Repulse the Monkey/ Stay out of the Hospital

April 12, 2020 Joe Brady

According to one of the Tai Chi Classics (Sun Tzi’s Art of War) and my teachers in New York City’s China Town, “When you are gettin’ your butt kicked, stay close to home and fortify your defenses.”  If you catch the COVID-19 you may be in for a rough time.  Here is the best advice we can find on how to treat yourself at home if you do get sick, and how to tell when it is time to go to the hospital.

Taking care of yourself at home

80% of COVID-19 cases are mild and require no hospitalization. Isolation at home is the recommended protocol, however, if the infection progresses to shortness of breath, immediate medical attention is advised. Supplemental oxygen and a ventilator may be needed.

Much of the current treatment protocols involve mainly supportive care, so Traditional Chinese Medicine (TCM) was called in to provide support in China. So far, TCM is incorporated in over 90% of COVID-19 patients in China. In this article, you will find the current recommendations for caring for COVD-19 patients at home, whether it is you or a loved one. Recommendations from a western medicine perspective are also presented, along with more detailed home treatments that have been used in China.

If you become sick, Keep Others Safe

  1. Wear a Face mask  

During the COVID-19 pandemic, medical-grade face masks are reserved for healthcare workers and some first responders. You may need to improvise a cloth face-covering using a scarf or bandana.

  • Cover: Cover your mouth and nose with a tissue when you cough or sneeze.
  • Dispose of: Throw used tissues in a lined trash can.
  • Wash hands: Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.

2) Stay Home (except to get medical care)

  • Stay home. Most people with COVID-19 have mild illness and are able to recover at home without medical care. Do not leave your home, except to get medical care. Do not visit public areas.
  • Stay in touch with your doctor. 
  • Call to verify that scheduled medical care visits have not changed. Many medical visits for routine care are being postponed or done by phone or telemedicine. If you have a medical appointment that cannot be postponed but you think you are sick, tell the doctor’s office when you call that you may have COVID-19. This will help the office protect themselves and other patients.
  • Wear a cloth face covering over your nose and mouth if you must be around other people (even at home.)
    • Stay Away From Others
      As much as possible, stay away from others. You should stay in a specific “sick room” if possible, and away from other people and pets* in your home. Use a separate bathroom, if available.
      *See COVID-19 and Animals is you have questions about pets.

4) Avoid shared transportation
Avoid using public transportation, ride-sharing, or taxis.

5) Clean all “high-touch” surfaces every day

6) Monitor your symptoms 

Common symptoms of COVID-19 include fever and cough. Additional warning signs include:

  1. Trouble breathing is a more serious symptom that means you should get medical attention.  Call ahead.
  2. Persistent pain or pressure in the chest
  3. New confusion or inability to arouse
  4. Bluish lips or face
  5. Other – This list is not all-inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

Emergency Home-Care Kit

Wall Street Journal talked with experts, including Mark Hyman, head of innovation at the Cleveland Clinic Center for Functional Medicine, and asked him to offer guidance to readers on how to assemble a COVID-19 emergency home-care kit. I, Joseph Brady, have added some modifications for Traditional Chinese Medicine.  Even Dr. Hyman recommends some Chinese herbs. For the original article in the Wall Street Journal, click the link at the bottom. https://www.wsj.com/articles/what-to-put-in-a-covid-19-emergency-home-care-kit-11585861195

Medical supplies:

  • Cough drops. Herbal Cough drops are fine, Chinese Medicine has some particularly good ones like Lo Quat Syrup or lozenges.
  • Over-the-counter cold medicines; Many western over the counter decongestants contain the Chinese herb Ma Huang or Chinese Ephedra a major ingredient in the herbal formulas used in China. In cough medicines look for ones that use the Chinese herb Feng mi or honey a natural expectorant.
  • Pulse oximeter and batteries (there is a pulse-oximeter app available for the iPhone, but none of the doctors we spoke to recommended it) these are a little expensive usually around $70 but great to have. Typically if your oxygen levels fall to 90 it’s time to call the doctor. If oxygen falls below 88 it’s time to get to the emergency room. 
  • Saline nasal spray
  • Thermometer
  • Tylenol/acetaminophen (children’s or infant’s versions if applicable.) Although not proven yet, reports from France indicate that ibuprofen may make symptoms worse. (In November 2019, my pulmonologist also discouraged the use of ibuprofen for asthma.)

Shennong’s, Ben Cao, The Chinese Medicine Pharmacopia

Dr. Hyman’s Ginger, Lemon and Honey recipe mentioned above dates back to one of the earliest Chinese medical books, Shen Nong’s Classic of Herbal Medicine. The original text no longer exists, but researchers believe the text is a compilation of oral traditions written between about 200 and 250 C.E. [1][2] It is said to have been composed of three volumes containing 365 entries on herbs and their descriptions.

The first volume of the treatise included 120 drugs harmless to humans. These herbs are described as “noble” or “upper herbs” (上品). Most of these herbs are available in Asian supermarkets and are considered foods.

The second volume is devoted to 120 therapeutic substances intended to treat the sick, but have potentially toxic properties of varying degrees. The Herbs of this group are described as “middle herbs” (中品). This category contains herbs like ginger that may not always be appropriate and can be contraindicative in some circumstances.

In the third and final volume, there are 125 entries corresponding to substances that have a strong or violent action on physiological functions and can have side effects. These herbs are referred to as “low herbs” (下品).

We will focus on the “noble herbs” and “middle herbs” that are commonly available and easy to use.

Food and the “Noble Herbs” help tonify energy

  • Eat healthily and regularly. You’ve got to keep your strength up.
  • Chicken soup or vegetable broth, Mark Hyman, head of innovation at the Cleveland Clinic Center for Functional Medicine adds “…Never underestimate the power of chicken soup…Protein is very important when fighting viral illnesses.”
  • Daily multivitamin and vitamin C tablets. Many doctors will recommend a daily multivitamin and vitamin C tablets.
  • Electrolyte-replacement drinks (if using sports drinks, cut in half with water)
  • Herbs from the produce department: fresh ginger, lemons, dill, fresh or dried oregano*
  • High-calorie, nutrient-rich foods like avocados
  • Honey for throat soothing 
  • Pectin-rich foods like bananas and apples to ease symptoms of diarrhea.
  • Jook or congee (cream of rice cereal) in traditional Chinese medicine also helps with diarrhea (the rice is very binding) and also helps to drain damp from the lungs and tonify digestion.  Jook was and still is used in Wuhan throughout the illness. Eating something warming, easy to digest and mild provides the body with much-needed energy while being very easy to digest that’s why they feed rice cereal to babies.
  • Apple sauce and avocados. Some patients tend to lose their appetite when sick, have comforting, high-calorie but nutrient-dense foods like apple sauce and avocados on hand.

Clear Heat Control Fever

Only high temperatures kill a virus, so let your fever run a little high. Tylenol will bring your fever down but that allows the virus to live longer. They are saying that Ibuprofen, Advil, Aleve, Motrin, etc. can possibly exacerbate the virus. Use common sense and don’t let a fever go over 103 or 104. If it gets higher than that, take your Tylenol, not Ibuprofen or Advil (or any type of anti-inflammatory drugs ) to keep it regulated. It helps to keep your house warm and cover up with blankets so your body does not have to work so hard to generate the heat. It usually takes about 3 days of this to break the fever. Once the fever breaks, start moving around to get the body back in shape and blood circulating.

Many Chinese herbs clear heat and lower fever as well. They accomplish it by promoting sweating your body’s natural way of ventilating heat and thus adjusting the body temperature; heat-clearing herbs act in the same way.

Clear heat with Anti-inflammatory Foods

Our diets play an important role in inflammation because our digestive bacteria release chemicals that may spur or suppress inflammation. The types of bacteria that populate our gut and their chemical byproducts vary according to the foods we eat. Some foods encourage the growth of populations of bacteria that stimulate inflammation, while others promote the growth of bacteria that suppress it. 

Fortunately, you are probably already enjoying many of the foods and beverages that have been linked to reductions in inflammation and chronic disease. As long as you are not allergic to any of these foods or beverages, they include the following: 

  • Fruits and vegetables. Most fruits and brightly colored vegetables naturally contain high levels of antioxidants and polyphenols – potentially protective compounds found in plants. 
  • Nuts and seeds. Studies have found that consuming nuts and seeds is associated with reduced markers of inflammation and a lower risk of cardiovascular disease and diabetes. 
  • Beverages. The polyphenols in coffee and the flavonols in cocoa are thought to have anti-inflammatory properties. 
  • Green tea is also rich in both polyphenols and antioxidants. 

For additional advice about ways to reduce inflammation, read Understanding Inflammation, an online guide from Harvard Medical School.

Release the exterior

Yin Qiao is a classic Chinese herbal formula that “releases the exterior”. It contains two herbs that help induce sweating. honeysuckle and forsythia.

Drinking chicken soup and ginger tea also helps the physiological actions of inducing sweating and ventilating the lungs are indispensable in the treatment of this disease.

Moisten the Lungs while Draining Damp

Drink plenty of fluids

  • Water – As with any flulike virus, it is important that you drink plenty of fluids. Occasionally, COVID-19 can cause gastrointestinal distress and diarrhea, and replenishing fluids in those cases is especially important, as dehydration can worsen a fever. 
  • Electrolyte-replacement drinks are recommended, but popular sports drinks like Gatorade tend to have high amounts of sugar. Pedialyte is better.

The body is going to dehydrate with the elevated temperature, so you must rehydrate yourself regularly if you get yourself dehydrated the mucous gets thicker and harder to expectorate. The surface of lung cells in critically-ill patients is covered by a layer of mucus secreted from the infected cells. This fluid buildup is very harmful as it prevents the efficient exchange of oxygen and carbon dioxide in respiration. It is critical to clear the mucus as it can lead to a cytokine storm where the fluid keeps building up until the patient cannot breathe at all. Keeping the body well hydrated and many Chinese herbs can help get rid of the mucus. This is again a critical function in the official formula Qing Fei Pai Du Tang.

You must keep your lungs moist. This is best done by taking long steamy showers on a regular basis. If you’re wheezing or congested, use a real minty (Chinese herb Bo He) toothpaste and brush your teeth while taking the steamy shower and deep breaths through your mouth. This will provide some bronchial dilation and help loosen the phlegm. Force yourself to cough into a wet washcloth pressed firmly over your mouth and nose, which will cause greater pressure in your lungs forcing them to expand more and break loose more of the congestion.

  • Green Tea (Black Tea)

The disease preventive properties of green tea are mainly due to the presence of polyphenols. These polyphenols comprise about one-third of the weight of the dried leaf of the plant. These are antioxidative, anti-inflammatory, anticarcinogenic, antimutagenic and antimicrobial effects. Green tea has the ability to enhance humoral and cell-mediated immunity and is, therefore, useful for preventing influenza by inhibiting flu replication, using potentially direct virucidal effect [108].

  • Ginger, Lemon, and Honey Tea

Ginger or Sheng Jiang  (Rhizoma Zingiberis Recens) is listed in Shen Kong’s classic as a “middle herb” because it is so spicy it may be inappropriate with hot burning kind of sore throat.

Doctor Hyman recommends adding dill, oregano and ginger to soups for their antiviral properties. Also, one of Dr. Hyman’s favorite home remedies is his “cold-buster tea” (which has actually been around in TCM for centuries): Take a 2-inch chunk of fresh ginger root, sliced thin. Boil it in a pot of water for several minutes. Add fresh lemon juice, honey and cayenne pepper. Steep for five minutes. “It becomes this spicy, sweet and tangy thing,” he says. “It’s great.”

According to one text, the Ming Yi Bie Lu (Miscellaneous Records of Famous physicians) the legend has it that one day when Shennong was collecting herbs, he accidentally took in a poisonous mushroom and fainted due to pain.  He regained consciousness after a while and found that the place he was lying had a cluster of green plants with pointed leaves.  He noticed that the plant possessed a very strong aroma, and felt very refreshed after smelling it.  Shennong believed that the plant’s aroma woke him up, so he took some of its root and started chewing.  His stomach began growling which then led to diarrhea.

Shennong felt relieved from the pain afterward clearing his colon and decided to give a name to this herb for its magical role.  Since “Jiang” was Shennong’s last name, he named this herb “Sheng Jiang”, meaning bringing him back to life.

http://www.suntenglobal.com/_en/News-Datain.php?id=431

Ginger is a natural spice that is used in diverse regions around the world to add a pungent flavor to food, but ginger is also used as an herbal medicine for common health problems. 

Where is the evidence for ginger’s healing qualities? In one systematic review of randomized controlled trials (RCT’s) regarding the efficiency of ginger, researchers found it had clinical effects on

  • nausea and vomiting 
  • gastrointestinal function
  • pain, inflammation
  • metabolic syndromes, and other symptoms

Ginger has also been shown to be effective in a majority of studies, including those that examined the alleviation of NVP, digestive function, improvement in the expression level of markers for colorectal cancer risk, and anti-inflammatory functions. Additional research trials showing ginger’s benefits can be found at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019938/

Compounds in ginger also increase levels of antioxidant enzymes, including superoxide dismutase and glutathione peroxidase, which may be beneficial in inflammatory reactions triggered by viral infections [63]. Anti-influenza agents have been isolated from Z. officinale. TNF-α, reported as anti-influenza cytokine, has been reported to be present in ginger [64].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957173/

Qing Fei Pai Du Tang 

The official Chinese herbal formula being used in China for treating COVID-19 is Qing Fei Pai Du Tang. This formula is not a cure but is keeping people out of the hospital by supporting the body in its fight against the virus. It contains many middle herbs, but nothing particularly toxic. Qing Fei Pai Du Tang was developed by combining the data from hundreds of Chinese hospitals and then using Artificial Intelligence and the principles of Traditional Chinese medicine to perform all of the functions mentioned above. 

It actually is a combination of four classical formulas that have been safely used for centuries in China. Those four classical formulas are (from the Shan Hun Lun a classical Chinese medicine textbook on epidemics and plagues):

Ma Xing Shi Gan Tang

She Gan Ma Huang Tang

Xiao Chai Hu Tang

Wu Ling San 

* Note for practitioners in the U.S.: Substitutes for Ma Huang and Xi Xin are Jing Jie, Fang Feng, Bai Qian, Zi Su Ye, Qiang Huo, and/or Jie Geng.

Other formulas that can be substituted are Ge Gen Tang, Xiao Qing long Tang, Gui Zhi Tang, Fu Ling, Bai Zhu, Shi Gao.



Finally, let’s take a deep breath and talk about breathing.

Tonify Qi… Ventilate the Lungs

Practice Qi breathing or other deep breathing exercises on a regular basis. Even when it’s hard. the deeper you breathe, the less likely you are to develop pneumonia. Respiratory therapists like pursed-lip breathing can really help. That’s breathing in deep and slow, then exhaling through tight lips as if you’re blowing out a candle. Blow until you have completely emptied your lungs and you will be able to breathe in an even deeper breath. This helps keep the lungs expanded, as well as increase your oxygen level. Singing, playing the harmonica and even arguing with your spouse will improve your oxygen levels.  Singing or chanting is probably more copacetic.

Tonify Qi… Support Oxygen Levels in the Blood

Reduced levels of blood oxygen saturation cause shortness of breath and may lead to respiratory failure. Chinese medicine has some evidence that herbs like Sheng Mai Yin and Ginseng can help improve the levels of oxygen saturation. This type of Chinese herbs in TCM are known as Qi (vital energy) tonics, which work by helping improve energy levels and physical endurance. The Qi breathing exercises help a lot to keep the lungs clear. Also important is to sit up or prop yourself up with some pillows. Lying down flat can cause fluid to stagnate in the lungs and increases congestion. It is much better if you don’t lie down flat it will be harder to breathe. When you feel up to it you can help keep the lungs clear by walking around every once in a while, not far not strenuously but just enough to keep some blood and fluids moving.

Limited Clinic Hours and Outside Safe Distance Tai Chi
We have been deemed essential healthcare workers by the City of Denver, but the City is discouraging treatments.  So, we are opening the clinic on a limited basis for herb pickup and consultations. Counseling and consultations can be scheduled online on Zoom. Call the clinic directly (303) 744-7676 if you have a medical concern, would like to schedule a meeting online, or if you have any questions about anything else in this important blog. If you are interested in the outside Safe Distance Tai Chi, also feel free to call us for the schedule.

Thanks and stay safe, 

Joe and Jacqui

P.S. If you’re still not improving, then go to the ER.