispel wind-cold and relieve
joint and muscle pain.
• Dang Gui and Chuan Xiong promote the circulation of qi and
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Modifications:
• In case of severe headache, add Man Jing Zi Fructus Viticis 10 g to
relieve the headache.
• In case of severe muscle pain, add Ji Xue Teng Caulis Milletiae
Reticulatae 10 g to harmonize the collaterals and relieve the mus-
cle pain.
• In case of severe aversion to cold, add Gui Zhi Ramulus
Cinnamomi Cassiae 10 g and Zi Su Ye Folium Perillae Frutescentis
10 g to dispel external cold.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Sanjian L.I.-3, Hegu L.I.-4 and Jianyu L.I.-15 with reducing tech-
nique promote qi and blood circulation and harmonize the large
intestine channel (the location of the injection site).
• Sanjian L.I.-3 is the shu-stream point and can thus treat joint pain;
Jianyu L.I.-15 is a point local to the injection site; Hegu L.I.-4, the
yuan-source point, dispels wind-cold and relieves pain.
• Waiguan SJ-5, Lieque LU-7 and Fengchi GB-20 promote opening the
skin pores and cause sweating to dispel external pathogenic factors.
Modifications:
• In case of a severe headache, add Fengfu DU-16 to relieve the
headache.
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Herbal Treatment:
Xiao Chai Hu Tang-Minor Bupleurum Decoction.
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TCM Treatment of Side Effects of COVID-19 Vaccines
Explanations:
• Chai Hu and Huang Qin in combination harmonize the Shaoyang
and regulate the San Jiao. Meanwhile, they could eliminate the
pathogenic factors.
• Zhi Zi clears heat in the Shaoyang.
• Zhi Ban Xia and Sheng Jiang harmonize the stomach and descend
the qi to relieve the nausea and vomiting.
• Ren Shen, Da Zao and Zhi Gan Cao support the zheng-qi and
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Modifications:
• In case of severe headache, add Bai Zhi Radix Angelicae dahuri-
cae 10 g and Man Jing Zi Fructus Viticis 10 g to relieve headache.
• In case of severe nausea and vomiting, add Huang Lian 3 g and Zhu
Ru Caulis Bambusae in Taeniis 10 g to relieve nausea and vomiting.
• In case of high fever, add Jin Yin Hua Flos Lonicerae Japonicae 10 g
and Lian Qiao Fructus Forsythiae Suspensae 10 g to relieve high fever.
• In case of poor appetite add Bai Zhu Rhizoma Atractylodis
Macrocephalae 10 g and Mai Ya Fructus Hordei Vulgaris
Germinantus 10 g to improve appetite.
• In case of chest pain, add Yu Jin Tuber Curcumae 10 g and Zhi Ke
Fructus Citri Aurantii 10 g to relieve chest pain.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41 with even technique to harmonize
the Yangwei mai and Shaoyang channel.
• Yangchi SJ-4, Fengchi GB-20, Jianjing GB-21, Yanglingquan GB-34
and Qiuxu GB-40 with even technique to regulate the Shaoyang
channel and promote qi circulation.
• Zhongwan REN-12 and Zusanli ST-36 with even technique to har-
monize the stomach, descend qi and relieve nausea and vomiting.
237
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Modifications:
• For a severe headache, add Shuaigu GB-8 and Hegu L.I.-4.
• For hypochondriac pain or distention, add Taichong LIV-3 and
Qimen LIV-14 to promote qi circulation.
• For mood changes or depression add Neiguan P-6 and Shenmen
HE-7 to regulate the emotions and calm the shen.
Herbal Treatment:
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Explanations:
• Sheng Shi Gao strongly clears heat in the Yangming channel and
reduces fever.
• Zhi Mu assists Sheng Shi Gao to clear heat and benefits body fluids
to relieve thirst.
• Huang Lian and Zhi Zi strengthen the effect of clearing heat in the
Yangming channel and reduce fever.
• Geng Mi protects the stomach from the bitter herbs.
• Zhi Gan Cao harmonizes all the herbs in the prescription.
Modifications:
• For a severe headache, add Bai Zhi Radix Angelicae dahuricae
10 g and Man Jing Zi Fructus Viticis 10 g.
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TCM Treatment of Side Effects of COVID-19 Vaccines
Acupuncture Treatment:
• Dazhui DU-14, the meeting point of all the yang channels,
together with Erjian L.I.-2, the ying-spring point, Hegu L.I.-4, the
yuan-source point, and Quchi L.I.-11, the he-sea point of the large
intestine channel clear heat and reduce fever.
• Neiting ST-44, the ying-spring point of the stomach channel, clears
heat from the Yangming channel, reduces fever and relieves thirst.
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Modifications:
• In case of a severe headache, add Fengchi GB-20.
• In case of severe thirst, add Sanyinjiao SP-6, the intersecting point
of the three yin channels of the leg, to benefit body fluids.
• In case of severe restlessness, add Shaohai HE-3, the he-sea and
water point of the heart channel, to clear heat.
• In case of difficult defecation, add Tianshu ST-25, the front-mu
point of the large intestine, to regulate the large intestine.
Herbal Treatment:
Wu Wei Xiao Du Yin-Five Ingredient Drink to Eliminate Toxins.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Jin Yin Hua, Ye Ju Hua, Pu Gong Ying, Lian Qiao, Zi Bei Tian Kui
and Zi Hua Di Ding clear heat, remove toxins and reduce swelling.
• Huang Lian and Huang Qin clear heat, remove toxins and prevent
invasion of toxic heat further into the body.
• Zhi Zi clears the heat in San Jiao.
• Zhi Gan Cao harmonizes the prescription.
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Modifications:
• In case of high fever with redness of the face and thirst, add Shi
Gao Gypsum Fibrosum 20 g and Zhi Mu Radix Anemarrhenae
Asphodeloidis 10 g to clear heat and reduce fever.
• In case of a severe headache, add Bai Zhi Radix Angelicae
Dahuricae 10 g to relieve the headache.
• In case of seizures, add Gou Teng Ramulus cum Uncis Uncariae 10
g and Jiang Can Bombyx Batryticatus 10 g to arrest the internal wind.
• In case of severe palpitations, add Dan Shen Radix Salviae
Miltiorrhizae 10 g to clear heat in the heart and calm the shen.
Acupuncture Treatment:
• Erjian L.I.-2, the ying-spring point, Hegu L.I.-4, the yuan-source
point, and Quchi L.I.-11, the he-sea point of the large intestine
channel respectively, to clear heat in the infection site and body,
remove toxins and subside swelling.
• Shaohai HE-3, the he-sea and water point of the heart channel,
Sanyinjiao SP-6, the crossing point of the three yin channels of the
leg, and Xuehai SP-10, combine to cool the blood and relieve pain
and swelling at the injection site.
• Dazhui DU-14, the meeting point of all the yang channels,
reduces fever and relieves headache.
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TCM Treatment of Side Effects of COVID-19 Vaccines
Modifications:
• In case of high fever with redness of the face or thirst, add Neiting
ST-44, the ying-spring point of the stomach channel, to clear heat
from the Yangming channel and reduce fever.
• In case of severe headache, add Fengchi GB-20 to relieve headache.
• In case of severe muscle pain in the general body, add Feiyang
BL-58 and Jinmen BL-63 to harmonize the Taiyang collaterals and
relieve the muscle pain.
• In case of seizure, add Yanglingquan GB-34 and Taichong LIV-3 to
arrest internal wind.
• In case of severe palpitations, add Shaofu HE-8, the ying-spring
point of the heart channel, to clear heat and calm the shen.
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Herbal Treatment:
• For patients presenting with excess patterns, the herbal formula
Yue Ju Wan-Escape Ju Wan is recommended. Yue Ju Wan consists
of Xiang Fu Rhizoma Cyperi Rotundi, Chuan Xiong Radix Ligustici
Wallichii, Cang Zhu Rhizoma Atractylodis, Shen Qu Massa
Medica Fermentata and Zhi Zi Fructus Gardeniae Jasminoidis.
These combine to eliminate the excess of qi, blood, fire, and
phlegm. It can be used to treat patients with pre-existing illness
who usually suffer from stagnation of these pathogenic factors. As
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
this single foundation formula is not sufficient to deal with all pos-
sible excess, modifications should be made accordingly. For
instance, if there is mainly stagnation of qi, the addition of other
herbs such as Qing Pi Pericarpium Citri Reticulatae Viride, Chen Pi
Pericarpium Citri Reticulatae and Zhi Shi Fructus Immaturus Citri
Aurantii should be considered. Depending upon the location of
the qi stagnation, herbs that enter the appropriate organs should
be added.
• For patients presenting with deficiency patterns the formulas Si Jun
Zi Tang-Four Gentlemen Decoction and Liu Wei Di Huang Wan-
Six-Ingredient Pill with Rehmannia can be considered. Although
these formulas are used to strengthen and build up the physical
condition, they may be insufficient to cover all types of weak
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Acupuncture Treatment:
• For excess patterns, the following acupuncture points should be
considered with reducing technique: Hegu L.I.-4, Neiguan P-6,
Fengchi GB-20, Yanglingquan GB-34, Gongsun SP-4, Sanyinjiao
SP-6, Yinlingquan SP-9, Fenglong ST-40, Taichong LIV-3, Zhongwan
REN-12. These points regulate the qi and blood and eliminate
excess to remove the blockage in the channels and zang-fu organs.
Combination of herbs and acupuncture can bring forth faster and
more reliable therapeutic benefits.
• For deficiency patterns, the following points should be considered
with tonifying technique: Zusanli ST-36, Sanyinjiao SP-6, Taixi KID-3,
Guanyuan REN-4, Ganshu BL-18, Pishu BL-20, and Shenshu
BL-23. These points can be used to strengthen qi, blood, yin and
yang. Combination of herbs and acupuncture can bring forth faster
and more reliable therapeutic benefits.
242
8
COVID-19 Case Study
methods. The below five cases of medical records are a partial sum-
mary of more than 100 patients treated.
8.1 Case 1
Female, 56 years old, a TCM practitioner.
Chief complaints: Fever with an aversion to cold, cough and short of
breath for six days, with further deterioration over two days.
First consultation: 30 December 2020.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
sary to increase the insulin dose to control her blood sugar. Short-
acting insulin was increased by two to four units compared to normal
doses. Long-acting insulin was 12 units in the morning and four
units in the evening before getting sick, increased to 16 units in the
morning and 6 to 8 units in the evening when she was sick. The
tongue was swollen and red, especially red on both sides, with a
deep and wide crack in the center, accompanied by dry thick brown
coating.
TCM Diagnosis:
Cough, due to failure of the lung to disperse and descend, phlegm
and dampness are accumulating, heat is flaring causing injury to the
body’s fluids, Yang ming fu shi syndrome (syndrome of excess of
Yangming fu-viscera).
Principle of Treatment:
Rapidly remove heat with urgent application of purgatives, eliminate
phlegm and descend the lung-qi.
244
COVID-19 Case Study
Herbal Treatment:
Da Cheng Qi Tang-Major Order the Qi Decoction.
Prescription 1:
Da Huang Radix et Rhizoma Rhei 10 g (decocting later)
Mang Xiao Mirabilitum 10 g
(infusion at the end with other already cooked herbal tea for oral taking)
Hou Po Cortex Magnoliae Officinalis 10 g
Zhi Shi Fructus Immaturus CitriAurantii 10 g
Zhi Mu Radix Anemarrhenae Asphodeloidis 10 g
Sang Bai Pi Cortex Mori Albae Radicis 10 g
Xing Ren Semen Pruni Armeniacae 10 g
Huang Qin Radix Scutellariae Baicalensis 10 g
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Above formula is for a one day dose, so she was prescribed a three
day dose. One dose divided into two portions, take one portion at
8:00 am, and another portion at 4:00 pm.
1. Put all the main herbs except Da Huang and Mang Xiao in a stain-
less pot with about 1000 ml of water, soak for half an hour and
then decocted in the same water for half an hour. The liquid
should reduce by half at this stage.
2. Then, put 10 g Da Huang in the pot and boil for another
5 minutes. After this, drain half of the herb tea (about 250 ml) and
add to the infusion half of Mang Xiao 5 g and drink it at 8:00 am.
3. Warm the other half of the tea and infuse with the rest of the Mang
Xiao 5 g at 4:00 pm.
Treatment Reaction:
On the first day of taking the first dose, she had watery diarrhea eight
times. The body temperature was controlled with a reading of
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
temperature 36°C under armpit that afternoon. She took the second
dose the next day and the body temperature was normal and steady.
Shortness of breath and chest tightness began to improve. What was
particularly gratifying was that after having a high fever that lasted for
eight days, it was seen that neither antipyretics nor antibiotics could
control it. However, only two days of TCM herbal medicine rescued
a critical situation. She was so happy that she was able to avoid being
sent to hospital. Since the fever had been controlled and the
Yangming excess syndrome disappeared, there was no need to con-
tinue taking the third dose.
Further Treatment:
Second consultation: 1 January 2021.
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She was still coughing up a lot of white sticky sputum, also with
white sticky sputum in the nasal cavity, mild headache, nausea with-
out vomiting, and shows no body pain.
Prescription 2:
Zi Su Zi Fructus Perillae Frutescentis 12 g
Bai Jie Zi Semen Sinapis Albae 10 g
Lai Fu Zi Semen Raphani Sativi 12 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii 10 g
Zhi Mu Radix Anemarrhenae Asphodeloidis 10 g
Huang Qin Radix Scutellariae Baicalensis 10 g
Hou Po Cortex Magnoliae Officinalis 10 g
Zhi Shi Fructus Immaturus CitriAurantii 10 g
Qing Pi Pericarpium Citri Reticulatae Viride 10 g
Xing Ren Semen Pruni Armeniacae 10 g
Zhi Ban Xia Rhizoma Pinelliae Ternatae Preparata 10 g
Jiao Bai Zhu Rhizoma Atractylodis Macrocephalae (grill) 10 g
Sang Bai Pi Cortex Mori Albae Radicis 10 g
Zhi Zi Fructus Gardeniae Jasminoidis 10 g
Bai Guo Semen Ginkgo Bilobae 10 g
Huang Lian Rhizoma Coptidis 5 g
Xiang Ru Herba Elsholtziae seu Moslae 10 g
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Above formula was one day dose, prescribed doses for five days,
decocted in water, one dose daily, taken twice a day.
Treatment Reaction:
The second prescription was taken on 1 January 2021. Although the
fever has subsided, endophytic heat still needs to be controlled. From
the morning of 2 January 2021, her body temperature was 36.6°C,
and she started to cough and spit yellow phlegm, which gradually
turned into white phlegm during the day. She still had chest pain,
mainly in the right chest and back, with poor physical strength. She
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Further Treatment:
Third consultation: 6 January 2021
Prescription 3:
Zi Su Zi Fructus Perillae Frutescentis 10 g
Lai Fu Zi Semen Raphani Sativi 12 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii 10 g
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Treatment Reaction:
During the period of taking the third prescription, the cough
decreased, with only a little white phlegm. Diet and physical strength
improved day by day, and stool can be maintained twice a day. On
8 January, she improved further, her spirits were good, body tempera-
ture was normal, appetite had recovered, blood oxygen saturation
was 98% and she was occasionally fatigued. On 9 January 2021, the
cough completely stopped, and everything was basically back to
normal.
Explanations:
At the beginning of this case, this patient first had the invasion of
wind and cold which weakened the dispersing and descending of the
lung-qi, therefore she felt cold and fever, body pain, and had a cough
with white sputum. Because she has had diabetes for a long time, this
resulted in a severe yin deficiency constitution, therefore her exterior
symptom had not been cleared yet. She then quickly developed
severe inner heat which was forming Yang Ming Fu Shi syndrome,
and the interior heat was consuming body fluids. Based on the prin-
ciple of treating the secondary symptoms in emergency and taking
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COVID-19 Case Study
Prescription 1:
Da Huang, Mang Xiao, Hou Po, Zhi Shi, which are the whole for-
mula of Da Cheng Qi Tang, can powerfully purge pyretic accumula-
tion. Xing Ren can soothe the lung and reduce phlegm. Some of the
characteristics of COVID-19 are high fever, shortness of breath, chest
pain and tightness, and being anxious, while the sputum color is still
white instead of yellow. All these symptoms indicate that the lung
had failed in the dispersing and descending of qi, which failed to
govern regulation of water passages. Therefore, descending lung-qi is
top priority. In addition, the fever doesn’t go away. Using Zhi Mu,
Huang Qin, Lian Qiao, etc. clear lung heat and reduce temperature,
Tian Hua Fen clears heat and promotes fluid, and prevents the soar-
ing blood sugar of diabetes.
Prescription 2:
Zi Su Zi, Bai Jie Zi and Lai Fu Zi, the complete composition of San
Zi Yang Qin Decoction, aims to cleanse the lung and phlegm,
descend lung-qi and relieve cough, preventing Yangming excess syn-
drome. Since Ma Huang is a contraindicated traditional Chinese
medicine in Europe, Xiang Ru is used instead. With reference to the
book Ben Cao Zheng Yi (Materia Medica Zheng yi): “The smell of
Xiang Ru is clear and light, and the quality is light. So, it can reach
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
the upper body, vent the lung, and reach the body surface to relieve
the cold on the surface. It can also go to the lower Jiao, ease the
bladder, inducing diuresis to reduce fluid retention”. Zhe Bei Mu
clears away heat and reduces phlegm, accompanied by Huang Qin,
Zhi Mu, Zhi Zi to clear lung heat and eliminate phlegm. Among
them, Zhi Mu and Zhi Zi can clear away the damp-heat from lower
Jiao and promote urination and have a good effect on urinary tract
infection (UTI). Together with Bai Guo, Sang Bai Pi and Xing Ren that
descend lung-qi, and phlegm heat that cannot dwell in the lung. Zhi
Ban Xia, Hou Po and Zhi Shi dry the damp, reduce phlegm, widen
the chest, descend qi, and relieve cough. Especially using Huang
Lian to clear heat in Yangming and ensure the passage is unob-
structed for eliminating the phlegm pyrexia. Qing Pi reduces chest
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and hypochondriac pain. Jiao Bai Zhu invigorates the spleen to ben-
efit the lung.
Prescription 3:
During the third consultation the patient has turned from the severe
stage to the convalescent stage. Su Zi, Lai Fu Zi and Zhe Bei Mu can
eliminate phlegm and relieve cough, Zhi Mu, Huang Qin can relieve
lung heat, Xing Ren and Sang Bai Pi descend lung-qi and relieve heat
phlegm. In addition, using Hou Po and Zhi Shi relieves pressure in
the chest, downward qi, and clear the hollow viscera. Huang Lian
can prevent the heat accumulating in the middle Jiao, Zhi Ban Xia
and Fu Ling to eliminate phlegm and dampness, and further ensure
that the middle Jiao does not accumulate dampness and produce
phlegm. In order to prevent the formation of pulmonary fibrosis, use
Ju Luo and Gua Lou Pi to activate collaterals of lung, Hong Hua and
Yu Jin to activate the blood in the chest and repair the damage in the
lung caused by pneumonia. Considering that the patient has had
diabetes for many years, Jiao Bai Zhu is used to supplement the
spleen in order to nourish the lung.
8.2 Case 2
Male, 44 years old, a chef.
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TCM Diagnosis:
Cough due to external infection of damp toxins, pulmonary failure of
dispersing.
Treatment Principles:
Expel toxins and relieve superficies by cooling combined cooling
blood to stop bleeding.
Herbal Treatment:
Modified Huang Lian Jie Du Tang-Coptidis Decoction for Detoxification.
Prescription 1:
Huang Qin Radix Scutellariae Baicalensis 12 g
Huang Lian Rhizoma Coptidis 5 g
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
The above formula is one day dose. Prescribed three days dose.
Decocted two-day doses together, divided into six portions, one por-
tion taken every four hours, day and night.
Treatment Reaction:
• 21 January 2021 (day 1) 8:00 pm: His body temperature was
37.5°C before taking the herbal medicine and half an hour later
after taking the first portion of the herbal tea the temperature
dropped to 37.0°C.
• 22 January 2021 (day 2) 11:00 am: At six o’clock in the morning,
his temperature was 37.8°C, and at 10:30 am it was 37.3°C.
However, his cough increased after taking the herbal tea. He
thought his condition had worsened and refused to take it any-
more. Plus waking him up at night to take the herbal tea made him
angry. We tried to explain to him that herbal medicine clears away
heat and resolves phlegm, cools blood to stop bleeding, it also
helps the phlegm in the lung to be discharged and restores the
normal function of the lung. Otherwise, the phlegm heat will
choke the lung, and the lung will lose the dispersing and descend-
ing function, just like drowning, and the consequences will be
very serious. After understanding that, he began to take it again.
All three doses of herbal medicine were taken every 4 hours
within a 36 hour time frame to increase the intensity of treatment.
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Further Treatment:
Second consultation: 22 January 2021 (day 2)
At first, he suspected that Chinese herbal medicine was useless, but
his condition had improved significantly, and he became very confi-
dent. After taking three doses of Chinese herbal medicine overnight
day and night for 36 hours continuously, he had an increased appe-
tite and still coughs (but without bloodspots in phlegm). His tempera-
ture was 37.2°C at 19:45 and 37.1°C at 22:14. The tongue was red,
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Prescription 2:
Huang Qin Radix Scutellariae Baicalensis 6 g
Huang Lian Rhizoma Coptidis 3 g
Zhi Zi Fructus Gardeniae Jasminoidis 5 g
Jie Geng Radix Platycodi Grandiflori 5 g
Xing Ren Semen Pruni Armeniacae 6 g
Xiang Ru Herba Elsholtziae seu Moslae 5 g
(Ma Huang Herba Ephedrae 5 g is preferred, but not available due to
EU regulations)
Zhi Mu Radix Anemarrhenae Asphodeloidis 5 g
Shi Gao Gypsum Fibrosum 10 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii 6 g
Sheng Di Huang Radix Rehmanniae Glutinosae Recens 8 g
Xuan Shen Radix Scrophulariae Ningpoensis 8 g
Zhu Ru Caulis Bambusae in Taeniis 5 g
Ban Xia Rhizoma Pinelliae Ternatae Cooked 5 g
Hou Po Cortex Magnoliae Officinalis 5 g
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Treatment Reaction:
23 January 2021 (day 3)
soreness disappeared.
Further Treatment:
Third consultation: 25 January 2021 (day 5)
The patient felt well, managed to go out for a walk, and his appetite
increased. Temperature was 36.3°C, cough and sputum were obvi-
ously reduced, stool was formed, tongue was pale red, and the yel-
low greasy coating gradually faded.
Prescription 3:
Huang Qin Radix Scutellariae Baicalensis 6 g
Huang Lian Rhizoma Coptidis 3 g
Zhi Zi Fructus Gardeniae Jasminoidis 5 g
Jie Geng Radix Platycodi Grandiflori 5 g
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COVID-19 Case Study
Treatment Reaction:
• 27 January 2021 (day 7): After taking prescription 3, cough and
sputum were significantly reduced, and the body temperature was
normal. The tongue coating was still yellow and greasy. The patient
usually has an irregular diet, and prefers to eat sweet, deep-fried
greasy food. He was advised to control his diet.
• 30 January 2021 (day 10): His temperature was 36.1°C, only a lit-
tle cough at night, appetite has greatly increased, and physical
strength has improved. He can walk without wheezing, and the
yellow greasy coating had gradually disappeared.
Fourth Consultation:
31 January 2021 (day 11): COVID-19 test had turned negative on
this day, and the patient was very happy. He was tested positive on
19 January and negative on 30 January which took only 11 days since
he took the herbal treatment. His temperature was 36.1°C, his appe-
tite was normal, occasionally coughed, breathing was normal, and
his physical strength returned to the previous level. His takeaway
business has also reopened. The patient’s appetite recovered, and he
began to eat irregularly again, resulting in a bit of yellow and greasy
tongue coating.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Prescription 4:
To prevent pulmonary fibrosis in the late stage of COVID-19
pneumonia.
Treatment Reaction:
After taking prescription 4, the patient followed up on 4 February
2021. The tongue coating improved significantly, no cough and spu-
tum, everything was normal.
Explanations:
This patient was in a critical condition when he consulted Professor
Peilin Sun. The syndrome was external infection of damp toxins, and
pulmonary failure of dispersing. The condition was complicated due
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COVID-19 Case Study
Prescription 1:
Huang Qin, Huang Lian, Zhi Zi is the Huang Lian Jie Du Decoction
that aims to clear away heat and detoxification. Jie Geng, Xing Ren
and Xiang Ru (prefer Ma Huang) helps in dispersing and descending
the lung to relieve cough. Zhi Mu, Shi Gao works by clearing heat
and purging fire. Zhe Bei Mu for clearing heat and resolving phlegm
and dispelling stagnation. Sheng Di Huang and Xuan Shen cool the
blood to stop bleeding. Zhu Ru clears away heat and reduces
phlegm, relieves fidgetiness, and prevents vomiting.
Professor Peilin Sun’s note: when the patient is seriously ill, he is
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Prescription 2:
After taking the prescription 1, his tongue coating is much better than
when he first consulted us. Moreover, his body temperature has
become normal, and his appetite has increased. The next step is asking
him to be more active. He still has damp and heat in the middle Jiao
which is not urgent but coughing with yellow sputum and shortness of
breath are very dangerous. Fortunately, it has been controlled now.
Since prescription 1 is effective, prescription 2 keeps the same formula
and adds Ban Xia and Hou Po to strengthen the effect of widening the
chest, resolving phlegm and protecting the lung. After he finished pre-
scription 2, he still needs to take the herbs because the phlegm heat
will not be removed at once, and it will take several weeks to clear.
Diarrhea is normal because his phlegm has not been removed com-
pletely. Considering that the patient weighed 90 kg, the dose of herb
medicine was increased to four times a day, 5 g each time. In just two
days, we rescued him from the dangerous situation which explained
that accurate diagnosis and treatment will bring good results.
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Prescription 3:
The patient is much better, and the tongue coating is much cleaner.
In the past few days, it has changed dramatically. He should con-
tinue to take herbs powder to prevent pulmonary fibrosis. He
needs to pay attention to his diet, so based on prescription 2, pre-
scription 3 removed Xiang Ru, Zhi Mu, Shi Gao, and added Fu
Ling, Cang Zhu and Bai Zhu to invigorate the spleen and dissipate
the damp.
Prescription 4:
The patient’s tongue coating is still a bit yellow and greasy. It is
related to his unhealthy diet. At this time, he has entered a recovery
period. The focus is on preventing pulmonary fibrosis, so the pre-
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8.3 Case 3
Male, 60 years old, an engineer.
Chief complaints: Fever with headache and sore throat for 12 days,
cough for three days.
First consultation: 15 February 2021.
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COVID-19 Case Study
guidance and treatment. Before the onset of illness, the patient was
busy with work and often stayed up late.
TCM Diagnosis:
Cough due to stagnant pathogen of Shaoyang, and the damp-heat
epidemic toxins is detained in middle Jiao and lower Jiao.
Principle of Treatment:
Harmonize the Shaoyang, clear heat, eliminate damp, remove toxins,
and regulate the middle Jiao.
Herbal Treatment:
Modified Xiao Chai Hu Decoction-Minor Bupleurum Decoction and
Lian Pu Decoction-Coptis and Officinal Magnolia Bark Beverage.
Prescription 1:
Chai Hu Radix Bupleuri 10 g
Huang Qin Radix Scutellariae Baicalensis 10 g
Zhi Ban Xia Rhizoma Pinelliae Ternatae cooked 10 g
Lian Qiao Fructus Forsythiae Suspensae 10 g
Zhi Zi Fructus Gardeniae Jasminoidis 10 g
Zhi Mu Radix Anemarrhenae Asphodeloidis 10 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii 10 g
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Treatment Reaction:
15 February 2021 (day 1)
• 8:41 am: A thin white coating began to appear on the tongue, but
the tongue itself was still very red. The yellow greasy coating
started to fade away in the back half of the tongue.
• 10:00 am: His body temperature dropped below 37°C for the first
time after onset.
• 12:32 pm: There was no cough, no sputum, no chest tightness,
and his appetite had improved. He had a smile for the first
time after onset. The blood oxygen concentration increased to
95%.
• 8:37 pm: The patient felt well, with a body temperature of 36.9°C.
He only felt a little fatigue, he had hiccups after eating, blood
oxygen concentration was 93%, no cough and sputum, no chest
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COVID-19 Case Study
Further Treatment:
Second consultation: 17 February 2021 (day 3)
Body temperature was normal, still a little belching, a slight cough, a
small amount of stool formation, fatigue, blood oxygen concentra-
tion was 94–96%, the tongue was red, and the coating had changed
from very yellow and greasy to scattered and thinned.
Prescription 2:
Chai Hu Radix Bupleuri 10 g
Huang Qin Radix Scutellariae Baicalensis 10 g
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Treatment Reaction:
• 8:35 pm (day 3): The patient had no fever for two days.
• 10:00 am (day 4): No obvious discomfort, red tongue, yellow
greasy coating had basically disappeared.
• 10:00 am (day 5): No short of breath when he went up and down
the stairs, Normal tongue coating began to appear, belching
stopped.
Further Treatment:
Third consultation: 21 February 2021 (day 7)
The patient’s condition was getting better every day and he had no
cough. He went for a walk on that day and felt his physical strength
had recovered well. His tongue was still red but better than before
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and the coating was only a bit greasy and yellow at the root of the
tongue.
Prescription 3:
Huang Lian Rhizoma Coptidis 5 g
Hou Po Cortex Magnoliae Officinalis 10 g
Zhi Ban Xia Rhizoma Pinelliae Ternatae cooked 10 g
Xing Ren Semen Pruni Armeniacae 10 g
Sang Bai Pi Cortex Mori Albae Radicis 10 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii 10 g
Chuan Bei Mu Bulbus Fritillariae Cirrhosae 10 g
Huang Qin Radix Scutellariae Baicalensis 10 g
Sheng Di Huang Radix Rehmanniae Glutinosae Recens 12 g
Dan Zhu Ye Herba Lophatheri Gracilis 10 g
Lian Qiao Fructus Forsythiae Suspensae 10 g
Zhi Zi Fructus Gardeniae Jasminoidis 10 g
Mu Dan Pi Cortex Moutan Radicis 10 g
Dan Shen Radix Salviae Miltiorrhizae 10 g
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COVID-19 Case Study
Treatment Reaction:
22 February 2021: Apart from a little night sweats and slight consti-
pation, no other complaints.
27 February 2021: The patient had no obvious discomfort except
occasional night sweats and poor sleep. He had resumed normal
work.
Explanations:
The patient had been feverish for nearly 12 days when he came to
consult Prof. Peilin Sun. The pathogen was in Taiyang at the beginning
of the onset. It was right for the local TCM doctor to use modified Sang
Ju Yin Decoction to evacuate the Taiyang pathogen. However later the
Taiyang exterior cold syndrome got inside the Shaoyang, phlegm-
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Prescription 1:
Chai Hu, Huang Qin, Zhi Ban Xia take the meaning of Xiao Chai Hu
Decoction to relieve the pathogen of Shaoyang. Lian Qiao clears heat
and toxins, Zhi Zi ventilates the fire of San Jiao, Zhi Mu clears heat
and purges fire, nourishes yin and moisturizes dryness. Combination
of the three herbs can clear and relieve the pathogen of damp-heat,
and unblock the San Jiao. Zhe Bei Mu for heat-resolving phlegm and
relieving cough, Sang Bai Pi to relieve lung and asthma, hydration
and swelling, Xing Ren to relieve cough and asthma, evacuate the
lung meridian wind, cold, phlegm and dampness, and also moisten
and relax bowels. The combination of the three herbs was used to
protect the lung’s descending function; Huang Lian, Hou Po, Zhi Zi
and Dan Dou Chi which is Lian Pu Yin Decoction to clear heat and
reduce damp, regulate qi and neutralize, remove interior retention of
heat-damp. Zhi Shi, Cang Zhu, Mu Xiang, Fu Ling which is Mu Xiang
Shun Qi Wan to conduct qi and dissipate damp, invigorated the
spleen and stomach. Prescription 1 exactly tackles the pathology by
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Prescription 2:
The patient’s condition was obviously relieved after taking the pre-
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scription 1, only the red tongue indicated that there is still heat in the
lung. If it was not controlled in time, it would have transferred to the
Ying Fen (Ying level). Therefore, based on prescription 1, Sheng Di
Huang and Xuan Shen were added and used together to clear the
heat and toxins before they get into the Ying-level. Plus, Lian Qiao
and Dan Zhu Ye are used together to clear the heat (also called “Tou
Re Zhuan Ying”), promoting qi circulation by relieving Ying Fen, so
that the pathogen of entering Ying level could be separated and
resolved. In addition, combining Chen Pi, Zhi Gan Cao, Hou Po and
Cang Zhu makes Ping Wei San Decoction (Stomach-Calming
Powder) to dry damp and promote spleen, promote qi and stomach
to relieve damp and stagnation of the spleen.
Prescription 3:
After taking the prescription 2, the patient’s condition improved every
day, except that the tongue was still a little red. Because the patient’s
Shaoyang syndrome had disappeared and the middle Jiao obstructed
by damp had been resolved, so on the basis of the second prescrip-
tion, prescription 3 removed Chai Hu, Cang Zhu, Chen Pi, Mu Xiang,
Zhi Shi, Xuan Shen, Fu Ling and Zhi Gan Cao, added Chuan Bei Mu
to moisturize the lung and relieve cough to prevent chronic cough
damage to the lung, added Mu Dan Pi and Dan Shen, combined with
Huang Lian, Hou Po, Zhi Ban Xia, Xing Ren, Sang Bai Pi, Zhe Bei
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COVID-19 Case Study
Mu, Huang Qin, Zhi Zi to continue to clear the lung of phlegm heat,
Sheng Di Huang, Dan Zhu Ye and Lian Qiao continue to clear the
heat. Prescription 3 was to protect his lung and heart, prevent blood
heat entering Ying level and causing pulmonary embolism.
8.4 Case 4
Female, 50 years old, a TCM practitioner.
Chief complaints: Aversion to cold, fever, and body pain for ten days.
First consultation: 13 December 2020.
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TCM Diagnosis:
Cough due to flaring of damp-heat, accumulation phlegm-heat in the
lung, and consumption of body fluid by excessive heat.
Treatment Principles:
Clear away heat, remove damp, descend the lung, resolve phlegm,
and promote fluid production at the same time.
Herbal Treatment:
Lian Po Yin-Coptis and Magnolia Bark Drink.
Prescription 1:
Huang Lian Rhizoma Coptidis 3 g
Hou Po Cortex Magnoliae Officinalis 5 g
Sang Bai Pi Cortex Mori Albae Radicis 5 g
Zhi Ban Xia Rhizoma Pinelliae Ternatae Cooked 5 g
Dan Dou Chi Semen Sojae Praeparatum 5 g
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COVID-19 Case Study
taken in warm water at a dosage of two grams, three times a day after
meals.
Treatment Reaction:
• 14 December 2020: Patient reported that after taking the above
herbal medicine within 24 hours the fever was mostly controlled.
She coughed up and vomited a large amount of thin white foamy
sputum, coughing ceaselessly, shallow breath, occasionally low
fever, numbness in the right arm lung meridian area, slight chest
tightness, and poor appetite. Sleep became better, and the sputum
was white and not thick.
• 15 December 2020: Patient reported that her body temperature
was normal, her blood oxygen increased to 98%, and she kept
coughing and vomiting a lot of thin white foamy sputum.
Further Treatment:
Second consultation: 19 December 2020.
After taking prescription 1, the patient had no fever, still coughing
with left chest pain when taking a deep breath. Her appetite
improved, still had night sweats, and her tongue coating became less
yellow and grease.
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Prescription 2:
Yu Ping Feng San (Jade-screen powder), San Zi Yang Qin Tang (Three-
Seed Filial Devotion Decoction), Wei Jing Tang (Phragmitis decoc-
tion) combined with modifications.
Treatment Reaction:
25 December 2020: Patient reported that for three consecutive nights
there was no cough and fever, sputum reduced significantly, much
less chest pain, able to take deep breaths, and less night sweats.
Further Treatment:
Third consultation: 29 December 2020.
At the third follow-up consultation, the sputum coughed up in the
morning was slightly brown and bloodspots, and there was no
sputum for the rest of the day. She coughed and had slight chest pain.
The COVID-19 test also turned negative on that day.
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COVID-19 Case Study
Prescription 3:
Huang Lian Rhizoma Coptidis 3 g
Zhu Ru Caulis Bambusae in Taeniis 5 g
Hou Po Cortex Magnoliae Officinalis 5 g
Zhi Zi Fructus Gardeniae Jasminoidis 5 g
Zhi Ban Xia Rhizoma Pinelliae Ternatae Cooked 5 g
Chen Pi Pericarpium Citri Reticulatae 3 g
Fu Ling Sclerotium Poriae Cocos 5 g
Fu Shen Sclerotium Poriae Cocos Paradicis 5 g
Hong Hua Flos Carthami Tinctorii 5 g
Yu Jin Tuber Curcumae 5 g
Yan Hu Suo Rhizoma Corydalis 5 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii 5 g
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Treatment Reaction:
30 December 2021: A small amount of white with rusty sputum was
reported, chest pain basically disappeared, and cough of qi inverse
was alleviated. The amount of discharge was less, and the color was
yellow and thinner. Patient also reported normal stool two times a
day. In the following days, the patient improved and recovered com-
pletely. A follow up consultation a month later, she was fully recov-
ered without any Long-COVID symptoms.
Explanations:
This case is different from the general cause and pathogenesis of
COVID-19, it is a case of grief weakening the lung, causing insuffi-
cient lung defending, and allowing damp heat to take the
advantage.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Prescription 1:
Zhi Ban Xia, Hou Po, Sang Bai Pi, and Zhe Bei Mu descend lung-qi,
relieve phlegm, reduce cough, soothe the chest, and alleviate pain.
Huang Lian, Huang Qin, Zhi Mu and Gua Lou Pi eliminate heat from
the lung. Hua Shi and Gan Cao, which is Liu Yi San-Six One Powder
together with Ge Gen, Fu Ling, are taking care of the lower Jiao
damp-heat. Zhi Zi can wipe out all the San Jiao to clean up the damp
and heat. Chuan Bei Mu and Lu Gen to relieve cough and enhance
the fluid.
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COVID-19 Case Study
Prescription 2:
Zhi Huang Qi and Jiao Bai Zhu nourish the lung, invigorate the
spleen and reduce phlegm, Zhi Ban Xia and Zhe Bei Mu expel
phlegm and relieve cough. Zhi Shi and Hou Po dissipate phlegm and
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Prescription 3:
Huang Lian, Zhu Ru and Zhi Zi clear the upper Jiao residual heat,
Hou Po descend lung-qi, calming the qi counterflow. Zhi Ban Xia,
Chen Pi, and Fu Ling which is Er Chen decoction without Gan Cao
which help to remove the phlegm dampness in middle Jiao, Hong
Hua, Yu Jin and Yan Hu Suo promote blood circulation, regulate qi
and relieve pain. Zhe Bei Mu and Xing Ren relieve cough and asthma
by resolve phlegm-heat. Huang Bai and Cang Zhu clear the damp and
heat of lower Jiao. Che Qian Zi promotes urination, percolates damp-
ness, dispels phlegm through lower Jiao. Fu Shen calms the shen.
The third prescription still focuses on the upper Jiao phlegm
dampness, and considers the lower Jiao, so that the phlegm damp-
ness is drained from the lower Jiao. This prescription considers the
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8.5 Case 5
Male, 37 years old, a chef.
Chief complaints: Cough expectoration of whitish foamy sputum,
accompanied by a feeling of gas rushing up toward the thorax for two
days.
First consultation: 17 January 2021.
Aversion to cold with fever, sore throat, loss of sense of smell and
taste, COVID-19 tested positive ten days ago. He took Xiao Chai Hu
granules for the first five days and Lian Hua Qing Wen Capsules for
another five days. Although his body temperature became normal, he
started to have diarrhea with undigested food in the stool. He kept
complaining that his chest was very tight.
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TCM Diagnosis:
Cough due to exterior tightened by wind-cold, cold fluid retention in
the chest, the disperse function of the lung is weakened, the damp
transforms into heat which gathers in the middle Jiao.
Principle of Treatment:
Expel wind and cold, disperse lung-qi, warm and resolve cold
phlegm, and eliminate damp-heat.
Herbal Treatment:
Modified Xiao Qing Long Tang-Minor Green Dragon Decoction.
Prescription 1:
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Treatment Reaction:
• 17 January 2021 (day 1): Half an hour after taking half dose of pre-
scription 1, his cough and reversed flow of qi improved significantly,
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Further Treatment:
Second consultation: 19 January 2021 (day 3)
He has finished the prescription 1. As a result, he has only a slight
tightness in the chest, slightly coughing and wheezing, and the spu-
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tum was thin and white in the morning, much less than before. The
image of the tongue was also improved, the coating was thinner and
the yellow and greasy coating was reduced, and the middle crack
became shallower as well. Urine and stool were normal.
Prescription 2:
Xiang Ru Herba Elsholtziae seu Moslae 5 g
(Prefer Ma Huang Herba Ephedrae 5 g, but not available due to EU
regulations)
Gan Jiang Rhizoma Zingiberis Officinalis 10 g
Bai Jie Zi Semen Sinapis Albae 10 g
Zi Su Zi Fructus Perillae Frutescentis 10 g
Lai Fu Zi Semen Raphani Sativi 10 g
Xing Ren Semen Pruni Armeniacae 10 g
Hou Po Cortex Magnoliae Officinalis 10 g
Yu Jin Tuber Curcumae 10 g
Ju Luo Citrus tangerina Hort.et Tanaka C.erythrosa Tanaka 5 g
Jie Geng Radix Platycodi Grandiflori 10 g
Zhi Ban Xia Rhizoma Pinelliae Ternatae Cooked 12 g
Qing Pi Pericarpium Citri Reticulatae Viride 10 g
Chen Pi Pericarpium Citri Reticulatae 10 g
Sang Bai Pi Cortex Mori Albae Radicis 12 g
Huang Qin Radix Scutellariae Baicalensis 10 g
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Further Treatment:
Third consultation: 21 January 2021.
All three doses of prescription 2 have been taken. He occasionally
felt tightness in the chest, sometimes gas reversal coughing, less white
sputum, a little breathlessness when going up the stairs, a little loose
stool, and had better sleep with good spirits. The tongue coating was
obviously improved, the yellow and greasy coating disappeared, only
the middle and back part was slightly white and greasy.
Prescription 3:
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Treatment Reaction:
• 24 January 2021 (day 8): After drinking prescription 3, he felt bet-
ter every day. He had no reversed flow of qi, only a little cough
and sputum when he lies down at night, his sleep improved a lot,
and had slight night sweats. We repeated the prescription 3 for
another two weeks.
• 4 February 2021 (day 17): He occasionally had reversed flow of qi
without coughing. Furthermore, he claimed with joy that the
peanut-sized cyst in the scrotum which he had for ten years
became much smaller after taking the above three formulas.
A month later during a follow-up call, the patient’s reported pul-
monary symptoms disappeared completely. His sleep became a lot
better than before onset. He returned to normal work.
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Explanations:
The patient’s symptoms were coughing, and expectorating white
foamy sputum, his retro-cardiac area is tight and cold, he likes to
drink warm water, which indicate the main pathogenesis of the
patient is cold phlegm and cold fluid dwelling in the lung, plus exter-
nal cold. The lung disperse function is blocked, so the treatment key
point lies in to restore the lung disperse function. However, the yel-
lowish tongue coating indicates that the exterior pathogens have
penetrated to the interior and transformed into heat.
Prescription 1:
Because the condition of COVID-19 is very complicated, we cannot
stick to the original formula, so in this case we only used Ma Huang
(Xiang Ru) and Gan Jiang without Gui Zhi and Xi Xin of the Xiao
Qing Long Decoction because the exterior pathogens has penetrated
to the interior and transform into heat but the exterior cold was not
resolved. Ma Huang (Xiang Ru) is to remove the cold from the sur-
face, and restore the function of the wei-yang (defending yang).
Because the pathogenic qi has entered the interior and transformed
to heat, Huang Lian was used to clear heat. In this formula, Ma
Huang (Xiang Ru) and Gan Jiang of Xiao Qinglong Decoction are
used to release the pathogenic factor of warmth and dissipate the
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COVID-19 Case Study
cold fluid retention in the lung. Bai Jie Zi warms the lung and resolve
phlegm, promote qi and dispel stagnation. Since the patient had
been suffering from the disease for ten days already, Yu Jin, Ju Luo and
Qing Pi are used to regulate qi and relieve collaterals to prevent pul-
monary fibrosis. Jie Geng promotes the lung, Cang Er Zi cannulate
the orifice, Huang Lian clears stagnant heat, Zhi Ban Xia, Chen Pi, Yi
Yi Ren, Fu Ling, Chao Ba Zhu invigorate the spleen to remove
phlegm, and aromatic Pei Lan eliminate dampness.
Prescription 2:
After the patient takes prescription 1, the yellow and greasy tongue
coating has obviously changed, and the exterior cold has been
resolved, so on the basis of prescription 1, prescription 2 removed
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Cang Er Zi, Yi Yi Ren, Huang Lian, Pei Lan, and added Zi Su Zi and
Lai Fu Zi to strengthen the function of descending lung-qi, and
increase the dosage of Fu Ling to increase the function of invigorate
the spleen and promote dampness.
Prescription 3:
At this stage, the patient’s internal heat has been removed, and the
patient still has the slight symptoms of lung-qi reversal, coughing
with sputum. Therefore, based on prescription 2, we removed
Huang Qin and added Xuan Fu Hua to descend lung-qi and
eliminate phlegm, and by adding Tao Ren and Hong Hua to
promote blood circulation, increases the strength to prevent pulmo-
nary fibrosis. Adding Pei Lan invigorates the spleen and resolves
phlegm.
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1
Ani Nalbandian, et al. Post-acute COVID-19 syndrome. Nature Medicine. 2021,
27: 601–615. https://www.nature.com/articles/s41591-021-01283-z.
279
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state prior to their illness, although they have been following good
advice from the practitioners, taking medications, and being careful
with their diets and emotions. Besides, when a patient tests negative
for COVID-19, or positive for antibodies, it does not necessarily
mean that their symptoms will cease automatically or in a short
period of time.
Persistent symptoms and clinical findings can occur regardless of
the severity of acute COVID-19. It means that post-COVID syndrome
isn’t exclusive to people who went to the hospital or stayed in the
ICU due to severe organ damage during their illness. Post-COVID
syndrome can be seen in people who went to the ER with concerning
symptoms or those who had advanced symptoms that required a
brief hospital stay, but it can also occur in people who had mild
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2
Katie McCallum. Post-COVID syndrome: What should you do if you have lingering
COVID-19 symptoms? Houston Methodist on Health. 19 November 2020. https://
www.houstonmethodist.org/blog/articles/2020/nov/post-covid-syndrome-what-
should-you-do-if-you-have-lingering-covid-19-symptoms/.
3
Centers for Disease Control and Prevention (CDC). Post-COVID conditions:
Information for healthcare providers. 9 July 2021. https://www.cdc.gov/
coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html.
4
National Institutes of Health (NIH). When-COVID-19-symptoms-linger. 13 August
2021. https://covid19.nih.gov/research-highlights/when-COVID-19-symptoms-linger.
280
Generalization of Long COVID
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
5
Lixue Huang, et al. 1-year outcomes in hospital survivors with COVID-19: A
longitudinal cohort study. The Lancet. 2021, 398(10302): 747–758. https://doi.
org/10.1016/S0140-6736(21)01755-4.
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Generalization of Long COVID
9.1 Definition
The definite term is not yet completely defined, but it refers that when
the acute phase of COVID-19 is over, some symptoms related to
COVID illness could remain for weeks, months, or longer. At this
moment, there are different terminologies used in the academic envi-
ronment to define these remaining symptoms after COVID-19, such
as post-COVID syndrome,7 post-COVID conditions, Long COVID,8
6
Hannah E. Davis, et al. Characterizing long COVID in an international cohort: 7
months of symptoms and their impact. The Lancet-EClinical Medicine. 2021, 38,
101019. https://doi.org/10.1016/j.eclinm.2021.101019.
7
Daniel Ayoubkhani, et al. Post-covid syndrome in individuals admitted to hospital
with COVID-19: Retrospective cohort study. BMJ. 2021, 372: n693. https://doi.
org/10.1136/bmj.n693.
8
Centers for Disease Control and Prevention (CDC). Long COVID or post-COVID
conditions. Updated 1 September 2021. https://www.cdc.gov/coronavirus/2019-
ncov/long-term-effects.html.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
damaged by the disease, after the risk factors are eliminated, the
body can repair itself and then return to normal without any seque-
lae. Probably, this is the reason that many research papers stressed
their investigation of post-COVID after six months.17,18 There are also
9
Ani Nalbandian, et al. op. cit.
10
NIH. op. cit.
11
Jennifer K. Logue, et al. Sequelae in adults at 6 months after COVID-19 infection.
JAMA Network. 2021, 4(2): e210830. doi: 10.1001/jamanetworkopen.2021.0830.
12
Robert J. Rolfe, et al. The emerging chronic sequelae of COVID-19 and implica-
tions for North Carolina. North Carolina Medical Journal. 2021, 82(1): 75–78.
https://doi.org/10.18043/ncm.82.1.75.
13
Wikipedia. Long COVID. https://en.wikipedia.org/wiki/Long_COVID.
14
Carlos del Rio, et al. Long-term health consequences of COVID-19. JAMA. 2020,
324(17): 1723–1724. doi: 10.1001/jama.2020.19719.
15
Ani Nalbandian, et al. op. cit.
16
CDC. 9 July 2021. op. cit..
17
Chaolin Huang, et al. 6-month consequences of COVID-19 in patients discharged
from hospital: A cohort study. The Lancet. 2021, 397(10270): 220–232. https://doi.
org/10.1016/S0140-6736(20)32656-8.
18
Maxime Taquet, et al. 6-month neurological and psychiatric outcomes in 236,379
survivors of COVID-19: A retrospective cohort study using electronic health
records. The Lancet. May 2021, 8(5): 416–427. https://doi.org/10.1016/S2215-
0366(21)00084-5.
284
Generalization of Long COVID
19
Mardani Masoud. Post COVID syndrome. Arch. Clin. Infect. Dis. 2020, 15:
e108819. doi: 10.5812/archcid.108819.
20
Colin Clapson. Over a fifth of corona patients have symptoms two months on.
flandersnews.be. 8 November 2020. https://www.vrt.be/vrtnws/en/2020/11/08/over-
a-fifth-of-corona-patients-have-symptoms-two-months-on/.
21
Jennifer K. Logue, et al. op. cit.
22
Berkeley Lovelace Jr. Dr. Fauci says new data suggests “Long” Covid symptoms can
last up to 9 months. CNBC. 24 February 2021. https://www.cnbc.com/2021/02/24/
fauci-says-new-data-suggest-long-covid-symptoms-can-last-up-to-9-months.html.
23
Ani Nalbandian, et al. op. cit.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
external pathogenic factors, but the main issues and focuses will be
harmonizing the zang-fu organs, rebalancing the qi, blood, yin,
and yang. There could be a slight difference in treatment for the
phase of post subacute COVID-19 and post chronic COVID-19
because the underlying ethology, pathology, and treatment are not
the same.
It is believed in TCM that the longer a disease or some symp-
toms last, the more complicated pathology will be. The purposes of
TCM treatment will examine the patients based upon eight princi-
ples, differentiation of six channels, San Jiao and wei, qi, ying, and
xue systems to find out the mechanisms and finally help the
patients.
24
César Fernández-de-las-Peñas, et al. Defining post-COVID symptoms (post-acute
COVID, long COVID, persistent post-COVID): An integrative classification. Int J
Environ Res Public Health. 2021, 18(5): 2621. doi: 10.3390/ijerph18052621.
25
Trisha Greenhalgh, et al. Management of post-acute COVID-19 in primary care.
BMJ. 2020, 370. https://doi.org/10.1136/bmj.m3026.
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Generalization of Long COVID
26
Jennifer K. Logue, et al. op. cit.
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before.28
It can be seen from above that the percentage of the post-COVID
syndrome is around 30% to 34%, six to nine months after the first
onset of illness of COVID-19.
9.4 Symptoms
American CDC listed the following symptoms as post COVID
conditions,29 including:
• tiredness or fatigue
• difficulty thinking or concentrating (sometimes referred to as
“brain fog”)
• headache
• loss of smell or taste
• dizziness on standing
• fast-beating or pounding heart (also known as heart palpitations)
27
Chaolin Huang, et al. op. cit.
28
Maxime Taquet, et al. May 2021. op. cit.
29
CDC. Updated 1 September 2021. op. cit.
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Generalization of Long COVID
• chest pain
• difficulty breathing or shortness of breath
• cough
• joint or muscle pain
• depression or anxiety
• fever
• symptoms that get worse after physical or mental activities
Angelo Carfì, et al. Persistent symptoms in patients after acute COVID-19. JAMA.
30
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
31
Chaolin Huang, et al. op. cit.
290
Generalization of Long COVID
still had more than one symptom. The vast majority (86%) were still
very tired 165 days after their first symptoms, while 59% still expe-
rienced shortness of breath. 36% often felt pressure on their chests,
35% had headaches, and 40% experienced muscle pain. The over-
whelming majority, 94%, were not hospitalized for COVID-19 and
only had light symptoms. These were relatively young people, with
an average age of 48 years. About 86% of respondents said they had
been in good health before their infection and 61% said they had
not had any chronic illness before.32 Again, in Belgium, a study,
published on 28 February 2021 and carried out by Hasselt University
together with three other institutions has confirmed the phenome-
non, in which some 30% of people who contracted COVID-19 but
did not have to be hospitalized continue to feel ill months later.
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32
Coronavirus health challenges persist six months after infection. The Brussels
Times. Updated 3 October 2020. https://www.brusselstimes.com/news/belgium-all-
news/134061/coronavirus-health-challenges-persist-six-months-after-infection-
covid-19-novel-sars-cov-2-belgium-netherlands/.
33
Coronavirus in Belgium: Your general questions answered. The Bulletin, Updated
28 February 2021. https://www.thebulletin.be/coronavirus-belgium-your-general-
questions-answered.
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34
Hannah E. Davis, et al. op. cit.
292
Generalization of Long COVID
35
Sushmita Panda. COVID-19 potential cause of liver injury. The Sunday Guardian
Live. Updated 17 April 2021. https://www.sundayguardianlive.com/news/covid-19-
potential-cause-liver-injury.
36
James Kingsland. COVID-19 liver damage may be more common than previously
thought. The Medical News Today. Updated 12 August 2020. https://www.
medicalnewstoday.com/articles/covid-19-liver-damage-may-be-more-common-
than-previously-thought.
293
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
37
Zhen Li, et al. Caution on kidney dysfunctions of 2019-nCoV patients. The
Medrxiv. Updated 12 February 2020. https://www.medrxiv.org/content/10.1101/202
0.02.08.20021212v1.
38
Sreedhar Adapa, et al. COVID-19 and renal failure: challenges in the delivery of
renal replacement therapy. J Clin Med Res. 2020, 12(5): 276–285. doi: 10.14740/
jocmr41602020.
294
Generalization of Long COVID
Rajit K. Basu, et al. Kidney–Lung cross-talk and acute kidney injury. Pediatric
39
295
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
296
Generalization of Long COVID
40
CDC. Updated 1 September 2021. op. cit.
41
Gemelli Against COVID-19 Post-Acute Care Study Group. Post-COVID-19 global
health strategies: The need for an interdisciplinary approach. Aging Clin Exp Res.
2020, 32(8): 1613–1620. doi: 10.1007/s40520-020-01616-x pmid:32529595.
42
Klok FA, et al. The post-COVID-19 functional status scale: A tool to measure func-
tional status over time after COVID-19. Eur Respir J. 2020, 56: 2001494. doi:
10.1183/13993003.01494-2020 pmid:32398306.
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hospital recover well with four to six weeks of light aerobic exercise
(such as walking or pilates), gradually increasing in intensity to toler-
able levels. Those returning to employment may need support to
negotiate a phased return.43
9.6.2 Pathogenesis
• Damage to the lungs
43
Trisha Greenhalgh, et al. op. cit.
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Generalization of Long COVID
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300
10
Meridian Palpation Treatment for
COVID-19 and Long COVID Conditions
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
10.2.5 Touching/sensing
It is to touch by checking temperature, sensing texture along the
meridians. Sensation by touch can help enforce the understanding of
the changes in the local area/meridian. A cold sensation indicates the
cold accumulated in the relevant area/meridian, while hot sensation
shows the heat stagnation. Puffiness is usually a sign for damp and
phlegm accumulation—the thicker, the more severe. Wetness or
clamminess indicates the damp or qi deficiency. Smooth and delicate
sensation on the surface point, like the Yuan-source point, is usually
a sign for deficiency of the relevant yin meridians.
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10.2.6 Palpation
It is to sense, by pressing into the points, the resistance and pains,
and hollowness of the relevant affected meridian. Take note of the
ratings on the sensitivity and hollowness upon pressure on the points
if applicable.
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
framework:
• The left body indicates pathology associated with yin and blood,
including yin deficiency, blood deficiency or stasis, or cold and
damp.
• The right body indicates pathology associated with yang and qi,
including yang deficiency, qi deficiency or stagnation, or heat and
fire.
• Skin that feels hot to the touch indicates heat; skin that feels cold
indicates cold.
• A point that feels hollow/empty to the touch indicates deficiency;
a point that is tight and solid indicates excess and stagnation.
• A point that feels puffy or swollen to the touch indicates damp or
phlegm.
• A sharp pain indicates blockage or stagnation, and excess, like qi
stagnation, fire, phlegm, damp, blood stasis, blood heat etc.
• A bruised or dull ache is a sign for deficiency, like blood defi-
ciency, qi deficiency, or yang deficiency.
• Severe qi or yang deficiency usually presents only hollowness.
• There could be a mixture of all different signs in reality. Signs of
both deficiency and excess may be seen at the same time on one
point.
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point decision to gain a more in-depth analysis for the final treat-
ment. This is especially useful when there is a complicated condition
involving multiple sensitized meridians. It particularly works well in
the case that the improvement of a patient’s key symptom can be
quantitatively measured on site.
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
the patient to measure the chest pain level and difficulty level of
breathing and note down the number by 1–10. The result with a con-
firmed reduction of measurement number on symptoms is deemed as
effective. In the end, Zulinqi GB-41 is the most effective point to
relieve the both symptoms by dropping the pain to 4/10 and breathing
to 3/10, Xiangu ST-43 helps some chest pain by dropping to 1/10,
while Kunlun BL-60 holds the least effect for both symptoms. We then
decide to use GB and ST meridians as the treatment target despite
bladder meridian showing a highest rating.
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on the point does not prove effective for the targeted symptom, the point
will be taken as irrelevant to the final treatment. By comparison on the
quantifiable measurement on level of severity of the relevant symptom
before and after the test treatment, this method can greatly enhance a
precise identification on the potential pathology of the illness in relation
to the meridians. The following fundamental test treatment procedure
demonstrates exactly what principle 3 aims to achieve.
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
achieved). At the end, only select the points with good response
for final treatment and give up on the points that do not have a
positive reaction in the test.
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the four principles of point decision, finally choose the right points
for a formal treatment. A fast-acting, profoundly effective, and relia-
ble treatment will be secured.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
10.4.2.1 Fatigue
• Yang meridian illness: Consistent disturbance on any yang meridi-
ans as a result from the external invasion of virus and the continuous
fighting state due to the disturbance within the yang meridians can
be a key factor that exhausts and depletes the body. Therefore, all
three yang meridians shall be checked. Diagnosis on these patterns
is straightforward. The highly sensitized points on relevant meridi-
ans are the direct evidence for the diagnosis.
• Yin meridian illness: Because of the depleting impairment from the
infection, it is understandable to see overall energy decline within
the body, especially with the yin organs. The most important thing
is to identify which organ is the leading one that was most affected
by the virus and needs immediate treatment so that we can help
speed up and support the recovery of the body. Among all the yin
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
organs, the spleen, lung, heart and kidney are the most common
organs to be affected. Their meridians hence need palpation
check.
• Secondary pathology: Damp is the most possible factor of second-
ary pathology to cause tiredness. Besides, Fenglong ST-40 may be
sensitive when there is phlegm pathology.
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essential nutrients into the head can both cause symptoms like
memory loss or brain fog. All meridians linking the head superficially
or internally can play a role in it.
• Yang meridians: All Yang meridians travel onto the head. Different
Yang meridians may differ in accompanied symptoms, but merid-
ian palpation with quantifiable rating on relevant points increases
the accuracy of differentiation.
• Yin meridians: Shaoyin kidney meridian has branches joining the
Du channel and entering the brain, and therefore affects the ability
of clear thinking, memory, and concentration. Taiyin spleen
meridian is responsible for lifting clear-qi to the head to support
the functions of all sense-orifices. Deficiency of spleen or kidney
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
10.4.2.6 Dizziness
It reflects the impairment related to body balancing. In meridian pal-
pation system, look for the connections to affect the neck, inner ears,
and eyeball movement, by which the blockage or impairment of the
relevant meridian(s) leads to muscle spasm or weakening, yin-fluid
or phlegm retention, accumulation of inflammation, or disorders of
blood supply into the brain. Overall, any meridian that travels to the
head, connects to eyes, and ears, and reaches the neck may all have
a potential to disturb the body balancing function. In addition,
although not as often, vertigo may occur with COVID-19 infection,
the understanding of pathology and treatment are similar.
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Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
• Yang meridian: All three yang meridians can have a play in the
pathology and need full meridian palpation check.
• Yin meridian: All yin meridians do not reach the head by their own
main pathways. They link to head by the divergent paths linking their
pairing yang meridians. Among the three Yin meridians Jueyin liver
meridian joins the Du mai reaching the vertex of head, via internal
connection to the back of eyes. Liver pathology is the most common
yin meridian associated with dizziness, which is often interpreted as
“hypertension” and so on. Shaoyin kidney meridian joins Du mai
along the spine into the brain, pathology of kidney therefore can
incur brain illnesses like dizziness, however usually with a more
chronic and deficient setting.
• Secondary pathology: When phlegm and damp blocks the “clear
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not only joints are attacked, but all body parts can be affected.
Because the immunity disorder apparently involves more yang
meridian disturbance, all yang meridians in principle need palpating
check. One important fact is that the involved yang meridians are not
only limited to the ones nearest to the affected joint or muscles (espe-
cially in those cases with multiple locations of pains), considering
this is a systematic disorder. The best treatment result comes from the
right selection of meridian(s) with the highest sensitivity. A good test
treatment procedure will help increase the efficacy and accuracy of
the treatment, and requires testing the effect of associated yang
meridian on joints and its corresponding yin meridian. If there are
noticeable signs of swelling or deformity on the relevant joint(s),
we also need to investigate the causes of damp, phlegm, and blood
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intestine meridians are the most common meridian pairs that cause
ear problems.
The secondary pathology like phlegm and damp/yin-fluid, can
also play a part in the occurrence of tinnitus and earache, but they
always serve as accompanying factors. The inclusion of the relevant
points in treatment for ears relies on strictly whether stimulation on
the point shows a definite effect through the test treatment.
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stomach, and lung, heart, liver, kidney, and spleen meridians need to
be checked. The meridians that reach the head can all cause head-
aches, although the affected area may vary according to the path-
ways of relevant meridians. The most widely accepted guidance for
allocating the meridian regarding headache area, is that the forehead
headache is related to Yangming, temporal headache Shaoyang and
back and top of headache Taiyang. However, this guidance is not
adequate to cover the precise distribution of the meridian route
and sometimes leads to false judgement. For example, the Taiyang
bladder meridian starts from the inner corner of eyes and the begin-
ning of the eyebrows then up over the forehead to reach the vertex
of head. Therefore, center-front headache may be related to the BL
meridian. Same idea applies to gallbladder meridian as the Yangbai
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
324
Meridian Palpation Treatment for COVID-19 & Long COVID Conditions
Yang Meridian:
• GB: Zulinqi GB-41, L=R 8/10; ST: Chongyang ST-42, L=R 8/10; SJ:
Waiguan SJ-5, L=R 7/10.
• Yin meridian, LU: Chize LU-5, L=R 6/10; LIV: Taichong LIV-3, L=R
9/10; KID: Zhaohai KID-6, L=R 9/10; P: Quze P-3, L=R 8/10.
• Secondary pathology, Yinlingquan SP-9, R 9/10; Fenglong ST-40,
L=R 8/10.
TCM Diagnosis:
• Invasion of wind-cold on Shaoyang and Yangming, with some heat
conversion.
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325
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
The result of the test treatment exactly reflects a clear picture of the
pathology:
326
11
TCM Treatment of Long COVID
11.1 Fatigue
As millions of patients have been infected by SARS-CoV-2 virus, a
vast number of individuals complain about some continuing symp-
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toms even months after the onset of the infection. During Long
COVID, concern has been raised that SARS-CoV-2 has the potential
to trigger a post-viral fatigue syndrome. Fatigue is a normal part of the
body’s physiological reaction and response to fighting a viral infec-
tion such as COVID-19. Fatigue is likely to continue for some time,
e.g., a couple of weeks, after the infection has cleared. Fatigue could
make the patients sleep more, feel unsteady on the feet, make stand-
ing for long periods difficult, as well as affect the ability to remember
and concentrate.
There are various main complaints during Long COVID (fatigue
is one of them) and the quality of life could be markedly affected by
fatigue. It usually appears in combination with shortness of breath,
and insomnia. Besides, fatigue significantly impacts the depression
scale. In this way, fatigue may identify a group worthy of further study
and early intervention.
A study published in the Journal of the American Medical
Association found that of 143 COVID-19 patients at a hospital in
Rome, 87% still had at least one coronavirus symptom two months
later, while more than half reported ongoing fatigue.1 In terms of
1
Ashley Zlatopolsky. Can chronic fatigue syndrome be treated? Rochester-based doc-
tor is trying to find an answer. The Detroit News. 30 November 2020. https://eu.
detroitnews.com/story/life/2020/11/30/rochester-based-doctors-research-links-
chronic-fatigue-syndrome-covid-19/6462044002/.
327
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
2
Liam Townsend, et al. Persistent fatigue following SARS-CoV-2 infection is common
and independent of severity of initial infection. PLOS ONE. 2020, 15(11): e0240784.
https://doi.org/10.1371/journal.pone.0240784.
328
TCM Treatment of Long COVID
fatigue
A significant proportion of COVID-19 patients are suffering from
prolonged Post-COVID-19 Fatigue Syndrome, with characteristics
typically found in Myalgic Encephalomyelitis/Chronic Fatigue Syn-
drome (ME/CFS). One researcher tried to demonstrate a clear patho-
physiological explanation for the patients suffering from prolonged
Post-COVID-19 Fatigue Syndrome. A novel paradigm for Post-
COVID-19 Fatigue Syndrome is developed from a recent unifying
model for ME/CFS. SARS-CoV-2, in common with the triggers (viral
and non-viral) of ME/CFS, is proposed to be a physiologically severe
stressor, which could be targeting a stress-integrator within the Brain:
the hypothalamic paraventricular nucleus (PVN). It is proposed that
inflammatory mediators, released at the site of COVID-19 infection,
would be transmitted as stress-signals via humoral and neural path-
ways, which overwhelm this stress center. In genetically susceptible
people, an intrinsic stress threshold is suggested to have exceeded,
causing ongoing dysfunction to the hypothalamic PVN’s complex
neurological circuitry. In this compromised state, the hypothalamic
3
Stefan R. Bornstein, et al. Chronic post-COVID-19 syndrome and chronic fatigue
syndrome: Is there a role for extracorporeal apheresis? Mol Psychiatry. 2022, 27:
34–37. https://doi.org/10.1038/s41380-021-01148-4.
329
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
4
Angus Mackay. A paradigm for post-covid-19 fatigue syndrome analogous to ME/CFS.
Front. Neurol. 2021. 12: 701419. doi: 10.3389/fneur.2021.701419.
330
TCM Treatment of Long COVID
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Eliminate damp, resolve phlegm, activate the spleen, and improve
appetite.
Herbal Treatment:
Ping Wei San-Calm the Stomach Powder, plus
Xiang Sha Liu Jun Zi Tang-Six Gentlemen Decoction with Aucklandia
and Amomum.
332
TCM Treatment of Long COVID
Explanations:
• Cang Zhu, Hou Po, Chen Pi, and Zhi Gan Cao, the complete com-
position of Ping Wei San, eliminate damp, resolve phlegm, activate
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Herbal Remedy:
Xiang Sha Liu Jun Wan-Six Gentlemen Pill with Aucklandia and
Amomum.
Acupuncture Treatment:
• Hegu L.I.-4, Neiguan P-6, Taichong LIV-3, Zhongwan REN-12,
Liangmen ST-21, Tianshu ST-25, Zusanli ST-36, Fenglong ST-40,
Sanyinjiao SP-6, and Yinlingquan SP-9.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, promote the qi circulation
in the body and relieve qi stagnation caused by the accumulation
of damp-phlegm.
• P-6, the luo-connecting point of the pericardium channel, regu-
lates qi circulation in the chest and abdomen, harmonizes the
stomach, descends stomach-qi, and improves appetite.
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• REN-12, the front mu point of the stomach and the gathering point
of the fu organs in the body, Fenglong ST-40, the luo-connecting
point of the stomach channel, and SP-9, and the he-sea point of
the spleen channel respectively, eliminate damp and resolve
phlegm in the body.
• ST-25, the front collecting point of the large intestine, together
with ST-21 are able to promote digestion and transportation in the
large intestine.
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of the three yin channels of the feet, tonify and acti-
vate the spleen and stomach and improve the appetite.
• Moxa on REN-12, ST-36 and SP-9 could warm the internal organs
and eliminate cold.
• GB-34, the he-sea point of the gallbladder channel, and SP-2, the
ying-spring point of the spleen channel clear heat and eliminate
damp.
11.1.2.2 Stagnation of qi
Fatigue, depression, headache, tension at the neck, fullness of the
chest, insomnia, hypochondriac pain and distention, poor appetite,
belching, acid regurgitation, slight depression, headache, insomnia,
aggravation of above situations when being nervous, irregular
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TCM Treatment of Long COVID
Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and improve
sleep.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver and relieve qi stagna-
tion in the liver.
• Zhi Ke, Xiang Fu, and Chuan Lian Zi promote qi circulation and
relieve qi stagnation and pain in the body.
• Dang Gui and Chuan Xiong nourish the liver-blood, benefit the
liver, and relieve spasms in the liver.
• Fu Shen and Yuan Zhi smooth emotions, regulate and calm the
shen, and improve sleep.
• Bai Zhu, Chen Pi and Sha Ren activate the spleen and stomach,
promote the qi circulation in the middle Jiao and improve the
appetite.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Shaohai HE-3,
Shenmen HE-7, Tanzhong REN-17, Fengchi GB-20, Sanyinjiao
SP-6, Yanglingquan GB-34, Taichong LIV-3, Zhangmen LIV-13,
Xinshu BL-15, and Ganshu BL-18.
• Even method is applied on P-6 + SP-4, and a reducing method is
applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation in the
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336
TCM Treatment of Long COVID
Principle of Treatment:
Tonify qi, warm yang, activate the spleen and improve appetite.
Herbal Treatment:
Fu Zi Li Zhong Tang-Prepared Aconite Pill to Regulate the Middle,
plus
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In case of deficiency of qi and yang of the heart, add Rou Gui Cortex
Cinnamomi Cassiae 5 g.
In case of deficiency of qi and yang of the kidney, add Ba Ji Tian
Radix Morindae Officinalis 10 g and Xian Mao Rhizoma Curculiginis
Orchioidis 10 g.
Explanations:
• Zhi Fu Zi, Gui Zhi and Gan Jiang warm yang and qi, eliminate
cold and strengthen the body.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao activate the
spleen, tonify the spleen-qi and the general body, and improve
appetite.
• Zhi Huang Qi and Shan Yao activate the spleen, tonify spleen-qi,
and lift the qi to the head.
• Rou Gui warms the heart-yang and strengthens heart-fire.
• Ba Ji Tian and Xian Mao warm the kidney, eliminate interior cold
and strengthen the back.
Herbal Remedy:
Li Zhong Wan-Decoction (Pill) to Regulate the Middle, or Si Jun Zi
Wan-Four Gentlemen Decoction.
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Acupuncture Treatment:
• Zusanli ST-36, Taibai SP-3, Shenmen HE-7, Guanyuan REN-4,
Qihai REN-6, Taixi KID-3, Baihui DU-20, Xinshu BL-15, Pishu
BL-20, and Shenshu BL-23.
• A tonifying method is applied to the first three points.
• Moxibustion could be applied on REN-4, REN-6, and ST-36.
Explanations:
• ST-36, the he-sea point of the stomach channel, SP-3, the yuan-
source point BL-20, the back-shu point of the spleen, activate the
spleen and stomach, and tonify qi of the general body.
• REN-4 and REN-6 tonify the yuan-qi in the body, warm yang,
eliminate interior cold and strengthen the body.
• HE-7 and BL-15, the yuan-source point and the back-shu point
of the heart respectively, tonify qi and yang of the heart and
strengthen the heart.
• KID-3, the yuan-source point of the kidney channel, BL-23, the
back-shu point of the kidney, warms the kidney, tonifies qi and
yang of the kidney and eliminates interior cold.
• DU-20 lifts qi and yang to the head and relieves fatigue.
• Moxibustion warms the qi and yang of the body and eliminates
interior cold.
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TCM Treatment of Long COVID
Principle of Treatment:
Nourish the yin, clear deficient heat, benefit the body fluid and
relieve the tiredness.
Herbal Treatment:
Sheng Mai San-Generate the Pulse Powder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Ren Shen, Mai Men Dong and Wu Wei Zi, the complete composi-
tion of Sheng Mai San, nourish the yin of the body. Meanwhile,
they can also tonify the qi of the body. They are the main herbs in
this prescription to relieve fatigue.
• Sheng Di Huang and Mu Dan Pi nourish the yin and clear the
deficient heat in the body.
• Ren Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao, the complete com-
position of Si Jun Zi Tang, activate the spleen and tonify the qi in
the body so as to promote the production of yin in the body.
• Shu Di Huang, Gou Qi Zi, Nu Zhen Zi and Han Lian Cao tonify
the kidney, nourish the yin and benefit the jing.
• Tian Hua Fen promotes the production of body fluid and relieves
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thirst.
• Chuan Bei Mu and Zi Wan nourish the lung-yin and relieve dry
cough.
• Dan Shen and Yuan Zhi benefit the heart and calm the shen.
• Chuan Lian Zi and Wu Mei benefit the liver and relieve the spasm
in the liver.
Herbal Remedy:
Sheng Mai San (Wan)-Generate the Pulse Powder (Pill).
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KI-6, Chize LU-5, Taiyuan LU-9, Shenmen
HE-7, Feishu BL-13, Zusanli ST-36, Sanyinjiao SP-6, Taixi KID-3,
Zhaohai KID-6, Yingu KID-10, Qihai REN-6 and Shenshu BL-23.
• An even method is applied on LU-7 + KID-6, and a tonifying
method is applied on the rest of the points.
Explanations:
• LU-7 + KID-6 are used to nourish the yin of the general body and
relieve dryness and deficient heat.
• LU-5 and LU-9,the he-sea point and the yuan-source point of the
lung channel respectively, and BL-13, the back-shu point of the
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TCM Treatment of Long COVID
lung, nourish the yin of the lung, consolidate the skin and restore
the physiological functions of the lung.
• ST-36, SP-6, REN-6, KID-3, KID-6, KID-10, and BL-23 tonify the
spleen and stomach, benefit the yin of the kidney and strengthen
the whole body.
• HE-7, the yuan-source point of the heart channel, tonifies the
heart, regulates the shen and relieves night sweating.
11.2 Breathlessness
Most people who have coronavirus disease 2019 (COVID-19)
recover completely within a few weeks. But some patients, even
those who had mild cases of the disease continue to experience
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symptoms after their initial recovery. It has been noticed that older
people and people with many serious medical conditions are the
most likely to experience lingering COVID-19 symptoms, but even
young and otherwise healthy people can feel unwell for weeks to
months after infection. Fatigue and breathlessness are among the
continuing and debilitating symptoms being reported by people with
COVID-19 months, or even more than one year after the onset of the
disease and after they have been declared to have recovered. One
study, published in JAMA (The Journal of the American Medical
Association) on 9 July 2020, shows that a high proportion of indi-
viduals still reported dyspnea (43.4%), which is the second com-
plaint besides fatigue (53.1%).5
Breathlessness, sometimes called shortness of breath and known
clinically as dyspnea, is one of the hallmark symptoms of COVID-
19. It is characterized by difficulty breathing deeply or feeling as if
unable to get enough air into the lungs. Some patients describe it as
feeling “puffed”, “winded” or like breathing through a straw. The
chest may feel too tight to inhale or exhale fully. The patient needs
to take greater effort to perform each shallow breath, which could
5
Angelo Carfì, et al. op. cit.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
6
Interpretation of “new coronavirus pneumonia diagnosis and treatment plan (trial
seventh edition)” 《新型冠状病毒肺炎诊疗方案
( (试行第七版)》解读) http://www.
nhc.gov.cn/yzygj/s7652m/202003/a31191442e29474b98bfed5579d5af95.shtml.
342
TCM Treatment of Long COVID
breathlessness
The main pathologies of Long COVID-associated breathlessness is
dysfunctions of the lung in dispersing or descending the lung-qi due
to various causative factors.
7
Zhan Xi, et al. Current status and thinking of pulmonary fibrosis after inflammation
of new coronavirus pneumonia. Chinese Journal of Tuberculosis and Respiratory
(中华结核和呼吸杂志). 2020, 43(9): 728–732. doi: 10.3760/cma.j.cn112147-
20200317-00359.
8
Centers for Disease Control and Prevention (CDC). Symptoms of COVID-19.
Updated 22 February 2021. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-
testing/symptoms.html.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
11.2.1.3 Stagnation of qi
Accumulation of damp, improper health care and treatment, being
emotionally upset or disturbed during COVID-19, unsolved emo-
tional disorders before COVID-19, etc., could lead to retardation of
qi circulation. When there is the occurrence of qi stagnation, it could
also block the chest or the lung, bringing about breathlessness. It is a
rule in TCM that qi circulation leads to blood circulation and blood
stagnation aggravates qi stagnation. When there is qi stagnation for a
while, there could be stagnation of blood, thus forming stagnation of
qi and blood at the same time. Blood stagnation often presents in
some severe types of COVID-19.
11.2.1.4 Deficiency of qi
Prolonged persistence of COVID-19 could cause consumption of qi,
leading to deficiency of qi in the body. It may affect different zang-fu
organs, such as the lung, spleen, and kidney, etc.
344
TCM Treatment of Long COVID
Principle of Treatment:
Eliminate pathogenic factors, disperse the lung-qi, descend the
lung-qi, and relieve the breathlessness.
Herbal Treatment:
Xing Su San-Apricot Kernel and Perilla Leaf Powder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Xing Ren, Jie Geng and Zhi Ban Xia disperse the lung-qi, eliminate
phlegm, and relieve the cough.
• Hou Po, Yu Jin, Gua Lou Pi, and Zhi Ke are used to relax the chest,
promote the qi circulation in the chest, descend the lung-qi, and
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Herbal Remedy:
Qiang Huo Sheng Shi Tablets-Notopterygium Tablets to Overcome
Damp Tablets.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Waiguan SJ-5, Lieque
LU-7, Chize LU-5, Tanzhong REN-17, Fenglong ST-40, Sanyinjiao
SP-6, Yinlingquan SP-9, Taichong LIV-3, Qimen LIV-14.
• Even method is applied on P-6 + SP-4, and a reducing method is
applied on the rest of the points.
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TCM Treatment of Long COVID
Explanations:
• The combination of P-6 + SP-4, one group of the eight confluence
points, promotes the qi circulation, and relaxes the chest to relieve
breathlessness.
• SJ-5, the luo-connecting point of the San Jiao, ST-40, the luo-con-
necting point of the stomach channel, SP-6, the crossing points of
the three yin channels of the foot, and SP-9, the he-sea point of the
spleen channel, regulate the San Jiao, eliminate damp-phlegm in
the body and activate the spleen and stomach.
• LU-7, and LU-5, the luo-connecting point and the he-sea point of
the lung channel respectively, disperse and descend the lung-qi,
restore the physiological functions of the lung, and relieve cough
and breathlessness.
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Principle of Treatment:
Eliminate damp-phlegm, disperse lung-qi, descend lung-qi, and
relieve breathlessness.
Herbal Treatment:
Ban Xia Hou Po Tang-Pinellia and Magnolia Bark Decoction, plus
Cang Fu Dao Tan Tang-Atractylodes-Poria Phlegm-Dissipating
Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Hou Po, Xing Ren and Zi Su Zi resolve phlegm, descend the
lung-qi, relieve the cough and breathlessness.
• Tian Nan Xing, Zhi Ban Xia, Chen Pi, Fu Ling, and Sheng Jiang
disperse the lung-qi, eliminate phlegm, and relieve cough.
• Cang Zhu eliminates damp-phlegm and activates the spleen.
• Xiang Fu, Gua Lou Pi and Zhi Ke promote the qi circulation in
the chest and relieve the blockage of the chest by damp-
phlegm.
Herbal Remedy:
Cang Fu Dao Tan Wan-Atractylodes-Poria Phlegm-Dissipating
Decoction.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Kongzui LU-6, Lieque
LU-7, Chize LU-5, Zhongwan REN-12, Tanzhong REN-17,
Fenglong ST-40, Sanyinjiao SP-6, Yinlingquan SP-9, Taichong
LIV-3, Qimen LIV-14.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
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TCM Treatment of Long COVID
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation and
relaxes the chest to relieve breathlessness.
• REN-12, the gathering point of the fu organs in the body, ST-40,
SP-6 and SP-9 activate the spleen and stomach and eliminate
damp-phlegm in the body.
• LU-6, the xi-cleft point of the lung channel, LU-7, and LU-5 dis-
perse and descend the lung-qi, restore the physiological functions
of the lung, and relieve cough and breathlessness.
• L.I.-4, LIV-3, LIV-14, and REN-17 promote the qi circulation and
relieve breathlessness.
11.2.2.3 Stagnation of qi
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Principle of Treatment:
Harmonize the liver, smooth emotions, promote qi circulation, and
relieve the breathlessness.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver and relieve qi stagna-
tion in the liver.
• Zhi Ke and Yu Jin promote the qi circulation in the body and regu-
late emotions.
• Dang Gui nourishes the liver-blood and benefits the liver.
• Hou Po and Gua Lou Pi promote the qi circulation in the chest and
relieve the fullness in the chest.
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• All these herbs are used to promote and regulate the qi circulation
in the liver and chest to relieve qi stagnation and breathlessness.
• Bai Zhu activates the spleen and eliminates damp in the body.
• Fu Shen, Duan Long Gu and Yuan Zhi smooth the emotions, regu-
late the shen and improve sleep.
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Lieque LU-7, Chize
LU-5, Tanzhong REN-17, Fengchi GB-20, Jianjing GB-21,
Sanyinjiao SP-6, Taichong LIV-3, Qimen LIV-14, Xinshu BL-15 and
Ganshu BL-18.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation and
relaxes the chest to relieve breathlessness.
• LU-7, LU-5, and REN-17 disperse and descend the lung-qi, relieve
the qi stagnation in the chest, and improve breathlessness.
• L.I.-4 promotes the qi and blood circulation in the body and
relieves pain and headache.
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TCM Treatment of Long COVID
• SP-6, the crossing points of the three yin channels of the foot,
GB-20, GB-21, LIV-3, LIV-14, BL-15 the back-shu point of the
heart, and BL-18 the back-shu point of liver, calm the shen,
smooth the liver, promote the qi circulation, and relieve breath-
lessness.
Principle of Treatment:
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Herbal Treatment:
Xue Fu Zhu Yu Tang-Drive out Stasis in the Mansion of Blood
Decoction, plus
Dan Shen Yin-Saliva Decoction.
Explanations:
• Tao Ren, Hong Hua, Dang Gui, Chi Shao Yao, Chuan Xiong, and
Shu Di Huang, the complete composition of Tao Hong Si Wu Tang,
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Tao Hong Si Wu Tang tablet-Four Substance (Things) Decoction Pill
with Safflower and Peach Pit.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Kongzui LU-6, Lieque
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Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation, relaxes
the chest, relieves breathlessness, and relieves the chest pain.
• LU-6, LU-7, LU-5, REN-17 and P-4 disperse and descend the
lung-qi, harmonize the collaterals, relieve the stagnation in the
chest, and improve breathlessness.
• L.I.-4 and LIV-3 promote the qi circulation in the body and relieve
pain and headache.
• SP-6, BL-15 and BL-17 promote blood circulation and relieve
breathlessness.
11.2.2.5 Deficiency of qi
Breathlessness which gets worse after exertion, difficulty in breathing
in, slight cough, no expectoration of phlegm, tiredness, dizziness,
palpitations, poor memory, timidness, pale complexion, pale tongue
with a thin and white coating, and a thready and weak pulse.
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TCM Treatment of Long COVID
Principle of Treatment:
Tonify qi, activate the spleen, and reinforce the kidney.
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Si Jun Zi Tang-Four Gentlemen Decoction.
Explanations:
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao, the complete
composition from Si Jun Zi Tang, activate the spleen and tonify the
qi in the body.
• Zhi Huang Qi, Wu Wei Zi, and Zi Wan tonify the qi in the lung
and benefit the lung.
• Sang Bai Pi descends the lung-qi and relieves the breathlessness.
• Shu Di Huang tonifies the kidney and benefits the lung.
Herbal Remedy:
Bu Zhong Yi Qi Wan-Tonify the Middle and Augment the Qi
Decoction.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Zhongfu LU-1, Chize LU-5, Taiyuan
LU-9, Tanzhong REN-17, Zusanli ST-36, Sanyinjiao SP-6, Taixi
KID-3, Qihai REN-6, Feishu BL-13, and Shenshu BL-23.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation, relaxes
the chest, relieves breathlessness, and relieves chest pain.
• LU-1, the front-mu point of the lung, LU-5, the he-sea point of
the lung channels, and LU-9, the yuan-source point of the lung
channel, and BL-13, the back-shu point of the lung, tonify the qi
of the lung and restore the physiological functions.
• REN-17, ST-36, SP-6, REN-6, KID-3, and BL-23 tonify the qi of
the spleen and kidney and support the lung-qi to relieve
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breathlessness.
• Moxibustion warms the qi and dispel cold in the body.
9
Angelo Carfì, et al. op. cit.
354
TCM Treatment of Long COVID
inevitable wearing down of cartilage and bone tissue over time for
most patients over the age of 50, and patients who have some joint
pain or joint stiffness due to rheumatoid arthritis, knee pain caused
by a torn meniscus, etc. However, joint pain during Long COVID
should not be thought simply as a normal part of aging or physical
damage. It is important to pay close attention to identify the symp-
toms and signs to find out their etiologies, and take steps to prevent
them from worsening, since TCM believes that joint pain could be
caused by a wide variety of etiologies and pathologies.
For some individuals, their joint pain becomes obvious, long last-
ing, and even bizarre, which impacts their quality of life. They start
to seek medical attention and imaging investigation. Joint pain due
to Long COVID could cause swelling, stiffness, and muscle weakness
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355
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
10
Chaitanya Deshpande. Long-term post Covid joint pain could be arthritis: Experts. The
Times of India. Updated 9 July 2021. https://timesofindia.indiatimes.com/city/nagpur/
long-term-post-covid-joint-pain-could-be-arthritis-experts/articleshow/84246127.cms.
11
Northwestern University. Radiological images confirm “COVID-19 can cause
the body to attack itself”. 17 February 2021. https://www.eurekalert.org/news-
releases/731722.
356
TCM Treatment of Long COVID
• superficial stages
• tissues stages
• internal organ stages
The primary factors for joint pain at superficial stages are an inva-
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sion of wind, cold and damp at the same time, which can be the
cause of the blockage, causing pain, numbness, and impaired move-
ment of the joints. Due to the predominance of three pathogenic
factors, the superficial stage of joint pain could be again subdivided
into wind Bi, cold Bi and damp Bi.
• Wind Bi: joint pain is not fixed, and it can be wandering in differ-
ent joints in different areas.
• Cold Bi: joint pain with stiffness that improves with the application
of heat and feels worse when it gets cold. It is accompanied by
reduced circulation and pale skin.
• Fixed Bi: the joint feels heavy, sore, and swollen and the pain is in
a definite spot.
• Heat Bi: the joints are red, swollen, and inflamed, and joint pain
improves with cold application and feels worse when it gets hot.
357
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
358
TCM Treatment of Long COVID
Principle of Treatment:
Eliminate external pathogenic factors and harmonize the collaterals.
Herbal Treatment:
Fang Feng Tang-Saposhnikovia Decoction.
359
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Fang Feng, Qin Jiao, Ge Gen, Qiang Huo and Du Huo dispel
remaining wind, cold and damp, harmonize the collaterals and
relieve the joint pain.
• Ma Huang opens the superficial portions of the body, dispel wind,
cold and damp, regulate lung-qi and blood vessels, and relieve
joint pain.
• Dang Gui and Chuan Xiong promote qi and blood circulation and
relieve joint pain.
• Fu Ling activates the spleen and stomach and eliminates damp in
the body.
• Sang Ji Sheng strengthens the tendons and relieves joint pain.
• Zhi Gan Cao harmonizes the herbs in the prescription.
• Huang Bai and Cang Zhu eliminate damp, clear heat, and subside
swelling.
Herbal Remedy:
Qiang Huo Sheng Shi Tablets-Notopterygium Tablets to Overcome
Damp.
360
TCM Treatment of Long COVID
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3,
Hegu L.I.-4, Lieque LU-7, Fenglong ST-40, Sanyinjiao SP-6,
Yinlingquan SP-9, Taichong LIV-3 and Yanglingquan GB-34.
• The xi-cleft points, luo-connecting points, and yuan-source points
from some affected channels, together with some local Ah Shi
points, should be applied accordingly.
• Moxibustion should be used on SP-9, GB-34, and some local Ah
Shi points.
• Even method is applied on SJ-5 + GB-41, BL-62 + SI-3, and a
reducing method is applied on the rest of the points. A reducing
method is applied on selected xi-cleft points, luo-connecting
points, and yuan-source points.
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• If there is local redness and hotness around the affected joints, add
Quchi L.I.-11 and ying-spring point from affected channels.
Explanations:
• The combination of SJ-5 + GB-41, and BL-62 + SI-3, two groups
of the eight confluence points, harmonize and invigorate Yangwei,
Dai, Yangqiao and Du channels and promote the qi circulation to
relieve joint pain.
• LU-7, the luo-connecting point of the lung channel, opens the skin
pores to eliminate the remaining pathogenic factors, disperses the
lung-qi, and restores the physiological functions of the lung.
• L.I.-4, the yuan-source of the large intestine channel, LIV-3, the
yuan-source of the liver channel, promotes the qi circulation and
relieves the pain in the body.
• GB-34, the influential point of the tendons in the body, relaxes the
tendons and relieves joint pain.
• ST-40, the luo-connecting point of the stomach channel, SP-6 and
SP-9, the crossing point of three yin channels of the foot and the
he-sea point of the spleen channel respectively, eliminate damp in
the body, promote blood circulation and relieve joint pain.
• The xi-cleft points, luo-connecting points, and yuan-source points
from some affected channels, together with some local Ah Shi
points, promote the qi and blood circulation and relieve the joint
361
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Eliminate damp phlegm, harmonize the collateral, promote qi circu-
lation, and relieve joint pain.
Herbal Treatment:
Juan Bi Tang-Remove Painful Obstruction Decoction.
362
TCM Treatment of Long COVID
Explanations:
• Qiang Huo, Qin Jiao and Wu Jia Pi eliminate damp in the chan-
nels and collaterals and relieve joint pain.
• Chuan Niu Xi eliminates damp in the collaterals, strengthens the
tendons, and relieves joint pain.
• Sang Zhi induces the effects of the herbs to the collaterals and
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Herbal Remedy:
Shen Ling Bai Zhu Wan-Ginseng, Poria and Atractylodis
Macrocephalae Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3, Hegu
L.I.-4, Zhongwan REN-12, Fenglong ST-40, Taibai SP-3, Sanyinjiao
SP-6, Yinlingquan SP-9, Taichong LIV-3 and Yanglingquan GB-34.
• The xi-cleft points, luo-connecting points, and yuan-source points
from some affected channels should be selected accordingly.
363
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• The combination of SJ-5 + GB-41, and BL-62 + SI-3, two groups
of the eight confluence points, harmonize and invigorate Yangwei,
Dai, Yangqiao and Du channels and promote the qi circulation to
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364
TCM Treatment of Long COVID
Principle of Treatment:
Smooth the liver and emotions, promote the qi circulation, and
relieve the breathlessness.
Herbal Treatment:
Shu Jing Huo Xue Tang-Relax the Channels and Invigorate the Blood
Decoction.
Explanations:
• Qiang Huo, Bai Zhi, Wei Ling Xian and Ji Xue Teng eliminate
damp in the body and collaterals, relax the tendons and relieve
joint pain.
• Dang Gui, Chuan Xiong, Chi Shao Yao, Ru Xiang and Mo Yao pro-
mote qi and blood circulation, eliminate blood stasis, and relieve
joint pain.
• Cang Zhu, Fu Ling and Chen Pi activate the spleen, regulate the
middle Jiao and eliminate damp in the body.
365
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Shu Jing Huo Xue Wan-Relax the Channels and Invigorate the Blood
Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3, Hegu
L.I.-4, Taiyuan LU-9, Tanzhong REN-17, Yanglingquan GB-34,
Sanyinjiao SP-6, Taichong LIV-3, Xinshu BL-15 and Geshu BL-17.
• The xi-cleft points, luo-connecting points, and yuan-source points
from some affected channels should be selected accordingly.
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Explanations:
• The combination of SJ-5 + GB-41, and BL-62 + SI-3, two groups
of the eight confluence points, harmonize and invigorate Yangwei,
Dai, Yangqiao and Du channels and promote the qi circulation to
relieve joint pain.
• L.I.-4, the yuan-source of the large intestine channel, LIV-3, the
yuan-source of the liver channel, REN-17, the influential point for
the qi in the body, promote the qi circulation and relieve the pain.
• GB-34, the influential point of the tendons in the body, relaxes the
tendons and relieves joint pain.
• LU-9, the influential point for the vessels in the body, SP-6, the
crossing point of three yin channels of the food, BL-15, the back-
shu point of the heart, and BL-17, the influential point for the
blood, promote blood circulation, eliminate blood stasis, and
relieve joint pain.
• The xi-cleft points, luo-connecting points, and yuan-source points
from some affected channels, together with some local Ah Shi points,
promote the qi and blood circulation and relieve the joint pain.
366
TCM Treatment of Long COVID
Principle of Treatment:
Tonify qi, benefit blood, strengthen the tendons and reinforce the
kidney.
Herbal Treatment:
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Explanations:
• Du Huo, Fang Feng and Qin Jiao eliminate some remaining patho-
genic factors and relieve joint pain.
• Sang Ji Sheng, Du Zhong and Huai Niu Xi strengthen the tendons
and lower back, benefit kidney-jing and relieve joint pain.
367
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Dang Gui, Shu Di Huang and Bai Shao Yao tonify liver-blood and
kidney-jing to strengthen the tendons and bones in the body.
• Bai Zhu, Shan Yao and Fu Ling activate the spleen and stomach,
eliminate damp and tonify the qi in the body.
• Rou Gui warms the channels and relieves cold in the body.
• Chuan Xiong promotes blood circulation and relieves joint pain.
• Zhi Gan Cao harmonizes the herbs in the prescription.
Herbal Remedy:
Ren Shen Zai Zao Wan-Ginseng Recreating Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3,
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Explanations:
• The combination of SJ-5 + GB-41, and BL-62 + SI-3, two groups
of the eight confluence points, harmonize and invigorate Yangwei,
Dai, Yangqiao and Du channels and promote the qi circulation to
relieve joint pain.
• GB-34, ST-36, SP-6, REN-6, KID-3 and BL-23 tonify liver-blood, ben-
efit the tendons, strengthen the bones, and reinforce kidney-jing.
• Moxibustion warms the channels and collaterals, eliminates inter-
nal colds, and supports yang-qi.
• The xi-cleft points, luo-connecting points, and yuan-source points
from some affected channels, together with some local Ah Shi
368
TCM Treatment of Long COVID
points, promote the qi and blood circulation and relieve the joint
pain.
12
Angelo Carfì, et al. op. cit.
369
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
13
Lin-Man Weng, et al. Pain symptoms in patients with coronavirus disease
(COVID-19): A literature review. J Pain Res. 2021, 14: 147–159. doi: 10.2147/JPR.
S269206.
14
Valentina O. Puntmann, et al. Outcomes of cardiovascular magnetic resonance
imaging in patients recently recovered from coronavirus disease 2019 (COVID-19).
JAMA Cardiol. 2020, 5(11): 1265–1273. doi: 10.1001/jamacardio.2020.3557.
370
TCM Treatment of Long COVID
15
Zsuzsanna Varga, et al. Endothelial cell infection and endotheliitis in COVID-19.
The Lancet. 2020, 395: 1417–1418.
16
Charles J. Lowenstein and Scott D. Solomon. Severe COVID-19 is a microvascular
disease. Circulation. 2020, 142: 1609–1611. doi: 10.1161/CIRCULATIONAHA.
120.050354.
371
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
372
TCM Treatment of Long COVID
even yang, bringing about the formation of deficient cold and stagna-
tion in the different zang-fu organs, such as the lung, heart, spleen
and kidney.
Deficiency of lung-qi could lead to weakness of the lung in dis-
persing and descending the qi. Deficiency of qi and yang of the heart
could cause disorder of the blood circulation and contraction of the
blood vessels. Deficiency of qi or yang of the spleen could eventually
lead to the formation of cold-damp and weakness of the lung.
Deficiency of qi or yang of the kidney could cause the failure of
the lung in performing its physiological functions, dysfunction of the
lung happens. All the above conditions may result in chest pain from
Long COVID.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Expel cold, eliminate damp, activate stagnated yang, and relieve
chest pain.
Herbal Treatment:
Gua Lou Xie Bai Ban Xia Tang-Trichosanthis Fruit, Chinese Garlic
and Pinellia Decoction.
Explanations:
• Gua Lou Pi and Xie Bai open and relax the chest, promote qi cir-
culation, and relieve chest pain.
• Qiang Huo dispels remaining pathogenic factors and relieves
chest pain.
• Zhi Ban Xia and Xing Ren eliminate phlegm in the lung, disperse
and descend the lung-qi and relieve cough.
• Rou Gui warms the channels and dispels cold in the chest to
relieve the blockage in the chest.
• Yu Jin and Chen Pi promote qi circulation and relieve chest pain.
• Dan Shen and Chuan Xiong promote blood circulation and relieve
chest pain.
Herbal Remedy:
Qiang Huo Sheng Shi Tablets-Notopterygium Tablets to Overcome
Damp.
374
TCM Treatment of Long COVID
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Lieque LU-7, Chize
LU-5, Ximen P-4, Tanzhong REN-17, Fenglong ST-40, Sanyinjiao
SP-6, Yinlingquan SP-9, Taichong LIV-3, Qimen LIV-14. Some
local Ah Shi points as well.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4, one group of the eight confluence
points, promotes the qi circulation, and relaxes the chest to relieve
chest pain.
• LU-7, and LU-5, the luo-connecting point and the he-sea point of
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375
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Eliminate damp-phlegm, promote qi circulation, and relieve chest
pain.
Herbal Treatment:
Ban Xia Hou Po Tang-Pinellia and Magnolia Bark Decoction, plus
Cang Fu Dao Tan Tang-Atractylodes-Poria Phlegm-Dissipating
Decoction.
Explanations:
• Hou Po, Xing Ren and Zi Su Zi resolve phlegm, descend the
lung-qi, and relieve chest pain.
• Zhi Shi, Gua Lou Pi and Cang Zhu eliminate damp-phlegm, pro-
mote qi circulation, and relieve chest pain.
• Xiang Fu, Chuan Xiong, Yu Jin and Zhi Ke promote the qi circulation
in the chest and relieve the blockage of the chest by damp-phlegm.
• Zhi Ban Xia, Fu Ling, Chen Pi and Sheng Jiang disperse the
lung-qi, eliminate phlegm and relieve cough.
Herbal Remedy:
Cang Fu Dao Tan Wan-Atractylodes-Poria Phlegm-Dissipating Pill.
376
TCM Treatment of Long COVID
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Kongzui LU-6, Lieque
LU-7, Chize LU-5, Ximen P-4, Tanzhong REN-17, Fenglong ST-40,
Sanyinjiao SP-6, Yinlingquan SP-9, Taichong LIV-3, Qimen LIV-14.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation and
relaxes the chest to relieve chest pain.
• ST-40, SP-6 and SP-9 activate the spleen and stomach and elimi-
nate damp-phlegm in the body.
• LU-6, the xi-cleft point of the lung channel, LU-7, and LU-5 dis-
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11.4.2.3 Stagnation of qi
Chest pain, fullness of the chest with distending pain, difficulty in
breathing out, depression, unstable emotions, headache, stiffness of
neck with some pain, insomnia, fullness of hypochondriac regions,
irritability, nervousness, poor appetite, swollen feeling in the abdo-
men, thin and white coating on the tongue, and a wiry and thready
pulse.
Principle of Treatment:
Harmonize the liver, smooth emotions, promote qi circulate, and
relieve chest pain.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver and relieve qi stagna-
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Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Lieque LU-7, Chize
LU-5, Ximen P-4, Tanzhong REN-17, Fengchi GB-20, Sanyinjiao
SP-6, Taichong LIV-3, Qimen LIV-14, Xinshu BL-15 and Ganshu
BL-18. Some local Ah Shi points on the chest could be selected.
378
TCM Treatment of Long COVID
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation and
relaxes the chest to relieve breathlessness.
• LU-7, LU-5, and REN-17 disperse and descend the lung-qi, relieve
the qi stagnation in the chest, and relieve chest pain.
• L.I.-4 promotes the qi and blood circulation in the body and
relieves pain and headache.
• GB-20 and BL-15 calm the shen and improve the emotions.
• L.I.-4, P-4, SP-6, LIV-3, LIV-14 and BL-18, together with some
local Ah Shi points, smooth the liver, promote the qi circulation,
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Principle of Treatment:
Promote the circulation of blood, eliminate stagnant blood, and
sedate chest pain.
Herbal Treatment:
Xue Fu Zhu Yu Tang-Drive out Stasis in the Mansion of Blood
Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Tao Ren, Hong Hua, Dang Gui, Chi Shao Yao, Chuan Xiong, and
Shu Di Huang, the complete composition of Tao Hong Si Wu Tang,
promote blood circulation, eliminate blood stasis, and relieve the
pain.
• Dan Shen and Tan Xiang promote blood circulation and relieve the
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Herbal Remedy:
Tao Hong Si Wu Tang tablet-Four Substance (Things) Decoction Pill
with Safflower and Peach Pit.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6,
Hegu L.I.-4, Kongzui LU-6, Chize LU-5, Tanzhong REN-17, Ximen
P-4, Sanyinjiao SP-6, Taichong LIV-3, Xinshu BL-15 and Geshu
BL-17. Some local Ah Shi points should be applied at the same
time.
• An even method is applied on P-6 + SP-4 and LU-7 + KID-6, and
a reducing method is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4, and LU-7 + KID-6 promote the qi
circulation, relaxes the chest, and relieves chest pain.
• LU-6, LU-5, REN-17, and P-4 disperse and descend the lung-qi,
harmonize the collaterals, relieve the stagnation in the chest and
relieve chest pain.
380
TCM Treatment of Long COVID
• L.I.-4 and LIV-3 promote the qi circulation in the body and relieve
pain.
• SP-6, BL-15, and BL-17, together with the local Ah Shi points,
promote blood circulation, eliminate blood stasis, and relieve
breathlessness.
Principle of Treatment:
Tonify qi, warm the heart and reinforce the kidney.
Herbal Treatment:
Zhi Gan Cao Tang-Honey-Fried Licorice Decoction, plus
You Gui Wan-Restore the Right Pill.
Explanations:
• Zhi Gan Cao and Gui Zhi warm the heart, eliminate cold in the
chest, and regulate the heart vessels.
381
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Zhi Dang Shen, Bai Zhu, Fu Ling, Wu Wei Zi and Zhi Huang Qi
activate the spleen and tonify the qi in the body.
• Shan Yao, Du Zhong and Xian Mao warm the kidney, tonify the
kidney-yang and strengthen the lower back.
• Shu Di Huang and E Jiao tonify blood and benefit the heart.
Herbal Remedy:
You Gui Wan-Restore the Right Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6, Taiyuan
LU-9, Tanzhong REN-17, KID-23, KID-24, Zusanli ST-36, Sanyinjiao
SP-6, Taixi KID-3, Qihai REN-6, Feishu BL-13 and Shenshu BL-23.
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Explanations:
• P-6 + SP-4, and LU-7 + KID-6 promote the qi circulation, relax the
chest, and relieve chest pain.
• LU-9, the yuan-source point of the lung channel and the influen-
tial point for the vessels, and BL-13, the back-shu point of the lung,
tonify the qi of the lung and restore the physiological functions.
• ST-36 and SP-6 tonify the qi of the spleen and activate the spleen.
• KID-3 and BL-23 tonify the qi of the kidney and strengthen the
lower back.
• REN-17, KID-23 and KID-24, together with the local Ah Shi point,
promote the qi circulation and relieve chest pain.
• REN-6 tonifies the qi of the general body and eliminates cold in
the body.
• Moxibustion warms the qi and dispels cold in the body.
11.5 Headache
The so-called Long COVID is a set of symptoms that accompanies
the patient for months after initial discharge from the hospital. These
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TCM Treatment of Long COVID
17
Willi S, et al. COVID-19 sequelae in adults aged less than 50 years: A systematic
review. Travel Med Infect Dis. 2021, 40: 101995. doi: 10.1016/j.tmaid.2021.101995.
18
Paolo Martelletti, et al. Long-COVID headache, SN Compr Clin Med. 2021, 3,
1704–1706. doi: 10.1007/s42399-021-00964-7.
19
Edoardo Caronna, et al. Headache: A striking prodromal and persistent symptom,
predictive of COVID-19 clinical evolution. Cephalalgia. 2020, 40(13): 1410–1421.
https://doi.org/10.1177/0333102420965157.
20
David García-Azorín, et al. Frequency and phenotype of headache in COVID-19:
A study of 2194 patients. Sci Rep. 2021, 11: 14674. https://doi.org/10.1038/s41598-
021-94220-6.
383
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
21
César Fernández-de-las-Peñas, et al. Headache as an acute and post-COVID-19
symptom in COVID-19 survivors: A meta-analysis of the current literature. Eur J
Neurol. 2021, 28(11): 3820–3825. https://doi.org/10.1111/ene.15040.
384
TCM Treatment of Long COVID
disperses qi to all the parts of the body, including the head. Heart
dominates blood circulation and is in charge of mental activity.
Moreover, blood is the basic energetic source for the physiological
activity of the brain. Disorders in one of these channels or internal
organs during Long COVID will influence the qi and blood circula-
tion in the head, leading to headache.
385
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
386
TCM Treatment of Long COVID
Principle of Treatment:
Dispel wind, eliminate damp, harmonize the collaterals, and relieve
headache.
387
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
Dampness.
Explanations:
• Qiang Huo, Du Huo and Fang Feng can dispel wind, eliminate
cold-damp from the upper parts of the body so as to relieve
remaining external pathogenic factors.
• Chuan Xiong expels wind, promotes qi and blood circulation, and
relieves headache.
• Gao Ben and Man Jing Zi dispel wind-damp and relieve headache.
• Ban Xia and Fu Ling are used to dry damp, eliminate phlegm and
harmonize the middle Jiao.
• Zhi Gan Cao coordinates the effects of the other herbs in the
recipe.
Herbal Remedy:
Qiang Huo Sheng Shi Pian-Notopterygium Tablets to Overcome
Dampness.
Acupuncture Treatment:
• Hegu L.I.-4, Lieque LU-7, Waiguan SJ-5, Zhigou SJ-6, Fengchi
GB-20, Sanyinjiao SP-6, Extra Yintang and Ashi points on the
head.
• A reducing method is applied on all these points.
388
TCM Treatment of Long COVID
Explanations:
• L.I.-4, the yuan-source point of the large intestine channel, and
GB-20, the crossing point of the foot Shaoyang and Yangwei chan-
nels, dispel wind-damp, regulate qi circulation, and relieve
headache.
• LU-7, the luo-connecting point of the lung channel, promotes the
qi circulation, eliminates damp in the upper Jiao and relieves
headache.
• Extra Yintang relieves headache symptomatically.
• SJ-5 and SJ-6 dispel wind-damp, harmonize the collaterals and
relieve headache.
• SP-6, the crossing point of three yin channels of the foot, promotes
qi circulation and eliminates damp.
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Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and relieve
headache.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Chai Hu regulates and promotes liver-qi circulation and relieve qi
stagnation in the liver.
• Bai Shao Yao and Dang Gui are used to nourish blood in the liver,
harmonize and smooth the liver, and relieve headache and hypo-
chondriac pain.
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Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Shuaigu GB-8, Extra
Yintang, Extra Taiyang, Fengchi GB-20, Jianjing GB-21, Taichong
LIV-3, Qimen LIV-14, Neiguan P-6, Sanyinjiao SP-6, Extra
Sishencong.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on these points.
Explanations:
• SJ-5 + GB-41 is a combination to harmonize Shaoyang channels,
benefit the gallbladder and relieve headaches.
390
TCM Treatment of Long COVID
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, and LIV-14, the front-mu
point of the liver, smooth the liver, regulate the qi circulation in the
body and relieve liver-qi stagnation. Meanwhile, they could
relieve headaches.
• P-6, the luo-connecting point of the pericardium channel, regu-
lates qi circulation and calms the shen.
• Extra Sishencong calms the shen, improves sleep and regulates
emotion.
• SP-6, the crossing point of the three yin channels of the foot, pro-
motes the smooth qi and blood circulation in the liver and in the
head to relieve headache.
• GB-8, GB-20 and GB-21 regulate the collateral of the gallbladder
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channel, smooth the emotions, relieve the neck tension, and pro-
mote qi circulation in the head to relieve headache.
• Extra Yintang and Extra Taiyang, the local points, relieve head-
aches.
Principle of Treatment:
Reduce liver-fire, clear heat, calm the shen and relieve headache.
Herbal Treatment:
Long Dan Xie Gan Tang-Gentiana Longdancao Decoction to Drain
the Liver.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Long Dan Cao, Huang Qin, Xia Ku Cao and Zhi Zi clear heat in
the liver, reduce liver-fire and relieve headaches.
• Dang Gui, Chuan Xiong and Chai Hu promote liver-qi circulation,
smooth the liver, and relieve headache.
• Ze Xie and Che Qian Zi promote urination and induce fire out of
the body through urination.
• Sheng Di clears heat and nourishes the yin of the liver and kidney.
• Man Jing Zi relieves headaches.
• Zhi Gan Cao harmonizes the actions of the other herbs.
• Gou Teng and Tian Ma calm the liver, suppress liver-wind, and
relieve headache.
Herbal Remedy:
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Zhongfeng LIV-4, Shaohai HE-3,
Shaofu HE-8, Shuaigu GB-8, Fengchi GB-20, Jianjing GB-21,
XiaxiGB-43, Baihui DU-20, Xingjian LIV-2, Qimen LIV-14,
Sanyinjiao SP-6 and Extra Tai Yang.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest of the points.
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TCM Treatment of Long COVID
Explanations:
• A combination of SJ-5 + GB-41 harmonizes the Shaoyang chan-
nels, benefits the gallbladder, and relieves headaches.
• L.I.-4 and LIV-14, the yuan-source point of the large intestine
channel and the front-mu point of the liver, smooth the liver,
regulate the qi circulation in the body and relieve liver-qi stagna-
tion. Meanwhile, they could relieve headaches.
• LIV-2 and GB-43, the ying-spring point of the liver channel and
gallbladder channel respectively, DU-20, clear heat, reduce liver-
fire and relieve headache.
• HE-3 and HE-8, the he-sea point and the ying-spring point of the
heart channel respectively, clear heat in the heart, calm the shen
and smooth the liver as well.
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Principle of Treatment:
Promote circulation of blood, eliminate blood stasis, and relieve
headache.
Herbal Treatment:
Tong Qiao Huo Xue Tang-Open the Portals and Quicken the Blood
Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Chuan Xiong, Chi Shao Yao, Dan Shen and Hong Hua promote
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Herbal Remedy:
Yan Hu Suo Zhi Tong Pian-Corydalis Pain Relief Tablet.
Acupuncture Treatment:
• Hegu L.I.-4, Fengchi GB-20, Neiguan P-6, Taiyuan LU-9, Shaohai
HE-3, Shenmen HE-7, Geshu BL-17, Sanyinjiao SP-6, Taichong
LIV-3, Qimen LIV-14 and Ashi points on the head.
• A reducing method is applied to these points.
Explanations:
• Qi is the guide for blood. L.I.-4 and LIV-3, the yuan-source point
of the large intestine channel and the liver channel respectively,
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TCM Treatment of Long COVID
Principle of Treatment:
Activate the spleen, eliminate damp, resolve phlegm, harmonize the
collaterals, and sedate headache.
Herbal Treatment:
Ban Xia Bai Zhu Tian Ma Tang-Pinellia, Atractylodes Macrocephala
and Gastrodia Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Ban Xia and Chen Pi dry damp, resolve phlegm in middle Jiao and
relieve nausea.
• Fu Ling and Bai Zhu activate the spleen and eliminate damp.
• Tian Ma, Bai Ji Li and Man Jing Zi calm the liver, eliminate damp
in the head and relieve headache and dizziness.
• Cang Zhu and Hou Po eliminate damp-phlegm in the body and
relieve nausea and diarrhea.
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Herbal Remedy:
Ban Xia Bai Zhu Tian Ma Pian-Pinellia, Atractylodes Macrocephala
and Gastrodia Tablet.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Shuaigu GB-8,
Fengchi GB-20, Jianjing GB-21, Touwei ST-8, Extra Taiyang, Extra
Yintang, Zhongwan REN-12, Taichong LIV-3, Fenglong ST-40,
Sanyinjiao SP-6, Yinlingquan SP-9 and Ashi points on the head.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest points.
Explanations:
• SJ-5 + GB-41 could regulate the shaoyang channels and relieve
headaches and dizziness.
• GB-20 and GB-21 smooth the tension at the neck, promote the qi
circulation in the gallbladder channel and relieve headache.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and liver channel respectively, promote qi circulation, calm
the liver, and relieve headache.
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TCM Treatment of Long COVID
• GB-8, ST-8, Extra Taiyang and Extra Yintang, as well as some local
Ah Shi points on the head, promote qi circulation, eliminate
damp-phlegm in the head and relieve headache.
• REN-12, the front-mu point of the stomach and the influential
point for the fu organs, SP-6, the crossing point of three yin chan-
nels of the foot, and SP-9, the he-sea point of the spleen channel,
activate the spleen, eliminate damp-phlegm, and relieve nausea
and diarrhea.
11.5.2.6 Deficiency of qi
Headache after COVID-19, empty sensation in the head, aggravation
of headache after physical exertion, fatigue, general weakness, pale
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Principle of Treatment:
Activate the spleen and stomach, tonify qi and relieve headache.
Herbal Treatment:
Bu Zhong Yi Qi Tang-Tonify the Middle and Augment the Qi
Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Dang Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, known as Si Jun Zi
Tang-Four Gentlemen Decoction, activate the spleen and stomach,
tonify spleen-qi and relieve general fatigue and weakness.
• Huang Qi tonify spleen-qi and lift-up the qi to the head to
benefit it.
• Chen Pi, Mu Xiang and Sha Ren harmonize stomach-qi and pro-
mote appetite.
Herbal Remedy:
Bu Zhong Yi Qi Wan-Tonify the Middle and Augment the Qi Pill.
Acupuncture Treatment:
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Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-3, the
yuan-source point of the spleen channel, BL-20 and BL-21, the
back-shu point of the spleen and stomach respectively, activate
the spleen and stomach, tonify qi and promote digestion.
• REN-6, and SP-6, the crossing point of the three yin channels of
the foot, tonify qi and blood at the same time and strengthen the
body to relieve general fatigue and weakness.
• DU-20, DU-24 and Extra Yintang lift up qi to the head and relieve
headache.
• Moxibustion promotes the yang-qi movement, benefits the body,
and relieves the weakness and cold in the body.
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TCM Treatment of Long COVID
Principle of Treatment:
Tonify blood, relieve weakness and sedate headache.
Herbal Treatment:
Si Wu Tang-Four Substances Decoction.
Explanations:
• Shu Di Huang, Dang Gui, Bai Shao and Chuan Xiong benefit
kidney-jing, tonify and nourish blood, and relieve headache.
• Tian Ma and Bai Ji Li benefit the head and relieve headaches.
• Man Jing Zi relieves headache.
Herbal Remedy:
Gui Pi Wan-Restore the Spleen Pill.
Acupuncture Treatment:
• Zusanli ST-36, Sanyinjiao SP-6, Taichong LIV-3, Ququan LIV-8,
Taixi KID-3, Yingu KID-10, Xuanzhong GB-39, Baihui DU-20,
Shenmen HE-7, Extra Taiyang and Extra Yintang.
• An even method is applied on LIV-3, Extra Taiyang and Extra Yintang.
• A tonifying method is applied on the rest points.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of three yin channels of the foot, activate the spleen
and stomach, tonify qi and blood and relieve headache.
• Since kidney-jing and blood share the same origin and benefit
each other constantly, some points should be used to tonify
kidney-jing to tonify blood. KID-3, the yuan-source point of the
kidney channel, LIV-8 and KID-10, the he-sea point of the liver
channel and kidney channel respectively, tonify blood and jing at
the same time, relieve the general fatigue and weakness so as to
relieve headache.
• GB-39, the influential point for marrow, benefits blood and
relieves blood deficiency.
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• DU-20, Extra Taiyang and Extra Yintang benefit the head, harmo-
nize the collateral and relieve headache.
• LIV-3, the yuan-source point of the liver channel, and HE-7, the
yuan-source point of the heart channel, promote qi and blood
circulation, calms the shen, improves sleep and relieves headache.
11.6 Myalgia
The World Health Organization (WHO) estimates that approximately
1.7 billion people around the world have a musculoskeletal condi-
tion. This is a group of conditions that affect the muscles and bones
and may cause body aches.22 But myalgia in Long COVID is some-
thing different.
Long COVID refers to a variety of symptoms affecting different
organs reported by people who contracted the coronavirus disease
2019 (COVID-19) infection. To date, there have been no robust esti-
mates of the incidence and co-occurrence of Long COVID features,
their relationship to age, sex, or severity of infection, and the extent
to which they are specific to COVID-19. Therefore, some experts
started a study on this subject. They believe that Long COVID clinical
www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions.
400
TCM Treatment of Long COVID
23
Maxime Taquet, et al. Incidence, co-occurrence, and evolution of long-COVID
features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19.
PLOS MEDICINE. September 2021, 18(9): e1003773. https://doi.org/10.1371/
journal.pmed.1003773.
24
Giuseppe Lippi, et al. Myalgia may not be associated with severity of coronavirus
disease 2019 (COVID-19). World J Emerg Med. 2020, 11(3): 193–194. doi: 10.5847/
wjem.j.1920-8642.2020.03.013.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
COVID pain in the total sample was 38%. Fifty percent of individuals
with preexisting musculoskeletal pain experienced a worsening of
their symptoms after COVID-19. No differences in fatigue, dyspnea,
anxiety/depressive levels, or sleep quality were observed between
myalgia and non-myalgia groups. The presence of myalgia at hospital
admission was associated with preexisting history of musculoskeletal
pain (OR 1.62, 95% confidence interval 1.10–2.40). In conclusion,
myalgia at the acute phase was associated with musculoskeletal pain
as long-term post-COVID sequelae. In addition, half of the patients
with preexisting pain conditions experienced a persistent exacerba-
tion of their previous syndromes.25 But one examination shows that
myalgia is only 3.24% based upon the data from 81 million patients
including 273,618 COVID-19 survivors.26
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25
César Fernández-de-las-Peñas, et al. Myalgia as a symptom at hospital admis-
sion by severe acute respiratory syndrome coronavirus 2 infection is associated
with persistent musculoskeletal pain as long-term post-COVID sequelae: A case-
control study. PAIN. 2021, 162(12): 2832–2840. doi: 10.1097/j.
pain.0000000000002306.
26
Angelo Carfì, et al. op. cit.
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TCM Treatment of Long COVID
affect one or several body parts and may range from mild to severe,
typically occurring with other symptoms. In the most serious cases,
myalgia could interfere with or prevent daily activities and tasks. The
types of myalgia a person experiences may vary by age. When myal-
gia occurs with other symptoms (for instance, trouble breathing,
persistent chest pain, inability to stay conscious, or confusion), drink-
ing plenty of fluids and resting will not be usually sufficient to sup-
port recovery. Some patients may not benefit from taking
over-the-counter medications, such as ibuprofen, a nonsteroidal anti-
inflammatory drug, to reduce body and muscle aches.
27
Adem Kucuk, et al. Can COVID-19 cause myalgia with a completely different
mechanism? A hypothesis. Clin Rheumatol. 2020, 39(7): 2103–2104. doi: 10.1007/
s10067-020-05178-1.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• superficial stages
• tissues stages
• internal organ stages
• Wind Bi: body pain is not fixed, and it can be wandering in differ-
ent joints in different areas.
• Cold Bi: body pain with stiffness that improves with the applica-
tion of heat and feels worse when it gets cold.
• TCM: the body feels heavy, sore, and swollen and the pain is at a
definite spot.
• Heat Bi: body pain with burning sensation, redness and swelling
at a certain place on the body, the body pain improves with the
application of cold and feels worse when it gets hot.
404
TCM Treatment of Long COVID
405
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
28
Dhanya Sunil, et al. Multi-target directed indole based hybrid molecules in cancer
therapy: An up-to-date evidence-based review. Curr Top Med Chem. 2017, 17(9):
959–985. doi: 10.2174/1568026616666160927150839.
406
TCM Treatment of Long COVID
Principle of Treatment:
Eliminate external pathogenic factors and harmonize the collaterals.
Herbal Treatment:
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
Damp.
29
Zhenzhen Han, et al. op. cit.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Qiang Huo and Du Huo dispel remaining wind, cold and damp,
harmonize the collaterals and relieve the body pain.
• Fang Feng and Bai Zhi promote sweat, eliminate external patho-
genic factors, and relieve myalgia.
• Cang Zhu, Ge Gen and Fu Ling eliminate damp in the muscles and
resolve phlegm in the body.
• Chuan Xiong, Sang Zhi and Ji Xue Teng promote the qi and blood
circulation in the channels and collaterals and relieve myalgia.
• Zhi Gan Cao harmonizes the herbs in the prescription.
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Herbal Remedy:
Qiang Huo Sheng Shi Tang Tablets-Qiang Huo Overcome Wind
Decoction Tablet.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3,
Hegu L.I.-4, Lieque LU-7, Fenglong ST-40, Sanyinjiao SP-6, Diji
SP-8, Yinlingquan SP-9, Taichong LIV-3, Yanglingquan GB-34 and
some local Ah Shi points.
• Moxibustion should be used on SP-9, GB-34, and some local Ah
Shi points.
• An even method is applied on SJ-5 + GB-41, BL-62 + SI-3, and a
reducing method is applied on the rest of the points.
• If there is local redness and hotness around the affected joints, add
Quchi L.I.-11 and ying-spring point from the affected channels.
Explanations:
• The combination of SJ-5 + GB-41, BL-62 + SI-3, and two groups
of the eight confluence points, harmonize and invigorate Yangwei,
Dai, Yangqiao and Du channels and promote the qi circulation to
relieve myalgia.
408
TCM Treatment of Long COVID
Principle of Treatment:
Eliminate damp, resolve phlegm, activate the spleen and stomach,
and relieve myalgia.
Herbal Treatment:
Cang Fu Dao Tan Tang-Atractylodes-Poria Phlegm-Dissipating
Decoction.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
In case of swelling of the muscle with local redness and hotness due
to damp-heat, remove Gui Zhi Ramulus Cinnamomi Cassiae and Wu
Jia Pi Cortex Acanthopanacis Gracilistyli Radicis, and add Huang
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Explanations:
• Cang Zhu, Zhi Ban Xia, Chen Pi, Fu Ling, Hou Po and Huo Xiang
eliminate damp, resolve phlegm, harmonize the middle Jiao, and
relieve nausea and diarrhea.
• Xiang Fu, Mu Xiang and Chuan Xiong promote qi circulation,
relieve the blockage in the muscles by damp-phlegm and sedate
myalgia.
• Wu Jia Pi and Gui Zhi warm the muscles, eliminate damp-phlegm,
and relieve myalgia.
• Zhi Gan Cao harmonizes the herbs in the prescription.
• Huang Lian clears heat, eliminates damp, subsides swelling and
relieves myalgia.
Herbal Remedy:
Shen Ling Bai Zhu Wan-Ginseng, Poria and Atractylodis
Macrocephalae Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3,
Hegu L.I.-4, Zhongwan REN-12, Fenglong ST-40, Taibai SP-3,
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TCM Treatment of Long COVID
If there is local redness and hotness around the affected muscles, add
Quchi L.I.-11 and ying-spring point from the affected channels.
Explanations:
• The combination of SJ-5 + GB-41, and BL-62 + SI-3, two groups
of the eight confluence points, harmonize and invigorate Yangwei,
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Smooth the liver, calm the emotions, promote the qi and blood cir-
culation, and relieve body pain.
Herbal Treatment:
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Explanations:
• Chai Hu and Bai Shao Yao smooth the liver, promote liver-qi cir-
culation, and relieve qi stagnation in the liver.
• Chuan Lian Zi, Zhi Ke and Zhi Shi promote qi circulation in the
body and relieve myalgia.
• Dang Gui, Chuan Xiong, Hong Hua and Yan Hu Suo promote
blood circulation, eliminate blood stasis, and relieve myalgia.
412
TCM Treatment of Long COVID
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Taichong LIV-3,
Qimen LIV-14, Neiguan P-6, Sanyinjiao SP-6, Diji SP-8, Geshu
BL-17, Taiyuan LU-9, Shaohai HE-3 and Shenmen HE-7.
• An even method is applied on SJ-5 + GB-41, and a reducing
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Explanations:
• The combination of SJ-5 + GB-41 harmonizes Shaoyang channels,
benefits the gallbladder, and relieves myalgia.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, and LIV14, the front-mu
point of the liver, smooth the liver, regulate the qi circulation in the
body and relieve liver-qi stagnation so as to relieve myalgia.
• P-6, the luo-connecting point of the pericardium channel, regu-
lates qi circulation and calms the shen.
• SP-6, the crossing point of the three yin channels of the foot, LU-9,
the influential point of the vessels, HE-3 and HE-7, the he-sea
point and the yuan-source point of the heart channel respectively,
BL-17, the influential point of blood, promote the smooth qi and
blood circulation in the body, calm the shen and relieve myalgia.
• SP-8, the xi-cleft point of the spleen channel, harmonizes the col-
laterals in the muscles and relieves myalgia.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Tonify qi, benefit blood, strengthen the muscle and relieve the pain.
Herbal Treatment:
Shi Quan Da Bu Tang-All-Inclusive Great Tonifying Decoction.
Explanations:
• Ren Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, the complete com-
position of Si Jun Zi Tang, tonify qi, activate the spleen, improve
appetite, and relieve fatigue.
• Shu Di Huang, Dang Gui, Bai Shao Yao and Chuan Xiong, the
complete composition of Si Wu Tang, tonify blood, benefit kidney-
jing and nourish the muscles.
• Huang Qi lifts qi and benefits the energy in the body.
• Rou Gui warms the channels and relieves cold in the body.
Herbal Remedy:
Ren Shen Zai Zao Wan-Ginseng Recreating Pill.
414
TCM Treatment of Long COVID
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Shenmai BL-62 + Houxi SI-3,
Yanglingquan GB-34, Zusanli ST-36, Sanyinjiao SP-6, Diji SP-8,
Qihai REN-6, Taixi KID-3 and Shenshu BL-23.
• Moxibustion should be used on ST-36, REN-6 and KID-3.
• An even method is applied on SJ-5 + GB-41, BL-62 + SI-3, and
SP-8, and a tonifying method is applied on the rest of the points.
Explanations:
• The combination of SJ-5 + GB-41, and BL-62 + SI-3, harmonizes
and invigorates Yangwei, Dai, Yangqiao and Du channels and pro-
motes the qi circulation to relieve myalgia.
• GB-34, ST-36, SP-6, REN-6, KID-3 and BL-23 tonify qi and blood,
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11.7 Cough
Physiologically, coughing is a normal and important defense mecha-
nism of the body to protect the lung and get rid of anything that
irritates them. During COVID-19, viral infections could leave patients
with a cough because the lung has been irritated. Coughing could be
non-productive, but sometimes people may have a cough with
phlegm. This should gradually disappear during the recovery.
Globally, cough is the most commonly reported symptom in
acute COVID-19 infection. Between 50–80% of those infected report
a dry persistent cough.30 Cough is one of the most common
An update from the global perspective. Front Public Health. 2021, 8: 567395. doi:
10.3389/fpubh.2020.567395.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Both dry (58%) and productive (25%) coughs have been described in
the literature.31
Whilst recovering quickly from COVID-19, some may have
ongoing symptoms. For instance, some of these patients may con-
tinue to experience an irritating cough for some time. Over time, a
cough can develop into a cycle, where excessive coughing causes
irritation and inflammation, which worsens the cough. A cough
because of Long COVID is highly likely to occur alongside throat
dryness, expectoration of slight sputum or an non-productive cough,
and it becomes aggravated by physical activities or exposure to cold
weather. Pressure over the chest and throat pain may also occur at
the same time. Cough is not limited to people who were seriously
unwell or hospitalized when they first caught the virus.
Moreover, a cough is no longer the most common reported
symptom during Long COVID.
One review showed that patients may experience symptoms
related to any system in the body, including respiratory, neurological,
and gastroenterological symptoms. This pooled data demonstrated
31
Government of Canada. COVID-19 signs, symptoms and severity of disease: A
clinician guide. https://www.canada.ca/en/public-health/services/diseases/2019-
novel-coronavirus-infection/guidance-documents/signs-symptoms-severity.html.
416
TCM Treatment of Long COVID
that the ten most commonly reported symptoms in Long COVID are
fatigue, shortness of breath, muscle pain, cough, headache, joint
pain, chest pain, an altered sense of smell, diarrhea and altered
taste.32
As these clinical symptoms of Long COVID are new medical
conditions, we are still trying to understand it gradually.
In terms of the prevalence of Long COVID cough, in a pooled
analysis, one study found that the estimated prevalence of persistent
cough was 18% (95% CI 12–24%; I2 = 93%) in 14 studies of hospi-
talized patients (follow-up duration ranged from six weeks to four
months).33 One multicenter study examined prevalence data and
associated risk factors of Long COVID cough one year after hospital
discharge in COVID-19 survivors, in which the individuals who
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32
Olalekan Lee Aiyegbusi, et al. Long COVID: Symptoms experienced during infec-
tion may predict lasting illness. Down to Earth. 28 July 2021. https://www.
downtoearth.org.in/blog/health/long-covid-symptoms-experienced-during-infection-
may-predict-lasting-illness-78146.
33
Woo-Jung Song, et al. Confronting COVID-19-associated cough and the post-
COVID syndrome: Role of viral neurotropism, neuroinflammation, and neuroimmune
responses. The Lancet Respir Med. 2021, 9(5): 533–544. https://doi.org/10.1016/
S2213-2600(21)00125-9.
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34
César Fernández-de-las-Peñas, et al. Prevalence of post-COVID-19 cough one
year after SARS-CoV-2 infection: A multicenter study. Lung. 2021, 199: 249–253.
https://doi.org/10.1007/s00408-021-00450-w.
35
David T. Arnold, et al. Patient outcomes after hospitalisation with COVID-19 and
implications for follow-up: Results from a prospective UK cohort. Thorax. 2021,
76(4): 399–401. doi: 10.1136/thoraxjnl-2020-216086.
36
Office for National Statistics. Prevalence of long COVID symptoms and COVID-19
complications. Office for National Statistics. 16 December 2020. https://www.ons.
gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19
complications.
37
Peter V. Dicpinigaitis and Brendan J. Canning. Is there (will there be) a post-COVID-19
chronic cough? Lung. 2020, 198: 863–865. doi: 10.1007/s00408-020-00406-6.
418
TCM Treatment of Long COVID
why it affects only some, and why most of the early prevalence stud-
ies looked only at patients who had been hospitalized with acute
COVID-19, when in fact, most people with COVID-19 are never ill
enough to be hospitalized. Finally, there is the question of what part
COVID-19 vaccines might play. Although many of them prevent
death and severe illness, scientists do not yet know whether they
prevent Long COVID.41
Some scientists have tried to explain why cough persists during
Long COVID. They hypothesize that the pathways of neurotropism,
neuroinflammation, and neuroimmunomodulation through the vagal
sensory nerves, which are implicated in SARS-CoV-2 infection, lead
to a cough hypersensitivity state. The Long COVID syndrome might
also result from neuroinflammatory events in the brain. They also
confirmed that although neuromodulators such as gabapentin or
38
Angelo Carfì, et al. op. cit.
39
Carole H. Sudre, et al. Attributes and predictors of long COVID. Nature Medicine.
2021, 27: 626–631. doi: https://www.nature.com/articles/s41591-021-01292-y.
40
Daniel P. Oran, et al. Prevalence of asymptomatic SARS-CoV-2 infection. Annals
of Internal Medicine. 2020, 1730(5): 362–367. https://doi.org/10.7326/M20-3012.
41
Michael Marshall. The four most urgent questions about long COVID. Nature.
2021, 594: 168–170. https://doi.org/10.1038/d41586-021-01511-z.
419
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
42
Woo-Jung Song, et al. op. cit.
43
Long Covid: Ongoing cough. Pulse Today. 7 June 2021. https://www.pulsetoday.
co.uk/clinical-feature/clinical-areas/respiratory/long-covid-ongoing-cough/.
44
Alyn Morice, et al. British thoracic society cough guideline group recommenda-
tions for the management of cough in adults. Thorax. 2006, 61(Suppl 1): i1–24. doi:
10.1136/thx.2006.065144.
420
TCM Treatment of Long COVID
421
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
45
Xuqin Du, et al. Add-on effect of Chinese herbal medicine in the treatment of mild
to moderate COVID-19: A systematic review and meta-analysis. PLoS ONE. 2021,
16(8): e0256429. https://doi.org/10.1371/journal.pone.0256429.
422
TCM Treatment of Long COVID
Principle of Treatment:
Dispel wind, eliminate cold-damp, disperse the lung-qi and relieve
cough.
Herbal Treatment:
Xing Su San-Apricot Kernel and Perilla Leaf Powder, plus
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Explanations:
• Jing Jie and Fang Feng are prescribed in low doses because the
external pathogenic factors are not so strong anymore. They are
applied in combination with Qiang Huo to dispel the remaining
pathogens and relieve some external symptoms, such as itching in
the throat, occasional nasal discharge, slight aversion to cold and
muscle pain, and headache.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Xing Ren, Jie Geng, Zi Su Zi, Zhi Ban Xia, Fu Ling, and Chen Pi
are applied to eliminate phlegm and relieve cough.
• Bai Bu relieves cough.
• Zhi Ke promotes qi circulation and relieves cough.
Herbal Remedy:
Zhi Sou San-Stop Coughing Powder.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Lieque LU-7, Chize
LU-5, Tianzhu BL-10, Feishu BL-13, Fenglong ST-40 and Yinlingquan
SP-9.
• An even method is applied on SJ-5 + GB-41, and a reducing
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Explanations:
• The combination of SJ-5 + GB-41, one group of the eight conflu-
ence points, regulates the Yangwei channel, dispel the remaining
pathogenic factors and relieve muscle pain and headache.
• L.I.-4, the yuan-source of the large intestine channel, LU-7, the
luo-connecting point of the lung channel, and BL-10 open the skin
pores, dispel external pathogenic factors, and relieve cough, mus-
cle pain, and headache.
• LU-5 and BL-13, the he-sea point of the lung channel and back-
shu point of the lung respectively, disperse the lung-qi, restore the
physiological functions of the lung and relieve cough.
• ST-40 and SP-9, the luo-connecting point of the stomach channel
and the he-sea point of the spleen channel respectively, eliminate
phlegm and relieve cough.
424
TCM Treatment of Long COVID
Principle of Treatment:
Eliminate damp-phlegm, activate the spleen, and relieve cough.
Herbal Treatment:
Cang Fu Dao Tan Tang-Atractylodes-Poria Phlegm-Dissipating
Decoction.
Explanations:
• Zhi Ban Xia, Fu Ling, Chen Pi, and Sheng Jiang, the chief compo-
sitions of Er Chen Tang, eliminate damp-phlegm and relieve
cough.
• Cang Zhu, Hou Po, Zhi Shi, and Xiang Fu eliminate damp-phlegm,
relieve the qi stagnation caused by the accumulation of damp-
phlegm.
• Xing Ren, Tian Nan Xing, Gua Lou Pi, and Zi Su Zi resolve phlegm,
regulate the lung-qi and relieve cough.
Herbal Remedy:
Er Chen Wan-Decoction of Two Old (Cured) Drugs
or
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Lieque LU-7, Chize
LU-5, Feishu BL-13, Zhongwan REN-12, Tanzhong REN-17,
Fenglong ST-40, Sanyinjiao SP-6 and Yinlingquan SP-9.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation in the
chest and abdomen and relieves cough.
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Principle of Treatment:
Clear heat, resolve phlegm, disperse the lung-qi, and relieve cough.
Herbal Treatment:
Qing Jin Hua Tan Tang-Clear Metal and Transform Phlegm Decoction.
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TCM Treatment of Long COVID
Explanations:
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• Huang Qin, Sang Bai Pi, and Zhi Zi clear heat in the lungs and
relieve coughing.
• Xing Ren, Zhe Bei Mu, and Gua Lou Pi clear and resolve heat-
phlegm and relieve cough.
• Zhi Ban Xia, Fu Ling, Chen Pi, and Zhi Gan Cao, the compositions
of Er Chen Tang, together with Jie Geng, resolve damp-phlegm and
relieve cough.
Herbal Remedy:
Qing Qi Hua Tan Tang Wan-Clear the Qi and Transform Phlegm Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Chize LU-5, Lieque LU-7, Yuji
LU-10, Feishu BL-13, Hegu L.I.-4, Quchi L.I.-11, Tanzhong REN-
17, Fenglong ST-40, Sanyinjiao SP-6 and Yinlingquan SP-9.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation in the
chest and relieves cough.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• LU-7, LU-5, and LU-10, the luo-connecting point, the he-sea point
and the ying-spring point of the lung channel respectively, BL-13,
the back-shu point of the lung, disperse the lung-qi, clear heat in
the lung, and relieve cough.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, clear heat in the body and
promote defecation.
• REN-17, the gathering point of the qi in the body, promotes the qi
circulation in the body and relaxes the chest.
• ST-40, SP-6, and SP-9, the luo-connecting point of the stomach
channel, the crossing point of three yin channels of the foot,
and the he-sea point of the spleen channel respectively, activate
the spleen and stomach and eliminate damp-phlegm in the
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body.
Principle of Treatment:
Tonify the lung-qi, resolve phlegm, and relieve cough.
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Si Jun Zi Tang-Four Gentlemen Decoction.
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TCM Treatment of Long COVID
Explanations:
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao activate the
spleen and tonify the qi in the body.
• Zhi Huang Qi, Wu Wei Zi, and Zi Wan tonify the qi of the lung
and benefit the lung.
• Sang Bai Pi descends the lung-qi and relieves cough.
• Shu Di Huang tonifies the kidney and benefits the lung.
• Zhi Ban Xia eliminates phlegm and relieves cough.
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Herbal Remedy:
Bu Fei Tang-Tonify the Lungs Decoction.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Chize LU-5, Taiyuan LU-9, Zusanli
ST-36, Sanyinjiao SP-6, Taixi KID-3, Qihai REN-6, Feishu BL-13,
and Shenshu BL-23.
• An even method is applied on P-6 + SP-4, and a tonifying method
is applied on the rest of the points. Moxibustion could be applied
on BL-13, BL-23, ST-36, KID-3, and REN-6.
Explanations:
• The combination of P-6 + SP-4 regulates the qi in the body and
relieves cough.
• LU-5, the he-sea point of the lung channels, and LU-9, the yuan-
source point of the lung channel, and BL-13, the back-shu point of
the lung, tonify lung-qi and restore the physiological functions of
the lung.
• ST-36, SP-6, REN-6, KID-3, and BL-23 tonify the qi of the spleen
and kidney and support the lung-qi to relieve cough.
• Moxibustion warms the qi and dispels the deficient cold in the
body.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Nourish yin, moisten the lung, and relieve cough.
Herbal Treatment:
Sha Shen Mai Men Dong Tang-Glehnia and Ophiopogonis Decoction.
Explanations:
• Bei Sha Shen, Mai Men Dong, and Wu Wei Zi nourish the yin of
the lung and relieve cough.
• Chuan Bei Mu, Zi Wan, and Di Gu Pi nourish the yin, clear the
heat in the lung, eliminate phlegm in the lung and benefit the lung
to relieve cough.
• Sheng Di Huang, Zhi Mu, and Huang Qin are used to clear the
remaining deficient heat in the lung and relieve coughing.
• Tian Hua Fen nourishes yin, promotes the secretion of body fluid,
and relieves thirst and dryness of the throat.
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TCM Treatment of Long COVID
Herbal Remedy:
Sheng Mai San (Wan)-Generate the Pulse Powder (Pill).
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Chize LU-5, Taiyuan LU-9, Feishu
BL-13, Zusanli ST-36, Sanyinjiao SP-6, Taixi KID-3, Qihai REN-6,
and Shenshu BL-23.
• An even method is applied on LU-7 + KID-6, and a tonifying
method is applied to the rest of the points.
Explanations:
• The combination of LU-7 + KID-6 nourishes the yin of the body
and clears deficient heat.
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• LU-5, the he-sea point of the lung channel, and LU-9, the yuan-
source point of the lung channel, and BL-13, the back-shu point of
the lung, nourish the yin of the lung, and restore the physiological
functions of the lung.
• ST-36, SP-6, KID-3, KID-6, BL-23, and REN-6 activate the spleen
and stomach, nourishing the yin of the body to benefit the yin of
the lung.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
COVID-19.
When COVID-19 broke out in China, several editions of national
guidelines on diagnosis and treatment were published. The latest edi-
tion, published on 3 March 2020, by the National Health Commission
& State Administration of Traditional Chinese Medicine, LST was not
included in the diagnostic symptoms.
However, when COVID-19 started its global journey from Italy to
Europe in March 2020, the loss or change in sense of smell and/or
taste—among all the other early symptoms and signs of the
infection—was raising more and more awareness as one of the
unique early symptoms of the COVID-19 infection. The UK govern-
ment was the latest one to recognize this, and the loss or change of
taste and/or smell was added onto the renewed guideline for
46
Michael Marshall. COVID’s toll on smell and taste: What scientists do and don’t
know. Nature. 2021, 589: 342–343. https://doi.org/10.1038/d41586-021-00055-6.
47
Taylor S. Pence, et al. Risk factors for hazardous events in olfactory-impaired
patients. JAMA Otolaryngol Head Neck Surg. 2014, 140(10): 951–955. doi: 10.1001/
jamaoto.2014.1675.
432
TCM Treatment of Long COVID
48
Gemma Mitchell. UK adds loss of smell to COVID-19 symptoms requiring self-
isolation. Nursing Time. Updated 18 May 2020. https://www.nursingtimes.net/news/
coronavirus/uk-adds-loss-of-smell-to-covid-19-symptoms-requiring-self-
isolation-18-05-2020/.
49
CDC. Updated 22 February 2021. op. cit.
50
Giacomo Spinato, et al. Alterations in smell or taste in mildly symptomatic outpa-
tients with SARS-CoV-2 infection. JAMA. 2020, 323(20): 2089–2091. doi: 10.1001/
jama.2020.6771.
51
Akosua Adom Agyeman, et al. Smell and taste dysfunction in patients with
COVID-19: A systematic review and meta-analysis. Mayo Clin Proc. 2020, 95(8):
1621–1631. doi: 10.1016/j.mayocp.2020.05.030.
52
Shima T. Moein, et al. Prevalence and reversibility of smell dysfunction measured
psychophysically in a cohort of COVID-19 patients. Int Forum Allergy Rhinol. 2020,
10(10): 1127–1135. doi: 10.1002/alr.22680.
433
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
53
Akosua Adom Agyeman, et al. op. cit.
54
Liji Thomas, et al. Smell abnormalities more common among long-COVID Patients.
News-Medical. 3 September 2021. https://www.news-medical.net/news/20210903/
Smell-abnormalities-more-common-among-long-COVID-Patients.aspx.
55
Mark W. Tenforde, et al. Symptom duration and risk factors for delayed return to
usual health among outpatients with COVID-19 in a multistate health care systems
network-United States, March–June 2020. Morbidity and Mortality Weekly Report
(Weekly), 69(30): 993–998. https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.
htm.
56
T. Klopfenstein, et al. Features of anosmia in COVID-19. Med Mal Infect. 2020,
50(5): 436–439. doi: 10.1016/j.medmal.2020.04.006.
434
TCM Treatment of Long COVID
57
David H. Brann, et al. Non-neuronal expression of SARS-CoV-2 entry genes in the
olfactory system suggests mechanisms underlying COVID-19-associated anosmia.
Sci Adv. 2020, 6(31): eabc5801. doi: 10.1126/sciadv.abc5801.
58
Sara Ferraro, et al. Olfactory and gustatory impairments in COVID-19 patients:
Mechanism, clinical characteristics, drug interferences and role in early diagnosis.
2020. Preprint doi: 10.31219/osf.io/hztp9.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
59
Gemma Mitchell. op. cit.
60
Jerome R. Lechien, et al. Olfactory and gustatory dysfunctions as a clinical presen-
tation of mild-to-moderate forms of the coronavirus disease (COVID-19): A
multicenter European study. Eur Arch Otorhinolaryngol. 2020, 277(8):2251–2261.
doi: 10.1007/s00405-020-05965-1.
436
TCM Treatment of Long COVID
437
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Qingren Wang. Yi Lin Gai Cuo (Correcting the Errors in the Forest of Medicine).
61
Blue Poppy Press. Bilingual edition. Boulder, 2007. p. 45. ISBN-13: 978-
1891845390.
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TCM Treatment of Long COVID
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The sense of ability to smell and taste all depend on the smooth
ascending, descending, entering, and exiting of qi. If qi is obstructed
or disrupted, these senses will not be functioning properly. Since the
nose is the opening of the lung, TCM stresses the importance of the
lung in terms of smell, which means that if lung-qi is healthy and
strong, the nose will be opened properly, and the sense of smell will
be normal and accurate. If lung-qi is disrupted, the sense of smell
may be weak or impaired. The mouth is the opening orifice of the
spleen, and the tongue is the opening orifice of the heart. If the qi of
the spleen and heart is strong, the sense of taste will be normal and
acute. If smelling the qi of the spleen or heart is disrupted, the sense
of taste may be weak or impaired.
Although each sense of body is mainly related to a certain zang-
fu organ, i.e., vision to the liver, taste to the spleen and heart, smell
to the lung and hearing to the kidney, TCM still holds that these inter-
nal zang-fu organs are mutually connected and influenced through
meridians systems and Mother and Son relationships. Moreover, the
physiological function of the heart plays an extreme role in the
senses’ function. For instance, Huang Di Nei Jing–Su Wen says:
“when the five qi enter the nose, they are stored by heart and lung.
When heart and lung have a disease, the nose is not free as a
440
TCM Treatment of Long COVID
63
Paul U. Unschuld, et al. op. cit. p. 208.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
442
TCM Treatment of Long COVID
regulated and harmonized in time, this loss of taste will remain the
same. Obtaining a clear identification and differentiation of relevant
meridians requires a thorough understanding of acupuncture and
herbal medicine.
To improve the qi and blood circulation for the loss of smell and
taste during Long COVID, the yuan-source points and luo-connecting
points from the relevant involved meridians should be selected on
purpose, with extra attention to the following meridians, such as
the lung, spleen, stomach, liver, heart, bladder, kidney and large
intestine. When these different meridians are impaired, they could
show different clinical symptoms and signs rather than only manifest-
ing as a loss of smell and taste. In most cases, impairment of one or
two meridians are often seen in the practice, seldom involving differ-
ent meridians at the same time.
The involvement of extraordinary meridians needs special atten-
tion and care. To identify and solve their problems, a unique tech-
nique in point combinations and procedures is required.
Here are some explanations and suggestions:
• Du mai
From the crown of the head, the channel descends along the midline
of the forehead and nose to its final point, Shui Gou DU-26, at the
junction of the upper lip and gum.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Ren mai
Ren mai is the Sea of Yin in the body, ascending along the midline of
the abdomen and ending at Chengjiang REN-24 below the lower lip.
An internal portion of the channel then winds around the mouth,
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• Chong mai
The fourth branch of Chong mai from the chest ascends alongside
the throat, curves around the lips and terminates below the eye,
reaching the end of the Ren mai. When Chong mai is impaired, it
can be typically manifested as qi rushing from the lower abdomen
up till the chest, or vomiting, nausea, saliva, or abdominal pain,
chest pain, blocked nose with loss of smell and taste in Long COVID.
Gongsun SP-4 + Neiguan P-6 should be added to harmonize this
meridian.
• Yangqiao mai
After reaching the points at Jianyu L.I.-15 and Jugu L.I.-16, Yangqiao
mai then travels to the face and connects with Dicang ST-4, Juliao
ST-3, Chengqi ST-1 and Jingming BL-1 where it meets with the BL,
444
TCM Treatment of Long COVID
DU and Yinqiao mai. From here it travels over the head and termi-
nates at Fengchi GB-20.
When Yangqiao mai is impaired, there can be numbness,
weakness, and spasms at the lateral aspect of the lower limbs,
headache, eyes or face pain, loss of smell and taste in Long
COVID. Shenmai BL-62 + Houxi SI-3 should be added to regulate
this meridian.
As compared to acupuncture, there are fewer choices of Chinese
herbs that can help regulate or harmonize different meridians.
Nonetheless, it is possible to add some specific herbs to achieve this
effect to improve the smell and taste.
It is an ideal herb to lead the prescription to the head and clear ori-
fice to promote the qi and blood circulation in the meridians.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
446
TCM Treatment of Long COVID
cases of loss of smell, the lung is not the only organ to be blamed and
treated during COVID-19. Sometimes the lung could be the victim
due to its impairment by some other organs or other pathogens.
Without eliminating this disturbance caused by these pathogens, the
lung will not be able to fulfill its task to disperse the qi to obtain a
good sense of smell.
The loss of taste in TCM is a condition showing that the spleen is
chiefly disturbed or impaired. In fact, this pandemic is mainly caused
by the invasion of cold-damp with the toxins, and the spleen is often
involved from the very beginning of the case. Besides the loss of
taste, there are often cases of sudden loose stool or diarrhea, abdomi-
nal distention and pain, poor appetite, and tiredness, supporting the
diagnosis that the cold-damp has disturbed the transportation and
transformation of the spleen. In some cases, loss of taste is a very
early symptom and sign, indicating that the spleen is involved. Thus,
it will be very logical that eliminating the cold-damp and activating
the spleen in transportation and transformation is the main therapeu-
tic management when loss of taste appears. Only focusing on treat-
ing loss of taste without consideration of recovery of the spleen in its
physiological function is absolutely an incomplete direction, and
even a wrong treatment.
Same as the explanations above about the lung, the spleen is an
organ connected with other organs and meridians, influenced by
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
many other factors. Therefore, in order to properly deal with the loss
of taste, we also need to perform a careful examination of the whole
body. For example, Chong mai or Yinwei mai can be impaired during
the ordinary cases of COVID-19 besides the spleen, which could also
lead to loss of taste. If these two extra meridians are not properly
treated—only treating the spleen for loss of taste—its treatment will
certainly fail.
activities of the shen, which are dominated by the heart. Our brain,
where clear-yang is situated, is also referred to in TCM as yuan shen
(the primary shen). Disturbance or disruption to the clear-yang by
cold-damp, toxins, or another pathogen could cause dysfunction of
the shen, leading to the limited physiological function of the sense of
smell and taste. In this sense, it could be seen that methods to regu-
late the shen to benefit the brain should be applied to deal with the
loss of smell and taste due to COVID-19.
Both the lung and heart are in the chest. The lung is responsible
for smooth qi circulation and the heart is responsible for regular
blood circulation. Coordination of qi and blood circulation could be
maintained when the lung and heart are in a harmonious state. So,
to treat loss of smell, the heart also needs to be cared for besides
treating the lung.
When there is a remaining cold-damp in the spleen, it is possible
to see the loss of taste. According to the Five Elements theory, earth-
spleen is the Son of the heart-fire, which means that the heart could
also be involved, resulting in dysfunction of the heart in housing the
shen, therefore the loss of taste could be aggravated. Thus, it should
be encouraged to deal with the spleen and heart at the same time.
There are different acupuncture points and Chinese herbs to
regulate the shen. However, it may not be suitable to select all of
448
TCM Treatment of Long COVID
• Shenting DU-24
It could calm the shen, benefit the brain, eliminate cold-damp, and
improve the sense of smell and taste.
• Extra Yintang
It is located at the midway between the medial ends of the two eye-
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brows, which could treat nasal congestion, sinus problems, calm the
shen, benefit the brain and relieve headache.
Both points are found along with the Du mai, which is connect-
ing and benefits the brain, regulating the nose and taste, and calming
the shen. They also have a very important function to regulate the
emotions during Long COVID.
Other points which could have the same functions should be
Extra Sishencong and Baihui DU-20, etc. In severe cases of LST,
Shuigou DU-26 could also be applied. A reducing method is
needed.
Usually, two of these points (preferable to the first two points),
could be applied in combination with the points to treat various syn-
dromes of Long COVID, dealing with general situations and local
complaints at the same time. This is a typical TCM way of treating any
disease. Regardless of LST could lead to further impairment.
Scalp acupuncture is one of the modern micro-system acupunc-
ture techniques which combines Chinese acupuncture needling
methods with western medical knowledge on neuroanatomy, physi-
ology, pathology, neurology, to allocate the mirror areas on the scalp
to the corresponding zones on the cerebral cortex. It is mainly used
for brain-related conditions, including neurological and psychologi-
cal conditions. In the treatment of LST, sensory area lower 2/5 is
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Chang Pu
It has a function to calm the shen and open the clear orifices, includ-
ing all the orifices. Besides, it could relieve depression and improve
emotional states. Due to invasion of cold-damp, the meridians and
orifice of the nose, mouth and tongue are obstructed by damp or
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• Yuan Zhi
It has a function to clear phlegm and calm the shen, indicated in the
acute invasion of cold-damp, or formation of phlegm-heat in the
lung, which blocks the nose or other orifices, resulting in LST. 10 g
to 12 g could be prescribed.
These two herbs also have good functions to improve emotions,
and relieve anxiety and depression during Long COVID.
Yu Liu, et al. COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 2021,
64
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TCM Treatment of Long COVID
65
Francesco Caso, et al. Could Sars-coronavirus-2 trigger autoimmune and/or auto-
inflammatory mechanisms in genetically predisposed subjects? Autoimmun Rev.
2020, 19(5): 102524. doi: 10.1016/j.autrev.2020.102524.
451
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
COVID-19 and dry mouth. Most of the patients were adults and
100% of patients with both COVID-19 and dry mouth were adults.66
The ACE-2 receptor is abundantly expressed on the epithelial
cells of the salivary glands, and when infected by SARS-CoV-2, these
receptors are overexpressed.67 It is speculated that signaling of the
ACE-2 receptor by the virus triggers a cascade of inflammatory pro-
cesses, ending in acute and chronic sialadenitis, causing disruption
in salivary secretion and resulting in dry mouth.68,6–70
9,
66
Joseph Katz. Prevalence of dry mouth in COVID-19 patients with and without
Sicca syndrome in a large hospital center. Ir J Med Sci. 2021, 190(4): 1639–1641.
doi: 10.1007/s11845-020-02480-4.
67
Li Liu, et al. Epithelial cells lining salivary gland ducts are early target cells of severe
acute respiratory syndrome coronavirus infection in the upper respiratory tracts of
rhesus macaques. J Virol. 2011, 85(8): 4025–30. doi: 10.1128/JVI.02292-10.
68
Maryam Baghizadeh Fini. Oral saliva and COVID-19. Oral Oncol. 2020, 108:
104821. doi: 10.1016/j.oraloncology.2020.104821.
69
Chenxing Wang, et al. Does infection of 2019 novel coronavirus cause acute and/
or chronic sialadenitis? Med. Hypotheses. 2020, 140: 109789. doi: 10.1016/j.
mehy.2020.109789.
70
Joseph Katz. op. cit.
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TCM Treatment of Long COVID
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Clear heat, remove toxins, reduce, cool blood, and relieve dryness.
Herbal Treatment:
Huang Lian Jie Du Tang-Coptis Decoction to Relieve Toxicity.
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TCM Treatment of Long COVID
Explanations:
• Huang Lian, Huang Qin, Huang Bai and Zhi Zi clear heat, remove
toxins, subside swelling and relieve pain. When heat and fire are
eliminated, the body fluid will be protected, and the dryness of the
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Herbal Remedy:
Huang Lian Jie Du Wan-Coptis Pill to Relieve Toxicity.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Lieque LU-7 + Zhaohai KID-6,
Hegu L.I.-4, Quchi L.I.-11, Shaohai HE-3, Shaofu HE-8, Fengchi
GB-20, Jianjing GB-21, Xiaxi GB-43, Xingjian LIV-2, Sanyinjiao
SP-6, Juliao ST-3, Dicang ST-4 and Lianquan REN-23.
• An even method is applied on SJ-5 + GB-41, LU-7 + KID-6, and a
reducing method is applied on the other points.
455
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• A combination of SJ-5 + GB-41 harmonizes the Shaoyang chan-
nels, benefits the gallbladder, and clears heat in the liver.
• A combination of LU-7 + KID-6 promotes the production of body
fluid, regulates the zang-fu organs and relieves dryness of the
mouth and eyes.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, SP-6, the crossing point of
three yin channels of the foot, clear heat, remove toxins and
reduce fire in the body. Meanwhile, they can also subside swelling
in the joints.
• LIV-2 and GB-43, the ying-spring point of the liver channel and
gallbladder channel respectively, GB-20, clear heat and reduce
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Principle of Treatment:
Nourish yin, promote the production of body fluid, benefit the shen
and relieve dryness.
456
TCM Treatment of Long COVID
Herbal Treatment:
Sha Shen Mai Men Dong Tang-Glehnia and Ophiopogonis
Decoction.
Explanations:
• Nan Sha Shen, Bei Sha Shen, and Mai Men Dong nourish the yin
of the lung and kidney and clear the deficient heat, promote the
secretion of body fluid, and relieve the thirst and dryness of the
mouth.
• Xi Yang Shen and Wu Wei Zi nourish the qi and yin of the general
body, improve appetite, and relieve fatigue.
• Zi Wan nourishes lung-yin, clears the remaining heat in the lung
and relieves dry cough.
• Mu Dan Pi clears deficient heat in the body and removes the
toxins in the blood.
• Lu Gen and Tian Hua Fen promote the secretion of body fluid and
relieve thirst and dryness of the mouth.
• Zhi Gan Cao harmonizes the prescription.
Herbal Remedy:
Qi Ju Di Huang Wan-Lyceum Fruit, Chrysanthemum and Rehmannia
Pill.
457
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Jingqu LU-8, Taiyuan LU-9, Zusanli
ST-36, Qihai REN-6, Taixi KID-3, Fuliu KID-7, Sanyinjiao SP-6,
Feishu BL-13, Shenshu BL-23, Juliao ST-3, Dicang ST-4 and
Lianquan REN-23.
• An even method is applied on LU-7 + KID-6. A tonifying method
is applied to the rest of the points.
Explanations:
• A combination of LU-7 and KID-6 nourishes the qi and yin of the
body, promotes the secretion of body fluid, and relieves dryness of
the mouth and eyes.
• LU-8, LU-9, and BL-13, the jing-metal point, the yuan-source
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point of the lung channel, and the back-shu point of the lung
respectively, nourish lung-yin, restore the physiological functions
of the lung, and relieve dry cough.
• KID-3 and KID-7, the yuan-source point and the jing-metal point
of the kidney channel respectively, BL-23, the back-shu point of
the kidney, nourish kidney-yin, benefit kidney-jing and relieve
weakness and dryness in the mouth and eyes.
• ST-36, the he-sea point of the stomach channel, SP-6, the crossing
point of three yin channels of the foot, and REN-6 tonify yin of the
general body, promote the secretion of body fluid and relieve dry-
ness in the mouth and eyes.
• ST-3, ST-4, and REN-23, regulate the eyes and mouth, promote
physiological functions, and relieve dryness in the eyes and mouth.
458
TCM Treatment of Long COVID
Principle of Treatment:
Tonify blood, improve weakness and relieve dryness.
Herbal Treatment:
Si Wu Tang-Four Substances Decoction.
Explanations:
• Shu Di Huang, Dang Gui, Bai Shao Yao and Chuan Xiong tonify
and nourish the blood, benefit the liver, and relieve dryness.
• Gou Qi Zi and Jue Ming Zi nourish the liver, benefit the eyes, and
relieve dryness of eyes.
• Lu Gen and Tian Hua Fen benefit the body fluid and relieve dry-
ness in the mouth.
• Zhi Gan Cao harmonizes the herbs in the prescription.
Herbal Remedy:
Si Wu Pian-Four Substances Tablets.
Acupuncture Treatment:
• Zusanli ST-36, Sanyinjiao SP-6, Ququan LIV-8, Taixi KID-3, Yingu
KID-10, Xuanzhong GB-39, Shenmen HE-7, Juliao ST-3, Dicang
ST-4 and Lianquan REN-23.
459
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of three yin channels of the foot, activate the spleen
and stomach, tonify qi and blood and relieve dryness.
• Since kidney-jing and blood share the same origin and benefit each
other constantly, some points should be used to tonify kidney-jing
to tonify blood. KID-3, the yuan-source point of the kidney channel,
LIV-8 and KID-10, the he-sea point of the liver channel and kidney
channel respectively, tonify blood and jing at the same time,
improve the general fatigue and weakness and relieve dryness.
• GB-39, the influential point for marrow, benefits blood and
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11.10 Rhinitis
Rhinitis is a condition, characterized by a nasal obstruction or con-
gestion, runny nose or post-nasal drip, itchy nose, and/or sneezing.
It is broadly divided into two types: allergic rhinitis and non-allergic
rhinitis. In modern medicine, it is considered that rhinitis may occur
before a case of sinusitis or with sinusitis, i.e., a condition where
infection or inflammation affects the sinuses.
Although there are many asymptomatic patients with SARS-
CoV-2 virus, one of the medical tasks is early recognition and correct
diagnosis of COVID-19.
When fever, a dry cough, fatigue, and loss of smell and taste, etc.,
appear during the pandemic, they could be considered as the main
warning symptoms and signs of COVID-19.
However, cold-like symptoms like a runny nose, may sometimes
also occur as a chief complaint during COVID-19, and it is possible
that COVID-19 symptoms are mistaken to be allergic rhinitis,
460
TCM Treatment of Long COVID
71
Ali Guvey. How does allergic rhinitis impact the severity of COVID-19?: A case-
control study. Eur Arch Otorhinolaryngol. 2021, 278(11): 4367–4371. doi: 10.1007/
s00405-021-06836-z.
72
Chiara Bruno, et al. Seasonal allergic rhinitis symptoms in relation to COVID-19.
Allergy & Rhinology. 2020, 11: 1–3. https://doi.org/10.1177/2152656720968804.
461
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• fever or chills
• dry cough
• trouble breathing
• body or muscle aches
• sore throat
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• fatigue
• fog in the head
• headache
• loss of taste or smell
• congestion or runny nose
• nausea, vomiting, or diarrhea
• palpitations
• sleep problems
• pinkeye
• skin rash
• emotional disturbance, etc.
73
Jan Hagemann, et al. Differentiation of COVID-19 signs and symptoms from allergic
rhinitis and common cold: An ARIA-EAACI-GA2 LEN consensus. Allergy. 2021,
76(8): 2354–2366. https://search.bvsalud.org/global-literature-on-novel-coronavirus-
2019-ncov/resource/en/covidwho-1138080.
462
TCM Treatment of Long COVID
• itchy throat
• itchy palate
• congestion in the nose, etc.
When rhinitis during Long COVID lasts too long, it may cause
some complications, including:
• sinusitis
• middle ear infections
• nasal polyps
• sleep apnea
• dental overbite
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74
Vincent Bauchau, et al. Prevalence and rate of diagnosis of allergic rhinitis in
Europe. Eur Respir J. 2004, 24(5): 758–764. doi: 10.1183/09031936.04.00013904.
75
Abhishek Kishore Dayal, et al. Trend of allergic rhinitis post COVID-19 pandemic:
A retrospective observational study. Indian J Otolaryngol Head Neck Surg. 2022, 74:
50–52. https://doi.org/10.1007/s12070-020-02223-y.
76
Amelia Licari, et al. Allergy and asthma in children and adolescents during the
COVID outbreak: What we know and how we could prevent allergy and asthma
flares. Allergy. 2020, 75(9): 2402–2405. doi: 10.1111/all.14369.
463
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Ismail M. Osmanov, et al. Risk factors for long covid in previously hospitalised
77
children using the ISARIC Global follow-up protocol: A prospective cohort study.
Eur Respir J. 2021, 58(6). doi: 10.1183/13993003.01341-2021.
464
TCM Treatment of Long COVID
465
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Dispel wind, eliminate cold-damp, disperse the lung-qi, and open
the nasal orifice.
Herbal Treatment:
Jing Fang Bai Du San-Schizonepeta and Saposhnikoviae Powder to
Overcome Pathogenic Influences, plus
Cang Er Zi San-Xanthium Powder.
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Explanations:
• Jing Jie, Fang Feng and Qiang Huo dispel wind, eliminate cold-
damp, and relieve some external symptoms.
• Jie Geng eliminates phlegm and relieves cough.
• Zhi Ke promotes qi circulation and eliminates phlegm.
• Bai Zhi, Cang Er Zi, Xin Yi Hua and E Bu Shi Cao open the nasal
orifice and promote the physiological functions of the nose.
Herbal Remedy:
Jing Fang Bai Du Wan-Schizonepeta and Saposhnikoviae Pill to
Overcome Pathogenic Influences, plus
Cang Er Zi San (Wan)-Xanthium Powder (Pill).
466
TCM Treatment of Long COVID
Acupuncture Treatment:
• Hegu L.I.-4, Lieque LU-7, Tianzhu BL-10, Feishu BL-13, Yingxiang
L.I.-20, Juliao ST-3, Extra Bitong, Extra Yintang, Fenglong ST-40 and
Yinlingquan SP-9.
• A reducing method is applied to these points.
Explanations:
• L.I.-4, the yuan-source of the large intestine channel, LU-7, the
luo-connecting point of the lung channel, and BL-10 open the skin
pores, dispel external pathogenic factors, and relieve cough, mus-
cle pain, and headache.
• BL-13, the back-shu point of the lung, disperses the lung-qi,
restores the physiological functions of the lung, and relieves nasal
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disorders.
• L.I.-20, ST-3, extra Bitong and extra Yintang open the nasal orifice
and relieve blockage and itching in the nose.
• ST-40 and SP-9, the luo-connecting point of the stomach channel
and the he-sea point of the spleen channel respectively, eliminate
phlegm in the body and nose and relieve cough.
Principle of Treatment;
Tonify qi of the lung and spleen, resolve phlegm and open the nasal
orifice.
467
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Cang Er Zi San-Xanthium Powder.
Explanations:
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao activate the
spleen and tonify the qi in the body.
• Zhi Huang Qi and Wu Wei Zi tonify the qi of the lung and benefit
the lung.
• Shu Di Huang tonifies the kidney and benefits the lung.
• Zhi Ban Xia eliminates phlegm and relieves cough.
• Cang Er Zi, Xin Yi Hua and E Bu Shi Cao open the nasal orifice and
promote the physiological functions of the nose.
Herbal Remedy:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Cang Er Zi San Wan-Xanthium Powder Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Yingxiang L.I.-20, Juliao ST-3, Extra
Bitong, Extra Yintang, Chize LU-5, Lieque LU-7, Taiyuan LU-9,
Zusanli ST-36, Sanyinjiao SP-6, Taixi KID-3, Qihai REN-6, Feishu
BL-13, and Pishu BL-20.
468
TCM Treatment of Long COVID
Explanations:
• The combination of P-6 + SP-4 regulates the qi in the body and
improves the physiological functions of the lung and spleen.
• Since the lung opens into the nose and the physiological functions
of the nose rely greatly upon the lung, LU-7, LU-5 and LU-9, the
luo-connecting, the he-sea point and the yuan-source point of the
lung channels respectively, and BL-13, the back-shu point of
the lung, tonify lung-qi and restore the physiological functions of
the lung to promote the functions of the nose and relieve nasal
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disorders.
• ST-36, SP-6, REN-6, KID-3 and BL-20 tonify the qi of the spleen
and kidney and support the lung-qi to improve the general condi-
tions of the body.
• Moxibustion warms the qi and dispels the deficient cold in the
body.
Principle of Treatment:
Clear heat, resolve phlegm, disperse lung-qi, and open the nasal
orifice.
469
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Qing Jin Hua Tan Tang-Clear Metal and Transform Phlegm Decoction,
plus
Cang Er Zi San-Xanthium Powder.
Explanations:
• Huang Qin and Zhi Zi clear heat in the lungs and relieve coughing.
• Xing Ren, Zhe Bei Mu and Jie Geng clear and resolve heat-phlegm
and relieve the blockage in the nose.
• Zhi Ban Xia, Fu Ling, Chen Pi, and Zhi Gan Cao, the compositions
of Er Chen Tang, eliminate damp and resolve phlegm in the body.
• Bai Zhi, Cang Er Zi, Xin Yi Hua and E Bu Shi Cao open the nasal
orifice and promote the physiological functions of the nose.
Herbal Remedy:
Qing qi Hua Tan Tang Wan-Clear the qi and Transform Phlegm Pill,
plus
Cang Er Zi San Wan-Xanthium Powder Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7, Chize LU-5, Yuji
LU-10, Hegu L.I.-4, Quchi L.I.-11, Yingxiang L.I.-20, Juliao ST-3,
470
TCM Treatment of Long COVID
Explanations:
• P-6 + SP-4, one of the point combinations from eight confluence
points, regulates the internal organs and clears heat in the body.
• LU-7, LU-5, and LU-10, the luo-connecting point, the he-sea
point, and the ying-spring point of the lung channel respectively,
disperse the lung-qi, clear heat in the lung, and relieve cough.
• Since the large intestine is the paired Fu organ with the lung, L.I.-4
and L.I.-11, the yuan-source point and the he-sea point of the
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471
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
taste, and muscle pain, eye infection should also be one of the signs
to look for.
Red eyes caused by COVID-19, often known as conjunctivitis, is a
condition in which the clear layer covering the white part of each eye
and the inner lining of each eyelid become inflamed and reddish.
One research showed that of the 38 included patients with clini-
cally confirmed COVID-19, 25 (65.8%) were male, and the mean
(SD) age was 65.8 (16.6%) years. Among them, 28 patients (73.7%)
had positive findings for COVID-19 on RT-PCR from nasopharyngeal
swabs, and out of these, two patients (5.2%) yielded positive findings
for SARS-CoV-2 in their conjunctival as well as nasopharyngeal
specimens. A total of 12 out of 38 patients (31.6%; 95% CI, 17.5–
48.7) had ocular manifestations consistent with conjunctivitis.78
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78
Ping Wu, et al. Characteristics of ocular findings of patients with coronavirus dis-
ease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020, 138(5):
575–578. doi: 10.1001/jamaophthalmol.2020.1291.
79
Mashael Al-Namaeh. COVID-19 and conjunctivitis: A meta-analysis. Ther Adv
Ophthalmol. 2021, 13. https://doi.org/10.1177/25158414211003368.
80
Shahina Pardhan, et al. Sore eyes as the most significant ocular symptom experi-
enced by people with COVID-19: A comparison between pre-COVID-19 and during
COVID-19 states. BMJ Open Ophthalmology. 2020, 5: e000632. doi: 10.1136/
bmjophth-2020-000632.
472
TCM Treatment of Long COVID
red eyes
In TCM, it is held that the eyesight is not an isolated phenomenon but
is rooted in body totality. The eyes are simultaneously connected to
the internal organs and different vessels, and they are constantly
nourished by qi, blood, jing and body fluid. Among them, the liver is
one of the most important organs. This is because the liver opens into
the eye, thus the eye is an outside reflection of the liver. Also, the liver
is the main reservoir of blood, and the main components used to
form the tears that moisten the eyes. If there is an accumulation of
toxins or heat in the blood, deficiency of liver-yin with hyperactivity
of deficient fire, or accumulation of damp-heat in the liver, red eyes
can occur due to disturbance in the eyes.
473
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
474
TCM Treatment of Long COVID
Principle of Treatment:
Cool heat in the blood, remove toxins, subside swelling and relieve
red eyes.
Herbal Treatment:
Pu Ji Xiao Du Yin-Universal Benefit Decoction to Eliminate Toxins.
475
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Huang Qin and Huang Lian clear heat in the liver and heart,
remove toxins and subside swelling of the eyes to relieve red
eyes.
• Ban Lan Gen, Bo He and Lian Qiao clear heat and remove
toxins in the upper parts of the body and subside the swelling in
the eyes.
• Sheng Di Huang, Xuan Shen and Chi Shao Yao cool heat in the
blood and remove toxins in the body.
• Sang Ye, Qing Xiang Zi and Jue Ming Zi clear heat in the eyes and
benefit the eyes.
• Gan Cao removes toxins and subsides swelling of the eyes.
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Herbal Remedy:
Yin Qiao Jie Du Wan-Lonicera and Forsythia Pill to Eliminate
Toxins.
Acupuncture Treatment:
• Erjian L.I.-2, Hegu L.I.-4, Quchi L.I.-11, Yuji LU-10, Fengchi
GB-20, Sanyinjiao SP-6, Xuehai SP-10, Shaohai HE-3, Xingjian
LIV-2, Zanzhu BL-2, and Tongziliao GB-1.
• A reducing method is used on these points.
Explanations:
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, and GB-20 clear heat,
remove toxins and subside the swelling in the eyes.
• L.I.-2 and LU-10, the ying-spring points of the large intestine chan-
nel and lung channel respectively, strongly clear heat, eliminate
toxins at the upper parts of the body and reduce the swelling in the
eyes.
• SP-6 and SP-10, the crossing point of three yin channels of the feet
and the he-sea point of the spleen channel respectively, HE-3 and
LIV-2, the he-sea point of the heart channel and the ying-spring
point of the liver channel respectively, cool heat in the blood,
reduce swelling, relieve pain, and subside red eyes.
476
TCM Treatment of Long COVID
• BL-2 and GB-1, the local points, clear heat in the eyes and relieve
red eyes.
Principle of Treatment:
Smooth the liver, circulate qi, harmonize the emotions and relieve
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red eyes.
Herbal Treatment:
Dan Zhi Xiao Yao San-Augmented Rambling Powder.
Explanations:
• Chai Hu regulates and promotes liver-qi circulation and relieves qi
stagnation in the liver and eyes.
• Bai Shao Yao and Dang Gui relax the liver, nourish the blood, and
strengthen the blood circulation in the liver.
• Mu Dan Pi, Zhi Zi, Sang Ye and Xia Ku Cao clear heat produced
in the liver and relieve red eyes.
477
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Jue Ming Zi and Bo He cool and clear heat in the liver and benefit
the eyes.
• Zhi Gan Cao harmonizes the actions of the other herbs in the
formula.
Herbal Remedy:
Dan Zhi Xiao Yao Wan-Augmented Rambling Pill.
Acupuncture Treatment:
• Xingjian LIV-2, Taichong LIV-3, Qimen LIV-14, Fengchi GB-20,
Neiguan P-6, Tanzhong REN-17, Zanzhu BL-2, Tongziliao GB-1,
Yanglingquan GB-34, Qiuxu GB-40, Xiaxi GB-43, and Shaofu
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HE-8.
• A reducing method is used on these points.
Explanations:
• LIV-2 and GB-43, the ying-spring points of the liver channel and
gallbladder channel respectively, and GB-20 clear heat, reduce
liver-Fire, subside swelling in the eyes and relieve red eyes.
• LIV-3 and LIV-14, the yuan-source point, and the front-mu point of
the liver channel respectively, smooth the liver and promote the
circulation of the liver-qi.
• P-6, the luo-connecting point of the pericardium channel and the
confluence point of the Yinwei channel, and REN-17, the gather-
ing point of the qi in the body, promote the circulation of the
liver-qi and regulate the emotions. They also promote the circula-
tion of qi in the heart and spleen.
• GB-34 and GB-40, the he-sea point, and the yuan-source point of
the gallbladder channel respectively, harmonize the gallbladder
and promote the qi circulation in the liver.
• HE-8, the ying-spring point of the heart channel, reduces heat
in the body and heart, calms the shen and relieves restlessness.
• BL-2 and GB-1, the local points, clear heat in the eyes and relieve
red eyes.
478
TCM Treatment of Long COVID
Principle of Treatment:
Clear heat, eliminate damp, reduce fire, and relieve red eyes.
Herbal Treatment:
Long Dan Xie Gan Tang-Gentiana Longdancao Decoction to Drain
the Liver.
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Explanations:
• When damp-heat accumulates in the liver, the channels and col-
lateral of the liver and gallbladder are obstructed, red eyes occur.
• Long Dan Cao, a herb with a bitter and cold nature entering the
liver channel, clears the excessive heat and eliminates damp. It is
used as the chief herb in the formula.
• Both Huang Qin and Zhi Zi are bitter and cold in nature. They are
used to reduce the fire caused by the accumulation of damp-heat
in the liver.
479
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver.
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Acupuncture Treatment:
• Zhigou SJ-6, Yanglingquan GB-34, Xingjian LIV-2, Qimen LIV-14,
Ganshu BL-18, Quchi L.I.-11, Sanyinjiao SP-6, Yinlingquan SP-9,
Zanzhu BL-2 and Tongziliao GB-1.
• A reducing method is applied to these points.
Explanations:
• SJ-6 and GB-34 regulate the qi in Shaoyang channels, disperse and
reduce damp-heat in San Jiao and gallbladder.
• LIV-2, LIV-14 and BL-18, the ying-spring point, the front-mu point
of the liver channel, and the back-shu point of the liver respec-
tively, eliminate damp-heat and restore the physiological functions
of the liver.
• L.I.-11, the he-sea point of the large intestine channel, SP-6 and
SP-9, the crossing point of three yin channels of the feet, and the
he-sea point of the spleen channel respectively, clear heat and
eliminate damp in the body.
• BL-2 and GB-1, the local points, clear heat in the eyes and relieve
red eyes.
480
TCM Treatment of Long COVID
Principle of Treatment:
Nourish yin, promote the production of body fluids, benefit the eyes,
and relieve the red eyes.
Herbal Treatment:
Ming Mu Di Huang Wan-Improve Vision Pill with Rehmannia.
Explanations:
• Shu Di Huang, Shan Zhu Yu and Shan Yao tonify the liver and
kidney and benefit kidney-jing.
• Dang Gui and Wu Wei Zi smooth the liver and tonify liver-yin.
• Chai Hu and Bai Shao Yao regulate liver-qi circulation and pro-
mote the physiological functions of the liver.
• Mu Dan Pi and Zhi Mu clear deficient heat in the body.
• Fu Shen calms shen and improves sleep.
• Gou Qi Zi, Ju Hua, Chong Wei Zi and Jue Ming Zi benefit the eyes
and relieve red eyes.
481
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Qi Ju Di Huang Wan-Lyceum Fruit, Chrysanthemum and Rehmannia
Pill.
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Sanyinjiao SP-6, Taixi KID-3, Yingu
KID-10, Ququan LIV-8, Qihai REN-6, Ganshu BL-18, Shenshu
BL-23, Zanzhu BL-2, and Tongziliao GB-1.
• An even method is applied on LU-7 + KID-6, and a tonifying
method is applied to the rest of the points.
Explanations:
• The combination of LU-7 + KID-6 nourishes the yin of the body
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482
TCM Treatment of Long COVID
81
Ximena M. Bustamante-Marin and Lawrence E. Ostrowski. Cilia and mucociliary
clearance. Cold Spring Harb Perspect Biol. 2017, 9(4): a028241. doi: 10.1101/
cshperspect. a028241.
82
Faryal I. Farooqi, et al. Airway hygiene in COVID-19 pneumonia: treatment
responses of 3 critically Ill cruise ship employees. Am J Case Rep. 2020, 21:
e926596. doi:10.12659/AJCR.926596.
83
Mohsin Ali Khan, et al. Cytokine storm and mucus hypersecretion in COVID-19:
Review of mechanisms. J Inflamm Res. 2021, 14: 175–189 https://doi.org/10.2147/
JIR.S271292.
483
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
84
Jan Hagemann, et al. op. cit.
85
Sufang Tian, et al. Pulmonary pathology of early phase 2019 novel coronavirus
(COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol. 2020, 15:
700–704. doi: 10.1016/j.jtho.2020.02.010.
86
Adam Bernheim, et al. Chest CT findings in coronavirus disease-19 (COVID-19):
relationship to duration of infection. Radiology. 2020, 295(3). https://doi.org/
10.1148/radiol.2020200463.
87
Hind Khairi Khashkhosha et al. A hypothesis on the role of the human immune
system in COVID-19. Med Hypotheses. 2020, 143: 110066. doi: 10.1016/j.
mehy.2020.110066.
88
Alexander P Earhart, et al. Consideration of dornase alfa for the treatment of severe
COVID-19 acute respiratory distress syndrome. New Microbes New Infect. 2020,
35: 100689. doi: 10.1016/j.nmni.2020.100689.
484
TCM Treatment of Long COVID
and tiredness, etc. Furthermore, the build-up of mucus can also con-
tribute to other complications found in Long COVID such as venous
engorgement, elevation in saliva secretions, mucus in stool, and
pulmonary oedema. Once there is a fever and profuse sputum (spu-
tum color turns into yellow and becomes sticky, or there is a mixture
of blood streaks in the sputum), some further examinations should be
carried out to identify the underlying infection or other causes.
485
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Since the lung is the upper source of water in the body and in charge
of the nose and throat, impaired function of the lung in dispersing the
lung-qi by damp could bring about the disturbance to the qi dispers-
ing and water regulation, and cough with expectoration of sputum
occurs. When COVID-19 in the acute phase is under control, there
is a great possibility that the external pathogenic factors are incom-
pletely eliminated, and they could still accumulate somewhere in the
lung or its opening orifices—the nose and throat. Therefore, sputum
production appears occasionally or permanently.
Remaining external damp in the spleen and stomach will cause
further disturbance to the physiological functions of these organs, lead-
ing to aggravation and continuation of sputum production, increased
saliva production, lack of taste, poor appetite, nausea, and loose stools.
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486
TCM Treatment of Long COVID
Principle of Treatment:
Eliminate damp, resolve phlegm, and relieve the external pathogens.
Herbal Treatment:
Xing Su San-Apricot Kernel and Perilla Leaf Powder, plus
Cang Er San-Xanthium Powder.
487
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Xing Ren, Zi Su Zi, Qian Hu, Jie Geng and Bai Jie Zi eliminate
phlegm and relieve cough.
• Cang Er Zi and Xin Yi Hua open the nasal orifice and eliminate
phlegm in the throat.
• Zhi Ban Xia, Fu Ling, Chen Pi and Zhi Gan Cao, which are the
complete composition of Er Chen Tang, are applied to eliminate
damp and resolve phlegm to assist the above herbs to eliminate
phlegm and relieve cough.
• Zhi Ke promotes qi circulation caused by the accumulation of
damp-phlegm.
• Qiang Huo dispels the remaining pathogens and relieves some
external symptoms, such as itching in the throat, sometimes nasal
discharge, slight aversion to cold and muscle pain, and headache.
Herbal Remedy:
Zhi Sou San Granulates-Stop Coughing Powder.
Acupuncture Treatment:
• Hegu L.I.-4, Yingxiang L.I.-20, Juliao ST-3, Fenglong ST-40, Yinlingquan
SP-9, Lieque LU-7, Chize LU-5, Feishu BL-13, and REN-22.
• A reducing method is applied on the rest of the points.
488
TCM Treatment of Long COVID
Explanations:
• L.I.-4, the yuan-source of the large intestine channel, and LU-7,
the luo-connecting point of the lung channel, open the skin pores,
promote sweating, and relieve some external symptoms.
• ST-40 and SP-9, the luo-connecting point of the stomach channel
and the he-sea point of the spleen channel respectively, eliminate
damp and resolve phlegm in the body.
• LU-5 and BL-13, the he-sea point of the lung channel and back-
shu point of the lung respectively, disperse the lung-qi, restore the
physiological functions of the lung and relieve cough and sputum
expectoration.
• L.I.-20 and ST-3, the local points from the face, are used to open
the nasal orifice, eliminate phlegm, and relieve the blockage in the
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nose.
• REN-22 is applied to resolve phlegm in the throat and improve
breathing.
Principle of Treatment:
Resolve phlegm, activate the spleen, disperse the lung-qi and relieve
cough.
Herbal Treatment:
Er Chen Tang-Decoction of Two Old (Cured) Drugs, plus
Shen Ling Bai Zhu San-Ginseng, Sclerotium Poriae Cocos and
Atractylodis Macrocephalae Powder.
489
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Zhi Ban Xia, Fu Ling, Chen Pi, and Zhi Gan Cao, the complete
compositions of Er Chen Tang, eliminate damp and resolve
phlegm.
• Dang Shen, Bai Zhu, Shan Yao, and Bai Bian Dou activate the
spleen and stomach and eliminate damp in the body.
• Hou Po, Cang Zhu and Zhi Ke eliminate phlegm, promote qi cir-
culation, and relieve the fullness in the chest and abdomen.
• Cang Er Zi and Bai Jie Zi eliminate phlegm in the lung system and
relieve cough.
Herbal Remedy:
Er Chen Wan-Pill of Two Old (Cured) Drugs, plus
Shen Ling Bai Zhu Wan-Ginseng, Poria and Atractylodis
Macrocephalae Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Zhongwan REN-12, Fenglong
ST-40, Sanyinjiao SP-6, Yinlingquan SP-9, Hegu L.I.-4, Lieque
LU-7, Chize LU-5, Feishu BL-13, Yingxiang L.I.-20, Juliao ST-3 and
Tiantu REN-22.
490
TCM Treatment of Long COVID
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation in the
chest and abdomen and relieves the fullness in the chest.
• REN-12, the gathering point of the fu organs in the body, ST-40,
SP-6, and SP-9 activate the spleen and stomach, eliminate damp,
and resolve phlegm in the body.
• LU-7 and LU-5, the luo-connecting point and the he-sea point of
the lung channel respectively, and BL-13, the back-shu point of the
lung, eliminate phlegm in the lung system, disperse and descend
the lung-qi, restore the physiological functions of the lung, and
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relieve cough.
• L.I.-4, the yuan-source point of the large intestine channel, pro-
motes the qi circulation and relieves the qi stagnation in the body
caused by the accumulation of damp-phlegm.
• L.I.-20, ST-3, and REN-22 eliminate phlegm in the nasal orifice
and throat.
Principle of Treatment:
Eliminate damp, promote blood circulation, subside the swelling,
and harmonize the collaterals.
Herbal Treatment:
Shu Jing Huo Xue Tang-Relax the Channels and Invigorate the Blood
Decoction.
491
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Dang Gui, Chuan Xiong, Chi Shao Yao and Shu Di Huang tonify
blood and promote blood circulation.
• Cang Zhu and Qiang Huo eliminate damp due to external inva-
sion and internal disorder.
• Tao Ren, Hong Hua, Pu Huang and Chuan Niu Xi promote blood
circulation and eliminate blood stasis in the vessels.
• Wei Ling Xian, Ji Xue Teng and Di Long promote blood circulation
and harmonize the vessels in the body.
Herbal Remedy:
Shu Jing Huo Xue Wan-Relax the Channels and Invigorate the Blood
Pill.
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Neiguan P-6 + Gongsun SP-4,
Zhongwan REN-12, Fenglong ST-40, Sanyinjiao SP-6, Yinlingquan
SP-9, Xuehai SP-10, Hegu L.I.-4, Taiyuan LU-9 and Shenmen
HE-7.
• An even method is applied on LU-7 + KID-6, P-6 + SP-4, and a
reducing method is applied on the rest of the points.
492
TCM Treatment of Long COVID
Explanations:
• The combination of LU-7 + KID-6, and P-6 + SP-4 harmonize the
qi circulation in the chest and abdomen, regulate the physiological
functions of zang-fu organs, eliminate damp, and harmonize the
collaterals.
• REN-12, the gathering point of the fu organs in the body, ST-40,
SP-6, and SP-9 activate the spleen and stomach, eliminate damp,
and resolve phlegm in the body.
• LU-7 and L.I.-4, the yuan-source point of the large intestine chan-
nel, LU-9, the yuan-source point of the lung channel and the
gathering point of the vessels in the body, HE-7, the yuan-source
point of the heart channel, and SP-10, promote qi and blood cir-
culation and eliminate blood stasis in the vessels.
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Principle of Treatment:
Tonify qi, strengthen yang and resolve phlegm.
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Li Zhong Wan-Pill to Regulate the Middle.
493
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao activate the
spleen and tonify the qi in the body.
• Zhi Huang Qi, Wu Wei Zi, and Zi Wan tonify the qi of the lung
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Herbal Remedy:
Bu Fei Tang Wan-Tonify the Lungs Decoction Pill, plus
Li Zhong Wan-Pill to Regulate the Middle.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Taiyuan LU-9, Zusanli ST-36,
Fenglong ST-40, Sanyinjiao SP-6, Yinlingquan SP-9, Taixi KID-3,
Qihai REN-6, Feishu BL-13, and Shenshu BL-23.
• Even method is applied on P-6 + SP-4, and a tonifying method
is applied on LU-9, ST-36, SP-6, KID-3, REN-6, BL-13 and BL-23.
A reducing method is applied on ST-40 and SP-9. Moxibustion
could be applied on BL-13, BL-23, ST-36, KID-3 and REN-6.
Explanations:
• The combination of P-6 + SP-4 regulates and harmonizes the qi in
the body.
494
TCM Treatment of Long COVID
• LU-9, the yuan-source point of the lung channel, and BL-13, the
back-shu point of the lung, tonify lung-qi and restore the physio-
logical functions of the lung.
• ST-36, SP-6, REN-6, KID-3 and BL-23 tonify the qi of the spleen
and kidney and eliminate damp in the body.
• ST-40, the luo-connecting point, and SP-9, the he-sea point of the
spleen channel, activate the spleen and eliminate damp-phlegm in
the body.
• Moxibustion warms the qi and dispels the deficient cold in the
body.
89
COVID-19 patients experience loss of appetite, diarrhea and other digestive symp-
toms. The Economic Times. 19 March 2020. https://economictimes.indiatimes.com/
magazines/panache/covid-19-patients-experience-loss-of-appetite-diarrhea-and-
other-digestive-symptoms/articleshow/74709329.cms?from=mdr.
495
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
90
Lei Pan, et al. Clinical characteristics of COVID-19 patients with digestive
symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J
Gastroenterol. 2020, 115(5): 766–773. doi: 10.14309/ajg.0000000000000620.
496
TCM Treatment of Long COVID
91
Jingrong Weng, et al. Gastrointestinal sequelae 90 days after discharge for
COVID-19. The Lancet Gastroenterology & Hepatology. 2021, 6(5): 344–346. doi:
10.1016/S2468-1253(21)00076-5.
92
Ximena M. Bustamante-Marin and Lawrence E. Ostrowski. op. cit.
497
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
498
TCM Treatment of Long COVID
499
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Eliminate damp, resolve phlegm, activate the spleen, and improve
appetite.
Herbal Treatment:
Ping Wei San-Calm the Stomach Powder, plus
Xiang Sha Liu Jun Zi Tang-Six Gentlemen Decoction with Aucklandia
and Amomum.
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Explanations:
• Hou Po, Cang Zhu, Chen Pi, and Zhi Gan Cao, the complete com-
position of Ping Wei San, eliminate damp, resolve phlegm, activate
the spleen, and improve appetite.
500
TCM Treatment of Long COVID
• Dang Shen, Bai Zhu, Fu Ling, Zhi Gan Cao, Zhi Ban Xia, Chen Pi,
Xiang Fu and Sha Ren, the complete composition of Xiang Sha
Liu Jun Zi Tang, activate the spleen and stomach, eliminate
damp, resolve phlegm, promote qi circulation, and improve the
appetite.
• Shen Qu and Jiao Gu Ya are used to promote digestion and
improve appetite.
• Gui Zhi and Gan Jiang warm the spleen and stomach and elimi-
nate cold in the body.
• Huang Lian and Zhi Zi clear heat and eliminate damp in the mid-
dle Jiao.
Herbal Remedy:
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Xiang Sha Liu Jun Wan-Six Gentlemen Pill with Aucklandia and
Amomum.
Acupuncture Treatment:
• Zhongwan REN-12, Liangmen ST-21, Tianshu ST-25, Zusanli
ST-36, Fenglong ST-40, Sanyinjiao SP-6, Yinlingquan SP-9, Hegu
L.I.-4, Neiguan P-6 and Taichong LIV-3.
• A tonifying method is applied on ST-36 and SP-6, and a reducing
method is applied on the rest of these points.
• In case of cold-damp, add moxa on REN-12, ST-36, and SP-9.
• In case of damp-heat, add Yanglingquan GB-34 and Dadu SP-2.
Explanations:
• REN-12, the front mu point of the stomach and the gathering point
of the fu organs in the body, ST-40, the luo-connecting point of the
stomach channel, and SP-9, and the he-sea point of the spleen
channel respectively, eliminate damp and resolve phlegm in the
body.
• P-6, the luo-connecting point of the pericardium channel,
harmonizes the stomach, descends stomach-qi, and improves
appetite.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, promote the qi circulation
501
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
in the middle Jiao and relieve the fullness and swelling in the epi-
gastric region and abdomen.
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of the three yin channels of the feet, tonify and acti-
vate the spleen and stomach and improve the appetite.
• Moxa on REN-12, ST-36 and SP-9 could warm the internal organs
and eliminate cold.
• GB-34, the he-sea point of the gallbladder channel, and SP-2, the
ying-spring point of the spleen channel clear heat and eliminate
damp.
Principle of Treatment:
Smooth the liver, promote qi circulation, active digestion, and
improve appetite.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
502
TCM Treatment of Long COVID
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver and relieve qi stagna-
tion in the liver.
• Zhi Ke, Xiang Fu, Chen Pi and Sha Ren promote the qi circulation
in the middle Jiao and improve the appetite.
• Dang Gui nourishes the liver-blood and benefits the liver.
• Bai Zhu activates the spleen and stomach and improves appetite.
• Shen Qu and Jiao Gu Ya promote digestion and improve appetite.
• Fu Shen and Yuan Zhi smooth emotions, regulate the shen, and
improve sleep.
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Herbal Remedy:
Xiao Yao Wan-Rembling Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Tanzhong REN-17,
Fengchi GB-20, Sanyinjiao SP-6, Taichong LIV-3, Zhangmen LIV-
13, Xinshu BL-15, and Ganshu BL-18.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation in the
body, regulates the Yinwei channel and Chong channel, and
improves appetite.
• L.I.-4, the yuan-source point of the large intestine channel, REN-
17, the gathering point of the qi in the body, LIV-3, the yuan-source
point of the liver channel, BL-18, the back-shu point of the liver,
and GB-20 promote the qi circulation in the body, smooth the
liver, improve emotions, and relieves pain and headache.
• SP-6, the crossing point of the three yin channels of the feet, and
LIV-13, the front-mu point of the spleen, activate the spleen and
improve appetite.
503
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• BL-15, the back-shu point of the heart, calms the shen, and
improves emotions.
Principle of Treatment:
Tonify qi, warm yang, activate the spleen and improve appetite.
Herbal Treatment:
Li Zhong Wan-Pill to Regulate the Middle, plus
Shen Ling Bai Zhu San-Ginseng, Sclerotium Poriae Cocos and
Atractylodis Macrocephalae Powder.
504
TCM Treatment of Long COVID
Explanations:
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao activate the
spleen, tonify the spleen-qi and the general body, and improve
appetite.
• Gui Zhi and Gan Jiang warm the spleen and eliminate cold in the
middle Jiao.
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• Zhi Huang Qi and Shan Yao activate the spleen, tonify spleen-qi,
and improve appetite.
• Shen Qu and Ji Nei Jin are used to promote digestion and improve
appetite.
• Rou Gui and Zhi Fu Zi warm the heart-yang and strengthen heart-
fire.
• Ba Ji Tian and Xian Mao warm the kidney, eliminate interior cold
and strengthen the back.
Herbal Remedy:
Li Zhong Wan-Pill to Regulate the Middle, plus
Shen Ling Bai Zhu Wan-Ginseng, Sclerotium Poriae Cocos and
Atractylodis Macrocephalae Pill.
Acupuncture Treatment:
• Guanyuan REN-4, Qihai REN-6, Zhongwan REN-12, Zhangmen
LIV-13, Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6, Shenmen
HE-7, Taixi KID-3, Xinshu BL-15, Pishu BL-20, and Shenshu
BL-23.
• A tonifying method is applied to these points.
• Moxibustion could be applied on REN-4, REN-6, and ST-36.
505
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• REN-4 and REN-6 tonify the yuan-qi in the body, warm yang,
eliminate interior cold and strengthen the body.
• ST-36, the he-sea point of the stomach channel, SP-3 and SP-6, the
yuan-source point and the crossing point of three yin channels of
the feet, LIV-13, the front-mu point of the spleen, BL-20, the back-
shu point of the spleen, and REN-12, the front-mu point of the
stomach, tonify and activate the spleen and stomach, and improve
appetite.
• HE-7 and BL-15, the yuan-source point and the back-shu point of
the heart channel and of the heart respectively, tonify qi and yang
of the heart and strengthen the heart.
• BL-23, the back-shu point of the kidney, warms the kidney, tonifies
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506
TCM Treatment of Long COVID
occurrence within six months and in the three to six months after
COVID-19 diagnosis were calculated for nine core features of Long
COVID symptoms that are frequently reported (breathing difficulties/
breathlessness, fatigue/malaise, chest/throat pain, headache,
abdominal symptoms, myalgia, other pain, cognitive symptoms,
and anxiety/depression). The percentage of throat pain was
5.71%.94
Although the quality of life was markedly affected by fatigue,
shortness of breath, and insomnia in Long COVID, sore throat is also
a persistent complaint affecting daily life.
93
Saee Savtale, et al. Prevalence of otorhinolaryngological symptoms in COVID 19
patients. Indian J Otolaryngol Head Neck Surg. 2021, 1–7. doi: 10.1007/s12070-
021-02410-5.
94
Maxime Taquet, et al. September 2021. op. cit.
507
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
508
TCM Treatment of Long COVID
sickness. When the lung is disturbed in dispersing the qi, and the
throat is blocked by damp-phlegm, a sore throat appears.
509
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
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Clear heat, remove toxins, subside swelling and relieve sore throat.
Herbal Treatment:
Pu Ji Xiao Du Yin-Universal Benefit Decoction to Eliminate Toxins.
Explanations:
• Huang Qin, Huang Lian, Ma Bo, and Ban Lan Gen clear heat and
remove the toxins.
• Lian Qiao and Niu Bang Zi dispel remaining external heat and
toxins, subside swelling, eliminate phlegm in the throat, and
relieve sore throat.
510
TCM Treatment of Long COVID
• Xuan Shen, Jie Geng, Bo He and Gan Cao cool heat, subside
swelling, eliminate toxins and relieve sore throat.
Herbal Remedy:
Yin Qiao San Pian-Honeysuckle and Forsythia Powder Tablet,
or Yin Qiao Jie Du Wan-Honeysuckle and Forsythia Pill to Relieve
Toxicity.
Acupuncture Treatment:
• Erjian L.I.-2, Hegu L.I.-4, Quchi L.I.-11, Chize LU-5, Yuji LU-10,
Fengchi GB-20, Tiantu REN-22, Lianquan REN-23, and Renying
ST-9.
• A reducing method is used on these points.
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Explanations:
• L.I.-4 and L.I.-11, the yuan-source point, and the he-sea point of
the large intestine channel respectively, and GB-20 clear heat,
remove toxins and subside swelling in the throat and relieve sore
throat.
• L.I.-2 and LU-10, the ying-spring points of the large intestine and
lung channel respectively, strongly clear heat, eliminate toxins and
reduce the swelling in the throat and sore throat.
• LU-5, the he-sea point of the lung channel, clears heat in the lung
and causes the lung-qi to disperse and descend. It is also the water
point, which serves to distinguish fire and eliminate toxins to
relieve sore throat.
• REN-22, REN-23 and ST-9 reduce swelling, relieve pain, and
eliminate the blockage in the throat to diminish sore throat.
511
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Eliminate damp-phlegm, activate the spleen, relieve the blockage in
the throat, and relieve sore throat.
Herbal Treatment:
Cang Fu Dao Tan Tang-Atractylodes-Poria Phlegm-Dissipating Decoction.
Explanations:
• Zhi Ban Xia, Fu Ling, Chen Pi, and Zhi Gan Cao, the complete
compositions of Er Chen Tang, eliminate damp, resolve phlegm,
and relieve general symptoms of damp-phlegm accumulation.
• Cang Zhu, Hou Po, Zhi Shi, and Xiang Fu dry damp, resolve
phlegm and relieve the qi stagnation caused by the accumulation
of damp-phlegm.
• Xing Ren, Tian Nan Xing, Zi Su Zi, Jie Geng and Niu Bang Zi
resolve phlegm in the throat and lung, regulate the lung-qi and
relieve sore throat.
512
TCM Treatment of Long COVID
Herbal Remedy:
Cang Fu Dao Tan Wan-Atractylodes-Poria Phlegm-Dissipating Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Lieque LU-7, Chize
LU-5, Feishu BL-13, Zhongwan REN-12, Tiantu REN-22, Lianquan
REN-23, Renying ST-9, Fenglong ST-40, Sanyinjiao SP-6 and
Yinlingquan SP-9.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
Explanations:
• The combination of P-6 + SP-4 promotes the qi circulation in the
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513
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Smooth the liver, circulate qi, harmonize the emotions and relieve
sore throat.
Herbal Treatment:
Xiao Yao San-Rambling Powder, plus
Ban Xia Hou Po Tang-Pinellia and Magnolia Bark Decoction.
Explanations:
• Chai Hu regulates and promotes liver-qi circulation and relieves qi
stagnation in the liver and throat.
• Bai Shao and Dang Gui relax the liver, nourish the blood, and
strengthen the blood circulation in the liver.
• Bai Zhu, Fu Ling and Sheng Jiang activate the spleen and stomach
and eliminate damp-phlegm in the body.
• Yan Hu Suo regulates blood circulation and relieves pain.
• Hou Po and Zi Su Zi promote qi circulation, and eliminate damp-
phlegm in the throat and sore throat.
• Bo He cools and clears heat in the liver.
• Zhi Gan Cao harmonizes the actions of the other herbs in the
formula.
Herbal Remedy:
Xiao Yao Wan-Rambling Pill, or Shu Gan Wan-Liver-Coursing Pill.
514
TCM Treatment of Long COVID
Acupuncture Treatment:
• Taichong LIV-3, Fengchi GB-20, Neiguan P-6, Zhongwan REN-12,
Tanzhong REN-17, Tiantu REN-22, Lianquan REN-23, Renying
ST-9.
• A reducing method is used on these points.
Explanations:
• In all kinds of qi stagnation, stagnation of the liver-qi is generally
the root cause. So, treatment for the stagnation of qi will be
focused on alleviating the stagnation of liver-qi.
• LIV-3, the yuan-source point of the liver channel, fulfills the above
function.
• P-6, the luo-connecting point of the pericardium channel and the
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Principle of Treatment:
Clear heat, promote defecation, reduce the swelling, and relieve sore
throat.
515
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Liang Ge San-Cool the Diaphragm Powder.
Explanations:
• Yin Hua, Lian Qiao, Zhi Zi and Huang Qin clear lung-heat, elimi-
nate toxins, reduce swelling, and relieve sore throat.
• Bo He benefits the throat and relieves sore throat.
• Dan Zhu Ye and Lu Gen clear heat and promote the production of
body fluids so as to benefit the throat and relieve thirst.
• Xuan Shen and Niu Bang Zi clear heat in the body and throat and
relieve sore throat.
• Da Huang and Mang Xiao clear stomach-fire and promote
defecation.
• Gan Cao clears fire and removes toxins.
Herbal Remedy:
Qing Fei Yi Huo Pian-Clear the Lungs, Suppress Fire Tablets.
Acupuncture Treatment:
• Hegu L.I.-4, Quchi L.I.-11, Chize LU-5, Yuji LU-10, Chongyang
ST-42, Neiting ST-44, Tiantu REN-22, Lianquan REN-23, and
Renying ST-9.
516
TCM Treatment of Long COVID
Explanations:
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel, ST-42 and ST-44, the yuan-source
point and the ying-spring point of the stomach channel respec-
tively, clear heat, descend stomach-qi, subside swelling in the
throat and relieve sore throat.
• LU-5, the water point and he-sea point, and LU-10, the ying-spring
point of the lung channel respectively, clear heat, subside swelling
in the throat and relieve sore throat. They can also cause the
lung-qi to descend, which is the root treatment for reducing fire in
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the throat.
• REN-22, REN-23, and ST-9 clear heat in the throat, reduce swell-
ing and relieve sore throat.
Principle of Treatment:
Nourish yin, moisten the lung, and relieve sore throat.
Herbal Treatment:
Sha Shen Mai Men Dong Tang-Glehnia and Ophiopogonis
Decoction.
517
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Bei Sha Shen, Mai Men Dong, and Wu Wei Zi nourish the yin of
the lung and relieve dryness in the throat and dry cough.
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• Chuan Bei Mu, Zi Wan, and Di Gu Pi nourish yin, clear the heat
in the lung, eliminate phlegm in the lung and benefit the lung to
relieve sore throat.
• Sheng Di Huang, Zhi Mu, and Huang Qin are used to clear the
remaining deficient heat in the lung and relieve sore throat.
• Tian Hua Fen nourishes yin, promotes the secretion of body fluid,
and relieves thirst and dryness of the throat.
• Yu Hu Die and Pang Da Hai benefit the throat, subside the swell-
ing and relieve sore throat.
Herbal Remedy:
Sheng Mai San (Wan)-Generate the Pulse Powder (Pill).
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6. Chize LU-5, Taiyuan LU-9, Tiantu
REN-22, Lianquan REN-23, Renying ST-9, Sanyinjiao SP-6, Taixi
KID-3, Qihai REN-6 and Shenshu BL-23.
• An even method is applied on LU-7 + KID-6, REN-22, REN-23, and
ST-9, and a tonifying method is applied to the rest of the points.
Explanations:
• The combination of LU-7 + KID-6 nourishes the yin of the body
and clears deficient heat.
518
TCM Treatment of Long COVID
• LU-5 and LU-9, the he-sea point and the yuan-source point of the
lung channel respectively, nourish the yin of the lung and restore
the physiological functions of the lung.
• SP-6, KID-3, KID-6, BL-23, and REN-6 nourish the yin of the body,
benefit the yin of the lung and moisten the throat.
• REN-22, REN-23, and ST-9 benefit the throat, clear the deficient
heat in the throat and relieve sore throat.
11.15 Dizziness
Dizziness is often used interchangeably with vertigo, however,
strictly speaking, they are slightly different. Dizziness is a feeling of
being off-balance, unsteady, lightheaded, or disoriented. Some even
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519
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
95
Avindra Nath, et al. Neurological issues during COVID-19: An overview. Neurosci
Lett. 2021, 742: 135533. doi: 10.1016/j.neulet.2020.135533.
96
Mark W. Tenforde, et al. op. cit.
97
Pasquale Viola, et al. Tinnitus and equilibrium disorders in COVID-19 patients:
preliminary results. Eur Arch Otorhinolaryngol. 2020: 1–6. doi: 10.1007/s00405-
020-06440-7.
98
Jeyasakthy Saniasiaya, et al. Dizziness and COVID-19. Ear Nose Throat J. 2020,
100(1): 29–30. doi: 10.1177/0145561320959573.
520
TCM Treatment of Long COVID
99
Ibrahim Almufarrij and Kevin Munro. One year on: An updated systematic review of
SARS-CoV-2, COVID-19 and audio-vestibular symptoms. International Journal of
Audiology. 2021, 60(12): 935–945. https://doi.org/10.1080/14992027.2021.1896793.
100
National Dizzy and Balance Center. Post-COVID vestibular and neurological
symptoms. 17 May 2021. https://www.nationaldizzyandbalancecenter.com/post-
covid-vestibular-and-neurological-symptoms/.
101
Zawn Villines. Is dizziness a symptom of anxiety? Medical News Today.
24 July 2020. https://www.medicalnewstoday.com/articles/anxiety-and-dizziness.
521
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
522
TCM Treatment of Long COVID
Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and relieve
dizziness.
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Herbal Treatment:
Xiao Yao San-Rambling Powder.
Explanations:
• Chai Hu regulates and promotes liver-qi circulation and relieves qi
stagnation in the liver.
• Bai Shao Yao and Dang Gui are used to nourish blood in the liver,
harmonize and smooth the liver and relieve tension and spasm in
the scalp, headaches, and hypochondriac pain.
• Chuan Xiong regulates liver-qi and relieves headaches.
523
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Bai Zhu and Fu Ling strengthen the spleen and stomach and
improve the appetite.
• Huang Qin and Bo He clear internal heat resulting from the stag-
nation of liver-qi and prevent further formation of liver-fire.
• Bai Ji Li and Ju Hua smooth the liver and relieve dizziness.
• Zhi Gan Cao harmonizes the actions of the other herbs.
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Tongziliao GB-1,
Tinghui GB-2, Shuaigu GB-8, Extra Yintang, Extra Taiyang, Fengchi
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Explanations:
• SJ-5 + GB-41 is a combination to harmonize Shaoyang channels,
benefit the gallbladder and relieve dizziness.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, and LIV-14, the front-mu
point of the liver, smooth the liver, regulate the qi circulation in the
body and relieve liver-qi stagnation.
• P-6, the luo-connecting point of the pericardium channel, regu-
lates qi circulation, calms the shen and benefits the stomach.
• Extra Sishencong calms the shen, improves sleep and regulates
emotion.
• SP-6, the crossing point of the three yin channels of the foot, pro-
motes the smooth qi and blood circulation in the liver and in the
head.
• GB-1, GB-2, GB-8, GB-20 and GB-21 regulate the collateral of the
gallbladder channel, smooth the emotions, benefit the head,
relieve the neck tension, and promote qi circulation in the head to
relieve dizziness.
524
TCM Treatment of Long COVID
• Extra Yintang and Extra Taiyang, the local points, relieve dizziness.
Principle of Treatment:
Reduce liver-fire, clear heat, calm the shen and relieve dizziness.
Herbal Treatment:
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Explanations:
• Long Dan Cao, Huang Qin, Xia Ku Cao and Zhi Zi clear heat in
the liver, reduce liver-fire and relieve dizziness.
525
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver.
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Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Zhongfeng LIV-4, Shaohai HE-3,
Shaofu HE-8, Tinghui GB-2, Shuaigu GB-8, Fengchi GB-20,
Jianjing GB-21, Xiaxi GB-43, Baihui DU-20, Xingjian LIV-2,
Qimen LIV-14, Sanyinjiao SP-6 and Extra Taiyang.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest of the points.
Explanations:
• A combination of SJ-5 + GB-41 harmonizes the Shaoyang chan-
nels, benefits the gallbladder, and relieves dizziness.
• L.I.-4 and LIV-14, the yuan-source point of the large intestine chan-
nel and the front-mu point of the liver, smooth the liver, regulate
the qi circulation in the body and relieve liver-qi stagnation.
• LIV-2 and GB-43, the ying-spring point of the liver channel and
gallbladder channel respectively, and DU-20, clear heat, reduce
liver-fire and relieve dizziness.
• HE-3 and HE-8, the he-sea point and the ying-spring point of the
heart channel respectively, clear heat in the heart, calm the shen
and smooth the liver as well.
• GB-2, GB-8, GB-20 and GB-21 regulate the collateral of the
gallbladder channel, smooth the emotions, relieve the neck ten-
sion, and promote qi circulation in the head to relieve dizziness.
526
TCM Treatment of Long COVID
• SP-6, the crossing point of the three yin channels of the foot, pro-
motes the smooth qi and blood circulation in the liver and in the
head.
• Extra Taiyang, the local point, relieves dizziness.
Principle of Treatment:
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Herbal Treatment:
Ban Xia Bai Zhu Tian Ma Tang-Pinellia, Atractylodes Macrocephala
and Gastrodia Decoction.
Explanations:
• Ban Xia and Chen Pi dry damp, resolve phlegm in the body and
relieve nausea.
• Fu Ling and Bai Zhu activate the spleen and eliminate damp.
527
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Tian Ma, Bai Ji Li, Shi Chang Pu and Yuan Zhi calm the liver,
eliminate damp, and relieve dizziness.
• Cang Zhu and Hou Po eliminate damp-phlegm in the body and
relieve nausea.
• Zhi Gan Cao harmonizes the functions of other herbs.
Herbal Remedy:
Ban Xia Bai Zhu Tian Ma Pian-Pinellia, Atractylodes Macrocephala
and Gastrodia Tablet.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Tinghui GB-2, Shuaigu
GB-8, Fengchi GB-20, Jianjing GB-21, Touwei ST8, Extra Taiyang,
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Explanations:
• SJ-5 + GB-41 could regulate the Shaoyang channels and relieve
dizziness.
• GB-20 and GB-21 smooth the tension at the neck, promote the qi
circulation in the gallbladder channel and relieve dizziness.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and Liver channel respectively, promote qi circulation, calm
the liver, and relieve dizziness.
• GB-2, GB-8, ST-8, Extra Taiyang and Extra Yintang promote qi cir-
culation, eliminate damp-phlegm in the head and relieve dizziness.
• REN-12, the front-mu point of the stomach and the influential
point for the fu organs, promotes their physiological functions and
eliminates damp-phlegm.
• SP-6, the crossing point of three yin channels of the foot, and SP-9,
the he-sea point of the spleen channel, P-6 and ST-40, the luo-
connecting point of the pericardium channel and stomach channel
respectively, activate the spleen, eliminate damp-phlegm and
improve digestion.
528
TCM Treatment of Long COVID
11.15.2.4 Deficiency of qi
Dizziness after COVID-19, empty sensation in the head, aggravation
of dizziness after physical exertion, fatigue, general weakness, pale
complexion, aversion to cold, cold hands, shortness of breath, spon-
taneous sweating, loose stools, poor appetite, low voice, thin and
white coating on the tongue, pale tongue with tooth marks, and a
slow and deep pulse.
Principle of Treatment:
Tonify qi, activate the spleen and stomach and relieve dizziness.
Herbal Treatment:
Bu Zhong Yi Qi Tang-Tonify the Middle and Augment the Qi Decoction.
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Explanations:
• Dang Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, known as Si Jun
Zi Tang-Four Gentlemen Decoction, activate the spleen and stom-
ach, tonify spleen-qi and relieve general fatigue and weakness.
• Huang Qi tonify spleen-qi and lift-up the qi to the head to benefit it.
• Chen Pi, Mu Xiang and Sha Ren harmonize stomach-qi and pro-
mote appetite.
• Bai Ji Li and Shi Chang Pu resolve damp in the head and relieve
dizziness.
529
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Bu Zhong Yi Qi Wan-Tonify the Middle and Augment the Qi Pill.
Acupuncture Treatment:
• Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6, Qihai REN-6, Pishu
BL-20 and Weishu BL-21, Tinghui GB-2, Touwei ST-8, Extra
Yintang, Baihui DU-20, Shenting DU-24.
• A tonifying method is applied on these points. Moxibustion should
be applied on REN-6 and ST-36.
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-3, the
yuan-source point of the spleen channel, BL-20 and BL-21, the
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Principle of Treatment:
Tonify blood, benefit kidney-jing, relieve weakness and relieve
dizziness.
530
TCM Treatment of Long COVID
Herbal Treatment:
Si Wu Tang-Four Substances Decoction.
Explanations:
• Shu Di Huang, Dang Gui, Bai Shao, Chuan Xiong, Huang Jing and
He Shou Wu benefit kidney-jing, tonify and nourish blood and
relieve dizziness.
• Tian Ma and Bai Ji Li benefit the head and relieve dizziness.
• Zhi Gan Cao harmonizes the herbs in the prescription.
Herbal Remedy:
Gui Pi Wan-Restore the Spleen Pill.
Acupuncture Treatment:
• Zusanli ST-36, Sanyinjiao SP-6, Taichong LIV-3, Ququan LIV-8,
Taixi KID-3, Yingu KID-10, Xuanzhong GB-39 and Shenmen HE-7,
Tinghui GB-2, Shuaigu GB-8, Baihui DU-20, Extra Taiyang, Extra
Yintang.
• An even method is applied on LIV-3, Extra Taiyang and Extra
Yintang.
• A tonifying method is applied to the rest points.
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of three yin channels of the foot, activate the spleen
and stomach, tonify qi and blood and relieve dizziness.
531
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Since kidney-jing and blood share the same origin and benefit
each other constantly, some points should be used to tonify
kidney-jing to tonify blood. KID-3, the yuan-source point of the
kidney channel, LIV-8 and KID-10, the he-sea point of the liver
channel and kidney channel respectively, tonify blood and jing at
the same time, relieve the general fatigue and weakness so as to
relieve headache.
• GB-39, the influential point for marrow, benefits blood and
relieves blood deficiency.
• DU-20 benefits the head and relieves dizziness.
• GB-2, GB-8, Extra Taiyang and Extra Yintang benefit the head, har-
monize the collateral and relieve dizziness.
• LIV-3, the yuan-source point of the liver channel, and HE-7, the
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11.16 Diarrhea
COVID-19 is a respiratory disease caused by SARS-CoV-2 infection.
Although the most common symptoms of COVID-19 are fever, tired-
ness, a dry cough and myalgia, some patients may develop gastroin-
testinal symptoms such as diarrhea, loss of appetite, or vomiting even
in the absence of other flu-like symptoms.
Diarrhea is the condition characterized by the frequent passage
of loose, soft and unformed or watery stools. It could be accompa-
nied by abdominal pain, cramp or distension, nausea, vomiting, poor
appetite, weakness, fatigue, and weight loss, etc. Although most
cases of acute diarrhea’s are self-curing, chronic diarrhea may be a
sign of some serious health problems.
Diarrhea isn’t a very common symptom of COVID-19. It can be
an early sign of COVID-19, starting on the first day of infection and
building in intensity during the first week. One finding points out that
in some cases, the digestive symptoms, particularly diarrhea, can be
532
TCM Treatment of Long COVID
102
Chaoqun Han, et al. Digestive symptoms in COVID-19 patients with mild disease
severity: Clinical presentation, stool viral RNA testing, and outcomes. Am J
Gastroenterol. 2020, 115(6): 916–923. doi: 10.14309/ajg.0000000000000664.
103
ZOE Health Study. Is diarrhea a symptom of COVID-19? 1 April 2021. https://
covid.joinzoe.com/post/covid-symptoms-diarrhea.
104
Sravanthi Parasa, et al. Prevalence of gastrointestinal symptoms and fecal viral
shedding in patients with coronavirus disease 2019: A systematic review and meta-
analysis. JAMA Netw Open. 2020; 3(6): e2011335. doi: 10.1001/jamanetworkopen.
2020.11335.
105
Lei Pan, et al. op. cit.
106
Abhilash Perisetti, et al. Prevalence, mechanisms, and implications of gastrointes-
tinal symptoms in COVID-19. Front Med—Gastroenterology. 2020, 7: 588711.
https://doi.org/10.3389/fmed.2020.588711.
533
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
2 (ACE2) and the serine protease TMPRSS2 for S protein priming. ACE2
and TMPRSS2 are not only expressed in the lung, but also in the small
intestinal epithelia. ACE2 is expressed furthermore in the upper oesoph-
agus, liver, and colon.109
Current treatment in modern medicine is supportive. It has been
noticed that early extensive use of antibacterial and antiviral drugs
could also lead to diarrhea in patients. Thus, treatment options for
COVID-19 patients should be promptly adjusted.110
107
John Gever. GI disruption lasts for months in many COVID survivors-persistently
loose stools were most common after-effect. MedPage Today. 24 May 2021. https://
www.medpagetoday.com/meetingcoverage/ddw/92766.
108
Arno R. Bourgonje, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2
and the pathophysiology of coronavirus disease 2019 (COVID-19). The Journal of
Pathology. 2020, 251(3): 228–248. https://doi.org/10.1002/path.5471.
109
Ferdinando D’Amico, et al. Diarrhea during COVID-19 infection: Pathogenesis,
epidemiology, prevention, and management. Clin Gastroenterol Hepatol. 2020,
18(8): 1663–1672. doi: 10.1016/j.cgh.2020.04.001.
110
Qing Ye, et al. The mechanism and treatment of gastrointestinal symptoms in
patients with COVID-19. Am J Physiol — Gastrointest Liver Physiol. 2020, 319:
G245–G252. doi: 10.1152/ajpgi.00148.2020.
534
TCM Treatment of Long COVID
factors
Although COVID-19 is mainly caused by the invasion of cold-damp
or damp-heat with a pestilent toxin to the lung and heart, some other
internal zang-fu organs can also be affected, such as the spleen,
stomach and large intestine. When these pathogenic factors are
not eliminated completely or in time, they could cause stagnation
and latent accumulation in these organs, resulting in dysfunction
of transportation, the transformation of the spleen, and diarrhea
occurs.
535
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
occurs.
536
TCM Treatment of Long COVID
Principal of Treatment:
Eliminate external damp, harmonize the spleen and stomach, and
relieve diarrhea.
537
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Huo Xiang Zheng Qi San-Agastache Powder to Rectify the Qi.
Explanations:
• Huo Xiang and Zi Su Ye eliminate the remaining external patho-
genic disturbance, resolve damp-phlegm, harmonize the middle
Jiao and relieve diarrhea.
• Hou Po, Cang Zhu and Zhi Ke promote qi circulation in the mid-
dle Jiao, resolve damp and regulate the ascending and descending
functions of the qi in the spleen and stomach to harmonize the
transportation and transformation.
• Zhi Ban Xia, Chen Pi, Fu Ling and Zhi Gan Cao, the complete
composition of Er Chen Tang, resolve damp, eliminate phlegm,
and relieve diarrhea.
• Bai Zhu and Gan Jiang activate the spleen and stomach, eliminate
cold and warm the middle Jiao to stop diarrhea.
Herbal Remedy:
Huo Xiang Zheng Qi Wan-Agastache Pill to Rectify the Qi.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Lieque LU-7, Hegu L.I.-4, Fengchi
GB-20, Neiguan P-6, Sanyinjiao SP-6, Yinlingquan SP-9 and
Tianshu ST-25.
538
TCM Treatment of Long COVID
Explanations:
• A combination of SJ-5 + GB-41 regulates the Yangwei and Dai chan-
nels and eliminates the remaining pathogenic factors in the body.
• L.I.-4, the yuan-source point of the large intestine channel, and
LU-7, the luo-connecting point of the lung channel, dispel damp,
regulate the large intestine functions, relieve the external symp-
toms, and stop diarrhea.
• GB-20 calms the shen, promotes qi circulation, eliminates the
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Principle of Treatment:
Activate the spleen, promote the qi transformation, resolve damp-
phlegm, and relieve diarrhea.
539
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Cang Fu Dao Tan Tang-Atractylodes, Poria Phlegm-Dissipating
Decoction.
Explanations:
• Cang Zhu and Zhi Shi strongly eliminate damp-phlegm, promote
qi circulation, and relieve diarrhea.
• Zhi Ban Xia, Chen Pi, Fu Ling and Zhi Gan Cao, the composition
of Er Chen Tang, eliminate damp, resolve phlegm, harmonize the
middle Jiao and relieve diarrhea.
• Bai Zhu, Shan Yao, Yi Yi Ren and Bian Dou activate the spleen,
eliminate damp, and relieve diarrhea.
• Mu Xiang and Zhi Ke promote qi circulation in the middle Jiao and
relieve diarrhea.
Herbal Remedy:
Shen Ling Bai Zhu Wan-Ginseng, Poria and Atractylodis
Macrocephalae Pill.
Acupuncture Treatment:
• Taibai SP-3, Sanyinjiao SP-6, Yinlingquan SP-9, Zusanli ST-36,
Fenglong ST-40, Zhongwan REN-12, Hegu L.I.-4, Taichong LIV-3,
Zhangmen LIV-13, Pishu BL-20 and Weishu Bl-21.
540
TCM Treatment of Long COVID
Explanations:
• SP-3 and SP-6, the yuan-source point of the spleen channel and
the crossing point of the three yin channels of the foot respectively,
ST-36, the he-sea point of the stomach channel, LIV-13, the front-
mu point of the spleen, BL-20 and BL-21, the back-shu point of the
spleen and stomach respectively, activate the spleen and stomach,
promote the physiological functions of these two organs, tonify qi,
eliminate damp-phlegm and relieve the diarrhea.
• SP-9, the he-sea point of the spleen channel, ST-40 and REN-12,
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Principal of Treatment:
Smooth the liver, harmonize the spleen, regulate the qi circulation,
and stop diarrhea.
Herbal Treatment:
Tong Xie Yao Fang-Important Formula for Painful Diarrhea.
541
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Chai Hu and Bai Shao Yao, entering the liver and its channel,
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smooth the liver and relieve stagnation of liver-qi. Bai Zhu and
Shan Yao, entering the spleen, activate and strengthen the spleen,
dry damp, and resolve phlegm to relieve diarrhea. These four herbs
regulate the function of the liver and spleen and build up the new
balance between these two organs.
• Invasion of the spleen by the liver could cause disturbance of the
spleen in transportation and transformation, and stagnation of qi
together with formation of damp-phlegm. Xiang Fu, Mu Xiang, Yan
Hu Suo, Chen Pi and Fang Feng regulate the qi in the middle Jiao
and liver, stop abdominal pain, dry damp-phlegm and relieve diar-
rhea.
• Zhi Gan Cao is used to harmonize the prescription.
Herbal Remedy:
Chai Hu Shu Gan Wan-Bupleurum Pill to Spread the Liver, plus
Shen Ling Bai Zhu Wan-Ginseng, Poria and Atractylodis
Macrocephalae Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Shenmen HE-7,
Taichong LIV-3, Zhangmen LIV-13, Qimen LIV-14, Yanglingquan
GB-34, Tianshu ST-25, Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6,
Ganshu BL-18 and Pishu BL-20.
542
TCM Treatment of Long COVID
Explanations:
• A combination of P-6 + SP-4 regulates emotion, smooths the liver,
and promotes digestion.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and liver channel respectively, LIV-14, the front-mu point of
the liver, GB-34, the he-sea point of the gallbladder channel, and
BL-18, the back-shu point of the liver, smooth the liver, promote
the circulation of liver-qi and sedate the abdominal pain.
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Principal of Treatment:
Tonify qi, activate the spleen and relieve diarrhea.
543
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Si Jun Zi Tang-Four Gentlemen Decoction.
Explanations:
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• Dang Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, the complete com-
position of Si Jun Zi Tang, tonifies spleen-qi, activates the spleen
and stomach and relieves diarrhea.
• Zhi Ban Xia and Chen Pi harmonize stomach-qi, transform phlegm
and relieve diarrhea.
• Mu Xiang and Sha Ren promote qi circulation in the middle Jiao
and relieve the pain and distension in the abdomen.
Herbal Remedy:
Si Jun Zi Pian-Four Gentlemen Tablets.
Acupuncture Treatment:
• Zusanli ST-36, Taibai SP-3, Pishu BL-20, Weishu BL-21, Qihai
REN-6, Tianshu ST-25, Sanyinjiao SP-6 and Yinlingquan SP-9.
• A tonifying method is applied on ST-36, SP-3, BL-20, BL-21,
REN-6, and Sanyinjiao SP-6. A reducing method is applied on
ST-25 and SP-9.
• Moxibustion is applied on ST-36 and REN-6.
Explanations:
• ST-36, the low he-sea point of the stomach and the he-sea point of
the stomach channel, SP-3, the yuan-source point of the spleen
544
TCM Treatment of Long COVID
channel, SP-6, the crossing point of the three yin channels of the
foot, BL-20, and BL-21, the back-shu point of spleen and stomach
respectively, tonify qi, activate the spleen and stomach, eliminate
damp, and relieve diarrhea.
• SP-9, the he-sea point of the spleen channel, and ST-25, the front-
mu point of the large intestine, eliminate damp-phlegm, regulate
the large intestine, and relieve diarrhea.
• REN-6 tonifies qi in the body and strengthens the body.
• Moxibustion warms the stomach and spleen and eliminates inte-
rior cold in the body.
Principal of Treatment:
Warm the spleen, tonify the kidney-yang and relieve diarrhea.
Herbal Treatment:
Si Shen Wan-Four Miracle Pill.
545
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Rou Dou Kou and Bu Gu Zhi warm and tonify kidney-yang and
dispel cold in the body.
• Wu Zhu Yu and Gan Jiang warm the spleen and eliminate interior
cold in the middle Jiao.
• Dang Shen, Shan Yao, Fu Ling and Bian Dou tonify and
activate the spleen and stomach, eliminate damp, and relieve
diarrhea.
• Wu Wei Zi stops diarrhea.
Herbal Remedy:
Si Shen Wan-Four Miracle Pill.
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Acupuncture Treatment:
• Guanyuan REN-4, Qihai REN-6, Taixi KID-3, Yingu KID-10, Pishu
BL-20, Shenshu BL-23, Tianshu ST-25, Zusanli ST-36, Taibai SP-3
and Yinlingquan SP-9.
• A tonifying method is applied on REN-4, REN-6, KID-3, KID-10,
ST-36, SP-3, BL-20 and BL-23. A reducing method is applied on
ST-25 and SP-9.
• Moxibustion is applied on REN-4, REN-6 and ST-36.
Explanations:
• KID-3 and KID-10, the yuan-source point and the he-sea point of
the kidney channel respectively, and BL-23, the back-shu point of
the kidney, tonify the kidney and promote the physiological func-
tions of the kidney.
• REN-4 and REN-6 with moxa strongly tonify the kidney, reinforce
kidney-qi and kidney-yang and eliminate interior cold in the body.
• ST-36 and SP-3, the he-sea point of the stomach channel and the
yuan-source point of the spleen channel respectively, and BL-20, the
back-shu point of the spleen, activate the spleen, tonify the spleen
and stomach, eliminate damp-phlegm and relieve the diarrhea.
• ST-25 and SP-9, the front-mu point of the large intestine and the
he-sea point of the spleen channel respectively, eliminate damp-
phlegm and relieve the diarrhea.
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TCM Treatment of Long COVID
• Moxibustion warms the body, tonifies yang of the spleen and kid-
ney and eliminates interior cold.
Principle of Treatment:
Tonify qi, warm heart-yang, activate the spleen and relieve diarrhea.
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Herbal Treatment:
Gui Zhi Gan Cao Tang-Cinnamon and Glycyrrhizae Decoction, plus
Shen Ling Bai Zhu San-Ginseng, Poria and Atractylodis Macrocep-
halae Powder.
Explanations:
• Gui Zhi and Zhi Gan Cao warm the heart, strengthen the heart,
and eliminate interior cold.
• Dang Shen, Bai Zhu, Fu Ling and Bian Dou activate the
spleen, tonify the spleen-qi and the general body, and relieve
diarrhea.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Gan Jiang warms the spleen and eliminates cold in the middle
Jiao.
• Huang Qi and Shan Yao activate the spleen, tonify spleen-qi, and
relieve diarrhea.
Herbal Remedy:
Li Zhong Wan-Pill to Regulate the Middle.
Acupuncture Treatment:
• Guanyuan REN-4, Qihai REN-6, Zusanli ST-36, Zhangmen LIV-13,
Taibai SP-3, Sanyinjiao SP-6, Shenmen HE-7, Tianshu ST-25,
Xinshu BL-15, Pishu BL-20, and Shenshu BL-23.
• A tonifying method is applied on REN-4, REN-6, ST-36, LIV-13,
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Explanations:
• REN-4 and REN-6 tonify the yuan-qi in the body, warm yang,
eliminate interior cold and strengthen the body.
• ST-36, the he-sea point of the stomach channel, SP-3 and SP-6, the
yuan-source point and the crossing point of three yin channels of
the feet, LIV-13, the front-mu point of the spleen, and BL-20, the
back-shu point of the spleen, tonify and activate the spleen and
stomach, eliminate interior cold and relieve diarrhea.
• HE-7 and BL-15, the yuan-source point of the heart channel and
the back-shu point of the heart respectively, tonify qi and yang of
the heart and strengthen the heart.
• BL-23, the back-shu point of the kidney, warms the kidney, tonifies
qi and yang of the kidney and eliminates interior cold.
• ST-25, the front-mu point of the large intestine, regulates the large
intestine and relieves diarrhea.
• Moxibustion warms the qi and yang of the body and eliminates
interior cold.
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TCM Treatment of Long COVID
Mental Health UK. Managing your mental health during the coronavirus outbreak.
111
https://mentalhealth-uk.org/help-and-information/covid-19-and-your-mental-
health/.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
the gaps between these two systems to understand and treat post-
COVID neuropsychiatric disorders (PCND).
While SARS-CoV-2 is still sweeping across the globe, our under-
standing of COVID-19 is developing day by day. As part of this, the
symptoms of neuropsychiatric disorders are raising growing concerns
of medical professionals, and yet, due to the complexity of the
neuropsychiatric system, post-COVID-19 patients are left with very
few options in terms of treatment. We have reason to be concerned
that COVID-19 may lead to severe and long-lasting neuropsychiatric
suffering for patients. Without proper management and treatment of
these symptoms, patients face a difficult, painful, and prolonged
recovery physically and mentally.
Previous influenza pandemics have been associated with long-
lasting neuropsychiatric consequences.113 A systematic review114 of
112
Stephen Matthews. Coronavirus patients can suffer from shortness of breath and
fatigue for MONTHS after their battle with the disease, government scientists warn.
Mail Online. 1 June 2020. https://www.dailymail.co.uk/news/article-8375747/
Coronavirus-patients-suffer-shortness-breath-fatigue-MONTHS.html.
113
Adrianna P. Ke˛pińska, et al. Schizophrenia and influenza at the centenary of the
1918–1919 Spanish influenza pandemic: Mechanisms of psychosis risk. Front.
Psychiatry. 2020, 11: 72. http://doi.org/10.3389/fpsyt.2020.00072.
114
Jonathan P. Rogers, et al. Psychiatric and neuropsychiatric presentations associ-
ated with severe coronavirus infections: A systematic review and meta-analysis with
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TCM Treatment of Long COVID
SARS and MERS infection shows that almost one in three hospital-
ized cases went on to develop post-traumatic stress disorder (PTSD),
rates of depression and anxiety were at roughly 15% one year after
the illness, and more than 15% of patients also complained of
fatigue, mood swings and sleep disorders. Although based on SARS
and MERS, this review suggests a clear prospect over the potential
future of post-COVID psychiatric symptoms. The possible impact of
COVID-19 on neuropsychiatric system may include several aspects
below.
• Psychological effects
As a global emergent event, this pandemic obviously holds a wider
social impact. The governmental rulings, including physical distanc-
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ing measures and quarantine can adversely affect the infected and
non-infected population.115,116 Reactions of the population include
widespread anxiety, social isolation, high levels of stress particularly
amongst healthcare and other essential workers,117 and concerns
over unemployment and financial difficulties.118 Those infected by
the virus tend to suffer even more, with fears about the outcome of
comparison to the COVID-19 pandemic. The Lancet Psychiatry. 2020, 7(7): 611–
627. doi: 10.1016/S2215-0366(20)30203-0.
115
Joseph A Lewnard and Nathan C Lo. Scientific and ethical basis for social-
distancing interventions against COVID-19. The Lancet Infect Dis. 2020, 20(6):
631–633. doi: 10.1016/S1473-3099(20)30190-0.
116
Samantha K. Brooks, et al. The psychological impact of quarantine and how to
reduce it: Rapid review of the evidence. The Lancet. 2020, 395(10227): 912–920.
https://doi.org/10.1016/S0140-6736(20)30460-8.
117
Neil Greenberg, et al. Managing mental health challenges faced by healthcare
workers during COVID-19 pandemic. BMJ. 2020, 368. https://doi.org/10.1136/bmj.
m1211.
118
Covadonga Chaves, et al. The impact of economic recessions on depression and
individual and social well-being: The case of Spain (2006–2013). Soc Psychiatry
Psychiatr Epidemiol. 2018, 53(9): 977–986. doi: 10.1007/s00127-018-1558-2.
551
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
119
Yu-Tao Xiang, et al. Timely mental health care for the 2019 novel coronavirus
outbreak is urgently needed. The Lancet Psychiatry. 2020, 7(3): 228–229. doi:
10.1016/S2215-0366(20)30046-8.
120
Judy Yuen-man Siu. The SARS-associated stigma of SARS victims in the post-SARS
era of Hong Kong. Qual Health Res. 2008, 18(6): 729–738. doi:
10.1177/1049732308318372.
121
Christina Jones, et al. Psychological morbidity following critical illness—The
rationale for care after intensive care. Clin Intensive Care. 1998, 9(5): 199–205.
https://doi.org/10.3109/tcic.9.5.199.205.
122
Ling Mao, et al. Neurologic manifestations of hospitalized patients with coronavi-
rus disease 2019 in Wuhan, China. JAMA Neurol. 2020: E1–E8. doi: 10.1001/
jamaneurol.2020.1127.
123
Julie Helms, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J
Med. 2020, 382: 2268–2270. doi: 10.1056/NEJMc2008597.
124
Jerome R. Lechien, et al. Olfactory and gustatory dysfunctions as a clinical pres-
entation of mild-to-moderate forms of the coronavirus disease (COVID-19): a
multicenter European study. Eur Arch Otorhinolaryngol. 2020, 17: 13. doi: 10.1007/
s00405-020-05965-1.
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TCM Treatment of Long COVID
• Neuro-endocrine impact
The stress experienced by patients facing severe illness hugely
impacts the progress of the disease and their mental health. When
Long COVID associated stress responses are triggered, the activation
of the neuroendocrine HPA stress axis and the renin-angiotensin-
aldosterone system (RAAS—an aspect of the endocrine system
involved in the regulation of blood pressure and fluid balance) plays
an important part in somatic psychiatric disturbance.126 Angiotensin-
converting enzyme 2 (ACE2) has been shown to have an effect on
stress responses and anxiety. In COVID-19 patients, expression of
ACE2 has been noted not only in the respiratory tract, lung, ileum,
125
Guang Chen, et al. Clinical and immunological features of severe and moderate
coronavirus disease 2019. J Clin Invest. 2020, 130(5): 2620–2629. doi: 10.1172/
JCI137244.
126
Haibo Zhang, et al. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2
receptor: Molecular mechanisms and potential therapeutic target. Intensive Care
Med. 2020, 46: 586–590. doi: 10.1007/s00134-020-05985-9.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
healing and the limited knowledge about the disease. The psycho-
logical and neuropsychiatric sufferings of patients in the recovery
stage of the disease tends to become clear when survivors emerge
from the acute stage. While there is still a lot of uncertainty about the
exact mechanism of the symptoms in modern medicine, we have
searched TCM literature to help outline a framework that acupunc-
ture treatment can resolve post-COVID symptoms.
TCM holds that a human being is composed of three important
interacting aspects: xing (形, physical body and internal organs), qi
(气, vital energy) and shen (神, mind, spirit).
• The xing, which is the body, provides the core of life activities,
supplying essential substances of qi, blood, body fluids and jing
127
Xin Zou, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression
reveals the potential risk of different human organs vulnerable to 2019-nCoV infec-
tion. Front Med. 2020, 14(2): 185–192. doi: 10.1007/s11684-020-0754-0.
128
Qiufeng Lv, et al. Effects of taurine on ACE, ACE2 and HSP70 expression of
hypothalamic-pituitary-adrenal axis in stress-induced hypertensive rats. Adv Exp
Med Biol. 2017, 975(Pt 2): 871–886. doi: 10.1007/978-94-024-1079-2_69.
129
Yanqing Ding, et al. Organ distribution of severe acute respiratory syndrome
(SARS) associated coronavirus (SARS-CoV) in SARS patients: Implications for
pathogenesis and virus transmission pathways. J Pathol. 2004, 203: 622–630. doi:
10.1002/path.1560.
554
TCM Treatment of Long COVID
through qi.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
anger and frustration due to the failure of Metal lung’s proper control
over the Wood liver.
The spleen is in charge of transportation and transformation of
food and fluid, providing the production of qi and blood. According
to the Five Elements theory, the spleen is associated with the Earth
Element, the mother of metal lung. When the spleen fails in transpor-
tation and transformation, the resulting accumulation of phlegm and
damp may end up in the lung. Moreover, due to the close relation-
ship between the spleen, liver and kidney, dysfunction of the spleen
can eventually lead to featuring mental and emotional symptoms,
such as lassitude-related depression, loss of interest in life and mental
fatigue, repetitive patterns of negative emotions such as frequent
recalling of traumatic memories. Impaired concentration and atten-
tion may occur too.
The San Jiao is the passageway for yuan (original) qi and water. It
also belongs to Shaoyang and is associated with the gallbladder and
liver. The emotional symptoms of Shaoyang patterns are irritability
and anger, bitter taste in the mouth, restlessness, anxiety, insomnia
with difficulty falling asleep or repetitive waking at the same time
through night, nightmares, depression with a stiff and heavy body,
and waking in morning with symptoms better after exercise. As stated
in Su Wen (Simple Questions) Chapter 8, “The gallbladder is
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TCM Treatment of Long COVID
130
John Stan. A “curious organ”—The gallbladder. Eastern Currents. 1 May 2017.
https://www.easterncurrents.ca/for-practitioners/practitioners%27-news/eastern-
currents-news/2017/05/01/a-curious-organ---the-gallbladder.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
558
TCM Treatment of Long COVID
adrenal glands. In this sense we may bravely conclude that the heart-
liver–kidney relation in TCM could be a mirror equivalence of the
HPA axis. The COVID-19 mechanism on ACE2 receptors not only has
physical, but also neuropsychiatric significance in the TCM
interpretation.
11.17.1.2 Disorder of qi
Upward, downward, outward and inward are the four directions of
qi movement in the body. If qi cannot travel smoothly in these direc-
tions, it could be life threatening for the patient. The different move-
ments of qi require proper coordination between the internal organs
and channels to maintain a harmonious balance. The emotional state
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
pear. In addition, since the qi and blood are closely related, block-
age of qi could cause blood stasis, which provides explanation to
why many COVID-19 patients develop thrombosis and CVA.
Formation of blood clotting is one of the main pathologies in severe
cases of COVID-19. Treatments to promote the qi and blood circula-
tion simultaneously should be considered during the peak of the
disease and will also be beneficial at the recovery stage by encour-
aging the restoration of damages that were done to the internal
organs and systems, especially to the brain and neuropsychiatric
system.
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TCM Treatment of Long COVID
Questions, anger injures the liver, joy injures the heart, grief and
melancholy injures the lung, worry injures the spleen, and fear and
fright injure the kidney. It is also stated that anger causes the qi to
rise, joy causes it to move slowly, grief drastically consumes it, fear
causes it to decline, fright causes it to be deranged, and worry causes
it to stagnate. This clearly explains that intense emotions certainly
have negative mechanisms on the movement of qi.
TCM also holds that the seven emotions are the expressive reac-
tions of the zang-fu organs toward different stimuli, environment, and
pathology. An imbalanced zang-fu organ often dominates the body
by its own featuring emotion. To restore a healthy mental and emo-
tional balance, we need to achieve a healthy internal organ system
as well as balanced qi circulation. It is this interactive relation
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between the qi of the emotions and internal organs that forms the
foundation for resolution of neuropsychiatric disorders. Therefore,
we set out the framework for how shen disorders follow the five-
organ sequence below.
The heart is the governor of all the emotions in the body, con-
necting the physiology of the brain. With the heart overseeing all the
mental activities, all emotions go through the monitoring of the heart.
Palpitations, insomnia, restlessness, forgetfulness, poor concentra-
tion, lack of enthusiasm and vitality, mental depression, and despair
are symptoms indicating that the heart is not functioning well. Other
emotions such as anger, frustration, anxiety, fear, sadness, and inse-
curity, are also the erratic patterns indicating the shaking of housing
for shen.
The lung is also related to certain emotions, i.e., grief and sad-
ness. Pathological changes of the lung due to COVID-19 can impair
its function causing emotional changes. And at same time, over-
whelming and lingering grief and sadness can affect the physiologi-
cal functions of the lung. Social distancing, home isolation, loss of
family members, poor or insufficient treatment, lack of adequate and
prompt viral test, and uncertainty of future and expectation, etc. are
all the possible emotional elements that cause severe disappointment
with grief and sadness. This may eventually lead to pressure in the
chest, hyperventilation, bad mood, and emotional turmoil.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
the liver. The impairment of liver then determines the mental suffer-
ings in a longer term. There is a vicious circle, where stress, frustra-
tion and devastation impede liver’s qi, which then generates the
stagnant heat in liver. Hyperactivity of liver-yang then follows, lead-
ing to headache, dizziness, depression, anger, feeling upset, frustra-
tion, nervousness, agitation, restlessness, and sleeping disorders over
the longer term. In practice, soothing the liver-qi and strengthening
liver blood and yin can help to resolve many mental sufferings.
The kidney is closely associated with post traumatic sufferings,
manifesting fears, fright, or terror. Meanwhile, fear arises from anxi-
ety over a short or long term. The feeling of insecurity and uncer-
tainty, weak willpower and isolation, lack of power in dealing with
an intense change in life or unstable living conditions, can also con-
tribute to the pathology of the kidney. On the other hand, we now
131
Ohio State University. Role of spleen in prolonged anxiety after stress. Science
Daily. 13 November 2016. https://www.sciencedaily.com/releases/2016/11/
161113154748.htm.
132
Joanne Lusher. COVID-19: Psychological support for healthcare workers during
and after the pandemic. Nursing Management. 12 May 2020. https://rcni.com/
nursing-management/opinion/comment/covid-19-psychological-support-healthcare-
workers-during-and-after-pandemic-160991.
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TCM Treatment of Long COVID
know that by strengthening the kidney, the body will be able to tackle
and overcome these symptoms much quicker and better.
To summarize, an imbalanced shen can be a factor in COVID-19
disease by disturbing the movement of qi which in turn impairs the
xing. However, a healthy and strong internal zang-fu system is the core
to maintain a balanced shen. The COVID-19 pandemic certainly
brought in a huge challenge on the psychological and neuropsychiat-
ric system, but TCM can be used to identify how the mental/emotional
conditions are linked with specific internal organs. TCM’s success at
treating the relevant psychological and neuropsychiatric symptoms is
not achieved only by targeting at the mental symptoms but looking
more into balance of the zang-fu balancing and qi regulation.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Dispel wind, eliminate cold-damp, restore the lung-qi, and improve
emotions.
Herbal Treatment:
Xing Su San-Apricot Kernel and Perilla Leaf Powder, plus
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
Damp.
564
TCM Treatment of Long COVID
Explanations:
• Jing Jie and Fang Feng are applied in combination with Qiang Huo
and Gao Ben to dispel the remaining pathogens and relieve exter-
nal symptoms, such as myalgia, headache, and slight aversion to
cold.
• Xing Ren, Zi Su Zi, Zhi Ban Xia, Fu Ling, and Chen Pi are applied
to eliminate phlegm and relieve cough.
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Herbal Remedy:
Zhi Sou San-Stop Coughing Powder (Granulates), plus
An Shen Ding Zhi Wan-Calm the Shen and Settle the Emotions Pill.
Principle of Treatment:
Eliminate damp, resolve phlegm, activate the spleen, and improve
emotion.
Herbal Treatment:
Ping Wei San-Calm the Stomach Powder, plus
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Hou Po, Cang Zhu, Chen Pi, and Zhi Gan Cao, the complete com-
position of Ping Wei San, eliminate damp, resolve phlegm, activate
the spleen, and improve appetite.
• Dang Shen, Bai Zhu, Fu Ling, Zhi Gan Cao, Zhi Ban Xia, Chen Pi,
Xiang Fu, and Sha Ren, the complete composition of Xiang Sha Liu
Jun Zi Tang, activate the spleen and stomach, eliminate damp,
resolve phlegm, and promote the qi circulation in the spleen and
stomach.
• He Huan Pi, Yuan Zhi, and Shi Chang Pu eliminate damp-phlegm,
regulate qi circulation and harmonize emotions.
• Shen Qu and Jiao Gu Ya promote digestion and improve appetite.
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TCM Treatment of Long COVID
• Gui Zhi and Gan Jiang warm the spleen and stomach and elimi-
nate cold in the body.
• Huang Lian and Zhi Zi clear heat and eliminate damp in the
middle Jiao.
Herbal Remedy:
Xiang Sha Liu Jun Wan-Six Gentlemen Pill with Aucklandia and
Amomum, plus
An Shen Ding Zhi Wan-Calm the Shen and Settle the Emotions Pill.
Principle of Treatment:
Smooth the liver, promote qi circulation and improve emotions.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
567
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver and relieve qi stagna-
tion in the liver.
• Zhi Ke, Xiang Fu, Chen Pi, and Sha Ren promote the qi circulation
in the middle Jiao and improve the appetite.
• Dang Gui nourishes the liver-blood and benefits the liver.
• Bai Zhu activates the spleen and stomach and improves appetite.
• Shen Qu and Jiao Gu Ya promote digestion and improve appetite.
• Fu Shen, Yuan Zhi, and He Huan Pi smooth emotions, regulate the
shen, and improve sleep.
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Herbal Remedy:
Xiao Yao Wan-Rambling Pill, plus
An Shen Ding Zhi Wan-Calm the Shen and Settle the Emotions Pill.
Principle of Treatment:
Eliminate damp, clear heat, harmonize the gallbladder, and calm the
shen.
Herbal Treatment:
Huang Lian Wen Dan Tang-Warm Gallbladder Decoction with
Coptis.
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TCM Treatment of Long COVID
Explanations:
• Zhi Ban Xia, Fu Ling, Chen Pi, and Zhi Gan Cao, the complete
compositions of Er Chen Tang, eliminate damp and regulate
digestion.
• Zhi Shi, Ru Zhu, Hou Po, and Gua Lou eliminate damp, promote
the qi circulation, and benefit the gallbladder.
• Huang Lian clears heat and calms the shen to relieve the
restlessness.
• Fu Shen, Yuan Zhi, and He Huan Pi regulate the emotions and
calm the shen.
Herbal Remedy:
Wen Dan Tang Ke Li-Warm Gallbladder Granule.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
cold peripheral limbs, thin with whitish coating on the tongue, pale
tongue, and a weak and thready pulse.
Principle of Treatment:
Tonify qi and blood, benefit jing, strengthen the body and improve
emotions.
Herbal Treatment:
Shi Quan Da Bu Tang-All Inclusive Great Tonifying Decoction.
Explanations:
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao activate the
spleen and tonify the qi in the body.
• Zhi Huang Qi, Shan Yao, and Wu Wei Zi tonify qi, benefit the lung
and relieve spontaneous sweating.
• Shu Di Huang and Dang Gui tonify the kidney and benefit jing.
• Gan Jiang and Rou Gui warm the body and dispel the interior
cold.
• He Huan Pi and Long Gu calm shen and improve sleep.
Herbal Remedy:
Gui Pi Wan-Restore the Spleen Pill.
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TCM Treatment of Long COVID
Principle of Treatment:
Nourish yin, promote the production of body fluid, and improve
emotion.
Herbal Treatment:
Tian Wang Bu Xin Dan-Emperor of Heaven’s Special Pill to Tonify the
Heart.
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Explanations:
• Sheng Di Huang, Tian Men Dong, Mai Men Dong, and Wu Wei Zi
nourish the yin of the body and clear the deficient heat.
• Xuan Shen and Bai Shao Yao clear deficient heat and smooth the
liver.
• Zhi Mu clears deficient heat and relieves night sweating.
• Dang Gui tonifies blood and benefits the yin in the body.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Dan Shen, Fu Shen, Yuan Zhi, Suan Zao Ren, and Bai Zi Ren clear
the heat in the heart, smooth the emotions and improve sleep.
Herbal Remedy:
Tian Wang Bu Xin Dan-Emperor of Heaven’s Special Pill to Tonify the
Heart.
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TCM Treatment of Long COVID
11.17.2.2.2 Regulation of qi
• Selection of points for further eliminating pathogenic factors
It is generally accepted that COVID-19 is initially caused by invasion
of wind, cold and damp mixed with toxic heat. Based on a patient’s
constitution, lifestyle habits, diet and emotional circumstances, these
pathogens can lead to various kinds of pathologies. Treatment to
eliminate these pathological factors should be based on stage,
573
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Peilin Sun and Wen Sheng Zhou. Acupuncture in the treatment of COVID-19: An
133
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TCM Treatment of Long COVID
• Scalp acupuncture
Scalp acupuncture is one of the modern micro-system acupuncture
techniques which combine Chinese acupuncture needling methods
with western medical knowledge on neuroanatomy, physiology,
pathology, and neurology, to allocate the mirror areas on the scalp to
the corresponding zones on the cerebral cortex. During the treat-
ment, needles are inserted into the specific stimulating areas on the
scalp to achieve the desired therapeutic effects, which is mainly for
brain-related conditions, including neurological and psychological
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conditions.134
The treatment principle should be focused on the major damaged
areas of the CNS. Scalp acupuncture would be a special technique
for the following types of brain-related diseases or symptoms:
Jason Jishun Hao and Linda Lingzhi Hao. Chinese Scalp Acupuncture. Blue Poppy
134
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
self-pity.
Hunmen BL-47 (Courage Gate)
This point is responsible for hun (Courage), Wood phase, and liver
organ. It could be used to treat depression, irritation, frustration,
guilt, grudge, aggression, accusation, self-disapproval, anger,
hostility, lack of motivation, bitterness, boredom, and apathy, etc.
Zhishi BL-52 (Will Chamber)
This point is responsible for zhi (Will), Water phase, and kidney
organ. It could be used to treat superior fear, lack of willpower,
terror, inferiority, distrust, suspicion, panic, and paranoia, etc.
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TCM Treatment of Long COVID
135
Emma Sandri. Brain fog to night sweats: Long COVID has more than 200 symp-
toms, study finds. National Post. 16 July 2021. https://nationalpost.com/news/
from-brain-fog-to-night-sweats-long-covid-has-over-200-symptoms-study-finds.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
578
TCM Treatment of Long COVID
579
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
a pestilent toxin to the body, especially the lung and heart. The lung
is connected to the skin and the heart is connected to the blood and
blood vessels. Invasion of pathogenic factors during COVID-19
could cause disharmony between the ying and wei systems, leading
to failure of the skin and muscles to be properly warmed and the
opening of the skin pores to be regulated, thus sweating occurs.
During Long COVID, if there are remaining external pathogenic fac-
tors, this pathogenic condition may influence the harmonization of
the ying and wei systems, resulting in the occurrence of sweating. In
this case, the proper treatment to relieve sweating should be focusing
on further elimination of external pathogenic factors and harmoniza-
tion of ying and wei systems.
580
TCM Treatment of Long COVID
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Harmonize the ying qi and wei qi, regulate the lung and relieve
sweating.
Herbal Treatment:
Gui Zhi Jia Long Gu Mu Li Tang-Cinnamon Twig Decoction, plus
Dragon Bone and Oyster Shell.
Explanations:
• Gui Zhi and Bao Shao Yao are used in combination to harmonize
the ying qi and wei qi and regulate the skin and blood vessels.
• Fang Feng opens the skin pores to eliminate the remaining patho-
genic factors.
• Wu Wei Zi regulates the ying qi, benefits the yin and arrests
sweating.
• Fu Xiao Mai, Duan Long Gu, and Duan Mu Li arrest sweating.
• Da Zao, Sheng Jiang and Zhi Gan Cao assist Gui Zhi and Bai Shao
Yao to harmonize the ying qi and wei qi.
Herbal Remedy:
Gui Zhi Jia Long Gu Mu Li Wan-Cinnamon Twig, plus Dragon Bone
and Oyster Shell Pill.
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TCM Treatment of Long COVID
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Hegu L.I.-4, Waiguan SJ-5, Taiyuan
LU-9, Shenmen HE-7, Feishu BL-13, Xinshu BL-15, Zusanli ST-36
and Sanyinjiao SP-6.
• An even method is applied on LU-7 + KID-6, LU-9, BL-13, BL-15,
ST-36, and SP-6. A reducing method is applied to L.I.-4 and SJ-5.
Explanations:
• The combination of LU-7 + KID-6, one group of the Eight conflu-
ence points, regulates and harmonizes ying qi and wei qi and
relieves sweating.
L.I.-4, the yuan-source point of the large intestine channel, and
back-shu point of the lung, tonify the lung-qi and benefit the
physiological functions of the lung to relieve sweating. ST-36
and SP-6, the he-sea point of the stomach channel and the
crossing point of three yin channels of foot, tonify qi and blood
and benefit the wei qi. HE-7 and BL-15, the yuan-source point
of the heart channel and the back-shu point of the heart respec-
tively, strengthen the heart and blood vessels and benefit the
ying qi. When these points are used in combination, they
could regulate and harmonize the ying qi and wei qi to relieve
sweating.
11.18.2.2 Deficiency of qi
Spontaneous sweating after COVID-19, fatigue, slight shortness of
breath, expectoration of slight white and diluted phlegm which gets
worse after any activities, aversion to cold, pale complexion, low
voice, lower back pain, poor appetite, aversion to wind and cold,
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
pale tongue with thin and white coating, and a thready, slow, and
weak pulse.
Principle of Treatment:
Tonify the qi, regulate the lung, strengthen the spleen and kidney,
and relieve sweating.
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Yu Ping Feng San-Jade Windscreen Powder.
Explanations:
• Zhi Huang Qi, Fang Feng and Jiao Bai Zhu, the complete compo-
sition of Yu Ping Feng San, consolidate the skin, tonify the wei qi
and improve the resistance to wind and cold.
• Zhi Dang Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao, the complete
composition from Si Jun Zi Tang, activate the spleen and tonify the
qi in the body.
• Wu Wei Zi and Zi Wan tonify the qi in the lung and benefit the
lung.
• Shu Di Huang tonifies the kidney and benefits the lung.
• Ma Huang Gen and Fu Xiao Mai arrest sweating.
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TCM Treatment of Long COVID
Herbal Remedy:
Yu Ping Feng Wan-Jade Windscreen Pill.
Acupuncture Treatment:
• Zhongfu LU-1, Lieque LU-7, Chize LU-5, Taiyuan LU-9, Shenmen
HE-7, Feishu BL-13, Zusanli ST-36, Sanyinjiao SP-6, Taixi KID-3,
Qihai REN-6 and Shenshu BL-23.
• An even method is applied on LU-7 and LU-5, and a tonifying
method is applied on the rest of the points. Moxibustion could be
applied on ST-36, KID-3 and REN-6.
Explanations:
• LU-1, the front-mu point of the lung, LU-7 and LU-5, the luo-
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Principle of Treatment:
Tonify the qi and yin of the lung and kidney and relieve sweating.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Bu Fei Tang-Tonify the Lungs Decoction, plus
Sheng Mai San-Generate the Pulse Powder.
Explanations:
• Ren Shen, Mai Men Dong and Wu Wei Zi, the complete composi-
tion of Sheng Mai San, tonify qi and nourish yin of the body.
• Chuan Bei Mu and Zi Wan nourish the yin and benefit the lung.
They could also relieve shortness of breath.
• Sheng Di Huang clears deficient heat in the body.
• Ren Shen, Jiao Bai Zhu, Fu Ling, and Zhi Gan Cao, the complete
composition of Si Jun Zi Tang, activate the spleen and tonify the qi
in the body.
• Shu Di Huang tonifies the kidney and benefits the lung.
• Ma Huang Gen and Fu Xiao Mai arrest sweating.
Herbal Remedy:
Sheng Mai San or Wan-Generate the Pulse Powder or Pill.
Acupuncture Treatment:
• Lieque LU-7, Chize LU-5, Taiyuan LU-9, Shenmen HE-7, Feishu
BL-13, Zusanli ST-36, Sanyinjiao SP-6, Taixi KID-3, Zhaohai
KID-6, Guanyuan REN-4, Qihai REN-6 and Shenshu BL-23.
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TCM Treatment of Long COVID
Explanations:
• LU-7 and LU-5, the luo-connecting point and the he-sea point of
the lung channel respectively, and LU-9, the yuan-source point of
the lung channel, and BL-13, the back-shu point of the lung, tonify
qi and yin of the lung, consolidate the skin and restore the physi-
ological functions.
• ST-36, SP-6, REN-4, REN-6, Taixi KID-3, KID-6 and BL-23 tonify
the qi of the spleen, benefit the qi and yin of the kidney and sup-
port the lung-qi.
• HE-7, the yuan-source point of the heart channel, tonifies the
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Principle of Treatment:
Tonify the yin of the lung, liver and kidney, reduce the deficient fire
and relieve sweating.
Herbal Treatment:
Dang Gui Liu Huang Tang-Decoction of Chinese Angelica and Six
Yellow Ingredients.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• The first seven herbs form the compositions of Dang Gui Liu Huang
Tang, which is applied to nourish the yin and clear deficient heat.
It is the treatment to solve the root cause of night sweating.
• Zhi Mu clears deficient heat and relieves the hotness of palms and
soles.
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Herbal Remedy:
Dang Gui Liu Huang Wan-Pill of Chinese Angelica and Six Yellow
Ingredients.
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Chize LU-5, Taiyuan LU-9,
Shenmen HE-7, Yinxi HE-6, Laogong P-8, Feishu BL-13, Xinshu
BL-15, Sanyinjiao SP-6, Taixi KID-3, Yingu KID-10, Qihai REN-6,
and Shenshu BL-23.
• An even method is applied on LU-7 + KID-6, and a tonifying
method is applied on the rest of the points.
Explanations:
• LU-7 + KID-6, one of the point combinations from eight conflu-
ence points nourishes the yin of the body.
• LU-5, the he-sea point of the lung channel, LU-9, the yuan-source
point of the lung channel, and BL-13, the back-shu point of the
lung, tonify the yin of the lung, consolidate the skin and restore the
physiological functions.
• SP-6, REN-6, KID-3, KID-10 and BL-23 tonify the yin of the kidney
and clear deficient heat.
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TCM Treatment of Long COVID
• HE-7 and HE-6, the yuan-source point and the xi-cleft point of the
heart channel respectively, P-8, the ying-spring point of the peri-
cardium channel, and BL-15, the back-shu point of the heart,
tonify the heart-yin, reduce deficient fire, regulate the shen and
relieve sweating.
Principle of Treatment:
Clear the internal heat, promote defecation, and relieve sweating.
Herbal Treatment:
Da Huang Huang Qin Xie Xin Tang-Rhubarb and Scute Decoction to
Drain the Epigastrium.
Explanations:
• Huang Qin, Huang Lian and Da Huang, the complete composi-
tion of Da Huang Huang Qin Xie Xin Tang, promote defecation,
clear excessive heat, and reduce fever.
• Zhi Mu and Sheng Di Huang clear heat and remove toxins.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Fang Feng Tong Sheng Pian-Saposhnikovia Pill that Sagely Unblocks.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Quchi L.I.-11, Chize
LU-5, Shenmen HE-7, Laogong P-8, Tianshu ST-25, Feishu BL-13,
Xinshu BL-15, Sanyinjiao SP-6, Xingjian LIV-2 and Neiting ST-44.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied on the rest of the points.
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Explanations:
• P-6 + SP-4, one of the point combinations from eight confluence
points, regulates the internal organs and clears heat in the body.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of
the large intestine channel respectively, ST-25, the front-mu point
of the large intestine, ST-44, the ying-spring point of the stomach
channel, clear excessive heat and promote defecation.
• LU-5, the he-sea point of the lung channel, and BL-13, the back-
shu point of the lung, clear heat in the lung and restore the
physiological functions.
• HE-7, the yuan-source point of the heart channel, and P-8, the
ying-spring point of the pericardium channel, and BL-15, the
back-shu point of the heart, clear heat in the heart and calm
the shen to arrest sweating.
• SP-6, the crossing point of three yin channels of the foot, tonifies
yin. LIV-2, the ying-spring point of the liver channel, clears heat in
the liver.
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TCM Treatment of Long COVID
heaviness of the body and head, nausea, poor appetite, loose stools
or defecation with a burning sensation in the anus, difficulty in uri-
nating, red tongue, yellow and slight greasy tongue coating, and a
slippery and rapid pulse.
Principle of Treatment:
Eliminate damp, clear the heat, regulate the liver and gallbladder,
and relieve sweating.
Herbal Treatment:
Hao Qin Qing Dan Tang-Sweet Wormwood and Scutellaria Decoction
to Clear the Gallbladder, plus
Lian Po Yin-Coptis and Magnolia Bark Drink.
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Explanations:
• Qing Hao and Zhi Zi clear damp-heat in the liver and gallbladder.
• Huang Qin clears damp-heat in the upper Jiao and relieves
cough.
• Huang Lian, Zhu Ru and Hou Po resolve damp in the middle Jiao,
clear heat and descend the stomach-qi.
• Zhi Ban Xia, Fu Ling and Chen Pi eliminate damp-phlegm in the
body and relieve cough and nausea.
• Lu Gen clears heat and relieves thirst.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Hao Qin Qing Dan Tang (Wan)-Sweet Wormwood and Scutellaria
Decoction to Clear the Gallbladder Pill.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Quchi L.I.-11, Yangchi
SJ-4, Shenmen HE-7, Zhongwan REN-12, Tianshu ST-25, Fenglong
ST-40, Sanyinjiao SP-6, Yinlingquan SP-9, Yanglingquan GB-34,
Qiuxu GB-40, and Xingjian LIV-2.
Explanations:
• The combination of P-6 + SP-4 regulates the internal organs and
clears damp-heat in the body.
• L.I.-4 and L.I.-11, the yuan-source point and the he-sea point of the
large intestine channel respectively, and ST-25, the front-mu point
of the large intestine, clear excessive heat and promote defecation.
• ST-40, the luo-connecting point of the stomach channel, SP-6 and
SP-9, the crossing point of the three yin channels of the foot and
the he-sea point of the spleen channel respectively, active the
spleen and stomach and eliminate damp-heat.
• SJ-4, the yuan-source point of the San Jiao, and REN-12, the gath-
ering point of the fu organs, eliminate damp-heat in the body.
• GB-34 and GB-40, the he-sea point and the yuan-source point of
the gallbladder channel respectively, together with LIV-2, the ying-
spring point of the liver channel, eliminate damp-heat in the liver
and gallbladder.
• HE-7, the yuan-source point of the heart channel, clears heat,
calms the shen, and relieves sweating.
592
TCM Treatment of Long COVID
136
Jude Mary Cénat, et al. Prevalence of symptoms of depression, anxiety, insomnia,
posttraumatic stress disorder, and psychological distress among populations affected
by the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatr Res.
2021, 295: 113599. doi: 10.1016/j.psychres.2020.113599.
137
Le Shi, et al. Prevalence of and risk factors associated with mental health symp-
toms among the general population in China during the coronavirus disease 2019
pandemic. JAMA Netw Open. 2020, 3(7): e2014053. doi: 10.1001/jamanetworko-
pen.2020.14053.
138
Zainab Alimoradia, et al. Sleep problems during COVID-19 pandemic and
its’ association to psychological distress: A systematic review and meta-
analysis. EClinicalMedicine. 2021, 36: 100916. https://doi.org/10.1016/j.
eclinm.2021.100916.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
139
Chaolin Huang, et al. op. cit.
Wei Wang, et al. Sleep disturbance and psychological profiles of medical staff
140
and non-medical staff during the early outbreak of COVID-19 in Hubei Province,
China. Front Psychiatry. 2020, 11: 733. 2020. https://doi.org/10.3389/
fpsyt.2020.00733.
594
TCM Treatment of Long COVID
141
Zainab Alimoradi, et al. op. cit.
142
Chenxi Zhang, et al. Survey of insomnia and related social psychological factors
among medical staff involved in the 2019 novel coronavirus disease outbreak. Front
Psychiatry. 2020, 11: 306. doi: 10.3389/fpsyt.2020.00306.
143
Yu-Tao Xiang, et al. The prevalence of insomnia, its sociodemographic and clinical
correlates, and treatment in rural and urban regions of Beijing, China: A general
population–based survey. Sleep. 2008, 31(12): 1655–1662. doi: 10.1093/
sleep/31.12.1655.
144
Ruey Chen, et al. Effects of a SARS prevention programme in Taiwan on nursing
staff’s anxiety, depression and sleep quality: A longitudinal survey. Int J Nurs Stud.
2006, 43(2): 215–225. doi: 10.1016/j.ijnurstu.2005.03.006.
595
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
of future life and financial stability, being afraid of losing family mem-
bers or friends, etc. Several policies implemented to reduce the
spread of COVID-19, such as home isolation, quarantine, curfews,
and lockdown could exert some negative influence on people.
Medications may be considered for patients with severe depres-
sion or anxiety disorders. Multicomponent interventions include
obtaining a comprehensive history, a sleep diary highlighting poten-
tial behavioral changes, addressing dysfunctional beliefs, and use of
stimulus control, sleep restriction and various relaxation methods
based on patient and therapist preferences.145
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TCM Treatment of Long COVID
In TCM, the heart is the location where the shen resides, deter-
mining the overall vitality of an individual. Besides sleep, the physi-
ological conditions are often observed through thinking, speaking,
responses, complexion, and the eyes. To fulfill its physiological func-
tions ultimately, the heart needs to maintain a harmonious relation-
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ship with different zang-fu organs. Any disorder in other organs could
result in dysfunction of the heart, leading to the occurrence of sleep
disorders. During COVID-19 and Long COVID, there are usually
dysfunctions of some zang-fu organs, which finally influence the
heart. Again, waking at certain hours, such as between 1:00–3:00 am,
between 3:00–5:00 am, or between 5 till 7:00 am, all indicate differ-
ent pathologies and involvement of different organs. For instance,
waking between 1:00–3:00 am is typically an indication of a disorder
in the liver and could relate to unresolved stress and anger. Waking
between 3:00–5:00 am is typically a disorder due to an imbalance in
the Metal Element and could relate to unresolved grief or a sense of
loss. Waking between 5:00–7:00 am is typically an indication due to
an imbalance in the Metal Element and large intestine.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
598
TCM Treatment of Long COVID
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
sensation, fatigue, thin, white, and greasy tongue coating, and a slip-
pery and superficial pulse.
Principle of Treatment:
Dispel wind, eliminate damp, harmonize the collaterals, and improve
sleep.
Herbal Treatment:
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
Damp.
Explanations:
• Qiang Huo, Du Huo and Fang Feng dispel wind, eliminate cold-
damp, and relieve remaining external pathogenic factors.
• Chuan Xiong and Gao Ben expel wind, promote qi and blood
circulation and relieve headaches.
• Fu Ling dries damp, eliminates phlegm, harmonizes the middle
Jiao and improves sleep.
• Ji Xue Teng, Ye Jiao Teng, and He Huan Pi harmonize the collater-
als, calm the shen and improve sleep.
• Zhi Gan Cao coordinates the effects of the other herbs in the
recipe.
Herbal Remedy:
Qiang Huo Sheng Shi Pian-Notopterygium Pill to Overcome Damp.
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TCM Treatment of Long COVID
Acupuncture Treatment:
• Hegu L.I.-4, Lieque LU-7, Waiguan SJ-5, Fengchi GB-20, Sanyinjiao
SP-6, Yinlingquan SP-9, Yanglingquan GB-34, Fenglong ST-40,
Taichong LIV-3, Neiguan P-6, Shaohai HE-3, Shenmen HE-7 and
Extra Sishencong.
• A reducing method is applied on all the points.
Explanations:
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and liver channel respectively, and GB-20, the crossing point
of the foot Shaoyang and Yangwei channels, regulate qi circulation
and relieve pain in the body.
• LU-7 and SJ-5, the luo-connecting point of the lung channel and
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Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and improve
sleep.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Xiao Yao San-Rambling Powder.
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver, promote the qi
circulation in the liver and relieve the qi stagnation in the liver.
• Zhi Ke promotes the qi circulation in the body and relieves
depression.
• Dang Gui and Chuan Xiong regulate the blood circulation in
the liver, harmonize and smooth the liver, and relieve pain in the
body.
• In most cases, the spleen and stomach will be invaded when there
is stagnation of liver-qi. Bai Zhu and Fu Ling strengthen the spleen
and stomach and improve the appetite.
• Huang Qin and Bo He clear internal heat resulting from the stag-
nation of liver-qi, and prevent further formation of liver-fire.
• Ye Jiao Teng, He Huan Pi and Fu Shen calm the shen and improve
sleep.
• Zhi Gan Cao harmonizes the actions of the other herbs.
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
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TCM Treatment of Long COVID
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Shuaigu GB-8,
Fengchi GB-20, Jianjing GB-21, Taichong LIV-3, Qimen LIV-14,
Neiguan P-6, Sanyinjiao SP-6, Shaohai HE-3, Shenmen HE-7 and
Extra Sishencong.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest points.
Explanations:
• SJ-5 + GB-41 is a combination to harmonize Shaoyang channels,
benefit the gallbladder and smooth the emotions.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, and LIV-14, the front-mu
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point of the liver, smooth the liver, regulate the qi circulation in the
body and relieve liver-qi stagnation. Meanwhile, they could
relieve depression.
• P-6, the luo-connecting point of the pericardium channel, regu-
lates qi circulation and calms the shen.
• HE-3, HE-7 and Extra Sishencong calm the shen, improve sleep
and regulate the emotion.
• SP-6, the crossing point of the three yin channels of the foot, pro-
motes the smooth qi and blood circulation in the liver.
• GB-8, GB-20 and GB-21 regulate the collateral of the gallbladder
channel, smooth the emotions, relieve the neck tension, and pro-
mote qi circulation.
Principle of Treatment:
Reduce liver-fire, clear heat in the heart, calm the shen and improve
sleep.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Treatment:
Long Dan Xie Gan Tang-Gentiana Longdancao Decoction to Drain
the Liver, plus
Dao Chi San-Guide Out the Red Powder.
Explanations:
• Long Dan Cao, Huang Qin, Xia Ku Cao and Zhi Zi clear heat in
the liver, reduce liver-fire and calm the liver.
• Dang Gui and Chuan Xiong promote liver-qi circulation, smooth
the liver, regulate blood circulation of blood, and relieve body
pain.
• Huang Lian clears heat, reduces heart-fire in the heart and
improves sleep.
• Sheng Di, Dan Zhu Ye, Mu Tong, Ze Xie and Zhi Gan Cao clear
heat, promote urination and induce fire out of the body through
urination.
• Gou Teng and Tian Ma calm the liver and suppress liver-yang.
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TCM Treatment of Long COVID
Herbal Remedy:
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4,
Hegu L.I.-4, Shaohai HE-3, Shaofu HE-8, Fengchi GB-20, Jianjing
GB-21, Xiaxi GB-43, Baihui DU-20, Xingjian LIV-2, Qimen LIV-
14, Sanyinjiao SP-6 and Extra Anmian.
• An even method is applied on SJ-5 + GB-41, P-6 + SP-4, and a
reducing method is applied on the rest of the points.
Explanations:
• A combination of SJ-5 + GB-41 harmonizes the Shaoyang chan-
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Promote circulation of blood, eliminate blood stasis, and improve
sleep.
Herbal Treatment:
Tao Hong Si Wu Tang-Four Substance Decoction with Safflower and
Peach Pit.
Explanations:
• Tao Ren, Hong Hua and Pu Huang promote blood circulation,
eliminate blood stasis and relieve body pain.
• Dang Gui, Chuan Xiong, Chi Shao Yao and Dan Shen promote
blood circulation, smooth the blood vessels and the collaterals,
and relieve body pain and painful menstruation.
• Since qi circulation promotes blood circulation, some herbs to
promote qi circulation are prescribed here as well, such as Xiang
Fu and Zhi Qiao.
• He Huan Pi, Fu Shen and Long Gu calm the shen and improve
sleep.
606
TCM Treatment of Long COVID
Herbal Remedy:
Tao Hong Si Wu Tang Pian-Four Substance Tablets with Safflower and
Peach Pit.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Taiyuan LU-9, Shaohai
HE-3, Shenmen HE-7, Geshu BL-17, Sanyinjiao SP-6, Taichong
LIV-3, Qimen LIV-14, Xinshu BL-15, and Ganshu BL-18.
• An even method is applied on P-6 + SP-4, and a reducing method
is applied to the rest points.
Explanations:
• Qi circulation guides blood circulation. A combination of P-6 +
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Clear heat, eliminate damp, calm the shen and improve sleep.
Herbal Treatment:
Huang Lian Wen Dan Tang-Warm Gallbladder Decoction with
Coptis.
Explanations:
• Huang Lian eliminates damp-heat in the gallbladder and heart,
clears the heart-fire and improves sleep.
• Zhi Ban Xia, Chen Pi, Fu Ling and Zhi Gan Cao eliminate damp,
resolve phlegm in the body, harmonize the middle Jiao and relieve
nausea.
• Zhi Shi and Zhu Ru harmonize the gallbladder and eliminate
damp-heat in the body.
• Sheng Di Huang and Zhi Zi clear heat in the heart and eliminate
the disturbance to the heart and gallbladder.
• He Huan Pi and Fu Shen calm the shen and improve sleep.
Herbal Remedy:
Huang Lian Wen Dan Pian-Warm Gallbladder Pill.
608
TCM Treatment of Long COVID
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Xingjian LIV-2,
Qimen LIV-14, Shaohai HE-3, Shaofu HE-8, Fengchi GB-20, Xiaxi
GB-43, Sanyinjiao SP-6, Zhongwan REN-12 and Extra Anmian.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest of the points.
Explanations:
• A combination of SJ-5 + GB-41 harmonizes the Shaoyang chan-
nels, benefits the gallbladder, and clears heat in the liver.
• L.I.-4 and LIV-14, the yuan-source point of the large intestine
channel and the front-mu point of the liver, smooth the liver, regu-
late the qi circulation in the body and relieve liver-qi stagnation.
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• LIV-2 and GB-43, the ying-spring point of the liver channel and
gallbladder channel respectively, clear heat, reduce fire and
relieve the disturbance to the gallbladder.
• LIV-14, the front-mu point of the liver, smooths the liver, promotes
qi circulation, and improves emotion.
• HE-3 and HE-8, the he-sea point and the ying-spring point of the
heart channel respectively, clear heat in the heart, calm the shen
and improve sleep.
• GB-20 regulates the collateral of the gallbladder channel, smooths
the emotions, and relieves the neck tension.
• Sanyinjiao SP-6, the crossing point of the three yin channels of the
foot, and REN-12, the gathering point of fu organs, eliminate
damp-heat in the body, resolve damp and improve sleep.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Activate the spleen and stomach, tonify qi and improve sleep.
Herbal Treatment:
Bai Zi Yang Xin Wan-Nourish the Heart Pill with Biotae.
Explanations:
• Dang Shen and Huang Qi tonify the qi of the body and relieve
fatigue and general weakness.
• Fu Ling and Zhi Gan Cao activate the spleen and tonify the qi.
Meanwhile, Fu Ling could improve sleep.
• Dang Gui and Chuan Xiong tonify blood and benefit the heart.
• Zhi Ban Xia benefits the middle Jiao and improves digestion.
• Bai Zi Ren, Suan Zao Ren, Ye Jiao Teng and Yuan Zhi benefit the
heart, improve sleep, and relieve sleep disorders.
Herbal Remedy:
Bai Zi Yang Xin Wan-Nourish the Heart Pill with Biotae.
Acupuncture Treatment:
• Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6, Qihai REN-6, Pishu
BL-20, Weishu BL-21, Shaohai HE-3, Shenmen HE-7 and Xinshu
BL-15.
• A tonifying method is applied to these points. Moxibustion should
be applied on ST-36 and REN-6.
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TCM Treatment of Long COVID
Explanations:
• ST-36, the he-sea point of the stomach channel, SP-3, the yuan-
source point of the spleen channel, BL-20 and BL-21, the back-shu
point of the spleen and stomach respectively, activate the spleen
and stomach, tonify qi and relieve fatigue and general weakness.
• REN-6 and SP-6, the crossing point of the three yin channels of the
foot, tonify qi and blood at the same time and strengthen the body
to relieve general fatigue and weakness.
• HE-3 and HE-7, the he-sea point, yuan-source point of the heart
channel respectively, and BL-15, the back-shu point of the heart,
tonify qi of the heart, calm the shen and improve sleep.
• Moxibustion promotes the yuan-source qi, benefits the body, and
relieves the weakness and cold in the body.
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Principle of Treatment:
Nourish blood, benefit the heart, calm the shen and improve sleep.
Herbal Treatment:
Gui Pi Tang-Restore the Spleen Decoction.
611
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Dang Shen, Huang Qi, Fu Ling and Zhi Gan Cao tonify the qi of
the body and relieve fatigue and general weakness. Meanwhile, Fu
Ling could improve sleep.
• Dang Gui, Shu Di Huang and Huang Jing tonify blood and benefit
the heart.
• Mu Xiang promotes qi circulation and benefits the middle Jiao to
improve digestion.
• Yuan Zhi, Suan Zao Ren, Ye Jiao Teng and Bai Zi Ren benefit the
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Herbal Remedy:
Gui Pi Wan-Restore the Spleen Pill.
Acupuncture Treatment:
• Zusanli ST-36, Sanyinjiao SP-6, Guanyuan REN-4, Qihai REN-6,
Taixi KID-3, Shenshu BL-23, Shaohai HE-3, Shenmen HE-7,
Neiguan P-6, Xinshu BL-15, Extra Sishencong and Extra Anmian.
• An even method is used on Extra Sishencong and Extra Anmian. A
tonifying method is applied to the rest of the points.
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of the three yin channels of the foot, activate the
spleen and stomach, tonify qi and blood and relieve general weak-
ness and fatigue.
• KID-3 and BL-23, the yuan-source point of the kidney channel and
the back-shu point of the kidney respectively, tonify kidney-jing
and benefit blood.
• REN-6 and REN-4 tonify qi and blood at the same time and relieve
general weakness and fatigue.
612
TCM Treatment of Long COVID
• HE-3 and HE-7, the he-sea point and the yuan-source point of the
heart channel respectively, P-6, the luo-connecting point, and
BL-15, the back-shu point of the heart, tonify heart-blood, benefit
the heart, calm the shen and improve sleep.
• Extra Sishencong and extra Anmian calm the shen and improve
sleep.
• REN-6, and SP-6, the crossing point of the three yin channels of
the foot, tonify qi and blood at the same time and strengthen the
body to relieve general fatigue and weakness.
• Moxibustion promotes the yuan-source qi, benefits the body, and
relieves the weakness and cold in the body.
of deficient fire
Sleep disorders (difficulty in falling asleep), restlessness, nervousness,
irritability, palpitations, thirst, dry throat and stool, tiredness, dizzi-
ness, night sweating, dry skin or hair, red tongue, thin and scanty
tongue coating, and a thready, weak, and rapid pulse.
Principle of Treatment:
Nourish yin, clear deficient heat, benefit the heart, calm the shen and
improve sleep.
Herbal Treatment:
Tian Wang Bu Xin Dan-Emperor of Heaven’s Special Pill to Tonify the
Heart.
613
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Mai Men Dong, Tian Men Dong, Yu Zhu, Gui Ban and Wu Wei Zi
nourish yin, promote the production of body fluid, and benefit the
body.
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• Bai Shao smooths the liver, nourishes liver-yin, and relieves spasms
in the body.
• Sheng Di Huang and Xuan Shen clear deficient heat and relieve
restlessness.
• Dan Shen clears heat in the heart and calms the shen.
• Dang Shen tonifies qi of the spleen to promote the production of
qi and yin in the body.
• Fu Shen, Duan Long Gu, Bai Zi Ren, and He Huan Pi calm the
shen and improve sleep.
• Zhi Gan Cao harmonizes the herbs in the prescription.
Herbal Remedy:
Tian Wang Bu Xin Dan-Emperor of Heaven’s Special Pill to Tonify the
Heart.
Acupuncture Treatment:
• Zusanli ST-36, Sanyinjiao SP-6, Taichong LIV-3, Ququan LIV-8,
Taixi KID-3, Fuliu KID-7, Yingu KID-10, Shenmen HE-7, Xinshu
BL-15, Ganshu BL-18, Shenshu BL-23, extra Sishencong and extra
Anmian.
• An even method is applied on LIV-3, extra Sishencong and extra
Anmian. A tonifying method is applied on these points.
614
TCM Treatment of Long COVID
Explanations:
• ST-36, the he-sea point of the stomach channel, activates the
spleen and stomach, tonifies qi and blood and relieves general
weakness and fatigue.
• SP-6, the crossing point of three yin channels of the foot, KID-3,
the yuan-source point of the kidney channel, BL-23, the back-shu
point of the kidney, LIV-8 and KID-10, the he-sea point of the liver
channel and kidney channel respectively, and KID-7 tonify blood,
yin and kidney-jing at the same time, relieve the general fatigue
and weakness so as to improve sleep.
• LIV-3 and BL-18, the yuan-source point of the liver channel and
the back-shu point of the liver respectively, smooth the liver, pro-
mote the qi circulation, and relieve tension in the body so as to
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improve sleep.
• HE-7 and BL-15, the yuan-source point of the heart channel and
the back-shu point of the heart respectively, nourish yin of the
heart, calm the shen, and improve sleep.
• Extra Sishencong and extra Anmian improve sleep and relieve
insomnia.
615
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
could be both, especially the latter, where the inner ear can’t process
sound that should be sent to the brain. Hearing loss associated
with COVID-19 has been reported across a wide age range and
severity, ranging from mild to severe. There are several case reports
of sudden loss of hearing in one ear, often accompanied by tinnitus.
Tinnitus is a common condition, affecting around 17% of all adults.
Most people with tinnitus also have hearing loss, suggesting a close
link between the two.146 In most studies of audio-vestibular dysfunc-
tion & COVID-19, tinnitus is not well-defined but has been described
as a non-pulsatile white noise or specific to certain frequencies,
intermittent or continuous. In addition to hearing loss, millions of
people are expected to suffer from tinnitus after diagnosis of
COVID-19.147
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146
Kevin Munro. COVID associated with hearing loss, tinnitus and vertigo–new study
confirms link. The Conversation. 22 March, 2021. https://theconversation.com/
covid-associated-with-hearing-loss-tinnitus-and-vertigo-new-study-confirms-
link-157522.
147
Sugata Bhattacharjee. Opinion: Millions of people have hearing loss after
COVID-19. NDTV. 1 June 2021. https://www.ndtv.com/opinion/opinion-millions-of-
people-have-hearing-loss-after-covid-19-2453615.
148
First reported UK case of sudden permanent hearing loss linked to COVID-19.
BMJ Case Reports. 13 October 2020. doi: 10.1136/bcr-2020-238419. https://www.
bmj.com/company/newsroom/first-reported-uk-case-of-sudden-permanent-hearing-
loss-linked-to-covid-19/.
616
TCM Treatment of Long COVID
7.6%(CI: 2.5-15.1) and 14.8%(CI: 6.3-26.1) for hearing loss and tin-
nitus respectively.149
Hearing threshold refers to the lowest level that sound can be
heard 50% of the time. Using electro audiometry, the average hear-
ing threshold for frequencies of 0.25–4 kHz was determined.
Based on the threshold, hearing acuity was classified into three
tiers:
www.nccaom.org/wp-content/uploads/pdf/Acupuncture%20and%20Herbs%20
Quiet%20Tinnitus.pdf.
617
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
151
Chantal Degen, et al. Acute profound sensorineural hearing loss after COVID-19
pneumonia. Mayo Clin Proc. 2020, 95(8): 1801–1803. doi: 10.1016/j.mayocp.2020.
05.034.
152
Turgut Celik, et al. Evaluation of cochlear functions in infants exposed to SARS-
CoV-2 intrauterine. Am J Otolaryngol. 2021, 42(4): 102982. doi: 10.1016/j.
amjoto.2021.102982.
153
Mohamed Wael Mohamed Mustafa. Audiological profile of asymptomatic
COVID-19 PCR-positive cases. Am J Otolaryngol. 2020, 41(3): 102483. doi:
10.1016/j.amjoto.2020.102483.
154
Toshiaki Iba, et al. The coagulopathy, endotheliopathy, and vasculitis of
COVID-19. Inflammation Research. 2020, 69(12): 1181–1189. doi: 10.1007/
s00011-020-01401-6.
155
Alireza Radmanesh, et al. COVID-19–associated diffuse leukoencephalopathy
and microhemorrhages. Radiology. 2020, 297(1): E223. https://doi.org/10.1148/
radiol.2020202040.
156
Joy Victory. COVID-19 and hearing loss: What we know. Healthy Hearing.
30 August 2021. https://www.healthyhearing.com/report/53127-Coronavirus-hearing-
loss-tinnitus-covid.
157
Eldré W. Beukes, et al. Changes in tinnitus experiences during the COVID-19
Pandemic. Front Public Health. 2020, 8: 592878. https://doi.org/10.3389/
fpubh.2020.592878.
618
TCM Treatment of Long COVID
619
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Yangqiao mai and Yangwei mai pass through or run in front of the ear
to maintain the physiological functions of the ear.
Besides, these channels have their mutual connections with dif-
ferent zang-fu organs, such as the liver and gallbladder, the heart and
small intestine, and the Pericardium and San Jiao. Moreover, the Du
channel and the liver channel also have their connection or distribu-
tion on the head. The kidney is the important organ to produce mar-
row and the Brain is the sea of marrow. The spleen transforms the
essence of food into qi and blood, which nourishes the brain and
the orifices. lung disperses qi to all the parts of the body, including
the head and ear. The heart dominates blood circulation, blood
vessels, and is in charge of mental activity. Moreover, blood is the
basic energetic source for the physiological activity of the brain.
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620
TCM Treatment of Long COVID
621
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Principle of Treatment:
Dispel wind, eliminate damp, harmonize the collaterals, and relieve
tinnitus.
Herbal Treatment:
Shu Jing Huo Xue Tang-Relax the Channels and Invigorate the Blood
Decoction.
622
TCM Treatment of Long COVID
Explanations:
• Qiang Huo, Fang Feng and Bai Zhi dispel the remaining external
wind, eliminate cold-damp from the upper parts of the body and
relieve remaining external pathogenic factors.
• Gao Ben and Wei Ling Xian harmonize the collaterals and elimi-
nate cold-damp.
• Hong Hua, Dang Gui, Chuan Xiong and Chi Shao Yao
promote qi and blood circulation, eliminating blood stasis in the
collaterals.
• Shi Chang Pu and Yuan Zhi eliminate damp, benefit the ear, and
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improve hearing.
• Zhi Gan Cao coordinates the effects of the other herbs in the
prescription.
Herbal Remedy:
Shu Jing Huo Xue Tang Ke Li-Relax the Channels and Invigorate the
Blood Granulate.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Lieque LU-7, Shuaigu
GB-8, Fengchi GB-20, Shenting DU-24, Tinghui GB-2, Sizhukong
SJ-23, Tinggong SI-19, and Sanyinjiao SP-6.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest of the points.
Explanations:
• A combination of SJ-5 + GB-41 harmonize Shaoyang collaterals,
dispel external pathogenic factors, benefit the ears, and improve
hearing.
• L.I.-4, the yuan-source point of the large intestine channel, and
LU-7, the luo-connecting point of the lung channel, promote the
qi circulation in the head, eliminate damp in the upper Jiao and
relieve external pathogenic factors.
623
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• GB-8, a local point around the ear, and GB-20, the crossing point
of the foot Shaoyang and Yangwei channels, dispel wind, harmo-
nize the collaterals, and relieve tension around the neck and head.
• GB-2, SJ-23 and SI-19, all the local points around the ear which
are connected with different channels, promote the qi and blood
circulation, harmonize the collaterals, improve hearing and relieve
tinnitus.
• DU-24 benefits the shen, opens the clear orifice and improves
hearing and tinnitus.
• SP-6, the crossing point of the three yin channels of the foot,
promotes blood circulation and relieves stagnation of blood in the
collaterals.
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Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and improve
hearing.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
624
TCM Treatment of Long COVID
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver, promote liver-qi cir-
culation, and relieve the spasm in the liver and at the neck.
• Dang Gui and Chuan Xiong nourish blood in the liver, harmonize
and smooth the liver and relieve tension and spasm in the scalp,
head, and hypochondriac region. Meanwhile, they promote blood
circulation and relieve blood stasis in the ear.
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• Bai Zhu and Fu Ling strengthen the spleen and stomach and
improve the appetite.
• Huang Qin, Ju Hua, and Bo He clear internal heat resulting
from the stagnation of liver-qi and prevent further formation of
liver-fire.
• Bai Ji Li and Yuan Zhi benefit the clear orifice and improve hearing
loss and tinnitus.
• Zhi Gan Cao harmonizes the other herbs in the prescription.
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4,
Hegu L.I.-4, Shuaigu GB-8, Tinghui GB-2, Yifeng SJ-17, Sizhukong
SJ-23, Tinggong SI-19, Fengchi GB-20, Jianjing GB-21, Taichong
LIV-3, Qimen LIV-14 and Sanyinjiao SP-6.
• An even method is applied on SJ-5 + GB-41, P-6 + SP-4, and a
reducing method is applied on the rest of the points.
Explanations:
• A combination of SJ-5 + GB-41 harmonizes Shaoyang channels,
benefits the gallbladder, and relieves hearing loss and tinnitus.
625
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
motes the smooth qi and blood circulation in the liver and in the
head.
Principle of Treatment:
Reduce liver-fire, clear heat, calm the shen and improve hearing loss
and tinnitus.
Herbal Treatment:
Long Dan Xie Gan Tang-Gentiana Longdancao Decoction to Drain
the Liver.
626
TCM Treatment of Long COVID
Explanations:
• Long Dan Cao, Huang Qin, Xia Ku Cao and Zhi Zi clear heat in
the liver, reduce liver-fire and relieve burning sensation in the ear.
• Dang Gui, Chuan Xiong and Chai Hu promote liver-qi circulation
and smooth the liver.
• Ze Xie and Che Qian Zi promote urination and induce fire out of
the body through urination.
• Sheng Di clears heat in the liver and nourishes the yin of the liver
and kidney.
• Bai Ji Li and Ju Hua smooth the liver and relieve dizziness.
• Zhi Gan Cao harmonizes the actions of the other herbs.
• Gou Teng and Tian Ma calm the liver and suppress liver-wind.
Herbal Remedy:
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Shaohai HE-3, Shaofu
HE-8, Shuaigu GB-8, Tinghui GB-2, Yifeng SJ-17, Sizhukong SJ-23,
Tinggong SI-19, Fengchi GB-20, Jianjing GB-21, Xiaxi GB-43,
Xingjian LIV-2, Qimen LIV-14, and Sanyinjiao SP-6.
627
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• A combination of SJ-5 + GB-41 harmonizes the Shaoyang chan-
nels, benefits the gallbladder, and improves hearing and tinnitus.
• L.I.-4 and LIV-14, the yuan-source point of the large intestine chan-
nel and the front-mu point of the liver, smooth the liver, regulate
the qi circulation in the body and relieve liver-qi stagnation.
• LIV-2 and GB-43, the ying-spring point of the liver channel and
gallbladder channel respectively, clear heat, reduce liver-fire and
sedate tinnitus.
• HE-3 and HE-8, the he-sea point and the ying-spring point of the
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heart channel respectively, clear heat in the heart, calm the shen
and smooth the liver as well.
• GB-20 and GB-21 regulate the collateral of the gallbladder chan-
nel, smooth the emotions, relieve the neck tension, promote qi
circulation in the head and improve hearing and tinnitus.
• GB-8, GB-2, SJ-17, SJ-23, and SI-19, all the local points around the
ear, harmonize the collaterals around the ear and improve hearing
and tinnitus.
• SP-6, the crossing point of the three yin channels of the foot, pro-
motes the smooth qi and blood circulation in the liver and in the
head.
Principle of Treatment:
Activate the spleen, eliminate damp, resolve phlegm, harmonize the
collaterals, and improve hearing loss and tinnitus.
628
TCM Treatment of Long COVID
Herbal Treatment:
Ban Xia Bai Zhu Tian Ma Tang-Pinellia, Atractylodes Macrocephala
and Gastrodia Decoction.
Explanations:
• Ban Xia and Chen Pi dry damp, resolve phlegm in the body and
relieve nausea.
• Fu Ling and Bai Zhu activate the spleen, promote the physiological
functions of the spleen, and eliminate damp in the body.
• Cang Zhu and Hou Po eliminate damp-phlegm in the body and
relieve nausea.
• Tian Ma, Bai Ji Li, Shi Chang Pu, Yuan Zhi and Di Long calm the
liver, eliminate damp, improve hearing, and relieve tinnitus.
• Zhi Gan Cao harmonizes the functions of other herbs in the
prescription.
Herbal Remedy:
Ban Xia Bai Zhu Tian Ma Pian-Pinellia, Atractylodes Macrocephala
and Gastrodia Tablet.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4,
Hegu L.I.-4, Shuaigu GB-8, Tinghui GB-2, Yifeng SJ-17, Sizhukong
629
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• SJ-5 + GB-41 promote the circulation of qi circulation Shaoyang
channels, harmonize the collaterals and improve hearing and
tinnitus.
• P-6 + SP-4 regulate emotions, promote digestion, and eliminate
damp-phlegm.
• L.I.-4, the yuan-source point of the large intestine channel, pro-
motes qi circulation in the body.
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• REN-12, the front-mu point of the stomach and the influential point
for the fu organs, SP-6, the crossing point of three yin channels of
the foot, SP-9, the he-sea point of the spleen channel, and ST-40,
the luo-connecting point of the stomach channel, activate the
spleen, eliminate damp-phlegm, and improve digestion.
• GB-8, GB-2, SJ-17, SJ-23, SI-19, ST-8, all the local points from the
ear, promote qi circulation, harmonize the collaterals, and improve
hearing and tinnitus.
Principle of Treatment:
Tonify qi, reinforce blood, benefit kidney-jing, and improve hearing
and tinnitus.
630
TCM Treatment of Long COVID
Herbal Treatment:
Shi Quan Da Bu Tang-All-Inclusive Great Tonifying Decoction.
Explanations:
• Dang Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, forming a prescrip-
tion as Si Jun Zi Tang, together with Huang Qi, activate the spleen
and stomach, tonify qi of the general body, dispel internal cold and
relieve tiredness.
• Shu Di Huang, Dang Gui, Bai Shao, Chuan Xiong, Huang Jing and
He Shou Wu tonify blood and benefit kidney-jing.
• Tian Ma and Bai Ji Li benefit the head and improve hearing and
tinnitus.
Herbal Remedy:
Shi Quan Da Bu Wan-All-Inclusive Great Tonifying Pill.
Acupuncture Treatment:
• Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6, Qihai REN-6, Pishu
BL-20, Weishu BL-21, Baihui DU-20, Shenting DU-24, Shuaigu
GB-8, Tinghui GB-2, Yifeng SJ-17, Sizhukong SJ-23, Tinggong
SI-19, and Touwei ST-8.
631
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-3, the
yuan-source point of the spleen channel, BL-20 and BL-21, the
back-shu point of the spleen and stomach respectively, activate
the spleen and stomach, tonify qi and blood.
• REN-6, and SP-6, the crossing point of the three yin channels of
the foot, tonify qi and blood at the same time and strengthen the
body to relieve general fatigue and weakness.
• DU-20 and DU-24 lift-up qi and blood to the headache to benefit
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632
TCM Treatment of Long COVID
COVID-19 infection. JAMA Netw Open. 2021, 4(10): e2130645. doi: 10.1001/
jamanetworkopen.2021.30645.
633
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
respiratory symptoms at the onset, and the severity of the illness (ICU
admission).161
With brain fog, the patients feel a sensation similar to “a foggy
haze in their head” that makes it harder to access their thoughts or
plans. Their thoughts and emotions may feel numb and different, and
daily physical activities and duties require more effort. As such, their
mental and physical states feel less sharp and flexible as usual. Some
additional symptoms of patients with brain fog include:
It’s not yet clear why COVID-19 survivors are so likely to experi-
ence neurological symptoms, but the medical community is still
researching potential causes of brain fog after COVID-19. Researchers
have identified several possible causes, including162:
161
Ali A. Asadi-Pooya, et al. Long COVID syndrome-associated brain fog. Journal of
Medical Virology. 2021, 94(3): 979–984.. https://doi.org/10.1002/jmv.27404.
162
Hackensack Meridian Health. Can COVID-19 cause brain fog? 11 August 2021.
https://www.hackensackmeridianhealth.org/HealthU/2021/08/11/can-covid-19-
cause-brain-fog/.
634
TCM Treatment of Long COVID
635
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
636
TCM Treatment of Long COVID
Principle of Treatment:
Activate the spleen, eliminate damp, resolve phlegm, harmonize the
collaterals, and relieve brain fog.
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Herbal Treatment:
Ban Xia Bai Zhu Tian Ma Tang-Pinellia, Atractylodes Macrocephala
and Gastrodia Decoction.
Explanations:
• Ban Xia and Chen Pi dry damp, resolve phlegm in the body and
relieve nausea.
• Fu Ling and Bai Zhu activate the spleen and eliminate damp.
• Cang Zhu and Hou Po eliminate damp-phlegm in the body and
relieve nausea.
637
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Tian Ma, Bai Ji Li, Shi Chang Pu and Yuan Zhi calm the liver,
eliminate damp, and relieve brain fog.
• Ge Gen ascends the clear-qi, descends turbid qi and relieves brain
fog.
• Zhi Gan Cao harmonizes the functions of other herbs in the
prescription.
Herbal Remedy:
Ban Xia Bai Zhu Tian Ma Pian-Pinellia, Atractylodes Macrocephala
and Gastrodia Tablet.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4,
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Explanations:
• A combination of SJ-5 + GB-41 could regulate the Shaoyang chan-
nels, harmonize the collaterals on the head, and relieve brain fog.
• A combination of P-6 + SP-4 harmonizes the Yinwei channel,
regulates the zang organs, promotes digestion and eliminates
damp-phlegm.
• GB-8, ST-8, Extra Taiyang, Extra Yintang and Extra Sishencong
eliminate damp-phlegm, remove the disturbance of damp-phlegm
to the brain, benefit the clear-yang and relieve brain fog.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine
channel and liver channel respectively, promote qi circulation,
calm the liver, and relieve the blockage in the brain by damp-
phlegm.
• GB-20 smooths the tension at the neck, promotes the qi circula-
tion in the gallbladder channel and calms emotions.
• REN-12, the front-mu point of the stomach and the influential
point for the fu organs.
638
TCM Treatment of Long COVID
• SP-9, the he-sea point of the spleen channel, and ST-40, the
luo-connecting point of the stomach channel, activate the spleen,
eliminate damp-phlegm, and improve digestion.
Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and relieve
brain fog.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
Explanations:
• Chai Hu and Bai Shao Yao smooth the liver, regulate and promote
liver-qi circulation and relieve qi stagnation in the liver.
639
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Dang Gui and Chuan Xiong nourish and benefit the blood in the
liver, harmonize and smooth the liver and relieve tension and
spasm in the scalp, head, and the hypochondriac region.
• Bai Zhu and Fu Ling strengthen the spleen and stomach and
improve the appetite.
• Huang Qin and Bo He clear internal heat resulting from the stag-
nation of liver-qi and prevent further formation of liver-fire.
• Bai Ji Li and Yuan Zhi benefit the brain, regulate the shen and
relieve brain fog.
• Zhi Gan Cao harmonizes the actions of the other herbs in the
prescription.
Herbal Remedy:
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Acupuncture Treatment:
• Waiguan SJ-5 + Zulingqi GB-41, Hegu L.I.4, Shuaigu GB-8,
Toulinqi GB-15, Yanglingquan GB-34, Extra Yintang, Extra Taiyang,
Extra Sishencong, Fengchi GB-20, Jianjing GB-21, Taichong LIV-3,
Qimen LIV-14, Neiguan P-6, and Sanyinjiao SP-6.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied on the rest of the points.
Explanations:
• SJ-5 + GB-41 is a combination to harmonize Shaoyang channels,
benefit the gallbladder and relieve brain fog.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, and LIV-14, the front-mu
point of the liver, smooth the liver, regulate the qi circulation in the
body and relieve liver-qi stagnation.
• P-6, the luo-connecting point of the pericardium channel, regulates
qi circulation, calms the shen and benefits the stomach.
• Extra Sishencong calms the shen, improves sleep and regulates
emotion.
640
TCM Treatment of Long COVID
• SP-6, the crossing point of the three yin channels of the foot, pro-
motes the smooth qi and blood circulation in the liver and in the
head.
• GB-8, GB-15, GB-20, GB-21 and GB-34 regulate the collateral of
the gallbladder channel, smooth the emotions, benefit the head,
relieve the neck tension, and promote qi circulation in the head to
relieve brain fog.
• Extra Yintang and Extra Taiyang, the local points, relieve
dizziness.
11.21.2.3 Deficiency of qi
Brain fog after COVID-19, empty sensation in the head, aggravation
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Principle of Treatment:
Tonify qi, activate the spleen and stomach and relieve brain fog.
Herbal Treatment:
Bu Zhong Yi Qi Tang-Tonify the Middle and Augment the Qi
Decoction.
641
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Dang Shen, Bai Zhu, Fu Ling and Zhi Gan Cao, known as Si Jun
Zi Tang, activate the spleen and stomach, tonify spleen-qi and
relieve general fatigue and weakness.
• Huang Qi and Sheng Ma tonify spleen-qi and lift the qi to the head
to benefit it.
• Chen Pi, Mu Xiang and Sha Ren harmonize stomach-qi and pro-
mote appetite.
• Bai Ji Li and Shi Chang Pu resolve damp in the head and relieve
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brain fog.
• Zhi Gan Cao harmonizes the herbs in the prescription.
Herbal Remedy:
Bu Zhong Yi Qi Wan-Tonify the Middle and Augment the Qi Tablets.
Acupuncture Treatment:
• Baihui DU-20, Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6, Qihai
Ren-6, Pishu BL-20, Weishu BL-21, Shenting DU-24, Touwei ST-8
and Extra Yintang.
• A tonifying method is applied to these points. Moxibustion should
be applied on REN-6 and ST-36.
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-3, the
yuan-source point of the spleen channel, BL-20 and BL-21,
the back-shu point of the spleen and stomach respectively, activate
the spleen and stomach, tonify qi and promote digestion.
• REN-6, and SP-6, the crossing point of the three yin channels of
the foot, tonify qi and blood at the same time and strengthen the
body to relieve general fatigue and weakness.
642
TCM Treatment of Long COVID
appetite, pale tongue, thin and white tongue coating, and a thready
and weak pulse.
Principle of Treatment:
Tonify blood, benefit kidney-jing, relieve weakness and brain fog.
Herbal Treatment:
Si Wu Tang-Four Substances Decoction.
643
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Shu Di Huang, Dang Gui, Bai Shao, Chuan Xiong, Huang Jing and
He Shou Wu tonify and nourish the blood, benefit kidney-jing and
relieve brain fog.
• Tian Ma and Bai Ji Li benefit the head and relieve brain fog.
• Zhi Gan Cao harmonizes the herbs in the prescription.
• Rou Cong Rong and Sang Ji Sheng tonify kidney-jing and
strengthen the lower back and relieve the weakness of the knees.
Herbal Remedy:
Shi Quan Da Bu Wan-All-Inclusive Great Tonifying Pill.
Acupuncture Treatment:
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Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of three yin channels of the foot, activate the spleen
and stomach, tonify qi and blood and relieve brain fog.
• Since kidney-jing and blood share the same origin and benefit
each other constantly, some points should be used to tonify
kidney-jing to tonify blood. KID-3, the yuan-source point of the
kidney channel, LIV-8 and KID-10, the he-sea point of the liver
channel and kidney channel respectively, tonify blood and jing at
the same time, relieve the general fatigue and weakness so as to
relieve brain fog.
• GB-39, the influential point for marrow, benefits blood and
relieves blood deficiency.
• DU-20 and DU-24, benefit the head and relieve brain fog.
• GB-8, Extra Taiyang, Extra Yintang and Extra Sishencong benefit
the head, harmonize the collateral and relieve brain fog.
644
TCM Treatment of Long COVID
• LIV-3, the yuan-source point of the liver channel, and HE-7, the
yuan-source point of the heart channel, promote qi and
blood circulation, calm the shen, improve sleep and relieve
brain fog.
anymore.
There are several types of hair loss, and it could be caused by
different factors, such as gender, age, genetics, malnutrition, improper
diet, environmental changes and pollution. Also, some sicknesses,
such as thyroid disorders, autoimmunity, and anaemia could also
cause hair loss. However, hair loss due to COVID-19 is something
else.
Whenever a person experiences severe infection, including
COVID-19, hair fall is not an unusual after-effect, since the body has
sustained an attack and fought off the virus, which often occurs a few
weeks post recovery from COVID-19. During this process, the hair
falls at a rate of more than 100–200 per day, although it could be
distressing for the patient. The hair growth patterns will return to nor-
mal after a few months. However, an overwhelming number of peo-
ple are reporting severe hair fall post COVID-19 infection.
Hair loss due to Long COVID is not the same as a skin condition,
called seborrheic dermatitis, wherein there is an excess production
of sebum on the scalp, typically accompanied by itching, pain, flak-
ing dandruff, oily and peeling scalp.
One finding revealed that 63% of the patients experienced
fatigue or muscle weakness, 26% suffered with sleeping problems,
23% had anxiety or depression, and 22% suffered from hair loss. It
also found that 76% of patients reported at least one symptom six
645
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
months after the first symptom onset, with the proportion higher in
women. Patients who were severely ill from the virus were more
likely to suffer from the likes of muscle weakness and depression.163
There’s no clear evidence yet that the novel coronavirus itself
directly causes hair loss, but it is generally accepted that the hair
entered the telogen phase prematurely, causing existing hair to shed
in order to pave way for new healthy hair to grow during COVID-19
infection. It is a temporary procedure. It is also believed that the
physical and emotional stress that accompanies a case of COVID-19
can lead to a reversible hair loss, a condition called telogen efflu-
vium. Stress can cause temporary hair shedding, and even if people
never developed a fever or COVID-19, it is still beneficial to observe
hair shedding in some patients. Emotional issues such as stress, anxi-
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ety, and restlessness during the pandemic, can also force more hairs
than normal into the shedding phase. Stress-induced telogen efflu-
vium is characterized by diffused hair loss within months of a signifi-
cant systemic stressor because of premature follicular transition from
the anagen (active growth phase) to the telogen (resting phase). The
telogen phase lasts approximately three months, after which exces-
sive hair loss ensues.164 “When there’s a shock to the system, the
body goes into lockdown mode and only focuses on essential func-
tions. Hair growth is not as essential as other functions, so you end
up with hair shedding” explained a dermatologist at the Ohio State
University Wexner Medical Centre.165
In terms of treatment, moderate hair fall can be controlled at
home with the help of diet, exercise, emotional coaches, meditation,
and having appropriate rest and sleep. However, both moderate and
severe hair loss should be managed properly to rebalance the
patient’s physical and mental conditions.
163
Chaolin Huang, et al. op. cit.
164
Fahham Asghar, et al. Telogen effluvium: A review of the literature. Cureus.
2020, 12(5): e8320. doi: 10.7759/cureus.8320.
165
Joni Sweet. COVID-19 survivors are losing their hair—here’s why. Healthline.
22 August 2020. https://www.healthline.com/health-news/covid-19-survivors-are-
losing-their-hair-heres-why#Stress-may-be-to-blame.
646
TCM Treatment of Long COVID
647
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
648
TCM Treatment of Long COVID
Principle of Treatment:
Smooth the liver, promote qi circulation, calm the shen and improve
hair loss.
Herbal Treatment:
Xiao Yao San-Rambling Powder.
Explanations:
• Chai Hu, Bai Shao Yao and Zhi Ke smooth the liver, regulate
and promote liver-qi circulation and relieve qi stagnation in the
liver.
• Dang Gui and Chuan Xiong nourish and benefit the blood in the
liver, harmonize and smooth the liver and relieve tension and
spasm in the scalp, head, and the hypochondriac region.
• Bai Ji Li, Jie Geng and Fang Feng guide the effect of the prescrip-
tion to the head and scalp and harmonize the collaterals on the
scalp.
• Yuan Zhi benefits the brain, regulates the shen and relieves insomnia.
• Ce Bai Ye strengthens hair growth and prevents further hair loss.
649
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Zhi Gan Cao harmonizes the actions of the other herbs in the
prescription.
Herbal Remedy:
Xiao Yao Wan-Rambling Pill.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Neiguan P-6 + Gongsun SP-4,
Hegu L.I.-4, Shuaigu GB-8, Toulinqi GB-15, Yanglingquan GB-34,
Extra Yintang, Extra Sishencong, Fengchi GB-20, Jianjing GB-21,
Taichong LIV-3, Qimen LIV-14, Shenmen HE-7 and Ganshu BL-18.
• An even method is applied on SJ-5 + GB-41, P-6 + SP-4, and a
reducing method is applied to the rest of the points.
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Explanations:
• A combination of SJ-5 + GB-41 harmonizes Shaoyang channels,
benefits the gallbladder, and relieves tension at the neck and lat-
eral aspects of the head.
• A combination of P-6 + SP-4 smooths the liver, regulates qi and
blood circulation, and calms the shen.
• L.I.-4 and LIV-3, the yuan-source point of the large intestine chan-
nel and the liver channel respectively, LIV-14, the front-mu point
of the liver, BL-18, the back-shu point of the liver, and GB-34, the
he-sea point of the gallbladder channel, smooth the liver, regulate
the qi circulation in the body, relieve liver-qi stagnation and
improve emotions.
• HE-7, the yuan-source point of the heart channel, and extra
Sishencong, promote qi circulation, calm the shen and emotions
and improve sleep.
• GB-8, GB-15, GB-20 and GB-21 regulate the collateral of the
gallbladder channel, smooth the emotions, benefit the head,
relieve the neck tension, and promote qi circulation in the head to
relieve hair loss.
• Extra Yintang and Extra Taiyang, the local points, improve qi and
blood circulation in the scalp and relieve hair loss.
650
TCM Treatment of Long COVID
Principle of Treatment:
Activate the spleen, eliminate damp, resolve phlegm, harmonize the
collaterals, and improve hair loss.
Herbal Treatment:
Qiang Huo Sheng Shi Tang-Notopterygium Decoction to Overcome
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Dampness.
Explanations:
• Qiang Huo, Du Huo, Fang Feng and Gao Ben dispel wind, elimi-
nating the remaining damp in the channels and collaterals.
• Chuan Xiong expels wind, promotes qi and blood circulation, and
relieves stagnation in the channels and collaterals.
• Jie Geng guides the effect of the prescription on the head and scalp
and harmonizes the collaterals on the scalp.
• Yuan Zhi benefits the brain, regulates the shen and relieves
insomnia.
• Ce Bai Ye strengthens hair growth and prevents further hair loss.
651
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Zhi Gan Cao coordinates the effects of the other herbs in the
recipe.
Herbal Remedy:
Qiang Huo Sheng Shi Pian-Notopterygium Pill to Overcome
Dampness.
Acupuncture Treatment:
• Waiguan SJ-5 + Zulinqi GB-41, Hegu L.I.-4, Lieque LU-7, Fengchi
GB-20, Shuaigu GB-8, Toulinqi GB-15, Yanglingquan GB-34,
Sanyinjiao SP-6, Yinlingquan SP-9 and Fenglong ST-40.
• An even method is applied on SJ-5 + GB-41, and a reducing
method is applied to the rest of the points.
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Explanations:
• A combination of SJ-5 + GB-41 harmonizes Shaoyang channels,
benefits the gallbladder, and relieves tension at the neck and lat-
eral aspects of the head.
• L.I.-4, the yuan-source point of the large intestine channel, and
LU-7, the luo-connecting point of the lung channel, promote the
qi circulation, dispel external damp in the channels and collaterals
on the head and scalp.
• GB-8, GB-15, GB-20, and GB-34 regulate the collateral of the
gallbladder channel, smooth the emotions, benefit the head,
relieve the neck tension, and promote qi circulation in the head to
relieve hair loss.
• SP-6 and SP-9, the crossing point of three yin channels of the foot,
and the he-sea point of the spleen channel respectively, and ST-40,
the luo-connecting of the stomach channel, promote, activate the
spleen and stomach and eliminate damp in the body.
652
TCM Treatment of Long COVID
Principle of Treatment:
Promote circulation of blood, eliminate blood stasis, and improve
hair loss.
Herbal Treatment:
Tong Qiao Huo Xue Tang-Open the Portals and Quicken the Blood
Decoction.
Explanations:
• Tao Ren, Hong Hua, Pu Huang, Xian He Cao and Dan Shen pro-
mote blood circulation and eliminate blood stasis. Meanwhile,
Dan Shen cools the heat in the blood due to stagnation of blood.
• Dang Gui, Chuan Xiong, Chi Shao Yao promote blood circulation,
regulate blood and benefit blood. In this way, blood is not dam-
aged by using some blood circulation herbs.
• Since qi circulation promotes blood circulation, some herbs to
promote qi circulation are prescribed here as well, such as Xiang
Fu and Zhi Qiao are used to promote qi circulation to lead blood
circulation.
• Zhi Gan Cao harmonizes the effects of the prescription.
653
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Huo Xue Tong Mai Pian-Quicken the Blood and Smooth the Vessels
Tablets.
Acupuncture Treatment:
• Lieque LU-7 + Zhaohai KID-6, Shenmai BL-62 + Houxi SI-3, Hegu
L.I.-4, Shenting DU-24, Shuaigu GB-8, Fengchi GB-20, Taiyuan
LU-9, Shaohai HE-3, Shenmen HE-7, Geshu BL-17, Sanyinjiao
SP-6 and Taichong LIV-3.
• An even method is applied to LU-7 + KID-6, and a reducing
method is applied to the rest of the points.
Explanations
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11.22.2.4 Deficiency of qi
Hair loss after COVID-19 infection, light sensation in the head,
aggravation of hair loss after physical exertion, fatigue, general weak-
ness, pale complexion, aversion to cold, cold hands, shortness of
654
TCM Treatment of Long COVID
Principle of Treatment:
Tonify qi, activate the spleen and stomach, benefit the kidney, and
improve hair loss.
Herbal Treatment:
Da Bu Yuan Jian-Great Tonify the Primal Decoction.
Explanations:
• Ren Shen greatly tonifies yuan-source qi, improves lung-qi and
spleen-qi and relieves general fatigue and weakness.
• Bai Zhu tonifies spleen-qi and activates the spleen.
• Shu Di Huang, Shan Zhu Yu, Shan Yao, Du Zhong, Gou Ji, Suo
Yang and Gou Qi Zi tonify kidney-qi, benefit kidney-jing and
relieve fatigue and lower back pain.
• Huang Jing and Wu Wei Zi tonify lung-qi and benefit the lung.
• Zhi Gan Cao harmonizes the effects of the other herbs in the
prescription.
655
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Herbal Remedy:
Da Bu Yuan Jian Ke Li-Great Tonify the Primal Granulates.
Acupuncture Treatment:
• Baihui DU-20, Zusanli ST-36, Taibai SP-3, Sanyinjiao SP-6, Qihai
REN-6, Guanyuan REN-4, Pishu BL-20, Weishu BL-21, Shenshu
BL-23, Shenting DU-24, Touwei ST-8 and Shuaigu GB-8.
• A tonifying method is applied to these points. Moxibustion should
be applied on REN-6 and ST-36.
Explanations:
• ST-36, the he-sea point of the stomach channel, SP-3, the yuan-
source point of the spleen channel, BL-20 and BL-21, the
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Principle of Treatment:
Tonify blood, benefit kidney-jing, relieve weakness and improve hair
loss.
656
TCM Treatment of Long COVID
Herbal Treatment:
Si Wu Tang-Four Substances Decoction.
Explanations:
• Shu Di Huang, Dang Gui, Bai Shao, Chuan Xiong, Huang Jing and
He Shou Wu tonify and nourish the blood, benefit kidney-jing and
improve hair loss.
• Tian Ma and Bai Ji Li benefit the head and improve hair loss.
• Zhi Gan Cao harmonizes the herbs in the prescription.
• Rou Cong Rong and Sang Ji Sheng tonify kidney-jing, strengthen
the lower back and relieve the weakness of the knees.
Herbal Remedy:
Shi Quan Da Bu Wan-All-Inclusive Great Tonifying Pill.
Acupuncture Treatment:
• Zusanli ST-36, Sanyinjiao SP-6, Taichong LIV-3, Ququan LIV-8,
Taixi KID-3, Yingu KID-10, Xuanzhong GB-39, Shenmen HE-7,
Shuaigu GB-8, Baihui DU-20, Shenting DU-24, Touwei ST-8, extra
Yintang and extra Sishencong.
657
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of three yin channels of the foot, activate the spleen
and stomach, tonify qi and blood and improve hair loss.
• Since kidney-jing and blood share the same origin and benefit
each other constantly, some points should be used to tonify
kidney-jing to tonify blood. KID-3, the yuan-source point of the
kidney channel, LIV-8 and KID-10, the he-sea point of the liver
channel and kidney channel respectively, tonify blood and jing at
the same time, relieve the general fatigue and weakness so as to
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658
12
Long COVID Case Study
12.1 Case 1
Male, 23 years old, a university student.
Chief complaints: Long COVID-associated breathlessness and
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fatigue.
First consultation: 20 October 2021.
659
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
had a red tongue with a thin and white coating, and a thready, deep,
and wiry pulse.
TCM Diagnosis:
Long COVID due to deficiency of qi and yin of the lung and kidney.
Principle of Treatment:
Tonify qi, nourish yin, restore the lung and kidney, and regulate
respiration.
Herbal Treatment:
Sheng Mai San-Generate the Pulse Powder, plus
Bu Fei Tang-Tonify the Lungs Decoction.
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Explanations:
• Dang Shen, Zhi Huang Qi, Bai Zhu, and Huang Jing tonify the
qi of the lung and spleen, improve the appetite and relieve
fatigue.
660
Long COVID Case Study
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Tanzhong REN-17, Hegu L.I.-4,
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Explanations:
• A combination of P-6 + SP-4 regulates the respiration, relaxes the
chest, harmonizes the stomach, and relieves shortness of breath.
• REN-17, the influential point of qi in the body, relaxes the chest,
regulates the diaphragm, and relieves shortness of breath.
• L.I.-4, the yuan-source point of the large intestine, LIV-3 and LIV-
14, the yuan-source point and the front-mu point of the liver
respectively, promote qi circulation and relieve the spasm at the
diaphragm.
• ST-36, the he-sea point of the stomach channel, SP-6, the crossing
point of three yin channels of the foot tonify qi and yin of the lung
and the qi of the spleen so as to relieve fatigue.
• LU-5, the he-sea point of the lung, tonifies qi and yin of the lung
and relieves shortness of breath.
661
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
12.2 Case 2
Female, 37 years old, a physiotherapist and acupuncturist.
Chief complaints: Long COVID-associated diarrhea and fatigue.
First consultation: 8 September 2021.
The patient experienced diarrhea since January 2021. After the con-
traction of the viral infection, she developed headache, fatigue, and
slight myalgia. Her general complaints were kept under control
quickly, but her diarrhea remained the same, usually a few times a
day with watery diarrhea. She had a poor appetite, felt extremely
tired, had cold hands and feet, occasionally showed a purplish color
on the fingers, had a weak feeling in the heart. On top of that, she
had an aversion to cold, preference to warmth, lost some weight (cur-
rent body weight is 48 kg), emaciation, superficial sleep, a pale
tongue with tooth marks, thin and white tongue coating, and a
thready, deep, and slow pulse.
When she was 11 years old, she suffered from Hodgkin’s lym-
phoma and received chemotherapy and radiation, which damaged
662
Long COVID Case Study
TCM Diagnosis:
Long COVID-associated diarrhea and fatigue due to deficiency of
Yang of the heart and spleen.
Principle of Treatment:
Tonify yang of the heart and spleen, activate the spleen and relieve
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Herbal Remedies:
Shen Ling Bai Zhu San-Ginseng, Poria and Atractylodis Macroce
phalae Pill.
Take three times a day, six pills each time after meals with warm
water.
Explanations:
• Normally an herbal formula, Fu Zi Li Zhong Wan-Prepared
Aconite Pill to regulate the middle, should be given. However, it
was not available at the clinic. Besides, she is too weak, and
would not be able to tolerate a big and complicated herbal decoc-
tion or concentrated powder granules. Thus, herbal remedy Shen
Ling Bai Zhu Wan was used as a substitute.
• In TCM it is held that the heart is a fire organ, which is the mother
organ of the spleen-earth. Constitutional damage to the heart-
yang could lead to the failure of the spleen to be warmed
and supported, resulting in weakness of the spleen in transporta-
tion and transformation. Although she has received a heart
transplant successfully, her heart-yang did not recover com-
pletely as it should be, and an underlying pathogenic factor thus
remains.
663
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
raw food, no sweet and greasy food, and drinking one glass of red
wine every day, etc.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6,
Zhongwan REN-12, Shaohai HE-3, Shenmen HE-7, Guanyuan
REN-4, Qihai REN-6, Zusanli ST-36, Sanyinjiao SP-6, Yinlingquan
SP-9, Taixi KID-3 and Taichong LIV-3.
• An even method is applied on P-6 + SP-4, and LU-7 + KID-6, a
reducing method is applied on LIV-3, REN-12 and SP-9, and a
tonifying method is applied on the rest of the points.
• Acupuncture treatment is given twice a week for the first three
weeks, and then once a week.
Explanations:
• A combination of P-6 + SP-4 harmonizes the stomach and relieves
diarrhea.
• A combination of LU-7 + KID-6 regulates the Ren and Yinqiao
channels and harmonizes the shen.
• ST-36, the he-sea point of the stomach channel, and SP-6, the
crossing point of three yin channels of the foot respectively, tonify
qi of the spleen, activate the spleen, improve the appetite, and
relieve tiredness and diarrhea.
664
Long COVID Case Study
• SP-9, the he-sea point of the spleen channel, eliminates damp and
relieves diarrhea.
• HE-3 and HE-7, the he-sea point and the yuan-source point of the
heart channel respectively, tonify heart-yang, eliminate interior
cold and calm the shen.
• REN-4 and REN-6 greatly tonify the qi and yang of the heart and
spleen and relieve fatigue.
• KID-3, the yuan-source point of the kidney channel, tonifies qi and
yang of the kidney and relieves fatigue.
• Usually, some more points to warm the yang of the heart and
spleen and a moxibustion should be applied to some points.
However, as she is so weak and emaciated, the treatment should
be given smoothly without too sudden and strong effects.
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• One day later, when she came for the second acupuncture treat-
ment, she mentioned that after a single treatment with acupuncture
and taking herbal remedy for one day, she felt much stronger and
better. Her diarrhea stopped but she still had an aversion to cold.
In the following weeks, her diarrhea is mostly under control. If she
works too much or feels too tired, her stools become loose.
Thankfully, it mostly happens once per day. Her tiredness and
aversion to cold also gradually improved in the following
treatment.
• On 25 October 2021, she mentioned that she has been taking
female hormone pills in the last three years to stimulate her men-
struation in order to maintain a good density of her bones.
However, her menstruation did not come in the last few months.
Thus, Shi Quan Da Bu Wan-AllInclusive Great Tonifying Pill was
given, three times a day, six pills each time. Her diarrhea remained
under control and her tiredness continuously improved.
12.3 Case 3
Female, 38 years old, a nurse.
Chief complaints: Long COVID-associated fatigue, palpitation and
lack of smell and taste.
First consultation: 6 September 2021.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
666
Long COVID Case Study
TCM Diagnosis:
Long COVID-associated fatigue due to accumulation of cold-damp
and stagnation of liver-qi.
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Principle of Treatment:
Eliminate cold, resolve damp, promote qi circulation, regulate the
shen and improve fatigue.
Herbal Treatment:
Cang Fu Dao Tan Tang-AtractylodesPoria PhlegmDissipating Dec
oction, plus
Huo Xiang Zheng Qi San-Agastache Powder to Rectify the Qi.
667
The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• Cang Zhu, Zhi Shi and Hou Po strongly eliminate cold-damp, pro-
mote qi circulation and relieve myalgia.
• Xiang Fu and Zhi Ke promote qi circulation and relieve pain in the
chest and abdomen.
• Chuan Xiong, Yan Hu Suo and Bai Zhi promote qi circulation and
relieve myalgia, chest pain and abdominal pain. Meanwhile, Bai
Zhi could improve the sense of smell.
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• All the above herbs can promote qi circulation, smooth the liver,
and relieve depression and stress.
• Bai Zhu and Fu Ling activate the spleen and stomach and elimi-
nate damp in the body.
• Huo Xiang, Chen Pi and Sha Ren regulate the middle Jiao, pro-
mote digestion, descend stomach-qi, relieve nausea, and improve
the sense of taste.
• Dan Shen and Hong Hua calm the shen, promote blood circula-
tion and relieve chest pain and abdominal pain.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6,
Hegu L.I.-4, Yingxiang L.I.-20, Taichong LIV-3, Qimen LIV-14,
Shaohai HE-3, Sanyinjiao SP-6, Yinlingquan SP-9, Zusanli ST-36,
Taixi KID-3, Qihai REN-6, Tanzhong REN-17, Zhongwan REN-12,
Fengchi GB-20 and Jianjing GB-21.
• An even method is applied on P-6 + SP-4, and LU-7 + KID-6, a
reducing method is applied to L.I.-4, LIV-3, LIV-14, REN-12, REN-
17, SP-6, SP-9, GB-20, GB-21 and HE-3, and a tonifying method
is applied to ST-36, KID-3, and REN-6.
• Acupuncture treatment is given twice a week for the first three
weeks, followed by once a week.
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Long COVID Case Study
Explanations:
It seems that there are too many acupuncture points selected but they
are all logical and necessary.
After receiving TCM treatment for two weeks, her fatigue and
myalgia greatly improved, and she felt relaxed during her work. Her
abdominal cramps and nausea also improved. The happiest point
was that the pain in her legs were much alleviated. Four weeks later,
she reported that she sometimes felt some irritability from the stress
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
12.4 Case 4
Female, 54 years old, a university professor.
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The patient suffered from a lot of stress and food allergy in the last
two years. She is allergic to red wine, peanuts, cauliflower, etc. She
contracted COVID-19 in October 2021, and everything went well
except that her smell and taste did not return completely. She could
taste something, but it was mainly a metal taste. She had a burning
sensation in the stomach and esophagus, alternative loose stools or
constipation, constant presence of phlegm in the throat, insomnia,
waking easily during the night, tension at the neck, headache, dizzi-
ness, hypertension, 150/90 mmHg, nervousness, irritability, and
painful eyes with redness. All the above situations worsened when
she gets very nervous or stressed, and she had pressure in the chest,
red tongue with a thick, yellow, and greasy coating, and a wiry and
slippery pulse.
TCM Diagnosis:
Long COVID-associated with disorder of taste due to impairment of
the collaterals, hyperactivity of liver-fire, and disharmony between
the liver and stomach.
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Long COVID Case Study
Principle of Treatment:
Harmonize the collaterals, restore the taste, reduce liver-fire, and
regulate the liver and stomach.
Herbal Remedy:
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver.
Explanations:
• Usually, the loss of smell and taste during COVID-19 could last a
few months, but this lady has been suffering from a disorder of
taste for more than a year. The taste she described in her mouth is
a metal taste. In TCM, Metal is an element belonging to the lung,
and a metal taste is often a disorder from the lung.
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Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KI-6, Hegu
L.I.-4, Yingxiang L.I.-20, Juliao ST-3, Dicang ST-4, Xingjian LIV-2,
Qimen LIV-14, Shaohai HE-3, Sanyinjiao SP-6, Yinlingquan SP-9,
Zhongwan REN-12, Tanzhong REN-17, Fengchi GB-20, and
Jianjing GB-21.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
Explanations:
• A combination of P-6 + SP-4 promotes qi circulation, regulates the
emotion, harmonizes the stomach, and improves the sense of
taste.
• A combination of LU-7 + KID-6 regulates the Ren and Yinqiao
channels, harmonize the shen and improve the sense of smell.
• L.I.-20, ST-3 and ST-4, the local points around the nose and mouth,
harmonize the collaterals, activate the opening of the nose and
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Long COVID Case Study
general points for the liver and middle Jiao, the total effects of the
treatment will be limited.
After TCM treatment for two weeks, her sense of taste started to
return. Meanwhile, her emotions are also greatly under control. She
could sleep better. But there is still constipation. Thus Tianshu ST-25
is added into the above acupuncture prescription. On 10 October
2021, she mentioned that she felt occasional dizziness, thus Shuaigu
GB-8 is added. After treatment for another four weeks, most of the
metal taste in her mouth disappeared and her liver-fire situations are
also greatly under control.
12.5 Case 5
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The patient suffered from vulvodynia for one year, which makes it
impossible for her to have sexual contact. The persistent, unex-
plained pain in the vulva started gradually. She went to the gynecolo-
gist but nothing abnormal was discovered. Therefore, she was
prescribed painkiller creams to be applied locally to relieve the pain.
Even with this cream, she could not have copulation. She usually has
cystitis a few times a year, and it is not always possible to detect a
bacterial infection. Her situation usually becomes worse when she is
stressed, as she faces a lot of stress with her university studies.
Meanwhile, she also has stress-related headaches, tension at the
neck, irritability, stomach pain, nausea, lack of appetite, abdominal
cramps and diarrhea. As the end of year examinations was approach-
ing, her vulvodynia was getting worse and worse. Herbal remedy
Long Dan Xie Gan Wan-Gentiana Longdancao Pill to Drain the Liver
was offered in combination with an acupuncture treatment to
smooth the liver, promote qi circulation on the liver and relieve the
vulvodynia. After six visits, everything went relatively well till the
end of July.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
TCM Diagnosis:
Long COVID-associated loss of smell and taste impairment of the
collaterals and stagnation of liver-qi.
Principle of Treatment:
Harmonize the collaterals, benefit the clear orifices, smooth the
liver, and promote urination.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Lieque LU-7 + Zhaohai KID-6,
Hegu L.I.-4, Yingxiang L.I.-20, Juliao ST-3, Dicang ST-4, Zanzhu
BL-2, Shenting DU-24, Ligou LIV-5, Jimai LIV-12, Sanyinjiao
SP-6, Yinlingquan SP-9, Shuidao ST-28, Fenglong ST-40, and Qugu
REN-2.
• An even method is applied on P-6 + SP-4, and LU-7 + KID-6. A
reducing method is applied to all the rest of the points.
• Acupuncture treatment is given once a week.
Explanations:
• A combination of P-6 + SP-4 promotes qi circulation, regulates the
emotion, smooths emotion, harmonizes the stomach, and improves
the sense of taste.
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Long COVID Case Study
SP-6, the crossing point of three yin channels of the foot, promote
qi and blood circulation and relieve qi stagnation.
• LIV-5, the luo-connecting point of the liver channel, and LIV-12, a
local point nearby the complaint of vulvodynia, smooth the liver,
promote liver-qi circulation, and relieve vulvodynia.
• SP-9, ST-28, ST-40, and REN-2 promote urination and relieve pain
when urinating.
Note:
Although this case does not belong to Long COVID associated with
loss of smell and taste because it is not consistent with the timeline
of Long COVID, it is still interesting to show how fast and effective
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
12.6 Case 6
Female, 30 years old, an artist and musician.
Chief complaints: Long COVID-associated breathlessness and diges-
tion dysfunction.
First consultation: 17 September 2021.
TCM Diagnosis:
Long COVID-associated breathlessness and digestion dysfunction
due to accumulation of damp-phlegm and stagnation of liver-qi.
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Long COVID Case Study
Principle of Treatment:
Eliminate damp, resolve phlegm, smooth the liver, and descend the
qi of the lung and stomach.
Herbal Remedy:
Xiang Sha Yang Wei Wan-Aucklandia, Amomum Nourish Stomach
Pill, plus
Xiao Yao Wan-Rambling Pill.
Take six pills from both remedies after meals, three times a day.
Explanations:
• Invasion of cold-damp with pestilent toxins could be the chief
causative factor for her COVID-19 infection during the acute phase.
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This is because she did not have a very high fever and suffered from
diarrhea and breathlessness at the same time. Although she survived
from this infection, external pathogenic factors in her body are not
eliminated completely, which blocked the lung and stomach.
• Accumulation of cold-damp in the lung is the main cause for her
superficial breathing, difficulty in breathing deeply, and chest pain
when taking a deep breath. On the other hand, accumulation of
cold-damp in the stomach is the main cause for her stomach com-
plaints, such as stomach pain with swollen feeling, acid
regurgitation, aggravation of stomach pain after eating, and poor
appetite. Nevertheless, she has stagnation of liver-qi due to a lot of
stress in her life and at work in the last few years, leading to the
occurrence of fear of sudden death, insomnia, sense of insecurity
and agitation, and neck pain and pain, etc. Additionally, stagna-
tion of liver-qi also could bring about qi stagnation in the lung and
stomach, resulting in aggravation of the above situations when
being nervous.
• Xiang Sha Yang Wei Wan is a very good herbal remedy for stomach
pain and distention, poor appetite, and acid regurgitation due
to the accumulation of cold-damp in the stomach. Although this
remedy is not capable of resolving cold-damp in the lung, acu-
puncture treatment could focus on this issue.
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The Pathogenesis & Treatment of COVID-19 & Long COVID with TCM
• Xiao Yao San is an excellent remedy to smooth the liver and pro-
mote qi circulation in the body. Besides, it could relieve stomach
pain and painful chest pain due to qi stagnation.
Acupuncture Treatment:
• Neiguan P-6 + Gongsun SP-4, Hegu L.I.-4, Taichong LIV-3, Qimen
LIV-14, Fengchi GB-20, Yanglingquan GB-34, Shenting DU-24,
Sanyinjiao SP-6, Yinlingquan SP-9, Tianshu ST-25, Zusanli ST-36,
Fenglong ST-40, Zhongwan REN-12, and Tanzhong REN-17.
• An even method is applied to P-6 + SP-4, and a reducing method
is applied to all the rest of the points.
• Acupuncture treatment is given twice weekly during the first two
weeks and followed by once a week after.
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Explanations:
• A combination of P-6 + SP-4 promotes qi circulation, regulates
respiration, smooths emotions, harmonizes the stomach, and
improves appetite.
• L.I.-4, the yuan-source point of the large intestine channel, LIV-3
and LIV-14, the yuan-source point and the front-mu point of the
liver channel respectively, REN-17, the influential point of the qi
in the body, promote qi circulation in the liver and relieve qi
stagnation.
• GB-34, the he-sea point of the gallbladder channel, and GB-20
promote qi circulation and relieve tension in the body and at the
neck.
• DU-24 calms the shen and improves sleep.
• SP-6 and SP-9, the crossing point of three yin channels of the foot
and the he-sea point of the spleen channel respectively, REN-12,
the influential point of the fu organs and the front-mu point of the
stomach, ST-25, ST-36 and ST-40, the front-mu point of the large
intestine, the he-sea point, and the luo-connecting point of the
stomach channel respectively, activate the spleen and stomach,
eliminate cold-damp, descend stomach-qi, promote digestion and
relieve pain.
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Long COVID Case Study
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