The Core Pathogenesis of COVID and Its Sequelae Is Blood Stasis with Cold Congelation
According to the survey, among those confirmed to have been infected, 78.89% had fever, 68.93% had headache, 64.88% had cough and expectoration, 61.98% had muscle aches, 61.23% had sore throat, 57.52% had fatigue and weakness, 53.74% had aversion to cold and cold limbs, 51.84% had nasal congestion and runny nose, 41.18% had joint pain, 36.05% had reduced appetite, 25.23% had reduced or lost taste or smell, 12.88% had abdominal pain and diarrhea, 10.6% had vomiting, 10% had overall mild symptoms, 8.64% had breathing difficulty, and 3.53% had rash or itchy skin.
This statistical data is very valuable and can serve as a reference for TCM practitioners. When infected with the same virus, most people have similar clinical reactions; only a tiny minority have unusual symptoms. There is little north-south difference; as far as I know, patients in Guangdong and Hainan also mostly have these symptoms.
The TCM doctrine of treating according to the person, the time, and the place, and the doctrine of five movements and six qi, were expedient assumptions from an era when technology was less developed. They have a certain rationale, but they are not scientific. Many people, on the basis of this doctrine, subjectively believe that people living in different regions and falling ill in different years will have different symptoms, and prescribe different treatments; I myself cannot agree with this practice.
Although the COVID virus keeps mutating, in fact its pathogenic mechanism has not changed much over three years. Whatever the variant, its functional host receptor is angiotensin-converting enzyme 2 (ACE2). ACE2 is a key regulator of the renin-angiotensin system (RAS); it plays an important role in cardiovascular balance by regulating vascular tone and fluid and electrolyte balance.
So, through all its transformations, the original COVID strain and its variants all first affect human cardiovascular balance. The COVID virus creates a large number of emboli in the human blood system—what we commonly call thrombi, which are actually coagulated and necrotic blood.
Once a thrombus enters the pulmonary artery and its branches, it causes pulmonary embolism; once it enters the cerebral vascular system, it causes cerebral infarction; once it enters the coronary artery, it causes myocardial infarction. I have already introduced this in my article The Clotted Blood Stream: The Lethal Secret of the Cold-Blooded Killer Omicron, in which I also gave recovery advice that remains valid today.
We now see some domestic data showing that the risk of pulmonary embolism increases 33-fold one month after a COVID-positive test. A US study in February 2022 showed that, compared with uninfected people, COVID patients within one year of recovery had about a 63% higher risk of a range of potentially fatal cardiovascular diseases—abnormal heartbeat, inflammation, thrombosis, stroke, heart attack, and heart failure.
I have said in previous articles that, from the TCM perspective, the pathogenesis of COVID is cold congelation with blood stasis (xue qi means blood not flowing). That is, patients present with both the clinical features of cold syndrome and the clinical features of blood coagulation. Strictly speaking, the pathogenesis should be called "blood stasis with cold congelation": blood stasis comes first, cold congelation follows. Blood coagulation occurs first, and cold symptoms appear later; so regardless of the season in which patients fall ill, they present this clinical feature. In fact, this pathogenesis runs through the entire course of COVID and its sequelae. TCM pattern differentiation for COVID is not complicated. It is neither wind-cold nor wind-heat common cold, nor a cold-damp epidemic; it is the syndrome of blood stasis with cold congelation.
When blood does not flow smoothly, our blood system cannot function normally. Yet the nutrients and oxygen our cells need all depend on blood flow. The nutrients we absorb from food and the oxygen we inhale must be carried by the blood to every cell in the body.
If there are thrombi in the blood blocking the vessels, the blood cannot perform its normal function; our cells become starved of oxygen and nutrients, and the person experiences breathing difficulty and malnutrition. The body's normal oxidation is also affected; if the body cannot oxidize normally, it cannot release enough heat, and we feel marked aversion to cold. Fever is merely a self-protective response of the body.
So, from the TCM perspective, the key to treating this disease and its sequelae is to warm yang and invigorate blood. Young people have better vascular systems and can tolerate the attack of the COVID virus (especially the less virulent Omicron variant); but middle-aged and elderly people's vessels have aged, and many already have cardiovascular and cerebrovascular disease, diabetes, COPD, and cancer—all of which adversely affect blood circulation. After COVID infection, these people are hit from both sides. It is therefore easy to understand why severe cases are more common among the elderly and rare among the young.
Western medicine's early anticoagulant and thrombolytic treatment can reduce mortality in severe patients. TCM's strategy of warming yang and activating blood (i.e., supporting yang and activating blood and resolving stasis) can also rescue severe patients. Moderate exercise and daily heat therapy (including keeping warm, using a hair dryer to induce sweating, and drinking 1–1.5 liters of warm water daily) can reduce the risk of thrombosis.
Incidentally, many people today turn pale at the mention of exercise, as if exercising after infection means certain death. In fact, very few people die from exercise now, and those who die from exercise are mostly doing vigorous, excessive exercise rather than normal exercise. Before the pandemic, the number of people who died each year from excessive exercise was no less than the number now reported in the media as dying from excessive exercise after COVID recovery. Yet many of us are now like birds frightened by the mere twang of a bowstring.
Normal exercise is moderate or gentler exercise that a person can perform easily, without too much burden on the body. These exercises are the most harmless way to promote blood circulation and are very beneficial for preventing thrombus formation. I myself began gradually resuming exercise ten days ago; now I mainly ride a stationary bike indoors for about 30 minutes each session, sweating for 10–20 minutes and burning 400–500 kcal.
Farsighted neurologists advise patients with cerebral thrombosis or cerebral hemorrhage to begin rehabilitation training as early as possible, because the earlier rehabilitation begins, the fewer the sequelae and the higher the quality of life after recovery. The pathogenic mechanism of the COVID virus is not very different from that of cerebral thrombosis, so if the physical condition permits, early resumption of moderate (not intense) exercise is more beneficial to patients.
In addition, I often use a hair dryer to induce sweating. My method is different from most people's: I tuck myself into a quilt and lie there reading. I leave a small opening in the quilt, turn on the hair dryer, lay it flat on the bed, and blow hot air in through the opening. In two or three minutes the quilt becomes very warm and I feel very comfortable. After breaking into a mild sweat all over, I pause for a few minutes and then blow again, continuing for 1–2 hours. This method has relieved the various discomforts I developed, such as palpitations from overwork and muscle aches.
Most people think that with a hair dryer, inducing sweat for just a few minutes is enough. This is wrong. To achieve the effect of activating blood and dissolving thrombus, this heat therapy must last at least 1–2 hours. If you also drink warm water, the effect will be even better. Of course, you may use any other heat therapy you like, but the duration must be sufficient. I personally prefer the hair dryer's rapid, forceful heat therapy because it solves problems quickly.
Some clinicians dismiss this, but I disagree. The human body's biochemical reactions are extremely complex. Blowing hot air with a hair dryer along the spine (especially the cervical and sacral vertebrae) can rapidly change blood flow, promote the secretion of various neurotransmitters, and trigger a cascade of biochemical reactions whose first-aid and disease-treating efficacy is no worse than any drug.
My father now soaks his feet every day; I also have him use the hair dryer, and I give him my Yiqi Huayu Pills and Guifu Dihuang Wan. Because he still has occasional aversion to cold, I use the acrid-warm, warming-and-unblocking Guifu Dihuang Wan to improve his circulation. Human vessels age continuously with increasing years, so COVID affects people of different ages differently. The older the person, the more severe the effect; every ten years of age raises the fatal risk considerably.
The impact of the COVID virus on the human body will last about a year; I plan to keep up this self-care for the coming year, and I also require my family (especially the elderly and those with underlying disease) to do the same.
Recently, when treating severe patients (some already in hospital ICIs with poor response), I have used large doses of warming-yang and blood-activating herbs such as Fuzi (aconite), Rougui (cinnamon bark), Guizhi (cinnamon twig), Ganjiang (dried ginger), and Chuanxiong (Sichuan lovage). These patients' temperatures rose higher and higher on heat-clearing and detoxifying herbs; after taking acrid-warm herbs like Fuzi, Rougui, Guizhi, and Ganjiang, their temperatures fell rapidly and their breathing improved markedly.
This is proof enough of how important the warming-yang-and-activating-blood strategy is for severe COVID patients. I will publish the case reports of my rescue of these critically ill patients at an appropriate time; because such patients are seriously ill and full recovery takes a long time, now is not the time to publish their cases.
In short, for people infected with COVID, preventing thrombosis is a very important matter. COVID's various strange sequelae are mostly related to thrombosis; treating these sequelae should also be based on the warming-yang-and-activating-blood strategy.