Understanding Long Covid Through the Lens of TCM

Summary of Contents
What Is Long Covid Syndrome?
Ongoing Long Covid Symptoms
Post-Covid Cough
Recommended Home Remedies

What is Long Covid Syndrome?

WHO defines Long covid, or post covid condition as follows:
“Post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.”

Most people with COVID-19 omicron variant won’t become severely ill, However, even a mild infection can cause long COVID. Researchers from Oxford University found that a startling one-third of people who caught the virus were still experiencing one or more symptoms between three and six months after being diagnosed. In some cases, recovered patients may experience new symptoms, or may still be disturbed by the effects of infection weeks after they tested negative. [1]

The long covid symptoms can be broadly divided into the following categories
The symptoms not fully recovered after the Covid test turn negative. (e.g. cough, fatigue, pain and gastrointestinal symptoms) Long covid symptoms developed due to the damage on various organ system during the acute infection of covid virus. The symptoms or conditions developed due to the stress and traumatic experience associated with Covid. (e.g. depression, anxiety, impairment of mood, memory loss and insomnia)

In this blog, we will cover the most common on-going long covid symptom – coughing after the covid test turns negative.

Ongoing Long Covid Symptoms

According to the CDC, the most common lasting symptoms are fatigue, shortness of breath, cough, joint pain and chest pain. Most of these symptoms are closely related to the weakening of lung function. This is quite understandable as a severe case of COVID-19 can produce scarring and other permanent problems in the lungs which take time to recover. From our clinical observation, however, even mild infections can cause a pretty long lasting cough and persistent shortness of breath, especially among older patients and patients with chronic conditions.

From a TCM point of view, most of these lasting symptoms are rooted in the weakening of qi (the vital energy) of the lung. When a person is infected by an external pathogen like covid, ones’ immune system needs to fight with the pathogen and restore its own internal balance. Both the energy (qi) and the yin essences deplete during the process. As the primary war zone is the lung system including the throat and upper respiratory tract, the qi movement and the normal nourishment in these areas were interrupted, and the effect will last beyond the viral infection.

When our lung system is healthy, the vital energy of our lungs will naturally help the outside fresh air to move downward, deep into our lungs to complete the breathing cycle. When the energy of the lung deplete, the downward movement will also weaken and lead to shallow breathing and shortness of breath. If the movement of qi is stagnated or blocked by phlegm, the lung qi could move upwards and manifested as cough and wheezing. To resolve these lingering symptoms, normally Chinese herbal medicine will be used to reduce the phlegm, strengthen and lung function, restore the proper direction of qi flow and resolve the coughing reflex.

Post-Covid Cough

Cough is a very common symptom that coexists with a number of diseases, like common cold and flu, it may also exist by its own due to various external factors and internal imbalances. In order to provide the best treatment protocol for coughing patients, TCM has divided cough into 8-9 commons patterns. These patterns developed according to the nature of disease, the change of seasons, environmental factors, and the unique body constitution of the individuals. From our clinical experience, the post covid cough normally falls into patterns of Lung qi deficiency, Yin deficiency, Damp phlegm, and Phlegm heat.

1. Lung Qi deficiency
Long haulers or long covid patients with congenitally weak physique, advanced age, chronic diseases, or chronic spleen and/or lung weaknesses are prone to develop or evolve into this pattern. Apart from coughing with clear phlegm in a husky sound, the patient will also feel weak and tired, looking pale with occasional sweating. To heal the cough and prevent the patient from contracting other pathogens due to weaknesses, herbal medicine will be used to tonify the Qi (vital energy) of both Lung and Spleen (digestive) systems. Ample rest is needed during the recovery process, and vigorous exercise is not recommended as it will further deplete the patient’s energy. Instead, work-out integrated with breathing, like Yoga, Tai chi and Qi gong will help the recovery. Certain breathing exercises like diaphragmatic breathing may also enhance the breathing efficiency and tonify Qi.

2. Yin deficiency of lung
Patient’s yin essence will deplete when fighting against Covid, especially for those suffering from fever. The Yin deficiency cough is characterized by a short dry cough, sometimes accompanied by little or sticky phlegm, which may become more severe at night. Patients may also experience other yin deficiency symptoms like dry nose, mouth and throat, flushed cheeks, and night sweats. Persistent dry cough may interrupt the qi flow and hurt the throat, hence it should not be overlooked. Herbal medicine is normally prescribed to nourish and moisten the lung, sooth the dryness in the air track and rebalance the yin and yang. Food selection could play a part in expediting the healing. Vegetables like lily bulb, sugarcane, white fungus; fruits like loquat, kumquat and pears, all serve to heal the dry cough. Avoid taking deep fried and spicy food and/or any food that may stimulate the throat. Cold and greasy food should also be limited.

3. Damp phlegm
A good number of long haulers or long covid patients continue with frequent or severe cough, accompanied by diluted damp white phlegm, resembling the condition of chronic bronchitis. The cough could last for weeks if proper treatment is not rendered. The patient may also suffer from fatigue, poor appetite, and occasional nausea. TCM reckoned that it is caused by internal dampness and spleen system dysfunction. This type of cough could aggravate with consumption of excessive animal protein, sweets, oily food or other food that is hard to digest. is necessary to expedite the healing of the cough associated with damp phlegm. Regular non-vigorous exercise, like walking, can move the qi and blood and remove the accumulation of dampness in the body. Herbal medicine can be used to reduce the dampness and enhance the metabolism of the phlegm in the body. After the phlegm is resolved, cough and chest congestion will also subside.

4. Phlegm-heat
For younger patients or patients with damp- heat body constitution, the lingering cough could manifest as Phlegm-heat cough. Phlegm-Heat coughs are hoarse coughs accompanied by thick yellow phlegm that is difficult to expel. Some may also have rapid breathing, and chest pain. The thick yellow phlegm is a good indicator of some level of inflammation happening in the body. The primary target of herbal medicine is to reduce the inflammation, reduce the heat and resolve the phlegm. Other TCM manual therapy, like Cupping and Guasha, may help to expedite the removal of dampness and heat from the body. Like Damp- phlegm cough, food elimination is crucial in expediting the healing. Apart from the sweetened and oily food which may promote inflammation and phlegm, spicy and hot food like curry, should also be temporarily eliminated from daily diet. Alcoholic drinks should be avoided until the cough and phlegm is totally resolved.

Recommended Home Remedies

Apart from taking Chinese Medicine, super food targets to tonify the Qi of the lung and spleen system will also help to speed up the recovery. According to the 5 element theory, those supper foods are normally vegetables in color white (enhancing lung function) and yellow (enhancing spleen function). Normally these foods could be combined to make tea, soup and desert. Before home remedies are used, it is suggestable to consult a TCM practitioner to assess the pattern of cough and one’s own body constitution.

Lung function enhancing food

Chinese yam 淮山 – Nourish both Lung and Spleen

Lily bulb 百合 – Nourish yin of the lung

White fungus 雪耳 – Nourish yin of the lung and detox

Almond 杏仁 – regulate qi of the lung

Pear 梨 – Reduce lung heat and nourish yin of the lung

Spleen function enhancing food

Ginseng 人參（including American Ginseng花旗蔘）- Nourish Spleen Qi

Millet 小米 Nourish the whole digestive system

Chestnut 栗子 Nourish Spleen qi and enhance digestion

Papaya 木瓜 Nourish Spleen qi and enhance digestion

Sweet potato 蕃薯 Tonify the function of spleen and stomach

Food to reduce cough & phlegm

Dried orange peel 陳皮 – resolve all damp phlegm and enhance qi movement

Water chestnut 馬蹄 – reduce heated phlegm

Monk fruit 羅漢果 – reduce dry cough and allergic cough

Recipe idea:

1/ Monk fruit tea to soothe dry cough and itchy throat

2/ Dried tangerine peel tea to reduce phlegm and cough

3/ American Ginseng tea to enhance lung qi

4/ Make soup with water chestnut, sugar cane and carrot to nourish the lung and reduce lung heat

5/ Make soup with Chinese yam, lily bulb, almond, white fungus and chestnut to tonify the lung and spleen

6/ Make congee with millet, chestnut and/or sweet potato to tonify the spleen

Before home remedies are used, however, it is suggestable to consult a TCM practitioner to assess the pattern of cough and one’s own body constitution.