Chinese Antiviral Herbs in the Prevention and Treatment of COVID-19

With a vaccine now available for COVID-19 (this article is being published in January 2021), patients have been inquiring again about recommendations for prevention of the disease as they are uncertain as to what direction to follow.

For the past year I have been dispensing variations of a formula I named Blue Heron, after the blue color from qing dai, indigo.

Chinese medicine has a long history of diagnosing and treating epidemic disease. The locus classicus of classical Chinese medicine, the Shanghan lun or Treatise on Cold Damage, was written over 2,000 years ago in response to pandemic illness of the time. The author Zhang Zhong-Jing described that doctors of his now-ancient-to-us time no longer understood how to properly diagnose disease and prescribe medicine properly. As a result, almost all of Zhang’s family and village perished from pestilential disease. His response was a detailed treatise on Chinese medical practice that has become the basis for herbal treatment.

Throughout the history of Chinese medicine, there has been academic and clinical response to new and changing disease. While the manifestation of illness can change, the foundational aspects of diagnosis and treatment in Chinese medicine do not.

The challenge that arises when new illness appears is that there is no clinical experience. In Zhang’s time the epidemic diseases were characterized by cold (as opposed to heat/warm) damage (shanghan). While the herbal treatment themselves were heavily focused on this, the text itself is detailed guide to understanding how externally contracted illness penetrates the body and produces symptoms. This was later applied to warm damage (wen bing) in the 17th century.

Epidemic illness is characterized by the wu yun liu qi, in English the five movements and six qi (also known as stems and branches). In short, this is a complex description of the movement of qi in the universe and earth. In the past I presented this information on a yearly basis in the form of a calendar. The character of this qi has great influence over the manifestation of illness at the time, much like there are seasonal illnesses that are influenced by local weather and climate.

COVID-19 presents with damp, as this has been the overriding quality of qi of the time.

The methodology for diagnosis and treatment formulation remains however the same as 2,000 years ago. In China, where COVID-19 cases have been abundant and where there is also great reliance on Chinese medicine, there has been success in identifying and treating the pathological factors related to this disease (in China as opposed to the United States, Chinese medicine is integrated with and incorporated into the conventional hospital system). Chinese medicine is always characterized by pattern discrimination, regardless of the particular disease that is being treated.

This means that individuation and complex prescription take precedence over treating only the disease itself. There is a saying in Chinese medicine: “One disease, many treatments; one treatment, many diseases.” This means that there is not just one treatment for any given disease, and that properly applied a particular treatment can address many diseases.

With the understanding that the climate of the time and the fundamental manifestation of COVID-19 is damp injury, and that symptom manifestation will change based on local climate and individual physiology, Chinese medicine can in theory prevent and treat this disease. There has not been enough time or cases yet to draw a final conclusion of the reality of this assumption, but Chinese medicine has been helpful in managing symptoms in situations where Western medicine has failed.

The most important aspect of the approach of Chinese medicine to treating COVID-19 has been this: don’t just focus on the virus. It is common in the West to look for herbs that act as antivirals. While this is not inherently wrong, if taken as the primary approach it will fail. Chinese medicine is only Chinese medicine when it is practiced as Chinese medicine. Prescribing an herb for its antiviral properties is fine, but this is not Chinese medicine.

Most recently attention has been given to three herbs from the isatis genus. The herbs used in Chinese medicine are ban lan gen, isatis root; da qing ye, isatis leaf; and qing dai, or indigo, which is processed from isatis root. They all have strong antiviral properties and are commonly added to formulas to treat viral infections. They have unique properties, but all are cold and bitter herbs that in excess can damage the stomach. I have included both isatis root and indigo in Blue Heron.

It is important to state though that the addition of these herbs is based largely on understanding of their energetic properties. Qing dai in particular treats infectious symptoms arising from damp damage. It is the least cold and bitter of the three. For the rest of the formula, I have heavily modified xiao chai hu tang, minor bupleurum soup. This formula, from the Shanghan lun, treats shaoyang disease characterized by dampness. Shaoyang refers to the energetic layer of the body in which external pernicious influence has settled and from which symptoms manifest.

This formula, Blue Heron, was largely intended to prevent symptom manifestation by strengthening the body’s defenses and treating dampness. Treatment for active disease would depend largely on individual presentation. In my practice, I have treated only one person with COVID-19, who presented with severe cough and mucus that would not resolve. The case was cleared within two weeks of treatment with bulk herbs.

I have stocked all three forms of isatis in my herbal pharmacy in New Jersey, along with various pill formulation that utilize these herbs. As supplies these days readily diminish with demand, I have purchased enough to be able to treat my patients without concern for running out. While most people have been using Blue Heron, these other pill formulations offer varying approaches for illness prevention.