Around this time last year, I posted a blog about some self care products to make at home for managing infections. A sore throat spray, a sinus inhalation and so on. Now we are one year deeper into this pandemic and beginning to understand it quite a bit better. Those self care agents are great, but may not always be enough. My blog today outlines a more aggressive stance towards this virus in the expectation that we are all likely to be exposed to it, maybe many times over the next many years. Just like the flu, we need to have a good plan for resilience and resistance, as well as a properly stocked toolkit for coping with an acute infectious episode.
In the case of an acute viral infection, there are several logical and sequential steps to be taken in determining the treatment plan. The first and most urgent action is to block viral replication, followed by modulation of the immune response in order to sustain an antiviral effect without damaging levels of inflammation. Thirdly, to treat the damage done to organs or tissues by the virus, and last but not least to address lingering post viral symptoms, which may be more or less severe and of varying duration.
If you encounter a virus that penetrates your primary defences of mucus, coughing, sneezing, cilia etc, the virus will soon activate the innate immune system of the body – the neutrophils and macrophages that represent the first responders to infection. In response to this, the body will release a host of chemicals that induce and support the immune system to deal with this pathogen. These may include factors that raise the core body temperature and bring about a fever, as well as chemotaxis substances that bring white cells to the affected area, and cytokines that activate and stimulate immune cell activity to ensure that the virus is neutralized.
In addressing an acute viral infection, diaphoretic herbs are used to encourage the fever and to promote the perspiration required to cool the body as well. The immune system responses and the cytokine release is upregulated by these heating and stimulating herbs, but the perspiration allows the release or purging of the heat through the skin, cooling the body so that safety is maintained at all times.
*Diaphoretic tea to drink freely in the first few days of an infection
A 1″ knob of fresh ginger, chopped anded to a pot with 1 L boiling water with the lid on for 10 minutes.
Remove pot from heat and add 10 g each of: boneset, elderflower, yarrow flower, catnip, peppermint, cinnamon – steep at least 10 minutes.
Another way to increase core body temperature is through the use of hot baths, Hot tubs or saunas and if none of those are available, then a mustard foot bath will also work. Make your foot bath by adding two to four tablespoons of yellow mustard powder into two or three litres of warm water or enough water to cover both feet in a small basin or bucket.
Blocking viral replication
The antiparasitic and antiviral drug, Ivermectin is showing great promise in blocking viral replication. It’s being used with good results in acute viral infections at higher doses and in post viral lingering symptoms in a lower dose, or sometimes a pulsed dose over a stretch of time (one week on and one week off). The research in Covid is controversial, but the drug has a long history of safe use in humans and may be a useful part of a treatment plan although not sufficient on its alone. Research published in November 2021 suggests that Ivermectin works best in populations with endemic parasitic infections and may be effective by killing parasites that are degrading immune resilience.
Herbalists look to the classic antivirals such as chaparral, black walnut, taheebo or pau d’arco, garlic, andrographis, thyme, oregano, echinacea, Oregon grape, Chinese wormwood and goldenseal.
These are all herbs which would be considered effectors or pathological correctors, and would generally be used for a short period of time, typically one week to one month, and they may have quite specific dosing or contraindications. You can combine more than one, and it is often worth considering prescribing them in a standalone bottle to be taken in the pulse dose, separate from any other part of the treatment plan.
A typical formula might be
- Taheebo / pau d’arco 30 ml
- Licorice 15 ml
- Oregon grape 10 ml
- Garlic 10 ml
- Thyme 10 ml
- Oregano 10 ml
Black walnut 5 ml - Andrographis 5 ml
- Chinese wormwood 5 ml
100 mL per week – dosed at 3 mL four times daily in a hot cinnamon and ginger decoction, and add honey if needed for flavour.
If the virus crosses the blood brain barrier and induces neural inflammation, then St. Johns wort (Hypericum perforatum) is particularly interesting for its nerve repair qualities and its antiviral effect. This is also interesting in light of new research showing Prozac and related SSRI drugs being somewhat effective in COVID-19 as well.
One of the most useful agents to prevent viral replication is zinc, especially zinc sulphate. It should be taken in doses of 15 to 20 milligrams three to four times daily, and never on an empty stomach because it can make you very nauseous if you do. In order to get the zinc into the virus more efficiently, it should be combined with quercitin and green tea.
Another agent that acts has zinc ionophore activity that induces cellular zinc uptake is the anti-malarial drug, hydroxychloroquine. This is one reason why it has been investigated for anti-viral activity as well, but the results are equivocal.
Inhalation and essential oils
To deliver anti-microbial herbs deep into the lungs, the best means is with a steam inhalation of volatile oils. Make an essential oils blend with
- 2 mL eucalyptus
- 1 mL tea tree
- 1 mL lavender
- 1 mL pine/fir/spruce
To use:
20 drops for humidifier or for a pan of water on a wood stove
10 drops for a cotton pad, Kleenex or piece of cloth to wear in top pocket of shirt
6 drops for a steam inhalation (basin, hot water & towel over your head)
2 – 3 drops on a face mask
TCM self care
I am not a Traditional Chinese Medicine practitioner and do not provide custom TCM formulas based on constitutions and energetics. But TCM also contain lots of popular proprietary formulas that are used for quick fix or self care. These may be found in granule form at Chinese medicine stores or may be prescribed in a decoction by a TCM practitioner.
One which has shown promise in reducing severity of acute viral infection is called Pu Ji Xiao Du Wan (which translates as Universal Benefit Decoction To Eliminate Toxins). It is used for draining toxic heat in acute febrile conditions with respiratory symptoms, lymph node enlargement and viral infections.
Herbs in it are Lian Qiao (Forsythia Fruit), Jie Geng (Platycodon Root), Huang Qin (Chinese Skullcap Root), Chai Hu (Bupleurum Root), Xuan Shen (Scrophularia Root), Ban Lan Gen (Isatis Root), Niu Bang Zi (Burdock Fruit), Ma Bo (Puffball mushroom), Bo He (Chinese Mint), Huang Lian (Coptis Rhizome), Sheng Ma (Chinese Cimicifuga Rhizome), Chen Pi (Tangerine Peel), Gan Cao (Licorice Root), Jiang Can (White Silkworm).
Two formulas that have been approved in China for treatment of acute Covid 19 infection include:
Lian-Hua-Qing-Wen Capsule (first approved as a new Chinese Patent Medicine (CPM) during the SARS epidemics in 2003), and Jin-Hua-Qing-Gan Granule that (first approved to treat H1N1 influenza virus infection in 2009). Lian-Hua-Qing-Wen is made from of Forsythia flowers, honeysuckle flowers, honey-fried Ephedra, Siberian cherry, Gypsum, Woad, Crown Lady fern, Fish mint, patchouli, Chinese rhubarb, Rhodiola , Canadian field mint and licorice.
The second option is Jin-Hua-Qing-Gan Granule, which is comprised of Forsythia flowers, honeysuckle flowers, honey-fried Ephedra, Siberian cherry, Gypsum , l-Menthol, licorice, baical skullcap, Fritillaria bulbs (Zhe Bei Mu), asphodel (Zhi mu), Burdock and Chinese wormwood.
What to do if you start to get sick
As the first signs of illness start (or before that if you have a known exposure)
Have a hot bath to bring up your fever and sweat it out. Fever is a sign of a robust immune system and can be encouraged within safe parameters (max. 103 in adults, 101 in children).
*Drink hot Cold and Flu Diaphoretic Tea 3-4 times daily
Take the herbal anti-viral formula dosed at 5 mL four times daily in hot water
And take:
Andrographis herb dosed at 2 x 500 mg caps four times daily.
Echinacea dosed at 2 x 500 mg caps four times daily.
Vitamin C to bowel tolerance
Vitamin D3 at 10,000 daily and 50,000 iu daily for up to a week if acutely sick
Probiotics with each meal
Use essential oils steam inhalation daily
Modulating the immune responses
One of the challenges in treating acute viral infections is they tend to cause overactivity of the immune responses and there can be a lot of inflammatory damage and debris as a consequence. There has been some concern around the question of inducing a cytokine storm with herbs, meaning a runaway immune system that causes substantial tissue damage, although this has actually not been seen in practice.
What is more likely to happen in herbal medicine is a modulation or a balancing of the immune functions such that there is appropriate progression through the steps and stages of the inflammatory process. It does in fact reach resolution and cease to be symptomatic so that chronic inflammatory disease is averted. In this way the herbs act as immune response modulators.
Those cytokines need to be downregulated when they have done sufficient work, and the immune modulating effects of herbs can be particularly beneficial in this instance. For example, turmeric is safe to use for inflammations that are acute and rapidly damaging, as well as for low, slow, lingering, chronic infections that need to be promoted through to resolution.
Pharmaceutical drugs that may be used to modulate the immune responses include the steroids that have shown some promise in treating COVID, but which have severe and profound side effects that may be incompatible with continued use. Newer biological drugs or immuno therapies that are so promising in cancer are also now being investigated and applied for covered infection. So far they are looking very promising, but they continue to be experimental and not widely available and it remains to be seen if there benefits continue to outweigh their risks.
Another drug that functional medicine doctors are prescribing in this context is low dose naltrexone, an opioid antagonist with a paradoxical analgesic effect in very low doses and which is commonly used to common control inflammatory pathways and pain in the body. This is widely prescribed by naturopaths in cancer care and has a high safety profile.
Inflammation mediating herbs
These can be introduced during the acute phase and continued for two to four weeks at least after fevers have abated.
Turmeric – 2 – 4 tsp. daily of powdered root
Licorice (avoid in hypertension)
Bupluerum (chai hu)
Ginger
Boswellia
Immune-modulating herbs
These can be taken for weeks or months after an infection and can really just become part of the diet thereafter.
Astragalus – take up to 20 g daily in soups or decoctions
Medicinal mushrooms – turkey tails, chaga, reishi, shiitake, maitake – take as much as you can in the diet, at least a few times a week, always cooked long and slow with water and oil (e.g. in a soup) for maximum availability of active constituents.
Add the treating the sequelae of infection
Postviral syndrome is not a new phenomenon and has been well recognized in the literature as a contributing factor to chronic fatigue syndrome. In the case of COVID-19 infections, the long term effects may include profound fatigue, neurological symptoms like brain fog or poor concentration, dizziness and disorientation, as well as cardiovascular symptoms like clotting disorders and bleeding disorders, cardiomyositis (inflammation of the heart muscle) and cardiomyopathy (damage to the heart muscle), and even profound and prolonged lung and kidney damage with functional impairment.
The virus enters the body by binding to ACE2 receptors in the lung, but these are also found in many other tissues of the body, especially including the endothelial lining of blood vessels. In some organs like lung and kidney, where the blood vessels are very densely allocated and exceptionally small, any inflammation as a consequence of viral binding in the vessel can result in catastrophic inflammatory response that may inhibit circulation and cause tissue damage.
While inhibiting inflammation is the first clinical focus, repair of tissue damage and restoration of function are also necessary to achieve resolution and healing. In the postviral phase of treatment, after acute symptoms have abated, anti inflammatory herbs, tissue trophorestorative or rebuilding herbs, tissue specific directing herbs, and nutritive herbs are all indicated.
Cardiovascular Tonics and Restoratives
Stabilizes and regulates cardiac function (rate and force)
Hawthorn berry, leaf and flower
Linden flower
Arjuna
Acetyl l carnitine
CoQ10
tonic / repair for veins
Blueberry leaf
Butchers broom
Horse chestnut
Promotes microcirculation
Yarrow leaf and flower
Ginkgo
Vasodilating
Magnesium citrate/glycinate
Linden flower
Blood thinning
Vitamin e (tocopherols and tocotrienols)
Ginkgo
Turmeric
Garlic
Ginger
Fish oils
Lumbrokinase if there is stasis or clotting
Brain Boosting
Ginkgo
Gotu kola
Holy basil
Rosemary
Periwinkle
Kidney Restoratives
Horsetail
Nettle seed
Pellitory of the wall
Parsley piert
Corn silk
Lung Tonics
Pleurisy root
Licorice
Horsetail
Plantain
N-Acetyl-Cysteine (especially in a nebulizer for deepest delivery)
Adaptogens and energy tonics
Licorice
Ashwagandha
Eleuthero
Rhodiola
Holy basil
American ginseng
Codonopsis
Deep Immune soup
Take 1 – 2 cups almost every day as a preventative
Use any or all of the following dried herbs in a strong decoction (simmered tea) added to a soup base
- 100 g dried mushrooms (reishi, turkey tails)
- 100 g dried astragalus root (milk vetch)
- 100 g dried taheebo bark (pau d’arco)
- 100 g elderberries
- 100 g schizandra fruit
Mix well together
Take ¼ cup of herb mix per 3 L water, cover with a tight lid, bring to a boil, turn down heat and simmer on very low for 30 minutes. Use this liquid in your soup or drink ½ cup twice daily for immune boosting. Also put the simmered herbs into a clean cloth bag or tied off in a sock and floated in the cooking soup where oils can act as further solvent.
Immune Restorative Formula for building resistance (for next 3 months)
Dosed at 5 mL (1 tsp.) twice daily in hot water (can be allowed to cool before drinking)
20 mL Sambucus nigra fruc.(elderberry) – immune stimulant
10 mL Asclepias tuberosa (pleurisy root) – respiratory tonic
15 mL Mahonia aquifolium (Oregon grape) – anti-viral, cilia protection, immuno-modulating
15 mL Salvia miltiorrhiza (red sage) – immune normalizing
10 mL Glycyrrhiza glabra (licorice root) – anti-viral, lung soothing and expectorant, anti-inflammatory
10 mL Eleutherococcus sent. (eleuthero) – Immune support
5 mL Cinnamonum zeylanica (cinnamon) – warming, anti-microbial
5 mL Rhodiola rosea (Arctic rose) – adaptogen, anti-viral
5 mL Pimpinella anisum (anise) – warming, moistening lung tonic
5 mL Hyssopus off. (hyssop) – warming, relaxing anti-microbial
Diet, Covid and the Microbiome
A study recently published in the Nutrients Journal has found that ingesting probiotics and building a healthy and well balanced gut flora profile (microbiome) is a “helpful instrument for immunomodulation” both in acute care and in prevention. Researchers suggest that probiotics may inhibit the ACE2 receptor where the viral protein usually docks with a cell, and may also be effective in suppressing the immune response caused by the proinflammatory cytokine cascade delivered by white blood cells.
Take home message
To further support immune functions the following supplements have been validated through clinical research as being especially helpful:
omega-3 fatty acids 2–4 g/day (1 – 1.5 mg EPA and approx. 1/3 of that in DHA)
selenium 300–450 μg/day
zinc 30–50 mg/day
vitamin A 900–700 µg/day
vitamin E 135 mg/day
vitamin D 10,000 / day higher if acutely sick, up to 50,000 for a few days caution in people with kidney stones)
vitamin C 1–2 g/day or to bowel tolerance
vitamin B6, and B12
A moderate diet with 1500 to 2000 calories daily and between 75 and 100 grams of protein is also recommended.
references
Patient Nutrition and Probiotic Therapy in COVID-19: What Do We Know in 2021?. Nutrients, 13(10), 3385. Hawryłkowicz, V. et al. https://doi.org/10.3390/nu13103385
Abstract
Background: The main nutritional consequences of COVID-19 include reduced food intake, hypercatabolism, and rapid muscle wasting. Some studies showed that malnutrition is a significant problem among patients hospitalized due to COVID-19 infection, and the outcome of patients with SARS-CoV-2 is strongly associated with their nutritional status. The purpose of this study was to collect useful information about the possible elements of nutritional and probiotic therapy in patients infected with the SARS-CoV-2 virus. Methods: A narrative review of the literature, including studies published up to 13 September 2021. Results: Probiotics may support patients by inhibiting the ACE2 receptor, i.e., the passage of the virus into the cell, and may also be effective in suppressing the immune response caused by the proinflammatory cytokine cascade. In patients’ diet, it is crucial to ensure an adequate intake of micronutrients, such as omega-3 fatty acids (at 2–4 g/d), selenium (300–450 μg/d) and zinc (30–50 mg/d), and vitamins A (900–700 µg/d), E (135 mg/d), D (20,000–50,000 IU), C (1–2 g/d), B6, and B12. Moreover, the daily calorie intake should amount to ≥1500–2000 with 75–100 g of protein. Conclusion: In conclusion, the treatment of gut dysbiosis involving an adequate intake of prebiotic dietary fiber and probiotics could turn out to be an immensely helpful instrument for immunomodulation, both in COVID-19 patients and prophylactically in individuals with no history of infection
Does Evidence Exist to Blunt Inflammatory Response by Nutraceutical Supplementation during COVID-19 Pandemic? An Overview of Systematic Reviews of Vitamin D, Vitamin C, Melatonin, and Zinc, Nutrients 2021, 13, 1261. Salvatore Corrao
https://doi.org/10.3390/nu13041261
Abstract
More than one year has passed since the first cases of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome (SARS)-CoV-2 coronavirus were reported inWuhan (China), rapidly evolving into a global pandemic. This infectious disease has become a major public health challenge in the world. Unfortunately, to date, no specific antivirals have been proven to be effective against COVID-19, and although a few vaccines are available, the mortality rate is not decreasing but is still increasing. One therapeutic strategy has been focused on infection prevention and control measures. In this regard, the use of nutraceutical supports may play a role against some aspect of the infection, particularly the inflammatory state and the immune system function of patients, thus representing a strategy to control the worst outcomes of this pandemic.
For this reason, we performed an overview including meta-analyses and systematic reviews to assess the association among melatonin, vitamin C, vitamin D, zinc supplementation and inflammatory markers using three databases, namely, MEDLINE, PubMed Central and the Cochrane Library of Systematic Reviews. According to the evidence available, an intake of 50,000 IU/month of vitamin D showed efficacy in CRP. An amount of 1 to 2 g per day of vitamin C demonstrated efficacy both in CRP and endothelial function, and a dosage of melatonin ranging from 5 to 25 mg /day showed good evidence of efficacy in CRP, TNF and IL6. A dose of 50 mg/day of elemental zinc supplementation showed positive results in CRP. Based on the data reported in this review, the public health system could consider whether it is possible to supplement the current limited preventive measures through targeted nutraceutical large-scale administration.
Zinc Ionophore Activity of Quercetin and Epigallocatechin-gallate: From Hepa 1-6 Cells to a Liposome Model
J. Agric. Food Chem. 2014, 62, 32, 8085–8093, July 22, 2014. Husam Dabbagh-Bazarbachi et al.
https://doi.org/10.1021/jf5014633
Zinc sulfate in combination with a zinc ionophore may improve outcomes in hospitalized COVID-19 patients. J Med Microbiol. 2020 Oct;69(10):1228-1234. Carlucci PM et al
Chloroquine Is a Zinc Ionophore, PLoS One. 2014; 9(10): e109180. Published online 2014 Oct 1. doi: 10.1371/journal.pone.0109180 Jing Xue et al
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Anti-inflammatory and Antimicrobial Effects of Heat-Clearing Chinese Herbs: A Current Review. Journal of traditional and complementary medicine, 4(2), 93–98. Muluye, R. A., Bian, Y., & Alemu, P. N. (2014).
Broad Anti-Viral Capacities of Lian-Hua-Qing-Wen Capsule and Jin-Hua-Qing-Gan Granule and Rational use Against COVID-19 Based on Literature Mining. Frontiers in pharmacology, 12, 640782. Shi, M., Penget al (2021).