Convalescence

Excerpt from: Principles and Practice of Phytotherapy, by Kerry Bone

Convalescence

It is ironic that at the very time that healthcare has to deal with so much chronic and debilitating disease it has abandoned the best strategic approach inherited from tradition. In the past it was taken for granted that any illness would require a decent period of recovery after it had passed, a period of recuperation, of convalescence, without which recurrence was possible or likely. For the really debilitating diseases convalescent care was the primary treatment, reaching its apogee in the many European sanatoria for tuberculosis patients.

Convalescence fell out of favour as powerful modern drugs emerged. It appeared that penicillin and the steroid anti-inflammatories produced so dramatic a resolution of the old killer diseases, including tuberculosis, that all the time spent convalescing was no longer necessary. Then, as healthcare provision became generally more effective and public expectations increased, pressure on hospital facilities led to shorter stays, whilst the increasing angst of the modern working rhythm has conspired to ensure that most people now could not consider time off to convalesce after a bout of flu. That this means they are more likely to get another bout the next year is a cruel irony.

A good convalescence is a marvellous thing. It rounds off an illness and gives it meaning; it makes the sufferer stronger for having had the illness. In a way no vaccination could do, it arms and strengthens the immune defences and provides real protection against recurrence, possibly forever. It is probably the only strategy that will allow real recovery from debilitating disease, fatigue syndromes, recurrent infections and states of compromised immunity. It is the therapeutic recognition that healing, like the growth of children, is almost inevitable but that it needs to be allowed to proceed. Convalescence needs time, one of the hardest commodities now to find.

There are four essential features of convalescence, in general agreed through history, though with many cultural embellishments.

Rest

This is by far the most important element. It should include maximum sleep, as physiologically this is the body’s time for repair. In the early stages of vigorous convalescence almost constant sleep should be encouraged (as in the former ‘sleep clinics’). Thereafter it should be promoted as much as possible. Rest also means less activity: if work has to be done it should be in brief bouts, switching frequently between different activities (‘change is as good as a rest’). Patients should be encouraged to pace themselves, to go to bed early, sleep late and not to volunteer for any work that is not absolutely necessary. As much as anything rest becomes a mental priority: all other considerations are secondary. That hour of more sleep is more important than a film on TV, a late-night conversation or night out.

Exercise

This is the flipside and necessary adjunct to rest, the equivalent to ‘turning the engine over’, to prevent congestion and stagnation. Essentially the body needs to be taken to aerobic exercise (defined for these purposes as any activity producing a pulse rate of between approximately 60–80% of 220 minus one’s age, e.g. 108–144 for a 40-year-old) at least briefly each day. Using the pulse rate to set exercise levels has the advantage of being self-adjusting: the very debilitated will reach high pulse rates with minimal activity. Nevertheless, caution is required. The debilitated will have very little stamina and even a minute may be too long. If exercise is followed by more fatigue, it is too much. Rather, one should build up to being able to undertake aerobic activity for up to 15 minutes each day. The main benefit of the aerobic mode is that it quickly dissipates sympathetic-adrenergic effects on the body (‘adrenaline’), constantly generated during the day in response to perceived stressors, and the enemy of convalescence. Timing one’s exercise for the evening will encourage better sleep that night.

Diet

The principle of the convalescent diet is that it should simply nourish. It should not stimulate or impose demands. Subject to individual dispositions, a convalescent diet is based on vegetables, especially root vegetables, cereals and pulses (if tolerated), fish and eggs, as the most easily assimilated protein sources, and chicken and other fowl if acceptable (chicken stock and soup remain one of the most universal and puzzling convalescent recommendations of history!). There should be no stimulants, caffeine, nicotine, alcohol or sugar, little dairy food and a minimum of convenience foods and food additives. Patients should thus be encouraged to take a simple peasant diet, sharing also with the peasant a simple respect for the food, taking time over it, building their daily rhythm around it.

Medication

It is obviously important to maintain treatment during convalescence: herbal or conventional. However, there is also a key contribution to the measures above in herbal traditions. It was accepted that rest, exercise and diet alone might not be sufficient to bring about recovery. A range of herbal remedies have been directed to facilitating the process, to drive recovery. Many of these are the tonics listed earlier. If recovery is from febrile disease, sustaining warming remedies like Achillea (yarrow), Angelica archangelica (common angelica), Cinnamonum zeylanicum (Ceylon cinnamon), Cardamomum (cardamom) or Foeniculum (sweet fennel) might be indicated. Recovery from low-grade assault on the immune system, chronic viral or fungal infections, conditions marked by swollen lymph glands, persistent sore throats or catarrhal states would need Echinacea, Picrorrhiza or Baptisia tinctoria (wild indigo). Digestion is often in need of support, whether from cooling bitters or warming aromatic digestives. Cleansing should be managed, above all, by gentle eliminatives.

For the phytotherapist convalescence is often the main strategy in making headway in chronic debilitated conditions such as a fatigue syndrome or persistent low-grade infections. Often these problems start with an infection early in life – a glandular fever or infectious mononucleosis, perhaps. The phytotherapist might suggest to the patient that the task is to go back and complete the convalescence from the original illness. The remedies available are probably

Bone, Kerry; Mills, Simon. Principles and Practice of Phytotherapy (pp. 86-87). Elsevier Health Sciences. Kindle Edition.

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I write often about topics that affect our health and well-being. Additionally, I teach and offer lecture about qigong, tai chi, baguazhang, and yoga.

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