Long Covid is a very often debilitating illness affecting up to 10% of people who have been infected with the COVID-19 virus. The total number of people said to be affected worldwide is around 65 million at the time of writing, and the list of symptoms currently attributed to the illness has clocked in at over 200. Given that this is such a widespread issue with such a myriad of presentations, the individually tailored patient specific approach of herbal medicine offers real support in the healing journey for those experiencing this condition.

Long Covid is a multi-systemic issue. As COVID-19 is capable of triggering inflammatory processes virtually anywhere in the body, it has been noted by many herbalists that underlying inflammation can be brought to the surface by the virus. For some this means inflammatory joint issues, for others it means the nervous system will need extra support or the digestive system may be affected, so on and so forth. In the same vein, it has been observed that new-onset illnesses are common in Long Covid including Type 2 Diabetes, cardiovascular disease and many more.

Many practitioners who have experience treating post-viral fatigue, chronic fatigue syndrome and myalgic encephalomyelitis have approached treating patients with Long Covid in a similar manner and have achieved good results. Similarities between these conditions are also acknowledged in orthodox circles and are influencing a lot of the research into Long Covid.

It is strongly advised to work with a qualified herbal practitioner when wishing to address Long Covid with herbal medicines; self treatment is an approach that even the most experienced of herbalists will testify is not always possible, and working with a practitioner means that the workload of devising a treatment plan is not contributing to the problem.

Pathogenesis
Hypotheses for pathogenesis of Long Covid are varied; proposed theories include virally induced microclots & vascular damage, viral persistence in the tissues, immunological disruption including autoimmunity and more. Those more at risk of developing Long Covid include women, those with type 2 diabetes, those who have contracted EBV, those with the presence of specific autoantibodies, connective tissue disorders, attention deficit hyperactivity disorder, chronic urticaria and allergic rhinitis. Though these observations are shared around the world, it is also important to note that a third of people with long COVID have no identified pre-existing conditions. Socio-economic circumstance, as it always does, plays a massive role in this area. Those on lower income streams and/or those with an inability to adequately rest in the early weeks after developing COVID-19 are far more likely to develop the chronic condition of Long Covid (and a wide range of other health issues as well, though this is a topic for another article). As with similar conditions myalgic encephalomyelitis and chronic fatigue syndrome, many of those with Long Covid appear to have been under a degree of long term stress before becoming infected with the virus, and the body has entered into a state of depression/malaise that it is having difficult rebalancing from. Given the sheer level of long term stress that the global population was placed under, it is perhaps of little surprise that there is now such a wave of Long Covid in the wake of the pandemic.


Going a Little Deeper into Exploring Some of the Potential Causes

Microclots & Vascular Damage:
It has now been widely observed that in some patients, the cells and tissues which are responsible for the flow of blood can become damaged during Covid infection and amplify a tendency in the blood to form microclots.
It is also now widely known that Covid affects our endothelial tissues. Healthy endothelial tissue will help keep the blood vessels relaxed to promote an easy flow of blood around the body. This tissue also releases circulating anticoagulants, endogenous substances which prevent blood clots. As Covid causes damage to these tissues (ACE2 receptors are abundant in the circulatory endothelium) it can lead to endothelial dysfunction and therefore dysfunction of some of these anticoagulant processes. Endothelial damage may be caused by direct infection by Covid spike proteins, indirect damage as a result of nearby cells becoming infected or raised levels of inflammatory cytokines in the blood triggering coagulation pathways. These microclots can be found virtually anywhere in the cardiovascular system, leading to the infamously long list of symptoms experienced during Covid infection or by Long Covid patients; microclots in the brain may explain cognitive disturbance (possibly by killing small fibre nerve cells), or microclots in the feet explaining Covid Toe.

Viral persistence:
There is a growing body of evidence showing viral replication continuing in cells even in autopsy reports, suggesting a possibility that the virus stubbornly endures in the body even after acute infection ceases (and in some cases triggering other residual pathogenic organisms). One study showed that all participants who had Long Covid symptoms were harbouring viral RNA and even viral proteins in some cases. One question which is born from this observation is whether or not this is actually driving illness in patients, as our GI tract harbours all kinds of organisms which do not cause issues when we are in a healthy balance. Preliminary research is suggesting that the presence of these antigens is triggering a response in local immune cells, and over a long time this essentially translates to a state of chronic inflammation. However it is not necessarily just the GI tract in which this viral persistence occurs – this is simply the easiest region of the body for the scientific research to take place. Given the range of symptoms, if viral persistence is implicated, it would be safe to propose that COVID-19 antigens may be found in a wide range of sites around the body and in a range of tissues as well.


Immunological Dysfunction:

There is also growing evidence which intersects with the previous two theories and also provides an alternative where no evidence of microclots or viral persistence can be found; a revved up or traumatised immune response which is unable to settle back down after acute infection passes. One study posted striking results which showed immunological dysfunction persisting for 8 months following initial infection.
Patients with Long Covid had highly activated innate immune cells, lacked ‘free’ T and B cells (strangely named ‘naive’ cells) and showed elevated levels of interferons that remained persistently high at 8 months after infection – this indicates that the body is in a high level of inflammation. It was also observed that there seems to be a particular immunological dysfunction to Long Covid patients that has been observed in chronic issues related to other coronaviruses. There is also some evidence to suggest that new onset auto-immune conditions following COVID-19 infection may be a result of molecular mimicry between viral cells and human proteins.
The theory for immunological dysfunction driving Long Covid would explain why in some cases inflammation is discovered in the brain and yet there is no evidence of microclots there. 

Some Other Possibilities

Amyloidosis, the buildup of amyloid tissue in the organs, shares many of the same symptoms as Long Covid and a potential link has been observed in vitro.

Where to From Here?

With all this information to hand, we once again must return to the simple principle of case by case exploration. Orienting oneself when exploring a chronic inflammatory condition can be done first and foremost by listening to the body on all levels, and asking the right questions to get a fuller picture of what may be going on.

In all cases of chronic disease when one is approaching their healing, a relaxed and comfortable spirit is the best energy to cultivate in oneself. People on this journey can develop difficult and stressful relationships with food, therapies and life itself, so the first step is to relax, tune into the body, assess what is the most appropriate next step and never forget to take a breath. Taking time to relax and connect into the rest of nature benefits our entire being, and it is my passionate belief that this should be the baseline for whatever approach of treatment is taken.

Some Other Useful Questions:
How do we begin to explore what may be going on using simple techniques?

Is there pain or redness anywhere in the body? What is the nature of the pain, how long has it been there, what makes it better or worse? Pain or redness tells us there is inflammation present, and the other questions give us insight into the nature of the inflammatory process taking place and what tissues it might be affecting.

On palpating this area, are there signs of oedema? This tells us there may be circulation issues. Other symptoms would include cold hands and feet, fatigue and ‘pins & needles’. Bear in mind that swelling with throbbing/cramping pain accompanied with breathlessness potentially indicates blood clots, so it would be wise to refer to your local medical service to rule this out. 

Are there any signs of hypoxia, or low levels of oxygen in the blood? Symptoms include shortness of breath, headache, confusion, restlessness and cyanosis. How do the lungs feel in general?

Is there any tingling or coldness in the extremities? How is the heart rate and rhythm, and the nature of the pulse? What is the blood pressure? This helps us get a sense of how the circulatory system is doing.

Are there any digestive symptoms? Gas/bloating? What else is going on the body alongside this? Note the symptom picture for dysregulation of the vagus nerve, which may be worth considering if also experiencing ongoing respiratory issues, or feeling anxious, dizzy, etc.

How does one’s mind and brain function feel? Often people with Long Covid experience short term memory issues, confusion, a sense of a daze or fogginess to the thought processes and generally a diminished mental capacity to what they are normally used to.

How is the spirit? Does one feel anxious, distressed or uneasy? How is one experiencing this? Is it a new feeling i.e. has this been experienced in the past, or has this developed since contracting COVID-19? At this point I feel it is quite important to introduce another causative factor to why one might be feeling any of the aforementioned symptoms. The COVID-19 pandemic landed very suddenly, and the vast majority of us went through a very real and sustained time of challenge, on many levels, regardless of worldview, political stance or personal choices made during the pandemic. Some of the symptoms of conditions such as complex post traumatic stress disorder (CPTSD) match up to some of the symptoms of Long Covid, and it may be difficult to discern where one issue is ending and the other is beginning. There is always going to be a degree of spiritual enquiry in a person who is exploring the roots of these kinds of complex conditions, and the continued psycho-emotional workload following the aftermath of the pandemic really should not be underestimated. Again, taking a breath and tuning into the body is our most important compass.

Once we have built a picture of how an affected person is feeling, we can make more informed decisions about which herbs and foods may be more specifically suited to support.

Exploring Common Presentations with Long Covid

When exploring presentations for Long Covid, it is important to note that energetically it can present in many different forms. Though often hot and dry, it can also present as a cold and damp condition. Moreover, the energetics often evolve so checking back and rebalancing the medicines regularly throughout the course of treatment may be necessary. After identifying which symptoms are being experienced, it is important to always then step back and see the whole person. Where is there depletion, or excess, and of what energetic states in which tissues? That said, let’s explore some common features of this condition.

Anosmia / Ageusia

Some researchers have found evidence of direct infection of the neurons of the olfactory & gustatory nerves. Others have found no evidence but suggest that surrounding ACE2 receptor rich tissues may trigger a localised inflammatory cascade. The current theory is generally that it is a combination of both viral infection and inflammation causing anosmia and/or ageusia. Patients with ageusia often describe the sensation or taste in their mouth as though there is a metal coin on their tongue. This sensation has also been reported as a side effect for several COVID vaccines.

Treatments:

Smell Training can be used to build up the sense of smell. Essential oils work very well for this. Take four different essential oils (a range can work, perhaps going by plant parts and changing the oils regularly) and hover them about 10 cm below the nostrils. Sniff calmly for about 20 seconds for each oil, and repeat every day for up to six weeks. Diffusion around the home can also help with this.

Vitamin A increases the expression of nerve growth factor (NGF) in the body. It also plays a role as an immunomodulator in the disease course for COVID-19. Its precursor beta-carotene is found in carrots, sweet potatoes, butternut squash – all orange/green/yellow fruits & vegetables.

B-Complex – B-Vitamins share various roles in protecting the nerves, balancing nerve metabolism and maintaining myelin sheaths. They act as cofactors for one another so are best taken as a complex. Sources include whole grains, seaweed, green leafy vegetables, pulses and brewer’s yeast; some people choose to take a supplement for B-Vitamins when needed.

Vitamin C – Essential for healthy nerve growth and given its role in immune function it is well worth taking some extra Vitamin C. The suckable tablets with Vitamin C & Zinc are recommended. Vitamin-C can be found in fresh fruits, and Zinc can be found in sesame seeds (tahini is a great source).

Hericium erinaceus stimulates the growth of NGF and has been shown to promote faster recovery from nerve injury. As it is also an immuno-modulating and inflammation-modulating medicine it makes an excellent choice for Covid related anosmia. 1-3g per day, or 20-60ml per week of a 1:3 tincture.

Rosmarinus officinalis also stimulates NGF, and as a warming aromatic it is energetically an excellent medicine for anosmia. It is  a circulatory stimulant, antioxidant medicine so may also help with inflammation affecting the healing of the olfactory tissues.
1-3g a day or 20-60ml of a 1:3 tincture

Other potentially helpful herbs include Ginkgo biloba (researched for non-Covid related post-viral anosmia with promising results), Verbena officinalis, Hypericum perforatum, Scutellaria lateriflora etc.

Time – it can often take weeks or even months for the sense of smell and taste to rebalance. Often patients will have an altered perception i.e. foods they once loved they may no longer enjoy.

Fatigue

Fatigue is one of the most commonly cited symptoms of Long Covid and can find itself wrapped up in other symptoms. Often people will report states of fatigue and anxiety being in a dance with one another, so often a first step is to gently untangle one sense from another in an attempt to explore the roots.

Research has identified a connection between CFS-related fatigue and an increase in cytotoxic T-lymphocytes and cytokines. Recent studies have also found an increase in T- and B-lymphocytes and inflammatory cytokines in patients convalescing from COVID-19. In other words, the body has become overwhelmed and is stuck in a state of low grade (or sometimes quite substantial) inflammation. Environmental damage in the tissues may also give rise to mitochondrial dysfunction. Vascular damage and microclots may also contribute to fatigue, and also lower oxygenation of the cells due to this damage or damage to the pulmonary tissues. Also COVID-19 and Long Covid appear to carry signature forms of depression and low mood, for which several herbs have been excellent at treating. As the whole body and spirit is involved in the healing process, the person must be approached from a holistic perspective for treatment to prove truly effective.

Treatments

Immune dysregulation can be treated with immuno-modulating herbs such as Astragalus membranaceus (which also acts as an inflammation modulating adaptogen, and is being reported by many herbalists as a key ally for assisting those with Long Covid), Ganoderma lucidum (also excellent for modulating inflammation, relaxing neuro-endocrine overstimulation and protecting cellular integrity) and Withania somnifera (also wonderful for promoting a restful sleep). Working on gut health is essential here also given the role of the microbiome in maintaining balance to the immune function. Prebiotic foods (e.g. roots, coffee, stewed apples), probiotic foods (little amounts which suit the person once or twice a day), eating as locally and organically as possible, adequate hydration & reducing sugar will all help build a healthy microbiome.

Vitamin D appears to play a role in staving off Long Covid but only if there is an adequate level in the body at the time of initial infection. There is debate as to whether or not it is healthy to take Vitamin D supplements consistently. If choosing supplementation, like with any supplementation, it may be wise to take intermittent breaks.  Exposure to sunlight is the most effective way for the body to produce Vitamin D, and certain foods can also be taken. Mushrooms will produce vitamin D2 and D4 when exposed to sunlight, and Lentinula edodes will produce some Vitamin D3 as well. The liver and kidneys will metabolise both vitamin D2 and D3 into calcifediol, so therefore mushrooms are a valuable winter source of vitamin D.


Mitochondrial dysfunction can be treated with Leonurus cardiaca or Geranium robertianum, along with some adaptogenic herbs such as Schisandra chinensis or Eleutherococcus senticosus. Where fatigue is accompanied by anxiety and/or heart palpitations, Leonurus is an excellent ally and can be dosed at 1-3g daily, or 20-60ml of 1:3 tincture per week. CoQ10 improves mitochondrial function and can be found in fatty fish, spinach and cruciferous vegetables, lentils, pistachios and sesame seeds (so tahini paste also). Carnitine is also vital for mitochondrial function, and can be found in red meats. The body makes its own carnitine once it has good sources of iron, vitamin C, l-lysine and methionine (the latter two can be found in leguminous vegetables). Alpha-lipoic-acid (ALA) is an antioxidant substance and coenzyme for mitochondrial function, and can be found in red meat, carrots, beetroots, spinach, broccoli, and potatoes.

Vascular damage & microclots can be treated with Crataegus spp. fruct, Vaccinium myrtillus, Ginkgo biloba, Achillea millefolium, Salvia miltiorrhiza, Cacao theobroma (make sure its dark), Vitis vinifera (red wine in low – moderate doses is not to be dismissed as a way to ingest this one). Pulmonaria officinalis (especially indicated where there is damage to pulmonary tissue i.e. shortness of breath), Capsicum annuum (excellent for connective tissue repair and for the circulation), and cooking with lots of herbs and spices. N-acetyl-l-cysteine is a precursor to the antioxidant glutathione, which has been noted as being particularly beneficial for epithelial tissue repair and can be found in brassicaceae vegetables & alliums.

Potential vagus nerve damage has been observed in numerous Long Covid patients (candidates in numerous studies have exhibited symptoms of damage, studies remain unpublished at the time of writing). Given the vagus nerve’s role in parasympathetic tone, this may account for the acute anxiety, insomnia and inability to relax in some Long Covid patients, which in turn creates a sense of exhaustion (coupled with hyperactivity, the ‘wired and tired’ cycle of chronic fatigue. Along with plenty of Vitamin A rich foods and perhaps a B-Complex, extra Vitamin C & Zinc, neuro-trophorestorative herbs such as Scutellaria lateriflora, Hypericum perforatum, Verbena officinalis, Hericium erinaceus  etc. may be beneficial. Also herbs to improve vagal tone, including Citrus aurantium flos. (good quality aromatic water works very well), Stachys officinalis, Cocoa theobroma, Rosmarinus officinalis and Prunus serotina (especially where there is lingering respiratory or cardiac issues alongside other indications of vagal tone dysruption). For a deeper look into vagal tone, see Nikki Darrell’s excellent article on this subject: http://veriditashibernica.org/uncategorized/re-establishing-good-vagal-tone-and-balance-with-herbs/


Depression
Depression and a sense of the dark shadow is commonplace with Long Covid and often goes hand in hand with a sense of chronic fatigue.

Treatments
The first thing to assess here is the nature of the patient’s experience. Is this truly depression, or is it burnout? One must consider COVID’s impact on the liver, as this can also trigger mood disturbance. COVID has been shown to raise liver enzymes, and there is a direct relationship between liver health and emotional well being (though this has been observed alongside other issues in the body including dysbiosis and intestinal permeability).
When assessing and treating a depressed state, we really need to move away from a reductionist approach of isolated chemical equations, and widen the perspective to include the whole body, the whole being. Many practitioners are drawn to Hypericum perforatum for this issue and if I feel it is indicated I generally start with a low to moderate dose and build up if needed as some people do experience psychic disturbance as a response to this plant. However Hypericum’s regenerative action on the liver makes this a useful option for a few reasons. Other options with lots of anecdotally reported success for this include Stachys officinalis, Centella asiatica, Verbena officinalis and nutritive tonics like Withania somnifera and Ganoderma lucidum. Inula helenium and Angelica archangelica are both excellent as resilience tonics especially where there are signs of cold and damp in the body, and herbs such as Crataegus spp. flos or Rosa damascena can be helpful where a person has gone into grief (which can occur in those dealing with chronic health issues). Again vagal tone is a consideration, as is digestive health, sleep patterns and so forth. Where one is stuck in worry, this may indicate a spleen qi deficiency. Suitable herbs for this issue include Codonopsis pilosula, Stachys officinalis, Tarax officinalis
Balancing one’s energy can be done with the herbs, but body work can greatly support this. A spirit healer who has undergone sufficient training can also be of great benefit, but the utmost of discernment is advised when one is choosing who to work with at this level.

Pain
Both muscle and nerve pain are common in Long Covid. Most (if not all) the herbs mentioned in this article will contribute to inflammation modulation in some way, which in itself may help to address pain.

Firstly we can identify exactly where the pain is. Then we can decipher which tissues are affected (sharp, shooting or tingling pain indicates nerve tissue, whereas dull, achy pain indicates muscular tissue).

There can be a degree of untangling and unwinding to help with soothing chronic pain in the body. For example, with pain in the lungs, this may also be accompanied by shortness of breath and a feeling of tension. So we must consider balancing the inflammation along with relaxing the tension while also encouraging deeper, relaxed breathing (see treatments for shortness of breath / respiratory dysregulation below).

Treatments
If there is pain in the digestive tract, consider reducing inflammatory foods, increasing inflammation modulating foods (see Digestive Dysregulation’), and drinking soothing teas of herbs such as Matricaria recutita, Mentha piperita, Althaea officinalis or Tilia europaea.

For muscular tension, we can look at antispasmodics such as Valeriana officinalis, Viburnum opulus and Scutellaria officinalis. These herbs are also valuable as they help to relax psycho-emotional stress, which in itself contributes to pain and impedes healing at the deeper levels.

For neurological pain, we can consider herbs such as Verbena officinalis, Hypericum perforatum, Scutellaria lateriflora, Passiflora incarnata and Citrus aurantium (there are many more also). The dosage for these herbs really does vary from individual to individual; for example small doses of Hypericum (practitioner-only medicine in Ireland) can induce anxious states in some people. As has been mentioned, it really is best to consult with a qualified herbalist when wanting to treat chronic pain with herbs, or in treating Long Covid in general. Where there has been nerve damage, medicines which encourage the healthy growth of new nerve tissue are also valuable, such as Hericium erinaceus (1-5g daily, or 20-100ml per week of a 1:3 tincture).

The role of the vagus nerve in pain management is an important consideration (see ‘vagus nerve damage’ above).


Shortness of Breath / Respiratory Dysregulation

When SARS-CoV-2 infects lung tissue, it affects the epithelial cells lining the airways, instigating an inflammatory response. When this inflammatory immune response continues to happen, it inhibits the regular transfer of gases, including oxygen, in the lungs, and fluid can build up as a result. This can lead to dyspnea, a feeling of breathlessness, especially after exertion. This very commonly leads to an anxious state, which constricts the tissues even more; as always, considering relaxing and balancing the psycho-emotional energy is central to supporting successful treatment.

Another potential cause of shortness of breath is the heart’s capacity to pump blood around the body. If this is the case, there may be other signs of poor circulation including swelling, and the blood pressure will most likely read as low, so it is important to rule this out by having the blood pressure accurately checked.

Treatments

Herbs which work on epithelial tissue repair and supporting the circulation in general (see vascular damage & microclots above).

Pulmonary vasodilators are exceptionally helpful for people with tight chests and difficulty breathing. Grindelia robusta & Lobelia inflata are excellent for this. Please note the latter is practitioner-only medicine in Ireland. I generally prescribe Lobelia in a separate small bottle, and encourage the person taking it to start with a dose of a few drops, very gradually increasing to find the effective dose. This is important for two reasons; Lobelia is emetic and can cause a person to become nauseous or even vomit if too much is taken. It is also quite heating which suits some people well but not others. In cases where I feel the Lobelia may be too strong, Grindelia is an excellent alternative.

Other antispasmodics and anxiolytics may be of great benefit as well as often the tissues and the mind are in a state of tightness at the same time; Valeriana officinalis & Viburnum opulus are excellent here but gentler tonic antispasmodics may be of great use as well such as Scutellaria lateriflora or Stachys officinalis. Again, it’s all about matching up the most appropriate plants given the full picture of what is going on for a person.

Where there is heat in the lungs one may consider demulcent herbs to help bring a soothing energy into the body. Althea officinalis, Asparagus racemosus, Tilia europaea & Plantago spp. (also excellent for tissue repair) are all excellent supports for this.

Essential oils diffused or diluted that can be helpful include, depending on how the person is presenting, mucolytic oils (e.g. Eucalyptus smithii, Picea mariana, Mentha spicata, Rosmarinus officinalis), antispasmodic oils (e.g. Eucalyptus smithii, Lavandula spp., Salvia sclarea, Myrtus communis) and so forth.
Each of the oils here possess constituents with a wide range of other therapeutic actions (for example Picea mariana, Eucalyptus smithii and Lavandula have all been shown to have analgesic actions with different mechanisms). So as with herbs in general, for the best therapeutic outcome one must choose the best suited oils, dilute them appropriately and apply regularly. An excellent reference guide for this is Nikki’ Darrell’s Essential Oils: A Concise Manual.
As with herbal medicine in general, it is best to work with a practitioner who has been trained in the proper use of essential oils, and where a practitioner is working with a single essential oil company, it is advised to ensure this company is not involved with  a multi-level marketing scheme.

Other techniques to assist with laboured breathing include doing simple relaxation work with deep belly breathing, lying on one’s front when in bed and doing gentle massage work (it may be a good idea to find a practitioner properly trained in essential oils as these will add another dimension of healing to the therapy). Cranio-sacral work, acupuncture, gentle yoga and other body treatments can be of great benefit here as well, and indeed for chronic inflammation in general.

Without pushing oneself, as the lung energy increases it can be a good idea to continue building it up. Going for walks, swimming, playing wind instruments and singing are all excellent ways to do this – whatever feels manageable. Foods which benefit the lung energy include organic vinegars (which can be infused with herbs that have an affinity with lung health), mustard and sesame seeds / tahini. In Traditional Chinese Medicine foods with a white center are said to build lung energy so cauliflower, almonds, daikon radish, potatoes, turnip, parsnip, rutabaga, apple, pear, rice, oats, onion, garlic, and white peppercorns are all possibilities. Inula helenium is excellent for building up the lung energy after infection and also holds a traditional use for those who have been ‘elf shot’ or burned out.

Digestive Dysregulation
It has now been shown that a healthy gut microbiome reduces the severity of COVID-19 infection and also reduces the risk of developing Long Covid. It has also been shown that COVID-19 infection can disrupt the biome and facilitate a pathogenic imbalance in the gut.
This commonly leads to digestive issues of all kinds, as the inflammation modulating, immune modulating and indeed all the mysterious levels that the biome protects us can be compromised.
In treatment considerations, we may wish to consider viral persistence in the gut as contributing to digestive symptoms. However, at this point it is vital to remember that our intention is to balance the terrain rather than going to war with the organism. Herbal medicines and healing foods provide treatment for digestive issues that simply cannot be replicated by pharmaceutical or nutraceutical medicine. The topic of herbs, foods and healing the gut is beyond the scope of this article, but here is a few sound bites to get some inspiration going:

– Herbs which support the digestive energy or Spleen Qi in TCM include Codonopsis pilolusa, Inula helenium, Taraxacum officinale, Asparagus racemosus, Curcuma longa etc.

– Herbs with astringent qualities which help to tone and heal the gut lining include Agrimonia eupatoria, Berberis vulgaris, Vaccinium spp. Achillea millefolium, Plantago spp., Filipendula ulmaria etc.

– Herbs with demulcent qualities soothe the digestion, coating the gut lining and encouraging the tissues to heal. These include Althaea officinalis, Tilia europaea, Plantago spp. and Asparagus racemosus.

– Herbs useful for balancing pathogenic organisms (well, this is a very big topic actually as all herbs will have an effect, in many different kinds of ways) include Rosa damascena, Azadirachta indica, Berberis vulgaris, Vaccinium spp. etc.

– Herbs with carminative properties encourage the gut to relax, and their essential oil content often helps to balance the biome as well. Matricaria recutita, Mentha piperita, Foeniculum vulgare etc.

– Other relaxing herbs help us to remember to chew our food and take a few minutes to rest after eating. They relax the gut to encourage slow and steady digestion. Scutellaria lateriflora, Passiflora incarnata, Valeriana officinalis, Stachys officinalis etc.

– The microbiota love a diverse range of vegetable and fruit fibers. Some people recommend 30 different plant species per week, organic where possible.

– Wild foraged greens contain minerals, vitamins, fibre, wild bacteria and the wild soul which all contribute to a health gut. Forage with care and respect, never more than a third of a patch and listening for permission from the plant without just assuming it is available because you found it.

– Fermented foods such as lacto-fermented vegetables, yoghurt and cultured seed/nut cheeses help to build up a healthy biome (find the preparation and daily dosage which suit your constitution, and bear in mind that this tends to evolve over time depending on a number of factors).

– Sprouted seeds are an excellent gut medicine, they taste great and are very cost effective.

 
Treating Viral Persistence

The nature of continued replication of Covid spike proteins in the body is still being explored, as it is the potential for how plants interact with this protein once ingested. However many of the plants demonstrating potential for direct protection from this protein also carry many absolutely proven beneficial medicines for the body which protect us in other ways, such as building up cellular health or modulating inflammation, and therefore are worth working with in any case. Below are some plants with potential specific antiviral activity against the COVID-19 spike protein, as well as some notes regarding other actions and indications of the plants. However bear in mind that studies indicating antiviral activity against COVID-19 in vitro cannot be assumed to translate to effectiveness in vivo. The converse argument of isolated constituents from herbs displaying pathogenic activity in vitro is often weaponised against herbal medicine, which is illogical as the whole herb and the isolated constituent cannot have direct lines drawn between them. Therefore it makes no sense to discount this approach on one hand and promote it on the other. However I believe we can still take potential antiviral activity of the herbs into consideration when we are choosing our medicines, once supporting the whole person is the main intention and one is not just in a perspective of going to war against the spike protein.

Treatments:

Urtica dioica contains a lectin which has been shown to prevent the spike protein from replicating.  There is a great deal of anecdotal evidence of people finding Urtica dioica highly beneficial during acute infection and in building up post infection. Generally high doses are recommended here so making strong infusions, making pesto / soup or working with a fluid extract 1:1 tincture is recommended.

Taraxacum officinalis folia has been shown to block the protein-protein connection between the COVID-19 spike protein.

Pinus sylvestris has been popularised due to its shikimic acid content, as well as other compounds which have been shown to block viral replication. The effectiveness of Pinus sylvestris in this regard remains theoretical but as it is a good expectorant and adrenal tonic, as well as a helpful ally to the blood vessels, and so is worth considering for other reasons in Long Covid. It is also an excellent medicine for building one’s resilience. The essential oil diluted to 1-2% and rubbed over the adrenal glands is a most-excellent remedy for adrenal fatigue, including in Long Covid.

Sambucus nigra fruct. has been shown in preliminary research at the University of Erlangen to demonstrate strong antiviral activity against COVID-19 in vitro, leading the team to file for a patent of their specific extract. As always, the whole herb itself cannot be patented and is well known for its broad spectrum antiviral activity against many strains of influenza, and there is a growing body of anecdotal and clinical evidence that elderberries are helping a lot of people through Long Covid. Though some people recommend high doses, others have found lower doses to be quite effective as well. 20-100ml per week of a 1:3 tincture, or 1-5g a day of the dried berries. It’s also beautiful macerated in vinegar, and makes a delicious ingredient for mead.

Cistus spp. have been shown to shorten duration of symptoms in mild COVID-19 patients, potentially indicating some activity against the spike protein. Cistus creates a strong energetic boundary and is used as a prophylactic medicine for all kinds of issues in eastern Europe. It is not available from many herbal suppliers but is very easy to grow in Ireland and eastern European supermarkets often stock the tea bags.

Extracts of Echinaceapurpurea has been shown to be effective against COVID-19 in vitro. Echinacea is also a tonic for the lymphatic system and excellent for repairing broken boundaries. Though it is generally given to people at relatively high doses in acute situations, for chronic conditions some herbalists have had success prescribing it at low doses.

Andrographis paniculata constituents, including andrographolide, can bind SARS-CoV-2 proteins as well as demonstrating other immunomodulating, inflammation modulating activity which could be very helpful in post-infectious treatment of COVID-19. It has been cleared for the treatment of COVID-19 in Thailand where it continues to be prescribed.

Final Notes

There are a great many approaches one can consider when treating Long Covid. Many practitioners recommend taking Vitamins A, C, D3, K2, NAC, Zinc, Magnesium, B-Complex (and this list goes on for much longer for some of the moe complex protocols out there). I generally recommend a good quality multi-vitamin complex (from a food based brand such as Terra Nova), extra Vitamin D in the winter months (and plenty of sunshine in the warmer seasons), and extra Vitamin C and Zinc when feeling run down or in a flare up. Convalescent foods are excellent (soups, stews, broths etc.) and nourishing the soul is of vital importance (music and other art which resonates with the spirit, immersion in nature and so forth).

Any chronic inflammatory problem with ‘flare up’ patterning can become a complex dance which requires a great deal of patience, self-work and self-love. It can often feel like it’s ‘two steps forward, three steps backward’ as inflammation smoulders in the body. But it is important to remember that no matter the situation, there is always something we can do to support ourselves for the next step. In my own experience, the most important medicine of all is to slow down as much as possible and connect with the rest of nature. Even in the densest smog of illness, the bright power of a dandelion flower reaches the very depth of the human soul and reminds us of the world’s beauty. I have no clinical trials to support what I am about to say, but I can certainly say that this is peer reviewed by the vast majority of herbalists and a great deal of our patients: herbal medicine is more effective when we take the time to tune in and connect with the actual plants around us, get to know them, befriend them and work with them on our life journey.