Stephen Janz discusses how public health initiatives and Chinese herbal medicine can work hand in hand to prevent and treat influenza.
The 2019 flu season has really started to hit. One local school reported an average of 300 students absent a day, most due to the flu. So what are the options to reduce your risk of illness?
Public Health Measures and the Flu
Vaccination is the mainstay of the public health approach to preventing influenza. Vaccination aims to reduce a person’s susceptibility to developing the flu by stimulating a specific immune response to the expected strains of flu. Personal measures such as avoiding crowded places can reduce exposure to people with the virus in the first place, which is not easy if it’s a school, university or shopping centre. So it is important for infected people to stay home to rest and avoid contact with others while they are still contagious. Measures to prevent spreading the virus to others include using alcohol-based hand sanitiser after using a tissue and ‘cough etiquette’ where a person is encouraged to cough or sneeze into a tissue or their elbow rather than hands or the air. These personal measures also reduce the risk of spreading other airborne viruses such as the common cold.
The Role of Anti-viral drugs
Despite these best efforts we can still get the flu and the question is what else can be done to prevent and manage influenza?
Anti-viral drugs attracted some attention when the government started stockpiling them in 2004 in anticipation of a potential influenza pandemic. The Queensland government is currently making these available to try and reduce the spread of the flu in nursing homes. These medications have limited effectiveness but can prevent the flu after exposure to the virus or shorten its duration. Some viruses have developed resistance to these medications.
Chinese herbs and Flu virus
Natural medicines also have a role in the prevention and management of influenza and respiratory illness and can support the general public health measures outlined above. Research has identified hundreds of herbs with anti-viral activity, many of these have been used for hundreds of years in traditional medicine. A 2013 Cochrane review comparing common Chinese herbal flu medicines to antiviral drugs found that the herbal preparations studied had similar effects to antiviral drugs in preventing and treating influenza. No adverse effects were identified in the studies, but the authors noted that further high-quality trials are needed to make a clear recommendation for these preparations. A 2017 review found a herb commonly used in Chinese and Indian medicine for cough, cold and influenza (Chuan Xin Lian or Andrographis paniculate) shortened the time to symptom resolution in acute respiratory infections. Research continues into many other common anti-viral herbs with promising results. In practice herbs are rarely used singly. Typically a core formula is used with additions depending on the individual case. Prescriptions are devised based on a traditional understanding of the role of each herb or formula and informed by research where it exists.
Early Treatment is Essential
Other treatments such as cupping and acupuncture are also traditionally used to support the immune system and reduce the symptoms associated with respiratory infections. The key to using these herbs and treatments is to treat at the first indication of symptoms. As with the antiviral medications there is no guarantee of success. The goal for everyone is to avoid getting the flu.
It is reassuring that natural medicine offers options that combine well with usual measures to prevent or reduce the extent of illness.
Commonwealth of Australia (2014) Australian Health Management Plan for Pandemic Influenza https://www.health.gov.au/internet/main/publishing.nsf/Content/519F9392797E2DDCCA257D47001B9948/$File/AHMPPI.pdf
Jiang L, Deng L, Wu T. Chinese medicinal herbs for influenza. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD004559. DOI: 10.1002/14651858.CD004559.pub4.
Law AH, Yang CL, Lau AS, Chan GC. Antiviral effect of forsythoside A from Forsythia suspensa (Thunb.) Vahl fruit against influenza A virus through reduction of viral M1 protein. J Ethnopharmacol. 2017 Sep 14;209:236-247. doi: 10.1016/j.jep.2017.07.015. Epub 2017 Jul 14.
Yan-Xi Zhou, Hai-Liang Xin, Khalid Rahman, Su-Juan Wang, Cheng Peng, and Hong Zhang, “Portulaca oleracea L.: A Review of Phytochemistry and Pharmacological Effects,” BioMed Research International, vol. 2015, Article ID 925631, 11 pages, 2015. https://doi.org/10.1155/2015/925631.
Ma Q, Yu Q, Xing X, Liu S, Shi C, Luo J. San Wu Huangqin Decoction, a Chinese Herbal Formula, Inhibits Influenza a/PR/8/34. (H1N1) Virus Infection In Vitro and In Vivo. Viruses. 2018 Mar 9;10(3). pii: v10030117. doi: 10.3390/v10030117.
Akram M, Tahir IM, Shah SMA, Mahmood Z, Altaf A, Ahmad K, Munir N, Daniyal M, Nasir 6, Mehboob H. Antiviral potential of medicinal plants against HIV, HSV, influenza, hepatitis, and coxsackievirus: A systematic review. Phytother Res. 2018 May;32(5):811-822. doi: 10.1002/ptr.6024. Epub 2018 Jan 22.
Ding Y, Chen L, Wu W, Yang J, Yang Z, Liu S. Andrographolide inhibits influenza A virus-induced inflammation in a murine model through NF-κB and JAK-STAT signaling pathway. Microbes Infect. 2017 Dec;19(12):605-615. doi: 10.1016/j.micinf.2017.08.009. Epub 2017 Sep 7.
Hu XY, Wu RH, Logue M, Blondel C, Lai LYW, Stuart B, Flower A, Fei YT, Moore M, Shepherd J, Liu JP, Lewith G. Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One. 2017 Aug 4;12(8):e0181780. doi: 10.1371/journal.pone.0181780. eCollection 2017. Review. Erratum in: PLoS One. 2018 Nov 14;13(11):e0207713. PubMed PMID: 28783743; PubMed Central PMCID: PMC5544222.