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InnerMovement
A Five-Star Wellness Center
Call Today: (818) 549-1300
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We are here To Help through the Holidays
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Greetings!
During this season of virus and stress, it is important to support your immune system. Whether it is a cold, flu or Coronavirus, we need to be in our very best health. Remember 80% of your defense is having a strong immune system by eating well, exercise and mediating stress. The other 20% is taking cleanliness precautions as recommended by the CDC and WHO.
Acupuncture is showing promising results for patients with "Long-Covid". If you or a loved one are suffering with long-term symptoms after exposure, please read the Acupuncture research study we shared below.
Here is a list of some of the Immune support products available at our office:
- Vitamin D
- Vitamin C & Zinc Lozenges
- Fish oil
- Ginger & Tumeric
- Detox kits
- Biotics Immune Support Packs
Please feel free to email or call to inquire, pick up supplies on your next visit, or our office can mail these supplements directly to you. We will continue to be your partners in staying well this season & always.
Our wellness services are also Immune Boosting and unless you have symptoms you should continue to keep up with your routine health care appointments.
Above all else - continue to enjoy your family, friends, nature, a good cup of tea or whatever brings you JOY!
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With Care, Commitment and Support,
Veronica & the InnerMovement Team
Clinical Director, , RN
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HEALING GIFT CARDS
Available now for 10% off any service. For your Best Friend, Parents, Kids, Teacher, Boss...
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A BETTER WAY
TO ABSORB VIT C
$3 DOLLAR in-house shots before or after your treatment this December
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OUR OFFICE WILL BE Open throughout the Holidays for your
Immune Boosting Treatments
Now is not the time to cancel, If you are WELL stay WELL
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The Role of Acupuncture for Long COVID: Mechanisms and Models
Mechanisms and Models
Published Online:16 Jun 2022
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INTRODUCTION
Between February 2020 and September 2021, 146.6 million people were infected in the United States, and 124.0 million were symptomatic resulting in 921,000 deaths.1 By mid-February 2022, deaths in the United States surpassed 1 million. Early studies found half of the patients who received mechanical ventilation died.2 While the world panicked, governmental health agencies disagreed about the epidemiologic fundamentals: did natural infection provide future immune protection in the absence of vaccines, would the high death rate occur across all age groups, and what comorbidities increased fatal outcomes? It became apparent that COVID-19 was a complex multiorgan disease with a broad spectrum of symptoms and a range of severity: from asymptomatic and mild to severe life-threatening illness. . .
Another model of protracted viral illness is myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), a multisymptomatic chronic condition dominated by unrelenting fatigue of unknown etiology, although reactivation of latent EBV infection is considered a likely cause. . .Smilar to ME/CFS, there is no specific, safe, and effective antiviral drug to treat Long COVID. However, some long-haulers have found Paxlovid (co-packaged nimatrelvir 150 mg and ritonavir 100 mg) alleviated some symptoms. . .
Typically, drug treatment for post-COVID focuses on managing symptoms and delivering supportive care. These include neurologic stimulants such as Adderall and Ritalin for fatigue and brain fog, SSRI antidepressants such as fluvoxamine to prevent clinical deterioration of mood,6 and inhaled Albuterol for difficulty breathing. Repurposed drugs used to treat COVID-19 include the anthelmintic Ivermectin and Type I antihistamines such as Fexofenadine but have limited use for Long COVID. Nonpharmacologic care in the conventional medical setting includes psychologic counseling, physical therapy, progressive exercises, and pulmonary rehabilitation, including breathing exercises. . .
While frontline health care workers focused on acute disease, post-COVID patients with chronic symptoms were left on their own. Out of their collective suffering, patient activists in the United Kingdom and the United States coined the term long-haulers, highlighting their never-ending symptoms. However, many bio-immunologic factors likely cause the broad pattern of symptoms associated with Long COVID, including incomplete cellular repair, chronic inflammatory cytokine production, pro-coagulant state, and impaired nitric oxide production. Additional factors include incomplete postviral recovery and reactivation of EBV.7
Since there is no medical consensus on effectively treating post-COVID, long-haulers are treating themselves . . .Because the original SARS outbreak of 2003 and the current COVID-19 pandemic 2019 occurred in China, Traditional Chinese Medicine (TCM) and acupuncture were widely used.8 Studies from these cases provide ample clinical information on the use and efficacy of acupuncture. Evidence supports the favorable effects of acupuncture in other illnesses with similar symptoms, including chronic pain, fibromyalgia, CFS, and postural orthostatic tachycardia. The authors propose that acupuncture is clinically helpful, safe, and useful as a frontline therapeutic modality for treating Long COVID patients in an integrative medical setting.
DISCUSSION
COVID-19 is a multiorgan disease associated with a spectrum of clinical manifestations. The array of symptoms is related with how SARS-CoV-2 infects cells. The virus uses its protruding spike proteins to attach to a specific receptor, angiotensin-converting enzyme-II (ACE2), on a cell membrane to enter human cells. Although ACE2 is considered the primary receptor for SARS-CoV and SARS-CoV-2,9 additional receptors, including dipeptidyl peptidase-4 (DPP4), participate in SARS-CoV-2 infection.10 ACE2 receptors are found in the respiratory tract, which explains SARS-CoV-2's ability to cause pneumonia. But it also lines other tissues, including the intestines, stomach, liver, pancreas, kidneys, heart, blood vessels, and the brain. This characteristic may explain the multiple organ involvement of COVID-19 and its disease complexity.11 But a more complex picture emerges once the virus enters cells, and the immune system responds.
Compared with acute COVID-19, Long COVID lacks an understanding of a single unifying mechanism. Physicians, therefore, find it challenging, even impossible, to treat something without a specific cause exactly because a cause-and-effect model is inadequate to explain Long-COVID. However, TCM is inherently well adapted to address symptomatic complexity, including the postacute sequelae (PASC) associated with COVID-19 infection and the extended symptoms of Long COVID. Therefore, the lack of an obvious target or specific mechanism should not deter physicians from referring Long COVID patients for acupuncture.
Long COVID Patient Characteristics
Long COVID patients, referred to as long-haulers, are a heterogeneous group. However, women are 4 times more likely to develop Long COVID syndrome than men. A similar gender propensity occurs in ME/CFS. Peak ages to develop chronic symptoms are between 35 and 49 years compared with severe illness in acute COVID-19 patients who are mainly 65 years and older. . . Postinfection symptoms commonly persist for 4–12 weeks after onset of the disease. In contrast, Long COVID is characterized by symptoms lasting longer than 12 weeks. Long-haulers are those patients who develop a multisystem multisymptomatic condition, including autoimmunity, who do not return to a normal preinfection baseline.
Symptom Manifestations of Long COVID
Since COVID-19 affects the entire body disrupting multiple biologic systems at once, symptoms can be diverse.13 The most common symptom is fatigue. At least 58% of Long COVID sufferers experience severe unrelenting fatigue and malaise not improved by rest and worse with activity. Other common symptoms include headache, brain fog and memory loss, chest discomfort, and dyspnea with cough.
The Long COVID symptom terrain is complex and extensive. Multiple surveys report as many as 200 symptoms across 10 organ systems making for a bewildering clinical landscape of signs and symptoms.14 Based on symptoms, there is general agreement as in the World Health Organization (WHO) definition, but no consensus, of a succinct clinical definition of Long COVID. Organizing symptoms by systems helps, as is listing by clinical type including systemic presentations such as fatigue and malaise, neuropsychiatric including anxiety and depression, the musculoskeletal system with soreness, aching, and joint pain, and the cardiovascular system. . .
Long COVID Disease Models
Although characterized by symptoms and signs, clinical attributes and disease predictors may be better models for understanding Long COVID. . .
Potential pathophysiologic mechanisms of Long COVID include virus-specific damage, immunologic response abnormalities, inflammatory damage from acute infection, and microvascular thrombosis. Of these different theoretical models, persistent neuroinflammation caused by viral targeting of neuronal tissue may explain the varied symptoms stemming from dysautonomia ranging from alterations in temperature, blood pressure, heart rhythm, gastrointestinal motility, and energy. Muscle aches and deep bone and joint pain, so common in ME/CFS, go largely unexplained in Long COVID. . .
Similarities between Long COVID and ME/CFS, both disorders linked to EBV infection, are apparent in the clinical presentation of Long COVID patients. The original SARS-CoV-2 infection could reactivate latent viruses, including enteroviruses such as EBV and coxsackie A/B, herpesviruses such as HHV-6, and cytomegalovirus. Both ME/CFS and Long COVID have similar clinical presentations, with persistent fatigue dominating, and may share a common pathophysiology, including acute hypoxia in tissues with high oxygen demand similar to the brain, reduced mitochondrial nitric oxide system function resulting in lower energy output, redox imbalances,17 and impaired nitric oxide processes in critical tissue such as the lungs.18
Townsend19 hypothesized that pulmonary microvascular immunothrombosis may be involved in Long COVID pathogenesis. The evaluation was based on chest pain, shortness of breath, and computed tomography pulmonary angiogram. . .
Another theory of Long COVID is that a low-grade inflammatory state produced by chronic persistent cytokine expression causes neuroinflammation, principally in the brain and brain stem. . . Successful disease management of these cases results in normalization of CRP and other markers of inflammation, including NT-proB-type natriuretic peptide, ferritin, interleukin-6 (IL-6), and procalcitonin.22
Acupuncture Mechanisms for Long-COVID
TCM theory explains that acupuncture works by restoring the normal flow of qi, blood, and body fluids; it regulates the relationship of yin and yang of the organ systems and meridians. TCM also describes the abnormal or persistent influence of environmental factors such as cold, heat, and dampness that disrupt the healthy flow of qi and organ function. This classical approach is a valuable guide for choosing acupuncture points; however, evidence-based medical acupuncture may have more value for point selection in the integrative medical setting for the effective treatment and management of Long COVID. Studies in how acupuncture influences bodily functions indicate that it alleviates many of the effects of COVID-19, including lowering inflammation, modulating the adaptive immune response, and influencing nitric oxide production. Disruption of these functions and their lack of a return to normal baselines are characteristic of Long COVID.
Vagal Tone Regulation
Modern research informs that acupuncture works in multiple physiologic ways, including regulation of the vagus nerve: interfacing with the parasympathetic control of the heart, lungs, and digestive system organs. After leaving the brain stem, the vagus nerve exits the cranium through the jugular foramen, dividing into left and right branches much similar to the acupuncture meridian system. Acupoints that regulate autonomic tone include PC 6 (Neiguan) and ST 36 (Zusanli). Stimulation at these points transmit signals through the vagus nerve to mediate the anti-inflammatory response.22 Shen demonstrated acupuncture's ability to modulate cardiac arrhythmias,23 and Boehmer found the auricular vagus nerve point can regulate heart rate.24
Chronic Inflammation Management
Evidence suggests elevated IL-6 is an independent risk factor for disease severity in acute COVID-19. Patients with increased mortality rates tend to have high IL-6.25 Theoretically, blocking viral replication and using anti-inflammatories shorten the duration of illness and limits damage from inflammatory responses.26 But there is little indication that IL-6 persists in Long COVID.27 Therefore, cytokines may not be helpful as treatment targets. However, since the dysfunction of autonomic tone is linked to cytokine release syndrome during the acute phase, regulating the autonomic nervous system with acupuncture could play a role in maintaining both cardiovascular homeostasis and modulating inflammatory activity.28 A mechanism of acupuncture in the treatment of sepsis is strengthening the vagus-cholinergic anti-inflammatory pathways to weaken the cytokine storm.29
Stimulation of ST36 (Zusanli), LI4 (Hegu), and LR3 (Taichong) have dual immune modulating and anti-inflammatory effects. Macrophage polarization occurs by environmental stimulation, including acupuncture needles, helping modulate pro-inflammatory cytokines, including tumor necrosis factor α, and interleukins 12, 23, 6, and 1 β. Macrophages involved in promoting inflammation contribute to disease progression. Downregulating inflammatory molecules exerts a modifying influence on inflammation, promoting improved disease tolerance.30
Electroacupuncture can reduce the expression of proinflammatory cytokines and modulate immunity through neuroregulation.31 Vagus nerve stimulation by implanted devices shows promise in improving outcomes in COVID-19 patients27. . . Monitoring acupuncture anti-inflammatory benefits by ordering d-dimer and CRP studies after a series of acupuncture is advisable. . .
Nitric Oxide Normalization
Nitric oxide (NO) plays an essential role in both the cardiopulmonary and immune systems. COVID-19 infection can lower NO due to tissue destruction by reactive oxygen species (ROS), which are increased during acute COVID-19.32 Acupuncture may decrease ROS production and restore oxidative-antioxidant balance. Tsuchiya33 demonstrated that acupuncture could raise NO levels and thereby increase not only local circulation but also lower viral replication and improve the adaptive immune response. Acupuncture can enhance host-to-disease interaction, favoring increasing NO for restoring adaptive immunity.34 It may reduce inflammatory distress, modulate ROS, and restore autonomic tone. Tissue damage from infection inevitably produces ROS. Inflammatory factors and ROS can enter the brain and invade vascular and other tissue. Acupuncture can reduce oxidative stress and suppress inflammation.35
Microcirculation
SARS-CoV-2 not only attacks the respiratory tract, but it also invades the heart and vessels, causing micro-clots, endotheliitis, and inhibits normal angiogenesis and cardiovascular regeneration. Compromised blood flow reduces tissue oxygenation, including to the brain that may contribute to brain fog, a common symptom among long-haulers and CFS patients.
Acupuncture stimulation modulates microcirculation although releasing nitric oxide and calcitonin gene-related factor. Strong stimulation by manual needle manipulation at LI4, the source point of the large intestine meridian, is a classical point for “moving the qi.”36 Synergistic points with LI4 for microcirculatory benefits include LI10 or LI11, SP9, ST25, ST36, SP6, and LR3.
Acupuncture Point Selection
. . . Early in the pandemic, a WHO-China Joint Mission provided guidance for TCM and acupuncture-moxibustion separated into 3 stages: (1) an observation stage for suspected cases, (2) an intervention stage for confirmed cases, and (3) the recovery stage to clear residual toxins and restore lung and spleen qi and support yin deficiency marked by fatigue and shortness of breath. The primary acupoints used for the recovery stage were ST 36, PC 6, CV 6 and 12, and ST 25. Supportive acupoints were selected based on symptoms, including shortness of breath with CV 17, BL 13, and LU 1. In addition, CV17 located in the center of the chest may stimulate thymic activity.22
Auricular Acupuncture
Acupuncture outcomes for Long COVID may be improved when adding auricular points. A 2022 meta-analysis found auricular acupuncture effective in relieving anxiety and depression in COVID-19 patients38. . .
CONCLUSION
Recovering from Long COVID takes time. It is a complicated illness with vacillating symptoms and suffering does not stop after the initial infection. The pathogenesis of acute COVID-19 differs significantly from Long COVID. Symptoms persist beyond 12 weeks after initial SARS-CoV-2 infection and can go on for months to years. Because the diverse range of symptoms spans multiple organ systems, acupuncture is an ideal therapy for disease modification. But the understanding of acupuncture's pathophysiology and therapeutic mechanisms for postviral illness is incomplete; however, recent studies and clinical evidence suggest considerable potential for medical acupuncture in treating Long COVID. Acupuncture may be particularly well suited for outpatient care in managing Long COVID, pending appropriate research studies to substantiate its therapeutic values.
Medical acupuncture can shorten posthospitalization recovery time, improve symptoms, and influence many of the causes of Long COVID, including modulating inflammation, restoring healthy nitric oxide production, adjusting redox imbalance, and regulating blood pressure to help positively influence disease outcome. . . Acupuncture can alleviate many of the clinical symptoms of COVID-19, including headaches, myalgia, and abdominal pain. Proactive care and treatment with acupuncture may be central to a comprehensive Long COVID clinical strategy. . .
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