Buhner - Herbal Antivirals: SARS and Coronaviruses

Stephen Harrod Buhner - Herbal Antivirals_ Natural Remedies for Emerging & Resistant Viral Infections-Storey Publishing, LLC (2013)

SARS and Coronaviruses
SARS is, in its impacts in the body, very similar to acute influenza
and at first was thought to be an emerging influenzal strain. However,
SARS (sudden acute respiratory syndrome) is a new, emerging viral
pathogen that appeared suddenly in 2002 in China. The disease is
characterized by fever followed by respiratory symptoms and, ultimately
for some of those infected, progressive respiratory failure. The
nature of the virus, at the time, was unknown but eventually it was
found to be a coronavirus that had jumped species. Into us.
Coronaviruses are enveloped, positive-stranded RNA viruses. They
possess the largest genome of all the RNA viruses. The viruses in this
group engage in a very high frequency of RNA combinations, continually
producing new variants. Of the dozen or so coronaviruses only
three infect people. Among them, SARS is the most serious.
The virus takes about 6 days to develop in the body and, like
influenza, is primarily spread by respiratory droplets — though direct
contact with body secretions can also transmit it. The virus sheds particles
in feces and urine, often for several weeks, and cleaning up after
the severely ill can spread the infection. Fever, cough, and difficulty
breathing are the first symptoms of the disease. Headache, muscular
stiffness, myalgia, loss of appetite, malaise, chills, confusion, dizziness,
rash, night sweats, nausea, and diarrhea occur for many.

With increasing age comes increasing fatality. Those under the
age of 24 are not very susceptible. For those aged 25 to 44 the fatality
rate is 6 percent. It is 15 percent in those 45 to 64 and greater than 50
percent in those over 65.
SARS, unlike influenza, attaches not to sialic acid linkages but to
angiotensin converting enzyme 2 (ACE-2). This is an integral membrane
protein on many cells throughout the body, including the heart,
vascular cells, and kidneys. It is intimately involved in regulating the
renin-angiotensin system (RAS). The RAS is intimately involved in
vascular constriction and renal electrolyte homeodynamis, which is
where its primary impacts were thought to be. But the RAS is also crucial
to the functioning of most organs, including the lungs, spleen, and
lymph nodes. ACE-2 converts angiotensin II to less potent molecular
forms. Among other things angiotensin II is a potent vasoconstrictor
but it also is highly bioactive along a range of cellular actions.
SARS viruses attach to ACE-2 on the surface of lung, lymph, and
spleen epithelial cells.
(Licorice, Chinese skullcap, luteolin, horse
chestnut, Polygonum spp., Rheum officinale, and plants high in procyanidins
and lectins such as elder and cinnamon block attachment
to varying degrees.)

Once the receptors on these cells are compromised
there is enhanced vascular permeability, increased lung edema,
neutrophil accumulation, and worsened lung function. In essence,
once the virus begins attaching to ACE-2, ACE-2 function begins to
be destroyed. ACE-2 function also tends to be less dynamic as people
grow older, hence the more negative the effects of SARS infection
on the elderly.
(Kudzu, Salvia miltiorrhiza, and ginkgo all upregulate
and protect ACE-2 expression and activity and lower angiotensin II
levels.)

ACE (in contrast to ACE-2) inhibitors increase the presence of
ACE-2 and help protect the lungs from injury. (Hawthorn and kudzu,
for example.)

Upon infection by the SARS virus, similarly to influenza, inflammatory
cytokines are strongly upregulated. IFN-γ, CXCL10, IL-1ß,
TNF-α, and IL-6 are primary, IL-6 particularly so. RANTES, MCP-1,
and IL-8 are elevated in about half of those who are infected. The p38

MAPK pathway is highly stimulated and as the infection progresses
levels of PGE2 (prostaglandin E2) and TGF-ß both rise (with a later
elevation of IL-2). Lowering TGF levels is very helpful (Angelica
sinensis, Astragalus mongholicus). HMGB1 levels during SARS cytokine
cascades are high, especially in those who die. During the infection,
the cytokine cascade initiates a massive immune cell migration,
infiltration, and accumulation into lung tissues. The older the infected
animal (human or otherwise), the greater the cytokine upregulation
and the worse the outcome. Sharply reducing IL-1ß has been found
to significantly decrease the impact of the disease on the infected
and to inhibit mortality (Japanese knotweed — i.e., Polygonum cuspidatum
— Chinese senega root, Chinese skullcap, cordyceps, kudzu,
and boneset).
Severe hypoxia occurs in the cells that are affected
(and in the person so afflicted). The RAS-stimulated cellular hypoxia
generates high levels of free radicals through the rapid increase of
angiotensin II, i.e., a hypoxia-reoxygenation injury cycle. In essence
an abundance of hydrogen peroxide and superoxide radicals is generated.
The high levels of angiotensin II stimulate free radical formation
from endothelial cells, vascular smooth muscle cells, and mesangial
cells as well. In short the excessive angiotensin II levels (due to the
destruction of ACE-2 cells by the virus) cause massive damage to the
lung, lymph, and spleen tissue. Protecting the cells from the induced
hypoxia significantly reduces the damage in the lungs. (Rhodiola
is specific for this. It prevents hypoxia-induced oxidative damage,
increases intracellular oxygen diffusion, and increases the efficiency
of oxygen utilization.)

The virus specifically targets (and replicates within) ciliated cells,
destroying the cells and their capacity to move mucus up and out of
the lungs. (Cilia-protective herbs are cordyceps, olive oil and leaf, the
berberine plants, and Bidens pilosa.) Autoantibodies are produced that
begin to attack host epithelial and endothelial cells, increasing the
destruction. Reducing the autoimmune response (rhodiola, astragalus,
cordyceps) and protecting endothelial cells (Japanese knotweed) is
crucial.

Autopsies of those who died revealed that the alveolar damage in
the lungs was severe. There was massive damage to the lymph nodes
in the lungs, as well as severe necrosis in the white pulp and marginal
sinus of the spleen, destruction of the germinal centers in the lymph,
apoptosis of lymphocytes, and an infiltration of monocytic cells.
Protection of the spleen and lymph is essential (red root, poke root,
Chinese skullcap).
SARS replicates primarily in ciliated epithelial cells but also in
infected dendritic cells, both mature and immature. Dendritic cells
exist abundantly just under the epithelium layers in the lung tissue.
The cytokine upregulation makes the endothelium much more porous,
allowing the virus to penetrate and infect the dendritic cells. It does
not kill the dendritic cells but merely stops them from stimulating
an effective adaptive immune response. The virus very powerfully
upregulates IL-6 and IL-8 in the epithelial cells. These particular cytokines
concentrate around the immature dendritic cells and strongly
inhibit their maturation.. This in turn inhibits mature dendritic cells’
ability to prime the production of active T cells and allows the virus to
enter and severely damage the lymph organs in the lungs. Stimulating
dendritic cell maturation (cordyceps) and increasing T cell counts
(licorice, red root, elder, and zinc) will reduce the symptom picture
and disease severity.

Medical Treatment
Ribavirin is only marginally effective against SARS but is still used
in spite of the side effects. Corticosteroids are used to try and reduce
inflammation. The nonsteroidal anti-inflammatory drug indomethacin
has shown potent antiviral activity against the virus and should
be used. Rimantidine and lopinavir have both been found active
in vitro.

The SARS Protocol
The plants found specific for the SARS virus are Chinese skullcap,
houttuynia, isatis, licorice, Forsythia suspensa, and Sophora flavescens.
I would use the exact same protocol as for influenza, outlined earlier,
with two exceptions:

• Because Salvia miltiorrhiza is so specific for the virus and due
to the fact that HMGB1 is usually present, I would use one of the
HMGB1 formulations (see page 52) from the day the infection
begins.

• Because kudzu is so specific for this virus, I would add kudzu to the
HMGB1 formulation. For the tincture formulation, add an equal
part of kudzu tincture and increase the dosage by one-third; for
the aqueous infusion, add an equal amount of the dried root to the
formulation.

Other Anti-SARS Herbs
Other plants found active against SARS are:
Artemisia annua
Cassia tora
Cibotium barometz
Dioscorea batatas
Eucalyptus spp.
Gentiana scabra
Lindera aggregata
Lonicera japonica
Lycoris radiata (stem extracts are
extremely potent)
Panax ginseng
Polygonum cuspidatum
Polygonum multiflorum
Pyrrosia lingua
Rheum officinale
Taxillus chinensis