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STREP THROAT YEAR 1 - HERBAL MEDICINE Dr. Matt Gowan, ND email: [email protected] LEARNING OBJECTIVES Define the main herbal actions used to treat strep Identify commonly used herbs for strep Remember both common names and latin binomial for the herbs discussed Explain the main indications and act...

STREP THROAT YEAR 1 - HERBAL MEDICINE Dr. Matt Gowan, ND email: [email protected] LEARNING OBJECTIVES Define the main herbal actions used to treat strep Identify commonly used herbs for strep Remember both common names and latin binomial for the herbs discussed Explain the main indications and actions for the herbs Evaluate the safety issues and contraindications of the herbs Provide a summary of the leading research on the herbs TRADITIONAL TEXTS The following texts will be referred to: German Commission E monographs King's American Dispensatory GERMAN COMMISION E The German Commission E is a scientific advisory board of the Federal Institute for Drugs and Medical Devices formed in 1978. The commission gives scientific expertise for the approval of substances and products previously used in traditional, folk and herbal medicine. Between 1984 and 1994 it compiled and published over 380 monographs evaluating the safety and efficacy of herbs for licensed medical prescribing in Germany. They gave herbs an approval rating for certain indications. KINGS AMERICAN DISPENSATORY King's American Dispensatory first published in 1854 considered an important text written by The Eclectics: Harvey Wickes Felter, M.D. Uri Lloyd, Phr. M., Ph. D. HERBAL ACTIONS HERBAL ACTIONS Select herbal actions for sore throats: Antimicrobial - Destroys or inhibits the growth of microorganisms (e.g. antibacterial, antifungal, antiviral, antiparasitic) Lymphatic - Promotes the proper functioning of the lymphatic system. Immunostimulant – activates the immune system to help fight infection Antipyretic (syn. Febrifuge) – reduces fever TRADITIONAL FORMULA H E M P for Strept Throat H E M P FORMULA A classic formula used for infections including strep throat contains: Hydratis (Goldenseal) Echinacea (Purple cone flower) Myrrh Phytolacca (Poke root) MATERIA MEDICA Herbal remedies for strep throat Goldenseal Echinacea Myrrh Usnea Pokeroot Garlic Essential oils GOLDENSEAL Latin: Hydrastis canadensis Family: Ranunculaceae Part: Root Drug: Hydrastis rhizoma Optional: Click here to read a monograph online GOLDENSEAL MAIN INDICATIONS “King of the mucous membranes” inflammation and infections: Respiratory tract Gastrointestinal tract ACTIONS Antimicrobial (Antibacterial, Antiviral, Antifungal, Antiparasitic) Digestive bitter Photo courtesy of Matt Gowan GOLDENSEAL King's American Dispensatory, 1898 Hydrastis is specifically indicated in catarrhal states of the mucous membranes, when unaccompanied with acute inflammation. An apparent exception to this is in acute 'purulent otitis media, in which it is said to act better than in chronic conditions; gastric irritability; irritation of parts with feeble circulation; muscular tenderness and soreness, worse under pressure or on motion; passive hemorrhages from uterus and other pelvic tissues; skin diseases depending on a gastric abnormality, indicating hydrastis. German Commission E (None) Not included. GOLDENSEAL PHYTOCHEMICALS Isoquinoline alkaloids (berberine, hydrastine) Flavonolignans SAFETY Contra-Indications: Gastritis & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea, vomiting and diarrhea. Pregnancy & lactation - unsafe ECHINACEA Latin: Different species are used: Purpled Cone Flower Echinacea purpurea Narrow-leaved purple coneflower Echinacea angustifolia Pale purple coneflower Echinacea pallida Family: Asteraceae Part used: Root and Herb Optional: Click here to read a monograph online ECHINACEA MAIN INDICATIONS Strep throat Prevent and treat the common cold, flu, and upper respiratory tract infections (URIs). Vaginal candidiasis Urinary tract infections ACTIONS Immuno-stimulant Photo courtesy of Matt Gowan Echinacea pallida (LEFT) & Echinacea purpurea (RIGHT) ECHINACEA German Commission E Echinacea purpurea herb (Approved) - Supportive therapy for colds and chronic infections of the respiratory tract and lower urinary tract. Echinacea pallida root - (Approved) Supportive therapy for influenza-like infections. Note: Echinacea angustifolia herb and root & Echinacea pallida herb are UNAPPROVED because lack of clinical trials for the specific plant parts. ECHINACEA King's American Dispensatory, 1898 Echinacea angustifolia: use for "bad blood," tendency to sepsis and malignancy, as in gangrene, sloughing and phagedenic ulcerations, carbuncles, boils, and various forms of septicaemia; foul discharges, with weakness and emaciation; deepened, bluish or purplish coloration of skin or mucous membranes, with a low form of inflammation; dirty-brownish tongue; jet-black tongue; tendency to the formation of multiple cellular abscesses of semi-active character, with marked asthenia. Of especial importance in typhoid, septicaemic and other adynamic fevers, and in malignant carbuncle, pulmonary gangrene, cerebro-spinal meningitis and pyosalpinx. Echafolta is advised as a cleansing wash in surgical operations, and to annul the pain of and to deodorize carcinomata. ECHINACEA PHYTOCHEMICALS Alkylamide Phenolics: Caffeic acid derivatives (Echinacoside) Polysaccharides Ketoalkenes SAFETY Caution: auto-immune disease (Theorectical) Pregnancy & lactation - safe Echinacoside MYRRH Latin: Commiphora myrrha Synonyms: Commiphora molmol Family: Burseraceae Part: Resin Drug: Myrrha Optional: Click here to read a monograph online MYRRH MAIN INDICATIONS Tonsilitis Gingivitis ACTIONS Antimicrobial (Antibacterial, Antiviral, Antifungal, Antiparasitic) Analgesic Expectorant Astringent Photo courtesy of Matt Gowan MYRRH German Commission E (Approved) The Commission E approved myrrh for topical treatment of mild inflammations of the oral and pharyngeal mucosa. King's American Dispensatory, 1898 Chronic bronchitis, with profuse secretion of mucus or muco-pus, with difficult expectoration; membranes lax and pallid, tonsils enlarged and spongy, throat pale and tumid; soreness and sponginess of the gums; reproductive disorders of women, with weight and dragging in the parts, and leucorrhoea. The British Herbal Compendium The British Herbal Compendium indicates the use of myrrh tincture as a gargle to treat pharyngitis and tonsillitis, as a mouthwash for gingivitis and ulcers, and external application to treat sinusitis and minor skin inflammations MYRRH PHYTOCHEMICALS Oleoresin Sesquiterpenes (Furanosesquiterpenoids) SAFETY PREGNANCY - not recommended POKE WEED Latin: Phytolacca americana Family: Phytolaccaceae Part: Root Drug: Phytolaccae Radix Optional: Click here to read a monograph online POKE WEED MAIN INDICATIONS Lymphadenopathy Infections associated with swollen lymph nodes (e.g. strep throat, mumps) Cancer ACTIONS Lymphatic Emetic Purgative Photo courtesy of Matt Gowan POKE WEED German Commission E (Approved) The Commission E not approved. King's American Dispensatory, 1898 The mucous membranes present whitish erosions, or vesicular patches. With these conditions it may be employed in tonsillitis, follicular pharyngitis, stomatitis, aphthae, nursing sore mouth, or ordinary sore mouth, and syphilitic faucial ulcerations. Pallid mucous membranes with ulceration; sore mouth with small blisters on tongue and mucous membrane of cheeks; sore lips, blanched, with separation of the epidermis; hard, painful, enlarged glands; mastitis; orchitis; parotitis; aphthae; soreness of mammary glands, with impaired respiration; faucial, tonsillar, or pharyngeal ulceration; pallid sore throat, with cough or respiratory difficulty; secretions of mouth give a white glaze to surface of mouth, especially in children; white pultaceous sloughs at corners of mouth or in the cheek; and diphtheritic deposits.. POKE WEED PHYTOCHEMICALS Triterpenoid Glycosides (E.g. Phytolaccosides) Lectins Pokeweed Antiviral Protein (Pap) Alkaloid (E.g. Phytolaccine) SAFETY TOXIC - May cause violent emesis, catharsis, convulsions and possibly death. PREGNANCY - not recommended USNEA Latin: Usnea barbata Family: Usneacea Part: Lichen Drug: Usnea Optional: Click here to read a monograph online USNEA MAIN INDICATIONS Infections Respiratory (including Strep throat) Topical skin infections ACTIONS Antimicrobial Antibacterial Antiviral Antifungal Antiparasitic Photo courtesy of Matt Gowan USNEA German Commission E (Approved) The Commission E approved usnea for mild inflammation of the oral pharyngeal mucosa. King's American Dispensatory, 1898 Not found USNEA PHYTOCHEMICALS Usnic acid SAFETY PREGNANCY & LACTATION - not recommended Hepatoxic - may cause drug-induced hepatitis via mitochondrial uncoupling. Usnic acid GARLIC Latin: Allium sativum Family: Amaryllidaceae Part: Clove Optional: Click here to read a monograph online GARLIC MAIN INDICATIONS Infections Heart disease ACTIONS Antimicrobial Antibacterial Antiviral Antifungal Antiparasitic Stimulant Expectorant Rubefacient Photo courtesy of Matt Gowan GARLIC German Commission E (Approved) Commission E approved the use of garlic as a support to dietary measures at elevated levels of lipids in the blood and as a preventive measure for age-dependent vascular changes. ESCOP also noted that garlic has been used traditionally for the relief of cough, colds, catarrh, and rhinitis, although clinical trials are not as abundant to support such uses. King's American Dispensatory, 1898 It has been beneficially used in coughs, catarrhal affections, pertussis, hoarseness, worms, and calculous diseases, during the absence of in animation. GARLIC PHYTOCHEMICALS Organosulfur compounds (Allicin) SAFETY Generally considered safe Pregnancy & lactation - safe Allicin THYME Latin: Thymus vulgaris Family: Lamiaceae Drug: Thymi herba Optional: Click here to read a monograph online THYME MAIN INDICATIONS Colds and flu Spastic cough ACTIONS Expectorant Antitussive Antispasmodic Antimicrobial Carminative Anti-inflammatory Photo courtesy of Matt Gowan THYME German Commission E (Approved) The Commission E approved thyme for symptoms of bronchitis and whooping cough and catarrhs of the upper respiratory tracts. King's American Dispensatory, 1898 Thyme is tonic, carminative, emmenagogue, and antispasmodic. The cold infusion is useful in dyspepsia, with weak and irritable stomach, and as a stimulating tonic in convalescence from exhausting diseases. The warm infusion is beneficial in hysteria, dysmenorrhoea, flatulence, colic, headache, and to promote perspiration. Occasionally the leaves have been used externally, in fomentation. The oil is valuable as a local application to neuralgic and rheumatic pains; and, internally, to fulfil any of the indications for which the plant is used. Dose of the infusion, from 1 to 3 fluid ounces; of the oil, from 2 to 10 drops on sugar, or in emulsion. Thyme, scullcap, and rue, of each, 2 ounces; peony and black cohosh, of each, 1 ounce; macerated for 14 days in diluted alcohol, and then filtered, forms a good preparation for nervous an spasmodic diseases of children. It may be given in teaspoonful doses to a child 3 years old, repeating it 3 or 4 times a day, sweetening and diluting it, if desired. A strong infusion of the Thymus Serpyllus, slightly sweetened, and mixed with gum Arabic, is stated by M. Joset to be a valuable remedy for whooping-cough, convulsive and catarrhal coughs, and stridulous sore throat, the favorable result occurring at the end of a very few days. It may be taken ad libitum. THYME PHYTOCHEMICALS Essential Oils: Monoterpenes (Thymol, Carvacrol) Polyphenols: Flavonoids SAFETY SAFE - generally considered safe TOXICITY - high amounts of pure essential oils may be toxic. Pregnancy & lactation - unknown ESSENTIAL OILS Thyme & Oregano ESSENTIAL OILS: THYME & OREGANO Steam distillation - extraction process that allows one to obtain pure essential oils from a plant. Note: Essential oils do not contain larger non-volatile compounds (e.g. polyphenols) that may impart some medical benefits. In general, essential oils have an antiseptic effect and disrupt. Both oregano and thyme essential oils are rich in monoterpenes (thymol, carvacrol) that inhibit Streptococcus pyogenes. RESEARCH No clinical trials exist. Numerous in vitro trials show herbal constituents possess antibacterial activity. RESEARCH HEMP formula study In vitro trials tested individual herbs for antibacterial properties. ONLY Hydrastis had antibacterial activity gram-negative Staphylococcus epidermis. Other herbs had no antibacterial activity. Why? IN VITRO TRIALS Herbs Goldenseal In vivo trials Berberine (found in goldenseal) inhibits Streptococcus pyogenes Echinacea Echinacea purpurea (Whole herb) extract inactivated Streptococcus pyogenes. Myrrh Myrrh not tested against Streptococcus pyogenes. Poke weed BUT exhibited antibacterial activity against Streptococcus mutans, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia None found. Usnea Usnic acid inhibits Streptococcus pyogenes. Garlic / oil Oregano Thyme oil Allicin inhibited Streptococcus pyogenes Numerous studies show thymol and carvacrol exhibit potent activity against Streptococcus pyogenes. REFERENCES REFERENCES - BOOKS Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3rd ed. London: Pharmaceutical Press, 2007. Bundesinstitut für Arzneimittel und Medizinprodukte , The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines Editors Mark Blumenthal, Werner R. Busse, J Klein, American Botanical Council, R. Rister, T. Hall, C. Riggins, Joerg Gruenwald, Ph.D., Alicia Goldberg. Institute for Drugs and Medical Devices, Bundesinstitut f ur Arzneimittel und Medizinprodukte (Germany). Publisher: American Botanical Council, 1998 Bone K. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone, 2000. Felter HW, Lloyd JU. King's American Dispensatory. 1898. http://www.ibiblio.org/herbmed/eclectic/kings/main.html. Accessed: Nov 19, 2022. Hoffman D. Medical Herbalism. Rochester, Vermont: Healing Arts Press, 2003. Edward Mills; Jean-Jacques Dugoua; Dan Perri "Herbal Medicines in Pregnancy and Lactation: An Evidence-Based Approach“ 1st edition. CRC Press; 2006. PubMed - 19 in vitro trials Herbal1: Scazzocchio F, Cometa MF, Tomassini L, Palmery M. Antibacterial activity of Hydrastis canadensis extract and its major isolated alkaloids. Planta Med. 2001 Aug;67(6):561-4. doi: 10.1055/s-2001-16493. PMID: 11509983. 2: Hwang BY, Roberts SK, Chadwick LR, Wu CD, Kinghorn AD. Antimicrobial constituents from goldenseal (the Rhizomes of Hydrastis canadensis) against selected oral pathogens. Planta Med. 2003 Jul;69(7):623-7. doi: 10.1055/s-2003-41115. PMID: 12898417. 3: Peng L, Kang S, Yin Z, Jia R, Song X, Li L, Li Z, Zou Y, Liang X, Li L, He C, Ye G, Yin L, Shi F, Lv C, Jing B. Antibacterial activity and mechanism of berberine against Streptococcus agalactiae. Int J Clin Exp Pathol. 2015 May 1;8(5):5217-23. PMID: 26191220; PMCID: PMC4503092. 4: Du GF, Le YJ, Sun X, Yang XY, He QY. Proteomic investigation into the action mechanism of berberine against Streptococcus pyogenes. J Proteomics. 2020 Mar 20;215:103666. doi: 10.1016/j.jprot.2020.103666. Epub 2020 Jan 23. PMID: 31981716. 5: Sun D, Courtney HS, Beachey EH. Berberine sulfate blocks adherence of Streptococcus pyogenes to epithelial cells, fibronectin, and hexadecane. Antimicrob Agents Chemother. 1988 Sep;32(9):1370-4. doi: 10.1128/AAC.32.9.1370. PMID: 3058020; PMCID: PMC175870. 6: Khalil N, Fikry S, Salama O. Bactericidal activity of Myrrh extracts and two dosage forms against standard bacterial strains and multidrug-resistant clinical isolates with GC/MS profiling. AMB Express. 2020 Jan 28;10(1):21. doi: 10.1186/s13568-020-0958-3. PMID: 31993779; PMCID: PMC6987268. 7: Sharma SM, Anderson M, Schoop SR, Hudson JB. Bactericidal and antiinflammatory properties of a standardized Echinacea extract (Echinaforce): dual actions against respiratory bacteria. Phytomedicine. 2010 Jul;17(8-9):563-8. doi: 10.1016/j.phymed.2009.10.022. Epub 2009 Dec 29. PMID: 20036523. 8: Macé S, Truelstrup Hansen L, Rupasinghe HPV. Anti-Bacterial Activity of Phenolic Compounds against Streptococcus pyogenes. Medicines (Basel). 2017 May 1;4(2):25. doi: 10.3390/medicines4020025. PMID: 28930240; PMCID: PMC5590061. CONCLUSION CONCLUSION Herbal medicine for strep throat: CLINICAL TRIALS - None In vitro - over 19 in vitro trials demonstrated antibacterial activity against for most of the herbs discussed Immuno-stimulant & Lymphatic herbs - in vitro trials are not a fair way to evaluate their efficacy THANK YOU MATT GOWAN, ND [email protected]