Gu Syndrome & Long COVID: The History, The Reality & The Remedies

While COVID has been around for almost 3 years now, and our understanding of it has developed incredibly rapidly, there is still so much that’s a mystery about the virus that now shapes so much of our lives—and even more that remains a mystery around its long-term effects. According to the CDC, anyone who’s been infected with COVID-19, even those who had mild illness or no symptoms at all, can experience the effects of long COVID. These effects can last weeks, months, or even years, and range from the general (fatigue and fever), to the neurological (dizziness, brain fog, headache, sleep problems, depression and anxiety), to the respiratory (shortness of breath and trouble breathing), to the gastrointestinal (diarrhea, stomach pain, loss of taste and/or smell). Some people even experience “multiorgan effects or autoimmune conditions with symptoms lasting weeks or months after COVID-19 illness.” Consequently, COVID-19 can increase a person’s likelihood of developing other serious illnesses, including diabetes and heart and/or neurological conditions.

Sounds pretty grim, right? Luckily, as vaccination against and treatment for COVID itself have emerged at lightning speed, so too have centers and studies that focus on the causes of and remedies for long COVID. Dr. Lekshmi Santhosh, for example, who was recently interviewed on Ezra Klein’s podcast, founded and is the medical director of UCSF’s Long COVID and Post-ICU Clinic, which was founded in May 2020 and was one of the first centers to focus on long COVID specifically. And just as encouraging, if less reported on in the mainstream, long COVID appears to fall under the umbrella of the ancient Chinese illness called Gu Syndrome. This is especially promising because many Western medicine tests and diagnostic tools fail to register or pinpoint what some long COVID patients are experiencing—they can be treated for their outward symptoms, but other symptoms keep popping up, or their initial symptoms may subside only to return. It is a story we hear over and over again as acupuncturists: when a patient has tried everything, done all the tests, seen all the doctors, but nothing seems to be working, they finally make their way to Traditional Chinese Medicine. This is great news because there are a number of TCM approaches to healing and relief for this murky ailment.

What is Gu Syndrome?

Like Long COVID, Gu Syndrome is not one illness: it is a term to describe a number of different illnesses that affect your body in disparate ways and then can leave you with long-lasting symptoms. Some common examples of illnesses that comprise Gu Syndrome are Epstein-Barr, Lyme Disease, and Syphilis—all viral and bacterial infections that can hide out in your body and come out later to create more issues. Another good example is shingles. If you had chicken pox as a child, this virus can remain in your nerve tissue for years and then reactivate as shingles. If you don’t treat shingles quickly enough, you can get stuck with long-term nerve pain.

Dr. Heiner Fruehauf, the founding professor of the National University of Natural Medicine, writes in “Driving Out the Demons and Snakes,” that Gu Syndrome is “chronic parasitism,” and its symptoms look startlingly like Long COVID: Gu can affect the digestive, neuromuscular, mental and constitutional systems. Fruehauf describes Gu as “a condition that weakens the entire organism by having become systemic in nature.” He goes on in “Treating Chronic Inflammatory Diseases with Chinese Herbs” to say that “the primary prerequisite for Gu Syndrome is that the person has some digestive distress, coupled with neurological distress, such as body pain or mental symptoms—light symptoms such as fogginess, or severe symptoms such as hallucinations—that are not explainable with Western medicine, and that are not explainable either by regular diagnostic patterning that we’ve learned in TCM school.” Similarly, Dr. Santhosh of UCSF describes Long COVID as “a disease of the whole body, acutely–in the short term—as well as chronically. So it’s not surprising that some people have acute impacts in multiple organ systems and some people have chronic impacts in multiple organ systems.”

Gu Syndrome has an ancient and somewhat frightening history dating back at least 3,500 years—a history that hasn’t helped its case much as far as credibility or embrace by modernity. Fruehauf describes the disease as a “hollow[ing] out” of your system by “dark yin forces that you cannot see.” And his definitive text on Gu, “Driving Out the Demons and Snakes,” cited above, explicitly references the historical association of Gu with demons, black magic, possession by evil spirits, degeneration, decay, and rottenness. But before you run away in disbelief, rest assured that Fruehauf recommends viewing these associations as metaphors for pathogens and parasites that take over your body, a process that he sees as central to Gu Syndrome.

So How Do You Know It’s Gu Syndrome:

There are cut and dry cases, in which a patient has traveled abroad and contracted amoebic dysentery, for example, or they took an antibiotic and they’ve not felt well ever since, or they tested positive for Epstein-Barr or SIBO; but Gu Syndrome can also present more amorphously: Fruehauf elaborates that “there are lots of people who never left the country, and they can’t remember any kind of initial infection, but all of a sudden they’ve become chronically fatigued or have been diagnosed with fibromyalgia.” In these cases, “they’ve likely picked up some parasite in a restaurant or had a tick bite they they never knew about. This category of parasites includes the widest possible range, including viruses such as herpes or the Coxsackie virus, chronic systemic yeast, and so on.”

We asked our very own Dr. Arlen McClellan how she knows when a patient has Gu Syndrome and she talked about identifying certain groupings of symptoms that include psychological and physical—joint pain, digestive issues—that started suddenly. McClellan explains that there is usually a progression of these symptoms but the patient can’t figure out what’s going on, and nothing’s helped. In these cases, she’ll do a very thorough history of the progression since they started feeling this way and that thorough history may alert her to the fact that they actually have Gu Syndrome. Some key phrases she looks out for that Gu patients often say: “I don’t feel like myself,” or “I feel like something else is in charge of my body.”

How Do You Treat Gu Syndrome?

At Soho Acupuncture by Jen Becker, we use a combination of acupuncture and herbs and acknowledge that you can’t treat Gu without extensive herbal medicine. In terms of acupuncture, we use the “ghost points,” 13 specific acupuncture points that were popularized by Sun Si Miao in the 7th century. Because Gu is defined by a “possession” of the body by foreign agents—pathogens, parasites, things that are not innate to the body—the ghost points are specific points on the body that, when stimulated, are thought to drive these pathogens out. The ghost points are also useful when treating certain psychiatric disorders.

When it comes to herbal medicine, there are a number of different formulas you can combine to treat Gu, and the treatment should keep evolving since the symptoms and the illness itself usually keep evolving as well. McClellan explains that “treatment with herbs can take 6 months to 3 years.” She goes on: “Because it’s such a sneaky pathogen, you have to constantly be switching up the herbs you’re taking to treat it, which is why people very often don’t finish their course of treatment because it can be long and arduous, and people want to feel better now.” But the length of the treatment is directly related to how long you’ve been dealing with the illness. For example, if you have SIBO (small intestinal bacterial overgrowth), there’s a bacterial overgrowth, which develops biofilms to protect itself from antibiotics. So the herbs you use will first have to “bust through the biofilm,” and then you’ll have to tweak the formula to be able to target the bacteria itself. So you have to go after each layer and each layer is different. “The longer you’ve had the illness, the more layers there may be,” McClellan reports. “It’s going to take longer to get taken care of because it’s been invading your immune system for so long and has set up really good defense mechanisms.”

There are certain herbs that are commonly used in treatment of Gu Syndrome, including Di Long, Perilla, and raw garlic, but the specific formula is going to be different for each person. As practitioners, we take into account numerous factors when formulating and prescribing an herbal treatment, including the length of the illness, where and how symptoms are presenting, if a patient has previously been diagnosed with a disease like Lyme or Epstein-Barr, as well as things like current diet, environment, routine, and stresses. While it is unfortunate that more and more people are experiencing this hard-to-pin-down disease, Traditional Chinese Medicine luckily has multiple angles from which to diagnose, attack, and ultimately provide relief.

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