Casebook: acupuncture aids long Covid recovery

With cases of self-reported long Covid on the rise, Scott Bridges illustrates how acupuncture alone can work to boost recovery. The name of his patient has been changed to preserve anonymity

Scott Bridges

Member: London

According to data from the Office for National Statistics (ONS), it is estimated 1.2 million people living in private households in the UK (1.9 per cent of the population) experienced self-reported long Covid – symptoms persisting for more than four weeks after the first suspected coronavirus (Covid-19) infection that were not explained by something else – as of 2 October 2021. Ongoing symptoms adversely affected the day-today activities of 780,000 people (65 per cent of those with self-reported long Covid), with 233,000 (19 per cent) reporting that their ability to undertake their day-to-day activities had been ‘limited a lot’. Fatigue continued to be the most common symptom reported by individuals experiencing long Covid (55 per cent of those with self-reported long Covid), followed by shortness of breath (39 per cent), loss of smell (33 per cent), and difficulty concentrating (30 per cent).

As a proportion of the UK population, prevalence of self-reported long Covid remained greatest in people aged 35 to 69 years, females, people living in more deprived areas, those working in health or social care, and those with another activity-limiting health condition or disability; compared with the previous month, prevalence of self-reported long Covid was notably higher among people aged 12 to 16 years or 17 to 24 years, with the latter now comparable to people aged 35 to 69 years.

I have treated several patients presenting with long Covid; all have done remarkably well using only acupuncture and I would like to present one such case here.

Steve, male, 35 years old, non-smoking

The patient in question caught Covid in March 2021. He reported he had such mild symptoms at the time that he didn’t initially realise he had it. His symptoms consisted of rhinitis, sinusitis, fatigue, and general malaise. Steve tried to continue his job as a firefighter but found it impossible to find the strength to carry out his necessary day-to-day obligations. He was signed off work and came to my clinic see if there was any way we could help him get back on his feet.

Upon presentation at the clinic towards the end of October, Steve was complaining of ongoing malaise, a slight sore throat, what he described as ‘crap’ at the back of his throat, a tight chest, excess fluids in the mouth (hypersalivation) and an uncomfortable shortness of breath, which he described as ‘air hunger’. He was also experiencing paraesthesia in his hands and feet (which had been improving), and soreness of his leg muscles. He reported little to no sweating, no appetite and felt hot to the touch although he reported subjectively feeling a normal temperature.

His tongue was slightly scalloped, with a deep and wide crack in the stomach area, and was pale red, but noticeably redder with heat prickles in the lung area with a very red peeled tip. The pulse was choppy.

My diagnosis was of a retained external pathogenic factor in the lung, with a vacuity of lung and wei qi causing lung phlegm-fluids.

Steve and I discussed his situation, and I advised an initial plan of six treatments once a week for six weeks followed by a review. I also asked him to complete a Chinese Medicine Symptom score list where he could record and score his symptoms at the beginning of each session. I often use this to help both me

and the patient to gauge improvements, or deterioration, in reported symptoms over time. Patients fill in the form themselves reporting symptoms they identify with, scoring them from 1 (mild) to 4 (severe) or leaving a blank where there is no problem. Scores are then totted up to give a global symptom score, which hopefully decreases with treatment progression. CM Symptom score lists can be found online and free to download.

Treatment one

I first conducted an aggressive energy (AE) treatment with the patient prone. This revealed pronounced redness around BL 13 fei shu and BL 14 jue yin shu corresponding to the lung and pericardium respectively. I waited for the redness to drain away before removing the needles and carrying on with the second part of my treatment.

I use an integrated approach when working and employ a variety of styles when deciding on a treatment strategy selecting points. I use a lot of Tung points and with the patient lying in supine position, continued the treatment, choosing the Fei Qi Two Needle Dao Ma group – Fei Qi Yi and Fei Qi Er – which lie on the posterior surface of the upper arm between the san jiao and large intestine channels. The large intestine channel is paired exteriorly-interiorly with the lung channel, explaining the use of these points in problems related to that channel. Also, according to the Ling Shu Chapter 10, the large intestine channel governs disorders of the fluids, ie jin and ye, and thus helps distributing fluids to the upper jiao where the channel traverses. The large intestine channel and its same name partner stomach channel travel to the throat area, as does the san jiao channel which is useful in clearing heat from the throat.

I also needled chong zi (22.01) and chong xian (22.02), along with Fei Qi Two Needle Dao Ma group, as this combination treats shortness of breath. I added Shuang Chuan (Double Cough) a two-point group on the palmar surface of the index finger, at the ulnar and radial margins of the PIP (proximal interphalangeal) joint and ce jian (Beside Distance), close to the MCP (metacarpophalangeal) joint and the proximal digital crease on the radial margin of the phalangeal bone; they treat shortness of breath, lung inflammation, swollen throat, chest oppression. Shuang Chuan clears and drains the upper jiao, rectifies qi and levels panting. Ce jian benefits the lung, transforms phlegm, frees the channels and quickens the network vessels, clears heat and settles pain.

In addition, I needled zhong kui (Important Chief), which overlaps with LI 3 san jian. This is a secret lineage point of Tung’s acupuncture indicated for the common cold and could also, therefore, be said to release the exterior.

Treatment two

A week later, Steve said he felt a bit better after the first treatment with an improvement in his chest tightness and he said he was feeling less unwell. He still had some sinusitis, and shortness of breath and his paraesthesia in his hands and feet were only to be felt in the tips of his fingers and his toes.

This time, I first decided to cup his upper back left and right around BL 12 feng men. I also bled the apex of his ear and squeezed a few drops of blood out. He felt this was quite powerful, so after turning him over I performed a gentle treatment to rectify and boost spleen and kidney qi, needling ST 36 zu san li, KID 3 tai xi, Tung’s point 77.19, GB 34 yang ling quan and retaining the needles for only ten minutes.

Treatment three

The following week, Steve reported feeling better again. He said he felt like he was getting incrementally better. His chest tightness had gone, as had his headaches, there was less mucus present, and his paraesthesia had largely gone.

I needled SJ 5 wai guan, LU 9 tai yuan and LU 10 yu ji, GB 34 yang ling quan, GB 41 zu lin qi all on the right; LI 4 he gu on the left; LIV 3 tai chong on the right; and Xia San Huang (Lower Three Emperors) 77.18, 77.19 and 77.21 on the left, which are on the spleen channel on the lower leg and work very effectively for tonifying pre- and post-heaven qi.

Treatment four

Steve reported his ‘air hunger’ improved a great deal after the last treatment, as well as a global improvement in all areas including his paraesthesia. He also reported improvements in his sleep. He did note some excess fluids in the mouth/ hypersalivation still, so I focused on treating the lung and spleen to improve the metabolism of fluids.

I needled the Fei Qi Dao Ma group once again, chong zi and chong xian, all bilaterally; Xia San Huang only on the left; ST 36 zu san li, ST 37 shang ju xu, GB 34 yang ling quan and LIV 2 xing jian all on the right.

He felt a bit better after the first treatment with an improvement in his chest tightness

Treatment five

Today, Steve reported continued improvement in ‘air hunger’, which went completely after the last treatment and had returned only the day before, albeit much less intensely. He also said he felt less tired last time than after the previous treatment. He reported having been much busier than of late and, despite this, felt less fatigued or ‘bad’ in himself. He mentioned he felt a better ‘baseline’ health level following each treatment.

My point selection was Fei Qi Dao Ma Group, chong zi and chong xian bilaterally; Xia San Huang on the left; LI 11 qu chi, LI 6 pian li and LU 5 chi ze bilaterally; GB 34 yang ling quan on the right.

Treatment six

Steve came in today saying he felt for the first time like his ‘old self’ again. His global symptom score went from 50 at the last treatment to only 27 this week. His neurological and respiratory scores were particularly impressive.

Points I needled: Fei Qi Dao Ma Group, 22.01, 22.02, LU 10 yu ji bilaterally; Xia San Huang Dao Ma group on the left; GB 34 yang ling quan and GB 41 zu lin qi on the right; REN 17 shan zhong and yin tang.

Lifestyle advice

I recently became aware of an information sheet of lifestyle tips penned by my herbalist colleague Malika Meddings from the Register of Chinese Herbal Medicine (RCHM); the sheet is called Finding a Way to Vitality and is a wonderful resource for anyone recovering from illness, so I also gave a copy of this to Steve. The advice given is split into three areas called Meals, Mindset and Movement and Malika has kindly made the sheet available for BAcC members to download as a PDF. You can find it here and depending on your browser it may go straight to download 〉 tinyurl.com/3nts999h

Long Covid is an unpleasant and debilitating condition, but it is also one from which we as acupuncturists can help our patients recover, mitigating its effects so they can get back on their feet and start living life again fully.