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Let’s talk about… Long Covid and acupuncture: an introduction

The following article has been compiled by the British Acupuncture Council (BAcC)

We have all been severely affected by the Covid-19 pandemic. The UK government and its scientific advisers have taken measures intended to slow the rate of transmission, reduce the number of fatalities and keep the NHS afloat. Whatever might be thought about the success or failure of these measures it is generally agreed that they do no more than buy some time.

The hope is that vaccines and/or effective treatments will at some point provide us with a more sustainable way of living with the virus for the long term. Some people believe instead that herd immunity is the way to go. Even if the recently announced vaccine does prove effective there are still questions about the value of such approaches for future different emerging pathogens, or indeed possibly mutating coronavirus species.

Prevention of disease should be the main goal

But how do we go about doing that? There are many factors involved here. Some have successfully been implemented, such as sanitation of housing, clean water supply, and some vaccinations have proved useful for some diseases. Vaccination draws on the innate ability of the human body to build its own immune defence.

The ancient and yet continuously further developed practice of acupuncture and East Asian medicine is one of many traditional medicines which at its core, aims to prevent disease. What is the evidence for this? There is a growing and increasingly convincing body of evidence showing that acupuncture, together with its related exercises taiji and qigong, as well as herbal medicine (especially mushrooms), are all able to balance the activity of our immune system. The emphasis is indeed on the word ‘balance’, which is specifically important in the context of Covid-19, where the immune system in some severely ill people causes a so-called ‘cytokine storm’; this overreaction of the immune system can and has led to patient deaths.

An increasing number of studies show that acupuncture is modulating the immune system and in addition, that it has an anti-inflammatory action, particularly useful in cases of patients suffering from symptoms caused by the coronavirus. (Arranz 2007; Karst 2003; Karst 2010; Silvério-Lopes 2013; Pais 2014; Pavão 2010; Takahashi 2009; Wu 2016)

These studies show that the levels of immune biomarkers, such as T-lymphocytes (CD3+, CD4+), NK cells, interleukins (for example IL8, IL17, IL2, IL 10) and macrophages change in an immune enhancing, overreaction dampening fashion. In other words, the studies have shown clear evidence that acupuncture increases the body’s ability to fight infections, while at the same time calming the body’s occasional but very detrimental tendency to overreact.

In addition to these directly measurable markers, scientific studies have shown that acupuncture reduces chronic pain, anxiety, depression and stress. It has been proved that these debilitating states of dis-ease have a clear and detrimental impact on our immune system. (MacPherson 2013; Hopton 2014; Smith 2018; Amorim 2018; Goyata 2016; Grant 2018; Chung 2018; Yin 2017)

We know that yoga, meditation, mindfulness-based practices, taiji and qigong, some herbs and fungi, and EFT (emotional freedom technique) all have a proven track record for reducing stress and anxiety. Three out of these five practices are based on the system of acupuncture channels.

Treating people with long Covid

Boosting people’s resistance to future infection is a major goal for acupuncture in respect of Covid-19. However, we must also recognise the great need for immediate help for those struggling with long-lasting symptoms of the disease, that is long Covid. UK data suggest that large numbers of people are suffering in this way: one in seven of those with Covid symptoms would be ill for at least a month, one in twenty for two months, and one in forty-five for three or more months:

Symptoms vary in type, intensity and duration, leading some experts to suggest that there may be several different syndromes at play, with consequent difficulties in diagnosis. Some people may not get the recognition and treatment they need, which will affect their mental as well as physical health. This applies particularly for non-hospitalised patients, who did not have severe respiratory problems and are assumed to have only a mild version of the disease that will clear up in a couple of weeks. (Mahase 2020)

One group of people get respiratory symptoms like cough and shortness of breath, but another has symptoms across many body systems. Fatigue is seen commonly, as are ‘brain fog’ and heart symptoms. Acupuncture that is based on the traditional East Asian models is well placed to help people with long Covid. Patients with multiple, chronic symptoms are treated using a holistic approach, helping to support their own self-healing capabilities to provide better sustained, overall improvement, rather than focusing on one symptom at a time. This approach will include the effects on the immune system and inflammatory processes discussed above, which in turn may play a part in treating long Covid, just as they can in preventing infection.

We are only just starting to collect data measuring the effect of acupuncture on long Covid. Although it is still too early for any results from clinical trials, we have already seen promising outcomes from individual cases treated by members of the British Acupuncture Council (BAcC). Many of the common symptoms seen with long Covid have been shown to respond to acupuncture in other contexts: BAcC-chronic fatigue; BAcC-fibromyalgia; BAcC-COPD; BAcC-heart arrhythmias; BAcC-nausea; BAcC-research digest.

In March, the China Association of Acupuncture and Moxibustion drew up guidelines as to how to treat Covid at all stages: early – suspected Covid; mid – with clinical symptoms; and post-Covid rehabilitation. There is also a section with recommendations for things that the patient can do when convalescing at home, for example diet, exercise, and mental health wellbeing:

Moxibustion, a procedure involving the burning of a particular herb on points on the body, has been used historically in China for preventing and alleviating epidemics. There is growing scientific evidence for its effects on immunity (Shu 2016; Yu 2020; Zhang 2018) though little direct clinical research on infectious diseases (Ibanda 2018). Small observational studies in China have shown promising results with Covid patients, both when practitioners apply the moxa (Huang 2020) and also when self-applied by the patient (Chen 2020).

Self-applied acupressure is another very useful tool for situations where face-to-face treatment is not possible or is undesirable. There is supportive research evidence for this across many different types of illness (for example, Cheung 2020; Murphy 2019; Song 2015);

not yet in relation to Covid, though acupressure has been used together with exercise to help pulmonary function in Covid patients (Zha 2020). Moxibustion and acupressure are the most commonly recommended traditional Chinese medicine interventions for home nursing care after Covid (Xu 2020). For more information about these self-treatment possibilities, talk to your local BAcC acupuncturist.

British Acupuncture Council acupuncturists

Members of the British Acupuncture Council (BAcC) are highly trained and skilled practitioners of acupuncture and East Asian medicine. All BAcC members have the equivalent of degree-level training and are recognised by the Professional Standards Authority (PSA), who operate the government backed Accredited Register (AR) scheme as well as overseeing the regulators of all statutory healthcare bodies, including the General Medical Council.

Some GPs and physiotherapists already refer their patients to acupuncturists, since they recognise the benefits of holistic acupuncture treatment. Even so, while the contribution of BAcC members to the health and wellbeing of the UK is increasingly better acknowledged, without much greater take-up by the NHS, acupuncture will remain largely in private practice.

Please note: trials are underway in China to assess the effectiveness of acupuncture treatment for some aspects of Covid-19 and we await the results with interest. There is existing evidence of acupuncture’s benefits for various symptoms that may be seen with Covid, but no substantial research as yet to support it as a treatment for people with Covid.

Pia Huber, Susan Evans & Mark Bovey

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