“Alternative”, “complementary”, “holistic” — whatever you call it, here are all articles discussing non-traditional approaches to healing and wellness. This also includes traditional Chinese medicine.
Isn’t it humbling that we have no cure for the world’s most common illness? Yes, the common cold, globally the #1 cause of sick days and doctor visits, still stampedes across the world, blissfully immune to any Eastern or Western prescriptions. As a family doctor, I’m always a bit frustrated that I can’t offer much to these patients, at least in terms of Western allopathic medicines. So, I decided to scour the literature again to see if any new research has shown benefits from herbals and supplements. And the good news is yes: there may actually be a couple of supplements which can help you get better, quicker. Here’s my advice below. (Please note that this research is for treating, and not preventing, colds and flu.)
Evidence-Based Literature Search
When it comes to supplements and natural therapies, I use only a tiny handful of resources that I consider trustworthy. All are certified by the Health on the Net Foundation as sources of trustworthy medical information. All these sites would review only the best, most unbiased research, which usually means the gold standard of all research: placebo-controlled, randomized controlled trials. I strongly recommend that everyone use HONCode’s search engine anytime you’re looking for medical advice, especially regarding supplements. For example, you’ll never see the anti-vaccine snake-oil salesman Dr. Mercola on their list. Here are my favorite medical resources, and their evaluations of therapies for the common cold:
- The Natural Medicines Database, a fantastic resource for doctors, on their review of the common cold, doesn’t rank anything as “effective” or even “likely effective”. Their next level, “possibly effective,” lists andrographis, vitamin C, zinc logenzes, echinacea, and elderberry.
- The Encyclopedia of Natural & Alternative Treatments has a common cold review which concludes that zinc logenzes, echinacea, and andrographis all have fair evidence to shorten a cold and lessen symptoms. Others such as vitamin C, ginseng and garlic perhaps may help to prevent colds, but do not improve symptoms.
- The Cochrane Library, a well respected independent review board, reviewed common cold treatments and found poor evidence for most supplements, including vitamin C bursts. However, they did find that zinc lozenges at a total dose more than 75 mg during a cold can quicken recovery time. There was “weak evidence” for echinacea. They also reviewed a popular European herbal treatment for colds, pelargonium sidoides, and concluded that this herb may help with symptoms of acute rhinosinusitis and the common cold in adults, “but doubt exists.”
- The National Center for Complementary and Integrative Health (NCCIH), the official governmental agency, has a review of common cold products and supports oral zinc for treatment; it finds no strong benefit for vitamin C, echinacea or probiotics as treatments.
Let’s break it down into the supplements that have the most evidence:
- Zinc: This seems to have the most support, especially higher doses (>75 mg daily) of lozenges containing zinc gluconate or zinc acetate. Some good studies show reduction in cough, runny nose, headache, sore throat and overall time of illness. But side effects are common, especially nausea and a bad taste in the mouth. Also, definitely do not do the zinc nasal sprays, which have clear evidence to permanently cause loss of smell. The data suggests you should stick with lozenges and not pills. I see a few brands of logenzes up to 30 mg each, which at three times a day would help. I see a few popular brands with only 5 mg zinc each, which seems far too low to work. I wouldn’t advise using these for children.
- Echinacea: This is probably the one you’ve heard about, and the evidence is encouraging — but not totally clear. Some “double-blind, placebo-controlled studies have found that various forms and species of echinacea can reduce the symptoms and duration of a common cold, at least in adults. The best evidence is for products that include the above-ground portion of E. purpurea rather than the root.” But it’s very difficult for me to recommend a proper dose, as studies have used multiple regimens via drops, pills and teas, also using many types of echinacea, as well as different combinations of root and plant. Here’s a useful list of test results from ConsumerLab showing which brands in the USA have proper amounts of the herb.
- Andrographis peniculata: An Indian herb very popular in Ayurvedic medicine and now in Europe, I think this actually has some good evidence. A handful of double-blind, placebo-controlled have shown benefit in reducing the duration and severity of cold symptoms, especially cough. An excellent meta-analysis of herbals from Germany showed significant improvement in severity and duration of a cough, especially via liquid formulation. The usual dose seems to be 48-500mg of the andrographolide aerial parts, usually divided three times a day. You can find a good list of andrographis brands on iherb.com. I keep reading about a Swedish patented combination with eleutherococcus and sambucus (Kan Jang Plus), but I don’t see it sold anywhere in the USA.
- Pelargonium sidoides (Umckaloabo): This is an interesting herbal, very popular in Europe and perhaps should be more popular here in the USA. That same German meta-analysis I mentioned above found strong evidence that it helped with cough, fevers, and sore throat — including for children as young as one year old, although the German independent Institute for Quality and Efficiency in Health Care says it shouldn’t be used for children under six years. The Cochrane Library also reviewed this herb and concluded, “P. sidoides may be effective in alleviating symptoms of acute rhinosinusitis and the common cold in adults, but doubt exists.” As with andrographis, the liquids and syrups were better than tablets. I see on iHerb a series of pelargonium products called Umcka with good reviews.
- Probiotics: Probiotics actually have pretty good evidence that taking them for months, especially over the winter, can markedly improve both the frequency and the severity of colds — for kids and for adults (as does vitamin D). That’s great news! But for symptom relief during a cold, the evidence is much more scant. I couldn’t find one good study for this; none of the groups above recommend probiotics as treatment.
- Vitamin C: Here’s another super popular supplement, which many people swear by. But again the evidence isn’t conclusive, and the few studies that do show a benefit show only mild improvement. Still, at least it seems safe for adults and children, and evidence is even stronger as a preventive during the cold seasons.
My Bottom Line
For immune boosting, don’t forget the most important advice: get a good’s night sleep; eat a lot of anti-oxidant foods; and stay well hydrated.
In terms of supplements, I think it’s appropriate for adults (not kids) to try some of the above supplements — and the sooner, the better, within 24 hours of your symptoms starting.
For what it’s worth, here’s my plan for myself and my wife the next time we get a cold: we’re going to continue our usual vitamin C + zinc bursts, usually using Airborne effervescent tablets, three times a day. Emergen-C and Wellness Formula also are similar, all three with a ton of vitamin C, some zinc and an assortment of herbals, many of which are mentioned above. I’m also adding andrographis 400mg twice a day and also pelargonium; and I’ll continue doubling up on my probiotic supplement, despite the lack of evidence. (One small note: last week my wife tried andrographis for the first time and had a horribly itchy rash for days. I was fine.)
In general, for children, I’m still hesitant about using any of these herbals for children under 6 years old, and I remain cautious about what I use with my own kids, both under 4 years of age. I still like probiotics during a cold, and I’m a big fan of honey for cough for all ages above one year, which studies show works better than any OTC syrup. I’m encouraged with the European studies using pelargonium and also ivy/primrose/thyme syrups, some of which are partially included in American brands like Zarbees. For more age-specific advice, please look at the recommendations in my previous article about curing a cough.
What herbals and supplements have you used? Please leave comments below.
Many of us have delved into China’s most famous traditions of acupuncture and traditional Chinese medicine (TCM), but it’s difficult to know not only which treatments are effective and safe, but which are suitable for your condition. I practice allopathic Western-style family medicine, but I also trained with many alternative medicine doctors in the hippie enclaves around San Francisco, so I am familiar with these complementary medicines. In my family medicine clinic, I am most comfortable with using some TCM herbs for stomach problems or the common cold. In fact, Western medicine is ineffective for the world’s most common illness – the common cold – and many OTC Chinese herbals, like my favorite cough syrup pipagao, can help relieve these symptoms. I sometimes recommend acupuncture to my patients for pain or headaches, especially if they’ve exhausted Western medical approaches.
I am more open-minded than other Western doctors – but only to a point. I am very strict about using only the strongest evidence-based treatments, both for Western medicine and for TCM. I’ve seen many patients approach alternative medicines with the false belief that TCM has no side effects and can do no harm. Everything we ingest can cause side effects such as allergic reactions or even toxic responses to the many heavy metals and chemicals often found in batches of herbal medicines and dried spices all over the world.
Concerning acupuncture for children, last year the American Academy of Pediatrics published a review that found a mild adverse event rate of 12 percent and a serious complication rate of 1 percent. I don’t consider this a small risk, especially as the proven benefits of acupuncture treatments for children are poorly-documented.
Fortunately, there are a handful of well-respected and objective websites with evidence-based data on TCM. My favorite is the National Center for Complementary and Alternative Medicine (NCCAM), which is sponsored by the US National Institute of Health.
Anyone interested in TCM should first visit NCCAM’s website at http://nccam.nih.gov/health/chinesemed and start researching. This same page also has an essential link to “Scientific Literature,” which takes you to all the top research papers listed on Pubmed, a database of all medical journal articles. The Pubmed group’s consumer version at MedlinePlus is also an excellent start for your research; you can find it at http://www.nlm.nih.gov/medlineplus.
If you want to see a TCM doctor, a few international clinics in Beijing have TCM doctors that speak English. If you speak Chinese, you can also go to Tongrentan (同仁堂)for its supply of herbs, which is probably the safest in China.
Click on the arrow below to listen, or click here.
Traditional Chinese medicine (TCM) is having a really good week. And a really bad week. On the Sept 26th Beijing Hour show (audio podcast is above), Paul and I talk about two major news stories this week regarding TCM. The good news comes from a prestigious medical award being awarded to a Chinese pharmacologist for her discovery in the 1970s of artemisinin, an extract of a famous Chinese herb which is now the cornerstone of malaria treatment all over the world. I think it’s the prime example of how good research can discover wonderfully effective treatments from Chinese herbs. The bad news comes from a China Daily article discussing how “among all academic theses on acupuncture indexed by the Science Citation Index (SCI), a leading world thesis index system, only 5 percent are from the Chinese mainland.” How can China, the birthplace of acupuncture, be an almost non-player in the research of its own creation? Click on the above audio links to find out.
You can listen to all my previous podcasts at the podcast archive. My Beijing Hour guest hosting is usually every Wednesday morning arounf 7:35AM. You can always listen to the Beijing Hour on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the CRI Radio network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.
A while back, I discussed Chinese herbs and the flu, and the difficulties I had in finding excellent studies either for or against their effectiveness. After that post, I was introduced to Dr Greg Livingston, an American doctor trained in Chinese Medicine and practicing in Hangzhou. We’ve had a fascinating discussion via email that I wanted to share with you:
Dr Livingston: As you mentioned, ganmao in Chinese Medicine (CM) is not actually a diagnosis. CM diagnoses what in Chinese is called a 证,
sometimes translated as “syndrome” or “pattern”, and ganmao is merely a 病, or “disease”. CM treatment is not based on “disease”, but rather
on “syndrome”. Since, as you mentioned, there are many different possible “syndromes” that could present when someone comes down with
ganmao (such as wind-cold, wind-heat, etc), there are many different types of treatment, and there is no one-size-fits-all treatment for
ganmao, or any other disease for the matter, in CM. Thus in Chinese we say 同病异治- same disease, different treatment. Furthermore, CM
infectious disease theory, of which ganmao is a part, is extremely complex, and to be well versed and clinically effective in it requires
years and years of study and practice.
As for the OTC CM preparations you mentioned, I don’t personally find any of them to be very effective. There are a couple reasons for this.
First, because they are prepared medicines there is no way to modify them to fit the patient’s “syndrome”, so even if used by a competent
CM physician based on solid diagnosis, unless the remedy somehow perfectly fits the patient, results will be less than optimal.
Second, these preparations are generally just not as strong as loose herb prescriptions. The latter of course also have the further
advantage of being tailored to fit the patient.
Third, many of these preparations are based not on CM ideas of herb function/traditional pharmacology, but on western medicine/modern
pharmacology. Ban Lan Gen Ke Li is a prime example: it’s used solely because it has anti-viral properties, not because of it’s traditional
actions and indications. Chinese herbs used in this manner cease to be Chinese Medicine, and are just Chinese herbs used according to western
medicine. One can of course do this, but the advantages of proper CM methodology are not used, and the anti-viral function is quite mild,
so this method is really neither here nor there, and it’s quite ineffective. In fact, Banlangen Keli/Chongji, etc, is really only
useful to try and prevent ganmao, is moderately effective at best for this purpose, and is completely worthless for treating people who
already have ganmao. In fact, I also think it’s almost useless to prevent ganmao as well. Other preparations such as Shuang Huang Lian
Kou Fu Ye are also based on this methodology, and are moderately effective at best.
Ganmao Qingre Keli is for wind cold with a bit of internal heat. Because many ganmao are the result of wind cold, this one is actually
not too bad for early stage wind cold ganmao with slight chills and aversion to wind and cold, mild cough, runny nose, etc.
Yin Qiao Jie Du Pian is for wind heat ganmao, with very very mild chills, slight aversion to heat, slight thirst, mild cough, runny
However, ganmao symptoms and “syndromes” change very rapidly, so it’s much more complicated than this. And there are actually 100’s of
prescriptions for ganmao as there are so many different ways it can present, so limiting oneself to these few preparations is a guaranteed
path to mediocre efficacy. Similarly, if a non-MD were to only “learn” how to use a couple antibiotics they would also be less than optimally
effective, to say the least.
As for studies, there are certainly many studies in Chinese, but probably not much in English. But again, because CM is by nature
individualistic, it doesn’t lend itself to RTC style studies, the object of which is to eliminate as much individual variation as
possible. Therefore, a study of 100 people with ganmao using one preparation is bound to show mixed results: the small number of
patients that are perfectly fit for the prescription will do well, those that are more or less fit for it will do ok, those that aren’t
fit will do poorly, and some people that have a completely opposite syndrome with suffer side effects. So, RTC studies don’t mean much for
CM physicians. If you want to take CM herbs and do RTC studies on their effectiveness, you can of course do that, but this is not CM,
and is not an evaluation of CM, but rather just an evaluation of an herb’s modern pharmacological function.
Me: Your insights are very helpful. It seems that indeed I may never be comfortable in recommending CM for my patients, in terms of those basic TongRen-style famous packaged formulas. We do have a TCM doc here and I will make more recommendations to see him directly. Although, I’m still disturbed that I won’t be able to recommend more packaged items. After all, it’s only pharmacology. Plenty of western OTC Rx can be very effective; we know that Tylenol or ibuprofen is extremely effective for fever in almost everyone. Why would we assume that all these famous CM packaged products are “weaker” than individual CM Rx?
DL: Actually, it isn’t “only” pharmacology. If you use Chinese herbs based purely on modern pharmacological knowledge of the herbs, then you are not using them according to CM principles, and thus they cease to be Chinese Medicine and become the same as pharmaceutical drugs, only
weaker in most cases. Of course pharmacology is always at play- it’s not that “intention” (“intending” to use an herb according to CM or
according to modern pharmacology) changes what that herb does to your body! The key point is diagnosis, and since western medicine doesn’t
differentiate/diagnose in the same way as CM, the medicine isn’t applied in the same manner/situation. This is really the key point. If
these prepared medicines are given in the appropriate situation (as determined by CM diagnostic and treatment methodology) they can be
quite effective, although as I mentioned earlier, they are generally not as effective as bulk-herb prescriptions/decoctions because: 1)
they are not tailored to the individual; 2) the dose is typically smaller than bulk-herb formulas/decoctions.
Me: If And if the evidence for things like banlangen is so weak, why does every Beijinger, including my staff and my wife, take them?
DL: People in China all have heard that banlangen has antiviral properties (it does, but pretty mild), it’s been marketed and promoted as a ganmao remedy, and it’s often an ingredient in government endorsed ganmao prophylactic formulas, so the overall impression is that it’s
good for ganmao. But in my own experience, and that of many of my teachers and colleagues, it is really only useful in prophylaxis, and
for this it is quite mild, but that’s not to say ineffective. Furthermore, this use is not a traditional use of the herb, but on based purely on pharmacological knowledge, and so it cannot be considered Chinese Medicine, even though it is a Chinese herb. This is an allopathic use of the herb, which is of course fine, but not really that effective. CM can be used to prevent ganmao, and can be quite effective (I take herbs often for this purpose, and rarely get sick even when people around me are all sick), but again, it must be done according to CM principles (otherwise it’s not CM, hehe) in order to get decent results. Simply, what CM does in this regard is strengthen and harmonize physiological function, which, among other things, improves immune system function.
Me: By the way, I take these medicines myself! My wife is a Beijinger and every time I have ganmao she makes me take one banlangen and one ganmao package, 3 times a day. I wish I could say I notice a difference, as it’s always hard to tell with ganmao whether I’d be getting better anyway.
DL: If you don’t notice a difference then I would say there is not much effect. If ganmao is treated properly with CM, it is quite effective. If treated at the first sign, most ganmao can be cured in a day or two, or at the very least be prevented from developing into a full
blown ganmao. If later stage, it should noticeably reduce symptoms and speed up recovery time. Anything less than that is a poor result
unless it’s due to a particularly nasty strain of flu, or to a patient’s weak or debilitated constitution.
The Bottom Line
Thanks so much, Greg, for your insight. After your comments, I’m now even less sure that I’ll be able to properly prescribe any Chinese medicines without more proper training. I think I will ultimately become what you describe as a more allopathic doctor using certain pre-made Chinese medicines if there is good evidence. Yes, as you say, it wouldn’t any longer be considered a traditional Chinese medical use, but I’m comfortable with that, as long as the data is there and the disease condition is clear.
(Most of this article was originally printed in an earlier MyHealth Beijing article; I am reposting some archives as I am on vacation now. I return to work on May 2nd at my new position at Beijing United Family Hospital, where I continue my family medicine practice but also am their new Group Director of Clinical Marketing and Communications for their national chain of hospitals.)
What is naturopathic medicine, you may ask? Here is naturopathic doctor Melissa Rodriguez‘s excellent review. She currently works in the Integrative Medicine department at Beijing United Family Hospital (where I also work):
These days many people know about the availability of natural medicines like herbal remedies, homeopathy, and the use of vitamins and minerals to treat and prevent disease. However, not many people are aware that there is a profession that is highly specialized in the use and prescription of natural medicines. A naturopathic doctor (N.D.), or naturopath, is very well educated when it comes to the appropriate use of nutritional supplements, herbal remedies, and other alternative treatments. Naturopaths are also knowledgeable about interactions between drugs and natural medicines. You might be asking yourself, what exactly is naturopathic medicine? How do I recognize a formally trained, licensed naturopath? And what can naturopathic medicine do for me? Let’s begin with a brief synopsis about the origins of naturopathic medicine.
Naturopathic medicine has been around in its primitive form since pre-historic times. In those days there was likely a “healer” in the village or a wise elder who knew what herbs and plants were useful for what condition. They were also aware of which foods were beneficial for which maladies; and what foods to avoid when ill. All ancient cultures have their traditional healing wisdom, the Persians, Native Americans, East Indians, Chinese… The list goes on and on. Hippocrates, a Greek physician who is considered by many to be the father of modern medicine, described the concept of “the healing power of nature” almost 2500 years ago.
Naturopathic medicine as it is known today developed in Europe in the late 1800’s before coming to North America. Dr. Benedict Lust popularized the term “naturopathy” and used it to describe a medical practice using herbal remedies, homeopathy, acupuncture, nutrition, lifestyle counseling and manipulative therapy. In the early 1900’s he opened many naturopathic colleges and healing centers in the United States. Naturopathic medicine flourished in North America until antibiotics and surgery took centre stage during the 1930’s and 40’s. This trend continued until the last few decades, when people began to look for alternatives to conventional medical treatments.
Treating the root cause of disease is the fundamental purpose of naturopathic medicine. A visit with a naturopathic doctor takes a long time, because many aspects of a person must be studied, their diet, lifestyle, medical history… Everything must be considered in order to understand the underlying cause of disease. The goal is not to treat the symptoms, although at times the symptoms must be alleviated. The goal is to find out the why, not just the what. Like a detective, a naturopathic doctor must put all the clues together to discover the cause. For example, why does this individual suffer from migraines? Could it be a reaction to stress? Perhaps a trigger in the environment, or maybe an unknown food sensitivity? While relieving the pain is important, to treat the cause is imperative in order to prevent further migraines from occurring. Thus the cause and therefore the prescription will be unique to each individual.
One of the most important principles of naturopathic medicine is that the body has the innate ability to heal itself. We see this phenomenon in everyday situations, if we get a cut or a cold, our body will naturally heal the wound and eventually cure the cold. This is true for most people and in most situations. A naturopathic doctor uses natural medicines to help the body heal itself. Naturopathic treatments can give the body that extra boost it needs to heal faster and more efficiently. For example, if a person’s body is too weak to handle a simple cold, complications can arise such as secondary bacterial infections. These become harder for the body to treat by itself. If natural medicines that support the immune system are given, we can potentially avoid complications like bronchitis or pneumonia. There are also extreme situations in which the body is struggling to heal itself, for example when someone has a disease like cancer. In this case, natural medicine can help strengthen the body and counteract the side effects of conventional therapies like radiation or chemotherapy.
To become a licensed naturopathic doctor one must go through a long and rigorous process that is both challenging and extremely rewarding.
Naturopaths must first receive a university Bachelor degree and complete certain pre-requisites such as biochemistry, anatomy and physiology. Then they apply to a naturopathic college that is accredited by whatever organization is responsible for that country. In Canada it is the Council on Naturopathic Medical Education (CNME), which is recognized by the US Department of Education. The naturopathic program is 4 years and is very intense. Courses include histology, embryology, and immunology, as well as pharmacology and other medical sciences. The naturopathic component includes botanical medicine, nutrition, traditional Chinese medicine, and homeopathy. There is also one year of clinical experience. By the time someone graduates from a naturopathic college they would have completed over 4200 hours of classroom and clinical training.
The next step to become a licensed N.D. is to successfully complete the licensing exams. In the US and Canada these are administered by the Naturopathic Physicians Licensing Examinations (NPLEX). After this process is complete, an ND must continue learning in order to maintain their license. The science of natural medicine is constantly being developed, so continuing education is critical to stay current and well informed.
The Naturopathic Advantage
Naturopathic doctors are trained primary care providers who can help a person optimize their health through diet and nutritional supplements. They empower and educate their patients, helping them make healthier choices. They can also treat disease, from acute conditions like ear infections to chronic conditions like Alzheimer’s. The methods they use are gentle and many have stood the test of time, some still being used after thousands of years. Naturopaths are also trained to recognize when to refer a patient. This is important because there are times when the perspective of a different professional is needed, when further investigations are warranted, or when natural medicines are not enough. A naturopathic doctor is your best resource to find a healthy balance between natural and modern medicine.