Acupuncture for COVID Long-Haulers, Pt. 2: Case Studies

Editor's Note: Part 1 of this article appeared in the August issue and discussed the 5 Element Acupuncture basis for diagnosis and treatment.

Patient #1

This patient presented with classic dysautonomia symptoms. A female, married with two young children, she was diagnosed in March 2020, not hospitalized, got through the acute viral phase, and then jumped back into life. A week later, she couldn't get out of bed for a month. Upon meeting her a year later, her symptoms included:

• Extreme fatigue all day; must walk slowly; little bandwidth for children or work
• Weakness, especially from sitting to standing/walking: heart rate goes from 65 to 150
• Temperature: cold all the time, especially hands
• Sinus pressure
• Brain fog
• Chest tightness throughout day and particularly upon waking in morning
• Sleep: wakes up at 2-3 a.m. with adrenalin surge
• Pins and needles all over body; arms numb
• Digestion/bowels: constipation, abdominal pain and gas

Examination / Observations

Color: white
Sound: weep
Odor: rotten
Emotion: grief
Three chou temperature: upper ... normal, middle .. normal, lower ... normal
Tongue: scalloped edges, swollen, pale
Structure: nothing significant on neck, back, shoulders and knees, but interesting observation on right arm is a breakage during childhood at LI 11
Pulses:

Note: First-position pulses on left / right lowest in quantity and not at proper level.

Diagnosis and Treatment

Causative factor: metal (earth within)
Official: large intestine
Level: mental
Treatment strategy: Tonify upright qi through metal element, in particular the large intestine. Give special attention to earth within metal points, as they are the source of the qi deficiency imbalance (LU 9 and LI 11). In TCM theory, Lung 9 generates the pulse, stabilizes its rhythms, and as reunion of veins supports venous return. The large intestine, as first aid for fainting, brings qi quickly to the head and clears the senses. Frequency of visits at once/week. The following points were applied with needle tonify and moxa over three treatments:

• LU 1
• LU 9 needle tonify
• LI 11 needle tonify
• CV 6 Sea of Qi
• LU 8 Meridian Gutter
• LI 4 Joining the Valleys
• LI 10 Arm Five Miles

Practitioner observation: Treatment on LI always brought universal pulse change.

Outcomes and Prognosis

The patient reported positive results from the first treatment onward: less brain fog, easing of headaches, slept through night, heart rate stabilized, and able to walk and be upright for longer duration of the day. She was able to stop Western medicine treatment for dysautonomia, namely compression stockings and cortisone.

This patient works extremely hard to have things perfected in her work life. Allowing for the "not perfect" is part of her learning curve; taking a breath in between tasks and accepting things as they are is an ongoing practice. This reflects the rhythmic aspect of the lungs and large intestine officials in our daily functioning.

Initially, it was observed that her first -osition pulses would return to the same state of deficiency by the time of her weekly return. Thus, due to lifestyle requirements of a working mother with two young children and a demanding mental-level job, I felt she would do better at the outset with treatment frequency at two times/week to restore qi support before her energy could backslide. This would enable her to build on each treatment and gain momentum.

Four months into treatment, the patient has some of her stride back and has graduated to treatment every other week. She will continue to need ongoing care for full recovery.

Patient #2

This patient presented with chronic fatigue. A female, age 56, she lives alone, divorced, with two grown children. Got sick in March 2020 after a plane flight, was not hospitalized, but had fever and sweating, burning in lungs with cough, shortness of breath and brain fog. Took 21 days to get over, whereupon the patient thought she was OK. However, at the end of April, she experienced a flare-up of all symptoms. Upon meeting her a year later, her symptoms still included:

• Fatigue: sleeps 9.5 hours per night and doesn't want to get up in the morning
• Difficult to sustain attention and engagement at work
• Memory poor
• Headaches
• No appetite
• Joint pain / body aches
• Worried she won't be able to continue her work
• Has lost touch with friends and family due to exhaustion

Examination / Observations

Color: lack of red
Sound: lack of laugh
Odor: scorch
Emotion: lack of joy
Three chou temperature: upper ... normal, middle ... normal, lower ... normal
Pulses:

Diagnosis and Treatment

Causative factor: fire (metal within)
Official: Heart Protector / pericardium
Level: spirit
Treatment strategy: Remove entry / exit blocks from small intestine to bladder, kidney to pericardium; tonify qi and nourish blood through the fire element on PC and TH to support return of memory and engagement with life; support yang qi through GV points. Use moxa. The following points were applied with needle tonify and moxa over three treatments:

• SI 19 to BL 1
• KI 22 to PC 2
• GV 1, Long Strength, to strengthen yang qi of lower chou, third-position pulses
• PC 7
• TE 4
• BL 38( 48), Rich for the Vitals, to strengthen essence / memory
• GV 12, Body Pillar, to support upright qi in her daily life
• PC 6
• TE 5

Outcomes and Prognosis

Following the third treatment, the patient reported the following: "I have been feeling basically back to myself since our last session. It's amazing! I will definitely come back should I need to. I am deeply grateful." This patient recovered quickly with no apparent long-term consequences. Her prognosis is good.

Note: Unlike case #1, this patient did not present with classic dysautonomia symptoms ,but rather classic deficient qi and blood symptoms: lethargy, lack of appetite, weakened memory, and withdrawal from personal engagement. The effects of social isolation due to Covid were more noteworthy for this patient. These dovetailed with her root imbalance in the fire element on the Heart Protector, the Official of Intimate Relationship. Her capacity to engage on an emotional, intimate, social level was seriously compromised by Covid. Once restored, this patient was able to recover her upright qi quickly and jump back into life.

Take-Home Points

Worsley Five Element Acupuncture, with its emphasis on causative factor as the root cause of illness, offers a theoretical construct for arriving at a targeted assessment and treatment for long haulers. Its differential diagnosis of color, sound, odor, emotion is well-suited to identify the cause of a set of symptoms that is widely varied, resulting from a virus that left each person it touched differently.

Both case studies were long-hauler patients, yet each had a completely different treatment strategy and treatment outcome based on their unique energetic nature. The concept of causative factor as unique to each person mirrors emerging Western medical thinking that an individual's constitution plays a role in how one's immune system responds to infection.