Influenza & Cytokine Storm
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Influenza & Cytokine Storm


The CDC reports that the H1N1 virus  is now a regular human flu virus that continues to circulate seasonally worldwide. In Naturopathic medicine, the prevention and treatment of H1N1 was based on the concept of Cytokine Storm or Cytokine Release SyndromeCytokine Storm is when too many immune cells are rapidly activated in a single place. It is a severe inflammatory immune response that damages body tissues, making one feel worse not better.  

Middle-aged people are more vulnerable to Cytokine Storm compared to elders. And immune-enhancing herbals will just make Cytokine Storm worse. The solution is balancing the immune system; decreasing inflammation; and enhancing the production of beneficial antiviral cytokines.

Feeling Worse Not Better?
Various types of cytokines are produced as a normal response to infection. They stimulate the attack and removal of pathogens & and assist in orchestrating the entire immune response. But Cytokine Storm makes one feel more ill- not less ill. The precise reason for this is not entirely understood but may be caused by an exaggerated response when the immune system encounters a new and highly pathogenic invader. Cytokine Storm accounted for the severity of symptoms in response to the virulence of H1N1: 

  • high fever
  • extreme fatigue, and body-aches
  • inflammation of various body systems [gastrointestinal, respiratory, musculoskeletal etc]. When Cytokine Storm concentrates in the lungs, fluids and immune cells accumulate and eventually damage them. People with respiratory H1N1 are at risk for pulmonary edema; micro pulmonary emboli & hemorrhage (blood stasis); ARDS and respiratory failure. 

Younger vs. Elder
Pandemic viral infections, like H1N, tend to be severe in young healthy adults vs. older adults. This may be because their immune system cannot depend on memory cells from vaccination or previous infection. Rather, the immune system must mount a sudden all out defense (Staruch, 2013). Younger people may have less H1N1 immunity from previous exposure compared to older people, as well as a stronger cytokine response by virtue of age. A hospital-based study reported that the median age for adults with H1N1 in their intensive care unit was 46 years old. 

Was it Cytokine Storm that caused mortality of the younger population during the 1918 Spanish Flu? Hoda Kiama ND says that during the 1918 flu epidemic, those taking standard cold & flu homeopathic remedies, even at the low potencies available then, faired better than the general population who contracted the flu. Homeopathics are not virus strain or antigen specific. They work with the body’s vital force without exacerbating Cytokine Storm, like immune-enhancing herbals do.

Why Not Immune-Boosting Herbals?
During H1N1 (as with any cold & flu) people tended to turn to immune-enhancing herbals. However, Dr. Arianna Staruch ND  (2013) warns that immune-stimulating herbs may not always be the best choice. For example elderberry (Sambucus nigra) has been shown to increase production of inflammatory cytokines (IL-6, IL-8, IL-1 beta, TNF-alpha ). Interleukin 6 [IL-6] is a pro-inflammatory cytokine implicated as the cause of mortality from respiratory H1N1 (Quan, Compans, Cho & Kang, 2007). In other words, immune-enhancing herbals exacerbate Cytokine Storm by stimulating the production of the damaging cytokines. Here are some herbs to avoid in this case:
  • mico-algea
  • kimchee
  • colloidal silver
  • echinacea
  • elderberry... etc.

Suppressing Harmful Cytokines
It is also good to know which herbals suppress harmful cytokines. More i importantly, which ones are accessible for self-care. Staruch (2013) cites a study by Quan, Compans, Cho & Kang (2007) showing that Ginseng and Salviae ssp (culinary sage) play a major role against influenza virus via this type of immune-modulation. Other appropriate herbals are (Natural Immune System Boosters (n.d.):

  • green tea
  • garlic
  • vitamin E / tocopherols
  • skullcap
  • astralagus/ huang qi
  • tea tree
  • tulsi/holy basil

Balancing the Immune System
Straruch (2013) suggests using herbals that balance the immune response by (1) decreasing inflammatory cytokines; and (2) enhancing antiviral cytokines. The following herbs do just that (Spelman et al, 2006): 

  • Acalypha wilkesiana (copperleaf, Joseph's coat, fire-dragon)
  • Acanthopanax gracilistylus (Eleutherococcus, ci wu ji)
  • Allium sativum (garlic, da xuan)
  • Ananus comosus (pineapple)
  • Cissampelos sympodialis 
  • Coriolus versicolor (turkey tail, Yun Zhi/Yun-Zhi, cloud mushroom)
  • Curcuma longa (turmeric, huang jiang)
  • Echinacea purpurea (echinacea)
  • Grifola frondosa (maitake mushroom)
  • Harpagophytum procumbens (devil's claw)
  • Panax ginseng
  • Polygala tenuifolia (Chinese senega root, yuan zhi) 
  • Poria cocos/Wolfiporia extensa (hoelen, tuckahoe, fu ling)
  • Silybum marianum (milk thistle)
  • Smilax glabra (sasparilla, tu fu ling)
  • Tinospora cordifolia (Guduchi, Giloy)
  • Uncaria tomentosa (cat’s claw)
  • Withania somnifera (ashwagandha)
  • Sophora root (ku shen) and Isatis (indigo root, ban lan gen) are antiviral   neuraminidase inhibitors. These are important herbs because the H1N1 virus has little or no resistance to neuraminidase inhibitors (Heuertz, 2007).

Traditional Chinese Medicine
Traditional Chinese Medicine [TCM] theory teaches that "Tonify Excess & Disperse Deficiency" is a major [even deadly] mistake. This mistake is possible when treating H1N1. Tonifying Excess (with immune-enhancing herbs) exacerbates Cytokine Storm by stimulating an immune system that is already in overdrive. This puts greater metabolic demand on an already excess terrain. "Dispersing a Deficiency" is killing pathogens too fast for a weakened terrain/viscera to manage all the metabolic byproducts. Or it might mean depressing an already depressed immune system. Rather, Dispersing Excess & Tonifying Deficiency is the default principle and the Chinese herbs listed above inherently regulate or balance the immune response.

In TCM, Cytokine Storm indicates a potent fight between External Evil qi and Yuan qi! The TCM treatment approach for H1N1 is "resolving the exterior" [e.g. stimulating humeral immune responses]; "clearing toxic heat" [infectious/ febrile disease]; "supplementing righteous qi" [e.g. cellular immune responses], and "harmonizing the viscera" [supporting the internal terrain]. Herbal treatment is done in phases: Prevention, Initial Exposure &  Fully Engaged or Critical phaseThese phases are how persons present in the natural course of H1N1 - the disease process

INTEGRATED MEDICINE TIP: 

References 
Center for Disease Control. (2014). H1N1 Guidelines. Retrieved from 
      www.cdc.gov/H1N1flu/guidance_homecare.htm
Heuertz, J. (2007). Chinese herbal medicine and the novel H1N1 Virus. In Jade Institute, Golden
      Flower Chinese Herbs and Herbal Medicine Press. Retrieved from www.jadeinstitute.com.
Hoda Kiama ND. In Natural Health Advisory. Retrieved from
     http://www.naturalhealthadvisory.com/person/hodakiama-nd/
Leung, P., Lau, T., Cheng, K., Lam, C. Report A: A herbal formula for the prevention of transmission
      of SARS during the SARS epidemic in Hong Kong special administrative region - a prospective
      cohort study.
Natural Immune System Boosters. (n.d.). Cytokine storm. Retrieved from
     https://sites.google.com/site/naturalimmunesystemboosters/cytokine-storm.
Quan, f., Compans, R., Cho, Y., Kang, S. (2007). Ginseng and Salviae herbs play a role as immune
     activators and modulate immune responses during influenza virus infection. Vaccine 25(2),
     272-82.
Spleman, K., Burns, J., Nicholas, D. Winters, D. Otterberg, S. Tenborg, M. (2006). Modulation of
     cytokine expression by traditional medicines: a review of herbal immunomodulators.
     Alternative Medicne Review 11(2), 128-50.  Retrieved from
     http://www.ncbi.nlm.nih.gov/pubmed/16813462
Staruch, A. (2013). Swine-flu epidemic: What it means. Retrieved from
     https://www.achs.edu/swine-flu-epidemic-–-what-it-means.






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