As the H1N1 swine flu sweeps across the world, it is important to keep several things in mind. First of all, while all flu is deadly, this one appears milder in symptoms and duration than the common flu.1 What distinguishes H1N1 is that it is highly contagious, and those who are getting sick are children and young adults.
It seems to be epidemic in the middle- and high-school age range. My experience is that this flu easily develops into a harsh-cough stage.
Traditional herbal doctors in China are familiar with both treatment and prevention of avian-swine flu, and the China Academy of Sciences has advised the general public to seek out herbal doctors or self-medicate with recommended herbal products. As H1N1 spreads widely throughout China, millions of people are taking these recommendations.2
Understanding the H1N1 Swine Flu
When a flu virus cross mutates between birds and mammals (such as pigs), and then further cross-mutates within a human host, the result can be the creation of a virulent strain of flu that overwhelms one's natural immune response. Avian-swine flu is the result of mutations between several different kinds of animal species. There have been several times in the last 100 years when an avian strain has further mutated within human hosts. This type of flu tends to be more virulent and contagious with more severe symptoms.
Like other influenza viruses, this H1N1 strain is spread by coughing, sneezing or touching contaminated surfaces, and then touching the nose or mouth. Symptoms, which last up to a week, are similar to those of seasonal flu, and can include fever, sneezing, sore throat, cough, headache, and muscle or joint pains. The main symptoms are fever (101-103°F) with chills or shivering, and headache.
During the 2003 SARS epidemic, the China Ministry of Health issued guidelines to TCM doctors for treatment. The approach was based on the classical wen bing (Warm Disease) organization from the late 17th century, and meant to address two of the most common presentations: lung wind-heat, and spleen-stomach damp-heat. The first presentation was marked by fever and cough, and the second by fever, nausea and diarrhea. The new swine flu does not seem to present with damp-heat, but the observations and recommendations made for SARS still apply for lung wind-heat. Wen bing formulas are recommended, but with the addition of herbs showing strong antiviral effect.3
The herbs that proved themselves during the SARS epidemic include well-known classical medicines such as lian qiao (Fructus forsythia suspensa), jin yin hua (Flos lonicerae japonicae), ban lan gen (Radix isatidis seu baphicacanthi) and da qing ye (Folium isatidis seu baphicacanthi). There were also recommendations for unusual antiviral herbs that found their way into the mainstream after 1950: chuan xin lian (Herba andrographis paniculatae), guan zhong (Rhizoma dryopteris crassirhizoma), mao dong qing (Radix ilicis pubescendis), zao xiu (Rhizoma paridis polyphyllae), bai jiang cao (Herba cum radix patriniae), hu zhang (Radix et rhizoma polygoni cuspidati) and zi hua di ding (Herba cum radice violae yedoensis).
As H1N1 has spread through China, various health ministries and individual hospitals have issued guidelines for both treatment and prevention of flu.4 I would like to show some of their herbal recommendations. For acute presentation with fever, chills, headache and sore throat, many herbal formulas take Yin Qiao San or Sang Ju Yin and add herbs with antiviral properties as well as additional qi tonics.5 Both Yin Qiao San and Sang Ju Yin were invented and recorded by Wu Ju-Tong in 1798 as part of the wen bing (warm diseases) movement.6
The following formula was generated during the SARS epidemic.7 The original Sang Ju Yin formula uses sang ye (Folium mori albae), ju hua (Flos chrysanthemi morifolii), lian qiao, bo he (Herba menthae haplocalycis), jie geng (Radix platycodi grandiflori), xing ren (Semen pruni armeniacae), lu gen (Rhizoma phragmitis communis) and gan cao (Radix glycyrrhizae uralensis). The adjusted formula added da qing ye, huang qin (Radix scutellariae) and huang qi (Astragali membranaceus). Other recommended prescriptions for acute presentation use simpler approaches, basically gathering together a few herbs with strong antiviral-type properties. The "Bird-Swine Formula" recommends four herbs: jin yin hua, ban lan gen, bo he and gan cao.
Another slightly larger formula recommends chuan xin lian, yi yi ren (Semen coicis lachryma-jobi), guan zhong, lian qiao, jin yin hua and hu zhang. Other herbal prescriptions are also reported.8 Besides recommending herbal decoctions and powders, the Chinese authorities also recommend various prepared products such as Gan Mao Ling, Zhong Gan Ling and Ban Lan Gen Chong Ji for acute symptoms.9
For herbalists who customize prescriptions, the following herbs can be added for specific symptoms: For fever, add shi gao (Gypsum) and dan zhu ye (Folium lophatherum). For sore throat, add lu gen (Rhizoma phragmites) and niu bang zi (Fructus arctii lappae). For chills and shivering, add ge gen (Radix puerariae) and chai hu (Radix bupleurum). For lymph node enlargement, add chai hu, huang qin and xuan shen (Radix scrophularia ningpoenses). For harsh cough, add zhi zi (Fructus gardenia jasminoides) and she gan (Rhizoma belamcandae).
Based on the Chinese recommendations, I created a formula called Clear Toxin that I use with my patients during acute flu illness. It consists of ban lan gen, lian qiao, bai zhu (Rhizome atractylodes macrocephala), dan zhu ye (Folium lophatheri), lu gen, yu xing cao (Herba houttuyniae), jin yin hua, ge gen, ju hua, fang feng (Radix ledebouriellae divaricatae), bo he and gan cao.
Prevention. For flu prevention, the recommended approach has been an adjusted Yu Ping Feng formula, adding in antiviral herbs. The original formula, dating back to 1481, supports the immune system by boosting both ying and wei qi.10 Antiviral herbs are added.11 The prescription, called "Flu Prevention Formula," formulated and issued by the Committee of Experts for Flu Prevention and Control under the Beijing Administration of Traditional Chinese Medicine, follows this approach.12 The herbs used are huang qi (Radix astragli), bai zhu, fang feng, guan zhong, jin yin hua and chen pi (Pericarpium citrus reticulata).
Based on Chinese recommendations, I have also created a formula called Immune Plus. It is taken when someone in the house is sick, or by people put at risk in crowded situations. It consists of huang qi, tai zi shen (Radix pseudostellaria heterophylla), fang feng, bai zhu, lian qiao, ban lan gen, huo xiang (Herba agastaches seu pogostemi), ju hua and gan cao.
Herbal Product Recommendations
Chinese herbal products: For illness, alternate Gan Mao Ling and Zhong Gan Ling, taking one of them every three hours.13 Both are commonly available from various manufacturers. If harsh cough develops, add formulas that clear lung fire.14 For prevention, use Yu Ping Feng San, also known as Jade Screen. My formulas, Clear Toxin and Immune Plus are also available to practitioners.
Support: Oscillococcinum (Boiron) is a homeopathic medicine made from duck liver. Ducks are normally immune to flu virus, and the homeopathic sarcode offers specific protection for flu, both as a preventative and as a treatment. Take one capful of pellets from the small vial. It is completely unnecessary to take the whole vial. In illness, take one capful every one to two hours. As a preventative, take once daily.
The D3 formula of vitamin D promotes natural killer cells for attacking virus. Take 5,000 units daily for prevention, and 10,000 units a day if sick. This is the single best prevention against flu.
These include the Shanghai Expert Panel on Preventing and Controlling A-H1N1 Flu; Beijing Ditan Hospital; the Committee of Experts for Flu Prevention and Control, Beijing Administration of Traditional Chinese Medicine; and Chinese Ministry of Health and the State Administration of Traditional Chinese Medicine.
Herbs with antiviral properties are cold and bitter, and do nothing in themselves to boost the immune system. The thinking is that anyone can be exposed to the H1N1 virus at any point, and should have herbs with antiviral effects circulating through the body.