Long COVID - Wokingham, Berkshire

1. Overview

Long COVID — also known as post-COVID syndrome, post-acute sequelae of SARS-CoV-2 (PASC), or post-COVID condition — is a multisystem condition in which symptoms persist or develop after the acute phase of a COVID-19 infection, typically defined as symptoms lasting twelve or more weeks that cannot be explained by an alternative diagnosis. At least 10% of people infected with COVID-19 develop long COVID, and with over 600 million confirmed global cases, the condition represents a significant and growing burden on individuals and healthcare systems worldwide.

Conventional medicine currently has no approved pharmaceutical treatment for long COVID. Management is largely supportive and symptom-focused. Traditional Chinese medicine (TCM), including acupuncture and Chinese herbal medicine, has an established history of treating post-viral syndromes and is accumulating a growing evidence base for long COVID, with clinical studies demonstrating meaningful improvements in fatigue, breathlessness, brain fog, sleep disturbance, anxiety and quality of life in long COVID patients.

2. Symptoms

Long COVID produces a wide and variable range of symptoms that fluctuate over time and often affect multiple body systems simultaneously. The most common symptoms include:

Extreme fatigue — the most universal long COVID symptom; a profound, disabling exhaustion that is not relieved by rest and may be worsened by physical or mental effort (post-exertional malaise)
Shortness of breath and breathlessness — persistent respiratory symptoms including difficulty breathing at rest or on exertion, chest tightness and reduced exercise tolerance, even after the lungs appear structurally normal on imaging
Brain fog and cognitive impairment — difficulty with memory, concentration, word-finding, mental processing speed and decision-making; often described as thinking through cotton wool
Sleep disturbance — insomnia, unrefreshing sleep and abnormal sleep patterns are extremely common in long COVID
Heart palpitations and chest pain — including postural orthostatic tachycardia syndrome (POTS), where the heart rate rises abnormally on standing
Dizziness and lightheadedness — particularly on standing or exertion
Anxiety and depression — mood disturbance is present in a significant proportion of long COVID patients, reflecting both the neurological impact of COVID-19 and the psychological burden of prolonged illness
Joint and muscle pain — widespread myalgia, arthralgia and nerve pain
Headaches — often new in onset or changed in character compared to pre-COVID
Pins and needles — peripheral tingling, numbness and sensory disturbance
Tinnitus — ringing or buzzing in the ears
Digestive symptoms — nausea, diarrhoea, abdominal pain, loss of appetite and irritable bowel-type symptoms
Persistent fever, cough, sore throat and changes to taste or smell — continuation or recurrence of acute COVID-19 symptoms
Rashes and skin manifestations — including persistent “COVID toes” and other post-viral skin conditions

3. Causes

The causes of long COVID are not yet fully established and are likely to be multifactorial. Current research points to several overlapping mechanisms:

Viral persistence — fragments of SARS-CoV-2 virus may persist in tissues (particularly the gut) beyond the resolution of the acute infection, maintaining a low-grade inflammatory and immune response
Immune dysregulation and chronic inflammation — COVID-19 triggers a powerful immune response that, in some individuals, remains dysregulated after the acute infection resolves. Hyper-inflammation and mast cell activation (MCA) are proposed as key drivers of many long COVID symptoms
Mitochondrial dysfunction and energy impairment — impaired cellular energy production is thought to underlie the profound fatigue and post-exertional malaise of long COVID
Microbiome disruption — COVID-19 significantly alters the gut microbiome; dysbiosis persists in long COVID and is associated with systemic inflammation, neurological symptoms and fatigue
Autonomic nervous system dysfunction — dysautonomia (including POTS) drives many of the cardiovascular and dizziness symptoms
Post-viral depletion of Qi and Yin — in TCM, COVID-19 is understood as a pathogenic invasion that consumes the body’s Qi, Yin and Blood in the process of fighting the infection. This depletion, combined in some cases with residual pathogenic factors, produces the spectrum of post-viral symptoms that characterise long COVID

4. Long COVID in Chinese medicine

In traditional Chinese medicine, long COVID corresponds to an established category of post-viral depletion syndromes known in classical texts as “remaining pathogen with correct Qi deficiency” or, more broadly, post-febrile exhaustion. COVID-19 in TCM is characterised as a Damp-Toxin pathogen that is particularly damaging to Lung and Spleen Qi, with the capacity to consume Yin fluids, stagnate Blood and, in some cases, leave residual pathogenic factors even after apparent recovery. The most common TCM patterns in long COVID include:

Lung and Spleen Qi deficiency — the most common pattern, producing extreme fatigue, shortness of breath on exertion, weak voice, poor appetite, loose stools and a pale tongue. The Lung’s governance of respiration and the Spleen’s role in generating Qi from food are both compromised by the COVID-19 pathogen. Treatment tonifies Lung and Spleen Qi, with formulae such as Bu Zhong Yi Qi Tang and Yu Ping Feng San
Qi and Yin deficiency — seen in patients where the viral pathogen has consumed both Qi and Yin fluids, producing fatigue alongside persistent low-grade heat symptoms, dry cough, dry throat, night sweats, afternoon heat sensations, insomnia and a red tongue with little coating. Post-COVID dry cough and persistent low-grade respiratory symptoms are characteristic. Treatment nourishes Lung and Stomach Yin and clears residual empty heat
Heart and Spleen Qi and Blood deficiency — produces the combination of fatigue, palpitations, anxiety, poor memory and concentration (brain fog), disturbed sleep and emotional instability. The Heart-Mind (Shen) is insufficiently nourished. Treatment nourishes Heart Blood, tonifies Spleen Qi and calms the Shen
Damp-Phlegm obstruction with Spleen deficiency — in patients where the prevailing symptom is heaviness, cloudiness and brain fog, with a sense of the head being wrapped or unclear thinking, digestive sluggishness, mucus in the chest and a thick tongue coating. Damp-Phlegm residue from the original pathogen obstructs the clear Yang from rising to the head. Treatment resolves Phlegm-Damp and opens the orifices
Qi and Blood stagnation with Lung involvement — in patients with persistent chest tightness, breathlessness and pain, reflecting stagnation of Qi and Blood in the Lung. May correspond to the microclotting and endothelial dysfunction implicated in post-COVID respiratory symptoms. Treatment moves Qi and Blood in the Chest, opens the Lungs and resolves stasis
Kidney Qi and Yang deficiency — in patients where COVID-19 has driven deep into the Kidney level, producing extreme fatigue with a deep constitutional quality, cold limbs, low back weakness, poor libido, tinnitus, hair loss and difficulty recovering stamina. More common in those who had severe acute COVID or in older or constitutionally weaker patients. Treatment warms and tonifies Kidney Qi and Yang with moxibustion and appropriate herbal formulae

5. Acupuncture for long COVID

Acupuncture addresses long COVID through multiple mechanisms that are directly relevant to its pathophysiology: regulating the immune system and cytokine balance (including the cytokine storm triggered by COVID-19), improving mitochondrial function and cellular energy production, modulating the autonomic nervous system (addressing dysautonomia and POTS), improving lung function and respiratory capacity, reducing neuroinflammation and supporting cognitive function, and calming the Heart-Mind to address anxiety and sleep disturbance. Research has shown that acupuncture can improve lung function in people suffering from long COVID.

Specific mechanisms by which acupuncture benefits long COVID include:

Regulating immune function and reducing the chronic low-grade inflammatory state, including modulating cytokine levels and reducing mast cell activation associated with long COVID
Increasing nitric oxide (NO) production via stimulation of acupoints, with research demonstrating that NO plays an important role in the pathophysiology of COVID-19 and that acupuncture’s NO-stimulating effect helps restore lung function by reducing airway resistance
Improving autonomic nervous system balance — reducing sympathetic overdrive and improving parasympathetic tone, directly addressing dysautonomia and POTS
Supporting cognitive function and reducing brain fog by improving cerebral blood flow, reducing neuroinflammation and modulating the neurotransmitter and neuroendocrine systems affected by COVID-19
Improving sleep quality through melatonin and serotonin regulation and reduction of nocturnal sympathetic activity
Reducing anxiety and depression by modulating the HPA axis and promoting endorphin and serotonin production

Research evidence

A systematic review and meta-analysis by Lam et al. (2024), published in Frontiers in Neurology, searched eight international databases through June 2023 and included RCTs examining acupuncture for the neurological and neuropsychiatric symptoms of long COVID — fatigue, depression, anxiety, cognitive abnormalities, headache and insomnia — confirming the safety and effectiveness of acupuncture across this range of long COVID symptom clusters. A retrospective cohort study by Kraft et al. (2025), published in Medicine (Baltimore), of 79 long COVID patients treated by experienced TCM physicians found that after an average of seven TCM consultations (acupuncture in 85% of cases, Chinese herbal medicine in 77%), physicians rated global symptom improvement at 62%, with statistically significant alleviation of fatigue (P < .001), impaired physical performance (P < .001) and exertional dyspnoea (P < .001).

6. Chinese herbal medicine for long COVID

Chinese herbal medicine is a particularly important component of TCM treatment for long COVID, providing daily therapeutic support between acupuncture sessions to address the deep patterns of deficiency, residual pathogen and stagnation that drive the condition. Research has shown that Chinese herbal medicine can alleviate long COVID symptoms including fatigue, respiratory distress and emotional disturbance. Formulae are individually tailored to the patient’s TCM pattern and current presentation. Clinically relevant formulae and herbs include:

Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi) — for Lung and Spleen Qi deficiency with fatigue, breathlessness and poor digestion; widely used in post-viral exhaustion states
Sha Shen Mai Dong Tang (Glehnia and Ophiopogon decoction) — for Lung and Stomach Yin deficiency with dry cough, dry throat, low-grade heat and thirst; specifically suited to the Qi and Yin deficiency pattern common in long COVID
Qing Jin Yi Qi Wan (Qingjin Yiqi granules) — a formula specifically studied in the context of post-COVID-19 condition in a randomised clinical trial published in the Journal of Evidence-Based Medicine (2022), demonstrating significant improvements in long COVID symptoms
Gui Pi Tang (Restore the Spleen) — for Heart and Spleen Blood and Qi deficiency with fatigue, palpitations, poor memory, anxiety and disturbed sleep; directly addresses the brain fog and sleep disturbance patterns
Xue Fu Zhu Yu Tang modifications — for Qi and Blood stagnation in the chest, addressing persistent chest tightness, breathlessness and post-COVID cardiovascular symptoms
Individual tonic herbs — Huang Qi (Astragalus), which supports and regulates immune function and tonifies Lung and Spleen Qi; Ren Shen (Ginseng) for severe Qi deficiency; Gou Qi Zi (Lycium berries) for Kidney Yin and Jing; and Sheng Jiang (ginger) and Da Zao (Chinese red dates/jujube) as warming digestive and blood-nourishing adjuncts

A systematic review and meta-analysis published in 2025 evaluated the clinical efficacy and safety of Chinese herbal medicine for post-COVID-19 syndrome through five databases to March 2025 and confirmed its effectiveness for fatigue, dyspnoea, cough, chest tightness, insomnia and exercise intolerance. All herbs prescribed at this clinic are pharmaceutical-grade granule extracts supplied by Sun Ten (Taiwan), ensuring consistent potency and safety. An online Chinese herbal medicine consultation is available for those who cannot attend in person.

7. Moxibustion and cupping for long COVID

Moxibustion — the warming of acupoints with burning moxa — is particularly valuable for long COVID patterns characterised by Qi and Yang deficiency, Cold and Dampness: the deep exhaustion, cold limbs, poor respiratory function and digestive weakness that are common in more advanced or prolonged presentations. Moxa at CV4 (Guanyuan), CV6 (Qihai), ST36 (Zusanli) and BL13 (Feishu, the Lung Back-Shu point) directly tonifies the body’s Qi and Yang reserves, warms the Lung and improves respiratory function. Heat therapy with an infrared TDP lamp over the chest and upper back further supports Lung function during treatment sessions.

Cupping therapy applied to the upper back and respiratory muscles helps release the physical tension and restriction in the chest wall that frequently accompanies post-COVID breathlessness, improving thoracic mobility, circulation to the lung tissue and the overall respiratory pattern. RCT evidence demonstrates that acupuncture combined with cupping can improve respiratory symptoms and reduce hospital stay in COVID-19 patients, and the same approach is applicable to the persistent respiratory symptoms of long COVID.

8. Exercise and self-care

Self-management in long COVID requires careful pacing, particularly given the post-exertional malaise (PEM) that affects many patients — where physical or mental exertion produces a disproportionate worsening of symptoms, sometimes delayed by 12–48 hours. The following self-care strategies complement TCM treatment:

Pacing and energy management — the most critical self-management strategy. Identifying your individual energy envelope and staying within it, avoiding the “boom and bust” pattern of overexertion followed by crash, is essential. Heart rate monitoring can help identify the anaerobic threshold above which PEM risk rises significantly
Traditional Chinese exercises — gentle mind-body practices including Tai Chi and Qigong are particularly well suited to long COVID recovery because they build Qi, improve respiratory function, support immune regulation and are adapted to the individual’s energy capacity. Research has shown that Tai Chi can improve recovery from COVID-19 and is recommended as a safe, graduated exercise for long COVID patients
Dietary support — eating warm, cooked, easily digestible foods that support Spleen and Stomach Qi is strongly recommended in TCM. Avoiding cold, raw foods, dairy, refined sugar and alcohol — all of which are damp-generating and Spleen-weakening — reduces the digestive burden and supports energy production. Chinese food therapy principles guide specific dietary choices based on the individual’s TCM pattern
Natural supportive herbs — certain easily sourced herbs and foods can support recovery between consultations: ginseng (Ren Shen) tonifies Qi and supports immune and cognitive function; astragalus (Huang Qi) supports immune regulation and Lung Qi; Chinese red dates (jujube/Da Zao) nourish Blood and calm the Heart-Mind; ginger (Sheng Jiang) warms the middle and supports Spleen function; and brown sugar in warm drinks warms the middle and assists Spleen function
Sleep prioritisation — adequate, good-quality sleep is essential for immune recovery and neural repair. Maintaining consistent sleep and wake times, creating a quiet dark sleep environment and addressing any insomnia with acupuncture supports the body’s overnight repair processes
Breathwork and gentle respiratory exercises — diaphragmatic breathing, pursed-lip breathing and gentle pranayama-style exercises strengthen the respiratory muscles and improve lung function without triggering PEM. These are best learned with physiotherapy guidance initially and then practised daily

9. Treatment at my clinic

I treat long COVID at my clinic in Wokingham, Berkshire, combining acupuncture, Chinese herbal medicine, moxibustion and cupping therapy in a programme individually matched to the patient’s TCM pattern and current energy capacity. Treatment for long COVID requires a sustained, graduated approach — the combined research and clinical evidence points to an average of seven or more TCM consultations for meaningful improvement, with ongoing treatment adapted as the presentation evolves over time.

The treatment pace is carefully calibrated to avoid triggering post-exertional malaise: gentler, less stimulating treatment is used in more severely affected patients, with intensity gradually increasing as the patient’s reserves build. Chinese herbal medicine, taken daily between sessions, accelerates the recovery of depleted Qi, Yin and Blood and is strongly recommended as part of a combined programme. For those who cannot attend in person, online herbal consultations are available. Visit the prices page for treatment costs, and the chronic fatigue syndrome page for related information on post-viral exhaustion patterns.

10. Frequently asked questions

Can acupuncture help with long COVID?

Yes. A growing body of clinical evidence, including systematic reviews and cohort studies, demonstrates that acupuncture produces meaningful improvements in the key symptom clusters of long COVID — fatigue, breathlessness, brain fog, sleep disturbance, anxiety and depression. Acupuncture addresses multiple pathophysiological mechanisms of long COVID including immune dysregulation, autonomic dysfunction, mitochondrial impairment and neuroinflammation. A 2024 systematic review confirmed acupuncture’s safety and effectiveness across the neurological and neuropsychiatric symptoms of long COVID.

How many sessions are needed for long COVID?

Long COVID is a complex, multi-system condition that requires sustained treatment. Clinical research suggests that meaningful global symptom improvement is seen after an average of seven or more TCM consultations. Most patients notice initial improvements in sleep, energy and anxiety within four to six sessions, with more sustained recovery in fatigue, breathlessness and cognitive function developing over three to six months of combined acupuncture and herbal medicine treatment. Periodic maintenance sessions help prevent relapse as the condition improves.

Is Chinese herbal medicine effective for long COVID?

Chinese herbal medicine is one of the most important components of TCM treatment for long COVID, providing continuous daily support between acupuncture sessions. Specific formulae have been studied in RCTs for post-COVID condition — including Qing Jin Yi Qi Wan — with demonstrated benefits. A 2025 systematic review and meta-analysis confirmed Chinese herbal medicine’s effectiveness for post-COVID fatigue, dyspnoea, cough, chest tightness and insomnia. Formulae are individually prescribed based on the patient’s TCM pattern, making the approach more targeted and effective than any standardised single-formula approach.

How is long COVID different from chronic fatigue syndrome?

Long COVID and ME/CFS (chronic fatigue syndrome) share many features — both are post-viral conditions characterised by profound fatigue, post-exertional malaise, cognitive impairment, sleep disturbance and autonomic dysfunction — and many researchers consider long COVID to be a new cause of ME/CFS. In TCM terms, both involve post-viral depletion of Qi, Yin and Yang with residual pathogenic factors, and the TCM treatment approaches overlap significantly. If you have been told you may have ME/CFS following COVID-19, the same TCM approach is applicable.

Is it safe to have acupuncture when I am very fatigued with long COVID?

Yes, with appropriate adaptations. In severely affected long COVID patients, acupuncture treatment is modified to use fewer needles, gentler stimulation and shorter sessions to avoid triggering post-exertional malaise from the treatment itself. As your reserves build over successive sessions, the pace and intensity of treatment can be gradually increased. This cautious, graduated approach is an important part of treating long COVID safely with acupuncture.