Summary

Numerous studies have confirmed that novel coronavirus infection in humans produced long-lasting side effects even after the symptoms of the initial infection disappeared completely, which we call long-term COVID-19 symptoms. These effects of post-coronavirus remnants mainly were the appearance of fatigue, general weakness, orthostatic intolerance, shortness of breath, palpitations, haze, loss of taste and smell, joint pain, insomnia, type 2 diabetes, alopecia, and impotence. These long-term COVID-19 symptoms can put eternal side effects on the body.

In this paper, the author studied the post-COVID-19 symptoms to find that there was a large number of people belonging to the symptoms of fatigue. The clinical manifestations of long-term COVID fatigue were summarized in the paper, only to be found that the fatigue symptoms caused by COVID-19 were very similar to that of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

In this paper, we provided not only the detection method of professional medical institutions to evaluate whether humans have developed long-term COVID-19 fatigue, but also an in-house assessment to judge whether people developed these symptoms. Then the pathogenesis of fatigue caused by COVID-19 infection was analyzed and summarized. The pathogenesis included the process of infection of human cells with novel coronavirus, the process of virus replication in human cells to cause pyroptosis, the process of immune system response to the virus, and the process of virus transmission in the human body. Combined with the pathogenesis, this paper brought forward the therapeutic ideas of western medicine in the treatment of fatigue after novel coronavirus infection.

Due to the limitation of western medicine treatment against fatigue, this paper also recommended some traditional Chinese medicine, including Chinese medicine formula and acupuncture treatment, to treat the related symptoms of fatigue. In addition, this paper made advises patients with long-term COVID fatigue on taking health care products, as well as on exercise, diet, and sleep. In the end, we hope that the treatment program for long-term COVID-19 chronic fatigue suggested in this paper could benefit patients by improving their symptoms of fatigue as soon as possible, and even cure the fatigue caused by novel coronavirus.

Keywords: Long COVID, Post-COVID Conditions, Post COVID-19 Symptoms, Long COVID fatigue, Post-COVID fatigue, long-term COVID-19 fatigue, chronic fatigue syndrome, myalgic encephalomyelitis.

1.What Are The Manifestations Of Long COVID Chronic Fatigue?

Since the COVID-19 pandemic, after being infected with these coronaviruses, some people experienced severe fatigue. Such fatigue sometimes is continuous and sometimes intermittent, usually lasting for a long time, even up to more than a year. This condition is called post-infectious fatigue syndrome or chronic fatigue syndrome by the medical community and is commonly called chronic fatigue by the general public.

According to statistics in the study report, approximately 10% of people infected with novel coronavirus developed post long-term COVID-19 symptoms, and patients with chronic fatigue accounted for one-fourth of all patients with post long-term COVID-19 symptoms. That means about 2.5% of people infected with the coronavirus would experience chronic fatigue. According to published medical papers on long-term COVID-19 symptoms of chronic fatigue, we conclude that the manifestations of chronic fatigue are as follows:

(1)Chronic fatigue: feel that one is in a state of extreme fatigue, the body is low in energy and has a feeling of heaviness. Insufficient endurance, weakness, slight sweating, and breathlessness during exercise. Physical deficiency and shortness of breath are commonly used in TCM to describe this condition.

(2) Brain fatigue: feel that it is easy for the brain to be tired, feel listless, it is easy to feel tired when pondering, feel easily sleepy when reading, and feel sleepy easily during the day.

(3) Common accompanying symptoms, shortness of breath: shortness of breath, gazing and wheezing occur with slight exercise, only able to walk very short distances or climb a dozen staircases, and then mild asthma symptoms also occur.

(4) Common accompanying symptoms, muscle weakness: feel generalized weak, stiffness, muscle weakness, leg weakness, orthostatic intolerance.

(5)Common accompanying symptoms, muscle and joint pain: generalized muscle pain, systemic chronic mild pain, joint pain, limb pain, movement site pain, migratory neuralgia.

(6) Common accompanying symptoms, sleep disorder: difficulty in falling asleep, poor sleep quality, unable to recover the physical condition, and still feel fatigued after having sleep. it is easy to wake up or have insomnia, or feel drowsiness and it is difficult to wake up, and other conditions at the same time, while sleepiness and tiredness appearing during the day. The patient presented with the conditions of day and night reversal, staying up late, and feeling tired in the daytime and energetic at night.

Because long-term COVID fatigue are very similar to Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS). We also list the diagnostic criteria for ME/CFS symptoms below.

ME/CFS is characterized by sudden or progressive onset of persistent incapacitating fatigue, post-exertional malaise (PEM)/exertional fatigue, inability to recover energy after sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headache, and sore throat and lymph node tenderness (no palpable lymphadenopathy) that persist for at least 6 months. This fatigue is not associated with other physical or mental illnesses and symptoms do not improve with sleep or rest. PEM may be better explained by exertional fatigue or a constellation of symptoms such as fatigue that usually increases in patients following exertional activities slightly beyond usually.

According to the American Academy of Medicine/IOM criteria, PEM is the most prominent feature of ME/CFS. PEM is described as a group of symptoms following mental effort or physical exertion that lasts 24 hours or more. Symptoms of PEM include fatigue, headache, muscle pain, cognitive impairment, and insomnia. PEM may even appear after simple activities (e.g., walking or talking), meaning that people with ME/CFS must substantially change their lifestyle, preserve physical and mental attention, and thus enable themselves to become competent in normal professional, educational, and social environments. Patients often work for only a few hours with productivity, the remain time spending on resting and slowly recovering from confusion, general pain, malaise, and other features of chronic fatigue.

ME/CFS also contains postural orthostatic tachycardia syndrome (POTS), which is characterized by orthostatic intolerance, that means abnormal autonomic responses for maintained upright cause a range of symptoms, including lightheadedness, blurred or diminished vision, generalized weakness, fatigue, palpitations, confusion, anxiety, nausea, dyspnea, or headache. The POTS clinical syndrome consists of intermittent orthostatic intolerance symptoms with excessive tachycardia without hypotension. Orthostatic hypotension is defined as a sustained decrease in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing or head-up tilt, with or without symptoms during assessment. Studies have shown that the majority of patients with COVID-19 symptoms of fatigue meet the diagnostic criteria for POTS.

Systemic exertion intolerance disease (SEID) is also included in ME/CFS , and the diagnostic criteria for SEID are incapacitating fatigue, PEM, and fatigue after sleep persisting, moderate or severe in severity, present at least 50% of the time, and cognitive problems or orthostatic intolerance of the same severity and frequency.

2.How Long Will Symptoms Of Fatigue Last After Being Infected With COVID-19?

2.1 What is Long COVID?

According to the definition of the World Health Organization, Post-COVID Conditions or Long COVID, also known as Post COVID-19 syndrome, refers to since the patient was infected with the novel coronavirus, the results of his PCR showed positive as criteria, and he still suffers uncomfortable symptoms after 3 months. More detailed updated statistical information on the incidence of Post COVID-19 Symptoms according to the timeline can be found in the figure below.

Post COVID-19 Symptoms are mainly concentrated in five aspects, including respiratory syndrome, cognitive system syndrome, chronic fatigue syndrome, chronic pain syndrome, and mental syndrome, such as long COVID of brain fog, which belongs to the cognitive system syndrome. long COVID chronic fatigue are one of chronic fatigue syndrome. According to medical classification, cognitive system syndrome includes fatigue symptoms, chronic fatigue syndrome, and brain fog. Moreover, two symptoms such as brain fog and fatigue will coexist in many patients with post long COVID-19, this coincident symptom of which we called brain fatigue. Of course, there is simple brain fog of non-fatigue, and physical fatigue with the brain awake.

2.2 How Long Will Symptoms Of Fatigue Last Following COVID-19 Infection?

If you have a history of the novel coronavirus, which means your previous result of PCR test showed positive, and before infection with the novel coronavirus, you didn’t suffer from the long-term COVID fatigue, but now you are presenting these symptoms of fatigue in the above section, you are likely to afflict by Post COVID-19 Symptoms, which can be called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in medicine. About 46.1% of hospitalized patients after COVID-19 infection developed fatigue after 12 weeks, the European Center for Disease Control and Prevention (ECDC) recently released. About 30.8% of non-hospitalized patients after COVID-19 infection developed fatigue symptoms after 12 weeks.

According to published medical statistics papers on the symptoms of COVID-19 fatigue, the symptoms of fatigue after COVID-19 infection will last for a considerable period of time. Fatigue tends to peak within a few months of infection with COVID-19 and generally improves over time, but symptoms of fatigue may persist for months. Recent studies have found that fatigue symptoms may persist for more than a year after infection with COVID-19, and studies have shown that more than 20% of patients with long-term COVID fatigue still do not improve after a year.

2.3 The Process Of COVID-19 Infecting Cells And Finally Triggering Pyroptosis Through Cell Reproduction

The mechanism by which novel coronavirus infects human cells is that virions recognize host receptors through the coronavirus spike glycoprotein (S protein), enter host cells in a membrane-fused manner, replicate in host cells through large replicative transcription complexes, and promote proliferation by interfering with and inhibiting the host immune response. The hosts of human highly pathogenic coronavirus are humans and vertebrates, and virions infect lung cells and upper respiratory cells through droplets, contact, and aerosols, and may also infect and spread through other routes such as the digestive tract, urine, and eyes.

The following figure shows the process how the COVID-19 infect cells and reproduce through the cells, finally triggering pyroptosis.

The approximate process is as follows:
(1) Novel coronavirus enters through the respiratory tract and attaches to epithelial cells of the upper respiratory tract and lungs.
(2) The novel coronavirus recognizes host receptors through the spike glycoprotein (S protein) of coronavirus, then binds to the angiotensin-converting enzyme 2 (ACE2) receptor and enters host cells in a membrane-fused manner.
(3)The novel coronavirus enters the Golgi apparatus and promotes the leakage of calcium (Ca2 +) ions stored in the Golgi apparatus by the E protein from the Golgi apparatus to the cytosol region.
(4) Simultaneous activation of ORF3a (a protein that opens pores in the cell membrane of the virus) , induces the efflux of potassium ions (K +) through the cytoplasmic membrane into the extracellular space.
(5) This imbalance in ion concentrations inside and outside the cell further leads to the generation of reactive oxygen species ROS oxidation reactions.
(6) In addition to inducing potassium ion (K +) efflux, ORF3a (a protein that opens pores in the cell membrane by the virus), also mediates ASC ubiquitination (protein ASC that drives apoptosis and open pores in the cell membrane) through TRAF3 (tumor necrosis factor receptor TNFR-related factor 3).
(7) This process in turn leads to mitochondrial damage and triggers activation of the NLRP3 inflammasome (tumor necrosis factor receptor TNFR-related factor 3).
(8) ORF8b directly interacts with leucine-rich repetitive DNA sequences of NLRP3 (tumor necrosis factor receptor TNFR-related factor 3) to stimulate its activation activity in independent of ion channels.
(9) NLRP3 inflammasome activates and induces the formation of gasdermin-D pores on the cell membrane, leading to IL-1 b and IL-18 secretion, which then spreads to the internal and external cellular environment.
(10) Water also flows into the interior of the cell through open holes in the cell membrane, which in turn leads to cell swelling and subsequent cell membrane rupture, which is pyroptosis.
(11) Novel coronavirus infection or vaccination can induce novel coronavirus specific antibodies (IgG) to adhere to novel coronavirus particles.
(12)Activated inflammasome NLRP3 (tumor necrosis factor receptor TNFR-related factor 3) in turn activates caspase-1 (caspase-1), resulting in gasdermin (GSDMD) cleavage.
(13)The cleaved NLRP3 inflammasome terminal N would be moved to the plasma membrane of the cell by GSDMD and assembled into pores in it.
(14) After the active replication of the coronavirus, the coronavirus would be released through emptiness on the cell membrane, or automatically after pyroptosis of the host cell.

2.4 The Process Of The Human Immune System Eliciting An Inflammatory Response In Order To Eliminate The Coronavirus

The response of the human immune system to the site of infection with novel coronavirus infection is divided into two phases: a preliminary phase in which the immune system mobilizes macrophages and polymorphonuclear phagocytes (e.g., neutrophils, basophils, eosinophils) to rapidly reach the site of infection to control infection. In the following stages: the immune system of the human body takes about 4 days to establish adaptive immune mechanisms through learning, including T cell-mediated immune mechanisms to solve the infection, and B system-mediated antibody production to clear the pathogen- novel coronavirus to prevent reinfection.

The following figure shows the process of the human immune system eliciting an inflammatory response in order to eliminate the novel coronavirus:

(1) Novel coronavirus enters through the respiratory tract and attaches to epithelial cells of the upper respiratory tract and lungs. The novel coronavirus recognizes host receptors via the spike glycoprotein (S protein) of coronavirus.
(2) Then the coronavirus binds to ACE2 (angiotensin-converting enzyme 2) receptor and TMPRSS2 (transmembrane serine protease 2) receptor to enter host cells in a membrane-fused manner.
(3) Novel coronavirus triggers DAMPS (Damage-associated molecular pattern) in cells leading to pyroptosis, after which cells release various factors, including ATP (adenosine triphosphate), nucleic acids, and ASC oligomers (adaptor molecules, apoptosis-associated speck-like protein with a caspase-recruitment domain).
(4) DAMPS (Damage-associated molecular pattern) is recognized by adjacent epithelial cells, endothelial cells, and alveolar macrophages. This in turn triggers the production of pro-inflammatory cytokines and chemokines including IL-6, IP-10, macrophage inflammatory protein 1α (MIP1α), MIP1β, and MCP1.
(5) These pro-inflammatory cytokine proteins attract monocytes, macrophages, and T cells produced by the immune system to the site of infection and then these cells begin to perform their duties to eliminate the novel coronavirus.
(6)At the same time, T cells will produce IFNγ in large amounts and establish a pro-inflammatory feedback loop. Pyroptosis also generates G-CSF (granulocyte colony-stimulating factor) and TNF (tumor necrosis factor).
(7) Immune cells accumulate further at the site of infection, resulting in excessive production of pro-inflammatory cytokines and further damage of the cellular environment at the site of infection, thus promoting a further inflammatory response.

There are trace viruses that escape in the human body in the long term, which will persistently infect and invade human tissue cells, causing tissue damage. Tissue damage, in turn, triggers chronic inflammation. This chronic inflammation is produced by a persistent immune response, also causing persistent massive cytokine diffusion. The continuous breakdown of a large number of cytokine proteins can lead to autoimmunity. Autoimmunity refers to the immune response produced by organisms against healthy cells and tissues of their bodies. Any disease caused by this immune abnormality is called autoimmune disease.

The persistence of trace novel coronavirus continues to deteriorate the situation, leading to T cell failure and immune memory defects. Defects in immune memory can make the immune system gradually insensitive to immune pathways that eliminate novel coronavirus, eventually becoming a coexisting state. This condition is characterized by generalized diffuse chronic inflammation. In the long run, the function of body organs and tissues is reduced.

Because novel coronavirus can easily mutate, so far as more and more coronavirus variants appear and the ability of immune escape is increasing, this makes the effect decrease when the antigens (HLA) produced by the human immune system to clear novel coronavirus, which means there will be a small number of novel coronavirus immune escape. Novel coronavirus in some patients has not yet been completely cleared, but because the human immune system is suppressing these coronaviruses, leading the content of novel coronavirus too small so as to make PCR tests negative.

3.What Are The Causes Of The Long COVID Chronic Fatigue?

According to the published medical papers on the long-term COVID chronic fatigue, we concluded that there are six conditions in the pathogenesis of the long COVID-19 chronic fatigue as follows:

(1) Coronavirus, a harmful antigen, causes persistent direct tissue damage, which produces chronic inflammation. The novel coronavirus antigen infects different organs, and each patient's autoimmune system is different, which leads to different immune responses. Tissue damage can present with shed tissue proteins, coupled with the mutilated corpse of the coronavirus, which decompose slowly in the human body, and these protein fragments, in turn, can trigger autoimmunity. For example, it has been found that autoreactive B lymphocytes remain activated in patients infected with novel coronavirus after negative PCR tests. This long-term autoimmunity is thought to be one of the main causes of chronic fatigue.

(2) There are too many variants of coronavirus. With the immune escape ability is getting stronger and stronger, the coronavirus and the patient's human leukocyte antigen (HLA) mismatch ingenetic ability, leading to the human immune system unable to completely eliminate the coronavirus. Studies have found that among some patients infected with novel coronavirus, the virus do not clean up in the human body. This long-standing trace amount of novel coronavirus will also gradually make the immune system insensitive to the route of eliminating novel coronavirus, finally in a coexisting state. At this time, these trace viruses will continue to damage various organs and body tissues. This condition is medically known as post multi-organ symptoms of non-serious novel coronavirus infections. This reduces body function, which has been shown to be one of the causes of fatigue.

(3) Studies have confirmed that the coronavirus can destroy the immune system of the human body, leading to reduced immune capacity. At this time, although the coronavirus is eliminated, Epstein-Barr virus, cytomegalovirus and herpes virus, which were originally hidden in the human body in a dormant state, will become active again. These viruses reinfect tissue cells in vivo, causing chronic inflammation and autoimmunity. It has also been shown to be one of the causes of the long-term COVID-19 symptoms of chronic fatigue.

(4) Patients infected with novel coronavirus experienced dysregulated cytokine networks or disturbed cytokine signaling in their bodies. For some people infected with coronavirus, they developed systemic chronic inflammation. Proinflammatory substances triggered by systemic viral infections, NLRP3, HMGB1, and interleukin 6, as they have been documented. Studies also have shown that this may also be one of the causes of the post long-term COVID-19 symptoms of chronic fatigue.

(5) For patients infected with novel coronavirus, the coronavirus invades tissue cells, resulting in disruption in cellular mitochondrial structure, cellular metabolism, and cellular energy cycling. Studies have shown that mitochondrial enzymes are involved in inflammatory and oxidative reactions from the onset of novel coronary symptoms, which may also be one of the causes of the post long-term COVID-19 symptoms of chronic fatigue.

(6) Long-term COVID-19 symptoms of fatigue have the same pathophysiological process as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and mainly autoantibodies against ß-2 adrenoceptors lead to disturbances in muscle and cerebrovascular regulation.

Most people who suffered from the long-term COVID are characterized by brain fog, fatigue and pain. Mady Hornig, a psychiatrist at Melman School in Colombia, is known for her research on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). She has made some of the most influential research on ME/CFS over the past decade to help establish ME/CFS as a biological disease rather than a psychological disease. She believed that research on the overlap between ME/CFS and Long COVID could help millions of people. In an interview with Columbia magazine last year, she said we could see an unprecedented wave of ME/CFS-like illness in the coming years and impose huge societal costs.

Mady Hornig found striking similarities between Long COVID and ME/CFS. First and foremost, it is a remarkable overlap of symptoms, particularly fatigue, lack of sleep, or "discomfort after exercise." Movement discomfort refers to physical discomfort that can be affected by even minor physical or cognitive movements, which is general discomfort. Viral infections can be traced to the onset of both Long COVID and up to 75% of ME/CFS cases.

Mady Hornig started with how SARS-Cov-2 impacts the nervous system and whether it continued to remain latent, infecting parts of the body that were invisible to testing. Her research on ME/CFS revealed how this happens. Because the immune response was hyperactive in the early stages of the disease, a state of immune failure ensued in response to chronic viral infections.

New research has confirmed that before the novel coronavirus infection, if patients have developed psychological diseases, such as insomnia, anxiety, depression, etc., after patients are infected with novel coronavirus, they are more likely to suffer from chronic fatigue symptoms. There is also evidence that infection with novel coronavirus can exacerbate this condition if the patient has a history of a similar chronic fatigue syndrome before the novel coronavirus infection.

4.How To Treat The Long COVID Chronic Fatigue?

At first, we need to take a thorough physical examination of our bodies, and besides taking routine examinations, we need to do another four examinations.

The first item: do several more PCR tests, and nasal and throat secretions should be dipped enough to check whether the result shows positive. If it shows positive, it means there is still some active novel coronavirus in the body.

The second item: evaluate whether diseases completely belonging to chronic fatigue syndrome according to the special examination of chronic fatigue syndrome. This test should be done more comprehensively, including specific assessment tests for fatigue, cognitive dysfunction, and pain. For example, complete blood cell differential examination, erythrocyte sedimentation rate examination, serum glutamate pyruvate transaminase examination, trace elements, blood glucose examination, serum creatinine, elevated urea nitrogen examination, electrolyte examination, thyroid function test, urinalysis, X-chest imaging.

The third item: further serum tests will be performed to check mainly which several viruses are still present in the body. Neuroimaging will also be performed to check if there are lesions in the brain.

The fourth item: further immunological tests should be performed. Test should be performed to check specifically whether the amount of p-tau217 protein in the blood exceeds considerably the person's average criteria. The result of excess means the brain is in the early stages of Alzheimer's disease.

Then, the results of the above comprehensive physical examination and four special examinations should be handed over to the doctor, and then the person should communicate with the doctor to describe one‘s own long COVID chronic fatigue in detail.

Additionally, the doctor can design the best treatment for you. Because the situation varied from person to person, after the interview the treatment plan given by the doctor is also different, so this paper cannot give a general treatment plan in this article.

The rough ideas for designing the treatment plan are as follows:
(1) According to the results of the patient's comprehensive physical examination and four special examinations as well as the communication with the patient, find out the most likely pathogenesis of the patient's long COVID chronic fatigue.

(2) Prescriptions are prescribed for treatment according to the pathogenesis and the patient's physical condition. If both clinical symptoms and test results show overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), the current international version of the ME/CFS treatment guidelines can be used for treatment.

(3) For the main direction of medication, if novel coronavirus remains in the body, antiviral drugs such as Paxlovid should be used as a priority. If there is no virus in the body, the drug is used from the perspective of reducing or eliminating the chronic inflammation of the patient, improving the metabolic circulation and immune mystery of patients. For example, rintatolimod (immunomodulator) and coenzyme Q10 + NADH (mitochondrial modulator) can be used to improve the immune system of patients.

(4) For the symptoms that seriously affect the work and life of patients, some drugs for improving the experience of symptoms can also be used according to the specific symptoms, such as drugs for invigorating the brain, refreshing the brain, stimulating the nerves, and other effects. Studies have shown that long COVID chronic fatigue patients taken low-dose amitriptyline will achieve better efficacy.

(5) Oxygen therapy and brain physical massage can also be tried, and studies have shown that these two methods are also beneficial in removing chronic fatigue.

(6) If patients suffer from psychiatric symptoms such as insomnia, anxiety, and depression, they should seek help from psychologists and TCM to eliminate these psychological symptoms. This method is also helpful in removing long-term COVID-19 chronic fatigue.

5.How To Treat Long COVID Chronic Fatigue From a Traditional Chinese Medicine(TCM) Perspective?

From the theory of syndrome differentiation and treatment of TCM, the treatment of long COVID chronic fatigue can obtain more accurate TCM syndrome differentiation and more suitable TCM formulas from the following three steps.

(1) Perform the observation, smelling, hearing, and inquiring of traditional Chinese medicine diagnosis, and consult the comprehensive physical examination report and four special examination reports of western medicine in the previous section at the same time. Only in this way can TCM doctors obtain the most detailed disease information of patients to support them to make the most accurate syndrome differentiation and treatment of patients' conditions.

(2) TCM doctors will classify and summarize the main symptoms, accompanying secondary symptoms, physical condition, and sick parts of the internal organs of the patients according to the most comprehensive disease information of the patients.

First, the main symptoms are the most unbearable symptoms of patients at present, such as long COVID chronic fatigue.

Second, accompanying secondary symptoms are that suffered from the main symptoms, the patient is experiencing other uncomfortable symptoms, such as feeling fatigued in a short time when using the brain, suffering from insomnia, anxiety, depression, and so on.

Third, to find out the physical condition of the patient, which means the patient's current physical health status, belongs to which category in the TCM constitution. For example, For example, yang-deficiency constitution, phlegm-dampness constitution, qi-deficiency constitution, blood stasis constitution, etc.

(3) TCM doctors, according to the above summary, combined with the internal organs and meridians related to symptoms, comprehensively use the theory and practical experience of TCM to make TCM prescriptions for patients. If acupuncture and moxibustion are required, these programs will also be prescribed.

Traditional Chinese medicine (TCM) theory is mainly based on: Zhang Zhongjing’s “Treatise on Febrile Diseases”, “Synopsis of Golden Chamber”, Huang Yuanyu's “Four Sacred Hearts Source”, “Typhoid Fever Suspension”, “Jinkui Suspension”, “Changsha Yao Jie”, Li Dongyuan 's “Treatise on the Spleen & Stomach”, and Zhang Jingyue' s “Jingyue Quanshu”.

TCM Practical experience, which can be found in Google Scholar (Fig. https://scholar.google.com/), and search for keywords for TCM treatment of long-term novel coronavirus symptoms. For example， COVID-19 Traditional Chinese Medicine, Long COVID Traditional Chinese Medicine. A large number of academic papers on medical research on the treatment of Long COVID by traditional Chinese medicine can be found in this way.

In order to make it easier for everyone to understand the treatment process of TCM, the following is a TCM treatment case of a patient with long COVID chronic fatigue

Case 1:

Name: Yang, female, aged 29 years, height 163cm, weight 50 kg.

MEDICAL HISTORY: PCR was positive for novel coronavirus on 14 Mar 2022, followed by typical symptoms of novel coronavirus infection: fever, cough, sore throat, sputum with blood streaks, ageusia, and anosmia. Two weeks later, the symptoms of novel coronavirus infection gradually relieved and disappeared. Later, long COVID chronic fatigue appeared successively.

Physical examination report of western medicine: (1) The special examination of chronic fatigue syndrome completely meets the criteria. (2) Abnormal values of angiopoietin-1 (ANG-1) and P-selectin (P-SEL) assays. (3) Abnormal values for α-2 antiplasmin (α-2AP) and D-dimer assays. (4) Pro-inflammatory markers were high, Serum amyloid A (SAA) test value exceeds the standard and there was slight systemic chronic inflammation.(5) Immune system examination items revealed abnormal lymphocyte subset determination, C-reactive protein, and immunoglobulin data.

Main symptoms: fatigue, meeting the criteria of chronic fatigue syndrome.

Accompanying secondary symptoms: anxiety, insomnia, easy to wake up, dreaminess.

Prescriptions given by Western physicians:
(1) Paxlovid (paxlovid, antiviral drug, use to prevent the replication of novel coronavirus in vivo).
(2) Coenzyme Q10 + NADH (mitochondrial modulator).
(3) rintatolimod (immunomodulator).
(4) Vitamin C, vitamin E, and β-carotene. (Use to reduce the inflammatory reaction in vivo.)

TCM constitution: the body presents phlegm-dampness constitution and showing symptoms of heart and liver blood deficiency.

TCM diagnosis evaluation: The body before being infected with the novel coronavirus was in a sub-health state with obesity, and the sub-health state deteriorates with the infection with novel coronavirus, presenting phlegm-dampness congestion, chronic fatigue and other symptoms.

Prescription given by the TCM doctor:
(1)Modification of Bugan Tang, Angelica72g, Paeonia lactiflora 12g, Ligusticum chuanxiong Hort 6g, Rehmanniae Radix Praeparata 10g, Semen Ziziphi Spinosae 12g, Ophiopogonis Radix 10g, Salvia miltiorrhiza 12g, Pawpaw10g, Baiziren 10g,
Liquorice 6g. This prescription is suitable for those with heart and liver blood deficiency and insufficient heart blood. For relieve chronic fatigue.
(2) Mailuotong capsules are used to dredge meridian vascular congestion.
(3) Chaihu plus Longgu oyster Tang are used to improve insomnia anxiety.
(4) Dabu Tang for deficiency of both qi and yin is used to remove phlegm and dampness and supplement vital energy.

Acupuncture program given by the TCM: Using an electronic moxibustion device, moxibustion on the following acupoints.
(1) Baihui, Neiguan, Quchi, Hegu, Taichong points are stimulated by moxibustion to improve cerebral blood circulation and metabolism.

6.Which Kind Of Health Care Products Are Beneficial To Improving Long COVID Chronic Fatigue?

Taking the patient above as an example, we give the following health product recommendations based on her condition:

(1) Omega 3 (Ω3) fatty acids, containing high amounts of DHA and EPA, are used to improve fatigue and protect against cardiovascular and cerebrovascular diseases.
(2) VC and VE are used to scavenge free radicals, anti-oxidation, and reduce systemic chronic inflammation.
(3) Curcumin is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.
(4) Sulforaphane is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.
(5) Melatonin is used to improve sleep quality.
(6) American ginseng is sliced for making tea or taken American ginseng capsules to replenish qi.

7.What Exercises Are Beneficial To Improving Long COVID Chronic Fatigue?

Taking the patient above as an example, we give the following exercise advice based on her condition:

(1)Take moderate aerobic exercise at least three times a week, such as walking and jogging to remove phlegm-dampness.
(2)Do yoga to relax tendons and activate blood.

8.What Is Beneficial To Improving Long COVID Chronic Fatigue In Terms Of Diet And Sleep?

Taking the patient above as an example, we give the following diet and sleep advice based on her condition:

(1) Control carbohydrate intake, which means reducing the amount of staple food such as rice and noodle, to control of animal fat intake.
(2) Bubble bathing until slightly sweating before sleeping, and lie in bed to do general muscle tightness and relaxation training, improving sleep quality.

9.Patients With Long COVID Chronic Fatigue Are Welcome To Contact With Our Long COVID Care Center

If there are similar symptoms among readers, contact our Long COVID Care Center for assistance.

Phone: +852 5765 5768

Whatsapp: +852 5765 5768

WeChat: longcovidcarecenter

Email: support@longcovidcarecenter.org

【Disclaimer: The treatment of diseases is a very complex and professional affair. Due to the limitation, Long COVID Care Center can only carry out remote simple interviews, unable to face-to-face offline interviews and obtain comprehensive physical examination results. Therefore, the suggestions, guidance, protocols, and documents conveyed by our Long COVID Care Center to patients can only be used as a reference for patients to understand their diseases in many aspects, but cannot be directly used as a treatment plan. Patients must discuss their symptoms with doctors in local hospitals through face-to-face communication. After the patients completed the physical examination required by doctors, they would get a prescription issued by doctors and get the treatment under the guidance of doctors. Therefore, Long COVID Care Center hereby declares that our center is completely exempted from liability when any adverse consequences are caused by self-treatment of the patient for applying any contents convoyed by the center, that is, we do not bear any responsibilities.】