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COLDS & COUGHS YEAR 1 - HERBAL MEDICINE Dr. Matt Gowan, ND email: [email protected] LEARNING OBJECTIVES Define the main herbal actions used to treat colds Identify commonly used herbs for colds Remember both common names and latin binomials for the herbs discussed Explain the main indications...

COLDS & COUGHS YEAR 1 - HERBAL MEDICINE Dr. Matt Gowan, ND email: [email protected] LEARNING OBJECTIVES Define the main herbal actions used to treat colds Identify commonly used herbs for colds Remember both common names and latin binomials for the herbs discussed Explain the main indications and actions for the herbs Understand what class of phytochemicals is responsible for the medicinal effects Evaluate the safety issues and contraindications of the herbs Provide a summary of the leading research on the herbs used to treat colds HERBAL ACTIONS COLDS AND COUGH HERBAL ACTIONS Immunostimulant – activates the immune system to help fight of infect Diaphoretic - induces sweating Antitussive - soothes and relieves coughs Antispasmodic - relaxes smooth muscles Expectorant - liquify respiratory secretions to facilitate the expulsion of phlegm and mucous Mucolytic - Helps to break down mucous & loosen thick bronchial secretions (similar to expectorants) Demulcent - Soothes irritated mucous membranes Antimicrobial - Destroys or inhibits the growth of microorganisms (e.g. antibacterial, antifungal, antiviral, anti-parasitic) Antiadherance - prevents micro-organisms from attaching and thus infecting the cells of the mucous membranes Antipyretic (syn. Febrifuge) - reduces a fever Lymphatic - Promotes the proper functioning of the lymphatic system. PHYTOCHEMICALS CLASS ACTION HERBS POLYSACCHARIDES Immunostimulants Echianacea, Asian ginseng, Canadian ginseng, Siberian ginseng ALKYLAMIDES Immunostimulants Echianacea SAPONINS expectorants Ivy, licorice STEROIDAL SAPONINS adaptogen, immunomodulators Asian ginseng, canadian ginseng, siberian ginseng MUCILAGE demulcent marshmallow ESSENTIAL OIL antispasmodic Thyme, oregano, eucalyptus / DITERPENE LACTIONS immunomodulating, antispasmodic Andrographis ECHINACEA Latin: Different species are used: Purpled Cone Flower Echinacea purpurea Narrow-leaved purple coneflower Echinacea angustifolia Pale purple coneflower Echinacea pallida Family: Asteraceae Drug: Root and Herb Optional: Click here to read a monograph online ECHINACEA MAIN INDICATIONS Prevent and treat the common cold, flu, and upper respiratory tract infections (URIs). Vaginal candidiasis Urinary tract infections ACTIONS Immunostimulant Antimicrobial 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 Alkylamides Phenolics: Caffeic acid derivatives (Echinacoside) Polysaccharides Echinacoside Glycoproteins Ketoalkenes SAFETY Caution: auto-immune disease Pregnancy & lactation - safe RESEARCH Clinical trial (2010): E. purpurea and E. angustifolia root standardized to alkamides showed no benefit. RESEARCH Systematic Review (2014): Echinacea products in this review did NOT show benefit for treating colds, although, it is possible there is a weak benefit from some Echinacea products. RESEARCH Meta-Analysis (2019): Based on the results of this review users of echinacea can be assured that echinacea preparations are safe to consume in the short term however they should not be confident that commercially available remedies are likely to shorten the duration or effectively prevent URTI. RESEARCH Clinical trial (2021): Echinacea purpurea (combo of root and herb) helped prevent respiratory tract infections and reduced associated antibiotic usage in children. GINSENG Latin: Asian “Korean” ginseng (Panax ginseng) & Canadian ginseng (Panax quinquefolius) Family: Araliaceae Part: Root Drug: Ginseng radix Optional: Click here to read a monograph online Optional: Click here to read a monograph online GINSENG MAIN INDICATIONS Stress Fatigue Cold and flu treatment and prevent Low immunity ACTIONS Adaptogen Immunostimulant & immunomodulator Antiviral Aphrodisiac Photo courtesy of Matt Gowan GINSENG German Commission E (Approved) The Commission E approved ginseng as a tonic for invigoration and fortification in times of fatigue and debility or declining capacity for work and concentration. Ginseng was also approved for use during convalescence. King's American Dispensatory, 1898 A mild tonic and stimulant. Useful in loss of appetite, slight nervous debility, and weak stomach. Continued for some length of time, for its temporary administration gives but little benefit, it is a very important remedy in nervous dyspepsia, and in mental exhaustion from overwork. It gives fairly good results in nervous prostration, and in cerebral anemia. t gives fairly good results in atonic laryngitis, bronchitis, and some relief in phthisis, being a secondary remedy for these complaints. GINSENG PHYTOCHEMICALS Steroidal saponins - triterpenoid glycosides (Ginsenosides) Polysaccharides (Poly-furanosyl-pyranosyl-saccharide) SAFETY Caution: High blood pressure Pregnancy & lactation - Korean ginseng is considered safe. Ginsenoside Rb1 RESEARCH Review (2021): Various clinical trials of ginseng have exhibited a reduction in repeated colds and the flu. ANDROGRAPHIS Latin: Andrographis paniculata Family: Acanthaceae Part: Herb Optional: Click here to read a monograph online ANDROGRAPHIS MAIN INDICATIONS Colds Colitis & infectious Diarrhea Liver disease Autoimmune disease (multiple sclerosis and rheumatoid arthritis) ACTIONS Immunomodulator Antimicrobial (Antiviral, Antibacterial) Bitter Antimicrobial Anti-inflammatory Emmenogogue Photo courtesy of Matt Gowan ANDROGRAPHIS German Commission E (Approved) Not included King's American Dispensatory, 1898 Not included ANDROGRAPHIS PHYTOCHEMICALS Diterpene lactones (Andrographolide) Polyphenols: Flavonoids SAFETY Contra-Indications: Gastritis & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea, vomiting and diarrhea. Pregnancy & lactation - Not recommended. Unknown Andrographolide RESEARCH Clinical trial (2009): Andrographis twice as effective as placebo in reducing symptoms and duration. SIBERIAN GINSENG Latin: Eleutherococcus senticosus Family: Araliaceae Part: root Drug: Eleuthro radix Optional: Click here to read a monograph online SIBERIAN GINSENG MAIN INDICATIONS Stress Fatigue Cold and flu treatment and prevent ACTIONS Adaptogen Immunostimulant & immunomodulator Antiviral Photo courtesy of Matt Gowan SIBERIAN GINSENG German Commission E (Approved) Commission E approved eleuthero as a tonic in times of fatigue and debility, declining capacity for work or concentration, and during convalescence. King's American Dispensatory, 1898 Not found. SIBERIAN GINSENG PHYTOCHEMICALS Steroidal Saponins - triterpenoid glycosides (Eleutheroside A) SAFETY Caution: High blood pressure Pregnancy & lactation - likely safe Eleutheroside A RESEARCH In vivo: Eleutherococcus senticosus roots inhibited the productive replication of human rhinovirus (HRV), respiratory syncytial virus (RSV) and influenza A virus in RESEARCH Clinical trial (2004): Eleutherococcus and Andrographis combo more effective than an Echinacea formula (with zinc, vitamins & astragalus) RESEARCH Clinical trial: Eleutherococcus and Andrographis reduced the recovery duration of patients by 21% and significantly relieves the severity of typical URTI ELDER FLOWER Latin: European: Sambucus nigra & Canadian: Sambucus canadensis Family: Caprifoliaceae Part: Flower (and berries) Drug: Sambuci flos, elder flower. Optional: Click here to read a monograph online ELDER FLOWER MAIN INDICATIONS Colds and flu ACTIONS Diaphoretic Antiviral Antiadherence Antirheumatic Diuretic Antiinflammatory Photo courtesy of Matt Gowan ELDER FLOWER German Commission E (Approved) The Commission E approved for colds. King's American Dispensatory, 1898 In skin affections, when the tissues are full, flabby, and oedematous; epidermis separates and discharge of serum is abundant, forming crusts; indolent ulcers, with soft, oedematous borders; mucous patches, with free secretions; post-scarlatinal dropsy; low deposits in, or depravation of tissues. ELDER FLOWER PHYTOCHEMICALS Anthocyanin & Flavonoids Tannins Ascorbic Acid Cyanogenic Glycoside (Unripe, bark and leaves) SAFETY SAFE - flower and berries are generally considered safe TOXICITY - Leaf, bark & unripe fruit may cause severe vomiting and diarrhea. Heat will destroy Pregnancy & lactation - unknown RESEARCH META-ANALYSIS: Elderberry supplementation significantly reduced the duration of upper respiratory symptoms compared to placebo. ENGLISH IVY LEAF Latin: Hedera helix Family: Araliaceae Part: Leaf Drug: Hederae helicis folium Optional: Click here to read a monograph online ENGLISH IVY LEAF MAIN INDICATIONS COUGH Acute and chronic respiratory inflammation & phlegm ACTIONS Expectorant Antitussive Antispasmodic Antimicrobial Photo courtesy of Matt Gowan ENGLISH IVY LEAF German Commission E (Approved) The Commission E confirms ivy leaf as treatment for catarrhs of the respiratory passages and for symptoms of chronic inflammatory bronchial conditions. King's American Dispensatory, 1898 The leaves are stimulating, and have been employed as an application to issues; and have likewise been efficient in diseases the skin, indolent ulcers, eczemas, itch, etc., in the form of decoction, and applied locally; this will also destroy vermin in the hair, which, it is stated, is stained black by the application. They are reputed beneficial as a cataplasm in glandular enlargements. Marasmus of children, rachitis, and pulmonary affections have been benefited by the dried leaves in powder, in doses of 20 grains or more. ENGLISH IVY LEAF PHYTOCHEMICALS Saponins - triterpenoid glycosides (Hederacoside C) SAFETY SAFE - generally considered safe TOXICITY - high amounts can cause irritation of the gastrointestinal tract leading to nausea and vomiting. Pregnancy & lactation - safe to be used in short term during Hederacoside C pregnancy RESEARCH Systematic review: All studies concluded that ivy leaf extract is an effective and safe option for the treatment of cough due to URTIs and bronchitis. LICORICE Latin: European licorice Glycyrrhiza glabra & Chinese licorice Glycyrrhiza uralensis Family: Fabaceae Part: Root Drug: Liquiritiae radix Optional: Click here to read a monograph online LICORICE MAIN INDICATIONS Respiratory tract infections (cough, sore throat) Inflammation in the GI tract (Gastritis, ulcers) Hepatitis and cirrhosis of the liver Adrenal fatigue ACTIONS Anti-spasmodic Expectorant Antimicrobial (Antiviral) Demulcent (Indirect) Adrenal tonic Antiulcer Hepatoprotective Photo courtesy of Matt Gowan LICORICE German Commission E (Approved) The Commission E approved the internal use of licorice root for catarrhs of the upper respiratory tract and gastric or duodenal ulcers. King's American Dispensatory, 1898 Liquorice root is emollient, demulcent, and nutritive. It acts upon mucous surfaces, lessening irritation, and is consequently useful in coughs, catarrhs, irritation of the urinary organs, and pain of the intestines in diarrhoea. LICORICE PHYTOCHEMICALS Saponins - triterpenoid glycosides (Glycyrrhizin) Flavonoids (Licoflavone) SAFETY Contra-Indications: High blood pressure Pregnancy & lactation - caution - may be unsafe Hypertension: can raise blood pressure Electrolytes - can causes potassium loss. Caution with medications for the cardiovascular system. Glycyrrhizin RESEARCH Review (2022). In vivo studies show antiviral effects but limited human research for licorice’s effectiveness in respiratory infections. MARSHMALLOW Latin: Althaea officinalis Family: Malvaceae Part: Root & flower Drug: Althaeae radix & Althaeae folium Optional: Click here to read a monograph online MARSHMALLOW MAIN INDICATIONS Inflamed mucous membranes Respiratory tract infections (cough, sore throat) Inflammation in the GI tract (Gastritis, ulcers) Urinary tract (UTI) ACTIONS Demulcent Antitussive Photo courtesy of Matt Gowan MARSHMALLOW German Commission E (Approved) The Commission E approved the internal use of marshmallow root for irritation of the oral and pharyngeal mucosa and associated dry cough, and for mild inflammation of the gastric mucosa. King's American Dispensatory, 1898 They will be found valuable, in the form of decoction, in diseases of the mucous tissues, as hoarseness, catarrh, pneumonia, gonorrhoea, vesical catarrh, renal irritation, acute dysentery, and diarrhoea. In strangury, inflammation of the bladder, hematuria, retention of urine, some forms of gravel, and indeed in nearly every affection of the kidney and bladder, their use will be found advantageous. Much use is made of them combined with equal parts of spearmint, in urinary derangements. They are likewise efficacious in gastro-intestinal irritation and inflammation. MARSHMALLOW PHYTOCHEMICALS Fiber: Mucilage Flavonoids SAFETY Side-Effects: None known. Very safe. Pregnancy & lactation - unknown Drugs: May delay absorption. RESEARCH Review: Marshmallow alone reduced cough but combinations (Zataria multiflora, Zingiber officinalis, or Helix hedera) increased the efficacy. EUCALYPTUS Latin: Eucalyptus globulus Family: Myristicaceae Part: Essential oil Optional: Click here to read a monograph online EUCALYPTUS MAIN INDICATIONS Respiratory tract infections Gastrointestinal tract spams ACTIONS Antitussive Expectorant Antimicrobial (Antibacterial, Antiviral, Antifungal, Antiparasitic) Carminative Photo courtesy of Matt Gowan EUCALYPTUS King's American Dispensatory, 1898 Sensations of coldness and weight in the bowels; cold extremities; cold perspiration; perspiration during chill; chronic catarrhal diarrhoea; chronic vesical catarrh, the urine containing pus; unhealthy fetid secretions from any part; relaxed mucous tissues, with profuse secretion; pasty, badly-smelling coating upon the tongue; fetid false membranes; sore throat, with fetid odor; fetid and catarrhal states of the broncho-pulmonic tract; and, in large doses, in chronic ague with exhausting discharges. German Commission E (None) The Commission E approved the internal use of eucalyptus oil for catarrhs of the respiratory tract and its external use for rheumatic complaints. The Commission E approved the internal use of eucalyptus leaf for catarrhs of the respiratory tract. EUCALYPTUS PHYTOCHEMICALS Essential oils: Monoterpenoids (Eucalyptol) Eucalyptol SAFETY Pure eucalyptus essential oil can be irritating but considered safe. Avoid drinking pure essential oil. Pregnancy & lactation - unknown RESEARCH In vitro (2013): Essential oils found in peppermint and eucalyptus are antitussive RESEARCH Meta-Analysis (2022): Eucalyptus is safe but efficacy considered minimal. RESEARCH SUMMARY RESEARCH SUMMARY HERB RESEARCH DETAILS Echinacea Clinical Trails Mixed benefits. American and Clinical Trials Reduced severity and duration. Korean Ginseng Andrographis Clinical Trials Benefit alone and combined with Eleuthero Eleuthro In vivo & Clinical trails In vivo shows antiviral activity against cold viruses. Only clinical (combo) trails combined with Andrographis (none alone exist). English Ivy Clinical trial Safe and effective for coughs. Elder /flower Clinical Trials Numerous studies demonstrated reduced severity and duration. Licorice In vivo Antiviral activity. No human trials for colds. Marshmallow Clinical trials Reduce cough alone and better in combos. RESEARCH SUMMARY HERB RESEARCH DETAILS Thyme Clinical trials Reduce in combos. In vitro antispasmodic. Eucalypus Clinical trials Reduce cough. In vitro some antimicrobial. Goldenseal In vitro Berberine has significant antiviral activity Garlic Clinical trials Shows some benefit. 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. PubMed Alkattan A, Alameer R, Alsalameen E, Almaary M, Alkhairat M, Alkhalifah A, Alghanim F, Radwan N. Safety of English ivy (Hedera helix) leaf extract during pregnancy: retrospective cohort study. Daru. 2021 Dec;29(2):493-499. doi: 10.1007/s40199-021-00415-7. Epub 2021 Sep 4. PMID: 34482524; PMCID: PMC8602585. 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 anti- inflammatory 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 THANK YOU MATT GOWAN, ND [email protected]