A Theory for Covid Treatment through Natural Interventions
Cimone Kamei, D.Ac.1

1 Jujube Hawaii Clinic 2001
Vancouver Drive Honolulu, Hawaii. 96822

Abstract
A recent study has shown that the rate of Covid re-infection, including instances with vaccinated individuals, is high in areas where the vaccination rate is high (Subramanian, S. V., & Kumar, A., 2021). Based on the results of a large-scale global study, it is possible that the current approach of prioritizing only vaccines should be reconsidered(Subramanian, S. V., & Kumar, A., 2021). The need for preventive measures including a healthy lifestyle has been studied to both prevent and heal health issues, and may be applicable in this area. While most research is focused on how disease enters the body as an external pathogenic factor, it is also important to also study the endogenous cause, or internal connection to the disease. There is even evidence that herbal formulas can help promote the effects of Western medical treatments (Ang, L., et al., 2020, Takayama, S., et al., 2020).

Keywords
Covid, Oriental medicine, Natural medicine, Lifestyle medicine, Acupuncture, Herbs

Introduction
Healing Through Kanpo Herbal Medicine

While the world is searching for new medicines to treat Covid symptoms, an alternative method may be to test the utility of already recognized treatments for other issues. Natural medicines such as Kanpo (traditional Chinese herbal medicine) and other herbs and enzymes, with the help of essential oils, can help regulate and boost the immune system (Benarba, B., & Pandiella, A., 2020, Boozari, M., & Hosseinzadeh, H., 2021, Kuchta, K., et al., 2021). It is possible that this immune system boost will help
prevent Covid infection, or minimize Covid symptoms and duration. There is even evidence that certain formulas may lower mortality rates (Zhang, L., et al., 2021).
Despite many perceptions of natural medicine as “unscientific” much of modern pharmaceuticals have been derived from natural ingredients. Many people prefer the idea of taking strong drugs that “defeat germs and viruses. This ignores the advantages of activating natural immunity, during which the immune system neutralizes the foreign virus (McKeating J., 1992).

Natural medicines can tap into the bodys natural immunity (Boozari, M., & Hosseinzadeh, H. (2021). Kanpo herbal formulas work on the immune system rather than acting directly on bacteria and viruses, as they encourage the body’s core function to promote healing and alleviate symptoms (Kiyohara, H., et al., 2006), and has been shown to be effective in treating respiratory symptoms caused not only by Covid, but also influenza and chronic asthma (Kuchta, K., et al., 2021, Nishi, A., et al., 2021, Takayama, S., et al., 2021, Tanno, Y., et al., 1988). For example, a Kanpo formula called Seihai-Haidoku-Tō (Qingfei Paidu Tang in Chinese) is undergoing the first round of FDA clinical trials as a treatment for Covid (Gordon Saxe, 2022). There is even evidence that herbal formulas can help promote the effects of Western medical treatments (Ang, L., et al, 2020, Takayama, S., et al., 2020).

Background
Blood Conditions and Onset of Disease

Lifestyle medicine is a simple process that can easily be practiced to correct fundamental health. There is evidence that the degree of symptoms caused by Covid is directly correlated to an individual’s underlying health conditions (Bansal M., 2020, Cavalcanti, I. & Soares, J., 2020, Du, Y., et al., 2021, Gazzaz Z. J., 2021, Ho, J., et al., 2020, Kompaniyets, L., et al., 2021, Mohabbat, A. B., Mohabbat, N., & Wight, E. C., 2020). While there have been many deaths attributed to Covid, it is also important to remember that there are many more cases of asymptomatic or mild illnesses (Petersen, E., et al., 2020).

What has emerged from the large-scale statistics is that health is related to the condition of their intestine and blood, and a patient should never be judged by exterior observation alone (Walton, G. E., Gibson, G. R., & Hunter, K. A. 2021). The consideration of gut and blood status as a barometer of health is a concept based on Oriental medicine, but it is gaining attention in Western medicine as well with the current pandemic (Walton, G. E., Gibson, G. R., & Hunter, K. A. 2021). It has been theorized that a decrease in good bacteria in the intestines is linked to severe illness (Vignesh, R., et al., 2021). A paper was also published on the relationship between Covid and worsening blood condition due to increased blood viscosity leading to an increased risk of thrombosis (Joob, B., & Wiwanitkit, V., 2021).

In addition to the Covid virus, the severity of disease caused by viral infections is often related to obesity, hypertension, heart disease,
chronic fatigue, diabetes, and other
underlying diseases, now called comorbidities in case of death (Bansal M., 2020, Du, Y., et al., 2021, Gazzaz Z. J., 2021, Ho, J., et al., 2020, Mohabbat, A. B., Mohabbat, N., & Wight, E. C., 2020). Oxidative stress, inflammation, and immune abnormalities have all attracted been linked to these diseases, and studies have suggested that underlying causes include intestinal disorders (Hullar, M. A., Burnett-Hartman, A. N., & Lampe, J. W., 2014, Yang, T., et al., 2015, Sharma, S., & Tripathi, P., 2019), and high-viscosity blood (Letcher, R. L., et al., 1981, Tamariz, L. J., et al., 2008). Improving the intestinal environment requires correcting the intestinal microflora. If the intestinal flora is corrected by diet, the blood quality should improve ( Fu, J., et al., 2015), which should have a beneficial effect on the immune system. This should improve the prognosis, as well as strengthening the effects of other interventions, such as Kanpo herbal formulas.

Theory
Purification of Blood and Acquired Immunity

Recent studies
have shown that in the case of Covid, natural immunity does respond and should still protect the individual if the immune system is properly supported (Yang, X., et al., 2020). Therefore, in the face of the pandemic it is important for individuals to maintain strong immune systems. There is also evidence that naturally acquired immunity from prior Covid infection also covers variant exposure, with multiple prior infections increasing the breadth of immunity (Kim, P., et al., 2021, Laurie, M. T., et al., 2022).

There are many methods to naturally maintain health and a responsive natural immune system, such as proper hydration (Stookey, J. D., et al., 2020), Vitamin D from the sunlight (Grant, W. B., et al., 2020), and Earthing (Grounding) (Menigoz, W., et al., 2020). Many studies suggest that utilizing interventions that support overall health, such as diet and meditation, it is then possible to support the immune system and improve the effectiveness of an immune response (Alkhatib A., 2020, Chaari, A., et al., 2020, Chandran, V., et al., 2021).
They also show that this can specifically help individuals with a Covid infection (Alkhatib A., 2020, Chaari, A., et al., 2020, Chandran, V., et al., 2021). It is possible that utilization of these combined interventions can support a decrease in the amount of stress placed on both society as a whole and the medical system specifically.

Kanpo Herbal Medicine for Covid

Herbal medicines are used according to symptoms, which means that while multiple formulas may work on the same issue they should not be mixed and taken at the same time. Covid has been observed to present in three different symptom patterns, or stages. While there is usually a progression from the first stage to the second this is not always the case. Presentations may jump stages, or individuals may not recognize the early symptoms. It is also possible to relieve symptoms without the individual progressing through all of the stages. This means that it is important to clearly identify an individual’s symptoms and not simply start giving them the formula for the first stage.

The stages, their symptoms, and the appropriate formula are listed below
:

Stage 1: Kakkon-Tō
This stage is from onset to early stages of recognizable symptoms. Kakkon-Tō is generally used as cold remedy for runny nose, sore throat, and chills. If symptoms disappear, treatment is done at this stage.

Stage 2: Maō-Tō
This stage begins with the person experiencing a fever. If the symptoms progress to a fever, it is time to switch to Maō-Tō which is used for the middle stage when chills and fever start, but sweating is not frequent. After a Maō-Tō treatment, sweating will occur, and symptoms will generally improve. As the person experiences sweating, they should change clothes often.

Stage 3: Seihai-Tō The late stage begins with a cough, phlegm, and potentially pneumonia. When the person starts to cough and have tangled phlegm, feel discomfort in the bronchial tubes and lungs, or develop pneumonia this is the time to use Seihai-Tō.
Herbal treatment can also be used with a series of other options which may support natural immunity. Though this is not a comprehensive list, examples include:

Therapeutic Effects of Essential Oils

Essential oils are natural medicine that can be used as a preventive measure on a regular basis but can also be effective as a treatment. For example, lavender and peppermint oils have been clinically proven to increase blood oxygen levels, which can help you breathe easier (Hedayat K. M., 2008). Essential oils have also been shown to possess antiviral effects, just like Kanpo medicine (Kiyohara, H., et al., 2006).

Fermented Foods and Intestinal Microflora

Diet has an effect on the intestinal bacteria, both positive and negative. Beneficial intestinal bacteria can be promoted by incorporating fermented foods into the daily diet (Bell, V., et al, 2018). There is reason to believe that reinforcing intestinal and pulmonary immunity with fermented foods would be an effective, or at least supportive, means of fighting Covid (Antunes, A., et al., 2020). There is also evidence supporting a link between eating fermented vegetables and lower Covid mortality rates (Bousquet, J., et al., 2021). Fermented foods include natto (fermented soybeans), Japanese Tsukemono (pickled vegetables), pickles, and sauerkraut, Hawaiian sour poi (Taro), miso and many other. Nukazuke pickles, in particular, are excellent fermented foods that contain diverse types of beneficial bacteria, including lactic acid bacteria, bacillus subtilis and butyric acid bacteria.

Conclusion
This paper explores the relationship between Covid and the innate immune system, as well as multiple possible pathways to support a healthy immune response. With this paradigm, it is important to improve our diet and eat fermented foods to support a healthy and complex gut microbiome. This in turn supports both the general health of the body and specifically the immune system. Further, it is important to utilize natural medicines such as Kanpo and other herbal and natural remedies, integrated with western medicine.

Acknowledgments
The author thanks the late Dr. Keiichi Morishita MD for guidance.

Reference
Alkhatib A. (2020). Antiviral Functional Foods and Exercise Lifestyle Prevention of Coronavirus. Nutrients, 12(9), 2633. https://doi.org/10.3390/nu12092633

Ang, L., Song, E., Lee, H. W., & Lee, M. S. (2020). Herbal Medicine for the Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of clinical medicine, 9(5), 1583. https://doi.org/10.3390/jcm9051583

Antunes, A., Vinderola, G., Xavier-Santos, D., & Sivieri, K. (2020). Potential contribution of beneficial microbes to face the COVID-19 pandemic. Food research international (Ottawa, Ont.), 136, 109577. https://doi.org/10.1016/j.foodres.2020.109577

Bansal M. (2020). Cardiovascular disease and COVID-19. Diabetes & metabolic syndrome, 14(3), 247250. https://doi.org/10.1016/j.dsx.2020.03.013

Bell, V., Ferro, J., Pimentel, L., Pintado, M., & Fernandes, T. (2018). One Health, Fermented Foods, and Gut Microbiota. Foods (Basel, Switzerland), 7(12), 195. https://doi.org/10.3390/foods7120195

Benarba, B., & Pandiella, A. (2020). Medicinal Plants as Sources of Active Molecules Against COVID-19. Frontiers in pharmacology, 11, 1189. https://doi.org/10.3389/fphar.2020.01189

Boozari, M., & Hosseinzadeh, H. (2021). Natural products for COVID-19 prevention and treatment regarding to previous coronavirus infections and novel studies. Phytotherapy research : PTR, 35(2), 864876. https://doi.org/10.1002/ptr.6873

Bousquet, J., Anto, J. M., Czarlewski, W., Haahtela, T., Fonseca, S. C., Iaccarino, G., Blain, H., Vidal, A., Sheikh, A., Akdis, C. A., Zuberbier, T., & ARIA group (2021). Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19. Allergy, 76(3), 735750. https://doi.org/10.1111/all.14549

Cavalcanti, Iago & Soares, Jos. (2020). Impact of COVID-19 on cancer patients: A review. Asia-Pacific journal of clinical oncology. 17. 10.1111/ajco.13445.

Chaari, A., Bendriss, G., Zakaria, D., & McVeigh, C. (2020). Importance of Dietary Changes During the Coronavirus Pandemic: How to Upgrade Your Immune Response. Frontiers in public health, 8, 476. https://doi.org/10.3389/fpubh.2020.00476

Chandran, V., Bermdez, M. L., Koka, M., Chandran, B., Pawale, D., Vishnubhotla, R., Alankar, S., Maturi, R., Subramaniam, B., & Sadhasivam, S. (2021). Large-scale genomic study reveals robust activation of the immune system following advanced Inner Engineering meditation retreat. Proceedings of the National Academy of Sciences of the United States of America, 118(51), e2110455118. https://doi.org/10.1073/pnas.2110455118

Du, Y., Zhou, N., Zha, W., & Lv, Y. (2021). Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutrition, metabolism, and cardiovascular diseases : NMCD, 31(3), 745755. https://doi.org/10.1016/j.numecd.2020.12.009

Fu, J., Bonder, M. J., Cenit, M. C., Tigchelaar, E. F., Maatman, A., Dekens, J. A., Brandsma, E., Marczynska, J., Imhann, F., Weersma, R. K., Franke, L., Poon, T. W., Xavier, R. J., Gevers, D., Hofker, M. H., Wijmenga, C., & Zhernakova, A. (2015). The Gut Microbiome Contributes to a Substantial Proportion of the Variation in Blood Lipids. Circulation research, 117(9), 817824. https://doi.org/10.1161/CIRCRESAHA.115.306807

Gazzaz Z. J. (2021). Diabetes and COVID-19. Open life sciences, 16(1), 297302. https://doi.org/10.1515/biol-2021-0034
Gordon Saxe, Krupp Center for Integrative Research, University of California, San Diego 2022 clinical trials. Gov pulled from https://clinicaltrials.gov/ct2/show/NCT04939415

Grant, W. B., Lahore, H., McDonnell, S. L., Baggerly, C. A., French, C. B., Aliano, J. L., & Bhattoa, H. P. (2020). Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients, 12(4), 988. https://doi.org/10.3390/nu12040988

Hedayat K. M. (2008). Essential oil diffusion for the treatment of persistent oxygen dependence in a three-year-old child with restrictive lung disease with respiratory syncytial virus pneumonia. Explore (New York, N.Y.), 4(4), 264266. https://doi.org/10.1016/j.explore.2008.04.005

Ho, J., Fernando, D. I., Chan, M. Y., & Sia, C. H. (2020). Obesity in COVID-19: A Systematic Review and Meta-analysis. Annals of the Academy of Medicine, Singapore, 49(12), 9961008. https://doi.org/10.47102/annals-acadmedsg.2020299

Hullar, M. A., Burnett-Hartman, A. N., & Lampe, J. W. (2014). Gut microbes, diet, and cancer. Cancer treatment and research, 159, 377399. https://doi.org/10.1007/978-3-642-38007-5_22

Joob, B., & Wiwanitkit, V. (2021). Blood viscosity of COVID-19 patient: a preliminary report. American journal of blood research, 11(1), 9395.

Kaur, M., Devi, G., Nagpal, M., Singh, M., Dhingra, G. A., & Aggarwal, G. (2020). Antiviral Essential Oils Incorporated in Nanocarriers: Strategy for Prevention from COVID-19 and Future Infectious Pandemics. Pharmaceutical nanotechnology, 8(6), 437451. https://doi.org/10.2174/2211738508666201016151850

Kim, P., Gordon, S. M., Sheehan, M. M., & Rothberg, M. B. (2021). Duration of SARS-CoV-2 Natural Immunity and Protection against the Delta Variant: A Retrospective Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, ciab999. Advance online publication. https://doi.org/10.1093/cid/ciab999

Kiyohara, H., Nagai, T., Munakata, K., Nonaka, K., Hanawa, T., Kim, S. J., & Yamada, H. (2006). Stimulating effect of Japanese herbal (kampo) medicine, hochuekkito on upper respiratory mucosal immune system. Evidence-based complementary and alternative medicine : eCAM, 3(4), 459467. https://doi.org/10.1093/ecam/nel030

Kompaniyets, L., Pennington, A. F., Goodman, A. B., Rosenblum, H. G., Belay, B., Ko, J. Y., Chevinsky, J. R., Schieber, L. Z., Summers, A. D., Lavery, A. M., Preston, L. E., Danielson, M. L., Cui, Z., Namulanda, G., Yusuf, H., Mac Kenzie, W. R., Wong, K. K., Baggs, J., Boehmer, T. K., & Gundlapalli, A. V. (2021). Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021. Preventing chronic disease, 18, E66. https://doi.org/10.5888/pcd18.210123

Kuchta, K., Cameron, S., Lee, M., Cai, S. Q., & Shoyama, Y. (2021). Which East Asian herbal medicines can decrease viral infections? Phytochemistry reviews: proceedings of the Phytochemical Society of Europe, 119. Advance online publication. https://doi.org/10.1007/s11101-021-09756-2

Laurie, M. T., Liu, J., Sunshine, S., Peng, J., Black, D., Mitchell, A. M., Mann, S. A., Pilarowski, G., Zorn, K. C., Rubio, L., Bravo, S., Marquez, C., Sabatino, J. J., Jr, Mittl, K., Petersen, M., Havlir, D., & DeRisi, J. (2022). SARS-CoV-2 variant
exposures elicit antibody responses with differential cross-neutralization of established and emerging strains including Delta and Omicron. The Journal of infectious diseases, jiab635. Advance online publication. https://doi.org/10.1093/infdis/jiab635

Letcher, R. L., Chien, S., Pickering, T. G., Sealey, J. E., & Laragh, J. H. (1981). Direct relationship between blood pressure and blood viscosity in normal and hypertensive subjects. Role of fibrinogen and concentration. The American journal of medicine, 70(6), 11951202. https://doi.org/10.1016/0002-9343(81)90827-5

McKeating J. (1992). Neutralization of virus. Methods in molecular biology (Clifton, N.J.), 8, 8993. https://doi.org/10.1385/0-89603-191-8:89

Menigoz, W., Latz, T. T., Ely, R. A., Kamei, C., Melvin, G., & Sinatra, D. (2020). Integrative and lifestyle medicine strategies should include Earthing (grounding): Review of research evidence and clinical observations. Explore (New York, N.Y.), 16(3), 152160. https://doi.org/10.1016/j.explore.2019.10.005

Mohabbat, A. B., Mohabbat, N., & Wight, E. C. (2020). Fibromyalgia and Chronic Fatigue Syndrome in the Age of COVID-19. Mayo Clinic proceedings. Innovations, quality & outcomes, 4(6), 764766. https://doi.org/10.1016/j.mayocpiqo.2020.08.002

Nishi, A., Kaifuchi, N., Shimobori, C., Ohbuchi, K., Iizuka, S., Sugiyama, A., Ogura, K., Yamamoto, M., Kuroki, H., Nabeshima, S., Yachie, A., Matsuoka, Y., & Kitano, H. (2021). Effects of maoto (ma-huang-tang) on host lipid mediator and transcriptome signature in influenza virus infection. Scientific reports, 11(1), 4232. https://doi.org/10.1038/s41598-021-82707-1

Petersen, E., Koopmans, M., Go, U., Hamer, D. H., Petrosillo, N., Castelli, F., Storgaard, M., Al Khalili, S., & Simonsen, L. (2020). Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. The Lancet. Infectious diseases, 20(9), e238e244. https://doi.org/10.1016/S1473-3099(20)30484-9

Sharma, S., & Tripathi, P. (2019). Gut microbiome and type 2 diabetes: where we are and where to go?. The Journal of nutritional biochemistry, 63, 101108. https://doi.org/10.1016/j.jnutbio.2018.10.003

Stookey, J. D., Allu, P., Chabas, D., Pearce, D., & Lang, F. (2020). Hypotheses about sub-optimal hydration in the weeks before coronavirus disease (COVID-19) as a risk factor for dying from COVID-19. Medical hypotheses, 144, 110237. https://doi.org/10.1016/j.mehy.2020.110237

Subramanian, S. V., & Kumar, A. (2021). Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States.
European journal of epidemiology, 36(12), 12371240. https://doi.org/10.1007/s10654-021-00808-7

Takayama, S., Namiki, T., Ito, T., Arita, R., Nakae, H., Kobayashi, S., Yoshino, T., Ishigami, T., Tanaka, K., Kainuma, M., Nochioka, K., Takagi, A., Mimura, M., Yamaguchi, T., & Ishii, T. (2020). A multi-center, randomized controlled trial by the Integrative Management in Japan for Epidemic Disease (IMJEDI study-RCT) on the use of Kampo medicine, kakkonto with shosaikotokakikyosekko, in mild-to-moderate COVID-19 patients for symptomatic relief and prevention of severe stage: a structured summary of a study protocol for a randomized controlled trial. Trials, 21(1), 827. https://doi.org/10.1186/s13063-020-04746-9

Takayama, S., Namiki, T., Odaguchi, H., Arita, R., Hisanaga, A., Mitani, K., & Ito, T. (2021). Prevention and Recovery of COVID-19 Patients With Kampo Medicine: Review of Case Reports and Ongoing Clinical Trials. Frontiers in pharmacology, 12, 656246. https://doi.org/10.3389/fphar.2021.656246

Tamariz, L. J., Young, J. H., Pankow, J. S., Yeh, H. C., Schmidt, M. I., Astor, B., & Brancati, F. L. (2008). Blood viscosity and hematocrit as risk factors for type 2 diabetes mellitus: the atherosclerosis risk in communities (ARIC) study. American journal of epidemiology, 168(10), 11531160. https://doi.org/10.1093/aje/kwn243

Tanno, Y., Kakuta, Y., Aikawa, T., Shindoh, Y., Ohno, I., & Takishima, T. (1988). Effects of qing-fei-tang (Seihai-Tō) and baicalein, its main component flavonoid, on lucigenin-dependent chemiluminescence and leukotriene B4 synthesis of human alveolar macrophages. The American journal of Chinese medicine, 16(3-4), 145154. https://doi.org/10.1142/S0192415X88000212

Vignesh, R., Swathirajan, C. R., Tun, Z. H., Rameshkumar, M. R., Solomon, S. S., & Balakrishnan, P. (2021). Could Perturbation of Gut Microbiota Possibly Exacerbate the Severity of COVID-19 via Cytokine Storm? Frontiers in immunology, 11, 607734. https://doi.org/10.3389/fimmu.2020.607734

Walton, G. E., Gibson, G. R., & Hunter, K. A. (2021). Mechanisms linking the human gut microbiome to prophylactic and treatment strategies for COVID-19. The British journal of nutrition, 126(2), 219227. https://doi.org/10.1017/S0007114520003980

Yang, T., Santisteban, M. M., Rodriguez, V., Li, E., Ahmari, N., Carvajal, J. M., Zadeh, M., Gong, M., Qi, Y., Zubcevic, J., Sahay, B., Pepine, C. J., Raizada, M. K., & Mohamadzadeh, M. (2015). Gut dysbiosis is linked to hypertension. Hypertension (Dallas, Tex: 1979), 65(6), 13311340. https://doi.org/10.1161/HYPERTENSIONAHA.115.05315

Yang, X., Dai, T., Zhou, X., Qian, H., Guo, R., Lei, L., Zhang, X., Zhang, D., Shi, L., Cheng, Y., Hu, J., Guo, Y., & Zhang, B. (2020). Naturally activated adaptive
immunity in COVID-19 patients. Journal of cellular and molecular medicine, 24(21), 1245712463. https://doi.org/10.1111/jcmm.15771

Zhang, L., Zheng, X., Bai, X., Wang, Q., Chen, B., Wang, H., Lu, J., Hu, S., Zhang, X., Zhang, H., Liu, J., Shi, Y., Zhou, Z., Gan, L., Li, X., & Li, J. (2021). Association between use of Qingfei Paidu Tang and mortality in hospitalized patients with COVID-19: A national retrospective registry study. Phytomedicine : international journal of phytotherapy and phytopharmacology, 85, 153531. https://doi.org/10.1016/j.phymed.2021.153531

Bio:
Cimone Kamei D.Ac. is the principal acupuncturist at Jujube Hawaii Clinic, 2001 Vancouver Drive Honolulu, Hawaii. 96822 email: cimone@jujubehawaii.com phone 1-808-926-0888