A TCM approach to COVID-19
Updated: Aug 25, 2020
As one might imagine, there has been a lot of research from the acupuncture community, especially from China, regarding the outbreak of coronavirus disease 2019 (COVID-19). In this discussion, I will summarize some of the studies that are making headlines in the Traditional Chinese Medicine (TCM) community.
Before discussing the different acupuncture protocols that are currently being used for preventing, treating and recovering from COVID-19, let me give a quick summary of how this virus attacks the body and how the body reacts when it encounters the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The virus enters the body
This coronavirus, which had not been seen in any part of the world until late 2019, enters the body through the upper respiratory system (nose and mouth) and incubates there for an average of 5 days before it descends to the lungs. At this point, the person is asymptomatic and very contagious. If the virus is not stopped, it will make its way down to the lungs where it will quickly begin its replication process, at which time the person’s immune system begins to respond and the person starts to show symptoms such as fever, dry cough, body ache, fatigue, etc. Up to this point, everything seems to be behaving the way it’s supposed to; the body detects an intruder and the immune system comes to the rescue.
The immune system kicks in
The problem with COVID-19 is that, in most cases – for some unknown reason, the immune system responds to this intruder by releasing a “storm” of signaling molecules that mediate and regulate immunity – a cytokine storm. This excessive or uncontrolled level of cytokine keeps activating more and more immune cells, resulting in the hyperinflammation that is seriously harming and killing patients. Inflammation, the arrival of different types of immune cells to the site of the invasion, is a natural response of the immune system. What is not natural is the amount of immune cells that are coming to the site of the invasion and marking tissue cells as “damaged”.
According to Mukesh Kumar, PhD, a virologist and immunologist at Georgia State University in Atlanta, “when cells sense that there is something foreign, that there is something bad happening, the immediate response of the cell is to kill itself”. He continued by saying: “It’s a protective mechanism so it doesn’t spread to other cells.” In a cytokine storm, like in the case of COVID-19, there are a lot of cells doing this at the same time, destroying a lot of tissue (lung tissue). As the tissue breaks down, the walls of the lungs’ tiny sacs become leaky and fill with fluid, causing pneumonia and starving the blood from oxygen.
A TCM Protocol from China to treat COVID-19
Traditional Chinese Medicine has been used for thousands of years to treat lung conditions, enhance the immune system, reduce inflammation and treat viral infections. TCM is very well positioned to help conquer this new coronavirus. In 2002, when SARS was on epidemic watch, three studies were conducted among medical staff taking preventative Chinese herbs. In total, the studies included a few thousand Asian participants. In all three of these studies, not one of the participants who took the preventative herbs contracted SARS(1).
With the outbreak of this new coronavirus (SARS-Covid-2) causing COVID-19, the “China Association of Acupuncture and Moxibustion” (CAAM) has developed and issued a series of guidelines for acupuncture and moxibustion intervention on COVID-19. (2) The guidelines list three different treatment protocols depending if the patient is trying to prevent the infection, treat the infection, or recover from it.
For the Prevention Stage the goal is to strengthen the Lungs, increase the Defensive Qi, and eliminate the pathogen. For the Clinical Symptoms Stage the goal is to protect the internal organs, strengthen the Qi of the Lungs, strengthen the Qi of the Spleen, and eliminate the pathogens. For the Recovery Stage the goal is to remove any residual toxins, restore the Defensive Qi, promote the repair of internal organs and recover the functions of Lungs and Spleen. For all three stages different points from the Bladder, Lung, Large Intestine, Spleen, Stomach and Ren meridians are chosen and stimulated using both; acupuncture and moxibustion. The exact protocol can be found here. (2)
Acupuncture reduces pro-inflammatory cytokines
As it was discussed earlier, the hyper-inflammation induced by the overproduction of cytokines, is a big problem when dealing with COVID-19. Recent studies show that the most elevated cytokines in COVID-19 patients are: IL-6, TNF-α, and IFN-y. In addition, more severe COVID-19 patients show the following elevated cytokines: IL-2, IL-7, IL-10, G-SCF, IP-10, MCP-1, MIP-1A, and TNF-α. (3)
A study authored by Jiannong W. et al showed that acupuncture at a specific bladder channel point (BL13) may inhibit the excessive production of TNF-α. The same study showed that electro-acupuncture at a specific stomach point (ST36) may reduce the levels of TNF, MCP-1, IL-6 and IFN-y. Another study conducted by L. Li et al found that electro-acupuncture at specific points in the stomach and lung channels (ST-36 and LU5) can increase the oxygenation index and decrease the TNF-α concentration.
Acupuncture strengthens the immune system
Along with an increase of pro-inflammatory cytokines, COVID-19 patients also show low levels of the important immune system T cells: CD3+, CD4+ and CD8+. Several studies have shown that acupuncture can be very effective in increasing levels of T cells. (4) There are many acupuncture points that can be used to strengthen the immune system, but the two most well researched and used are Stomach-36 and Large Intestine-4.
Chinese herbal formulas
One of my professors used to say that “practicing TCM without prescribing herbs is like walking on one leg”. In order to be successful, a practitioner of TCM must include herbal formulas in the treatment plan. I mentioned earlier that when the SARS epidemic hit in 2002, several studies were done in China, including 3 where none of the participants who took the preventative herbs contracted SARS.
Another Chinese herbal formula that was very effective in preventing and treating SARS in 2002-2003 and that is now being used with a lot of success in China with COVID-19 patients is Lianhua-Qingwen (LHQW). This is a 13-herb formula developed from two classical traditional Chinese medicine formulas (Ma Xing Shi Gan Tang and Yin Qiao San), which have a long history of clinical application in the treatment of viral influenza. To no surprise to the herbalists out there, the two main herbs in this formula are: Lian Qiao (Fructus Forsythiae) and Jin Yin Hua (Flos Lonicerae Japonicae). According to the National Center for Biotechnology Information (NCBI), the herbal formula LHQW inhibits the replication of SARS-COV-2 in vitro, and can significantly reduce pro-inflammatory cytokines production (IL-6, TNF-α), which might mediate strong immune response or even the cytokine storm.(5)
Modern research has discovered that the smoke produced by moxibustion is anti-bacteria, anti-fungus, anti-virus and anti-pathogen. Therefore, depending on the tolerance of the COVID-19 patient, the use of moxibustion on certain points is recommended. Alternatively, burning moxa in the room where the patient is could bring a level of disinfection to the room and to the patient.(2)
TCM is one of the best modalities in preventive medicine. If you would like to take preventive measures against getting COVID-19, please make an appointment. For some unknown reason, COVID-19 affects people in different ways. If you have tested positive, and you have no symptoms, or your symptoms are minor, please make a telemedicine appointment so that I can evaluate your symptoms and prescribe some Chinese herbs and recommend some acupuncture points for you to stimulate on your own, using either acupressure or moxibustion.