Medicinal Plants for the Management of Post-COVID-19 Fatigue

Long COVID: Since the onset of the COVID-19 pandemic in late 2019, the global community has faced unprecedented health challenges. With over 4 billion possible infections to date and more than 30 million deaths (including all excess deaths), the virus's impact is undeniable. While COVID-19 primarily affects the respiratory system, it is now understood as a systemic disease with a wide range of symptoms, some of which persist long after the acute phase of the infection. This phenomenon, often referred to as "Long COVID" or "post-acute sequelae of SARS-CoV-2 infection (PASC)," encompasses a variety of symptoms, with fatigue being one of the most common and debilitating.


Medicinal Plants for the Management of Post-COVID-19 Fatigue

Fatigue in post-COVID-19 patients can persist for months, significantly impacting daily life and overall health. As traditional treatments offer limited relief, attention has turned to alternative approaches, including the use of medicinal plants. This Long COVID news report delves into the potential of medicinal plants for managing post-COVID-19 fatigue, exploring their mechanisms and efficacy based on a study review conducted by researchers from the School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR-China.
 
Pathophysiology of Post-COVID-19 Fatigue
Understanding the complex mechanisms underlying post-COVID-19 fatigue is essential for developing effective treatments. The condition is multifactorial, involving various systems and processes within the body.
 
Mitochondrial Dysfunction
Mitochondria, the powerhouse of cells, are crucial for energy production. Viral infections, including COVID-19, can disrupt mitochondrial function, leading to reduced energy production and increased oxidative stress. Studies have shown that SARS-CoV-2 can alter mitochondrial pathways, exacerbating energy deficits and contributing to fatigue. Abnormal mitochondrial structures have been observed in muscle biopsies of post-COVID-19 patients, highlighting the role of mitochondrial dysfunction in persistent fatigue.
 
Inflammation
COVID-19 triggers an excessive inflammatory response, often resulting in a cytokine storm. This uncontrolled release of cytokines leads to widespread inflammation, which can persist even after the acute phase of the infection. Elevated levels of pro-inflammatory cytokines such as IL-6 and CRP have been linked to post-COVID-19 fatigue. Chronic inflammation can also affect the nervous system, contributing to fatigue and other symptoms.
 
Oxidative Damage
Oxidative stress, marked by an imbalance between reactive oxygen species (ROS) and antioxidants, is a significant factor in post-COVID-19 fatigue. Elevated ROS levels can damage cellular components, including mitochondria, further impairing energy production. Markers of oxidative stress, such as malondialdehyde (MDA), have been found in higher levels in post-COVID-19 patients , suggesting a link between oxidative damage and persistent fatigue.
 
Autonomic Nervous System (ANS) Abnormalities
The ANS regulates involuntary bodily functions such as heart rate, blood pressure, and digestion. Dysregulation of the ANS has been observed in post-COVID-19 patients, contributing to symptoms like fatigue, dizziness, and heart rate variability. This dysregulation may result from direct viral damage to ANS components or an inflammatory response affecting autonomic functions.
 
Central Nervous System (CNS) Abnormalities
COVID-19 can impact the CNS, leading to cognitive symptoms and fatigue. The presence of the SARS-CoV-2 spike protein in the CNS can trigger an immune response and inflammation, affecting neuronal function. Additionally, the glymphatic system, responsible for clearing waste from the brain, can be disrupted by COVID-19, leading to an accumulation of toxic substances and contributing to fatigue.
 
Potential of Medicinal Plants
Medicinal plants have been used for centuries to treat various ailments, including fatigue. Their minimal toxicity and wide availability make them attractive candidates for managing post-COVID-19 fatigue. Recent studies have explored the efficacy of several medicinal plants, highlighting their potential mechanisms of action.
 
Bu-Zhong-Yi-Qi Decoction
Bu-Zhong-Yi-Qi decoction is a traditional Chinese herbal formula known for its immune-boosting and anti-inflammatory properties. Key components like Radix Astragali have been shown to reduce pro-inflammatory cytokines such as IL-6 and TNF-α. This formula also enhances mitochondrial function and antioxidant activity, making it a promising candidate for alleviating post-COVID-19 fatigue.
 
Qingjin Yiqi Granules
Qingjin Yiqi granules, another traditional Chinese medicine, have demonstrated efficacy in improving fatigue in clinical trials. These granules contain ginsenoside Rb1, which has been shown to enhance antioxidant activity, reduce oxidative stress markers like MDA, and improve mitochondrial function.
 
Rhodiola Rosea
Rhodiola rosea is an adaptogenic herb known for its ability to enhance physical and mental performance. Studies have shown that it can improve mitochondrial function and reduce oxidative stress. Its potential to modulate the immune response and decrease inflammation makes it a valuable option for managing post-COVID-19 fatigue.
 
Eleutherococcus Senticosus
Commonly known as Siberian ginseng, Eleutherococcus senticosus is used to enhance stamina and reduce fatigue. Clinical trials have shown that it can improve post-COVID-19 symptoms by reducing the duration and severity of fatigue. Its adaptogenic properties help the body resist stress and restore energy levels.
 
Case Studies and Clinical Trials
Recent clinical studies have provided valuable insights into the efficacy of medicinal plants for post-COVID-19 fatigue. A retrospective study involving 102 patients revealed that herbal formulas like Hochuekkito significantly reduced fatigue symptoms. Another randomized clinical trial demonstrated the benefits of Qingjin Yiqi granules in improving Borg scale scores, a measure of fatigue severity.
 
A case study of a 55-year-old female with chronic fatigue post-COVID-19 showed significant improvement after using Bu-Zhong-Yi-Qi decoction for 21 weeks. These findings underscore the potential of medicinal plants in managing post-COVID-19 fatigue, though more rigorous trials are needed to confirm their efficacy and safety.
 
Mechanisms of Action
Medicinal plants alleviate fatigue through several mechanisms:
 
-Anti-Inflammatory Effects
Medicinal plants like Radix Astragali and Bu-Zhong-Yi-Qi decoction reduce inflammation by lowering levels of pro-inflammatory cytokines such as IL-6 and TNF-α. This helps mitigate the chronic inflammation associated with post-COVID-19 fatigue.
 
-Antioxidant Activity
Plants such as ginseng and Rhodiola rosea enhance antioxidant defenses by increasing the activity of enzymes like superoxide dismutase (SOD) and glutathione peroxidase (GPx). This reduces oxidative stress and protects against cellular damage.
 
-Restoration of Mitochondrial Function
Herbs like Panax ginseng improve mitochondrial function by enhancing ATP production and reducing oxidative damage. This helps restore energy levels and alleviate fatigue.
 
-Regulation of ANS and CNS
Medicinal plants can modulate the ANS and CNS, reducing symptoms of dysregulation and cognitive fatigue. This is achieved through anti-inflammatory and antioxidant mechanisms, as well as direct effects on neuronal function.
 
Conclusion and Future Perspectives
The emergence of post-COVID-19 fatigue presents a significant challenge, affecting millions worldwide. While conventional treatments offer limited relief, medicinal plants provide a promising alternative due to their multifaceted mechanisms of action. Clinical studies have shown positive outcomes, but further research is needed to fully understand their efficacy and safety.
 
Future efforts should focus on large-scale clinical trials to validate the benefits of medicinal plants in managing post-COVID-19 fatigue. Additionally, identifying specific compounds responsible for therapeutic effects will enhance our understanding and enable the development of targeted treatments. As the global community continues to navigate the long-term impacts of COVID-19, integrating medicinal plants into treatment protocols could offer much-needed relief to those suffering from persistent fatigue.
 
The study findings were published in the peer reviewed journal:  Journal of Traditional and Complementary Medicine.
https://www.sciencedirect.com/science/article/pii/S2225411024000622
 
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