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Long COVID
from the Perspective of Anthroposophic Medicine – Symptoms and Treatment
Options
Recommendations
of an international expert commission for health professionals
Henrik
Szőke, Markus Sommer, Eva Streit, Christian Grah, Madeleen Winkler, Philipp
Busche, Severin Pöchtrager, Jan Mergelsberg, Carla Wullschleger, Katharina
Gerlach, Rolf Heine, Robert Fitger, Harald Matthes, Georg Soldner
Last
update: 27.09.2021
https://www.anthromedics.org/PRA-0993-EN
Tradução para o Português Sonia von Homrich (em curso)
https://soniavonhomrich.blogspot.com/2021/11/c-longo-da-perspectiva-da-medicina.html
Corresponding
author: henrik.szoke@etk.pte.hu
Abstract
A growing
number of people are affected by a Long COVID syndrome with often long-lasting,
significant impairment of their health. Different pictures with prolonged
hyperinflammation, damage and functional restriction of the musculature, the
heart, the nervous system and the sensory organs occur. A relatively large
group of rather younger patients shows symptoms of post-viral chronic fatigue
syndrome/myalgic encephalomyelitis syndrome (CFS/MES). These patients more
often had a rather mild COVID-19 course and may subsequently develop
long-lasting CF/ME symptoms. This article presents aspects for an understanding
the disorder as well as a multimodal treatment concept of Anthroposophic Medicine.
Definitions
Acute
COVID-19 disease: the first four weeks of illness.
Persistent
post-COVID syndrome (PPCS; ICD-10: U09.9) or Long COVID: mostly used
synonymously with post-COVID, especially for post-COVID symptoms that persist
longer than 12 weeks (1, 2): residual symptoms/permanent damage or
post-infectious symptoms existing four weeks or more after the onset of the
disease.
Risk
factors, triggers, prevalence
The
severity of the acute phase and the triggering mutation of the pathogen do not
correlate with the frequency and severity of Long COVID. Three months after
disease onset, approximately ten to 65 percent of all registered adult COVID
patients report persistent symptoms (3, 4, 5). In childhood, these symptoms
occur much less frequently (6, 7).
Patients
with severe symptoms show a high incidence of complex post-intensive care
syndrome (PICS), the first signs of which may already appear in the acute
phase. Approximately half of patients receiving intensive care experience a
Long COVID symptom (8).
The
frequency, duration and extent of long-term pulmonary sequelae,
immunosuppression and general impairment of quality of life are significantly
related to the severity of the acute phase (9).
People over
the age of 55 and with pre-existing conditions (known risk groups for severe
COVID-19 disease progression: distress, exhaustion, depression, anxiety
disorder, overweight, etc.) are significantly more often and more severely
affected (10).
Competitive
sportspeople also seem to be more affected (11). The frequency of other
symptoms does not show such a clear correlation with the course of the disease,
the level of inflammatory laboratory parameters or the severity of the acute
disease.
Children
only seem to be affected by Post or Long COVID significantly less. Because of
many asymptomatic courses in children (12), only preliminary assertions can be
made (13). In children, too, pre-existing conditions can facilitate Long COVID
symptoms (6, 7). Still unclear, as they have been little studied, are the
psychosocial consequences of a long lockdown.
Symptoms,
pathophysiology and diagnosis
Cardinal
symptoms:
Tiredness/fatigue/general
weakness;
Breathlessness/dyspnoea,
especially on exertion, including a feeling of constriction and chest pain with
or without objective restriction of lung function (obstructive/restrictive);
Palpitations
without objective impairment of cardiac function;
Headache,
especially during/after exertion;
Cognitive
disorders (concentration, memory, "brain fog" etc.);
Anxiety can
accompany all of the above disorders in specific ways (see below).
Symptoms
may present as a dry irritating cough, in the form of pain (head, muscle,
joints, chest) and myopathy (CIM). With cardiac involvement: acute myocardial
infarction, microinfarctions, ventricular or atrial fibrosis with
ischaemic/non-ischaemic cardiomyopathy, myocarditis, symptomatic/subclinical
dysfunction, various arrhythmias. Hair loss and various exanthema may occur on
the skin.
In
children, the main symptoms are fatigue, sleep disorders, taste and smell
disorders and headaches.
Despite the
frequent gastrointestinal complaints of the acute phase, they appear less
frequently in PPCS. However, severe gastrointestinal motility disorders have
been described.
The most
common long-term neurological disorders (PCND) include: sleep disorder,
dizziness, taste and smell disorders (14), polyneuropathy (CIP),
ischaemia/apoplexy due to endothelitis and coagulopathy, autoinflammatory
demyelination, encephalitis (15). The central nervous system seems to be
affected more than the peripheral. The most common mental and psychological
disorders include: memory disorders, impaired concentration, lack of presence
of mind ("brain fog"), stress intolerance, anxiety (16) and
depression, post-traumatic stress symptoms (PTSD) (17), obsessive-compulsive
disorder (OCD), subjective distress and deterioration in quality of life (18,
19). Here, nocebo effects must also be taken into account, which can be attributed
to pandemic measures such as social distancing (20, 21). Ten to 15 percent of
those affected take psychoactive substances, ten percent have suicidal
thoughts.
Pathophysiology
With regard
to the pathophysiological processes, two polar tendencies are evident in severe
courses:
Persistent
inflammation (endothelitis, myositis, myocarditis (with elevated serum
parameters: CRP, D-dimers, LDH)), increased thromboembolic events (22).
Fibrosing
stiffness in the lungs and other tissues, chronic proliferative inflammation
with fibrosis.
Immunologically,
both the triggering virus (persistent reservoirs, viral fragments/spike
proteins, reverse transcription into the human genome) and autoantibodies and
immune regulation disorders can play a role here. An excessive first phase up
to a so-called cytokine storm can be followed by a similarly excessive
reaction, such as the compensatory anti-inflammatory response syndrome (CARS)
and the persistent inflammation, immunosuppression, catabolism syndrome (PICS).
Persistent
inflammation-related damage can occur in the lungs and airways (23).
Innervation disorders and weakened respiratory muscles may also contribute to
complex respiratory insufficiency after COVID (24).
Myocardial
lesions occurring in the heart are already signalled in the acute phase by
elevated troponin levels. Myocarditis, right heart strain, rening-angiotensin
axis dysfunction, coagulopathy, neurovegetative influences and systemic
prolonged hyperinflammation can lead to rhythm and conduction disorders,
microfibroses and cardiomyopathies.
Endothelitis
and disorders of the blood-brain barrier play an essential role in damage to
the sensory and nervous system.
Diagnosis
An
individualised medical history is required, which also includes the time before
falling ill with COVID, and a complete physical examination, which is
specifically supplemented by laboratory and functional diagnostics
(pulmonological, cardiological, neurological). The change in quality of life
can be evaluated by questionnaires (e.g. SF-36, E5-QD) or by Management of
Daily Life questionnaires.
After the
initial staging, regular follow-up examinations and a final examination are
indicated.
Extended
understanding of disease from the perspective of Anthroposophic Medicine
The
dynamics of infectious diseases are determined by the interaction of the
microorganism with the affected person, their susceptibility to the pathogen
and their fabric of forces. COVID-19 in the first instance clearly shows the
importance of age and biographical development. Genetic disorders (Down’s
syndrome) can significantly reinforce the relevance of the ageing processes.
The vitality of the body decreases with age and can be impeded by obesity,
metabolic diseases such as diabetes mellitus and others. A significant role in
post-COVID is played by disorders and dissociations in the patient's fabric of
forces. These normally proceed in a dynamic equilibrium between a dissolving
and hardening tendency (25). In contrast, chronic inflammation and a
degenerative, hardening (sclerosing) tendency dominate and persist in Long
COVID, which are experienced mentally as exhaustion and are accompanied by the
weakening of generative vital processes.
The
decisive factor is whether, especially at night, during sleep, the inflammatory
degenerative tendency recedes in favor of vital generative processes. This
day-night rhythm can be severely disrupted in Long COVID. From an
anthroposophical perspective and therapeutic experience, the focus here is on
strengthening of the warmth organisation ("I-organisation") in order
to achieve the changeover from persistent inflammatory processes to a day-night
rhythm with nightly predominant generative processes. Other, often younger
patients suffer predominantly from a post-viral dissociation of their bodily
vitality. This is where treatment primarily starts, to support the patients so
that they can direct the organism again with the power of their individuality,
perceive themselves, and deploy their vitality. In doing so, it is essential to
revitalize the body itself and make it receptive to psychological impulses. It
is about overcoming both the psychological alienation/dissociation from our own
body and the clear feeling in some patients that their individuality is cut off
from the spiritual sphere.
A normally
low level of effort proves exhausting for many. Even breathing loses its
naturalness. Dyspnoea, fatigue are often accompanied by anxiety. Not
infrequently, there are also cognitive impairments in the ability to think and
concentrate and in memory retention. Some patients say that they experience
something alien within them that feels different from other infectious diseases
they have been through. They often feel powerless and paralysed inside.
Less
Therapeutic
principles
Conventional
standard treatment
The
strategy includes the following steps: evaluation of the course of the acute
phase, staging, screening of comorbidities, assessment of prognosis,
formulation of the treatment plan with full involvement of the informed patient
(26, 4, 27).
Drug
therapy
Pharmacotherapy
is based on the established spectrum and corresponds to the organic permanent
injury to health or respective functional disorders.
Non-drug
therapy
Cardiopulmonary
rehabilitation measures, such as e.g. breathing techniques ("inhalatory
muscle training") (28, 29), breathing exercisers (e.g. Tri-Ball system)
should be used under professional physiotherapeutic supervision. With incremental exertion, monitoring of
heart rate and oxygen saturation may be indicated.
Psychological/psychotherapeutic,
neuropsychological (such as e.g. olfactory training), neurological, psychiatric
rehabilitation measures (cognitive training, etc.) may be indicated up to and
also during reintegration/fitness for work (30).
Sport/strenuous
physical exertion: even in an asymptomatic course or mild acute phase, a break
of two to four weeks is necessary, in a symptomatic course at least four to six
weeks.
From a
social psychiatric perspective, protective elements play an essential role:
social contacts, support opportunities, resources, secure livelihood,
employment, recreational opportunities, basic social hygiene and medical care.
Supportive
measures to help isolated patients look after themselves are essential
(outpatient clinics, hotline, etc.).
Principles
of sustainable integrative treatment
Integrative
anthroposophical treatment is multimodal and sees itself as an extension of
standard conventional treatment. It serves to support the forces of
self-healing and self-regulation on a physical-physiological, psychological and
mental-spiritual level. The resource analysis on the physical, psychological
and spiritual level is an essential part of the treatment planning.
1. Heat:
The patients show a picture of the stagnation of inflammation and/or fibrosis.
The therapeutic stimulation of body temperature (I-organisation) can enable the
self-regulatory processes to intervene again on all levels. The patient's
self-perception can be directly addressed through heat. At first, many patients
do not consciously feel the inner lack of heat. By strengthening and supporting
the warmth organisation through appropriate clothing, external applications,
self-active treatment methods and anthroposophical medicines (e.g. mistletoe
therapy, see below), patients experience a more intensive access to their own
corporeality (embodiment) again. If fibrosing stiffness in the lungs and other
tissues and chronic proliferative inflammation are prominent, a sustained
warming treatment is the determining therapeutic principle. This allows the
vital forces in the metabolic system and limbs to become "tangible"
again for the patients. At the same time, the dyspnoea fades, especially when there
are few limitations in the measured lung function.
2.
Respiration: The one-sided failure of respiration and life rhythms, which takes
on a life of its own and which can be accompanied by typical anxieties, needs
to be re-integrated and harmonised on a physical as well as on a psychological
level. The treatment can support a deepened exhalation into the world as well
as a deepened inhalation into the inner self. Especially for overcoming
persistent inflammatory processes, a therapeutic reinforcement of
self-regulation is necessary on the psychological level. Here it is essential
that the patient feels emotionally accepted and understood and is initially
relieved emotionally and physically of stressors that take on a life of their
own. Care and self-care, rhythmisation of everyday life with regular breaks,
individually appropriate, moderately self-active and artistic treatment methods
(see principles 5 and 6) can open up new access to the content of psychological
experience.
3. Fluids
and circulation: At the level of the life processes, the primary concern is
toning and rhythmisation in order to overcome the pervasive weakness and
heaviness. Morning rosemary washes tone the circulation and strengthen the
day-night rhythm. External treatments such as the yarrow liver compress
stimulate body awareness via the skin, directly promote inner vitality and can
improve sleep quality. A revitalisation of the microcirculation can be achieved
through rhythmical massage therapy, the revitalisation of body awareness and
deepening of the sleep-wake rhythm through rhythmical Einreibung. Actively,
such revitalisation can be achieved through forest bathing (31, 32) and/or
eurythmy therapy. Stabilising a healthy daily rhythm with adequate breaks is
essential. The rhythm of meals contributes significantly to this. The diet
should support vitality, with organically grown fruit and vegetables, regular
freshly cooked hot meals and adequate food breaks. Bitters support vitality,
promote generative processes and strengthen the interaction between soul and
body. Lastly, anthroposophical medicines can specifically stimulate the
vitality of individual organs.
4.
Regeneration of tissue disorders: Treatment of impaired sensory functions
(smell and taste disorder/alteration) with anthroposophical medicines and
mindfulness-based olfactory training. Organ damage, e.g. in the area of the
lungs, cardiovascular system and kidneys, and functional organ disorders, such
as "brain fog", can be treated complementarily with anthroposophical
medicines and eurythmy therapy.
5.
Self-activity: A person's own limits must be carefully observed and can only be
expanded gradually, otherwise there can often be a prolonged collapse in the
person's own strength. Situations in which conscientious patients are under the
impression that they are obliged to make a greater effort are also particularly
risky, which is why they should be advised as a precautionary measure to check
themselves, before engaging in any activity, as to whether they are ready to
perform it. It is helpful with Long COVID to have a four-week interval in which
the focus is on therapy and reorientation and the workload is scaled back.
6.
Psychosomatic aspects: Initially, the focus is on actively reshaping a person's
own life balance. Exercises to strengthen self-awareness (sensory exercises,
mindfulness exercises) and mindful encounters with nature are helpful. Talking
therapy and psychotherapy, artistic therapies and eurythmy therapy offer
possibilities to effectively support the finding of the new balance in life.
Anthroposophical speech therapy can provide effective support for breathing
disorders. It is always important to consider the individual resources of the
patient.
The removal
of anxiety has a central role to play. To overcome the loss of trust, the
alienation from our own corporeality, it is essential to promote trust in our
own corporeality through external treatments. Related to organs, heart
compresses with Aurum/Lavandula comp. ointment, abdominal Einreibung with
Oxalis oil, kidney compresses with ginger, and foot baths with lavender should
for example be considered here (31). Patients who were already prone to anxiety
and depression before they developed COVID are more likely to show Long COVID
symptoms. Art therapies are particularly recommended for them, such as
modelling, in order to strengthen the relationship with their own corporeality.
7.
Biographical and spiritual aspects: It is important to support the patient in
developing a new perspective for the future. Small first steps can be
significant in the first instance here.
It is a matter of the patient finding their own measure anew and thus
transforming the experience of the illness into a growth crisis of their own
personality. This enables the patient to find their way out of the feeling of
being a victim of the disease. Here it is essential to replace notions of
achievement adopted from outside (from others) with more individualized goals.
Spiritual and religious aspects can be of significance depending on the individual
relationship with them.
Less
Pharmaceuticals
and nursing measures
1. Support
of the warmth organisation – medicines for general weakness, fatigue
Anthroposophical
mistletoe treatment is not only used in oncology but also offers a very
effective way of stimulating the warmth organisation and vitality in
non-oncological clinical patients, thus strengthening the patient's
self-regulation. Suitable mistletoe host trees are
hawthorn
(Crataegus) especially in weakness of the cardiovascular system,
lime
mistletoe (Tiliae) for intensive warming, especially in weakness in the lung
area and the immune system,
maple
mistletoe (Aceris) to vitalise the metabolic system,
birch
mistletoe (Betulae) for depressively tinged exhaustion and to vitalise the
kidney/adrenal system,
pine
mistletoe (Pini) in disorders of the nervous and sensory system (33) .
Preparations
that can be considered for this are:
ABNOBA
Viscum Crataegi, Aceris, Betulae, Pini: 0.02mg 2 x/wk, after 8 amp., followed
by 0.2mg s.c. 2 x/wk
HELIXOR P
Series Pack 1: 1 amp. 2 x/wk, repeat if required
ISCADOR P
Series O: 1 amp. 2 x/wk, followed by Series Pack 1
ISCUCIN
Crataegi, Tiliae, Pini Potency Series I WALA: 1 amp. s.c. 2 x/wk Potency Series
I, repeat if required
This
treatment can be supplemented with potentised gold and meteoric iron (Ferrum
sidereum), especially in cases of anxiety and depression
Aurum D 10/Ferrum sidereum D 10 amp. WELEDA: 1 – 3 x/wk s.c. or
Aurum D12 trit. WELEDA: 1 saltsp. 1 – 2 x/d
Ferrum sidereum D 20 tab. WELEDA: I tab. 1 – 2 x/d
Fatigue in
the context of chronic persistent inflammatory processes / post-viral syndrome
Ferrum
hydroxydatum 5% trituration WELEDA: 1 – 2 saltsp. 3 x/d, on failure
Ferrum
hydroxydatum 50% trituration, Apotheke an der WELEDA: 1 x ¼ - ½ level teaspoon
in the morning.
For
conspicuous feelings of cold, circulatory insufficiency – quickly invigorating
and warming effect
Camphora D
1 WELEDA: 5 – 10 gtt in water 1 – 3 x/d
Camphora D 3 amp. WALA: 1 amp. s.c. 3 x/wk – 1 x/d.
2.
Respiration
In case of
a protracted course of COVID-19 pneumonia and weakness
Bryonia/Stannum
amp. WALA: 1 amp. s.c./d (upper abdomen or between the shoulder blades)
For cough,
loss of appetite, persistent inflammatory processes in the lung tissue,
exhaustion
Roseneisen/Graphit
pillules/amp. WALA: 1 amp. s.c. 3 x/wk/ 10 – 15 pillules 2 - 3 x daily.
For cough,
loss of appetite, persistent inflammatory processes in the lung tissue,
exhaustion
Verbascum comp. WELEDA: 3 x 20 gtt.
For
persistent signs of inflammation, mucus and tissue remodelling, also in the
case of disorders of lung perfusion, s/p pulmonary emoblism
Pulmo/Mercurius Amp. WALA : 1 amp. s.c. 3 x/wk.
3. Cardiovascular system
For
exhaustion, circulatory and blood pressure regulation disorders,
tachyarrhythmias, possibly also sleep rhythm disorders
Cardiodoron®
Tr. WELEDA: 10 – 25 gtt 2 – 3 x/d.
For
myocardial involvement, in elderly patients with a tendency to arterial
hypertension, mild heart failure in myocardial relaxation disorder, in cardiac
arrhythmias
Cardiodoron®/Aurum
comp. WELEDA: 10 – 15 gtt 3 x/d.
Supplementary
for myocarditis
Cor/Aurum II Amp. WALA: 1 amp. s.c. 1 x/d – 2 x/wk.
For
exhaustion, chronic persistent pain, post-viral burn-out syndrome
Crataegus/Ferrum sidereum/Saccharum tostum Amp. WELEDA: 1 amp. s.c. 3 x/wk.
For
arterial hypotension, dizziness, tendency to faint, feeling of weakness and
coldness
Skorodit
Kreislauf Globuli WALA: 10 pillules 2 – 3 x/d
Skorodit
Kreislauf Inject Amp. WALA: 1 amp. s.c. 3 x/wk – daily
For s/p
thrombotic events, weakened circulation in the venous area and general
weakness, also in young patients
Kalium
aceticum comp. D6 Amp., Verreibung WELEDA: 1 amp. s.c. 1 x/d or 1 saltsp. 3
x/d.
4.
Gastrointestinal system
For
appetite disorders, nausea, indigestion
Absinthium D1/Resina laricis D3 Dil. WELEDA: 10 gtt 3 x/d before meals, also
counteracts a tendency to infection.
alternatively
Bitter
Elixier WALA: 1 teaspoon to tablespoon 3 x/d (alcohol-free).
5.
Musculoskeletal system
For
myalgias, muscle weakness
Magnesium
phosphoricum acidum D6 WELEDA: 50 gtt 1 x/d Take dissolved in water throughout
the day
Plantago Primula cum Hyoscyamo Amp. WELEDA: 1 amp. s.c. 2 – 3 x weekly or 1 amp.
per os daily
Primula
Muskelnähröl WALA: apply locally
6. Sensory
and nervous system
For loss of
smell, disorders of the sense of smell
Bulbus
olfactorius D5 Amp. WALA: 1 amp. s.c. 3 – 7 x/wk. or per os
Jaspis D6 –
D12 Verreibung , z. B. Apotheke an der Weleda: 1 x 1 saltsp. Daily
For loss of
taste
Topas D15
Amp. WALA, D12: (extemporaneous production) 1 amp. s.c. 3 x/wk or 10
gtt/pillules/1 saltsp trituration 1 x/d
For headache,
weakness, possibly iron deficiency
Ferrum/Quarz
Kapseln WELEDA: 1 – 3 x/d, if required supplemented by
Ferrum sidereum comp. Amp. WELEDA oder Ferrum/Sulfur comp. WALA: 1 x/d - 2 x/wk s.c. in the
neck area
For
"brain-fog", cognitive weakness and disorders (retentiveness, ability
to concentrate)
Scleron®
Tbl. WELEDA: 1 tab 1 – 2 x /d
Helleborus
niger D12 Amp. WALA, HELIXOR : 1 amp. 1 – 3 x/wk.
7. Sleep
disorders
For
difficulties falling asleep and staying asleep
Valeriana
comp. Glob. WALA: 7 – 15 pillules 1 x/d in the evening
alternatively
Calmedoron®
Tr. WELEDA : 15 – 20 gtt 1 x/d in the evening
8. For
vital weakness, depression and emotional irritability
Aurum/Apis regina comp. Amp., Glob. WALA: 1 amp. s.c. 1 x/d – 2 x/wk; 10 – 15
pillules 3 x/d
complementary
or alternatively for depressively tinged exhaustion and weakness
Aqua Maris D3/Prunus spinosa D5 Amp. WELEDA: 1 amp. s.c. 3 x/wk
can be
supplemented with
Levico D1
Tropfen, WELEDA : daily. Gradually increase from initial dose (5 gtt) to target
dose (20 gtt daily) and continue as long as needed.
Composition
of the German medicinal products mentioned: Verbascum comp.: Cetraria
islandica, ethanol. Decoctum Ø, Achillea millefolium, Flos, ethanol. Infusum Ø,
Pimpinella anisum, ethanol. Decoctum Ø, Verbascum densiflorum, Fructus immat.
Dil. D2. Cardiodoron: Ethanol. Digestio (1:3,1) from Onopordum acanthium, Flos
rec., produced with 1% Hyoscyamus niger, Herba rec. Ø, ethanol. Digestio
(1:3,1) from Primula veris, Flos rec., produced with 1% Hyoscyamus niger, Herba
rec. Ø. Skorodit Kreislauf Glob./Inj.: Camphora Dil. D3 aquos., Hypophysis
bovis Gl Dil. D7, Prunus spinosa e floribus et summitatibus ferm 33d Dil. D5,
Skorodit Dil. D5, Veratrum album e radice ferm 33c Dil. D3. Bitter Elixier
WALA: Gentian roots (Gentianae luteae radix), Wormwood herb (Artemisiae
absinthii herba), ginger roots (Zingiberis rhizoma), calamus roots (Acori
calami rhizoma), black pepper fruit (Piperis nigri fructus), sugar. Ferrum
sidereum comp.: Ferrum sidereum Dil. D8, Quarz Dil. D20, Sulfur Dil. D6. Scleron: Plumbum mellitum Trit.
D12 (Plumbum mellitum base substance: produced from plumb, honey and cane
sugar). Calmedoron Tr.: Avena sativa Ø, Coffea tosta, ethanol. Decoctum
Dil. D60, Humulus lupulus Ø, Passiflora incarnata, Valeriana, ethanol. Decoctum
Ø .
Nursing
measures, external treatments
Principle
1. Strengthening the warmth organisation
Heat
treatments have a primary role as they promote the harmonising intervention of
the warmth organisation, especially in patients with a fibrosing course,
exhaustion with a feeling of cold.
Warm
footbaths (34) 1 x/d in the morning
- with oak
bark, have a fortifying and structuring effect
- chestnut
foot bath especially for venous circulation disorders, feeling of heaviness in
the legs, muscle pain
- with
rosemary tea or bath milk have a vitalising effect
Kidney
compresses with ginger powder, also have a harmonising effect on breathing, 1
x/d for 5 consecutive days, then 1 – 3 x/wk.
For
instructions, see https://www.pflege-vademecum.de/ingwer.php?locale=en
Kidney
Einreibung with Red Copper ointment (Kupfer Salbe rot) WALA for patients who
are anxious, little weakened in vitality but have little emotional access to
their condition.
Beeswax
packs on individual hypothermic, cold-sensitive areas of the body.
The
pentagram Einreibung in anthroposophical nursing supports reorientation for the
vital body out of the warmth organisation.
Whole-body
hyperthermia under inpatient conditions.
Oil
dispersion baths , for instructions, see
https://www.pflege-vademecum.de/odb-grl-oel.php?locale=en .
Principle
2. Harmonization of the breathing
Yarrow lung
compress for residual lung damage 1x/d for 5 consecutive days, then 1-3 x /wk,
for instructions, see https://www.pflege-vademecum.de/sg-luw.php?locale=en
Upper
abdominal compress (diaphragm compress) with rosemary-copper oil 1 x/d for 5
consecutive days, then 1-3 x/wk: deepens and slows the breathing, improves
diaphragm mobility, relieves cramps, also in fibrosing changes of the lungs.
For instructions, see
https://www.pflege-vademecum.de/rosm-ku-zfw.php?locale=en
Principle
3. Fluid and circulation
Yarrow
liver compress for weak vitality, to initiate treatment (if necessary
Millefolium 10% ointment WELEDA CH) 1 x/d for 5 consecutive days, then 1-3
x/wk. Ffor instructions, see
https://www.pflege-vademecum.de/schafgarben_leberwickel.php?locale=en
Rosemary-copper
diaphragm compress, 1 x/d for 5 consecutive days, then 1-3 x/wk. For
instructions, see https://www.pflege-vademecum.de/rosm-ku-zfw.php?locale=en
Principle
4. Regeneration of tissue disorders
Thorax
Einreibung with rock salt + 3 gtt rosemary oil for fibrosing lung changes 1 x/d
for 5 consecutive days, then 1-3 x/wk
To
stimulate the metabolism in general: yarrow liver compress, 1 x/d for 5
consecutive days, then 1-3 x/wk., for instructions, see
https://www.pflege-vademecum.de/schafgarben_leberwickel.php?locale=en
Principle
7. Psychosomatic complaints / pain
To support
embodiment in general: rosemary-copper diaphragm compress; 1 x/d for 5
consecutive days, then 1-3 x/wk., for instructions, see
https://www.pflege-vademecum.de/rosm-ku-zfw.php?locale=en
For
post-traumatic symptoms: pentagram Einreibung with Aurum/Lavandula comp.
ointment WELEDA for three consecutive days, for instructions, see
https://www.pflege-vademecum.de/aurum_lavandula_salbe.php?locale=en
Invigorating
rhythmising effect: alternately rosemary footbath 1 x/d in the morning and
lavender footbath 1 x/d in the evening.
Head: spray
Formica D1 WELEDA as a spray 1:5 or Arnica tincture 1:10 on the head, 2 – 3
sprays every 2 hours until improvement occurs. Application is also possible as
a head cover.
Chest: Back
Einreibung with Solum oil WALA to open the rearward space.
Heart:
Heart lobe or organ Einreibung with Aurum/Lavandula comp. cream WELEDA for
impairment of mental functions, "brain fog", for functional heart
complaints, anxiety.
Abdomen:
Oxalis upper abdomen compress/Einreibung after traumatic experiences;
see also
https://www.pflege-vademecum.de/oxalissalbe.php?locale=en .
Muscle/joint
pain: Einreibung with Aconite Schmerzöl (Nerve Oil) WALA.
Feeling of
exhaustion: oil dispersion baths with prunus, rosemary.
Less
Body and
Movement Therapies, Art and Talking Therapies
Body
therapy
Rhythmical
massage therapy with Oxalis 10% oil WALA for anxiety (35),
Betula/Arnica
oil WALA for pain and cramps,
Rosemary
oil for exhaustion.
Movement
therapies
Endurance
training (walking, Nordic walking or jogging) 3 x/wk, preferably in nature. The
intensity and duration should be adapted to the given situation.
Spacial
Dynamics can be used especially for neurological movement disorders.
Eurythmy
Therapy is presented here in greater detail as an example.
It is a
holistic, self-activating, movement-oriented mind-body therapy (MMBT) within
Anthroposophical Medicine that uses movement exercises with arms, legs and the
whole body (36) to harmonise dysfunctional functional, vital-emotional and
intentional processes in the human organism (37) comparable to Traditional
Chinese Medicine TCM (38). Eurythmy therapists usually work in an individual
setting with their patients and give exercises that can be done at home. The
therapy development focuses on the individual person and is based on exercises
attributed to certain symptom circles. The connection with the organs, heart,
lungs, liver and kidneys is always taken into consideration because of the
long-lasting impairment of the essential organ functions after a COVID disease
(39).
Short case history:
In November 2020, a 23-year-old athletic male developed COVID-19 symptoms,
tested positive and immediately went into quarantine. Symptoms included fever,
dry cough, rhinorrhoea, myalgia, headache, sore throat, dyspnoea, asthenia,
fatigue and general body tension. The fever lasted only 3 days, dry cough,
rhinorrhoea, myalgia, asthenia and headache 14 days. He did not suffer from any
underlying diseases, which favoured a mild course in COVID-19. Besides
paracodeine drops, paracetamol (one time), honey sage throat pain tablets,
fennel and chamomile tea and a balanced healthy diet, the patient helped
himself with some of the Eurythmy Therapy exercises he had learnt since July
2020: 7-fold rod exercise (40), waterfall rod exercise (41), 12-fold rod exercise
(42) and lemniscates with the copper ball (43) performed in front of the torso.
After the fever had gone down, he practised daily at least once and
additionally as needed. The patient described the lemniscate movement with the
copper ball as overall calming and relaxing, resulting in improvement of cough,
headache and fatigue. He attributed the improvement in chest pain, dyspnoea and
fatigue to the fact that the whole body was stretched and vitalised by the 7-
and 12-part rod exercises. Beyond the acute condition, dyspnoea, fatigue and
occasional concentration problems and headaches persisted until May 2021. The
patient self-actively put together an exercise programme and practiced it in
situations of need. Self-help exercise (SHE) can improve the emotional distress
of COVID-19 circumstances (44) and symptoms of fatigue (45). The patient's
information suggests the self-active nature and positive effect of eurythmy
therapy for post-COVID-19 symptoms.
The
following exercises (46) have already proven their worth in the treatment of
long-lasting symptoms after an illness with COVID-19. The differentiated
information on the exercises can be found in Rudolf Steiner's (47) and
Margarete Kirchner-Bockholt's (48) basic works.
Table of
symptoms and exercises (PDF)
Art
Therapies, Talking Therapy
Music and
singing therapy as well as painting therapy support the therapeutic principles
6 and 7.
Breathing,
singing, and speech exercises are especially recommended for patients with
fibrosing courses.
Talking
therapy, biography work, meditation exercises are indicated in cases of
emotional and spiritual affliction.
Complex
rehabilitation cures may be worth recommending — e.g. at the Casa di Salute
Raphael in Roncegno.
Prevention
Due to the
compromised immune balance and weakened organ functions, a relapse, recurrence
or new disease is possible in post and Long COVID patients. Hence prevention is
important.
In the
acute phase of COVID-19, the regulated course of the fever should be positively
accompanied and supported (49).
From the
first day of the acute phase of the illness, it is advisable to put aside daily
obligations and set up media-free time and space for recovery. If there are clear symptoms of the disease,
this period should comprise four weeks.
Lifestyle
Exercise in
nature (50, 51), healthy nutrition with sufficient food breaks, regeneration
times, sleep, media hygiene should be maintained and practised. Systemically,
attention should also be paid to exhausting resources in the family and, as
relevant, professional environment and preventing this from happening.
Vaccinations
Data to
date show no significant worsening of Long COVID symptoms after administration
of mRNA or adenovirus vector vaccines (52).
In
individual cases, vaccination can even have a slightly positive effect on the
improvement of symptoms (own observations). The risk factors and immunological
parameters (incl. signs of immunosuppression, autoimmune tendency, inflammatory
parameters, proinflammatory factors, SARS-Cov-2 IgM/IgG antibodies) should be
considered individually in the vaccination decision (53).
Having had
the disease is very likely to ensure – possibly lifelong – natural immunity
against further severe courses of the disease (54).
Acknowledgements:
We would like to thank the members of the Anthroposophic Medicine Forum (GAÄD)
for their suggestions and sharing their experiences.
Conflict of
interest statement: The authors declare no conflicts of interest.
Less
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