October 20, 2009.
Published in abbreviated form in Acupuncture Today, January 2010.
This article presents a number of ideas on the history and treatment of avian-swine flu. If you are looking for immediate recommendations, please go to the last section of the article, “Herbal Product Recommendations for Clinicians”, end of the article.
As the H1N1 Swine Flu sweeps across the world, it is important to keep the illness in perspective. First of all, while all flu is deadly, this flu appears to be milder in symptoms and duration than the common flu. What distinguishes H1N1 is that it is highly contagious, and those who are getting sick are children and young adults. It seems epidemic in the middle and high school age range. Despite its relative mildness, H1N1 is causing death and hospitalizations, and health authorities throughout the world are making effort to address the pandemic.
Traditional Chinese 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 Chinese herbal doctors, or to self-medicate with recommended Chinese herbal products. As H1N1 spreads widely throughout China, millions of people are taking advantage of these government sponsored recommendations.
China had a successful experience with the use of Chinese herbs during the 2003 SARS epidemic (“Sudden Acute Respiratory Syndrome”), a flu with many similar clinical features to H1N1. At that time, a massive public health campaign educated people what herbal medications to use, and provided more sophisticated guidelines for doctors of Traditional Chinese Medicine (TCM). For several years, I presented material on Chinese herbs in the treatment of SARS in a lecture to acupuncturist-herbalists, and the lecture notes are available on my website.
In one study done in Hong Kong, Chinese herbs proved more efficacious than any of the Western approaches for the treatment of SARS. At the time, 20% of those coming down with SARS in Hong Kong were health care workers in the Western hospitals, all of whom needed to be hospitalized. The Hong Kong health authorities created an herbal supplement that was given to volunteer hospital healthcare workers, who were then monitored for sickness. All of the healthcare workers avoided hospitalization, and those that got sick had markedly reduced signs and symptoms. The Hong Kong health ministry then mass produced the formula and gave them first to all healthcare workers requesting it, and afterwards made it available to the general population.
Understanding Avian-Swine Flu.
When a flu virus cross mutates between birds and mammals (such as pig), and then further cross-mutates within a human host, the result can be the creation of a virulent strain of flu.
Research epidemiologists and demographers are most concerned about the emergence of flu like the 1918 Spanish Grippe pandemic. That tragic event killed at least 50 million people worldwide within 5 months. Many people who died did so within 48 hours of their first symptoms. It attacked the young and strong, leading scientists to wonder if the virus was made more virulent by strong immune systems. The notoriety of the 1918 Flu is based on its extreme contagion and the severity of the symptoms. That flu was also a strain of the H1N1 virus, which is why modern demographers and epidemiologists have been so concerned.
Avian-swine flu is the result of mutations between several different kinds of animal species. All influenza is transmitted around the world by birds that carry the virus in their intestines. Rarely do the birds themselves get sick. If the virus mutates in a certain way that sickens the bird, the virus is then called Avian Flu. (Often, it is only domestic chickens, turkey and ducks that get sick.) There have been several times in the last 100 years when an avian strain has further mutated when exposed to a flu virus of another species, and then goes on to affect humans. This type of flu tends to be more contagious with more severe symptoms.
In the 1918 Spanish Grippe, multiple species transmutations occurred. It is thought that the first mutation happened in south China ponds used for raising carp fish. Here, pig feces were spread into the ponds to facilitate algae growth, which fed the carp. Migrating ducks and geese fed on the pond surface, ingesting contaminated pig feces, and allowed a mutation that created avian-swine flu. The next mutation occurred when it settled into wounded soldiers who were closely packed in trains and hospitals in Europe. This final swine-avian-human mutation was unprecedented in its virulence and contagion.
Some scientists think that it is unlikely that a third human mutation based on similar circumstances would happen again. They argue that we have seen pandemic H1N1 flu in 1957, 1968, 2003, and 2009, and all have been less virulent then the 1918 Spanish Grippe. Nevertheless, other epidemiologists and demographers are concerned about a possible reoccurrence of the 1918 pandemic, also caused by the H1N1 virus, explaining the attention shown by public health officials around the world.
Understanding the H1N1 Swine Flu.
“Influenza A (H1N1) virus is the most common cause of influenza in humans. H1N1 strains caused roughly half of all human flu infections in 2006. Other strains of H1N1 are endemic in pigs (swine influenza) and in birds (avian influenza).”
“Swine Flu”, a strain of the H1N1, was first identified and labeled in April, 2009. The illness is relatively mild in most cases. People in higher risk groups include those with asthma, diabetes, obesity, heart disease, or who are pregnant or have a weakened immune system. People who were previously healthy, however, may develop secondary infections, such as bacterial pneumonia, which may become serious and require medical hospitalization.
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, headache, and muscle or joint pains. The main symptoms are fever (101-103°F) with chills or shivering, and headache. In my clinical practice, we have seen Swine Flu develop easily into a harsh cough (lung fire). 
China’s Recommendations for the Treatment for H1N1 Swine Flu.
During the SARS epidemic of 2003, 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 as the damp-heat type, but the observations and recommendations made for the lung wind-heat type still apply.
In the classical Wen Bing approach, prescriptions were advised for various stages of an illness. In the late 18th century, we saw the addition of more robust heat-clearing herbs, such as Huang Qin (Radix Scutellariae) and zhi zi (Fructus Gardenia Jasminoides). In the modern approach, especially since the SARS epidemic of 2003, wen bing formulas are still recommended, but now with the addition of herbs showing strong antiviral effect.
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), as well as recommendations for 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 ministries of health and individual hospitals have issued guidelines for both treatment and prevention of flu. 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. Both yin qiao san and sang ju yin were recorded by Wu Ju-Tong in 1798 as part of the wen bing (warm diseases) movement.
The following formula was generated during the SARS epidemic of 2003. The original Sang Ju Yin formula uses Sang Ye (Folium Mori Albae), Ju Hua (Flos Chrysanthemi Morifolii), Lian Qiao (Fructus Forsythiae Suspensae), 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 (Folium Isatidis seu Baphicacanthi), Huang Qin (Radix Scutellariae) and Huang Qi (Radix 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 (Flos Lonicerae Japonicae), ban lan gen (Radix Isatidis seu Baphicacanthi), bo he (Herba Mentha Haplocalyces) and gan cao (Radix Glycyrrhizae Uralensis).
Another slightly larger formula recommends the following: chuan xin lian (Herba Andrographis Paniculatae), yi yi ren (Semen Coicis Lachryma-jobi), guan zhong (Rhizoma Dryopteris crassirhizoma), lian qiao (Fructus Forsythia Suspensa), jin yin hua (Flos Lonicerae Japonicae) and hu zhang (Radix et Rhizoma Polygoni Cuspidati). Other herbal prescriptions are also reported.
Besides recommending herbal decoctions and powders, the Chinese authorities also recommend the use of various prepared products such as gan mao ling, zhong gan ling, ban lan gen chong ji for acute symptoms.
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 (Radix Bupleurum), huang qin (Radix Scutellariae Baicalenses) 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 (Radix Isatidis seu Baphicacanthi), lian qiao (Fructus Forsythiae), bai zhu (Rhizome Atractylodes Macrocephala), dan zhu ye (Folium Lophatheri), lu gen (Rhizoma Phragmitis), yu xing cao (Herba Houttuyniae), jin yin hua (Flos Lonicerae Japonicae), ge gen (Radix Puerariae), ju hua (Flos Chrysanthemum Morifoli), fang feng (Radix Ledebouriellae Divaricatae), bo he (Herba Menthae), gan cao (Radix Glycyrrhizae Uralensis).
This formula does not address the harsh cough stage.
Prevention. For flu prevention, the recommended approach has been an adjusted yu ping feng, adding in antiviral herbs. The original yu ping feng formula, dating back to 1481 supports the immune system by boosting both ying and wei qi. Antiviral herbs are added in the expectation that in a pandemic one will inadvertently be exposed to the flu virus. The prescription called “Flu Prevention Formula”, formulated and issued by the Committee of Experts for Flu Prevention and Control under Beijing Administration of Traditional Chinese Medicine, follows this approach. The herbs used are huang qi (Radix Astragli), bai zhu (Rhizome Atractylodes Macrocephala), fang feng (Radix Ledebouriellae Divaricatae), guan zhong (Rhizoma Dryopteris crassirhizoma), jin yin hua (Flos Lonicerae Japonicae) and chen pi (Pericarpium Citrus Reticulata).
Based on Chinese recommendations, I have 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: schools, airplanes, work, etc. It consists of huang qi (Radix Astragli), tai zi shen (Radix Pseudostellaria Heterophylla), fang feng (Radix Ledebouriellae Divaricatae), bai zhu (Rhizome Atractylodes Macrocephala), lian qiao (Fructus Forsythia Suspensa), ban lan gen (Radix Isatidis seu Baphicacanthi), huo xiang (Herba Agastaches seu Pogostemi), ju hua (Flos Chrysanthemum Morifoli), gan cao (Radix Glycyrrhizae Uralensis).
Herbal Product Recommendations for Clinicians.
Flu usually presents with rapid-onset fever with chills or shivering, headache or neck ache. If not using customized formulas referred to in this article, my recommendations are as follows:
1. Chinese Herbal Products.
For illness, alternate GAN MAO LING and ZHONG GAN LING, taking one of them every 3 hours. Both are commonly available from various manufacturers.
If harsh cough develops, add formulas that clear lung fire.
For prevention, use Yu Ping Feng San, also known as JADE SCREEN.
My formulas, CLEAR TOXIN and IMMUNE PLUS are also available to practitioners.
a. Oscillococcinum (Boiron), 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 1-2 hours. As a preventative, take once daily.
b. Vitamin D. This is D3, and it promotes natural killer cells that attack virus. Take 5000 units daily for prevention, and 10,000 units a day if sick. In my opinion, this is the single best prevention against flu.
A webinar on this subject by Dr. Jake Fratkin can be found at tiny.cc/jakeflu
JAKE PAUL FRATKIN, OMD is a Doctor of Oriental Medicine in practice since 1978. After seven years basic training in Japanese acupuncture and Chinese herbal medicine in this country, he went to Beijing for one year to do advanced hospital training in herbal internal medicine, pediatrics and medical qi gong. He is the author of CHINESE HERBAL PATENT MEDICINES, (2001), a respected reference work of 1200 Chinese herbal products available in this country. In 1999 he received the national award, Acupuncturist of the Year, from the American Association of Oriental Medicine, and 2006 he received the award as Acupuncture Teacher of the Year. He is a recognized expert in the treatment of leaky gut syndrome, chronic respiratory and digestive disorders. Jake lives and practices in Boulder, Colorado.
 There are varying degrees of mortality. The CDC reports that in a typical flu in the United States, “it is estimated that, on average, approximately 5% to 20% of U.S. residents get the flu, and more than 200,000 persons are hospitalizedfor flu-related complications each year. About 36,000 Americans die on average per year from the complications of flu.”
 See “Using Wen Bing Theory in the Treatment of Modern Epidemics”, http://drjakefratkin.com/articles_tcm.php
 “Report A: A Herbal Formula for the Prevention of Transmission of SARS During the
SARS Epidemic in Hong Kong Special Administrative Region — A Prospective Cohort
Study”. Leung PC, Lau TF, Cheng KF and Lam CWK.
 Birds such as geese carry factors that make them immune to the various viruses that cause flu. This explains the efficacy of the flu medicine Oscillococcinum, a homeopathic medicine made by Boiron. It is a homeopathic sarcode (organ remedy) of duck liver.
 See Barry Gardener and Robert Brown, http://www.wellcome.ac.uk/stellent/groups/corporatesite/@msh_publishing_group/documents/web_document/wtd019376.pdf, p. 42-43.
 In 1918, the European people were exhausted and demoralized by war. Authorities, through their wartime control of newspapers, refused to report on the pandemic except for Spain, a neutral country. The great pandemic became known as the Spanish Grippe, thinking, erroneously, that it began in Spain.
 See Footnote 6, above.
 For treatment, see my article, “Plotting Acute Cough”, http://drjakefratkin.com/articles_tcm.php
 These include the Shanghai Expert Panel on Preventing and Controlling A-H1N1 Flu; Beijing Ditan Hospital (designated to treat influenza A/H1N1 by Beijing Health Bureau); 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. Reference sites include the following:
http://www.tcmdiscovery.com/product/show.asp?id=103; http://hubpages.com/hub/Stay-Safe-From-The-H1N1-Mexican-Swine-Flu-Traditional-Chinese-Medicine; http://www.cctv.com/english/special/excl/20090706/107942.shtml; http://www.chinesemedicinetimes.com/forum/showthread.php?t=688
 Herbs with documented antiviral properties belong to the herbal category qing re jie du, Clear Heat and Resolve Toxin. See Chen and Chen, Chinese Medical Herbology and Pharmacology, Art of Medicine Press, 2003.
 See Footnote 3.
 I have written on these two formulas in several articles. See: “Treating Viral Infections with Chinese Herbal Products”, http://drjakefratkin.com/articles_tcm.php
and “Modern Applications for Antiviral Therapy”, March, 2005 (Vol. 06, Issue 03), http://www.acupuncturetoday.com/mpacms/at/article.php?id=30038
 dan xi xin fa, “Dan-Xi’s Essential Teachings”; Zhu Dan-Xi (Zhu Zhen-Heng), 1481.
 Herbs with antiviral properties are cold and bitter, and do nothing in themselves to boost the immune system. The thinking here is that one adds in antiviral herbs because, potentially, anyone can be exposed to the H1N1 virus at any point, and should have herbs with antiviral effects circulating through the body.
 See Footnote 15, above.
 See Footnote 9, above.
 Information on the formulas can be found at www.maxwellhealthproducts.com.
 Various references for the efficacy of Vitamin D can be found at http://www.google.com/search?client=safari&rls=en&q=vitamin+d+and+flu+prevention&ie=UTF-8&oe=UTF-8
© Copyright 2009 Jake Paul Fratkin. All rights reserved.