Treating long Covid in my Japanese acupuncture clinic

10 Practice Acu. | Issue #29 | Winter 2020

Treating long Covid in my Japanese acupuncture clinic

Marian Fixler

Member: London

Little did I know when returning to my practice in early July, that some of the first patients to come to my clinic – both existing and new – would be those suffering from long Covid symptoms. Also known as ‘long-haulers’, these people continue to experience postviral symptoms weeks or even months after first contracting what was thought to be (but not necessarily confirmed) Covid-19. An apt phrase, conjuring up an image of ‘hauling’ oneself around with, at times, tremendous effort and lacking vitality.

Long-haulers include two groups of people affected by the virus: those who experience some permanent damage to their lungs, heart, kidneys, or brain that may affect their ability to function, and those who continue to experience debilitating symptoms despite no detectable damage to these organs.

One of the panel members of the BMJ, discussing long Covid in early September, defined it as: ‘not recovering [for] several weeks or months following the start of symptoms that were suggestive of covid, whether they were tested or not’.

The patients I’ve seen – five female and one male, two in their 50s and four in their 40s – had not been hospitalised and had not had a positive Covid diagnosis, all having contracted the virus in the early spring. They were previously quite healthy, with no chronic illnesses. Their Covid-related symptoms lasted for a few days up to a couple of weeks. By the time they came to see me in the summer, they were still experiencing symptoms at least four months from the time of contracting the virus.

According to scientists involved in the King’s College research, being over 50, female, overweight and having asthma raised the risk of having long Covid, as does having more than five different symptoms. This study estimates that one in twenty people continue to have symptoms for at least eight weeks and one in fifty for more than twelve weeks. Researchers have been using data from the Covid Symptom Study app, to develop a model that can predict who is most at risk of long Covid based on their age, gender, and count of early symptoms.

The common symptoms my patients experienced included:

• fatigue; poor stamina; difficulty breathing; shortness of breath; heavy chest

• aches and pains; muscular twitching

• headaches; pressure in head; dizziness

• brain fog; difficulty concentrating; losing words

• loss of sense of smell and taste

• anxiety and insomnia

As a practitioner of Japanese meridian therapy (MT) and more specifically, Toyohari, (founded by blind practitioners), the primary focus of treatment is on tonification of the most deficient yin meridians in order to re-establish the correct balance of qi and blood.

The four diagnoses – of asking, looking, smelling/listening and touching with final confirmation from the abdomen and pulse – are used to identify and treat the primary pattern of deficiency on the yin meridians. I have observed that my long Covid patients have all presented with more deficient signs, including weak and deep quality pulses, overall poor lustre to their complexion and skin quality, and debilitating symptoms.

These patients have mostly presented with kidney or liver patterns – with spleen or lung treated on the secondary (controlling cycle) pattern. A kidney pattern involves tonification on kidney and its ‘mother’ lung; a liver pattern involves tonification on liver and its ‘mother’ kidney. The second part of the root treatment addresses imbalance in the yin meridians on the controlling cycle. So, for example, excess on spleen would involve draining technique. This decision would not be decided on symptoms, but on pulse quality and palpation of the acupuncture point to be treated. The final part of the root treatment treats the yang channels.

As well as the established points indicated for MT patterns (using Nan Jing 69 theory of treating the mother to treat the child), I have found that (as in Nan Jing 68) using metal points – for respiratory symptoms – or earth points – for heavy and achy joints/fatigue/ digestive disturbances – can work more effectively in some cases.

This initial focus on tonification, strengthens the ‘seiki/zhengqi’ upright qi in order to more effectively expel the ‘jyaki/xieqi’ pathogenic qi from the body. With good needle technique, the jyaki is brought more to the surface in order to apply draining techniques on the affected meridians. Differentiation is made between pathogenic qi at the qi or in more chronic cases, the blood level, each with their own needle technique. This is a very different approach to TCM which warns about the dangers of tonifying when there is a pathogen present. For further discussions on these differing approach to treatment, I refer you to an article by one of my teachers, Stephen Birch: Acupuncture: How Might the Mechanisms of Treatment Have Contributed to the Diagnosis of ‘Patterns’ and Pattern-based Treatments – Speculations on the Evolution of Acupuncture as a Therapy. Implications for Researchers

Many of the lingering and debilitating symptoms of fatigue, brain fog, heaviness on the chest, muscle and body aches and digestive disturbances would be identified in TCM as retained damp or damp cold pathogen. In MT, with its focus on qi regulation, these symptoms can still be addressed and resolved at the same time as strengthening the upright qi of the patient, which, in these cases of long Covid is certainly much needed.

In MT, we also make a distinction between treating the ‘root’ and the ‘branch’ – though somewhat differently to the ben and biao of TCM. Root treatment regulates the qi and blood in the meridians, branch treatment addresses the symptoms. These branch treatments also influence the pulse – thereby continuing to regulate qi and blood but in a more targeted way.

One frequently used branch treatment is direct moxa (aka ‘okyu’ – small halfrice grain pure moxa applied directly to the skin), which is very helpful for chronic conditions. Effectiveness depends on palpating and identifying tight, tender points or indurations. For respiratory symptoms and cardiac related conditions, as well as anxiety

and insomnia, I look for these on the upper back area – from BL 12 feng men to BL 17 ge shu and the DU points between the spinous processes.

Direct moxa is also applied in combination with polarity agents (copper and zinc) on the eight extra vessel points, to specifically treat the meridians affected – for example LU 7 lei que and KID 6 zhao hai (yin qiao/ ren mai) for respiratory symptoms or P 6 nei guan and SP 4 gong sun (yin wei/ chong mai) for anxiety/palpitations/ digestive disturbances. Direct moxa is not contraindicated in perceived ‘heat’ conditions and is used to treat fevers and has been shown to treat inflammatory conditions – historically it was used to treat TB before the advent ofantibiotics. For more detailed discussion about the uses of moxibustion, see Merlin Young’s comprehensive book The Moon over Matsushima: Insights into Moxa and Mugwort. See also Birch S, Lewith G. ‘Acupuncture research, the story so far’. In MacPherson H, Hammerschlag R, Lewith G, Schnyer R (eds). Acupuncture Research: Strategies for Building an Evidence Base. London, Elsevier, 2007:15-35.

"My patient reported that ‘unbelievable amounts of mucus came up’ from her chest"

One of the first patients I treated for long Covid – a returning patient, female age 46, a make-up artist – described her main symptom like having a ‘massive lasagne sitting on my chest’. She had also had months of sinus type headaches, brain fog, nausea with no appetite, fatigue and oral thrush. She experienced anxiety at night and palpitations on exertion. She also experienced a horrible taste in her mouth – a phlegmy mucous taste.

I diagnosed her as a kidney pattern – treating a kidney point and the mother of kidney, a lung point. The secondary pattern was spleen excess, on the controlling cycle. Instead of the usual points indicated for this pattern, I treated the shu stream, earth points – KID 3 tai xi and LU 9 tai yuan (Nan Jing 68, for heaviness and achiness in the joints) – relevant for an earth related imbalance. I chose the metal spleen point, SP 5 shang qiu, with draining technique. This was the root treatment.

Branch treatment involved using polarity treatment with zinc and copper pellets on LU 7 lie que and KID 6 zhao hai, with direct moxa and some direct moxa on tight points on the upper back – DU 14 da zhui, BL 43 gao huang shu and DU 12 shen zhu (three cones on each). Direct moxa was also used on ST 36 zu san li and DU 23 shang xing (sinus point). The only point where I retained a needle was REN 17 shan zhong.

I use this case as an example as the patient had a really dramatic reaction to treatment. She returned more than two weeks later (no sooner as work commitments had taken her out of London) and described having had three days of feeling awful that involved expelling huge amounts of phlegm. Normally I would react to such feedback as indicating that I had exceeded the appropriate dose of treatment for this patient, expecting any worsening of symptoms to last no more than a maximum of 24 hours. However, my patient was delighted! She reported that ‘unbelievable amounts of mucus came up’ from her chest – her brain fog got much clearer, the sinus pressure greatly reduced, she was less fatigued and she could breathe more easily.

Most patients have improved after each treatment, with many symptoms clearing up completely – chest symptoms, dizziness, headaches, digestive complaints, improved appetite. Some cases have been harder to clear – loss of sense of taste and smell and headaches come and go and might need other interventions.

The trajectory has mostly been upwards, with steady improvements in vitality and sense of wellbeing. Some of my patients continue to have setbacks, commonly when they have tried to do too much; however, setbacks are generally less severe and shorter. I have just seen the patient I described earlier again, after two and a half months. She had been doing really well till she caught a cold back in October, when working outdoors. The only symptom to have returned has been the heavy feeling in her chest, which we have just started working on again. She is also having further investigations. Much is still to be learnt about the long-term effects and damage to internal organs and even the brain.

As practitioners, we have a lot to offer people experiencing these debilitating and frightening chronic symptoms and their emotional effects, not only through our acupuncture treatments – and of course herbs and mushrooms etc – but also with advice and suggestions around diet, lifestyle, and restorative exercise such as qigong. Interestingly, many of the patients I have seen presenting with long Covid are people who push themselves quite hard, with work and/or physical exertion, for example one is a long-distance swimmer. We can also guide our patients to find the right balance between rest and activity and help them to manage their expectations.

I’ll leave the last words to a GP patient of mine: ‘After the first treatment, I felt immediately calmer and happier, and my symptoms have improved day by day since. My energy levels are better and I’m more able to function day-today. My body felt good after my second session and I feel my heart rate is behaving more normally since I started the treatment. Overall I’m definitely making progress now and I’m hopeful I will make a full recovery in time.’

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