Getting to the Root of Long Covid

Long Covid in the UK

Long Covid is defined as symptoms continuing for more than twelve weeks after the first suspected coronavirus (COVID-19) infection, if these symptoms are not otherwise explained. The length of Covid recovery is not linked to the severity of the initial infection, and is independent of hospitalisation status.

Long Covid

While it is difficult to estimate the number of those affected by Long Covid in the UK, some estimates show that 5-50% of those post Covid infection are still experiencing long term symptoms.[1]

A recent study in the Lancet showed that one in eight people reported long-term symptoms directly related to their COVID-19 infection, including chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. [2]

According to the ONS, an estimated 2.3 million people living in private households in the UK (3.5% of the population) experience self-reported long COVID as of 3 September 2022.
Fatigue continues to be the most common symptom reported as part of individuals’ experience of long COVID (69% of those with self-reported long COVID), followed by difficulty concentrating (45%), shortness of breath (42%), and muscle ache (40%).
In addition, many suffer Health Anxiety as long Covid is a new disease with an uncertain prognosis.[3]

Long Covid Fatigue

As a proportion of the UK population, the prevalence of self-reported long COVID is greatest in people aged 35 to 69 years, females, people living in more deprived areas, those working in social care, those aged 16 years or over who were not working and not looking for work, and those with another activity-limiting health condition or disability. [4]

Many RCHM members have recently seen patients suffering from Long Covid in their practice.

What happens when a Long Covid patient comes for treatment with Chinese Medicine?

In your first Chinese Herbal Medicine consultation, you will be asked questions, observations made, and a diagnosis will be formed to help understand the 'patterns' which are seen as being at ‘the root’ of the symptoms you are experiencing.

The practitioner records your full case history, including any previous or ongoing medical investigations. There will be questions to help assess the whole body, and the nature, location, severity, frequency, quality of any symptoms you are experiencing.
In addition to this case history, your practitioner will ask to look at your tongue and feel your pulse at the wrist. This tongue and pulse diagnosis helps them to understand your body’s qi and blood flow and form an accurtate diagnosis.

The herbalist will use their diagnosis to create an individualised prescription that aims to address the root causes of the symptoms. They may also offer you acupuncture, and explain which foods are necessary to avoid or to take to help your recovery.
It is usually necessary to follow up as your condition should change in response to your treatment and your prescription may need to stop or change.

Pulse taking

Why is there a need for Individual Diagnosis and treatment of Long Covid?

From the initial infection through to the post viral stage, Chinese Medical Theory explains why there are differences in each individual’s responses to the highly infectious SARS Cov2 pathogen.

For instance, when the individual’s Defensive-Qi (Wei Qi) is strong, there will more likely be a strong and rapid immune system response- (eg. there will be raised temperature and a rapid pulse).

The Lungs (which are the front line of the at this stage are affected at this early stage) are involved - there may be a cough, tightness of the chest, rapid breathing. If this is a short lived phase, or the variant is weak compared to the host, or if medicines are taken that competitvely inhibit the binding of the spike protein to the body’s ACE2 receptors, there will be a more rapid immune response, faster reduction in viral load and more complete and rapid recovery.

If however, this high temperature stage lingers, the immune battle is more sustained, Chinese Medicine would say that the body may have encounterd a depletion of its qi and yin. In Western medical terms, this can be potentially seen in the change the blood viscosity, and blood coagulation- which is an indicator of clinical severity, and may later present as Long Covid’s cardiovascular symptoms [5]. The herbal prescription would be given to replenish the body’s fluids and restore blood flow in such a case history, where tongue and pulse signs indicated this would be suitable.

On the other hand, if the host did not produce such a rapid and a strong Defensive–Qi response at the time of infection, there may have only been a mild, or even no fever. With a milder immune response, the virus may have been able to take the chance to enter deeper into the body’s internal organs. When the superficial aspect of immune response did not respond promptly enough to neutralise viral entry to the deeper levels, or where there is pre existing weakness in the digestion there will be clear signs of gut dysbiosis. Even at the acute stage, gut dysbiosis and disruption of the microbiome can affect clinical severity, and may persist even in recovery stages [6].

Even after around the second week post infection, when the viral load should have reduced in most people, and the person is no longer infectious, the patient may still feel unwell.

In Chinese Medical theory it is considered that if a virus and/ or its debris is incompletely cleared from any of these levels, the myriad of symptoms of Post Viral Fatigue / ‘Long Covid’ can present themselves as the organs, channels, Qi and Blood and body fluids are blocked or depleted. Recovery is possible when a correct diagnosis is made of the post infection state of the body, and plant medicinals and acupuncture are applied to facilitate the normal functioning of the organs and channels, Qi and Blood.

Symptoms such as Fatigue, breathlessness, chest pain, poor digestion, abdominal distension, nausea, unstable temperature, brain fog, poor concentration, headaches, heavy and weak limbs, decrease sense of taste and smell are all symptoms, not of the active infection at this stage, but of Residual Pathogenic Factors lingering in the body.

For instance, when ‘dampness’ remains in the body - it continues to impede the normal flow of Qi and Blood in the channels and the blood vessels. Herbs would be administered to transform the dampness and restore the correct movement of qi in the channels.
Where digestion is weak, gentle herbs can be used to strengthen the function of the Stomach, and eliminate mucous build up.

Where there is a persistent cough, sub optimal oxygen saturation, or chest pain and weakness, herbs to clear the lungs and restore proper Qi flow (function) in the chest can be selected.

Such relatively simple treatments can have major impacts on energy levels via treating the correct organs and channels affected. By understanding and diagnosing through a different medicial lens that makes sense of the various post viral symptoms, patients feel heard and can themselves contibute to their own healing through appropriate changes to diet and lifestyle, as well as receiving targetted treatments.

Find out more by exploring our articles and patient story about CHM and Long Covid.




3. Office for National Statistics –Coronavirus (COVID-19) Infection Survey (CIS)

4. Ref:

5 Ref:

6 Ref:

Prevalance of LC
Viral Load Kinetics and clearance
Blood viscosity