There is a lot of information out there on the internet and on various social media groups about which herbs to use/not use, some of that info is helpful and some of it is incorrect.
What follows here is some information which I hope will help you clarify and also answer some of your questions, especially about the use of Elderberry, the nature of this virus and which herbs might be useful for you as an individual.
Firstly – lets understand a little about what we are dealing with.
The pathogen itself is called SARS-Cov-2, once it becomes an infection it is called Covid-19. It is a very close relative to SARS, but is actually more aggressive. I am not going to quote mortality rates here because actually we don’t really know for sure as there are currently differences in the ways countries are classifying this, either by primary cause or generally where there are underlying health conditions.(1)
Following the current advice and remaining in Lockdown is of course utterly sensible and correct in light of this, and we must respect that this virus is deadly for some, damaging for others and mild for a percentage of people, but the concerns over the burdens on our public health systems underpins the approach and the precautionary principle.
Studies imply that there is direct damage to the lungs from the virus, rather than purely damage from a hyper inflammatory response and there is evidence that some patients respond to Covid-19 with a ‘cytokine storm reaction’. (2)
Now, this cytokine storm is something that a lot of people are talking about in social media, especially when it comes to using elderberry.
Those of you who know me, also know that I am a massive fan of elder medicine in general and certainly the use of elderberries has gained huge popularity in recent years, with many people foraging and creating their own syrups, tinctures and elixirs. It quite correctly has become a ‘go to’ for many lay people in the cold and flu season and there are studies showing the effective anti-viral activity when it comes to Influenza and many of the ILI’s (Influenza like illnesses) such as RSV that do the rounds in winter time.
What exactly is a cytokine storm I hear you ask and what has it got to do with Elderberry?
Cytokine: The name comes from the Greek Cyto meaning Cell and kinos meaning movement. There are many cytokines and they have a specific effect on communication and interactions between cells, there are both pro-inflammatory and anti-inflammatory cytokines, and they can be seen as regulators of the response to infection as well as inflammation and trauma.
A Cytokine Storm refers to excessive and uncontrolled release of pro-inflammatory cytokines and commonly presents as systemic inflammation, that may lead to multiple organ failure. Lab results for severe cases of Covid-19 in ICU wards have shown high levels of C-Reactive Protein and ESR which are systemic inflammatory markers and high levels of the pro-inflammatory cytokines IL-6,TNFα, IL-1β, IL-8, IL2R. (3)
People get a little bit confused when it comes to herbs and the immune system, I hear a lot of people say that this herb or that herb ‘boosts’ the immune system. It’s not as simple as that and we prefer to use the term immune modulators. Immunomodulation has three types of action, stimulation, suppression and restoration of the immune response. Herbs mostly restore and occasionally stimulate but again that ‘stimulation’ needs to be taken in context.
So, on social media a lot of people started saying that Elderberry is dangerous because it is an immune booster and would promote a Cytokine Storm, when I challenged this I was given a study to back up the claim.(4)
What I question as do a lot of other (very respected) Medical Herbalists is the fact that this study looked a healthy subjects and showed that elderberry activated the healthy immune system by increasing inflammatory cytokine production. A very good outcome for elderberry in this study, but nowhere at all did it mention Cytokine Storm, and is it fair that we should accuse this gentle effective medicine for having a potential fire hose action on the immune system? No.
Do I think that elderberry could be useful in helping with Covid-19? Yes I think it could be helpful in supporting the immune system at this time, I am not adverse to giving it to my patients as a tonic in these times. It’s high in Vitamin C and we know it is anti-viral, anti-inflammatory and an immune modulator specifically inflammation and in fact other studies have shown that elderberry down regulates the inflammatory cytokines which contribute to Covid-19 associated lung damage.(5)
Generally I think we as Medical Herbalists are in agreement that elderberry is not dangerous in this situation. The respected Herbalist and researcher Stephen Buhner wrote a very useful book Herbal Antivirals which I refer to a lot in my clinical practice and he recently released an article where he advocates the use of Elder leaves instead of the berry simply because he felt the berry was not potent enough. Many people think that the Elder leaves are toxic, they can indeed cause vomiting in some people but not all and again it depends on the sensitivity of the individual and the preparation. If we decoct or boil the leaves we can deactivate the constituents which can cause vomiting. I have been getting ready to do just this and would like to make some tincture very soon. I quite like the idea of using the berry and the leaves together.
Of course we cannot make any claims to treat, suppress or cure Covid-19. All we can do is try to understand the virus ( thank you scientists) understand our plants and support our patients. It can’t cause any significant harm – but may cause significant good.
We Herbalists have a mantra.. ‘treat the person not the disease’
Of course there are herbs that will be indicated specifically for their chemical constituents and properties, but herbs have more depth and nuance (or we can say character) some are hot some are cool, moist or dry and it is important to take this into consideration.
The Chinese Herbalists have categorised this as a condition of ‘Wind Heat’ and have used their herbal formulas based on this principle. This translates into choosing herbs that are cool in nature rather than heating. The ‘Condition’ is also understood to be drying – think of the typical cough presentation here, its unproductive and dry with an associated shortness of breath. Some people are constitutionally more dry than others, take a look at your tongue in the mirror, if it is quite cracked and looks dry then you will be dry, if it is wet with a nice coating then you will be moist. Obviously there are going to be variations and in-between states and for those of you who are interested in this art here is a website with a lot of helpful information https://www.sacredlotus.com/go/diagnosis-chinese-medicine/get/tongue-diagnosis-chinese-medicine
Where we need to focus is on herbs that may work on the particular viral pathway, in this case we know that the SARS group of virus attach to a membrane protein found on many cells including lung cilia cells called ACE-2 linkages, the linkages are the entry point for the virus to infect cells. Herbs that protect ACE-2 include Scutellaria baicalensis. We know that this herb is anti-viral and we often include it in our prescriptions for Asthma and we know it is a cooling herb. Liquorice and Elder are also in this category.
We also need to use herbs that moisten and nourish the lungs, this is a class of herbs we call ‘mucilaginous’ it’s a perfect description as these herbs have a slimy characteristic and can moisten and protect the mucosa of the lungs.
Herbs that we can consider are Marshmallow root (a really wonderful traditional herb we use for dry coughs and mucilaginous extraordinaire) Coltsfoot leaf and flower, Plantago lanceolata and Sweet Violet leaf. Red Clover flowers are wonderful for coughs and are also supportive to the lymphatic system.
I really like Inula helenium as a restorative to the lungs and I have been including a little of this in my prescriptions with the anti-viral and mucilaginous herbs.
In the fever stage the above herbs might not be appropriate and instead herbs that gently reduce a fever to promote sweating might be useful if you are very uncomfortable, a traditional Western Herbal Medicine approach is to use a tea blend of Yarrow, Elderflower and maybe Mint or Lime flower.
These are my general thoughts but again I cannot press strongly enough that it is important to choose the herbs to suit the person and the situation.
It was not my intention to go deeply into the nutrient and supplement protocols today but just to say there is again a lot of information and mis-information floating around the web. Generally I recommend the supportive Nutrients to include are Vitamin C, Zinc and Vitamin D. You may read some articles saying Vitamin D is not a good idea but my take is, if a person is low in Vitamin D then of course they should supplement as Vitamin D is indicated in many immune pathways.
It has been shown than people who are low in Zinc fare less well with Covid-19 than those who are replete.
The use of Vitamin C as an antiviral is also very well researched.
I hope you have found this informative and useful, stay well, follow the guidelines, eat real and nourishing foods and use the herbs.
Medical Herbalists are still working in their clinics during this time and we are dispensing and delivering valuable medicines, we are also continuing to support via remote video consultations.
Please do find a Medical Herbalist locally to you to work with and make sure they are either NIMH or CPP registered.
Please do share this blog if you resonate with what I am saying here.
I would like to thank the collective wisdom of our Medical Herbalist community who give their research and thoughts so freely and unconditionally. Herbalists such as Donnie Yance, Stephen Buhner who are so helpful with citing the studies that are so relevant and important.
For your interest and further reading here are the referenced studies for this post: