What we will do - look at what we know about COVID-19 so far in - - PowerPoint PPT Presentation

What we will do - look at what we know about COVID-19 so far in relation to prospects for herbal practitioners to support their patients

• stages of immune involvement with COVID-19
• what the risk factors for COVID-19 tell us
• key areas where we may be able to help
• insights from Chinese and Indian traditions
• some practical herbal steps

Barrier immunity Inflammation/fever Acquired /specific immunity Innate immunity

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Instant

Innate immunity

Skin, airway defences, saliva, stomach acid, microbiome

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Up to 4 hours Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks 4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

No symptoms!

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

25-60%?

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

No symptoms!

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

25-60%?

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

aches, cough nausea fatigue

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

25-60%?

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

fever more pain more fatigue breathlessness > slow recovery RISK of pneumonia arthritis chronic inflammation

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

EITHER healing and reduced symptoms OR risk of immune damage, kidney disease, sepsis,

• rgan failure ...

25-60%?

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

25-60%?

4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Of the 40-75% of those infected who know it, 80% have mild or moderate symptoms and mostly engage the three outer defensive rings.

THIS IS WHERE WE NEED TO WORK TOO – to reduce our patients’ odds of being among the 8-15% who have a severe or critical infection – AND STOP THERE?

Inflammation/fever

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Check ourhealth.directory for more

The first stage of inflammation

> the endothelium > endothelial activation

What conditions are most vulnerable to COVID-19 complications?

• High blood pressure
• Heart disease and stroke
• Diabetes
• Obesity
• Cancer
• Lung disease
• Liver and kidney disease

High blood pressure often involves an increase in the angiotensin converting enzyme (ACE). ACE inhibitors like ramipril, and angiotensin receptor blockers (ARBs) like candesartan, are commonly prescribed to block the effects of this enzyme. The body also produces ACE2 which counterbalances

• ACE. These prescriptions also increase the production
• f ACE2.

ACE2 is important in protecting the lungs. However cells producing ACE2 are targeted by coronaviruses, including COVID-19. It has been suggested that patients taking ACE- inhibitor or ARB prescriptions may be increasing routes

• f infection by this coronavirus. However there is new

evidence that suggests the opposite. Do not encourage patients remotely to stop taking these medicines: the increase in blood pressure itself is probably a worse risk. Endothelial dysfunction: Increased inflammatory activity > cardiovascular and chronic diseases Loss of elasticity > high blood pressure Blood vessel damage and increased clotting > intravascular coagulopathy, hypoxia, kidney disease, stroke, thrombosis

Insulin resistance > diabetes

!!

Other reasons? Being male Ethnicity Smoking!

< COVID viral endothelitis?

Endothelial dysfunction: Increased inflammatory activity > cardiovascular and chronic diseases Loss of elasticity > high blood pressure Blood vessel damage and increased clotting > intravascular coagulopathy, hypoxia, kidney disease, stroke, thrombosis

Insulin resistance > diabetes

The first stage of inflammation

Q: What can we do to reduce endothelial dysfunction?

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Q: What can we do to reduce endothelial dysfunction?

A: Eat more plants!

Vegetables – especially greens, roots like beetroot, carrot, parsnip, and onions, garlic Fruits – especially coloured fruits, tomatoes, berries , red grapes Cereals and grains Nuts and seeds Herbal teas, green tea Cocoa / dark chocolate!

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Q: What can we do to reduce endothelial dysfunction?

A: Eat more plants!

Polyphenols

• Flavonoids
• Anthocyanidins
• Lignans

Improve many endothelial functions Prevent many forms of heart and circulatory disease “HAVE YOU EATEN YOUR RAINBOW TODAY?!”

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Q: What can we do to reduce endothelial dysfunction?

A: Take more spices!

Taking Asian spices like turmeric, ginger and cinnamon has also been shown to have positive benefits for endothelial health, even when combined with fatty

• foods. This can be really quick –
• ne meal will make a difference!

A number of these spices have also been shown to help reduce blood pressure. They also help gut immunity and microbiome defences.

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Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks 4 hours – 4 days

Check ourhealth.directory for more

Defensive rings: our immune system

Wei

defensive

Ying

nutritive

Xue

blood

Qi

The four levels of Wen Bing

Wen Bing Xue

Warm Disease Theory

Wind-Heat ✲ Damp-Heat ✲ Summer-Heat ✲ Wind-Dry-Heat Lung-Heat ✲ Stomach-Heat ✲ Stomach and Intestines Dry-Heat ✲ Gall-Bladder ✲ Heat Stomach and Spleen Damp-Heat Heat in Pericardium ✲ Heat in Ying Heat Victorious agitates Blood ✲ Heat Victorious stirs Wind ✲ Empty-Wind agitates in the Interior ✲ Collapse

• f Yin/Yang

Wu You Ke (1582-1652)

温病

TCM experience of coronavirus Some of the most frequently used TCM plants species in SARS treatments included

• Lonicera japonica,
• Astragalus membranaceus
• Glycyrrhiza uralensis
• Atractylodes macrocephala
• Scutellaria baicalensis
• Angelica sinensis
• Panax quinquenfolius
• Schisandra chinensis.

Ayurveda during the time of COVID

“Physiological masks” measures to barricade against the viral invasion.

• hot water, hot food, and herbal decoctions, improving digestion of āma ,
• gargling with aqueous Zingiber officinale Glycyrrhiza glabra, Cyperus rotundus,

Hemisdesmus indicus, Coriandrum sativum, Cuminum cyminum, Cinnamomum verum and Acacia catechu

• steam inhalation,
• local applications. gargles (gandusha) or mouth rinses (kavala) with Curcuma

longa, Glycyrrhiza glabra, Azadiracta indica, Acacia arabica and salt (Jala neti) Rasayana remedies for strengthening immunity and as potential immunomodulators

• ashwagandha (Withania somnifera )
• guduchi (Tinospora cordifolia)
• shatavari (Asparagus racemosus )
• amalaki (Phylanthus embelica )
• yashtimadhu (Glycyrrhiza glabra )

Tillu G, Chaturvedi S, Chopra A, and Patwardhan B. (2020) Public Health Approach of Ayurveda and Yoga for COVID-19

• Prophylaxis. The Journal of Alternative and Complementary Medicine (ahead of print)

Barrier immunity Inflammation/fever Acquired /specific immunity

Antigen presentation Humoral immunity: B-cells > antibodies

Cell-mediated immunity: T-cells

Up to 4 hours

Increased blood flow, activation of blood wall defences Movement of white blood cells into tissues Histamine and other cytokines

Instant

Innate immunity

Phagocytes: neutrophils, macrophages, monocytes, natural killer cells Complement, cytokines, interferons Skin, airway defences, saliva, stomach acid, microbiome

Days to weeks

COVID-19

fever more pain more fatigue breathlessness > slow recovery 25-60%?

4 hours – 4 days

Check ourhealth.directory for more

Some herbal thoughts

aches, cough nausea fatigue

andrographis calendula echinacea elderberry myrrh pelargonium vitamin D

>

fever

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cough fatigue

Initially non-productive licorice (Glycyrrhiza glabra) baical (Scutellaria baicalensis) thyme (Thymus officinalis) - strong! Standard principles of convalescence apply: managed REST, managed activity, supportive diet (mostly plants, some fish and eggs - mostly cooked, eg Indian?), and tonics like the following ashwagandha (Withania somnifera) gotu kola (Centella asiatica) astragalus (Astragalus membranaceus)

• St. John’s wort (Hypericum perforatum) *

“Although high fever (≥ 102.2°F) was associated with a higher likelihood of ARDS development, it was associated with a lower likelihood of death.” Good fever management approaches are appropriate ... Any pneumonia is different! “It’s not acting like influenza or other bacteria pneumonia where you get inflammation in the lungs and fluid build-up ... at least early on...” Instead multiple clots (intravascular coagulopathy) appear to cut off blood flow to the alveoli, leading to hypoxia ” – more like altitude sickness

Some herbal thoughts