CHINESE HERBS AND INFLUENZA

Unlike the vaccines, which are made in response to flu strains as they appear, Chinese herb therapies for influenza are not specific for the viral strain. Instead, they may provide general actions, such as to help boost the immune response so that it is able to eliminate the virus faster. At high enough dosage the herbs may have some direct inhibitory effects on viral reproduction; they may also ameliorate some of the symptoms, thus making a serious infection seem mild.

Instead of having a single herb or a single formulation as the response to flu, there are a collection of herbs and formulas that have developed a good reputation. During the period from the 1950s to the 1970s, several large scale studies were undertaken in China to evaluate the use of traditional herb formulas and newer herbal remedies to prevent and treat influenza, with favorable results reported for several compounds. These findings appeared in medical journals and in books summarizing progress in Chinese herb research. The information has been gathered at ITM, while many of those original publications are no longer available due to limited print runs. While there is insufficient proof from these studies that Chinese herbal therapies can cure or impede influenza because of problems in methodology and reporting, practitioners of Chinese medicine and their patients are convinced of the efficacy of this approach.

Routine prescription of Chinese herbs for influenza or other therapeutic applications remains limited primarily to the countries where herbal medicine is officially recognized, such as China, Japan, and Korea. In other countries, the herbs have been made available mainly through the work of licensed acupuncturists, naturopaths, and other non-M.D. practitioners, as well as through direct marketing of products to consumers.

The non-toxic herbs found useful in these studies have been incorporated into formulations that ITM has produced for practitioners to use. Several of the formulations, such as Ilex 15, have been available for more than 15 years, so that there is some experience gained through several influenza seasons.

Practitioners of Chinese medicine in the U.S., Canada, and Europe will be called upon to provide natural therapies for influenza this year as before, with a potential for higher demand and with more concern about prevention strategies. Even though such therapies are not proven to be effective, many people will feel the need to do everything that seems reasonably possible. Thus, it is worthwhile to review the therapeutic approach described by the Chinese and to offer some of the readily available remedies (ITM formulary items will be described here; others are easily obtained).

A REGIMEN FOR SEVERE INFLUENZA

Chinese herb therapy, applied to address the first signs of influenza, might prevent the infection from developing into the full symptomatic disease. For persons who are highly susceptible to influenza and those who tend to experience severe symptoms, as well as during influenza seasons that are defined as being highly virulent or dangerous, it may be prudent to treat even the initial symptoms as though a severe disease was about to develop. These herbal remedies would be used in persons who are developing symptoms despite having been vaccinated (since there is the possibility of vaccine failure, especially later in the season when new strains might dominate) and could also be used along with drugs such as Tamiflu, which are not completely efficacious on their own.

To review key herbs that are used in these treatments, please see these articles:

Forsythia and Lonicera (antiviral herbs)

Shuanghuanglian (this article focuses on three antiviral herbs; the two herbs in the article above, plus scute)

Schizonepeta and Mentha (these herbs are used to alleviate symptoms)

Yin Qiao San (this article describes a common anti-influenza formula used in China; it includes forsythia, lonicera, schizonepeta, and mentha).

The Jade Screen (article about a formula for preventing infections and aiding recovery afterward)

A protocol using ITM formulations (which are prescribed by health professionals and are not sold in stores) could be designed in this manner (these dosages are for adults):

• Ilex 15: 5-6 tablets each time, three times daily
  
• Myrolea-B: 1 tablet each time, three times daily
  
• Calmagnium: 1 tablet each time, three times daily
  
• Quercenol: 1 tablet each time, three times daily

Ilex 15 (Seven Forests) is a complex formulation of Chinese herbs that are used to treat upper respiratory system infections. The pattern of herb combining follows principles used in producing two popular patent remedies from China: Yin Qiao Jie Du Pian and Gan Mao Ling. This formula has been used for 15 years. It is suitable for use by itself in the early stage of common influenza and other upper respiratory viral infections. ITM also provides a modification of the original Yin Qiao Jie Du Pian (Pine Mountain), which has been modified with herbs indicated as effective for influenza by ongoing research in China. In addition, there is a potent broad-spectrum antiviral combination called Isatis 6 that may be used alternatively or along with Ilex 15.

Myrolea-B (White Tiger) is a simple formulation of highly concentrated extracts from four Chinese herbs and one Western herb. The Chinese herbs include forsythia and lonicera, two of the key ingredients of Ilex 15 (and the main antiviral ingredients of Yin Qiao Jie Du Pian), thus boosting the dosage of these essential ingredients. Myrolea-B also contains the antiviral agents scute (huangqin) and terminalia (hezi). The Western herb in this formulation is olive leaf, which is one of the primary anti-viral herbs derived from the European tradition.

Calmagnium (White Tiger) is a comprehensive mineral and vitamin supplement (not a Chinese formula). The concept behind its use is that by providing optimal or even high levels of certain nutrients, the immune system has a stronger effect against pathogens. For example, it is considered possible that vitamin C, zinc, and selenium contribute to antiviral activity. The point of providing a broad nutritional supplementation, rather than just focusing on a few of the established ingredients, is to assure a more balanced effect. In China and Japan, it is increasingly common to prescribe nutritional supplements, similar to this, along with herb remedies.

Quercenol (White Tiger) is an antioxidant mixture. It has recently been reported that influenza causes oxidative stress that adversely affects the lungs, perhaps increasing symptoms and susceptibility to secondary lung infections. There is a decline in vitamin E levels. Quercetin, the main ingredient in Quercenol, has been shown to increase pulmonary concentrations of the antioxidants catalase, reduced glutathione, and superoxide dismutase. By taking Quercenol, the vitamin C intake from Calmagnium is increased (total of 1162 mg per day with the above suggested dosing) as is the vitamin E intake (total of 337 IU per day with above dosing). In addition, zinc supplementation is often recommended for to boost immune responses; the use of Quercenol with Calmagnium at the suggested dosing provides 25 mg of zinc. Selenium from Calmagnium alone at the dose of 1 tablet three times daily is 75 mcg, but adding Quercenol brings it to 175 mcg.

The antiviral agents are expected to have their best effect at the earliest sign of infection and for the phase of the disease where the amount of virus is exponentially growing, perhaps the first two to three days of symptoms. After that, the virus comes under some degree of control, even though symptoms can persist. However, additional symptoms can be generated if a bacterial infection arises; typically, a bronchial infection develops, and it may persist for several days or weeks if not successfully treated (if herbal therapy is not successful, antibiotics should be used in cases of bacterial infections). After the initial viral development phase, one may focus more on symptomatic relief, for example, deleting Ilex 15 in the regimen above and replacing it with another formula; aimed at relief of symptoms, such as for nasal congestion, sore throat, or bronchial infection with cough. Examples of those therapies include these Seven Forests formulas:

Belamcanda 15: suited for respiratory bacterial infection that accompanies or follows influenza

Chyrsanthemum 9: for headache, fever, sinus congestion accompanying influenza

Gardenia 7: for sore throat

Lily 14: for dry, irritated throat and dry cough

PREVENTION STRATEGIES

For those who are concerned about high susceptibility to influenza (due to past experience of frequent infection by viruses or a high level of exposure to crowds), immune enhancing formulas, such as Jade Screen Tablets or Astragalus 10+, may be taken during the flu season (e.g., for up to about 16 weeks) in an effort to avoid developing a symptomatic infection after exposure. Jade Screen Formula (with astragalus as a major constituent) and its variants are the most widely studied prescriptions for prevention of upper respiratory tract infections. ITM's version of the formula includes additional herbs benefiting the lungs: the anti-infection herb houttuynia, the yin nourishing glehnia, and the congestion-alleviating centipeda (an herb, not to be confused with the insect centipede). Astragalus 10+ is especially suitable for persons of middle age or older, as it also contains tonics for the kidney/liver as part of the therapeutic approach to immune enhancement. Greater immune enhancing effects may be attained by including, along with one of these tonifying formulas, a high dose of either astragalus (using Astragalus Extract Tablets) or cordyceps (using Cordyceps Tablets); these herbs also strengthen the lungs. ITM has received reports that some patients successfully use Ilex 15 as a preventive; this formula may function in this role by helping inhibit the virus as soon as exposure occurs, perhaps being effective at dosages lower than those described for treatment of the disease once symptoms appear.

It is important to note that high doses of the tonic formulas with astragalus may not be effective when the infection begins producing symptoms. The flu symptoms include the adverse impact of a high immune response, and attempts to elevate that immune response will not only fail to have a substantial extra impact on the virus but may contribute to the severity of the symptoms. Thus, one should be careful about attempting to apply this approach. Generally, the immune based therapies are applied either during a preventive health care phase of treatment or during a recovery phase when the dominant symptoms are reducing rather than at the time when the symptoms of an infection are first noted.

Some of the suggested ITM formulations are relatively new, including Myrolea-B, Yin Qiao Jie Du Pian, Chrysanthemum 9, Astragalus Extract Tablets, Cordyceps Tablets, and Gardenia 7. All of these, and the other formulations mentioned here, are included in the book A Bag of Pearls (2004). Additional suggestions for treatment of influenza or its symptoms may be gleaned from the pages describing the formulas and in the index of formula indications.

PLEASE NOTE: The side-by-side presentation of the following formulas
is not intended to suggest any particular pairings, it is for presentation only.

IMPORTANT REMINDER: There is no clinical evidence that the specific formulas mentioned above provide any protection from or effective treatment for influenza (or related disorders). The information about these formulas is given here to illustrate the types of ingredients that practitioners of Chinese herbalism (such practitioners are usually licensed acupuncturists) might give to their patients, including the dosage, the timing in relation to beginning of influenza symptoms, and the duration of use (a nutritional supplement comprised of vitamins and minerals is also mentioned). Such practitioners might recommend these specific formulas or many others that have a similar design. Several articles are referenced in the above description as a resource to learn more about certain of the ingredients and about related formulas described in the Chinese herbal literature