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Gu and The Grey Area in Medicine

Puget Sound

Modern medicine can be miraculous (I would not be alive without it). However, despite the meteoric advancements that have occurred over the last hundred years, many conditions remain best suited to a complementary approach— one that combines the current medical paradigm with traditional modalities.


East Asian Medicine (EAM) excels where ‘modern’ medicine often falls short (and vice versa), primarily in difficult-to-treat conditions like chronic pain, post-viral or bacterial illnesses, neurological disorders, and mental-emotional conditions. In Chinese medicine, these diseases are often classified as Gu syndrome.

Gu syndrome refers to mysterious diseases caused by lingering pathogens. This definition includes viral reserves, parasites, antibiotic-resistant infections, or toxicity from environmental pollutants. Even when leveraging the wisdom of EAM, Gu syndrome presents a formidable challenge.

Here is an excerpt from an article written by Heidi Lovie, DACM, that provides a more comprehensive definition:

Gu Syndrome (Gu Zheng) historically refers to parasitic infections with references dating back to the 7th century. Although archival sources throughout different Chinese dynasties present varying hypotheses on the provenance of Gu Syndrome, the texts agree that “by definition [Gu] is not a regular parasitic infection, but a condition that weakens the entire organism by having become systemic in nature.”...

The symptoms presented by Gu Syndrome are inclusive but not limited to muscle weakness, fatigue, depression, chaotic thought patterns, low-grade chronic fever, and a range of digestive symptoms. It refers to diseases that are recalcitrant, debilitating, present disparate symptoms, are resistant to standard forms of treatment and originate from an external infection. However, part of the syndrome definition notes that there is often a preexisting condition that has enabled the infection to take root. The immune system has been rendered ineffective in this situation due to either comorbidities or other environmental factors that have taxed the body’s defense mechanisms.

Read the rest here.


Dr. Lovie wrote this article in reference to the growing number of Americans suffering from Long COVID, a modern manifestation of Gu syndrome affecting millions of people in the United States. According to the CDC, up to 17% of Americans reported having long-term COVID in the 2024 Household Pulse Survey.


At the height of the COVID-19 pandemic, I worked at a high-volume practice where I treated many acupuncture 'first-timers' for mysterious COVID-related symptoms. I vividly remember one young, fit, seemingly healthy woman in her late twenties who sat before me with a litany of symptoms. Her main concerns were new-onset palpitations and brain fog. I placed my fingers on her pulse and was shocked by how it skipped around beneath my fingers. Luckily, she was also under the care of a physician, who was monitoring her condition.

Another previously healthy young woman had become wheelchair-bound. She, too, experienced heart-beat irregularities, brain fog, orthostatic hypotension (Dizziness and fainting upon standing), and fatigue. Her doctors were at a loss; their only counsel was to avoid reinfection. She slowly improved over a year and a half under the care of a team of acupuncturists.


Less extreme examples include mild lingering coughs, fatigue, muscle aches and weakness, loss of smell, and strange neuropathies, most of which responded well to acupuncture treatment and herbs but required several months of treatment. Fortunately, research into the effectiveness of EAM in treating long COVID has begun. Thus far, most studies investigate Chinese herbal formulas:

click here for a recent review by An et al.

Below is an excerpt that summarizes a randomized controlled trial of an herbal formula called Sheng Mai Yin (replenish pulse pills):

The intervention measures were Shengmai oral liquid that contained ginseng, Ophiopogon japonicus, and Schisandra (Tongrentang (Beijing) Co., Ltd., Beijing, China; National Drug Approval No. Z11020372). The patients received 10 mL of the formulation three times a day for 2 weeks. The placebo group received a comforting agent following the same regimen. The cure standard was a symptom VAS score of zero after treatment. If the symptom VAS score decreased by 30% or more after treatment, the intervention was considered effective. Of the 200 patients, 192 completed the clinical observations. The results showed that the 2-week treatment with Shengmai oral liquid improved the chest tightness symptoms more than the placebo (75.00% vs. 55.56%, P < 0.05). The study also showed that Shengmai oral liquid effectively improved lung and heart function and the quality of life of patients recovering from COVID-19.


There are fewer studies available in English investigating the effects of acupuncture, but I've selected a section of one interesting retrospective study from Canada by Peng et al., that collected data on 85 patients.


General Information

Data was collected from 85 patients with post COVID-19 condition in Montreal at Acuenergie Acupuncture Clinic from June 2020 to December 2021. These 85 cases were divided into 4 categories according to the main symptoms. The number and percentage of clinical symptoms were shortness of breath and general fatigue (35 cases, 41%); body pain (26 cases, 31%); brain fog (17 cases, 20%); and irregular menstrual cycle (7 cases, 8%). The age of the patients ranged between 25 and 65, and the breakdown of case distribution according to age range was as such: age 25 to 35, 15 cases; age 36 to 45, 29 cases; age 46 to 55, 24 cases, and age 56 to 65, 17 cases. There were 37 cases of men and 48 cases of women. The average age was (44.54±10.39)

Treatment Methods

85 patients received acupuncture weekly for 8 to 12 consecutive weeks, to tonify lung and kidney qi and strengthen spleen and stomach qi. The acupuncture points used were on the meridians of the lung, kidney, spleen, stomach, bladder, Ren (Conception) and Du (Governing). The tonification technique was used for needling. Disposable sterile needles, size 0.25x25mm and 0.30x75mm were used.


Of the 85 patients, 72 cases were clinically cured, and 13 cases were ineffective. None of them were infected with Covid-19 a second time. The rate of overall effectiveness was 85%.


A scoping review by Ren et al., published in 2022, evaluated 131 studies that utilized acupuncture to treat acute and long-term COVID symptoms. Ninety-three percent of the studies were Chinese, and only four were from the United States. Here is a section discussing randomized controlled trials (considered the gold standard in research) and non-randomized experimental studies:

RCTs and nonrandomized studies of the effects of interventions (NRSIs)

There were six RCTs, three self-controlled trials and one non-randomized clinical trial included (Supplement 3), and they were all published by Chinese researchers. The intervention group used different ways of acupuncture and moxibustion, including Xizhiyanbing moxibustion,40 thunder fire moxibustion,41 thumb-tack needle,42 fiery dragon cupping comprehensive moxibustion,45 and filiform-fire needle,48 with or without other Chinese medicine and routine western medicine. And the control group received corresponding conventional treatment,3940,4344 TCM decoction41 and sham needle,42 etc. The outcomes these trials focused on were more about total clinical effective rate, TCM syndrome score, pulmonary function, clinical symptoms, as well as the depression and anxiety scores (Table 5). The results showed that acupuncture and moxibustion can improve the above outcomes of COVID-19 patients to some extent, but the findings were not always consistent.


The authors note the inconsistency of the findings. Acupuncture research is tricky; creating a 'one size fits all' protocol for a particular health condition is antithetical to the classical tenets of East Asian Medicine, which consider each person's unique needs. As a result, trials using a standard protocol might not reflect the true effects of acupuncture for a particular condition. We’ll talk about other issues in research, like the concept of ‘sham’ acupuncture, another time.


Although Chinese Medicine and acupuncture do not neatly fit into the "gold standard" research model, high-quality evidence is still needed to improve accessibility and integrate EAM into the current medical system. Luckily, we are beginning to catch up in acupuncture research! The Osher Center at the University of Washington is currently conducting an RCT on long COVID and acupuncture. One of the research aims of this study is to test the feasibility of acupuncture for long COVID using a whole-person approach! The tides are finally changing.


In the clinic, Gu is treated much like every other health condition—using a holistic approach to care. These pathogens make a home in the body by exploiting constitutional weaknesses exacerbated by lifestyle factors. Using Chinese Medicine, we can treat symptoms while slowly replenishing the body so the immune system can fulfill its role.

Until next time!




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