Cold_BOT_T2_URTI (updated) PDF

BOT MED TERM 2 URTI – COMMON COLD WRITTEN BY DR. FIONA SMULDERS ND LEARNING OUTCOMES 1. Describe the botanical treatment strategy for a common cold 2. Understand the selection process of anti-microbial herbs 3. Identify which herbal actions would be most beneficial for treatment of...

BOT MED TERM 2 URTI – COMMON COLD WRITTEN BY DR. FIONA SMULDERS ND LEARNING OUTCOMES 1. Describe the botanical treatment strategy for a common cold 2. Understand the selection process of anti-microbial herbs 3. Identify which herbal actions would be most beneficial for treatment of a common cold 4. List herbs that would be indicated in the treatment of a common cold 5. Recognize safety concerns regarding the use of the herbs discussed in today’s lecture. 6. Formulate an herbal remedy for a common cold UPPER RESPIRATORY TRACT INFECTION (URTI) Involves an infection of the nose, sinuses, pharynx, larynx and large airways Viral causes: rhinovirus (m/c), adenovirus, parainfluenza virus, enterovirus, respiratory syncytial virus (RSV) Diagnosis: typically a clinical diagnosis, but nasal & nasopharyngeal swabs/aspirates can be used Complications: pneumonia; sinusitis; otitis media; coinfection with bacterial agents; and exacerbation of preexisting medical conditions (asthma & COPD) COMMON COLD SSx: Typically mild and self-limited Nasal mucosal erythema and edema Rhinorrhea and nasal congestion Sore throat Cough and sneezing Headache and low-grade fever Onset of symptoms usually begins one to three days after exposure and can last 7–10 days or persist up to 3 weeks. BOTANICAL TREATMENT STRATEGIES 1. Enhance immune system’s first line and second lines of defense 2. Choose herbs with tissue and microbial specificity 3. Relieve common symptoms such as sore throat, congestion, rhinorrhea, etc 4. Prevent recurrence HERBAL ACTIONS Antivirals / antimicrobials Expectorants Immune stimulants Diaphoretics Deep immune tonics Demulcents Adaptogens Lymphatics Anti-catarrhals / Anti-inflammatories mucolytics How would these actions be beneficial for a common cold? ANTIMICROBIALS & IMMUNE STIMULANTS Herbs can have a direct effect by attacking the microorganism and/or destroying its cell wall & inhibiting replication, or inhibiting enzymes involved in the pathogenesis of infection. Or an indirect action by preventing viral entry into the cell or stimulating phagocytes, lymphocytes or other immune cells to attack the pathogen Many herbal antimicrobials display tissue specificity HOW TO CHOOSE THE RIGHT ANTIMICROBIAL HERBS Where is the site of infection? Choose antimicrobial herbs with a tissue specificity for the URT for common cold Age of the patient and general health status? Choose gentle antimicrobial herbs at lower dosing for children, elderly and those with chronic disease Specific pathogen? Use antimicrobial herbs that target the pathogen causing harm. Ex: herbs that target rhinovirus for common cold History of antibiotic use? Some herbs require a healthy gut flora to activated bioavailable metabolites of herbs MATERIA MEDICA URTI – COMMON COLD MATERIA MEDICA - COMMON COLD Achillea millefolium Eupatorium perfoliatum Panax ginseng Allium sativum Glycyrrhiza glabra Phytolacca spp Althea officinalis Hydrastis canadensis Sambucus nigra Andrographis paniculata Ligusticum porteri Salix alba Baptisia tinctoria Lomatium dissectum Thymus vulgaris Echinacea angustifolia / Mentha piperita Verbascum Thapsus purpurea Oleo europaea Zingiber officinalis, etc Eleutherococcus senticosus Origanum vulgare BAPTISIA TINCTORIA (WILD INDIGO) BAPTISIA TINCTORIA Common name: Wild Indigo Family: Fabaceae Part used: Root Main Actions: Lymphatic, anti-microbial, immune- stimulant, anti-catarrhal Main Constituents: Polysaccharides (arabinogalactans) & glycoproteins, quinolizidine alkaloids, isoflavones, flavonoids BAPTISIA TINCTORIA Pharmacology: Glycoproteins and polysaccharides stimulate the immune system by increasing the number of WBCs and improving endogenous defense mechanisms Stimulates lymphocyte DNA synthesis and antibody production Indicated in acute infection with excessive mucus production associated with laryngitis, pharyngitis, tonsilitis, rhinitis and sinusitis Has been shown to substantially reduce time to improvement in common cold in combination with Echinacea and Thuja Beuscher N, Scheit KH, Bodinet C, Kopanski L. Immunologisch aktive Glykoproteine aus Baptisia tinctoria [Immunologically active glycoproteins of Baptisia tinctoria]. Planta Med. 1989 Aug;55(4):358-63. German. doi: 10.1055/s-2006-962028. PMID: 2813570. Naser B. et al. A randomized, double-blind, placebo-controlled, clinical dose–response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold. Phytomedicine. 2005 Nov; 12(10): 715-722. BAPTISIA TINCTORIA Pharmacy: Decoction: 1 tbsp/cup, simmered 15 mins, 1 cup TID Tincture (1:5, 60%): 1-3ml TID, max 60ml/week Dried herb: 1g TID Safety: Can cause nausea, vomiting, anorexia, hypersalivation, tachypnea, tachycardia, respiratory paralysis with toxic doses internally CI in long-term use or high doses, pregnancy & lactation ECHINACEA ANGUSTIFOLIA / PURPUREA ECHINACEA ANGUSTIFOLIA / PURPUREA Common name: Echinacea / Coneflower Family: Asteraceae Part used: Root (aerial of E. purpurea also used) Main Actions: Anti-microbial, immunomodulator, immune- stimulant, anti-inflammatory, diaphoretic, lymphatic, vulnerary, anti-catarrhal Main Constituents: Caffeic acid esters (echinacosides), polysaccharides (arabinogalactans), alkylamides, VO, alkaloids ECHINACEA SPP Pharmacology: Polysaccharides, alkylamides and caffeic acid derivatives activate immune response via enhanced granulocyte chemotaxis, macrophage phagocytosis, and increased levels of TNF, IL-1, Ig binding, and neutrophils Caffeic acid esters stabilize mucosal connective tissue against pathogen invasion and repair tissue damage via inhibition of hyaluronidase When used preventatively, echinacea shows a 10-20% relative risk reduction for common cold Karsch-Völk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014 Feb 20;2(2):CD000530. doi: 10.1002/14651858.CD000530.pub3. PMID: 24554461; PMCID: PMC4068831. ECHINACEA SPP Pharmacy: Best used preventatively or in high doses at early stages of acute infection Decoction: 1g/cup, simmer 15 mins, 1 cup TID Tincture: (1:2, 60%), 3-6ml QD. During acute infection, dose can be increased to 3-5 ml q 2 hours. 40 ml weekly max. Powdered extract (standardized to 3.5% echinacoside): 300mg TID Safety: High doses may cause nausea, throat irritation and skin irritation Caution in Asteraceae allergy Selectively modulates CYP 3A4 substrates – potential for interactions ZINGIBER OFFICINALE (GINGER) ZINGIBER OFFICINALE Common name: Ginger Family: Zingiberaceae Part used: Rhizome Main Actions: Anti-oxidant, anti-inflammatory, anti- microbial, diaphoretic, carminative, anti-spasmodic Main Constituents: VO (zingiberene), sesquiterpenes, oleoresins (gingerols & shogaols) ZINGIBER OFFICINALE Pharmacology: Sesquiterpenes in ginger have specific anti-viral effects against rhinoviruses and RSV by inhibiting viral attachment and inoculation Fresh ginger may stimulate mucosal cells to secrete IFN-β to counter viral infection Oleo-resins (gingerols & shogaols) help reduce pain, suppress coughing and modulate fever Clive V. Denyer, Peter Jackson, David M. Loakes, Malcolm R. Ellis, and David A. B. Young. Antirhinoviral Sesquiterpenes from Ginger (Zingiber officinale). Journal of Natural Products 1994 57 (5), 658-662 Chang JS, Wang KC, Yeh CF, Shieh DE, Chiang LC. Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. J Ethnopharmacol. 2013 Jan 9;145(1):146-51. doi: 10.1016/j.jep.2012.10.043. Epub 2012 Nov 1. PMID: 23123794. ZINGIBER OFFICINALE Pharmacy: Infusion: 1g/cup, 1 cup TID Tincture: (1:5, 90%) 1.5-3 ml TID, 60 ml weekly max Dry herb: 1-10 g in divided doses Fresh herb: 5 g QD Safety: Caution with ulcers, GERD, gallstones, kidney disease, bleeding disorders, and those with sensitive stomachs Additive effect with anticoagulant medication HERBAL PHARMACY URTI – COMMON COLD HERBAL PHARMACY: HERBAL SELECTION Echinaceae angustifolia *NB: there is mixed research on the efficacy of Echinacea during cold/flu Baptisia tinctoria (best used in high doses at the onset of Zingiber officinale symptoms, or used preventatively) May consider substituting Echinacea for How will these herbs help a Andrographis, Siberian Ginseng or Elderflower/berry common cold? HERBAL PHARMACY: PHARMACY & POSOLOGY Echinaceae angustifolia Baptisia tinctoria Zingiber officinale What pharmacy will we choose? Which will be our lead herb? Supporting herbs? How will we dose this formula? For how long? HERBAL PHARMACY: PHARMACY & POSOLOGY 100mL Tincture 50 ml - Echinaceae angustifolia Why did we choose this ratio? 30 ml - Baptisia tinctoria What is the therapeutic dose and weekly 20 ml - Zingiber officinale max of each herb? Dose: 1-2 tsp (5-10 ml) TID starting at onset of symptoms during acute infection, continue for 3-5 days *Choosing 5 or 10 ml depends on symptom severity, patient tolerability and constitution/vitality of patient. *Studies show greater efficacy for Echinacea & Baptisia at higher end of therapeutic range in acute infection OTHER CONSIDERATIONS Herbal lozenges or infusions for symptom relief of sore throat using demulcent herbs like Althea officinalis, Glycyrrhiza glabra, Verbascum thapsus and/or Ulmus fulvus. What other benefits would these herbs offer? (How to make an herbal lozenge) Steam inhalations with Eucalyptus, Thyme and/or Peppermint essential oils to relieve cough and congestion HOW TO DO A STEAM INHALATION 1. Half fill a fairly wide bowl with boiling water 2. Stir in 5 drops EO 3. Immediately place a towel over head and bowl 4. Breathe in through nose and out through mouth for 10 minutes Make sure towel is large enough to fall below sides of the bowl so steam is trapped EO evaporate readily so use quickly OTHER CONSIDERATIONS Rest, hydration & nutrition Food as Medicine - Herbal support through food - adding garlic, onion, ginger, thyme, oregano, sage or mushrooms to soups or stews (see recipe on next slide) IMMUNE SUPPORT SOUP 1 large onion, chopped (antibacterial, 2 cups carrots or other root vegetables, antiviral) chopped (rehydrating, carotenes, potassium source) 3 cloves garlic, minced (antibacterial, antiviral) 4 dried or 2 fresh shiitake/reishi mushrooms (immune modulation) 2 tablespoons olive oil Ginger, cayenne, oregano, thyme &/or sage 4 or 5 astragalus sticks (immune to taste (diaphoretic, antimicrobial) modulation, antiviral) *not to be used in acute fever 1 to 2 tablespoons miso (alkaline, rehydrating) *added at the end 1 cup celery, chopped (fiber and vitamin source) 1 cup quinoa (fiber source, protein) 1 cup green beans, chopped (fiber and 8 cups water vitamin source) PREVENTING RECURRENCE Long-term considerations of adaptogens and deep immune tonics to support HPA axis and strengthen immune system to prevent recurrence and recover from convalescence Astragalus membranaceus Schisandra chinensis Panax ginseng Medicinal Mushrooms Reishi Chaga Cordyceps SUMMARY There are many herbs to consider during URTI / common cold that can directly attack pathogens, indirectly support the immune response and/or provide symptomatic relief Be mindful and respectful of the patient’s cultural background, preferences and level of compliance when choosing herbal pharmacy THANK YOU. A N D H AV E A LO V E LY D AY