Traditional Chinese Herbs For InfluenzaAdina Stanescu, R.TCMP June 1, 2009
The recent possibility of an influenza pandemic had many in the health professions thinking about how we might deal with this potentially severe illness. Since SARS hit China, Hong Kong and Canada in 2003, Traditional Chinese Medicine (TCM) experts worldwide have suggested protocols for the prevention and treatment of likely symptom patterns. In fact, there is some evidence to suggest that Chinese herbal therapy decreased the likelihood and severity of complications and improved the outcome for SARS patients. The World Health Organization has published several reports on this, they can be found online at http://apps.who.int/medicinedocs/en/d/Js6170e/6.html.
The stages of TCM intervention are: preventing infection; treatment of the initial onset of symptoms; and prevention and or treatment of secondary complications.
For centuries, Traditional Chinese Medicine was the only medicine available to treat all manner of epidemic diseases that regularly swept through China. TCM doctors observed the natural course of such illnesses and saw predictable patterns in the way that symptoms expressed themselves, from the initial phase of the first few days, to the more dangerous later phases – what today we would call secondary complications – when pneumonias, encephalitis, diarrhea or hemorrhage might develop. These observations lead to fairly sophisticated protocols aimed at staying one step ahead of the evolving infection and to ensure survival. One of the most famous medical textbooks that systematized the treatment of epidemics was the Shang Han Lun, The Treatment of Febrile Diseases, published around 200 AD.
HERBS FOR INFLUENZA PROTECTION
Right away we will think of boosting the immune system when it comes to treating influenza, but in fact not every immune system needs boosting. One of the most interesting things to come out of SARS, as well as from retrospective investigations of the Spanish ‘flu, has been the idea that it is often hyper-immunity that ultimately kills the patient. Modern medicine calls this the cytokine storm. Cytokines are chemicals that signal immune cells to go to the site of infection. The immune systems of young, vigorous people may go into overdrive when attacked by an aggressive virus, and the cytokines produce an inflammatory immune response that does not seem able to turn itself off. This inflammation can profoundly damage organs such as the lungs, by producing swelling and fluid accumulation that obstructs breathing.
So how do you know if you need preventive immune boosting, for example with herbs such as Astragalus, ginseng or Echinacea, or the famous preventive formula Yu Ping Feng San (Jade Windscreen Powder)? It is useful to look at your own pattern of colds and ‘flus of the past, and compare these with other members of your family. People with deficient immunity tend to catch frequent, lingering, but not particularly severe colds. They rarely run fevers and may continue to feel run down and not quite well for weeks afterwards. On the other hand, people with normal or potentially excessive immunity get sick very fast, are pretty much bedridden with a high temperature and sweating, and are red cheeked and physically sturdy. TCM considers these to be “hot” constitutions with plenty of normal Qi/ immunity. They also recover quite quickly and completely, at least from an ordinary cold or ‘flu.
However, in the event of a more troublesome pathogen, their immune system may unleash the kind of cytokine storm that is like a wild horse galloping out of the starting gate. This may explain why the Spanish ‘flu killed people in the prime of life, seeming to spare the presumably more deficient young and old. Vigorous people do not need, and indeed should never have, immune tonics. It is better to take low doses of antiviral formulas such as Yin Qiao San or Zhong Gan Ling. Nor should young people use hot herbs such as ginger or garlic, as this will add further Fire to their already considerable inflammatory “heat.”
In contrast, people with weak immunity may take the same antiviral formulas together with the Astragalus-based immune formulas found online or in health food stores. Keep in mind that remedies sold in Chinatown may often be adulterated, but the online sources of companies such as KPC, Health Concerns, Kan Herbals, Seven Forests, Blue Poppy and Mayway are generally safe. It is always best to use TCM formulas made by TCM companies.
A neglected but very important opportunity for prevention is the detoxification of air in the home or office by using herbal vapours or fumigants — especially if there are already sick people there. A folk remedy during the Spanish Flu was to keep a pot of onions always boiling on the stove. The acrid vapours have an antiviral effect on airborne particles. The same effect is obtained from the burning smoke of dried moxa (Artemesia vulgaris). This is a very beneficial smudging. Although some may object to the smoke, it is not harmful for short-term use. Aromatherapy may also be useful.
TREATMENT: FOUR LEVELS
TCM bases its treatment of epidemics on the theory of The Four Levels. This theory proposes that viruses move from the exterior of the body, where they produce relatively mild symptoms, to the interior, where they may affect the organs and produce life-threatening complications through four levels.
The first level is the Defensive Level. This is when we first feel that we have “caught a chill.” The virus is at the superficial level of the skin and upper mucous membranes, as indicated by chills, sore throat, runny nose and emerging fever. The pulse is floating near the surface, as this is where the battle begins. The skin may have goose bumps and there is sneezing as the body tries to squeeze the skin shut to prevent further entry and expel the invader. A sneeze is an attempt at a violent outward thrusting of infection. These are standard symptoms of a head cold, and if it goes no further the body has succeeded in keeping the infection out of deeper layers.
A person with normal immunity would be given the formula Yin Qiao San (Lonicera and Forsythia Powder), composed in part of the very strong anti-virals honeysuckle flower and forsythia fruit. To this formula we should add Isatis root (Banlangen) or Andrographis paniculata (Chuan Xin Lian), as these have shown very strong anti-infective properties.
The key to treatment is to start as soon as symptoms appear and to take a sufficiently high dosage of pills, or ideally a high-strength boiled decoction. This off-label increase in dosage should only be prescribed by a qualified TCM herbalist. A virulent ‘flu will not respond adequately to the two to three pills, 3X per day printed on the package.
In contrast, the treatment of a person with deficient immunity at this point might require a cautious use of immune boosters such as ginseng, rhemannia root or angelica dang gui, or a formula such as Ren Shen Bai Du San (“Ginseng Powder To Overcome Pathogenic Influences”). A good remedy available online is Cold Quell by Blue Poppy company. However, supervised treatment with a qualified herbalist is best. The tonics will strongly boost the body’s resources so it can mount a defence. Level One treatment is only given for the first two to three days.
Here, the virus begins to affect the more interior energetic layers of the body. This is when symptoms become much more severe, with high fever, sweating, thirst and a big, strong pulse. The patient is too sick to do anything.
Interestingly, Chinese medicine teaches that the severity of symptoms is directly proportional to the strength of the individual: i.e. stronger people will be sicker. In this context, it is no surprise that the hyper-immunity of cytokine storm may develop. In contrast, we can think of “walking pneumonia” in old people. Older people generally do not produce the kind of obvious, loud, red-flag symptoms of the young, because their immune system is no longer capable of a fierce battle, and so their pneumonia may be missed until it becomes life-threatening. Their treatment will always include some tonics.
Level Two treatment requires the use of Bai Hu Tang (White Tiger Decoction), which consists of Shi Gao (Gypsum), Zhi Mu (Anemarrhena root), licorice and white rice. This formula is only for the young and vigorous, and may be added to the Level One formula, Yin Chiao San, to continue the anti-viral detoxification, or to herbs such as Houttynia, yu xing cao and Belacamda/She Gan, to treat or prevent development of pneumonia.
If shortness of breath and phlegm congestion of the lungs develops, one can use the related formula Ma Xing Shi Gan Tang, which incorporates bronchodilators such as Ma Huang (Ephedra). If the infection affects the gastro-intestinal system with diarrhea and vomiting, we use Gan Lu Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxin) instead.
This type of specific treatment targeted to each patient’s exact symptom presentation is what makes TCM effective.
LEVELS THREE AND FOUR
The virus has now penetrated the Yin and blood levels, which are the deepest layers of the body. The extreme heat produced by the virus, as well as by the inflammation of the immune response, will produce rashes, possible hemorrhage, as well as changes in consciousness such as restlessness, delirium, a crimson red tongue with dry, yellow coat and a surging or slippery, rapid pulse. Encephalitis (brain inflammation) or coma are the most severe manifestations. This stage may also correspond to the Western diagnosis of sepsis, a body wide inflammation characterized by the inflammation and impairment of organ function.
At this stage a patient would be hospitalized, and possibly admitted to intensive care, so there are many practical obstacles to herbal treatment. Nonetheless, a possible formula is Qing Wen Bai Du Yin (Clear the Scourge and Vanquish Toxins Beverage) — a powerful combination of anti-toxin, anti-viral, blood cooling and fire purging herbs such as gypsum, buffalo horn, coptis root and scrophularia root.
Fortunately, swine flu seems to be trailing off, but SARS, as well as the lurking Avian flu, have shown us that a truly threatening pandemic is always a possibility.
The main challenges for patients in such a case are preparedness and timely access to effective treatment and medicines. In a time of crisis, herbs would quickly sell out as they did in China during SARS, or become prohibitively expensive. If you think you would turn to herbs to treat a flu, it might be best to assemble a kit beforehand, in consultation with your practitioner. All herbal protocols given here can be used in conjunction with Western antivirals, such as TAMIFLU or antibiotics.
The challenge for TCM practitioners is to brush up on their herbal formulas and diagnosis, and familiarize themselves with the latest protocols. The fact is that in this modern day, the study of epidemics in TCM schools is rather abridged. It is essential to be able to nimbly prescribe according to the idiosyncrasies of an emerging flu strain and to have confidence in prescribing the high dosages that are essential to recovery. As well, experienced practitioners should consider making themselves available for online consultations in order to treat flus as quickly as possible, and minimize travel and contagion.
Good resources for practitioners are: