02 May Antiviral and immune support herbal, dietary and lifestyle strategies for prevention and treatment

I. Prevention stage:

Creating a hostile biological environment for virus survival and spreading at the point of infection in the nasopharynx:

The efficacy of this approach is believed to be dependent upon initiating treatment at a very early stage of the infection process, ideally as close as possible to the time when virus replication begins. (1) Gargle and nasal irrigations with warm salty water (1/2 tsp salt in 1/2 glass of water) each time you come back home or morning and evening if you stay in, as virus initially lodges in the nasal passageways, where the air is cooler.

You can also gargle with Hydrogen peroxide 1% (food grade), since viruses is vulnerable to oxidation (2), (3). Drinking warm teas constantly helps the virus descend to your stomach where the acid destroys it. Green and black tea contain flavonoids that directly inhibit coronavirus protease activity, resulting in decreased virus propagation (4). Saunas can likely reach temperatures capable of killing Coronavirus (56 degrees Celsius (132 degrees F for 25 minutes), but are not a cure for Covid-19 if one is already infected and the disease progressed to cellular level.

Support cellular and body health with diet and supplements. Adopt low-carbohydrate diets (hyperglycemia targets immune suppression), coenzyme Q-10, lipoic acid, and acetyl-L-carnitine to support mithochondria (energy production units of your cells). Mild exercise and proper rest also supports mitochondria, as well as adopting strategies to decrease total overall bacterial load through colon and liver cleanses (less work for your system).

(5) Immuno-nutrition – Poor nutrition has long been associated with increased susceptibility to infectious disease. Avoid low nutrient high calories food such as processed foods, prefer protein and vegetables because they are high in mineral and vitamins content. Tend to your digestive fires: consume warm cooked foods, your digestive system needs “fire” to fuel your metabolic system (soups, cooked vegetables, fermented foods, nothing from refrigerator, garlic, ginger). Strengthen the microbiome: consume probiotics. Study on efficacy of probiotics in preventing infectious respiratory diseases (6). Boost immune system: vitamin C (intravenous best as revealed by Chinese teams, liposomal form second best) (7) (8), glutamine, whey protein isolate, vitamin A, vitamin D, fish oil, and zinc (5).
Infrared saunas: Infrared saunas increase your white blood cell count. Studies have shown near-infrared light activates white blood cells and boosts antibodies against pathogens (9). Infrared saunas amp up core body temperature, which helps to keep your immune system healthy and in good working order. When your body fights off an infection like the flu, your immune system will naturally peak your temperature. It’s usually anywhere from 100.9°F or higher, which is considered a fever. This temperature increase in the body creates a less suitable environment for viruses. Infrared saunas work a lot like how a natural fever does in the body. The infrared heat penetrates works deep in the tissues after penetrating our skin, pushing up core body temperature to around 102°F (39°C). Your body responds to this constructed “fever” by stepping up its immune response and mobilizing the Th1 branch of the immune system. This part of the immune system antiviral and antibacterial. In the infrared sauna, “Heat shock proteins” are produced, which helps your body do a better job of creating proteins for healing and staying healthy. Research has shown that heat shock proteins also improve the function of the immune system (10).
Immune strengthening/ antiviral Chinese herbal formula: The Medical Treatment Unit of Wuhan’s Novel Coronavirus (2019-nCoV), Prevention and Control Headquarters issued a “Notice Regarding the Agreement to Recommend the Use of Chinese Medicine in the Treatment of Pneumonia due to Infection from the Novel Coronavirus”. The “Notice” emphasizes that all designated medical institutions in Wuhan will ensure that all infected patients take Chinese medicine (11). At preventative stage, they recommend Pneumonia Prevention #1 肺炎预防1号. This formula contains immune strengthening herbs and antiviral herbs. In my opinion it is important to take this formula to address the virus in the incipient stages and build immunity. Pneumonia Prevention #1 肺炎预防1号:
Huang Qi 黄芪 (Radix Astragali) 15g
Bai Zhu 炒白术 (Rhizoma Atractylodis Macrocephalae), dry fried 10g
Fang Feng 防风 (Radix Saposhnikoviae) 10g
Mian Ma Guan Zhong 贯众 (Rhizoma Dryopteridis Crassirhizomatis) 10g
Jin Yin Hua 金银花 (Flos Lonicerae Japonicae) 10g
Chen Pi 陈皮 (Pericarpium Citri Reticulatae) 6g
Pei Lan佩兰(Herba Eupatorii) 10g
II. Influenza Phase
A. Nutrition/ supplements
In 2009 dr. Alex Vasquez (5) proposed a multifaceted antiviral strategy to defeat viruses infections consisting in 4 aspects, all diet, lifestyle and supplements based. I will summarize the magic bullets of each:
1. Targeting the virus directly: zinc, vitamin A and D (get sunlight), selenium, anti-viral herbs like licorice. (5)
2. Blocking viral replication: N-Acetyl-L-Cysteine plus vitamin C (5) (powerful antioxidants – as inflammation and oxidant stress enhances viral replication, so antioxidants are needed). High doses of vitamin C (12,000 to 24,000 mg/day of vitamin C by IV) also prevent virus replication (8). Flavonoids: the activity of coronavirus proteases is a key factor in coronaviruses’ ability to propagate in cells. Flavonoids directly inhibit coronavirus protease activity, resulting in decreased virus propagation (4). The flavonoids with the highest virus inhibitory power appear to be herbacetin, isobavachalcone, quercetin 3‐β‐d‐glucoside, and helichrysetin.
The highest total flavonoids content is found in onion leaves (1497.5 mg/kg quercetin, 391.0 mg/kg luteolin, and 832.0 mg/kg kaempferol), followed by Semambu leaves (2041.0 mg/kg), bird chili (1663.0 mg/kg), black tea (1491.0 mg/kg), papaya shoots (1264.0 mg/kg), and guava (1128.5 mg/kg). The major flavonoid in these plant extracts is quercetin, followed by myricetin and kaempferol. Luteolin could be detected only in broccoli (74.5 mg/kg dry weight), green chili (33.0 mg/kg), bird chili (1035.0 mg/kg), onion leaves (391.0 mg/kg), belimbi fruit (202.0 mg/kg), belimbi leaves (464.5 mg/kg), French bean (11.0 mg/kg), carrot (37.5 mg/kg), white radish (9.0 mg/kg), local celery (80.5 mg/kg), limau purut leaves (30.5 mg/kg), and dried asam gelugur (107.5 mg/kg). Apigenin was found only in Chinese cabbage (187.0 mg/kg), bell pepper (272.0 mg/kg), garlic (217.0 mg/kg), belimbi fruit (458.0 mg/kg), French peas (176.0 mg/kg), snake gourd (42.4 mg/kg), guava (579.0 mg/kg), wolfberry leaves (547.0 mg/kg), local celery (338.5 mg/kg). (12)

3. Immunonutrition – see Preventative stage above.

4. Supporting cellular and whole-body health – see Preventative stage above. Dr. Vasquez writes (5): “ Viral infections have numerous adverse effects on cellular and whole-body health. Intracellular consequences of viral infections include mitochondrial dysfunction and endoplasmic reticulum stress , manifesting clinically as prolonged inflammation, fatigue and – likely – in the case of herpes simplex infections, Alzheimer’s disease. “

B. Chinese Herbal Medicine Approach
Chinese medicine has been frequently used as an adjunct therapy to treat SARS patients, as evidenced by a Cochrane systematic review that concluded Chinese Medicine as an adjunct therapy “may improve symptoms, quality of life and absorption of pulmonary infiltration, and decrease the corticosteroid dosage for SARS patients” (14).
This stage can be differentiated in 3 patterns, each with different antiviral herbs prescriptions (11).
For Wind-Cold Invading the Exterior 风寒袭表证 (Symptoms: onset of fever – mostly low-grade fever – aversion to cold and fear of cold, chills, headache, ticklish throat, soreness of muscles of limbs, no sweat or night sweats) use Ge Gen Tang (Kudzu Decoction) or Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Release the Muscle Layer).
For Toxic Heat Attacking the Lung 热毒袭肺证 (Symptoms: Fever, aversion to cold, sore and dry throat, dry cough, scanty sputum, sore and painful muscles in the limbs, weakness, headache, CT scan reveals both lungs to have scattered ground-glass opacity (GGO). Tip and sides of the tongue are red; thin white or yellow tongue coating. Floating and rapid pulse) use Expel Wind, Release the Exterior; Clear Heat, Detoxify Herbal Formulas: (Yin Qiao San (Honeysuckle and Forsythia Powder) and Qing Wen Bai Du San (Clear Epidemics and Overcome Pathogenic Influences Powder).
For Damp Cold in the Lung 濕寒鬱肺 (Symptoms: Aversion to cold, fever or absence of fever, dry cough, dry throat, fatigue, weakness, chest stuffiness, epigastric distention, nausea, diarrhea. Pale tongue, white greasy coating, slippery pulse.) Expel Wind, Release the Exterior; Dispel Damp Cold use Damp Cold Formula #1 listed here.
C. Supportive measures
• If cough is present: Humidification and drinking lots of fluids helps to moisten and loosen up sticky mucus. Humidification of the air you breathe (use vaporizer, pans of evaporating water, or steaming tub or shower) and lots of fluids help. You can use a steamer/ inhaler like Mypuremist etc.
• If throat is sore: Gargle with warm water (1/2 tsp salt in 1/2 glass of water). Pine tree resin and other terpenes posses antiviral properties (8).
• If temperature is elevated: fluids are even more important. Persistent temperature elevation of 103-104 degrees can create severe dehydration and other negative consequences.
• If nausea and/or diarrhea are present: drink/ eat only clear liquids, soups, or juices as tolerated. Fluids are important to prevent dehydration.
D. Other antiviral herbs proven to exhibit inhibitory activity against SARS-coronavirus:
1. Licorice root. Glycyrrhizin, an active constituent of licorice roots, has been shown to exhibit potent inhibitory activity against SARS-coronavirus replication. Glycyrrhizin appears to be more effective during the early stages of coronavirus replication (3).
2. Cinnamon (16).
3. Other antiviral Chinese medicine formulas. Chinese medicine has been frequently used as an adjunct therapy to treat SARS patients, as evidenced by a Cochrane systematic review that concluded Chinese Medicine as an adjunct therapy “may improve symptoms, quality of life and absorption of pulmonary infiltration, and decrease the corticosteroid dosage for SARS patients” (6). Another study has also proposed Shu Feng Jie Du Capsules and Lian hua qing wen Capsule as a potentially effective treatment for 2019 novel coronavirus, considering previous studies demonstrating their ability to both treat and prevent respiratory infectious viruses (17).

III. Pneumonia stage
Large doses of vitamin C “Increased oxidative stress, an underlying “cytokine storm,” leads to ARDS which is the key pathology of high mortality of these pandemic viral infections. Cytokine storm-induced ARDS is the key pathology leading to death of these patients [2]. Intravenous vitamin C effectively counters oxidative stress.” “Early and sufficiently large doses of intravenous vitamin C are critical. Vitamin C is not only a prototypical antioxidant, but also involved in virus killing and prevention of viral replication. The significance of large dose intravenous vitamin C is not just at antiviral level. It is acute respiratory distress syndrome (ARDS) that kills most people from coronaviral pandemics (SARS, MERS and now NCP). ARDS is a common final pathway leading to death.” (8).
Chinese herbal formulas
The various patterns of clinical manifestations and the herbal formulations are discussed in detail here.

3. From Hippocrates times, doctors used Inhalations with different herbs and medicinals to treat pneumonia. At the beginning of 20th century studies with substances such as licorice, iodine etc. have been published. While the safety of these methods is still poorly understood in the modern times, there is historical evidence of a certain rate of success for some influenza viruses:
https://digitalcommons.unmc.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1270&context=mdtheses

In modern times, Acetylcysteine inhalation is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions such in pneumonia. (https://www.drugs.com/pro/acetylcysteine-inhalation.html)

IV. Recovery stage
In the recovery stage, there is absence of fever, dry cough, chest stuffiness, shortness of breath, shortness of breath upon exertion, dry mouth, weakness. CT reveals inflammation begins to subside as well as pulmonary interstitial changes. Pale red tongue, thick or greasy coating, thread, rapid pulse. (11)
Treatment Strategy: Tonify Qi, Nourish Yin, Tonify Lung and Open the Collaterals
Herbal Formula: 沙参麦门冬汤(Sha Shen Mai Dong Tang (Glehnia and Ophiopogonis Decoction) (11).

Citations:
Hull D, Rennie P, Noronha A, et al. Effects of creating a non-specific, virus-hostile environment in the nasopharynx on symptoms and duration of common cold. Acta Otorhinolaryngol Ital. 2007;27(2):73–77.
Mentel’ R, Shirrmakher R, Kevich A, Dreĭzin RS, Shmidt I. [Virus inactivation by hydrogen peroxide]. Vopr Virusol. 1977 Nov-Dec;(6):731-3.
https://www.nature.com/articles/s41368-020-0075-9
Jo, S., Kim, H., Kim, S., Shin, D. H., & Kim, M. S. (2019). Characteristics of flavonoids as potent MERS-CoV 3C-like protease inhibitors. Chemical biology & drug design, 94(6), 2023-2030. https://doi.org/10.1111/cbdd.13604
Vasquez, Alex. The Proof is in the Panic: We Need a New Strategy against Viral Infections. Wednesday, December 10th 2014. https://www.greenmedinfo.com/blog/proof-panic-we-need-new-strategy-against-viral-infections
Fabrizio Pregliasco, Giovanni Anselmi, Luigi Fonte, Francesca Giussani, Stefano Schieppati, Lidia Soletti. A new chance of preventing winter diseases by the administration of synbiotic formulations. Carcinogenesis. 2008 May;29(5):1049-56. Epub 2008 Mar 20. PMID: 18685511
Saul, Andrew and Atsuo Yanagisawa, MD, PhD. Hospital-based Intravenous Vitamin C Treatment for Coronavirus and Related Illnesses. http://www.doctoryourself.com/Coronavirus_Chinese_IV_C_Protocol.pdf
Richard Z Cheng, MD, PhD; Hanping Shi, MD, PhD; Atsuo Yanagisawa, MD, PhD; Thomas Levy, MD, JD; Andrew Saul, PhD. Early Large Dose Intravenous Vitamin C is the Treatment of Choice for 2019-nCov Pneumonia. Orthomolecular Medicine News Service, Feb 16, 2020. http://orthomolecular.org/resources/omns/v16n11.shtml
Pilch W, Pokora I, Szyguła Z, Pałka T, Pilch P, Cisoń T, Malik L, Wiecha S. Effect of a single finnish sauna session on white blood cell profile and cortisol levels in athletes and non-athletes. J Hum Kinet. 2013 Dec 31;39:127-35. doi: 10.2478/hukin-2013-0075. PMID: 24511348; PMCID: PMC3916915.
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Image copyright © 2014 Vasquez A. Antiviral Nutrition.

International College of Human Nutrition and Functional Medicine,

2014. https://www.amazon.com/dp/B00OPDQG4W

Disclaimer: This article represents the result of my research and own clinical experience with respiratory infections in general. It has an informative nature and it is not meant to treat Coronavirus infection. Please consult your doctor before adopting any of these strategies. This article is meant to reveal some of the existing studies on diet and supplements, along with recent experiences of the Chinese doctors in treating COV-19 infection by using herbs, dietary supplements and lifestyle recommendations. I will not discuss here the exogenic/ endogenic balance in this respiratory infection and the statistics clearly suggest that the terrain of the patient matter (18). I will limit myself to the strategies I think can be helpful in the limiting the epidemic and increase the therapeutic success. Ultimately, increasing the ability of the body to fight disease is the main part of the solution to any health crisis, including a viral epidemic.]