Herbal Treatments for Pandemic Influenza: Learning from the Eclectics' Experience

Abstract

A group of physicians treated victims of the 1918 influenza pandemic with botanical medicines and the treatments were very successful. This article reviews some of the botanicals that were used to treat patients who had influenza. It also reviews research indicating that herbs can counteract the cytokine dysregulation induced by severe types of influenza. Coverage includes Gelsemium sempervirens (gelsemium root; also known as yellow jasmine and yellow jessamine), Eupatorium perfoliatum (boneset; also known as thoroughwort and Indian sage), Actea racemosa (black cohosh; also known as macrotys; formerly Cimicifuga racemosa), Asclepias tuberosa (pleurisy root; also known as butterfly weed), and Atropa belladonna (belladonna) as well as the roles that interleukin (IL)-6, interferon-γ-inducible protein (IP)-10, cytokines, and chemokines play in influenza.

Full text

Kathy Abascal B.S., J.D., R.H. (AHG),
and Eric Yarnell, N.D., R.H. (AHG)
Abstract
Agroup of physicians treated victims of the 1918 influenza
pandemic with botanical medicines and the treatments
were very successful. This article reviews some of the
botanicals that were used to treat patients who had influenza. It
also reviews research indicating that herbs can counteract the
cytokine dysregulation induced by severe types of influenza.
Coverage includes Gelsemium sempervirens (gelsemium root;
also known as yellow jasmine and yellow jessamine), Eupatorium
perfoliatum (boneset; also known as thoroughwort and Indian
sage), Actea racemosa (black cohosh; also known as macrotys; for-
merly Cimicifuga racemosa),Asclepias tuberosa (pleurisy root; also
known as butterfly weed), and Atropa belladonna (belladonna) as
well as the roles that interleukin (IL)-6, interferon-a–inducible
protein (IP)-10, cytokines, and chemokines play in influenza.
Introduction
Pandemic influenza looms on the horizon, and society finds
itself poorly equipped to deal with the threats this poses. We are
stockpiling vaccines and antiviral drugs for the anticipated crisis
but there is real concern that they will be both in short supply
and ineffective in a pandemic.
Currently, life support in the form of respirators and intra-
venous fluids remains the primary treatment for patients with
avian influenza. However, there may be an insufficient number
of respirators available, and we lack the facilities, drugs, and per-
sonnel to care for a sharp upsurge in patients needing intensive
treatment. For most individuals, little to no conventional treat-
ment will be available in a fast-moving epidemic. Thus, there is a
great need for alternative ways to cope with severe influenza.
Given our concern about this threat, it is surprising that we
have overlooked the physicians known as the Eclectics, who
treated patients successfully with herbs in earlier pandemics.
These physicians’ treatments reportedly alleviated the painful
symptoms of the 1918 influenza and prevented pulmonary com-
plications and death in many of the patients.
Overall, the Eclectics reported a fatality rate of only 0.6 percent
in an epidemic that usually claimed closer to 3 percent of its vic-
tims.1The Eclectics reported similar treatment successes in the
1889–1890 influenza pandemic.1This article is an introduction to
the Eclectics’ treatment of influenza. It does not cover all of the
herbs used by these physicians for influenza but provides some
essential tools to help health care practitioners cope with the next
pandemic, which experts assure us will arrive in the not too dis-
tant future.*
General Advice for Patients with Influenza
The general Eclectic advice given to patients in the influenza
pandemic was much the same as that given to anyone stricken
with seasonal influenza—bed rest and plenty of fluids. “The
remedies for influenza are few and direct. If the attack is abrupt
and there is much pain, give the patient a warm bath, put him to
bed and administer hot ginger tea, hot lemonade or similar hot
infusion.”2
The Eclectics also used tepid sponge baths to bring fever
down, considering these baths to be more useful than ice or
cold water. A tepid sponge bath was given by constantly
sponging the head with warm water, drawing the sponge
back and forth, and, at the same time, fanning the person.
Researchers who performed a modern meta-analysis of the
limited clinical trial evidence on tepid sponge baths conclud-
ed that they are effective for reducing fever, at least in chil-
dren.3
In the 1918 pandemic, the Eclectics found it imperative that
patients rest—mentally and physically—and many physicians
commented that complications were more common in patients
who got up too early. Then, as now, working people and those
caring for sick family members had a hard time complying with
this directive.
214
HerbalTreatmentsfor
PandemicInfluenza
Learning from the Eclectics’ Experience
*For more information on the Eclectics, see Abascal K, Yarnell E. The
Eclectics’ plant knowledge. Altern Complement Ther 2006;12:172–176.

The Eclectics also noted that sleep was necessary to allow
recovery, and that sleeplessness often occurred in the feverish
patients and caused complications if not countered. In some hos-
pitals, sleep was considered so vital to recovery that heroin was
sometimes administered to ensure that patients got a good
night’s sleep. Most physicians, however, relied on herbal seda-
tives such as Passiflora incarnata (passionflower) leaf to help
patients rest.
Most Eclectics were adamant that aspirin and other early syn-
thetic remedies were damaging to patients who had influenza.
Aspirin can, of course, have serious side-effects in children with
influenza, and this drug is no longer administered to children.
The Eclectics claimed that aspirin weakened the already-stressed
hearts of adults who had influenza. These physicians also tended
to disapprove of pain medicines that depressed the body’s sys-
tem, such as codeine, especially when there were pulmonary
complications. Instead, the Eclectics used herbs to alleviate pain.
Experimental vaccines were available back in 1918. The viral
nature of the disease was not understood at the time, and vac-
cines were prepared against various bacteria from patients who
died of lung complications. These vaccines were widely recom-
mended by allopathic physicians, but the Eclectics warned
against the use of vaccines because of their unknown efficacy.
Some Eclectics reported that patients who were vaccinated and
infected with influenza at approximately the same time seemed
to fare poorly. This can happen with some frequency in an epi-
demic, as it usually takes a few weeks for the vaccine to “teach”
the immune system to respond effectively to the virus.4
The Eclectics did not treat influenza as such. Instead, they
selected herbs to match the symptom picture of the individual
patient who presented with influenza. Given the many different
symptom pictures that have occurred in pandemic influenza, a
wide variety of herbs were used. However, the following four
herbs discussed in the sections below typically “fit” the symptom
picture of patients in the 1918 pandemic and were widely used.
Gelsemium
In both the 1889 and 1918 pandemics, gelsemium root was
praised for its ability to reduce quickly the high, hectic fever that
so many patients experienced. The Eclectics considered gelsemium
to be the specific remedy for a highly feverish state characterized
by tremulous, jerky muscles, nervous excitation, spasms, and pain.
Gelsemium was described as a sedative because it dimin-
ished the velocity of blood delivery to the head and spinal
tract, and prevented spasms. The herb was considered to be
useful for all types of hyperemia but was contraindicated in
congested conditions. Thus, gelsemium was considered to be
highly useful for patients in the early stages of acute meningeal
inflammations but was not used beyond the sthenic stage—and
was not given to patients with dull eyes, dilated pupils, and or
expressionless faces.
Along with Aconitum spp. (aconite) root and Veratrum viride
(false hellebore; also known as veratrum) root,gelsemium
formed a triad known as the Chief Sedatives that were used to
treat patients with feverish conditions.1Aconite and false helle-
bore are very potent herbs that should only be used by practi-
tioners who are experts in botanical medicine.
Physicians who reported on how they treated pandemic
influenza commented:
With boneset and gelsemium almost the whole range of symp-
toms of influenza may safely be brought under control. Only when
there is a known damaged heart need one be specially careful in the
use of gelsemium. . . .Study these two drugs faithfully before an
invasion comes and by thus being prepared, you will be doubly
armed to battle the foe.5
One physician with many years of experience treating influen-
za favored gelsemium for patients with high fever, intense
headache, and body aches, along with extreme restlessness and
sleeplessness.6Another wrote: “If the patient displays marked
restlessness, flushed face, bright eyes, and evidences excited cere-
bral excitation,” gelsemium should be used.2
Gelsemium became the standard influenza treatment at an allied
military hospital in France after an investigation into the effective-
ness of eight remedies in use to treat soldiers with influenza.7
Two physicians—one American and one British–administered
eight drugs to groups of 15 patients with influenza and com-
pared their progress. The groups were randomly selected, based
on the order in which the patients were admitted, and the treat-
ing physicians worked independently of each other. Three of the
drugs were herbs (aconite, belladonna, and gelsemium), while
five were remedies more commonly used by allopathic physi-
cians (aspirin, sodium salicylate, arsenic, quinine, and Dover’s
powder [a mixture of opium and ipecac]).7
The two researchers observed regarding the patients: “Those
treated with gelsemium improved in a manner far exceeding
those given any other treatment. After a few doses their
headache[s] and backache[s] were much relieved, [their tempera-
tures] began to fall and [their general conditions were] observ-
ably improved.” With the exception of belladonna, none of the
other treatments appeared to have the slightest effect.7
Although the treatment was randomized, the investigators still
questioned their results. Stating that, “we are well aware of the fal-
lacies of judgment attending the action of remedies,” they repeated
the test.7The second study results were so striking that the physi-
cian-investigators decided to use gelsemium to treat all of their
patients who had influenza. Although far less helpful, belladonna
also provided some benefit and was added to the gelsemium for-
mula (see box entitled Two Eclectic Anti-Influenza Formulas).
Using this formula, the physicians treated 937 cases of influenza
among soldiers who were sick enough to be hospitalized with a
mortality rate of 2.77 percent—a good result in that population
group.†(In one sector of the Western front, one third of American
ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006 215
†The Eclectics actually noted that belladonna and gelsemium counteract-
ed each other, and the effectiveness of the formula may have been
reduced by using both simultaneously. The Eclectics’ greater knowledge
of plants may help explain why these physicians generally had a very
low fatality rate among their patients, which was reportedly approxi-
mately 0.6 percent in the 1918 pandemic. See ref. 1.

soldiers hospitalized with influenza died of the disease.8) Except
for rare cases of visual disturbances, there were no side-effects.7
Gelsemium continues to be used by herbalists and naturopath-
ic physicians to treat fevers associated with influenza, muscular
weakness, myalgia, flowing pulse, apathy, deliriousness, and/or
hysteria.9
Michael Moore, director of the Southwest School of Botanical
Medicine, Bisbee, Arizona, teaches that gelsemium cools the
brain and decreases wasteful fever (e.g., a fever that is too high to
be beneficial to a patient) in adults. He considers the herb to be
useful when a patient has red eyes, a flushed face, overly acute
hearing, skin hypersensitivity, and agitation with a large amount
of blood moving to the surface (personal communication with
Michael Moore, May 1998).
French herbalists use gelsemium for neuralgic headaches, pre-
scribing a dose of 15 drops, three or four times a day.10 German
phytotherapists use the herb as a cardiac sedative for extrasys-
toles and functional heart disease.11
Modern research has demonstrated that gelsemium has valu-
able, potent effects on the nervous system. Low doses of gelsemi-
um root extracts have protected mice against neurologic damage
and gastric erosions induced by stress.12 A fluid extract of
gelsemium root has also demonstrated antiseizure ability in rats
with epilepsy that was induced by lithium and pilocarpine injec-
tions.13
A warning to patients is vital: Gelsemium should only be
administered by an experienced practitioner. It is very safe in
appropriate doses, and the Eclectics reported that gelsemium poi-
soning was quite rare despite its extensive use. Nonetheless, it is
toxic in excess. The cardinal symptoms of poisoning are ptosis,
diplopia, dropping of the lower jaw, and absolute muscular pros-
tration. Death results from respiratory paralysis and cardiac arrest.
The Eclectics preferred a gelsemium tincture made from the
fresh root, and considered it to be vastly superior to that made
from the dried plant. John Uri Lloyd wrote:
For thirty years or more, Eclectic physicians have insisted that the
green drug [fresh herb] possesses qualities entirely absent in the dry.
This we accept without reserve, and for decades have worked only
the green drug, believing that the point as concerns its superiority is
not debatable.
The Eclectic dose was 0.1–10 drops of Specific Medicine of
gelsemium, usually administered by mixing 10 drops to 1 dram
(approximately 4 mL) in four ounces of water and then giving a
patient 1 teaspoon every 1–3 hours. Practitioners currently dose
gelsemium tincture at 2–10 drops every 1–3 hours.
Boneset
The name boneset comes from this plant’s successful use in
influenza pandemics and other severe febrile illnesses that
caused such severe pain that patients felt as if their bones were
breaking. Many Native American tribes used boneset to treat
colds, fevers, sore throats, chills, influenza, pneumonia, and
pleurisy.15 Herbalists, naturopathic physicians, and other mod-
ern practitioners continue to use boneset similarly, especially for
treating febrile diseases.
The Eclectics considered boneset to be a very valuable
medicine. The Eclectic Materia Medica noted: “In every epidemic of
influenza [boneset] has been used with great advantage. During
the severe pandemic of 1918–1919 it was one of the safest and
most successful remedies employed and contributed much to the
successful management of disease under Eclectic treatment.”16
Felter commented that boneset was used as a prophylactic but
that this action was unproven. However, he also noted: “[t]hat
cases were rendered milder, deep-seated pain promptly relieved,
cough and respiratory irritation lessened, and recovery expedited
under the liberal administration of eupatorium is a matter of
record. It is especially valuable to relieve the intolerable backache
and pain in the limbs.”16
The Eclectics found that boneset relieved deep-seated pain in
febrile conditions consistently. The herb was considered to be
especially useful for relieving coughs in elderly and weak
patients who lacked the strength to cough up the abundance of
mucus caused by the influenza.
In 1889, one physician commented that boneset was very valu-
able for allaying cough with high fever, free perspiration, and
lack of power to expectorate.17
In a review of influenza in 1915, another physician recom-
mended boneset whenever black cohosh failed to relieve pain.2
Yet another physician commented that almost the whole range of
influenza symptoms could be controlled with boneset and
gelsemium, saying that boneset was “absolutely safe under all
conditions. If too much is used, emesis is the only unpleasant
result.”5And, in 1918, it was reported that “recent experiences
point to [boneset] as being one of the best agents to give quick
results in epidemic influenza.”18
Boneset gained popularity as part of a preventative formula
after the following announcement was published in 1918:
In a well-known manufacturing establishment five employees
were recently stricken in one day with “Spanish influenza.” Imme-
diately a prescription of this remedy was compounded and a bottle
given to every member in the establishment, with directions to
take one teaspoonful every two hours the first day, afterward three
times daily. Since that date not one member of the establishment
has been afflicted. And yet strenuous business has kept them
employed night and day. Possibly this result is exceptional, but it
is no less a fact.19
The box entitled Two Eclectic Anti-Influenza Formulas shows the
prophylactic formula.
In the 1918 pandemic, one physician noted that the choice of
the “most important” remedy in influenza varied from patient-
to-patient but that boneset fit more cases than any other remedy.
Another physician used boneset “from start to finish,” and some-
times gave it as a tonic after the acute stage of the disease was
over. In the very early stages, when a patient only complained of
aches and pains, this physician immediately gave large doses of
boneset often. He was convinced that many influenza cases were
aborted by the early use of boneset.20
216 ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006

One physician, who saw 10–35 patients with influenza per day
during the epidemic began treatment by mixing 2 teaspoons of bone-
set and 1 teaspoon of pleurisy root tinctures in a cup of hot water.
This was given immediately with a second dose 15 minutes later, a
third dose half an hour later, and a fourth dose an hour after the first
dose. He reported that this treatment typically reduced a fever of
103–104ºF by 3–4º in a few hours. Yet another physician reported that
boneset was always a significant remedy in influenza.20
The German physician Weiss echoed the Eclectic view that
boneset appears to enhance resistance to infection by influenza.
He also acknowledged that there was no objective proof of its
anti-infectious effect but commented that practical experience
indicated such an effect. Because it alleviated many symptoms of
influenza and was quite safe, he used it extensively in influenza.11
Despite its long history of use, there is little research on bone-
set. An early study showed that the plant had mild antibacterial
activity in vitro against Staphylococcus aureus and Bacillus mega-
terium and was potently antineoplastic.21
In mice, boneset tincture is an immunostimulant.22 It contains
eupatorin, an antioxidant and inflammation-modulating
flavone.9Although safe for short-term use, the plant belongs to a
plant family that often contains hepatotoxic unsaturated
pyrrolizidine alkaloids and, thus, boneset should not be used
casually.23 An overdose of boneset can be emetic and cathartic.
The aboveground parts of the plant are used, and many practi-
tioners think it is a more effective medicine if it is tinctured while
fresh. It is diaphoretic when taken as a hot tea, and the tincture is
usually dispensed in hot water to augment this effect.
The Eclectic dose was 5–60 drops of Specific Medicine Eupato-
rium or an infusion of 1–4 fluid drams (4–12 mL). The dose for
boneset tincture ranges from 20–40 drops to 3–5 mL of tincture in
hot water, three times per day.
Black Cohosh
Historically, black cohosh root was primarily used as an anal-
gesic. Native American tribes used it to relieve arthritic pain but
also used it as a tonic and a remedy for colds, cough, and con-
sumption.15 Today, black cohosh is best known for its ability to
ease negative symptoms in perimenopause but botanical practi-
tioners still consider the herb to be one of the better remedies for
muscular, rheumatic, intercostal, and ovarian pain.9,24 One clini-
cal trial demonstrated that black cohosh, combined with other
herbs, reduces pain caused by osteoarthritis significantly better
than placebo. The root contains salicylic acids.25
One of the first Eclectic uses for black cohosh—learned from
the Native Americans—was for “putrid” sore throats. The plant
soon came into general use, and the Eclectics reported: “Few of
our remedies have acquired as great a reputation in the treatment
of rheumatism and neuralgia.”26 The herb was used for any dull,
tensive, intermittent pain and soreness in muscular tissue, espe-
cially over the abdomen.
Black cohosh was described as being promptly curative for the
headache of influenza. In tuberculosis, the herb was used to
lessen coughing, soothe pain (especially aching under the scapu-
lae), lessen secretions, and lessen nervous irritability.
Black cohosh was also used to relieve a variety of fevers. The
Eclectic physician Felter called it the most important remedy for
relieving muscular discomfort and, when combined with bone-
set—both in liberal doses—the best remedy for the intense muscu-
lar aching and “bone-breaking” pains at the onset of influenza.16
One physician reported treating 200 cases of influenza success-
fully during the 1918 pandemic, using a combination of gelsemi-
um, black cohosh, and Euphrasia officinalis (eyebright). He
estimated that 75 percent of all influenza cases could be handled
with these three herbs alone. After bringing down a fever with
gelsemium, he would switch to 10 drops each of gelsemium and
black cohosh in 4 ounces of water, administering 1 teaspoon
every 2–3 hours.27 Another physician recommended black
cohosh for all cases in which a patient emphasized the symptom
of muscular soreness; he also used it in the early stages of pneu-
monia to alleviate aching.28
The Eclectics typically used low doses of black cohosh, often
0.1–20 drops of Specific Medicine Actaea, by mixing 10–30 drops
in 4 ounces of water and dispensing 1 teaspoon every 2 hours.
However, they also noted that larger doses, short of producing
headaches, were very effective and that the amount given to an
adult could be increased to 1 dram and all the way up to 1 ounce
(30 mL). The current dose for black cohosh tincture ranges from
10–25 drops to 2–4 mL of tincture, three times per day.
Pleurisy Root
The root of this plant has a very long history of use for respira-
tory problems—hence its common name, pleurisy root. It is also
called butterfly weed because of the Monarch butterfly’s fond-
ness for it.
Native American tribes used pleurisy root to treat pleurisy,
pneumonia, influenza, and other respiratory ailments. Contem-
porary herbalists and naturopathic physicians use it to treat res-
ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006 217
Two Eclectic Anti-Influenza Formulas
Prophylactic formula
•Eupatorium perfoliatum (boneset)—One half-ounce
•Aconitum napellus (aconite)—5 drops
• Water—4 oz
The dose of the prophylactic formula was 1 teaspoonful, every
2 hours, on the first day and thereafter three times per day.
Treatment formula
•Gelsemium sempervirens (gelsemium) tincture—9 drops
•Atropa belladonna (belladonna) tincture—5 drops
• Potassium citrate—10 grains
• Orange syrup—1 dram
•Aqua chloroformi—1 dram
This formula was used at a military hospital in France in the
pandemic of 1918–1919. One (1) dram was given every 4 hours
for the first 24 hours, and one-half dram every 4 hours thereafter
until the patient’s temperature returned to normal, at which point,
the formula was discontinued. One (1) dram is approximately one
eighth of an ounce. The potassium citrate was added as a mild
diuretic.

piratory infections, reduce inflammation, and promote expecto-
ration.24 Pleurisy root is often used today to treat influenza when
a patient has a tight feeling in the chest or a painful cough.
Michael Moore noted that pleurisy root is useful for address-
ing pleurisy and mild pulmonary edema because the herb
increases fluid circulation, cilia function, and lymphatic
drainage.29 Pleurisy root is diaphoretic, which makes it useful for
relieving fevers.30 Its diuretic and diaphoretic effect may be the
result of constituents that strengthen heart contractions and
allow fluid removal as a result of improved circulatory force.9
The Eclectics considered pleurisy root to be a very safe remedy
because, even if used without the proper indications, it did not
cause harm. At worst, it simply did not produce the desired
result. The Eclectics reported that pleurisy root worked well as a
diaphoretic—no matter how high a patient’s fever was—and,
because the herb normalized secretion through the skin, could be
used even in a patient who was perspiring heavily.
Pleurisy root was considered to be an excellent remedy for
ordinary colds and was used as a cold remedy in infants.
Although the herb can reduce high fevers, the Eclectics conclud-
ed that it was best for treating moderate fevers when the skin is
moist and when the pulse is vibratile but not too rapid.
Combined with a properly chosen Chief Sedative, pleurisy root
was one of the Eclectics’ preferred remedies in the early stages of
pneumonia and pleuropneumonia. As a rule, these physicians
viewed pleurisy root as an assistant to other herbs rather than as a
single, stand-alone remedy in pneumonia. For instance, if a patient
had a dry and constricted cough, the Eclectics used small doses of
pleurisy root with 1- or 2-drop doses of Lobelia spp. (lobelia).
Physicians made the following comments on pleurisy root’s
usefulness in pandemic influenza: “For pectoral pains, [it] was
one of the best herbs.” It controls inflammatory conditions within
the lungs and is particularly valuable in allaying cough.17 One
physician who treated influenza for decades and who “failed
only six times in a thousand cases” stated that pleurisy root can
be used in “all pleuritic complaints.”6
Another Eclectic physician noted that, while gelsemium was
the mainstay, he minimized bronchial complications by giving
pleurisy root in small doses at the onset of symptoms. In a paper
on treating influenza in the Eclectic Medical Journal, the author
commented that pleurisy root was one of his favorites and that
he used it to treat all catarrhal affections, particularly in
children.31 He used it when a patient’s skin was hot and dry,
especially when a patient had pneumonia symptoms.
In a monograph, another physician reported that veratrum
combined with pleurisy root will abort pneumonia in 2–4 days
but that the combination was most effective if given in the early
stages of the disease.32
There is no clinical research on pleurisy root. It should be used
cautiously in individuals who take cardiac glycoside drugs (such
as digoxin) because it also contains low levels of cardiac glyco-
sides, which could lead to synergistic drug toxicity. However,
some herbalists suggest that the plant is such a feeble cardiac stim-
218 ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006
Asclepias tuberosa (pleurisy root). Drawing ©2006 by Eric Yarnell, N.D.,
R.H. (AHG).
Chest Applications
Most Eclectic physicians used some type of chest application and
considered them to be vital for preventing pulmonary complications.
Historically, chest rubs and applications were widely used by physicians
and lay folk alike. There is no explanation for when, or why, this
practice was discontinued, but these applications are not commonly
used today.
No research indicates that chest applications lack benefit. In fact,
animal research indicates that volatile oils (often found in chest rubs)
penetrate lung tissue and produce a strong antimicrobial action. And,
a recent study showed that Vick’s salve applied to the chest enhanced
lung clearance in patients with chronic airway obstruction.a
Many types of applications were used in the 1918 pandemic, and
one of the most popular ones was the Compound Powder of Lobelia
consisting of:
•Lobelia spp. (lobelia) powder—6 drams
•Sanguinaria canadensis (bloodroot) powder—3 drams
•Symplocarpus foetidus (skunk cabbage)—3 drams
•Cephaelis ipecacuanha (ipecac) powder—4 drams
•Capsicum annuum (cayenne) powder—1 dram.
This formula was mixed and then sprinkled on a larded or oiled
cloth and applied to the chest while the formula was warm.
aHasani A, Pavia D, Toms N, et al. Effect of aromatics on lung mucociliary clearance
in patients with chronic airways obstruction. J Altern Comp Med 2003;9:243–249.

ulant that it should not have a synergistic effect on heart and blood
pressure medications but caution against combining it with anti-
cholinergic drugs.29 Pleurisy root is contraindicated in pregnancy
and may cause vomiting but this occurs only at rather high doses.
The Eclectic dose was 1–60 drops of Specific Medicine Ascle-
pias, which was typically administered by mixing 20 drops to 1
dram in 4 ounces of water, and giving 1 teaspoon every 1 or 2
hours. Today, the tincture is given at 1–3 mL and the cold infu-
sion of the dried root is given at 2–4 ounces, three times per day.
Herbs and Cytokine Storms
Human influenza replicates primarily in respiratory epithelial
cells. Experiments with a reconstituted strain of the 1918 influen-
za show that, in mice, the virus had close to a 200-fold replication
rate compared with a milder seasonal influenza strain.33
Thus, one feature of pandemic influenza is an ability to repli-
cate at an unusually fast rate. Influenza damages the epithelial
cells in this process, and there is evidence that bacteria are much
more able to attach and move into the respiratory tract during a
serious case of influenza. Secondary infections thus pose a much
greater risk in pandemic influenza.
The human immune system uses cytokines and chemokines to
communicate and muster appropriate responses to viruses, can-
cer, bacteria, and parasites. All influenza strains induce a dysreg-
ulation of the cytokine and chemokine system, resulting in
increased levels of proinflammatory messengers such as IL-6 and
decreased concentration of anti-inflammatory cytokines such as
IL-10.34
In one study, an avian flu strain from a deceased patient dra-
matically increased IL-6 and IP-10.35 This severe dysregulation
has been referred to as a cytokine storm. It is the rapid produc-
ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006 219
Capsicum annuum (cayenne).
Symplocarpus foetidus (skunk cabbage).
Sanguinaria canadensis (bloodroot).

tion of proinflammatory cytokines that is responsible for the
severe damage done to lung tissue in patients who develop avian
flu and, thus, is a major cause of fatality.
The existence of a cytokine storm has many scientists con-
cerned about the appropriateness of the use of botanicals that, in
common parlance, are viewed as immune-stimulants. As we
have discussed in previous articles, herbs, in fact, act as inflam-
mation and immune modulators rather than as stimulants or
suppressors.36 There is one interesting study that strongly sup-
ports our view and shows that herbs may be capable of moderat-
ing the influenza “cytokine storm.”36
The common cold, a rhinovirus, also dysregulates the immune
system in humans, although to a vastly lesser degree than pan-
demic influenza.37 The rhinovirus does not replicate with any
substantial speed and does little damage to the respiratory
epithelial system. This virus, however, does change the profile of
31 different cytokines and chemokines.
Like influenza, the rhinovirus sharply upregulates IL-6 and
interferon-awhile downregulating IL-10. This dysregulation of
this system causes the inflammation, fatigue, and other bother-
some symptoms of the common cold. Researchers puzzled over
the fact that herbs such as Echinacea spp. (echinacea) were used to
ease these symptoms although the herbs also were commonly
referred to as immune-stimulants.
Echinacea should make cold symptoms worse if it, in fact,
stimulated the already-dysregulated immune response to the
rhinovirus. Researchers, therefore, studied the effect of echi-
nacea on cytokine and chemokine production in healthy and
infected respiratory cells. Interestingly, echinacea downregu-
lated, or normalized, cytokine production in infected cells and
upregulated cytokine production in healthy cells. This shows
that, while echinacea can upregulate immune function, its
ability to modulate inflammation can dominate where
needed.38
Unfortunately, similar experiments have not yet been done on
cells infected with influenza virus. However, we feel confident
that herbs that historically have been used successfully to allevi-
ate flu symptoms also work to normalize cytokines, reducing the
production of the proinflammatory cytokines responsible for the
challenging symptoms of influenza. Although unproven, the
clinical evidence of symptom reduction appears to be a result of a
quieting of the cytokine storm.
Conclusions
Herbs have long been used to treat influenza, a disease that has
afflicted humans for millennia. They are highly useful in seasonal
influenza, appear to have been very successful in past pan-
demics, and are likely to prove critical for treating patients who
develop influenza when the next pandemic arrives. ■
References
1. Abascal K. Herbs & Influenza: How Herbs Used in the 1918 Flu Pan-
demic Can Be Effective in the Next. Vashon, WA: Tigana Press, 2006.
2. Anonymous. Eclectic medication in la grippe. Eclectic Med J 1915;75:
102–103.
3. Oyo-Ita A, Meremikwu M. Physical methods for treating fever in chil-
dren. Cochrane Database Syst Rev 2003;2:CD004264.
4. Centers for Disease Control and Prevention. Questions & Answers: Flu
Vaccine. Online document at: www.cdc.gov/flu/about/qa/fluvac
cine.htm Accessed August 2006.
5. Anonymous. Influenza again. Eclectic Med J 1919;79:557.
6. Bowles T. Remedies I Employ in Treating Influenza. Ohio State Eclectic
Medical Association.
7. Small WDD, Blanchard WO. The treatment of influenza. Eclectic Med J
1919;79:444–446.
8. Influenzia [sic] in the First World War. Online document at: www.spar-
tacus.schoolnet.co.uk/FWWinfluenzia.htm Accessed July 12, 2006.
9. Mitchell WA Jr. Plant Medicine in Practice. St. Louis: Churchill Living-
stone, 2003
10. Goetz P. Phytotherapy of headaches [in French]. Phytotherapie
2005;3:176–177.
11. Weiss RF. Weiss’s Herbal Medicine, classic ed. New York: Thieme, 2001.
12. Bousta D, Soulimani R, Jarmouni I, et al.Neurotropic, immunological
and gastric effects of low doses of Atropa belladonna L., Gelsemium semper-
virens L. and Poumon histamine in stressed mice. J Ethnopharmacol
2001;74:205–215.
13. Peredery O, Persinger MA. Herbal treatment following post-seizure
induction in rat by lithium pilocarpine: Scutellaria lateriflora (Skullcap),
Gelsemium sempervirens (Gelsemium) and Datura stramonium (Jimson
Weed) may prevent development of spontaneous seizures. Phytother Res
2004;18:700–705.
14. Lloyd JU. Gelsemium. Online document at: www.swsbm.com/Manu
alsOther/Gelsemium-Lloyd.PDF Accessed April 2006.
15. Moerman DE. Native American Ethnobotany. Portland, OR: Timber
Press, 1998.
16. Felter HW. The Eclectic Materia Medica: Pharmacology and Thera-
peutics. Sandy, OR: Eclectic Medical Publications, 1994.
17. Felter HW. Epidemic influenza. Eclectic Medical J 1899; 59:42-45.
18. Anonymous. Some influenza suggestions. Eclectic Med J 1918;78:604.
19. Anonymous. Eupatorium perfoliatum as a prophylactic. Ellingwood’s
Therapeutist 1918;18.
20. Brother L. Favorite Remedies Used in Treatment of Influenza. 1919. .
Online document at: www.herbaltherapeutics.net/herbal_thera
peutics_library.htm Accessed June 2006
21. Habtemariam S, Macpherson AM. Cytotoxicity and antibacterial
activity of ethanol extract from leaves of a herbal drug, boneset (Eupatori-
um perfoliatum). Phytother Res 2000;14:575–577.
22.Wagner H, Jurcic K. Immunological studies of plant extract combina-
tions: In vitro and in vivo studies on the stimulation of phagocytosis.
Arzneim Forsch 1991;41:1072–1076.
23. McGuffin M, Hobbs C, Upton R, Goldberg R. American Herbal Prod-
ucts Association’s Botanical Safety Handbook. Boca Raton: CRC Press,
1997.
24. Hoffmann D. Medical Herbalism. Rochester, VT: Healing Arts Press,
2003.
25. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine:
Expanded Commission E Monographs. Newton MA: Integrative
Medicine Communications, 2000.
26. Felter HW, Lloyd JU. King’s American Dispensatory. Sandy, OR:
Eclectic Medical Publications, 1993.
27. Dawley MW. Influenza. Eclectic Med J 1919;79:530–531.
28. Mundy WN. Valuable remedies for influenza, grippe, and “common
colds.” Online document at: www.herbaltherapeutics.net/herbal_thera
peutics_library.htm Accessed June 2006.
29. Moore M. Medicinal Plants of the Mountain West, rev. & exp. ed.
Santa Fe: Museum of New Mexico Press, 2003.
30. Mills S, Bone K. Principles and Practice of Phytotherapy. New York:
Churchill Livingstone, 2000.
31. Anonymous. Influenza in children. Eclectic Med J 1922;82:407–408.
32. Daniels WE. Veratrum viride monograph. Ellingwood’s Therapeutist
1918.
33. Tumpey TM, Garcia-Sastre A, Taubenberger JK, et al. Pathogenicity of
influenza viruses with genes from the 1918 pandemic virus: Functional
220 ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006

roles of macrophages and neutrophils in limiting virus replication and
mortality in mice. J Virol 2005;79:14933–14944.
34. Hayden FG, Fritz RS, Lobo MC, et al. Local and systemic cytokine
responses during experimental human influenza A virus infection. J Clin
Invest 1998;101:643–649.
35. Chan MCW, Cheung CY, Chui WH, et al. Proinflammatory cytokine
responses induced by influenza A (H5N1) viruses in primary human
alveolar and bronchial epithelial cells. Resp Res 2005;6:135–147.
36. Yarnell E, Abascal K. Herbs for curbing inflammation. Altern Comple-
ment Ther 2006;2:22–28.
37. Sharma M, Arnason JT, Burt A, Hudson JB. Echinacea extracts
modulate the pattern of chemokine and cytokine secretion in rhi-
novirus-infected and uninfected epithelial cells. Phytother Res 2006;
20:147–152.
38. Tragni E, Galli CL, Tubaro A, et al. Anti-inflammatory activity of Echi-
nacea angustifolia fractions separated on the basis of molecular weight.
Pharmacol Res Comm 1988;20(suppl5):87–90.
Kathy Abascal, B.S., J.D., R.H. (AHG), is executive director of the Botan-
ical Medicine Academy, Vashon, Washington. Eric Yarnell, N.D., R.H.
(AHG), is president of the Botanical Medicine Academy, a specialty
board for using medicinal herbs, and is an adjunct faculty member at
Bastyr University, Kenmore, Washington.
To order reprints of this article, write to or call: Karen Ballen, ALTERNA-
TIVE & COMPLEMENTARY THERAPIES, Mary Ann Liebert, Inc., 140
Huguenot Street, 3rd Floor, New Rochelle NY 10801, (914) 740-2100.
ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 2006 221