Synopsis: Can herbal medicine be used either as an adjuvant therapy to help build resistance to COVID-19 or as a direct treatment of the infections symptomology?
Numerous communities world-wide that are not well served by our current medical system, either by lack of insurance or limited access to medical facilities, have relied on herbal treatments to help limit the likelihood of contracting COVID-19 or to self-treat. It is incumbent on us to provide an accurate narrative about which herbal treatment are potential efficacious and safe to use.
A plethora of studies and numerous scientific reviews, including some by the World Health Organization (WHO), conclude that those hospital workers in SARS-treatment hospitals taking herbs had a reduced risk of contracting SARS and that patients receiving integrated Western and traditional Chinese treatment showed better therapeutic outcomes than when taking Western therapies alone. Numerous studies provide mechanistic evidence as to why the botanicals chosen are beneficial, including a reduction in viral invasion and viral replication, modulation of immune responses in the event of an invasion, reduction of inflammation, assistance in reducing phlegm and restoration of breathing, and aid in recovery.
Our effort in this project is to characterize the strongest evidence for use of medicinal plants within the context of three strategic models for COVID-19 treatment.
- Develop models for building resilience using herbal formula derived from western herbal traditions of adaptogens and trophorestoratives, as well as tonics (from Traditional Chinese Medicine) and rasayanas (from Ayurvedic Medicine) used to rebuild vital force and the functioning capacity of physiologic systems worn down from long-term exposure to stress.
- A model for prophylactic use of herbal medicine to specifically prime the immune system. In the case of COVID-19, that may mean also looking for herbs that will quiet inflammatory responses found during the cytokine storm.
- A model for creating a series of herbal formula in response to the varied stages of COVID-19 symptom etiology.
Academics and practitioners in the field of integrative health have struggled to agree on a single definition of resilience. For the purposes of this narrative resilience allows humans to sustainably pursue the functions and purposes of life in the face of stress; to recover from adversity; to adapt and adjust in maintaining health, well-being, disease prevention and vital life force.
The “trophic state” is representative of the vital capacity of a system or tissue in the body. In chronic states of irritation or depression some degree of vital deficiency will manifest in the affected tissue, with a gradual loss of functional capability. Long-term tonics with few side-effects, trophorestoratives are used to restore normal function.
Herbal adaptogens limit the toll of stress, physical, mental and emotional and physiological, by regulating HPA axis, which secrets glucocorticoids that redirects energy supply of multiple organ systems to meet demand; the SAS (sympathoadrenal system) function that is critical to regulating the thermogenic responses to cold and dietary intake; the cortisol-induced mitochondrial dysfunction link between psychosocial stressors, emotional states, the resulting neuroendocrine and immune processes, and mitochondrial energetics; the neuropeptide Y that regulates energy resources through appetite stimulant, antithermogenic, and insulin secretory actions.
Both Ayurveda and Traditional Chinese Medicine (TCM) are well developed healing systems that share clinical strategies for the use of herbs in support of resilience. The Rasayanas (Ayurveda) act as nootropics, antioxidants, adaptogens and neurotransmitters regulators, while TCM herbal tonics are used prophylactically, to treatment acute ailments and build strength when recovering from an illness by restoring balance qi and energy systems of the body.
Priming the Immune System with Herbal Medicine
Research to understand the specific mechanisms of COVID-19 is incomplete. This list of botanicals provides a quick review of known anti-viral herbal supplements that may be candidates for treatment.
Phase 2-inductive nutraceuticals – such as ferulic acid, lipoic acid, or sulforaphane – induce heme oxygenase-1 (HO-1), and thus boost type 1 interferon response.
The encoded protein angiotensin I converting enzyme 2 (ACE-2) is a functional receptor for the spike glycoprotein of the human coronavirus HCoV-NL63 and the human severe acute respiratory syndrome coronaviruses, SARS-CoV and SARS-CoV-2 (COVID-19 virus).The following herbs block attachment by the virus on the ACE-2 receptors of the lung, lymph, and spleen epithelial cells – Scutellaria baicalensis, Aesculus hippocastanum, Polygonum spp., and Glycyrrhiza glabra.
Cytokines are localized cellular messengers that help mobilize the immune system. A dangerous complication of viral infections is systemic inflammation. A cytokine storm is experienced in the advanced stages of infection or acute respiratory distress syndrome when significant damage to the tissues exists. The body is trying to mobilize and activate immune cells, and the resulting increase in activated immune cells results in severe complications.
High mobility group box-1 (HMGB1) is a cellular protein secreted by immune cells during infection. The hyper expression of proinflammatory cytokines stimulated by HMGB1 activity is part of the cytokine storm response. The following herbs reduce HMGB1 levels during cytokine storm – Pueraria spp., Salvia miltiorrhiza and Ginkgo biloba.
Sambuca nigra, Angelica sinsensis, Pueraria spp. and Salvia miltiorrhiza block attachment of viruses to cells. The mechanism of Sambuca nigra anthocyanidin, cyanidin-3-glucoside (cyn 3-glu) inhibits the virus in early stages of infection by suppressing post-infection phase of the cycle, decreasing plaque number and size and inhibiting cell-to-cell transmission. Elderberry juice displayed a stronger influence on post-infection phase than in the early stages of the virus cycle, including viral glycoprotein entry suppression, cellular transmission and altered expression of immune cells. In particular, elderberry supplementation at onset of symptoms reduced overall symptom duration and severity.
Hypericum kills viruses containing an envelope, such as herpes simplex, HSV-1 and HSV-2.
Natural Products Current Research:
Investigation into isolated natural products for antiviral activity has focused on the use of flavonoids against COVID. Their activity appears to directly inhibit 3C-like protease (3CLpro), blocking replication of the virus. The most effective compounds were herbacetin, a flaxseed flavonoid; rhoifolin from Rhus succedanea; and pectolinarin from Cirsium setidens.
Another study that fractioned plant material to find compounds most active at preventing the replication of SARS-CoV identified compounds from Artemisia annua whole plant, Lycoris radiata stem cortex, Pyrrosia lingua leaf, and Lindera aggregata root with antiviral activity in Vero cell-based CPE/MTS screening, without providing mechanistic data for the activity.
Creating a Series of Herbal Formula
Both Western Herbal Medicine and Traditional Chinese Medicine have modules for treatment based on the stage of the disease, which alters formulary based on the specific symptomology. The commonality of the treatment stages includes:
- Stimulation of lymphatic-immune-fluid-excretory system
- Active Treatment – mild
- Active Treatment – moderate
- Active Treatment – severe
List of plants from the Botancopia Database that make up the formulas above:
Avena fatua or sativa
Biography: Dr. Bhodi (Michael) Tims is director of Herbal Product Design and Manufacture, the Cannabis Science Programs, and the Botanical Pharmacognosy Lab at Maryland University of Integrative Health (MUIH). He is the Vice-President of Verax Research Board of directors. His broad herbal research experience includes product and formulary development, clinical application, analytical method development, and the chemical ecology of medicinal plants. He maintains a blog, bhoditims.com about medicinal plant research.