Post covid chronic fatigue, a variant of long covid, is a post viral syndrome with symptoms of extreme and persistent physical exhaustion and a lagged depletion of energy that presents up to 2 days after exercise and lasts up to a week or more, known as a crash. Symptoms include persistent headaches, dizziness, joint and muscle aches, brain fog, sore throat, tender lymph nodes and susceptibility to illness. It is a long-lasting condition and is thought to involve, amongst other things, a dysfunction of the biochemical energy pathways in the mitochondria. There is always an underlying susceptibility to the condition and often a viral infection will be the final trigger in setting off a cascade of maladaptive biochemical processes.
Proper functioning of the human body involves the harmonisation of eleven intrinsically linked biological systems. Namely skin, muscular, skeletal, nervous, circulatory, respiratory, endocrine, urinary/excretory, reproductive and digestive. These are known to be influenced by thought, external environment, internal toxicity and cellular nutrient availability. When one or more system is under stress, others will compensate to maintain homeostasis and secure the survival of the individual. In doing so, unwelcome symptoms will arise, such as those experienced in chronic fatigue.
Mitochondrial dysfunction and its role in long covid chronic fatigue
The main dysfunction is within the energy manufacturing organelle at cellular level. Often this dysfunction in energy production pre-existed but symptoms only surfaced once one or more systems were sufficiently stressed. In long covid chronic fatigue, this is due to viral attack and the body’s subsequent over-zealous inflammatory response. If one or more of the eleven biological systems are stressed, energy production cannot meet demand and toxicity builds, this in turn stresses other systems. The role of the mitochondria is to produce energy (ATP) in a useable form for all the biological processes in the body. Within the mitochondria, ATP is converted to ADP and energy is released, ADP is then recycled back to ATP within 10 seconds to begin another round. In a healthy body, this is an efficient process and requires a good cellular oxygen supply. If oxygen is low or the process is hampered in any way, ATP becomes AMP which cannot be recycled and builds up as a toxic substance to be excreted via the kidneys. Brand new ATP can be made from a sugar molecule, D-ribose but this is a slow process, talking anything from 1-4 days, hence the lengthy recovery needed after exercise in chronic fatigue patients. In addition, to meet immediate energy needs, an anaerobic energy production process will occur. This involves the conversion of ATP to lactic acid. Producing only a small amount of energy but needing even more ATP to convert lactic acid back to glucose. Most chronic fatigue sufferers produce energy this way, resulting in the burn and heaviness felt in the muscles and the lengthy time for recovery after energy expenditure.
Cortisol resistance and the inflammatory process
In addition, there are numerous studies implicating cortisol resistance as a key factor in chronic fatigue syndrome. With chronic stress, the cortisol is secreted but doesn’t activate the immune shut down receptors and a runaway inflammatory response escalates. We therefore see a higher disposition to illness, illness that lasts longer and a likely triggering of the immune response to allergens. We also see physical stress such as exercise and illness, that actively breaks down tissue, cause the unregulated inflammatory response contributing to fatigue and delayed recovery.
How homeopathy can improve the dysfunctional systemic response in long covid chronic fatigue patients
Long covid patients often present a lengthy list of varied symptoms that are often shared in patients suffering with the same syndrome. These symptoms include neurological, respiratory and circulatory and finding a remedy to cover the entire set of symptoms is sometimes unachievable.
Although patients may present with a similar set of symptoms, the case analysis depends on whether there are individualised modalities, a unifying principal running through the case or an obvious state or subacute overlaying the constitutional or other layers. The sought-after remedy that covers the acute, the constitutional and the miasmatic influence is most often too difficult to find in the case and in fact, only in some individuals would this run throughout the whole picture.
Homeopathic treatment of symptoms could therefore include symptom specific remedies, organ or detoxification support, organopathic remedies, sarcodes and nosodes, as well as constitutional remedies.
In March 2020, my husband, two of our children and I contracted covid. The medical profession had little to offer at that time. It was more than two decades since I’d first found homeopathy but with some professional supervision, I tentatively began using remedies to treat my family. The outstanding effectiveness of these remedies triggered my return to homeopathic study to complete my diploma with the Contemporary College. The following case examples the treatment of long covid syndrome in my son, an adolescent boy, covering a 22-month period.
April 2020 my 13-year-old son developed symptoms of Covid19. I treated his acute and gave him Belladonna 200c one tablet, repeated as needed at the first sign of fever due to his flushed face, increased thirst and throbbing headache. He also had a distinct loquacity just before he presented with this fever. The fever abated and Belladonna kept him comfortable with his head pain. After 24 hours his symptoms moved on to perspiration at night, sore throat and muscle aches with heaviness over his eyes and limbs. With guidance, I gave him Gelsemium 200c twice a day for the next 5 days. The remedy reduced the body pain and he was able to chat, eat and drink and play the Xbox. Days 1-8, his symptoms remained steady under homeopathic remedies.
However, he was increasingly getting pain and a sense of inflation in his lungs as if they were pushing against his ribcage and needed to sleep for many hours. He wanted to stay in his room with little disturbance and wanted the window open. He was thirsty with a dry mouth overnight and in the morning had the beginnings of a sore throat. His ribs were very sensitive to touch. He wasn’t coughing but there was mucus on his chest that urged him to cough occasionally but this was unproductive.
Day 9 was the worst day for intensity of symptoms – apparently common for those experiencing covid at the time. He had inflammation of right lung, drenching sweats and then his sore throat became very painful. He had inflamed lymph nodes under arms and neck, pain behind his eyes and even a small amount of movement brought on a low-grade fever. After consultation with a homeopath, Bryonia 30 was prescribed but there was no change, he was then prescribed Mercury 30c which improved his symptoms, reducing his lymph node inflammation and painful sore throat. This was then given twice a day for 3 days until the symptoms abated. Mercury is complimentary to Belladonna and has an affinity with all organs and tissues of the body, particularly the lymphatic system. Further justification of its prescription was that any movement caused easy perspiration and his tongue was coated white/yellow with obvious teeth indentations.
He began to improve in health and by day 14, he felt relatively well. Day 14-16 gave us the false impression that the impact of the virus was now over and we encouraged him to be active as he had spent the past 2 weeks in bed. He had energy so went for a bike ride. Hindsight is a wonderful thing and if we knew what we know now about long covid, we would never have encouraged this.
Day 18, he took a huge down-turn. His lung inflammation reappeared, slight fever and body aches and inflamed throat. I repeated the Mercury 30 as it had worked so well before and over time his symptoms subsided but from then on, his energy was always low and he developed the mix of changing symptoms experienced in long covid.
He had 9 weeks of continual debilitating symptoms. They changed in expression, location and severity but tended towards swollen glands, sore throat, mouth and tongue ulcers, sinusitis and sinus headaches, pressure behind the eyes, nausea, sensation of fullness, loss of appetite, muscle fatigue and vertigo. Increased need to sleep: he was sleeping 13-18 hours a day. His digestion was disordered, his spleen area swollen, tongue was white, flabby and indented. He was given a course of anti-biotics for his lung inflammation, but nothing improved as there was no subsequent bacterial infection. There has been more experience in using homeopathy to address covid symptoms now and suggested remedies include Bryonia, Baptisia and Gelsemium because of their similarity with the slow and progressing disorder created by Covid19.
Mercury was failing to cure, so it was suggested we use remedies to support his digestion and detoxification could be used, as it was obvious by the heavy sleep, coated tongue and irritability that his liver was working hard in the aftermath of the initial viral infection.
He was prescribed Nux Vomica 30c twice a day for his irritability, chilliness, fullness on eating and toxicity due to the virus. This remedy took away his sensation of fullness that he had experienced intermittently before he became ill with Covid as well as in this recovery phase. His irritability dramatically improved and gave him an emotional sense of ease.
Taraxacum 6x was included twice a day as organ support for his liver and spleen in detoxification. Herbally, dandelion root has many health benefits and in particular, viral support. It has been proven to have anti-viral and anti-microbial properties, reduce inflammation and support liver detoxification. Taraxacum is indicated if the tongue is coated and mapped, taste is bitter or sour, night-sweats are profuse, symptoms worse at night and the throat is better from drinking.
There was a slow and steady improvement over the summer holidays, but he was easily exhausted. We continued with the liver remedies and began giving him Gelsemium 200c twice a week to help with his anticipatory anxiety about returning to school.
Gelsemium was warranted because his heaviness of limbs worsened in anticipation of school and he was finding himself unable to sleep as school approached. Gelsemium fitted his picture of never been well since influenza, apathy and dullness, denial of his illness, muscular weakness, dizziness, heavy eyelids, flushed face, dull headache, sleeplessness from mental excitement/thinking and low appetite. The anxiety certainly improved as did the feeling of weakness and he took Gelsemium 200c 3 times a week for the next few weeks. Gelsemium is a deep acting and long-lasting remedy, Sankaran describes the main feeling of Gelsemium as “I have to keep my control when going through ordeals, I have to be able to withstand shock and bad news without loosing my control”. Sankaran describes a lot of fear, anxiety and panic that is held on the inside but not expressed so that they appear to be in control. This perfectly describes the state my son experiences in school, as he uses so much energy controlling his emotions that he develops a headache, dizziness and exhaustion. He appeared to emotionally disassociate from the physical ordeal of his covid experience, bed bound and unable to be the active boy he was before. He was outwardly very calm during his covid experience, however I feel he was rather disengaging from the reality of his situation.
School began in the September which brought its challenges for an almost 14year old boy. Exposure to bacteria and viruses alongside the huge leap in energy expenditure brought another crash in his energy which again brought back the sore throat, mouth ulcers, low grade fever and coated tongue.
He was prescribed a single spilt dose of Epstein Barr Virus in potency. He had never shown symptoms of glandular fever as a child but often this virus is picked up asymptomatically and can lay dormant and then reactivate when the immune system is under stress. I cannot conclusively say if this remedy had an effect, if it did, the effect wasn’t immediate, but the subsequent occurrence of the sore throat and low-grade fever did reduce.
We maintained the liver remedies and palliated his symptoms with Mercury 30c occasionally (esp for ulcers) and moved the potency of Gelsemium to 1M weekly because of his increased vitality, which worked well for his fatigue and headaches. I continued to give him Nux Vomica 30c as suggested as needed for gastric disturbances and irritability – this tended to be once every 2 weeks.
Combination remedies can sometimes be useful in treating acutes and although Gelsemium covered the dull headaches, he began to get sinusitis symptoms. The sinus combination Kali Bich, Hydrastis and Pulsatilla worked to very good effect and only 1-2 days of the remedy twice a day was needed when the sinus symptoms presented. Over time we began to correlate the fluctuations in energy and crashes with infection, errors in diet (namely sugar and milk) and over-activity. We cut out dairy and reduced sugar but new challenges came in the form of sport injuries as he attempted to return to the life before covid. After reading literature about chronic fatigue, I found often as soon as one feels better, they try to return to the lifestyle they had before the illness and unless this is addressed, the cycle of fatigue perpetuates.
During this time, I used another combination remedy: the injury combination of Arnica, Rhus Tox and Ruta which were invaluable in speeding up the recovery of the soft tissue and reducing inflammation. A feature of chronic fatigue is the reduction in elasticity/hydration of the fascia and increase in sluggishness of the lymphatic system. Cellular energy production and its subsequent toxic by-products, particularly where there is metabolic dysfunction, cannot be moved away from the tissue and into the bloodstream fast enough and consequently muscle tissues remain with lactic acid and other by products, leaving them more prone to inflammation and injury.
This palliation using homeopathy continued and the cycle of energy, injury and fatigue continued in a manageable way through the lockdowns and beyond. His nutritional supplements were increased, particularly vitamin C and zinc, and with high vitamin C supplementation (5-10g per day up to bowel tolerance, as advised by a naturopath), he worked through another symptom producing virus in a healthy way with a high fever. He had a month of high vitality after this virus, but unfortunately the same pattern of fatigue returned as the pressure from school increased and we moved into the winter months.
Finding the constitutional
Physically he is tall, slender with soft dark blonde hair and blue eyes and stoops forward. He is quiet and academic with a good memory. He likes to please at school and does not like chaos or high emotion. He is not particularly tidy but likes clean clothes with calm colours. He does not like to stand out from the crowd or be centre of attention. He is fearful of new events and will get emotional if pushed to do something when he gets angry and tearful. He is sensitive and sympathetic. He will ruminate over events, of how he could do better and describes himself as perfectionist but only as to his own behaviour. He is controlled in his interactions and emotions. He tires easily and desires to lie down rather than stand. He is self- critical particularly when alone at night. He has acne on his upper arms that leave reddish purple marks. He has a peculiarity in that sunshine makes him sneeze. He is chilly, likes warmth but does not like to be over heated. He is of average thirst, likes sweet, spicy flavours and frozen fruit. Overheating causes skin rashes that are unbearably itchy. He is a fearful person and perceives danger in new experiences.
Initially his picture tended towards liver remedies and potentially could have looked like a Lycopodium picture with his sensitivity, timidity and irritability. However, Lycopodium was given in the first year with little effect for his overall improvement. This may have been because there were overlying layers that needed to be addressed first.
His inherited miasms are Tubercular from his father with asthma, allergies, restlessness and desire to experience new things and Carcinosin from myself. He was prescribed Tub Bov 200c and Carcinosin 200c as intercurrent remedies during the course of the first year.
Repertorisation using Vithoulkas compass
The repertorisation uncovered Mercury, Arsenicum and Sulphur as the most fitting remedies.
Mercury is a useful acute remedy in this case as there is much disorder amongst many systems of the body including the stomach, liver, a tendency to inflammation, generals of worse by heat and cold and better by rest. In all stages of the illness his eyes were affected and he had the peculiarity of sneezing in sunshine.
Progress to cure
As the action of the Gelsemium and Mercury continued only to palliate, his obstacles to cure were explored by a functional nutritionist who added amongst other vitamins and minerals, a supplementation of coenzyme Q10, a superior molecule that protects the mitochondria from oxidative stress. This addition to his regime allowed the vital force to shift his picture to one of health. He is now able to increase his sport without risk of severe fatigue and is not needing palliative remedies. Recently he contracted the Omicron variant. This, he sailed through with only sinus issues and mild fatigue of which the sinus combination of Kali Bich, Pulsatilla and Hydrastis successfully treated him.
Serious viral illnesses are processed by the body with a huge requirement of available Vitamin D, C and Zinc. The same is true of growth spurts during adolescence. It is very likely that his base levels of Zinc and Vitamin D were low and hence his body did not have the resources to either eliminate the virus of prevent the inflammatory process from accelerating. Although he received supplementation with these during the chronic stage post virus, his low pre-covid levels meant that the cellular damage was already done and the need for recovery became a lengthy process. His main remedies for recovery were Gelsemium and Mercury at all stages and Sulphur to finish. Gelsemium was useful for his heaviness around the eyes, emotional state and his muscle weariness. Mercury has been helpful in reducing his acne, improving his energy and mouth ulcers and working with his syphilitic state, night sweats and improving his self- confidence which was displayed as indifference.
Sulphur was given as a split dose of 200c and appears to be the last push the vital force needed to move towards cure. Sulphur corresponds with the psoric aspect to this case and the perpetual relapsing of complaints. Sulphur is often used in the beginning of chronic disease and in finishing off acutes when the indicated remedy fails to act. It was not a remedy I would have thought of for him and it is important to be aware that some Sulphur’s can be chilly, especially in chronic ill health.
Sulphur and its invaluable presence within human biochemistry and energy production
Sulphur is present in many important biochemical molecules and of course has featured as such an important and widely used homeopathic remedy. Respected homeopath, K. C. Chandran Nambiar in his homeopathic perspective of Sulphur biochemistry describes in detail the importance of the element in maintaining health. He describes Sulphur as a constituent in glutathione, a powerful antioxidant made within the cells. Aging, stress and toxin exposure deplete glutathione levels leading to oxidative cell damage and inflammation. Additionally and amongst other uses, Sulphur is present in an essential B vitamin, Biotin, that helps support enzyme activity in breaking down fat, protein and carbohydrates and strengthens nail and hair. Disorders that impair gut integrity can lead to biotin deficiency, skin rashes, nail weakness and hair loss and chronic fatigue. Homeopathic Sulphur reaches the greatest symptomology of all remedies and its value in completing the case in chronic disease can be understood through its diversity in use within the biochemical processes within the body.
The case presented shows the use of polycrest remedies in curing post viral chronic fatigue. The case was undertaken whilst I was a student of homeopathy and despite the heartache, fortuned me with a wonderful insight into the progression and cure of disease and disorder with the use of homeopathic remedies.
Murphy, Robin (2018) Murphy MetaRepertory 4th Edition
Biotin Deficiency Symptoms, Causes and Natural Remedies – Dr. Axe (draxe.com)