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July 9, 2020

TCM and COVID-19: What Every Practitioner Should Know (Part 2)

AIMC student Erin Stewart spoke to Dr. Michael McCulloch, a licensed acupuncturist with a master’s degree in public health and a doctorate in epidemiology, about how acupuncturists and TCM practitioners can be best prepared to help with the COVID-19 pandemic. See what he had to say in part one of the interview here.

The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your acupuncturist, physician, or another qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 or local emergency number immediately.

Part Two of an Interview Series with Dr. Michael McCulloch, LAc, MPH, PhD.

Erin Stewart (E): You are currently treating a patient remotely with suspected COVID-19. It is so heartening to hear she’s recovering. Can you provide an update on her case and tell us about the treatment plan you used?

Michael McCulloh (M): This person was my acupuncture classmate when I was a tutorial student of Chinese medicine in the 80s. She has a probable case of moderately-severe COVID-19 and was experiencing a cluster of five signs: severe body pain, persistent fever, heart-related symptoms including arrhythmias (there was probably some mild ventricular arrhythmias because it was a heavy pounding type), persistent and long-lasting dry cough with shortness of breath and altered sense of smell and taste.

That first began on Friday, March 13th. It took her four weeks to get to the point where she could walk around the block and she’s now still experiencing the occasional relapsing and remitting recurrent fever, fatigue and body aches, but fortunately the heart and lungs have gotten better. The herbal strategy we provided for her is a compounded formula Yu Ping Feng San, with blood moving and blood cooling herbs. She is still using that same formula, this has been at distance, and she’s made an estimated 70-75% recovery.

E: Wow, that is so great to hear she’s been able to turn the corner. I can imagine that must have been absolutely terrifying.

M: Oh yes it was, we were quite limited in what we were able to do because this was all done at needing to be done at a distance. We weren’t able to have access. She is nevertheless doing much better I’m happy to say.

E: That’s fantastic news. Was it her choice wanting to treat this solely with TCM? Did she ever seek medical care at a hospital?

M: Yes, she was treated only with herbal medicine. She’s an experienced meditator and was able to stay focused on the task. We had her doing a four-part sequence three to four times everyday. She would first take her herb medicine; second, she would do three to five minutes of exercise to get the blood moving so that we could help drive the herbs more thoroughly through her system, through the meridians and channels; third, a nutrient snack; and four, a nap. Those four parts represent one treatment cycle and she was repeating that cycle four times a day.

This strategy was used because you’re generally profoundly fatigued with moderate COVID-19, but even with that, most people can generally muster up strength to exercise for a few minutes. We’ll take what we can get. Three to five minutes. Then you reward the body by giving it protein-rich, nutrient-dense nutrition right after. That way you’re taking advantage of the metabolic signals that are being created by the muscles that will call for more nutrients to support healing and repair, right after you’re done with the exercise.

If you catch that within 30 minutes you’re going to get more muscle gain than if you waited. The timing matters a lot. And then you take a nap. Sometimes for her that nap would be for an hour and a half and sometimes 15 minutes. This was one of the signs as she got better, her body wasn’t demanding as long a duration of a nap. So you might think well, gee, that sounds like a lot, I don’t know about that, I’ve got other things to do. But if you have moderately severe coronavirus you won’t feel like doing much anyways.

So you might as well reserve the energy you have for something very productive and therapeutically rewarding. My classmate began to get better followed by a period of two weeks with intense symptoms due to premature resumption of activities. One has to be very mindful about not even trying partial return as soon as you start feeling better. It’s a very cautious process.

One has to be very mindful about not even trying partial return as soon as you start feeling better. It’s a very cautious process.

There were several other parts of the treatment worth mentioning. Right now UCSF and Stanford are testing intravenous vitamin C for sepsis – whole body infection – that happens during COVID-19. But one can also use that [vitamin C] earlier with frequent, high oral dosing in the early to moderate stages. So we were combing her herbs with vitamin C at each of the four stages per day. She was taking 2-3g vitamin C and 300-600mg N-acetylcysteine daily. Both the N-acetylcysteine and vitamin C help smooth the movement of phlegm in the lungs.

We were basically using these to help prevent toxic phlegm stagnation, not waiting until it happened, and then attempt a response. Also, at each of the four-dose points she’d take 500 mg of quercetin, a flavonoid present in a lot of common foods. Five grams of Chen Pi will give you close to 500 mg of corcatin. So you can take that as an herb, or get a capsule of the concentrate.

E: This is great information to have. I have a question regarding the recovery stages of this case. A dangerous consequence of COVID-19 is the immune-mediated “cytokine storm” that causes a deadly build up of infiltrate in the lungs.1 If a patient survives, how might you provide support during the convalescent stages of recovery?

M: As I mentioned earlier my classmate’s premature return to full activity led to a relapse of pretty intense symptoms. I believe that she may be left with some cardiorespiratory deficits. It has already been estimated that people who survive moderate or severe COVID-19 can be left with 20-30% reduced lung capacity. So we have to work on rebuilding that very slowly.

In China, they’re doing clinical trials on Qigong and Tai Chi as ways to build aerobic capacity during the convalescent stages of recovery. Five to ten minutes broken out throughout the day is sufficient; don’t try to do the whole 108 movement kind of thing. I still have her following the intermittent herbs, exercise food, and rest routine. To simply sum up how I would support a patient during recovery I’d use Chinese medicine very strategically to measure out the dose of food, rest, exercise, and herbs so that you don’t overload the system.

To simply sum up how I would support a patient during recovery I’d use Chinese medicine very strategically to measure out the dose of food, rest, exercise, and herbs so that you don’t overload the system.

E: I appreciate you sharing the details of your case, I think this is really valuable information for all practitioners. In addition to working with COVID-19 on the patient-practitioner level, you’re also working on a larger scale project with Bay Area Hospitals. Can you share what you hope to accomplish?

M: Yes, that is correct. So one of the ways that we’re trying to address that [COVID-19] here in some of the Bay Area hospitals is we’re building a plan for a physician education health and wellness program. And talking to them about how chinese herbs could be used and then offering them the opportunity to see whether they’d like to try them.

E: That’s exciting news. I think there are a lot of people, front line workers, going into Whole Foods or other grocery stores searching for herbal supplements and teas that could be helpful in strengthening the immune system. It would be great if they could receive expert support in choosing herbs.

M: Exactly. You are free to borrow my slide from webinar #2 where I present the 100 foods* with the highest quercetin content.

E: Awesome.

*The list of 100 foods high in quercetin has been provided at the end of this article.

M: It’s in sequential order. Top to bottom left to right. This list is derived from USDA food composition research so it’s very reliable.

E: I have a final question: This is a difficult time for people in so many different ways. So much of the information we’re receiving- wear a mask, wash your hands – tells us how to protect our physical bodies against the virus. Little is shared about how to support our emotional being. Is there anything in your day to day that you’ve found particularly helpful to keep your own heart and mind in a harmonized state?

M: I think it does help very much to have something that you can commit your efforts to, which then implemented at the right dose level can help activate your own immune system. So whether that’s direct patient care, working on your own physical strength and cardiovascular training or relaxation training or protecting and supporting your family, all of these are valid. Participating in webinars, learning, studying, going to school.

All of that ideally would come with a robust scaffold of the sensible use of time, and appropriate use of yin and yang in the pragmatic form of following sensible cycles of alternating activity and rest. And doing what you can to avoid any temptation to really overwork to the point of Qi and Organ injury.

E: What you said really hits home for me. I noticed my most challenging time from the start of quarantine to now was the two weeks I had off school. I think your point of being able to give a piece of yourself to something outside yourself right now is huge.

M: That helps keep the eye on the bigger picture, which is part of keeping heart and kidney connected.

E: Before we close, is there anything else you’d like to share?

M: Yes. And that is the CDC experts out there are having a pretty difficult time surviving politically which means they’re not always able to give us the whole story. Students should really take the time to study that material for themselves. Read the medical journals. Go to the COVID tracking project which is online. And really think through these issues for themselves, medically in terms of patient care, and not just rely on the government.

When you see a newspaper article that looks encouraging, interesting, or shocking, really read it closely, tear it up, and cross-reference; don’t just believe it from the headlines.

Learn More!
Good sources of information are provided in each of the three presentations done so far: webinar links and slides at all posted at www.pinestreetfoundation.org.

Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The Cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system [published online ahead of print, 2020 May 11]. Cytokine Growth Factor Rev. 2020;doi:10.1016/j.cytogfr.2020.05.003

About the interviewer

Erin is currently a candidate for a Master’s in Oriental Medicine at the Acupuncture and Integrative Medicine College, Berkeley. When she’s not studying acupuncture she finds great joy in hiking, coastal camping and getting lost in a good book.

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