I am a veterinarian. So, while I am a doctor, humans are not one of the species that I treat. However, treating different species and taking novel approaches to disease are some of the things veterinarians do best.
In this article, I take a slightly “outside the box” approach to looking at the new strain of Coronavirus: COVID-19.
In addition to my veterinary education, I have also taken post-graduate courses in Chinese Medicine and Acupuncture. My training in integrative medicine, along with my unique understanding of cross-species medicine, has led me to come up with this hypothesis that I present to you here.
I will end this discussion by looking at a case study based out of Wuhan, China, where a doctor of Chinese Medicine used this approach to successfully treat 30 patients in mid-to late stages of this disease.
Disclaimer: This is not medical advice. Contact a physician if you feel sick, and please go to the CDC website (cdc.gov) for the latest information and recommendations.
Could COVID-19 be a Cold Pathogen?
An interesting pattern emerges when you take a step back to watch how COVID-19, this “new” strain of coronavirus, is behaving:
- It has spread fastest in places like Wuhan (China), Iran, South Korea, Northern Italy, and now in Seattle, New York and San Francisco.
- It largely affects the elderly.
- In early reports we learned that women are less affected than men.
- Children are more resilient to this pathogen.
- Anti-inflammatories, such as Ibuprofen, tend to make symptoms of this virus worse.
At first glance, none of these things appear to make any sense, other than the traditional “spread of disease” model and various other hypotheses (men are more likely to smoke, children have less toxin exposure, etc. etc.).
But a different perspective shows that COVID-19 might actually be following a pattern.
Bats are natural hosts to over 60 viruses known to infect humans. They carry these diseases but don’t seem to get sick from them.
Why might this be?
One hypothesis is that when bats fly, they are able to attain higher body temperatures, compared to other mammals. It was found that when in flight, bats attain body temperatures that range from 100 to 105 degrees Fahrenheit.
Having a high body temperature, even for a few minutes a day, may keep viruses such as Coronavirus, in check.
Now let’s take a look at what is happening with COVID-19 in the general population.
There are two demographics that appear to be more resilient against the effects of Coronavirus: women and children.
While there are various theories circulating as to why this may be the case, there is something that is particular to both of these groups:
Women and children tend to, on average, have a slightly higher body temperature than men.
In some ways, the metabolisms of children bear some similarities to bats: Both are small, fast, and always on the move. Children tend to have a higher resting metabolic rate than adults and they just naturally tend to run a little bit warmer.
On the other hand, as some previous studies have shown, elderly people on average, tend to have LOWER body temperatures, as shown in this pubmed study here, titled appropriately: Older is colder.
Dogs and cats, on the other hand, have body temperatures in the 100-102 degree range. This is higher than the body temperatures of people for whom 97-99.5 is considered normal.
While the reports about COVID-19 and pets are changing daily, it appears from the most recent reports out of WHO (World Health Organization) that some animals may get infected (indicated by “mild positives” on the tests), but are currently not thought to spread the disease to humans or get sick themselves.
And so if the body temperature theory turns out to have some validity (which at this point, it is just a theory I am presenting), then this may explain why our pets are not becoming sick with this illness.
Dogs and cats for decades, (perhaps longer?) have been susceptible to other types of Coronaviruses that have not been shown to be transmissible to humans.
I will likely edit this section on pets as we learn more, but I decided to include some early thoughts on this phenomenon here.
And now, a quick look at weather.
While we are seeing that Covid-19 is able to spread under ALL weather conditions, it does appear from early reports to spread faster and farther in cold and dry weather.
On the same note, a preliminary study out of China showed that high temperatures and humidity decreased the virus’ ability to replicate:
High Temperature and High Humidity Reduce the Transmission of COVID-19
19 Pages Posted: 10 Mar 2020 Last revised: 19 Mar 2020 Date Written: March 9, 2020 This paper investigates how air…papers.ssrn.com
And finally, when this virus invades the human body, it creates specific symptoms.
One patient in China described having “pains that tortured every part of my body,” while a 53-year old man from New Jersey talked of: “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.”
To most of us, these just sound like symptoms of a bad virus.
While in another medical paradigm entirely, these features point to a very specific phenomenon. One that in ancient times was called: a Cold Pathogen.
I present to you in this blog post, a novel, yet at the same time ancient disease phenomenon appropriately called: “A Cold Pathogen”
A model that originates, perhaps ironically, in none other than China itself…
Ancient Chinese medicine has both acknowledged, diagnosed and treated what they described as Cold Pathogens for thousands of years.
Ancient Chinese doctors carefully observed the natural world around them. They took note of the seasons, the natural cycles of life, and how the environment and diet influenced both health and disease in the human body.
They found that states of health and disease were intricately connected to everything: our emotions, the food we ate, the time of year, the time of day, and the specific weather patterns surrounding us.
And through this approach, they discovered that disease states followed very specific patterns.
And so, they would analyze these patterns, and over thousands of years of trial and error, eventually come up with the paradigm of medicine that constitutes a large component of Traditional Chinese Medicine today.
And now, a short word about terminology:
Today, in modern day medicine, we use Latin-based medical terms to describe what we see, using words such as “Idiopathic Epilepsy” and “Granulomatous Inflammation.” In Chinese Medicine, practitioners also used words to describe what they saw, but they instead used words such as: “exogenous wind” and “internal damp heat.”
Even though, in many cases, they were actually describing the exact same thing.
Just like in modern medicine, Chinese medicine also believes that the body has a defense system. Today we call it the immune system, while they called it: the Wei Qi. The ancient practitioners also understood that the success or failure of a pathogen to create disease in the body largely depended on the strength or the weakness of this defense system.
As both warfare and weather were important parts of daily life in ancient China, the practitioners often used war and climate metaphors to describe what they saw happening in the body.
And while they did not know about microscopic pathogens which today we call: viruses, bacteria and fungi, they still understood that some “foreign invasion” was happening in the body.
And so, based on their many years of observation, they found that these were the six “invasions” that they believed could infiltrate the body:
They also noted that combinations of these pathogens were also possible and commonly seen. And so an invasion could be described as having elements of “wind-damp-heat” or a “damp-cold.”
And while a detailed description of what each of these “invasions” looks like is beyond the scope of this article, I will outline some basic features of a few of them below:
A wind invasion, is a disease that is characterized by occurring suddenly and seemingly out of nowhere (like the wind). In some ways, the coronavirus is showing characteristics of a “wind” invasion, because it has a fast and sudden onset.
It is the wind that brings the pathogen deeper into the body. And so, a stronger wind quality of the pathogen, or a weaker defense system, can lead to a more severe form of disease.
A heat invasion, as you can imagine, shows signs of heat: the patient feels hot, is thirsty and wants to drink cold water, has a red tongue with a yellow or dry coating, and a rapid pulse. Some examples of heat pathogens include bacterial infections and auto-immune diseases.
A cold invasion, on the other hand, consists more of chills and despite having a fever, the patient may feel cold and want to be under the covers. You may see cold limbs and an aversion to drinking cold water. The tongue is often pale or has a white coating. The pulses are often found to be slow.
While cold stagnates and heat moves, a cold invasion is seen to slow the circulation, leading to signs of acute contraction and sometimes pain.
Note that a fever may exist in both states of hot and cold
Invasions, however, like everything else in life, were often not static.
In the case of hot and cold pathogens, they observed that a cold pathogen (if left untreated or if the immune defense was not strong enough) could transition and become a heat pathogen.
And the opposite was also true: a heat pathogen could also transition into one of cold.
And so, an herb or treatment approach that may have worked when symptoms first appeared, might not be appropriate in later stages of the disease.
Looking for treatments: Herbs
When a Chinese Pathogen invades the body, it does so in a predictable way. An invasion of damp will look wet. The best example: a wet and phlegmy cough. An invasion of dry will be dry, and may cause symptoms such as dry lips and dry mouth. Heat speeds things up, and may show up as restlessness, while cold slows you down and tends to make you feel sluggish.
In the same way that the Chinese observed the ways a pathogen invades and affects the body, they also took note of how the world around them: plant and animal, when taken internally, would counteract and act against these various disease states.
They found for example, that certain herbs were cooling and draining, while others were warming and drying. And they would use the unique characteristics of these herbs to treat the condition, based on what was needed most.
There are over 300 commonly used Chinese herbs that have been extensively studied in Ancient China as well as today, each with their own specific indications, use and function.
However, one useful theme and predictive element of how a given therapy will act in the body turns out to be: It’s Taste.
(Keep in mind that this is not an “all or nothing” approach. While there are many herbs and medicines that follow this principle, there are some that do not)
Based on Chinese medical principles, ancient practitioners found that sweet herbs tended to be moisturizing, helped add fluids, and “tonified” the body, which could be seen as strengthening.
Bland herbs were found to have diuretic properties, and helped to drain excess fluids out of the body such as with edema and dysuria.
Bitter herbs were found to be cooling (in our modern terminology- anti-inflammatory), and drying which helped to drain dampness (inflammation).
Spicy and aromatic herbs, not surprisingly, were considered warming. Spicy herbs pushed blood and pathogens up and out of the body and into the exterior. As anyone who has ever experienced a flushed face after eating something spicy can attest to, this one in particular makes intuitive sense to us.
A Treatment Approach
In order to successfully treat a pathogen, or “invader,” one had to counteract the qualities of that specific invader, with its equal and opposite force.
In other words, one treats HEAT pathogens with bitter and cooling treatments, and COLD pathogens with warming and aromatic herbs.
And this is where some of this knowledge becomes useful.
Antibiotics, non-steroidal anti-inflammatories (NSAIDs) such as Ibuprofen, steroids and chemotherapy are all considered to be bitter-tasting, cooling treatments. This makes sense, as many of them have varying degrees of anti-inflammatory properties.
This is a concept that we are taught early on in our Veterinary Chinese medical training: Do not use cooling pharmaceuticals for a “cold” pathogen, or you may make that patient worse.
And, as the news and media outlets are reporting, that when it comes to COVID-19, this is exactly what we are seeing:
Updated: WHO Now Doesn’t Recommend Avoiding Ibuprofen For COVID-19 Symptoms
Editor’s note (19 March 2020): Since the publication of this article, the World Health Organization has updated its…www.sciencealert.com
Since Ibuprofen is a cooling, anti-inflammatory treatment, using it with a cold virus, especially early in the disease process (before heat signs appear), could actually make symptoms of the virus worse.
And while scientists are looking at the enzymes that could explain this phenomenon, Chinese medicine could have predicted this response simply by following the larger thermodynamic properties at play:
If COVID-19 is a Cold Pathogen, then using cooling, anti-inflammatory drugs is not going to be a good idea
Tylenol, on the other hand, which is not anti-inflammatory (and therefore much less cooling), has not caused a problem for patients with COVID-19.
Interestingly enough, many common diseases that both doctors and veterinarians treat are often inflammatory and heat conditions. Or, in some cases, there is secondary heat produced as the disease progresses.
Acknowledging this, one can see why in much of modern medicine, the use of cooling pharmaceuticals (NSAIDs, steroids, antibiotics and chemotherapy) has proven to be quite useful.
On the other hand, finding an effective treatment for the flu virus, a sometimes “cold pathogen” according to Chinese Medicine, has remained somewhat of a challenge for our Western Medical approach.
The use of Spicy and Aromatic Herbs for a Cold Invasion
A true deep dive into how Chinese medicine uses herbs to address a “cold” invasion is likely beyond the scope of this article.
However, the simple idea behind this theory is such:
An invasion of cold tends to congeal and stagnate the circulation. Warm and spicy herbs counteract this effect by inducing vasodilation and increasing circulation around the body and to the periphery.
According to modern day medicine, one could offer this explanation: the vasodilatory property of the spicy herbs allows the immune system to get to where the pathogen (virus) is to destroy it.
While in simpler terms, the Chinese just observed that warming herbs helped to counteract the symptoms of “cold.”
While I have focused this post mainly on Chinese Medicine, there are aspects of traditional folk medicine that follow these same principles. It is not uncommon to treat the common Cold with warming spices, such as, for example:
Independently of one another, many cultures have reached similar conclusions, perhaps intuitively sensing that warming spices could be helpful when one felt cold.
I do not know if any of these common herbs and foods would be helpful with the new Coronavirus strain (and I am not claiming that they would be). However, given their warming properties, they may be a useful avenue to explore.
It is also important to note that each of these herbs has unique qualities, treating and affecting the body in a slightly different way. Consulting with experienced herbalists as well as practitioners of Traditional Chinese Medicine, or TCM, may be worth our while in order to come up with strategies for addressing this novel pathogen.
Furthermore, “cold” is just one aspect of this new disease (as we will see in a minute). In order to treat this new pathogen, one would have to look at ALL the ways the virus is showing up (is there dampness, phlegm, wind?), and choose herbal combinations appropriately based on what exactly we are seeing.
The beauty of this approach, however, is that it makes us worry less about the virus mutating. If it does mutate, and starts to affect the body in a different way, we adjust our sails and once again treat the new pattern we are seeing.
And so with all of these thermal concepts in mind, let’s now take a closer look at the Covid-19 virus itself…
If you would like to get more details about how one could approach a viral invasion from a diet and herbal perspective (as well as how to address it in early vs later stages of the infection — a topic I do not discuss very much here), I recommend reading Chapter 4 and 5: Heat/Cold the Thermal Nature of Food and People: Healing with Whole Foods
COVID-19 — AN INVASION OF COLD
There is a case study that is quietly making its rounds among acupuncturists, Chinese medicine practitioners, and integrative veterinarians outlining how one doctor in Wuhan, China successfully treated 30 patients in various stages of infection with COVID-19. She used an integrative approach with Chinese herbs and traditional anti-viral medications.
I will provide a link to this article at the end of this post.
In this case study, the Chinese practitioner detailed her approach to treating this disease using TCM principles.
Tongue color: In her case study, this practitioner observed and noted the color of the tongue in her patients.
Here are photos of initial tongue presentations of some of her patients, all presenting in Wuhan, China in early February:
As you may notice, there is a whitish hue to many of these tongues.
Which, if you remember from my previous descriptions, is an indicator in Chinese medicine that we have an “invasion of cold.”
You will also notice that some of these tongues are a little less white. This is generally due to underlying disease processes and predispositions. For example, some people may have an underlying inflammatory or heat condition that may make the tongue slightly less white.
This doctor described the symptoms and findings as follows:
“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.”
By observing tongue color, pulse quality (which is not mentioned in the article but I am assuming was part of the process) and specific symptoms, this doctor concluded that her patients were largely exhibiting signs of Damp Cold.
(There is still some discussion among practitioners of Chinese Medicine as to the exact pattern of disease we are seeing with COVID-19 based on Chinese Medical Principles. It seems that the pattern may change into one of heat as the disease progresses. Some thoughts on this topic as well as specific herbal approaches can be read here and here)
TCM Treatment Approach
The patients in this discussion were treated with an integrative approach, meaning that they took both medications and herbs.
And while it is unclear in this case which of the therapies were 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 places like Europe.
As I do not have access to that data and am only presenting this particular case study, I will leave that topic alone for now.
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.
Meaning that each patient is treated based on what symptoms their body is showing, and not necessary on the disease process affecting them.
This means that two separate patients both affected by COVID-19 may be treated with a different herbal protocol.
I will not go into the four herbs she chose and why, because that discussion requires a more advanced understanding of Chinese Medicine and pathology, but the herbs that she chose had some properties of tackling the damp cold invasion that she was seeing in her patients.
Next the practitioner wrote:
“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.
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.”
If anyone has read the sad tale describing the two young, female, medical professionals in China written up in the New York Times last week, we see this same pattern of disease described in those cases as well:
The patients appeared to get better initially, only to become sick again down the road.
And this is exactly what this clinician is noting here.
While the patients felt better, their CT scans were actually showing the opposite: signs of progression of the disease in the lungs without clinical symptoms of disease.
And this seems to be one of the reasons that this disease has proven to be so difficult to treat and so frightening.
However, here is how this clinician addressed this problem.
Throughout the entire treatment process, regardless of which formula was used, Ephedra herb [Ma Huang] 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.
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.
Now, a short side-note and diversion here: The intention of this blog post is to discuss the symptomology of a “cold pathogen, ” and how one might use its features to come up with a treatment strategy (rather than to promote any single treatment option).
However, because I wanted to use the symptoms presented in this particular case study, I cannot ignore the fact that the doctor in this case, discovered that Ephedra seemed to work quite well in patients that were in mid-to late stages of this disease process.
And so here is a short discussion about Ephedra which is tangential to the discussion, yet not something I can entirely ignore, either:
As many people may know, Ephedra (Ma Huang) is actually not available in the United States. The FDA banned this herb a number of years ago after a few deaths were reported in people taking it in diet supplements for weight loss.
Many practitioners of Chinese Medicine will argue that this herb is not indicated for weight loss, and that this herb was taken and used inappropriately in these cases.
Ephedra has been used for thousands of years in Chinese medicine, (in small doses for short periods of time) in exactly these types of infections: It is indicated when the pathogen needs to be kicked out of the body. The Chinese call this indication to “release the pathogen to the exterior.”
After a quick google search, I felt like this article did a decent job outlining the indications as well as the use and misuse of Ephedra in the Western World:Ma Huang Herb Misused and Abused – Pacific College
Although the February 17 heatstroke death of 23-year-old Baltimore Oriels pitcher Steve Bechler has re-raised concerns…www.pacificcollege.edu
And who knows? Perhaps looking at the unique characteristics of Ephedra and how they play out with this particular pathogen, might be worth exploring for those working on the front lines of this epidemic…
And now, back to our case study.
In her final words describing her treatment strategy, the practitioner in Wuhan writes:
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.
As the practitioner points out here, choosing herbs appropriately and monitoring for changes was an important part of the treatment strategy.
And finally, here is a photo of how one patient’s tongue color went back to normal with the resolution of this disease:
Link to full text of the Case Study:
Medical Records from a Young and Brave Female Traditional Chinese Medicine (TCM) doctor on Fighting…
John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac. Medical Records from a Young and Brave Female Traditional Chinese Medicine…www.elotus.org
Chinese Medicine and the Malaria discovery
I wanted to end this article with a short story about a woman who made a significant impact on modern day medicine using Ancient Chinese Medical knowledge.
During the time of the Vietnam War, Vietnamese soldiers were dying in droves from Malaria and were not responding to the traditional treatment at the time: Chloroquine.
Scientists around the world were aware of this new strain, and a search for the treatment began. Over 240,000 compounds were carefully screened, without much success.
A secret task force was created between Vietnamese and Chinese leaders to continue the search for a cure against this new pathogen.
One woman, named Tu Youyou, who at the time was a 39-year old Chinese chemist, was appointed head of this secret project in 1969. She had had some training in Traditional Chinese Medicine during medical school and came up with the idea to search Classical Chinese medical texts for insight.
After searching the literature, and screening thousands of herbal extracts and testing them in mice, she finally found her answer:
Artemisia Annua, or Sweet Wormwood, a common Chinese plant, was prescribed in a 4th century Jin Dynasty text, for treating: Intermittent fevers. The same same type of fevers that we see with Malaria. And lo and behold, the herbal extract worked.
In 1972, Tu and her colleagues obtained the pure substance of this herb and named it: quinghaosu, or Artemisinin, as it is more commonly called today. This treatment has been credited with saving millions of lives in the developing world.
Tu Youyou was awarded the Nobel Prize in Medicine for her discovery in 2015.
(As a side-note, the malarial drug described here is NOT the same one that is being currently tested against COVID-19. Incidentally, it is the older drug: Chloroquine, that according to media outlets has shown more promise and is currently being tested against Coronavirus. There may be an explanation in Chinese Medicine for why the older substance may be more effective against this new pathogen. However, it is beyond my level of expertise to provide any insight to this conversation at this time.)
Those are my thoughts on this matter.
I hope you learned something, or at least enjoyed seeing medicine from a new perspective.
And so, in the mean time, drink your warm, Cinnamon-spiced Latte, enjoy time with your housemates, wash your hands and avoid unnecessary social interactions.
Contact your doctor if you feel sick.
Stay Safe my friends.
If you would like to learn more about Chinese medicine, or the thermal qualities of food, spices, herbs from an Eastern Medicine perspective, here are some great books to check out (affiliate links):
The Web that Has No Weaver by Ted Kaptchuk
Healing with Whole Foods by Paul Pitchford
And, if you want to learn about Chinese medicine for pets, here is a great resource: Four Paws Five Directions, by Sheryl Schwartz
And follow my blog for more on Chinese medicine and pet-related topics! www.holistikapet.com