Anxiety and Depression in Ayurveda

Anxiety and Depression in Ayurveda

For those of you that missed it, here’s a recording of my recent free lecture on anxiety and depression, from April 1 2021. First given at the AHG Symposium in 2018, this lecture provides a practical review of yuktivyapāśraya cikitsā (i.e. rational therapy), sattvāvajayacikitsā (i.e. behavioural therapy), and daivavyapāśraya cikitsā (spiritual therapy). This lecture will also incorporate the use of entheogenic and psychedelic therapies, which I have been using in my practice for a decade.

Dealing with cold and flu season

Dealing with cold and flu season

(pictured above Ligusticum canbyi) 

Well, it’s that time of year, and people are dropping like flies. Why is it that almost everyone succumbs to sickness during that fall, and how can we prevent it?

From the perspective of medical science, a cold or flu is caused by one of over 200 different viruses, most commonly one of the rhinoviruses, coronaviruses, influenza viruses or the adenoviruses. Typical symptoms include cough, sore throat, runny nose, sneezing, and fever, and while most people get better in about seven to ten days, some symptoms can last up to three weeks or longer.

While the science isn’t clear, it is generally thought that susceptibility to viral infection occurs during this time due to factors such as decreased humidity, which increases viral transmission rates by allowing tiny viral droplets to disperse farther and stay in the air longer, as well as the fact that most of use spend more time indoors, which enhances viral transmission. But apart from that, medical science doesn’t have too much to say, and when it comes to treatment and prevention, there are few options, including the flu vaccine that researchers say provides only a modest benefit at best, with a small risk of certain diseases including Guillain-Barré Syndrome. Thankfully, we have other options. But before we review these, let’s look at why we get sick.

Is the common cold caused by cold?

For almost a hundred years now doctors have dismissed the idea as an “old wive’s tale”, that it is exposure to cold weather that causes the common cold. Given my healthy respect for “grandma wisdom”, I have always railed against such an attitude, not only because it easily dismisses this kind of non-technical assessment, but also because it denies the very experience of getting a cold, which itself FEELS cold! Thus, despite the non-technical use of the term “cold”, it is a term that defines not only the experience but the basic pathology, which relates to a down-regulation of the bodily heat, and the diminishment of the immune response which relies upon this heat to function. I think it is important to honour the language of disease, because even simple words like “cold” not only tell us about the experience itself, but provide clues for treatment. Likewise are our use of idioms such as “venting the spleen”, which allows to connect emotions like anger and frustration to the health of the visceral organs. After all, when you feel frustrated and angry, where do you feel it? In some discrete part of your cerebral cortex, or in your belly? In this way, simple terms like catching a “cold” provide us with more information than we might immediately be aware of.

Dispelling the cold

It is no co-incidence that we catch colds more frequently during the fall and winter. In the classical system of medicine of India, called Ayurveda, the period from the summer solstice to the winter solstice is called the “dakshinayana”, when the north pole tips away from the sun and the northern hemisphere is plunged into increasing darkness. It is said that during the dakshinayana the empowering influence of the sun diminishes, and in response all life hunkers down to wait out the season of death and dissolution. Thus during the dakshinayana the dominant quality is one of coldness, and thus it should be no surprise that archetypal diseases such as “cold” become more dominant. Part of this relates to our growing inability to synthesize vitamin D3 from sunlight, and with diminished vitamin D3 production immune function begins to weaken.

Here in Vancouver, we stop producing vitamin D around mid-September, when the shadow cast by your shadow at mid-day (when the sun is highest in the sky) is now longer than your height. The low angle of the sunlight means that too much ultraviolet B light is filtered out by the atmosphere, and without sufficient UVB, the body cannot produce vitamin D3. Thus traditional fall/winter foods such as marrow broth, little oily fish (e.g. smelts and herring), liver and blood pudding are relied upon to help boost vitamin D levels, although because many people don’t eat these foods regularly, they don’t get their full benefit. This is why for most people supplementing with vitamin D3 is a good idea, and to this end I recommend liquid vitamin D3 drops that contain 1000 IU per drop, usually in the neighbourhood of around 3-5 drops per day (3000-5000 IU).

Not everyone gets the full benefit of an oral dose, however, particularly if you suffer from chronic diseases of the digestive tract and liver, including malabsorption issues. Thus I frequently recommend topical administration, either as a transdermal cream, or the judicious use of sun-beds. While the latter might raise some eyebrows, there is a growing body of evidence that a non-erythemal dose, i.e. not allowing the skin to even become slightly pink, is an excellent way to boost vitamin D3 status. There is further evidence that UV light not only promotes vitamin D synthesis, but is an independent factor in supporting immune function generally. Thus there should be little surprise that judicious UVB exposure may be helpful in autoimmune diseases such as Crohn’s disease.

The exposure of our bodies to UVB light is exactly the way we evolved to manufacture vitamin D3, and when we do, we provide many more sites for vitamin D synthesis and metabolism than a simple oral dose, including the involvement of other tissues such as the prostate, colon, skin and osteoblasts. Besides which, the judicious use of sunbeds provides very clear psychological benefits in Seasonal Affective Disorder, and guess what – it WARMS you up. Since I have been visiting a solarium once a week, from Oct-March, I haven’t had a cold in 10 years. The key issue, however, is NOT TO TAN, as this defeats the purpose by increasing melanin production, which inhibits your ability to absorb UVB light and blunts its benefit in the body. Over the long term, however, it is probably better to rely upon the sun for vitamin D synthesis (e.g. tropical vacation), and find a balance of other options that suits your individual needs.

Preventing ama

In Ayurveda, the underlying pathogenesis for the common cold relates to poor digestion, and the production of a waste product called “ama”, which literally means undigested food. Viewed as a kind of detritus that interferes with digestion, ama can mobilize from the digestive tract into circulation, where it interferes with the proper nourishment of cells and the elimination of cellular and lymphatic wastes. According to Ayurveda, ama is associated with the qualities of heavy, cold, greasy, sticky and slow, and it is easy to see how these qualities could impair both digestion and metabolism.

The primary cause for the accumulation of ama is weakness of digestion, and/or eating foods which increase the qualities of heavy, cold, greasy, sticky and slow in the body. These qualities promote symptoms such as lassitude and inertia, coldness, poor circulation, mucus congestion, poor appetite and indigestion, all of which are prominent symptoms with a cold or flu. Thus the best way to prevent as well as treat the common cold, is to stop the accumulation of ama, which includes avoiding all the foods that promote the qualities of heavy, cold, greasy, sticky and slow. This means avoiding excessively greasy and fatty foods unless your digestion is very strong, as well as congesting foods such as flour products, dairy and sweets.

In particular, watch for minor symptoms of congestion, such as increase in mucus, and take appropriate measures in hand to prevent the accumulation of ama. In Ayurveda, this includes not only avoiding those heavy and congesting foods, but actively eating foods and beverages to warm and stimulate the body, such as ginger tea, Mulligatawny soup and a spicy Kitchari.

Destressing

Immune function is influenced by the health of our nervous system, and when we’re stressed and tired, our immune system begins to suffer. Energy is energy is energy, and if you are using up all your vital energy rushing from hither to thither, trying to keep up with work load, commitments and family, you shouldn’t be too surprised if you get sick. It is said in Ayurveda that the dakshinayana takes “energy away from the people”, and so we need to respect the fact that we are simply more susceptible to illness and disease in the fall. Partly this relates to the dynamics of doshas in Ayurveda, and the natural increase of vata during the autumn. This period is marked by dissolution and deficiency, and we need to take active measures to protect our vital energy. According to the ancient Indian physician Charaka, the most important way to do this is to avoid stress and worry, which perhaps sounds easier than it is, but it is a recommendation by Charaka to take some time to go within and destress the mind. Options include activities such as yoga, meditation, and tai qi, as well as fun ways to release stored anxiety in a creative way, through activities such as dance, art, singing, poetry, and music. In this way, the dakshinayana is a time to go within, and recharge the emotional batteries.

Herbs for colds and flu

According to Charaka, another way to preserve the vital energy is to take herbs that protect the heart and promote circulation. In Ayurveda, however, this means something a little bit different, as the heart isn’t viewed simply as a mechanical pump, but also as the seat of the mind and emotions. Thus herbs to calm the mind and enhance vitality are definitely indicated during cold/flu season to stay healthy. In my clinic, I often give patients my “Immune formula” to stay healthy, which includes an assortment of herbs used in both Ayurveda and Chinese medicine to boost immune function and calm the mind. Some of the herbs in this formula include Reishi mushroom, Astragalus root, Schizandra berry, Siberian Ginseng root, Ashwagandha Myrrh resin, and Licorice root. And while I don’t use this formula to treat colds/flu, some of the herbs may be very helpful. For example, during the SARS outbreak of 2002-2003, one of the more effective remedies to inhibit the cytokine explosion that was killing otherwise healthy patients was a component of Licorice root.

My favourite go-to remedies for cold and flu are all those which are warming, opening and clearing in action. Remember, we are dealing with a COLD, and so most of our remedies need to be spicy and warming. Examples include Bayberry bark, Ginger root, Prickly Ash bark, Cinnamon bark, Black Pepper fruit and Peppermint leaf. These are all good remedies for nascent symptoms, when you just start to feel yourself getting sick. But if it progresses further, then you may need to kick it up a notch, and add in some stronger antiviral remedies such as Lomatium root, St. John’s Wort flower, Canby’s Lovage root (pictured at the top), and Echinacea (angustifolia) root. Usually this will take care of the major symptoms, but if you just can’t beat it and it descends into your chest, causing a cough, then we need to alter our strategy, adding in expectorants and cough remedies such as Mullein leaf, Wild Cherry bark, and Elecampane root, and if the cough gets real bad, herbs such as Cottonwood bud, Gumweed leaf/flowers or Lobelia leaf. For kids up at night with a chronic cough, a little bit of Lobelia, or even Ephedra (Ma Huang, in small doses) mixed with a herb like Licorice can help to ease cough and promote a restful sleep.

In addition to these measures, I am really big on inhalant therapies, using essential oils such as Fir, Pine, Cedar, Spruce Cajeput, and Eucalyptus. These can be used with a hot pot of water and a towel, or, you can use a bed-side warm-mist humidifier that has a medicated well, using about 1/2-1 tsp of the oils per session. Similarly aromatic topical therapies are also helpful, not least the old-fashioned “mustard plaster”, prepared by grinding up mustard seeds and mixing with a little water, and then applying this to the chest and back, over top a piece of wax paper. The powerful essential oils in the mustard seed will pass through the paper and migrate into the lung tissue, where they exert both a strong antimicrobial effect, as well as ease coughing. Remove the plaster after 10-20 minutes, or when the area underneath becomes reddened.

While this is by no means an exhaustive review of the treatment of cold and flu, hopefully you’ve learned some valuable tips to stay healthy this season. For more information, please check out my page on Cold, Flu and Fever.

COVID-19 Video Blog

COVID-19 Video Blog

Hello everyone!

This is our COVID-19 Video Blog page. Here you will find all of the video blog posts we have published on the subject of COVID-19. The newest videos appear first.

If you have any questions please ask on our Instagram or Facebook pages, or send us an email at study@legacy.dogwoodbotanical.com.

Part five:

Part four:

Part three:

Part two:

Part one:

Herbal medicine and COVID-19

Herbal medicine and COVID-19

Shortly before we began the Ayurveda in Nepal program in February, details on what was initially called the Wuhan virus were just beginning to emerge, and I began to receive a lot of questions about what people should do to prepare for it. Given that I’ve been so busy in the Nepal program I haven’t had much time to write anything on the subject. Now that the program is over and I’m spending a few days at the beach in Kerala, I have a little more time to share my thoughts on COVID-19. Part of my hesitation is that there has been so much written on the subject that I really didn’t want to play into the whole “disaster porn” narrative that is so prevalent. Now, as more facts have emerged, I feel it’s probably a good time to share my thoughts on the subject.

What is the coronavirus?

Although I don’t pay too much attention to social media, there is a lot of speculation on the source for the coronavirus including a conspiracy theory peddled that it is a bioweapon developed by either the Chinese or US governments to target each other’s population. It’s easy to understand that such conspiracies may develop simply because the field of virology is relatively recent, and viruses occupy a weird place in biology, as obligate intracellular parasites that aren’t actually living, but like a demonic force, require a living body in which to replicate itself. Not completely understanding what viruses are and how different strains arise is a cause of much of the ignorance and fake news that is so pervasive on the internet.

As one among many different types of viruses, the coronavirus (CoV) was only discovered in the 1960s, but has likely been around for millions of years, naturally hosted in bat, rodent, and bird species, thought to spread to humans through intermediate hosts such as pigs, camels, civet cats, and cattle. It derives its name from a fringe of viral particles that surrounds the virus, giving it the appearance of a crown (“corona” in Latin). Soon after it’s discovery it was found that some strains of CoV were a viral factor in the development of the common cold, causing relatively mild symptoms such as runny nose (rhinitis), sore throat, fever, and cough, but in immunocompromised people can progress to cough and pneumonia, and can even be fatal. As virology has progressed other the last 60 years a number of other strains of CoV have been identified and their genome mapped. Each season during winter and spring when infection becomes more common, scientists see these same CoVs causing problems such as cold and flu with some regularity. 

Every so often, a new strain of CoV makes itself known. In 2003 a novel strain of CoV later identified as SARS (severe acute respiratory syndrome) resulted in severe illness marked by systemic symptoms of muscle pain, headache, and fever, shortly followed by the onset of cough, difficulty breathing, and pneumonia. Although only about 8000 people were infected over 2003-04, it had a fatality rate of about 10%, and in patients over the age of 60 a mortality rate that approached 50%. Likewise in 2012 another novel CoV developed in the Middle East, later identified as MERS (Middle-East respiratory syndrome) CoV that caused even more severe illness, but because the virus wasn’t shed as easily, the transmission rate was much lower. Unlike SARS, however, which eventually became dormant, MERS continues to cause illness, and as of December 2019, there have been almost 2500 confirmed cases of MERS-CoV infections since it first appeared, with a mortality rate of approximately 34.5%.

Like SARS and MERS, the COVID-19 is another novel coronavirus that scientists hadn’t seen before, and like the 2003 SARS virus was thought to have originated in China. Specifically, it is thought that COVID-19 developed in one of the so-called “wet markets” in Wuhan province in China, where vendors selling exotic wild animals such as civet cats are packed into a small area. Due to lack of proper hygiene or regulation, it is a perfect breeding ground for contagious illness. The virus began to be active in humans in late 2019 and the number of infections grew dramatically over a short period of time. By early 2020 the viral genome had been sequenced and identified as being closest to a SARS-like coronavirus strain naturally found in bats called BatCov RaTG13. Initially the virus was named SARS-CoV-2  but due to the public confusing it with the 2003 SARS virus, the WHO officially named it COVID-19 on Feb 11 2020.

We’ve all born witness to the rapid spread of this virus in China, and as the weeks have progressed, we are now seeing the illness spread well beyond its borders including other Asia countries (e.g. South Korea), the Middle East (e.g. Iran), Europe (e.g. Italy) and now North America. Only in the last few days has the WHO declared the illness a pandemic and this has predictably triggered some irrational behaviors by various governments, including the US, which in turn is having a significant impact upon the global economy. Many countries dependent on tourism for example, have seen a dramatic decline in visitors, and there is a good chance – especially with the recent losses in the stock market – that COVID-19 will trigger a major recession. The upside, however, is that all this inactivity has had a favorable impact on the environment – particularly in China – where the government’s response to COVID-19 is thought to be responsible for a 25% reduction in greenhouse gas emissions. Hopefully this not a sign of what needs to happen to bring the human relationship with the earth back into balance.

While I do think there is reason for concern, there is clearly a lot of fear when it comes to COVID-19, and I believe some this is due to the WHO and media outlets reporting an artificially high fatality rate. In a normal year, influenza has a fatality rate of about 0.1% in developed countries such as the US, but according to WHO data, the fatality rate for COVID-19 is hovering around 3.4%. If this is the true mortality rate for COVID-19 this would be very worrisome indeed, but it appears that this is not an accurate reflection of the actual number of cases. The data I have seen suggests that most of the confirmed COVID-19 cases are moderate to severe in nature, and like influenza, seems to be affecting primarily older patients that have pre-existing conditions including cardiovascular, respiratory, or immunological issues. Unlike the H1N1 influenza virus that was responsible for the pandemic of 1918, or the more recent “swine” flu of 2009, COVID-19 doesn’t seem to cause a “cytokine storm”, where the immune systems of otherwise healthy individuals becomes hyper-stimulated and triggers severe illness. In fact, it appears that more than 80% of people infected with COVID-19 experience very mild to no symptoms at all. Early on in the COVID-19 story, epidemiologists such as Dr Michael Mina were suggesting that the true infection rate in China was well over a million, which if accurate, brings the fatality rate for COVID-19 down to about the same as seasonal influenza. 

While there are still a lot of unknowns, the closest thing we have to a controlled study is the pattern of COVID-19 infection on the cruise ship the Diamond Princess, which shortly returned to port in Yokohama just after it was discovered that a passenger had the illness. Of the 3,711 passengers and crew members on board, 705 became infected (~19%), with about half showing symptoms and the other half showing no symptoms at all. The population most affected were those over the age of 70, and as of March 14 2020 a total of seven passengers have died – all over the age of 70 – bringing the fatality rate in those infected to about 1%. While this isn’t as high as the 3.4% fatality rate that is being reported for COVID-19, it is about 10 times higher than seasonal influenza. One big concern is that COVID-19 is significantly more contagious than influenza, and so we’re likely going to see a very large spike in the number of infected people – particularly as testing becomes more available. It’s also important to note that COVID-19 is targeting people with pre-existing health issues, and for patients over the age of 70 in poor health the fatality rate may be as high as 8-15%.

What can we do to prevent coronavirus?

Like all other infectious diseases, the most important factor to prevent the spread of coronavirus is proper hygiene. It appears that COVID-19 is spread from infected persons via respiratory droplets and other bodily secretions, including mucus, saliva or feces, whether or not they have symptoms. These viral particles are then introduced into the body by penetrating mucus membranes and other exposed surfaces including the eyes, nose, and mouth. Thus to prevent exposure, one of the best things to do is to wash your hands with warm soapy water on a regular basis, and avoid touching the face or any other exposed body parts with unclean hands. The reason why masks may not be effective to stop the spread of coronavirus is because in taking the masks on and off, or if they are being reused, we may be reinfecting ourselves. Apart from proper hygiene, the practice of social distancing is recommended, making sure to keep at least 3-5 feet away from others, using the Asian-style bow, Indian-style folded hands, or touching one’s heart instead of shaking hands, hugging or kissing. Likewise it’s important during this time to avoid large crowds and busy places, and if you display any symptoms, to stay at home until you’re better. If you are around others, make sure to wear a mask to avoid spreading infectious viral particles.

How can we treat coronavirus?

While I believe Western medicine has a good handle on how to limit the spread of coronavirus, when it comes to treatment there are precious few options available, and this is where I believe that traditional systems of medicines have a lot to offer. Given that this virus appears to be targeting mostly older and immunocompromised people, as well as those suffering from comorbidities, the best thing you can do to prevent serious illness is to get healthy by following a proper diet and lifestyle (e.g. stop smoking, exercising),  making sure to have access to clean air, water, and plenty of sunshine to replenish vitamin D3 levels. In all systems of traditional medicine the primary factor underlying seasonal illness is the presence of congestion, i.e. kapha/ama, phlegm/dampness, canker, etc. Therefore, it is important to take measures to prevent the accumulation of this congestive factors, and avoid any habit that produces an increase in mucus, causing the coating on the tongue to become thicker, or weakens the appetite. The best foods to eat during this time are those which are warm, soupy, light, and not too greasy, e.g. soup, kitchari, steamed vegetables, etc. Several years ago I wrote a rather extensive piece on dealing with cold and flu season; if you haven’t seen it, I suggest checking it out.

For most people, infection with the coronavirus is limited to an upper respiratory infection, causing symptoms such as runny nose, nasal congestion, and sore throat, often accompanied by some degree of bodily fever, body ache, and sometimes a dry cough. While unpleasant and uncomfortable, nothing about these symptoms is dangerous, as they represent first-line defense mechanisms the body uses to inhibit viral infiltration and replication. The real danger is when the infection descends down into the lungs causing inflammation and secondary infection, progressing from the typical cold/flu symptoms to pneumonia. In most cases this is caused because the patient aspirates (inhales) their own infected nasal secretions. Thus one of the more effective measures to inhibit this is a combination of inhalant therapies and using specialized techniques such as nasya. Inhalant therapies can be both active and passive in nature: inhaling steam medicated with essential oils such as lavender, eucalyptus, and spruce, and using bedside humidifiers at night. 

Nasya is a very helpful technique to cleanse and purify the upper respiratory tract.

To inhibit auto-infection from the nose, nasya is a fantastic technique that makes use of a medicated oil dropped into the nose to gently irritate, stimulate, and decongest the nasal and sinus mucosa, thinning the mucosal secretions, which are then expectorated from the mouth. For this purpose, a medicated oil can be made with decongesting herbs, as per the following formula:

  • 2 parts bayberry
  • 2 parts neem
  • 2 parts mullein
  • 2 parts ginger
  • 2 parts licorice 

Make a decoction of the herbs using one part cut/sifted herb (by weight), to four parts sesame oil (by volume), to sixteen parts water (by volume), and reduce down to four parts oil. You can test for it being ready by wetting a cotton wick in the oil, and setting this alight. If the flame burns without a crackling sound, it is done. If not, the preparation should be cooked a little longer. After it’s ready, strain through some linen or cheesecloth to filter out the herb material. If this is too difficult or time-consuming, other ready-made nasya formulations can be used such as Anu taila or Shadbindhu taila. When using any medicated oil for nasya, the general rule is to use 2-3 drops instilled into each nostril, twice daily before eating, making sure to expectorate any oil or mucus that comes to the mouth, and follow application by breathing practices such as nadi shodhana (anulom-viloma).

Coronavirus and pneumonia

If the coronavirus infection does extend down into the lower respiratory tract, it can result in pneumonia, an inflammatory condition of the lung that primarily affects the lung parenchyma including the alveolar spaces and interstitial tissues. Typical symptoms of pneumonia include chronic cough (both productive and non-productive), fever, chills, dyspnea, tachypnea, and confusion. More severe signs and symptoms include vomiting, fluctuating body temperature, blue-tinged skin (cyanosis), and convulsions. Elderly patients may also present with disorientation as the most prominent sign.

Risk factors for pneumonia include pre-existing lung problems such as chronic bronchitis, asthma, emphysema, and cystic fibrosis, as well as an impaired cough reflex (e.g. from stroke), GERD (from PPIs), diabetes, heart disease, chronic liver disease (e.g. alcoholism), chronic kidney disease, immunodeficiency, and chronic periodontitis. Pneumonia can also be acquired in a hospital setting, and is particularly common among those using mechanical ventilation by endotracheal intubation. Colloquially referred to as the “old man’s friend” pneumonia is a leading cause of death in the aged as well as in those suffering from chronic illness. Pneumonia is also more prevalent in those living in poverty. In such communities it is a leading cause of death in children, caused by poor nutrition, improper hygiene, over-crowding, and a lack of access to proper health care.

The word “pneumonia” derives from the ancient Greek word pneúmōn (“lung”), originally described by the ancient physician Hippocrates, who described in his writings how pneumonia often occurs as an epidemic illness, associating the disease with seasonal changes and in particular the influence of cold weather, which causes phlegm to accumulate in the head and then seep down into the chest. This concept of pestilence as a causative factor was explored further by the Roman physician Claudius Galen who formulated the concept of miasma, a form of air pollution caused by noxious fumes that emanate from putrid materials, which enter into the body through the lungs and skin. It is perhaps no surprise then, that many Chinese patients have succumbed to COVID-19 due to very poor air quality, compounded by the common practice of cigarette smoking.

In Ayurveda, pneumonia can be equated with a condition called uroghata, which refers to a “pain in the chest,” described in the Sushruta samhita (Uttarasthana 24:13) as a result of the neglected care of pratishyaya, or the common cold. Uroghata is of four types: one each relating to one of the dosha(s), and the fourth which is a combination of all three (sannipattaja). The primary treatment consists of specific measures to resolve the signs and symptoms along with general measures to balance the affected dosha(s). 

In Chinese medicine, infectious pneumonia is a febrile disorder caused by extrinsic factors (i.e. Six Evils) attacking the Lungs, usually Wind-Heat, resulting in a Phlegm-Heat condition of the Lungs. In cases where the qi and yin of the Lungs is deficient, such as in the elderly or in those suffering from chronic disease, the Lungs cannot properly expel the Phlegm, and hence the condition stagnates and becomes a serious disorder. Here the primary approach used is to clear Heat, detoxify and resolve Phlegm, and promote the descent of the Lung qi. Where the qi and yin of the Lungs is found to be deficient, specific measures are taken to replenish qi and moisten yin, while ensuring that the excess Phlegm is properly dispelled.

In many respects the etiology of pneumonia is the same as it is for bronchitis, and thus many of the same holistic measures used for bronchitis apply in the treatment of pneumonia. In particular, it’s important to remember that most cases of pneumonia are a form of autoinfection, and hence ensuring the health of the nasopharyngeal microbiome is key to treatment and prevention: including diet and hygienic measures such as nasya and proper oral care, i.e. in Ayurveda, “tongue-scraping” (jihwanirlekhana), “cleaning the teeth” (dantadhavana), “oil-pulling” (gandusha), and “gargling” (kavalagraha).

The following is a collection of tactics used to address pneumonia and deal with both the underlying factors, the source of infection, and the specific signs and symptoms of the patient. Not every herb or tactic described below will necessarily be used; rather, each tactic should be chosen as part of an overall strategy to address the specific signs and symptoms presented by each patient. 

1. Alleviate cough and pain, ensure proper respiration

There are a variety of tactics used to address cough and relieve the pain and discomfort of bronchospasm, including mucolytic expectorants, stimulant expectorants, astringent expectorants, respiratory antispasmodics, and respiratory demulcents. Reports suggest that with COVID-19 there is a greater tendency to experience more of a dry cough with difficulty breathing, suggesting that these cases may require a greater emphasis on respiratory demulcents and antispasmodics. However, given that each case may present with its own unique pattern let’s review review each group to alleviate cough and ensure proper breathing. Bear in mind, however, that many herbs display multiple properties, and just because I have placed one herb in a certain category it doesn’t mean that it doesn’t have other properties too.

Mucolytic expectorants 
Mucolytic expectorants are used to decrease viscosity of mucus secretions (kapha, Wind-Cold, Spleen yang deficiency). Examples include ginger (Zingiber officinalis rhizome), cardamom (Elettaria cardamomum fruit), garlic (Allium sativum bulb), aniseed (Pimpinella anisum seed), cinnamon (Cinnamomum zeylanica bark), angelica (Angelica archangelica root), cayenne (Capsicum annuum fruit), prickly ash (Zanthoxylum americanum bark), (Inula helenium root), horseradish (Armoracia sativa root), pippali (Piper longum fruit), kartakashringi (Pistacia intergerrima insect gall), cang er zhi (Xanthium sibiricum), zhi ban xia (Pinellia ternata prepared rhizome), and chen pi (Citrus reticulata peel). Mucolytic expectorants are used with caution in symptoms of heat (pitta).

Garden angelica (Angelica archangelica) is a useful mucolytic expectorant.

Stimulant expectorants
Stimulant expectorants are used in highly congested conditions with a thick profuse catarrh (kapha, Phlegm). Examples include (Viola tricolor herb), cowslip (Primula vera herb), daisy (Bellis perrenis herb), myrrh (Commiphora myrrha resin), balm of Gilead (Populus trichocarpa leaf bud), coltsfoot (Tussilago farfara leaf), gumweed (Grindelia spp. herb), marijuana (Cannabis indica/sativa flower), and kantakari (Solanum xanthocarpum herb). Stimulant expectorants are used with caution in weak/dry lungs (vata) and active inflammation (pitta).

Poplar bud (Populus trichocarpa) is a useful stimulating expectorant.

Astringent expectorants
Astringent expectorants are used to check mucus production and reduce active inflammation (pitta-kapha, Wind-Heat, Phlegm-Heat). Examples include vasaka (Justicia adhatoda leaf), mullein (Verbascum thapsus  leaf), goldenrod (Solidago canadensis herb), sage (Salvia officinalis herb), neem (Azadirachta indica leaf), bhunimba (Andrographis paniculata herb), duralambha (Fragonia cretica herb), sapistan (Cordia latifolia fruit), haridra (Curcuma longa rhizome), and huang qin (Scutellaria baicalensis root). Astringent expectorants are possibly contraindicated with symptoms of dryness (vata).

Vasaka leaf (Justicia adhatoda) has both astringent and antispasmodic properties.

Respiratory antispasmodics
Respiratory antispasmodics are used to relieve spasmodic coughing and relax respiratory response. Examples include thyme (Thymus vulgaris herb), hyssop (Hyssopus officinalis herb), wild cherry (Prunus virginiana bark), vasaka (Justicia adhatoda leaf), mullein (Verbascum thapsus seed), coltsfoot (Tussilago farfara herb), gumweed (Grindelia spp. herb), pleurisy root (Asclepius tuberosa root), lobelia (Lobelia inflata herb), eastern skunk cabbage (Symplocarpus foetidus root), western skunk cabbage (Lysichiton americanus root), sundew (Drosera rotundifolia herb), bloodroot (Sanguinaria canadensis root), jimsonweed (Datura leaf/root), ma huang (Ephedra sinica herb), khella (Ammi visnaga leaf/seed), wild lettuce (Lactuca virosa root), and opium poppy (Papaver somniferum immature capsule). Respiratory antispasmodics are only used where there is spasmodic coughing, and some of these herbs such as ma huang should be avoided in cardiovascular issues such as hypertension.

Lobelia (Lobelia siphilitica) is a useful respiratorty antispasmodic.

Respiratory demulcents
Respiratory demulcents are to soothe inflammation and dryness (pitta-vata, Lung yin deficiency). Examples include marshmallow (Althaea officinalis root), slippery elm (Ulmus fulva inner bark), Irish moss (Chondrus crispus), licorice (Glycyrrhiza glabra root), plantain (Plantago spp. herb), selfheal (Prunella vulgaris leaf), St. John’s wort (Hypericum perforatum flower), chickweed (Stellaria media herb), shatavari (Asparagus racemosa root), mai men dong (Ophiopogon japonicus root), tian men dong (Asparagus cochinchinensis root), yin chai hu (Stellaria dichotoma root), and sapistan (Cordia latifolia fruit)Respiratory demulcents are avoided with symptoms of wet/cold (kapha, Wind-Cold, Phlegm-Cold).

Marshmallow (Althaea officinalis) is useful for dry cough.

2. Topical measures for cough and pneumonia

Besides internal therapies and previously mentioned measures such as steam inhalation and nasya, there are a number of topical therapies that be used to treat pneumonia and alleviate chest congestion. These are applied over the chest, throat, and back as a plaster or liniment, and include examples such as mustard (Brassica nigra seed plaster), kafoori (Cinnamomum camphora leaf balm), cayenne (Capsicum annuum fruit liniment or oil), and balsam fir (Abies balsamea oleo-resin liniment, turpentine). Mustard seed is a time-honored folk remedy that is quite effective. In this case the seeds are ground into a little paste with water, and the chest is covered with a piece of wax paper. The mustard seed paste is then applied over the chest and covered with a piece of wax paper, and then this is covered with a towel. The paste is allowed to sit on the chest for 15-20 minutes until the skin becomes reddened and hot, after which it is then gently removed. The mustard seed contains antimicrobial compounds that penetrate directly into lung tissue, and the local vasodilation of the skin helps to pull blood and congestion away from the lung parenchyma, alleviating cough. If such remedies aren’t easily available, even something like Tiger Balm® or Vicks® vaporub® will be helpful.

A mustard plaster to treat pneumonia

3. Treat infection and restore the microbiome

While addressing respiratory symptoms is a big part of treating pneumonia, it’s also important to include a tactic to resolve the underlying infection and re-establish a healthy microbiome. Some of these measures include the use of herbs with antiviral, antibacterial, and anti fungal properties, as well as pre/probiotic supplements and foods.

  • Antiviral herbs, as a first-line treatment for COVID-19, include St. John’s wort (Hypericum perforatum flower), osha (Ligusticum porter/canbyi root), biscuit root (Lomatium dissectum/nudicaule root), bhunimba (Andrographis paniculata herb), ban lan gen (Isatis tinctoria root), and yu xing cao (Houttuynia cordata herb).
  • Antibacterial herbs, to treat secondary infection, include goldenseal (Hydrastis canadensis rhizome/root), purple coneflower (Echinacea angustifolia root), wild indigo (Baptisia tinctoria root), garlic (Allium sativum bulb), myrrh (Commiphora myrrha), neem (Azadirachta indica leaf), bhunimba (Andrographis paniculata herb), haridra (Curcuma longa rhizome), huang lian (Coptis chinense root/rhizome), lian qiao (Forsythia suspens flower), jin yin hua (Lonicera japonica flower), ban lan gen (Isatis tinctoria root), and huang qin (Scutellaria baicalensis root).
  • Prebiotics, e.g. FODMAP-containing foods, chicory root, beet root, fructo-oligosaccharides (e.g. inulin)
  • Probiotics, e.g. Lactobacillus, Bifidobacterium etc., live-culture lactofermented foods

Canby’s Lovage (Ligusticum canbyi), a powerful antiviral herb

4. Modulate and support the immune system

Beyond dealing with lung issues and addressing infection, it is also important to take measures to support the immune system. This may include measures to either boost, modulate, or down-regulate immune responses  depending on the signs and symptoms and case history of the patient. While the cytokine storm observed in H1N1 and H5N1 influenza doesn’t seem to be a factor in COVID-19, it may be important to down-regulate inflammation, using cytokine storm inhibitors such as licorice (Glycyrrhiza glabra root), boneset (Eupatorium perfoliatum herb), huang qin (Scutellaria baicalensis root), elderflower (Sambucus nigra flower), jin yin hua (Lonicera japonica flower), and xi yang shen (Panax quinquefolium root). 

Boneset (Eupatorium perfoliatum): an effective herb for fever and cytokine storm

Given that COVID-19 seems to be more lethal in elderly and immunocompromised patients, herbs with adaptogenic and immunomodulating properties that help build and enhance the vital reserve (i.e. ojas, qi) are likely indicated, including reishi (Ganoderma lucidum fruiting body), maitake (Grifola frondosa fruiting body), huang qi (Astragalus membranaceus), amalaki (Phyllanthus emblica fruit), and wu wei zi (Schizandra chinense fruit). 

A class of herbs referred to as respiratory restoratives are also indicated in this case, including herbs such as bibhitaki (Terminalia belirica fruit pulp), punarnava (Boerhavia diffusa root), ashwagandha (Withania somnifera root), ren shen (Panax ginseng root), American ginseng (Panax quinquefolium root), dang shen (Codonopsis pilosula), and fu ling (Poria cocos fruiting body). 

Additional immunosupportive nutrients include vitamin A (25,000 IU daily), vitamin B complex (50 mg daily), vitamin C (to bowel tolerance), vitamin D3 (2000 IU daily), vitamin E (400 IU daily), and zinc (50 mg daily).

5. Useful formulas in cold, cough, and pneumonia.

While it is very possible to create a custom formula from some of the herbs described above, there are a number of standard formulas drawn from Ayurveda, Chinese medicine, and Unani medicine that would likely be of great help in treating COVID-19 pneumonia. This is not an exhaustive review of every single formula, but some key formulas used in each tradition, and are represented to provide some examples of how some of herbs already described can be used together.

Ayurveda formula: Chaturdasangha churna
Contains equal parts katphala (Myrica nagi bark), nilotpala (Iris nepalensis flower), karkatashringi (Pistacia intergerrima insect gall), pippali (Piper longum fruit), maricha (Piper nigrum fruit), shunthi (Zingiber officinalis rhizome), duralambha (Fragonia cretica herb), krisnajiraka (Nigella sativa seed), musta (Cyperus rotundus tuber/rhizome), talisha (Rhododendron stesum leaf), twak (Cinnamomum zeylanicum bark), patra (Cinnamomum tamala leaf), sthula ela (Amomum subulatum fruit), and nagakeshara (Mesua ferrea seed). 

Taken with honey as an anupana, Chaturdasangha churna is used as a general formula for kasa (cough), shwasa (asthma), uroghata (pneumonia), and parswashula (pleurisy).

Rx: powder, 1-3 g bid-tid

Ayurveda formula: Mrgamadasava
This formula is made from a distillation of a fermented preparation called Mrtasanjivani sura which contains 45 different ingredients, that is mixed with latakasturi (Hibiscus abelmoschus seed), and other herbs such as maricha (Piper nigrum seed), lavanga (Syzigium aromaticum flower bud), jatiphala (Myristica fragrans seed), pippali (Piper longum fruit), and twak (Cinnamomum zeylanicum bark). 

Mrgamadasava is a very spicy and stimulating formula that is effective for overcoming dampness and congestion, and has the power to restore breathing in very difficult cases. Mrgamadasava is used for uroghata (pneumonia), vishuchika (painful gastroenteritis), hikka (hiccough), sannipataja jwara (tridosha fever).

Rx: liquid extract, 10-20 gtt bid-tid

Chinese medicine formula: Yin Qiao San (Honeysuckle and Forsythia Powder)
This formula contains jin yin hua (Lonicera japonica flower – 15 g), lian qiao (Forsythia suspens flower – 15 g), jie geng (Platycodon grandiflorum root – 6 g), niu bang zi (Arctium lappa seed – 12 g), bo he (Mentha haplocalyx herb – 6 g), dan dou chi (Glycine max fermented fruit – 6 g), jing jie sui (Schizonepeta tenuifolia herb – 9 g), dan zhu ye (Lophatherum gracile stem – 6 g), and gan cao (Glycyrrhiza uralensis root). 

In Chinese medicine Yin Qiao San is used as a first-line remedy to disperse Wind-Heat, clear Heat, and resolve toxicity. While not specifically used for pneumonia, this formula is helpful to address the underlying infection and fever.

Rx: powder, 9 g of this powder is taken with a mild decoction of xian lu gen (Phragmites communis recently dried rhizome – 30 g).

Chinese medicine formula: Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction)
This formula contains ma huang (Ephedra sinica herb – 12 g), xing ren (Armeniaca amarum seed – 12 g), shi gao (gypsum 40 g), and gan cao (Glycyrrhiza uralensis root – 10 g). Currently, the administration overseeing the practice of Traditional Chinese Medicine in China suggests a modified form of Ma Xing Shi Gan Tang for COVID-19 also containing huo xiang (Agastache rugosa herb – 15 g), pei lan (Eupatorium fortunei – 15 g), cang zhu (Atractylodes lancea – 15 g), sha ren (Amomum villosum – 10 g), ban lan gen (Isatis tinctoria herb – 20 g), shen qu (Massa fermentata – 30 g), sang bai pi (Morus alba – 15 g), and pipa ye (Eriobotrya japonica – 15 g).**

Both the original and modified forms of Ma Xing Shi Gan Tang clears Heat and resolves Phlegm, used to treat cough, difficulty breathing, weak appetite, fatigue, thirst, and fever. Given that ma huang has adrenergic and vasoconstrictive properties, it is probably wise to avoid this particular herb in patients that present with hypertension.

Rx: decoction, 200 mL bid-tid

Unani medicine formula: Laooq-e-Sapistan
This is a confection that contains sapistan (Cordia latifolia fruit) and unnab (Zizyphus vulgaris fruit) as the primary ingredients, with smaller amounts of koknar (Papaver somniferum immature seed capsule) as an antitussive, and other herbs including asl-ul-soos (Glycyrrhiza glabra root), parsiyaoshan (Adiantum capillus veneris rhizome), tukhm-e-khatmi (Althaea officinalis seed), tukhm-e-khubbazi (Malva sylvestris seed), and behidana (Cydonia oblonga seed). These herbs are decocted and then mixed with qand safaid (sugar), and cooked down to the consistency of a syrup, during which are added smaller amounts of sheera-maghz-e-badam (Prunus amygdalus seed), sheera-e-tukhm-e-khashkhash (Papaver somniferum seed), katira (Cochlospermum religiosum gum), samagh-e-arabi (Acacia arabica gum), and rubb-us-soos (Glycyrrhiza glabra root extract). The primary herb in the formula called sapistan fruit has a cooling anti-inflammatory effect, used as an expectorant and antitussive agent, and has both astringent and demulcent properties. The formula Laooq-e-Sapistan is used for nazla (catarrh), zukam (coryza), sual-e-muzmin (chronic cough), and anaf-ul-anzah (influenza).

Western herbal medicine formula: Cough Powder
First mentioned in Benjamen Colby’s Guide To Health (1846), this cough powder contains one part each finely sieved powders of cayenne (Capsicum annuum fruit), lobelia (Lobelia inflata herb), skunk cabbage (Symplocarpus foetidus root), wake robin (Trillium erectum root), valerian (Valeriana officinalis root), and prickly ash (Zanthoxylum americanum bark), along with two parts slippery elm (Ulmus fulva inner bark). Of this mixture, the dose is 1/2 to 1 tsp of the powder mixed hot water, given every 2-3 hours.

Western herbal medicine formula: Winter Solstice Cough/Cold Syrup
This formula was developed by herbalist Michael Moore, and is prepared from tinctures and mixed with an equal portion of Monarda or Manuka honey to create a syrup. Vegetable glycerin can also be included as a portion of the honey used in the final preparation. The Winter Solstice Cough/Cold Syrup contains four parts wild cherry (Prunus virginicus bark) tincture, and three part each tinctures of white pine (Pinus strobus bark), osha (Ligusticum porter/canbyi root) tincture, elecampane (Inula racemosa root) tincture, balsamroot (Balsamorhiza sagittata root) tincture, sweetroot (Osmorhiza occidentalis root) tincture, and licorice (Glycyrrhiza glabra root) tincture. Of this mixture, the dose is 5-10 mL, given 3-5 times daily.

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** Ochs S, Avery-Garran T. 2020. Official Treatment Protocols Include Chinese Herbal Medicine Formulas for Novel Coronavirus. Available from: http://passiflora-press.com/covid-19/

Spring can really hang you up…

Spring can really hang you up…

[pictured above, an alder (Alnus rubra) male catkin that releases pollen]

It’s officially Spring and many of you may be witnessing what some refer to as ‘yellow season’, the season of pollen dusting everything in it’s wake and wreaking havoc on our bodies. I’m reminded of one of the original bannock recipes, eaten by First Nations peoples, calling for cattail pollen, which grows in abundance for only a short few days in the spring. It’s one of the few examples of a pre-agrarian food that is comprised of tiny microparticles, and given its sticky, heavy properties, it’s probably a good thing that this special treat wasn’t available too often. In my book Food As Medicine, I make reference to research, which shows that a diet high in microparticles plays a role in gastrointestinal inflammation, which itself is a causative factor in the development of allergies and autoimmune disease. Of course, I don’t think that cattail bannock as a rare treat is the issue, but considering how high our diet is in microparticles, from highly refined flour products to additives such as titanium dioxide and mixed silicates, it’s no surprise that our immune systems are a little hyper-reactive.

There’s been a nasty cold going around as of late as well, and it seems like its one of those that seems to hang on. If that’s your experience, you might want to look at my post on how to properly deal with cold and flu. If you’re in the PNW, I expect that the high pollen count here has something to do with it, so you might also want to review my other post on the treatment of hay fever too. But if we want the high level perspective, we need to remember that spring is naturally a time of inertia and congestion. In Āyurveda, spring in northern temperate regions is associated with an increase in kapha, the aspect of the body that relates to its nourishment and structure, expressing the qualities of heavy, wet, stable, greasy, and cold. With the increasing presence of the sun during spring, the snow turning rain as the temperature begins to thaw, the primeval qualities of light, warmth and moisture initiates a gradual re-awakening of life. But this transition requires a break-through, a crisis, like a seedling which must take the risk and consume all its energy, to burst forth and penetrate through the heavy, dark soil to meet with the nourishing light of the sun. Some plants, like the Western Anenome (Anenome occidentalis), don’t even wait for the snow to melt before sprouting, rising up against all odds to commune with the meek rays of the early spring sun. It is perhaps no surprise that this plant is used medicinally (as the fresh plant tincture) – in small doses – to help reduce anxiety, ground and connect, particularly during difficult transitions.

According to Āyurveda, all living things naturally experience this obstructive element in the act of receiving abundance, and so it is true for us as well. As the weather becomes more spring-like, there is a natural congestion and saturation of the body, which increases our susceptibility to certain types of viral illness, overwhelming mucosal, metabolic, and lymphatic mechanisms, leaving you feeling tired and uninspired:

Spring this year has got me feeling
like a horse that never left the post.
I lie in my room
staring up at the ceiling.
Spring can really hang you up the most.

The solution for this of course, is found in the natural world. Like the struggle of the seedling, we need to marshal our energy and challenge ourselves to increase our physical activity. Exercise (vyāyāma) is an especially important practice in Āyurveda during spring, helping to decongest and expel the accumulated kapha, opening and clearing the channels of the body to sharpen and fine tune metabolic activities. Consider that from a physiological perspective, the only way to pump lymphatic wastes out of the tissues is through the regular contraction and expansion of skeletal muscle. Consider as well, all the research demonstrating that a lack of exercise impairs mitochondrial function, and increases insulin resistance in muscles, and along with this, an increase in the risk of diabetes, cancer, and cardiovascular disease. In this way, all these diseases are related to kapha and a state of excess nutrition, which when paired with the qualities of inertia, brings about ill health and disease. It is for this reason that Āyurveda articulates ṛtucaryā – the seasonal regimen – as a preventative strategy that provides the foreknowledge of how to best cope and adapt to the different seasons, as well as their transitions.

Thus the doctrine of ṛtucaryā tells us that when the kapha that accumulates over winter begins to ‘melt’ and flood the body during spring, just as a landowner clears the dry streams and creek beds of debris in preparation for the spring run-off, so too should the eliminative faculties of the body be prepared. The traditional practice in many cultures of a spring cleanse is an example of such a measure, best implemented just before the season has completely transitioned from winter to spring. In Āyurveda, a specialized technique called vamana (emetic therapy) is usually considered to be the most effective technique to reduce kapha, but other techniques such as virecana (purgation), vasti (enema), and nasya (errhines) may also be used. A simplified approach might consist of a course of kapha-reducing herbs such as Śuṇṭhī (ginger) rhizome, Pippalī (long pepper) fruit, and Dāruharidrā (barberry) root, taken with honey for 2-3 weeks. With regard to diet, light and easily digestible cereals such as barley, millet, amaranth and quinoa can be emphasized to reduce kapha, rather than heavier cereals such as wheat, rice, and oat. Meat with a light property such as goat, lamb, poultry and rabbit are appropriate to balance kapha, whereas heavier meats such as pork, beef, and duck should be limited. The emergent “green” energy of spring is particularly well-represented by the leafy green vegetables and shoots available at this time, consumed along with spicy herbs such as black pepper, ginger, mustard, and fenugreek. Many of the local herbs that are just starting to emerge, such as chickweed, dandelion, and nettle, all have a natural kapha-reducing activity, and are an excellent choice to prevent the congestion that frequently occurs with this seasonal transition.

As part of the kapha-reducing regimen mentioned above, I referred to a technique called nasya, which can be utilized to cleanse the nostrils, nasal cavity, sinuses and nasopharynx. Among the most commonly used preparations for nasya is either a plain sesame oil, or medicated oils such as Aṇu taila, two to three drops instilled into each nostril and inhaled back into the nasopharynx. Although it is oily (snigdha), another property of sesame oil is that it is tikṣṇa (‘sharp’), and when instilled into the nose, promotes a sensation of mild irritation followed by the liquefaction of kapha. This results in the draining of formerly congested mucus, which can then be expectorated out through the mouth. This type of nasya can be performed by most people, but is contraindicated in acute conditions of the nasopharynx, such as in a cold, fever or flu. For acute sinus congestion, two to three drops of a preparation made from equal parts Ārdraka (fresh ginger) rhizome juice, honey, and water can be instilled and inhaled into the nasopharynx. This medication is particularly effective to drain the sinuses and relieve pressure, and can be a godsend when you have an awful sinus headache. If you have particularly sensitive mucus membranes, however, you might coat the inside of your nostrils with a little bit of ghee first, before applying this remedy, in order to protect them.

Btw, here’s my favorite version of Spring Can Really Hang You Up: