Long Covid Symptoms: Curing the Ongoing Effects of Coronavirus With Herbs

A man exercising on a mat with a child on his back looking at a computer screen.

Long Covid refers to a condition where individuals experience persistent symptoms long after the initial infection has resolved. The lingering effects or complications that some individuals experience after recovering from COVID-19 are often referred to as “long Covid” or “post-acute sequelae of SARS-CoV-2 infection” (PASC).

Residual Covid symptoms can vary from person to person and can affect different systems of the body. Factors such as underlying conditions prior to infection, the severity of the acute infection phase, gender, age, race, and ethnicity are important.

Symptoms like asthenia, dyspnea, headache, fatigue, cough, post-exertional malaise, cognitive dysfunction, emotional symptoms, and digestive disorders are among the most commonly reported long Covid sequels.

Between 2020 and 2023, the Chinese National Health Commission released and updated 11 versions of the Diagnosis and Treatment Protocol for COVID-19, which includes official traditional medicine treatment protocols for the different phases of severity of Covid for adults and children. Protocols for the treatment of post-COVID syndrome are also emerging. 

Table of Contents

Long Covid Symptoms

Commonly  reported symptoms of post-COVID syndrome include the following:

  • Fatigue: Many people experience persistent fatigue that can interfere with daily activities and quality of life.
  • Shortness of Breath: Some individuals continue to experience difficulty breathing or shortness of breath after their acute infection has resolved.
  • Cognitive Issues: Brain fog, difficulty concentrating, and memory problems.
  • Joint and Chest Pain: Lingering joint pain and chest pain.
  • Loss of Smell and Taste: Even after recovery, some people may continue to experience a loss of taste or smell.
  • Headaches: Persistent headaches, including migraines, have been reported.
  • Cardiovascular Issues: Heart palpitations, chest tightness, and other cardiovascular symptoms.
  • Gastrointestinal Symptoms: Some individuals experience ongoing digestive issues such as nausea, diarrhea, or abdominal pain.
  • Mental Health Effects: Anxiety, depression, and other mental health issues.
  • Sleep Disturbances: Insomnia and other sleep-related problems.

In a study published in Nature Medicine that used the data from two cohort studies involving a total of 34605 patients, the main long-term Covid symptoms were organized into four subphenotypes by identifying what group of conditions patients had post-COVID infection [1].

PASC subphenotypes According to study by Zhang, H., Zang, C., Xu, Z. et al.:

Cardiac and renal

There are several health conditions that can be included in this category. These conditions include cardiac and circulatory conditions, renal failure, anemia, and fluid and electrolyte disorders.

Respiratory, sleep, and anxiety

Anxiety, sleep disorders, and symptoms such as chest pain and headache.

Musculoskeletal and nervous

Headaches, musculoskeletal pain, and disorders in the circadian rhythm.

Digestive and respiratory

Stomach and duodenum disorders, hematemesis, and digestive system neoplasm.

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  • Commonly reported symptoms of post-COVID syndrome include fatigue, shortness of breath, cognitive issues, joint and chest pain, loss of smell and taste, headaches, cardiovascular issues, gastrointestinal symptoms, mental health effects, and sleep disturbances. 
  • The main lingering COVID symptoms are cardiac and circulatory conditions, renal failure, anemia, fluid and electrolyte disorders, anxiety, sleep disorders, chest pain, headaches, musculoskeletal pain, circadian rhythm disorders, stomach and duodenum disorders, hematemesis, and digestive system neoplasm.

Post-COVID Syndrome Physiopathology According to Chinese Medicine

Coronavirus infection is diagnosed in TCM according to the classical Chinese medical text Wen Bing Xue (Warm Disease Theory), which focuses on the diagnosis and treatment of epidemic diseases

The Wen Bing divides the organism into four layers, starting from the most superficial where the pathogen enters the body, up to the deepest layer the virus can penetrate. The four layers explained in the Wen Bing are Wei → Qi → Ying → Xue.

According to this theory, the order of penetration of a pathogen does not always follow the gradation described above. It may happen that a virus directly attacks the deep layers of the organism depending on its ability to infect its host (xie qi) and the overall health condition of the infected individual (zheng qi).

When an illness is very intense and complex, it can lead to damage in multiple organs and long-term effects such as post-COVID syndrome.

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  •  Wen Bing Xue was the first text to integrate the perspectives of five prominent medical experts who most notably influenced the development of Warm Disease theory.
  • The damaging effect of viruses depends on their ability to infect their host and the overall health condition of the infected individual.

Long Covid Symptoms According to TCM

According to the updated Diagnosis and Treatment Protocol for COVID-19 released officially by the Chinese National Health Commission, coronavirus’ symptoms are diagnosed according to the following syndromes:

Spleen Qi Deficiency

Fatigue, ageusia, poor appetite, asthenia, weak voice, abdominal swelling with distention that worsens with eating, bloating, loose stools, muscle laxity, and cramps.

Lung Qi Deficiency

Dry cough, weakness, dyspnea at minimal effort, tiredness, weak voice, and spontaneous sweating.

Heart Qi Deficiency

Palpitations, dyspnea on minimal exertion, chest tightness, insomnia, and amnesia.

Kidney Yin Deficiency

Vertigo, tinnitus, loss of memory, intermittent fever, night sweats, chest tightness, heat on the palms of hands and feet, dry throat and mouth, tingling pain in the lumbar area and knees.

Liver Yang Rising

Headache, vertigo, tinnitus, distensive headache with parietal-temporal distribution or in the vertex, irritability, congestive eye pain, insomnia, red eyes and face, nightmares, dry mouth, restlessness, agitation, and anxiety.

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  • Chinese medicine’s syndromes associated with coronavirus infection are Spleen Qi Deficiency, Lung Qi Deficiency, Heart Qi Deficiency, Kidney Qi Deficiency, and Liver Yang Rising. 

Herbal Treatment Protocol for Long Covid 

In TCM, syndrome differentiation by a qualified practitioner is crucial for determining the appropriate treatment for patients. It involves analyzing the specific symptoms and signs, pathological state, and history of each patient.

When it comes to treating complex illnesses, using just one herb may not be effective. In order to achieve the desired effect, it is often necessary to combine different herbs. This allows for a more comprehensive approach to treatment.

Syndrome differentiation helps to develop treatment ideas and select the appropriate herb combinations based on the established formulae. This allows for personalized treatment adapted to each individual case.

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  • Syndrome differentiation by a qualified practitioner is crucial for determining the appropriate treatment for patients.
  • Single herb supplementation is not enough to treat complex illnesses. 

General Formula For Long Covid Symptoms

Based on the basic TCM syndrome phenotypes that are most commonly linked to post-acute sequelae of SARS-CoV-2 infection, it is possible to draw which classic formulas could be appropriate.

Nevertheless, In a real-case scenario, those syndromes are more subjective and mixed, and an accurate diagnosis would require the information from pulse, and tongue examination by a qualified practitioner. 

SI JUN ZI TANG – 四君子汤 – Four Gentlemen Decoction

Si Jun Zi Tang is a classic formula mentioned in the Northern Song Dynasty prescription manual Tai Ping Hui Min He Ji Ju Fang (Prescriptions of the Bureau of the Management and Administration of Pharmacy). 

This formula has been used in China for over one thousand years in the treatment of digestive and metabolic disorders, a phenotype designated as Spleen Qi Deficiency Syndrome. The combination of herbs presented in Si Jun Zi Tang appears inside many other complex formulas.

Si Jun Zi Tang is a basic formula to tonify qi, since organic qi depends on the Spleen. Unlike other tonic formulas, which are Hot and have a drying effect, Si Jun Zi Tang is characterized by its harmonizing and moderate nature. It can be used to treat any alteration caused by a lack of qi.

COMPOSITION 

Radix Ginseng – Ren Shen 

Ren Shen has several very important health benefits [2] that make it a precious medicine:

    • Antioxidative and anticancer effects.

    • It helps improve immunity, energy levels, and sexuality.

    • Additionally, Ren Shen can combat cardiovascular diseases, diabetes mellitus, and neurological diseases.

    • It can improve mental performance, such as focus and concentration in middle-aged adults.

    • Ginseng stimulates the central nervous system and helps the body metabolize harmful substances released during stressful situations, while also increasing physical resistance to stress.

    • It has also been reported to reduce fatigue in females with multiple sclerosis. 

    • Ginseng may have a positive impact on blood pressure by normalizing it and reducing blood viscosity and clot formation.

Rhizoma Atractylodis macrocephalae – Bai Zhu

Bai Zhu has multiple health benefits [3], especially for the nervous, endocrine, and urinary systems:

    • It has diuretic, antidiuretic, and anti-inflammatory effects.

    • It also has antitumor properties.

    • Bai Zhu can help regulate gastrointestinal function and has a hypoglycemic effect.

    • It can also provide analgesic relief and protect against liver ischemia-reperfusion injury in rats.

    • Bai Zhu inhibits aromatase and can be used to treat bone diseases.

    • It strengthens myocardial contraction ability and has detoxification and cholagogic effects.

    • Baizhu can also lower hematic fat and treat acute renal injury.

    • Additionally, it acts as an anticoagulant and improves the nervous system.

    • It affects the immune system and regulates uterine smooth muscle.

    • Baizhu also has antioxidant, antiaging, and antibacterial effects.

Sclerotium Poriae – Fu Ling

Fu Ling has the following health benefits [4] :

    • Fu Ling has a potent anti-inflammatory activity.

    • Fu Ling is known as an immunomodulator. It can change how the immune system works by regulating molecules called cytokines.

    • Anticancer properties.

    • Reduces blood glucose by increasing insulin sensitivity.

    • Antinephritic, antioxidant, and anti-emetic properties.

Radix Glycyrrhizae cum melle tosta – Zhi Gan Cao 

Zhi Gan Cao is added to many of the TCM formulae in order to balance the action of the other herbs. In addition, Zhi Gan Cao has the following health benefits [5]:

    • Antiulcer, antiinflammation, spasmolysis, and antioxidative.

    • Contravariance, antiviral, anticancer, and hepatoprotective.

    • Zhi Gan Cao eliminates phlegm and reinforces remembrance effects.

    • Protects the digestive, respiratory, nervous, and endocrine systems.

Contraindications

Excessive use of this formula can cause dry mouth, thirst, and irritability. It should not be used without modification in cases of high fever, Heat deficiency, or a combination of irritability, thirst, and constipation. Contraindicated in Liver Yang Rising syndrome.

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  • Si Jun Zi Tang is a moderate classic formula that is used to tonify qi in patients with Spleen Qi Deficiency.
  • Si Jun Zi Tang is composed of ginseng, atractylodis root, poria cocos, and Chinese liquorice.
  • Si Jun Zi Tang is contraindicated in Liver Yang Rising syndrome.

Other Formulas 

Classic formulations containing herbs with specific therapeutic effects are restricted to professional prescription only

Many classic formulas in the form of tablets and pills are available to the public on the internet and in TCM shops. Despite their easy availability, one must be very careful before purchasing any TCM medicine for two reasons:

    • Quality. China’s economic policies prioritize quantity over quality. Many herbs of Chinese origin are very cheap and their quality is proportional to their price. Unfortunately, not all Chinese herbal medicine manufacturers can be trusted. When it comes to medicine, the quality of the raw materials is of decisive importance.

    • Incompatibility. Herbal medicines can be very harmful to health when taken outside of their original indication, just like any other drug. In traditional Chinese medicine, self-medicating is just as contraindicated as in Western medicine.

Chinese authorities claim that long Covid is being satisfactorily controlled in their territory thanks to traditional medicine. Other countries where TCM is widespread, such as Taiwan and Singapore, have also benefitted from traditional Chinese medicine during the health crisis caused by SARS-CoV-2.

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  • Always consult with a qualified practitioner before purchasing any TCM medicine.
  • Traditional Chinese medicine has been successful in the treatment of Covid in many Asian countries.

Disclaimer 

This article is only for informational purposes. It is not a replacement for professional medical advice or personal guidance. If you have any questions about your health or a medical condition, it’s important to consult with a qualified health professional. It is not recommended to ignore or delay medical advice based on something you read on this website.

References:

1. et al. Data-driven identification of post-acute SARS-CoV-2 infection subphenotypes. Nat Med 29, 226–235 (2023). https://doi.org/10.1038/s41591-022-02116-3

2. Ratan ZA, Haidere MF, Hong YH, Park SH, Lee JO, Lee J, Cho JY. Pharmacological potential of ginseng and its major component ginsenosides. J Ginseng Res. 2021 Mar;45(2):199-210. doi: 10.1016/j.jgr.2020.02.004. Epub 2020 Mar 25. PMID: 33841000; PMCID: PMC8020288.

3. Yang L, Yu H, Hou A, Man W, Wang S, Zhang J, Wang X, Zheng S, Jiang H, Kuang H. A Review of the Ethnopharmacology, Phytochemistry, Pharmacology, Application, Quality Control, Processing, Toxicology, and Pharmacokinetics of the Dried Rhizome of Atractylodes macrocephala. Front Pharmacol. 2021 Nov 3;12:727154. doi: 10.3389/fphar.2021.727154. PMID: 34803677; PMCID: PMC8595830.

4. Ríos JL. Chemical constituents and pharmacological properties of Poria cocos. Planta Med. 2011 May;77(7):681-91. doi: 10.1055/s-0030-1270823. Epub 2011 Feb 23. PMID: 21347995.

5. Gao X, Wang W, Wei S, Li W. [Review of pharmacological effects of Glycyrrhiza radix and its bioactive compounds]. Zhongguo Zhong Yao Za Zhi. 2009 Nov;34(21):2695-700. Chinese. PMID: 20209894. 

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