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SUMMARY: In late stages of COVID-19, some people’s lungs fill with fluid and they have trouble breathing. When they cannot breathe, they need a ventilator to breathe for them. Ventilators are in short supply and carry their own set of risks. In China, some doctors used a different approach — an herb called Ephedra that has diuretic properties and pulls fluid out of the lungs and then out of the body via the urine allowing patients to breathe on their own. We will look at a case study out of Wuhan, China where 30 patients with late stage COVID-19 infection were successfully treated using this herb. We in the West have misappropriated this herb. This herb has been used in China for thousands of years for infections like the novel Coronavirus. Based on Chinese medicine principles, we will look at why this herb might be worth considering for this new disease.
By some accounts, over 90% of patients infected with the novel Coronavirus in China were treated with TCM, or Traditional Chinese Medicine, in addition to conventional treatments. One herb in particular was used repeatedly.
In a small case study that quietly made its rounds on the internet, a physician from Wuhan who was also trained in TCM, successfully used herbs to treat COVID-19. Among those herbs, she found that the herb Ephedra worked well in all stages of this disease, but particularly in late stages when the lungs fill with fluid. Her patients urinated more after taking this herb, and then remarkably were able to breathe again. There did not seem to be any long-term side effects. All of the patients in the case study went on to regain full energy levels and their health was restored back to normal.
And so, let’s take a look at this herb: Ephedra. Why might it be useful?
Ephedra: The Good, The Ban and The Ugly
The name Ephedra may sound familiar to you. That’s because it was tossed around in the headlines a lot in the early 2000s. It was painted as a scary supplement with lethal side effects. Ephedra is no longer available for purchase in the United States. The FDA banned this herb after 155 deaths were reported in people taking this supplement for the purpose of weight loss.
And yet, this herb has been used safely for thousands of years in China. What happened here?
Ephedra, with the Chinese name: Ma Huang, has unique properties that speed up the metabolism, move circulation, and release excess fluid from the body. Our Western culture — obsessed with body image and weight loss — perhaps unsurprisingly, hijacked these properties and used them to fulfill our unending desires for attaining the perfect body.
The herb was often included in diet supplements and energy enhancers, and sometimes, in really high doses. On top of this, independent studies found that labeled doses did not always match their contents. And so, what was written on the label was different (in most cases much higher) than the amount of herb actually found in the pills.
High doses of this herb, not surprisingly, led to problems. Speeding up the metabolism and increasing blood pressure are well known effects of this herb. These effects can be dangerous in the same way that high doses of any stimulant can be dangerous, especially to those with underlying high blood pressure or heart disease.
Experienced TCM practitioners argued that even the “safe” doses listed on the labels of the weight-loss and performance enhancing supplements were too high. Licensed herbalists administer this herb in much lower doses, for short periods of time, and often in combination with other herbs that counteract and balance any of the negative side effects of this herb.
Also, in Chinese Medicine, Ephedra was not used for weight loss. Instead, it was used for lung problems and viruses. And in particular, viruses like COVID-19.
Understanding The COVID-19 Virus: The Chinese Medical Paradigm
In our western and modern day world, we understand viruses to be microscopic, pathogenic little pieces of hardware (for lack of a better word) that overtake our cells, use the cell’s equipment to multiply, and if our immune system cannot stop them, they create disease and wreak havoc in our bodies.
Furthermore, we divide viruses into groups according to their specific features- from specific proteins or receptors on their external layer, to microscopic details such as if they are an RNA or a DNA virus.
In Ancient China, however, they looked at viruses differently.
They had no microscopes nor modern technology and so they did not know what a virus looked like. However, remarkably, Ancient Chinese medical practitioners understood, almost 2000 years before Louis Pasteur came up with “the germ theory” in 1860, that in some disease states a “foreign invader” was attacking the body.
And while they could not identify the pathogen based on its genus or species, Ancient Chinese doctors instead carefully observed their patients and found some interesting patterns.
They found that some viruses created symptoms of COLD while others created symptoms of HEAT.
To understand this better, let’s take a look at water: If you add cold to water, everything slows things down and eventually solidifies into ice. On the other hand, adding heat to water will speed things up, creating fast moving bubbles and steam.
And what is remarkable is that ancient Chinese medicine found that viruses can have these same effects in the body. We do not have this concept in modern medicine – the idea that a virus can have a unique thermal reaction in the body. And yet, this approach can be very useful, especially when looking for a potential treatment.
According to Chinese Medicine, COVID-19 shows many of the characteristics associated with a cold pathogen or virus. When a person is infected with this strain of Coronavirus, other than the most common symptoms (a fever and dry cough), other common symptoms include: severe chills, pain and lethargy.
According to Chinese medical observations, when a cold pathogen enters the body, one can literally feel cold and have chills. The cold will slow everything down including the circulation. Eventually, like with ice formation, things become stuck and immobile. This creates pain. The slowing down effect also depletes our energy and makes us slow.
One common symptom of COVID-19 are massive chills. You want to be under a blanket, despite having a fever . A patient from New Jersey described his symptoms as: “Chills every night and the chills would be so bad that it would cause my body to shake so bad that my breathing was spasmatic.”
Chris Cuomo, the CCN news anchor, said “he was shivering so much that he chipped a tooth”
Cold contracts. When there is contracture, the circulation isn’t moving well. When things are stuck, this puts pressure on nerve endings and creates pain. A man in Wuhan, China describes having: “pains that tortured every part of my body.”
Recently we are learning that some patients develop blood clots from the virus. This is creating a higher than usual incidence of strokes, even in younger patients. If you can imagine: fast moving circulation will break up clots and not allow them to form, while slow moving circulation can lead to areas where things stagnate and get stuck. When the circulation is slowed, clotting factors accumulate and there is a higher likelihood of blood clot formation.
In a similar way, when you are invaded by a virus of COLD, your energy is zapped and you become lethargic and slow. This is another common symptom we are seeing in patients with COVID-19. One patient, Hedy Bauman, 74, was so weak she could barely make it home from a short walk to the store. Reading a few pages of the newspaper was exhausting. “My bathroom is maybe 15 steps from my bed,” Bauman, of Silver Spring, Maryland, told NBC News. “I wasn’t sure I could get from the bathroom to my bed.”
In Chinese medicine, one also looks at the tongue and pulse for clues on what is happening to the circulation.
A cold virus creates a white coating on the tongue and slows down the pulse. While I could not find anything about the pulse rate in Coronavirus patients specifically, here are some photos of a white tongue coating in patients in Wuhan, China taken from the case study I will look at later in this article:
With all of that in mind, let’s briefly compare these cold symptoms to a pathogen of Heat.
A virus that creates heat in the body will speed things up. With a heat pathogen, you have no chills, but a very high fever. (We will come back to fever in a minute).
Because a heat pathogen speeds things up, you often become agitated and restless (as opposed to lethargic and tired). You feel overheated and cannot stand being under the covers. You crave cold liquids and want to drink more.
Your pulse is fast, and your tongue is often red with a yellow coating.
With a heat pathogen, the circulation is often moving fast, and so there is no pain.
WIth everything that we are seeing with COVID-19, this appears to be a pathogen creating COLD.
A quick note: both hot and cold pathogens can create fevers. Fevers tend to be milder with cold pathogens. However, in the case of COVID-19, the virus seems to follow a few phases– after the initial COLD enters the body, some TCM practitioners believe that the cold can become trapped inside in the body, leading to more signs of heat in later stages of the disease: high fevers, agitation etc. And so, while both hot and cold may be present in later stages of this disease, this virus appears to be ultimately a pathogen of cold.
So, Now Back To Ephedra: Why Might This Herb Help COVID-19?
Ephedra by its very nature is a stimulatory herb. It warms you up, speeds up the metabolism, and gets the circulation moving. It has been shown in various studies to stimulate thermogenesis in the body, which is another word for creating heat.
In Chinese Medicine, Ephedra has been used for thousands of years in exactly COVID-19 type of situations: a case where the body has slowed down and the circulation has contracted.
And so with a “cold virus,” Ephedra was prescribed in small doses and for short periods of time. Once the symptoms resolved, the herb was discontinued.
Chinese text books such as Chinese Medical Herbology and Pharmacology, discussed its indications as:
In later stages of COVID-19, some people experience what is called a cytokine storm. At this point it appears that the body’s own immune system is causing the problem rather than the virus itself. This “storm” may cause an accumulation of fluid or thick phlegm in the lungs, creating a common finding called a “ground glass opacity” on a CT scan or a fluid-filled lung field on an X-ray.
When the lungs fill with fluid, the body’s ability to oxygenate will plummet, and doctors decide whether or not the person needs to go on a ventilator. Recent numbers indicate that 88% of patients that were put on ventilators died. This means that ventilators, while for many people remain the only option, are actually not a very effective treatment.
This is where Ephedra becomes interesting. The herb appears to have diuretic properties. This means that it pulls excess fluid out of the body. It achieves this either by sweating out the excess fluid or by urination. According to the text books, this herb works specifically on the lungs.
Chinese Medical Herbology and Pharmacology described its properties this way:
Ephedra also appears to have bronchodilatory properties, which means that it improves the patient’s ability to breathe. Chinese herbalists have historically used Ephedra to treat asthma- a disease where the bronchioles constrict and become small. It has also been used for chest tightness, lung congestion and COPD, or Chronic Obstructive Pulmonary Disorder.
One of Ephedra’s active ingredients, Ephedrine, has even been used to make a pharmaceutical drug for treating asthma, due to these properties.
For all of these reasons, this herb was often used in China in the fight against this novel Coronavirus. And so with that in mind, let’s take a look at the case study.
Word of Caution: Ephedra should be used judiciously, especially in people with underlying heart disease or increased blood pressure. It should only be taken under the supervision of a health professional or a Traditional Chinese Medical practitioner who is trained when and how to use this herb. I am providing this information here as an interesting avenue to explore, rather than as a means to self-medicate.
A Case Study of Ephedra in Late-Stage COVID-19
There was a case study out of Wuhan, China, from February of this year that included 30 patients successfully treated using an integrative medical approach, meaning that they took both traditional medications and herbs. And while it is unclear which of the therapies was more effective (or do they work well together?), one would think that if anti-viral therapies alone were effective, we might be seeing more treatment success in the US and Europe. As we are still waiting for that data and I am only presenting this particular case study, I will leave that topic open for further discussion.
The patients in the case study received a combination of antiviral medications (mainly Oseltamivir and Abidol) as well as four different herbal formulas, chosen based on the patient’s specific and individual Chinese medicine presentation. Chinese medicine differs from conventional medicine is that it is largely individualized medicine. This means that each patient is treated based on what symptoms their body is showing, and not necessary on the disease process affecting them. Nevertheless, this doctor felt that Ephedra was an appropriate herb for patients in all stages of this disease.
The practitioner begins by describing the Chinese Medicine pattern. We see the photos of the white colored tongues (included earlier), as well as her description of the symptoms:
“Virtually all of these patients had a fever, and those who did not, had chills. Furthermore, most patients presented with cold extremities; while some had perspiration, others did not have any perspiration. Additionally, patients experienced headache, nausea, a bitter taste in the mouth, and dry throat. The most common symptom they all shared was a dry cough. Of these 30 patients, only a few could expectorate phlegm.“
Based on this information, she diagnoses a “damp cold” pattern (Oftentimes there are mixed patterns in Chinese Medicine. See my article here for further discussion of this).
She also describes a peculiar characteristic of this new viral infection that is baffling many doctors: The patients appear to get better initially, only to become sick again down the road.
“What I noticed was that while many patients were experiencing symptomatic relief, their CT scans were showing the progression of the disease. It showed the worsening of lung conditions as the white area in the scan continued to show expansion. Surprisingly, the patient’s sleep, appetite, energy level, etc. were, by and large, improving.
At first, I was baffled and tried to explore possible explanations for this phenomenon. Hence, I asked my senior colleague whether he thought it was possible that phlegm was unsuspectingly lodging in the lungs of patients.“
Due to the fluid or phlegm silently accumulating in the lungs of some patients, the doctor chose Ephedra to counteract this.
“Throughout the entire treatment process, regardless of which formula was used, Ephedra herb was found to be an essential adjunct to treatment. Initially, there was a great deal of dispute regarding the use of Ephedra, but those debates were quickly put to rest when we saw how effective it was.
What my patients reported was that once they expectorated the sputum, their respiration felt much more open. This was especially the case for patients with a dry cough, for the 30 patients I was overseeing. They all experienced the same thing: difficult inhalation, but normal exhalation. So, with that in mind, I insisted on using Ephedra for all my patients from that time forward.
Throughout the entire treatment period from February 4, 2020 through February 20, 2020, most of the critically ill patients became mild cases and most mild cases were released out of the hospital with this integrative approach to care. From this, we learned that Ephedra was pivotal in achieving exceptional results for these 30 patients.
Following this experience, I now highly recommend the use of Chinese herbs to treat COVID-19, in all of its stages. Though the use of herbs is non-invasive with relatively mild side effects, it is not only effective to treat mild and mid-stages of this illness, it can also help prevent patients from moving into the more critical stages of this disease. However, I cannot stress the importance of achieving accurate diagnosis and regularly updated herbal prescriptions for the particular stage of illness.“
She also describes another common phenomenon with COVID-19, patients with no or minimal symptoms all of a sudden cannot breathe. Here is a recent NYT article that talks about this same problem: Click to read article.
The TCM doctor found that Ephedra had the ability to prevent symptoms as well as treat them (dyspnea means trouble breathing):
“Furthermore, my ward primarily used TCM treatment, whereas others strictly used Western medicine. I noticed that some patients, when admitted, had very few symptoms. However, after 3-4 days, they would start to develop dyspnea and respiratory obstruction. After discovering this pattern, I urged my colleagues to start using phlegm eliminating herbs EVEN before the patient starts to show symptoms. Five of the herbs that I used the most were Zi Su Zi (Fructus Perillae), Jie Zi (Semen Sinapis), Jiang Can (Bombyx Batryticatus), Cang Zhu (Rhizoma Atractylodis) and finally Ephedra. Ephedra was something that I used throughout the entire course of the treatment. It’s a key herb that must NOT be left out. Most of our patients were using Ephedra from February 8, 2020 – February 20, 2020.
This group of patients, especially the 15 who were released on 2/25/20 showed complete absorption without leaving a trace. So, I suppose this theory is accurate.“
Her final notes said:
“In my opinion, the two greatest benefits of Ephedra for treatment of this epidemic are: FIRST – it opens the ENTIRE chest cavity; SECOND – it opens the water passageway up above the lungs, by increasing urine output, leading to the dissipating accumulated fluids and dampness from the Lungs. Case after case, I saw patients increase urine output, without experiencing thirst. Furthermore, they expressed feeling lighter and more energetic. Hence, I gained much more confidence in prescribing Ephedra as time went on.“
Here is a LINK to the Case study.
Final Considerations For the Use Of Ephedra In Treating COVID-19
Many of us in the western world are skeptical, if not downright suspicious of herbs and alternative therapies. And yet, you may be surprised to learn that many of our current medicines come from nature and plant-based sources.
Aspirin comes from willow bark. Opium and opioids were originally derived from poppy seeds. Penicillin comes from the Penicillium mold.
Traditional Chinese Medicine has also played a role in modern treatments: In 1972 a Chinese Chemist used ancient Chinese medical texts to find an herb that could treat a resistant strain of Malaria. She won the Nobel Prize for this discovery. The herb-based medicine is largely still in use today and credited with saving millions of lives (NOT chloroquine- the treatment being studied for the Coronavirus).
You may further be surprised to learn that the active components of Ephedra are already used in modern medicine. Ephedrine, as I mentioned before, is an older asthma treatment, while pseudo-ephedrine, is the common ingredient in the over-the-counter cold and flu medicine such as Sudafed. Both are derived from the herb Ephedra.
I do not know whether pseudo-ephedrine or ephedrine might work against COVID-19. Or whether one needs the whole herb for maximum benefit. Ephedrine and pseudo-ephedrine constitute only 3% of the original plant, and have very specific actions and functions. Both components, however, are found within the full spectrum herb.
Furthermore, as in many such cases, the whole plant many have additional buffering or protective effects against any side effects. It may be worth looking at the whole herb with all of its components rather than just the active constituents for addressing this new disease.
Given what we know about this herb, I believe that the FDA did the right thing to ban this supplement in 2004. This herb was being used for the wrong purpose, in the wrong doses and without the supervision of a health professional.
However, I also believe that the smear campaign against Ephedra was unjustified. Most modern-day medications can also be bad if they are taken or used inappropriately. Rather than take the time to ask questions and learn about this herb, we immediately labeled it as “dangerous.”
And yet, herbs such as Ephedra have many unique attributes that have yet to be fully explored. If used in the right way, this herb could be very beneficial.
And in the case of COVID-19, it might even be lifesaving.