Clinical Considerations
➤ General comments
– Colds and flu are the most common reasons for the loss of working hours.
– Around 90 % of all catarrhal disorders are caused by viruses, especially rhinoviruses. Secondary bacterial infection can also develop. Viral and secondary bacterial infections are especially common in individuals with temporary or permanent asthenia of the unspecific (congenital) or specific (acquired) immune system.
– Drafts, cold weather, excessive indoor heating, stress, and loss of sleep are factors that promote the development of colds. When the body (especially lower body) is subjected to hypothermia or ischemia, it responds by reducing the blood flow to the mucous membranes in the upper respiratory passages. This and the drying of the mucous membranes due to excessive room heating promote the growth of pathogens.
➤ Herbal and general treatment measures
– Once a cold has fully developed, treatment focuses on alleviating typical symptoms, such as a runny nose, sore throat, and hoarseness with or without fever. Nasal douches, throat wraps, inhalation, sweat-inducing agents (diaphoretics), and baths with aromatic herbs have proved to be effective. Cold remedies usually contain secretolytic and expectorant herbs with essential oils, mucilage, and saponins.
– Hot baths for colds and flu are prepared with aromatic oils, such as spruce oil, pine needle oil, eucalyptus oil, thyme oil, camphor and/or menthol.
– The administration of a diaphoretic tea after a hot bath can enhance the febrifuge effects of the treatment.
➤ Clinical value of herbal medicine in colds and flu: All measures that improve the natural function of the mucous membranes of the upper respiratory tract, alleviate cold symptoms, and strengthen the immune system, can be recommended for symptomatic treatment of all virally induced catarrhal disorders. There are no comparable synthetic drug preparations. Self-treatment measures should be coordinated with the help of a physician.
Recommended Herbal Remedies for cold and flu(Overview)
Immunostimulants
➤ Purple echinacea herb (Echinaceae purpureae herba); paleflowered echinacea root (Echinacea pallidae radix); wild indigo (Baptisiae tinctoriae radix); and arbor vitae tips (Thujae occidentalis stipites).
Note: The efficacy of other plant parts of the two Echinacea species has not been convincingly demonstrated, although the roots of E. purpurea, and especially E. angustifolia are frequently thought to be more potent in North America.
– Action
• Echinacea: Certain compounds in echinacea (arabinogalactans, arabinogalactan proteins) enhance the body’s nonspecific immune defenses by activating the granulocytes and macrophages, thereby improving the body’s capacity to phagocytose viruses and bacteria. Activated macrophages secrete interleukin-1, interleukin-6, and tumor necrosis factor,substances that stimulate the specific immune system and protect the cells from viral attacks. These mechanisms are activated when the pathogen comes in contact with the oral mucous membranes.
• Caffeic acid derivatives such as chicoric acid and alkylamides are responsible for the antiviral effect of purple echinacea juice.
• Echinacea juice inhibits hyaluronidase, thereby reducing the permeability of the blood vessels and inhibiting the spread of local infection.
• Clinical and postmarketing surveillance studies indicate that echinacea juice and alcoholic extracts of Echinacea pallida root increase the time until the occurrence of a new infection. In those who already have a cold, the course of the infection is less severe and the symptoms subside more quickly. Since many antibiotics can suppress the immune system, these herbal remedies should be helpful in patients with bacterial infections.
• Wild indigo promotes the release of interleukin 1 and stimulates the production of interferons.
• Arbor vitae stimulates the T cells, increases interleukin-2 secretion, and has a direct antiviral effect.
– Indications: Viral and bacterial infections of the upper respiratory passages.
– Contraindications: See cautions noted on labels of commercial products.
– Dosage and administration: Oral echinacea preparations are available. Based on the current data, combinations of Echinacea root (E. purpurea, E. pallida), wild indigo (Baptisia tinctoria), and arbor vitae tips (Thuja occidentalis) appear to be superior to preparations with Echinacea alone. Further in-depth studies are needed for final clarification.
• Flavored liquid products containing coneflower preparations that include glycerine instead of alcohol are popular for children.
– Side effects: None known for oral administration.
Diaphoretics (Sweat Inducers)
➤ Elder flower (Sambuci flos); yarrow flower and leaf (Millefolii herba); and linden flower (Tiliae flos).
– Action: Elder, yarrow, and linden flowers have febrifuge and anti-inflammatory effects due to the inhibition of prostaglandins by their flavonoid constituents. Prostaglandins play a role in fever development. Linden flower tea also induces nonspecific activation of the immune system. Yarrow has anti-inflammatory properties.
– Indications: Viral and bacterial infections of the upper respiratory passages.
– Contraindications: None known.
– Dosage and administration: Elder flower.
– Side effects: None known.
➤ Vitamin C Supplements
– Black currant (Ribes nigrae fructus); rose hip peel (Rosae pseudofructus).
– Action: Increases the stores of vitamin C, yielding unspecific enhancement of the immune system.
– Indications: For prevention and treatment of upper respiratory tract infections.
– Contraindications: None known.
– Dosage and administration:• Black currant juice: Dilute with hot water. Drink 1 glass with meals at noon and in the evening. Can be used by patients in all age groups.
• Rose hip tea: Steep 2–5 g of the herb in 1 cup of boiled water for 15 to 30 minutes. Take one cup, several times a day.
• Cold rose hips tea is an effective thirst quencher for patients with fever.
Note: These preparations have relatively low concentrations of vitamin C, and their beneficial action depends also on their flavonoid or anthocyanin content. Their effectiveness is not proven with clinical trials; they fall more into the realm of pleasant-tasting home remedies.
– Side effects: None known.
Remedies to Apply at the First Signs of a Cold
Circulatory Stimulants
➤ Powdered black mustard seed (Sinapis nigrae semen) or white mustard seed (Sinapis albae semen).
– Action: Mustard stimulates the blood flow in the mucous membranes of the mouth and nose by reflex mechanisms. It can prevent the outbreak of a cold if treatment by footbath is started early enough.
– Contraindications: Powdered mustard seed should not be used by patients with kidney diseases or by children under 6 years of age due to transdermal absorption of mustard oil.
– Dosage and administration: Powdered mustard seed should not be applied to mucous membranes. When used for footbaths, add enough warm water to cover the feet and ankles.
Warning: After treatment, all mustard particles should be removed by rinsing the skin with warm water. Prolonged exposure can cause skin irritation and blistering, especially in patients with sensitive skin.
– Side effects: Prolonged use (>2 weeks) of strongly heated preparations externally can lead to skin burns and nerve damage.
Diaphoretics (Sweat Inducers).
– Contraindications: None known.
– Dosage and administration: The tea should be taken as hot as tolerable during the early afternoon.
– Linden flower tea: 2 teaspoons per cup.
– Diaphoretic tea Rx: Sambuci flos 35.0, Tiliae flos 25.0, Liquiritiae radix 10.0, Rosae pseudofructus 30.0. Use 1 teaspoon per cup of boiled water.
Warning: Diaphoretic teas should not be taken on a full stomach.
Nonspecific Immunostimulants
➤ Vitamin C supplements.
➤ Immunomodulators.
– Dosage and administration: Oral dosage forms are used. Treatment should be continued for at least 5 to 6 days.
• Liquids: 20 to 40 drops (up to 2–4 mL [2 to 4 droppersful]), 3 to 4 times a day.
• Solids: 1 to 2 lozenges, tablets or capsules, 3 times a day, as directed on the product label.
Note: Echinacea should be taken at the first signs of a cold. The efficacy of the herbal remedy is questionable when treatment is started at the climax of the disease. The preventive effect of echinacea is still under investigation. Chronic Infections of the Upper Respiratory Tract
➤ Purple echinacea leaf juice, liquid extracts of the root of E. purpurea or E. angustifolia, or a combination of various parts of the two species can be very helpful in chronic upper respiratory tract infections and recurrent colds. Products manufactured from the fresh, or recently-dried plants are preferred by most herbalists.
➤ The usefulness of echinacea preparations past 2 weeks or so is still controversial and requires further clinical studies. Oral administration of alcoholic extracts and homeopathic tinctures (mother tinctures to D2 tinctures) is reported to be more effective than other preparations. The current data suggest that preparations combining echinacea with other herbs are more effective than echinacea alone.
➤ Siberian ginseng (Eleutherococcus senticosus) may also be useful.
Warning: The immune status of severely ill patients should be checked before starting immunostimulatory therapy. Supposed risks must be carefully weighed against the expected but unproven benefits of treatment.
Patients with Low Resistance to Infection
➤ Echinacea.
– Dosage and administration: Oral dosage forms are used. In the early phases of manifest disease, administer for a period of no less than 6 days and no more than 14 days.
• Liquids: 30 to 40 drops, 3 to 4 times a day.
• Solids: 1 to 2 lozenges, tablets of capsules, 3 times a day, as directed on the label.
Chronic Recurrent Respiratory Tract Infections
➤ Echinacea.
– Dosage and administration: Liquid oral preparations
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