COVID-19

An integrative medical concept is required for prevention, understanding and therapy of the new COVID-19 disease which appeared at the end of 2019. This article summarizes preventive and therapeutic concepts and the practical experience of anthroposophic doctors regarding COVID-19 from the authors’ point of view, as far as this is possible at the time of publication.

Many COVID-19 patients have been and still are being treated as outpatients with Anthroposophic Medicine. Severe, advanced stages of the disease require clinical treatment and possibly all measures of intensive care, up to temporary extracorporeal membrane oxygenation (ECMO). At this level too, several anthroposophic clinics in Germany are involved in patient care, up to and including maximum intensive medical therapy. For example, Havelhöhe Community Hospital in Berlin developed into a focal point for COVID-19 diagnostics and therapy in the German capital. This demonstrates the specific integrative medical competence of Anthroposophic Medicine in the field of conventional medicine as well as in the extended complementary medical framework of a regulative therapeutic approach. Scientific evaluation of this integrative medical therapy is planned.

Viruses and human beings – a dialogue

Many people infected with SARS-CoV-2 do not fall ill or do so only slightly. Children are largely protected against severe disease progression and, in contrast to influenza, also play a subordinate role as carriers of the SARS-CoV-2 virus (1, 2). These facts alone show that in COVID-19 the pathogen is just as important as the respective susceptibility to the virus and individual disposition to disease. There is a relationship of biological dialogue involved (3) which opens up valuable opportunities in both prevention and treatment, especially of early stages of the disease. As important as it is to avoid infection by washing hands, distancing, cough hygiene, mouth-nose protection and protective goggles, etc., especially for medical professionals and so-called risk patients, it is also essential to comprehensively strengthen the human immune system and its resilience in dialogue with the SARS-CoV-2 virus. This approach is at the heart of a therapeutic procedure such as Anthroposophic Medicine, which is primarily oriented towards self-regulation.

Other approaches in complementary medicine, such as Traditional Chinese Medicine (TCM), also work in this direction. It is noteworthy that during a WHO hearing at the end of March 2020 (4) Prof. Zhang Boli reported that 91.5% of all COVID-19 patients recorded in China (about 74,000 patients) at that time received integrative treatment with TCM, with medicines containing, e.g., bitter substances, which are also used in Anthroposophic Medicine. (Zhang Boli, MD, TCM practitioner and Vice Chairman of the World Federation of Chinese Medicine Societies (WFCMS).) Their activating effect on the immune system of the respiratory tract has now been researched (5). According to Chinese experts, this integrative approach has alleviated symptoms in many patients, prevented the progression of the disease into severe stages and also reduced the mortality rate. Since corresponding studies had not yet been published in writing when this work went to press, we refer here to this expert hearing. While in western countries, especially at the beginning of the COVID-19 pandemic, symptomatic fever reduction was widely carried out, in therapeutic experience such an approach, which is contrary to letting the organism self-regulate, has often proven to be unfavorable. In Anthroposophic Medicine, on the other hand, a positively regulating approach to fever is practiced as a matter of principle, which should enable patients to develop fever at an appropriate level. On the other hand, an integrative medical approach does not exclude the use of conventional drugs for COVID-19 (e.g., Remdesivir (6)).

Infection and disposition

The SARS-CoV-2 virus enters the organism primarily via the mucous membranes in the facial region (eyes, nose, mouth) and can penetrate early into the alveolar space of the lungs. The infection itself is caused by the virus binding to the ACE2 receptor, which normally has a protective function for the cardiovascular system. The viral infection weakens this system. The path of infection means that COVID-19 is primarily a disease of the respiratory and cardiovascular systems, which in Anthroposophic Medicine are summarized as the rhythmic system. This system plays a central regulating and balancing role in the human organism, balancing between the head-centered neurosensory system close to consciousness on the one hand and the motor-metabolic system centered below the diaphragm (7, p. 23–46) on the other. The connection between the rhythmic system and human soul experience is close. A first fundamental description of this psychosomatic connection can be found in Rudolf Steiner’s book Riddles of the Soul, see also (8). It is well known that every emotion changes respiration and pulse rate and that stress and anxiety, for example, promote high blood pressure, sinusitis and asthma, while moderate exercise, for example, has a balancing effect on the health of the respiratory and cardiovascular systems. According to our own observations, mental/social conflict situations experienced as stressful can also play a role in the medical history of patients with pneumonia. If one looks at the human organism in this way, it becomes understandable why, for example, sufficient sleep and exercise can increase resilience against infections. Sunlight also plays an important role, not only through the formation of vitamin D (if sunscreen is not used), but also through direct light-dependent immune processes in the skin. Conversely, smoking and air pollution, for example, weaken the rhythmic system. The first ‘epicenters' of COVID-19 happened in ecologically massively impaired conurbations such as Wuhan and Lombardy in northern Italy (9). For the genesis of the SARS-CoV-2 virus, ecological correlations – particularly the relationship between humans and animals – probably play a major role (10).

We find that based on this the constitutional disposition for COVID-19 disease can be noted in a first approximation as follows:

• anxiety, stress,
• lack of sleep,
• lack of exercise and the light/vitamin D deficiency that is often correlated,
• insufficient warmth generation and distribution,
• malnutrition, vitamin and trace element deficiency, high sugar consumption (5),
• nicotine and alcohol,
• older age.

All these factors can be accompanied by a weakening of the rhythmic system (respiratory and cardiovascular systems) and immune system.

Conversely, this already provides important preventive possibilities in terms of strengthening resilience:

• Care of personal body warmth (exercise, nutrition, clothing); suitable teas, e.g., ginger/lemon/honey tea; active and possibly passive warming of cool extremities (warming foot baths and oil rubs); restrained use of air conditioning.
• Fostering mental and physical balance by cultivating relationships (!), spending time in the great outdoors (!), singing, meditation and meditative movement exercises (e.g., yoga, eurythmy).
• Stress reduction, especially reduction of screen media time; conscious handling of social conflicts.
• Care of vitality-promoting rhythms: regular meal times and meal breaks, healthy sleep rhythm, sufficient nightly sleep.
• Regular exercise in sunlight.  In the case of slight infections, reduce physical strain.
• Wholefood diet, freshly cooked food, (bitter) vegetables, fruits (vitamin C, etc.).
• Moderate consumption of sweets, restraint with alcohol, avoidance of nicotine.

Clinically there is often an increased susceptibility to infections due to zinc (11) and iron deficiency (12). The ACE2 receptor is also a zinc-containing enzyme (metallocarboxypeptidase). In the area of the lungs, iron plays a central physiological role in oxygen exchange. Immune processes against invading microorganisms are directly linked to iron and targeted production of free oxygen radicals and are particularly important in the respiratory tract. Corresponding trace element deficiencies should be avoided or compensated.

In medical terms, Anthroposophic Medicine offers the following possibilities for strengthening resilience to viral respiratory tract infections:

• Meteoreisen (Meteoric iron) pilules WALA: 10 pil. 10 x daily in the morning on an empty stomach; for unspecific signs of an upper respiratory tract infection 10 pil. 3 x daily.
  Ingredients: Ferrum sidereum D11, phosphorus D5, quartz D11 (conjointly potentized in the final step).

This preparation has proven itself for many years in the prophylaxis and therapy of influenza. “The composition combines three mineral substances (phosphorus, quartz, meteoritic iron), which show a strong relationship to light and are leading substances in meteorites. It strengthens the inner relationship to light, presence of the ‘I’ and immunocompetence, especially during winter.” (13, p. 540) This medication is widely recommended and used for prevention in connection with SARS-CoV-2.

Echinacea seems to be suitable for increasing resilience towards this pathogen in a phytotherapeutic context:

• Echinacea Mund- und Rachenspray (Echinacea mouth and throat spray) WALA: 5 sprays into the throat 2–3 x daily
  Ingredients: Argentum nitricum D13; Calendula officinalis, Flos 20%; Echinacea pallida, Herba 20%; Eucalyptus globulus e foliis D1; Gingiva bovis Gl D4; Gingiva bovis Gl D8; Salvia officinalis, Folium 20%; Tonsillae palatinae bovis Gl D4; Tonsillae palatinae bovis Gl D8.

In preclinical studies (as yet unpublished at the time of going to press), echinacea extracts increase resilience against the adhesion and penetration of corona viruses into the mucosa of the respiratory tract. From the point of view of and according to the therapeutic experience of Anthroposophic Medicine, echinacea extracts strengthen the human warmth organization, and echinacea, calendula and sage enhance resilience against the penetration and advance of pathogenic micro-organisms. Potentized silver nitrate can counteract inflammation of the mucous membranes.

If the patient is prone to iron deficiency, headaches and susceptibility to infections:

• Ferrum-Ouarz capsules (Bidor) WELEDA: 1 capsule 1 x daily in the morning
  (original substance produced from Ferrum sulfuricum, Mel, Vinum, quartz),

which contains iron in an elaborately produced complex with sulfur and silicic acid in a well-tolerated form. Zinc can be supplied dietetically or as a supplement.
Zinc-rich foods include poppy seeds, pumpkin seeds, sunflower seeds, flax seeds, oat flakes, sesame seeds and whole grain flour.

COVID-19 disease shows a characteristic temporal sequence. Its weekly rhythm offers a certain orientation. The incubation period is usually between 3 and 7 days (fluctuation range 1–14 days). The end of the first week of illness often plays a decisive role in the course of the disease. Accordingly, guidance of patients should be rigorous already in the first week of illness (sick leave, relief, rest).

Influenza stage

A characteristic early symptom is a

• usually temporary loss of the ability to smell and taste.

Other symptoms in the initial, influenza stage of the disease are

• fever
• headache and sore throat
• cough, dry, but sometimes with mucus,
• diarrhea.

The lab results may show lymphopenia, increased prothrombin time, LDH and D-dimers – the issue of blood coagulation must always be taken into account with COVID-19, especially during hospitalization and in cases of limited mobility, and appropriate prophylaxis must be initiated if necessary. A positive swab result (PCR) for SARS-CoV-2 is relatively reliable; initially false negative results are not uncommon even in infected people (14).

In the experience of Chinese doctors, this first phase of the illness can be regarded as a “golden window” for regulative treatment. The aim here is to stabilize the patient, alleviate the symptoms of the disease and above all prevent pneumonia. This goal justifies intensive treatment with anthroposophic medications at this stage of the disease, as described by the authors in the next section. The symptoms of the disease initially show that the person’s immune system, which is centrally linked to their individual warmth organization, is actively trying to stop further virus replication. In this respect, the symptoms themselves are signs of meaningful activity of the organism in “dialogue” with the virus. Warmth and self-regulation, not symptom suppression, are therefore the focus. In the majority of cases, the course of the disease, often lasting about one to two weeks, is followed by a considerable convalescence period, since SARS-CoV-2 infections are often followed by significant exhaustion. The time needed for convalescence must be taken into account.

COVID-19 pneumonia

The second stage of the disease, COVID-19 pneumonia, can occur quickly, but in many cases not until about a week after the onset of symptoms. It follows that careful treatment and care during the first week of illness is all the more important.

The pneumonia initially appears in the thoracic CT in characteristic milky glass-like changes that indicate a developing interstitial edema (15). The oxygen saturation of the blood drops and the breathing frequency increases, often without the patient clearly noticing this. – At this stage of the disease, it is appropriate to use Anthroposophic Medicine’s approach to treating outpatient-acquired pneumonia (which often has viral causes), which has been tried and tested for decades. Great importance is attached to external applications and the injection of anthroposophic medicines. The aim here is to further strengthen the person’s immunological self-regulation and individual warmth organization and at the same time to counteract an independent increase in inflammatory edema in the lungs. The treatment stimulates respiration and excretion processes. Figuratively speaking, the aim is to prevent the lungs from “drowning” in the inflammatory interstitial edema. Breathing and self-regulation are central. If COVID-19 pneumonia occurs, CT images and clinical experience show that the course of the disease can be expected to last approximately four weeks, even if no invasive intensive care measures are taken. The peak in the disease process, as far as the pneumonia itself is concerned, is generally reached towards the end of the 2nd week of illness. Convalescence can take a long time and must be carefully monitored.

Acute Respiratory Distress Syndrome (ARDS), sepsis and multiple organ failure

If a full picture of Acute Respiratory Distress Syndrome (ARDS) (16) develops from this, often in the course of the 2nd week of illness, the focus will be on a correspondingly extensive intensive medical treatment, which will not be discussed in detail here. The exceptionally long ventilation times of COVID-19 patients with ARDS are well known. Patients are particularly at risk of developing a septic inflammatory derailment of the immune system (“cytokine storm” (17)). The clinical picture thus reaches far beyond the rhythmic system. This excessive immune reaction can lead to disseminated intravascular coagulation (DIC), endothelial damage with capillary leakage and multiple organ failure. In addition, direct viral endotheliitis (18) is also discussed, mediated by generalized endothelial infection through binding to the endothelial ACE2 receptor. Laboratory chemical increases may include CRP, LDH, IL-6, D-dimer, ferritin and NT-proBNP.

From the point of view Anthroposophic Medicine, intensive medical treatment can be supplemented by measures that primarily support circulation and the basic life processes of the organism. In case of imminent multi-organ failure, the organism’s vital functions are central. The clinical picture no longer shows a clear temporal structure in the course of the disease, which is an expression of failing self-regulation.

1. Infuenza stage

Medication

In this stage of the disease, antipyretics, antibiotics and anti-inflammatory drugs are not usually indicated. In contrast, anthroposophic medicines and external applications that strengthen self-regulation of the organism represent an appropriate and widely available medicinal treatment strategy. Here the therapy not only aims to relieve the (in principle self-limiting) symptoms, it also seeks to prevent progression to the stage of pneumonia or even the 3rd stage of ARDS and sepsis. Although no clinical studies are available at the time of going to press, the authors’ therapeutic experience and the experience of other anthroposophic medical colleagues clearly confirm the effectiveness of the not undemanding therapy listed below, provided it is carried out early and consistently enough. Appropriate rest and relief for the patient is a strict requirement: sick leave, bed rest in case of fever, media abstention, basically strict nicotine abstention, etc.

Mild abortive courses with moderate fever, no involvement of the lower respiratory tract and vital patients without concomitant diseases require only oral, symptomatic treatment. Suitable in such cases is the anthroposophic mixture

• Infludoron® (Ferrum phos. comp.) pilules WELEDA: 10–15 pilules 5 x daily.
  Ingredients: Aconitum napellus D1, Bryonia D1, Eucalyptus Ø, Eupatorium perfoliatum D1, Ferrum phosphoricum D6, Sabadilla Ø.

This composition already has a preventive effect on the possible progression of the infection in the lower respiratory tract and has a regulating effect on the feverish response of the immune system. It is suitable for lighter courses and should not be given for longer than 5–7 days.

In case of headache and aching limbs it can be supplemented by

• Gelsemium comp. pilules WALA: 10 pil. 5 x daily.
  Ingredients: Bryonia cretica D2, Gelsemium sempervirens e rhizoma D14, Gelsemium sempervirens e rhizoma D2, Vivianit D7.

For patients with bronchitic symptoms, for older and weakened patients, patients with concomitant diseases (arterial hypertension, COPD, diabetes mellitus type 2) and all other risk patients, whereby obesity (19) must also be mentioned, the comprehensive therapy concept described below is recommended:

• Meteoreisen Inject (Meteoric iron) amp. WALA and
• Pulmo/Vivianit comp. amp. WALA: mixed in the syringe (1 amp. each) 1 x daily s.c. between the shoulder blades, approx. 5 cm next to the spine (switch sides daily), if not possible s.c. in the upper abdomen.
  Ingredients: Pulmo D16, Vivianit D7, Bryonia e rad. D5, Tartarus stibiatus D5.

The composition Pulmo/Vivianit comp. WALA occupies a central position in the anthroposophic treatment of viral outpatient-acquired pneumonia in children and adults. The therapeutic experience of the authors in many cases shows that the medication is very effective for lower respiratory tract infections when injected early, initially daily. In view of the fact that the SARS-CoV-2 virus often attacks the alveoli at a very early stage, which goes unnoticed, this therapy is already indicated in the first stage of the disease in COVID-19 patients. Vivianit is a natural iron phosphate; in potentized form, phosphorus has a regulatory function in inflammatory processes in the lungs. The role of iron with respect to lung physiology and the human immune system has already been mentioned above. Added to this is the circulation-stabilizing effect of potentized iron. Potentized iron phosphate is a standard medication in Anthroposophic Medicine for pneumonia with simultaneous circulatory instability. “Pulmo/Vivianit comp. primarily strengthens the rhythmic system itself, both via the circulation and via the lungs.” (20, p. 339) The Tartarus stibiatus contained in this compositional medication also has a circulation stabilizing and mucus mobilizing effect. Potentized Bryonia root has proven to be effective for painful coughing and autonomization of inflammatory fluid exudates and interstitial edema formation (21, pp. 688–691). Potentized (!) organ preparations such as the Pulmo recommended here can prove therapeutically very valuable in the control of excessive inflammatory processes (22).

In the treatment of deep respiratory tract infections and outpatient acquired pneumonia (23), Anthroposophic Medicine largely uniformly applies a standard treatment with relatively concentrated plant extracts of aconitum, wolfsbane, bryonia, supplementing this orally with a second composition of potentized phosphorus and Tartarus stibiatus:

• Pneumodoron® 1 dil. (Aconite/Bryonia drops) WELEDA: 50 drops in 1 glass of water, taken in sips throughout the day.
  Ingredients: Aconitum D2, Bryonia D2. Recommended from the age of 9, younger children should be given Bryonia/Aconitum pilules WALA (Bryonia D8, Aconitum D6).
• Pneumodoron® 2 dil. (Phosphorus/Tart. stib.) WELEDA: 10 drops 4 x daily, not after 6:00 pm.
  Ingredients: Phosphorus D4, Tartarus stibiatus D2.

If a high, protracted and debilitating fever develops, or if a feverish COVID-19 patient shows signs of vital weakness at the same time, an injection preparation of potentized silver and echinacea – a standard medication in this situation in Anthroposophic Medicine – can be very effective both s.c. and i.v. (the i.v. application is an off-label use, but has proven its value many times over, while there is no risk of undesirable drug effects at these potency levels):

• Argentum D30/Echinacea D6 amp. WELEDA: 1 amp. s.c. or i.v. 1 x daily, especially in the evening.

As already mentioned, bitter substances are characterized by the fact that they activate the body’s defenses in the area of the respiratory tract and by no means only improve digestion (digestion and the immune system are closely related in terms of their developmental history). In the form of amarogentine, yellow gentian concentrates the bitterest known plant substance (24) in its root:

• Gentiana lutea, eth. dec. D1 [= 10%] WELEDA: 7–10 drops 3 x daily.

If the patient has an allergy tendency in the area of the respiratory tract and a tendency to winter infections (13, p. 44), a suitable alternative is wormwood in combination with potentized larch resin:

• Absinthium D1/Resina laricis D3 WELEDA: 10 drops 3 x daily.

As the sensitivity to bitter substances varies greatly from person to person, it may be possible to apply a gradually increasing dosage and dilute the drops in a little water. The bitter taste is essential for its effectiveness.

If there is a pronounced sensation of coldness and circulatory weakness at the onset of the illness, it has proven effective to give

• Camphora D3 amp. WALA: 1 amp s.c. as needed, as well as
• Camphora D1 dil. WELEDA: 5–10 drops 3 x daily during the whole course.

Camphora particularly strengthens the patient’s warmth organization, thus strengthening both immunological self-regulation and circulation regulation. It is also suitable as a preventative measure for patients with winter susceptibility to infection and frequent freezing (5–10 drops 1 x daily).

Especially for older patients and for all patients with accompanying cardiovascular disease, diabetes mellitus (type 2) or obesity it is recommended to accompany the strengthening of self-regulation in the rhythmic system with (13, p. 266–270)

• Cardiodoron® drops, amp. (Onopordon comp. A) WELEDA: 10–20 drops 3 x daily, where required 1 amp. 1% s.c. daily.
  Ingredients: Cardiodoron® dil., amp. (5%, 1%, 0.1%): Onopordum acanthium, Flos;
  Primula veris, Flos; each prepared with 1% Hyoscyamus niger, Herba Ø.

For patients with a never-ending, debilitating irritable cough, also during convalescence, we recommend a composition of plant extracts from the fruits of Verbascum, the lichen Cetraria islandica, the yarrow flower Achillea millefolium and anise:

• Verbascum comp. dil. WELEDA: 10–20 drops 3–6 x daily.

External applications

At this stage of the disease, primary consideration may be given to lemon throat compresses for sore throats, lemon pulse compresses for chills and poor circulation, and lemon calf compresses for relieving high fever and stimulating circulation. Instructions are available on the website www.pflege-vademecum .

To accompany the treatment of coughs it is helpful to apply

• Plantago Bronchialbalsam (bronchial balm, oil for external use) WALA: Rub into the chest thinly 3 x daily.
  Ingredients: D-Camphora, Cera flava, Drosera e planta tota D3, Eucalypti aetheroleum, Petasites hybridus e radice D1, Plantago lanceolata e foliis D1, Terebinthina laricina, Thymi aetheroleum.

Sufficient quantities to drink and appropriate tea preparations are also very helpful. For example: Elderflower blossoms (Sambucus nigra) 20 g, lime blossoms (Tilia platyphyllos) 20 g, dense-flowered mullein blossoms (Verbascum densiflorum) 7.5 g, cowslip (Primula veris) 7.5 g, narrowleaf plantain (Planta lanceolota) 7.5 g, thyme (Thymus vulgaris) 7.5 g. Add 2 teaspoons to 500 ml of boiling water and leave to stand for 5 minutes (covered). Drink sips of 1 cup of tea 5 times a day, adding a little lemon juice and up to 1/2 teaspoon of honey.

2. COVID-19 pneumonia (as part of an integrative therapy concept)

The clinical picture was described above. As with any COVID-19 patient, the generally applicable guidelines on diagnostics, protection of medical staff and the environment, and therapy must be observed. The risk of progression (ARDS, sepsis, see section 3.3) requires close monitoring and diagnosis. In the following section we present a specific selection of therapeutic options in Anthroposophic Medicine for COVID-19 pneumonia. In this concept, essential elements of the treatment with medications were already given for the initial influenza stage (see section 4.1.1) and are therefore only briefly mentioned here. An essential and effective element in the treatment of pneumonia in Anthroposophic Medicine is to administer external applications in the form of warm, moist chest compresses with powdered ginger root, mustard flour or yarrow tea. These three compresses can be considered therapeutically for all cases of outpatient-acquired pneumonia and are presented with their indications in section 4.2.2.

Medication

The following medicines, described above in more detail in terms of composition, effect and dosage, form the basis of COVID-19 pneumonia therapy from the perspective Anthroposophic Medicine:

• Pneumodoron® 1 dil. (Aconite/Bryonia drops) WELEDA: 50 drops in 1 glass of water, taken in sips throughout the day.
  Ingredients: Aconitum D2, Bryonia D2. Recommended from the age of 9, younger children should be given Bryonia/Aconitum pilules WALA (Bryonia D8, Aconitum D6).
• Pneumodoron® 2 dil. (Phosphorus/Tart. stib.) WELEDA: 10 drops 4 x daily, not after 6:00 pm.
  Ingredients: Phosphorus D4, Tartarus stibiatus D2.
• Pulmo/Vivianit comp. amp. WALA: mixed in the syringe (1 amp. each) 1 x daily s.c. between the shoulder blades, approx. 5 cm next to the spine (switch sides daily), if not possible s.c. in the upper abdomen.
  Ingredients: Pulmo D16, Vivianit D7, Bryonia e radice D5, Tartarus stibiatus D5.

Pulmo/Vivianit comp. can be supplemented with

• Formica ex animale D8 amp. WALA: 1 amp s.c. daily and, if needed
• Equisetum/Stannum amp. WALA: 1 amp s.c. daily

The use of the latter two preparations (13, pp. 393, 417) is primarily aimed at treating interstitial inflammation and increasing infiltrates in the lung tissue. These medications have a limiting and resorption-promoting effect, they stimulate excretion and thus promote aeration. Formica is particularly indicated in patients who are exhausted and tend to get cold, often older patients (25).

We pay special attention to kidney function in COVID-19 patients. Not only because the infection itself via the ACE2 receptor can impair important regulatory processes related to the renin-angiotensin-aldosterone system (RAAS), but also because the maintenance of good excretory function is important for lung aeration. The following composition is suitable for therapeutic support, especially for older patients and those with impaired kidney function:

• Renes/Equisetum comp. pilules, amp. WALA: 10 pil. 2x/d or 1 x/d 1 amp s.c.
  Ingredients: Apis mellifica ex animale Gl D31, Equisetum arvense ex herba D14, Renes bovis Gl D6, Veratrum album e radice D5, Viscum album (Mali) e planta tota D14.

In cases of pronounced dyspnea, potentized birch charcoal can have a relieving effect:

• Carbo Betulae D20 amp. WELEDA: 1 amp s.c. as needed, 1–2 x daily

Alternatively, a composition of potentized birch charcoal with hawthorn extracts is indicated in cases of respiratory distress and circulatory weakness, especially for elderly patients and patients with cardiovascular concomitant diseases. In medical experience, this composition has also proven successful for COVID-19 patients:

• Carbo Betulae D8 / Crataegus D2 amp. WELEDA: 1 amp s.c. daily

In cases of high fever, weakness with disturbed microcirculation and incipient sepsis, a continuous infusion with the addition of 1 ampoule each of the following anthroposophic medicines can be used as part of clinical treatment

• Argentum metallicum praep. D30 amp. WELEDA
• Stibium metallicum praep. D6 10 ml amp. WELEDA
• Lachesis D20 amp. WELEDA
• Cardiodoron® 0.1% amp. WELEDA

The therapeutic goals are warmth regulation, limitation of excessive inflammatory reactions, preservation of capillary microcirculation and the basal vitality of the vital organs.

All other medications mentioned under “Infuenza stage“, e.g., bitter substances, may also be considered individually at this stage of the disease. There is experience in administering these to intubated patients via stomach tubes.

External applications

For instructions on how to administer all three external thorax applications mentioned below, we refer to the Vademecum of External Applications in Anthroposophic Medicine, available online under the indication “Pneumonia” (26). Normally these compresses are applied once a day. These external applications can also be adapted for use on ventilated patients. Maintaining the necessary protective measures for the person administering the compress is a prerequisite for all of the applications mentioned below.

We describe the following three compresses in reverse chronological order in terms of their therapeutic application, since yarrow lung compresses are relatively easy to apply and have a broad indication for pneumonia, whereas mustard lung compresses are the most demanding in application and indication. It should be emphasized that each of the three compresses should only be applied when the patient’s feet are sufficiently warm or have been warmed up, otherwise their effectiveness can be significantly reduced. As a rule, the chosen compress is applied once a day.

• A yarrow lung compress (27) is an easy-to-handle, effective and safe chest compress for COVID-19 pneumonia, even for weakened patients or high fever.

In addition to all other measures, it supports the organism in stabilizing the pulmonary interfaces and counteracts fluid accumulation in the lung area. In this respect it can be used for all stages of pneumonia. It is particularly important in the resorption and healing phase of COVID 19 pneumonia.

Yarrow (Achillea millefolium) is a plant characterized by outstanding structuring power. Its finely feathered leaves form a “structured air space”. Its composite flowers are grouped umbel-like above them, spread out to form a surface. The bitter substances of yarrow, which also work through bitter substance receptors in the skin (28), support differentiation and circulation processes in the lungs. The compress reduces swelling and promotes absorption, relieving interstitial inflammation in the lung tissue. Adding freshly squeezed lemon and lemon peel can enhance the effect, especially in cases of high fever, and can also have a positive effect on the patient’s alertness. It is also well tolerated by patients of an advanced age.

• Ginger lung compress (29)

The domain of ginger compresses is to achieve lasting stimulation of the patient’s warmth organism and blood circulation in the depths of the organism. Ginger compresses have an antispasmodic effect, relieving and deepening breathing. They have a relaxing and anxiety-relieving effect on both the soul and the body. They are particularly indicated for patients with warmth deficits, cold extremities and a nervous, head-dominated constitution. They are mainly used in the first week of clinically manifest Pneumonia, especially in the absence of warmth or fever, and are particularly suitable for patients with concomitant chronic obstructive pulmonary disease (COPD).

Ginger compresses should be used with caution when there are existing cardiac problems because these patients may experience the resulting intensive, inwardly directed warmth generation as stressful.

• Mustard lung compress (30)

Mustard powder lung compresses are impulse-giving and irritating compresses that deepen respiration, which can be very helpful in the initial phase of COVID-19 pneumonia if the patient has sufficient strength. Due to the strong irritation it causes on the skin, it reflexively enhances inhalation, which can have a measurable positive effect on oxygen saturation (hypoxemia). This application’s irritating effect contributes to diverting excessive local inflammatory activity to the outside, thus relieving respiration and circulation.

Mustard compresses are not indicated for patients who are not able to develop a strong warmth response (immune response, e.g., with fever). This is especially important to bear in mind for older and weakened patients. On the other hand, if the patient is sufficiently vital, mustard lung compresses can show rapidly observable effects in the first days of COVID-19 pneumonia treatment.

3. Sepsis, multiple organ failure

We would like to briefly point out the therapeutic possibilities offered by Anthroposophic Medicine in this third stage of the disease. With regard to lung treatment (ARDS), the measures and medications mentioned in the previous sections remain applicable. The treatment options for sepsis and multiple organ failure can be grouped according to their indications as follows:

Medication for microcirculatory disorders

A continuous infusion with the addition of 1 ampoule each of the following anthroposophic medicines can be used as part of clinical treatment

• Argentum metallicum praep. D30 amp. WELEDA
• Stibium metallicum praep. D6 10 ml amp. WELEDA
• Carbo Betulae D30 amp. WELEDA
• Cardiodoron® 1% amp. WELEDA

Carbo Betulae D30 has a toning effect on the cardiovascular system, especially in cases of acidosis. It stimulates and supports kidney function (13, p. 257). The potentized silver in D30 has been used in Anthroposophic Medicine since its inception for excessive inflammatory processes that lead to destruction (31) (13, p. 118) and it strengthens the coherence of the organism’s basic vital functions. The intravenous application of potentized antimony (Stibium metallicum praep.) counteracts structure-dissolving inflammatory processes in the endothelial area.

Medication for disseminated intravascular coagulation (DIC) / coagulopathy

This life-threatening disorder, which is characteristic of advanced COVID-19 disease, can be treated by Anthroposophic Medicine beyond the standard intensive-care measures with

• Kalium aceticum comp. D6 amp. WELEDA: 1 amp. s.c. or i.v. 1–2 x daily.

The leading indication for this medication is an independent disseminated coagulation process which, from the point of view Anthroposophic Medicine, is an expression of a failure of the overriding integrating self-regulation of the organism in the flowing blood. This preparation has a specific connection to the area of venous circulation and pulmonary vessels (“low pressure system”). It has proven itself as a supportive therapy for circulation and coagulation disorders in this area of the circulatory system (20, p. 1052).

A toxicologically clear relationship to coagulopathies is shown by snake venoms, especially those of the Crotalidae (Lachesis, Crotalus, Bothrops and others) (32). From this perspective, potentized bushmaster poison is primarily indicated for COVID-19 in Anthroposophic Medicine:

• Lachesis D20 amp. WELEDA: 1 amp. daily as a continuous infusion or i.v.

Medication for cardiomyopathy

Especially vital in the third stage of COVID-19 disease are heart and kidney function. Anthroposophic Medicine also uses potentized organ preparations to treat this vital threat to basal organ function (33, pp. 1176–1177). The medication characterized above

• Carbo Betulae D8/Crataegus D2 amp. WELEDA: 1 amp. s.c. 1–2 x daily

can thus be supplemented by

• Cor/Aurum I Amp. WALA: 1 amp. i.v. or s.c. 1 x daily.

Medication for nephropathy

The maintenance or recovery of kidney function can be supported by

• Renes/Cuprum amp. WALA: 1 amp. s.c. or i.v. 1 x daily.

or by the preparation described above.

• Renes/Equisetum comp. amp. WALA: 1 amp. s.c. or i.v. 1 x daily.

The basis for convalescence, the duration of which can be roughly equated with the duration of the acute illness, is to ensure sufficiently long discharge from work (sick leave) as needed and the observance of all the principles and measures mentioned in the section on prevention (see above, 2.).

Medication

The following medications are suitable as specific support for the rhythmic system:

• Roseneisen/Graphit (Rose Iron/Graphite) pilules WALA (13, p. 647–649).
  Ingredients: Graphites D14, Rosa e floribus cum Ferro D2

or

• Ferrum rosatum D3/Graphites D15 dil. WELEDA: 10 pil. or 10 drops 2 x daily.

in combination with

• Prunuseisen (Prunus/Iron) pilules WALA: 10 pilules 2 x daily.

“The vitalizing forces of the tips of blackthorn shoots and flowers are specifically directed towards the respiratory system through additional use of hematite (iron oxide) in the WALA manufacturing process. Prunus/Iron can be understood as a plant-acidic iron preparation. It is particularly relevant for etheric weakness in the respiratory system that also manifests as weak appetite.” (13, p. 622)

These medications focus on lung recovery. They can be given for 2–4 weeks. Valuable, vitalizing support can be given through the subcutaneous administration of a potentized lung organ preparation in the form of

• Pulmo Gl Serial pack III amp. WALA: every 3rd day 1 amp. s.c. in descending potentization over a total of 4 weeks (10 amp.).

Potentized Christmas rose extract (Helleborus niger) can have a profound effect during convalescence. This medicinal product shows a clear relation to kidney function, promotes edema resorption and excretion processes and can positively influence attention and concentration:

• Helleborus niger D6–D12 amp. HELIXOR, WALA: initially D6, later D12 amp. s.c., 2–3 x per week.

For many patients, it is also helpful to support the cardiovascular system by prescribing

• Cardiodoron® drops (Onopordon comp. B) WELEDA: 10–20 drops 3 x daily.

This medication has a stabilizing effect on the rhythmic system in a comprehensive sense. Especially in the senium it can regulatively counteract disintegration of rhythms, especially the sleep-wake rhythm (13, p. 269).

Potentized gold enhances the effect of Cardiodoron®. It has a fear-dispelling effect and promotes alert ‘I’-presence. A specific therapeutic option in Anthroposophic Medicine is the use of jointly potentized myrrh and frankincense in the form of

• Aurum comp. pilules, amp. WALA: 10 pil. or 1 amp. s.c. 1 x daily.

External applications

The medicinal plants yarrow and ginger characterized under 4.2.2 are also suitable for other organotropic external applications in the form of moist-warm compresses. Exhausted patients with weakened vitality, possibly sleep disorders, reduced appetite, weak digestive activity benefit greatly from the use of a

• Yarrow Liver Compress (34): 1 x daily to 3 x weekly in the early afternoon or evening.

Nervous, hypersensitive, weakened patients who tend to freeze appreciate the use of a

• Ginger kidney compress (35): 1 x daily to 3 x weekly preferably in the morning.

This compress does not only strengthen organ function. Lasting strengthening of inner warming can be achieved by administering a series of ginger kidney compresses. This can lead to significant relaxation and, where needed, reduced anxiety.

Note: This contribution was translated from the German and will appear as chapter 52 in the book “Anthroposophische Medizin. Arzneitherapie für 350 Krankheitsbilder”, published by Wissenschaftliche Verlagsgesellschaft Stuttgart in September 2020.

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