The Herbalist’s Corner
Jake Paul Fratkin
Published in Acupuncture Today, March, 2005 as “The Price of Western Medicine and the Promise of Eastern Medicine”
When a patient comes into the clinic with an acute infection, I recommend that the herbal practitioner prioritize treatment of the infection over any other complaints. Most infections that come into the clinic are viral in nature, and include sore throat, common cold, influenza, ear infection[i], bronchitis, herpes simplex, herpes zoster, mononucleosis, acute viral syndrome (Coxsackie, Cytomegalia, West Nile, etc.), and vaccination reaction.[ii] Bacterial infections that we see in the clinic include strep throat, impetigo, minor infected wounds and boils, urinary tract infections and pink eye.
Serious bacterial infections don’t begin with a visit to a TCM practitioner, but rather to the ER room: deep wounds, bacterial pneumonia, bacterial meningitis and so on. These conditions, as well as post-surgery, require pharmaceutical antibiotics and often accompany hospitalization. Here, antibiotics are truly miraculous, saving lives that otherwise might be lost to organ failure, systemic sepsis or gangrene.
The success of antibiotics in serious infections has been a great source of satisfaction to the medical world, and as a result, antibiotics are commonly given for less serious infections in outpatient clinics. Physicians will often prescribe antibiotics when they are unnecessary or unhelpful, such as viral infections or when no clear bacterial infection exists. These include ear infection[iii], bronchitis[iv], viral (“walking”) pneumonia, sore throat, non-bacterial skin infections including eczema and acne, fever and chronic sinus infection. Often, the physician will justify his prescription as necessary for “avoiding a secondary infection”, which rarely occur.[v]
There are two reasons physicians overuse antibiotics. First, patients want a medicine when they visit a doctor’s office, and doctors comply by using familiar medicines in their armory. It is the brave doctor who tells the patient that antibiotics won’t work for their condition, and to go home and wait it out. Second, doctors are unaware or dismissive of effective herbal alternatives, leaving them the restrictive choice of antibiotics or no medicine at all.[vi]
Whether indicated or not, there are two problems caused by the use of antibiotics. The one that is acknowledged by scientists and doctors is the creation of “super-bugs”. As antibiotics have entered the human population in significant amounts[vii], bacteria are mutating to form resistant strains that are disease-causing and drug resistant, such as MERSA (Methicillin-resistant Staphylococcus aureus).
The second, and in my opinion more important, consideration is the damage inflicted on a person’s health by the use of antibiotics. The innate strength of one’s immunity is dependent of the role of beneficial bacteria in the digestive tract. Over 500 different species of beneficial bacteria collectively destroy pathogenic microbes while also neutralizing harmful chemical toxins that the body is trying to excrete.[viii] When one ingests antibiotics orally, the beneficial intestinal bacteria are significantly impaired. This gives rise to dysbiosis: unnatural colonies of pathogenic fungus and bacteria. Now it is up to the body’s immune agents, at the site of digestive tract epithelia, to try and take the place of these protective bacteria.
Our immune system is unequipped for the task, and slowly we weaken. In Western physiology the stress affects the adrenals, endocrine support of the pituitary and thyroid glands, bone marrow WBC production, as well as compromising serotonin production in the gut. In terms of TCM, we see this stress affecting kidney and spleen qi with consequences for normal production of qi and blood. Our zheng qi weakens, allowing xie qi – pathogenic influences – to attack and compromise zang-fu function. A hundred diseases follow.
When antibiotics are given the immune system crashes, and patients develop new infections. In my practice, especially with children, we see the “antibiotic merry-go-round”: children placed on antibiotics for repeat ear infections every 6-8 weeks![ix] How can we help this situation? Foremost is the avoidance of antibiotics except in situations where good alternatives do not exist.
Use of Chinese Herbal Medicine. Most outpatient bacterial infections affect the epithelia of the nose, throat, lung, skin, urethra and bladder. All of these can successfully be treated with formulas utilizing Chinese herbs that have antibacterial properties. In the Chinese materia medica, all of the herbs contained in the category “Clear Heat and Dry Dampness” have well-documented antibacterial effects.[x] The yellow huang herbs, those that contain berberine, include huang qin (Radix Scutellariae), huang lian (Rhizoma Coptidis), huang bai (Cortex Phellodendri), long dan cao (Radix Gentianae) and ku shen (Radix Sophorae Flavescentis).
While the anti-viral properties of herbs in the category “Clear Heat and Resolve Toxicity” are well known, many also exhibit strong anti-bacterial activity, including jin yin hua (Flos Lonicerae), lian qiao (Fructus Forsythiae), pu gong ying (Herba Taraxaci), ban zhi lian (Herba Sciutellariae Barbatae), da qing ye (Folium Isatidis), ban lan gen (Radix Isatidis), chuan xin lian (Herba Andrographis) and yu xing cao (Herba Houttuyniae).[xi]
Finally, a few herbs in the category “Drain Dampness” have antibacterial effects useful in bladder and kidney infections. These include deng xin cao (Medulla Junci), bian xu (Herba Polygoni Avicularis), yin chen hao (Herba Artemisiae Scopariae), bi xie (Rhizoma Dioscoreae Hypoglaucae) and others.[xii]
The foundation formula for any bacterial infection should be huang lian jie du tang.[xiii] This formula consists of huang lian (Rhizoma Coptidis), huang qin (Radix Scutellariae), huang bai (Cortex Phellodendri) and zhi zi (Fructus Gardeniae). Scientific validation of its antibacterial effects can be found in numerous research articles on the Internet and in the literature.[xiv] The formula can be used alone, or in conjunction with other formulas, depending on the application. For example, in impetigo or infected wounds, Huang lian jie du tang can be combined with any number of skin formulas designed to clear heat and resolve toxins.[xv] If one can accept its bitter taste, one can use it as a mouthwash following dental work to minimize bacterial dissemination. In powder form, it can be applied directly to open or infected wounds.
For strep throat, one can use Huang lian jie du tang. More appropriate, however, is Pu ji xiao du yin.[xvi] The formula was originally used in diphtheria epidemics during the Song dynasty (12th c.), and has a positive therapeutic effect for strep throat, tonsillitis and mumps.[xvii] I would recommend combining it with topical applications of Watermelon Frost to solidify the effect.[xviii] One could also use Huang Lian Shang Qing Pian[xix], but be careful of the dosage of da huang (Radix et Rhizoma Rhei) which is quite high (17%) in most of the patent medicine versions, and can cause loose stools or diarrhea.
For urinary tract infections, Ba zheng tang[xx] has been effective in 85% of my patients. Dosage is recommended at three times per day, and will be required for one to three days. For pink eye (eye infection) and red eye due to trauma, the patent medicine Ming Mu Shang Qing Pian [xxi] is valuable. Antibacterial herbs in this formula include zhi zi, huang lian, da huang, huang qin and lian qiao. Supportive herbs to bring the formula directly to the eye include ju hua (Flos Chrysanthemi) and bai ji li (Fructus Tribuli).
My Personal Experience. Several years ago, I had elective surgery to correct a deviated septum that has been forcing me to mouth-breathe. In the procedure, pieces of x-ray film are sometimes inserted to prevent occlusion of the newly opened nasal canal. I “googled” to see what the risk of infection following the surgery would be. Normally the risk is quite small and antibiotics are typically not recommended. In operations using the x-ray film, however, infections are almost certain. Following the procedure, within a few days, I was discharging smelly pus and phlegm. I sent a sample to the lab, and sure enough, a raging bacterial infection was underway. I elected not to use pharmaceutical antibiotics, and instead took a combination of two patent medicines: Huang lian jie du wan and Bi tong wan, 4 times per day. Within 3 days, the discharge was gone, not to return. Whereas pharmaceutical antibiotics are recommended for 5 to 14 day courses, my infection completely cleared in three days.
Last year, my teenage son developed a sore throat. I did a swab in my clinic, and it was positive for strep. I said to him, “Tom, normally, your sore throat would be gone tomorrow with Gan Mao Ling. But this is bacterial, and it’s going to take 3 days.” I gave him Pu ji xiao du yin and Watermelon Frost. And the throat was normal in 3 days, without progression to a cough.
When we in Chinese medicine recommend against antibiotics for epithelial bacterial infections, we are not advocating against treatment. You must have confidence that Chinese herbal formulas are as effective, if not more so, then conventional antibiotics, and without the massive destruction of necessary gut bacteria. Because of the widespread acceptance in medical recommendations for prescription antibiotics, I will say to patients, “Try the herbs for 24 hours. If there is no improvement, then yes, consider antibiotics. But if there is some improvement, try to stay on the herbs in order to avoid the stress of antibiotics on your immune system.” This encourages the patient, and they typically find that the herbal approach is successful.
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.
[i] Although ear infections are treated as bacterial by Western doctors, the literature points out that many are viral in nature. See ”Heikkinen T, et al. (1999). “Prevalence of Various Respiratory Viruses In The Middle Ear During Acute Otitis Media.” The New England Journal of Medicine, 1999; 340:260-264, 312-313. Also, see my article on treating ear infection at http://drjakefratkin.com/pdf/EarInfection.pdf
[ii] I have written extensively on the management of viral disorders. See Acupuncture Today: “Treatment and Prevention of H1N1 Swine Flu”, January, 2010; “Plotting Acute Cough”, May, 2007; “The Potential Avian Flu Epidemic”, April, 2006; “Modern Applications for Antiviral Therapy”, March, 2005. Also, see my website, www.drjakefratkin.com, Articles, for the following: “Using Wen Bing Theory in the Treatment of Modern Epidemics”; “Treating Viral Infections with Chinese Herbal Products”; “Hepatitis C: Differentiation and Treatment According to Wu Boping”; and “Viruses”.
[iii] “Antibiotic treatment of otitis media is no more effective than placebo, and increases the risks of reoccurrence.” Cantekin EI., “Antibiotics to prevent acute otitis media and to treat otitis media with effusion.” Journal Of The American Medical Association 1994; 272(3):203-4 / Medline ID: 94293436
[iv] Most bronchitis is viral in nature, not bacterial. “Among otherwise healthy individuals, antibiotics have not demonstrated benefit in the symptomatology or natural history of acute bronchitis.” Bronchitis: Treatment & Medication, Samuel Ong, MD. http://emedicine.medscape.com/article/807035-treatment
[v] Ironically, and for unknown reasons, antibiotics seem to help minimize phlegm production in viral cough and sinusitis.
[vi] This, of course, is due to negative propaganda promoted by the pharmaceutical industry for their own commercial interests. They will claim that scientific validation does not exist for herbal medicine, or else promote questionable research that negatively implicates herbal remedies. This ignores supportive research from other countries such as China or Japan.
[vii] Most of the antibiotics entering the human population, and least in the United States, are from animal products in the diet: eggs, beef, chicken, turkey, pork, farm-raised catfish and salmon, etc.
[viii] See: “Leaky Gut Syndrome: Handout Notes”; http://drjakefratkin.com/pdf/LeakyGutHandout.pdf
[ix] “The authors believe the frequent use of antibiotics for common ear infections raises risks that children will harbor drug-resistant bacteria during subsequent illness. They point out that children whose previous ear infections were treated with antibiotics have a rate of Ampicillin (amoxicillin)- resistant bacteria that is three times higher during subsequent otitis media.” JAMA, November 26,1997;278(20):1643-1645
[x] Supportive documentation can be found in Chen and Chen, Chinese Medical Herbology and Pharmacology, Art of Medicine Press, 2004, p. 137-152; and Bensky, et al, Chinese Herbal Medicine Materia Medica, 3rd Edition, Eastland Press, 2004, p.130-147.
[xi] Chen and Chen, p. 171-217.
[xii] Ibid, p. 399-427.
[xiii] Huang lian jie du tang. “Coptis Resolve Toxin Decoction”. From Wai tai bi yao, “Outer Platform (Imperial Library) Secret Essentials”; Wang Tao, 752.
[xiv] For example, Chen and Chen, Chinese Herbal Formulas and Applications, Art of Medicine Press, 2009, p. 342-345.
[xv] See Fratkin, Chinese Herbal Patent Medicines, Shya Publications, 2001, p. 802-824.
[xvi] Pu ji xiao du yin, “Universal Benefit Disperse Toxin Cool-Decoction”. From Dong yuan shi xiao fang, “Dong-Yuan’s Tested (and) Effective Formulas”; Li Gao (Li Dong-Yuan), edited by Luo Tian-Yi, 1202.
[xvii] See Chen and Chen, Chinese Herbal Formulas and Applications, p. 357.
[xviii] Guilin Watermelon Frost, product 2B3-2, Fratkin, Chinese Herbal Patent Medicines.
[xix] Huang lian shang qing pian. See product 2B2-1, Fratkin, Chinese Herbal Patent Medicines.
[xx] Ba zheng tang, “Eight Righteous (Ingredients) Decoction.” Attributed to Chen Shi-Wen, 1080. Recorded in Tai ping hui min he ji ju fang, “Heavenly Peace Benefit (the) People Harmonious Medicines Office of Formulas”; Imperial Medical Bureau, 1107.
[xxi] Ming mu shang qing pian, product 11A1-1, Fratkin, Chinese Herbal Patent Medicines.